A 68-year-old man with severe depression is scheduled for electroconvulsive therapy. He had a myocardial infarction two years ago and continues to have angina on exertion. Pretreatment with which of the following drugs is most likely to maintain stability during the procedure?
(A) Esmolol
(B) Fentanyl
(C) Hydralazine
(D) Lidocaine
(E) Midazolam
A
In a 45-year-old patient with severe mitral regurgitation, which of the following is the most important hemodynamic condition to avoid during induction of anesthesia?
(A) Decreased heart rate to less than 60 bpm
(B) Increased heart rate to greater than 90 bpm
(C) Increased preload
(D) Increased afterload
(E) Enhanced myocardial contractility
D
Which of the following is the most likely finding in the affected extremity during the acute stage of reflex sympathetic dystrophy?
(A) Dermatomal distribution of pain
(B) Hypesthesia
(C) Increased growth of hair and nails
(D) Localized edema
(E) Radiographic evidence of osteoporosis
D
A normotensive 66-year-old man undergoes total hip arthroplasty. Mean arterial pressure is maintained at 60 mmHg with isoflurane and labetalol; intraoperative FiO2 is 1.0. Eight units of red blood cells are administered intraoperatively because of an injury to the femoral artery. Five days later, the patient develops jaundice. Which of the following is the most likely cause of the jaundice?
A patient with lumbar disk disease requires lumbar epidural injection of a corticosteroid for control of low back pain. Which of the following statements concerning this treatment is true?
(A) Maximum effect occurs one hour after injection
(B) Maximum effect occurs when drug concentration peaks in cerebrospinal fluid
(C) Maximum effect occurs during the acute phase of the disease
(D) The beneficial effect results primarily from sympathetic neurolysis
(E) It is contraindicated if the patient has had prior surgical procedures on the lumbar disks
C
Which of the following statements about thiopental is true?
(A) Rapid uptake into maternal tissues limits its transfer to the fetus
(B) Its short duration of action is due to its extensive binding to plasma proteins
(C) Accumulation in fat leads to acute tolerance
(D) Alkalinity of solution causes respiratory depression
(E) Uptake into brain is slowed by respiratory acidosis
A 70-kg 78-year-old man undergoing small-bowel resection during anesthesia with isoflurane in oxygen becomes hypotensive and develops frothy pink sputum in the endotracheal tube. Heart rate is 50 bpm, blood pressure is 75/60 mmHg, pulmonary artery occlusion pressure is 22 mmHg, and cardiac output is 1.7 L/min. The most appropriate initial step in management is administration of which of the following?
A full-term newborn has marked respiratory distress in the delivery room. Breath sounds are asymmetric and the abdomen is scaphoid. Which of the following maneuvers is most appropriate?
(A) Hyperventilation with bag and mask
(B) Intubation and ventilation with positive end-expiratory pressure
(C) Intubation and ventilation with zero end-expiratory pressure
A 70-year-old patient has absence of the left radial pulse one month after repair of an aortic aneurysm. Arterial pressure was monitored perioperatively with a 20-gauge left radial artery catheter. Which of the following statements concerning this complication is true?
(A) A preoperative Allen's test would have predicted this complication
(B) Stellate ganglion block should be performed
(C) This complication would have been less likely with an 18-gauge catheter
(D) This patient has poor collateral circulation in the hand