Министерство образования и науки Кыргызской Республики
Ошский государственный университет
Международный медицинский факультет
Кафедра хирургических дисциплин с курсом травматологии
Тестовые задания
по дисциплине Анестезиология и реаниматология
(Anesthesiology and Intensive Care)
для студентов очного отделения 6 курса, обучающихся по направлению:
560001 «Лечебное дело»
Курс 6
Семестр 11
Количество часов 45 часов
Составители преподаватели : Муратов А. Исаков А . Бакиров С
ОШ– 2021
TEST
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Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level?
A. Decreased abdominal muscle tone
B. Decreased afferent input from the thoracic wall
C. Increased dead space ventilation
D. Increased intrapulmonary shunting E. Partial diaphragmatic paralysis
A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a
metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements
concerning this condition is true?
A. A radiograph of the distal bones of the painful foot will show severe osteoporosis
B. A technetium scan of the distal joints of the painful foot will show decreased uptake
C. Early use of opioid analgesia will prevent progression of the symptoms
D. Intravenous phentolamine will relieve the pain
E. The chance of spontaneous recovery within eight weeks is greater than 80%
A celiac plexus block provides effective relief of pain associated with primary cancers at each of the following locations
EXCEPT the
A. adrenal gland
B. liver
C. pancreas
D. sigmoid colon
E. stomach
After termination of an inhalation anesthetic, patient-controlled analgesia will
A. be effective without a loading dose of opioid if started in the immediate post anesthetic period
B. be associated with greater analgesic requirements than conventional intramuscular opioid techniques
C. cause addiction or dependence to opioids if continued for more than 72 hours
D. produce less patient satisfaction than intermittent intravenous administration of opioids
E. show a diurnal variation in analgesic requirement
A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one
hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100
mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show no abnormalities. Which
of the following is the most appropriate immediate management?
A. Continuous epidural analgesia using local anesthetics
B. Mechanical ventilation
C. Infusion of midazolam
D. Patient-controlled analgesia with morphine sulfate E. Surgical stabilization of rib fractures
Which of the following causes of circulatory insufficiency can lead to shock as a result of decreased plasma volume? A.
Penetrating trauma with blood loss
B. Gastrointestinal bleeding
C. Anaphylaxis because of medications
D. All of the above
Patients admitted with hypovolemic shock usually have:
A. Very low serum sodium concentrations
B. Very low serum chloride concentrations
C. Elevated diastolic blood pressure
D. Elevated blood urea nitrogen
Overwhelming infection and resulting vasodilation can lead to the following type of shock A. Anaphylactic
B. Cardiogenic
C. Hypovolemic D. Septic
A firefighter who was involved in extinguishing a house fire is being treated for smoke inhalation. He develops severe
hypoxia 48 hours after the incident, requiring intubation and mechanical ventilation. Which of the following conditions
has he most likely developed?
A. Acute respiratory distress syndrome (ARDS).
B. Atelectasis.
10.
11.
12.
13.
14.
15.
16.
17.
18.
C. Bronchitis.
D. Pneumonia.
What is one important way that local anesthetic drugs differ from all other drugs used in dentistry? A.
High
potential of overdose
B. Route of administration
C. Rate of uptake into bloodstream
D. Action ceased when absorbed into bloodstream
E. Blood levels must be sufficient to exert effect
All of the following are reasons to include a vasoconstrictor, EXCEPT one. Which one is the EXCEPTION? A. Lower
blood flow to injection site
B. Increase anesthetic blood levels
C. Increase duration of local anesthetic
D. Lower anesthetic toxicity
E. Improve field of vision for treatment
After properly loading the cartridge into the syringe, a few drops of local anesthetic should be expelled. Why? A. The
ensure proper placement of the harpoon
B. To ensure free flow of the solution
C. The ensure the correct anesthetic has been used
D. To ensure the needle has not been barbed E. To ensure the ability to aspirate
A male client suffers acute respiratory distress syndrome as a consequence of shock. The client’s condition deteriorates
rapidly, and endotracheal (ET) intubation and mechanical ventilation are initiated. When the high-pressure alarm on the
mechanical ventilator sounds, the nurse starts to check for the cause. Which condition triggers the high-pressure alarm? A.
Kinking of the ventilator tubing
B. A disconnected ventilator tube
C. An ET cuff leak
D. A change in the oxygen concentration without resetting the oxygen level alarm
A new intravenous anesthetic is found to have a very large volume of distribution. This drug is most likely to have which
of the following properties?
A. Hydrophilic with a high degree of plasma protein binding
B. Hydrophilic with a large nonionized fraction
C. Hydrophilic with a low degree of tissue protein binding
D. Lipophilic with a high degree of tissue protein binding
Which of the following drugs has the longest duration of action in a patient with renal failure? A. Neostigmine
B. Rocuronium
C. Succinylcholine D. Vecuronium
In an anesthesia machine with a circle system, which of the following findings indicates a leak in the oxygen flowmeter
tube above the level of the bobbin?
A. Activation of the machine fail-safe alarm
B. A decrease in the expired tidal volume
C. A decrease in FiO2 when oxygen and nitrous oxide are administered concurrently
D. Failure of the oxygen bobbin to rise when turned on
A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent
intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the client has
absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other signs of: A. Right
pneumothorax
B. Pulmonary embolism
C. Displaced endotracheal tube
D. Acute respiratory distress syndrome
Instillation of local anesthetic into the trachea via the cricothyroid membrane mimics the sensory effect seen following
blockade of which of the following nerves?
A. Glossopharyngeal nerve
B. Hypoglossal nerve
C. Internal branch of the superior laryngeal nerve
D. Recurrent laryngeal nerve
19. Which of the following are abnormal to be found in the urine?
A. K
B. Amino acids
C. Glucose
D. All of the above
E. Amino acids and Glucose
20. Stridor is a sign of _______________.* A. Pneumonia
B. Aspiration
C. Upper airway obstruction
D. Bronchoconstriction
21. Which of the following medications is least likely to alter the usual presentation of patients presenting with hypovolemic
shock? A. Metoprolol
B. diltiazem
C. furosemide D. cefalexine
22. Trauma to the spinal cord and resultant loss of autonomic and motor reflexes below the injury level can lead to the
following type of shock
A. A.Cardiogenic
B. Hypovolemic
C. Neurogenic
D. Obstructive
23. Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves? A.
Superior laryngeal and glossopharyngeal
B. Superior laryngeal and hypoglossal
C. Recurrent laryngeal and glossopharyngeal
D. Recurrent laryngeal and superior laryngeal
24. A small bubble of approximately 1 to 2 mm diameter will frequently be found in the local anesthetic cartridge. These
bubbles are caused by?
A. The anesthetic solution being frozen
B. The cartridge was stored in a chemical disinfectant
C. Nitrogen gas being pumped in during manufacturing
D. Oxygen being trapped in the cartridge
E. Shaking the cartridge vigorously
25. How do kidneys control Na+ levels and K+ levels?
A. The kidneys release renin, which controls angiotensin. The angiotensin controls aldosterone. Aldosterone controls the
levels of Na+ and K+
B. Kidneys release aldosterone which controls renin. Renin causes the release of angiotensin. Angiotensin controls the
levels of Na+ and K+
C. The kidneys release renin which controls K+.
D. The kidneys release angiotensin which causes Na+ realease.
26. Which stage of shock initiates the compensatory mechanisms to maintain the BP and blood flow to the vital organs? A.
A.Initial
B. B.Compensatory
C. C .Progressive
D. Refractory
27. The acid base balance which commonly accompanies shock is
A. A.Metabolic acidosis
B. B.Metabolic alkalosis
C. C.Respiratory acidosis
D. Respiratory alkalosis
28. What should be the position given to a patient in shock? A. A.Head low
B. B.Fowler’s
C. C.Semi fowler’s
D. Supine
29. FRC (functional residual capacity) is best characterized as:
A.
