question

Disodium edentate or sodium metabisulfite is added to formulations of propofol to: -enhance drug solubility -adjust pH -inhibit bacterial growth -increase drug potency

answer

increase drug potency

question

Sensory innervation of the trachea and larynx below the vocal cords is supplied by the: internal laryngeal nerve external laryngeal nerve recurrent laryngeal nerve glossopharyngeal nerve

answer

recurrent laryngeal nerve

question

Correct statements concerning the use of benzodiazepines in the elderly include: -volume of distribution is increased -reduced pharmacodynamic sensitivity is observed -the elimination half-life of diazepam, but not midazolam, is increased -all of the above

answer

volume of distribution is increased

question

The National Institute for Occupational Safety (NIOSH) recommends limiting the operating room concentration of nitrous oxide to: 0.5 ppm 5 ppm 25 ppm 50 ppm

answer

25 ppm

question

The highest incidence of muscle pain following the use of succinylcholine is seen in: infants octogenarians outpatients pregnant patients

answer

outpatients

question

The cardiovascular effects of pancuronium are caused by: (Select 3) vagal blockade stimulation of cardiac muscarinic receptors ganglionic stimulation decreased catacholamine reuptake direct myocardial stimulation blockade of cardiac slow calcium channels central thalamic stimulation

answer

vagal blockade, ganglionic stimulation, decreased catecholamine reuptake

question

Anesthetic implications of multiple sclerosis include: - exacerbation induced by spinal anesthesia - exacerbation induced by epidural anesthesia - exacerbation of symptoms secondary to hypothermia - the presence of significant peripheral neuropathy causing severe hyperkalemia after succinylcholine administration

answer

exacerbation induced by spinal anesthesia

question

Local anesthetics with the potential to form methemoglobin include: (Select 3) EMLA topical anesthetic cream bupivacaine benzocaine ropivacaine prilocaine mepivacaine

answer

EMLA topical anesthetic cream, prilocaine, benzocaine

question

Ulnar nerve injury: - results in wrist drop and loss of sensation in the web space between the thumb and index finger - occurs more frequently in males - manifests itself in the immediate postoperative period - is most commonly seen in the patient with a BMI of less than 18

answer

occurs more frequently in males

question

The potency of local anesthetics increases as the: lipid solubility increases pKa increases number of double bonds in the anesthetic molecule increases molecular weight decreases

answer

lipid solubility increases

question

A decrease in cerebral blood flow is seen after the administration of: isoflurane propofol desflurane ketamine

answer

propofol

question

The age group with the highest minimum alveolar concentration (MAC) of desflurane is: 2 - 3 months 1 - 2 years 25 - 30 years greater than 75 years

answer

2 - 3 months

question

The loss of ventricular filling as a result of acute atrial fibrillation is approximately:

answer

15-25%

question

During surgical repair of a detached retina, 1 mL of sulfur hexafluoride is injected into the posterior chamber. If the patient is receiving 4% desflurane and a 2:1 ratio of N2O and O2, the pressure-volume relationship of the bubble will approximately: decrease by one third remain the same double triple

answer

triple

question

During pregnancy, the minimum alveolar concentration (MAC): decreases until the 20th week increases until the 20th week decreases throughout the pregnancy increases throughout the pregnancy

answer

decreases throughout the pregnancy

question

Physiologic effects of electroconvulsive therapy (ECT) include an: - initial sympathetic response with sustained tachycardia -initial sympathetic discharge followed by a sustained parasympathetic response - initial parasympathetic discharge followed by a sustained sympathetic response - initial parasympathetic response with sustained bradycardia

answer

initial parasympathetic discharge followed by a sustained sympathetic response

question

The postretrobulbar block apnea syndrome: - is likely secondary to intravascular injection - most commonly occurs during or immediately after injection - is associated with unconsciousness - carries a high morbidity and mortality

answer

is associated with unconsciousness

question

A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant for third degree heart block treated with a permanent pacemaker. Problems with electrocautery use in this patient can be minimized by: - placing the grounding pad near the pacemaker - using infrequent bursts of longer duration - the use of a bipolar cautery - reducing the surface area of the return electrode

answer

the use of a bipolar cautery

question

The most severe transfusion reactions are due to: ABO incompatibility Rh incompatibility febrile reactions non-ABO hemolytic reactions

answer

ABO incompatibility

question

Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above: 5 mm Hg 15 mm Hg 25 mm Hg 30 mm Hg

answer

15 mm Hg

question

The rapid shallow breathing index (RSBI) is useful in predicting successful weaning from mechanical ventilation. Prior to extubation this index should be: between 300 and 400 between 200 and 300 between 100 and 200 less than 100

answer

less than 100

question

The perception of an ordinarily non-noxious stimulus as pain is referred to as: allodynia anesthesia dolorosa dysesthesia hyperalgesia

answer

allodynia

question

Cholinesterase inhibitors that freely cross the blood-brain barrier include: neostigmine pyridostigmine physostigmine edrophonium

answer

physostigmine

question

Ninety percent of congenital diaphragmatic hernias occur: through the left posterolateral foramen through the right posterolateral foramen through the anterior foramen along the inferior vena cava

answer

through the left posterolateral foramen

question

During fetal monitoring, Type III decelerations are thought to be related to: head compression umbilical cord compression uteroplacental insufficiency placental abruption

answer

umbilical cord compression

question

Pathophysiologic factors affecting the anesthetic management of patients with hypothyroidism include: hypernatremia hyperglycemia difficulty with intubation and airway management increased blood viscosity due to elevated hematocrit

answer

difficulty with intubation and airway management

question

The most frequent manifestation of sickle cell disease is: pain splenic sequestration aplastic crisis right upper quadrant syndrome

answer

pain

question

Reactants that are regenerated during the absorption of carbon dioxide by soda lime include: carbonic acid sodium hydroxide calcium hydroxide calcium carbonate

answer

sodium hydroxide

question

The effects of barbiturates on ischemic areas of the brain include: vasoconstriction vasodilation redirection of blood flow to the ischemic areas redirection of blood flow away from ischemic areas

answer

redirection of blood flow to the ischemic areas

question

*FLIP FOR QUESTION Answer = A - Curve A best represents the effects of changing oxygen tensions on cerebral blood flow. Hypoxemia causes a significant increase in CBF to meet the brain's metabolic demand. Hyperoxia, however, causes little change in CBF. - Barash pg 999

answer

In the graph of cerebral blood flow below, PaO2 would best be represented by curve: A, B, C, or D

question

In patients receiving vecuronium, the greatest augmentation of neuromuscular blockade is seen with the use of: isoflurane sevoflurane desflurane nitrous oxide

answer

desflurane

question

During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3) - hypotension secondary to cement monomer absorption - hypoxemia secondary to air embolization - hypoxemia secondary to fat embolization - hypocarbia - decreased pulmonary artery pressure - increased end-tidal carbon dioxide

answer

hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, hypoxemia secondary to fat embolization

question

Maternal mortality associated with amniotic fluid embolization is: 10 - 15% 20 - 25% 40 - 45% greater than 50%

answer

greater than 50%

question

Absolute contraindications to electroconvulsive therapy (ECT) include: congestive heart failure pregnancy myocardial infarction 5 months prior to therapy increased intracranial pressure

answer

increased intracranial pressure

question

The primary mechanism of intraoperative heat loss resulting in hypothermia is: convection radiation conduction evaporation

answer

radiation

question

Sinus arrhythmia: - is mediated through sympathetic innervation of the AV node - causes an increase in heart rate with inspiration - is indicative of SA node ischemia - is the primary cause of premature atrial contractions

answer

causes an increase in heart rate with inspiration

question

Of the following, the block associated with the highest blood level of local anesthetic per volume injected is the: epidural block spinal block intercostal block caudal block

answer

intercostal block

question

A 34-year-old female is undergoing tumescent liposuction of the abdomen and flanks. Peak serum levels of local anesthetic from the tumescent solution are most commonly seen in: the first 2 hours 4 to 6 hours 7 to 9 hours 12 to 14 hours

