AKT6

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AKT6
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  1. 1. The motor nerve supply to the intrinsic muscles of the larynx is the:
    a. superior laryngeal nerve
    b. internal laryngeal nerve
    c. recurrent laryngeal nerve
    d. cricothyroid nerve
    C
  2. 2. Which is NOT a paired cartilage of the larynx?
    a. cuneiform
    b. corniculate
    c. cricoid
    d. aryteniod
    D
  3. 3. The maneuver NOT considered appropriate when positioning a patient for intubation using a Macintosh blade is to:
    a. move the patient to the head of the operating table
    b. hyperextend the head
    c. raise the occiput 10 cm on a towel or donut
    d. adjust the table to the height of the anesthesia provider
    C
  4. 4. The larynx is located at which level of the spine in the normal adult?
    a. C1-C2
    b. C3-C4
    c. C4-C6
    d. C6-T1
    B
  5. 5. Sensory innervation to the larynx is provided by the:
    a. Internal obturator nerve
    b. Recurrent laryngeal nerve
    c. External branch of the superior laryngeal nerve
    d. Glossopharyngeal nerve
    C
  6. 6. The normal adult trachea is 9-10 mm in diameter. Obstruction, causing respiratory stridor at rest, is not evident until the diameter is reduced to:
    a. 3 mm
    b. 4 mm
    c. 5 mm
    d. 6 mm
    A
  7. 7. The cranial nerves that innervate the pharynx are the:
    a. eighth and ninth
    b. ninth and tenth
    c. seventh and eleventh
    d. first and second
    B
  8. 8. You have just extubated your patient. Your patient exhibits a sudden onset tracheal tug and “rocking boat” respirations with no misting of the mask. The most probable cause of this respiratory pattern is:
    a. laryngospasm
    b. airway obstruction
    c. residual paralysis
    d. aspiration
    A
  9. 9. The first line of treatment employed when laryngospasm is suspected should be:
    a. administer succinylcholine
    b. apply positive pressure with a mask
    c. suction the patient
    d. place a pulse oximeter
    B
  10. 10. Common causes of upper airway obstruction include all of the following EXCEPT:
    a. relaxation of the voluntary pharyngeal muscles
    b. tongue falling backwards into the pharynx
    c. neck extension and jaw thrust
    d. stage 2 anesthesia
    C
  11. 11. Which of the following procedures would mandate general endotracheal anesthesia?
    a. procedure over two hours
    b. removal of breast lesion
    c. laparascopic hysterectomy
    d. TURP
    c
  12. 12. The nerve most commonly injured from anesthesia face masks with head straps is the:
    a. optic nerve
    b. facial nerve
    c. glossopharyngeal nerve
    d. trigeminal nerve
    B
  13. 13. Your patient has a suspected difficult airway. You plan an awake nasal fiberoptic intubation. You would perform all of the following EXCEPT:
    a. apply vasoconstrictive media to the nasal mucosa
    b. dilate the nares with progressively larger nasopharyngeal airways
    c. heavily sedate the patient with midazolam and fentanyl
    d. place a recurrent laryngeal nerve block
    C
  14. 14. After arriving in the recovery room your patient begins to exhibit signs of airway obstruction. You should:
    a. place an oral airway
    b. place a nasal airway
    c. suction the patient
    d. administer oxygen
    B
  15. 15. If an oral airway is the proper size and placed correctly it will:
    a. push the tongue against the posterior pharyngeal wall
    b. avoid an injury to the tongue
    c. separate the tongue and posterior pharynx
    d. always be better than a nasal airway
    C
  16. 16. During tracheal intubation, the tip of the Macintosh blade should be placed:
    a. under the epiglottis
    b. in the left side of the mouth
    c. in the vallecula
    d. in the glottis
    C
  17. 17. Your patient vomited on induction. After emergence and extubation your patient is tachycardic, tachypneic and confused with an O2 sat of 80%. You suspect gastric aspiration, the chest X ray is normal. The next appropriate therapeutic intervention would be:
    a. nasal CPAP in the recovery room, med consult
    b. administration of corticosteroid
    c. PA catheter placement
    d. Administration of antibiotics
    A
  18. 18. Your patient has a suspected tooth fragment aspiration. The most appropriate technique for airway management is:
    a. mask induction
    b. awake intubation
    c. tracheostomy
    d. blind nasal intubation
    B
  19. 19. Complications of a mask induction include all of the following EXCEPT:
    a. soft tissue damage to ears
    b. undetected aspiration
    c. corneal drying
    d. trigeminal nerve damage
    D
  20. 20. Rapid sequence induction is INAPPROPRIATE if:
    a. a difficult intubation is expected
    b. patient has eaten 3 hours before surgery
    c. patient is obese
    d. patient has a known hiatal hernia
    A
  21. 21. Contraindications to nasal fiberoptic intubation in the patient with head and neck trauma include all of the following EXCEPT:
    a. facial fractures
    b. basilar skull fractures
    c. cervical spine fracture with instability
    d. bleeding from the nares
    C
  22. 22. Placement of an oral airway before adequate depth of anesthesia has been achieved may lead to:
    a. dental damage
    b. uvular edema
    c. lip damage
    d. laryngospasm
    D
  23. 23. Your patient has a suspected difficult airway. You plan to mask induce to maintain spontaneous respirations. What actions can you take to optimize success?
    a. priming the circuit with 1 MAC of sevoflurane
    b. pretreat the patient with an opioid
    c. pretreat the patient with an anxiolytic
    d. pretreat the patient with an antisialogogue
    C
  24. 24. Which statement is correct regarding the LMA?
    a. The LMA when placed correctly will protect against aspiration of gastric contents
    b. Insufflation of the stomach can occur if excess positive pressure is driven through the LMA
    c. Administration of emergency drugs through an LMA will have equal success rates when compared to an endotracheal tube
    d. A cuffless LMA is available for pediatric use, in order to minimize soft tissue ischemia
    B
  25. 25. Your patient presenting for surgery has severe TMJ ankyloses and cannot open her mouth enough to place dentures. You plan for an awake nasal fiberoptic intubation to preserve spontaneous respirations. Besides glycopyrolate and anesthetizing the nasal mucosa, which intervention can best facilitate awake nasal fiberoptic intubation?
    a. anesthetize the pharyngeal branch of the glossopharyngeal nerve
    b. anesthetize the recurrent laryngeal nerve
    c. anesthetize the recurrent laryngeal nerve
    d. administer 4% lidocaine for 20 minutes preoperatively via nebulizer
    D
  26. 1. Which if the following is NOT a usual sign of hypoxemia?
    a. cyanosis
    b. mental confusion
    c. tachycardia
    d. acidosis
    D
  27. 2. Cyanosis is produced by all of the following EXCEPT:
    a. purple hemoglobin
    b. poor lighting
    c. polycythemia
    d. anemia
    B
  28. 3. The most sensitive muscle(s) to the paralyzing effect of neuromuscular blocking drugs are (is):
    a. diaphragm
    b. limb muscles
    c. masseter and temporalis muscles
    d. eye muscles
    C
  29. 4. Liquification of a gas:
    a. cannot occur
    b. may occur if the gas is heated
    c. may occur if the gas is cooled
    d. is solely pressure dependent
    C
  30. 5. The normal cylinder pressure of nitrous oxide is:
    a. 2000 psi
    b. 75 psi
    c. 25 psi
    d. 750 psi
    D
  31. 6. At a temperature of 21 degrees Celsius, oxygen will be stored as a:
    a. compressed gas
    b. liquid
    c. solid
    d. vapor
    • A

  32. 8. When monitoring the EtCO2, the most accurate measurement is obtained at which phase of the respiratory cycle?
