id
string | choice_num
int64 | answer
string | level
int64 | en_question
string | en_A
string | en_B
string | en_C
string | en_D
string | zh_question
string | zh_A
string | zh_B
string | zh_C
string | zh_D
string | en_E
string | zh_E
string | en_F
string | zh_F
string | en_G
string | zh_G
string | en_H
string | zh_H
string | en_I
string | zh_I
string |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
f575a4f4-9039-5720-b3fb-b413557cd49e
| 4 |
D
| 1 |
36. Which of the following statements is true of perioperative venous
|
Novel oral anticoagulants are more effective than once-daily enoxaparin in VTE prophylaxis without increased rates of postoperative bleeding.
|
Major trauma increases VTE risk to a greater degree than postpartum status.
|
The VTE prophylactic effects of aspirin and warfarin are synergistic.
|
Neuraxial anesthesia initiated before surgical incision reduces rates of perioperative VTE.
|
36. 以下哪项关于围手术期静脉血栓栓塞的说法是正确的？
|
新型口服抗凝药在静脉血栓栓塞预防中比每日一次的依诺肝素更有效，并且不会增加术后出血率。
|
重大创伤比产后状态更能增加静脉血栓栓塞的风险。
|
阿司匹林和华法林的静脉血栓栓塞预防效果具有协同作用。
|
在手术切口前开始的椎管内麻醉可降低围手术期静脉血栓栓塞的发生率。
| null | null | null | null | null | null | null | null | null | null |
97054359-6ab8-526b-bc0c-65839ca1417b
| 4 |
C
| 1 |
A 48-year-old man presents for retroperitoneal sarcoma resection. Pharmacologic VTE prophylaxis should be continued postoperatively for what length of time?
|
3 days
|
14 days
|
28 days
|
60 days
|
一名48岁的男性接受后腹膜肉瘤切除术。术后应持续多长时间进行药物VTE预防？
|
3天
|
14天
|
28天
|
60天
| null | null | null | null | null | null | null | null | null | null |
ea276da0-28b5-50f3-b24f-c92c55858e8d
| 4 |
A
| 1 |
Which of the following pathophysiologic changes occurs with a pulmonary embolism?
|
Increased dead space
|
Increased shunt
|
Reduced pulmonary vascular resistance
|
Reflex bronchodilation
|
下列哪项病理生理变化发生在肺栓塞中？
|
增加的无效腔
|
增加的分流
|
降低的肺血管阻力
|
反射性支气管扩张
| null | null | null | null | null | null | null | null | null | null |
7b0e1ea1-18d4-581b-995e-3ea08520c51a
| 4 |
D
| 2 |
Which of the following arterial blood gas results, on an FiO2 of 0.4, is most consistent with a diagnosis of acute, submassive pulmonary embolism?
|
| pH 7.39 | PaCO2 44 | PaO2 90 | HCO3 26 |
|
| pH 7.47 | PaCO2 40 | PaO2 74 | HCO3 28 |
|
| pH 7.59 | PaCO2 28 | PaO2 90 | HCO3 26 |
|
| pH 7.50 | PaCO2 32 | PaO2 74 | HCO3 24 |
|
在FiO2为0.4的情况下，以下哪项动脉血气结果最符合急性、亚大块肺栓塞的诊断？
|
| pH 7.39 | PaCO2 44 | PaO2 90 | HCO3 26 |
|
| pH 7.47 | PaCO2 40 | PaO2 74 | HCO3 28 |
|
| pH 7.59 | PaCO2 28 | PaO2 90 | HCO3 26 |
|
| pH 7.50 | PaCO2 32 | PaO2 74 | HCO3 24 |
| null | null | null | null | null | null | null | null | null | null |
8d05f78c-6eba-5231-b10c-821f718861ce
| 4 |
C
| 1 |
Which of the following ECG findings is most sensitive for acute pulmonary embolus?
|
Incomplete right bundle branch block
|
Rightward axis
|
Sinus tachycardia
|
Large S wave in lead I, combined with Q wave and inverted T wave in lead III
|
以下哪项心电图发现对急性肺栓塞最敏感？
|
不完全性右束支传导阻滞
|
右偏轴
|
窦性心动过速
|
I导联大S波，III导联Q波和倒置T波的组合
| null | null | null | null | null | null | null | null | null | null |
236acb71-5de5-5419-8b82-68c16984c8de
| 4 |
D
| 3 |
A 59-year-old woman with a history of hypertension presents for total abdominal hysterectomy for endometrial cancer. She has continued her home amlodipine and metoprolol up until the day of surgery but has held her lisinopril for 2 days. In the preoperative day, she is very anxious and her blood pressure is 179/88. Which of the following is the most appropriate next step?
|
Cancel the case.
|
Administer home lisinopril dose.
|
Proceed with the case and maintain blood pressure within high-normal range.
|
Administer appropriate anxiolysis and reassess.
|
一名59岁的女性有高血压病史，因子宫内膜癌需进行全腹子宫切除术。她在手术当天继续服用家中的氨氯地平和美托洛尔，但已经停用赖诺普利2天。在术前一天，她非常焦虑，血压为179/88。以下哪项是最合适的下一步措施？
|
取消手术。
|
给予家中的赖诺普利剂量。
|
继续手术并将血压维持在高正常范围内。
|
给予适当的抗焦虑药物并重新评估。
| null | null | null | null | null | null | null | null | null | null |
267ee312-185e-599d-87b0-3870db66530b
| 4 |
C
| 1 |
42. Which of the following statements is true with respect to essential hypertension?
|
Systolic dysfunction will precede diastolic dysfunction in the progression.
|
LV eccentric hypertrophy is likely to occur.
|
Essential hypertension accounts for >80% of all hypertension diagnoses.
|
Cerebral autoregulation is unchanged with long-standing essential hypertension.
|
42. 关于原发性高血压，下列哪项陈述是正确的？
|
在进展过程中，收缩功能障碍将先于舒张功能障碍出现。
|
可能发生左心室偏心性肥大。
|
原发性高血压占所有高血压诊断的80%以上。
|
长期原发性高血压患者的脑自动调节不变。
| null | null | null | null | null | null | null | null | null | null |
7f9598b0-ffb9-5a36-916c-025aca7ead3f
| 4 |
A
| 1 |
Which of the following antihypertensives should be held for 12-24 hours preoperatively?
|
Captopril
|
Labetalol
|
Amlodipine
|
Clonidine
|
以下哪种降压药应在术前12-24小时停用？
|
卡托普利
|
拉贝洛尔
|
氨氯地平
|
可乐定
| null | null | null | null | null | null | null | null | null | null |
c7516c0a-2568-54ec-a17c-944974bedb1a
| 4 |
C
| 2 |
In which of the following scenarios should a β-blocker be initiated preoperatively?
|
A 60-year-old woman presenting for bilateral mastectomy with poorly controlled hypertension on lisinopril, amlodipine, and hydrochlorothiazide
|
A 48-year-old man with 100-pack-year smoking history presenting for thoracoscopic lobectomy
|
A 74-year-old man with coronary artery disease presenting for endovascular aortic aneurysm repair (EVAR)
|
A 65-year-old woman with hypertension and hyperlipidemia presenting for laparoscopic cholecystectomy for acute cholecystitis
|
在以下哪种情况下应在术前开始使用β受体阻滞剂？
|
一名60岁女性，准备进行双侧乳房切除术，服用赖诺普利、氨氯地平和氢氯噻嗪，但高血压控制不佳
|
一名48岁男性，有100包年吸烟史，准备进行胸腔镜肺叶切除术
|
一名74岁男性，有冠状动脉疾病，准备进行血管内主动脉瘤修复术（EVAR）
|
一名65岁女性，有高血压和高脂血症，准备进行腹腔镜胆囊切除术以治疗急性胆囊炎
| null | null | null | null | null | null | null | null | null | null |
6251ac42-e118-52a1-8ece-8783767f8752
| 4 |
D
| 3 |
Administration of which of the following drugs is most likely to resolve intraoperative hypotension refractory to phenylephrine in a patient who took lisinopril the morning of surgery?
|
Ephedrine
|
Methylene blue
|
Norepinephrine
|
Vasopressin
|
在手术当天早上服用赖诺普利的患者中，以下哪种药物的使用最有可能解决对苯肾上腺素无反应的术中低血压？
|
麻黄碱
|
亚甲蓝
|
去甲肾上腺素
|
加压素
| null | null | null | null | null | null | null | null | null | null |
40fd069a-c716-5de3-9843-9bfe04d694ac
| 4 |
B
| 1 |
Which of the following monitoring modalities is the gold standard with which to assess cerebral ischemia during carotid cross-clamp for carotid endarterectomy (CEA) under general anesthesia?
|
Somatosensory evoked potentials (SSEPs)
|
Electroencephalography (EEG)
|
Transcranial Dopplers (TCDs)
|
Near-infrared spectroscopy
|
在全身麻醉下进行颈动脉内膜切除术（CEA）时，以下哪种监测方式是评估颈动脉夹闭期间脑缺血的金标准？
|
体感诱发电位（SSEPs）
|
脑电图（EEG）
|
经颅多普勒（TCDs）
|
近红外光谱
| null | null | null | null | null | null | null | null | null | null |
cba4bc9e-9d22-5b0e-8829-043ecb4e6a5a
| 4 |
A
| 1 |
Which of the following is a class I recommendation for spinal cord protection during open and endovascular thoracic aortic aneurysm repair for patients at high risk of spinal cord ischemia?
|
Cerebrospinal fluid drainage
|
Systemic hypothermia
|
Hyperventilation
|
Hyperosmotic agents
|
以下哪项是对高风险脊髓缺血患者在开放和血管内胸主动脉瘤修复期间进行脊髓保护的I类推荐？
|
脑脊液引流
|
全身低温
|
过度通气
|
高渗透剂
| null | null | null | null | null | null | null | null | null | null |
495fae7a-db09-533e-aefb-92b9741a21e7
| 4 |
C
| 1 |
Which of the following is true regarding the physiologic changes that ensue following release of the aortic cross-clamp during aortic surgery?
|
Cardiac output increases.
|
Venous return increases.
|
Mixed venous oxygen saturation rapidly falls.
|
PaCO2 abruptly falls.
|
以下哪项关于主动脉手术中解除主动脉阻断后的生理变化是正确的？
|
心输出量增加。
|
静脉回流增加。
|
混合静脉氧饱和度迅速下降。
|
动脉二氧化碳分压突然下降。
| null | null | null | null | null | null | null | null | null | null |
c6ba1455-9287-5466-a759-8c66f137d796
| 4 |
D
| 1 |
49. Which of the following statements is true with respect to EVAR compared with open abdominal aortic aneurysm repair?
|
Lower rate of operative survival with EVAR
|
Increased hemodynamic shifts with EVAR
|
Worsened intraoperative acid-base status with EVAR
|
Higher rate of secondary interventions with EVAR at 6 years
|
49. 关于EVAR与开放性腹主动脉瘤修复术相比，下列哪项陈述是正确的？
|
EVAR的手术生存率较低
|
EVAR导致血流动力学变化增加
|
EVAR导致术中酸碱状态恶化
|
EVAR在6年内需要进行更多的二次干预
| null | null | null | null | null | null | null | null | null | null |
db51f659-2809-5e76-af93-cc5a0db40dbe
| 4 |
D
| 2 |
A 69-year-old man with type 2 diabetes mellitus, coronary artery disease after drug-eluting stent (28 months ago), COPD, and atrial fibrillation presents for lower limb revascularization for claudication. Which of the following is true with respect to timing of epidural placement as the primary anesthetic?
|
Clopidogrel should be held for 5 days before epidural placement.
|
The case should be canceled if the epidural placement is bloody.
|
It is unnecessary to check platelet count before epidural removal.
|
Systemic heparin may be administered 1 hour after epidural placement.
