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True Learn Main Points > Former ITE Questions > Flashcards

Former ITE Questions Flashcards

1
Q

A 30-kg patient with asthma is receiving general anesthesia and being mechanically ventilated with a measured tidal volume of 300 mL. Increasing the fresh gas flow from 3 L/min to 9 L/min without changing the ventilatory rate or I:E ratio will result in

(A) decreased physiologic dead space

(B) increased delivered tidal volume

(C) increased end-expired carbon dioxide

(D) unchanged delivered minute volume

(E) unchanged peak inspiratory pressure

A

B ***

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2
Q

A subarachnoid block to a sensory level of the second thoracic dermatome is associated with each of the following EXCEPT (A) total sympathetic block (B) decreased gastrointestinal smooth muscle tone (C) bradycardia (D) relaxation of gastrointestinal sphincters (E) decreased renal blood flow

A

B ***

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3
Q

Which of the following statements concerning pressure support ventilation is true? (A) It augments gas inflow in response to spontaneous inspiration (B) It increases inspiratory airway pressure during controlled mandatory ventilation (C) It requires the use of positive end-expiratory pressure (D) It functions independently of airway resistance/lung compliance (E) It correlates linearly with spontaneously achieved tidal volume

A

A

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4
Q

A patient develops urticaria and pruritus while receiving a blood transfusion in the PACU. Blood pressure and heart rate are unchanged from pretransfusion values. The most appropriate action is administration of (A) diphenhydramine (B) epinephrine (C) furosemide (D) hydrocortisone (E) mannitol

A

A

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5
Q

The patient at LEAST risk of pulmonary aspiration of gastric contents during induction of anesthesia is (A) markedly obese and NPO for eight hours (B) fed black coffee four hours before elective surgery (C) scheduled for elective cesarean delivery and NPO for 20 hours (D) NPO for four hours after a full meal (E) scheduled for elective repair of a hiatus hernia

A

B

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6
Q

During anesthesia with nitrous oxide, oxygen, and a relaxant, the patient’s lungs are being mechanically ventilated and there is a heated humidifier in the circuit. The most likely cause of an apparent increase in inspired oxygen concentration is (A) a hole in the ventilator bellows (B) backflow of fresh gas because of resistance in the humidifier (C) decreased oxygen utilization by the patient (D) heat damage to the oxygen sensor (E) water condensation on the oxygen sensor

A

A

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7
Q

Each of the following is a physiologic effect of intra-aortic balloon pump therapy EXCEPT (A) decreased peak systolic pressure (B) increased cardiac output (C) increased coronary perfusion (D) increased diastolic pressure (E) increased total peripheral resistance

A

E

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8
Q

The cardiovascular effects of an inhalational anesthetic are evaluated in 10 normal volunteers in the awake resting state and after 15 minutes of constant inspired concentration. Results were analyzed by t-test for paired data and are presented below as mean +/- standard deviation. Based on these data, which of the following conclusions is most valid? (A) A decrease in cardiac output would have been evident if more subjects were included in the study (B) The anesthetic decreases mean arterial pressure (C) The anesthetic does not cause cardiac depression (D) The anesthetic is unsafe for patients with coronary after disease (E) There is a 95% to 100% chance that the anesthetic increases heart rate.

A

E

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9
Q

Which of the following must be considered during perioperative management of a patient on long-term lithium therapy?

(A) Intravenous fluids should include sodium

(B) Therapy should be discontinued for 14 days prior to anesthesia

(C) The requirement for succinylcholine is increased

(D) The requirement for volatile anesthetics is increased

(E) Urine output should be maintained with furosemide

A

A

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10
Q

Which of the following is the most likely cause of a decrease in end-tidal carbon dioxide tension during general anesthesia with a constant minute ventilation?

(A) Administration of sodium bicarbonate

(B) Intravenous administration of hypertonic glucose solution

(C) Decrease in cardiac output

(D) Decrease in fresh gas flow in a Bain circuit

(E) Malfunction of the inspiratory valve in a circle system

A

C

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11
Q

Desflurane is delivered using a vaporizer that contains internal heaters because

(A) heat decreases the drug’s viscosity

(B) heat reduces thermal loss in the patient

(C) heat increases the drug’s oil-gas partition coefficient

(D) heat prevents fluctuations of vapor pressure

(E) it does not vaporize adequately at room temperature

A

D

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12
Q

A 70-kg patient experiences pain on incision of a thigh abscess. The area around the abscess had been infiltrated with 30 ml of 1% lidocaine in 1:200,000 epinephrine. The local anesthetic was most likely ineffective because of

(A) acidosis at the site of the injection

(B) epinephrine-induced limitation of drug diffusion

(C) insufficient dose

(D) low ionization of lidocaine

(E) protein binding of lidocaine

A

A

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13
Q

A previously healthy 28-year-old man is admitted to the emergency department with a probable opioid overdose. Arterial blood gas values are: PaO2 49 mmHg, PaCO2 76 mmHg, and pH 7.12 while breathing room air. Which of the following statements is true?

