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WorksheetsInterns Long Exam- Anesthesia
Total questions: 100
Worksheet time: 1hrs 26mins
1. The MAP in a patient with a blood pressure of 180/60 mmHg is:
90mmHg
100mmHg
110mmHg
120 mmHg
2. The primary determinants of myocardial O2 consumption, from most to least important, are
Preload > afterload > heart rate
Heart rate > preload > afterload
Afterload > preload > heart rate
Heart rate > afterload > preload
3. Cardiac tamponade is associated with
Pulsus alterans
Pulsus tardus
Pulsus parvus
Pulsus paradoxus
4. Calculate the systemic vascular resistance (SVR) from the following data: Cardiac output 5.0 L/min, central venous pressure (CVP) 8mmHg, mean arterial blood pressure 86 mmHg, mean pulmonary arterial blood pressure 20 mmHg, pulmonary capillary wedge pressure 9mmHg, heart rate 85 beats/min, patient weight 100kg.
750
1000
1250
1500
5. The MOST important pathophysiologic difference between pericardial effusion and cardiac tamponade is
Type of fluid (e.g. transudate, exudate, blood)
Quantity of fluid
Pressure
Inflammation
6. A healthy 59-year old, 60kg, woman with normal preoperative ECG develops wide complex tachycardia under general anesthesia for breast biopsy. Blood pressure is 81/47 mmHg, and heart rate is 220 beats/min and regular. The MOST appropriate therapy would be
Electrical cardioversion
Administration of lidocaine 60mg IV
Administration of procainamide 20mg/min IV
Administration of amiodarine 300mg IV
The ECG rhythm strip represents
Atrial fluter
Third degree heart block
Sinus tachycardia with second degree heart block
Junctional rhythm
8. A 78-year old patient is anesthetized for right hemicolectomy with isoflurane and nitrous oxide. Vecuronium is administered to facilitate muscle relaxation. At the end of the operation, the neuromuscular blockade is reversed with neostigmine 4mg and glycopyrrolate 0.8mg. The rhthm below is noted shortly before administration of these drugs. The patient’s blood pressure is 90/60. The MOST appropriate course of action it this point is
DC cardioversion
Isoproterenol drip
Atropine
Transcutaneous pacemaker
9. The wave designated by the arrow is produced physiologically by
Atrial filling
Bulging of tricuspid valve into right atrium
Contraction of atrium against closed valve
Pressure transmitted from carotid artery
10. In a normal person, what percentage of the cardiac output is dependent on the “atrial kick”?
25%
35%
45%
55%
11. Normal resting myocardial O2 consumption is
2.0 mL/100g/min
3.5 mL/100g/min
8mL/100g/min
15mL/100g/min
12. Which of the following treatments would be the LEAST useful in treatment of the rhythm shown
Procainamide
Magnesium
Overdrive pacing
Unsynchronized cardioversion
13. Select the TRUE statement regarding cardiopulmonary resuscitation (CPR) and defibrillation by a healthcare provider in patients experiencing sudden cardiac arrest
Defibrillation times one should always precede CPR
CPR should always be carried out for 2 minutes before defibrillation
Two minutes of chest compression alone (no ventilation) should be carried out before first shock
If arrest less than 1 minute (witnessed), deliver one biphasic shock then 5 cycles of CPR
14. Which of the following medications blocks angiotension at the receptor?
Losartan
Terazosin
Lisinopril
Spironolactone
15. A patient with known Wolff-Parkinson-White (WPW) syndrome develops a wide complex tachycardia during a hernia operation under general anesthesia. Vital signs are stable, and pharmacologic treatment is desired. Which of the following drugs is MOST likely to be successful in controlling heart rate in this patient?
