Renal, Hepatic, Endocrine, Hematologic, and Metabolic Systems

Questions

DIRECTIONS (Questions 290-365): Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

290. A 50-year-old patient underwent a thyroidectomy that finished at 1000, and at 2200 he complained to the nurse of difficulty in breathing. She took his blood pressure that was moderately elevated above previous determinations, but she also noticed that his wrist flexed when the blood pressure cuff remained inflated. The cause of the stridor is probably

(A) vocal cord paralysis

(B) partial vocal cord paralysis

(D) cervical hematoma

(E) hypocalcemia

291. A 62-year-old man with chronic renal failure who is receiving dialysis three times weekly suffers a fracture of the humerus in a fall. He is brought to the operating room for an open reduction of the fracture on the evening of a day on which he missed his dialysis due to the injury. Expected abnormalities in this patient include all of the following EXCEPT

(A) metabolic acidosis

(B) hyperkalemia

(D) thrombocytopenia

(E) hypervolemia

292. A previously healthy 25-year-old man suffers a ruptured spleen during a rugby game. During the emergency splenectomy, he is given ten units of packed red blood cells. After achieving hemostasis, an acceptable hematocrit value of 27%, and euvolemia via the administration of normal saline, the most likely electrolyte abnormality is

(A) hypercalcemia

(B) hypermagnesemia

(D) hypokalemia

(E) hyperkalemia

293. A 50-year-old alcoholic man with a long history of tobacco abuse and who is chronically dyspneic at rest is in the recovery room after an emergency appendectomy. He is receiving supplemental oxygen by mask and appears to be hypoventilating. An arterial blood gas is obtained that shows pH = 7.19, PO₂ = 85 mm Hg, and PCO₂ = 90 mm Hg. This state can best be described as

(A) pure respiratory acidosis

(B) combined respiratory acidosis and metabolic acidosis

(D) metabolic acidosis with compensating respiratory alkalosis

(E) pure metabolic acidosis

294. A hypotensive, comatose 47-year-old man is brought to the operating room after being struck by a bus. He is emaciated and has a long history of alcoholism. It is important to administer thiamine to this patient because thiamine deficiency may

(A) be the cause of the observed coma

(B) be the cause of the observed hypotension

(D) cause rhabdomyolysis if succinylcholine is given

(E) potentiate the cardiovascular depressant effects of volatile anesthetics

295. A 59-year-old woman requires treatment for non-Hodgkin’s lymphoma. Antineoplastic chemotherapy with which one of the following agents may cause a peripheral neuropathy?

(A) methotrexate

(B) doxorubicin

(D) bleomycin

(E) vincristine

296. A 20-year-old college student is found dead in his dormitory room after consuming a large amount of alcohol. When a lethal amount of ethanol is ingested, the toxic effect of ethanol usually leading to death is

(A) hypotension due to vasodilation

(B) hypotension due to decreased cardiac output

(D) apnea

(E) ventricular arrhythmia

297. A 73-year-old patient is undergoing implantation of a hip prosthesis under general anesthesia. She has been taking prednisone for rheumatoid arthritis for 6 months. During the procedure, there is a sudden drop in blood pressure. The first step to be taken is to

(A) administer hydrocortisone 100 mg intravenously

(B) establish the cause of the hypotension

(D) begin an infusion of phenylephrine

(E) discontinue all anesthetic agents

298. A 72-year-old man with esophageal carcinoma has been receiving total parenteral nutrition with a solution containing 20% glucose and 4% amino acids for several weeks prior to surgery through a central venous catheter in the left subclavian vein. The patient is undergoing a left thoracotomy for resection, and during the procedure the medical student holding the rib retractor accidentally removes the subclavian catheter. Regarding the infusion of total parenteral nutrition, the most appropriate maneuver to perform during the surgical procedure would be to

(A) do nothing

(B) position the patient supine, insert a right subclavian catheter, and restart the infusion of parenteral nutrition

(D) administer 5 units of regular insulin intravenously and measure the serum glucose concentration in 15 min

(E) begin an infusion of 10% glucose via a peripheral vein

299. A 36-year-old nurse in good health is stuck with a used needle during the unsuccessful resuscitation of a homeless man with an unknown medical history. She is at potential risk of all of these diseases from exposure to a needle contaminated with blood or tissue from an infected patient EXCEPT

