Peak airway pressure increases from 25 to 50 cmH2O when beginning right endobronchial ventilation with a right double-lumen tube. The most likely explanation for this increase is
(A) failure to decrease tidal volume
(B) inadvertent intubation of the left mainstem bronchus
(C) intrinsic resistance of small endobronchial lumina
(D) obstruction of the orifice of the right upper lobe
A 90-kg, 59-year-old man with chronic obstructive pulmonary disease is undergoing laparotomy. Mechanical ventilation is being carried out with a fresh gas flow of 2 L/min at a rate of 16/min and tidal volume of 900 ml; I:E ratio is 1:2.5. PaCO2 remains greater than 50 mmHg. Preoperative PaCO2, was normal. Which of the following is the most appropriate next step?
(A) Adding 10 cmH20 of positive end-expiratory pressure
A 57-year-old man who weighs 150 kg and is 170 cm (67 in) tall is scheduled for cholecystectomy. He has a 100 pack-year smoking history. Which of the following findings on pulmonary function testing are most likely?
An 8-year-old child with chronic renal failure is scheduled for an operation to create an arteriovenous fistula. Laboratory studies include: Hemoglobin 6.5 g/dl, Blood gases (breathing air) : PaO2 97 mmHg, PaCO2 29 mmHg, pH 7.30 Sodium 129 mEq/L Potassium 5.5 mEq/L Chloride 101 mEq/L Bicarbonate 15 mEq/L. Before inducing general anesthesia, which of the following abnormalities should be corrected?
(A) Anemia
(B) Metabolic acidosis
(C) Potassium concentration
(D) Anemia, metabolic acidosis, and potassium concentration
Syringe A contains 100 ml of normal blood with a PO2 of 2 mmHg, and syringe B contains 100 ml of normal blood with a PO2 of 98 mmHg. The contents of the two syringes are mixed anaerobicaily to equilibrium. The PO2 of the resultant mixture Is
If a patient with chronic obstructive pulmonary disease is uncooperative during pulmonary function testing, the most accurate assessment of his disease will be derived from the
A 30-kg patient with asthma is receiving general anesthesia and being mechanically ventilated with a measured tidal volume of 300 mL. Increasing the fresh gas flow from 3 L/min to 9 L/min without changing the ventilatory rate or I:E ratio will result in
In a patient with adult respiratory distress syndrome who is being mechanically ventilated, which of the following findings indicates the most severe disease?
A pulmonary artery catheter is placed in an awake patient breathing room air. Typical right ventricular and pulmonary artery pressure tracings are obtained. With the catheter balloon inflated, blood drawn from the distal port has a PaO2 of 100 mmHg, while a simultaneous radial artery sample has a PaO2 of 90 mmHg. These data indicate that the
A computer program for hemodynamic calculations has the following input values: body surface area, arterial blood pressure, heart rate, pulmonary artery occlusion pressure, pulmonary artery pressure, and cardiac output. Each of the following values can be derived with this program EXCEPT
A 35-year-old woman with severe myasthenia gravis is scheduled for thymectomy. Which of the following preoperative pulmonary function tests is most likely to be normal?
Compared with a patient who is breathing spontaneously, a patient in the supine position receiving controlled positive-pressure ventilation will most likely have which of the following findings?
Prior to occlusion of any major pulmonary blood vessels during a thoracotomy, applying positive end-expiratory pressure to ventilation through the dependent lumen of a double-lumen tube and occluding the upper lumen of the tube will
(A) increase blood flow to the dependent lung
(B) increase the alveolar-arterial oxygen tension difference
During induction of general anesthesia in a patient with a supraglottic tumor, both intubation and subsequent ventilation via a face mask are impossible. A cricothyroidotomy is performed with a 16-gauge intravenous catheter. Which of the following statements is true?
