Medtext 2007 a-Type Questions

Anesthesia Practice Questions 2007

cC' (()(/;/('J 6J

lisa M. Councilman-Gonzales, MD

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A '17-yedl-o lci f,;male w llll a PClst medical history of hypertension and diabetes mell itus pI escnts to thf: operating room for a cholecystectomy having taken her morning doses of rneloprolol , caplopnl, and half of I,er usuai dOSE of NPH insulin. Following a standard induction Wltll propofol, felltanyl, and rocuroil lum, the patient develops hypotension th at is refrdctmy to phenyiephrine.

WC1l(:h of the following dl'ugs wou ld MOST likely be effective in this situation7

A) Dopamil){-:~

S) flobutarn ifl l" C) DeXdrnethasorJC':: D) Glucagon E) V<)sopress lli

VVh lch of t ile follow ill9 stateil len ts are TRU E regarding ad enosine?

A) ~l ay be Ineffective in patients taking metll ylxanthlnes (theophyl line) B) It is lIsefu l in conve rtjnq atrial fl utter to normal sinus rhythm C) Significan tly higher d05~;:S must be used in patients receiving dipyridamole D) Peak drug "ffeet occurs at 3 minutes E) Is Ineffecti ve III Wolff,Parki nson -Wh ite Syndrome

A eI7-year-old male with severe hypertrophlc card iomyopathy presents for an emergent appendectomy. Preoperative blood pressu re is 100/67 mmHg with a heart rate of 70 beats PC I- minute.

An appropriate al1esthetlc pl,, " may include all of the following drugs EXCEPT:

A) l'lalothane B) l'1etoproiol C) ~lllnl1()ne

D) Phenylepllnl1e E) Sulenlil nil

'I. A.II of tile fo llowlOCI [I rugs Jre phosphod iesterase InhlbitOl's EXCEPT :

A) 5,l denafil B) Aminophylline C) Iv1il ,, " one D) Hyrt ra lazine C) Amrinorle

7/lI:'; mall .. 'fl.11 m.Jy flll( IA'lfupltCJILV (){ used /{I an ecfl/Cilltonaf cmllfonmell[ without writtell permission from the publisher. Copyrigllt~) 2nn !, All ){i ~j hlS );: es t'lv t2 ci 1Y1edtext i"!edical World, Inc.

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Anesthesia Practice Questio-"n",s,-: "'20-"0:'7 ___ _ _

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A-Type Queslrons (Single Best Answer)

A 67-year-ol d male arrives to the post-anesthesia care unit following" cholecystectomy . He is shive ring and has a temperature of 35° Celsius . His heart rate is 130 beats per minute, blood pressure is 230/110 mmHg, oxygen saturation is 97%, and ECG monitor shows ST elevations.

What is the BEST first tre"tment7

A) Metoprolol 5 m9 IV B) Forced air warming blanket C) Demerol 25 mg IV 0) Oxygen 2 liters per minute via nasa l cannu la E) Morphine 5 mg IV

A 23-year-old, Type A, Rh -negative, male is transferred to the operating room for removal of a fractu red spleen following a motor vehicle accident. Vital signs include a blood pressure of 90/65 mmHg, a heart rate of 128 beats/minute, and an oxygen saturation of 92% by face mask with 6 liters of oxygen per minute. Upon incis ion of the peritoneum, 1100 ml of sudden blood loss occurs .

Which of the fo llowing blood products is the MOST appropnate tor administration at this time?

A) Type O-negative whole blood B) Fresh frozen plasma C) Type A-negative platelets 0) Type A-positive packed red blood cells E) Type O-negative packed red blood cells

All of the following antibiotics may potentiate nondepolarizing neuromuscu lar blocking drugs EXCEPT?

A) Cefazo lin B) Clindamycin C) Gentamycin 0' I Bacitracin E) Amikacin

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/I.nes th_f::s ia Pructl ce QU~~UOIlS: 2007

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A-Type Questions (S ingle Best Answer)

A 2-year-old boy wlll, a history of tetralogy of Fallot 15 to undergo a general anesthetic for bi ldlE'ra l myringotomy with lube placements. He is noted to be cyanotic in the holding area pl coperatively .

Prirnary int(~ rven tion s ror the trCJtmen t of a "te t spell" include al l of the fol lowing EXCEPT:

A) Valsa lva maneuver B) fJheny lephnne C) OXY~Jcll D) I lypervel1t llatlon E) Intravenous flu id bolus

WI,l ch of the fol lowing combinations are the main determinants of (1) right ventricular perfusion, and (2) left venlrlcu lar subendocardial perfusion)

A) (l) diastolic arteria l pressure, (2) mean arterial pressure B) (I) mean altenal pressu re, (2) cl iastollc arterial pressure C) (1) diastolic arterial pressu re, (2) systolic arterial pressure D) (1) pulmonary artery diastolic pressure (2) diastolic arterial pressure E) (1) systolic artenal pressure, (2) mean arterial pressure

Five Illinules dfter completion of a sp ina l anestlletic for an elective cesarean section, the jJJtient's fJloocl pressure decreases to 85/60 mmHg. The patient is treated with ephedrine 10 m~1 int l-aven olls.

f he PRIMARY rllechanisll1 by which ephedrine increases uterine blood flow in this scenario IS

A) Positive inotropy B) VClloconstriction C) Positive chronotropy D) I ncreclse ill sys temic vascu lar resista nce E) Uterine artery dilation

A '17-year-olcl lTIale IS scl.eduled for a transurethral resection of a bladder tumor: He quit smoking four days ago . Which of the fo llOWing benefiCia l effects of smoking cessation Will be seen at th is lime7

A) A lel't shift of tloe oxyllemog lobin dissociation curve 8) Norma l immune function C) Improved pulmonary function tests D) Decreasecl sputum production E) NOI-mal r al-boxyhemoglobin levels

-n-;;;-;;;·-;;;~;;-;,~;y flot 1J~-d~;licated or used IfI an cd~·cation-;i er7VIronment without written permission from.the publisher. COpy;i9h l: «(;) 2LJ07, All Rigllts Reserved Medtext fvled lcal World, Inc.

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Anesthesia Practice Questions: 2007

A-Type Questions (Single Best Answe-r)

12. Which of th e fo llowing are true statements reg ard ing Guillain-Barre syndrome (GBS)?

A) Symptoms are most often preceded by an infectious syndrome with staphylococclls au reus.

B) Corticosteroids have been shown to be beneficia l. C) Orthostatic hypotension and bradyarrhythmias are frequent complications of

GBS. D) Respiratory failure occurs at initial presentation in 60% of patients. E) Intravenous immunoglobu lin has not been shown to be helpful.

