10 Random Questions
A 30-year-old man is brought to the emergency department after being rescued from a house fire. With the trachea intubated and FiO2 at 1.0, arterial blood gas values are PaO2 495 mmHg, PaCO2 28 mmHg, and pH 7.28. Hemoglobin saturation measured by co-oximeter is 50%. The most appropriate next step is to
- (A) add positive end-expiratory pressure
- (B) add n-acetylcysteine to the inhaled gases
- (C) administer sodium bicarbonate intravenously
- (D) transfuse 2 units of packed red blood cells
- (E) transfer to a hyperbaric chamber
Which of the following statements concerning the cerebral effects of barbiturates is true?
- (A) Barbiturate coma produces greater cerebral protection than hypothermia to 17 C
- (B) Barbiturate-induced reduction in cerebral blood flow is greater at normocarbia than at hypocarbia
- (C) Barbiturates decrease the cerebral metabolic rate for oxygen by decreasing cerebral blood flow
- (D) Somatosensory evoked potentials and the EEG are equally sensitive to suppression by barbiturates
- (E) When administered in doses sufficient to produce an isoelectric EEG, barbiturates decrease the cerebral metabolic rate for oxygen by 50%
Which of the following is the most likely effect of intramuscular ketamine used for induction of anesthesia in a 2-year-old child undergoing elective surgery?
- (A) Bronchoconstriction
- (B) Decreased heart rate
- (C) Decreased intracranial pressure
- (D) Increased salivation
- (E) Respiratory depression
A patient with low cardiac output following coronary artery bypass grafting is transferred to the intensive care unit where a chest roentgenogram confirms proper placement of the pulmonary artery catheter. Serial pulmonary artery occlusion pressures are then measured. Immediately following inflation of the balloon with 1.5 ml of air in the wedged position, brisk bleeding is noted from the endotracheal tube. The most appropriate immediate management is to
- (A) withdraw the pulmonary artery catheter
- (B) perform endobronchial intubation
- (C) apply 15 to 20 cmH20 positive end-expiratory pressure to the airway
- (D) administer fresh frozen plasma rapidly
- (E) decrease blood pressure rapidly with nitroprusside
Compared with the adult airway, the airway of an infant is characterized by
- (A) greater narrowing at the cricoid ring
- (B) a less rigid epiglottis
- (C) a more caudad laryngeal opening
- (D) a relatively smaller tongue
- (E) relatively larger tonsils
Which Mapleson breathing circuit shown in the illustration permits the LEAST amount of fresh gas inflow to prevent rebreathing during spontaneous ventilation?
- (A) A
- (B) B
- (C) C
- (D) D
- (E) E
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
The twitch responses shown are from a healthy 80-kg patient anesthetized with fentanyl and nitrous oxide. Relaxant drugs X and Y are most likely
- (A) X: atracurium 30 mg, Y: vecuronium 4 mg
- (B) X: atracurium 30 mg, Y: vecuronium 8 mg
- (C) X: pancuronium 4 mg, Y: pancuronium 8 mg
- (D) X: vecuronium 4 mg, Y: atracurium 30 mg
- (E) X: vecuronium 4 mg, Y: pancuronium 8 mg
A 26-year-old woman has headache, nausea, and photophobia 36 hours after cesarean delivery for chorioamnionitis using subarachnoid block. Temperature is 38.8°C and leukocyte count is 14,200/mm3. Which of the following is the most appropriate next step in management?
- (A) Oral ibuprofen
- (B) Intravenous caffeine sodium benzoate
- (C) Intravenous hydration
- (D) Epidural blood patch
- (E) Diagnostic lumbar puncture
A 25-year-old man with Wolff-Parkinson-White syndrome has paroxysmal supraventricular tachycardia with a heart rate of 200 bpm during insertion of an intramedullary rod for a femoral fracture. Duration of the QRS complex is 0.12 sec. Each of the following antidysrhythmic agents would be appropriate for use in this patient EXCEPT
- (A) lidocaine
- (B) metoprolol
- (C) procainamide
- (D) propranolol
- (E) verapamil