284 questions match your search.

ADVANCED Respiratory & Critical Care General

A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment?


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ADVANCED General

A 19-year-old college student is brought to the emergency department cyanotic and incoherent. Respiratory rate is 48/min, pulse is 140 bpm, and blood pressure is 140/85 mmHg. The only history obtainable is that he was at a party and suddenly felt sick. Cyanosis persists despite administration of pure oxygen by mask. A venous blood sample is chocolate-brown. The action most beneficial to the patient is to


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BASIC General

Each of the following statements about the anatomy of the autonomic nervous system is true EXCEPT:


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BASIC General

A healthy 60-kg 52-year-old woman undergoing reduction mammoplasty is anesthetized with isoflurane and oxygen, and deliberate hypotension to 80/40 mmHg is induced with nitroprusside. Urine output through an indwelling urethral catheter has been 10 mL during the past hour. You should now


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BASIC Pharmacology & Pharmacokinetics General

Which of the following must be considered during perioperative management of a patient on long-term lithium therapy?


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BASIC General

During general anesthesia, a patient has the acute onset of atrial fibrillation with rapid ventricular response and hypotension to 50 mmHg systolic. The most appropriate treatment is


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BASIC Respiratory & Critical Care General

Which of the following is the most appropriate initial management of a patient with hypotension secondary to sepsis?


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ADVANCED General

Which of the following is the most sensitive indicator of impending renal failure following trauma?


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BASIC General

Which of the following is increased in patients with chronic anemia?


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ADVANCED Respiratory & Critical Care General

Following pneumonectomy, a paralyzed patient being mechanically ventilated has the following arterial blood gas values: PaO2 71 mmHg, PaCO2 55 mmHg, pH 7.29. SvO2 is 45%. The most likely explanation for this SvO2 is


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ADVANCED Respiratory & Critical Care General

Two days after total abdominal hysterectomy, a 54-year-old woman develops lethargy followed by seizures and coma. Laboratory studies show a serum sodium concentration of 108 mEq/L and serum osmolality of 225 mOsm/kg. The most appropriate next step in management is administration of which of the following?


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ADVANCED General Cardiac

A 68-year-old man has a permanent DVI pacemaker that has been functioning appropriately. Which of the following is most likely to cause conversion to VOO pacing?


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ADVANCED General

A 75-year-old man is confused, restless and disoriented two days after an aortic aneurysm repair. Serum sodium concentration is 112 mEq/L, serum osmolality is low, and urine is hypertonic. The most appropriate treatment is


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BASIC Pharmacology & Pharmacokinetics General

A patient develops jaundice one week after undergoing laparoscopic cholecystectomy during halothane anesthesia. Laboratory studies show an increased serum alkaline phosphatase concentration, a mildly increased serum aspartate aminotransferase concentration, and a markedly increased conjugated bilirubin fraction. Which of the following is the most likely diagnosis?


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BASIC Respiratory & Critical Care General

Pulsus paradoxus is commonly seen during anesthesia in patients with each of the following conditions EXCEPT


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BASIC Transfusions & Fluids General

A 48-year-old woman with von Willebrand's disease is scheduled for a hysterectomy. The most appropriate initial preoperative therapy to decrease bleeding is administration of


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BASIC General

During anesthesia with nitrous oxide and isoflurane in a 70-kg, 25-year-old patient, airway resistance would be decreased by


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BASIC General

Which of the following is the most effective treatment of shivering following general anesthesia?


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BASIC General

A 40-year-old man is undergoing open reduction and internal fixation of a fractured femur. During anesthesia with fentanyl, sevoflurane, and oxygen, heart rate decreases to 20 bpm and 6 premature ventricular contractions per minute are noted. No pulse is detected. The most appropriate next step is to


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ADVANCED Respiratory & Critical Care General

A 120-kg 56-year-old man undergoing gastrectomy during anesthesia with fentanyl and isoflurane has a PetCO2 of 35 mmHg and a PaCO2 of 50 mmHg. His FEV,/FVC ratio is 80% of predicted. Heart rate is 120 bpm and arterial blood pressure is 80/40 mmHg. Which of the following is the most likely cause of the difference in PaCO2 and PetCO2?


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BASIC General

Which of the following processes is primarily responsible for the decrease in core body temperature that occurs during the first hour of general anesthesia?


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ADVANCED Respiratory & Critical Care General

A 50-year-old woman develops stridor 10 hours after undergoing thyroidectomy. The most appropriate management is administration of which of the following drugs?


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ADVANCED General Cardiac

You are called to anesthetize a patient for an emergency pericardial window for a large pericardial effusion. Which of the following drugs is most appropriate for initiation of anesthesia?


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BASIC Respiratory & Critical Care General

A patient has decreased lung compliance and hypoxemia after a 30-minute episode of laryngospasm following extubation. The most likely cause is


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ADVANCED General

Which of the following postoperative treatments decreases the risk for deep venous thrombosis?


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BASIC General

A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is trauma to which of the following structures on the left?


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BASIC General Regional & Pain

A 30-year-old man receives spinal anesthesia to the level of T4. Ten minutes later, heart rate and blood pressure abruptly decrease to 30 bpm and 60/25 mmHg, respectively. The most appropriate management is administration of which of the following drugs?


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ADVANCED Respiratory & Critical Care General

The acute onset of hypotension without a decrease in mixed venous oxygen saturation is most likely associated with the onset of


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BASIC General

Which of the following is the most common initial manifestation of malignant hyperthermia?


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ADVANCED General

Compared with healthy nonhypertensive patients, in patients with untreated hypertension undergoing anesthesia and operation,


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BASIC Respiratory & Critical Care General

Initiation of positive pressure mechanical ventilation is LEAST likely to decrease cardiac output in patients with which of the following conditions?


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ADVANCED General Cardiac

Four days after mitral valve replacement, a 49-year-old, 70-kg woman who has had oliguric renal failure since the operation requires insertion of a Schribner shunt for hemodialysis. Her BUN concentration is 104 mg/dl, serum creatinine is 9.3 mg/dl, serum sodium is 130 mEq/L, and serum potassium is 6.7 mEq/L. During the operation under local anesthesia, diazepam 7.5 mg and morphine 10 mg are administered intravenously to control agitation. Five minutes later while she is sleeping quietly, unifocal premature ventricular contractions appear at a rate of 10 per minute on the ECG monitor. The most appropriate therapy is to


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ADVANCED General

Six hours after coronary artery bypass grafting, a pulmonary artery catheter oximeter shows a mixed venous hemoglobin oxygen saturation of 50%. This value may result from each of the following EXCEPT


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BASIC General

A patient with a fasting blood glucose concentration of 100 mg/dl undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be


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ADVANCED General Regional & Pain

A patient has hoarseness after undergoing surgery involving the aortic arch. The most likely cause is an injury to which of the following nerves?


