(A) most particles 1 to 2 microns in size are deposited in the trachea
(B) respiratory epithelial cilia become less active
(C) alveolar water vapor pressure is unchanged
(D) respiratory heat loss is abolished
(E) sterilization of breathing apparatus is mandatory
C
A 64-year-old patient with chronic obstructive pulmonary disease sustained fractures of ribs 4 through 8 on the left one hour ago. Examination shows agitation, heart rate of 120 bpm, respiratory rate of 30/min, and blood pressure of 180/100 mmHg. PaO2 is 70 mmHg and PaCO2 is 35 mmHg on room air. Radiographs of the chest show no abnormalities. Which of the following is the most appropriate immediate management?
(A) Continuous epidural analgesia using local anesthetics
(B) Mechanical ventilation
(C) Infusion of midazolam
(D) Patient-controlled analgesia with morphine sulfate
A 66-year-old patient with aortic stenosis is scheduled for aortic valve replacement. Examination shows blood pressure of 110/60 mmHg and sinus rhythm at a rate of 75 bpm. Pulmonary artery occlusion pressure (PAOP) is 20 mmHg with a prominent a-wave on the tracing. Which of the following is the most appropriate management?
(A) Increasing myocardial contractility
(B) Maintaining PAOP below 20 mmHg
(C) Maintaining sinus rhythm
(D) Promoting mild tachycardia
(E) Decreasing peripheral resistance
C
During cardiopulmonary bypass at a nasopharyngeal temperature of 28°C and a hematocrit of 20%, temperature-corrected PaCO2 is 50 mmHg and uncorrected PaCO2 is 60 mmHg. The most appropriate management is to
(A) administer additional opioid
(B) administer packed red blood cells to increase hematocrit to 25%
A 50-year-old man with an 80 pack-year history of cigarette smoking has a forced expiratory volume in one second of 1.5 L and a forced vital capacity of 3.5 L. Which of the following statements concerning intraoperative anesthetic management is true?
(A) An I:E ratio of 1:1 will improve carbon dioxide removal more than an I:E ratio of 1:2.5
(B) Antagonism of neuromuscular block will most likely trigger acute bronchospasm
(C) Functional residual capacity will increase during an acute exacerbation of bronchospasm
(D) Induction with ketamine will increase airway resistance
Two days after myocardial infarction involving the left anterior descending coronary artery, a patient's blood pressure decreases acutely from 125/80 to 70/40 mmHg, heart rate increases from 75 to 90 bpm, pulmonary artery pressure increases to 50/30 mmHg, and urine output decreases from 60 to 10 ml/hr. Thermodilution cardiac output has increased from 4 to 7 L/min. The most appropriate action is to
(A) compare mixed venous oxygen saturation in the right atrium and pulmonary artery
(B) draw blood for culture and start antibiotic therapy
(C) start dopamine infusion in low dose
(D) administer a fluid challenge
(E) monitor peripheral capillary oxygenation by transcutaneous oximetry