Sana haj

1. Which of the following drugs is least likely to be effective for prophylaxis for postoperative nausea
and vomiting?

A. Ondansetron B. Scopolamine patch C. Aprepitant D. Metoclopramide

2. All of the following have an antiemetic action, except

A. Promethazine B. Propofol C. Etomidate D. Haloperidol

3. A patient with a history of severe asthma is scheduled for an appendectomy. Which of the following
induction agents will cause the least respiratory depression?

A. Ketamine B. Propofol C. Etomidate D. Thiopental

4. As per ASA classification, a controlled hypertensive patient with no target end-organ damage
scheduled for elective surgery will be classified as

A. ASA I B. ASA II C. ASA III D. ASA VI

5. Which of the following agents is associated with the highest incidence of hepatitis postoperatively?

A. Halothane B. Isoflurane C. Desflurane D. Sevoflurane

5. Ondansetron causes its antiemetic effect by acting as an

A. Agonist at 5-HT2 receptors B. Antagonist at 5-HT2 receptors C. Agonist at 5-HT3 receptors

D. Antagonist at 5-HT3 receptors

6. Midazolam can be administered through all of the following routes, except

A. Oral B. Sublingual C. Transcutaneous D. Transnasal

7. All of the following are side effects of anticholinesterase drugs, except

A. Excessive salivation B. Increased bowel motility C. Bradycardia D. Bronchodilation

8. Which of the following anesthetic agents is contraindicated for use in patients with intermittent
porphyria?

A. Ketamine B. Etomidate C. Isoflurane D. Thiopental

9. Which of the following statements about ketamine is true?

A. Tolerance may develop after repeated administration

B. It is extensively bound to plasma protein

C. Primary site of action is GABA receptor

D. Kidney is the primary route of elimination

10. The shorter duration of action of remifentanil compared with fentanyl is primarily due to its

A. Rapid redistribution B. Renal elimination C. Metabolism by esterases D. Hepatic extraction ratio

11. Which of the following drugs is the most effective in the emergency management of malignant
hyperthermia?

A Atropine B Dantrolene C Haloperidol D Succinylcholine E Vecuronium

12. Which drug is most likely to cause hyperkalemia leading to cardiac arrest in patients with spinal cord
injuries?

A Baclofen B Dantrolene C Pancuronium D Succinylcholine E Vecuronium

13. Which drug has spasmolytic activity and could also be used in the management of seizures caused by
overdose of a local anesthetic?

A. Baclofen B. Cyclobenzaprine C.Diazepam D.Gabapentin E. Tizanidine

14. A 23-year-old man has a pheochromocytoma, blood pressure of 190/120 mm Hg, and hematocrit of
50%. Pulmonary function and renal function are normal. His catecholamines are elevated, and he has a
well-defined abdominal tumor on MRI. He has been scheduled for surgery. Which one of the following
agents should be avoided in the anesthesia protocol?

A Desflurane B Fentanyl C Isoflurane D Midazolam E Sevoflurane

A 20-year-old male patient scheduled for hernia surgery was anesthetized with halothane and nitrous
oxide; tubocurarine was provided for skeletal muscle relaxation. The patient rapidly developed
tachycardia and became hypertensive. Generalized skeletal muscle rigidity was accompanied by marked
hyperthermia. Laboratory values revealed hyperkalemia and acidosis.

15. This unusual complication of anesthesia is most likely to be caused by

A Acetylcholine release from somatic nerve endings at skeletal muscle

B Activation of brain dopamine receptors by halothane

C Antagonism of autonomic ganglia by tubocurarine

D Calcium released within skeletal muscle

E Toxic metabolites of nitrous oxide

16. The patient should be treated immediately with

A Atropine B Baclofen C Dantrolene D Edrophonium E Flumazenil

17. If ketamine is used as the sole anesthetic in the attempted reduction of a dislocated shoulder joint,
its actions will include

A Analgesia B Bradycardia C Hypotension D Muscle rigidity E. Respiratory depression

18. . Which drug is a full agonist at opioid receptors with analgesic activity equivalent to morphine, a
longer duration of action, and fewer withdrawal signs on abrupt discontinuance than morphine?

A. Fentanyl B. Hydromorphone C. Methadone D. Nalbuphine E. Oxycodone

:

Katzung book:

QUESTIONS sedative:

1. This drug is used in the management of insomnia and facilitates the inhibitory actions of GABA, but
it lacks anticonvulsant or muscle-relaxing properties and has minimal effect on REM sleep. Its actions
are antagonized by flumazenil.

(A) Buspirone

(B) Chlordiazepoxide

(C) Eszopiclone

(D) Ramelteon

(E) Phenobarbital

2. Which statement concerning the barbiturates is most accurate?

(A) Abstinence syndromes are more severe during withdrawal from phenobarbital than from
secobarbital

(B) Alkalinization of the urine accelerates the elimination of phenobarbital

(C) Barbiturates may increase the half-lives of drugs metabolized by the liver

(D) Compared with barbiturates, the benzodiazepines exhibit a steeper dose-response relationship

(E) Respiratory depression caused by barbiturate overdosage can be reversed by flumazenil

3. A 24-year-old stockbroker has developed a “nervous disposition.” He is easily startled, worries

about inconsequential matters, and sometimes complains of stomach cramps. At night he grinds his
teeth in his sleep. There is no history of drug abuse. Diagnosed as suffering from generalized anxiety
disorder, he is prescribed buspirone. The patient should be informed to anticipate

(A) A need to continually increase drug dosage because of tolerance

(B) A significant effect of the drug on memory

(C) Additive CNS depression with alcoholic beverages

(D) That the drug is likely to take a week or more to begin working

(E) That if he stops taking the drug abruptly, he will experience withdrawal signs
4. Which of the following best describes the mechanism of action of benzodiazepines?

(A) Activate GABAB receptors in the spinal cord

(B) Block glutamate receptors in hierarchical neuronal pathways in the brain

(C) Increase frequency of opening of chloride ion channels coupled to GABAA receptors

(D) Inhibit GABA transaminase to increase brain levels of GABA

(E) Stimulate release of GABA from nerve endings in the brain

5. An 82-year-old woman, otherwise healthy for her age, has difficulty sleeping. Triazolam is
prescribed for her at one half of the conventional adult dose. Which statement about the use of
triazolam in this elderly patient is most accurate?

(A) Ambulatory dysfunction is unlikely to occur in elderly patients taking one half of the conventional
adult dose

(B) Hypertension is a common adverse effect of benzodiazepines in elderly patients

(C) Over-the-counter cold medications may antagonize the hypnotic effects of the drug

(D) The patient may experience amnesia, especially if she also consumes alcoholic beverages

(E) Triazolam does not cause rebound insomnia on abrupt discontinuance

6. Flumazenil will counteract the action of each of the following drugs except

(A) Alprazolam

(B) Buspirone

(C) Diazepam

(D) Eszopiclone

(E) Zaleplon

7. A 40-year-old woman has occasional acute attacks of intense anxiety with marked physical
symptoms, including hyperventilation, tachycardia, and sweating. If she is diagnosed as suffering from
a panic disorder, the most appropriate drug to use is

(A) Alprazolam

(B) Eszopiclone

(C) Flurazepam

(D) Propranolol

(E) Ramelteon
8. Which drug used in the maintenance treatment of patients with tonic-clonic or partial seizure states
increases the hepatic metabolism of many drugs including both phenytoin and warfarin?

(A) Buspirone

(B) Clonazepam

(C) Eszopiclone

(D) Phenobarbital

(E) Triazolam

9. A patient with liver dysfunction is scheduled for a surgical procedure. Lorazepam or oxazepam can
be used for preanesthetic sedation in this patient without special concern regarding excessive CNS
depression because these drugs are

(A) Actively secreted in the renal proximal tubule

(B) Conjugated extrahepatically

(C) Eliminated via the lungs

(D) Reversible by administration of naloxone

(E) Selective anxiolytics like buspirone

10. A 43-year-old very overweight man complains of not sleeping well and feeling tired during the
day. He says that his wife is the cause of the problem because she wakes him up several times during
the night because of his loud snores. This appears to be a breathing-related sleep disorder, so you
should probably write a prescription for

(A) Clorazepate

(B) Diazepam

(C) Flurazepam

(D) Pentobarbital

(E) Weight loss

QUESTIONS: general anesthesia

1. A new halogenated gas anesthetic has a blood:gas partition coefficient of 0.5 and a MAC value of
1%. Which prediction about this agent is most accurate? (Refer to Table 25–1 for comparison of
agents.)

