10 Random Questions
Which of the following interventions is most effective in preventing neurologic injury resulting from global cerebral ischemia?
- (A) Induction of barbiturate coma prior to ischemia
- (B) Maintenance of serum glucose concentration greater than 200 mg/dl prior to ischemia
- (C) Induction of hypothermia to a core temperature of 15 degrees C prior to ischemia
- (D) Maintenance of PaCO2 less than 25 mmHg following ischemia
- (E) Prevention of systemic hypertension following ischemia
Which of the following shaded areas most accurately represents the dead space of a properly functioning circle system?
A 36-year-old woman who undergoes peritoneal dialysis for chronic renal failure requires emergency surgical exploration for bowel obstruction. Serum creatinine concentration is 9.8 mg/dl and BUN concentration is 124 mg/dl. The most likely abnormality of coagulation is
- (A) decreased euglobulin lysis time
- (B) decreased platelet count
- (C) prolonged activated partial thromboplastin time
- (D) prolonged bleeding time
- (E) prolonged prothrombin time
A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?
- (A) Diphenhydramine
- (B) Epinephrine
- (C) Hydrocortisone
- (D) Norepinephrine
- (E) Phenylephrine
A 16-year-old child has an arterial catheter inserted prior to a potentially difficult intubation for a craniofacial operation. While awake and breathing room air, arterial blood gas values are: PaO2 134 mm Hg, PaCO2 28 mm Hg, and pH 7.45. These values can be explained by
- (A) excess heparin mixed with the arterial sample
- (B) a patient core temperature of 38°C
- (C) excess air entrained in the syringe during sampling
- (D) storing the sample at room temperature for 15 minutes before processing
- (E) anxiety and hyperventilation
The Bain circuit
- (A) provides nearly identical delivered and inspired anesthetic concentrations
- (B) has the fresh gas flow inlet near the reservoir bag
- (C) is a nonrebreathing circuit at any fresh gas flow rate
- (D) is most efficient during spontaneous ventilation
- (E) has a time constant greater than 1 minute for change in inspired anesthetic concentrations
Ninety minutes after administration of succinylcholine 1 mg/kg to a 28-year-old woman, the train-of-four shows a T4:T1 ratio of 25%. This is most consistent with
- (A) dibucaine number of 30
- (B) hypersensitivity to succinylmonocholine
- (C) pregnancy
- (D) pretreatment with pancuronium 2 mg
- (E) severe cirrhosis
Compared with dopamine, dobutamine
- (A) is more useful in patients taking monoamine oxidase inhibitors because it depends on the release of norepinephrine for its effect
- (B) is more useful in patients in right heart failure because it does not increase pulmonary vascular resistance
- (C) has no positive chronotropic response
- (D) induces diuresis without increasing cardiac output
- (E) in doses greater than 10 mcg/kg/min increases systemic vascular resistance more than similar doses of dopamine
An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin concentration of 1.5 mcg/ml. Five minutes after induction of general anesthesia, ventricular bigeminy is noted; blood pressure is 85/65 mmHg, SpO2 is 97%, and PetCO2, is 20 mmHg. Which of the following is the most appropriate management?
- (A) Administration of calcium chloride
- (B) Administration of ephedrine
- (C) Administration of lidocaine
- (D) Administration of potassium chloride
- (E) Decrease in ventilation
A 50-year-old woman with subarachnoid hemorrhage and left hemiparesis undergoes clipping of a right cerebral aneurysm. On the second postoperative day, mental status deteriorates. Blood pressure is 110/70 mmHg. A cerebral angiogram shows vasospasm. The most appropriate management is to
- (A) administer dexamethasone
- (B) administer mannitol
- (C) administer phentolamine
- (D) expand intravascular volume
- (E) intubate and hyperventilate to a PaC02 of 28 mmHg