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 statement about the presence of postoperative cognitive dysfunction (POCD) in
patients seven days after noncardiac surgery is MOST likely true?
(A)
(B)
(C)
(D)
2.
Which of the following agents is MOST appropriate for acute treatment of severe
hypertension in the preeclamptic patient?
(A)
(B)
(C)
(D)
3.
Advanced age is an independent risk factor.
The prevalence of POCD is decreased in patients receiving regional as opposed to
general anesthesia.
The majority of patients who manifest POCD at seven days will experience
worsening of symptoms at six months.
The prevalence of POCD is the same in patients having inpatient and outpatient
surgery.
Methyldopa
Enalaprilat
Labetalol
Magnesium
Soon after induction of general anesthesia, a 2-year-old boy has the following
electrocardiographic tracing.
His pulse is present and the blood pressure is 48/29 mm Hg. The MOST appropriate
intervention at this time is to administer
(A)
(B)
(C)
(D)
4.
epinephrine.
lidocaine.
synchronized cardioversion.
Valsalva maneuvers.
Which of the following conditions is MOST likely to occur during the formation of a
reentrant tachycardia?
(A)
(B)
(C)
(D)
Two areas of myocardium develop the same conductivity or refractoriness
Rapid conduction in the circuit that does not allow recovery from the initial
conduction block
Unidirectional block in one conduction pathway
Persistent blockade of an initial conduction pathway
1
5.
A 4-year-old girl with a history of congenital heart disease is scheduled for dental
restorations. According to the updated guidelines from the American Heart Association,
for which of the following conditions would providing prophylaxis against infective
endocarditis (formerly known as subacute bacterial endocarditis) MOST likely be
indicated?
(A)
(B)
(C)
(D)
6.
Visual assessment of which of the following nerve stimulation patterns BEST estimates
complete reversal of neuromuscular blockade?
(A)
(B)
(C)
(D)
7.
Absence of fade on tetanic stimulation at 50 Hz for five seconds
Absence of fade on tetanic stimulation at 100 Hz for five seconds
Train-of-four ratio of 1
Double burst ratio of 1
A 35-year-old woman at 39 weeks gestation is undergoing labor induction. She
complains of not feeling well and then becomes unresponsive. A pulse cannot be
detected. The electrocardiographic trace shows ventricular fibrillation. According to
Advanced Cardiac Life Support (ACLS) guidelines, cardiopulmonary resuscitation
(CPR) in this patient should MOST likely include immediate
(A)
(B)
(C)
(D)
8.
Patent ductus arteriosus (PDA) ligation one year ago
Unrepaired tetralogy of Fallot
Ventricular septal defect repaired one year ago
Heart transplantation four months ago
bedside cesarean delivery.
performance of CPR in the full lateral position.
defibrillation.
insertion of a laryngeal mask airway.
According to the American Society of Anesthesiologists Practice Advisory for the
Prevention and Management of Operating Room Fires, which of the following statements
is MOST likely true?
(A)
(B)
(C)
(D)
Only the anesthesia care team should perform formal operating room fire drills.
Surgical drapes should be placed in a configuration to impede the release of
oxidizing gases.
Surgical sponges should be kept dry when in the proximity of an ignition source.
Fire safety education should emphasize the risk posed by an oxidizer-enriched
environment.
2
9.
Which of the following statements about evoked potential monitoring is MOST likely
true?
(A)
(B)
(C)
(D)
10.
Which statement about the administration of mannitol to treat intracranial hypertension is
MOST likely true?
(A)
(B)
(C)
(D)
11.
A propofol infusion should be administered continuously throughout the surgery.
Local anesthetic scalp infiltration should be performed with 2-chloroprocaine.
The anesthetic management must allow sophisticated cognitive testing.
Invasive blood pressure monitoring is never required.
Which of the following is MOST likely to lengthen the seizure duration in a patient
undergoing electroconvulsive therapy (ECT)?
(A)
(B)
(C)
(D)
13.
Systemic hypertension usually occurs as a result of very rapid administration.
The maximum decrease in intracranial pressure occurs within one hour after
mannitol administration.
Mannitol administration should be targeted to achieve a serum osmolarity greater
than 340 mOsm.
The hyperosmotic effect of mannitol lasts for approximately 24 hours.
A patient with an inadequately controlled seizure disorder presents for resection of a
seizure focus during an awake craniotomy. Which statement about the anesthetic
management of this patient is MOST likely true?
(A)
(B)
(C)
(D)
12.
Motor evoked potentials do not change the amplitude in response to volatile
anesthetics.
Visual evoked potentials are easy to obtain.
Nerve ischemia can change the configuration of a somatosensory evoked
potential.
Evoked potential monitoring is only used during spine procedures.
Administration of glycopyrrolate prior to stimulus
Administration of caffeine prior to stimulus
Elevation of partial pressure of carbon dioxide in arterial blood
Treatment with labetalol
Which of the following is MOST likely to be decreased during an episode of autonomic
hyperreflexia in a patient with a spinal cord injury at the T4 level?
