10 Random Questions
A 70-year-old patient is shivering and has chest pain in the PACU following a cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97% at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous administration of nitroglycerin. Which of the following is the most appropriate next step?
- (A) Administration of esmolol
- (B) Administration of hydralazine
- (C) Administration of nitroprusside
- (D) Application of a warming blanket
- (E) Increasing FiO2
A 10-week-old infant born at 28 weeks gestation is scheduled for elective repair of bilateral inguinal hernias. It is most appropriate to
- (A) delay the operation until the infant is 6 months old
- (B) transfuse blood preoperatively if hemoglobin concentration is 9 g/dl
- (C) avoid tracheal intubation
- (D) limit inspired oxygen concentration to less than 50%
- (E) monitor for apnea for 24 hours postoperatively
A 16-year-old patient who sustained trauma is being resuscitated. In deciding whether to infuse lactated Ringer's solution or albumin, which of the following is true?
- (A) At one hour, both will remain in the intravascular compartment to an equal extent
- (B) Both have zero risk for hepatitis transmission
- (C) Both will decrease ionized calcium levels
- (D) The glomerular filtration rate will be higher with infusion of albumin
- (E) Lactated Ringer's solution causes a greater increase in intracranial pressure
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
Pulmonary artery occlusion pressure is NOT a reliable estimate of left ventricular end-diastolic pressure when
- (A) junctional cardiac rhythm is present
- (B) mitral insufficiency is present
- (C) pulmonary compliance is decreased
- (D) pulmonary hypertension is present
- (E) the catheter tip is in zone 1 of the lung
Compared with other volatile inhalation anesthetics, desflurane has which of the following characteristics?
- (A) Equipotency to isoflurane
- (B) Greater extent of biotransformation than enflurane
- (C) Less airway irritation than halothane
- (D) Lower blood gas solubility coefficient than enflurane
- (E) Lower vapor pressure than isoflurane
A patient has sudden cardiopulmonary arrest five minutes after retrobulbar block with 0.75% bupivacaine 2 ml with hyaluronidase for ophthalmologic surgery. No premonitory changes were noted on the pulse oximeter. The most likely cause is
- (A) allergic reaction to hyaluronidase
- (B) direct cardiac toxicity
- (C) oculocardiac reflex
- (D) intravenous injection of local anesthetic
- (E) subarachnoid injection of local anesthetic
The arterial waveform and EKG shown are from a 60-year-old man with uremia who is the PACU after hip surgery under general anesthesia. The patient is drowsy, extubated, and breathing easily. The most likely diagnosis is
- (A) hypovolemia
- (B) myocardial ischemia
- (C) nontension pneumothorax
- (D) pericardial tamponade
- (E) pulmonary embolus
A patient is undergoing exploration of a stab wound to the left side of the neck. On awake laryngoscopy, the left vocal cord is in midposition and the right vocal cord is abducted during inspiration. The most likely cause of these findings is trauma to which of the following structures on the left?
- (A) C7-8 nerve root
- (B) Stellate ganglion
- (C) Glossopharyngeal nerve
- (D) Superior laryngeal nerve
- (E) Vagus nerve
A patient with uremia is scheduled for emergency surgery. Bleeding time is 18 minutes. The most appropriate initial treatment is
- (A) cryoprecipitate
- (B) desmopressin
- (C) fresh frozen plasma
- (D) platelets
- (E) vitamin K