(A) Application of pressures greater than 35 cmH2O to the catheter will increase the risk for pulmonary barotrauma
(B) PaC02 can be maintained at a normal level using a standard circle system attached to the catheter
(C) PaO2 greater than 100 mmHg can be maintained indefinitely using transtracheal jet ventilation with pure oxygen through the catheter
(D) Emergency surgical tracheostomy would have improved the likelihood of survival
(E) The presence of this tumor contraindicates jet ventilation via cricothyroidotomy
You are called to a witnessed cardiac arrest where cardiopulmonary resuscitation is being performed. After successful intubation, arterial blood gas values are PaO2 86 mmHg, PaCO2 63 mmHg, and pH 7.25 at an FiO2 of 1.0. The most appropriate management at this time is to
(A) repeat arterial blood gas analysis using a new specimen
(B) administer sodium bicarbonate
(C) administer fluid challenge with 500 ml of normal saline solution
A 60-kg, 17-year-old girl with severe idiopathic scoliosis is scheduled for Harrington rod fixation. Which of the following respiratory parameters is compatible with this disorder?
(A) Alveolar-to-arterial oxygen tension difference (A-aDO2) less than 100 mmHg while breathing pure oxygen
A 52-year-old woman undergoes facial surgery during general endotracheal anesthesia. The ventilator is set to deliver a tidal volume of 600 ml and a respiratory rate of 10/min at an FiO2 of 1.0. SpO2 is 100%, peak inspiratory pressure is 18 cmH2O, and PetCO2 is 40 mmHg. The surgeon flexes the patient's head so the chin touches the chest. Which of the following findings indicates that endobronchial intubation has NOT occurred?
(A) Fluctuating capnographic waveform
(B) Greater expiratory volume than inspiratory volume
An acutely ill 65-year-old man with sepsis has severe hypophosphatemia. Which of the following is most likely to result from this electrolyte disorder?
During craniotomy in the sitting position, end-tidal carbon dioxide tension suddenly decreases. Ventilatory excursion of the chest is normal. Further evaluation is most likely to show a decrease in
Four hours after open cholecystectomy, a patient who is breathing spontaneously has an SpO2 of 93% in the supine position and an SpO2 of 98% when placed in the head-up position. The most likely cause of this change is an increase in which of the following?
A 30-year-old man who is undergoing laparotomy and resection of a large kidney tumor has a decrease in SpO2 from 100% to 92% and an increase in peak airway pressure from 20 to 35 cm H2O. Plateau pressure is unchanged at 18 cm H2O. Which of the following is the most likely cause?
An obese, 70-year-old woman with a long history of tobacco abuse is awake and semirecumbent after uneventful anesthesia with isoflurane for a ventral hernia repair. During the first hour in the recovery room while breathing 50% oxygen by face mask, her arterial oxygen saturation decreases to 90% while other vital signs remain satisfactory. Which of the following is most likely to be effective in the management of this situation?
A 70-kg, 77-year-old man Is undergoing left nephrectomy with nitrous oxide, oxygen, fentanyl, and midazolam anesthesia. He has a 90 pack-year history of cigarette smoking and has chronic obstructive pulmonary disease. One hour after incision, expiratory wheezing occurs and peak Inspiratory pressure increases from 35 to 65 cmH20; end-tidal PCO2 is unchanged, but SpO2 decreases from 97% to 88%. The most likely cause is
During rapid-sequence induction prior to an emergency surgical procedure, a 20-year-old patient vomits gastric contents containing particulate matter. An endotracheal tube is easily inserted and ventilation with pure oxygen is initiated. Despite the presence of bilateral breath sounds, SpO2 is 90%. Which of the following is the most appropriate next step?
(A) Administration of broad-spectrum antibiotics
(B) Intravenous administration of high-dose methylprednisolone
A patient undergoes thoracotomy in the lateral decubitus position. Which of the following maneuvers is most likely to increase PaO2 during one-lung ventilation?
(A) Applying continuous positive airway pressure to the nondependent lung
(B) Applying positive end-expiratory pressure to the dependent lung
A 54-year-old man is scheduled for open reduction of a fracture sustained when he jumped from a burning building. The carboxyhemoglobin concentration is 25%. Which of the following is the most reliable indicator of adequate oxygenation during general anesthesia?
(A) PaO2 of 300 mmHg
(B) pH of 7.38 with a PaCO2 of 41 mmHg
(C) Mixed venous PO2 of 45 mmHg
(D) Oxyhemoglobin saturation of 100% measured by co-oximeter
A 95-kg, 65-year-old woman receives sevoflurane and pancuronium during a laparoscopic cholecystectomy. Three minutes after administration of neostigmine 5 mg and atropine 1.2 mg, the twitch height returns to normal. Spontaneous tidal volume is 500 ml when the endotracheal tube is removed. In the PACU she reports dyspnea and appears distressed. Which of the following is the most likely cause of the respiratory distress?
