An asymptomatic 38-year-old woman is scheduled for elective cesarean delivery. The preoperative EKG shows left axis deviation that was not present one year ago. The most appropriate next step is to
(A) postpone the procedure and consult a cardiologist
(B) postpone the procedure and obtain an echocardiogram
(C) proceed with the procedure after administration of digitalis
(D) proceed with the procedure but avoid inhalational agents
(E) proceed without intervention since this is a normal finding
A 33-year-old woman is scheduled for emergency appendectomy under general anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope in the past year. Which of the following statements concerning anesthetic management is true?
(A) Spinal anesthesia is preferred to general anesthesia
(B) Deep levels of isoflurane anesthesia are appropriate
(C) Fluid administration should be restricted
(D) Phenylephrine is preferred to ephedrine to treat hypotension
(E) Positive end-expiratory pressure will decrease left ventricular outflow obstruction
An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate initial management is
(A) a benzodiazepine as needed and at bedtime
(B) an oxycodone preparation as needed and a tricyclic antidepressant at bedtime
(C) intravenous patient-controlled analgesia
(D) morphine infusion via an implanted epidural catheter
A 19-year-old college student is brought to the emergency department cyanotic and incoherent. Respiratory rate is 48/min, pulse is 140 bpm, and blood pressure is 140/85 mmHg. The only history obtainable is that he was at a party and suddenly felt sick. Cyanosis persists despite administration of pure oxygen by mask. A venous blood sample is chocolate-brown. The action most beneficial to the patient is to
(A) intubate the trachea and control ventilation
(B) perform bronchoscopy to treat foreign body aspiration
(C) obtain a pulmonary ventilation-perfusion scan
(D) administer methylene blue intravenously
(E) administer thiosulfate in normal saline solution intravenously
A 1150-g, 10-day-old infant is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200 bpm and blood pressure measured through a femoral artery catheter is 45/24 mmHg. The most appropriate next step is administration of