Multiple choice questions

Questions

Chapter 2 : Behavioral development

1.
Which neurodevelopmental outcomes have been used to assess children exposed to anesthesia?
- a.
  IQ testing
- b.
  Behavioral surveys
- c.
  Academic achievement
- d.
  All of the above
2.
The age at which children are vulnerable to the neurotoxic effects of anesthesia is:
- a.
  In utero
- b.
  Under 1 month of age
- c.
  Under 3 years of age
- d.
  Unknown
3.
Clinical studies of anesthetic neurotoxicity in children are difficult to carry out for all of the following reasons except :
- a.
  Need for anesthesia is often linked to patient comorbidity.
- b.
  Long-term neurodevelopmental outcomes are difficult to assess at an early age.
- c.
  Translating the timing of brain development between animals and humans is impossible.
- d.
  All of the above.
4.
The SmartTots Consensus statement recommends that providers:
- a.
  Highlight the uncertainty in the human studies and the potentially harmful consequences of delaying surgery.
- b.
  Modify anesthetic management to reduce exposure to sevoflurane.
- c.
  Consider delaying all procedures until after 3 years of age.
- d.
  Attempt to use spinal anesthesia whenever possible.

Chapter 3 : Respiratory physiology

1.
With regard to postnatal respiratory function, all of the following physiologic findings are true except :
- a.
  Newborns respond to hyperoxia by increasing ventilation.
- b.
  Periodic breathing only occurs in preterm infants.
- c.
  Newborns breathing a hypoxic mixture will decrease ventilation in response to CO2.
- d.
  Central chemoreceptors respond to changes in H+ ion, while peripheral chemoreceptors respond to PAO2 and pH.
2.
All of the following respiratory findings are true about postnatal lung development except :
- a.
  Intrapleural pressure is more negative in infants than older children.
- b.
  The number of alveoli reaches adult levels by 17 to 18 months of age.
- c.
  Two thirds of airway resistance is between the airway opening and the trachea.
- d.
  Anesthesia is associated with a 25% to 45% decrease in FRC.
3.
Concerning the end-expiratory lung volume or functional residual capacity (FRC) in infants, which of the following statements is false ?
- a.
  FRC is maintained by sustained (basal) tension of the diaphragm and intercostals against elastic recoil of the thorax at end-expiration.
- b.
  General anesthesia relaxes inspiratory muscle tone and decreases FRC in all ages.
- c.
  The addition of a neuromuscular blocking agent does not further decrease the FRC in infants more than general anesthesia alone.
- d.
  Periodic deep inspirations (sighs) and CPAP/PEEP (>5 cm H2O) help to minimize postoperative atelectasis and resultant hypoxemia.

Chapter 4 : Airway physiology and development

1.
An 18-month-old boy with Apert syndrome is scheduled for frontal orbital surgery with a mid-face advancement. You are concerned about his preoperative status because he has clear but copious nasal secretions; his parents deny any recent cold and claim that he looks better than ever. He has typical dysmorphic facies as well, so you are equally concerned about his airway management. What is the MOST appropriate strategy in this situation?
- a.
  Canceling the case out of concern for an upper respiratory tract infection.
- b.
  Proceeding with the case and anticipate difficult mask induction followed by a difficult intubation.
- c.
  Perform a sedated endotracheal intubation prior to induction.
- d.
  Perform an inhalation induction with the possibility of a challenging mask fit, and conventional direct laryngoscopy.
2.
A five-year-old boy has experienced recurrent swelling and purulent discharge from a point in his neck 1 cm lateral to the midline at the level of the thyroid notch and along the anterior border of the sternocleidomastoid muscle, especially during the recovery phase from upper respiratory tract infections. You can palpate a soft, mobile mass that is nontender at the site, approximately 1 × 1 cm. He has been on broad-spectrum antibiotics and is now here for a surgical excision as a day surgery patient. What is the MOST likely diagnosis based on the location?
- a.
  Persistently infected lymph node.
- b.
  A branchial cleft cyst, in isolation
- c.
  A branchial cleft sinus tract without involvement of contiguous structures
- d.
  A third or fourth branchial cleft sinus tract with possible involvement of contiguous structures including the internal carotid artery, hypoglossal and/or glossopharyngeal nerve.
3.
A 14-month-old with croup is admitted to your intensive care unit; his respiratory rate is 62, he is tachycardic and looks scared. His SpO ₂ is 91%. You are giving him supplemental oxygen which improves his saturation, but not his work of breathing. Which of the following therapeutic maneuvers is LEAST appropriate?
- a.
  CPAP
- b.
  Sedation
- c.
  Heliox mixture
- d.
  Inhaled nitric oxide
4.
An 8-year-old girl with Klippel–Feil syndrome, scoliosis, a solitary kidney, neurogenic bladder, sacral agenesis and a tethered cord was scheduled to undergo cervical spine fusion following one month in halo traction. She is on no medications, is doing well in school and is developmentally normal. Which of the following clinical findings is LEAST likely?
- a.
  difficult intubation
- b.
  difficulty visualizing the glottis
- c.
  difficult extubation
- d.
  impaired jaw mobility
5.
In which of the following clinical situations is a cleft palate MOST likely associated?
- a.
  Turner
- b.
  Down
- c.
  Pierre Robin
- d.
  Crouzon

Chapter 5 : Cardiovascular physiology

1.
A 2-year old patient presents with difficulty swallowing food. Which of the following diagnostic methods is best utilized to determine the presence of a vascular ring?
- a.
  Echocardiogram
- b.
  Cardiac catheterization
- c.
  Physical exam
- d.
  Computed tomography
2.
During fetal circulation, what is the oxygen saturation in the left ventricular outflow tract when the mother is breathing room air?
- a.
  99%
- b.
  85%
- c.
  65%
- d.
  50%
3.
At what age does pulmonary vascular resistance begin to approximate adult values?
- a.
  4 days
- b.
  2 months
- c.
  18 months
- d.
  3 years
4.
Which of the following anesthetic agents causes the greatest drop in mean arterial pressure in an otherwise healthy toddler?
- a.
  Propofol
- b.
  Dexmedetomidine
- c.
  Etomidate
- d.
  Ketamine
5.
When auscultating a murmur, which of the following findings is MOST indicative of a pathologic finding?
- a.
  Associated with a systolic click
- b.
  Quiets with standing
- c.
  Occurs at the end of systole
- d.
  Is faint
6.
Which of the following is a correct statement about fetal circulation?
- a.
  The stroke volume of the left ventricle is the same as the stroke volume of the right ventricle.
- b.
  The Eustachian valve directs the more highly oxygenated blood from the SVC to the left atrium.
- c.
  The factors associated with the persistent fetal circulation include hypoxia, hypothermia, hypercarbia, and acidosis.
- d.
  About 20% of umbilical venous blood bypasses the liver.
7.
Which of the following best categorizes fetal hemoglobin?
- a.
  The P ₅₀ value of fetal hemoglobin is 26 mm Hg.
- b.
  The oxygen dissociation curve is shifted to the left due to the higher affinity to 2,3-diphosphoglycerate (2,3-DPG)
- c.
  Neonates have lower content of 2,3-DPG
- d.
  Fetal hemoglobin is completely replaced by adult hemoglobin by 1 month of age

