Question 1
Question
The canogram below is a sign that your patient has just had:
Question 2
Question
The leading cause of cardiac arrest in children is:
Answer
-
trauma
-
congenital heart failure
-
respiratory problem
-
circulatory problem
Question 3
Question
The leading cause of cardiac arrest in adults is
Answer
-
congenital heart failure
-
trauma
-
abnormal heart rhythm
-
respiratory problem
Question 4
Question
Brain stem reflexes include:
Question 5
Question
Which of the following investigations is the most important to perform immediately after hospital admission in a patient with clinical signs of stroke?
Question 6
Question
Acute Kidney injuryt is associated with
Answer
-
hyperkalemia
-
alkalosis
-
hypophosphatemia
-
hypocalcemia
Question 7
Question
The typical pattern of hyperdynamic septic shock is
Answer
-
Low CVP/ high CO / low SVR
-
Low CVP / low CO / high SVR
-
High CVP / low CO / low SVR
-
high CVP / low CO/ high SVR
Question 8
Question
Which equation describes Cardiac output (CO)
Answer
-
HR X SV
-
Preload X Afterload
-
HR x Preload
-
HR x CVP
Question 9
Question
ARDS is characterized by all except:
Answer
-
Non-cardiogenic lung edema
-
increased respiratory system compliance
-
acute inflammatory reaction in the lungs, increased permeability of pulmonary vascular endothelium
-
Hypoxemia
Question 10
Question
Early phase septic shock is characterized by
Question 11
Question
The initial MAP target values for the treatment of shock should be:
Answer
-
MAP 50 mmHg
-
MAP 65 mmHg
-
MAP 80 mmHG
-
MAP 100mmHg
Question 12
Question
Risk of misdiagnosis of brain death according to circulatory criteria is possible in circumstances EXCEPT:
Question 13
Question
Gold standard for the diagnosis of death using confirmatory investigation is:
Answer
-
evoked potentials
-
arterial angiography
-
EEG
-
Transcranial Doppler
Question 14
Question
Calculate cerebral perfusion pressure (CPP) based on the following data: HR 75, BP 120/80 (MAP 65), CVP 15, ICP 15, Respiratory rate 25, Minute volume 10 l/min
Question 15
Question
Categories of ARDS:
Answer
-
mild: 300 <pO2 /FiO2 ≤ 400 (previously called ALI – acute lung injury)
-
Moderate: 100 <pO2 /FiO2 ≤ 200
-
Severe: pO2 /FiO2 ≤ 150
-
Very severe: pO2 /FiO2 ≤ 500
Question 16
Question
Noninvasive mechanical ventilation (NIV) can be considered in patient:
Question 17
Question
65-year-old man with acute STEMI MI undergoes emergent cardiac catherization followed by PCI. A pulmonary artery cathartic is inserted for hemodynamic monitoring. Which of the following hemodynamic subsets satisfies the criteria for cardiogenic shock in this patient?
Answer
-
Pulmonary Artery Occlusion Pressure (PAOP) < 18mmhG; Cardiac Index > 2.21/min/m2
-
PAOP > 18mmHg; CI >2.2/min/m2
-
PAOP < 18mmHg; CI <2.2/min/m2
-
PAOP > 18mmHg; CI <2.2/min/m2
Question 18
Question
Which is the TRUE STATEMENT about insulin therapy in septic patient.
Answer
-
Septic patients are often hypoglycemic
-
the optimal management is to maintain glucose < 180mg/dL
-
insulin should not be given IV
-
the best and safest route of insulin administration is subcutaneous supply
Question 19
Question
Vasopressors during septic shock resuscitation
Answer
-
lowest mortality was achieved when vasopressors were initiated 6-12 hours after or after at least 1 liter of fluid was given during first hour
-
first choice vasopressor was based SSC recommendations is Norepinephrine
-
First choice vasopressor based SSC recommendation is Vasopressin
-
Dopamine can be considered in patients with high risk of tachyarrhythmia’s
Question 20
Question
Beside score – quick SOFA (qSOFA) includes the indicators described below with THE EXCEPTION of:
Question 21
Question
What does DO2 refer to?
Answer
-
amount of oxygen in blood
-
amount of O2 delivered to tissues of the body per minute
-
cardiac output only
-
arterial partial pressure of oxygen
Question 22
Question
All of following are examples of distributive shock EXCEPT:
Question 23
Question
Once the patient is defibrillated and high quality CPR is in progress, the first drug you would expect to give would be
Answer
-
lidocaine
-
morphine
-
adrenaline (epinephrine)
-
magnesium sulfate
Question 24
Question
You are working in emergency department. Your 69-years old patient who is being treated for chest pain. He has an IV in place and is on the bedside monitor. He is awaiting the arrival of the Cath Lab Team. Suddenly the patient loses consciousness. You look up at the monitor and see ventricular fibrillation. You are not sure whether you feel a pulse or not. You should immediately
Answer
-
ventilate using bag-valve-mask ventilation (BVM)
-
precordial thumb
-
defibrillate at 200 joules or manufacturer guidelines
-
have another colleague to double check the presence of the pulse
Question 25
Question
Indicate A FALSE STATEMENT describing the principles of mechanical lung ventilation in the ARDS:
Answer
-
selecting the lowest FiO2 at which is it possible to SpO2 99-95%
-
Tidal volume 10 ml/kg
-
Plateu pressure in the airways <30 cm H20
-
increased respiratory frequency up to pH >7.30
Question 26
Question
Indicate A FALSE STATEMENT describing the effect of inotropic drugs
Answer
-
levosimedan increases cardiac contractility by sensitizing his myofilaments to calcium
-
dopamine is a selective B1 receptor agonist
-
dobutamine increases heart rate and increases O2 mycardial O2 consumption
-
adrenaline infusion is accompanies by an increase in serum lactate
Question 27
Question
According to international definition pain is:
Answer
-
an acute sensory experience associated with local tissue damage
-
actual or potential tissue damage associated with unpleased experience
-
an unpleasant sensory and emotional experience associated wit actual or potential tissue damage
-
an unpleasant sensory or emotional experience described in terms of tissue damage
Question 28
Question
The PCA analgetic therapy means:
Answer
-
peridural continuous analgesia
-
pain control analgesia
-
perioperative control of pain
-
Patient controlled analgesia
Question 29
Question
What is not typical for the chronic pain syndrome:
Question 30
Question
In the learned chronic pain syndrome typical behavior called “five Ds” concerns following symptoms EXCEPT:
Answer
-
disability
-
dysphagia
-
drug misuse
-
dependency
Question 31
Question
Basic goal after the recognition of sepsis is to administer the antimicrobials within:
Answer
-
1 hour
-
3 hours
-
6 hours
-
12 hours
Question 32
Question
In the sepsis Six algorithm of severe sepsis treatment, Step 1 is:
Question 33
Question
ET CO2 is increased in the following conditions EXCEPT:
Answer
-
Hyperthermia
-
COPD
-
Malignant Hyperthermia
-
Hyperventilation
Question 34
Question
45 year old man was admitted to the emergency department after a traffic accident. Physically examination: conscious, in a logical touch, suffering, heart rate of 120/min, blood pressure 80/50mmHg, major bleeding due to amputation of the right lower limb, VAS is 10. In CT: without head injury. What is the most appropriate anesthetic agent during transport the patient to operating theater?
