Hall Anesthesia Practice Test

These questions are part of the practice quiz. Start practicing

• An patient with a new chest tube placement after central line change shows tachycardia and a sudden hemodynamic change; the most appropriate initial step is to:
• Chloroprocaine is classified as which type of local anesthetic?
• Which statement regarding potential untoward effects of lithium therapy is NOT true?
• Arrange the following local anesthetics by cardiotoxicity from most to least cardiotoxic: which is correct order?
• Which IV anesthetic agent is associated with the highest incidence of postoperative nausea and vomiting?
• After zeroing an arterial line at the transducer located 10 cm below the heart, how will the measured arterial pressure compare to the true arterial pressure?
• Which level of spinal cord injury is most associated with autonomic hyperreflexia?
• Clopidogrel (Plavix) inhibits which platelet receptor?
• Side effects of ritodrine include all of the following except:
• In a 75-year-old patient undergoing craniotomy for resection of a large astrocytoma, with a PaCO2 of 30 mmHg while on isoflurane, the global cerebral blood flow would be approximately which value?
• What is the typical adult VO2 in mL/kg/min?
• The dial of an isoflurane-specific, variable bypass, temperature-compensated, flowover, out-of-circuit vaporizer set on 2% yields 2% output at 700 mL/min. When the flowmeter is set to 100 mL/min and 15 L/min (dial still 2%), how will the outputs compare?
• Which opioid is unique in having both local anesthetic and narcotic properties?
• Which statement about umbilical catheterization is true?
• In a breathing mixture containing 50% helium and 50% oxygen with isoflurane present, how does helium affect the mass spectrometer reading of isoflurane concentration?
• Which nerve can be electrically stimulated at the ankle to produce flexion of the toes?
• Dopamine receptor affinity follows which order?
• Which statement about venous air embolism detection methods is true?
• A 20-kg, 5-year-old child with a hematocrit of 40% could lose how much blood and still maintain a hematocrit of 30%?
• In a patient with hemophilia A with factor VIII at 35% preoperatively, which preoperative therapy is most appropriate to prepare for elective surgery?
• Which intrathecal morphine dose provides analgesia similar to epidural 10 mg morphine?
• How many hours should elapse before performing a single-shot spinal anesthetic in a patient receiving enoxaparin 1 mg/kg twice daily for deep vein thrombosis?
• The pulmonary vascular resistance in newborns decreases to that of adults by which age?
• The Fontan procedure involves connecting which structures?
• Etomidate does all of the following EXCEPT which statement?
• Allergic reactions to protamine can occur with each of the following except?
• Normal intracranial pressure is considered to be less than which value?
• Which of the following is NOT a brain death criterion?
• What is an appropriate intravenous dose range for ondansetron in pediatric patients?
• Which structure is the narrowest part of the larynx in infants?
• Therapy for cerebral vasospasm includes all of the following except which of the following?
• During a midline spinal block at the L3-L4 level, which structure would the needle NOT pass through?
• The main reason for the difference between the dialed vaporizer concentration and the reading on the gas monitor after induction is?
• Which inhaled agent has the least hepatic metabolism?
• When intracranial hypertension exists, the main compensatory mechanism from the body is to
• Which premedication is associated with extrapyramidal side effects?
• Which intraoperative transesophageal echocardiography (TEE) view is best for monitoring myocardial ischemia?
• Which is not a typical sign of opioid withdrawal?
• Which airway device is commonly used to achieve one-lung ventilation during thoracic procedures?
• What is the normal FEV1/FVC ratio?
• A mechanical ventilator delivers a tidal volume of 500 mL at 10 breaths/min with an I:E ratio of 1:2 and fresh gas flow of 6 L/min. With a closed inspiratory valve, what is the actual tidal volume delivered to the patient?
• What is the most common cause of mortality associated with blood transfusion?
• Infants have more CSF than adults, which leads to which spinal anesthesia effect compared with adults?
• During a negative-pressure leak test, leaks are tested upstream from the check valve, including vaporizers and flow controls. True or False?
• How long after a stroke can anesthesia for surgery be carried out with about the same risk of a perioperative occlusive vascular accident as existed immediately before the previous stroke?
• Fluoride toxicity is associated with which inhaled anesthetic?
• An ABG from a patient with diabetic ketoacidosis shows pH 6.95, PaCO2 30 mm Hg, HCO3- 6 mEq/L. This pattern represents what acid-base disorder?
• How much local anesthetic should be administered per spinal segment to patients aged 20 to 40 receiving a lumbar epidural anesthetic?
• A venous blood sample from which site would correlate most reliably with PaO2 and PaCO2?
• Which electrolyte disturbance can occur with succinylcholine administration in neonates?
• Propofol infusion syndrome is thought to be related to a failure of which process?
• In the setting of heparin resistance due to antithrombin III deficiency, which agent can be used to restore heparin effectiveness?
• Which statement is NOT correct when advising the surgeon to perform infiltration anesthesia for an emergency cesarean delivery when general and neuraxial anesthesias are contraindicated?
• Admixture of room air into the waste gas disposal system during a paralyzed patient under general volatile anesthesia is best explained by which mechanism?
• Which statement about visceral pain from the abdominal viscera is false?
• Which statement about ketamine is FALSE?
• Which statement best describes the incidence of brady-dysrhythmias with succinylcholine given intramuscularly in neonates?
• Which local anesthetic is associated with methemoglobinemia?
• Which intravenous anesthetic is commonly associated with pain on injection and can cause severe hypotension in the elderly?
• In acute intermittent porphyria, which intravenous anesthetic class is contraindicated?
• The most common inherited bleeding disorder is which of the following?
• Which drug is contraindicated in a patient with acute intermittent porphyria undergoing anesthesia?
• Jervell-Lange-Nielsen syndrome is characterized by prolonged QT intervals and which additional feature?
• Chloroprocaine-induced severe back pain is associated with epidural anesthesia and
• If the bobbin in the O2 rotameter is not rotating, this most likely indicates what?
• Regarding hyperventilation in intracranial pressure management, which statement is true?
• At a rate of 6 breaths per minute with an I:E ratio of 1:2, what is the approximate inspiratory time for each breath?
• The compensatory shift of the oxyhemoglobin dissociation curve toward normal in chronic (>24 hours) respiratory alkalosis is due to what?
• What is the normal range for partial thromboplastin time (PTT)?
• Which inhaled anesthetic is commonly irritant to the airway and is associated with airway irritation during induction, particularly in smokers?
• The pressure and volume per minute delivered from the central hospital oxygen supply are which of the following?
• Which of the following is NOT a typical sign of malignant hyperthermia?
• Which drug may cause a systemic lupus erythematosus-like syndrome at high doses?
• Which Mapleson circuit is best for spontaneous ventilation?
• Which statement best describes the latency and duration when a mixture of chloroprocaine and bupivacaine is used for epidural anesthesia?
• In the O2 content equation, which term represents the oxygen bound to hemoglobin?
• A 40-kg, 10-year-old child with 50% TBSA burns requires fluid resuscitation in the first 24 hours. Using 4 mL/kg/% TBSA, what is the estimated volume?
• Which MEN subset is associated with pheochromocytoma, medullary thyroid carcinoma, and hyperparathyroidism (Sipple’s syndrome)?
• Which gas is typically not detected by standard mass spectrometers in anesthesia monitoring?
• Which is the most sensitive means of detecting venous air embolism?
• The leading direct cause of pregnancy-related deaths in the United States is:
• Changing the I:E ratio from 1:3 to 1:2 increases inspiratory time by about what percent?
• In patients with increased dead space, end-tidal CO2 (EtCO2) tends to do what relative to arterial CO2 (PaCO2)?
• Normal cerebral blood flow is approximately which value in mL/100 g/min?
• During a malignant hyperthermia crisis, which metabolic change is typically observed?
• Which finding is not a sign of severe preeclampsia?
• A 55-year-old with a right carotid bruit is scheduled for colonoscopy and polypectomy under general anesthesia. What is the most appropriate course?
• Which artery supplies the atrioventricular (AV) node in the majority of individuals?
• During nasotracheal intubation, extension of the neck tends to move the tube in which direction?
• Romano-Ward syndrome dysrhythmias can be effectively treated with which autonomic intervention?
• In carbon monoxide poisoning, tissue hypoxia occurs primarily because carboxyhemoglobin reduces oxygen delivery by causing which of the following?
• What is the mechanism by which 5% dextrose in water worsens intracranial pressure in neurosurgical patients?
• In the alveolar gas equation, which term represents the effect of CO2 elimination relative to metabolism?
• The anterior spinal artery originates from which arteries?
• In patients treated with echothiophate, the prolonged duration of succinylcholine is due to
• Which drug exerts its main central nervous system action by inhibiting NMDA receptors?
• Which wavelength combination correctly identifies deoxygenated and oxygenated hemoglobin in dual-wavelength sensing?
• The useful clinical range of neuromuscular blockade corresponds to what percent blockade?
• Which statement concerning local anesthetics is CORRECT?
• CPP is defined as mean arterial pressure minus the greater of which values?
• Why is bradycardia particularly concerning in pediatric patients during anesthesia?
• Select the correct order from greatest to least for anesthetic requirement.
• In a 70-kg patient, 1 unit of platelet concentrate should increase the platelet count by approximately which range?
• Motor innervation to the tonsils is provided by which nerve?
• An oxygen E cylinder contains 625 liters. Approximately 560 liters are deliverable. If the total gas consumption is 7 L/min, how long will the supply last?
• The vessel-rich group receives what percent of the cardiac output?
• What is the most common type of tracheoesophageal fistula?
• In a premature neonate with a left-sided congenital diaphragmatic hernia, during ventilation, sudden desaturation occurs. What is the most appropriate step?
• You prepare dopamine by mixing 200 mg in 250 mL of solution. What is the infusion rate in mL/hr needed to achieve 5 µg/kg/min for a 70-kg patient?
• Which structure in the antecubital fossa is the most medial?
• What is the PAO2 of a patient on room air in Denver with Patm 630 mm Hg, FiO2 0.21, PH2O 47, PaCO2 34 mm Hg, and respiratory quotient 0.8?
• All of the following are associated with acromegalic patients undergoing transsphenoidal hypophysectomy EXCEPT which statement?
• During surgery in the Trendelenburg position, a sudden drop in urine output is most likely due to which of the following?
• Laudanosine is a metabolite of which neuromuscular blocking agent?
• Which antidysrhythmic drug can cause hypothyroidism or hyperthyroidism?
• Which airway management option is most appropriate for suspected epiglottitis in a child with upper airway obstruction?
• Which structure is most likely involved in the acute bilateral blindness after a prolonged surgery in a morbidly obese patient who became hypotensive during a 6-hour procedure?
• Which treatment is LEAST useful for torsades de pointes?
• A healthy 1-month-old neonate is anesthetized for an inguinal hernia repair. The systolic blood pressure is 65 mm Hg and the heart rate is 130 beats/min. The most appropriate intervention would be:
• To minimize fetal bradycardia during reversal of neuromuscular blockade in obstetric patients, which combination is preferred?
• Which observation would NOT indicate intravascular injection with an epinephrine-containing caudal block solution?
• The afferent input for somatosensory evoked potentials (SSEPs) travels through which spinal cord tract?
• Benzocaine is unique among local anesthetics for which reason?
• If the internal diameter of an intravenous catheter were doubled, by what factor would the flow through the catheter change (assuming laminar flow and other conditions constant)?
• In a hypercalcemic patient undergoing anesthesia, what is the primary intraoperative risk?
• An otherwise healthy 3-month-old infant with a birth hemoglobin of 19 mg/dL has preoperative hemoglobin of 10 mg/dL. The most likely explanation for this anemia is?
• The most common cause of bronchiectasis is
• Nonanion gap metabolic acidosis can result from all of the following except:
• An axillary block performed with 30 mL of 0.75% bupivacaine results in seizure and ventricular fibrillation 15 minutes later. Which measure below is NOT indicated?
• For a 1-year-old with tetralogy of Fallot requiring elective surgery, which anesthetic would provide the most stable hemodynamics?
• The artery of Adamkiewicz most frequently arises from the aorta at which spinal level?
• If NEC develops in a neonate with an umbilical artery catheter, what is the recommended course of action regarding the catheter?
• The MAC for sevoflurane is similar in which age groups?
• In the O2 content equation, what does the coefficient 0.003 represent?
• Type O-negative whole blood contains which antibodies in its plasma?
• Which of the following is NOT a cause of fetal bradycardia?
• In the event of misfilling, what percent sevoflurane would be delivered from an isoflurane vaporizer set at 1%?
• Which of the following is the LEAST likely sequela of venous air embolism during posterior fossa surgery in the upright position?
• The half-life of pseudocholinesterase is
• Which statement correctly describes differences between fetal and maternal blood during labor?
• Meperidine is contraindicated in patients taking which Parkinson's disease medication?
• A 58-year-old patient presents with miosis, abdominal cramping, salivation, bradycardia, and muscle weakness. The most likely diagnosis is which condition?
• Which is the most likely cause of fetal bradycardia after reversal of muscle relaxants in a pregnant patient during surgery?
• What is the first symptom in the progression of an epidural abscess after neuraxial block?
• Which property most closely determines the rate of onset of an inhaled anesthetic?
• Ketamine would increase cerebral blood volume (CBV) through which mechanism?
• In a rotameter, at low gas flow, which physical property primarily governs the accuracy of the flow indication?
• The most common adverse cardiac event in the pediatric population is?
• How many milliliters of a 1:100,000 epinephrine solution can be injected submucosally safely without ventricular arrhythmias in a 70-kg patient?
• In acromegaly, which factors predispose to a difficult airway?
• Which drug would have the LEAST impact on somatosensory evoked potentials in a 15-year-old undergoing scoliosis?
• The Mapleson D breathing circuit is described as which type of breathing system?
• Which nerve supplies motor innervation to most intrinsic laryngeal muscles (except the cricothyroid)?
• In a myasthenia gravis patient with edrophonium challenge, if tidal volume decreases after administration, what is the most appropriate management step?
• Which system prevents attachment of gas-administering equipment to the wrong type of gas line?
• Which nerve provides sensory innervation to the vocal cords?
• Which drug produces alpha-adrenergic receptor and beta-adrenergic receptor blockade?
• All of the following are symptoms of a developing epidural hematoma EXCEPT
• In a Parkinson's disease patient with postoperative nausea, which antiemetic is best?
• If cardiac output and alveolar ventilation are doubled, the effect on the rate of rise of FA/FI for isoflurane compared with that which existed immediately before these interventions would be
• Which regional anesthesia technique is associated with the highest serum concentration of lidocaine?
