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Valley Prep > Valley Post-test > Flashcards

Valley Post-test Flashcards

1
Q

The hemodynamic changes that should be avoided in the patient with mitral valve regurgitation include:

a. tachycardia
b. bradycardia
c. decreased systemic vascular resistance
d. hypervolemia

A

b. bradycardia

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2
Q

Indicate the changes that occur when the thoracic aorta is cross-clamped during repair of an aortic aneurysm?

AFTERLOAD-PCWP-CARDIAC OUTPUT-HEART RATE

a. increased-increased-increased-decreased
b. increased-increased-decreased-decreased
c. increased-decreased-increased-increased
d. decreased-increased-increased-decreased

A

b. increased-increased-decreased-decreased

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3
Q

General anesthesia with nitrous oxide and fentanyl was used for hernia repair. Postoperatively, the patient develops truncal rigidity. Oxygen saturation falls to 45%. What should be done?

a. give oxygen by mask
b. give morphine
c. give succinylcholine
d. give narcan

A

c. give succinylcholine

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4
Q

The patient with Eaton-Lambert syndrome responds to muscle relaxants in what way?

SUCCINYLCHOLINE-NONDEPOLARIZING AGENT

a. decreased sensitivity-decreased sensitivity
b. decreased sensitivity-increased sensitivity
c. increased sensitivity-increased sensitivity
d. increased sensitivity-decreased sensitivity

A

c. increased sensitivity-increased sensitivity

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5
Q

The patient with Parkinson’s disease. Which drug would you AVOID?

a. Ketamine
b. Diphenhydramine
c. Succinylcholine
d. Droperidol

A

d. droperidol

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6
Q

The soda lime changes color during the case. What should you do?

a. Change the canister immediately, and then continue with the case
b. increase the fresh gas flow rate, and change after the case
c. switch immediately to a new gas machine
d. no immediate action is necessary; wait and change the canister after the case

A

b. increase the FGF rate, and change after the case

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7
Q

Which of the following is appropriate preoperative anesthetic management of the patient with cardiac tamponade?

a. positive inotrope
b. maintain acidosis
c. fluid restriction
d. decrease afterload pharmacologically

A

a. positive inotrope

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8
Q

Accidental subarachnoid injection occurred during an intended epidural. Which of the following is a rapid early sign?

a. tinnitus
b. dyspnea
c. confusion
d. inability to speak

A

b. dyspnea

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9
Q

Oozing of blood after a massive blood transfusion is probably due to:

a. thrombocytopenia
b. decreased factors 5 and 8
c. aspirin therapy
d. dysfunctional thrombin

A

a. thrombocytopenia

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10
Q

What is the maximum does of dantrolene for treating malignant hyperthermia?

a. 0.5 mg/kg
b. 2.5 mg/kg
c. 5.0 mg/kg
d. 10 mg/kg

A

d. 10 mg/kg

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11
Q

What is the most common hematologic disorder in the alcoholic?

a. Deficiency of factors V and VIII
b. Megaloblastic anemia
c. Disseminated intravascular coagulopathy
d. Thrombocytopenia

A

b. Megaloblastic anemia

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12
Q

Shown in the following graph is the uptake of four volatile agents: Curve A is

a. N2O
b. Sevoflurane
c. Halothan
d. Isoflurane

A

a. N2O

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13
Q

The purpose of the pin index system is to:

a. keep cylinders with different gases from being used interchangeably
b. perit valve yoke to fit perfectly
c. provide a mechanism for gas escape if the cylinder overheats
d. increase the accuracy of reading from he Bourdon gauge.

A

a. keep cylinders with different gases from being used interchangeably

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14
Q

In PACU, the patient says she remembers some things that were said in the intraoperative period? What should you do?

a. Tell the patient what happened
b. Make a note of this on the anesthesia record
c. Inform the surgeon
d. Explain to the patient that she can sue if she wishes

A

a. tell the patient what happened

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15
Q

Hemorrhage is the most common complication of mediastinoscopy. What is the next most common complication of this procedure?

a. Damage to the phrenic nerve
b. Venous air embolism
c. Infection
d. Pneumothorax

A

d. pneumothorax

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16
Q

Stimulation of what receptor explains why arterial diastolic blood pressure may decrease when epinephrine is administered with a local anesthetic.

a. Beta-2 adrenergic receptor
b. Beta-1 adrenergic receptor
c. Alpha-1 adrenergic receptor
d. Alpha-2 adrenergic receptor

A

a. Beta-2 adrenergic receptor

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17
Q

Which of the following neural tracts modulates pain?

a. Lateral spinothalamic
b. Anterior spinothalamic
c. Dorsolateral fasciculus
d. Cuneatus/gracilis

A

c. dorsolateral fasciculus

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18
Q

Trigger agents for malignant hyperthermia include;

a. Halothane
b. Curare
c. Lidocaine
d. Pentothal

A

a. Halothane

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19
Q

At the NMJ Aminophylline:

a. decreases the excitability of the motor end-plate
b. increases the release of acetylcholine from the motor nerve terminal
c. locks the voltage-gated sodium channel in the inactivated state
d. has no effect

A

b. increases the release of acetylcholine from the motor nerve terminal

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20
Q

What is the necessary treatment for the patient with sickle cell disease who goes into sickle cell crisis during surgery?

a. give large volumes of LR?
b. give heparin?
c. take the patient to dialysis?
d. give the patient an exchange transfusion

A

d. give the patient an exchange transfusion

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21
Q

During surgery for a subdural hematoma, a cerebral vasospasm develops. A drug that is appropriate for treating this problem is:

a. Verapamil
b. Nimodipine
c. Nitroprusside
d. Labetalol

A

b. Nimodipine

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22
Q

Pneumothorax is most commonly associated with which approach to the brachial plexus?

