Two hours after sustaining extensive burns of the head, neck and chest in a house fire, a patient has stridor and difficulty breathing. The most appropriate management is
The shorter duration of action of alfentanil relative to fentanyl is due to its
(A) greater lipid solubility
(B) increased clearance
(C) increased rate of hepatic metabolism
(D) lesser protein binding
(E) smaller volume of distribution
E
Upon removal of the epidural catheter after uneventful labor and delivery in a 25-year-old primiparous woman, approximately 1.2 cm of the Teflon catheter is left behind in the epidural space. The patient is informed of the complication. The most appropriate management is
(A) immediate surgical removal
(B) prophylactic antibiotics
(C) lumbar myelogram
(D) monthly neurologic examinations
(E) no intervention
E
During postoperative indirect laryngoscopy, the vocal cords appear symmetric during quiet breathing and approximate to the left of midline during phonation. The most likely cause is
(A) pure abductor paralysis of the left cord
(B) pure abductor paralysis of the right cord
(C) abductor and adductor paralysis of the left cord
(D) abductor and adductor paralysis of the right cord
A 72-year-old man has had residual hemiparesis since having a cerebrovascular accident three years ago. Compared with the response of the unaffected limbs to nondepolarizing muscle relaxants, the hemiparetic limbs will show
(A) the same response
(B) greater depression of tetanus
(C) greater twitch depression
(D) less twitch depression
(E) less post-tetanic facilitation
D
A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia?
(A) Preoperative withdrawal of nifedipine therapy
(B) Intraoperative mild respiratory acidosis
(C) Intraoperative administration of isoflurane
(D) Intraoperative administration of nitroglycerin
An adult patient with atrial fibrillation develops pulseless ventricular tachycardia wfiile undergoing synchronized electirical cardioversion. Which of the following is the most appropriate management?
(A) Intravenous administration of adenosine
(B) Intravenous administration of a bolus of lidocaine followed by electrical cardioversion
(C) Immediate repeat synchronized cardioversion at the same energy level
(D) Immediate repeat synchronized cardioversion at twice the previous energy level