Answer
-
Propofol
-
Etomidate
-
Ketamine
-
Thiopental
Question 35
Question
Which of the following anesthetics is safe in patients with a history of malignant hyperthermia?
Question 36
Question
How to do assess ASA classification in the following patients?
I – 34 years old man with good control of diabetes mellitus
II – 86 years old with hypertension without treatment and creatinine level 1.2 mg/dL
III – 45 year old man with the diagnosis of brain death
Answer
-
I-1, II-2, III-5
-
I-2, II-3, II-5
-
I-2, II-3, III-6
-
I-2, II-4, III-5
Question 37
Question
Epidural anesthesia is contraindicated EXCEPT:
Question 38
Question
Hypotension is least likely to occur following induction with which of the following anesthetics agents?
Answer
-
Ketamine
-
Propofol
-
Thiopental
-
Midazolam
Question 39
Question
Which of the following local anesthetics can cause most likely an allergic reaction?
Answer
-
procaine
-
lidocaine
-
Bupivacaine
-
Ropivacaine
Question 40
Question
Regarding to succinylcholine the following statements are true EXCEPT:
Answer
-
it is depolarizing relaxant drug
-
succinylcholine has short duration due to plasma cholinesterase
-
side effects include malignant hyperthermia, muscle pains, acute rhabdomyolysis with high blood levels of potassium
-
it is a medication used as a part of general anesthesia for long-term paralysis to help with tracheal intubation
Question 41
Question
Regarding CVP find FALSE STATEMENT:
Answer
-
mean pressure in VCS or RA
-
it is increased in hypovolemia
-
measurement performed with central venous catheter
-
to estimate the filling of vascular bed and preload of the right heart
Question 42
Question
Find TRUE STATEMENT regarding pulsoximetry
Question 43
Question
CVP is typically elevated in all EXCEPT
Answer
-
congestive heart failure
-
cardial tamponade
-
hypervolemia
-
Sepsis
Question 44
Question
Interpret the following blood gas: PaO2 78mmHg, PaCO2 29mmHg, pH 7.29, HCO3 14, BE -10
Answer
-
respiratory alkalosis
-
respiratory acidosis
-
metabolic acidosis
-
metabolic alkalosis
Question 45
Question
The patient with confirmed sudden cardiac arrest presents PEA on ECF tracing. You should:
Answer
-
administer 3mg of atropine each 2-5min of CPR
-
debibrilate the patient with 360J energy
-
administer 1mg of adrenaline each 2-5 mins of CPR
-
perform cardioversion with 150J energy
Question 46
Question
The best indicator of adequate fluid resuscitation in the trauma patient is:
Answer
-
Arterial pH
-
Blood pressure
-
core temperature
-
serum lactate level
Question 47
Question
A 24-year-old man is brought to the emergency department following a car accident. He is unconscious and has an obvious fractured right femur, as well as a taut abdomen. His BP is 92/58 and pulse 110. Prior to going to CT, radiology, and then surgery, the anesthesiologist request that a PA catheter be inserted. This is done, and the following values are obtained:
SvO2 = 54%
Cl = 2.5/L/min/m2
PAOP = 3 mmHg
Answer
-
left ventricular failure
-
fluid overload
-
sepsis
-
hypovolemia
Question 48
Question
A 40-year old woman is undergoing an internal fixation of her tibia under general anesthesia. While the surgeon is inserting the implant she develops sudden hypotension and her EtCO2 shows
a sudden drop from 40 mmHg to 22 mmHg. What is the most likely diagnosis?
Question 49
Question
Which one of the following findings would be contraindication to spontaneous breathing?
Answer
-
FiO2 0.4
-
PEEP 5
-
GCS 4
-
Minute volume 10 L/min
Question 50
Question
You are in the library when a gentleman who was standing at the desk collapses. He falls to the ground and does not appear to be breathing. You ask the clerk to call for help and to get the AED. Because the man is not responding and does not appear to be breaking normally you should immediately
Answer
-
Do nothing until the AED arrives
-
start compressions at least 100 per minute but no more than 120 per minute
-
open the airway, deliver 4 breaths and await to the arrival of the AED
-
Deliver 2 breaths followed by 15 compressions
Question 51
Question
the FALSE STATEMENT concerning cardiogenic shock is:
Answer
-
is characterized by low cardiac output
-
is characterized by a low systemic vascular resistance
-
may be caused by papillary muscle rupture
-
is inability of the heart to maintain the circulation
Question 52
Question
Subarachnoid anaesthesia is contraindicated in:
Question 53
Question
Amiodarone is indicated for the treatment of:
Answer
-
hypertension
-
arrhythmia
-
hyperthyroidisms
-
seizure
Question 54
Question
The patient is admitted with cardiogenic shock and oliguric acute kidney injury. Hemodynamics parameters reveal the following:
BP 105/60 mmHg, Sinus rhythm (108/min), Cl 1.8 (CO2.4), CVP 23 mmhG, PCWP 25mmHg, SVRI 2088 (SVR 1566). Which one of the following interventions would you anticipate?