(A)
(B)
(C)
(D)
Blood pressure
Heart rate
Temperature
Serum norepinephrine concentration
3
14.
A patient with vitamin K deficiency requires emergency surgery for gastrointestinal
hemorrhage. Which statement about the patient’s coagulopathy is MOST likely true?
(A)
(B)
(C)
(D)
15.
A patient with known type 1 von Willebrand disease presents for emergency splenectomy
following a motor vehicle collision. Which of the following is the MOST appropriate
initial treatment?
(A)
(B)
(C)
(D)
16.
(B)
(C)
(D)
By reducing chest wall tone, neuromuscular blockade may decrease external
airway compression.
A computed tomography scan may reveal compression of the heat by the mass.
A double lumen tracheal tube is required.
Intravenous access should be obtained only above the diaphragm.
Rebound hypertension is MOST likely to occur after discontinuation of which of the
following class of drugs?
(A)
(B)
(C)
(D)
18.
Intravenous desmopressin (DDAVP)
Cryoprecipitate
Platelets
Fresh frozen plasma
A 17-year-old male presents to the operating room for removal of an anterior mediastinal
mass. He is asymptomatic while sitting up, but becomes dyspneic when supine. Which of
the following statements is MOST likely true?
(A)
17.
Vitamin K cannot be given intravenously.
Vitamin K can rapidly correct the coagulopathy.
Fresh frozen plasma should be administered before vitamin K.
Vitamin K deficiency is associated with prolonged partial thromboplastin time.
Angiotensin receptor blocker
Calcium channel blocker
Angiotensin converting enzyme inhibitor
Central alpha agonist
Which of the following is MOST likely to occur in a patient taking lithium carbonate?
(A)
(B)
(C)
(D)
Prolonged response to succinylcholine
Attenuated response to rocuronium
Decreased response to midazolam
Hypocalcemia
4
19.
Which statement about complications associated with a pulmonary artery catheter (PAC)
is MOST likely true?
(A)
(B)
(C)
(D)
20.
At sea level, which of the following is MOST likely a normal arterial blood gas for a
healthy parturient at 35 weeks gestation who is in an upright position and not receiving
supplemental oxygen?
(A)
(B)
(C)
(D)
21.
Restriction of intravenous fluids
Premedication with atropine
Avoidance of corticosteroids
Use of ST segment monitoring
An increase in which of the following is the MOST likely cause for the development of
severe respiratory depression in a patient with end-stage renal disease who is receiving
morphine?
(A)
(B)
(C)
(D)
23.
pH 7.40, PaO2 100, PaCO2 40, HCO3- 24
pH 7.44, PaO2 104, PaCO2 30, HCO3- 20
pH 7.50, PaO2 90, PaCO2 30, HCO3- 25
pH 7.30, PaO2 100, PaCO2 45, HCO3- 20
A 16-year-old female who received a heart transplant eight years ago is scheduled for a
diagnostic laparoscopy. Assuming she has a normal functioning donor heart and remains
on immunosuppressant therapy, which of the following is the MOST appropriate
management during general anesthesia for this patient?
(A)
(B)
(C)
(D)
22.
Dysrhythmias are the most frequently occurring complication.
Left bundle branch block commonly occurs during pulmonary artery
catheterization.
Embolism of catheter-related thrombi is the most common cause of a catheterrelated pulmonary infarction.
Weekly changes of the pulmonary artery catheter through the existing introducer
sheath decreases the risk of PAC-related bacteremia.
Elimination of half-life
Volume of distribution
Morphine-6-glucuronide levels
Morphine-3-glucuronide levels
Of the following conditions, which is the MOST likely cause for the intraoperative
development of severe hypotension in a 10-year-old male with a history of spina bifida?
(A)
(B)
(C)
(D)
Autonomic hyperreflexia
Latex anaphylaxis
Malignant hyperthermia
Epilepsy
5
24.
A healthy 19-year-old athlete is undergoing an Achilles tendon repair and pinning of a
medial malleolar fracture under a popliteal fossa block. Which of the following nerves is
MOST likely to require supplemental blockade?
(A)
(B)
(C)
(D)
25.
Which of the following statements about methadone is MOST likely true?
(A)
(B)
(C)
(D)
26.
The glossopharyngeal nerve provides taste sensation to the anterior two thirds.
The hypoglossal nerve provides sensation to the posterior one third.
A branch of cranial nerve V provides tactile sensation to the anterior two thirds.
A branch of cranial nerve VII provides sensation of the posterior one third.
Which of the following factors is MOST likely associated with the decline in partial
pressure of oxygen in arterial blood (PaO2) in patients older than 65?
(A)
(B)
(C)
(D)
28.
It has low bioavailability after oral intake.
It has action as an N-methyl-D-aspartate (NMDA) receptor antagonist.
It is known to produce neurotoxic metabolites.
It has a higher affinity for mu opioid receptors than morphine.
