DIRECTIONS FOR ITEMS 1-100: Each of the questions or incomplete statements below is followed
by four suggested answers or completions. Select the one that is best in each case and fill in the circle
containing the corresponding letter on the answer sheet.
1.
A 34-year-old woman presents at 39 weeks gestation for an elective cesarean delivery. She is 5
feet, 3 inches tall, weighs 360 lbs, and has had two previous cesarean deliveries. She has no other
medical problems. Which of the following is the MOST appropriate anesthetic technique for her
cesarean delivery?
(A)
(B)
(C)
(D)
2.
Which statement about patients with type I congenital long QT syndrome is MOST likely true?
(A)
(B)
(C)
(D)
3.
Increased sympathetic nervous system stimulation is the most common cause of
symptomatic episodes.
Approximately 90% of patients have diagnostic changes on a screening
electrocardiogram (ECG).
Beta-blockade is contraindicated.
Ventricular fibrillation is the dysrhythmia most commonly associated with sudden
cardiac death in patients with this syndrome.
When used for induction of anesthesia, which of the following drugs is MOST likely to increase
the risk of an adverse cardiac event in a patient with congenital long QT?
(A)
(B)
(C)
(D)
4.
Single injection spinal anesthesia
General anesthesia
Combined spinal-epidural (CSE) anesthesia
Continuous epidural anesthesia
Thiopental
Propofol
Midazolam
Ketamine
A child with a history of asthma requiring mechanical ventilation develops stridor following
extubation. A mixture of helium and oxygen is administered by face mask in an attempt to avoid
reintubation. Which statement about this intervention is MOST likely true?
(A)
(B)
(C)
(D)
Maximum benefit is achieved with a mixture of 50% oxygen and 50% helium.
The benefits are not evident during the initial hour of treatment.
Work of breathing will be decreased.
Efficacy of nebulized beta agonists will be decreased.
1
5.
Soon after induction of general anesthesia, a 10-month-old male has a heart rate of 220 beats/min
with the following electrocardiographic tracing.
His blood pressure is 58/42 mm Hg and the SpO2 is 100%. The patient is intubated and has
intravenous access. Which of the following is the MOST appropriate initial treatment?
(A)
(B)
(C)
(D)
6.
Which of the following is a component of the Apgar score for the assessment of the newborn?
(A)
(B)
(C)
(D)
7.
Administration of succinylcholine is safe.
The disease affects skeletal muscle only.
Regional anesthesia will not affect the diseased muscle.
The dose of nondepolarizing muscle relaxants should be increased.
Which statement about cerebral vasospasm after subarachnoid hemorrhage is MOST likely true?
(A)
(B)
(C)
(D)
9.
Serum glucose
Muscle tone
Blood pressure
Temperature
A 45-year-old man with myotonic dystrophy is scheduled for a surgical procedure. Which
statement about his care is MOST likely true?
(A)
(B)
(C)
(D)
8.
Defibrillation
Lidocaine
Amiodarone
Valsalva maneuver
The risk of developing cerebral vasospasm is dependent on the amount of blood in the
subarachnoid space.
Nifedipine is the drug of choice for the treatment of vasospasm.
If cerebral vasospasm occurs, diuresis should be initiated.
Vasospam occurs most frequently in the first three days after the subarachnoid
hemorrhage.
Which statement about ketamine is MOST likely true?
(A)
(B)
(C)
(D)
It has no analgesic efficacy in subhypnotic doses.
Termination of action occurs as a result of renal excretion.
The R(-) isomer is more potent than the S(+) isomer.
It is metabolized in the liver.
2
10.
Which of the following presents the highest risk for an adult to develop propofol infusion
syndrome?
(A)
(B)
(C)
(D)
11.
A patient underwent a combined femoral and sciatic nerve block for an open reduction and
fixation of a right tibial fracture. In the postanesthesia care unit, the patient complains of
superficial pain above the medial malleolus. Blockade of which of the following nerves is MOST
appropriate?
(A)
(B)
(C)
(D)
12.
Caffeine citrate
Prostaglandin E1
Continuous positive airway pressure
Aminophylline
Which statement about the effects of herbal medications during the perioperative period is MSOT
likely true?
(A)
(B)
(C)
(D)
15.
It is a measure of tubular function.
It cannot be estimated without direct urine testing.
It is normal if serum creatinine is in the normal range.
It is affected by advancing age.
Which of the following is MOST likely to increase the likelihood of postoperative apnea in an
infant born at 34 weeks gestational age?
(A)
(B)
(C)
(D)
14.
Sural
Superficial peroneal
Posterior tibial
Saphenous
Which statement about creatinine clearance in adults is MOST likely true?
