Q1 .
Which of the following statements concerning awareness (recall) during opioid anesthesia
is true?
(A) It is usually not associated with pain
(B) It correlates well with intact auditory evoked responses
(C) It is prevented if the dose of opioid blocks the hemodynamic response to stimuli
(D) It is prevented if the dose of opioid is adequate to prevent movement without
muscle relaxants
(E) It is predicted by a specific EEG pattern
Q2. 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?
(A) Atypical : atypical
(B) Fluoride-resistant : fluoride-resistant
(C) Fluoride-resistant : silent
(D) Normal : normal
(E) Normal : silent
Q3. 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
(A) administer furosemide
(B) administer labetalol
(C) administer 3% sodium chloride
(D) change the irrigating solution to normal saline
(E) induce general endotracheal anesthesia
Q4. Each of the following conditions is a complication of mediastinoscopy EXCEPT
(A) air embolism
(B) hemorrhage
(C) injury to the left recurrent laryngeal nerve
(D) occlusion of the left carotid artery
(E) tension pneumothorax
Q5. 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
(A) marked hypoglycemia
(B) mild hypoglycemia
(C) normoglycemia
(D) mild hyperglycemia
(E) marked hyperglycemia
Q6. 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
(A) atrial fibrillation (ventricular rate 100 bpm)
(B) paroxysmal atrial tachycardia (150 bpm)
(C) sinus bradycardia
(D) piloerection above the level of C6
(E) sweating above the level of C6
Q7. Which of the following statements concerning neuroleptic malignant syndrome is true?
(A) It does not respond to dantrolene therapy
(B) It is inherited as an autosomal trait
(C) It is not triggered by succinylcholine
(D) It occurs after long-term use of L-dopa
(E) The halothane-caffeine contracture test is negative in susceptible patients
Q8. In the absence of coronary artery disease, isoflurane-induced vasodilation and
tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases?
(A) Aortic regurgitation
(B) Aortic stenosis
(C) Asymmetric septal hypertrophy (IHSS)
(D) Mitral stenosis
(E) Pulmonary regurgitation
Q9. Reduction of fire hazards during laser surgery of the airway is best accomplished by use
of
(A) continuous mode laser emissions
(B) a nitrous oxide/opioid/relaxant anesthetic technique
(C) a polyvinylchloride endotracheal tube and cuff
(D) topical lidocaine
(E) saline-filled sponges over exposed tissues
Q10. During controlled ventilation, which of the following will cause an increase in end-tidal
carbon dioxide tension with a normal waveform on the capnograph?
(A) Bronchospasm
(B) Rapid blood loss
(C) Ventricular fibrillation
(D) Endobronchial migration of the endotracheal tube
(E) Release of a thigh tourniquet
Q11. 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
(A) aspiration during induction
(B) decreased functional residual capacity
(C) increased cardiac output
(D) increased oxygen consumption
(E) increased ventilatory dead space
Q12. 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?
(A) Convective heat loss from cutaneous vasodilation
(B) Decreased heat production
(C) Evaporative heat loss during skin preparation
(D) Heat loss from the respiratory tract
(E) Redistribution of core body heat to the periphery
Q13. 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?
(A) Albumin
(B) Digoxin
(C) Dopamine
(D) Esmolol
(E) Nitroglycerin
Q14. 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
(A) citrate intoxication
(B) factor V and VIII deficiencies
(C) rhabdomyolysis
(D) thrombocytopenia
(E) transfusion reaction
Q15. 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
(A) administer an inhaled bronchodilator
(B) apply continuous positive airway pressure to the right lung
(C) apply positive end-expiratory pressure to the left lung
(D) increase tidal volume
(E) reinflate the right lung
Q16. Which of the following is the most effective treatment of shivering following general
anesthesia?
(A) Administration of droperidol
(B) Administration of morphine
(C) Administration of midazolam
(D) Administration of warm intravenous fluids
(E) Skin-surface warming
Q17. Compared with healthy nonhypertensive patients, in patients with untreated
hypertension undergoing anesthesia and operation,
(A) cerebral ischemia may occur at higher blood pressures
(B) intravenous fluid should be restricted before induction
(C) left ventricular hypertrophy enhances compensation for intraoperative fluid loss
(D) responses to sympathetic stimulation are decreased
(E) the incidence of intraoperative hypotension is lower
Q18. Which of the following statements concerning absorption of irrigation fluid during
transurethral resection of the prostate is true?
(A) Hydrostatic pressure has minimal effect on the amount of fluid absorbed
(B) Typically 10 to 30 ml of fluid per minute are absorbed
(C) Use of iso-osmotic solutions decreases the risk of hyponatremia
(D) CNS complications are independent of the type of fluid used
(E) Spinal anesthesia to T6 will mask the symptoms of overhydration
Q19. 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?
(A) Prothrombin time
(B) Serum alanine aminotransferase concentration
(C) Serum albumin/globulin ratio
(D) Serum alkaline phosphatase concentration
(E) Serum bilirubin concentration
Q20. When used for irrigation during transurethral resection of the prostate, glycine 1.5% is
associated with each of the following EXCEPT
(A) hemolysis
(B) hyperammonemia
(C) cerebral edema
(D) hypofibrinogencmia
(E) visual disturbances
Q21. Which of the following remains normal in an otherwise healthy patient with obesity?