Answer
-
Dopamine at 2mcg/kg/min
-
captoprin 6.5 mg q6h
-
metoprolol 25mmHg
-
Dobutamine 5mcg/kg/min
Question 55
Question
Calculate the PaO2: FiO2 ratio passed on the following data:
FiO2 1.0, PEEP 10, PaO2 65mmHg, pH 7.34 mmHg, PaCO2 45mmHg, SpO2 90%
Question 56
Question
The inotropic drug of the first choice for septic shock is:
Answer
-
dopamine
-
dobutamine
-
epinephrine
-
dopexamine
Question 57
Question
Pneumothorax as a complication occurs more often during cannulation of:
Answer
-
jugular internal vein
-
jubgular external vain
-
Subclavian vein
-
Femoral Vein
Question 58
Question
What is the correct treatment of an adult patient with VF:
Answer
-
administer 500ug of digoxin IV
-
administration of 1mg of adrenaline after each defribrillation
-
administration of 3mg of atropine after each two loops of CPR
-
performing the first debribilliation with energy 150-200J (biphasic)
Question 59
Question
According to ERC guidelines for resuscitation 2010 (adults):
“Atropin is no longer recommended for routine use in asystole or pulseless electrical activity (PEA).
a) this sentence is false
b) forst part is true, and second part is false
c) atropine is not mentioned in the newest ERC Guidelines for Resuscitation 2010 (adults)
d) this sentence is true
Question 60
Question
The correct ratio of compression of chest to breaths in cardiac arrest in neonates is:
a) 15:2
b) 30:2
c) 3:1
d) 5:1
Question 61
Question
12) Tuohy needle is used to perform:
a) epidural anesthesia
b) spinal anesthesia
c) arterial puncture
d) central vein puncture
Question 62
Question
Spinal anesthesia results from the injection of a local anesthetic drug directly:
a) outside the dura
b) into spinal cord
c) to the nerve roots
d) into cerebrospinal fluid
Question 63
Question
The spinal needle can only be inserted below the second lumbar and above the first sacral vertebrae:
a) this sentence is true
b) this sentence is fasle
c) first part is true and, second is false
d) first part is false and, second is true
Question 64
Question
A patient with systemic disease that is a constant threat to life- is according to ASA classification:
a) I
b) II
c) III
d) IV
Question 65
Question
ANESTHESIOLOGY EXAM 2016/2017
Question 66
Question
1. A 16-year-old girl has intermittent bifrontal and occipital headaches, which she describes as “squeezing, bandlike, or vinelike” that are worse when she is at school. She has undergone counseling at school for depression and anxiety. Which of the following is the most likely diagnosis?
a. Temporal arteritis
b. Migraine headache
c. Malingering
d. Tension-type headache
Question 67
Question
2. A 55-year-old man has severe pain on gentle touching of the arm. Six months ago, the median n. was damage during creation of an arteriovenous fistula for dialysis. Which of the following terms best describes this phenomenon?
a. Hypesthesia
b. Hyperalgesia
c. Allodynia
d. Hypersensitivity
Question 68
Question
The placebo effect is mediated by:
a. Opioid mechanism
b. Oxytocin mechanism
c. Cannabinoid mechanism
d. All of them
Question 69
Question
According to international definition, pain is:
a. An unpleasant sensory or emotional experience described in terms of tissue damage
b. Actual or potential tissue damage associated with unpleasant experience
c. An acute sensory experience associated with local tissue damage
d. An unpleasant sensory and emotional experience associated with actual or potential tissue damage
Question 70
Question
The latest full definition of sepsis is as follows:
Answer
-
sepsis is a life-threatening organ failure caused by an incorrect response of the body to blood infection. Organ insufficiency is recognized on the basis of the SOFA score> 4
-
sepsis is a life threatening organ failure caused by an incorrect response of the body to infection. Organ failure is diagnosed based on a sudden change in SOFA> 2 due to infection.
-
sepsis is a life-threatening syndrome shaped by factors associated with the pathogen itself as well as factors related to the patient's body (eg. gender, race, and other genetic factors, age, coexisting disease, environment)
-
sepsis is a life-threatening organ failure diagnosed on the basis of a change in the SOFA scale> 4
Question 71
Question
Patient with COPD: CO2 48 mm Hg, HCO3 - 28 mm Hg, pH 7.35
Answer
-
compensated respiratory acidosis
-
compensated respiratory alkalosis
-
compensated metabolic acidosis
-
compensated metabolic alkalosis
Question 72
Question
To qSOFA belong all EXCEPT:
Answer
-
temperature above 38 or below 36
-
breath above 22 / min
-
systolic pressure below 100
-
disturbances of consciousness
Question 73
Question
65-year-old man. It shows the symptoms of cardiogenic shock. You're connecting a swann-Ganz catheter and what you see.
Answer
-
Pcwp > 18, CI > 2.1
-
Pcwp < 18, CI > 2.1
-
Pcwp > 18, CI < 2.1
-
Pcwp < 18, CI < 2.1
Question 74
Question
In sepsis, increased fibrin formation may impair the following:
Answer
-
Loss of vascular capillary barrier function leading to extensive swelling of
-
expandable and blood-vessel tissues and 5 -stage vascular resistence
-
formation of thrombosis in incisions, perturbation disorders, organ ischaemia, organ damage and development of multiple organ failure syndrome
-
severe adhi leukocyte to vasomotor vessels with increased migration of leukocytes into tissues
Question 75
Question
Pathophysiological changes observed in sepsis are:
Answer
-
vascular endothelial dysfunction leading to increased vascular permeability and extensive tissue swelling
-
haemostasis disorders, reduced energy production in the mitochondria
-
circulatory insufficiency and hypotension
-
a, b, c
Question 76
Question
The term hypoxemia means a reduced content of oxygen in arterial blood. The causes of hypoxemia may be as follows:
Question 77
Question
Measuring the concentration of pro-calcitonin in patients treated in the intensive care unit is useful:
Answer
-
in the diagnosis of severe fungal infections
-
in the diagnosis of severe viral infections
-
in the diagnosis and monitoring of the treatment of thin bacterial infections
-
in the diagnosis and monitoring of treatment of severe coagulation disorders (eg disseminated intravascular coagulation)
Question 78
Question
Cardiogenic shock (WK) from septic shock (WS) differs mainly:
Answer
-
Patients with cardiogenic shock have greater tachycardia
-
Patients with septic shock are more likely to have severe lactic acidosis
-
The diastolic pressure is very low in patients with cardiogenic shock
-
The septic shock patients are usually characterized by increased vasodilatation
Question 79
Question
If there are difficulties in ventilating the patient and the presence of a foreign body has been ruled out, which of the following may be helpful in providing ventilation to the mask?
