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Each of the questions or incomplete statements in this section is followed by answer or by completions of the statement, respectively. Select the ONE BEST answer or completion for each item. 1. Which of the following would be the most likely cause of oozing in a patient transfused with 10 units of packed red blood cells (RBCs)? A. B. C. D. E. 2. The blood volume of a 10-kg, 1-year-old infant is A. B. C. D. E. 3. 650 mL 800 mL 1100 mL 1300 mL 1500 mL A 20-kg, 5-year-old child with a hematocrit of 40% could lose how much blood and still maintain a hematocrit of 30%? A. B. C. D. E. 4. Citrate toxicity Low factor V Low fibrinogen Dilutional thrombocytopenia Low factor VIII 140 mL 250 mL 350 mL 450 mL 550 mL A 100-kg male patient has a measured serum sodium concentration of 105 mEq/L. How much sodium would be needed to bring the serum sodium to 120 mEq/L? A. B. C. D. E. 600 mEq 900 mEq 1200 mEq 2400 mEq 3600 mEq 5. Which of the following peripheral nerves is most likely to become injured in patients who are under general anaesthesia? A. B. C. D. E. 6. Renal failure associated with fluoride toxicity anaesthesia most closely resembles A. B. C. D. E. 7. Ulnar nerve Median nerve Radial nerve Common peroneal nerve Sciatic and peroneal nerve Papillary necrosis Acute tubule necrosis Hepatorenal syndrome Central diabetes insipidus Nephrogenic diabetes insipidus Naltrexone is A. B. C. D. A narcotic with local anaesthetic properties An opioid agonist-antagonist similar to nalbuphine A pure opioid antagonist with a shorter duration of action than Naloxone An opioid anatagonist used for treatment of previously detoxified heroin addicts E. A synthetic opioid derived from oxymorphone 8. Which of the following mechanisms is most frequently responsible for hypoxia in the recovery room? A. B. C. D. E. 9. Ventilation/perfusion mismatch Hypoventilation Hypoxic gas mixture Intracardiac shunt Abnormal gas diffusion Pheochromocytoma would be most likely to coexist with which of the following? A. B. C. D. E. Insulinoma Pituitary adenoma Primary hyperaldosteronism (Conn’s syndrome) Medullary carcinoma of the thyroid Carcinoid tumor 10. A 3-year-old child is scheduled for tonsillectomy. Clear liquids may be consumed up to how many hours preoperatively. A. B. C. D. E. 11. Each of the following postoperative complications of thyroid surgery can result in upper airway obstruction EXCEPT A. B. C. D. E. 12. Tachycardia Hypertension Fever Hypoxia Increased end-expiratory CO2 tension (PECO2) Which of the following is NOT a component of the Post-Anaesthetic Discharge Scoring System (PADSS) used to evaluate the suitability of a patient to be discharged from an ambulatory surgical facility? A. B. C. D. E. 14. Tracheomalacia Tetany Cervical hematoma Bilateral recurrent laryngeal nerve injury Bilateral superior laryngeal nerve injury The most sensitive early sign of malignant hyperthermia during general anaesthesia is A. B. C. D. E. 13. 2 4 6 8 Anytime before induction Drinking Ambulation Nausea and vomiting Pain Surgical bleeding Which of the following drugs is useful in the treatment of asthma by specifically interfering with the leukotriene pathway? A. B. C. D. E. Fluticasone (Flovent) Ipratropium bromide (Atrovent) Triamcinolone (Azmacort) Montelukast (Singulair) Salmeterol 15. Which of the following would not result in an increase in intraocular pressure? A. B. C. D. E. 16. Remifentanil is metabolized primarily by A. B. C. D. E. 17. Venous air embolism Pneumothorax Peripheral neuropathies Postdural puncture headache Hypotension with regional anaesthesia Each of the following may increase MAC for volatile anaesthetics EXCEPT A. B. C. D. E. 19. Kidneys Liver Hoffman elimination Pseudocholinesterase Nonspecific esterases