Key words

Question 1 of 30

1

A 67-yo with a Hodgkin's lymphoma on bleomycin to undergo a laparotomy.
Which of the following increase risk of pulmonary toxicity?

Select one of the following:

PEEP 10 cmH2O
TV 600 mL
Peak pressure 20 cmH2O
FiO2 0.80

Explanation

Question 2 of 30

1

5-year-old boy is admitted to the PACU after receiving GA for a MRI. The patient is screaming, kicking and not making eye contact. The PACU nurse cannot calm him down.
Which of the following would prevented this presentation?

Select one of the following:

Rectal acetaminophen
Ondansetron
Dexmedetomidine
Glycopyrrolate

Explanation

Question 3 of 30

1

40-year-old man receives a 0.7 mcg/kg bolus of dexmedetomidine over ten minutes before an intubation.
What will be the most likely effect from this dose of dexmedetomidine ?

Select one of the following:

Apnea
Bradycardia
Increased salivation
Nystagmus

Explanation

Question 4 of 30

1

60-year-old woman is oliguric after a bowel resection marked by intraoperative hypotension despite
aggressive Ringer's lactate administration. Her plasma sodium is 126 mEq/L.
Which one is the most probable cause for her oliguria?

Select one of the following:

Excessive antidiuretic hormone
Inadvertent ureteral ligation
Excessive Ringer's lactate administration
Renal artery occlusion

Explanation

Question 5 of 30

1

Two days after returning from Colombia a 37-year-old man became ill with flu-like prodrome, mild fever and rash in the face and trunk, as well as ocular pain and arthralgia; The symptoms alleviated after a few days. Along with the serum sample, a urine sample was taken and identified as Zika virus. He had been evaluated now for paresthesia of the four limb extremities that evolved into ascendant muscular weakness.
Which of the following has been associated with Zika virus infection?

Select one of the following:

Guillain-Barré syndrome
Vasculitic neuropathy
Myasthenia gravis
Cauda equina syndrome

Explanation

Question 6 of 30

1

A 75-yo man with CAD on aspirin and clopidogrel after a bare metal stent placement. He need ligation and stripping of painful varicose veins in his legs.
Which is the earliest time after stent placement that appropriate to discontinue clopidogrel for elective surgery?

Select one of the following:

1 week
1 month
3 months
1 year

Explanation

Question 7 of 30

1

A 72-kg patient receives GA in a semi-closed circle system with fresh gas flows of O2 0.4 L/min, N2O 0.4 L/min and desflurane 4%. After 90 minutes, the inspired FiO2, as measured by the oxygen analyzer in the circuit, is 33%.
Which of the following is likely explanation for the discrepancy between the delivered and inspired oxygen concentrations?

Select one of the following:

Exhausted CO2 absorber
Incorrectly calibrated O2 analyzer
Dilution of delivered gases with desflurane
Increased uptake of O2 as compared to N2O

Explanation

Question 8 of 30

1

Which of the following changes in CV function is usually occur in a healthy extremely old patient compared to his status at young age?

Select one of the following:

Decrease in LVEDP
Increase in systemic arterial compliance
Decrease in beta-receptor sensitivity to catecholamines
Increase in left ventricular stroke volume

Explanation

Question 9 of 30

1

A 33 yo woman is for a laparoscopic assisted hysterectomy under general anesthesia placed in the Trendelenburg position. Over the first 40 minutes, her SpO2 decreases to 86% with no change in vital signs, pulse oximeter waveform, or end tidal CO2.
Which of the following interventions is needed to treat her hypoxemia?

Select one of the following:

Perform a recruitment maneuver
Decrease the tidal volume
Increase the expiratory time
Place the operating table flat

Explanation

Question 10 of 30

1

After knee replacement, a woman reports no pain relief after taking relatively large doses of codeine fPO. Which of the following pharmacodynamics problems with codeine is causing the inadequate analgesia?

Select one of the following:

Excessive renal excretion
Increased metabolism
Decreased conversion to morphine
Impaired gastric absorption

Explanation

Question 11 of 30

1

After complete reversal of rocuronium with neostigmine a full dose of succinylcholine was given for re-intubating . How this going to effect the duration of the succinylcholine-induced neuromuscular blockade?

Select one of the following:

Unknown
Prolonged
Shortened
Unchanged

Explanation

Question 12 of 30

1

Pulse pressure variation will be most accurate indicator of hypovolemia with which of the following methods of ventilation ?