Chapter 6 : Regulation of fluids and electrolytes

1.
Which of the following statements is false when comparing the neonatal kidney to the adult kidney?
- a.
  Has lower GFR
- b.
  Has lower fractional excretion of sodium
- c.
  Has an inability to concentrate urine.
2.
Lactated Ringers is more likely to cause which of the following disturbances in comparison to 0.9% saline?
- a.
  Hyponatremia
- b.
  Hypernatremia
- c.
  Acute kidney injury
- d.
  Hyperkalemia
3.
Which is the preferred treatment of hyponatremic encephalopathy?
- a.
  Vasopressin 2 antagonists (vaptans)
- b.
  0.9% sodium chloride
- c.
  3% sodium chloride
- d.
  Fluid restriction
4.
Which of the following is a useful test to distinguishing between central and nephrogenic diabetes insipidus in the evaluation of hypernatremia?
- a.
  A water deprivation test
- b.
  Plasma copeptin testing
- c.
  Urine osmolality
- d.
  Serum osmolality
5.
All of the following are true regarding maturation of renal function except:
- a.
  By 36 weeks’ gestation, all nephrons are formed.
- b.
  At birth, the GFR in term infants is about 30% of adult GFR.
- c.
  At birth, the infant can concentrate their urine to that of an adult.
- d.
  At birth, the infant can dilute their urine to that of an adult.

Chapter 7 : Thermoregulation

1.
Radiation heat loss is most accurately defined by the transfer of heat between which of the following objects?
- a.
  Two surfaces in direct contact
- b.
  Two objects of different temperatures that are not in contact with each other
- c.
  Moving molecules such as air or liquids
- d.
  Conversion of water to gas
2.
Brown fat (adipose) tissue and nonshivering thermogenesis differentiates in the human fetus at which of the following gestational ages?
- a.
  10–20 weeks
- b.
  20–30 weeks
- c.
  30–40 weeks
- d.
  After 40 weeks
3.
Which of the following mechanisms best describes the decrease in central core temperature during the first 30 to 45 minutes of anesthesia after induction?
- a.
  Decreased metabolism
- b.
  Radiation
- c.
  Internal redistribution
- d.
  Cold fluid resuscitation
4.
Which of the following statements is the LEAST accurate regarding specific effects of anesthetics on thermoregulation?
- a.
  Opioids reduce threshold temperature for vasoconstriction and shivering in a linear function of dose.
- b.
  Propofol reduces threshold temperature for vasoconstriction and shivering in a linear function of dose.
- c.
  Volatile anesthetics produce a nonlinear inhibition of the thermoregulatory defense mechanisms, with the inhibition being proportionally greater at higher end-tidal vapor concentrations.
- d.
  N ₂ O decreases vasoconstriction threshold more than halogenated volatile agents.
5.
With regards to thermoregulation in infants, which of the following statements is false ?
- a.
  They are homeotherms and have a functional thermoregulatory system.
- b.
  Oxygen consumption correlates with rectal temperature.
- c.
  They are at risk of hypothermia due to an increased body surface-to-body mass ratio.
- d.
  In a neutral thermal environment, radiation contributes most to heat loss.
6.
Anesthetic agents affect thermoregulatory mechanisms by:
- a.
  Lowering hypothermic threshold and increasing hyperthermic threshold
- b.
  Increasing hypothermic threshold and increasing hyperthermic threshold
- c.
  Lowering hypothermic threshold and lowering hyperthermic threshold
- d.
  Increasing hyperthermic threshold and lowering hyperthermic threshold

Chapter 8 : Developmental pharmacology

1.
The volume of distribution is typically larger in neonates and infants than adults. Which of the following pharmacokinetic factors could make the volume of distribution of a drugs larger in an adult rather than a neonate?
- a.
  Blood volume
- b.
  Lipophilicity
- c.
  Clearance
2.
Which of the following pharmacokinetic values regarding context-sensitive half-life in children compared to adults is most accurate?
- a.
  Fentanyl shorter, propofol longer.
- b.
  Fentanyl shorter, propofol shorter.
- c.
  Fentanyl longer, propofol shorter.
3.
All of the following statements are true except :
- a.
  Clearance per kg underestimates actual clearance at lower weights.
- b.
  Clearance per body surface area overestimates clearance at lower weights.
- c.
  Clearance of highly extracted drugs is affected by hepatic blood flow.
- d.
  Clearance of highly extracted drugs is affected by protein binding.
4.
All of the following are true except :
- a.
  In zero-order kinetics, a constant amount of drug is eliminated per unit of time.
- b.
  It takes five half-lives of a drug to reach steady state.
- c.
  A drug’s half-life determines its context-sensitive half-time.
- d.
  CYP3A7 is more abundant at birth than CYP3A4.

Chapter 9 : Intravenous anesthetics

1.
Which of the following statements is true regarding the MAC of volatile anesthetics in children?
- a.
  For desflurane, it is highest between ages 6 to 9 years.
- b.
  For sevoflurane, it is highest at 1 year of age, then declines throughout life.
- c.
  MAC-BAR is the concentration at which 95% do not move.
- d.
  The ratio of MAC-awake to MAC is approximately 0.33.
2.
Which of the following statements is false for infant GABA-A receptors?
- a.
  Four amino acids located in the transmembrane regions of the β subunit may contribute toward an anesthetic binding pocket for volatile general anesthetics.
- b.
  Bind volatile anesthetics at distinct sites and reduce the incidence of postoperative emergence delirium (ED).
- c.
  Have, in animals, been implicated in developmental neuroapoptosis following neonatal exposure to sevoflurane.
- d.
  GABA acts as an excitatory neurotransmitter in both immature and adult neurons.
3.
Propofol infusion syndrome is associated with which of the following findings?
- a.
  Ryanodine receptor mutation
- b.
  Metabolic alkalosis, lipemic plasma, rhabdomyolysis
- c.
  Disruption of the mitochondrial respiratory chain
- d.
  High-dose propofol bolus

Chapter 10 : Inhaled anesthetics

1.
Which of the following anesthetic agents has the greatest 20-year carbon dioxide equivalent?
- a.
  Desflurane
- b.
  Nitrous oxide
- c.
  Sevoflurane
- d.
  Xenon
2.
During which age period is MAC at its LOWEST value?
- a.
  Neonatal
- b.
  Infancy
- c.
  Adult
- d.
  Old age
3.
Which factor contributes to the faster uptake and distribution of inhaled anesthetics in neonates and infants?
- a.
  Higher cardiac output
- b.
  Lower solubility of inhaled anesthetic
- c.
  Functional residual capacity
- d.
  Greater fraction of cardiac output delivered to the vessel-rich group
4.
Elimination of which inhaled anesthetic involves the MOST extensive hepatic and renal metabolism?
- a.
  Desflurane
- b.
  Sevoflurane
- c.
  Halothane
- d.
  Isoflurane