(A) Creutzfeldt–Jakob disease

(B) hepatitis A

(D) cytomegalovirus

(E) syphilis

300. A 29-year-old anesthesia resident is found dead of an overdose in his call room one morning. The following statements are true concerning substance abuse among anesthesiologists EXCEPT

(A) alcohol and fentanyl are the drugs most likely to be abused

(B) a proper drug accountability system will prevent misuse

(D) the relapse rate of anesthesiology residents allowed to reenter a program is about 66%

(E) it is the policy of the ASA to treat substance abuse disorders as a disease

301. A 37 year-old-woman with a history of scleroderma is brought to the hospital after a motor vehicle accident and requires an emergency laparotomy for management of intraabdominal bleeding. Problems that may be encountered in scleroderma include all of the following EXCEPT

(A) limited mouth opening

(B) arterial dilatation

(D) contractures

(E) pericardial effusion

302. A 2-year-old child with Hurler syndrome (gargoylism), a disturbance of mucopolysaccharide metabolism, needs anesthesia for an umbilical hernia repair. Anesthesia for such patients is complicated by all of the following EXCEPT

(A) dwarfism

(B) macroglossia

(D) hepatosplenomegaly

(E) short neck

303. An 80-year-old patient has a normal value of 1.0 mg/dL for serum creatinine. Compared with a 20-year-old patient of the same weight and with the same serum creatinine value, the 80-year-old patient has approximately what fractional value of creatinine clearance?

(A) 0.1

(B) 0.2

(D) 0.7

(E) 0.9

304. A 40-year-old alcoholic man with a massive gastrointestinal bleed is treated with a variety of blood components. The blood component with the least risk of transmitting hepatitis C is

(A) cryoprecipitate

(B) fresh frozen plasma

(D) frozen washed red blood cells

(E) 5% albumin

305. A 64-year-old man with a history of stable exertional angina for 3 years presents for preoperative evaluation before an elective hip replacement for severe degenerative arthritis. In terms of his preoperative medications or his need for additional evaluations prior to surgery, he

(A) needs a cardiac catheterization

(B) needs a dobutamine stress echocardiogram

(D) should be taking a beta-blocker unless there is a specific contraindication

(E) should discontinue his statin preoperatively

306. You are the anesthesiologist assigned to the preoperative testing area for the day. All of the following statements regarding stopping or continuing medications are true EXCEPT

(A) patients with coronary artery disease should ideally never stop aspirin because of a rebound phenomenon resulting in an increased risk of perioperative cardiac complications; risk of bleeding versus thrombosis need to be assessed

(B) statins should be continued and may even exert a protective effect in patients undergoing vascular surgery

(D) it is advisable to stop furosemide a day before surgery because of an increased risk of hypovolemia

(E) birth control pills should be continued on the day of surgery

307. A 79-year-old man with coronary artery disease develops acute kidney injury after a carotid endarterectomy. The circulation to the kidney is

(A) autoregulated over a mean arterial pressure range of about 80 to 160 mm Hg

(B) not regulated by neural factors

(D) not affected by epinephrine

(E) constricted by prostaglandin E₂

308. A 33-year-old woman takes clarithromycin chronically for sinusitis. After falling on ice, she suffers a complex fracture of her ankle. In the emergency department, her ankle is too swollen to permit immediate operative repair so it is casted and she is scheduled for surgery in a week. She is given a fentanyl patch, 25 mcg/h, for pain. The following morning, she is found dead in bed. The most likely mechanism for her death is

(A) excessive fentanyl effect due to excessive dose

(B) excessive fentanyl effect due to impaired metabolism

(D) pulmonary embolus of clot originating in injured leg

(E) bone marrow embolus

309. A morbidly obese 42-year-old woman is scheduled for bariatric surgery. Which one of the following statements is true about the perioperative management of a morbidly obese patient?

(A) Obese patients have different fasting guidelines compared to non-obese patients.

(B) Neck circumference is the single best predictor of problematic intubations in obese patients.