(A) Aspiration of gastric contents must have occurred

(B) Hypoventilation alone can explain the acidosis and hypoxemia

(C) The hypoxemia is probably due to noncardiogenic pulmonary edema

(D) Naloxone should be administered only if the patient is normothermic

(E) Pure oxygen is contraindicated

A

B

***

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14
Q

A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxemia, and rales. Which of the following is the most likely diagnosis?

(A) Gastric acid aspiration

(B) Myocardial infarction

(C) Pulmonary edema

(D) Pulmonary embolism

(E) Vocal cord paralysis

A

C

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15
Q

A 66-year-old man with chronic obstructive pulmonary disease who underwent colectomy 12 hours ago has been receiving an epidural infusion of fentanyl at a rate of 100 mcg/hr. Which of the following is LEAST likely to develop?

(A) Hypotension

(B) Nausea

(C) Pruritus

(D) Respiratory depression

(E) Urinary retention

A

A

***

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16
Q

Perception of pain from cutaneous sources involves each of the following EXCEPT

(A) frontal lobe gyri

(B) lateral spinothalamic tracts

(C) periaqueductal gray matter

(D) spinal dorsal horn lamina V

(E) unmyelinated C fibers

A

A

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17
Q

During laparotomy for a ruptured spleen, unexplained oozing occurs after infusion of 2 liters of crystalloid and 3 units of blood. The most likely cause is

(A) citrate toxicity

(B) dilutional thrombocytopenia

(C) hemolytic transfusion reaction

(D) labile clotting factor deficiency

(E) leukoagglutinin reaction

A

C

***

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18
Q

Which of the following findings would be considered normal in the EEG of an adult?

(A) Decreased frequency during induction with halogenated anesthetics

(B) Decreased frequency in frontal areas with administration of nitrous oxide 50%

(C) Dominance of beta rhythm at 20 to 30 Hz during the awake relaxed state

(D) Electrical silence with administration of isoflurane 2.5 MAC

(E) The presence of burst-suppression during natural sleep

A

D

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19
Q

A 68-year-old patient is undergoing total hip replacement during general anesthesia using positive pressure ventilation and neuromuscular blockade. Intraoperative monitoring shows a gradual decrease in end-tidal CO2, an increase in exhaled tidal volume, and an increase in measured FiO2. Which of the following is the most likely cause of these changes?

(A) Air entrainment around a deflated endotracheal tube cuff

(B) Channeling of the exhaled air through the carbon dioxide canister

(C) Fat embolism

(D) Inadequate muscle relaxation with spontaneous patient ventilation

(E) A small hole in the ventilator bellows

A

E

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20
Q

In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will

(A) increase slightly because of decreased shunt blood flow

(B) decrease slightly because of decreased mixed venous PO2

(C) increase because of decreased affinity of hemoglobin for oxygen

(D) decrease because of an increased dead space to tidal volume ratio

(E) increase because of increased pulmonary oxygen uptake per milliliter of blood

A

B

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21
Q

Which of the following characteristics of local anesthetics is associated with long duration of action?

(A) High degree of lipid solubility

(B) High degree of protein binding

(C) High molecular weight

(D) High pKa

(E) Presence of ester linkage

A

B

22
Q

Which of the following is increased in patients with chronic anemia?

(A) Mixed venous oxygen content

(B) P50

(C) Pulmonary vascular resistance

(D) Systemic vascular resistance

(E) Blood viscosity

A

B

23
Q

Which of the following is a sign of cyclosporine toxicity?

(A) Abnormal hepatic enzyme activity

(B) Decreased hemoglobin concentration

(C) Increased serum creatinine concentration

(D) Nodular density on radiograph of the chest

(E) ST-T wave changes on ECG

A

C

24
Q

In a normally functioning circle anesthesia system, if the length of the inspiratory and expiratory hose is doubled, the mechanical dead space will be

(A) halved

(B) unchanged

(C) doubled

(D) quadrupled

(E) dependent on compression volume

A

A ***

25
Q

Which of the following is the most important function of temperature compensation in anesthetic vaporizers?