(A) Equilibrium between arterial and venous gas tension will be achieved very slowly

(B) It will be metabolized by the liver to release fluoride ions

(C) It will be more soluble in the blood than isoflurane

(D) Speed of onset will be similar to that of nitrous oxide

(E) The new agent will be more potent than halothane

2. Which statement concerning the effects of anesthetic agents is most accurate?

(A) Bronchiolar smooth muscle contraction occurs during halothane anesthesia

(B) Chest muscle rigidity often follows the administration of fentanyl

(C) Mild, generalized muscle twitching occurs at high doses of isoflurane

(D) Severe nausea and vomiting has been reported after the use of propofol

(E) The use of thiopental preceding inhalation anesthetics may prolong postanesthesia recovery

3. A 23-year-old man has a pheochromocytoma, blood pressure of 190/120 mm Hg, and hematocrit of
50%. Pulmonary function and renal function are normal. His catecholamines are elevated, and he has
a well-defined abdominal tumor on MRI. He has been scheduled for surgery. Which one of the
following agents should be avoided in the anesthesia protocol?

(A) Desflurane

(B) Fentanyl

(C) Isoflurane

(D) Midazolam

(E) Sevoflurane

4. Which statement concerning nitrous oxide is most accurate?

(A) A useful component of anesthesia protocols because it lacks cardiovascular depression

(B) Anemia is a common adverse effect in patients exposed to nitrous oxide for periods longer than 2 h

(C) It is the most potent of the inhaled anesthetics

(D) There is a direct association between the use of nitrous oxide and malignant hyperthermia
(E) Up to 50% of nitrous oxide is eliminated via hepatic metabolism

5. Which statement concerning anesthetic MAC (minimum anesthetic concentration) value is most
accurate?

(A) Anesthetics with low MAC value have low potency

(B) MAC values increase in elderly patients

(C) MAC values give information about the slope of the dose-response curve

(D) Methoxyflurane has an extremely low MAC value

(E) Simultaneous use of opioid analgesics increases the MAC for inhaled anesthetics

6. Total intravenous anesthesia with fentanyl has been selected for a frail elderly woman about to
undergo cardiac surgery. Which statement about this anesthesia protocol is most accurate?

(A) Fentanyl’s effects can be reversed with naloxone after the procedure

(B) Marked relaxation of skeletal muscles is anticipated

(C) Opioids such as fentanyl provide useful hypotensive effects

(D) Patient awareness is rare during surgery, with minimal recall after recovery

(E) The patient is likely to experience pain during surgery

Questions 7 and 8. A 20-year-old male patient scheduled for hernia surgery was anesthetized with
halothane and nitrous oxide; tubocurarine was provided for skeletal muscle relaxation. The patient
rapidly developed tachycardia and became hypertensive. Generalized skeletal muscle rigidity was
accompanied by marked hyperthermia. Laboratory values revealed hyperkalemia and acidosis.

7. This unusual complication of anesthesia is most likely to be caused by

(A) Acetylcholine release from somatic nerve endings at skeletal muscle

(B) Activation of brain dopamine receptors by halothane

(C) Antagonism of autonomic ganglia by tubocurarine

(D) Calcium released within skeletal muscle

(E) Toxic metabolites of nitrous oxide

8. The patient should be treated immediately with

(A) Atropine

(B) Baclofen

(C) Dantrolene

(D) Edrophonium
(E) Flumazenil

9. If ketamine is used as the sole anesthetic in the attempted reduction of a dislocated shoulder joint,
its actions will include

(A) Analgesia

(B) Bradycardia

(C) Hypotension

(D) Muscle rigidity

(E) Respiratory depression

10. Postoperative vomiting is uncommon with this intravenous agent, and patients are often able to
ambulate sooner than those who receive other anesthetics.

(A) Enflurane

(B) Etomidate

(C) Midazolam

(D) Propofol

(E) Thiopental
QUESTIONS: local

1. Characteristic properties of local anesthetics include all of the following except

(A) An increase in membrane refractory period

(B) Blockade of voltage-dependent sodium channels

(C) Effects on vascular tone

(D) Preferential binding to resting channels

(E) Slowing of axonal impulse conduction

2. The pKa of lidocaine is 7.7. In infected tissue, which can be acidic, for example, at pH 6.7, the
percentage of the drug in the nonionized form will be

(A) 1%

(B) 10%

(C) 50%

(D) 90%

(E) 99%

3. Which statement about the speed of onset of nerve blockade with local anesthetics is correct?

(A) Faster in hypercalcemia

(B) Faster in myelinated fibers

(C) Faster in tissues that are infected

(D) Slower in hyperkalemia

(E) Slower in the periphery of a nerve bundle than in the center of a bundle

4. The most important effect of inadvertent intravenous administration of a large dose of lidocaine is

(A) Bronchoconstriction

(B) Methemoglobinemia

(C) Renal failure

(D) Seizures

(E) Tachycardia
5. All of the following factors influence the action of local anesthetics except

(A) Acetylcholinesterase activity in the region of the injection site

(B) Blood flow through the tissue in which the injection is made

(C) Dose of local anesthetic injected

(D) The use of vasoconstrictors

(E) Tissue pH

6. You have a vial containing 10 mL of a 2% solution of lidocaine. How much lidocaine is present in 1
mL?

(A) 2 mg

(B) 5 mg

(C) 10 mg

(D) 20 mg

(E) 50 mg

7. Which statement about the toxicity of local anesthetics is correct?

(A) Bupivacaine is the safest local anesthetic to use in patients at risk for cardiac arrhythmias

(B) In overdosage, hyperventilation (with oxygen) is helpful to correct acidosis and lower extracellular
potassium

(C) Intravenous injection of local anesthetics may stimulate ectopic cardiac pacemaker activity

(D) Most local anesthetics cause vasoconstriction

(E) Serious cardiovascular reactions are more likely to occur with tetracaine than with bupivacaine

8. A vasoconstrictor added to a solution of lidocaine for a peripheral nerve block will

(A) Decrease the risk of a seizure

(B) Increase the duration of anesthetic action of the local anesthetic

(C) Both A and B

(D) Neither A nor B

9. A child requires multiple minor surgical procedures involving the nasopharynx. Which drug has high
surface local anesthetic activity and intrinsic vasoconstrictor actions that reduce bleeding in mucous
membranes?

(A) Bupivacaine

(B) Cocaine

(C) Lidocaine

(D) Mepivacaine

(E) Tetracaine

10. Prilocaine is relatively contraindicated in patients with cardiovascular or pulmonary disease

because the drug

(A) Acts as an antagonist at β adrenoceptors in the heart and the lung

(B) Causes decompensation through formation of methemoglobin

(C) Inhibits cyclooxygenase in cardiac and pulmonary cells

(D) Is a potent bronchoconstrictor

(E) None of the above

QUESTIONS: skeletal muscle relaxant

1. Characteristics of phase I depolarizing neuromuscular blockade due to succinylcholine include

(A) Easy reversibility with nicotinic receptor antagonists

(B) Marked muscarinic blockade

(C) Muscle fasciculations only in the later stages of block

(D) Reversibility by acetylcholinesterase (AChE) inhibitors

(E) Sustained tension during a period of tetanic stimulation

Questions 2 and 3. A patient underwent a surgical procedure of 2 h. Anesthesia was provided by
isoflurane, supplemented by intravenous midazolam and a nondepolarizing muscle relaxant. At the
end of the procedure, a low dose of atropine was administered followed by pyridostigmine.

2. The main reason for administering atropine was to

(A) Block cardiac muscarinic receptors

(B) Enhance the action of pyridostigmine

(C) Prevent spasm of gastrointestinal smooth muscle

(D) Provide postoperative analgesia

(E) Reverse the effects of the muscle relaxant

3. A muscarinic receptor antagonist would probably not be needed when a cholinesterase inhibitor
was given for reversal of the skeletal muscle relaxant actions of a nondepolarizing drug if the NM
blocking agent used was

(A) Cisatracurium

(B) Mivacurium

(C) Pancuronium

(D) Tubocurarine

(E) Vecuronium

4. Which of the following drugs is the most effective in the emergency management of malignant
hyperthermia?

(A) Atropine

(B) Dantrolene

(C) Haloperidol

(D) Succinylcholine

(E) Vecuronium

5. The clinical use of succinylcholine, especially in patients with diabetes, is associated with

(A) Antagonism by pyridostigmine during the early phase of blockade

(B) Aspiration of gastric contents

(C) Decreased intragastric pressure

(D) Histamine release in a genetically determined population

(E) Metabolism at the neuromuscular junction by acetylcholinesterase

6. Which drug is most often associated with hypotension and is related to clonidine?

(A) Baclofen

(B) Pancuronium

(C) Succinylcholine

(D) Tizanidine

(E) Vecuronium

7. Regarding the spasmolytic drugs, which of the following statements is least accurate?

(A) Baclofen acts on GABA receptors in the spinal cord to increase chloride ion conductance

(B) Cyclobenzaprine decreases both oropharyngeal secretions and gut motility

(C) Dantrolene has no significant effect on the release of calcium from sarcoplasmic reticulum in cardiac
muscle

(D) Diazepam causes slight sedation at doses commonly used to reduce muscle spasms

(E) Intrathecal use of baclofen is effective in some refractory cases of muscle spasticity

8. Which drug is most likely to cause hyperkalemia leading to cardiac arrest in patients with spinal
cord injuries?

(A) Baclofen

(B) Dantrolene

(C) Pancuronium

(D) Succinylcholine

(E) Vecuronium

9. Which drug has spasmolytic activity and could also be used in the management of seizures caused
by overdose of a local anesthetic?