|
一名69岁患有2型糖尿病、药物洗脱支架术后冠状动脉疾病（28个月前）、慢性阻塞性肺病和心房颤动的男性因跛行接受下肢血管重建术。关于硬膜外麻醉作为主要麻醉方式的时机，下列哪项是正确的？
|
氯吡格雷应在硬膜外麻醉前停用5天。
|
如果硬膜外麻醉穿刺出血，应取消手术。
|
在移除硬膜外导管前无需检查血小板计数。
|
硬膜外麻醉后1小时可以给予全身肝素。
| null | null | null | null | null | null | null | null | null | null |
0c114dca-492a-5a1f-a2c7-771c57af373b
| 4 |
D
| 1 |
To decrease the risk of postoperative pulmonary complications associated with smoking, when should the patient stop smoking?
|
48 hours
|
1-2 weeks
|
2-4 weeks
|
4-6 weeks
|
为了减少与吸烟相关的术后肺部并发症风险，患者应在何时停止吸烟？
|
48小时
|
1-2周
|
2-4周
|
4-6周
| null | null | null | null | null | null | null | null | null | null |
87b802a3-5735-5d62-a891-36152fb76adf
| 4 |
A
| 1 |
Which one of the following is a risk for acute lung injury (ALI) postoperatively?
|
Active ethanol abuse
|
History of myocardial infarction
|
History of peripheral vascular disease
|
History of stroke
|
以下哪一项是术后急性肺损伤（ALI）的风险因素？
|
活跃的乙醇滥用
|
心肌梗死病史
|
外周血管疾病病史
|
中风病史
| null | null | null | null | null | null | null | null | null | null |
23b87228-ea5b-552c-a781-456bf501bf52
| 4 |
D
| 2 |
A 67-year-old woman presents for right lower lobe lobectomy. Which of the following results obtained via spirometry testing would place her at an increased risk for postoperative complications?
|
Forced expiratory volume in 1 second (FEV1) of 1300 mL
|
Predicted postoperative FEV1 70% of normal
|
Maximum voluntary ventilation of 62% or predicted value
|
Reserve volume (RV)/total lung capacity (TLC) of 57%
|
一名67岁的女性准备进行右下叶肺叶切除术。以下哪项通过肺活量测定获得的结果会使她术后并发症的风险增加？
|
1秒用力呼气量（FEV1）为1300毫升
|
预计术后FEV1为正常值的70%
|
最大自主通气量为预测值的62%
|
储备容量（RV）/总肺容量（TLC）为57%
| null | null | null | null | null | null | null | null | null | null |
c2916556-c89f-544c-9d62-0b0cdb9d995a
| 4 |
C
| 1 |
Which of the following symptoms is most consistent with theophylline toxicity?
|
Tinnitus
|
Itching
|
Tachyarrhythmia
|
Heart block
|
以下哪种症状最符合茶碱中毒？
|
耳鸣
|
瘙痒
|
心动过速性心律失常
|
心脏传导阻滞
| null | null | null | null | null | null | null | null | null | null |
118c591c-57c6-5fef-b330-ecfa0a12e21b
| 4 |
B
| 2 |
Which of the following patients would have a low probability of developing postoperative respiratory complications?
|
A 56-year-old man whose oxygen saturation drops 6% during exercise
|
A 58-year-old woman who has a 6-minute walk distance of 610 m
|
A 54-year-old woman who can climb 2 flights of stairs
|
A 55-year-old man with a VO2 max of 12 mL/kg/min
|
以下哪位患者术后发生呼吸并发症的概率较低？
|
一位56岁男性，运动时血氧饱和度下降6%
|
一位58岁女性，6分钟步行距离为610米
|
一位54岁女性，可以爬2层楼梯
|
一位55岁男性，最大摄氧量为12 mL/kg/min
| null | null | null | null | null | null | null | null | null | null |
c7990cec-91ec-5739-81e9-aa08040a63ea
| 4 |
C
| 1 |
6. Which of the following is a predictor of desaturation during one-lung ventilation (OLV)?
|
Left-sided thoracotomy
|
Lateral position during surgery
|
Normal preoperative spirometry
|
Balanced perfusion on ventilation/perfusion (V/Q) imaging
|
6. 以下哪项是单肺通气（OLV）期间脱饱和的预测因素？
|
左侧开胸术
|
手术期间的侧卧位
|
术前肺功能检查正常
|
通气/灌注（V/Q）成像的灌注平衡
| null | null | null | null | null | null | null | null | null | null |
94a06bae-210f-5383-ab03-87280f04e989
| 4 |
D
| 2 |
Which patient is most likely to desaturate during OLV?
|
A 68-year-old woman with a history of moderate chronic obstructive pulmonary disease (COPD) with a PaO2 : 481 mm Hg on 100% O2 before OLV
|
A 72-year-old man undergoing thoracotomy for left lower lobe adenocarcinoma
|
A 59-year-old man undergoing video-assisted thoracoscopic (VAT) resection of left upper lobe adenocarcinoma
|
A 61-year-old man with a PaO2 of 187 mm Hg on 100% O2 before OLV
|
哪位患者在单肺通气期间最有可能出现血氧饱和度下降？
|
一名68岁女性，既往有中度慢性阻塞性肺病（COPD）病史，单肺通气前在100%氧气下PaO2为481 mm Hg
|
一名72岁男性，因左下叶腺癌接受开胸手术
|
一名59岁男性，接受左上叶腺癌的胸腔镜辅助下切除术
|
一名61岁男性，单肺通气前在100%氧气下PaO2为187 mm Hg
| null | null | null | null | null | null | null | null | null | null |
210800c0-cadd-502b-884b-424c3a93a866
| 4 |
D
| 2 |
For which of the following surgical procedures is a right-sided double-lumen tube (DLT) most likely indicated?
|
Left lower lobectomy
|
Bilateral lung transplantation
|
Open thoracic aortic aneurysm repair
|
Left sleeve resection with involvement of left mainstem
|
以下哪种手术最有可能需要使用右侧双腔管（DLT）？
|
左下肺叶切除术
|
双侧肺移植
|
开放性胸主动脉瘤修复术
|
涉及左主支气管的左袖状切除术
| null | null | null | null | null | null | null | null | null | null |
df03dfc7-23af-5eb5-86fb-25e9c93e2cca
| 4 |
B
| 3 |
During a routine right thoracotomy for tumor resection with peak airway pressures in the mid 40s cm H2O during OLV, the patient suddenly becomes hypotensive and hypoxic. End-tidal carbon dioxide drops precipitously. Which of the following is the next best step in management?
|
Bronchoscopy
|
Needle decompression of dependent lung
|
Resumption of two-lung ventilation
|
Application of continuous positive airway pressure (CPAP) to operative lung
|
在进行常规右侧开胸手术以切除肿瘤时，单肺通气期间气道峰压达到40多厘米水柱，患者突然出现低血压和低氧血症。呼气末二氧化碳急剧下降。以下哪项是管理的下一步最佳措施？
|
支气管镜检查
|
依赖肺的针刺减压
|
恢复双肺通气
|
对手术肺应用持续气道正压通气（CPAP）
| null | null | null | null | null | null | null | null | null | null |
829b4991-0e59-5917-b0ec-326e26cd62c6
| 4 |
A
| 1 |
Which of the following is an absolute indication for OLV with a DLT as opposed to a bronchial blocker?
|
Need for independent lung ventilation in a patient with severe unilateral rib fractures
|
Wedge resection
|
Pneumonectomy
|
Lobectomy
|
以下哪项是使用双腔气管导管（DLT）进行单肺通气（OLV）而不是支气管阻塞器的绝对指征？
|
需要对严重单侧肋骨骨折的患者进行独立的肺通气
|
楔形切除术
|
全肺切除术
|
肺叶切除术
| null | null | null | null | null | null | null | null | null | null |
96e41ed8-720e-557f-b29f-2b575fb42758
| 4 |
B
| 3 |
During VAT wedge resection for a right lower lobe tumor with a bronchial blocker, the patient develops increased peak airway pressures, hypoxia, and a decreased end-tidal carbon dioxide. The surgeon reports good lung isolation in the field. Which of the following is the appropriate next step?
|
Fiberoptic evaluation of the bronchial blocker
|
Deflation of the bronchial blocker and ventilation of both lungs
|
Needle decompression of dependent lung
|
Application of CPAP to operative lung
|
在使用支气管封堵器进行右下叶肿瘤的胸腔镜楔形切除术期间，患者出现气道峰压升高、低氧血症和呼气末二氧化碳减少。外科医生报告术野中肺隔离良好。以下哪项是适当的下一步措施？
|
纤维支气管镜检查支气管封堵器
|
放气支气管封堵器并通气双肺
|
对依赖肺进行针刺减压
|
对手术肺应用持续气道正压通气
| null | null | null | null | null | null | null | null | null | null |
df67ec43-0358-5211-a5ce-216949df68f8
| 4 |
A
| 3 |
During right middle lobe resection for adenocarcinoma, you notice that your patient appears to be developing a mild acidosis on arterial blood gas. pH is 7.22, lactic acid is mildly elevated, hemoglobin is 10.1, urine output has been 0.5 mL/kg/h for the past 3 hours, and estimated blood loss is 150 mL. Which of the following is the best next step?
|
Start low-dose inotropes.
|
Give a fluid bolus of 10 mL/kg.
|
Transfuse 1 unit of packed red blood cells.
|
Increase minute ventilation to correct the acidosis.
|
在进行右中叶腺癌切除术时，你注意到患者在动脉血气中出现轻度酸中毒。pH值为7.22，乳酸轻度升高，血红蛋白为10.1，尿量在过去3小时内为0.5 mL/kg/h，估计失血量为150 mL。以下哪项是最佳的下一步措施？
|
开始低剂量正性肌力药物。
|
给予10 mL/kg的液体推注。
|
输注1单位的浓缩红细胞。
|
增加分钟通气量以纠正酸中毒。
| null | null | null | null | null | null | null | null | null | null |
765b236b-470c-5e3d-ae7b-a5190f95e9e9
| 4 |
B
| 1 |
13. Which level of oxygen saturation (SpO2 ) is acceptable for a patient undergoing OLV?
|
92%
|
90%
|
80%
|
76%
|
13. 对于正在进行单肺通气（OLV）的患者，哪一水平的血氧饱和度（SpO2）是可以接受的？
|
92%
|
90%
|
80%
|
76%
| null | null | null | null | null | null | null | null | null | null |
52fd4edd-a4d6-5d0f-8982-5b6fc8d29957
| 4 |
D
| 2 |
Which gas mixture is associated with the highest incidence of postthoracotomy atelectasis?
|
98% O2 /2% sevoflurane
|
60% O2 /33% air/7% desflurane
|
50% O2 /49% air/2% isoflurane
|
28% O2 /70% nitrous oxide/2% sevoflurane
|
哪种气体混合物与术后肺不张的发生率最高相关？
|
98% O2 /2% 七氟醚
|
60% O2 /33% 空气/7% 地氟醚
|
50% O2 /49% 空气/2% 异氟醚
|
28% O2 /70% 一氧化二氮/2% 七氟醚
| null | null | null | null | null | null | null | null | null | null |
82b71eec-a413-58eb-bbbf-62951dbb689c
| 4 |
A
| 3 |
A patient who has a history of bleomycin chemotherapy for testicular cancer is undergoing a left VAT surgery for metastasis. The patient begins to desaturate to 88% with stable hemodynamics. Which of the following is the most appropriate next step?
|
Attempt recruitment maneuver of dependent lung.
|
Resume two-lung ventilation.
|
Increase the fraction of inspired oxygen.
|
Increase positive end-expiratory pressure (PEEP) of the dependent lung.
|
一名有睾丸癌博来霉素化疗史的患者正在接受左侧VAT手术以治疗转移。患者开始脱饱和至88%，血流动力学稳定。以下哪项是最合适的下一步措施？
|
尝试对依赖肺进行复张操作。
|
恢复双肺通气。
|
增加吸入氧浓度。
|
增加依赖肺的呼气末正压（PEEP）。
| null | null | null | null | null | null | null | null | null | null |
30b57887-6b73-5b0f-9189-2f5be4eb510e
| 4 |
B
| 2 |
A patient is undergoing surgery for correction of a bronchopleural fistula. A DLT has been placed without difficulty. During the procedure, the patient's oxygen saturation decreases to 85%. Which of the following is the most appropriate next step?
