10 Random Questions
A 35-year-old woman receiving isoflurane anesthesia suddenly develops tachycardia, hypertension, and multifocal ventricular ectopy during dissection of a pheochromocytoma. Each of the following would be appropriate treatment EXCEPT
- (A) administration of an alpha-adrenergic blocker
- (B) administration of a beta-adrenergic blocker
- (C) administration of lidocaine
- (D) administration of nitroprusside
- (E) switching from isoflurane to enflurane
Each of the following would be expected in an otherwise healthy 165-kg woman undergoing cholecystectomy EXCEPT
- (A) decreased functional residual capacity
- (B) decreased ventilatory response to carbon dioxide
- (C) increased cardiac output
- (D) increased gastric fluid volume
- (E) increased metabolism of volatile anesthetics
Which of the following shaded areas most accurately represents the dead space of a properly functioning circle system?
A 33-year-old primigravid woman with myasthenia gravis, well-controlled with pyridostigmine, is in labor with the cervix dilated 7 cm. She has a headache and feels very nervous. Blood pressure is 160/115 mmHg, she has 3+ pitting edema, and urinalysis shows 4+ protein. Appropriate management of her labor should include
- (A) lumbar epidural block with bupivacaine 8 ml of 0.5% solution
- (B) chlorpromazine 2.5 mg administered intravenously
- (C) avoidance of narcotics
- (D) lumbar epidural block with 2-chloroprocaine 8 ml of 3% solution
- (E) chlorpromazine 10 mg administered intramuscularly
An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin concentration of 1.5 mcg/ml. Five minutes after induction of general anesthesia, ventricular bigeminy is noted; blood pressure is 85/65 mmHg, SpO2 is 97%, and PetCO2, is 20 mmHg. Which of the following is the most appropriate management?
- (A) Administration of calcium chloride
- (B) Administration of ephedrine
- (C) Administration of lidocaine
- (D) Administration of potassium chloride
- (E) Decrease in ventilation
The decreased duration of action of an intravenous dose of fentanyl compared with an intravenous dose of morphine is best explained by
- (A) greater lipid solubility
- (B) increased hepatic metabolism
- (C) less protein binding
- (D) shorter elimination half-life
- (E) smaller volume of distribution
A 32-year-old man is scheduled for hernia repair. He underwent heart transplantation for cardiomyopathy five years ago. Which of the following findings is most likely?
- (A) Absence of coronary atherosclerosis
- (B) Biventricular hypokinesis on echocardiography
- (C) Down-regulation of cardiac beta-adrenergic receptors
- (D) Increased heart rate at rest
- (E) Right ventricular hypertrophy
A decreased dose of sodium thiopental is administered to patients in hypovolemic shock primarily because
- (A) acidosis increases the fraction of unionized drug
- (B) delivery of the drug to the brain is increased
- (C) hepatic clearance is decreased
- (D) thiopental is a myocardial depressant
- (E) thiopental is a venous dilator
The concentration effect is greater with nitrous oxide than with the volatile anesthetics because nitrous oxide
- (A) has a lower blood-gas partition coefficient
- (B) has less effect on cardiac output (0 has lower lipid solubility
- (D) is affected less by ventilation-perfusion mismatch
- (E) is used in much higher concentrations
A 157 cm (5 ft 2 in), 180-kg, 40-year-old woman has a PaO2 of 65 mmHg, a PaCO2 of 38 mmHg, and a pH of 7.43 while breathing room air preoperatively. The most likely cause of these values is
- (A) decreased hypoxic ventilatory drive
- (B) higher than normal oxygen extraction from blood
- (C) lower than normal cardiac output
- (D) lower than normal functional residual capacity
- (E) polycythemia