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6251ac42-e118-52a1-8ece-8783767f8752 | Administration of which of the following drugs is most likely to resolve intraoperative hypotension refractory to phenylephrine in a patient who took lisinopril the morning of surgery? | Ephedrine | Methylene blue | Norepinephrine | Vasopressin | 4 | D | 3 | null | null | null | null | null |
40fd069a-c716-5de3-9843-9bfe04d694ac | Which of the following monitoring modalities is the gold standard with which to assess cerebral ischemia during carotid cross-clamp for carotid endarterectomy (CEA) under general anesthesia? | Somatosensory evoked potentials (SSEPs) | Electroencephalography (EEG) | Transcranial Dopplers (TCDs) | Near-infrared spectroscopy | 4 | B | 1 | null | null | null | null | null |
cba4bc9e-9d22-5b0e-8829-043ecb4e6a5a | Which of the following is a class I recommendation for spinal cord protection during open and endovascular thoracic aortic aneurysm repair for patients at high risk of spinal cord ischemia? | Cerebrospinal fluid drainage | Systemic hypothermia | Hyperventilation | Hyperosmotic agents | 4 | A | 1 | null | null | null | null | null |
495fae7a-db09-533e-aefb-92b9741a21e7 | Which of the following is true regarding the physiologic changes that ensue following release of the aortic cross-clamp during aortic surgery? | Cardiac output increases. | Venous return increases. | Mixed venous oxygen saturation rapidly falls. | PaCO2 abruptly falls. | 4 | C | 1 | null | null | null | null | null |
c6ba1455-9287-5466-a759-8c66f137d796 | 49. Which of the following statements is true with respect to EVAR compared with open abdominal aortic aneurysm repair? | Lower rate of operative survival with EVAR | Increased hemodynamic shifts with EVAR | Worsened intraoperative acid-base status with EVAR | Higher rate of secondary interventions with EVAR at 6 years | 4 | D | 1 | null | null | null | null | null |
db51f659-2809-5e76-af93-cc5a0db40dbe | A 69-year-old man with type 2 diabetes mellitus, coronary artery disease after drug-eluting stent (28 months ago), COPD, and atrial fibrillation presents for lower limb revascularization for claudication. Which of the following is true with respect to timing of epidural placement as the primary anesthetic? | Clopidogrel should be held for 5 days before epidural placement. | The case should be canceled if the epidural placement is bloody. | It is unnecessary to check platelet count before epidural removal. | Systemic heparin may be administered 1 hour after epidural placement. | 4 | D | 2 | null | null | null | null | null |
0c114dca-492a-5a1f-a2c7-771c57af373b | To decrease the risk of postoperative pulmonary complications associated with smoking, when should the patient stop smoking? | 48 hours | 1-2 weeks | 2-4 weeks | 4-6 weeks | 4 | D | 1 | null | null | null | null | null |
87b802a3-5735-5d62-a891-36152fb76adf | Which one of the following is a risk for acute lung injury (ALI) postoperatively? | Active ethanol abuse | History of myocardial infarction | History of peripheral vascular disease | History of stroke | 4 | A | 1 | null | null | null | null | null |
23b87228-ea5b-552c-a781-456bf501bf52 | A 67-year-old woman presents for right lower lobe lobectomy. Which of the following results obtained via spirometry testing would place her at an increased risk for postoperative complications? | Forced expiratory volume in 1 second (FEV1) of 1300 mL | Predicted postoperative FEV1 70% of normal | Maximum voluntary ventilation of 62% or predicted value | Reserve volume (RV)/total lung capacity (TLC) of 57% | 4 | D | 2 | null | null | null | null | null |
c2916556-c89f-544c-9d62-0b0cdb9d995a | Which of the following symptoms is most consistent with theophylline toxicity? | Tinnitus | Itching | Tachyarrhythmia | Heart block | 4 | C | 1 | null | null | null | null | null |
118c591c-57c6-5fef-b330-ecfa0a12e21b | Which of the following patients would have a low probability of developing postoperative respiratory complications? | A 56-year-old man whose oxygen saturation drops 6% during exercise | A 58-year-old woman who has a 6-minute walk distance of 610 m | A 54-year-old woman who can climb 2 flights of stairs | A 55-year-old man with a VO2 max of 12 mL/kg/min | 4 | B | 2 | null | null | null | null | null |
c7990cec-91ec-5739-81e9-aa08040a63ea | 6. Which of the following is a predictor of desaturation during one-lung ventilation (OLV)? | Left-sided thoracotomy | Lateral position during surgery | Normal preoperative spirometry | Balanced perfusion on ventilation/perfusion (V/Q) imaging | 4 | C | 1 | null | null | null | null | null |
94a06bae-210f-5383-ab03-87280f04e989 | Which patient is most likely to desaturate during OLV? | A 68-year-old woman with a history of moderate chronic obstructive pulmonary disease (COPD) with a PaO2 : 481 mm Hg on 100% O2 before OLV | A 72-year-old man undergoing thoracotomy for left lower lobe adenocarcinoma | A 59-year-old man undergoing video-assisted thoracoscopic (VAT) resection of left upper lobe adenocarcinoma | A 61-year-old man with a PaO2 of 187 mm Hg on 100% O2 before OLV | 4 | D | 2 | null | null | null | null | null |
210800c0-cadd-502b-884b-424c3a93a866 | For which of the following surgical procedures is a right-sided double-lumen tube (DLT) most likely indicated? | Left lower lobectomy | Bilateral lung transplantation | Open thoracic aortic aneurysm repair | Left sleeve resection with involvement of left mainstem | 4 | D | 2 | null | null | null | null | null |
df03dfc7-23af-5eb5-86fb-25e9c93e2cca | During a routine right thoracotomy for tumor resection with peak airway pressures in the mid 40s cm H2O during OLV, the patient suddenly becomes hypotensive and hypoxic. End-tidal carbon dioxide drops precipitously. Which of the following is the next best step in management? | Bronchoscopy | Needle decompression of dependent lung | Resumption of two-lung ventilation | Application of continuous positive airway pressure (CPAP) to operative lung | 4 | B | 3 | null | null | null | null | null |
829b4991-0e59-5917-b0ec-326e26cd62c6 | Which of the following is an absolute indication for OLV with a DLT as opposed to a bronchial blocker? | Need for independent lung ventilation in a patient with severe unilateral rib fractures | Wedge resection | Pneumonectomy | Lobectomy | 4 | A | 1 | null | null | null | null | null |
96e41ed8-720e-557f-b29f-2b575fb42758 | During VAT wedge resection for a right lower lobe tumor with a bronchial blocker, the patient develops increased peak airway pressures, hypoxia, and a decreased end-tidal carbon dioxide. The surgeon reports good lung isolation in the field. Which of the following is the appropriate next step? | Fiberoptic evaluation of the bronchial blocker | Deflation of the bronchial blocker and ventilation of both lungs | Needle decompression of dependent lung | Application of CPAP to operative lung | 4 | B | 3 | null | null | null | null | null |
