10 Random Questions
In a spontaneously breathing patient, each of the following increases the work of breathing EXCEPT
- (A) an increase in respiratory rate by 10/min
- (B) a decrease in lung-thorax compliance by 10 cmH2O
- (C) an increase in carbon dioxide production by 1 ml/kg/min
- (D) a decrease in PaO2 from 80 to 65 mmHg
- (E) a 0.1 increase in the ratio of dead space to tidal volume
Long-term use of cimetidine is associated with
- (A) delayed emergence after thiopental induction
- (B) increased hypotension after morphine
- (C) increased risk for isoflurane-induced nephrotoxicity
- (D) prolonged action of succinylcholine
- (E) prolonged sedation with diazepam
Each of the following statements concerning norepinephrine is true EXCEPT:
- (A) Extraneuronal uptake is important in the termination of its activity
- (B) It is formed from dopamine
- (C) Its release is facilitated by ephedrine
- (D) Its uptake is affected by cocaine
- (E) It has minimal beta2-adrenergic activity
A 40-year-old woman with chronic renal failure is undergoing revision of an arteriovenous shunt with general anesthesia. The capnographic waveform was obtained during spontaneous ventilation 20 minutes after administration of succinylcholine and tracheal intubation. Which of the following is the most likely cause of these findings?
- (A) Leaking endotracheal cuff
- (B) Channeling of soda lime
- (C) Light anesthesia
- (D) Metabolic acidosis
- (E) Residual neuromuscular block
During active labor, 10 ml of bupivacaine 0.5% with epinephrine 1:200,000 is administered epidurally. Fifteen minutes later, maternal blood pressure is 70/50 mmHg and heart rate is 70 bpm; fetal heart rate is 90 bpm for 45 seconds, with loss of beat-to-beat variability. The most likely explanation for the fetal vital signs is
- (A) fetal bupivacaine cardiotoxicity
- (B) maternal bupivacaine cardiotoxicity
- (C) maternal hypotension
- (D) uterine artery vasoconstriction
- (E) umbilical cord compression
Which of the following is most effective in preventing intraoperative hypothermia in adults?
- (A) Heating and humidifying inspired gases
- (B) Maintaining a warm operating room
- (C) Using a circulating warm-water mattress
- (D) Using reflective coverings
- (E) Warming intravenous fluids
A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to
- (A) apply positive end-expiratory pressure to the breathing circuit
- (B) attempt to aspirate air from the central venous catheter
- (C) expand intravascular volume
- (D) place the patient in the Trendelenburg position
- (E) turn the patient to the left lateral decubitus position
A 70-kg, 22-year-old man who is unconscious after a closed head injury is to undergo emergency splenectomy. He is anesthetized with thiopental, given pancuronium for paralysis, and started on nitrous oxide and oxygen 50% each with controlled ventilation (tidal volume 700 ml, rate 10/min). Pulse is 70 bpm, blood pressure is 160/100 mmHg, PaO2 is 65 mmHg, PaC02 is 45 mmHg, and pH is 7.30. In adjusting the ventilator at this time, which of the following is most appropriate?
- (A) Add 10 cmH2O positive end-expiratory pressure (PEEP), increase respiratory rate to 14/min
- (B) Add sufficient PEEP to increase PaO2 to 80 mmHg
- (C) Add 10 cmH2O PEEP, increase FlO2 to 1.0
- (D) Increase tidal volume to 1000 ml, increase FiO2 to 1.0
- (E) Increase tidal volume to 1200 ml, decrease respiratory rate to 8/min
A 62-year-old man with severe emphysema was treated for the sixth time with assisted mechanical ventilation (Fi02 0.6, peak inspiratory pressure 25 mmHg, rate 22/min, insp/exp 0.3). Arterial blood gas values with this therapy are Pa02 73 mmHg, PaC02 48 mmHg, and pH 7.32. During the second day of treatment he suddenly becomes dusky, with increased respiratory rate. Arterial blood gas values are Pa02 42 mmHg, PaC02 67 mmHg, and pH 7.25. Tracheal lavage and suction fail to improve his condition. The therapeutic measure most likely to correct this acute episode is to
- (A) administer heparin
- (B) increase Fi02
- (C) paralyze him with pancuronium
- (D) add positive end-expiratory pressure 5 to 10 cmH20
- (E) insert a chest tube
The twitch responses shown are from a healthy 80-kg patient anesthetized with fentanyl and nitrous oxide. Relaxant drugs X and Y are most likely
- (A) X: atracurium 30 mg, Y: vecuronium 4 mg
- (B) X: atracurium 30 mg, Y: vecuronium 8 mg
- (C) X: pancuronium 4 mg, Y: pancuronium 8 mg
- (D) X: vecuronium 4 mg, Y: atracurium 30 mg
- (E) X: vecuronium 4 mg, Y: pancuronium 8 mg