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BASIC General

A 36-year-old woman who undergoes peritoneal dialysis for chronic renal failure requires emergency surgical exploration for bowel obstruction. Serum creatinine concentration is 9.8 mg/dl and BUN concentration is 124 mg/dl. The most likely abnormality of coagulation is


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ADVANCED General

Preoperative administration of an alpha-adrenergic blocker for 10 days to patients with pheochromocytoma will decrease


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BASIC Respiratory & Critical Care General

During a cardiac arrest with effective chest compression and positive-pressure ventilation, 50 mEq of sodium bicarbonate is administered. Which of the following is the most likely result?


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ADVANCED General Cardiac

Nitroprusside therapy for hypertension should be discontinued in the presence of


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ADVANCED General Regional & Pain

Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both feet and ankles. The most likely diagnosis is


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BASIC General Cardiac

An EKG shows ventricular tachycardia in a patient with a heart rate of 160 bpm and a blood pressure of 90/60 mmHg. The best initial therapeutic maneuver prior to cardioversion is


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ADVANCED General

A 30-year-old man is brought to the emergency department after being rescued from a house fire. With the trachea intubated and FiO2 at 1.0, arterial blood gas values are PaO2 495 mmHg, PaCO2 28 mmHg, and pH 7.28. Hemoglobin saturation measured by co-oximeter is 50%. The most appropriate next step is to


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ADVANCED Respiratory & Critical Care General

Which of the following statements regarding carbon monoxide poisoning is true?


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BASIC General

A patient being mechanically ventilated in the ICU requires wound debridement twice daily. Each of the following agents would be appropriate for induction of brief general anesthesia EXCEPT


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ADVANCED General

Patients with acute alcohol intoxication are at increased risk for each of the following complications of general anesthesia EXCEPT


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ADVANCED General

Each of the following would be expected in an otherwise healthy 165-kg woman undergoing cholecystectomy EXCEPT


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BASIC Respiratory & Critical Care General

Which of the following results in decreased mixed venous oxygen saturation?


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ADVANCED General

During transurethral resection of the prostate, intravascular absorption of glycine irrigant most commonly produces


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ADVANCED Pharmacology & Pharmacokinetics General

Each of the following improves coagulation in patients with uremia EXCEPT


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ADVANCED Equipment & Physics Respiratory & Critical Care General

During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?


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ADVANCED General Cardiac

A 69-year-old woman with mitral stenosis and atrial fibrillation is scheduled for mitral valve replacement and removal of a left atrial thrombus. After administration of pancuronium, heart rate increases to 140 bpm and blood pressure decreases to 70/40 mmHg. Which of the following is the LEAST appropriate treatment?


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BASIC General

During induction of anesthesia, a 56-year-old man with small bowel obstruction vomits a large quantity of undigested food particles and presumably aspirates. After instituting ventilation with pure oxygen, the most appropriate management is to


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ADVANCED Pharmacology & Pharmacokinetics General

A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?


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ADVANCED General Cardiac

A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?


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BASIC General

Which of the following remains normal in an otherwise healthy patient with obesity?


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ADVANCED General

An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin concentration of 1.5 mcg/ml. Five minutes after induction of general anesthesia, ventricular bigeminy is noted; blood pressure is 85/65 mmHg, SpO2 is 97%, and PetCO2, is 20 mmHg. Which of the following is the most appropriate management?


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ADVANCED General Cardiac

In the absence of coronary artery disease, isoflurane-induced vasodilation and tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases?


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ADVANCED Pharmacology & Pharmacokinetics General

A 70-year-old man who has just undergone an abdominal aortic aneurysm repair under halothane anesthesia develops hypertension, dyspnea, and cyanosis shortly after awakening in the recovery room. Administration of furosemide 20 mg intravenously improves the cyanosis within 10 minutes. This immediate effect of furosemide is best explained by


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BASIC General

Which of the following is an effect of magnesium sulfate at the neuromuscular junction?


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ADVANCED General

Which of the following is a complication of glycine used for irrigation during transurethral resection of the prostate?


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ADVANCED General

DC shocks of 200 joules applied directly to the heart are likely to


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BASIC Respiratory & Critical Care General

Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia?


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ADVANCED Respiratory & Critical Care General

Following a right lower lobectomy, a patient develops a bronchopleural fistula and becomes hypoxic. He is orally intubated and mechanically ventilated with pure oxygen. PaO2 is 65 mmHg, PaCO2 is 70 mmHg, and pH is 7.25. Which of the following will produce the most favorable change in the blood gases?


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ADVANCED General

Each of the following is an effect of electroconvulsive therapy EXCEPT


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BASIC General

The human immunodeficiency virus (HIV)


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BASIC General

The acute onset of hypotension without a decrease in mixed venous oxygen saturation is most likely associated with the onset of


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ADVANCED General Cardiac

Which of the following pre-existing conditions predisposes to new-onset third-degree heart block during pulmonary artery catheterization?


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BASIC General

Which of the following complications is more likely to occur during cannulation of the left internal jugular vein than during cannulation of the right internal jugular vein?


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BASIC General Regional & Pain

A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will provide anesthesia of the


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ADVANCED Equipment & Physics General

During laser excision of a vocal cord polyp, the tracheal tube ignites. Which of the following is the most appropriate next step?


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BASIC General

Which of the following cardiovascular abnormalities is LEAST likely to be present in a patient with end-stage alcoholic cirrhosis?


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ADVANCED General

Which of the following situations is most likely related to paraplegia following repair of a descending thoracic aortic aneurysm?


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BASIC General

A patient is in sinus rhythm but has no pulse during cardiopulmonary resuscitation. There is marked resistance to positive pressure ventilation and breath sounds are difficult to hear bilaterally. The endotracheal tube is clearly in the trachea. The most appropriate next step in management is to


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BASIC General

A 77-year-old woman is still intubated and breathing spontaneously following a total hip replacement. The muscle relaxant has been reversed. Tidal volume is 400 ml, end-tidal carbon dioxide tension is 45 mmHg, and SpO2 is 98% at an FiO2 of 1.0. On transfer from the operating table to the gurney, heart rate increases from 65 to 100 bpm and blood pressure decreases from 130/80 to 80/50 mmHg. End-tidal carbon dioxide tension is 30 mmHg and SpO2 is 94%. The most likely diagnosis is


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BASIC General

The most common early indication of drug dependence in an anesthesiologist is


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BASIC Respiratory & Critical Care General Cardiac

Addition of 20 cmH2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by


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ADVANCED General

After the first 70 minutes of a transurethral resection of the prostate, a 70-year-old man becomes confused and has tachycardia, hypertension, and shortness of breath. Serum sodium concentration is 116 mEq/L. After informing the surgeon that the procedure should be terminated as soon as possible, the most appropriate next step would be to


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BASIC Equipment & Physics General

During laser microsurgery of the larynx using an endotracheal tube, a fire occurs in the airway. Which of the following is the most appropriate initial management?


