INSTRUCTIONS
This booklet contains self-study questions of different types. Be sure you understand the directions
accompanying the questions before attempting to answer them.
All of your answers should be recorded on the separate answer sheet, which is enclosed.
The six-digit Identification Number printed in the box above the column labeled ACE ID# will be the
only means of identifying your scores. Fill in one number in each box and the corresponding circle under
each digit as shown in the SAMPLE below. Only one digit should be marked in each column. Be sure all
pencil marks are heavy and black. Marks should completely fill the circles. You need not enter your
Social Security Number.
Please note that this answer sheet has spaces for filling in more answers than are actually included in this
booklet. Ignore the part of the answer sheet after number 122.
It is requested that you answer the demographic questions (items 101-122) at the back of this booklet and
mark these answers on the answer sheet. Cumulative information gained will be used to describe the total
group of participants in the program and will help guide the development of future educational programs.
After you have submitted your answer sheet for scoring, an individualized Performance Report, which
provides a record of your answers, an evaluation of your performance, and the correct answers, will be
returned to you. It is suggested that you keep a record of your answers in this booklet as well as a record
of the Identification Number printed on your answer sheet in case you have any questions concerning the
scoring of your materials.
The completed answer sheet should be submitted for scoring in the pre-addressed postpaid envelope
provided. Scoring on this exercise will end on September 30, 2008.
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.
Which of the following is MOST likely to minimize pain with fewest side effects for patients
undergoing laparoscopic cholecystectomy?
(A)
(B)
(C)
(D)
2.
A 63-year-old female developed worsening metabolic acidemia on postoperative day one
following uneventful coronary artery bypass surgery. With FIO2 = 0.5, arterial blood gas analysis
reveals pH 7.24, PaCO2 30 mm Hg, PaO2 257 mm Hg, and base deficit 14. Serum electrolyte
determinations include Na+ 138 mEq/L, K+ 3.4 mEq/L, Cl- 112 mEq/L, HCO3- 8mEq/L. Based on
these results, the patient is MOST likely to have which of the following?
(A)
(B)
(C)
(D)
3.
NaCl administration
Acute renal failure
Mesenteric ischemia
Severe magnesium deficiency
Which of the following is MOST likely to be associated with the use of ketamine?
(A)
(B)
(C)
(D)
5.
A metabolic acidosis with an increased anion gap
A metabolic acidosis with a normal anion gap
A metabolic acidosis with a decreased anion gap
A mixed metabolic and respiratory acidosis
Which of the following is MOST likely to result in a metabolic acidosis with an increased anion
gap?
(A)
(B)
(C)
(D)
4.
Regular (scheduled) dosing of nonsteroidal antiinflammatory drugs
Regular (scheduled) dosing of intravenous opioids
Epidural local anesthetic
Epidural opioids
Maintenance of spontaneous respiration
Profound depression of airway reflexes
Decreased intracranial pressure
Absence of analgesia
Which of the following is MOST likely to increase the concentration of carbon monoxide (CO)
during the administration of a volatile anesthetic?
(A)
(B)
(C)
(D)
Recent use of the absorber
Use of lower anesthetic concentrations
Use of high fresh gas flows during administration of anesthesia
Excessive drying of the absorbent
1
6.
An otherwise healthy patient indicates that 10 years ago her brother required mechanical
ventilation due to a prolonged response to succinylcholine. At the time of her sibling’s problem
she was tested and found to have a dibucaine number of 18. Based on this information, which of
the following is MOST likely true?
(A)
(B)
(C)
(D)
7.
An infant has undergone an extensive surgical procedure and the surgeon intends to infiltrate the
incision with local anesthetic. Which of the following is associated with the HIGHEST allowable
dose of local anesthetic expressed as mg/kg?
(A)
(B)
(C)
(D)
8.
Administration of 1 mg/kg of succinylcholine will likely result in a normal duration of
apnea (5-10 minutes).
Administration of 1 mg/kg of succinylcholine will likely result in a slightly prolonged
duration of apnea (15-20 minutes).
Administration of 1 mg/kg of succinylcholine will likely result in a very prolonged
duration of apnea (> 60 minutes).
The patient’s dibucaine number should be rechecked prior to administration of
succinylcholine.
Bupivacaine
Levobupivacaine with 1:200,000 epinephrine
Ropivacaine
Lidocaine with 1:200,000 epinephrine
In the United States, the MOST common etiology of mortality related to transfusion of blood
products is
(A)
(B)
(C)
(D)
bacterial contamination.
hemolytic transfusion reaction.
hepatitis C infection
transfusion-related acute lung injury.
2
9.
During a major surgical resection, the surgeon says that the field is “oozy” and a
thromboelastogram (TEG) is performed. The graphical representation of the TEG is shown in
comparison to a normal TEG.
Which of the following is the MOST likely cause of the derangement of coagulation?
(A)
(B)
(C)
(D)
10.
