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2e206e86-a82a-57e7-876d-2d176b034f8e | 50. According to the American Society of Anesthesiologists: "Practice advisory for the prevention and management of operating room fires, " which of the following is considered a best practice? | For every case the entire OR team should take part in determining whether a significant fire risk exists and should jointly take active roles in mitigating the risk of fire. | High FiO2 at high flows should be used for sedation procedures to lessen the risk of oxygen accumulation under the drapes. | Nitrous oxide should be used as an anesthetic adjunct to mitigate the fire risk of 100% FiO2 . | Unipolar electrocautery should be used ahead of bipolar electrocautery to mitigate the risk of fire. | 5 | A | 1 | If an airway fire is suspected, the ETT should be left in place until rigid bronchoscopy can be used to ensure that the tube is removed intact. | null | null | null | null |
dd724951-886f-5c43-9dbc-f17bb24bb1eb | All of the following qualities make carbon dioxide a suitable gas for intraperitoneal insufflation EXCEPT which one? | Noncombustible | High blood solubility | Clear and colorless | Lack of cardiopulmonary effects | 4 | D | 1 | null | null | null | null | null |
1db27046-6916-5749-b027-c65d4eb8f0bc | A 70-year-old woman is scheduled for total abdominal hysterectomy for endometrial cancer. Her medical history is significant ischemic cardiomyopathy with an ejection fraction of 25% and severe mitral regurgitation. Which of the following is a common effect of pneumoperitoneum seen with laparoscopic surgical procedures that would be least deleterious for her? | Pneumoperitoneum-induced increase in systemic vascular resistance (SVR) | Release of pneumoperitoneum-related decrease in SVR | Hypercapnia-related decrease in arrhythmia threshold | Hypercapnia-related increase in pulmonary vascular resistance (PVR) | 4 | B | 3 | null | null | null | null | null |
bf2bad8d-bedb-52c8-826f-6a736fcd37dc | A 62-year-old man is undergoing laparoscopic Nissen fundoplication. During the procedure, the patient becomes progressively hypoxemic with an oxygenation saturation that falls to 82%. You note a significant rise in end-tidal CO 2 despite hyperventilation, increased peak inspiratory pressure, and unequal chest expansion with ventilation. What should your first action be? | Suction the endotracheal tube. | Give albuterol. | Change the CO2 absorbent. | Stop the surgery and deflate the pneumoperitoneum. | 4 | D | 3 | null | null | null | null | null |
f34e4f25-bf2f-5d2a-80cf-3f515f58f752 | 5. A 65-year-old woman with a history of hypertension and chronic kidney disease is undergoing a laparoscopic liver resection for hepatocellular carcinoma. You record 100 cc of urine output after positioning at the beginning of the case. Three hours into the procedure, you note the patient has not had any further urine output. The patient is hemodynamically stable, oxygenating and ventilating well, and has no pulse pressure variation in her arterial line tracing. Which of the following is most likely contributing to her low urine output? | High central venous pressure | Elevated intra-abdominal pressure (IAP) of 22 mm Hg | Kinked foley catheter | Reverse Trendelenburg position | 4 | B | 3 | null | null | null | null | null |
cd1a78b8-4b3e-5b9f-a7ef-93c25b05b506 | A 24-year-old woman is scheduled to undergo a laparoscopic appendectomy. The surgeon inserts the Veress needle and insufflates the abdomen to an IAP of 15 mm Hg without incident. As the surgeon proceeds with insertion of the other ports, you note the patients' blood pressure drops precipitously. The end-tidal CO2 remains stable at 38 mm Hg. Given this clinical scenario, what is the most likely cause of the hypotension? | CO2 embolism | Positioning | Deep anesthesia | Hemorrhage | 4 | D | 3 | null | null | null | null | null |
cb66d1a9-bc4c-5588-aafe-cb39068ed519 | All of the following are benefits of laparoscopic versus open surgical procedures EXCEPT which one? | Decrease in hypothermia | Decrease in postoperative pain | Decrease in time to ambulation | Minimize surgical incision and stress response | 4 | A | 1 | null | null | null | null | null |
bec075a4-5627-564c-a21d-62dac560b190 | A 64-year-old woman with obesity and obstructive sleep apnea is undergoing a laparoscopic low anterior resection for colon cancer. Your anesthetic consists of 1.2 minimum alveolar concentration of sevoflurane. Three hours into the procedure, you note her blood pressure and heart rate start to rise. You treat this with 2 mg of hydromorphone. Thirty minutes later they are still elevated and you administer another 2 mg of hydromorphone. You are relieved for a lunch break, and when you return, your colleague tells you he gave another 2 mg of hydromorphone. The heart rate and blood pressure are not improved. Which of the following is the next best step? | Increase the sevoflurane. | Start a propofol infusion. | Give 200 µg of fentanyl. | Ensure adequate ventilation to maximize CO2 removal. | 4 | D | 3 | null | null | null | null | null |
916d50f4-21d2-5846-8b75-1551370fae07 | Changes in pulmonary function during laparoscopic procedures include all of the following EXCEPT which one? | Reduction in lung volume | Reduction in lung compliance | Reduction in ventilation-perfusion mismatch | Increase in airway pressures | 4 | C | 1 | null | null | null | null | null |
2d914f3c-936e-523c-8fc0-0198fc6a6239 | Regarding robotic surgery, which of the following statements is false? | Robotic surgery improves depth perception. | One advantage of robotic surgery is that it broadens the application of minimally invasive surgery. | Studies have shown that robotic surgery tends to have shorter operative times when compared with laparoscopic surgery. | Robotic surgery enhances a surgeon's skills and can be utilized for technically challenging procedures. | 4 | C | 1 | null | null | null | null | null |
579c3c66-ce6c-5cc4-a837-293f59c0f9b4 | The da Vinci robotic surgical system is composed of which of the following? | A control console, an equipment tower with an optical system, and a side cart with robotic arms | A control console and a robotic platform | An equipment tower, which includes equipment that allows the physician to control the robot utilizing any computer and a side car with robotic arms | An equipment tower, which includes technology that allows the physician to control the robot utilizing any computer, a control console, and an anesthesia unit | 4 | A | 1 | null | null | null | null | null |
4149a052-36a8-5b04-a489-d9c8b990e5ea | A healthy 52-year-old man is scheduled for a robotic prostatectomy. He tells you that he read on the Internet that robotic surgery can have negative impacts on his "cardiac" system and he is clearly concerned. Which of the following would be your most appropriate response? | The Trendelenburg/head down tilt required for robotic prostatectomies does cause increased strain on the heart. | Cardiac performance measures in healthy patients are maintained despite steep Trendelenburg position and pneumoperitoneum. | Increased cardiac output in healthy patients has not been shown to increase overall cardiac risk. | Increases in SVR can cause an increased cardiac risk even in healthy patients. | 4 | B | 2 | null | null | null | null | null |
