DIRECTIONS FOR ITEMS 1-100: For each item, select the best answer to the question or
response to complete the statement from the four provided.
1.
Which of the following is the MOST predictive single independent risk factor that an
adult patient has obstructive sleep apnea (OSA)?
(A)
(B)
(C)
(D)
2.
A 6-week-old child with tetralogy of Fallot is scheduled for a pyloromyotomy. Which of
the following would be the BEST drug for induction of anesthesia in this patient?
(A)
(B)
(C)
(D)
3.
(B)
(C)
(D)
Long-acting neuromuscular blocking drugs should be used to facilitate
postoperative mechanical ventilation.
Peak inspiratory pressures should be kept to a minimum.
Local anesthetic agents should be excluded from thoracic epidural infusions.
Hypercapnia is poorly tolerated.
Which of the following is MOST likely to occur as a result of denitrogenation prior to
induction of general anesthesia?
(A)
(B)
(C)
(D)
5.
Propofol
Ketamine
Sevoflurane
Thiopental
Which statement about the postoperative management of patients undergoing lung
volume reduction surgery is MOST likely true?
(A)
4.
Current smoker
Increased body mass index
Age
Diabetes
Augmentation of hypoxic pulmonary vasoconstriction
Increased second gas effect
Prevention of diffusion hypoxia
Increased oxygen within the functional residual capacity
In which of the following is the compliance of the respiratory system MOST likely
increased?
(A)
(B)
(C)
(D)
Acute respiratory distress syndrome (ARDS)
Morbid obesity
Emphysema
During laparoscopy
1
6.
A man taking 50 mg/d of methadone for chronic pain is scheduled for abdominal
surgery. Which statement about this patient is MOST likely true?
(A)
(B)
(C)
(D)
7.
Which of the following is NOT characteristic of pressure support ventilation (PSV)?
(A)
(B)
(C)
(D)
8.
Administering sodium nitroprusside
Allowing PaCO2 to increase by 10 mm Hg from baseline
Initiating beta-blocker therapy
Administering furosemide
Which of the following is the BEST choice for the invasive treatment of trigeminal
neuralgia?
(A)
(B)
(C)
(D)
10.
The clinician sets the inspiratory pressure.
The inspiratory flow is decelerating.
The breath is time-cycled.
The tidal volume varies from breath to breath.
A patient with a history of mitral stenosis but without evidence of congestive heart failure
presents for emergency appendectomy. The patient’s electrocardiogram shows normal
sinus rhythm, blood pressure is 140/85 mm Hg, and heart rate is 105 beats/min. Which of
the following is MOST likely to be useful in the management of this patient?
(A)
(B)
(C)
(D)
9.
His chronic opioid use increases his risk of postoperative respiratory depression.
Because of the long half-life of methadone, he will require less opioid than an
opioid-naïve patient following surgery.
He is more likely than an opioid- naïve patient to experience opioid-induced
nausea after surgery.
Acetaminophen is contraindicated in a patient taking methadone.
Percutaneous radiofrequency rhizotomy of the gasserian ganglion
Microvascular decompression of the facial nerve
Cyber knife surgery of the facial nerve
Phenol ablation of the facial nerve
A 57-year-old otherwise healthy woman presents for laparoscopic removal of a uterine
fibroma. She only takes a multivitamin and several over-the-counter herbal medicines to
help her relax and sleep. During the procedure, there is a significant amount of bleeding
that requires conversion to an open laparotomy. Which of the following herbal medicines
is MOST likely to be associated with increased bleeding?
(A)
(B)
(C)
(D)
Ginger
Kava
St.-John's-wort
Valerian
2
11.
Administration of a continuous intravenous opioid infusion (basal rate) in addition to
patient-controlled analgesia is MOST associated with
(A)
(B)
(C)
(D)
12.
Which of the following drugs is MOST dependent on metabolism to become clinically
active?
(A)
(B)
(C)
(D)
13.
Morphine
Methadone
Fentanyl
Buprenorphine
A patient with widely metastatic breast cancer presents with intractable pain despite
optimized oral nonsteroidal antiinflammatory drugs and opioid therapy. Intrathecal
opioids were not tolerated. Which of the following is the MOST appropriate next step?
(A)
(B)
(C)
(D)
15.
Oxycodone
Codeine
Morphine
Hydromorphone
Which of the following drugs is BEST described as having N-methyl-D-aspartic acid
(NMDA) antagonist properties?
(A)
(B)
(C)
(D)
14.
improved pain relief.
improved sleep pattern.
decreased need for demand doses.
increased respiratory depression.
Intrathecal baclofen
Intrathecal midazolam
Intrathecal ziconotide
Intrathecal ketamine
Which of the following outcomes is MOST likely to be present 5 years after surgery in
patients who experienced complex regional pain syndrome (CRPS) after knee surgery?
(A)
(B)
(C)
(D)
Spreading of their pain
Abnormal hair growth in the affected extremity
Trophic skin changes in the affected extremity
Resolution of symptoms
3
16.
Which statement about the cervical spine is MOST likely true?