    a. Peak of inspiration
    b. Middle of expiration
    c. End of expiration
    d. Beginning of inspiration
    C
  33. 9. The best monitor of adequacy of ventilation is the:
    a. arterial blood gas
    b. shunt determinant
    c. capnogram
    d. pulse oximeter
    C
  34. 10. High peak inspiratory pressures may be caused by all of the following EXCEPT:
    a. low pulmonary compliance
    b. endotracheal tube kinking
    c. high fresh gas flows
    d. increased anesthetic depth

    D


    11. Successful endotracheal intubation is most readily confirmed by:
    a. pulse oximetry
    b. capnography
    c. esophageal stethoscope
    d. arterial wave form
    • /question>
    • B
  35. 12. Post tetanic facilitation is related to:
    a. time to spontaneous recovery
    b. diagnosis of a phase II block
    c. twitch height ratio
    d. extent of neuromuscular disease
    A
  36. 13. After intubation, the patient exhibits lack of EtCO2 waveform and a slow decrease in oxygen saturation. One would suspect:
    a. esophageal intubation
    b. right mainstem bronchus intubation
    c. exhausted CO2 absorber
    d. malignant hyperthermia
    A
  37. 14. Which of the following sites for temperature monitoring provide the LEAST accurate correlation to central core temperature?
    a. rectum
    b. nasopharynx
    c. axilla
    d. esophagus
    C
  38. 15. Ventilatory settings for patients with chronic obstructive pulmonary disease should include a (an):
    a. high FIO2
    b. slow respiratory rate
    c. high inspiratory flow
    d. high peak pressure
    B
  39. 16. Indications for the placement of an arterial line include all of the following EXCEPT:
    a. cardiac surgery
    b. tonsillectomy
    c. pre-existing poorly controlled hypertension in an urgent situation
    d. morbid obesity
    B
  40. 17. Induced hypotension is requested by the surgeon in anticipation of heavy bleeding. Essential monitors include all EXCEPT:
    a. Foley catheter
    b. Blood pressure cuff
    c. EEG
    d. Arterial line
    C
  41. 18. When placing a blood pressure cuff the anesthesia provider should:
    a. select a cuff that is 40-50% of the circumference of the arm
    b. consider that a cuff that is too wide will yield a falsely high value
    c. make sure the bladder covers 1/3 of the arm
    d. make sure the middle of the bladder is over the artery
    D
  42. 19. You are extracting teeth on a morbidly obese man who has a large neck, smokes two packs per day for 15 years and has known OSA. Baseline SaO2 was 96% and the patient was placed on oxygen at 3 liters via nasal cannula. Induction was carried out with 100 mcg of fentanyl and 5 mg of midazolam. You are placing a block when your assistant calls your attention that the patient appears to not be breathing and looks cyanotic. The SaO2 remains at 96%. What is the most likely explanation for this?
    a. Patient motion artifact
    b. Elevated carboxyhemoglobin levels due to smoking
    c. Elevated hemoglobin and hematocrit due to OSA
    d. Supplemental oxygen effect
    B
  43. 20. All anesthesia machines are equipped with oxygen supply failure alarms that sound when:
    a. the oxygen concentration drops below 21%
    b. the oxygen pressure drops below 30 psi
    c. a hypoxic gas mixture is being delivered
    d. the high pressure alarm, sensitive to oxygen depletion in the cylinder, is triggered
    B
  44. 21. A safety system for small cylinders that prevents the wrong tank placed on the wrong yoke is called:
    a. Pin Index Safety System
    b. American Standard Compressed Cylinder Valve System
    c. Compressed gas Association Yoke Standards
    d. Color Pin Safety System
    A
  45. 1. Gastric emptying can be delayed by all of the following factors EXCEPT:
    a. pain and anxiety
    b. narcotics
    c. trauma
    d. parasympathetic agents
    D
  46. 2. An OR nurse who is six months pregnant crushed her foot under an operating table six hours ago and presents for surgery. She had had breakfast two hours before the accident. She should have rapid sequence induction as a gastric aspiration risk because she:
    a. is pregnant
    b. has been NPO for eight hours
    c. received narcotics in the emergency department
    d. only had coffee for breakfast
    A
  47. 3. The constant to be used when calculating blood volume for a healthy ASA I 70 kg male patient is:
    a. 65 cc/kg
    b. 70 cc/kg
    c. 75 cc/kg
    d. 80 cc/kg
    B
  48. 4. Your trauma patient is bleeding heavily. Your team decides to treat for DIC. Treatment would contain all of the following EXCEPT:
    a. platelet transfusion
    b. heparin administration
    c. fresh frozen plasma administration
    d. cryoprecipitate administration
    B
  49. 5. Your patient has just underwent a tonsillectomy and is being emergently returned to the OR due to uncontrolled bleeding. You should plan for:
    a. an inhalational induction
    b. fluid restriction
    c. standard induction
    d. rapid sequence induction
    D
  50. 6. Long term storage of blood causes:
    a. 2,3 DPG to increase
    b. pH to increase
    c. extracellular potassium to decrease
    d. calcium to decrease
    D
  51. 7. Your patient was thrown from a motorcycle, suffering a chest wall hematoma but no rib fractures. He presents for ORIF of his right ankle. He is healthy and has no other apparent injuries. Nitrous oxide administered to this patient will increase a risk for:
    a. decreased volume of air in the middle ear
    b. expansion of a subclinical pneumothorax
    c. decrease in the size of an air embolus
    d. bone marrow depression
    B
  52. 8. The best crystalloid solution to infuse to a trauma patient who has suffered significant blood loss and will need multiple transfusions is:
    a. plasmalyte
    b. Hetastarch
    c. Albumin
    d. 5% dextrose in water
    A
  53. 9. Persistent bleeding after massive blood transfusion is most commonly due to:
    a. factor V and VIII deficiency
    b. dilutional thrombocytopenia
    c. DIC
    d. Fibrinolysis
    B
  54. 10. You are on trauma call to see a young man with a 10% spontaneous pneumothorax. He is spontaneously breathing and not complaining of SOB. The BEST treatment is:
    a. needle decompression with a 14 gauge angiocath
    b. placement of a chest tube
    c. 100% oxygen via non rebreather mask for 30 minutes
    d. Unpressurized albuterol treatment via nebulizer
    C
  55. 11. Your trauma patient has a suspected C spine and basilar skull fracture. The patient must be intubated for airway protection. The BEST technique would be:
    a. blind nasal under sedation
    b. awake fiberoptic intubation
    c. intubation is contraindicated for this patient
    d. surgical airway
    B
  56. 12. Your multiple gunshot trauma patient was intubated in the ER and is brought to surgery for an emergency laparotomy. You note decreased breath sounds, distended neck veins, cyanosis, an SpO2 of 80 and tracheal deviation. You suspect:
    a. right mainstem intubation
    b. tension pneumothorax
    c. cardiac tamponade
    d. mediastinal laceration
    B
  57. 13. Massive transfusion of blood bank blood usually causes:
    a. platelet dysfunction
    b. erythrocytosis
    c. dilutional thrombocytopenia
    d. CPD intoxication
    C
  58. 14. In an emergency situation, which unit of blood is preferred?
