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Which substances contribute to the symptoms of carcinoid syndrome? (Select 2) A. Choline acetyltransferase B. Histamine C. Parathyroid Hormone D. Serotonin ✔ Correct Answers: B. Histamine, D. Serotonin According to preanesthesia equipment checks, which steps should be done before every individual case? (Select 2) A. Calibrate O₂ sensor and test the low-O₂ alarm B. Perform a circuit pressure and leak test C. Check for low-pressure circuit leaks D. Ensure suction is ready to clear the airway ✔ Correct Answers: B. Perform a circuit pressure and leak test, D. Ensure suction is ready to clear the airway An interincisor gap of which size (in cm) is typically associated with possible intubation difficulty? A. 3 B. 5 C. 7 D. 9 ✔ Correct Answer: A. 3 Which drugs should be dosed based on total body weight in an obese patient with a BMI of 39 kg/m²? (Select 2) A. Cisatracurium (Nimbex) B. Lidocaine (Xylocaine) C. Propofol (Diprivan) D. Remifentanil (Ultiva) ✔ Correct Answers: A. Cisatracurium, B. Lidocaine
What is the primary mineralocorticoid hormone secreted by the adrenal cortex? A. Aldosterone B. Androgen C. Cortisol D. Epinephrine ✔ Correct Answer: A. Aldosterone Which monitoring method most quickly detects accidental extubation? A. Blood pressure monitoring B. Capnography C. ECG D. Pulse oximetry ✔ Correct Answer: B. Capnography Injury to which nerve results in vocal cord paralysis? A. Glossopharyngeal B. Hypoglossal C. Recurrent laryngeal D. Superior laryngeal ✔ Correct Answer: C. Recurrent laryngeal Which drug should be avoided in patients with elevated T3 and T4 levels due to risk of exacerbating thyroid dysfunction? A. Adenosine B. Amiodarone C. Bupivacaine D. Lidocaine ✔ Correct Answer: B. Amiodarone For which patient is metoclopramide (Reglan) most appropriate for postoperative nausea prevention? A. Patient with a bowel obstruction B. Patient with GERD history C. Patient with a seizure disorder D. Patient taking haloperidol at home ✔ Correct Answer: B. Patient with GERD history Metoclopramide (Reglan) is a central-acting prokinetic gastrointestinal drug that should not be administered in those with Parkinson's disease, restless legs syndrome, or seizure disorder due to increased risk for extrapyramidal symptoms (EPS) and akathisia. It should not be coadministered with phenothiazines or butyrophenones due to increased central nervous system depression and increased incidence of EPS. And it should not be administered with a
D. Initiation of hyperventilation B. Coughing, straining, and bucking C. Face mask pressure There is an increase in vitreal herniation with the use of depolarizing muscle relaxants; pressure on the eyeball; coughing, straining, and bucking; and hypercarbia. Which adverse effect would MOST likely result from administration of dexamethasone (Decadron), 10mg? A. Akathisia B. Hyperglycemia C. Hypertension D. Tachycardia B. Hyperglycemia High-dose dexamethasone causes an increase in blood glucose level; obese and diabetic patients are at the highest risk of perioperative hyperglycemia. Which symptoms are related to histamine release in the patient exhibiting an allergic reaction? (Select 2) A. Decreased vascular permeability B. Increased gastric secretion C. Tachycardia D. Vasoconstriction B. Increased gastric secretion C. Tachycardia Histamine reactions are mediated by H1 and H2 receptors on target cells. The correct answers are positive in these reactions. Which drug will reverse the life-threatening respiratory depressant effects of opioids in a patient with obstructive sleep apnea? A. Flumazenil (Romazicon) B. Naloxone (Narcan) C. Naltrexone (ReVia, Vivitrol) D. Neostigmine (Prostigmin) B. Naloxone (Narcan)
The drug of choice for life-threatening respiratory depression is naloxone. Patients with OSA are at an even greater risk of respiratory compromise as a result of excessive opioids. Which IV induction drug could be administered to treat persistent bronchospasm? A. Dexmedetomidine (Precedex) B. Etomidate (Amidate) C. Ketamine (Ketalar) D. Propofol (Diprivan) C. Ketamine Ketamine is a potent bronchodilator and can be used to treat persistent bronchospasm. A 70-kg patient is having a left lung partial lobectomy for lung cancer. He consents for general anesthesia with the addition of a left intercostal nerve block for postoperative pain management. What is the maximum dose in milligrams of lidocaine 2% (Xylocaine) with epinephrine for this patient's block? A. 70 B. 140 C. 350 D. 490 D. 490 Local anesthetic toxicity usually occurs from an inadvertently large amount of drug being administered into the IV system. It can also occur from a large amount of drug absorption from a nerve block administration. The maximum dose of lidocaine with epinephrine is recommended at 7 mg/kg: 7 mg x 70 kg = 490 mg What is the definitive treatment for a patient with local anesthetic systemic toxicity? A. Intralipid B. Midazolam (Versed) C. Propofol (Diprivan) D. Thiopental (Pentothal) A. Intralipid A lipid infusion begun immediately after suspected local anesthetic toxicity improves the rate of success of resuscitation from cardiac arrest. An infusion of 20% lipids is recommended.