(A) Alveolar PO2
(B) Expiratory reserve volume
(C) Functional residual capacity
(D) Lung compliance
(E) Static lung volumes
Q22. 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?
(A) Carbon dioxide embolus
(B) Endobronchial intubation
(C) Hypoventilation
(D) Inadvertent application of high levels of positive end-expiratory pressure
(E) Leak in the capnography sampling catheter
Q23. Which of the following is the most common initial sign of hemolytic transfusion reaction
during general anesthesia?
(A) Bronchospasm
(B) Diffuse bleeding
(C) Fever
(D) Hemoglobinuria
(E) Hypotension
Q24. Hypothermia to 29°C will decrease
(A) hematocrit
(B) plasma fibrinogen concentration
(C) plasma pH
(D) plasma protein concentration
(E) platelet function
Q25. Which of the following is the best initial treatment of anaphylaxis that occurs during
general anesthesia?
(A) Diphenhydramine
(B) Dopamine
(C) Epinephrine
(D) Hydrocortisone
(E) Ranitidine
Q26. Administration of 200 mEq of sodium bicarbonate during cardiopulmonary resuscitation
is associated with
(A) CSF alkalosis
(B) hypercalcemia
(C) hypercarbia
(D) hyperkalemia
(E) shift of the oxyhemoglobin dissociation curve to the right
Q27. Which of the following is the most sensitive indicator of impending renal failure following
trauma?
(A) Central venous pressure
(B) Creatinine clearance
(C) Fractional excretion of sodium
(D) Hourly urine output
(E) Urine osmolality
Q28. 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?
(A) Application of pressures greater than 35 cmH2O to the catheter will increase the
risk for pulmonary barotrauma
(B) PaC02 can be maintained at a normal level using a standard circle system
attached to the catheter
(C) PaO2 greater than 100 mmHg can be maintained indefinitely using
transtracheal jet ventilation with pure oxygen through the catheter
(D) Emergency surgical tracheostomy would have improved the likelihood of survival
(E) The presence of this tumor contraindicates jet ventilation via cricothyroidotomy
Q29. A patient has hoarseness after undergoing surgery involving the aortic arch. The most
likely cause is an injury to which of the following nerves?
(A) Glossopharyngeal
(B) Left recurrent laryngeal
(C) Right recurrent laryngeal
(D) Left superior laryngeal
(E) Right superior laryngeal
Q30. 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
(A) nitrous oxide
(B) etomidate
(C) ketamine
(D) methohexital
(E) midazolam
Q31. 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
(A) atropine
(B) calcium
(C) hydrocortisone
(D) isoproterenol
(E) norepinephrine
Q32. 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
(A) administer dantrolene sodium
(B) administer potassium iodide
(C) administer propranolol
(D) administer propylthiouracil
(E) increase the concentration of isoflurane
Q33. 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?
(A) Administration of hydrocortisone
(B) Administration of fresh frozen plasma
(C) Administration of epsilon-aminocaproic acid
(D) Rapid infusion of crystalloid
(E) Transfusion of platelet concentrates
Q34. In a patient with hypovolemic shock, which of the following factors is the best measure of
the overall balance between oxygen supply and demand?
(A) Arterial oxygen content
(B) PetO2
(C) Mixed venous oxygen saturation
(D) PaO2
(E) Transcutaneous oxygen tension
Q35. When methylmethacrylate is inserted into the femur, each of the following may occur
EXCEPT
(A) monomer metabolic breakdown
(B) vasodilation
(C) hypercarbia
(D) hypoxia
(E) increased intramedullary pressure
Q36. A patient undergoes thoracotomy in the lateral decubitus position. Which of the following
maneuvers is most likely to increase PaO2 during one-lung ventilation?
(A) Applying continuous positive airway pressure to the nondependent lung
(B) Applying positive end-expiratory pressure to the dependent lung
(C) Increasing inspiratory flow rate
(D) Increasing the tidal volume
(E) Increasing the ventilatory rate
Q37. 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
(A) carotid sinus massage
(B) intravenous administration of bretylium
(C) intravenous administration of amiodarone
(D) intravenous administration of propranolol
(E) precordial "thump"
Q38. Which of the following statements concerning myasthenia gravis is true?
(A) Neostigmine is inappropriate for antagonism of neuromuscular blockade
(B) The number of acetylcholine receptors is decreased
(C) Plasma cholinesterase concentration is decreased
(D) The risk for malignant hyperthermia is increased
(E) Succinylcholine is contraindicated
Q39. 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
(A) external branch of the superior laryngeal nerve
(B) internal branch of the superior laryngeal nerve
(C) recurrent laryngeal nerve
(D) glossopharyngeal nerve
(E) vocal cords
Q40. A bilateral superior laryngeal nerve block performed to facilitate fiberoptic intubation will
provide anesthesia of the
(A) base of the tongue
(B) larynx above the vocal cords
(C) superior surface of the epiglottis
(D) tonsillar pillars
(E) upper trachea