(A) Baclofen

(B) Cyclobenzaprine

(C) Diazepam

(D) Gabapentin

(E) Tizanidine
10. Myalgias are a common postoperative complaint of patients who receive large doses of
succinylcholine, possibly the result of muscle fasciculations caused by depolarization. Which drug
administered in the operating room can be used to prevent postoperative pain caused by
succinylcholine?

(A) Atracurium

(B) Baclofen

(C) Dantrolene

(D) Diazepam

(E) Lidocaine

QUESTIONS: opioids

Questions 1 and 2. A 63-year-old man is undergoing radiation treatment as an outpatient for

metastatic bone cancer. His pain has been treated with a fixed combination of oxycodone plus
acetaminophen taken orally. Despite increasing doses of the analgesic combination, the pain is getting
worse.

1. The most appropriate oral medication for his increasing pain is

(A) Buprenorphine

(B) Codeine plus aspirin

(C) Hydromorphone

(D) Pentazocine

(E) Tramadol

2. It is possible that this patient will have to increase the dose of the analgesic as his condition
progresses as a result of developing tolerance. However, tolerance will not develop to a significant
extent with respect to

(A) Biliary smooth muscle

(B) Emesis

(C) Pupillary constriction

(D) Sedation

(E) Urinary retention

3. You are on your way to take an examination and you suddenly get an attack of diarrhea. If you stop
at a nearby drugstore for an over-the-counter opioid with antidiarrheal action, you will be asking for

(A) Codeine

(B) Dextromethorphan

(C) Diphenoxylate

(D) Loperamide

(E) Nalbuphine

4. An emergency department patient with severe pain thought to be of gastrointestinal origin

received 80 mg of meperidine. She subsequently developed a severe reaction characterized by
tachycardia, hypertension, hyperpyrexia, and seizures. Questioning revealed that the patient had
been taking a drug for a psychiatric condition. Which drug is most likely to be responsible for this
untoward interaction with meperidine?

(A) Alprazolam

(B) Bupropion

(C) Lithium

(D) Phenelzine

(E) Mirtazapine

5. Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are established to
be responsible for variations in analgesic response to

(A) Buprenorphine

(B) Codeine

(C) Fentanyl

(D) Methadone

(E) Tramadol
Questions 6 and 7. A young man is brought to the emergency department in an anxious and agitated
state. He informs the attending physician that he uses “street drugs” and that he gave himself an
intravenous “fix” approximately 12 h ago. After an initial period of contentment and relaxation, he
now has chills and muscle aches and has also been vomiting. His symptoms include hyperventilation
and hyperthermia. The attending physician notes that his pupil size is larger than normal.

6. What is the most likely cause of these signs and symptoms?

(A) The patient had injected dextroamphetamine

(B) The patient has hepatitis B

(C) The patient has overdosed with an opioid

(D) The signs and symptoms are those of the opioid abstinence syndrome

(E) These are early signs of toxicity due to contaminants in “street heroin”

7. Which drug will be most effective in alleviating the symptoms experienced by this patient?

(A) Buprenorphine

(B) Codeine

(C) Methadone

(D) Naltrexone

(E) Tramadol

8. Which statement about nalbuphine is most accurate?

(A) Activates μ receptors

(B) Does not cause respiratory depression

(C) Is a nonsedating opioid

(D) Pain-relieving action is not superior to that of codeine

(E) Response to naloxone in overdose may be unreliable

9. Which drug does not activate opioid receptors, has been proposed as a maintenance drug in
treatment programs for opioid addicts, and with a single oral dose, will block the effects of injected
heroin for up to 48 h?

(A) Fentanyl

(B) Nalbuphine

(C) Naloxone

(D) Naltrexone

(E) Propoxyphene
10. Which drug is a full agonist at opioid receptors with analgesic activity equivalent to morphine, a
longer duration of action, and fewer withdrawal signs on abrupt discontinuance than morphine?

(A) Fentanyl

(B) Hydromorphone

(C) Methadone

(D) Nalbuphine

(E) Oxycodone
Perioperative Evaluation and Management chapter 1:

1. Preoperative application of scopolamine patch to prevent postoperative nausea and vomiting

should be avoided in

A. Female, 35 years old

B. Smoker, 20 years old

C. Patient with a blood pressure of 160/96 mm Hg

D. Male, 70 years old

2. Which of the following drugs is least likely to be effective for prophylaxis for postoperative nausea
and vomiting?

A. Ondansetron

B. Scopolamine patch

C. Aprepitant

D. Metoclopramide

3. Famotidine, when used for stress ulcer prophylaxis, must be avoided preoperatively in which of the
following patients?

A. Patients with replaced mitral valve on warfarin

B. Patients with idiopathic thrombocytopenic purpura (ITP) for splenectomy

C. Patients with achalasia cardia for esophageal myotomy

D. Patients with a history of coronary stenting on aspirin

4. Which of the following drugs antagonizes substance P in the central nervous system and is used as
premedication to prevent postoperative nausea and

vomiting?

A. Palonosetron

B. Aprepitant

C. Metoclopramide

D. Prochlorperazine
5. Which of the following predictors is likely to be associated with lower incidence of perioperative
nausea and vomiting?

A. Female gender

B. Use of fentanyl for pain relief

C. Patients with a history of smoking

D. Patients undergoing laparoscopic surgery

6. All of the following have an antiemetic action, except

A. Promethazine

B. Propofol

C. Etomidate

D. Haloperidol

7. Cefazolin, as a component of perioperative antimicrobial prophylaxis for surgery, must begin within
what time before incision?

A. Simultaneously with incision

B. Within 30 minutes prior to incision

C. Within 60 minutes prior to incision

D. Within 120 minutes prior to incision

8. Vancomycin, as a component of perioperative antimicrobial prophylaxis for surgery, must begin

within what time before incision?

A. Simultaneously with incision

B. Within 30 minutes prior to incision

C. Within 60 minutes prior to incision

D. Within 120 minutes prior to incision

9. A 65-year-old male with a history of hypertension and diabetes presents to emergency department
with altered sensation with a likely subdural hematoma. To assess his cardiorespiratory status, he is
asked about his level of physical activity. If he is capable of performing at least which of the following
activities independently, he is less likely to have significant cardiopulmonary ailment during surgery?

A. Walk to washroom on level floor

B. Play the accordion

C. Walk one block

D. Climb a flight of stairs

10. In preoperative assessment of patients, physical activity is graded in terms of metabolic
equivalents (METs). The value that corresponds to oxygen

consumption of 1 MET in an adult is

A. 2 mL/kg/min

B. 7 mL/kg/min

C. 3.5 mL/kg/min

D. 5.5 mL/kg/min

11. As per American Society of Regional Anesthesia (ASRA) guidelines, intravenous infusion of
unfractionated heparin should be stopped how long prior to a planned epidural?

A. 1 to 1.5 hours

B. 2 to 4 hours

C. at least 12 hours

D. at least 24 hours

12. For emergent surgery, anticoagulation produced by warfarin can be reversed by using

A. Fresh-frozen plasma (FFP)

B. Injectable vitamin K

C. Prothrombin complex concentrate

D. Factor VIII concentrate

13. Neuraxial block is not contraindicated for patients on which of the following drugs?

A. Warfarin

B. Low-molecular-weight heparin

C. Aspirin

D. Clopidogrel

14. All of the following are risk factors for obstructive sleep apnea, except

A. Obesity

B. Short neck

C. Enlarged tonsils

D. Female gender
15. A 70-year-old male, who is diabetic for the last 20 years, is scheduled for an elective surgery.
Which of the following is not a sign of autonomic diabetic neuropathy?

A. History of recurrent diarrhea

B. History of postural hypotension

C. History of recurrent constipation

D. History of urinary retention

16. Which of the following perioperative factors in patients undergoing dialysis prior to surgery
predicts the possibility of hypotension (due to increased volume removed)?

A. Change in serum sodium

B. Change in body weight

C. Change in serum potassium

D. Change in pH after dialysis

17. A patient with a history of severe asthma is scheduled for an appendectomy. Which of the
following induction agents will cause the least respiratory depression?