C. Hypotension D. Hypoxemia Cardiopulmonary changes associated with the application of acrylic bone cement during hip replacement surgery include hypotension secondary to cement monomer absorption, hypoxemia secondary to air embolization, and hypoxemia secondary to fat embolization. Hypotension has been attributed to absorption of methyl methacrylate monomer, embolization of air and bone marrow, lysis of red cells and marrow, and conversion of methyl methacrylate to methacrylic acid. Hypoxemia commonly occurs. Embolic events cause increased dead space, with reduced ETCO₂ and increased PaCO₂. Which anesthetic agent should ideally be avoided in the asthmatic patient? A. Desflurane (Suprane) B. Isoflurane (Forane) C. Ketamine (Ketalar) D. Propofol (Diprivan) A. Desflurane (Suprane) Anesthetic agents should be selected for their bronchodilating effects in the asthmatic patient. With the exception of desflurane, all of the inhalation anesthetics produce bronchodilation. Both the IV agents ketamine and propofol produce bronchodilation. Which nerve innervates all of the intrinsic muscles of the larynx EXCEPT the cricothyroid muscle? A. Hypoglossal B. Recurrent laryngeal C. Superior laryngeal D. Trigeminal B. Recurrent laryngeal The cricothyroid is an extrinsic muscle and is the only muscle of the larynx not innervated by the recurrent laryngeal nerve. It is part of the anterior larynx innervated by a branch of the vagus nerve known as the external laryngeal branch of the superior laryngeal nerve. A common fibular nerve injury is suspected following a lengthy laparoscopic-assisted vaginal hysterectomy. Which findings confirm this diagnosis? (Select 2) A. Footdrop B. Loss of cutaneous sensation in the anterior aspect of the upper leg
C. Loss of cutaneous sensation in the lateral and anterior aspect of the lower leg D. Motor weakness of lower extremities A. Footdrop C. Loss of cutaneous sensation in the lateral and anterior aspect of the lower leg Common peroneal nerve injury may result from direct pressure, excessive stretch due to prolonged flexion of the knee, and excessive external rotation of the hip. Injury manifests as loss of cutaneous sensation in the lateral and anterior aspect of the lower leg or footdrop Cricoid pressure applied during a rapid-sequence induction is CONTRAINDICATED in which patient condition? (Select 2) A. Cervical spine fracture B. Gastroparesis C. Hiatal hernia D. Partutient at 24 weeks' gestation A. Cervical spine fracture C. Hiatal hernia Cricoid pressure is a technique used during rapid-sequence induction to prevent gastric contents from entering the pharynx. Cricoid pressure is contraindicated in patients with cervical spine fracture, active vomiting, or laryngeal fracture. Which muscle is tested to assess the return of function of the laryngeal adductor muscles? A. Adductor pollicis B. Corrugator supercilli C. Flexor carpi ulnaris D. Flexor hallucis brevis B. Corrugator supercilli Paralysis of the laryngeal muscles approximates the neuromuscular block of the corrugator supercilii. Vocal cord paralysis is caused by damage to which nerve? A. Glossopharyngeal B. Hypoglossal C. Recurrent laryngeal D. Superior laryngeal C. Recurrent laryngeal
Which ECG lead would BEST detect occlusion of the right coronary artery? A. I B. II C. V₄ D. V₅ B. II The right coronary artery supplies the inferior wall of the myocardium, which is best monitored with ECG leads II, III, and aVF. What is a complication of excessive endotracheal tube cuff pressure? A. Air leak B. Pneumonitis C. Pulmonary edema D. Tracheal mucosal injury D. Tracheal mucosal injury Excessive endotracheal cuff pressure may result in tracheal mucosal injury, vocal cord dysfunction due to recurrent laryngeal nerve palsy, and a sore throat. Which is an appropriate intervention in the patient taking exogenous steroids who develops severe hypotension unresponsive to vasopressor medications? A. Atropine (Atropen) B. Calcium chloride C. Hydrocortisone (Cortef) D. Vasopressin C. Hydrocortisone (Cortef) A patient who takes exogenous steroids may become hypotensive due to the lack of glucocorticoid and mineralocorticoid. Corticosteroid coverage in these patients may avoid hemodynamic instability due to adrenal suppression. Fever, sore throat, excessive drooling, and a preference for sitting up with the head extended are signs and symptoms of: A. Croup