B.
C.
D.
E.
31.
32.
33.
34.
35.
36.
37.
The volume of gas present in the lungs when a patient has exhaled as much as (s)he can
The volume of gas present in the lungs after a patient takes in a normal tidal volume
The maximal volume of gas a patient can exhale starting from the normal end-expiratory lung volume
The volume of gas present in the lungs when the respiratory muscles are totally relaxed
The volume of gas a patient can inhale from the end-inspiratory point of tidal volume to total lung capacity 30. Under
normal conditions, lung sterility is maintained by:
A. Cough and gag reflexes
B. The mucociliary escalator, phagocytic cells, and bronchus-associated lymphoid tissue
C. Surfactant production by Type I cells
D. Filtering of air in the nasal passages
E. Alveolar macrophages
Chemoreceptors control ventilation through the following mechanisms:
A. Elevated PaCO2 leads to a decrease in respiratory drive
B. Low PaO2 leads to increased output from the respirator control center in the medulla
C. Low pH leads to decreased output from the medullary control center
D. Hypercarbia is sensed in both the peripheral and the central chemoreceptors
E. b and d
Which of these drugs is nephrotoxic?
A. Diuretics
B. ACE inhibitors
C. NSAIDs
D. Sodium bicarbonate/ Potassium bicarbonate
A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the
following disorders?
A. Acute glomerulonephritis
B. Acute renal failure
C. Chronic renal failure D. Nephrotic syndrome
A 65 year old man presents to your office with increasing abdominal distension and bilateral leg swelling. He is
accompanied by his daughter. He reports his symptoms started 3 months ago and progressively worsening. He smokes
about one pack cigarettes per day and drinks one pint vodka every day. His last drink was 1 day ago. On examination, he
is afebrile and he has abdominal distension and ascites with out any tenderness on palpation. Lab studies show WBC
8k/µl, Hemoglobin of 10.2 gm%, Platelets 90k/µl, Total protein of 6.4, Albumin 2.2, SGOT 300, SGPT 130, Total
Bilirubin 4.2 , Direct Bilirubin 3.3, Prothrombin time of 19 seconds and Creatinine 2.2. Ultrasound reveals cirrhosis of the
liver and splenomegaly. The daughter asks you if her father can be considered for Liver transplantation. The most
common indication for liver transplantation in the United States :
A. Alcoholic Liver Disease
B. Chronic Hepatitis B
C. Acute Liver Failure
D. Hepatitis C
E. Primary Biliary Cirrhosis
which of the following serum levels would help in distinguishing an acute liver disease from chronic liver disease? A.
Aminotransferasa
B. alkaline phosfatase
C. C.Bilirubin D. D.albumin
which of the following drugs is used in the treatment of hyperkaliemia in acute renal failure ? A. A.Amilorid
B. Amlodipin
C. captopril
D. insulin
E. E.Propranalol
The primary treatment for ARDS is? A. diuretics.
B. bronchodilators.
C. antibiotics.
D. Anti-inflammatory agents.
E. supportive care
38. Ventilator-induced lung injury is caused by al the following except
A. V entilator-induced fluid retention B. high oxygen concentrations
C. alveolar collapse.
D. alveolaroverdistention.E) volutrauma
39. Regarding hepatorenalsyndrome ?
A. it is irreversible
B. the ability to concentrate urine is retained
C. the urine is surprisingly low in sodium
D. thefavoured theory is the decrease in renal blood flow, secondary to systemic vasodilation
E. the urine is hyperosmolar, devoid of proteins and sediment and low in sodium
40. Which of the following drugs INCREASES gastric pH while DECREASING gastric volume?
A. Glycopyrrolate
B. Magnesium trisilicate
C. Metoclopramide D. Ranitidine
41. Which of the following conditions is NOT associated with upregulation of the postjunctional acetylcholine receptors at the
neuromuscular junction? A. Burn injuries
B. Myasthenia gravis
C. Prolonged bed rest
D. Prolonged use of neuromuscular blocking agents
42. What characteristic of nitrous oxide MOST likely explains why its alveolar and inspired concentrations equilibrate more
rapidly than those of des flurane? A. Higher vapor pressure
B. Lower blood gas solubility
C. Creation of a second gas effect
D. Delivery at a higher inspired concentration
43. What is the PRIMARY purpose of denitrogenation prior to anesthetic induction?
A. Improving matching of ventilation and perfusion
B. Increasing contribution of second gas effect to rate of induction
C. Increasing oxygen reserve in the functional residual capacity
D. Maximizing arterial oxygen content
44. What is the expected mixed venous oxygen tension, in mmHg, in a normal adult after breathing 100% oxygen for 10
minutes?
A. 573
B. 150
C. 95
D. 45
45. Which of the following drugs has the SHORTEST elimination half-life?
A. Flumazenil
B. Diazepam
C. Lorazepam
D. Midazolam
46. which of the following have anesthetic have half life more then 2 hours ?
A. Bipuvocaine
B. B.Lignocaine
C. Mepivacaine
D. D.Etidocaine E. Chlorprocaine
47. Phenobarbitone:
A. is used in the treatment of grand mal epilepsy
B. can produce skin rashes
C. is rapidly metabolised
D. has its effects terminated by redistribution
48. Buprenorphine:
A. causes little nausea and vomiting
B. has a respiratory depressant action antagonised by naloxone
C. is mostly metabolised in the liver
50.
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D. must be given parenterally 49. Salbutamol can cause:
A. headache
B. an increase in uterine contractility
C. a worsening of intermittent claudicating
D. hypocalcaemia
post spinal headache is prevented by?
A. use off thinner needle
B. NSAIDs
C. Preanesthetic medication
D. Plenty of oral fluids
What is the best method of treatment for nitrate poisoning?
A. Methylene blue given orally
B. Methylene blue given IM
C. Methylene blue given SQ
D. Methylene blue given IV
E. Methylene blue is not a treatment for nitrate poisoning.
Which medical condition will develop from severe blood loss? A. Shock.
B. Hypoglycaemia.
C. Anaphylaxis.
D. Hypothermia.
What names are given to the three different depths of burns? A. Small, medium and large.
B. First, second and third degree.
C. Minor, medium and severe.
D. Superficial, partial thickness, full thickness.
Which test should you use if you suspect that a casualty has had a stroke? A. Face, Arms, Speech, Test.
B. Alert, Voice, Pain, Unresponsive.
C. Response, Airway, Breathing, Circulation.
D. Pulse, Respiratory Rate, Temperature
Which of the following can cause a stroke? A. A blood clot in an artery in the brain.
B. A blood clot in an artery in the heart.
C. A blood clot in an artery in the leg.
D. A blood clot in an artery in the lungs.
What should your first action be when treating an electrical burn? A. Ensure that the casualty is still breathing.
B. Wash the burn with cold water.
C. Check for danger and ensure that contact with the electrical source is broken.
D. Check for level of response.
Which is the correct ratio of chest compressions to rescue breaths for use in CPR of an adult casualty? A. 2
compressions : 30 rescue breaths.
B. 5 compressions : 1 rescue breath.
C. 15 compressions : 2 rescue breaths. D. 30 compressions : 2 rescue breaths.
What is one important way that local anesthetic drugs differ from all other drugs used in dentistry? A. High
potential of overdose
B. Route of administration
C. Rate of uptake into bloodstream
D. Action ceased when absorbed into bloodstream
E. Blood levels must be sufficient to exert effect
End-stage renal disease is defined as GFR less than________________ ml/min per 1.73m2. A. 45
B. 30
C. 15
D. 10
_________ is the most frequent complication during hemodialysis?
A. Hypertension
B. Bleeding
C. Infection
D. Dialysis dementia
61. For a male client in the oliguric phase of acute renal failure (ARF), which nursing intervention is most important?
A. Encouraging coughing and deep breathing
B. Promoting carbohydrate intake
C. Limiting fluid intake
D. Providing pain-relief measures
62. A female client with acute renal failure is undergoing dialysis for the first time. The nurse in charge monitors the
client closely for dialysis equilibrium syndrome, a complication that is most common during the first few dialysis
sessions.