(A)
(B)
(C)
(D)
13.
Infusion rate greater than 5 mg ∙ kg-1 ∙ h-1
Orthopedic traumatic injury
Infusion for sedation in the intensive care unit lasting less than six hours
High carbohydrate diet prior to admission
St. John’s wort exerts no significant effects in the perioperative period.
Garlic can inhibit platelet function.
Valerian inhibits barbiturate action.
Ginkgo biloba stimulates platelet function.
Which statement about the toxicity of sodium nitroprusside is MOST likely true?
(A)
(B)
(C)
(D)
Adults are more likely than children to develop toxicity.
Thiocyanate toxicity is independent of renal function.
Metabolic alkalosis is commonly associated with toxicity.
Tachyphylaxis is a sign of toxicity.
3
16.
Which statement about the pulmonary toxicity of amiodarone is MOST likely true?
(A)
(B)
(C)
(D)
17.
Which statement about the “descending bellows” ventilators on an anesthesia machine is MOST
likely true?
(A)
(B)
(C)
(D)
18.
The bellows descends during the inspiratory phase.
The bellows will continue its upward and downward movement in the event of a circuit
disconnect.
The low airway pressure alarm is reliably activated by an anesthesia circuit disconnect.
They are safer than “ascending bellows” ventilators.
Which statement about carbon monoxide (CO) poisoning is MOST likely true?
(A)
(B)
(C)
(D)
19.
Toxicity correlates best with serum concentrations of the drug.
The most common presentation is a solitary pulmonary mass.
Discontinuation of the drug generally results in prompt resolution of symptoms.
Toxicity typically occurs after months of therapy.
The oxyhemoglobin dissociation curve is shifted to the right.
The partial pressure of oxygen in arterial blood (PaO2) will be decreased.
Hyperbaric oxygen therapy may be indicated.
Methylene blue should be administered.
In patients who have undergone orthotopic heart transplantation, which of the following is MOST
likely true?
(A)
(B)
(C)
(D)
Post-transplant coronary artery disease is the primary cause of death in the first year after
transplantation.
Glycopyrrolate is the drug of choice for treating bradycardia.
If central venous access is required for drug infusion, the right internal jugular vein is the
vessel of choice.
Ventricular output is preload dependent.
4
20.
An anesthesiologist performs a study to evaluate the use of regional anesthesia in patients
undergoing elbow surgery. Her hypothesis is that patients in whom regional anesthesia is used as
an adjunct to general anesthesia are more likely to be pain free on the day after surgery than those
in whom general anesthesia alone is used. Patients are asked to answer a simple question “Are
you pain free?” with either a “Yes—Pain Free” or a “No—Not Pain Free” response. She enrolls
200 patients in her study, 100 in each group. The following results are obtained:
Pain Free
Not Pain Free
General anesthesia alone
21
79
Combined regional/general anesthesia
24
76
The use of which of the following statistical tests is MOST appropriate to analyze these data?
(A)
(B)
(C)
(D)
21.
Which of the following is MOST likely to be increased relative to body weight in infants
compared to adults?
(A)
(B)
(C)
(D)
22.
Furosemide
Caffeine
Ampicillin
Sildenafil
Which statement about a pacemaker in the DOO mode is MOST likely true?
(A)
(B)
(C)
(D)
24.
Functional residual capacity
Tidal volume
Dead space
Oxygen consumption
A 2-month-old male with bronchopulmonary dysplasia is scheduled for repair of an incarcerated
inguinal hernia. Administration of which of the following would MOST likely result in an
improvement in respiratory mechanics?
(A)
(B)
(C)
(D)
23.
Student’s t-test
Analysis of variance (ANOVA)
McNemar’s test
Chi-square test
It senses both atrium and ventricle.
It is in the synchronous pacing mode.
It is not associated with a risk of ventricular fibrillation.
It paces both atrium and ventricle.
A 7-year-old male presents with the acute onset of high fever, drooling, and dysphagia. Which of
the following is the MOST likely diagnosis?
(A)
(B)
(C)
(D)
Tracheal foreign body
Croup
Peritonsillar abscess
Epiglottitis
5
25.
A patient scheduled for an awake fiberoptic intubation has received an aerosolized local
anesthetic solution containing benzocaine. Although ventilation is adequate and the patient is
awake and alert, she now has an oxygen saturation of 84% on 4L/min of oxygen by nasal
cannula. The MOST appropriate management is the administration of
(A)
(B)
(C)
(D)
26.
Which statement about propofol infusion syndrome is MOST likely true?
(A)
(B)
(C)
(D)
27.
the amount of ultrasound that is reflected.
coupling between the transducer and the patient.
the acoustic impedance at the air-tissue interface.
the image resolution.
