A 73-year-old woman taking warfarin for chronic atrial fibrillation is brought to the operating room for evacuation of a spontaneous left temporal intracerebral hematoma with uncal herniation syndrome. Her INR is 3.8. Her platelet count and hematocrit are normal. What is the recommended medical therapy for reversing her coagulopathy?
Cryoprecipitate
4-Factor prothrombin complex concentrate (PCC)
Fresh frozen plasma
Vitamin K
The incidence of headache with inadvertent dural puncture during epidural anesthesia is decreased:
with decreasing age
by keeping the patient supine for more than 12 hours following puncture
with the use of fluid, instead of air, for loss of resistance
by inserting the needle with the bevel aligned perpendicular to the long axis of the meninges
All of the following statements are true about hypoxic pulmonary vasoconstriction (HPV) EXCEPT:
HPV is a local response of bronchiolar artery smooth muscle in underventilated areas of the lung
HPV is responsible for most lung perfusion redistribution during one-lung ventilation
HPV occurs in areas of the lung with low alveolar oxygen pressure
HPV allows the lung to maintain optimal ventilation/perfusion matching
Factors decreasing physiologic dead space include:
the supine position
anticholinergic agents
increasing age
emphysema
A 64-year-old, 73 kilogram male with a 50 pack-year smoking history is scheduled to undergo a lobectomy for a right upper lobe mass. You have placed a left-sided double lumen endotracheal tube, and you would like to confirm proper placement. Which of the following findings would suggest that your double-lumen endotracheal tube has entered the right main bronchus by accident?
Inflate tracheal cuff, ventilate tracheal lumen, bilateral lung breath sounds
Inflate bronchial cuff, inflate tracheal cuff, ventilate tracheal lumen, right lung breath sounds
Inflate bronchial cuff, ventilate bronchial lumen, left lung breath sounds
Inflate bronchial cuff, ventilate bronchial lumen, right lung breath sounds
The development of transient neurologic symptoms (TNS) after spinal anesthesia is MOST associated with which of the following local anesthetics?
Bupivacaine
Lidocaine
Prilocaine
Tetracaine
Selective adrenergic stimulation of the β2-receptor results in:
increased heart rate
increased insulin secretion
detrusor muscle contraction
pupillary constriction
A patient with a severe traumatic brain injury is emergently brought to the operating room for evacuation of a parenchymal hematoma causing uncal herniation. The neurosurgeon requests that you limit systolic blood pressure to < 160 mmHg but keep cerebral perfusion pressure > 60mmHg. Currently, blood pressure is 190/100 mmHg and ICP is 25 mmHg. What antihypertensive agent will avoid a further increase in intracranial pressure?
Hydralazine
Minoxidil
Nitroglycerin
Nicardipine
Hormones released by the neurohypophysis include: (Select 2)
thryotropin
growth hormone
arginine vasopressin
adrenocorticotropic hormone
follicle stimulating hormone
oxytocin
prolactin
luteinizing hormone
A 50-year-old woman presents for lumbar spine surgery. Vital signs include blood pressure 210/130 mmHg. She appears comfortable but somewhat anxious. The anesthesiologist is concerned that this is a hypertensive emergency. What is the MOST appropriate next step in her management?
Apply nitroglycerin paste to the chest wall and proceed to surgery
Cancel surgery and send the patient to the emergency room
Proceed with surgery without further consideration
Question the patient regarding history of hypertension and antihypertensive therapies
At 10,000 feet elevation (atmospheric pressure is 520 mm Hg), oxygen 100 mL/min is bubbled through a vaporizer containing an anesthetic with a vapor pressure of 260 mmHg. This mixture is added to a fresh gas flow of 5 L/min. The delivered anesthetic concentration is:
0.25%
0.5%
1%
2%
Pancreatic somatostatin producing cells in the Islets of Langerhans are:
alpha cells
beta cells
gamma cells
delta cells
The recommended maximum leakage current allowed in operating room equipment is:
5 μA
10 μA
1 mA
5 mA
In a coagulopathic patient, the risk of bleeding after a paravertebral blockade is MOST similar to which other form of regional anesthesia?