df67ec43-0358-5211-a5ce-216949df68f8 | During right middle lobe resection for adenocarcinoma, you notice that your patient appears to be developing a mild acidosis on arterial blood gas. pH is 7.22, lactic acid is mildly elevated, hemoglobin is 10.1, urine output has been 0.5 mL/kg/h for the past 3 hours, and estimated blood loss is 150 mL. Which of the following is the best next step? | Start low-dose inotropes. | Give a fluid bolus of 10 mL/kg. | Transfuse 1 unit of packed red blood cells. | Increase minute ventilation to correct the acidosis. | 4 | A | 3 | null | null | null | null | null |
765b236b-470c-5e3d-ae7b-a5190f95e9e9 | 13. Which level of oxygen saturation (SpO2 ) is acceptable for a patient undergoing OLV? | 92% | 90% | 80% | 76% | 4 | B | 1 | null | null | null | null | null |
52fd4edd-a4d6-5d0f-8982-5b6fc8d29957 | Which gas mixture is associated with the highest incidence of postthoracotomy atelectasis? | 98% O2 /2% sevoflurane | 60% O2 /33% air/7% desflurane | 50% O2 /49% air/2% isoflurane | 28% O2 /70% nitrous oxide/2% sevoflurane | 4 | D | 2 | null | null | null | null | null |
82b71eec-a413-58eb-bbbf-62951dbb689c | A patient who has a history of bleomycin chemotherapy for testicular cancer is undergoing a left VAT surgery for metastasis. The patient begins to desaturate to 88% with stable hemodynamics. Which of the following is the most appropriate next step? | Attempt recruitment maneuver of dependent lung. | Resume two-lung ventilation. | Increase the fraction of inspired oxygen. | Increase positive end-expiratory pressure (PEEP) of the dependent lung. | 4 | A | 3 | null | null | null | null | null |
30b57887-6b73-5b0f-9189-2f5be4eb510e | A patient is undergoing surgery for correction of a bronchopleural fistula. A DLT has been placed without difficulty. During the procedure, the patient's oxygen saturation decreases to 85%. Which of the following is the most appropriate next step? | Apply CPAP to the operative lung. | Increase the fraction of inspired oxygen. | Fiberoptic confirmation of DLT placement. | Resume two-lung ventilation. | 4 | B | 2 | null | null | null | null | null |
6e24a393-a581-5f6b-abb9-89f0804191c3 | A patient is scheduled to undergo a bilateral thoracoscopic MAZE procedure for chronic atrial fibrillation. The procedure is to be performed in the supine position. Which of the following interventions will reduce the likelihood of desaturation during OLV? | Operating on the right side first | Use of a total intravenous anesthetic | Use of a right-sided DLT | Use of a tidal volume of 10 mL/kg to maintain lung inflation | 4 | A | 2 | null | null | null | null | null |
eb9959f2-c09a-5af5-9a66-1aeae3982a04 | A patient has persistent pain in the posterior and lateral aspects of the shoulder 10 days following thoracotomy. Which of the following positioning errors that can occur during the surgery is the most likely mechanism for this patient's pain? | Inadequate padding of the dependent chest wall | Lateral flexion of the cervical spine | Placement of the axillary roll in the axilla | Oversupination of the suspended arm | 4 | C | 2 | null | null | null | null | null |
5e36b5ff-0da0-528b-9a6b-716965088d98 | In which of the following patients would the administration of PEEP be expected to improve oxygenation during OLV? | A 68-year-old man with severe emphysema on tiotropium undergoing lobectomy | A 34-year-old man with α1 antitrypsin deficiency undergoing wedge resection | A 51-year-old woman with moderate COPD on pulmonary function tests (PFTs) undergoing pleurectomy for mesothelioma | A 42-year-old woman with interstitial lung disease undergoing VAT wedge resection | 4 | D | 3 | null | null | null | null | null |
af48a34a-61c6-5b47-8b45-7a35a7404c8d | 20. A 70-kg, 1.8-m tall man is scheduled for open thoracotomy/sleeve resection for adenocarcinoma of the lung. Preoperative PFTs are within normal limits, and the patient denies any smoking history. A right-sided DLT is placed uneventfully after induction of anesthesia. Which of the following ventilation strategies is most appropriate? | Volume control with a tidal volume of 700 mL, respiratory rate of 10, PEEP of 0 | Volume control with a tidal volume of 800 mL, respiratory rate of 8, PEEP of 5 | Volume control with a tidal volume of 450 mL, respiratory rate of 14, PEEP of 5 | Volume control with a tidal volume of 750 mL, respiratory rate of 12, PEEP of 8 | 4 | C | 2 | null | null | null | null | null |
71b5191a-272d-529c-9ea9-66ef050aa02e | A 61-year-old man with a history of COPD, 40-pack-year smoking history, and hypertension is undergoing right lower lobe resection for primary lung cancer. While under OLV, he is ventilated with the following settings: assist control/pressure control inspiratory pressure: 20 cm H2O, PEEP: 5 cm H2O, inspiratory time: 0.8 seconds, and inspired oxygen: 70%. During the return to two-lung ventilation, which of the following parameters needs to be monitored very closely for sudden changes? | Peak airway pressure | Systolic blood pressure variability | Tidal volume | Heart rate | 4 | C | 2 | null | null | null | null | null |
b675d482-1f7f-55c5-b339-37357c49c04b | A 47-year-old woman who is status post bilateral lung transplant is undergoing laparoscopic cholecystectomy. Which of the following is the benefit of pressure control ventilation in this patient? | Reduced risk of lung injury from high airway pressures | Better oxygenation | Decreased risk of pulmonary edema | Decreased risk of rejection | 4 | A | 1 | null | null | null | null | null |
689454a4-ccc2-588c-9514-d0f36df9e2bd | For which of the following patients might pressure control ventilation be a | A 67-year-old man having VAT bullae resection | A 38-year-old man having VAT sympathectomy for hyperhidrosis | A 71-year-old woman with coronary artery disease having thoracotomy for empyema decortication | A 51-year-old woman undergoing thoracotomy for right lower lobe resection for adenocarcinoma | 4 | A | 3 | null | null | null | null | null |
9eb9e4c4-5dc2-5c2b-a6de-acd525457c4c | A 67-year-old woman with normal PFT (ideal body weight of 60 kg) is scheduled to undergo VAT lobectomy for adenocarcinoma. Which of the following ventilator settings is most optimal for lung ventilation in this patient? | Tidal volume: 600 mL, PEEP: 0 cm H2O, respiratory rate: 13 breaths per minute, FiO2 : 0.8 | Tidal volume: 350 mL, PEEP: 0 cm H2O, respiratory rate: 12 breaths per minute, FiO2 : 0.8 | Tidal volume: 350 mL, PEEP: 5 cm H2O, respiratory rate: 14 breaths per minute, FiO2 : 0.8 | Tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 11 breaths per minute, FiO2 : 0.8 | 4 | C | 2 | null | null | null | null | null |