(C) Postoperative continuous positive airway pressure increases the incidence of major anastomotic leakage after gastric bypass surgery.

(D) Patients with obesity-hypoventilation syndrome have a decreased sensitivity to the respiratory depressant effects of general anesthetics.

(E) Succinylcholine should be dosed based on lean body weight in obese patients.

310. A 59-year-old man with moderate chronic obstructive pulmonary disease (COPD) is scheduled for a nephrectomy for renal cell carcinoma. All of the following statements about patients with chronic pulmonary disease are correct EXCEPT

(A) a patient with severe but stable COPD should routinely have preoperative pulmonary function tests before major abdominal or pelvic surgery

(B) to prevent intraoperative bronchospasm in patients with asthma, pretreatment with a β₂-adrenoceptor agonist and/or an anticholinergic agent is indicated

(D) ketamine has little effect on ventilatory drive in patients with COPD

(E) in patients with COPD, longer-acting neuromuscular blockade is associated with a greater risk of postoperative pulmonary complications than use of shorter acting neuromuscular blockers

311. The liver affects glucose metabolism by all of the following mechanisms EXCEPT

(A) glycogen storage

(B) gluconeogenesis

(D) insulin production

(E) conversion of galactose to glucose

312. A 55-year-old woman with recurrent nephrolithiasis is treated with extracorporeal shock wave lithotripsy. The shock wave during extracorporeal shock wave lithotripsy is timed to coincide with a particular point in the ECG, and occurs

(A) at the peak of the P-wave.

(B) 100 msec after the peak of the P wave

(D) 200 msec after the peak of the R wave

(E) at the peak of the T wave

313. A 60-year-old man with a history of well-controlled type 2 diabetes and a myocardial infarction 7 years ago with no recent cardiac symptoms presents for preoperative evaluation prior to prostatectomy. All of the following statements about perioperative cardiac risk assessment are true EXCEPT

(A) most ischemic events occur postoperatively rather than intraoperatively

(B) in terms of cardiac risk stratification for noncardiac surgery, intrathoracic and intraperitoneal surgeries are deemed intermediate risk

(C) according to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, patients with asymptomatic type 2 diabetes have the same risk of perioperative cardiac complications (PCC) as a patient with a previous MI

(D) cardiomegaly by itself is not a risk factor for PCC

(E) renal insufficiency is one of the five perioperative risk factors in the ACC/AHA guidelines

314. A 40-year-old alcoholic man is found to have massive ascites. Ascites

(A) follows chronic decreased portal vein pressure

(B) follows periods of hyperalbuminemia

(D) may have an adverse cardiopulmonary effect

(E) should be removed rapidly to avoid reaccumulation

315. An elderly woman is brought into the hospital after being found on the floor of her apartment. She is found to have prerenal failure and her urine will

(A) be positive for nitrites

(B) be concentrated

(D) be excreted in large amounts

(E) have a reddish tinge due to presence of red blood cells

DIRECTIONS: use the following scenario to answer Questions 316-317: A 46-year-old woman with myxedema is scheduled for emergency intraabdominal surgery.

316. A finding consistent with the myxedematous state is

(A) fine, soft hair

(B) moist skin

(D) heat intolerance

(E) pitting edema of the eyelids

317. Fluid and blood replacement in this patient

(A) should be guided by blood pressure

(B) should be guided by electrocardiographic voltage

(D) should be guided by invasive arterial and central venous pressure monitoring

(E) should be accompanied by rapid restoration of the euthyroid state

318. A 75-year-old woman with aortic stenosis and depression treated with fluoxetine presents for aortic valve replacement surgery. All of the following statements about depression are correct EXCEPT

(A) St. John’s wort is an herbal remedy often taken by patients to treat depression

(B) successful treatment of depression has been shown to correlate with a reduced risk of postoperative death

(D) depression may be a symptom of hypocalcemia

(E) depression may be a symptom of Cushing syndrome

319. A 60-year-old woman presents with episodic hypertension to 180/105 associated with headache and profuse sweating. A diagnosis of pheochromocytoma is made. She

(A) requires immediate surgery

(B) should be treated for 10 to 14 days with an α-adrenoceptor antagonist

(D) is usually hypervolemic

(E) should have a Swan-Ganz catheter in place preoperatively

DIRECTIONS: use the following scenario to answer Questions 320-321: A 52-year-old woman with a one-year history of type 2 diabetes controlled on metformin is scheduled for a partial colectomy for recurrent diverticulitis.