    a. O negative
    b. Patient specific, uncrossmatched
    c. O negative, crossmatched
    d. Patient specific, partially crossmatched
    A
  59. 15. Your patient is undergoing general anesthesia and needs a blood transfusion. What is the FIRST sign of transfusion reaction?
    a. hypotension and tachycardia
    b. hives and wheezing
    c. hemoglobinuria and hypertension
    d. hyperthermia and hives
    A
  60. 16. Intravenous solutions containing dextrose are to be avoided in patients with brain injury because:
    a. osmotic diuresis occurs as a result
    b. brain caloric needs are reduced in the acute injury setting
    c. the brain becomes hyper osmolar relative to blood
    d. of the deleterious effects of lactate
    C
  61. 17. In an emergency, anesthesia or surgery may be done without consent if the adult patient presents or is brought to the hospital unconscious, unable to consent and life is in danger without medical intervention. This situation is called:
    a. expressed consent
    b. implied consent
    c. implied in law
    d. statutory authority
    B
  62. 18. Your ASA I trauma patient was in a motorcycle accident and is undergoing IM nail of his right femur. During reaming of the femoral canal the patient’s SaO2 and EtCO2 suddenly and precipitously drop. Administering a fluid bolus does nothing. You place the patient on 100% O2 but he is tachycardic and hypotensive now. The decision is made to abandon the surgery and transport the patient to the ICU intubated and on pressors. Which diagnostic test is best for the planning of treatment?
    a. ultrasound of neck and shoulder vessels
    b. nuclear V/Q scan
    c. chest X ray
    d. spiral CT of the chest
    D
  63. 19. Hemorrhage of greater than 20% of blood volume is associated with:
    a. oliguria
    b. confusion
    c. hypotension
    d. tachycardia
    D
  64. 1. Depth of anesthesia may become more profound in the patient with chronic renal failure. Which is the LEAST likely reason for this?
    a. altered drug metabolism
    b. decreased plasma protein
    c. decreased cardiac reserve
    d. enzyme activation
    B
  65. 2. In a patient with coronary artery disease, the intraoperative event LEAST likely to cause myocardial infarction is:
    a. hypertension during endotracheal intubation
    b. hypotension while skin preparation
    c. hypercarbia after endotracheal tube confirmation
    d. tachycardia upon incision
    B
  66. 3. Your patient has mitral stenosis. Your primary goal when inducing anesthesia is to:
    a. maintain high afterload
    b. reduce preload
    c. maintain baseline heart rate
    d. provide a higher FiO2
    C
  67. 4. Which characteristic is descriptive of Type II diabetes?
    a. prone to ketoacidosis
    b. associated with other diseases
    c. drug or pregnancy induced
    d. concordance rate of 25-50%
    B
  68. 5. All of the following are possible mediators of bronchial asthma EXCEPT:
    a. histamine
    b. bradykinin
    c. anxiety
    d. epinephrine
    D
  69. 6. A morbidly obese patient presents difficulties in all of the following EXCEPT:
    a. intraoperative ventilation
    b. safe intubation
    c. blood loss
    d. postoperative ventilation
    C
  70. 7. An OR nurse who is six months pregnant crushed her foot under an operating table six hours ago and presents for surgery. She had had breakfast two hours before the accident. She should have rapid sequence induction as a gastric aspiration risk because she:
    a. is pregnant
    b. has been NPO for eight hours
    c. received narcotics in the emergency department
    d. only had coffee for breakfast
    A
  71. 8. Rheumatoid arthritis can present intubation challenged for all of the pathophysiological reasons EXCEPT:
    a. synovitis of the temporomandibular joint
    b. cephalad larynx
    c. inability to extend the cervical spine
    d. cricoaretynoid arthritis
    B
  72. 9. The most serious electrolyte abnormality for patients with chronic renal failure is:
    a. hyperkalemia
    b. hypermagnesemia
    c. hypocalcemia
    d. hyponatremia
    A
  73. 10. Ventilatory settings for patients with chronic obstructive pulmonary disease should include a (an):
    a. high FIO2
    b. slow respiratory rate
    c. high inspiratory flow
    d. high peak pressure
    B
  74. 11. The most advantageous non-depolarizing muscle relaxant for patients with chronic renal failure is:
    a. vecuronium
    b. cisatracurium
    c. succinylcholine
    d. rocuronium
    B
  75. 12. The inhalational agent of choice for patients with chronic renal failure is:
    a. isoflurane
    b. desflurane
    c. sevoflurane
    d. nitrous oxide
    A
  76. 13. The safest intubation technique for an insulin dependent diabetic patient is:
    a. slow IV narcotic induction
    b. inhalational induction
    c. rapid sequence induction
    d. standard induction
    C
  77. 14. The LEAST advantageous inhalational agent for an asthmatic patient undergoing surgery is:
    a. isoflurane
    b. desflurane
    c. sevoflurane
    d. nitrous oxide
    D
  78. 15. Which of the following beta blockers would be most inadvisable to administer to an asthmatic patient?
    a. esmolol
    b. propanolol
    c. labetolol
    d. metoprolol
    B
  79. 16. While under general anesthesia, the signs of hypoglycemia are likely to be confused with:
    a. hypovolemia
    b. response to painful stimuli
    c. deep anesthesia
    d. hypervolemia
    B
  80. 17. If wheezing is noted after intubation the first intervention by the anesthesia provider should be:
    a. deepen the anesthetic gas
    b. administer an inhaled beta agonist
    c. remove the endotracheal tube
    d. administer a corticosteroid
    B
  81. 18. Your patient is a T4 spinal cord paraplegic undergoing a general anesthetic for repair of a complex mandible fracture. The surgery takes 4.5 hours, 2.5 hours longer than expected. No Foley catheter had been placed per your order due to anticipated short length of case. At case completion the anesthesia resident notices abrupt onset of hypertension and bradycardia. Skin flushing and sweating is evident and the patient’s eyes are mydriatic. The resident cannot find his attending. Your diagnosis most likely would be:
    a. myocardial infarction
    b. autonomic hyperreflexia
    c. increased intracranial pressure
    d. pulmonary embolism
    B
  82. 19. Your patient has a history of moderate to severe coronary artery disease but must have teeth extracted before surgery. Which anesthetic agent should you AVOID?
    a. propofol
    b. fentanyl
    c. sevoflurane
    d. ketamine
    D
  83. 20. You have been called to the emergency department to stabilize a frontal sinus table fracture in a 47 year old patient very recently diagnosed with Grave’s Disease that has not begun any treatment for it. The patient also has hypertension and osteoarthritis she does not treat. Her only medication is furosemide which she rarely takes. She must go to surgery due to altered LOC from an accompanying epidural hematoma. In order to avoid life threatening anesthetic complications from her Grave’s Disease, what is the best pre-anesthetic treatment in this emergent situation?
    a. Propylthiouracil
    b. Dexamethasone
    c. Iodide
    d. Propanolol
    D
  84. 21. You are evaluating a 50 year old male patient for full mouth extraction and reduction of mandibular tori. Your patient denies any health history and chart review from his primary care provider is unremarkable. When you auscultate his chest, a high pitched blowing murmur heard at the apex is heard and this radiates to the left axilla and does not change with inspiration. You order a 12 lead EKG, which reads atrial fibrillation and LV hypertrophy. How would you plan perioperative anesthetic management for this patient?
    a. Plan for a faster heart rate and increase the preload.
    b. Plan for a faster heart rate and the same preload
    c. Plan for a slower heart rate and increase preload.