Verapamil
Esmolol
Adenosine
Procainamide
16. Which of the following terms refer to myocardial relaxation or diastole?
Inotropy
Chronotropy
Dromotropy
Lusitropy
17. You are called to the Postanesthesia care unit to see a patient who had undergone a general anesthesic for a debridement of an infected sternum after aortic valve surgery 3 weeks earlier. The patient has a heart rate of 110 and a respiratory rate of 24 and is confused. The blood pressure is 85/40 mmHg. Under the current sepsis guidelines, the patient meets the criteria for:
Septic shock
SIRS syndrome
SEPSIS
Severe septic shock
18. P wave flattening, widening of the QRS complex, peaked T waves
Hypokalemia
Hyperkalemia
Hyponatremia
Hypercalcemia
19. Depressed ST segments, flat T wave, U wave present
Hypokalemia
Hyperkalemia
Hyponatremia
Hypercalcemia
20. Normal or increased PR interval, short QT interval
Hypokalemia
Hyperkalemia
Hyponatremia
Hypercalcemia
21. Calculate the body mass index (BMI) of a man 200cm (6 feet 6 inches) tall who weighs 100kg (220lbs)
20
25
30
35
22. Maximizing which of the lung parameters is the most important factor in prevention of postoperative pulmonary complication?
Tidal volume
Inspiratory reserve volume
Vital Capacity
Functional residual capacity
23. The normal FEV1/FVC ratio is
0.99
0.80
0.60
0.50
24. The FRC is composed of the
Expiratory reserve volume and residual volume
Inspiratory reserve volume and residual volume
Inspiratory capacity and vital capacity
Expiratory capacity and Tidal volume
25. The normal vital capacity for a 70-kg man is
1 L
2 L
5 L
7 L
26. A 32-year old man is found unconscious by the fire department in a room where he has inhaled 0.1% carbon monoxide for a prolonged period. His respiratory rate is 42 breaths/min, but he is not cyanotic. Carbon monoxide has increased this patient’s minute ventilation by which of the following mechanisms?
Shifting of the O2 hemoglobin dissociation curve to the left
Increasing CO2 production
Causing lactic acidosis
Decreasing PaO2
27. The following blood gas would best be explained by which disorder
pH 7.18, PaCO2 25 mmHg, HCO3- 11mEq/L
Aspirin overdose
Nasogastric suction
Chloride wasting diarrhea
Hyperaldosteronism
28. Each of the following is decreased in elderly patients compared with their younger counterparts, EXCEPT
Closing volume
FEV1
Ventilatory response to hypoxia
Vital Capacity
29. Which of the following statements regarding the distribution of O2 and CO2 in the upright lungs is TRUE?
PaO2 is greater at the apex than at the base
PaCO2 is greater at the apex than at the base
Both PaO2 and PaCO2 are greater at the apex than at the base
Both PaO2 and PaCO2 are greater at the base than at the apex
30. The most important buffering system in the body is
Hemoglobin
Plasma proteins
Phosphate
[HCO3-]
31. Each of the following will shift the oxyhemoglobin dissociation curve to the right EXCEPT
Volatile anesthetics
Decreased PaO2
Decreased pH
Increased temperature
32. Which of the following can cause a rightward shift of the oxyhemoglobin dissociation curve?
Methemoglobine-mia
Carboxyhemoglo-binemia
Hypothermia
Pregnancy
33. A 30-year old woman has undergone a 2-hour abdominal surgical procedure and is sent to the ICU intubated for postoperative monitoring, due to suspected sepsis. Three hours later, the ventilator malfunctioned and the resident disconnects patient from the ventilator and hand ventilated the patient with 100% oxygen. The patient has good bilateral breath sounds, the chest rises nicely, and moisture is seen in the ETT. Shortly thereafter, the patient’s heart rate slows to 30 beats/min and the blood pressure is 50mmHg systolic. The next intervention should be done in addition to chest compression is
Administer atropine
Start epinephrine
Confirm ETT position
Apply external pacemaker
34. Anatomic dead space begins at the mouth and/or nose and ends at the:
Lobar bronchi
Respiratory bronchioles
Terminal bronchioles
Alveolar ducts
35. Anatomic dead space for a 70-kg man is approximately:
140 mL
240 mL
350 mL
500 mL
36. Please fill in the gaps. Surfactant _____ surface tension, ______ compliance of the lung, ______ work of breathing, and is produced by _______ in the lung.