Select one of the following:

Spontaneous ventilation with continuous positive airway pressure
Spontaneous ventilation
Pressure support ventilation
Volume control ventilation

Explanation

Question 13 of 30

1

A 61-year-old woman with a serum creatinine of 2.2 mg/dL requires intravenous contrast for an interventional radiology procedure. Which one of the following interventions is proven to reduce his risk of renal failure from contrast-induced nephrotoxicity?

Select one of the following:

Administration of methylprednisolone
Euvolemic hydration with normal saline
Intravenous infusion of mannitol
Avoidance of sevoflurane

Explanation

Question 14 of 30

1

After an block placement, a previously healthy woman suffers a cardiac arrest. Which one of the following medications is appropriate to be used during local anesthetic systemic toxicity resuscitation?

Select one of the following:

Vasopressin
Metoprolol
Verapamil
Epinephrine

Explanation

Question 15 of 30

1

Which of the following anesthesia machine safety devices is only one that continuously monitors to detect a low-pressure leak when delivering an anesthetic?

Select one of the following:

Oxygen analyzer
One-way check valve
Proportioning system
Oxygen supply failure alarm

Explanation

Question 16 of 30

1

A 63-year-old woman had a CABG five hours ago. She is intubated and mechanically ventilated. Her BP decreases to 65/45 mmHg with a HR of 120 bpm. His CVP is 19 mmHg, PAP is 25/20 mmHg, and PCWP is 20 mmHg. Which of the following TEE findings is more likely to be present in this patient?

Select one of the following:

Distended left ventricle
Mitral valve prolapse
Akinetic right atrium
Normal left ventricular contractility

Explanation

Question 17 of 30

1

Which of the following clinical scenarios does NOT constitute a sentinel event?

Select one of the following:

Intraoperative hemolytic transfusion reaction secondary to blood group mismatch
Acute postoperative hepatic failure in a patient with metastatic liver disease who underwent a liver resection
Intraoperative anaphylactic reaction to cefuroxime in a patient with history of major PCN allergy
Unanticipated postoperative death of a full term infant

Explanation

Question 18 of 30

1

A 70-year-old woman with dementia received GA for a hysterectomy. After the operation her pain was treated with opioids and nonsteroidal anti-inflammatory drug (NSAID). Three days after surgery the patient develops delirium. Which of the following preoperative factors is the best predictor of her postoperative delirium?

Select one of the following:

History of dementia
General anesthesia (GA)
Nonsteroidal anti-inflammatory drug (NSAID)
Female sex

Explanation

Question 19 of 30

1

A 72-year-old woman develops arterial hypotension, bradycardia, and respiratory arrest immediately after undergoing a retrobulbar block using 5 mL of lidocaine for a vitrectomy, . Injection into which one of the following structures is responsible for her condition?

Select one of the following:

Ophthalmic artery
Optic nerve sheath
Myopic staphyloma
Episcleral space

Explanation

Question 20 of 30

1

A 55-year-old woman with CAD would like to have a breast augmentation. She has been on aspirin and clopidogrel since placement of a drug-eluting stent (DES) two months ago. At what point after stent placement would it be very appropriate to consider stopping clopidogrel for elective surgery?

Select one of the following:

Six months
Nine months
Twelve months
Eighteen months

Explanation

Question 21 of 30

1

A 43 yo man was admitted to the hospital six days earlier for an intracranial hemorrhage that required emergency evacuation. The patient was later extubated when his neurologic status improved. He has been receiving 0.9% normal saline since admission, and his sodium level has been gradually decreasing from 141mEq/L, the level at admission, to 121 mEq/L. The patient appears hypovolemic, with a blood pressure of 115/70 mm Hg and pulse of 90 beats per minute. His intake and outtake documentation reveals that his urine output has been 2 to 4 L/d despite a fluid restriction of <1.5 L/d that was initiated two days earlier. Workup reveals a low serum osmolarity of, a normal serum creatinine level, and high urine osmolarity. His brain natriuretic peptide (BNP) is elevated. Which of the following is NOT correct in differentiating syndrome of inappropriate antidiuretic hormone (SIADH) from cerebral salt wasting (CSW)?

