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.
l.
Maternal administration of which of the following tocolytic agents is MOST likely to be
associated with an increased risk of hypoglycemia in the neonate?
(A)
(B)
(C)
(D)
2.
When discussing fetal circulation, it is common to consider combined (right and left)
ventricular output. On average, the approximate combined ventricular output flow
through the ductus arteriosus is
(A)
(B)
(C)
(D)
3.
10%.
25%.
45%.
70%.
A 69-year-old woman is scheduled for total hip replacement. When she arrives, she has
severe dyspnea after her walk from the waiting room and insists on sitting upright. She
has been taking an angiotensin-converting enzyme inhibitor and a diuretic since her
myocardial infarction (MI) 6 months earlier. Her SpO2 is 87% on room air, her blood
pressure is 137/67 mm Hg, and her heart rate is 114 beats/min and regular. You suspect
she has an acute exacerbation of her chronic heart failure (HF). Which of the following
would MOST likely confirm the diagnosis?
(A)
(B)
(C)
(D)
4.
Nifedipine
Terbutaline
Indomethacin
Magnesium sulfate
B-type natriuretic peptide (BNP, also known as brain natriuretic peptide)
determination
Chest radiograph
Electrocardiogram (ECG)
C-reactive protein determination
Forty-eight hours after a left upper lobectomy the patient develops dyspnea and a massive
air leak via his chest tube. The diagnosis of a bronchopleural fistula is established, and he
is scheduled for a thoracotomy for closure of a bronchial stump leak. Which of the
following is MOST likely to be indicated in the management of this patient?
(A)
(B)
(C)
(D)
Placement of a thoracostomy tube on the right
Left-sided double lumen tracheal tube
Continuous positive airway pressure (CPAP) to the operative lung
Extubation in the operating room at the end of the procedure
5.
A patient with an object embedded in the plantar surface of the medial forefoot is
scheduled for foreign-body removal. Which of the following nerves is MOST important
to anesthetize for this procedure?
(A)
(B)
(C)
(D)
Deep peroneal nerve
Superficial peroneal nerve
Sural nerve
Posterior tibial nerve
6.
When transporting spontaneously breathing patient, which of the following semiopen
breathing systems with differing positions for the fresh gas flow (FGF) inlet and
adjustable pressure-limiting (APL) valve would be MOST efficient at preventing
rebreathing?
7.
Which of the following is MOST likely to represent an absolute indication that an
anesthesia machine is obsolete according to the American Society of Anesthesiologists
Guidelines for Determining Anesthesia Machine Obsolescence?
(A)
(B)
(C)
(D)
8.
Presence of a vaporizer in which clockwise rotation of the rotary concentration
dial results in a decreased concentration of volatile anesthetic
Presence of connectors in the scavenging system that are 30 mm in diameter
Notification by the manufacturer that it will no longer provide service for the
anesthesia machine
Absence of a vaporizer interlock system
Which of the following is the MOST appropriate lasting interval for infant formula in an
otherwise healthy 4-month-old infant scheduled for elective inguinal herniorrhaphy?
(A)
(B)
(C)
(D)
9.
Which statement about intraoperative anaphylaxis is MOST likely true?
(A)
(B)
(C)
(D)
10.
It occurs most commonly within minutes of anesthesia induction.
A rash is present in all severe cases.
An elevated tryptase level occurs only with an anaphylactic reaction.
Anesthesia induction agents are the most common class of drugs causing this
reaction.
A 32-year-old man presents for knee surgery. He reports an allergy to cephalexin. After
induction of general anesthesia, he inadvertently receives l g of cefazolin intravenously.
Within 2 minutes his blood pressure drops from 128/72 mm Hg to 64/30 mm Hg.
Ventilation is difficult due to bronchospasm. Immediate administration of which of the
following medications is MOST appropriate?
(A)
(B)
(C)
(D)
11.
Two hours
Four hours
Six hours
Eight hours
Hydrocortisone
Vasopressin
Epinephrine
Diphenhydramine
Which of the following graphs BEST represents the flow-time and pressure-time graphs
for pressure support ventilation?
12.
Which of the following is the MOST accurate formula to calculate the pulmonary
vascular resistance index?
Where
MAP = mean arterial pressure
CVP = central venous pressure
CI = cardiac index
MPAP = mean pulmonary artery pressure
PAOP = pulmonary artery occlusion pressure
SVI = stroke volume index
l3.
Regional anesthesia is planned for the performance of a cesarean delivery. Blockade of
which of the following dermatome ranges is MOST likely to provide adequate anesthesia
for cesarean delivery?
(A)
(B)
(C)
(D)
l4.
T4 to S4
T2 to Ll
T8 to S4
T3 to L5
Which of the following nondepolarizing neuromuscular blockers is MOST likely to
produce histamine induced bronchospasm?
(A)
(B)
(C)
(D)
Vecuronium
Atracurium
Cisatracurium
Rocuronium
15.
Which statement about epidural labor analgesia and its relationship to maternal
temperature during labor is MOST likely true?
(A)
(B)
(C)
(D)
16.