(A) Compensation for changes in the specific heat of the anesthetic during vaporization

(B) Delivery of diluent gas at a constant temperature regardless of flow rate

(C) Increase of bypass flow when the vaporizer is cooled by high fresh gas flow

(D) Maintenance of constant anesthetic vapor output over a range of vaporizer temperatures

(E) Maintenance of constant vapor concentrations at low flow rates

A

D

***

26
Q

An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes

(A) mechanical ventilation with positive end-expiratory pressure (PEEP), cancellation of surgery, and transfer to the intensive care unit

(B) saline lavage and continuation of surgery using halothane anesthesia

(C) cancellation of surgery and administration of corticosteroids and antibiotics

(D) thorough suctioning and proceeding with halothane anesthesia

(E) cancellation of surgery, vigorous mechanical ventilation, thorough suctioning, and administration of aminophylline

A

A

27
Q

Following enflurane anesthesia, serum free fluoride concentration is most likely to be increased in association with long-term use of

(A) diazepam

(B) ethanol

(C) isoniazid

(D) phenobarbital

(E) phenytoin

A

C

28
Q

The mortality rate of patients given drug A is 12% (8 of 66) and the mortality rate of patients given drug B is 15% (10 of 66). Which of the following tests is most appropriate to compare these mortality rates?

(A) t-Test for paired data

(B) t-Test for unpaired data

(C) Wilcoxon rank test

(D) Chi-square test

(E) Analysis of covariance

A

D - Chi Squared

***

29
Q

Which of the effects of epidural morphine is most resistant to intravenous naloxone?

(A) Analgesia

(B) Nausea

(C) Pruritus

(D) Respiratory depression

(E) Urinary retention

A

A ***

30
Q

A patient develops jaundice one week after undergoing laparoscopic cholecystectomy during halothane anesthesia. Laboratory studies show an increased serum alkaline phosphatase concentration, a mildly increased serum aspartate aminotransferase concentration, and a markedly increased conjugated bilirubin fraction. Which of the following is the most likely diagnosis?

(A) Biliary obstruction

(B) Gilbert’s disease

(C) Halothane-associated hepatitis

(D) Hematoma resorption

(E) Infectious hepatitis

A

A

31
Q

Spontaneously breathing enflurane at 1 MAC causes increased

(A) airway resistance

(B) diaphragm function

(C) carbon dioxide production

(D) intercostal muscle function

(E) physiologic dead space

A

E

***

32
Q

In a patient with chronic renal failure, which of the following statements concerning muscle relaxants is true?

(A) Duration of action of vecuronium is prolonged

(B) The elimination half-life of atracurium is tripled

(C) Reversal with neostigmine is con train dicated

(D) The onset of action of mivacurium is delayed

(E) Succinylcholine is contraindicated

A

A

33
Q

Which of the following is most effective in preventing intraoperative hypothermia in adults?

(A) Heating and humidifying inspired gases

(B) Maintaining a warm operating room

(C) Using a circulating warm-water mattress

(D) Using reflective coverings

(E) Warming intravenous fluids

A

B

***

34
Q

Following transfusion of packed red blood cells during general anesthesia, the patient’s blood pressure decreases, heart rate and temperature increase, and hemoglobinuria and diffuse oozing are observed. Which of the following is the most appropriate first step in management?

(A) Administration of hydrocortisone

(B) Administration of fresh frozen plasma

(C) Administration of epsilon-aminocaproic acid

(D) Rapid infusion of crystalloid

(E) Transfusion of platelet concentrates

A

D

35
Q

Which of the following is an effect of ketorolac administered after vaginal hysterectomy?

(A) Euphoria

(B) Prolonged prothrombin time

(C) Respiratory depression

(D) Suppression of inflammation

(E) Thrombocytopenia

A

C

36
Q

Trimethaphan causes each of the following EXCEPT

(A) cerebral vasodilation

(B) urinary retention

(C) pupillary cycloplegia

(D) histamine release

(E) potentiation of succinylcholine block

A

A

37
Q

In normal tissue, which property of drugs has the greatest effect on the speed of onset of a local anesthetic?

(A) Amide structure

(B) Degree of protein binding

(C) Intrinsic vasoconstrictor activity

(D) pKa

(E) Potency

A

D

38
Q

Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine

(A) has a lower rate of plasma clearance

(B) has a secondary blocking effect on cardiac beta,-adrenergic receptors

(C) dissociates more slowly from sodium channels in cardiac muscle

(D) inhibits spontaneous phase 4 depolarization in pacemaker cells

(E) preferentially blocks calcium channels in Purkinje fibers

A

C

***

39
Q

Proper handling of oxygen cylinders includes

(A) maintenance of storage room temperature above 60°F

(B) separate storage rooms for nitrous oxide and oxygen

(C) opening the cylinder valve just sufficiently to register tank pressure accurately