Chapter 11 : Local anesthetics

1.
Which of the following local anesthetic properties correlates with both potency and duration of action?
- a.
  Protein binding
- b.
  Lipid solubility
- c.
  pKa
- d.
  All of the above
2.
Which of the following local anesthetics is metabolized by pseudocholinesterase?
- a.
  Bupivacaine
- b.
  Lidocaine
- c.
  Chloroprocaine
- d.
  Ropivacaine
3.
Neonates are more susceptible to local anesthetic toxicity (LAST) because they have:
- a.
  Lower alpha-1-acid-glycoprotein levels
- b.
  Immature liver function
- c.
  They have a higher intrinsic heart rate
- d.
  All of the above
4.
All of the following are true except :
- a.
  Local anesthetics are reversible sodium channel blockers.
- b.
  Increase in cardiac output decreases the duration of action of local anesthetics.
- c.
  Neonates have a higher free drug fraction of local anesthetic agents than adults.
- d.
  Lidocaine is metabolized by plasma esterases.
5.
1:100,000 solution of epinephrine contains:
- a.
  0.1 mcg/mL of epinephrine
- b.
  1.0 mcg/mL of epinephrine
- c.
  10 mcg/mL of epinephrine
- d.
  100 mcg/mL of epinephrine

Chapter 12 : Opioids

1.
Which of the following opioids is a prodrug requiring metabolism into an active compound?
- a.
  Fentanyl
- b.
  Codeine
- c.
  Methadone
- d.
  Tramadol
2.
Which of the following polymorphisms in each of the following genes is LEAST likely to affect the analgesic efficacy?
- a.
  ABCB1 (MDR-1), which encodes P-glycoprotein
- b.
  5HT3B, which encodes serotonin receptor 3B
- c.
  OPRM1, which encodes the μ-opioid receptor
- d.
  Catechol-O-methyl transferase (COMT)
3.
The potential abuse of an opioid formulation and method of manipulation (e.g. snorting, smoking, injection) can be assessed by which of the following pharmacologic attributes?
- a.
  The total amount of drug per dose.
- b.
  The duration of analgesic effect.
- c.
  The area under the curve of the serum concentration plotted over time.
- d.
  The rate of rise of the serum drug concentration.

Chapter 13 : Neuromuscular blocking agents

1.
Which of the following age groups has the largest volume of distribution for non-depolarizing neuromuscular blocking agents?
- a.
  Infants
- b.
  Children
- c.
  Adolescents
2.
Which of the following groups would be expected to have the shortest duration of effect from vecuronium?
- a.
  Infants (<1 year),
- b.
  Children
- c.
  Adults
3.
Which of the following muscles has the fastest onset from non-depolarizing neuromuscular blockade in children?
- a.
  Diaphragm
- b.
  Adductor pollicis
- c.
  Obicularis oculi
4.
Adequate patient recovery of NMB should be determined by:
- a.
  TOF count of 4 with no fade felt or seen
- b.
  Normal tidal volume
- c.
  5-second head lift
- d.
  TOF ratio of 0.9 or greater
5.
Which of the following statements about neuromuscular blocking drugs is false?
- a.
  The Ed ₉₅ is the dose that produces 95% block of initial twitch height.
- b.
  The speed of onset of the drug is inversely related to its potency.
- c.
  Patients with butyrylcholinesterase deficiency have high dibucaine numbers.
- d.
  Anaphylaxis to neuromuscular blocking drugs is IgE mediated.

Chapter 14 : Anesthetic adjuncts

1.
Which of the following statements regarding anticholinergics is true?
- a.
  Atropine does not cross the blood–brain barrier.
- b.
  Atropine is a more effective antisialagogue than glycopyrrolate.
- c.
  The scopolamine transdermal patch is an effective antiemetic.
- d.
  Glycopyrrolate and edrophonium have a similar onset and duration of action.
- e.
  IM atropine’s onset of action is fastest following injection to the deltoid muscle.
2.
Which of the following factors is not associated with an increased risk for postoperative nausea and vomiting (PONV) in pediatric patients?
- a.
  Older than 3 years of age
- b.
  Surgical duration longer than 15 minutes
- c.
  Strabismus surgery
- d.
  Family history of PONV
3.
Which of the following statements regarding ketorolac is true?
- a.
  Ketorolac’s effects on PGE-2 and thromboxane are limited to its duration of action.
- b.
  Ketorolac’s peak analgesic effect is within 30 minutes.
- c.
  CSF concentrations of ketorolac vary directly with age, height, weight, and body surface area.
- d.
  Ketorolac has a modest effect on prothrombin time and partial thromboplastin time.
4.
Actions of acetaminophen include all of the following except:
- a.
  Inhibition of COX -3
- b.
  Inhibition of the hypothalamic heat-regulation center
- c.
  Reduction of substance P-induced hyperalgesia
- d.
  Inhibition of COX 1 and 2
5.
Which of the following statements regarding antiemetic therapy is true?
- a.
  QT prolongation is a concern with droperidol and promethazine.
- b.
  Dexamethasone is not effective alone as an antiemetic agent.
- c.
  Half-life of palonosetron is longer than ondansetron and granisetron.
- d.
  Metoclopramide has a black box warning for pediatric patients.

Chapter 15 : Psychological aspects of pediatric anesthesia

1.
At what age is “stranger anxiety” MOST likely to develop?
- a.
  6 months
- b.
  9 months
- c.
  12 months
- d.
  15 months
2.
Which of the following factors is a risk for preoperative anxiety in children?
- a.
  Age <1 year
- b.
  Multiple medical encounters
- c.
  Anxious parents
- d.
  Depression
3.
Which of the following factors is MOST important for the development of postoperative maladaptive behaviors?
- a.
  Midazolam premedication
- b.
  Preoperative anxiety
- c.
  Preoperative pain
- d.
  Divorced parents
4.
How does parental anxiety affect anxiety in the pediatric patient? Does parental anxiety affect their suitability for PPAI?
5.
How efficacious are technology-based distractions when compared to other more traditional interventions?

Chapter 16 : Preoperative preparation

1.
Which of the following findings is not a risk factor for a perioperative complication in a child with a URI?
- a.
  Fever
- b.
  Paternal smoking
- c.
  Age less than 5 years
- d.
  Inguinal hernia surgery
2.
All of the following statements are true except:
- a.
  In patients with Duchene muscular dystrophy, an FVC of less than 50% is associated with respiratory complications.
- b.
  Type 1 von Willebrand disease will respond to DDAVP.
- c.
  A normal A-1-C level is less than 6%.
- d.
  Patients with diabetes on an insulin pump should have it discontinued prior to surgery so it will not interfere with the cautery.