A 57-year-old female with a history of open-angle glaucoma presents to the preoperative
clinic for anesthesia consultation. Her glaucoma is medically managed with daily
administration of a topical beta- blocker and parasympathomimetic eye drops. Which
statement about the anesthetic management of this patient with open-angle glaucoma is
MOST likely true?
(A)
(B)
(C)
(D)
17.
Epidural analgesia is associated with a higher incidence of neonatal sepsis.
Epidural analgesia typically results in a decrease in maternal core temperature.
Epidural analgesia is associated with an increased risk of maternal fever
(temperature >38°C) during labor.
An increase in maternal temperature does not typically begin until 3 hours after
initiation of epidural analgesia.
Use of topical beta-blockers can result in exaggerated hypotension.
Use of a defasciculating dose of nondepolarizing neuromuscular blocking agent
prior to induction will reliably prevent increases in intraocular pressure associated
with succinylcholine administration
Parasympathomimetics should be stopped during the perioperative period.
The use of atropine during the perioperative period is strictly contraindicated.
A central venous catheter is being placed via the basilic vein to allow aspiration of air
during a sitting craniotomy. The electrocardiographic (ECG) V lead is being used to
determine position of the catheter. The ECG signal originates from the middle orifice of a
multiorifice catheter. Which of the following tracings BEST indicates that the middle
orifice of the catheter is in the desired position?
l8.
A 53-year-old woman presents to the preoperative anesthesia clinic for evaluation. She is
scheduled to undergo elective parathyroidectomy for primary hyperparathyroidism. She
is complaining of polyuria, polydipsia, vomiting, and muscle weakness. Administration
of which of the following would he MOST appropriate at this time?
(A)
(B)
(C)
(D)
l9.
Which of the following is LEAST likely to be present in a patient with systemic lupus
erythematosus (SLE)?
(A)
(B)
(C)
(D)
20.
Initiating skin surface warming
Warming intravenous fluids in the operating room
Using an airway humidifier
Warming the anesthesia circuit
A healthy subject has indwelling arterial catheters simultaneously transducing pressure
from the brachial, radial, femoral, and dorsalis pedis arteries. Which of the following
catheters is likely to record the HIGHEST systolic pressure?
(A)
(B)
(C)
(D)
22.
Pulmonary hypertension
Cornary artery disease
Renal dysfunction
Thrombocytosis
A 75-year-old woman is scheduled to undergo a simple abdominal hysterectomy. Which
of the following is MOST effective in preventing hypothermia in this patient?
(A)
(B)
(C)
(D)
21.
Hydrocortisone
Hydrochlorothiazide
Normal saline infusion
Calcitonin
Brachial
Radial
Femoral
Dorsalis pedis
Which of the following medications is MOST likely to be contraindicated in patients with
pulmonary hypertension?
(A)
(B)
(C)
(D)
l5-Methylprostaglandin F2alpha(Hemabate)
Sildenafil (Revatio, Viagra)
Nitric oxide
Epoprostenol (Flolan)
23.
One of the factors that determines the blood level of local anesthetic agent following
regional anesthesia is the site of injection. In order of decreasing serum local anesthetic
concentration after placement of a regional block, which of the following is the MOST
accurate sequence?
(A)
(B)
(C)
(D)
24.
Which of the following local anesthetics is combined with lidocaine to produce the
eutectic mixture of local anesthetics (EMLA) cream?
(A)
(B)
(C)
(D)
25.
Dobutamine
Norepinephrine
Vasopressin
Phenylephrine
Which statement about the supraclavicular approach to the brachial plexus is MOST
likely true?
(A)
(B)
(C)
(D)
27.
Etidocaine
Mepivacaine
Bupivacaine
Prilocaine
Which of the following vasoactive agents is MOST likely to decrease systemic vascular
resistance (SVR)?
(A)
(B)
(C)
(D)
26.
Lumbar epidural, femoral nerve, intercostal
Caudal epidural, intercostal, brachial plexus
Intercostal, femoral nerve, caudal epidural
Caudal epidural, lumbar epidural, femoral nerve
The point of needle entry is medial to the clavicular head of the
sternocleidomastoid.
Phrenic nerve block occurs in less than 5% of cases.
The block provides reliable anesthesia for shoulder surgery.
Ultrasound allows visualization of the nerves to be blocked.
Which of the following is MOST likely to cause the oxyhemoglobin dissociation curve to
shift to the right?
(A)
(B)
(C)
(D)
Decrease in pH
Hypothermia
Carboxyhemoglobin
Decreased 2,3-diphosphoglycerate (2,3-DPG)
28.
A normovoleinic patient with hyponatremia who is scheduled for surgery has the
following laboratory values:
Test
Serum sodium (mmol/L)
Serum osmolality (mOsm/kg)
Urine sodium (mmol/L)
Patient Data
130
265
35
Normal Values
135-145
280-300
20
Which of the following medical conditions is MOST likely associated with this patient’s
laboratory values?
(A)
(B)
(C)
(D)
29.
Water intoxication
Hyperglycemia
Diabetes insipidus
Syndrome of inappropriate antidiuretic hormone secretion
Which of the following ventilator settings is NOT usually set during high-frequency
oscillatory ventilation (HFOV)?