13. Which of the fo llowing are abso lute contra indications to tra nsesophageal echocardiography7

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A) Esophageal stricture B) Esophageal varices C) Coagulopathy D) History of dysphagia E) History of radiation to the mediastinum

A 68-year-old ma le is undergoing an elective abdomina! aortic aneurysm resection under general anesthesia. The fo llowing radial arterial wave form is noted :

1,}i),--H---+-I7-"---l--\-----I--l--_

~c------__________________________ _

Wh ich of the following wou ld exp lain this waveform7

A) High compliance arteria l line tu bing B) Bubbles in the arteriai line tubing C) An 18 gauge catheter used for the arterial line D) Hyperviscosity of arte rial blood E) Arterial line transducer above the level of the right atrium

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~n~'sttles~~~~~~ __ g~~_~;~~]~_~ 2q~~ _

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A-Type Qu~stion5 (Single Best Answer)

Blood concentrat lorlS lollowing allsorption of local anesthetics associated with regio nal ,,,,esthetlc techn iques vary from hlgllest to lowest in Wllich of the following orders?

f\) Inte l'Costdl nerve block > Ca uejal block> Epidural block B) Cauda l block> Sciatic nerve block > Brachia l plexus nerve block C) In tercosta l nerve block > Epiciural blocl< > Paracervica l block ll) Caudul block;. Brachia l plexus nerve block> Epiciural block E) Pclf-accrvicJ I bloCk > Sciat ic nerve block> Epid ural block

A 41 yeclHJle) )-e rnale arrives in the post-anesthesia care un it fo llowing an uneventful chol ecystectomy. She com plains of right eye pain , learinCJ, and ph otophobia. All of the 1U\ I ( Jwi n ~J 21re appropriate ;nitial stE'PS EXCEPT:

A) Ophthalmology co nsultation B) Top ical steroids ilpplled to COI'I',ea C) Eye patch I)) Ophthalm iC an tib iotic ointml'nt c) Huoresc ien up ilthJ lmic d roops

1.7 A 4-yea r~ol d boy with <J ventricul,,, septal defect IS about to lJnd el~go a tonsil lectomy and {} fl el lO!r1ecto rn y ullrJc'r genera l anesthesia. An inllClJation induction wi th sevoflu rane is nlclll lled.

Wila t is the i:lnLICipoleo effecl on tile inhalation induction in this child compared to a healthy CJI I!cP

,6. ) Decreased speed of induction 8) Increased speed of induction C) No siCj niflca nt change in speed of induct ion LJ) Inlt rally slower speed II I Induction fol lowed by an increase In speed of induction E) Initial ly fasler speeci of Induction followed by a decrease in speed of induction

Ie. WJ 1iI:I I of tile tallowin,) patients has the Inwest predicted minimum alveolar concentration ( fYIAC) of inha led anesthetics va lue')

A) J\ nongravicJ 25-year-old woman U) A gravid 2S-yea r--o ld woman C) A 6-InontJr-old boy LJ) A 16 year-old boy E) A 'I O-yeJ I 'olcj man

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Anesthesia Practice Questions : 2007

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A 42-year-old fema le with a history of chronic hypertension is post-operative day one following an uneventfu l to tal abdomina l hysterectomy. She has had only 200 ml of urine output in the last twenty-fou r hours .

Which of the fo llowing lab resu lts wou ld be associated with a pre-rena l etiology of the oliguria7

A) Serum sodium < 130 mEq/ liter B) Urine sodium > 40 mEq/li ter C) BUN/creatinine ratio < 10 D) Fractional excret ion of sod ium < 1 O/u

E) Urine osmolarity < 350 mOsm/ li ter

All of th e fo llowing medications work primaril y by affecli ng GABA receptors EXCEPT:

A) Etomidate B) Ketamine C) Thiopental D) Midazolam E) Propofo l

A l8-yea r-old male with Parkinson's disease, treated with levodopa-carbidopa, undergoes a cystoscopy and transurethra l resection of a bladder tumor under general anesthesia . He

. awakens in the post-anesthesia ca l~e unit and camplaills of nausea .

Which of the fol lowing medications ca n be used safely to treat nausea in this patient)

A) Droperidol B) Metoclopramide C) Promethazine D) Ondansetron E) Prochlorperazine

A 42-year-old woman presents to the chronic pa in c linic w ith com plaints of fatigue/ generalized weakness, and du ll, acll ing pain in I-, el~ neCk, siloulders, and back. On physical examination the patient is noted to have discrete painful areas in her back, neck, and on both upper extremities without rad iation of the pa in . Laboratory studies are normal.

The MOST likely diagnosis in this patient is :

A) Rheu matoid arthritis 6) Polymyalgia Rheumatica C) Fibromya lgia D) Mera lgia Paresthetica E) Complex Regional Pain Syndrome Type r

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Anesthesia Practice Out'stions: 2007

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~ ~-~e~estion s (Single Best Answer)

A 2-week -olcl premature infant is undergoing ligation of a patent ductus arteriosus ligation under general anesthesia . The recurrent laryngeal nerve is inadvertently severed during the procedure

WI-lich of the fo ll owing findings wou ld be present under direct laryngoscopy'

A) Left vocal cord paramedian position B) Right voca l cord parameclian position C) Left vocal cord abducted 0) Rig llt vocal col·d abducted E) Bilatel·a l vocal cord abduct ion

2~ . A one-clily -old infant IS discovered to have a left-sided congenital diaphragmatic hernia . On chest auscultation, heart sounds are heard over the right thorax.

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All of the follOWi ng trea tments may be instituted EXCEPT:

A) Maintenance 01 PaCO, < ~5 rnml-lg B) Placemen t of a nasogastric tube C) Intubate anel ventilate with high frequency Jet ventila tion D) Intubate and use of high positive end-expiratory pressure to reexpand the left

lung E) Vcn til(ltioll w ith extracorporea l membrane oxygenation

A 47-year-Old tnel le undergoes cOfnplex instrumentation of t he upper th orac ic spine in the prone posi t ion employing Mayfie ld tongs for head positioning . Controlled hypotension uSing a soclium IlItroprLlsside infusion is employed to min imize blood loss. Surgical t ime is six hours and esti mated blood loss IS 2200 mL. Blood loss is replaced with eight liters of crystal loid solution, 500 011 of Il etastarch solution, and two units of cell -saver blood . Post-operative hemog lobin is B.I g/cIL. Upon awakening, the patient complains of vision loss bilaterally.

What is til e M OST like ly diagnOSIs?