A. Ketamine

B. Propofol

C. Etomidate

D. Thiopental

18. Which of the following drugs can significantly prolong the QT interval on the ECG?

A. Dexamethasone

B. Droperidol

C. Aprepitant

D. Glycopyrrolate

19. Which of the following tests is used to confirm coagulation after stopping low-molecular-weight
heparin (LMWH)?

A. PT

B. aPTT

C. ACT

D. None of the above

20. Effect of combined administration of midazolam and fentanyl is

A. Additive

B. Synergistic

C. Competitively antagonistic

D. Noncompetitively antagonistic

21. Preoperative anesthetic evaluation is likely to bring down the incidence of all the following, except

A. Case cancellations

B. Patient morbidity

C. Preoperative anxiety

D. Direct procedural costs

22. For elective procedures, an anesthesia provider must obtain informed and preferably written
consent

A. Just prior to transferring the patient to the operating room for surgery

B. During preoperative anesthetic evaluation

C. At the same time that a surgeon obtains consent for the surgical procedure

D. Just prior to induction of anesthesia in the operating room

23. An optimal preoperative evaluation is designed

A. To screen for and properly manage comorbid conditions

B. To assess the risk of anesthesia and surgery and lower it

C. To identify patients who may require special anesthetic techniques or postoperative care

D. All the above

24. ASA classification for risk stratification is validated for predicting preoperative morbidity
associated with the following, except

A. General or regional anesthesia

B. Conscious sedation

C. Monitored anesthesia care

D. Surgical procedure
25. A healthy pregnant patient in labor has which of the following ASA classifications?

A. I

B. II

C. III

D. IV

26. Sedatives, as premedication, must be avoided in which of the following patients?

A. Uncontrolled hypertensive

B. Toddler for tonsillectomy

C. Brain tumor patients

D. Patients with alcohol abuse

27. As per the American Society of Regional Anesthesia (ASRA) guidelines, which of the following
drugs can be continued preoperatively in patients planned for neuraxial blockade for an elective
procedure?

A. Aspirin

B. Clopidogrel

C. Warfarin

D. Low-molecular-weight heparin

28. As per ASA classification, a controlled hypertensive patient with no target end-organ damage
scheduled for elective surgery will be classified as

A. ASA I

B. ASA II

C. ASA III

D. ASA VI

29. A brain-dead organ donor undergoing laparotomy for “kidney harvesting” will be classified as an

A. ASA III

B. ASA IV

C. ASA V

D. ASA VI
30. A moribund patient who is not expected to survive without the operation is categorized as an

A. ASA III

B. ASA IV

C. ASA V

D. ASA VI

31. A patient with a history of uncontrolled hypertension, diabetes, and angina, who is to undergo a
laparoscopic cholecystectomy, will be classified as an

A. ASA II

B. ASA III

C. ASA IV

D. ASA V

32. A 65-year-old male with a history of mitral valve replacement 2 years back presents for a knee
replacement. He is on warfarin since the time of valve replacement. As per ASRA guidelines, the ideal
time to stop his warfarin prior to surgery would be

A. 12 hours

B. 3 days

C. 5 days

D. 10 days

33. A 26-year-old female, with a history of rheumatic mitral stenosis, is scheduled for an elective
cesarean section at 38 weeks of gestation. Just prior to surgery, she is diagnosed to have atrial
fibrillation (AF) with no hemodynamic instability. The first step in preparation for surgery is

A. Perform an echocardiogram to rule out left-atrial clot

B. Synchronized DC cardioversion under sedation

C. Antiarrhythmic medication

D. Plan for therapy postdelivery

34. A 72-year-old patient with a history of hypertension and angina at moderate activity is to undergo
a laparoscopic cholecystectomy. Due to decreased effort tolerance and a significant blockade of left
anterior descending coronary artery on stress thallium, a preprocedure coronary intervention is
planned. Which of the following procedures performed prior to the elective surgery is least likely to
delay the laparoscopic surgery?

A. Coronary artery bypass graft (CABG)

B. Percutaneous coronary stenting—bare-metallic stent

C. Percutaneous coronary stenting—drug-eluting stent

D. Percutaneous balloon dilatation

35. Which of the following is not seen as a result of primary renal disease in patients with chronic
renal failure?

A. Hypocoagulable state

B. Hypercoagulable state

C. Hyperproteinemia

D. Anemia

36. A 2-year-old child is to undergo a tonsillectomy. The child had formula milk 2 hours ago. As per
ASA guidelines, optimal NPO status would be to wait another _____ before proceeding to surgery:

A. No waiting, since it is a child

B. 2 hours

C. 4 hours

D. 6 hours

37. A 45-year-old patient is scheduled for an abdominal hysterectomy. She states that her aunt had a
severe reaction to anesthesia and was in the ICU for 1 week. You would avoid which of the following
drugs for her general anesthesia?

A. Droperidol

B. Ketamine

C. Sevoflurane

D. Etomidate
38. Elective surgery should be postponed after a myocardial infarction for at least

A. 30 days

B. 6 weeks

C. 3 months

D. 6 months

39. The most significant risk factor for developing pulmonary complications is

A. Site of surgery (abdominal/thoracic)

B. Presence of respiratory infection

C. Presence of obstructive sleep apnea

D. Smoking

40. Maximum international normalized ratio (INR) before proceeding for elective surgery should be

A. 1.0

B. 1.2

C. 1.4

D. 1.6

41. A 73-year-old patient has residual weakness on the right arm and leg following a stroke 5 years
ago. He is now scheduled for laparoscopic cholecystectomy under general anesthesia. Which of the
following sites should be preferably used to monitor the train of four muscle twitches for estimating
neuromuscular blockade?

A. Right ulnar nerve–innervated muscles

B. Right posterior tibial nerve–innervated muscles

C. Left ulnar nerve–innervated muscles

D. Left facial nerve

42. A 32-year-old patient after being involved in a road traffic accident due to alcohol intoxication is
taken to the operating room for open fracture reduction of an ankle fracture. His blood alcohol level is
above the legal limit. Compared to a patient who is not intoxicated with alcohol, you would expect
the minimum alveolar concentration (MAC) of sevoflurane to be

A. Higher

B. Lower

C. Equal

D. Unpredictable due to pharmacodynamic variations

43. A 55-year-old patient with a history of asthma and heart failure is to undergo a hernia repair. On
physical examination, you notice that the patient is wheezing. Following treatment with albuterol, the
patient should be monitored for which electrolyte?

A. Potassium

B. Calcium

C. Sodium

D. Chloride

44. Smoking cessation for 24 hours before a scheduled surgery will lead to

A. Improvement of ciliary function

B. Decrease in mucous production

C. Decrease in airway irritability

D. Decrease in level of carboxyhemoglobin

45. Which of the following tests is likely to detect clinically relevant bleeding tendency most
efficiently?

A. Activated partial thromboplastin time

B. Prothrombin time

C. Activated clotting time

D. Thromboelastogram (TEG)
46. As per AHA guidelines, which of the following is not a major clinical risk predictor in a patient with
cardiac disease scheduled for noncardiac surgery?

A. Recent myocardial infarction

B. Symptomatic mitral stenosis

C. Presence of congestive cardiac failure

D. Uncontrolled systolic hypertension

47. Glycopyrrolate, when given preoperatively, can cause all of the following, except

A. Skin flushing

B. Dry mouth

C. Bronchoconstriction

D. Tachycardia

48. Which of the following is true about metoclopramide?

A. Decreases lower esophageal sphincter tone

B. Delays gastric emptying

C. Can cause extrapyramidal side effects

D. Useful in preventing postoperative nausea

49. Which of the following occurs during the preoxygenation of a patient?

A. Increase in functional residual capacity

B. Denitrogenating

C. Increase in CO2 clearance from lungs

D. Increase in closing capacity of lungs

50. Which of the following agents is associated with the highest incidence of hepatitis
postoperatively?

A. Halothane

B. Isoflurane

C. Desflurane

D. Sevoflurane
51. The inhalation agent of choice in a 2-year-old child for ophthalmologic surgery is

A. Halothane

B. Desflurane

C. Sevoflurane

D. Nitrous oxide

52. Which of the following is true of nitrous oxide?

A. Acts on central nervous system GABA receptors

B. Lowers pulmonary vascular resistance

C. Suppresses EEG pattern in the cerebral cortex

D. Precipitates vitamin B12 deficiency anemia

53. The antiemetic effect of propofol is thought to occur due to

A. Depressant effect on the chemoreceptor trigger zone

B. Inhibition of dopamine activity

C. Inhibition of glutamate release

D. All of the above

54. Which of the following is the preferred intravenous agent of induction of anesthesia for
maintaining spontaneous breathing and airway tone?

A. Midazolam

B. Propofol

C. Ketamine

D. Diazepam

55. Succinylcholine is contraindicated in a patient with

A. Chronic renal failure

B. Duchene muscular dystrophy

C. Myasthenia gravis

D. Patient with full stomach

56. A 75-year-old patient with a history of hypertension is to undergo laparoscopic colectomy for
carcinoma colon. Continuing of which of the following antihypertensive drugs, preoperatively, in the
geriatric age group, can be associated with profound hypotension on induction of general anesthesia?

