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ACE 11A

QUESTION

1. A patient undergoing lumbar spine fusion surgery is monitored by measuring lower extremitysomatosensory evoked potentials (SSEPs). Which of the following is MOST likely to cause a50% increase from baseline in the SSEP latency?

A. Anterior spinal artery ischemia

B. Compression of the anterior column of the spinal cord

C. Changing from an inhaled anesthetic to a total intravenous anesthetic

D. Compression of the dorsal column of the spinal cord

Comments on the incorrect answers

B. Anterior spinal cord compression may not have any effect on SSEPs.

C. Changing to a total intravenous anesthetic would most likely decrease SSEP latency.

D. Lower extremity SSEPs are not transmitted by the dorsal column of the spinal cord.

Correct answer is A

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 1. Central and Peripheral Nervous Systems

II.A. ADVANCED: Basic Sciences, 1. Physics, Monitoring, and Anesthesia Delivery Devices

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QUESTION

2. Cyclosporine toxicity is MOST commonly seen in which of the following solid organs?

A. Lung

B. KidneyC. Pancreas

D. Heart


A. Although cyclosporine has been reported to be associated with the development of bronchospasm,cough, and dyspnea, pulmonary sequelae are not the most common complications.

C. Toxicity of the pancreas does not occur with cyclosporine administration.

D. Although cyclosporine has been reported to be associated with myocardial infarction, dysrhythmias,

and heart failure, cardiac complications are not the most common manifestation of cyclosporinetoxicity.

Correct answer is B

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 1. Evaluation of thePatient and Preoperative Preparation

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QUESTION

3. Which of the following anesthetic agents undergoes the MOST metabolism?

A.Nitrous oxide

B.Isoflurane

C.Sevoflurane

D.Desflurane


A.Nitrous oxide has not demonstrated any degree of metabolism when administered.

B.Only approximately 2% of the administered isoflurane is metabolized.

D.Only approximately 0.2% of the administered desflurane dose is metabolized.

Correct answer is C

Taxonomy

I.D. BASIC: Special Problems or Issues in Anesthesiology, 2. Ethics, Practice Management, andMedicolegal Issues

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QUESTION

4. In a preoperative anesthesia machine safety check, which of the following is MOST likelyaffected by the presence of a check valve between the oxygen flush valve and the anestheticvaporizers?

A. Calibration of the oxygen analyzer

B. The low-pressure circuit leak test

C. The circle system flow test

D. The piped gas supply pressure check


A. Calibration of the oxygen analyzer does not depend on the presence or absence of a check valve.

C. The circle system flow test evaluates leaks in the circle system and the integrity of the unidirectionalvalves and does not depend on the presence or absence of a check valve.

D. The pressure check in the piped gas supply is part of the high-pressure system and is independentof the presence of a check valve.

Correct answer is B

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 7. Postoperative Period

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QUESTION

5. A patient presents with pain associated with osteoarthritis. Treatment with which of thefollowing medications appears to be associated with the LOWEST risk of myocardialinfarction?

A.Diclofenac

B.Naproxen

C.Ibuprofen

D.Celecoxib


A. Available evidence suggests that diclofenac is not associated with the lowest risk of myocardialinfarction.

C. Available evidence suggests that ibuprofen is not associated with the lowest risk of myocardialinfarction.

D.Celecoxib appears to be the safest of the COX-2 inhibitors but is not associated with the lowest risk

of myocardial infarction.

Correct answer is B

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 1. Painful Disease States

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QUESTION

6. Administration of which of the following is LEAST likely to be appropriate in the setting of acute intraoperative bronchospasm?

A. Isoflurane

B. Albuterol

C. Montelukast

D. Hydrocortisone


A. Administration of isoflurane will improve bronchospasm by both deepening the level of anesthesiaand via a direct bronchodilating effect.

B. The !2-agonist albuterol has direct bronchodilating properties and is a mainstay of therapy for acute

bronchospasm.

D. Administration of steroids will decrease airway inflammation. The clinical effects are not immediatebut steroids will decrease the chance of recurrent or persistent bronchospasm and are appropriatefor administration in the acute phase.

Correct answer is C

Taxonomy

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 2. Respiratory System

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QUESTION

7. Your patient has a preoperative cardiac arrest while moving himself from the stretcher to theoperating room table. According to the 2010 American Heart Association guidelines, the firstclinical response is to

A. intubate the trachea.

B. begin chest compressions.

C. deliver a precordial thump.

D. attach a monitor/defibrillator.


A. Ventilation of the patient’s lungs—in particular, placement of an advanced airway device—should notdelay or cause long interruptions in resuscitation.

C. A precordial thump may be considered in patients with witnessed, monitored, unstable ventricular

tachycardia (VT), including pulseless VT, if a defibrillator is not immediately available.

D. Attaching a monitor/defibrillator to the patient should be done as expeditiously as possible but shouldnot delay the start of resuscitation.

Correct answer is B

Taxonomy

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 3. Cardiovascular System

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QUESTION

8. Which of the following is MOST likely associated with an increase in minimum alveolar concentration (MAC) in humans?

A. Advanced age

B. Concurrent administration of intravenous local anesthetics

C. Preoperative administration of clonidine

D. Chronic alcohol abuse


A. Advanced age is associated with a decrease in MAC.

B. Concurrent administration of intravenous local anesthetics is associated with a decrease in MAC.

C. Preoperative administration of "2 agonists such as clonidine is associated with a decrease in MAC.

Correct answer is D

Taxonomy

I.A. BASIC: Basic Sciences, 4. Pharmacology

II.A. ADVANCED: Basic Sciences, 2. Pharmacology

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QUESTION

9. The BEST choice for a postoperative antiemetic medication for a patient with Parkinsondisease who has already been treated with intraoperative ondansetron and steroid is

A. droperidol.

B. ondansetron.

C. diphenhydramine.

D. prochlorperazine (Compazine).


A. Droperidol, a butyrophenone, may aggravate Parkinson symptoms.

B. Repeat dosing of ondansetron in a multimodal regimen for postoperative nausea and vomiting hasnot been shown to be effective.

D. Prochlorperazine, a phenothiazine, may aggravate Parkinson symptoms.

Correct answer is C

Taxonomy


II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 1. Central and Peripheral Nervous Systems

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QUESTION

10. Which of the following diseases is MOST closely associated with life-threateningsuccinylcholine-induced hyperkalemia?

A. Myotonic dystrophy

B. Familial hypokalemic periodic paralysis

C. End-stage renal disease

D. Glycogen storage disease type 2 (acid maltase deficiency)


A. Succinylcholine administration to patients with myotonic dystrophy might cause diffuse andprolonged muscle contractions but not life-threatening hyperkalemia.

B. Patients with familial hypokalemic periodic paralysis do not develop life-threatening hyperkalemiawith succinylcholine administration.

C. Patients with end-stage renal disease do not exhibit a life-threatening hyperkalemic response tosuccinylcholine.

Correct answer is D

Taxonomy



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QUESTION

11. A patient undergoes placement of an axillary brachial plexus block using 1.25% mepivacaine.Epinephrine at 5 µg/mL is added to the local anesthetic solution to test for intravascular injection. Which statement about the magnitude of the heart rate response to epinephrine isMOST likely true?

