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7c678657-e35a-58f4-a5a2-025207726feb | A 70-year-old man is in the ICU after undergoing a left upper lobectomy. He develops atrial fibrillation on the second postoperative day. His heart rate is 150 beats per minute and blood pressure is 85/50 mm Hg. Which of the following is the least appropriate treatment of his tachycardia? | Phenylephrine | Amiodarone | Metoprolol | Verapamil | 4 | A | 2 | null | null | null | null | null |
9ceefb9b-f6fb-5477-8b3c-6d621486d219 | A 63-year old man is admitted to the ICU with sepsis after abdominal surgery for perforated diverticulitis. After fluid resuscitation, he continues to require high doses of norepinephrine. Bedside echocardiography shows a dilated left ventricle with a reduced ejection fraction. Which of the following statements is true? | The recommendation for use of dobutamine in patients with evidence of persistent hypoperfusion despite adequate fluid loading and vasopressor use is based on high-quality evidence. | Milrinone is a phosphodiesterase inhibitor that increases contractility independent of β-adrenergic receptors. | Levosimendan increases both inotropy and blood pressure. | When compared with norepinephrine and dobutamine, epinephrine is associated with increased mortality. | 4 | B | 1 | null | null | null | null | null |
cb4a4930-580d-5b44-b225-407a66ee5da0 | A 65-year-old man is admitted to the ICU after undergoing an uncomplicated 3 vessel coronary artery bypass graft (CABG × 3). His blood pressure is 185/95 mm Hg. Which of the following is false regarding clevidipine? | It is contraindicated in patients with allergies to soybeans, soy products, eggs, or egg products. | When compared with nitroprusside, clevidipine demonstrated a significant mortality advantage. | Clevidipine is superior for blood pressure control when compared with nitroprusside, nitroglycerin, and nicardipine. | Rebound hypertension can occur after discontinuation of clevidipine. | 4 | C | 1 | null | null | null | null | null |
d4b9ebc3-96fa-5377-91f7-2e3c792e2003 | Which of the following agents is categorized as a Category A bioterrorism agent by the Centers for Disease Control and Prevention (CDC)? | Ricin toxin | Vibrio cholerae | Yersinia pestis (plague) | Hantavirus | 4 | C | 1 | null | null | null | null | null |
2247ab44-ac2d-528e-86ee-225c27d60600 | You are asked to evaluate several patients who presented with symptoms of mydriasis, ptosis, diplopia, dysphagia, dysarthria, and progressive, symmetric descending flaccid paralysis. The patients are conscious and have no cardiovascular perturbations. You hear from colleagues that there are several similar cases at area hospitals as well. You recommend which of the following? | Treatment with plasmapheresis or IV immunoglobulin and close respiratory and cardiovascular monitoring | Supportive care, close monitoring for respiratory failure and risk of aspiration, and administration of antitoxin | Treatment with atropine, pralidoxime, anticonvulsants if seizures occur, and close monitoring for respiratory failure and risk of aspiration | Thorough skin examination, removal of tick, and supportive care | 4 | B | 3 | null | null | null | null | null |
47578365-9baa-5644-9a8a-bf53032483d1 | 48. Which of the following statements regarding smallpox is false? | The incubation period for smallpox is 10-14 days. | Smallpox is highly infective requiring exposure to only 10-100 organisms to be infected. | The lesions of smallpox appear over the face and trunk and progress from macule to papule to vesicle to crust within 24-48 hours, and lesions at different stages can coexist on any 1 part of the body. | The World Health Organization (WHO) recommends a surveillance and containment strategy for the management of smallpox. | 4 | C | 1 | null | null | null | null | null |
ec2d84f4-e0ca-529b-9bd9-0ba40439628f | What are the 4 properties of hazards within the biological weapon spectrum? | Toxicity, latency, persistency, and transmissibility | Virulence, stability, endemic, and determination | Toxicity, stability, transmissibility, and transitory | Virulence, weaponization, toxicity, and transmissibility | 4 | A | 1 | null | null | null | null | null |
f4229d1e-3e9d-5cc2-b23a-5fe904631f1f | You are caring for a 35-year-old man with respiratory failure, fever, shock, and acidosis. He presented 3 days ago with nonspecific complaints of fever, cough, and malaise. His chest radiograph shows mediastinal widening and pleural effusions. Blood cultures are growing Bacillus anthracis. Which of the following is NOT part of his management? | He should be started on an antibiotic with bactericidal activity such as a fluoroquinolone as well as a protein synthesis inhibitor such as clindamycin to reduce toxin production. | He should be placed on airborne precautions in a negative pressure room. | A lumbar puncture should be performed to evaluate for meningitis. | He should be treated early with an anthrax antitoxin. | 4 | B | 2 | null | null | null | null | null |
f4443c9a-569f-5032-bbe3-1bd27de0c020 | A 69-year-old woman presents to an outpatient surgical center for elbow arthroscopy under regional anesthesia. Her medical history is significant for well-controlled hypertension on 2 antihypertensive agents, type 2 diabetes on metformin with a most recent HbA1c of 6, and obesity with a body mass index of 35. During preoperative assessment, she reports a good functional capacity, able to carry heavy loads of laundry up and down stairs from the basement. When asked, she admits that she has been told she snores loudly, has had witnessed apneic episodes, and is frequently tired during the day. What should the attending anesthesiologist do? | Cancel the surgery because she is at high risk for having obstructive sleep apnea (OSA) and refer her for a sleep study. | Cancel the surgery because she is at high risk for having OSA and refer her to have to procedure done at an inpatient facility. | Proceed with the surgery despite the fact that she is at high risk for having OSA because her comorbidities are well controlled and she will have a regional anesthetic. | Proceed with the surgery, as she is not at high risk for having OSA. | 5 | C | 3 | Cancel the surgery because of her obesity and hypertension. | null | null | null | null |
d4e67ab9-2c1a-5f04-830b-d94c329fe393 | A 22-year-old woman presents to the same-day surgery clinic for a rhinoplasty revision. Upon meeting her in the preoperative area, you note she is chewing gum. When you ask her about it, she immediately swallows the gum. Upon further questioning she admits that this is the fifth piece of gum she has chewed and swallowed this morning. Which of the following is the most appropriate action? | Proceed with the surgery as scheduled because chewing gum has little effect on gastric volume or pH. | Delay the surgery for 2 hours because chewing gum is considered similar to liquids according to ASA guidelines. | Delay the surgery for 4 hours because chewing gum is considered similar to breast milk according to ASA guidelines. | Delay the surgery for 6 hours because the gum she swallowed qualifies as a solid/light meal. | 5 | D | 2 | Cancel the surgery because she did not follow directions. | null | null | null | null |