320. The most important goal in the treatment of a middle-aged diabetic patient undergoing anesthesia is to

(A) keep blood sugar in the normal range

(B) prevent glycosuria

(D) prevent ketoacidosis

(E) prevent acetonuria

321. Hypoglycemia in the awake patient

(A) is identical to that in the anesthetized patient

(B) is characterized by bradycardia

(D) is due to ketoacidosis

(E) is characterized by a marked parasympathetic response

322. You are called to see a patient on the medical service in need of a cholecystectomy for acute cholecystitis. The patient was admitted with abdominal pain and hyperosmolar coma. Hyperosmolar coma

(A) usually occurs in young people

(B) occurs at osmolar levels of 150 to 175 mOsm/L

(D) is usually accompanied by oliguria

(E) requires treatment with large doses of insulin

323. A 33-year-old woman with type 1 diabetes who uses an insulin pump presents for surgical drainage of a pilonidal abscess. She has been fasting since the night before surgery. All of the following statements regarding perioperative management of this patient are correct EXCEPT

(A) in general, it is best to maintain the basal infusion rate of insulin

(B) scheduled preprandial insulin boluses should be omitted

(D) she should resume her usual diet and insulin therapy regimen as soon as possible postoperatively

(E) uptake of insulin from the pump is not affected by alterations in tissue perfusion

324. A 26-year-old otherwise healthy female trauma patient is brought to the operating room with massive injuries and requires multiple units of blood to attempt to maintain euvolemia. Which one of the following statements about blood transfusions in her is correct?

(A) Cross-matching is necessary for fresh frozen plasma (FFP).

(B) Most platelet transfusions are given to treat dilutional thrombocytopenia after massive transfusion.

(D) A unit of packed red blood cells should increase the hemoglobin level by 3 g/dL.

(E) FFP transfusion should be guided by the INR value.

325. A 47-year-old patient is to be operated on for a tumor of the small bowel. In the preoperative interview, a history of flushing, diarrhea, and joint pain is elicited. There are also symptoms compatible with congestive heart failure. A likely diagnosis is

(A) Zollinger-Ellison syndrome

(B) carcinoid syndrome

(D) Peutz-Jeghers syndrome

(E) adrenal tumor with metastasis

326. A 59-year-old man with cirrhosis needs hip replacement surgery for severe osteoarthritis. Which one of the following statements regarding cirrhotic patients is correct?

(A) The serum albumin level will be elevated.

(B) Excessive sodium is lost in the urine.

(D) Serum gamma globulin level will be low.

(E) Less thiopental is required for induction.

327. The optimal anesthetic regimen for a 50-year-old patient with fulminant hepatic failure from hepatitis C undergoing liver transplantation

(A) will avoid fentanyl

(B) will avoid nondepolarizing relaxants

(D) will avoid halogenated hydrocarbons

(E) will depend on the cause of the liver failure and the patient’s status

328. A 35-year-old woman with hyperparathyroidism undergoes a parathyroidectomy. Features of hypocalcemia relevant to the perioperative period include all of the following EXCEPT

(A) hypocalcemia predisposes to laryngospasm

(B) hypocalcemia can present as change in mental status

(D) one gram of calcium chloride solution provides three times the amount of elemental calcium present in one gram of calcium gluconate

(E) concentrated calcium solutions may be caustic to peripheral veins

329. A 43-year-old male patient who has had a transsphenoidal hypophysectomy for acromegaly several years ago presents for cholecystectomy. Which one of the following hormones should be given in the perioperative period?

(A) ACTH

(B) TSH

(D) cortisol

(E) insulin

330. A 39-year-old diabetic man is scheduled for a podiatric procedure. Which one of the following statements is TRUE regarding the effects of medications on blood sugar?

(A) Propranolol potentiates the hyperglycemic response to stress.

(B) Lisinopril increases insulin requirements in the diabetic.

(D) Atenolol decreases insulin release from the pancreas.