answer

12 - 14 hours

question

A 82-year-old female is scheduled for a total hip replacement under spinal anesthesia. She has been receiving enoxaparin for deep vein thrombosis prophylaxis. Current recommendations regarding the dosing of enoxaparin state that the drug be: continued without interruption as scheduled held for 4 - 6 hours prior to the spinal anesthetic held for 10 - 12 hours prior to the spinal anesthetic held for not less than 24 hours prior to the spinal anesthetic

answer

held for 10 - 12 hours prior to the spinal anesthetic

question

Safety features that prevent filling of the vaporizer with an incorrect agent include: the pin index safety system agent-specific keyed filling ports the diameter index safety system counter-threading of the bottle attachment

answer

agent-specific keyed filling ports

question

A person acting as an amicus curiae: is not a party to the litigation gives expert testimony for the defense gives expert testimony for the plaintiff cannot file a written brief

answer

is not a party to the litigation

question

The first nurse anesthetist to be appointed to a university medical school faculty was: Alice Maude Hunt Agatha Hodgins Helen Lamb Alice Magaw

answer

Alice Maude Hunt

question

inhaled agents from highest vapor pressure to lowest

answer

Nitrous Oxide, Des, Iso, Sevo

question

Reduction of heart rate seen with the administration of opiates is mediated through the: sigma receptors delta receptors kappa receptors mu receptors

answer

mu receptors

question

The effects of 60-Hz current on a human for 1-second match the current to the physiologic effect. a.) Perception Threshold b.) Let-Go Current c.) Microshock Risk d.) V Fib Choices: 100 micro amps; 200 mAmp; 15 mAmp; 1 mAmp

answer

a.) 1 mAmp b.) 15 mAmp c.) 100 micro-amps d.) 200 mAmp

question

Mortality after liposuction procedures most commonly is the result of: pulmonary embolism bowel perforation fat embolization reactions to anesthetic agents

answer

pulmonary embolism

question

Heart rate: is the sole determinant of cardiac output in the elderly is normally determined by the intrinsic rate of the AV node decreases with increasing age is increased by stimulation of the M2 cholinergic receptors

answer

decreases with increasing age

question

Pulmonary effects of β2-adrenergic stimulation include: (Select 2) - inhibition of hypoxic pulmonary vasoconstriction - decreased bronchial secretions - pulmonary vasoconstriction - bronchodilation - redirection of blood flow to lower V/Q alveolar units - activation of type II pneumocytes

answer

decreased bronchial secretions, bronchodilation

question

Nervous system changes seen in the pregnant patient at term include: (Select 2) - increased minimum alveolar concentration - increased sensitivity to local anesthetics - decreased cerebrospinal fluid volume - decreased cephalad spread of spinal anesthetics - decreased epidural space pressure - increased potential volume of the epidural space

answer

increased sensitivity to local anesthetics, decreased cerebrospinal fluid volume

question

Clinical signs of tension pneumothorax include: contralateral absence of breath sounds ipsilateral hyporesonance to percussion neck vein distention all of the above

answer

neck vein distention

question

Portal hypertension leads to the development of portal-systemic venous collateral channels. These collateral sites commonly include the: hemorrhoidal veins pulmonary veins hepatic vein azygous vein

answer

hemorrhoidal veins

question

As compared to hygroscopic heat-moisture exchangers, hydrophobic heat-moisture exchangers: - depend on electrostatic properties to retain moisture - are more effective filters of pathogens - are more efficient devices for retaining heat and moisture - are more likely to become saturated and increase resistance to ventilation

answer

are more effective filters of pathogens

question

A nonselective α-antagonist used in the preoperative preparation of a patient with pheochromocytoma is: phenoxybenzamine doxazosin propranolol terazosin

answer

phenoxybenzamine

question

The portion of the nephron responsible for concentration of urine via the countercurrent mechanism is the: glomerulus loop of Henle proximal convoluted tubule distal convoluted tubule

answer

loop of Henle

question

Postoperative ulnar nerve injury: results in wrist drop and loss of sensation in the web space between the thumb and index finger occurs more frequently in males manifests itself in the immediate postoperative period is most commonly seen in the patient with a BMI of less than 38

answer

occurs more frequently in males

question

In contrast to patients undergoing on-pump coronary artery bypass grafting (CABG), patients undergoing off-pump CABG: usually require little volume replacement do not require anticoagulation have isolated left coronary of left anterior descending artery disease usually require relatively high mean arterial pressures during distal anastomoses grafting

answer

usually require relatively high mean arterial pressures during distal anastomoses grafting

question

The single greatest cause of mortality in the patient with sickle cell disease is a result of: acute chest syndrome sequestration crisis aplastic crisis vaso-occlusive crisis

answer

acute chest syndrome

question

The line isolation monitor: provides a source of ungrounded electrical power reduces the risk microshock monitors the integrity of the isolated power system monitors the integrity of equipment grounding wires

answer

monitors the integrity of the isolated power system

question

Electrolyte containing irrigation solutions are avoided during transurethral resection of the prostate because they: interfere with the use of the cautery can precipitate severe hyponatremia can cause hyperglycemia in diabetic patients are associated with elevated ammonia levels postoperatively

answer

interfere with the use of the cautery

question

The use of nonionic gadolinium contrast media during MRI: - can result in ionizing radiation exposure to the patient & anesthesia provider - results in frequent allergic reactions, urticaria & bronchospasm - is commonly associated with nausea - should be avoided in patients with a pacemaker or AICD

answer

is commonly associated with nausea

question

The speed in an inhalation induction is slowed by right-to-left shunting. The change in the rate of induction is LEAST pronounced when using: nitrous oxide sevoflurane isoflurane desflurane

answer

isoflurane

question

Local anesthetic solutions that are isobaric with the cerebrospinal fluid include: (Select 2) tetracaine 0.5% in 5% dextrose bupivacaine 0.75% in normal saline procaine 10% in sterile water lidocaine 2% in normal saline bupivacaine 0.3% in sterile water lidocaine 5% in 7.5% dextrose

answer

bupivacaine 0.75% in normal saline lidocaine 2% in normal saline

question

A fresh E-cylinder of oxygen: contains more liters of gas than an E-cylinder of nitrous oxide contains about 90% liquid oxygen and 10% oxygen as a gas contains about 660 liters of oxygen has a lower pressure than the pipeline oxygen supply

answer

contains about 660 liters of oxygen

question

An 82-year-old female arrives to the OR for open reduction of a left intratrochanteric fracture. Significant past medical history includes hypertension, moderate aortic stenosis and dementia. The most appropriate anesthetic technique for this patient is: opioid-based general anesthesia spinal anesthesia volatile-agent-based general anesthesia epidural anesthesia

answer

opioid-based general anesthesia

question

During the delivery of an inhalation anesthetic using 6.5% desflurane in oxygen, nitrous oxide is introduced into the gas mixture. The effect of the addition of nitrous oxide on the concentration of desflurane delivered is: - to cause an increase in desflurane concentration - to cause a decrease in desflurane concentration - to cause no change in desflurane concentration - variable, depending on the ambient atmospheric pressure

answer

to cause a decrease in desflurane concentration

question

The formation of active metabolites has NOT been associated with the use of: vecuronium rocuronium pancuronium succinylcholine

answer

rocuronium

question

The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately: 0.03% 0.09% 0.3% 0.9%

answer

0.09%

question

A decrease in cholinesterase activity has been associated with: obesity thyrotoxicosis alcoholism burns

answer

burns

question

Hormones released by the neurohypophysis include: (Select 2) thryotropin growth hormone arginine vasopressin adrenocorticotropic hormone follicle stimulating hormone oxytocin prolactin luteinizing hormone

answer

oxytocin, arginine vasopressin

question

Congenital heart diseases associate with right-to-left shunting include: (Select 3) tricuspid atresia hypoplastic left heart syndrome aortopulmonary window patent ductus arteriosus tetralogy of Fallot subvalvular aortic stenosis ventricular septal defects atrial septal defects