Typically, dialysis equilibrium syndrome causes:
A. Confusion, headache, and seizures.
B. Acute bone pain and confusion.
C. Weakness, tingling, and cardiac arrhythmias.
D. Hypotension, tachycardia, and tachypnea.
63. What is the MOST likely explanation for the initial reduction in core temperature during general anesthesia? A.
Ablation of thermoregulatory vasoconstriction
B. Conductive heat loss
C. Evaporative heat loss in the respiratory tract
D. Redistribution of heat the core to the periphery from
64. Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following
dermatomes? A. C4
B. C6
C. C8
D. T2 E. T4
65. A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the
left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood
pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest
show no abnormalities. Which of the following is the most appropriate immediate management?
A. Continuous epidural analgesia using local anesthetics
B. Mechanical ventilation
C. Infusion of midazolam
D. Patient-controlled analgesia with morphine sulfate
66. After termination of an inhalation anesthetic, patient-controlled analgesia will
A. be effective without a loading dose of opioid if started in the immediate post anesthetic period
B. be associated with greater analgesic requirements than conventional intramuscular opioid techniques
C. cause addiction or dependence to opioids if continued for more than 72 hours
D. produce less patient satisfaction than intermittent intravenous administration of opioids
67. How should you open the airway of an unconscious casualty? A. Head tilt and chin lift.
B. Jaw thrust.
C. Head tilt and jaw thrust.
D. Lift the chin.
68. The client has been receiving garamycin 65 mg IVPB every 8 hours for the past 6 days. Which lab result indicates
an adverse reaction to the medication?
A. WBC 7500
B. Serum glucose 92
C. Protein 3.5
D. Serum creatinine 2.0
69. Regarding the common pathogens in sepsis and septic shock, which of the following statements is correct?
A.
Since the late 1970s, gram-negative organisms continued to be the predominant pathogens
B.
St Escherichia coli is the most frequent cause of sepsis fatalityaphylococcus aureus,
C.
Streptococcuspneumoniae, and coagulase-negative staphylococci are the common gram-positive pathogens
D.
Non-albicans Candida species have become the most common causes of fungal sepsis 70. Shock (mean BP
less than 60 mmHg) can be caused by:
A. Low intravascular volume
B. Low cardiac output
C. Pleural effusion
D. Decreased peripheral vascular resistance
71. A 30 year old man is admitted to the Emergency Ward with sudden onset of severe shortness of breath, no chest pain,
diffuse wheezing, cyanosis, and a BP of 70/30, Pulse = 100. This event occurred soon after a meal. What is the likely
diagnosis:
A. Acute pulmonary embolism
B. Tension pneumothorax
C. Anaphylaxis
D. Myocardial infarction
72. In a subject in shock with low body temperature, cold and clammy extremities, low urine output, and elevated lactic acid
level in the blood, the most likely cause of shock is:
A. Asthma
B. Pulmonary embolism
C. Sepsis D. CHF
73. Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves? A.
Superior laryngeal and glossopharyngeal
B. Superior laryngeal and hypoglossal
C. Recurrent laryngeal and glossopharyngeal
D. Recurrent laryngeal and superior laryngeal
74. What is the MOST likely explanation for the initial reduction in core temperature during general anesthesia? A. Ablation
of thermoregulatory vasoconstriction
B. Conductive heat loss
C. Evaporative heat loss in the respiratory tract
D. Redistribution of heat from the core to the periphery
75. Which of the following is characteristic of the pharmacokinetics of alfentanil?
A. Clearance is greater than that of fentanyl
B. Protein binding is minimal
C. The majority of alfentanil in plasma is ionized
D. Volume of distribution is smaller than that of fentanyl
76. A 65-kg, 70-year-old man in the PACU is breathing spontaneously at 20/min through an endotracheal tube connected to a
T-piece with a fresh gas flow of 5 L/min and an FiO2 of 0.5. His tidal volume is 350mL. Over one hour, his SpO2
decreases from 98% to 84%, and then improves to 92% when FiO2 is increased to 1.0. Which of the following is the
MOST likely cause of his hypoxemia?
A. Decreased functional residual capacity
B. Increased dead space ventilation
C. Inhibition of hypoxic pulmonary vasoconstriction
D. Room air admixture during inspiration
77. A 40-year-old man who is scheduled for repair of a tendon laceration of the left hand has complete anesthesia in the
median, radial, and ulnar nerve distributions after supraclavicular block. Two hours of tourniquet inflation are required for
completion of the procedure. The MOST appropriate NEXT step is an additional block of which of the following nerves?
A. Axillary
B. Intercostobrachial
C. Lateral antebrachial cutaneous D. Musculocutaneous
78. A 25 year old woman has a blood pressure of 160/90 mmHg at week 10 of her first pregnancy. She had recurrent urinary
infections in childhood. Her urinalysis shows protein but no blood. Her blood tests show:
Haemoglobin 109 g/L, Serum urea 7.5 mmol/L, Serum creatinine 125 μmol/L. What
is the SINGLE most likely cause of her hypertension?
A. Chronic glomerulonephritis
B. Chronic pyelonephritis
C. Essential hypertension
D. Pre-eclampsia
E. Renal artery stenosis
79. A 78 year old man has collapsed. He has had a severe headache for 12 hours and had an upper respiratory tract infection
three days ago. He has a temperature of 39.2o C, a pulse of 122 beats/minute, a blood pressure of 84/60 mmHg and a
80.
81.
82.
83.
84.
85.
86.
87.
respiratory rate of 34 breaths/minute but his chest is clear. He has a Glasgow Coma Scale score of 10 and some neck
stiffness. He has been started on high-flow oxygen. What is the SINGLE most appropriate immediate management?
A. Intravenous antibiotic; lumbar puncture
B. Intravenous fluids; computed tomography brain scan
C. Intravenous fluids; intravenous antibiotic D. Intravenous fluids; lumbar puncture
A 16 year old boy was brought to hospital in a comatose state having taken methadone belonging to his sister. He was
given naloxone and rapidly became alert. Some hours later, he gradually becomes semiconscious again. What is the
SINGLE most likely reason for this patient becoming semiconscious again in hospital?
A. Methadone hepatotoxicity has caused acute liver failure
B. Methadone is eliminated from the body more slowly than naloxone
C. Naloxone is a partial agonist at the central nervous system opioid receptor
D. The patient has misused another substance that has caused an intracranial bleed
E. The patient has misused another substance that is absorbed more slowly than methadone
A 48 year old man with renal cancer had radiotherapy for metastatic spinal cord compression at the 11th thoracic vertebra
four weeks ago. He has retained sensation but is unable to stand. He has pain in a band around his lower trunk controlled
by regular oral morphine. He is distressed by increasingly frequent episodes of painful muscle spasms in his right leg.
What is the SINGLE most appropriate management of his symptoms?
A. Amitriptyline
B. Baclofen
C. Fentanyl patch
D. Gabapentin
E. Increase morphine dose
A 64yo pt has been having freq episodes of secretory diarrhea, which is extremelywatery, with large amts of mucus. A dx
of villous adenoma was made after endoscopy.What electrolyte abnormality is most likely in this pt? A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia
D. Hypokalemia
E. Hypercalcemia
Dopamine affects the following receptors except
A. a1
B. a2
C. B1
D. B2
Determinants of cardiac output include:
A. Heart and rate rhythm
B. Preload and after load
C. Contractility
D. All of the above
Oxygen supply to the body is determined by: A. hemoglobin concentration.