5be785f1-9571-5a46-82e4-9042a01a9817 | A 28-year-old, 60-kg man with no significant medical history is undergoing VAT pleurodesis for spontaneous pneumothorax. While transitioning to OLV with a DLT, the peak airway pressure is noted to be 41 cm H2O. Current ventilator settings are as follows: tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 14, FiO2 : 0.8. Bronchoscopy confirms proper tube position. Which of the following is the next most appropriate step? | Decrease the PEEP from 5 cm H2O to 0 cm H2O. | Increase the fraction of inspired oxygen to 100%. | Decrease tidal volume. | Increase the respiratory rate. | 4 | C | 2 | null | null | null | null | null |
c3bc7b10-3906-5d03-a49d-a5f3b4399a34 | 26. A 47-year-old woman is undergoing rigid bronchoscopy with jet ventilation. Which of the following most likely represents the best anesthetic choice? | Inhaled anesthetic with sevoflurane. | Intravenous anesthetic using only propofol. | Intravenous anesthetic using propofol and remifentanil. | Inhaled anesthetic with desflurane. | 4 | C | 3 | null | null | null | null | null |
e799f24e-e1d5-5ffa-9ddd-07026c187501 | High-frequency jet ventilation provides which of the following benefits when compared with traditional mechanical ventilation? | Decreased risk of pneumothorax | Faster onset of inhaled anesthetic | Decreased diaphragmatic movement | Improved postoperative pain scores | 4 | C | 1 | null | null | null | null | null |
90512188-7dbe-5581-989e-e867ca000a51 | Which of the following is the most efficient way to reduce the incidence of airway fires? | Handheld jet ventilation | Lowest inspired oxygen level tolerated by the patient | Use of a total intravenous anesthetic | Preoperative administration of bronchodilators | 4 | B | 2 | null | null | null | null | null |
99fbdb25-bc1d-5882-9640-84c7f5f9eb71 | Which of the following is a drawback when utilizing jet ventilation? | Inability to monitor oxygenation | Difficulty in monitoring adequacy of ventilation | Poor surgical access to the airway because of extra equipment | Increased risk of airway fires during laser procedures | 4 | B | 1 | null | null | null | null | null |
076d8674-35b5-5289-b090-58cd32eb0860 | A patient is scheduled to undergo right upper lobectomy. What is the predicted postoperative forced expired volume in 1 second (FEV1)? Preoperative FEV1 is 80%of predicted. | 69% | 64% | 59% | 72% | 4 | A | 2 | null | null | null | null | null |
701d502b-b952-5329-a6e6-e27e9b1d68fc | 33. A patient presents for lobectomy for small cell lung cancer. He has a history of Lambert-Eaton syndrome. Which of the following symptoms would be expected on review of systems? | Weakness in the distal muscles that worsens throughout the day | Improvement in muscle function with repeated use | Urinary incontinence | Delayed gastric emptying | 4 | B | 1 | null | null | null | null | null |
3dc10eda-eee1-555e-ad34-ccbbac2021d2 | A patient is undergoing left sleeve lobectomy for adenocarcinoma which is subsequently causing significant narrowing of the left mainstem bronchus. Which of the following lung isolation devices is most appropriate? | Right-sided DLT | Left-sided DLT | EZ-Blocker | Arndt bronchial blocker | 4 | A | 2 | null | null | null | null | null |
83088845-229f-5088-ab61-bcbedefe1b7c | A patient post pneumonectomy is recovering in the surgical intensive care unit (ICU) when she suddenly develops hypotension and cardiovascular collapse. Pulmonary artery catheter demonstrates a pulmonary artery systolic pressure of 20 mm Hg (previously 42 mm Hg) and a CVP of 22 mm Hg (previously 8 mm Hg). Which of the following is the most likely cause of her acute event? | Volume overload | Right ventricular failure | Postpneumonectomy herniation syndrome | Mucous plugging | 4 | B | 2 | null | null | null | null | null |
fd104f59-7936-567d-8612-884ced590a6f | A 19-year-old man with no known medical history presents with a gunshot wound to the right chest. His vital signs are stable and he is brought to the operating room for repair of an open tibia fracture. After intubation and initiation of positive pressure ventilation, his blood pressure acutely drops and he loses his pulse. Which of the following is the next step in management? | Transcutaneous pacing | Needle thoracostomy | Chest X-ray | Initiation of dopamine infusion | 4 | B | 2 | null | null | null | null | null |
86f1d2c1-f18f-5e20-89b0-49ba82bb240f | A 68-year-old woman with a history of pulmonary embolism on therapeutic anticoagulation is admitted to the surgical ICU in profound shock. To guide management a pulmonary artery catheter is placed uneventfully. Four hours later you are called urgently to the bedside because the patient has had acutely worsening blood pressure and there is blood noted in the endotracheal tube. Which of the following is the next most appropriate step? | Chest tube placement | Isolation of the bleeding lung and emergent transport to endovascular therapy | Inflation of the pulmonary catheter balloon and advancement to the wedge position | Emergent bedside thoracotomy | 4 | B | 2 | null | null | null | null | null |
d5bf6566-26d2-5f6b-b8c4-83c66bf5d452 | A 47-year-old man who is status post left thoracotomy for esophageal rupture is doing well immediately postoperatively. On postoperative day 5 the patient is tolerating a regular diet when he develops progressive shortness of breath. Chest X-ray reveals a large left pleural effusion. A chest tube is placed, which drains white fluid. Which of the following is the most likely cause? | Chylothorax | Esophageal perforation | Empyema | Reactive effusion from esophageal rupture | 4 | A | 1 | null | null | null | null | null |
e2eac625-0ee1-5420-a73f-6ed10d57d0af | 39. A patient with a large left upper lobe abscess is scheduled for thoracotomy and drainage. Which of the following is the optimal lung isolation system? | Left-sided DLT | EZ-Blocker | Mainstem intubation with a single-lumen tube | Arndt bronchial blocker | 4 | A | 1 | null | null | null | null | null |
858be2af-32ba-557d-b97d-73cb40e27ea2 | A patient is 6 days post right pneumonectomy for adenocarcinoma and is doing well on the ward. She develops progressive dyspnea and an increased oxygen requirement. Chest X-ray reveals a decreased fluid level on the right side. Which of the following is the most likely diagnosis? | Mediastinal herniation | Pneumonia | Bronchopleural fistula | Mucous plug | 4 | C | 2 | null | null | null | null | null |
d8e8db3c-d6c0-552f-868d-21d989284650 | A 34-year-old, 140-kg, 160-cm woman is scheduled to undergo VAT resection of a hamartoma. Which of the following maneuvers is most effective at prolonging the time to desaturation in obese patients? | Applying CPAP or PEEP during induction | Applying cricoid pressure to reduce the chance of aspiration | Using a video laryngoscope | Using 50% FiO2 during induction to prevent absorption atelectasis | 4 | A | 2 | null | null | null | null | null |
b446e3e9-8edd-503f-a1e1-5c440b2a1615 | A patient with severe idiopathic pulmonary fibrosis is being evaluated before undergoing elective surgery. Which of the following clinical findings reflects impaired oxygen diffusion? | Elevated PCO2 at rest | Decreased PO2 with exercise | Chronic respiratory acidosis with renal compensation | Improved symptoms with inhaled bronchodilators | 4 | B | 2 | null | null | null | null | null |