(E) Prednisone increases the blood glucose concentration.

331. Cryoprecipitate contains all of the following clotting factors EXCEPT

(A) factor VIII

(B) factor IX

(D) von Willebrand factor

(E) fibrinogen

332. The treatment of a hemolytic transfusion reaction in a middle-aged female patient who received blood during a surgical procedure may involve the immediate administration of all of the following EXCEPT

(A) crystalloid intravenous fluids

(B) furosemide

(D) sodium bicarbonate

(E) mannitol

333. An elderly man with urosepsis develops disseminated intravascular coagulation (DIC). Which one of the following statements is FALSE regarding DIC?

(A) DIC is usually due to the abnormal consumption of clotting factors.

(B) DIC may be treated with heparin.

(D) Abnormalities in laboratory tests include a prolonged prothrombin time and decreased values for platelet count and plasma fibrinogen.

(E) Regardless of the etiology, therapy of DIC is directed toward replacement of clotting factors and inhibition of the clotting cascade.

334. A middle-aged man with long-standing hypertension and chronic renal insufficiency on a beta-blocker and simvastatin requires an intraoperative angiogram while undergoing a vascular procedure. What should be done to decrease his risk of developing contrast-induced acute tubular necrosis?

(A) Administer a fluid bolus of normal saline prior to the procedure.

(B) Stop his statin a week before surgery.

(D) Start a calcium channel blocker immediately after the procedure.

(E) Start a beta-blocker at a low dose one week before surgery.

335. Which one of the following patients requires stress doses of steroids on the day of surgery to drain a postoperative wound infection a week after a partial colectomy for recurrent diverticulitis?

(A) A patient who uses topical steroids daily for eczema on both elbows as needed.

(B) A patient who uses inhaled budesonide daily in the spring and fall for allergy-related asthmatic symptoms.

(D) A patient who was treated with one dose of dexamethasone last week for postoperative nausea.

(E) A patient treated with steroids for lymphoma 3 years ago.

336. Perioperative management of a 47-year-old man with carcinoid syndrome undergoing a prostatectomy should include

(A) infusion of epinephrine to treat bronchospasm

(B) avoiding the use of vasopressin to treat intraoperative hypotension

(D) administration of octreotide preoperatively

(E) starting a calcium channel blocker one week before surgery

337. All of the following facts about antidiuretic hormone (ADH) are true EXCEPT

(A) release is under control of osmoreceptors in the hypothalamus

(B) release is from the posterior pituitary

(D) acts on the proximal convoluted tubule

(E) causes increased reabsorption of free water from the kidney

338. A 50-year-old man with long-standing obstructive sleep apnea who uses a CPAP machine intermittently at home and needs a cholecystectomy

(A) would benefit from a short-acting benzodiazepine given at bedtime for the week before surgery

(B) should be kept intubated and mechanically ventilated for the night following surgery

(D) would usually require large doses of opioids to treat postoperative pain

(E) should completely stop using CPAP for a week prior to surgery

339. The perioperative management of a middle-aged man with gout undergoing knee replacement should include the avoidance of

(A) local anesthetics in the amide class

(B) succinylcholine

(D) hypovolemia

(E) etomidate

340. Which one of the following abnormalities does not cause a hypercoagulable state?

(A) Factor V Leiden

(B) Protein S deficiency

(D) Antithrombin III deficiency

(E) Von Willebrand disease

341. You are called to see a 57-year-old patient in the recovery room with a serum potassium concentration of 5.9 mEq/L after a colonic resection for colon cancer. Treatment of hyperkalemia includes all of the following EXCEPT

(A) elimination of exogenous sources

(B) correction of cause of endogenous sources

(D) administration of acidifying solutions

(E) administration of calcium gluconate

342. Regarding a young adult with Duchenne muscular dystrophy who is to undergo general anesthesia, all of the following are true EXCEPT

(A) the patient often has delayed gastric emptying

(B) the patient has an increased risk of malignant hyperthermia

(D) the patient is usually a difficult intubation

(E) ineffective cough from diminished respiratory muscle strength can cause retention of secretions post-operatively

343. Relatively rare diseases that are much more common in patients with the acquired immunodeficiency syndrome include all of the following EXCEPT