A) Opl:ic chiasm hematoma B) Cortical blindness C) Central retinal artery occlusion 0) Eml)ollc stroke E) i sche ill ia of the optic nerve

Tlii:; {/Ji:l tr..'riai may flot {}e dup(ll:iJ red or (1)(;.,(/ in an eCfucaCiOflaf t"nvlronmen( WIt/lOut written permission from the publisher. COPYrigh t (~) 2007, All I<ight~, Reserved Medtext Medical World, Inc.

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Anesthesia Practice Questions: Z007

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A-Type Questions (Single Best Answer)

A 33 -year-old male with a history of Five previous back surgeries and high dose ~PiOid use is referred to the pa in clinic for evaluation for suspicion of opioid addiction.

Addiction is BEST described as:

A) A physiological phenomenon of withdrawal symptoms following abrupt discontinuation of a drug

B) A reduced effect of a drug following repeated doses C) Frequent visits to health care providers with complaints of inadequate pain re lief 0) A compulsive use of a substance that results in harm to an individual and

continued use despite the negative consequences E) The presence of wi thdrawal symptoms upon administralion of an antagonist drug

such as na loxone

A nurse accidentally deflates the tourniquet five minutes fo llowing an intravenous regiona l anesthetic in the left upper arm using 50 mL of 0.5% lidocaine. -

Ail of the following are appropria te in itial meaSUIes EXCEPT: A) Reinflation of the tou rn iquet to the previous pressure B) Administration of oxygen C) Administration of a benzodiazepine 0) Administration of sodium thiopental E) Application of a CNS monitor

Appm priate precautions for Il clping to insure an adequate intravenous regiona l anesthetic include all of the fo llowing EXCEPT :

A) Infiation of the tourniquet to 300 mml-l9 B) Using an epinephrine-containing loca l anestlletic solution C) Feel ing for an absent radial artery pu lse fo llowing inflation of the tourniquet 0) Using a double tourniquet E) Exsanguination of t ile ai m with an eiastic bandage prior to in flation of the

tourniquet

One minute post-delivery, a 4 kg newborn's artel ia l blood gases on room air are pH 7 .20, PaO,70, PaCO, 48 .

The BEST course of action is:

A) Admin istration of oxygen by face mask B) Bag-valve-mask ventilation with 100% oxygen C) Administration of sodium bicarbonate D) R.outine neonatal care E) Intubate the trachea

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Que:',tiuns (Single Best Answer)

A pati ent is post-operative day 3 from a total knee replacement with an epidural for postoperative pain management . Upon rernoval of the epidural ca theterl 2 cm is noted to be 11 1">51119 from tile lip of tile catlleter.

Wilat. IS ti le MOST appropria te step at tll is tl me7

A) Observation and r-eassurance B) Obta in STAT myelogra rn C) Obtain STAT lumbar spi nE MRJ D) Obtai!1 STf\T neuro logy Cor15Ult E) Surg ical removal of catheter tip

External elr-:'ctri c;: !1 imerfcl-ence wi th implanted defibr illator function may be expected with all these electrica l devlcc,,; or eiectrrca l devi ces used in the following procedures EXCEPT:

A) Magnetic resonance imager (MRI) B) Electrocautery C) i:lectroconvulslve IIlerapy D) Ra diation therapy E) Rad io frequency abla ti on

Megaloblastic hematopoiesis occurs Wi th long-term administration (> 12 hours) of which of the follow irrg agerr ts'

A) Nitrous oxide fJ) NltropllisslCle C) Nitrocllycerrne D) Nitric oxide [) 1~ l trofurantOli1

A 47 -yea r-old female presents for resection of an ovarian t umor. Her symptoms include flustlif19, bmnchoconstrlctiOrl l and dia rrhea .

Prf--.:ope r-ative edlOCCH'clio~Faphic fi ndings woulcl be most likely to demonstrate which of the folloW lrllj Glrd laC lesions ';

A) Systolic anterior mo tion of the rnlti-al valve EI) Mltrall nsufficiency C) Mitral stenosis D) Pulmonic stenosis E) Aortic insufficiency

illis IIIdttoYh/ / (/lay {lo t be! dUjJ/!(~atcd Oi USf;;!U If} an t:t((1(J(lllIJdl ~f'/IIJI()nrnl:!nl wtllltJul w ricteo pernll55fOff (rom tile publisher.

CU !J y ri ~lhl' 'u ;!'007, A/ I r~i9h1S ik.s("1 vt: d Medtext Medical World, InL 23

Anesthesia Practice Question,,:s,::::2c:O::.07~_--=:_-;c-_=---c--c::_ _ _____ _ _ _ __ _ A-Type Questions (Single Best Answer)

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A 55-year-old male with a past med ical histOlY of atherosclerotic coronary vascular disease, status-post coronary stenting of the left anterior descending coronary artelY one month ago, presents for emergency exploratory laparotomy for small I)owel obstruction . Preoperative medications include metoprolol, clopidogrel, and nitrog lycerin. Intraoperatively and postoperatively, the su rgeon complains of increased "oozing " From the t issue . Postoperative lab work reveals a hemo[jlobin of 9.1 gjdL and a platelet count of 1 20,OOOj~L.

Which of the following treatrnents is the BEST clloiee to correct this patient's coagulopathy'

A) DDAVP B) Cryoprecipitate C) Platelet tra nsfusion D) Fresh frozen plasrna E) Vitamin K

A clinical investigator wishes to conduct a research project comparing the presence or absence of a low incidence outcome between two groups in a placebo-controlled trial.

Which of the followi ng statistica l ana lyses wou ld be the MOST appropi-iate to apply to the f indings?

A) Analysis of Va riance S) Fisher's Exact test C) Chi-Square test D) Student's T-test E) Unpaired T-test

A 52-year-old ma le is seen In the pain clinic for evaluation of a large L3-4 herniated disk with right-sided mild to moderate radicu lar symptoms arrd no other neurologic findings. He is currently taking clopidogrel and aspi rin following placement of a pacli taxel-eluting stent in the left anterior descend ing artery eight weeks prior. A trial of epidural steroid injections is requested by his referring physicia n.

What is the MOST appropriate course of action"

A) Discontinue clopidogrel and aspirin for 7 days, then proceed with epidural steroid injection

S) Discontinue clopidogrel and aspirin for 14 days, then proceed with epidural steroid injection

C) Discontinue clopidogrel for 7 days, continue aspirin, then proceed with epidural steroid .injection

D) Discontinue clopidogrel for 14 days, continue aspirin, then proceed with epidura l steroid injection

E) Continue clopidogrel and aspirin and defer epidural steroid injection for fou r months

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.0llesthesid ~Jracl~~_ QuesUo~~' 1.007

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A -Typt~ Questions (Single Best Answer)

A 46-I'car-old female diagnosed with deep vein thrombosis develops sudden onset of chest pam and dyspnea.