1427c4e1-ab27-55d6-932a-85c8ce6f8274 | A 76-year-old woman with a history of COPD presents for preoperative evaluation before shoulder surgery. Which of the following tests is best able to identify CO2 retention? | PFTs showing improvement in symptoms with bronchodilators | PFTs showing a decreased diffusion capacity | Arterial blood gas | Exercise tolerance | 4 | C | 1 | null | null | null | null | null |
ce01b312-e119-556b-973d-27d6a4c0f06a | A 68-year-old man with a history of severe COPD presents for urgent exploratory laparotomy for small bowel obstruction. A room air arterial blood gas reveals a PaO2 of 51 mm Hg, and brief history reveals noncompliance with prescribed oxygen therapy. On induction of anesthesia, the CVP rises from 14 to 26 mm Hg, and the patient becomes progressively hypotensive. Airway pressures are normal, ECG shows sinus bradycardia, and oxygen saturation is >90%. Which of the following is the most likely mechanism of this patient's hypotension? | Right ventricular dysfunction | Tension pneumothorax | Acute blood loss | Severe bronchospasm | 4 | A | 3 | null | null | null | null | null |
6da8650c-82d0-5e4d-8091-2f00cfcefbd2 | A 36-year-old man with severe scoliosis is scheduled to undergo operative repair. Which of the following best predicts postoperative ventilation need? | A vital capacity <40% of normal | A decreased DLCO | A Cobb angle of 42° | A lack of response to bronchodilators on PFT | 4 | A | 1 | null | null | null | null | null |
92bc588a-cd71-513e-a907-b9154db9733a | A 48-year-old woman with small cell lung cancer presents for urgent angle incision and drainage after being bitten by a dog. In an abbreviated history, she describes increased fatigue in the mornings that improves as the day progresses. She denies any cardiac or neurologic history. Her preoperative coagulation panel, basic metabolic panel, and liver function panel are all normal. Before progression of her cancer, she had been very active. Her anesthetic is unremarkable with neuromuscular relaxation maintained with rocuronium. Despite appropriate reversal of neuromuscular blockade, she remains weak and requires postoperative mechanical ventilation. Which of the following is the most likely cause? | Hypocalcemia | Impaired acetylcholine release from nerve terminals | Impaired pseudocholinesterase function | Antibodies to acetylcholine receptors at the neuromuscular junction | 4 | B | 2 | null | null | null | null | null |
b280df30-cfc7-5961-8e71-67955ab1f79b | A 27-year-old woman with a history of mild asthma is undergoing arthroscopic anterior cruciate ligament repair with a laryngeal mask airway. During incision, airway pressures increase significantly and bilateral wheezes are appreciated. Which of the following is the next step in management? | Administer bolus propofol to deepen the anesthetic. | Administer intravenous nitroglycerin. | Increase the concentration of inhaled sevoflurane. | Switch the patient to a volume-controlled mode of ventilation. | 4 | A | 2 | null | null | null | null | null |
eb7160fe-6b40-543d-8af0-ea7a26e10bda | A 34-year-old woman with a history of chronic bronchiectasis is scheduled for partial lung resection for recurrent pneumonia. Which of the following is an important consideration for patients with chronically infected lung tissue? | Preincision coverage with cefazolin | Ensuring there is adequate lung isolation before positioning | Place a thoracic epidural for pain control | Use of high PEEP to recruit bronchiectatic lung | 4 | B | 2 | null | null | null | null | null |
e9c9a9bf-1992-5144-ac00-43519247e88e | Which of the following is most concerning for vascular compression in a patient with a mediastinal mass? | Supine presyncope | Size of mass on chest X-ray | Tachyarrhythmia | Recent weight loss | 4 | A | 1 | null | null | null | null | null |
65163e5a-dec9-5240-9ec8-856298521fe0 | Which of the following features of the infant airway compared with the adult airway is correct? | Infants are obligate mouth breathers through the first several months of life. | The infant larynx is more cephalad in the neck than the adult larynx. | The infant epiglottis is shorter and broader than the adult epiglottis. | The narrowest part of the upper airway in the infant is at the level of the vocal cords. | 5 | B | 1 | The larger occiput of the infant requires extra elevation of the head to achieve an optimal "sniffing" position. | null | null | null | null |
44fc63a7-052c-5247-ad6b-65e3b6c3fbad | Which of the following statements is correct concerning airway innervation? | The recurrent laryngeal nerve innervates all the intrinsic muscles of the larynx save the cricothyroid, which is innervated by the external branch of the superior laryngeal nerve. | To numb sensation to the posterior third of the tongue and oropharynx, local anesthetic can be infiltrated into the base of the palatoglossal arch to block the lingual nerve. | An inferior laryngeal nerve block is completed by injecting local anesthetic 1 cm below the greater cornu of the hyoid bone bilaterally. | A transtracheal block, achieved by injecting local anesthetic through the cricoid membrane into the trachea, can serve as the sole anesthetic needed for an awake fiberoptic intubation. | 5 | A | 1 | Numbing of the oropharynx through topical approaches is rarely effective, and direct injection of local anesthetics is usually required to achieve adequate numbing for an awake fiberoptic intubation. | null | null | null | null |
d7ef5db5-59f9-5939-b547-9df4a5f63498 | In the postanesthesia care unit (PACU), a patient develops hoarseness following surgical removal of the left lobe of the thyroid (without violation of the right neck), and you suspect a unilateral recurrent laryngeal nerve injury. You consult your ENT colleagues to help evaluate recurrent laryngeal nerve function. Which of the following appearances of the vocal cords would be expected from this proposed mechanism of injury? | Immobile bilateral vocal cords, with an adequate glottic opening and no change during vocalization | Immobile bilateral vocal cords, with a very small glottic opening | Immobile left vocal cord and movement of the right vocal cord across midline during phonation | Immobile right vocal cord and movement of the left vocal cord across midline during phonation | 5 | C | 2 | Bilateral flaccid, partially abducted, immobile vocal cords | null | null | null | null |
a7f960ed-3de3-509f-b32e-782df605c1a2 | 4. A 26-year-old professional singer is in your operating room (OR) undergoing suspension microlaryngoscopy for vocal cord polyps. Soon after induction and just after the surgeon places the patient into suspension, the heart rate drops from 85 to 30 beats per minute. Which of the following is the best initial course of action? | Increase the depth of anesthetic. | Administer an opioid. | Administer glycopyrrolate. | Continue to monitor the heart rate and cycle the blood pressure cuff with the knowledge that these parameters should recover, as the patient becomes accustomed to the positioning. | 5 | E | 3 | Direct the surgeon to take the patient out of suspension and before proceeding with additional measures. | null | null | null | null |