(A)
(B)
(C)
(D)
17.
A healthy 1-year-old infant is undergoing a bilateral herniorrhaphy. After inducing
general anesthesia and with the child breathing spontaneously, a caudal block was placed
for postoperative analgesia. The anesthesiologist suspects that the local anesthetic was
inadvertently injected into the intrathecal space. Which of the following would be the
MOST likely manifestation of total spinal anesthesia in an infant?
(A)
(B)
(C)
(D)
18.
Hyperthermia
Hypokalemia
Hyperoxia
Acidosis
Which of the following is MOST likely to result from the administration of intravenous
(IV) caffeine to an infant for the prevention of postoperative apnea?
(A)
(B)
(C)
(D)
20.
Bradycardia
Hypertension
Hypotension
Apnea
Which of the following conditions is MOST likely to contribute to the reversion to fetal
circulation in a neonate?
(A)
(B)
(C)
(D)
19.
The first cervical spinal nerve (C1) does not have a sensory root.
The cervical spinal nerves for C2 through C7 exit under the transverse processes
of the vertebral body for which they are named (eg, C6 exits under the C6
transverse process between C6 and C7).
The eighth cervical nerve (C8) exits above the transverse process of C8.
The segment contributing the most to flexion-extension is the atlantoaxial joint
(between C1 and C2)
Irritability
Hypoxemia
Hypothermia
Bradycardia
An otherwise healthy 3-year-old boy is scheduled for an elective adenoidectomy. He has
a 4-day history of isolated, clear rhinorrhea. His lungs are clear to auscultation and he is
afebrile. His mother reports that his activity level and appetite have been unchanged since
the onset of the rhinorrhea. Which of the following is MOST appropriate for this patient?
(A)
(B)
(C)
(D)
Postpone the procedure.
Obtain a preoperative chest radiograph.
Require postoperative admission.
Proceed with the procedure.
4
21.
A child presents for emergency rigid bronchoscopy for a foreign body located in a
mainstem bronchus. As the foreign body is being removed, it lodges in the distal trachea
and the patient develops complete airway obstruction. Which of the following is the
BEST way to reestablish ventilation?
(A)
(B)
(C)
(D)
22.
Which of the following BEST describes the mechanism of action of an
acetylcholinesterase inhibitor (AChEI)?
(A)
(B)
(C)
(D)
23.
An AChEI binds directly to the neuromuscular blocker.
An AChEI produces conformational changes at the neuromuscular junction
leading to the release of the neuromuscular blocker.
An AChEI dramatically increases acetylcholine that competes with the
neuromuscular blocker.
An AChEI binds directly to the neuromuscular junction, displacing the
neuromuscular blocker.
Which of the following side effects is LEAST likely to occur in a patient who applies a
standard transdermal scopolamine patch to prevent postoperative nausea and vomiting?
(A)
(B)
(C)
(D)
24.
Administer albuterol.
Administer succinylcholine.
Perform an emergency cricothyroidotomy.
Advance the foreign body into a mainstem bronchus.
Dry mouth
Visual disturbances
Dizziness
Agitation
A 69-year-old woman with end-stage liver disease and dialysis-dependent renal failure
requires general anesthesia and surgery for debridement of an infected, nonhealing leg
ulcer. The duration of action of which of the following drugs is MOST likely to be
normal in this patient?
(A)
(B)
(C)
(D)
Pancuronium
Vecuronium
Cisatracurium
Rocuronium
5
25.
A 52-year-old man is undergoing thoracotomy and right upper lobe resection for cancer.
A left-sided double lumen tracheal tube has been placed. During one-lung ventilation, the
patient‘s oxygen saturation decreases to 73% and remains low despite increasing FIO2 to
1.0. Which of the following is the MOST appropriate next intervention at this time?
(A)
(B)
(C)
(D)
26.
A 36-year-old man is undergoing craniotomy in the sitting position for resection of a
posterior fossa tumor. A change in which of the following is MOST sensitive for the
detection of venous air embolism (VAE)?
(A)
(B)
(C)
(D)
27.
Administer nitrous oxide and oxygen in a 70:30 ratio.
Change the position so that the patient sits up to a greater degree.
Apply pressure to the jugular veins.
Place a chest tube.
Assuming the blood pressure remains within the limits of cerebral autoregulation,
administration of which of the following is MOST likely to produce a decrease in
cerebral blood flow (CBF)?
(A)
(B)
(C)
(D)
29.
End-tidal N2
Central venous pressure
Electrocardiogram
Precordial Doppler
In the event a venous air embolism (VAE) develops when a patient is undergoing a
posterior fossa craniotomy, which of the following interventions is MOST appropriate?
(A)
(B)
(C)
(D)
28.
Apply continuous positive airway pressure (CPAP) to the nonventilated right
lung.
Initiate high-frequency jet ventilation.
Apply positive end-expiratory pressure (PEEP) to the ventilated left lung.
Ask the surgeon to clamp the right main pulmonary artery.
Phenylephrine
Epinephrine
Esmolol
Dexmedetomidine
Which of the following is MOST likely to be a manifestation of citrate intoxication?