a. Interscalene
b. Supraclavicular
c. Axillary
d. Subscapular

A

b. Supraclavicular

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23
Q

The patient’s hemiplegia resulted from an accident six months ago. How will the twitches elicited by a PNS on the paralyzed side compare with those on the non-paralyzed side during NDM blockade?

a. Twitches on the paralyzed side will be smaller
b. Twitches on the paralyzed side with be larger
c. Twitches on the paralyzed side will have the same size
d. There will be no twitches on the paralyzed side

A

b. twitches on the paralyzed side will be larger

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24
Q

What drug stimulates alpha-1, alpha-2, and beta-1 receptors?

a. Norepinephrine
b. Dobutamine
c. Clonidine
d. Prazosin

A

a. Norepinephrine

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25
Q

A patient is given 400 mg of drug. Sixteen hours later, 25 mg remain. How much drugs is lost in the next 8 hours?

a. 12.5 mg
b. 18.75 mg
c. 21.87 mg
d. 25 mg

A

b. 18.75 mg

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26
Q

The voltage-gated sodium channel is in the inactivated state in all but which of the following situations?

a. Administration of a LA
b. Severe hypokalemia
c. Perfusion of the coronary arteries with cardioplegic solution
d. During phase 2 of the cardiac action potential

A

b. severe hypokalemia

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27
Q

The patient who cannot adduct the thumb has had what nerve blocked by LA?

a. Radial
b. Median
c. Ulnar
d. Musculocutaneous

A

c. Ulnar

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28
Q

You determine that magnesium sulfate should be given to the patient with pregnancy-induced hypertension(pre-eclampsia/eclampsia). At what concentration of magnesium(mEq/L) will toxicity begin to manifest?

a. 1-4
b. 4-6
c. 8-12
d. 12-16

A

c. 8-12

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29
Q

What set of data correctly describes the actions of magnesium in the patient with pregnancy-induced hypertension(preeclampsia/eclampsia)?

ACH RELEASED FROM MOTOR NERVE TEMINAL/SENSITIVITY OF MOTOR END PLATE TO ACH/UTERINE TONE/VASCULAR SMOOTH MUSCLE TONE

a. increased/increased/increased/decreased
b. decreased/decreased/decreased/increased
c. decreased/decreased/decreased/decreased
d. decreased/increased/increased/decreased

A

c. decreased/decreased/decreased/decreased

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30
Q

There is a misunderstanding about the amount of magnesium sulfate that should have been administered to a patient with pregnancy-induced hypertension(pre-eclampsia/eclampsia). You are concerned about magnesium toxicity. If magnesium toxicity is developing, you might see each of the following signs EXCEPT:

a. Loss of deep tendon reflexes
b. sedation
c. hypotension
d. tachycardia

A

d. tachycardia

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31
Q

The degree of aortic regurgitation is largely determined by what factors? Select three:

a. diastolic pressure gradient
b. afterload
c. duration of diastole
d. incompetent aortic valve
e. left ventricular failure
f. cardiac contractility

A

a. diastolic pressure gradient
c. duration of diastole
d. incompetent aortic valve

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32
Q

During the case, the blood pressure of the patient with PIH(preeclampsia/eclampsia) increases to 190/125. Of the following, which drug is LEAST appropriate for treating this hypertension?

a. Hydralazine
b. Labetalol
c. Esmolol
d. Nitroprusside

A

c. Esmolol

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33
Q

Aspiration is a risk associated with anesthesia for patients with each of the following diseases except:

a. amyotrophic lateral sclerosis
b. multiple sclerosis
c. Parkinson’s disease
d. Mad cow disease(Jacob-Creutzfeldt disease)

A

b. multiple sclerosis

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34
Q

Immediate delivery of the fetus is imperative if fetal heart rate decelerations are:

a. variable
b. early
c. late with no beat-to-beat variability
d. late with diminished beat-to-beat variability

A

c. late with no beat-to-beat variability

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35
Q

You are applying cricoid pressure to a patient that has lost consciousness; how much pressure should be used(kg)?

a. 2
b. 4
c. 6
d. 8

A

b. 4

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36
Q

At least 98% of the drug will be gone after how many half-times of elimination?

a. 4
b. 5
c. 6
d. 7

A

c. 6

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37
Q

25 mL of solution containing 1% lidocaine and 1:200,000 epinephrine contains how much of each drug?

LIDOCAINE-EPINEPHRINE

a. 25 mg-12.5 mcg
b. 25 mg-125 mcg
c. 250 mg-12.5 mcg
d. 250 mg-125 mcg

A

d. 250 mg-125 mcg

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38
Q

The patient has a left ventricular EF of 0.22. This indicates:

a. normal L ventricular function
b. cardiomyopathy
c. mitral valve stenosis
d. mild L ventricular function

A

b. cardiomyopathy

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39
Q

The patient who has been taking digitalis develops a prolonged PR interval and PVC during anesthesia What drug should you give?

a. Phenytoin
b. Verapamil
c. Propranolol
d. Bethanechol

A

a. Phenytoin

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40
Q

What is the most common cause of acute myocarditis?

a. metastatic disease
b. rheumatoid arthritis
c. irradiation
d. viral infection

A

d. viral infection

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41
Q

The shift in the Starling curve shown by the arrow in the figure at right is consistent with administration of:(select three)

a. Neo-synephrine
b. Nipride
c. Digitalis
d. Inocor
e. Lasix
f. hemorrhage

A

b. Nipride
c. Digitalis
d. Inocor

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42
Q

ANSI standards for reservoir bags require that the pressure not exceed 50 cm H20 when the bag is distended to how many times its normal capacity?