a5c07425-ccd8-50a0-97f0-b08b060c08a4 | 3. A nurse calls you from the preoperative area of an outpatient surgical center to tell you about a 35-year-old man with type 1 diabetes scheduled for knee arthroscopy. She notes he has vomited once, is tachycardic, and is constantly asking either to use the bathroom or to be able to drink water. He told her that he has not taken insulin in 2 days, so she took his blood glucose level and it is 467. Which of the following is the best course of action? | Proceed with surgery and treat the hyperglycemia intraoperatively with IV regular insulin. | Ask the nurse to give the patient his normal dose of NPH and proceed with surgery treating intraoperative hyperglycemia with IV regular insulin. | Evaluate the patient yourself and proceed with surgery only if he understands how to treat his hyperglycemia postoperatively. | Evaluate the patient yourself. Explain to him that you are concerned that he is showing signs and symptoms of diabetic ketoacidosis, cancel the surgery, draw appropriate laboratory test results, and send him to a tertiary care center for further evaluation and treatment. | 5 | D | 3 | Counsel the nurse that she should not have checked the blood glucose level without discussing it with you first. | null | null | null | null |
6feeb5de-4fab-5a9a-8086-d16da3ac18da | A 23-year-old woman presents for same-day surgery for hysteroscopy for a misplaced intrauterine device. She is very anxious about anesthesia. On your preoperative assessment, you note she gets carsick frequently and is a | Based on her Apfel score, she has 3 risk factors of PONV, giving her a 60% risk of PONV. A multimodal approach using antiemetics of 2 or 3 different classes is appropriate. | Her anxiety confers additional risk for PONV. | Both avoiding nitrous oxide and minimizing neostigmine dose can help reduce her risk of PONV. | Scopolamine patch and ondansetron are most effective when administered before surgery. | 5 | A | 2 | The use of haloperidol as an antiemetic requires doses the same as or higher than those that are used to treat psychiatric disorders. | null | null | null | null |
fcdcaa41-3e54-5d40-82fb-8d39c488aa2d | A 40-year-old woman presents to an ambulatory surgical center for knee arthroscopy. She tells you she needs to get home as soon as possible after the surgery because she has "important things to take care of." What is the best anesthetic plan to ensure the shortest time from arrival to discharge? | General anesthesia | Regional anesthesia with a "3-in-1" block technique | Spinal anesthesia | All of the above techniques can be used to affect a short time to discharge | 5 | D | 3 | Knee arthroscopy is not an appropriate surgery for an ambulatory center | null | null | null | null |
5c74d1c5-8f38-58e7-99f1-7b67d5f5e83e | A 23-year-old woman is having nausea and vomiting in the postanesthesia care unit (PACU) after hysteroscopy. She was deemed to be at high risk for PONV and received dexamethasone, ondansetron, and haloperidol as PONV prophylaxis intraoperatively. Which of the following is the best next step in management? | Repeat the same dose of ondansetron. | Repeat the same dose of dexamethasone. | Repeat the same dose of haloperidol. | Give a higher dose of ondansetron. | 5 | E | 2 | Administer perphenazine or promethazine. | null | null | null | null |
0a771324-6f44-5f74-9e13-63829aa786eb | All of the following are common reasons for delay in ambulatory surgical patient discharge EXCEPT which one? | Drowsiness | Nausea | Vomiting | Anxiety | 5 | D | 1 | Pain | null | null | null | null |
7a2a9b98-065f-528c-9ad8-1fe92a4d8bf6 | 8. A 31-year-old man complains of 7/10 pain in the PACU after hemorrhoidectomy under general anesthesia. Which is the most appropriate intervention to treat his pain and facilitate a shorter time to discharge home? | Assume his complaint is due to discomfort from something else such as hypoxemia, hypercapnia, or full bladder rather than surgical pain. | Administer IV hydromorphone. | Administer IV morphine. | Administer IV fentanyl. | 5 | E | 3 | Evaluate for other sources of discomfort such as hypoxemia, hypercapnia, or full bladder. Once these are eliminated, administer IV fentanyl and a nonsteroidal anti-inflammatory drug. | null | null | null | null |
dae863f7-c037-5dc4-bb15-55ec6c3a0a8b | A 65-year-old man is recovering from general anesthesia for umbilical hernia repair. You go to evaluate him and note he is sleeping with an oxygen saturation of 94%on room air. When you call his name, he takes a deep breath, coughs, and yells at you for interrupting his nap. You note his blood pressure is 166/70. He kicks his blanket off and throws it at you, yelling "that's what it always is!" | His modified Aldrete score is 5 and he is NOT ready for discharge. | His modified Aldrete score is 9 and he is ready for discharge. | He is hypertensive and therefore is not ready for discharge. | He is angry and therefore is not ready for discharge. | 5 | B | 2 | He was sleeping and therefore is not ready for discharge. | null | null | null | null |
1220665f-dcfd-58f7-8227-0b288a23ffc2 | A 21-year-old man is in the PACU after receiving general anesthesia for excision and grafting of a small burn he sustained to his right lower extremity several days ago. He is demanding to be discharged home, but the nurse tells him he must urinate and eat crackers first. Which of the following is true regarding the need to void and eat/drink before discharge home? | It is absolutely necessary for all patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU. | It is never necessary for patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU. | All patients who received general anesthesia need to demonstrate that they can eat and drink before discharge home. Only patients who had neuraxial blocks are required to urinate. | Requiring all patients to void before discharge home is necessary from a medicolegal standpoint. | 5 | E | 2 | Requiring patients who are at low risk to void and to eat and drink before discharge home is not necessary. | null | null | null | null |
0c3dc24c-7028-5ef6-a0fa-eb9eaa639a87 | Which of the following is the expected physiologic response to electroconvulsive therapy (ECT), beginning with the electrical stimulus? | Initial sympathetic discharge followed by parasympathetic response | Initial parasympathetic discharge followed by sympathetic response | Initial sympathetic discharge without parasympathetic response | Initial prominent sympathetic discharge leading to arrhythmia | 5 | B | 1 | No physiologic response | null | null | null | null |
374abd47-7a07-53fb-babe-c9c8194b525c | Which of the following agents CANNOT be used safely and effectively for induction of anesthesia for ECT? | Methohexital | Propofol | Ketamine | Etomidate | 5 | E | 1 | None of the above, all can be used safely and effectively | null | null | null | null |