Which statement about the sensory innervation of the tongue is MOST likely true?
(A)
(B)
(C)
(D)
27.
Deep peroneal nerve
Sural nerve
Saphenous nerve
Superficial peroneal nerve
Reduced carbon dioxide elimination
Chronic silent aspiration
Upper airway obstruction
Ventilation/perfusion mismatch
A 65-year-old, non-immunocompromised male develops a fever during transfusion of
one unit of banked red blood cells. The ABO cross-match is confirmed as accurate, and
the storage time of the donor unit is determined to be seven days. Which of the following
is the MOST likely cause of a febrile transfusion reaction in this patient?
(A)
(B)
(C)
(D)
Bacterial sepsis
Cytomegalovirus
Hemolysis
Donor white blood cells
6
29.
Which statement about the application of leukocyte filters for donated blood is MOST
likely true?
(A)
(B)
(C)
(D)
30.
Which of the following medical therapies for primary hyperaldosteronism would be the
MOST effective for the majority of causes?
(A)
(B)
(C)
(D)
31.
Glucocorticoids
Calcium channel blockers
Amiloride
Spironolactone
Which statement about ischemic mitral regurgitation is MOST likely true?
(A)
(B)
(C)
(D)
32.
It is most effective when done at the time of donation.
It is most effective when done at the blood bank.
It is most effective when done during transfusion at the bedside.
Leukocyte filtration is not effective in reducing febrile transfusion reactions.
Exercise-induced pulmonary edema only occurs in the presence of severe mitral
regurgitation.
Angiotensin receptor blockers are contraindicated.
Papillary muscle rupture is the most frequent cause.
Patients with mitral regurgitation are at increased risk of cardiac death.
A healthy 26-year-old woman in spontaneous labor has been receiving epidural labor
analgesia for the past five hours. She reports good pain relief and has a T10 bilateral
sensory level. Her blood pressure is 82/40 mm Hg and heart rate is 125 beats/min. The
fetal heart rate pattern that had been normal has changed as illustrated below.
The MOST appropriate initial management of this patient should include
(A)
(B)
(C)
(D)
immediate cesarean delivery.
discontinuation of epidural infusion.
administration of intravenous phenylephrine.
administration of intravenous ephedrine.
7
33.
Which statement about the use of intrathecal lipophilic opioids in labor analgesia is
MOST likely true?
(A)
(B)
(C)
(D)
34.
A patient develops vasospasm following aneurysmal subarachnoid hemorrhage and
“triple-H” therapy is instituted. Which of the following is a component of this therapy?
(A)
(B)
(C)
(D)
35.
lidocaine allergy.
phenytoin toxicity.
methemoglobinemia.
anxiety attack.
Which of the following is MOST likely to cause a decrease in P50 (the PO2 at which
hemoglobin is 50% saturated)?
(A)
(B)
(C)
(D)
37.
Hypothermia
Hypovolemia
Hypertension
Hyperventilation
A 30-year-old woman is scheduled to undergo knee surgery in an outpatient surgery
center. She takes phenytoin for a seizure disorder but has no other medical problems. She
has a severe needle phobia and applied a eutectic mixture of local anesthetics (EMLA)
cream to potential sites for intravenous catheter placement before arriving at the surgery
center. She applied an entire 30 gram tube to extensive areas on both upper extremities.
Upon arrival at the surgery center, she is awake and alert but complaining of dizziness
and a headache. The pulse oximetry reading is 85%. These are MOST likely signs of
(A)
(B)
(C)
(D)
36.
Maternal respiratory depression only occurs with large doses (fentanyl > 50 mcg).
Pruritus occurs in approximately 5% of these patients.
Addition of dextrose to make the solution hyperbaric is recommended.
Maternal respiratory depression is often associated with previous administration
of a parenteral opioid during labor.
Hypothermia
Acidosis
Isoflurane
Fentanyl
Which of the following is included in the definition of the systemic inflammatory
response syndrome (SIRS)?
(A)
(B)
(C)
(D)
Heart rate less than 60 beats per minute
Systolic blood pressure less than 80 mm Hg
Elevated serum lactate
Elevated white blood cell count
8
38.
Which statement about the development of atelectasis is MOST likely true?
(A)
(B)
(C)
(D)
39.
It is more likely to develop with surgical procedures on the lower limbs than
intraabdominal procedures.
It is less likely to develop if 100% oxygen is administered prior to induction.
It develops within 10 minutes of induction of general anesthesia.
It does not develop when a total intravenous anesthetic technique is used.
A patient presents with the following electrocardiogram (ECG).
The abnormality MOST likely reflected on the ECG is
(A)
(B)
(C)
(D)
40.
right bundle branch block.
Wolff-Parkinson-White syndrome.
left bundle branch block.
Mobitz type I atrioventricular block.
Which statement about the Pin Index Safety System is MOST likely true?
(A)
(B)
(C)
(D)
It prevents turning on two vaporizers at the same time.
