Free Printable JULY 2022 SUMMATIVE

1.

By direct effects on the postjunctional receptors, which of the following inhalational agents potentiates the effects of rocuronium the most?

a)

a. Sevoflurane

b)

b. Desflurane

c)

c. Isoflurane

d)

d. Nitrous Oxide

2.

Hydrolysis by plasma cholinesterase is the primary elimination route of all the following drugs EXCEPT?

a)

a. Succinylcholine

b)

b. Mivacurium

c)

c. Remifentanil

d)

d. Procaine

e)

e. Chloroprocaine

3.

13. A patient survived a motorcycle accident 4 days ago but left paraplegic. In the intensive care unit he develops respiratory failure, requiring urgent intubation. Still sleepy, you forget about the contraindications and decide on Rapid Sequence intubation with succinylcholine shortly after administration, the patient develops asystole. Blood gas administration shows a serum potassium of 8.5 mmol/L. You start cardiopulmonary resuscitation and get help. What treatment would not be appropriate at this time?

a)

a. IV calcium chloride

b)

b. IV Insulin and Glucose

c)

c. IV bicarbonate

d)

d.polystyrene sulfonate

e)

e. Hemodialysis

4.

A 20 year old male with burn injury. When can succinylcholine be given safely?

a)

a. The burn was acquired less than 2 days ago

b)

b. Precurarization with low dose rocuronium is used

c)

c. patient’s age is less than 6 months

d)

e. Never: succinylcholine is always contraindicated in burn victims

5.

A 6 year old boy S/p Appendectomy was given neostigmine with atropine. All of the following are side effects of neuromuscular blockade reversal except?

a)

a. Bronchoconstriction

b)

b. Drowsiness

c)

c. Bradycardia

d)

d. Abdominal Cramps

e)

e. Urinary Retention

6.

A 70 year old Male who has chronic renal failure. Which NDMR should be especially avoided in patients with chronic renal failure?

a)

a. Rocuronium

b)

b. Mivacurium

c)

c. Vecuronium

d)

d. Pancuronium

e)

e. Cisatracurium

7.

Which of these statements about liver failure is INCORRECT?

a)

a. Induction of cytochrome P450 occurs in early alcoholic liver failure

b)

b. Hoffmann elimination is not affected by liver failure

c)

c. Patients with liver failure need higher doses of NMBA to achieve a certain block leve;l compared to those with normal liver function

d)

d. Aminosteroid NMBA doses should be reduced in end stage liver failure

e)

e. The elimination half life of atracurium but not cis-atracurium, is significantly slower in patients with moderate liver failure

8.

Which statement about neuromuscular blocking agents is incorrect?

a)

A. Hypothermia prolongs the duration of action of rocuronium and vecuronium, but not of atracurium and cis atracurium

b)

b. the onset time of nondepolarizing NMBAs can be expedited by fast intravenous injection

c)

c. The difference in onset times of vecuronium and mivacurium in different muscle groups is based on regional perfusion differences between these muscle groups

d)

d. Neuromuscular blockade onset time is generally shorter in children compared to adults

e)

e. The duration of action of rocuronium and cis atracurium is increased during intravenous administration of magnesium

9.

Of the following neuromuscular blocking drugs, the order of histamine release potential at equipotent doses, from biggest to smallest potential is

a)

a. Succinycholine, rapacuronium, mivacurium, cis atracurium

b)

b. Cis atracurium, mivacurium, rapacurium, succinylcholine

c)

c. Rapacurium, succinylcholine, cis atracurium, mivacurium

d)

d. Succinylcholine, rocuronium, mivacurium, cis atracurium

e)

e. Succinycholine, mivacurium, rapacurium, cis atracurium

10.

20. Which statement about the effects of succinylcholine in healthy patients is correct?

a)

a. A phase I block is commonly associated with a fade of TOF

b)

b. A phase I block can be antagonized with acetylcholinesterase inhibitors

c)

c. A phase II block is defined as TOF ratio of less than 10%

d)

d. A phase II block is observed at a cumulative dose of more than 7.5mg/kg

e)

e. A phase II block cannot be antagonized with acetylcholinesterase inhibitors

11.

Before surgery, a patient for mastectomy complained because the ward nurse had difficulty searching for an IV in the antecubital fossa. She complained that she was unable to oppose her thumb and the little finger. which nerve may be injured?

a)

a Median nerve

b)

b Radial nerve

c)

c Ulnar nerve

d)

d Musculocutaneous nerve

12.