A. It is independent of age.

B. It is blunted by pre-procedure administration of !-blockade.

C. It is similar whether the block is performed before or after induction of general anesthesia.

D. When administered with mepivacaine, epinephrine does not affect heart rate.


A. The magnitude of the heart rate increase is reduced as patients age, particularly after the age of 40.

C. The heart rate and blood pressure responses to epinephrine are reduced when a patient undergoes

general anesthesia.

D. The effect of epinephrine on heart rate when used as a marker for intravascular injection isindependent of the local anesthetic used.

Correct answer is B

Taxonomy


II.B. ADVANCED: Clinical Sciences (Procedures, Methods, Techniques), 1. Regional Anesthesia

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QUESTION

12. You are taking care of a patient with an acute abdomen who is entering the operating roomwithin the first few hours of septic shock. Which of the following is MOST likelyrecommended at this point?

A. Measurement of serum lactate

B. Administration of bicarbonate to keep arterial pH above 7.3

C. Fluid restriction

D. Administration of phenylephrine for systemic hypotension


B. Bicarbonate administration is not recommended unless arterial pH is below 7.15.

C. By definition, a patient in septic shock is hypotensive. Delivery of an initial minimum of 30 mL/kgcrystalloid or an equivalent is recommended in the treatment of patients who are hypotensive or

have a serum lactate in excess of 4 mmol/L.

D. Although evidence is not strong, administration of norepinephrine is recommended as the first-linechoice for vasopressor therapy, with addition of vasopressin if needed.

Correct answer is A

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 12. Critical Care

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QUESTION

13. Which of the following is MOST likely a characteristic of postpolio syndrome?

A. Recurrent motor weakness

B. Persistent vomitingC. Fever

D. Increased tolerance to opioids


B. Dysphagia, not persistent vomiting, is associated with postpolio syndrome.

C. Patients with postpolio syndrome are often cold intolerant. Fever is not associated with thesyndrome.

D. Postpolio syndrome is associated with increased sensitivity to anesthetic agents, especially

sedatives.

Correct answer is A

Taxonomy

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 8. Neuromuscular Diseases and Disorders:Clinical Science

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QUESTION

14. A patient presents with visceral pelvic pain secondary to radiation therapy for rectal cancer.Which of the following interventions is MOST likely to relieve this patient’s pain?

A. Celiac plexus block

B. Lumbar sympathetic block

C. Bilateral pudendal nerve blocks

D. Superior hypogastric plexus block


A. A celiac plexus block will relieve visceral pain secondary to cancer of the upper abdomen but isunlikely to relieve this patient’s visceral pelvic pain.

B. A lumbar sympathetic block will relieve pain due to conditions such as lower extremity complexregional pain syndrome and arterial insufficiency of the lower extremities but is unlikely to relieve

visceral pelvic pain.

C. Bilateral pudendal nerve blocks are unlikely to relieve this patient’s visceral pain.

Correct answer is D

Taxonomy


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QUESTION

15. Which of the following conditions is MOST likely associated with an increase in carbonmonoxide diffusion capacity of the lung (DLCO)?

A.

Chronic obstructive pulmonary disease (COPD)

B. Asthma

C.Sarcoidosis

D.Idiopathic pulmonary hypertension


A. COPD is associated with a low DLCO.

C. Sarcoidosis is associated with a low DLCO.

D. Idiopathic pulmonary hypertension is associated with a low DLCO.

Correct answer is B

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 2. Respiratory System


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QUESTION

16. Which of the following respiratory function parameters is MOST likely decreased in pregnantpatients during the third trimester?

A. Tidal volume

B. Vital capacity

C. Expiratory reserve volume

D. Forced expiratory volume in 1 second


A. Tidal volume increases significantly during pregnancy.

B. Vital capacity remains unchanged during pregnancy.

D. Forced expiratory volume in 1 second remains unchanged during pregnancy.

Correct answer is C

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 3. Obstetric Anesthesia

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QUESTION

17. A 36-year-old man who was admitted to the intensive care unit develops polyuria. Hislaboratory values are significant for serum sodium 153 mmol/L, serum potassium 4.0 mmol/L,serum osmolality 340 mOsm/kg, and urine osmolality 230 mOsm/kg. Which of the following isthe MOST likely reason for this increase in urine output?

A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

B. Central diabetes insipidus

C. Cerebral salt wasting

D. Diabetic ketoacidosis


A. SIADH is associated with hyponatremia and oliguria.

C. Cerebral salt wasting is associated with hyponatremia.

D. Serum sodium is normal or low in diabetic ketoacidosis.

Correct answer is B

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 5. Renal and Urinary Systems/ Electrolyte Balance

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 7. Endocrine and Metabolic Systems

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QUESTION

18. Which statement BEST describes neonatal injuries associated with forceps delivery?

A. Injuries are more common after outlet forceps than after midforceps delivery.

B. Facial nerve palsy secondary to forceps use is usually permanent.C. There is an increased risk of brachial plexus injuries with forceps delivery.

D. Maternal epidural labor analgesia can significantly reduce these injuries.


A. Neonatal injuries are more common after midforceps delivery.

B. Facial nerve palsy secondary to forceps use usually resolves spontaneously.

D. Maternal epidural labor analgesia has not been demonstrated to have any impact on the risk of neonatal injuries with forceps deliveries.

Correct answer is C

Taxonomy


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QUESTION

19. A patient receiving general anesthesia develops severe hypotension, tachycardia, andincreased peak airway pressures approximately 10 minutes after placement of a left internal

jugular central venous catheter. Physical examination reveals decreased breath sounds onthe left. Which of the following is the MOST appropriate initial management?

A.Order a stat chest radiograph.

B.Withdraw the tracheal tube 3 cm.

C. Administer albuterol.

D.Perform needle decompression to the left chest.


A.Ordering a stat chest radiograph would not be the most appropriate initial management for a patientwith severe hypotension, tachycardia, and increased peak airway pressures.

B.Withdrawing the tracheal tube would be appropriate management for a mainstem intubation.

Although intubation of the right mainstem bronchus would result in increased peak airway pressuresand diminished breath sounds on the left, it is unlikely to cause severe hypotension and tachycardia.

C.The administration of albuterol would be appropriate management for a patient with bronchospasm.

Although bronchospasm would cause increased peak airway pressure and could be associated withtachycardia, it is unlikely to cause a unilateral decrease in breath sounds

Correct answer is D

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 6. Complications

(Etiology, Prevention, Treatment)II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 2. Respiratory System

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QUESTION

20. Which statement about the clinical presentation of heparin-induced thrombocytopenia (HIT)is MOST likely true?

A. Thrombosis occurs in less than 25% of patients with HIT.

B. Pulmonary embolism is rare in patients with HIT.

C. Significant thrombosis occurs only if the platelet count is less than 100,000/µL.

D. Spontaneous bleeding is rare in patients with HIT.


A. Thrombosis occurs in up to 75% of patients with HIT.

B. The most common presentation of HIT is pulmonary embolism.

C. Significant thrombosis can occur with platelet counts in excess of 100,000/µL and may even precede

the development of thrombocytopenia.

