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NEUROLOGY
Hemiparesis 8 days post aneurysm clipping is due
to
1. Rebleed
2. Vasospasm
3. Obstructive hydrocephalus
4. Cerebral edema
5. Thrombosis
The following are true concerning Post-Herpetic Neuralgia EXCEPT:
1. Initial lesion caused by herpes zoster
2. Usually affects thoracic dermatomes
3. If age > 70 yrs, 25% get neuralgia after shingles
4. Local sympathetic block reduces incidence
5. Narcotics are mainstay of treatment
Regarding glycine and blindness - All EXCEPT
1) Decreased visual evoked potentials
2) Permanent loss of vision
Consistent with brain death:
1. Tonic clonic seizure
2. Oculocephalic reflex
3. Nystagmus with cold caloric stimulation
4. ACA interrupted blood flow
5. Interrupted blood flow to extracranial structures
ICP may not rise immediately after a closed head injury mainly due to:
1. Decreased cerebral blood flow
2. Decreased brain water
3. Decreased CMRO2
4. Translocation of CSF from brain to spinal cord
TURP, ammonia in solution can cause
1. visual disturbance
2. seizures
3. hypervolemia
ENDOCRINOLOGY
Pheochromocytoma - Can get increased BP with
1) Prazosin
2) Sodium nitroprusside
3) Propranolol
4) Hydralazine
5) Phenoxybenzamine
EQUIPMENT
With regards to end tidal CO2 monitoring which is true?
1. A stable CO2 tracing ensures correct endotracheal tube position
2. Is more specific than seeing the endotracheal tube pass through the
vocal cords
3. Six breaths with end tidal CO2 is needed to ensure proper position
4. Absence CO2 is indicative of incorrect placement
5. Is useful in a complete cardiac arrest
Re: Disadvantages of closed circuit ventilation, all are true EXCEPT
1. Need to vent the circuit intermittently to get rid of N2 build-up.
2. Cannot monitor ventilation.
3. Cannot easily increase depth of anaesthesia
Pulmonary artery rupture is associated with the following except:
1. Age > 60 years
2. Balloon > 5 cm out from midline
3. Hypothermia
4. Pulmonary hypertension
5. Balloon inflated 1.5 cc for insertion
With oximetry the reading when ratio of absorbance at 660nm and 940nm is
one is:
1. 50%
2. 55%
3. 75%
4. 85%
5. 100%
MISCELLANEOUS
Acute renal failure is most commonly associated with which of the
following procedures or illnesses?
1. Gastrointestinal surgery
2. Hepatic failure
3. Sepsis
4. Cardiovascular surgery
5. Chronic respiratory illness
Hepatorenal Syndrome:
1. Is irreversible
2. Causes a urinalysis picture like ATN
3. Is due to vasoconstriction
4. Increased incidence in patients with cirrhosis and no ascites
5. NSAIDs are helpful
OBSTETRICS
Beta-2 adrenergic tocolytic therapy may cause
all of the following EXCEPT:
1. ST abnormalities
2. Hypokalemia
3. Hypoglycemia
4. Pulmonary edema
5. Tachyarrhythmias
Local anaes in pregnant patient
1. etidocaine is more potent than bupivicaine because of higher lipid
solubility
2. the higher the lipid solubility the less the placental transfer
3. pKa is important in speed of onset
4. fetal acidosis causes accumulation of local anaesthetics
Re: Obstretric hemorrhage - appropriate management EXCEPT
1. If DIC occurs, treat coagulopathy
2.
The following are normal changes in pregnancy EXCEPT:
1. Lowered fibrinogen
2. Raised minute ventilation
3. Raised blood volume
4. Lowered gastric emptying time
5. Physiologic anemia
PAIN
Temperature fiber type
1. A delta
2. B
3. C delta
4.
PEDIATRICS
Physiologic closure of the foramen ovale is associated with all of the
following EXCEPT:
1. Decreased right atrial pressure
2. Increased PO2
3. Increased pulmonary blood flow
4. Increased left atrial pressure
5. Decreased heart rate
Persistent pulmonary hypertension occurs with all except
1. Acidosis
2. Hypoxia
3. Hypercarbia
4. Meconium aspiration
5. Congenital diaphragmatic hernia
Which of the following are true regarding pediatric day care surgery?
1. Suitable for ASA I, II & III patients
2. Unsuitable for patients undergoing cystoscopy
3. Recovery is delayed more by premedication with midazolam than morphine
4. Suitable for ex-prems 3 months post-natal or greater
5. Post-op nausea & vomiting is more common with procedures longer
than 20 minutes.
The following is a difference between adults and neonates with respect to
regional anaesthesia:
1. Neonates have a smaller VD
2. duration of tetracaine spinal will be longer in neonates
3. Spinal will last longer in neonates
4. Increased protein binding in the neonates which progressively decreases
to levels of adulthood
5. Addition of 1:200,000 epinephrine to bupivicaine will show greater
constriction in the neonate
Neonate - cardiac output greater than adults in which organ
1. brain
2. cardiac
3. muscle
4. splanhnic
Which is true concerning Demerol?
1. Elimination half-life in neonate is 13 hours
2. Demerol 50 mg in 50 cc of NaCl if given epidurally provides 8 hours of
analgesia
3. If baby is delivered 5 hours after mother has been given Demerol 75 mg
im there are no measurable differences in Apgar or Brazelton score
compared to babies of mothers not given Demerol
4. Normeperidine is an active metabolite providing analgesia
5. Dose of naloxone for drpressed neonate is 0.01 mg/kg
Which congenital cardiac anomaly is associated with the following
requirements for management?