Patients who undergo extracorporeal shock wave lithotripsy are at increased risk for A. B. C. D. E. 18. Increase in Paco2 from 35 to 40 mm Hg 100 mg IV succinylcholine after pretreatment with 1 mg Vecuronium 100 mg IM succinylcholine Acute rise in venous pressure from coughing 100 mg IV succinylcholine in patient in whom eye muscles have been detached from the globe Cocaine Hyperthyroidism Monoamine oxidase inhibitor therapy Tricyclic antidepressants Hypernatremia Hypoglycemia is more likely to occur in the diabetic surgical patient with which of the following diseases? A. Renal disease B. Rheumatoid arthritis requiring high-dosage prednisone C. Chronic obstructive lung disease treated with a terbutaline inhaler and Aminophylline D. Manic-depressive disorder treated with lithium E. Congestive heart failure 20. The most sensitive test for detecting primary hypothyroidism in the preoperative evaluation of a patient in whom hypothyroidism is suspected is A. B. C. D. E. 21. In the newborn the cricoid cartilage is at which level relative to the cervical spine? A. B. C. D. E. 22. TSH level Total plasma T3 level Total plasma T4 level Resin T3 uptake Antithyroid antibodies C3 C4 C5 C6 C7 The most common cause of neonatal bradycardia (heart rate less than 100/min) is A. Congenital heart disease B. Maternal drug intoxication (narcotics, alcohol, magnesium, barbiturates, digitoxin) C. Fever D. Postpartum cold stress E. Hypoxemia 23. Each of the following statements concerning side effects of succinylcholine when used to paralyze neonates is true EXCEPT A. B. C. D. E. 24. It seldom causes muscle fasciculation It can cause bradycardia Dysrhythmias frequently occur following intramuscular injections It can cause myoglobinuria It can cause hyperkalemia Magnesium sulfate (MgSO4) is used as an anticonvulsant in patients with preeclampsia and may produce any of the following effects EXCEPT A. B. C. D. E. Sedation Analgesia Hypotension Respiratory paralysis Tocolysis. 25. Normal fetal heart rate (FHR) is A. B. C. D. E. 26. Toxic side effects of MgSO4 when used to treat preeclampsia include all the following EXCEPT A. B. C. D. E. 27. Dyspnea Hypertension Bleeding (disseminated intravascular coagulation) Hypoxemia Seizures Which of the following respiratory parameters is not increased in the parturient? A. B. C. D. E. 29. Cardiac arrest Neonatal hypotonia Potentiation of neuromuscular blockade with Vecuronium Renal failure Hypoventilation Which of the following signs and symptoms is NOT associated with amniotic fluid embolism? A. B. C. D. E. 28. 60 to 100 beats/min 100 to 140 beats/min 120 to 160 beats/min 150 to 200 beats/min None of the above Minute ventilation Tidal volume Arterial PaO2 Oxygen consumption Serum bicarbonate A patient having which of the following conditions is LEAST likely to develop disseminated intravascular coagulation? A. B. C. D. E. Pregnancy-induced hypertension Placenta abruption Placenta previa (bleeding) Amniotic fluid embolism Dead fetus syndrome 30. Morphine is not used routinely for labor epidurals because it A. B. C. D. E. 31. Which of the following lung volumes or capacities change the LEAST during pregnancy? A. B. C. D. E. 32. 5 mm Hg 15 mm Hg 25 mm Hg 40 mm Hg None of the above Which of the following intravenous anaesthetics is contraindicated in patients with intracranial hypertension? A. B. C. D. E. 34. Tidal volume Functional residual capacity Expiratory reserve volume Residual volume Vital capacity Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above A. B. C. D. E. 33. Increases uterine tone Causes excessive neonatal respiratory depression Has a slow onset Decreases uterine blood flow Adversely affects FHR variability Diazepam Fentanyl Thiopental Midazolam Ketamine Normal global CBF is A. B. C. D. E. 25 mL/100 