(A)
(B)
(C)
(D)
Inspiratory time
Tidal volume
Frequency
Amplitude
30.
In a patient with a heart rate of 120 beats/min and a mean arterial pressure of 50 mm Hg,
which of the following sets of hemodynamic data is MOST consistent with cardiogenic
shock induced by acute right-sided heart failure?
31.
Which of the following would MOST likely indicate that a 65-year-old patient scheduled
for emergency exploratory laparotomy is in septic shock?
(A)
(B)
(C)
(D)
Mixed venous oxygen saturation of 70%
Serum lactic acid level of 4 mg/dL
Base excess of 2.1 mg/dL
Mean arterial pressure of 55 mm Hg
32.
Which of the following is MOST likely a part of The joint Commission “time-out”
verification protocol conducted before the start of surgery?
(A)
(B)
(C)
(D)
33.
According to the American Congress of Obstetricians and Gynecologists, which of the
following would be the MOST appropriate first-line therapy for acute treatment of
hypertension in a patient with severe preeclampsia (eg, blood pressure 190/105 mm Hg)?
(A)
(B)
(C)
(D)
34.
The needle should be advanced to a deeper position.
The needle should he withdrawn and redirected more superiorly.
The needle should be withdrawn and redirected more inferiorly.
The needle is in an optimal position
A patient presents with painful paresthesias radiating to the dorsal web space between the
thumb and forefinger following a midhumeral fracture. Which of the following nerves is
MOST likely to have been injured by the midhumeral fracture?
(A)
(B)
(C)
(D)
36.
Sublingual nifedipine
Intravenous magnesium sulfate
Sodium nitroprusside infusion
Intravenous labetalol
An axillary block is being performed for surgery on the palmar aspect of the thumb. As
the needle is advanced with nerve-stimulator guidance, the patient reports paresthesias in
the fifth digit, and finger flexion is seen at 0.4 volts. Which statement about the needle
position is MOST likely true?
(A)
(B)
(C)
(D)
35.
Surgical site
Administration of beta-blockers
Use of a warming device
Appropriate selection of antibiotics
Radial nerve
Musculocutaneous nerve
Ulnar nerve
Median nerve
A woman presents with refractory pain from advanced but localized anal cancer despite
optimized systemic opioid therapy and adjuvant medications. She reports burning pain in
her anus radiating to her vagina, and pain to the touch upon wiping after voiding.
Neurolytic block of which of the following would provide the MOST appropriate
management of her pain?
(A)
(B)
(C)
(D)
Celiac ganglion
Superior hypogastric plexus
Left lumbar sympathetic ganglion
Pudendal nerves
37.
A 4-year-old child scheduled for a 4-hour ear reconstruction has been intubated with an
uncuffed tracheal tube. With the tube correctly positioned in the trachea, a stethoscope is
placed over the larynx and auscultation is performed while positive pressure applied to
the tracheal tube is gradually increased. Under which of the following conditions is
extubation and reintubation with a different tracheal tube LEAST likely to be warranted?
(A)
(B)
(C)
(D)
38.
Which of the following is MOST likely to be associated with an increased risk of
postdural puncture headache (PDPH) in an adult?
(A)
(B)
(C)
(D)
39.
Trigeminal neuralgia
Complex regional pain syndrome type II
Multiple sclerosis
Pancreatitis
You have been called to evaluate a patient with oliguria on postoperative day l. Which of
the following findings is MOST consistent with an intrarenal etiology for oliguria?
(A)
(B)
(C)
(D)
41.
Patient age of 20 years
Increased body mass index
Increased opening pressure at time of lumbar dural puncture
History of migraine headaches
The pain associated with which of the following is MOST likely to be classified as
nociceptive pain?
(A)
(B)
(C)
(D)
40.
Leak initially heard at 10 cm H2O
Leak initially heard at 20 cm H2O
Leak initially heard at 35 cm H2O
No leak heard at 50 cm H2O
Urine specific gravity greater than 1.020
Fractional excretion of sodium (FENa) less than 1%
Urine osmolality greater than 1,000 mOsm/kg
Urine sodium greater than 40 mEq/L.
A 5-year-old boy is undergoing an orchiopexy. Assuming a normal body mass index,
which of the following is the MOST appropriate rate for maintenance intravenous fluid
administration?
(A)
(B)
(C)
(D)
10 mL/h
30 mL/h
60 mL/h
100 ml/h
42.
You have been providing anesthesia for an emergent caesarean delivery. The neonate has
just been delivered, and a colleague is now available to care for the mother. Despite
opening the airway and providing tactile stimulation and positive pressure ventilation the
neonate is apneic and has a heart rate of 50 beats/min. According to the 2010 American
Heart Association (AHA) Neonatal Resuscitation guidelines, which of the following
interventions is MOST appropriate at this time?
(A)
(B)
(C)
(D)
43.
Which of the following is MOST likely associated with the administration of
succinylcholine to an otherwise healthy patient with a dibucaine number of 20?
(A)
(B)
(C)
(D)
44.
