Which causes of hypoxemia will NOT improve with increasing FiO2?
Carotid bodies located at the bifurcation of the common carotid artery respond primarily to which parameter as a mechanism for chemical control of ventilation?
A 55-year-old man with colon cancer undergoes an open colectomy under general anesthesia. Which of the following is the MOST likely cause of a 1oC decrease in core temperature during the first hour of anesthesia?
Radiation heat loss to the operating room
Conductive heat loss to the operating table
Evaporative heat loss from surgical site
Redistribution of heat from the core to the periphery
A 33-year-old critically ill woman develops ventilator-associated pneumonia (VAP) caused by a non-fermenting gram-negative rod. For how long should she be maintained on appropriate antibiotics?
The sensory nerves that innervate the anterior abdominal wall are located in a fascial plane between which muscle layers?
External oblique and internal oblique
External oblique and transversus abdominis
Internal oblique and transversus abdominis
Rectus abdominis and transversus abdominis
A femoral nerve block is MOST appropriate for which of the following surgical procedures:
Analgesia for a traumatic pelvic fracture
Surgical anesthesia for total hip arthroplasty
Analgesia for medial leg laceration repair
Sural nerve biopsy
You are providing the anesthetic for a 55-year-old man with end stage renal disease undergoing a parathyroidectomy. After surgery is completed, he is extubated but quickly develops acute airway obstruction necessitating reintubation. Which of the following is MOST likely responsible for his airway compromise?
Bilateral recurrent laryngeal nerve injury
Unilateral recurrent laryngeal nerve injury
You are caring for a 40-year-old woman undergoing a thyroidectomy for Graves’ thyroid disease. In the recovery room, she develops sinus tachycardia to 135 beats per minute, a temperature increase from 36.6°C preoperatively to 38.9°C, and you note that she is difficult to arouse and has twitching movements. Which of the following is the BEST initial intervention?
Administer IV propranolol
Provide topical cooling
The definition of functional residual capacity (FRC) is:
Gas remaining in the lungs at passive end-expiration
Gas remaining in lungs at end of forced maximal expiration
Gas that moves in and out of lungs during quiet breathing
Gas that can be expired from the lungs with effort after passive expiration
General anesthesia decreases functional residual capacity by what percentage?
1 - 2%
5 - 10%
20 - 25%
25 - 30%
The effect of hypercarbia on oxygenation is BEST explained by which of the following:
Hypercarbia decreases the partial pressure of oxygen in the alveolus
Hypercarbia has no effect on the partial pressure of oxygen
Hypercarbia increases oxygen saturation
Hypercarbia increases the partial pressure of oxygen in the alveolus
Physiologic effects of electroconvulsive therapy (ECT) include an:
initial sympathetic response with sustained tachycardia
initial sympathetic discharge followed by a sustained parasympathetic response
initial parasympathetic discharge followed by a sustained sympathetic response
initial parasympathetic response with sustained bradycardia
Which of the following BEST explains the shorter duration of action of single bolus of alfentanil relative to an equipotent bolus of fentanyl?
Greater protein binding
Lack of active metabolites
Smaller volume of distribution
The postretrobulbar block apnea syndrome:
Is likely secondary to intravascular injection
most commonly occurs during or immediately after injection
is associated with unconsciousness
carries a high morbidity and mortality
Which of the following is LEAST likely to exacerbate pulmonary hypertension?
0.1 mcg/kg/min norepinephrine IV
1 unit of vasopressin IV
100 mcg of phenylephrine IV
The arteria radicularis magna, or artery of Adamkiewicz, most commonly arises from:
T4 - T8
T8 - L2
L2 - L4
L4 - S1
A 76-year-old man is scheduled for a hemicolectomy. His past medical history is significant for third degree heart block treated with a permanent pacemaker. Problems with electrocautery use in this patient can be minimized by:
placing the grounding pad near the pacemaker
using infrequent bursts of longer duration
the use of a bipolar cautery
reducing the surface area of the return electrode
Which of the following is the MOST likely result of a new ulnar neuropathy in a patient?
