10 Random Questions
Which of the following changes in pulmonary function best explains the more rapid rate of rise of alveolar concentration of volatile anesthetics in pregnant women than in nonpregnant women?
- (A) Decreased functional residual capacity
- (B) Decreased dead space ventilation
- (C) Increased cardiac output
- (D) Increased oxygen consumption
- (E) Increased pulmonary venous admixture
A 57-year-old man who weighs 150 kg and is 170 cm (67 in) tall is scheduled for cholecystectomy. He has a 100 pack-year smoking history. Which of the following findings on pulmonary function testing are most likely?
A 20-year-old woman with poorly controlled diabetes mellitus is scheduled for urgent drainage of an abdominal abscess. She received an initial dose of regular insulin 10 units followed by regular insulin 5 units/hr for the past five hours. Laboratory studies show serum sodium concentration 128 mEq/L, potassium 5.4 mEq/L, chloride 80 mEq/L, and glucose 750 mg/dl. The most appropriate perioperative management is
- (A) addition of subcutaneous NPH insulin
- (B) administration of sodium bicarbonate to correct metabolic acidosis
- (C) administration of normal saline solution to correct the presumed hypovolemia
- (D) administration of furosemide to correct hyponatremia
- (E) infusion of 5% dextrose in 0.2% saline solution to prevent hypoglycemia
When antagonizing neuromuscular block produced by pancuronium, the combination of simultaneously administered anticholinergic and anticholinesterase drugs that is most likely to produce bradycardia is
- (A) glycopyrrolate and pyridostigmine
- (B) atropine and edrophonium
- (C) glycopyrrolate and edrophonium
- (D) atropine and neostigmine
- (E) glycopyrrolate and neostigmine
A 15-year-old previously healthy boy is scheduled for a celiotomy to relieve an acute intestinal obstruction. A rapid sequence induction is used. Anesthesia is maintained with a balanced technique including nitrous oxide and oxygen (5L:2L), meperidine, and pancuronium. Because of abdominal distention and the high pressure required for inflation of the lungs, a nasogastric tube is inserted. The abdomen remains distended, but compliance improves dramatically. At this time the patient is cyanotic, PaO2 is 48 mmHg, PaCO2 is 52 mmHg, and pH is 7.29. Nitrous oxide is discontinued. The most important therapeutic measure is to
- (A) remove the nasogastric tube
- (B) insert a chest tube on the right side
- (C) withdraw the endotracheal tube 1 cm
- (D) deflate the cuff on the endotracheal tube
- (E) replace the endotracheal tube with one of larger internal diameter
Carbon dioxide retention first occurs when the ratio of forced expiratory volume in 1 second to vital capacity (FEV1/VC) decreases below
- (A) 15%
- (B) 35%
- (C) 50%
- (D) 65%
- (E) 75%
Deliberate hypothermia and circulatory arrest is planned for clipping of a giant basilar artery aneurysm. Which of the following statements is true?
- (A) Administration of a muscle relaxant slows the cooling process
- (B) Anesthesia is not required if body temperature is below 31°C
- (C) Decreasing body temperature below the level at which the EEG is isoelectric further decreases cerebral metabolic rate for oxygen
- (D) Sinus bradycardia during cooling results from increased intracranial pressure
- (E) T-wave inversion during cooling indicates myocardial ischemia
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
In treating arterial hypertension in a patient with a head injury, the agent LEAST likely to increase intracranial pressure is
- (A) hydralazine
- (B) nitroprusside
- (C) nitroglycerin
- (D) trimethaphan
- (E) halothane
A 35-year-old patient with asymmetric septal hypertrophy (IHSS) is undergoing bladder suspension with sevoflurane 1%, nitrous oxide 50%, and oxygen 50%. Immediately after skin incision, blood pressure decreases to 90/60 mmHg and junctional tachycardia of 150 bpm is noted on the ECG. Which of the following is the most appropriate management?
- (A) Decreasing sevoflurane concentration
- (B) Infusion of nitroglycerin
- (C) Intravenous administration of a fluid bolus
- (D) Intravenous administration of esmolol
- (E) Intravenous administration of phenylephrine