In the preoperative evaluation clinic a 74-year-old man complains of dyspnea on exertion. On
auscultation of his precordium, he has a systolic ejection murmur that is heard best at the second
right intercostal space and radiates to the carotid arteries. This patient MOST likely has which of
the following valvular lesions?
(A)
(B)
(C)
(D)
11.
Mitral stenosis
Mitral regurgitation
Aortic stenosis
Aortic regurgitation
Which of the following represents the MOST important hemodynamic goal in a patient with a
severe valvular aortic stenosis?
(A)
(B)
(C)
(D)
12.
Thrombocytopenia
Heparin administration
Fibrinolysis
Hemophilia B
Heart rate over 100 beats/min
Decreased preload
Decreased contractility
Maintenance of afterload
Which statement about dopamine is MOST likely true?
(A)
(B)
(C)
(D)
At high doses it decreases systemic vascular resistance.
The drug has central nervous system effects.
An infusion at mcg · kg-1 · min-1 will decrease the chance of developing acute renal
failure after major vascular surgery.
It causes bradycardia.
3
13.
During the preoperative assessment, a patient indicates he takes garlic to prevent heart disease.
His prothrombin time, partial thromboplastin time, activated thromboplastin time, and platelet
count are normal. The surgeon proceeds with the suprapubic prostatectomy. The patient’s
coagulation studies remain unchanged; however the surgeon cannot achieve hemostasis. The
BEST treatment would be to administer
(A)
(B)
(C)
(D)
14.
An otherwise healthy 26-year-old man is scheduled to undergo the final stage of a two-stage
spinal surgery for scoliosis. He is a devout Jehovah’s Witness. During the first stage of his
surgery two months ago, he received aprotinin to minimize surgical blood loss. Which of the
following is the single MOST appropriate step to improve his surgical outcome without violating
his religious beliefs?
(A)
(B)
(C)
(D)
15.
aminocaproic acid.
1-deamino-8-D-arginine vasopressin (DDAVP) alone.
DDAVP and platelet transfusion.
aprotinin.
Autologous blood donation
Administration of erythropoietin four weeks prior to surgery
Administration of aprotinin
Prophylactic administration of recombinant activated factor VII
Shortly after uneventful tracheal intubation of a healthy 21-year-old athlete the following
waveform is noted on the capnogram.
The MOST likely cause of this waveform is
(A)
(B)
(C)
(D)
16.
bronchial intubation.
incompetent expiratory valve.
incompetent inspiratory valve
leak in the sampling line
Which of the following values for arterial oxygen tension (PaO2) is MOST likely outside the
normal range for the indicated age for a patient breathing air at sea level?
(A)
(B)
(C)
(D)
25-year-old male; PaO2 = 95 mm Hg
42-year-old female; PaO2 = 85 mm Hg
57-year-old male; PaO2 = 75 mm Hg
77-year-old female; PaO2 = 60 mm Hg
4
17.
Which of the following parameters is MOST likely to be part of the orders for pressure support
ventilation (PSV)?
(A)
(B)
(C)
(D)
18.
In a severely asthmatic parturient, which of the following drugs would be the MOST appropriate
treatment for postpartum uterine atony?
(A)
(B)
(C)
(D)
19.
The closing volume increases with age.
The response to beta-adrenergic agonists increases with age.
There is progressive atrophy of the left ventricle with age.
There is a steady increase in the chest wall compliance with age.
You are asked to assist with a neonatal resuscitation. The amniotic fluid was noted to be
meconium stained at delivery. The infant is crying, vigorous, and has a heart rate over 100 beats
per minute. Which statement about the role of tracheal intubation in this situation is MOST likely
true?
(A)
(B)
(C)
(D)
21.
Ergometrine
Oxytocin
Methylergonovine
15-Methyl prostaglandin F2-alpha (Hemabate)
Which statement about age-related physiologic changes in geriatric patients (age ≥ 65) is MOST
likely true?
(A)
(B)
(C)
(D)
20.
Tidal volume
Rate
Inspiratory pressure
Inspiratory flow rate
Tracheal intubation should be initiated with suctioning of the tracheal tube as it is
withdrawn.
Tracheal intubation is only necessary if oropharyngeal suctioning was not performed by
the obstetrician prior to delivery of the shoulders (intrapartum suctioning).
Tracheal intubation should not be performed.
Tracheal intubation with saline lavage should be performed.
You are caring for a postpartum patient with a retained placenta. The obstetrician is having
difficulty with manual removal of the placenta and requests uterine relaxation. Assuming this
patient is hemodynamically stable, administration of which of the following agents is the MOST
appropriate initial therapy to facilitate uterine relaxation?
(A)
(B)
(C)
(D)
Fentanyl
Halothane
Nitroglycerine
Ketamine
5
22.
In which of the following situations is work of breathing MOST efficient with slow, deep
breaths?
(A)
(B)
(C)
(D)
23.
Arterial and venous blood gases are drawn from a healthy patient breathing room air. In the
process, a bubble fills one third of the volume of each syringe. Which statement MOST
accurately reflects the change in the blood gases that will occur as the result of the bubble?
(A)
(B)
(C)
(D)
24.
