A 3-day-old infant is comatose 18 hours after surgical correction of transposition of the great vessels. Tracheal suctioning produces only a tachycardic response. Anesthesia included midazolam 0.5 mg/kg, fentanyl 60 mcg/kg, and pancuronium 0.3 mg/kg. Which of the following is the most appropriate first step in evaluation of this infant?
A 62-year-old man, who had a myocardial infarction three years ago, complicated by congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery catheter demonstrates a cardiac output higher than measurements recorded during a cardiac catheterization two months after the infarction. Which of the following most likely contributes to the increased cardiac output?
(A) Creation of an arteriovenous fistula
(B) Increased hemoglobin concentration from 10 to 12 g/dL
(C) Stimulation of carotid body receptors
(D) Transcutaneous nitroglycerin
(E) Use of a beta-adrenergic blocker to prevent myocardial reinfarction
A
A 60-kg, 45-year-old woman who takes digoxin for atrial fibrillation receives furosemide 40 mg and mannitol 60 g during resection of a supratentorial meningioma. After initiation of hyperventilation to decrease PaC02 from 35 to 20 mmHg, multifocal premature ventricular contractions are noted on the ECG. The most likely cause is
(A) acute hypokalemia
(B) cerebral ischemia
(C) impending herniation of the brain stem
(D) paradoxical air embolism
(E) surgical manipulation of the meningioma
A
Which of the following statements concerning intercostal nerve block for postoperative pain is true?
(A) Block at the midaxillary line provides analgesia for the anterior and lateral abdominal walls
(B) Blood levels of local anesthetic are higher than after an axillary block
(C) Intravascular injection is unlikely
(D) Loss of resistance assures proper needle placement
(E) Paravertebral spread is prevented by adding epinephrine to the local anesthetic solution
Three hours after undergoing coronary artery bypass grafting, an elderly man develops severe hypotension after intravenous administration of morphine 4 mg. Pulmonary artery occlusion pressure is 27 mmHg and central venous pressure is 30 mmHg. Transesophageal echocardiography shows decreased end-diastolic ventricular volumes. Which of the following is the most likely diagnosis?
With long-term administration, which of the following drugs produces the most prolonged sedative effect of diazepam?
(A) Cimetidine
(B) Famotidine
(C) Metoclopramide
(D) Ranitidine
(E) Warfarin
A
A 40-year-old woman has continuous nondermatomal burning pain of the distal foot four weeks after sustaining a metatarsal fracture. On examination, the foot is mildly swollen, tender, and cool. Which of the following statements concerning this condition is true?
(A) A radiograph of the distal bones of the painful foot will show severe osteoporosis
(B) A technetium scan of the distal joints of the painful foot will show decreased uptake
(C) Early use of opioid analgesia will prevent progression of the symptoms
(D) Intravenous phentolamine will relieve the pain
(E) The chance of spontaneous recovery within eight weeks is greater than 80%