(A)
(B)
(C)
(D)
Hypotension
Short QT interval on the electrocardiogram (ECG)
Peaked T waves on the ECG
Wide pulse pressure
6
30.
A 65-year-old male develops severe hypoxemia approximately 24 hours after an
uncomplicated pneumonectomy. Which of the following factors is NOT a risk factor
associated with the development of postpneumonectomy pulmonary edema following
uncomplicated pneumonectomy?
(A)
(B)
(C)
(D)
31.
Which of the following volatile anesthetics is MOST associated with high levels of
carbon monoxide (CO) production when delivered across a desiccated absorbent?
(A)
(B)
(C)
(D)
32.
TNS usually resolves spontaneously.
TNS occurs most frequently with the use of bupivacaine spinal anesthesia.
TNS does not occur in patients placed in the lithotomy position.
TNS must be treated with emergent surgical laminectomy and spinal cord
decompression.
A 24-year-old woman is placed on parenteral nutrition (PN) for chronic malnutrition
related to short-gut syndrome. Which statement about PN is MOST likely true?
(A)
(B)
(C)
(D)
34.
Sevoflurane
Desflurane
Halothane
Isoflurane
A patient complains of severe back and leg pain the day after she underwent an
uncomplicated knee arthroscopy with spinal anesthesia in an outpatient surgical center.
She reports no fever or lower extremity weakness. Which statement about transient
neurologic symptoms (TNS) is MOST likely true?
(A)
(B)
(C)
(D)
33.
Right-sided surgical procedure
Intraoperative peak ventilatory pressures greater than 25 cm H2O
Preoperative alcohol abuse
Perioperative fluid restriction
The majority of the calories in PN are derived from protein.
PN cannot supply all of the required daily calories for most patients.
Studies have not demonstrated a clear benefit with PN in most patient groups.
PN uses a hypotonic solution.
Which statement about the measured plateau pressure during positive pressure
ventilation is MOST likely true?
(A)
(B)
(C)
(D)
It is used to calculate dynamic compliance.
It is the measured airway pressure during an inspiratory pause.
It represents the airway resistance in the large airways.
It should be maintained above 30 cm H2O in patients with acute respiratory
distress syndrome (ARDS).
7
35.
Which statement about radiation therapy for the treatment of cancer is MOST likely true?
(A)
(B)
(C)
(D)
36.
Radiation therapy does not produce bone marrow suppression.
Radiation therapy may result in impaired renal function.
Radiation-induced pericarditis is always symptomatic.
The liver does not exhibit a radiation-induced injury.
The cardiovascular changes associated with pregnancy may exacerbate preexisting heart
disease. A patient with which of the following conditions is MOST likely to tolerate
pregnancy without cardiovascular decompensation?
(A) Mitral stenosis
(B) Hypertrophic obstructive cardiomyopathy
(C) Mitral regurgitation
(D) Aortic stenosis
37.
A 29-year-old woman at 37 weeks gestation is undergoing labor induction due to
preeclampsia. The fetal heart tracing shows the following:
The MOST likely etiology for this tracing is
(A)
(B)
(C)
(D)
fetal head compression.
uteroplacental insufficiency.
umbilical cord compression.
maternal administration of an intravenous opioid.
8
38.
Which statement about cardiac arrest during general anesthesia is MOST likely true?
(A)
(B)
(C)
(D)
39.
The risk of transfusion-transmitted infection in the United States is HIGHEST for which
of the following viruses?
(A)
(B)
(C)
(D)
40.
kappa-opioid receptors.
gamma-aminobutyric acid-A (GABAA) receptors.
voltage-gated sodium channels.
voltage-gated calcium channels.
A 35~year~old man has widely metastatic prostate cancer but is most troubled by
constant severe right-sided chest pain radiating from the midaxillary line to the right
epigastric area. A computed tomography scan of the chest demonstrates a metastasis in
the right T6 rib. Which of the following is the BEST treatment for his chest pain?
(A)
(B)
(C)
(D)
43.
The valve is controlled by oxygen supply pressure.
It is present in the gas line supplying the oxygen flowmeter.
The valve mechanism is standardized for all anesthesia machines.
It prevents administration of a hypoxic mixture of gases.
Gabapentin is MOST likely to bind to
(A)
(B)
(C)
(D)
42.
Human immunodeficiency virus (HIV)
Hepatitis B virus (HBV)
Hepatitis C virus (HCV)
West Nile virus
Which statement about the oxygen fail-safe valve is MOST likely true?
(A)
(B)
(C)
(D)
41.
Tachydysrhythmia is the most common dysrhythmia at the time of cardiac arrest.
The most frequent immediate response is to perform cardiac compressions.
SPO2 is usually above 90% at the time of the arrest.
Calcium is routinely immediately administered.
T6 intercostal neurolytic block
T5 intercostal neurolytic block
Celiac plexus neurolytic block
Thoracic epidural neurolytic block
Which of the following is the MOST likely reason the US Food and Drug Administration
instituted a black box warning regarding the administration of succinylcholine to children
undergoing nonemergent surgery?
