Two days after myocardial infarction involving the left anterior descending coronary artery, a patient's blood pressure decreases acutely from 125/80 to 70/40 mmHg, heart rate increases from 75 to 90 bpm, pulmonary artery pressure increases to 50/30 mmHg, and urine output decreases from 60 to 10 ml/hr. Thermodilution cardiac output has increased from 4 to 7 L/min. The most appropriate action is to
(A) compare mixed venous oxygen saturation in the right atrium and pulmonary artery
(B) draw blood for culture and start antibiotic therapy
(C) start dopamine infusion in low dose
(D) administer a fluid challenge
(E) monitor peripheral capillary oxygenation by transcutaneous oximetry
A 70-year-old man has a pacemaker set at VOO mode at 70 bpm with temporary atrial and ventricular wires placed prior to separation from cardiopulmonary bypass. Fifteen minutes after separation, he develops atrial fibrillation with a ventricular response of 80 to 100 bpm. Which of the following ECG findings is most likely?
(A) Irregular atrial and ventricular complexes with loss of pacer artifacts
(B) Irregular ventricular complexes with preserved ventricular pacer artifacts at 70 bpm
(C) Occasional pacer artifacts when intrinsic ventricular rate is slower than 70 bpm
(D) Regular ventricular complexes at 70 bpm
(E) Ventricular complexes with preserved atrial and ventricular pacer artifacts at 70 bpm
B
In a patient with a history of grand mal seizures, which of the following is most useful in distinguishing a seizure from normal anesthetic emergence?
(A) Mydriasis
(B) Myoclonic activity
(C) Nystagmus
(D) Positive Babinski sign
(E) None of the above
E
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?
Nine months after sustaining an injury to the left forearm, a 30-year-old woman has diffuse, burning pain on the anterior aspect of the forearm and posterior aspect of the hand and discoloration of the skin in the affected areas. The patient should be informed that
(A) if left untreated, muscle atrophy may develop in the involved limb
(B) if left untreated, the pain will remain well localized
(C) physical therapy is not indicated
(D) the symptoms are directly related to the severity of the initial injury
(E) the symptoms are most likely secondary to underlying peripheral vascular disease
A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment?