Anesthesia Practice Questions

2007

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(()(/;/('J

6J
lisa M. Councilman-Gonzales, MD

Anesthesia Practice Questio-"n",s,-:"'20-"0:'7_ __ _ _

A-Type Queslrons (Single Best Answer)
l.

A '17-yedl-o lci f,;ma le w llll a PClst medical history of

pI escnts to thf: operating room fo r a cholecystectomy
rnelopro lol , caplopnl, and half of I,er usuai dOSE of
induction Wltll propofol, felltanyl, and rocuro il lum, the
refrdctmy to ph en y iephrine.

hypertension and diabetes mellitus

having ta ken her morning doses of
NPH insulin. Following a standard
pa ti ent develops hypotension th at is

5.

A 67-year-ol d male arrives to t he post-anesthesia care unit following" cholecystectomy . He

is shive ring and has a tempera ture of 35 Celsius . His heart rate is 130 beats per m inute,
blood pressure is 230/110 mm Hg, oxygen saturation is 97%, and ECG monitor shows ST
elevations.
What is t he BEST first tre"tment7

WC1l(:h of th e following dl'ug s wou ld M OS T likely be effective in this situation 7

A)

Meto pro lol 5 m9 IV

B) Forced air warming blanket
C) Demerol 25 mg IV
0) Oxygen 2 liters per min ute via nasa l cannu la
A)

D opamil){-:~

S) flo butarn ifll"

C) DeXdrnet haso rJC'::
D) Glucagon
E)

6,

2.

A 23-year-old, Type A, Rh -negative, male is transfe rred to the operating room for removal of
a fractu red spleen followi ng a motor vehicle accident. Vital sig ns include a blood pressure of
90/65 mmHg, a heart rate of 128 beats/min ute, and an oxygen sa t uration of 92% by face
mask with 6 liters of oxygen per minute. Upon incision of the peritoneum, 1100 ml of
sudden blood loss occurs .

VVh lch of t ile follow ill9 stateillen ts are TRU E regarding ad enosine?
A) ~l ay be Ineffective in patients takin g metll ylxanthlnes (theophyl line)
B) It is lIse fu l in con ve rtjnq atrial fl utter to normal sinus rhythm
C) Significan tly higher d05~;:S must be used in patients recei ving dipyridamole
D) Peak drug "ffeet occurs at 3 minutes
E) Is Ineffecti ve III Wolff,Parki nson -Wh ite Syndrome

3,

Morphine 5 mg IV

E)

V<)s opress lli

Which of the fo llowing blood products is the MOST appropnate tor administration at this
time?
A) Type O-negative whole blood
B) Fresh frozen plasma
C) Type A-negative platelets
0) Type A-positive packed red blood cells
E) Type O-negative packed red blood cells

A eI7-year-old male with severe hypertrophlc card iomyopathy presents for an emergent
appendectomy. Preoperative blood pres su re is 100/67 mmHg with a heart rate of 70 beats
PC I- mi nute .
An appropriate al1es thetlc pl,, " may include all of the following drugs EXCEPT:

A) l'lalothane
B) l'1etoproiol

All of the follow ing antibioti cs may potentiate nondepolarizing neuromuscu lar blocking d rugs
EX CEPT?

7.

C) ~lllnl1()n e
D) Phenylepll nl1e
E) Sulenlil nil

'I.

A) Cefazo li n
B) Clindamycin
C) Gentamycin
0'I Bacitracin
E) Amikacin

A.II of tile fo llowlOCI [I rugs Jre phosphod iesterase InhlbitOl's EXCEPT :

A) 5,l denafil
B) Aminophylline
C) Iv1il,, " one
D) Hyrt ra lazine
C) Amri norl e

7/lI:'; mall..'fl.11 m.Jy flll( IA'lfupltCJILV (){ used

2nn !, All ){i ~j hlS );: es t'lvt2 ci

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/I. nes th_f::s ia Pructl ce

QU~~ U OIlS:

2007

Anesthesia Practice Questions: 2007

A-Type Question s (S in gle Best Answer)

8.

A- Type Questions (Sin gle Best Answe-r)

A 2-year -old bo y wlll, a history of tetral ogy of Fallot 15 to undergo a general anesthetic fo r
bi ldlE'ra l my ring otomy with lube placements. He is noted to be cyanotic in the holding area

12. Which of th e fo llowing are true statements reg ard ing Guillain-Barre sy ndrome (GBS)?

pl co peratively .

A) Symptoms are most often preceded by an infectious syndrome with

staphylococclls au re us .
B) Corticosteroids have been shown to be beneficia l.
C) Orthostatic hypotension and bradyarrhythmias are frequent complications of
GBS .
D) Respiratory failure occurs at initial presentation in 60% of patients.
E) Intravenous immunoglobu lin has not been shown to be helpful.

Prirnary int(~ rv en tion s ror the trCJtm en t of a "te t spell" include al l of the fol lowing EXCEPT:

A) Valsa lva maneuver

B) fJheny lephnne
C) OXY ~Jcll
D) I lypervel1tllatlon
E) Intravenous flu id bolus

13. Which of the fo llowing are abso lute contra indications to tra nsesophageal echocardiography7
WI,l ch of the fol lowin g com bi nations are the main determinants of (1) right ventricular
perfu sion, and (2) left venlrlcu lar subendoca rdial perfusion)
A) (l)
(I)
C) (1)
D) (1)
E) (1)
B)

A)
B)
C)
D)
E)

diastolic arteria l pressure, (2) mean arterial pressure

mean altenal pressu re, (2) cliastollc arterial pressure
diastolic arterial pressu re, (2) systolic arterial pressure
pulmonary artery diastolic pressure (2) diastolic arterial pressure
systoli c artenal pressure, (2) mea n arterial pressure
14.

Esophageal stricture
Esophageal varices
Coagulopathy
History of dysphagia
History of radiation to the mediastinum

A 68-year-old ma le is undergoing an elective abdomina! aortic aneurysm resection under

general anesthesia. The fo llowing radial arterial wave form is noted :

Five Illinules dfter completion of a sp ina l anestlletic for an elective cesarean section, th e
jJJtient's fJloocl pressure decreases to 85/60 mmHg. Th e patient is treated with ephedri ne 10
m~1 intl-aven oll s.
f he PRIMARY rllech anisll1 by which ep hedrine increases uterine blood flow in this scenario
IS
A)
B)
C)
D)
E)

l 1.

