Canadian MCQs 2nd Flashcards by B -

At what core temperature do the ACLS guidelines recommend limiting defibrillation to 3 stacked shocks prior to active rewarming?
a. 29 C
b. 30 C
c. 31 C
d. 32 C

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What is the principal binding protein for basic drugs?
a. albumin
b. globulin
c. lipoprotein
d. alpha1-acid glycoprotein

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Which of the following cardiac anomalies requires endocarditis prophylaxis for dental extraction?
a. mitral valve prolapse without regurgitation
b. isolated secundum atrial septal defect
c. implanted defibrillator
d. hypertrophic cardiomyopathy

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According to the CAS document regarding testing of adequacy of operating room scavenging systems, which of the following can be used?
a. CO2
b. N2O
c. halogenated hydrocarbons
d. chlorofluorcarbons

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Regarding anesthesia for morbid obese patient which of the following medications has to be calculated to lean body mass:
a. Midasolam
b. Fentanyl
c. Sux
d. Rocuronium

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At atmospheric pressure 600 mm Hg, pCO2=40 and RQ=0.8, what is pAO2 in a healthy young man:
a. 56 mm Hg
b. 66 mm Hg
c. 76 mm Hg
d. 100 mm Hg

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12 y.o. patient weight 40 kg has 40 mcg/kg/hour continious i/v infusion of morphine for pain control after hand surgery. What would you prescribed to convert him to oral route?
a. 20 mg PO q 8 H
b. 20 mg PO q 4 H
c. 40 mg PO qid
d. 50 mg PO q 6 H

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After major surgery, level of which of the following hormones will decrease?
a. Cortisol
b. Insulin
c. ACTH
d. ADH

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Which of the following is a useful adjunct for post-deflation analgesia following IVRA with a local anesthetic?
a. clonidine
b. opioid
c. toradol
d. alkalinization of the local anesthetic with sodium bicarbonate

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What is the major advantage of inhaled NO versus intravenous vasodilator agents for treating pulmonary hypertension?
a. pulmonary selectivity
b. absence of negative inotropic effect
c. absence of platelet effects
d. ease of administration

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Which of the following is LEAST effort dependent?
a. FEV
b. FVC
c. FEF25-75
d. flow volume loop

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Which of the following is LEAST effective in treating postoperative shivering?
a. clonidine
b. magnesium
c. demerol
d. alfentanil

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Which of the following is most likely to cause anaphylaxis?
a. latex
b. propofol
c. bupivacaine
d. mivacurium

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Following laceration to the forearm, which of the following causes ongoing widespread discomfort?
a. Type A fibre conduction leading to central sensitization
b. Substance P causing NMDA receptor stimulation
c. Repeated Type C fibre stimulation causing augmented response
d. Increased activity in the spinothalamic tracts

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Complication of lateral decubitus position on the non-dependent side
a. suprascapular nerve injury
b. avascular necrosis femoral head
c. retinal ischemia
d. peroneal nerve injury

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Pharmacokinetics of which opiod is least affected by hepatic failure?
a. fentanyl
b. alfentanyl
c. sufentanyl
d. remifentanyl

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Which test most reliably confirms correct ETT placement?
a. auscultation
b. ETCO2 first exhaled breath
c. endoscopic inspection of the airway
d. observation of chest movement

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When is use of Sux considered safe?
a. 40% burn, 3 days post injury
b. Duchene’s muscular dystrophy
c. Cerebral Palsy
d. Spinal cord injury with paraplegia, 10 days post trauma

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All are features assoc with BPD in children except:
a. cor pulmonale
b. hypoxemia
c. reactive airways disease
d. often persists into adulthood

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Hyponatremia occurs in all except:
a. 4% postop patients
b. always assoc with hypoosmolality
c. may be assoc with increased total body sodium
d. rapid correction can lead to quadriplegia

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Chiari type 2 malformations is assoc with all of the following except:
a. Seizures
b. Latex allergy
c. Hydrocephalus
d. Syringomyelia

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T5 spinal is assoc with decreases in all except:
a. Myocardial oxygen demand
b. Coronary blood flow
c. Hepatic blood flow
d. Resting ventilation

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PCWP overestimates the LVEDP in which of the following circumstances:
a. LV Diastolic Dysfunction
b. Pneumonectomy
c. Aortic Insufficiency
d. CHF

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What is the MOST reliable method of determining correct tube placement:
a. Auscultation of the chest
b. ETCO2 on FIRST breath
c. Endoscopic examination of the airway
d. Chest Movement

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25. What proportion of deaths within 48hrs are attributable solely to the anesthetic provider? a. 0.4% b. 4% c. 10% d. 14%

26. The addition of 0.75% Isoflurane to a mixture of 50% N20/O2 will result in which of the following a. Depression of the neonate b. Increased blood loss c. Reduced maternal awareness d. Atonic uterus

27. Which of the following is an abolute indication for lung separation? a. Thoracoscopy b. upper lobectomy c. pneumonectomy d. giant unilateral bullae

28. For patients with severe COPD, which of the following best explains the predisposition to hypercarbia hours following an anesthetic? a. Reduced responsiveness to CO2 b. Reduced Responsiveness to O2 c. Intercostal muscle weakness d. ??something else

29. At what temperature does the ACLS guidelines recommend limiting defibrillation attempts? a. 29 b. 30 c. 31 d. 32

30. Which of the following IS NOT a risk factor for Afib following non cardiac surgery a. DM b. Ischemic heart disease c. Age d. Previous AF