9719ad1c-a679-53b3-b90e-aa1511f34fba | During a robotic surgical procedure, the surgeon tells you the patient is "tight | Additional paralytic is not needed for robotic surgical procedures. | You will give additional paralytic, as muscle paralysis reduced IAP needed for the same degree of abdominal distension. | Additional paralytic is not needed, as studies have not shown a correlation between the degree of muscle paralysis and surgeons' ability to perform the surgical procedure. | You will give additional paralytic, as patient movement during robotic surgery can result in displacement of robotic arms, which can cause potential patient harm. | 4 | D | 3 | null | null | null | null | null |
4fdb615d-c756-5831-83f5-aad573814b0d | 15. Following a laparoscopic cholecystectomy, a 67-year-old patient states that he can feel crackling when he touches his stomach and chest area. Which of the following is a risk for this specific complication following a laparoscopic procedure? | Short surgery duration | Patient age above 65 years | Use of fewer surgical ports | Laparoscopic cholecystectomy | 4 | B | 1 | null | null | null | null | null |
96806999-ea41-5596-a969-911334ea3cee | A 36-year-old man is undergoing a laparoscopic appendectomy. Your anesthetic consists of isoflurane, oxygen, and air. You chose to avoid nitrous oxide secondary to which of the following? | The ability of nitrous oxide to contribute significantly to postoperative nausea and vomiting | The potential of nitrous oxide to build up in the lumen of bowel, causing distension and obscuring the view of the surgeon | The increase in postoperative opioid requirements | The increase in IAPs | 4 | B | 2 | null | null | null | null | null |
2610403e-8984-5f35-a848-721e1c1b8c61 | A 63-year-old woman is undergoing a robotic hysterectomy for uterine cancer. The duration of the surgery is 6 hours, and despite aggressive warming maneuvers at the end of the procedure, the patient's core temperature is 35.8°C. Which of the following statements is true regarding the incidence of hypothermia following laparoscopic or robotic surgery? | Extra heat loss is thought to occur via convection of cold gas in laparoscopic/robotic surgical procedures. | Cold CO2 gas makes esophageal temperature probes inaccurate followinglaparoscopic/robotic procedures. | Additional heat loss is thought to occur via radiation, as forced warming blankets can only be placed on a small percentage of body area in laparoscopic/robotic surgical procedures. | Heat loss is transient and drastically improves upon cessation of the laparoscopic procedure without the use of additional heating equipment. | 4 | A | 1 | null | null | null | null | null |
c1bb6766-56c7-5284-bf80-a65cac35a596 | A 61-year-old obese man is undergoing a robotic prostatectomy for prostate cancer. The surgery is technically difficult and lasts approximately 7 hours, most of which the patient is in a steep head down position. Which of the following positioning complications is not attributable to patient positioning in a robotic prostatectomy? | Upper airway obstruction because of pharyngeal and laryngeal edema | Blindness | Numbness and burning of the lower ear lobe | Corneal abrasions | 4 | C | 1 | null | null | null | null | null |
2a2c64e0-9ee8-58cf-9770-2b2cc8e1d849 | A 22-year-old man is complaining of pain in both the right upper quadrant and right lower quadrant of his abdomen which he states is a 6/10 upon his arrival to the postoperative anesthesia recovery unit (PACU) following a laparoscopic appendectomy. Given the procedure that the patient underwent, the pain is likely classified as which type of pain? | Parietal | Referred | Visceral | Neuropathic | 4 | C | 2 | null | null | null | null | null |
d222a5ac-774b-507d-b385-ee9f501e8cc1 | You are providing anesthesia for an in-office liposuction procedure that is utilizing a tumescent lidocaine technique. What is the maximum dose of lidocaine that can be safely utilized for this procedure? | A. 5-7 mg/kg | 3-5 mg/kg | 15-25 mg/kg | 35-55 mg/kg | 4 | D | 1 | null | null | null | null | null |
986c3518-f712-5828-9264-84b25d21bc8a | During a liposuction procedure that is utilizing the tumescent lidocaine technique, the patient begins to desaturate and reports feeling anxious. She begins to cough and you note she has almost pink, frothy sputum. You begin to suspect that the cause of her symptoms originates from which of the following? | Pulmonary edema | Pulmonary embolism | Hemorrhage | Abdominal viscous perforation | 4 | A | 2 | null | null | null | null | null |
e88ca6f6-d4b7-54d6-b091-db984d7d22d2 | A 28-year-old woman is undergoing a blepharoplasty under minimum alveolar concentration anesthesia. Before the start of the procedure, you give her a small amount of midazolam and place a nasal cannula with an FiO2 of 60%. After the surgeon injects a local anesthetic, it will be important for you to communicate the timing of which part of the procedure to prevent an adverse intraoperative event? | Scalpel usage | Need for additional local anesthetic | Tissue removal | Use of electrocautery | 4 | D | 2 | null | null | null | null | null |
b6903688-0ca7-55d7-a61e-434244249c01 | You are performing a preoperative interview with a 38-year-old woman just before the start of her planned procedure of a tissue graft to her right thigh for a scald injury. Which of the following is not considered to be a risk factor associated with poor wound healing? | Smoking | Marijuana use | Poor nutrition | Obesity | 4 | B | 1 | null | null | null | null | null |
1f642da9-e1ca-50a7-8dbf-09f0306196dc | You are performing a laparoscopic cholecystectomy on a 49-year-old obese woman with a past medical/surgical history of a right-sided mastectomy and lymph node dissection for breast cancer, hepatitis C, and a remote history of IV drug abuse. As you attempt to place the IV, you note that the patient does not have many sites where an IV can be placed. Even after utilizing ultrasound, you can only see the median cubital vein clearly on the right. The patient tells you she has always been told to never let anyone place an IV on her right arm. Which of the following do you inform the patient? | She may need central vascular access if no superficial cite can be found. | The median cubital vein on the ipsilateral side of her previous surgical procedure should be utilized because there is poor evidence that needlesticks on the same side as a previous lymph node dissection contribute to lymphedema. | Venous access on the ipsilateral side of her mastectomy and lymph node dissection is unlikely to cause lymphedema if good skin hygiene is utilized following the procedure. | She should have a peripherally inserted central catheter line placed under fluoroscopy. | 4 | C | 3 | null | null | null | null | null |
d0a49fec-5c1a-5e2e-a5b5-11bfb51d63b4 | A 25-year-old man is brought to the emergency department after being involved in an accident. All of his fingers have been amputated from his right hand, and digital reimplantation is planned. After a successful surgical procedure, the patient is brought to the PACU. Which of the following has not been shown to influence the viability of the reimplantation? | Room temperature | Pain control | Hydration status | Secure dressing | 4 | D | 1 | null | null | null | null | null |
485fafbb-30d2-51d4-bb3f-8883d1d7cfb1 | A healthy 24-year-old man fell while he was snowboarding and was found to have a complete rotator cuff tear of his left shoulder. You would like to perform a peripheral nerve block under ultrasound guidance for intraoperative and postoperative analgesia. Which of the following is the most common complication for which you should counsel the patient? | Ipsilateral pneumothorax | Ipsilateral phrenic nerve paresis | Infection at the site of the peripheral block | Peripheral nerve block failure | 5 | B | 1 | Ipsilateral Horner syndrome | null | null | null | null |
