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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
19069c99-826c-5805-a54f-c59b69b717b4
| 4 |
D
| 1 |
A 56-year-old man with a history of end-stage liver disease (ESLD) presents for liver transplant evaluation. His ESLD has been complicated by esophageal varices, recurrent gastrointestinal (GI) bleeds, and hepatorenal syndrome, and the MELD (Model for End-Stage Liver Disease) score is calculated to be 32 with a Child-Pugh score of 13. Which of the following is NOT included as a component when calculating the MELD score?
|
Total bilirubin
|
International normalized ratio (INR)
|
Serum creatinine
|
Partial thromboplastin time
|
一名56岁的男性有终末期肝病（ESLD）病史，前来进行肝移植评估。他的ESLD并发有食管静脉曲张、反复的胃肠道（GI）出血和肝肾综合征，MELD（终末期肝病模型）评分计算为32，Child-Pugh评分为13。以下哪一项不包括在计算MELD评分的成分中？
|
总胆红素
|
国际标准化比值（INR）
|
血清肌酐
|
部分凝血活酶时间
| null | null | null | null | null | null | null | null | null | null |
4a1f2432-c6c7-5953-9c66-9e6905428462
| 4 |
C
| 2 |
A 62-year-old woman with ESLD due to alcoholic cirrhosis is undergoing an orthotopic liver transplant. Her medical history is significant for paroxysmal atrial fibrillation, coronary artery disease, hypertension, and chronic kidney failure. The patient starts having frequent premature ventricular contractions, which progress into a sustained ventricular tachycardia causing hemodynamic instability after the surgeon releases the inferior vena cava (IVC) clamp. Of the following choices listed below, which would NOT be considered an appropriate choice for immediate therapy?
|
Sodium bicarbonate infusion
|
Low-dose epinephrine bolus
|
Immediate synchronized cardioversion
|
Calcium chloride injection
|
一名62岁的女性因酒精性肝硬化导致的终末期肝病正在接受原位肝移植。她的病史包括阵发性房颤、冠状动脉疾病、高血压和慢性肾功能衰竭。在外科医生释放下腔静脉（IVC）夹钳后，患者开始出现频繁的室性早搏，并进展为持续性室性心动过速，导致血流动力学不稳定。在以下列出的选项中，哪一项不被认为是立即治疗的合适选择？
|
碳酸氢钠输注
|
低剂量肾上腺素推注
|
立即同步电复律
|
氯化钙注射
| null | null | null | null | null | null | null | null | null | null |
c97cbf00-7e16-556a-ba85-db6bd28975c5
| 4 |
D
| 2 |
23. A 59-year-old man with ESLD complicated by portopulmonary hypertension (PPH), hepatorenal syndrome, and hepatic encephalopathy presents for an orthotopic liver transplant. Intraoperatively, the patient becomes progressively hypoxic despite adjustments to the ventilator. Of the following choices listed below, which would NOT be considered an appropriate INITIAL choice for therapeutic intervention to improve the patient's oxygenation status?
|
Start milrinone.
|
Start dobutamine.
|
Start inhaled nitric oxide (iNO).
|
Start dopamine.
|
23. 一名59岁的男性患者患有终末期肝病（ESLD），并发有门肺高压（PPH）、肝肾综合征和肝性脑病，现准备进行原位肝移植。在手术过程中，尽管对呼吸机进行了调整，患者仍逐渐出现低氧血症。在以下选项中，哪一项不被视为改善患者氧合状态的适当初始治疗干预选择？
|
开始使用米力农。
|
开始使用多巴酚丁胺。
|
开始使用吸入一氧化氮（iNO）。
|
开始使用多巴胺。
| null | null | null | null | null | null | null | null | null | null |
3f7118ed-d6ea-595c-812f-57597f3a804e
| 4 |
A
| 2 |
A 48-year-old woman with end-stage renal disease secondary to severe hypertension presents for a renal transplant. Intraoperatively, you notice that the patient's urine output has dropped to less than 0.5 mL/h after the allograft kidney has been transplanted. The surgeon is requesting that you intervene to
|
Dopamine
|
Mannitol
|
Albumin
|
Norepinephrine
|
一名48岁的女性因严重高血压导致的终末期肾病，前来进行肾移植手术。在手术过程中，你注意到患者在移植异体肾后尿量下降到每小时少于0.5毫升。外科医生要求你进行干预以
|
多巴胺
|
甘露醇
|
白蛋白
|
去甲肾上腺素
| null | null | null | null | null | null | null | null | null | null |
7138a83d-e8cf-5fe4-9a57-8fe961ece74e
| 4 |
C
| 1 |
A 72 year old man with a history of ESLD due to hepatitis C received an orthotopic liver transplant 2 months ago and is now presenting for a ventral hernia repair. Which of the following laboratory values is the best marker in assessing the patient's liver synthetic function posttransplant?
|
Bilirubin
|
AST/ALT (aspartate aminotransferase/alanine aminotransferase)
|
International normalized ratio
|
Albumin
|
一名72岁男性因丙型肝炎导致终末期肝病，2个月前接受了原位肝移植，现在前来进行腹壁疝修补术。以下哪项实验室指标是评估患者移植后肝脏合成功能的最佳标志？
|
胆红素
|
AST/ALT（天冬氨酸氨基转移酶/丙氨酸氨基转移酶）
|
国际标准化比值
|
白蛋白
| null | null | null | null | null | null | null | null | null | null |
5c779e95-f79c-564c-8fb6-cc0a77cb3a3f
| 4 |
B
| 2 |
A 71-year-old woman with a history of rheumatoid arthritis is scheduled for a left total knee arthroplasty. She has been taking prednisone 5 mg PO daily for the last 2 weeks to control her rheumatoid arthritis. Which of the following is the most appropriate perioperative steroid plan given her chronic steroid regimen?
|
Recommend to the patient that she stop taking prednisone before the operation given the risk of intraoperative hyperglycemia.
|
Recommend that she continues taking her home dose of prednisone up until the operation.
|
Recommend that she doubles her dose of steroid on the morning of the operation.
|
Recommend that she continue taking her home dose of prednisone up until the operation and give her an additional dose of hydrocortisone during the operation.
|
一名71岁的女性有类风湿性关节炎病史，计划进行左侧全膝关节置换术。她在过去两周每天口服5毫克泼尼松来控制类风湿性关节炎。考虑到她的慢性类固醇方案，以下哪项是最合适的围手术期类固醇计划？
|
建议患者在手术前停止服用泼尼松，因为存在术中高血糖的风险。
|
建议她在手术前继续服用家中的泼尼松剂量。
|
建议她在手术当天早晨将类固醇剂量加倍。
|
建议她在手术前继续服用家中的泼尼松剂量，并在手术期间给予额外剂量的氢化可的松。
| null | null | null | null | null | null | null | null | null | null |
e8e04034-569f-55a8-89d5-d048d696cdb1
| 4 |
D
| 3 |
A 64-year-old woman with a 70-pack-year smoking history and hypertension was recently admitted to the hospital with a severe COPD exacerbation and is currently receiving 40 mg of prednisone daily. On hospital day 3 she begins to complain of abdominal pain and spikes a fever. Imaging demonstrates evidence of appendicitis, and she is scheduled for an urgent appendectomy. Throughout the procedure, you note that she is becoming gradually more hypotensive. You place a radial arterial catheter, and she is consistently in the 80s-90s/40s-50s. You decide to do which of the following?
|
Start peripheral phenylephrine, place an nasogastric tube (NGT), and administer40 mg prednisone.
|
Place a central venous catheter, and start norepinephrine.
|
Administer 100 mg hydrocortisone IV (intravenously) in addition to placing an NGT and administering 40 mg prednisone.
|
Administer 100 mg hydrocortisone IV, and start peripheral phenylephrine.
|
一名64岁的女性，有70包年吸烟史和高血压，最近因严重的COPD加重住院，目前每天接受40毫克的泼尼松治疗。在住院第3天，她开始抱怨腹痛并发烧。影像学检查显示阑尾炎的证据，并计划进行紧急阑尾切除术。在手术过程中，你注意到她逐渐变得更加低血压。你放置了桡动脉导管，她的血压持续在80-90/40-50。你决定采取以下哪种措施？
|
开始使用外周去氧肾上腺素，放置鼻胃管（NGT），并给予40毫克泼尼松。
|
放置中心静脉导管，并开始使用去甲肾上腺素。
|
静脉注射100毫克氢化可的松，此外放置NGT并给予40毫克泼尼松。
|
静脉注射100毫克氢化可的松，并开始使用外周去氧肾上腺素。
| null | null | null | null | null | null | null | null | null | null |
db43f1b1-5fdb-5362-94b1-b8edf8910647
| 4 |
A
| 2 |
28. A 46-year-old man, with a history of IV drug use on chronic methadone therapy and hepatitis C, is 1 year post orthotopic liver transplant and is now scheduled for a ventral hernia repair. In an attempt to address his anticipated postoperative pain with nonopioid analgesia, you plan to give him IV ketorolac. Which of the following immunosuppressive agents, in combination with ketorolac, increases the risk for potential postoperative renal dysfunction?
|
Tacrolimus
|
Mycophenolate Mofetil
|
Azathioprine
|
Prednisone
|
28. 一名46岁的男性，有静脉药物使用史，正在接受慢性美沙酮治疗和丙型肝炎治疗，1年前接受了原位肝移植，现在计划进行腹壁疝修补术。为了用非阿片类镇痛药解决他预期的术后疼痛，你计划给他静脉注射酮咯酸。以下哪种免疫抑制剂与酮咯酸联合使用会增加术后肾功能障碍的风险？
|
他克莫司
|
吗替麦考酚酯
|
硫唑嘌呤
|
泼尼松
| null | null | null | null | null | null | null | null | null | null |
9cac743b-8bc8-5fbf-93ac-565377730f8d
| 4 |
A
| 2 |
A 55-year-old woman with a history of a kidney transplant has newly diagnosed lung cancer and presents for a right-sided thoracotomy. You plan to place a preoperative epidural. Which of the following immunosuppressive agents would raise concern for a possible increased risk of epidural hematoma?
|
Azathioprine
|
Cyclosporine
|
Tacrolimus
|
Prednisone
|
一名55岁的女性有肾移植史，最近被诊断出患有肺癌，并准备进行右侧开胸手术。您计划在术前放置硬膜外导管。以下哪种免疫抑制剂可能会增加硬膜外血肿的风险？
|
硫唑嘌呤
|
环孢素
|
他克莫司
|
泼尼松
| null | null | null | null | null | null | null | null | null | null |
fe1186ad-e97e-58f6-8170-4c3a354ac641
| 4 |
D
| 1 |
Antithymocyte globulin (ATG) is given for acute rejection prevention during a kidney transplant. What is ATG's mechanism of action?
|
Reduction in the demargination of neutrophils
|
Depletion of B cells
|
Inhibition of IL-1 receptors on B cells and T cells
|
Depletion of T cells
|
抗胸腺细胞球蛋白（ATG）用于预防肾移植期间的急性排斥反应。ATG的作用机制是什么？
|
减少中性粒细胞的边缘化
|
消耗B细胞
|
抑制B细胞和T细胞上的IL-1受体
|
消耗T细胞
| null | null | null | null | null | null | null | null | null | null |
19dd6b84-f8f6-58f8-85c4-bacd481112de
| 4 |
C
| 1 |
Compared with pulsatile left ventricular assist devices (LVADs), continuousflow LVAD therapy confers which of the following?
|
Comparable risk of device-related infections
|
A worse neurologic outcome
|
Increased risk of GI bleeding
|
Increased levels of circulating von Willebrand factor
|
与搏动式左心室辅助装置（LVAD）相比，连续流LVAD治疗具有以下哪种情况？
|
设备相关感染的风险相当
|
更差的神经系统结果
|
增加胃肠道出血的风险
|
循环中的von Willebrand因子水平增加
| null | null | null | null | null | null | null | null | null | null |
84d5dd0f-814d-5239-809f-b442803da65d
| 4 |
B
| 1 |
Regarding perioperative considerations for lung transplantation (LTx), which of the following statements are true?
|
Compared with donation-after-brain-death LTx, donation-after-circulatory-death (DCD) LTx results in decreased graft survival.
|
Perioperative hyperglycemia is associated with increased mortality in patients undergoing LTx.
|
Use of lung protective ventilation strategies in organ donors with brain death has not increased the number of available donor lungs.
|
Lung transplant using cardiopulmonary bypass (CPB) provides better long-term outcomes compared with off-pump LTx.
|
关于肺移植（LTx）的围手术期考虑，下列哪项陈述是正确的？
|
与脑死亡后捐献的肺移植相比，循环死亡后捐献（DCD）的肺移植导致移植物存活率降低。
|
围手术期高血糖与接受肺移植患者的死亡率增加有关。
|
在脑死亡器官捐献者中使用肺保护性通气策略并未增加可用捐献肺的数量。
|
使用体外循环（CPB）进行的肺移植与非体外循环肺移植相比，提供了更好的长期结果。
| null | null | null | null | null | null | null | null | null | null |
18fb7b21-a4ee-5eeb-9888-3d2d3602c42d
| 4 |
A
| 1 |
33. A 59-year-old man with a history of mild hypertension, hyperlipidemia, and B-cell lymphoma with doxorubicin-induced cardiomyopathy requiring orthotopic heart transplantation 5 years ago is brought in by EMS to the ED. His posttransplant course was complicated by postoperative renal failure with permanent need for dialysis. He presents now in shock. He does not follow a renal diet but has undergone a routine hemodialysis 2 days ago. "He only takes tacrolimus and mycophenolate mofetil" at home per EMS report. His vitals are HR 115, BP 74/41, RR 35, and O2 Sat 85% on 10 L FM. The patient's ECG shows ST elevations in multiple leads, his troponin I is 0.4, and serum lactate is 6. Before he can be brought to a heart catheterization laboratory, the patient passes away. Which of the following medications/intervention most likely would have helped prevent this situation?