|
Apply CPAP to the operative lung.
|
Increase the fraction of inspired oxygen.
|
Fiberoptic confirmation of DLT placement.
|
Resume two-lung ventilation.
|
一名患者正在接受手术以矫正支气管胸膜瘘。双腔气管导管已顺利置入。在手术过程中，患者的氧饱和度下降到85%。以下哪项是最合适的下一步措施？
|
对手术侧肺应用持续气道正压通气（CPAP）。
|
增加吸入氧浓度。
|
纤维支气管镜确认双腔气管导管的位置。
|
恢复双肺通气。
| null | null | null | null | null | null | null | null | null | null |
6e24a393-a581-5f6b-abb9-89f0804191c3
| 4 |
A
| 2 |
A patient is scheduled to undergo a bilateral thoracoscopic MAZE procedure for chronic atrial fibrillation. The procedure is to be performed in the supine position. Which of the following interventions will reduce the likelihood of desaturation during OLV?
|
Operating on the right side first
|
Use of a total intravenous anesthetic
|
Use of a right-sided DLT
|
Use of a tidal volume of 10 mL/kg to maintain lung inflation
|
一名患者计划接受双侧胸腔镜MAZE手术以治疗慢性心房颤动。手术将在仰卧位进行。以下哪项干预措施可以降低单肺通气期间脱饱和的可能性？
|
先在右侧进行手术
|
使用全静脉麻醉
|
使用右侧双腔管
|
使用10 mL/kg的潮气量以维持肺部充气
| null | null | null | null | null | null | null | null | null | null |
eb9959f2-c09a-5af5-9a66-1aeae3982a04
| 4 |
C
| 2 |
A patient has persistent pain in the posterior and lateral aspects of the shoulder 10 days following thoracotomy. Which of the following positioning errors that can occur during the surgery is the most likely mechanism for this patient's pain?
|
Inadequate padding of the dependent chest wall
|
Lateral flexion of the cervical spine
|
Placement of the axillary roll in the axilla
|
Oversupination of the suspended arm
|
患者在开胸术后10天出现肩部后侧和外侧持续疼痛。以下哪种手术中可能发生的体位错误最有可能是导致该患者疼痛的机制？
|
对依赖侧胸壁的衬垫不足
|
颈椎的侧屈
|
将腋下卷放置在腋窝中
|
悬挂手臂的过度旋前
| null | null | null | null | null | null | null | null | null | null |
5e36b5ff-0da0-528b-9a6b-716965088d98
| 4 |
D
| 3 |
In which of the following patients would the administration of PEEP be expected to improve oxygenation during OLV?
|
A 68-year-old man with severe emphysema on tiotropium undergoing lobectomy
|
A 34-year-old man with α1 antitrypsin deficiency undergoing wedge resection
|
A 51-year-old woman with moderate COPD on pulmonary function tests (PFTs) undergoing pleurectomy for mesothelioma
|
A 42-year-old woman with interstitial lung disease undergoing VAT wedge resection
|
在以下哪位患者中，预计在单肺通气期间给予PEEP会改善氧合？
|
68岁男性，患有严重肺气肿，正在使用噻托溴铵，接受肺叶切除术
|
34岁男性，患有α1抗胰蛋白酶缺乏症，正在接受楔形切除术
|
51岁女性，肺功能测试（PFTs）显示中度慢性阻塞性肺病（COPD），正在接受胸膜切除术以治疗间皮瘤
|
42岁女性，患有间质性肺病，正在接受胸腔镜楔形切除术
| null | null | null | null | null | null | null | null | null | null |
af48a34a-61c6-5b47-8b45-7a35a7404c8d
| 4 |
C
| 2 |
20. A 70-kg, 1.8-m tall man is scheduled for open thoracotomy/sleeve resection for adenocarcinoma of the lung. Preoperative PFTs are within normal limits, and the patient denies any smoking history. A right-sided DLT is placed uneventfully after induction of anesthesia. Which of the following ventilation strategies is most appropriate?
|
Volume control with a tidal volume of 700 mL, respiratory rate of 10, PEEP of 0
|
Volume control with a tidal volume of 800 mL, respiratory rate of 8, PEEP of 5
|
Volume control with a tidal volume of 450 mL, respiratory rate of 14, PEEP of 5
|
Volume control with a tidal volume of 750 mL, respiratory rate of 12, PEEP of 8
|
20. 一名70公斤、1.8米高的男性计划进行肺腺癌的开胸手术/袖状切除术。术前肺功能检查在正常范围内，患者否认有吸烟史。麻醉诱导后顺利放置了右侧双腔管。以下哪种通气策略最为合适？
|
容量控制，潮气量700毫升，呼吸频率10，PEEP为0
|
容量控制，潮气量800毫升，呼吸频率8，PEEP为5
|
容量控制，潮气量450毫升，呼吸频率14，PEEP为5
|
容量控制，潮气量750毫升，呼吸频率12，PEEP为8
| null | null | null | null | null | null | null | null | null | null |
71b5191a-272d-529c-9ea9-66ef050aa02e
| 4 |
C
| 2 |
A 61-year-old man with a history of COPD, 40-pack-year smoking history, and hypertension is undergoing right lower lobe resection for primary lung cancer. While under OLV, he is ventilated with the following settings: assist control/pressure control inspiratory pressure: 20 cm H2O, PEEP: 5 cm H2O, inspiratory time: 0.8 seconds, and inspired oxygen: 70%. During the return to two-lung ventilation, which of the following parameters needs to be monitored very closely for sudden changes?
|
Peak airway pressure
|
Systolic blood pressure variability
|
Tidal volume
|
Heart rate
|
一名61岁男性，有COPD病史，40包年吸烟史和高血压，正在接受右下叶切除术以治疗原发性肺癌。在单肺通气期间，他的通气设置如下：辅助控制/压力控制吸气压：20 cm H2O，PEEP：5 cm H2O，吸气时间：0.8秒，吸入氧气：70%。在恢复双肺通气期间，以下哪个参数需要非常密切地监测以防突然变化？
|
气道峰压
|
收缩压变异性
|
潮气量
|
心率
| null | null | null | null | null | null | null | null | null | null |
b675d482-1f7f-55c5-b339-37357c49c04b
| 4 |
A
| 1 |
A 47-year-old woman who is status post bilateral lung transplant is undergoing laparoscopic cholecystectomy. Which of the following is the benefit of pressure control ventilation in this patient?
|
Reduced risk of lung injury from high airway pressures
|
Better oxygenation
|
Decreased risk of pulmonary edema
|
Decreased risk of rejection
|
一名47岁的女性在双肺移植术后正在接受腹腔镜胆囊切除术。对于该患者，压力控制通气的好处是什么？
|
降低因高气道压力导致肺损伤的风险
|
更好的氧合
|
降低肺水肿的风险
|
降低排斥反应的风险
| null | null | null | null | null | null | null | null | null | null |
689454a4-ccc2-588c-9514-d0f36df9e2bd
| 4 |
A
| 3 |
For which of the following patients might pressure control ventilation be a
|
A 67-year-old man having VAT bullae resection
|
A 38-year-old man having VAT sympathectomy for hyperhidrosis
|
A 71-year-old woman with coronary artery disease having thoracotomy for empyema decortication
|
A 51-year-old woman undergoing thoracotomy for right lower lobe resection for adenocarcinoma
|
以下哪位患者可能适合使用压力控制通气？
|
67岁男性，进行VAT肺大疱切除术
|
38岁男性，进行VAT交感神经切除术以治疗多汗症
|
71岁女性，患有冠状动脉疾病，进行胸廓切开术以清除脓胸
|
51岁女性，进行胸廓切开术以切除腺癌的右下叶
| null | null | null | null | null | null | null | null | null | null |
9eb9e4c4-5dc2-5c2b-a6de-acd525457c4c
| 4 |
C
| 2 |
A 67-year-old woman with normal PFT (ideal body weight of 60 kg) is scheduled to undergo VAT lobectomy for adenocarcinoma. Which of the following ventilator settings is most optimal for lung ventilation in this patient?
|
Tidal volume: 600 mL, PEEP: 0 cm H2O, respiratory rate: 13 breaths per minute, FiO2 : 0.8
|
Tidal volume: 350 mL, PEEP: 0 cm H2O, respiratory rate: 12 breaths per minute, FiO2 : 0.8
|
Tidal volume: 350 mL, PEEP: 5 cm H2O, respiratory rate: 14 breaths per minute, FiO2 : 0.8
|
Tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 11 breaths per minute, FiO2 : 0.8
|
一名67岁的女性，肺功能正常（理想体重为60公斤），计划进行腺癌的胸腔镜辅助肺叶切除术。以下哪种呼吸机设置最适合该患者的肺通气？
|
潮气量：600 mL，PEEP：0 cm H2O，呼吸频率：13次/分钟，FiO2：0.8
|
潮气量：350 mL，PEEP：0 cm H2O，呼吸频率：12次/分钟，FiO2：0.8
|
潮气量：350 mL，PEEP：5 cm H2O，呼吸频率：14次/分钟，FiO2：0.8
|
潮气量：600 mL，PEEP：5 cm H2O，呼吸频率：11次/分钟，FiO2：0.8
| null | null | null | null | null | null | null | null | null | null |
5be785f1-9571-5a46-82e4-9042a01a9817
| 4 |
C
| 2 |
A 28-year-old, 60-kg man with no significant medical history is undergoing VAT pleurodesis for spontaneous pneumothorax. While transitioning to OLV with a DLT, the peak airway pressure is noted to be 41 cm H2O. Current ventilator settings are as follows: tidal volume: 600 mL, PEEP: 5 cm H2O, respiratory rate: 14, FiO2 : 0.8. Bronchoscopy confirms proper tube position. Which of the following is the next most appropriate step?
|
Decrease the PEEP from 5 cm H2O to 0 cm H2O.
|
Increase the fraction of inspired oxygen to 100%.
|
Decrease tidal volume.
|
Increase the respiratory rate.
|
一名28岁、60公斤的男性，无显著病史，正在接受VAT胸膜固定术以治疗自发性气胸。在使用双腔管过渡到单肺通气时，观察到峰值气道压为41 cm H2O。目前的呼吸机设置如下：潮气量：600 mL，PEEP：5 cm H2O，呼吸频率：14，FiO2：0.8。支气管镜检查确认管道位置正确。以下哪一项是下一个最合适的步骤？
|
将PEEP从5 cm H2O减少到0 cm H2O。
|
将吸入氧浓度增加到100%。
|
减少潮气量。
|
增加呼吸频率。
| null | null | null | null | null | null | null | null | null | null |
c3bc7b10-3906-5d03-a49d-a5f3b4399a34
| 4 |
C
| 3 |
26. A 47-year-old woman is undergoing rigid bronchoscopy with jet ventilation. Which of the following most likely represents the best anesthetic choice?
|
Inhaled anesthetic with sevoflurane.
|
Intravenous anesthetic using only propofol.
|
Intravenous anesthetic using propofol and remifentanil.
|
Inhaled anesthetic with desflurane.
|
26. 一名47岁的女性正在接受使用喷射通气的硬质支气管镜检查。以下哪种最有可能代表最佳的麻醉选择？
|
使用七氟醚的吸入麻醉。
|
仅使用丙泊酚的静脉麻醉。
|
使用丙泊酚和瑞芬太尼的静脉麻醉。
|
使用地氟醚的吸入麻醉。
| null | null | null | null | null | null | null | null | null | null |
a533d626-6bab-5809-8e66-ae4365083c53
| 4 |
B
| 2 |
A 26-year-old man with no known medical history is status post an uneventful
|
Administration of an albuterol nebulizer
|
Chest X-ray
|
Electrocardiogram and cardiac enzymes
|
Transthoracic echocardiogram
|
一名26岁无已知病史的男性在术后状态良好
|
给予沙丁胺醇雾化吸入
|
胸部X光检查
|
心电图和心脏酶检查
|
经胸超声心动图
| null | null | null | null | null | null | null | null | null | null |
e799f24e-e1d5-5ffa-9ddd-07026c187501
| 4 |
C
| 1 |
High-frequency jet ventilation provides which of the following benefits when compared with traditional mechanical ventilation?