Chapter 17 : Equipment

1.
Heat and moisture exchangers provide maximum humidity after how many minutes?
- a.
  Immediately
- b.
  20 minutes
- c.
  45 minutes
- d.
  2 hours
2.
Mapleson D circuits can maintain normal arterial carbon dioxide tension with flows as low as:
- a.
  4 times the patient’s minute ventilation
- b.
  4 liters per minute
- c.
  100 ml per kilogram per minute
- d.
  50 ml per kilogram per minute
3.
The Bain modification of the anesthesia circuit has the gas flow characteristics of a:
- a.
  Circle system
- b.
  Mapleson A circuit
- c.
  T piece
- d.
  Mapleson D circuit
4.
Extending the corrugated anesthesia circuit while a procedure is underway in a small infant may:
- a.
  Make it easier to move the infant to the end of the table
- b.
  Change the compliance of the circuit making the tidal volume delivered by the machine to the patient less
- c.
  Have no effect on the patient’s ventilation
- d.
  Have no effect on the transition to an ICU ventilator postoperatively
5.
Cuffed tracheal tubes are far more likely to cause post-extubation croup than uncuffed tubes.
- a.
  True
- b.
  False
6.
What percent of body heat is lost through the respiratory tract?
- a.
  4% to 8%
- b.
  10% to 14%
- c.
  16% to 22%
- d.
  24% to 28%
7.
During controlled ventilation with a Mapleson D circuit, the patient is noted to have an elevated PaCO ₂ . Which of the following statements is true ?
- a.
  The PaCO ₂ can be lowered by increasing the respiratory rate.
- b.
  The PaCO ₂ can be lowered by increasing the inspiratory flow rate.
- c.
  The PaCO ₂ can be lowered by increasing inspiratory time.
- d.
  The PaCO ₂ can be lowered by decreasing the inspired oxygen concentration.

Chapter 18 : Monitoring

1.
Among pediatric patients, which of the following age group categories have the highest risk for cardiac arrests during anesthesia care?
- a.
  <1 year old
- b.
  1–3 years old
- c.
  3–5 years old
- d.
  5–7 years old
2.
Which arterial catheter placement location in pediatric patients has the highest risk for adverse events?
- a.
  Radial artery
- b.
  Ulnar artery
- c.
  Femoral artery
- d.
  Dorsalis pedis artery
3.
Which of the following statements is not true of mainstream analyzers for capnography?
- a.
  Mainstream analyzers can provide nearly instant analysis.
- b.
  Mainstream analyzers are very small and are not a concern for dislodgment in small endotracheal tubes.
- c.
  Mainstream analyzers use a sample chamber that is directly placed into the circuit.
- d.
  Mainstream analyzers can be used in conjunction with other monitors to evaluate the patient condition.
4.
Which of the following statements is true regarding blood pressure monitoring in children?
- a.
  Non-invasive oscillometry measures systolic and diastolic pressure.
- b.
  Systolic blood pressure increases from the central to peripheral arteries.
- c.
  Pulse pressure decreases from the central to peripheral arteries.
- d.
  Inappropriately large cuffs will provide falsely elevated pressures.
5.
Which of the following statements regarding pulse oximetry oxygen saturations (PsO2) is false?
- a.
  Fetal hemoglobin has no effect on pulse oximetry.
- b.
  PsO2 measurements in methemoglobinemia overestimates actual oxygen saturation.
- c.
  Carbon monoxide lowers the PsO2.
- d.
  Methylene blue lowers the PsO2.
6.
Which of the following statements regarding neurophysiological monitoring is false?
- a.
  Ketamine causes dose-dependent increases in SSEP amplitude.
- b.
  SSEP conduction velocity reaches adult values at age 12 years.
- c.
  Potent inhaled anesthetic agents increase latency and decrease amplitude of SSEP monitoring.
- d.
  Opiates have a minimal effect on SSEP and MEP latency and amplitude.

Chapter 20 : Point of care ultrasonography

1.
A linear, high frequency transducer would best be utilized for which of the following applications?
- a.
  Focused cardiac echocardiogram
- b.
  Free fluid in the pelvis
- c.
  Inferior vena cava assessment
- d.
  Pneumothorax evaluation
2.
During ultrasound-guided vascular access (out of plane approach), which of the following maneuvers should be performed first if the needle is not adequately visualized on the screen as a bright hyperechoic dot?
- a.
  Advance the needle further.
- b.
  Fan the transducer back and forth.
- c.
  Increase the depth.
- d.
  Slide the transducer away from the needle.
3.
You are called to the bedside of a 13-year-old male who requires intubation for respiratory failure secondary to pneumonia. You place the endotracheal tube and confirm placement with capnography. Immediately following intubation, his pulse oximeter drops to 85%. Point-of-care ultrasound of the left hemithorax demonstrates the following pattern (see Figure). Which of the following actions is the next best step?
- a.
  Call surgery to place a chest tube.
- b.
  Increase the rate of ventilation delivered by bag-valve-mask ventilation.
- c.
  Place a catheter and suction down the endotracheal tube.
- d.
  Pull back the endotracheal tube.

4.
A 3-year-old female unrestrained back seat passenger of a motor vehicle collision arrives at the emergency department tachycardic and hypotensive. Based on the images below (see Figure), which of the following actions is the next step in management?
- a.
  Begin vasopressors.
- b.
  Perform needle thoracostomy.
- c.
  Perform pericardiocentesis.
- d.
  Transfuse 20 ml/kg of packed red blood cells.
5.
All of the following findings are examples of ultrasound artifacts except
- a.
  Acoustic shadowing
- b.
  Impedance artifact
- c.
  Mirror artifact
- d.
  Reverberation artifact

Chapter 21 : Induction, maintenance, and recovery

1.
Which of the following patients is MOST likely to benefit from parental presence at induction of anesthesia?
- a.
  A calm child with a calm parent
- b.
  A calm child with an anxious parent
- c.
  An anxious child with an anxious parent
- d.
  An anxious child with a calm parent
2.
Which of the following statements is true regarding the use of dexmedetomidine in pediatric patients?
- a.
  Dexmedetomidine is known to cause significant hypotension when given as a bolus dose of 1 mcg/kg over 10 minutes.
- b.
  Dexmedetomidine has been shown to be a more effective sedative than propofol for radiologic studies.
- c.
  Dexmedetomidine has been effective in the treatment of ventricular tachycardia due to its slowing of conduction at the atrioventricular node.
- d.
  With its minimal effects on respiration, dexmedetomidine has been successfully used for analgesia in obese patients with obstructive sleep apnea undergoing tonsillectomy.
3.
Which of the following interventions is most effective in reducing the incidence of emergence delirium?
- a.
  Premedication with oral midazolam
- b.
  Parental presence during induction and recovery
- c.
  Intraoperative infusion of dexmedetomidine
- d.
  Postoperative pain prevention with regional blocks
4.
Which of the following inhalational agents has the LEAST greenhouse gas effect?
- a.
  Sevoflurane
- b.
  Isoflurane
- c.
  Desflurane
- d.
  Nitrous oxide
5.
Which of the following conditions is MOST associated with an increased risk of postoperative apnea?
- a.
  Spinal opioids
- b.
  Prematurity
- c.
  Tonsillar hypertrophy
- d.
  Propofol anesthesia