Question 80
Question
Indicates a FALSE statement:
Answer
-
In systemic bacterial infections, procalcitonia is produced in all parenchymal devices and excreted into the bloodstream, which provide a high concentration.
-
In severe viral infections, procalcitonin is produced in all parenchymal vessels and excreted into the bloodstream, where it reaches a high concentration
-
outside of procalcitonin can grow after major surgery, reaching the highest values 24-48 hours. after treatment. PCT returns to normal values within a few days that they do not have
-
Continuity testing
Question 81
Question
Treatment of life-threatening hyperkalaemia includes:
1. Magnesium IV
2. Calcium IV
3. IV glucose infusion with insulin
4. Lidocaine IV
Question 82
Question
Which of the painkillers can be used in the treatment of postoperative pain in children?
Answer
-
Paracetamol
-
morphine
-
acetylsalicylic acid
-
A and B
Question 83
Question
It is not true that: The dose of adrenalin in the treatment of anaphylactic shock:
Answer
-
It should be given only if there is no response to an earlier intravenous GCS supply
-
In adults with spontaneous circulation, it is injected into the lateral surface of the thigh
-
. It can be repeated every 5-15 minutes if there is no improvement or the blood pressure is still too low.
-
For adults with spontaneous circulation, the recommended dose is 0.5 mg
Question 84
Question
In the course of resuscitation, the indication to be given adrenalin is:
Question 85
Question
The indication for defibrillation is:
Answer
-
Asystole
-
Ventricular fibrillation
-
Electrical activity without the presence of pulse on the carotid arteries, occurring in the form of tachycardia with narrow QRS syndromes
-
Any cardiac arrest, regardless of the electrical activity of the heart
Question 86
Question
Recommendations for the treatment of patients with carcinogenic shock include all of the below listed EXCEPT
Answer
-
ECG and echocardiographic examinations should be performed immediately on vomiting patients suspected of having cardiogenic shock
-
ECG monitoring and invasive blood pressure monitoring are recommended
-
intravenous inotropic drug (dobutamine) may be considered to increase cardiac output
-
in the first-line treatment, in the absence of symptoms of acute inflammation, urgent administration of fluids IV (saline or Ringer's solution,> 2000ml / 15-30min) is recommended
Question 87
Question
Sepsis may develop:
Question 88
Question
The aim of CRRT therapy (continuously renal replacement therapy) is:
Question 89
Question
During ALS, persons performing external cardiac massage should change to ensure the best quality of pressure
Question 90
Question
Continuous monitoring of ET CO2 during CPR (cardiopulmonary resuscitation):
Answer
-
confirms and monitors the position of the tracheal tube
-
is used only in the case of a public airway device
-
may be an indicator of the quality of CPR and ROSC
-
correct answers a and c
Question 91
Answer
-
the first-line drug in septic shock
-
during resuscitation we give 1mg IV every 2 minutes
-
by activating peripheral beta 1 receptors, it causes vasodilatation
-
has a positive inotropic, chronotropic, bathmotropic and non-tropic effect
Question 92
Question
In cardiac arrest in the VF / VT mechanism without heart rate monitored by the patient and witnesses
Answer
-
Precordial thump may be effective while waiting for the defibrillator to be used?
-
In special cases, defibrillations may be performed in a sequence of three consecutive discharges when the defibrillator is immediately available
-
we give adrenaline after the third defibrillation
-
all correct
Question 93
Question
Amiodaron in sudden cardiac arrest
Answer
-
we always use 300 mg iv
-
we give after 3 defibrillations
-
we use when lidocaine is not available
-
. in recurrent PEA we give again after 5 defibrillations
Question 94
Question
For the reversible causes of cardiac arrest, do not:
Question 95
Question
The cerebral blood flow (CBF) and brain oxygen supply depend on the brain's perfusion pressure(CPP), which we pour out:
Answer
-
CPP = CVP + ICP
-
CPP = MAP- ICP
-
CPP = CVP- ICP
-
CPP = PCWP-I CP
Question 96
Question
In the treatment of increased intracranial pressure > 20mmHg does not include:
Question 97
Question
A patient's COPD test usually shows
Answer
-
Hypocrisy
-
hypercapnia
-
Hypoxia
-
Hypoxia and hypocapnia
Question 98
Question
Depression of the circulatory system during the induction of intravenous anaesthesia is mainly caused by:
Answer
-
Propofol
-
Fentanyl
-
Atropine
-
Reccuronium
Question 99
Question
Local aesthetic agents are compounds of:
Answer
-
acid
-
alkaline
-
all of the above
-
none of the above
Question 100
Question
Under epidural anesthesia, the extent of the anesthesia obtained depends mainly on:
Answer
-
The position of the patient during the administration of the local anasthetic
-
Anesthetic concentrations
-
The volume of the anesthetic agent given
-
Adjuqants administered together with the drug for local anesthesia
Question 101
Question
Consequences regarding subarachnoid anaesthesia include:
Question 102
Question
We observe the monitoring of tissue perfusion by assessing:
Question 103
Question
In the treatment of pain, the administration of analgesics is standard:
Answer
-
After transporting the patient to the recovery rooms
-
Anticipating the appearance of pain
-
After the patient reports discomfort and pain
-
With pain that cause blood pressure to rise
Question 104
Question
Subarachnoid spinal anaesthesia is possible at the level of the spine
Answer
-
Th12 - L1
-
L1- L2
-
L3-L4
-
S1-S2
Question 105
Question
For the treatment of sepsis, immediate surgical control of the outbreak is always recommended, with the exception of:
Question 106
Question
In the ICU patient with suspected pre-hospital pulmonary infections, the following diagnostic tests should be performed:
Answer
-
chest x-ray
-
) microbiological culture of bronchial tree and blood secretion and examination for legionella infection in the direction of chlamydia and mycoplasma from blood, for pneumococcal infection with blood or urine, sputum test or throat swab for viral infection by PCR in justified cases
-
blood biochemistry including markers of inflammation (leukocytosis, PCT, CRP)
-
all the answers are true
Question 107
Question
Prevention of pneumonia in mechanically ventilated patients (VAP) is carried out through:
Answer
-
elevating the head of the bed at an angle of 30-50 degrees
-
vacuum suction and pressure control in the intubation / tracheotomy tube balloon
-
decolonizing the oral cavity with disinfectants
-
all the answers are true
Question 108
Question
You collect an interview and examine a patient admitted to the emergency care system of your hospital diagnosed with STEMI. The patient is monitored (NIBP, EKG, SpO2), has peripheral venous access, receives oxygen therapy, awaits surgery, in the hemodynamic laboratory. During the examination, the patient loses consciousness, and on the cardiomonitator you can see the VF record. Give the order of handling.