|
Pravastatin
|
Aspirin
|
Diltiazem
|
Prophylactic coronary angioplasty with left main coronary artery stent deployment
|
33. 一名59岁男性，有轻度高血压、高脂血症和B细胞淋巴瘤病史，因阿霉素引起的心肌病需要在5年前进行原位心脏移植。EMS将他送到急诊室。他的移植后过程因术后肾衰竭而复杂化，需永久性透析。他现在表现为休克。他不遵循肾脏饮食，但在2天前进行了常规血液透析。根据EMS报告，他在家中只服用他克莫司和吗替麦考酚酯。他的生命体征为心率115，血压74/41，呼吸频率35，氧饱和度在10升面罩下为85%。患者的心电图显示多导联ST段抬高，肌钙蛋白I为0.4，血清乳酸为6。在他被送到心导管实验室之前，患者去世。以下哪种药物/干预最有可能帮助预防这种情况？
|
普伐他汀
|
阿司匹林
|
地尔硫卓
|
预防性冠状动脉成形术并植入左主冠状动脉支架
| null | null | null | null | null | null | null | null | null | null |
7b1c3fc4-6b75-5419-b804-b3857196662b
| 4 |
A
| 1 |
Which of the statements regarding thyroid function and its impacts on cardiovascular pathophysiology is most likely true?
|
Pulmonary hypertension is linked to hyper- and hypothyroidism.
|
Hypothyroidism is associated with a slower progression of heart failure patients.
|
Triiodothyronine (T3)/thyroxin (T4) therapy to the donor increases availability of thoracic donor organs but causes increased graft rejection after transplantation.
|
T3 levels do not correlate with the presence of coronary artery disease.
|
关于甲状腺功能及其对心血管病理生理影响的陈述中，哪一项最有可能是真的？
|
肺动脉高压与甲亢和甲减有关。
|
甲减与心力衰竭患者的病情进展较慢有关。
|
给予供体三碘甲腺原氨酸（T3）/甲状腺素（T4）治疗增加了胸部供体器官的可用性，但在移植后导致移植物排斥增加。
|
T3水平与冠状动脉疾病的存在无关。
| null | null | null | null | null | null | null | null | null | null |
ce572bfd-2619-53eb-a047-18436efe452f
| 4 |
C
| 1 |
Patients with end-stage heart failure pending heart transplantation may require
|
Intra-aortic balloon pump (IABP) counterpulsation raises the effective cardiac output more than percutaneously inserted axial flow pumps (eg, Impella).
|
Percutaneously inserted axial flow pumps (eg, Impella) generally do not require anticoagulation while inserted.
|
Extracorporeal membrane oxygenation (ECMO) decreases left ventricular (LV) afterload less than IABP.
|
It is recommended to continue supportive catecholamine infusions with indwelling percutaneously inserted axial flow pumps to enhance cardiac output.
|
等待心脏移植的终末期心力衰竭患者可能需要
|
主动脉内球囊反搏（IABP）比经皮插入的轴流泵（如Impella）更能提高有效心输出量。
|
经皮插入的轴流泵（如Impella）在插入期间通常不需要抗凝。
|
体外膜氧合（ECMO）减少左心室（LV）后负荷的效果不如IABP。
|
建议在留置的经皮插入轴流泵的情况下继续支持性儿茶酚胺输注以增强心输出量。
| null | null | null | null | null | null | null | null | null | null |
58c46797-2e3f-5d10-abb9-5d5afd6ed050
| 4 |
C
| 3 |
You are taking care of an otherwise healthy 35-year-old man undergoing repair of his left anterior cruciate ligament. Shortly after induction, his heart rate increased from 70 to 110 beats per minute and his blood pressure drops to 60/40 mm Hg. You also notice an increase in his peak inspiratory pressure. Which of the following is your next step?
|
Administer a 500-cc bolus of crystalloid, and turn down the concentration of volatile anesthetic.
|
Start a phenylephrine infusion to target an MAP greater than 60 mm Hg.
|
Call for help, give epinephrine 10-100 µg IV, and repeat or escalate dose every 1-2 minutes and titrate to effect.
|
Call for help, and give epinephrine 1 mg IV.
|
您正在照顾一名35岁健康男性，他正在进行左前交叉韧带修复手术。诱导后不久，他的心率从70次/分钟增加到110次/分钟，血压降至60/40 mm Hg。您还注意到他的吸气峰压增加。您接下来的步骤是什么？
|
给予500毫升晶体液快速输注，并降低挥发性麻醉药的浓度。
|
开始去氧肾上腺素输注，目标是平均动脉压大于60 mm Hg。
|
呼叫支援，给予10-100微克肾上腺素静脉注射，每1-2分钟重复或增加剂量，并根据效果调整。
|
呼叫支援，给予1毫克肾上腺素静脉注射。
| null | null | null | null | null | null | null | null | null | null |
936e2dca-930c-50f1-b4ea-d78f906d8fb0
| 4 |
A
| 2 |
37. The following scenario applies to the next 3 questions: You are asked to evaluate a 65-year-old 80-kg man in the postanesthesia care unit (PACU). He has just undergone a laser lithotripsy of a right ureteral stone. His temperature is 38.5°C, heart rate is 100 beats per minute, blood pressure is 83/55 mm Hg, and respiratory rate is 30 breaths per minute. He is arousable but confused. He has already received 2 L of crystalloid in the perioperative period. The most appropriate next step in management is administration of which of the following?
|
Start norepinephrine infusion, and titrate to MAP >65 mm Hg.
|
Start dopamine infusion, and titrate to MAP >65 mm Hg.
|
Start phenylephrine infusion, and titrate to SBP >90 mm Hg.
|
Give 250 cc of 5% albumin.
|
37. 以下情境适用于接下来的3个问题：您被要求评估一名65岁、80公斤的男性，他在术后恢复室（PACU）中。他刚刚接受了右侧输尿管结石的激光碎石术。他的体温为38.5°C，心率为每分钟100次，血压为83/55 mm Hg，呼吸频率为每分钟30次。他可以被唤醒但有些困惑。他在围手术期已经接受了2升晶体液。最合适的下一步管理措施是给予以下哪种药物？
|
开始去甲肾上腺素输注，并调整至平均动脉压（MAP）>65 mm Hg。
|
开始多巴胺输注，并调整至平均动脉压（MAP）>65 mm Hg。
|
开始去氧肾上腺素输注，并调整至收缩压（SBP）>90 mm Hg。
|
给予250毫升5%白蛋白。
| null | null | null | null | null | null | null | null | null | null |
d4bac66d-36f5-528f-9ec9-276aae0c90b0
| 4 |
C
| 2 |
The patient is now on norepinephrine at 20 µg/min, and his MAP remains less than 65 mm Hg. The next appropriate step is which of the following?
|
Add dopamine as a second vasopressor.
|
Add phenylephrine as a second vasopressor.
|
Add vasopressin as a second vasopressor.
|
Decrease your MAP goal to 60 mm Hg, as his baseline pressure is usually low.
|
患者目前正在使用去甲肾上腺素，剂量为20 µg/min，但其平均动脉压仍低于65 mm Hg。接下来的适当步骤是以下哪一项？
|
添加多巴胺作为第二种血管加压药。
|
添加苯肾上腺素作为第二种血管加压药。
|
添加加压素作为第二种血管加压药。
|
将平均动脉压目标降低到60 mm Hg，因为他的基线血压通常较低。
| null | null | null | null | null | null | null | null | null | null |
8606e961-5938-5adb-a3bc-74d0a4b586d7
| 4 |
D
| 1 |
The patient has already received 2 L of crystalloid, but you want to determine if he remains intravascularly volume-depleted. How is "fluid responsiveness" defined?
|
Decrease in heart rate
|
Urine output
|
Increase in SBP
|
Increase in cardiac output
|
患者已经接受了2升晶体液，但您想确定他是否仍然存在血管内容量不足。如何定义“液体反应性”？
|
心率下降
|
尿量
|
收缩压增加
|
心输出量增加
| null | null | null | null | null | null | null | null | null | null |
3d463c35-f98e-5f1b-ab4b-b70f21daeb26
| 4 |
A
| 2 |
A 55-year old man is scheduled for elective colectomy. His medical history is significant for hypertension, which is controlled on lisinopril. Shortly after induction with propofol and rocuronium, his blood pressure decreases from 130/85 to 80/50 mm Hg. Administration of ephedrine 5 mg and phenylephrine 40 µg IV has no effect. The most appropriate treatment at this time is administration of which of the following?
|
Vasopressin
|
Epinephrine
|
Phenylephrine
|
Calcium chloride
|
一名55岁的男性计划进行选择性结肠切除术。他的病史中有高血压，服用赖诺普利控制。用丙泊酚和罗库溴铵诱导后不久，他的血压从130/85降至80/50 mm Hg。静脉注射5 mg麻黄碱和40 µg去氧肾上腺素无效。此时最合适的治疗是给予以下哪种药物？
|
加压素
|
肾上腺素
|
去氧肾上腺素
|
氯化钙
| null | null | null | null | null | null | null | null | null | null |
71430050-64c5-5033-b953-a02e515cea3c
| 4 |
D
| 1 |
Which of the following treatments for catecholamine-resistant vasoplegia does NOT inhibit nitric oxide?
|
Methylene blue
|
Hydroxocobalamin
|
Vitamin C
|
Angiotensin II
|
以下哪种治疗儿茶酚胺抵抗性血管麻痹的方法不抑制一氧化氮？
|
亚甲蓝
|
羟钴胺
|
维生素C
|
血管紧张素II
| null | null | null | null | null | null | null | null | null | null |
7c678657-e35a-58f4-a5a2-025207726feb
| 4 |
A
| 2 |
A 70-year-old man is in the ICU after undergoing a left upper lobectomy. He develops atrial fibrillation on the second postoperative day. His heart rate is 150 beats per minute and blood pressure is 85/50 mm Hg. Which of the following is the least appropriate treatment of his tachycardia?
|
Phenylephrine
|
Amiodarone
|
Metoprolol
|
Verapamil
|
一名70岁的男性在接受左上肺叶切除术后进入ICU。他在术后第二天出现心房颤动。心率为每分钟150次，血压为85/50 mm Hg。以下哪种治疗他的心动过速的方法最不合适？
|
去氧肾上腺素
|
胺碘酮
|
美托洛尔
|
维拉帕米
| null | null | null | null | null | null | null | null | null | null |
1f9a0312-4800-529a-ad9c-f5f67fba1b31
| 4 |
D
| 2 |
43. A 75-year-old man is admitted to the ICU with perforated diverticulitis and
|
Mean arterial pressure >60 mm Hg
|
Mean arterial pressure >65 mm Hg
|
Mean arterial pressure >70 mm Hg
|
Mean arterial pressure >80 mm Hg
|
43. 一名75岁男性因穿孔性憩室炎被送入ICU
|
平均动脉压 >60 mm Hg
|
平均动脉压 >65 mm Hg
|
平均动脉压 >70 mm Hg
|
平均动脉压 >80 mm Hg
| null | null | null | null | null | null | null | null | null | null |
9ceefb9b-f6fb-5477-8b3c-6d621486d219
| 4 |
B
| 1 |
A 63-year old man is admitted to the ICU with sepsis after abdominal surgery for perforated diverticulitis. After fluid resuscitation, he continues to require high doses of norepinephrine. Bedside echocardiography shows a dilated left ventricle with a reduced ejection fraction. Which of the following statements is true?
|
The recommendation for use of dobutamine in patients with evidence of persistent hypoperfusion despite adequate fluid loading and vasopressor use is based on high-quality evidence.
|
Milrinone is a phosphodiesterase inhibitor that increases contractility independent of β-adrenergic receptors.
|
Levosimendan increases both inotropy and blood pressure.
|
When compared with norepinephrine and dobutamine, epinephrine is associated with increased mortality.
|
一名63岁的男性在因穿孔性憩室炎进行腹部手术后因败血症被送入ICU。液体复苏后，他仍需高剂量去甲肾上腺素。床旁超声心动图显示左心室扩张，射血分数降低。以下哪项陈述是正确的？
|
在液体负荷和血管加压药使用充足的情况下，仍有持续低灌注证据的患者中使用多巴酚丁胺的推荐是基于高质量证据的。
|
米力农是一种磷酸二酯酶抑制剂，可在不依赖β-肾上腺素能受体的情况下增加心肌收缩力。
|
左西孟旦可同时增加心肌收缩力和血压。
|
与去甲肾上腺素和多巴酚丁胺相比，肾上腺素与更高的死亡率相关。
| null | null | null | null | null | null | null | null | null | null |
cb4a4930-580d-5b44-b225-407a66ee5da0
| 4 |
C
| 1 |
A 65-year-old man is admitted to the ICU after undergoing an uncomplicated 3 vessel coronary artery bypass graft (CABG × 3). His blood pressure is 185/95 mm Hg. Which of the following is false regarding clevidipine?
|
It is contraindicated in patients with allergies to soybeans, soy products, eggs, or egg products.