The PO2 of the arterial sample will be decreased.
The PO2 of the venous sample will be decreased.
The PCO2 of the arterial sample will be increased.
The PCO2 of the venous sample will be decreased.
Which of the following is MOST likely to be associated with a P50 (the partial pressure of oxygen
at which hemoglobin is 50% saturated) of 22 mm Hg?
(A)
(B)
(C)
(D)
25.
Pulmonary fibrosis
Aspiration pneumonia
Pulmonary edema
Chronic obstructive lung disease
Fetal hemoglobin
Normal hemoglobin in the presence of nitrous oxide
Carboxyhemoglobin
Normal hemoglobin in a healthy parturient
Which of the following pulmonary artery occlusion pressure waveform findings would MOST
likely be present during left ventricular ischemia?
(A)
(B)
(C)
(D)
Increase in the width of the a wave
Increase in the height of the a wave
Decrease in the width of the v wave
Decrease in the height of the v wave
6
26.
A recently published article that compares four commercially available tests contains the
following figure. Which receiver operating characteristic (ROC) curve (A, B, C, or D) represents
the test BEST able to discriminate patients with the disease from those without the disease?
27.
Which statement about the differences between the respiratory system in healthy infants and
adults is MOST likely true?
(A)
(B)
(C)
(D)
28.
An 85-year-old nursing home resident with a history of diabetes mellitus requires emergent
laparotomy for presumed bowel perforation. Which of the following laboratory analyses would
be MOST consistent with a concomitant diagnosis of hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)?
(A)
(B)
(C)
(D)
29.
Infant dead space as a fraction of body weight is substantially larger than that of adults.
Infant work of breathing is greater than that of adults.
Closing capacity is a similar fraction of total lung capacity in infants and adults.
Functional residual capacity as a fraction of body weight is smaller in infants than in
adults.
Arterial pH 7.15
Serum osmolality 280 mOsm/kg
Serum bicarbonate concentration 20 mEq/L
Plasma glucose concentration 340 mg/dL
Which statement about the use of epidural 2-chloroprocaine for cesarean delivery is MOST likely
true?
(A)
(B)
(C)
(D)
It enhances the efficacy of epidural morphine.
It is contraindicated when late fetal heart rate decelerations are present.
The risk of systemic toxicity is increased in a woman homozygous for atypical plasma
cholinesterase.
The ethylenediaminetetraacetic acid (EDTA) present in some formulations of 2chloroprocaine causes neurotoxicity.
7
30.
Which statement about potential anesthetic concerns in a patient with ankylosing spondylitis is
MOST likely true?
(A)
(B)
(C)
(D)
31.
Which of the following opioids is “naturally” long acting such that it does not need to be
provided in a sustained-release formulation?
(A)
(B)
(C)
(D)
32.
Regional anesthesia is contraindicated.
Fresh frozen plasma should be administered before surgery.
Vitamin K should be administered before surgery.
Low molecular weight heparin should be initiated in the postoperative period.
Which statement about the oculocardiac reflex (OCR) is MOST likely true?
(A)
(B)
(C)
(D)
34.
Morphine
Hydromorphone
Fentanyl
Methadone
A patient previously diagnosed with antiphospholipid syndrome presents for cesarean delivery for
breech presentation. An activated partial thromboplastin time (aPTT) obtained earlier in the day
was prolonged at 50 seconds. All other laboratory values, including prothrombin time, fibrinogen,
and platelet count, were normal and she has not received recent anticoagulation therapy. Which
statement about her perioperative management is MOST likely true?
(A)
(B)
(C)
(D)
33.
There is an increased risk of neurologic injury with minimal neck extension.
The tempromandibular joints are rarely affected.
Aortic stenosis is the most common cardiac lesion.
Pulmonary function studies are most likely to reveal an obstructive flow pattern.
Pressure on the eye may cause a decrease in blood pressure.
Retrobulbar block reliably prevents this reflex.
The most common manifestation is aystole.
Glycopyrrolate is ineffective in blunting the effects of the reflex.
A 56-year-old man has suffered a massive subarachnoid hemorrhage and is intubated and
mechanically ventilated in the intensive care unit. He is comatose, and unresponsive to painful
stimuli. His Glasgow coma score is 5. He breathes above the rate set on the ventilator and has a
cough when suctioned. The medical staff involved in his care feel that his prognosis for
meaningful neurologic recovery is dismal. Based on a previously signed advanced directive, his
family feels that the patient would desire withdrawal of life-sustaining therapies under these
circumstances. He had previously expressed a strong desire to donate his organs for
transplantation and his driver’s license indicates that he would wish to be an organ donor. Which
statement about this patient’s situation is MOST likely true?
(A)
(B)
(C)
(D)
The patient meets the criteria for brain death.
The patient is too old to be a candidate for organ donation.
“Donation after cardiac death” can occur without a formal declaration of brain death.
Discussion with the family regarding organ donation should occur before the decision to
withdraw life-sustaining therapies has been made.
8
35.