A. Metoprolol

B. Angiotensin-converting-enzyme (ACE) inhibitors

C. Hydrochlorothiazide

D. Furosemide

57. Which of the following findings in the preoperative evaluation cannot be attributed to obesity
with obstructive sleep apnea (OSA) in a patient planned for bariatric surgery?

A. Pulmonary artery hypertension

B. Congestive heart failure

C. Peripheral neuropathy

D. Dementia

58. All of the following medications can be administered via an epidural anesthesia, except

A. Fentanyl

B. Sufentanil

C. Alfentanil

D. Remifentanil

59. Ondansetron causes its antiemetic effect by acting as an

A. Agonist at 5-HT2 receptors

B. Antagonist at 5-HT2 receptors

C. Agonist at 5-HT3 receptors

D. Antagonist at 5-HT3 receptors

60. Which of the following statements is false regarding scopolamine patch applied preoperatively?

A. May produce sedation

B. Decreases the risk of nausea

C. Adds to the analgesia

D. Inhibits muscarinic receptors

61. Overdose with dexmedetomidine results in

A. Hypertension

B. Bradycardia

C. Hypertension and bradycardia

D. Hypotension and bradycardia

62. Abrupt withdrawal of steroids can lead to

A. Malignant hypertension

B. Sickle cell crisis

C. Addisonian crisis

D. Psychosis

63. Promethazine primarily inhibits which of the following receptors?

A. Serotonin

B. Dopamine

C. Muscarinic

D. Acetylcholine

64. All of the following surgeries are associated with an increased risk of postoperative nausea and
vomiting, except

A. Shoulder arthroscopy

B. Laparoscopic surgery

C. Strabismus repair

D. Tympanoplasty

65. Abrupt stoppage of total parenteral nutrition (TPN) would most likely cause

A. Hypoglycemia

B. Hyperglycemia

C. Hyperphosphatemia

D. Hypophosphatemia
66. Glycopyrrolate causes all of the following, except

A. Sedation

B. Tachycardia

C. Antisialagogue effect

D. Lowers lower esophageal sphincter tone

67. In general, herbal medications should be stopped before surgery for at least _____ days:

A. 3

B. 7

C. 10

D. 14

68. Which of the following antibiotics can prolong the action of neuromuscular-blocking drugs?

A. Gentamicin

B. Penicillin

C. Levofloxacin

D. Cephalexin

69. Estrogen in birth control pills increases the perioperative risk of

A. Diarrhea

B. Thromboembolism

C. Stroke

D. Myocardial infarction

70. A 42-year-old patient is scheduled for a hernia repair under general anesthesia. His medications
include fluoxetine, alprazolam, and lithium for bipolar disorder. In the preoperative area, he appears
confused, has tremors, and is ataxic. Your next step would be to

A. Cancel the case

B. Proceed with the case

C. Order a lithium blood level

D. Consult a psychiatrist
71. A 34-year-old patient is to undergo an appendectomy under general anesthesia. He is taking a
monoamine oxidase inhibitor (MAOI) for depression. Intraoperatively, his blood pressure drops to
72/36 mm Hg and a medication is administered. His blood pressure suddenly increases to 220/120
mm Hg. The most likely medicine that was administered is

A. Ephedrine

B. Meperidine

C. Phenylephrine

D. Norepinephrine

72. All of the following are true about diabetic patients, except

A. Patients should take half or one-third of their insulin dose the morning of the surgery

B. Patients should continue their oral hypoglycemic agents the morning of the surgery

C. Finger-stick blood glucose should be tested before taking the patient to the operating room

D. Patient with an insulin pump should continue the insulin at their basal rate

73. Digoxin toxicity is most likely exacerbated by

A. Hyperkalemia

B. Hypokalemia

C. Hypercalcemia

D. Hypocalcemia

74. The most common complication of inserting a central venous catheter is

A. Carotid artery puncture

B. Thrombosis

C. Cardiac arrhythmias

D. Air embolism

75. A patient is administered cephalexin preoperatively. Within 5 minutes of starting the antibiotic,
the patient starts to wheeze and develops tachycardia, and the blood pressure drops to 78/42 mm Hg.
Your next step would be to administer

A. Ephedrine

B. Phenylephrine

C. Epinephrine

D. Oxygen
76. All of the following may occur with an interscalene block, except

A. Subarachnoid injection

B. Radial nerve blockade

C. Median nerve blockade

D. Ulnar nerve blockade

77. An axillary nerve block would not produce loss of sensation of the

A. Lateral aspect of the forearm

B. Medial aspect of the forearm

C. The entire forearm

D. None of the above

78. The femoral nerve lies

A. Medial to the femoral artery

B. Anterior to the femoral artery

C. Posterior to the femoral artery

D. Lateral to the femoral artery

79. All of the following nerves are blocked by an ankle block, except

A. Sural

B. Superficial peroneal

C. Deep peroneal

D. Anterior tibial

80. Sore throat is

A. More common after using an endotracheal tube

B. More common after using a laryngeal mask airway

C. Similar incidence with either endotracheal tube or a laryngeal mask airway

D. More common after using an oral airway

81. A patient with hypertrophic obstructive cardiomyopathy (HOCM) presents with dyspnea and
angina on exertion. Which of the following is the best agent to treat these symptoms?

A. Hydrochlorothiazide

B. Metoprolol

C. Morphine

D. Nitroglycerin

82. St. John wort (Hypericum perforatum) potentiates the effects of

A. Heparin

B. Warfarin

C. Aspirin

D. Clopidogrel

83. The most powerful predictor of atrial fibrillation post–cardiac surgery is

A. History of diabetes

B. History of hypertension

C. Age

D. Time on bypass

84. A patient with Parkinson disease undergoes a general anesthetic. Your plan to treat his nausea
would include all of the following, except

A. Dexamethasone

B. Scopolamine patch

C. Metoclopramide

D. Ondansetron

85. A 65-year-old patient is being treated for congestive cardiac failure. He is able to take a shower
but gets dyspneic on mowing the lawn. His New York Heart Association classification is

A. Class 1

B. Class 2

C. Class 3a

D. Class 3b
86. The percentage of postdural puncture headaches that would resolve spontaneously by 1 week is
approximately

A. 30%

B. 50%

C. 50%

D. 70%

87. A 46-year-old lady is seen at the preoperative assessment clinic. She is taking 180 mg/day
methadone. The most likely change to be found in her preoperative ECG is

A. Prolonged PR interval

B. Prolonged QTc

C. U wave

D. Tented T-waves

88. You are about to anesthetize a 55-year-old man who is undergoing liver resection for removal of
metastatic carcinoid tumor. The drug of choice to treat intraoperative hypotension is

A. Octreotide

B. Dobutamine

C. Milrinone

D. Vasopressin

89. You are performing an interscalene brachial plexus block on an awake 40-year-old patient who is
healthy with no significant medical history. Soon after injecting 20 mL of 0.25% bupivacaine the
patient becomes agitated, has a seizure, and loses consciousness. Your first step in management is

A. Administer intralipid

B. Administer midazolam or propofol to control the seizure

C. Establish airway and give 100% O2 via a face mask

D. Administer epinephrine

90. Patients with dilated cardiomyopathy exhibit all of the following, except

A. Decreased myocardial contractility

B. Afterload should be maximized

C. Increased preload

D. Left ventricular hypertrophy

91. A septic patient has a central venous pressure of 10 mm Hg, a blood pressure of 80/40 mm Hg, and
a pulse rate of 96 beats/min. The best agent to treat the hypotension is

A. Dopamine

B. Dobutamine

C. Noradrenaline

D. Epinephrine

92. Which of the following organs is least tolerant of ischemia for removal for transplantation?

A. Cornea

B. Heart

D. Kidney

E. Pancreas

93. You have administered a patient 1.2 mg/kg of rocuronium to do an intubation. You are unable to
intubate or ventilate the patient and decide to reverse the patient’s paralysis with sugammadex. The
dosage you would use is

A. 2 mg/kg

B. 4 mg/kg

C. 8 mg/kg

D. 16 mg/kg

94. A young female patient with anorexia nervosa has just started eating again. After 4 days, she
develops dyspnea and is found to have cardiac failure. Which of the following is most important to
correct?

A. Potassium

B. Phosphate

C. Glucose

D. Sodium
95. A pregnant lady is to undergo general anesthesia for acute appendicitis. At what gestational age
should you monitor fetal heart rate?

A. 16 weeks

B. 18 weeks

C. 24 weeks

D. 28 weeks

96. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient?

A. Pretracheal tissue volume

B. Body mass index

C. Mallampati score

D. Thyromental distance

97. A patient with a history of chronic obstructive pulmonary disease presents for lung volume–
reduction surgery. Which of the following is a contraindication for surgery?