Select one of the following:

In both SIADH and CSWS, laboratory tests alone cannot easily differentiate because in both conditions, serum Na is low, plasma osmolality low, urine osmolality high, and urine Na high.
Serum uric acid is low in CSW, and high in SIADH
CSW is associated with negative fluid balance and clinical evidence of volume depletion, whereas in SIADH no negative fluid balance or volume depletion is seen
Urea/Creatinine ratio may increase in CSW and is normal in SIADH

Explanation

Question 22 of 30

1

A 55-y-o man with NIDDM, HTN and Afib is scheduled for elective surgery. Which one of the following oral medications is appropriate for the patient to continue on the morning of surgery?

Select one of the following:

Lisinopril
Atenolol
Metformin
Coumadin

Explanation

Question 23 of 30

1

A 65 yo male with a history of HTN and nicotine abuse complaint of severe chest pain, nausea, dyspnea and diaphoresis.
On examination, the patient is in moderate distress. His skin is warm and dry. BP is 98/64 mm Hg and pulse is regular at 63/min. There is an S4 gallop at the apex together with a grade 2/6 systolic ejection murmur. Neck veins are 4 cm above the clavicle at 30 degrees. Lungs are clear and the peripheral pulses are normal. His ECG is shown, below.
The patient received sublingual NTG, 3 mg of intravenous morphine sulfate, and ASA. Two minutes later, the patient's BP drops to 70/30 mm Hg. Pulse is 60/min.
Which of the following represents the most likely cause for his hypotension:

Select one of the following:

Papillary Muscle dysfunction
Cardiogenic shock
Acute inferior wall MI with right ventricular infarction
Myocardial rupture

Explanation

Question 24 of 30

1

Which safety event is NOT considered sentinel event by The Joint Commission?

Select one of the following:

Abduction of any patient receiving care
Rape of a visitor while on site at the practice
Any intrapartum maternal death
Unintended retention of a foreign object in a patient after a clinical determination

Explanation

Question 25 of 30

1

A 64-yo woman is evaluated prior to THR. She takes losartan for HTN, simvastatin for hyperlipidemia, and metformin for T2D. She can climb a flight of stairs (4 METS). When she shovels snow in the winter she has to take breaks because she gets short of breath. Which one of the following actions is the more appropriate next step?

Select one of the following:

Prescribe perioperative beta-blocker
Proceed with surgery
Schedule pharmacologic stress test
Discontinue simvastatin

Explanation

Question 26 of 30

1

In which patients low flow anesthesia is NOT contraindicated?

Select one of the following:

acute alcoholic intoxication
diabetic ketoacidosis
carbon monoxide poisoning
chemotherapy with bleomycin

Explanation

Question 27 of 30

1

A 55-yo woman with asthma for an endovascular aneurysm repair. She currently takes metoprolol and has an allergy to shellfish. Which one of the following is the predictor for an anaphylactic reaction to intravenous contrast media in this patient?

Select one of the following:

Male sex
History of asthma
Metoprolol treatment
Shellfish allergy

Explanation

Question 28 of 30

1

A 55-yo smoker undergoes laparotomy using GA with desflurane after awake intubation. Which one of the following factors would be responsible for a carboxyhemoglobin level of 22% in this patient after surgery?

Select one of the following:

Desiccated carbon dioxide (CO2) absorbent
Incompetent expiratory valve in anesthesia machine
Use of benzocaine spray for awake intubation
Heavy smoking preoperatively

Explanation

Question 29 of 30

1

A 19-yo patient with Down syndrome will receive a GA for an cholecystectomy. Which one of the following findings is more likely to impair visualization of the vocal cords during direct laryngoscopy in this patient?

Select one of the following:

Midface hypoplasia
Macroglossia
Micrognathia
Atlanto-occipital fusion

Explanation

Question 30 of 30

1

A patient receives 20 mg of IV morphine over the first 24 hours after an exploratory laparotomy and develops postoperative nausea and vomiting (PONV). Which one of the following is the most important opioid-related factor contributing to the risk of postoperative nausea and vomiting?

Select one of the following:

Opioid class
Route of administration
Cumulative dose
Dosing interval

	Created by Mike Ru over 8 years ago

2016

Question 1 of 30

A 67-yo with a Hodgkin's lymphoma on bleomycin to undergo a laparotomy. Which of the following increase risk of pulmonary toxicity?

Select one of the following:

Explanation

Question 2 of 30

5-year-old boy is admitted to the PACU after receiving GA for a MRI. The patient is screaming, kicking and not making eye contact. The PACU nurse cannot calm him down. Which of the following would prevented this presentation?

Select one of the following:

Explanation

Question 3 of 30

40-year-old man receives a 0.7 mcg/kg bolus of dexmedetomidine over ten minutes before an intubation. What will be the most likely effect from this dose of dexmedetomidine ?

