10 Random Questions
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 55-year-old man undergoes abdominal perineal resection in the lithotomy position during combined epidural (bupivacaine 0.5%) and isoflurane anesthesia. The epidural catheter is left in place with an infusion of fentanyl 50 jug/hr. Twelve hours after surgery, the patient has left footdrop. Which of the following is the most likely explanation?
- (A) Epidural hematoma
- (B) Epidural opioid
- (C) Inadequate padding of the knee during surgery
- (D) Nerve injury from the epidural catheter
- (E) Residual effects of the local anesthetic
Which of the following is the primary factor regulating normal coronary blood flow?
- (A) Aortic diastolic pressure
- (B) Coronary perfusion pressure
- (C) Heart rate
- (D) Myocardial oxygen consumption
- (E) Systolic wall tension
A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is
- (A) decreased functional residual capacity
- (B) diffusion hypoxia
- (C) hypercarbia
- (D) increased airway resistance produced by the endotracheal tube
- (E) inhibition of hypoxic pulmonary vasoconstriction
A 27-year-old man with a one-month history of quadriplegia at a C6 level is given general anesthesia for cystoscopy. During the cystoscopy, blood pressure suddenly increases to 220/120 mmHg. Further evaluation is most likely to show
- (A) atrial fibrillation (ventricular rate 100 bpm)
- (B) paroxysmal atrial tachycardia (150 bpm)
- (C) sinus bradycardia
- (D) piloerection above the level of C6
- (E) sweating above the level of C6
During cardiopulmonary bypass, the perfusionist notes that the mixed venous oxygen saturation has decreased from to 55%. Which of the following is the most likely cause?
- (A) Administration of a nitroprusside bolus
- (B) Administration of a thiopental bolus
- (C) Decrease in rectal temperature from 34°C to 28°C
- (D) Inadequate muscle relaxation
- (E) Increase in pump flow
Which of the following statements concerning brain stem auditory evoked responses is true?
- (A) They monitor cortical function
- (B) They are not affected by changes in carbon dioxide tension
- (C) They are not affected by mild hypothermia (34°C)
- (D) They are more resistant to anesthetic effects than somatosensory evoked responses
- (E) They are abolished coincident with flattening of the EEG
An intubated patient is breathing spontaneously through the T-piece shown in Figure 1. Addition of tubing at A and B as shown in Figure 2 without an increase in minute ventilation will result in
- (A) unchanged FiO2 and increased PaCO2
- (B) unchanged FiO2 and unchanged PaCO2
- (C) increased FiO2 and increased PaCO2
- (D) increased FiO2 and unchanged PaCO2
- (E) decreased FiO2 and increased PaCO2
Two hours after a colon resection, a 60-year-old woman with adult-onset diabetes mellitus is somnolent and has a blood glucose concentration of 612 mg/dl. Which of the following findings are most likely? (Sodium, Osmolality, Intravascular volume)
- (A) 127, 280, High
- (B) 127, 310, High
- (C) 127, 330, Low
- (D) 140, 280, Normal
- (E) 140, 300, Low
Which of the following statements concerning isolated mitral stenosis is true?
- (A) Afterload reduction increases cardiac output
- (B) Pulmonary artery occlusion pressure overestimates left ventricular filling pressure
- (C) Pulmonary hypertension is irreversible
- (D) Tachycardia decreases the mitral transvalvular gradient
- (E) Thermodilution cardiac output measurements are unreliable