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7266f38d-4104-53ed-9dae-fb99a19102df | Which information is not collected in the National Practitioner Data Bank? | Malpractice payments | License actions by medical boards | Clinical privilege actions taken by hospitals or other health care bodies | Participation in substance abuse rehabilitation | 5 | D | 1 | Actions taken by the Drug Enforcement Agency | null | null | null | null |
2adc75b4-c4c8-5f9c-8ae1-fdcd0e27d253 | You are a primary care physician caring for a 72-year-old woman with multiple comorbid illnesses. She asks you about creating a living will. Which of the following subjects would not usually be covered in this document? | Wishes regarding CPR | Naming a health care proxy | Nutritional support (tube feeding) | Blood transfusions | 5 | B | 1 | Respiratory support | null | null | null | null |
2365b153-6f4b-5f98-aaf2-d88f88c61526 | You are taking care of a 62-year-old man with early-onset dementia who has a subdural hematoma after a fall at home. After looking through his records, you discover he has a court-appointed guardian who is a different individual than his health care proxy. His brother, sister, wife, and children are in the waiting area. Which of the following people possesses the authority to provide consent for nonemergency procedures? | Court-appointed guardian | Health care proxy/durable power of attorney for health care decisions | Spouse | Children | 5 | A | 1 | Siblings | null | null | null | null |
0dda6097-2d57-51d4-910e-e0ce3eecbb77 | 11. Which of the following statements is false regarding the treatment of a Jehovah's Witness? | Some means of blood sequestration or preservation are allowed by some members of the faith. | A physician may decline to care for such a patient. | Individuals of this faith may differ in which blood products they refuse to receive. | Parents of this faith may elect to prevent the use of blood products for their child. | 5 | D | 1 | Discussions regarding blood product administration should be documented in detail in the chart. | null | null | null | null |
bbe6714a-0e9e-51ac-9b27-7611c64c9bf3 | A 75-year-old man with stage IV lung cancer comes in for a rigid bronchoscopy with stenting. He has an existing DNR/DNI order in place. Which of the following is/are automatically allowed when he consents for general anesthesia? | Intubation | Defibrillation | Chest compressions | All of the above | 5 | E | 2 | None of the above | null | null | null | null |
c2e85d12-d08c-5594-beae-31897b99810e | Which of the following is an accepted reason by professional societies for an anesthesiologist to participate in executions? | Participation is a separate activity from routine clinical practice so should not be considered as part of one's normal clinical work. | Being involved is "beneficent," in that one's involvement may facilitate a more humane death. | Executions are legal, so participation by clinicians should not be limited. | Anesthesiologists are most facile with some of the medications used, so they are obligated to ensure they are used appropriately. | 5 | E | 1 | None of the above. | null | null | null | null |
bb649542-1424-569d-859f-56f46a2cdbec | You are an anesthesia resident on an acute pain rotation who stops by the coffee cart in the hospital lobby between consults. Your patient list falls out of your scrub pocket to the floor as you leave. The list is found shortly thereafter by an unrelated health care provider. You go back to look for it when you realize your mistake, but it is gone. Does this constitute a HIPAA (Health Insurance Portability and Accountability Act of 1996) violation, and what is the minimum fine given this situation? | $0 because it is not a violation | $0 because it was an "unknowing" violation | $100 because it was an "unknowing" violation | $10 000 because it constitutes willful neglect | 5 | C | 2 | $50 000 because the information was "knowingly" disclosed | null | null | null | null |
6da11878-34d4-5278-9dd5-021a266f23cd | A 45-year-old woman is diagnosed with metastatic lung cancer. She declines chemotherapy and other interventions and opts instead for hospice care. Allowing the patient to decline all medical conditions upholds which of the following ethical principles? | Autonomy | Justice | Nonmaleficence | Beneficence | 5 | A | 1 | Integrity | null | null | null | null |
631120b2-c1d7-5bf1-9a98-c5f2fcc91d9a | 17. An 86-year-old man with hypertension, chronic obstructive pulmonary disorder, and benign prostatic hyperplasia presents to the emergency department after slipping on a sidewalk during his morning walk. He is found to have a hip fracture and needs surgery. Which of the following diagnoses would rule out his capacity to give informed consent? | Schizoaffective disorder | Substance use disorder | Alzheimer disease | Depression | 5 | E | 2 | None of the above | null | null | null | null |
dd155e6e-0145-502f-ae53-7fef6f2d7e44 | A 42-year-old man presents for liver transplantation. During the procedure, laboratory test results are checked, and ionized calcium is noted to be low. The anesthesia provider begins to administer calcium chloride but after giving 0.5 mL from the syringe realizes that he picked up epinephrine instead. The patient's blood pressure increases but is quickly controlled, and no harm comes to the patient. How is this event qualified? | Preventable adverse event | Ameliorable adverse event | Adverse event due to negligence | Near miss | 5 | D | 2 | Error | null | null | null | null |
