Free Printable MAY 2022 SUMMATIVE

1.

1. The following are the treatment for severe hypokalemia (K <2.0 mEq/L)

a)

A. Intravenous KCl infusion <40 mEq/L

b)

B. IV KCL infusion <10 mEq/H

c)

C. Both

d)

D. All of the above

2.

1. The following are advantages of colloid except

a)

A. Smaller infused volume

b)

B. Prolonged increase in plasma volume

c)

C. Less peripheral edema

d)

D. Greater urinary flow

3.

The following are signs and symptoms of severe hyponatremia ( Na < 120 mEq/L_

a)

Nausea and vomiting

b)

Cramps,Loss of appetite

c)

Seizures

d)

All of the above

4.

The following are treatments for Acute hypomagnesemia

a)

IV Mg: 8-16 mEq ( 1 – 2 g MgSo4) bolus over 1 H followed by 2 to 4 mEq/H (250-500 mg/H MgSO4 as continuous Infusion

b)

Calcium

c)

None of the above

d)

All of the above

5.

1. Patient has undergone radical neck dissection and flap construction lasted for 16 hours. Post ABG revealed pH – 7.40, HCO3 19 mEq/L, PaCO2 32 mm Hg, sodium 140 mEq/L, Cl 114 mEq/L, CO2 20 mEq/L, anion gap 8 mEq/L. Interpret ABG result

a)

A. Hyperchloremic metabolic acidosis

b)

B. Hyperchloremic respiratory acidosis

c)

C. Hypochloric metabolic alkalosis

d)

D. None of the above

6.

1. Ascending muscle weakness appears when plasma Potassium approaches to

a)

A. 7 mEq/L

b)

B. 8 m Eq/L

c)

C. 5.5 mEq/L

d)

D. 10 mEq/L

7.

1. ECG changes abnormalities seen for potassium >8 mEq/L

a)

A. Sine wave

b)

B. Ventricular fibrillation

c)

C. Asystole

d)

D. All of the above

8.

1. The following symptoms were noted in patients with moderate hypercalcemia ( 11.5 -13 mg/dl)

a)

Lethargy

b)

Anorexia,Nausea

c)

Polyuria

d)

All of the above

9.

1. The anesthetic implication of Metabolic acidosis

a)

A. Hyperchloremic metabolic acidosis may be relatively healthy

b)

B. Lactic acidosis, ketoacidosis, uremia will chronically for acutely ill

c)

C. Pre assessment should emphasize volume and renal functions

d)

D. All of the above

10.

1. The following are treatment for hypermagnesemia ( > 2.5 mg/dl)

a)

A. IV Calcium ( 5 to 10 mEq)

b)

B. Induced Diuresis

c)

C. Both

d)

D. None of the above

11.

1) If you need to transfuse blood in an immunosuppressed patient, what are your instructions for Transfusion services?

a)

A. Ask the blood bank for irradiated leukodepleted blood.

b)

B. Properly typed and cross-matched blood will do.

c)

C. Both A and B

d)

D. None of the Above

12.

1) In isovolemic hemodilution, what mechanisms serve to maintain oxygen delivery?

a)

A. Increase in cardiac output (CO) and redistribution of blood flow to organs with greater oxygen requirement

b)

B. Increased oxygen extraction and decreased hemoglobin oxygen affinity.

c)

C. Both A and B

d)

D. None of the Above

13.

1) Regarding ways of collecting autologous blood for transfusion

a)

A. Pre-donation of the patient’s blood 1 day prior to surgery

b)

B. Intraoperative blood withdrawal w/o volume replacement with cell-free substitutes

c)

C. Perioperative blood salvage during and immediately after surgery

d)

None of the above

14.

1) The most common inherited coagulopathy is

a)

A. Hemophilia A

b)

B. Hemophilia B

c)

C. von Willebrand disease

d)

D. Factor V deficiency

15.

1) Each of the following treatments might be useful in restoring a prolonged prothrombin time to the normal range EXCEPT

a)

A. Recombinant factor VIII

b)

B. Vitamin K

c)

C. Fresh frozen plasma

d)

D. Cryoprecipitate

16.