42c6c842-ccec-51c3-9bed-3435a5d12949 | 13. A 52-year-old woman presents for ECT for refractory depression. You note she is on multiple psychiatric medications, including a selective serotonin reuptake inhibitor, a tricyclic antidepressant, and a monoamine oxidase inhibitor (MAOI). Which of the following is false regarding MAOIs and ECT? | Patient's taking MAOIs are at increased risk for hypertensive crisis if direct- or indirect-acting sympathomimetic drugs are given. | If the decision is made to continue MAOI therapy, the patient should be on a stable dose before ECT. | If the decision is made to discontinue the MAOI, it should be held for 3 days before ECT. | If the decision is made to discontinue the MAOI, it should be held for 2 weeks before ECT. | 5 | C | 1 | The decision to either stop or continue MAOIs for ECT should be made on an individual patient-by-patient basis. | null | null | null | null |
ce28da7a-1860-550c-91bf-43718809b141 | In which of the following patients would you be MOST concerned about ECT? | A 55-year-old man who had a cerebral aneurysm coiled last year, stable on follow-up imaging. | An 87-year-old woman with multivessel coronary artery disease and ejectionfraction on 35% | A 41-year-old man with untreated pheochromocytoma | A 71-year-old woman with severe osteoporosis | 5 | C | 2 | A 65-year-old man with Parkinson disease | null | null | null | null |
99a92e36-9c2e-5b3b-b185-f26e65b7a8ba | A 27-year-old woman with depression who has not responded well to medical management presents for ECT. You are about to go over the consent for anesthesia with her when a nurse tells you "not to bother, " consent is implied because she is depressed and therefore cannot consent for herself. Which of the following is the most appropriate response? | Thank her for reminding you and do not consent the patient. | Thank her for reminding you and call the patient's mother to obtain consent. | Cancel the ECT. | Assess the patient to evaluate if she understands the information relevant to consenting for anesthesia for ECT, and if she does, continue with the consent process. | 4 | D | 3 | null | null | null | null | null |
ec191689-ff06-566e-b075-0b590bc4a98c | All of the following are advantages of an office-based procedure EXCEPT which one? | Cost containment | Patient convenience | Surgeon convenience | Increased patient exposure to nosocomial infections | 5 | D | 1 | Improved patient privacy | null | null | null | null |
2e426671-692b-517e-838b-055a029a09fb | Which of the following equipment is NOT required to be available for the safe delivery of office-based anesthesia? | Pulse oximeter | Capnography | Anesthesia machine | Suction equipment | 5 | C | 1 | Dantrolene and malignant hyperthermia supplies | null | null | null | null |
22dc5452-9747-5d46-ba59-a76971b6a914 | According to the ASA Closed Claims Project database, which of the following were the most common adverse events during office-based procedures? | Respiratory events | Cerebrovascular events | Equipment-related injuries | Gastrointestinal-related events | 5 | A | 1 | Postanesthetic events | null | null | null | null |
cea0c723-9183-5e4f-8151-1780bfd3b10a | 19. All of the following patients are considered poor candidates for an officebased procedure EXCEPT which one? | A 30-year-old woman with type 1 diabetes mellitus and HbA1c 9 | A 20-year-old man with history of intravenous drug use on Suboxone | A 40-year-old woman with body mass index of 43 | A 70-year-old woman with osteoporosis | 5 | D | 3 | A 50-year-old man without an escort | null | null | null | null |
51371bd3-a373-554b-8ba2-74c5486eb876 | The last patient of the day is recovering from her general anesthetic for liposuction at a plastic surgery office. The anesthesiologist and a medical assistant are the only people who remain in the office after a long day. The anesthesiologist tells the administrative assistant she has to leave and asks him if he can give the patient's escort the postoperative care instructions when he gets there. Which of the following statements is correct? | This is inappropriate because the anesthesiologist must stay until the last patient has left the office. | This is appropriate only if the medical assistant is ACLS/PALS-certified. | This is appropriate because the anesthesiologist has to leave. | This is inappropriate because the anesthesiologist is taking advantage of the medical assistant. | 5 | B | 2 | This is inappropriate because the anesthesiologist should remain to answer the escort's questions about postsurgical care. | null | null | null | null |
3d739736-6293-5065-a45b-32b921c665d1 | The 3-step paradigm to nonoperating room anesthesia describes a systematic approach that addresses which of the following? | The patient, the procedure, and the environment | The patient, the proceduralist, and the anesthesiologist | The proceduralist, the anesthesiologist, and the ASA classification | The anesthesiologist, the environment, and the equipment | 5 | A | 1 | The proceduralist, the environment, and the equipment | null | null | null | null |
8beb395d-deea-5d6c-b039-0cc10f385ed8 | You are delivering general anesthesia in the interventional radiology suite for fluoroscopy-guided radiofrequency ablation of hepatocellular carcinoma. All of the following steps can be taken to minimize exposure to radiation EXCEPT which one? | Leaving the procedure room when active radiation is in use | Wearing a lead-lined protective garment | Working behind a lead-lined glass shield | Working on the side of the table on which the X-ray source originates | 5 | D | 1 | Limiting the length of time of the procedure | null | null | null | null |
33a868f7-1285-5d6e-8971-6115b23d1297 | You are performing a general anesthesia for a 4-year-old undergoing an MRI. After induction of anesthesia, you take all of the following steps to ensure safety in the MRI EXCEPT which one? | Ear protection is placed in the patient's ears. | IV tubing and cables are wound neatly in loops at the patient's skin. | Ensure absence of ferromagnetic equipment such as IV poles, gas cylinders, and pens. | The patient achieves adequate tidal volumes after moving into the scanner. | 5 | B | 2 | The patient is adequately anesthetized. | null | null | null | null |
88a6cb40-ece3-5ab3-a62e-d260e7b81972 | After inducing general anesthesia, you observe your patient as she moves into the MRI scanner. After ensuring MRI safety standards have been met and she is adequately anesthetized and hemodynamically stable, you move to the monitoring room. When you are in the monitoring room, you are in which zone? | Zone I | Zone II | Zone III | Zone IV | 5 | C | 1 | Zone V | null | null | null | null |
6d8e3483-faaf-563a-a263-8a4d199392aa | 25. ASA standards for nonoperating room anesthetizing locations include all of the following EXCEPT which one? | Adequate and reliable suction is available. | Easy and expeditious access to the patient is required, but limited access to the anesthesia machine and monitoring equipment is acceptable. | Defibrillator, emergency drugs, and cardiopulmonary resuscitation equipment are all immediately available. | There is adequate illumination of the patient, anesthesia machine, and monitoring equipment with a battery-operated backup light source. | 5 | B | 1 | Electrical outlets are sufficient for both the anesthesia machines and monitors. | null | null | null | null |
c60a1a09-a605-5e70-a383-55bb7117bb34 | ,, Of the following choices, which opioid has consistently been associated with delirium when used for postoperative pain management in the elderly? | Fentanyl | Morphine | Hydromorphone | Meperidine | 4 | D | 1 | null | null | null | null | null |
