General Anesthesia

Questions

DIRECTIONS (Questions 524 through 558): Each of the numbered items or incomplete statements in this section is followed by answers or by completions of the statement. Select the ONE lettered answer or completion that is BEST in each case.

524. A patient with obstructive lung disease has an altered anesthetic induction with an insoluble agent because of

(A) decreased cardiac output

(B) increased perfusion

(D) uneven ventilation

(E) decreased minute volume

525. The term MAC refers to

(A) the median anesthetic concentration

(B) the anesthetic concentration that prevents movement after skin incision in 50% of patients

(D) a measurement that is pertinent only to volatile anesthetics

(E) the mean alveolar concentration

526. Signs of inadequate general anesthesia include all of the following EXCEPT

(A) eyelid movement

(B) pupillary constriction

(D) sweating

(E) limb movement

527. A patient has chronic obstructive pulmonary disease requiring the constant administration of oxygen. He is dyspneic at rest and can walk at most 20 feet before needing to rest. He is scheduled to undergo an exploratory laparotomy because of a small bowel obstruction. He would be classified by the American Society of Anesthesiologists as physical status

(A) III

(B) IIIE

(D) V

(E) VE

528. The person who performed the first public demonstration of diethyl ether as a general anesthetic was

(A) Karl Koller

(B) William Thomas Green Morton

(D) Charles Jackson

(E) John Collins Warren

529. The most common postoperative visual complication following general anesthesia is

(A) retinal detachment

(B) retinal artery occlusion

(D) vitreous hemorrhage

(E) corneal abrasion

530. The correlation of anesthetic potency with lipid solubility is known as the rule of

(A) Ferguson

(B) Michaelis and Menten

(D) Singer and Nicholson

(E) Meyer and Overton

531. One mL of desflurane liquid occupies what volume at 1 atm pressure and 37°C if all of the liquid is vaporized? The ideal gas constant is 0.082 L-atm-°K^–1-mole^–1, the specific gravity of desflurane is 1.45, and its molecular weight is 168.

(A) 219 mL

(B) 238 mL

(D) 256 mL

(E) 276 mL

532. The correct order of solubilities in blood, from greatest to least, among the volatile anesthetics is

(A) halothane > isoflurane > sevoflurane > desflurane

(B) sevoflurane > isoflurane > desflurane > halothane

(D) desflurane > halothane > sevoflurane > isoflurane

(E) sevoflurane > halothane > desflurane > isoflurane

533. The state of general anesthesia may be reversed by

(A) the administration of a competitive antagonist

(B) increasing the atmospheric pressure

(D) decreasing the ambient temperature

(E) the administration of any medication that increases cerebral perfusion

534. A 30-year-old patient is to have a cholecystectomy. The anesthesiologist decides to use sevoflurane in oxygen as the sole anesthetic agent, with no other medications administered. Approximately what concentration of sevoflurane will be required to prevent hemodynamic changes in response to surgical incision?

(A) 2.1%

(B) 3.4%

(D) 5.5%

(E) 6.4%

535. If 2% isoflurane in oxygen, flowing at a rate of 3 L/min, is added to a circle system, what will the concentration of isoflurane be after 6 min? Assume complete mixing of gas in the system, and that excess gas is scavenged. The reservoir bag has a volume of 2 L, the carbon dioxide absorber has a volume of 3 L, and the connecting hose and valves have a volume of 1 L.

(A) 1%

(B) 1.26%

(D) 1.90%

(E) 1.96%

536. If the uptake of gaseous anesthetic in L/min is x, and the patient’s cardiac output suddenly doubles, the rate of uptake

(A) cannot be calculated without further information

(B) will become x/2

(D) will become 4x

(E) will become x²

537. The likelihood of intraoperative awareness under general anesthesia is highest with the use of

(A) inadequate benzodiazepine doses

(B) high-dose opioids

(D) no premedication

(E) nitrous oxide as the sole gaseous anesthetic

538. Stage 2 anesthesia can be characterized by all of the following signs EXCEPT

(A) amnesia

(B) purposeless movement

(D) disconjugate gaze

(E) increased airway reflexes

539. Contraindications to the discharge to home of a patient who had a hernia repair under general anesthesia include all of the following EXCEPT

(A) nausea

(B) inability to drink liquids without vomiting

(D) inability to walk due to groin pain

(E) disorientation to person and place

540. You are given the honor of providing the first anesthetic in a new radiology room. The patient is a 38-year-old man with an arteriovenous malformation of the thoracic spine that is causing severe pain but no neurologic deficit. The radiologist plans to embolize the lesion, and estimates that the procedure will require ten hours. Which one of the following is the LEAST important requirement for the room in which this procedure will occur?

