10 Random Questions
Numbness and tingling on the lateral aspect of the thigh 24 hours after uneventful vaginal delivery is most likely a complication of
- (A) forceps delivery
- (B) lithotomy position
- (C) pudendal nerve block
- (D) lumbar epidural anesthesia
- (E) spinal anesthesia
A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood gas analysis shows PaO2 80 mmHg, PaCO2 84 mmHg, and pH 7.16. Which of the following statements concerning this patient is true?
- (A) Hypercarbia is contributing to the decreased level of consciousness
- (B) Naloxone is ineffective for reversing the respiratory depression
- (C) The oxygen saturation is higher than expected because of the pH
- (D) The risk for respiratory depression would have been lower with subarachnoid administration of 0.5 mg morphine
- (E) Residual local anesthetic is contributing to the respiratory depression
Which of the following statements regarding innervation of the upper extremity is true?
- (A) Blockade of the radial nerve decreases the patient's ability to spread the fingers apart
- (B) The brachial plexus receives preganglionic sympathetic fibers arising from C5 through T2
- (C) Interscalene injection of the brachial plexus at C6 is likely to spare the axillary nerve.
- (D) The musculocutaneous nerves receive contributions from C5 and C6
- (E) The vertebral artery lies posterior to the nerve roots of the brachial plexus
Meperidine has a more rapid onset of action than morphine following intravenous injection because of its
- (A) lesser ionization
- (B) greater lipid solubility
- (C) lesser protein binding
- (D) smaller volume of distribution
- (E) slower rate of hepatic clearance
Which of the following combinations of hemoglobin, blood gases, and cardiac output provides the greatest delivery of oxygen to tissue? (Hb, PaO2, SaO2, CO)
- (A) 7.0 85 95 7.0
- (B) 8.0 290 100 8.0
- (C) 9.9 61 90 9.8
- (D) 12.0 140 100 4.5
- (E) 16.0 40 75 5.8
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
Which of the following limits the use of nalbuphine for relief of postoperative pain?
- (A) High incidence of nausea and vomiting
- (B) High incidence of delayed respiratory depression
- (C) Potential for inducing seizures with repeated doses
- (D) Relatively low maximal analgesic effect
- (E) Short duration of action
An 80-kg, 70-year-old woman is scheduled for a mastectomy. She has a history of congestive heart failure treated with digoxin 0.25 mg daily. Preoperative examination shows a sinus rhythm at 80 bpm and blood pressure of 110/70 mmHg. Laboratory studies show a serum potassium concentration of 4.2 mEq/L and a serum digoxin concentration of 1.5 mcg/ml. Five minutes after induction of general anesthesia, ventricular bigeminy is noted; blood pressure is 85/65 mmHg, SpO2 is 97%, and PetCO2, is 20 mmHg. Which of the following is the most appropriate management?
- (A) Administration of calcium chloride
- (B) Administration of ephedrine
- (C) Administration of lidocaine
- (D) Administration of potassium chloride
- (E) Decrease in ventilation
A 2-year-old child has cardiac arrest during an inguinal herniorrhaphy under general anesthesia administered during a Jackson-Rees system. The graph shows end-tidal PCO2 monitored from the tip of the endotracheal tube during cardiopulmonary resuscitation; minute ventilation is unchanged. Which of the following is the most likely cause of the change beginning at the arrow?
- (A) Decreased fresh gas flow
- (B) Inadequate chest compression
- (C) Increased dead space
- (D) Restoration of cardiac output
- (E) Sampling artifact
An advantage of CPDA-1 over CPD for storage of packed red blood cells is
- (A) greater enhancement of red cell survival
- (B) lesser increase in plasma hemoglobin concentration
- (C) lesser increase in PC02 of stored blood
- (D) better maintenance of blood pH
- (E) better maintenance of 2,3-diphosphoglycerate concentration