10 Random Questions
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
Reveal Answer
BASIC
General
Compared with dopamine, dobutamine
(A) is more useful in patients taking monoamine oxidase inhibitors because it depends on the release of norepinephrine for its effect
(B) is more useful in patients in right heart failure because it does not increase pulmonary vascular resistance
(C) has no positive chronotropic response
(D) induces diuresis without increasing cardiac output
(E) in doses greater than 10 mcg/kg/min increases systemic vascular resistance more than similar doses of dopamine
Reveal Answer
BASIC
Pharmacology & Pharmacokinetics
Cardiac
During an aortic aneurysm repair, end-tidal carbon dioxide tension decreases from 35 to 20 mmHg in three breaths. The most likely cause is
(A) acute arteriovenous fistula
(B) bronchospasm
(C) decreased cardiac output
(D) increased tidal volume
(E) venous air embolism
Reveal Answer
Which of the following is the primary physiologic response in a neonate exposed to a hypothermic environment?
(A) Hyperventilation
(B) Increased 2,3-DPG concentration in erythrocytes
(C) Metabolism of brown fat
(D) Shivering
(E) Vasoconstriction
Reveal Answer
ADVANCED
Pediatric
Compared with normal adults, which of the following characteristics of neonates best explains the more rapid inhalation induction in neonates?
(A) Greater cardiac index
(B) Greater metabolic rate
(C) Greater perfusion of vessel-rich tissues
(D) Greater ratio of alveolar ventilation to functional residual capacity
(E) Less lean body mass
Reveal Answer
ADVANCED
Pediatric
A successful celiac plexus block can be expected to
(A) block parasympathetic fibers to the adrenal medulla
(B) block sympathetic fibers to the sigmoid colon
(C) block somatic fibers to the pancreas
(D) enhance peristalsis
(E) inhibit ejaculation
Reveal Answer
ADVANCED
Regional & Pain
Bupivacaine is more likely than lidocaine to cause refractory cardiac arrest because bupivacaine
(A) has a lower rate of plasma clearance
(B) has a secondary blocking effect on cardiac beta,-adrenergic receptors
(C) dissociates more slowly from sodium channels in cardiac muscle
(D) inhibits spontaneous phase 4 depolarization in pacemaker cells
(E) preferentially blocks calcium channels in Purkinje fibers
Reveal Answer
BASIC
Pharmacology & Pharmacokinetics
A 6-year-old child with severe cerebral palsy is scheduled for general anesthesia. He is at increased risk for each of the following EXCEPT
(A) gastroesophageal reflux
(B) hypersensitivity to central nervous system depressants
(C) poor function of laryngeal reflexes
(D) postoperative pulmonary complications
(E) succinylcholine-induced hyperkalemia
Reveal Answer
ADVANCED
Pediatric
Each of the following is a characteristic of prostaglandin E1 (alprostadil) pharmacology in an infant EXCEPT:
(A) It is effective in the treatment of large left-to-right shunts
(B) It is a cause of apnea
(C) It is a potent vasodilator
(D) It prevents closure of the ductus arteriosus
(E) It is metabolized rapidly
Reveal Answer
ADVANCED
Pharmacology & Pharmacokinetics
Pediatric
Compared with adults, caudal anesthesia in children is associated with
(A) higher risk for subarachnoid puncture
(B) more severe hypotension
(C) more rapid onset of sensory block
(D) smaller volume of anesthetic per kilogram of body weight
(E) toxic effects at lower serum levels of bupivacaine
Reveal Answer
ADVANCED
Pediatric
Regional & Pain