Worksheets2025 MAY SUMMATIVE EXAMS
Total questions: 50
Worksheet time: 50mins
In a trauma patient with a prolonged PT but normal PTT, which factor is most likely deficient, directly affecting the speed of the extrinsic pathway?
Factor VIII
Factor VII
Factor IX
Factor XII
A patient with elevated PT and INR is being evaluated preoperatively. Which coagulation pathways are assessed by these tests?
Intrinsic only
Extrinsic only
Common only
Both extrinsic and common
A patient develops coagulopathy while on long-term antibiotics. Which factor affecting vitamin K availability is most likely?
Dietary deficiency
Malabsorption and warfarin use
Liver disease only
Renal failure
Which vitamin K-dependent factor, due to its short half-life, is most sensitive to early warfarin effect seen in PT prolongation?
Factor VII
Factor IX
Factor X
Factor II
If an INR result is greater than 5, what is the most likely clinical concern in a patient undergoing a minor procedure?
High risk of bleeding
Increased clot formation
Liver dysfunction
Disseminated intravascular coagulation
What does an INR of 0.5 indicate in a patient requiring therapeutic anticoagulation?
Therapeutic range
Increased risk of thrombotic events
Over-anticoagulated
Normal value
Which is true regarding Activated Clotting Time (ACT), especially in high-dose heparin monitoring?
Tests the extrinsic pathway only
Less useful in cardiac bypass
Normal ACT is between 90-120 seconds
It is more sensitive than PTT
When performing PTT, what reagents must be added to initiate clot formation in the intrinsic pathway?
Platelet factor 3
Calcium and kaolin
Fibrinogen
Warfarin
What is the primary physiologic cardiovascular response to acute blood loss anemia?
Vasodilation
Increased cardiac output and venous return
Bradycardia
Decreased preload
Which statement is true about blood preservatives and shelf life of stored blood units?
CPDA has a 21-day shelf life
CPD blood must be used within 10 days
Citrate-phosphate-dextrose = 21 days; CPDA = 35 days
Only frozen blood can last beyond 2 weeks
Which inhalational agent should be avoided in patients with a history of malignant hyperthermia (MH)?
Sevoflurane
Nitrous oxide
Xenon
Ketamine
Which factor most significantly prolongs recovery from inhalational anesthesia?
High cardiac output
High fresh gas flow
High lipid solubility of the agent
Low vaporizer setting
Why is desflurane not ideal for mask induction?
High blood solubility
Low potency
Airway irritation and pungency
Slow onset of action
Which anesthetic agent undergoes the least metabolism in the body?
Isoflurane
Sevoflurane
Desflurane
Halothane
Which volatile agent is most associated with compound A formation in low-flow anesthesia?
Sevoflurane
Isoflurane
Desflurane
Halothane
How does increased cardiac output affect the induction with volatile anesthetics?
Speeds induction
Slows induction
Has no effect
Increases MAC
What is the MAC of an agent that prevents movement in 50% of patients exposed to a noxious stimulus?
It reflects agent's potency
It indicates blood solubility
It measures lipid partitioning
It denotes minimum toxic dose
Which factor decreases MAC?
Hyperthermia
Chronic alcoholism
Increasing age
Hypernatremia
In low-flow anesthesia, which change prevents compound A accumulation with sevoflurane?
Increase fresh gas flow
Use desiccated soda lime
Add nitrous oxide
Use lower vaporizer setting
Why is the FA/Fi ratio used clinically?
To monitor depth of anesthesia
To assess MAC
To evaluate speed of alveolar concentration rise
To measure cardiac output
What is the primary goal of fluid management in neurosurgical cases?
To minimize cerebral edema
To maintain cerebral perfusion
To prevent electrolyte imbalance
To reduce intracranial pressure
What is the recommended serum glucose range during neurosurgical procedures?
90-180 mg/dl
90-150 mg/dl
80-150 mg/dl
80-110 mg/dl
Why is prompt neurologic examination important at the conclusion of brain aneurysm coiling?
To assess cognitive function
To detect coil migration
To evaluate anesthesia depth
To identify any new deficits
Lundberg waves that are always pathologic:
A waves
B waves
C waves
D waves
During AV Malformation resection, strict blood pressure control is crucial because of the following, except?
To maintain Cerebral Perfusion Pressure
To prevent ischemic 'steal' phenomenon
To avoid worsening blood loss
To avoid cerebral edema
Compute for Cerebral Perfusion Pressure (CPP): ICP = 15mmHg, BP = 120/80, CVP = 7
85 mmHg
90 mmHg
75 mmHg
80 mmHg
How does ischemia typically appear on EEG during carotid surgery?
Increased waveform amplitude
Decreased waveform latency
Ipsilateral slowing of oscillations
Alpha rhythm suppression
What advantage does dexmedetomidine offer over a propofol-remifentanil combination during awake craniotomy?
Improved brain mapping efficacy
Reduced respiratory depression
Faster recovery time
Enhanced patient comfort
How should seizures during awake craniotomy be managed?
Administer cold saline to the brain surface
Increase systemic blood pressure
Apply ice packs to the patient's head
Perform emergency intubation
A tetracycline antibiotic that inhibits ADH action in the renal tubules that is used for the treatment of SIADH:
Demeclocycline
Doxycycline
Minocycline
Methacycline
A 6-year-old is scheduled for elective procedural sedation. He had a light meal 4 hours ago. According to UpToDate fasting guidelines, what's your next step?
Proceed-light meal requires 4-hour fast.