28ef53de-b853-5489-aa3c-6bda92fdfc52 | When considering the anesthetic management for a patient undergoing suspension microlaryngoscopy, which of the following is MOST important? | Complete immobility during surgical manipulation of the larynx | Light sedation so that the surgeon may observe vocal cord mobility during phonation | Permissive hypotension to limit surgical bleeding | Generous β-blockade to limit sympathetic discharge with suspension | 5 | A | 2 | Long-acting opioids are the best agents to manage postoperative pain | null | null | null | null |
5ea44ff8-664b-5350-9913-9ca49ceb3d36 | You are caring for a patient in the intensive care unit (ICU) who remains intubated overnight following oromaxillofacial surgery procedure for irrigation and debridement of a submandibular abscess. The patient has a nasotracheal tube sutured in place and still has significant external facial swelling as well as discharge from the surgically placed drains. The patient has passed a spontaneous breathing trial and has a fully intact neurologic exam. Which of the following evaluations is likely to provide the best information regarding the patient's readiness for extubation? | Upright X-ray of the neck | CT of the neck | Bedside cuff leak test | Fiberoptic evaluation around the endotracheal tube (ETT) to visualize the posterior pharynx, larynx, and glottic aperture | 5 | D | 3 | Fiberoptic evaluation through the ETT to visualize the trachea and proximal bronchi | null | null | null | null |
16c44888-a7cf-5198-b917-79016b8525ea | A 24-year-old woman with a medical history of exercise-induced asthma and subsequent use of an albuterol inhaler several times a week is currently undergoing urgent laparoscopic appendectomy. Several minutes after induction, you note increased peak inspiratory pressures and observe diffuse bilateral wheezes and a falling blood pressure. Which of the following is the best initial treatment? | Spray albuterol into the breathing circuit with inspiration. | Administer a corticosteroid such as hydrocortisone. | Administer IV epinephrine 1 mg. | Administer histamine blockers such as Benadryl and ranitidine. | 5 | E | 2 | Administer IV epinephrine in 50-100 µg divided doses. | null | null | null | null |
8d39ae9e-271e-50ef-a067-20924723bc1f | A patient undergoing a routine elective inguinal hernia repair suffers from a suspected anaphylactic reaction, which is successfully treated with epinephrine, corticosteroids, and histamine blockers. However, at the end of the case, airway pressures remain elevated, there is evidence of swelling of the oral mucosa, and the decision is made to bring the patient into the ICU intubated. Upon admission to the ICU, the patient appears to be euvolemic by examination but remains hypotensive. After an additional dose of epinephrine, corticosteroids, and histamine blockers, which of the following would be the MOST appropriate next step? | Proceed to extubation, as anaphylaxis rarely requires more than 2 treatments. | Trend tryptase levels until they begin to downtrend, then consider extubation. | Transition from crystalloid infusion to albumin, as capillary leak is likely to lead to pulmonary edema, which could delay extubation. | Begin a low-dose epinephrine infusion and titrate to blood pressure and bronchospasm. | 5 | D | 3 | Begin a low-dose norepinephrine infusion, as the continued symptoms demonstrate that they are refractory to epinephrine therapy. | null | null | null | null |
35da10bb-c383-504c-94ce-3c97d253de5b | Which of the following statements about anaphylaxis is MOST true? | Elevated tryptase levels are pathognomonic of anaphylaxis. | The level of severity of cutaneous reaction correlates with the severity of shock with anaphylaxis. | The most common causes of intraoperative anaphylaxis are opioids and inhalational anesthetics. | Patients suffering from an intraoperative anaphylactic reaction should be monitored in an inpatient unit for 24 hours. | 5 | D | 1 | Prophylaxis against anaphylaxis allows for the repeated safe use of the offending agent. | null | null | null | null |
7dfd35e3-30d4-5a86-9dd2-1cea5511fe0e | A 3-year-old child with fever, dysphagia, and drooling is brought to the emergency department (ED) by the caregiver. Lateral neck X-ray films reveal evidence of a "thumbprint" sign. Which of the following disorders is highest on your differential? | Epiglottitis | Croup | Tracheal stenosis | Tracheoesophageal fistula | 5 | A | 1 | Tonsillitis | null | null | null | null |
1a8a7991-76ee-588b-9f36-f8a7871294f0 | 13. Which organism is MOST associated with epiglottitis? | Parainfluenza | Haemophilus influenza | Group A Streptococcus | Group B Streptococcus | 5 | B | 1 | Candida albicans | null | null | null | null |
7e34fa18-a0e4-5219-9747-6241072f5cac | The 3-year-old patient from question 12, suffering from dysphagia and drooling, is now "tripoding" with increased work of breathing, and the decision is made to proceed to intubation. Which of the following is the safest method of securing the airway? | Proceed to an immediate rapid sequence intubation in the ED via direct laryngoscopy. | Proceed to an intravenous induction in the semirecumbent position in the ED via video laryngoscopy with fiberoptic backup. | Move to an OR for emergent surgical airway. | Proceed to an OR for an emergent rapid sequence intubation with surgeons at the bedside for possible rigid bronchoscopy or surgical airway. | 5 | E | 3 | Proceed to an OR for an urgent inhalational induction in the seated position followed by laryngoscopy with surgeons at the bedside for possible rigid bronchoscopy or surgical airway. | null | null | null | null |
86cb27bc-5b5a-58b6-afa9-806f3ce01c9d | You are called to the ED to evaluate an 18-month-old child suffering from a suspected aspiration. The child's parents describe coughing, choking, and a slight bluish tinge to the lips after a meal, including pieces of corn and carrots, rushing to the hospital. The child is now quietly lying down without any outward signs of respiratory distress but with an O2 saturation of 92%. Which of the following is the MOST appropriate method of caring for this patient? | Reassure the parents of the child that because it was only small pieces of vegetable and not a larger piece of meat or other protein, and the child is no longer actively coughing, no intervention is required and should simply be monitored in the ED until the O2 saturation normalizes. | Advise that you are booking an OR for emergent bronchoscopic removal of the aspirate and oral midazolam should be administered immediately to ensure that the child remains calm and does not dislodge the aspirated material. | Ask that antibiotics and steroids be started in the emergency department to be continued for only a 4-day course because this has been shown to be noninferior to a 7-day course. | Take the patient to the OR emergently and complete a gentle inhaled induction to maintain spontaneous ventilation, place a laryngeal mask airway (LMA), and allow a surgeon to pass a flexible fiberoptic bronchoscope through the LMA to remove the aspirated particles. | 5 | D | 3 | Take the child to the OR emergently, and after placing a peripheral IV under topical anesthesia with the child on the OR table, proceed with a rapid sequence intubation, securing the airway with an ETT before allowing the surgeon to proceed with flexible or rigid bronchoscopy. | null | null | null | null |
