A patient is undergoing cholecystectomy with enflurane, nitrous oxide, fentanyl, and oxygen. He takes theophylline and cromolyn sodium for bronchial asthma. During skin incision he has bilateral wheezing; peak inspiratory pressure is 50 cmHzO, and the ECG shows occasional premature ventricular contractions. The most appropriate management is to
(A) switch from enflurane to isoflurane
(B) administer lidocaine intravenously
(C) administer methylprednisolone intravenously
(D) administer nebulized cromolyn sodium
(E) administer nebulized metaproterenol
E
During extracorporeal shock wave lithotripsy, the shock wave should be synchronized with
A 65-year-old man is disoriented and has a headache and nausea in the recovery room 30 minutes after transurethral resection of the prostate with glycine irrigation performed under spinal anesthesia. Heart rate is 50 bpm and blood pressure is 180/110 mmHg. Which of the following is LEAST likely?
A 32-year-old woman sustains an injury to the left recurrent laryngeal nerve during thyroidectomy, Which of the following is the most likely postoperative finding?
(A) Adduction of the left vocal cord at rest
(B) Aphonia
(C) Aspiration caused by glottic incompetency
(D) Impaired coughing
(E) Paralysis of the left cricothyroid muscle
A
Which of the following is the most common cause of coagulopathy occurring during massive blood transfusion?
(A) Decreased serum fibrinogen concentration
(B) Decreased serum ionized calcium concentration
(C) Dilutional thrombocytopenia
(D) Disseminated intravascular coagulation
(E) Hypothermia
C
A patient with moderate hypothyroidism and unstable angina requires urgent coronary artery bypass grafting. Which of the following is most appropriate before proceeding with the operation?
(A) Initiation of epinephrine infusion
(B) Intramuscular administration of a barbiturate
(C) Intravenous administration of triiodothyronine (T3)
Five minutes after intrathecal administration of tetracaine 12 mg in hyperbaric solution, a 60-year-old man has a weak hand grasp. Respirations are normal, heart rate has decreased from 80 to 45 bpm, and blood pressure has decreased from 150/80 to 90/50 mmHg. The most appropriate management at this time is
(A) administration of atropine
(B) administration of ephedrine
(C) administration of phenylephrine
(D) placement of the patient in the head-down position
A 62-year-old woman with obesity and type II diabetes mellitus is scheduled to undergo vitrectomy of the right eye. Five minutes after retrobulbar injection with 0.75% bupivacaine 4 ml and intravenous administration of fentanyl 50 ju-g and midazolam 1 mg, she is apneic and unresponsive. Which of the following is the most likely cause?
(A) Fentanyl-midazolam interaction
(B) Hypoglycemia
(C) Intravenous bupivacaine
(D) Retrobulbar hematoma
(E) Subarachnoid bupivacaine
C
The effect of succinylcholine is terminated at postsynaptic effector cells by
(A) binding and uptake by effector cells
(B) diffusion into capillaries
(C) hydrolysis by junctional cholinesterase
(D) hydrolysis by pseudocholinesterase
(E) spontaneous degradation to succinylmonocholine