16) A 51-year-old patient was an unrestrained driver in a motor vehicle crash in which he sustained multiple traumatic injuries. He is on mechanical ventilation, and has received 8 units of packed red blood cells, 4 units of fresh-frozen plasma, and 6 units of platelets. His arterial blood gas reveals a metabolic alkalosis. The most likely explanation for this finding is

a)

A. Metabolism of citrate to bicarbonate

b)

A. Under-resuscitation

c)

A. Continued bleeding

d)

A. Hypoventilation

17.

17) A 70-year-old patient with chronic renal failure is in the operating room undergoing a kidney transplant. There has been more blood loss than expected, and he has received 6 units of packed red blood cells and 3 units of fresh-frozen plasma. The surgeons still complain that the patient “won’t clot.” All of the following are potential contributors to his coagulopathy, except

a)

A. The temperature of 34.9°C

b)

A. Uremia

c)

A. Dilutional thrombocytopenia

d)

A. Fibrinogen level of 250 mg/dL

A.

18.

18) Which of the following patients is least likely to need calcium supplementation due to citrate-induced hypocalcemia related to blood transfusion?

a)

A. A 30-year-old trauma patient receiving massive blood transfusion through a rapid transfuser at a rate of 75 mL/min

b)

B. A patient with end-stage liver disease undergoing a complicated open shunt procedure, who is hypothermic and has received greater than 2 blood volumes of transfusion

c)

C. A neonate undergoing congenital diaphragmatic hernia repair

d)

D. A 50-year-old patient with coronary artery disease undergoing an open femoral popliteal bypass procedure, who has received 3 units of packed red blood cells

19.

19) You are caring for an 18-year-old female trauma patient who was emergently transported to the operating room for control of massive bleeding. Due to the acuteness of the patient’s bleeding, there was no time for blood typing and she has received 3 units of O-negative packed red blood cells. The blood bank notifies you that the patient’s blood type is A-positive. If the patient requires further transfusion, which of the following should be administered?

a)

A. A-positive RBCs

b)

A. A-negative RBCs

c)

A. O-negative RBCs

d)

A. RhoGAM

20.

1. Cardiac output increases greatly during pregnancy and delivery. The cardiac output then returns to nonpregnant values by how long post-partum?

a)

A. 12 hours

b)

B. 1 day

c)

C. 2 weeks

d)

D. 6 months

21.

1. Uterine blood flow at term typically increases to approximately

a)

A. 100 mL/min

b)

B. 250 mL/min

c)

C. 500 mL/min

d)

D. 750 mL/min

22.

20) A patient with type O blood will have which of the following plasma antibodies?

a)

A. Anti-A

b)

B. Anti-B

c)

C. Both anti-A and anti-B

d)

D. None

23.

1. Which of the following cardiovascular parameters is decreased at term?

a)

A. Central venous pressure

b)

B. Pulmonary capillary wedge pressure

c)

C. Systemic vascular resistance

d)

D. Left ventricular end-systolic volume

24.

1. Cardiac output is greatest when?

a)

A. During 1^st trimester

b)

B. During 3^rd trimester

c)

C. During labor

d)

D. Immediately after delivery of the newborn

25.

1. Which of the following respiratory parameters is not increased in the parturient?

a)

A. Minute ventilation

b)

B. Tidal Volume

c)

C. Arterial PaO2

d)

D. Serum bicarbonate

26.

1. Which of the following lung volumes or capacities change the least during pregnancy?

a)

A. Tidal volume

b)

B. Functional residual capacity

c)

C. Expiratory reserve volume

d)

D. Vital Capacity

27.

1. The most common side effect of intrathecal narcotics in the obstetric population

a)

A. Pruritus

b)

B. Nausea and vomiting

c)

C. Respiratory depression

d)

D. Urinary retention

28.

1. Which of the following narcotics has the longest duration of action when added during a cesarean section under epidural anesthesia?

a)

A. Fentanyl

b)

B. Sufentanil

c)

C. Morphine

d)

D. Meperidine

29.