Which statement about calcium antagonists is MOST likely true?
(A)
(B)
(C)
(D)
36.
An anesthesiologist develops a new technique (technique X) to perform an ankle block for distal
foot surgery. She believes that technique X will allow earlier patient dismissal from the
ambulatory surgical center. Her colleagues are skeptical. She wishes to compare the new
technique against the conventional approach to obtain definitive evidence of a decrease in time to
discharge. The MOST common study design for this purpose is
(A)
(B)
(C)
(D)
37.
It requires that the patient be in the prone position.
It maximizes the patient’s tidal volume.
It requires an intact respiratory drive.
It delivers breaths at a frequency between 3 and 15 Hertz (breaths/sec).
Which statement about methemoglobinemia is MOST likely true?
(A)
(B)
(C)
(D)
39.
case control study.
observational cohort study.
randomized control trial.
cross-sectional study.
A patient with the acute respiratory syndrome (ARDS) is receiving high-frequency oscillatory
ventilation (HFOV). Which statement about this method of ventilation is MOST likely true?
(A)
(B)
(C)
(D)
38.
Verapamil has minimal effects on the atrioventricular node.
Diltiazem is not available as an intravenous formulation.
Nifedipine is the calcium antagonist of choice for the treatment of atrial fibrillation with
rapid ventricular response.
Nicardipine may be used as an anthihyperintensive.
The treatment is with amyl nitrate.
Neonates are at higher risk for development of methemoglobinemia.
Methemoglobin levels of greater than 10% are commonly seen in smokers.
The saturation reported on a conventional arterial blood gas will be less than that reported
on a pulse oximeter.
A healthy 42-year-old patient has undergone wrist surgery as an outpatient. He received general
anesthesia using propofol for induction and sevoflurane via a laryngeal mask airway for
maintenance of anesthesia. He also received an axillary block with 0.5% ropivacaine for
postoperative analgesia. Based on the American Society of Anesthesiologists (ASA) guidelines
for postanesthetic care, which of the following is MOST likely to be required before he is
released home?
(A)
(B)
(C)
(D)
Ability to drink clear liquids without vomiting
Ability to urinate
Presence of a responsible adult to accompany him home
Resolution of the axillary block
9
40.
Which statement about postoperative ulnar neuropathy is MOST likely true?
(A)
(B)
(C)
(D)
41.
Which of the following is MOST likely to be increased as a result of administration of 100%
oxygen to a normal, healthy patient for six hours?
(A)
(B)
(C)
(D)
42.
more efficient removal of viral particle.
less resistance to breathing.
an increased risk of tracheal tube occlusion when used in a critical care setting.
greater humidification.
A patient has a pacemaker that detects an atrial stimulus and responds by stimulating the atrium
only when the atrial rate is less than the lower rate limit. The three-letter designation of this
pacemaker is MOST likely to be
(A)
(B)
(C)
(D)
45.
Age less than 12 months
Use of a cuffed tracheal tube
Absence of an air leak around the tracheal tube at 40 cm H2O airway pressure
Use of a lubricant on the tracheal tube
Compared to a hydrophobic heat and moisture exchanger (HME), a hygroscopic HME is MOST
likely to be associated with
(A)
(B)
(C)
(D)
44.
Pulmonary compliance
Vital capacity
Shunt fraction
PaCO2
Which of the following factors MOST likely increases the risk that a child will develop
postextubation croup following a surgical procedure?
(A)
(B)
(C)
(D)
43.
It is more common in women than men.
It is more common after regional anesthesia than general anesthesia.
Pronation of the forearm decreases the risk of developing this injury.
It is the most common postoperative peripheral nerve therapy.
AOO.
DOO.
VVI.
AAI.
Which statement about perioperative wound infections is MOST likely true?
(A)
(B)
(C)
(D)
Maintenance of normoglycemia may be associated with a lower risk of wound infection.
They account for 50% of nosocomial (hospital-acquired) infections.
Perioperative oxygen supplementation may increase the incidence.
Mild systemic hypothermia protects against wound infection.
10
46.
Which statement about a practice advisory developed by the American Society of
Anesthesiologists (ASA) is MOST likely true?
(A)
(B)
(C)
(D)
47.
In which of the following situations is mannitol MOST likely to provide beneficial renal effects?
(A)
(B)
(C)
(D)
48.
(D)
Drowning in sea water is commonly associated with hypervolemia.
Drowning in fresh water is commonly associated with profound hyponatremia.
Surfactant deficiency is more likely to be present when a drowning occurs in fresh water
than in sea water.
In approximately 50% of drowning victims, laryngospasm prevents inhalation of
significant quantities of water.
Ten mL of blood from a healthy adult is divided into two equal aliquots. One is exposed to an
oxygen-enriched environment and achieves an oxygen saturation (SO2) of 100%. All oxygen is
removed from the environment of the second sample and its SO2 approaches 0%. Which of the
following is MOST likely the PO2 of the sample after these aliquots are mixed together?
(A)
(B)
(C)
(D)
51.
High doses are associated with systemic vasoconstriction.