• What is the normal global cerebral blood flow (CBF) in mL per 100 g of brain tissue per minute?
• One gram of hemoglobin can bind approximately how many milliliters of oxygen?
• Which intervention is LEAST likely to improve this patient's hemodynamics in hypertrophic obstructive cardiomyopathy during surgery?
• What is the most rapid maneuver available for lowering ICP in a patient with a large intracranial mass?
• In a placenta previa patient with hypotension and active bleeding, which induction agent would be preferred to maintain hemodynamics?
• Which reversal agent is most likely to cause postoperative bradycardia due to prolonged acetylcholine elevation?
• Damage to which nerve may lead to wrist drop?
• A 65-year-old patient with COPD and CAD undergoes an uneventful appendectomy under general anesthesia. In the recovery room, ABGs show PaO2 60 mm Hg, PaCO2 50 mm Hg, pH 7.35, and Hb 8.1 g/dL. Which intervention would most increase oxygen delivery to the myocardium?
• Calculate the anion gap for Na 138, Cl 115, HCO3- 12. What is the value?
• Discharge criteria from the PACU would be reached fastest after a 20 to 30 mL volume of which epidurally administered local anesthetic?
• Which factor best explains why desflurane is often favored for rapid emergence?
• A 6-year-old child is given droperidol and develops extrapyramidal symptoms. The most appropriate drug for treatment is
• In a cholinergic crisis due to myasthenia gravis after edrophonium challenge, which intervention primarily addresses muscarinic symptoms?
• According to Gay-Lussac’s law, if the ambient temperature decreases by 2°C from body temperature, the gas pressure changes by approximately what percentage?
• In neonates with CDH, what is the purpose of inserting an orogastric or nasogastric tube?
• Adenosine is rapidly metabolized and its effects are not influenced by liver or renal dysfunction. Which statement is true?
• Discontinuation of 1 MAC of one volatile followed by immediate introduction of 1 MAC of a second volatile would temporarily result in the greatest combined anesthetic potency.
• In a patient with extrinsic midtracheal compression causing obstruction, what is the type of airflow at the site of obstruction in the trachea?
• Select the TRUE statement concerning administration of glucose-containing solutions to the patient with a closed head injury versus a patient with a spinal cord injury.
• Ketorolac exerts its analgesic effects at which part of the afferent pathway?
• Ketorolac is contraindicated in scoliosis surgery primarily because of its effect on...
• Amide local anesthetics typically have which letter immediately before 'caine' in their name?
• The splitting ratio of vaporizer gas depends on which property of the volatile anesthetic?
• Useful therapy for hypercyanotic 'tet spells' in patients with tetralogy of Fallot might include any of the following EXCEPT:
• Which mechanism best describes how neostigmine reverses nondepolarizing neuromuscular blockade?
• Which finding would be a relative contraindication to tracheal resection?
• The transgastric mid-papillary left ventricular short-axis view images the myocardium supplied by which arteries?
• Which muscle relaxant causes slight histamine release at 2 to 3 times the ED95 dose?
• Recovery of neuromuscular function from nondepolarizing blockers occurs primarily by which process?
• The cerebral blood flow autoregulatory curve is shifted to the right by which condition?
• The more rapid onset and shorter duration of fentanyl relative to morphine is primarily due to which property?
• Which reversal agent is associated with fetal bradycardia due to placental transfer when reversing anesthesia in pregnancy?
• The stellate ganglion lies in closest proximity to which vascular structure?
• In an 89-year-old man with transient ischemic attacks undergoing carotid endarterectomy under general anesthesia, which management is appropriate?
• How would a right mainstem intubation affect the rate of increase in arterial partial pressure of volatile anesthetics?
• A 54-year-old female is awakened in the OR after thyroidectomy and develops severe stridor two days later. The most likely cause of airway obstruction is
• Inhalational anesthetics that decrease arterial pressure primarily by reduction in left ventricular afterload include each of the following EXCEPT:
• Which color corresponds to Nitrogen?
• A decrease in PaCO2 of 10 mm Hg will result in which change in serum potassium concentration?
• Excessive hyperventilation may cause cerebral vasoconstriction that reduces cerebral blood flow; which statement is true?
• Hetastarch interferes with coagulating through interacting with which coagulation factor?
• During a posterior cervical fusion performed in the sitting position, sudden air detected by precordial Doppler is most consistent with which condition?
• The Mapleson D breathing circuit is FALSE in which statement?
• Which of the following best describes the duration of action of naltrexone compared to naloxone?
• During placement of an epidural in an elderly patient with sharp pain radiating down the leg as the catheter is inserted to 2 cm, what is the most appropriate action?
• A 58-year-old woman is awaiting orthotopic liver transplantation for primary biliary cirrhosis in the ICU. An oximetric pulmonary artery catheter is placed and an SVO2 of 90% is measured. Which of the following blood pressure interventions is the LEAST appropriate for treatment of hypotension in this patient?
• In this emergency cesarean section for a pregnancy with asthma, which induction agent is most appropriate for rapid sequence induction?
• A full oxygen cylinder contains approximately how many liters?
• Amrinone functions as a phosphodiesterase III inhibitor, resulting in increased intracellular cAMP and what combined effect?
• Which pulmonary function test is least dependent on patient effort?
• Which statement concerning peripheral nerve structure and function is FALSE?
• Which intravenous drug is associated with thrombosis and phlebitis but has a specific antagonist available?
• Which nondepolarizing drug is known to release histamine and is often avoided when histamine release is undesirable?
• Which of the following lung changes increases with age?
• In malignant hyperthermia, which sign typically appears earlier than fever and is considered an early indicator?
• In a patient with a left-to-right intracardiac shunt, accidental venous air embolism is more likely to be directed toward the pulmonary circulation rather than arterial circulation because which statement is correct?
• Where is the V5 lead placed?
• Which sign is commonly associated with neonatal hypocalcemia?
• Which epidural dose of bupivacaine will give similar sensory analgesia as 10 mL of 2% lidocaine?
• Anesthesia is induced in a 50-year-old man; peak airway pressure rises after initial intubation. The most likely cause is?
• At serum magnesium levels of 5 to 10 mEq/L, which electrocardiographic change is seen?
• Which volatile anesthetic is not an ether derivative?
• At high altitudes, what is the behavior of a rotameter flow for gas through the device?
• Clopidogrel's antiplatelet effect lasts for the life of the platelets because it irreversibly inhibits which receptor?
• Mapleson D breathing circuits are not circle systems and do not preserve which of the following?
• Which inhaled anesthetic is associated with a higher risk of ventricular arrhythmias when submucosal epinephrine is used?
• During one-lung ventilation with a double-lumen endotracheal tube, which maneuver is least likely to raise the PaO2 after proper tube placement?
• In the described intraoperative setting, the rationale for administering 5 to 10 mg of furosemide is to offset the effects of increased antidiuretic hormone (ADH).
• Which treatment would NOT restore a prolonged prothrombin time (PT) to the normal range?
• In the context of ocular perfusion, when intraocular pressure is elevated, ocular perfusion becomes more dependent on which systemic parameter?
• A size E cylinder filled with nitrous oxide stores about 1590 L at approximately what pressure?
• Which pair of local anesthetics are commonly used for Bier blocks (IV regional anesthesia)?
• Which blood type is the most appropriate for further intraoperative transfusions in this scenario?
• Disadvantage of using propofol for prolonged sedation (days) of intubated patients in the ICU is potential:
• Which agent is contraindicated in asthmatics?
• Which inhalation anesthetic does NOT produce uterine relaxation?
• Which set of parameters represents ideal management for high filling pressures, high SVR, and fast heart rate in anesthesia?
• The action of epidural narcotics is antagonized by the prior or concomitant administration of which of the following epidurally administered local anesthetics?
• Which option would NOT reduce trace gas pollution in the operating room?
• Analgesia (supraspinal and spinal) is mediated by which receptor combination?
• In thermodilution cardiac output measurement, which parameter primarily determines the cardiac output?
• In hyperkalemia, which ECG change represents a late stage?
• Vaporizers for which of the following volatile anesthetics could be used interchangeably with accurate delivery of the concentration set on the vaporizer dial?
• Preoperative hypotension in various age groups is defined as which of the following statements?
• Intrapulmonary shunt scenarios, which statement about the alveolar-arterial (A-a) gradient is true?
• Which equals the anti-inflammatory activity of 50 mg of prednisone (Deltasone)?
• Following a severe head injury with extreme micrognathia and obesity, which airway technique is acceptable?
• In treating venous air embolism during posterior fossa surgery in the sitting position, which maneuver is NOT appropriate?
• After low-dose LMWH prophylaxis, how long should you wait before performing neuraxial anesthesia techniques?
• In patients with increased intracranial pressure, hyperventilation to a PaCO2 of 30–35 mm Hg is limited because it may be associated with which outcome?
• Scopolamine should not be given as a premedication in patients with which neurologic disease?
• Malignant hyperthermia and neuroleptic malignant syndrome share several features. Which characteristic is NOT shared?
• Orifice flow occurs through regions of severe constriction. Which option correctly identifies this condition?
• In the alveolar gas equation, what is PH2O value at body temperature used in the equation?
• Selective inhibition of serotonin and norepinephrine reuptake is the mechanism of which drug used to treat neuropathic pain?
• Magnesium sulfate used as anticonvulsant and tocolytic may produce all of the following except:
• In obstructive airway disease, an FEV1/FVC ratio less than 70% indicates which level of obstruction?
• Remifentanil is metabolized primarily by which mechanism?
• Anesthetics that decrease ICP include which of the following?
• Which neuromuscular blocker tends to increase heart rate and mean arterial pressure?
• The pH of commercially available thiopental is which value?
• Which statement best describes cerebral autoregulation with respect to mean arterial pressure?
• Which beta-adrenergic antagonist is nonselective for both beta1 and beta2 receptors?
• Which agent is a known trigger for malignant hyperthermia?
• A patient develops numbness in the arm after an interscalene brachial plexus block. The most likely cause is which?
• Increased total lung capacity is most consistent with which condition?
• Clonidine can be used as an adjuvant in spinal anesthesia to prolong sensory block.
• A 25-year-old unconscious patient has PaO2 190 mmHg with an SpO2 of 90%. The most likely explanation is the presence of which factor?
• Pheochromocytoma can show an autosomal dominant inheritance pattern. Which description matches this pattern?
• Vaginal delivery is associated with a blood loss of about?
• The common element thought to be present in every cauda equina syndrome after continuous spinal anesthesia is?
• Ketamine's effect on uterine tone is:
• Which statement about the distribution of alveolar ventilation in upright lungs is true?
• Pain at the intravenous injection site is least with which agent?
• What is the typical pressure of the hospital oxygen pipeline in a anesthesia system?
• Which condition describes maternal new onset vaginal bleeding that stops, with no pain and no fetal distress?
• Which statement is correct regarding fetal hemoglobin compared to maternal hemoglobin?
• What is the greatest predictor of sleep apnea in adults?
• Which statement about dibucaine numbers is true?
• Which patient is most likely to require an emergency hysterectomy for uncontrolled bleeding at delivery?
• In the equation SVR = (MAP - CVP) / CO × 80, what is the conversion factor used to convert units to dynes·s·cm^-5?
• For rapid onset of an inhaled anesthetic, which property is most favorable?
• Regarding MgSO4 therapy for preeclampsia, which statement is true?
• In an emergency where the oxygen flush is pressed at a remote location, which component is NOT bypassed during 100% oxygen delivery?
• Which statement about tricyclic antidepressants in patients receiving general anesthesia is TRUE?
• Which drug class blocks the conversion of angiotensin I to angiotensin II?
• Four days after a left total hip arthroplasty, an obese 62-year-old woman develops severe back pain in the region of the epidural block. The pain progresses with radicular pain down the leg over 72 hours. The most likely diagnosis is
• Which statement about Flumazenil is true?
• In liver transplantation, the phase with the greatest hemodynamic instability is the?
• In addition to the postural component, which sign is NOT typically associated with postdural puncture headache?
• Cauda equina syndrome has occasionally developed when an epidural dose was unintentionally injected into the subarachnoid space most commonly with which local anesthetic?
• In tetralogy of Fallot, which intraoperative strategy most effectively reduces the magnitude of the right-to-left intracardiac shunt?
• A patient with which eye disease would be at greatest risk for retinal damage from hypotension during surgery?
• The incidence of NEC in newborns weighing less than 1500 g is approximately what percentage?
• Variable decelerations are most commonly associated with which cause?
• Hemoglobin contributes approximately what fraction of the buffering capacity of blood?
• The prothrombin time primarily assesses which coagulation pathway?
• Systemic inflammatory response syndrome differs from sepsis in that patients with SIRS have which of the following?
• Which statement about postdural puncture headaches is true?
• Termination of action of the neurotransmitter norepinephrine is achieved predominately by which mechanism?
• During arterial line monitoring with the transducer at the level of the heart, if the patient raises both arms so the wrist is 20 cm above the heart, what is the true arterial BP?
• With which inhalational agent is cardiac output moderately increased?
• What is the maximum FIO2 that can be delivered by a nasal cannula?
• Which factor would have the greatest effect on the sensory blockade level after a subarachnoid injection of hyperbaric 0.75% bupivacaine?
• A 45-year-old obese male is in the ICU after an elective open lung biopsy. Which would provide the best prophylaxis against deep vein thrombosis?
• Differences in onset time between an epidural block using 3% 2-chloroprocaine and 2% lidocaine are primarily due to which property?
• After induction and intubation, if the O2 saturation falls and the pipeline oxygen pressure is 65 psi while the machine’s O2 tank reads 2100 psi, what is the next appropriate step?
• Why is a lower caudal block volume used in neonates compared with older children?
• Methylene blue is used to treat methemoglobinemia.
• The etiology of cerebral palsy occurs most frequently during which period?
• Placental abruption is classically described as which type of vaginal bleeding?
• Which of the following is NOT a compensatory mechanism for maintaining intracranial volume during intracranial hypertension?
• Carrying out induction in a different city would have what reliable effect on the rate of inhalation induction?
• Which drug can prevent tachyarrhythmias in patients with WPW syndrome?
• The significance of Immunoglobulin A antibodies in transfusion medicine is related to which reaction?
• During ventilation with a peak airway pressure of 50 cm H2O and PEEP of 5 cm H2O in a patient with VT of 600 mL and rate 14/min, which change most effectively reduces peak airway pressure without compromising alveolar ventilation?
• A prolonged neuromuscular block with succinylcholine is not seen in which scenario?
• Which of the following respiratory parameters is NOT increased in the parturient?