62f746fa-397f-57f9-9c44-2263ac0b272c | Which of the following changes that occur with increasing age can account for the possible increase of morphine's duration of action in the elderly? | Increased adipose tissue | Increased lean body mass | Increased total body water | Decreased gastric pH | 4 | A | 1 | null | null | null | null | null |
6970a036-01aa-5276-8874-993423007d52 | Which of the following opioids would be most appropriate to treat pain in an elderly patient on fluoxetine? | Tramadol | Meperidine | Fentanyl | Oxycodone | 4 | D | 2 | null | null | null | null | null |
847094f5-bfd3-51bf-9cf9-162a1eb4f01b | When comparing an 80-year-old patient with a 20-year-old patient with the same lean body mass, which of the following statements about remifentanil is false? | A reduction of the bolus dose will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old. | A reduction of the maintenance infusion rate will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old. | The 80-year-old patient may have a delayed emergence after receiving a remifentanil infusion. | The 20-year-old patient may have a delayed emergence after receiving a remifentanil infusion. | 4 | D | 3 | null | null | null | null | null |
f5aa7b5c-23ae-5b91-8e55-e9a3ac78f940 | 5. An 80-year-old man is scheduled for radical prostatectomy. He denies any significant medical history other than hypertension, for which he takes hydrochlorothiazide. He reports a good exercise tolerance and is able to climb 4 flights of stairs without difficulty. What would be the expected minimum alveolar concentration (MAC) of sevoflurane to prevent movement to surgical stimulation assuming the patient has a response to anesthesia in line with the median population? | 1.8% | 1.6% | 1.4% | 1.2% | 4 | C | 1 | null | null | null | null | null |
bc201de4-1b89-576e-94c9-1e25c945d7d1 | A 90-year-old man with no significant cardiopulmonary history, other than hypertension, is undergoing an elective right hemicolectomy. After induction of general anesthesia, the patient is noted to be requiring escalating doses of phenylephrine to maintain a mean arterial pressure (MAP) >65 mm Hg. ECG shows normal sinus rhythm, and airway pressures are within normal limits. End tidal carbon dioxide is stable. He is being maintained on desflurane with an expired concentration of 6%. Which of the following is the most appropriate next step? | Decrease the desflurane with a goal expired concentration of 5.5%. | Decrease the desflurane with a goal expired concentration of 4.6%. | Tolerate a MAP of 55 mm Hg. | Administer midazolam with the goal of creating a balanced anesthetic. | 4 | B | 2 | null | null | null | null | null |
4da2d9d5-dd9a-5bbe-8cff-856439b9e81c | Which of the following statements regarding cardiovascular physiology in the elderly is true? | Vascular stiffening leads to a decrease in pulse pressure. | Diastolic dysfunction is present in half of those diagnosed with congestive heart failure. | Nitric oxide production is increased to balance increases in systemic vascular resistance. | Cardiac output is maintained by increased stroke volume and ventricular contractility. | 4 | B | 1 | null | null | null | null | null |
63da3e2b-9aca-52cb-a93f-0a5b725e5c65 | Which of the following cardiovascular changes associated with aging is false? | Reduced ventricular compliance | Decreased blood vessel contractility | Desensitization of carotid and aortic baroreceptors | Preserved sympathetic and vagal resting tone | 4 | D | 1 | null | null | null | null | null |
0e187d64-f7c2-5ef4-a845-152393c65cea | Which of the following statements regarding cardiovascular pathology in elderly patients is false? | Out of every 3 patients older than 70 years, 1 patient will develop significant coronary artery disease. | Hypertension can develop in the setting of normal systemic vascular resistance. | In the developing world, rheumatic heart disease affecting the aortic valve is the most common cause of valvular heart disease. | In the absence of disease, resting systolic cardiac function can be preserved even in octogenarians. | 4 | C | 1 | null | null | null | null | null |
93bfae81-8b9f-5ec9-ad01-7bf32e734fa0 | Which of the following statements regarding autonomic physiology in the elderly is true? | α-Adrenergic sensitivity and response to α-agonists are increased. | β-Adrenergic sensitivity and response to β-agonists are increased. | Adrenal tissues atrophy, resulting in a decrease in circulating norepinephrine and epinephrine levels. | Maintenance of MAP is dependent on increases in vascular resistance. | 4 | D | 1 | null | null | null | null | null |
71e47de5-d333-5d6b-a63e-f7ac839c7cd3 | A 82-year-old woman with a medical history of hypertension, hyperlipidemia, and chronic kidney disease (CKD) (baseline Cr 1.4) is brought to the emergency department by ambulance from her retirement home with altered mental status. The patient's vital signs are as follows: T 39.3°C, HR 121, BP 72/45, RR 38, SaO2 88%, and FiO2 1.0 via nonrebreather mask. The patient is admitted to the intensive care unit with subsequent intubation and initiation of norepinephrine (4 µg/min) infusion. The patient's P/F ratio is 102 and serum lactate is 3. Which of the following statements is false? | The patient meets criteria for septic shock according to Sepsis-3 consensus. | Nondialysis requiring CKD in septic and septic shock patients is associated with increased mortality. | Titration of vasopressors to a mean arterial perfusion pressure of 75-85 mm Hg increases mortality. | The patient's expected in-hospital mortality is approximately 40%. | 4 | C | 2 | null | null | null | null | null |
fa76cc36-b7c1-529c-999d-aac94250fcb1 | A 85-year-old woman with a history of hypertension, atrial fibrillation, type II diabetes mellitus (DM), hypercholesterolemia, CKD stage IV (glomerular filtration rate 15-29 mL/min; baseline creatinine 2.3), a recent ST-elevation myocardial infarction, and osteoporosis on hormone replacement therapy returns to the hospital with chest pain and dyspnea. Her home medications include aspirin, clopidogrel, apixaban, and lisinopril. She states she was recently started on exenatide (glucagonlike peptide-1 [GLP-1] receptor agonist). The patient shows clinical signs of congestive heart failure. A diagnosis of pericarditis was made. The patient receives diclofenac for pain control and furosemide for a diagnosis of pulmonary edema. Which of the following statements with regard to this patient is true? | CKD in women is characterized by low estradiol levels, but estrogen replacement might be associated with progressive renal loss. | Exenatide is a preferred oral antiglycemic in patients with severe CKD. | Androgens may protect renal function through prevention of parenchymal, fibrotic remodeling. | Apixaban is relatively contraindicated in patients with atrial fibrillation and endstage CKD. | 4 | A | 1 | null | null | null | null | null |