It has a half-life of four hours.
Dosing should be adjusted for patients with advanced liver disease.
Administration is associated with an increase in creatinine clearance.
Which statement about drowning is MOST likely true?
(A)
(B)
(C)
50.
Renal transplantation
Abdominal aortic surgery
Contrast nephropathy
Cardiac surgery with cardiopulmonary bypass
Which statement about fenoldopam is MOST likely true?
(A)
(B)
(C)
(D)
49.
It results from a meta-analysis of relevant published material.
It does not include input from the members of the ASA.
It is intended to be a guideline for practice.
It includes opinions from experts.
100 mm Hg
50 mm Hg
26 mm Hg
10 mm Hg
Which of the following conditions is MOST likely to increase the cardiac toxicity of
bupivacaine?
(A)
(B)
(C)
(D)
Bradycardia
Hyopkalemia
Hyperthermia
Acidosis
11
52.
Which of the following diuretics would be MOST effective in lowering serum potassium in a
patient with life-threatening hyperkalemia?
(A)
(B)
(C)
(D)
53.
Which of the following statements about transient neurologic symptoms (TNS) is MOST likely
true?
(A)
(B)
(C)
(D)
54.
It does not occur after combined spinal/general anesthesia.
Use of lidocaine increases the risk by more than fourfold compared to bupivacaine.
TNS has never been reported after a mepivacaine spinal anesthetic.
The relative risk of TNS after a spinal anesthetic is 1/1,000.
Which of the following would MOST likely decrease the mixed venous oxygen saturation (SVO2)
of a mechanically ventilated patient?
(A)
(B)
(C)
(D)
55.
Hydochlorothiazide
Ethacrynic acid
Triamterene
Mannitol
Status epilepticus
Transfusion of packed red blood cells
Initiation of dobutamine infusion
Increasing inspired oxygen concentration
Lung compliance (change in volume over change in pressure) is MOST likely to be greatest at
which of the points (A, B, C, or D) on the static pressure volume curve below?
12
56.
Compared with a full-term infant of the same postnatal age, a 2-month-old infant who was born at
32 weeks gestational age is at increased risk of developing which of the following in the
perioperative period?
(A)
(B)
(C)
(D)
57.
Which statement about the risk of developing retinopathy of prematurity is MOST likely true?
(A)
(B)
(C)
(D)
58.
(D)
Often tends to be worse at night
Asymmetric proximal distribution of pain
Evidence of neuropathy confirmed by nerve conduction velocity testing
A prevalence of 2%-5% in patients with diabetes mellitus
Which of the following medications is approved by the Food and Drug Administration for the
treatment of diabetic peripheral neuropathic pain (DPNP)?
(A)
(B)
(C)
(D)
61.
Children benefit from parental presence equally regardless of age.
Most parents prefer not to be present during induction.
Presence of a parent during induction is more effective than oral midazolam in relieving a
child’s anxiety.
Parental presence is associated with increased satisfaction of the parent for the
perioperative experience.
Which of the following is MOST characteristic of diabetic peripheral neuropathic pain (DPNP)?
(A)
(B)
(C)
(D)
60.
Only patients exposed to high oxygen concentrations are at risk.
Risk is proportional to birth weight.
Risk is increased by alkalosis.
Risk is minimal after 44 weeks postconceptional age.
Which statement about parental presence during the induction of anesthesia for pediatric patients
is MOST likely true?
(A)
(B)
(C)
59.
Hyperglycemia
Hypercalcemia
Malignant hyperthermia
Apnea
Carbamazepine
Gabapentin
Amitriptyline
Duloxetine
Which statement about anesthesia in a patient with Guillain-Barré syndrome is MOST likely `
true?
(A)
(B)
(C)
(D)
Regional anesthesia is contraindicated.
Autonomic dysfunction may result in profound hypotension.
The response to nondepolarizing muscle relaxants is likely to be decreased.
The response to indirect-acting vasoconstrictors is likely to be decreased.
13
62.
A 45-year-old female weighs 100 kg and is 66 inches tall. Based on calculation of body mass
index, she is MOST accurately classified as
(A)
(B)
(C)
(D)
63.
Which statement about diffusion hypoxia is MOST likely true?
(A)
(B)
(C)
(D)
64.
(C)
(D)
Preexisting obstructive sleep apnea will be exacerbated by pregnancy.
The morbidly obese parturient will experience a greater percentage decrease of functional
residual capacity (FRC) from prepregnant values compared to a nonobese parturient.
The supine hypotensive syndrome is more severe compared to a nonobese parturient.
Gastric volume is similar to that in a nonobese parturient.
A 2-week-old neonate born at term has a three-day history of projectile vomiting and an oliveshaped mass palpable in the epigastrium. Which of the following is MOST likely to be present in
this patient?
(A)
(B)
(C)
(D)
67.
Glomerular filtration rate
Ability to concentrate the urine
Sodium losses
Renal threshold for bicarbonate
Which statement about a morbidly obese parturient is MOST likely true?
