10 Random Questions
A 72-year-old patient who takes levodopa and carbidopa is undergoing colon resection. Metoclopramide is administered preoperatively and anesthesia is maintained with proposal, fentanyl, and nitrous oxide, with vecuronium for muscle relaxation. Fifteen minutes after reversal of muscle relaxation with neostigmine and atropine and tracheal extubation, the patient has dyspnea and muscular rigidity. Which of the following is the most likely cause?
- (A) Central anticholinergic syndrome
- (B) Fentanyl-induced rigidity
- (C) Inhibition of methionine synthetase by nitrous oxide
- (D) Metoclopramide-induced dopamine antagonism
- (E) Peripheral conversion of levodopa to dopamine
A 4-year-old child has just undergone a one-hour tonsillectomy with a volatile anesthetic, nitrous oxide, and oxygen. Which of the following will result in the most rapid emergence?
- (A) Decreased PaCO2
- (B) Increased cardiac output
- (C) Increased fresh gas flow
- (D) Increased solubility of the volatile agent
- (E) Presence of a ventricular septal defect
A 35-year-old man has acute onset of low back pain, lower extremity weakness, and bladder dysfunction. He had a lumbar laminectomy two years ago. A myelogram shows disk herniation at L4-5. The most appropriate management is
- (A) bed rest
- (B) administration of a nonsteroidal anti-inflammatory agent
- (C) epidural administration of a corticosteroid
- (D) epidural administration of a local anesthetic
- (E) surgical decompression
Pulmonary artery occlusion pressure
- (A) does not reliably reflect left ventricular end-diastolic volume when left ventricular compliance is reduced
- (B) inaccurately reflects left atrial pressure when left atrial pressure exceeds 15 mmHg
- (C) is measured at end-inspiration in mechanically ventilated patients
- (D) overestimates left atrial pressure in patients with poor lung compliance
- (E) reflects left atrial pressure only if the catheter tip is located in zone II of the lung
A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?
- (A) Carbon dioxide embolus
- (B) Endobronchial intubation
- (C) Hypoventilation
- (D) Inadvertent application of high levels of positive end-expiratory pressure
- (E) Leak in the capnography sampling catheter
Following induction of anesthesia with sufentanil and pancuronium, a patient with left main coronary artery disease has a decrease in blood pressure from 110/70 to 60/40 mmHg. There is no change in heart rate or ECG. The most appropriate management of the hypotension is administration of
- (A) calcium chloride
- (B) ephedrine
- (C) epinephrine
- (D) isoproterenol
- (E) phenylephrine
Miosis, incontinence, excess salivation, and convulsions are toxic effects of
- (A) amphetamines
- (B) phenothiazines
- (C) cocaine
- (D) tricyclic antidepressants
- (E) organophosphate insecticides
Compared with a patient without liver disease, a patient with cirrhosis will have
- (A) greater accumulation of vecuronium with infusion
- (B) increased unbound plasma vecuronium concentration
- (C) more frequent occurrence of phase II block after succinylcholine administration
- (D) prolonged elimination half-life of atracurium
- (E) unchanged volume of distribution for pancuronium
This flow-volume loop from a 57-year-old man is most consistent with which of the following conditions?
- (A) Bronchospasm
- (B) Decreased vital capacity
- (C) Myasthenia gravis
- (D) Narrowing of the upper airway
- (E) Pneumothorax
A computer program for hemodynamic calculations has the following input values: body surface area, arterial blood pressure, heart rate, pulmonary artery occlusion pressure, pulmonary artery pressure, and cardiac output. Each of the following values can be derived with this program EXCEPT
- (A) cardiac index
- (B) stroke volume index
- (C) systemic vascular resistance
- (D) pulmonary vascular resistance
- (E) left ventricular stroke work index