A. Age >60 years

B. Chronic asthma

C. FEV <25%

D. Evidence of bullous disease

98. All of the following help increase the excretion of calcium, except

A. Bisphosphonates

B. Calcitonin

C. Furosemide

D. IV crystalloids

99. Which of the following is contraindicated to use during pregnancy?

A. Aspirin

B. Enalapril

C. Metoprolol

D. Hydralazine
100. During scoliosis surgery, monitoring of somatosensory-evoked potentials indicates monitoring of

A. Anterior horn

B. Anterior corticospinal tract

C. Dorsal column

D. Spinothalamic tract

101. The desflurane vaporizer is heated because of desflurane’s

A. High vapor pressure

B. High boiling point

C. High minimum alveolar concentration

D. High volatility

102. Which of the following is the most effective way to reduce renal failure in a patient having an
abdominal aortic aneurysm repair?

A. Fluid bolus prior to aortic clamping

B. Fluid bolus after aortic clamp release

C. Administration of mannitol

D. Minimization of cross-clamp time

Anesthetic Pharmacology chapter 6

1. Correct statement about metabolism of drugs by the liver is

A. For drugs with low extraction ratio, liver blood flow is the rate-limiting step in their metabolism

B. For drugs with high extraction ratio, the capacity of the liver to metabolize the drug is the rate-limiting
step

C. Cytochrome P450 system is highly drug-specific

D. Removal of the drug from the blood by hepatic clearance is directly proportional to hepatic blood
flow and intrinsic clearance

2. When asked to describe the symptoms of her allergy to a local anesthetic that a 26-year-old female
had at the dentist’s office, the patient describes a feeling of light-headedness, palpitations, and
flushing. This reaction is most likely caused by

A. Methylparaben reaction

B. Vasovagal reaction

C. Para-aminobenzoic acid allergy

D. Epinephrine in the local anesthetic

3. All of the following drugs increase the mean arterial blood pressure, except

A. Dopamine

B. Norepinephrine

C. Epinephrine

D. Isoproterenol

4. All of the following drugs increase cardiac output, except

A. Dopamine

B. Epinephrine

C. Dobutamine

D. Norepinephrine

5. In general, norepinephrine causes increase in all of the following, except

A. Mean arterial blood pressure

B. Heart rate

C. Cardiac dysrhythmias

D. Systemic vascular resistance

6. Stimulation of α2 receptors causes

A. Hypertension

B. Bradycardia

C. Salivation

D. Anxiety

7. Labetalol is relatively contraindicated for

A. Treatment of hypertension in aortic dissection

B. Treatment of hypertension in preeclampsia

C. Hypertensive emergencies after cardiac surgery involving second-degree heat block

D. Hypertension secondary to clonidine withdrawal

8. The best initial treatment for anaphylaxis during general anesthesia is

A. Methylprednisolone

B. Famotidine

C. Diphenhydramine

D. Epinephrine

9. Compared with thiopental, etomidate causes

A. Less nausea

B. Increased seizure threshold

C. Greater myoclonic activity

D. Greater histamine release

10. Compared with propofol, ketamine causes

A. More depression of respiratory drive

B. More depression of airway reflexes

C. More bronchodilation

D. Less analgesia
11. A 65-year-old African American patient is undergoing laparoscopic repair of inguinal hernia under
general anesthesia. He has a history of hypertension, diabetes, and depression. His medication list
includes lisinopril, hydrochlorothiazide, metformin, and phenelzine. Intraoperative hypotension
develops secondary to injury to inferior epigastric artery. Which of the following medications is
relatively contraindicated to treat this hypotension?

A. Epinephrine

B. Norepinephrine

C. Ephedrine

D. Phenylephrine

12. True statement regarding flumazenil is

A. It binds irreversibly with benzodiazepine receptor

B. It causes hypertension and tachycardia

C. It has a shorter duration of action than midazolam

D. It reverses opioid-induced respiratory depression

13. Midazolam can be administered through all of the following routes, except

A. Oral

B. Sublingual

C. Transcutaneous

D. Transnasal

14. When sodium bicarbonate is added to lidocaine, more rapid onset of action of lidocaine occurs
because of

A. Increased nonionized lidocaine concentration

B. Increased ionized lidocaine concentration

C. Decreased extracellular pH

D. Increased intracellular pH

15. Which of the following findings suggests current use of cocaine in a patient undergoing
preoperative evaluation?

A. Bradycardia

B. Hypertension

C. Pinpoint pupils

D. Hypothermia
16. Which of the following local anesthetics is an ester?

A. Lidocaine

B. Prilocaine

C. Mepivacaine

D. Cocaine

17. Which of the statements among the following is true?

A. Ropivacaine is more potent than bupivacaine

B. Ropivacaine causes more motor than sensory block

C. Bupivacaine causes more vasoconstriction than ropivacaine

D. Ropivacaine is an S-enantiomer of bupivacaine

18. A 75-year-old patient is shivering and has chest pain in the recovery room following exploratory
laparotomy for a rupture-obstructed hernia. His heart rate is 123/min, blood pressure is 200/100 mm
Hg, and SpO2 is 97% on 2 L of oxygen via nasal cannula. An EKG shows ST-T wave changes, which are
treated with nitroglycerine with no effect. Which of the following is the most appropriate next step?

A. Administration of hydralazine

B. Administration of nitroprusside

C. Administration of esmolol

D. Application of a warming blanket

19. Which of the following statements about the local anesthetics is false?

A. They are weak bases

B. They contain either ester or amide linkage

C. It is their charged form that interacts with the receptor

D. They bind the receptor inside the cell

20. Local anesthetics cause their effects by

A. Increasing the threshold potential

B. Altering the resting membrane potential

C. Increasing the rate of depolarization

D. Decreasing the rate of depolarization

21. Lipid solubility of local anesthetics

A. Generally correlates directly with the time to onset of action

B. Increases as the fraction of ionized form of the local anesthetic increases

C. Increases as the fraction of unionized form of the local anesthetic increases

D. May be different in in vivo or in vitro systems

22. Which is the correct expected duration of anesthesia after infiltration with the following local
anesthetics?

A. Lidocaine 60 to 120 minutes

B. Mepivacaine 120 to 240 minutes

C. Ropivacaine 120 to 180 minutes

D. Bupivacaine 120 to 180 minutes

23. Use of which of the following local anesthetics for spinal anesthesia is controversial?

A. Ropivacaine

B. Bupivacaine

C. Tetracaine

D. Lidocaine

The following three questions belong to this clinical situation: During placement of an interscalene
block utilizing 0.5% bupivacaine, a 62-year-old patient suddenly starts experiencing seizures and loses
consciousness.

24. Which of the following statements regarding local anesthetic toxicity is correct?

A. Seizure is a sign of neurotoxicity from high dose of local anesthetic

B. Loss of consciousness is a sign of low-dose local anesthetic neurotoxicity

C. The seizure threshold is increased by the administration of thiopental

D. Seizure may have been caused by injection of the local anesthetic into cervical nerve root

25. Which of the following statements is false?

A. Seizure may have happened secondary to the injection of local anesthetic into vertebral artery

B. Loss of consciousness may be secondary to high epidural anesthesia

C. Loss of consciousness may be secondary to high spinal anesthesia

D. In general, decreased local anesthetic protein-binding decreases potential CNS toxicity

26. Which of the following statements is false?

A. Repeated attempts at aspiration would have prevented this complication

B. Addition of epinephrine to the local anesthetic may have helped to prevent this complication

C. Loss of consciousness means that patient has developed cardiac arrest

D. Amiodarone is the first line of treatment for cardiovascular toxicity caused by bupivacaine

27. During induction of anesthesia for cesarean delivery in a 22-year-old female, rocuronium is
inadvertently substituted for succinylcholine. The neonate does not show any sign of muscle
relaxation because rocuronium is

A. Highly protein bound

B. “Unaffected by ion trapping”

C. Lipid soluble

D. Highly ionized

28. All of the following can lead to hyperkalemic response to the administration of succinylcholine,
except

A. Burn injury

B. Spinal cord injury

C. Prolonged ICU stay

D. Cerebral palsy

29. The dibucaine number in a patient having heterozygous type of plasma cholinesterase will be

A. 20% to 30%

B. 30% to 40%

C. 60% to 80%

D. 50% to 60%

30. Which of the following muscle relaxants is eliminated mostly by the kidneys?

A. Rocuronium

B. Succinylcholine

C. Vecuronium

D. Pancuronium
31. The correct recommended intubating dose among the following muscle relaxants is

A. Vecuronium 0.08 to 0.1 mg/kg

B. Pancuronium 0.05 to 0.07 mg/kg

C. Succinylcholine 0.5 to 0.07 mg/kg

D. Cisatracurium 0.5 to 0.8 mg/kg

32. Which of the following drugs is able to cross the blood–brain barrier?

A. Physostigmine

B. Neostigmine

C. Pyridostigmine

D. Glycopyrrolate

33. All of the following are side effects of anticholinesterase drugs, except

A. Excessive salivation

B. Increased bowel motility

C. Bradycardia

D. Bronchodilation

34. Which of the following characteristics of electrical stimulation is the correct representation of the
stimulus generated by the nerve stimulator used for monitoring the neuromuscular blockade?