5327ee95-4664-51eb-8086-7a7601d07e5d | According to closed claims analysis, which of the following is the most common site of peripheral nerve injury after anesthetic care? | Brachial plexus | Ulnar nerve | Lumbosacral nerve root | Common peroneal nerve | 5 | B | 1 | Cervical nerve root | null | null | null | null |
b7d9a94c-eeb8-5973-acd0-2fc5dd00118d | Which of the following is a commonly used means of identifying medication errors and resultant adverse events? | Chart review | Computerized monitoring | Claims data | Reporting systems | 5 | E | 1 | All of the above | null | null | null | null |
2cc17799-965f-5564-9a80-b940ae5bf908 | Which of the following does NOT qualify as a "sentinel event" that requires reporting to The Joint Commission? | Wrong site surgery | Suicide within 7 days of discharge from the hospital | Hemolytic transfusion reaction due to administration of incorrect blood group | Retained sponge after surgery | 5 | B | 1 | Infant abduction | null | null | null | null |
8ccc748f-ab9e-5e6d-9ffb-b91c76ff6433 | You are an anesthesia provider involved in commission of a medical error that results in harm to a patient. Which of the following is your next step? | Ameliorate harm and say nothing to patient and family. | Immediate full disclosure and apology to patient and family. | Consult hospital liability group and risk manager, and/or administrator before moving forward with an apology. | Retain a personal lawyer and say nothing to patient and family. | 5 | C | 3 | Adjust medical record such that personal culpability is minimized. | null | null | null | null |
44f30d51-3042-546b-a402-461058485d6a | 23. A resident places a radial arterial line before thoracotomy. Which of the following ACGME (Accreditation Council for Graduate Medical Education) competencies does this illustrate? | Patient care | Medical knowledge | Professionalism | Interpersonal and communication skills | 5 | A | 2 | Systems-based practice | null | null | null | null |
2bddbac5-2711-505b-9a72-ece562d5d535 | Within the ACGME "Milestones" framework of resident assessment, which "Level" is seen as the graduation target? | Level 1 | Level 2 | Level 3 | Level 4 | 5 | D | 1 | Level 5 | null | null | null | null |
7d1536e6-cfdb-55a0-8198-5546c905ef48 | An anesthesia provider has achieved certification by the American Board of Anesthesiology (ABA). Which "Level" (Milestones framework) has the individual achieved and in which "core competency?" | Patient care, Level 3 | Medical knowledge, Level 5 | Practice-based learning, Level 4 | Interpersonal and communication skills, Level 5 | 5 | B | 2 | Systems-based practice, Level 3 | null | null | null | null |
85b079ce-23d3-510e-b7f4-d3790a785144 | Which of the following postoperative treatments decreases the risk for deep venous thrombosis? | Blood transfusion | Epidural anesthesia | Etomidate | Ketorolac | 5 | B | 1 | Patient-controlled analgesia | null | null | null | null |
59f1e612-be10-5f19-9f00-df3d2f996b1e | A patient has hoarseness after undergoing surgery involving the aortic arch. The most likely cause is an injury to which of the following nerves? | Glossopharyngeal | Left recurrent laryngeal | Right recurrent laryngeal | Left superior laryngeal | 5 | B | 1 | Right superior laryngeal | null | null | null | null |
2d81d53e-097d-5fda-ad39-00704d9d5d13 | A 36-year-old woman develops acute airway obstruction 24 hours after total thyroidectomy. The most likely cause is | bilateral recurrent laryngeal nerve injury | unilateral recurrent laryngeal nerve injury | hypocalcemia | subglottic edema | 5 | C | 2 | tracheomalacia | null | null | null | null |
84bc61bf-0c4a-5902-85f9-511c6bcfb387 | A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to | apply positive end-expiratory pressure to the breathing circuit | attempt to aspirate air from the central venous catheter | expand intravascular volume | place the patient in the Trendelenburg position | 5 | C | 2 | turn the patient to the left lateral decubitus position | null | null | null | null |
1ba46d03-bbef-5855-9b9a-99d37c92e5df | A 65-kg, 57-year-old man has an initial activated clotting time (ACT) of 122 seconds prior to elective cardiopulmonary bypass. Five minutes after administration of heparin 200 mg, ACT increases to 154 seconds. After two additional doses of 200 mg each from different lots, ACT increases to 240 seconds. The most appropriate next step is to | administer additional heparin 400 mg | administer fresh frozen plasma 2 units | initiate cardiopulmonary bypass | measure the plasma heparin concentration | 5 | B | 3 | start an infusion of desmopressin | null | null | null | null |
8f100fe0-35a1-55e9-870f-51fefd5fe223 | An obese, 75-year-old woman is scheduled for open reduction of a left forearm fracture. Thirty minutes after successful interscalene block using 20 ml of 2% lidocaine, she becomes dyspneic. The dyspnea is most likely related to | cervical epidural block | cervical sympathetic block with bronchospasm | chylothorax | elevation of the left hemidiaphragm | 5 | D | 2 | recurrent laryngeal nerve block | null | null | null | null |
2bcfacdb-b04d-5cbf-b755-4378ab4e17f1 | A 54-year-old man is scheduled for open reduction of a fracture sustained when he jumped from a burning building. The carboxyhemoglobin concentration is 25%. Which of the following is the most reliable indicator of adequate oxygenation during general anesthesia? | PaO2 of 300 mmHg | pH of 7.38 with a PaCO2 of 41 mmHg | Mixed venous PO2 of 45 mmHg | Oxyhemoglobin saturation of 100% measured by co-oximeter | 5 | C | 3 | SpO2 of 100% measured by pulse oximeter | null | null | null | null |
