A 25-year-old man with known rheumatic heart disease is being evaluated in the critical care unit. Despite decreasing cardiac output, mixed venous blood from a pulmonary artery catheter shows an increase in Sv02. Which of the following is the most likely cause?
(A) Decreasing hematocrit
(B) Hypothermia to 35°C
(C) Metabolic alkalosis
(D) Mitral regurgitation
(E) Wedging of the catheter
E
An 8-year-old child with chronic renal failure is scheduled for an operation to create an arteriovenous fistula. Laboratory studies include: Hemoglobin 6.5 g/dl, Blood gases (breathing air) : PaO2 97 mmHg, PaCO2 29 mmHg, pH 7.30 Sodium 129 mEq/L Potassium 5.5 mEq/L Chloride 101 mEq/L Bicarbonate 15 mEq/L. Before inducing general anesthesia, which of the following abnormalities should be corrected?
(A) Anemia
(B) Metabolic acidosis
(C) Potassium concentration
(D) Anemia, metabolic acidosis, and potassium concentration
A 1100-g, 10-day-old infant is to undergo ligation of a patent ductus arteriosus after unsuccessful medical treatment. Within three minutes of intravenous administration of atropine 20 mcg, fentanyl 20 mcg, and pancuronium 0.1 mg, systemic blood pressure decreases from 80 to 30 mmHg, heart rate from 180 to 140 bpm, and arterial oxygen saturation from 90% to 80%. The most appropriate management is to
A tourniquet with dual bladders is being used for intravenous regional anesthesia of the upper extremity. At what point in the procedure should the distal tourniquet be inflated?
(A) During injection of the local anesthetic
(B) After the patient complains of tourniquet pain
(C) Coincident with inflation of the proximal tourniquet
Pain and spasm due to injury of the deltoid muscle is most effectively relieved by
(A) axillary block
(B) cervical sympathetic block
(C) interscalene brachial plexus block
(D) paravertebral block at C4
(E) superficial cervical plexus block
C
A patient has sudden cardiopulmonary arrest five minutes after retrobulbar block with 0.75% bupivacaine 2 ml with hyaluronidase for ophthalmologic surgery. No premonitory changes were noted on the pulse oximeter. The most likely cause is
(A) allergic reaction to hyaluronidase
(B) direct cardiac toxicity
(C) oculocardiac reflex
(D) intravenous injection of local anesthetic
(E) subarachnoid injection of local anesthetic
E
The syndrome of inappropriate ADH secretion is characterized by
(A) ADH secretion unrelated to serum osmolality
(B) decreased ADH secretion in response to hypovolemia