(A)
(B)
66.
It may be a consequence of the administration of any volatile anesthetic agent.
It occurs due to the high solubility of nitrous oxide in blood.
It is most likely to occur in the postanesthesia care unit.
It is more likely to occur if the patient has some degree of airway obstruction on
emergence from anesthesia.
Compared to normal values in adults, which of the following renal parameters is MOST likely to
be increased in a neonate?
(A)
(B)
(C)
(D)
65.
normal weight for height.
overweight.
obese.
morbidly obese.
Hypernatremia
Hyperkalemia
Hyperchloremia
Metabolic alkalosis
Which of the following surgical procedures is associated with the LOWEST risk of complications
related to sickle cell disease in a susceptible patient?
(A)
(B)
(C)
(D)
Dilatation and curettage
Cesarean delivery
Cholecystectomy
Tonsillectomy and adenoidectomy
14
68.
Compared to adults receiving an equivalent dose of fentanyl (expressed as mcg/kg), which of the
following is MOST likely to be decreased in a 21-day-old neonate born at term?
(A)
(B)
(C)
(D)
Serum blood level
Volume of distribution
Clearance
Elimination half-life
69.
Electrocardiographic guidance is used to insert a multi-orificed central venous pressure (CVP)
catheter into the right atrium in a patient undergoing a craniotomy in the sitting position. The
ECG is set to monitor lead II and the leg lead is connected to a specialized CVP catheter designed
for this purpose, which is filled with sodium bicarbonate. Which of the following ECG traces
MOST likely indicates that the tip of the catheter is located in the middle of the right atrium?
70.
Which of the following is MOST likely required to establish the diagnosis of fibromyalgia?
(A)
(B)
(C)
(D)
Widespread pain above and below the waist
Elevated erythrocyte sedimentation rate
Lymphadenopathy
Abnormal deep tendon reflexes
15
71.
Which of the following is MOST likely to produce resolution of pain symptoms in a patient with
fibromyalgia?
(A)
(B)
(C)
(D)
72.
Which statement about the diffusing capacity for carbon monoxide (DLCO) is MOST likely true?
(A)
(B)
(C)
(D)
73.
esmolol.
hydralazine.
nitroglycerin.
metoprolol.
Which statement about neonatal abdominal wall defects (ie, gastroschisis and omphalocele) is
MOST likely true?
(A)
(B)
(C)
(D)
76.
Emphysema
Atelectasis
Exercise
Bleomycin-induced pulmonary toxicity
A 27-year-old male presents for open reduction and internal fixation of an open tibia fracture
sustained in a fall several hours ago. His urine drug screen in the emergency room is positive for
cocaine. In the preoperative holding area his blood pressure is 190/110 mm Hg and his heart rate
is 120 beats/min. He is agitated. The BEST medication to treat his hypertension is
(A)
(B)
(C)
(D)
75.
Carbon monoxide diffuses across the alveolar/capillary membrane more rapidly than
oxygen.
Decreased DLCO is a highly specific indicator of decreased diffusing capacity of the
alveolar/capillary membrane (“alveolar/capillary block”).
The value of DLCO is uninfluenced by inspired oxygen concentration.
DLCO is a useful indicator of progression of lung disease.
Which of the following conditions is MOST likely to be associated with an increase in the
diffusing capacity for carbon monoxide (DLCO)?
(A)
(B)
(C)
(D)
74.
Glucocorticoids
Nonsteroidal antiinflammatory drugs
Prolonged rest
Tricyclic antidepressants
Omphaloceles are commonly associated with other congenital anomalies.
Ventilation usually improves after primary repair of a large defect.
Intraoperative fluid management typically includes the administration of isotonic
crystalloid at the standard maintenance rate.
Gastroschisis is more common than omphalocele.
Which statement about emergence agitation in pediatric patients is MOST likely true?
(A)
(B)
(C)
(D)
Using sevoflurane for induction then switching to isoflurane prevents emergence
agitation.
Midazolam premedication reliably prevents emergence agitation.
It is frequently confused with postoperative pain.
It is more likely to occur in older rather than preschool-aged children.
16
77.
Which statement about intussusception is MOST likely true?
(A)
(B)
(C)
(D)
78.
A healthy 23-year-old parturient is having uterine contractions every three minutes and is
requesting pain relief. Her cervix is dilated 2 cm. According to the American Society of
Anesthesiologists Practice Guidelines for Obstetric Anesthesia, which statement about
performing epidural labor analgesia in this patient is MOST likely true?
(A)
(B)
(C)
(D)
79.
81.
Epidural analgesia should not be performed until she reaches a cervical dilation of 4 cm.
A platelet count should be obtained before proceeding with epidural placement.
She may continue to ingest clear liquids after initiation of epidural analgesia.
Continuous fetal heart rate monitoring must be maintained during epidural placement.
Which statement about the toxicity of amiodarone is MOST likely true?
(A)
(B)
(C)
(D)
80.
Ultrasonography is ineffective in establishing the diagnosis.
Patients are at increased risk for aspiration of gastric contents.