9
(A)
(B)
(C)
(D)
44.
After a motorcycle accident, a 23-year-old man is undergoing repair of an open femur
fracture. He was unconscious at the scene and is presumed to have a traumatic brain
injury. All laboratory values are normal except his blood glucose (BG), which is 220
mg/dL (12 mmol/L). Which of the following is the MOST appropriate therapeutic
intervention’?
(A)
(B)
(C)
(D)
45.
(B)
(C)
(D)
Patients at risk for alcohol withdrawal syndrome (AWS) are detected more than
80% of the time during a routine inquiry about alcohol use.
Serum liver enzyme values detect alcohol abuse more reliably than a
questionnaire.
Preemptive treatment of patients at risk for AWS improves outcome.
A screening tool will reliably predict AWS.
Which of the following MOST likely results in a type II statistical error?
(A)
(B)
(C)
(D)
47.
Delay glucose treatment until the patient is in the intensive care unit.
Initiate insulin therapy to maintain BG between 140 and 180 mg/dL (7.8-10
mmol/L).
Delay initiating therapy until BG is greater than 275 mg/dL (15.8 mmol/L).
Use insulin therapy to maintain BG between 60 mg/dL and 80 mg/dL (3.8-4.4
mmol/L).
Your anesthesia group proposes adding a more complete alcohol-use screening test to the
perioperative assessment questionnaire. A member of the hospital oversight committee
objects to the change. Which statement about the effect of adding the alcohol-use
screening test is MOST likely true?
(A)
46.
Development of phase II block
Development of myalgias
Potential for atypical plasma cholinesterase
Potential for an undiagnosed myopathy
Use of an incorrect statistical test
Use of too high a P value
Concluding a difference exists when no true difference exists
Concluding a difference does not exist when a true difference exists
A 32-year-old man with Hodgkin lymphoma presents for a mediastinoscopy. He has an
8-cm anterior mediastinal mass and has dyspnea in the supine position. The BEST airway
management in this situation would be
10
(A)
(B)
(C)
(D)
48.
tracheostomy.
awake fiberoptic intubation.
rapid sequence induction and intubation.
laryngeal mask airway.
A patient is complaining of pain and numbness in the lateral aspect of his arm and
forearm radiating into the thumb and index finger. On physical examination, weakness in
biceps and wrist extension is noted and both the brachioradialis and biceps reflexes are
absent. The cervical nerve root MOST likely affected is
(A)
(B)
(C)
(D)
C5.
C6.
C7.
C8.
49.
Which of the following Mapleson circuits is MOST efficient (ie, requires the lowest rate
of fresh gas flow) in preventing rebreathing during controlled ventilation?
50.
An otherwise healthy 55-year-old man has undergone uneventful coronary artery bypass
grafting. The following table presents initial parameters after separation from bypass as
well as those same parameters after administration of protamine. Peak airway pressures
are also noted to have increased after administration of protamine.
11
Parameter
Heart rate
Blood pressure
Pulmonary artery
pressure
Central venous pressure
SpO2
Off Pump Before Protamine
80 beats/min
110/56 mm Hg
35/12 mm Hg
After Protamine
80 beats/min
60/35 mm Hg
55/31 mm Hg
8 mm Hg
100
22 mm Hg
87
Which of the following would MOST likely be included in the initial management of this
patient?
(A)
(B)
(C)
(D)
51.
A 72-year-old man is in the operating room for a coronary artery bypass procedure.
Sternotomy has been performed and the surgeon is harvesting the left internal mammary
artery (LIMA). During LIMA harvesting, the pulmonary artery pressure (PAP) increases
from 30/16 mm Hg to 62/34 mm Hg. Vital signs otherwise remain unchanged with blood
pressure 130/76 mm Hg and SaO2 98% on FIO2 1.0. His electrocardiogram (ECG) reveals
a right bundle branch block with a heart rate of 80 beats/min, unchanged from his
preoperative ECG. The MOST appropriate initial management step is to
(A)
(B)
(C)
(D)
52.
administer nitroglycerin.
administer inhaled nitric oxide.
hyperventilate the patient.
initiate cardiopulmonary bypass.
A 77-year-old woman with a biventricular implantable cardioverter-defibrillator (ICD)
device is scheduled for an elective thyroidectomy. Interrogation of her device 2 days ago
revealed 99.9% of beats were paced in DDD mode at 60 beats/min. Per report, there is no
underlying (intrinsic) cardiac rhythm. Which of the following will MOST likely prevent
pacemaker inhibition by surgical electrocautery?
(A)
(B)
(C)
(D)
53.
Ephedrine
Fluid bolus
Epinephrine
Nitroglycerin
Reprogramming the pacemaker to an asynchronous mode
Limiting electrocautery bursts to 1 second
Placing a magnet over the device
Programming the defibrillator function to the “off” mode
A 46-year-old woman is scheduled for a mediastinoscopy for biopsy of an enlarged
mediastinal lymph node. During the procedure, the right radial arterial line pressure
tracing becomes nonpulsatile. A noninvasive blood pressure cuff on her left arm is
recycled and measures 137/78 mm Hg. Her electrocardiogram (ECG) is unchanged with
normal sinus rhythm at 80 beats/min. Which of the following is MOST likely in this
scenario?