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BASIC General

A morbidly obese patient is to undergo gastric stapling during general anesthesia. Following preoxygenation and induction, the oxygen saturation decreases after 40 seconds of laryngoscopy and attempted intubation. The rapid onset of arterial desaturation is most likely due to


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ADVANCED General

Which of the following statements concerning myasthenia gravis is true?


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ADVANCED General Cardiac

A 63-year-old man with a history of congestive heart failure and left ventricular dilation is scheduled for carotid endarterectomy. During carotid cross-clamping, the surgeon requests that systolic blood pressure be increased from 100 to 160 mmHg. Compared with an identical patient with normal left ventricular size, what is the effect of this change in blood pressure on this patient's myocardial oxygen consumption?


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ADVANCED General

During insufflation of the peritoneal cavity with carbon dioxide at the start of laparoscopy, heart rate increases to 140 bpm, blood pressure decreases to 70/40 mmHg, and a loud murmur is heard through the esophageal stethoscope. The most appropriate immediate step is to


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ADVANCED General

Which of the following statements best describes testing for susceptibility to malignant hyperthermia (MH)?


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ADVANCED Equipment & Physics General Cardiac

Pulmonary artery occlusion pressure


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ADVANCED General

In a patient undergoing liver transplantation, sodium bicarbonate and calcium chloride are administered immediately before reperfusion of the transplanted liver to counteract


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ADVANCED Respiratory & Critical Care General

A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia?


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ADVANCED General

The syndrome of inappropriate ADH secretion is characterized by


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ADVANCED General

A 50-year-old patient undergoes subtotal thyroidectomy for Graves' disease. In the immediate postoperative period, he has marked hoarseness but no stridor. The most likely cause of the hoarseness is trauma to the


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BASIC Pharmacology & Pharmacokinetics General

Each of the following decreases hepatic blood flow EXCEPT


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BASIC General

A 28-year-old woman undergoes total thyroidectomy. The left recurrent laryngeal nerve is transected during the procedure. Which of the following findings is most likely postoperatively?


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ADVANCED Pharmacology & Pharmacokinetics General

Which of the following statements concerning neuroleptic malignant syndrome is true?


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ADVANCED Respiratory & Critical Care General

Which of the following statements concerning carbon monoxide poisoning is true?


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ADVANCED General

A 39-year-old patient with insulin-dependent diabetes mellitus receives thiopental 250 mg and succinylcholine 80 mg and is ventilated with 0.75% isoflurane in oxygen. Arterial pressure decreases abruptly from 140/100 to 80/50 mmHg while heart rate remains unchanged at 70 bpm. Failure of heart rate to increase most likely results from


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ADVANCED General

Which of the following perioperative interventions decreases the risk for renal insufficiency in patients undergoing aortic aneurysm repair?


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BASIC Respiratory & Critical Care General

Systemic hypothermia to 30°C is accompanied by


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ADVANCED General

A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of


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ADVANCED General Cardiac

A 33-year-old woman is scheduled for emergency appendectomy under general anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope in the past year. Which of the following statements concerning anesthetic management is true?


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ADVANCED Equipment & Physics General Pediatric

During laser excision of vocal cord polyps in a 5-year-old boy, dark smoke suddenly appears in the surgical field. The trachea is intubated and anesthesia is being maintained with halothane, nitrous oxide, and oxygen. The most appropriate initial step is to


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BASIC General Neuro

A middle-aged, 70-kg man with a brain tumor is scheduled for an elective craniotomy. Preoperatively, he is alert but papilledema is present. Anesthesia is induced with thiopental 300 mg and succinylcholine 100 mg, followed by tracheal intubation. Immediately following intubation vigorous bucking occurs. The best immediate management would be to


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BASIC General

A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. End-expiratory carbon dioxide tension decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to


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BASIC Pediatric General

Each of the following structures may participate in causing acute bradycardia during strabismus surgery EXCEPT the


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ADVANCED General

A 70-year-old man with mild hypertension and aortoiliac occlusive disease is undergoing aortofemoral bypass grafting. Which of the following interventions is most effective in maintaining renal perfusion during infrarenal aortic clamping?


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ADVANCED General

An elderly man has an acute dissection of the descending thoracic aorta. Which of the following antihypertensive therapies is most likely to extend the dissection?


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ADVANCED General

A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to


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ADVANCED General

A patient has a decrease in heart rate from 80 to 50 bpm and a decrease in blood pressure from 140/90 to 60/40 mmHg while in the recovery room after adrenalectomy for pheochromocytoma. The most appropriate treatment is administration of


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BASIC General

The cardiovascular effects of an inhalational anesthetic are evaluated in 10 normal volunteers in the awake resting state and after 15 minutes of constant inspired concentration. Results were analyzed by t-test for paired data and are presented below as mean +/- standard deviation. Based on these data, which of the following conclusions is most valid?

1993b 86

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BASIC General

Which of the following factors is LEAST predictive of postoperative cardiac complications?


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ADVANCED General

A 40-year-old woman with Graves' disease is undergoing thyroidectomy with 1% isoflurane, 60% nitrous oxide, and oxygen. During surgical manipulation of the thyroid, temperature increases to 38.5°C, heart rate to 160 bpm, and blood pressure to 150/100 mmHg. The most appropriate initial treatment is to


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BASIC General

A 26-year-old man who sustained multiple trauma undergoes open reduction and internal fixation of bilateral tibial-fibular fractures during anesthesia with isoflurane. nitrous oxide, and oxygen with positive pressure ventilation. During the procedure, the patient has sudden onset of hypotension, jugular venous distention, deviation of the trachea to the right, and decreased ventilatory compliance. Isoflurane is discontinued and 100% oxygen is administered. Which of the following is the most appropriate next step in management?


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ADVANCED General Regional & Pain

A 70-kg, 50-year-old man is scheduled for muscle flap closure of a decubitus ulcer over the sacrum. He has been quadriplegic at the level of C6-7 for six years. Which of the following is most likely to result from subarachnoid anesthesia with tetracaine 10 mg for this procedure?


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BASIC General

The ECG tracing shows

1993a 55

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ADVANCED General

Each of the following conditions is a complication of mediastinoscopy EXCEPT


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BASIC General

Which of the following statements about the standard error of the mean (SE) is true?


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BASIC General

Each of the following values is associated with acute tubular necrosis EXCEPT


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ADVANCED General

During transurethral resection of the prostate under spinal anesthesia with a sensory level to T10, a patient has sudden onset of sharp upper abdominal pain and nausea. Arterial blood pressure increases from 120/80 to 150/90 mmHg; the patient becomes diaphoretic. Which of the following is the most likely diagnosis?


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BASIC General

Which of the following combinations of hemoglobin, blood gases, and cardiac output provides the greatest delivery of oxygen to tissue? (Hb, PaO2, SaO2, CO)


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BASIC Respiratory & Critical Care General

An obese, 70-year-old woman with a long history of tobacco abuse is awake and semirecumbent after uneventful anesthesia with isoflurane for a ventral hernia repair. During the first hour in the recovery room while breathing 50% oxygen by face mask, her arterial oxygen saturation decreases to 90% while other vital signs remain satisfactory. Which of the following is most likely to be effective in the management of this situation?


