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Test 1A:

1) A 57 yo, 60 kg, otherwise healthy man with a coin lesion in RUL underwent
lobectomy of 3 hrs. Frozen section revealed oat cell CA. Anesthesia was iso-N2O-
O2 with 75mcg Fentanyl and 6mg vec. At the end of the operation, 1 mg atropine
and 3mg neostigmine given IV. Within 5 min., the pt. Responds to voice and pain.
NIF –5cm H2O. The next logical action is to:
A) Admin. 2 mg neo and 1 mg atropine and repeat NIF
B) Extubate and send to PACU
C) Place on T-tube and O2 in recovery
D) Ventilate mechanically
E) Admin. 0.4mg naloxone and repeat NIF.

4) (K) Valid reasons for inc. risk of hypoxemia in neonates vs. adults:
1) Dec. Vd
2) Dec. FRC cc/kg
3) Inc. body surface area to weight ratio in neonates
4) Inc. metabolic rate

7) Blood from the umbilical art. Of a normal newborn has


A) spO2 > 90%
B) pCO2 below 40
C) Hct > 65%
D) PO2 > 80 torr
E) PH below 7.35

10) 48 yo man is scheduled for inguinal hernia repair under GA. He claims his health
is excellent except for chronic simple open angle glaucoma X 2 yrs for which he is
taking ? drug. PE and labs normal except electrolytes: Na 138 K4.1 Cl 113 HCO3
10. You immediately request add’l lab work but suspect that he has:
A) Undiagnosed renal dz
B) Undiagnosed DM
C) Been taking echothiophate
D) Been taking acetazolamide
E) Been taking furosemide

13) 3-day old 3kg, otherwise healthy infant with imperforate anus symptoms. Preop
Hct 43%. NPO X 3 hrs. TBL 75 mls. During 3 hrs of anesthesia and surgery,
infant received 75 mls PRBCs, 40 mls 5% albumin and 150 mls isotonic
crystalloid sol’n. Post-op breathing hood 50%, spont vent through ETT. RR is
70/min with intercostals retractions and nasal flaring. HR is 180/min, BP 150/100,
PaO2 70, PaCO2 29, pH 7.33. Most appropriate immediate therapy
A) Aspirate both chests for air
B) Withdraw the ETT 1cm
C) CPAP and furosemide
D) CPAP and 10mls of 25% mannitol
E) Add dead space

16) (K) A 42 yo man with suspected bronchogenic CA is undergoing bronch-apneic


O2 technique with 100% O2, incremental thiopental and vec. After pre-O2 and
insertion of scope, PaO2 500, PaCO2 36 and pH 7.37. Considerable bleeding
results with multiple cautery attempts. 2nd ABG PaO2 290, PaCO2 120, pH 6.98.
BP inc. from 130/80 to 190/110 with multifocal PVCs. True statements include:
1) The values reported after the 2nd ABG are incorrect
2) Lactic acidosis is prob. Present
3) Treatment of the arrhythmia with propranolol would be harmful
4) The pt. Has been apneic at least 20 min.

19) During CPB, the most sensitive indicator of inadequate tissue perfusion is
A) mixed venous PO2
B) mixed arterial PO2
C) Mean PAP
D) MAP
E) Arterial pH

22) Each of the following values is normal for a term neonate after vag. Delivery
except:
A) pH immediately after delivery 7.25
B) pCO2 immed. After del. 70 mmHg
C) pCO2 12 hrs. after del. 35
D) pO2 immed. After del. 20
E) pO2 12 hrs. after del. 100

25) You rec. brachial plexus block for a 15 yo boy for closed reduction of a fract
elbow. Pulses at wrist are absent. He was injured after eating pizza. His mother
states that he and sister are both “allergic to xylocaine” received during dental
procedure. Each suffered pallor, tachycardia, anxiety and unconsciousness after
mandibular blocks. The most approp action is
A) Recommend GA with RSI and intub
B) Proceed with lidocaine block as planned
C) Skin test the child with 0.01% lido before proceeding
D) Admin antihistamine and corticosteroid, proceed with block using a small
test dose
E) Admin the block using mepivicaine