31. Which of the following best predicts renal failure follwoing a laparotomy? a. Hypertension b. Hypovolemia c. Age>60 d. Coronary disease

32. Which is most commonly seen with hyperkalemia? a. long QT b. VF c. Conduction Block (AV block)

33. Which is not part of the aldrete score a. pain b. activity c. spo2

34. Which of the following drugs should be dosed on lean body mass for morbidly obese patients a. midaz b. fentanyl c. sux d. roc

35. In which of the following is amiodarone not indicated a. polymorphic VT b. rate control for SVT in patient with preexcitation c. ?VF d. Torsades

36. Which of the following drugs (?elimination/clearance) is effected most by renal failure a. midaz b. fent c. roc d. neostigmine

37. Patient with a severe blunt neck injury, hypoxic, hoarse, stridulous. WHich is least desirable method of securing the airway a. Direct laryngoscopy with in line stabilization b. blind nasal c. fibreoptic d. tracheostomy

38. Which of the following diuretics act at the collecting duct? a. mannitol b. spironolactone c. hctz d. furosemide

39. when does PAW mean overestimate LVEDP a. tachycardia b. AS c. AI d. pneumonectomy

40. With which of the following is bis unreliable a. propfol b. des c. sevo d. ketamine

41. Which is best at reducing gastic volume a. ranidine b. cimetidine c. pantoloc d. na citrate

42. which adjunt provides most reliable analgesia to IVRA a. cloinidine b. opiate c. ketorolac d. bicarb

43. which is least likely to impair lidocaine elimination? a. elderly b. hepatic disease c. renal failure d. chf

44. low Vt ventilation (6/kg) which is not a benefit a. improved mortality b. improved/fewer ventilator free days c. improved/fewer days free of end organ failure d. reduced barotraumas

45. All of the following occur during pregnancy, except a. CO increases 50% b. SVR decreases 20% c. EF unchanged d. CVP unchanged

46. Which lead is positioned at the 4th IC space Lt sternal border a. v2 b. v3 c. v4 d. v5

47. Which epidural opiate lasts the longest a. hydromorph b. meperidine c. two short acting lipophilic choices

48. What does teh CAS recommed as adequate monitoring for adequacy of scavenging a. CFCs b. halogenated hydrocarbons c. nitrous d. CO2

49. Which will depress the amplitude of SSEPs the most a. 1.5 MAC isoflurane b. 2.5 mg/kg propofol c. .1 / kg midaz d. ?fentanyl

50. What is the most common reason for malpractice claims against Canadian anesthesiologists

51. Ketamine works at all receptors, except a. nmda b. gaba c. monoamine d. opiate

52. which herbal causes hypoglycemia a. st johns b. kava c. valerian d. ginseng

53. Regarding factors that limit vapor output accuracy in a variable bypass vaporizor, pick the exception a. Fresh gas flow rate less than 250 ml/min. b. Ambient temperature c. Intermittent Backpressure d. Carrier gas composition

54. Regarding Low tidal volume venitlation (6ml/kg) in ARDS, all are true except a. more ventilator-free days b. more organ-failure free days c. lower mortality d. lower barotraumas

55. Which of the following volatiles produces the LEAST amount of fluoride? a. sevoflurane b. halothane c. desflurane d. isoflurane

56. Which of the following accounts for a faster rise in alveolar concentration of sevoflurane in neonates as compared to adults? a. Neonates have a relatively greater cardiac output b. Neonates have relatively greater body water c. Neonates have a relatively smaller FRC per kg d. Neonatal anesthetic delivery systems have much smaller volumes

57. The shorter duration of analgesia from a single dose of fentanyl compared to an equipotent dose of morphine can best be explained by? a. Fentanyl has a smaller volume of distribution (Vd) b. Fentanyl quickly redistributes from the CNS to other tissues c. Fentanyl has a shorter elimination half time d. Fentanyl is less lipid soluble

58. Resistance to the antagonism of neuromuscular blockade by neostigmine may be influenced by? a. Metabolic alkalosis b. Hyperkalemia c. Respiratory acidosis d. Hyperthermia

59. Regarding neurolytic celiac plexus blockade, which one of the following statements is TRUE: a. Is MOST effective in Chronic Pancreatitis b. Requires needle placement at L2 c. Is commonly blocked bilaterally d. Requires the use of Phenol for neurolysis

60. What is the normal P50 of maternal hemoglobin at full term? a. 18 mm Hg b. 20 mm Hg c. 27 mm Hg d. 30 mm Hg

61. Which one of the following interventions is LEAST effective in preventing maternal hypotension after establishing a neuraxial blockade? a. Avoidance of Aorto-caval compression b. Administration of fluids c. Frequent monitoring of blood pressure d. Prophylactic use of ephedrine

62. Which of the following is MOST likely to render the BIS monitor unreliable? a. Propofol b. Ketamine c. Sevoflurane d. Desflurane

63. The clinical features of MVP may include which ONE of the following? a. Associated mesenchymal and skeletal abnormalities b. Most patients are symptomatic c. Chest pain is anginal in nature d. The murmur is an early systolic murmur

64. Which of the following would decrease the amplitude of SSEP waveforms the MOST? a. Isoflurane 1.5 MAC b. Propofol 2.5 mg/kg c. Midazolam 0.1 mg/kg d. Fentanyl 1 mcg/kg

65. For which of the following is TENS the LEAST helpful? a. Phantom Limb Pain b. Peripheral Nerve Injuries c. Myofascial Pain d. Central Pain