Correct answer is D

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 6. Hematologic System

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 6. Hematologic System

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QUESTION

21. Which of the following radiological “signs” is MOST likely to be present in a child withlaryngotracheobronchitis?

A. Thumb sign

B. Anteater nose sign

C. Hampton hump

D. Steeple sign


A. The thumb (or thumbprint) sign is seen on lateral neck radiographs in children with epiglottitis.

B. The anteater nose sign is seen on radiographs of the foot/ankle in calcaneonavicular tarsal coalition(the abnormal fusion of 2 or more tarsal bones).

C. Hampton hump is a wedge-shaped area of pulmonary consolidation that is sometimes seen on chestradiographs in the presence of a pulmonary embolus.

Correct answer is D

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 2. Pediatric Anesthesia

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QUESTION

22. Which of the following parameters is MOST likely to be increased after release of a lower extremity tourniquet during total knee arthroplasty?

A. Central venous pressure

B. Systemic vascular resistance

C. Serum lactate level

D. Core body temperature


A. Central venous pressure would be expected to decrease after release of a lower extremity tourniquetduring total knee arthroplasty.

B. Tourniquet release is associated with a decrease in systemic vascular resistance.

D. Core body temperature would be expected to decrease after release of a lower extremity tourniquetduring total knee arthroplasty.

Correct answer is C

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 8. Orthopedic Anesthesia; Tourniquet Management,Complications, Regional vs. General Anesthesia

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QUESTION

23. Which of the following sets of arterial blood gases is MOST typical of a patient with severechronic obstructive pulmonary disease (COPD) seen in the preoperative evaluation clinic?

PaO2 (mm Hg) PaCO

2 (mm Hg) pH

HCO3

-

(mEq/L)

(A) 85 29 7.40 19

(B) 64 60 7.35 31

(C) 100 28 7.52 24

(D) 100 40 7.40 24

A.(A)

B.(B)

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C.(C)

D.(D)


A.These results show a normal pH, a metabolic acidosis, and a respiratory alkalosis. They are nottypical of a patient with COPD.

C.These results show a primary respiratory alkalosis with alkalemia. This situation is unlikely to beseen in a patient with COPD.

D.These are normal results.

Correct answer is B

Taxonomy


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QUESTION

24. Which of the following management strategies is MOST likely to improve perioperativeoutcome in patients with chronic obstructive pulmonary disease (COPD)?

A. Preoperative cardiopulmonary conditioning

B. Use of general (versus regional) anesthesia

C.

Application of high levels of positive end-expiratory pressure (PEEP) if mechanical ventilation isnecessary

D. Use of high tidal volumes during mechanical ventilation


B. In patients with COPD, avoidance of general anesthesia and mechanical ventilation is preferable.Regional anesthesia is a preferred option if the procedure is suitable for a regional technique.

C. Structural changes in the lungs of patients with COPD mean that they are at increased risk for

ventilator-induced lung injury. Mechanical ventilation should aim to avoid pulmonary hyperinflationand the development of intrinsic PEEP.

D. Mechanical ventilation of patients with COPD should aim to avoid pulmonary hyperinflation and thedevelopment of intrinsic PEEP.

Correct answer is A

Taxonomy

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QUESTION

25. The following clinical scenarios describe critically ill patients requiring mechanicalventilation who have loss of corneal reflexes but intact cardiac function. In which case woulda formal assessment for determination of brain death MOST likely be carried out?

A.

A 45-year-old man with traumatic brain injury after a motor vehicle crash whose core temperatureis 31.8°C

B. A 60-year-old woman with coma of undetermined etiology

C.

A 58-year old man with subarachnoid hemorrhage who received a single dose of atracurium for intubation 4 days earlier

D. A 69-year-old woman after in-hospital cardiac arrest who has decerebrate posturing


A. A patient should have a core temperature of at least 36.5°C degrees prior to brain deathassessment.

B. The cause of coma should be known before assessment for the presence of brain death isperformed.

D. Decerebrate posturing is not seen in patients with brain death as it implies the presence of somebrain stem function.

Correct answer is C

Taxonomy


II.E. ADVANCED: Special Problems or Issues in Anesthesiology, 2. Organ Donors: Pathophysiology andClinical Management

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QUESTION

26. Which statement about carbon monoxide (CO) formation as a result of administration of inhaled anesthetic agents is MOST likely true?

A.

Increased temperature in the canister of carbon dioxide (CO2) absorbent is predictive of CO

production.

B. Exposure to desiccated CO2 absorbent is a necessary step in producing CO.

C. Desflurane produces the lowest amounts of CO.

D. The more acidic the CO2 absorbent, the greater the amount of CO produced.


A. CO2 absorbent temperature is a poor predictor of CO formation.

C. Desflurane produces the highest amounts of CO.

D. CO2 absorbents that are highly alkaline are capable of producing the highest amounts of CO in thepresence of potent inhaled anesthetic agents.

Correct answer is B

Taxonomy

I.A. BASIC: Basic Sciences, 2. Physics, Monitoring, and Anesthesia Delivery Devices

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QUESTION

27. Which statement about the management of a patient undergoing parathyroidectomy for asingle parathyroid adenoma is MOST likely true?

A. The nadir of serum calcium occurs within 30 minutes of parathyroid adenoma resection.

B. Hungry bone syndrome occurs when bone rapidly remineralizes.

C. Total intravenous anesthesia with propofol can interfere with the rapid parathormone assay.

D.

Injury of one recurrent laryngeal nerve will result in immediate airway obstruction uponextubation.


A. The nadir of serum calcium occurs 3 to 10 days after successful parathyroid adenoma resection.

C. Total intravenous anesthesia has not been shown to interfere with rapid parathyroid hormone assay.

D. Injury of a single recurrent laryngeal nerve will result in hoarseness.

Correct answer is B

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 7. Endocrine and Metabolic Systems


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QUESTION

28. Which statement about local anesthetic toxicity is MOST likely true?

A. Respiratory acidosis decreases the risk of central nervous system toxicity.

B. Vasoconstriction is the predominant vascular response.C. Prior administration of a benzodiazepine decreases the likelihood of a seizure.

D.

The ratio of the dosage that induces cardiovascular collapse to the dosage that will produceseizures is higher for bupivacaine than other local anesthetics.


A. Acidosis, whether respiratory or metabolic, increases the risk of local anestheticâ #’induced centralnervous system toxicity.

B. Although vasoconstriction may be present at low concentrations of local anesthetics, vasodilation willbe the predominant vascular response in circumstances of local anesthetic toxicity.

D. The ratio of the dosage that induces cardiovascular collapse to the dosage that will produce seizuresis lower for bupivacaine than other local anesthetics.

Correct answer is C

Taxonomy


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QUESTION

29. Which of the following ipsilateral signs is the BEST indicator of complete sympatheticblockade of the upper extremity following a stellate ganglion block?

A. Exophthalmos

B. Miosis

C. Nasal congestion

D. Increased forearm skin temperature


A. Stellate ganglion block produces ipsilateral enophthalmos, not exophthalmos.

B. Although successful stellate ganglion block produces ipsilateral miosis, this does not guaranteesympathetic blockade of the upper extremity.

C. Although successful stellate ganglion block produces ipsilateral nasal congestion, this does notguarantee sympathetic blockade of the upper extremity.