A large pulmonClrY embolus is associated with a DECREASE in which of the fol lowing parameters?

A) Pu lmonary artery wedge pressure B) Right atna l pressure C) Respira tory rate D) Mean pulmonary " ILery pressure E) PilCO,

A J-year-old child Ilas ail inhalation induction for an umbilica l hernia repair. Intubation of the l l-achea with un t-~ n dotrachea l tube is planned.

Will et) of til e followin'l is tile narrowest paiL of tile Infant airway?

A) GlottiS B) Cricoid caltil age C) Thyroid (2)rtila~]l:~

D) Larynx E) l)harY f1 x

A 15·-year-olcl fcma le arrives in the pl·eoperative holding unit schedu led for a left breast lumpectomy. Sile is a patienl: 111 the chmnlc pain cl inic and uses a transdermal fentanyl patch SCI mcg/h l·. She re moved the patch at 6 A~1 the morning of surgery after having the patch on for the prior 48 I,ours.

What is the half-life for tile decl ine in fentanyl level after patch removal?

A) £} hours

B) 12 hours C) l8 hours D) 24 huur·s

E) 72 hours

Ali aI' the follOWing can deliver a mlCl"oshock to a patient EXCEPT :

A) Cen tral line guidewire B) Sa line-filled cent l·al line C) Blood-filled central line D) Frayed eleetmcardlogram wire E) Pacemaker wile

----.-~-.----.---

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~nesthesia Practice Questions: 2007

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A l-week-old neonate has an MRI of the brain to evaluate a parenchymal hemorrhage. After the procedure the patient is noted to have susta ined a burn on the foot at the site of the pulse oximeter.

Which of the following would explain the etiology of the burn)

A) Pu lse oximeter taped too tight 8) Malpositioned electrosurgica l return plate C) Current was generated through the pulse OXimeter wiles D) The MRI unit was grounded E) The MRI unit was ungrounded

In a 50-year-old man, the dura mater terminates at which spinal level?

A) L, B) ~ C) Ls D) 5, E) 5,

A 6-week-old infant arrives for repair of ingu ina l hernia. He is noted to have low-set ea rs and appears micrognathic.

All of the following syndromes are associated wi th a difficult intubation EXCEPT:

A) Treacher-Collins 8) Ehlers-Dan los C) Pierre Robin D) Hurler E) Goldenhar

44. Which of the following fil ling errors would result in the LEAST amount of error in Ilalogenated volatile agent delivered?

A) Desfiurane in an isoflurane vaporizer 8) Halothane in a sevoflurane vaporizer C) Halothane in an isoflurane vaporizer DJ Desfiurane in a ha lothane vaporizer E) Desfiurane in a sevoflurane vaporizer

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~~~:,<::::S i ;.-) P r_~£.l~~ SLl!.~-~~~~_~~_. ___ __ _____ _

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A-Type Questions (Sin~J l e Best" Answer)

A ialJOf epidura l is placed In a 20-year·old woman, gravida 1, para 0, at 39 weeks gestation. Dur ing the irlseltioll of th,' Tuohy neerlle util izing the loss of resistance to saline technique, clear flU id retur" s flOIli tile needle

rlk' BEST way to cliffererl tidte sclli ne from CSF clt this point is:

II) Fee l lUI temperature of flUid El) Inject Fentany l 15 mcg C) lnject iidocaine L .5~/o with epinephrine, -3 mL D) Cil eck Fi ulcl lor glucose rc) See If fluid return stops

Wh ich of the followiilD stateme nts regarding high altitude inhalation anesthesia i-KJrnin istration vi a d modern vaporizer at a specific vaporizer setting is CORRECf?

1\) The pclrtial IHeSS LJ re of the ca rrier gas is unchanged with varying altitude. f1) The parti;:11 preSSUi·e of the vaporized inhalational agent is unchanged with

varyillq al ti tude C) rile vapm pr-essli re of the vaporIZed Inilalatlona l agent IS unchanged with

varying alti tude D) Prior to anesth esia admin istration, the inhaled oxygen cOllcentration wi ll change

inve r·selY with altitude. F) The Il loocJclas partition coeificiell t of the inhaled agent will (Ilange inversely with

il ilitudc

A 26-year-old fema le ilt 37 weeks gestation with severe mitral stenosis suddenly develops atria l fibr illation wi th a rapiel ventricula r response. Her blood pressure is 72/42 mmHg, heart rate IS 158 beats/nllnute, and feta l lleart rate is 72 beats/minute.

Til E:' BEST imillecli3tc treatment is:

i\) Adenosine B) CarrJiovel-c;ion C) [smola I D) Carotid IllJssa9t: E) Amiocl cll-one

- - _._- _. -- - --_ .. _ - - - - -_._-_.- ------~--------This f71,_'! tefl~'J/ f/h'W not iJe dU!J/iCdit.-'"li (If USf!(! ,rl J(I educatIOnal environment without written permission from the publisher.

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.0_~thesi~Practi,:e Questions: 2007

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A-Type Questions (Single Best IInswer)

A 51 -year-old male with chronic obstructive pulmonary Gisease IS being transported to the MRI suite for a lumbar spine MR!. He is tl'ansported with oxygen via nasal cannula at ] liters/minute.

If ti,e oxygen E-cylinder reads 1000 psi, rougil ly how long wi ll the oxygen last?

A) One-ha lf hour 8) One hour C) One and one ·ha lf hours 0) Two hours E) Unable to ca lCUlate with the given Informa tion

The "3·in-l " nerve block targets blockade of all of tile fol lowing nerves EXCEPT:

A) Latera l femoral cutaneous nerve B) Femoral nerve C) Sciatic nerve 0) Anterior femoral nerve E) Obturator nerve

Minimum alveolar concentration (MAC) of an in iliJlationai volatile anesthetic:

A) Is unaffected by supplemental anesthetic adjuvant drugs B) Is not a useful number foe comparing potencies of volatile agents C) Is unaffected by the age of the patient D) Is a single point on a dose-respoll se curve E) Is equally comparative between agents when used in multiples of MIIC

A 28-year-old male was anesthetized for an appendectomy. General anesthesia was uneventful with the patient's arms tucked to his sLde . On postoperative day 2 the patient complains of numbness in his index and long fingertips . He also has Impaired thumb

opposition and wrist flexion.

Wh ich nerve was affected'

A) Radial nerve B) Ulnar nerve C) Musculocutaneous nerve D) Median nerve E) None of the above

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58. IscllcnllC optic neuropathy (ION):

A) Is prim2lri iy associa tecJ w ith occip ita l ischern ia 8) Is u5Lkilly temporary C) J's always associated with severe atherosclerosis D) I s assoCiated with prone position surgery E) Js associated most frequently with unrecognized in traoperative eye pressure

')9. Which of I.he fo lloWII-lg med ications has the shortest elimination halF- life?