Decreases, increases, decreases, endothelial cells
Increases, increases, decreases, type 2 alveolar epithelial cells
Decreases, decreases, decreases, type 1 alveolar epithelial cells
Decreases, increases, decreases, type 2 alveolar epithelial cells
37. The following muscles of respiration are used for inspiration EXCEPT
Diaphragm
Scalene muscles
External intercostal
Internal intercostal
38. Vital capacity consists of:
Functional residual capacity + inspiratory capacity
Expiratory reserve volume + inspiratory reserve volume
Expiratory reserve volume + inspiratory capacity
Tidal volume + inspiratory reserve volume
39. Which is the site of greatest airway resistance?
Trachea
Largest bronchi
Medium-sized bronchi
Small bronchi
40. The modified Cormack-Lehane grading system of the laryngoscopic view and its modified cations are used to grade the visualization of the vocal cords, glottis, and epiglottis at the time of laryngoscopy. A grade IIb view as classified by the original Cormack-Lehane system means the operator can visualize:
More than 50% of the glottic opening
Posterior part of the glottis and arytenoids
Arytenoids, but not the glottis
The epiglottis only, which can be lift ed from the posterior pharyngeal wall
41. The Mallampati classification focuses on the visibility of oropharyngeal structures when the patient is examined in which of the following positions?
Supine, mouth fully open, tongue protruded, with phonation
Semi-recumbent, mouth fully open, tongue protruded, without phonation
Sitting, mouth opened, tongue in neutral position, without phonation
Sitting, mouth fully opened, tongue protruded, without phonation
42. Which of the following patient presentations presents with the LEAST risk of difficult intubation?
67-year-old woman, 82 kg, thyromental distance 7 cm, mouth opening 3 cm, Mallampati II, prominent incisors
45-year-old man, 145 kg, thyromental distance 5 cm, mouth opening 6 cm, Mallampati III, short neck with limited extension
56-year-old man, 72 kg, thyromental distance 5 cm, mouth opening 5 cm, Mallampati III, poor dentition
52-year-old man, 45 kg, thyromental distance 5 cm, mouth opening 5 cm, Mallampati II, history of neck radiation, limited submandibular compliance
43. Inability to ventilate will eventually lead to hypoxemia and hypercarbia. Th e rate of difficult mask ventilation is estimated to be between 0.1% and 5%. Which of the following has NOT been associated with difficult mask ventilation?
Lack of teeth
Age more than 55 years
Presence of beard
Male sex
44. Which of the following structures in the infant and adult respectively determine the correct size for an endotracheal tube?
Glottis; vocal cords
Vocal cords; vocal cords
Cricoid cartilage; vocal cords
Vocal cords; cricoid cartilage
45. An airway fire is one of the most serious complications of laser surgery. Th e “fire triad” describes the three necessary components: an oxidizing source (endotracheal tube), an ignition source (laser), and oxygen. To reduce the risk of airway fi re during laser surgery, many specialized tubes have been created. Which of the following statements is INCORRECT?
Wrapped Teflon/silicon/aluminum tubes (Laser-Shield II Tracheal Tubes) are designed for use with CO 2 and KTP lasers. However, part of the tube and cuff is unprotected, so the tube must be wrapped in cottonoids and kept moist to reduce fi e risk.
Flexible stainless steel tubes (Laser-Flex Tracheal Tubes) and red rubber tubes wrapped with copper tape (Sheridan Laser Trach Tubes) are designed for use with the Nd-YAG laser but do not hold up well when used with CO 2 or KTP lasers.
Laser tube cuff s often contain methylene blue crystals and should always be filled with saline. The methylene blue acts as a marker for cuff rupture or perforation due to laser damage. Also, fluid acts as a heat sink and makes the cuff more difficult to perforate.
Positive end-expiratory pressure (PEEP) can reduce the risk of fi re in PVC tubes when CO 2 lasers are in use.