Positive inotropy
VClloconstriction
Positive chronotropy
I ncreclse ill sys te mic va scu lar resista nce
Uterine artery dilation

~c------

(;)

A)
B)
C)
D)
E)

High compliance arteria l line tu bing

Bubbles in the arteriai line tubing
An 18 gauge catheter used for the arterial lin e
Hyperviscosity of arte ri al blood
Arterial line transducer above the level of the right atrium

A lel't shift of tloe oxyllemog lo bin dissociation curve

Norma l immune function

I mproved pulmon ary function tests

Decreasecl sputum production
NOI-ma l r al-boxyhemoglobin levels

-n-;;;-;;;-;;;~;;-;,~;y flot 1J~-d~;licated or used

CO py;i9h l:

___________________________

Wh ich of th e following wou ld exp lain this waveform 7

A '17-year-olcl lTIale IS scl.eduled for a transureth ral resection of a bladder tumor: He quit
smoking four days ago . Which of the fo llOWing benefiCia l effects of smoking cessation Will be
seen at th is lime 7
A)
8)
C)
D)
E)

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an

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Copyright 2007, All Rights Reserved

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~n~'sttles~~~~~~__g~~_~;~~]~_~ 2q~~

A-Ty pe

15 .

(Single Best Answer)

A-Type Questions (Single Best Answer)- - -

Blood concentrat lorlS l ollowi ng allsorption of local anesthetics associated with regio nal
,,,,esthetlc techn iques vary from hlgllest to lowest in Wllich of the follow ing orders?

f\)
B)
C)
ll)
E)

ICi.

Anesthesia Practice Questions : 2007

Q u~ stion5

Inte l'Costdl nerve block > Ca uejal block> Epid ural block
Cauda l block> Sciatic nerve block > Brachia l plexus nerve block
In tercosta l nerve block > Epiciural blocl< > Paracervica l block
Caudul block;. Brachia l plex us nerve block> Epiciural block
Pclf-accrvicJ I bloCk > Sciatic nerve block> Epid ural block

A)
B)
C)
D)
E)

Serum sodium < 130 mEq/ liter

Urine sodium > 40 mEq/liter
BUN/creatinine ratio < 10
Fractional excretion of sod ium < 1 O/u
Urine osmolarity < 350 mOsm/ liter

21re appropriate ;nitial stE'PS EXCE PT:

A) Oph thal mology co nsultati on

B) Top ical steroids ilpplled to COI'I',ea
C) Eye patc h
I)) Ophthalm iC an tibiotic ointml'nt
c ) Huoresc ien up ilthJ lmic dro ops

A 42-year-old fema le with a history of chronic hypertension is post-operati ve day one

follow ing an uneventfu l to tal abdomi na l hysterectom y. Sh e has had only 200 ml of urine
output in th e last twenty-fou r hours .
Which of the fo llowing lab resu lts wou ld be associated with a pre-rena l etiology of the
oligu ria7

A 41 ye clHJle) )-e rnal e arrives in t he pos t-a nest hesia care un it fo llowi ng an uneventful
chol ecystecto my. She com plains of right eye pain , learinCJ, and ph otophobia. All of the
1U\ I ( Jwi n ~J

1.7

19.

- - - -- -

4-ye a r~ol d

boy with

<J

20.

All of th e fo llowing medications work primaril y by affecli ng GABA receptors EXCEPT :

A)
B)
C)
D)
E)

Etomidate
Ketamine
Thiopental
Mida zolam
Propofo l

ventricul,,, septal defect IS about to lJnd el~g o a t onsil lectomy and

An inllClJation induction wi th sevoflu rane is

{} fl el lO!r1ecto rn y ullrJc'r genera l anesthesia.

nlclll lled.

21.
Wila t is the i:lnLICipoleo effecl on tile in halation in duction in this child compared to a healthy
CJI I!cP

,6. )
8)
C)
LJ)
E)

A l8-yea r-old mal e with Parkinson's disease, treated with levodopa-carbidopa, undergoes a
cystoscopy and tra nsurethra l resection of a bladder tumor under general anesthesia . He
. awakens in the post-anesthesi a ca l~e unit and cam plaills of nausea .
Which of the fol lowing medications ca n be used safely to treat nausea in this pa ti ent)

Decreased speed of ind uction

Increased speed of induction
No siCj niflca nt change in speed of indu ct ion
Inlt rally slower speed III In duction fol lowed by an increase In speed of induction
Initi al ly fa sl er speeci of Induction followed by a decrease in speed of induction

A) Droperido l
B) Met oclopram ide

C) Promethazine
D) Onda nset ron

E) Prochlorperazine

Ie.

WJ1iI:I I of til e tallowin,) patients has th e Inwest predicted mi nim um alveolar concen tration
( fYIAC ) of inha led anesthetics va lue')

22.
A) J\ nongra vicJ 25-year-old woman
U) A gravi d 2S-yea r--o ld wom an
C) A 6-InontJr-old boy
LJ) A 16 year-old boy
E) A 'I O- yeJ I 'olcj man

A 42 -year-old woman presents to the chronic pa in c linic w ith com plaints of fatigue/
generalized weakn ess, and du ll, aclling pai n in I-, el~ neCk, siloulders, and back. On physical
exa mination the patient is noted t o have discrete painful areas in her back, neck, and on
both upper extremi ties without rad iation of the pa in . La bora tory studies are normal.

Th e MOST likely diagnosis in this patient is :

A) Rheu matoid arthritis
6) Polym yal gia Rheumatica
C) Fibromya lgia
D) Mera lgia Paresthetica
E) Complex Region al Pain Syndro me Type

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Anesthes ia Practice Out'stions: 2007

23.

Anesthesia Practice Questions: Z007

~-~e~estions (Single Best Answer)

A-Type Questions (Single Best Answer)

A 2-week -olcl premature infant is undergoing ligation of a patent ductus arteriosus ligation
under general anesthesia . The recurrent laryngeal nerve is inadvertently severed during the
proced ure

26 .

use is

A) A physiological phenomenon of withdrawal symptoms following abrupt

discontinuation of a drug
B) A reduced effect of a drug following repeated doses
C) Frequent visits to health care providers with complaints of inadequate pain re lief
0) A compulsive use of a substance that results in harm to an individual and
continued use despite the nega tive con sequences
E) The presence of wi thdrawal sy mptoms upon administralion of an antagonist drug
such as na loxone

A)

Left vocal cord paramedian position

Right voca l cord parameclian position
C) Left vocal cord abducted
0) Rig llt vocal cold abducted
E) Bilatela l vocal cord abduct ion
B)

A one-clily -old infan t IS discovered to have a left-sided congenital diaphragmatic hernia . On

chest auscultation, heart sounds are hea rd over the right thorax.

27 .
All of the follOWi ng trea tments may be instituted EXCEPT:
A)

Mai n tenance 01 PaCO, <

~5

rnml-lg

C) Intubate anel ve ntilate with high frequency Jet ventila tion

D) Intubate and use of high positive end -expiratory pressure to reexpand the left
lung
E) Vcn til(ltioll w ith extracorporea l membrane oxygenation

A 47-year-Old tnel le undergoes cOfnplex instrumentation of t he upper th orac ic spine in t he

prone posi t ion employing Mayfie ld tongs for head positioning . Con trolled hypotension uSing
a soclium IlItroprLlsside infusion is employed to min imize blood loss. Surgical t ime is six hours
and esti mated blood loss IS 2200 mL. Blood loss is replaced with eight liters of crystalloid
solution, 500 011 of Il eta starch solution, and two units of cell -saver blood . Post-operative
hemog lobin is B.I g/cI L. Upon awakening, the patient comp lains of vision loss bilaterally.