Which statement about alpha2-agonists is MOST likely true?
(A)
(B)
(C)
(D)
31.
The frequency of a wave is determined by the medium through which it travels.
The propagation velocity of a wave is determined by the sound source.
The depth of penetration of a sound wave increases as frequency increases.
Image resolution improves as the signal frequency of the transducer increases.
The MOST likely reason that water-based gel is applied to the ultrasound transducer is to increase
(A)
(B)
(C)
(D)
30.
Diabetes insipidus
Hypertonia
Hyperthyroidism
Obesity
Which of the following BEST describes the properties of ultrasound?
(A)
(B)
(C)
(D)
29.
It occurs in pediatric patients.
A pathognomonic symptom is treatment-resistant asystole.
On exposure to ultraviolet light, urine demonstrates a red-brown fluorescence.
Metabolic alkalosis is a common finding.
Which of the following is the MOST likely condition associated with Prader-Willi syndrome?
(A)
(B)
(C)
(D)
28.
sodium thiosulfate.
sodium nitrite.
isosulfan blue.
methylene blue.
They increase the minimum alveolar concentration (MAC) of volatile anesthetics.
Clonidine is a more selective alpha2-agonist than dexmedetomidine.
They increase heart rate.
Administration is associated with a decrease in postoperative analgesic requirements.
Which statement about dexmedetomidine is MOST likely true?
(A)
(B)
(C)
(D)
Flumazenil reverses the sedative effects.
Long-term administration is associated with addiction.
It may be used in the management of patients undergoing opioid withdrawal.
Administration is associated with muscle rigidity.
6
32.
Which of the following is MOST likely to be associated with an increased risk of developing
postoperative delirium?
(A)
(B)
(C)
(D)
33.
An ankle block is performed as the primary anesthetic for a toe amputation. However, the block is
incomplete, with skin sensation remaining at the interdigital cleft between the great and second
toes. Which of the following nerves is MOST likely to be responsible for the persistence in
sensation?
(A)
(B)
(C)
(D)
34.
(C)
(D)
Postoperative atelectasis is reduced in patients receiving 1.0 FIO2..
Atelectasis develops in patients receiving intravenous general anesthesia.
Compared to the supine position, atelectasis is increased by prone positioning.
The amount of atelectasis is in direct proportion to the duration of the anesthetic.
Which statement about patients with obstructive sleep apnea (OSA) is MOST likely true?
(A)
(B)
(C)
(D)
47.
Lithium should be continued during the perianesthetic period.
Meperidine is the preferred agent for treatment of postanesthetic shivering in a patient
taking a selective serotonin reuptake inhibitor (SSRI).
Fluoxetine (an SSRI) should be discontinued preoperatively.
Patients taking SSRIs are hypercoagulable.
Which statement about the pulmonary atelectasis in the perioperative period is MOST likely true?
(A)
(B)
(C)
(D)
46.
Sural nerve
Superficial peroneal nerve
Tibial nerve
Deep peroneal nerve
Which statement about the perianesthetic management of a patient receiving medication for a
mood disorder is MOST likely true?
(A)
(B)
35.
Intraoperative hypoxemia
Intraoperative hypotension
History of alcohol abuse
Postoperative polycythemia
The risk of OSA is independent of body mass index.
Modafinil is used to treat night-time apneic episodes.
Use of continuous positive airway pressure increases life expectancy in OSA patients.
Effective treatment of OSA significantly reduces systemic blood pressure in hypertensive
patients.
Which statement about the mechanisms by which carbamazepine works in the treatment of
neuropathic pain is MOST likely true?
(A)
(B)
(C)
(D)
It increases the release of glutamate.
It blocks NA+ channels.
It increases conductance of Ca++.
It inhibits release of gamma-aminobutyric acid (GABA).
7
48.
49.
Which of the following combination of metabolic abnormalities is MOST likely to be present in a
5-week-old boy with pyloric stenosis?
Na+
K+
Cl-
pH
(A)
High
Low
Low
High
(B)
Low
High
High
Low
(C)
Low
Low
Low
High
(D)
Low
Low
High
Low
A patient is placed on cardiopulmonary bypass via cannulation of the femoral artery and femoral
vein for the elective initiation of deep hypothermic circulatory arrest. On rewarming, the patient
is successfully defibrillated, normal sinus rhythm is reestablished, and the cardiopulmonary
bypass flow is 4 L/min. During this time, the following arterial blood gas is obtained from a
catheter placed in the patient’s right radial artery: pH 7.21, PaCO2 35 mm Hg, PaO2 34 mm Hg.
Which of the following would MOST likely improve the patient’s oxygenation?