Correct answer is D

Taxonomy

II.B. ADVANCED: Clinical Sciences (Procedures, Methods, Techniques), 1. Regional Anesthesia


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QUESTION

30. A 42-year-old woman presents to the emergency department with acute back pain after having been lost to follow-up for addiction treatment 2 months ago. She has a past medicalhistory of intravenous heroin addiction in remission and is currently being managed withbuprenorphine/naloxone therapy. The patient appears calm, drowsy, and comfortable. She isasking for her usual dose of buprenorphine as she has not yet taken her medication today.Which of the following is MOST indicative of intravenous heroin relapse if this patient isgiven buprenorphine?

A. Respiratory depression

B. Sedation

C. Mydriasis

D. Headache


A. Respiratory depression is a symptom of opioid overdose. Introduction of buprenorphine in the settingof intravenous heroin use precipitates opioid withdrawal.

B. Sedation is a symptom of opioid overdose. Introduction of buprenorphine in the setting of intravenous heroin use precipitates opioid withdrawal.

D. Headache is a potential side effect of buprenorphine but does not indicate relapse to intravenousheroin use.

Correct answer is C

Taxonomy


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QUESTION

31. A decrease in the maximum dose of lidocaine for liposuction is MOST appropriate for patients taking which of the following medications?

A. Nicardipine

B. Carbamazepine

C. St John’s wort

D. Omeprazole


B. Carbamazepine induces cytochrome P450 3A4, which metabolizes lidocaine. Greater activity of theenzyme will result in more rapid elimination of lidocaine.

C. St John’s wort induces cytochrome P450 3A4, which metabolizes lidocaine. Greater activity of theenzyme will result in more rapid elimination of lidocaine.

D. Omeprazole induces cytochrome P450 1A2, which metabolizes lidocaine. Greater activity of theenzyme will result in more rapid elimination of lidocaine.

Correct answer is A

Taxonomy

II.D. ADVANCED: Clinical Subspecialties, 5. Anesthesia for Plastic Surgery, Liposuction

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QUESTION

32. Assuming an inadvertent dural puncture occurs during placement of an epidural catheter,which of the following conditions will MOST likely be associated with a higher risk of postdural puncture headache (PDPH)?

A.Morbid obesity

B.Patient age greater than 60 years

C.Use of saline to identify the epidural space

D.Previous PDPH


A.Morbid obesity is associated with a decreased risk of PDPH.

B.The risk of PDPH is lower in patients 60 years old and older.

C.Use of saline to locate the epidural space is not reported to be a risk factor for development of PDPH.

Correct answer is D

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QUESTION

33. A 56-year-old man with superior vena cava syndrome presents for a cervical lymph nodebiopsy under general anesthesia. Which of the following is MOST likely an importantcomponent of the management strategy?

A. Armored tracheal tube

B. Large-bore intravenous (IV) access in forearm

C. Preoperative diuresis

D. Trendelenburg position


B. Upper extremity IV access should be avoided in patients with superior vena cava syndrome due tointerrupted blood flow from the upper body.

C. Maintenance of preload is recommended for patients with superior vena cava syndrome.

D. Trendelenburg position increases upper extremity and cerebral venous engorgement and should beavoided.

Correct answer is A

Taxonomy


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QUESTION

34. Abrupt withdrawal of levodopa places the patient with Parkinson disease at increased risk for each of the following EXCEPT

A. chest wall rigidity.

B. aspiration.

C. autonomic instability.

D. nausea.


A. Chest wall rigidity is a symptom of Parkinson disease and can occur after acute withdrawal of levodopa.

B. Acute withdrawal of levodopa is associated with exacerbation of Parkinson symptoms, one of whichis dysphagia, leading to increased risk of aspiration.

C. Acute discontinuation of levodopa has been reported to precipitate autonomic instability, alteredmental status, muscle rigidity, and fever.

Correct answer is D

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35. Which of the following is LEAST likely to decrease allogenic blood transfusion duringelective hip replacement surgery?

A. Hypotensive epidural technique

B. Selective mild hypothermia (35°C)

C. Preoperative erythropoietin therapy

D. Normovolemic hemodilution


A. Hypotensive epidural technique reduces blood loss.

C. Preoperative erythropoietin therapy reduces the need for blood transfusion.

D. Normovolemic hemodilution reduces the need for blood transfusion.

Correct answer is B

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QUESTION

36. Which of the following statements about transfusion-associated graft versus host disease(TA-GVHD) is MOST likely true?

A. The risk is increased with administration of directed donor blood products.

B. It most commonly presents within the first 48 hours following transfusion.

C. Patients remain afebrile.

D. It is more common in children.


B. TA-GVHD generally presents 1 to 6 weeks after transfusion.

C. Fever is one of the presenting manifestations of TA-GVHD.

D. TA-GVHD occurs most commonly in patients over 60 years of age.

Correct answer is A

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QUESTION

37. Which of the following factors has the STRONGEST association with the development of acommon peroneal neuropathy following surgery in the lithotomy position?

A. Nonsmoking patients

B. Low body mass index

C. Procedures of short duration

D. Spondylolisthesis at L1-2


A. In a large retrospective review, patients with this neuropathy were more likely to be smokers.

C. In a large retrospective review, patients with a common peroneal neuropathy were more likely tohave undergone longer procedures.

D. The common peroneal nerve contains nerve fibers originating at L4 to S2, and a motor neuropathy of this nerve can result in an inability to dorsiflex the foot (foot drop).

Correct answer is B

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 6. Complications(Etiology, Prevention, Treatment)

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38. Which of the following is BEST avoided in the perioperative period in a patient with multiplesclerosis (MS)?

A. Hyperthermia

B. Nondepolarizing neuromuscular blockers

C. Corticosteroids

D. Epidural anesthesia


B. Even though there can be a variable response to nondepolarizing neuromuscular blockers inpatients with MS, their use is considered safe.

C. Acute exacerbations of MS symptoms are treated with immunosuppressant medications, includingcorticosteroids.

D. Epidural anesthesia in patients with MS is generally considered to be associated with less risk thanspinal anesthesia; however, both have been used successfully in patients with MS.

Correct answer is A

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 2. Regional Anesthesia


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QUESTION

39. Which of the following agents is likely to produce the LONGEST seizure duration when usedto induce anesthesia for electroconvulsive therapy (ECT)?

A.

Methohexital

B.Etomidate

C.Propofol

D.Ketamine


A.Methohexital exerts little to no effect on seizure duration in patients receiving ECT.

C.In patients receiving ECT, propofol has been shown to shorten seizure duration significantly unlessgiven in subhypnotic doses.

D.Ketamine is associated with a significantly shortened seizure duration in patients receiving ECT.

Correct answer is B

Taxonomy

II.E. ADVANCED: Special Problems or Issues in Anesthesiology, 1. Electroconvulsive Therapy

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QUESTION

40. Which of the following is MOST likely to occur in a patient who develops a moderate sizedpulmonary embolism during surgery?

A. Increased dead space

B. Decreased peak inspiratory pressure

C. Bradycardia

D. Increased end-tidal carbon dioxide


B. Bronchospasm, associated with the release of serotonin and thromboxane A2 occurring as a resultof platelet activation, commonly produces an increase in peak inspiratory pressure in patients withpulmonary embolism.