• A 5-week-old infant with projectile vomiting and severe dehydration is brought to the OR for pyloromyotomy. The most appropriate anesthetic management would be:
• In the oxygen content example, what is the absolute increase in O2 content when PaO2 rises from 120 to 150 with Hb 15 g/dL and SaO2 100%?
• In the context of altered dead space and capnography, which statement is correct about ventilation-perfusion mismatch?
• Which medication is NOT useful in the immediate management of status asthmaticus?
• Autoregulation is abolished by which of the following?
• Which statement about bladder temperature during cardiac surgery is true?
• An oximetric pulmonary artery catheter shows a mixed venous O2 saturation decrease from 75% to 60%. Which could account for the decrease EXCEPT?
• Which statement best describes metformin and phenformin?
• The main disadvantage of Sugammadex compared with neostigmine is it is not effective with which type of relaxants?
• Which muscle of the larynx is innervated by the external branch of the superior laryngeal nerve?
• Which term refers to myocardial relaxation or diastole?
• Which factor is NOT associated with an increased risk of sickling in patients with sickle-cell disease?
• In infants, the larynx is located at which vertebral level?
• In a premature neonate undergoing emergency repair of a left diaphragmatic hernia, which artery is suitable for preductal arterial blood sampling?
• A patient has an end-tidal CO2 of 35 mm Hg while an arterial blood gas drawn at the same moment shows a PaCO2 of 45 mm Hg. Which of the following is the least plausible explanation for this discrepancy?
• What is the most common side effect of intraspinal narcotics in the obstetric population?
• The blood volume of a 10-kg, 1-year-old infant is approximately:
• Select the true statement about spinal anesthesia in infants vs adults: dose and duration?
• Which nerve may be anesthetized during deep cervical plexus block and cause diaphragmatic paralysis if bilateral blocks are performed?
• If the venous return cannula is inserted too far into the superior vena cava during CPB, which venous structure is most likely obstructed?
• Which drug is most appropriate to treat hypotension in a patient with hypertrophic obstructive cardiomyopathy after induction?
• Reversal of chest wall rigidity at induction in a patient with fentanyl-induced rigidity should be achieved with which agent?
• Which statement about necrotizing enterocolitis (NEC) is NOT true?
• Which region of the foot is primarily innervated by the posterior tibial nerve branches?
• Which muscle relaxant inhibits the reuptake of norepinephrine by the adrenergic nerves?
• Intracranial hypertension is defined as a sustained increase in ICP above which threshold?
• Which observation would be considered a positive test dose response to an epinephrine-containing local anesthetic solution?
• Which drug should be avoided to treat hypotension in carcinoid disease due to release of vasoactive substances?
• A No. 6 endotracheal tube indicates which size?
• What percentage of neuromuscular receptors could be blocked and still allow a patient to perform a 5-second head lift?
• Estimated blood volume (EBV) is commonly approximated as 70 mL per kilogram of body weight in pediatric patients. For a 20 kg child, which EBV value is closest?
• Which statement about safe storage of compressed-gas cylinders is FALSE?
• The fundamental difference between microshock and macroshock is related to which of the following?
• Intraoperative awareness under general anesthesia can be eliminated by closely monitoring which of the following?
• Which statement is true regarding the relationship between PaCO2 and cerebral blood flow?
• If naloxone is given to a patient receiving ketorolac for postoperative pain, the most likely result would be?
• During treatment of a seizure induced by lidocaine during an interscalene block, which rationale for hyperventilating with 100% O2 is incorrect?
• Which commonly used uterotonic is safe to use in an asthmatic with severe preeclampsia to treat uterine atony?
• According to NIOSH regulations, the highest concentration of volatile anesthetic contamination allowed in the OR atmosphere when administered with N2O is which of the following?
• Isoflurane, when administered to healthy patients in concentrations less than 1.0 MAC, will decrease all the following EXCEPT:
• At which intravenous dopamine dose range does renal blood flow increase?
• Which post-thyroidectomy complication is NOT typically associated with upper airway obstruction?
• Which opioid is noted for anticholinergic properties and is sometimes described as the 'weird uncle' of the opioid family?
• Which mechanism terminates the neuromuscular effects of an intubating dose of vecuronium?
• A patient under general anesthesia with hypothetical core body temperature 35°C has a PaO2 of 77 mm Hg. The corrected PaO2 would be closest to which value?
• Which nerve is NOT derived from the sacral plexus among the following options?
• A mechanically ventilated patient is transported with a portable ventilator using 2 L/min of oxygen to run valves and drive the ventilator. If an E cylinder gauge reads 2000 psi, and the patient’s VT is 500 mL at 10 breaths/min, how long could ventilation continue if the ventilator requires 200 psi to operate and the cylinder holds 625 L?
• A needle introduced 1.5 cm inferior and 1.5 cm lateral to the pubic tubercle will be in close proximity to which nerve?
• A central venous catheter tip placed in the superior vena cava is withdrawn so that it lies just proximal to the SVC. In which vessel is the catheter tip now located?
• Which finding would be least consistent with mainstem intubation after endotracheal intubation?
• Cardiogenic shock has the greatest impact on the rate of increase in FA/FI for which volatile anesthetic?
• Which drug is a potent uterine relaxant and is rarely used in obstetrics because it can cause increased hemorrhage?
• Which rotameter statement is true?
• Between sevoflurane and halothane, which has the higher vapor pressure based on the provided values?
• Guanethidine lowers blood pressure by which mechanism?
• Which statement describes the effect of increasing cardiac output on the rate of inhalation induction?
• The effects of clopidogrel (Plavix) can be reversed with
• Which agent among the following reduces CSF production?
• Which blood product is most associated with bacterial sepsis due to room-temperature storage?
• Succinylcholine, when given to patients with renal failure, will increase serum potassium by approximately
• Which type of insulin preparation has the fastest onset of action when administered subcutaneously?
• Intravascular injection of local anesthetic most likely leads to CNS toxicity such as seizures. Which option reflects this risk?
• Clindamycin is part of which antibiotic class that can augment neuromuscular blockade?
• A 27-year-old patient scheduled for foot surgery is evaluated for euthyroid status. Which laboratory test is most useful to determine euthyroid function?
• A modern isoflurane-specific vaporizer is described as variable bypass, flowover, temperature-compensated, out-of-circuit. This statement is:
• At what inspiratory pressure should an endotracheal tube leak occur in an infant?
• After repair of a ruptured abdominal aortic aneurysm, a patient on PEEP develops sudden hypotension and desaturation. The most likely cause is?
• Which medication is associated with pericardial effusion and cardiac tamponade?
• Which factor is NOT associated with an increased risk of pulmonary artery rupture in patients with a pulmonary artery catheter?
• What is a first-line pharmacologic treatment to stabilize cardiac membranes in hyperkalemia?
• The most common initial symptom of esophageal atresia with tracheoesophageal fistula is:
• The P50 of sickle cell hemoglobin is
• Which formula is commonly used to estimate endotracheal tube depth in children?
• Which statement is FALSE regarding autonomic hyperreflexia?
• Rapid-sequence induction in a pediatric patient with severe gastroesophageal reflux is used primarily to minimize what risk during induction?
• For rapid-sequence induction in a patient with cerebral palsy and severe gastroesophageal reflux, which neuromuscular blocker is preferred at RSI dose?
• Flumazenil has a short elimination half-time, which may lead to what phenomenon?
• Which antihypertensive drug used to treat severe pregnancy-induced hypertension is not associated with increased postpartum hemorrhage?
• An obese 39-year-old female undergoing abdominal hysterectomy with Trendelenburg positioning develops desaturation when the head is flexed. What is the most likely explanation for this desaturation?
• Which statement about tramadol's reversal with naloxone is true?
• Which of the following will shift the oxyhemoglobin dissociation curve to the Right EXCEPT?
• A dilated right pupil observed during surgery is most likely due to which cause?
• Which drug is best for treating hypotension in the setting of severe acidemia?
• In carbon monoxide poisoning, pulse oximetry readings can be misleading; which statement is true?
• A 75-year-old male patient is scheduled to undergo elective orchiectomy for prostate cancer. The patient has selected spinal anesthesia. What is the minimum dermatomal level that must be achieved to carry out this operation?
• All the following agents inhibit cerebrospinal fluid production EXCEPT which one?
• Two days after a spinal anesthesia for knee surgery, a patient reports a severe unilateral headache not posture-related. The LEAST likely cause is which?
• Which congenital anomaly is least commonly associated with other congenital abnormalities?
• Which pharmacologic agent would have the LEAST effect on somatosensory evoked potentials?
• Which obstetric condition most frequently requires blood transfusions during or after cesarean delivery?
• Untoward effects associated with administration of sodium bicarbonate during massive blood transfusion include each of the following EXCEPT:
• Which of the following is not increased during pregnancy?
• Compared with adult hemoglobin, fetal hemoglobin has a left-shifted dissociation curve, which means what about oxygen affinity?
• An increase in [HCO3-] of 10 mEq/L will result in an increase in pH by approximately how much?
• Under 1.2 MAC of sevoflurane or isoflurane anesthesia, what is the maximum epinephrine dose (in micrograms) that can be injected submucosally without ventricular arrhythmias in a 70-kg patient?
• Treatment of hypotension in a patient with metastatic carcinoid undergoing surgery would be best accomplished with which medication?
• Which characteristic is used to calculate the time constant for volatile anesthetics?
• A 31-year-old patient has been in the ICU on a ventilator for 24 hours after a motor vehicle accident. The patient does not open his eyes to any stimulus and has no verbal or motor response. The Glasgow Coma Scale corresponding to this patient would be
• Which concentration corresponds to a 1:200,000 epinephrine mixture?
• Halothane does not cause tachycardia because it:
• Which pulsus finding is associated with cardiac tamponade?
• Which organ is NOT considered a member of the vessel-rich group?
• An umbilical arterial blood gas with PO2 20 mm Hg, PCO2 50 mm Hg, HCO3 22 mEq/L, and pH 7.25 is interpreted as which category?
• Do intravenous anesthetics abolish the cerebrovascular response to CO2 changes?
• The compensatory shift toward normal in chronic respiratory alkalosis is mediated by changes in which erythrocyte metabolite?
• Adverse effects (on the mother) associated with aortocaval compression by the gravid uterus include
• Which portion of the upper extremity is not innervated by the brachial plexus?
• Which nail polish color would have the greatest effect on the accuracy of dual-wavelength pulse oximeters?
• For each 1°C decrease in body temperature, by what percentage is CMRO2 diminished?
• Chloroprocaine is an ester local anesthetic that is rapidly metabolized by which enzyme?
• Pheochromocytoma is most likely to coexist with which endocrine tumor?
• Visceral pain from thoracic or abdominal organs is transmitted by which nerve fibers?
• Which CNS injury complication is most associated with hyponatremia due to natriuresis after brain injury?
• A 28-week gestational age infant is born to heroin-using mother; the infant's respiratory depression would be best managed by?
• Anomalies and features associated with Down syndrome include:
• What is the primary function of the line isolation monitor in the operating room?
• In the O2 content equation, which term represents dissolved oxygen content?
• Which nerve originates from the cervical plexus rather than the trigeminal nerve?
• During needle manipulation for a supraclavicular brachial plexus block, a patient develops chest pain and dyspnea. The most likely diagnosis is:
• Which scenario carries the least risk of venous air embolism during removal of a central line?
• If PaO2 increases significantly while SaO2 remains 100%, which component of O2 content increases?
• In evaluating a 19-year-old undergoing emergency mandibular fracture repair, which information would be LEAST useful in ruling out malignant hyperthermia?
• Which drug is most associated with tachycardia due to autonomic ganglia stimulation?
• In cardiac pacemaker coding, what does the second letter represent?
• During somatosensory evoked potential monitoring, an increase in latency and a decrease in amplitude could be explained by all of the following EXCEPT
• Low-molecular-weight heparin is best monitored by which laboratory test?
• Arrange the percutaneous insertion sites for pulmonary artery catheter from nearest to farthest.
• Which factor most contributed to a prolonged neuraxial block when using bupivacaine described as lasting 8 to 12 hours with a large volume and epinephrine added?
• The dose of adenosine necessary to convert paroxysmal supraventricular tachycardia to normal sinus rhythm should be initially reduced in which scenario?
• Which reversal agent crosses the placenta slightly and may contribute to fetal bradycardia?
• Which of the following is NOT a characteristic of beta-2 receptor stimulation?
• A 45-year-old woman experiences progressive deterioration several days after subarachnoid hemorrhage treated with clip ligation. The most likely cause is which condition?
• A ventilator pressure-relief valve stuck in the closed position can result in which complication?
• Which of the following procedures in a 5-year-old child would have the least incidence of postoperative nausea and vomiting?
• Atropine causes each of the following EXCEPT which?
• Which of the following will alter the position or slope of the CO2-ventilatory response curve EXCEPT?
• Pulmonary vascular resistance is calculated as which formula?
• The Mapleson D circuit design includes which feature?
• The O2 pressure sensor shutdown valve requires what O2 pressure to remain open and allow N2O to flow into the N2O rotameter?
• Cesarean delivery is associated with a blood loss of about?
• During pregnancy, which change occurs in the heart?
• The true statement concerning thermoregulation in neonates is which of the following?
• Which facial muscle serves as the clinical indicator of adequate paralysis for intubation?
• Which of the following is most likely to be associated with a falsely elevated SaO2 as measured by pulse oximetry?
• In cardiac pacemaker coding, what does the first letter represent?
• Which statement about insulin transfer across the placenta in pregnancy is true?
• In an 18-year-old preeclamptic patient with back pain after epidural for labor analgesia and greater-than-expected leg weakness, what is the most appropriate next step?
• Under max stress, what is the approximate daily production of cortisol in adults?
• Which local anesthetic is rarely used for epidural anesthesia?
• Which of the following is NOT part of tetralogy of Fallot?
• A 55-year-old man undergoing liver surgery develops metabolic acidosis with pH 7.17, HCO3- 12, Cl- 119, Na+ 145, base deficit -11 after receiving large volumes of fluids. The most likely cause is?
• The most important buffering system in the body is which of the following?
• Carbon monoxide poisoning causes a leftward shift of the oxyhemoglobin dissociation curve. Which option correctly describes this effect?
• Select the FALSE statement regarding noninvasive arterial blood pressure monitoring devices.
• The most sensitive test for detecting primary hypothyroidism in the preoperative evaluation is which of the following?
• Which statement about sudden infant death syndrome (SIDS) is true?
• In SSEPs during spinal cord ischemia, how is the waveform affected?
• Which alpha-adrenergic antagonist produces an irreversible blockade?
• Pharmacologic agents that might reduce pulmonary vascular resistance in primary pulmonary hypertension include all of the following except which?