243025fb-3e75-5876-8fd2-dcf93d1dae5e | You are called emergently to the bedside of a patient in the ICU after his nurse observed an acute desaturation event. You note the patient had a tracheostomy placed 6 days ago for chronic respiratory failure after a prolonged course of acute respiratory distress syndrome. You arrive at the patient's bedside to find an O2 saturation of 88%, the trach collar seated against the skin with the pilot balloon inflated, and the patient moving air very noisily through his mouth. The nurse describes that during a coughing fit his trach "fell out, " but she was able to push it back in. Which of the following would be the most inappropriate next move? | Place an oxygen mask over the patient's mouth and nose. | Attach an Ambu bag to the trach and support the patient's ventilation. | Remove the trach and cover the ostomy site with a bandage. | Call for a fiberoptic bronchoscope to interrogate the tracheostomy track. | 5 | B | 2 | Attach an Ambu bag to a mask, place over the mouth and nose, and support the patient's ventilation. | null | null | null | null |
230cdc85-a96f-509e-8204-963dfa814dc5 | 17. According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is the correct definition of a difficult airway? | A clinical situation where a physician experiences difficulty with ventilation, intubation, or both. | A clinical situation in which a conventionally trained anesthesiologist requires adjuncts for ventilation and/or advanced airway equipment for intubation. | A clinical situation in which a conventionally trained anesthesiologist fails to ventilate and/or intubate a patient. | A clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both. | 5 | D | 1 | A clinical situation in which a conventionally trained physician experiences difficulty with facemask ventilation, tracheal intubation, or both. | null | null | null | null |
fccfba93-df6a-5011-a741-63bebc0bfedb | Which of the following has NOT been independently associated with challenging mask ventilation? | Edentulousness | Neck circumference >19 cm | BMI >36 kg/m2 | Presence of a beard | 5 | B | 1 | Snoring/obstructive sleep apnea (OSA) history | null | null | null | null |
899e5902-a432-5b52-9cff-b01558c8509e | According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following components of the preoperative airway physical examination is correctly paired with a nonreassuring finding, as it relates to a potential difficult intubation? | Relationship of maxillary and mandibular incisors during voluntary protrusion of the mandible: inability to bring mandibular incisors anterior to maxillary incisors | Thyromental distance: four ordinary finger breaths | Visibility of uvula: only upper third of uvula visible | Range of motion of the head and neck: inability to rotate chin to each shoulder | 5 | A | 1 | Interincisor distance: 5 cm | null | null | null | null |
1b715f7b-3947-5fc5-a434-ec8429d1ab5b | According to the Mallampati classification, if you are able to view the fauces, | Class 0 | Class I | Class II | Class III | 5 | C | 1 | Class IV | null | null | null | null |
6f2ec914-392a-56c3-9912-eae0d217d8bc | Which of the following is MOST correct regarding the Mallampati classification system? | The Mallampati score correlates well with difficulty of mask ventilation. | Phonation increases the specificity of the Mallampati test. | A Mallampati IV classification has a high positive predictive value of difficult direct laryngoscopy. | Ability to visualize lingual tonsils requires a Mallampati IV score. | 5 | B | 1 | Partial view of the glottis or arytenoids defines a Mallampati II score. | null | null | null | null |
b7a2720c-f56d-5bb9-9b5d-a834415a495c | According to the ASA Difficult Airway Algorithm, which of the following is NOT included in the assessment of the likelihood of basic management problems? | Difficulty with patient cooperation | Difficult mask ventilation | Difficult laryngoscopy | Difficult intubation | 5 | E | 1 | Difficult extubation | null | null | null | null |
8c937a08-bb1a-5a64-bbc8-cd392878506c | 23. According to the ASA Difficult Airway Algorithm, which of the following correctly describes the pathway through the "Awake Intubation" Algorithm? | The first decision to make is to determine whether invasive airway access or noninvasive intubation will be attempted. | If noninvasive intubation fails, then progress to facemask ventilation. | If noninvasive intubation fails, then consider waking the patient up and canceling the case. | If invasive airway access fails, then consider canceling the case. | 5 | A | 1 | If noninvasive intubation is successful, then the patient should be provided with a difficult airway note following the case. | null | null | null | null |
7be41a97-1cc6-5930-b246-d1227e46d068 | According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following definitions is MOST correct? | Failed intubation: inability to place an ETT after a single attempt | Difficult laryngoscopy: failure of direct laryngoscopy and required use of videolaryngoscopy or fiberoptic bronchoscopy for successful intubation | Difficult supraglottic airway placement: tracheal pathology making a supraglottic airway seal inadequate | Difficult tracheal intubation: tracheal intubation requiring multiple attempts, with or without tracheal pathology | 5 | D | 1 | Difficult facemask ventilation: use of airway adjuncts, including 2-handed mask and oral/nasal airways to achieve adequate ventilation | null | null | null | null |
4c31a850-8d20-57d7-8303-9afe490f0c80 | According to the ASA Difficult Airway Algorithm for intubation after induction of general anesthesia, if initial intubation is unsuccessful and facemask ventilation is not adequate, then which of the following would be the best next step? | Awaken the patient. | Proceed to emergency invasive airway access. | Proceed video-assisted or fiberoptic intubation. | Cancel the case. | 5 | E | 1 | Attempt supraglottic airway placement. | null | null | null | null |
c8ecbe29-17f8-5696-b89a-650c0189d578 | According to the ASA Difficult Airway Algorithm, which of the following is NOT considered a noninvasive alternative in the difficult intubation approach? | Light wand | Intubating LMA | Video-assisted laryngoscopy | Percutaneous jet ventilation | 5 | D | 1 | Blind nasal intubation | null | null | null | null |
