KW Q2 16

1

72 yo 127 kg M w CAD & OSA after total hip arthroplasty (THA) received intrathecal opiod for postoperative pain. Two hours after the procedure, the patient was hemodynamically stable and was transferred to the ward with and order for analgesic management, normal diet and periodic monitoring for bleeding and vital signs. Ten hours after transfer, the patient was found unconscious, cyanotic, diaphoretic, hypotensive and bradycardic. Which of the following opioids is associated with delayed respiratory depression after intrathecal injection?

1

A 62-yo man admitted to ICU for pneumonia with severe hypoxemia was intubated and ventilated with volume-controlled mode, with VT 6 mL/kg, respiratory rate 30 breaths/min, inspiratory time 0.4 s, FIO2 0.60, and PEEP 10 cm H2O. Pressure-support ventilation was started on day 7, at 20 cm H2O, and gradually lowered, by 5 cm H2O at a time, as long as the respiratory rate was between 26 and 35 breaths/min and pulse oximetry was >88%. PEEP was kept constant at 5 cm H2O. Which of the following changes is primarily responsible for triggering inspiration with pressure support ventilation?

1

A 20-yo woman after MVA blunt chest injury with pneumothorax, and right rib fractures. After a placement of Rt chest tube, her heart rate of 140 bpm, blood pressure of 80/40 mmHg, 20 mm pulsus paradoxus, distended neck veins, muffled heart sounds, and decreased voltage on ECG. Which of the following findings on Echo would support the diagnosis of cardiac tamponade?

1

A 21-year-old patient with asthma presents for preoperative evaluation. He reports that despite using his albuterol inhaler daily, his asthmatic symptoms have recently worsened. Addition of a medication from which of the following classes to his current regimen would be MOST appropriate prior to his surgery?

1

A 13-year-old, 165-lb girl is scheduled to undergo tonsillectomy and adenoidectomy. She has been diagnosed with sleep apnea. Use of which of the following analgesics would be the BEST initial choice for treatment of postoperative pain in this patient?

1

Which of the following is characteristic of the pathophysiology of transfusion-associated circulatory overload (TACO) but not of transfusion-related acute lung injury (TRALI)?

1

70yo female patient undergoing cardiopulmonary bypass. Which of the following interventions is the MOST appropriate prophylactic measure to minimize the risk of postoperative renal failure?

1

A 19-yo develops pink, frothy sputum after an episode of laryngospasm and has an SpO2 of 86% on supplemental oxygen (FiO2 0.6). Which of the following interventions is MOST appropriate to treat his hypoxemia?

1

A 52-year-old woman for urgent LIH repair and has a moderate to severe mitral regurgitation. Which of the following would definitely INCREASE regurgitant flow?

1

A 36 year old male trauma patient for emergency surgery. The patient received five units of packed RBCs during surgery. After infusion of 100mL of the sixth unit, the patient became hypotensive and the transfusion was stopped. The patient’s hypotension resolved and the surgery was completed without additional transfusions. Soon after arriving in the ICU, hemoglobinuria is observed. This along with the drop in blood pressure during infusion led the attending physician to suspect a transfusion reaction. Pre-transfusion samples, post-transfusion samples, and a segment from the sixth unit transfused are delivered to the blood bank for testing. What is the MOST likely cause of a life-threatening hemolytic transfusion reaction?

1

A 81-yo man with severe aortic stenosis is receiving a GA to facilitate a prostatectomy. His heart rate is 67 bpm, mean arterial pressure is 47 mmHg, and SpO2 is 97%. His ECG shows sinus rhythm with new ischemic changes. Which of the following medications is MOST appropriate at this time?

1

Which of the following nerves blockade will provide the BEST anesthesia of the medial ankle?

1

After an GA a 22-yo woman develops malignant hyperthermia. 2.5 mg/kg of dantrolene is administered a bolus dose and every five minutes. Which of the following is best appropriate indication to stop dantrolene administration?

1

A 52-year-old female is on a nitroprusside infusion of 10 μg/kg/min after a right carotid endarterectomy. Over the next 72 hours, the SaO2 decreases from 99% to 85% with no changes in ventilator settings. Physical examination reveals no changes and chest x-ray is unremarkable. What is the MOST likely cause of this desaturation?

1

Which of the following is MOST likely associated with an increase in minimum alveolar concentration (MAC) in humans?

1

A 44-year-old woman underwent insertion of a biventricular implantable cardioverter defibrillator (ICD) for idiopathic cardiomyopathy. This was performed under monitored anesthesia care with propofol and fentanyl. Vital signs at the end of the procedure included heart rate 75 beats/min, blood pressure 105/72 mm Hg, SaO2 98% on 2L O2 via nasal cannula (NC). One hour postoperatively, she is noted to be anxious and has the following vital signs: sinus tachycardia at 130 beats/min, blood pressure 68/45 mm Hg, SaO2 89% on 2L O2 NC.
Which of the following would be the MOST appropriate immediate management step for this patient?