C. Tachycardia is reported to occur in 71% of patients with pulmonary embolism.

D. Because end-tidal gas results from a mixture of gas from normal alveoli and from alveoli lackingperfusion as a result of the embolus, end-tidal carbon dioxide concentrations decrease withpulmonary embolism.

Correct answer is A

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QUESTION

41. A 63-year-old man is scheduled for video-assisted left lower lobe lobectomy for adenocarcinoma of the lung. He had a drug-eluting stent placed in his right coronary artery 5months ago. He currently takes daily clopidogrel and aspirin. The MOST appropriateperioperative management at this time is to

A. postpone the surgery for 1 month.

B. discontinue clopidogrel for 7 days prior to surgery.

C. discontinue both clopidogrel and aspirin for 7 days prior to surgery.

D. continue clopidogrel and aspirin throughout the perioperative period.


A. Elective procedures should be postponed if possible for 12 months following placement of a drug-eluting coronary stent. This case should proceed as the patient has lung cancer.

B. Clopidogrel and aspirin should be continued throughout the perioperative period in a patient with adrug-eluting stent in place for less than 12 months.

C. Clopidogrel and aspirin should be continued throughout the perioperative period in a patient with adrug-eluting stent in place for less than 12 months.

Correct answer is D

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QUESTION

42. A 65-year-old woman with a 100 pack-year history of tobacco use presents for acholecystectomy. Which of the following would be LEAST consistent with cor pulmonalesecondary to chronic obstructive pulmonary disease?

A. Lower extremity edema

B. Elevated pulmonary artery occlusion pressure

C. Jugular venous distension

D. Pulmonary arterial hypertension


A. Lower extremity edema is a sign of cor pulmonale.

C. Jugular venous distension is a sign of cor pulmonale.

D. Pulmonary arterial hypertension is a sign of cor pulmonale.

Correct answer is B

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QUESTION

43. Which of the following is MOST likely to indicate an increased risk in adult patients for perioperative adrenal insufficiency?

A. A high normal plasma preoperative cortisol level

B. Prednisone therapy consisting of 5 mg every other day for 3 doses

C. Testosterone therapy for andropause in men

D. A septic patient induced with etomidate


A. A high normal plasma cortisol level is not indicative of increased risk for adrenal insufficiency.

B. Short-term, low-dose, every-other-day glucocorticoid treatment does not increase the risk of adrenalinsufficiency.

C. Testosterone therapy for androgen deficiency does not increase the risk of adrenal insufficiency.

Correct answer is D

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QUESTION

44. Which statement about monitoring patients having surgery performed in the sitting positionis MOST likely true?

A. The circle of Willis is level with the external auditory meatus.

B. Approximately 90% of patients have an intact circle of Willis.

C.

Blood pressure measured in the lower extremity may be as much as 35 mm Hg higher than at theexternal auditory meatus.

D.

There is a 1.25 mm Hg decrease in blood pressure for each 1 cm height above the level at whichthe blood pressure is being measured.


A. In the sitting position, the base of the brain is commonly estimated to be level with the externalauditory meatus. In this position, the circle of Willis is more than 10 cm above the base of the brainand the external auditory meatus.

B. Autopsy studies show that more than 45% of the adult population has an incomplete circle of Willis.

D. There is approximately a 0.77 mm Hg decrease in blood pressure for each cm in height above thelevel at which the blood pressure is being measured.

Correct answer is C

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QUESTION

45. Which statement about malignant hyperthermia (MH) is MOST likely true?

A. The risk of MH is lower in children than in adults.

B. The first sign of an MH episode is an increase in temperature.C. The first dose of dantrolene is 5 mg/kg intravenously (IV).

D. Central core disease is clearly linked to MH.


A. The rate of MH reported in children is 1:3,000 to 1:15,000 anesthetics. The reported rate in adults is1 in 50,000 anesthetics.

B. The first sign of MH is tachypnea (if breathing spontaneously) or tachycardia. Hyperthermia isconsidered an intermediate sign.

C. Dantrolene dosing begins at 2.5 mg/kg IV.

Correct answer is D

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QUESTION

46. Which of the following abnormal movements is MOST likely to occur in children duringinduction with propofol?

A. Opisthotonus (an arching position exemplified by severe hyperextension of the back and neck)

B. Choreoathetoid movements

C. Generalized tonicâ #’clonic activity

D. Myoclonus


A. A few case reports describe opisthotonus after propofol administration.

B. Case reports of choreoathetoid movements are rare.

C. Tonicâ #’clonic seizure-like movements have been reported to occur in 5.5% of adult patients, rarely

in children. Electroencephalography-documented seizures are rare after propofol.

Correct answer is D

Taxonomy


II.D. ADVANCED: Clinical Subspecialties, 2. Pediatric Anesthesia

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QUESTION

47. A 78-year-old patient and his family report that he has had some difficulty concentrating andremembering things. He is scheduled for prostate surgery and states he may refuse to havethe surgery if it means he won’t “be himself” afterward. Which of the following statementsabout this situation is MOST likely true?

A. Delirium occurs in less than 2% of patients who are over 65 years.

B. Administration of a sedative will help prevent delirium.

C. Preexisting mild dementia does not increase the risk of postoperative cognitive change.

D. Preoperative treatment of cognitive impairment may decrease the risk of delirium.


A. Delirium is a serious postoperative complication occurring in 5% to 15% of elderly patients after general anesthesia and in up to 64% of elderly patients after total joint replacement under spinalanesthesia.

B. Risk factors for postoperative delirium include the use of central nervous system depressant drugs,particularly benzodiazepines.

C. Patients with preexisting cognitive disorders have a higher risk for postoperative cognitivecomplications than other patients. The most common complication is delirium, which occurs in about40% of elderly surgical patients with preexisting cognitive impairment.

Correct answer is D

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II.D. ADVANCED: Clinical Subspecialties, 11. Geriatric Anesthesia/Aging

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QUESTION

48. Which of the following medications is the MOST appropriate therapy for a patient withextrapyramidal symptoms associated with the administration of metoclopramide?

A. Flumazenil

B. Neostigmine

C. Physostigmine

D. Diphenhydramine


A. Flumazenil is a benzodiazepine antagonist and would not be expected to be effective in themanagement of extrapyramidal symptoms.

B. Neostigmine is an acetylcholinesterase inhibitor. Its administration results in an increase inacetylcholine and would not be expected to be effective in the management of extrapyramidal

symptoms.

C. Physostigmine is an acetylcholinesterase inhibitor. Its administration results in an increase inacetylcholine and would not be expected to be effective in the management of extrapyramidalsymptoms.

Correct answer is D

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QUESTION

49. According to the American Heart Association’s pediatric basic life support (BLS) guidelines,which of the following is the MOST appropriate first step in management for an unresponsiveand apneic pediatric patient?

A. Open the airway

B. Start chest compressions

C. Check for a pulse

D. Start rescue breathing


A. According to the BLS guidelines, opening the airway is not the first step in the management for anunresponsive and apneic pediatric patient.

B. According to the BLS guidelines, starting chest compressions is not the first step in the management

for an unresponsive and apneic pediatric patient.

D. According to the BLS guidelines, starting rescue breathing is not the first step in the management for an unresponsive and apneic pediatric patient.

