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
(E) Pa02 and PaC02 while breathing room air
C
A patient who is scheduled for a parathyroidectomy for a parathyroid adenoma has a preoperative serum calcium concentration of 13.5 mg/dl. The ECG shows no acute changes. The most appropriate preoperative management is administration of
(A) calcitonin
(B) hydrocortisone
(C) intravenous saline solution
(D) mannitol
(E) potassium phosphate
C
During insufflation of the peritoneal cavity with carbon dioxide at the start of laparoscopy, heart rate increases to 140 bpm, blood pressure decreases to 70/40 mmHg, and a loud murmur is heard through the esophageal stethoscope. The most appropriate immediate step is to
Which of the following is the most appropriate initial therapy for acute pulmonary hypertension with right ventricular dysfunction and severe systemic hypotension that occurs during anesthesia?
Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?
(A) Blood gas analysis is performed at the patient's temperature
(B) Carbon dioxide should not be added to the bypass circuit
(C) The carbon dioxide content of the patient's blood is greater than it would be without temperature correction
(D) The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method
(E) The patient's temperature should be maintained above 25°C
A 55-year-old patient with hypertrophic cardiomyopathy (IHSS) is undergoing bladder suspension with enflurane 1%, nitrous oxide 50%, and oxygen 50%. Junctional tachycardia and hypotension develop suddenly immediately after skin incision. The most appropriate management is to
(A) decrease enflurane concentration
(B) administer an intravenous fluid bolus
(C) administer intravenous esmolol
(D) administer intravenous phenylephrine
(E) begin nitroglycerin infusion
C
When compared with diazepam, midazolam
(A) metabolites contribute more significantly to the sedative effect
(B) elimination is less dependent on hepatic metabolism
(C) has more predictable action after intramuscular administration
(D) produces less respiratory depression
(E) produces less hypotension during induction of anesthesia with opioids