*Decreased contractility
*Decreased pulmonary vascular resistance
*Normal systemic vascular resistance
*Normal heart rate
*High RV preload
1. Pulmonic valve stenosis
2. Pulmonary infundibular stenosis
3. VSD with left to right shunt
4. VSD with right to left shunt
5. ASD
PHARMACOLOGY
Curare requirements are increased by:
1. Major burns
2. Increased age
3. Renal failure
4. Liver failure
The steady state during a continuous infusion
1. Is mainly dependent on the rate of clearance
2. Loading dose depends on volume or distribution and plasma concentration
3. A large initial dose can cause initial adverse effects
Thiobarbiturates which is true?
1. Vasodilation is due to
histamine release
2. no brain protection in adults in cardiac arrest
3. decreases CMRO2 in dose dependent fashion to a max of 90%
4. only CVS effect is a decrease in SVR
5. no change in intraocular pressure
Smallest volume of distribution
1. alfentanil
2. morphine
3. fentanil
4. sufentanil
Beta blockers with longest t1/2:
1. Emolol
2. Labetalol
3. Nadolol
4. Atenolol
5. Metoprolol
Sample size calculation, which is false
1. type B is false positive
2. type 1 is false positive
3. alpha is false positive
Prostaglandin F2alpha
1.?
The following are true concerning IV morphine except:
1. Causes spasm of sphincter of Oddi
2. Causes urinary retention
3. Get CTZ stimulation
4. Used to treat shivering
5. Causes nausea
Cyclooxygenase is involved in production of all of the following from
arachadonic acid except
1. Leukotrienes
2. Prostaglandins
3. Prostacyclin
4. Thromboxane
Phenylephrine raises BP because of:
1. Venoconstriction
2. Lowered SVR
A 70 Kg man receives 1000 mg of drug IV.
What is the volume of distribution?
(Graph depicting 2 compartment model of kinetics with initial rapid
redistribution. Phase and slower B elimination decay curve which
intersects with y axis)
1. 12.5L
2. 20L
3. 25L
4. 40L
All potentiate NMB except
1. Hypercalcemia
2. Hypermagnesium
3. Hypokalemia
Antibiotic not associated with NMB prolongation:
1. Neomycin
2. Gentamycin
3. Clindamycin
Flumazenil 2mcg/kg except:
1. onset within 2 mins
2. rarely nausea and vomiting
3. no effect on neuroendocrine axis
4. may precipitate withdrawal seizures
5. cardiac arrhythmias
Side effects of iv demerol:
1. increased biliary pressure
2. tachycardia
3. vasodilation
4. myocardial depression
HPV inhibited by all except
1. Ibuprophen
2. Dopamine
3. Dobutamine
4. Nitroprusside
5. Isoproterenol
PHYSIOLOGY
SIADH:
1. Urine osmolality > serum
2. Increased osmo of serum and extracellular fluid
3. Reduced renal excretion of sodium
4. Increased serum osmolarity
5. Responds to chlorpropromide
Lowered Mixed venous saturation is found is
1. severe anemia
2. cyanosis
Which is true regarding the cardiovascular system in the elderly?
1. Heart rate is increased more than usual by beta-agonist therapy.
2. Left ventricular diastolic filling rate is increased
3. Resting heart rate is decreased
4. There is decreased response by vascular adrenoreceptors
5. There are increased numbers of cardiac adrenoreceptors
Spinal shock which is not consistent?
1. vasodilation
2. tachycardia
3.
REGIONAL
Advantages of epidural
vs. GA for hip surgery include:
1. Increased blood loss
2. Decreased thromboembolic phenomenon post-op
3. Decreased blood flow to extremities
4. Greater chance of hypoxia in first 24 hrs.
5. Reduced long term mortality
Advantage of spinal/epidural for patient with limited coronary reserve -
all, except
1. Increased contractility
2. Decreased afterload
3. Decreased stress response
4. Coronary artery vasodilation
Epidural morphine for post-op C/S causes all except:
1. Increased N&V
2. Urticaria
3. increased urinary retention
4. increased hemodynamic complications
5. reactivation of labial herpes
Regarding the addition of bicarb to lidocaine 1.5%, which is true?
1. pCO2 increases
2. Solution precipitates because local anaesthetic is in an alkaline
solution
3. Addition of 1 mmol NaHCO3 increases pH to 10
4. Local anaesthetic is more ionized when bicarb added
5. slower onset and longer duration
RESPIRATORY
Resistance is defined by
1. pressure x volume
2. pressure/flow rate
3. ?
Increased pulmonary pressure can occur with all except
1. Epinephrine infusion
2. Atelectasis
3. Hyperinflation
4. Respiratory alkalosis
initial measures during one lung ventilation when O2 sat is 90% all except
1. add Peep to dependent lung
2. cPap to non dependent lung
3. tidal volume 10-12 ml/kg
4. resp rate 10-12/min
5. FiO2 1.0
Alveoli are smallest at the base of the lung in an upright person because:
1. Transpulmonary pressure is decreased at the base
2. Intrapleural pressure is more negative at the base
3. Action of surfactant is enhanced
4. Gravity dependent blood flow compresses airways
5. Alveolar pressure is increased at the base
PEEP will result in:
1. Increased CVP
2. Increased RVEDV
3. Decreased afterload
Increased closing capacity with all except
1. Age
2. Smoking
3. Hypotension
4. Obesity
5. Supine position
Anatomic dead space:
1. Is increased by intubation
2. Equals the physiologic minus the alveolar dead space
3. Is comprised of the trachea and the mainstem bronchi
4. Is approximately 2 ml/kg
5. Calculated with Bohr equation.
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