answer

tricuspid atresia, hypoplastic left heart syndrome, tetralogy of Fallot

question

The recommended maximum leakage current allowed in operating room equipment is: 5 μA 10 μA 1 mA 5 mA

answer

10 μA

question

Hypoxemia during one-lung anesthesia is most effectively treated by: PEEP applied to the ventilated lung continuous oxygen insufflation to the collapsed lung changing tidal volume and rate periodic inflation of the collapsed lung

answer

periodic inflation of the collapsed lung

question

Sympathetic blockade during acute herpes zoster has been shown to: increase analgesic requirements reduce the incidence of postherpetic neuralgia increase the need for corticosteroid therapy be an effective treatment for patients who have had postherpetic neuralgia for a number of years

answer

reduce the incidence of postherpetic neuralgia

question

During the delivery of an anesthetic in the radiology department, full E-cylinders of nitrous oxide and oxygen are being used. If a 3:2 mixture of nitrous oxide:oxygen is being delivered and the case has been proceeding for 60 minutes, the expected pressure in the nitrous oxide E-cylinder is: _______

answer

745 - 750 psig

question

The formation of metanephrine is the result of: - catechol-O-methyltransferase metabolism of epinephrine - catechol-O-methyltransferase metabolism of norepinephrine - monamine oxidase metabolism of epinephrine - monamine oxidase metabolism of norepinephrine

answer

catechol-O-methyltransferase metabolism of epinephrine

question

Characteristics of human immunodeficiency virus neuropathy include: (Select 2) distal polyneuropathy rapid sudden onset proximal muscle weakness allodynia upper extremities most commonly involved proximal to distal progression of symptoms

answer

distal polyneuropathy allodynia

question

During placement of a lumbar epidural using a midline approach, the needle passes through the: (Select 3) interspinous ligament anterior longitudinal ligament intervertebral disk supraspinous ligament ligamentum flavum facet joint

answer

supraspinous ligament, interspinous ligament, ligamentum flavum

question

Prior to pneumonectomy, split lung function testing is indicated in the patient with: an FEV1 of 2.2 L a PaCO2 of 49 mm Hg on room air a PaO2 of 54 mm Hg on room air a maximum VO2 of 21 mL/kg/min

answer

a PaCO2 of 49 mm Hg on room air

question

Postintubation croup: is secondary to inflammation of subglottic structures is less common when cuffed endotracheal tubes are used occurs most frequently in infants less than 4 months of age is most often seen immediately upon extubation

answer

is secondary to inflammation of subglottic structures

question

Physiologic derangements seen in the patient with scleroderma include: (Select 3) pulmonary hypertension esophageal dysmotility excessive oral secretions and salivation myocardial fibrosis hypotension spastic quadraparesis

answer

pulmonary hypertension esophageal dysmotility myocardial fibrosis

question

Basal metabolic oxygen consumption in a 20-kg patient is approximately: (Enter numerical answer in box below. Click 'Next' when completed.) mL/min

answer

Basal metabolic oxygen consumption in a 20 kg patient is approximately: 95 ml/min

question

During emergent transtracheal jet ventilation using a 14 gauge catheter, generation of sufficient gas flow requires a driving pressure of: 20 cmH2O 50 cmH2O 25 psi 50 psi

answer

50 psi

question

A 24-year-old female is scheduled for resection of a cerebral aneurysm. She has no other significant past medical history. Acceptable levels of hypotension would include a mean arterial pressure of: 20 - 30 mm Hg 35 - 45 mm Hg 50 - 60 mm Hg 90 - 100 mm Hg

answer

50 - 60 mm Hg

question

Topically applied ophthalmic medications are absorbed: - as quickly as intravenous administration - more quickly than subcutaneous administration - only minutely, with insignificant clinical effect - directly into the central nervous system through the optic nerve foramen

answer

- more quickly than subcutaneous administration

question

Which of the following is NOT a contraindication to activated charcoal in the setting of suspected aspirin poisoning? Bowel obstruction Bowel perforation Inability to protect airway Two hours since ingestion

answer

Two hours since ingestion

question

Which of the following is MOST true regarding acetaminophen poisoning? - 5% of acetaminophen is excreted in the urine - Acetaminophen is responsible for at least 90% of acute hepatic failure in the US - Acetaminophen is a central COX-1 inhibitor - The majority of acetaminophen is oxidized by NAPQI (which is detoxified by glutathione)

answer

- 5% of acetaminophen is excreted in the urine

question

During pregnancy, the minimum alveolar concentration (MAC): - decreases until the 20th week - increases until the 20th week - decreases throughout the pregnancy - increases throughout the pregnancy

answer

decreases throughout the pregnancy

question

Correct location of the catheter tip of a central venous line is in the: superior vena cava right atrium right ventricle pulmonary artery

answer

superior vena cava

question

Which of the following is NOT a potential treatment for salicylate poisoning? Activated charcoal Administration of a reversible COX-inhibitor Hemodialysis Sodium bicarbonate

answer

Administration of a reversible COX-inhibitor

question

A 70-year-old man with a DDD-R pacemaker for a history of symptomatic bradycardiais undergoing an anterior cervical discectomy and fusion with somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring. The pacemaker should be reprogrammed to which of the following? Discontinue R function Dual chamber asynchronous pacing No reprogramming Ventricular asynchronous pacing

answer

Discontinue R function

question

A 35-year-old woman who underwent orthotopic heart transplantation 2 years ago for nonischemic cardiomyopathy presents after a motor vehicle accident for exploratory laparotomy under general anesthesia. Intraoperatively, her blood pressure is 75/35 mmHg and heart rate is 90 bpm. After the administration of phenylephrine, which of the following hemodynamic responses do you MOST expect? HR decreased, BP increased HR decreased, BP no change HR no change, BP increased HR no change, BP no change

answer

HR no change, BP increased

question

The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from: T4 - T8 T8 - L2 L2 - L4 L4 - S1

answer

T8 - L2

question

A 55-year-old woman with a history of congenital long QT syndrome is undergoing a hysteroscopy for abnormal uterine bleeding. She had uneventful induction of general anesthesia but after paracervical block with lidocaine develops ventricular tachycardia with morphological appearance of torsades de pointe. Which of the following medications should be AVOIDED in the treatment of her arrhythmia? Amiodarone Calcium chloride Esmolol Magnesium sulfate

answer

Amiodarone

question

A 59-year-old man presents with nausea, diaphoresis, and bradycardia. His blood pressure is 80/40 mmHg, HR 45 bpm. A transthoracic echocardiogram reveals global left ventricular hypokinesis with bulging of the interventricular septum into the left ventricle, mild mitral regurgitation, and moderate tricuspid regurgitation. Which coronary artery do you MOST expect to be occluded? First diagonal artery Left anterior descending artery Left circumflex artery Right coronary artery

answer

Right coronary artery

question

Which of the following monitoring modality is MOST important in the setting of tricyclic antidepressant (TCA) poisoning? Pulse oximetry Electrocardiogram Blood pressure PaCO2

answer

Electrocardiogram

question

Which of the following is MOST often associated with carbon monoxide poisoning? Salicylate poisoning Cyanide toxicity Ethanol toxicity Acetaminophen toxicity

answer

Cyanide toxicity

question

After an accidental needle stick with a contaminated needle, which of the following viruses carries the HIGHEST risk of transmission? HIV Hepatitis A Hepatitis B Hepatitis C

answer

Hepatitis B

question

Which of the following has NOT been definitely shown to reduce central line infection rates? Chlorhexidine-impregnated sponges Routine dressing changes Use of a checklist Use of single lumen catheters

answer

Routine dressing changes

question

Local anesthetics block which of the following channels for their primary action? Sodium Calcium Potassium Magnesium

