A 26-year-old man is in the ICU one hour after sustaining a displaced cervical fracture at the level of C7-8 in a diving accident. Each of the following findings is consistent with this patient's injury EXCEPT
(A) bilateral paralysis of the vocal cord adductors
(B) gastric dilatation
(C) hypotension without tachycardia
(D) inward movement of the chest with inspiration
(E) normal tidal volume
A
In the absence of coronary artery disease, isoflurane-induced vasodilation and tachycardia are beneficial hemodynamic goals for which of the following cardiac diseases?
The odor of isoflurane is noted during isoflurane anesthesia with an endotracheal tube and mechanical ventilation. Mean airway pressure is unchanged. A scavenging system with an open interface and an active disposal system is being used. The most likely cause of the isoflurane odor is
(A) a leak in the inspiratory limb of the anesthesia circuit
(B) application of excessive negative pressure to the scavenging interface
(C) malfunction of the pop-off valve of the anesthesia machine
(D) obstruction of the gas disposal tubing leading from the scavenging interface
(E) obstruction of the transfer tubing to the scavenging interface
D
Six hours after coronary artery bypass grafting, a pulmonary artery catheter oximeter shows a mixed venous hemoglobin oxygen saturation of 50%. This value may result from each of the following EXCEPT
A 65-year-old man has a history of alcohol abuse. Which of the following preoperative serum concentrations would provide the best assessment of synthetic hepatic function?
A 30-kg patient with asthma is receiving general anesthesia and being mechanically ventilated with a measured tidal volume of 300 mL. Increasing the fresh gas flow from 3 L/min to 9 L/min without changing the ventilatory rate or I:E ratio will result in
Pulmonary artery diastolic pressure increases acutely from 10 to 20 mmHg in a 28-year-old man undergoing cervical laminectomy in the sitting position. The most appropriate first step in the management of this patient is to
(A) administer furosemide
(B) aspirate from the proximal port of the pulmonary artery catheter
(C) inflate the balloon on the pulmonary artery catheter
(D) place the patient in the left lateral decubitus position
(E) start an infusion of nitroglycerin
B
Evaluation of a postoperative neurologic deficit discloses inability to oppose the thumb and little finger, weakness of abduction of the thumb, and loss of flexion of the distal phalanx of the index finger. This problem is most likely related to
(A) paresthesia occurring during an interscalene brachial plexus block
(B) attempted radial artery cannulation at the wrist
(C) inadequate padding under the elbow
(D) attempted venipuncture in the antecubital fossa
(E) abduction of the upper humerus against an "ether screen"
D
The most likely cause of a fetal heart rate pattern of variable decelerations to 90 bpm is
A healthy patient is receiving general endotracheal anesthesia with nitrous oxide 4 L/min, oxygen 2 L/min, and isoflurane 1% with spontaneous ventilation. The inspiratory breathing hose becomes disconnected from the inspiratory valve. The earliest alarm will be produced by
(A) a pulse oximeter with finger probe set to alarm at 60% saturation
(B) a mass spectrometer set to alarm when no breath is detected for 30 seconds
(C) an oxygen analyzer mounted on the inspiratory valve outlet and set to alarm at 25% oxygen concentration
(D) a capnograph sensor at the Y-piece that alarms when end-tidal carbon dioxide tension is greater than 60