Prolonged onset of action
Increased dose requirements
Severe hyperkaleinia
Prolonged duration of action
Which statement about physiologic anemia of infancy is MOST likely true?
(A)
(B)
(C)
(D)
45.
Administration of epinephrine
Administration of atropine
Administration of vasopressin
Initiation of chest compressions
A healthy term neonate reaches the lowest hemoglobin at 8-12 weeks of postnatal
age (48-52 weeks postconceptual age).
A hemoglobin of 6 g/dL would be considered normal for a term neonate at the
nadir of physiologic anemia.
In premature neonates, the hemoglobin concentration at the nadir is inversely
proportional to gestational age at birth.
Red blood cell transfusion of a premature neonate results in a higher hemoglobin
value at the nadir of physiologic anemia.
Which of the following drugs is the BEST choice for lowering intracranial pressure (ICP)
while preserving cerebral perfusion pressure (CPP) in a patient with intact cerebral
autoregulation?
(A)
(B)
(C)
(D)
Propofol
Thiopental
Mannitol
Sevoflurane
46.
An unconscious patient with a systolic blood pressure of 60 mm Hg is brought into your
hospital for an emergent craniotomy secondary to intracranial hemorrhage after a
snowmobile accident. Which of the following would be BEST to use during
laryngoscopy?
(A)
(B)
(C)
(D)
47.
A patient with end-stage liver disease secondary to alcoholic cirrhosis requires general
anesthesia for repair of a fractured hip. Which of the following anesthetic interventions is
MOST likely to preserve hepatic blood flow?
(A)
(B)
(C)
(D)
48.
Manual in-line neck stabilization
Hard cervical collar
Soft cervical collar
In-line cervical traction
Application of positive end-expiratory pressure (PEEP)
Administration of isoflurane
Spinal anesthesia
Use of sodium thiopental for induction
Arterial blood gas analysis on a patient in the intensive care unit receiving 2 L/min of
oxygen by nasal cannula demonstrates the following:
PaO2
PaCO2
pH
HCO3-
104 mm Hg
38 mm Hg
7.42
24 mEq/L
Which of the following is the BEST interpretation of this blood gas?
(A)
(B)
(C)
(D)
49.
Respiratory acidosis
Metabolic acidosis
Respiratory alkalosis
Normal
Which of the following variables is MOST likely calculated (rather than measured) in a
standard blood gas analyzer?
(A)
(B)
(C)
(D)
PO2
pH
PCO2
[HCO3-]
50.
Which of the following conditions is MOST likely indicated by the presence of an
isolated tall v wave on the central venous pressure (CVP) waveform?
(A)
(B)
(C)
(D)
51.
A 58-year-old woman is admitted to the intensive care unit after open repair of a type-III
thoracoabdominal aortic aneurysm. Preoperatively, an intrathecal catheter was placed for
cerebrospinal fluid drainage. Estimated blood loss was 6 L, and packed red blood cells,
cell saver blood, platelets, fresh frozen plasma, and cryoprecipitate were administered to
treat anemia and coagulopathy. Postoperatively, the patient is unable to move her lower
extremities. Sensation is normal. She has no back pain. Which of the following is MOST
likely to account for her neurologic deficit?
(A)
(B)
(C)
(D)
52.
Mitral stenosis
Tricuspid regurgitation
Constrictive pericarditis
Tricuspid stenosis
Epidural hematoma
Brown-Séquard syndrome
Anterior spinal artery syndrome
Guillain-Barré syndrome
A 55-year-old man with a history of cocaine abuse presents to the operating room with a
Stanford type A aortic dissection. He is awake, alert, and complaining of chest pain. His
blood pressure is 75/40 mm Hg, pulse l05 beats/min, SaO2 95% on 2 L nasal cannula. A
12-lead electrocardiogram reveals ST elevation in leads II, III, and aVF. An
echocardiogram reveals large pericardial fluid with right ventricular compression during
systole. Which of the following is the BEST initial management strategy for this patient?
(A)
(B)
(C)
(D)
Pericardiocentesis
Surgical repair
Coronary angiography
Toxicology screen
53.
A 26-year-old woman at 39 weeks gestation acutely complains of shortness of breath
while pushing during the second stage of labor. Pulse oximetry indicates an oxygen
saturation of 65%. The patient becomes unresponsive and has a weak but palpable pulse.
She is intubated and emergently taken to the operating room for cesarean delivery. After
delivery of the infant, the parturient’s blood pressure is 62/38 mm Hg and oxygen
saturation is 70%. Transesophageal echocardiography shows evidence of pulmonary
artery hypertension and decreased right ventricular function. The obstetrician reports the
uterus is firm but that severe vaginal bleeding and bleeding within the surgical field
persists. Management of this patient’s hemorrhage should MOST likely include
administration of
(A)
(B)
(C)
(D)
prostaglandin F2alpha (Hemabate).
cryoprecipitate.
intramuscular methylergonovine maleate (Methergine).
heparin infusion.
54.
Which of the following umbilical artery blood gas values is MOST likely to be associated
with an increased risk of neonatal complications?
55.
