10 Random Questions
A 28-year-old woman receives a lumbar epidural anesthetic for uncomplicated labor and delivery. During removal of the catheter, 1 cm breaks off and remains in her back. After informing the patient, the most appropriate management is
- (A) no intervention unless symptoms occur
- (B) prophylactic antibiotics
- (C) epidural corticosteroids
- (D) dye contrast study of the epidural space
- (E) neurosurgical exploration
A 40-year-old woman is undergoing a posterior fossa craniotomy in the sitting position for clipping of a basilar artery aneurysm. Nitroprusside is being used to maintain mean arterial pressure at 50 mmHg, measured at head level. During dissection, over the course of one minute, the mean blood pressure decreases to 30 mmHg. Simultaneously, end-tidal carbon dioxide and pulmonary artery pressures decrease and heart rate increases. The most likely cause of these changes is
- (A) progressive hypoxemia
- (B) nitroprusside bolus
- (C) junctional rhythm
- (D) brain stem manipulation
- (E) venous air embolism
Which Mapleson breathing circuit shown in the illustration permits the LEAST amount of fresh gas inflow to prevent rebreathing during spontaneous ventilation?
- (A) A
- (B) B
- (C) C
- (D) D
- (E) E
Which of the following is the strongest indication for one-lung ventilation?
- (A) Descending thoracic aortic aneurysm
- (B) Esophageal resection
- (C) Lobectomy for lung abscess
- (D) Lobectomy for tumor
- (E) Pneumonectomy for tumor
Preoperative evaluation shows a serum sodium concentration of 140 mEq/L, serum chloride concentration of 90 mEq/L, PaCO2 of 46 mmHg, and arterial pH of 7.50. These findings are most indicative of prior treatment with
- (A) acetazolamide
- (B) enalapril
- (C) furosemide
- (D) mannitol
- (E) spironolactone
A 72-year-old woman with stable angina is undergoing bowel resection. Anesthesia is induced with etomidate. Five minutes after starting isoflurane 1% in nitrous oxide 50%, her blood pressure decreases from 110/84 to 70/40 mmHg. The most likely cause is
- (A) coronary steal produced by isoflurane
- (B) direct myocardial depression produced by isoflurane
- (C) vasodilation produced by isoflurane
- (D) adrenocortical suppression produced by etomidate
- (E) myocardial depression produced by etomidate
Intrabiliary pressure will be increased to the greatest extent by intravenous administration of
- (A) atropine
- (B) glucagon
- (C) naloxone
- (D) fentanyl
- (E) butorphanol
Each of the following changes is expected with deliberate hypothermia EXCEPT
- (A) decreased unloading of oxygen from hemoglobin
- (B) a 5% decrease in MAC for each 1°C decrease in temperature
- (C) increased arterial oxygen and carbon dioxide contents
- (D) a 50% decrease in cerebral metabolic rate at 28°C
- (E) spike and dome EEG activity at temperatures below 30°C
A 35-year-old woman with systemic lupus erythematosus is admitted to the critical care unit following sudden onset of severe chest pain. Examination shows tachycardia, hypotension, pulmonary edema, and a blowing systolic murmur in the left parasternal region. The most appropriate management is
- (A) aerosol administration of terbutaline
- (B) intravenous infusion of phenylephrine and nitroglycerin
- (C) intravenous infusion of esmolol
- (D) intravenous infusion of epinephrine and nitroprusside
- (E) volume loading with lactated Ringer's solution
A 60-year-old man with type II diabetes mellitus requires emergency incision and drainage of a perirectal abscess. Laboratory studies show a serum glucose concentration of 850 mg/dl and a pHa of 7.30. The most appropriate management is administration of regular insulin and which of the following infusions?
- (A) 5% Dextrose in water
- (B) 5% Dextrose in 0.45% saline solution with potassium chloride
- (C) 5% Dextrose in 0.45% saline solution with potassium chloride and mannitol
- (D) Normal saline solution
- (E) Normal saline solution and sodium bicarbonate