answer

Sodium

question

Which of the following statements regarding the addition of clonidine to an epidural infusion is MOST correct? - Clonidine is an alpha-2-receptor antagonist - Clonidine effect in peripheral nerve blocks is primarily centrally mediated - Clonidine prolongs the sensory block when added to intermediate local anesthetics - Commonly reported side effects include tachycardia and hypertension

answer

Clonidine prolongs the sensory block when added to intermediate local anesthetics

question

During fetal monitoring, Type III decelerations are thought to be related to: head compression umbilical cord compression uteroplacental insufficiency placental abruption

answer

umbilical cord compression

question

Compared to "plain" local anesthetic without epinephrine, a pre-mixed local anesthetic with epinephrine solution is MOST associated with which of the following? Little effect on peak plasma levels Decreased sensory block Increased onset time Decreased cardiac output

answer

Increased onset time

question

A 44-year-old man presents to the emergency room with a table saw injury to the left hand. The surgeon plans to explore the wound and possibly repair tendon and vascular injuries. The estimated operative duration is between 1-5 hours and an axilla block with bupivacaine is planned as the primary anesthetic technique. The patient has a seizure with the inejction of bupivacaine. Which of the following should be your FIRST therapeutic action? Administer a short-acting muscle relaxant to stop muscle contractions Administer intra-lipid Administer lidocaine to prevent cardiac arrhythmias Administer oxygen and ensure a patent airway

answer

Administer oxygen and ensure a patent airway

question

Airway obstruction caused by the tongue falling posteriorly against the wall of the pharynx is secondary to relaxation of the: - genioglossus muscle - longitudinal muscle of the tongue - palatoglossus muscle - styloglossus muscle

answer

genioglossus muscle

question

The lumbar plexus is derived from which of the following? - Dorsal rami of L1-4 - Ventral rami of L1-4 and variable contributions from T12 and L5 - Dorsal rami of L1-4 and variable contributions from S1-2 and L5 - Ventral rami of L1-4 and variable contributions of S1-2 and L5

answer

- Ventral rami of L1-4 and variable contributions from T12 and L5

question

A 73-year-old man with prostate adenocarcinoma presents for robotic-assisted prostatectomy. His medical history is significant for poorly controlled, refractory hypertension, COPD, chronic kidney disease, and non-obstructive coronary artery disease. His home medications include aspirin, hydrochlorothiazide, lisinopril, and amlodipine. His blood pressure in the pre-op holding area is 177/98 mmHg. Anticipating likely intraoperative hypertension, you consider the vasodilatory agents in your armamentarium. Which of the following is MOST correct regarding these drugs? The vasodilatory effects of nitroglycerin on the arterial and venous sides are similar The pharmacologic half-life of hydralazine is prolonged in patients with chronic kidney disease Nesiritide is less effective than nitroglycerin in reducing right atrial pressure The most common acid-base disturbance seen with sodium nitroprusside overuse is metabolic acidosis

answer

The most common acid-base disturbance seen with sodium nitroprusside overuse is metabolic acidosis

question

Which of the following BEST explains why higher settings of desflurane are needed at higher altitudes to produce the same anesthetic effect? Decreased concentration of desflurane at higher altitudes Decreased partial pressure of desflurane at higher altitudes Decreased oxygen concentration at higher altitudes This statement is incorrect; equivalent settings produce the same anesthetic effect

answer

Decreased partial pressure of desflurane at higher altitudes

question

An infant had a patent ductus arteriosus closed and is recovering in the NICU. You note that the patient has new-onset stridor and hoarseness. Which of the following is the MOST likely cause of this finding? Surgical dissection causing recurrent laryngeal nerve injury Hypocalcemia after transfusion of packed red blood cells Laryngospasm after deep extubation Incorrectly sized endotracheal tube

answer

Surgical dissection causing recurrent laryngeal nerve injury

question

Which of the following positions is associated with the LOWEST risk of ventilator associated pneumonia? Prone Supine head up Supine head down Supine flat

answer

Supine head up

question

Venous irritation associated with the injection of diazepam and lorazepam is secondary to: the high degree of water solubility of these agents the presence of propylene glycol as a solvent the presence of metabisulfite as a preservative the low pH of these agents

answer

the presence of propylene glycol as a solvent

question

Which of the following symptoms would be MOST expected in a 64-year-old man with an acute right anterior cerebral artery (ACA) stroke? Left leg weakness Left hand weakness Left CN VII palsy Hoarseness

answer

Left leg weakness

question

You have designed a study that compares average postoperative opioid consumption after three different anesthetic techniques. After informed consent, 120 patients undergoing total knee arthroplasty will be randomly assigned to one of the three groups. Which of the following statistical tests can be BEST used to compare the means of three groups? Chi-square One-way ANOVA Paired t-test Unpaired t-test

answer

One-way ANOVA

question

Correct statements regarding cerebral metabolism include: - the brain can only utilize glucose as an energy source - forty percent of brain glucose consumption is anaerobically metabolized - hyperglycemia can reduce the damage from focal hypoxic injury - the adult brain consumes approximately 50 ml/min of oxygen

answer

the adult brain consumes approximately 50 ml/min of oxygen

question

Which muscle is the only abductor of the vocal cords? Cricothyroid muscle Thyroarytenoid muscle Posterior cricoarytenoid muscle Lateral cricoarytenoid muscle

answer

Posterior cricoarytenoid muscle

question

At approximately what level or above will a patient with spinal cord injury be at GREATEST risk for autonomic hyperreflexia? C8 T4 T7 T10

answer

T7

question

Portal hypertension is defined as sustained portal vein pressure greater than: 5 mm Hg 10 mm Hg 20 mm Hg 25 mm Hg

answer

10 mm Hg

question

At approximately what carboxyhemoglobin level will a patient start to display mild signs and symptoms (headache, nausea and vomiting) of carbon monoxide toxicity? 5% 10% 15% 25%

answer

15%

question

A baby is born at 39 weeks gestation with congenital diaphragmatic hernia. The baby is cyanotic and limp. He has a slow, irregular respiratory pattern and appears to be grimacing. His heart rate is 120 bpm at the one-minute of life. Which APGAR score correctly corresponds with these findings? 3 4 5 6

answer

4

question

During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3) - hypotension secondary to cement monomer absorption - hypoxemia secondary to air embolization - hypoxemia secondary to fat embolization - hypocarbia - decreased pulmonary artery pressure - increased end-tidal carbon dioxide

answer

hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, hypoxemia secondary to fat embolization

question

Which of the following pharmacologic agents is MOST appropriate for the prevention of venous thromboembolism in the setting of suspected heparin-induced thrombocytopenia (HIT)? Subcutaneous heparin Low Molecular Weight Heparin Warfarin Fondaparinux

answer

Fondaparinux

question

Which of the following is MOST correct regarding the treatment of known venous thromboembolism with either low molecular weight heparin (LMWH) or unfractionated heparin (UFH)? LMWH more efficacious but with more side effects LMWH more efficacious and with fewer side effects UFH more efficacious but with more side effects UFH more efficacious and with fewer side effects

answer

LMWH more efficacious and with fewer side effects

question

Dextran 40 has been shown to improve microcirculation by: reducing blood density increasing blood density decreasing blood viscosity increasing blood viscosity

answer

decreasing blood viscosity

question

A 58-year-old man is admitted with chest pain, ST elevation in ECG leads II, III and aVF, and increased cardiac troponin levels. His echocardiogram shows regional wall motion abnormalities in the inferior wall. Which of the following medications should be initiated within 24 hours after admission to improve his survival following his myocardial infarction? Hydrochlorothiazide Losartan Metoprolol Ramipril

answer

Ramipril

question

An 85-year-old man is in atrial fibrillation in the intensive care unit after aortic valve replacement. Amiodarone 150 mg is administered by intravenous bolus injection. Which of the following BEST describes that mechanism of amiodarone? Blocks cardiac sodium channels Prolongs repolarization Shortens the QT interval Slows conduction at the AV node

answer

Prolongs repolarization

question

The highest level of protein binding is seen with: procaine lidocaine mepivacaine bupivacaine

