10 Random Questions
A 62-year-old man with severe emphysema was treated for the sixth time with assisted mechanical ventilation (Fi02 0.6, peak inspiratory pressure 25 mmHg, rate 22/min, insp/exp 0.3). Arterial blood gas values with this therapy are Pa02 73 mmHg, PaC02 48 mmHg, and pH 7.32. During the second day of treatment he suddenly becomes dusky, with increased respiratory rate. Arterial blood gas values are Pa02 42 mmHg, PaC02 67 mmHg, and pH 7.25. Tracheal lavage and suction fail to improve his condition. The therapeutic measure most likely to correct this acute episode is to
- (A) administer heparin
- (B) increase Fi02
- (C) paralyze him with pancuronium
- (D) add positive end-expiratory pressure 5 to 10 cmH20
- (E) insert a chest tube
Of the following, the most reliable criterion for adequate clinical reversal of neuromuscular blockade is
- (A) return of twitch height to 90% of normal
- (B) peak inspiratory force of -20 cmH20
- (C) T4:T1 ratio of 0.75 for train of four
- (D) normal tidal volume
- (E) disappearance of post-tetanic facilitation
A 50-year-old woman with subarachnoid hemorrhage and left hemiparesis undergoes clipping of a right cerebral aneurysm. On the second postoperative day, mental status deteriorates. Blood pressure is 110/70 mmHg. A cerebral angiogram shows vasospasm. The most appropriate management is to
- (A) administer dexamethasone
- (B) administer mannitol
- (C) administer phentolamine
- (D) expand intravascular volume
- (E) intubate and hyperventilate to a PaC02 of 28 mmHg
This flow-volume loop from a 57-year-old man is most consistent with which of the following conditions?
- (A) Bronchospasm
- (B) Decreased vital capacity
- (C) Myasthenia gravis
- (D) Narrowing of the upper airway
- (E) Pneumothorax
Phase II neuromuscular block is characterized by
- (A) depressed twitch height, sustained tetanus, post-tetanic potentiation
- (B) depressed twitch height, tetanic fade, post-tetanic potentiation
- (C) depressed twitch height, tetanic fade, no post-tetanic potentiation
- (D) normal twitch height, tetanic fade, post-tetanic potentiation
- (E) normal twitch height, tetanic fade, no post-tetanic potentiation
Each of the following statements about pheochromocytoma is true EXCEPT:
- (A) Preoperative administration of alpha-adrenergic inhibitors will usually reverse EKG changes due to catecholamine myocarditis
- (B) Preoperative administration of alpha-adrenergic inhibitors decreases operative mortality
- (C) Beta-adrenergic inhibitors should be administered preoperatively only in conjunction with alpha-adrenergic inhibitors
- (D) Vasopressor therapy may be necessary postoperatively for treatment of hypotension
- (E) Nasal congestion is a sign of inadequate alpha-adrenergic block
Bronchospasm occurring during anesthesia in a patient with an ileal carcinoid is best treated by administration of
- (A) aminophylline
- (B) dexamethasone
- (C) halothane
- (D) ketamine
- (E) somatostatin
A 77-year-old woman is still intubated and breathing spontaneously following a total hip replacement. The muscle relaxant has been reversed. Tidal volume is 400 ml, end-tidal carbon dioxide tension is 45 mmHg, and SpO2 is 98% at an FiO2 of 1.0. On transfer from the operating table to the gurney, heart rate increases from 65 to 100 bpm and blood pressure decreases from 130/80 to 80/50 mmHg. End-tidal carbon dioxide tension is 30 mmHg and SpO2 is 94%. The most likely diagnosis is
- (A) anaphylactic reaction
- (B) bronchospasm
- (C) myocardial infarction
- (D) pulmonary embolism
- (E) unreplaced blood loss
Coughing that occurs during awake intubation is prevented by local anesthetic block of which of the following nerves?
- (A) Glossopharyngeal
- (B) Hypoglossal
- (C) Recurrent laryngeal and glossopharyngeal
- (D) Recurrent laryngeal and superior laryngeal
- (E) Superior laryngeal and glossopharyngeal
A 26-year-old woman has persistent uterine bleeding following a normal spontaneous delivery without anesthesia. The uterus is firm on manual examination. Which of the following anesthetics is most appropriate for manual extraction of the placenta?
- (A) Halothane
- (B) Pudendal block with lidocaine
- (C) Subarachnoid tetracaine
- (D) Thiopental
- (E) Vecuronium