a. 2
b. 3
c. 4
d. 5

A

c. 4

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43
Q

Cerebrospinal fluid passes from the lateral ventricles to the third ventricle through the foramina of:

a. Luschka
b. Magendie
c. Munro
d. Sylvia

A

c. Munro

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44
Q

What substance manufactured by vascular endothelial cells(formerly called endothelium-derived relaxation factor, EDRF) diffuses into the smooth muscle layer and causes vasodilation?

a. Nitric oxide
b. Bradykinin
c. Endothelia
d. Acetylcholine

A

a. Nitric oxide

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45
Q

The most important factor determining whether or not a patient will file a malpractice law suit is the:

a. anesthetist’s rapport with the patient
b. dollar amount that might be awarded
c. degree of bodily harm
d. fairness of the anesthetist’s attorney

A

a. anesthetist’s rapport with the patient

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46
Q

The American National Standards Institute Z79.9 1979 standard was replaced in 1988 with:

a. American National Standards Institute Z79.9 1988 standard
b. Occupational Safety and Health Administration standard 65-88
c. Department of Transportation code #652339-88
d. American Society for Testing and Materials F1161-88 standard

A

d. American Society for Testing and Materials F1161-88 standard

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47
Q

What size endotracheal tube should be placed in a 2 year-old-child and what size suction catheter should be used to keep this ETT clean?

a. 4.0;8F
b. 5.0;10F
c. 5.5;12F
d. 6.0;14F

A

b. 5.0;10F

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48
Q

Hemodynamic data for the patient are: arterial blood pressure, 130/70 mmHg; ICP 15 mmHg, LVEDP 10 mmHg, right atrial pressure 5 mmHg, HR 80. What is the cerebral perfusion and coronary artery perfusion pressure?

CEREBRAL PP-CORONARY PP

a. 75 mmHg-65 mmHg
b. 85 mmHg-60 mmHg
c. 75 mmHg-60 mmHg
d. 85 mmHg-65 mmHg

A

c. 75 mmHg-60 mmHg

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49
Q

What site should not be used for insertion of a pulmonary artery catheter with a right pneumothorax?

a. Right EJ
b. Femoral
c. Subclavian
d. Left EJ

A

d. Left EJ

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50
Q

What do the following ECG traces show?

a. RBBB
b. Atrial hypertrophy
c. Hyperkalemia
d. LBBB

A

a. RBBB

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51
Q

Digitalis slows HR by working on what phase of the cardiac action potential?

a. Phase 0
b. Phase 1
c. Phase 2
d. Phase 4

A

d. Phase 4

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52
Q

What problem is indicated by the solid-line pressure-volume loop shown at the right?

a. Acute mitral regurgitation
b. Chronic mitral regurgitation
c. Acute aortic regurgitation
d. Chronic aortic regurgitation

A

a. Acute mitral regurgitation

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53
Q

While the patient is breathing room air, blood gasses were: PaO2 50 mmHg, PCO2 55 mmHg, PAO2-PaO2 gradient 10 mmHg. This patient:

a. is dead spacing
b. has a right to left shunt
c. is hyperventilating
d. is breathing a hypoxic gas mixture

A

c. is hypo-ventilating

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54
Q

What should be given to treat a prolonged bleeding time?

a. Cryoprecipitate
b. Desmopressin
c. FFP
d. Platelets

A

d. Platelets

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55
Q

What would cause the P50 to increase from 20 to 33 mmHg?

a. Hypothermia
b. Respiratory acidosis
c. Metabolic alkalosis
d. Decreased 2,3-DPG

A

b. Respiratory acidosis

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56
Q

What is the most common cause of death in the patient with chronic renal failure?

a. Sepsis
b. MI
c. Cardiac arrest secondary to hyperkalemia
d. Respiratory failure

A

a. Sepsis

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57
Q

Shortly after induction, the patient begins wheezing. The concentration of inhaled agent is increased and the airway is checked for obstruction with negative findings. The wheezing continues, What should be done now?

a. Place the patient on PEEP
b. Increase FiO2
c. Give terbutaline
d. Wake the patient up

A

c. give terbutaline

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58
Q

A 57 year-old-male who was involved in a MVA is undergoing surgery to repair a fractured pelvis. The patient was taking nitroglycerin for angina. During the case SaO2 falls abruptly from 85% to 40%? Petechiae are noted on the chest and arms. What happened?

a. CHF
b. Hemorrhagic shock
c. Allergic reaction
d. Fat embolism

A

d. fat embolism

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59
Q

In what situation will CVP be greater than PCWP?

a. Cirrhosis of the liver
b. Left heart failure
c. Pulmonary arterial HTN
d. Aortic Stenosis

A

c. PHTN

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60
Q

What muscle dilates the cords?

a. Thyroarytenoid
b. Posterior cricoarytenoid
c. Lateral cricoarytenoid
d. Cricothyroid

A

b. Posterior cricoarytenoid

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61
Q

Compare PAO2 and PACO2 in zones I and III when the patient is sitting.

