Anesthesia Hub -

10 Random Questions

A 58-year-old man with a history of angina is undergoing resection of an abdominal aortic aneurysm under morphine, nitrous oxide, d-tubocurarine anesthesia. Just before removal of the aortic cross-clamp, heart rate is 74 bpm, blood pressure is 115/70 mmHg, and pulmonary artery occlusion pressure is 7 mmHg. Immediately after removal of the cross-clamp, heart rate increases to 120 bpm, blood pressure decreases to 80/55 mmHg, and pulmonary artery occlusion pressure decreases to 3 mmHg. The V5 lead on the EKG demonstrates sudden ST-segment depression and T-wave inversion. Initial therapy should be

(A) reapplication of the aortic cross-clamp
(B) intravenous administration of sodium bicarbonate
(C) initiation of a phenylephrine infusion
(D) rapid expansion of blood volume by transfusion
(E) initiation of a nitroglycerin infusion

ADVANCED General

A 70-kg man has stable 80% neuromuscular block induced with d-tubocurarine. Compared with neostigmine 3 mg, antagonism with edrophonium 70 mg will

(A) be of shorter duration
(B) be of slower onset
(C) be less reliable
(D) produce less change in heart rate
(E) require more anticholinergic

BASIC Pharmacology & Pharmacokinetics

A 75-year-old man with aortic stenosis and coronary artery disease has a preinduction heart rate of 68 bpm and blood pressure of 125/70 mmHg. After induction of anesthesia with fentanyl, midazolam, and pancuronium, heart rate is 90 bpm and blood pressure is 85/45 mmHg. ECG shows a new ST-segment elevation in lead II. Which of the following is the most appropriate initial management?

(A) Ephedrine
(B) Epinephrine
(C) Esmolol
(D) Nitroglycerin
(E) Phenylephrine

ADVANCED General

A 45-year-old man is scheduled for exploratory laparotomy. Six months ago, he received doxorubicin (Adriamycin) therapy for testicular cancer. This patient is at increased risk for

(A) abnormal liver function
(B) bone marrow depression
(C) heart failure
(D) chronic renal failure
(E) pulmonary fibrosis

BASIC Pharmacology & Pharmacokinetics

In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will

(A) increase slightly because of decreased shunt blood flow
(B) decrease slightly because of decreased mixed venous PO2
(C) increase because of decreased affinity of hemoglobin for oxygen
(D) decrease because of an increased dead space to tidal volume ratio
(E) increase because of increased pulmonary oxygen uptake per milliliter of blood

BASIC Respiratory & Critical Care

The increased resistance of severely burned patients to pancuronium is primarily due to

(A) enhanced urinary excretion of pancuronium
(B) decreased number of presynaptic cholinergic receptors
(C) increased number of postsynaptic cholinergic receptors
(D) increased rate of metabolism of pancuronium
(E) increased volume of distribution of pancuronium

Which of the following statements is true concerning administration of 70% nitrous oxide to a patient with an unrecognized pneumothorax?

(A) Expansion of the pneumothorax by nitrous oxide occurs at a greater rate than expansion of bowel gas
(B) Expansion of the pneumothorax by nitrous oxide occurs at a linear rate
(C) The maximum expansion of a closed space occurs within 15 minutes
(D) The maximum concentration of nitrous oxide achievable within the pneumothorax is 35%
(E) The maximum increase in a closed gas-containing space is 100%

BASIC Pharmacology & Pharmacokinetics

Which of the following is most effective in decontaminating an anesthesia machine that was splattered with HIV-contaminated blood?

(A) Bleach
(B) Deionized water
(C) Ethylene oxide
(D) Hydrogen peroxide
(E) Isopropyl alcohol

BASIC Equipment & Physics

A 55-year-old man undergoes abdominal perineal resection in the lithotomy position during combined epidural (bupivacaine 0.5%) and isoflurane anesthesia. The epidural catheter is left in place with an infusion of fentanyl 50 jug/hr. Twelve hours after surgery, the patient has left footdrop. Which of the following is the most likely explanation?

(A) Epidural hematoma
(B) Epidural opioid
(C) Inadequate padding of the knee during surgery
(D) Nerve injury from the epidural catheter
(E) Residual effects of the local anesthetic

Which of the following findings differentiates the pickwickian syndrome from morbid obesity?

(A) Carbon dioxide retention
(B) Upper airway obstruction
(C) Decreased forced expiratory volume
(D) Increased shunt fraction
(E) Increased functional residual capacity

ADVANCED Respiratory & Critical Care