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WorksheetsAPRIL 2022 SUMMATIVE
Total questions: 50
Worksheet time: 26mins
The anatomic dead space in a 70-kg man is
A.50mL
B. 150 mL
C. 250 mL
D. 500 mL
The most important buffering system in the body is
A. Hemoglobin
B. Plasma proteins
C. Phosphate
D. [HCO3−]
A decrease in pH of 0.1 unit will result in
A. A decrease in serum potassium concentration [K+]
of 0.6 mEq/L
B. A decrease in [K+] of 1.2 mEq/L
C. An increase in [K+] of 0.6 mEq/L
D. An increase in [K+] of 1.2 mEq/L
An increase in [HCO3−] of 10 mEq/L will result in an increase in pH of
A. 0.10 pH unit
B. 0.15 pH unit
C. 0.20 pH unit
D. 0.25 pH unit
. A 28-year-old, 70-kg woman with ulcerative colitis is receiving a general anesthetic for a colon resection and ileostomy. The patient’s lungs are mechanically ventilated with the following parameters: V ̇ E 5000 mL and respiratory rate 10 breaths/min. Assuming no change in V ̇ E , how would V ̇ A change if the respiratory rate were increased from 10 to 20 breaths/min?
A. Increase by 500 mL
B. Increase by 1000 mL
C. Decrease by 750 mL
D. Decrease by 1500 mL
Each of the following will shift the oxyhemoglobin dissociation curve to the right EXCEPT
A. Volatile anesthetics
B. Decreased Pao2
C. Decreased pH
D. Increased temperature
The half-life of carboxyhemoglobin in a patient breathing 100% O2 is
A. 5 minutes
B. 1 hour
C. 2 hours
D. 4 hours
A disadvantage of using propofol for prolonged sedation (days) of intubated patients in the ICU is potential
A. Acidosis
B. Tachyphylaxis
C. Hyperglycemia
D. Bradycardia
A 17-year-old type 1 diabetic with a history of renal failure is in the preoperative holding area awaiting an operation for acute appendicitis. Arterial blood gases are obtained with the following results: Pao2 88 mm Hg, Paco2 32 mm Hg, pH 7.2, [HCO3−] 12, [Cl−] 115 mEq/L, [Na+] 138 mEq/L, and glucose 251 mg/dL. The most likely cause of this patient’s acidosis is
A. Renal tubular acidosis
B. Lactic acidosis
C. Diabetic ketoacidosis
D. Aspirin overdose
Methods to decrease the incidence of central venous catheter infections include all of the following EXCEPT
A. Changing the central catheter every 3 to 4 days
over a guidewire
B. Using minocycline/rifampin impregnated catheters over chlorhexidine/silver sulfadiazine impregnated catheters for suspected long-term use
C. Using the subclavian over the internal jugular
route for access
D. Using a single lumen over a multi-lumen catheter
Data from the ARDS network trial (ARDSNet) showed increased mortality from
A. Atelectrauma
B. Volutrauma
C. Barotrauma
D. Inhaled nitric oxide
Which of the following statements regarding the geriatric patient and neuromuscular blocking agents is/are true?
A. the time to onset of neuromuscular blockade is decreased
B. the dose requirement decreases in parallel with an age-related decline in muscle mass
C. age is the primary determinant of the completeness of antagonism of neuromuscular block
D. the clinical duration of action of most neuromuscular blocking agents is increased
Which of the following statements regarding cardiovascular changes associated with aging is false?
A. there is a modest decrease in investing in cardiac index
B. the maximal heart rate is age limited
C. there is myocardial muscle atrophy
D. there is a decrease ventricular compliance
The principle pharmacodynamic change associated with aging is:
A. arthritis
B. pulmonary changes
C. lipid solubility
D. reduced anesthetic requirements
Geriatric cardiovascular changes that occur include all, except:
A. Elevated afterload
B. Left ventricular hypertrophy
C. Elevated systolic blood pressure
D. Increased arterial elasticity
The onset of drug action in the elderly is determined mainly by:
A. Alveolar ventilation
B. Lipid solubility
C. Increased circulation time
D. decreased circulation time
The most prominent and consistent pharmacokinetic effect of aging is decrease in drug metabolism. This is typically due to:
A. The increase Vdss (Volume of distribution at steady state) with age is likely due to an increase in body fat
B.The decrease in Clearance with age for any drug metabolized by the liver and kidney
c. A and B is correct
d. only A is correct
Which of the following statements regarding the pulmonary system in the geriatric patient is/are true?
a. pulmonary shunting increases
b. pulmonary dead space increases
vital capacity decreases
lung elasticity decreases
all are correct
Which of the following statements regarding an 80-year-old patient compared with a 20-year-old patient is/are true/?
A. liver tissue mass decreased by 40%
B. renal blood flow decreased by 40%
C. glomeruli decreases by 30%, renal tissue mass decreases by 30%
all are correct
“Life-span” is defined as….