8ea24c41-d879-5aad-b58e-e731079bf77e | Which of the following statements concerning diazepam is true? | Absorption is more predictable after intramuscular administration than after oral administration | It produces a shift to the left of the carbon dioxide ventilatory response curve | Rebound drowsiness is caused by a metabolite | The degree of CNS depression is independent of serum albumin concentration | 5 | C | 1 | The extent of amnesia is proportional to the degree of sedation | null | null | null | null |
0bf5caf6-4209-5924-9a9e-461905de39fc | A 30-year-old woman has an abrupt change from sinus to nodal rhythm with unchanged heart rate on ECG during induction of halothane anesthesia. Which of the following is the most likely result of this change? | Decreased jugular venous pulsation | Decreased mean arterial pressure | Decreased systemic vascular resistance | Increased cardiac output | 5 | B | 2 | Increased pulse pressure | null | null | null | null |
640e49b7-394b-5a70-8673-961ad52ca8ba | Properly performed local anesthetic block of the celiac plexus | requires that the needle tip be positioned anterior to the vertebral body of LI | preserves efferent parasympathetic outflow | produces urinary retention | is not associated with hypotension | 5 | A | 1 | produces truncal cutaneous hypesthesia | null | null | null | null |
0d823d9e-c1b5-5932-a7f4-d45d978d6c75 | Compared with morphine, a single epidural administration of fentanyl is associated with | delayed onset of analgesia | increased incidence of pruritus | increased incidence of respiratory depression | longer duration of action | 5 | E | 1 | more restricted segmental spread | null | null | null | null |
eafa6f7c-3df5-5b68-8ec8-2d8ae4af9eee | Ten days after sustaining burns over 40% of his body surface area, a patient requires greater than expected doses of vecuronium for adequate relaxation of skeletal muscle. The primary cause is increased | plasma protein binding of d-tubocurarine | metabolism of d-tubocurarine | number of acetylcholine receptors | renal clearance of d-tubocurarine | 5 | C | 2 | blood flow to skeletal muscle | null | null | null | null |
75a41682-b930-5178-8d9a-bdb3f217d582 | The sudden onset of pulmonary edema can be caused by each of the following EXCEPT | rapid re-expansion of the lungs following pneumothorax | upper airway obstruction | oxygen toxicity | rupture of mitral papillary muscle | 5 | C | 1 | severe preeclampsia | null | null | null | null |
f735d09e-dded-5287-8067-41634a127730 | Following extubation after nasotracheal intubation for seven days, a 35-year-old man has fever, facial pain, nasal stuffiness, and purulent nasal secretions. The most likely cause is | eustachian tube obstruction | frontal sinusitis | maxillary sinusitis | parotiditis | 5 | C | 2 | retropharyngeal abscess | null | null | null | null |
7c94c1be-c8b6-5738-8112-d2d2b6b65cfb | Meperidine has a more rapid onset of action than morphine following intravenous injection because of its | lesser ionization | greater lipid solubility | lesser protein binding | smaller volume of distribution | 5 | B | 1 | slower rate of hepatic clearance | null | null | null | null |
bcabcf9f-9355-587c-8295-1668833bef66 | The decreased duration of action of an intravenous dose of fentanyl compared with an intravenous dose of morphine is best explained by | greater lipid solubility | increased hepatic metabolism | less protein binding | shorter elimination half-life | 5 | A | 1 | smaller volume of distribution | null | null | null | null |
a44563f7-726c-57a3-b370-f357506dc44f | Spontaneously breathing enflurane at 1 MAC causes increased | airway resistance | diaphragm function | carbon dioxide production | intercostal muscle function | 5 | E | 1 | physiologic dead space | null | null | null | null |
538832c0-54b5-5a57-a225-1d6683a7dc5b | An infant with congenital lobar emphysema is scheduled for thoracotomy. Which of the following should be included in the anesthetic management of this infant? | Helium-oxygen inspired gas mixture | Nitrous oxide administration | Positive pressure ventilation | Prophylactic placement of a chest tube | 5 | E | 2 | Spontaneous ventilation until the chest is opened | null | null | null | null |
1fb1d737-afdb-5e3d-bb43-e66a38c002eb | A 50-year-old patient is undergoing craniotomy for clipping of a cerebral aneurysm with isoflurane, nitrous oxide, and fentanyl anesthesia. At the time of aneurysm exposure, the EEG shows burst suppression. Which of the following is the most likely cause? | Cerebral ischemia | Cerebral vasospasm | Fentanyl effect | Isoflurane effect | 5 | D | 1 | Petit mal seizure activity | null | null | null | null |
ac667218-9fd3-59fc-bb44-f3fb36a5d8c0 | A 75-year-old man is confused, restless and disoriented two days after an aortic aneurysm repair. Serum sodium concentration is 112 mEq/L, serum osmolality is low, and urine is hypertonic. The most appropriate treatment is | restriction of fluid intake | administration of isotonic saline solution | administration of hypertonic (3%) saline solution | administration of spironolactone | 5 | C | 3 | infusion of mannitol 25 g | null | null | null | null |
572a5b4d-ef38-548f-8817-bd57f0c4bb2c | Which of the following complications is the primary cause of neurologic deficit following carotid endarterectomy? | Global hypoperfusion | Hypertension | Hypotension | Improper shunt insertion | 5 | E | 1 | Thromboembolism | null | null | null | null |