|
Decreased risk of pneumothorax
|
Faster onset of inhaled anesthetic
|
Decreased diaphragmatic movement
|
Improved postoperative pain scores
|
与传统机械通气相比，高频喷射通气提供了以下哪些好处？
|
降低气胸风险
|
吸入麻醉药物起效更快
|
减少膈肌运动
|
改善术后疼痛评分
| null | null | null | null | null | null | null | null | null | null |
90512188-7dbe-5581-989e-e867ca000a51
| 4 |
B
| 2 |
Which of the following is the most efficient way to reduce the incidence of airway fires?
|
Handheld jet ventilation
|
Lowest inspired oxygen level tolerated by the patient
|
Use of a total intravenous anesthetic
|
Preoperative administration of bronchodilators
|
以下哪种方法最有效减少气道火灾的发生率？
|
手持喷射通气
|
患者可耐受的最低吸入氧浓度
|
使用全静脉麻醉
|
术前给予支气管扩张剂
| null | null | null | null | null | null | null | null | null | null |
99fbdb25-bc1d-5882-9640-84c7f5f9eb71
| 4 |
B
| 1 |
Which of the following is a drawback when utilizing jet ventilation?
|
Inability to monitor oxygenation
|
Difficulty in monitoring adequacy of ventilation
|
Poor surgical access to the airway because of extra equipment
|
Increased risk of airway fires during laser procedures
|
以下哪项是使用喷射通气时的缺点？
|
无法监测氧合
|
难以监测通气的充分性
|
由于额外设备导致手术通道不佳
|
激光手术中增加气道火灾的风险
| null | null | null | null | null | null | null | null | null | null |
076d8674-35b5-5289-b090-58cd32eb0860
| 4 |
A
| 2 |
A patient is scheduled to undergo right upper lobectomy. What is the predicted postoperative forced expired volume in 1 second (FEV1)? Preoperative FEV1 is 80%of predicted.
|
69%
|
64%
|
59%
|
72%
|
一名患者计划进行右上肺叶切除术。术后预计1秒钟用力呼气量（FEV1）是多少？术前FEV1为预测值的80%。
|
69%
|
64%
|
59%
|
72%
| null | null | null | null | null | null | null | null | null | null |
508376b4-20b3-5c66-82e9-e8bf9e57a003
| 4 |
C
| 3 |
During a double-lung transplant a patient has a saturation of 85% during OLV despite aggressive pulmonary toilet, 100% oxygen, and optimal recruitment maneuvers. Transesophageal echocardiography shows worsening right ventricular function, and pulmonary artery catheterization demonstrates
|
CPAP to the operative lung
|
Initiation of inotropes
|
Immediate initiation of cardiopulmonary bypass or extracorporeal membrane oxygenation
|
Diuresis to improve fluid status
|
在双肺移植过程中，尽管进行了积极的肺部清理、100%氧气和最佳复苏措施，患者在单肺通气时的饱和度为85%。经食道超声心动图显示右心室功能恶化，肺动脉导管检查显示
|
对手术肺进行持续气道正压通气（CPAP）
|
开始使用正性肌力药物
|
立即启动体外循环或体外膜氧合（ECMO）
|
通过利尿改善液体状态
| null | null | null | null | null | null | null | null | null | null |
701d502b-b952-5329-a6e6-e27e9b1d68fc
| 4 |
B
| 1 |
33. A patient presents for lobectomy for small cell lung cancer. He has a history of Lambert-Eaton syndrome. Which of the following symptoms would be expected on review of systems?
|
Weakness in the distal muscles that worsens throughout the day
|
Improvement in muscle function with repeated use
|
Urinary incontinence
|
Delayed gastric emptying
|
33. 一名患者因小细胞肺癌接受肺叶切除术。他有Lambert-Eaton综合征病史。在系统回顾中预期会出现以下哪种症状？
|
远端肌肉无力，且随着一天的进展而加重
|
肌肉功能在反复使用后改善
|
尿失禁
|
胃排空延迟
| null | null | null | null | null | null | null | null | null | null |
3dc10eda-eee1-555e-ad34-ccbbac2021d2
| 4 |
A
| 2 |
A patient is undergoing left sleeve lobectomy for adenocarcinoma which is subsequently causing significant narrowing of the left mainstem bronchus. Which of the following lung isolation devices is most appropriate?
|
Right-sided DLT
|
Left-sided DLT
|
EZ-Blocker
|
Arndt bronchial blocker
|
一名患者正在接受左侧袖状肺叶切除术以治疗腺癌，导致左主支气管显著狭窄。以下哪种肺隔离装置最合适？
|
右侧双腔管
|
左侧双腔管
|
EZ-Blocker
|
Arndt支气管阻塞器
| null | null | null | null | null | null | null | null | null | null |
83088845-229f-5088-ab61-bcbedefe1b7c
| 4 |
B
| 2 |
A patient post pneumonectomy is recovering in the surgical intensive care unit (ICU) when she suddenly develops hypotension and cardiovascular collapse. Pulmonary artery catheter demonstrates a pulmonary artery systolic pressure of 20 mm Hg (previously 42 mm Hg) and a CVP of 22 mm Hg (previously 8 mm Hg). Which of the following is the most likely cause of her acute event?
|
Volume overload
|
Right ventricular failure
|
Postpneumonectomy herniation syndrome
|
Mucous plugging
|
一名肺切除术后的患者正在外科重症监护病房（ICU）恢复，突然出现低血压和心血管崩溃。肺动脉导管显示肺动脉收缩压为20 mm Hg（之前为42 mm Hg），中心静脉压为22 mm Hg（之前为8 mm Hg）。以下哪项是她急性事件的最可能原因？
|
容量超负荷
|
右心室衰竭
|
术后肺切除疝综合征
|
粘液堵塞
| null | null | null | null | null | null | null | null | null | null |
fd104f59-7936-567d-8612-884ced590a6f
| 4 |
B
| 2 |
A 19-year-old man with no known medical history presents with a gunshot wound to the right chest. His vital signs are stable and he is brought to the operating room for repair of an open tibia fracture. After intubation and initiation of positive pressure ventilation, his blood pressure acutely drops and he loses his pulse. Which of the following is the next step in management?
|
Transcutaneous pacing
|
Needle thoracostomy
|
Chest X-ray
|
Initiation of dopamine infusion
|
一名19岁无已知病史的男性因右胸枪伤就诊。他的生命体征稳定，被送入手术室修复开放性胫骨骨折。插管和开始正压通气后，他的血压急剧下降并失去脉搏。以下哪项是下一步的处理措施？
|
经皮起搏
|
针刺胸腔减压
|
胸部X光
|
开始多巴胺输注
| null | null | null | null | null | null | null | null | null | null |
86f1d2c1-f18f-5e20-89b0-49ba82bb240f
| 4 |
B
| 2 |
A 68-year-old woman with a history of pulmonary embolism on therapeutic anticoagulation is admitted to the surgical ICU in profound shock. To guide management a pulmonary artery catheter is placed uneventfully. Four hours later you are called urgently to the bedside because the patient has had acutely worsening blood pressure and there is blood noted in the endotracheal tube. Which of the following is the next most appropriate step?
|
Chest tube placement
|
Isolation of the bleeding lung and emergent transport to endovascular therapy
|
Inflation of the pulmonary catheter balloon and advancement to the wedge position
|
Emergent bedside thoracotomy
|
一名68岁的女性，有肺栓塞病史，正在接受治疗性抗凝治疗，因严重休克被送入外科ICU。为了指导治疗，顺利放置了肺动脉导管。四小时后，由于患者血压急剧下降且气管插管中出现血液，您被紧急叫到床边。以下哪一项是下一个最合适的步骤？
|
放置胸管
|
隔离出血的肺并紧急转运至血管内治疗
|
充气肺动脉导管球囊并推进至楔位
|
紧急床边开胸术
| null | null | null | null | null | null | null | null | null | null |
d5bf6566-26d2-5f6b-b8c4-83c66bf5d452
| 4 |
A
| 1 |
A 47-year-old man who is status post left thoracotomy for esophageal rupture is doing well immediately postoperatively. On postoperative day 5 the patient is tolerating a regular diet when he develops progressive shortness of breath. Chest X-ray reveals a large left pleural effusion. A chest tube is placed, which drains white fluid. Which of the following is the most likely cause?
|
Chylothorax
|
Esophageal perforation
|
Empyema
|
Reactive effusion from esophageal rupture
|
一名47岁的男性在因食管破裂接受左侧开胸手术后状态良好。术后第5天，患者在能够耐受正常饮食时出现进行性呼吸困难。胸部X光显示左侧有大量胸腔积液。放置胸管后引流出白色液体。以下哪项是最可能的原因？
|
乳糜胸
|
食管穿孔
|
脓胸
|
食管破裂引起的反应性积液
| null | null | null | null | null | null | null | null | null | null |
e2eac625-0ee1-5420-a73f-6ed10d57d0af
| 4 |
A
| 1 |
39. A patient with a large left upper lobe abscess is scheduled for thoracotomy and drainage. Which of the following is the optimal lung isolation system?
|
Left-sided DLT
|
EZ-Blocker
|
Mainstem intubation with a single-lumen tube
|
Arndt bronchial blocker
|
39. 一名患者患有左上叶大脓肿，计划进行开胸手术和引流。以下哪种是最佳的肺隔离系统？
|
左侧双腔管
|
EZ-Blocker
|
单腔管主支气管插管
|
Arndt 支气管封堵器
| null | null | null | null | null | null | null | null | null | null |
858be2af-32ba-557d-b97d-73cb40e27ea2
| 4 |
C
| 2 |
A patient is 6 days post right pneumonectomy for adenocarcinoma and is doing well on the ward. She develops progressive dyspnea and an increased oxygen requirement. Chest X-ray reveals a decreased fluid level on the right side. Which of the following is the most likely diagnosis?
|
Mediastinal herniation
|
Pneumonia
|
Bronchopleural fistula
|
Mucous plug
|
一名患者在右侧肺腺癌切除术后6天，病情在病房中稳定。她出现进行性呼吸困难和氧气需求增加。胸部X光显示右侧液体水平减少。以下哪项是最可能的诊断？
|
纵隔疝
|
肺炎
|
支气管胸膜瘘
|
粘液栓
| null | null | null | null | null | null | null | null | null | null |
d8e8db3c-d6c0-552f-868d-21d989284650
| 4 |
A
| 2 |
A 34-year-old, 140-kg, 160-cm woman is scheduled to undergo VAT resection of a hamartoma. Which of the following maneuvers is most effective at prolonging the time to desaturation in obese patients?
|
Applying CPAP or PEEP during induction
|
Applying cricoid pressure to reduce the chance of aspiration
|
Using a video laryngoscope
|
Using 50% FiO2 during induction to prevent absorption atelectasis
|
一名34岁，140公斤，160厘米的女性计划进行VAT切除错构瘤。以下哪种操作最能有效延长肥胖患者的脱饱和时间？
|
在诱导期间应用CPAP或PEEP
|
施加环状软骨压力以减少误吸的可能性
|
使用视频喉镜
|
在诱导期间使用50% FiO2以防止吸收性肺不张
| null | null | null | null | null | null | null | null | null | null |
b446e3e9-8edd-503f-a1e1-5c440b2a1615
| 4 |
B
| 2 |
A patient with severe idiopathic pulmonary fibrosis is being evaluated before undergoing elective surgery. Which of the following clinical findings reflects impaired oxygen diffusion?