46. You are called to evaluate a patient in the emergency department for severe airway swelling aft er administration of an angiotensin-converting enzyme (ACE) inhibitor. On examination the patient exhibits inspiratory “crowing” and expiratory stridor. Th e patient’s oxygen saturation is slowly dropping despite the administration of an increased fraction of inspired oxygen. The most appropriate next step is to
Administer intravenous epinephrine and give oxygen via a nasal cannula
Administer high-dose steroids and request an emergent ENT consult
Start an intravenous line and induce general anesthesia in preparation for intubation
Assess the patient’s airway, call for help, administer topical anesthetic to the airway for an awake fiberoptic intubation with surgical backup for a possible tracheostomy
47. A 25-year-old man is brought to the emergency room after a near-drowning. Witnesses saw him dive into a shallow pond while intoxicated. He hit his head, was unable to swim, and was then rapidly pulled from the pond by his family. He never lost consciousness yet
appears to have aspirated some pond water. He is complaining of severe weakness in his arms and hands and cannot move his feet. The emergency department physician would like the patient intubated due to marginal oxygen saturation, presumed aspiration pneumonia, and anticipated surgery to stabilize the cervical spine. All of the following are true EXCEPT:
Cervical alignment with manual in-line stabilization should be maintained during laryngoscopy.
An awake fiberoptic intubation should be attempted if the patient is cooperative.
The patient’s head and neck should be stabilized in a neutral position by a rigid cervical neck collar and standard induction of anesthesia and intubation attempted.
Because the injury has already been sustained with neurologic sequelae, proceeding with a standard rapid sequence intubation and direct laryngoscopy is appropriate.
48. A patient in the intensive care unit has massive hemoptysis and pulmonary hemorrhage. You are asked to place a double-lumen endotracheal tube for lung isolation. Which of the following is CORRECT regarding lung isolation?
Double-lumen tubes are smaller than single-lumen tubes and are therefore more difficult to provide pulmonary toilet through.
It is necessary to know which lung is bleeding prior to placement of the double-lumen
endotracheal tube in order to know which type of tube to place.
A bronchial blocker is equally efficacious for lung isolation during pulmonary hemorrhage.
A left double-lumen tube advanced into either the left or right mainstem bronchus will achieve lung isolation.
49. Risk factors for aspiration of gastric contents at the time of airway management include all of the following EXCEPT
Emergency surgery
Higher ASA classification
Small bowel obstruction
Obesity
50. . Cricoid pressure (Sellick’s maneuver) can be used in an attempt to
Reduce gastric distention during bag-mask ventilation
Reduce passive regurgitation of gastric contents
Improve laryngoscopic view by applying backward, upward, and rightward pressure
All of the above
51. The process of preoxygenation/de-nitrogenation greatly increases the time to desaturation during intubation. The reasons for failure to achieve an FiO2 close to 100% include leak, rebreathing of gases, and using systems incapable of delivering highly enriched oxygen. Th e main causes of circuit leak include all of the following EXCEPT:
Beards
Edentulous patients
Nasogastric tubes
None of the above
52. Shortly after the induction of general anesthesia and during mask ventilation, bile-stained fluid filling the facemask is observed. Your next course of action should be all of the following EXCEPT:
Turn the patient’s head to the side.
Call for help.
Attempt to clear the pharynx of gastric fluid with a Yankauer suction.
Place the patient into the reverse Trendelenburg position.
53. You are called to intubate an obtunded patient in the emergency department. Upon review of the chart you find one of the documents listed below. Which of these documents holds the greatest weight with regard to your next course of action in terms of intubation?
Living will
"Do not intubate” order in the chart
A healthcare surrogate, such as spouse or next of kin
A healthcare proxy/agent/power of attorney for healthcare
54. Hypoxemia is defined as a partial pressure of oxygen in arterial blood (Pa o2 ) less than _______ mm Hg while breathing room air.
50
60
70
80
55. You are called to evaluate a patient in the medical intensive care unit with an ETT cuff leak. Your first course of action should be which of the following?
Review the most recent x-ray and order another.
Check the patient’s vital signs and evaluate for immediate reintubation.
Suction the posterior oropharynx.
Deflate the pilot balloon.
56. Common clinical events that affect uterine blood flow in the term parturient during labor and delivery include all of the following EXCEPT:
Uterine blood flow is decreased in most parturients when supine due to aortocaval compression.
