10 Random Questions
A 66-year-old woman with essential hypertension has a preoperative blood pressure of 160/95 mmHg despite receiving the usual dose of labetalol on the morning of surgery. Following endotracheal intubation, blood pressure increases to 220/120 mmHg. Which of the following is the most likely explanation?
- (A) Decreased arteriolar compliance
- (B) Increased circulating blood volume
- (C) Increased receptor sensitivity to norepinephrine
- (D) Unopposed beta-adrenergic receptor stimulation
- (E) Upregulation of alpha-adrenergic receptors
A patient with low cardiac output following coronary artery bypass grafting is transferred to the intensive care unit where a chest roentgenogram confirms proper placement of the pulmonary artery catheter. Serial pulmonary artery occlusion pressures are then measured. Immediately following inflation of the balloon with 1.5 ml of air in the wedged position, brisk bleeding is noted from the endotracheal tube. The most appropriate immediate management is to
- (A) withdraw the pulmonary artery catheter
- (B) perform endobronchial intubation
- (C) apply 15 to 20 cmH20 positive end-expiratory pressure to the airway
- (D) administer fresh frozen plasma rapidly
- (E) decrease blood pressure rapidly with nitroprusside
In an Infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a
- (A) higher risk for neurotoxicity
- (B) higher risk for systemic toxicity
- (C) lower risk for spinal cord injury
- (D) more significant decrease in blood pressure
- (E) shorter duration of action
Which of the following is the most likely sequela of interscalene brachial plexus block?
- (A) Cervical epidural block
- (B) Hemidiaphragmatic paralysis
- (C) Pneumothorax
- (D) Seizure
- (E) Vocal cord paralysis
A 45-year-old man is scheduled for appendectomy under general anesthesia. He reports that for many years he has occasionally felt his heart "skip a beat." The ECG tracing shown was obtained one hour ago. Which of the following is the most appropriate next step?
- (A) Proceeding with induction of anesthesia
- (B) Administration of a loading dose of digoxin
- (C) Carotid sinus massage
- (D) Intravenous administration of atropine
- (E) Placement of a temporary pacemaker
Which of the following findings necessitates the preoperative insertion of a ventricular pacemaker in a 48-year-old man scheduled to undergo cholecystectomy?
- (A) Atrial flutter with 3:1 atrioventricular block
- (B) Bifascicular (right bundle branch block and left anterior hemiblock) block
- (C) Left bundle branch block with first-degree atrioventricular block
- (D) Second-degree (Mobitz I) atrioventricular block
- (E) Second-degree (Mobitz II) atrioventricular block
Halothane anesthesia is usually associated with an increase in
- (A) cardiac contractility
- (B) venous capacitance
- (C) arterial pressure
- (D) venous return
- (E) heart rate
A 70-year-old man with stable angina is scheduled for cataract removal with a retrobulbar block. After injection of 5 ml of 0.75% bupivacaine, heart rate decreases from 90 to 55 bpm, and frequent premature ventricular contractions are noted on the EKG. These changes are most likely caused by
- (A) intravascular injection of bupivacaine
- (B) subarachnoid injection of bupivacaine
- (C) myocardial ischemia
- (D) oculocardiac reflex
- (E) retrobulbar hemorrhage
During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?
- (A) Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma
- (B) PaC02 can be maintained at a normal level using a standard circle system attached to the catheter
- (C) PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter
- (D) Emergency surgical tracheostomy would have improved the likelihood of survival
- (E) The presence of this tumor contraindicates jet ventilation via cricothyroidotomy
Syringe A contains 100 ml of normal blood with a PO2 of 2 mmHg, and syringe B contains 100 ml of normal blood with a PO2 of 98 mmHg. The contents of the two syringes are mixed anaerobicaily to equilibrium. The PO2 of the resultant mixture Is
- (A) 27 mmHg
- (B) 50 mmHg
- (C) 63 mmHg
- (D) 96 mmHg
- (E) 100 mmHg