Answer
-
you alert the duty team, you implement external heart massage, you defibrillate as soon as possible
-
you implement external cardiac massage, as soon as you perform intubations, and then defibrillation
-
you alert the duty team, you implement external heart massage, as soon as you give 1mg of adrenaline
-
you alert the duty team, implement the external cardiac massage, as soon as you perform intubations
Question 109
Question
A 68-year-old patient with a ruptured abdominal aortic aneurysm HR 120/min, BP 80/40, SpO2 95% without passive oxygen therapy requires immediate laparotomy. What drug do you choose to induce anaesthesia?
Answer
-
ketamine
-
propofol
-
thiopental
-
midazolam
Question 110
Question
The inotropically positive drug of the first choice in the treatment of septic shock is
Answer
-
dopamin
-
dobutamine
-
adrenaline
-
dopexamine
Question 111
Question
The leading cause of cardiac arrest in children is:
Answer
-
Respiratory problem
-
Circulatory problem
-
Congenital heart failure
-
Trauma
Question 112
Question
The capnogram below is a sign of:
Question 113
Question
Indicate a false statement about central venous pressure (CVP)
Answer
-
This is the average pressure measured in the left atrium
-
The CVP measurement is performed using a zonal central catheter
-
It evaluates the vascular vessel fill and the assessment of the pre-load of the right ventricle
-
Valid values 0-5 mmHg
Question 114
Question
Which of the following clinical conditions does not cause a shift in the haemoglobin dissociation curve to the left?
Question 115
Question
The trunk reactions evaluated in the second stage of recognition of the brainstem death in Poland are listed below with the exception
Answer
-
Lack of cerebrovascular reflex
-
Lack of corneal reflex
-
Lack of temperature sensation
-
Lack of motor reactions to a painful stimulus
Question 116
Question
In an adult patient with SCC with clinical features of brain death, in order to find a permanent and irreversible cessation of brain function (brain death) one should:
Answer
-
after at least a 6-hour pre-observation period, two series of clinical trials should be performed with an interval of 12 hours
-
after at least a 24 - hour observation period, two series of clinical trials should be performed with an interval of 6 hours
-
in this case, brain death must be confirmed in EEG or cerebral artery angiography
-
after a minimum of 12 hours of preliminary observation, two series of clinical trials should be performed 24 hours apart
Question 117
Question
After defibrillation, continuing CPR (cardiopulmonary resuscitation) the first drug that can be administered is:
Answer
-
lidocaine
-
morphine
-
adrenaline
-
magnesium sulphate
Question 118
Question
Before diagnosing brain death, exclude EXCEPT
Question 119
Question
A 55-year-old man after successful CPR is admitted to the ICU. No data from the interview. The patient intubated, ventilated mechanic FIO2 O.6, creaks and croaking over the pulmonary fields. Due to the persistent hypotension with symptoms of hypo perfusion, a catheter was introduced into the pulmonary artery with the following values
SvO2 = 45%
CI = 2.2 L / min / M2
PAOP = 19 mm H
The most likely cause of this condition is:
Answer
-
Left ventricular failure
-
Isolation with fluid
-
sepsis
-
aspiration pneumonia
Question 120
Question
You are called to the Hospital Rescue Department to an 18-year-old man brought by the Emergency Service Team after a traffic accident. The patient is unconscious, has a cool, pale, sweaty skin, cyanosis of lips and respiratory effort is visible 30 shallow breaths / min, the pulse on the radial artery is present, filamentous about 120min. The cervical veins are over-filled, the trachea is moved to the right. The thorax cage moves asymmetrically, with a lack of breathing noise on the left. The most probable diagnosis is
Answer
-
cardiac tamponade
-
pneumothorax
-
massive pleural hematoma
-
closed pneumothorax
Question 121
Question
The following clinical conditions are associated with hypokalaemia, EXCEPT
Question 122
Question
Continuous renal replacement therapy (CRRT) it is used to:
Question 123
Question
During rescue compressions the change occurs:
Question 124
Question
What dose of lidocaine in cardiac arrest:
Answer
-
1 mg / kg
-
1.5mg / kg
-
150mg
-
1 mg UV
Question 125
Question
as you can not see the arches of the palate, what is the degree on the Mallapati scale?
Question 126
Question
The level of lactate typical for shock is:
Question 127
Question
How to calculate CO:
Answer
-
HR × BP
-
HR x SVR
-
BO x SVR
-
HR x SV
Question 128
Question
What drug we can give the earliest after defibrillation in the skin and...
Answer
-
adrenalin
-
morphine
-
lidocaine
-
NaHCO3
Question 129
Question
Calculate cerebral blood flow, all parameters given: CV, HR, saturation, pressure, MAP 65, intracranial pressure 20
Question 130
Question
pH = 7.22; PaCO2 = 55; HCO3- = 25
What is it?
Answer
-
Non compensated respiratory acidosis.
-
Non compensated respiratory alkalosis.
-
Non compensated metabolic acidosis.
-
Non compensated metabolic alkalosis.