A. Tetany: A sustained stimulus of 50 to100 Hz, usually lasting 2 seconds

B. Twitch: A single pulse 0.5 second in duration

C. Train of four: A series of four twitches in 2 seconds (2-Hz frequency), each 0.2 ms long

D. Double-burst stimulation: Three short (0.2 ms) high-frequency stimulations separated by a 30-ms
interval and followed 1 second later by two or three additional impulses

35. Which of the following antibiotics augments the action of nondepolarizing muscle relaxants?

A. Penicillin

B. Cephalosporin

C. Erythromycin

D. Streptomycin
36. Immediately after induction of general anesthesia for hip replacement surgery, a 56-year-old
patient with severe mitral stenosis and a normal ejection fraction develops a blood pressure of 70/35
mm Hg with a heart rate of 90 bpm. Which of the following is the most appropriate initial treatment?

A. Dobutamine

B. Epinephrine

C. Phenylephrine

D. Milrinone

37. Mechanism of action of droperidol involves antagonism at all of the following receptors, except

A. Serotonin

B. Dopamine

C. α-Adrenergic

D. Glutamate

38. Which of the following is not seen in acute cyanide poisoning?

A. Metabolic acidosis

B. Cardiac arrhythmias

C. Tolerance to the antihypertensive effect of nitroprusside

D. Decreased mixed venous oxygen saturation

39. Which of the following medications is associated with extrapyramidal effects?

A. Midazolam

B. Glycopyrrolate

C. Metoclopramide

D. Famotidine

40. Which of the following medications should be discontinued before the elective surgery?

A. Metoprolol

B. Monoamine oxidase inhibitors

C. Atorvastatin

D. Ranitidine
41. Administration of magnesium sulfate for preeclampsia results in a decreased dose requirement for
each of the following, except

A. Succinylcholine

B. Rocuronium

C. Desflurane

D. Lidocaine

42. Benefits of epinephrine 1:200,000 added to lidocaine for an epidural injection include all of the
following, except

A. Prolongation of duration of action of lidocaine

B. Better quality of block

C. Prophylactic treatment of hypotension associated with the bolus administration of lidocaine

D. Delayed absorption into systemic circulation, thereby decreasing probability of local anesthetic
toxicity

43. Which of the following choices is correct regarding the blood gas partition coefficient?

A. Nitrous oxide 0.47

B. Desflurane 0.62

C. Isoflurane 2.4

D. Sevoflurane 0.85

44. The use of neostigmine to reverse residual neuromuscular block may slow the metabolism of
which of the following drugs administered subsequently?

A. Rocuronium

B. Cisatracurium

C. Pancuronium

D. Succinylcholine

45. A 45-year-old patient with history of hypertrophic subaortic cardiomyopathy becomes

hypotensive. Which of the following drugs is most appropriate for treatment of hypotension?

A. Ephedrine

B. Amrinone

C. Phenylephrine

D. Nitroglycerine
46. Factors that contraindicate ketorolac administration include all of the following except

A. Renal insufficiency

B. Factor VIII deficiency

C. Active peptic ulcer disease

D. Daily ingestion of aspirin

47. After receiving massive blood transfusion, a patient anesthetized with isoflurane, fentanyl, and
nitrous oxide develops acute pulmonary edema. The drug most likely to help him acutely is

A. Isoflurane

B. Nitroglycerine

C. Digoxin

D. Morphine

48. A 22-year-old college athlete with a history of prolonged QT syndrome presents for an inguinal
hernia repair. Which of the following agents would be least likely to further lengthen the QT interval?

A. Ondansetron

B. Metoclopramide

C. Succinylcholine

D. Propofol

49. Which of the following statements concerning naloxone is true?

A. Elimination half-life is longer than most of the μ-receptor opioids

B. It has mixed agonist–antagonist activity

C. It relieves opioid-induced spasm of the sphincter of Oddi

D. It does not cross the placenta

50. Which of the following drugs is most likely to cause tachycardia?

A. Fentanyl

B. Meperidine

C. Morphine

D. Sufentanil
51. Addition of fentanyl to epidural bupivacaine will cause

A. No change in duration of analgesia

B. More rapid onset of analgesia

C. Increased vagal activity

D. Increased sensory block

52. Compared with sufentanil, alfentanil is characterized by

A. Higher pKa

B. Larger unionized fraction at physiologic pH

C. Less protein-binding

D. Greater lipid solubility

53. An inhaled anesthetic has blood/gas partition coefficient of 14.8. Recovery time primarily depends
on

A. Oil/gas solubility of the agent

B. Cardiac output

C. Duration of administration

D. MAC of the drug

54. Nitroprusside therapy for hypertension should be discontinued in the presence of

A. Acute myocardial infarction

B. Increasing metabolic acidosis

C. Mitral regurgitation

D. Renal failure

55. A 24-year-old man is apprehensive of general anesthesia and prefers a regional anesthetic.
Decision is made to conduct spinal anesthesia for the repair of inguinal hernia along with midazolam
and fentanyl to allay anxiety. During the procedure, he suddenly loses consciousness. There is
profound hypotension with systolic blood pressure of 44 mm Hg and a heart rate of 28 bpm.
Cardiopulmonary resuscitation is started. The next most appropriate intervention is administration of

A. Atropine

B. Ephedrine

C. Epinephrine

D. Flumazenil
56. The effect of gentamycin at the neuromuscular junction is

A. Prevented by pretreatment with magnesium

B. Potentiated by anticholinesterases

C. Decreased by depolarizing relaxants

D. Partially reversed by calcium

57. Compared with lorazepam (Ativan), midazolam (Versed)

A. Has a shorter elimination half-life

B. Has more rapid clearance

C. Has a larger volume of distribution

D. Undergoes slower hepatic metabolism

58. The drug that causes dose-dependent EEG evidence of both central nervous system excitation and
depression is

A. Thiopental

B. Lidocaine

C. Isoflurane

D. Midazolam

59. Normal pseudocholinesterase

A. Is produced primarily at nerve terminals

B. Is antagonized by acetyl cholinesterase

C. Resists dibucaine inhibition more than atypical pseudocholinesterase

D. Metabolizes succinylcholine by Hofmann elimination

60. Succinylcholine has prolonged action in patients carrying homozygous pseudocholinesterase.

Which of the following best explains this phenomenon?

A. Diffusion away from the neuromuscular junction is slow

B. Hepatic clearance of succinylcholine is reduced

C. Succinylmonocholine induces neuromuscular block

D. An increased proportion of succinylcholine reaches the neuromuscular junction

61. Opioid analgesics cause all of the following effects except

A. Contraction of smooth muscle of the gallbladder

B. Contraction of detrusor muscle of the urinary bladder

C. Depress cellular immunity

D. Delayed gastric emptying

62. Opioids may have more pronounced action in all of the following except

A. In men compared to women

B. In older than in younger patients

C. During liver transplant surgery

D. In kidney failure

63. Which of the following drugs decreases lower esophageal sphincter tone?

A. Succinylcholine

B. Glycopyrrolate

C. Metoclopramide

D. Neostigmine

64. A 28-year-old burn patient needs daily wound debridement. Which of the following agents is not
appropriate to provide a short duration of anesthesia?

A. Nitrous oxide

B. Ketamine

C. Etomidate

D. Midazolam

65. Eutectic mixture of local anesthetics (EMLA cream) is sometimes used to numb the skin before
attempting an intravenous access in pediatric patients.

Which of the following local anesthetics is combined with prilocaine to produce this cream?

A. Bupivacaine

B. Lidocaine

C. Mepivacaine

D. Ropivacaine
66. A 76-year-old man with history of hypertension and cancer of the colon had colectomy under
general anesthesia 24 hours ago. He is receiving an epidural infusion of fentanyl at the rate of 100
micro symbol g/h. Which of the following is least likely?

A. Nausea

B. Pruritus

C. Respiratory depression

D. Hypotension

67. Which of the following may help in mapping of a seizure focus under general anesthesia by
enhancing the EEG activity or inducing the seizure?

A. Thiopental

B. Ketamine

C. Diazepam

D. Isoflurane

68. Which of the following anesthetic agents is contraindicated for use in patients with intermittent
porphyria?

A. Ketamine

B. Etomidate

C. Isoflurane

D. Thiopental

69. Replacing 10 mg of morphine with 30 mg of ketorolac can increase the risk of

A. Respiratory depression

B. Analgesia

C. Nausea

D. Bleeding

70. The minimum anesthesia concentration (MAC) of desflurane is decreased by

A. Chronic alcohol use

B. Respiratory alkalosis

C. Chronic anemia with hemoglobin of 7.5 gm/dL

D. Hypothermia to 34°C
71. A 45-year-old woman has been using heroin for last 20 years. Use of which of the following drugs
will cause acute withdrawal symptoms?