Correct answer is C

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QUESTION

50. A 62-year-old man with a 30 pack-year history of smoking presents with a chronic cough andoccasional blood-tinged sputum. A computed tomography scan of the thorax revealsmediastinal lymphadenopathy and a right upper lobe lesion. The patient is scheduled for adiagnostic mediastinoscopy with lymph node biopsy. Which of the following would beconsidered the MOST appropriate site for an arterial line placement to quickly detectcompression caused by the mediastinoscope during this procedure?

A. Left lower extremity

B. Right upper extremity

C. Left upper extremity

D. Right lower extremity


A. The left lower extremity would not be the most appropriate site for placement of an arterial line.

C. The left upper extremity would not be the most appropriate site for placement of an arterial line.

D. The right lower extremity would not be the most appropriate site for placement of an arterial line.

Correct answer is B

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QUESTION

51. A 67-year-old man with adenocarcinoma of the lung is scheduled for a thoracotomy and rightupper lobectomy. Which of the following preoperative values is MOST predictive of postoperative pulmonary complications?

A.Maximal oxygen consumption (V $ O2max) = 10 mL • kg

–1 • min –1

B.Diffusing capacity of the lung for carbon monoxide (DLCO) = 80% of predicted

C.PaCO2 = 40 mm Hg

D.FEV1 = 80% of predicted


B.Predicted postoperative DLCO less than 40% is predictive of perioperative, but not long-term,

mortality. Resection of only the right upper lobe should not decrease DLCO to less than 40% of

predicted from a preoperative value of 80% of predicted.

C. A preoperative PaCO2 level greater than 60 mm Hg has been a traditional cutoff for pulmonary

resection. However, alone, it is not a sensitive predictor of perioperative complications.

D. An FEV1 less than 40% is predictive of perioperative respiratory complications.

Correct answer is A

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QUESTION

52. Which of the following drugs is MOST likely safe in a patient with acute intermittentporphyria?

A. Etomidate

B. Succinylcholine

C. Ketorolac

D. Methohexital


A. Etomidate is listed as being unsafe in patients with acute intermittent porphyria.

C. Ketorolac is listed as being possibly porphyrogenic.

D. Methohexital is listed as being unsafe in patients with acute intermittent porphyria.

Correct answer is B

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QUESTION

53. You are called to the magnetic resonance imaging (MRI) suite to assist with managing apatient who has experienced a cardiac arrest that has occurred inside the scanner. Which of the following pieces of equipment is MOST likely safe to bring into the MRI room?

A. Defibrillator

B. Video laryngoscope

C. Laryngeal mask airway

D. Standard code cart


A. The use of a defibrillator is not safe inside the MRI environment.

B. The use of a video laryngoscope is not safe inside the MRI environment.

D. The use of a code cart is not safe inside the MRI environment.

Correct answer is C

Taxonomy

II.E. ADVANCED: Special Problems or Issues in Anesthesiology, 3. Radiologic Procedures; CT Scan; MRI- Anesthetic Implications/Management, Anesthesia in Locations Outside the Operating Rooms

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QUESTION

54. When performing a single injection, large volume (>15 mL) thoracic paravertebral block,which of the following complications is MOST likely to occur?

A. Nausea and vomiting

B. Neuraxial spread of the solution

C. Hypotension

D. Pneumothorax


A. Nausea and vomiting occurs in up to 17% of patients receiving a paravertebral block but is not themost likely to occur.

C. Hypotension occurs in approximately 4% of patients receiving a thoracic paravertebral block withoutneuraxial spread and in only a portion of those who experience a neuraxial spread.

D. Pneumothorax has been reported to occur in up to 0.5% of patients receiving a thoracicparavertebral block.

Correct answer is B

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QUESTION

55. In managing perioperative opioid withdrawal in a patient with anxiety, muscle aches,insomnia, runny nose, sweating, nausea, and vomiting, the BEST approach would be toadminister

A.regional anesthesia.

B.a mu receptor agonist.

C.N -methyl-D-aspartate (NMDA) receptor antagonists.

D."-antagonists.


A.Regional anesthesia can be used to treat perioperative surgical pain, but it does not treat opioidwithdrawal.

C. Administration of NMDA receptor antagonists may be beneficial in perioperative pain managementbut is ineffective in treating withdrawal symptoms.

D. Administration of "-antagonists may be beneficial in perioperative pain management but is

ineffective in treating withdrawal symptoms.

Correct answer is B

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QUESTION

56. Which statement about carcinoid syndrome in a patient with a carcinoid tumor is MOST likelytrue?

A. Over half of all patients with carcinoid tumor will develop carcinoid syndrome.

B.

In patients with an isolated tumor, the risk of developing carcinoid syndrome is greater in thosepatients with rectal tumors than those with ovarian tumors.

C.

Less than half of all patients with carcinoid tumor will develop cardiac manifestations of carcinoidsyndrome.

D. Bronchoconstriction is the most common manifestation of carcinoid syndrome.


A. Carcinoid syndrome occurs in only about 20% of patients with carcinoid tumors.

B. In patients with carcinoid tumor of the small bowel, development of carcinoid syndrome is commonly

associated with the development of hepatic metastases. Isolated ovarian and intrathoracic tumorscause carcinoid syndrome. Rectal tumors are rarely associated with development of carcinoidsyndrome.

D. Although bronchospasm may occur, it is less common than flushing, diarrhea, and right-sided heartdisease that constitute carcinoid syndrome.

Correct answer is C

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QUESTION

57. Which of the following is MOST likely to be an anesthetic management consideration in apatient with systemic lupus erythematosus (SLE)?

A. Atlantoaxial subluxation

B. Obstructive pulmonary disease

C. Pituitary hyperactivity

D. Tracheomalacia


B. Lupus patients have a restrictive pulmonary disease.

C. Pituitary hyperactivity is not associated with SLE.

D. Patients with SLE tend to acquire subglottic stenosis, not tracheomalacia.

Correct answer is A

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QUESTION

58. Which of the following is MOST likely to be present in a patient with Lambert–Eatonmyasthenic syndrome (LEMS)?

A.

Resistance to depolarizing neuromuscular blocking agents

B. Autonomic dysfunction

C.Resistance to nondepolarizing neuromuscular blocking agents

D.Decreased strength with repetitive activity


A.Patients with LEMS have increased sensitivity to depolarizing neuromuscular blocking agents.

C.Patients with LEMS have increased sensitivity to nondepolarizing neuromuscular blocking agents.

D.Patients with LEMS exhibit increased strength with repetitive activity.

Correct answer is B

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QUESTION

59. Which of the following statements about local anesthetics is MOST likely true?

A. Amino esters are eliminated primarily via hepatic transformation.

B. Local anesthetics with a low pK

a have the longest duration of block.

C. Increased lipid solubility is associated with increased potency.

D.

When applied to a peripheral nerve, the addition of epinephrine results in a shortened time toonset of block.


A. Amino esters are primarily hydrolyzed by plasma cholinesterase within the blood.

B. Local anesthetics with the lowest pK a are associated with the most rapid onset but not a longer

duration of block.