66. In a morbidly obese patient, which drug is most appropriately dosed by ideal body weight: a. midazolam b. fentanyl c. Succinylcholine d. Rocuronium

67. What is the Palveolar at atmospheric pressure 600 mmHg in an healthy patient with a PCO2 of 40 and a respiratory quotient of 0.8: a. 66 b. 76 c. 88 d. 104

68. Which of the following decreased with surgical stress: a. Cortisol b. Growth hormone c. ADH d. insulin

69. 12 year old 40 kg boy has been receiving on average 40 mcg/kg/hr of morphine for an arm surgery. He is being switched to oral medication. What is the most appropriate oral conversion: a. 20 mg PO q8h b. 20 mg PO q4h c. 40 mg PO qid d. 50 mg PO q6h

70. All except one is associated with the use of NIPPV in a patient with acute respiratory distress secondary to an acute COPD exacerbation. Indicate the Exception a. Reduced length of ICU stay b. Increased patient comfort c. Improved bronchial hygiene d. Decreased need for sedation

71. I think the options were a. more ventilator-free days b. more organ-failure free days c. reduced ICU admission d. improved bronchial hygiene

72. All except one is associated with increase local anesthetic toxicity in respiratory acidosis. Indicate the exception. a. Increased CBF b. Increased drug trapping in neuron c. Decreased protein binding d. Increased transfer of drug into neuron

73. All are associated with tracheal complications except a. Age b. Gender c. Duration of intubation d. Low pressure cuff

74. All agent readily cross the placenta except a. opioids b. IV induction agents c. Inhalational agents d. Neuromuscular blockers

75. Which of the following will cause an overestimation of cardiac output using the thermodilution method: a. Catheter tip in Zone 2 lung b. Using half the required volume of injectate c. The first few mintues off CPB d. Using Dextrose and Saline mixed for injectate

76. Which of the following opioids has the LONGEST duration of action when used epidurally: a. Meperidine b. Sufentanil c. Fentanyl d. Hydromorphone

77. The amount of epinephrine in 0.1ml of 1:1000 solution is: a. 1 mg b. 1 mcg c. 10 mcg d. 100 mcg

78. A 28 year-old male with WPW presents with a 4-hour history of ATRIAL FLUTTER and a ventricular rate of 150 bpm. He is normotensive, and previously well. Which one of the following medications would be appropriate at this time: a. Adenosine b. Diltiazem c. Esmolol d. Amiodarone

79. Regarding risk factors for postop AFib, please indicate the exception a. DM b. Cardiac Surgery c. Advanced Age d. Pre op AFib

80. Regarding preop preparation of a pt with Cystic Fibrosis, please indicate the exception a. Chest physio and positional drainage b. Bronchodilation using B agonists c. Decrease secretions with anticholinergics d. Decrease viscosity of secretions with recombinant deoxyribonuclease

81. Which of the following has been associated with postoperative pain except a. decreased total lung capacity b. increased circulating catecholamines c. increased coagulopathy d. decreased gastric motility

82. Which of the following ECG changes is NOT seen in pulmonary hypertension? a. biphasic p waves in V6 b. RBBB c. p pulmonale (p wave greater than 2.5mm) d. right axis deviation

83. A patient is having a one hour procedure on his forearm, and wants a regional anesthetic. Compared to an axillary block, an intravenous regional block will have all EXCEPT ONE of the following? a. superior surgical conditions b. equivalent risk of systemic local anesthetic toxicity c. facilitation of post operative neurological assessment d. higher success rate

84. What nerve originates from L2-L2, travels through groove between iliacus and psoas, gives articular branch to hip and supplies medial thigh? a. saphenous b. femoral c. obturator d. lateral femoral cutaneous

85. Max apnea from remifentanyl at (mins): a. 1 b. 2 c. 5 d. 10

86. What is the most appropriate for an old patient with pain secondary to post herpetic neuralgia a. Narcotics b. TCA c. local anaesthesia d. steroids .

87. For a side stream capnography an erroneous high reading in the Et CO2 is secondary to a. very low sampling flow b. very high sampling flow c. inability to compensate for oxygen in the expiratory limb d. Water condensation in the sampling line .

88. What is the terminal arrhythmia associated with hyperkalemia? a. Prolonged QT b. Ventricular fibrillation c. Supraventricular tachycardia d. Heart block

89. According to the 2004 CAS guidelines, anesthesia equipment is deemed required, exclusively available, or immediately available. Of the following, which is REQUIRED? a. Temperature probe b. Stethoscope c. Capnography

90. All of the following EXCEPT ONE may be used for post operative nausea and vomiting: a. Dexamethasone b. Ketamine c. Diphenhydramine d. Ondansetron

91. All of the following EXCEPT ONE may be used as a weaning mode: a. Pressure support ventilation b. Pressure control ventilation c. Synchronized intermittent mandatory ventilation d. T piece

92. Amiodarone may be used for all of the following EXCEPT: a. PSVT b. Polymorphic VT c. Rate control for atrial fibrillation and pre-excitation d. Torsades de Pointes

93. Which of the following DOES NOT contribute to PaCO2 during insufflation of CO2 with pneumoperitoneum a. Duration of inflation b. Rate of inflation c. Blood flow to the abdominal wall d. Location of inflation (trochar?)