|
When compared with nitroprusside, clevidipine demonstrated a significant mortality advantage.
|
Clevidipine is superior for blood pressure control when compared with nitroprusside, nitroglycerin, and nicardipine.
|
Rebound hypertension can occur after discontinuation of clevidipine.
|
一名65岁的男性在进行了一次无并发症的三支血管冠状动脉旁路移植术（CABG × 3）后被送入ICU。他的血压为185/95 mm Hg。关于克利维地平，下列哪项是错误的？
|
对大豆、大豆制品、鸡蛋或蛋制品过敏的患者禁用。
|
与硝普钠相比，克利维地平显示出显著的死亡率优势。
|
与硝普钠、硝酸甘油和尼卡地平相比，克利维地平在血压控制方面更优。
|
停用克利维地平后可能会出现反弹性高血压。
| null | null | null | null | null | null | null | null | null | null |
d4b9ebc3-96fa-5377-91f7-2e3c792e2003
| 4 |
C
| 1 |
Which of the following agents is categorized as a Category A bioterrorism agent by the Centers for Disease Control and Prevention (CDC)?
|
Ricin toxin
|
Vibrio cholerae
|
Yersinia pestis (plague)
|
Hantavirus
|
以下哪种剂被美国疾病控制与预防中心（CDC）分类为A类生物恐怖主义剂？
|
蓖麻毒素
|
霍乱弧菌
|
鼠疫耶尔森菌（鼠疫）
|
汉坦病毒
| null | null | null | null | null | null | null | null | null | null |
2247ab44-ac2d-528e-86ee-225c27d60600
| 4 |
B
| 3 |
You are asked to evaluate several patients who presented with symptoms of mydriasis, ptosis, diplopia, dysphagia, dysarthria, and progressive, symmetric descending flaccid paralysis. The patients are conscious and have no cardiovascular perturbations. You hear from colleagues that there are several similar cases at area hospitals as well. You recommend which of the following?
|
Treatment with plasmapheresis or IV immunoglobulin and close respiratory and cardiovascular monitoring
|
Supportive care, close monitoring for respiratory failure and risk of aspiration, and administration of antitoxin
|
Treatment with atropine, pralidoxime, anticonvulsants if seizures occur, and close monitoring for respiratory failure and risk of aspiration
|
Thorough skin examination, removal of tick, and supportive care
|
你被要求评估几位出现瞳孔散大、上睑下垂、复视、吞咽困难、构音障碍以及进行性、对称性下降性弛缓性麻痹症状的患者。这些患者意识清醒且无心血管异常。你从同事那里得知，地区医院也有几例类似病例。你推荐以下哪种治疗方案？
|
使用血浆置换或静脉注射免疫球蛋白进行治疗，并密切监测呼吸和心血管状况
|
支持性护理，密切监测呼吸衰竭和误吸风险，并给予抗毒素
|
使用阿托品、氯解磷定治疗，如发生癫痫则使用抗惊厥药，并密切监测呼吸衰竭和误吸风险
|
彻底的皮肤检查，去除蜱虫，并进行支持性护理
| null | null | null | null | null | null | null | null | null | null |
47578365-9baa-5644-9a8a-bf53032483d1
| 4 |
C
| 1 |
48. Which of the following statements regarding smallpox is false?
|
The incubation period for smallpox is 10-14 days.
|
Smallpox is highly infective requiring exposure to only 10-100 organisms to be infected.
|
The lesions of smallpox appear over the face and trunk and progress from macule to papule to vesicle to crust within 24-48 hours, and lesions at different stages can coexist on any 1 part of the body.
|
The World Health Organization (WHO) recommends a surveillance and containment strategy for the management of smallpox.
|
48. 以下关于天花的说法哪一项是错误的？
|
天花的潜伏期为10-14天。
|
天花具有高度传染性，仅需接触10-100个病原体即可感染。
|
天花的皮损出现在面部和躯干，并在24-48小时内从斑疹发展为丘疹、疱疹到结痂，同一部位可同时存在不同阶段的皮损。
|
世界卫生组织（WHO）建议采用监测和控制策略来管理天花。
| null | null | null | null | null | null | null | null | null | null |
ec2d84f4-e0ca-529b-9bd9-0ba40439628f
| 4 |
A
| 1 |
What are the 4 properties of hazards within the biological weapon spectrum?
|
Toxicity, latency, persistency, and transmissibility
|
Virulence, stability, endemic, and determination
|
Toxicity, stability, transmissibility, and transitory
|
Virulence, weaponization, toxicity, and transmissibility
|
生物武器谱系中危害的四个特性是什么？
|
毒性、潜伏性、持久性和传播性
|
毒力、稳定性、地方性和决断性
|
毒性、稳定性、传播性和暂时性
|
毒力、武器化、毒性和传播性
| null | null | null | null | null | null | null | null | null | null |
f4229d1e-3e9d-5cc2-b23a-5fe904631f1f
| 4 |
B
| 2 |
You are caring for a 35-year-old man with respiratory failure, fever, shock, and acidosis. He presented 3 days ago with nonspecific complaints of fever, cough, and malaise. His chest radiograph shows mediastinal widening and pleural effusions. Blood cultures are growing Bacillus anthracis. Which of the following is NOT part of his management?
|
He should be started on an antibiotic with bactericidal activity such as a fluoroquinolone as well as a protein synthesis inhibitor such as clindamycin to reduce toxin production.
|
He should be placed on airborne precautions in a negative pressure room.
|
A lumbar puncture should be performed to evaluate for meningitis.
|
He should be treated early with an anthrax antitoxin.
|
您正在照顾一名35岁的男性患者，他患有呼吸衰竭、发热、休克和酸中毒。3天前，他因发热、咳嗽和不适等非特异性症状就诊。他的胸部X光片显示纵隔增宽和胸腔积液。血液培养显示生长有炭疽杆菌。以下哪项不属于他的管理措施？
|
他应该开始使用具有杀菌活性的抗生素，如氟喹诺酮类药物，以及蛋白质合成抑制剂如克林霉素，以减少毒素的产生。
|
他应该被安置在负压病房中进行空气隔离。
|
应进行腰椎穿刺以评估是否存在脑膜炎。
|
应及早使用炭疽抗毒素进行治疗。
| null | null | null | null | null | null | null | null | null | null |
f4443c9a-569f-5032-bbe3-1bd27de0c020
| 5 |
C
| 3 |
A 69-year-old woman presents to an outpatient surgical center for elbow arthroscopy under regional anesthesia. Her medical history is significant for well-controlled hypertension on 2 antihypertensive agents, type 2 diabetes on metformin with a most recent HbA1c of 6, and obesity with a body mass index of 35. During preoperative assessment, she reports a good functional capacity, able to carry heavy loads of laundry up and down stairs from the basement. When asked, she admits that she has been told she snores loudly, has had witnessed apneic episodes, and is frequently tired during the day. What should the attending anesthesiologist do?
|
Cancel the surgery because she is at high risk for having obstructive sleep apnea (OSA) and refer her for a sleep study.
|
Cancel the surgery because she is at high risk for having OSA and refer her to have to procedure done at an inpatient facility.
|
Proceed with the surgery despite the fact that she is at high risk for having OSA because her comorbidities are well controlled and she will have a regional anesthetic.
|
Proceed with the surgery, as she is not at high risk for having OSA.
|
一名69岁的女性因肘关节镜检查在门诊手术中心接受区域麻醉。她的病史包括通过两种降压药物控制良好的高血压、服用二甲双胍的2型糖尿病，最近的糖化血红蛋白为6，以及体重指数为35的肥胖。在术前评估中，她报告说功能能力良好，能够从地下室上下楼搬运重物。当被问及时，她承认有人告诉她打鼾声很大，有目击的呼吸暂停发作，并且白天经常感到疲倦。麻醉师应该怎么做？
|
取消手术，因为她有高风险患阻塞性睡眠呼吸暂停（OSA），并建议她进行睡眠研究。
|
取消手术，因为她有高风险患OSA，并建议她在住院设施进行手术。
|
尽管她有高风险患OSA，但由于她的合并症控制良好且将进行区域麻醉，因此继续手术。
|
继续手术，因为她没有高风险患OSA。
|
Cancel the surgery because of her obesity and hypertension.
|
取消手术，因为她的肥胖和高血压。
| null | null | null | null | null | null | null | null |
d4e67ab9-2c1a-5f04-830b-d94c329fe393
| 5 |
D
| 2 |
A 22-year-old woman presents to the same-day surgery clinic for a rhinoplasty revision. Upon meeting her in the preoperative area, you note she is chewing gum. When you ask her about it, she immediately swallows the gum. Upon further questioning she admits that this is the fifth piece of gum she has chewed and swallowed this morning. Which of the following is the most appropriate action?
|
Proceed with the surgery as scheduled because chewing gum has little effect on gastric volume or pH.
|
Delay the surgery for 2 hours because chewing gum is considered similar to liquids according to ASA guidelines.
|
Delay the surgery for 4 hours because chewing gum is considered similar to breast milk according to ASA guidelines.
|
Delay the surgery for 6 hours because the gum she swallowed qualifies as a solid/light meal.
|
一名22岁的女性来到日间手术诊所进行鼻整形修复术。在术前区域见到她时，你注意到她正在嚼口香糖。当你询问她时，她立即吞下了口香糖。经过进一步询问，她承认这是她今天早上嚼过并吞下的第五块口香糖。以下哪项是最合适的行动？
|
按计划进行手术，因为嚼口香糖对胃容量或pH值影响很小。
|
将手术推迟2小时，因为根据ASA指南，嚼口香糖被视为类似于液体。
|
将手术推迟4小时，因为根据ASA指南，嚼口香糖被视为类似于母乳。
|
将手术推迟6小时，因为她吞下的口香糖被视为固体/轻食。
|
Cancel the surgery because she did not follow directions.
|
取消手术，因为她没有遵循指示。
| null | null | null | null | null | null | null | null |
a5c07425-ccd8-50a0-97f0-b08b060c08a4
| 5 |
D
| 3 |
3. A nurse calls you from the preoperative area of an outpatient surgical center to tell you about a 35-year-old man with type 1 diabetes scheduled for knee arthroscopy. She notes he has vomited once, is tachycardic, and is constantly asking either to use the bathroom or to be able to drink water. He told her that he has not taken insulin in 2 days, so she took his blood glucose level and it is 467. Which of the following is the best course of action?
|
Proceed with surgery and treat the hyperglycemia intraoperatively with IV regular insulin.
|
Ask the nurse to give the patient his normal dose of NPH and proceed with surgery treating intraoperative hyperglycemia with IV regular insulin.
|
Evaluate the patient yourself and proceed with surgery only if he understands how to treat his hyperglycemia postoperatively.
|
Evaluate the patient yourself. Explain to him that you are concerned that he is showing signs and symptoms of diabetic ketoacidosis, cancel the surgery, draw appropriate laboratory test results, and send him to a tertiary care center for further evaluation and treatment.
|
3. 一名护士从门诊手术中心的术前区域打电话给你，告知一名35岁患有1型糖尿病的男性计划进行膝关节镜检查。她注意到他呕吐过一次，心动过速，并且不断要求要么上厕所，要么喝水。他告诉她他已经两天没有注射胰岛素了，所以她测了他的血糖，结果是467。以下哪项是最佳的处理方案？
|
继续手术，并在术中用静脉注射常规胰岛素治疗高血糖。
|
让护士给病人注射正常剂量的NPH，并继续手术，在术中用静脉注射常规胰岛素治疗高血糖。
|
亲自评估病人，并仅在他了解如何在术后处理高血糖的情况下继续手术。
|
亲自评估病人。向他解释你担心他表现出糖尿病酮症酸中毒的体征和症状，取消手术，进行适当的实验室检查，并将他送往三级护理中心进行进一步评估和治疗。
|
Counsel the nurse that she should not have checked the blood glucose level without discussing it with you first.
|
建议护士在没有先与你讨论的情况下不应检查血糖水平。
| null | null | null | null | null | null | null | null |
6feeb5de-4fab-5a9a-8086-d16da3ac18da
| 5 |
A
| 2 |
A 23-year-old woman presents for same-day surgery for hysteroscopy for a misplaced intrauterine device. She is very anxious about anesthesia. On your preoperative assessment, you note she gets carsick frequently and is a
|
Based on her Apfel score, she has 3 risk factors of PONV, giving her a 60% risk of PONV. A multimodal approach using antiemetics of 2 or 3 different classes is appropriate.
|
Her anxiety confers additional risk for PONV.
|
Both avoiding nitrous oxide and minimizing neostigmine dose can help reduce her risk of PONV.
|
Scopolamine patch and ondansetron are most effective when administered before surgery.
|
一名23岁的女性因宫内节育器移位而进行同日手术进行宫腔镜检查。她对麻醉非常焦虑。在术前评估中，你注意到她经常晕车，并且是一个
|
根据她的Apfel评分，她有3个PONV的风险因素，给她带来60%的PONV风险。使用2或3种不同类别的止吐药的多模式方法是合适的。
|
她的焦虑增加了PONV的额外风险。
|
避免使用氧化亚氮和最小化新斯的明剂量都可以帮助降低她的PONV风险。
|
东莨菪碱贴片和昂丹司琼在术前使用效果最佳。
|
The use of haloperidol as an antiemetic requires doses the same as or higher than those that are used to treat psychiatric disorders.