b107cc36-79c0-5d93-9779-81b73bc23d0a | A 30-year-old primiparous woman delivered a healthy infant by cesarean section during uneventful spinal anesthesia with tetracaine 10 mg in 2 ml of 5% dextrose solution. Twelve hours after delivery she has bilateral loss of pain and temperature sensibility, but not touch, below T8 and paralysis of both legs. The most likely cause of this complication is | chemical arachnoiditis | injection of tetracaine into the spinal cord | demyelination of the posterior tracts | thrombosis of the anterior spinal artery | 5 | D | 3 | cord transection from spondylolisthesis | null | null | null | null |
130d74c0-cc79-5799-9ff8-c08d849f575d | Following cardiopulmonary bypass, right ventricular distention is noted after infusion of protamine 40 mg. Pulmonary artery pressure has increased from 25/18 to 50/30 mmHg and systemic arterial pressure has decreased from 110/65 to 0 mmHg. Which of the following is the most appropriate treatment? | Administration of amrinone | Administration of nitroglycerin | Administration of phenylephrine | Initiation of intra-aortic balloon pump assist | 5 | E | 3 | Reheparinization and resumption of cardiopulmonary bypass | null | null | null | null |
f370d653-61f7-5fbb-9b08-f52464f426a3 | Phase II neuromuscular block is characterized by | depressed twitch height, sustained tetanus, post-tetanic potentiation | depressed twitch height, tetanic fade, post-tetanic potentiation | depressed twitch height, tetanic fade, no post-tetanic potentiation | normal twitch height, tetanic fade, post-tetanic potentiation | 5 | B | 1 | normal twitch height, tetanic fade, no post-tetanic potentiation | null | null | null | null |
ce17dd92-be06-5cbf-bcd6-753a05fb96d6 | A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is trauma to which of the following structures on the left? | C7-8 nerve root | Stellate ganglion | Glossopharyngeal nerve | Superior laryngeal nerve | 5 | E | 1 | Vagus nerve | null | null | null | null |
a3820a6e-cdce-5c94-9bfc-a0c850fad333 | A 15-kg, 3-year-old child is anesthetized for an inguinal hernia repair with halothane and nitrous oxide. The trachea is intubated after administration of succinylcholine 30 mg. At the conclusion of the 45-minute procedure, the child is not breathing; a peripheral nerve twitch monitor indicates no response to a train-of-four stimulus. Further investigation is most likely to show | abnormal response to nondepolarizing muscle relaxants | a low dibucaine number | a low plasma cholinesterase concentration | an underlying myopathy | 5 | B | 2 | a positive halothane-caffeine contracture test | null | null | null | null |
d9fbf38d-e38d-51ed-8b54-1be1fd1bacdb | The principal rationale for the use of warmed humidified inspired anesthetic gases in children is to | decrease postoperative respiratory complications | decrease postoperative shivering | preserve ciliary function | prevent dehydration | 5 | E | 1 | prevent evaporative heat loss | null | null | null | null |
c3418585-d841-5d22-b22b-8724080fe766 | A 33-year-old woman is scheduled for emergency appendectomy under general anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope in the past year. Which of the following statements concerning anesthetic management is true? | Spinal anesthesia is preferred to general anesthesia | Deep levels of isoflurane anesthesia are appropriate | Fluid administration should be restricted | Phenylephrine is preferred to ephedrine to treat hypotension | 5 | D | 3 | Positive end-expiratory pressure will decrease left ventricular outflow obstruction | null | null | null | null |
e162b65a-e625-576f-94e0-52c68f08c1f4 | A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under halothane/morphine general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is | opioid-induced spasm of the sphincter of Oddi | hepatic dysfunction secondary to halothane exposure | worsening of underlying chronic hepatitis | extrahepatic biliary obstruction | 5 | D | 3 | acute viral hepatitis | null | null | null | null |
f0d2a3ac-0c02-5239-a339-7a95b586b684 | In a patient taking a beta-adrenergic blocker, the drug most likely to produce atrioventricular junctional block is | diltiazem | fentanyl | halothane | nifedipine | 5 | E | 2 | verapamil | null | null | null | null |
f2f8ab7a-5375-5c71-ad49-901e2473925f | Which of the following statements about thiopental is true? | Rapid uptake into maternal tissues limits its transfer to the fetus | Its short duration of action is due to its extensive binding to plasma proteins | Accumulation in fat leads to acute tolerance | Alkalinity of solution causes respiratory depression | 5 | A | 1 | Uptake into brain is slowed by respiratory acidosis | null | null | null | null |
331434d9-d5f6-56ce-9fec-69e4afa6f0f0 | The most effective treatment of severe carbon monoxide poisoning in a 2-year-old child is | intravenous administration of methylene blue | intravenous administration of thiocyanate | intravenous administration of thiosulfate | exchange transfusion | 5 | E | 1 | hyperbaric oxygenation | null | null | null | null |
3429d3d5-c615-588c-856f-f448cef5be14 | Which of the following statements concerning myasthenia gravis is true? | Neostigmine is inappropriate for antagonism of neuromuscular blockade | The number of acetylcholine receptors is decreased | Plasma cholinesterase concentration is decreased | The risk for malignant hyperthermia is increased | 5 | B | 1 | Succinylcholine is contraindicated | null | null | null | null |