ZONE 1 PAO2-ZONE 3 PAO2-ZONE 3 PACO2-ZONE 1 PACO2

a. high-low-high-low
b. low-high-high-low
c. high-low-low-high
d. low-high-low-high

A

a. high-low-high-low

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62
Q

The patient has an FEV1 of 2.0 Liters and an FVC of 2.5 liters. These data suggest:

a. normal pulmonary function
b. restrictive pulmonary disease
c. obstructive pulmonary disease
d. mixed restrictive obstructive disease

A

b. restrictive pulmonary disease

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63
Q

Total body sodium content is controlled primarily by:

a. ADH
b. thyroxine
c. cortisol
d. aldosterone

A

d. aldosterone

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64
Q

Ipratropium works by decreasing the concentration of what second messenger?

a. Calmodulin
b. Inositol triphosphate
c. Cyclic guanosine monophosphate
d. Cyclic adenosine monophosphate

A

b. Inositol triphosphate

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65
Q

The patient’s medial thigh is resting on support straps while in the lithotomy position. Numbness along the medial calf would suggest compression of what nerve?

a. Obturator
b. Common peroneal
c. Saphenous
d. Lateral femoral cutaneous

A

c. Saphenous

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66
Q

Where does the spinal cord end in the child?

a. L1
b. L2
c. L3
d. L4

A

c. L3

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67
Q

The signs and symptoms of Horner’s syndrome include(select 4):

a. contralateral facial flushing
b. ipsilateral mydriasis
c. ipsilateral myosis
d. contralateral anhydrosis
e. ipsilateral ptosis
f. ipsilateral nasal congestion
g. contralateral mydriasis
h. ipsilateral enophthalmos

A

c. ipsilateral myosis
e. ipsilateral ptosis
f. ipsilateral nasal congestion
h. ipsilateral enophthalmos

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68
Q

What area of the brain responds to opioids to promote spinal analgesia?

a. Substantia nigra
b. Primary sensory cortex
c. Periventricular/periaqueductal gray
d. Caudate nucleus of basal ganglia

A

c. Periventricular/periaqueductal gray

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69
Q

The patient’s episode of intraoperative MH resolves with dantrolene treatment. This patient remains at risk for each of the following except:

a. myoglobinuric renal failure
b. disseminated intravascular coagulation
c. recurrence of the hyperthermia
d. liver failure

A

d. liver failure

70
Q

Why are chronic renal disease patients anemic?

a. Red cells hemolyze at a rapid rate
b. Erythropoietin production is low
c. Bone marrow is dysfunctional
d. The life-span of the red cell is about 12 days

A

b. Erythropoietin production is low

71
Q

What should be avoided in the patient with sickle cell disease?

a. Hypotension
b. Over-hydration
c. FiO2 of 1.0
d. Succinylcholine

A

a. hypotension

72
Q

Which bleeding disorder obeys an X-linked recessive pattern of inheritance?

a. von Willebrand’s disease
b. factor V-Leiden
c. Hemophilia B
d. Hageman factor deficiency

A

c. Hemophilia B

73
Q

What is the most common cause of sudden death in the pediatric and young adult population?

a. sudden infant death syndrome
b. pulmonary hypertension
c. hypertrophic cardiomyopathy
d. respiratory failure

A

c. hypertrophic cardiomyopathy

74
Q

An inhalational agent that is potent is(has)_____?

a. a fast uptake and distribution
b. a large MAC number
c. fast recovery
d. lipid soluble

A

d. lipid soluble

75
Q

After partial thyroidectomy, the patient has one floppy VC and is hoarse. Why?

a. Unilateral damage to the recurrent laryngeal nerve
b. Unilateral damage to the superior laryngeal nerve
c. Bilateral damage to the recurrent laryngeal nerve
d. Hypocalcemia

A

a. Unilateral damage to the recurrent laryngeal nerve

76
Q

“Ongoing monitoring, problem identification, development and implementation of solutions re-evaluation and documentation” are the five components of:

a. risk management
b. outcome assessment
c. claims made
d. quality assurance

A

d. quality assurance

77
Q

What happens to the blood flow and the diameter of arterial blood vessels in ischemic region of the brain when the patient is hyperventilated?

BLOOD FLOW—ARTERIAL VESSEL DIAMETER

a. increased—increases
b. decreases—increases
c. increases—No change
d. decreases—No change

A

c. increases—No change

78
Q

Autonomic hypereflexia may develop if the spinal cord lesion is above what level and if what period of time has elapsed since the injury?

LEVEL OF LESION—–TIME ELAPSED SINCE LESION

a. Above T2—–2 weeks
b. Above T6—–2 weeks
c. Above T2—–3 months
d. Above T6—–3 months

A

d. Above T6—–3 months

79
Q

The patient is weak and exhibits hypotension with hyperkalemia, hyponatremia and hypoglycemia…You suspect:

a. Addison’s disease
b. Cushing’s disease
c. diabetes insipidus
d. myxedema

A

a. Addison’s disease

80
Q

What is the major benefit of stopping smoking two days prior to anesthesia and surgery?

a. Improved ciliary function
b. Decreased sputum production
c. Decreased closing volume
d. Decreased carboxyhemoglobin

A

d. decreased carboxyhemoglobin

81
Q

Which flow-volume loop would be exhibited by a patient who has smoked two packages of cigarettes per day for 40 years?

a. Loop A
b. Loop B
c. Loop C
d. Loop D

A

d. Loop D

82
Q

Which of the following anesthetics produces the greatest motor blockade when injected into the epidural space?

a. 3% Chloroprocaine
b. 1% Lidocaine
c. 0.25 Bupivacaine
d. 1% Mepivacaine

A

a. 3% Chloroprocaine

83
Q

The patient is given 10 mg of a drug. The decrease in plasma concentration with time is shown in the following figure. The volume of distribution of this drug is:

a. 20 liters
b. 50 liters
c. 133 liters
d. 200 liters

A

d. 200 liters

84
Q

When should cricoid pressure be released?

a. When the cords are visualized
b. As soon as the tip of the ETT has passed into the trachea
c. When the ETT is correctly positioned and the cuff can be inflated
d. After the cuff of the ETT has been inflated and bilateral breath sounds are heard.