(A) Pipeline oxygen supply

(B) Pipeline nitrous oxide supply

(D) Availability of suction

(E) Auxiliary lighting available to the anesthesiologist

541. A 22-year-old patient is brought to the operating room for repair of a fractured femur. He fell off a boat and remained in the water for a long time prior to rescue. He is hypothermic with a temperature of 33°C. Other vital signs and laboratory values are normal. It can be assumed that the MAC for isoflurane in this patient is approximately

(A) 1%

(B) 1.25%

(D) 1.75%

(E) 2%

542. Which one of the following volatile agents undergoes the greatest degree of biotransformation?

(A) halothane

(B) isoflurane

(D) sevoflurane

(E) nitrous oxide

543. All of the following factors determine alveolar tension of an inhaled anesthetic EXCEPT

(A) minute ventilation

(B) blood:gas partition coefficient

(D) inspired concentration

(E) body temperature

544. The second gas effect

(A) has its maximum effect early in an anesthetic

(B) applies only to anesthetic gases

(D) involves two gases administered at similar concentrations

(E) may be responsible for diffusion hypoxia

545. At the anesthetic level associated with the alveolar concentration MAC-awake, patients

(A) do not respond to simple commands

(B) will not move in response to a surgical incision

(D) may manifest signs of excitement

(E) will likely be apneic

546. During a surgical procedure to repair a traumatized liver in a patient who was in a motor vehicle accident, the patient required 100% O₂ in order to maintain an adequate value for oxygen saturation, and each time a volatile anesthetic was given, the blood pressure dropped to an unacceptable value. A medication that might prevent the occurrence of recall for intraoperative events in the absence of nitrous oxide and a volatile agent is

(A) morphine

(B) fentanyl

(D) droperidol

(E) dexmedetomidine

547. During general anesthesia with isoflurane, nitrous oxide, and cisatracurium, expected ocular effects include

(A) mildly increased intraocular pressure in normal individuals

(B) ablation of the oculocardiac reflex

(D) ocular akinesia

(E) angle closure glaucoma in susceptible patients

548. A patient has had a total laryngectomy in the distant past. The patient now presents for mastectomy and axillary node dissection for the management of breast cancer. A reasonable method of managing this patient’s airway during general anesthesia is inserting a(n)

(A) low-pressure cuffed endotracheal tube via the mouth

(B) nasotracheal RAE tube

(D) laryngeal mask airway

(E) reinforced, cuffed endotracheal tube into the tracheostomy stoma

549. Nasotracheal intubation may be used safely in a patient who has

(A) fractures of the lower cervical spine and the ethmoid bone

(B) a LeFort I fracture of the maxilla

(D) a LeFort III fracture of the maxilla

(E) a CSF leak requiring repair

550. A 24-year-old woman is to have diagnostic laparoscopy as an outpatient. Her medical history is significant only for symptomatic gastroesophageal reflux. She is 61 inches tall and weighs 185 pounds. Prior to the induction of general anesthesia, she should be premedicated with all of the following medications EXCEPT

(A) metoclopramide

(B) droperidol

(D) cimetidine

(E) ondansetron

551. Among all patients undergoing general anesthesia, the overall risk of awareness is approximately one case in how many anesthetics?

(A) 75

(B) 325

(D) 2,200

(E) 6,300

552. Moderate sedation is associated with all of the following characteristics EXCEPT the patient

(A) follows a simple command like making a fist

(B) may need a jaw thrust to relieve airway obstruction

(D) has a normal minute ventilation

(E) has a normal blood pressure

553. If nitrous oxide is administered at a constant concentration, the uptake into the bloodstream in milliliters per minute will

(A) be constant

(B) increase with time

(D) depend on temperature

(E) be independent of concentration

554. An 85-kg patient was brought urgently to the operating room after sustaining multiple gunshot wounds to the abdomen. Exploratory laparotomy revealed multiple injuries to both large and small bowel that were repaired by resecting the damaged segments and performing anastomoses. There were no vascular injuries and the prolonged surgical procedure was associated with little blood loss. What is the most reasonable infusion rate of lactated Ringer solution intraoperatively in order to maintain adequate urine output in the absence of significant blood loss?

(A) 175 mL/h

(B) 400 mL/h

(D) 1,400 mL/h

(E) 2,200 mL/h

555. Intraarterial injection of which one of these medications may lead to limb-threatening ischemia distal to the arterial catheter?

(A) sodium nitroprusside

(B) methohexital

(D) verapamil

(E) papaverine

556. Superficial thrombophlebitis may follow the intravenous injection of many medications. Which one of the following medications has the LOWEST incidence of thrombophlebitis?

(A) midazolam

(B) lorazepam

(D) etomidate

(E) dantrolene

557. Which one of the following medications is thought to be the safest during the first trimester of pregnancy?

(A) Prednisone

(B) Diazepam

(D) Phenytoin

(E) Thalidomide

558. A young, previously healthy man suffered an extensive crush injury to his lower extremities at work. Before being brought to the operating room for debridement of devitalized tissue, he was given lactated Ringer solution in the emergency department and was considered euvolemic by the anesthesiologist at the beginning of the case. As the surgical procedure progressed, the surgeon requested that 5% albumin solution be given instead of additional lactated Ringer solution. Such use would be expected to cause

(A) an unequivocal decrease in mortality

(B) an unequivocal increase in mortality

(D) less of an impairment of coagulation than 10% pentastarch solution

(E) a low incidence of allergic reaction as long as the blood types are matched

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