Reduction by enema is associated with recurrence in approximately 50% of patients.
The classic triad (abdominal pain, currant jelly stools, and a palpable abdominal mass) is
present in approximately 90% of children with intussusception.
Toxicity does not occur if the drug is administered intravenously rather than orally.
Amiodarone-induced corneal microdeposits commonly reduce visual acuity.
Refractory bradycardia necessitating pacemaker placement may occur.
Hyperthyroidism is not a manifestation.
In which of the following is hyponatremia consistent with the syndrome of inappropriate
antidiuretic hormone (SIADH)?
Serum
osmolality
Volume
status
(A)
High
Euvolemic
(B)
Low
Euvolemic
(C)
High
Hypovolemic
(D)
Low
Hypovolemic
Which statement about the psoas compartment (lumbar plexus) block is MOST likely true?
(A)
(B)
(C)
(D)
Only 5-10 mL of local anesthetic is required.
The psoas compartment lies between the psoas major and the quadratus lumborum
muscles.
The entire lower extremity can be anesthetized using this technique alone.
The needle should be aimed to contact the transverse process of L1.
17
82.
Which statement about the anatomy for cannulation of the subclavian vein is MOST likely true?
(A)
(B)
(C)
(D)
83.
A 23-year-old woman with myasthenia gravis and receiving pyridostigmine presents for
thymectomy. Which statement about her anesthetic management is MOST likely true?
(A)
(B)
(C)
(D)
84.
Transesophageal echocardiography
Pulmonary artery pressure monitoring
End-tidal carbon dioxide monitoring
Precordial Doppler ultrasound
A patient with a history of obstructive sleep apnea (OSA) is scheduled for an outpatient
procedure at your facility. According to the American Society of Anesthesiologists practice
guidelines on the management of patients with OSA, which of the following statements is MOST
likely true?
(A)
(B)
(C)
(D)
87.
Her platelet aggregation will be abnormal.
Her platelet count will be low.
Administration of desmopressin will increase von Willebrand factor levels for 48 hours.
Her factor IX level will be low.
Which of the following is the MOST sensitive technique for detecting vascular air embolism
(VAE)?
(A)
(B)
(C)
(D)
86.
An increased dose of nondepolarizing muscle relaxants will be required.
Pyridostigmine will prevent the muscle relaxant effects of volatile anesthetics.
A decreased dose of opioid analgesics should be administered.
The duration of action of succinylcholine will be decreased.
A 32-year-old woman with von Willebrand disease presents for an elective surgical procedure.
Which statement about her hematologic status is MOST likely true?
(A)
(B)
(C)
(D)
85.
The subclavian vein lies posterior to the medial third of the clavicle.
The subclavian vein lies posterior to the apical portion of the pleura.
The subclavian vein does not remain patent in a hypovolemic patient.
Cannulation of the subclavian vein is usually performed by the supraclavicular approach.
Clinical signs and symptoms reliably predict the severity of OSA.
Choice of anesthetic technique appears to be the most important determinant of
postoperative complications.
During moderate sedation ventilation should be monitored with capnography.
If general anesthesia is utilized, awake intubation is recommended.
Performance of a regional anesthesia technique using ultrasound guidance is MOST difficult with
which of the following blocks?
(A)
(B)
(C)
(D)
Axillary block
Interscalene block
Sciatic nerve block at the popliteal fossa
Epidural block
18
INSTRUCTIONS FOR ITEMS 88 AND 89: This series of items refers to the diagnosis, treatment,
or management of a single patient.
88.
After monitored anesthesia care with deep sedation using a propofol infusion for a carpal tunnel
release under local anesthesia, a 56-year-old woman is alert and oriented on arrival in Phase 2
Recovery but develops increasing disorientation, lethargy, and then becomes difficult to arouse.
Her past medical history includes endovascular coil embolization of a left middle cerebral artery
aneurysm nine weeks ago as well as insulin-dependent diabetes. Vital signs include blood
pressure 160/90 mm Hg, heart rate 54 beats/min, temperature 36.0°C. Her SPO2 is 96% on room
air. Her change in mental status is MOST likely due to
(A)
(B)
(C)
(D)
89.
hyperglycemia.
opioid overdose.
cerebral aneurysm rebleed.
postictal state following a seizure.
Imaging confirms the patient has a new subarachnoid hemorrhage (SAH). She is brought
immediately to the operating room for a clip ligation of the aneurysm. Which of the following
perioperative anesthetic management strategies is MOST likely to improve her neurological
outcome?
(A)
(B)
(C)
(D)
Maintaining her blood glucose below 140 mg/dL
Decreasing her core body temperature to 33.5°C
Administering magnesium rather than nimodipine
Decreasing mean arterial pressure to 50 mm Hg
19
INSTRUCTIONS FOR ITEMS 90 THROUGH 92: This series of items refers to the diagnosis,
treatment, or management of a single patient.
90.