B. oxygen saturation.
C. A, b and C.
D. wasserrot's
Charles Jenkins, a 47 yo male with a history of aortic stenosis, is experiencing weakness, fatigue and decreased exercise
tolerance. A cardiac catheterization revealed a 60mm pressure gradient across the aortic valve and calcification of the
aortic ring. On POD #2, Mr. Jenkins developed a heart rate of 42 and his BP dropped to 84/20 and respirations were 22.
A rhythm strip recorded showed:
A. sinus bradycardia
B. sick sinus syndrom
C. Mobitz II
D. third degree heart block
Mr. Jenkins returned to surgery and had a permanent dual- chamber pacemaker implanted. The following strip was
recorded in CTICU. It revealed:
A. normal sinus rhythm
B. LBBB
88.
89.
90.
91.
92.
93.
94.
95.
96.
C. p wave tracking or DDD pacing mode
D. RBBB
Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak
hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from
150/80 to 90/50 mmHg. The most appropriate management at this time is
A. administration of atropine
B. administration of ephedrine
C. administration of phenylephrine
D. placement of the patient in the head-down position
E. observation
Surgery is cancelled 10 minutes after initiation of intravenous regional anesthesia with 50 ml of lidocaine 0.5%. To
terminate anesthesia safely, what is the most appropriate timing for deflating the tourniquet?
A. Immediately if benzodiazepines have been administered
B. Immediately after intravenous administration of ephedrine 10 mg
C. Immediately, followed by repeated reinflation and deflation
D. In no less than 20 minutes after initial injection
E. In no less than 45 minutes after initial injection
A 17-year-old boy develops pulmonary edema after resolution of postoperative laryngospasm. While breathing 100%
oxygen, SpO2 is 80%. Which of the following is the most appropriate management?
A. Administration of albuterol
B. Administration of furosemide
C. Infusion of nitroglycerin
D. Positive-pressure ventilation
An otherwise healthy 61-year-old man receives a spinal anesthetic for transurethral resection of the prostate (TURP).
Forty-five minutes after the start of the procedure, he suddenly develops nausea, diaphoresis, and sharp pain in the left
shoulder. Which of the following is the most likely cause?
A. Angina pectoris
B. Bladder perforation
C. Hyponatremia
D. Inadequate spinal sensory level
A 36-year-old woman is receiveing general anesthesia for a diagnostic laparoscopy in the Trendelenburg position with
carbon dioxide insufflation. During a 15-minute period after induction, her SpO2 decreases from 99% to 90% and
PETCO2 increases from 38 to 43 mmHg. FiO2 is 0.3; all ventilator settings have been constant. Which of the following is
the most likely cause of the decrease in SpO2?
A. Carbon dioxide embolus
B. Compression of the vena cava
C. Decreased diaphragmatic excursion D. Pneumothorax
Two hours after a laparoscopic cholecystectomy, an obese 45-year- old woman is receiving intravenous patient-controlled
analgesia with morphine. Her SpO2 is 92% on room air. Which of the following is the most likely cause? A. Absorption
of carbon dioxide from the abdomen
B. Hypoventilation
C. Impaired oxygen diffusion
D. Increased dead space
In a patient receiving pressure support ventilation, pressure support breaths are triggered by achieving which of the
following preset milestones? A. A decrease in airway pressure
B. An increase in airway pressure
C. An inspiratory flow rate D. An inspired volume
A healthy 42-year-old man has an increase in heart rate from 60 bpm to 120 bpm during induction of anesthesia.Which of
the following factors is most likely to satisfy the increased metabolic demand of the myocardium?
A. Decreased coronary artery resistance
B. Increased coronary perfusion pressure
C. Increased oxygen extraction by the myocardium
D. Shift to anaerobic metabolism
Which of the following laboratory values is most likely to confirm adequate synthetic hepatic function? A. Partial
thromboplastin time
B. Prothrombin time
C. Serum alanine aminotransferase concentration
D. Total serum bilirubin concentration
97. In a patient undergoing extracorporeal shock wave lithotripsy, ventricular dysrhythmias are best prevented by: A. Betaadrenergic blockade.
B. ECG synchronization.
C. Epidural blockade to T4.
D. General anesthesia.
98. Pressure support ventilation:
A. Can only be used in a spontaneously breathing patient.
B. Cannot be used in conjunction with continuous positive airway pressure.
C. Delivers a specified volume regardless of airway pressure.
D. Increases the work of breathing.
99. A 56-year-old man is anesthetized for pneumonectomy. After initiation of one-lung ventilation, SpO2 rapidly decreases to
69%. Which of the following is the most appropriate next step in management?
A. Apply continuous positive airway pressure to the nonventilated lung
B. Increase respiratory rate and decrease tidal volume
C. Occlude the pulmonary artery supplying the nonventilated lung
D. Resume bilateral lung ventilation
100. Use of a laryngeal mask airway during general anesthesia is most appropriate for which of the following patients?
A. A patient undergoing cesarean delivery who cannot be intubated after induction of anesthesia
B. A patient who has a peak inspiratory pressure greater than 30 cmH2O
C. A patient who has a tracheoesophageal fistula
D. A patient who requires emergency appendectomy two hours after eating
101. A therapeutic concentration of inhaled nitric oxide does NOT cause systemic hypotension because it: A. Has no effect on
systemic vessels.
B. Is metabolized by pulmonary endothelium.
C. Is a mild inotrope.
D. Is rapidly inactivated by hemoglobin.
102. An axillary block is performed in a patient undergoing surgery on the distal ventral forearm and lateral aspect of the wrist.
No tourniquet is to be used. Which of the following nerves will most likely require supplemental blockade? A.
Intercostobrachial
B. Median
C. Musculocutaneous D. Radial
103. A 42-year-old woman develops jaundice two days after an exploratory laparotomy following blunt trauma to the abdomen.
During the four-hour procedure, she was anesthetized with isoflurane and received four units of packed red blood cells.
Laboratory evaluation shows an increased total serum bilirubin concentration, normal direct serum bilirubin concentration,
and normal serum alanine aminotransferase and aspartate aminotransferase concentrations. There is no bilirubin in the
urine. Which of the following is the most likely cause of the jaundice?
A. Anesthetic-induced hepatic injury
B. Bile duct injury
C. Hemolysis
D. Hepatic ischemia
104. A 70-kg, 65-year-old man with chronic obstructive pulmonary disease has severe pain after undergoing thoracotomy for
excision of a tumor in the lung. Which of the following methods is most effective for decreasing pain while improving
ventilation?
A. Application of thoracic TENS (transcutaneous electrical nerve stimulation)
B. Continuous lumbar epidural infusion of fentanyl
C. Continuous thoracic epidural infusion of morphine and bupivacaine
D. Intravenous patient-controlled analgesia with morphine
105. A 52-year-old man has stridor on admission to the PACU after biopsy of a vocal cord lesion. His stridor is not evident
after five minutes, but he develops sternal retractions and a tracheal tug. Which of the following is the LEAST appropriate
intervention?
A. Administration of an aerosolized vasoconstrictor
B. Intubation
C. Oral airway insertion
D. Positive airway pressure by mask
106. If a patient sustains acute renal failure (ARF) secondary to cardiogenic shock, what type of renal failure is this considered?
A. intrinsic
B. perenal
C. post renal
D. latrogenic
107. The RIFLE classification system provides a definition and classification system for acute renal failure (ARF). What does
the "R" in the RIFLE acronym refer to?
A. A, risk of renal difunction
B. rapid response to failure
C. role of dialysis
D. recurrence of intrinsic disease
108. Emily has been admitted to the ICU after being found unconscious on the street. She was found to be in diabetic
ketoacidosis (DKA) with a blood sugar of 785. Emily is homeless, has had multiple admissions for DKA, and could
benefit from use of an insulin pump, but says she has been repeatedly told, "Those are for rich people. & quot; What
ethical principle supports Emily's right to have an insulin pump?