94. Incompetent circuit expiratory valve present in the capnography with a. slow drop of the slope of the inspiratory phase b. oscillation of the plateau of the expiratory phase c. slow rise of the expiratory phase slope d. gradual increase in the baseline CO2

95. A patient with chronic A fib which will benefit from Anticoagulant the most : a. age

96. What nerve originates from L2-L2, travels through groove between iliacus and psoas, gives articular branch to hip and supplies medial thigh? a. Saphenous b. Femoral c. Obturator d. Lateral femoral cutaneous

97. Max respiratory depression from remifentanyl at (mins): a. 1 b. 2 c. 5 d. 10

98. What does the CDC recommend re: exposure to HIV from mucous membrane? a. no prophylaxis until HIV titre known b. multidrug prophylaxis offered to everyone c. prophylaxis only if high risk contact d. no prophylaxis needed

99. Placement of electrode at left 4th intercostals space at left lateral sternal border will detect which lead? a. V1 b. V2 c. V3 d. V4

100. Regarding caudal anesthesia in pediatric patients, which is true? a. Catheter insertion is contraindicated in children younger than 5 years old b. The dose of morphine should be double in comparison to lumbar opioid to obtain the same level of analgesia c. The needle should not be inserted beyond 1 cm of the sacrococcygeal ligament d. Lateral decubitus position favours block on one side

101. Which one of the following herbal therapies is associated with hypoglycemia: a. Kava b. St Johns Wort c. Valeria d. Ginseng

102. Which of the following with exacerbate cerebral ischemic injury? a. Mannitol b. Thiopental c. Calcium Channel Blocker d. Hyperglycemia

103. All of the following are components of GCS, EXCEPT a. Eyes open to pain b. Pupillary response to light c. Obeys commands d. Spontaneous extension of limbs

104. Concernig neonatal vs. adult cardiac physiology, all are true EXCEPT a. decreased contractile force per gram of myocardium b. decreased LV compliance c. increased ability to increase cardiac output d. decreased baroreceptor response to hypotension

105. All of the following are a part of the calculation of oxygen content EXCEPT a. P50O2 b. O2Sat c. PAO2 d. solubility of O2 in plasma

106. All of the following are consistant with the diagnoses of pre-eclampsia EXCEPT a. increased fibrinogen b. thrombocytopenia c. proteinuria d. hemoconcentration

107. All of the following are components of GCS, EXCEPT a. Eyes open to pain b. Pupillary response to light c. Obeys commands d. Spontaneous extension of limbs

108. Concernig neonatal vs. adult cardiac physiology, all are true EXCEPT a. decreased contractile force per gram of myocardium b. decreased LV compliance c. increased ability to increase cardiac output d. decreased baroreceptor response to hypotension

109. All of the following are a part of the calculation of oxygen content EXCEPT a. P50O2 b. O2Sat c. PAO2 d. solubility of O2 in plasma

110. All of the following are consistant with the diagnoses of pre-eclampsia EXCEPT a. increased fibrinogen b. thrombocytopenia c. proteinuria d. hemoconcentration

111. Regarding CO2 monitoring with sidestream analyzer, which of the following could be responsible for a falsely elevated ET CO2: a. too low a sampling flow rate b. too high a sampling flow rate c. water in CO2 tubing d. failure to adjust for oxygen in expired gas

112. Patient is undergoing a TURP under spinal anaesthesia with a level at T9. The patient begins to experience restlessness, nausea and epigastric pain. What is the most likely diagnosis responsible for his symptoms? a. myocardial ischemia b. TURP syndrome c. inadequate level of anaesthesia d. intraperitoneal bladder rupture

113. Which of the following regional techniques could cause an MS flare? a. Epidural b. Spinal c. Femoral d. Bier

114. In which of the following patients would an ambulatory inguinal hernia repair be contraindicated? a. 101 year old patient b. morbid obesity and asthma c. infant born pre-term now 60 weeks postconceptual age d. patient know to be MH susceptible

115. Earliest sign or symptom of accidental IV infusion of local anesthetic: a. Dizziness b. Tinnitus c. Cardiac dysrhythmias d. Muscle twitching

116. What is LEAST likely w/ neuromuscular blockade reversal w/ neostigmine and gycopyrrolate? a. Persistent tachycardia b. Memory deficits c. Salivation d. Bronchospasm

117. Other than neurological deficits, what is the most common sign or symptom w/ epidural hematoma a. Severe back pain b. Local back tenderness c. Bladder & bowel symptoms d. Increased temperature

118. Young man is badly injured in in a snowmobile accident. C-spine films are not yet done. He is stridorous, hypoxic, hoarse and has significant neck swelling. Which of the following is LEAST optimal for urgent airway management? a. Direct laryngoscopy and endotracheal intubation b. Blind nasal intubation c. Awake fibreoptic intubation d. Awake tracheostomy

119. All except one is associated with the use of NIPPV in a patient with acute respiratory distress secondary to an acute COPD exacerbation. Indicate the Exception a. Reduced length of ICU stay b. Increased patient comfort c. Improved bronchial hygiene d. Decreased need for sedation

120. All except one is associated with increase local anesthetic toxicity in respiratory acidosis. Indicate the exception. a. Increased CBF b. Increased drug trapping in neuron c. Decreased protein binding d. Increased transfer of drug into neuron

121. All are associated with tracheal complications except a. Age b. Gender c. Duration of intubation d. Low pressure cuff

122. All agent readily cross the placenta except a. Opioids b. IV induction agents c. Inhalational agents d. Neuromuscular blockers

123. All, EXCEPT ONE, of the following are risk factors for post-operative apnea in the neonate. Indicate the exception. a. Anemia b. Post-conceptual age c. Gestational age d. Upper respiratory tract infection