(A)
(B)
(C)
(D)
50.
Which of the following conditions is MOST likely to be associated with left-to-right shunting
through a patent foramen ovale (PFO)?
(A)
(B)
(C)
(D)
51.
Primary pulmonary hypertension
Mitral stenosis with heart failure
Tricuspid stenosis
Strenuous exercise
Which of the following recurring patterns of behavior is MOST likely to be an indication of
opioid addiction in an anesthesia provider?
(A)
(B)
(C)
(D)
52.
Increasing the pump flow rate to 5 L/min
Resuming mechanical ventilation
Initiating a dobutamine infusion
Administering furosemide
Requesting to go home early
Avoiding call
Requesting frequent breaks
Personally administering opioids in postanesthesia care unit
An otherwise healthy 65-year-old male who underwent an uncomplicated laparoscopic
cholecystectomy complains of pain in the left eye and the sensation of a foreign body in the eye.
After determining that no foreign body is present and obtaining confirmation of the diagnosis by
ophthalmologic consultation, which of the following is the MOST appropriate treatment?
(A)
(B)
(C)
(D)
Topical application of lidocaine eye drops
Patching the eye
Topical application of steroid eye drops
Topical application of nonsteroidal antiinflammatory agent
8
53.
A 65-year-old, 80-kg woman has undergone a total knee replacement under general anesthesia
with fentanyl (250 mcg), isoflurane, and 70% nitrous oxide. At the end of the two-hour procedure
the patient is somnolent with a respiratory rate of 20 breaths/min and a spontaneous tidal volume
of 300 mL. She is transported to the postanesthesia care unit and the tracheal tube is connected to
a T-piece with an FIO2 of .4 at a flow rate of 3 L/min. Over the ensuing five minutes her SPO2
decreases from 98% to 84%. Which of the following is the MOST likely etiology of this decrease
in SPO2?
(A)
(B)
(C)
(D)
54.
A 25-year-old African-American man is scheduled to undergo total knee replacement under
general anesthesia. Which statement about sickle cell syndromes is MOST likely true?
(A)
(B)
(C)
(D)
55.
It is almost entirely caused by anatomic dead space.
It is decreased when pulmonary blood flow is reduced.
It is increased when cardiac output is greater.
It may vary during laparoscopy.
Which statement about latex sensitivity is MOST likely true?
(A)
(B)
(C)
(D)
57.
Deoxygenated sickle cell hemoglobin (HbS) is insoluble.
Sickling of red blood cells occurs at approximately the same oxygen saturation (SO2) in
sickle cell trait as in sickle cell disease.
Pneumatic tourniquets may be used safely in patients with sickle cell disease.
Approximately 25% of the African-American population is at risk of sickle cell
syndromes.
Assuming accurate measurement, calibration, and a relatively flat expiratory plateau in the
capnograph, which statement about the difference between arterial and end-tidal CO2, thePaCO2PETCO2, gradient, is MOST likely true?
(A)
(B)
(C)
(D)
56.
Increased dead space ventilation
Diffusion hypoxia
Increased functional residual capacity
Entrainment of room air during inspiration
Reactions to latex are the most common cause of intraoperative anaphylaxis.
An increase in serum tryptase levels is a specific indication of latex-induced anaphylaxis.
Cornstarch, used as a donning agent in latex gloves, increases the risk of latex reactions.
Pretreatment with a combination of antihistamines and steroids will prevent an allergic
reaction in a latex-sensitive patient.
Which statement about innervation of the larynx is MOST likely true?
(A)
(B)
(C)
(D)
Injury to the recurrent laryngeal nerve occurs more commonly on the right side.
The recurrent laryngeal nerve innervates the cricothyroideus muscle.
Transtracheal blockade blocks sensation of the laryngeal mucosa below the vocal cords.
Bilateral complete recurrent laryngeal nerve damage will result in a severely
compromised airway that may necessitate emergency tracheostomy.
9
58.
Which of the following is MOST likely to be present in a neonate with a patent ductus arteriosus
(PDA)?
(A)
(B)
(C)
(D)
59.
Which of the following is the MOST appropriate description for needle placement during the
performance of a pediatric caudal block?
(A)
(B)
(C)
(D)
60.
Bradycardia
Decreased sensitivity to nondepolarizing neuromuscular blocking drugs
Muscle weakness
Prolongation of the QT interval
Which of the following positions is MOST likely associated with the largest functional residual
capacity (FRC) in an awake patient?
(A)
(B)
(C)
(D)
63.
It is relatively contraindicated in patients with asthma.
It irreversibly inhibits cyclooxygenase.
It causes spasm of the sphincter of Oddi.
It causes thrombocytopenia.