It prevents interchanging the connections for different gases from the wall outlet
to the anesthesia machine.
It is designed to prevent administration of an hypoxic gas mixture.
It couples the nitrous oxide and oxygen flowmeters.
9
41.
A 67-year-old patient who is taking vitamin E requires preoperative antibiotics. He has
renal insufficiency, but the surgeon requests an aminoglycoside and a beta-lactam
antibiotic. Which statement about the risk of an aminoglycoside exacerbating his renal
insufficiency is MOST likely true?
(A)
(B)
(C)
(D)
42.
A 4-year-old man undergoes pancreatic cyst excision. Pathology reveals benign disease.
Six months following surgery he is referred to a pain management physician for
persistent intractable epigastric pain. Which of the following statements is MOST likely
true if the pain is somatic in origin?
(A)
(B)
(C)
(D)
43.
The risk is decreased by coadministration of a beta-lactam antibiotic.
The risk is decreased by a single daily dose compared to multiple dividend doses.
The risk is increased by coadministration of antioxidants (eg, vitamin E).
The risk is decreased by preexisting hypoalbuminemia.
Superior hypogastric plexus block is useful in establishing the etiology of this
pain.
Intercostal nerve blocks may result in temporary relief of his pain.
Neurolytic celiac plexus block will result in permanent pain relief.
Temporary pain relief following diagnostic celiac plexus block suggests a
component of sympathetically maintained pain.
An 8-year-old boy underwent bilateral hand surgery three months ago and experienced
difficult placement of an intravenous catheter in his right foot just proximal to the medial
malleolus. After surgery the patient reported pain initially along the right foot instep.
Now the pain is felt diffusely over the medial calf, medial foot, and entire dorsum of the
foot. On examination he reports diminished sensation of cold when touched with ice over
the medial right foot but intact sensation over the dorsum of the foot. He appears to have
some mild edema of the foot with loss of skin creases overlying the toe joints. There are
not trophic changes to the skin or hair of the foot. Plain radiographs and bone scan of the
foot are entirely normal. Which of the following statements is MOST likely true?
(A)
(B)
(C)
(D)
The patient has saphenous neuralgia.
The patient has complex regional pain syndrome I (formerly known as reflex
sympathetic dystrophy).
The patient has complex regional pain syndrome II (formerly known as
causalgia).
The patient has a superficial peroneal nerve injury.
10
44.
A 44-year-old woman presents to the emergency room with complaints of exquisite pain
in the right forearm and hand. Examination reveals a white hand with pulses only
appreciable on Doppler ultrasonography. An angiogram reveals severe vasospasm of the
radial and ulnar arteries. The attending surgeon consults the anesthesiology pain service
to conduct a stellate ganglion block. Which of the following is the BEST evidence of an
adequate therapeutic sympathetic block?
(A)
(B)
(C)
(D)
45.
A 34-year-old woman develops a right upper extremity complex regional pain syndrome
type II from an injury to the palmar cutaneous branch of the median nerve at the time of a
carpal tunnel release. Her pain management physician schedules her for a stellate
ganglion block. Which of the following statements is MOST likely true?
(A)
(B)
(C)
(D)
46.
A chest radiograph taken following the procedure will show an elevated right
hemidiaphragm only if the block is done incorrectly.
Total spinal anesthesia is not a risk of stellate ganglia block.
Seizure during stellate ganglia block is most likely due to vertebrobasilar
vasospasm.
A correctly performed block may result in hoarseness.
Which of the following locations would be BEST for obtaining a sample of preductal
blood in a neonate?
(A)
(B)
(C)
(D)
47.
Ptosis
Scleral hyperemia
Nasal stuffiness
Forearm temperature elevation
Right radial artery
Right dorsalis pedis artery
Left brachial artery
Umbilical artery
A 65-year-old male develops new onset fever, elevated white blood cell count, and
hypotension requiring vasopressor therapy in the intensive care unit six days after open
abdominal aneurysm repair. His postoperative course has been complicated by failure to
wean from mechanical ventilation. The nurse reports an increase in sputum production,
and a chest radiograph demonstrates a new infiltrate in the right lower lobe. Which of the
following BEST describes when antibiotic therapy should be initiated?
(A)
(B)
(C)
(D)
After the results of a culture and sensitivity are available
After a specimen has been obtained for culture but before results are obtained
When the duration of the fever exceeds 12 hours
After the results of the gram stain are available
11
48.
In a child with tetralogy of Fallot, which of the following is MOST likely to be successful
in treating a hypercyanotic episode (“tet spell”) during anesthesia?
(A)
(B)
(C)
(D)
49.
Atropine
Dopamine
Phenylephrine
Furosemide
Analysis of an arterial blood gas sample drawn from a patient in the intensive care unit
reveals the following:
PaO2
PaCO2
pH
HCO3
Na
K
BUN
Cl
380 mm Hg (on mechanical ventilation with FIO2 0.5)
32 mm Hg
6.90
5.0 mEq/L
135 mEq/L
4.9 mEq/L
6 mg/dL
110 mEq/L
Which of the following is the MOST likely cause of the acid-base disturbance?