124. Regarding hyponatremia, all EXCEPT ONE of the following are true. Indicate the exception. a. 4% of all post-operative patients have serum sodium concentrations

125. All EXCEPT ONE of the following are associated with Chiari type II malformation. Indicate the exception. a. Latex allergy b. Hydrocephalus c. Syringomyelia d. Seizures

126. Following establishment of spinal anesthesia to T5, there is a fall in all EXCEPT ONE of the following parameters. Indicate the exception. a. Myocardial oxygen consumption b. Hepatic blood flow c. Resting ventilation d. Coronary blood flow

127. Which of the following cause hypoglycemia: a. Ginseng b. St.johns wort c. Valerian d. Kava

128. Which of the following should be avoided in traumatic brain injury? a. hyperglycemia b. thiopental c. propoful d. hypothermia

129. Placing precardial lead in the right fourth intercostal space will correspond to: a. V1 b. V2 c. V3 d. V4

130. Regarding caudal anesthesia in pediatric patients, which is true? a. Catheter insertion is contraindicated in children younger than 5 years old b. The dose of morphine should be double in comparison to lumbar opioid to obtain the same level of analgesia c. The needle should not be inserted beyond 1 cm of the sacrococcygeal ligament d. Increased morphine absorption because the caudal region is more vascularized

131. In a morbidly obese patient, which drug is most appropriately dosed by ideal body weight: a. midazolam b. fentanyl c. Succinylcholine d. Rocuronium

132. What is the Palveolar at atmospheric pressure 600 mmHg in an healthy patient with a PCO2 of 40 and a respiratory quotient of 0.8: a. 66 b. 76 c. 88 d. 104

133. Which of the following decreased with surgical stress: a. Cortisol b. Growth hormone c. ADH d. insulin

134. A 12 year old 40 kg boy has been receiving on average 40 mcg/kg/hr of morphine for an arm surgery. He is being switched to oral medication. What is the most appropriate oral conversion: a. 20 mg PO q8h b. 20 mg PO q4h c. 40 mg PO qid d. 50 mg PO q6h

135. All of the following are characteristics of Flumazenil except: a. Low protein binding b. Rapid onset c. Short elimination half life d. Clinically significant intrinsic activity

136. All of the following are risk factors for postoperative apnea in infants except: a. Anemia b. Post-conceptual age c. Gestational age d. Upper respiratory tract infection

137. All are hemodynamic effects of positive end-expiratory pressure except: a. Increased Left ventricular afterload b. Decreased Left ventricular preload c. Increased pulmonary artery pressures d. Decreased right venticular preload

138. All of the following are associated with Chiari II malformation except: a. Seizures b. Latex allergy c. Syringomyelia d. Hydrocephalus

139. Which of the following volatiles produces the LEAST amount of fluoride? a. Sevoflurane b. Halothane c. Desflurane d. Isoflurane

140. Which of the following accounts for a faster rise in alveolar concentration of sevoflurane in neonates as compared to adults? a. Neonates have a relatively greater cardiac output b. Neonates have relatively greater body water c. Neonates have a relatively smaller FRC per kg d. Neonatal anesthetic delivery systems have much smaller volumes

141. The shorter duration of analgesia from a single dose of fentanyl compared to an equipotent dose of morphine can best be explained by? a. Fentanyl has a smaller volume of distribution (Vd) b. Fentanyl quickly redistributes from the CNS to other tissues c. Fentanyl has a shorter elimination half time d. Fentanyl is less lipid soluble

142. Resistance to the antagonism of neuromuscular blockade by neostigmine may be influenced by? a. Metabolic alkalosis b. Hyperkalemia c. Respiratory acidosis d. Hyperthermia

143. In a patient in the lateral decubitus position, which injury is most likely to occur on the non-dependent side? a. Suprascapular nerve injury b. Peroneal nerve injury c. Ischemic retinopathy d. Femoral head avascular necrosis

144. Following a supraclavicular nerve block, 96 hours post-op. a patient is unable to abduct his arm laterally and has sensory loss in the area between the deltoid and elbow. Which nerve is most likely affected? a. Posterior cord b. Musculocutaneous nerve c. Axillary nerve d. Subscapular nerve

145. In a patient with hepatic failure, which drug would be LEAST affected? a. Fentanyl b. Alfentanil c. Sufentanil d. Remifentanil

146. A patient involved in a MVA arrives in the ER with head injuries. His blood pressure is 190/110 and heart rate is 47 with a GCS of 4. What would be the appropriate initial management? a. Decreasing the MAP to 60 mmHg b. High dose barbiturates c. Hyperventilate to PaCO2 to 25- 30 mmHg d. Mannitol 0.5 g/kg

147. In chronic renal failure which of the following drugs would have the greatest increase in their half life? a. Neostigmine b. Rocuronium c. Sufentanil d. Sodium Thiopental

148. Comparing lidocaine vs. bupivicaine, which of following is true? a. Similar CNS toxicity b. Greater myocardial depression with lidocaine c. Bupivicaine cardiac toxicity is enhanced by hypocarbia d. AV blockade is seen more often with lidocaine

149. Which of the following is responsible for the initial presentation inamniotic fluid embolism? a. Pulmonary vasospasm b. Bronchospasm c. Debris in the pulmonary vasculature d. Left ventricular failure