Question 131
Question
The latest complete definition of septic shock is as follows
Answer
-
Septic shock is defined as sepsis in which circulatory and cellular / metabolic disorders are so high that they significantly increase mortality. Patients in septic shock are diagnosed based on an occurrence
1) clinical symptoms of sepsis
2) persistent hypotension requiring vasopressor treatment to support MAP> 65 mmHg and serum lactate> 2mmol / L
-
Septic shock is defined as sepsis in which circulatory and cellular / metabolic disorders are so high that they significantly increase mortality. Patients in septic shock are diagnosed based on an occurrence
1) clinical symptoms of sepsis
2) hypotension requiring treatment with vasopressors to support MAP> 65 mmHg
-
Septic shock is defined as sepsis in which circulatory and cellular / metabolic disorders are so high that they significantly increase mortality. Patients in septic shock are diagnosed based on an occurrence
1) hypotension requiring treatment with vasopressin to support MAP> 85 mmHg and
2) serum lactate> 2.5mmol / L
-
Septic shock is defined as sepsis in which circulatory and cellular / metabolic disorders are so high that they significantly increase mortality. Patients in septic shock are diagnosed based on an occurrence
1) clinical symptoms of sepsis
2) persistent hypotension requiring treatment with vasopressors for maintenance
systolic pressures> 100mmHg and serum lactate> 2.5mmol / L
Question 132
Question
In the study of placebo effect the highest decrease of pain intensity was observed in:
a. Open (expected) injection of analgetic
b. Hidden (unexpected) injection of analgetic
c. No difference between both interventions
d. Hidden injection was effective in neuropathic pain only
Question 133
Question
What kind of treatment is not used in the postoperative pain theory:
a. Epidural blockade
b. Intrapleural blockade?
c. Spinal blockade
d. Neurolytic blockade
Question 134
Question
Which of the following agents is an inotrope?
a. Metoprolol
b. Milrinone
c. Diltiazem
d. Ramipril
Question 135
Question
1. The patient is admitted with cardiogenic shock and oliguric acute kidney injury. Hemodynamics reveal the following: BP 105/60 mmHg, sinus rhythm 108/min, CI 1.8 (CO 2.4), CVP 23 mmHg, PCWP 25 mmHg, SVRI 2088 (SVR 1566). The most appropriate management is administration of:
a. Captopril 6.5 mg q6h
b. Dobutamine at 5 mcg/kg/min
c. Metoprolol 25 mg BID
d. Dopamine at 2 mcg/kg/min
Question 136
Question
Clopidogrel is classified as an:
a. Inhibitor of platelets’ aggregation
b. Factor Xa inhibitor
c. Vit. K antagonist
d. Anti-hypertensive
Question 137
Question
Dabigatran (Pradaxa) is classified as an:
a. Factor Xa inhibitor
b. Direct thrombin inhibitor
c. Inhibitor of platelets’ aggregation
d. Vit. K antagonist - warfarin
Question 138
Question
Which of the following information is TRUE about naloxone?
a. Naloxone is a pure opioid antagonist that competitively binds to u-opioid receptors
b. Naloxone has a short duration of activity about 30 to 90 minutes
c. No tolerance or dependence is associated with naloxone use
d. All information are true
Question 139
Question
In the Sepsis Six algorithm of severe sepsis treatment, Step 1 is:
a. 1000 mL crystalloids infusion
b. 100% oxygen via mask
c. Intravenous antibiotics
d. Dopamine IV
Question 140
Question
A patient with a spinal abscess is admitted to the ICU in septic shock and requires pressors. Which of the following agents would be most efficacious for increasing cardiac output while increasing mean arterial pressure (MAP)?
a. Digoxin
b. Phenylephrine
c. Dopamine
d. Norepinephrine (Noradrenaline)
Question 141
Question
Atypical bacterial pathogens that are associated with community-acquired pneumonia (CAP) include:
a. Chlamydia pneumoniae
b. Haemophilus influenzae
c. Streptococcus pneumoniae
d. Moraxella catarrhalis
Question 142
Question
CVP monitoring:
a. Indicated hypovolemia when CVP is low
b. Allows assessment of preload of the heart
c. May not reflect left heart filling pressures in patients with COPD
d. All are true
Question 143
Question
Which ONE of the following statements about vasoactive drugs is FALSE:
a. Adrenaline (epinephrine) has alpha and beta receptor agonist activity
b. Noradrenaline (Norepinephrine) is a vasoconstrictor
c. Dopamine has a specific renal protective action in critical care patients at risk of renal failure
d. Dobutamine is a systemic and pulmonary vasodilator
Question 144
Question
Which ONE of the following statements about PCWP (PAOP) is TRUE:
a. Measurement involves passage of pulmonary artery catheter across the interarterial septum
b. Is typically raised in ARDS
c. Is typically raised in septic shock
d. Is a reflection of left atrial pressure
Question 145
Question
Quantitative measurement of cardiac output can be made using all methods except:
a. An esophageal Doppler probe
b. Thermodilution techniques
c. Mixed venous saturation (SvO2) and heart rate
d. The Fick principle
Question 146
Question
Which ONE of the following statements about cardiogenic shock is FALSE:
a. Is characterized by inability of the heart to maintain the circulation
b. Is characterized by a low systemic vascular resistance
c. Can be caused by papillary muscle rupture
d. Is characterized by low cardiac output
Question 147
Question
The following are risk factors for pulmonary embolism except:
a. Immobilization after surgery
b. Clinically suspected DVT
c. Malignancy
d. Heart LBBB
Question 148
Question
Factors influencing preload are all except:
a. Atrial contraction
b. Systemic vascular resistance
c. Heart valves diseases
d. Intrathoracic pressure
Question 149
Question
Positive end-expiratory pressure can contribute to:
a. Increase in systemic venous return
b. FRC increase (prevention of airway collapse)
c. Decrease in airway pressure
d. Increase in work of breathing
Question 150
Question
Infant CPR should be considered for what age?
a. Under 6 months
b. Under 12 months
c. Under 18 months
d. Under 24 months
Question 151
Question
1. Criteria regarding apnea testing during brain death examination requires:
a. Hypoxemia below a specified PaO2 must be achieved to assure that no CNS hypoxia-sensing centers are active
b. A specified degree or change in blood pH (acidemia)must be achieved to confirm medullary respiratory center inactivation
c. Arterial PaCO2 must reach or exceed a specified level above baseline
Question 152
Question
The diagnosis of brain death:
a. Is primarily clinical and no other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and apnea tests, is conclusively performed - (Glasgow Coma Scale of 3, lack of brainstem derived reflexes, apnea test)
b. Ancillary instrumental tests are needed only in patients in persistent vegetative state
c. Always needs confirmation by ancillary instrumental tests (EEG, evoked potentials, cerebral angiography, transcranial Doppler, perfusion scintigraphy)
Question 153
Question
These are circulatory criteria for death except:
a. Loss of consciousness
b. Apnea
c. Loss of pulse on big arteries (carotid, femoral)
d. Stiffness
Question 154
Question
These are criteria for brain death except:
a. Loss of consciousness
b. Loss of all neurological reflexes
c. Loss of brainstem reflexes
d. Loss of capacity to breathe
Question 155
Question
During diagnosis of brain death the following brainstem reflexes are examined except:
a. Nasocranial
b. Oculocephalic
c. Vestibulo-ocular
d. Corneal
Question 156
Question
Identify the formula for minute volume:
a. Tidal volume X respiratory rate
b. Cardiac output X respiratory rate
c. Forced vital capacity X respiratory rate
d. Functional residual capacity – tidal volume
Question 157
Question
Administration of an agonist for which of the following autonomic receptors would be expected to cause airway resistance to decrease?
