10 Random Questions
A 75-year-old man is confused, restless, and disoriented two days after an aortic aneurysm repair. Serum sodium concentration is 112 mEq/L, serum osmolality is low, and urine is hypertonic. The most appropriate treatment is
- (A) restriction of fluid intake
- (B) administration of isotonic saline solution
- (C) administration of hypertonic (3%) saline solution
- (D) administration of spironolactone
- (E) infusion of mannitol 25 g
One hour after induction of anesthesia for a posterior fossa craniotomy using opioid, relaxant, and nitrous oxide, the brain begins to protrude through the dura. The most effective measure to decrease intracranial pressure is to
- (A) administer additional opioid
- (B) decrease PaCO2 from 25 to 15 mmHg
- (C) drain cerebrospinal fluid
- (D) discontinue nitrous oxide
- (E) induce hypotension
During anesthesia, the ventilation/perfusion ratios change
- (A) to preferential ventilation of the dependent portion
- (B) due to cephalad shift of the diaphragm
- (C) by insignificant amounts from that in the awake state
- (D) to preferential perfusion of the superior portion
- (E) from changes in pulmonary compliance
During laser excision of a vocal cord polyp, the tracheal tube ignites. Which of the following is the most appropriate next step?
- (A) Continue ventilation with air
- (B) Ensure patency of the endotracheal tube
- (C) Extubate the trachea
- (D) Flood the surgical field with saline solution
- (E) Increase the concentration of nitrous oxide
A 62-year-old woman with obesity and type II diabetes mellitus is scheduled to undergo vitrectomy of the right eye. Five minutes after retrobulbar injection with 0.75% bupivacaine 4 ml and intravenous administration of fentanyl 50 ju-g and midazolam 1 mg, she is apneic and unresponsive. Which of the following is the most likely cause?
- (A) Fentanyl-midazolam interaction
- (B) Hypoglycemia
- (C) Intravenous bupivacaine
- (D) Retrobulbar hematoma
- (E) Subarachnoid bupivacaine
Which of the following is indicated by an alarm condition in the line-isolation monitor?
- (A) An electrical shock to the patient
- (B) A power surge in the main hospital power supply
- (C) Disconnection of the patient from an electrocautery grounding pad
- (D) Overload of the operating room circuits
- (E) The presence of a current leak between an operating room electrical device and ground
A successful ankle block for transmetatarsal amputation of the first and second toes should include each of the following nerves EXCEPT the
- (A) saphenous
- (B) deep peroneal
- (C) superficial peroneal
- (D) sural
- (E) tibial
The pin index system
- (A) is not used in central pipeline connections
- (B) requires aligning four pins with four holes
- (C) is used on all sizes of medical gas cylinders
- (D) has been replaced by color coding of gas cylinders
- (E) prevents overfilling of gas cylinders
A 45-year-old man is scheduled for appendectomy under general anesthesia. He reports that for many years he has occasionally felt his heart "skip a beat." The ECG tracing shown was obtained one hour ago. Which of the following is the most appropriate next step?
- (A) Proceeding with induction of anesthesia
- (B) Administration of a loading dose of digoxin
- (C) Carotid sinus massage
- (D) Intravenous administration of atropine
- (E) Placement of a temporary pacemaker
Which of the following statements concerning use of temperature-corrected blood gas measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?
- (A) Blood gas analysis is performed at the patient's temperature
- (B) Carbon dioxide should not be added to the bypass circuit
- (C) The carbon dioxide content of the patient's blood is greater than it would be without temperature correction
- (D) The incidence of postoperative neurologic deficits is increased compared with the alpha-stat method
- (E) The patient's temperature should be maintained above 25°C