f5af5a4f-9ab6-5276-ad83-50fd6bd44045 | An infant is delivered by forceps following labor in which variable decelerations were noted. Amniotic fluid was clear. Initial evaluation shows a cyanotic, limp infant with a heart rate of 80 bpm, poor respiratory efforts, and grimacing in response to suctioning. The most appropriate method of resuscitation for this newborn is | vigorous tactile stimulation | bag and mask ventilation with oxygen | immediate endotracheal intubation | administration of sodium bicarbonate 1 mEq/kg | 5 | B | 2 | volume expansion with normal saline solution 10 mL/kg | null | null | null | null |
da9e0a58-44f0-5173-a53d-a43367b92b4b | In a patient who is to undergo clipping of a cerebral aneurysm, an advantage of isoflurane over nitroprusside for induction of hypotension is | better maintenance of cardiac output | better maintenance of cerebral blood flow | greater decrease in cerebral oxygen consumption | greater decrease in afterload | 5 | C | 1 | more rapid titration of systemic blood pressure | null | null | null | null |
8d5c407a-6a84-5168-bee7-8a91a72b6760 | If both recurrent laryngeal nerves were severed during a difficult thyroidectomy for cancer, the most likely finding would be | paralysis of the cricothyroid muscles | cadaveric positioning of the true vocal cords | anesthesia of both sides of the epiglottis | bilateral pure adductor vocal cord paralysis | 5 | B | 1 | stridor | null | null | null | null |
d35954db-3260-5f39-ab04-746d4a17f8d4 | Which of the following findings is characteristic of whole blood preserved in CPD and stored at 4°C for one week? | Increased potassium concentration | Normal concentrations of factors V and VIII | PaCO2 of 40 mmHg | pH of 7.3 | 5 | A | 1 | 50% Viable platelets | null | null | null | null |
785242be-7a22-5e55-8504-a6d39ccc5e44 | A 70-year-old man who has just undergone an abdominal aortic aneurysm repair under halothane anesthesia develops hypertension, dyspnea, and cyanosis shortly after awakening in the recovery room. Administration of furosemide 20 mg intravenously improves the cyanosis within 10 minutes. This immediate effect of furosemide is best explained by | inotropic effect from electrolyte shifts | decreased preload through diuresis | increased peripheral venous capacitance | decreased pulmonary vascular resistance | 5 | C | 3 | increased coronary blood flow | null | null | null | null |
318aabb4-0ee3-5409-8764-990ea3086727 | Halothane anesthesia is usually associated with an increase in | cardiac contractility | venous capacitance | arterial pressure | venous return | 5 | B | 1 | heart rate | null | null | null | null |
ecb30a73-6fc3-560b-82c6-2729ed0bbdc5 | During active labor, 10 ml of bupivacaine 0.5% with epinephrine 1:200,000 is administered epidurally. Fifteen minutes later, maternal blood pressure is 70/50 mmHg and heart rate is 70 bpm; fetal heart rate is 90 bpm for 45 seconds, with loss of beat-to-beat variability. The most likely explanation for the fetal vital signs is | fetal bupivacaine cardiotoxicity | maternal bupivacaine cardiotoxicity | maternal hypotension | uterine artery vasoconstriction | 5 | C | 2 | umbilical cord compression | null | null | null | null |
d2b0f2d1-174a-5921-80d3-f7db7549f74b | A 65-year-old man undergoes prostatectomy in the lithotomy position under spinal anesthesia using bupivacaine 12 mg. Ten hours later, he reports that his left foot is numb. Examination shows decreased pinprick sensation over the lateral dorsal aspect of the left foot; dorsiflexion is limited. Which of the following is the most likely cause? | Cauda equina syndrome | Compression of the common peroneal nerve | Compression of the posterior tibial nerve | L5 nerve root damage | 5 | B | 2 | Stretching of the sciatic nerve | null | null | null | null |
6a988cb5-fd43-514e-81a8-ec2d835b9cff | Which of the following phenomena is primarily responsible for the decrease in core body temperature that commonly occurs during the first hour of general anesthesia? | Convective heat loss from cutaneous vasodilation | Decreased heat production | Evaporative heat loss during skin preparation | Heat loss from the respiratory tract | 5 | E | 1 | Redistribution of core body heat to the periphery | null | null | null | null |
975c1ff5-d339-52b3-ab9c-22f03eb4cb4f | Which of the following is an effect of hypothermia in neonates? | Decreased duration of neuromuscular blockade | Increased narcotic requirements | Increased pulmonary vascular resistance | Metabolic alkalosis | 5 | C | 1 | Shivering | null | null | null | null |
10af43af-b72f-5fb3-8211-ec440ae10a7a | An unconscious adult patient is being ventilated through an esophageal obturator airway (EOA) in the emergency department. In the absence of cervical spine injury, which of the following is appropriate? | Use of the EOA for airway management until the patient regains consciousness | Removal of the EOA before insertion of an endotracheal tube | Placement of an endotracheal tube before removal of the EOA | Removal of the EOA under fiberoptic endoscopic visualization | 5 | C | 2 | Cricothyroidotomy | null | null | null | null |
f1644bc0-61c8-5837-a95b-81c7fd5b2735 | Which of the following statements concerning flumazenil is true? | Hepatic clearance is low | It binds irreversibly with the benzodiazepine receptor | It causes hypertension and tachycardia | It has a shorter duration of action than midazolam | 5 | D | 1 | It reverses opioid-induced respiratory depression | null | null | null | null |