Axillary block
Bier block
Epidural block
Supraclavicular block
Which of the following changes would MOST likely result in increased coronary artery perfusion in a patient with aortic stenosis?
Decreased systemic diastolic pressure
Increased systemic vascular resistance
Increased left ventricular diastolic pressure
Tachycardia
Causes of normal-anion-gap acidosis include:
renal failure
starvation
diarrhea
lactic acidosis
A 62-year-old man has had CABG surgery and develops atrial fibrillation in the ICU afterward. He is administered an amiodarone loading dose with a planned maintenance dose to follow. Which of the following hemodynamic effects is MOST likely to occur during the acute bolus phase?
Decreased systemic vascular resistance
Decreased pulmonary vascular resistance
Increased pulmonary vascular resistance
The area of myocardium most vulnerable to ischemia is the:
left ventricular epicardium
right ventricular epicardium
left ventricular subendocardium
right ventricular subendocardium
Hypoxemia during one-lung anesthesia is most effectively treated by:
PEEP applied to the ventilated lung
continuous oxygen insufflation to the collapsed lung
changing tidal volume and rate
periodic inflation of the collapsed lung
Which of the following antibiotics is nephrotoxic?
Quinolones
Rifampin
Vancomycin
All of the above
Which of the following statements regarding open surgical versus percutaneous tracheostomies is MOST likely true?
Open tracheostomies are associated with fewer major complications
Open tracheostomies are associated with fewer infectious complications
Percutaneous tracheostomies are associated with fewer major complications
There is no difference in the incidence of major complications
Sympathetic blockade during acute herpes zoster has been shown to:
increase analgesic requirements
reduce the incidence of postherpetic neuralgia
increase the need for corticosteroid therapy
be an effective treatment for patients who have had postherpetic neuralgia for a number of years
Branches of the femoral nerve anesthetized during an ankle block include the:
deep peroneal nerve
sural nerve
saphenous nerve
posterior tibial nerve
A 35-year-old woman complains of chest pain on her seventh postpartum day. EKG reveals STEMI in anterior leads and a regional wall motion abnormality is appreciated on TTE. An angiogram reveals LCA dissection and the diagnosis of acute MI secondary to spontaneous coronary artery dissection (SCAD) is made. What is the incidence of SCAD in pregnant patients with MI?
27%
17%
7%
0.7%
Pulmonary complications from advanced hepatic disease with cirrhosis include:
an obstructive ventilatory defect
respiratory acidosis
increased intrapulmonary shunting
increased functional residual capacity
A patient with a large mediastinal tumor presents for excision of the mass. CT scan shows a mass of 14 x 10 cm causing about 40% tracheal compression and moderate compression of the superior vena cava (SVC) and other mediastinal structures. The heart is displaced laterally and an apical impulse is felt just medial to the anterior axillary line. The patient is asymptomatic with no signs of SVC syndrome. Which of the following is the MOST common mechanism of hemodynamic collapse under general anesthesia in this patient?
Increased afterload
Decreased preload
Ventilation-perfusion mismatch
Rhythm abnormalities
An anxiolytic herbal medication associated with a decrease in the requirement of inhaled anesthetic agent (MAC) is:
echinacea
valerian
ginkgo
ephedra
A 23-year-old primiparous woman in spontaneous labor is monitored with continuous fetal heart monitors. The cardiotocograph shows a baseline fetal heart rate of 110/min with moderate variability. There are no accelerations over a period of 20 minutes and no early decelerations. This tracing falls under which of the following categories?
Category I
Category II
Category III
Category IV
The formation of metanephrine is the result of:
catechol-O-methyltransferase metabolism of epinephrine
catechol-O-methyltransferase metabolism of norepinephrine
monamine oxidase metabolism of epinephrine
monamine oxidase metabolism of norepinephrine
A 35-year-old man who had right ankle ORIF under general anesthesia after sciatic-saphenous nerve blockade develops right foot drop postoperatively. Which nerve is most likely injured?