A 148 kg, 65 inch tall, 54-year-old woman has necrotizing fasciitis of the perineum and requires
immediate surgery. Prior to this illness she had an exercise tolerance of two flights of stairs and
poorly controlled hypertension. Vital signs include blood pressure 98/62 mm Hg, heart rate 115
beats/min, SPO2 94% on room air, temperature 38.2°C. She has received morphine and 5 liters of
crystalloid in the emergency room. Which of the following statements about this patient is MOST
likely true?
(A)
(B)
(C)
(D)
91.
Which statement about drug administration in this patient is MOST likely true?
(A)
(B)
(C)
(D)
92.
Her gastric volume is likely decreased.
Her risk of fluid overload is low.
Trendelenburg position would improve her ventilation mechanics.
She is at increased risk of a fatal thromboembolic event.
Drugs should be administered based on actual body weight (ABW).
Renal clearance of drugs is not affected by obesity.
Drugs should be administered based on ideal body weight (IBW).
Some antibiotic doses should be adjusted for body weight.
After an eight-hour surgical procedure, the patient is mechanically ventilated for 12 hours in the
intensive care unit. During the second postoperative day, the patient complains of numbness and
muscular pain in both legs and is noted to have brown urine and purpura on both legs. Which of
the following statements is MOST likely true?
(A)
(B)
(C)
(D)
Rhabdomyolysis occurs in obese patients who undergo long surgical procedures.
Acidifying the urine will reduce renal injury.
Her symptoms are the results of acute renal failure.
The rash is caused by a drug reaction.
20
INSTRUCTIONS FOR ITEMS 93 AND 94: This series of items refers to the diagnosis, treatment,
or management of a single patient.
93.
A 53-year-old woman in the intensive care unit develops the following electrocardiographic
changes.
This ECG demonstrates which of the following?
(A)
(B)
(C)
(D)
94.
Acute myocardial infarction
Junctional tachycardia
Prolonged QT interval
Left bundle branch block
Which of the following electrolyte abnormalities is MOST likely to be seen on analysis of this
patient’s blood?
(A)
(B)
(C)
(D)
Hyperkalemia
Hypophosphatemia
Hypomagnesemia
Hypernatremia
21
INSTRUCTIONS FOR ITEMS 95 AND 96: This series of items refers to the diagnosis, treatment,
or management of a single patient.
95.
On the fifth postoperative day following coronary artery bypass surgery a 69-year-old male who
had preexisting renal failure treated with hemodialysis is noted to have a decreasing platelet
count. Type II heparin-induced thrombocytopenia (HIT) is suspected. Which statement about
type II HIT is MOST likely true?
(A)
(B)
(C)
(D)
96.
HIT is secondary to the destruction of platelets by IgM antibodies in the majority of
patients.
The risk of developing HIT is increased in cardiac surgical patients.
The majority of morbidity from HIT results from complications related to bleeding.
Arterial thrombosis occurs with a higher frequency than venous thrombosis.
Heparin therapy is discontinued and laboratory findings confirm the diagnosis of type II heparininduced thrombocytopenia (HIT). Which of the following would be the MOST appropriate
anticoagulant therapy for treatment?
(A)
(B)
(C)
(D)
Low molecular weight heparin (LMWH)
Warfarin
Clopidogrel
Argatroban
INSTRUCTIONS FOR ITEMS 97 AND 98: This series of items refers to the diagnosis, treatment,
or management of a single patient.
97.
A 32-year-old woman presents at 10 weeks gestation for prenatal care. She has systemic lupus
erythematosus (SLE). She takes prednisone daily. Which statement about her situation is MOST
likely true?
(A)
(B)
(C)
(D)
98.
She is at increased risk for preterm delivery.
Renal function will improve during pregnancy.
Prednisone should be discontinued.
Her risk of intrauterine fetal demise is less than 5%.
At 26 weeks gestation, fetal bradycardia of 60 beats/min is detected during ultrasound
examination. A normal biophysical profile of the fetus is obtained. The MOST appropriate
management at this time is
(A)
(B)
(C)
(D)
emergency cesarean delivery.
maternal intravenous administration of atropine.
fetal scalp pH testing.
initiation of long-term maternal dexamethasone therapy.
22
INSTRUCTIONS FOR ITEMS 99 AND 100: This series of items refers to the diagnosis, treatment,
or management of a single patient.
99.
Following brainstem herniation an organ donor is brought to the operating room for harvest of
solid organs, including heart, lungs, liver, and kidneys. Which statement about brain-dead,
beating-heart donors is MOST likely true?
(A)
(B)
(C)
(D)
100.
Brain death produces a generalized inflammatory response.
Catecholamine storm follows reperfusion injury of the brainstem.
Posterior pituitary failure is uncommon.
Long-term graft survival is greater in recipients receiving organs from brain-dead,
beating-heart donors than from living related donors.
On surgical incision, the donor’s systemic arterial blood pressure increases and his left leg
twitches. Activation of which of the following would MOST likely explain these events?
(A)
(B)
(C)
(D)
Spinal cord reflex
Central pain pathways
Intact brainstem
Parasympathetic pathways
23