81c93dc6-028b-5421-b844-99807bb64ce0 | According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is NOT a recommended preformulated strategy for extubation of the difficult airway? | Long-term intubation until the perioperative period is completed | Short-term use of an airway exchange catheter | Consideration of fully awake extubation | Preparation for postextubation noninvasive ventilation or high-flow oxygen | 5 | A | 1 | Extubation to an LMA | null | null | null | null |
9ef53567-7fb5-5857-a601-20c710bcb1ef | Which of the following symptoms is a major indication for tonsillectomy? | Initial presentation with tonsillitis | Children with valvular cardiac disease at first presentation with tonsillitis | Severe OSA | Recurrent step pharyngitis | 5 | C | 1 | Presence of tonsillar stones | null | null | null | null |
290d59c3-0e85-590c-8da7-cf4965ec078d | 29. According to the ASA Practice Guidelines for the Perioperative Management of Patients with OSA, which of the following is recommended for children undergoing tonsillectomy for OSA? | Codeine is superior to nonsteroidal anti-inflammatory drugs for postoperative pain relief. | Sleep studies should be obtained on all children undergoing elective tonsillectomy and/or adenoidectomy. | For children undergoing tonsillectomy for OSA, the task force advises that opioid dosing should be decreased because repeated hypoxemia increases the sensitivity of µ-opioid receptors. | All children undergoing tonsillectomy and/or adenoidectomy for OSA should be watched in a monitored setting for at least 24 hours following surgery. | 5 | C | 1 | The ASA Practice Guidelines require the use of noninvasive CPAP in the immediate postoperative setting for all children undergoing tonsillectomy and/or adenoidectomy for OSA. | null | null | null | null |
cf1c71d1-569f-5981-be53-96727961da85 | Recent studies have shown that a single intraoperative dose of dexamethasone is associated with all the following EXCEPT which one? | Decreased postoperative pain | Decreased postoperative bleeding | Decreased time to first oral intake | Decreased postoperative nausea and vomiting in the immediate postoperative period | 5 | B | 1 | Decreased postoperative nausea and vomiting in the first 24 hours | null | null | null | null |
06363e4b-70ef-525c-909e-54ef9ac21ade | Which of the following is MOST correct regarding posttonsillectomy hemorrhage? | Primary hemorrhage occurs during the tonsillectomy surgery itself, whereas secondary hemorrhage occurs within the first 24 hours. | Posttonsillectomy hemorrhage is a common occurrence and should be treated with maintenance of NPO status and "watchful waiting." | Nearly half of patients suffering from posttonsillectomy hemorrhage have an undiagnosed coagulation disorder. | Posttonsillectomy hemorrhage usually presents as brisk bleeding. | 5 | C | 1 | Because of the friable nature of the tonsillar tissue, take-back surgeries for bleeding should be completed under moderate sedation. | null | null | null | null |
59c558b3-4afa-5210-9553-68c10b63947f | A 5-year-old child presents to the ED 12 hours posttonsillectomy with bleeding | Proceed directly to the OR, induce via inhalation, secure IV access, and intubate. | IV access should be secured in the ED with fluid resuscitation before proceeding to the OR. | Proceed directly to the OR, secure IV access, and proceed with the least sedation necessary to allow for hemostasis through electrocautery. | Consult interventional radiology for embolization of the external carotid artery on the side of bleeding. | 5 | B | 2 | Manage the patient medically with volume resuscitation and reversal of coagulopathy. | null | null | null | null |
8991513d-7d0f-5bef-aac5-a030472b5b13 | Which of the following blocks is correctly matched with the anatomic location of injection of local anesthetic? | Retrobulbar block: extraconal block outside the muscle cone formed by 4 recti muscles | Peribulbar block: intraconal block in the middle of the muscle cone | Median orbital block: in the space between the medial rectus muscle and the medial orbital wall | Superior orbital block: medial to the supraorbital notch and advanced intraconal | 5 | C | 1 | Subtenon block: in the space between the conjunctiva and subtenon capsule | null | null | null | null |
212e824b-95fe-538f-b966-e48ff25ac209 | 34. Which of the following correctly describes the pathway involved with the oculocardiac reflex? | Cranial nerve V → medulla → cranial nerve X | Cranial nerve V → medulla → cardiac accelerator fibers | Cranial nerve VII → midbrain → cervical parasympathetics | Cranial nerve VII → medulla → cranial nerve V | 5 | A | 1 | Cranial nerve V → pons → cervical parasympathetics | null | null | null | null |
824e86b3-d6a0-568f-8130-a6bb8af95799 | Which of the following complications of ophthalmic regional anesthesia is correctly paired? | Optic nerve sheath injection: retinal detachment/loss of vision | Intra-arterial injection: loss of vision | Globe penetration/injection: epidural injection | Extraocular muscle injury: diplopia | 5 | D | 1 | Trauma to the optic nerve: local anesthetic toxicity, seizure activity | null | null | null | null |
102b0158-ccc9-567b-97ea-1f4fd0ff11ee | Which of the following ophthalmic medications is correctly paired with its side | Epinephrine topical solution: reflex bradycardia | Echothiophate: increased longevity of succinylcholine | Cyclopentolate: sedation | Acetazolamide: metabolic alkalosis | 5 | B | 1 | Sulfur hexafluoride: nitrous oxide is not contraindicated | null | null | null | null |
ba83765a-5bad-59a0-8589-84ea55705d37 | Which of the following ophthalmic medications is correctly paired with its side effect or anesthetic complication? | Dipivefrin hydrochloride: trigger angle-closure glaucoma attack | Phenylephrine topical solution: reflex tachycardia | Timolol: meiosis | Apraclonidine: agitation | 5 | A | 1 | Scopolamine topical solution: sedation in the elderly | null | null | null | null |
56512a8a-8ef3-5045-9f1b-592e72a01df8 | Which of the following medications, when administered intravenously, is MOST associated with increased ocular pressure? | Midazolam | Ketamine | Propofol | Dexmedetomidine | 5 | B | 1 | Etomidate | null | null | null | null |
ba65ed13-e863-532b-97cf-6bf92adeed2d | Which of the following can increase intraocular pressure (IOP)? | Hypoxia | Hypotension | Hypothermia | Hyperventilation | 5 | A | 1 | Enhanced venous outflow | null | null | null | null |