d87545c2-d11a-552a-98cf-e4f846c03683 | A 65-year-old man with essential hypertension well controlled around 140/90 mmHg with hydrochlorothiazide is scheduled for right colectomy for carcinoma. Preoperative EKG and all laboratory values are normal except for a hematocrit of 29% and serum potassium level of 3.2 mEq/L. Central venous pressure (CVP) measured from an internal jugular catheter inserted before induction of anesthesia is 7 mmHg. Ten minutes after induction with thiopental 200 mg followed by enflurane 3% in nitrous oxide and oxygen (50% each), blood pressure decreases suddenly from 110/70 to 80/50 mmHg with heart rate unchanged at 78 bpm. CVP is now 20 mmHg and the EKG demonstrates a midjunctional rhythm. After discontinuing the enflurane, the most appropriate action would be to | administer furosemide 20 mg intravenously | verify proper placement of the CVP catheter | administer atropine 0.4 mg intravenously | administer packed erythrocytes 1 unit | 5 | C | 3 | administer potassium 20 mEq in 250 ml of intravenous fluid over 15 minutes | null | null | null | null |
2928083e-e2b2-57db-8d57-a4053b73bd57 | When performed with identical doses, which of the following types of regional block is associated with the highest plasma concentration of the drug? | Brachial plexus | Caudal | Intercostal | Subcutaneous infiltration | 5 | C | 1 | Thoracic epidural | null | null | null | null |
a4e18e1e-1200-5b41-bff3-d75458f92f08 | Infants with untreated pyloric stenosis are at increased risk for each of the following EXCEPT | congenital heart disease | dehydration | hypokalemia | increased gastric acidity | 5 | A | 1 | metabolic alkalosis | null | null | null | null |
385505f0-83fa-5edd-a05e-c6983644df1a | Which of the following statements concerning the metabolism of atracurium is true? | It is related to cardiac output | It is decreased by hyperthermia | It is unaffected by increasing age | It is decreased by low plasma cholinesterase activity | 5 | C | 1 | It is decreased in renal failure | null | null | null | null |
1bdf6e32-c16d-54da-b0b8-6331914429af | In a 35-year-old patient, which of the following is associated with an increased duration of clinical narcosis following infusion of a total dose of 10 mg/kg thiopental over three hours? | Alcoholism in remission | Asthma | Fever | Obesity | 5 | D | 2 | Use of appetite suppressants | null | null | null | null |
deaf3bba-49fd-55ef-8ff1-c8a75dc1c660 | Which of the following is the most appropriate action after an anesthetic vaporizer is tipped? | Return to the manufacturer for recalibration | Flush the vaporizer with oxygen at 5 L/min for 24 hours | Store the vaporizer for 24 hours at room temperature | Set the vaporizer at low concentration and flush with oxygen at 10 L/min for 30 minutes | 5 | D | 2 | Verify the vaporizer output with mass spectrography | null | null | null | null |
50a30478-1880-5f4f-a8a5-0aa31f2c69c4 | A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is | decreased functional residual capacity | diffusion hypoxia | hypercarbia | increased airway resistance produced by the endotracheal tube | 5 | A | 2 | inhibition of hypoxic pulmonary vasoconstriction | null | null | null | null |
721200d3-1cae-5908-8ccd-970c9be57629 | A 55-year-old man who is scheduled to undergo carotid endarterectomy (CEA) has a persistent myocardial filling defect at three hours on a dipyridamole-thallium scan. Which of the following statements is correct? | Coronary autoregulation is effective in this segment | Coronary revascularization should precede CEA | Isoflurane is contraindicated | Myocardial infarction is impending | 5 | E | 2 | There is a segment of nonviable myocardium | null | null | null | null |
72a5253a-8f8c-5d24-ba9c-022c931317d2 | A multigravid woman is receiving oxytocin by infusion for augmentation of labor. Fetal heart rate is 190 bpm with beat-to-beat variability of 6 to 8 bpm. The most appropriate immediate action would be to | continue observation | sample fetal scalp blood | discontinue oxytocics | administer a beta-adrenergic blocker to the mother | 5 | A | 3 | deliver the fetus | null | null | null | null |
041275a1-0afe-53d1-b571-d7ac55b7a857 | A patient undergoes thoracotomy in the lateral decubitus position. Which of the following maneuvers is most likely to increase PaO2 during one-lung ventilation? | Applying continuous positive airway pressure to the nondependent lung | Applying positive end-expiratory pressure to the dependent lung | Increasing inspiratory flow rate | Increasing the tidal volume | 5 | A | 2 | Increasing the ventilatory rate | null | null | null | null |
8b43d293-b3ca-5cc9-8da8-5e8745a7728a | A patient sustains cardiac arrest while being mechanically ventilated. Which of the following is the most likely effect on PetCO2? | Gradual increase with the duration of asystole | Maintenance of the prearrest value | Abrupt decrease below the prearrest value | Decrease when thoracic compression is started | 5 | C | 2 | Gradual decrease independent of the ventilator cycle | null | null | null | null |
24f2e4bf-26e1-546b-b235-b8c8eb159ffa | A patient undergoes differential spinal block for evaluation of persistent foot pain. If the pain returns coincident with a decrease in skin temperature, which of the following is the most appropriate conclusion? | A somatic origin is ruled out | The patient has causalgia | The patient has peripheral vascular disease | The pain is caused by central neuropathy | 5 | E | 3 | Lumbar sympathetic blocks are indicated | null | null | null | null |
f6ed4acc-f4e4-5361-b591-b7e178f0494d | A 54-year-old woman who is scheduled to undergo emergency exploratory laparotomy takes warfarin sodium for anticoagulation. Prothrombin time is 19 sec (control 12 sec). Which of the following agents is most appropriate to reverse the effects of warfarin? | Cryoprecipitate | Desmopressin (DDAVP) | Factor IX concentrate | Fresh frozen plasma | 5 | D | 2 | Pooled factor VIII | null | null | null | null |