28) (K) The treatment for carbon monoxide poisoning for a pt briefly comatose in a
fire:
1) 100% O2, high flow
2) hospitalization
3) hyperbaric O2
4) Exchange transfusion
31) The most effective treatment for significant gastric acid aspiration (pH <2.5) is:
A) Prophylactic broad-spec abx
B) IV hydrocortisone
C) Furosemide-induced diuresis
D) ETT intubation and mech vent
E) ETT and saline lavage

34) (K) In an otherwise healthy person, chronic Fe-def anemia with a Hgb 6 is assoc
with:
1) metabolic acidosis
2) dec RA PO2
3) dec LA PO2
4) inc HR

37) A 16 yo boy with hemophilia A (factor 8 def) is scheduled for open red of a jaw
fract. Circulating factor 8 conc is 10% of normal and Hgb is 10. The most approp
operative therapy is admin of:
A) sufficient FFP to inc factor 8 to 50% of normal
B) PRBCs (10 mg/kg body wt.)
C) One unit cryo per 5 kg body wt.
D) Sufficient cryo to maintain factor 8 at 30% normal
E) PRBCs and cryo sufficient to inc factor 8 to 80 % normal

40) (K) Commerical prep of plasma protein fractions for use as volume expanders
1) Must be refrigerated
2) Contain large amts of antihemophilic factor (factor 8)
3) Carry the same risk of viral hepatitis as PRBCs
4) May cause hypotension during rapid admin

43) If halothane is used in a sevoflurane vaporizer and dial is turned to 1%, the actual
delivered concentration is:
A) 0.35
B) 0.67
C) 1.0
D) 1.5
E) 2.0

46) The lowest risk of serum hepatitis for the recipient follows admin of:
A) donor platelet concentrates
B) normal serum albumin (25%)
C) ACD-reserved PRBCs
D) Reconstituted PRBCs
E) Washed erythrocytes

49) The anticoagulant effect of heparin is based upon:


A) alteration of thrombin level
B) potentiation of antithrombin III
C) Activation of plasmin to plasminogen
D) Inactivation of iCa
E) Reduction of available factor VI

52) 75 kg man is given 25 ml of 1.5% lido for axillary block. 20 min later, pinprick
test reveals no analgesia on the radial side of the mid-forearm, the side of the
proposed incision. Appropriate action should be to
A) change to GA
B) inject 5 ml 1% lido lateral to biceps tendon just above elbow crease
C) repeat ax block in 1st dose
D) repeat ax block, but add 15 ml lido
E) sedate pt with enough fentanyl admin slowly to prevent discomfort

55) (K) Appropriate landmarks for an IS block include:


1) thyroid cartilage
2) middle and post scalene muscles
3) medial border SCM
4) cricoid cartilage

58) A 22 yo man has just sustained a high voltage electrical burn, requires anesthesia
for excision of necrotic skin and muscle of the upper extremities. His urine is
wine colored. The most important consideration in this pt is to:
A) Maintain urine and serum osmolality to prevent dehydration
B) Maintain vigorous diuresis with IVFs and mannitol or lasix
C) Avoid volatile anesthetics and obtain LFTs
D) Give albumin sol’n to inc plasma colloid pressure
E) Use regional anesthesia

61) Following N2O-O2-Des anesthesia for T&A, a 6 yo child is noted by recovery


room nurse to be apneic, ashen and pulseless. Blood trickles from mouth. Which
of the following are the most approp immediate steps?
A) Suction pharynx, tracheal intubation, IV NaHCO3
B) Tracheal intub, vent with O2, IV epi
C) Suction pharynx, mask vent with O2, closed chest cardiac massage
D) Suction pharynx, mask vent with O2, IV epi
E) Tracheal intubation, vent w/ O2, closed chest cardiac massage

64) 5 yo submerged X 4 min. Father gave mouth-to-mouth and took to ER.