28.

Appm priate preca utions for Il clping to insure an adequate intravenous reg iona l anesthetic
include all of t he fo llowing EXCEPT :
A) Infiation of the tourniquet to 300 mml-l9
B) Using an epinephrine-containing loca l anestlletic solution
C) Feel ing fo r an absent radial artery pu lse fo llowing inflation of the tourniquet
0) Using a double tourniquet
E) Exsanguination of t ile ai m with an eiastic bandage prior to in flation of the
t ourniq uet

What is til e M O ST like ly diagnOSI s?

Opl:ic chia sm hematoma

Cortical blindness
Central retinal artery occlusi on
0) Eml)ollc stroke
E) i sche ill ia of the optic nerve

A nurse accidentally deflates the tourniquet five minutes fo llowing an intravenous regiona l
anesthetic in the left upper arm using 50 mL of 0.5% lidocaine .
Ail of th e follow ing are appropria te in itial meaSUIes EXC EPT :
A) Reinflation of th e tou rn iq uet to the previous pressure
B) Adm inistration of oxygen
C) Administration of a benzodiazepine
0) Administration of sodium thiopental
E) Application of a CNS monitor

B) Placemen t of a nasogastric tube

25 .

~PiOid

Ad diction is BEST described as:

WI-lich of the fo ll owing findings wou ld be present under direct laryngoscopy'

2~ .

A 33 -year-old male with a history of Five previous back surgeries and high dose
referred to the pa in clinic for evaluation for suspicion of opioid addictio n.

A)
B)
C)

29.

One minute post-delivery,

PaO,70, PaCO, 48 .

a 4 kg newborn's artel ia l blood gases on room air are pH 7 .20,

The BEST course of action is:

A)
B)
C)
D)
E)

Tlii:; {/Ji:l tr..'riai may flot {}e dup(ll:iJ red or

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Admin istration of oxygen by face mask

Bag-valve-mask ventilation with 100% oxygen
Administration of sodium bicarbonate
R.o utine neonatal care
Intubate the tra chea

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Anesthesia Practice Question,,:s,::::2c:O::.07~_--=:_-;c-_=---c--c::_

_ _____ _
A- Type Questions (Single Best Answer)

Que:',tiuns (Single Best Answe r)

30.

A pati en t is post-ope rative day 3 from a total knee replacement with an epidural for postoperative pain management . Upon rernoval of the epidural ca theterl 2 cm is noted to be
11 1">51119 from tile lip of til e catlleter.

34.

Wilat. IS ti le MOST appropria te step at tll is tl me 7

A)
B)

Observation and r-eass urance

Obta in STAT myelogra rn
C) Obtain STAT lumbar spi nE MRJ
D) Obtai!1 STf\T neuro log y Cor15Ult
E) Surg ical removal of catheter tip

31

32.

33.

Magnetic resonance imager (MRI)

Electrocautery
i:lectroconvulslve IIlerapy
Ra diati on therapy
Rad io frequency abla ti on

B)
C)
D)
E)

35.

Nitrous oxide
NltropllisslCle
Nitrocllycerrne
Nitric oxide

Her symptoms include

f olloW lrllj Glrd laC lesions ';

A)
EI)

Systolic anterior mo ti on of the rnlti-al valve

Mltrall nsufficiency
C) Mitral stenosis
D) Pulmonic stenosis
E) Aortic insufficiency

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publisher.

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A 52-year-old ma le is seen In the pain clinic for evaluation of a large L3-4 herniated disk with
right-sided mild to moderate radicu lar symptoms arrd no other neurologic findings. He is
currently taking clopidogrel and aspi rin following placement of a paclita xel-eluting stent in the
left anterior descend ing artery eight weeks prior. A trial of epidural steroid injections is
requested by his referri ng physicia n.
What is the MOST appropriate course of action"

fi ndings woulcl be most likely to demonstrate which of the

CU !J y ri ~lhl' 'u ;!'007 , A/ I r~i9h1S ik.s("1 vt: d

A clinical investigator wishes to conduct a research project comparing the presence or

absence of a low incidence outcome between two groups in a placebo -controlled trial.

A) Analysis of Va ri ance
S) Fisher's Exact test
C) Chi-Square test
D) Student's T-test
E) Unpaired T-test

36.

1~ l trofurantOli1

edlOCCH'clio~Faphic

Cryoprecipitate
Pla telet tra nsfusi on
Fresh frozen plasrna
Vitamin K

Which of the followi ng statistica l ana lyses wou ld be th e M OST appropi-iate to apply to the
f indings?

A 47 -yea r-old female presents for resection of an ovarian t umor.

flustlif19, bmnchoconstrlctiOrl l and dia rrhea .
Prf--.:ope r-ative

A 55-year-old male with a past med ical histOlY of atherosclerotic coronary vascular disease,
status-post coronary stenting of the left anterior descending coronary artelY one month ago,
presents for emergency exploratory laparotomy fo r small I)owel obstruction . Preoperative
medications include metoprolol, clopid ogrel, and nitrog lycerin.
Intra operatively and
postoperatively, the su rg eon complains of increased "oozing " From the t issue . Postoperative
la b work reveals a hemo[jlobin of 9.1 gjdL and a platelet count of 1 20,OOOj~L.

A) DDAVP

Megaloblas tic hematopoiesis occurs Wi th long-term administration (> 12 hours) of which of

the follow irrg agerr ts'
A)
fJ)
C)
D)
[)

_ _ __

Which of the following treatrnents is the BEST clloiee to correct this patient's coagulopathy'

External elr-:'ctri c;:!1 im erfcl-ence wi th implanted defibr illator function may be expected with all
these electrica l devlcc,,; or eiectrrca l devi ces used in the following procedures EXCEPT:
A)
B)
C)
D)
E)

A) Discontinu e clopidogrel and aspirin for 7 days, then proceed with epidural steroid
injection
S) Discontinue clopidogrel and aspirin for 14 days, then proceed with epid ural
steroid injection
C) Discontinue clopidogrel for 7 days, continue aspirin, then proceed with epidural
steroid .injection
D) Discontinue clopidogrel for 14 days, continu e aspirin, t hen proceed with epidura l
steroid injection
E) Continue clo pidogrel and as pirin and defer epidu ral steroid injecti on fo r fou r
months

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.0llesthesid ~Jracl~~_ Ques Uo~~' 1.007

A - Typt~

37.

~nesthesia

Practice Questions: 2007

A-Type Questions (Single Best Answer)

Questions (Single Best Answer)

A 46-I'car-old fem ale diagnosed with deep vein thrombosis develops sudden onset of chest
pam and dyspnea.