f16aa290-7b11-510c-9737-1537aee4331a | An 83-year-old man with obesity, poorly controlled hypertension, hyperlipidemia, type II DM, and nonalcoholic fatty liver disease (NAFLD) presents to the emergency department with abdominal pain, nausea, and vomiting. Vitals are as follows: T 38.3°C, HR 113, BP 81/51, RR 32, Sa O2 94%, and FiO2 0.4. The patient's WBC count is 17, Hgb 12, Plt 102, Na 145, K 3.4, Cl 104, CO2 15, BUN 34, Cr 1.6, INR 1.6, PTT 41, and albumin 2.3. Which of the following statements is true? | Hypoalbuminemia is associated with increased perioperative morbidity but not mortality. | Preoperative albumin administration in patients with hypoalbuminemia may increase the incidence of AKI. | NAFLD lowers the risk of CKD by decreasing renal artery vascular resistance. | The patient is at increased risk of thromboembolic complications due to increased circulating levels of vitamin K–dependent and vitamin K–independent clotting factors. | 4 | D | 3 | null | null | null | null | null |
d5b48359-6b91-539f-9762-e59c701021f0 | 15. An 87-year-old man with a history of perforated diverticulitis is now transferred to the intensive care unit after a >12 hour operation secondary to prolonged sedation and inability to extubate. The patient's intraoperative anesthetic consisted of propofol and sufentanil infusions. The patient was hypotensive for the majority of the case in the absence of large blood loss, requiring varying degrees of vasopressor infusion support. Which aging related changes to liver/renal physiology/anatomy help explain the patient's clinical presentation? | Although absolute liver weight decreases in patients older than 50 years, liver blood flow stays largely constant. | Drugs with a high hepatic extraction ratio are less affected by the age-related hepatic enzyme changes compared with drugs with a low hepatic extraction ratio. | The geriatric population is relatively protected from drug-induced liver injury because of decreased mitochondrial radical oxygen species production. | Changes in the medullary vasculature, increased renin-angiotensin-aldosterone system activity, and increased tubular ammonium ion excretion are key features of renal aging. | 4 | B | 2 | null | null | null | null | null |
85de1549-d4b1-5864-bc98-eb3cbc640315 | A 72-year-old man is scheduled for an elective ankle fracture repair. He has a history of anxiety and panic attacks. He prefers not to have a nerve block but is concerned that general anesthesia will considerably increase his risk of developing dementia. You decide to do which of the following? | Convince the patient that regional anesthesia is a safer option in this case. | Suggest a third option—fracture repair under monitored anesthesia care. | Agree that general anesthesia increases risk of dementia and address specific concerns about the nerve block. | Explain that there is no convincing evidence that general anesthesia increases the risk of dementia. | 4 | D | 2 | null | null | null | null | null |
514d05d8-8e65-532e-80d7-16f0eee9e00c | A 78-year-old woman is participating in a study that is assessing pain perception. A cryoprobe on her forearm is gradually cooled to produce a painful stimulus. She has undergone a similar experiment at the age of 27 years. Compared with the results of the experiment obtained in younger age, the findings are likely to elicit which of the following? | Increased pain threshold but decreased pain tolerance | Unchanged pain threshold and pain tolerance | Decreased pain threshold and tolerance | Prominent local vasodilatation due to cold-reacting agglutinins | 4 | A | 1 | null | null | null | null | null |
f1e3429d-17e2-57b1-b689-376e7c7d5db3 | A 71-year-old man is scheduled for elective surgical removal of a posterior neck cyst. He is overall healthy but reports occasional dizziness when sitting up in bed after he wakes up in the morning. Of the following choices, which is the most likely the cause of his dizziness in light of his age? | Decreased baroreceptor reflex | Decreased sympathetic system activity | Decreased venous capacitance | Decreased brain volume | 4 | A | 2 | null | null | null | null | null |
6a78305f-1b05-5cc4-aa86-3e7e4f941aa0 | A 73-year-old woman is scheduled for hip arthroplasty. She has a history of hypertension, hyperlipidemia, depression, and type 2 DM. She mentions that after a cholecystectomy 3 years ago, as she was recovering in PACU, she saw another elderly patient who was "acting crazy." She asks you if she will "act crazy" after her surgery. Of the following choices, which statement is the most appropriate reply in response to her concerns? | This is unlikely to happen, as she has an excellent mental status before surgery. | It is uncommon for patients who are fit enough to undergo a hip arthroplasty to have postoperative delirium. | If she develops postoperative delirium, you expect it to resolve quickly. | She may have postoperative delirium, which can affect her recovery from surgery. | 4 | D | 3 | null | null | null | null | null |
8d4cef02-867a-59a1-9ffa-f79e750a5c65 | 20. Which of the following lung volumes, or combination of lung volumes, changes most significantly over the lifetime of an adult? | Total lung capacity (TLC) | Closing capacity (CC) | Functional residual capacity (FRC) | Tidal volume | 4 | B | 1 | null | null | null | null | null |
ec718f37-2172-5a25-835b-3c3bab563825 | Which of the following statements regarding oxygenation and ventilation in the elderly is false? | The resting PaO2 in a 20-year-old is similar to that in an 80-year-old. | They have a decreased ventilatory response to hypercapnia. | They have a decreased ventilatory response to hypoxia. | The muscles of the upper airway atrophy. | 4 | A | 1 | null | null | null | null | null |
c4b1ed80-7943-5a37-a2eb-00a34b14e7b5 | All of the following statements regarding oxygenation and ventilation in the elderly (as compared with the average adult) are correct EXCEPT which one? | FEV1 (forced expiratory volume in 1 s) is decreased. | Diffusing capacity is decreased. | The amount of physiologic dead space is increased. | Their ventilation/perfusion matching is relatively preserved. | 4 | D | 1 | null | null | null | null | null |
f456be80-a9c9-5870-a11d-2692fcbf65f6 | All of the following changes in respiratory mechanics are seen in the geriatric population EXCEPT which one? | Decreased compliance of the chest wall | Increased compliance of the lung parenchyma | Increased curvature of the diaphragm | Decreased mass of accessory muscles | 4 | C | 1 | null | null | null | null | null |
062f2b50-8562-5038-9144-18745711dedd | The pattern that most accurately describes the change in CC over time starting from age 30 years and progressing to age 80 years is which of the following? | An asymptotic increase, followed by a plateau | An exponential increase | An approximately linear increase | An approximately linear, steep increase until middle age (50 y old), followed by a more gradual decrease | 4 | C | 1 | null | null | null | null | null |
b5895c05-be57-5ad6-8e60-dab619472991 | The increase in CC seen with aging can BEST be attributed to which of the | A relatively more positive intrapleural pressure compressing alveoli | A functional extrathoracic large airway obstruction | The loss of cartilage from large airways | The loss of elastin from surrounding tissues, which once tethered open small airways | 4 | D | 1 | null | null | null | null | null |