Chapter 22 : Transfusion medicine

1.
Which of the following interventions best increases oxygen delivery in a premature neonate with a hemoglobin of 8 g/dL?
- a.
  Decrease temperature
- b.
  Allogenic blood transfusion
- c.
  Increase pH
- d.
  EPO administration
2.
A 6-year-old boy with hemoglobin SS disease with a baseline Hg concentration of 8 g/dl, with one prior episode of veno-occlusive crisis and no prior history of major sickle cell complications is to undergo elective adenotonsillectomy for sleep-disordered breathing. Which of the following interventions is MOST important in the perioperative management of these patients?
- a.
  Hypoventilation to prevent acidosis
- b.
  Maintain normothermia
- c.
  Transfuse to Hg S concentration to <30%
- d.
  Preoperative hydration
3.
A 3-month-old infant is undergoing open craniosynostosis surgery. As a blood conservation strategy, which intervention would most likely be of benefit?
- a.
  Preoperative iron supplementation
- b.
  Antifibrinolytic with tranexamic acid
- c.
  Induced hypotension with nitroprusside
- d.
  Preoperative autologous donation
4.
A 1200-gram, 28-week premature infant has thrombocytopenia without bleeding or planned surgical procedure. Which of the following platelet transfusion triggers (platelets/mm ³ ) is associated with the least risk of bleeding and 28-day mortality?
- a.
  100,000 platelets/mm ³
- b.
  75,000 platelets/mm ³
- c.
  50,000 platelets/mm ³
- d.
  25,000 platelets/mm ³
5.
A 2-year-old child undergoing craniofacial reconstruction is receiving a massive blood transfusion. Which of the following interventions is most likely to be associated with hyperkalemia?
- a.
  Small bore peripheral catheters for RBC transfusions
- b.
  Rapid RBC infusion rate
- c.
  14 day old RBC units
- d.
  Irradiated PRBCs

Chapter 23 : Acute pain management

1.
In children undergoing abdominal surgery, which of the following non-opioid adjuncts has been shown to decrease the incidence of severe post-operative pain?
- a.
  Dexmedetomidine
- b.
  Lidocaine
- c.
  Ketamine
- d.
  Ketorolac
2.
Which of the following medications is the MOST commonly prescribed over-the-counter medication for children with sleep disturbances?
- a.
  Antihistamines
- b.
  Melatonin
- c.
  Trazadone
- d.
  Cough syrup (e.g. Nyquil)
3.
At what gestational age do the nerve pathways essential for the transmission, perception, and modulation of pain become functional?
- a.
  16 weeks’ gestation
- b.
  24 weeks’ gestation
- c.
  32 weeks’ gestation
- d.
  40 weeks’ gestation
4.
Which of the following genetic factors are able to modulate pain pathways?
- a.
  Genetic mutations
- b.
  Single nucleotide polymorphisms
- c.
  Epigenetics
- d.
  All of the above
5.
Which of the following mechanisms is NOT responsible for the analgesic and anti-nociceptive effects of methadone?
- a.
  Mu-opioid receptor agonism
- b.
  NMDA receptor antagonism
- c.
  Binding at voltage-gated calcium channels
- d.
  Serotonin reuptake inhibition

Chapter 24 : Regional anesthesia

1.
At which of the following ages is a sympathectomy observed after a spinal anesthetic?
- a.
  1 year
- b.
  3 years
- c.
  5 years
2.
A neonate has a caudally placed epidural for a laparotomy. The weight is 3 kg and ropivacaine 0.1% is being infused. Which of the following infusion rates is most appropriate?
- a.
  0.3 ml/hr
- b.
  0.6 ml/hr
- c.
  1.2 ml/hr
3.
Which of the following anatomic locations most likely represents the location of the lumbar plexus?

a.
A
b.
B
c.
C

4.
A 6-year-old female presents for surgical repair of a ventral hernia at T7. The surgeon has requested a truncal block. Which of the following bilateral nerve blocks would be most appropriate for this surgical repair?
- a.
  Rectus sheath
- b.
  Tranverse abdominus plane
- c.
  Quadratus lumborum
5.
A 10-year-old male presents for a muscle biopsy of the right leg for a definitive evaluation for malignant hyperthermia. Which of the following nerve blocks would be most appropriate?
- a.
  Adductor canal
- b.
  Femoral
- c.
  Lateral femoral cutaneous
6.
A test dose using epinephrine while placing an epidural to help rule out intravascular injection of local anesthetic should have which of the following concentrations?
- a.
  1:10,000
- b.
  1:100,000
- c.
  1:200,000
7.
All of the following cords of the brachial plexus are blocked by the infraclavicular nerve block except:
- a.
  Lateral
- b.
  Superior
- c.
  Medial
8.
This ultrasound image below demonstrates which of the following anatomic structures?

a.
Internal oblique, sartorius, fascia iliaca
b.
Fascia lata, internal oblique, rectus femoris
c.
Sartorius, pectineus, fascia iliaca

Chapter 27 : Neonatology for anesthesiologists

1.
At what gestational age do alveoli develop?
- a.
  Before 16 weeks
- b.
  17–28 weeks
- c.
  28–36 weeks
- d.
  After 36 weeks
2.
Which of the following metabolic pathways is a Phase I (as opposed to a Phase II or III) reaction for hepatic drug metabolism?
- a.
  Glucuronidation
- b.
  Oxidation-reduction
- c.
  Sulfation
- d.
  Methylation
3.
Which of the following findings is NOT a characteristic of neonatal renal function?
- a.
  Low renal blood flow
- b.
  Low glomerular filtration rate (GFR)
- c.
  Low serum creatinine immediately following birth
4.
Which of the following physiologic parameters MOST accurately depicts fetal circulation?
- a.
  High pulmonary vascular resistance, high pulmonary blood flow, high systemic vascular resistance
- b.
  High pulmonary vascular resistance, low pulmonary blood flow, low systemic vascular resistance.
- c.
  Low pulmonary vascular resistance, high pulmonary blood flow, high systemic vascular resistance
- d.
  Low pulmonary vascular resistance, low pulmonary blood flow, high systemic vascular resistance
5.
All of the following statements are correct except:
- a.
  Term newborns lose 5% to 10% of body weight in the first 3 to 7 days of life.
- b.
  Hyperkalemia in newborns is defined as a potassium plasma concentration greater than 6.5 meq/L
- c.
  Preterm newborns have a higher fractional excretion of sodium than term newborns.
- d.
  Newborns have a higher bicarbonate level than adults.
6.
All of the following statements are correct except:
- a.
  By 36 weeks’ gestation, neonates have a full complement of nephrons.
- b.
  In term infants at birth, serum creatinine is higher than at 2 weeks of age.
- c.
  Apgar scores predict neurocognitive outcome.
- d.
  Surface active material is generally secreted in the lung alveoli at 34 to 36 weeks.
7.
All of the following statements are correct except:
- a.
  Brown fat is mostly deposited during the last trimester.
- b.
  Nonshivering thermogenesis is mediated by norepinephrine and thyroid hormone.
- c.
  Fetal hemoglobin binds 2,3 DPG less avidly than adult hemoglobin.
- d.
  Fetal hemoglobin has a higher P50 value than adult hemoglobin
8.
“New bronchopulmonary dysplasia” is characterized by all of the following findings except:
- a.
  Abnormal growth of alveoli
- b.
  Dilation of the alveolar ducts
- c.
  Marked fibrosis
- d.
  Reduced gas surface exchange

