10 Random Questions
Diffuse microvascular bleeding is noted in a patient who has received 25 units of whole blood for a liver resection. Platelet count is 40,000/mm3, prothrombin time is 18 sec, activated partial thromboplastin time is 54 sec, and serum fibrinogen concentration is 60 mg/dl. The most likely cause of the bleeding is
- (A) abnormal platelet function
- (B) citrate toxicity
- (C) depressed levels of factors V and VIII
- (D) dilutional thrombocytopenia
- (E) disseminated intravascular coagulation
Two days after coronary artery bypass grafting, a 62-year-old man remains sedated, tracheally intubated, and mechanically ventilated with full neuromuscular block. Over the next three hours, Pa02 decreases from 90 to 70 mmHg at an Fl02 of 0.7, peak inspiratory pressure measured proximally in the ventilatory circuit increases from 40 to 66 cmH20, and plateau pressure remains unchanged at 30 cmH20. Which of the following is the most likely cause of these changes?
- (A) Adult respiratory distress syndrome
- (B) Bronchial mucus plugging
- (C) Left ventricular failure
- (D) Lobar pneumonia
- (E) Tension pneumothorax
In an unpremedicated, spontaneously breathing patient, an alveolar halothane concentration of 0.74% in oxygen is consistently associated with
- (A) absence of overt response to skin incision
- (B) constricted pupils
- (C) flaccidity of abdominal muscles
- (D) normal glomerular filtration rate
- (E) normal myocardial contractility
A 54-year-old woman who is scheduled to undergo emergency exploratory laparotomy takes warfarin sodium for anticoagulation. Prothrombin time is 19 sec (control 12 sec). Which of the following agents is most appropriate to reverse the effects of warfarin?
- (A) Cryoprecipitate
- (B) Desmopressin (DDAVP)
- (C) Factor IX concentrate
- (D) Fresh frozen plasma
- (E) Pooled factor VIII
Alveolar dead space is decreased by
- (A) halothane anesthesia
- (B) positive end-expiratory pressure
- (C) deliberate hypotension
- (D) atropine premedication
- (E) decreased tidal volume
A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should
- (A) recommend sevoflurane anesthesia since abnormal postoperative liver function tests are unlikely with this drug
- (B) recommend subarachnoid anesthesia since changes in hepatic blood flow would be less than with general anesthesia
- (C) indicate that abnormal liver function tests are likely to follow this operation regardless of the anesthetic drugs used
- (D) require preoperative screening for hepatitis B antigen and antibodies
- (E) recommend avoiding halothane since it is more likely to produce hepatitis in patients who had previous upper abdominal surgery
In the diagram, point "X" represents a patient with severe left ventricular dysfunction. The points labeled 1, 2, and 3 each represent the results of a different therapeutic intervention. Which of the following represents the most likely intervention at each point?
- (A) 1-Dopamine, 2-Furosemide, 3-Nitroprusside
- (B) 1-Dopamine, 2-Nitroprusside, 3-Furosemide
- (C) 1-Furosemide, 2-Dopamine, 3-Nitroprusside
- (D) 1-Nitroprusside, 2-Dopamine, 3-Furosemide
- (E) 1-Nitroprusside, 2-Furosemide, 3-Dopamine
Pseudocholinesterase
- (A) is increased in patients with myasthenia gravis
- (B) is inhibited by glycopyrrolate
- (C) is inhibited by pilocarpine
- (D) is synthesized by the liver
- (E) reverses atracurium blockade
Which of the following statements concerning ketorolac is true?
- (A) It binds to opioid receptors
- (B) It causes dose-related thrombocytopenia
- (C) It decreases heart rate during isoflurane anesthesia
- (D) It is eliminated unchanged in urine
- (E) It reversibly inhibits cyclooxygenase
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