Inability to extend the wrist
Inability to flex the fifth finger
Loss of sensation in posterior forearm
Loss of sensation over the palmar side of the thumb
The most severe transfusion reactions are due to:
non-ABO hemolytic reactions
You observe a regional wall motion abnormality in area indicated by the arrow. What coronary artery MOST likely supplies this part of the heart?
Left anterior descending
Right coronary artery
At what point in the cardiac cycle is left ventricular volume at its lowest?
When the aortic valve closes
Following the “T” wave on ECG
At the peak of the “v” wave on a CVP tracing
All of the above
Intracranial hypertension is defined as a sustained increase in intracranial pressure (ICP) above:
5 mm Hg
15 mm Hg
25 mm Hg
30 mm Hg
What are the three terminal branches of the posterior tibial nerve?
Plantar nerve, lateral calcaneal nerve, medial calcaneal nerve
Medial plantar nerve, lateral plantar nerve, medial calcaneal nerve
Lateral calcaneal nerve, medial calcaneal nerve, medial plantar nerve
Lateral calcaneal nerve, medial calcaneal nerve, plantar nerve
Cholinesterase inhibitors that freely cross the blood-brain barrier include:
The perception of an ordinarily non-noxious stimulus as pain is referred to as:
A 72-year-old man with an acoustic neuroma is undergoing a craniotomy in the sitting position. The patient acutely develops hypotension and tachycardia. The ETCO2 is 12 mmHg and an ABG reveals a PaCO2 of 43 mmHg. Which of the following represent the most likely cause of the PaCO2 to ETCO2 gradient?
Expiratory valve malfunction
Inspiratory valve malfunction
Right mainstem intubation
Venous air embolism
A 74-year-old woman undergoing an exploratory laparotomy and has blood pressure 60/40 mmHg and heart rate of 50 beats per minute. Based on the intraoperative TEE below (which shows severe aortic insufficiency), what would be the MOST appropriate drug to treat her hypotension?
10 mcg of epinephrine
50 mcg of nitroglycerine
100 mcg of phenylephrine
1 unit of vasopressin
Ninety percent of congenital diaphragmatic hernias occur:
through the left posterolateral foramen
through the right posterolateral foramen
through the anterior foramen
along the inferior vena cava
You are performing a transversus abdominis plane block. What is the inferior border of the Triangle of Petit?
External oblique muscle
Transversus abdominis muscle
Inferior costal margin
When performing a landmark-based thoracic paravertebral block, which transverse process is contacted when the needle is inserted at the level of the T5 spinous process?
Pathophysiologic factors affecting the anesthetic management of patients with hypothyroidism include:
difficulty with intubation and airway management
increased blood viscosity due to elevated hematocrit
Airway obstruction caused by the tongue falling posteriorly against the wall of the pharynx is secondary to relaxation of the:
longitudinal muscle of the tongue
What bony surface landmarks are used for classical posterior approach to sciatic nerve blockade?
Anterior superior iliac spine, sacral hiatus, greater trochanter
Anterior superior iliac spine, pubic tubercle, greater trochanter
Posterior superior iliac spine, sacral hiatus, greater trochanter
Posterior superior iliac spine, sacral hiatus, iliac crest
A 70-year-old woman develops paraplegia after the repair of an open descending thoracoabdominal aortic aneurysm. Which of the following is the MOST likely cause?
Hypotension distal to the aortic cross-clamp
Decrease in CSF pressure
Improper patient positioning
The most frequent manifestation of sickle cell disease is:
right upper quadrant syndrome
The effects of barbiturates on ischemic areas of the brain include:
redirection of blood flow to the ischemic areas
redirection of blood flow away from ischemic areas
A left ventricular pressure-volume loop is displayed below. Which cardiac valvular disease is MOST likely characterized by the red pressure-volume loop?
What is MOST sensitive marker or symptom for detecting a pheochromocytoma?
Urinary vanillylmandelic acid
Which of the following syndromes is NOT associated with a pheochromocytoma?
