10 Random Questions
During isoflurane anesthesia, a 45-year-old patient with chronic asthma has wheezing, prolonged expiration, sinus tachycardia of 120 bpm, and premature ventricular contractions. Preoperative medication included cromolyn and theophylline. The most appropriate treatment is to administer
- (A) albuterol aerosol
- (B) aminophylline by intravenous infusion
- (C) cromolyn aerosol
- (D) halothane
- (E) hydrocortisone by intravenous bolus
On routine inspection of an anesthesia machine, the nitrous oxide E cylinder pressure is 360 psi. This indicates that the
- (A) pressure in the cylinder is 16 atm
- (B) cylinder contains no liquid nitrous oxide
- (C) cylinder is half full
- (D) cylinder contains enough nitrous oxide for one hour of anesthesia at a flow rate of 3 L/min
- (E) reducing valve is malfunctioning
Thirty-six hours after primary repair of meningomyelocele, a term newborn has frequent periods of apnea lasting 25 seconds and associated with oxygen desaturation to 80%. The most likely explanation is
- (A) hyperglycemia
- (B) loss of cerebrospinal fluid
- (C) obstructive hydrocephalus
- (D) residual anesthetic effect
- (E) normal postoperative events
A patient with uremia is scheduled for emergency surgery. Bleeding time is 18 minutes. The most appropriate initial treatment is
- (A) cryoprecipitate
- (B) desmopressin
- (C) fresh frozen plasma
- (D) platelets
- (E) vitamin K
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
Which of the following is characteristic of the pharmacokinetics of alfentanil?
- (A) Clearance is greater than that of fentanyl
- (B) Elimination half-life is normal in patients with hepatic insufficiency
- (C) Protein binding is minimal
- (D) The majority of alfentanil in plasma is ionized
- (E) Volume of distribution is smaller than that of fentanyl
A 35-kg child requires mechanical ventilation with pure oxygen at a tidal volume of 350 ml and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is
- (A) hypoxic circulatory depression
- (B) inadequate expiratory time
- (C) increased pulmonary vascular resistance
- (D) respiratory alkalosis
- (E) tension pneumothorax
The second gas effect refers to
- (A) acceleration of rise in alveolar concentration of a gas caused by concomitantly administered nitrous oxide
- (B) change in volatile anesthetic vaporizer output with the addition of nitrous oxide to the carrier gas mixture
- (C) decrease in MAC of a volatile anesthetic by addition of nitrous oxide
- (D) expansion of gas-containing spaces by addition of nitrous oxide
- (E) rapid diffusion of nitrous oxide from pulmonary capillary blood into alveolar gas at the termination of anesthesia
Which of the following statements concerning myasthenia gravis is true?
- (A) Neostigmine is inappropriate for antagonism of neuromuscular blockade
- (B) The number of acetylcholine receptors is decreased
- (C) Plasma cholinesterase concentration is decreased
- (D) The risk for malignant hyperthermia is increased
- (E) Succinylcholine is contraindicated
The hemodynamic changes shown would most likely result from infusion of
- (A) dopamine
- (B) epinepherine
- (C) dobutamine
- (D) norepinepherine
- (E) isoproterenol