41.

A l-week-old neonate ha s an MRI of the brain to evaluate a parenchymal hemorrhage . After

the procedure t he patient is noted to have susta ined a burn on the foot at the site of t he
pulse oximeter.

A large pul monClrY embolus is associated with

parameters?
A)
B)
C)
D)
E)

38.

DECREASE in which of the fol lowing

Which of the following would explain the etiology of the burn)

A) Pu lse oximeter taped too tight
8) Ma lpositioned electrosurgica l return plate
C) Current was generated through the pulse OXimeter wiles
D) The MRI unit was grounded
E) The MRI unit was ungrounded

Pu lmon ary artery wedge pressure

Right atna l pressure
Respira tory rate
Mean pulmonary " ILery pressure
PilCO,

A J-year -old child Ilas ail inhalation induction for an umbilica l hernia repair. Intubation of the
l l- achea with un t-~ n dotrachea l tube is planned.

42.

In a 50-year-old man, the dura mater terminates at which spinal level?

A) L,
B)

Will et) of til e followin'l is tile na rrowest paiL of tile Infant airway?
A) GlottiS
B) Cri coid caltil age
C) Thyroid (2)rtila~]l:~
D ) Larynx
E) l)harY f1 x

43.

39.

A)
8)
C)
D)
E)

What is the half-life for til e decl ine in fentanyl level after patch removal?

He is noted to have low-set ea rs

Treacher-Collins
Ehlers-Dan los
Pierre Robin
Hurler
Goldenhar

hours

A)

B)

12 hours
l8 hours

44.

D) 24 huurs
E) 72 hours

40.

A 6-week-old infant arrives for repai r of ingu ina l hernia.

and appears microgna t hic.

All of the following syndromes are associated wi t h a difficult intubation EXCEPT:

A 15-year-olcl fcma le arrives in the pleoperative holding unit schedu led for a left breast
lumpectomy. Sile is a patienl: 111 the chm nlc pain cl inic and uses a transdermal fentanyl patch
SCI mcg/h l. She re moved the patch at 6 A~1 the morning of surgery after having the patch
on for the prior 48 I,ours.

C)

C) Ls
D) 5,
E) 5,

Ali aI' the follOWing can deliver a mlCl"oshock to a patient EXCEPT :

Cen tral line guidewire
B) Sa li ne-filled cent lal line
C) Blood-filled cen tral line
D) Frayed eleetmcardlogram wire
E) Pacemaker wile

A)

----. -~ -.-- -- .- - -

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Which of the following fil ling errors would result in the LEAST amount of error in
Ilalogenated volatile agent delivered?
A)
8)
C)
DJ
E)

Desfiurane in an isoflurane vaporizer

Halothane in a sevoflurane vaporizer
Halothane in an isoflurane vaporizer
Desfi urane in a ha lothane vaporizer
Desfiurane in a sevoflurane vaporizer

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~~~:,<::::S i ;.-) P r_~.l~~ SLl!.~-~~~ ~_~~ _.

___ __ _____ _

.0_~thesi~Practi,:e Questions:

A-Type Questions (Sin~J l e Best" Answer)

A ialJOf epidura l is placed In a 20-yearold woman, gravida 1, para 0, at 39 weeks gestation.

Dur ing th e irlseltioll of th,' Tuo hy neerlle util izing the loss of resistance to saline techniq ue,
clear flU id retur " s flOIli til e needle

4S .

54 .

rl k' BEST way to cliffererl tidte sclli ne from CSF clt this point is:

II)
El)
C)
D)
rc)

46

2007
A-Type Questions (Single Best IInswer)

A 51 -year-old male with chronic obstructive pulmonary Gisease IS being transported to the
MRI suite fo r a lumbar spine MR!. He is tl'ansported with oxygen via nasal cann ula at ]
liters/minute .

If ti,e oxygen E-cylinder reads 1000 psi, rougil ly how long wi ll the oxygen last?

Fee l lUI temperature of flUid

Inject Fentany l 15 mcg
lnject iidocaine L .5~/o with epinephrine, -3 mL
Cil eck Fi ulcl lor glucose
See If fluid return stops

A)
8)
C)
0)
E)

of the followiilD sta teme nts regardi ng high altitude in halation anesthesia
i-KJrnin istration vi a d modern vaporizer at a specific vaporizer setting is CORRECf?

Wh ich

55 .

One-ha lf hour
One hour
One and one ha lf ho urs
Two hours
Unable to ca lCUlate with th e given Informa tion

The "3in-l " nerve block targets blockade of all of tile fol lowing nerves EXCEPT:
A) Latera l femoral cutaneous nerve
B) Femoral nerve
C) Sciatic nerve
0) Anterior fem oral nerve
E) Obturator nerve

The pclrtial IHeSS LJ re of the ca rrier gas is unchanged with varying altitude.
f1) The parti;:11 preSSUie of th e vaporized inhalational agent is unchanged with
varyillq al ti tude
C) rile vapm pr-essli re of the vaporIZed Inilalatlona l agent IS unchanged with
va rying altitude
D) Prior to anesth esia admin is tration, the inhaled oxygen cOllcentration wi ll change

1\)

inve rse lY with altitude.

F)

The Il loocJcl as partition coeificiell t of the inhaled agent will (Ilange inversely with

il ilitudc

4 /.

56.

A)
B)
C)
D)
E)

A 26-year-old fema le ilt 37 weeks gestation with severe mitral stenosis suddenly develops
atria l fibr illation wi th a rapiel ventricula r response. Her blood pressure is 72/42 mmHg, heart
rate IS 158 beats/nllnute, and feta l lleart rate is 72 beats/minute.
Til E:' BEST imillecli3tc treatment is:
57.
i\)

Ade nosine
CarrJiovel-c;ion

B)
C) [smola I
D) Carotid IllJssa9 t:
E) Amiocl cll-on e

Minimum alveolar concentratio n (MAC) of an in iliJlationai volatile anesthetic:

A 28-year-old male was anesthetized for an appendectomy.

General anesthesia was
uneventful with the patient's arms tu cked to his sLde . On postoperative day 2 the patient
complains of numbness in his index and long fingertips . He also has Impaired thu mb
opposition and wrist flexion.
Wh ich nerve was affected'
A)
B)
C)
D)
E)

- - _._- _. --

- --_ .. _

This f71,_'! tefl~'J/ f/h'W not iJe dU!J/iCdit.-'"li

Cupyrigll t

(If

Is unaffected by supplemental anestheti c adjuvant drugs

Is not a useful number foe comparing potencies of volatile agents
Is un affected by the age of the patient
Is a single point on a dose-respoll se curve
Is eq ually comparative between agents when used in multiples of MIIC

- - - - - _._ -_ . -

USf!(! ,rl

J(I

--- - -~ --------

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Radial nerve
Ulnar nerve
Musculocutaneous nerve
Median nerve
None of the above

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Anesthesia Practice Questions: 2007

A~Typ e

58.

