10 Random Questions
A patient with alcoholic cirrhosis, ascites, and gastrointestinal bleeding receives 4 units of red blood cells prior to anesthesia with isoflurane in oxygen for emergency exploratory laparotomy. After the peritoneum is opened and the fluid is drained, blood pressure decreases to 60/40 mmHg and SpO2 decreases to 90%. The most likely cause of the hypoxemia is
- (A) acute myocardial ischemia
- (B) decreased 2,3-diphosphoglycerate in transfused blood
- (C) increased intrapulmonary shunting
- (D) relative hypovolemia
- (E) venous air embolism
Which of the following statements concerning functional residual capacity is true?
- (A) It decreases linearly during a three-hour anesthetic
- (B) It decreases in pregnancy primarily because of a decrease in the expiratory reserve volume
- (C) It increases in patients with a history of heavy smoking
- (D) It increases with pulmonary contusions
- (E) It is smaller (ml/kg) in children than in adults
Which of the following factors is the major cause of hypotension following release of the infrarenal aortic cross-clamp during aortic reconstruction?
- (A) Abnormal myocardial function
- (B) Decreased systemic vascular resistance
- (C) Down-regulation of adrenergic receptors
- (D) Increased PaCO2
- (E) Suppression of the renin-angiotensin system
After the first 70 minutes of a transurethral resection of the prostate, a 70-year-old man becomes confused and has tachycardia, hypertension, and shortness of breath. Serum sodium concentration is 116 mEq/L. After informing the surgeon that the procedure should be terminated as soon as possible, the most appropriate next step would be to
- (A) administer furosemide
- (B) administer labetalol
- (C) administer 3% sodium chloride
- (D) change the irrigating solution to normal saline
- (E) induce general endotracheal anesthesia
A full-term neonate has physical findings suggestive of congenital diaphragmatic hernia. Initial Apgar score is 2. Which of the following is the most appropriate initial management?
- (A) Placement of an orogastric tube
- (B) Insertion of a chest tube
- (C) Controlled ventilation by face mask
- (D) Controlled ventilation through an endotracheal tube
- (E) Spontaneous ventilation through an endotracheal tube
Twenty minutes after thiopental induction for femoral herniorrhaphy, a 34-year-old woman is breathing spontaneously and receiving nitrous oxide-oxygen (2 liters each) and enflurane 3% by face mask. Pulse is 90 bpm, blood pressure is 80/60 mmHg, end-tidal enflurane concentration is 2%, and end-tidal carbon dioxide tension is 48 mmHg. Which of the following is most likely to occur on skin incision?
- (A) Pupillary dilation
- (B) Laryngeal stridor
- (C) Gross muscular movement
- (D) Increased blood pressure
- (E) No response
When performed with identical doses, which of the following types of regional block is associated with the highest plasma concentration of the drug?
- (A) Brachial plexus
- (B) Caudal
- (C) Intercostal
- (D) Subcutaneous infiltration
- (E) Thoracic epidural
Proper handling of oxygen cylinders includes
- (A) maintenance of storage room temperature above 60°F
- (B) separate storage rooms for nitrous oxide and oxygen
- (C) opening the cylinder valve just sufficiently to register tank pressure accurately
- (D) storage in a room with conductive flooring
- (E) opening the cylinder valve briefly before attachment to the anesthesia machine
An otherwise healthy 20-year-old man undergoes laser surgery for vocal cord polyp removal. During jet ventilation with 100% oxygen, arterial blood gas analysis shows PaO2 90 mmHg, PaCO2 40 mmHg, and pH 7.40. Which of the following is the most likely explanation?
- (A) Aspiration of gastric contents
- (B) Atelectasis
- (C) Pneumothorax
- (D) Pulmonary embolism
- (E) Room air entrainment
A 68-year-old man with stable angina treated with propranolol and nifedipine is scheduled for coronary artery bypass grafting. After induction with fentanyl and tracheal intubation, heart rate decreases to 40 bpm and blood pressure decreases to 70/40 mmHg. The ECG is shown. Which of the following is the most appropriate first step in management?
- (A) Infusion of isoproterenol
- (B) Administration of phenylephrine
- (C) Closed chest cardiopulmonary resuscitation
- (D) Defibrillation
- (E) Synchronized cardioversion