• Which of the following antibiotics does NOT augment neuromuscular blockade?
• Which property of morphine explains its greater risk of delayed respiratory depression after epidural administration?
• Ciprofloxacin for 60 days is used as prophylaxis for exposed patients for which disease?
• What is the compression factor for the described ventilator circuit delivering 750 mL at 10/min with 6 L/min measured ventilation and 30 cm H2O peak pressure?
• What is the O2 content of whole blood with Hb 10 g/dL, PaO2 60 mm Hg, and SaO2 90%?
• Which drug shows little change in systemic vascular resistance with mild increases in heart rate and mean arterial pressure?
• With neuraxial anesthesia, which nerve fiber type is blocked first?
• For infants with CDH, which ventilation approach has been associated with better outcomes?
• Which statement about non-invasive positive pressure ventilation is false?
• By what percentage is tissue metabolic rate reduced during cardiopulmonary bypass at 30 degrees Celsius?
• Which rotameter flow indicator is read in the middle of the dial?
• An 8-hour-old, 1600-gram neonate shows twitching movements and signs consistent with hypocalcemia. The most appropriate course of action is to administer which of the following?
• The most appropriate combination of drugs, in terms of a stable heart rate, during reversal of nondepolarizing neuromuscular blockade is which?
• What is the most common reason for admitting outpatients to the hospital following general anesthesia?
• In a craniotomy for tumor debulking with signs of elevated ICP, which measure is useful to reduce the hemodynamic response to intubation?
• Which property of thiopental facilitates its penetration into the central nervous system?
• Which statement about the distribution of O2 and CO2 in upright lungs is true?
• An anesthesia pain service consult is sought for a 78-year-old with trigeminal nerve–distribution pain who also has congestive heart failure on digoxin and thiazide. In addition to the chief complaint, over the last 72 hours the patient has dysesthesia in the feet, vision changes, and emesis. What is the most appropriate next step?
• Remifentanil's duration of action is due to metabolism by which mechanism?
• Which agent can cause a phase II depolarizing block when used repeatedly for neuromuscular blockade reversal or maintenance?
• Which patient would be least likely to develop a decrease in heart rate with a high (C8) level spinal anesthesia?
• Clonidine is which of the following?
• How much fresh gas-derived volume is delivered during inspiration if fresh gas flow is 6 L/min and the inspiratory time is 2 seconds?
• Which of the following is NOT listed as associated with DIC in pregnancy?
• When performing an interscalene block with a peripheral nerve stimulator you note diaphragmatic movement. You should now
• Osmotic diuresis can be produced by which agent used to reduce intracranial pressure?
• Which nerve lies immediately lateral to the trachea?
• A 59-year-old patient with long-standing congestive heart failure and hypoxemia is scheduled for knee replacement. The most appropriate plan would be which option?
• Which volatile anesthetic is most likely to reduce arterial pressure by decreasing cardiac output rather than systemic vascular resistance?
• Cardiac accelerator fibers originate from which spinal segments?
• Administration of dantrolene with mannitol is expected to cause which effect?
• Select the FALSE statement regarding iatrogenic bacterial infections from anesthetic equipment.
• ABG results show PaO2 88 mm Hg, PaCO2 32 mm Hg, pH 7.2, HCO3- 12, Cl- 115, Na+ 138. The anion gap is normal. Which acid-base disorder is most likely responsible?
• During direct laryngoscopy and tracheal intubation for a patient with a temporal lobe tumor, which drug is most appropriate to control systemic arterial blood pressure?
• A 54-year-old man on a morphine PCA after total hip arthroplasty has a maximum of 2 mg every 15 minutes and a 30 mg four-hour limit. How should pain control be adjusted if he reports inadequate relief and receives 15 doses in four hours?
• A lumbar epidural catheter is placed for an elective cesarean section. Twenty-five minutes after the full dose, the patient has nasal congestion. The most likely explanation is?
• Which of the following arrangements of rotameters on the anesthesia machine manifold is safest with left to right gas flow?
• Which obstetric complication is the most common cause of DIC in pregnant patients?
• Milrinone is a phosphodiesterase III inhibitor. It increases cyclic adenosine monophosphate by inhibiting which enzyme class?
• A 5-year-old child undergoing strabismus surgery under general anesthesia suddenly develops sinus bradycardia and intermittent ventricular escape beats but is hemodynamically stable. Which therapy is appropriate?
• Advantages of catheterization of the umbilical artery versus the umbilical vein in a newborn include all of the following EXCEPT which?
• A 78-year-old patient on chlorpropamide and regular insulin develops severe hypoglycemia after overnight fasting. What is the most likely cause?
• Postanesthetic shivering can be treated with all of the following EXCEPT:
• Which opioid antagonist has a longer duration of action than naloxone?
• What is the major disadvantage of interscalene brachial plexus block compared with other approaches?
• Which cardiovascular parameter is decreased at term?
• Preterm neonates are at increased risk for retinopathy of prematurity until what postconceptual age?
• Special considerations for porphyria cutanea tarda include which of the following?
• If an anesthesia machine was found to have run on only oxygen 5 L/min all weekend, what is the most reasonable course of action before the next induction?
• Which biguanide was withdrawn due to association with lactic acidosis?
• The minimum macroshock current required to elicit ventricular fibrillation is:
• Which setting would give the highest arterial oxygen concentration during inhalation induction with sevoflurane?
• The PAO2 - PaO2 difference when breathing 100% O2 equals 240 mm Hg; the estimated transpulmonary shunt is?
• Which technique is least effective in treating pruritus from neuraxial opioids?
• An incompetent ventilator pressure-relief valve can result in
• In burn patients more than 24 hours after injury, succinylcholine should be avoided due to the risk of which complication?
• Shivering can occur with normothermia due to which factor?
• Which airway management approach was described for the neonate with diaphragmatic hernia?
• Which practice would NOT reduce central venous catheter infection risk?
• Increasing PEEP in mechanical ventilation primarily lowers arterial blood pressure by which mechanism?
• Using a conversion factor of approximately 0.31 L per psi, how many liters remain in a cylinder at 1000 psi?
• Which condition would cause a high anion gap metabolic acidosis?
• Decreased total pulmonary compliance is most consistent with which pulmonary disease?
• Which statement about neonatal respiratory physiology is true?
• Which disease is not contagious?
• PVR increases in atelectasis due to hypoxia causing which process?
• In a septic patient with hypotension and high cardiac output, which vasopressor is least appropriate?
• Which medication reduces MAC?
• Recombinant human activated protein C (Xigris) is indicated for which condition?
• Arrange the percutaneous coronary interventions in order from shortest to longest aspirin plus clopidogrel therapy.
• A 3-year-old boy presents to the emergency department with high fever, sore throat, drooling, inspiratory stridor, tachypnea, and sternal retractions. Which of the following is the most appropriate management of airway obstruction?
• Which anesthetic is most likely to cause myocardial depression?
• Severe hypotension associated with high spinal anesthesia is caused primarily by
• Which drug class can prolong nondepolarizing neuromuscular blockade?
• Morphine is not used routinely for labor epidurals because it is characterized by which of the following?
• During pregnancy, which renal parameter increases?
• Which volatile anesthetic has the smallest blood–gas partition coefficient, contributing to the fastest onset and offset?
• Stellate ganglion block supplies sympathetic fibers to which regions?
• Which muscle group is used to monitor extubation readiness when assessing recovery from neuromuscular blockade?
• At 1600 psi, approximately how long could O2 be delivered from a cylinder at a flow rate of 2 L/min?
• Compared with his ideal body weight, how is cardiac output affected in a 140 kg patient undergoing thyroid surgery?
• Which vasopressor lowers systemic vascular resistance at low doses and increases it at high doses, with increased cardiac output at all doses and decreased renal blood flow?
• Which vaporizer configuration should be flushed after a tip-over, with the dial set to a low concentration and at high fresh gas flow, until output shows no excess agent (usually 20–30 minutes)?
• For complete anesthesia of the foot during a popliteal block for ankle and foot surgery, which additional nerve must be blocked?
• Which section of the brachial plexus is blocked with a supraclavicular block?
• For barbiturates like methohexital, what determines onset of action?
• All of the following characterize stored packed red blood cells kept for 35 days at 4° C in CPDA-1 except:
• Which statement about retinopathy of prematurity is most accurate?
• Hazards of oxygen administration include which of the following?
• Transient neurologic syndrome (TNS) is most commonly seen after the spinal anesthetic injection of which local anesthetic?
• During normal laminar airflow, resistance is dependent upon which characteristic of the gas?
• Anastomosis of the right atrium to the pulmonary artery (Fontan procedure) is used for all of the following defects EXCEPT which one?
• Compared with the adult dose, the succinylcholine dose for a 14-day-old neonate with bowel obstruction should be:
• Direct current cardioversion is not useful in unstable patients with which of the following arrhythmias?
• A 62-year-old patient undergoing frontal lobe tumor resection should have PaCO2 maintained within which range?
• Which observation would most reduce arterial oxygen saturation (SpO2) readings on a dual-wavelength pulse oximeter?
• What does P50 represent in the context of hemoglobin's oxygen binding?
• Preoperative treatment of subarachnoid hemorrhage patients without cerebral vasospasm might include all of the following EXCEPT:
• Which of the following drugs does NOT enhance the neuromuscular blockade produced by nondepolarizing muscle relaxants?
• Which local anesthetic undergoes the least hepatic clearance?
• Which nerve injury is characterized by weakness of all muscles below the knee?
• Which insulin preparation has the slowest onset and longest acting profile?
• The half-life of carboxyhemoglobin in a patient breathing 100% O2 is approximately:
• The most common complication of a celiac plexus block is which of the following?
• Pulmonary vascular resistance is typically expressed in which units?
• Under which circumstance would energy expenditure per day be the greatest?
• The rate of induction of anesthesia with isoflurane would be slower than expected in patients with which condition?
• Epidural use of which opioid would result in the greatest incidence of delayed respiratory depression?
• Patients can be safely imaged in the MRI scanner with conventional versions of which monitor?
• The 'snap' felt before entering the epidural space represents passage through which ligament?
• An 85-year-old man with COPD and CAD undergoes transurethral resection of the prostate under spinal anesthesia. Twenty minutes into the procedure, he becomes restless and hypertensive, with bradycardia and dyspnea. The most likely cause is
• Leftward shift of the oxyhemoglobin dissociation curve is produced by which condition?
• Sensory innervation to the posterior one third of the tongue is provided by which nerve?
• Cerebral salt wasting syndrome is characterized by which triad?
• A left-to-right tissue shunt, such as an arteriovenous fistula, physiologically resembles which of the following?
• In a right-to-left intracardiac shunt, which inhalation anesthetic would have the greatest impact on the rate of induction?
• In a patient undergoing foot surgery under spinal anesthesia, which statement about immediate physiologic response to incision is true?
• Which statement about Desflurane metabolism is correct?
• An 18-year-old patient is at risk for certain complications in the first 24 hours after a cervical spine injury. The most likely combination is:
• Why does nitrous oxide dissolution in the volatile agent cause transient changes in vaporizer output when nitrous oxide enters or leaves the vaporizing chamber?
• A 20-year-old, 75-kg patient with diabetic ketoacidosis presents with ABG on room air: pH 6.95, PaCO2 30 mm Hg, PaO2 98 mm Hg, HCO3- 6 mEq/L. What is the total body deficit of HCO3-?
• Which of the following is LEAST likely to impair cerebral blood flow autoregulation?
• Which statement is NOT true regarding spinal anatomy and spinal anesthesia?
• Normal values for a healthy 6-month-old, 7-kg infant include which of the following?
• Maximizing which lung parameter is most important in preventing postoperative pulmonary complications?
• The likelihood of a clinically significant hemolytic transfusion reaction from administration of type-specific blood is less than which of the following?
• Damage to which nerve would account for inability to oppose the left thumb and left little finger after an abdominal surgery with antecubital IV access?
• In a deep cervical plexus block for thyroidectomy, which complication would be LEAST likely?
• Which inhaled agent tends to increase cardiac output due to mild sympathetic tone?
• What is the approximate negative pressure produced by the esophageal detector device bulb when first compressed?
• Which statement correctly compares adult and newborn oxygen requirements in mL/kg/min?
• Respiratory depression is LEAST after induction dose of which agent?
• Which statement correctly describes the Bohr effect?
• Which factor is NOT associated with an increased risk of postoperative nausea and vomiting?
• Postoperatively, a patient cannot focus on near objects after receiving scopolamine preoperatively. What is the most likely cause?
• Sensory innervation to the mucous membranes of the false cords is provided by which nerve?
• In a patient exposed to carbon monoxide with tachypnea but no cyanosis, CO exposure increases minute ventilation by which mechanism?
• Alfentanil characteristics: which statement is true?
• Regarding mass spectrometry sampling in anesthesia circuits, which statement is true?
• Under general anesthesia, which peripheral nerve is most likely to be injured?
• A 24-year-old undergoing anesthesia with sevoflurane, N2O and O2 via LMA experiences spontaneous breathing as the vaporizer dial is increased, but the inspiratory valve does not fully close. The likely result is an increase in the inspired concentration of which gas?
• Volatile anesthetics affect somatosensory evoked potentials by which of the following?
• A size E compressed-gas cylinder completely filled with nitrous oxide contains approximately how many liters?
• Which statement correctly explains why some local anesthetics have a faster onset of action?
• Functional residual capacity is composed of which of the following?
• What is the normal respiratory quotient used in the alveolar gas equation for normal pulmonary function?
• Which cardiac defect is most commonly associated with Down syndrome?
• General anesthesia is planned for elective cesarean with two unsuccessful intubation attempts but adequate mask ventilation. The most appropriate next step is to:
• Bilateral recurrent laryngeal nerve injury would most likely cause which voice change?
• Which vasopressor increases systemic vascular resistance at both low and high doses, with usually unchanged or decreased cardiac output and decreased renal blood flow?
• Metabolism plays an important role on the rate of rise of FA/FI during induction of anesthesia for which of the following anesthetics?
• Bulging sclerae during cardiopulmonary bypass with venous congestion most likely indicates improper positioning of which cannula?
• Atracurium differs from cis-atracurium primarily in what aspect?
• What was the calculated anion gap in the ABG case?
• In hypertrophic obstructive cardiomyopathy, which hemodynamic goals are preferred?
• Which of the following is the FALSE statement regarding tramadol (Ultram)?
• Postoperative polyuria after pituitary surgery due to ADH deficiency is best described as which hormone deficiency?
