10 Random Questions
Two days after coronary artery bypass grafting, a 62-year-old man remains sedated, tracheally intubated, and mechanically ventilated with full neuromuscular block. Over the next three hours, Pa02 decreases from 90 to 70 mmHg at an Fl02 of 0.7, peak inspiratory pressure measured proximally in the ventilatory circuit increases from 40 to 66 cmH20, and plateau pressure remains unchanged at 30 cmH20. Which of the following is the most likely cause of these changes?
- (A) Adult respiratory distress syndrome
- (B) Bronchial mucus plugging
- (C) Left ventricular failure
- (D) Lobar pneumonia
- (E) Tension pneumothorax
Which of the following pre-existing conditions predisposes to new-onset third-degree heart block during pulmonary artery catheterization?
- (A) First-degree heart block
- (B) Left bundle branch block
- (C) Sick sinus syndrome
- (D) Sinus bradycardia
- (E) Wenckebach second-degree heart block
In an unpremedicated, spontaneously breathing patient, an alveolar halothane concentration of 0.74% in oxygen is consistently associated with
- (A) absence of overt response to skin incision
- (B) constricted pupils
- (C) flaccidity of abdominal muscles
- (D) normal glomerular filtration rate
- (E) normal myocardial contractility
During cardiopulmonary resuscitation (CPR) in an adult, external chest compression is being performed at the rate of 90/min with 2 inches of sternal depression and a compression-relaxation ratio of 20:80. The most appropriate action is to
- (A) decrease the rate of compression
- (B) increase the duration of compression
- (C) increase the duration of relaxation
- (D) increase the depth of sternal depression
- (E) continue the original pattern of CPR
A 35-year-old woman with a grade III subarachnoid hemorrhage is undergoing clipping of a middle cerebral artery aneurysm 48 hours after initial hemorrhage. Which of the following drugs used to induce hypotension is LEAST likely to affect intracranial pressure?
- (A) Esmolol
- (B) Hydralazine
- (C) Isoflurane
- (D) Nitroglycerin
- (E) Sodium nitroprusside
A 72-year-old man has massive venous hemorrhage during a radical prostatectomy. Blood pressure decreases from 110/60 to 75/30 mmHg and central venous pressure decreases from 12 to 4 mmHg. PetC02 decreases from 34 to 24 mmHg during constant minute ventilation. The most appropriate next step should be to
- (A) apply positive end-expiratory pressure to the breathing circuit
- (B) attempt to aspirate air from the central venous catheter
- (C) expand intravascular volume
- (D) place the patient in the Trendelenburg position
- (E) turn the patient to the left lateral decubitus position
Heparin-induced thrombocytopenia
- (A) does not occur with porcine mucosal heparin
- (B) is caused by direct suppression of platelet production
- (C) is immunologically mediated
- (D) is diagnosed by peripheral blood smear
- (E) occurs only with larger intravenous doses of heparin
Which of the following interventions is most effective in preventing neurologic injury resulting from global cerebral ischemia?
- (A) Induction of barbiturate coma prior to ischemia
- (B) Maintenance of serum glucose concentration greater than 200 mg/dl prior to ischemia
- (C) Induction of hypothermia to a core temperature of 15 degrees C prior to ischemia
- (D) Maintenance of PaCO2 less than 25 mmHg following ischemia
- (E) Prevention of systemic hypertension following ischemia
In a patient with surgically significant aortic insufficiency, cardiac output measured by thermodilution will
- (A) be greater than right ventricular output
- (B) be less than left ventricular output
- (C) be less than cardiac output measured by the Fick method
- (D) be inaccurate because of decreased signal-to-noise ratio
- (E) underestimate net systemic arterial blood flow
The most likely cause of this capnographic tracing obtained just after laryngoscopy and intubation is
- (A) esophageal intubation
- (B) partial obstruction of the endotracheal tube
- (C) pulmonary embolus
- (D) insertion of an endotracheal nasogastric tube
- (E) mild bronchospasm