3cafbea4-d51a-5d78-ab8d-80241357da5b | A 17-year-old boy presents to the ED with an open globe injury after being hit in the eye by a line drive while playing baseball. He had a hot dog just before sustaining his injury. Which of the following statements is MOST correct with regard to attempting to prevent increased ocular pressure with the induction of general anesthesia? | A. Benzodiazepine premedication is contraindicated. | Succinylcholine should be avoided at all cost. | Awake fiberoptic intubation with minimal sedation or topicalization is the "gold standard" approach. | Direct pressure to the globe by an assistant should be provided during directlaryngoscopy to limit any extrusion of vitreal contents. | 5 | E | 2 | Every effort should be made to limit Valsalva or coughing during intubation. | null | null | null | null |
ef4aa316-c5e2-5e5f-bbd7-c651ec20dd20 | Which of the following statements is MOST correct concerning the anesthetic implication of sulfur hexafluoride injection for retinal detachment? | Nitrous oxide is contraindicated following injection with sulfur hexafluoride; however, it is safe to use with octafluoropropane. | Nitrous oxide should be discontinued 15-20 minutes before injection of gas into the globe. | At least a 30-day safety margin should be given before nitrous oxide is used for a patient who received an unknown intraocular gas injection. | The worst complication of nitrous oxide use with an intraocular gas bubble is transient diplopia. | 5 | B | 1 | At least a 15-day safety margin should be given before nitrous oxide is used for a patient who received an intraocular air injection. | null | null | null | null |
24e0bdce-ecea-56e9-accc-65de6323f81f | When considering surgical placement of a cochlear implant, which of the following is MOST important regarding the anesthetic management? | Nitrous oxide is absolutely contraindicated. | Conscious sedation is the preferred technique. | Regional block and local anesthetic infiltration provide superior surgical outcomes. | Patient immobility is paramount. | 5 | D | 1 | Mean arterial pressures should be maintained at greater than 65 mm Hg to ensure middle ear perfusion during mastoidotomy. | null | null | null | null |
5e9453bc-02a2-5564-9be5-1cdd222288bd | A 55-year-old woman is in the second hour of a middle ear exploration with eventual stapedotomy. Current vital signs are as follows: HR 85, BP 145/83, RR 16, SpO2 99%, and ETCO2 40 mm Hg. The current anesthetic is a propofol/remifentanil total IV anesthetic. The surgeon reports "more bleeding" than she expected and asks for your assistance in reducing the blood loss. Which of the following strategies is MOST likely to be effective in limiting surgical bleeding? | Increase the respiratory rate on the ventilator to reduce PaCO2 . | Add nitrous oxide to the anesthetic. | Add paralytic to the anesthetic. | Lower BP through deepening the plane of propofol anesthesia or adding an antihypertensive agent. | 5 | D | 3 | Place the patient in Trendelenburg position. | null | null | null | null |
6cc4df1f-0c49-5e23-8551-1567e200dfe9 | You are giving a lunch break for a fellow anesthesiologist who has been taking care of a 32-year-old otherwise healthy man who is undergoing functional endoscopic sinus surgery. About 10 minutes into the break, the surgeon notes that "there is too much bleeding" and places some fluid-saturated sponges into the nasal passage. Several minutes later, you note that the blood pressure cuff cycles several times before reading 220/110, the patient's heart rate has increased to 130 beats per minute, and there are depressions of the ST segments on the intraoperative ECG. Which of the following treatments is MOST likely to improve the patient's condition? | Administration of Dantrolene 1 mg/kg bolus followed by 0/25 mg/kg/h infusion | Administration of an intralipid 2.5 mg/kg bolus | Transition from a propofol/remifentanil total IV anesthetic to inhalational anesthesia | Administration of an intravenous β-blocker | 5 | D | 3 | Deepening the plane of anesthesia | null | null | null | null |
ab551b18-af7e-53a8-b68c-6fa201a1b064 | 45. Which of the following is an advantage of a deep extubation versus a normal emergence and extubation following fiberoptic endoscopic sinus surgery? | There is a lower incidence of laryngospasm. | Time to discharge is decreased. | It is associated with decreased postoperative opioid use. | It can facilitate extubation with minimal movement or bucking. | 5 | D | 1 | It allows for less intensive postoperative nursing care. | null | null | null | null |
ffc65a4a-cf97-59c9-9f88-9e7335b4485b | You are assigned to give a break to another anesthesiologist just beginning a routine tonsillectomy for a 4-year-old child under general anesthesia with a cuff-less polyvinyl chloride (PVC) ETT. The surgeon is utilizing electrocautery, and you note that the FiO2 is still 95%. Which of the following is the best action to take? | Immediately reduce the fresh gas flow to 2 L and turn off the sevoflurane inhalational anesthetic. | Ask the surgeon to turn down the intensity of the electrocautery until the FiO2 is below 30%. | Immediately tell the surgeon to cease using electrocautery until the FiO2 is below 30%. | Allow the surgeon to continue, but turn the oxygen dial to 0 and increase the air dial to maximum, disconnect the circuit from the ETT, occlude the end of the circuit, and "flush" it with multiple manual compressions of the reservoir bag. | 5 | C | 2 | Remove the PVC ETT and exchange it for an armored ETT. | null | null | null | null |
3f1acaea-f0ae-560a-89c6-7ae1ca0d62d0 | According to the American Society of Anesthesiologists Practice Advisory for the Prevention and Management of Operating Room Fires, the proper management of a nonairway fire includes all of the following EXCEPT which one? | Remove the drapes and all burning and flammable materials from the patient. | Stop the flow of all airway gases immediately. | Remove the ETT. | Extinguish flames by pouring saline or smothering. | 5 | C | 1 | If burning persists, utilize a CO2 fire extinguisher. | null | null | null | null |
c18a4b0c-9fd4-566c-b6b4-0cbcfae04d83 | An airway fire has just occurred in an adjacent OR where 100% O2 was being used for laser surgery of the vocal cords with a normal PVC ETT, and you are asked to provide assistance. When you arrive, the fire has been put out, there is a burnt and mangled ETT by the anesthesia machine, and the patient is being bag masked on room air. Which of the following describes the best immediate management for this patient? | Order a STAT chest X-ray (CXR) in the OR to assess for inhalational injury. | Travel to the CT scanner to assess for ETT remnants in the airway. | Begin high-volume saline lavage of the lungs. | Immediately switch to low FiO2 to avoid further oxygen toxicity. | 5 | E | 3 | Proceed to rigid or flexible bronchoscopy to assess for plastic remnants and thermal or smoke injury. | null | null | null | null |
afd3cf09-b2ec-58e8-b630-1fb2aa6cc406 | Which of the following is MOST closely linked to OR fires caused by inhalational anesthetics? | Use of xenon inhalational anesthesia | Use of high FiO2 | A preceding period of ventilator inactivity | High humidity in the breathing circuit | 5 | C | 1 | Concomitant use of nitrous oxide | null | null | null | null |
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