a. Histaminic
b. Cholinergic
c. Alpha-adrenergic
d. Beta-adrenergic
Question 158
Question
Immediately following intubation, the patient has an end tidal CO2 reading of 1 mmHg. This finding is consistent with:
a. Pulmonary embolism
b. Right mainstem bronchus intubation
c. Esophageal intubation
d. Correct placement of endotracheal tube
Question 159
Question
What is the PRIMARY purpose of preoxygenation (denitrogenation) prior to anesthetic induction?
a. Improving matching of ventilation and perfusion
b. Increasing oxygen reserve in the functional residual capacity
c. Increasing contribution of second gas effect to rate of induction
d. Maximizing arterial oxygen content
Question 160
Question
Two hours after a laparoscopic cholecystectomy, and obese 45-year-old woman is receiving intravenous patient-controlled analgesia with morphine. Her SpO2 is 92% on room air. Which of the following is the most likely cause?
a. Absorption of carbon dioxide from the abdomen
b. Increased dead space
c. Impaired oxygen diffusion
d. Hypoventilation
Question 161
Question
Use of a laryngeal mask airway during general anesthesia is most appropriate for which of the following patients?
a. A patient undergoing cesarean delivery who cannot be intubated after induction of anesthesia
b. A patient who has trachoesophageal fistula
c. A patient who has a peak inspiratory pressure greater than 30 cmH2O
d. A patient who requires emergency appendectomy 2 hours after eating
Question 162
Question
A patient has received atropine 1% eye drops after eye surgery. How many milligrams of atropine are in one drop of a 1% solution? 1 mL = 20 drops.
a. 0.05 mg
b. 0.1 mg
c. 0.5 mg
d. 1 mg
Question 163
Question
Which ONE of the following statements about postintubation croup is FALSE:
a. Almost always appears within 3 doses after intubation
b. Is associated with repeated intubation attempts
c. Is associated with early childhood
d. The only effective treatment is urgent trachestomy
Question 164
Question
Which ONE of the following statements about pediatric patients is FALSE:
a. Fluid deficits in infants are usually replaced with 5% glucose
b. Infants respond to dehydration with decreased blood pressure but without tachycardia
c. The cardiac output of neonates and infants is dependent on heart rate, since stroke volume is relatively fixed
d. Postoperative hypothermia in pediatric patients is associated with delayed awakening and respiratory depression
Question 165
Question
Risk Factors for bronchial aspiration like oesophageal hiatus , diabetes with stomach atony, obesities , pregnancy :
a. are indications to RSI ( Rapid sequence induction )
b. are absolute contraindication to general anaesthesia
c. do not constitute major aesthetic problem , because some of them are physiology .
d. do not present a problem if the patient is fasting for six hours before anaesthesia .
Question 166
Question
intravascular volume changes , electrolyte disturbances , anaemia are typical problem for the patient with :
a. Diabetes
b. Liver failure
c. Chronic renal failure
d. Hyperthyrodism
Question 167
Question
calcium homeostasis malfunction in sarcoplasmic reticulum of skeletal muscle , related to some anaesthetic usage can lead to :
a. Propofol syndrome .
b. Malignant hyperthermia .
c. Pheochromocytoma .
d. Takotsubo cardiomyopathy .
Question 168
Question
Capnography is used as
1. an indicator of adequacy of ventilation .
2. disconnection indicator .
3. an indicator of correct placement of tracheal tube .
4. an indicator of cardiac output .
a. All answers are true .
b. 4 is false .
c. 2 and 4 are false .
d. 1 is true .
Question 169
Question
how many fluids should be infused in the first hour of treatment of septic shock in children :
a. fluids are not important for this kind of treatment
b. 10 ml/kg/h
c. 20 ml/kg/h
d. 10-20 ml/kg / 20 min ( up to 60 ml/kg/h)
Question 170
Question
Which kind of approach of epidural block can be used in children :
a. thoracic and lumbar
b. cervical , thoracic and lumbar
c. thoracic , lumbar and sacral
d. only sacral
Question 171
Question
Hemodynamically stable 70 kg , 40 year old man with adult respiratory distress syndrome is being mechanically ventilated with the following settings :
Tidal volume 500 ml , Respiratory rate 12/ min. FiO2 0.80 , I:E ratio 1:2 positive , end- expiratory pressure 5 cmH2O
Analysis of arterial blood gases shows PaO2 50 mmHG , PaCO2 40 mmHG , and pH 7,42 , Which of the following changes in ventilators settings is most appropriate :
a. increase FiO2
b. increase positive end-expiratory pressure
c. increase tidal volume
d. increase ventilatory rate
Question 172
Question
Vasoconstrictors decrease the rate of vascular absorption which allows more anaesthetic to reach the nerve membrane and improved the depth of anaesthesia :
a. 1:200000 ( dosage 5 µg/ml ) epinephrin appear to be the best vasoconstrictor .
b. 1:20000 ( dosage 5 µg/ml ) epinephrin appear to be the best vasoconstrictor .
c. 1:200000000( dosage 5 µg/ml ) epinephrin appear to be the best vasoconstrictor .
d. 1:200 ( dosage 5 µg/ml ) epinephrin appear to be the best vasoconstrictor .
Question 173
Question
Vascular disease, Asymptomatic myocardial ischemia , Neuropathic sensation disturbances, Gastric atony , Chronic renal failure is common problems in patient with
a. Thyroid disorder .
b. Adrenal cortical disease .
c. Diabetes .
d. Addison disease .