IscllcnllC optic neuropath y (ION):

62 .

A)

Is prim2lriiy associa tecJ w ith occip ita l ischern ia

8)
C)
D)
E)

Is u5 Lkilly temporary
J's alw ays as socia te d with severe atherosclerosis
I s as soCiated with prone position surgery
Js associated most frequently w ith unrecognized in traoperative eye pressure

An 80 ~year~old female is undergoing a t horacotomy fo r a right upper lobe resection. During

one~ lung venti lation her oxygen saturatio n drops to 89% .
The MOST ap propriate next step is:
A)
B)
C)
D)
E)

')9. Which of I.he fo lloWII-l g med ications has the shortest elimination halF- life?

A)

Questions (Single 3est Answer)

Positive e n d~expiratory pressure (PEEP) to the left lung

PEEP to the right lung
Contin uous positive airway pressure ( CPAP) to the left lung
CpAp to the right lung
Institute two~lu ng ventilation

H UI11(JLt::l lll

13) Clonazepalll
C) Midazo larn
0) Lorazepam
E) Dia zepam

63.

B lood~gas solubility of th e volatile agent

Degree of dead space in t he lungs
C) Degree of intra pulmona ry shunt
0 ) Inspired concentration of the agen t
E) Size of a rig h t~to ~ left intraca rdlac shu nt

A)
B)

ao

k~J, is b ro U~lht to t hf-~ operati ng room for corona ry arte ry bypa ss

A 1.1S-yea r- o :c1 rna n,
g ra lt irl ~J , A subcl21vidli u~ n t ra l li ne is in se rtt~ d und er loca l an esthesia, Genera l anesthesia is

6U .

",clueecl with micl uzolam 10 1119 an d fentany l ~OO meg . I mmediately fol lowing indu ction, the
p;;ltien t's centl-a l veno us pressu re inuea ses and the pu lmonary artery pressu re increases ,
T h (~ p;Jtl en t is nu ta b ly 1 1Iu ~ e difficult to m i) S :\ ventil;:lte,
I-he B EST initial

64 .

~;te p

[\ 70-year-Old male is sc heduled to have a lumbar laminectom y. He has a history of coronary

arte r-y d,sease and ha d J 3-ve sse l coronary artery bypass graft five yea rs ago. He plays
ten nis for one houri three times a w eek, without any cardiac symptoms.

A) Hemog lobin electrop horeSIS for sickle cell diagnosis

B) Maintain an FiO, > 50% to prevent sicklin g of erythrocytes
C) Transfuse w ith packed red blood cells to 50% hem og lobin A
D) Tourniq uet use for intraveno us catheter insertion is contraindicated
E) None of t he above

65,

Wh ich of th e foli o wi ll~J is t he MOST appropriate next step?

1'.)
8)
C)
0)
E)

A lO -day-old t erm in fant is schedu led for a ventricu lo- peritoneal shunt for hydroceph alus .
The pat ie nt's mother is homozygous for si ck le cell disecls, The in fant's electrolyte s are
with in normal range and hematOCrIt is 40% .
Special con cerns for th e management of t his patient inclu de:

A) Con tin ue to I'll<.'l sk venti la te and wake patien t up

8) Mrn lnlst el' sUCCl r,ylcllol lne
C) rU III pa tier lt to t he left lateral decubitus position
D) Mask vcn ti la l.c with isoflLlI'ane and oxygen to "break" the laryngospasm
Ie ) Admini ster na loxo l',e

61

The speed of induction duri ng an in halation inductio n vari es directly w ith the:

Exercise stress test

Dobutam ille stress ccho cardlo graphy
Echocardi ogram
24-hour Holter monitol
Proceed With scheduled surgery

A 19 ~yea r~0 Id intoxi cated male is brought to the emergency department with a traumatIC
head injury fo llowing a motor vehicle accident. Th e patient's vita l signs are sta ble and he IS
breathing sponta neously. Multiple lacerations are noted on hiS chest and face . Both upper
incisors are miSSing and there is a large ling ual laceration and hematoma. The mandible
appears disfigured and has ecchymotiC areas . A celvical immobilization collar is in place.
Which of the fo llowing airway ma nagement techniques is the MOST appropriate fo r t his
patient?
A)
B)
C)
0)
E)

Rapid sequence induction and intubation with thiopental and succinylcho line
Awake nasal fiberoptic intubation
Awake oral fib eroptic intu bation
Tracheo stomy
Blind nasa l intubation

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.0.:.1cst ~~~~ __1'..r2~L!~~:) uc ~>~i()~ .~=,--:_3~l}

A-TYiJ; Q u~'stiO'ls (S)-r~e-Best Answer) -

60.

Anesthesia Practice Questions: 2007

-- -

A , 6 year aiel hoy IS in [i'le preoperative Iloldlng area awa iting electroconvulsive therapy fo r
severe, intractable
He IS give n haloperidol for ag itation. Twenty minutes la t er
tl'le PiitiCllt is rlclcl
lias ilbrlorma l movement in Ilis extremities. The patient's vita l si gns
,] re wltllin no rma l li mits and Ile is brea thing spontaneously.

A-Type Questions (Single Best Answer)

69 .

Wh ich of th e following statements Is TRUE regarding an I ABpo

Th e BEST treatment for t ill'; patient at th is time is:

A)

A) The IASP infiates during early diasto le and deflates during late systo le
B) The IABP inflates during early diastole and defl ates during early systole

Dclll t,olell e

C) T he IAB P inflates du rin g late systole and deRates dUring late diastole

[I) Naloxo ne
Olpi lc il hydr<lmilic
D) Pra licloximc
[) Fl um,lZe nil

0) The IABP infiates du ri ng late diastole and deflates during early systOle
E) The IABP infiates during la te diastole and deflates during late systole

C)

70.
67 .

A 26-year-old asthmatic f emale is postpartum after a twin del ivery. She has uteri ne aton y
that has been un res ponsive to oxytoci n.

A 22-ycc r-olcl cornatose rn ale w ith a tra um atic head injU ry and a C3 fracture is being
eva luated for 11 1"Clin stem ciu!Tla ge in the neur-osurgical inte nsive ca re unit.

Which of the fo llowing medications wou ld be the BEST choice for treatment of the uterine
atony at this time?