A 56-year-old woman with pulmonary fibrosis is scheduled for pneumonectomy. Which of the following parameters best predicts potential postoperative functional impairment?
The illustration depicts flow-volume loops for the same person at two different times in his life. Which of the following is indicated by the dotted loop?
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
The graphs shown illustrate various respiratory patterns in a patient who is breathing spontaneously with continuous positive airway pressure. Which of the following patterns is associated with the LEAST work of breathing?
(A) 1
(B) 2
(C) 3
(D) All patterns are associated with equal work
(E) There is not enough information to answer the question
One hour after an open cholecystectomy, a 42-year-old patient is hemodynamically stable and breathing spontaneously (rate 10/min and regular) at an FiO2 of 0.4. Fentanyl, isoflurane, nitrous oxide, and pancuronium were used during the procedure. Analysis of arterial blood gases (pH, pCO2, pO2) is most likely to show:
A 64-year-old, 87-kg woman in good general health is undergoing a right knee arthroplasty while in the supine position with general anesthesia consisting of enflurane 2% and nitrous oxide 50% in oxygen. She is breathing spontaneously through a 7-mm endotracheal tube. During the first 30 minutes of the procedure, the arterial oxygen saturation measured by pulse oximetry decreases from 98% to 92%. The most likely cause of the desaturation is
(A) decreased functional residual capacity
(B) diffusion hypoxia
(C) hypercarbia
(D) increased airway resistance produced by the endotracheal tube
(E) inhibition of hypoxic pulmonary vasoconstriction
A comatose 40-year-old man is to undergo evacuation of an acute subdural hematoma. His left pupil is dilated and blood is present behind the left tympanic membrane. Each of the following is an acceptable intervention EXCEPT
(A) application of 5 cm H20 positive end-expiratory pressure
(B) blind nasotracheal intubation
(C) use of isoflurane
(D) use of nitrous oxide
(E) use of succinylcholine
B
Five minutes after initiating one-lung ventilation using a double-lumen endobronchial tube, a 70-year-old patient has a decrease in Sp02 from 99% to 90%. Tidal volume and respiratory rate are unchanged. Fiberoptic bronchoscopy verifies appropriate positioning of the tube. Which of the following is the most likely cause of the desaturation?
(A) Blood flow to the nondependent lung
(B) Failure of hypoxic pulmonary vasoconstriction in the dependent lung
(C) Inadequate filling of the bronchial cuff
(D) Inadequate minute ventilation
(E) Surgical manipulation of the nondependent lung
A 29-year-old man who has been nasotracheally intubated for two weeks following a motor vehicle accident has a fever (39C) and a constant headache. Leukocyte count is 18,000/mm3. The most likely cause is
A 20-kg, 5-year-old boy under treatment for five days for a cerebral contusion not requiring an operation is still unconscious. After three days of mechanical ventilation, humidified oxygen 40% via T-tube is started. Arterial blood gas analysis shows PaO2 120 mmHg, PaCO2 44 mmHg, pH 7.48, and base excess +6. A nasogastric tube is in place and draining to gravity. Daily fluid therapy has been 5% dextrose in 0.5 normal saline solution 500 ml and 5% dextrose in lactated Ringer's solution 500 ml. Serum electrolyte concentrations are sodium 140, potassium 3.2, and chloride 91 mEq/L. Serum osmolality is 300 mOsm/L. Urine output averages 15 ml/hour. Dexamethasone 8 mg/day has been the only drug therapy. This patient most likely requires
A 50-year-old man who takes aspirin and nifedipine is scheduled for thoracotomy with one-lung ventilation. Which of the following is associated with the greatest risk for intraoperative hypoxemia?