1. Which inhalation anesthetic does not produce uterine relaxation?

a)

A. Isoflurane

b)

B. Sevoflurane

c)

C. Nitrous oxide

d)

D. All produce uterine relaxation

30.

1. During the second stage of labor, complete pain relief can be obtained with?

a)

A. Paracervical block

b)

B. Neuraxial block with fentanyl and morphine

c)

C. Pudendal nerve block

d)

D. Lumbar epidural block with bupivacaine and no narcotic

31.

True statement regarding malignant hyperthermia (MH):

a)

Succinylcholine is the most potent agent triggering malignant hyperthermia

b)

An early sign of MH is the increase in body temperature

c)

Gastric lavage with cold saline should not be done to avoid hypothermia

d)

Primary treatment is the administration of dantrolene 2-3 mg/kg intravenously

32.

Hypoglycemia in preterm neonates is defined by a plasma concentration of:

a)

Less than 40 mg/dl

b)

Less than 55 mg/dl

c)

. Less than 70 mg/dl

d)

Less than 100 mg/dl

33.

True regarding neonatal pulmonary physiology, EXCEPT:

a)

Intercostal muscle tone is decreased and chest wall compliance is increased in infants compared to adults.

b)

b. Tidal volume per weight in neonates is similar to that of adults.

c)

c. Alveolar ventilation in neonates is at least 10 times higher than that of adults.

d)

d. The respiratory rate in neonates is three to four times higher than that of adults

34.

The following are true statements:

a)

1. Intercostal muscle tone is decreased and chest wall compliance is increased in infants compared to adults.

b)

2. Alveolar ventilation in neonates is four to five times higher than that of adults (NOT at least 10 times).

c)

3. Tidal volume per weight in neonates is similar to that of adults.

d)

4. The respiratory rate in neonates is three to four times higher than that of adults.

35.

True statement regarding post-extubation stridor in pediatric patients:

a)

a. It is less common in children with recent URTIs and Down syndrome.

b)

b. Heliox has not been shown to be effective in reducing the work of breathing.

c)

c. Usually results from swelling of the tongue after the endotracheal tube has been removed

d)

d. Treatment includes humidified oxygen, intravenous dexamethasone and nebulized racemic epinephrine.

36.

Benefits of maintaining intraoperative normothermia in infants and children, EXCEPT:

a)

a. Decrease in wound infection rates.

b)

b. Decreased myocardial infarction rates.

c)

c. Reduced need for transfusions.

d)

d. None of the above.

37.

True regarding pediatric cardiovascular system:

a)

a. Pediatric patients increase their cardiac output mainly by increasing cardiac contractility

b)

b. Infants have an increased vagal tone and are prone to bradycardia.

c)

c. The baroreceptor reflex is mature at birth and therefore neonates are able to compensate for hypotension

d)

d. Compared to adults, they are less dependent on extracellular calcium for maintaining cardiac contractility

38.

Compared with adults, neonates, infants, and small children have:

a)

1. Less compliant ventricles and limited ability to increase cardiac output by increasing contractility; they increase CO only by increasing heart rate.

b)

2. They are also more dependent on extracellular calcium for maintaining cardiac contractility.

c)

2. Infants have an immature baroreceptor reflex and limited ability to compensate for hypotension.

d)

3. Infants have increased vagal tone and are prone to bradycardia.

39.

Oxygen consumption of a full-term neonate:

a)

a. 1-2 ml/kg/min

b)

b. 0.5-1 ml/kg/min

c)

c. 2-3 ml/kg/min

d)

d. 5-7 ml/kg/min

40.

The nasal passages account for how much of the total resistance to airflow in a neonate?

a)

a. 10%

b)

b. 60%

c)

c. 25%

d)

d. 75%

41.

The estimated endotracheal tube depth in a 3kg neonate is:

a)

a. 5 cms

b)

b. 7 cms

c)

c. 9 cms

d)

d. 12 cms

42.

What is the laryngoscope blade type and size appropriate for a 5-year-old weighing 18kg?

a)

a. Miller 0

b)

b Miller 1

c)

c. Macintosh 2

d)

d. Wisconsin 1

43.