|
Elevated PCO2 at rest
|
Decreased PO2 with exercise
|
Chronic respiratory acidosis with renal compensation
|
Improved symptoms with inhaled bronchodilators
|
一名患有严重特发性肺纤维化的患者正在接受择期手术前的评估。以下哪项临床发现反映了氧气扩散受损？
|
静息时PCO2升高
|
运动时PO2降低
|
慢性呼吸性酸中毒伴肾脏代偿
|
吸入支气管扩张剂后症状改善
| null | null | null | null | null | null | null | null | null | null |
1427c4e1-ab27-55d6-932a-85c8ce6f8274
| 4 |
C
| 1 |
A 76-year-old woman with a history of COPD presents for preoperative evaluation before shoulder surgery. Which of the following tests is best able to identify CO2 retention?
|
PFTs showing improvement in symptoms with bronchodilators
|
PFTs showing a decreased diffusion capacity
|
Arterial blood gas
|
Exercise tolerance
|
一名76岁的女性，有慢性阻塞性肺病病史，现进行肩部手术前的术前评估。以下哪项检查最能识别二氧化碳潴留？
|
肺功能测试显示使用支气管扩张剂后症状改善
|
肺功能测试显示扩散能力下降
|
动脉血气分析
|
运动耐量
| null | null | null | null | null | null | null | null | null | null |
ce01b312-e119-556b-973d-27d6a4c0f06a
| 4 |
A
| 3 |
A 68-year-old man with a history of severe COPD presents for urgent exploratory laparotomy for small bowel obstruction. A room air arterial blood gas reveals a PaO2 of 51 mm Hg, and brief history reveals noncompliance with prescribed oxygen therapy. On induction of anesthesia, the CVP rises from 14 to 26 mm Hg, and the patient becomes progressively hypotensive. Airway pressures are normal, ECG shows sinus bradycardia, and oxygen saturation is >90%. Which of the following is the most likely mechanism of this patient's hypotension?
|
Right ventricular dysfunction
|
Tension pneumothorax
|
Acute blood loss
|
Severe bronchospasm
|
一名68岁的男性，有严重COPD病史，因小肠梗阻需进行紧急探查性剖腹手术。室内空气动脉血气显示PaO2为51 mm Hg，简短病史显示患者未遵医嘱进行氧疗。在麻醉诱导时，CVP从14升至26 mm Hg，患者逐渐出现低血压。气道压力正常，心电图显示窦性心动过缓，氧饱和度>90%。以下哪种机制最可能导致该患者的低血压？
|
右心室功能障碍
|
张力性气胸
|
急性失血
|
严重支气管痉挛
| null | null | null | null | null | null | null | null | null | null |
85250317-88a1-5e27-b865-712028dd9e68
| 4 |
A
| 2 |
45. A 58-year-old woman with a 20-pack-year smoking history and severe
|
Decreasing the respiratory rate
|
Increasing the PEEP
|
Administering IV fluid bolus
|
Initiating a vasopressin infusion
|
45. 一名58岁的女性，有20包年吸烟史和严重的
|
降低呼吸频率
|
增加PEEP
|
给予静脉输液推注
|
开始使用加压素输注
| null | null | null | null | null | null | null | null | null | null |
6da8650c-82d0-5e4d-8091-2f00cfcefbd2
| 4 |
A
| 1 |
A 36-year-old man with severe scoliosis is scheduled to undergo operative repair. Which of the following best predicts postoperative ventilation need?
|
A vital capacity <40% of normal
|
A decreased DLCO
|
A Cobb angle of 42°
|
A lack of response to bronchodilators on PFT
|
一名36岁的严重脊柱侧弯男性计划进行手术修复。以下哪项最能预测术后通气需求？
|
肺活量小于正常值的40%
|
弥散能力降低
|
Cobb角为42°
|
肺功能测试中对支气管扩张剂无反应
| null | null | null | null | null | null | null | null | null | null |
92bc588a-cd71-513e-a907-b9154db9733a
| 4 |
B
| 2 |
A 48-year-old woman with small cell lung cancer presents for urgent angle incision and drainage after being bitten by a dog. In an abbreviated history, she describes increased fatigue in the mornings that improves as the day progresses. She denies any cardiac or neurologic history. Her preoperative coagulation panel, basic metabolic panel, and liver function panel are all normal. Before progression of her cancer, she had been very active. Her anesthetic is unremarkable with neuromuscular relaxation maintained with rocuronium. Despite appropriate reversal of neuromuscular blockade, she remains weak and requires postoperative mechanical ventilation. Which of the following is the most likely cause?
|
Hypocalcemia
|
Impaired acetylcholine release from nerve terminals
|
Impaired pseudocholinesterase function
|
Antibodies to acetylcholine receptors at the neuromuscular junction
|
一名48岁的女性患有小细胞肺癌，在被狗咬后需要紧急进行切口引流。在简要病史中，她描述了早晨疲劳增加，随着一天的进展而改善。她否认有任何心脏或神经系统病史。她的术前凝血功能检查、基础代谢面板和肝功能面板均正常。在癌症进展之前，她非常活跃。她的麻醉过程无异常，使用罗库溴铵维持神经肌肉松弛。尽管适当逆转了神经肌肉阻滞，她仍然虚弱，需要术后机械通气。以下哪项是最可能的原因？
|
低钙血症
|
神经末梢乙酰胆碱释放受损
|
假性胆碱酯酶功能受损
|
神经肌肉接头处乙酰胆碱受体抗体
| null | null | null | null | null | null | null | null | null | null |
b280df30-cfc7-5961-8e71-67955ab1f79b
| 4 |
A
| 2 |
A 27-year-old woman with a history of mild asthma is undergoing arthroscopic anterior cruciate ligament repair with a laryngeal mask airway. During incision, airway pressures increase significantly and bilateral wheezes are appreciated. Which of the following is the next step in management?
|
Administer bolus propofol to deepen the anesthetic.
|
Administer intravenous nitroglycerin.
|
Increase the concentration of inhaled sevoflurane.
|
Switch the patient to a volume-controlled mode of ventilation.
|
一名27岁的女性，有轻度哮喘病史，正在接受喉罩下的关节镜前交叉韧带修复术。在切口过程中，气道压力显著增加，并出现双侧哮鸣音。以下哪项是下一步的处理措施？
|
给予推注丙泊酚以加深麻醉。
|
给予静脉注射硝酸甘油。
|
增加吸入七氟醚的浓度。
|
将患者切换到容量控制通气模式。
| null | null | null | null | null | null | null | null | null | null |
eb7160fe-6b40-543d-8af0-ea7a26e10bda
| 4 |
B
| 2 |
A 34-year-old woman with a history of chronic bronchiectasis is scheduled for partial lung resection for recurrent pneumonia. Which of the following is an important consideration for patients with chronically infected lung tissue?
|
Preincision coverage with cefazolin
|
Ensuring there is adequate lung isolation before positioning
|
Place a thoracic epidural for pain control
|
Use of high PEEP to recruit bronchiectatic lung
|
一名34岁的女性有慢性支气管扩张病史，计划进行部分肺切除术以治疗复发性肺炎。对于慢性感染肺组织的患者，下列哪项是重要的考虑因素？
|
切口前使用头孢唑林覆盖
|
确保在定位前有足够的肺隔离
|
放置胸椎硬膜外麻醉以控制疼痛
|
使用高PEEP以招募支气管扩张的肺
| null | null | null | null | null | null | null | null | null | null |
e9c9a9bf-1992-5144-ac00-43519247e88e
| 4 |
A
| 1 |
Which of the following is most concerning for vascular compression in a patient with a mediastinal mass?
|
Supine presyncope
|
Size of mass on chest X-ray
|
Tachyarrhythmia
|
Recent weight loss
|
以下哪项最令人担心纵隔肿块患者的血管受压？
|
仰卧时的晕厥前状态
|
胸部X光片上的肿块大小
|
心动过速性心律失常
|
近期体重减轻
| null | null | null | null | null | null | null | null | null | null |
65163e5a-dec9-5240-9ec8-856298521fe0
| 5 |
B
| 1 |
Which of the following features of the infant airway compared with the adult airway is correct?
|
Infants are obligate mouth breathers through the first several months of life.
|
The infant larynx is more cephalad in the neck than the adult larynx.
|
The infant epiglottis is shorter and broader than the adult epiglottis.
|
The narrowest part of the upper airway in the infant is at the level of the vocal cords.
|
以下关于婴儿气道与成人气道的比较，哪一项是正确的？
|
婴儿在生命的最初几个月是强制性用口呼吸的。
|
婴儿的喉部在颈部的位置比成人的更靠头侧。
|
婴儿的会厌比成人的会厌更短更宽。
|
婴儿上气道最狭窄的部分是在声带的水平。
|
The larger occiput of the infant requires extra elevation of the head to achieve an optimal "sniffing" position.
|
婴儿较大的枕骨需要额外抬高头部以达到最佳的“嗅探”位置。
| null | null | null | null | null | null | null | null |
44fc63a7-052c-5247-ad6b-65e3b6c3fbad
| 5 |
A
| 1 |
Which of the following statements is correct concerning airway innervation?
|
The recurrent laryngeal nerve innervates all the intrinsic muscles of the larynx save the cricothyroid, which is innervated by the external branch of the superior laryngeal nerve.
|
To numb sensation to the posterior third of the tongue and oropharynx, local anesthetic can be infiltrated into the base of the palatoglossal arch to block the lingual nerve.
|
An inferior laryngeal nerve block is completed by injecting local anesthetic 1 cm below the greater cornu of the hyoid bone bilaterally.
|
A transtracheal block, achieved by injecting local anesthetic through the cricoid membrane into the trachea, can serve as the sole anesthetic needed for an awake fiberoptic intubation.
|
以下关于气道神经支配的说法哪一项是正确的？
|
喉返神经支配喉部所有内在肌肉，除了由喉上神经外支支配的环甲肌。
|
为了麻醉舌后1/3和口咽的感觉，可以在腭舌弓基部注射局部麻醉剂以阻断舌神经。
|
通过在舌骨大角下1厘米处双侧注射局部麻醉剂来完成下喉神经阻滞。
|
通过环状软骨膜注射局部麻醉剂进入气管的经气管阻滞可以作为清醒纤维支气管镜插管所需的唯一麻醉。
|
Numbing of the oropharynx through topical approaches is rarely effective, and direct injection of local anesthetics is usually required to achieve adequate numbing for an awake fiberoptic intubation.
|
通过局部方法麻醉口咽通常效果不佳，通常需要直接注射局部麻醉剂以达到清醒纤维支气管镜插管所需的充分麻醉。
| null | null | null | null | null | null | null | null |
d7ef5db5-59f9-5939-b547-9df4a5f63498
| 5 |
C
| 2 |
In the postanesthesia care unit (PACU), a patient develops hoarseness following surgical removal of the left lobe of the thyroid (without violation of the right neck), and you suspect a unilateral recurrent laryngeal nerve injury. You consult your ENT colleagues to help evaluate recurrent laryngeal nerve function. Which of the following appearances of the vocal cords would be expected from this proposed mechanism of injury?
|
Immobile bilateral vocal cords, with an adequate glottic opening and no change during vocalization
|
Immobile bilateral vocal cords, with a very small glottic opening
|
Immobile left vocal cord and movement of the right vocal cord across midline during phonation
|
Immobile right vocal cord and movement of the left vocal cord across midline during phonation
|
在麻醉后监护病房（PACU），一名患者在左侧甲状腺叶切除术后出现声音嘶哑（未涉及右侧颈部），你怀疑是单侧喉返神经损伤。你咨询了耳鼻喉科同事以帮助评估喉返神经功能。根据这种损伤机制，声带的哪种表现是可以预期的？
|
双侧声带不动，声门开口足够，发声时无变化
|
双侧声带不动，声门开口非常小
|
左侧声带不动，发声时右侧声带越过中线移动
|
右侧声带不动，发声时左侧声带越过中线移动
|
Bilateral flaccid, partially abducted, immobile vocal cords
|
双侧声带松弛，部分外展，不动
| null | null | null | null | null | null | null | null |
a7f960ed-3de3-509f-b32e-782df605c1a2
| 5 |
E
| 3 |
4. A 26-year-old professional singer is in your operating room (OR) undergoing suspension microlaryngoscopy for vocal cord polyps. Soon after induction and just after the surgeon places the patient into suspension, the heart rate drops from 85 to 30 beats per minute. Which of the following is the best initial course of action?