    d. Plan for a slower heart rate and the same preload
    B
  85. 22. Your first patient of the day is morbidly obese and needs general anesthesia. You explain the risks and go to prepare your room. When planning ventilator settings you keep in mind that obese people with restrictive lung disease have which primary characteristic?
    a. decreased total lung capacity
    b. decreased FEV1/FVC capacity
    c. increase vital capacity
    d. increased airway resistance
    A
  86. 23. When comparing respiratory physiology of obese patients, when compared to non-obese patients, which of the following statements is correct?
    a. Normal weight patients have higher rates of oxygen consumption
    b. FRC is identical in both groups
    c. If apnea occurs time to desaturation is the same
    d. the supine position may diminish pulmonary reserve to a higher degree in the obese patient
    D
  87. 24. Your 49 year old patient presents for removal of tooth 15-17 and wishes anesthesia. You examine her and hear a loud 4/6 murmur at the apex of her heart which radiates to the left axilla. You diagnose probable mitral regurgitation. Your perioperative anesthetic management should include the following?
    a. decrease intravascular volume
    b. decrease myocardial contractility
    c. increase peripheral vascular resistance
    d. increase heart rate
    D
  88. 25. You are evaluating a patient with a history of moderate coronary artery disease for removal of multiple decayed teeth and tori before coronary stenting can be done. Of the following agents, which has the greatest potential for disrupting myocardial oxygen supply and demand?
    a. fentanyl
    b. ketamine
    c. midazolam
    d. propofol
    B
  89. 7. The temperature monitoring site that most closely correlates to core body temperature is:
    a. tympanic membrane
    b. lower esophageal segment
    c. skin
    d. rectum
    B
  90. 1. To calculate the fluid deficit for a 10 kg child, which constant is the most appropriate?
    a. 5 ml/kg/hr
    b. 4 ml/kg/hr
    c. 3 ml/kg/hr
    d. 2 ml/kg/hr
    B
  91. 2. The narrowest part of a child’s trachea is the:
    a. glottis
    b. thyroid cartilage
    c. cricoid cartilage
    d. arytenoid folds
    C
  92. 3. The pediatric cardiac output is dependent primarily upon:
    a. heart rate
    b. heart contractility
    c. peripheral vascular resistance
    d. degree of anatomic shunt
    A
  93. 4. Compared to the adult, anatomical differences the anesthesia provider will encounter when instrumenting the pediatric airway include all of the following EXCEPT:
    a. large unstable head
    b. large tongue
    c. larynx anatomically lower
    d. short stiff and U shaped epiglottis
    C
  94. 5. Infants maintain their body temperature predominantly by:
    a. shivering thermogenesis
    b. nonshivering thermogenesis
    c. peripheral vasoconstriction
    d. assuming the fetal position
    B
  95. 6. A five kg infant has an hourly fluid requirement during anesthesia of approximately:
    a. 20cc/hr
    b. 40 cc/hr
    c. 60cc/hr
    d. 65cc/hr
    A
  96. 7. The factor which will LEAST influence your pediatric patient to intraoperative hypothermia is:
    a. a cold operating room
    b. ventilate with dry anesthetic gases
    c. a greater surface to body mass ratio
    d. types of anesthetic drugs administered
    D
  97. 8. The factor responsible for increased succinylcholine requirements in the pediatric patient is:
    a. immaturity of the neuromuscular junction
    b. larger volume of distribution
    c. increased protein binding
    d. proportionally greater blood flow to the central organs
    B
  98. 9. Which statement regarding physiologic differences between the pediatric and adult patient is FALSE?
    a. FRC in a child is less than an adult
    b. Pediatric oxygen consumption is less than an adult
    c. Metabolic degradation pathways in children are not as fully developed as adults
    d. Pediatric glomerular filtration is less than an adult
    B
  99. 10. Which statement is CORRECT regarding airway anatomy of the infant?
    a. caudad larynx, wide epiglottis, narrowest at vocal cords
    b. cephalad larynx, narrow and stiff epiglottis, long trachea
    c. anterior larynx, stiff U shaped epiglottis, short trachea, narrowest at the cricoid cartilage
    d. cephalad larynx, floppy epiglottis, narrowest at the arytenoids
    C
  100. 11. Characteristics of the normal infant upper airway include all of the following EXCEPT:
    a. large head and short neck
    b. obligatory mouth breathing
    c. large tongue
    d. large tonsils and adenoids
    B
  101. 12. Compared to adults, the uptake and distribution of inhalational agents in pediatric patients is more rapid because of:
    a. irregular respiratory rate
    b. decreased cardiac index
    c. distribution of a greater portion of cardiac output to the vessel rich organs
    d. higher pulmonary pressures
    C
  102. 13. Strategies for minimizing heat loss in a pediatric patient include all of the following EXCEPT:
    a. use of a non rebreathing circuit
    b. warming all IV fluids
    c. using warmed skin preparation solutions
    d. use of a warming mattress
    A
  103. 14. You are providing anesthesia for a child with strabismus, and notice sudden onset bradycardia. You tell the surgeons to stop. What should be your NEXT BEST course of action?
    a. Administer atropine 0.5 mg
    b. Assess the patient’s vital signs
    c. Tell the surgeons to resume since the reflex will quickly fatigue
    d. Ask the surgeon to perform a retrobulbar block
    B
  104. 15. You are about to treat a healthy 14 year old who presents for extraction of a mobile tooth. She is extremely apprehensive and you plan a single IV anesthetic for her since the procedure will last about 30 seconds. Her parents report she is currently menstruating and suffered severe nausea and vomiting after general anesthesia for PE tubes when she was 8. Which of the following anesthetics would be best for this patient?
    a. etomidate
    b. ketamine
    c. brevital
    d. propofol
    D
  105. 16. Right mainstem bronchus intubation of an infant may occur more easily than in an adult due to (choose the best answer):
    a. the trachea is short
    b. distance from lips to larynx is short
    c. uncuffed endotracheal tubes can easily slip distally
    d. the mainstem bronchi are less angulated in their relationship to the trachea
    A
  106. 1. The average crystalloid fluid replacement for a patient undergoing a total hip replacement or bowel surgery should be estimated at:
    a. 3 cc/kg/hr
    b. 7 cc/kg/hr
    c. 10 cc/kg/hr
    d. 15 cc/kg/hr
    C
  107. 2. If blood loss is being replaced with crystalloid the ratio which should be used is:
    a. 2cc of crystalloid per 1 cc of blood loss
    b. 3 cc of crystalloid per 1 cc of blood loss
    c. 4 cc of crystalloid per 1 cc of blood loss
    d. 5 cc of crystalloid per 1 cc of blood loss
    B
  108. 3. An estimate for the base intravenous fluid requirements for a normal healthy 70 kg ASA I adult patient undergoing minor surgery is:
    a. 80 cc/hr
    b. 110cc/hr
    c. 125cc/hr
    d. 200cc/hr
    B
  109. 4. The constant to be used when calculating blood volume for a healthy ASA I 70 kg male patient is:
    a. 65 cc/kg
    b. 70 cc/kg
    c. 75 cc/kg
    d. 80 cc/kg
    B
  110. 5. To calculate the estimated red cell mass for any patient, the data required would include:
    a. weight, height, hematocrit
    b. weight, gender, hematocrit
    c. weight, age, hematocrit
    d. weight, health status, gender
    B
  111. 6. Which of the following procedures is most likely to involve blood replacement?
