10 Random Questions
A 75-year-old man received an uneventful epidural anesthetic for total knee arthroplasty. Twenty-four hours later he has a painless flaccid paralysis in both legs. This clinical presentation is most consistent with
- (A) adhesive arachnoiditis
- (B) anterior spinal artery thrombosis
- (C) epidural abscess
- (D) epidural hematoma
- (E) transverse myelitis
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
The left ventricular function curve is from a young, healthy patient. If X represents the patient's myocardial function prior to anesthesia, the effect of 1 MAC of isoflurane at normocarbia is best represented by which of the following positions?
- (A) A
- (B) B
- (C) C
- (D) D
- (E) E
Which of the following drugs is LEAST likely to cross the placenta?
- (A) Lidocaine
- (B) Meperidine
- (C) Midazolam
- (D) Thiopental
- (E) Vecuronium
Which of the following increases the cephalad spread of hyperbaric intrathecal local anesthetics?
- (A) Cephalad-directed needle bevel
- (B) Coughing
- (C) Lithotomy position
- (D) Obesity
- (E) Rapid injection
A 1-month-old infant becomes hypoxemic faster during apnea than an adult. Which of the following is the primary cause of this difference?
- (A) Functional residual capacity in an infant is half that of an adult
- (B) Metabolic rate in an infant is twice that of an adult
- (C) Resting PaO2 in an infant is lower than that in an adult
- (D) The number of alveoli in an infant is 12% the number in an adult
- (E) The hemoglobin dissociation curve in an infant is shifted to the right
A 36-year-old woman who undergoes peritoneal dialysis for chronic renal failure requires emergency surgical exploration for bowel obstruction. Serum creatinine concentration is 9.8 mg/dl and BUN concentration is 124 mg/dl. The most likely abnormality of coagulation is
- (A) decreased euglobulin lysis time
- (B) decreased platelet count
- (C) prolonged activated partial thromboplastin time
- (D) prolonged bleeding time
- (E) prolonged prothrombin time
A 20-year-old man is scheduled for emergency laparotomy for an abdominal stab wound. Ten minutes after induction with oxygen, thiopental, and succinylcholine, blood pressure is 220/120 mmHg and esophageal temperature is 39°C. ST-segment depression of 4 mm is noted in ECG lead V5. Which of the following is the most likely cause?
- (A) Adrenal laceration
- (B) Cocaine intoxication
- (C) Inadequate anesthesia
- (D) Malignant hyperthermia
- (E) Small cardiac puncture
A 70-year-old patient has absence of the left radial pulse one month after repair of an aortic aneurysm. Arterial pressure was monitored perioperatively with a 20-gauge left radial artery catheter. Which of the following statements concerning this complication is true?
- (A) A preoperative Allen's test would have predicted this complication
- (B) Stellate ganglion block should be performed
- (C) This complication would have been less likely with an 18-gauge catheter
- (D) This patient has poor collateral circulation in the hand
- (E) The pulse will likely return
A 62-year-old patient undergoes resection of a descending thoracic aneurysm under anesthesia with morphine, nitrous oxide, oxygen, and pancuronium. In spite of normal somatosensory evoked potentials (SSEP) during the procedure, the patient has paraplegia postoperatively. The factor most likely responsible for failure to note the deficit intraoperatively is
- (A) the effect of nitrous oxide on SSEP
- (B) the effect of morphine on SSEP
- (C) failure to test motor pathways
- (D) hyperventilation to a PaC02 of 30 mmHg
- (E) unintentional hypothermia to 34°C