(A) Preoperative withdrawal of nifedipine therapy
(B) Intraoperative mild respiratory acidosis
(C) Intraoperative administration of isoflurane
(D) Intraoperative administration of nitroglycerin
A healthy, spontaneously breathing, supine, anesthetized patient has a PaCO2 to PetCO2 difference of 3 mmHg. Following institution of mechanical ventilation the value increases to 12 mmHg. The most likely cause of this change is
(A) cephalad displacement of the diaphragm
(B) decreased production of carbon dioxide
(C) increased cardiac output
(D) increased shunting of blood through dependent lung zones
(E) increased ventilation of nondependent lung zones
A previously healthy 28-year-old man is admitted to the emergency department with a probable opioid overdose. Arterial blood gas values are: PaO2 49 mmHg, PaCO2 76 mmHg, and pH 7.12 while breathing room air. Which of the following statements is true?
(A) Aspiration of gastric contents must have occurred
(B) Hypoventilation alone can explain the acidosis and hypoxemia
(C) The hypoxemia is probably due to noncardiogenic pulmonary edema
(D) Naloxone should be administered only if the patient is normothermic
A 75-kg, 45-year-old patient with quadriplegia at the level of C6 is scheduled for elective cholecystectomy. Pulmonary function tests show an FVC of 2.4 L and an FEV, of 1.2 L. Which of the following is the most appropriate conclusion based on these findings?
(A) Intercostal muscle function is normal
(B) SpO, will be 80% or less while breathing room air
(C) Total lung capacity is normal
(D) The patient has chronic obstructive pulmonary disease
During a cardiac arrest with effective chest compression and positive-pressure ventilation, 50 mEq of sodium bicarbonate is administered. Which of the following is the most likely result?
A 20-year-old man involved in a motor vehicle accident is brought to the operating room for irrigation and debridement of open fractures of the femur and humerus. Cyanosis, decreased breath sounds on the left, increased peak airway pressure, and hypotension are noted after intubation of the trachea. The most likely cause is
After the bronchial and tracheal cuffs of a right endobronchial tube are inflated, ventilation through the tracheal lumen is not possible. This finding is most consistent with
(A) cuff occlusion of the right upper lobe bronchus
Following a right lower lobectomy, a patient develops a bronchopleural fistula and becomes hypoxic. He is orally intubated and mechanically ventilated with pure oxygen. PaO2 is 65 mmHg, PaCO2 is 70 mmHg, and pH is 7.25. Which of the following will produce the most favorable change in the blood gases?
A 14-year-old girl with status asthmaticus is receiving oxygen 3 L/min through nasal prongs. Heart rate is 110 bpm. Arterial blood gas values are PaO2 90 mmHg, PaCO2 32 mmHg, and pH 7.46. If ventilation appears unchanged, which of the following is the most reliable sign of impending respiratory failure?
An apneic adult is receiving an oxygen flow of 4 L/min through a rigid bronchoscope. After five minutes of apnea, which of the following findings is most likely?
A woman with chronic obstructive pulmonary disease is extubated and minimally responsive after isoflurane anesthesia. She is receiving oxygen 6 L/min through a face mask. Respirations are 10/min, PaO2 is 68 mmHg, PaCO2 is 54 mmHg, and pH is 7.28. The most likely cause of the respiratory acidemia is
(A) blunted sensitivity to low pH in the medullary respiratory center
(B) chronic carbon dioxide retention
(C) decreased lung volume from supine positioning
(D) depression of carotid body chemoreceptors by halothane
(E) suppression of hypoxic ventilatory drive by supplemental oxygen
Two days after myocardial infarction involving the left anterior descending coronary artery, a patient's blood pressure decreases acutely from 125/80 to 70/40 mmHg, heart rate increases from 75 to 90 bpm, pulmonary artery pressure increases to 50/30 mmHg, and urine output decreases from 60 to 10 ml/hr. Thermodilution cardiac output has increased from 4 to 7 L/min. The most appropriate action is to
(A) compare mixed venous oxygen saturation in the right atrium and pulmonary artery
(B) draw blood for culture and start antibiotic therapy
(C) start dopamine infusion in low dose
(D) administer a fluid challenge
(E) monitor peripheral capillary oxygenation by transcutaneous oximetry
A combined epidural and general anesthetic is used for aortofemoral bypass surgery. Just prior to extubation, the patient received morphine 5 mg through the epidural catheter. Eleven hours later, he is unresponsive while breathing 40% oxygen from a face mask. Respiratory rate is 6/min and SpO2 is 92%. Arterial blood gas analysis shows PaO2 80 mmHg, PaCO2 84 mmHg, and pH 7.16. Which of the following statements concerning this patient is true?