D. When applied to a peripheral nerve, the addition of epinephrine is not associated with a shortenedtime to onset of block but is associated with increased block intensity, prolonged duration of block,and decreased systemic absorption of local anesthetic.

Correct answer is C

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QUESTION

60. (9B-53) A 44-year-old woman underwent insertion of a biventricular implantable cardioverter defibrillator (ICD) for idiopathic cardiomyopathy. This was performed under monitoredanesthesia care with propofol and fentanyl. Vital signs at the end of the procedure includedheart rate 75 beats/min, blood pressure 105/72 mm Hg, SaO2 98% on 2L O2 via nasal cannula

(NC). One hour postoperatively, she is noted to be anxious and has the following vital signs:sinus tachycardia at 130 beats/min, blood pressure 68/45 mm Hg, SaO2 89% on 2L O2 NC.

Which of the following would be the MOST appropriate immediate management step for thispatient?

A. Place a magnet over the ICD.

B. Obtain a transthoracic echocardiogram.

C. Perform coronary angiography.

D. Obtain a chest computed tomography (CT) scan.


A. Placing a magnet on modern ICDs will disable the antitachycardia therapies and is not warranted atthis time.

C. After ICD placement, a different diagnostic procedure should be performed prior to coronaryangiography to rule out cardiac tamponade.

D. Chest CT is a sensitive test but is more time consuming than another option to rule out cardiactamponade.

Correct answer is B

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QUESTION

61. Compared to a regimen that involves opioids alone for the treatment of postoperative pain,administration of nonsteroidal antiinflammatory drugs (NSAIDs) in conjunction with opioidsis MOST likely to result in which of the following?

A. Increased sedation

B. Reduced nausea

C. Reduced hepatic function

D. Increased hallucinations


A. A regimen that involves the use of NSAIDs in conjunction with opioids is associated with asignificantly decreased risk of sedation compared with use of opioids alone.

C. Perioperative administration of NSAIDs is not associated with hepatic dysfunction.

D. Perioperative administration of NSAIDs is not associated with an increased rate of postoperativehallucinations.

Correct answer is B

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QUESTION

62. A patient is undergoing electroencephalographic (EEG) monitoring during a carotidendarterectomy performed under general anesthesia. Which of the following EEG changes isMOST consistent with severe cerebral ischemia?

A. Increased amplitude

B. Increased presence of fast frequencies

C. Preservation of amplitude

D. Loss of amplitude


A. EEG amplitude is not increased in the presence of severe cerebral ischemia.

B. Severe ischemia causes an increase in theta waves (slow frequency waves) on EEG.

C. EEG amplitude is not maintained in the presence of severe cerebral ischemia.

Correct answer is D

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QUESTION

63. A transesophageal echocardiogram (TEE) is obtained in the transgastric mid short-axis view.The left ventricle (LV) wall designated by the arrow is MOST likely supplied by which of thefollowing coronary arteries?

A. Left circumflex

B. Obtuse marginal

C. Left anterior descending

D. Right coronary


A. The arrow shown in the TEE is pointing to the septal wall of the left ventricle. The circumflex arterysupplies the lateral and inferolateral or posterior walls of the left ventricle.

B. The arrow shown in the TEE is pointing to the septal wall of the left ventricle. The obtuse marginalartery, a branch of the circumflex artery, supplies the lateral and inferolateral walls of the leftventricle.

D. The arrow shown in the TEE is pointing to the septal wall of the left ventricle. The right coronaryartery supplies the right ventricle and inferior wall of the left ventricle.

Correct answer is C

Taxonomy


http://mycmecredit.com/ASA/ACEonline/showMedia.php?medianame=Q063F01

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QUESTION

64. Based on the American Society of Anesthesiologists (ASA) definitions, which of the followingcharacteristics BEST describes patients in a state of deep sedation?

A. No airway intervention is required.

B. Spontaneous ventilation is frequently inadequate.

C. Cardiovascular function is commonly impaired.

D. Responsiveness is only purposeful following repeated or painful stimulation.


A. This describes a patient under moderate or lighter sedation.

B. This describes a patient under general anesthesia.

C. This does not describe a patient experiencing deep sedation; impaired cardiovascular function is anindication of general anesthesia.

Correct answer is D

Taxonomy

I.B. BASIC: Clinical Sciences: Anesthesia Procedures, Methods, and Techniques, 4. Monitored AnesthesiaCare and Sedation: ASA Guidelines for Sedation, Sedation Guidelines for Non-Anesthesiologists

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QUESTION

65. Which of the following is MOST likely included among the diagnostic criteria for obesityhypoventilation syndrome (OHS)?

A.Central obesity

B. Awake hypercapnia (PaCO2 > 45 mm Hg)

C.Presence of obstructive sleep apnea (OSA)

D.Normal polysomnography findings


A.

Although the diagnosis of OHS requires a body mass index greater than 30 kg/m2, the specificdistribution of obesity is not a requirement for the diagnosis.

C.OSA is frequently found in patients with OHS, but it is not a requirement for the diagnosis.

D.Polysomnography findings are abnormal and include hypoventilation with nocturnal hypercapnia.

Correct answer is B

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Taxonomy


II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 4. Gastrointestinal / Hepatic Systems

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QUESTION

66. A patient with a carboxyhemoglobin concentration of 25% is MOST likely to have which of thefollowing?

A. Nausea

B. Coma

C. Cardiac dysrhythmias

D. Cherry-red colored blood


B. Patients with carbon monoxide poisoning generally do not become comatose unless thecarboxyhemoglobin concentration is greater than 40%.

C. Patients with carbon monoxide poisoning generally do not develop cardiac dysrhythmias unless thecarboxyhemoglobin concentration is greater than 40%.

D. Patients with carbon monoxide poisoning generally do not develop cherry-red colored blood unlessthe carboxyhemoglobin concentration is greater than 40%.

Correct answer is A

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QUESTION

67. Which of the following BEST describes the purpose of having isolated electrical power in theoperating room (OR)?

A. It minimizes the risk of microshock.

B. It eliminates the need to have equipment with a 3-prong grounded plug.

C. It minimizes the risk of macroshock.

D. It provides uninterruptible power to the OR.


A. An isolated power supply does not provide protection against microshock.

B. An isolated power supply does not eliminate the need to have 3-prong grounded plugs in the OR.

D. An isolated power supply does not provide uninterruptible power to the OR.

Correct answer is C

Taxonomy

I.A. BASIC: Basic Sciences, 2. Physics, Monitoring, and Anesthesia Delivery Devices


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QUESTION

68. Which of the following is MOST likely to increase the risk of perioperative corneal abrasion?

A. Regional rather than general anesthesia

B. Case duration less than 90 minutesC. Procedure involving the foot rather than the head and neck

D. Preexisting proptosis


A. The risk of corneal abrasion is higher in patients undergoing general anesthesia.

B. The risk of corneal abrasion is higher in patients undergoing longer procedures.

C. The risk of corneal abrasion is higher in patients undergoing head and neck procedures.

Correct answer is D

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QUESTION

69. You are caring for a patient who has suffered an aneurysmal subarachnoid hemorrhage(SAH). Which statement about this patient is MOST likely true?