• If the isoflurane vaporizer dial of an older non–pressure-compensating machine is set to deliver 1.15% in Denver, Colorado (barometric pressure 630 mm Hg), how many MAC will the patient receive?
• Which measure is not recommended in aspiration management?
• Autoregulation of cerebral blood flow is impaired in which of the following conditions?
• In an 18-year-old female in shock after a motor vehicle collision who is receiving rapid transfusions, the most likely cause of the described scenario is:
• Methylene blue is used to treat which condition?
• To minimize pulmonary artery catheter migration during cardiopulmonary bypass, which precaution is routinely indicated?
• Bradycardia observed after administration of succinylcholine to children is attributable to which mechanism?
• In congenital diaphragmatic hernia, timing of surgical correction is best after stabilization rather than rushing to the operating room. Which option reflects this approach?
• Which medications are effective in the management of acute exacerbations of bronchial asthma?
• What do the first two letters in the drug name Rocuronium stand for in terms of its onset of action?
• If ventilator rate is decreased from 10 to 6 breaths/min, with the same ventilator settings, what is the approximate tidal volume delivered per breath?
• Select the FALSE statement regarding nasotracheal intubation with Magill forceps:
• Postoperative labs showing low urine osmolality with high serum sodium are most consistent with which condition?
• For a 3-year-old requiring emergency weight-based dosing, which weight estimate is commonly used?
• Which acid-base disturbance is least well compensated?
• Administration of protamine to a patient who has not received heparin can result in which effect?
• Prolonged use of which intravenous agent may lead to lactic acidosis?
• The most common side effect of oral dantrolene used to prevent malignant hyperthermia is which?
• Basic Life Support single rescuer to multiple rescuer ratio for infants, children, and adults (excluding newborns) is which of the following?
• Select FALSE statement regarding amiodarone (Cordarone).
• Motor innervation to the cricothyroid muscle is provided by which nerve branch?
• The most common minor side effect reported after flumazenil administration in anesthesia is which?
• The term luxury perfusion in the brain refers to which phenomenon?
• The incidence of unpleasant dreams during emergence from ketamine anesthesia can be reduced by the administration of
• The risk of seroconversion after a needlestick exposure to HIV-infected blood is approximately?
• What minimum MAC is the patient receiving with 3 L/min N2O, 1 L/min O2, and isoflurane 0.85%?
• Calculate the systemic vascular resistance (SVR) given CO 5.0 L/min, CVP 8 mm Hg, MAP 86 mm Hg.
• In the context of gas flow in airways, helium’s lower density compared with nitrogen results in what effect on the onset of turbulence?
• Predominant mechanism for succinylcholine-induced tachycardia in adults?
• The portion of the ventilator that compresses the bellows is driven by:
• Pudendal nerve originates from which spinal segments?
• A sevoflurane vaporizer will deliver an accurate concentration of an unknown volatile anesthetic if it shares which property with sevoflurane?
• Which color corresponds to Helium?
• If an epidural hematoma is suspected and MRI confirms a hematoma in a laboring patient, what sequence of management reduces permanent neurologic deficits?
• Calculate cerebral perfusion pressure with BP 100/70, CVP 20 mm Hg, and ICP 15 mm Hg. CPP is:
• Normal fetal heart rate is:
• During a laparoscopic cholecystectomy exhaled CO2 is 6%, but inhaled CO2 is 1%. Which explanation could NOT account for rebreathing CO2?
• Damage to which nerve is most at risk at the antecubital fossa due to extravasation of IV drugs such as thiopental?
• In a patient with end-stage liver disease undergoing hepatic resection, the most likely cause of a high-anion-gap metabolic acidosis is:
• Given the arterial blood gas values pH 7.2, CO2 34, HCO3- 14, Na 135, Cl 95, calculate the base deficit from these data.
• The normal serum magnesium level is approximately:
• Nitrous oxide's effect on somatosensory evoked potentials is best described as:
• Which of the following is the least appropriate technique for induction of general anesthesia in a newborn undergoing surgical repair of a tracheoesophageal fistula (TEF)?
• Late decelerations are most indicative of which condition?
• The action of succinylcholine at the neuromuscular junction is terminated by which mechanism?
• Etomidate commonly causes pain on intravenous injection in many patients. What is the approximate percentage of patients experiencing this pain?
• Sildenafil (Viagra) belongs to the same class of drugs as which of the following?
• Sensory innervation to the posterior pharynx is provided by which nerve?
• The most sensitive early sign of malignant hyperthermia during general anesthesia is which of the following?
• Effective inflation of an intra-aortic balloon pump should occur at which time?
• Inhalation of CO2 increases minute ventilation by what range of L/min per mm Hg PaCO2?
• Inhibitory presynaptic fibers to the gastrointestinal tract originate from which spinal segments?
• A 7-week-old male infant is admitted to the pediatric ICU with bowel obstruction. The most appropriate fluid for resuscitation would be which?
• After transsphenoidal hypophysectomy, which statement about postoperative airway management is true?
• Which adverse effect is NOT attributable to respiratory or metabolic acidosis?
• The pressure gauge of a size 'E' cylinder containing air shows 1000 psi. Approximately how long could air be delivered from this cylinder at 10 L/min?
• Which of the following is NOT a relative contraindication to the sitting position?
• Which nerve provides sensory innervation to the medial length of the calf?
• Normal or increased PR interval and short QT interval on ECG indicate which electrolyte abnormality?
• Which of the following is the least useful analgesic for prevention or treatment of postoperative tonsillar pain?
• Malignant hyperthermia may not manifest until the recovery room or later. Which statement is true regarding the timing of MH onset?
• Which maneuver would slow induction of inhalational anesthesia through a tracheostomy?
• A Datex Ohmeda Sevotec 5 vaporizer is tipped over while being attached to the anesthesia machine, but is placed upright and installed. The soonest it can be safely used is
• Decreased FEV1 with a normal FEV1/FVC ratio is most consistent with which pulmonary condition?
• When the inspiratory valve malfunctions by staying open during exhalation, which gas concentration will increase in the inspired gas mixture?
• Which factor among the following increases MAC for volatile anesthetics EXCEPT?
• Phrenic nerve fibers originate from which spinal segments?
• Which antibiotic class includes Gentamicin?
• During a right hemicolectomy, a patient develops ST elevation and complete heart block. Which coronary artery is most likely affected?
• Select the false statement about isoflurane at or below 1 MAC.
• Intrathecal opioids require about what fraction of IV/epidural doses?
• Ketamine can be administered by which routes?
• Which fluid would most likely worsen intracranial pressure in a neurosurgical patient with intracranial hypertension?
• Which inhalational anesthetic is most likely to produce a coronary steal syndrome by preferentially dilating small coronary arterial resistance vessels?
• Which statement about edrophonium is true?
• Which drug or intervention will cause the LEAST increase in heart rate in a transplanted denervated heart?
• Compared with adults, the infant epiglottis is relatively:
• A celiac-plexus block would NOT effectively treat pain resulting from a malignancy involving which organ?
• Which local anesthetic is commonly used at a 0.5% concentration due to availability and relative safety?
• Most congenital diaphragmatic hernias occur on which side?
• Select the true statement concerning phantom limb pain.
• Increased fresh gas flow will accelerate the rate of rise of the FA/FI ratio the most for which agent?
• Which of the following medications blocks the angiotensin receptor?
• Treatment for cerebral salt wasting includes volume replacement with what, and why should correction be slow?
• During retrieval of a foreign body from the left mainstem bronchus, the object is pushed into the right mainstem and ventilation becomes impossible; the most appropriate next step is to
• A healthy 4-year-old child experiences rapid breathing 60 seconds after inhalation induction with sevoflurane during a tonsillectomy. The most likely stage of anesthesia is:
• Refractory cardiac arrest is most likely after the rapid unintentional IV injection of which of the following local anesthetics?
• Factor VIII is produced primarily by which cells?
• A patient with a recent myocardial infarction undergoes noncardiac surgery. On which postoperative day is the risk of another MI highest?
• Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases?
• In a patient with Wolff-Parkinson-White syndrome who develops a wide-complex tachycardia under anesthesia, which drug is most appropriate to control the heart rate?
• Which statement about rotameters is false?
• Frost develops on the outside of an N2O compressed-gas cylinder during general anesthesia. This phenomenon indicates that
• An axillary block utilizing the transarterial approach with 0.5% bupivacaine and epinephrine (1:200,000) is performed in a 70-kg patient. Thirty mL is injected posterior to the axillary artery and 30 mL anterior to it. How many mg have been injected and was the maximum recommended dose exceeded?
• An acute spinal cord injury above T4–T6 produces a sympathectomy below the level of injury with vasodilation and hypotension, a condition known as spinal shock. Which statement best describes this physiologic change?
• Factors predisposing to formation and/or rebreathing of Compound A include each of the following EXCEPT:
• Term neonate blood volume per kilogram is approximately:
• What are the lower and upper limits of cerebral blood flow autoregulation in mean arterial pressure?
• Which drug should be administered with caution to patients receiving echothiophate for glaucoma?
• Normal PVR is in which range?
• The Diameter Index Safety System refers to the interface between which components?
• A 44-year-old patient hyperventilated to a PaCO2 of 24 mm Hg for 48 hours. What [HCO3-] would you expect (normal [HCO3-] is 24 mEq/L)?
• The P50 for normal adult hemoglobin is approximately?
• Which nerve is not derived from the sciatic nerve and contributes to sensation of the foot?
• In an MRI, if a patient is pinned by a large metallic object, which course of action is appropriate?
• Which of the following is NOT an advantage of calcium hydroxide lime over soda lime?
• Treatment includes trivalent equine antitoxin for which disease?
• Which property of epidurally administered local anesthetics determines the extent to which epinephrine will prolong the duration of blockade?
• Which local anesthetic is characterized as the longest lasting, most potent, and most cardiotoxic?
• During cardiac surgery, a urinary catheter temperature transducer and a distal pulmonary artery catheter temperature transducer are used together to determine which purpose?
• Which natural hormone suppresses the release of serotonin and other vasoactive substances from carcinoid tumors?
• During the first minute of apnea, the PaCO2 rises by approximately how many mm Hg per minute?
• Which dye has the greatest impact on pulse oximeter readings?
• Which statement about glycopyrrolate is true?
• Placenta previa in a patient with a prior uterine scar raises concern for which abnormal placentation that increases the risk of emergency cesarean hysterectomy?
• Which reversal strategy is preferred to reverse neuromuscular blockade at the end of surgery in a pregnant patient?
• Which statement about the infant airway compared with the adult airway is true?
• Three primary types: cutaneous, gastrointestinal and inhalation pertain to which disease?
• A 5-year-old is noted with dark brown urine after anesthesia; the most appropriate action is to evaluate for malignant hyperthermia.
• What is the best postoperative pain management for a 10-week-old infant undergoing inguinal hernia repair?
• Which inhaled anesthetic has the lowest blood/gas partition coefficient, resulting in the fastest onset of anesthesia?
• What is the greatest source of contamination of the OR atmosphere?
• Which device on an anesthesia machine most reliably detects delivery of hypoxic gas mixtures?
• Early signs of digoxin toxicity include which symptoms?
• Calculate the physiologic dead-space ventilation ratio (Vd/Vt) using Bohr's equation with PaCO2 45 mm Hg and mixed expired CO2 tension (PECO2) 30 mm Hg.
• If one of four thumb twitches in the train-of-four (TOF) stimulation of the ulnar nerve can be elicited, how much suppression would there be for a single twitch?
• Which drug produces strong pulmonary arterial dilation with the least amount of systemic arterial dilation?
• Passive diffusion of substances across the placenta is enhanced by all of the following EXCEPT
• Treatment may include streptomycin, gentamicin or tetracycline for which disease?
• In transpulmonary shunt, the arterial rise in anesthetic partial pressure is reduced the most for which type of agents?
• For a 6-year-old, 20-kg child with pulseless ventricular tachycardia, what energy level is recommended for initial defibrillation?
• Amrinone is best described as which pharmacologic action?
• Which nerves innervate the great toe?
• Why is a 40:60 helium-oxygen mix preferred over a 40:60 nitrogen-oxygen mix in a spontaneously breathing patient with tracheal stenosis?
• Besides inspiratory stridor, which sign best supports epiglottitis in a child?
• Which dose range of dopamine primarily stimulates beta-1 receptors?
• Allergic reactions occurring during the immediate perioperative period are most commonly attributable to which class of drugs?
• The most frequent cause of mechanical failure of the anesthesia delivery system to deliver adequate O2 to the patient is
• Which drug is a principal prostacyclin analog used to reduce pulmonary vascular resistance in pulmonary hypertension?
• A disadvantage of port-access coronary artery bypass surgery using the da Vinci Robot compared with standard cardiopulmonary bypass revascularization is which of the following?
• Using the formula PVR = (PAP - PAOP)/CO × 80, calculate the pulmonary vascular resistance for a patient with PAP 20 mm Hg, PAOP 12 mm Hg, and CO 4 L/min.
• The deep peroneal nerve innervates which region?
• Afterload reduction is beneficial during anesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT
• Which maneuver is least effective in preventing postoperative pulmonary complications in a patient with diminished lung bases after abdominal surgery?
• Which would NOT cause erroneous readings by dual-wavelength pulse oximeters?
• During inspiration in a patient with cardiac tamponade, what happens to left ventricular preload and arterial pressure?
• Retinopathy of prematurity typically occurs in newborns born at less than how many weeks of gestational age?
• Which inhalational agent is MOST likely to produce a decrease in systemic blood pressure by causing a junctional rhythm?
• The mean arterial pressure in a patient with a blood pressure of 180/60 mm Hg is approximately:
• Decreased FEV1/FVC ratio is most consistent with which pulmonary condition?
• Uterine blood flow at term pregnancy is approximately:
• Unilateral recurrent laryngeal nerve injury most commonly causes which voice change?
• Which of the following is not associated with an increased incidence of postdural puncture headache?
• Increased lung compliance due to loss of elastic recoil is most characteristic of which condition?
• During anesthesia, a scavenging system reservoir bag distends during inspiration. What is the most likely cause?
• A 56-year-old with liver disease and osteomyelitis develops postoperative hypotension with metabolic acidosis and abnormal venous blood gas values. Which diagnosis is most consistent?
• In the resting adult, what percentage of total body O2 consumption is due to the work of breathing?
• Which nondepolarizing neuromuscular blocker is commonly used for rapid sequence intubation due to its rapid onset?
• Which set of signs comprises the four cardinal features of amniotic fluid embolism?
• Which statement about risk factors for retinopathy of prematurity is true?
• Which statement about postoperative shivering is NOT true?
• Which valve prevents transfilling between compressed-gas cylinders?