|
Increase the depth of anesthetic.
|
Administer an opioid.
|
Administer glycopyrrolate.
|
Continue to monitor the heart rate and cycle the blood pressure cuff with the knowledge that these parameters should recover, as the patient becomes accustomed to the positioning.
|
4. 一名26岁的职业歌手在您的手术室（OR）接受声带息肉的悬吊显微喉镜检查。诱导后不久，外科医生将患者置于悬吊状态后，心率从85次/分钟降至30次/分钟。以下哪项是最佳的初步处理措施？
|
加深麻醉深度。
|
给予阿片类药物。
|
给予氨甲酰胆碱。
|
继续监测心率并循环血压袖带，了解这些参数应会恢复，因为患者会逐渐适应这种体位。
|
Direct the surgeon to take the patient out of suspension and before proceeding with additional measures.
|
指示外科医生将患者从悬吊状态中取出，然后再进行其他措施。
| null | null | null | null | null | null | null | null |
6b3c0ae9-a4f0-5b97-9073-479b107d5a4b
| 5 |
E
| 2 |
An ENT surgeon is planning microlaryngoscopy for laser ablation of vocal cord hemangiomas and asks that low-frequency jet ventilation be used so that "the
|
Care must be taken to allow passive exhalation and avoid breath stacking to limit the possibility of barotrauma.
|
Reliable pulse oximetry is essential because jet ventilation relies on the venture effect and entrainment of room air, making the exact FiO2 challenging to measure.
|
Total intravenous anesthesia is required.
|
Pressure monitoring at the distal tip of the jet ventilation catheter is essential.
|
一位耳鼻喉科外科医生计划进行激光消融声带血管瘤的显微喉镜检查，并要求使用低频喷射通气，以便
|
必须小心允许被动呼气并避免呼吸堆积，以限制气压伤的可能性。
|
可靠的脉搏血氧仪是必需的，因为喷射通气依赖于文丘里效应和室内空气的引入，使得确切的FiO2难以测量。
|
需要全静脉麻醉。
|
在喷射通气导管远端的压力监测是必不可少的。
|
The trigger pressure must be preset at a level to allow adequate synchronization between the jet ventilator and the patient's spontaneous breaths.
|
触发压力必须预设在一个水平，以允许喷射通气器与患者自发呼吸之间的充分同步。
| null | null | null | null | null | null | null | null |
28ef53de-b853-5489-aa3c-6bda92fdfc52
| 5 |
A
| 2 |
When considering the anesthetic management for a patient undergoing suspension microlaryngoscopy, which of the following is MOST important?
|
Complete immobility during surgical manipulation of the larynx
|
Light sedation so that the surgeon may observe vocal cord mobility during phonation
|
Permissive hypotension to limit surgical bleeding
|
Generous β-blockade to limit sympathetic discharge with suspension
|
在考虑为接受悬吊显微喉镜检查的患者进行麻醉管理时，以下哪项是最重要的？
|
在喉部手术操作期间完全不动
|
轻度镇静以便外科医生在发声时观察声带活动
|
允许性低血压以减少手术出血
|
大量使用β受体阻滞剂以限制悬吊时的交感神经放电
|
Long-acting opioids are the best agents to manage postoperative pain
|
长效阿片类药物是管理术后疼痛的最佳药物
| null | null | null | null | null | null | null | null |
5ea44ff8-664b-5350-9913-9ca49ceb3d36
| 5 |
D
| 3 |
You are caring for a patient in the intensive care unit (ICU) who remains intubated overnight following oromaxillofacial surgery procedure for irrigation and debridement of a submandibular abscess. The patient has a nasotracheal tube sutured in place and still has significant external facial swelling as well as discharge from the surgically placed drains. The patient has passed a spontaneous breathing trial and has a fully intact neurologic exam. Which of the following evaluations is likely to provide the best information regarding the patient's readiness for extubation?
|
Upright X-ray of the neck
|
CT of the neck
|
Bedside cuff leak test
|
Fiberoptic evaluation around the endotracheal tube (ETT) to visualize the posterior pharynx, larynx, and glottic aperture
|
您正在重症监护室（ICU）照顾一位患者，该患者在进行下颌下脓肿冲洗和清创的口颌面外科手术后，过夜仍需插管。患者的鼻气管插管已缝合固定，仍有明显的面部外部肿胀以及手术放置的引流管有分泌物。患者已通过自发呼吸试验，神经系统检查完全正常。以下哪项评估最有可能提供有关患者拔管准备情况的最佳信息？
|
颈部直立X光片
|
颈部CT
|
床旁袖带漏气测试
|
通过纤维镜在气管插管（ETT）周围进行评估，以观察后咽、喉和声门开口
|
Fiberoptic evaluation through the ETT to visualize the trachea and proximal bronchi
|
通过纤维镜在ETT内进行评估，以观察气管和近端支气管
| null | null | null | null | null | null | null | null |
e4dd83b9-905b-5439-a209-4e4c7ee66d9d
| 5 |
A
| 1 |
A 35-year-old man with no significant medical history, with the exception of morbid obesity, is currently undergoing elective laparoscopic cholecystectomy for biliary cholic. Five minutes after a routine induction and a smooth
|
A. Rocuronium
|
Fentanyl
|
Propofol
|
Midazolam
|
一名35岁的男性，除了病态肥胖外，无其他显著病史，目前正在进行选择性腹腔镜胆囊切除术以治疗胆绞痛。在常规诱导和顺利进行五分钟后
|
A. 罗库溴铵
|
芬太尼
|
丙泊酚
|
咪达唑仑
|
Lidocaine
|
利多卡因
| null | null | null | null | null | null | null | null |
16c44888-a7cf-5198-b917-79016b8525ea
| 5 |
E
| 2 |
A 24-year-old woman with a medical history of exercise-induced asthma and subsequent use of an albuterol inhaler several times a week is currently undergoing urgent laparoscopic appendectomy. Several minutes after induction, you note increased peak inspiratory pressures and observe diffuse bilateral wheezes and a falling blood pressure. Which of the following is the best initial treatment?
|
Spray albuterol into the breathing circuit with inspiration.
|
Administer a corticosteroid such as hydrocortisone.
|
Administer IV epinephrine 1 mg.
|
Administer histamine blockers such as Benadryl and ranitidine.
|
一名24岁的女性，有运动诱发哮喘病史，每周多次使用沙丁胺醇吸入器，目前正在进行紧急腹腔镜阑尾切除术。诱导后几分钟，你注意到吸气峰压增加，观察到弥漫性双侧哮鸣音和血压下降。以下哪项是最佳的初始治疗？
|
在吸气时将沙丁胺醇喷入呼吸回路。
|
给予皮质类固醇，如氢化可的松。
|
静脉注射1毫克肾上腺素。
|
给予组胺阻滞剂，如苯海拉明和雷尼替丁。
|
Administer IV epinephrine in 50-100 µg divided doses.
|
静脉注射50-100微克分次剂量的肾上腺素。
| null | null | null | null | null | null | null | null |
8d39ae9e-271e-50ef-a067-20924723bc1f
| 5 |
D
| 3 |
A patient undergoing a routine elective inguinal hernia repair suffers from a suspected anaphylactic reaction, which is successfully treated with epinephrine, corticosteroids, and histamine blockers. However, at the end of the case, airway pressures remain elevated, there is evidence of swelling of the oral mucosa, and the decision is made to bring the patient into the ICU intubated. Upon admission to the ICU, the patient appears to be euvolemic by examination but remains hypotensive. After an additional dose of epinephrine, corticosteroids, and histamine blockers, which of the following would be the MOST appropriate next step?
|
Proceed to extubation, as anaphylaxis rarely requires more than 2 treatments.
|
Trend tryptase levels until they begin to downtrend, then consider extubation.
|
Transition from crystalloid infusion to albumin, as capillary leak is likely to lead to pulmonary edema, which could delay extubation.
|
Begin a low-dose epinephrine infusion and titrate to blood pressure and bronchospasm.
|
一名正在进行常规择期腹股沟疝修补术的患者出现疑似过敏性反应，成功用肾上腺素、皮质类固醇和组胺阻滞剂治疗。然而，在手术结束时，气道压力仍然升高，口腔黏膜有肿胀的迹象，决定将患者插管送入ICU。在ICU入院时，检查显示患者血容量正常，但仍然低血压。在额外给予一剂肾上腺素、皮质类固醇和组胺阻滞剂后，以下哪项是最合适的下一步措施？
|
进行拔管，因为过敏反应很少需要超过2次治疗。
|
监测胰蛋白酶水平，直到其开始下降，然后考虑拔管。
|
从晶体液输注转为白蛋白，因为毛细血管渗漏可能导致肺水肿，从而延迟拔管。
|
开始低剂量肾上腺素输注，并根据血压和支气管痉挛进行滴定。
|
Begin a low-dose norepinephrine infusion, as the continued symptoms demonstrate that they are refractory to epinephrine therapy.
|
开始低剂量去甲肾上腺素输注，因为持续的症状表明对肾上腺素治疗无效。
| null | null | null | null | null | null | null | null |
35da10bb-c383-504c-94ce-3c97d253de5b
| 5 |
D
| 1 |
Which of the following statements about anaphylaxis is MOST true?
|
Elevated tryptase levels are pathognomonic of anaphylaxis.
|
The level of severity of cutaneous reaction correlates with the severity of shock with anaphylaxis.
|
The most common causes of intraoperative anaphylaxis are opioids and inhalational anesthetics.
|
Patients suffering from an intraoperative anaphylactic reaction should be monitored in an inpatient unit for 24 hours.
|
以下关于过敏性休克的陈述中哪一项最为正确？
|
升高的胰蛋白酶水平是过敏性休克的特征性标志。
|
皮肤反应的严重程度与过敏性休克的休克严重程度相关。
|
术中过敏性休克最常见的原因是阿片类药物和吸入麻醉剂。
|
术中发生过敏性休克反应的患者应在住院病房监测24小时。
|
Prophylaxis against anaphylaxis allows for the repeated safe use of the offending agent.
|
针对过敏性休克的预防措施可以安全地重复使用致病药物。
| null | null | null | null | null | null | null | null |
7dfd35e3-30d4-5a86-9dd2-1cea5511fe0e
| 5 |
A
| 1 |
A 3-year-old child with fever, dysphagia, and drooling is brought to the emergency department (ED) by the caregiver. Lateral neck X-ray films reveal evidence of a "thumbprint" sign. Which of the following disorders is highest on your differential?
|
Epiglottitis
|
Croup
|
Tracheal stenosis
|
Tracheoesophageal fistula
|
一名3岁儿童因发热、吞咽困难和流口水被看护人带到急诊科。侧颈X光片显示“拇指征”迹象。以下哪种疾病在你的鉴别诊断中最有可能？
|
会厌炎
|
哮吼
|
气管狭窄
|
气管食管瘘
|
Tonsillitis
|
扁桃体炎
| null | null | null | null | null | null | null | null |
1a8a7991-76ee-588b-9f36-f8a7871294f0
| 5 |
B
| 1 |
13. Which organism is MOST associated with epiglottitis?
|
Parainfluenza
|
Haemophilus influenza
|
Group A Streptococcus
|
Group B Streptococcus
|
13. 哪种生物与会厌炎最相关？
|
副流感病毒
|
流感嗜血杆菌
|
A组链球菌
|
B组链球菌
|
Candida albicans
|
白色念珠菌
| null | null | null | null | null | null | null | null |
7e34fa18-a0e4-5219-9747-6241072f5cac
| 5 |
E
| 3 |
The 3-year-old patient from question 12, suffering from dysphagia and drooling, is now "tripoding" with increased work of breathing, and the decision is made to proceed to intubation. Which of the following is the safest method of securing the airway?