6U .

61

A) H UI11(JLt::l lll

13) Clonazepalll C) Midazolarn 0) Lorazepam E) Diazepam

A 1.1 S-yea r-o:c1 rna n, ao k~J, is b roU~lht to t hf-~ operating room for corona ry artery bypass g ra lt irl ~J , A subcl21vidli u~ n t ra l li ne is in se rtt~ d under loca l anesthesia, Genera l anesthesia is ",clueecl with micl uzolam 10 1119 an d fentany l ~OO meg . I mmediately fol lowing induction, the p;;ltien t 's centl -a l veno us pressu re inueases and the pu lmonary artery pressu re increases , Th (~ p;Jtlent is nu tably 1 1Iu ~e difficult to m i) S :\ ventil;:lte,

I-he B EST init ial ~;tep

A) Con tin ue to I'll<.'lsk venti la te and wake patien t up 8) Mrn lnlstel' sUCCl r,ylcllol lne C) rU III pa tier lt to the left lateral decubitus position D) Mask vcn ti la l.c with isoflLlI'ane and oxygen to "break" the laryngospasm Ie ) Administer na loxo l',e

[\ 70-year-Old male is scheduled to have a lumbar laminectomy. He has a history of coronary arter-y d,sease and had J 3-vessel coronary artery bypass graft five years ago. He plays ten nis for one houri three t imes a week, without any cardiac symptoms.

Wh ich of the foliowi ll~J is t he MOST appropriate next step?

1'.) Exercise stress test 8 ) Dobutamille stress cchocardlography C) Echocardiogram 0) 24-hour Holter monitol E) Proceed With scheduled surgery

~ - ----~-'r;;;; --;;;;;;;;f~,~:)I: ~;J_:;v flo-t !)~ tfupiiCL.;t-~;:;;;~~-~;d-----;;;--;;;;~ducalkHla/ environment without wntten permissk:Hi from. the publisher. Copy r i 9~l t (() 2nO?. All RigbLc, r<ese rvcrl Medtext iVledlca l World, Inc.

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62.

A~Type Questions (Single 3est Answer)

An 80~year~old female is undergoing a t horacotomy fo r a right upper lobe resection. During one~lung venti lation her oxygen saturation drops to 89%.

The MOST appropriate next step is:

A) Positive end~expiratory pressure (PEEP) to the left lung B) PEEP to the right lung C) Continuous positive airway pressure (CPAP) to the left lung D) CpAp to the right lung E) Institute two~lu ng ventilation

63. The speed of induction during an inhalation induction varies directly with the:

64 .

65,

A) B lood~gas solubility of the volatile agent B) Degree of dead space in the lungs C) Degree of intrapulmonary shunt 0 ) Inspired concentration of the agent E) Size of a rig h t~to~ left intraca rdlac shunt

A lO -day-old t erm infant is schedu led for a ventricu lo-peritoneal shunt for hydrocephalus. The pat ient's mother is homozygous for sick le cell disecls€, The infant's electrolytes are with in normal range and hematOCrIt is 40% .

Special concerns for the management of t his patient include:

A) Hemoglobin electrophoreSIS for sickle cell diagnosis B) Maintain an FiO, > 50% to prevent sickling of erythrocytes C) Transfuse w ith packed red blood cells to 50% hemog lobin A D) Tourniquet use for intravenous catheter insertion is contraindicated E) None of the above

A 19~yea r~0Id intoxicated male is brought to the emergency department with a traumatIC head injury fo llowing a motor vehicle accident. The patient's vita l signs are stable and he IS breathing spontaneously. Multiple lacerations are noted on hiS chest and face . Both upper incisors are miSSing and there is a large lingual laceration and hematoma. The mandible appears disfigured and has ecchymotiC areas . A celvical immobilization collar is in place.

Which of the fo llowing airway management techniques is the MOST appropriate for this patient?

A) Rapid sequence induction and intubation with thiopental and succinylcholine B) Awake nasal fiberoptic intubation C) Awake oral fiberoptic intubation 0) Tracheostomy E) Blind nasa l intubation

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Copyright © 2007, All Rights Reserved Medtext Medical World, Inc. 32

.0.:.1cst~~~~ __ 1 '..r2~L!~~:)uc~>~i()~ .~=,--:_3~l} A-TYiJ; Qu~'stiO'ls (S)-r·~e-Best Answer) - ---

60.

67 .

68.

A ,6 year aiel hoy IS in [i'le preoperative Iloldlng area awa iting electroconvulsive therapy fo r severe, intractable He IS given haloperidol for ag itation. Twenty minutes la t er tl'le PiitiCllt is rlclcl l ias ilbrlorma l movement in Ilis extremities. The patient's vita l signs ,]re wltllin norma l limits and Ile is brea thing spontaneously.

Th e BEST treatment for t ill'; patient at th is time is:

A) Dclll t,·olelle [I) Naloxone C) Olpi lc ilhydr<lmilic D) Pra licloximc [) Fl um,lZenil

A 22-ycc r-olcl cornatose rnale with a tra umatic head injU ry and a C3 fracture is being eva luated for 11 1"Clin stem ciu!Tlage in the neur-osurgical intensive care unit.

Which of the fo llowiog is the BEST method to eva luate th is patient's ocular and vestibular injurie,s?

A) Use the oCLl locepha lic reflex (doll's eye maneuver) to show the patient's eyes ciri fti Cl9 to the left when turning the patient's to the left, showing no bra in stem injury

B) Use the oculoccpha lic refl ex (doll's eye maneuver) to show the patient's eyes c1nftiCl9 to the nght when tum;ng the patient's to the left, showing no brain stem InJLHY

C) Use tile ocu locepilailc refl ex (doli's eye maneuver) to show the patient's eyes drifti ng superior· when turn in ~J the patien t's to the left, showing no brain stem Injury

0) Use t ile oculocephalic l efiex (cioli's eye maneuver) to show the patient's eyes rerna inir19 fixed in the center, showing no brain stem injury

E) None of the above

A 42-year -ol d male With illSlllin-d ependent diabetes is ad mitted for acute appendicitis. HIS blood glucose is 510 g/dL and Il is temperature is 102.4° F. He is listless and his ora l mucosa IS dry.