Delay sedation for an additional 2 hours.
Administer ondansetron and proceed.
Switch to clear liquids and proceed immediately.
While sedating a 5-year-old with propofol for a fracture reduction, capnography readings show a rising CO₂ trend with slight hypoventilation-yet SpO₂ remains > 95%. What is the best resident response?
Wait for SpO₂ to drop before intervening.
Increase oxygen flow and reposition airway.
Discontinue propofol and activate code blue.
Continue monitoring-this is expected.
A 2-year-old is undergoing placement of an IV line for sedation. You want analgesia and sedation in one agent, with preserved respiratory function. Which UpToDate-supported choice is best?
Propofol
Midazolam
Ketamine
Fentanyl
During sedation with fentanyl and midazolam, a child becomes apneic and desaturated to 88%. What is the most appropriate initial resident response?
Administer flumazenil IV.
Use bag-valve-mask ventilation with oxygen.
Give naloxone only.
Attempt verbal stimulation while giving supplemental O₂.
A 5-year-old with severe anxiety is scheduled for a dental procedure under sedation. You want hemodynamic stability, minimal respiratory depression, and a smooth emergence. Which agent aligns best with these goals?
Propofol bolus
Dexmedetomidine loading dose + maintenance infusion
Ketamine bolus
Midazolam + fentanyl
A hypotensive 7-year-old requires urgent sedation for cardioversion. Which agent is most appropriate?
Propofol
Midazolam + fentanyl
Etomidate
Ketamine
A 7-year-old receiving midazolam for a laceration repair becomes unresponsive to verbal but responsive to painful stimuli. You intended only moderate sedation. What's your best next step?
Continue the procedure, cervently monitoring vitals.
Stop the procedure, support airway, reduce sedation depth, and allow recovery to moderate sedation.
Immediately administer flumazenil to reverse sedation fully.
Proceed to intubation and general anesthesia.
A sedated 2-year-old develops snoring and decreasing SpO₂ (to 89%) during ketamine sedation for fracture reduction. What immediate steps should you take?
Administer propofol to deepen sedation.
Reposition head (chin lift or jaw thrust) and apply bag-valve-mask ventilation if needed.
Give atropine to reverse secretions and secretory-induced obstruction.
Begin flumazenil to wake the child.
A 3-year-old sedated with propofol for foreign body removal suddenly stops breathing during manipulation and cannot be ventilated manually. What should the resident do next?
Administer naloxone to reverse potential opioid depression.
Escalate to pediatric rapid sequence intubation (RSI).
Call anesthesia for assistance, continue mask ventilation.
Give flumazenil and observe.
What is the primary QI benefit of a pre-sedation procedural checklist?
Faster sedation onset
More consistent medication choices
Reduced risk of medication dosing or airway preparation errors
Improved parental consent rates
A 75 year old man is confused, restless, and disoriented a day after his TURP surgery. Serum sodium concentration is 112mEq/L, serum osmolality is low, and urine is hypertonic. The most important treatment is:
Restriction of fluid intake
Administration of isotonic saline solution
Administration of hypertonic saline solution (3%)
Administration of spironolactone infusion or mannitol 25g
Which of the following would suggest a pre-renal cause of kidney injury?
Low BUN/Crea ratio
Elevated urine osmolality
Elevated urine sodium
Fractional excretion of sodium > 2%
Which of the following is considered as a risk factor for the development of NSAID-induced Acute Kidney Injury?
Hypertension
Advanced age
Any surgery
Hypervolemia
The following drugs have nephrotoxic potential except:
Non-steroidal anti-inflammatory agents
Morphine
Vecuronium
Suxamethonium
A 60-kg, 70-year-old man requires open reduction and internal fixation of an intertrochanteric fracture sustained 24 hours ago. Serum creatinine concentration is 1 mg/dl and blood urea nitrogen concentration is 40 mg/dl. The most likely cause of these findings is:
obstruction of the bladder outlet
chronic renal insufficiency
acute tubular necrosis
dehydration
A 70-kg 61-year-old patient undergoes a four-hour resection of an abdominal aortic aneurysm during anesthesia with fentanyl and enflurane. Infrarenal clamping is required during the procedure. Twelve hours after the procedure, urine output is 15 ml/hr with a fractional sodium excretion of 6%. Which of the following is the most likely cause?
Hypovolemia
Positive pressure ventilation
Intraoperative renal ischemia
Unilateral ureteral obstruction
Postoperative urine output in a renal transplant patient remains < 20 mL/h despite stable hemodynamics. Which is the next BEST step?
Increase IV fluids to raise CVP to 18 mmHg
Administer mannitol or furosemide to 'kick-start' diuresis
Evaluate surgical site and graft perfusion with Doppler ultrasound
Give low-dose dopamine infusion
A 58-year-old patient undergoes laparoscopic nephrectomy in the full flank position with table flexion. Post-op, he complains of right thigh numbness and burning. Which nerve is most likely injured?
Obturator
Femoral
Ilioinguinal
Lateral femoral cutaneous
In CKD patients, hypermagnesemia is most likely to cause which of the following anesthetic concerns intraoperatively?
Resistance to non-depolarizing neuromuscular blockers
Hypertension and vasospasm
Potentiation of NMBs and hypotension
Seizures from increased NM excitability
A 48-year-old patient with a 1.2 cm proximal ureteral stone is scheduled for SWL. Which of the following is an absolute contraindication to this procedure?
Pacemaker
Presence of ureteral stent
Bleeding diathesis
BMI >35
