10 Random Questions
An 18-year-old patient with hemophilia A is scheduled for inguinal hernia repair. Preoperatively, factor VIII concentration is 60% of normal. The most appropriate management is administration of
- (A) fresh frozen plasma
- (B) cryoprecipitate
- (C) factor VIII concentrate
- (D) vitamin K
- (E) none of the above
The correlation between anesthetic potency and lipid solubility
- (A) suggests that the number of molecules dissolved at the site of action causes anesthesia
- (B) applies to anesthetic agents dissolved in olive oil
- (C) suggests that the type of molecule causes anesthesia
- (D) is consistent with the synergistic effect of anesthetics
- (E) is not consistent with a unitary molecular site of action of anesthetics
Anesthesia is induced with halothane in a 3-year-old girl. Sixty seconds after administration of succinylcholine 1 mg/kg intravenously, heart rate decreases rapidly from 120 to 60 bpm. The most likely cause is
- (A) acute hyperkalemia
- (B) failure to pretreat with a nondepolarizing relaxant
- (C) halothane overdose
- (D) muscarinic activity
- (E) sympathetic ganglionic blockade
Optimal positioning of a left-sided double-lumen endobronchial tube is easier than positioning of a right-sided endobronchial tube because the
- (A) angle between the trachea and bronchus is wider on the left
- (B) diameter of the left mainstem bronchus is larger
- (C) diameter of the left upper lobe bronchus is larger
- (D) distance between the left upper lobe bronchus and the carina is greater
- (E) left mainstem bronchus is more rigid
A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should
- (A) recommend sevoflurane anesthesia since abnormal postoperative liver function tests are unlikely with this drug
- (B) recommend subarachnoid anesthesia since changes in hepatic blood flow would be less than with general anesthesia
- (C) indicate that abnormal liver function tests are likely to follow this operation regardless of the anesthetic drugs used
- (D) require preoperative screening for hepatitis B antigen and antibodies
- (E) recommend avoiding halothane since it is more likely to produce hepatitis in patients who had previous upper abdominal surgery
Preoperative administration of alpha-adrenergic inhibitors will usually reverse ECG changes due to
- (A) catecholamine myocarditis
- (B) Preoperative administration of alpha-adrenergic inhibitors decreases operative mortality
- (C) Beta-adrenergic inhibitors should be administered preoperatively only in conjunction with alpha-adrenergic
- inhibitors
- (D) Vasopressor therapy may be necessary postoperatively for treatment of hypotension
The ECG tracing shows
- (A) aberrant intraventricular conduction
- (B) acceleration of phase 4 depolarization of the sinus node
- (C) a compensatory pause
- (D) initiation of re-entrant supraventricular tachycardia
- (E) paroxysmal atrial fibrillation
A 30-year-old woman undergoes thyroidectomy under general endotracheal anesthesia. Immediately after extubation while breathing spontaneously, she has laryngospasm that resolves after 60 seconds of continuous positive airway pressure applied by face mask. In the PACU, she develops shortness of breath, tachypnea, hypoxemia, and rales. Which of the following is the most likely diagnosis?
- (A) Gastric acid aspiration
- (B) Myocardial infarction
- (C) Pulmonary edema
- (D) Pulmonary embolism
- (E) Vocal cord paralysis
A 55-year-old man is undergoing craniotomy in the sitting position. Mean arterial pressure is 75 mmHg; arterial blood gas values are PaCO2 41 mmHg and pH 7.37. End-tidal CO2 is 7 mmHg. Which of the following is the most likely cause of the increased PaCO2 to PetCO2 gradient?
- (A) Decreased cardiac output
- (B) Endobronchial intubation
- (C) Hyperinflation of the lungs
- (D) Partial disconnect of the capnograph sample tubing
- (E) Venous air embolism
A 3.3-kg neonate is brought to the operating room for repair of a left diaphragmatic hernia. A 3-mm endotracheal tube is placed to a depth of 9 cm. Initial arterial blood gas values from a right radial catheter while spontaneously breathing oxygen 50% are PaO2 82 mmHg, PaCO2 41 mmHg, pH 7.33, and base excess -5. After reduction of the hernia (during closure of the abdomen), vigorous attempts to expand the atelectatic lung are unsuccessful. The infant rapidly becomes very dusky, heart rate is 60 bpm, breath sounds are distant and squeaky bilaterally, and pulmonary compliance is decreased. Which of the following should be done first?
- (A) Obtain a radiograph of the chest
- (B) Place a chest tube on the left side
- (C) Place a chest tube on the right side
- (D) Withdraw the endotracheal tube 1 cm and suction
- (E) Reopen the abdomen