Which of the fo llowi og is the BE ST method to eva luate th is patient's ocular and vestibular
injurie,s?
Use the oCLl locepha lic reflex (doll's eye maneu ver) to show the pa ti ent's eyes
ciri fti Cl9 to th e left wh en turning th e patient's to the left, showing no bra in stem
injury
B) Use th e oculoccpha lic refl ex (doll's eye maneuver) to show t he patient's eyes
c1nftiCl9 to the nght when tum;ng th e patient's to th e left, showin g no brain stem
InJLHY
C) Use til e ocu locepilailc refl ex (doli's eye maneuver) to show the patient's eyes
drifti ng superior when turn in ~J the patien t's to th e left, showing no brain stem
Inj ury
0) Use t ile oc ulocep halic l efiex (cioli's eye maneuver) to show the patient's eyes
rerna inir19 fixed in the center, showi ng no brain stem injury
E) None of the above

A)
B)
C)
0)
E)

A)

68.

A 65-year-old ma le is undergoing coronary revascu !a rization . He has fa iled weaning from

cardi opulm onary bypass and an Intraaortlc balloon pump (JABP) Is placed .

A 42-year -ol d male With illSlllin-d ependent diabetes is ad mitted for acute appendicitis. HIS
blood glucose is 510 g/dL and Il is temperature is 102.4 F. He is listless and his ora l mucosa
IS dry.

71.

Intramuscular 1S-methyl-prostag landi n f'."ph'

Intravenous IS-metllyl-proslaglandin F,.",h,
Intramuscular methylergon ovine
Intravenous methylerg onovine
Oxytocin 20 units IV bolu s

A 31-year-old male is undergoing a splenectomy after sustaining a splenic ruptu re during a

motor vehicle accident. Intraoperatively he received eight liters of normal saline intravenous,
as well as a total of one liter of hetastarch Intrave nous fo r flui d replacement.
Which of the fol lowing is the MOST likely complica tion fro m this fluid resuscitation"
A) In creased PT
B) Increased PIT
C) Anaphylactoid reaction
0) Hyperchloremic metabol ic acidosis
E) T hrombocytopenia

Wildt is tilE' FI RST step III treatment for t hiS patient)

A) emergency SUI,]CIY
B) Insu lin illfuslon at a rate of O.l unit/kg/hI'
C) Ill t ra venous Il ydr'at,oll With Ilorma l sal ine bo lus
0) Aceta minop hen
[) lntr-i:wen ou s antibiotic s

li/l~;- flIail'oa/ r]l.), I/O! be duplic,.ltt.'u U! li '.<S}

COP'l l iSJh t
2007, /\11 Ri::} h L5 l{e~l' l v t,d

I/J .}I/

{vu, _
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An C!Sth esia P ract i c~ Quesl!ons: 2007 ,~--:c--cc--cccc-c-:c-,---:

A-Type Questions (Single Best Answer)

Ane.sthesia Practice Questions: 2007

A-Type Questions (Single Best Answer)

72.

75.

(\ 56-yea r-old fema le presents to the pa in clin ic with terminal osteosarcoma. She is on
extended-release morph ine for pa in but continues to have pain with ambulation; however,
she compla ins she is too som nolen t at rest.

A 15-year-old girl is undergoing Harrington rod placement for scoliosis .

evoked potentials (SSEPs) are to be monitored throughout the procedure .

Somatosensory

What changes in the SSEPs would be expeded if spinal cord ischem ia develops7
Which 01 the 10110win9
patient)

IS

the MO ST appropriate treatment for the bleakthrough pain in this

A)
8)
C)
D)
E)

A) Transdermal lentanyl patcl,

B) Transm ucosi'J 1 fentanyl lozenges
C) lilu ed se clo se oj- (~x te nd e d-relea se morphine

Increased amplitude
Decreased amplitude
Decreased latency
lncreased frequency
Loss of signal

D) Oxycoclone
E) MOrjJhine PCA pUIll P
76 .
73.

Which of the following statements ale TRUE regarding the standard error of the mean
(SEM):

A ll Cdlthy 2 5-ye,]r-o lcl male undergoes an elective ingu inal hernia repair with a nondisposable

A) SEM is used for computation s about the certainty of th e mean of the data
B) If you have a very large number of data paints, the SEM will be large
C) 5EM is a computation based on measured data
D) SEM is computed from sing le group determinations
E) 5EM is a computation t hat is used to replace the standard deviati on

lalyngeal mask " "way. Induction is accomplished with propofol, lidocaine, and fentanyl. No
lleurol11L1sculiJr blocking agents are used . Desflurane is used for maintenance of anesthesia.
Two ho urs postoperatively the patient devel ops a fever and diaphoresis.
Wllich of the followill g
A)

B)
C)
D)
E)

IS

tile MOST like ly etiology of this patient's symptoms?

Malignant hypel-tllelmia
Contaminated propofol
Neurolepti c mal ignant syndrome
Atelecta sis
Latex alle rgy

77 .

A 23-year-old female delivers a 9 Ib 5 oz infant with a labor epidura l for analgesia . She
received a "top-off" dose of 2% 2-chloroprocaine for delivery. The fo llowing day she
complains of weakness in her left foot with a foot drop and inability to invert the left ankle.
She is slightly weak in her left hip flexion and knee extension.
What is the MOST likely cause of this weakness'

74.

A 63-year-old alcoholic is scheduled for Iepair of an incarcerated umbilical hernia.

A)
8)
C)
D)
E)

Which of the 10liowin(1 la bolatory tests wou ld be BEST for determining adequate synthetic
hepatic functioning'
A) Aspartate aminotransferase
B) Ala nine aminotransferase

C) Tota l bil iru bin

D) Alkal ine phosplla tase
E) Partial tll rombopla slin time

78 .

Neurotoxic injury from epidural bupivacaine

Direct nerve trauma froin epidural needle
Peroneal nerve injury from position during delivery
Compression of the lumbosacral nerve trunk during delivery
Sciatic nerve injury

A 78-year-old male is scheduled for a suprarenal abdominal aortic aneurysm repa ir. After
induction the patient's neck and upper chest are prepped and draped for insertion of a
pulmonary artery catheter.
Which of the following findings on the patient's preoperative electrocardiogram would cause
you the MOST concern regarding place ment of the pulmonary artery catheter7
A)
B)
C)
D)

Right bundle branch block

Left bundle branch block
Left ventricular hypertrophy .
Nonspecific ST-T wave abnormalities
E) Old inferior myocardial infarction

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Anesthesia Practice Questions: 200 7

A- TY1.H'

7'1.

(~lu e s Uurl':;

(Slrlg le !Jest Answer)

A:--=T-yp-e-Qcc,-,e-s-C:ti-on-s-("'SC-,ngle Best Answer )

/\ 62.-ycd r o ld rna le l'i uilclenjO ir-rg II lapclro5copic cho lecystectomy. During Ule

procedure, the

patient's ell ci-tir\a I cal'bon dioxid e (ETC02) is noted to decrease to 12 mmHg.

82.