    a. laparascopic cholecystectomy
    b. total hip replacement
    c. rhytidectomy
    d. ORIF of mandible
    B
  112. 7. Ringer’s lactate contains all of the following ions EXCEPT:
    a. calcium
    b. chloride
    c. magnesium
    d. potassium
    C
  113. 8. Transfusing one unit of packed red blood cells in a healthy 70 kg adult is expected to raise the Hgb by 1 gm/dl and the hematocrit:
    a. 1%
    b. 3%
    c. 5%
    d. 10%
    B
  114. 9. The best crystalloid solution to infuse to a trauma patient who has suffered significant blood loss and will need multiple transfusions is:
    a. plasmalyte
    b. Hetastarch
    c. Albumin
    d. 5% dextrose in water
    A
  115. 10. Intravenous solutions containing dextrose are to be avoided in patients with brain injury because:
    a. osmotic diuresis occurs as a result
    b. brain caloric needs are reduced in the acute injury setting
    c. the brain becomes hyper osmolar relative to blood
    d. of the deleterious effects of lactate
    C
  116. 11. Your patient is a healthy ASA I male weighing 70 kg presenting for surgery. He has been NPO for eight hours. What is his hourly IV fluid rate?
    a. 60 cc/hr
    b. 80 cc/hr
    c. 110 cc/hr
    d. 140 cc/hr
  117. 12. Your patient is a healthy ASA I male weighing 90 kg presenting for surgery. He has been NPO for eight hours. What is his estimated fluid deficit?
    a. 1000 ccs
    b. 1040 ccs
    c. 1080 ccs
    d. 1100 ccs
    B
  118. 13. A previously healthy ASA I 70 kg man comes to your room as an RB after a shoulder stabbing which caused an estimated 2 liter blood loss. Which one of the following statements best applies to this patient?
    a. His pulse pressures will be widened
    b. his urinary output will be a the lower limits of normal
    c. he will have tachycardia but no change in his systolic blood pressure
    d. his systolic blood pressure will be decreased with a narrowed pulse pressure
    D
  119. 14. Hemorrhage of greater than 20% of blood volume is associated with:
    a. oliguria
    b. confusion
    c. hypotension
    d. tachycardia
    D
  120. 1. Depth of anesthesia may become more profound in the patient with chronic renal failure. Which is the LEAST likely reason for this?
    a. altered drug metabolism
    b. decreased plasma protein
    c. decreased cardiac reserve
    d. enzyme activation
    B
  121. 2. The primary site of most drug metabolism (or biotransformation) is the:
    a. plasma
    b. kidney
    c. ileum
    d. liver
    B
  122. 3. If 50% of a drug is eliminated from the body in ten minutes, how many elimination half times are required for 95% elimination?
    a. 3
    b. 4
    c. 5
    d. 6
    C
  123. 4. To make 20 cc’s of epinephrine 1:200,000 from an ampule containing 1 cc of 1:1000 epinephrine, how many cc’s of epinephrine 1:1000 must be added to your saline diluent?
    a. .10 cc
    b. .15 cc
    c. .20 cc
    d. .25 cc
    D
  124. 5. Nausea and vomiting induced by morphine and its derivatives are side effects caused by:
    a. direct stimulation of chemoreceptor trigger zones (CTZ) in the medulla
    b. stimulation of the cerebellum
    c. irritation of the intestinal lining
    d. assuming a standing position following administration
    A
  125. 6. Meperidine is metabolized primarily in the:
    a. liver
    b. kidneys
    c. plasma cholinesterase
    d. tissue enzymes
    A
  126. 7. The respiratory rate after administration of ketamine is:
    a. decreased
    b. increased
    c. unchanged
    B
  127. 8. The most common cardiac arrhythmia seen after administration of most narcotics (except meperidine) is:
    a. sinus tachycardia
    b. sinus bradycardia
    c. junctional rhythm
    d. premature ventricular contractions

    C


    9. How are the actions of ultra short acting barbituates such as brevital and propofol terminated?
    a. metabolism
    b. excretion
    c. enzymatic activity
    d. redistribution
    D
  128. 10. Succinylcholine is eliminated by:
    a. metabolism
    b. biotransformation
    c. renal excretion
    d. hydrolysis
    D
  129. 11. Ester local anesthetics are biotransformed in the:
    a. heart
    b. kidney
    c. liver
    d. blood
    D
  130. 12. The earliest sign of local anesthetic systemic toxicity is:
    a. cardiac arrhythmias
    b. confusion
    c. respiratory depression
    d. seizures
    A
  131. 13. Because of a decrease in lean body mass and plasma proteins in the elderly, drugs that are mainly distributed to these compartments will show plasma levels that are:
    a. decreased
    b. increased
    c. decreased initially and then increased
    d. unchanged
    A
  132. 14. During a continuous intravenous infusion of a drug, the time to reach steady state level is controlled by the:
    a. volume of the drug solution
    b. concentration of the drug
    c. rate of absorption of the drug
    d. rate of elimination of the drug
    B
  133. 15. Metoclopramide (Reglan) can cause extrapyramidal side effects if injected too rapidly. The endogenous neurotransmitter associated with this side effect is:
    a. acetylcholine
    b. norepinephrine
    c. dopamine
    d. oxytocin
    C
  134. 16. Your patient has myasthenia gravis. What class of drugs should be avoided?
    a. opioids
    b. muscle relaxants
    c. inhalational agents
    d. benzodiazepines
    B
  135. 17. The most advantageous non-depolarizing muscle relaxant for patients with chronic renal failure is:
    a. vecuronium
    b. cisatracurium
    c. succinylcholine
    d. rocuronium
    B
  136. 18. Your patient has severe allergies to multiple substances and uses an inhaler twice per day, and also has severe GERD that requires her to sit up for 30 minutes after meals and sleep upright. During sedation for full mouth extraction the patient experiences laryngospasm you cannot break with positive pressure ventilation. You elect to intubate the airway. Which paralytic is safest?
    a. Succinylcholine
    b. Rocuronium
    c. Vecuronium
    d. Cisatracurium
    A
  137. 19. Your healthy 18 year old male received 10 mg of midazolam, 50 mcg of fentanyl and 50 mg of propofol during a long extraction case. Emergence was prolonged and respirations are shallow with the SaO2 at 89% on 4L supplemental O2. You administer flumazenil 0.2 mg and naloxone 0.2 mg with immediate improvement in mentation and respiratory status. Thirty minutes later in recovery your assistant summons you due to the patient’s drowsiness and non-responsiveness to verbal commands. The SaO2 is 91% and respirations are shallow at 12 per minute. What is the best action to take in this situation?
    a. administer flumazenil
    b. administer naloxone
    c. support the patient’s airway
    d. increase the supplemental oxygen
    A
  138. 20. Your patient is a C6 quadriplegic on dialysis who fell from his wheelchair and sustained a mandible fracture. He is scheduled for the OR today for ORIF of the mandible. Your intern notes the morning serum potassium is 5.1. You and your CRNA clear the patient for surgery, but which muscle relaxant is BEST used in this case?
    a. rocuronium
    b. vecuronium
    c. cisatracurium
    d. succinylcholine
    C
  139. 21. Which anesthetic agent drug combination best balances out the potential adverse hemodynamic effects of each?
    a. propofol and remifentanyl
    b. propofol and ketamine
    c. etomidate and midazolam
    d. propofol and midazolam
    B
  140. 22. You are treating a patient with a known active opiate addiction. You should:
    a. discontinue the opiate or substitute one postoperatively
    b. continue the opiate as a primary anesthetic agent
    c. be aware that hypotension is the most common postoperative problem
    d. assume these patients have less postoperative pain than nonaddicted patients
    C
  141. 23. Your patient, a 66 year old male with a history of hypertension, coronary artery disease, and gout is in the PAR after a mandible advancement for OSA. The PAR is calling you as no anesthesia personnel are available. They patient has an elevated BP of 200/120, pulse 84, RR 16 and sat 99% on room air. The patient is sleeping comfortably, not in pain and has a foley catheter in place. What is the most appropriate medication to order?
    a. labetolol 20 mg
    b. hydralazine 10 mg
    c. phentolamine 5 mg
    d. esmolol 30 mg
    A
  142. 24. Which of the following statement pertaining to opioid induced chest wall rigidity is correct?
    a. Chest wall rigidity incidence is highest with sufentanil or remifentanil.
    b. The addition of nitrous oxide can exacerbate chest wall rigidity.
    c. Chest wall rigidity is caused by direct action on the muscle fibers.
    d. Concomittantly administering midazolam will worsen opiate induced chest wall rigidity.