(A) pneumonia due to Pneumocystis carinii

(B) Addison disease

(D) B-cell lymphoma

(E) Kaposi’s sarcoma

344. A 56-year-old woman with a diagnosis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) requires a mastectomy for recently diagnosed breast cancer. Findings seen in patients with SIADH includes all of the following EXCEPT

(A) hypernatremia

(B) low serum osmolality

(D) normal renal function

(E) absence of edema

345. A 26-year-old man with severe inflammatory bowel disease is being treated with complete bowel rest for several weeks. A nutritionist recommends parenteral nutrition. All of the following facts about parenteral nutrition administered via a peripheral vein are true EXCEPT that peripheral nutrition

(A) IV catheters should be changed every three days

(B) has a low incidence of phlebitis if the dextrose concentration is kept below 10%

(D) uses protein as a source of calories

(E) can be stopped during patient transport if it will be restarted within an hour

346. The blood supply to the liver is by two vessels, the hepatic artery and the hepatic portal vein. Which one of the following statements regarding hepatic circulation is correct?

(A) 60% of the blood supply comes from the hepatic artery.

(B) The portal vein provides 90% of the oxygen supply.

(D) The portal vein supplies the bulk of the nutrients to the liver.

(E) The hepatic artery is more important than the portal vein in transporting orally administered medications to the liver.

347. A 61-year-old woman who had a cadaveric kidney transplant seven years ago now presents for knee replacement surgery. All of the following statements about immunosuppression are correct EXCEPT

(A) immunosuppression may occur with protein–calorie malnutrition

(B) renal transplant recipients have a higher incidence of acute rejection and immunologic graft loss than recipients of any other solid organ

(D) cyclosporine use after renal transplantation may cause hypertension, hyperlipidemia, and accelerated atherosclerosis in renal transplant patients

(E) the most common cause of invasive fungal infections in immunocompromised patients is Candida species

348. A 59-year-old man with recent cholangitis undergoing an open cholecystectomy under general anesthesia develops intraoperative hypotension unresponsive to vasopressors and fluids. There is no sign of hemorrhage. What drug should you administer at this point?

(A) hydrocortisone 100 mg intravenously

(B) regular insulin 5 units intravenously

(D) levothyroxine 100 mcg intravenously

(E) 50 mL of 50% glucose intravenously

349. When evaluating renal function in a 75-year-old healthy man undergoing preoperative assessment for an elective orthopedic procedure, one must consider that

(A) proteinuria is always pathological

(B) a specific gravity of 1.023 or greater demonstrates good concentrating function

(D) less creatinine is produced by muscular persons

(E) by the eighth decade of life, GFR is reduced by 85% in otherwise healthy adults

350. A 40-year-old woman with no history of diabetes develops hyperglycemia during abdominal surgery. Mechanisms by which blood glucose can increase during surgery include all of the following EXCEPT

(A) intravenous administration

(B) secretion from the liver secondary to catecholamine-stimulated glycogenolysis

(D) increased catecholamine output stimulating pancreatic insulin secretion

(E) stress-induced cortisol release from the adrenal cortex

351. All of the following statements about a 47-year-old male patient with diabetes insipidus (DI) are correct EXCEPT

(A) the serum sodium is high

(B) the osmolality of the serum is high

(D) thirst need not be present

(E) pituitary DI is treated with desmopressin

352. A 39-year-old man has been diagnosed with primary hyperaldosteronism. He is expected to have all of the following manifestations EXCEPT

(A) excess secretion of hormone from the adrenal medulla

(B) hypertension

(D) hypokalemia

(E) inability to concentrate urine

353. A 49-year-old woman with hyperthyroidism due to Graves disease is having a thyroidectomy. She

(A) is likely to have an increased MAC

(B) is likely to have a palpable nodule

(D) should not be treated with beta blockers perioperatively

(E) should be pretreated with iodide one hour before surgery

354. A 56-year-old man with Gilbert syndrome is scheduled for a bone marrow harvest for donation to his sister. Important considerations in the perioperative period for this patient should include

(A) avoidance of preoperative sedation

(B) preoperative transfusion of fresh frozen plasma

(D) recognition of the benign etiology of the laboratory abnormality

(E) liver biopsy for confirmation of the diagnosis

355. A 52-year-old woman undergoes a total thyroidectomy for a toxic goiter. Upon arrival to the PACU her temperature is 38°C; all other vital signs are normal. Thirty minutes later you are called by the patient’s nurse who tells you the patient is now in atrial fibrillation with a heart rate of 140. What medication should you order first?