g/min 50 mL/100 g/min 75 mL/100 g/min 100 mL/100 g/min 150 mL/100 g/min 35. Which of the following is the most sensitive means of detecting venous air embolism (VAE)? A. B. C. D. E. 36. Which of the following is the earliest sign of lidocaine toxicity? A. B. C. D. E. 37. Bupivacaine, lidocaine, ropivacaine Bupivacaince, ropivacaine, lidocaine Lidocaine, bupivacaine, ropivacaine Ropivacaine, bupivacaine, lidocaine Lidocaine, ropivacaine, bupivacaine The primary determinant of local anaesthetic potency is A. B. C. D. E. 39. Shivering Nystagmus Lightheadedness and dizziness Tonic-clonic seizures Nausea and vomiting The correct arrangement of local anaesthetics in order of their ability to produce cardiotoxicity from most to least is A. B. C. D. E. 38. Electroencephalography (EEG) Pulmonary artery catheter Transesophageal echocardiography Mass spectrometry Right atrial catheterization pKa Molecular weight Lipid solubility Concentration Protein binding Severe hypotension associated with high spinal anaesthesia is caused primarily by A. B. C. D. E. Decreased cardiac output secondary to decreased preload Decreased systemic vascular resistance Decreased cardiac output secondary to bradycardia Decreased cardiac output secondary to decreased myocardial contractility Increased shunting through metarterioles 40. Select the FALSE statement regarding spinal anatomy and spinal anaesthesia A. B. C. D. E. 41. A retrobulbar block anaesthetizes each of the following nerves EXCEPT A. B. C. D. E. 42. Common carotid artery Internal carotid artery Vertebral artery Axillary artery Aorta If the recurrent laryngeal nerve were transected bilaterally, the vocal cords would A. B. C. D. E. 44. Ciliary nerves Cranial nerve IV (trochlear nerve) Cranial nerve III (oculomotor nerve) Cranial nerve VI (abducens nerve) Maxillary branch of the trigeminal nerve The stellate ganglion lies in closest proximity to which of the following vascular structures? A. B. C. D. E. 43. The addition of phenylephrine to lidocaine will prolong spinal anaesthesia A high thoracic sensory block will result in total sympathetic blockade The largest vertebral interspace is L5-S1 The dural sac extends to the S3-4 interspace Tetracaine provides longer anaesthesia than does procaine Be paralyzed in the open position Be paralyzed in the closed position Be paralyzed in the intermediate position Not be affected unless the superior laryngeal nerve were also injured Appear exactly the same as if an intubating dose of succinylcholine were given The most common complication associated with a supraclavicular brachial plexus block is A. B. C. D. E. Blockade of the phrenic nerve Intravascular injection into the vertebral artery Spinal blockade Blockade of the recurrent laryngeal nerve Pheumothorax 45. Epidural use of which of the following opioids would result in the greatest incidence of delayed respiratory depression? A. B. C. D. E. 46. Which of the following is the most sensitive indicator of left ventricular myocardial ischemia? A. B. C. D. E. 47. Wall-motion abnormalities on the echocardiogram ST-segment changes in lead V5 of the electrocardiogram (ECG) Appearance of V waves on the pulmonary capillary wedge pressure tracing Elevation of the pulmonary capillary wedge pressure Decrease in cardiac output as measured by the thermodilution technique Afterload reduction is beneficial during anaesthesia for noncardiac surgery in patients with each of the following conditions EXCEPT A. B. C. D. E. 48. Sufentanil Fentanyl Morphine sulfate Hydromorphone Meperidine Aortic insufficiency Mitral regurgitation Tetralogy of Fallot Congestive heart failure Patent ductus arteriosus Which of the following drugs should NOT be administered via an endotracheal tube? A. B. C. D. E. Lidocaine HCO3 Atropine Naloxone Epinephrine