10 Random Questions
Neurolytic block is most appropriate for
- (A) abdominal pain secondary to hepatic carcinoma
- (B) abdominal pain secondary to chronic pancreatitis
- (C) persistent chest wall pain secondary to intercostal neuralgia following a thoracotomy for trauma
- (D) reflex sympathetic dystrophy of the upper extremity with an excellent but transient response to a series of stellate ganglion blocks with local anesthetic
- (E) a diabetic patient scheduled for surgical sympathectomy to relieve unilateral lower extremity pain secondary to severe peripheral vascular disease
A patient receiving mechanical ventilation with oxygen 60% postoperatively has a PaO2 of 160 mmHg and a PaCO2 of 38 mmHg. One hour later, with mechanical ventilation unchanged, the PaO2 is 150 mmHg and PaCO2 is 48 mmHg. The most likely cause of these changes is
- (A) metabolic acidosis
- (B) pulmonary embolism
- (C) increased body temperature
- (D) interstitial pulmonary edema
- (E) aspiration pneumonia
During cardiopulmonary bypass at a nasopharyngeal temperature of 28°C and a hematocrit of 20%, temperature-corrected PaCO2 is 50 mmHg and uncorrected PaCO2 is 60 mmHg. The most appropriate management is to
- (A) administer additional opioid
- (B) administer packed red blood cells to increase hematocrit to 25%
- (C) further decrease the patient's temperature
- (D) increase fresh gas flow to the oxygenator
- (E) institute mechanical ventilation
A 58-year-old man undergoes repeat coronary artery bypass grafting. Which of the following is LEAST likely to decrease the need for exogenous blood transfusion?
- (A) Cell saver blood collection before and after cardiopulmonary bypass
- (B) Epsilon-aminocaproic acid administered during cardiopulmonary bypass
- (C) High-dose aprotinin administered during cardiopulmonary bypass
- (D) Tranexamic acid infusion during cardiopulmonary bypass
- (E) Desmospressin administered after cardiopulmonary bypass
A 32-year-old man who is addicted to opioids complains of pain in the PACU one hour after fixation of a mandibular fracture. He has received intravenous morphine 30 mg during the past hour. The most appropriate management is
- (A) continued intravenous administration of morphine until the pain resolves
- (B) intravenous administration of nalbuphine in 5-mg increments until the pain resolves
- (C) intramuscular administration of hydroxyzine 75 mg
- (D) evaluation for entrapment of the mandibular nerve
- (E) evaluation for drug-seeking behavior
A 70-kg, 46-year-old man is undergoing clipping of a cerebral aneurysm with nitrous oxide, opioid, relaxant anesthesia. He is otherwise healthy. As the surgeons are about to enter the dura, the brain is noted to be tense and bulging. Heart rate is 100 bpm and mean arterial pressure is 90 mmHg. PaO2 is 120 mmHg, PaCO2 is 23 mmHg, and pH is 7.50. Which of the following should be done immediately?
- (A) Hyperventilation to a PaCO2 of 15 to 20 mmHg
- (B) Administration of furosemide 20 mg intravenously
- (C) Administration of mannitol 0.5 g/kg
- (D) Administration of thiopental 250 mg in increments
- (E) Addition of halothane 1% to deepen anesthesia
A patient receives an emergency transfusion of three units of O, Rh-negative blood for profuse hemorrhaging. If his blood type is AB, Rh-negative, which of the following is most appropriate for continuing transfusion?
- (A) AB, Rh-negative whole blood
- (B) B, Rh-negative whole blood
- (C) O, Rh-negative whole blood
- (D) A, Rh-negative erythrocytes
- (E) O, Rh-negative erythrocytes
During induction of anesthesia for cesarean delivery, pancuronium is inadvertently substituted for succinylcholine. The neonate shows no clinical signs of muscle relaxation because pancuronium is
- (A) highly ionized
- (B) highly protein bound
- (C) a large molecule
- (D) lipid soluble
- (E) unaffected by "ion trapping"
A normal adult is receiving general anesthesia via a standard circle system and controlled ventilation. Mass spectrometer data are shown. Which event is most compatible with these data?
- (A) Endobronchial intubation
- (B) Hemorrhagic shock
- (C) Incompetent expiratory valve
- (D) Substantial decrease in fresh gas flow
- (E) Venous air embolism
Which of the following drugs is contraindicated in patients with Parkinson's disease?
- (A) Atropine
- (B) Dopamine
- (C) Droperidol
- (D) Fentanyl
- (E) Isoflurane