A 65-year-old man complains of painless visual loss in his right eye 2 days after a
coronary artery bypass procedure. Preoperative carotid ultrasound revealed no significant
atherosclerosis. Funduscopic examination reveals optic disk swelling. Which of the
following is the MOST likely diagnosis?
(A)
(B)
(C)
(D)
56.
Cortical blindness
Anterior ischemic optic neuropathy
Temporal arteritis
Posterior ischemic optic neuropathy
A fiberoptic bronchoscope is inserted into a properly placed left-sided double-lumen
tube. Each of the following may be visualized EXCEPT
(A)
(B)
(C)
(D)
3 orifices of the right upper lobe bronchus via the tracheal lumen.
longitudinal elastic bundles extending posteriorly via the bronchial lumen
left upper and lower lobe bronchi via the bronchial lumen.
proximal left upper lobe bronchus via the tracheal lumen.
57.
Anesthesia is being induced in a 3-year-old child with congenital heart disease using an
inhalation technique. Which of the following congenital heart lesions is MOST likely to
slow the rate of induction of anesthesia?
(A)
(B)
(C)
(D)
58.
Which of the following is MOST likely to increase as adults age?
(A)
(B)
(C)
(D)
59.
Proximal limb weakness
Preservation of autonomic function
Decreased muscle strength with activity
Resistance to depolarizing blockers
A 28-yearold woman at 39 weeks gestation presents for cesarean delivery due to breech
presentation. She has a history of hypertrophic cardiomyopathy (HCM). Her only
medication is metoprolol. She reports having a few presyncopal episodes before her
pregnancy. Which statement about the anesthetic management of this patient is MOST
likely true?
(A)
(B)
(C)
(D)
61.
Closing capacity
Total lung capacity
Diffusion capacity
Vital capacity
A 56-year-old man presents for resection of a bronchial mass. He has been diagnosed
with Lambert-Eaton myasthenic syndrome (LEMS). Which of the following is MOST
likely to be present?
(A)
(B)
(C)
(D)
60.
Ventricular septal defect
Tricuspid atresia
Patent ductus arteriosus
Aortic coarctation
Metoprolol should be discontinued before surgery.
Phenylephrine is the preferred drug for treatment of hypotension.
Single-injection spinal anesthesia is a preferred anesthetic technique.
If general anesthesia is required, propofol is the preferred agent for induction of
anesthesia.
Which of the following is MOST likely to be a perioperative consideration for a 4-yearold with a history of Prader-Willi syndrome (PWS)?
(A)
(B)
(C)
(D)
Postoperative monitoring for obstructive sleep apnea
An increased requirement for pain medications
Need to administer perioperative stress-dose steroids
A resistance to nondepolarizing neuromuscular blocking drugs
62.
A popliteal block is performed as the primary anesthetic for repair of an Achilles tendon
rupture. During the surgery the patient begins to complain of pain along the medial aspect
of his ankle. Which of the following nerves is MOST likely to be inadequately blocked?
(A)
(B)
(C)
(D)
63.
Deep peroneal nerve
Sural nerve
Superficial peroneal nerve
Saphenous nerve
Major thromboelastogram parameters are shown below
Which of the following interpretations of these parameters is MOST accurate?
(A)
(B)
(C)
(D)
64.
After receiving an uneventful 45-mg, 5% hyperbaric lidocaine spinal anesthetic for an
outpatient hysteroscopy, a patient calls on postoperative day l to complain of severe
burning in her buttocks and posterior thighs. Which statement about this patient’s
condition is MOST likely true?
(A)
(B)
(C)
(D)
65.
R-time reflects platelet function.
LY30 reflects fibrinogen formation.
MA reflects clot strength.
K-time reflects fibrinolysis activity.
This is a dose-dependent phenomenon.
The patient should be treated with nonsteroidal antiinflammatory agents.
A neurologic consult should be obtained for suspected cauda equina syndrome.
Use of a lower concentration of lidocaine would have reduced the risk.
Epidural administration of 3% 2-chloroprocaine results in a rapid onset of neural
blockade. Which of the following properties is MOST likely responsible for this drug’s
rapid onset?
(A)
(B)
(C)
(D)
Lipid solubility
Degree of protein binding
Drug concentration
The pKa of the drug
66.
A patient develops acute respiratory distress syndrome following aspiration of gastric
contents during induction of anesthesia. Which of the following is MOST likely to be
associated with a decreased risk of mortality for this patient?
(A)
(B)
(C)
(D)
67.
Which of the following agents would be MOST likely to increase cardiac output and
reduce pulmonary vascular resistance in a patient with end-stage heart disease?
(A)
(B)
(C)
(D)
68.
Gamma-aminobutyric acid-A (GABAA) receptor agonism
Gamma- aminobutyric acid-B (GABAB) receptor agonism
GABAA receptor antagonism
Alpha2 receptor agonism
A 47-year-old man developed pain along the C6 dermatome. There is no history of
injury. On physical examination, there are no sensorimotor disturbances or skin changes
in the upper extremities. Which of the following BEST describes this type of pain?
(A)
(B)
(C)
(D)
70.
Milrinone
Epinephrine
Norepinephrine
Dopamine
Which of the following is the MOST likely mechanism of action of baclofen?