B. Epiglottitis C. Laryngospasm D. Tonsilitis B. Epiglottitis Fever, sore throat, excessive drooling, and tripod position are all signs and symptoms of epiglottitis. Following denitrogenation, which local anesthetic used to perform an awake fiberoptic intubation could potentiate a sustained oxygen desaturation from 100% to 85%? A. Benzocaine (Hurricaine) B. Bupivacaine (Marcaine) C. Cocaine (Delcaine) D. Lidocaine (Xylocaine) A. Benzocaine (Hurricaine) Benzocaine, when systemically absorbed, can produce methemoglobinemia resulting in compromised oxygen transport and decreased oxygen saturations. Which medication is CONTRAINDICATED in a patient with Parkinson's disease taking carbidopa/levodopa (Sinemet)? A. Fentanyl (Sublimaze) B. Metoclopramide (Reglan) C. Midazolam (Versed) D. Propofol (Diprivan) B. Metoclopramide (Reglan) Metoclopramide is a dopamine antagonist and should be avoided in patients with Parkinson's disease. Rapid administration of fentanyl can produce dystonic reactions, but it can be given. Propofol and midazolam do appreciably increase adverse responses, but can also be given. When is it an acceptable practice to reuse a medication-filled syringe? A. After replacing the needle on a used syringe to access a single dose vial B. During sequential medication doses using a single syringe C. When accessing a multidose vial with a used needle D. When accessing medication from a multidose vial with a used syringe B. During sequential medication doses using a single syringe
Gastric aspiration into the lungs causes chemical destruction of lung tissue, microhemorrhage leading to hypoxia, alveolar membrane capillary edema and degeneration, and alveolar type II pneumocyte destruction. High peak airway pressures contribute to gastric insufflation. What are the causes of acute prerenal injury in the anesthetized patient? (Select 2) A. Hemorrhage B. Hyperthyroidism C. Hyponatremia D. Hypotension A. Hemorrhage D. Hypotension Decreases in renal blood flow are a common cause of acute renal injury in the anesthetized patient. Conditions that can lead to acute renal injury include intravascular volume depletion such as hemorrhage, heart failure, and any condition that leads to hypotension, such as sepsis. In caring for a patient with Clostridium difficile, what precautions should be taken? (Select 3) A. Eye protection B. Gloves C. Gown D. Mask E. Use of hand sanitizer F. Washing hands with soap and water B. Gloves C. Gown F. Washing hands with soap and water Standard precautions are to be used, but alcohol-based hand sanitizer will not clear C. difficile, requiring hand washing between patients. How is sevoflurane (Ultane) administration affected by the tipping of the vaporizer when it is not in transport mode? A. A higher concentration of sevoflurane may be delivered B. A lower concentration of sevoflurane may be delivered C. If no sevoflurane liquid is visible, the vaporier is safe to use D. The vaporizer will no longer work until properly flushed A. A higher concentration of sevoflurane may be delivered
Tipping of the vaporizer can allow liquid agent to enter the bypass chamber, allowing for very high concentrations of agent to be delivered. Stimulation of which sensory nerve may trigger a laryngospasm? A. Glossopharyngeal B. Hypoglossal C. Recurrent laryngeal D. Superior laryngeal D. Superior laryngeal A laryngospasm is initiated by stimulation of the superior laryngeal nerve. Airway exchange catheters are BEST used in which situations? (Select 2) A. During trial extubation of a known difficult airway B. In place of an endotracheal tube C. To allow gas exchange through jet ventilation D. To facilitate laryngeal mask placement A. During trial extubation of a known difficult airway C. To allow gas exchange through jet ventilation Airway exchange catheters may be used to change an endotracheal tube (ETT), provide assurance for reintubation during extubation, and allow for gas exchange through jet ventilation or bag ventilation using an adaptor. It is not used in place of an ETT or to aid in laryngeal mask airway placement. Which is the MOST appropriate anesthetic consideration for a 26-week parturient who is scheduled for laparoscopic cholecystectomy? A. Conscious sedation B. General anesthesia using laryngeal mask airway C. Pretreatment with midazolam (Versed) D. Rapid-sequence induction D. Rapid-sequence induction Due to physiologic changes with pregnancy, most patients beyond 12 weeks' gestation are considered full stomachs and should have a rapid-sequence induction. Conscious sedation and laryngeal mask airway do not prevent airway aspiration. Midazolam should not be administered during pregnancy.