Which of the following is MOST likely to be present in a patient with severe hypophosphatemia?
(A)
(B)
(C)
(D)
62.
Medial to the ligamentum flavum
Lateral to the sacral cornua
At the apex of the sacral hiatus
At the second sacral vertebra
Which statement about the administration of ketorolac for the treatment of postoperative pain is
MOST likely true?
(A)
(B)
(C)
(D)
61.
Isolated diastolic heart murmur
Apnea
Weak peripheral pulses
Boot-shaped heart on chest radiograph
Sitting
Supine
Lateral
Prone
Which statement about the Mallampati score in a pregnant patient is MOST likely true?
(A)
(B)
(C)
(D)
It does not correlate with weight gained during pregnancy.
It does not correlate with difficulty at intubation.
It is not affected by pushing during the second stage of labor.
It increases with duration of pregnancy.
10
64.
With regard to the American Society of Anesthesiologists Closed Claims database, which
statement about adverse respiratory events and difficult intubation in anesthesia is MOST likely
true?
(A)
(B)
(C)
(D)
65.
You have just induced general anesthesia with thiopental and succinylcholine for an emergency
cesarean delivery secondary to a prolapsed umbilical cord. After several unsuccessful attempts to
visualize the larynx with direct laryngoscopy, you readily institute mask ventilation with cricoid
pressure and the SPO2 is 99%. The fetal monitor indicates a heart rate of 50 beats/min. You decide
to proceed with surgery. Which of the following would be the MOST appropriate management
prior to delivery of the neonate?
(A)
(B)
(C)
(D)
66.
Insert a Combitube.
Continue mask ventilation while maintaining cricoid pressure.
Insert a laryngeal mask airway.
Perform a blind nasal intubation.
You are performing a preoperative evaluation of a surgical patient taking dual antiplatelet therapy
(aspirin and clopidogrel) for a drug-eluting coronary artery stent (DES) placed two months ago.
The patient is to undergo an elective cosmetic surgical procedure with a significant risk of
postoperative bleeding. Which statement about the care of this patient is MOST likely true?
(A)
(B)
(C)
(D)
67.
Adverse respiratory events account for the largest portion of malpractice claims in the
database.
The majority of difficult airway claims were for events occurring in the postanesthetic
phase.
Care was judged appropriate in 90% of adverse airway events.
Death or brain damage account for 5% of difficult airway claims.
Discontinue aspirin only.
Discontinue clopidogrel only.
Postpone elective surgery until at least 12 months after DES implantation.
Discontinue both aspirin and clopidogrel then initiate therapy with low molecular weight
heparin.
Which statement about the myocardial toxicity of bupivacaine is MOST likely true?
(A)
(B)
(C)
(D)
Increased plasma protein concentrations are associated with increased toxicity.
Convulsions always occur prior to cardiac arrest.
Cardiac arrest occurs at a higher serum concentration with the R- enantiomer of
bupivacaine than with the S- enantiomer.
The atrioventricular node is more sensitive than the sinoatrial node.
11
68.
During placement of an axillary block, 30 mL of 0.5% bupivacaine are accidentally injected
intravenously. Which statement about the use of intravenous fat emulsion to treat bupivacaine
toxicity is MOST accurate?
(A)
(B)
(C)
(D)
69.
Anesthetizing which of the following is MOST likely to allow carotid endarterectomy to be
performed under regional anesthesia?
(A)
(B)
(C)
(D)
70.
It has been approved by the Food and Drug Administration (FDA) for treatment of local
anesthetic toxicity.
It is known to act by disrupting the carbon bond in bupivacaine rendering it nontoxic.
Animal models indicate it is effective at reversal of local anesthetic toxicity.
The optimal dose for treatment of local anesthetic toxicity has been established to be a
bolus dose of 15 mL/kg.
Deep cervical plexus
Facial nerve
Stellate ganglion
Cords of the brachial plexus
An arterial blood gas obtained on an awake, spontaneously breathing patient reveals the
following:
PaO2
PaCO2
pH
HCO3
180 mm Hg (on FIO2 -= 0.5 by face mask)
32 mm Hg
7.47
24 mEq/L
Which of the following conditions is MOST likely to be associated with the above arterial blood
gas?
(A)
(B)
(C)
(D)
71.
Which of the following is MOST likely a normal cardiovascular finding in a pregnant woman at
38 weeks gestation?
(A)
(B)
(C)
(D)
72.
Diarrhea
Renal tubular acidosis
Hypoperfusion
Anxiety
Grade IV diastolic murmur
Central venous pressure of 2 mm Hg
Tricuspid regurgitation on echocardiography
S-T segment elevation
Which of the following components is MOST responsible for enabling the user to interact with
the computer?