|
作为止吐药使用氟哌啶醇需要与治疗精神障碍相同或更高的剂量。
| null | null | null | null | null | null | null | null |
fcdcaa41-3e54-5d40-82fb-8d39c488aa2d
| 5 |
D
| 3 |
A 40-year-old woman presents to an ambulatory surgical center for knee arthroscopy. She tells you she needs to get home as soon as possible after the surgery because she has "important things to take care of." What is the best anesthetic plan to ensure the shortest time from arrival to discharge?
|
General anesthesia
|
Regional anesthesia with a "3-in-1" block technique
|
Spinal anesthesia
|
All of the above techniques can be used to affect a short time to discharge
|
一名40岁的女性来到门诊手术中心进行膝关节镜检查。她告诉你，她需要在手术后尽快回家，因为她有“重要的事情要处理”。为了确保从到达到出院的时间最短，最佳的麻醉计划是什么？
|
全身麻醉
|
使用“3合1”阻滞技术的区域麻醉
|
脊髓麻醉
|
以上所有技术都可以用于缩短出院时间
|
Knee arthroscopy is not an appropriate surgery for an ambulatory center
|
膝关节镜检查不适合在门诊中心进行
| null | null | null | null | null | null | null | null |
5c74d1c5-8f38-58e7-99f1-7b67d5f5e83e
| 5 |
E
| 2 |
A 23-year-old woman is having nausea and vomiting in the postanesthesia care unit (PACU) after hysteroscopy. She was deemed to be at high risk for PONV and received dexamethasone, ondansetron, and haloperidol as PONV prophylaxis intraoperatively. Which of the following is the best next step in management?
|
Repeat the same dose of ondansetron.
|
Repeat the same dose of dexamethasone.
|
Repeat the same dose of haloperidol.
|
Give a higher dose of ondansetron.
|
一名23岁的女性在子宫镜检查后出现恶心和呕吐，正在麻醉后恢复室（PACU）。她被认为是PONV的高风险患者，并在术中接受了地塞米松、昂丹司琼和氟哌啶醇作为PONV预防措施。以下哪项是管理的最佳下一步？
|
重复相同剂量的昂丹司琼。
|
重复相同剂量的地塞米松。
|
重复相同剂量的氟哌啶醇。
|
给予更高剂量的昂丹司琼。
|
Administer perphenazine or promethazine.
|
给予丙氟嗪或异丙嗪。
| null | null | null | null | null | null | null | null |
0a771324-6f44-5f74-9e13-63829aa786eb
| 5 |
D
| 1 |
All of the following are common reasons for delay in ambulatory surgical patient discharge EXCEPT which one?
|
Drowsiness
|
Nausea
|
Vomiting
|
Anxiety
|
以下哪一项不是导致门诊手术患者出院延迟的常见原因？
|
嗜睡
|
恶心
|
呕吐
|
焦虑
|
Pain
|
疼痛
| null | null | null | null | null | null | null | null |
7a2a9b98-065f-528c-9ad8-1fe92a4d8bf6
| 5 |
E
| 3 |
8. A 31-year-old man complains of 7/10 pain in the PACU after hemorrhoidectomy under general anesthesia. Which is the most appropriate intervention to treat his pain and facilitate a shorter time to discharge home?
|
Assume his complaint is due to discomfort from something else such as hypoxemia, hypercapnia, or full bladder rather than surgical pain.
|
Administer IV hydromorphone.
|
Administer IV morphine.
|
Administer IV fentanyl.
|
8. 一名31岁的男性在全身麻醉下进行痔疮切除术后，在PACU中抱怨7/10的疼痛。哪种干预措施最适合治疗他的疼痛并缩短出院时间？
|
假设他的抱怨是由于其他不适引起的，例如低氧血症、高碳酸血症或膀胱充盈，而不是手术疼痛。
|
给予静脉注射氢吗啡酮。
|
给予静脉注射吗啡。
|
给予静脉注射芬太尼。
|
Evaluate for other sources of discomfort such as hypoxemia, hypercapnia, or full bladder. Once these are eliminated, administer IV fentanyl and a nonsteroidal anti-inflammatory drug.
|
评估其他不适来源，如低氧血症、高碳酸血症或膀胱充盈。一旦排除这些因素，给予静脉注射芬太尼和非甾体抗炎药。
| null | null | null | null | null | null | null | null |
dae863f7-c037-5dc4-bb15-55ec6c3a0a8b
| 5 |
B
| 2 |
A 65-year-old man is recovering from general anesthesia for umbilical hernia repair. You go to evaluate him and note he is sleeping with an oxygen saturation of 94%on room air. When you call his name, he takes a deep breath, coughs, and yells at you for interrupting his nap. You note his blood pressure is 166/70. He kicks his blanket off and throws it at you, yelling "that's what it always is!"
|
His modified Aldrete score is 5 and he is NOT ready for discharge.
|
His modified Aldrete score is 9 and he is ready for discharge.
|
He is hypertensive and therefore is not ready for discharge.
|
He is angry and therefore is not ready for discharge.
|
一名65岁的男性在接受脐疝修补术的全身麻醉后正在恢复。你去评估他，注意到他在空气中氧饱和度为94%时正在睡觉。当你叫他的名字时，他深吸一口气，咳嗽，并对你打断他的午睡大喊大叫。你注意到他的血压是166/70。他踢掉毯子并扔向你，喊道“这就是它一直的样子！”
|
他的改良Aldrete评分是5，他尚未准备好出院。
|
他的改良Aldrete评分是9，他已准备好出院。
|
他是高血压患者，因此尚未准备好出院。
|
他很生气，因此尚未准备好出院。
|
He was sleeping and therefore is not ready for discharge.
|
他在睡觉，因此尚未准备好出院。
| null | null | null | null | null | null | null | null |
1220665f-dcfd-58f7-8227-0b288a23ffc2
| 5 |
E
| 2 |
A 21-year-old man is in the PACU after receiving general anesthesia for excision and grafting of a small burn he sustained to his right lower extremity several days ago. He is demanding to be discharged home, but the nurse tells him he must urinate and eat crackers first. Which of the following is true regarding the need to void and eat/drink before discharge home?
|
It is absolutely necessary for all patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU.
|
It is never necessary for patients to urinate and demonstrate that they can eat and drink before discharge home from the PACU.
|
All patients who received general anesthesia need to demonstrate that they can eat and drink before discharge home. Only patients who had neuraxial blocks are required to urinate.
|
Requiring all patients to void before discharge home is necessary from a medicolegal standpoint.
|
一名21岁的男性在接受全身麻醉后正在PACU中，他几天前右下肢的小面积烧伤进行了切除和移植。他要求出院回家，但护士告诉他必须先排尿和吃饼干。关于出院前需要排尿和吃喝，下列哪项是正确的？
|
所有患者在从PACU出院回家前，绝对有必要排尿并证明他们可以吃喝。
|
患者在从PACU出院回家前，绝对不需要排尿并证明他们可以吃喝。
|
所有接受全身麻醉的患者在出院前需要证明他们可以吃喝。只有接受神经轴阻滞的患者需要排尿。
|
从医学法律的角度来看，要求所有患者在出院前排尿是必要的。
|
Requiring patients who are at low risk to void and to eat and drink before discharge home is not necessary.
|
对于低风险患者，要求他们在出院前排尿和吃喝是不必要的。
| null | null | null | null | null | null | null | null |
0c3dc24c-7028-5ef6-a0fa-eb9eaa639a87
| 5 |
B
| 1 |
Which of the following is the expected physiologic response to electroconvulsive therapy (ECT), beginning with the electrical stimulus?
|
Initial sympathetic discharge followed by parasympathetic response
|
Initial parasympathetic discharge followed by sympathetic response
|
Initial sympathetic discharge without parasympathetic response
|
Initial prominent sympathetic discharge leading to arrhythmia
|
以下哪项是电休克疗法（ECT）从电刺激开始的预期生理反应？
|
最初的交感神经放电，随后是副交感神经反应
|
最初的副交感神经放电，随后是交感神经反应
|
最初的交感神经放电，没有副交感神经反应
|
最初显著的交感神经放电导致心律失常
|
No physiologic response
|
没有生理反应
| null | null | null | null | null | null | null | null |
374abd47-7a07-53fb-babe-c9c8194b525c
| 5 |
E
| 1 |
Which of the following agents CANNOT be used safely and effectively for induction of anesthesia for ECT?
|
Methohexital
|
Propofol
|
Ketamine
|
Etomidate
|
以下哪种药物不能安全有效地用于电休克治疗的麻醉诱导？
|
甲氧己妥
|
丙泊酚
|
氯胺酮
|
依托咪酯
|
None of the above, all can be used safely and effectively
|
以上都可以安全有效地使用
| null | null | null | null | null | null | null | null |
42c6c842-ccec-51c3-9bed-3435a5d12949
| 5 |
C
| 1 |
13. A 52-year-old woman presents for ECT for refractory depression. You note she is on multiple psychiatric medications, including a selective serotonin reuptake inhibitor, a tricyclic antidepressant, and a monoamine oxidase inhibitor (MAOI). Which of the following is false regarding MAOIs and ECT?
|
Patient's taking MAOIs are at increased risk for hypertensive crisis if direct- or indirect-acting sympathomimetic drugs are given.
|
If the decision is made to continue MAOI therapy, the patient should be on a stable dose before ECT.
|
If the decision is made to discontinue the MAOI, it should be held for 3 days before ECT.
|
If the decision is made to discontinue the MAOI, it should be held for 2 weeks before ECT.
|
13. 一名52岁的女性因难治性抑郁症接受电休克疗法（ECT）。你注意到她正在服用多种精神药物，包括选择性5-羟色胺再摄取抑制剂、三环类抗抑郁药和单胺氧化酶抑制剂（MAOI）。关于MAOI和ECT，下列哪项是错误的？
|
服用MAOI的患者如果给予直接或间接作用的拟交感神经药物，发生高血压危象的风险增加。
|
如果决定继续MAOI治疗，患者在ECT前应保持稳定剂量。
|
如果决定停用MAOI，应在ECT前停药3天。
|
如果决定停用MAOI，应在ECT前停药2周。
|
The decision to either stop or continue MAOIs for ECT should be made on an individual patient-by-patient basis.
|
是否在ECT中停用或继续使用MAOI的决定应基于个体患者的情况。
| null | null | null | null | null | null | null | null |
ce28da7a-1860-550c-91bf-43718809b141
| 5 |
C
| 2 |
In which of the following patients would you be MOST concerned about ECT?
|
A 55-year-old man who had a cerebral aneurysm coiled last year, stable on follow-up imaging.
|
An 87-year-old woman with multivessel coronary artery disease and ejectionfraction on 35%
|
A 41-year-old man with untreated pheochromocytoma
|
A 71-year-old woman with severe osteoporosis
|
在以下哪位患者中，您最担心进行电休克疗法（ECT）？
|
55岁男性，去年进行了脑动脉瘤栓塞术，随访影像显示稳定。
|
87岁女性，患有多支冠状动脉疾病，射血分数为35%。
|
41岁男性，未治疗的嗜铬细胞瘤。
|
71岁女性，患有严重的骨质疏松症。
|
A 65-year-old man with Parkinson disease
|
65岁男性，患有帕金森病。
| null | null | null | null | null | null | null | null |
99a92e36-9c2e-5b3b-b185-f26e65b7a8ba
| 4 |
D
| 3 |
A 27-year-old woman with depression who has not responded well to medical management presents for ECT. You are about to go over the consent for anesthesia with her when a nurse tells you "not to bother, " consent is implied because she is depressed and therefore cannot consent for herself. Which of the following is the most appropriate response?
|
Thank her for reminding you and do not consent the patient.
|
Thank her for reminding you and call the patient's mother to obtain consent.
|
Cancel the ECT.
|
Assess the patient to evaluate if she understands the information relevant to consenting for anesthesia for ECT, and if she does, continue with the consent process.
|
一名27岁的女性患有抑郁症，对药物治疗反应不佳，现准备接受电休克治疗。你正准备与她讨论麻醉同意书时，一名护士告诉你“别费心了”，因为她抑郁，所以无法为自己做出同意。以下哪项是最合适的回应？
|
感谢她的提醒，并不为患者进行同意。
|
感谢她的提醒，并打电话给患者的母亲以获得同意。
|
取消电休克治疗。
|
评估患者是否理解与电休克麻醉同意相关的信息，如果她理解，则继续进行同意过程。
| null | null | null | null | null | null | null | null | null | null |
ec191689-ff06-566e-b075-0b590bc4a98c
| 5 |
D
| 1 |
All of the following are advantages of an office-based procedure EXCEPT which one?
|
Cost containment
|
Patient convenience
|
Surgeon convenience
|
Increased patient exposure to nosocomial infections
|
以下哪一项不是基于办公室的手术的优点？
|
成本控制
|
患者便利
|
外科医生便利
|
增加患者接触医院感染的风险
|
Improved patient privacy
|
改善患者隐私
| null | null | null | null | null | null | null | null |
2e426671-692b-517e-838b-055a029a09fb
| 5 |
C
| 1 |
Which of the following equipment is NOT required to be available for the safe delivery of office-based anesthesia?
|
Pulse oximeter
|
Capnography
|
Anesthesia machine
|
Suction equipment
|
以下哪种设备不是安全实施办公室麻醉所必需的？
|
脉搏血氧仪
|
呼气末二氧化碳监测仪
|
麻醉机
|
吸引设备
|
Dantrolene and malignant hyperthermia supplies
|
丹曲林和恶性高热供应
| null | null | null | null | null | null | null | null |
22dc5452-9747-5d46-ba59-a76971b6a914
| 5 |
A
| 1 |
According to the ASA Closed Claims Project database, which of the following were the most common adverse events during office-based procedures?