A. Beneficence
B. Nonmalficence
C. Justice
D. Autonomy
109. A 47-year-old male has been admitted to the CCU from the emergency room with a history of sudden diaphoresis, nausea,
vomiting and radiating pain down his left arm. He reports no significant medical history, and has been a two PPD smoker
since his early twenties. His admitting diagnosis is UA/NSTEMI and he is being prepped for cardiac catheterization for
possible angioplasty with stent placement. What type of medication orders might the doctor see prior to his procedure? A.
Clopidogrel and ASA
B. Clopidogrel and prasugrel
C. Clopidogrel and meperidine
D. Prasugrel, ASA, and hyoscyamine
110. A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with large amts of mucus. A dx
of villous adenoma was made after endoscopy. What electrolyte abnormality is most likely in this pt? A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia D. Hypokalemia
111. A 60-year-old man who is being monitored in the ICU for an evolving myocardial infarction has the sudden onset of
pulseless ventricular tachycardia. Which of the following is the most appropriate initial intervention? A. Administration of
lidocaine
B. Chest compressions
C. Defibrillation
D. Precordial thump
112. A hemodynamically stable 70-kg, 40-year-old man with adult respiratory distress syndrome is being mechanically
ventilated with the following settings: Tidal volume 500 mL Respiratory rate 12/min FiO2 0.80 I:E ratio 1:2 Positive
endexpiratory pressure 5 cmH2O Analysis of arterial blood gases shows PaO2 50 mmHg, PaCO2 40 mmHg, and pH 7.42.
Which of the following changes in ventilator settings is most appropriate?
A. Increase FiO2
B. Increase positive end-expiratory pressure
C. Increase tidal volume
D. Increase ventilatory rate
113. An anesthetized patient has a decrease in his SpO2 from 100% to 91% after being moved into the lateral decubitus
position. His lungs are being mechanically ventilated with isoflurane 1% in oxygen; SpO2 remains at 91% for several
minutes. Which of the following is the most likely cause of the desaturation?
A. Atelectasis
B. Endobronchial intubation
C. Hypoventilation with inadequate minute ventilation
D. Isoflurane inhibition of hypoxic pulmonary vasoconstriction
114. In a patient receiving general anesthesia, a thigh tourniquet is released after being inflated for 90 minutes. Which of the
following will most likely occur one minute after tourniquet release?
A. Decreased arterial pH
B. Decreased PaCO2
C. Decreased PETCO2
D. Increased mixed venous oxygen saturation
115. A 20-year-old woman is undergoing resection of laryngeal papillomas with a carbon dioxide laser during anesthesia with
oxygen, nitrous oxide, and isoflurane. During the procedure, the surgeon observes a perforation in the endotracheal tube
and a fire in the airway. Which of the following is the most appropriate initial management?
A. Copiously irrigate the airway with saline
B. Remove the endotracheal tube
C. Substitute air for nitrous oxide
D. Substitute air for oxygen
116. Which is the correct order of the blood flow?
A. Renal artery - segmental artery - interlobular artery - peitubular capillaries - afferent arterioles
B. Interlobular areteries - arcuate arteries - glomerular capillaries - arcuate veins
C. Arcuate veins - arcuate arteries - glomerular capillaries - renal vein
D. Interlobar veins - afferent arterioles - efferent arterioles - glomerular capillaries
E. Renal vein - segmental arteries - interlobar arteries - efferent arterioles 117. Which of the following is a way
angiotensin II affects the kidneys?
A. It increases the GFR
B. It decreases the GFR
C. It enhances reabsorption of certain ions
D. It suppresses the release of aldosterone
E. It stimulates the release of calcitriol
118. GLUCAGON - is secreted by
A.
Thymus gland
B.
pancreas
C.
pituitary gland
D.
adrenal gland
119. Urea is less toxic form of
A.
magnesium
B.
potassium
C.
ammonia D. phosphorus 120. In asthma:
A.
the white blood cell count will often be elevated
B.
the ECG may show signs of acute left heart strain
C.
a CXR should be routine in all patients admitted
D.
blood gas results correlate well with pulmonary function testing E. theophylline dosing needs to be increased
if erythromycin is given 121. Which of the following is NOT an effector of respiration?
A. Heart
B. diaphragm
C. intercostals
D. ……
122. Which of the following is the first branching of the bronchial tree that has gas exchanging capabilities? A. Terminal
bronchioles.
B. Respiratory bronchioles.
C. Alveoli
D. segmental bronchi
E. alveolar ducts.D.Trapezius.
123. HYPOGLYCEMIC SHOCKS - mainly affect
A. adrenal gland
B. brain
C. intestines
D. pancreas
124. STORAGE FORM OF FATS IN ADIPOSE TISSUES - is
A. amino acids
B. triglycerides
C. lipase
D. acetoacetic acid
125. Which of the following findings best indicates complete resolution of spinal anesthesia?
A. Ability to ambulate
B. Ability to urinate
C. Perianal pinprick sensation
D. Pain at the surgical site
E. Proprioception of the big toe
126. A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal
cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is
trauma to which of the following structures on the left?
A. C7-8 nerve root
B. Stellate ganglion
C. Glossopharyngeal nerve
D. Superior laryngeal nerve E. Vagus nerve
127. A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant
hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?
A. Administration of a regional anesthetic
B. Administration of dantrolene orally for two days prior to surgery
C. Avoidance of all inhalational anesthetics except isoflurane
D. Avoidance of ester local anesthetics
E. Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours
128. Each of the following is a complication or side effect of neurolytic celiac plexus blockade EXCEPT A. constipation
B. hematuria
C. orthostatic hypotension
D. paraplegia
E. pneumothorax
129. 38-year-old woman with severe asthma presents to your clinic complaining that for the past 2 days, she has been
experiencing progressive shortness of breath. She now experiences shortness of breath while at rest. She reports little relief
of her symptoms with the use of her albuterol inhaler. She says that she is feeling tired. On examination, the patients
respiratory rate is 18 breaths/min; oxygen saturation on room air is 86%. She has few expiratory wheezes with very little
air movement. Results of arterial blood gas measurements are as follows: pH, 7.2; PaO2, 62 mm Hg; and PCO2, 63 mm
Hg. On the basis of the arterial blood gas measurements, which of the following best describes this patients condition? A.
Acute hypoxemic respiratory failure
B. Acute hypercarbic respiratory failure
C. Chronic hypercarbic respiratory failure
D. Mixed hypoxemic and hypercarbic respiratory failure
130. Functions of liver includes
A. destroying old RBCs
B. production of fibrinogen
C. de-amination
D. all of above
131. Shock of physical trauma to the kidneys can result in?
A. acute renal failure
B. B.chronic renal failure
C. diabetes insipidus
D. urinary incontinence
132. According to the Law of Laplace, air should flow from the smaller alveoli to the larger, collapsing them. In the lungs,
several factors counter that tendency, and stabilize the alveolar structures. Which of the following is NOT one of them?
A. Surfactant lowers surface tension to a greater degree when it is on a smaller surface area, allowing the smaller alveoli
to stay open.
B. Mechanical stability is given by surrounding alveoli.
C. Transpulmonary pressure is lower for smaller alveoli, allowing them to stabilize in comparison to the bigger ones.
D. Surface tension at the gas-liquid interface increases as alveolar surface area increases.
133. A 17-year-old boy develops pulmonary edema after resolution of postoperative laryngospasm. While breathing 100%
oxygen, SpO2 is 80%. Which of the following is the most appropriate management?
A. Administration of albuterol
B. Administration of furosemide
C. Infusion of nitroglycerin
D. Positive-pressure ventilation
134. What is the expected mixed venous oxygen tension, in mmHg, in a normal adult after breathing 100% oxygen for 10
minutes?