An arteria l

blood (JLlS is obtain ed iJrld til e arterial p~lrtia) pressure of carbon dioxide (PaC02) is 55
rnmHq"
All of the ~u ll o wirj(::J wou ld

Ci;IUS t:

Which complication of cau dal epid ural blocks is more likely in chi ldren than in ad ults?

t he PaC0 2 to increase and the ETC0 2 to decrease EXCEPT :

A)

A CJrtJon d ioxi de embo lus

B)
C)
D)
E)

An expiratory valve stuck In the open position

CarcJicK arTest

A)
5)
C)
D)
E)

Ai rwd Y cirC!.1!t disconnect

f\ G8- ye;:\f"-oIcJ IT\ale IS adm itted to t he in tc l"lSivc ca re unit for acute myocardial iscllemia. He
is Sl artcd 0 11 d h ep;:llin If"lfusion , Clnd mo rph ine and nitroglycerin are administered for chest

pa in Four cl ays after ad miSSion tile patient's chest pain IS contro lled, and his heart rate and
b.ood pressure arc sta bllizeci with labeta lol. The patient's platelet count is 80, OOO/~L,
decrci]secl froll] 185,OOO/llt two clays prior.

HI

Discontlrlu e lalletalol and sta rt esmolo l infusion and oral hydrala zine
Ad min ister Single donor plate iets
Discontillue hep,mn and administer argan t robam
Mn'"l1ster metlwlene blue
Do nul:hing sillce th is is exp ected f o llowill g a mycard ial ischemic ev ent

A 42-year-old ma le is broug ht to the operating room emergently for a Ilcmoperitoneum

following a motor veh icle accident. The patient admits to dri llkl ng over six beers a day and
using cocaine for "a long time."
Which of the following medications would be LE AST effective in improving hemodynamics in
this patient?
A) Ephedrine
B) Epinephrine
C) Phenylephrine
D) Dopamine
E) Dobutam ine

Which of the fO llowi ng is the MOST appropriate step at th iS time 7

A)
El)
C)
D)
E)

Intravascular injection
Profound motor block
Neurotoxicity
Tota l spinal
Obturator nerve da mage

Ai ,way obslructlOll

83.
80.

A 6-month-old child is undergoing a caudal epidura l block with 0.25% bupivacain e for
bilatera l inguinal hern ia repair.

84.

For cardia-protection against dysrhythmias, extracorporea l shock wave lithotripsy shou ld be

synchronized with the :
A) P wave of the e lectrocard iogram (ECG)
B) T wave of the ECG
C) Peak inspiration
D) R wave of the ECG
E) Respiratory pla teau

A 3D -yea r- old 11I;:11e: is emerging h"orn gen eral anesthesia following a vasectomy. He sudd enly
bitl.:' S c10W11 on t he endolr"".lCheal tube .
fVlultiple attem pts to open the patient's jaw are
unsliccessfu l i:H1d th e patient',;; oxygen satura tion begins to decline. Succinylcholine 30 rng is
aclrnlllist(=re ci and the patien t's jaw relaxes " Th e oxygen saturatio n re m ai ns 85% for 15
minutes"
rile M OST apprupri ate action at t his time

J~ "

8S.
A)

B)

J1ll1l1(~'cJiate cl"lest x-rdy J llclil ig h freque ncy ventilation

li Tll lH-:LJii:lle c(lest x-ray arId exlu lJation if chest x-ray is normal

C) Keep intub,]teci and aci rfll nlster I(,travenous antibiotics and steroids
D) Keel-' 11111.11)a lc,1 With postitive end-expiratory pressure (PEEP) added, administer
intravenol.l~; antibiotics, and perforrn pu lmonary lavag e
[e ) Keep intulJateei With PEEP addelj, aciminister diuret ics, and co ntinue close

The viru s most often tran smitted by blood t ra nsfusion currently is:
A)
B)
C)
D)
E)

Hepatitis A
Hepatitis B
Hepatitis C
Huma n immunodeficiency virus
HUman T-cell Iymphotropic virus (HTLV)

ob se rv,"ltion

~ - -

/.Jtj dllplieJ(eJ Uf UCiN f{/ ,tn

Z007, All Ri<;Jllts Re;erveel

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...

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~nesti l eS la_

86.

Practice Q~~bS"'~200 7 ______ .

A-Type Questions (Si ngle Best Answer)

Anesthesia Practice Questions: 2007

A-Type Questions (Single Best Answer)

A 78 yea r- old ma le presents to the Pain Clinic with a one- montll history of herpes zoster in
th e thoracic area.

A 55-year-old, 72 kg, fema le is scheduled to undergo cataract extraction under retrobu lbar
block. She has a history of heart transplantation 5 years ago for idiopathic dilated
cardio myopathy. She has no other medical history and is doing well on her anti-rejection
drug regimen. The patient receives propofol for genera l anestllesia for the retrobulbar
block. At the conclusion of the blOCk, the patien t develops a sinus bradycardia with a heart
rate of 38 beats/minute.

90.

fh e lesions have since resolved, but the patient continues to have severe

pil in in the affec ted area . He has been treated wi t h tho ra cic epidura l local anesthetics and
stemicls , anel has been started on oral pregaba lin 7Smg twice daily.

The

me [h ~1 11IS1ll

of acLion of pregabalin is:

Which of the following agents would be the MOST effective for treating the bradycardia?

A) Sodium cll an nel blockade

B)

Calc iu nl ch ann el modul ati on

A) Milrinone
8) Isoproterenol
C) Ephedrine
D) Atropi ne
E) Dobutamine

C) Gelllma -amillo butyric acid receptor (GABA) stim ulation

D) Selotonin specific reuptake inhibi tion
E)

87.

Non-specific catecho lam ine reuptake inhibition

All ot th e l ullo wII1g ,lclleln nts cr bout pregabali n are t rue EXCEPT:
A) D OS d"C of pregabalin must be adjusted in renal impairment
13) Pregaballn can cause sig llificant slowing of heart rate.

If no IV access is available durin g a cardiac an'est, all of t he following drugs may be

91.

administered through the endotracll eal tube of an int ubated patient EXCEPT>

C) Pregabalin may cause dizz iness and som nolence

D) f'lega balin is a structural derivative of gamma -amino buty ric aCid (GABA)
E) Prega llalln can be used to colltrol partial onset seizures
.

g8.

A)
B)
C)
D)
E)

O ile effec t of intr"Jvenous morphine Cldmlliistration is a decrease in heart rate.

The rnechan lsm of action of this decrease in heart rate fo llowing in travenous morphine

92 .