answer

bupivacaine

question

Which of the following anti-platelet agents works by inhibiting platelet activation via an adenosine diphosphate-dependent mechanism? Aspirin Clopidogrel Dipyridamole Tirofiban

answer

Clopidogrel

question

The highest rate of systemic absorption of local anesthetic is seen with: epidural injection intercostal injection caudal injection brachial plexus injection

answer

intercostal injection

question

A 75-year-old woman presents for combined mitral valve repair and aortic valve replacement after CABG 10 years ago. She is deemed to be high risk for bleeding after cardiopulmonary bypass and during the postoperative period in the ICU. You plan to administer tranexamic acid prior to commencement of cardiopulmonary bypass. Which of the following BEST describes the mechanism of tranexamic acid? Activates platelets Improves fibrin concentration Increases thrombin Inhibits activation of plasmin

answer

Inhibits activation of plasmin

question

A 40-year-old man was diagnosed with hypertension and his primary care physician started him on hydrochlorothiazide for blood pressure control. He presents for elective laparoscopic cholecystectomy. Which of the following electrolyte disturbances is MOST common in patients taking hydrochlorothiazide? Increased calcium Increased magnesium Increased potassium Increased sodium

answer

Increased calcium

question

In the neuromuscular junction, acetylcholine receptor binding sites are found on the: α-subunits β-subunits δ-subunits ε -subunits

answer

α-subunits

question

Four days after an ureteral stent placement, an 87-year-old woman becomes increasingly confused. Vital signs include T 38.9°C, BP 100/60 mmHg (MAP 73), HR 103 bpm, respiratory rate 16 /min, SpO2 96% on room air. White blood cell count is 16,000 µL-1, creatinine is 2.2 mg/dL (up from 0.8 mg/dL baseline), and lactate is 3 mmol/L. Urinalysis shows leukocytes and positive nitrite; a urine culture is pending. Which of the following is this patient's MOST appropriate sepsis classification? Sepsis Severe sepsis Sepsis-induced hypotension Septic shock

answer

Severe sepsis

question

In the fetus, the percentage of cardiac output directed to the placenta is approximately: 10% 25% 50% 100%

answer

50%

question

The criteria for systemic inflammatory response syndrome includes which of the following parameters? Temperature, blood pressure, respiratory rate or PaCO2, white blood cell count Temperature, heart rate, respiratory rate or PaCO2, urine output Temperature, heart rate, respiratory rate or PaCO2, white blood cell count Temperature, blood pressure, respiratory rate or PaCO2, urine output

answer

Temperature, heart rate, respiratory rate or PaCO2, white blood cell count

question

The elimination half-life of intravenously administered oxytocin in the parturient is approximately: 30 to 120 seconds 3 to 5 minutes 10 to 15 minutes 20 to 30 minutes

answer

The elimination half-life of intravenously administered oxytocin in the parturient is approximately: 3 to 5 minutes

question

Which of the following statements regarding the pharmacology of heparin is MOST correct? Warfarin increases the synthesis of endogenous heparin Low Molecular Weight Heparin preferentially inhibits Factor Xa Heparin is a highly sulfated protein molecule with negative charge Protamine reverses heparin action as a competitive antagonist on the receptor binding site

answer

Low Molecular Weight Heparin preferentially inhibits Factor Xa

question

Which nerve innervates the only abductor muscle of the vocal cords? Internal branch of superior laryngeal nerve Recurrent laryngeal nerve External branch of superior laryngeal nerve Glossopharyngeal nerve

answer

Recurrent laryngeal nerve

question

A 3-month-old infant presents to the hospital febrile, lethargic, and tachypneic. Upon questioning, the infant's parents indicate that the infant had been treated for colic with a combination of aspirin and a bismuth subsalicylate solution for the past several weeks. Salicylate toxicity is suspected. An arterial blood gas would MOST likely show which of the following abnormalities? Primary metabolic acidosis with respiratory compensation Primary metabolic alkalosis with respiratory compensation Primary respiratory acidosis with metabolic compensation Primary respiratory alkalosis with metabolic compensation

answer

Primary metabolic acidosis with respiratory compensation

question

Which of the following is NOT an absolute contraindications to Ramipril? Hereditary angioedema Pregnancy Renal artery stenosis Sulfonamide allergy

answer

Sulfonamide allergy

question

Which of the following is LEAST likely to be a risk factor for the development of postherpetic neuralgia? Age > 60 years Corticosteroid administration Female sex Severe acute pain

answer

Corticosteroid administration

question

During the delivery of an inhalation anesthetic using 6.5% desflurane in oxygen, nitrous oxide is introduced into the gas mixture. The effect of the addition of nitrous oxide on the concentration of desflurane delivered is: to cause an increase in desflurane concentration to cause a decrease in desflurane concentration to cause no change in desflurane concentration variable, depending on the ambient atmospheric pressure

answer

to cause a decrease in desflurane concentration

question

A 63-year-old woman with a six-month history of headache and visual disturbances is diagnosed with a non-functioning pituitary macroadenoma. Serum levels of which following hormones is MOST likely to be elevated in this patient? Adrenocorticotropic hormone (ACTH) Growth hormone (GH) Prolactin Thyroid-stimulating hormone (TSH)

answer

Prolactin

question

The area of myocardium most vulnerable to ischemia is the: left ventricular epicardium right ventricular epicardium left ventricular subendocardium right ventricular subendocardium

answer

left ventricular subendocardium

question

Which of the following neurotransmitters is MOST commonly used by preganglionic sympathetic neurons at sympathetic ganglia? Acetylcholine Dopamine Epinephrine Norepinephrine

answer

Acetylcholine

question

An otherwise healthy 61-year-old woman is in the operating room for the placement of an intramedullary rod after a femur fracture 2 days ago. During reaming, her SpO2 falls from 98% to 85% on FiO2 0.5, she develops sinus tachycardia to 120 bpm and her blood pressure is currently 65/40 mmHg. Which of the following would you MOST expect to see on an intraoperative transesophageal echocardiogram? Anterolateral regional wall dyskinesis Global left ventricular hypokinesis Patent foramen ovale Right ventricular dilation

answer

Right ventricular dilation

question

A 45-year-old woman with a history of hypertrophic cardiomyopathy is undergoing a total abdominal hysterectomy for fibroids. Which of the following is MOST consistent with reducing the pressure gradient across the left ventricular outflow tract? Decrease afterload Decrease heart rate Increase contractility Reduce preload

answer

Decrease heart rate

question

Actuation of the oxygen flush valve delivers 100% oxygen at a rate of: 10 - 20 L/min 20 - 30 L/min 35 - 75 L/min 80 - 100 L/min

answer

35 - 75 L/min

question

A 60-year-old man is undergoing a Type A aortic dissection repair under deep hypothermic circulatory arrest. His current temperature is 24°C and his uncorrected ABG shows pH 7.40, PaCO2 40 mmHg and PaO2 250 mmHg. Which of the following changes would you MOST expect If you were to adjust his ABG to his core body temperature of 24°C? PaCO2 increased, PaO2 increased PaCO2 decreased, PaO2 decreased PaCO2 increased, PaO2 decreased PaCO2 decreased, PaO2 increased

answer

PaCO2 decreased, PaO2 decreased

question

After a CABG, a 65-year-old man is hypotensive upon weaning from cardiopulmonary bypass. The surgeon is considering insertion of an intraaortic balloon pump for counterpulsation. Which of the following represents the MOST significant contraindication to placement of an intraaortic balloon pump? Aneurysm of left ventricle Aortic atheroma Aortic regurgitation Aortic stenosis

answer

Aortic regurgitation

question

Factors decreasing physiologic dead space include: the supine position anticholinergic agents increasing age emphysema

answer

the supine position

question

Which of the following is the LARGEST branch of the lumbar plexus? Femoral nerve Lateral femoral cutaneous Sciatic nerve Obturator nerve

answer

Femoral nerve

question

As compared with plasma osmolality, hypertonic crystalloid solutions include: D5W Ringer's lactate D5 0.25NS D5 0.45 NS

