10 Random Questions
A 50-year-old patient is undergoing middle ear exploration with isoflurane, nitrous oxide, and oxygen anesthesia. Ventilation is controlled; PetC02 is 35 mmHg, heart rate is 90 bpm, and blood pressure is 120/70 mmHg. Assistance is needed to minimize bleeding in the surgical field. Which of the following is the most appropriate next step in management?
- (A) Addition of 5 cmH20 positive end-expiratory pressure
- (B) Changing the anesthetic agent to halothane
- (C) Hyperventilation to a PetC02 of 20 mmHg
- (D) Placing the patient in reverse Trendelenburg position
- (E) Titration of nitroprusside to a mean arterial pressure of 55 mmHg
A woman has weakness of the right quadriceps and a decreased knee jerk reflex on the right one day after forceps delivery under epidural anesthesia. The most likely cause is
- (A) epidural hematoma
- (B) intrapelvic nerve trauma
- (C) lithotomy positioning
- (D) reaction to the preservative in the anesthetic solution
- (E) trauma from the epidural needle
Mismatching of ventilation to perfusion in the lung is greatest in which of the following situations?
- (A) Awake patient, spontaneous ventilation, lateral decubitus position
- (B) Anesthetized patient, controlled ventilation, supine position
- (C) Anesthetized patient, controlled ventilation, lateral decubitus position
- (D) Anesthetized patient, controlled ventilation, sitting position
- (E) Anesthetized patient, spontaneous ventilation, prone position
A 65-kg man is scheduled for wrist surgery with intravenous regional anesthesia with 0.5% lidocaine 50 ml. Which of the following statements is true?
- (A) This anesthetic is contraindicated if the patient has sickle cell disease
- (B) Mottling of the skin after injection dictates abandonment of the technique
- (C) Tourniquet discomfort is an indication to inject more local anesthetic
- (D) Bupivacaine 0.5% could be substituted to prolong anesthesia
- (E) Epinephrine (1:400,000) should be added to prolong anesthesia
A 13-year-old African American boy has severe abdominal pain after debridement of an open fracture of the lower extremity. His hemoglobin concentration is 10 g/dl and a peripheral blood smear shows elongated crescent-shaped erythrocytes. The most appropriate initial therapy is
- (A) sodium bicarbonate administration
- (B) dopamine infusion
- (C) blood transfusion
- (D) volume loading with crystalloid
- (E) high-dose corticosteroid administration
A 25-year-old woman is undergoing emergency appendectomy at 36 weeks' gestation. Following subarachnoid injection of hyperbaric bupivacaine and placement in the supine position, the patient has nausea; heart rate is 105 bpm and blood pressure is 90/60 mmHg. Which of the following is the most appropriate management?
- (A) Displacement of the uterus to the left
- (B) Immediate tracheal intubation
- (C) Intramuscular administration of ephedrine
- (D) Placement of the operating table in the reverse Trendelenburg position
- (E) Ventilation by mask with 100% oxygen
In this diagram of a circle system, an increase in dead space is most likely to result from placement of the pressure relief valve at location
- (A) 1
- (B) 2
- (C) 3
- (D) 4
- (E) 5
Metoclopramide
- (A) decreases gastric acid secretion
- (B) decreases gastroesophageal sphincter tone
- (C) is contraindicated in patients with Parkinson's disease
- (D) is most effective when administered in combination with atropine
- (E) requires an intact vagus nerve for gastrointestinal effects
During general anesthesia using a modern anesthesia machine, a patient's spontaneous ventilation is manually assisted with a fresh gas flow of 5 L/min. A sudden malfunction of the pressure-relief (pop-off) valve of the circle absorption system occurs, and the valve cannot be opened. The most appropriate next step is to
- (A) change to a smaller reservoir bag
- (B) increase total fresh gas flow
- (C) open the scavenger valve
- (D) control ventilation manually
- (E) switch to mechanical ventilatory mode
Each of the following is a complication of celiac plexus block with 0.5% lidocaine 40 ml EXCEPT
- (A) hematuria
- (B) ileus
- (C) postural hypotension
- (D) retroperitoneal hematoma
- (E) weakness of hip flexors