A. Hypothermia during surgery improves outcome.

B. Delayed cerebral ischemia, if it occurs, usually occurs 3 to 14 days after SAH.

C. Barbiturate coma should be routinely instituted.

D. Diltiazem is the only pharmacologic agent shown to improve outcome.


A. Hypothermia during surgery does not improve outcome.

C. Barbiturate coma may be indicated for the treatment of refractory status epilepticus but is notroutinely indicated for treatment of SAH.

D. Nimodipine is the only pharmacologic agent shown to improve outcome.

Correct answer is B

Taxonomy


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QUESTION

70. Which statement about a spontaneously breathing patient anesthetized with only an inhaledanesthetic agent at 1.5 minimum alveolar concentration is MOST likely true?

A.

All inhaled anesthetic agents cause an increase in tidal volume.

B. All inhaled anesthetic agents increase laryngeal irritant receptor sensitivity.

C. All inhaled anesthetic agents cause a decrease in respiratory rate.

D. A patient receiving desflurane will have a lower PaCO2 than a patient receiving sevoflurane.


A. All inhaled anesthetic agents cause a decrease in tidal volume.

C.Isoflurane increases respiratory rate.

D.Desflurane produces a higher PaCO2 than sevoflurane.

Correct answer is B

Taxonomy



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QUESTION

71. Which of the following is MOST likely to be removed in the pulmonary circulation?

A. Epinephrine

B. DopamineC. Norepinephrine

D. Isoproterenol


A. Epinephrine is not eliminated by the pulmonary circulation.

B. Dopamine is not eliminated by the pulmonary circulation.

D. Isoproterenol is not eliminated by the pulmonary circulation.

Correct answer is C

Taxonomy


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QUESTION

72. Which of the following is the PRIMARY afferent nerve involved in the laryngeal closure reflexduring laryngospasm?

A. Glossopharyngeal

B. Superior laryngeal

C. Trigeminal

D. Recurrent laryngeal


A. The glossopharyngeal nerve is the primary afferent nerve for stimuli in the oropharynx andhypopharynx. While stimulus of the glossopharyngeal nerve may contribute to laryngospasm, it is notthe primary afferent nerve involved in the laryngeal closure reflex.

C. The trigeminal nerve is the primary afferent nerve for stimuli in the nasopharynx. While stimulus of

the trigeminal nerve may contribute to laryngospasm, it is not the primary afferent nerve involved inthe laryngeal closure reflex.

D. The recurrent laryngeal nerve is the primary efferent nerve for laryngeal closure duringlaryngospasm.

Correct answer is B

Taxonomy



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QUESTION

73. Which of the following is MOST likely to occur in a patient with severe hypophosphatemia(serum phosphate level < 1.0 mg/dL)?

A. Muscle weakness

B. Seizures

C. Prolonged QT interval

D. Bronchospasm


B. The central nervous system manifestations of hypophosphatemia include altered mental status, gaitdisturbances, and paresthesias. Seizures occur in conjunction with hyperphosphatemia.

C. The cardiovascular manifestations of hypophosphatemia include decreased myocardial contractilityand, if longstanding, cardiomyopathy. Prolonged QT interval occurs as a result of hypocalcemia,

which is caused by hyperphosphatemia.

D. The primary ventilatory consequence of hypophosphatemia is muscle weakness, which may besufficiently severe as to result in acute respiratory failure. Bronchospasm occurs as a result of hypocalcemia, which is caused by hyperphosphatemia.

Correct answer is A

Taxonomy

I.C. BASIC: Organ-based Basic and Clinical Sciences, 5. Renal and Urinary Systems/ Electrolyte Balance

II.C. ADVANCED: Organ-based Basic and Clinical Sciences, 5. Renal and Urinary Systems/ ElectrolyteBalance

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QUESTION

74. Which of the following is MOST likely to cause development of acquired von Willebrandsyndrome (aVWS)?

A. Plasmapheresis

B. Severe aortic insufficiency

C. Hyperthyroidism

D. Presence of a nonpulsatile left ventricular assist device


A. Plasmapheresis is one of the recommended forms of therapy for aVWS.

B. Severe aortic stenosis, not aortic insufficiency, has been associated with aVWS (likely because of the high shear stress to which the blood and major vasculature are exposed).

C. Hypothyroidism, not hyperthyroidism, has been associated with decreased production anddecreased storage of von Willebrand factor, leading to aVWS.

Correct answer is D

Taxonomy


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QUESTION

75. Which of the following is MOST likely to be increased 30 minutes after a subject accustomedto living at sea level rapidly ascends to an altitude of 8,000 feet?

A.

Partial pressure of carbon dioxide in the alveolus (PaCO2)

B.Partial pressure of oxygen in arterial blood (PaO2)

C.Minute ventilation

D.Partial pressure of oxygen at which hemoglobin is 50% saturated (P50)


A. Abrupt ascent to a higher altitude causes an increased ventilatory drive with an initial phase of hyperventilation resulting in a decrease in the PaCO2.

B.Increased altitude is associated with decreased barometric pressure that results in decreased PaO2.

D.The acute respiratory alkalosis occurring as a result of ascent to a higher altitude results in a leftwardshift of the oxyhemoglobin dissociation curve that is reflected in a decreased P50.

Correct answer is C

Taxonomy


II.B. ADVANCED: Clinical Sciences (Procedures, Methods, Techniques), 2. Special Techniques

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QUESTION

76. Which of the following agents is MOST likely to produce bronchoconstriction in the parturientwith reactive airway disease?

A. Methylergonovine (Methergine)

B. Carboprost tromethamine (Hemabate)

C. Oxytocin (Pitocin)

D. Terbutaline (Brethine)


A. Methylergonovine can precipitate hypertension rather than bronchoconstriction.

C. Oxytocin is associated with hypotension, not bronchoconstriction, when administered in bolus doses.

D. Terbutaline is not associated with bronchoconstriction.

Correct answer is B

Taxonomy


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QUESTION

77. A patient receiving chronic lithium therapy for treatment of bipolar disorder is MOST likely tobe at increased risk for developing which of the following?

A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

B. Hypothyroidism

C. Peaked T waves on an electrocardiogram (ECG)

D. Leukopenia


A. Up to 20% of patients on lithium therapy develop nephrogenic diabetes insipidus; they are not at riskfor developing SIADH.

C. Patients receiving chronic lithium therapy commonly manifest flattened T waves on ECG; they arenot at increased risk for the development of peaked T waves.

D. Patients on chronic lithium therapy have been reported to develop a leukocytosis with white bloodcell counts as high as 14,000/mm3 attributed solely to lithium.

Correct answer is B

Taxonomy


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QUESTION

78. A 55-year-old alcoholic experiences arterial desaturation when standing that improves whensupine. Which process is MOST likely to be responsible for this phenomenon?

A. Chronic pulmonary emboli

B. Splenorenal shunting

C. Portopulmonary hypertension

D. Hepatopulmonary syndrome


A. While chronic pulmonary emboli can lead to both chronic hypoxemia and pulmonary hypertension,they are not the most likely cause of positional hypoxemia in this patient.

B. Creation of a splenorenal shunt is employed to relieve portal hypertension; it does not explain thepositional hypoxia in this patient.

C. Portopulmonary hypertension is defined as the presence of otherwise idiopathic pulmonaryhypertension in a patient with portal

ACE 2014 11A Q_A

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