1e33e94a-207c-547b-9681-d24902f6e671 | A 35-year-old woman was involved in a motor vehicle accident and broke her right ulna. She reports using heroin daily. You have already performed an upper-extremity brachial plexus block, but she reports anesthesia in all digits except her fifth digit. The surgeon asks you to supplement her block. Where should you inject local anesthesia? | Within the coracobrachialis muscle near its point of insertion on the humerus | Medial to the brachial artery in the antecubital fossa | Between the humeral and ulnar heads of the flexor carpi ulnaris muscle | Posterior to the axillary artery in the axilla | 4 | C | 2 | null | null | null | null | null |
72ad6636-088c-589a-82c5-7a94c173839b | An 85-year-old patient with mild dementia, hypertension, paroxysmal atrial fibrillation on Coumadin, and chronic kidney disease fell and fractured her femoral shaft. The orthopedic surgeons need to place intramedullary nails. Her health care proxy is at bedside, and you discuss the risks and benefits of regional and general anesthesia with the health care proxy. Which of the following statements is correct? | Provided her international neutralized ratio (INR) is less than 1.5, a neuraxial technique is safe. | Provided her INR is less than 1.8, a neuraxial technique is safe. | Provided her INR is less than 2.0, a neuraxial technique is safe. | Provided her INR is less than 2.0, a neuraxial technique is safe if she receives 1 unit of fresh frozen plasma. | 4 | A | 1 | null | null | null | null | null |
38f8e9ee-651d-5ece-bac3-72c01f8e0087 | A 22-year-old man severed his first and second digits. You elect to place an infraclavicular catheter for use intraoperatively and postoperatively. To provide adequate coverage, the cords that must be covered are: | Lateral cord | Medial cord | Posterior cord | A, B, and C | 6 | D | 1 | A and B | A and C | null | null | null |
4bb8c513-0d8b-5809-bd42-d477390c7c50 | 8. While snowboarding, a 33-year-old man suffered a bimalleolar ankle fracture. You are planning a regional anesthetic technique as his primary anesthetic using nerve stimulation. You elicit a foot twitch of plantar flexion. This response means that your needle must be located: | Medially, within the semitendinosus muscle, and the needle should be redirected laterally | Laterally, eliciting stimulation of the biceps femoris muscle, and the needle should be redirected medially | Near the common peroneal nerve, eliciting a foot twitch, and the needle shouldnot be redirected | Near the tibial nerve, eliciting a foot twitch, and the needle should not be redirected | 4 | D | 2 | null | null | null | null | null |
7807014f-2f42-51a4-8daa-ff6de9bde64a | Before confirmation of the anatomy with ultrasonography, you anticipate that the femoral nerve is located _____ and is responsible for _____. | Lateral to the femoral artery; knee extension | Medial to the femoral artery; hip flexion | Medial to the femoral artery; knee flexion | Lateral to the femoral artery; hip flexion | 4 | A | 1 | null | null | null | null | null |
2bfeccc8-b49b-5d8f-ac37-1987a9ba9b1d | A 73-year-old man is scheduled for a right total knee arthroplasty for severe osteoarthritis. He has a history of aortic stenosis with an aortic valve area of 1.1 cm2 , hypertension, and chronic obstructive pulmonary disease. He takes lisinopril daily and is not on home oxygen. The surgeons are eager for him to engage in physical therapy on postoperative day 0. Consequently, you would like to minimize weakness of the quadriceps muscle. You believe the best anesthetic and analgesic plan for this patient is to: | Offer a femoral nerve block and general anesthesia | Offer a femoral nerve block and spinal anesthesia | Offer a saphenous nerve block and general anesthesia | Offer a saphenous nerve block and spinal anesthesia | 5 | C | 3 | Forego a peripheral nerve block given his aortic stenosis and proceed with general anesthesia | null | null | null | null |
c3677a6a-f502-5e46-8ce1-f433edc86a10 | 12. A 81-year-old man presents for an open reduction and internal fixation of his distal tibial fracture after he suffered a mechanical fall at home. He currently takes clopidogrel 75 mg daily, hydrochlorothiazide 12.5 mg daily, and omeprazole. His family is very anxious about general anesthesia. You would like to offer a regional anesthetic and counsel him and his family that: | Although there are small risks of bleeding, infection, and postdural puncture headache, you will proceed with neuraxial anesthesia. | You can offer regional anesthesia if he has stopped his clopidogrel for 5 days. | You can offer regional anesthesia if he has stopped his clopidogrel for 7 days. | You can offer regional anesthesia if he has stopped his clopidogrel for 14 days. | 5 | C | 2 | You can offer regional anesthesia if his INR is less than 1.5. | null | null | null | null |
99b0b0f5-6981-5675-864d-e374b93d7b14 | A 22-year-old incarcerated woman was involved in a fight and subsequently suffered a distal radius fracture. The surgeon informs you that the procedure will take under an hour, and he plans to use a tourniquet. You decide to offer the patient a regional anesthetic. You can offer her: | Supraclavicular nerve block | Infraclavicular nerve block with intercostobrachial nerve block | Interscalene nerve block with intercostobrachial nerve block | Paravertebral nerve block | 5 | B | 2 | Regional anesthesia is inappropriate for this patient | null | null | null | null |
856166f1-ef0f-5ae9-bbbe-280b0661e9fd | A 19-year-old baseball player is scheduled to undergo repair of his ulnar collateral ligament. He would like a peripheral nerve block. You choose to perform a(n): | Interscalene nerve block | Sciatic nerve block | Femoral nerve block | Supraclavicular nerve block | 4 | D | 2 | null | null | null | null | null |
b673a421-fe2f-5276-ad46-58e0f6bedaa4 | A 53-year-old woman with chronic obstructive pulmonary disease on 2 L of oxygen at baseline and end-stage renal disease is scheduled to undergo an arteriovenous fistula creation. The surgeon requests a regional anesthetic. You perform a peripheral nerve block, and intraoperatively, the surgeon complains that the patient does not have anesthesia on her lateral forearm. You fear that you may have missed the: | Intercostobrachial nerve | Lateral cord | Musculocutaneous nerve | Posterior cord | 5 | C | 2 | Median nerve | null | null | null | null |
78dd13e9-c9e5-5001-b89f-8c467867aeed | A 67-year-old man underwent a peripheral nerve block for his reverse total shoulder arthroplasty 1 week ago. On his follow-up visit, his wrist remains in flexion. You determine that he has suffered an injury to his: | Radial nerve | Median nerve | Ulnar nerve | Musculocutaneous nerve | 5 | A | 1 | Axillary nerve | null | null | null | null |
d3f5eaf4-754e-555a-99af-b8d5e96b887e | 19. A 27-year-old man who has a history of type 1 diabetes mellitus and recent intravenous heroin use presents for an amputation of his first 3 toes. To provide adequate anesthesia and analgesia, you need to block the: | Femoral nerve, sural nerve, superficial peroneal nerve, deep peroneal nerve, posterior tibial nerve | Saphenous nerve, sural nerve, common peroneal nerve, lateral femoral cutaneous nerve | Femoral nerve, superficial peroneal nerve, deep peroneal nerve, posterior tibial nerve | Saphenous nerve, sural nerve, femoral nerve, posterior tibial nerve | 4 | A | 1 | null | null | null | null | null |
