10 Random Questions

Equipment & Physics

Arterial pressure in the radial artery is 155/70 mmHg measured by a correctly calibrated catheter-transducer system. At the same time, aortic pressure is 140/75 mmHg using a high-fidelity catheter tip transducer. The most likely cause of this discrepancy is

(A) a large amount of air in the dome of the radial artery transducer
(B) coarctation of the aorta
(c) peripheral vascular constriction produced by sympathetic stimulation
(D) physiologic amplification of the waveform from the aorta to the radial artery
(E) too high a frequency response in the catheter-transducer system

Reveal answer

A 66-year-old patient with aortic stenosis is scheduled for aortic valve replacement. Examination shows blood pressure of 110/60 mmHg and sinus rhythm at a rate of 75 bpm. Pulmonary artery occlusion pressure (PAOP) is 20 mmHg with a prominent a-wave on the tracing. Which of the following is the most appropriate management?

(A) Increasing myocardial contractility
(B) Maintaining PAOP below 20 mmHg
(C) Maintaining sinus rhythm
(D) Promoting mild tachycardia
(E) Decreasing peripheral resistance

Reveal answer

Pediatric

A 22-year-old woman with severe preeclampsia vaginally delivers a 3-kg infant after 12 hours of treatment with magnesium sulfate and continuous epidural infusion of bupivacaine 0.0625% and fentanyl 1 mcg/ml at 10 ml/hr. The infant is pink and hypotonic; heart rate is 110 bpm and blood pressure is 35/25 mmHg. Which of the following is the most appropriate initial management of the infant?

(A) 10% Dextrose in water
(B) Calcium gluconate
(C) Epinephrine
(D) Naloxone
(E) Intubation and ventilation

Reveal answer

Pharmacology & Pharmacokinetics Pediatric

A 16-year-old girl is receiving isoflurane, nitrous oxide, oxygen, and pancuronium for insertion of a Harrington rod. In order to perform a "wake-up test" the muscle relaxant was antagonized with neostigmine 2.5 mg and atropine 1 mg. The patient abruptly moved all extremities and was given thiopental 100 mg and succinylcholine 100 mg rapidly. Forty-five minutes later no twitch could be elicited with a nerve stimulator. The most likely explanation is

(A) a dibucaine number of 20
(B) incomplete antagonism of pancuronium
(C) prolongation of the action of succinylcholine by neostigmine
(D) spinal cord damage caused by the abrupt arousal
(E) synergism between succinylcholine and pancuronium

Reveal answer

Regional & Pain

In performing a diagnostic left lumbar sympathetic block for lower extremity claudication, the tip of the needle ideally should lie at point

(A) A
(B) B
(C) C
(D) D
(E) E

Reveal answer

A programmable DVI pacemaker can be inhibited or inactivated by each of the following EXCEPT

(A) myopotentials from shivering
(B) succinylcholine-induced fasciculations
(C) the ventricular R wave
(D) the atrial P wave
(E) placement of a magnet over it

Reveal answer

General

Each of the following values is associated with acute tubular necrosis EXCEPT

(A) urine osmolality of 200 mOsm/L
(B) urine sodium concentration of 15 mEq/L
(C) urine specific gravity of 1.009
(D) urine/serum osmolality ratio of 1.2
(E) fractional excretion of sodium of 4%

Reveal answer

General

During transurethral resection of the prostate, intravascular absorption of glycine irrigant most commonly produces

(A) alkalosis
(B) hemolysis
(C) hypertension
(D) tachycardia
(E) wheezing

Reveal answer

General

A 28-year-old patient has severe laryngospasm after extubation of the trachea following general anesthesia. Administration of 100% oxygen using continuous positive airway pressure does not improve symptoms. SpO2 is 75%. Which of the following is the most appropriate immediate management?

(A) Laryngeal mask airway
(B) Lidocaine
(C) Racemic epinephrine
(D) Succinylcholine
(E) Cricothyroidotomy

Reveal answer

Pediatric

A delay in surgery for 24 to 48 hours for preoperative stabilization and preparation is acceptable in each of the following neonatal conditions EXCEPT

(A) biliary atresia
(B) diaphragmatic hernia
(C) meningomyelocele
(D) pyloric stenosis
(E) tracheoesophageal fistula

Reveal answer