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ADVANCED General

A 40-year-old patient has pain following injection of 8 ml of thiopental 2.5% through a right radial artery catheter. His hand remains pink. Which of the following is the most appropriate next step?


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ADVANCED General

Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?


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ADVANCED General

A 70-kg 61-year-old patient undergoes a four-hour resection of an abdominal aortic aneurysm during anesthesia with fentanyl and enflurane. Infrarenal clamping is required during the procedure. Twelve hours after the procedure, urine output is 15 ml/hr with a fractional sodium excretion of 6%. Which of the following is the most likely cause?


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ADVANCED General

Two hours after sustaining extensive burns of the head, neck and chest in a house fire, a patient has stridor and difficulty breathing. The most appropriate management is


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ADVANCED General Pediatric

Compared with a normal child, which of the following is expected during inhalation induction in a child with a 2:1 left-to-right intracardiac shunt?


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ADVANCED Pharmacology & Pharmacokinetics General

Each of the following is a recognized complication during a transurethral resection for which glycine is used as an irrigant EXCEPT


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ADVANCED Transfusions & Fluids General

A 35-year-old woman undergoes a one-hour abdominal liposuction procedure under general anesthesia. During the procedure, 2000 ml of crystalloid is administered and 800 ml of fatty tissue is extracted. Thirty minutes postoperatively, blood pressure is 75/40 mmHg and heart rate is 100 bpm; SpO2 is 94% on room air. Which of the following is the most likely cause of these findings?


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ADVANCED Equipment & Physics General

Reduction of fire hazards during laser surgery of the airway is best accomplished by use of


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ADVANCED General

A man with alcoholic cirrhosis and a hemoglobin concentration of 10 g/dl has an intraoperative PaO2 of 75 mmHg at an FiO2 of 0.5. Which of the following is the most likely cause of the low PaO2?


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ADVANCED General

A 70-kg man with ischemic heart disease is undergoing abdominal aortic aneurysm resection. At the time of infrarenal cross-clamping, 0.2-mV ST-segment depression appears on lead V5 of the ECG. Hemodynamic changes occurring at the same time are shown below. Systemic blood pressure 90/50 --> 150/90; Heart rate 80 --> 95; PAp 20/10 --> 45/24; Mean pulmonary artery occlusion pressure (mmHg) 10 --> 23; Cardiac output (L/min) 4.5 --> 3.2. Ischemia would be decreased by restoring the pre-clamp level of each of the following EXCEPT


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BASIC General Cardiac

In a patient with ventricular fibrillation refractory to repeated attempts at defibrillation and epinephrine administration, the most appropriate management is administration of


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BASIC General

A previously healthy, 60-kg, 17-year-old boy is undergoing emergency surgery for a gunshot wound involving the iliac vein. Ventilation is controlled with a tidal volume of 700 ml/breath, rate of 10/min, and peak inspiratory pressure of 30 cmH2O. Body temperature is normal. The most likely cause of an end-tidal carbon dioxide partial pressure of 16 mmHg is


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BASIC Respiratory & Critical Care General

In a patient with hypovolemic shock, which of the following factors is the best measure of the overall balance between oxygen supply and demand?


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BASIC Transfusions & Fluids General

Which of the following is the most common initial sign of hemolytic transfusion reaction during general anesthesia?


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BASIC General

Which of the following phenomena is primarily responsible for the decrease in core body temperature that commonly occurs during the first hour of general anesthesia?


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BASIC General Cardiac

A 65-year-old patient with hypertrophic cardiomyopathy has chest pain prior to induction of anesthesia. Pulse is 80 bpm and blood pressure is 130/80 mmHg. The ECG (V5) shows sinus rhythm and new ST-segment depression. The most appropriate management is administration of


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ADVANCED General

Which of the following statements concerning autonomic hyperreflexia after spinal cord transection is true?


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ADVANCED Respiratory & Critical Care General

You are called to a witnessed cardiac arrest where cardiopulmonary resuscitation is being performed. After successful intubation, arterial blood gas values are PaO2 86 mmHg, PaCO2 63 mmHg, and pH 7.25 at an FiO2 of 1.0. The most appropriate management at this time is to


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ADVANCED General

A 45-year-old man with chronic liver failure is scheduled for liver transplantation. Which of the following preoperative findings is most likely?


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BASIC Equipment & Physics General

The most likely cause of this capnographic tracing obtained just after laryngoscopy and intubation is

1992a 62

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BASIC Equipment & Physics General

An unconscious adult patient is being ventilated through an esophageal obturator airway (EOA) in the emergency department. In the absence of cervical spine injury, which of the following is appropriate?


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ADVANCED General

The use of glycine as irrigating solution during transurethral resection of the prostate could be associated with each of the following EXCEPT


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BASIC General

Which of the following is most likely to increase hepatic blood flow during general anesthesia?


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BASIC Respiratory & Critical Care General

The primary purpose of denitrogenation prior to anesthetic induction is to


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BASIC General

An obese, 35-year-old man had an episode of coughing followed by vomiting during induction of anesthesia for arthroscopy of the left knee. Intense wheezing developed bilaterally over five minutes. PaO2 is 60 mmHg, PaCO2 is 42 mmHg, and pH is 7.35. Optimal management following intubation of the trachea includes


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BASIC General

A 70-year-old man who underwent bilateral carotid endarterectomies two years ago is to undergo anesthesia and surgery. The denervation of the carotid bodies is likely to result in


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ADVANCED General

Which of the following complications is the primary cause of neurologic deficit following carotid endarterectomy?


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ADVANCED Transfusions & Fluids General

A 68-year-old man has signs of a coagulopathy after receiving 10 units of packed erythrocytes during emergency repair of a leaking abdominal aortic aneurysm. The most likely cause is


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ADVANCED General Neuro

In patients with head trauma, which of the following factors results in a return of arterial pH toward normal levels after two days of mechanical hyperventilation?


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BASIC General

Which of the following is described by the standard deviation during analysis of the results of a clinical study?


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ADVANCED General

At a body temperature of 30°C, resistance to blood flow increases because of


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BASIC General

Ten minutes after induction of anesthesia with thiopental and isoflurane but before incision, a patient's nasopharyngeal temperature has decreased to 35.4°C. Which of the following contributed most to this decrease in temperature?


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ADVANCED General

Which of the following factors is the major cause of hypotension following release of the infrarenal aortic cross-clamp during aortic reconstruction?


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ADVANCED General

A patient with moderate hypothyroidism and unstable angina requires urgent coronary artery bypass grafting. Which of the following is most appropriate before proceeding with the operation?