Wildt is tilE' FIRST step III treatment for t hiS patient)

A) emergency SUI,]CIY B) Insu lin illfuslon at a rate of O.l unit/kg/hI' C) Ill t ravenous Il ydr'at,oll With Ilormal sal ine bo lus 0) Aceta minophen [) lntr-i:wen ous antibiotics

li/l~;- flIail'oa/ r]l. ), I/O! be duplic,.ltt.'u U! li '.<S} I/J .}I/ {vu,_-atiuIJa/ 2nVIIDflfl ll::,n t withuut written penTIIssion from the publisher.

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33


69.

70.

71.


A 65-year-old ma le is undergoing coronary revascu !a rization . He has fa iled weaning from cardiopulmonary bypass and an Intraaortlc balloon pump (JABP) Is placed .

Wh ich of the following statements Is TRUE regarding an IABpo

A) The IASP infiates during early diasto le and deflates during late systo le B) The IABP inflates during early diastole and deflates during early systole C) The IABP inflates during late systole and deRates dUring late diastole 0) The IABP infiates du ri ng late diastole and deflates during early systOle E) The IABP infiates during la te diastole and deflates during late systole

A 26-year-old asthmatic female is postpartum after a twin del ivery. She has uteri ne atony that has been unresponsive to oxytoci n.

Which of the fo llowing medications wou ld be the BEST choice for treatment of the uterine atony at this time?

A) Intramuscular 1S-methyl-prostag landin f'."ph' B) Intravenous IS-metllyl-proslaglandin F,.",h, C) Intramuscular methylergonovine 0 ) Intravenous methylergonovine E) Oxytocin 20 units IV bolus

A 31-year-old male is undergoing a splenectomy after sustaining a splenic rupture during a motor vehicle accident. Intraoperatively he received eight liters of normal saline intravenous, as well as a total of one liter of hetastarch Intravenous for fluid replacement.

Which of the fol lowing is the MOST likely complication from this fluid resuscitation"

A) Increased PT B) Increased PIT C) Anaphylactoid reaction 0) Hyperchloremic metabol ic acidosis E) Thrombocytopenia

This material may not be duplicated or used in an educational envifonment I,..i £/Jout wnlten permission from the publisher. Copyright © 2007, All Rights Reserved Mecl text Medlcol World, Inc.

34

An C!Sthesia P ract i c~ Quesl!ons: 2007 ,~--:c--cc--cccc-c-:c-,---:A-Type Questions (Single Best Answer)

72.

73.

74.

(\ 56-yea r-old fema le presents to the pa in clin ic with terminal osteosarcoma. She is on extended-release morph ine for pa in but continues to have pain with ambulation; however, she compla ins she is too som nolen t at rest.

Which 01 the 10110win9 IS the MOST appropriate treatment for the bl·eakthrough pain in this patient)

A) Transdermal lentanyl patcl, B) Transm ucosi'J 1 fentanyl lozenges C) lilu ed se close oj- (~x tended-release morphine

D) Oxycoclone E) MOrjJhine PCA pUIll P

A llCdlthy 25-ye,]r-o lcl male undergoes an elective ingu inal hernia repair with a nondisposable lalyngeal mask " "way. Induction is accomplished with propofol, lidocaine, and fentanyl. No lleurol11L1sculiJr· blocking agents are used . Desflurane is used for maintenance of anesthesia. Two hours postoperatively the patient develops a fever and diaphoresis.

Wllich of the followillg IS tile MOST like ly etiology of this patient's symptoms?

A) Malignant hypel-tllelmia B) Contaminated propofol C) Neurolepti c mal ignant syndrome D) Atelectasis E) Latex alle rgy

A 63-year-old alcoholic is scheduled for I·epair of an incarcerated umbilical hernia.

Which of the 10 liowin(1 labolatory tests would be BEST for determining adequate synthetic hepatic functioning'

A) Aspartate aminotransferase B) Alanine aminotransferase C) Tota l bil iru bin D) Alkal ine phosplla tase E) Partial tll romboplaslin time

- .. ------ -- - - -~--- ---- - -- - _ ._----,'j~"s-;;,:-;;e;I~;;;'JdJ' nut Ut' dupiir.-aleJ Of u·;t:'d in an I;·ducalionai en vironment without written permission tinm the publisher.

C:opyri~)hl ,x.! 2007 r A ll RiSJhls r{ esE' lv t;;"u Med tex t Medical World, lnc.

3S

Ane.sthesia Practice Questions: 2007

75.


A 15-year-old girl is undergoing Harrington rod placement for scoliosis . Somatosensory evoked potentials (SSEPs) are to be monitored throughout the procedure .

What changes in the SSEPs would be expeded if spinal cord ischemia develops7

A) Increased amplitude 8) Decreased amplitude C) Decreased latency D) lncreased frequency E) Loss of signal

76 . Which of the following statements ale TRUE regarding the standard error of the mean (SEM):

77 .

78.

A) SEM is used for computations about the certainty of th e mean of the data B) If you have a very large number of data paints, the SEM will be large C) 5EM is a computation based on measured data D) SEM is computed from sing le group determinations E) 5EM is a computation that is used to replace the standard deviati on

A 23-year-old female delivers a 9 Ib 5 oz infant with a labor epidura l for analgesia . She received a "top-off" dose of 2% 2-chloroprocaine for delivery. The fo llowing day she complains of weakness in her left foot with a foot drop and inabi lity to invert the left ankle. She is slightly weak in her left hip flexion and knee extension.

What is the MOST likely cause of this weakness'

A) Neurotoxic injury from epidural bupivacaine 8) Direct nerve trauma froin epidural needle C) Peroneal nerve injury from position during delivery D) Compression of the lumbosacral nerve trunk during delivery E) Sciatic nerve injury

A 78-year-old male is scheduled for a suprarenal abdominal aortic aneurysm repa ir. After induction the patient's neck and upper chest are prepped and draped for insertion of a

pulmonary artery catheter.

Which of the following findings on the patient's preoperative electrocardiogram would cause you the MOST concern regarding placement of the pulmonary artery catheter7

A) Right bundle branch block B) Left bundle branch block C) Left ventricular hypertrophy . D) Nonspecific ST-T wave abnormalities E) Old inferior myocardial infarction

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36

7'1.

80.