|
Respiratory events
|
Cerebrovascular events
|
Equipment-related injuries
|
Gastrointestinal-related events
|
根据ASA关闭索赔项目数据库，以下哪项是办公室手术中最常见的不良事件？
|
呼吸事件
|
脑血管事件
|
设备相关伤害
|
胃肠道相关事件
|
Postanesthetic events
|
麻醉后事件
| null | null | null | null | null | null | null | null |
cea0c723-9183-5e4f-8151-1780bfd3b10a
| 5 |
D
| 3 |
19. All of the following patients are considered poor candidates for an officebased procedure EXCEPT which one?
|
A 30-year-old woman with type 1 diabetes mellitus and HbA1c 9
|
A 20-year-old man with history of intravenous drug use on Suboxone
|
A 40-year-old woman with body mass index of 43
|
A 70-year-old woman with osteoporosis
|
19. 以下哪位患者被认为不适合在诊所进行手术，除了哪一位？
|
30岁女性，1型糖尿病，HbA1c 9
|
20岁男性，有静脉药物使用史，正在服用Suboxone
|
40岁女性，体重指数43
|
70岁女性，患有骨质疏松症
|
A 50-year-old man without an escort
|
50岁男性，没有陪同人员
| null | null | null | null | null | null | null | null |
51371bd3-a373-554b-8ba2-74c5486eb876
| 5 |
B
| 2 |
The last patient of the day is recovering from her general anesthetic for liposuction at a plastic surgery office. The anesthesiologist and a medical assistant are the only people who remain in the office after a long day. The anesthesiologist tells the administrative assistant she has to leave and asks him if he can give the patient's escort the postoperative care instructions when he gets there. Which of the following statements is correct?
|
This is inappropriate because the anesthesiologist must stay until the last patient has left the office.
|
This is appropriate only if the medical assistant is ACLS/PALS-certified.
|
This is appropriate because the anesthesiologist has to leave.
|
This is inappropriate because the anesthesiologist is taking advantage of the medical assistant.
|
今天最后一位患者正在整形外科诊所从吸脂手术的全身麻醉中恢复。麻醉师和一名医疗助理是经过漫长一天后办公室里仅剩的人。麻醉师告诉行政助理她必须离开，并询问他是否可以在患者的陪同人员到达时给他们提供术后护理说明。以下哪种说法是正确的？
|
这是不合适的，因为麻醉师必须留到最后一位患者离开办公室。
|
只有在医疗助理拥有ACLS/PALS认证时，这才是合适的。
|
这是合适的，因为麻醉师必须离开。
|
这是不合适的，因为麻醉师在利用医疗助理。
|
This is inappropriate because the anesthesiologist should remain to answer the escort's questions about postsurgical care.
|
这是不合适的，因为麻醉师应该留下来回答陪同人员关于术后护理的问题。
| null | null | null | null | null | null | null | null |
3d739736-6293-5065-a45b-32b921c665d1
| 5 |
A
| 1 |
The 3-step paradigm to nonoperating room anesthesia describes a systematic approach that addresses which of the following?
|
The patient, the procedure, and the environment
|
The patient, the proceduralist, and the anesthesiologist
|
The proceduralist, the anesthesiologist, and the ASA classification
|
The anesthesiologist, the environment, and the equipment
|
非手术室麻醉的三步范式描述了一种系统的方法，该方法解决了以下哪些问题？
|
患者、手术过程和环境
|
患者、手术医生和麻醉师
|
手术医生、麻醉师和ASA分级
|
麻醉师、环境和设备
|
The proceduralist, the environment, and the equipment
|
手术医生、环境和设备
| null | null | null | null | null | null | null | null |
8beb395d-deea-5d6c-b039-0cc10f385ed8
| 5 |
D
| 1 |
You are delivering general anesthesia in the interventional radiology suite for fluoroscopy-guided radiofrequency ablation of hepatocellular carcinoma. All of the following steps can be taken to minimize exposure to radiation EXCEPT which one?
|
Leaving the procedure room when active radiation is in use
|
Wearing a lead-lined protective garment
|
Working behind a lead-lined glass shield
|
Working on the side of the table on which the X-ray source originates
|
您正在介入放射科的手术室中进行肝细胞癌的透视引导射频消融术的全身麻醉。以下所有步骤都可以用来减少辐射暴露，除了哪一个？
|
在使用主动辐射时离开手术室
|
穿戴铅衬保护服
|
在铅衬玻璃屏障后工作
|
在X射线源发出的桌子一侧工作
|
Limiting the length of time of the procedure
|
限制手术时间的长度
| null | null | null | null | null | null | null | null |
33a868f7-1285-5d6e-8971-6115b23d1297
| 5 |
B
| 2 |
You are performing a general anesthesia for a 4-year-old undergoing an MRI. After induction of anesthesia, you take all of the following steps to ensure safety in the MRI EXCEPT which one?
|
Ear protection is placed in the patient's ears.
|
IV tubing and cables are wound neatly in loops at the patient's skin.
|
Ensure absence of ferromagnetic equipment such as IV poles, gas cylinders, and pens.
|
The patient achieves adequate tidal volumes after moving into the scanner.
|
您正在为一名4岁的儿童进行全身麻醉以进行MRI。在麻醉诱导后，您采取以下所有步骤以确保MRI中的安全，除了哪一个？
|
在患者的耳朵里放置耳部保护装置。
|
将静脉输液管和电缆整齐地缠绕在患者的皮肤上。
|
确保没有铁磁性设备，如静脉输液杆、气瓶和笔。
|
患者在进入扫描仪后达到足够的潮气量。
|
The patient is adequately anesthetized.
|
患者被充分麻醉。
| null | null | null | null | null | null | null | null |
88a6cb40-ece3-5ab3-a62e-d260e7b81972
| 5 |
C
| 1 |
After inducing general anesthesia, you observe your patient as she moves into the MRI scanner. After ensuring MRI safety standards have been met and she is adequately anesthetized and hemodynamically stable, you move to the monitoring room. When you are in the monitoring room, you are in which zone?
|
Zone I
|
Zone II
|
Zone III
|
Zone IV
|
在诱导全身麻醉后，你观察到你的病人进入MRI扫描仪。在确保MRI安全标准已达到并且她已充分麻醉且血流动力学稳定后，你移动到监控室。当你在监控室时，你处于哪个区域？
|
区域I
|
区域II
|
区域III
|
区域IV
|
Zone V
|
区域V
| null | null | null | null | null | null | null | null |
6d8e3483-faaf-563a-a263-8a4d199392aa
| 5 |
B
| 1 |
25. ASA standards for nonoperating room anesthetizing locations include all of the following EXCEPT which one?
|
Adequate and reliable suction is available.
|
Easy and expeditious access to the patient is required, but limited access to the anesthesia machine and monitoring equipment is acceptable.
|
Defibrillator, emergency drugs, and cardiopulmonary resuscitation equipment are all immediately available.
|
There is adequate illumination of the patient, anesthesia machine, and monitoring equipment with a battery-operated backup light source.
|
25. ASA 对非手术室麻醉地点的标准包括以下所有内容，除了哪一项？
|
有足够且可靠的吸引设备可用。
|
需要对患者进行便捷快速的接触，但对麻醉机和监测设备的有限接触是可以接受的。
|
除颤器、急救药物和心肺复苏设备均可立即使用。
|
患者、麻醉机和监测设备有足够的照明，并配有电池供电的备用光源。
|
Electrical outlets are sufficient for both the anesthesia machines and monitors.
|
电源插座足以供麻醉机和监测设备使用。
| null | null | null | null | null | null | null | null |
c60a1a09-a605-5e70-a383-55bb7117bb34
| 4 |
D
| 1 |
,, Of the following choices, which opioid has consistently been associated with delirium when used for postoperative pain management in the elderly?
|
Fentanyl
|
Morphine
|
Hydromorphone
|
Meperidine
|
在以下选项中，哪种阿片类药物在用于老年人术后疼痛管理时一贯与谵妄有关？
|
芬太尼
|
吗啡
|
氢吗啡酮
|
哌替啶
| null | null | null | null | null | null | null | null | null | null |
62f746fa-397f-57f9-9c44-2263ac0b272c
| 4 |
A
| 1 |
Which of the following changes that occur with increasing age can account for the possible increase of morphine's duration of action in the elderly?
|
Increased adipose tissue
|
Increased lean body mass
|
Increased total body water
|
Decreased gastric pH
|
以下哪种随年龄增长而发生的变化可以解释吗啡在老年人中作用时间可能增加的原因？
|
脂肪组织增加
|
瘦体重增加
|
总身体水分增加
|
胃酸度降低
| null | null | null | null | null | null | null | null | null | null |
6970a036-01aa-5276-8874-993423007d52
| 4 |
D
| 2 |
Which of the following opioids would be most appropriate to treat pain in an elderly patient on fluoxetine?
|
Tramadol
|
Meperidine
|
Fentanyl
|
Oxycodone
|
以下哪种阿片类药物最适合用于治疗服用氟西汀的老年患者的疼痛？
|
曲马多
|
哌替啶
|
芬太尼
|
羟考酮
| null | null | null | null | null | null | null | null | null | null |
847094f5-bfd3-51bf-9cf9-162a1eb4f01b
| 4 |
D
| 3 |
When comparing an 80-year-old patient with a 20-year-old patient with the same lean body mass, which of the following statements about remifentanil is false?
|
A reduction of the bolus dose will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old.
|
A reduction of the maintenance infusion rate will be required in the 80-year-old to have the same therapeutic effect as in the 20-year-old.
|
The 80-year-old patient may have a delayed emergence after receiving a remifentanil infusion.
|
The 20-year-old patient may have a delayed emergence after receiving a remifentanil infusion.
|
在比较具有相同瘦体重的80岁患者和20岁患者时，关于瑞芬太尼的以下哪项陈述是错误的？
|
80岁的患者需要减少推注剂量才能达到与20岁患者相同的治疗效果。
|
80岁的患者需要减少维持输注速率才能达到与20岁患者相同的治疗效果。
|
80岁的患者在接受瑞芬太尼输注后可能会出现延迟苏醒。
|
20岁的患者在接受瑞芬太尼输注后可能会出现延迟苏醒。
| null | null | null | null | null | null | null | null | null | null |
f5aa7b5c-23ae-5b91-8e55-e9a3ac78f940
| 4 |
C
| 1 |
5. An 80-year-old man is scheduled for radical prostatectomy. He denies any significant medical history other than hypertension, for which he takes hydrochlorothiazide. He reports a good exercise tolerance and is able to climb 4 flights of stairs without difficulty. What would be the expected minimum alveolar concentration (MAC) of sevoflurane to prevent movement to surgical stimulation assuming the patient has a response to anesthesia in line with the median population?
|
1.8%
|
1.6%
|
1.4%
|
1.2%
|
5. 一名80岁的男性计划进行根治性前列腺切除术。他除了高血压外否认有任何显著的病史，并服用氢氯噻嗪。他报告有良好的运动耐力，能够轻松爬4层楼梯。假设患者对麻醉的反应与中位数人群一致，预期的七氟醚最低肺泡浓度（MAC）是多少以防止手术刺激引起的运动？
|
1.8%
|
1.6%
|
1.4%
|
1.2%
| null | null | null | null | null | null | null | null | null | null |
bc201de4-1b89-576e-94c9-1e25c945d7d1
| 4 |
B
| 2 |
A 90-year-old man with no significant cardiopulmonary history, other than hypertension, is undergoing an elective right hemicolectomy. After induction of general anesthesia, the patient is noted to be requiring escalating doses of phenylephrine to maintain a mean arterial pressure (MAP) >65 mm Hg. ECG shows normal sinus rhythm, and airway pressures are within normal limits. End tidal carbon dioxide is stable. He is being maintained on desflurane with an expired concentration of 6%. Which of the following is the most appropriate next step?
|
Decrease the desflurane with a goal expired concentration of 5.5%.
|
Decrease the desflurane with a goal expired concentration of 4.6%.
|
Tolerate a MAP of 55 mm Hg.
|
Administer midazolam with the goal of creating a balanced anesthetic.
|
一名90岁的男性，除高血压外无显著心肺病史，正在接受择期右半结肠切除术。在诱导全身麻醉后，发现患者需要逐渐增加去氧肾上腺素的剂量以维持平均动脉压（MAP）>65 mm Hg。心电图显示正常窦性心律，气道压力在正常范围内。呼气末二氧化碳稳定。他正在使用呼气浓度为6%的地氟醚维持麻醉。以下哪项是最合适的下一步措施？
|
减少地氟醚，目标呼气浓度为5.5%。
|
减少地氟醚，目标呼气浓度为4.6%。
|
容忍MAP为55 mm Hg。
|
给予咪达唑仑以达到平衡麻醉的目的。
| null | null | null | null | null | null | null | null | null | null |
4da2d9d5-dd9a-5bbe-8cff-856439b9e81c
| 4 |
B
| 1 |
Which of the following statements regarding cardiovascular physiology in the elderly is true?
|
Vascular stiffening leads to a decrease in pulse pressure.
|
Diastolic dysfunction is present in half of those diagnosed with congestive heart failure.
|
Nitric oxide production is increased to balance increases in systemic vascular resistance.