(A)
(B)
(C)
(D)
50.
You are evaluating a 40-year-old, 110-kg, gravid 4, para 3 patient at 38 weeks gestation
with a history of three previous cesarean deliveries and an anterior placenta previa with
her current pregnancy. Which statement about the anesthetic consideration for repeat
cesarean delivery is MOST likely true?
(A)
(B)
(C)
(D)
51.
Diarrhea
Bowel ischemia
Renal tubular acidosis
Large volume saline resuscitation
Spinal anesthesia is the anesthetic technique of choice.
The risk of a placenta accreta is less than 5%.
Mortality for a placenta accreta is greater than 50%.
Blood products should be immediately available.
Which of the following hemodynamic parameters is MOST likely to be decreased in a
healthy 70-year-old male compared to a younger man?
(A)
(B)
(C)
(D)
Left ventricular end-diastolic pressure
Resting cardiac index
Stroke volume
Pulse pressure
12
52.
Which of the following techniques MOST likely will provide analgesia only for the first
stage of labor?
(A)
(B)
(C)
(D)
53.
A patient with glossopharyngeal neuralgia undergoes a local anesthetic block of the left
glossopharyngeal nerve using the extraoral approach. During injection of 2 mL of 2%
lidocaine he has a tonic-clonic seizure. The MOST likely cause is injection of the local
anesthetic into which of the following structures?
(A)
(B)
(C)
(D)
54.
Tachypnea
Tachycardia
Hypoxemia
Hypotension
Which of the following is MOST likely to be a manifestation of adrenal suppression?
(A)
(B)
(C)
(D)
56.
Basilar artery
Internal jugular vein
Internal carotid artery
Vertebral artery
A patient with a documented deep vein thrombosis becomes suddenly short of breath,
complains of chest pain, and develops hemoptysis. Which of the following is MOST
likely to occur in an awake patient with a pulmonary embolism?
(A)
(B)
(C)
(D)
55.
Epidural block
Lumbar sympathetic block
Pudendal block
Combined spinal-epidural block
Hypokalemia
Hypernatremia
Hypotension
Hypothermia
Which statement about the use of remifentanil during a craniotomy is MOST likely true?
(A)
(B)
(C)
(D)
High doses increase electroencephalographic (EEG) activity in an epileptogenic
area.
In normal patients a bolus dose increases the processed EEG (Bispectral Index)
number.
Prolonged infusion causes prolonged analgesia in the postoperative period.
It can cause postoperative pain.
13
57.
Which of the following is MOST likely found in a patient with isolated mitral stenosis?
(A)
(B)
(C)
(D)
58.
A 28-year-old man is involved in a motor vehicle accident and requires an emergency
open reduction and internal fixation of a pelvic fracture. He is hemodynamically stable
and admits to recently smoking “crack” cocaine. For management of anesthesia, which of
the following agents is MOST appropriate?
(A)
(B)
(C)
(D)
59.
Aortic valve area index less than 0.6 (cm2/m2)
Mean valve gradient = 25 mm Hg
Aortic jet velocity = 1 m/sec
Exercise-induced hypertension
Which of the following drugs is MOST likely useful in the preoperative preparation of a
patient with pheochromocytoma?
(A)
(B)
(C)
(D)
61.
Propofol for induction
Ketamine for induction
Metoprolol to blunt the sympathetic response to laryngoscopy
Ephedrine for the treatment of hypotension
Which of the following is MOST consistent with a diagnosis of severe aortic stenosis?
(A)
(B)
(C)
(D)
60.
Normal left atrial pressure if mitral stenosis is mild
Left ventricular dilation
Increased risk of systemic embolism
Hemodynamic improvement with tachycardia.
Vasopressin
Doxazosin
Somatostatin
Calcitonin
Which statement about intraoperative management of a patient with a
pheochromocytoma is MOST likely true?
(A)
(B)
(C)
(D)
Hypertension worsens after venous drainage of the tumor is occluded.
Octreotide should be administered at regular intervals.
Intraoperative hyperglycemia is common.
Use of sodium nitroprusside is contraindicated.
14
62.
The activated partial thromboplastin time (aPTT or PTT) is MOST likely to be normal in
which of the following conditions?
(A)
(B)
(C)
(D)
63.
Which statement about a penile block in an adult is MOST likely true?
(A)
(B)
(C)
(D)
64.
(D)
total lung capacity.
residual volume.
the ratio of forced expiratory volume in 1 sec to forced vital capacity
(FEV1/FVC).
the response to bronchodilator administration.
Which of the following is MOST likely to occur as a consequence of intravenous
administration of a continuous infusion of dobutamine?
(A)
(B)
(C)
(D)
66.
The dorsal nerve of the penis is a branch of the pudendal nerve.
Low-dose epinephrine should be added to the local anesthetic for injection.
Approximately 30 mL of local anesthetic are required.