(A) metoprolol

(B) amiodarone

(D) nitroglycerin

(E) diltiazem

356. A 20-year-old African-American woman with sickle cell disease develops severe knee pain after pelvic surgery for a tubal pregnancy. She tells you this pain is typical of her sickle cell crises and usually responds well to opioids. The sickling of red blood cells in this patient

(A) is a reversible process

(B) occurs when oxygenated hemoglobin molecules precipitate

(D) may cause infarction in tissues with a high oxygen extraction ratio

(E) may be related to acute splenic infarction given her age

357. A 57-year-old man with cirrhosis develops hepatorenal syndrome. Regarding the hepatorenal syndrome, all of the following are true EXCEPT

(A) it is associated with kidneys that are normal on biopsy

(B) type I is an indication for urgent liver transplantation

(D) it may be readily diagnosed by the abnormalities in urinary sediment analysis

(E) the prognosis is poor

358. A 19-year-old male patient arrives at the hospital with a gunshot wound through the liver and is brought immediately to the operating room hypotensive and still bleeding heavily. He remains hypotensive following fluid resuscitation with 3 L of lactated Ringer solution. Fluid resuscitation should continue using

(A) uncrossmatched O-negative packed red blood cells

(B) platelets

(D) fresh frozen plasma

(E) cryoprecipitate

359. A 36-year-old woman with polycythemia vera (PV) presents for a diagnostic laparoscopy as part of an infertility work-up. All of the following statements about PV are correct EXCEPT

(A) PV is the most common of the chronic myeloproliferative disorders

(B) PV is most often diagnosed by the incidental finding of a high hemoglobin and hematocrit

(D) if untreated, erythrocytosis causes hyperviscosity that can lead to thrombosis

(E) the goal of treatment in female patients is to maintain the hemoglobin level <12 g/dL

360. A 32-year-old female patient with Sipple syndrome (multiple endocrine neoplasia type IIa) is scheduled for a thyroidectomy. Soon after induction, hypertension of 210/130 is recorded. A likely cause for this is

(A) light anesthesia

(B) pheochromocytoma

(D) hypercarbia

(E) allergic response to an anesthetic agent

361. A middle-aged woman is found to have a plasma calcium concentration of 11 mg/dL while undergoing a preoperative evaluation for an elective cholecystectomy. All of the following are true about hypercalcemia in this patient EXCEPT

(A) mild hypercalcemia as seen in this patient is usually asymptomatic

(B) hypercalcemia decreases renal concentrating ability that can cause polyuria and polydipsia

(D) primary hyperparathyroidism is an unlikely cause of her hypercalcemia

(E) if her parathyroid hormone level is suppressed, she is likely to have an underlying malignancy as the cause of her hypercalcemia

362. Which one of the following statements is true regarding anion gap?

(A) An anion gap of 12 mEq/L is considered abnormal.

(B) Diabetic ketoacidosis is associated with a low anion gap.

(D) Anion gap may be estimated by subtracting the serum chloride concentration from the serum sodium concentration.

(E) Acetazolamide therapy causes increased anion gap metabolic acidosis.

363. Factors released in response to hypovolemia include all of the following EXCEPT

(A) atrial natriuretic peptide

(B) renin

(D) aldosterone

(E) arginine vasopressin

364. Physiologic compensation for anemia includes all of the following EXCEPT

(A) increased plasma volume

(B) increased cardiac output

(D) bradycardia

(E) increased minute alveolar ventilation

365. A few months into her anesthesiology residency, a previously healthy 27-year-old woman is diagnosed with herpetic whitlow. This infectious disease

(A) is caused by the varicella zoster virus

(B) may be effectively prevented by wearing gloves

(D) is usually acquired from a needle stick

(E) is initially treated with intravenous antiviral agents

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