|
Proceed to an immediate rapid sequence intubation in the ED via direct laryngoscopy.
|
Proceed to an intravenous induction in the semirecumbent position in the ED via video laryngoscopy with fiberoptic backup.
|
Move to an OR for emergent surgical airway.
|
Proceed to an OR for an emergent rapid sequence intubation with surgeons at the bedside for possible rigid bronchoscopy or surgical airway.
|
第12题中的3岁患者，患有吞咽困难和流口水，现在出现“三脚架”姿势并伴有呼吸困难，决定进行插管。以下哪种方法是确保气道安全的最安全方法？
|
在急诊室通过直接喉镜进行立即快速序列插管。
|
在急诊室通过视频喉镜进行半卧位静脉诱导，并备有纤维光学设备。
|
转移到手术室进行紧急外科气道。
|
转移到手术室进行紧急快速序列插管，外科医生在旁以备可能的硬质支气管镜检查或外科气道。
|
Proceed to an OR for an urgent inhalational induction in the seated position followed by laryngoscopy with surgeons at the bedside for possible rigid bronchoscopy or surgical airway.
|
转移到手术室进行紧急吸入诱导，坐姿后进行喉镜检查，外科医生在旁以备可能的硬质支气管镜检查或外科气道。
| null | null | null | null | null | null | null | null |
86cb27bc-5b5a-58b6-afa9-806f3ce01c9d
| 5 |
D
| 3 |
You are called to the ED to evaluate an 18-month-old child suffering from a suspected aspiration. The child's parents describe coughing, choking, and a slight bluish tinge to the lips after a meal, including pieces of corn and carrots, rushing to the hospital. The child is now quietly lying down without any outward signs of respiratory distress but with an O2 saturation of 92%. Which of the following is the MOST appropriate method of caring for this patient?
|
Reassure the parents of the child that because it was only small pieces of vegetable and not a larger piece of meat or other protein, and the child is no longer actively coughing, no intervention is required and should simply be monitored in the ED until the O2 saturation normalizes.
|
Advise that you are booking an OR for emergent bronchoscopic removal of the aspirate and oral midazolam should be administered immediately to ensure that the child remains calm and does not dislodge the aspirated material.
|
Ask that antibiotics and steroids be started in the emergency department to be continued for only a 4-day course because this has been shown to be noninferior to a 7-day course.
|
Take the patient to the OR emergently and complete a gentle inhaled induction to maintain spontaneous ventilation, place a laryngeal mask airway (LMA), and allow a surgeon to pass a flexible fiberoptic bronchoscope through the LMA to remove the aspirated particles.
|
你被叫到急诊科评估一名18个月大的儿童，该儿童疑似吸入异物。孩子的父母描述说，孩子在进食包括玉米和胡萝卜的餐后出现咳嗽、窒息和嘴唇轻微发蓝的情况，并迅速赶往医院。孩子现在安静地躺着，没有明显的呼吸窘迫迹象，但氧饱和度为92%。以下哪种方法是对该患者最合适的护理方法？
|
安抚孩子的父母，因为只是小块蔬菜而不是较大的肉块或其他蛋白质，并且孩子不再主动咳嗽，不需要干预，只需在急诊科监测直到氧饱和度正常化。
|
建议预订手术室进行紧急支气管镜取出吸入物，并立即给予口服咪达唑仑，以确保孩子保持平静，不会使吸入物移位。
|
要求在急诊科开始使用抗生素和类固醇，并仅持续4天的疗程，因为这已被证明不劣于7天的疗程。
|
紧急将患者送至手术室，完成温和的吸入诱导以维持自主呼吸，放置喉罩（LMA），并允许外科医生通过LMA插入柔性纤维支气管镜以去除吸入的颗粒。
|
Take the child to the OR emergently, and after placing a peripheral IV under topical anesthesia with the child on the OR table, proceed with a rapid sequence intubation, securing the airway with an ETT before allowing the surgeon to proceed with flexible or rigid bronchoscopy.
|
紧急将孩子送至手术室，在手术台上用局部麻醉放置外周静脉后，进行快速序列插管，用气管导管（ETT）固定气道，然后允许外科医生进行柔性或刚性支气管镜检查。
| null | null | null | null | null | null | null | null |
243025fb-3e75-5876-8fd2-dcf93d1dae5e
| 5 |
B
| 2 |
You are called emergently to the bedside of a patient in the ICU after his nurse observed an acute desaturation event. You note the patient had a tracheostomy placed 6 days ago for chronic respiratory failure after a prolonged course of acute respiratory distress syndrome. You arrive at the patient's bedside to find an O2 saturation of 88%, the trach collar seated against the skin with the pilot balloon inflated, and the patient moving air very noisily through his mouth. The nurse describes that during a coughing fit his trach "fell out, " but she was able to push it back in. Which of the following would be the most inappropriate next move?
|
Place an oxygen mask over the patient's mouth and nose.
|
Attach an Ambu bag to the trach and support the patient's ventilation.
|
Remove the trach and cover the ostomy site with a bandage.
|
Call for a fiberoptic bronchoscope to interrogate the tracheostomy track.
|
在ICU中，一名患者的护士观察到急性氧饱和度下降事件后，您被紧急叫到床边。您注意到患者在6天前因急性呼吸窘迫综合征的长期病程导致的慢性呼吸衰竭而进行了气管切开术。您到达患者床边时发现氧饱和度为88%，气管套管贴在皮肤上，导管球囊充气，患者通过嘴呼吸时发出很大的噪音。护士描述说，在咳嗽发作期间，气管套管“掉了出来”，但她能够将其推回去。以下哪项是最不合适的下一步措施？
|
在患者的口鼻上放置氧气面罩。
|
将Ambu气囊连接到气管套管上，支持患者的通气。
|
移除气管套管，并用绷带覆盖造口部位。
|
呼叫纤维支气管镜检查气管切开通道。
|
Attach an Ambu bag to a mask, place over the mouth and nose, and support the patient's ventilation.
|
将Ambu气囊连接到面罩上，放在口鼻上，支持患者的通气。
| null | null | null | null | null | null | null | null |
230cdc85-a96f-509e-8204-963dfa814dc5
| 5 |
D
| 1 |
17. According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is the correct definition of a difficult airway?
|
A clinical situation where a physician experiences difficulty with ventilation, intubation, or both.
|
A clinical situation in which a conventionally trained anesthesiologist requires adjuncts for ventilation and/or advanced airway equipment for intubation.
|
A clinical situation in which a conventionally trained anesthesiologist fails to ventilate and/or intubate a patient.
|
A clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both.
|
17. 根据ASA困难气道管理实践指南，以下哪一项是困难气道的正确定义？
|
医生在通气、插管或两者上遇到困难的临床情况。
|
常规训练的麻醉医师在通气时需要辅助设备和/或在插管时需要高级气道设备的临床情况。
|
常规训练的麻醉医师未能对患者进行通气和/或插管的临床情况。
|
常规训练的麻醉医师在面罩通气上呼吸道、气管插管或两者上遇到困难的临床情况。
|
A clinical situation in which a conventionally trained physician experiences difficulty with facemask ventilation, tracheal intubation, or both.
|
常规训练的医生在面罩通气、气管插管或两者上遇到困难的临床情况。
| null | null | null | null | null | null | null | null |
fccfba93-df6a-5011-a741-63bebc0bfedb
| 5 |
B
| 1 |
Which of the following has NOT been independently associated with challenging mask ventilation?
|
Edentulousness
|
Neck circumference >19 cm
|
BMI >36 kg/m2
|
Presence of a beard
|
以下哪项未被独立关联为困难面罩通气的因素？
|
无牙
|
颈围 >19 厘米
|
BMI >36 kg/m2
|
有胡须
|
Snoring/obstructive sleep apnea (OSA) history
|
打鼾/阻塞性睡眠呼吸暂停（OSA）病史
| null | null | null | null | null | null | null | null |
899e5902-a432-5b52-9cff-b01558c8509e
| 5 |
A
| 1 |
According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following components of the preoperative airway physical examination is correctly paired with a nonreassuring finding, as it relates to a potential difficult intubation?
|
Relationship of maxillary and mandibular incisors during voluntary protrusion of the mandible: inability to bring mandibular incisors anterior to maxillary incisors
|
Thyromental distance: four ordinary finger breaths
|
Visibility of uvula: only upper third of uvula visible
|
Range of motion of the head and neck: inability to rotate chin to each shoulder
|
根据ASA困难气道管理实践指南，以下哪项术前气道体检的组成部分与可能的困难插管相关的不良发现正确配对？
|
下颌自愿前突时上下门齿的关系：无法使下门齿前于上门齿
|
甲颏距离：四个普通手指宽度
|
悬雍垂的可见度：仅上三分之一的悬雍垂可见
|
头颈的活动范围：无法将下巴旋转到每个肩膀
|
Interincisor distance: 5 cm
|
门齿间距：5厘米
| null | null | null | null | null | null | null | null |
1b715f7b-3947-5fc5-a434-ec8429d1ab5b
| 5 |
C
| 1 |
According to the Mallampati classification, if you are able to view the fauces,
|
Class 0
|
Class I
|
Class II
|
Class III
|
根据Mallampati分类，如果可以看到咽门，
|
0级
|
I级
|
II级
|
III级
|
Class IV
|
IV级
| null | null | null | null | null | null | null | null |
6f2ec914-392a-56c3-9912-eae0d217d8bc
| 5 |
B
| 1 |
Which of the following is MOST correct regarding the Mallampati classification system?
|
The Mallampati score correlates well with difficulty of mask ventilation.
|
Phonation increases the specificity of the Mallampati test.
|
A Mallampati IV classification has a high positive predictive value of difficult direct laryngoscopy.
|
Ability to visualize lingual tonsils requires a Mallampati IV score.
|
以下关于Mallampati分类系统的描述中，哪一项是最正确的？
|
Mallampati评分与面罩通气困难的相关性良好。
|
发声增加了Mallampati测试的特异性。
|
Mallampati IV级分类对困难直接喉镜检查具有很高的阳性预测值。
|
可视化舌扁桃体需要Mallampati IV评分。
|
Partial view of the glottis or arytenoids defines a Mallampati II score.
|
部分可见声门或杓状软骨定义为Mallampati II评分。
| null | null | null | null | null | null | null | null |
b7a2720c-f56d-5bb9-9b5d-a834415a495c
| 5 |
E
| 1 |
According to the ASA Difficult Airway Algorithm, which of the following is NOT included in the assessment of the likelihood of basic management problems?
|
Difficulty with patient cooperation
|
Difficult mask ventilation
|
Difficult laryngoscopy
|
Difficult intubation
|
根据ASA困难气道算法，以下哪项不包括在基本管理问题可能性的评估中？
|
患者配合困难
|
面罩通气困难
|
喉镜检查困难
|
插管困难
|
Difficult extubation
|
拔管困难
| null | null | null | null | null | null | null | null |
8c937a08-bb1a-5a64-bbc8-cd392878506c
| 5 |
A
| 1 |
23. According to the ASA Difficult Airway Algorithm, which of the following correctly describes the pathway through the "Awake Intubation" Algorithm?
|
The first decision to make is to determine whether invasive airway access or noninvasive intubation will be attempted.
|
If noninvasive intubation fails, then progress to facemask ventilation.
|
If noninvasive intubation fails, then consider waking the patient up and canceling the case.
|
If invasive airway access fails, then consider canceling the case.
|
23. 根据ASA困难气道算法，以下哪项正确描述了“清醒插管”算法的路径？
|
首先要做的决定是确定是尝试侵入性气道通路还是非侵入性插管。
|
如果非侵入性插管失败，则进展到面罩通气。
|
如果非侵入性插管失败，则考虑唤醒患者并取消手术。
|
如果侵入性气道通路失败，则考虑取消手术。
|
If noninvasive intubation is successful, then the patient should be provided with a difficult airway note following the case.