2b52e399-0344-5c90-8a41-1c2835f8389e | A 16-year-old ice hockey player injured his right arm during a game. He is unable to abduct his fingers and exhibits a loss of sensation over his fourth and fifth digits. This injury may have occurred: | Medial to the brachial artery in the antecubital fossa | Medial aspect of the olecranon | In the humeral groove | Medial within the flexor retinaculum | 4 | B | 2 | null | null | null | null | null |
143d5705-5204-5efa-b23b-c07ce3e1bf09 | A 20-kg, 5-year-old child suffered traumatic finger amputations of his left hand. You and your colleagues consent the parents for placement of an infraclavicular catheter. After the child is anesthetized, you place the catheter and bolus with 0.2%plain ropivacaine. The maximum dose of ropivacaine in this child is: | 40 mg | 60 mg | 100 mg | 120 mg | 5 | B | 2 | 140 mg | null | null | null | null |
2ebfcaf3-38f6-5d41-8a40-461f7170c12f | In the child mentioned in question 21, the first sign of local anesthetic toxicity is: | Bradycardia | Hypotension | Unresponsiveness | Seizures | 5 | C | 1 | Cardiac arrest | null | null | null | null |
7db19637-6e0e-5edd-9659-a557bb46087a | The absorption of local anesthetic, from greatest to least, is: | Intravenous > intercostal > supraclavicular > caudal > intrathecal | Intercostal > caudal > brachial plexus > lumbar plexus > Intrathecal | Intravenous > intercostal > caudal > epidural > brachial plexus | Transtracheal > intercostal > epidural > brachial plexus > subcutaneous | 5 | C | 1 | Intrathecal > epidural > sciatic > transtracheal > subcutaneous | null | null | null | null |
98f8384f-ba2f-5bca-b997-f8911e7f57bb | Your surgical colleague inquires about performance of a nerve block for a coagulopathic gentleman with fulminant hepatic failure with a MELD score of 41. You educate your colleague that you would use _____ as it is metabolized by ____ | Lidocaine; pseudocholinesterase | Chloroprocaine; pseudocholinesterase | Mepivacaine; pseudocholinesterase | Bupivacaine; pseudocholinesterase | 5 | B | 2 | Prilocaine; pseudocholinesterase | null | null | null | null |
ca83f284-8a9c-59f8-9c30-c70526f968b2 | 25. A patient experiences sudden restlessness, dizziness, tinnitus, and what appears to be rhythmic movements of her body following accidental release of an arm tourniquet 10 minutes after performing an intravenous Bier block. Which of the following medications is the most appropriate initial treatment? | Physostigmine | Phenytoin | Midazolam | Diphenhydramine | 5 | C | 2 | Propofol | null | null | null | null |
aa63c406-c3c2-54ea-968c-9958094f9f96 | A 59-year-old man is undergoing debridement of a nonhealing foot ulcer. An ankle block was performed using a landmark technique. One hour following performance of the block, the surgeon makes incision, but the patient describes pain on the plantar surface of the foot. Failure to anesthetize which of the following nerves is responsible? | Sural nerve | Deep peroneal nerve | Superficial peroneal nerve | Posterior tibial nerve | 5 | D | 1 | Saphenous nerve | null | null | null | null |
1d7b0f8b-818f-5469-b3ae-637471e0f44b | A 66-year-old man with a history of emphysema (on 2 L nasal cannula oxygen at night) and atrial fibrillation (on warfarin) had a witnessed fall while at home. He suffered a small subdural hematoma, left proximal humerus fracture, leftsided rib fractures (ribs 6-8), and a right-sided hemothorax. He is alert and oriented. Neurology recommended monitoring his subdural hematoma. He is saturating 93%on 3 L nasal cannula. The orthopedic surgeon plans to bring him to the operating room to perform a left total shoulder arthroplasty. You would like to perform a peripheral nerve block to help with postoperative pain control. You decide to perform: | Axillary nerve block | Suprascapular nerve block | Interscalene nerve block | Paravertebral nerve block | 5 | B | 3 | Supraclavicular nerve block | null | null | null | null |
c293a9ff-9737-5aa4-8fb5-1b5f19c55e13 | A 31-year-old intravenous heroin user was involved in a motor vehicle accident and is scheduled for an open reduction and internal fixation of his left ankle. He has been on prophylactic enoxaparin. You should wait for how many hours before inserting a peripheral nerve catheter for postoperative pain control? | 2 hours | 8 hours | 12 hours | 24 hours | 5 | C | 1 | 72 hours | null | null | null | null |
c2175a45-8899-5ff5-942e-52d059889388 | A 56-year-old woman is scheduled to undergo operative fixation of a left distal humerus fracture. You are performing a supraclavicular nerve block for postoperative pain. You choose to use: | 20 cc of 0.5% bupivacaine | 10 cc of 1.5% mepivacaine | 40 cc of 0.2% ropivacaine | 30 cc of 0.25% bupivacaine | 4 | A | 1 | null | null | null | null | null |
61c33532-9b20-51e1-af90-93691e4875bf | A 14-year-old, 40-kg girl presented to the emergency department as a pedestrian struck by a vehicle. She suffered a right wrist fracture with significant articular displacement necessitating an open reduction and internal fixation. You perform a supraclavicular block using 15 mL of 0.5% bupivacaine. The patient complains of full sensation of her fifth digit. You choose to supplement your block but cannot use more than: | 12 cc of 0.25% bupivacaine | 10 cc of 0.5% bupivacaine | 10 cc of 0.25% bupivacaine | 9 cc of 0.5% bupivacaine | 5 | D | 2 | 5 cc of 0.5% bupivacaine | null | null | null | null |
0f71fb9c-037b-5e2f-b491-4e5b73192d6e | A 25-year-old man sustained a pelvic fracture during a motor vehicle accident and has been receiving 5000 units of subcutaneous heparin 3 times daily to prevent deep venous thromboses. He desires an epidural for analgesia. Which of the following laboratory tests is most valuable before epidural placement? | Bleeding time | Anti-Xa level | International neutralized ratio | PTT (partial thromboplastin time) | 6 | D | 2 | PT (prothrombin time) | Platelet count | null | null | null |
2407b0e6-37f0-57f1-9611-8e6bf131e958 | 33. A 36-year-old man is undergoing a lower-extremity orthopedic procedure under regional anesthesia. You note that his blood pressure continues to rise despite administration of β-blockers and intravenous opioids, and you suggest to the surgeon that the tourniquet should be deflated. You expect to observe all of the following hemodynamic responses EXCEPT a(n): | Decrease in central venous pressure | Increase in ETCO2 | Decrease in minute ventilation | Decrease in temperature | 5 | C | 2 | Decrease in mean arterial pressure | null | null | null | null |
7be7e60f-72b6-5964-b6d6-fa5e3bcac990 | A 35-year-old man is scheduled to undergo a cubital tunnel release of the right upper extremity. The surgeon plans to use a tourniquet. The patient desires regional anesthesia with monitored anesthesia care. To use an axillary nerve block as your primary anesthetic, you must ensure all of the following nerves are covered EXCEPT: | Ulnar nerve | Median nerve | Intercostobrachial nerve | Radial nerve | 5 | E | 2 | Suprascapular nerve | null | null | null | null |
