Which of the following findings necessitates the preoperative insertion of a ventricular pacemaker in a 48-year-old man scheduled to undergo cholecystectomy?
(A) Atrial flutter with 3:1 atrioventricular block
(B) Bifascicular (right bundle branch block and left anterior hemiblock) block
(C) Left bundle branch block with first-degree atrioventricular block
During a right lower lobe resection, SpO2 decreases from 99% to 70% after institution of one-lung ventilation. FiO2 is 1.0. The most appropriate management is to
(A) administer an inhaled bronchodilator
(B) apply continuous positive airway pressure to the right lung
(C) apply positive end-expiratory pressure to the left lung
Which of the following drugs is contraindicated in patients with Parkinson's disease?
(A) Atropine
(B) Dopamine
(C) Droperidol
(D) Fentanyl
(E) Isoflurane
C
A 70-kg patient with no acute bleeding has a preoperative platelet count of 40,000/mm3. Following preoperative transfusion of platelets 10 units, the predicted platelet count would be
Two months ago a 68-year-old man with insulin-dependent diabetes mellitus had a transurethral resection of the prostate under spinal anesthesia with tetracaine plus epinephrine. He now has numbness and tingling in both feet and disturbance of gait. Physical examination demonstrates stocking-type hypesthesia of both feet and ankles. The most likely diagnosis is
(A) anterior spinal artery syndrome
(B) diabetic neuropathy
(C) adhesive arachnoiditis
(D) cauda equina syndrome
(E) peripheral nerve injury from the lithotomy position
In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will
(A) increase slightly because of decreased shunt blood flow
(B) decrease slightly because of decreased mixed venous PO2
(C) increase because of decreased affinity of hemoglobin for oxygen
(D) decrease because of an increased dead space to tidal volume ratio
(E) increase because of increased pulmonary oxygen uptake per milliliter of blood
A patient who is scheduled for a parathyroidectomy for a parathyroid adenoma has a preoperative serum calcium concentration of 13.5 mg/dl. The ECG shows no acute changes. The most appropriate preoperative management is administration of
(A) calcitonin
(B) hydrocortisone
(C) intravenous saline solution
(D) mannitol
(E) potassium phosphate
C
Compared with adults, caudal anesthesia in children is associated with
(A) higher risk for subarachnoid puncture
(B) more severe hypotension
(C) more rapid onset of sensory block
(D) smaller volume of anesthetic per kilogram of body weight
(E) toxic effects at lower serum levels of bupivacaine