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1.  You are called to the Emergency Department to assist with a difficult intubation of an adult patient. In addition to an intubation tray, bag-valve-mask and supplemental oxygen, which of the following equipment would you recommend be available?


A. A
B. B
C. C
D. D


2.  You would perform an apnea test to assist a doctor in determining


A. hypoxic response
B. brain death
C. paralysis level
D. diffusing capacity


3.  Which of the following statements are TRUE regarding cardioversion?


A. discharges of 5-10 Joules/kg are used on children
B. discharges are used to stop ventricular fibrillation
C. discharges of 100-200 Joules used on adults
D. discharges occur during the relative refractory period


4.  A doctor asks you to assist her with positioning a cooperative and mobile patient for a thoracentesis. The correct position for this procedure is:


A. a modified prone position, with target side rotated 30° toward vertical
B. a semi-Fowler’s position with legs flexed and knees supported
C. a sitting position (chair or bed), leaning forward with arms supported
D. the lateral decubitus position with the affected side up


5.  You are assisting a resident perform orotracheal intubation of an semiconscious adult patient in the emergency room. After three failed attempts by the resident to place the tube in the trachea, your efforts to ventilate the patient using a bag-valve-mask system fail. Which of the following would you recommend to the resident as the next course of action?


A. carry out at least one more intubation attempt
B. perform a percutaneous dilational tracheotomy
C. suspend intubation efforts and continue bagging
D. insert a laryngeal mask airway


6.  A doctor premedicates a patient with atropine prior to performing fiberoptic bronchoscopy. Which of the following is the primary reason for administering this drug to the patient?.


A. decrease vagal responses
B. provide moderate sedation
C. promote bronchorrhea
D. provide topical anesthesia


7.  You are assisting a physician during cardioversion of a patient with unstable atrial flutter. The patient is receiving oxygen via a nonrebreather mask at this time. After the initial shock has been delivered, the patient’s SpO2 drops to 85%, respirations become slow and shallow, and the heart rate is now 82/min with normal sinus rhythm. The next immediate action should be:


A. open the airway and ventilate with 100% O2
B. administer 2 mg IV naloxone (Narcan)
C. deliver another synchronized 100 J shock
D. intubate and initiate mechanical ventilation


8.  An Emergency Department doctor is having difficulty orally intubating a patient with suspected spinal trauma because you are applying manual in-line stabilization to the patient’s head and neck. The patient is at risk of aspiration and will need ventilatory support. Which of the following would you recommend as the next step in securing the patient’s airway?


a. performing a cricothyrotomy and applying jet ventilation
b. foregoing in-line stabilization and placing the patient in the sniffing position
c. abandoning endotracheal intubation and inserting a laryngeal mask airway
d. re-attempting intubation using a tube introducer/bougie or fiberoptic stylet 


9.  A first-year resident has just inserted an indwelling arterial catheter in an ICU patient. A good indication that the catheter has been successfully inserted in an artery is:


A. a positive Allen test
B. a good blood return
C. ability to flush the line
D. proper blood pressure and waveform


10.  During fiberoptic bronchoscopy, a patient receiving intravenous (IV) fentanyl exhibits signs of respiratory depression. Which of the following would you recommend?


A. increase the O2 flow rate and continue monitoring
B. immediately administer naloxone (Narcan)
C. decrease the O2 flow rate and continue monitoring
D. immediately administer neostigmine or prostigmine


11.  A first year resident asks you to assist him during elective intubation of an adult patient. Although the patient’s head and neck are properly positioned, the resident is having difficulty visualizing the larynx/cords with the laryngoscope. Which of the following procedures could you perform to help the resident intubate the patient?


A. push the thyroid cartilage down and toward the patient’s head
B. rotate the patient’s head and neck forty-five degrees to the right
C. place the patient in the lateral decubitus (side-lying) position
D. grab the patient’s tongue and gently extend it out of the mouth


12.  An anesthesiologist is planning a rapid sequence induction to intubate an adult trauma patient in the ED. In preparation for intubation, you are ventilating and oxygenating the patient with a bag-valve-mask. The anesthesiologist is concerned about the potential for gastric distention and aspiration before the tube is placed. To help avoid this problem, you would:


A. place the patient in the lateral decubitus (side-lying) position
B. sit the patient up and keep airway pressure < 20-25 cm H2O
C. place gentle pressure on the the patient’s upper epigastrium
D. rotate the patient’s head and neck forty-five degrees to the right


13.  You are assisting a pediatrician performing orotracheal intubation of an 8 year-old child. Which of the following endotracheal tube sizes would you select for this patient?


A. 4.0 mm
B. 5.0 mm
C. 6.0 mm
D. 7.0 mm


14.  A physician asks you to assist her during a cardioversion procedure. The patient is undergoing moderate sedation with propofol (Diprivan) and receiving 60% oxygen via high flow nasal cannula. Which of the following parameters would you monitor during this procedure?