4957907d-82ed-50af-83c1-7ad636ec3157 | A 62-year-old man is undergoing a right total hip replacement, and the surgeon mentions that the patient is continuing to "ooze." You note that all of his laboratory values and coagulation factors are within normal limits. You suggest a dose of tranexamic acid because it has been shown to reduce bleeding during | By potentiating the action of antithrombin II and inactivating thrombin to prevent the conversion of fibrinogen to fibrin | By reversibly and noncompetitively binding the adenosine diphosphate receptor on the platelet surface to reduce platelet aggregation | By forming a complex that displaces plasminogen from fibrin to block the conversion to plasmin | By inhibiting vitamin K complexes and therefore reducing the synthesis of clotting factors | 4 | C | 1 | null | null | null | null | null |
b2c98963-45a5-5782-a103-f96721e45b75 | An 18-year-old man undergoes open appendectomy, and you place a postoperative truncal regional block for pain control. You believe the most effective block involves placing local anesthesia: | Superficial to the iliacus muscle | Deep to the superior costotransverse ligament | Between the rectus abdominis muscle and the posterior rectus sheath | Superficial to the transversus abdominis muscle | 5 | D | 1 | Deep to the ligamentum flavum | null | null | null | null |
f8d7174b-b850-58ee-9765-7207757d7553 | A patient underwent an interscalene nerve block for his left total shoulder arthroplasty. Although nerve injury is uncommon, all of the following complications can occur, with the exception of: | Left wrist drop | Inability to abduct the left upper arm | Inability to abduct the fingers of the left hand | Inability to flex at the elbow joint | 5 | C | 2 | Inability to extend at the elbow joint | null | null | null | null |
d815714d-5704-5e3f-a343-8aa7ae07fbe2 | 38. A 33-year-old patient with sickle cell disease is presenting for an orthopedic procedure, and the surgeon would like to use a tourniquet. You counsel the patient that: | Tourniquet use in this patient population is not associated with increased complications. | The tourniquet will be placed at the proximal part of the limb at the greatest circumference of the limb. | Tourniquet use of longer than 2 hours increases the risk of compression neurapraxia. | All of the above. | 5 | D | 1 | None of the above. | null | null | null | null |
357c1455-08b4-5eb5-a05b-f9acfb929491 | You are taking care of an 18-year-old woman in the operating room. The tourniquet has been inflated for more than 90 minutes. The signs and symptoms that support your theory that her pain is secondary to the tourniquet inflation EXCEPT: | Hypertension | Tachycardia | Hypoxia | Diaphoresis | 4 | C | 2 | null | null | null | null | null |
258126fd-a384-53e7-8a6b-3529725ef069 | A 25-year-old woman elects to have spinal anesthesia for her procedure on her right lower extremity. Following placement of her neuraxial anesthesia, she can move her toes but does not have sensation around her knee. This differential block is explained by: | Sympathetic nerve fibers that are blocked at the lowest concentration of local anesthetic | Motor nerve fibers that are sensitive to local anesthetic blockade | An ineffective spinal anesthetic | A subarachnoid block | 5 | A | 2 | A slow-onset intrathecal block | null | null | null | null |
2f26caef-3c34-5cde-b381-b18cf3b7abd7 | Following injection of local anesthetic, blood levels are highest for (from highest to lowest): | Caudal > epidural > sciatic > brachial plexus > subcutaneous | Intercostal > epidural > sciatic > brachial plexus > subcutaneous | Intercostal > epidural > caudal > brachial plexus > subcutaneous | Intercostal > caudal > epidural > brachial plexus > sciatic | 5 | D | 1 | Epidural > caudal > sciatic > brachial plexus > subcutaneous | null | null | null | null |
34ce4a14-b161-51ae-a75d-d7c1f8c63607 | A lumbar epidural is placed for intraoperative anesthesia and postoperative analgesia. Epidurals may affect pulmonary function tests by causing a(n): | Significant decrease in forced expiratory volume in 1 second | Decrease in cough strength | Increase in vital capacity | Increase in residual volume | 5 | B | 1 | Decrease in tidal volumes | null | null | null | null |
38dcb49e-9432-5cc8-ab34-4ef5c2c89443 | A 46-year-old woman is presenting for a procedure on her left upper extremity. She has been on 120 mg of methadone daily for a history of opioid abuse. | Discontinuation of methadone as it will make managing her pain postoperatively more difficult | Changing her methadone to oxycodone that she should use the morning of surgery | Discontinuation of methadone and performance of a left brachial plexus block | Administration of intravenous methadone in addition to her oral morning dose | 5 | E | 2 | Continuation of methadone perioperatively | null | null | null | null |
a0d72f69-9238-5717-85e9-9ec98bd8a8c5 | 44. A 64-year-old man is scheduled to undergo a left total shoulder arthroplasty. You are performing an interscalene block using nerve stimulation. You notice the patient begins to hiccup, so you decide to: | Reposition the needle more anteriorly | Withdraw your needle | Reposition the needle more posteriorly | Reposition the needle deep to this point of stimulation | 4 | C | 2 | null | null | null | null | null |
87610683-810b-5313-86fa-11e8bdb5e7d8 | A 33-year-old G3P1 woman who has been taking buprenorphine for a history of oxycodone abuse is scheduled to undergo a repeat cesarean section. Your colleague suggests performance of transversus abdominis plane (TAP) blocks to help with postoperative pain. Which of the following statements regarding TAP blocks is true? | TAP blocks help with visceral and somatic pain. | TAP blocks should be performed as laterally as possible on the trunk. | TAP blocks involve injection of local anesthetic deep to the transversus abdominis muscle. | TAP blocks cannot be performed if a patient is on buprenorphine. | 5 | B | 1 | TAP block placement requires discontinuation of prophylactic heparin for at least 1 hour. | null | null | null | null |
4b1a2a77-eed7-582c-b20a-ed5d3831a25b | A patient is undergoing surgery on her wrist and hand. Your colleague performs an axillary nerve block, but the patient can flex the wrist and has sensation over the lateral portion of the palm. To provide complete anesthesia, you need to supplement by ensuring blockade of which nerve? | Ulnar nerve | Radial nerve | Median nerve | Musculocutaneous nerve | 5 | A | 2 | Axillary nerve | null | null | null | null |
feb8c651-f8ad-5316-aee1-da438a09ca6d | A 16-year-old man injured his ankle while skateboarding. You elect to perform a peripheral nerve block for intraoperative anesthesia and postoperative analgesia. You use a total of 18 mL of ropivacaine 0.2%, but the patient reports complete sensation of his lateral shin. You need to ensure adequate coverage of: | Saphenous nerve | Tibial nerve | Common peroneal nerve | Sural nerve | 5 | C | 2 | Deep peroneal nerve | null | null | null | null |
1a77c115-410b-547a-9a59-d14ec4133112 | A 35-year-old man is presenting for a procedure on his right elbow. You are deciding what type of block to perform. In discussions with your colleagues, you suggest: | A supraclavicular block would be adequate for his elbow procedure and would cover the arm | An interscalene block would be adequate for his elbow procedure and would provide anesthesia and analgesia up to the midforearm | An infraclavicular block would be adequate for his elbow procedure and would provide anesthesia and analgesia up to the wrist | An axillary nerve block would be adequate for his elbow procedure and would provide anesthesia and analgesia of his arm | 5 | A | 1 | A targeted median and ulnar nerve block at the olecranon would be best to provide adequate anesthesia and analgesia of his elbow | null | null | null | null |
