10 Random Questions
Which of the following best explains the decreased effect of hyperventilation on cerebral blood flow when PaCO2 decreases below 20 mmHg?
- (A) Maximal constriction of cerebral vessels
- (B) Decreased cerebral perfusion pressure
- (C) Decreased cerebral metabolic rate for oxygen
- (D) Increased cardiac output
- (E) Increased cerebrospinal fluid pressure
You are asked to evaluate a 2000-g male infant three hours after vaginal delivery because of a respiratory rate of 50/min, pulse rate of 115 bpm, and the following arterial blood gas values while breathing room air: PaO2 64 mmHg, PaCO2 43 mmHg, and pH 7.33. His mother received meperidine 75 mg two hours before delivery. Appropriate management includes
- (A) administration of naloxone 50 mcg intramuscularly
- (B) increasing the FiO2 to 0.4
- (C) intubation and mechanical ventilation at an FiO2 of 0.5
- (D) administration of oxygen 50% with 5 cm H2O continuous positive airway pressure
- (E) observation, with no action at present
Which of the following is most likely to increase hepatic blood flow during general anesthesia?
- (A) Addition of positive end-expiratory pressure
- (B) Discontinuation of isoflurane and administration of enflurane
- (C) Increased PaCO2
- (D) Moderate controlled hypotension
- (E) Subarachnoid administration of morphine
When compared with a healthy 30-year-old man, which of the following respiratory parameters is decreased in an otherwise healthy 80-year-old man?
- (A) Alveolar to arterial oxygen gradient
- (B) Lung compliance
- (C) Ratio of functional residual capacity to total lung capacity
- (D) Resting tidal volume
- (E) Ventilatory response to carbon dioxide
A 68-year-old man who is scheduled for outpatient cystoscopy has non-insulin-dependent diabetes mellitus controlled with glipizide (Glucatrol) 5 mg twice daily. He has had nothing to eat since awakening this morning and has not taken glipizide today. His blood glucose level is 185 mg/dl. Before proceeding, the most appropriate management is to administer
- (A) glipizide 5 mg orally
- (B) NPH insulin 10 units subcutaneously
- (C) regular insulin 10 units intravenously
- (D) dextrose and regular insulin by infusion
- (E) no additional diabetic medication
Early deceleration of fetal heart rate
- (A) correlates with high concentrations of local anesthetic in maternal blood
- (B) frequently occurs with fetal scalp pH greater than 7.25
- (C) indicates need for immediate cesarean delivery
- (D) indicates subclinical uteroplacental insufficiency
- (E) predicts low Apgar scores at delivery
Compared with the adult airway, the neonatal airway has which of the following characteristics?
- (A) More cephalad larynx
- (B) Narrowest diameter at the vocal cords
- (C) Relatively smaller epiglottis
- (D) Smaller tongue relative to the size of the oral cavity
- (E) Vocal cords perpendicular to the trachea
A 46-year-old patient is undergoing resection of a posterior fossa tumor with the head elevated 10 cm above the level of the heart. During the procedure, the following changes in vital signs are observed. Which of the following is the most likely cause of the change in heart rate?
- (A) Brain stem compression
- (B) Increased intracranial pressure
- (C) Myocardial ischemia
- (D) Trigeminal nerve retraction
- (E) Venous air embolism
Deliberate hypothermia and circulatory arrest is planned for clipping of a giant basilar artery aneurysm. Which of the following statements is true?
- (A) Administration of a muscle relaxant slows the cooling process
- (B) Anesthesia is not required if body temperature is below 31°C
- (C) Decreasing body temperature below the level at which the EEG is isoelectric further decreases cerebral metabolic rate for oxygen
- (D) Sinus bradycardia during cooling results from increased intracranial pressure
- (E) T-wave inversion during cooling indicates myocardial ischemia
An asymptomatic 38-year-old woman is scheduled for elective cesarean delivery. The preoperative EKG shows left axis deviation that was not present one year ago. The most appropriate next step is to
- (A) postpone the procedure and consult a cardiologist
- (B) postpone the procedure and obtain an echocardiogram
- (C) proceed with the procedure after administration of digitalis
- (D) proceed with the procedure but avoid inhalational agents
- (E) proceed without intervention since this is a normal finding