|
Cardiac output is maintained by increased stroke volume and ventricular contractility.
|
以下关于老年人心血管生理的说法中哪一项是正确的？
|
血管僵硬导致脉压下降。
|
在被诊断为充血性心力衰竭的人中，一半存在舒张功能障碍。
|
一氧化氮的产生增加以平衡全身血管阻力的增加。
|
通过增加的搏出量和心室收缩力来维持心输出量。
| null | null | null | null | null | null | null | null | null | null |
63da3e2b-9aca-52cb-a93f-0a5b725e5c65
| 4 |
D
| 1 |
Which of the following cardiovascular changes associated with aging is false?
|
Reduced ventricular compliance
|
Decreased blood vessel contractility
|
Desensitization of carotid and aortic baroreceptors
|
Preserved sympathetic and vagal resting tone
|
以下哪项与衰老相关的心血管变化是错误的？
|
心室顺应性降低
|
血管收缩性降低
|
颈动脉和主动脉压力感受器脱敏
|
交感神经和迷走神经的静息张力保持不变
| null | null | null | null | null | null | null | null | null | null |
0e187d64-f7c2-5ef4-a845-152393c65cea
| 4 |
C
| 1 |
Which of the following statements regarding cardiovascular pathology in elderly patients is false?
|
Out of every 3 patients older than 70 years, 1 patient will develop significant coronary artery disease.
|
Hypertension can develop in the setting of normal systemic vascular resistance.
|
In the developing world, rheumatic heart disease affecting the aortic valve is the most common cause of valvular heart disease.
|
In the absence of disease, resting systolic cardiac function can be preserved even in octogenarians.
|
以下关于老年患者心血管病理的陈述中哪一项是错误的？
|
在每3名70岁以上的患者中，1名患者将发展为显著的冠状动脉疾病。
|
在正常全身血管阻力的情况下也可能出现高血压。
|
在发展中国家，影响主动脉瓣的风湿性心脏病是瓣膜性心脏病的最常见原因。
|
在没有疾病的情况下，即使是八十多岁的老人，静息收缩期心功能也可以保持。
| null | null | null | null | null | null | null | null | null | null |
93bfae81-8b9f-5ec9-ad01-7bf32e734fa0
| 4 |
D
| 1 |
Which of the following statements regarding autonomic physiology in the elderly is true?
|
α-Adrenergic sensitivity and response to α-agonists are increased.
|
β-Adrenergic sensitivity and response to β-agonists are increased.
|
Adrenal tissues atrophy, resulting in a decrease in circulating norepinephrine and epinephrine levels.
|
Maintenance of MAP is dependent on increases in vascular resistance.
|
以下关于老年人自主神经生理的说法中哪一项是正确的？
|
α-肾上腺素能敏感性和对α-激动剂的反应增加。
|
β-肾上腺素能敏感性和对β-激动剂的反应增加。
|
肾上腺组织萎缩，导致循环中去甲肾上腺素和肾上腺素水平下降。
|
平均动脉压的维持依赖于血管阻力的增加。
| null | null | null | null | null | null | null | null | null | null |
8feeb366-b3fa-5054-8d71-58607a1f5c64
| 4 |
D
| 1 |
11. A 84-year-old man is admitted to the hospital after a fall from standing, striking his left chest on a night stand. The patient's medical history includes hypertension, coronary artery disease with multiple drug eluting stent placements in the left and right coronary arteries, non-ST elevation myocardial infarction (5 years ago), and heart failure with a left ventricular (LV) ejection fraction of 35%. He is taking aspirin, clopidogrel, and apixaban (factor Xa [FXa] inhibitor), as well as ibuprofen as needed for intermittent back pain. The patient's laboratory test results reveal the following: Na 134, K 3.2, Cl 100,
|
Andexanet alfa administration is associated with acute kidney injury (AKI).
|
Ibuprofen (NSAID) caused acute interstitial nephritis by inhibition of local prostaglandin production.
|
The patient's urine output was inadequate.
|
The degree of the patient's increase in creatinine is associated with an increased risk of hospital death.
|
11. 一名84岁男性在从站立位置跌倒后入院，他的左胸撞到了床头柜。患者的病史包括高血压、冠状动脉疾病（左、右冠状动脉多处药物洗脱支架置入）、非ST段抬高型心肌梗死（5年前）以及左心室射血分数为35%的心力衰竭。他正在服用阿司匹林、氯吡格雷和阿哌沙班（Xa因子抑制剂），以及按需服用布洛芬以缓解间歇性背痛。患者的实验室检查结果显示：钠134，钾3.2，氯100，
|
Andexanet alfa的使用与急性肾损伤（AKI）有关。
|
布洛芬（NSAID）通过抑制局部前列腺素的产生导致急性间质性肾炎。
|
患者的尿量不足。
|
患者肌酐升高的程度与住院死亡风险增加有关。
| null | null | null | null | null | null | null | null | null | null |
71e47de5-d333-5d6b-a63e-f7ac839c7cd3
| 4 |
C
| 2 |
A 82-year-old woman with a medical history of hypertension, hyperlipidemia, and chronic kidney disease (CKD) (baseline Cr 1.4) is brought to the emergency department by ambulance from her retirement home with altered mental status. The patient's vital signs are as follows: T 39.3°C, HR 121, BP 72/45, RR 38, SaO2 88%, and FiO2 1.0 via nonrebreather mask. The patient is admitted to the intensive care unit with subsequent intubation and initiation of norepinephrine (4 µg/min) infusion. The patient's P/F ratio is 102 and serum lactate is 3. Which of the following statements is false?
|
The patient meets criteria for septic shock according to Sepsis-3 consensus.
|
Nondialysis requiring CKD in septic and septic shock patients is associated with increased mortality.
|
Titration of vasopressors to a mean arterial perfusion pressure of 75-85 mm Hg increases mortality.
|
The patient's expected in-hospital mortality is approximately 40%.
|
一名82岁的女性，有高血压、高脂血症和慢性肾病（CKD）（基线肌酐1.4）的病史，从养老院被救护车送到急诊科，表现为精神状态改变。患者的生命体征如下：体温39.3°C，心率121，血压72/45，呼吸频率38，血氧饱和度88%，通过非再呼吸面罩吸氧，氧浓度1.0。患者被送入重症监护室，随后进行插管并开始去甲肾上腺素（4 µg/min）输注。患者的P/F比值为102，血清乳酸为3。以下哪项陈述是错误的？
|
根据Sepsis-3共识，患者符合脓毒性休克的标准。
|
在脓毒症和脓毒性休克患者中，不需要透析的慢性肾病与死亡率增加有关。
|
将血管加压药物滴定至平均动脉灌注压75-85 mm Hg会增加死亡率。
|
患者的预期住院死亡率约为40%。
| null | null | null | null | null | null | null | null | null | null |
fa76cc36-b7c1-529c-999d-aac94250fcb1
| 4 |
A
| 1 |
A 85-year-old woman with a history of hypertension, atrial fibrillation, type II diabetes mellitus (DM), hypercholesterolemia, CKD stage IV (glomerular filtration rate 15-29 mL/min; baseline creatinine 2.3), a recent ST-elevation myocardial infarction, and osteoporosis on hormone replacement therapy returns to the hospital with chest pain and dyspnea. Her home medications include aspirin, clopidogrel, apixaban, and lisinopril. She states she was recently started on exenatide (glucagonlike peptide-1 [GLP-1] receptor agonist). The patient shows clinical signs of congestive heart failure. A diagnosis of pericarditis was made. The patient receives diclofenac for pain control and furosemide for a diagnosis of pulmonary edema. Which of the following statements with regard to this patient is true?
|
CKD in women is characterized by low estradiol levels, but estrogen replacement might be associated with progressive renal loss.
|
Exenatide is a preferred oral antiglycemic in patients with severe CKD.
|
Androgens may protect renal function through prevention of parenchymal, fibrotic remodeling.
|
Apixaban is relatively contraindicated in patients with atrial fibrillation and endstage CKD.
|
一名85岁女性，有高血压、房颤、II型糖尿病、高胆固醇血症、CKD IV期（肾小球滤过率15-29 mL/min；基线肌酐2.3）、近期ST段抬高型心肌梗死和骨质疏松病史，正在接受激素替代疗法，因胸痛和呼吸困难返回医院。她的家庭用药包括阿司匹林、氯吡格雷、阿哌沙班和赖诺普利。她表示最近开始使用艾塞那肽（胰高血糖素样肽-1 [GLP-1] 受体激动剂）。患者显示充血性心力衰竭的临床症状。诊断为心包炎。患者接受双氯芬酸用于疼痛控制和呋塞米用于诊断肺水肿。关于该患者，下列哪项陈述是正确的？
|
女性CKD的特征是低雌二醇水平，但雌激素替代可能与肾功能的进行性丧失有关。
|
艾塞那肽是重度CKD患者首选的口服降糖药。
|
雄激素可能通过防止实质性纤维化重塑来保护肾功能。
|
阿哌沙班在房颤和终末期CKD患者中相对禁忌。
| null | null | null | null | null | null | null | null | null | null |
f16aa290-7b11-510c-9737-1537aee4331a
| 4 |
D
| 3 |
An 83-year-old man with obesity, poorly controlled hypertension, hyperlipidemia, type II DM, and nonalcoholic fatty liver disease (NAFLD) presents to the emergency department with abdominal pain, nausea, and vomiting. Vitals are as follows: T 38.3°C, HR 113, BP 81/51, RR 32, Sa O2 94%, and FiO2 0.4. The patient's WBC count is 17, Hgb 12, Plt 102, Na 145, K 3.4, Cl 104, CO2 15, BUN 34, Cr 1.6, INR 1.6, PTT 41, and albumin 2.3. Which of the following statements is true?
|
Hypoalbuminemia is associated with increased perioperative morbidity but not mortality.
|
Preoperative albumin administration in patients with hypoalbuminemia may increase the incidence of AKI.
|
NAFLD lowers the risk of CKD by decreasing renal artery vascular resistance.
|
The patient is at increased risk of thromboembolic complications due to increased circulating levels of vitamin K–dependent and vitamin K–independent clotting factors.
|
一名83岁男性，患有肥胖、控制不良的高血压、高脂血症、II型糖尿病和非酒精性脂肪性肝病（NAFLD），因腹痛、恶心和呕吐来到急诊科。生命体征如下：体温38.3°C，心率113，血压81/51，呼吸频率32，血氧饱和度94%，吸氧浓度0.4。患者的白细胞计数为17，血红蛋白12，血小板102，钠145，钾3.4，氯104，二氧化碳15，尿素氮34，肌酐1.6，国际标准化比值1.6，部分凝血活酶时间41，白蛋白2.3。以下哪项陈述是正确的？
|
低白蛋白血症与围手术期发病率增加有关，但与死亡率无关。
|
在低白蛋白血症患者中，术前给予白蛋白可能增加急性肾损伤的发生率。
|
非酒精性脂肪性肝病通过降低肾动脉血管阻力来降低慢性肾病的风险。
|
由于维生素K依赖和非依赖凝血因子循环水平增加，患者发生血栓栓塞并发症的风险增加。
| null | null | null | null | null | null | null | null | null | null |
d5b48359-6b91-539f-9762-e59c701021f0
| 4 |
B
| 2 |
15. An 87-year-old man with a history of perforated diverticulitis is now transferred to the intensive care unit after a >12 hour operation secondary to prolonged sedation and inability to extubate. The patient's intraoperative anesthetic consisted of propofol and sufentanil infusions. The patient was hypotensive for the majority of the case in the absence of large blood loss, requiring varying degrees of vasopressor infusion support. Which aging related changes to liver/renal physiology/anatomy help explain the patient's clinical presentation?
|
Although absolute liver weight decreases in patients older than 50 years, liver blood flow stays largely constant.
|
Drugs with a high hepatic extraction ratio are less affected by the age-related hepatic enzyme changes compared with drugs with a low hepatic extraction ratio.
|
The geriatric population is relatively protected from drug-induced liver injury because of decreased mitochondrial radical oxygen species production.
|
Changes in the medullary vasculature, increased renin-angiotensin-aldosterone system activity, and increased tubular ammonium ion excretion are key features of renal aging.
|
15. 一名87岁的男性，有穿孔性憩室炎病史，因长时间镇静和无法拔管，在超过12小时的手术后被转入重症监护室。患者的术中麻醉包括丙泊酚和舒芬太尼输注。在没有大量失血的情况下，患者在大部分手术过程中出现低血压，需要不同程度的血管加压药支持。哪些与衰老相关的肝脏/肾脏生理/解剖变化有助于解释患者的临床表现？
|
虽然绝对肝脏重量在50岁以上的患者中减少，但肝脏血流量基本保持不变。
|
与低肝脏提取率的药物相比，高肝脏提取率的药物受年龄相关的肝酶变化影响较小。
|
老年人群由于线粒体自由基氧物种生成减少而相对不易发生药物性肝损伤。
|
髓质血管结构的变化、肾素-血管紧张素-醛固酮系统活性增加和管状铵离子排泄增加是肾脏老化的关键特征。
| null | null | null | null | null | null | null | null | null | null |
85de1549-d4b1-5864-bc98-eb3cbc640315
| 4 |
D
| 2 |
A 72-year-old man is scheduled for an elective ankle fracture repair. He has a history of anxiety and panic attacks. He prefers not to have a nerve block but is concerned that general anesthesia will considerably increase his risk of developing dementia. You decide to do which of the following?
|
Convince the patient that regional anesthesia is a safer option in this case.
