10 Random Questions
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
A 30-year-old, 70-kg woman with mitral stenosis is scheduled for elective laparoscopic sterilization. Preoperatively she is taking digoxin and an unknown medication for chronic mental depression. The EKG demonstrates atrial fibrillation. Heart rate is 68 bpm. Anesthesia is induced with thiopental followed by nitrous oxide 50%, halothane 0.75%, and a continuous succinylcholine infusion. The ventilator is set to deliver a minute volume of 5 liters through an endotracheal tube. As the carbon dioxide is being insufflated into the abdomen, the blood pressure is noted to be elevated (150/100 mmHg) and ventricular bigeminy is present. The most appropriate therapy is to
- (A) increase the halothane concentration to 1.25%
- (B) discontinue the succinylcholine infusion
- (C) increase minute ventilation to 7.5 L/min
- (D) administer potassium 5 mEq intravenously over one minute followed by propranolol 0.25 mg
- (E) measure arterial blood gas and serum electrolyte values
Intraoperatively, the occurrence of prominent "a" waves on the central venous pressure waveform can be explained by each of the following EXCEPT
- (A) acute right ventricular failure
- (B) atrial flutter
- (C) complete heart block
- (D) onset of junctional tachycardia
- (E) ventricular pacing
A 50-year-old man with alcoholism and jaundice is scheduled to undergo umbilical herniorrhaphy. An increase in which of the following best indicates impaired synthetic hepatic function?
- (A) Prothrombin time
- (B) Serum alanine aminotransferase concentration
- (C) Serum albumin/globulin ratio
- (D) Serum alkaline phosphatase concentration
- (E) Serum bilirubin concentration
The arterial waveform and EKG shown are from a 60-year-old man with uremia who is the PACU after hip surgery under general anesthesia. The patient is drowsy, extubated, and breathing easily. The most likely diagnosis is
- (A) hypovolemia
- (B) myocardial ischemia
- (C) nontension pneumothorax
- (D) pericardial tamponade
- (E) pulmonary embolus
Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time, aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is
- (A) a large amount of air in the dome of the radial artery transducer
- (B) coarctation of the aorta
- (c) peripheral vascular constriction produced by sympathetic stimulation
- (D) physiologic amplification of the waveform from the aorta to the radial artery
- (E) too high a frequency response in the catheter-transducer system
A computer program for hemodynamic calculations has the following input values: body surface area, arterial blood pressure, heart rate, pulmonary artery occlusion pressure, pulmonary artery pressure, and cardiac output. Each of the following values can be derived with this program EXCEPT
- (A) cardiac index
- (B) stroke volume index
- (C) systemic vascular resistance
- (D) pulmonary vascular resistance
- (E) left ventricular stroke work index
A healthy patient is receiving general endotracheal anesthesia with nitrous oxide 4 L/min, oxygen 2 L/min, and isoflurane 1% with spontaneous ventilation. The inspiratory breathing hose becomes disconnected from the inspiratory valve. The earliest alarm will be produced by
- (A) a pulse oximeter with finger probe set to alarm at 60% saturation
- (B) a mass spectrometer set to alarm when no breath is detected for 30 seconds
- (C) an oxygen analyzer mounted on the inspiratory valve outlet and set to alarm at 25% oxygen concentration
- (D) a capnograph sensor at the Y-piece that alarms when end-tidal carbon dioxide tension is greater than 60
- mmHg
A 27-year-old man with chronic renal failure is to undergo revision of an arteriovenous graft. He insists on general anesthesia. Hemodialysis was completed two hours ago, and serum potassium concentration is now 5 mEq/L. Which of the following statements concerning anesthetic management of this patient is true?
- (A) Enflurane is contraindicated
- (B) Succinylcholine is contraindicated
- (C) Neostigmine will be required in larger than usual dosage
- (D) The duration of action of atracurium will be prolonged
- (E) The duration of action of propofol will be unchanged
The patient whose flow-volume loop is shown on the right most likely has
- (A) bronchial asthma
- (B) a fixed midtracheal tumor
- (C) nasal polyps
- (D) restrictive lung disease
- (E) vocal cord paralysis