(a)
1. The gold standard of ICP monitoring and is the most commonly used device:
CT scan
External ventricular drain
Intraparenchymal device
Subarachnoid bolts
1. Lundberg waves that are always pathologic:
A waves
B waves
C waves
D waves
1. Serum glucose levels during neurosurgical procedures should be maintained at a range of:
80 to 120 mg/dL
90 to 180 mg/dL
120 to 150 mg/dL
120 to 200 mg/dL
1. Neurosurgical patients having nonurgent surgery should have a platelet count of:
70,000/mm3
80,000/ mm3
90,000/ mm3
Over 100,000/ mm3
1. Most common metastatic tumors to the brain:
Melanomas
Gliomas
Astrocytomas
Medulloblastomas
1. A tetracycline antibiotic that inhibits ADH action in the renal tubules that is used for the treatment of SIADH:
Demeclocycline
Doxycycline
Minocycline
Methacycline
1. “Large” aneurysm:
Less than 10 mm in diameter
10 to 24 mm in diameter
24 to 30 mm in diameter
More than 30 mm in diameter
1. According to the World Federation of Neurological Surgeons (WFNS) Grading Scale, what grade are those patients with GCS score of 14-13 and with a motor deficit?
Grade 1
Grade 2
Grade 3
Grade 4
1. According to the World Federation of Neurological Surgeons (WFNS) Grading Scale, what grade are those patients with GCS Score of 14-13 and without motor deficit?
Grade 1
Grade 2
Grade 3
Grade 4
1. According≥ to the Fisher Grade System, based on the presence of blood on CT Scan, what fisher grade are those with localized clot and/or vertical layer of blood ≥1 mm thick?
Grade 1
Grade 2
Grade 3
Grade 4
Factor/s that decrease liver blood flow EXCEPT:
Hypoxemia
Hypercarbia
Hypocarbia
Hypervolemia
Which of the following best indicates hepatocellular injury?
INR > 1.5
Increase in Alkaline Phosphatase
Increased Unconjugated Bilirubin
Increase in alanine aminotransferases
You are presented with a patient for EGD with BP 80/60 PR 110 with a history of hematemesis. Which of the following is LEAST appropriate for a management?
Check for coagulopathies
Transfuse with blood products
Intubate the patient possibly using RSI
Give non-selective beta blockers to treat portal hypertension
The following tests are indices for obstructive causes of liver dysfunction except:
ALT
Bilirubin
5’-Nucleotides
Gamma Glutamyl Transferase
This is true of Transjugular Intrahepatic Portosystemic Shunt:
This procedure is indicated for most cases of ascites and liver failure
A stent is passed through the internal jugular vein into the hepatic vein
It is a minimally invasive procedure and has minimal risks
Sedation is always the choice for anesthetic plan
For intraoperative monitoring of a patient with hepatic disease, which will you consider least?
Arterial pressure monitoring
CVP
TEE
TEG
In pharmacokinetics/pharmacodynamics of anesthetics in relation to the liver:
All volatile anesthetics decrease hepatic blood flow at MAC>1
All opioids cause a decrease in Sphincter of Oddi pressure
All neuromuscular blockers require a decrease in dose in induction because of prolonged effects
All anesthetic plans decrease blood flow by 20-30%
Which of these patients will you not clear about elective surgery?
Acute alcoholic hepatitis
Severe chronic hepatitis
Autoimmune hepatitis
Childs Pugh Class C
The following are hallmarks of renal dysfunction in cirrhotic patients EXCEPT:
Renal hypoperfusion
Decreased glomerular filtration
Hypersensitivity to prostaglandin inhibitors
Inappropriate avid retention of sodium and free water
Which of the following patients will have a permissible risk for elective surgery?
Patient with ascites, albumin 2.5, PT 10, INR 1.6, drowsy
Patient with tense abdomen, PT 23, with incoherent speech, albumin 2
Patient Bilirubin 55, INR 1.5, Creatinine 120, moderate ascites
Patient Bilirubin 19, INR 1.7, Creatinine 75, sli
Positive chronotropic?
Increase in heart rate
Faster conduction velocity
Greater contractility
Rapid relaxation
Among the following catecholamines, which one has no effect on the α1-adrenoceptor subtypes?
Epinephrine
Dobutamine
Isoproterenol
Phenylephrine
Based on the catecholamine synthesis, which among the enzymes determines the overall rate of dopamine and norepinephrine formation?
Phenylalanine hydroxylase
Tyrosine hydroxylase
Dopamine hydroxylase
Phenylethanolamine-N-methyltransferase
What is the most common adrenoceptor subtype in skeletal muscle?
Alpha1
Alpha2
Beta1
Beta2
Among the catecholamines, which one is useful in ICU patients with pulmonary arterial hypertension?
Epinephrine
Norepinephrine
Dopamine
Dobutamine
Which among the following drugs is not arrhythmogenic?
Dopamine
Dobutamine
Ephedrine
Phenylephrine
Which of the following drugs can cause hyperglycemia due to inhibition of insulin release?
Clonidine
Phenoxybenzamine
Ephedrine
Fenoldapam
Which among the following exerts neuroprotective effects against cerebral ischemia and hypoxia?
Clonidine
Dexmedetomidine
Dobutamine
Norepinephrine
Preferred intravenous beta-blocker for the treatment of tachyarrhythmias because of its short half-life?
Propranolol
Esmolol
Carvedilol
Labetalol
Which among the following catecholamines is an established treatment in patients with septic shock?
Epinephrine
Norepinephrine
Dopamine
Dobutamine