    A
  143. 25. You are evaluating a 42 year old patient for multiple tooth extractions. She is requesting anesthesia. Her history includes asthma controlled with Advair daily and albuterol which she uses twice per year. She also has a 1 pack per day for 30 years smoking habit, and takes Elavil (amitriptyline) for depression. Which anesthetic agent should be avoided for this patient?
    a. fentanyl
    b. ketamine
    c. propofol
    d. midazolam
    B
  144. 1. If blood flow through both internal carotid arteries is compromised, cerebral circulation will depend on flow via the:
    a. Occipital arteries
    b. Vertebral arteries
    c. Superficial temporal arteries
    d. Posterior auricular arteries
    B
  145. 2. Which of the following is NOT a functional characteristic of the carotid bodies?
    a. Sensitive to excess blood carbon dioxide
    b. Sensitive to reduced blood oxygen
    c. Sensitive to mean blood pressure changes
    d. Sensitive to pH changes
    B
  146. 3. The two primary determinants of cardiac output are:
    a. heart rate and arterial pressure
    b. stroke volume and preload
    c. stroke volume and heart rate
    d. contractility and heart rate
    C
  147. 4. The function of the cytochrome P-450 system in the liver is to:
    a. catalyze oxidation reactions
    b. stimulate conjugation processes
    c. precipitate enzyme induction
    d. sustain liver PaO2
    C
  148. 5. Functions of insulin in the body include all of the following EXCEPT:
    a. facilitate transfer of glucose across cell membranes
    b. facilitate potassium transfer into cells
    c. enhance glycogen formation
    d. increase role of glyconeogenesis and gluconeogenesis
    B
  149. 6. If a patient’s baseline MAP is 60, during surgery cerebral blood flow will be controlled by:
    a. pH
    b. autoregulation
    c. blood flow
    d. metabolic influences
    B
  150. 7. The most important factor in the control of normal breathing is:
    a. PaO2
    b. PaCO2
    c. Oxygen saturation
    d. pH
    B
  151. 8. Your patient is young and healthy. If induced hypotension is requested, your patient’s MAP can generally safely be reduced to:
    a. 50
    b. 60
    c. 70
    d. 80
    B
  152. 9. Which statement concerning the oculocardiac reflex is INCORRECT?
    a. It is mediated by afferent vagal and efferent trigeminal nerves
    b. It occurs more commonly in the pediatric population
    c. It results from medial rectus eye muscle traction
    d. Scopolamine is of little value for prevention
    A
  153. 10. Which is the most profound cerebral vasodilator?
    a. oxygen
    b. lactic acid
    c. carbon dioxide
    d. bicarbonate
    C
  154. 11. The process where cerebral blood vessels contract and expand to maintain a constant blood supply to the brain is called:
    a. autoregulation
    b. cerebral perfusion
    c. cerebral blood flow
    d. cerebral spasm
    A
  155. 12. You suspect the patient you are working up has hyperaldosteronism. Which laboratory value would be consistent with this?
    a. elevated serum potassium
    b. low serum potassium
    c. elevated serum calcium
    d. low serum calcium
    B
  156. 1. The most commonly injured peripheral nerve noted in anesthetized patients positioned supine is the:
    a. Median nerve
    b. Sciatic nerve
    c. Peroneal nerve
    d. Ulnar nerve
    C
  157. 2. In an upright normal adult, lung ventilation is greatest, per unit volume, in:
    a. lung bases
    b. lung apices
    c. lung posterior portions
    d. lung middle lobes
    B
  158. 3. Oliguria in patients kept in the reverse Trendelenberg position for extended periods may be present because:
    a. renal blood flow is compromised
    b. decreased ADH secretion
    c. urine pooling in the dome of the bladder
    d. fluid accumulating in the upper body
    A
  159. 4. The most common respiratory complication associated with the lateral position is:
    a. increased dead space
    b. decreased compliance
    c. increased shunt
    d. ventilation/perfusion mismatch
    D
  160. 5. The nerve most commonly injured from anesthesia face masks with head straps is the:
    a. optic nerve
    b. facial nerve
    c. glossopharyngeal nerve
    d. trigeminal nerve
    B
  161. 6. Which nerve is most commonly injured by improper traction on the angle of the mandible?
    a. trigeminal
    b. facial
    c. recurrent laryngeal
    d. X
    B
  162. 7. The upper extremity nerves most commonly injured by stretching while under general anesthesia are the:
    a. brachial plexus
    b. radial nerves
    c. saphenous nerves
    d. cranial nerves
    A
  163. 1. Which characteristic is descriptive of Type II diabetes?
    a. prone to ketoacidosis
    b. associated with other diseases
    c. drug or pregnancy induced
    d. concordance rate of 25-50%
    B
  164. 2. Platelet function can best be determined by the following test:
    a. Factor assay
    b. prothrombin time
    c. bleeding time
    d. thrombin time
    C
  165. 3. Which of the following responses would warrant further investigation if noted on a preoperative assessment?
    a. mother died of a heart attack
    b. father has type 2 diabetes
    c. brother died under general anesthesia
    d. sister has Marfan’s syndrome
    C
  166. 4. Perioperative steroid therapy needs to be considered if your patient has been on steroid therapy for more than:
    a. one month over the past one year
    b. two weeks over the past six months
    c. one week over the last year
    d. one week over the last six months
    B
  167. 5. Which of the following preoperative tests would NOT be necessary when evaluating a healthy 24 year old male for ankle surgery who wishes spinal anesthesia?
    a. chest X ray
    b. PT/PTT
    c. CBC
    d. Urinalysis
    A
  168. 6. Where should the stethoscope be placed in order to best auscultate the mitral valve?
    a. over the right ventricle
    b. along the right sternal border
    c. at the apex of the heart
    d. along the left sternal border
    C
  169. 7. A patient with severe systemic disease which limits functionality is an ASA classification:
    a. II
    b. III
    c. IV
    d. V
    B
  170. 8. Rheumatoid arthritis can present intubation challenged for all of the pathophysiological reasons EXCEPT:
    a. synovitis of the temporomandibular joint
    b. cephalad larynx
    c. inability to extend the cervical spine
    d. cricoaretynoid arthritis
    B
  171. 9. The most serious electrolyte abnormality for patients with chronic renal failure is:
    a. hyperkalemia
    b. hypermagnesemia
    c. hypocalcemia
    d. hyponatremia
    A
  172. 10. Which pre-operative test is the best indicator of platelet function?