(A)
(B)
(C)
(D)
The motherboard
The central processing unit (CPU)
The operating system (OS)
The hard drive
12
73.
A 40-year-old man is undergoing a laparoscopic cholecystectomy. Intraoperatively he develops
atrial fibrillation with rapid ventricular response at a rate of 170 beats per minute. An
electrocardiograph obtained two months previously by his primary care physician appears as
follows:
Which medication is MOST appropriate for the intraoperative treatment of his atrial fibrillation?
(A)
(B)
(C)
(D)
74.
Which statement MOST accurately describes intrapulmonary shunt (also known as venous
admixture)?
(A)
(B)
(C)
(D)
75.
Verapamil
Digoxin
Procainamide
Adenosine
Alveolus is perfused but not ventilated.
Alveolus is ventilated and perfused but perfusion is greater than ventilation.
Alveolus is ventilated and perfused but ventilation is greater than perfusion.
Alveolus is ventilated but not perfused.
As chief of your hospital’s anesthesiology department, the medical director of your endoscopy
suite requests your assistance in developing a policy for sedation of patients by personnel other
than anesthesiologists. Based on guidelines from the American Society of Anesthesiologists
(ASA), which of the following should MOST likely be included in this policy?
(A)
(B)
(C)
(D)
Capnography should be utilized in all patients receiving moderate sedation.
A nurse responsible for monitoring a patient receiving deep sedation may intermittently
assist the physician with endoscopy equipment.
When propofol is being administered to achieve moderate sedation, a practitioner trained
in advanced cardiac life support should be present in the procedure room.
A patient who received flumazenil for benzodiazepine-induced respiratory depression
may be discharged 30 minutes later if he or she meets all discharge criteria.
13
76.
Which statement about upper extremity intravenous regional anesthesia (Bier block) is MOST
likely true?
(A)
(B)
(C)
(D)
77.
Which statement about a 20-year-old man admitted to the intensive care unit with tetanus is
MOST likely true?
(A)
(B)
(C)
(D)
78.
The technique is best performed using bupivacaine as the local anesthetic.
The technique is suitable for procedures on the shoulder.
The technique is suitable for the treatment of complex regional pain syndrome.
The technique cannot be performed without a “double tourniquet” system.
Use of muscle relaxants is contraindicated.
Recovery usually takes less than 48 hours.
The disease is preventable.
The cause is Clostridium botulinum toxin.
In this electrocardiographic tracing,
the cardiac rhythm depicted to the left of the arrow is MOST likely
(A)
(B)
(C)
(D)
79.
atrial fibrillation.
normal sinus rhythm with equipment-related artifact.
sinus tachycardia.
supraventricular tachycardia.
Which statement about a transdermal fentanyl (Duragesic) patch is MOST likely true?
(A)
(B)
(C)
(D)
The site of application should be cleansed with alcohol prior to application of the patch.
Dosing may be reduced by cutting the patch.
Drug uptake is decreased while in a hot tub.
Upon removal of the patch, the serum fentanyl conocentration is reduced by 50% in 17
hours.
14
80.
A patient who has been using the transdermal fentanyl (Duragesic) 100 mcg/h patch for chronic
low back pain for one year presents for an elective outpatient laparoscopic cholecystectomy. The
patch was last changed the day before the surgery. Which of the following is the MOST
appropriate management of this patient’s perioperative analgesic requirement?
(A)
(B)
(C)
(D)
81.
A Caucasian patient is given codeine for postoperative pain after a minor surgical procedure. He
has significant complaints of pain despite increasing doses of codeine but reports adequate
analgesia when switched to morphine. Which of the following is the MOST likely reason for his
inadequate analgesic response to codeine?
(A)
(B)
(C)
(D)
82.
Simultaneous administration of tricyclic antidepressants that increases the metabolism of
codeine
Genetic variation resulting in rapid metabolism of codeine
Simultaneous administration of metoclopramide that increases the metabolism of codeine
Genetic variation resulting in poor metabolism of codeine
Which statement about acetaminophen is MOST likely true?
(A)
(B)
(C)
(D)
83.
Begin a continuous infusion of fentanyl in the preoperative period immediately after
removing the patch.
Place a second patch at the end of the procedure.
Remove the patch at the end of the surgical procedure and discharge home on oral
codeine.
Leave the patch on and use additional opioids intraoperatively as needed.
It is well tolerated in patients with liver damage.
It has primarily central mechanisms of action.
It is an effective antiinflammatory.
It is more efficacious than aspirin as an analgesic.