Somnolent but oriented and cooperative. Findings on CXR normal. PaO2 82,
PaCO2 34, pH 7.44, Na 134, K 3.8, Cl 96, CO2 26. Mgmt:
A) Send her home with instructions to return immed if resp probs occur
B) Admin 125 mls of 5% NaCl with 20 meq KCl IV over 60 min.
C) Intubate the trachea and admin IMV to maintain PaO2 125.
D) Hospitalize X 24 hrs and observe with ABG levels, repeat CXR
E) Admin CPAP by mask at FiO2 .4
67) (K) A 32 yo female is undergoing lap tubal ligation under GA. Ten min after
induction, the ECG shows HR 150. BP dec from 140/90 to 105/60. Approp
treatment includes which
1) verapimil
2) cardioversion
3) adenosine
4) procainamide

70) (K) Which info is required to calculate PAO2?


1) barometric pressure
2) FiO2
3) Resp quotient
4) PaO2

73) 60 yo pt hist of bronchitis, HTN in recovery following a left total hip. Epidural 4
hrs ago. Now, agitated, restless, MAP 120, tachy at 105. O2 by face mask FiO2
0.6. ABG PaO2 160, PaCO2 90, pH 7.2. Initial therapy should be to:
A) Start sodium nitroprusside drip to dec BP to 90
B) Place CVP line to check blood and fluid status
C) MSO4 in 1 mg increments until pain free
D) Reduce face mask FiO2 to 0.28 and repeat ABG in 30 min.
E) Intubate and control vent.

76) 30 yo, 70 kg mitral stenosis for elective lap sterilization. Pre-op, taking digoxin
and unknown med for chronic depression. ECG shows A-fib, HR 68. Anesthesia
induced with STP followed by 50% N2O, 1.15% iso and continuous sux infusion.
The vent is set to deliver a minute vol of 5 L/min via tracheal tube. As CO2 is
being insufflated into abdomen, BP is noted to be 150/100 and ventricular
bigeminy is present. The most appropriate treatment is to:
A) inc the isoflurane conc to 1.5%
B) d/c sux infusion
C) inc min vent to 7.5L/min
D) Admin 5 meq KCl IV over 1 min, followed by 0.25 mg propranolol
E) Measure ABG levels and serum elect levels

79) 18 hrs after inguinal herniorraphy under spinal, 49 yo otherwise healthy man
experiences severe headache when in upright pos, diplopia, and weakness of LLE.
Pronounced anisocoria is present. Temp 38, HR 64, BP 150/80. Most approp
mgmt:
A) LP with CSF cell ct
B) Rapid IV infusion of 1000 ml LR
C) Neuro consult
D) Strict bedrest until symptoms resolve
E) Epidural blood patch
82) The rate limiting enzyme in catecholamine synthesis is:
A) L-aromatic amino acid decarboxylase
B) Tyrosine hydroxylase
C) Dopamine- b-hydroxylase
D) Adenylate cyclase
E) Monoamine oxidase

85) Pt with cardiac tamponade is brought to OR for emergent pericardial window.


Which induction agent is approp
A) STP
B) Etomidate
C) Midazolam
D) Ketamine
E) Propofol

88) (K) 54 yo undergoing aortofemoral grafting is known to have recurrent coronary


artery spasm with angina (prinzmetal’s). During STP-narcotic-N2O anesthesia, an
attack of coronary spasm should be suspected upon the appearance of
1) bradycardia
2) ventricular extrasystoles
3) ST segment depression
4) ST segment elevation

91) 28 yo male with abd stab wound to O.R. for ex lap. BP 120/80. After induction
with STP and sux, BP 210/200 with 4 mm ST seg depression in lead V5. Temp
38.9. Most likely diagnosis is
A) Pheochromocytoma
B) Cocaine intoxication
C) Light anesthesia
D) Pneumothorax
E) Malignant hyperthermia

92k
65 yo male is hospitalized for repair fx of L hip the next afternoon. For 2 years he has been
taking hydralasine and clonidine for HTN and propranolol for agina. HR 62, BP 140/85.
Preop recommendation should include
1 immediate dc of clonidine
2. Postponing operation for at least 48h
3. Immediate dc of propranolol
4 hydralasine thru the am dose.