12
(A)
(B)
(C)
(D)
54.
A new cardiac anesthesia drug is under investigation. The developer wishes to test this
drug versus placebo in a group of 500 patients undergoing cardiac surgery, with mortality
being the primary outcome variable. The patients will be randomized to receive either the
new drug or placebo. Which of the following statistical tests is the MOST appropriate to
use?
(A)
(B)
(C)
(D)
55.
decreased C fiber substance P concentration.
demyelination.
slowed nerve conduction.
increased sensitivity to pain (hyperalgesia).
Which statement about femoral nerve block is MOST likely true?
(A)
(B)
(C)
(D)
58.
Mandibular nerve
Facial nerve
Superior laryngeal nerve
Glossopharyngeal nerve
Repeated stimulation of peripheral nociceptive C nerve fibers MOST likely produces
(A)
(B)
(C)
(D)
57.
Paired t-test
Analysis of variance (ANOVA)
Wilcoxon signed-rank test
Chi-square
Which nerve provides tactile innervation to the anterior aspect of the tongue?
(A)
(B)
(C)
(D)
56.
Myocardial ischemia
Compression of the innominate artery
Venous air embolus
Hemorrhage
When performing a femoral nerve block, the needle should be placed medial to
the femoral artery.
Femoral nerve block is suitable as the sole anesthetic for total knee replacement.
Ultrasound guidance is of limited use in performing a femoral nerve block.
Persistent weakness of the quadriceps muscle can be a complication of a femoral
nerve block.
Which statement about allergic reactions to antibiotics is MOST likely true?
(A)
(B)
The prevalence of cross-reactivity between penicillins and cephalosporins is
approximately 10%.
In patients with a penicillin allergy, an allergic reaction is more likely to occur
13
(C)
(D)
59.
Which statement about the effect of amiodarone administration is MOST likely true?
(A)
(B)
(C)
(D)
60.
Administration of nitroglycerin
Diuresis
Surgical exploration
Administration of nitric oxide
A 42-year-old woman with symptomatic, severe primary pulmonary hypertension
presents for an appendectomy. Which of the following is the MOST appropriate
intraoperative management strategy?
(A)
(B)
(C)
(D)
62.
Hepatitis has been reported in 15% of patients.
Hyperthyroidism has not been reported.
Seizures are frequently reported with rapid administration.
Interstitial pneumonitis is the most serious irreversible side effect.
A 50-year-old man underwent an uneventful coronary artery bypass procedure. While
intubated in the intensive care unit, a 300 mL/h blood loss was measured from his
mediastinal tubes during the initial 4 hours, followed by abrupt cessation of output from
these tubes. Throughout the next 2 hours, lactate levels steadily increased. Currently, his
blood pressure is 60/29 mm Hg, heart rate 130 beats/min, SaO2 92%, central venous
pressure 24 mm Hg, pulmonary artery pressure 45/28 mm Hg, despite blood transfusion
to a hemoglobin level of 10 g/dL and increasing inotropic support. Which of the
following is the MOST appropriate next step?
(A)
(B)
(C)
(D)
61.
with newer rather than older generations of cephalosporins.
The probability that a patient will develop red man syndrome following penicillin
administration is related primarily to the rate of drug administration,
The sensitivity of skin testing for penicillin allergy is approximately 90%.
Apply 20 cm H2O positive end-expiratory pressure (PEEP).
Maintain PCO2 at 45 mm Hg.
Maintain core temperature at 35°C.
Administer a phosphodiesterase III inhibitor (eg, milrinone).
A 6-year-old boy scheduled for outpatient surgery received a nontriggering anesthetic
due to a history of increased susceptibility for malignant hyperthermia (MH). He had an
uneventful intraoperative course. According to the Malignant Hyperthermia Association
of the United States (MHAUS), which of the following postoperative dispositions is
MOST appropriate for this patient?
14
(A)
(B)
(C)
(D)
63.
The combination of clonidine and local anesthetic is administered caudally for a
hypospadias repair in a 2-year-old boy. Compared to the administration of local
anesthetic alone, the MOST likely postoperative effect of combining clonidine and local
anesthetic for caudal anesthesia in this patient would be
(A)
(B)
(C)
(D)
64.
Povidone-iodine should be used for skin preparation.
A bacterial filter during continuous epidural infusion should always be used.
A sterile gown should be worn during the performance of neuraxial procedures.
The practitioner should remove hand and arm jewelry before performing
neuraxial procedures.
Based on a recent American Society of Anesthesiologists practice advisory addressing
infectious complications of neuraxial procedures, which of the following statements
about the diagnosis and management of these complications is MOST likely true?
(A)
(B)
(C)
(D)
66.
decreased respiratory rate.
increased urinary retention.
decreased blood pressure.
increased sedation.
According to the recent American Society of Anesthesiologists practice advisory
regarding neuraxial infections, which of the following is MOST likely a recommendation
for the prevention of infections?