A. 573
B. 150
C. 95
D. 45
135. A 32-year-old woman sustains an injury to the left recurrent laryngeal nerve during thyroidectomy. Which of the
following is the MOST likely postoperative finding? A. Adduction of the left vocal cord at rest
B. Aphonia
C. Aspiration caused by glottic incompetency D. Impaired coughing
136. An 82-year-old woman is brought to your clinic by her family. They report that the patient has been increasingly confused
for the past few days. She is lethargic and barely arousable. The patient has stage IV breast cancer with widespread bony
metastases and requires long- and short-acting narcotics for pain control. Her daughter reports that the patient has been
taking increasing doses of her long-acting morphine to control the pain. Results of physical examination are as follows:
blood pressure, 98/62 mm Hg; heart rate, 63 beats/min; respiratory rate, 8 breaths/min; temperature, 98.2?° F (36.8?° C);
and oxygen saturation on room air, 95%. Arterial blood gas measurement reveals an acute respiratory acidosis. Because of
the patients altered mental status and the inability to protect her airway, the patient is admitted to the intensive care unit for
mechanical ventilation. Which of the following conditions would place this patient at risk for acute hypercapnic
respiratory failure?
A. Guillain-Barre syndrome
B. Acute respiratory distress syndrome
C. Large pulmonary embolism D. Pulmonary edema
137. Which of the following is INCORRECT concerning the O2 / CO2 movement and processing through the lungs and
tissues?
A. Binding of O2 to Hb changes its configuration so that CO2 and H+ ions are more likely to dissociate.
B. When CO2 diffused into the alveoli, the PaCO2 is lowered.
C. Carbonic acid is an intermediate in the reaction combining H+ with HCO3- to form H2O and CO2.
D. Arterial blood flows to the tissues where H+ ions combine with HCO3- to form H2O and CO2.
138. Which out of the following is used for the pharmacologic management of Asthma? I. Long-acting bronchodilators. II.
Ipratropium. III. Skeletal muscle relaxant.
A. I only
B. II only
C. I and II
D. I and III
139. Which out of the following is used for the pharmacologic management of Asthma? I. Skeletal muscle relaxant. II.
Shortacting bronchodilators. III. Immunoglobulin E (IgE) antibodies (omalizumab). A. I only
B. II only
C. III only
D. I and II
E. II and III
F. I and III
140. Pulseoximetry accurately reflects SaO2 in which of the following situations?
A. Administration of indocyanine green
B. Carboxyhemoglobinemia
C. 40% fetal hemoglobin concentration D. Methemoglobinemia
141. As compared to an intravenous dose of morphine, what is the MOST likely explanation for the DECREASED duration of
action of an intravenous dose of fentanyl? A. It has a greater lipid solubility
B. It has increased hepatic metabolism
C. It has less protein binding
D. It has a shorter elimination half-life
142. The healthcare provider is caring for a patient with a diagnosis of hemorrhagic pancreatitis. The patient's central
venous pressure (CVP) reading is 2, blood pressure is 90/50 mmHg, lung sounds are clear, and jugular veins are flat.
Which of these actions is most appropriate for the nurse to take?
A. Slow the IV infusion rate
B. Administer dopamine
C. No interventions are needed at this time
D. Increase the IV infusion rate
143. Which of the following assessment findings is an early indication of hypovolemic shock?
A. Diminished bowel sounds
B. Increased urinary output
C. Tachycardia
D. Hypertension
144. Which type of fluid is most appropriate for volume replacement for a patient with non-hemorrhagic hypovolemic shock?
A. Lactated Ringers (LR)
B. 10% Dextrose in Water (D 10 W)
C. One-half Normal Saline (1/2% NS)
D. Packed Red Blood Cells (PRBC)
145. Which of the following pairs is NOT a pulmonary mechanoreceptor paired to a possible stimulus? A. Stretch receptor:
inflation
B. Irritant receptor: inhaled dust
C. Juxtacapillary receptors: decreases interstitial fluid volume in alveolar walls.
D. Bronchial C receptors: large inflations.
146. Which of the following tests requires the use of a right-sided heart catheter (pulmonary artery catheter) for routine
measurements in the intensive care unit setting?
A. A.Lactate concentration
B. Cardiac output
C. Base deficit
D. Intramucosal stomach pH
147. Which of the following is the key goal of therapy in the first hour of hypovolemic shock?
A. MAP greater than 90 mm Hg
B. SBP greater than 90 mm Hg
C. SBP greater than 60 mm Hg
D. Hematocrit is at least 30% (0.30) using transfusions
E. Normalization of urine output and base deficit
148. What potential adverse event requires caution if using dextran in hemorrhagic hypovolemic shock?
A. Hemolytic reaction
B. Risk of infection from contamination
C. Drug-induced pancreatitis
D. Inhibition of the coagulation cascade
E. Electrolyte abnormalities
149. Which of the following is the most likely cause of dyspnea during spinal anesthesia to a T3 sensory level?
A. Decreased abdominal muscle tone
B. Decreased afferent input from the thoracic wall
C. Increased dead space ventilation
D. Increased intrapulmonary shunting E. Partial diaphragmatic paralysis
150. A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a
metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements
concerning this condition is true?
A. A radiograph of the distal bones of the painful foot will show severe osteoporosis
B. A technetium scan of the distal joints of the painful foot will show decreased uptake
C. Early use of opioid analgesia will prevent progression of the symptoms
D. Intravenous phentolamine will relieve the pain
E. The chance of spontaneous recovery within eight weeks is greater than 80%
151. A celiac plexus block provides effective relief of pain associated with primary cancers at each of the following
locations EXCEPT the
A. adrenal gland
B. liver
C. pancreas
D. sigmoid colon
E. stomach
152. After termination of an inhalation anesthetic, patient-controlled analgesia will
A. be effective without a loading dose of opioid if started in the immediate postanesthetic period
B. be associated with greater analgesic requirements than conventional intramuscular opioid techniques
C. cause addiction or dependence to opioids if continued for more than 72 hours
D. produce less patient satisfaction than intermittent intravenous administration of opioids
E. show a diurnal variation in analgesic requirement
153. A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the
left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood
pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show
no abnormalities. Which of the following is the most appropriate immediate management?
A. Continuous epidural analgesia using local anesthetics
B. Mechanical ventilation
C. Infusion of midazolam
D. Patient-controlled analgesia with morphine sulfate E. Surgical stabilization of rib fractures
154. Which of the following causes of circulatory insufficiency can lead to shock as a result of decreased plasma
volume? A. Penetrating trauma with blood loss
B. Gastrointestinal bleeding
C. Anaphylaxis because of medications
D. All of the above
155. Patients admitted with hypovolemic shock usually have:
A. Very low serum sodium concentrations
B. Very low serum chloride concentrations
C. Elevated blood urea nitrogen
D. Elevated diastolic blood pressure
156. Overwhelming infection and resulting vasodilation can lead to the following type of shock A. Anaphylactic
B. Cardiogenic
C. Hypovolemic D. Septic
157. A male client has been admitted with chest trauma after a motor vehicle accident and has undergone subsequent
intubation. A nurse checks the client when the high-pressure alarm on the ventilator sounds, and notes that the
client has absence of breathe sounds in right upper lobe of the lung. The nurse immediately assesses for other
signs of: A. Right pneumothorax
B. Pulmonary embolism
C. Displaced endotracheal tube
D. Acute respiratory distress syndrome
158. Instillation of local anesthetic into the trachea via the cricothyroid membrane mimics the sensory effect seen
following blockade of which of the following nerves?