1

Which of the following findings is MOST consistent with the diagnosis of transfusion-related acute lung injury (TRALI)?

1

Which of the following clinical circumstances represents an absolute contraindication to the use of pressure support mode in a patient who requires mechanical ventilator support?

1

A 56-year-old man after a cholecystectomy exhibits extrapyramidal side effects . He has been treated with metoclopramide for a gastroparesis and skipped his usual medications in the morning. He received metoclopramide and droperidol for PONV. Administration of which of the following medications would be MOST appropriate for his symptoms?

1

Most likely cause of tissue necrosis after accidental subcutaneous injection by which of the following intravenous medications?

1

A 72-yo woman undergoing a right pneumonectomy during one-lung anesthesia has a PaO2 of 52 mmHg at an FiO2 of 1.0. Which of the following maneuvers will MOST reliably INCREASE the PaO2?

1

Which of the following clinical abnormalities is common in propofol infusion syndrome?

1

A 43-year-old man receiving general anesthesia requires frequent re-dosing of vecuronium to maintain adequate neuromuscular blockade. Which of the following medications is the MOST likely cause of this?

1

Which of the following airway characteristics MOST reliably predicts difficulty visualizing the larynx during direct laryngoscopy?

1

A 69-year-old woman develops hypertension, chest pain, and ST segment depression in the PACU. She is given nitroglycerin and becomes profoundly hypotensive. Which of the following medications did she MOST likely take before surgery?

1

Which of the following medications is MOST likely to cause prolongation of neuromuscular blockade by steroidal
neuromuscular agents?

1

A 4-yo for hernia repair with inhalational GA. The administration of dexmedetomidine is more likely to reduce the incidence of which of the following postoperative problems?

1

After performing a spinal, which of the following factors is more likely to contribute to a (PDPH) post-dural puncture headache?

1

A 55-yo woman with chronic liver failure caused by alcohol abuse. Which serum concentration of the following substances is more likely to be DECREASED?

1

Prior to induction and during preoxygenation , which of the following measurements implies the biggest degree of denitrogenation?

Key Words

A 13-year-old, 165-lb girl is scheduled to undergo tonsillectomy and adenoidectomy. She has been diagnosed with sleep apnea. Use of which of the following analgesics would be the BEST initial choice for treatment of postoperative pain in this patient?

Which of the following is characteristic of the pathophysiology of transfusion-associated circulatory overload (TACO) but not of transfusion-related acute lung injury (TRALI)?

70yo female patient undergoing cardiopulmonary bypass. Which of the following interventions is the MOST appropriate prophylactic measure to minimize the risk of postoperative renal failure?

A 19-yo develops pink, frothy sputum after an episode of laryngospasm and has an SpO2 of 86% on supplemental oxygen (FiO2 0.6). Which of the following interventions is MOST appropriate to treat his hypoxemia?

A 52-year-old woman for urgent LIH repair and has a moderate to severe mitral regurgitation. Which of the following would definitely INCREASE regurgitant flow?

A 81-yo man with severe aortic stenosis is receiving a GA to facilitate a prostatectomy. His heart rate is 67 bpm, mean arterial pressure is 47 mmHg, and SpO2 is 97%. His ECG shows sinus rhythm with new ischemic changes. Which of the following medications is MOST appropriate at this time?

Which of the following nerves blockade will provide the BEST anesthesia of the medial ankle?

After an GA a 22-yo woman develops malignant hyperthermia. 2.5 mg/kg of dantrolene is administered a bolus dose and every five minutes. Which of the following is best appropriate indication to stop dantrolene administration?

Which of the following is MOST likely associated with an increase in minimum alveolar concentration (MAC) in humans?

Which of the following findings is MOST consistent with the diagnosis of transfusion-related acute lung injury (TRALI)?

Which of the following clinical circumstances represents an absolute contraindication to the use of pressure support mode in a patient who requires mechanical ventilator support?

Most likely cause of tissue necrosis after accidental subcutaneous injection by which of the following intravenous medications?

A 72-yo woman undergoing a right pneumonectomy during one-lung anesthesia has a PaO2 of 52 mmHg at an FiO2 of 1.0. Which of the following maneuvers will MOST reliably INCREASE the PaO2?

Which of the following clinical abnormalities is common in propofol infusion syndrome?

Which of the following medications is MOST likely to cause prolongation of neuromuscular blockade by steroidal
neuromuscular agents?