• From MOST to LEAST rapid, select the correct temporal sequence of neuromuscular blockade in the adductor of the thumb, the orbicularis oculi, and the diaphragm after administration of an intubating dose of vecuronium to an otherwise healthy patient.
• Which pharmacologic agent decreases uterine contraction in a dose-dependent fashion?
• What is the minimum quantity of intracardiac air detectable by a precordial Doppler?
• An acute increase in PaCO2 of 10 mm Hg will result in a decrease in pH of
• Which drug should NOT be administered via an endotracheal tube?
• Which disease is characterized by skin lesions that all appear at the same stage and at the same time?
• Which of the following vaporizer configurations would deliver a higher-than-expected concentration of volatile anesthetic to the patient?
• Normal resting coronary artery blood flow is approximately how many milliliters per 100 grams of tissue per minute?
• A healthy 27-year-old female undergoing ankle debridement requires an ankle block. Which nerves must be adequately blocked?
• If both cardiac output and alveolar ventilation are doubled, the net effect on the rate of rise of FA/FI for isoflurane would be
• If an arterial line transducer is placed 20 cm below the level of the heart, how much higher will the measured arterial pressure be compared with the true arterial pressure?
• In calculating arterial oxygen content (CaO2), which formula correctly represents CaO2?
• A healthy 59-year-old woman develops wide complex tachycardia with hypotension during anesthesia; the most appropriate therapy is:
• Which condition increases the ventricular capture threshold, potentially jeopardizing pacing during anesthesia?
• In asynchronous pacing modes (DOO/VOO), what phenomenon may occur if the native heart rate exceeds the programmed rate?
• EMLA cream is a mixture of which local anesthetics?
• The therapeutic serum magnesium range for clinical use is approximately:
• Loss of deep tendon reflexes occurs at approximately what serum magnesium concentration?
• If a patient had a right stellate ganglion block, which syndrome would be expected?
• Which of the following is NOT an effective means of preventing hypothermia in a 10-month-old undergoing surgery?
• Tachyphylaxis to local anesthetics is most closely related to which factor?
• The predicted blood volume in a 4-kg term neonate is approximately which value?
• The least likely side effect of dexmedetomidine in a healthy patient is which?
• Which respiratory index is increased in neonates compared with adults?
• A 100-kg male 24 hours after four-vessel coronary artery bypass grafting: which pulmonary parameters would be compatible with successful extubation?
• A leftward shift in the oxyhemoglobin dissociation curve is caused by decreased 2,3-DPG in stored red blood cells. What is the net effect on oxygen unloading?
• Which statement is true regarding HIV-infected parturients?
• Which local anesthetic has an extremely short plasma half-life, approximately 23 seconds?
• Cryoprecipitate is most commonly used to replace which plasma protein?
• Beckwith-Wiedemann syndrome may also be associated with which hematologic finding?
• Which combination is most likely to predispose to formation of Compound A when using sevoflurane in a breathing circuit?
• Methohexital has a shorter elimination half-time than thiopental because methohexital?
• A 65-year-old patient with moderate aortic stenosis develops rapid, irregular tachycardia with hypotension and ST-segment depression. Which treatment is most appropriate for myocardial ischemia?
• Quenching a superconducting MRI magnet involves which of the following?
• Sugammadex is effective for reversal of neuromuscular blockade produced by which class of relaxants?
• Which intravenous anesthetic is contraindicated in patients with intracranial hypertension?
• Which intervention is effective in preventing autonomic hyperreflexia during surgery in spinal cord injury patients?
• Which induction agent is associated with increased cerebral blood flow and intracranial pressure?
• By what percentage does cerebral blood flow change for each mm Hg increase in PaCO2?
• PVR increases when lung volume rises above FRC due to which mechanism?
• Anesthetic loss to the plastic and rubber components of the anesthetic circuit hindering achievement of an adequate inspired concentration is a factor with which of the following anesthetics?
• What is the typical pressure in the low-pressure system after the second-stage regulator?
• Temporary abolition of imbalance between the right and left sides of the sympathetic nervous system may shorten QT intervals with which intervention?
• Which statement best reflects the deliverable volume of an oxygen cylinder, given realistic regulator efficiency?
• Postoperative polyuria with a very dilute urine and high serum sodium after pituitary surgery is most consistent with which condition?
• Pain fibers to the uterus originate from which spinal segments?
• 1 MAC of isoflurane depresses mean arterial pressure by about what percentage in isovolumic subjects?
• Addition of positive end-expiratory pressure (PEEP) during anesthesia can cause a drop in blood pressure primarily due to:
• Which of the following drugs should NOT be used as a tocolytic for preterm labor?
• A 22-year-old patient with Hb 15 g/dL has pre-induction PaO2 120 mm Hg with SaO2 100%, and post-induction PaO2 150 mm Hg with the same saturation. How has the oxygen content changed?
• How long would a vaporizer containing 150 mL of isoflurane deliver a 2% concentration at a total fresh gas flow of 4 L/min?
• The reason CO2 measured by capnometer is less than the arterial PaCO2 value measured simultaneously is?
• Which agent is associated with adrenal suppression?
• From cephalad to caudad, what is the correct order of structures in the intercostal space?
• Which of the following is the third compensatory mechanism for maintaining intracranial volume when ICP rises?
• Which method can be used to detect all leaks in the low-pressure circuit of any contemporary anesthesia machine?
• Which drug is LEAST likely to cause unfavorable hemodynamic changes in patients with severe mitral stenosis?
• The unique advantage of rocuronium over other muscle relaxants is its which property?
• Which local anesthetic is an ester with rapid hydrolysis by esterases?
• Which vasopressor increases systemic blood pressure indirectly by releasing norepinephrine from sympathetic nerve fibers and directly by binding to adrenergic receptors?
• Which statement is true about CPR and defibrillation by a health care provider in sudden cardiac arrest?
• The most common reason for patients rating anesthesia with etomidate as unsatisfactory is which?
• Cyanide toxicity may be treated with all of the following except:
• Which maneuver is LEAST likely to improve arterial saturation when the endotracheal tube is seated in the right mainstem bronchus?
• The plasma half-life of low-molecular-weight heparin is approximately how many times longer than standard heparin?
• Below what cerebral blood flow value will first signs of cerebral ischemia appear on EEG?
• Time of onset from most rapid to least rapid for reversal agents is which of the following sequences?
• Which of the following factors is LEAST responsible for killing bacteria in anesthesia machines?
• 15-Methyl PGF2a (carboprost, Hemabate) is administered directly into the myometrium to treat uterine atony. Possible effects include
• In Type C (IIIB) tracheoesophageal fistula, which description best fits the anatomy?
• Which nerve is NOT derived from a cranial nerve?
• Which statement correctly describes the risk associated with intra-arterial injection of thiopental?
• Which lung volume changes the least during pregnancy?
• If minute ventilation is held at 5000 mL/min and the respiratory rate increases from 10 to 20 breaths/min with no change in Ve, how would alveolar ventilation change?
• In a patient who becomes apneic after stopping propofol and remifentanil infusions during anesthesia, what is the most appropriate immediate management?
• A patient after clipping an anterior communicating artery aneurysm has hyponatremia with high urine sodium and low CVP. What is the most likely diagnosis?
• Which Mapleson circuit is best for controlled ventilation?
• Succinylcholine is contraindicated in routine pediatric tracheal intubation due to an increased incidence of which adverse effect?
• Discontinuation of which of the following medications is strongly recommended before elective surgery?
• Which of the following clotting factors has the shortest half-life?
• In biliary obstruction, which liver enzyme is typically elevated?
• How long after the last dose of dalteparin (Fragmin) should one wait prior to placement of a thoracic epidural for a patient on DVT prophylaxis?
• Proper processing of platelet concentrates before administration to avoid transfusion reactions involves which compatibility matching?
• An acute decrease in serum potassium levels causes what effect on neuromuscular blockade?
• When air embolism is suspected during surgery in the sitting position, what is the first action to take?
• Hirudin is used in patients with
• In the infant, hypothermia can be manifested as which of the following?
• A patient develops generalized itching during a packed red blood cell transfusion with stable vital signs. The most likely underlying mechanism is a mild allergic reaction. Which option best reflects the antibody involved?
• What is the normal cerebral glucose (GLC) consumption per minute?
• In a patient with an axial-flow left ventricular assist device, which monitoring modality is most likely to be difficult to obtain reliably?
• If the alveolar to venous partial pressure difference of a volatile anesthetic is PA>Pv and the arterial to venous partial pressure difference is PV>PA, which scenario is most likely to be true?
• Which inhaled anesthetic has substantial hepatic metabolism, around 30%?
• What is the P50 of fetal hemoglobin at term?
• Naltrexone is
• Which inhaled anesthetic has the highest blood/gas solubility coefficient, leading to the largest storage of gas in blood and slower onset?
• In newborns, the spinal cord ends at which vertebral level?
• A patient with rheumatoid arthritis has normal FEV1 and FVC but MVV is 40% of predicted. The next step in pulmonary function evaluation should be to which test?
• While moving a parturient with suspected aspiration, the appropriate treatment is
• In von Willebrand disease, which of the following is NOT a recommended treatment?
• Which drug crosses the blood-brain barrier?
• Which statement about intrathecal clonidine as a spinal analgesic is true?
• In the described sciatic nerve block, which fiber type is blocked last?
• Low-molecular-weight heparin primarily inhibits which clotting factor?
• After the first-stage regulator, the intermediate pressure is approximately:
• During induction for a patient with complex coronary disease, the appearance of new V waves on the pulmonary capillary wedge pressure tracing would prompt administration of which medication to reduce left atrial pressure?
• Which property is most closely associated with the minimum alveolar concentration (MAC) of inhaled anesthetics?
• Which postoperative maneuver is most commonly used to increase functional residual capacity?
• For a full mouth extraction in a 70-kg adult, what is the maximum safe single dose of lidocaine with epinephrine infiltration?
• Which factor primarily determines the duration of action of local anesthetics?
• An intradural mass lesion at the tip of a drug infusion catheter is least likely to present as
• In addition to C nerve fibers, which nerve fibers carry pain impulses?
• Hemolytic-uremic syndrome is characterized by which of the following?
• Desmopressin (DDAVP) is used in von Willebrand disease to increase which factors?
• Postspinal headaches may be associated with which neurologic symptoms?
• Which intravenous anesthetic is converted from water-soluble to lipid-soluble after exposure to the bloodstream?
• The recovery index (RI) of which of the following nondepolarizing muscle relaxants is not altered by aging?
• If minute ventilation is constant and dead space ventilation increases, then PaCO2 will ...
• Which vasopressor lowers systemic vascular resistance and mean arterial pressure, with marked tachycardia?
• A 9-year-old experiences severe hypertension after an unmeasured bolus of phenylephrine. Which is the most appropriate treatment?
• Inhalation induction in a patient with a left-to-right shunt such as an arteriovenous fistula: which statement is correct?
• The effect of inhaled anesthetics is determined by which factor?
• Neonatal hemoglobin typically declines to a nadir around which age?
• Why are four twitches used in the train-of-four to determine the degree of neuromuscular blockade rather than five?
• Which statement about midazolam is FALSE?
• Which drug produces little change in systemic vascular resistance, but at low or intermediate doses increases renal blood flow while at high doses decreases it?
• Little respiratory depression but dysphoria and diuresis are produced by which receptor subtype?
• During a wake-up test for a Harrington rod procedure, four thumb twitches are present with the ulnar nerve stimulus, but the patient cannot move hands or feet after volatile anesthetic and nitrous oxide have been stopped for 10 minutes. The most appropriate intervention?
• A 31-year-old moderately obese female is undergoing anesthesia with isoflurane. Inspired isoflurane is 1.7%, expired 0.6%, nitrous oxide flow is 500 mL/min and oxygen flow is 250 mL/min. Approximately how many MAC of anesthesia is represented by the alveolar concentration?
• Why should air not be used to identify the epidural space in children?
• The esophageal detector device
• Which narcotic causes the greatest decrease in myocardial contractility when given in high doses alone?
• Which of the following characteristics of inhaled anesthetics most closely correlates with recovery from inhaled anesthesia?
• In suspected venous air embolism, what is the immediate best action regarding inhaled anesthetic gas to prevent bubble expansion?
• Smokers are most likely to show a mild, but transient increase in airway resistance following intubation and general anesthesia with which inhaled anesthetic?
• Which statement best describes neuromuscular blockade in myasthenia gravis?
• Fluid resuscitation during major abdominal surgery with which agent is associated with the best survival data?
• All of the following statements about the physiology of newborns compared with adults are true EXCEPT:
• Cardiac output is greatest when?
• The structure least likely to be encountered during placement of an interscalene block is
• Which measure is least useful in responding to suspected venous air embolism during a neurosurgical procedure in the upright position?
• Which local anesthetic is unique for being a weak acid with a pKa around 3.5?
• Which local anesthetic is contraindicated for epidural use in parturients due to cardiotoxicity and long duration?
• Which pair of inhaled anesthetics are described as having very minimal hepatic metabolism?
• If the recurrent laryngeal nerve were severed on both sides, the vocal cords would assume which position?
• Each of the following factors can influence the partial pressure gradient necessary for the achievement of anesthesia EXCEPT:
• During inhalation induction with halothane, a child's rhythm changes to multifocal ventricular ectopy. The most likely explanation is:
• Depressed ST segments, flat T waves, and U waves present on ECG indicate which electrolyte abnormality?
• The Robin Hood phenomenon describes what happens when PaCO2 is decreased?
• Select the correct statement regarding the effects of volatile anesthetics on nondepolarizing neuromuscular blocking drugs and the reversal agents.
• Cardiac output returns to nonpregnant values by how long postpartum?
• Which expression correctly represents the alveolar gas equation PAO2?
• Which is the most serious complication associated with a supraclavicular block?
• Which analgesic's respiratory depression is not readily reversed by naloxone?
• Which statement best describes the effect of present-day volatile anesthetics on systemic blood pressure as dose increases?
• Which obstetric condition is least likely to develop disseminated intravascular coagulation (DIC)?
• A nervous 57-year-old woman with a fear of injections receives a premedication in the waiting area and, 45 minutes later, presents with dry mouth and a heart rate of 45 bpm. Which premedication is most likely responsible for these symptoms?
• Which of the following statements about buffering in the body is true based on the discussed physiology?
• Neuraxial opioid pruritus is not histamine-mediated; which statement best describes its management?
• Which technique has been shown to prevent anesthetic-related nerve injury during placement of peripheral nerve blocks?
• Which condition would cause a rightward shift of the oxyhemoglobin dissociation curve?
• Pulsus bisferiens is most commonly associated with which valvular pathology?