(A)
(B)
(C)
(D)
65.
Admit to the intensive care unit (ICU)
Admit to the hospital for overnight observation
Discharge per usual protocol/criteria
Observe in the postanesthesia care unit for a minimum of 2 hours
Symptoms will develop within 48 hours after the procedure is performed.
Hospitalized patients with continuous catheters should be examined daily for
signs of infection.
An epidural catheter should be removed only if the patient has an elevated white
blood cell count.
Antibiotic therapy should be initiated for a suspected infection after consultation
with an infectious disease specialist.
Which of the following is MOST likely to be greater in a healthy infant born at term than
in a healthy adult?
(A)
(B)
(C)
(D)
Hematocrit
P50
PaO2
PaCO2
15
67.
A healthy subject performs a Valsalva maneuver for 10 seconds. Blood pressure is likely
to be HIGHEST at which of the following times?
(A)
(B)
(C)
(D)
68.
An otherwise healthy 53-year-old man is undergoing an uncomplicated total knee
replacement under general anesthesia. Which of the following mechanisms is likely to
account for the GREATEST percentage of heat loss in this situation?
(A)
(B)
(C)
(D)
69.
Obturator nerve
Saphenous nerve
Sciatic nerve
Superficial peroneal nerve
An otherwise healthy 28-year-old male is scheduled to undergo an emergency
appendectomy. A rapid-sequence induction of anesthesia is performed, but a copious
quantity of nonparticulate gastric contents is noted in the posterior pharynx on
laryngoscopy. Which of the following is MOST likely recommended in the management
of this patient following tracheal intubation?
(A)
(B)
(C)
(D)
71.
Conduction
Convection
Evaporation
Radiation
After undergoing a complicated vaginal hysterectomy, a patient complains of foot drop
and notes a sensory deficit on the side of her foot. Injury to which of the following nerves
would BEST explain this finding?
(A)
(B)
(C)
(D)
70.
Before initiation of the maneuver
During the first 1-2 seconds after initiation of the maneuver
Immediately upon terminating the maneuver
Several seconds after terminating the maneuver
Tracheal suctioning
Steroid administration
Antibiotic administration
Bronchial lavage
A 63-year-old man with severe chronic obstructive pulmonary disease is scheduled to
undergo femoral-popliteal bypass surgery and will receive intraoperative heparin.
Epidural anesthesia is the planned anesthetic technique. Based on recently updated
American Society of Regional Anesthesia and Pain Medicine (ASRA) guidelines for
regional anesthesia in patients receiving antithrombotic therapy, which statement about
the management of this patient is MOST likely true?
(A)
The surgery must be canceled if blood is obtained during epidural needle
16
(B)
(C)
(D)
72.
Based on recently updated American Society of Regional Anesthesia and Pain Medicine
(ASRA) guidelines regarding regional anesthesia in patients receiving antithrombotic or
thrombolytic therapy, which of the following patients is MOST likely an appropriate
candidate to receive regional anesthesia?
(A)
(B)
(C)
(D)
73.
Fractional excretion of urea (FEUN) less than 35%
Fractional excretion of sodium (FENa) equal to 2.5%
Ratio of urinary to plasma creatinine (U:PCr) less than 10
Ratio of urine to plasma osmolality (U:Posm) equal to 1
Administration of which of the following agents is MOST likely to be associated with an
increase in intraocular pressure (IOP)?
(A)
(B)
(C)
(D)
75.
A patient who received her last dose of twice-daily enoxaparin 14 hours ago
A patient on chronic warfarin therapy with an international normalized ratio
(INR) of 1.5
A patient who has been taking garlic extract on a daily basis
A patient who discontinued clopidogrel therapy 4 days ago
A patient who has undergone emergency repair of a ruptured abdominal aortic aneurysm
is in the postanesthesia care unit (PACU). His urine output for the last 3 hours totaled 20
mL. Which of the following is MOST likely to be associated with a prerenal cause of his
oliguria?
(A)
(B)
(C)
(D)
74.
placement.
Intraoperative heparin should not be administered until at least 1 hour after
epidural needle placement.
The epidural catheter can be removed within 1 hour after the last heparin dose.
A postoperative heparin infusion should not be started until at least 6 hours after
the epidural catheter has been removed.
Thiopental
Etomidate
Propofol
Ketamine
Which of the following is MOST likely the “gold standard” for monitoring intracranial
pressure (ICP)?
(A)
(B)
(C)
(D)
Subarachnoid bolt
Intraventricular catheter
Intraparenchymal microtransducer
Epidural fiberoptic transducer
17
76.
Which of the following conditions is MOST likely to be treated with stellate ganglion
block?
(A)
(B)
(C)
(D)
77.
A patient presents with painful paresthesias radiating to the web space between the first
and second toe. The surgeon suspects the pain may be related to a lipoma compressing
the deep peroneal nerve. The deep peroneal nerve is MOST reliably blocked by placing
the needle in which of the following locations at the intramaleolar line?
(A)
(B)
(C)
(D)
78.