(A)
(B)
(C)
(D)
69.
Increasing FIO2, to maintain arterial oxygen saturation above 94%
Increasing positive end-expiratory pressure (PEEP) to maintain a PaO2/FIO2 ratio
of at least 300
Limiting plateau pressure to less than 30 cm H2O
Setting tidal volume to 10 mL/kg (predicted body weight)
Allodynia
Complex regional pain syndrome
Hyperalgesia
Neuralgia
Which of the following symptoms is MOST consistent with the diagnosis of severe
lumbar spinal stenosis?
(A)
(B)
(C)
(D)
Pain that worsens when bending forward
Numbness and tingling in the toes that worsen when walking uphill
Burning pain in the calves that worsens when riding a bicycle
Burning pain in the thighs that worsens when walking downhill
71.
A woman taking fluoxetine (Prozac) for depression does not mention this to her treating
physician because she is embarrassed. Four days after being given amitriptyline for
postherpetic neuralgia, she develops palpitations and is taken to the emergency
department. There she is found to have a QRS
complex duration greater than I60 ms and intermittent episodes of ventricular tachycardia
without loss of consciousness. Which of the following is the MOST appropriate
immediate therapy for her dysrhythmia?
(A)
(B)
(C)
(D)
72.
Which statement about a DVIR pacemaker is MOST likely true?
(A)
(B)
(C)
(D)
73.
The atrium and ventricle are sensed.
The paced rate may respond to increases in minute ventilation.
The paced rate is not inhibited by the patient's intrinsic heart rate.
Only the ventricle is paced.
A patient with known hereditary angioneurotic edema (HAE) is scheduled for an elective
laparoscopic cholecystectomy. Which of the following is LEAST likely to be indicated in
the preoperative prophylaxis against complications of HAE?
(A)
(B)
(C)
(D)
74.
Amiodarone
Calcium gluconate
Sodium bicarbonate
Procainamide
Daily administration of an anabolic steroid (eg, danazol) beginning 5 days before
surgery
Single close of epsilon-aminocaproic acid on the morning of surgery
Administration of fresh frozen plasma to achieve a minimum C1 esterase inhibitor
level of approximately 40% normal
Administration of Berinert P (C1 esterase inhibitor concentrate) on the morning or
surgery
An increase in which of the following is MOST likely to result in an increase in
myocardial wall tension?
(A)
(B)
(C)
(D)
Ventricular wall thickness
Ventricular cavity size
Ejection fraction
Systemic venous capacitance
75.
A healthy woman resents at 33 weeks gestation in preterm labor. She has a cervical
dilation of 4 cm. The obstetrician plans to attempt tocolysis but also requests that epidural
analgesia be provided since the patient is complaining of moderate pain. If the patient
remains normotensive, which of the following will MOST likely decrease uteroplacental
blood flow?
(A)
(B)
(C)
(D)
76.
Compared to boys receiving postoperative caudal analgesia following circumcision,
which statement about other postoperative analgesic options is MOST likely true?
(A)
(B)
(C)
(D)
77.
Epidural analgesia with 0.0625% bupivacaine plus 1:200,000 epinephrine
Magnesium sulfate
Nifedipine
Uterine contractions
Boys receiving parenteral analgesia are significantly more likely to require rescue
medication.
Boys receiving a dorsal nerve penile block are significantly more likely to require
rescue medication.
Boys receiving parenteral analgesia are significantly more likely to develop
postoperative nausea or vomiting.
Boys receiving a dorsal nerve penile block are significantly less likely to develop
motor nerve weakness.
An obese man complains of pain in the right lower back and buttock radiating to the right
lateral thigh and right groin but not extending below the knee. Examination reveals
sensory deficits on the skin of the right lateral thigh and right upper buttock with a loss of
muscle bulk in the right thigh. External rotation of the hip is not painful. Which statement
about this patient is MOST likely true?
(A)
(B)
(C)
(D)
Nonsteroidal antiinflammatory drugs (NSAIDs) are contraindicated in this
condition.
A transforaminal injection of steroid along the ipsilateral L4 nerve root may be
helpful.
Steroid injection at the site of the anterior superior iliac spine is likely to result in
significant relief.
An epidural steroid injection maybe helpful in relieving symptoms.
DIRECTIONS FOR ITEMS 78 AND 79: These Items refer to the diagnosis, treatment, or
management of a single patient.
78.
One month following her surgery to repair a fracture of the styloid process of the distal
ulna, a woman complains of pain and numbness on the dorsal surface of the hand
radiating from the medial wrist to the 4th and 5th finger. She reports intermittent sweating
of the hand but denies any swelling, change of skin color, or nail texture. Which of the
following statements is MOST likely true?
(A)
(B)
(C)
(D)
79.
The patient has an ulnar neuralgia.
The patient has complex regional pain syndrome 1 (formerly known as reflex
sympathetic dystrophy).
The patient has complex regional pain syndrome II (formerly known as
causalgia).
The patient has an injury to the superficial branch of the radial nerve.
Several weeks later while being: treated with oral sustained-release morphine, 30 mg
three times daily, and gabapentin, l,200 mg three times daily, the woman is observed to
have a new tremor in the affected hand. She reports that she is having trouble
coordinating movements with that hand during activities such as buttoning her blouse.