Question 174
Question
The aim of early goal directed therapy in severe septic shock is to reach urine output ( ml/kg/h) values :
a. > 0.1
b. > 0.5
c. > 1.0
d. > 2.0
Question 175
Question
The dosage of hydrocortisone for septic shock is :
a. 100-200 mg iv daily
b. 200-300 mg iv daily
c. 200-300 mg 3 x day
d. 2000-3000 mg daily
Question 176
Question
The false is the statement about positive end-expiratory pressure ( PEEP )
a. PEEP increases functional residual capacity .
b. Hepatic and renal blood flow is increased with higher levels of PEEP .
c. PEEP application increases intrathoracic pressure diminishing venous return to the right heart .
d. An observed increase in lung compliance suggest alveolar recruitment .
Question 177
Question
Effective methode to decrease an elevated PaCO2 may include all of the following Except :
a. increase tidal volume
b. increase frequency
c. decrease circuit dead space
d. increase PEEP
Question 178
Question
High central venous pressure , low blood pressure and acute circulatory failure are founding in following condition except :
a. Tension pneumothorax .
b. Pulmonary embolism .
c. Venous air embolism .
d. Haemorrhage .
Question 179
Question
Lung compliance is increased in :
a. The presence of intra-alveolar fluid .
b. ARDS .
c. Idiopathic pulmonary fibrosis .
d. Emphysema .
Question 180
Question
1. Decreased ETCO2 can be noted in :
a. Hyperthermia .
b. Muscular activity .
c. Partial airway obstruction .
d. Hypoperfusion .
Question 181
Question
Sellick manuver during rapid sequence induction ( RSI ) is :
a. 3 - 5 min pre-oxygenation .
b. Anaesthetics and Succinylcholine ( ev . rocuronium ) iv. injection .
c. Cricoid pressure to occlude oesophagus .
d. Combitube insertion .
Question 182
Question
False is the sentence determining Sevoflurane properties :
a. Sevoflurane decreases intracranial pressure .
b. During the maintenance of anaesthesia increasing the concentration of the sevoflurane produce dose dependent decrease in blood pressure .
c. Sevoflurane produces more profund respiratory depression at high MAC .
d. The use may be a cause of malignant hyperthermia .
Question 183
Question
a patient with administrated epidural anaesthesia with 15 ml of 0.5% bupivacaine with adrenaline for hernia surgery , he developed hypotension and respiratory depression within 3 minutes after drug administration , the commonest cause would be :
a. Allergy to drug administrated .
b. Systemic toxicity to drug administrated .
c. Vasovagal shock .
d. Drug has entered subarachnoid space .
Question 184
Question
The false statement about propofol is :
a. Is suspended in an emulsion of soya bean oil .
b. Has a little effect on the cardiovascular system .
c. Impairs ventilatory response to CO2
d. Can give the pain during injection .
Question 185
Question
Concerning analgesic drugs :
a. Paracetamol is an anti-inflammatory drug .
b. Paracetamol cause gastric irritation
c. Metamizol can cause agranulocytosis .
d. Tramadol has anti-emetic properties
Question 186
Question
Drugs given to epidural space include all except :
a. Clonidine
b. ketamine
c. Sufentantil
d. Norepinephrine
Question 187
Question
Which of anaesthetic gas can be used for induction of anaesthesia :
a. Desflurane
b. Isoflurane
c. Sevoflurane
d. Nitric oxide
Question 188
Question
1. A lung-protective ventilation strategies includes:
A. High positive end-expiratory pressure (PEEP)
B. Use of volume-controlled ventilation (VCV), which achieves a lower peak airway pressure than pressure-controlled ventilation (PCV) for the same tidal volume
C. A large (10-12 ml/kg) tidal volume to avoid atelectasis
D. Maintenance of strict PaCO2 control to avoid acidosis
Question 189
Question
1. What is the main reason of insertion of central line in children :
a. taking sample of blood for daily analysis
b. the need for parenteral nutrition
c. the measurement of hemodynamic parameters
d. ALL OF ABOVE
Question 190
Question
Opioids :
a. Are contraindicated during regional anaesthesia
b. May cause Apnea
c. Increase the frequency of heart contraction
d. Do have anaesthetic , but not analgesic properties
Question 191
Question
60 year old man , scheduled for CABG surgery , with the symptoms of unstable coronary artery disease , arterial pressure of 140/80 and well controlled diabetes on oral medications , has the risk of anaesthesia in ASA score :
a. ASA 2
b. ASA 3
c. ASA 4
d. ASA 5
Question 192
Question
Which one of the following is most likely to be associated with a high mixed venous oxygen saturation SvO2 :
a. Acute myocardial infarction
b. Acute pulmonary embolism
c. Cardiac temponade
d. Sepsis
Question 193
Question
The agent of reversal of neuromuscular blockade is :
a. dantrolen
b. levosimendan
c. sugammadex
d. nimbex
Question 194
Question
Rank the various Opioids according to their duration action from the longest to the shortest :
a. alfentanil , fentanil , remifentanil , morphine
b. morphine , alfentanil , fentanil , remifentanil
c. morphine , alfentanil , remifentanil , fentanil
d. morphine , fentanil , alfentanil , remifentanil
Question 195
Question
Cardiac arrhythmia is frequent manifestation of hypokalemia , which of the following does not cause hypokalemia :
a. metabolic acidosis
b. magnesium deficit
c. diarrhoea
d. furosemide
Question 196
Question
Factor increasing ETCO2 is :
a. Sepsis
b. exogenous CO2 absorption ( laparoscopy )
c. i.v bicarbonate administration ( transient )
d. all above
Question 197
Question
Indication for giving calcium during CPR ( adults ) are :
(a) hyperkalemia
(b) hypokalemia
(c) hypercalcaemia
(d) overdose of calcium channel-blocking drugs
a. a , b , c ,d
b. a , b , c
c. a , b , d
d. a , d
Question 198
Question
In the sepsis six algorithm of severe sepsis treatment step 3 is :
a. hydrocortisone 300 mg i.v
b. epinephrine 1 mg i.v
c. intravenous antibiotics within the first hour
d. 500 ml of colliods infusion
Question 199
Question
In the sepsis six algorithm of severe sepsis treatment step 6 is :
a. central venous catheterization and CVP monitoring
b. urine output monitoring
c. checking lactate level
d. checking pulseoxymetry
Question 200
Question
the pulmonary artery wedge pressure ( PAWP ) may be used as surrogate of the left atrial pressure and therefore , LVEDP :
a. both parts in the sentence are true
b. both parts in the sentence are false
c. first part of the sentence is true and second is false
d. first part of the sentence is false and second is true