The dorsal nerves lie superficial to the fascial plane.
Pulmonary function testing of a patient with obstructive lung disease would MOST likely
show a decrease in
(A)
(B)
(C)
65.
The presence of antiphospholipid antibodies
Factor VII deficiency
An underfilled collection tube
Polycythemia
Systemic vasoconstriction
Bradycardia
Increased stroke volume
Inhibition of phosphodiesterase
A 9-month-old boy presents with a new onset of respiratory distress following a two-day
history of a viral upper respiratory tract infection manifested by rhinorrhea and cough.
The child is noted to have a respiratory rate of 45 breaths/min, supraclavicular
retractions, and nasal flaring. His temperature is 37.8°C and he occasionally has a highpitched “barking” cough. Based on this information, the MOST likely diagnosis is
(A)
(B)
(C)
(D)
epiglottitis.
foreign body in trachea.
tracheomalacia.
croup.
15
67.
Which of the following disorders is MOST commonly associated with Down syndrome?
(A)
(B)
(C)
(D)
68.
A 52-year-old woman with a history of a persistent left superior vena cava (PLSVC)
presents for coronary artery bypass surgery with cardiopulmonary bypass. Which
statement about the clinical significance of a PLSVC is MOST likely true?
(A)
(B)
(C)
(D)
69.
Continuous lumbar epidural anesthesia
Rocuronium
Succinylcholine
Epidural opioids
Which of the following BEST explains why bupivacaine has a lower fetal to maternal
plasma ratio when compared with lidocaine?
(A)
(B)
(C)
(D)
71.
Left internal mammary artery dissection may be difficult.
Correct positioning of a pulmonary artery catheter via the left subclavian vein
approach may be difficult.
Cardioplegia delivery through the coronary sinus will be effective.
Venous cannulation technique must be altered.
Which of the following is MOST likely to be contraindicated in a patient with GuillainBarré syndrome?
(A)
(B)
(C)
(D)
70.
Atrioventricular septal defect
Congenital diaphragmatic hernia
Hyperthyroidism
Tracheomalacia
Bupivacaine has a smaller molecular weight.
Bupivacaine is more protein bound.
Bupivacaine has a lower dissociation constant (pKa).
Bupivacaine is less lipid soluble.
A critically ill, intubated patient needs to be transported to the surgical intensive care unit
postoperatively. You are able to maintain adequate ventilation on 100% oxygen using an
Ambu bag. The anesthesia technician obtains an oxygen E cylinder for transport; the
gauge reads approximately 500 psig. At 10 L/min flow, which of the following is the
BEST estimate of the approximate time remaining for transport with this E cylinder?
(A)
(B)
(C)
(D)
60 minutes
33 minutes
17 minutes
6 minutes
16
72.
Which of the following conditions is MOST likely to be associated with an increase in
mixed venous oxygen saturation (S v O2)?
(A)
(B)
(C)
(D)
73.
Neonates are quicker than adults to experience oxygen desaturation during periods of
apnea. The BEST explanation for this is that on a mL/kg basis neonates compared to
adults have
(A)
(B)
(C)
(D)
74.
Density of sensory blockade
Risk for local anesthetic toxicity
Dosing requirement for lidocaine
Onset time of analgesia
Which of the following BEST characterizes the syndrome of inappropriate antidiuretic
hormone (SIADH) secretion?
(A)
(B)
(C)
(D)
76.
a larger tidal volume.
a larger dead space volume.
an increased closing capacity.
an increased functional residual capacity.
During performance of epidural analgesia with lidocaine, which of the following is
MOST likely to be increased by the addition of sodium bicarbonate?
(A)
(B)
(C)
(D)
75.
Pulmonary embolism
Pulmonary edema
Severe hemorrhage
Cyanide toxicity
High serum osmolality
Hypernatremia
Low urine osmolality
High urine sodium
A patient treated with duloxetine (Cymbalta), a serotonin and norepinephrine reuptake
inhibitor, for painful diabetic peripheral neuropathy reports sensations of stinging pain in
the feet are reduced. Pain relief in this patient is PRIMARILY mediated by
(A)
(B)
(C)
(D)
sodium channel blockade.
enhancing descending inhibition from the brainstem.
modulation of NMDA receptors.
alpha2-adrenergic blockade.
17
77.
A 56-year-old man who is chronically treated with sublingual buprenorphine/naloxone
(Suboxone) presents for an emergency appendectomy. Which of the following statements
is MOST likely to be true?
(A)
(B)
(C)
(D)
78.
Compared to intermittent nurse-administered opioid analgesia, the use of patientcontrolled analgesia (PCA) is MOST likely to
(A)
(B)
(C)
(D)
79.
Increased cerebral perfusion pressure
Increased heart rate
Sedation
Hypercapnia
A 5-kg, 4-week-old patient with palpable epigastric mass presents with a one-day history
of projectile vomiting. Which of the following is the MOST appropriate initial
management step?