answer

D5 0.45NS

question

Which of the following BEST estimates the incidence of epidural spread following a lumbar plexus (psoas) block ? 0.1% 1% 16% 54%

answer

16%

question

Pathophysiologic changes associated with hypercortisolism include: (Select 2) hyperkalemia plasma volume depletion metabolic alkalosis hypoglycemia hypotension osteoporosis hyponatremia

answer

metabolic alkalosis, osteoporosis

question

You are in the maintenance phase of a 6-hour anesthetic for craniotomy for the resection of a craniopharyngioma. Urine output abruptly increases to over 1 liter/hour. What is the most appropriate next step in this patient's management? Maintain euvolemia and watch the base deficit Maintain euvolemia and check serial serum sodium levels Reduce fluid administration to reduce urine output Target hypervolemia by keeping ahead of urine output

answer

Maintain euvolemia and check serial serum sodium levels

question

A patient with a cerebral tumor and seizure disorder is being treated with phenobarbital for seizure prophylaxis. Which of the following is the MOST likely anesthetic implication of chronic phenobarbital? Etomidate is contraindicated Propofol is contraindicated Slower metabolism of hepatically metabolized drugs Rapid metabolism of hepatically metabolized drugs

answer

Rapid metabolism of hepatically metabolized drugs

question

The most consistent clinical manifestation of aspiration pneumonitis is: bronchospasm arterial hypoxemia pulmonary vasoconstriction tachypnea

answer

arterial hypoxemia

question

A full-term, 4.2 kg neonate is scheduled for a thoracotomy for resection of congenital lobar emphysema. The infant's starting hematocrit is 48%. Estimated allowable blood loss to maintain a hematocrit at or above 38% is: (Enter numerical answer)

answer

70 - 110 mL

question

A 55-year-old man is admitted with progressively worsening headache. Non-contrast head CT suggests cerebral venous sinus thrombosis and the diagnosis is confirmed by CT venography. He is treated with intravenous heparin but becomes more somnolent. Which of the following is the MOST appropriate management at this time? Add argatroban (direct thrombin inhibitor) Repeat head CT and send for endovascular therapy Add a glycoprotein IIb/IIIa inhibitor Increase heparin infusion to target a higher PTT

answer

Repeat head CT and send for endovascular therapy

question

During a craniotomy, a patient develops intraoperative diabetes insipidus. Which of the following is the MOST likely cause of central diabetes insipidus and what is the MOST appropriate treatment? Medullary compression; vasopressin Pontine injury; vasopressin Hypertonic saline; diuresis Hypophyseal injury; vasopressin

answer

Hypophyseal injury; vasopressin

question

Pancreatic somatostatin producing cells in the Islets of Langerhans are: alpha cells beta cells gamma cells delta cells

answer

delta cells

question

Ten hours after total thyroidectomy, a patient is found to be obtunded and cyanotic. The patient's SpO2 is 70%. What is the MOST likely etiology of this clinical deterioration? Acute hypocalcemia Bilateral recurrent laryngeal nerve injury Postoperative hematoma Tracheomalacia

answer

Postoperative hematoma

question

An 18-year-old man presents with pinpoint pupils, salivation, confusion, GI upset, and impending respiratory failure after performing yard work for a neighbor. Which of the following medications is MOST appropriate? Atropine Echothiophate Glycopyrrolate Physostigmine

answer

Atropine

question

A 55-year-old woman with seasonal allergies and history of Hepatitis C presents for elective inguinal hernia repair. She has no known drug allergies. General anesthesia is induced with fentanyl, propofol, and lidocaine. Endotracheal intubation is facilitated with succinylcholine after a 5 mg defasciculating dose of rocuronium. After intubation, ventilation is difficult with high pressures with dense wheezes bilaterally. The non-invasive blood pressure cuff reads 55/30 mmHg. The patient's skin appears flushed. Which of the following medications should MOST likely be administered first? Albuterol Diphenhydramine Epinephrine Phenylephrine

answer

Epinephrine

question

Causes of normal-anion-gap acidosis include: renal failure starvation diarrhea lactic acidosis

answer

diarrhea

question

Which of the following is the narrowest portion of the pediatric airway? Cricoid ring Glottic opening Nasal opening Posterior pharynx

answer

Glottic opening

question

Carbonic anhydrase inhibitors are used in the treatment of: acute glaucoma renal tubular acidosis diarrhea induced acidosis acidosis resulting from hypoventilation

answer

acute glaucoma

question

What is the MOST likely position of the larynx in a normal full term infant? C2-C3 C3-C4 C4-C5 C5-C6

answer

C3-C4

question

You are caring for a neonate with congenital diaphragmatic hernia and pulmonary hypertension. She is intubated and receiving inhaled nitric oxide (iNO). iNO reduces pulmonary vascular resistance by activating protein kinase G via cyclic GMP. This reduces which of the following intracellular ions? Calcium Magnesium Potassium Sodium

answer

Calcium

question

You are evaluating a 4-year-old boy for an urgent endoscopy. He was previously healthy and active but complained of a severe sore throat earlier today. His family elected to avoid vaccines for fear of autism. On exam, he is febrile and is sitting upright with his hands and on his knees with his neck extended. He is tachypneic and has excess salivation from is mouth. His voice is muffled and you note inspiratory stridor. Which of the following is the MOST likely explanation for his respiratory distress? Bacterial epiglottitis Foreign body Peritonsillar abscess Viral Croup

answer

Bacterial epiglottitis

question

Branches of the femoral nerve anesthetized during an ankle block include the: deep peroneal nerve sural nerve saphenous nerve posterior tibial nerve

answer

saphenous nerve

question

A 4-year-old boy with acute epiglottitis is receiving humidified oxygen by facemask. He has a functioning IV in his right hand. Which of the following is the MOST appropriate induction technique? Inhalation induction with sevoflurane Intravenous sedation with propofol Intravenous induction with propofol and rocuronium Intravenous induction with ketamine and rocuronium

answer

Inhalation induction with sevoflurane

question

Pulmonary complications from advanced hepatic disease with cirrhosis include: an obstructive ventilatory defect respiratory acidosis increased intrapulmonary shunting increased functional residual capacity

answer

increased intrapulmonary shunting

question

In which of the following cardiac conditions would a patient presenting in shock be LEAST likely to benefit from intra-aortic balloon pump (IABP) placement? A ruptured papillary muscle from a recent myocardial infarction A low ejection fraction of 10% secondary to ischemic cardiomyopathy Aortic valve endocarditis resulting in severe aortic insufficiency Severe aortic stenosis and congestive heart failure

answer

Aortic valve endocarditis resulting in severe aortic insufficiency

question

An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is: echinacea valerian ginkgo ephedra

answer

valerian

question

Assuming no other clinical risk factors, which of the following conditions should MOST be evaluated and treated prior to a 65-year-old patient undergoing elective hip replacement? Moderate mitral regurgitation resulting from a myocardial infarction 6 months ago New asymptomatic atrial fibrillation with a heart rate of 120 NYHA class III heart failure symptoms that have been present for the last year An uncomplicated myocardial infarction 2 months ago

answer

New asymptomatic atrial fibrillation with a heart rate of 120

question

A decrease in pseudocholinesterase activity has been associated with the use of: (Select 3) pancuronium esmolol droperidol vecuronium metoclopramide magnesium sulfate dantrolene rocuronium

answer

pancuronium, esmolol, metoclopramide

question

Which of the following is MOST likely to INCREASE a patient's mixed venous oxygen saturation? Administering a beta-blocker Inducing general anesthesia with a muscle relaxant Reducing the FiO2 so that the patient's SpO2 decreases 100% to 95% Removing 2 units of blood during acute normovolemic hemodilution (ANH)

answer

Inducing general anesthesia with a muscle relaxant

question

Regarding critically ill patients that require mechanical ventilation in the ICU, early tracheostomy after 4 days of mechanical ventilation compared to late tracheostomy after 10 days of mechanical ventilation is MOST associated with which of the following? Lower mortality Higher mortality No difference in mortality No difference in mortality but more ventilator days