Chapter 28 : Anesthesia for general surgery in neonates

1.
Minimal-access surgery in the neonatal population has been shown to decrease all the following findings except :
- a.
  Post-operative pain
- b.
  Length of stay
- c.
  Operative time
- d.
  Surgical site infections
2.
Syndromes of midline defects often include gastroschisis, and this lesion also has been included in the nonsyndromic multiple congenital anomalies (MCA) complex.
- a.
  True
- b.
  False
3.
Congenital diaphragmatic hernia is associated with which of the following syndromes?
- a.
  Beckwith–Wiedemann
- b.
  Carpenter Syndrome
- c.
  Pfeiffer syndrome
- d.
  Saethre–Chotzen
4.
The majority of infants diagnosed with necrotizing enterocolitis are premature, and the severity of symptoms, complications, and mortality are inversely related to gestational age.
- a.
  True
- b.
  False
5.
Imperforate anus can be associated with which of the following abnormalities?
- a.
  Tracheoesophageal fistula
- b.
  Renal anomalies
- c.
  Heart disease
- d.
  All of the above
6.
With regards to neonates with abdominal wall defects, all of the following statements are correct except:
- a.
  Omphaloceles have incomplete gut rotation.
- b.
  A gastroschisis defect is to the right of the umbilical cord.
- c.
  Beckwith-Wiedemann syndrome is associated with omphalocele.
- d.
  The abdominal contents in patients with gastroschisis defect are contained in a sac.
7.
Which of the following findings is not associated with abdominal compartment syndrome?
- a.
  Decreased venous return
- b.
  Increased intracranial pressure
- c.
  Decreased respiratory compliance
- d.
  Increased renal output
8.
With regard to congenital diaphragmatic hernia, all of the following statements are correct except:
- a.
  Mortality correlates with the degree of pulmonary hypertension.
- b.
  The most common site of herniation is the foramen of Morgagni.
- c.
  There is a decreased number of pulmonary arteries per lung volume.
- d.
  Pulmonary function and pulmonary hypertension tend to normalize by adolescence.
9.
With regard to congenital diaphragmatic hernia, all of the following statements are correct except:
- a.
  Lung-to-head (LTH) ratio can be a predictor of pulmonary hypoplasia.
- b.
  The presence of the liver in the chest increases mortality.
- c.
  A large difference between the right-radial and lower-extremity pulse oximeters implies a right-to-left shunt at the ductus arteriosus.
- d.
  A low pulse oximeter value and no difference between the right-radial and lower-extremity pulse oximeter values implies no right-to-left shunting.
10.
Goals of intraoperative ventilation of neonates with congenital diaphragmatic hernia include which of the following strategies?
- a.
  Small tidal volumes
- b.
  Increased PEEP
- c.
  SaO ₂ 90 to 95
- d.
  High PaCO ₂
11.
All of the following statements regarding tracheoesophageal fistula/esophageal atresia (TEF/EA) are correct except:
- a.
  TEF/EA has a higher mortality in premature infants than in term infants.
- b.
  VACTERL anomalies are associated with TEF/EA.
- c.
  In the most common version of TEF/EA, the fistula enters the trachea in the left main bronchus and the upper esophageal segment ends blindly.
- d.
  Tracheomalacia can be a long-term consequence of TEF/EA.

Chapter 29 : Anesthesia for fetal surgery

1.
In what way is the anesthetic management of an ex-utero intrapartum treatment (EXIT) procedure different from a mid-gestation open fetal procedure?
- a.
  Aortocaval compression is avoided.
- b.
  Profound uterine relaxation is achieved prior to hysterotomy.
- c.
  Uterine tone is maximized after completion of the fetal intervention.
- d.
  Adequate uteroplacental blood flow is maintained.
2.
Following maternal administration, which of the following drugs will most readily cross the placenta to the fetus?
- a.
  Heparin
- b.
  Desflurane
- c.
  Rocuronium
- d.
  Glycopyrrolate
3.
During fetal interventions, which of the following measurements is the most reliable indicator of fetal well-being?
- a.
  Fetal hematocrit
- b.
  Fetal heart rate
- c.
  Umbilical artery Doppler
- d.
  Fetal pulse oximetry
4.
Which of the following conditions is a contraindication to prenatal repair of myelomeningocele?
- a.
  Previous lower segment cesarean section
- b.
  Evidence of fetal hindbrain herniation
- c.
  Gestational age of 20 weeks
- d.
  Poorly controlled maternal diabetes mellitus
5.
During an EXIT-to-airway procedure for a giant cervical teratoma, a fetal heart rate of 60 bpm is noted. Which of the following is the most appropriate next step in the management?
- a.
  Administer fetal intramuscular epinephrine.
- b.
  Perform fetal chest compressions.
- c.
  Rule out umbilical cord compression and reposition the fetus.
- d.
  Clamp the umbilical cord and deliver the fetus.

Chapter 30 : Anesthesia for congenital heart disease

1.
In the post-bypass period following a bidirectional Glenn procedure, the patient begins to get hypotensive, the systemic venous pressure is increased, the common atrial pressure is decreased, and the transpulmonary gradient is increased. Which of the following findings is most likely?
- a.
  Pulmonary artery stenosis
- b.
  Restrictive intra-atrial septum
- c.
  Coarctation of the aorta
2.
All of the following clinical findings are associated with pulmonary hypertension except:
- a.
  Right ventricular heave
- b.
  Enlarged liver
- c.
  Widely split second heart sound
- d.
  Loud single second heart sound
3.
Which of the following anatomic findings is a component of tetralogy of Fallot?
- a.
  Pulmonic stenosis
- b.
  Atrial septal defeat
- c.
  Left ventricular hypertrophy
- d.
  Overriding pulmonary artery

Chapter 31 : Anesthesia for neurosurgery

1.
Which of the following neurophysiologic features is greater in a child compared to an adult
- a.
  CMRO ₂
- b.
  The volume of CSF (ml/kg)
- c.
  CPP
2.
All volatile anesthetics cause direct cerebral vasodilation and may lead to the uncoupling of CMRO ₂ and CBF thereby potentially elevating ICP.
- a.
  True
- b.
  False
3.
Neurosurgeons may request pharmacoactivation of interictal spikes in epilepsy surgery, which can be induced with all of the following medications except :
- a.
  Alfentanil
- b.
  Etomidate
- c.
  Propofol
4.
All of the following statements are true regarding the management of brain tumors in children compared to adults except :
- a.
  The risk of cerebral hypoperfusion is greater in children.
- b.
  The relative decrease in sympathetic tone in young children may make bradycardia and other arrhythmias less likely.
- c.
  The majority of brain tumors are infratentorial in children.

