A 22-year-old woman at 33 weeks' gestation has abdominal pain and vaginal bleeding after sustaining blunt trauma to the abdomen. Heart rate is 125 bpm, blood pressure is 98/65 mmHg, and respiratory rate is 20/min. Fetal heart rate is 100 bpm. Which of the following is the most appropriate management?
(A) Conservative observation and monitoring if fetal immaturity is seen on ultrasound
(B) Increasing maternal blood pressure with a vasopressor
(C) Infusion of terbutaline
(D) Lumbar epidural anesthesia
(E) Urgent cesarean delivery
E
A 64-year-old man with a large pancreatic tumor has severe abdominal pain that radiates to the low back. Which of the following is the most appropriate management?
(A) Bilateral LI rhizotomy
(B) Dorsal column stimulation
(C) Hypogastric plexus block
(D) Neurolytic celiac plexus block
(E) Patient-controlled analgesia
D
Which of the following statements concerning the pharmacokinetics of nondepolarizing muscle relaxants is true?
(A) Drugs with a longer duration of action depend on the liver for excretion
(B) Drugs with a shorter duration of action depend primarily on redistribution for recovery
(C) Onset of action is independent of dose
(D) Recovery rate parallels the decrease in plasma relaxant concentration
(E) The shorter the duration of action, the faster the onset
D
A 2.3-kg 1-day-old term infant requires repair of a gastroschisis. Which of the following combinations is most appropriate for intraoperative fluid management?
(A) Dextrose 5% in water for maintenance and lactated Ringer's solution for replacement of third space losses
(B) Dextrose 10% in water for maintenance and lactated Ringer's solution for replacement of third space losses
(C) Lactated Ringer's solution for maintenance and replacement of third space losses
(D) Lactated Ringer's solution for maintenance and albumin 5% for replacement of third space losses
(E) Normal saline solution for maintenance and lactated Ringer's solution for replacement of third space losses
A 66-year-old man with aortic regurgitation is brought to the operating room for aortic valve replacement after having received morphine, scopolamine premedication. PO2 is 40 mmHg in a sample of pulmonary artery blood drawn 10 minutes after the patient started breathing pure oxygen. This finding is compatible with
A 24-year-old man who sustained multiple rib fractures in a motor vehicle accident has air leaks through bilateral chest tubes. Which of the following is most likely following initiation of high-frequency jet ventilation?
(A) Airway pressure will be measured most reliably at the proximal (external) end of the endotracheal tube
(B) Atelectatic areas of the lungs will re-expand
(C) Changes in end-tidal carbon dioxide tension measured at the tip of the endotracheal tube will match changes in PaCOz
(D) Hypercarbia will develop
(E) The air leaks will be proportional to peak airway pressure
E
The last muscle to be affected by an interscalene brachial plexus block is the
To measure the contribution of intrapulmonary shunting to arterial hypoxemia, which of the following measurements are necessary? (Assume normal cardiac output and anatomy.)
(A) PaC02 and PeC02
(B) PaC02 and Pe02 while breathing pure oxygen
(C) Pa02 and Pv02 while breathing pure oxygen
(D) Pa02 while breathing both room air and pure oxygen