Pretest Surgery ( 1 )

A pregnant woman in her 32nd wk of gestation is given magnesium sulfate for pre-eclampsia . The earliest .1
clinical indication of hypermagnesemia is
A. Loss of deep tendon reflexes
B. Flaccid paralysis
C. Respiratory arrest
D. Hypotension

The chief surgical risk to which patients with polycythemia vera are exposed is that due to .2
A. Anemic disturbances
B. Hemorrhage
C. Infection
D. Renal dysfunction

The surgeon should be particularly concerned about which coagulation function in patients receiving anti- .3
?inflammatory or analgesic medications
A. APTT
B. PT
C. Reptilase time
D. Bleeding time

The substrate depleted earliest in the postoperative period is .4

A. Branched-chain amino acids
B. Non-branched-chain amino acids
C. Ketone
D. Glycogen
E. Glucose

Signs and symptoms of hemolytic transfusion reactions include .5

A. Hypothermia
B. Hypertension
C. Polyuria
D. Abnormal bleeding

A patient suspected of having a hemolytic transfusion reaction should be managed with .6

A. Removal of nonessential foreign body irritants, e.g., Foley catheter
B. Fluid restriction
C. 0.1 M HC1 infusion
D. Steroids
E. Fluids and mannitol
In a hemolytic reaction caused by an incompatible blood transfusion, the treatment that is most likely to be .7
helpful is
A. Promoting a diuresis with 250 ml of 50% mannitol
B. Treating anuria with fluid and potassium replacement
C. Acidifying the urine to prevent hemoglobin precipitation in the renal tubules
D. Removing foreign bodies, such as Foley catheters, which may cause hemorrhagic complications
E. Stopping the transfusion immediately

The enteric fluid with an electrolyte (Na+, K+, C1 ) content similarto that of Ringer’slactate is .8
A. Saliva
B. Contents of small intestine
C. Contents of right colon
D. Pancreatic secretions
E. Gastric juice

Which of the following medications administered for hyperkalemia counteracts the myocardial effects of .9
?potassium without reducing the serum potassium level
A. Sodium polystyrene sulfonate(Kayexalate)
B. Sodium bicarbonate
C. 50% dextrose
D. Calcium gluconate
E. Insulin

Hypocalcemia is associated with .10

A. Acidosis
B. Shortened QT interval
C. Hypomagnesemia
D. Myocardial irritability

?Which of the following characteristics of this patient might increase the risk of a wound infection .11
A. History of colon surgery
B. Hypertension
C. Male sex
D. Receipt of chemotherapy
E. Asthma

?A correct statement regarding 5% dextrose in 0.9% saline is which of the following .12
A. It contains the same concentration of sodium ions as does plasma
B. It can be given in large quantities without seriously affecting acid-base balance
C. It is isosmotic with plasma
D. It has a pH of 7.4
E. It may cause a dilutional acidosis
?Correct statements regarding lactated Ringer’s solution include which of the following .13
A. It contains a higher concentration of sodium ions than does plasma
B. It is most appropriate for replacement of nasogastric tube losses
C. It is isosmotic with plasma
D. It has a pH of less than 7.0
E. It may induce a significant metabolic acidosis

Prophylactic regimens of documented benefit in decreasing the risk of postoperative thromboembolism .14
include
A. Early ambulation
B. External pneumatic compression devices placed on the upper extremities
C. Elastic stockings
D. Leg elevation for 24 h postoperatively

Signs and symptoms associated with early sepsis include .15

A. Respiratory acidosis
B. Decreased cardiac output
C. Hypoglycemia
E. Cutaneous vasodilation

The most common physiologic cause of hypoxemia is .16

A. Hypoventilation
B. Incomplete alveolar oxygen diffusion
C. Ventilation-perfusion inequality
D. Pulmonary shunt flow

Generally accepted indications for mechanical ventilatory support include .17

A. PaO2 of less than 70 kPa and Pa greater than 50 kPa while breathing room air
B. Alveolar-arterial oxygen tension difference of 150 kPa while breathing 100% O2
C. Vital capacity of 40–60 mL/kg
D. Respiratory rate greater than 35 breaths/min
E. A dead space:tidal volume ratio (VD /VT) less than 0.6 CO2 of