(A) Hypercarbia is contributing to the decreased level of consciousness
(B) Naloxone is ineffective for reversing the respiratory depression
(C) The oxygen saturation is higher than expected because of the pH
(D) The risk for respiratory depression would have been lower with subarachnoid administration of 0.5 mg morphine
(E) Residual local anesthetic is contributing to the respiratory depression
After a gastric stapling procedure, a 150-kg woman is extubated and breathing spontaneously in the recovery room at a rate of 26/min and an FiO2 of 0.5. Arterial blood gas analysis shows PaO2 96 mmHg, PaCO2 44 mmHg, and pH 7.37. The parameter most closely related to her increased alveolar-arterial oxygen tension gradient is
A patient is undergoing thoracotomy in the lateral position. Five minutes after initiation of one-lung ventilation using a double-lumen tube and 100% oxygen, SpO2 decreases from 100% to 65%. Which of the following is the most appropriate initial step in management?
(A) Adding continuous positive airway pressure to the nondependent lung
(B) Adding positive end-expiratory pressure to the dependent lung
(C) Increasing the tidal volume to the dependent lung
(D) Resuming two-lung ventilation
(E) Verifying the position of the double-lumen tube
A 55-year-old woman who is scheduled to undergo carotid endarterectomy has a history of essential hypertension and chronic obstructive pulmonary disease. Over a 30-minute period beginning one hour after induction of general anesthesia, Sp02 decreases from 99% to 95%. During that time, she has received fentanyl 100 mcg, isoflurane 1%, nitrous oxide 49.5%, oxygen 49.5%, and a nitroglycerin infusion to maintain blood pressure at approximately 160/95 mmHg. Which of the following is the most likely cause for the decline in oxygen saturation?
(A) Decreased cardiac output
(B) Increased dead space ventilation
(C) Inhibition of hypoxic pulmonary vasoconstriction
Compared with a person of normal weight, which of the following findings are most likely on pulmonary function testing of a patient with morbid obesity? (FVC, FEV/FVC, FRC, A-a DO2)?
Two days after total abdominal hysterectomy, a 54-year-old woman develops lethargy followed by seizures and coma. Laboratory studies show a serum sodium concentration of 108 mEq/L and serum osmolality of 225 mOsm/kg. The most appropriate next step in management is administration of which of the following?
Which of the following is the most likely cause of a decrease in end-tidal carbon dioxide tension during general anesthesia with a constant minute ventilation?
(A) Administration of sodium bicarbonate
(B) Intravenous administration of hypertonic glucose solution
(C) Decrease in cardiac output
(D) Decrease in fresh gas flow in a Bain circuit
(E) Malfunction of the inspiratory valve in a circle system
After tracheal extubation, a healthy 21-year-old man has a 30-second episode of laryngospasm with marked intercostal and sternal retractions, which are corrected with continuous positive airway pressure administered by mask. He now has dyspnea and tachypnea, and a roentgenogram of the chest shows diffuse bilateral interstitial edema. The most likely cause is increased
A patient receiving mechanical ventilation with oxygen 60% postoperatively has a PaO2 of 160 mmHg and a PaCO2 of 38 mmHg. One hour later, with mechanical ventilation unchanged, the PaO2 is 150 mmHg and PaCO2 is 48 mmHg. The most likely cause of these changes is
A healthy, spontaneously breathing, supine, anesthetized patient has an arterial to end-tidal carbon dioxide tension difference of 3 mmHg. Following institution of mechanical ventilation the value increases to 12 mmHg. The most likely cause of this change is
(A) cephalad displacement of the diaphragm
(B) decreased production of carbon dioxide
(C) increased cardiac output
(D) increased shunting of blood through dependent lung zones
(E) increased ventilation of nondependent lung zones
A child has tachypnea immediately after reintubation for intractable laryngospasm. Oxygen saturation is 78% at an FiO2 of 1.0. A radiograph of the chest taken 15 minutes later is most likely to show
(A) bilateral pleural effusions
(B) diffuse homogenous pulmonary infiltrates
(C) patchy central infiltrates of the right upper lobe
An anesthetized, paralyzed patient is placed in the lateral position and mechanically ventilated. End-tidal PCO2 is 34 mmHg and PaCO2 is 43 mmHg. This gradient
(A) increases during spontaneous breathing
(B) indicates increased dead space ventilation
(C) is caused by increased intrapulmonary shunt
(D) reflects inhibition of hypoxic pulmonary vasoconstriction
A 70-kg, 22-year-old man who is unconscious after a closed head injury is to undergo emergency splenectomy. He is anesthetized with thiopental, given pancuronium for paralysis, and started on nitrous oxide and oxygen 50% each with controlled ventilation (tidal volume 700 ml, rate 10/min). Pulse is 70 bpm, blood pressure is 160/100 mmHg, PaO2 is 65 mmHg, PaC02 is 45 mmHg, and pH is 7.30. In adjusting the ventilator at this time, which of the following is most appropriate?