|
Suggest a third option—fracture repair under monitored anesthesia care.
|
Agree that general anesthesia increases risk of dementia and address specific concerns about the nerve block.
|
Explain that there is no convincing evidence that general anesthesia increases the risk of dementia.
|
一名72岁的男性计划进行择期踝关节骨折修复手术。他有焦虑和惊恐发作的病史。他不希望进行神经阻滞，但担心全身麻醉会大大增加他患痴呆症的风险。您决定采取以下哪种措施？
|
说服患者在这种情况下区域麻醉是更安全的选择。
|
建议第三种选择——在监测麻醉护理下进行骨折修复。
|
同意全身麻醉增加痴呆风险，并解决关于神经阻滞的具体担忧。
|
解释没有令人信服的证据表明全身麻醉增加痴呆风险。
| null | null | null | null | null | null | null | null | null | null |
514d05d8-8e65-532e-80d7-16f0eee9e00c
| 4 |
A
| 1 |
A 78-year-old woman is participating in a study that is assessing pain perception. A cryoprobe on her forearm is gradually cooled to produce a painful stimulus. She has undergone a similar experiment at the age of 27 years. Compared with the results of the experiment obtained in younger age, the findings are likely to elicit which of the following?
|
Increased pain threshold but decreased pain tolerance
|
Unchanged pain threshold and pain tolerance
|
Decreased pain threshold and tolerance
|
Prominent local vasodilatation due to cold-reacting agglutinins
|
一名78岁的女性正在参与一项评估疼痛感知的研究。她前臂上的冷冻探针逐渐冷却以产生疼痛刺激。她在27岁时进行过类似的实验。与年轻时获得的实验结果相比，以下哪项是可能的发现？
|
疼痛阈值增加但疼痛耐受性降低
|
疼痛阈值和疼痛耐受性不变
|
疼痛阈值和耐受性降低
|
由于冷反应凝集素引起的显著局部血管扩张
| null | null | null | null | null | null | null | null | null | null |
f1e3429d-17e2-57b1-b689-376e7c7d5db3
| 4 |
A
| 2 |
A 71-year-old man is scheduled for elective surgical removal of a posterior neck cyst. He is overall healthy but reports occasional dizziness when sitting up in bed after he wakes up in the morning. Of the following choices, which is the most likely the cause of his dizziness in light of his age?
|
Decreased baroreceptor reflex
|
Decreased sympathetic system activity
|
Decreased venous capacitance
|
Decreased brain volume
|
一名71岁的男性计划进行择期手术切除颈后囊肿。他总体健康，但报告早上醒来坐起时偶尔感到头晕。在以下选项中，考虑到他的年龄，哪一个最可能是他头晕的原因？
|
减弱的压力感受器反射
|
交感神经系统活动减少
|
静脉容量减少
|
脑容量减少
| null | null | null | null | null | null | null | null | null | null |
6a78305f-1b05-5cc4-aa86-3e7e4f941aa0
| 4 |
D
| 3 |
A 73-year-old woman is scheduled for hip arthroplasty. She has a history of hypertension, hyperlipidemia, depression, and type 2 DM. She mentions that after a cholecystectomy 3 years ago, as she was recovering in PACU, she saw another elderly patient who was "acting crazy." She asks you if she will "act crazy" after her surgery. Of the following choices, which statement is the most appropriate reply in response to her concerns?
|
This is unlikely to happen, as she has an excellent mental status before surgery.
|
It is uncommon for patients who are fit enough to undergo a hip arthroplasty to have postoperative delirium.
|
If she develops postoperative delirium, you expect it to resolve quickly.
|
She may have postoperative delirium, which can affect her recovery from surgery.
|
一名73岁的女性计划进行髋关节置换术。她有高血压、高脂血症、抑郁症和2型糖尿病的病史。她提到，3年前胆囊切除术后，在PACU恢复时，她看到另一位老年患者“表现得很疯狂”。她问你，她在手术后是否会“表现得很疯狂”。在以下选项中，哪种说法是对她担忧的最合适的回答？
|
这种情况不太可能发生，因为她在手术前的精神状态非常好。
|
对于身体状况足以进行髋关节置换术的患者来说，术后谵妄是不常见的。
|
如果她出现术后谵妄，你预计它会很快消退。
|
她可能会出现术后谵妄，这可能会影响她的术后恢复。
| null | null | null | null | null | null | null | null | null | null |
8d4cef02-867a-59a1-9ffa-f79e750a5c65
| 4 |
B
| 1 |
20. Which of the following lung volumes, or combination of lung volumes, changes most significantly over the lifetime of an adult?
|
Total lung capacity (TLC)
|
Closing capacity (CC)
|
Functional residual capacity (FRC)
|
Tidal volume
|
20. 以下哪种肺容量或肺容量组合在成年人的一生中变化最显著？
|
总肺容量 (TLC)
|
闭合容量 (CC)
|
功能残气量 (FRC)
|
潮气量
| null | null | null | null | null | null | null | null | null | null |
ec718f37-2172-5a25-835b-3c3bab563825
| 4 |
A
| 1 |
Which of the following statements regarding oxygenation and ventilation in the elderly is false?
|
The resting PaO2 in a 20-year-old is similar to that in an 80-year-old.
|
They have a decreased ventilatory response to hypercapnia.
|
They have a decreased ventilatory response to hypoxia.
|
The muscles of the upper airway atrophy.
|
以下关于老年人氧合和通气的说法中哪一项是错误的？
|
20岁时的静息PaO2与80岁时相似。
|
他们对高碳酸血症的通气反应降低。
|
他们对低氧血症的通气反应降低。
|
上呼吸道肌肉萎缩。
| null | null | null | null | null | null | null | null | null | null |
c4b1ed80-7943-5a37-a2eb-00a34b14e7b5
| 4 |
D
| 1 |
All of the following statements regarding oxygenation and ventilation in the elderly (as compared with the average adult) are correct EXCEPT which one?
|
FEV1 (forced expiratory volume in 1 s) is decreased.
|
Diffusing capacity is decreased.
|
The amount of physiologic dead space is increased.
|
Their ventilation/perfusion matching is relatively preserved.
|
以下关于老年人（与普通成年人相比）的氧合和通气的陈述都是正确的，除了哪一个？
|
FEV1（一秒钟用力呼气量）减少。
|
弥散能力降低。
|
生理无效腔量增加。
|
他们的通气/灌注匹配相对保持。
| null | null | null | null | null | null | null | null | null | null |
f456be80-a9c9-5870-a11d-2692fcbf65f6
| 4 |
C
| 1 |
All of the following changes in respiratory mechanics are seen in the geriatric population EXCEPT which one?
|
Decreased compliance of the chest wall
|
Increased compliance of the lung parenchyma
|
Increased curvature of the diaphragm
|
Decreased mass of accessory muscles
|
老年人群中呼吸力学的所有以下变化中，除了哪一项？
|
胸壁顺应性降低
|
肺实质顺应性增加
|
膈肌弯曲度增加
|
辅助肌肉质量减少
| null | null | null | null | null | null | null | null | null | null |
062f2b50-8562-5038-9144-18745711dedd
| 4 |
C
| 1 |
The pattern that most accurately describes the change in CC over time starting from age 30 years and progressing to age 80 years is which of the following?
|
An asymptotic increase, followed by a plateau
|
An exponential increase
|
An approximately linear increase
|
An approximately linear, steep increase until middle age (50 y old), followed by a more gradual decrease
|
从30岁开始到80岁，CC随时间变化的模式最准确地描述为以下哪一项？
|
渐近增加，然后达到平台期
|
指数增加
|
大约线性增加
|
大约线性、陡峭增加到中年（50岁），然后逐渐减少
| null | null | null | null | null | null | null | null | null | null |
b5895c05-be57-5ad6-8e60-dab619472991
| 4 |
D
| 1 |
The increase in CC seen with aging can BEST be attributed to which of the
|
A relatively more positive intrapleural pressure compressing alveoli
|
A functional extrathoracic large airway obstruction
|
The loss of cartilage from large airways
|
The loss of elastin from surrounding tissues, which once tethered open small airways
|
随着年龄增长，CC的增加最主要可以归因于以下哪一项
|
相对更正的胸膜内压压迫肺泡
|
功能性胸外大气道阻塞
|
大气道软骨的丧失
|
周围组织弹性蛋白的丧失，曾经将小气道牵开
| null | null | null | null | null | null | null | null | null | null |
d5163a31-629f-5332-b8c2-35f7fc624448
| 5 |
C
| 2 |
All of the following patients with respiratory failure may be candidates for noninvasive positive pressure ventilation (NIPPV) EXCEPT which one?
|
Decompensated heart failure and SpO2 85% on room air
|
HIV-positive patient with bilateral opacities on chest X-Ray and PaO2 /FiO2 150
|
Urosepsis requiring norepinephrine with tachypnea and SpO2 90% on 6 L nasal cannula
|
Acute chronic obstructive pulmonary disease (COPD) exacerbation and PaCO2 70 mm Hg
|
以下所有呼吸衰竭患者都可能是无创正压通气（NIPPV）的候选者，除了哪一个？
|
失代偿性心力衰竭，室内空气下SpO2 85%
|
HIV阳性患者，胸部X光片显示双侧阴影，PaO2/FiO2 150
|
尿路感染性休克需要去甲肾上腺素，伴有呼吸急促和6升鼻导管下SpO2 90%
|
急性慢性阻塞性肺疾病（COPD）加重，PaCO2 70 mm Hg
|
Immediately following extubation in a patient at high risk for reintubation
|
拔管后立即在高风险再插管的患者
| null | null | null | null | null | null | null | null |
052b846d-6362-59b0-b3fb-f77bbad32f4b
| 5 |
D
| 3 |
You are called to intubate a patient with a COPD exacerbation. Following intubation, you confirm bilateral breath sounds and presence of carbon dioxide by capnogram. You manually ventilate with an Ambu bag while waiting for the ventilator circuit. The automated blood pressure cuff is unable to read a blood pressure, and the pulse oximeter tracing is lost while the blood pressure cuff repeatedly cycles on the ipsilateral arm. ECG shows sinus bradycardia in the 60s. You are unable to palpate a carotid pulse. Your team initiates chest compressions and administers epinephrine. Which of the following is the next maneuver?
|
Increase minute ventilation.
|
Remove endotracheal tube and reintubate.
|
Needle decompression in second intercostal space.
|
Disconnect patient from Ambu bag.
|
你被叫去为一位COPD急性加重的患者插管。插管后，你通过听诊双侧呼吸音和二氧化碳波形图确认气管插管位置正确。在等待呼吸机回路时，你用Ambu袋手动通气。自动血压袖带无法读取血压，脉搏血氧仪的波形消失，而血压袖带在同侧手臂上反复循环。心电图显示窦性心动过缓，心率在60次左右。你无法触及颈动脉搏动。你的团队开始胸外按压并给予肾上腺素。以下哪项是下一步措施？
|
增加分钟通气量。
|
移除气管插管并重新插管。
|
在第二肋间隙进行针刺减压。
|
将患者与Ambu袋断开连接。
|
Place an arterial line.
|
放置动脉导管。
| null | null | null | null | null | null | null | null |
e76ec597-c1d7-5f92-b7da-10f157dcaf09
| 5 |
C
| 2 |
A patient with acute respiratory distress syndrome (ARDS) is being mechanically ventilated with the following settings on volume control ventilation: tidal volume 480 cc, respiratory rate 20 breaths per minute, PEEP (positive end-expiratory pressure) 12 cm H2O, FiO2 50%, plateau pressure 33 cm H2O, and peak inspiratory pressure 35 cm H2O. His ideal body weight is 70 kg. The most recent arterial blood gas test shows PaO2 80 mm Hg, PaCO2 48 mm Hg, and pH 7.33. What change should you make to the ventilator settings?
|
No change.
|
Decrease PEEP.
|
Decrease tidal volume.
|
Increase FiO2 .
|
一名患有急性呼吸窘迫综合征（ARDS）的患者正在使用容量控制通气进行机械通气，设置如下：潮气量480毫升，呼吸频率每分钟20次，PEEP（呼气末正压）12 cm H2O，FiO2 50%，平台压33 cm H2O，峰值吸气压35 cm H2O。他的理想体重是70公斤。最近的动脉血气检查显示PaO2 80 mm Hg，PaCO2 48 mm Hg，pH 7.33。你应该对呼吸机设置做出什么改变？
|
不做改变。
|
降低PEEP。
|
降低潮气量。
|
增加FiO2。
|
Switch to pressure support ventilation.
|
切换到压力支持通气。
| null | null | null | null | null | null | null | null |
e4135283-4800-5ade-b4c6-4ea92906c14b
| 5 |
E
| 1 |
4. When preparing to extubate an ICU patient, all of the following criteria should be met EXCEPT which one?
|
Rapid shallow breathing index (RSBI) of less than 100
|
Minimal secretions
|
Presence of cuff leak
|
Successful spontaneous breathing trial (SBT) lasting 30 minutes using continuous positive airway pressure of 5 cm H2O
|
4. 在准备拔除ICU患者的气管插管时，以下所有标准都应满足，除了哪一项？
|
快速浅呼吸指数（RSBI）小于100
|
分泌物少
|
存在套囊漏气
|
成功的自发呼吸试验（SBT）持续30分钟，使用5 cm H2O的持续气道正压
|
Ability to follow commands
|
能够遵循指令
| null | null | null | null | null | null | null | null |
f4598c43-29c6-52d4-98da-20b122a5af11
| 5 |
A
| 3 |
Which of the following hypotensive patients could potentially show improvement in their hemodynamics with the administration of positive pressure ventilation?