(A)
(B)
(C)
(D)
81.
reduce overall consumption of opioids.
reduce the risk of respiratory depression.
reduce the risk of nausea.
improve patient satisfaction.
Which of the following is MOST likely to occur in a patient receiving dexmedetomidine?
(A)
(B)
(C)
(D)
80.
Patients taking this drug will have increased sensitivity to morphine.
The naloxone will not affect the patient’s opioid requirements.
Morphine has a higher affinity for the mu opioid receptor than buprenorphine.
Buprenorphine has kappa opioid receptor agonist properties.
Emergency pyloromyotomy
Intravenous administration of sodium bicarbonate
Intravenous administration of 0.9% sodium chloride solution
Oral administration of sodium bicitrate
Which statement about hepatic encephalopathy is MOST likely true?
(A)
(B)
(C)
(D)
There is a strong association between portal hypertension and the development of
encephalopathy.
Serum ammonia levels are predictive of the severity of encephalopathy.
Hypoactive deep tendon reflexes are a manifestation of encephalopathy.
The severity of asterixis correlates with the severity of the encephalopathy.
18
82.
A patient who admits to frequent use of lysergic acid diethylamide (LSD) with the last
dose taken six hours ago presents for an emergency repair of lacerations to the arm
sustained when he struck a window with his hand. Which of the following is MOST
likely to be present as a result of LSD ingestion?
(A)
(B)
(C)
(D)
83.
An otherwise healthy 21-year-old male is undergoing open repair of bilateral ankle
fractures under general anesthesia. Which statement about applying bilateral lower
extremity pneumatic tourniquets to decrease blood loss by this patient is MOST likely
true?
(A)
(B)
(C)
(D)
84.
The tourniquets should be inflated to 50 mm Hg above the patient’s mean arterial
pressure.
The width of the cuff of the tourniquet should be more than half the diameter of
the limb.
Once inflated, the tourniquet pressure should remain constant no matter what the
patient’s blood pressure.
The point where cuff overlap occurs should be placed directly over the
neurovascular bundle.
A healthy 20-year-old male is spontaneously breathing room air during an inguinal
herniorrhaphy under subarachnoid block without any accompanying sedation. Which of
the following respiratory parameters is MOST likely to be decreased as a consequence of
the spinal anesthesia with a T2 level?
(A)
(B)
(C)
(D)
85.
Fever
Hypoglycemia
Abbreviated duration of action of succinylcholine
Withdrawal symptoms
Partial pressure of oxygen in arterial blood (PaO2)
Tidal volume
Partial pressure of carbon dioxide in arterial blood (PaCO2)
Expiratory reserve volume
Which of the following statements is MOST likely true for a patient taking echothiophate
eye drops?
(A)
(B)
(C)
(D)
The dibucaine number will be reduced.
Tachycardia is a common complication.
The response to succinylcholine will be normal one week after discontinuation of
echothiophate.
The concentration of plasma cholinesterase will be increased.
19
86.
Which of the following is MOST likely to be increased in a patient with morbid obesity?
(A)
(B)
(C)
(D)
87.
Functional residual capacity
Cardiac output
Pulmonary compliance
Gastric emptying time
Type I statistical error is MOST descriptive of
(A)
(B)
(C)
(D)
negative predictive value.
positive predictable value.
false positives.
false negatives.
20
DIRECTIONS FOR ITEMS 88 AND 89: These items refer to the diagnosis, treatment, or
management of a single patient.
88.
A 27-year-old pregnant patient at 36 weeks gestation presents for management of labor
and delivery. She has a past medical history significant for neurofibromatosis type 1
(NF1 or von Recklinghausen disease). Which statement about this disorder is MOST
likely true?
(A)
(B)
(C)
(D)
89.
The number of neurofibromas tends to increase during pregnancy.
The neurofibromas are typically isolated to the skin.
The neurofibromas tend to decrease in size during pregnancy.
Bilateral acoustic neuromas occur in 95% of these patients.
The patient is moderately hypertensive (160/95 mm Hg) but has no protein in her urine
and a normal platelet count. She has a normal airway and reports no neurologic
symptoms. Prior to induction of labor, the patient indicates she desires epidural analgesia.
Which statement about the anesthetic management of this patient with neurofibromatosis
is MOST likely true?
(A)
(B)
(C)
(D)
The presence of hypertension requires further workup before proceeding.
Succinylcholine is contraindicated in neurofibromatosis patients.
No workup is required prior to performing epidural analgesia.
General anesthesia does not carry any increased risk in neurofibromatosis.
21
DIRECTIONS FOR ITEMS 90 THROUGH 92: These items refer to the diagnosis,
treatment, or management of a single patient.
90.
A healthy 24-year-old patient requires right upper extremity surgery following a
motorcycle accident. It is extremely painful for the patient to abduct his arm. Which
statement about the use of an infraclavicular approach for blockade of the brachial plexus
is MOST likely true?
(A)
(B)
(C)
(D)
91.