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ADVANCED General

During enflurane anesthesia for colectomy in a 75-year-old man with sepsis, urine output decreases to 10 ml/hr. Heart rate is 120 bpm, blood pressure is 100/50 mmHg, central venous pressure is 10 mmHg, and pulmonary artery occlusion pressure is 15 mmHg. The most appropriate management at this time is to


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ADVANCED General

A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of


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ADVANCED General Cardiac

Each of the following statements concerning the activated clotting time (ACT) is true EXCEPT:


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BASIC Respiratory & Critical Care General

Which of the following is the most likely cause of the increased incidence of right ventricular failure in patients with morbid obesity?


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ADVANCED General

Following extubation after nasotracheal intubation for seven days, a 35-year-old man has fever, facial pain, nasal stuffiness, and purulent nasal secretions. The most likely cause is


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BASIC General

A 50-year-old man with alcoholism and jaundice is scheduled to undergo umbilical herniorrhaphy. An increase in which of the following best indicates impaired synthetic hepatic function?


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ADVANCED General

When methylmethacrylate is inserted into the femur, each of the following may occur EXCEPT


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ADVANCED General

A 25-year-old woman undergoes a difficult open cholecystectomy during anesthesia with isoflurane, nitrous oxide, fentanyl, and vecuronium. Five units of blood are administered intraoperatively. Two days later, the patient has mildly increased serum transaminase concentrations and markedly increased alkaline phosphatase and direct bilirubin concentrations. Which of the following is the most likely cause?


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ADVANCED General

A 38-year-old woman with hyperthyroidism is undergoing open reduction and internal fixation of a fractured humerus with isoflurane anesthesia. Intraoperatively her heart rate increases to 120 bpm with occasional premature ventricular contractions. The most appropriate therapy at this time is to


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BASIC General

A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should


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ADVANCED General

A 75-year-old man with aortic stenosis and coronary artery disease has a preinduction heart rate of 68 bpm and blood pressure of 125/70 mmHg. After induction of anesthesia with fentanyl, midazolam, and pancuronium, heart rate is 90 bpm and blood pressure is 85/45 mmHg. ECG shows a new ST-segment elevation in lead II. Which of the following is the most appropriate initial management?


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ADVANCED General Cardiac

Which of the following is the best method of pacing to improve cardiac output in a patient with third-degree heart block?


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BASIC General

The mortality rate of patients given drug A is 12% (8 of 66) and the mortality rate of patients given drug B is 15% (10 of 66). Which of the following tests is most appropriate to compare these mortality rates?


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BASIC General

Intraoperative heat loss in an unclothed, undraped patient is caused primarily by


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BASIC General

Each of the following values is associated with acute tubular necrosis EXCEPT


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BASIC General

Which of the following findings on the left is most likely to be associated with an increased risk of complications with cannulation of the left internal jugular vein compared with cannulation of the right internal jugular vein?


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BASIC General

Pseudocholinesterase


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BASIC Pharmacology & Pharmacokinetics General

The EKG rhythm shown developed during cholecystectomy in a 62-year-old man who had a myocardial infarction and is taking atenolol. The drug of choice for treating this arrhythmia is

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BASIC Pharmacology & Pharmacokinetics General

A previously healthy 46-year-old woman has severe substernal chest pain one hour after receiving morphine sulfate 10 mg intramuscularly for an elective cholecystectomy. Vital signs, SpO2, and findings on a five-lead ECG on the operating room monitor are within normal limits. Which of the following is the most appropriate next step?


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ADVANCED General

A 70-year-old man undergoes cross clamping of the aorta for repair of an abdominal aneurysm. Which of the following methods is most appropriate for decreasing hypotension associated with removal of the cross clamp?


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ADVANCED General

A 65-year-old man with essential hypertension well controlled around 140/90 mmHg with hydrochlorothiazide is scheduled for right colectomy for carcinoma. Preoperative EKG and all laboratory values are normal except for a hematocrit of 29% and serum potassium level of 3.2 mEq/L. Central venous pressure (CVP) measured from an internal jugular catheter inserted before induction of anesthesia is 7 mmHg. Ten minutes after induction with thiopental 200 mg followed by enflurane 3% in nitrous oxide and oxygen (50% each), blood pressure decreases suddenly from 110/70 to 80/50 mmHg with heart rate unchanged at 78 bpm. CVP is now 20 mmHg and the EKG demonstrates a midjunctional rhythm. After discontinuing the enflurane, the most appropriate action would be to


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BASIC General Regional & Pain

A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?


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ADVANCED General

A 19-year-old man is undergoing inguinal herniorrhaphy. He is anesthetized with a spinal block supplemented with midazolam and fentanyl. During the procedure, he has sudden loss of consciousness, profound hypotension, and bradycardia; systolic pressure is 40 mmHg and heart rate is 30 bpm. Cardiopulmonary resuscitation is started. The most appropriate next step is administration of


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ADVANCED General

The preanesthetic ECG trace (lead II) shown from a 32-year-old woman suggests

1991b 15

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ADVANCED Respiratory & Critical Care General

During one-lung ventilation, each of the following affects hypoxic pulmonary vasoconstriction in the nonventilated lung EXCEPT


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ADVANCED General

A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under halothane/morphine general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is


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BASIC General

Which of the following statements regarding latex allergy is true?


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BASIC General

Statistical analysis of 20 patients shows a mean cardiac output (CO) of 5 L/min with a standard deviation of 1 L/min. The distribution pattern in the sample population is normal. Which of the following is the most appropriate conclusion?


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ADVANCED General

A patient who is scheduled for emergency laparotomy for bowel obstruction has had oliguria for three hours. She has had hypertension for 10 years. Which of the following laboratory findings would indicate preoperative fluid challenge?


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ADVANCED General Cardiac

The tracing indicates that the pacemaker generator is

1995a 22

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BASIC General

In clinical anesthesia practice, the term "informed consent" is best described as a legal concept in which patients


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ADVANCED General

During cardiopulmonary resuscitation (CPR) in an adult, external chest compression is being performed at the rate of 90/min with 2 inches of sternal depression and a compression-relaxation ratio of 20:80. The most appropriate action is to


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ADVANCED General Regional & Pain

A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show no abnormalities. Which of the following is the most appropriate immediate management?


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BASIC Pharmacology & Pharmacokinetics General

A 70-kg 78-year-old man undergoing small-bowel resection during anesthesia with isoflurane in oxygen becomes hypotensive and develops frothy pink sputum in the endotracheal tube. Heart rate is 50 bpm, blood pressure is 75/60 mmHg, pulmonary artery occlusion pressure is 22 mmHg, and cardiac output is 1.7 L/min. The most appropriate initial step in management is administration of which of the following?


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BASIC General Cardiac

An adult patient with atrial fibrillation develops pulseless ventricular tachycardia wfiile undergoing synchronized electirical cardioversion. Which of the following is the most appropriate management?