A. A
B. B
C. C
D. D
15.  In addition to vital signs, SpO2 and ECG, which of the following should be monitored during a cardiopulmonary exercise test?


A. maximum inspiratory pressure
B. physiologic deadspace and VD/VT
C. FEV1 and peak expiratory flow rate
D. patient’s perceived level of exertion


16.  A physician is having difficulty visualizing the airway of an obese patient during an emergency intubation procedure. He asks for your recommendation to quickly secure the airway and provide ventilation. You should recommend:


A. a cricothyrotomy
B. inserting an LMA
C. sedating the patient
D. using a double-lumen ET tube


17.  A first year resident asks you to assist her during an elective intubation. Other than auscultation via stethoscope, which of the following devices could help assess tube placement?


A. A
B. B
C. C
D. D


18.  You are covering the ER in a trauma center. You are paged STAT by the ER physician to assist her during intubation of a 43-year-old MVA victim in cardiopulmonary arrest. On what basis would you initially assess proper endotracheal tube placement following intubation?


A. a STAT chest x-ray
B. chest/epigastric auscultation
C. a STAT arterial blood gas
D. passage of a suction catheter

19.  Soon after undergoing a therapeutic thoracentesis, a patient exhibits hypotension. The most likely cause of this problem is:


A. fluid shifts out of the vascular compartment
B. a vasovagal reaction
C. re-expansion pulmonary edema
D. cardiovascular collapse


20.  Approximately what exercise target heart rate would you set for a COPD patient with a maximum heart rate at the limit of exercise tolerance of 150/min and a resting heart rate of 80/min?


A. 90/min
B. 110/min
C. 130/min
D. 150/min


21.  A physician has attempted on several occasions to insert a central venous catheter into the right subclavian vein of a patient receiving mechanical ventilation. Suddenly the ventilator’s high-pressure alarm sounds, the patient’s blood pressure drops, and the SpO2 value drops from 96% to 84%. Breath sounds are greatly diminished over the right-lung field. What action should you recommend?


A. Pull the ET back 2 – 3 cm into the trachea
B. Insert a chest tube into the left pleural space
C. Insert a pulmonary artery catheter
D. Insert a chest tube into the right pleural space


22.  In explaining to a terminally ill patient’s family the available options for withdrawing ventilatory support from their loved one, which of the following information is essential to share?


A. how often you will monitor the patient for distress
B. if and when the ET tube will be removed
C. how long they can expect the procedure to last
D. how much sedation the patient will receive


23.  You are assisting a physician performing orotracheal intubation of a 100 kg 6-foot 4-inch male patient. Which of the following endotracheal tube sizes would you select for this patient?


A. 6.0 mm
B. 7.0 mm
C. 8.0 mm
D. 9.0 mm
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24.  While assisting a physician who is inserting a pulmonary artery catheter, you note a changeover on the monitor from pulsatile pressures of about 25/5 mm Hg to pulsatile pressures of 25/15 mm Hg. Which of the following has occurred?


A. the catheter has advanced from right atrium to right ventricle
B. the catheter has moved from right ventricle to pulmonary artery
C. the catheter has advanced into the pulmonary wedge position
D. the catheter has moved from the vena cava into the right atrium


25.  While you are assisting an anesthesiologist with an intubation of a premature infant, he asks for a laryngoscope blade. You would give him a:


A. MacIntosh blade number 1
B. Miller blade number 2
C. MacIntosh blade number 0
D. Miller blade number 0


26.  Which of the following equipment is required for patient monitoring during a fiberoptic bronchoscopy procedure?


A. capnography adaptor
B. oxygen cannula
C. EEG monitor
D. pulse oximeter


27.  Which of the following is a diagnostic use of fiberoptic bronchoscopy?


A. extracting foreign bodies
B. aiding difficult intubations
C. removing mucus plugs
D. obtaining tissue biopsies


28.  At the end of each graded step of a cardiopulmonary exercise test, you normally would measure which of the following?


A. physiologic deadspace
B. intrapulmonary shunt
C. Borg exertion rating
D. pulmonary diffusing capacity


29.  In order to maximize patient safety during cardiopulmonary stress testing, which of the following precautions would you recommend?


A. A
B. B
C. C
D. D


30.  You assist a physician insert a pulmonary artery catheter via the subclavian venous route on a patient receiving volume control ventilation in the coronary care unit. Soon thereafter, the ventilator high pressure alarm begins sounding on each breath and the patient appears in acute respiratory distress. Which of the following would you recommend at this time?


A. Taking a 12-lead ECG
B. Withdrawing the catheter 2-3 cm
C. Switching to pressure control
D. Obtaining a STAT chest x-ray
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