|
Large myocardial infarction in left anterior descending territory
|
Acute liver failure (ALF)
|
Acute pulmonary embolism
|
Induction of anesthesia
|
以下哪位低血压患者在给予正压通气后可能会改善其血流动力学？
|
左前降支区域的大面积心肌梗死
|
急性肝功能衰竭（ALF）
|
急性肺栓塞
|
麻醉诱导
|
Sepsis
|
败血症
| null | null | null | null | null | null | null | null |
60fa98ba-7690-51c3-895a-dd3654986d12
| 5 |
C
| 1 |
What is the static thoracic compliance on the following volume control ventilation settings?
|
18 mL/cm H2O
|
22 mL/cm H2O
|
30 mL/cm H2O
|
33 mL/cm H2O
|
在以下容量控制通气设置中，静态胸腔顺应性是多少？
|
18 mL/cm H2O
|
22 mL/cm H2O
|
30 mL/cm H2O
|
33 mL/cm H2O
|
50 mL/cm H2O
|
50 mL/cm H2O
| null | null | null | null | null | null | null | null |
b9e68c38-bb74-5de7-8ef5-84f7a414aca1
| 5 |
B
| 1 |
Which of the following differentiates pressure support from assist-control pressure control ventilation?
|
Delivered tidal volume increases with increased patient effort.
|
Cycling depends on change in inspiratory flow.
|
Ability of a patient to trigger breaths.
|
Lung injury is unlikely on pressure support ventilation.
|
以下哪项区别了压力支持通气与辅助控制压力控制通气？
|
随着患者努力增加，送达的潮气量增加。
|
循环取决于吸气流量的变化。
|
患者触发呼吸的能力。
|
在压力支持通气下，肺损伤不太可能发生。
|
Delivered tidal volume depends on thoracic compliance.
|
送达的潮气量取决于胸腔顺应性。
| null | null | null | null | null | null | null | null |
f397d702-bf73-5c06-92f8-69b5ec816ec9
| 5 |
D
| 1 |
Which of the following parameters determines the tidal volume delivered in volume control ventilation?
|
Peak inspiratory pressure
|
Lung compliance
|
Airway resistance
|
Inspiratory flow
|
在容量控制通气中，以下哪个参数决定了潮气量的输送？
|
吸气峰压
|
肺顺应性
|
气道阻力
|
吸气流量
|
Patient effort
|
患者努力
| null | null | null | null | null | null | null | null |
26f4fcad-c0a1-5ba9-9e29-51bae7d2c36b
| 5 |
B
| 1 |
All of the following interventions are recommended to reduce the risk of ventilator-associated pneumonia (VAP) EXCEPT which one?
|
Elevation of head of bed at least 30°
|
Early tracheostomy
|
Daily SBTs
|
Noninvasive positive pressure ventilation
|
以下所有干预措施均建议用于降低呼吸机相关性肺炎（VAP）的风险，除了哪一项？
|
将床头抬高至少30°
|
早期气管切开
|
每日自发呼吸试验（SBT）
|
无创正压通气
|
Minimizing sedation
|
最小化镇静
| null | null | null | null | null | null | null | null |
f28a8bcc-e6c7-596e-94ad-6924315888b5
| 5 |
D
| 1 |
Which of the following statements regarding catheter-related bloodstream infections (CRBSIs) is true?
|
Central venous catheters (CVCs) should be replaced weekly.
|
CRBSI is diagnosed when blood cultures drawn from the catheter are positive.
|
Arterial lines carry a negligible risk of CRBSI.
|
Skin preparation with chlorhexidine/alcohol is more effective than povidone iodine in preventing CRBSI.
|
以下关于导管相关血流感染（CRBSI）的说法哪一项是正确的？
|
中心静脉导管（CVC）应每周更换一次。
|
当从导管抽取的血培养呈阳性时，诊断为CRBSI。
|
动脉导管的CRBSI风险可以忽略不计。
|
使用氯己定/酒精进行皮肤准备比使用聚维酮碘更能有效预防CRBSI。
|
The most common pathogens in CRBSI are gram-negative rods.
|
CRBSI中最常见的病原体是革兰氏阴性杆菌。
| null | null | null | null | null | null | null | null |
0cf3063c-eece-54ff-97e8-efc71d7b0bbf
| 5 |
B
| 2 |
Which of the following is an acceptable indication for replacing a CVC over a guidewire?
|
Replacing a CVC that was emergently placed without maximum barrier precautions
|
Loss of blood return
|
After 14 days of catheter use
|
Fever
|
以下哪项是通过导丝更换中心静脉导管（CVC）的可接受指征？
|
更换在紧急情况下未使用最大屏障预防措施放置的CVC
|
失去回血
|
导管使用14天后
|
发热
|
CVC should never be replaced over a guidewire
|
CVC绝不应通过导丝更换
| null | null | null | null | null | null | null | null |
4b4944b0-7b42-5279-a9bd-9ef4c68b64b9
| 5 |
E
| 1 |
14. Which of the following statements regarding catheter-associated urinary tract infection (CAUTI) is true?
|
External urinary catheters have similar rates of complications compared with indwelling catheters.
|
Asymptomatic catheter-associated bacteriuria should be treated to reduce the risk of developing systemic infection.
|
Intermittent catheterization does not reduce the risk of CAUTI.
|
Indwelling catheters should be replaced at regular intervals to reduce the risk of CAUTI.
|
14. 关于导尿管相关尿路感染（CAUTI），以下哪项陈述是正确的？
|
外部导尿管与留置导尿管的并发症发生率相似。
|
无症状的导尿管相关菌尿应进行治疗以降低发生全身感染的风险。
|
间歇性导尿不能降低CAUTI的风险。
|
留置导尿管应定期更换以降低CAUTI的风险。
|
Screening for bacteriuria is not effective in reducing CAUTI.
|
筛查菌尿对减少CAUTI无效。
| null | null | null | null | null | null | null | null |
596a2197-363a-5a6e-84c9-b485251fb840
| 5 |
C
| 1 |
Alcohol-based hand rubs are effective in removing all of the following pathogens EXCEPT which one?
|
Methicillin-resistant Staphylococcus aureus (MRSA)
|
Vancomycin-resistant enterococci
|
Clostridium difficile
|
Mycobacterium tuberculosis (MTB)
|
酒精类手消毒剂对去除以下所有病原体有效，除了哪一个？
|
耐甲氧西林金黄色葡萄球菌 (MRSA)
|
耐万古霉素肠球菌
|
艰难梭菌
|
结核分枝杆菌 (MTB)
|
They are effective for all pathogens
|
对所有病原体都有效
| null | null | null | null | null | null | null | null |
ab9d38e7-88b5-5211-a675-c2cee23c89e9
| 5 |
D
| 1 |
All of the following statements regarding Clostridium difficile prevention are true EXCEPT which one?
|
Tighter regulations on antibiotic use have decreased the incidence of C. difficile.
|
Only chlorine-containing cleaning products should be used for environmental decontamination.
|
Monotherapy with metronidazole is appropriate for mild cases of C. difficile.
|
Contact precautions can be lifted when diarrhea resolves.
|
关于艰难梭菌预防的以下所有陈述都正确，除了哪一个？
|
对抗生素使用的更严格规定已减少艰难梭菌的发生率。
|
只有含氯的清洁产品应用于环境去污。
|
甲硝唑单药治疗适用于轻度艰难梭菌病例。
|
当腹泻消失时可以解除接触预防措施。
|
Limiting acid suppression therapy can reduce the risk of C. difficile.
|
限制酸抑制疗法可以降低艰难梭菌的风险。
| null | null | null | null | null | null | null | null |
2428e814-f3b5-5f76-afaf-7101df27ac1b
| 5 |
C
| 1 |
Which of the following personal protective equipment items (PPEs) is sufficient for a provider to wear before performing endotracheal intubation?
|
Goggles
|
Mask
|
Face shield
|
Gown
|
以下哪种个人防护装备（PPE）足以让医护人员在进行气管插管前穿戴？
|
护目镜
|
口罩
|
面罩
|
防护服
|
No PPE required if low suspicion for respiratory infection
|
如果对呼吸道感染的怀疑较低，则不需要佩戴任何PPE
| null | null | null | null | null | null | null | null |
f7099fbd-773b-5fe0-b832-d0bf0aa74069
| 5 |
D
| 1 |
An HIV-positive patient is admitted to the ICU with respiratory failure requiring intubation. Mycobacterium tuberculosis (MTB) disease is suspected. All of the following statements regarding MTB precautions are true EXCEPT which one?
|
The patient should be placed in a negative-pressure isolation room.
|
Empiric therapy for MTB disease with a 4-drug regimen should be initiated immediately.
|
Contact precautions are not necessary.
|
Airborne precautions can be discontinued if a tuberculin skin test is negative.
|
一名HIV阳性患者因呼吸衰竭需要插管而被送入ICU。怀疑是结核分枝杆菌（MTB）感染。以下关于MTB预防措施的陈述中，除了哪一项外，其他都是正确的？
|
患者应被安置在负压隔离病房。
|
应立即开始使用四种药物的经验性治疗方案治疗MTB疾病。
|
不需要接触预防措施。
|
如果结核菌素皮肤试验为阴性，可以停止空气传播预防措施。
|
A bacterial filter should be placed on the ventilator circuit.
|
应在呼吸机回路上安装细菌过滤器。
| null | null | null | null | null | null | null | null |
c892416a-c1ae-589d-977d-7dd0948807df
| 5 |
B
| 2 |
While caring for a patient with acute hepatitis B virus (HBV), an anesthesia resident sustains a needle stick injury. The resident received the HBV vaccine series as an adolescent. Which of the following is true regarding his need for postexposure prophylaxis for HBV?
|
He does not require any HBV prophylaxis or further testing because he has been vaccinated.
|
Anti-HBs titers should be checked.
|
His risk of acquiring HBV is 30%.
|
He should receive 1 dose of hepatitis B immune globulin and be revaccinated.
|
在照顾一名急性乙型肝炎病毒（HBV）患者时，一名麻醉科住院医师遭遇针刺伤。该住院医师在青少年时期接种过HBV疫苗系列。关于他对HBV暴露后预防的需求，下列哪项是正确的？
|
他不需要任何HBV预防或进一步检测，因为他已经接种过疫苗。
|
应检查抗HBs滴度。
|
他感染HBV的风险是30%。
|
他应接受1剂乙型肝炎免疫球蛋白并重新接种疫苗。
|
He should undergo baseline testing for anti-HBc now and repeat testing at 6 months.
|
他现在应进行抗HBc基线检测，并在6个月后重复检测。
| null | null | null | null | null | null | null | null |
89d9c8b1-f9ae-5b1d-bbf1-7c7e921f9fec
| 5 |
C
| 2 |
20. A 75-year-old man presents with fever, cough, and infiltrate on chest X-ray. His oxygen saturation is 90% on room air and he is subsequently admitted to the floor for treatment of a presumed pneumonia. He was previously healthy except for hypertension and has not had recent hospital admissions or antibiotic therapy. He has no smoking history. Which of the following empiric antibiotic regimens is appropriate while awaiting the results of sputum culture?
|
Vancomycin and cefepime
|
Piperacillin/tazobactam monotherapy
|
Ceftriaxone and azithromycin
|
Meropenem and levofloxacin
|
20. 一名75岁男性出现发热、咳嗽和胸部X光片显示浸润。他在室内空气中的氧饱和度为90%，随后因疑似肺炎被收治入院。他之前除了高血压外身体健康，最近没有住院或抗生素治疗史。他没有吸烟史。在等待痰培养结果期间，以下哪种经验性抗生素方案是合适的？
|
万古霉素和头孢吡肟
|
哌拉西林/他唑巴坦单药治疗
|
头孢曲松和阿奇霉素
|
美罗培南和左氧氟沙星
|
Vancomycin, piperacillin/tazobactam, and fluconazole
|
万古霉素、哌拉西林/他唑巴坦和氟康唑
| null | null | null | null | null | null | null | null |
54b88f84-61ad-5506-b1ed-c27e598ecc1a
| 5 |
B
| 2 |
Additional echocardiography views reveal McConnell sign. Which of the following is the next step in the management of this patient?
|
Cardiac catheterization
|
Systemic fibrinolytic therapy
|
Rapid infusion of 2 L crystalloid
|
Initiation of heparin infusion
|
额外的超声心动图视图显示麦康奈尔征。以下哪项是该患者管理的下一步？
|
心脏导管插入术
|
全身纤溶治疗
|
快速输注2升晶体液
|
开始肝素输注
|
CT scan
|
CT扫描
| null | null | null | null | null | null | null | null |
1e1739f3-18d1-5159-ac64-e121cd256f7e
| 5 |
B
| 2 |
Which of the following is the next step with regard to the appropriate management of this patient's immediate problem?
|
Pericardiocentesis
|
Immediately returning to OR for redo sternotomy
|
Rapid fluid bolus
|
Ordering a transesophageal echocardiography for further evaluation
|
以下哪项是针对该患者当前问题的适当管理的下一步措施？
|
心包穿刺
|
立即返回手术室进行再次胸骨切开术
|
快速输液
|
为进一步评估订购经食道超声心动图
|
Cardiac catheterization
|
心脏导管插入术
| null | null | null | null | null | null | null | null |
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