|
如果非侵入性插管成功，则在手术后应为患者提供困难气道说明。
| null | null | null | null | null | null | null | null |
7be41a97-1cc6-5930-b246-d1227e46d068
| 5 |
D
| 1 |
According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following definitions is MOST correct?
|
Failed intubation: inability to place an ETT after a single attempt
|
Difficult laryngoscopy: failure of direct laryngoscopy and required use of videolaryngoscopy or fiberoptic bronchoscopy for successful intubation
|
Difficult supraglottic airway placement: tracheal pathology making a supraglottic airway seal inadequate
|
Difficult tracheal intubation: tracheal intubation requiring multiple attempts, with or without tracheal pathology
|
根据ASA困难气道管理实践指南，以下哪个定义是最正确的？
|
插管失败：在一次尝试后无法放置气管导管
|
困难喉镜检查：直接喉镜检查失败，需要使用视频喉镜或纤维支气管镜进行成功插管
|
困难的声门上气道放置：气管病变导致声门上气道密封不充分
|
困难的气管插管：气管插管需要多次尝试，无论是否存在气管病变
|
Difficult facemask ventilation: use of airway adjuncts, including 2-handed mask and oral/nasal airways to achieve adequate ventilation
|
困难的面罩通气：使用气道辅助工具，包括双手面罩和口/鼻气道以实现充分通气
| null | null | null | null | null | null | null | null |
4c31a850-8d20-57d7-8303-9afe490f0c80
| 5 |
E
| 1 |
According to the ASA Difficult Airway Algorithm for intubation after induction of general anesthesia, if initial intubation is unsuccessful and facemask ventilation is not adequate, then which of the following would be the best next step?
|
Awaken the patient.
|
Proceed to emergency invasive airway access.
|
Proceed video-assisted or fiberoptic intubation.
|
Cancel the case.
|
根据ASA困难气道插管算法，在全身麻醉诱导后，如果初次插管不成功且面罩通气不充分，那么以下哪一项是最佳的下一步措施？
|
唤醒患者。
|
进行紧急侵入性气道通路。
|
进行视频辅助或纤维光学插管。
|
取消手术。
|
Attempt supraglottic airway placement.
|
尝试放置声门上气道。
| null | null | null | null | null | null | null | null |
c8ecbe29-17f8-5696-b89a-650c0189d578
| 5 |
D
| 1 |
According to the ASA Difficult Airway Algorithm, which of the following is NOT considered a noninvasive alternative in the difficult intubation approach?
|
Light wand
|
Intubating LMA
|
Video-assisted laryngoscopy
|
Percutaneous jet ventilation
|
根据ASA困难气道算法，以下哪项不被视为困难插管方法中的非侵入性替代方案？
|
光棒
|
插管LMA
|
视频辅助喉镜检查
|
经皮喷射通气
|
Blind nasal intubation
|
盲插鼻插管
| null | null | null | null | null | null | null | null |
81c93dc6-028b-5421-b844-99807bb64ce0
| 5 |
A
| 1 |
According to the ASA Practice Guidelines for Management of the Difficult Airway, which of the following is NOT a recommended preformulated strategy for extubation of the difficult airway?
|
Long-term intubation until the perioperative period is completed
|
Short-term use of an airway exchange catheter
|
Consideration of fully awake extubation
|
Preparation for postextubation noninvasive ventilation or high-flow oxygen
|
根据ASA困难气道管理指南，以下哪项不是困难气道拔管的推荐预先制定策略？
|
长期插管直到围手术期结束
|
短期使用气道交换导管
|
考虑完全清醒拔管
|
准备拔管后无创通气或高流量氧气
|
Extubation to an LMA
|
拔管至喉罩
| null | null | null | null | null | null | null | null |
9ef53567-7fb5-5857-a601-20c710bcb1ef
| 5 |
C
| 1 |
Which of the following symptoms is a major indication for tonsillectomy?
|
Initial presentation with tonsillitis
|
Children with valvular cardiac disease at first presentation with tonsillitis
|
Severe OSA
|
Recurrent step pharyngitis
|
以下哪种症状是扁桃体切除术的主要指征？
|
首次出现扁桃体炎
|
首次出现扁桃体炎的心脏瓣膜病儿童
|
严重的阻塞性睡眠呼吸暂停
|
反复链球菌性咽炎
|
Presence of tonsillar stones
|
存在扁桃体结石
| null | null | null | null | null | null | null | null |
290d59c3-0e85-590c-8da7-cf4965ec078d
| 5 |
C
| 1 |
29. According to the ASA Practice Guidelines for the Perioperative Management of Patients with OSA, which of the following is recommended for children undergoing tonsillectomy for OSA?
|
Codeine is superior to nonsteroidal anti-inflammatory drugs for postoperative pain relief.
|
Sleep studies should be obtained on all children undergoing elective tonsillectomy and/or adenoidectomy.
|
For children undergoing tonsillectomy for OSA, the task force advises that opioid dosing should be decreased because repeated hypoxemia increases the sensitivity of µ-opioid receptors.
|
All children undergoing tonsillectomy and/or adenoidectomy for OSA should be watched in a monitored setting for at least 24 hours following surgery.
|
29. 根据ASA关于OSA患者围手术期管理的实践指南，以下哪项是对接受扁桃体切除术的OSA儿童的推荐？
|
可待因在术后疼痛缓解方面优于非甾体抗炎药。
|
所有接受选择性扁桃体切除术和/或腺样体切除术的儿童都应进行睡眠研究。
|
对于接受扁桃体切除术的OSA儿童，工作组建议减少阿片类药物的剂量，因为反复的低氧血症会增加µ-阿片受体的敏感性。
|
所有接受扁桃体切除术和/或腺样体切除术的OSA儿童在术后至少24小时内应在监护环境中观察。
|
The ASA Practice Guidelines require the use of noninvasive CPAP in the immediate postoperative setting for all children undergoing tonsillectomy and/or adenoidectomy for OSA.
|
ASA实践指南要求在术后立即为所有接受扁桃体切除术和/或腺样体切除术的OSA儿童使用无创CPAP。
| null | null | null | null | null | null | null | null |
cf1c71d1-569f-5981-be53-96727961da85
| 5 |
B
| 1 |
Recent studies have shown that a single intraoperative dose of dexamethasone is associated with all the following EXCEPT which one?
|
Decreased postoperative pain
|
Decreased postoperative bleeding
|
Decreased time to first oral intake
|
Decreased postoperative nausea and vomiting in the immediate postoperative period
|
最近的研究表明，单次术中使用地塞米松与以下所有情况有关，除了哪一项？
|
减少术后疼痛
|
减少术后出血
|
缩短首次口服摄入时间
|
减少术后即刻的恶心和呕吐
|
Decreased postoperative nausea and vomiting in the first 24 hours
|
减少术后24小时内的恶心和呕吐
| null | null | null | null | null | null | null | null |
06363e4b-70ef-525c-909e-54ef9ac21ade
| 5 |
C
| 1 |
Which of the following is MOST correct regarding posttonsillectomy hemorrhage?
|
Primary hemorrhage occurs during the tonsillectomy surgery itself, whereas secondary hemorrhage occurs within the first 24 hours.
|
Posttonsillectomy hemorrhage is a common occurrence and should be treated with maintenance of NPO status and "watchful waiting."
|
Nearly half of patients suffering from posttonsillectomy hemorrhage have an undiagnosed coagulation disorder.
|
Posttonsillectomy hemorrhage usually presents as brisk bleeding.
|
以下关于扁桃体切除术后出血的说法中，哪一项是最正确的？
|
原发性出血发生在扁桃体切除手术过程中，而继发性出血发生在术后24小时内。
|
扁桃体切除术后出血是常见现象，应通过保持禁食状态和“观察等待”来处理。
|
几乎一半的扁桃体切除术后出血患者有未诊断的凝血障碍。
|
扁桃体切除术后出血通常表现为急性出血。
|
Because of the friable nature of the tonsillar tissue, take-back surgeries for bleeding should be completed under moderate sedation.
|
由于扁桃体组织易碎，止血的再次手术应在中度镇静下完成。
| null | null | null | null | null | null | null | null |
59c558b3-4afa-5210-9553-68c10b63947f
| 5 |
B
| 2 |
A 5-year-old child presents to the ED 12 hours posttonsillectomy with bleeding
|
Proceed directly to the OR, induce via inhalation, secure IV access, and intubate.
|
IV access should be secured in the ED with fluid resuscitation before proceeding to the OR.
|
Proceed directly to the OR, secure IV access, and proceed with the least sedation necessary to allow for hemostasis through electrocautery.
|
Consult interventional radiology for embolization of the external carotid artery on the side of bleeding.
|
一名5岁儿童在扁桃体切除术后12小时出现出血，来到急诊科
|
直接进入手术室，通过吸入麻醉诱导，建立静脉通路并插管。
|
在急诊科建立静脉通路并进行液体复苏，然后再进入手术室。
|
直接进入手术室，建立静脉通路，并在尽可能少的镇静下通过电灼止血。
|
咨询介入放射科，进行出血侧颈外动脉的栓塞。
|
Manage the patient medically with volume resuscitation and reversal of coagulopathy.
|
通过容量复苏和逆转凝血功能障碍进行医学管理。
| null | null | null | null | null | null | null | null |
8991513d-7d0f-5bef-aac5-a030472b5b13
| 5 |
C
| 1 |
Which of the following blocks is correctly matched with the anatomic location of injection of local anesthetic?
|
Retrobulbar block: extraconal block outside the muscle cone formed by 4 recti muscles
|
Peribulbar block: intraconal block in the middle of the muscle cone
|
Median orbital block: in the space between the medial rectus muscle and the medial orbital wall
|
Superior orbital block: medial to the supraorbital notch and advanced intraconal
|
以下哪种阻滞与局部麻醉药注射的解剖位置匹配正确？
|
球后阻滞：肌锥外由4条直肌形成的锥外阻滞
|
球周阻滞：肌锥中部的锥内阻滞
|
中位眼眶阻滞：在内直肌和内侧眼眶壁之间的空间
|
上眼眶阻滞：在眶上切迹内侧并向锥内推进
|
Subtenon block: in the space between the conjunctiva and subtenon capsule
|
筋膜下阻滞：在结膜和筋膜下囊之间的空间
| null | null | null | null | null | null | null | null |
212e824b-95fe-538f-b966-e48ff25ac209
| 5 |
A
| 1 |
34. Which of the following correctly describes the pathway involved with the oculocardiac reflex?
|
Cranial nerve V → medulla → cranial nerve X
|
Cranial nerve V → medulla → cardiac accelerator fibers
|
Cranial nerve VII → midbrain → cervical parasympathetics
|
Cranial nerve VII → medulla → cranial nerve V
|
34. 以下哪项正确描述了眼心反射所涉及的通路？
|
颅神经 V → 延髓 → 颅神经 X
|
颅神经 V → 延髓 → 心脏加速纤维
|
颅神经 VII → 中脑 → 颈部副交感神经
|
颅神经 VII → 延髓 → 颅神经 V
|
Cranial nerve V → pons → cervical parasympathetics
|
颅神经 V → 脑桥 → 颈部副交感神经
| null | null | null | null | null | null | null | null |
824e86b3-d6a0-568f-8130-a6bb8af95799
| 5 |
D
| 1 |
Which of the following complications of ophthalmic regional anesthesia is correctly paired?
|
Optic nerve sheath injection: retinal detachment/loss of vision
|
Intra-arterial injection: loss of vision
|
Globe penetration/injection: epidural injection
|
Extraocular muscle injury: diplopia
|
以下哪种眼科区域麻醉的并发症配对正确？
|
视神经鞘注射：视网膜脱离/视力丧失
|
动脉内注射：视力丧失
|
眼球穿透/注射：硬膜外注射
|
眼外肌损伤：复视
|
Trauma to the optic nerve: local anesthetic toxicity, seizure activity
|
视神经损伤：局部麻醉药毒性，癫痫活动
| null | null | null | null | null | null | null | null |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.