10 Random Questions
During laparotomy for a ruptured spleen, unexplained oozing occurs after infusion of 2 liters of crystalloid and 3 units of blood. The most likely cause is
- (A) citrate toxicity
- (B) dilutional thrombocytopenia
- (C) hemolytic transfusion reaction
- (D) labile clotting factor deficiency
- (E) leukoagglutinin reaction
A 60-year-old obese man who has an antithrombin III deficiency is scheduled for radical prostatectomy. Prior to the operation this patient should receive
- (A) fresh frozen plasma
- (B) vitamin K
- (C) epsilon-aminocaproic acid
- (D) heparin
- (E) none of the above
A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is
- (A) decreased functional residual capacity
- (B) diffusion hypoxia
- (C) hypercarbia
- (D) increased airway resistance produced by the endotracheal tube
- (E) inhibition of hypoxic pulmonary vasoconstriction
During pulmonary artery catheterization, a 65-year-old man receives morphine 6 mg and scopolamine 0.4 mg intravenously. The pulse oximeter indicates desaturation, which quickly resolves with stimulation. When the drapes are removed, he has unilateral eye pain, decreased visual acuity, and dilated and irregular pupils. These eye symptoms are most likely caused by
- (A) retinal hemorrhage
- (B) morphine-induced oculogyric crisis
- (C) corneal abrasion
- (D) carotid artery embolization
- (E) angle-closure glaucoma
Which of the following postoperative treatments decreases the risk for deep venous thrombosis?
- (A) Blood transfusion
- (B) Epidural anesthesia
- (C) Etomidate
- (D) Ketorolac
- (E) Patient-controlled analgesia
An 18-year-old patient with hemophilia A is scheduled for inguinal hernia repair. Preoperatively, factor VIII concentration is 60% of normal. The most appropriate management is administration of
- (A) fresh frozen plasma
- (B) cryoprecipitate
- (C) factor VIII concentrate
- (D) vitamin K
- (E) none of the above
Compared with morphine, a single epidural administration of fentanyl is associated with
- (A) delayed onset of analgesia
- (B) increased incidence of pruritus
- (C) increased incidence of respiratory depression
- (D) longer duration of action
- (E) more restricted segmental spread
Which of the following findings necessitates the preoperative insertion of a ventricular pacemaker in a 48-year-old man scheduled to undergo cholecystectomy?
- (A) Atrial flutter with 3:1 atrioventricular block
- (B) Bifascicular (right bundle branch block and left anterior hemiblock) block
- (C) Left bundle branch block with first-degree atrioventricular block
- (D) Second-degree (Mobitz I) atrioventricular block
- (E) Second-degree (Mobitz II) atrioventricular block
The most likely explanation for the intraoperative capnographic tracing shown is
- (A) cardiac oscillation
- (B) exhaustion of soda lime
- (C) kinking of the endotracheal tube
- (D) partial recovery from vecuronium
- (E) presence of water droplets in the analyzer
An 88-kg man is anesthetized with 66% nitrous oxide, 33% oxygen, and 1% isoflurane using a circle system. Following tracheal intubation, the nitrous oxide flow is set at 1 L/min and the oxygen flow is set at 0.5 L/min. After two hours the oxygen monitor indicates a circuit oxygen concentration of only 25% despite the flows noted above. The most likely explanation for this discrepancy is
- (A) decrease of oxygen pipeline pressure to 20 psi
- (B) increase in the concentration of nitrous oxide in the circuit
- (C) inaccuracy of flowmeters at low flow rates
- (D) malfunction of the oxygen monitor
- (E) progressive hypothermia