Uterine blood flow can be increased in about 15% of parturients when supine due to the uterine arteries taking off above the level of compression of the aorta.
Uterine blood flow decreases when maternal systolic blood pressure drops below 80 mm Hg.
Effective epidural analgesia can increase uterine blood fl ow in the parturient with severe preeclampsia by up to 80%.
57. Risk factors for postpartum hemorrhage include all of the following EXCEPT:
The relative dilution of clotting factors due to plasma volume expansion during gestation
Previous postpartum hemorrhage
Protracted prolonged labor
Retained products of conception
58. The chronological order of the stages of labor is as follows:
Latent phase, transition, active phase, second stage, fetal descent, neonatal delivery, third stage, placental delivery
First stage, latent phase, active phase, second stage, transition, fetal descent, neonatal delivery, third stage, placental delivery
Latent phase, transition, active phase, second stage, neonatal delivery, third stage, placental delivery
Latent phase, active phase, transition, fetal descent, second stage, neonatal delivery, third stage, placental delivery
59. Preeclampsia is most often associated with all of the following physiologic characteristics EXCEPT
Decreased uteroplacental blood flow
Increased systemic vascular resistance
Hyperdynamic cardiac function
Increased central venous and pulmonary artery wedge pressures
60. Which of the following end-organ dysfunction would be UNEXPECTED in a patient with severe preeclampsia?
Splenomegaly
Hepatic subcapsular hematoma
Proteinuria
Subarachnoid hemorrhage
61. Normal pulmonary function in the term parturient can be described most accurately by which one of the following statements?
Minute ventilation is decreased due to the decreased excursion of the diaphragm from the impingement of the gravid uterus.
Minute ventilation is similar to the normal, nonpregnant levels due to an increase in respiratory rate.
There is evidence of a moderate to severe restrictive physiology as evidenced by fl ow-volume loop analysis and the ratio of forced expiratory volume in 1 second to forced vital capacity (FEV 1 :FVC).
The increased minute ventilation results in decreased maternal arterial carbon dioxide concentration (Paco2 ).
62. Which of the following medications does NOT significantly cross the placenta to accumulate in the fetal circulation?
Etomidate
Fentanyl
Esmolol
Succinylcholine
63. The factors that determine uteroplacental transfer of medications include all of the following EXCEPT:
The ionic charge of the molecule
The size of the uteroplacental surface area
The concentration difference between the mother
and the fetus
The maternal blood pressure
64. Normal maternal physiologic changes at term can be most correctly described as
A decrease in minute ventilation due to reduction of pulmonary functional residual capacity from the gravid uterus
An increase in systemic vascular resistance in response to an increase in cardiac output
Peripheral edema resulting from an systolic ventricular dysfunction with a concomitant increase in central venous pressure and pulmonary capillary wedge pressure
A decrease in serum hemoglobin concentration despite increased red cell production
65. The normal changes that support the fetal transition to neonatal physiology include all of the following EXCEPT:
Expansion of the collapsed lungs with air
Closure of the foramen ovale
Decreased pulmonary vascular resistance
Patent ductus arteriosus
66. A full-term newborn boy delivered vaginally is limp and cyanotic; he has a heart rate of 80, gasping respirations, and no response to suctioning. His Apgar score at 1 minute of life would be:
1
2
3
4
67. All of the following statements concerning lung volume changes in pregnancy are true EXCEPT:
Functional residual capacity (FRC) begins to fall at the fifth month of pregnancy and is decreased to 80% of that of pre pregnancy capacity by term.
Vital capacity is significantly decreased by term pregnancy.
A 25% reduction in expiratory reserve volume and a 15% reduction in residual volume account for the change in FRC.
Inspiratory capacity increases by 15% during the third trimester because of the increases in tidal volume and inspiratory reserve volume.