ab48d31c-f127-5e7c-881c-f8141142299f | A 53-year-old woman victim of a high-speed motor vehicle accident has just arrived at the emergency department (ED). As the anesthesiologist, you are a member of the trauma team expected to provide initial care. First responders in the field report that the patient was an unrestrained driver in a head-on collision with a telephone pole around 25 minutes ago. The patient was the sole victim in the crash, and it is unclear whether alcohol contributed to the accident. En route, the patient's mental status steadily declined, and she remained hypotensive despite receiving 2 L of lactated ringers. Her current vital signs are: NIBP 81/53, RR 20, SPO2 96%, and T 36.2°F. What is the best initial step in the management of this patient? | Obtain a brief medical history from the patient's next of kin. | Assess the patient's airway and prepare to intubate as needed. | Obtain a complete blood count for suspected hemorrhagic shock. | Immediately transport the patient to CT scan. | 5 | B | 2 | Place an arterial line to assess patient's oxygenation and ventilation with an arterial blood gas. | null | null | null | null |
e8a1de9e-5d8b-5f29-b5c8-359d90d1b233 | You are called to intubate a 17-year-old boy who was hit in the face with a baseball. You notice bilateral periorbital ecchymosis and swelling, a displaced nasal bridge, and a large soft tissue hematoma underneath his left maxilla. A | Perform an awake fiberoptic intubation. | Administer a short-acting opioid to facilitate tolerance of an awake fiberoptic intubation. | Induce general anesthesia followed by bag mask ventilation (BVM) with cricoid pressure with subsequent orotracheal intubation. | Induce general anesthesia followed by rapid sequence orotracheal intubation. | 4 | D | 3 | null | null | null | null | null |
1b43cdfc-0c74-5f23-905a-fc6548597b98 | A 39-year-old man who requires intubation has a potentially unstable cervical spine and Glasgow Coma Scale (GCS) of 7. Before induction of general anesthesia, you ask your surgical colleague to perform manual in-line stabilization (MILS) and your anesthesia colleague to apply cricoid pressure. Your first 2 attempts at indirect video laryngoscopy result in visualization of the epiglottis only, and the patient begins to desaturate. What is the next appropriate step in the management of this patient? | Maintain MILS, and ask your anesthesia colleague to release cricoid pressure. | Ask your surgical colleague to adjust MILS to improve airway view, and ask your anesthesia colleague to release cricoid pressure. | Call for help and prepare to perform cricothyroidotomy. | Wake the patient up. | 4 | B | 3 | null | null | null | null | null |
590cfae8-4730-58a7-8ca2-443fb74f0642 | 4. A 68-year-old man who sustained an epidural hematoma after a fall while skiing is now being emergently taken to the operating room (OR) for decompression. Per the ED note, on physical examination the patient opens his eyes to sternal rub and grabs the hand used to perform the sternal rub. When asked where he is, the patient responds, "Take the cat to the car." What is the patient's GCS score? | 5 | 8 | 10 | 12 | 5 | C | 2 | 15 | null | null | null | null |
dc141cd6-51df-5631-a807-d2b9ce77acbf | An 18-year-old woman is an unrestrained victim of a high-speed motor vehicle collision. In the resuscitation bay of the ED, the patient appears confused and lethargic. Her initial vitals are BP 75/50, HR 144, and RR 32. Based on the Advanced Trauma Life Support (ATLS) classification of hemorrhagic shock, approximately what is this patient's estimated blood loss? | <750 cc | 750-1500 cc | 1500-2000 cc | >2000 cc | 4 | D | 2 | null | null | null | null | null |
866f1907-2822-51ad-a462-bfeecab8628a | A 24-year-old unseatbelted passenger who was involved in a motor vehicle collision is scheduled for an emergent exploratory laparotomy and external fixation of the pelvis. Her vitals in the ED are BP 85/60, HR 125, and RR 28 with a negative FAST exam. As you prepare the OR for her anesthesia, what should be your primary source of fluid for volume resuscitation in this patient? | Hypotonic crystalloid | Isotonic crystalloid | 5% albumin | Blood and blood components | 4 | D | 3 | null | null | null | null | null |
68782b66-1b7a-5cd7-965b-e268a377a04c | You are asked to help interpret an arterial blood gas test that was obtained by your colleague on one of her patients who is hemorrhaging in the OR. The values include pH 7.23, PaO2 415, PaCO2 41, FiO2 1.0, and base deficit 10.4. What degree of shock is this patient in? | Mild shock | Moderate shock | Severe shock | Not enough information to determine degree of shock | 4 | C | 3 | null | null | null | null | null |
ad053e89-995a-5ea7-ba49-a6644f54ef96 | A 68-year-old woman with a history of hypertension, hyperlipidemia, coronary artery disease, atrial fibrillation on dabigatran, and type 2 diabetes is brought to the OR for an emergent decompressive craniectomy after sustaining a spontaneous intraparenchymal hemorrhage with midline shift. Vitals are BP 150/75, HR 72, and RR 14. The neurosurgeon asks if there is "something you can give" to reverse the anticoagulant effects of her dabigatran. You reach for which of the following? | Idarucizumab | Bebulin | Pertuzumab | Kcentra | 5 | A | 1 | Fresh frozen plasma | null | null | null | null |
0b08453a-720c-51bb-ba66-ee983a484df6 | A 29-year-old woman on warfarin for a history of an unprovoked pulmonary embolism is now undergoing an urgent open reduction and internal fixation for a right femur fracture sustained in a motorcycle crash. At the start of the case, she is transfused 2 units of FFP for significant oozing despite tourniquet use. Her anesthetic and surgical course are otherwise unremarkable. During surgical closure, the patient becomes acutely hypoxemic, febrile, and hypotensive, and pink froth is noted to be coming out of her endotracheal tube. | Increased fraction of inspired oxygen | Bolus of lactated ringers | Initiation of phenylephrine | Diuretic therapy | 4 | D | 3 | null | null | null | null | null |
dcd6076c-a9d8-5e2c-bedb-fb2c6233af36 | 12. A 32-year-old man is a helmeted victim in a car versus pole motor vehicle collision with prolonged extrication. He is found on secondary survey to have bilateral comminuted femur fractures and an open book pelvic fracture. He is brought emergently to the OR for external fixation. Before arrival to the OR, he has received 6 units of packed red blood cells and 4 units of FFP and remains hemodynamically unstable. His most recent laboratory test results include hemoglobin 6.9 mg/dL, platelets 150 000, INR 1.9, and fibrinogen 250 mg/dL. In addition to blood products, your colleague suggests administering tranexamic acid (TXA). Which of the following is your response? | TXA given beyond 1 hour of injury may increase bleeding-related mortality. | TXA given beyond 2 hours of injury may increase bleeding-related mortality. | TXA given beyond 3 hours of injury may increase bleeding-related mortality. | There is no difference in bleeding-related mortality in trauma patients given TXA. | 4 | C | 2 | null | null | null | null | null |