?Which of the following inhalation anesthetics accumulates in air-filled cavities during general anesthesia .18
A. Diethyl ether
B. Nitrous oxide
C. Halothane
D. Methoxyflurane
E. Trichloroethylene
Major alterations in pulmonary function associated with adult respiratory distress syndrome (ARDS) .19
include
A. Hypoxemia
B. Increased pulmonary compliance
C. Increased resting lung volume
E. Decreased dead space ventilation

Dopamine is a frequently used drug in critically ill patients because .20

A. At high doses it increases splanchnic flow
B. At high doses it increases coronary flow
C. At low doses it decreases heart rate
D. At low doses it lowers peripheral resistance

?If end-diastolic pressure is held constant, increasing which of the following will increase the cardiac index .21
A. Peripheral vascular resistance
B. Pulmonary wedge pressure
C. Heart rate
D. Systemic diastolic pressure

The preoperative characteristics of patients likely to experience postoperative ischemia after non cardiac .22
surgery include
A. Angina
B. More than three premature ventricular contractions (PVCs) per minute
C. Dyspnea on exertion
D. Tricuspid regurgitation

Compensatory mechanisms during acute hemorrhage include .23

A. Decreased cerebral and coronary blood flow
B. Decreased myocardial contractility
C. Renal and splanchnic vasodilation
D. Increased respiratory rate
E. Decreased renal sodium resorption

An 18-year-old woman develops urticaria and wheezing after an injection of penicillin. Her blood pressure .24
is 120/60 mm Hg, heart rate is 155 beats/min, and respiratory rate is 30 breaths/min. Immediate therapy
should include
A. Intubation
B. Epinephrine
C. Beta blockers
D. Iodine
E. Fluid challenge
During blood transfusion, clotting of transfused blood is associated with .25
A. ABO incompatibility
B. Minor blood group incompatibility
C. Rh incompatibility
D. Transfusion through Ringer’s lactate

When an arterial blood gas determination of PCO2 40 kPa is obtained .26

A. There is probably a paradoxical aciduria
B. Alveolar ventilation is adequate
C. Arterial P will indicate the adequacy of alveolar ventilation
D. Arterial PO2 will indicate the degree of ventilation-perfusion mismatch
E. Arterial PO2 can be safely predicted to exceed 90 kPa on room air

Among patients who require nutritional resuscitation in an intensive care unit, the best evidence that .27
nutritional support is adequate is
A. Urinary nitrogen excretion levels
B. Total serum protein level
C. Serum albumin level
D. Serum transferrin levels

Paradoxical aciduria (the excretion of acid urine in the presence of metabolic alkalosis) may occur in the .28
presence of
A. Release of inappropriate antidiuretic hormone
B. Severe crush injury
C. Acute tubular necrosis
D. Gastric outlet obstruction

If a patient suffered a pulmonary arterial air embolism during an open thoracotomy, the anesthesiologist’s .29
most likely observation would be
A. Unexpected systemic hypertension
B. Rising right atrial filling pressures
C. Reduced systemic arterial oxygen saturation
D. Rising systemic CO partial pressures
E. Falling end-tidal CO2

A 72-year-old man undergoes resection of an abdominal aneurysm. He arrives in the ICU with a core .30
temperature of 33°C (91.4°F) and shivering. The physiologic consequence of the shivering is
A. Rising mixed venous oxygen saturation
B. Increased production of carbon dioxide
C. Decreased consumption of oxygen
D. Rising base excess
E. Decreased minute ventilation
To prepare for operating on a patient with a bleeding history diagnosed as von Willebrand’s disease .31
(recessive), you would give
A. High-purity factor VIII:C concentrates
B. Low-molecular-weight dextran
C. Fresh frozen plasma (FFP)
D. Cryoprecipitate
E. Whole blood

The accidental aspiration of gastric contents into the tracheobronchial tree should be initially treated by .32
A. Tracheal intubation and suctioning
B. Steroids
C. Intravenous fluid bolus
D. Cricothyroidotomy