Between the tendon of extensor hallucis longus and the tendon of the extensor
digitorum longus
Between the tendon of extensor hallucis longus and the tendon of the tibialis
anterior
Lateral to the tendon of the extensor digitorum longus tendon
Medial to the tibialis anterior tendon
A woman presents with refractory pain from advanced but localized uterine cancer
despite optimized systemic opioid therapy and adjuvant medications. Which of the
following neurolytic blocks is MOST appropriate for management of her pain?
(A)
(B)
(C)
(D)
79.
Acute herpes zoster pain
Coronary vasospasm
Hoarseness
Subclavian steal syndrome
Celiac ganglion
Superior hypogastric plexus
Left lumbar sympathetic ganglion
Pudendal nerve
Which of the following flow-volume loops is MOST characteristic of a patient with
unilateral vocal cord paralysis?
18
80.
Which statement about complications resulting from transfusion of leukoreduced blood
products is MOST likely true?
(A)
(B)
(C)
(D)
Hemolytic transfusion reaction is the most common cause of transfusion-related
death.
Leukoreduction reduces the risk of allergic reactions.
Bacterial contamination is most frequent with red blood cells.
Transfusion of the wrong blood product to the wrong patient (mistransfusion) is
the most common complication.
DIRECTIONS FOR ITEMS 81 AND 82: These items refer to the diagnosis, treatment, or
management of a single patient.
19
81.
A farmer presents for emergency repair of an open tibial fracture after a farming accident.
The patient is not in respiratory distress but appears anxious and diaphoretic. His pupils
are miotic and he reports having severe diarrhea and vomiting. Which of the following is
the MOST likely diagnosis?
(A)
(B)
(C)
(D)
82.
Organophosphate poisoning
Cocaine intoxication
Anticholinergic toxicity
Amphetamine intoxication
Which of the following is the MOST appropriate therapy for this patient?
(A)
(B)
(C)
(D)
Neostigmine
Physostigmine
Glycopyrrolate
Atropine
DIRECTIONS FOR ITEMS 83 THROUGH 85: These items refer to the diagnosis,
treatment, or management of a single patient.
20
83.
An otherwise healthy 56-year-old woman is scheduled for an elective exploratory
laparotomy for an abdominal mass. A thoracic epidural is placed for postoperative pain
control and tested with 3 mL of lidocaine. Within 10 minutes of induction of general
anesthesia, her blood pressure decreases from 128/68 mm Hg to 68/38 mm Hg and her
heart rate increases from 88 beats/min to 120 beats/min. Her peak airway pressure
suddenly rises to 40 cm H2O and the plateau pressure is 15 cm H2O. Which of the
following is the MOST likely cause for the hypotension?
(A)
(B)
(C)
(D)
84.
In addition to the lidocaine administered via the epidural, the patient received propofol,
rocuronium, fentanyl, and sevoflurane in oxygen. Which of the following drugs is the
MOST likely to have caused this patient's condition?
(A)
(B)
(C)
(D)
85.
Hypovolemia
General anesthesia immediately following placement of the epidural
High intrathoracic pressures from ventilator setting
Anaphylaxis
Lidocaine
Propofol
Rocuronium
Sevoflurane
Which of the following drugs is the MOST appropriate first-line agent to administer in
treating this patient?
(A)
(B)
(D)
(D)
Epinephrine
Cimetidine
Hydrocortisone
Albuterol
DIRECTIONS FOR ITEMS 86 AND 87: These items refer to the diagnosis, treatment, or
management of a single patient.
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86.
A 56-year-old woman is seen in the preoperative evaluation clinic prior to laparoscopic
cholecystectomy. She has a remote history of rheumatic fever. Auscultation of her
precordium reveals a loud first heart sound and a mid-diastolic rumbling murmur
localized to the apex. Which of the following is the MOST likely associated valvular
pathology?
(A)
(B)
(C)
(D)
87.
Aortic regurgitation
Pulmonic stenosis
Mitral stenosis
Aortic stenosis
Which of the following is the MOST important hemodynamic management goal for this
patient?
(A)
(B)
(C)
(D)
Decreased heart rate
Increased pulmonary vascular resistance
Decreased preload
Decreased systemic vascular resistance
DIRECTIONS FOR ITEMS 88 AND 89: These items refer to the diagnosis, treatment, or
management of a single patient.
88.
A 65-year-old woman requires an emergency T5 to T8 decompressive laminectomy due
to abrupt onset of lower extremity weakness. She has metastatic breast cancer and is
currently receiving tamoxifen with spot irradiation therapy to her spine for bony
metastasis. Which of the following metabolic abnormalities is MOST likely?
(A)
(B)
(C)
(D)
89.
Hypercalcemia
Hypernatremia
Elevated serum creatinine
Hyperkalemia
The patient is taken to surgery and monitoring of evoked potentials (MEPs) is planned.
The patient has significant motor weakness but no sensory changes in her legs. Which of
the following is likely to provide the BEST conditions for monitoring MEPs in this
situation?
(A)
(B)
(C)
(D)
Administer a volatile anesthetic only.
Use controlled hypotension.