aba9ab9a-3eb2-576d-beda-53e92e305bd4 | A 42-year-old otherwise healthy right-handed man is brought in by helicopter after falling approximately 50 feet while hiking. He was intubated in the field for a GCS of 7, and a CT scan of his head reveals right frontal and anterior temporal cortical contusions, with punctate hemorrhages at the gray-white junctions and hypodensities in the right frontal white matter. Vital signs include BP 90/50, HR 114 (sinus), T 35.9°C, and RR = 16 on volume control ventilation. Laboratory test results are significant for a hemoglobin of 9.2 mg/dL. Which of the following is the best fluid to use for initial volume resuscitation? | Normal saline 0.9% | 5% dextrose in water | Lactated ringers | Albumin 5% | 5 | A | 2 | Packed red blood cells | null | null | null | null |
b433b7e2-0f52-5af0-983c-90faf9c78c22 | 15. A bedside Codman ICP Monitor ("bolt") is placed by your neurosurgical colleague in the OR after induction of anesthesia for a patient who suffered blunt trauma to the head and had a GCS of 8. The intracranial pressure (ICP) is found to be 35 mm Hg. Other vitals include BP 90/60, HR 84, and core T | The patient's CPP is too high. | The patient's CPP is too low. | The patient's CPP is within the target range for TBI patients. | There is no CPP target range for TBI patients. | 4 | B | 2 | null | null | null | null | null |
63f824e6-f71b-59b9-bc6c-f430f8a83ec6 | Mannitol is initiated to decrease a patient's ICP. Which of the following is the target ICP in TBI? | <15 mm Hg | <20-25 mm Hg | <25-30 mm Hg | <35 mm Hg | 4 | B | 1 | null | null | null | null | null |
9293fd9c-8238-5096-819c-d75be592409b | A 24-year-old woman is admitted to the ICU postoperatively after surgical management of her traumatic right lower extremity amputation. To prevent venous thromboembolism (VTE), a sequential compression device is placed on her left lower extremity, and she is administered a daily prophylactic dose of low-molecular-weight heparin. On hospital day 4, she complains of left thigh pain, and a deep vein thrombosis (DVT) is found on duplex ultrasonography. All the following risk factors for VTE in blunt trauma victims have been shown to be refractory to well-established VTE prophylaxis clinical management guidelines EXCEPT which one? | Pelvic ring injury | Spinal cord injury | Immobilization | >3 days of mechanical ventilation | 4 | C | 1 | null | null | null | null | null |
a10d669c-d0f0-505c-8939-b1b251f571b7 | An otherwise healthy 37-year-old man weighing 100 kg has burned 40% of his total body surface area (TBSA) in a construction accident. By current guidelines, which of the following is an acceptable range of crystalloid administration in the first 24 hours? | 4-8 L | 5-10 L | 8-16 L | 10-20 L | 4 | C | 1 | null | null | null | null | null |
19069c99-826c-5805-a54f-c59b69b717b4 | A 56-year-old man with a history of end-stage liver disease (ESLD) presents for liver transplant evaluation. His ESLD has been complicated by esophageal varices, recurrent gastrointestinal (GI) bleeds, and hepatorenal syndrome, and the MELD (Model for End-Stage Liver Disease) score is calculated to be 32 with a Child-Pugh score of 13. Which of the following is NOT included as a component when calculating the MELD score? | Total bilirubin | International normalized ratio (INR) | Serum creatinine | Partial thromboplastin time | 4 | D | 1 | null | null | null | null | null |
4a1f2432-c6c7-5953-9c66-9e6905428462 | A 62-year-old woman with ESLD due to alcoholic cirrhosis is undergoing an orthotopic liver transplant. Her medical history is significant for paroxysmal atrial fibrillation, coronary artery disease, hypertension, and chronic kidney failure. The patient starts having frequent premature ventricular contractions, which progress into a sustained ventricular tachycardia causing hemodynamic instability after the surgeon releases the inferior vena cava (IVC) clamp. Of the following choices listed below, which would NOT be considered an appropriate choice for immediate therapy? | Sodium bicarbonate infusion | Low-dose epinephrine bolus | Immediate synchronized cardioversion | Calcium chloride injection | 4 | C | 2 | null | null | null | null | null |
c97cbf00-7e16-556a-ba85-db6bd28975c5 | 23. A 59-year-old man with ESLD complicated by portopulmonary hypertension (PPH), hepatorenal syndrome, and hepatic encephalopathy presents for an orthotopic liver transplant. Intraoperatively, the patient becomes progressively hypoxic despite adjustments to the ventilator. Of the following choices listed below, which would NOT be considered an appropriate INITIAL choice for therapeutic intervention to improve the patient's oxygenation status? | Start milrinone. | Start dobutamine. | Start inhaled nitric oxide (iNO). | Start dopamine. | 4 | D | 2 | null | null | null | null | null |
7138a83d-e8cf-5fe4-9a57-8fe961ece74e | A 72 year old man with a history of ESLD due to hepatitis C received an orthotopic liver transplant 2 months ago and is now presenting for a ventral hernia repair. Which of the following laboratory values is the best marker in assessing the patient's liver synthetic function posttransplant? | Bilirubin | AST/ALT (aspartate aminotransferase/alanine aminotransferase) | International normalized ratio | Albumin | 4 | C | 1 | null | null | null | null | null |
5c779e95-f79c-564c-8fb6-cc0a77cb3a3f | A 71-year-old woman with a history of rheumatoid arthritis is scheduled for a left total knee arthroplasty. She has been taking prednisone 5 mg PO daily for the last 2 weeks to control her rheumatoid arthritis. Which of the following is the most appropriate perioperative steroid plan given her chronic steroid regimen? | Recommend to the patient that she stop taking prednisone before the operation given the risk of intraoperative hyperglycemia. | Recommend that she continues taking her home dose of prednisone up until the operation. | Recommend that she doubles her dose of steroid on the morning of the operation. | Recommend that she continue taking her home dose of prednisone up until the operation and give her an additional dose of hydrocortisone during the operation. | 4 | B | 2 | null | null | null | null | null |
e8e04034-569f-55a8-89d5-d048d696cdb1 | A 64-year-old woman with a 70-pack-year smoking history and hypertension was recently admitted to the hospital with a severe COPD exacerbation and is currently receiving 40 mg of prednisone daily. On hospital day 3 she begins to complain of abdominal pain and spikes a fever. Imaging demonstrates evidence of appendicitis, and she is scheduled for an urgent appendectomy. Throughout the procedure, you note that she is becoming gradually more hypotensive. You place a radial arterial catheter, and she is consistently in the 80s-90s/40s-50s. You decide to do which of the following? | Start peripheral phenylephrine, place an nasogastric tube (NGT), and administer40 mg prednisone. | Place a central venous catheter, and start norepinephrine. | Administer 100 mg hydrocortisone IV (intravenously) in addition to placing an NGT and administering 40 mg prednisone. | Administer 100 mg hydrocortisone IV, and start peripheral phenylephrine. | 4 | D | 3 | null | null | null | null | null |
db43f1b1-5fdb-5362-94b1-b8edf8910647 | 28. A 46-year-old man, with a history of IV drug use on chronic methadone therapy and hepatitis C, is 1 year post orthotopic liver transplant and is now scheduled for a ventral hernia repair. In an attempt to address his anticipated postoperative pain with nonopioid analgesia, you plan to give him IV ketorolac. Which of the following immunosuppressive agents, in combination with ketorolac, increases the risk for potential postoperative renal dysfunction? | Tacrolimus | Mycophenolate Mofetil | Azathioprine | Prednisone | 4 | A | 2 | null | null | null | null | null |
