10 Random Questions
A 66-year-old patient with aortic stenosis is scheduled for aortic valve replacement. Examination shows blood pressure of 110/60 mmHg and sinus rhythm at a rate of 75 bpm. Pulmonary artery occlusion pressure (PAOP) is 20 mmHg with a prominent a-wave on the tracing. Which of the following is the most appropriate management?
- (A) Increasing myocardial contractility
- (B) Maintaining PAOP below 20 mmHg
- (C) Maintaining sinus rhythm
- (D) Promoting mild tachycardia
- (E) Decreasing peripheral resistance
A 26-year-old woman has weakness on extension of the right knee one day after uneventful vaginal delivery under spinal anesthesia with lidocaine. The most likely cause is
- (A) femoral nerve injury from thigh abduction
- (B) obturator nerve injury from obstetric forceps
- (C) peroneal nerve compression from the leg support
- (D) saphenous nerve injury from the stirrups
- (E) chemical arachnoiditis following the spinal anesthetic
A patient who is receiving ventilatory support after coronary artery bypass grafting has a PaO2 of 132 mmHg, a PaCO2 of 19 mmHg, and a pH of 7.57. Which of the following is most likely to result from this level of hypocarbia?
- (A) Decreased airway resistance
- (B) Increased myocardial contractility
- (C) Hyperkalemia
- (D) Shortened QT interval
- (E) Cerebral ischemia
Mivacurium-induced neuromuscular blockade is prolonged for the greatest period of time in patients who have which of the following conditions?
- (A) Ethanol-induced hepatitis
- (B) Hemiplegia
- (C) Pseudocholinesterase deficiency
- (D) Renal insufficiency
- (E) Thermal burns
A 68-year-old man with stable angina treated with propranolol and nifedipine is scheduled for coronary artery bypass grafting. After induction with fentanyl and tracheal intubation, heart rate decreases to 40 bpm and blood pressure decreases to 70/40 mmHg. The ECG is shown. Which of the following is the most appropriate first step in management?
- (A) Infusion of isoproterenol
- (B) Administration of phenylephrine
- (C) Closed chest cardiopulmonary resuscitation
- (D) Defibrillation
- (E) Synchronized cardioversion
With long-term administration, which of the following drugs produces the most prolonged sedative effect of diazepam?
- (A) Cimetidine
- (B) Famotidine
- (C) Metoclopramide
- (D) Ranitidine
- (E) Warfarin
In a patient with severe mitral stenosis, induction of anesthesia must include avoidance of increased
- (A) airway pressure
- (B) heart rate
- (C) myocardial contractility
- (D) right ventricular preload
- (E) systemic vascular resistance
A 72-year-old man has had residual hemiparesis since having a cerebrovascular accident three years ago. Compared with the response of the unaffected limbs to nondepolarizing muscle relaxants, the hemiparetic limbs will show
- (A) the same response
- (B) greater depression of tetanus
- (C) greater twitch depression
- (D) less twitch depression
- (E) less post-tetanic facilitation
A 43-year-old man has been hoarse for two weeks since undergoing anterior cervical fusion at C7-8 for treatment of a herniated disk. Laryngoscopy shows paralysis of the right vocal cord. Which of the following is the most likely cause?
- (A) Damage to the glossopharyngeal nerve during surgery
- (B) Damage to the superior laryngeal nerve during surgery
- (C) Nerve root compression by the herniated disk
- (D) Stretching of the recurrent laryngeal nerve during surgery
- (E) Trauma to the vocal cords during intubation
A 27-year-old man with type I von Willebrand's disease requires internal fixation of an open fracture of the femur. Prothrombin time, partial thromboplastin time, and platelet count are normal. During surgery, there is significant oozing from the wound and the surgeon notes poor clot quality. The most appropriate therapy at this time is administration of
- (A) cryoprecipitate
- (B) desmopressin
- (C) fresh frozen plasma
- (D) lyophilized factor VII concentrate
- (E) platelets