(D) storage in a room with conductive flooring

(E) opening the cylinder valve briefly before attachment to the anesthesia machine

A

E

***

40
Q

During induction of anesthesia, a 56-year-old man with small bowel obstruction vomits a large quantity of undigested food particles and presumably aspirates. After instituting ventilation with pure oxygen, the most appropriate management is to

(A) administer dexamethasone

(B) administer penicillin G

(C) perform bronchoscopy

(D) ventilate with positive end-expiratory pressure 15 cmH2O

(E) proceed with the anesthesia plan if the tracheal pH is greater than 2.5

A

C

41
Q

Measurement of blood pressure with a Doppler device involves

(A) reflection of ultrasound waves off blood elements

(B) detection of oscillations in cuff pressure

(C) amplification of Korotkoff sounds with a miniature microphone

(D) transillumination with a near infrared light

(E) detection of variations in blood vessel diameter

A

A

42
Q

Postoperatively a 70-kg patient has a serum sodium value of 130 mEq/L. To increase this value to 140 mEq/L would require the administration of how much sodium in mEq?

A

140 mEq of sodium

43
Q

During direct intra-arterial measurement of blood pressure

(A) the mean arterial pressure will be unaffected by small air bubbles in the system

(B) an underdamped system will overestimate the mean arterial pressure

(C) an underdamped system will overestimate the diastolic pressure

(D) long tubing from the catheter to the transducer will tend to decrease resonance in the system

(E) calibration of the transducer by opening a stopcock to air at the sternal angle will overestimate the mean

A

A

44
Q

The effect of succinylcholine is terminated at postsynaptic effector cells by

(A) binding and uptake by effector cells

(B) diffusion into capillaries

(C) hydrolysis by junctional cholinesterase

(D) hydrolysis by pseudocholinesterase

(E) spontaneous degradation to succinylmonocholine

A

B

45
Q

Which of the following findings is characteristic of whole blood preserved in CPD and stored at 4°C for one week?

(A) Increased potassium concentration

(B) Normal concentrations of factors V and VIII

(C) PaCO2 of 40 mmHg

(D) pH of 7.3

(E) 50% Viable platelets

A

A

46
Q

The most medial of the following components in the antecubital fossa is the

(A) brachial artery

(B) brachioradialis muscle

(C) cephalic vein

(D) median nerve

(E) radial nerve

A

D

Median Nerve

47
Q

In a patient with hypovolemic shock, which of the following factors is the best measure of the overall balance between oxygen supply and demand?

(A) Arterial oxygen content

(B) PetO2

(C) Mixed venous oxygen saturation

(D) PaO2

(E) Transcutaneous oxygen tension

A

C

Mixed Venous Oxygen Saturation

48
Q

Syringe A contains 100 ml of normal blood with a PO2 of 2 mmHg, and syringe B contains 100 ml of normal blood with a PO2 of 98 mmHg. The contents of the two syringes are mixed anaerobicaily to equilibrium. The PO2 of the resultant mixture Is

(A) 27 mmHg

(B) 50 mmHg

(C) 63 mmHg

(D) 96 mmHg

(E) 100 mmHg

A

A

***

49
Q

A normotensive 66-year-old man undergoes total hip arthroplasty. Mean arterial pressure is maintained at 60 mmHg with isoflurane and labetalol; intraoperative FiO2 is 1.0. Eight units of red blood cells are administered intraoperatively because of an injury to the femoral artery. Five days later, the patient develops jaundice. Which of the following is the most likely cause of the jaundice?

(A) Delayed hemolysis from transfusion

(B) Heart failure with hepatic congestion

(C) Hepatocellular injury from labetalol

(D) Intraoperative hypotension

(E) Isoflurane-associated hepatitis

A

A

50
Q

If minute ventilation remains constant, a decrease in end-expiratory carbon dioxide concentration will occur with

(A) a decrease in physiologic dead space

(B) a decrease in cardiac output

(C) a decrease in physiologic shunt fraction

(D) the development of metabolic alkalosis

(E) an increase in body temperature

A

B

51
Q

Cessation of smoking on the day prior to an operation is associated with a perioperative

(A) decrease in carbon monoxide in blood

(B) improvement in ciliary beating in the airways

(C) decrease in sputum volume

(D) decrease in the need for postoperative ventilatory support

(E) decrease in the risk of deep vein thrombosis

A

A

52
Q

Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia?

(A) It does not change compliance

(B) It is greater with spontaneous ventilation than with controlled ventilation

(C) It is independent of body position

(D) It is not corrected by application of positive end-expiratory pressure

(E) It occurs within the first 10 minutes of anesthesia

A

E

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