Multiple endocrine neoplasia IIa
Treacher Collins Syndrome
von Hippel-Lindau disease
Venous irritation associated with the injection of diazepam and lorazepam is secondary to:
the high degree of water solubility of these agents
the presence of propylene glycol as a solvent
the presence of metabisulfite as a preservative
the low pH of these agents
Which of the following is MOST likely a complication of using EMLA cream for topical analgesia?
Correct statements regarding cerebral metabolism include:
the brain can only utilize glucose as an energy source
forty percent of brain glucose consumption is anaerobically metabolized
hyperglycemia can reduce the damage from focal hypoxic injury
the adult brain consumes approximately 50 ml/min of oxygen
Portal hypertension is defined as sustained portal vein pressure greater than:
What is the maximum cuff pressure in a tracheostomy cuff?
What is the phenomenon that MOST likely causes the sciatic nerve to appear severed in this image?
Incorrect time gain compensation settings
In the graph of cerebral blood flow below, PaO2 would best be represented by curve:
A 33-year-old man with a pheochromocytoma presents for operative resection. Which of the following BEST describes the mechanism of pretreatment with alpha-methyl-para-tyrosine (metyrosine)?
It blocks the conversion of norepinephrine to epinephrine
It prevents release of catecholamines from nerve endings
It gives patients a euphoria and thus has high abuse potential
It decreases stores of catecholamines in peripheral neurons
In patients with a history of hypertrophic cardiomyopathy, intraoperative management should include:
a nitroglycerine infusion
maintenance of adequate preload
A 74-year-old woman undergoing an exploratory laparotomy and has blood pressure 60/40 mmHg and heart rate of 50 beats per minute. Based on the intraoperative TEE that shows severe aortic insufficiency, what would be the MOST appropriate drug to treat her hypotension?
What mode of mechanical ventilation is MOST characterized by constant pressure throughout inspiration, allowing both controlled breaths and assisted breaths (with pressure support), as well as a set tidal volume?
Adaptive pressure control (APC)
Airway pressure release ventilation (APRV)
Synchronized intermittent mandatory ventilation (SIMV)
In patients receiving vecuronium, the greatest augmentation of neuromuscular blockade is seen with the use of:
What mode of mechanical ventilation is MOST characterized by a requirement for the operator to set the percentage of required minute ventilation to be supported? The ventilator then automatically determines the respiratory rate and tidal volume required to provide the minimum minute ventilation should the patient not achieve that on his or her own.
Adaptive support ventilation (ASV)
Maternal mortality associated with amniotic fluid embolization is:
10 - 15%
40 - 45%
greater than 50%
A 10-year-old obese boy is in the recovery room after undergoing a tonsillectomy and adenoidectomy for obstructive sleep apnea. The majority of post-tonsillectomy hemorrhages are MOST likely to occur within what time period following surgery?
within the first 30 min
within the first hour
within the first 6 hours
within the first 24 hours
Dextran 40 has been shown to improve microcirculation by:
reducing blood density
increasing blood density
decreasing blood viscosity
increasing blood viscosity
The highest level of protein binding is seen with:
A 2-year-old, 11 kg boy is scheduled for cleft lip repair. You successfully intubate the patient with a 4.5 endotracheal tube and confirm bilateral breath sounds. Which change in patient positioning from the supine position would be MOST likely to increase the likelihood of endobronchial intubation?
Placing a head ring under the head so that the neck is flexed
Placing a shoulder roll under the patient so that the neck is extended
Placing the bed in Trendelenberg positioning
Placing the bed in reverse Trendelenberg positioning
What does 4-factor prothrombin complex concentrate (PCC) contain?
Factors I, II, IV, V
Factors II, VII, IX, X
Factors IV, VIII, IX, X
The highest rate of systemic absorption of local anesthetic is seen with
brachial plexus injection
Absolute contraindications to electroconvulsive therapy (ECT) include:
congestive heart failure
myocardial infarction 5 months prior to therapy
increased intracranial pressure
Which of the following electrolyte abnormalities occurs MOST commonly with hydrochlorothiazide and is paired with the BEST choice for treatment?