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ADVANCED General

A 15-year-old previously healthy boy is scheduled for a celiotomy to relieve an acute intestinal obstruction. A rapid sequence induction is used. Anesthesia is maintained with a balanced technique including nitrous oxide and oxygen (5L:2L), meperidine, and pancuronium. Because of abdominal distention and the high pressure required for inflation of the lungs, a nasogastric tube is inserted. The abdomen remains distended, but compliance improves dramatically. At this time the patient is cyanotic, PaO2 is 48 mmHg, PaCO2 is 52 mmHg, and pH is 7.29. Nitrous oxide is discontinued. The most important therapeutic measure is to


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BASIC General

If a patient with excessive bleeding during exploratory laparotomy has a normal activated clotting time, the LEAST likely cause of the bleeding is


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BASIC General

Which of the following is the most reliable indicator of adequate reversal of neuromuscular block?


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BASIC Pharmacology & Pharmacokinetics General

Which of the following is the best initial treatment of anaphylaxis that occurs during general anesthesia?


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BASIC General Cardiac

As part of a preoperative evaluation, a patient had a thallium scan showing a 'cold spot' over the left ventricle that occurs with moderate exercise and disappears at rest. This most likely indicates


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ADVANCED General

Which of the following is the LEAST likely cause of a prolonged prothrombin time?


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BASIC General

A patient with cirrhosis presenting for liver transplantation is likely to exhibit each of the following EXCEPT


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BASIC General

Assignment of a patient to an ASA physical status category is used to


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BASIC General

A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxemia, and rales. Which of the following is the most likely diagnosis?


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ADVANCED Respiratory & Critical Care General

A 70-kg, 77-year-old man Is undergoing left nephrectomy with nitrous oxide, oxygen, fentanyl, and midazolam anesthesia. He has a 90 pack-year history of cigarette smoking and has chronic obstructive pulmonary disease. One hour after incision, expiratory wheezing occurs and peak Inspiratory pressure increases from 35 to 65 cmH20; end-tidal PCO2 is unchanged, but SpO2 decreases from 97% to 88%. The most likely cause is


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BASIC General

The patient at LEAST risk of pulmonary aspiration of gastric contents during induction of anesthesia is


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BASIC General

Twenty minutes after thiopental induction for femoral herniorrhaphy, a 34-year-old woman is breathing spontaneously and receiving nitrous oxide-oxygen (2 liters each) and enflurane 3% by face mask. Pulse is 90 bpm, blood pressure is 80/60 mmHg, end-tidal enflurane concentration is 2%, and end-tidal carbon dioxide tension is 48 mmHg. Which of the following is most likely to occur on skin incision?


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BASIC General

During controlled ventilation, which of the following will cause an increase in end-tidal carbon dioxide tension with a normal waveform on the capnograph?


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ADVANCED General

During a right lower lobe resection, SpO2 decreases from 99% to 70% after institution of one-lung ventilation. FiO2 is 1.0. The most appropriate management is to


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ADVANCED General

Each of the following statements about pheochromocytoma is true EXCEPT:


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BASIC Pharmacology & Pharmacokinetics General

A 68-year-old man who is scheduled for outpatient cystoscopy has non-insulin-dependent diabetes mellitus controlled with glipizide (Glucatrol) 5 mg twice daily. He has had nothing to eat since awakening this morning and has not taken glipizide today. His blood glucose level is 185 mg/dl. Before proceeding, the most appropriate management is to administer


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BASIC General

A 78-year-old man who is scheduled for an inguinal hernia repair has a preoperative ECG showing left bundle branch block. He has had no symptoms of cardiovascular disease. This ECG finding most likely indicates


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ADVANCED General

When used for irrigation during transurethral resection of the prostate, glycine 1.5% is associated with each of the following EXCEPT


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ADVANCED General

A 76-year-old man has a leaking abdominal aortic aneurysm. His blood pressure and pulse have remained stable for 15 minutes at 90/60 mmHg and 130 bpm, respectively. His hemoglobin concentration is 11 g/dl, and the EKG shows a left bundle branch block. Induction of anesthesia should proceed


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BASIC General Cardiac

Each of the following changes is expected with deliberate hypothermia EXCEPT


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BASIC General

Which of the following statements concerning awareness (recall) during opioid anesthesia is true?


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BASIC Transfusions & Fluids General

Following transfusion of packed red blood cells during general anesthesia, the patient's blood pressure decreases, heart rate and temperature increase, and hemoglobinuria and diffuse oozing are observed. Which of the following is the most appropriate first step in management?


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ADVANCED General Respiratory & Critical Care

A patient is scheduled for right pneumonectomy. A left-sided double-lumen endobronchial tube is inserted. After the endobronchial side is clamped and both cuffs are inflated, breath sounds are heard only on the left. Which of the following is the most likely cause?


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BASIC Equipment & Physics Respiratory & Critical Care General

A 30-year-old man who is undergoing laparotomy and resection of a large kidney tumor has a decrease in SpO2 from 100% to 92% and an increase in peak airway pressure from 20 to 35 cm H2O. Plateau pressure is unchanged at 18 cm H2O. Which of the following is the most likely cause?


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BASIC Respiratory & Critical Care General

A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is


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BASIC General

A 60-kg, 70-year-old man requires open reduction and internal fixation of an intertrochanteric fracture sustained 24 hours ago. Serum creatinine concentration is 1 mg/dl and blood urea nitrogen concentration is 40 mg/dl. The most likely cause of these findings is


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ADVANCED General

A 35-year-old woman with systemic lupus erythematosus is admitted to the critical care unit following sudden onset of severe chest pain. Examination shows tachycardia, hypotension, pulmonary edema, and a blowing systolic murmur in the left parasternal region. The most appropriate management is


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BASIC General

A 65-year-old man has a history of alcohol abuse. Which of the following preoperative serum concentrations would provide the best assessment of synthetic hepatic function?


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ADVANCED General Cardiac

Following blunt trauma to the chest, a patient has tachycardia, hypotension, and markedly distended neck veins. Each of the following is expected EXCEPT


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BASIC General Cardiac

Pulsus paradoxus is commonly seen during anesthesia in patients with each of the following conditions EXCEPT


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ADVANCED General

A patient is bleeding excessively after routine transurethral resection of the prostate. Re-exploration discloses diffuse oozing. The most appropriate management is administration of


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ADVANCED General

A patient who is paraplegic secondary to spinal cord transection at T3 develops bradycardia and facial flushing during a nephrectomy under general anesthesia with nitrous oxide, fentanyl, and atracurium. The most likely cause of this response is


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BASIC General

A 57-year-old man with hepatocellular disease is scheduled to undergo a colectomy for colon cancer. Preoperative laboratory studies show a plasma albumin concentration of 2.4 g/dl (normal = 3.5 to 5.5 g/dl); prothrombin time is 16 sec (control 12 sec). Which of the following statements concerning the anesthetic management of this patient is true?


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ADVANCED General

Each of the following conditions is associated with autonomic hyperreflexia in patients with spinal cord injury EXCEPT


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BASIC General

Hypothermia to 29°C will decrease


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ADVANCED General

A patient who had liver transplantation two years ago now requires general anesthesia for ENT surgery. Minimal rejection has occurred on a regimen of cyclosporine and prednisone. Which of the following is most likely?