297409c7-4340-5553-a2ae-8ab46f1e8250 | Which of the following decreases dead space in an anesthetic circle system? | Larger surface area of the expiratory unidirectional valve | Placing a septum in the Y-piece | Shorter expiratory limb tubing | Smaller carbon dioxide absorber | 5 | B | 1 | Smaller reservoir bag | null | null | null | null |
ec9d214c-1f84-5d29-802e-40b686f5cef6 | A 58-year-old man with a history of angina is undergoing resection of an abdominal aortic aneurysm under morphine, nitrous oxide, d-tubocurarine anesthesia. Just before removal of the aortic cross-clamp, heart rate is 74 bpm, blood pressure is 115/70 mmHg, and pulmonary artery occlusion pressure is 7 mmHg. Immediately after removal of the cross-clamp, heart rate increases to 120 bpm, blood pressure decreases to 80/55 mmHg, and pulmonary artery occlusion pressure decreases to 3 mmHg. The V5 lead on the EKG demonstrates sudden ST-segment depression and T-wave inversion. Initial therapy should be | reapplication of the aortic cross-clamp | intravenous administration of sodium bicarbonate | initiation of a phenylephrine infusion | rapid expansion of blood volume by transfusion | 5 | A | 3 | initiation of a nitroglycerin infusion | null | null | null | null |
ef9df767-8a91-5921-902b-7a09f495dc4d | Ten minutes after induction of anesthesia with thiopental and isoflurane but before incision, a patient's nasopharyngeal temperature has decreased to 35.4°C. Which of the following contributed most to this decrease in temperature? | Anesthesia-induced block of nonshivering thermogenesis | Failure to use a warming blanket | Infusion of room-temperature crystalloid | Inhalation of room-temperature gases | 5 | E | 2 | Mixing of peripheral and central blood | null | null | null | null |
f976cceb-6a6f-5e89-8cd3-8c309eb760ec | During a cardiac arrest with effective chest compression and positive-pressure ventilation, 50 mEq of sodium bicarbonate is administered. Which of the following is the most likely result? | Decreased mixed venous pH | Decreased SpO2 | Increased PetCO2 | Increased plasma lactate concentration | 5 | C | 2 | Increased serum potassium concentration | null | null | null | null |
35ab40ef-bdd2-5d5d-ba8e-3ca5f3f9102d | Each of the following values is associated with acute tubular necrosis EXCEPT | urine osmolality of 200 mOsm/L | urine sodium concentration of 15 mEq/L | urine specific gravity of 1.009 | urine/serum osmolality ratio of 1.2 | 5 | B | 1 | fractional excretion of sodium of 4% | null | null | null | null |
59a4db4f-63f8-5f4d-ae3b-f2d6a4fbd45d | Which of the following statements concerning awareness (recall) during opioid anesthesia is true? | It is usually not associated with pain | It correlates well with intact auditory evoked responses | It is prevented if the dose of opioid blocks the hemodynamic response to stimuli | It is prevented if the dose of opioid is adequate to prevent movement without muscle relaxants | 5 | A | 1 | It is predicted by a specific EEG pattern | null | null | null | null |
da2ef699-7c7c-59a6-8889-c0c2ea81aa97 | Peak airway pressure increases from 25 to 50 cmH2O when beginning right endobronchial ventilation with a right double-lumen tube. The most likely explanation for this increase is | failure to decrease tidal volume | inadvertent intubation of the left mainstem bronchus | intrinsic resistance of small endobronchial lumina | obstruction of the orifice of the right upper lobe | 5 | E | 3 | overinflation of the bronchial tube cuff | null | null | null | null |
0821c37d-d6a0-5391-aebf-3e07913e9e89 | Which of the following statements about the standard error of the mean (SE) is true? | Sample mean SE has approximately a 95% chance of containing the population mean | The SE describes the precision of the population mean | The SE describes the range of the sample values | The SE is greater than the standard deviation | 5 | B | 1 | The SE is obtained by multiplying the sample standard deviation by the square root of the sample size | null | null | null | null |
012e2f6f-dcd6-568d-8c63-b2e6c485fba3 | Which of the following statements concerning diabetes mellitus in pregnancy is true? | Beta-mimetic tocolytics cause maternal hypoglycemia | Epidural anesthesia produces hyperglycemia | Fetal insulin secretion is suppressed | Maternal insulin does not cross the placenta | 5 | D | 1 | Maternal insulin resistance develops abruptly after delivery | null | null | null | null |
112ed515-dca6-5faa-9ad1-3580d410648e | Pulmonary artery occlusion pressure | does not reliably reflect left ventricular end-diastolic volume when left ventricular compliance is reduced | inaccurately reflects left atrial pressure when left atrial pressure exceeds 15 mmHg | is measured at end-inspiration in mechanically ventilated patients | overestimates left atrial pressure in patients with poor lung compliance | 5 | A | 1 | reflects left atrial pressure only if the catheter tip is located in zone II of the lung | null | null | null | null |
399d848f-2d9c-5d7f-b0b6-db2fccd777ed | The human immunodeficiency virus (HIV) | is inactivated by irradiation | is transmitted by cryoprecipitate | is transmitted by 5% albumin | passes through intact dermis | 5 | B | 1 | provokes an immediate antibody response | null | null | null | null |
