10 Random Questions
A 45-year-old patient with chronic alcoholism develops jaundice four days after a cholecystectomy under halothane/morphine general anesthesia. Bilirubin and alkaline phosphatase are elevated, but ALT is only slightly above normal. All values were within normal limits preoperatively. The most likely cause of jaundice is
- (A) opioid-induced spasm of the sphincter of Oddi
- (B) hepatic dysfunction secondary to halothane exposure
- (C) worsening of underlying chronic hepatitis
- (D) extrahepatic biliary obstruction
- (E) acute viral hepatitis
Compared with normal adults, which of the following characteristics of neonates best explains the more rapid inhalation induction in neonates?
- (A) Greater cardiac index
- (B) Greater metabolic rate
- (C) Greater perfusion of vessel-rich tissues
- (D) Greater ratio of alveolar ventilation to functional residual capacity
- (E) Less lean body mass
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
A 67-year-old man undergoes spinal anesthesia with hyperbaric tetracaine 10 mg for transurethral resection of the prostate. At the end of the 50-minute procedure, the level of anesthesia is T6 and blood pressure is 120/70 mmHg. Within two minutes after transfer to a stretcher, the patient has nausea and blood pressure decreases to 76/42 mmHg. Which of the following is the most likely cause of the acute hypotension?
- (A) Acute congestive heart failure
- (B) Decreased venous return
- (C) Dilutional hyponatremia
- (D) Progression of sympathetic block
- (E) Unrecognized bladder perforation
A 70-kg 78-year-old man undergoing small-bowel resection during anesthesia with isoflurane in oxygen becomes hypotensive and develops frothy pink sputum in the endotracheal tube. Heart rate is 50 bpm, blood pressure is 75/60 mmHg, pulmonary artery occlusion pressure is 22 mmHg, and cardiac output is 1.7 L/min. The most appropriate initial step in management is administration of which of the following?
- (A) Albumin
- (B) Digoxin
- (C) Dopamine
- (D) Esmolol
- (E) Nitroglycerin
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
A 46-year-old man is scheduled for repair of an inguinal hernia. Six years ago, he had an episode of malignant hyperthermia during cholecystectomy. Which of the following is the most appropriate perioperative management?
- (A) Administration of a regional anesthetic
- (B) Administration of dantrolene orally for two days prior to surgery
- (C) Avoidance of all inhalational anesthetics except isoflurane
- (D) Avoidance of ester local anesthetics
- (E) Flushing the anesthesia machine with oxygen 10 L/min for a minimum of 12 hours
A 50-year-old man is scheduled to undergo emergency craniotomy for evacuation of an epidural hematoma. His Glasgow Coma Scale score is 6; heart rate is 54 bpm, and blood pressure is 190/110 mmHg. The most appropriate initial management is administration of which of the following agents?
- (A) Atropine
- (B) Mannitol
- (C) Nimodipine
- (D) Sodium nitroprusside
- (E) Thiopental
A 68-year-old man with stable angina treated with propranolol and nifedipine is scheduled for coronary artery bypass grafting. After induction with fentanyl and tracheal intubation, heart rate decreases to 40 bpm and blood pressure decreases to 70/40 mmHg. The ECG is shown. Which of the following is the most appropriate first step in management?
- (A) Infusion of isoproterenol
- (B) Administration of phenylephrine
- (C) Closed chest cardiopulmonary resuscitation
- (D) Defibrillation
- (E) Synchronized cardioversion
The risk for airway fire during laser resection of a tracheal tumor is decreased by use of
- (A) a CO2 laser rather than a YAG laser
- (B) an inspired helium concentration greater than 60%
- (C) an inspired nitrous oxide concentration greater than 60%
- (D) a polyvinylchloride endotracheal tube
- (E) halothane in the inspired mixture