Use a nondepolarizing muscle relaxant.
Maintain hemoglobin above 10 mg/dL.
DIRECTIONS FOR ITEMS 90 AND 91: These items refer to the diagnosis, treatment, or
management of a single patient.
22
90.
A 64-year-old man is scheduled for a colon resection for a large adenocarcinoma of the
colon. He presents complaining of the worst headache of his life and neck stiffness.
These symptoms have been present for about 8 hours. After consulting with the surgeon,
you decide the MOST appropriate immediate action would be to
(A)
(B)
(C)
(D)
91.
perform a noncontrast cranial computed tomography scan.
send the patient to the emergency department.
request a cerebral arteriogram.
proceed with the scheduled surgery.
The diagnosis of subarachnoid hemorrhage is confirmed and the decision is made to
embolize the aneurysm. The patient's mental status has deteriorated over the intervening
hour, and he requires a general anesthetic for the procedure. Which statement about the
neurologic risks or anesthetic management of this patient is MOST likely true?
(A)
(B)
(C)
(D)
Intracranial hypertension is unlikely.
The risk of rebleeding is less than 1%.
Hypothermia should be induced.
Normal blood pressure should be maintained.
DIRECTIONS FOR ITEMS 92 AND 93: These items refer to the diagnosis, treatment, or
management of a single patient.
92.
An intravascular injection of 30 mL 0.5% bupivacaine occurs during performance of an
axillary block. Which of the following cardiovascular effects is MOST likely to occur in
this setting?
(A)
(B)
(C)
(D)
93.
Increase in the rate of ventricular depolarization
Decrease in the PR interval
Increase in the effective refractory period
Decrease in myocardial contractility
The patient develops ventricular fibrillation that is refractory to defibrillation efforts. In
addition to advanced cardiac life support (ACLS) management, which of the following is
the MOST appropriate medication to administer at this time?
(A)
(B)
(C)
(D)
Lipid emulsion (Intralipid)
Methylene blue
N-acetylcysteine
Amyl nitrite
DIRECTIONS FOR ITEMS 94 AND 95: These items refer to the diagnosis, treatment, or
management of a single patient.
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94.
You are asked to evaluate a 2-year-old boy in the emergency department with a 2-day
history of low-grade fever, rhinorrhea, and a sore throat. He now has mild respiratory
distress and a barking cough. The child is awake and has moderate inspiratory stridor and
chest retractions; auscultation of the chest reveals the lungs are clear bilaterally. The
respiratory rate is 30 breaths/min and the room air oxygen saturation is 96%. Which of
the following is the MOST likely diagnosis for this patient’s postoperative symptoms?
(A)
(B)
(C)
(D)
95.
Epiglottitis
Bronchospasm
Aspiration pneumonia
Croup
Which of the following is the MOST appropriate initial management for this patient?
(A)
(B)
(C)
(D)
Intravenous antibiotics
Nebulized albuterol
Tracheal intubation
Nebulized epinephrine
DIRECTIONS FOR ITEMS 96 THROUGH 98: These items refer to the diagnosis,
treatment, or management of a single patient.
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96.
A patient with a history of hypertension (baseline blood pressure 160/100 mm Hg)
experiences an acute myocardial infarction (Ml). The presence of which of the following
is MOST likely to be associated with an increased risk of developing cardiogenic shock
following an acute MI?
(A)
(B)
(C)
(D)
97.
Which of the following is MOST consistent with the diagnosis of cardiogenic shock?
(A)
(B)
(C)
(D)
98.
History of tobacco abuse
ST-segment elevation MI
Age less than 50 years
Male sex
Initial systemic systolic blood pressure of 100 mm Hg
Cardiac index of 2.5 L • min-1 • m2
Pulmonary artery occlusion pressure of 8 mm Hg
Oliguria
The diagnosis of cardiogenic shock is established and the decision is made to institute
intra-aortic balloon counterpulsation. Which of the following is MOST likely to decrease
as a result of this intervention?
(A)
(B)
(C)
(D)
Left ventricular afterload
Systemic diastolic blood pressure
Cardiac output
Coronary artery blood flow
DIRECTIONS FOR ITEMS 99 AND 100: These items refer to the diagnosis, treatment, or
management of a single patient.
25
99.
Following an axillary block, a patient undergoes surgery on the distal radius. Prior to
incision, the surgeon checks for adequate anesthesia, and the patient reports numbness in
all of the fingers and inability to move the fingers or thumb. The patient reports pain on
beginning the incision over the distal radial aspect of the wrist. Which of the following
nerves is MOST likely to be inadequately blocked?
(A)
(B)
(C)
(D)
100.
Musculocutaneous nerve
Medial antebrachial cutaneous nerve
Medial brachial cutaneous nerve
Ulnar nerve
Infiltrating local anesthetic at which of the following locations is MOST likely to rescue
this block?
(A)
(B)
(C)
(D)
Superior and lateral to the cubital tunnel
At the cubital tunnel
Proximal to the styloid process of the ulna
Lateral to the biceps tendon and medial to the brachioradialis at the cubital fossa
26