answer

No difference in mortality

question

The formation of metanephrine is the result of: - catechol-O-methyltransferase metabolism of epinephrine - catechol-O-methyltransferase metabolism of norepinephrine - monamine oxidase metabolism of epinephrine - monamine oxidase metabolism of norepinephrine

answer

catechol-O-methyltransferase metabolism of epinephrine

question

Regarding neuromuscular blockade in the ICU, which of the following statements is MOST true? Decreased incidence of polyneuropathy and myopathy, potentially harmful in severe ARDS Decreased incidence of polyneuropathy and myopathy, potentially useful in severe ARDS Increased incidence of polyneuropathy and myopathy, potentially useful in severe ARDS Increased incidence of polyneuropathy and myopathy, potentially harmful in severe ARDS

answer

Increased incidence of polyneuropathy and myopathy, potentially useful in severe ARDS

question

A 50-year-old woman is undergoing a mitral valve repair. She has been taking garlic prior to surgery as an herbal supplement to reduce blood pressure and improve her overall health. She has significant mediastinal blood loss after separation from bypass. Which of the following effects can MOST be attributed to garlic? Increased fibrinolysis Increased consumption of coagulation factors Inhibition of the prothrombinase complex Inhibition of platelet aggregation

answer

Inhibition of platelet aggregation

question

An action potential characterized by a spike followed by a plateau phase is seen in: peripheral sensory nerve cells peripheral motor nerve cells striated skeletal muscle cells cardiac muscle cells

answer

cardiac muscle cells

question

An 80-year-old man has been in the ICU for 12 hours following an aortic valve replacement and has been on nitroprusside for control of hypertension. Which of the following is MOST responsible for the toxicity caused by nitroprusside? Accumulation of thiosulfate and cyanide Formation of cyanmethemoglobin Inactivation of cytochrome oxidase Production of thiocyanate

answer

Inactivation of cytochrome oxidase

question

A 79-year-old patient suffers an ascending aortic dissection and presents with acute pericardial tamponade physiology. The patient demonstrates pulsus paradoxus on his arterial waveform tracing. What physiologic event MOST accounts for this pulsus paradoxus? Increased systemic vascular resistance Reduced diastolic filling Shift of interventricular septum Tachycardia

answer

Shift of interventricular septum

question

During mediastinoscopy the risk of air embolization is greatest: when the patient is supine during spontaneous ventilation immediately after closure of the incision in the postoperative period

answer

during spontaneous ventilation

question

Which of the following MOST accurately reflects changes in lung volumes during pregnancy? Decrease in functional residual capacity (FRC) Decrease in vital capacity (VC) Increased expiratory reserve volume (ERV) Increased residual volume (RV)

answer

Decrease in functional residual capacity (FRC)

question

Autonomic hyperreflexia: is common with cord lesions below T8 can precipitate pulmonary edema is not effectively prevented by regional anesthesia can be prevented with adequate intraoperative sedation

answer

can precipitate pulmonary edema

question

In planning for the intubation of the full-term parturient patient who requires general anesthesia, which of the following is MOST correct? - Enlarged tracheal caliber due to changes in cartilage composition at term may necessitate selected of a larger ETT - Capillary engorgement of mucosal lining of the upper airway, including vocal cords and arytenoids, leads to tissue edema and may necessitate selection of smaller ETT - Pre-oxygenation for a full one minute should precede induction of general anesthesia - Anesthetic requirements may be greater

answer

Capillary engorgement of mucosal lining of the upper airway, including vocal cords and arytenoids, leads to tissue

question

Which of the following can be MOST expected from mask ventilation of the full-term parturient? Easier due to increased neck range of motion Easier due to increased chest wall compliance More difficult secondary to upper airway edema More difficult secondary to left uterine displacement positioning

answer

More difficult secondary to upper airway edema

question

Interpleural analgesia can be accomplished by placing local anesthetic: along the cephalad border of the T6 rib immediately deep to the parietal pleura immediately deep to the visceral pleura superficial to the internal intercostal muscle

answer

immediately deep to the parietal pleura

question

A patient with preeclampsia is receiving magnesium and has a magnesium level of 10 mEq/L. A magnesium level of 10 mEq/L is MOST associated with which of the following? Heart block Increased sensitivity to both depolarizing and non-polarizing muscle relaxants Therapeutic range for seizure prophylaxis No side effects

answer

Increased sensitivity to both depolarizing and non-polarizing muscle relaxants

question

A patient with a creatinine of 1.6 mg/dL is receiving IV magnesium for preeclampsia. The patient develops a widened QRS complex. After cessation of magnesium administration, which of the following is the MOST appropriate therapy? Calcium chloride Glucagon Kayexalate Propranolol

answer

Calcium chloride

question

The synthesis of acetylcholine from acetylcoenzyme A and choline is catalyzed by: free acetate anion choline acetyltransferase acetyl cholinesterase pseudocholinesterase

answer

choline acetyltransferase

question

Before going back to the OR for a hernia repair, a 75-year-old man with hypertension complains of chest pain. During your evaluation, he grabs his chest and falls to the floor unresponsive. He has no pulse and is not breathing. When providing chest compressions you should do which of the following? Provide compressions at least 90 times per minute Compress to a depth of 2 inches Rotate with relief person only when you begin to feel exhausted Keep EtCO2 above 20mmHg when endotracheal tube is placed

answer

Compress to a depth of 2 inches

question

Electrocardiographic changes seen with hypokalemia include: peaked T waves increasingly prominent U waves shortened PR interval with P wave inversion decreased QRS amplitude

answer

increasingly prominent U waves

question

You are called to intubate a patient in the emergency department who was found pulseless in front of the hospital. Which of the following is MOST correct regarding the use of cricoid pressure during endotracheal intubation in this scenario? Cricoid pressure should be used only if the victim is unconscious The routine use of cricoid pressure is not recommended Cricoid pressure should be used if the patient has food contents in mouth at the time of intubation Cricoid pressure should only be applied by trained personnel

answer

The routine use of cricoid pressure is not recommended

question

Closing capacity is defined as: closing volume + expiratory reserve volume functional residual capacity - residual volume closing volume + residual volume residual volume + expiratory reserve volume

answer

closing volume + residual volume

question

Which of the following is LEAST consistent with a Phase II block after succinylcholine? Fade with tetanic stimulation Post-tetanic potentiation Train-of-four ratio of 1.0 Total dose of succinylcholine >4 mg/kg

answer

Train-of-four ratio of 1.0

question

Dantrolene: (Select 2) depends on an extracellular mechanism to achieve muscle relaxation inhibits calcium ion release from the sarcoplasmic reticulum can also be used in the treatment of thyroid storm therapy should not be repeated after an MH episode has terminated has a half-life of approximately 12 hours

answer

inhibits calcium ion release from the sarcoplasmic reticulum, can be used in the treatment of thyroid storm

question

A 52-year-old man with a parathyroid adenoma presents for surgical resection. Which of the following ECG changes are MOST consistent with hypercalcemia? Peaked P-wave Peaked T-wave Short PR interval Short QT interval

answer

short QT interval

question

A 21-year-old healthy man is mechanically ventilated after an ORIF of a tibial plateau fracture. The addition of 15 cmH2O PEEP would MOST likely have which of the following cardiovascular effects? Increased LV afterload Increased LV preload Increased RV afterload Increased RV preload

answer

increase RV afterload

question

Renal effects of nitrous oxide include: decreased renal blood flow secondary to decreased cardiac output decreased renal blood flow secondary to increased renal vascular resistance increased renal blood flow secondary to sympathetic stimulation increased glomerular filtration with increased reabsorption

answer

decreased renal blood flow secondary to increased renal vascular resistance

question

A 50-year-old woman presents with chest pain, shortness of breath, and diaphoresis. She is found to have a large pericardial effusion. She has pulsus paradoxus. Which of the following accounts for the finding of pulsus paradoxus? Leftward shift of interventricular septum Rightward shift of interventricular septum Compression of left atrium Compression of right atrium