Chapter 32 : Anesthesia for thoracic surgery

1.
Which of the following congenital lesions is most likely to result in contralateral lung soiling during surgical resection?
- a.
  CCAM
- b.
  Pulmonary sequestration
- c.
  Bronchogenic cyst
2.
A 12-year-old male presents with cough, weight loss and an anterior mediastinal mass on CT scan. Tracheal compression is more than 50% and he is unable to lie flat without coughing. Which of the following anesthetic plans would be most appropriate to obtain a tissue biopsy?
- a.
  General anesthesia
- b.
  Radiation treatment followed by general anesthesia
- c.
  Local anesthesia and sedation
3.
A 2-year-old presents for thoracic surgery and requires lung isolation. Which of the following techniques would be most appropriate?
- a.
  Double lumen tube
- b.
  Univent tube
- c.
  Arndt bronchial blocker
4.
All of the following anesthetic risk factors are found in children with mediastinal masses except:
- a.
  Superior vena cava syndrome
- b.
  Tracheal cross-sectional area <50%
- c.
  Pulsus paradoxus
- d.
  Peak expiratory flow rate <90%
5.
All of the following statements regarding single lung physiology are true except:
- a.
  In awake infants in the lateral position, ventilation is better to the dependent lung.
- b.
  In awake adults in the lateral position, ventilation is better to the dependent lung.
- c.
  In awake infants in the lateral position, perfusion is better to the dependent lung.
- d.
  In awake adults in the lateral position, perfusion is better to the dependent lung.

Chapter 33 : Anesthesia for general abdominal, urologic surgery

1.
Which of the following findings is not associated with prune belly syndrome?
- a.
  Abdominal muscle hypoplasia
- b.
  Pulmonary hypoplasia
- c.
  Urinary tract abnormalities
- d.
  Autosomal recessive inheritance
2.
A 6-month-old patient with known congenital adrenal hypoplasia (21 hydroxylase deficiency) presents for an inguinal hernia repair. Following induction, he becomes hypotensive. Which of the following findings is most likely to occur?
- a.
  Peaked T waves
- b.
  High end tidal CO ₂
- c.
  Low pulse oximeter reading
- d.
  Elevated temperature
3.
All of the following statements are true regarding pyloric stenosis except :
- a.
  Hypochloremic metabolic alkalosis
- b.
  Non-surgical emergency
- c.
  Bilious vomiting
4.
Which of the following findings is NOT associated with neuroblastoma.
- a.
  opsiclonus
- b.
  Horner’s syndrome
- c.
  Hypertension
- d.
  Increased intracranial pressure
5.
Wilms tumor is associated with all of the following findings except :
- a.
  Hypertension
- b.
  Opsiclonus
- c.
  Acquired von Willebrand syndrome
- d.
  Aniridia

Chapter 34 : Anesthesia for otorhinolaryngologic surgery

1.
A 2-year-old with notable snoring underwent a sleep study and was diagnosed with obstructive sleep apnea with an AHI of 18 and oxygen saturation nadir of 79%. He is scheduled for tonsillectomy. Which of the following statements about this clinical situation is true ?
- a.
  This child can safely undergo outpatient surgery.
- b.
  An AHI of 18 is considered evidence of moderate OSAS.
- c.
  This child should be given a reduced dose of opioid in the operating room.
- d.
  The child’s mother should be told that the primary risk of the surgery is bleeding.
2.
A 15-month-old is admitted with drooling, stridor and a barking cough. She was well except for a mild runny nose and has no fever. She is agitated with oxygen saturations around 90%. The surgeons have requested OR time for SML and bronchoscopy. Which of the following statements about this case is false ?
- a.
  A chest radiograph should be ordered to look for hyperinflation of either lung field.
- b.
  A chest radiograph should be ordered to look for consolidation of either lung field
- c.
  An A-P neck film should be ordered to look for a steeple sign.
- d.
  A lateral neck film should be ordered to look for the “thumb print” sign.
3.
A 10-year-old child admitted to the hospital 2 weeks ago has been recovering from a closed head injury and hospital course complicated by aspiration pneumonia. He is scheduled for tracheotomy. He is currently ventilated with 50% oxygen and ventilating peak/PEEP pressures of 20/5 cm of H2O, SIMV 10 breaths per minute, pressure support 12. Which of the following statements about this situation is false ?
- a.
  The case is high risk for airway fire because of the fire triad.
- b.
  In case of fire the first action should be to extinguish flames with a CO ₂ fire extinguisher.
- c.
  In case of fire, the first action should be to remove the endotracheal tube.
- d.
  In case of fire, the surgeons should be notified to flood the field.
4.
All of the following laryngeal structures are innervated by the recurrent laryngeal nerve except:
- a.
  Posterior cricoarytenoid
- b.
  Thyroarytenoid
- c.
  Vocalis
- d.
  Cricothyroid
5.
Which of the following patients is eligible for same-day discharge following tonsillectomy?
- a.
  2-year-old, AHI of 7 events/hour, heterozygous Factor V Leiden
- b.
  2-year-old, AHI of <3 events/hour, BMI 30
- c.
  4-year-old, AHI <3 events/hour, no vomiting for 2 hours
- d.
  3-year-old, AHI <3 events/hour, family history of von Willebrand’s disease

Chapter 35 : Anesthesia for plastic surgery

1.
A 3-month-old patient is being evaluated for cranial vault reconstruction for multisuture craniosynostosis. They are syndromic and present with the following features: proptosis, midface hypoplasia and broad thumbs and great toes. Which of the following craniofacial syndromes does this patient most likely have?
- a.
  Pfeiffer
- b.
  Crouzon
- c.
  Apert
- d.
  Carpenter
2.
A 1-month-old infant with Pierre Robin sequence is scheduled for mandibular distraction osteogenesis. Which of the following anomalies is most likely associated with this sequence?
- a.
  Congenital cardiac defects
- b.
  Cervical spine abnormalities
- c.
  Renal anomalies
- d.
  Imperforate anus
3.
Which of the following interventions is MOST effective at reducing exposure to allogeneic blood in infants during craniofacial surgery?
- a.
  Tranexamic acid
- b.
  Cell salvage
- c.
  Controlled hypotension
- d.
  Normovolemic hemodilution

Chapter 36 : Anesthesia for pediatric orthopedic surgery

1.
Which of the following medications has the LEAST effect on transcranial motor evoked potentials (tcMEP)?
- a.
  Fentanyl
- b.
  Dexmedetomidine
- c.
  Cis-atracurium
2.
At what Cobb angle degree will restrictive lung disease MOST likely begin to develop?
- a.
  40
- b.
  60
- c.
  80
3.
A 10-year-old male is recovering in the PACU after repair of a pelvic and femur fracture from an ATV accident. He remains intubated and unresponsive despite termination of his anesthetic agents. During your evaluation you notice he is febrile, tachycardic and his oxygen saturation is 92% on an FiO ₂ of 0.5. Which of the following clinical conditions MOST likely explain his clinical findings?
- a.
  Pneumothorax
- b.
  Aspiration pneumonitis
- c.
  Fat embolism
4.
All of the following statements regarding scoliosis are true except:
- a.
  In curves greater than 65 degrees, PFTs reveal restrictive lung disease.
- b.
  The first change in PFTs is a decrease in vital capacity.
- c.
  Curves greater than 110 degrees are associated with pulmonary hypertension at rest.
- d.
  FEV ₁ less than 80% predicted is an indicator of the need for postoperative respiratory support following posterior spinal fusion.
5.
Which of the following clinical findings is not consistent with anterior spinal artery syndrome?
- a.
  Flaccid paralysis below the level of the lesion
- b.
  Loss of pain sensation below the level of the lesion
- c.
  Loss of temperature sensation below the level of the lesion
- d.
  Loss of proprioception below the level of the lesion

Chapter 37 : Anesthesia for ophthalmic surgery

1.
Which of the following cranial nerves provides the afferent limb for the oculocardiac reflex?
- a.
  V
- b.
  VII
- c.
  X
2.
A 5-year-old boy has an open globe injury. Which of the following clinical factors will increase his intraocular pressure the most?
- a.
  Respiratory acidosis
- b.
  Metabolic acidosis
- c.
  Hyperoxia
3.
Which of the following physiologic effects on intraocular pressure (IOP) is most accurate for dexmedetomidine?