A patient’s arterial blood gas sample is sent to the laboratory and stored at room temperature prior
to analysis. Which of the following is MOST likely to result in the measured partial pressure of
carbon dioxide in the sample being greater than the actual partial pressure of carbon dioxide in
the arterial blood?
(A)
(B)
(C)
(D)
Dilution of the sample with saline
Air bubble in syringe
Decrease in body temperature to 30°C
Delay in time for sample to be analyzed
15
INSTRUCTIONS FOR ITEMS 84 AND 85: This series of items refers to the diagnosis, treatment,
or management of a single patient.
84.
A 20-day-old, full-term female is scheduled for an inguinal hernia repair. Anesthesia is induced
with sevoflurane followed by intravenous catheter and tracheal tube placement. Neuromuscular
blocking agents were not administered. Caudal block was performed using an amide local
anesthetic; cardiac arrest occurs one minute later. Which of the following MOST likely
contributed to the development of local anesthetic toxicity in this patient?
(A)
(B)
(C)
(D)
85.
Decreased albumin levels
Decreased free fraction of the local anesthetic
Increased alpha-1-glycoprotein levels
Decreased plasma cholinesterase activity
The patient is now pulseless with the following electrocardiographic rhythm:
Administration of which of the following is the MOST appropriate specific treatment for this
rhythm?
(A)
(B)
(C)
(D)
Lidocaine
Calcium
Amiodarone
Magnesium
16
INSTRUCTIONS FOR ITEMS 86 AND 87: This series of items refers to the diagnosis, treatment,
or management of a single patient.
86.
A 45-year-old man is scheduled to undergo a laparoscopic cholecystectomy. During preoperative
evaluation a systolic murmur is noted on auscultation. Echocardiography reveals a 50 mm Hg
gradient across his aortic valve, with preserved left ventricular function; coronary angiography
shows no significant atherosclerotic lesions. Which of the following BEST describes his New
York Heart Association objective assessment?
(A)
(B)
(C)
(D)
87.
Objective assessment A
Objective assessment B
Objective assessment C
Objective assessment D
In response to questions about his functional status the patient indicates that he has no limitations
to normal physical activity and exercises by walking briskly for 30 minutes on a treadmill daily.
Which of the following MOST accurately describes his New York Heart Association (NYHA)
functional capacity?
(A)
(B)
(C)
(D)
NYHA Functional Capacity Class I
NYHA Functional Capacity Class II
NYHA Functional Capacity Class III
NYHA Functional Capacity Class IV
INSTRUCTIONS FOR ITEMS 88 AND 89: This series of items refers to the diagnosis, treatment,
or management of a single patient.
88.
A 74-year-old female presents to the preoperative testing center for an elective right hip
replacement. Her electrocardiogram is significant for normal sinus rhythm and left bundle branch
block (LBBB). Which statement about LBBB is MOST likely true?
(A)
(B)
(C)
(D)
89.
The lateral wall of the left ventricle contracts earlier than other ventricular segments.
Conduction through the interventricular septum remains unchanged.
Paradoxical motion of the interventricular septum may occur.
Left ventricular isovolumic contraction time is shortened.
After further interrogation, the patient describes New York Heart Association class III symptoms
despite optimal medical therapy. Previously obtained echocardiography results determined her
left ventricular ejection fraction to be 30%. Cardiology consultation recommends cardiac
resynchronization therapy (CRT). Which statement about CRT is MOST likely true?
(A)
(B)
(C)
(D)
CRT requires pacing leads to be placed into the right and left chambers of the heart.
CRT increases myocardial work.
CRT results in an increase in left ventricular cavity size.
CRT commonly results in an improvement in New York Heart Association class
symptoms.
17
INSTRUCTIONS FOR ITEMS 90 AND 91: This series of items refers to the diagnosis, treatment,
or management of a single patient.
90.
A patient who recently sustained a wrist fracture (eg, Colles fracture) now complains of tingling
and numbness in the palmar aspect of his index and long fingers. Which of the following nerves
is MOST likely injured?
(A)
(B)
(C)
(D)
91.
Radial nerve
Ulnar nerve
Musculocutaneous nerve
Median nerve
The patient subsequently develops severe pain in his hand that is only relieved with long-acting
opioids, which he is taking as prescribed. Over time, he requires more and more opioid to control
his pain. The patient is MOST likely manifesting
(A)
(B)
(C)
(D)
opioid tolerance.
opioid physical dependence.
opioid pseudoaddiction
opioid addition.
INSTRUCTIONS FOR ITEMS 92 AND 93: This series of items refers to the diagnosis, treatment,
or management of a single patient.
92.
A 72-year-old man is undergoing an elective open repair of an abdominal aortic aneurysm.
Without intervention by the anesthesiologist, which of the following is MOST likely to be
decreased as a consequence of application of an infrarenal aortic cross-clamp?