HI

A- TY1.H' (~lu e sUurl':; (Slrlg le !Jest Answer)

/\ 62.-ycd r o ld rna le l'i uilclenjOir-rg II lapclro5copic cho lecystectomy. During Ule procedure, the patient's ell ci-tir\a I cal'bon dioxid e (ETC02) is noted to decrease to 12 mmHg. An arteria l blood (JLlS is obtained iJrld tile arterial p~lrtia) pressure of carbon dioxide (PaC02) is 55 rnmHq"

All of the ~u llo wirj(::J wou ld Ci;IUSt: the PaC02 to increase and the ETC02 to decrease EXCEPT :

A) A CJrtJon d ioxide embo lus B) An expiratory valve stuck In the open position C) CarcJicK arTest

D) Ai rwd Y cirC!.1!t disconnect E) Ai ,way obslructlOll

f\ G8-ye;:\f"-oIcJ IT\ale IS adm itted to the intc l"lSivc ca re unit for acute myocardial iscllemia. He is Slartcd 0 11 d hep;:ll· in If"lfusion, Clnd morph ine and nitroglycerin are administered for chest pa in Four clays after admiSSion tile patient's chest pain IS contro lled, and his heart rate and b.ood pressure arc sta bllizeci with labeta lol. The patient's platelet count is 80, OOO/~L,

decrci]secl froll] 185,OOO/llt two clays prior.

Which of the fO llowing is the MOST appropriate step at th iS time7

A) Discontlrlue lalletalol and sta rt esmolo l infusion and oral hydralazine El) Ad min ister Single donor plate iets C) Discontillue hep,mn and administer argantrobam D) Mn'"l1ster metlwlene blue E) Do nul:hing sillce th is is expected fo llowill g a mycard ial ischemic event

A 3D-yea r-old 11I;:11e: is emerging h"orn general anesthesia following a vasectomy. He suddenly bitl.:' S c10W11 on the endolr"".lCheal tube . fVlultiple attempts to open the patient's jaw are unsliccessfu l i:H1d the patient',;; oxygen saturat ion begins to decline. Succinylcholine 30 rng is aclrnlllist(=reci and the patient's jaw relaxes " The oxygen saturation remai ns 85% for 15

minutes"

rile M OST apprupriate action at t his time J~ "

A) J1ll1l1(~'cJiate cl"lest x-rdy J llclil ig h frequency ventilation B) li Tll lH-:LJi i:lle c(lest x-ray arId exlu lJation if chest x-ray is normal C) Keep intub,]teci and aci rfllnlster I(,travenous antibiotics and steroids D) Keel-' 11111.11)a lc,1 With postitive end-expiratory pressure (PEEP) added, administer

intravenol.l~; antibiotics, and perforrn pu lmonary lavage [e ) Keep intulJateei With PEEP addelj, aciminister diuret ics, and co ntinue close

obse rv,"ltion

1 hi\ rlIdleffJI {IIay flof /.Jtj dllplieJ(eJ Uf UCiN f{/ ,tn ~uciJrlona/ eovlroomeot without written permission from the pubfls/1Cr.

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37


82.

83.

84.

8S.

A:--=T-yp-e-Qcc,-,e-s-C:ti-on-s-("'SC-,ngle Best Answer)

A 6-month-old chi ld is undergoing a caudal epidura l block with 0.25% bupivacaine for bilatera l inguinal hern ia repair.

Which complication of caudal epidural blocks is more likely in chi ldren than in adults?

A) Intravascular injection 5) Profound motor block C) Neurotoxicity D) Tota l spinal E) Obturator nerve damage

A 42-year-old ma le is brought to the operating room emergently for a Ilcmoperitoneum following a motor veh icle accident. The patient admits to dri llklng over six beers a day and using cocaine for "a long time."

Which of the following medications would be LEAST effective in improving hemodynamics in this patient?

A) Ephedrine B) Epinephrine C) Phenylephrine D) Dopamine E) Dobutamine

For cardia-protection against dysrhythmias, extracorporea l shock wave lithotripsy shou ld be synchronized with the :

A) P wave of the e lectrocard iogram (ECG) B) T wave of the ECG C) Peak inspiration D) R wave of the ECG E) Respiratory plateau

The virus most often transmitted by blood t ransfusion currently is:

A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Human immunodeficiency virus E) HUman T-cell Iymphotropic virus (HTLV)

~-- ... - - - - - -nus material may not be duplicated or used in an educational environment WIthout written permission from the publisher.

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~nesti l eS la_ Practice Q~~bS"'~2007 ______ .

86.

A-Type Questions (Si ngle Best Answer)

A 78 yea r-old ma le presents to the Pain Clinic with a one-montll history of herpes zoster in th e thoracic area. fhe lesions have since resolved, but the patient continues to have severe pil in in the affected area . He has been treated wi th thoracic epidura l local anesthetics and stemicls , anel has been started on oral pregaba lin 7Smg twice daily.

The me[h~1 1 1IS1ll of acLion of pregabalin is:

A) Sodium cll annel blockade B) Calc iu nl channel modul ation C) Gelllma-amillo butyric acid receptor (GABA) stimulation D) Selotonin specific reuptake inhibi tion E) Non-specific catecho lamine reuptake inhibition

87. All ot the lullowII1g ,lclleln nts cr bout pregabali n are t rue EXCEPT:

A) D OSd"C of pregabalin must be adjusted in renal impairment 13) Pregaballn can cause sig llificant slowing of heart rate. C) Pregabalin may cause dizz iness and somnolence D) f'lega balin is a structural derivative of gamma-amino buty ric aCid (GABA) E) Prega llalln can be used to colltrol partial onset seizures .

g8. Oile effect of intr"Jvenous morphine Cldmlliistration is a decrease in heart rate.

89.

The rnechan lsm of action of this decrease in heart rate fo llowing intravenous morphine

<-l dillinistration is:

A) Vagus nerve stimulation B) Ca;-otid body response to increased PaC02

C) A clirect response to opioid receptors ill the myocardium D) Venoclilat,on causing decreased venous retum to the heart E) An effect of the associated histamine r"elease

Which of the foll owi ng lists of npioicls is in order of elim ination half-time from shortest to

longest:

A) Morplline < Ilydromorphone " fentanyl < remifentani l 8) RemlfentJ nil < hydrolllorphone < fentanyl < morphine C) Rellliientafill < hydromorphone < morphine < fentanyl D) Remifentani l <; fentany l < hyciromorphone < morphine E) Hydrornorphone < rermfentanil < fentany l < morphine

_ . f/Ji5----;;au...'I~;I-(lIdy nor b;·U~f.J!Jca{f!£i or usec! If) an edul<'lliafldl 13fwlronment without wdtten permission from the publisher. Cnpy ri ght (,, ) ~~007 , All R j~!h l·'; r~ e5erved Medtext Medical World, Inc.

3 9


90.

91.

92.


A 55-year-old, 72 kg, fema le is scheduled to undergo cataract extraction under retrobu lbar block. She has a history of heart transplantation 5 years ago for idiopathic dilated cardiomyopathy. She has no other medical history and is doing well on her anti-rejection drug regimen. The patient receives propofol for genera l anestllesia for the retrobulbar block. At the conclusion of the blOCk, the patient develops a sinus bradycardia with a heart rate of 38 beats/minute.