	Child	Adult
A	Decrease	Decrease
B	No change	Decrease
C	No change	No change

a.
A
b.
B
c.
C

4.
Which of the following statements is true?
- a.
  Intraocular pressure is generally greater than intracranial pressure.
- b.
  Hyperventilation increases IOP.
- c.
  Miosis increases IOP.
- d.
  Increased aqueous humor outflow increases IOP.

Chapter 38 : Solid organ transplantation

1.
What medication has been shown to improve blood pressure and cardiac output in pediatric DND when other vasoactive substances have failed?
2.
Is it safe to administer potassium containing crystalloid solutions to end-stage kidney failure recipients during kidney transplantation?
3.
At which stage during liver transplantation is metabolic acidosis most likely to peak?
- a.
  Stage 1: dissection stage due to ongoing bleeding and caval compression resulting in renal hypoperfusion
- b.
  Stage 2: anhepatic stage due to lack of hepatic metabolism and clearance of lactate.
- c.
  Stage 3: reperfusion due to portal vein unclamping and reperfusion of the donor liver.
- d.
  Stage 4: biliary reconstruction due to manipulation of bowel.
4.
It is still common for pediatric liver transplant recipients to lose several blood volumes over the course of a liver transplantation operation.
- a.
  True
- b.
  False
5.
What is the minimum acceptable islet cell mass for effective pancreatic islet cell transplantation?
- a.
  500 islet equivalents (IEQ) per kg
- b.
  1000 IEQ/kg
- c.
  3500 IEQ/kg
- d.
  5000 IEQ/kg
6.
The postreperfusion syndrome that occurs after liver transplantation includes all of the following clinical findings except:
- a.
  Tachycardia
- b.
  Hypotension
- c.
  Decreased cardiac output
- d.
  Increased peripheral vascular resistance
7.
All of the following statements about kidney transplantation are correct except:
- a.
  Infants receiving adult kidneys commonly become hypothermic.
- b.
  Fluid restriction is essential after graft reperfusion.
- c.
  Kidneys that are transplanted from living related donors produce better survival rates in recipients than do organs that are transplanted from cadavers.
- d.
  Infants and children with delayed graft function after transplantation have an increased incidence of graft loss over the next 5 years.
8.
All of the following statements are true regarding pediatric liver transplantation except :
- a.
  Hypokalemia is more common in the intra-operative period than hyperkalemia.
- b.
  Ornithine transcarbamylase deficiency (OTCD) is associated with hypercoagulation.
- c.
  Treatment of post-transplant lymphoproliferative disorder (PTLD) requires an increase in immunosuppression.
- d.
  Renal insufficiency is common following liver transplantation.

Chapter 39 : Conjoined twins

1.
Which of the following sites of conjuncture for conjoined twins is most common?
- a.
  Pyopagus
- b.
  Craniopagus
- c.
  Thoracopagus
- d.
  Parapagus
2.
During the induction of anesthesia for thoracopagus twins, rocuronium is administered to twin A. Twin B also develops muscle relaxation. Which of the following findings most likely explains this clinical situation?
- a.
  Conjoined diaphragm
- b.
  Spine fusion
- c.
  Drug error
- d.
  Cross-circulation
3.
Compared to other conjunctures, thoracopagus twins are more likely to have which of the following clinical challenges during anesthesia care?
- a.
  Difficult airway
- b.
  Hemorrhage
- c.
  Hypothermia
- d.
  Postoperative pain

Chapter 40 : Anesthesia for pediatric trauma

1.
What is the MOST common cause of traumatic brain injury (TBI) in infants less than 1 year old?
- a.
  Falls
- b.
  Motor vehicle accidents
- c.
  Abuse
- d.
  Dog bite
2.
A 5-year-old male arrives in the emergency department after a motor vehicle accident. His pulse is 110, BP 80/50, and Glasgow coma scale (GCS) is 6. Which of the following steps would be the next MOST appropriate intervention to perform?
- a.
  Administer normal saline
- b.
  Intubate the trachea
- c.
  Administer 3% saline
- d.
  Obtain CT of the head
3.
A 4-year-old child presents to the emergency department after a bicycle accident. Her R-time is prolonged on the thromboelastogram performed on admission. Which of the following hematologic components MOST likely contributes to this finding?
- a.
  Factor VII
- b.
  Antithrombin III
- c.
  Factor VIII
- d.
  Protein C

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Questions

Chapter 2 : Behavioral development

Chapter 3 : Respiratory physiology

Chapter 4 : Airway physiology and development

Chapter 5 : Cardiovascular physiology

Chapter 6 : Regulation of fluids and electrolytes

Chapter 7 : Thermoregulation

Chapter 8 : Developmental pharmacology

Chapter 9 : Intravenous anesthetics

Chapter 10 : Inhaled anesthetics

Chapter 11 : Local anesthetics

Chapter 12 : Opioids

Chapter 13 : Neuromuscular blocking agents

Chapter 14 : Anesthetic adjuncts

Chapter 15 : Psychological aspects of pediatric anesthesia

Chapter 16 : Preoperative preparation

Chapter 17 : Equipment

Chapter 18 : Monitoring

Chapter 20 : Point of care ultrasonography

Chapter 21 : Induction, maintenance, and recovery

Chapter 22 : Transfusion medicine

Chapter 23 : Acute pain management

Chapter 24 : Regional anesthesia

Chapter 27 : Neonatology for anesthesiologists

Chapter 28 : Anesthesia for general surgery in neonates

Chapter 29 : Anesthesia for fetal surgery

Chapter 30 : Anesthesia for congenital heart disease

Chapter 31 : Anesthesia for neurosurgery

Chapter 32 : Anesthesia for thoracic surgery

Chapter 33 : Anesthesia for general abdominal, urologic surgery

Chapter 34 : Anesthesia for otorhinolaryngologic surgery

Chapter 35 : Anesthesia for plastic surgery

Chapter 36 : Anesthesia for pediatric orthopedic surgery

Chapter 37 : Anesthesia for ophthalmic surgery

Chapter 38 : Solid organ transplantation

Chapter 39 : Conjoined twins

Chapter 40 : Anesthesia for pediatric trauma

You're Reading a Preview

Related Posts

Inside back cover

Abbreviations

Normal pulmonary function values

Growth curves