10 Random Questions
The flow-volume loop shown is most likely from a patient with which of the following?
- (A) Bilateral vocal cord paralysis
- (B) Chronic bronchitis
- (C) Tracheal stenosis six months after a previous tracheostomy
- (D) Tumor of the lower trachea
- (E) Normal respiratory status
Which of the following statements concerning the pharmacokinetics of local anesthetics is true?
- (A) Decreased molecular weight is associated with decreased incidence of allergic reactions
- (B) Decreased protein binding is associated with decreased systemic toxicity
- (C) Increased ionization is associated with increased placental transfer
- (D) Increased lipid solubility is associated with faster onset
- (E) Presence of an ester linkage is associated with increased duration of action
A patient undergoes thoracotomy in the lateral decubitus position. Which of the following maneuvers is most likely to increase PaO2 during one-lung ventilation?
- (A) Applying continuous positive airway pressure to the nondependent lung
- (B) Applying positive end-expiratory pressure to the dependent lung
- (C) Increasing inspiratory flow rate
- (D) Increasing the tidal volume
- (E) Increasing the ventilatory rate
A 28-year-old woman receives a lumbar epidural anesthetic for uncomplicated labor and delivery. During removal of the catheter, 1 cm breaks off and remains in her back. After informing the patient, the most appropriate management is
- (A) no intervention unless symptoms occur
- (B) prophylactic antibiotics
- (C) epidural corticosteroids
- (D) dye contrast study of the epidural space
- (E) neurosurgical exploration
A 68-year-old man who is scheduled for outpatient cystoscopy has non-insulin-dependent diabetes mellitus controlled with glipizide (Glucatrol) 5 mg twice daily. He has had nothing to eat since awakening this morning and has not taken glipizide today. His blood glucose level is 185 mg/dl. Before proceeding, the most appropriate management is to administer
- (A) glipizide 5 mg orally
- (B) NPH insulin 10 units subcutaneously
- (C) regular insulin 10 units intravenously
- (D) dextrose and regular insulin by infusion
- (E) no additional diabetic medication
A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. End-expiratory carbon dioxide tension decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to
- (A) apply positive end-expiratory pressure to the breathing circuit
- (B) attempt to aspirate air from the central venous catheter
- (C) expand intravascular volume
- (D) place the patient in the Trendelenburg position
- (E) turn the patient to the left lateral decubitus position
Which of the following statements concerning intercostal nerve block for postoperative pain is true?
- (A) Block at the midaxillary line provides analgesia for the anterior and lateral abdominal walls
- (B) Blood levels of local anesthetic are higher than after an axillary block
- (C) Intravascular injection is unlikely
- (D) Loss of resistance assures proper needle placement
- (E) Paravertebral spread is prevented by adding epinephrine to the local anesthetic solution
An obese, 70-year-old woman with a long history of tobacco abuse is awake and semirecumbent after uneventful anesthesia with isoflurane for a ventral hernia repair. During the first hour in the recovery room while breathing 50% oxygen by face mask, her arterial oxygen saturation decreases to 90% while other vital signs remain satisfactory. Which of the following is most likely to be effective in the management of this situation?
- (A) Intravenous doxapram
- (B) Racemic epinephrine by inhalation
- (C) Continuous positive airway pressure by mask
- (D) Reintubation of the trachea
- (E) Coughing
During general anesthesia with spontaneous ventilation, a patient has a VD/VT of 0.5. Which of the following is most likely to decrease the ratio?
- (A) Acute bronchospasm
- (B) Continuous positive airway pressure
- (C) Decreased tidal volume
- (D) Increased cardiac output
- (E) Pulmonary embolism
During transurethral resection of the prostate under spinal anesthesia with a sensory level to T10, a patient has sudden onset of sharp upper abdominal pain and nausea. Arterial blood pressure increases from 120/80 to 150/90 mmHg; the patient becomes diaphoretic. Which of the following is the most likely diagnosis?
- (A) Bladder perforation
- (B) Hemolysis
- (C) Hypervolemia
- (D) Hyponatremia
- (E) Myocardial ischemia