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BASIC Transfusions & Fluids General

Which of the following abnormalities in serum is most likely to result from intraoperative discontinuation of parenteral hyperalimentation?


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ADVANCED General

An endobronchial Robertshaw tube is inserted for resection of a midesophageal tumor under isoflurane, oxygen, pancuronium anesthesia. Forty minutes into a planned two-hour resection, arterial blood gas values are reported as PO2 45 mmHg, PCO2 45 mmHg, and pH 7.33. Ten minutes earlier, the values were PO2 210 mmHg, PCO2, 41 mmHg, and pH 7.39. The first action should be to


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BASIC Respiratory & Critical Care General

During rapid-sequence induction prior to an emergency surgical procedure, a 20-year-old patient vomits gastric contents containing particulate matter. An endotracheal tube is easily inserted and ventilation with pure oxygen is initiated. Despite the presence of bilateral breath sounds, SpO2 is 90%. Which of the following is the most appropriate next step?


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ADVANCED General

Which of the following statements concerning absorption of irrigation fluid during transurethral resection of the prostate is true?


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BASIC General Transfusions & Fluids

A patient with uremia is scheduled for emergency surgery. Bleeding time is 18 minutes. The most appropriate initial treatment is


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ADVANCED General Cardiac

Hypomagnesemia is associated with


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BASIC Equipment & Physics Respiratory & Critical Care General

The trend plot shows end-tidal gases measured during a radical neck dissection. The event occurring at A is most likely

1993a 72

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BASIC Pharmacology & Pharmacokinetics General Cardiac

Which of the following findings would be considered normal in the EEG of an adult?


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BASIC General

A 30-year-old, 70-kg woman with mitral stenosis is scheduled for elective laparoscopic sterilization. Preoperatively she is taking digoxin and an unknown medication for chronic mental depression. The EKG demonstrates atrial fibrillation. Heart rate is 68 bpm. Anesthesia is induced with thiopental followed by nitrous oxide 50%, halothane 0.75%, and a continuous succinylcholine infusion. The ventilator is set to deliver a minute volume of 5 liters through an endotracheal tube. As the carbon dioxide is being insufflated into the abdomen, the blood pressure is noted to be elevated (150/100 mmHg) and ventricular bigeminy is present. The most appropriate therapy is to


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ADVANCED General

A 65-year-old man is disoriented and has a headache and nausea in the recovery room 30 minutes after transurethral resection of the prostate with glycine irrigation performed under spinal anesthesia. Heart rate is 50 bpm and blood pressure is 180/110 mmHg. Which of the following is LEAST likely?


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ADVANCED General

A patient with a fasting blood glucose concentration of 100 mg/dL undergoes a four-hour operation under general anesthesia without intraoperative administration of glucose. On emergence the most likely finding will be


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ADVANCED General

Which of the following statements concerning neuroleptic malignant syndrome is true?


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ADVANCED Equipment & Physics General

A healthy 57-year-old man with a ureteral calculus is scheduled for immersion extracorporeal shock wave lithotripsy. Which of the following statements is true?


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BASIC General

Which of the following is the most appropriate treatment of methemoglobinemia prior to emergency surgery?


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BASIC General

A 27-year-old man with a one-month history of quadriplegia at a C6 level is given general anesthesia for cystoscopy. During the cystoscopy, blood pressure suddenly increases to 220/120 mmHg. Further evaluation is most likely to show


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ADVANCED General

Which of the following is most likely in a 30-year-old patient with untreated hypothyroidism?


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BASIC General

Administration of 200 mEq of sodium bicarbonate during cardiopulmonary resuscitation is associated with


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BASIC General

When evaluating a screening test, which of the following is the most appropriate term for the proportion of patients with a disease who have a positive test result?


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ADVANCED General

Which of the following statements concerning carbon monoxide poisoning is true? A 38-year-old woman with a large goiter has undergone subtotal thyroidectomy. Airway obstruction is noted immediately after extubation despite normal vocal cord function on laryngoscopy. Which of the following is the most likely explanation?


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ADVANCED General

Unilateral or bilateral diaphragmatic paralysis is a complication of each of the following EXCEPT


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ADVANCED General

Bronchospasm occurring during anesthesia in a patient with an ileal carcinoid is best treated by administration of


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ADVANCED General

A 36-year-old woman develops acute airway obstruction 24 hours after total thyroidectomy. The most likely cause is


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BASIC Pharmacology & Pharmacokinetics General

A patient has severe hypotension, bronchospasm, and edema of the upper airway after injection of radiocontrast medium during cerebral angiography. The most appropriate immediate treatment is administration of


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ADVANCED General

A 58-year-old man with a history of angina is undergoing resection of an abdominal aortic aneurysm under morphine, nitrous oxide, d-tubocurarine anesthesia. Just before removal of the aortic cross-clamp, heart rate is 74 bpm, blood pressure is 115/70 mmHg, and pulmonary artery occlusion pressure is 7 mmHg. Immediately after removal of the cross-clamp, heart rate increases to 120 bpm, blood pressure decreases to 80/55 mmHg, and pulmonary artery occlusion pressure decreases to 3 mmHg. The V5 lead on the EKG demonstrates sudden ST-segment depression and T-wave inversion. Initial therapy should be


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ADVANCED Respiratory & Critical Care General

A patient is undergoing thoracotomy in the lateral position. Five minutes after initiation of one-lung ventilation using a double-lumen tube and 100% oxygen, SpO2 decreases from 100% to 65%. Which of the following is the most appropriate initial step in management?


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ADVANCED Pharmacology & Pharmacokinetics General

A 23-year-old man who is receiving his first anesthetic has not resumed spontaneous ventilation two hours after receiving succinylcholine. The train-of-four monitor shows no twitch response. Which of the following is the most likely cholinesterase genotype in this patient?


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BASIC Respiratory & Critical Care General

A patient receiving mechanical ventilation with oxygen 60% postoperatively has a PaO2 of 160 mmHg and a PaCO2 of 38 mmHg. One hour later, with mechanical ventilation unchanged, the PaO2 is 150 mmHg and PaCO2 is 48 mmHg. The most likely cause of these changes is


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ADVANCED Pharmacology & Pharmacokinetics General

A previously healthy 28-year-old woman scheduled for laparoscopic tubal ligation becomes, agitated and refuses to undergo the procedure after being brought to the operating room. This behavior most likely resulted from preoperative administration of


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BASIC General

A 28-year-old patient has severe laryngospasm after extubation of the trachea following general anesthesia. Administration of 100% oxygen using continuous positive airway pressure does not improve symptoms. SpO2 is 75%. Which of the following is the most appropriate immediate management?


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ADVANCED General Cardiac

A 55-year-old man who is scheduled to undergo carotid endarterectomy (CEA) has a persistent myocardial filling defect at three hours on a dipyridamole-thallium scan. Which of the following statements is correct?


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ADVANCED General Respiratory & Critical Care

During right upper lobectomy and one-lung ventilation with a double-lumen endotracheal tube, the PaO2 decreases to 40 mmHg. The PaCO2 is 39 mmHg. Which of the following is most appropriate?