    a. PT
    b. PTT
    c. bleeding time
    d. platelet count
    D
  173. 11. Which one of these patients would be considered safe for a standard anesthetic induction according to current ASA guidelines for NPO status?
    a. 6 month old having taken 30ccs of commercial formula 4 hours ago
    b. 15 year old having taken 500 ccs of black coffee 3 hours ago
    c. 46 year old having taken 60 ccs of fresh squeezed orange juice 3 hours ago
    d. 65 year old having taken peanut butter on toast six hours ago
    C
  174. 12. Which patient is INAPPROPRIATE for an outpatient surgical procedure?
    a. ASA II, well controlled NIDDM
    b. ASA II well controlled htn for 4 hour cosmetic procedure
    c. Infant with a history of prematurity, 44 weeks postconceptual age, for urethral repair
    d. Obese patient, BMI 32, for knee arthroscopy
    C
  175. 13. Which of the following antihypertensives should be held day of surgery?
    a. atenolol
    b. clonidine
    c. lisinopril
    d. minoxidil
    C
  176. 14. Your patient has stable known coronary artery disease. You are ordering beta blockade for him preoperatively. Which statement below is correct?
    a. All beta blockers have similar ischemic risk reduction
    b. Beta blocker dosage should be adjusted to a resting heart rate of 50-60 beats per minute.
    c. Effects on heart rate and inflammatory response will occur rapidly.
    d. The most common beta blocker side effects are pulmonary edema and bronchospasm.
    B
  177. 15. Your patient has hypertrophic cardiomyopathy. Which drug class should be avoided?
    a. beta blockers
    b. ACE inhibitors
    c. Calcium channel blockers
    d. diuretics
    D
  178. 16. Your patient is a well controlled hypertensive. Which class of antihypertensive medication would cause you to avoid the use of a local anesthetic with vasoconstrictor?
    a. ACE inhibitor
    b. nonselective beta blocker
    c. calcium channel blocker
    d. angiotensin receptor inhibitor
    B
  179. 17. You are working up a newly admitted patient for cataract surgery. He is a 70 year old male with a history of mitral stenosis. He presents with fatigue, exertional dyspnea and occasional chest pain. You observe JVD, peripheral edema and hepatosplenomegaly. In order to confirm if he is OK for surgery, what other diagnostic finding should you search for?
    a. decreased PA pressures by cardiac cath
    b. LVH on his chest X ray
    c. Right axis deviation with tall P waves in II III and AVF on his 12 lead EKG
    d. No second heart sound upon auscultation
    C
  180. 18. Your 40 year old patient smokes a pack a day for 20 years and has a chronic productive cough present for six months of the year. What is the most likely process at work?
    a. COPD
    b. cystic fibrosis
    c. asthma
    d. chronic bronchitis
    D
  181. 19. You are evaluating a 72 year old male for extraction of teeth 3-6. His written medical history includes stable angina, CHF, well controlled type 2 diabetes and a coronary stent placed 3 months ago after an anterior MI 3 months ago. His medications are metoprolol and furosemide. You examine him and he reports no chest pain when climbing two flights of stairs. His heart sounds are normal and lungs reveal inspiratory bibasilar rales. What is your greatest concern when evaluating his surgical and anesthetic risk?
    a. stable angina
    b. MI and stent placement 3 months ago
    c. congestive heart failure
    d. type 2 diabetes
    C
  182. 20. Your 17 year old asthmatic patient presents for extraction of all four third molars. He plays basketball three times per week and has an albuterol inhaler he uses twice per year on average. His pediatrician has ordered a PFT which indicates a FEV1/FVC of 85%. What preoperative treatment should you administer?
    a. ipratropium MDI
    b. nebulized racemic epinephrine
    c. Advair MDI
    d. No treatment
    D
  183. 21. You are evaluating a 42 year old patient for multiple tooth extractions. She is requesting anesthesia. Her history includes asthma controlled with Advair daily and albuterol which she uses twice per year. She also has a 1 pack per day for 30 years smoking habit, and takes Elavil (amitriptyline) for depression. Which anesthetic agent should be avoided for this patient?
    a. fentanyl
    b. ketamine
    c. propofol
    d. midazolam
    B
  184. 1. Hyperkalemia can be treated intraoperatively by all of these methods EXCEPT:
    a. Alkalinization with sodium bicarbonate
    b. Hypoventilation of the patient
    c. Hypertonic glucose and insulin
    d. Calcium gluconate
    C
  185. 2. An increased PaCO2 is most usually caused by:
    a. tachypnea
    b. hyperpnea
    c. increased alveolar ventilation
    d. hypoventilation
    D
  186. 3. The most important factor in the control of normal breathing is:
    a. PaO2
    b. PaCO2
    c. Oxygen saturation
    d. pH
    B
  187. 4. A patient with acute hypoventilation will exhibit blood gas values that reflect a:
    a. high PaO2, low PaCO2, and normal pH
    b. low PaO2, high PaCO2 and low pH
    c. low PaO2, normal PaCO2 and normal pH
    d. high PaO2, high PaCO2 and increased pH
    D
  188. 5. A patient with chronic renal failure on dialysis who is being mechanically ventilated is at risk for all of the following complications EXCEPT:
    a. hyperkalemia
    b. hypoxia
    c. hypotension
    d. hypermagnesmia
    D
  189. 6. Metabolic derangements in patients suffering from prolonged vomiting include:
    a. hyperchloremia
    b. hypervolemia
    c. hypernatremia
    d. hypokalemia
    D
  190. 7. Complications of prolonged vomiting include all of the following EXCEPT:
    a. Increased ventricular irritability from hypokalemia
    b. Prolonged neuromuscular blockade from nondepolarizing agents
    c. Increased risk of aspiration on induction or emergence
    d. Increased anesthetic requirements
    D
  191. 8. Your trauma patient is undergoing an ex lap. You draw an ABG and the results are as follows: pH 7.32, PaCO2 46, HCO3 23. This indicates:
    a. respiratory acidosis
    b. respiratory alkalosis
    c. metabolic acidosis
    d. metabolic alkalosis
    A
  192. 1. The most serious complication of hypothermia during the perioperative period is:
    a. patient discomfort
    b. drop in metabolic demand
    c. increase in oxygen consumption
    d. oxyhemoglobin dissociation curve shift to the right
    C
  193. 2. All of the following will help reduce evaporative heat loss from the lungs under general anesthesia EXCEPT:
    a. the use of an inline humidifier
    b. reduced fresh gas flows from the anesthesia machine
    c. ventilation with dry gases
    d. heated anesthetic dry gases
    B
  194. 3. The earliest observable sign for malignant hyperthermia is:
    a. elevated temperature
    b. cyanosis
    c. hypertension
    d. increased end tidal CO2
    D
  195. 4. The physical phenomenon responsible for most heat loss in the anesthetized patient during surgery is:
    a. conduction
    b. convection
    c. radiation
    d. evaporation
    C
  196. 5. The temperature monitoring site that most closely correlates to core body temperature is:
    a. tympanic membrane
    b. lower esophageal segment
    c. skin
    d. rectum
    B
  197. 6. If the anesthesia provider suspects malignant hyperthermia is occurring during surgery, the provider should do first:
    a. inform the surgeon and begin cooling procedures
    b. monitor the situation and ask the surgeon to finish quickly
    c. inform the surgeon and wake the patient up
    d. discontinue all trigger agents, call for help and prepare to administer dantrolene
    D
  198. 7. Which of the following sites for temperature monitoring provide the LEAST accurate correlation to central core temperature?