A. Butorphanol

B. Nalbuphine

C. Buprenorphine

D. Naltrexone

72. Ketamine administered in anesthetic doses

A. Decreases intracranial pressure

B. Causes respiratory depression

C. Is metabolized by the liver

D. Increases bronchomotor tone

73. Which of the following drugs is the most appropriate agent for acute treatment of hypertension in
a preeclamptic patient?

A. Magnesium

B. Labetalol

C. Lisinopril

D. Nitroglycerine

74. Which of the following provides the best estimate of complete reversal of neuromuscular
blockade?

A. Double-burst ratio of 1

B. Train-of-four-ratio of 1

C. Absence of fade on tetanic stimulation at 50 Hz

D. Absence of fade of single twitch

75. Which of the following is contraindicated in a patient with Guillain–Barré syndrome?

A. Intrathecal opioids

B. Nondepolarizing muscle relaxant

C. Epidural local anesthetics

D. Succinylcholine
76. Which of the following drugs is the most appropriate for management of anesthesia in a patient
who needs emergency surgery and admits to using cocaine in last 3 hours?

A. Labetalol before induction

B. Ketamine for induction

C. Propofol for induction

D. Ephedrine for treatment of hypotension

77. During general anesthesia, which of the following agents is most appropriate to treat an acute
episode of cyanosis in a child with tetralogy of Fallot?

A. Atropine

B. Epinephrine

C. Phenylephrine

D. 100% oxygen

78. Rebound hypertension is most likely after sudden discontinuation of which of the following classes
of antihypertensive drugs?

A. Thiazide diuretics

B. Calcium channel blockers

C. α-Agonist

D. Angiotensin-converting enzyme inhibitors

79. A 65-year-old man has nausea and vomiting in the post–anesthesia care unit, needing antiemetic
therapy. He develops involuntary facial movements, difficulty swallowing, and torticollis. Which of the
following drugs is most likely to be the cause of these symptoms?

A. Promethazine (Phenergan)

B. Diphenhydramine (Benadryl)

C. Metoclopramide (Reglan)

D. Granisetron (Kytril)

80. Which of the following statements about ketamine is true?

A. Tolerance may develop after repeated administration

B. It is extensively bound to plasma protein

C. Primary site of action is GABA receptor

D. Kidney is the primary route of elimination

81. Which of the following statements about etomidate is most likely true?

A. It causes significant dose-dependent respiratory depression

B. It causes cerebral vasodilatation

C. It increases frequency of excitatory spikes on the EEG more than thiopental

D. Most of the administered dose is excreted unchanged by the kidney

82. The MOST likely analgesic mechanism of action of gabapentin for neuropathic pain is

A. Antagonism at the GABA receptor

B. NMDA receptor inhibition

C. Sodium channel blockade

D. Calcium channel modulation

83. Which of the following properties of local anesthetics is most likely a primary determinant of
potency?

A. Vasodilation

B. pKa

C. Protein-binding

D. Lipid solubility

84. Which of the following statements about etomidate is most likely true?

A. It is water soluble at an acidic pH and lipid soluble at physiologic pH

B. It may be used as an infusion for sedation in the ICU

C. It is related to propofol in its chemical structure

D. Awakening from induction dose is secondary to very rapid liver metabolism

85. A 64-year-old man is scheduled for an open abdominal aortic aneurysm surgery. Anesthetic plan
includes placement of an epidural catheter for postoperative pain relief. On review of his medication
list, it is noted that he has been taking clopidogrel for a coronary artery stent that was inserted 2
years ago. Which of the following statements about clopidogrel is most likely true?

A. The American Society for Regional Anesthesia recommends that clopidogrel be stopped 3 days before
neuraxial anesthesia

B. A single dose of clopidogrel may have a clinically significant effect on platelet function

C. Clopidogrel is associated with pancytopenia

D. Inhibition of platelet function by clopidogrel is reversible

86. Which of the following statements about ketamine is most likely true?

A. Analgesic efficacy of epidural ketamine is equivalent to epidural morphine

B. Ketamine decreases the duration of action of nondepolarizing neuromuscular-blocking drugs

C. Ketamine is a direct myocardial depressant

D. Ketamine decreases the cortical amplitude of somatosensory-evoked potentials

87. A patient has a history of an allergic reaction to a local anesthetic but does not recall the name.
Which of the following local anesthetics will most likely be the cause of a true allergic reaction?

A. Procaine

B. Lidocaine

C. Mepivacaine

D. Bupivacaine

88. Which of the following is most likely the (analgesic) mechanism of action of lidocaine when used
for neuropathic pain?

A. Inhibition of G-protein–coupled receptors

B. Antagonism of NMDA receptors

C. Calcium channel blockade

D. Sodium channel blockade

89. A 45-year-old farmer is brought into the emergency room. He is agitated and confused. On
examination, he has dry skin with fever and rapid heart rate. Anticholinergic poisoning is suspected.
Which of the following medications is most appropriate to treat his condition?

A. Neostigmine

B. Pyridostigmine

C. Edrophonium

D. Physostigmine

90. Which of the following medications will prolong the neuromuscular blockade produced by
vecuronium?

A. Carbamazepine

B. Clindamycin

C. Quinidine

D. Verapamil
91. The shorter duration of action of remifentanil compared with fentanyl is primarily due to its

A. Rapid redistribution

B. Renal elimination

C. Metabolism by esterases

D. Hepatic extraction ratio

92. Which of the following statements about dexmedetomidine is most likely true?

A. It has more α2 selectivity than clonidine

B. It can increase opioid-induced rigidity

C. Context-sensitive half time increases markedly after prolonged infusion of dexmedetomidine

D. It has no effect on systemic vascular resistance

93. Which of the following can precipitate an episode of myotonia in a patient with myotonic
dystrophy?

A. Lidocaine administration

B. Neostigmine administration

C. Nondepolarizing neuromuscular-blocker administration

D. Hypothermia

94. A 50-year-old woman had cholecystectomy done under general anesthesia. Rocuronium was used
as muscle relaxant, and a combination of anticholinergic and anticholinesterase was used for reversal
of muscle-relaxant action. The patient is now bradycardic. The combination of reversal agents most
likely to cause the bradycardia is

A. Atropine and edrophonium

B. Glycopyrrolate and edrophonium

C. Atropine and neostigmine

D. Glycopyrrolate and neostigmine

95. A 68-year-old man is undergoing exploratory laparotomy for intestinal obstruction. Cause of
obstruction is found to be an ileal carcinoid tumor. Suddenly, the patient develops bronchospasm, and
the peak airway pressure increases from 24 to 45 cm of H2O. Which of the following is the best
treatment for the bronchospasm in this situation?

A. Dexamethasone

B. Sevoflurane

C. Ketamine

D. Somatostatin

96. A 15-year-old boy has severe gastroenteritis with nausea, vomiting, and diarrhea for last 3 days. A
CT scan of the abdomen shows intussusceptions, which needs exploratory laparotomy for relief of
intestinal obstruction. The patient’s systolic blood pressure is 78 mm Hg and heart rate is 112 bpm.
Thiopental is selected as the induction agent for general anesthesia. A decreased dose of this agent is
recommended in patients with hypovolemic shock primarily because

A. Delivery of the drug to the brain is increased

B. Hepatic clearance is decreased

C. Thiopental is a myocardial depressant

D. Thiopental is a vasodilator

97. A 75-year-old woman is scheduled for mitral valve repair. High-dose fentanyl is used to induce
anesthesia. In order to counteract the bradycardia caused by fentanyl, pancuronium is administered.
Pancuronium blocks the bradycardia caused by fentanyl by acting on which of the following?

A. β-Adrenergic receptors

B. Cardiac muscarinic receptors

C. Carotid baroreceptors

D. Central vagal nuclei

98. Which of the following medications would be most appropriate to treat symptomatic bradycardia
1 month after cardiac transplant?

A. Glycopyrrolate

B. Phenylephrine

C. Atropine

D. Isoproterenol
99. Which of the following statements about propofol infusion syndrome is most likely false?

A. Mortality rate in an established case is very high

B. Rhabdomyolysis is one of the diagnostic criteria

C. Tachycardia is an early sign of this syndrome

D. Cardiac dysfunction is very common in this condition

100. A patient is undergoing resection of a supratentorial brain tumor. He is normocarbic, and his
mean blood pressure is 70 mm Hg. Administration of which of the following is most likely to decrease
cerebral blood volume?

A. Nitrous oxide at 0.5 minimum alveolar concentration (MAC)

B. Desflurane at 1 MAC

C. Thiopental 2 mg/kg

D. Phenytoin 15 mg/kg

101. Which of the following classes of drugs is most likely to be responsible for an anaphylactic
reaction during general anesthesia?

A. Neuromuscular-blocking drugs

B. Opioids

C. Antibiotics

D. Radio contrast dyes