In the neuromuscular junction, acetylcholine receptor binding sites are found on the:
A 65-year-old woman with rheumatic mitral stenosis, tricuspid regurgitation, and pulmonary hypertension has undergone combined mitral valve replacement and tricuspid valve repair surgery. She has low systemic vascular resistance with arterial blood pressure 80/40 mmHg after separation from bypass but her pulmonary arterial blood pressure continues to be elevated at 60/30 mmHg. She is receiving milrinone and epinephrine by infusion. Which of the following medications would provide the MOST favorable conditions to increase systemic blood pressure but not worsen pulmonary hypertension?
Oxygen 100 mL/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 253 mmHg. This mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is:
In the fetus, the percentage of cardiac output directed to the placenta is approximately:
Which of the following drugs is associated with postoperative atrial fibrillation after CABG surgery?
A and B only
You are anesthetizing a 60-year-old woman for coronary artery bypass surgery. After completion of the surgery, her left ventricular function is hyperdynamic on TEE, her cardiac output is increased to 6 liters/minute but her blood pressure is 85/50 mmHg. Due to her left ventricular hypertrophy you want to increase her blood pressure to maintain end organ perfusion. Which of the following agents would be the BEST choice at this time to achieve these goals?
A fresh E-cylinder of oxygen:
contains more liters of gas than an E-cylinder of nitrous oxide
contains about 90% liquid oxygen and 10% oxygen as a gas
contains about 660 liters of oxygen
has a lower pressure than the pipeline oxygen supply
Which of the following is the MOST common cause of a new neurologic deficit following a carotid endarterectomy?
The elimination half-life of intravenously administered oxytocin in the parturient is approximately:
30 to 120 seconds
3 to 5 minutes
10 to 15 minutes
20 to 30 minutes
A 40-year-old woman has undergone mitral valve surgery for mitral regurgitation. She has been given vasopressin by infusion for systemic hypotension. Which of the following is the CORRECT mechanism of action by which vasopressin improves systemic blood pressure?
Binds to V1a receptors: vascular smooth muscle
Binds to V1b receptors: pituitary gland
Binds to V2a receptors: renal collecting duct permeability
Binds to V2b receptors: vascular endothelium
During hip replacement surgery, cardiopulmonary changes associated with the application of acrylic bone cement include: (Select 3)
hypotension secondary to cement monomer absorption
hypoxemia secondary to air embolization
hypoxemia secondary to fat embolization
decreased pulmonary artery pressure
increased end-tidal carbon dioxide
All of the following changes in pulmonary physiology occur with aging EXCEPT:
Decreased sensitivity to hypoxemia
Dilation of alveoli and airspace enlargement
Increased elastic recoil of the lung
Increased small airway resistance
A healthy 28-year-old male fell 8 feet from a ladder and suffered a small calcaneal fracture. An incision from the heel to the midfoot is planned. The anesthetic plan calls for an ankle block. Blocking which nerve is MOST important for this surgery?
Deep peroneal nerve
Superficial peroneal nerve
Posterior tibial nerve
The formation of active metabolites has NOT been associated with the use of:
Which of the following comorbidities MOST increase the risk of central postoperative apnea in a preterm infant?
A 75-year-old man with coronary artery disease and ejection fraction of 25% has just undergone CABG surgery and is receiving milrinone and epinephrine to improve left ventricular function. Milrinone acts by which of the following mechanisms?
Decreases breakdown of cyclic AMP
Decreases breakdown of cyclic GMP
Increases breakdown of cyclic AMP
Increases breakdown of cyclic GMP
The rate of seroconversion after exposure of mucous membranes to HIV-infected blood is approximately:
A 70-year-old woman is started on maintenance therapy with amiodarone for atrial fibrillation. She develops cold intolerance, weight gain, constipation and fatigue. Which of the following is MOST likely responsible for her symptoms?
Low T3 syndrome
Low T4 syndrome
Low TSH syndrome
Low TRH syndrome
A decrease in cholinesterase activity has been associated with:
Nicardipine belongs to what drug class?
Dihydropyridine calcium channel blocker