d5163a31-629f-5332-b8c2-35f7fc624448 | All of the following patients with respiratory failure may be candidates for noninvasive positive pressure ventilation (NIPPV) EXCEPT which one? | Decompensated heart failure and SpO2 85% on room air | HIV-positive patient with bilateral opacities on chest X-Ray and PaO2 /FiO2 150 | Urosepsis requiring norepinephrine with tachypnea and SpO2 90% on 6 L nasal cannula | Acute chronic obstructive pulmonary disease (COPD) exacerbation and PaCO2 70 mm Hg | 5 | C | 2 | Immediately following extubation in a patient at high risk for reintubation | null | null | null | null |
052b846d-6362-59b0-b3fb-f77bbad32f4b | You are called to intubate a patient with a COPD exacerbation. Following intubation, you confirm bilateral breath sounds and presence of carbon dioxide by capnogram. You manually ventilate with an Ambu bag while waiting for the ventilator circuit. The automated blood pressure cuff is unable to read a blood pressure, and the pulse oximeter tracing is lost while the blood pressure cuff repeatedly cycles on the ipsilateral arm. ECG shows sinus bradycardia in the 60s. You are unable to palpate a carotid pulse. Your team initiates chest compressions and administers epinephrine. Which of the following is the next maneuver? | Increase minute ventilation. | Remove endotracheal tube and reintubate. | Needle decompression in second intercostal space. | Disconnect patient from Ambu bag. | 5 | D | 3 | Place an arterial line. | null | null | null | null |
e76ec597-c1d7-5f92-b7da-10f157dcaf09 | A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated with the following settings on volume control ventilation: tidal volume 480 cc, respiratory rate 20 breaths per minute, PEEP (positive end-expiratory pressure) 12 cm H2O, FiO2 50%, plateau pressure 33 cm H2O, and peak inspiratory pressure 35 cm H2O. His ideal body weight is 70 kg. The most recent arterial blood gas test shows PaO2 80 mm Hg, PaCO2 48 mm Hg, and pH 7.33. What change should you make to the ventilator settings? | No change. | Decrease PEEP. | Decrease tidal volume. | Increase FiO2 . | 5 | C | 2 | Switch to pressure support ventilation. | null | null | null | null |
e4135283-4800-5ade-b4c6-4ea92906c14b | 4. When preparing to extubate an ICU patient, all of the following criteria should be met EXCEPT which one? | Rapid shallow breathing index (RSBI) of less than 100 | Minimal secretions | Presence of cuff leak | Successful spontaneous breathing trial (SBT) lasting 30 minutes using continuous positive airway pressure of 5 cm H2O | 5 | E | 1 | Ability to follow commands | null | null | null | null |
f4598c43-29c6-52d4-98da-20b122a5af11 | Which of the following hypotensive patients could potentially show improvement in their hemodynamics with the administration of positive pressure ventilation? | Large myocardial infarction in left anterior descending territory | Acute liver failure (ALF) | Acute pulmonary embolism | Induction of anesthesia | 5 | A | 3 | Sepsis | null | null | null | null |
60fa98ba-7690-51c3-895a-dd3654986d12 | What is the static thoracic compliance on the following volume control ventilation settings? | 18 mL/cm H2O | 22 mL/cm H2O | 30 mL/cm H2O | 33 mL/cm H2O | 5 | C | 1 | 50 mL/cm H2O | null | null | null | null |
b9e68c38-bb74-5de7-8ef5-84f7a414aca1 | Which of the following differentiates pressure support from assist-control pressure control ventilation? | Delivered tidal volume increases with increased patient effort. | Cycling depends on change in inspiratory flow. | Ability of a patient to trigger breaths. | Lung injury is unlikely on pressure support ventilation. | 5 | B | 1 | Delivered tidal volume depends on thoracic compliance. | null | null | null | null |
f397d702-bf73-5c06-92f8-69b5ec816ec9 | Which of the following parameters determines the tidal volume delivered in volume control ventilation? | Peak inspiratory pressure | Lung compliance | Airway resistance | Inspiratory flow | 5 | D | 1 | Patient effort | null | null | null | null |
26f4fcad-c0a1-5ba9-9e29-51bae7d2c36b | All of the following interventions are recommended to reduce the risk of ventilator-associated pneumonia (VAP) EXCEPT which one? | Elevation of head of bed at least 30° | Early tracheostomy | Daily SBTs | Noninvasive positive pressure ventilation | 5 | B | 1 | Minimizing sedation | null | null | null | null |
f28a8bcc-e6c7-596e-94ad-6924315888b5 | Which of the following statements regarding catheter-related bloodstream infections (CRBSIs) is true? | Central venous catheters (CVCs) should be replaced weekly. | CRBSI is diagnosed when blood cultures drawn from the catheter are positive. | Arterial lines carry a negligible risk of CRBSI. | Skin preparation with chlorhexidine/alcohol is more effective than povidone iodine in preventing CRBSI. | 5 | D | 1 | The most common pathogens in CRBSI are gram-negative rods. | null | null | null | null |
0cf3063c-eece-54ff-97e8-efc71d7b0bbf | Which of the following is an acceptable indication for replacing a CVC over a guidewire? | Replacing a CVC that was emergently placed without maximum barrier precautions | Loss of blood return | After 14 days of catheter use | Fever | 5 | B | 2 | CVC should never be replaced over a guidewire | null | null | null | null |
4b4944b0-7b42-5279-a9bd-9ef4c68b64b9 | 14. Which of the following statements regarding catheter-associated urinary tract infection (CAUTI) is true? | External urinary catheters have similar rates of complications compared with indwelling catheters. | Asymptomatic catheter-associated bacteriuria should be treated to reduce the risk of developing systemic infection. | Intermittent catheterization does not reduce the risk of CAUTI. | Indwelling catheters should be replaced at regular intervals to reduce the risk of CAUTI. | 5 | E | 1 | Screening for bacteriuria is not effective in reducing CAUTI. | null | null | null | null |
596a2197-363a-5a6e-84c9-b485251fb840 | Alcohol-based hand rubs are effective in removing all of the following pathogens EXCEPT which one? | Methicillin-resistant Staphylococcus aureus (MRSA) | Vancomycin-resistant enterococci | Clostridium difficile | Mycobacterium tuberculosis (MTB) | 5 | C | 1 | They are effective for all pathogens | null | null | null | null |
ab9d38e7-88b5-5211-a675-c2cee23c89e9 | All of the following statements regarding Clostridium difficile prevention are true EXCEPT which one? | Tighter regulations on antibiotic use have decreased the incidence of C. difficile. | Only chlorine-containing cleaning products should be used for environmental decontamination. | Monotherapy with metronidazole is appropriate for mild cases of C. difficile. | Contact precautions can be lifted when diarrhea resolves. | 5 | D | 1 | Limiting acid suppression therapy can reduce the risk of C. difficile. | null | null | null | null |
2428e814-f3b5-5f76-afaf-7101df27ac1b | Which of the following personal protective equipment items (PPEs) is sufficient for a provider to wear before performing endotracheal intubation? | Goggles | Mask | Face shield | Gown | 5 | C | 1 | No PPE required if low suspicion for respiratory infection | null | null | null | null |
f7099fbd-773b-5fe0-b832-d0bf0aa74069 | An HIV-positive patient is admitted to the ICU with respiratory failure requiring intubation. Mycobacterium tuberculosis (MTB) disease is suspected. All of the following statements regarding MTB precautions are true EXCEPT which one? | The patient should be placed in a negative-pressure isolation room. | Empiric therapy for MTB disease with a 4-drug regimen should be initiated immediately. | Contact precautions are not necessary. | Airborne precautions can be discontinued if a tuberculin skin test is negative. | 5 | D | 1 | A bacterial filter should be placed on the ventilator circuit. | null | null | null | null |