9cac743b-8bc8-5fbf-93ac-565377730f8d | A 55-year-old woman with a history of a kidney transplant has newly diagnosed lung cancer and presents for a right-sided thoracotomy. You plan to place a preoperative epidural. Which of the following immunosuppressive agents would raise concern for a possible increased risk of epidural hematoma? | Azathioprine | Cyclosporine | Tacrolimus | Prednisone | 4 | A | 2 | null | null | null | null | null |
fe1186ad-e97e-58f6-8170-4c3a354ac641 | Antithymocyte globulin (ATG) is given for acute rejection prevention during a kidney transplant. What is ATG's mechanism of action? | Reduction in the demargination of neutrophils | Depletion of B cells | Inhibition of IL-1 receptors on B cells and T cells | Depletion of T cells | 4 | D | 1 | null | null | null | null | null |
19dd6b84-f8f6-58f8-85c4-bacd481112de | Compared with pulsatile left ventricular assist devices (LVADs), continuousflow LVAD therapy confers which of the following? | Comparable risk of device-related infections | A worse neurologic outcome | Increased risk of GI bleeding | Increased levels of circulating von Willebrand factor | 4 | C | 1 | null | null | null | null | null |
84d5dd0f-814d-5239-809f-b442803da65d | Regarding perioperative considerations for lung transplantation (LTx), which of the following statements are true? | Compared with donation-after-brain-death LTx, donation-after-circulatory-death (DCD) LTx results in decreased graft survival. | Perioperative hyperglycemia is associated with increased mortality in patients undergoing LTx. | Use of lung protective ventilation strategies in organ donors with brain death has not increased the number of available donor lungs. | Lung transplant using cardiopulmonary bypass (CPB) provides better long-term outcomes compared with off-pump LTx. | 4 | B | 1 | null | null | null | null | null |
18fb7b21-a4ee-5eeb-9888-3d2d3602c42d | 33. A 59-year-old man with a history of mild hypertension, hyperlipidemia, and B-cell lymphoma with doxorubicin-induced cardiomyopathy requiring orthotopic heart transplantation 5 years ago is brought in by EMS to the ED. His posttransplant course was complicated by postoperative renal failure with permanent need for dialysis. He presents now in shock. He does not follow a renal diet but has undergone a routine hemodialysis 2 days ago. "He only takes tacrolimus and mycophenolate mofetil" at home per EMS report. His vitals are HR 115, BP 74/41, RR 35, and O2 Sat 85% on 10 L FM. The patient's ECG shows ST elevations in multiple leads, his troponin I is 0.4, and serum lactate is 6. Before he can be brought to a heart catheterization laboratory, the patient passes away. Which of the following medications/intervention most likely would have helped prevent this situation? | Pravastatin | Aspirin | Diltiazem | Prophylactic coronary angioplasty with left main coronary artery stent deployment | 4 | A | 1 | null | null | null | null | null |
7b1c3fc4-6b75-5419-b804-b3857196662b | Which of the statements regarding thyroid function and its impacts on cardiovascular pathophysiology is most likely true? | Pulmonary hypertension is linked to hyper- and hypothyroidism. | Hypothyroidism is associated with a slower progression of heart failure patients. | Triiodothyronine (T3)/thyroxin (T4) therapy to the donor increases availability of thoracic donor organs but causes increased graft rejection after transplantation. | T3 levels do not correlate with the presence of coronary artery disease. | 4 | A | 1 | null | null | null | null | null |
ce572bfd-2619-53eb-a047-18436efe452f | Patients with end-stage heart failure pending heart transplantation may require | Intra-aortic balloon pump (IABP) counterpulsation raises the effective cardiac output more than percutaneously inserted axial flow pumps (eg, Impella). | Percutaneously inserted axial flow pumps (eg, Impella) generally do not require anticoagulation while inserted. | Extracorporeal membrane oxygenation (ECMO) decreases left ventricular (LV) afterload less than IABP. | It is recommended to continue supportive catecholamine infusions with indwelling percutaneously inserted axial flow pumps to enhance cardiac output. | 4 | C | 1 | null | null | null | null | null |
58c46797-2e3f-5d10-abb9-5d5afd6ed050 | You are taking care of an otherwise healthy 35-year-old man undergoing repair of his left anterior cruciate ligament. Shortly after induction, his heart rate increased from 70 to 110 beats per minute and his blood pressure drops to 60/40 mm Hg. You also notice an increase in his peak inspiratory pressure. Which of the following is your next step? | Administer a 500-cc bolus of crystalloid, and turn down the concentration of volatile anesthetic. | Start a phenylephrine infusion to target an MAP greater than 60 mm Hg. | Call for help, give epinephrine 10-100 µg IV, and repeat or escalate dose every 1-2 minutes and titrate to effect. | Call for help, and give epinephrine 1 mg IV. | 4 | C | 3 | null | null | null | null | null |
936e2dca-930c-50f1-b4ea-d78f906d8fb0 | 37. The following scenario applies to the next 3 questions: You are asked to evaluate a 65-year-old 80-kg man in the postanesthesia care unit (PACU). He has just undergone a laser lithotripsy of a right ureteral stone. His temperature is 38.5°C, heart rate is 100 beats per minute, blood pressure is 83/55 mm Hg, and respiratory rate is 30 breaths per minute. He is arousable but confused. He has already received 2 L of crystalloid in the perioperative period. The most appropriate next step in management is administration of which of the following? | Start norepinephrine infusion, and titrate to MAP >65 mm Hg. | Start dopamine infusion, and titrate to MAP >65 mm Hg. | Start phenylephrine infusion, and titrate to SBP >90 mm Hg. | Give 250 cc of 5% albumin. | 4 | A | 2 | null | null | null | null | null |
d4bac66d-36f5-528f-9ec9-276aae0c90b0 | The patient is now on norepinephrine at 20 µg/min, and his MAP remains less than 65 mm Hg. The next appropriate step is which of the following? | Add dopamine as a second vasopressor. | Add phenylephrine as a second vasopressor. | Add vasopressin as a second vasopressor. | Decrease your MAP goal to 60 mm Hg, as his baseline pressure is usually low. | 4 | C | 2 | null | null | null | null | null |
8606e961-5938-5adb-a3bc-74d0a4b586d7 | The patient has already received 2 L of crystalloid, but you want to determine if he remains intravascularly volume-depleted. How is "fluid responsiveness" defined? | Decrease in heart rate | Urine output | Increase in SBP | Increase in cardiac output | 4 | D | 1 | null | null | null | null | null |
3d463c35-f98e-5f1b-ab4b-b70f21daeb26 | A 55-year old man is scheduled for elective colectomy. His medical history is significant for hypertension, which is controlled on lisinopril. Shortly after induction with propofol and rocuronium, his blood pressure decreases from 130/85 to 80/50 mm Hg. Administration of ephedrine 5 mg and phenylephrine 40 µg IV has no effect. The most appropriate treatment at this time is administration of which of the following? | Vasopressin | Epinephrine | Phenylephrine | Calcium chloride | 4 | A | 2 | null | null | null | null | null |
71430050-64c5-5033-b953-a02e515cea3c | Which of the following treatments for catecholamine-resistant vasoplegia does NOT inhibit nitric oxide? | Methylene blue | Hydroxocobalamin | Vitamin C | Angiotensin II | 4 | D | 1 | null | null | null | null | null |
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