Which of the following agents would be the MOST effective for treating the bradycardia?

A) Milrinone 8) Isoproterenol C) Ephedrine D) Atropi ne E) Dobutamine

If no IV access is available during a cardiac an'est, all of t he following drugs may be administered through the endotracll eal tube of an intubated patient EXCEPT>

A) lidocaine B) Amiodarone C) Atropine D) Na loxon e E) Epinephrine

A 42 year-old male is being t reated with linezolid for an abscess ill the left lower extremity. He is brought to the operating room fo r an inCision and drainage of the abscess, Upon induction of general anesthesia the patient 's blood pressure drops to 83/38 IllmHg . .

Which of the following drugs should be avoided III this patient7

A) Phenylephrine B) Norepinephrine C) Epinephrine D) Ephedrine E) Dobutamine

This matedal may not be duplicated or used in an educational environment without written permission from. the publisher.

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j\nesthesid Practice Questlolls: 200?

93 .

A-Type Questions (Single Best Answel-)

A 37-yed r-old partunent at 37 weeks gestation is diagnosed with pre-eclampsia and is being treated with magnesiull1 sulfate. You are cal led to see the patient because she becomes weak, is Ilypoventilating, ancl Ilavll19 dlFtlcu lty breathing . Your First response is to place oxygen on tile patient and support her respirations.

Wilich of the fo llOWing IS the MOST approp,·iate next step in til is patient's course of lrea tment7

A) Aclrnlilister sudium tillopental, succinylcholine, and intubate the patient B) Administer calcium gluconate C) Ask the obstetriCian to deliver the baby emergently D) Aclmlnister propranolo l E) Sit til e p<ltient up dnd prepare For an epidural catheter placement

lIcioca lne aFleets conductiorl of tile hea rt by all of the following EXCEPT:

A) Decreasing rate of depolariz<ltion 13) 1ncreas ing ra tio of effective reFractory period to the duration of the action

potential C) Decreasing action potential duration D) Increasing sinus r-a te F:) Decreasin~J effective refractory period

95 1n the neonate, chest compressions (jur·ing carclro pulmonary resuscitation (CPR) should be

9G.

discontinued when the neonates hea lt rate reaches:

A) 60 beats/minute B) 80 beats/minute C) lOa beats/minute D) 120 beats/minute E) Discontinua tion of chest compressions during CPR is not based on heart rate

A 28 year-old rna le is Ilaving dlt llWSCOPIC knee su rgery under general anesthesia . He has no known allergies. Cefazolin is udil linistered just priur to the skin incision. The patient's heart rate increases tu 123 beats/m inute, blooel pressure drops to 58/23 rnrnHg, peak airway pres~:; ures nse to 28 (Ill H20, and wheezi ll ~l is heard on auscultation to the chest.

cac! I DC the fullowin9 is ~lppropriate Irulial tnerapy EXCEPT:

A) Administer JOO(;lo 0 " B) Discontinue all anesthetic drugs C) Admin isler clexametll asone Intravenous D) Volume expansion with isoton ic fluids E) Administer 5-10 l11(g intravenous doses of epinephrine

~ ---- - - ------~ ----~- .. ------ ---------------------------~

Ih,!; 1/1"1.·,,,11111')' flu/be dU(lhtJ:.>t/ 1/1 us(-d in an educational environment without written permission from the publi5her. Copynght «") 2007, AIl I<ights RC'::.erved Medtext Medical World, Inc.

41

Anesth~iaPractice_Q~u~~~t~io_n_s_:_20_0~7~ __ ~ __ ~~~-c _~~ ____ ~ __ ___ A-Type Questions (Single Best Answer)

97.

98.

99.

Which of the following analgesics has the highest InCidence of anaphylaxis and anaphylactoid reactions'

A) Ketamine 6) Ice C) Acetaminophen 0) Meperidine E) Acupuncture

An 81-year-old male is scheduled For a carotid endarterectomy. A preoperative dobutamine stress echocardiogram is performed which revea ls reg iona l wall motion abnormalities that improve during the exam.

Which of the following statements BEST explains this improvement in regional wall motion abnorma lities?

A) Normal coronary artery blood flow B) Hibernating myocardium C) Cardiac amyloidosis 0) Postinfarction myocardial scar tissue E) Testing error

Pulsus paradoxus may be seen with all of the fol lowing conditions EXCEPT:

A) Obesity 6) Hypovolemia C) Atria l septal defect 0) Severe asthma E) Right-sided heart Failure

100. Perception of pain From a surgical Incision invo lves all of the following structures EXCEPT :

A) Unmyelinated C Fibers 6) Fronta l lobe gyri C) Lateral spinothalamic tracts 0) Rexed lamina V E) Periaqueductal gray matter

This material may not be duplicated or used in an educational environment without written permission (rom the publisher.

Copyright © 2007, All Rights Reserved Medtext Medical World, Inc 42

_~~sthe~~~~~ct i cf'~gLJe.:~t.i9(~~2~C2Q!_ !\ 'TYr)eQuesti~~{Si!-lg ll:: .Se5tAnswer) - --- - ---- -.---- - - ---

WI. A 62 -yeM -old mal" 15 uncl erguing laser removal of a distal trachea l tumor under general aneslheslCl with Isufluralle 111 oxygen and air with an FiO, of 0.3_ He is intubated with a 9.0 endotracllecll tube (ETT) iJnd the su rgeon is administering laser therapy through tile Err via a rlexible fiberoptic bronchoscope. fhe sur-geon and anesthesiologist simultaneously notice the deve lopment of a Fire dt the tip of the En-,

What is the most appropriate FIRST ste'J?

A) Flood the JIr,vay With 50 111 1 of normal sal ine f-3) Remove the crr C) Rapid ventilation With low tidal volumes D) Shut orf gas flow to the bl-mth ing circu it E) lnueilse the 1'10, to LOlJ%

102. A ixernatlHe infarlt born at 31 weeks gestation is brought to the oper-ating room for repair of a left-slderJ congeril ial diapllragmatic Ilernia. Following an uneventful awake tracheal in tubation, anesthesid is maintained w it h sevoflurane, oxyge n, and fentanyl. Fifteen minutes latcr the heart rate clecreases to 55 beats/m inute, the oxygen saturation fal ls to 50%, and t hee ancslllesiolog ist Ilotes hlgll peak airway pressures .

What IS the MOST appropriate Jctlon at th is t ime7

A) Adm inister positive end-expira tory pressure 8) Decompress the stomacil C) Place a chest tube a ll the left D) Pldce a chest tul,e all tile light [) Pu ll the endotrachea l tube back one centimeter

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