150. Which of the following formula would allow you to calculate the power of a study? a. beta b. 1 –  c. 1 –  d. 1 + 

151. A patient with chronic renal insufficiency, suffers an isolated head injury, is intubated, ventilated and sedated using a propofol infusion for 48 hours. Following discontinuation of the infusion, a slow elimination half life of the propofol would be due to which of the following reasons? a. Slow hepatic clearance of the central compartment b. Slow renal clearance of active metabolites c. Lack of extra-hepatic routes of metabolism d. Diffusion of the drug from poorly perfused compartments back into the central compartment

152. Which of the following increases CO production in a circle circuit anesthetic setup? a. Long duration of anesthesia b. Moisture in the circuit c. Sevoflurane (vs. desflurane) d. Sodalime (vs.baralyme)

153. Which of the followin perdisposes to Torsades des Pointes? a. Hypercalcemia b. Hyperkalemia c. Hypomagnesemia d. Decreased QT interval

154. Most common ECG changes seen with hyperkalemia a. supraventricular tachycardia b. ventricular tachycardia c. heart block d. long QT

155. The CAS 2004 guidelines recommending equipment that is required, exclusively available or immediately available for patients. Which of the following is required? a. Nerve stimulator b. Stethoscope c. temperature monitor d. capnography

156. Which will promote the formation of CO in anesthesia machine with a circuit a. length of anesthesia b. condensation in the circuit c. sevo vs Des d. sodalym vs baralyme

157. Associated with torsades de point a. Hypercalcemia b. Hyperkalemia c. Hypomagnesemia d. long QT

158. Universal barrier precautions should be used for all except which body fluid: a. Sweat b. Blood c. Urine d. Mucous

159. Physiologic changes of the term pregnancy include all except: a. No change in CVP b. Increased CO by 50% c. Decreased SVR by 20% d. No change in ejection fraction

160. Leukodepletion of blood products reduces all except: a. CMV b. JCD c. Febrile reactions d. Alloimmunization

161. All except which of the following are part of the PACU aldrete patient rating score a. Activity b. Circulation c. Resp d. Temp

162. All of the following potentiate NDMR, except one. Indicate the exception a. Antiarrythmics b. Diuretics c. Antibiotics d. Phenothiazides

163. All of the following cause hypervolemic hyponatremia, except one. Indicate the exception a. Cirrhosis b. TURP syndrome c. SIADH d. CHF

164. All of the following cause a decrease in mixed venous oxygen, except one. Indicate the exception a. Decreased CO b. Increased oxygen consumption c. Low hemoglobin d. Low pulmonary capillary wedge pressure

165. All of the following are seen with TPN use except. Indicate the exception a. Hyperosmolar non-ketotoc b. Hypoglycemia c. Hypocarbia d. Metabolic acidosis

166. Cryoprecipitate contains all of the following elements EXCEPT: a. factor V b. factor VIII c. vWF d. factor XIII

167. Advantages of a double lumen tube over a bronchial blocker include all EXCEPT: a. ability to independently suction each lung b. ease of placement in a patient with distorted airway anatomy c. ease of conversion from double lung to single lung ventilation d. ease of application of CPAP to nonventilated operative lung

168. Renal mechanisms to prevent academia include all except: a. ammonium excreted into the tubules b. increase in ammonia production c. acidification of buffers in the tubules d. prevents sodium reabsorption in the ascending loop of Henle.

169. Pulsus paradoxus is most likely associated with all except: a. Acute LV failure b. Acute myocardial infarction in right ventricle. c. Cardiac tamponade d. Constrictive pericarditis

170.All are true about midazolam except a. Midazolam is equipotent with diazepam b.

171. Regarding decrease of FRC with the induction of general anesthesia, it’s due to all of the following except: a. Increase in air way resistance. b. Decrease in inspiratory muscles tone at the end of expiration. c. Cephalic displacement of diaphragm. d. Decrease in surfactant production.

172. The CAS has guidelines recommending equipment that is required, exclusively available or immediately available for patients. Which of the following is required? a. Temperature probe b. Nerve Stimulator c. Spirometry d. Capnograph

173. Hyperkalemia most typically you see a. prolonged QT b. Heart block c. VT d. SVT

174. Hypomagnesemia cause one of a. SVT b. AF c. Torsales de pointes

175. What is the core body temperature for which the ACLS Guidelines recommend only one series of 3 shocks for Vent Fib prior to attempts to re-warm? a. 29 C b. 30 c. 31 d. 32

176. What is the serum binding protein for most of the basic drugs (as opposed to acidic)? a. Albumin b. Lipoprotein c. Globulin d. alpha1- acid glycoprotein

177. According to the CAS Guidelines for Standards of Practice of Anesthesia, which gas is measured to assess adequacy of scavenging systems? a. CO2 b. N2O c. Fluorocarbons d. Halogenated hydrocarbons

178. A patient with an acute asthma exacerbation has the following blood gases: pH 7.26, PaC02 54, Pa02 90 and HC03 25. The MOST appropriate management strategy is? a. Mechanical ventilation b. IV corticosteroids c. Supplemental Oxygen d. IV aminophylline

179. What is TRUE about a pregnant patient with severe PIH undergoing a general anesthetic for cesarean section? a. Ketamine is the induction agent of choice b. Magnesium does not have to be continued in the postoperative period c. The increase in airway edema is exaggerated compared with the normal pregnant patient d. An increased dose of succinylcholine is required if the patient is on magnesium e. 0.5 MAC halothane causes neonatal depression