Her tremor and incoordination are MOST likely due to which of the following?
(A)
(B)
(C)
(D)
Emotional distress
Involvement of a motor branch of the ulnar nerve at the time of her injury
Evolution of complex regional pain syndrome (CRPS) II
Her pharmacologic regimen
DIRECTIONS FOR ITEMS 80 AND 81: These Items refer to the diagnosis, treatment, or
management of a single patient.
80.
A 75-year-old woman with Parkinson disease is seen in the preoperative clinic prior to
hysterectomy. Which of the following signs is MOST likely associated with Parkinson
disease?
(A)
(B)
(C)
(D)
81.
Lack of tone
Intention tremor
Hemiballismus
Bradykinesia
Which of the following antiemetic medications is MQST suitable for management of
postoperative nausea and vomiting in this patient?
(A)
(B)
(C)
(D)
Ondansetron
Droperidol
Metoclopramide
Prochlorperazine
DIRECTIONS FOR ITEMS 82 AND 83: These items refer to the diagnosis, treatment, or
management of a single patlent.
82.
Which of the following is MOST likely increased in a healthy parturient at term?
(A)
(B)
(C)
(D)
83.
Systemic vascular resistance
Central venous pressure
Hematocrit
Cardiac output
Compared to nonpregnant patients, which statement about a parturients pulmonary status
is MOST likely true?
(A)
(B)
(C)
(D)
Tidal volume remains unchanged.
Viral capacity increases.
Closing capacity remains unchanged.
Total lung capacity increases.
DIRECTIONS FOR ITEMS 84 AND 85: These items refer to the diagnosis, treatment, or
management of a single patient.
84.
A 67-uyear-old patient with no prior history of cardiac disease is scheduled to undergo a
Whipple procedure. Prior to induction of anesthesia the patient is in sinus rhythm with a
heart rate of 81 beats per minute (bpm) and a blood pressure of 137/88 mm Hg. During
the procedure the following is noted on the monitor.
According to current Advanced Cardiac Life Support (ACLS) guidelines, which of the
following is the MOST appropriate initial management?
(A)
(B)
(C)
(D)
Synchronized cardioversion
Intravenous lidocaine
Intravenous amiodarone
Intravenous magnesium
85.
Despite the initial therapy the rhythm deteriorates further and, as shown on the monitor
tracing below, the patient becomes pulseless.
According to current Advanced Cardiac Life Support According to current Advanced
Cardiac Life Support (ACLs) guidelines, which of the following is the MOST appropriate
management at this time?
(A)
(B)
(C)
(D)
Provide a single defibrillation shock.
Provide 3 consecutive (“stacked”) defibrillation shocks.
Administer intravenous epinephrine.
Administer intravenous vasopressin.
DIRECTIONS FOR ITEMS 86 THROUGH 88: These items refer to the diagnosis,
treatment, or management of a single patient.
86.
You are asked to examine a random sample of 1,000 patient charts to study whether use
of paravertebral blocks prevents chronic postoperative pain after elective hernia surgery.
Among the 600 patients who did not receive paravertebral blocks, 500 did not have pain.
Of the 400 patients who had paravertebral blocks, 300 did not have pain. Among those
who had a paravertebral block, which of the following BEST represents the odds of
having pain?
(A)
(B)
(C)
(D)
87.
A study involving l,000 patients assessed the efficacy of paravertebral blocks in
preventing chronic pain after elective hernia surgery. Of the 400 patients who had
paravertebral blocks, 300 did not have pain. Among the 600 patients who did not receive
paravertebral blocks, 500 did not have pain. Which of the following BEST expresses the
odds ratio describing the relationship of pain to paravertebral block exposure?
(A)
(B)
(C)
(D)
88.
0.33
0.25
3
0.2
1.65
0.61
0.33
0.2
A study involving 1,000 patients assessed the efficacy of paravertebral blocks in
preventing chronic pain after elective hernia surgery. Of the 400 patients who had
paravertebral blocks, 300 did not have pain. Among the 600 patients who did not receive
paravertebral blocks, 500 did not have pain. The calculation MOST likely to determine if
the use of paravertebral blocks is associated with a statistically significant change (P<.05)
in the odds of chronic pain is
(A)
(B)
(C)
(D)
a chi-square test.
an odds ratio.
a log-rank test.
a relative risk.
DIRECTIONS FOR ITEMS 89 AND 90: These items refer to the diagnosis, treatment, or
management of a single patient.
89.
Shortly after arrival in the emergency department a previously healthy 20-year-old athlete
with an isolated closed head injury develops profound hypoxemia associated with
bilateral infiltrates on his chest radiograph. Which of the following is MOST likely to be
decreased in this patient?
(A)
(B)
(C)
(D)
90.
Left ventricular output
Pulmonary artery pressure
Systemic vascular resistance
Pulmonary artery occlusion pressure
Following tracheal intubation and initiation of positive pressure ventilation with
supplemental oxygen, the patient remains hypertensive and tachycardic. Which of the
following interventions is the MOST appropriate?