    a. rectum
    b. nasopharynx
    c. axilla
    d. esophagus
    C
  199. 8. A drug which should NEVER be administered to children with myotonia dystrophica is:
    a. Brevital
    b. Vecuronium
    c. Succinylcholine
    d. Midazolam
    C
  200. 9. All of the following can serve to maintain or increase a patient’s temperature intraoperatively EXCEPT:
    a. high flows of anesthetic gases
    b. humidification of the breathing circuit
    c. forced air warming blanket
    d. IV fluid warmer
    A
  201. 10. Your patient has Duchenne muscular dystrophy. Which anesthetic agent should NOT be used?
    a. nitrous oxide
    b. cisatracurium
    c. succinylcholine
    d. morphine
    C
  202. 11. Dantrolene sodium can only be mixed with:
    a. distilled sterile water
    b. sterile sodium chloride
    c. sterile D5W
    d. Ringer’s lactate
    A
  203. 12. The factor which will LEAST influence your pediatric patient to intraoperative hypothermia is:
    a. a cold operating room
    b. ventilate with dry anesthetic gases
    c. a greater surface to body mass ratio
    d. types of anesthetic drugs administered
    D
  204. 13. A very early symptom of malignant hyperthermia in the child is:
    a. masseter muscle spasm
    b. laryngospasm
    c. hyperthermia
    d. wheezing
    A
  205. 14. Strategies for minimizing heat loss in a pediatric patient include all of the following EXCEPT:
    a. use of a non rebreathing circuit
    b. warming all IV fluids
    c. using warmed skin preparation solutions
    d. use of a warming mattress
    A
  206. 15. Patient introperative hypothermia is best prevented by:
    a. high rates of laminar gas flow
    b. an inspiratory humidifier on the anesthesia circuit
    c. a large capacity warm air blanket
    d. increasing the temperature of the operating room
    C
  207. 16. Administering dry anesthetic gases and oxygen at room temperature with no humidifier via an endotracheal tube can lead to:
    a. atelectasis
    b. A-a shunting
    c. heat loss
    d. hypertension
    C
  208. 17. A 21 year old patient with severe cerebral palsy will require general anesthesia with nasal intubation for multiple tooth extractions. Why is succinylcholine contraindicated for this patient?
    a. its structural similarity to acetylcholine
    b. its potential for significantly increasing the circulating levels of potassium
    c. the patient’s pseudocholinesterase deficiency
    d. the risk of postoperative muscle pain from fasciculations
    B
  209. 1. Diffusion hypoxia is a phenomenon associated with very rapid movement of which anesthetic agent from the blood to the lungs, producing a significant dilution of oxygen?
    a. isoflurane
    b. desflurane
    c. sevoflurane
    d. nitrous oxide
    D
  210. 2. The high incidence of shivering after anesthesia using isoflurane and sevoflurane is related to their:
    a. alpha receptor blocking effects
    b. halogenated components
    c. relaxant properties
    d. vasodilatory action
    D
  211. 3. When the initial rapid absorption of nitrous oxide results in an increased alveolar concentration and faster uptake of another inhalational anesthetic, this is known as the:
    a. concentration effect
    b. diffusion effect
    c. synergistic effect
    d. second gas effect
    D
  212. 4. Liquification of a gas:
    a. cannot occur
    b. may occur if the gas is heated
    c. may occur if the gas is cooled
    d. is solely pressure dependent
    C
  213. 5. Anesthetic gases are effective CNS depressants because of their high solubility in:
    a. blood
    b. other gases
    c. lipids
    d. enzymes
    C
  214. 6. Which of the following statements are FALSE regarding nitrous oxide?
    a. it is 1.5 times as heavy as air
    b. it is highly blood soluble
    c. it supports combustion
    d. it is manufactured by decomposing ammonium nitrate
    B
  215. 7. The safest anesthetic gas for use in a patient with cirrhosis of the liver is:
    a. isoflurane
    b. desflurane
    c. sevoflurane
    d. nitrous oxide
    A
  216. 8. Nitrous oxide will expand an endotracheal tube cuff because:
    a. it diffuses faster than nitrogen
    b. it diffuses faster then carbon dioxide
    c. of the second gas effect
    d. of diffusion hypoxia
    A
  217. 9. Compared to adults, the uptake and distribution of inhalational agents in pediatric patients is more rapid because:
    a. irregular respiratory rate
    b. decreased cardiac index
    c. distribution of a greater portion of cardiac output to the vessel rich organs
    d. higher pulmonary pressures
    C
  218. 10. Your patient was thrown from a motorcycle, suffering a chest wall hematoma but no rib fractures. He presents for ORIF of his right ankle. He is healthy and has no other apparent injuries. Nitrous oxide administered to this patient will increase a risk for:
    a. decreased volume of air in the middle ear
    b. expansion of a subclinical pneumothorax
    c. decrease in the size of an air embolus
    d. bone marrow depression
    B
  219. 11. All of these factors contribute to the determination of the concentration of inhaled anesthetic gases in the body tissues EXCEPT:
    a. partial pressure of the gas
    b. blood flow to the lungs
    c. blood/gas solubility
    d. hydration status
    D
  220. 12. All of the following statements regarding uptake and distribution of drugs are correct EXCEPT:
    a. A decrease in cardiac index will provide a slower inhalational induction
    b. Drugs given IV must be titrated to evaluate effects
    c. Decreases in FRC will provide more rapid inhalational inductions
    d. Cardiovascular depression is common following large doses of propofol
    A
  221. 13. Volatile anesthetics depress respiratory drive by which of the following mechanisms?
    a. metabolic oxygen requirements
    b. hypoxic and hypercarbic respiratory drive
    c. depression of the cerebral cortex
    d. respiratory automaticity
    B
  222. 14. The inhalational agent considered to be most cerebrally protective is:
    a. nitrous oxide
    b. isoflurane
    c. desflurane
    d. sevoflurane
    B
  223. 15. Which of the following BEST describes the effects of desflurane on the cardiovascular system?
    a. maintaining positive pressure ventilation while using desflurane minimizes the risk of cardiovascular collapse
    b. of all the inhalational agents desflurane is the most likely to cause coronary steal syndrome
    c. Pungency and associated airway irritability will cause a reflex tachycardia not seen with isoflurane or sevoflurane
    d. Administering fentanyl with desflurane potentiates the sympatholytic effects of fentanyl and thus will result in a decreased heart rate
    C
  224. 16. Your elderly patient has a decreased MAC requirement?
    a. true
    b. false
    A
  225. 1. The “excitement” phase of anesthesia is when stimulation of the patient can cause thrashing, coughing and laryngospasm in an unprotected airway. This is also known as stage:
    a. I
    b. 2
    c. 3
    d. 4
    B
  226. 2. The gag and vomiting reflexes are lost in stage:
    a. I
    b. 2
    c. 3
    d. 4
    C
  227. 3. The surgical stage of anesthesia is stage:
    a. I
    b. 2
    c. 3
    d. 4
    C
  228. 4. A deep extubation should take place when the patient:
    a. is spontaneously breathing
    b. swallows while suctioning
    c. has a BIS of 90
    d. coughs to deflation of the endotracheal tube cuff
    A
  229. 5. You have just completed an ORIF of a mandible fracture and the mandible has been wired. Your preferred method of extubation is:
    a. deep extubation with agent on
    b. extubate in Stage II
    c. extubate fully awake with reflexes intact
    d. extubation after placing superior laryngeal nerve blocks
    C

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