10 Random Questions
Which of the following statements concerning the cardiovascular effects of intravenous bupivacaine is true?
- (A) Intralipid is effective in treating bupivacaine-induced ventricular arrhythmias
- (B) Cardiovascular toxicity is decreased during pregnancy
- (C) Cardiovascular toxicity occurs at lower blood levels than central nervous system toxicity
- (D) Systemic vascular resistance is unchanged
- (E) The rate of impulse conduction through the heart is increased
Diplopia following lumbar puncture with a 25-gauge, 3 1/2-inch needle is the result of
- (A) stretching the abducens nerve
- (B) pressure on the optic nerve
- (C) distortion of the oculomotor nucleus from collapse of the wall of the third ventricle
- (D) the severity of the accompanying headache
- (E) compensatory cerebral swelling
A 57-year-old man has back pain, a heart rate of 90 bpm, decreased pulse in the left arm, and blood pressure of 200/110 mmHg. During infusion of nitroprusside, heart rate increases to 115 bpm and blood pressure decreases to 140/80 mmHg. The most appropriate management at this time is administration of
- (A) droperidol
- (B) nifedipine
- (C) normal saline solution
- (D) propranolol
- (E) verapamil
A 75-year-old, 60-kg man with moderately disabling heart failure secondary to ischemic heart disease is undergoing a transurethral prostatic resection under halothane-nitrous oxide anesthesia. Resection time is 30 minutes, and fluid replacement has been lactated Ringer's solution 500 mL. Although heart rate is unchanged, the arterial pressure monitor used because of his cardiac condition has changed from A to B over the last 15 minutes. The most appropriate management is to
- (A) discontinue halothane
- (B) adminster ephedrine 10 mg intravenously
- (C) administer digoxin one half of his daily dose intravenously
- (D) administer sodium chloride 100 mL of 3%
- (E) do none of the above
A patient with chronic obstructive pulmonary disease is undergoing spinal anesthesia to a T6 sensory level. The most pronounced effect on pulmonary function will be a decrease in
- (A) minute ventilation
- (B) peak expiratory flow
- (c) physiologic dead space
- (D) tidal volume
- (E) vital capacity
A patient is scheduled for amputation of the third metatarsal. A tourniquet will not be used during the procedure. The most effective anesthesia will be provided by block of which of the following nerves?
- (A) Femoral
- (B) Common peroneal and tibial
- (C) Sural and deep peroneal
- (D) Sural and tibial
- (E) Tibial, saphenous, and deep peroneal
A patient has fever and chills in the recovery room following an abdominal hysterectomy that required the intraoperative administration of whole blood 1 unit. A blood sample drawn in the recovery room shows no free hemoglobin. Subsequently, packed red blood cells 1 unit and fresh frozen plasma 1 unit are administered, and the fever and chills recur. The most likely cause of the fever and chills is
- (A) an allergic-type transfusion reaction
- (B) a hemolytic transfusion reaction to untested antibodies
- (C) bacterial contamination of blood
- (D) a reaction to leukocytes contained in the plasma
- (E) the presence of cold agglutinins in the patient
A 70-kg, 77-year-old man Is undergoing left nephrectomy with nitrous oxide, oxygen, fentanyl, and midazolam anesthesia. He has a 90 pack-year history of cigarette smoking and has chronic obstructive pulmonary disease. One hour after incision, expiratory wheezing occurs and peak Inspiratory pressure increases from 35 to 65 cmH20; end-tidal PCO2 is unchanged, but SpO2 decreases from 97% to 88%. The most likely cause is
- (A) endobronchial intubation
- (B) overinflation of the endotracheal tube cuff
- (C) pneumothorax
- (D) pulmonary edema
- (E) pulmonary embolism
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
A comatose 40-year-old man is to undergo evacuation of an acute subdural hematoma. His left pupil is dilated and blood is present behind the left tympanic membrane. Each of the following is an acceptable intervention EXCEPT
- (A) application of 5 cm H20 positive end-expiratory pressure
- (B) blind nasotracheal intubation
- (C) use of isoflurane
- (D) use of nitrous oxide
- (E) use of succinylcholine