Which of the following changes in pulmonary function best explains the more rapid rate of rise of alveolar concentration of volatile anesthetics in pregnant women than in nonpregnant women?
A 30-year-old woman is undergoing laparoscopic tubal ligation. Thirty minutes after induction of general anesthesia, arterial oxygen saturation has decreased to 89%. Arterial blood gases at an FiO2 of 1.0 are PaO2 63 mmHg and PaCO2 40 mmHg; PetCO2 is 32 mmHg. Which of the following is the most likely cause?
(A) Carbon dioxide embolus
(B) Endobronchial intubation
(C) Hypoventilation
(D) Inadvertent application of high levels of positive end-expiratory pressure
In a patient with 20% pulmonary shunt and a PaO2 of 60 mmHg, cardiac output suddenly decreases from 5 L/min to 3 L/min. Oxygen consumption is unchanged. As a result, the PaO2 will
(A) increase slightly because of decreased shunt blood flow
(B) decrease slightly because of decreased mixed venous PO2
(C) increase because of decreased affinity of hemoglobin for oxygen
(D) decrease because of an increased dead space to tidal volume ratio
(E) increase because of increased pulmonary oxygen uptake per milliliter of blood
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
In a 65-year-old man, which of the following findings on preoperative pulmonary function testing is associated with the highest risk for respiratory insufficiency following pneumonectomy?
(A) Maximum voluntary ventilation at 65% of predicted
(B) Mean pulmonary artery pressure of 28 mmHg
(C) Predicted postoperative forced expiratory volume in one second (FEV1) of 800 ml
(D) Residual volume to total lung capacity (RV/TLC) ratio of 0.35
If minute ventilation remains constant, which of the following changes in PetCO2 and PaCO2 will result from a decrease in cardiac output? (PetCO2, PaCO2)
During right upper lobectomy and one-lung ventilation with a double-lumen endotracheal tube, the PaO2 decreases to 40 mmHg. The PaCO2 is 39 mmHg. Which of the following is most appropriate?
(A) Confirm position of the tube with bronchoscopy
(B) Apply 5 cmH20 continuous positive airway pressure to the nondependent lung
(C) Apply 5 cmH20 positive end-expiratory pressure to the dependent lung
(D) Resume two-lung ventilation
(E) Clamp the pulmonary artery of the nondependent lung
Following pneumonectomy, a paralyzed patient being mechanically ventilated has the following arterial blood gas values: PaO2 71 mmHg, PaCO2 55 mmHg, pH 7.29. SvO2 is 45%. The most likely explanation for this SvO2 is
A 120-kg 56-year-old man undergoing gastrectomy during anesthesia with fentanyl and isoflurane has a PetCO2 of 35 mmHg and a PaCO2 of 50 mmHg. His FEV,/FVC ratio is 80% of predicted. Heart rate is 120 bpm and arterial blood pressure is 80/40 mmHg. Which of the following is the most likely cause of the difference in PaCO2 and PetCO2?
A 70-kg 24-year-old man with bilateral pneumonia whose lungs are being mechanically ventilated has the following measured parameters: tidal volume 750 ml; FiO2 0.7; rate 12/min; positive end-expiratory pressure 10 cmH2O; PaO2 75 mmHg; PaCO2 55 mmHg; pH 7.30. Which of the following alterations should be made in the ventilatory settings?