A 58-year-old anesthesiologist has chronic back pain and is scheduled for laminectomy at a University Medical School Teaching hospital. The OR lasted for 8 hours. After the successful completion of the surgery, the patient has visual complaints of vision loss. What is the most common cause of permanent POVL?

a)

a central retinal artery occlusion

b)

b ischemic optic neuropathy

c)

c cerebral vision loss

d)

d None of the above

13.

Aortic arch baroreceptor is innervated by which nerve?

a)

a Glossopharyngeal nerve

b)

b Facial nerve

c)

c Vagus nerve

d)

d Accessory nerve

14.

A patient for craniotomy is positioned for OR. The anesthesiologist avoids excessive spine flexion/extension in anesthetized patients because?

a)

a. it may decrease surgical exposure for the surgeon

b)

b it may dislodge the ET tube

c)

c it may contribute to spinal cord ischemia and neurologic sequelae

d)

d none of the above

15.

Before turning a patient, what should the anesthesiologist ensure?

a)

a All body parts are accounted for by a staff member

b)

b All lines and tubes are clear

c)

c All appropriate pillows, padding, and proper table are in place

d)

d all of the above

16.

What position has the greatest FRC?

a)

a Reverse Trendelenburg

b)

b Upright

c)

c Prone

d)

d Supine

17.

An Obese female is for laparoscopic cholecystectomy. What position will you place her in for intubation? .

a)

a .the patient is face up with their head resting on a pillow and their neck up position.

b)

b the patient's head and torso are elevated such that the external auditory meatus and the sternal notch are horizontally aligned

c)

c the patient is seated in a semi-sitting position (45-60 degrees) and may have knees either bent or straight

d)

d b the patient's head and abdomen are elevated such that the external auditory meatus and the abdomen are horizontally aligned

18.

The patient who went into labor had epidural anesthesia attached to her. A day after the delivery of the baby, she complained that she can not plantar flex her feet. What nerve is damaged?

a)

a Sciatic Nerve

b)

b Common peroneal Nerve

c)

c Lateral femoral cutaneous nerve

d)

d Obturator nerve

19.

A patient for hemorrhoidectomy is placed in a jackknife position. He is prone to hypotension because?

a)

a anesthesia

b)

b pooling of blood in the legs

c)

c blood loss

d)

d all of the above

20.

A patient for laparoscopic cholecystectomy was placed in a fowler and right-up position. What respiratory alterations can be noticed?

a)

a increased FRC

b)

b Decrease FRC

c)

c no change in FRC

d)

d all of the above

21.

1. False, regarding the management of thyroid storm.

a)

a. Administer IV fluids

b)

b. Administer hydrocortisone 50-100mg IV q6

c)

c. Give propylthiouracil 200-400mg PO or via NGT

d)

d. Administer sodium iodide 500mg PO or IV q6

22.

In non-critically ill hospitalized patients, the goal is to keep glucose level between 180-200mg/dL.

a)

TRUE

b)

FALSE

c)

TRUE

d)

FALSE

23.

1. True of glucose lowering regimen in DM before surgery.

a.

a)

Metformin is associated with severe lactic acidosis if not stopped on the day of procedure

b)

b. Usual dose of evening long-acting insulin should be reduced by 50%

c)

c. Sulfonylurea DHA are at risk of developing acute myocardial infarct

d)

d. Postpone elective surgery if there is an acute rise in glucose to above 250mg/dL

24.

1. Muscle relaxants and topical laryngeal anesthesia are needed to obtain appropriate signals during thyroidectomy surgery.

a)

TRUE

b)

FALSE

c)

TRUE

d)

FALSE

25.

1. Initial dose of Levothyroxine in Myxedema Coma.

a)

a. 50 micrograms IV

b)

b. 100-200 micrograms IV

c)

c. 200-300 micrograms IV

d)

d. 300-400 micrograms IV

26.

1. True or False. Cortisol production is under the control of the adrenocorticotrophic hormone released by the posterior pituitary gland.

a)

TRUE

b)

FALSE

c)

TRUE

d)

FALSE

27.

1. 80-90% of pheochomocytomas:

a)

a. Are multiple tumors and diffuse to the adrenals

b)

b. 95% are located in the thorax, neck and urinary bladder

c)

c. Occurs in the elderly

d)

d. Located on the right

28.