A. Glossopharyngeal nerve
B. Hypoglossal nerve
C. Internal branch of the superior laryngeal nerve
D. Recurrent laryngeal nerve
159. Which of the following are abnormal to be found in the urine?
A. K
B. Amino acids
C. Glucose
D. All of the above
E. Amino acids and Glucose
160. Stridor is a sign of _______________.*
A. Pneumonia
B. Aspiration
C. Upper airway obstruction D.
Bronchoconstriction
161. Which of the following medications is least likely to alter the usual presentation of patients presenting with
hypovolemic shock? A. Metoprolol
B. diltiazem
C. furosemide D.
cefalexine
162. Trauma to the spinal cord and resultant loss of autonomic and motor reflexes below the injury level can lead to the
following type of shock
A. A.Cardiogenic
B. Hypovolemic
C. Neurogenic D. Obstructive
163. Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following
nerves? A. Superior laryngeal and glossopharyngeal
B. Superior laryngeal and hypoglossal
C. Recurrent laryngeal and glossopharyngeal
D. Recurrent laryngeal and superior laryngeal
164. A small bubble of approximately 1 to 2 mm diameter will frequently be found in the local anesthetic cartridge.
These bubbles are caused by?
A. The anesthetic solution being frozen
B. The cartridge was stored in a chemical disinfectant
C. Nitrogen gas being pumped in during manufacturing
D. Oxygen being trapped in the cartridge
E. Shaking the cartridge vigorously
165. A history of infection specifically caused by group A beta-hemolytic streptococci is associated with which of the
following disorders?
A. Acute glomerulonephritis
B. Acute renal failure
C. Chronic renal failure D. Nephrotic syndrome
166. A 65 year old man presents to your office with increasing abdominal distension and bilateral leg swelling. He is
accompanied by his daughter. He reports his symptoms started 3 months ago and progressively worsening. He
smokes about one pack cigarettes per day and drinks one pint vodka every day. His last drink was 1 day ago. On
examination, he is afebrile and he has abdominal distension and ascites with out any tenderness on palpation. Lab
studies show WBC
8k/µl, Hemoglobin of 10.2 gm%, Platelets 90k/µl, Total protein of 6.4, Albumin 2.2, SGOT 300, SGPT 130, Total
Bilirubin 4.2 , Direct Bilirubin 3.3, Prothrombin time of 19 seconds and Creatinine 2.2. Ultrasound reveals cirrhosis
of the liver and splenomegaly. The daughter asks you if her father can be considered for Liver transplantation.
The most common indication for liver transplantation in the United States :
A. Alcoholic Liver Disease
B. Chronic Hepatitis B
C. Acute Liver Failure
D. Hepatitis C
E. Primary Biliary Cirrhosis
167. which of the following serum levels would help in distinguishing an acute liver disease from chronic liver
disease? A. Aminotransferasa
B. alkaline phosfatase
C. C.Bilirubin
D. D.albumin
168. Hepatitis A
A. does not have a chronic carrier state, and blood-borne transmission is rare, hence blood is not routinely
screened.
B. has an associated mortality of 0.1%, and is generally a self limiting benign disease
C. infection is more severe in the setting of concurrent alcohol consumption
D. has an incubation period of 2-6 weeks
E. has its own genus (hepatovirus)
169. which of the following drugs is used in the treatment of hyperkaliemia in acute renal
failure ? A. A.Amilorid
B. Amlodipin
C. captopril
D. insulin
E. E.Propranalol
170. The primary treatment for ARDS is?
A. diuretics
B. Bronchodilator
C. antibiotics
D. antiinflammatory agents
E. supportive care
171. Ventilator-induced lung injury is caused by al the following except
A. ventilator-induced fluid retention B.
high oxygen concentrations
C. alveolar collapse.
D. alveolaroverdistention.
E. volutrauma
172. Phenobarbitone:
A. is used in the treatment of grand mal epilepsy
B.
can produce skin rashes
C.
is rapidly metabolized
D.
has its effects terminated by redistribution 173. Buprenorphine:
A. causes little nausea and vomiting
B. has a respiratory depressant action antagonised by naloxone
C. is mostly metabolised in the liver
D. must be given parenterally
174. Salbutamol can cause:
A. headache
B. an increase in uterine contractility
C. a worsening of intermittent claudicating
D. hypocalcaemia
175. post spinal headache is prevented by?
A. use off thinner needle
B. B.NSAIDs
C. Preanesthetic medication
D. Plenty of oral fluids
176. What is the best method of treatment for nitrate poisoning?
A. Methylene blue given orally
B. Methylene blue given IM
C. Methylene blue given SQ
D. Methylene blue given IV
E. Methylene blue is not a treatment for nitrate poisoning.
177. Which medical condition will develop from severe blood loss?
A. Shock.
B.
Hypoglycaemia.
C.
Anaphylaxis.
D.
Hypothermia.
178. What names are given to the three different depths of burns?
A. Small, medium and large.
B.
First, second and third degree.
C.
Minor, medium and severe.
D.
Superficial, partial thickness, full thickness.
179. Whichtest should you use if you suspect that a casualty has
had a stroke? A. Face, Arms, Speech, Test.
B.
Alert, Voice, Pain, Unresponsive.
C.
Response, Airway, Breathing, Circulation.
D.
Pulse, Respiratory Rate, Temperature 180. Which of the following can cause a stroke?
A. A blood clot in an artery in the brain.
B. A blood clot in an artery in the heart.
C. A blood clot in an artery in the leg.
D. A blood clot in an artery in the lungs.
181. What is the MOST likely explanation for the initial reduction in core temperature during general
anesthesia? A. Ablation of thermoregulatory vasoconstriction
B. Conductive heat loss
C. Evaporative heat loss in the respiratory tract
D. Redistribution of heat from the core to the periphery
182. Tingling in the fifth finger during spinal anesthesia is associated with anesthesia at which of the following
dermatomes? A. C4
B. C6
C. C8
D. T2
E. T4
183. A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the
left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood
pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show
no abnormalities. Which of the following is the most appropriate immediate management?
A. Continuous epidural analgesia using local anesthetics
B. Mechanical ventilation
C. Infusion of midazolam
D. Patient-controlled analgesia with morphine sulfate
184. After termination of an inhalation anesthetic, patient-controlled analgesia will
A.
be effective without a loading dose of opioid if started in the immediate postanesthetic period
B.
be associated with greater analgesic requirements than conventional intramuscular opioid techniques
C.
cause addiction or dependence to opioids if continued for more than 72 hours
D.
produce less patient satisfaction than intermittent intravenous administration of opioids 185. How
should you open the airway of an unconscious casualty? A. Head tilt and chin lift.
B. Jaw thrust.
C. Head tilt and jaw thrust.
D. Lift the chin.
186. The client has been receiving garamycin 65 mg IVPB every 8 hours for the past 6 days. Which lab result indicates
an adverse reaction to the medication?
A. WBC 7500
B. Serum glucose 92
C. Protein 3.5
D. Serum creatinine 2.0
187. Regarding the common pathogens in sepsis and septic shock, which of the following statements is
correct? A. Since the late 1970s, gram-negative organisms continued to be the predominant pathogens
B. St Escherichia coli is the most frequent cause of sepsisfatalityaphylococcusaureus,
C.
Streptococcuspneumoniae, and coagulase-negative staphylococci are the common
gram-positive pathogens
D.