93) k
Causes of increased myocardial O2 consumption are
1 Aortic Stenosis
2. Ketamine anesthesia
3. Increase of Enddastolic volume
4. Sevofluorane

94) 55yo female with 3 vessel CAD scheduled for CABG, receives 5 mg diazepam
orally and 10 mg MSO4 IM. On arrival in O.R., she has epigastric and substernal
pain. HR 110, BP 120/90. Therapy should include IV admin of
A) 0.3 mg atropine
B) 0.2 mg naloxone
C) 0.5 mg propranolol
D) 0.1 mg phenylephrine
E) 0.5 mg/kg/min SNP

95) s
A patient has temperature of 33, Cardiac Index of 2.2 ABG fio2 70% 7.38/38/98. In
this patient a MVPO2 of 40 is result of
a. failure to correct value for body temperature
b. undetected L to R cardiac shunt
c. Increased O2 consumption from shivering
d. Decreased CO2

96) During Intra Aortic Balloon Pump Counterpulsation

A Balloon inflates after Aortic Valve opens and Deflates during Ventricular Diastole
b. just after AV closes and deflates during ventricular systole
c. balloon remains unchanged in volume but is displaced forward
d. Balloon deflates after av opens and inflates in v systole
e balloon deflates after av closes and inflates in ventricular diastole

97) 46 yo male with angina pectoris refractory to medical therapy is scheduled for
coronary revascularization. He is taking propranolol, 320 mg/day. Coronary
angio is normal except for a 90% prox stenosis of the RCA. LVEF 0.68 and ECG
normal at rest. Sustained intraoperative hypotension (40%) prior to
revascularization would be expected to cause
A) LVEF dec to 0.35
B) Sinus tachy
C) AV block
D) ST dec in V5
E) Pulm edema
F)
98) s
65 yo male 70kg transported to recovery following 3vCABG. Over the next 4hours total of
1.5 mg digoxin was administered to slow the ventricular rate during recurrent episodes of
SVT of 150 to 170 min. During next 20 min his HR remained stabile at 120 but then
increased to 220 without evidence of heart block. BP decreased from 120/70 to 80/65.
Most appropriate therapy is
a. digoxin 0.25 mg iv
b. edrophonium 10mg iv
c. cardioversion
d. Morphine 4 mg iv
e Lidocaine 100 mg iv

99)k
70yo male seen preop for fem pop bypass has ho chronic angina and 1 moth ho severe
chest pain. 12 Lead ekg reveals L BBB. Appropriate preop evals?
1. 12 h Holter EKG
2. Dipyridamole thalium
3. serum cpk
4. echo

100) Pt with h/o rheumatic fever presents for elective chole. A PAC is in place for
heart disease. The pt is noted to develop dec CO in conjunction with inc svO2.
What is the best explanation for this?
A) sepsis
B) CHF
C) R to L intracardiac shunt
D) Mitral Regurgitation
E) The PAC is wedged

101) S. Which of the following will result in better tissue O2 delivery

Hb pO2 %SaO2 CO
1 11.1 260 100 5.6
2 8.0 130 98 10.0
3 9,8 90 90 11
4 6.9 140 99 9
5 16.0 80 75 6

102) 24 yoto OR with liver laceration. Blood type AB-. After opening abdo bleeding
occurs. Bp drops 70/40. There is no AB- available in the hospital. Appropriate
blood products to give for transfusion include.
1. O+ prbc
2. O- Prbc
3. A+
4. A-

103) A pt arrives in the morning of surgery with the following lab values: pH 7.42,
pCO2 52, HCO3 28, Na 140, Cl 90. Which of the following agents would most
likely produce these lab results?
A) Carbonic anhydrase inhibition
B) HCTZ
C) Mannitol
D) Lasix
E) Spironolactone

104)s
Which following infection is most likely transmitted during blood transfusion?
A. ebv
B. cmv
C. hep b
D. hep c
E. hiv