10 Random Questions
A 38-year-old woman with B-positive blood requires immediate blood transfusion during abdominal hysterectomy. No B-positive blood is available; O-negative blood is used. Three minutes after starting transfusion of packed red blood cells, the patient develops tachycardia, bronchospasm, and hypotension. Which of the following is the most likely cause?
- (A) Anaphylactic reaction to donor IgA
- (B) Bacterial contamination of transfused blood
- (C) Hemolysis resulting from ABO incompatibility
- (D) Hypocalcemia
- (E) IgG-mediated reaction to Rh antigens
Which of the following statements concerning cerebral blood flow (CBF) during anesthesia is true?
- (A) CBF changes minimally when PaC02 increases from 30 to 40 mmHg
- (B) CBF changes minimally when P02 decreases from 160 to 100 mmHg
- (C) CBF is autoregulated when mean arterial pressure is 40 mmHg
- (D) CBF is coupled to cerebral metabolism during isoflurane anesthesia
- (E) CBF is unaffected by 1.2% isoflurane at a PaC02 of 40 mmHg
A 55-year-old man undergoes abdominal perineal resection in the lithotomy position during combined epidural (bupivacaine 0.5%) and isoflurane anesthesia. The epidural catheter is left in place with an infusion of fentanyl 50 jug/hr. Twelve hours after surgery, the patient has left footdrop. Which of the following is the most likely explanation?
- (A) Epidural hematoma
- (B) Epidural opioid
- (C) Inadequate padding of the knee during surgery
- (D) Nerve injury from the epidural catheter
- (E) Residual effects of the local anesthetic
Which of the following is the correct sequence of anatomic structures encountered when using a paramedian approach for lumbar spinal anesthesia?
- (A) Ligamentum flavum — dura mater — arachnoid mater
- (B) Interspinous ligament — ligamentum flavum — dura mater — arachnoid mater
- (C) Posterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater
- (D) Anterior longitudinal ligament — ligamentum flavum — dura mater — arachnoid mater
- (E) Ligamentum flavum — dura mater — pia mater — arachnoid mater
Which of the following drugs best facilitates management of cerebral vasospasm after subarachnoid hemorrhage?
- (A) Nifedipine
- (B) Nimodipine
- (C) Nitroglycerin
- (D) Nitroprusside
- (E) Thiopental
A patient with end-stage renal disease has prolonged ventilatory depression after administration of morphine. The most likely cause is increased
- (A) serum concentration of morphine-6-glucuronide
- (B) elimination half-life of morphine
- (C) opioid receptors
- (D) receptor affinity
- (E) volume of distribution
The effect of neomycin at the neuromuscular junction is
- (A) decreased by depolarizing relaxants
- (B) partially reversed by calcium
- (C) potentiated by anticholinesterases
- (D) prevented by pretreatment with magnesium
- (E) primarily prejunctional
A 2.2-kg, 6-hour-old neonate is to undergo gastrostomy followed by repair of a tracheoesophageal fistula. During induction with halothane, air, and oxygen, the abdomen becomes distended. Appropriate management is to
- (A) intubate and assist spontaneous ventilation
- (B) intubate and control ventilation
- (C) insert an orogastric tube
- (D) allow the patient to breathe spontaneously by mask until gastrostomy
- (E) control ventilation by mask until gastrostomy
The plasma concentration of an intravenously administered drug follows the two-compartment kinetic model shown in the graph. Which of the following events is illustrated by the decline in plasma concentration shown at Time #2?
- (A) Decreasing activity of the drug at its receptor site
- (B) Distribution from plasma to tissue
- (C) Elimination of the drug from plasma
- (D) Increasing volume of distribution
- (E) Redistribution from vessel-rich groups to vessel-poor groups
Nonsteroidal analgesics such as aspirin decrease pain by
- (A) decreasing axonal transmission of pain stimuli through a local anesthetic mechanism
- (B) directly competing with substance P for receptor occupancy
- (C) inhibiting enzymatic breakdown of met-enkephalin
- (D) inhibiting production of prostaglandin E2
- (E) potentiating the action of endorphin in the substantia gelantinosa of the spinal cord