180. What is the total body water of a term infant (% body weight)? a. 30% b. 45% c. 60% d. 75% e. 90%

181. A term neonate is born limp and apneic. After 60 seconds of PPV with 100% 02 and 30 seconds of chest compressions, the HR remains less than 60bpm. What is the most appropriate next step? a. Naloxone 0.1 mg/kg IV b. Atropine 20 mcg/kg IV c. Dopamine 5g/kg/min IV (exactly as written) d. Epinephrine 0.01mg/kg IV

182. Regarding the proportioning system on modern anaesthetic machines? a. It guarantees 21% FiO2 at the fresh gas outlet b. It prevents a downstream leak c. It is not affected by 2nd stage regulator failure d. Links only O2 and NO2

183. Which of the following is contraindicated in acute cocaine intoxication? a. Midazolam b. Phentolamine c. Metoprolol d. ECASA

184. Providing a high FiO2 to a pregnant individual will: a. Increase fetal oxygenation b. Decrease uterine blood flow c. Increase umbilical arterial flow d. Increase risk of intra-uterine retrolental fibroplasias

185. A 65 yo M c 60% FEV1 scheduled for Left Upper Lobectomy. A V/Q scan of the LUQ shows ventilation = 7%, perfusion = 3% of total lung values. Predicted post-operative FEV1 is: a. 60% b. 55% c. 50% d. 45%

186. All the following conditions cause a drop of 11 mm Hg in SBP upon inspiration EXCEPT: a. chronic left ventricular failure b. constrictive pericarditis c. acute right ventricular infarction d. cardiac tamponade

187. The following findings can all be found 12 hours post traumatic C7 quadraplegic injury EXCEPT a. Hyperkalemia b. pulmonary edema c. bradycardia d. gastric dilation

188. All of the following contribute to the fall in FRC during GA EXCEPT: a. increased airway resistance b. decreased inspiratory muscle tone at end expiration c. cephalad displacement of the diaphragm d. decreased surfactant production

189. With regards to vasopressin during cardiac arrest, all are true EXCEPT: a. exerts a non-adrenergic vasoconstrictor effect b. increases coronary perfusion pressure c. increases myocardial oxygen consumption d. maintains its effect even in severe acidosis 190. Regarding innervation of the carotid body, which is TRUE? a. It is located distally to the internal carotid artery. b. In response to elevated PaCO2 there is an increase in tidal volume. c. Causes increased minute ventilation in response to PaO2 less than 60. d. It is innervated by the vagus nerve.

191. Caracteristic finding on CXR of lobar collapse is? a. Alveolar shadowing b. Air bronchograms c. Hilar shift d. Reticulonodular pattern

192. Onset of action is the fastest for which opioid? a. Fentanyl b. morphine c. remifentanil d. alfentanil

193. What is the most common complication of Lateral Decubitus Position on the nondependent side? a. Suprascapular nerve injury b. Avascular necrosis of femoral neck c. Retinal ischemia d. Peroneal nerve injury

194. 96h Post shoulder arthroscopy patient is unable to abduct arm and sensation deficit on lateral aspect of upper arm to elbow. No other abnormal findings. Which nerve injury is the cause? a. Suprascapular nerve b. Posterior cord c. Axillary nerve d. Musculocutaneous nerve

195. Which one of the following opioids is least affected by hepatic metabolism? a. Alfentanyl b. Sufentanyl c. Remifentanyl d. Fentanyl

196. A 28y patient arrived in ER with a Glascow coma score of 4 and BP 190/110 and a pulse of 45/min. what is the best initial management? a. High dose barbiturates b. Ventilate to CO2 of 25-30 mmHg c. Treat blood pressure to a mean of 60 mmHg d. Mannitol 0.5 g/kg

197. Which of the following, if used chronically, would increase MAC a. Amphetamines b. MAOI c. Lithium d. 􃲍-Methyldopa

198. Discontinuing smoking two days pre-operatively would lead to ... a. Decreased sputum production b. Increased cilia firing c. LEFTward shift of ODC d. Decreased overall respiratory complications

199. Regarding Midazolam in children, which of the following is true? a. Can be given orally or rectally b. Is palatable c. Does not interfere with opiods as pre-med d. Optimally leads to a sleeping child prior to OR

200. When used to treat raised ICP which of the following leads to an increase in cerebral vascular resistance? a. Sodiumpentothal b. Mannitol c. Lasix d. Asetozolamide

201. At what core temperature do the ACLS guidelines recommend limiting defibrillation to 3 stacked shocks prior to active rewarming? a. 29C b. 30C c. 31C d. 32C

202. What is the principal binding protein for basic drugs? a. albumin b. globulin c. lipoprotein d. alpha1-acid glycoprotein

203. Which of the following cardiac anomalies requires endocarditis prophylaxis for dental extraction? a. mitral valve prolapse without regurgitation b. isolated secundum atrial septal defect c. implanted defibrillator d. hypertrophic cardiomyopathy

204. According to the CAS document regarding testing of adequacy of operating room scavenging systems, which of the following can be used? a. CO2 b. N2O c. halogenated hydrocarbons d. chlorofluorcarbons

205. Regarding thyroid storm which of the following statements is true: a. caused by a sudden release of T4 and T3 into the circulation b. most likely to occur 48 hours post operatively c. potassium iodide is administered to suppress thyroid stimulating hormone d. propylthiouracil is rarely used as oral administration is not practical

206. A man sustains a laceration to the base of the fourth toe on the plantar surface of the foot. What area should be injected to anesthetize the affected area: a. posterior to the lateral malleolus b. posterior to the arterial pulse behind the medial malleolus c. lateral to the anterior tibial artery pulse at the level of the ankle skin crease d. between the lateral malleolus and the pulse of the anterior tibial artery