A

d. after the cuff of the ETT has been inflated and bilateral breath sounds are heard

85
Q

You might consider mixing phenylephrine instead of epinephrine with your LA if the patent has:

a. cirrhosis of the Liver
b. coronary artery disease
c. chronic renal failure
d. elevated ICP

A

b. CAD

86
Q

The patient with chronic renal failure may exhibit each of the following abnormalities EXCEPT:

a. hypocalcemia
b. prolonged prothrombin time
c. hypertension
d. hyperphosphatemia

A

b. prolonged prothrombin time

87
Q

What function test best distinguished renal from pre-renal failure?

a. Creatinine clearance
b. Blood urea nitrogen
c. Fractional excretion of filtered sodium
d. Urine osmolality

A

c. Fractional excretion of filtered sodium

88
Q

The patient is receiving colloid when he suddenly complains he is dying. Hypotension with tachycardia and vasodilation are noted. What caused these signs and symptoms?

a. Histamine release
b. Hypoxia
c. Respiratory arrest
d. Immunoglobulin M

A

a. Histamine release

89
Q

Acid-base data for a patient you are about to anesthetize are: pH- 7.38, pCO2-60 mmHg, HCO3-30 mEq/liter. What is the problem?

a. Chronic respiratory acidosis
b. Chronic metabolic acidosis
c. Acute respiratory acidosis
d. Acute metabolic alkalosis

A

a. chronic respiratory acidosis

90
Q

A 57- year old man with triple CAD is scheduled for a CABG. He had a MI 7 months ago. He is taking nitroglycerin, digoxin, propranolol, isosorbide dinitrate(Isordil), and nifedipine. His BP and HR are 120/80 and 60 BPM. The patients Hgb is 11 and SaO2 is 90%.

What is the total oxygen content of the arterial blood of this patient?

a. 13.27 mL O2/100 mL blood
b. 13.45 mL O2/100 mL blood
c. 14.74 mL O2/100 mL blood
d. 14.92 mL O2/100 mL blood

A

b. 13.45 mL O2/100 mL blood

91
Q

A 57- year old man with triple CAD is scheduled for a CABG. He had a MI 7 months ago. He is taking nitroglycerin, digoxin, propranolol, isosorbide dinitrate(Isordil), and nifedipine. His BP and HR are 120/80 and 60 BPM. The patients Hgb is 11 and SaO2 is 90%.

The incidence of preoperative reinfarction for this patient is about:

a. 1%
b. 5%
c. 15%
d. 30%

A

b. 5%

92
Q

A 57- year old man with triple CAD is scheduled for a CABG. He had a MI 7 months ago. He is taking nitroglycerin, digoxin, propranolol, isosorbide dinitrate(Isordil), and nifedipine. His BP and HR are 120/80 and 60 BPM. The patients Hgb is 11 and SaO2 is 90%.

The Swan-Ganz catheter is inserted into the R-IG a distance of 45 cm. what trace would you see?

a. Trace A
b. Trace B
c. Trace C
d. Trace D

A

c. Trace C

93
Q

A 57- year old man with triple CAD is scheduled for a CABG. He had a MI 7 months ago. He is taking nitroglycerin, digoxin, propranolol, isosorbide dinitrate(Isordil), and nifedipine. His BP and HR are 120/80 and 60 BPM. The patients Hgb is 11 and SaO2 is 90%.

The most common complication of inserting Swan-Ganz catheter is:

a. damage to the chord tendineae
b. pneumothorax
c. hematoma
d. arrhythmias

A

d. arrhythmias

94
Q

A healthy 59 year-old(60 mg) woman with a normal preoperative ECG develops wide-complex tachycardia under GA for breast biopsy. Blood pressure is 81/47 and HR is 220 beats/min. The most appropriate therapy would be:

a. electrical cardioversion
b. lidocaine 60mg IV
c. Procainamide 20mg/min IV
d. amiodarone 300 mg IV

A

a. electrical cardioversion

95
Q

The patient is heparinized and the ACT is found to be 430 seconds. This means that:

a. the patient does not have antithrombin III
b. the heparin has not neutralized any of the clotting factors
c. it it time to give protamine
d. thrombin and factor Xa have been inactivated

A

d. thrombin and factor Xa have been inactivated

96
Q

The left ventricle must be drained during cardiopulmonary bypass because:

a. Thebesian and bronchial circulation drain into the left ventricle
b. a right to left inter-ventricular defect frequently develops
c. not all of the venous return is bypassed from the right ventricle
d. serous fluid leaks across the endocardium into the left ventricle

A

a. Thebesian and bronchial circulation drain into the left ventricle

97
Q

After cardiopulmonary bypass, how much protamine sulfate should be administered for each 100 units of heparin remaining? What kind of bond does protamine form with heparin?

PROTAMINE DOSE—–TYPE OF BOND

a. 1.1-1.3 mg—–Covalent
b. 1.1-1.3 mg—–Ionic
c. 0.1-0.3 mg—–Covalent
d. 0.1-0.3 mg—–Ionic

A

b. 1.1-1.3 mg—–Ionic

98
Q

What volume of anesthetic is injected into the arm for a Bier block?

a. 5-25 mL
b. 25-50 mL
c. 50-75 mL
d. 75-100 mL

A

b. 25-50 mL

99
Q

All of the following are anesthetized in a 3-in-1 block except for the:

a. femoral nerve
b. sciatic nerve
c. obturator nerve
d. lateral femoral cutaneous nerve

A

b. sciatic nerve

100
Q

A four-year-old has inspiratory stridor, chest retractions, tachypnea, cyanosis, drooling and difficulty swallowing. This condition probably results from:

a. a viral infection
b. infection by Hemophilus influenza type B
c. infection by staphylococcus
d. aspirin therapy

A

b. infection by Hemophilus influenza type B

101
Q

The internal diameter of the ETT for a six-year-old child should be?

a. 4.5
b. 5.0
c. 5.5
d. 6.0

A

c. 5.5

102
Q

A 35 kg child will need how much fluid per hour?

a. 25 mL
b. 50 mL
c. 75 mL
d. 100 mL

A

c. 75 mL

103
Q

What data set correctly compares gastroschisis and omphalocele?