1. True or False. Pheochromocytomas can be disguised as MH.

a)

TRUE

b)

FALSE

c)

TRUE

d)

FALSE

29.

1. Catecholamines and metabolites screened when entertaining pheochromocytoma, EXCEPT:

a)

a. Vanillyl mandelic acid

b)

b. Free dopamine

c)

c. Unconjugated norepinephrine

d)

d. Free epinephrine

30.

1. True or False. 2009 criteria to diagnose DM include Hemoglobin A1c above 6.5%.

a)

TRUE

b)

FALSE

c)

TRUE

d)

FALSE

31.

A 25/M was involved in a mauling incident. He was directly transferred to the OR from the emergency room because of an open fracture of the right humerus that was squirting out blood. He was also reported to have sustained multiple facial fractures. He was received in the OR anxious and confused. Vital signs showed BP 80/50, HR 126, RR 30, O2St 96%.

1. According to the modified ASA difficult airway algorithm for trauma, failure of an awake intubation attempt would entail:

a)

a. Cancelling the case

b)

b. Consideration of other options for intubation

c)

c. Immediate invasive airway access

d)

d. Waiting to return to spontaneous ventilation

32.

A 25/M was involved in a mauling incident. He was directly transferred to the OR from the emergency room because of an open fracture of the right humerus that was squirting out blood. He was also reported to have sustained multiple facial fractures. He was received in the OR anxious and confused. Vital signs showed BP 80/50, HR 126, RR 30, O2St 96%.

1. As the attending anesthesiologist, this patient has an ABC (Assessment of Blood Consumption) score of:

a)

1

b)

2

c)

3

d)

4

33.

For the next 5 items, refer to the situation below:

A 25/M was involved in a mauling incident. He was directly transferred to the OR from the emergency room because of an open fracture of the right humerus that was squirting out blood. He was also reported to have sustained multiple facial fractures. He was received in the OR anxious and confused. Vital signs showed BP 80/50, HR 126, RR 30, O2St 96%.

1. His ABG showed a base deficit of -11. This means that the patient is in:

a)

a. Mild haemorrhagic shock

b)

a. Moderate haemorrhagic shock

c)

a. Severe haemorrhagic shock

d)

a. Blood lactate is a better prognostic marker in the management of shock.

34.

A 25/M was involved in a mauling incident. He was directly transferred to the OR from the emergency room because of an open fracture of the right humerus that was squirting out blood. He was also reported to have sustained multiple facial fractures. He was received in the OR anxious and confused. Vital signs showed BP 80/50, HR 126, RR 30, O2St 96%.

1. Given the patient’s clinical condition, you immediately institute resuscitation. Which of the following is FALSE regarding damage-control resuscitation?

a)

a. A massive transfusion protocol is activated based on ABC score of 2 or more.

b)

a. Crystalloid infusions are minimized.

c)

a. Blood products are administered early with a recommended ratio of 1:1:1.

d)

a. Coagulation studies are done only after bleeding has been controlled.

35.

For the next 5 items, refer to the situation below:

A 25/M was involved in a mauling incident. He was directly transferred to the OR from the emergency room because of an open fracture of the right humerus that was squirting out blood. He was also reported to have sustained multiple facial fractures. He was received in the OR anxious and confused. Vital signs showed BP 80/50, HR 126, RR 30, O2St 96%.

1. After bleeding has been controlled, tachycardia was resolved but the patient was still noted to be hypotensive. The surgeon tells you that intraoperative blood loss was estimated to be only 800cc and that 4 units of pack RBC has already been given. His ECG was noted to have a prolonged QT interval due to lengthening of the ST segment. Which of the following manoeuvres will you do next?

a)

a. Administer 1g CaCl₂ intravenously.

b)

a. Immediate referral to cardiology.

c)

a. Tell the surgeon to search for occult sources of blood loss.

d)

a. Do nothing. The hypotension is due to unaccounted blood loss outside the hospital.

36.

1. The following are challenges to acute pain management of trauma patients EXCEPT:

a)

a. Substance abuse.

b)

b. Emotional issues.

c)

c. Multiple sites of injury.

d)

d. Intensive nature of care.

37.

1. Of the drugs given for intraoperative management of traumatic brain injury, the only drug associated with an increase in mortality is:

a)

a. Propofol

b)

b. Phenobarbital

c)

c. Succinylcholine

d)

d. Corticosteroids

38.

