A 24-year-old man is undergoing induction of general anesthesia prior to appendectomy. During laryngoscopy, he regurgitates a large amount of bilious material. An endotracheal tube is inserted; aspiration shows bile-stained fluid. Which of the following is the most appropriate next step in management?
(A) Infusion of a loading dose of aminophylline
(B) Intravenous administration of broad-spectrum antibiotics
(C) Lavage of the tracheobronchial tree with saline solution
(D) Radiograph of the chest
(E) Proceeding with the operation
E
Which of the following changes is most likely in the patient whose pulmonary pathology is schematically illustrated?
A 76-year-old patient is restless and hallucinating in the preoperative holding area. He received morphine 5 mg and scopolamine 0.4 mg intramuscularly as premedication and is now breathing oxygen 2 L/min through nasal prongs. SpO2 is 98%. Which of the following is the most appropriate next step?
(A) Administration of naloxone
(B) Administration of physostigmine
(C) Induction of general anesthesia
(D) Determination of serum electrolyte concentrations
A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?
(A) Maximum effect occurs one hour after injection
(B) Maximum effect occurs when drug concentration peaks in cerebrospinal fluid
(C) Maximum effect occurs during the acute phase of the disease
(D) The beneficial effect results primarily from sympathetic neurolysis
(E) It is contraindicated if the patient has had prior surgical procedures on the lumbar disks
C
Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine
(A) has a lower rate of plasma clearance
(B) has a secondary blocking effect on cardiac beta,-adrenergic receptors
(C) dissociates more slowly from sodium channels in cardiac muscle
(D) inhibits spontaneous phase 4 depolarization in pacemaker cells
(E) preferentially blocks calcium channels in Purkinje fibers
A 72-year-old woman with stable angina is undergoing bowel resection. Anesthesia is induced with etomidate. Five minutes after starting isoflurane 1% in nitrous oxide 50%, her blood pressure decreases from 110/84 to 70/40 mmHg. The most likely cause is
(A) coronary steal produced by isoflurane
(B) direct myocardial depression produced by isoflurane
(C) vasodilation produced by isoflurane
(D) adrenocortical suppression produced by etomidate