(A)
(B)
(C)
(D)
Furosemide
Mannitol
Permissive hypercapnia
Esmolol
DIRECTIONS FOR ITEMS 91 AND 92: These items refer to the diagnosis, treatment, or
management of a single patient.
91.
A 46-year-old woman presents to the preoperative anesthesia clinic in preparation for
next-day elective plastic surgery. She is currently asymptomatic but does report that she
has frequent episodes of facial flushing and diarrhea with the most recent episode
occurring last evening. She was diagnosed with asthma 2 years ago when her other
symptoms also began. She reports that she often develops an asthma attack at the same
time as the flushing and diarrhea. Which statement about the preoperative evaluation of
this patient is MUST likely true?
(A)
(B)
(C)
(D)
92.
Surgery can proceed without any further evaluation.
Spirometry should be performed.
Urinary metanephrine levels can establish the likely diagnosis.
An echocardiogram should be obtained.
After a thorough evaluation, the patient is diagnosed with a duodenal carcinoid tumor. An
echocardiogram is normal. The patient is scheduled to undergo excision of the tumor.
Which statement about the perioperative management of this patient is MUST likely
true?
(A)
(B)
(C)
(D)
She should receive octreotide preoperatively.
A rapid sequence induction with succinylcholine is recommended.
Propofol is contraindicated.
Ondansetron should be avoided.
DIRECTIONS FOR ITEMS 93 AND 94: These items refer to the diagnosis, treatment, or
management of a single patient.
93.
An elderly man with urosepsis develops agitation associated with delirium while in the
intensive care unit. Which of the following would be LEAST likely to be associated with
a diagnosis of delirium?
(A)
(B)
(C)
(D)
94.
Fluctuating level of consciousness
Focal neurologic findings
Reduced awareness of environment
Inability to maintain attention or focus
In the absence of significant physiologic derangements (eg, hypoxemia, hypoglycemia),
which of the following therapies would be MOST effective in treating delirium in this
patient?
(A)
(B)
(C)
(D)
Fluoxetine
Haloperidol
Lorazepam
Fentanyl
DIRECTIONS FOR ITEMS 95 AND 96: These items refer to the diagnosis, treatment, or
management of a single patient.
95.
A 59-year-old patient complains of pain over her face extending from her cheek to temple
and scalp without a history of an associated rash. The pain is sharp and stabbing in
nature. Which of the following would provide the MOST appropriate initial therapy?
(A)
(B)
(C)
(D)
96.
Naproxen
Morphine
Acyclovir
Carbamazepine
Unfortunately, the patient’s pain is unresponsive to a number of medication trials.
Magnetic resonance imaging of the brain reveals no evidence of a neurologic tumor.
Which of the following would be the MOST appropriate next therapy?
(A)
(B)
(C)
(D)
Radiofrequency thermal lesioning of the maxillary (V2) nerve
Application of transcutaneous electrical nerve stimulation (TENS)
Glycerol gasserian ganglion block
Local anesthetic gasserian ganglion block
DIRECTIONS FOR ITEMS 97 AND 98: These items refer to the diagnosis, treatment, or
management of a single patient.
97.
A 62-year-old man is scheduled for coronary artery bypass procedure with
cardiopulmonary bypass. For which of the following concomitant valvular conditions in
this patient is retrograde cardioplegia MOST likely essential?
(A)
(B)
(C)
(D)
98.
Tricuspid stenosis
Aortic insufficiency
Mitral stenosis
Mitral insufficiency
During cardiopulmonary bypass, the retrograde cardioplegia delivery system is monitored
via a pressure transducer. During retrograde cardioplegia, pressure measured from the
cardioplegia cannula is l mm Hg. Which of the following is the MOST likely position of
the retrograde cardioplegia cannula tip in this scenario?
(A)
(B)
(C)
(D)
Right ventricle
Coronary sinus
Aortic root
Left atrium
DIRECTIONS FOR ITEMS 99 AND 100: These items refer to the diagnosis, treatment, or
management of a single patient.
99.
A patient with a history of previous low transverse cesarean delivery presents to the labor
floor. According to the most recent American College of Obstetricians and Gynecologists
guidelines, which of the following statements about a trial of labor after cesarean delivery
(TOLAC) is MOST accurate?
(A)
(B)
(C)
(D)
100.
Spontaneous labor increases the likelihood of a successful TOLAC.
A history of 2 previous cesarean deliveries would be an absolute contraindication
to TOLAC.
Epidural analgesia is considered a risk factor for unsuccessful TOLAC.
The presence of twin gestations would be a contraindication to TOLAC.
The patient, whose 1 previous low transverse cesarean delivery was for a breech
presentation, is requesting epidural analgesia For labor and plans to attempt a trial of
labor after cesarean delivery (TOLAC). Which statement about the risk to a patient of
undergoing TOLAC compared to an elective repeat cesarean delivery (ERCD) is MUST
likely true?
(A)
(B)
(C)
(D)
The overall risk of maternal death is less.
The overall risk of a peripartum hysterectomy is higher.
The risk of transfusion is significantly higher.
Overall hospital stay is likely to be longer.