A 50-year-old man with an 80 pack-year history of cigarette smoking has a forced expiratory volume in one second of 1.5 L and a forced vital capacity of 3.5 L. Which of the following statements concerning intraoperative anesthetic management is true?
(A) An I:E ratio of 1:1 will improve carbon dioxide removal more than an I:E ratio of 1:2.5
(B) Antagonism of neuromuscular block will most likely trigger acute bronchospasm
(C) Functional residual capacity will increase during an acute exacerbation of bronchospasm
(D) Induction with ketamine will increase airway resistance
Which of the following is the most important factor affecting the incidence of postoperative pulmonary complications?
(A) Age of the patient
(B) Anesthetic technique
(C) Duration of surgery
(D) Obesity
(E) Site of the operation
E
Twenty minutes after an axillary block, the patient reports feeling over the "back of the hand." Examination shows normal sensation over the lateral aspect of the dorsum of the hand and the dorsal base of the thumb and index finger. Supplementary anesthesia of this area can be provided by blocking which of the following nerves?
A patient who is scheduled for emergency laparotomy for bowel obstruction has had oliguria for three hours. She has had hypertension for 10 years. Which of the following laboratory findings would indicate preoperative fluid challenge?
(A) Urine osmolality: 300 mOsm/L
(B) Urine specific gravity: 1.015
(C) Urine sodium concentration: 35 mmol/L
(D) Fractional excretion of sodium: 0.5
(E) Ratio of urine-to-plasma creatinine concentrations: 8
During insertion of a Harrington rod with deliberate hypotension for correction of spinal scoliosis, accurate interpretation of somatosensory evoked potentials requires
(A) core temperature greater than 35∞C
(B) hematocrit of at least 25%
(C) mean arterial pressure greater than 70 mmHg
(D) P02 of at least 80 mmHg
(E) reversal of neuromuscular block
A
Two hours after coronary artery bypass grafting, a 60-year-old man has a heart rate of 140 bpm and blood pressure of 80/60 mmHg. Cardiac index is 1.5 L/min/m2. Central venous pressure is 23 mmHg with large a-waves in the right atrial pressure tracing. A pulsus paradoxus of 6 mmHg is noted. Which of the following is the most likely diagnosis?
A 24-year-old man who sustained multiple rib fractures in a motor vehicle accident has air leaks through bilateral chest tubes. Which of the following is most likely following initiation of high-frequency jet ventilation?
(A) Airway pressure will be measured most reliably at the proximal (external) end of the endotracheal tube
(B) Atelectatic areas of the lungs will re-expand
(C) Changes in end-tidal carbon dioxide tension measured at the tip of the endotracheal tube will match changes in PaCOz
(D) Hypercarbia will develop
(E) The air leaks will be proportional to peak airway pressure
E
A 35-kg child requires mechanical ventilation with 100% oxygen at a tidal volume of 350 mL and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is