1. A patient with a T5 spinal cord injury was referred to you for debridement of pressure ulcers of the right upper extremity. You then instituted general anesthesia for this case. Intraoperatively, you noted hypertension with bradyarrhythmia despite adequate analgesia and anesthetic depth. The next best thing to do is:

a)

a. Cancel the case.

b)

b. Check the abdomen for a distended urinary bladder.

c)

c. Change general anesthetic from inhalational to TIVA.

d)

d. Refer to radiology for emergency cranial CT scan.

39.

1. The following is not a feature of pericardial tamponade:

a)

a. Bradycardia

b)

b. Distended neck veins

c)

c. Distant heart sounds

d)

d. Pulsus paradoxus

40.

1. A patient at the ER was referred to you for intubation due to sudden loss of consciousness following a blow to the chest from a mixed martial arts tournament. He had a thready pulse when he arrived at the ER and his ECG showed a ventricular tachyarrhythmia. This patient probably has:

a)

a. Pericardial tamponade

b)

b. Spinal shock

c)

c. Occult blood loss

d)

d. Commotio cordis

41.

The following conditions are major indication for Tonsillectomy except?

a)

a. Peritonsillar abscess

b)

a. Tonsillar hyperplasia

c)

a. Obstructive sleep apnea

d)

a. Patient discomfort

42.

1. Which of the following conditions can lead to cor pulmonale?

a)

a. Increase Airway resistance

b)

b. Hypertension

c)

c. Uncontrolled diabetes

d)

d. Left sided heart failure

43.

1. Which of the following statements is true regarding the outcome of tonsillectomy

a)

a. Cardiac enlargement is frequently reversible

b)

b. Persistent airway obstruction during deep sleep

c)

c. Usually results to less post op pain compared to adenoidectomy

d)

d. Commonly presents with Negative pressure pulmonary edema within 24 hours post-op

44.

1. This is the most serious complication of tonsillectomy?

a)

a. Severe vomiting

b)

b. Hemorrhage

c)

c. Edema

d)

d. Hypercarbia

45.

1. Which of the following maxillofacial fracture is considered a major contraindication to Nasotracheal intubation

a)

a. Lefort 1

b)

b. Lefort II

c)

c. Lefort III

d)

d. Lefort IV

46.

1. A high velocity injury may result in facial trauma with cervical spine fracture.The highest probability of facture is located at what segment?

a)

a. C6 to C7

b)

b. C2 to c3

c)

c. C4 to C5

d)

d. C1

47.

1. Which of the following statements is true regarding the use of Laryngeal Mask Airway in tonsillectomy?

a)

a. Decrease in incidence of immediate post operative oxygen saturation

b)

b. Decrease in incidence of post op stridor and laryngospasm

c)

c. Decrease in incidence of airway fire

d)

d. Decrease in incidence of post op hemorrhage

48.

1. An 8 y/o boy was referred to you for elective tonsillectomy. On airway examination, the patient presented with class 4 tonsil size with adequate neck mobility. Which of the following anesthetic management will you consider

a)

a. give sedative premedication to prevent agitation during induction

b)

b. provide multimodal analgesia by giving opiods and nsaid

c)

c. consider giving corticosteroids to relieve patient discomfort from possible edema formation

d)

d. consider long acting NMBA to ensure patient immobility and provide optimum surgical condition

49.

1. Myringotomy tube insertion is a relatively short procedure. Which of the following anesthetic management is true.

a)

a. It can be accomplished using inhalational agent via FM and muscle relaxant

b)

b. Presence of concomitant upper respiratory infection is not an absolute indication for cancellation of surgery

c)

c. It is recommended that patients with URI received continuous positive airway pressure

d)

d. Myringotomy tubes is replaced every 6 months

50.

1. The Resident from Otolaryngologic service called you for an emergency foreign body aspiration of 40 year old patient. He was described to be agitated with vital signs of 130/80 HR 95 RR 22 Temp 36.5 and O2 saturation of 98% at room air. What will be your anesthetic consideration for this patient

a)

a. Examine the Chest X ray film to look for air trapping, infiltrates and atelectasis

b)

b. Provide sedative premedicaton to address his agitation

c)

c. Consider Nitrous oxide

d)

d. Spontaneous ventilation must be observed until the location of foreign have been deter mined

JULY 2022 SUMMATIVE

Total questions: 50

Worksheet time: 50mins

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