10 Random Questions
Which of the following factors is LEAST likely to affect serum ionized calcium concentration following blood transfusion?
- (A) Age of blood transfused
- (B) Amount of blood transfused
- (C) Body temperature
- (D) Serum pH
- (E) Rate of transfusion
An otherwise healthy 42-year-old woman is referred for management of pain associated with adenocarcinoma of the breast and metastasis to the anterior body of L3. She perceives the pain as moderate and currently takes no pain medication. Her oncologist estimates her life expectancy to be 18 months. The most appropriate initial management is
- (A) a benzodiazepine as needed and at bedtime
- (B) an oxycodone preparation as needed and a tricyclic antidepressant at bedtime
- (C) intravenous patient-controlled analgesia
- (D) morphine infusion via an implanted epidural catheter
- (E) parenteral meperidine
An 8-kg, 5-month-old infant undergoes craniotomy for an arteriovenous malformation. During the procedure, severe hemorrhaging occurs and packed red blood cells 3 units are transfused rapidly. During infusion of the third unit, hypotension, nodal bigeminy, and prolongation of the QT interval are noted. The most appropriate management includes administration of
- (A) bicarbonate
- (B) calcium
- (C) ephedrine
- (D) lidocaine
- (E) potassium
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
A 24-year-old man is undergoing induction of general anesthesia prior to appendectomy. During laryngoscopy, he regurgitates a large amount of bilious material. An endotracheal tube is inserted; aspiration shows bile-stained fluid. Which of the following is the most appropriate next step in management?
- (A) Infusion of a loading dose of aminophylline
- (B) Intravenous administration of broad-spectrum antibiotics
- (C) Lavage of the tracheobronchial tree with saline solution
- (D) Radiograph of the chest
- (E) Proceeding with the operation
Which of the following findings is most likely in a 3-year-old child who has a secundum-type atrial septal defect with a 2:1 left-to-right shunt?
- (A) Pulmonary blood flow twice that of systemic blood flow
- (B) Pulmonary vascular resistance twice normal
- (C) Mean pulmonary artery pressure twice normal
- (D) Right atrial pressure twice normal
- (E) Hypoxemia while breathing room air
The graphs shown illustrate various respiratory patterns in a patient who is breathing spontaneously with continuous positive airway pressure. Which of the following patterns is associated with the LEAST work of breathing?
- (A) 1
- (B) 2
- (C) 3
- (D) All patterns are associated with equal work
- (E) There is not enough information to answer the question
Which of the following is the most common initial manifestation of malignant hyperthermia?
- (A) Hyperkalemia
- (B) Increased distal esophageal temperature
- (C) Increased PETCO2
- (D) Red discoloration of urine
- (E) Ventricular irritability
A 64-year-old man with diabetes mellitus well controlled with NPH insulin undergoes lower extremity revascularization. Following administration of protamine 10 mg, the patient has facial flushing and blood pressure of 60/30 mmHg. The most appropriate initial step in management is administration of which of the following drugs?
- (A) Diphenhydramine
- (B) Epinephrine
- (C) Hydrocortisone
- (D) Norepinephrine
- (E) Phenylephrine
Maximum current is delivered to the myocardium by a countershock for defibrillation when
- (A) paddle contact pressure is minimal
- (B) petroleum jelly is used under the paddles
- (C) previous countershocks of the same power have been attempted
- (D) the patient is grounded securely
- (E) the shock is applied at the end of inspiration