D. Unexpected, sudden rise in ETCO D. Unexpected, sudden rise in ETCO The earliest sign of malignant hyperthermia (MH) is an unexplained and sudden increase in ETCO2 disproportionate to minute ventilation. Other early signs of MH crisis include tachycardia, cyanosis, decrease in SaO2, and jaw muscle or total body rigidity. Which are complications of direct arterial pressure monitoring (A-line)? (Select 2) A. Compartment syndrome B. Distal ischemia C. Limb edema D. Peripheral neuropathy B. Distal ischemia D. Peripheral neuropathy The following are complications of direct arterial pressure monitoring: distal ischemia, pseudoaneurysm, arteriovenous fistula, hemorrhage, arterial embolization, infection, peripheral neuropathy, misinterpretation of data, and misuse of equipment. Which are risks of transtracheal jet ventilation? (Select 2) A. Barotrauma B. Nasal fracture C. Hypocarbia D. Subcutaneous emphysema A. Barotrauma D. Subcutaneous emphysema Transtracheal jet ventilation is done in connection with a needle cricothyrotomy for emergency ventilation. Ventilation is done using an oxygen regulator and a high-pressure oxygen source. The oxygen regulator controls ventilation through tubing that is refractory to expansion. Complications include pneumothorax, subcutaneous emphysema, barotrauma, esophageal puncture, catheter kinking, pneumomediastinum, hypercarbia, and accidental removal. What are the hemodynamic goals of hypertrophic cardiomyopathy? (Select 2) A. Decreased contractility B. Decreased preload C. Increased afterload D. Increased heart rate
A. Decreased contractility C. Increased afterload What are potential complications of pulmonary artery catheter insertion? (Select 2) A. Cardiac perforation B. Left bundle-branch block C. Mitral valve rupture D. Pulmonary infarction A. Cardiac perforation D. Pulmonary infarction Pharmacologic characteristics that best describe the effect of naloxone at the opioid receptors include: (Select 2) A. Affinity B. Efficacy C. Intrinsic activity D. Reversibility E. Stereo selectivity A. Affinity D. Reversibility Abnormal placental implantations beyond the endometrium include: (Select 3) A. Abruptio placentae B. Placenta accreta C. Placenta increta D. Placenta percreta E. Placenta previa B. Placenta accreta C. Placenta increta D. Placenta percreta Characteristics of Eaton-Lambert syndrome include: (Select 3) A. Positive response to anticholinesterase agents B. Improved strength with activity C. Reduced anticholine release D. Destruction of acetylcholine receptors
A. Inhibition of the actions of GABA B. Inhibition of NMDA receptors C. Inactivation of sodium receptors D. Limitation of the activation of calcium channels B. Inhibition of NMDA receptors C. Inactivation of sodium receptors D. Limitation of the activation of calcium channels The musculocutaneous nerve arises from which nerve roots? (Select 3) A. C B. C C. C 7 D. C E. T F. T A. C B. C C. C Successful laryngoscopy for intubation requires alignment of which 3 axes? (Select 3) A. Nasal B. Oral C. Tracheal D. Laryngeal E. Glottic F. Pharyngeal B. Oral D. Laryngeal F. Pharyngeal Which of the following pulmonary function tests results indicate restrictive pulmonary disease? (Select 3) A. Decreased forced vital capacity (FVC) B. Decreased FEV1/FVC ratio C. Decreased FEF 25%-75% D. Decreased total lung capacity (TLC) E. Decreased functional residual capacity (FRC) F. Increased FEV
A. Decreased forced vital capacity (FVC) D. Decreased total lung capacity (TLC) E. Decreased functional residual capacity (FRC) Pharmacological management of thyroid storm may include: (Select 3) A. Sodium thiosulfate B. Sodium iodide C. Levothyroxine D. Hydrocortisone E. Methylene blue F. Propranolol B. Sodium iodide D. Hydrocortisone F. Propranolol What is the BMI for a 70-kg patient who is 1.6 meters tall? Enter your answer below as a whole number with no decimals, in kg/m² 27 kg/m² Calculate cardiac output given the following hemodynamic parameters: stroke volume, 60 mL; blood pressure, 150/70 mm Hg; heart rate, 50/min. Enter your answer below as a whole number with no decimals, in L/min. 3 L/min Use of positive pressure greater than how many mmHg with a laryngeal mask airway may cause stomach inflation? Enter your answer below as a whole number with no decimals, in mmHg. 20 mmHg In the lateral position, blood flow to the dependent lung of the anesthetized patient most represents which zone of flow? Enter your answer below as a whole number with no decimals. Zone 3