207. A patient heterozygous for atypical pseudocholinesterase is expected to have what dibucaine number: a. 90-100 b. 70-80 c. 50-60 d. 20-30

208. Which condition is likely to result in mean PACWP overestimating LVEDP: a. Tachycardia b. LV diastolic dysfunction c. aortic insufficiency d. post pneumonectomy

209. Lequel des médicaments suivants n'est pas associé à une augmentation de l'intensité du bloc neuromusculaire a. anesthésiques locaux b. antiarythmiques cardiaques c. diurétiques d. phénothiazines

210. Toutes les situations suivantes sont associées à une hyponatrémie hypervolémique sauf une a. Cirrhose b. insuffisance cardiaque congestive c. SIADH d. TURP

211. Tous les effets secondaires suivants sauf un sont liés à l'hyperalimentation intraveineuse a. coma hyperglycémique hyperosmolaire non cétosique b. hypoglycémie c. hypocarbie d. acidose métabolique

212. Toutes les situations suivantes sont associées à une diminution de SvO2 sauf une a. diminution du débit cardiaque b. diminution de la concentration d'hémoglobine c. diminution de la pression capillaire bloquée d. augmentation de la consommation d'O2

213. Which of the following anticoagulation regimes is not a contraindication to neuraxial anesthesia? a. clopidigrel 75mg PO QD b. warfarin 5mg PO QD c. Heparin 5000 U SC BID d. Enoxaparin 40 U SC BID

214. Which of the following does not enhance neuromuscular blockade? a. local anesthetics b. diurectics c. antidysrhythmic drugs d. phenothiazines

215. Cocaine abuse during pregnancy is associated with increased likelihood of all of the following complications EXCEPT a. placenta previa b. fetal acidosis c. preterm labour d. congenital malformations

216. TPN is associated with all of the following EXCEPT a. hypoglycemia b. hypocarbia c. nonketotic hyperosmolar hyperglycemia d. metabolic acidosis

217. Tous les facteurs suivants affectent l'émergence suite à une dose de propofol SAUF: a. Sexe b. Baisse du débit sanguin hépatique c. Insuffisance rénale d. Température

218. La douleur post-opératoire a les effets suivant, SAUF: a. diminution de la capacité pulmonaire totale b. augmentation des catécholamines circulantes c. augmentation de la coagulopathie d. diminution de la vidange gastrique

219. Prise en charge d'une tamponnade cardiaque, tous SAUF: a. ventilation spontanée b. diminution de la fréquence cardiaque c. péricardocentèse d. vasoconstriction périphérique

220. Effets des bradikinines, tous SAUF: a. augmentation des résistances des voies aériennes b. vasodilatation c. augmentation de la perméabilité capillaire d. diminution du débit cardiaque

221. A patient with severe COPD presents to the OR for lower limb surgery. He states that he wants a general anesthetic and "doesn't even want to hear about a regional". What willyou do? a. do the block b. explain the block c. give him a GA as he requested d. refuse to participate in his care

222.What is the APGAR score of a neonate that is blue, grunting, grimaces to suction, HR

223. With respect to the rate of rise of Fa/Fi of inhaltional anesthetics, which of the following statements is true? a. initially slow rise regardless of agent b. accelerated rise with increased ventilation c. decreased rise with increased cardiac output d. no effect with use of N2) on induction

224. With respect to cerebral blood flow, which of the following is linearly related? a. PaCO2 b. PCO2 c. perfusion pressure d. temperature

225. In chronic renal failure, which will have the most significant increase in it's half life? a. Sufentanil b. STP c. Rocuronium d. Neostigmine

226. Comparing clinically equivalent local anesthetic doses of lidocaine and bupivacaine, which is true? a. Similar CNS toxicity b. Greater depression of contractility with lidocaine c. Bupivacaine cardiotoxicity is enhanced by hypocarbia d. AV block is seen more with lidocaine

227. What is the formula to calculate the power of a study? a. 1 - Beta b. Beta c. 1 - Alpha d. 1 + Beta

228. A patient with renal insufficiency and an isolated head injury is in the ICU intubated and sedated on a propofol drip for 48 hours. Following the discontinuation of the infusion, what is the reason for the prolonged elimination half-life? a. Slowed hepatic metabolism from the central compartment b. Decreased renal clearance of active metabolites c. Slow diffusion of propofol from poorly perfused compartments to the central compartment d. Lack of non-hepatic routes of elimination

229. For neurolytic celiac plexus block, which of the following is true? a. Is best for chronic pancreatitis b. Needle should be placed lateral to L2 c. The block is performed bilaterally d. Phenol is commonly used for fast onset of block

230. Which of the following has not been shown to prevent hypotension in the parturient? a. IV fluids b. Preventing aortocaval compression c. Frequent NIBP cycling d. Prophylactic ephedrine

231. Termination of propofol effect is affected by all of the following except? a. gender b. age c. hepatic blood flow d. renal failure

232. All are effects of acute post-operative pain except? (note, site of pain not indicated on exam) a. decrease in total lung capacity b. increase catecholamines c. decrease gastric motility d. increase coagulopathy

233.Management of pericardial tamponade include all of the following except? a. maintain spontaneous ventilation b decrease heart rate c. vasoconstriction d. pericardiocentesis

234. All of the following are effects of bradykinin except? (note: site of pain not indicated on exam) a. increase in airway resistance b. vasodilation c. increase capillary permeability d. decrease cardiac output