(A)
(B)
(C)
(D)
93.
Renal blood flow
Venous tone
Systolic blood pressure
Serum catecholamine levels
In preparation for removal of the infrarenal aortic cross-clamp, administration of which of the
following is MOST appropriate?
(A)
(B)
(C)
(D)
Crystalloid
Mannitol
Nitroprusside
Sodium bicarbonate
18
INSTRUCTIONS FOR ITEMS 94 AND 95: This series of items refers to the diagnosis, treatment,
or management of a single patient.
94.
A 56-year-old man is scheduled for next day prostate surgery for carcinoma. Two weeks ago he
had a bare-metal left main coronary artery stent placed. He is currently taking aspirin and
clopidogrel. Which statement about this patient is MOST likely true?
(A)
(B)
(C)
(D)
95.
Surgery should be postponed until six weeks after stent placement.
The risk of an adverse cardiac event is low after surgery performed two to three weeks
after stent placement.
The American College of Cardiology and American Heart Association (ACC/AHA)
recommend discontinuing aspirin therapy six months after stent placement.
Regional anesthesia prevents thrombus formation in the newly stented coronary artery.
Six weeks later the patient is again scheduled for prostate surgery. He has been advised to
continue the aspirin and clopidogrel by his cardiologist. The urologist asks for advice on how to
manage his antiplatelet medication. The patient also wants a regional anesthetic for postoperative
pain control. Which statement about this situation is MOST likely true?
(A)
(B)
(C)
(D)
Continuing clopidogrel does not increase the risk of a subdural hematoma after neuraxial
anesthesia.
Continuing aspirin increases the risk of requiring transfusion of blood components by
about 1.5 times.
Continuing aspirin will increase the risk of reoperation.
Aspirin has been shown to double the risk of a subdural hematoma after neuraxial
anesthesia.
19
INSTRUCTIONS FOR ITEMS 96 THROUGH 98: This series of items refers to the diagnosis,
treatment, or management of a single patient.
96.
A 28-year-old woman at 30 weeks gestation is brought to the emergency room after being
involved in a head-on motor vehicle collision. She is fully immobilized on a spinal board. Which
statement about the initial assessment and management of this patient is MOST likely true?
(A)
(B)
(C)
(D)
97.
On initial evaluation, the patient is found to be hemodynamically stable. She is breathing without
difficulty and has an O2 saturation of 98% while receiving 40% O2 via facemask. Which
statement about her secondary trauma assessment is MOST likely true?
(A)
(B)
(C)
(D)
98.
Fetal heart tones should immediately be confirmed upon arrival of the patient in the
emergency room.
She is at lower risk for splenic injury than a nonpregnant patient.
The spinal board should be tilted 30 degrees laterally.
She should be transferred to the labor and delivery unit for evaluation if she is
hemodynamically stable upon arrival in the emergency room.
Laboratory studies to assess for the presence of fetomaternal hemorrhage are not required
unless there is evidence of placental abruption.
Her pregnancy will make the focused abdominal ultrasound of trauma (FAST) unreliable.
An abdominal computed tomography (CT) scan is contraindicated due to her pregnancy.
She is at increased risk for premature labor.
After a complete trauma assessment has been performed, it is determined that the patient’s only
significant injury is a fracture of the right femur. She remains hemodynamically stable. Fetal
heart tracing is normal and no uterine contractions are detected. An open reduction and internal
fixation of the fracture is to be performed. Which statement about her perioperative management
is MOST likely true?
(A)
(B)
(C)
(D)
She should receiving preoperative diazepam.
Halogenated volatile anesthetics should be avoided.
During general anesthesia, mechanical ventilation should be adjusted to maintain a
PaCO2 of 40 mm Hg.
Deep venous thrombosis prophylaxis should be initiated.
20
INSTRUCTIONS FOR ITEMS 99 AND 100: This series of items refers to the diagnosis, treatment,
or management of a single patient.
99.
The following is a mid-esophageal four-chamber view of the heart obtained by transesophageal
echocardiography (TEE).
The area labeled as X is MOST representative of which cardiac chamber?
(A)
(B)
(C)
(D)
100.
Right atrium
Right ventricle
Left atrium
Left ventricle
From the mid-esophageal four-chamber view, the transesophageal echocardiography (TEE) probe
is advanced slightly further into the esophagus, and the following image is obtained of the rightsided cardiac chambers (RA = right atrium, RV = right ventricle).
The white arrow pointing to the lucency near the top is BEST descried as which of the following
structures?
(A)
(B)
(C)
(D)
Inferior vena cava
Superior vena cava
Coronary sinus
Right atrial appendage
21