answer

Leftward shift of the interventricular septum

question

The elimination half-life of a drug: is inversely proportional to the clearance is inversely proportional to the volume of distribution is directly proportional to clearance is shortest in drugs that are rapidly redistributed

answer

is inversely proportional to the clearance

question

A 50-year-old woman presents with chest pain, shortness of breath and diaphoresis. She has pulsus paradoxus and is hypotensive. Which of the following echocardiographic signs is MOST SPECIFIC for cardiac tamponade? Left atrial collapse Right atrial collapse Right ventricular wall inversion Left ventricular wall inversion

answer

Left atrial collapse

question

Effects of lidocaine include: increased intracranial pressure increased refractory period of cardiac muscle decreased fibrinolysis myonecrosis

answer

myonecrosis

question

At what age does the clearance of morphine in pediatric patients reach adult values? 1 month 6 months 18 months 24 months

answer

6 months

question

Which of the following sequence of events MOST commonly occurs in drowning? Breath-holding, laryngospasm, involuntary ventilatory efforts, desaturation, muscular relaxation, inhalation of water, cardiac arrest Breath-holding, involuntary ventilatory efforts, inhalation of water, laryngospasm, desaturation, muscular relaxation, cardiac arrest Involuntary ventilatory efforts, laryngospasm, breath-holding, desaturation, muscular relaxation, inhalation of water, cardiac arrest Breath-holding, laryngospasm, involuntary ventilatory efforts, muscular relaxation, inhalation of water, desaturation, cardiac arrest

answer

Breath-holding, laryngospasm, involuntary ventilatory efforts, desaturation, muscular relaxation, inhalation of water, cardiac arrest

question

Correct statements concerning the use of antidepressants in pain management include: - analgesic effects require a higher dose than that needed for antidepression - analgesic effects appear to be secondary to the blockade of serotonin and norepinephrine reuptake - antidepressants are not effective in neuropathic pain - newer SSRIs are more effective analgesics than the older tricyclic antidepressants

answer

analgesic effects appear to be secondary to the blockade of serotonin and norepinephrine reuptake

question

What is the approximate sensitivity and specificity of the β-D-Glucan Assay for the diagnosis of invasive fungal infection (IFE)? ~ 50% sensitivity, ~ 95% specificity ~ 75% sensitivity, ~ 85% specificity ~ 95% sensitivity, ~ 95% specificity ~ 95% sensitivity, ~ 50% specificity

answer

~ 75% sensitivity, ~ 85% specificity

question

A 60-year-old man with a medically refractory seizure disorder has a generalized tonic clonic seizure complicated by aspiration pneumonia. He improves and his respiratory mechanics are compatible with extubation by ICU day #6. He is awake and alert; however, he has no leak around the endotracheal tube with the cuff deflated. What is the MOST appropriate management? Elective tracheostomy Proceed with extubation Methylprednisolone therapy prior to extubation Extubate over a tube changer, to facilitate re-intubation if necessary

answer

Methylprednisolone therapy prior to extubation

question

The dibucaine number: is normally less than 60% is a quantitative assessment of pseudocholinesterase activity is inversely proportional to pseudocholinesterase function reflects inhibition of pseudocholinesterase by dibucaine

answer

reflects inhibition of pseudocholinesterase by dibucaine

question

The body mass index (BMI) associated with morbid obesity is: > 30 > 35 > 40 > 45

answer

> 40

question

Which nerve provides sensory innervation to the airway below the level of the vocal cords? External branch of superior laryngeal nerve Internal branch of superior laryngeal nerve Glossopharyngeal nerve Recurrent laryngeal nerve

answer

Recurrent laryngeal nerve

question

Release of aldosterone by the adrenal cortex is stimulated by: (select 3) angiotensin I angiotensin II hypokalemia pituitary ACTH congestive heart failure hypervolemia

answer

angiotensin II, pituitary ACTH, congestive heart failure

question

Which of the following MOST accurately describes respiratory changes in pregnancy? Arterial blood gas analysis of the parturient can be expected to show a pH between 7.45-7.50 At term, minute ventilation is increased by 70% over pre-pregnancy levels Minute ventilation increases by approximately 50% during the first trimester PaO2 at full term is increased by 40% over pre-pregnancy levels

answer

Minute ventilation increases by approximately 50% during the first trimester

question

Renal blood flow: (Select 2) is largely determined by renal oxygen consumption accounts for 20 - 25% of the cardiac output is distributed mostly to juxtamedullary nephrons can be directed away from cortical nephrons by sympathetic stimulation is not autoregulated

answer

accounts for 20 - 25% of the cardiac output, can be directed away from cortical nephrons by sympathetic stimulation

question

Regarding motor innervation of the larynx, which of the following muscles is NOT innervated by the recurrent laryngeal nerve? Cricothyroid muscle Lateral cricoarytenoid muscle Thyroarytenoid muscle Posterior cricoarytenoid muscle

answer

Cricothyroid muscle

question

A 36-year-old female is scheduled for an elective cholecystectomy. Her past medical history is significant for depression treated with phenelzine (Nardil). Her anesthetic plan should include: (Select 2) discontinuation of phenelzine for at least 2 weeks prior to surgery the avoidance of indirect acting vasopressors the avoidance of propofol the avoidance of meperidine the avoidance of nitrous oxide the avoidance of volatile anesthetic agents

answer

the avoidance of meperidine, the avoidance of indirect acting vasopressors

question

Which of the following nerves provides sensory innervation to the pharynx? Internal branch of superior laryngeal nerve Recurrent laryngeal nerve External branch of superior laryngeal nerve Glossopharyngeal nerve

answer

Glossopharyngeal nerve

question

A 2-day-old boy with a lumbar meningomyelocele is scheduled to undergo surgical repair. Which of the following associated anomalies are MOST likely to occur with a meningomyelocele? Cleft palate Chiari malformation Radial anomalies Renal failure

answer

Chiari malformation

question

Neuroleptic malignant syndrome: can be precipitated with the use of metoclopramide carries a mortality of over 80% can be treated with physostigmine administration can be diagnosed with muscle biopsy

answer

can be precipitated with the use of metoclopramide

question

The most common complication of thoracic paravertebral nerve block is: hypotension subarachnoid injection pneumothorax intravascular injection

answer

pneumothorax

question

Which of the following is the MOST likely side effect of inhaled epoprostenol (Flolan)? Increased nitrogen oxides Methemoglobinemia Platelet dysfunction Systemic hypotension

answer

Platelet dysfunction

question

A 67-year-old man with no prior heparin exposure underwent an uneventful aortic valve replacement. Three days after surgery, the patient has an isolated and asymptomatic drop in platelet count > 50%. What is the probability of heparin-induced thrombocytopenia? 10%

answer

< 1%

question

At which point of the ECG cycle should an intraaortic balloon pump (IABP) inflate? P wave Q wave R wave T wave

answer

T wave

question

The formation clinically significant amounts of carbon monoxide has been associated with: the use of a non-rebreathing circuit the use of fresh carbon dioxide absorber the use of desflurane expiratory valve incompetence

answer

the use of desflurane

question

Which of the following local anesthetics has the LEAST amount of maternal-fetal transfer across the placenta? Bupivacaine 0.25% Chloroprocaine 3% Lidocaine 1.5% Ropivacaine 0.2%

answer

Chloroprocaine 3%

question

During an anterior-posterior spinal fusion, in a 70-kg patient, the laboratory reports an intraoperative hematocrit of 21% with a hemoglobin of 7g/dL. Two units of packed red blood cells are administered over the course of 30 minutes. Upon completion of the transfusion, the anticipated hematocrit will be approximately: (Enter numerical answer in box below. Click 'Next' when completed.)

answer

25-27

question

Which of the following coagulation factors has the SHORTEST half-life? Factor II Factor VII Factor IX Factor X

answer

Factor VII

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