c892416a-c1ae-589d-977d-7dd0948807df | While caring for a patient with acute hepatitis B virus (HBV), an anesthesia resident sustains a needle stick injury. The resident received the HBV vaccine series as an adolescent. Which of the following is true regarding his need for postexposure prophylaxis for HBV? | He does not require any HBV prophylaxis or further testing because he has been vaccinated. | Anti-HBs titers should be checked. | His risk of acquiring HBV is 30%. | He should receive 1 dose of hepatitis B immune globulin and be revaccinated. | 5 | B | 2 | He should undergo baseline testing for anti-HBc now and repeat testing at 6 months. | null | null | null | null |
89d9c8b1-f9ae-5b1d-bbf1-7c7e921f9fec | 20. A 75-year-old man presents with fever, cough, and infiltrate on chest X-ray. His oxygen saturation is 90% on room air and he is subsequently admitted to the floor for treatment of a presumed pneumonia. He was previously healthy except for hypertension and has not had recent hospital admissions or antibiotic therapy. He has no smoking history. Which of the following empiric antibiotic regimens is appropriate while awaiting the results of sputum culture? | Vancomycin and cefepime | Piperacillin/tazobactam monotherapy | Ceftriaxone and azithromycin | Meropenem and levofloxacin | 5 | C | 2 | Vancomycin, piperacillin/tazobactam, and fluconazole | null | null | null | null |
54b88f84-61ad-5506-b1ed-c27e598ecc1a | Additional echocardiography views reveal McConnell sign. Which of the following is the next step in the management of this patient? | Cardiac catheterization | Systemic fibrinolytic therapy | Rapid infusion of 2 L crystalloid | Initiation of heparin infusion | 5 | B | 2 | CT scan | null | null | null | null |
ca9e0057-b422-5ee8-a978-df3fef1e7eb9 | 25. A 70-year-old man presents to the hospital with chest pain and dyspnea. ECG shows 2-mm ST elevations in V2-V4. His vital signs are as follows: HR 85, BP 100/55, SpO2 95% on room air. Laboratory test results are remarkable for troponin 3.5 ng/mL and lactate 6 mmol/L. Emergent cardiac catheterization is planned. What other treatment should be initiated at this time? | Dopamine | 1 L crystalloid bolus | Dobutamine | Norepinephrine | 5 | C | 3 | No other intervention necessary besides immediate cardiac catheterization | null | null | null | null |
fafbe627-abb0-59e3-ae24-974f902a7839 | Data from a pulmonary artery catheter (PAC) can be used to derive all of the following hemodynamic and oxygen transport parameters EXCEPT which one? | Stroke volume | Mixed venous oxygen saturation | Systemic vascular resistance | Oxygen consumption | 5 | E | 1 | Left ventricle (LV) ejection fraction | null | null | null | null |
89cc982f-9c1d-50eb-ad66-b276d06335e7 | You are called to evaluate a 60-year-old woman with a history of nephrolithiasis and urinary tract infections who is in the PACU recovering from ureteroscopy and ureteral stone extraction 1 hour ago. Her vital signs are as follows: temperature 37.8°C, HR 110, BP 95/50, and respiratory rate 25 breaths per minute. She appears to be shivering and drowsy but does answer questions appropriately. Which of the following is the next step in your management of this patient? | This is likely due to residual effects of anesthetics and pain; continue observation in PACU for now. | Discharge to phase II PACU with a prescription for ciprofloxacin. | Transfer to ICU. | Start vancomycin and cefepime and continue observation in PACU. | 5 | D | 3 | Suggest her urologist repeat ureteroscopy for possible retained stone. | null | null | null | null |
105ea361-e0da-5713-a8d3-38deb8f95878 | The patient continues to have mean arterial pressures (MAPs) in the low 60s | Administer a 500 cc bolus of 5% albumin. | Place a central line and initiate norepinephrine. | Initiate peripheral phenylephrine. | Consider adding antifungal coverage to your antibiotic regimen. | 5 | B | 3 | MAP is adequate; continue to observe. | null | null | null | null |
8d65507f-447a-5c81-a9db-6fb20196b7cb | All of the following practices may reduce the risk of ICU-acquired weakness (ICUAW) EXCEPT which one? | Treatment of hyperglycemia | Minimizing use of steroids | Minimizing use of neuromuscular blockers | Passive exercises in sedated patients | 5 | E | 1 | Early diagnosis with electrophysiology studies | null | null | null | null |
bd48d9a0-80f6-544f-a02e-995fd426d3e8 | 32. Which of the following statements regarding venous thromboembolism (VTE) prevention and treatment is true? | Upperextremity deep venous thromboses (DVTs) associated with CVCs do not require systemic anticoagulation. | VTE is very unlikely in patients receiving appropriate pharmacologic prophylaxis. | Low-molecular-weight heparin (LMWH) is preferred to subcutaneous heparin for patients at high risk of DVT. | Prophylactic LMWH is preferred to subcutaneous heparin because it does not carry the risk of heparin-induced thrombocytopenia. | 5 | C | 1 | An IVC filter should be considered for all trauma patients. | null | null | null | null |
150982cf-ff65-5c03-ac86-433c5f3d2df0 | Which of the following statements regarding nutrition in the ICU is true? | Gastric residual volumes should be frequently measured to monitor for feeding intolerance. | Initiation of enteral nutrition should be delayed until signs of return of bowel function. | Early enteral nutrition decreases mortality. | Protein has the lowest respiratory quotient. | 5 | C | 1 | A postpyloric tube should be placed for enteral feeding. | null | null | null | null |
cc0da6b7-cbae-5d61-9b5c-61de34c0674f | Diagnosis of brain death requires all of the following criteria EXCEPT which one? | Absence of spontaneous respirations at PaCO2 of 60 or greater | Complete absence of motor function | Absent brainstem reflexes | Normotension | 5 | B | 1 | Establishing etiology of coma | null | null | null | null |
2c580619-3185-5ba5-9560-3ddaecda3be6 | Which of the following statements regarding the performance of ancillary testing in patients with suspected brain death is true? | Isoelectric EEG using frontal leads identifies brain death. | Absence of cerebral vessel filling on cerebral angiography is the gold standard ancillary test. | At least 1 ancillary test is required in addition to clinical testing for determination of brain death. | Noncontrast CT showing extensive edema and herniation can serve as an ancillary test. | 5 | B | 1 | Evoked potentials are not used as ancillary tests. | null | null | null | null |
2133ddfd-0185-5e80-8787-3fcbec708440 | A 21-year-old man is admitted to the ICU with a massive subarachnoid hemorrhage and is displaying signs of herniation. He arrives intubated from the emergency department (ED) and is not receiving any sedative agents. His initial physical examination demonstrates GCS 3, absence of brainstem reflexes and no spontaneous respirations with a PaCO2 65. There are 4 strong twitches on train-of-four monitoring on the ulnar nerve. His temperature is 37.5°C. His laboratory test results are unremarkable. He is requiring norepinephrine to maintain SBP >100. He is evaluated by neurosurgery and determined not to be a candidate for surgical intervention. Which of the following is the next appropriate step in management | Declare brain death and withdraw ventilator support. | Declare brain death and contact organ bank. | Increase norepinephrine to goal SBP >120. | Perform cerebral angiography. | 5 | E | 2 | Repeat brain death examination in 6 hours. | null | null | null | null |