Select one of the following:

Explanation

Question 4 of 30

60-year-old woman is oliguric after a bowel resection marked by intraoperative hypotension despite aggressive Ringer's lactate administration. Her plasma sodium is 126 mEq/L. Which one is the most probable cause for her oliguria?

Select one of the following:

Explanation

Question 5 of 30

Select one of the following:

Explanation

Question 6 of 30

A 75-yo man with CAD on aspirin and clopidogrel after a bare metal stent placement. He need ligation and stripping of painful varicose veins in his legs. Which is the earliest time after stent placement that appropriate to discontinue clopidogrel for elective surgery?

Select one of the following:

Explanation

Question 7 of 30

Select one of the following:

Explanation

Question 8 of 30

Which of the following changes in CV function is usually occur in a healthy extremely old patient compared to his status at young age?

Select one of the following:

Explanation

Question 9 of 30

Select one of the following:

Explanation

Question 10 of 30

After knee replacement, a woman reports no pain relief after taking relatively large doses of codeine fPO. Which of the following pharmacodynamics problems with codeine is causing the inadequate analgesia?

Select one of the following:

Explanation

Question 11 of 30

After complete reversal of rocuronium with neostigmine a full dose of succinylcholine was given for re-intubating . How this going to effect the duration of the succinylcholine-induced neuromuscular blockade?

Select one of the following:

Explanation

Question 12 of 30

Pulse pressure variation will be most accurate indicator of hypovolemia with which of the following methods of ventilation ?

Select one of the following:

Explanation

Question 13 of 30

A 61-year-old woman with a serum creatinine of 2.2 mg/dL requires intravenous contrast for an interventional radiology procedure. Which one of the following interventions is proven to reduce his risk of renal failure from contrast-induced nephrotoxicity?

Select one of the following:

Explanation

Question 14 of 30

After an block placement, a previously healthy woman suffers a cardiac arrest. Which one of the following medications is appropriate to be used during local anesthetic systemic toxicity resuscitation?

Select one of the following:

Explanation

Question 15 of 30

Which of the following anesthesia machine safety devices is only one that continuously monitors to detect a low-pressure leak when delivering an anesthetic?

Select one of the following:

Explanation

Question 16 of 30

A 63-year-old woman had a CABG five hours ago. She is intubated and mechanically ventilated. Her BP decreases to 65/45 mmHg with a HR of 120 bpm. His CVP is 19 mmHg, PAP is 25/20 mmHg, and PCWP is 20 mmHg. Which of the following TEE findings is more likely to be present in this patient?

Select one of the following:

Explanation

Question 17 of 30

Which of the following clinical scenarios does NOT constitute a sentinel event?

Select one of the following:

Explanation

Question 18 of 30

Select one of the following:

Explanation

Question 19 of 30

A 72-year-old woman develops arterial hypotension, bradycardia, and respiratory arrest immediately after undergoing a retrobulbar block using 5 mL of lidocaine for a vitrectomy, . Injection into which one of the following structures is responsible for her condition?

Select one of the following:

Explanation

Question 20 of 30

A 55-year-old woman with CAD would like to have a breast augmentation. She has been on aspirin and clopidogrel since placement of a drug-eluting stent (DES) two months ago. At what point after stent placement would it be very appropriate to consider stopping clopidogrel for elective surgery?

Select one of the following:

Explanation

Question 21 of 30

Select one of the following:

A 67-yo with a Hodgkin's lymphoma on bleomycin to undergo a laparotomy.
Which of the following increase risk of pulmonary toxicity?

5-year-old boy is admitted to the PACU after receiving GA for a MRI. The patient is screaming, kicking and not making eye contact. The PACU nurse cannot calm him down.
Which of the following would prevented this presentation?

40-year-old man receives a 0.7 mcg/kg bolus of dexmedetomidine over ten minutes before an intubation.
What will be the most likely effect from this dose of dexmedetomidine ?

60-year-old woman is oliguric after a bowel resection marked by intraoperative hypotension despite
aggressive Ringer's lactate administration. Her plasma sodium is 126 mEq/L.
Which one is the most probable cause for her oliguria?

A 75-yo man with CAD on aspirin and clopidogrel after a bare metal stent placement. He need ligation and stripping of painful varicose veins in his legs.
Which is the earliest time after stent placement that appropriate to discontinue clopidogrel for elective surgery?