68. Each of the following groups contains a list of factors which decrease MAC, EXCEPT:
Hypothermia, induced hypotension, and hyponatremia
Metabolic acidosis, pregnancy, and lithium
Increasing age, opioids, and α2 agonists
Acute ethanol administration, hypernatremia, and hypothyroidism
69. The rapid onset of central nervous system (CNS) effects of most intravenous (IV) anesthetics is best explained by their:
Low hepatic extraction ratio
Small volume of distribution
High lipid solubility
Large ratio of ionized to unionized drug
70. Ketamine interacts with all of the following receptors EXCEPT:
N-Methyl-D-aspartate (NMDA)
Opioid receptors
Aminobutyric acid (GABA)
Muscarinic receptors
72. Recovery of cognitive function after general anesthesia is slowest when which of the following agents is used for induction?
Thiopental
Propofol
Midazolam
Etomidate
73. Concerning the antiemetic effect of propofol, all of the following hypotheses have been postulated EXCEPT:
It has antidopaminergic activity.
It has a depressant effect on the chemoreceptor trigger zone
It increases the release of glutamate and aspartate in the olfactory cortex.
It decreases the concentration of serotonin in the area postrema
74. Involuntary myoclonus or myoclonus-like activity is seen with all of the following IV anesthetic drugs EXCEPT:
Etomidate
Propofol
Methohexital
Dexmedetomidine
75. Rank the following induction agents in order of their degree of cardiovascular depression.
Propofol > etomidate > thiopental
Propofol > etomidate > thiopental
Propofol > thiopental > etomidate
Etomidate > thiopental > Propofol
76. Which of the following statements concerning the mechanisms of action of intravenous induction agents is NOT true?
Barbiturates appear to increase the duration of γ-aminobutyric acid (GABA)-activated opening of chloride ion channels.
Benzodiazepines appear to increase the efficiency of coupling between GABA receptors and chloride ion channels.
Ketamine produces dissociative amnesia through interaction with N-Methyl-D-aspartic acid (NMDA) receptors.
Propofol appears to have a mechanism of action most similar to that of the benzodiazepines.
77. Ketamine is associated with all of the following physiologic effects EXCEPT:
Bronchodilation
Maintenance of consciousness and protective reflexes
Increased oral secretions
Unchanged peripheral arteriolar resistance
78. Which of the following induction agents may facilitate the interpretation of somatosensory evoked potentials (SSEPs)?
Ketamine
Propofol
Methohexital
Etomidate
79. For which of the following patients would ketamine be LEAST appropriate as an induction agent?
A 39-year-old woman with acute asthma exacerbation who is undergoing emergency appendectomy.
A 70-year-old woman with cardiac tamponade who is undergoing emergency thoracotomy.
A 50-year-old woman with glaucoma who is scheduled for elective cataract resection.
A 55-year-old man with mild renal insufficiency who is undergoing sigmoid resection for diverticulitis.
80. Which of the following intravenous (IV) induction agents produces dissociative anesthesia?
Propofol
Ketamine
Etomidate
Midazolam
81. Which of the following intravenous induction agents has metabolites that are pharmacologically inactive?
Diazepam
Ketamine
Propofol
Thiopental
82. Which of the following statements about flumazenil is FALSE?
It is structurally similar to benzodiazepines except that it lacks a phenyl group and has a carbonyl group instead.
Its elimination half-time is approximately 1 hour.
It behaves as a noncompetitive antagonist in the presence of benzodiazepine agonist compounds.
A dose of 1 to 3 mg will usually antagonize a benzodiazepine for 45 to 90 minutes.
83. Which of the following intravenous (IV) induction agents is associated with least respiratory depression?
Ketamine
Propofol
Thiopental
Etomidate
84. In terms of propensity to cause allergic reactions, which of the following intravenous (IV) anesthetics is considered to be the most immunologically “safe”?
Ketamine
Etomidate
Propofol
Midazolam
85. Which of the following intravenous (IV) induction agents is contraindicated in patients who are predisposed to acute intermittent porphyria?