Non-albicans Candida species have become the most common causes of fungal sepsis
188. Shock (mean BP less than 60 mmHg) can be caused by: A. Low intravascular volume
B. Low cardiac output
C. Pleural effusion
D. Decreased peripheral vascular resistance
189. A 30 year old man is admitted to the Emergency Ward with sudden onset of severe shortness of breath, no chest
pain, diffuse wheezing, cyanosis, and a BP of 70/30, Pulse = 100. This event occurred soon after a meal. What is
the likely diagnosis:
A. Acute pulmonary embolism
B. Tension pneumothorax
C. Anaphylaxis
D. Myocardial infarction
190. A 78 year old man has collapsed. He has had a severe headache for 12 hours and had an upper respiratory tract
infection three days ago. He has a temperature of 39.2o C, a pulse of 122 beats/minute, a blood pressure of 84/60
mmHg and a respiratory rate of 34 breaths/minute but his chest is clear. He has a Glasgow Coma Scale score of
10 and some neck stiffness. He has been started on high-flow oxygen.What is the SINGLE most appropriate
immediate management? A. Intravenous antibiotic; computed tomography brain scan
B. Intravenous antibiotic; lumbar puncture
C. Intravenous fluids; computed tomography brain scan
D. Intravenous fluids; intravenous antibiotic E.
Intravenous fluids; lumbar puncture
191. A 16 year old boy was brought to hospital in a comatose state having taken methadone belonging to his sister. He
was given naloxone and rapidly became alert. Some hours later, he gradually becomes semi-conscious again. What
is the SINGLE most likely reason for this patient becoming semi-conscious again in hospital?
A. Methadone hepatotoxicity has caused acute liver failure
B. Methadone is eliminated from the body more slowly than naloxone
C. Naloxone is a partial agonist at the central nervous system opioid receptor
D. The patient has misused another substance that has caused an intracranial bleed
E. The patient has misused another substance that is absorbed more slowly than methadone
192. A 48 year old man with renal cancer had radiotherapy for metastatic spinal cord compression at the 11th thoracic
vertebra four weeks ago. He has retained sensation but is unable to stand. He has pain in a band around his lower
trunk controlled by regular oral morphine. He is distressed by increasingly frequent episodes of painful muscle
spasms in his right leg.What is the SINGLE most appropriate management of his symptoms?
A. Amitriptyline
B. Baclofen
C. Fentanyl patch
D. Gabapentin
E. Increase morphine dose
193. A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with large amts of
mucus. A dx of villous adenoma was made after endoscopy.What electrolyte abnormality is most likely in this pt?
A. Hyperkalemia
B. Hypernatremia
C. Hyponatremia D. Hypokalemia
E. Hypercalcemia
194. Dopamine affects the following receptors except
A. a1
B. a2
C. B1
D. B2
195. Determinants of cardiac output include:
A. Heart and rate rhythm
B. Preload and after load
C. Contractility
D. All of the above
196. Oxygen supply to the body is determined
by: A. hemoglobin concentration.
B. oxygen saturation.
C. A, b and C. D.
wasserrot's
197. Charles Jenkins, a 47 yo male with a history of aortic stenosis, is experiencing weakness, fatigue and decreased
exercise tolerance. A cardiac catheterization revealed a 60mm pressure gradient across the aortic valve and
calcification of the aortic ring. On POD #2, Mr. Jenkins developed a heart rate of 42 and his BP dropped to 84/20
and respirations were 22. A rhythm strip recorded showed:
A. sinus bradycardia
B. sick sinus syndrom
C. Mobitz II
D. third degree heart block
198. Mr. Jenkins returned to surgery and had a permanent dual-chamber pacemaker implanted. The following strip
was recorded in CTICU. It revealed:
A. normal sinus rhythm
B. LBBB
C. p wave tracking or DDD pacing mode
D. RBBB
199. Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a
weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has
decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is
A. administration of atropine
B. administration of ephedrine
C. administration of phenylephrine
D. placement of the patient in the head-down position
E. observation
200. Surgery is cancelled 10 minutes after initiation of intravenous regional anesthesia with 50 ml of lidocaine 0.5%. To
terminate anesthesia safely, what is the most appropriate timing for deflating the tourniquet?
A. Immediately if benzodiazepines have been administered
B. Immediately after intravenous administration of ephedrine 10 mg
C. Immediately, followed by repeated reinflation and deflation
D. In no less than 20 minutes after initial injection E.
In no less than 45 minutes after initial injection
201. A 17-year-old boy develops pulmonary edema after resolution of postoperative laryngospasm. While breathing
100% oxygen, SpO2 is 80%. Which of the following is the most appropriate management?
A. Administration of albuterol
B. Administration of furosemide
C. Infusion of nitroglycerin
D. Positive-pressure ventilation
202. An otherwise healthy 61-year-old man receives a spinal anesthetic for transurethral resection of the prostate
(TURP). Forty-five minutes after the start of the procedure, he suddenly develops nausea, diaphoresis, and sharp
pain in the left shoulder. Which of the following is the most likely cause?
A. Angina pectoris
B. Bladder perforation
C. Hyponatremia
D. Inadequate spinal sensory level
203. A 36-year-old woman is receiveing general anesthesia for a diagnostic laparoscopy in the Trendelenburg position
with carbon dioxide insufflation. During a 15-minute period after induction, her SpO2 decreases from 99% to 90%
and PETCO2 increases from 38 to 43 mmHg. FiO2 is 0.3; all ventilator settings have been constant. Which of the
following is the most likely cause of the decrease in SpO2?
A. Carbon dioxide embolus
B. Compression of the vena cava
C. Decreased diaphragmatic excursion D.
Pneumothorax
204. Two hours after a laparoscopic cholecystectomy, an obese 45-year-old woman is receiving intravenous patientcontrolled analgesia with morphine. Her SpO2 is 92% on room air. Which of the following is the most likely
cause? A. Absorption of carbon dioxide from the abdomen
B. Hypoventilation
C. Impaired oxygen diffusion D.
Increased dead space
205. In a patient receiving pressure support ventilation, pressure support breaths are triggered by achieving which
of the following preset milestones? A. A decrease in airway pressure
B. An increase in airway pressure
C. An inspiratory flow rate D. An inspired volume
206. A healthy 42-year-old man has an increase in heart rate from 60 bpm to 120 bpm during induction of
anesthesia. Which of the following factors is most likely to satisfy the increased metabolic demand of the
myocardium?
A. Decreased coronary artery resistance
B. Increased coronary perfusion pressure
C. Increased oxygen extraction by the myocardium
D. Shift to anaerobic metabolism
207. Which of the following laboratory values is most likely to confirm adequate synthetic hepatic
function? A. Partial thromboplastin time
B. Prothrombin time
C. Serum alanine aminotransferase concentration
D. Total serum bilirubin concentration
208. In a patient undergoing extracorporeal shock wave lithotripsy, ventricular dysrhythmias are best prevented by: A.
Beta-adrenergic blockade.
B. ECG synchronization.
C. Epidural blockade to T4.
D. General anesthesia.
209. Pressure support ventilation:
A. Can only be used in a spontaneously breathing patient.
B. Cannot be used in conjunction with continuous positive airway pressure.
C. Delivers a specified volume regardless of airway pressure.
D. Increases the work of breathing.
210. A 56-year-old man is anesthetized for pneumonectomy. After initiation of one-lung ventilation, SpO2 rapidly
decreases to 69%. Which of the following is the most appropriate next step in management?
A. Apply continuous positive airway pressure to the nonventilated lung
B. Increase respiratory rate and decrease tidal volume
C. Occlude the pulmonary artery supplying the nonventilated lung
D. Resume bilateral lung ventilation
211. Use of a laryngeal mask airway during general anesthesia is most appropriate for which of the following patients?
A. A patient undergoing cesarean delivery who cannot be intubated after induction of anesthesia
B. A patient who has a peak inspiratory pressure greater than 30 cmH2O
C. A patient who has a tracheoesophageal fistula
D. A patient who requires emergency appendectomy two hours after eating
212. A therapeutic concentration of inhaled nitric oxide does NOT cause systemic hypotension because it: A.
Has no effect on systemic vessels.
B. Is metabolized by pulmonary endothelium.
C. Is a mild inotrope.
D. Is rapidly inactivated by hemoglobin.
213. An axillary block is performed in a patient undergoing surgery on the distal ventral forearm and lateral
aspect of the wrist. No tourniquet is to be used. Which of the following nerves will most likely require
supplemental blockade? A. Intercostobrachial
B. Median
C. Musculocutaneous
D. Radial