b8442e7c-2a35-5eaf-b8a3-1aaad3f6456a | A 70-year-old man is admitted to the ICU following a thoracotomy and lobectomy for lung cancer. Over the next few days, he develops progressively worsening hyponatremia. He is alert and tolerating oral intake. Maintenance IV fluids have been stopped. | Syndrome of inappropriate antidiuretic hormone secretion (SIADH) | Hypovolemia | Pseudohyponatremia | Cerebral salt wasting | 5 | A | 3 | Mineralocorticoid deficiency | null | null | null | null |
b31478fe-0412-5b02-abfe-7ca548013149 | 42. A 55-year-old man with a history of alcohol dependence is admitted to the ICU for management of acute pancreatitis. Enteral feeding is initiated on hospital day 2. Laboratory test results the following day are notable for phosphate 0.8 mg/dL, total calcium 6.5 mg/dL, magnesium 1 mEq/L, potassium 2.8 mEq/L, and albumin 1.5 g/dL. Which of the following is the most appropriate regarding the next step in management of this patient? | Increase enteral feeds. | Temporarily stop enteral feeding. | Switch to total parenteral nutrition. | Initiate work-up for hyperparathyroidism. | 5 | B | 2 | Increase phosphate, magnesium, and potassium content in enteral feeds. | null | null | null | null |
94e14a60-45d8-5eff-951c-6b611a00983b | A 6-year-old child is rescued from a pool and is found to be unresponsive and pulseless. His skin is cool and cyanotic. There is one Basic Life Supportcertified rescuer present. All of the following resuscitation maneuvers should be performed EXCEPT: | Chest compressions | Rescue breaths | Heimlich maneuver | Vigorous warming | 5 | C | 2 | Attach Automated external defibrillator (AED) pads | null | null | null | null |
0659025f-0f68-53c1-9d4c-ad8248eb5890 | Which of the following is true regarding the management of a comatose drowning victim after return of spontaneous circulation (ROSC)? | Therapeutic hypothermia is contraindicated. | PEEP should be minimized to reduce alveolar injury. | Prophylactic antibiotics are indicated if the patient was rescued from a natural body of water. | Hypothermic drowning victims may have a better prognosis. | 5 | D | 1 | Fluid restriction and diuretics are indicated. | null | null | null | null |
1dad364b-ea0d-555d-9be6-3158b57217af | A 21-year-old woman with a history of major depression disorder is brought to the ED by her roommate. Her roommate states she found an empty bottle of acetaminophen next to the patient in her bedroom. She is lethargic and vomiting. Which of the following is the first step in management? | Measure serum APAP levels. | Administer IV N-acetylcysteine (NAC). | Administer activated charcoal. | Observe clinically for now while trending liver function tests. | 5 | B | 2 | Transfer to a liver transplant institution. | null | null | null | null |
42e8522c-5f6e-5148-9136-b5da07da13dc | All of the following are risk factors for APAP hepatoxicity EXCEPT which one? | Chronic alcohol use | Elderly | Malnutrition | Pregnancy | 5 | D | 1 | Concurrent use of certain herbal medications | null | null | null | null |
e3f07960-5ec2-5264-8d1d-9cef9c0a288a | Which of the following drug-antidote combinations is incorrect? | Metoprolol-glucagon | Nortriptyline-sodium bicarbonate | Ethanol-fomepizole | Diltiazem-insulin | 5 | C | 1 | Sarin gas-glycopyrrolate | null | null | null | null |
1a931b6f-0428-5cc4-81ad-7cabb0166bfc | 48. A middle-aged woman is brought to the ED after being rescued from a house fire. She is tachypneic and agitated. She has first- and second-degree burns affecting her right leg (total body surface area 9%). Examination of her airway and nasal passages does not demonstrate any signs of smoke inhalation. Pulse oximetry is 95% on room air. Laboratory test results are notable for pH 7.19, lactate 10 mmol/L, and PCO2 24 mm Hg. Which of the following is/are the most appropriate initial therapy(ies)? | Hydroxocobalamin | Oxygen at 10 L/min via nonrebreather facemask | Intubation | Aggressive resuscitation with crystalloid | 5 | E | 2 | A and B | null | null | null | null |
2e0f0dcf-c7ff-5930-953b-1ac5b93e8153 | Which of the following statements is false of anesthesiologists with chemical dependence? | 50% are younger than 35 years old. | The most frequently abused drugs are nonopiate anesthetics. | One-third of these individuals have a family history of addiction. | Rates of chemical abuse among residents are higher than among attending anesthesiologists. | 5 | B | 1 | One-third to one-half of individuals abuse multiple classes of drugs. | null | null | null | null |
95222761-b570-5736-8995-d755b3cc7256 | Which of the following behaviors is inconsistent with an anesthesiologist with chemical dependence? | Withdrawal from friends and family | Mood swings, with increased anger and hostility | Calling in sick and avoiding call | Requesting frequent bathroom breaks | 5 | C | 1 | Signing out more narcotics than appropriate for given case | null | null | null | null |
ce30096b-08c0-5717-bce1-e66ddc3a553d | Which of the following legal statutes provides protection for anesthesiologists as they age? | Age Discrimination Act | Americans with Disabilities Act | Equal Pay Act | Medical and Family Leave Act | 5 | A | 1 | Fair Labor Standards Act | null | null | null | null |
6f891439-a52e-5521-aa43-c2e5f1ef044f | 5. Which of the following statements is false about the Americans with Disabilities Act of 1990? | Reasonable accommodations for employees with disabilities are required. | If a condition is episodic, it cannot be considered a disability under this act. | Blindness, deafness, and mobility impairments are included. | Conditions that often result in illegal activity (eg, kleptomania, pedophilia) are not covered. | 5 | B | 1 | Mental health conditions (eg, posttraumatic stress disorder, obsessivecompulsive disorder, schizophrenia) may be considered under this act. | null | null | null | null |
fb5388ad-f2f9-56ab-9f89-ac5329128f12 | The American Society of Anesthesiology Statement on Professionalism states that professionalism involves "the application of ethical principles…". Which of the following is not delineated in their guidelines for the Ethical Practice of Anesthesiology? | Anesthesiologists have ethical responsibilities to their patients. | Anesthesiologists have ethical responsibilities to medical colleagues. | Anesthesiologists have ethical responsibilities to the health care facilities in which they practice. | Anesthesiologists have ethical responsibilities to their families. | 5 | D | 1 | Anesthesiologists have ethical responsibilities to their community and to society. | null | null | null | null |
20016fbf-873a-5996-b652-21c5d88471d6 | Which of the following test(s) need to be passed before an anesthesia provider can be considered licensed? | USMLE Steps 1, 2, and 3 | ABA BASIC | ABA ADVANCED | ABA APPLIED | 5 | A | 1 | B, C, and D | null | null | null | null |
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