In performing a tracheostomy, authorities agree that .33

A. The strap muscles should be divided
B. The thyroid isthmus should be preserved
C. The trachea should be entered at the second or third cartilaginous ring
D. Only horizontal incisions should be used

If malignant hyperthermia is suspected intraoperatively .34

A. Complete the procedure but pretreat with dantrolene prior to future elective surgery
B. Administer inhalational anesthetic agents
C. Administer succinylcholine
D. Hyperventilate with 100% oxygen
E. Acidify the urine to prevent myoglobin precipitation in the renal tubules

Central venous pressure (CVP) may be decreased by .35

A. Pulmonary embolism
B. Hypervolemia
C. Positive-pressure ventilation
D. Pneumothorax
E. Gram-negative sepsis

Characteristics of continuous arteriovenous hemofiltration (CAVH) in the treatment of surgical patients .36
with acute renal failure include
A. CAVH is useful only in hemodynamically stable patients
B. CAVH requires placement of largebore(8 French) arterial and venous catheters, usually in the femoral vessels
C. CAVH is not effective in treating hypervolemia
D. Continuous heparinization of the patient who undergoes CAVH is unnecessary
E. During CAVH, blood flow is maintained by a mechanical extracorporeal
pump–oxygenator
Signs and symptoms of unsuspected Addison’s disease include .37
A. Hypothermia
B. Hypokalemia
C. Hyperglycemia
D. Hyponatremia
E. Hypervolemia

The etiologic factor implicated in the development of pulmonary insufficiency following major non thoracic .38
trauma is
A. Aspiration
B. Atelectasis
C. Fat embolism syndrome
D. Fluid overload

For the severely traumatized patient requiring airway management .39

A. Awake endotracheal intubation is indicated in patients with penetrating ocular injury
B. Steroids have been shown to be of value in the treatment of aspiration of acidic gastric secretions
C. The stomach may be assumed to be empty only if a history is obtained indicating no ingestion of food or liquid
during the prior 8 h
D. Intubation should be performed in the emergency room if the patient is unstable
E. Cricothyroidotomy is contraindicated in the presence of maxillofacial injuries

?Treatment for clostridial myonecrosis (gas gangrene) Includes which of the following measures .40
A. Administration of an antifungal agent
B. Administration of antitoxin
C. Wide debridement
D. Administration of hyperbaric oxygen

An abnormal ventilatioperfusion ratio (Qs/Qr) in the postoperative patient has been associated with .41
A. Pulmonary thromboembolism
B. Lower abdominal surgery
C. starvation
D. The upright position
E. Increased cardiac output

?Correct statements concerning drowning or near-drowning include which of the following .42
A. The prognosis for recovery of cerebral function in affected persons is better if submersion occurs in warm
water rather than extremely cold water
B. A majority of victims will demonstrate a severe metabolic alkalosis
C. Prompt administration of corticosteroids to affected persons has been shown to decrease the extent of
pulmonary membrane damage
D. Renal damage may occur in affected persons as a result of hemoglobinuria
E. The most important initial treatment of drowning victims is emptying the stomach of swallowed water
Spontaneous retroperitoneal hemorrhage during anticoagulant therapy .43
A. Is best confirmed by bleeding scan
B. Is equally likely with parenteral and oral anticoagulants
C. May mimic an acute surgical abdomen
D. Frequently requires laparotomy for ligation of the bleeding site

Indications for surgical intervention to remove smuggled drug packets that have been ingested include .44
A. Refusal to take high doses of laxatives
B. Refusal to allow endoscopic retrieval
C. Refusal to allow digital rectal disimpaction
D. Intraintestinal drug packets evident on abdominal x-ray in an asymptomatic smuggler
E. Signs of toxicity from leaking drug packets

1 A 11 D 21 C 31 D 41 A
2 B 12 E 22 C 32 A 42 D
3 D 13 D 23 D 33 C 43 C
4 D 14 B 24 B 34 D 44 E
5 D 15 E 25 D 35 E
6 E 16 C 26 B 36 B
7 E 17 D 27 C 37 D
8 B 18 B 28 D 38 C
9 D 19 A 29 E 39 D
10 C 20 B 30 B 40 C