Which of the following is MOST likely to be a useful landmark for placement of an
infraclavicular block in this patient?
(A)
(B)
(C)
(D)
92.
It is conducive to placement of a continuous catheter.
It has a higher complication rate than the axillary approach.
It requires supplementation of the musculocutaneous nerve.
It provides adequate anesthesia for shoulder surgery.
Sternocleidomastoid muscle
External jugular vein
Coracoid process
Ipsilateral nipple
During placement of the infraclavicular block using a nerve stimulation technique, a
pectoralis twitch is obtained with arm adduction. The MOST likely interpretation of this
is that the needle
(A)
(B)
(C)
(D)
needs to be withdrawn because it is too deep.
needs to be redirected slightly caudad.
is properly placed for injection of local anesthetic.
needs to be advanced because it is too shallow.
22
DIRECTIONS FOR ITEMS 93 AND 94: These items refer to the diagnosis, treatment, or
management of a single patient.
93.
At the end of a 30-minute general anesthetic for a cystoscopy, the patient is noted to be
developing a splotchy, erythematous rash across his chest and face and has sternal
retraction. Which statement about this situation is MOST likely true?
(A)
(B)
(C)
(D)
94.
The patient may have pulmonary edema from excess fluid absorption.
The rash is no cause for concern.
The patient may be having an allergic reaction.
Sternal retractions are common during emergence.
Repeat vital signs are blood pressure 67/34 mm Hg, heart rate 140 beats/min, SPO2 89%.
The presumptive clinical diagnosis is anaphylaxis. Which of the following statements is
MOST likely true?
(A)
(B)
(C)
(D)
Peak serum concentrations of tryptase occur within two hours after a reaction.
The risk of anaphylaxis in response to a specific antigen is the same worldwide.
Skin testing can identify all antigens.
Opioids are the most frequent cause of anaphylaxis.
23
DIRECTIONS FOR ITEMS 95 AND 96: These items refer to the diagnosis, treatment, or
management of a single patient.
95.
A 26-year-old man needs immediate surgery for an orbital fracture that occurred during a
snowboarding accident. There is concern that a fragment of bone has perforated the
globe. Which of the following will MOST likely reduce the patient’s intraocular pressure
(IOP)?
(A)
(B)
(C)
(D)
96.
Hypotension
Administration of hypotonic fluid
Increased PaCO2
Administration of mannitol
An ophthalmologist and an otolaryngologist are going to jointly perform the surgery. The
ophthalmologist is very concerned that an oculocardiac reflex (OCR) will occur during
the procedure. Which statement about OCR is MOST likely true?
(A)
(B)
(C)
(D)
Sustained traction on the structures of the eye will increase the severity of cardiac
response.
Pretreatment with atropine would prevent the response.
Asystole can occur.
A peribulbar block to prevent OCR does not affect intraocular pressure (IOP).
24
DIRECTIONS FOR ITEMS 97 AND 98: These items refer to the diagnosis, treatment, or
management of a single patient.
97.
A 67-year-old patient with type 2 diabetes is being seen in the preoperative anesthesia
assessment clinic prior to a colon resection. The patient denies any cardiac symptoms.
Which of the following is the STRONGEST predictor of the presence of diabetic
cardiomyopathy?
(A)
(B)
(C)
(D)
98.
Hemoglobin A1C levels
Left ventricular ejection fraction
Male sex
Albuminuria
The patient’s transthoracic echocardiogram (TTE) indicates she has a normal ejection
fraction but severe diastolic dysfunction. On the morning of surgery, her finger stick
glucose is 375 mg/dL. Vital signs include blood pressure 145/82 mm Hg, heart rate 100
beats/min, SPO2 96%. In this context, which of the following statements about the
preoperative period is MOST likely true?
(A)
(B)
(C)
(D)
A single preoperative dose of angiotensin-converting enzyme (ACE) inhibitor
will reduce cardiac risk.
Intraoperative serum glucose control is best achieved with glargine insulin
(Lantus).
Her serum glucose concentration is associated with an increased risk of adverse
perioperative cardiac events.
Preoperative tachycardia indicates good cardiac reserve.
25
DIRECTIONS FOR ITEMS 99 AND 100: These items refer to the diagnosis, treatment, or
management of a single patient.
99.
A patient presents with sharp, stabbing facial pain in the distribution of the maxillary
division of the trigeminal nerve (V2). There is no history of an associated facial rash. The
MOST effective initial treatment is
(A)
(B)
(C)
(D)
100.
naproxen.
baclofen.
oxycodone.
carbamazepine.
The patient is refractory to conservative medical management. Magnetic resonance
imaging reveals no evidence of a tumor causing pain. The MOST appropriate next
therapy is
(A)
(B)
(C)
(D)
transcutaneous electrical nerve stimulation (TENS).
radiofrequency (RF) ablation of the maxillary branch (V2) of the trigeminal
nerve.
gasserian ganglion block with glycerol.
gasserian ganglion block with local anesthetic.
26
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