<-l dillinistration is:

A)
B)

Vagu s nerve stimu lat ion

Ca;-otid body response to increased PaC0 2

C) A clirect re spon se to opioid receptors ill the myocardium

D) Venoclilat,on causing decreased venous retum to the heart
E)

89.

lidocaine
Ami odarone
Atro pine
Na loxon e
Epin ephrine

An effect of the associated histamine r"e lease

Which of th e foll owi ng lists of npioicls is in ord er of e lim ination half-time from shortest to

A 42 year-old male is being t rea ted with linezolid for an abscess ill the left lower extremity.
He is brought to the operating room fo r an inCision and drainage of the abscess, Upon
induction of general anesthesia the patien t's blood pressure drops to 83/38 IllmHg . .
Which of the following drugs should be avoided
A)
B)
C)
D)
E)

III

this patient7

Phenylephrine
Norepinephrine
Epinephrine
Ephedrine
Dobutamine

longest:
A) Morplline < Ilydromorphone " fentanyl < rem ifentani l
8) RemlfentJ nil < hydrolllorphone < fentanyl < morphine
C) Rellliientafill < hydromorphone < morphine < fentanyl
D) Remifentani l <; fentany l < hyciromo rphone < morphine
E) Hyd ro rnor phone < rermfentanil < fentany l < morphine

_ . f/Ji5----;;au...'I~;I-(lIdy nor b;U~f.J!Jca{f!i or usec!

If)

an edul<'lliafldl 13fwlronment without wdtten permission from the publisher.

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j\nesthesid Practice Questlolls: 200?

Anesth~iaPractice _Q~u~~
~t~io_n_s_:_
20_0~7~__~__~~~-c _~~____~_____

A-Type Questions (Single Best Answel-)

93 .

A-Type Questions (Single Best Answer)

A 37-yed r-old partunent at 37 weeks gestation is diagnosed with pre-eclampsia and is being
trea ted with magnesiull1 sulfate. You are cal led to see the patient because she becomes
weak, is Ilypoventilating, ancl Ilavll19 dlFtlcu lty breathing . Your First response is to place
oxyg en on tile patien t and support her res pirations.
Wilich of the fo llOWing
lrea tment7

A)
B)
C)
D)
E)

IS

97.

Which of the following analgesics has the highest InCidence of anaphylaxis and anaphylactoid
reactions'
Ketamine
Ice
Acetaminophen
Meperidine
E) Acupuncture

A)
6)
C)
0)

the MOST approp,iate next step in til is patient's course of

Aclrnlilister sudiu m tillopental, succinylcholine, and intubate the patient

Admini ster calciu m gluconate
Ask the obstetriCian to deliver the baby emergently
Aclmlnister propranolo l
Sit til e p<ltient up dnd prepare For an epidural catheter placement

An 81-year-old male is scheduled For a carotid endarterectomy . A preoperative dobutamine

stress echocardiogram is performed which revea ls reg iona l wall motion abnormalities that
improve during the exam .

98.

Which of the following statements BEST explains this improvement in regional wall motion
abnorma lities?

lIcioca ln e aFleets conductiorl of tile hea rt by all of the following EXCEPT:

A)

A) Normal coronary artery blood flow

B) Hibernating myocardium
C) Cardiac amyloidosis
0) Postinfarction myocardial scar tissue
E) Testin g error

Decreasing rate of depolariz<ltion

13) 1ncreas ing ra tio of effective reFractory period to the duration of the action
potential
C)
D)
F:)

Decreasing action potential duratio n

Increasing sinus r-a te
Decreasin~J effective refra ctory period

99.
95

1n th e neonate, chest compressions (juring carclro pulmonary resuscitation (CPR) should be

discontinued when the neonates hea lt rate rea ch es:

A) Obesity
6) Hypovolemia
C) Atria l septal defect
0) Severe asthma
E) Right-sided heart Failure

A) 60 beats/minute
B) 80 beats/ minute
C) lOa beats/minute
D) 120 beats/minute
E) Discontinua tio n of chest compressions during CPR is not based on heart rate
100.
9G.

A 28 year-ol d rna le is Ilaving dlt llWSCOPIC knee su rgery under general anesthesia . He has no
known allergies. Cefazolin is udil linistered just priur to the skin incision. The patient's heart
rate increases tu 123 beats/m inute, blooel pressure drops to 58/23 rnrnHg , peak airway
pres~:; ures n se to 28 (Ill H20, and wh eezi ll ~l is heard on auscultation to the chest.

Pulsus paradoxus may be seen with all of the fol lowing conditions EXCEPT :

Perception of pain From a surgical Incision invo lves all of the following structures EXCEPT :
A) Unmyelinated C Fibers
6) Fronta l lobe gyri
C) Lateral spinothalamic tracts
0) Rexed lamina V
E) Periaqueductal gray matter

cac! I DC the fullowin9 is ~lpp ropri a te Irulial tnerapy EX CEPT:

A)
B)
C)
D)
E)

Administer JOO(;lo 0 "

Discontinue all anesthetic drugs
Admin isler clexametll asone Intravenous
Volume ex pan si on with isoton ic fluids
Administer 5-10 l11(g intravenous doses of epinephrine

---- - - ------

~ ---- ~ - ..

------

------------- --------------~

Ih,!; 1/1"1.,,,11111')' flu/be dU(lhtJ:.>t/ 1/1 us(-d in an educational environment without written permission from the publi5her.
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_~~sthe~~~~~ct i cf'~gLJe.:~t.i9(~~2~C2Q!_

!\ ' TYr)eQuesti~~{Si!-lg ll::

WI.

.Se5tAnswer) - --- - ---- -. ----

- - ---

A 62 -yeM -old mal" 15 uncl erguing laser rem oval of a distal trachea l tumor under general
aneslheslCl with Isuflu ralle 111 oxygen and air with an FiO, of 0.3_ He is intubated wit h a 9.0
endotracllecll tube (ETT) iJnd the su rgeon is administering laser therapy through tile Err via
a rl exi ble fibero ptic bronchoscope. fhe sur-geon and anesthesiologist simultaneously notice
th e deve lopment of a Fire dt the tip of the En-,
What is the most appropriate FI RST ste'J?

A) Flood t he JIr,va y With 50 111 1of normal sal ine

f-3)
C)
D)
E)

102.

A ixernatlHe infarlt born at 3 1 weeks gestation is brought to the oper-ating room for repa ir of
a left-slderJ congeril ial diapllragmatic Ilernia.
Following an uneventful awake tracheal
in tubation, anesthesid is maintained w it h sevoflurane, oxyge n, and fentanyl. Fifteen minutes
latcr the heart rate clecreases to 55 beats/m inute, the oxygen satura tion fal ls to 50%, and
t hee ancslllesiolog ist Ilotes hlgll peak airway pressures .
What

IS

the MOST appropriate Jctlon at th is t ime 7

A)
8)
C)
D)
[)

Remove the crr

Rapid ven tilation With low tidal volum es
Shut orf gas flo w to the bl-mth ing circu it
lnueilse the 1'10, to LOlJ%

- ihl< ~~,---:r~'ri"l ;~~( no{

Adm inister positive end-expira tory pressure

Decompress th e stomacil
Place a ch est tube a ll the left
Pldce a chest tul,e all tile light
Pu ll the endotrachea l tube back one centimeter

[II:!

{iuplica{eri or /J',eLi Ii} iJn educational eflv/ron ment wit/lout written permission from the publisher.

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