10 Random Questions
A 70-kg man with ischemic heart disease is undergoing abdominal aortic aneurysm resection. At the time of infrarenal cross-clamping, 0.2-mV ST-segment depression appears on lead V5 of the ECG. Hemodynamic changes occurring at the same time are shown below. Systemic blood pressure 90/50 --> 150/90; Heart rate 80 --> 95; PAp 20/10 --> 45/24; Mean pulmonary artery occlusion pressure (mmHg) 10 --> 23; Cardiac output (L/min) 4.5 --> 3.2. Ischemia would be decreased by restoring the pre-clamp level of each of the following EXCEPT
- (A) blood pressure
- (B) heart rate
- (C) pulmonary artery pressure
- (D) pulmonary artery occlusion pressure
- (E) cardiac output
A 14-year-old girl with status asthmaticus is receiving oxygen 3 L/min through nasal prongs. Heart rate is 110 bpm. Arterial blood gas values are PaO2 90 mmHg, PaCO2 32 mmHg, and pH 7.46. If ventilation appears unchanged, which of the following is the most reliable sign of impending respiratory failure?
- (A) PaO2 of 80 mmHg
- (B) PaCO2 of 39 mmHg
- (C) Heart rate of 140 bpm
- (D) Increased wheezing
- (E) Deterioration of mental status
Which of the following drugs has the shortest elimination half-life?
- (A) Diazepam
- (B) Flumazenil
- (C) Flumazepam
- (D) Lorazepam
- (E) Midazolam
During laparotomy for a ruptured spleen, unexplained oozing occurs after infusion of 2 liters of crystalloid and 3 units of blood. The most likely cause is
- (A) citrate toxicity
- (B) dilutional thrombocytopenia
- (C) hemolytic transfusion reaction
- (D) labile clotting factor deficiency
- (E) leukoagglutinin reaction
While delivering nitrous oxide 1.5 L/min, oxygen 1.5 L/min, and halothane 1%, a leak in the oxygen flowmeter will most likely be detected by the
- (A) low airway pressure alarm
- (B) "fail-safe" system
- (C) oxygen analyzer on the expiratory limb
- (D) oxygen flowmeter reading
- (E) mass spectrometric analysis of gases
The ECG rhythm shown developed during cholecystectomy in a 62-year-old man who had a myocardial infarction and is taking atenolol. The drug of choice for treating this dysrhythmia is
- (A) atropine
- (B) bretylium
- (C) isoproterenol
- (D) lidocaine
- (E) procainamide
Which of the following statements concerning monitoring of neuromuscular function during general anesthesia is true?
- (A) Facial nerve electrodes underestimate recovery from block, compared with ulnar nerve electrodes
- (B) More current is required to depolarize a nerve beneath the negative electrode than beneath the positive electrode
- (C) Needle electrodes should be electrically grounded
- (D) Supramaximal voltage is 10% higher than the voltage required to elicit pain in the awake patient
- (E) The amount of neuromuscular block is underestimated if electrodes are placed on a paretic limb
Each of the following increases arterial to end-tidal carbon dioxide tension difference EXCEPT
- (A) addition of positive-end expiratory pressure
- (B) deliberate hypotension
- (C) endobronchial intubation
- (D) hypovolemia
- (E) pulmonary embolism
Each of the following would slow induction with a volatile anesthetic agent EXCEPT
- (A) hypoalbuminemia
- (B) hyperlipemia
- (C) clean rubber tubing in the circle system
- (D) fresh soda lime
- (E) obesity
Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both feet and ankles. The most likely diagnosis is
- (A) anterior spinal artery syndrome
- (B) diabetic neuropathy
- (C) adhesive arachnoiditis
- (D) cauda equina syndrome
- (E) peripheral nerve injury from the lithotomy position