A 70-kg 22-year-old patient with head trauma and multiple fractures of the long bones is scheduled for fixation of bilateral femoral fractures. Preoperative laboratory studies show a serum sodium concentration of 150 mEq/L, a serum potassium concentration of 3.1 mEq/L, and a urine output greater than 500 ml/hr. Which of the following agents will decrease urine output?
A 55-year-old man is undergoing craniotomy in the sitting position. Mean arterial pressure is 75 mmHg; arterial blood gas values are PaCO2 41 mmHg and pH 7.37. End-tidal CO2 is 7 mmHg. Which of the following is the most likely cause of the increased PaCO2 to PetCO2 gradient?
(A) Decreased cardiac output
(B) Endobronchial intubation
(C) Hyperinflation of the lungs
(D) Partial disconnect of the capnograph sample tubing
A 35-kg child requires mechanical ventilation with pure 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
A 60-kg 25-year-old woman is undergoing laparoscopy in the Trendelenburg position during general anesthesia. Five minutes after peritoneal inflation, the peak airway pressure required to deliver a tidal volume of 800 ml increases from 25 cmH2O to 60 cmH2O. SpO2 decreases from 100% to 80% and systolic blood pressure increases from 110 mmHg to 140 mmHg. Which of the following is the most likely cause?
Postoperatively, a patient is being mechanically ventilated by a constant-flow, pressure-cycled ventilator with the following initial settings: inspiratory/expiratory (I/E) ratio of 1:2, peak inspiratory pressure (PIP) of 25 cmH2O, and rate of 10/min. One hour later, the I/E ratio is 1:4. Which of the following would ensure that the minute ventilation is the same as that initially set?
(A) Inflate the endotracheal tube cuff to prevent leakage
(B) Double the respiratory rate
(C) Decrease the expiratory pause until the I/E ratio is 1.0
A 65-kg 70-year-old man in the PACU is breathing spontaneously at 20/min through an endotracheal tube connected to a T-piece with a fresh gas flow of 5 L/min. He has a tidal volume of 350 mL and an FiO2 of 0.5. SpO2 decreases from 98% to 84% over one hour, then improves to 92% with an FiO2 of 1.0. Which of the following is the most likely cause of the hypoxemia?
(A) Decreased functional residual capacity
(B) Increased dead space ventilation
(C) Inhibition of hypoxic pulmonary vasoconstriction
Addition of 20 cmH2O positive end-expiratory pressure to a patient receiving controlled mechanical ventilation decreases cardiac output and left ventricular function by
For any given FiO2 and PaCO2, the PaO2 is lower in a healthy paralyzed patient anesthetized with isoflurane than in the same patient unanesthetized and breathing spontaneously. The primary cause of this difference is
(A) controlled ventilation
(B) increased airway resistance
(C) inhibition of hypoxic pulmonary vasoconstriction
A 50-year-old woman develops stridor 10 hours after undergoing thyroidectomy. The most appropriate management is administration of which of the following drugs?
A patient is scheduled for right pneumonectomy. A left-sided double-lumen endobronchial tube is inserted. After the endobronchial side is clamped and both cuffs are inflated, breath sounds are heard only on the left. Which of the following is the most likely cause?
(A) Herniation of the endobronchial cuff over the carina
(B) Occlusion of the right upper lobe bronchus
(C) Placement of the endobronchial lumen in the left mainstem bronchus
(D) Placement of the endobronchial lumen in the right mainstem bronchus
(E) Placement of the endobronchial lumen in the trachea
A patient with chronic obstructive pulmonary disease is undergoing spinal anesthesia to a T6 sensory level. The most pronounced effect on pulmonary function will be a decrease in
A 157 cm (5 ft 2 in), 180-kg, 40-year-old woman has a PaO2 of 65 mmHg, a PaCO2 of 38 mmHg, and a pH of 7.43 while breathing room air preoperatively. The most likely cause of these values is
(A) decreased hypoxic ventilatory drive
(B) higher than normal oxygen extraction from blood
(C) lower than normal cardiac output
(D) lower than normal functional residual capacity