Peroneal nerve
Tibial nerve
Saphenous nerve
Sural nerve
Which of the following is MOST true regarding a pediatric patient with a URI and the risk of anesthesia?
Airway reactivity has been demonstrated to occur in the lab, but has not been definitively shown to occur
Increased incidence of adverse airway events have been demonstrated in children to last for 2-4 weeks after the URI
The best approach is to cancel all children with a URI presenting for elective surgery
There are no known affects of a URI on the lower airways
Characteristics of human immunodeficiency virus neuropathy include: (Select 2)
distal polyneuropathy
rapid sudden onset
proximal muscle weakness
allodynia
upper extremities most commonly involved
proximal to distal progression of symptoms
An action potential characterized by a spike followed by a plateau phase is seen in:
peripheral sensory nerve cells
peripheral motor nerve cells
striated skeletal muscle cells
cardiac muscle cells
Patient risk factors associated with the development of perioperative peripheral nerve injuries include all of the following EXCEPT:
Diabetes mellitus
Hypertension
Female sex
Tobacco abuse
Autonomic hyperreflexia:
is common with cord lesions below T8
can precipitate pulmonary edema
is not effectively prevented by regional anesthesia
can be prevented with adequate intraoperative sedation
Mannitol may be administered during surgical clipping of an aneurysm to decrease brain water and thus brain bulk. The peak effect of mannitol occurs approximately:
5 – 10 minutes after the infusion begins
15 – 20 minutes after the infusion begins
30 – 45 minutes after the infusion begins
About 1 hour after the infusion begins
Renal effects of nitrous oxide include:
decreased renal blood flow secondary to decreased cardiac output
decreased renal blood flow secondary to increased renal vascular resistance
increased renal blood flow secondary to sympathetic stimulation
increased glomerular filtration with increased reabsorption
What are the primary anatomic landmarks for a fascia iliaca block?
Anterior superior iliac spine and pubic tubercle
Anterior superior iliac spine and greater trochanter of femur
Iliac crest and pubic tubercle
Posterior superior iliac spine and greater trochanter of femur
The dibucaine number:
is normally less than 60%
is a quantitative assessment of pseudocholinesterase activity
is inversely proportional to pseudocholinesterase function
reflects inhibition of pseudocholinesterase by dibucaine
A 45-year-old morbidly obese man with a medical history of hypertrophic cardiomyopathy presents for ear surgery. He has an ejection fraction of 65% on transthoracic echocardiography. After induction of general anesthesia, his blood pressure is 78/40 mmHg with a regular heart rate of 80 bpm. Which of the following is the MOST appropriate initial intervention?
Ephedrine 20 mg IV
Epinephrine 30 mcg IV
Esmolol 50 mg IV
Phenylephrine 100 mcg IV
Chronic aortic regurgitation results in all the following EXCEPT:
Decreased aortic diastolic pressure
Increased stroke volume
Decreased LV end diastolic pressure
Increased LV mass
Release of aldosterone by the adrenal cortex is stimulated by: (select 3)
angiotensin I
angiotensin II
hypokalemia
pituitary ACTH
congestive heart failure
hypervolemia
The most common complication of thoracic paravertebral nerve block is:
hypotension
subarachnoid injection
pneumothorax
intravascular injection
A 55-year-old woman with an infected automatic cardioverter-defibrillator (AICD) lead presents for removal. During the course of the procedure she develops acute profound, refractory hypotension that progresses to cardiovascular collapse and pulseless electrical activity. Which of the following is the MOST appropriate intervention at this time?
Administration of epinephrine to increase blood pressure
Needle thoracostomy to treat pneumothorax
Thoracotomy to evacuate pericardial effusion
Transcutaneous pacing to increase heart rate
Which of the following drugs is NOT a cell cycle inhibitor?
Azathioprine
Mycophenolate mofetil
Ortho Kung T3 (OKT3)
Sirolimus
According to the Modified Glasgow Coma Scale, a moderate head injury is associated with a score of:
13 - 15
9 - 12
6 - 9
less than 6