Lorazepam
Ketamine
Etomidate
Thiopental
86. The ability of an opioid to cross the blood–brain barrier depends on all of the following properties EXCEPT:
Lipid solubility
Ionization
Protein binding
μ affinity
87. The chemoreceptor trigger zone (CTZ) in the area prostema of the medulla is rich in all of the following receptors EXCEPT:
Muscarinic
Dopamine
Histamine
Nicotinic
88. The clinical effects of meperidine that differ from those observed with other commonly used opioids include:
Absence of histamine release from tissue mast cells
Increase in cardiac index after high doses
Less nausea and vomiting at equianalgesic doses
Direct local anesthetic effects
89. Common potential disadvantages of a high-dose opioid anesthetic technique using fentanyl as the sole agent for anesthesia include all of the following EXCEPT:
Hemodynamic instability and cardiac depression
Impaired ventilation resulting from intense chest wall muscle rigidity
Prolonged anterograde amnesia
Apnea lasting for the duration of anesthetic
90. Which of the following is true regarding opioid-induced respiratory depression?
Suppression of the central ventilatory drive is the sole mechanism leading to respiratory depression.
Frequent hypoxemic episodes invariably do not occur after the first post operative day.
Utility function curves can be used to estimate analgesic and respiratory depressant effects for different opioids.
Naloxone causes a leftward shift of the dose response curve of most clinically used opioids.
91. Regarding the clinical use of succinylcholine, all of the following statements are true EXCEPT:
Infants and children are relatively resistant to succinylcholine compared with adults.
The duration of neuromuscular blockade produced by succinylcholine is significantly increased in patients homozygous for an atypical form of plasma cholinesterase.
Increases in serum potassium levels after succinylcholine injection can be mitigated by precurarization.
Precurarization may be effective at blocking the increase in intragastric pressure observed after succinylcholine administration.
92. Which of the following muscle groups demonstrates the earliest recovery from neuromuscular blockade after administration of an anticholinesterase agent?
Adductor pollicis
Diaphragm
Geniohyoid
Pharyngeal
93. Which of the following is an acetylcholinesterase inhibitor with an onset of action most similar to atropine?
Glycopyrrolate
Edrophonium
Neostigmine
Pyridostigmine
94. All of the following are side effects associated with anticholinesterase drugs EXCEPT:
Increased salivation
Increased peristalsis
Bradycardia
Bronchodilation
95. The following scenarios represent patients at increased risk of hyperkalemia in response to succinylcholine administration EXCEPT:
A 57-year-old woman who sustained extensive burns 1 week ago.
A 20-year-old patient with T12 paralysis after a motor vehicle collision 1 month ago.
A 70-year-old man 1 month following a debilitating stroke.
A 40-year-old woman diagnosed with myasthenia gravis 1 year ago.
96. Which of the following acetylcholinesterase inhibitors can cross the blood–brain barrier?
Edrophonium
Pyridostigmine
Neostigmine
Physostigmine
97. The rate of absorption of local anesthetic upon injection to various sites generally increases in the following order:
Intercostal, caudal, epidural, brachial plexus, sciatic/femoral
Caudal, intercostal, epidural, brachial plexus, sciatic/femoral
Sciatic/femoral, brachial plexus, epidural, caudal, intercostal
Intercostal, brachial plexus, epidural, caudal, sciatic/femoral
98. Which of the following about local anesthetics is FALSE?
They are weak bases.
The charged form of local anesthetics is lipid soluble.
They have substituted benzene rings.
They contain either an ester or amide linkage.
99. Which statement concerning treatment of systemic toxicity from local anesthetics is FALSE?
Signs of central nervous system (CNS) toxicity typically occur before cardiovascular events.
Propofol can terminate seizures from systemic local anesthetic toxicity.
Succinylcholine (Sch) may terminate seizure activity.
Ventricular dysrhythmias may be difficult to treat.
100. Which of the following statements concerning spinal administration of opioids is TRUE?
It is primarily dependent on supraspinal mechanisms.
Combining a local anesthetic with opioids results in synergistic analgesia.
2-chloroprocaine increases the summative effectiveness when co-administered with opioids epidurally.
Spinal administration of opioids provides analgesia primarily by attenuating the αδ fiber nociception.
71. Which of the following intravenous anesthetic agents has the highest degree of plasma protein binding?
Thiopental
Propofol
Ketamine
Methohexital