HERNIA SAC———-CONGENITAL ABNORMALITIES
GASTRO/OMPHAL—–GASTRO/OMPHAL

a. present/absent———-present/absent
b. present/absent———-absent/present
c. absent/present———-present/absent
d. absent/present———-absent/present

A

d. absent/present———-absent/present

104
Q

One reason the neonate needs more succinylcholine than the adult is because:

a. plasma cholinesterase activity is greater in the neonate
b. greater ED95
c. renal clearance is slower in the neonate
d. the neonate has more adipose tissue

A

b. greater ED95

105
Q

If a Tec-6 vaporizer calibrated in Los Angeles is brought to Steamboat Springs, Colorado, the percent delivered to the patient:

a. will be more than the dial setting
b. will be less than the dial setting
c. will be the same as the dial setting
d. cannot be determined

A

a. will be more than the dial setting

106
Q

A 67 year old man with mild CHF has during the past month become increasingly lethargic and has had headaches, and right sided weakness. Moderate bilateral papilledema was present. Arteriogram and CT scan suggested the presence of a left convexity meningioma that involved the superior sagittal sinus.

Making room for the surgeon to work in the head is one of the special requirements of anesthesia for brain tumor removal. Each of the following techniques is acceptable for making room for the surgeon to work in the head EXCEPT:

a. controlled hypotension
b. hyperventilaton
c. removal of spinal fluid
d phlebotomy

A

d. phlebotomy

107
Q

What is the concentration and dose of mannitol for decreasing ICP?

CONCENTRATION—VOLUME

a. 20%—1 g/kg
b. 50%—1 g/kg
c. 20%—10 g/kg
d. 50%—10 g/kg

A

a. 20%—1 g/kg

108
Q

Your major concern with administering the correct dose of mannitol is:

a. cardiac arrest
b. renal failure
c. pulmonary edema
d. seizures

A

c. pulmonary edema

109
Q

Who is responsible for quality assurance?

a. each hospital employee
b. each hospital department or service area
c. the hospital
d. the JC

A

b. each hospital department or service area

110
Q

The paraplegic patient had spinal cord injury two years ago. What anesthetic technique is best for this patient?

a. general anesthesia with a volatile agent
b. general anesthesia with an opioid after succinylcholine and propofol induction
c. spinal anesthesia
d. general with N2O and a volatile agent after infection with thiopental

A

c. spinal anesthesia

111
Q

The posterior longitudinal ligament is the ___ boundary of the epidural space?

a. Cephalad
b. Caudad
c. Posterior
d. Anterior

A

Anterior

112
Q

What drug would you not give in the perioperative period to the patient undergoing surgery for pheochromocytoma?

a. Phentolamine
b. Phenylephrine
c. Droperidol
d. Nitroprusside

A

c. Droperidol

113
Q

What monitoring modality is most sensitive for detecting venous air embolism?

a. Capnography
b. Pulse oximeter
c. Precordial Doppler U/S
d. Transesophageal echocardiography

A

d. TEE

114
Q

A 72 year old male suffered from benign prostatic hyperplasia. A transurethral resection of the prostate under epidural anesthesia is planned. BP is 150/80, pulse 88 and weight 167 lbs.

If during the case the patient suddenly becomes tachycardic and hypertensive and simultaneously complained of abdominal and shoulder pain, you should suspect?

a. MI
b. perforation of the bladder
c. acute pancreatitis
d. passage of a kidney stone.

A

b. perforation of the bladder

115
Q

A 72 year old male suffered from benign prostatic hyperplasia. A transurethral resection of the prostate under epidural anesthesia is planned. BP is 150/80, pulse 88 and weight 167 lbs.

During the case, the patient becomes restless, agitated and confused. These signs and symptoms are generally seen when serum sodium falls below what level?

a. 130 mEq/Liter
b. 120 mEq/Liter
c. 110 mEq/Liter
d. 100 mEq/Liter

A

b. 120 mEq/Liter

116
Q

What drug for altering hemodynamic status should generally be avoided in the patient with idiopathic sub aortic hypertrophic stenosis?

a. Nitroglycerin
b. Phenylephrine
c. Propranolol
d. Halothane

A

a. Nitroglycerin

117
Q

During rigid bronchoscopy, the patient becomes dyspneic and hypotensive. The pulse oximeter shows a decrease in arterial blood oxygen saturation to 50%. What happened?

a. Stimulation of the cords
b. Cardiac tamponade
c. Pneumothorax
d. Vaso-vagal reflex

A

c. Pneumothorax

118
Q

What drug should be AVOIDED in the patient with cystic fibrosis?

a. Metoclopramide
b. Esmolol
c. Thiopental
d. Atropine

A

d. atropine

119
Q

The ECG traces at right indicate that the patient has:

a. hypokalemia
b. LBBB
c. Mobitz Type II second-degree block
d. RBBB

A

b. LBBB

120
Q

Each of the following decreases with age EXCEPT:

a. FEV1
b. Vital capacity
c. PaCO2
d. PaO2

A

c. PaCO2

121
Q

Controlled(deliberate) hypotension is appropriate for:

a. radical cystectomy
b. vaginal hysterectomy
c. anterior cervical laminectomy
d. appendectomy

A

a. radical cystectomy

122
Q

Which of the following pulmonary parameters decrease in the geriatric person?

a. total lung capacity
b. alveolar-arterial oxygen difference
c. closing volume
d. lung compliance

A

a. total lung capacity

123
Q

What is the suggested inflation volume for a LMA size 1.5?

a. 10
b. 15
c. 21
d. 30

A

a. 10

124
Q

What is the minimum fasting period after ingesting breast mile(hr)?

a. 2
b. 4
c. 6
d. 8

A

b. 4

125
Q

Calculate the allowable blood loss for a 6 month-old infant who weighs 7 kg. Give your answer as a whole number in mL.

