10 Random Questions
The following breath sounds are heard after placement of a left-sided double-lumen endobronchial tube. The most likely cause of these findings is
- (A) presence of both lumens in the right mainstem bronchus
- (B) presence of both lumens in the left mainstem bronchus
- (C) presence of both lumens in the trachea
- (D) herniation of the bronchial cuff at the bifurcation of the trachea
- (E) presence of the bronchial lumen in the right mainstem bronchus
A moderately obese 38-year-old woman is using patient-controlled morphine analgesia one day after open cholecystectomy. While breathing room air, oxygen saturation is 85%, Pa02 is 48 mmHg, PaC02 is 42 mmHg, and pH is 7.36. In addition to administration of oxygen, the most effective management is to
- (A) decrease the dosage of opioids
- (B) change to epidural morphine
- (C) administer an inhaled bronchodilator
- (D) initiate 4 cm of nasal continuous positive airway pressure
- (E) initiate incentive spirometry therapy
In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will
- (A) increase slightly because of decreased shunt blood flow
- (B) decrease slightly because of decreased mixed venous PO2
- (C) increase because of decreased affinity of hemoglobin for oxygen
- (D) decrease because of an increased dead space to tidal volume ratio
- (E) increase because of increased pulmonary oxygen uptake per milliliter of blood
A 30-year-old primiparous woman delivered a healthy infant by cesarean section during uneventful spinal anesthesia with tetracaine 10 mg in 2 ml of 5% dextrose solution. Twelve hours after delivery she has bilateral loss of pain and temperature sensibility, but not touch, below T8 and paralysis of both legs. The most likely cause of this complication is
- (A) chemical arachnoiditis
- (B) injection of tetracaine into the spinal cord
- (C) demyelination of the posterior tracts
- (D) thrombosis of the anterior spinal artery
- (E) cord transection from spondylolisthesis
A 31-year-old man received an uneventful epidural anesthetic for arthroscopy of the knee and meniscectomy. Twenty-four hours later he still has painless flaccid paralysis in both legs. This clinical presentation is most consistent with
- (A) adhesive arachnoiditis
- (B) anterior spinal artery thrombosis
- (C) epidural abscess
- (D) epidural hematoma
- (E) transverse myelitis
A patient has sudden cardiopulmonary arrest five minutes after retrobulbar block with 0.75% bupivacaine 2 ml with hyaluronidase for ophthalmologic surgery. No premonitory changes were noted on the pulse oximeter. The most likely cause is
- (A) allergic reaction to hyaluronidase
- (B) direct cardiac toxicity
- (C) oculocardiac reflex
- (D) intravenous injection of local anesthetic
- (E) subarachnoid injection of local anesthetic
Compared with the adult airway, the neonatal airway has which of the following characteristics?
- (A) More cephalad larynx
- (B) Narrowest diameter at the vocal cords
- (C) Relatively smaller epiglottis
- (D) Smaller tongue relative to the size of the oral cavity
- (E) Vocal cords perpendicular to the trachea
In a patient who is breathing spontaneously, the work of breathing increases with each of the following EXCEPT
- (A) decreased compliance
- (B) decreased vital capacity
- (C) increased carbon dioxide production
- (D) increased respiratory rate
- (E) increased dead space
Which of the following is most indicative of reflex sympathetic dystrophy?
- (A) Dry skin
- (B) Dull pain that improves with movement
- (C) Fasciculations
- (D) Motor weakness
- (E) Pallor and cyanosis
During apneic oxygenation (FiO2 1.0) through a rigid bronchoscope
- (A) duration of the procedure is limited by the increase in PaCO2
- (B) functional residual capacity decreases 5%/min
- (C) PaO2 remains unchanged for the first 5 minutes
- (D) PaCO2 increases 2 to 6 mmHg/min for 15 minutes and then reaches a plateau
- (E) PaO2 and PaCO2 equilibrate with mixed venous gases at the same rate