1. The following is true regarding renal anatomy, EXCEPT:

a)

a. The renal blood vessels lie anterior to the pelvis of the kidney, but some branches may pass posteriorly.

b)

b. Renal pain sensation is conveyed back to spinal cord segments T10 through L1 by sympathetic fibers.

c)

c. Sympathetic innervation is supplied by preganglionic fibers from T6 to L1.

d)

d. The vagus nerve provides parasympathetic innervation to the kidney, and the S2 to S4 spinal segments supply the ureters.

44.

1. The following statements are true, EXCEPT:

a)

a. The bladder receives its innervation from sympathetic nerves originating from T8 to L1, which conduct pain, touch, and temperature sensations.

b)

b. Bladder stretch sensation is transmitted via parasympathetic fibers from segments S2 to S4.

c)

c. The prostate, penile urethra, and penis also receive sympathetic and parasympathetic fibers from the T11 to L2 and S2 to S4 segments, respectively.

d)

d. The pudendal nerve provides pain sensation to the penis via the dorsal nerve of the penis.

45.

1. The anion gap (AG) represents the total serum concentration of unmeasured anions and can be calculated as:

a)

a. AG = (Na⁺ - K⁺) + (HCO3⁻ - Cl⁻)

b)

b. AG = (Na⁺ + K⁺) + (HCO3⁻ + Cl⁻)

c)

c. AG = (Na⁺ - K⁺) − (HCO3⁻ - Cl⁻)

d)

d. AG = (Na⁺ + K⁺) − (HCO3⁻ + Cl⁻)

46.

1. The potential of volatile agent-induced nephrotoxicity has been related to the production of compound A during prolonged, low-fresh-gas-flow anesthesia using this agent:

a)

a. Isoflurane

b)

b. Sevoflurane

c)

c. Enflurane

d)

d. Halothane

47.

1. The potential of volatile agent-induced nephrotoxicity has been related to the production of compound A during prolonged, low-fresh-gas-flow anesthesia using this agent:

a)

a. Isoflurane

b)

b. Sevoflurane

c)

c. Enflurane

d)

d. Halothane

48.

1. Angiotensin II plays an important role in the regulation of extracellular fluid volume (ECF). Which of the following actions is due to angiotensin II?

a)

a. inhibition of aldosterone secretion

b)

b. inhibition of ACTH secretion

c)

c. inhibition of vasopressin secretion

d)

d. stimulation of thirst

49.

1. In the proximal convoluted tubule, the main driving force or water and other solute reabsorption is generated by which of the following electrolytes?

a)

a. Na⁺

b)

b. K⁺

c)

c. Cl^‑

d)

d. HCO3^-

50.

1. A patient at risk of perioperative acute kidney injury (AKI) is administered an infusion of low-dose dopamine (1–3 mcg/kg/min). Theoretically, what is the potential benefit of using dopamine for renal protection?

a)

a. D₁ receptor-mediated increase in mean blood pressure and heart rate

b)

b. D₂ receptor-mediated natriuresis

c)

c. D₁ receptor mediated diuresis

d)

d. D₁ receptor-mediated activation of Na⁺-H⁺ exchanger in distal convoluted tubule

51.

1. After acute administration of a diuretic, a patient notes tinnitus and hearing impairment. Which of the following diuretics is most likely to cause ototoxicity?

a)

a. Acetazolamide

b)

b. Hydrochlorothiazide

c)

c. Furosemide

d)

d. Mannitol

52.

1. 68yo patient undergoing TURP procedure for more than 1hr under neuraxial anesthesia. Noted confusion and restlessness. Possible ECG changes:

a)

a. Widening of QRS complex

b)

b. Elevated ST segment

c)

c. Ventricular tachycardia

d)

d. Ventricular fibrillation

53.

1. The retroperitoneal approach to nephrectomy involves:

a)

a. supine positioning

b)

b. risk of unintentional pneumothorax

c)

c. breach of the peritoneal cavity

d)

d. risk of visceral injury and peritonitis

MAY 2022 SUMMATIVE

Total questions: 53

Worksheet time: 53mins

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