10 Random Questions
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
An endobronchial Robertshaw tube is inserted for resection of a midesophageal tumor under isoflurane, oxygen, pancuronium anesthesia. Forty minutes into a planned two-hour resection, arterial blood gas values are reported as PO2 45 mmHg, PCO2 45 mmHg, and pH 7.33. Ten minutes earlier, the values were PO2 210 mmHg, PCO2, 41 mmHg, and pH 7.39. The first action should be to
- (A) reposition the Robertshaw tube
- (B) apply positive end-expiratory pressure to the ventilated lung
- (C) reinflate and ventilate the non ventilated lung
- (D) increase minute ventilation
- (E) repeat the arterial blood gas analysis
A 63-year-old man with a history of congestive heart failure and left ventricular dilation is scheduled for carotid endarterectomy. During carotid cross-clamping, the surgeon requests that systolic blood pressure be increased from 100 to 160 mmHg. Compared with an identical patient with normal left ventricular size, what is the effect of this change in blood pressure on this patient's myocardial oxygen consumption?
- (A) Equal decrease
- (B) Greater decrease
- (C) Lesser increase
- (D) Equal increase
- (E) Greater increase
A patient has sudden cardiopulmonary arrest five minutes after retrobulbar block with 0.75% bupivacaine 2 ml with hyaluronidase for ophthalmologic surgery. No premonitory changes were noted on the pulse oximeter. The most likely cause is
- (A) allergic reaction to hyaluronidase
- (B) direct cardiac toxicity
- (C) oculocardiac reflex
- (D) intravenous injection of local anesthetic
- (E) subarachnoid injection of local anesthetic
Which of the following statements concerning flumazenil is true?
- (A) Hepatic clearance is low
- (B) It binds irreversibly with the benzodiazepine receptor
- (C) It causes hypertension and tachycardia
- (D) It has a shorter duration of action than midazolam
- (E) It reverses opioid-induced respiratory depression
Which of the following statements best describes the decrease in functional residual capacity that accompanies the induction of general anesthesia?
- (A) It does not change compliance
- (B) It is greater with spontaneous ventilation than with controlled ventilation
- (C) It is independent of body position
- (D) It is not corrected by application of positive end-expiratory pressure
- (E) It occurs within the first 10 minutes of anesthesia
Which of the following shaded areas most accurately represents the dead space of a properly functioning circle system?
A patient who is paraplegic secondary to spinal cord transection at T3 develops bradycardia and facial flushing during a nephrectomy under general anesthesia with nitrous oxide, fentanyl, and atracurium. The most likely cause of this response is
- (A) release of histamine
- (B) stimulation of the carotid sinus
- (C) release of prostaglandins
- (D) vagal response to peritoneal traction
- (E) release of epinephrine
The best indication that a patient is ready for discharge from an outpatient facility after spinal anesthesia is return of
- (A) pinprick sensation to the S4-5 dermatome
- (B) micturition
- (C) plantar flexion
- (D) proprioception of the big toe
- (E) knee extension
Reduction of fire hazards during laser surgery of the airway is best accomplished by use of
- (A) continuous mode laser emissions
- (B) a nitrous oxide/opioid/relaxant anesthetic technique
- (C) a polyvinylchloride endotracheal tube and cuff
- (D) topical lidocaine
- (E) saline-filled sponges over exposed tissues