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ADVANCED General

During isoflurane anesthesia, a 45-year-old patient with chronic asthma has wheezing, prolonged expiration, sinus tachycardia of 120 bpm, and premature ventricular contractions. Preoperative medication included cromolyn and theophylline. The most appropriate treatment is to administer


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BASIC Pharmacology & Pharmacokinetics General Cardiac

During induction of anesthesia in a 70-year-old man with aortic stenosis, the blood pressure decreases from 140/ 80 to 70/45 mmHg as the cardiac rhythm changes from normal sinus at 70 bpm to junctional at 120 bpm. The most appropriate initial therapy would be


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BASIC Transfusions & Fluids General

During a reoperative total hip arthroplasty requiring transfusion of 8 units of packed red blood cells, blood begins to ooze from the operative field and intravenous catheter sites. Urine is pink. The most likely cause is


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ADVANCED General

A 72-year-old woman is somnolent one day after left carotid endarterectomy. She has smoked 2 packs of cigarettes daily for 50 years. Six weeks ago, she underwent right carotid endarterectomy. At this time, arterial blood gases while breathing room air are PO2, 45 mmHg, PCO2, 60 mmHg, and pH 7.30. Which of the following is the most likely cause of the increased PCO2?


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ADVANCED General Neuro

Which of the following findings is most likely in patients with acute transection of the spinal cord at the level of C6?


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BASIC General

Following induction of general anesthesia, mask ventilation and the initial attempt at intubation is unsuccessful. Which of the following procedures is most appropriate?


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ADVANCED General

A 26-year-old patient with multiple trauma is admitted to the intensive care unit postoperatively. The early development of polyuria, hypotension, low urine sodium excretion, high serum osmolality, and normal serum creatinine concentration is best explained by


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ADVANCED General

Which of the following is the most appropriate initial therapy for acute pulmonary hypertension with right ventricular dysfunction and severe systemic hypotension that occurs during anesthesia?


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BASIC General Cardiac

The ECG strip shown is recorded as a patient with a permanent transvenous DDD pacemaker enters the operating room. These changes indicate that the pacemaker is

1993a 45

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ADVANCED General

Which of the following physiologic changes occurs with immersion in water during extracorporeal shock wave lithotripsy?


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BASIC Respiratory & Critical Care General

A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?


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ADVANCED General Respiratory & Critical Care

Five minutes after initiating one-lung ventilation using a double-lumen endobronchial tube, a 70-year-old patient has a decrease in Sp02 from 99% to 90%. Tidal volume and respiratory rate are unchanged. Fiberoptic bronchoscopy verifies appropriate positioning of the tube. Which of the following is the most likely cause of the desaturation?


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BASIC General

One hundred children who are to have strabismus surgery are enrolled in a research protocol. Fifty receive a new antiemetic and 50 receive a placebo preoperatively. Fifteen children in the treatment group and 37 children in the control group have nausea and vomiting postoperatively. Which of the following analyses is most appropriate for determining the statistical significance of the group differences?


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ADVANCED General

A patient with alcoholic cirrhosis, ascites, and gastrointestinal bleeding receives 4 units of red blood cells prior to anesthesia with isoflurane in oxygen for emergency exploratory laparotomy. After the peritoneum is opened and the fluid is drained, blood pressure decreases to 60/40 mmHg and SpO2 decreases to 90%. The most likely cause of the hypoxemia is


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BASIC General

Which of the following will result in the largest change in oxygen content?


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ADVANCED Respiratory & Critical Care General

A 90-kg, 59-year-old man with chronic obstructive pulmonary disease is undergoing laparotomy. Mechanical ventilation is being carried out with a fresh gas flow of 2 L/min at a rate of 16/min and tidal volume of 900 ml; I:E ratio is 1:2.5. PaCO2 remains greater than 50 mmHg. Preoperative PaCO2, was normal. Which of the following is the most appropriate next step?


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BASIC Respiratory & Critical Care General

Which of the following is the most likely cause of a decrease in end-tidal carbon dioxide tension during general anesthesia with a constant minute ventilation?


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BASIC General

During acute normovolemic hemodilution in an adult, which of the following compensatory mechanisms is most important in maintaining tissue oxygenation?


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ADVANCED General

A patient with chronic paraplegia (T4 level) is undergoing cystoscopy and removal of bladder calculi without anesthesia. After 10 minutes, blood pressure is 240/100 mmHg and pulse is 50 bpm. The most appropriate management is administration of


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ADVANCED General

A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/L, chloride 80 mEq/L, and glucose 750 mg/dl. The most appropriate perioperative management is


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BASIC General

Preoperative evaluation of a patient who has marked malnutrition will demonstrate each of the following EXCEPT


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ADVANCED General

During liver transplantation, venovenous bypass from the femoral and portal veins to the axillary vein during cross-clamping of the inferior vena cava


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BASIC General Cardiac

A 45-year-old man is scheduled for appendectomy under general anesthesia. He reports that for many years he has occasionally felt his heart "skip a beat." The ECG tracing shown was obtained one hour ago. Which of the following is the most appropriate next step?

1994b 34

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BASIC General

Left ventricular subendocardial perfusion pressure is best estimated by the difference between


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BASIC Transfusions & Fluids General

A patient becomes flushed, dyspneic, and hypotensive during transfusion of 1 unit of packed red blood cells in the PACU. After discontinuing the transfusion, the most appropriate next step is administration of


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ADVANCED General Cardiac

A 67-year-old man is undergoing total hip replacement under general anesthesia. He had a permanent endocardial VVI pacemaker placed two years ago for complete heart block, and since arrival in the operating room has been paced continuously. Use of the electrocautery causes the pacemaker to malfunction intermittently. The most appropriate management is to


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ADVANCED General

A 75-year-old, 60-kg man with moderately disabling heart failure secondary to ischemic heart disease is undergoing a transurethral prostatic resection under halothane-nitrous oxide anesthesia. Resection time is 30 minutes, and fluid replacement has been lactated Ringer's solution 500 mL. Although heart rate is unchanged, the arterial pressure monitor used because of his cardiac condition has changed from A to B over the last 15 minutes. The most appropriate management is to

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ADVANCED General

Which of the following is the most likely effect of infrarenal cross clamping of the aorta without pharmacologic manipulation?


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ADVANCED Respiratory & Critical Care General

A patient undergoes thoracotomy in the lateral decubitus position. Which of the following maneuvers is most likely to increase PaO2 during one-lung ventilation?


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BASIC Pharmacology & Pharmacokinetics General

A 25-year-old man requires exploratory laparotomy following a motor vehicle accident. He is acutely intoxicated with alcohol. Which of the following is the most likely result of the alcohol ingestion?


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ADVANCED General Cardiac

A 32-year-old man is scheduled for hernia repair. He underwent heart transplantation for cardiomyopathy five years ago. Which of the following findings is most likely?


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