• During an airway exam, a 53-year-old patient mentions that his right thumb tingles and then becomes numb if he extends his head for more than a few seconds. This symptom most likely represents
• Which statement correctly characterizes atenolol?
• In the Fick equation Q = VO2 / [(CaO2 − CvO2) × 10], what is the purpose of the factor 10?
• In a 24-year-old primiparous woman undergoing an elective cesarean section with spinal anesthesia who develops hypotension after 5 minutes, the best initial treatment (best fetal pH) after ensuring adequate left uterine displacement would be
• In which of the following situations is succinylcholine most likely to cause severe hyperkalemia?
• Which property differentiates helium from nitrogen that makes helium-oxygen mixtures advantageous in airway resistance?
• Base deficit formula: Base deficit = kg × deviation from normal HCO3 (24 mEq/L) × 0.3. What extracellular fluid fraction is used in this calculation?
• In a differential block, which fiber is blocked two levels above sensory blockade?
• A mixture change leads to the expired isoflurane concentration rising to 2.3% after 1 minute; the best explanation is which of the following?
• Which agent is most useful for raising the gastric pH just before induction of general anesthesia for an emergency cesarean section?
• Clonidine is useful in all of the following applications EXCEPT:
• Interscalene block is contraindicated in patients with which condition due to the risk of diaphragmatic paralysis and reduced pulmonary function?
• Which of the following is a goal in the management of hypercyanotic spells in tetralogy of Fallot?
• Which nerve fiber is primarily responsible for proprioception?
• After a difficult intubation, there is no observed end-tidal CO2. Which of the following is NOT a likely cause?
• The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of approximately:
• Which muscle relaxant is eliminated most by renal excretion?
• Which of the following is a hazard commonly associated with positive end-expiratory pressure (PEEP)?
• On a pulmonary capillary wedge pressure tracing, the presence of V waves can indicate ischemia affecting which region of the heart?
• Gas from an N2O compressed-gas cylinder enters the anesthesia machine through a pressure regulator that reduces the pressure to which value?
• Which action is most appropriate in a suspected malignant hyperthermia crisis with severe hypercapnia?
• Management of propofol infusion syndrome includes which immediate action?
• During resection of a pheochromocytoma, which muscle relaxant would be the best choice due to minimal cardiovascular changes?
• Approximately what percentage of cardiac output does coronary blood flow represent under normal conditions?
• Which law relates intra-alveolar pressure to surface tension and radius of an alveolus?
• The incidence of failed intubation is how many times greater in the obstetric population compared with the general population?
• A 38-year-old primiparous patient with placenta previa and active vaginal bleeding arrives for planned cesarean. Which induction plan is most appropriate?
• What is the typical resting myocardial oxygen consumption in mL per 100 g of tissue per minute?
• Critical CBF in patients anesthetized with isoflurane is
• During epidural anesthesia in a preeclamptic parturient on magnesium therapy, sudden respiratory distress and pink froth in the endotracheal tube occur with IV leakage. The most likely diagnosis is?
• How long should a patient be off clopidogrel (Plavix) before performing a central neuraxial block?
• Laminar flow occurs when gas flows down parallel-sided tubes at rates below the critical velocity. Which statement best describes this condition?
• Why is end-tidal CO2 (EtCO2) typically lower than arterial CO2 (PaCO2)?
• During a left hepatectomy under general isoflurane anesthesia, arterial blood gases are: O2 138, CO2 39, pH 7.38, saturation 99%. At the same time, CO2 on mass spectrometer is 26 mm Hg. The most plausible explanation for the difference between CO2 measured with mass spectrometer versus arterial blood gas is which of the following?
• Which intraspinal opioid dose would NOT be acceptable to administer with 12 mg bupivacaine for a cesarean section in a 60 kg parturient?
• During inhalational induction, which action would increase the rate at which alveolar concentration rises (FA/FI)?
• The term azeotrope refers to which of the following?
• Which statement is true regarding robotic port-access coronary bypass grafting with a left mini-thoracotomy?
• A 78-year-old patient has an arterial line zeroed at the wrist. How will the arterial line pressure compare with the true blood pressure?
• During the second stage of labor, complete pain relief can be obtained with which option?
• Which test is the best screening test for hemophilia A, a deficiency of factor VIII?
• Which drug blocks sodium channels and reduces transmission by decreasing acetylcholine release at the neuromuscular junction?
• A parturient with emergent cesarean section extubation develops cyanosis with high airway pressures and hypotension; the most likely cause is?
• In a 23-year-old in the first trimester undergoing emergency appendectomy, which drug has been suggested (but not proven) to be associated with congenital malformations and should be avoided?
• During bronchoscopic removal of a lodged peanut, the airway becomes obstructed and ventilation cannot be maintained. What is the next best step?
• A VVI pacemaker is programmed to 70 beats per minute but shows a preoperative rate of 61 bpm. The most likely reason is:
• Which term describes the redistribution of cerebral blood flow from normal tissue to ischemic tissue?
• In which condition would the response to atropine be most pronounced?
• A 48-year-old man develops fever, dyspnea, and bilateral pulmonary infiltrates after a transfusion during surgery. Which item is inconsistent with a diagnosis of transfusion-related acute lung injury (TRALI)?
• In a normal adult, approximately what percentage of cardiac output depends on the atrial contraction known as the atrial kick?
• In a patient undergoing extensive transfusion during major surgery, which component is most likely to be the source of postoperative sepsis?
• The occipital portion of the skull receives sensory innervation from which option?
• Bradycardia in a patient shortly after reversal with pyridostigmine is most likely due to:
• If the venous cannula is inserted too far into the inferior vena cava during CPB, which problem may occur?
• Which of the following volatile anesthetics is unique in containing preservative?
• Which intervention is least likely to reduce postoperative apnea in preterm infants undergoing surgery for inguinal hernia repair?
• For von Willebrand disease, which treatment is commonly used to improve hemostasis?
• Which is the earliest sign of lidocaine toxicity?
• Which factor could NOT explain a PaO2 of 48 mm Hg in a patient breathing a mixture of nitrous oxide and oxygen?
• Which statement about neuraxial anesthesia in HIV-infected parturients is true?
• In a normal sized term fetus, the normal oxygen consumption is approximately?
• Which analgesic would be best for postoperative pain management in a patient who is taking fluoxetine (Prozac)?
• Which statement about postspinal headaches is true?
• For halothane or isoflurane, the minimum alveolar concentration (MAC) is greatest in which group?
• Which local anesthetic has the lowest ratio of dose needed to produce cardiovascular collapse relative to dose causing CNS toxicity?
• Which drug may cause severe rebound hypertension when abruptly discontinued?
• Which analgesic is contraindicated in patients taking monoamine oxidase inhibitors due to risk of a severe hypertensive reaction?
• If the endotracheal tube is in the esophagus, how does the esophageal detector device respond?
• In isovolumic normal human subjects, 1 MAC of isoflurane anesthesia depresses mean arterial pressure by approximately 25%. The single BEST explanation for this is
• In a sciatic nerve block with 15 mL of 1.5% mepivacaine, which nerve fiber type is blocked first?
• Which of the following would hasten the onset and increase the clinical duration of action of a local anesthetic for epidural anesthesia, providing the greatest depth of motor and sensory blockade?
• Select FALSE statement about time constants for volatile anesthetics after three time constants.
• Which nerve supplies the posterior medial aspect of the arm?
• In TURP with glycine irrigation, which electrolyte disturbance is most commonly observed if glycine is absorbed systemically?
• Which group of volatile anesthetics decreases systemic vascular resistance?
• Which of the following is the least appropriate use of non-invasive positive pressure ventilation (NIPPV)?
• A patient with a wide-complex tachycardia after induction for abdominal aortic aneurysm repair is treated most appropriately with which drug given IV over 10 minutes?
• Which site is the least reliable for measuring core body temperature?
• The anticoagulant and anti-inflammatory effects of recombinant human activated protein C are achieved by inhibiting which coagulation factors?
• After the second-stage regulator, the O2 pressure in the low-pressure system is typically in which range?
• Ketamine's analgesia is greater for which type of pain?
• Hypoparathyroidism secondary to inadvertent parathyroid removal during total thyroidectomy typically results in hypocalcemia within which postoperative time frame?
• Premature infants are at increased risk for apnea until they reach how many weeks postconceptual age?
• Which structure is NOT involved in conveyance of the stimulus from the posterior tibial nerve to the cerebral cortex during somatosensory evoked potential monitoring?
• In brain death assessment, absence of cortical function is manifested by which of the following?
• A full N2O tank contains about 1600 L. If the tank is one-quarter full, approximately how many liters remain?
• P wave flattening, widening of the QRS complex, and peaked T waves on ECG indicate which electrolyte abnormality?
• A 21-year-old patient reports tingling in her thumb during cesarean section under epidural anesthesia. To which dermatomal level would this correspond?
• Supraspinal analgesia and prolactin release are produced by which receptor subtype?
• Transposition of the great arteries affects anesthesia induction by slowing inhalation induction and speeding intravenous induction. Which option correctly describes this?
• Somatosensory evoked potentials primarily assess which pathway?
• In severe pulmonary hypertension, nitrous oxide should be avoided because it can worsen pulmonary vascular resistance. Which statement is true?
• Which first-line pharmacologic treatment is most appropriate for postoperative shivering?
• Three hours after disconnecting a patient from the ventilator, the patient shows bradycardia and hypotension; what is the next step in addition to chest compressions?
• Meperidine should be used with caution in patients taking which type of medication?
• Cutaneous innervation of the plantar surface of the foot is provided by which nerve?
• Which statement regarding the effect of chronic ethanol consumption on MAC is correct?
• A fresh-gas flow rate of 2 L/min or greater is recommended for administration of sevoflurane because
• Central postoperative depression of ventilation in a full-term neonate is most likely to occur after surgery for which condition?
• What is the antidote for magnesium toxicity?
• Which maneuver would NOT increase the rate of an inhalation induction?
• A full O2 cylinder stores approximately 660 L at about which pressure?
• The rational for storage of platelets at room temperature (22° C) is to:
• For any given concentration of volatile anesthetic, the splitting ratio depends on which characteristic?
• Which color corresponds to Carbon dioxide?
• Which anesthetic would increase both the amplitude and latency of somatosensory evoked potentials?
• Which factor has minimal impact on pulse oximeter accuracy among the following?
• Which component is NOT considered in the wash-in process of the anesthesia circuit?
• Pretreatment with a nondepolarizing muscle relaxant is least effective in attenuating which side effect of succinylcholine?
• Patients on propranolol are at increased risk for all of the following EXCEPT which?
• Decreased FRC is most consistent with which pulmonary disease?
• Atracurium belongs to which class of nondepolarizing muscle relaxants?
• In patients receiving protamine to reverse heparin after cardiopulmonary bypass, which protamine dose is used to completely reverse heparin administered during surgery (e.g., 20,000 units heparin)?
• Which of the following is NOT decreased in elderly patients compared with younger counterparts?
• Which statement about intrathecal fentanyl as a spinal additive is true?
• In Beckwith-Wiedemann syndrome presenting with omphalocele and macroglossia, which metabolic abnormality is commonly observed?
• All the following agents are acceptable for use in a Bier block EXCEPT
• What effect does thiopental have on the CO2 responsiveness of the cerebral vasculature?
• Infantile pyloric stenosis symptoms most commonly present between which ages?
• Which patient is least likely to develop retinopathy of prematurity?
• One hour after a motor vehicle accident with C7 spinal cord transection and ruptured spleen, regarding neurologic injury, which anesthetic concern is correct?
• The leftward shift of the oxyhemoglobin dissociation curve caused by hypocarbia is known as the
• Which benzylisoquinolinium nondepolarizing neuromuscular blocking drug is unique among this class of drugs in that it does not cause release of histamine?
• 2-Chloroprocaine administered epidurally appears to decrease the quality and duration of subsequently administered fentanyl or morphine. The exact mechanism is unclear but is not related to which factor?
• A patient on nitroprusside infusion develops desaturation to 85% with stable exam after several days. The most likely cause is:
• Which is the least plausible reason for prolonged apnea in a postoperative patient?
• Which of the following is NOT a predictor of difficult mask ventilation?
• Which intravenous adrenergic blocker is most suitable for treating hypertension and tachycardia in a patient with reactive airway disease?
• Flumazenil reverses the effects of which class of drugs?
• Which factor is the primary determinant of local anesthetic potency?
• The relationship PV = constant for a fixed mass of gas at constant temperature is known as which gas law?
• A patient with long bone fractures develops tachycardia, hypoxia, and a petechial rash postoperatively. The most likely diagnosis is which of the following?
• Which statement regarding a pregnant patient abusing cocaine is TRUE?
• Co-administration of dantrolene and verapamil intravenously increases the risk of which complication?
• Treatment for compartment syndrome is which intervention?
• A patient receiving 70% helium in oxygen to ease airway obstruction: which gas property change best explains the decrease in airway resistance?
• Select the correct order from greatest to least for the sensitivity of neurophysiologic monitoring techniques to volatile anesthetics (SSEP; VEP; BAEP).
• What is the treatment of choice for malignant hyperthermia and neuroleptic malignant syndrome?
• Which local anesthetic would produce the lowest fetal concentration relative to maternal serum during a continuous lumbar epidural?
• Fick's law of diffusion of a gas through a lipid membrane: rate of diffusion is directly proportional to surface area and diffusion coefficient and inversely proportional to membrane thickness. In the equation V = D × A × (P1–P2) / T, which variable represents thickness?
• Which of the following would NOT result in an increase in intraocular pressure?
• Pulmonary vascular resistance is least at which lung volume?
• Uterine blood flow is consistently decreased after the administration of which regimen?
• Which intervention does NOT reduce the incidence of nausea and vomiting in children undergoing strabismus surgery?
• After an epidural dose is accidentally administered into the subarachnoid space, which physiologic effect is not expected with a large-volume subarachnoid injection?
• Which statement about diabetes in pregnancy is false?
• Which of the following is NOT a potential complication in the anesthetic management of a patient with neurofibromatosis undergoing acoustic neuroma resection?
• In Ohmeda 7900 ventilator, which statement is true regarding tidal volume delivery?
• Select the true statement about the interaction of nondepolarizing neuromuscular blocking drugs when durations are dissimilar.
• Using the Fick principle, if the arterial-venous oxygen content difference increases while oxygen consumption remains constant, what happens to calculated cardiac output?
• Induction of general anesthesia for an elective operation should be delayed after breastfeeding by how many hours?
• Which anatomical site is associated with the LEAST incidence of central line infection?
