10 Random Questions
Upon removal of the epidural catheter after uneventful labor and delivery in a 25-year-old primiparous woman, approximately 1.2 cm of the Teflon catheter is left behind in the epidural space. The patient is informed of the complication. The most appropriate management is
- (A) immediate surgical removal
- (B) prophylactic antibiotics
- (C) lumbar myelogram
- (D) monthly neurologic examinations
- (E) no intervention
A 63-year-old man with a history of congestive heart failure and left ventricular dilation is scheduled for carotid endarterectomy. During carotid cross-clamping, the surgeon requests that systolic blood pressure be increased from 100 to 160 mmHg. Compared with an identical patient with normal left ventricular size, what is the effect of this change in blood pressure on this patient's myocardial oxygen consumption?
- (A) Equal decrease
- (B) Greater decrease
- (C) Lesser increase
- (D) Equal increase
- (E) Greater increase
Which the following findings is most hazardous in premature infants?
- (A) Hematocrit of 55%
- (B) Rectal temperature of 35 degrees C
- (C) Umbilical arterial blood PO2 of 50 mmHg
- (D) Umbilical arterial blood PCO2 of 45 mmHg
- (E) Umbilical arterial systolic pressure of 60 mmHg
Which of the following is characteristic of the pharmacokinetics of alfentanil?
- (A) Clearance is greater than that of fentanyl
- (B) Elimination half-life is normal in patients with hepatic insufficiency
- (C) Protein binding is minimal
- (D) The majority of alfentanil in plasma is ionized
- (E) Volume of distribution is smaller than that of fentanyl
Which of the following statements concerning cystoscopy in a patient with a spinal cord injury is true?
- (A) The risk for autonomic hyperreflexia is lower with injury below T10 than with injury above T10
- (B) Anesthesia is unnecessary if the injury is above T7
- (C) Ganglionic blockade is ineffective in preventing autonomic hyperreflexia
- (D) Spinal anesthesia is contraindicated
- (E) Bladder irrigation causes tachycardia
A patient who is scheduled for a gastrectomy had abnormal liver function tests for four days following a prior cholecystectomy. In your consultation note, you should
- (A) recommend sevoflurane anesthesia since abnormal postoperative liver function tests are unlikely with this drug
- (B) recommend subarachnoid anesthesia since changes in hepatic blood flow would be less than with general anesthesia
- (C) indicate that abnormal liver function tests are likely to follow this operation regardless of the anesthetic drugs used
- (D) require preoperative screening for hepatitis B antigen and antibodies
- (E) recommend avoiding halothane since it is more likely to produce hepatitis in patients who had previous upper abdominal surgery
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
A 70-kg 61-year-old patient undergoes a four-hour resection of an abdominal aortic aneurysm during anesthesia with fentanyl and enflurane. Infrarenal clamping is required during the procedure. Twelve hours after the procedure, urine output is 15 ml/hr with a fractional sodium excretion of 6%. Which of the following is the most likely cause?
- (A) Enflurane nephrotoxicity
- (B) Hypovolemia
- (C) Intraoperative renal ischemia
- (D) Positive pressure ventilation
- (E) Unilateral ureteral obstruction
The most common early indication of drug dependence in an anesthesiologist is
- (A) a positive finding on random screening of urine
- (B) inconsistency between anesthetic and drug control records
- (C) change in behavior
- (D) incapacitation due to overdose
- (E) the presence of needle tracks on the extremities
Compared with the adult airway, the airway of an infant is characterized by
- (A) greater narrowing at the cricoid ring
- (B) a less rigid epiglottis
- (C) a more caudad laryngeal opening
- (D) a relatively smaller tongue
- (E) relatively larger tonsils