A

175 mL

126
Q

At what point during pregnancy does the maternal intra-gastric pressure increase, often resulting in heartburn?

a. first trimester
b. second trimester
c. third trimester
d. post-delivery

A

c. third trimester

127
Q

How should left ventricular preload be managed in the patient with hypertrophic cardiomyopathy? Preload should be:

a. increased
b. maintained
c. decreased

A

a. increased

128
Q

Breathing circuit pressure is limited to _____ cm H2O.

a. 50
b. 75
c. 100
d. 125

A

d. 125 cm H2O

129
Q

Which of the following is not an intrinsic laryngeal muscle?

a. cricothyroid
b. oblique arytenoid
c. thyrohyoid
d. thyroarytenoid

A

c. thyrohyoid

130
Q

What is the prominent pathophysiologic derangement associated with mitral regurgitation?

a. left atrial volume overload
b. decreased left atrial pressure
c. left ventricular volume overload
d. increased left atrial pressure

A

c. left ventricular volume overload

131
Q

All of the following are normal changes in geriatric cardiovascular function except:

a. increased circulation time
b. decreased peripheral vascular resistance
c. hypotension
d. decreased cardiac output

A

b. decreased peripheral vascular resistance

132
Q

Which inhalational agent has the following characteristics; non pungent, reacts with soda lime, and may trigger MH?

a. halothane
b. isoflurane
c. desflurane
d. sevoflurane

A

d. sevoflurane

133
Q

The outer and inner diameter measurements for the common gas outlet are, respectively:

a. 22, 15
b. 15, 10
c. 25, 15
d. 10, 25

A

a. 22, 15

134
Q

What is the terminal result of an increased HR in the patient with mitral stenosis?

a. pulmonary edema
b. chest pain
c. decreased left atrial pressure
d. atrial fibrillation

A

a. pulmonary edema

135
Q

Which of the following correctly characterizes afferent hepatic blood flow?

a. 25% from hepatic artery, 75% from portal vein
b. 50% from hepatic artery, 50% from portal vein
c. 75% from hepatic artery, 25% from portal vein
d. 100 from hepatic artery, 0% from portal vein

A

a. 25% from hepatic artery, 75% from portal vein

136
Q

A difficult endotracheal intubation is not typically associated with:

a. Klippel-Feil syndrome
b. Turner syndrome
c. Zollinger-Ellison syndrome
d. Goldenhar syndrome

A

c. Zollinger-Ellison syndrome

137
Q

What agency has published guidelines to help hospitals develop systems to create and sustain community-wide emergency preparedness?

a. Centers for Disease Control and Prevention
b. Occupational Safety and Health Administration
c. National Patient Safety Foundation
d. the Joint commission(formerly JCAHO)

A

d. Joint Commission

138
Q

The cardiovascular effects of burn shock are due to:

a. hypertension
b. increased CO and increased SVR
c. decreased systemic vascular resistance secondary to myocardial depressant factor and decreased smooth muscle contractility
d. mechanical ventilation with positive end expiration pressure causing increased venous return and increased preload

A

c. decreased systemic vascular resistance secondary to myocardial depressant factor and decreased smooth muscle contractility

139
Q

Signs and symptoms of rheumatoid arthritis include:

a. spasmodic dystonia
b. pain that worsens with activity
c. aortic stenosis
d. pain on swallowing

A

d. pain on swallowing

140
Q

During general anesthesia for parathyroidectomy for relief of hyperparathyroiditis, you should monitor the ECG closely for:

a. prolonged QT interval
b. shorted QT interval
c. shorted PR interval
d. prolonged ST segment

A

b. shortened QT interval

141
Q

A process by which a professional agency attests to a professional’s level of knowledge, skill or ability is called:

a. licensure
b. accreditation
c. certification
d. APRN compact model

A

c. certification

142
Q

Cor pulmonale is defined as:

a. tension pneumothorax
b. symptomatic pulmonary hypertension
c. chronic hypercapnia
d. left ventricular hypertrophy

A

b. symptomatic pulmonary hypertension

143
Q

Hyperventilation can produce which of the following electrolyte disturbances?

a. hyperkalemia
b. hypermagnesemia
c. hyponatremia
d. hypocalcemia

A

d. hypocalcemia

144
Q

Which of the following statements regarding pulse oximetry is true?

a. It may be inaccurate with SaO2 is less than 80%
b. bronchial intubation will usually be detected by pulse oximetery with low fraction of inspired oxygen concentration
c. methemoglobinemia causes a falsely high saturation reading when SaO2 is actually greater than 85%
d. it measures a falsely low reading in patients with carbon monoxide poisoning

A

a. it may be inaccurate with SaO2 less than 80%

145
Q

Which of the following anticholinesterase agents is not a quaternary ammonium substance?

a. edrophonium
b. neostigmine
c. physostigmine
d. pyridostigmine

A

c. physostigmine

146
Q

How many unidirectional valves does the semi-closed anesthetic breathing system have?

a. 1
b. 2
c. 3
d. 4

A

b. 2

147
Q

Ms Reed is scheduled for a vaginal hysterectomy. She request a spinal anesthetic. You perform the spinal, without complication, by injecting 12 mg of 0.75% spinal Marcaine. How many milliliters of agent did you administer?

a. 1.6 mL
b. 1.4 mL
c. 1.2 mL
d. 1.0 mL

A

a. 1.6 mL

148
Q

Which of the following is not a contraindication to jet ventilation?

a. hiatal hernia
b. trauma
c. pregnancy
d. patient under 2 years of age

A

d. patient under 2 years of age

149
Q

If you suspect drug abuse/addiction and do not report it, you may be held accountable. This is referred to as:

a. tort
b. vicarious liability
c. negligence
d. res is pa loquitur

A

b. vicarious liability

150
Q

The statistical test that a researcher would use to compare the difference between means of three of more normally distributed data sets would be the:

a. Pearson’s test
b. analysis of variance
c. chi-squared test
d. paired t test

A

b. analysis of variance

151
Q

Which of the following agents should not be used as an anesthetic in a patient prone to arrhythmias?

a. desflurane
b. isoflurane
c. sevoflurane
d. nitrous oxide

A

a. desflurane

152
Q

Which site of temperature monitoring is thought to be the best method of measuring core body temperature?

a. proximal esophagus
b. pulmonary artery
c. oropharynx
d. axillary

A

b. pulmonary artery

153
Q

Which of the following is an important CV effect of pneumoperitoneum?

a. increased SV during insufflation
b. distention of the vagus nerve during insufflation
c. decrease MAP during insufflation
d. decrease SVR during insufflation

A

b. distention of the vagus nerve during insufflation

154
Q

2,3-bisphosphoglycerate(2,3-BPG or 2,3-DPG) is a by-product(shunt) of which biochemical pathway?

a. glycolysis
b. Krebs/TCA
c. B-oxidation
d. oxidative phosphorylation

A

a. glycolysis

155
Q

Which of the following cells mature into an antibody-secreting plasma cell upon antigen exposure and presentation?

a. T-lymphocyte
b. B-lymphocyte
c. eosinophil
d. neutrophil

A

b. B-lymphocyte

156
Q

Which rate-limiting enzyme catalyzes the first step in the synthesis of prostaglandins and is inhibited by corticosteroids?

a. cyclooxygenase
b. PGH-synthase
c. thromboxane synthase
d. phospholipase A2(PLA-2)

A

d. phospholipase A2(PLA-2)

157
Q

What electroencephalogram(EEG) waveform is characterized as lowest-frequency(0-4 Hz), highest amplitude and are typically seen in the sleeping adult?

a. alpha
b. beta
c. delta
d. theta

A

c. delta

158
Q

Which of the following gas machine components is not exposed to intermediate, pipeline pressure(50 psig)?

a. pipeline inlets
b. common gas outlet
c. oxygen flush valve
d. ventilator power inlet

A

b. common gas outlet

159
Q

An infant has life-threatening succinylcholine-induced hyperkalemia. the quickest treatment is:

a. dialysis
b. beta-2 agonist
c. calcium chloride IV
d. sodium bicarbonate IV

A

c. calcium chloride IV

160
Q

Which of the following is not an example of nominal data?

a. eye color
b. ASA classification
c. blood type
d. “yes or “no”

A

b. ASA classification

161
Q

Which of the following combinations of acute electrolyte abnormalities will most stabilize nerve, skeletal muscle and cardiac ventricular muscle cells?

a. hyperkalemia and hypocalcemia
b. hyperkalemia and hypercalcemia
c. hypokalemia and hypocalcemia
d. hypokalemia and hypercalcemia

A

d. hypokalemia and hypercalcemia

162
Q

A 48 year-old female was in a MVA. She arrives in the OR for repair of a fractured pelvis. She has a history of angina and takes nitroglycerin. During the case, the pulse oximeter reading abruptly falls from 92% to 40%. You notice petechiae on her arms and chest. These signs could result from:

a. allergic reaction
b. hemorrhage shock
c. fat embolism
d. CHF

A

c. fat embolism

163
Q

With respect to West’s zones of the lungs, which zone exhibits the greatest increase in blood flow as a function of zone distance?

a. Zone 1
b. Zone 2
c. Zone 3
d. Zone 4

A

b. Zone 2

164
Q

Which drug is correctly associated with its primary site of action?

a. chlorothiazide-proximal tubule
b. metolazone-ascending limb of Loop of Henle
c. mannitol-proximal tubule
d. spironolactone-descending limb of Loop of Henle

A

c. mannitol-proximal tubule

165
Q

Which statistical tests is most appropriate to evaluate the difference between expected and observed frequencies form normal data?

a. paired Student’s test
b. Chi-squared analysis
c. ANOVA
d. Wilcoxon rank sum

A

b. Chi-squared analysis

166
Q

All of the following are associated with Treacher-Collins syndrome except:

a. ventricular septal defect(VSD)
b. cleft palate
c. macroglossia
d. macrostomia

A

c. macroglossia

167
Q

What electrolyte disturbances are expected during a Whipple procedure?(select 3)

a. hyperkalemia
b. hypocalcemia
c. hyperglycemia
d. hypokalemia
e. hyponatremia
f. hypomagnesemia

A

b. hypocalcemia
d. hypokalemia
f. hypomagnesemia

168
Q

The capnograph to the right is most consistent with:

a. pulmonary embolism
b. esophageal intubation
c. cardiogenic oscillation
d. external chest compression

A

b. esophageal intubation

169
Q

If the medial aspect of the knee is compressed, what nerve may be damaged?

a. femoral
b. saphenous
c. sciatic
d. obturator

A

b. saphenous

170
Q

Which cranial nerve supplies motor innervation to the superior oblique muscle of the eye?

a. trochlear
b. oculomotor
c. abducens
d. trigeminal

A

a. trochlear

Valley Prep (14 decks)

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