2e0376b5-532d-5ffc-9bfe-ac99b123307d | A healthy patient is receiving general endotracheal anesthesia with nitrous oxide 4 L/min, oxygen 2 L/min, and isoflurane 1% with spontaneous ventilation. The inspiratory breathing hose becomes disconnected from the inspiratory valve. The earliest alarm will be produced by | a pulse oximeter with finger probe set to alarm at 60% saturation | a mass spectrometer set to alarm when no breath is detected for 30 seconds | an oxygen analyzer mounted on the inspiratory valve outlet and set to alarm at 25% oxygen concentration | a capnograph sensor at the Y-piece that alarms when end-tidal carbon dioxide tension is greater than 60 mmHg | 4 | E | 2 | null | null | null | null | null |
da07f4ee-5222-503e-9abe-a10348613502 | A 75-year-old man with a left bundle branch block is undergoing placement of a pulmonary artery catheter through the right internal jugular vein. He becomes pale and his heart rate decreases to 40 bpm when the catheter tip enters the right ventricle. The most likely cause is | a catheter loop in the right atrium | acute myocardial infarction | acute pneumothorax | carotid sinus reflex | 5 | E | 3 | complete heart block | null | null | null | null |
84e8c6d4-744f-58f3-b7f1-399e21370c14 | Which of the following is the best initial treatment of anaphylaxis that occurs during general anesthesia? | Diphenhydramine | Dopamine | Epinephrine | Hydrocortisone | 5 | C | 1 | Ranitidine | null | null | null | null |
34a5c3c3-dfb0-5f00-8261-af9d3dae929a | Three hours after undergoing coronary artery bypass grafting, an elderly man develops severe hypotension after intravenous administration of morphine 4 mg. Pulmonary artery occlusion pressure is 27 mmHg and central venous pressure is 30 mmHg. Transesophageal echocardiography shows decreased end-diastolic ventricular volumes. Which of the following is the most likely diagnosis? | Anaphylactoid reaction | Cardiac tamponade | Coronary graft occlusion | Excessive fluid administration | 5 | B | 3 | Pulmonary thromboembolus | null | null | null | null |
fed72e3d-86e2-51c0-9207-42b46e848c88 | The most common transfusion-related infection is | bacterial sepsis | cytomegalovirus infection | hepatitis B | hepatitis C (non-A, non-B) | 5 | D | 1 | human immunodeficiency virus infection | null | null | null | null |
04b34464-96d7-5ada-84ce-4214604dd11e | A 3.3-kg neonate is brought to the operating room for repair of a left diaphragmatic hernia. A 3-mm endotracheal tube is placed to a depth of 9 cm. Initial arterial blood gas values from a right radial catheter while spontaneously breathing oxygen 50% are PaO2 82 mmHg, PaCO2 41 mmHg, pH 7.33, and base excess -5. After reduction of the hernia (during closure of the abdomen), vigorous attempts to expand the atelectatic lung are unsuccessful. The infant rapidly becomes very dusky, heart rate is 60 bpm, breath sounds are distant and squeaky bilaterally, and pulmonary compliance is decreased. Which of the following should be done first? | Obtain a radiograph of the chest | Place a chest tube on the left side | Place a chest tube on the right side | Withdraw the endotracheal tube 1 cm and suction | 5 | C | 3 | Reopen the abdomen | null | null | null | null |
c67b283e-c5ee-5cea-bbb3-cd40d413bd31 | Which of the following is the most appropriate pharmacologic therapy for trigeminal neuralgia? | Buprenorphine | Carbamazepine | Chlorpromazine | Pentazocine | 5 | B | 1 | Phenelzine | null | null | null | null |
e8a530e7-84c4-5f1d-a74d-58dd5350e7b5 | Twenty minutes after thiopental induction for femoral herniorrhaphy, a 34-year-old woman is breathing spontaneously and receiving nitrous oxide-oxygen (2 liters each) and enflurane 3% by face mask. Pulse is 90 bpm, blood pressure is 80/60 mmHg, end-tidal enflurane concentration is 2%, and end-tidal carbon dioxide tension is 48 mmHg. Which of the following is most likely to occur on skin incision? | Pupillary dilation | Laryngeal stridor | Gross muscular movement | Increased blood pressure | 5 | D | 2 | No response | null | null | null | null |
edc2d74f-31e5-5161-960a-5b6f1c177958 | Which of the following complications of caudal anesthesia with 0.25% bupivacaine is more likely in children than in adults? | Intravascular injection | Neurotoxicity | Profound motor block | Systemic toxicity | 5 | E | 1 | Total spinal block | null | null | null | null |
f6552280-80fd-5cda-8243-02ee0472a7be | Which of the following anesthetic techniques is most appropriate for a woman in the second stage of labor? | Epidural opioids | Local infiltration of the perineum | Lumbar sympathetic block | Paracervical nerve block | 5 | E | 1 | Pudendal nerve block | null | null | null | null |
6d65a370-a05f-5cfb-be25-fdb3634330e6 | Leakage current and microshock hazards are eliminated by | an isolation transformer | conductive flooring | a three-wire grounding system | a line-isolation monitor | 5 | E | 1 | none of the above | null | null | null | null |
932b7dee-1760-55ed-a3e7-15083d847c79 | A patient has a heart rate of 110 bpm one year after heart transplantation. His tachycardia is most likely the result of | altered baroreceptor sensitivity | cardiac denervation | compensation for a fixed stroke volume | cyclosporine | 5 | B | 1 | prednisone | null | null | null | null |
77926a83-db22-5f82-a7f6-59723f1bd7d0 | Each of the following factors may lead to erroneous readings using pulse oximetry EXCEPT | electrocautery | high cardiac output states | infrared lights near the sensor | intravenous dyes | 5 | B | 1 | severe hemodilution | null | null | null | null |
5808b73a-6807-5aee-a9c0-1fb2a2a09ad9 | Which of the following is the most appropriate initial management of a patient with hypotension secondary to sepsis? | Calcium chloride | Corticosteroids | Crystalloid infusion | Dopamine | 5 | C | 1 | Fresh frozen plasma | null | null | null | null |
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