• A 57-year-old patient with COPD, HTN, traumatic foot amputation who is on phenelzine (MAOI), thiazide diuretic, and potassium; which anesthetic plan is most appropriate?
• Which plexus supplies pelvic organs such as the uterus, ovaries, and prostate?
• A knee arthroscopy patient has a VDD pacemaker. Which statement is true?
• Accidental air injection into a peripheral vein is least likely to cause arterial air embolism in a patient with which congenital heart defect?
• Postdural puncture headaches characteristically worsen with which posture?
• Raising the frequency of an ultrasound transducer used for line placement or regional anesthesia from 3 MHz to 10 MHz will result in which combination of tissue penetration and resolution?
• Which pharmacologic class is commonly used to treat autonomic hyperreflexia?
• Which postoperative respiratory intervention is contraindicated after transsphenoidal hypophysectomy?
• Kinking or occlusion of the transfer tubing from the patient breathing circuit to the scavenging system interface can result in which of the following?
• Which of the following is NOT a component of the postoperative discharge scoring system (PADSS) used to evaluate ambulatory discharge readiness?
• The normal vital capacity for a 70-kg man is approximately which value?
• In a patient on magnesium therapy for preeclampsia, signs of magnesium overdose most commonly include which symptom?
• Which statement about the side effects of succinylcholine when used to paralyze neonates is NOT true?
• Which of the following clotting factors is not synthesized by the liver?
• Bupivacaine is approximately how many times more potent than lidocaine?
• The anatomic dead space in a 70-kg male is approximately how many milliliters?
• The Diameter-index Safety System is implemented on which part of the gas delivery system?
• Which pharmacologic agent would have the LEAST effect on transcranial motor evoked potentials (MEPs)?
• Frozen erythrocytes can be stored for up to how many years?
• Which opioid receptor agonist has anticholinergic properties?
• Which patient would not be a good candidate for outpatient inguinal hernia repair under general anesthesia?
• Which neuromuscular blocker is least likely to cause histamine release?
• Very short DOA of 3% 2-chloroprocaine is due to metabolism by which enzyme?
• Patients undergoing extracorporeal shock-wave lithotripsy are at increased risk for which complication at the end of the procedure under regional anesthesia?
• A dilation and evacuation (D&E) at 10 weeks estimated gestational age is performed. She has persistent bleeding and cramping after expulsion of tissue. The obstetric condition is called
• Aortocaval compression starts to become significant in a normal pregnancy at how many weeks EGA?
• In a patient with a DDD-R pacemaker wired to asynchronous mode (DOO) with increased native heart rate during surgery, which action is most appropriate?
• After the first graft is sewn into the aorta during cardiopulmonary bypass, which explanation best accounts for a rise in arterial pressure with a concomitant low pulmonary artery pressure?
• Rewarming adequacy after cardiopulmonary bypass is best evaluated by considering which temperatures?
• The P50 of normal hemoglobin is approximately
• Which factor lowers MAC for volatile anesthetics?
• A 17-year-old patient with third-degree burns over 30% of body area is 12 days post-injury for débridement and grafting. Which statement about muscle relaxants is true?
• During placement of an interscalene block, the patient becomes hypotensive, bradycardic, and cyanotic. The most likely cause is
• Which agent is known to increase intracranial pressure?
• Which of the following is NOT a potential complication of lumbar sympathetic blocks?
• For a 70 kg patient, what is the maximum recommended dose of bupivacaine?
• Hemolytic-uremic syndrome is best described by which statement?
• Regarding cerebral autoregulation and PaCO2, which statement is true?
• Which medication is a skeletal muscle relaxant that reduces calcium release from the sarcoplasmic reticulum and treats malignant hyperthermia?
• Which condition would most likely cause a rightward shift of the oxyhemoglobin dissociation curve?
• In an emergency with limited type O-negative RBCs, O-positive RBCs are reasonable for transfusion except for which patient group?
• In a 33-year-old woman with 20% carboxyhemoglobin, which finding is least consistent with carbon monoxide poisoning?
• True statements regarding intrathecal morphine, fentanyl, or sufentanil in obstetric anesthesia include all EXCEPT which?
• A volatile anesthetic has a saturated vapor pressure of 360 mm Hg at room temperature. At what carrier-gas flow would this agent be delivered from a bubble-through vaporizer if the carrier-gas flow through the vaporizing chamber is 100 mL/min?
• The maximum dose of lidocaine containing 1:200,000 epinephrine that can be administered to a 70-kg patient for regional anesthesia (other than spinal) is which amount?
• The most appropriate next step after an incomplete interscalene block for shoulder anesthesia is to perform which block?
• Which blood pressure response would you expect in a patient taking guanethidine when given indirect-acting sympathomimetics compared to direct-acting sympathomimetics?
• Upon emergence from anesthesia after a short desflurane case with remifentanil, which is the most likely issue?
• Which disease is associated with increased resistance to neuromuscular blockade with succinylcholine?
• Which anesthetic would undergo 90% elimination most rapidly after a 6 hour Whipple procedure under one MAC?
• Heparin resistance is likely in patients with which hereditary deficiency?
• What is the minimal time after angioplasty and placement of a drug eluting stent that dual antiplatelet therapy should be continued before considering stopping it for elective surgery?
• Which antibiotic is a member of the lincosamines?
• Which local anesthetic has the most rapid metabolism in maternal and fetal blood?
• Which adverse effect is commonly associated with epidural morphine used for labor analgesia?
• In the VEAL CHOP mnemonic, which deceleration corresponds to head compression?
• The following are reasons for selecting a cuffed endotracheal tube over an uncuffed tube EXCEPT:
• In brain death criteria, apnea must persist for at least how many minutes?
• With regard to regulation of blood flow, the correct order of vascular responsiveness to PaCO2 from most to least sensitive is
• Which agent is most likely to cause tachycardia and should be avoided in patients with LVOT obstruction?
• Buprenorphine has a pharmacologic property that explains its resistance to reversal by naloxone. What is it?
• Cord compression is most typically associated with which type of fetal heart rate deceleration?
• What effect does cerebral ischemia have on CBF autoregulation?
• Which of the following is NOT a potential complication of total parenteral nutrition (TPN)?
• CMR is decreased by which agent?
• After traumatic brain injury, polyuria and plasma sodium 159 mEq/L are noted. Which pathologic condition is associated with these findings?
• What is the normal cerebral metabolic rate for oxygen (CMRO2) in mL of oxygen per 100 g of brain tissue per minute?
• What is the most common cause of neonatal bradycardia (heart rate less than 100 beats/min)?
• Neuroleptic malignant syndrome shares features with malignant hyperthermia and is managed by which of the following?
• Dexmedetomidine is not commonly used for postoperative analgesia mainly because of which reason?
• Which drug should not be used to treat severe bradycardia caused by excessive beta-adrenergic blockade?
• Above which infusion rate does cyanide toxicity become a concern in a healthy adult receiving sodium nitroprusside?
• The main advantage of milrinone over amrinone for long-term use is the lack of which adverse effect?
• A 6-kg, 3-month-old infant undergoing inguinal herniorrhaphy with a spinal anesthetic receives 0.5 mL of 0.5% bupivacaine. What is the expected duration of the block?
• The underlying feature of metabolic syndrome X is...
• The loss-of-resistance technique for placing an epidural needle in a child should be performed with which substance?
• The concept of context-sensitive half-time emphasizes the relationship between half-time and?
• Oxygen tension (PaO2) has what effect on the position of the oxyhemoglobin dissociation curve?
• The esophageal detector device indicates correct tracheal placement when the bulb
• When the pressure gauge on a size E N2O cylinder begins to fall from 750 psi, approximately how many liters remain?
• If PaCO2 increases from 35 to 45 mm Hg, the cerebral blood flow increases by approximately how much per 100 g/min?
• Which of the following medical conditions would not prompt the administration of prophylactic antibiotics for this patient scheduled to undergo a right hemicolectomy?
• If etomidate is accidentally injected into a left radial arterial line, what is the most appropriate immediate action?
• In a 12-year-old child, the length of an oral endotracheal tube from lips to midtrachea should be approximately:
• In patients with WPW syndrome, verapamil can have what effect on conduction?
• Which local anesthetic used for intravenous regional anesthesia (Bier block) is most rapidly metabolized and thus, least toxic?
• A patient with a VVI pacemaker experiences intraoperative bradycardia after hyperventilation. What is the most likely cause?
• The primary reason desflurane is not used for inhalation induction is due to which effect?
• Which is NOT a potential complication of a stellate ganglion block?
• Low flow anesthesia is associated with higher serum fluoride levels.
• Which procedure for treatment of chronic pain requires localization of the epidural space with an epidural needle as part of the technique?
• Which neuromuscular blocking drug causes the greatest release of histamine when administered intravenously?
• Following the first minute of apnea, the PaCO2 increases at approximately what rate per minute?
• A 2-year-old child with cerebral palsy and severe gastroesophageal reflux is scheduled to undergo iliopsoas release under general anesthesia. Which induction technique is most appropriate?
• Five days after knee arthroscopy under spinal anesthesia, a 55 year old complains of double vision and difficulty hearing. The other likely finding would be
• Which class of nondepolarizing muscle relaxants is associated with no significant histamine release?
• Administration of an interscalene block is associated virtually 100% of the time with which?
• Which finding is NOT consistent with malignant hyperthermia?
• Which statement best describes drug safety in porphyria cutanea tarda?
• Which nerve provides sensation to the medial length of the calf in an ankle block?
• Which choice is NOT consistent with a limb affected by complex regional pain syndrome?
• Which statement explains why sevoflurane has a faster onset than isoflurane?
• Which of the following reasons best explains the more rapid alveolar washout of halothane compared with isoflurane?
• Which of the following is NOT part of the standard endotracheal drug list abbreviated as VLEAN?
• Which statement about risk factors for retinopathy of prematurity is true?
• Uptake of sevoflurane during first minute is 50 mL. Between the 16th and 36th minutes, how much sevoflurane is taken up?
• Which inhalational agent is a potent cerebral vasodilator and can increase intracranial pressure?
• The oxygen flush valve draws from the intermediate pressure system, which operates at approximately which pressure?
• Which oral hypoglycemic drug is associated with a risk of intraoperative lactic acidosis if not discontinued at least 24 hours before surgery?
• In a patient with suspected antithrombin III deficiency and heparin resistance, which product best replenishes antithrombin III?
• Hypocalcemia predisposes to laryngospasm by decreasing which electrical property of nerve membranes?
• Which local anesthetic is inappropriately paired with its clinical application because of toxicity concerns?
• According to the 2004 ASRA practice advisory, what is the most important action to maintain aseptic technique and prevent cross-contamination during regional anesthesia techniques?
• Electrocardiographic changes associated with hyperkalemia include which of the following?
• What is the approximate half-life of chloroprocaine in plasma?
• Which intervention would be considered useful in managing intracranial hypertension in a patient with a head injury EXCEPT?
• The most reliable method of determining mild dehydration in a child is which of the following?
• In patients with Down syndrome (trisomy 21), which of the following is NOT increased in incidence?
• Which observation after nerve injury is correctly paired with the appropriate nerve?
• The primary determinants of myocardial oxygen consumption, from most to least important, are which sequence?
• Signs and symptoms of intracranial hypertension include which of the following?
• The addition of epinephrine to epidural bupivacaine will
• In a neonate with congenital diaphragmatic hernia, which immediate management step is recommended?
• In a Thorpe tube rotameter, how does the bore diameter change from bottom to top?
• Abrupt and large increases in the delivered concentration of which inhalational agent may produce transient increases in systemic blood pressure and heart rate?
• Which conditions increase physiologic dead space?
• Which organ has the greatest impact on insulin metabolism, contributing to hypoglycemia risk in renal disease?
• Which statement about the hemodynamic state in cirrhosis is most accurate when SVO2 is high?
• TOF 4/4 can have up to what percentage of receptors blocked?
• Depressed ventilation and marked constipation are associated with which receptor subtype?
• With a properly functioning circle system, which of the following is not a disadvantage of low flow anesthesia?
• A 75-year-old patient with signs of a leaking cerebral aneurysm has ECG changes including T-wave inversion, QT prolongation, and U waves. The appropriate action at this point would be to:
• A 35-year-old morbidly obese patient readmitted after gastric bypass surgery presents with atrial fibrillation and hypotension. The next step in management of her dysrhythmia should be
• During anesthesia, fever is a late finding of malignant hyperthermia. Which finding would be considered a late sign?
• The most common complication associated with a supraclavicular brachial plexus block is:
• Sensory innervation below the vocal cords to the carina is provided by which nerve?
• An old enflurane vaporizer with a vapor pressure of 170 mmHg is used. Which volatile would deliver an output when the dial setting equals the vaporizer output?
• Caution is advised when using succinylcholine in patients with Huntington's chorea because
• Treatment of neuroleptic malignant syndrome may be carried out with all of the following EXCEPT:
• Which statement about perioperative cardiac arrest in children is NOT correct?
• A pregnant patient has blood pressure of 180/95 at 18 weeks and 170/95 one week later with ankle edema but no protein in urine. How would this be classified?
• Fetal oxygen store is about 42 mL; how long would it take to deplete during an interruption of oxygen delivery?
• What agent is indicated to treat hypertension due to vasopressor extravasation in pediatric patients?
• Approximately, what is the incidence of PIH in women with BMI >35?
• Which type of gas flow occurs when the flow velocity exceeds the critical velocity?
• Select the false statement about ketamine.
• After cessation of general anesthesia, which item acts as a reservoir delaying emergence?
• Calculate the BMI for a man who is 200 cm tall and weighs 100 kg.
• Which muscle relaxant would provide the most rapid airway control for RSI in a patient with recent burn injuries?
• In compartment syndrome, which sign is last to appear?
• Gestational hypertension is defined as new-onset hypertension after 20 weeks gestation without proteinuria.
• Which mechanism is most frequently responsible for hypoxia in the recovery room?
• What is the approximate prevalence of preeclampsia in pregnancies?
• Methemoglobinemia typically causes pulse oximetry to read around which value, despite a normal PaO2?
• Which sign is NOT associated with amniotic fluid embolism?
• Which factor is NOT associated with a significantly higher incidence of pregnancy-induced hypertension (PIH) compared with a healthy 25-year-old primigravida?
• Select the true statement regarding blood pressure when 1.5 MAC nitrous oxide–isoflurane is substituted for 1.5 MAC isoflurane–oxygen.
• Why are ester local anesthetics not used for intravenous regional blocks?
• The highest trace concentration of nitrous oxide allowed in the OR atmosphere by NIOSH is which?
• Which antibiotic is a member of the lincosamines and may prolong nondepolarizing neuromuscular blockade?