WorksheetsInhalational and venous anesthetics
Total questions: 40
Worksheet time: 3600secs
Compared with thiopental, etomidate causes
Less nausea
Increased seizure threshold
Greater myoclonic activity
Greater histamine release
Compared with propofol, ketamine causes
More depression of respiratory drive
More depression of airway reflexes
More bronchodilation
Less analgesia
An inhaled anesthetic has blood/gas partition coefficient of 14.8. Recovery time primarily depends on
Oil/gas solubility of the agent
Cardiac output
Duration of administration
MAC of the drug
Which of the following may help in mapping of a seizure focus under general anesthesia by enhancing the EEG activity or inducing the seizure?
Thiopental
Ketamine
Diazepam
Isoflurane
Propofol has all of the following properties EXCEPT:
Antiemetic
Antipyretic
Anticonvulsant
Antipruritic
Which of the following choices is correct regarding the blood gas partition coefficient?
Nitrous oxide 0.47
Desflurane 0.62
Isoflurane 2.4
Sevoflurane 0.85
Which of the following statements about etomidate is most likely true?
It is water soluble at an acidic pH and lipid soluble at physiologic pH
It may be used as an infusion for sedation in the ICU
It is related to propofol in its chemical structure
Awakening from induction dose is secondary to very rapid liver metabolism
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?
Nitrous oxide
Ketamine
Etomidate
Midazolam
Which of the following anesthetic agents is contraindicated for use in patients with
intermittent porphyria?
Ketamine
Etomidate
Isoflurane
Thiopental
The minimum anesthesia concentration (MAC) of desflurane is decreased by
Chronic alcohol use
Respiratory alkalosis
Chronic anemia with hemoglobin of 7.5 gm/dL
Hypothermia to 34°C
Ketamine administered in anesthetic doses
Decreases intracranial pressure
Causes respiratory depression
Is metabolized by the liver
Increases bronchomotor tone
Which of the following statements about ketamine is true?
Tolerance may develop after repeated administration
It is extensively bound to plasma protein
Primary site of action is GABA receptor
Kidney is the primary route of elimination
Which of the following statements about etomidate is most likely true?
It causes significant dose-dependent respiratory depression
It causes cerebral vasodilatation
It increases frequency of excitatory spikes on the EEG more than thiopental
Most of the administered dose is excreted unchanged by the kidney
Which of the following statements about ketamine is most likely true?
Analgesic efficacy of epidural ketamine is equivalent to epidural morphine
Ketamine decreases the duration of action of nondepolarizing neuromuscular blocking drugs
Ketamine is a direct myocardial depressant
Ketamine decreases the cortical amplitude of somatosensory-evoked potentials
Which of the following statements about propofol infusion syndrome is most likely false?
Mortality rate in an established case is very high
Rhabdomyolysis is one of the diagnostic criteria
Tachycardia is an early sign of this syndrome
Cardiac dysfunction is very common in this condition
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?
Nitrous oxide at 0.5 minimum alveolar concentration (MAC)
Desflurane at 1 MAC
Thiopental 2 mg/kg
ketamine 2mg/kg
All of the following decrease cerebral blood flow (CBF), except
Etomidate
Propofol
Thiopental
Ketamine
All of the following have an antiemetic action, except
dexamethasone
Propofol
Etomidate
Haloperidol
Which of the following anaesthetic agents act via potentiation of gamma-aminobutyric acid (GABA)?
Midazolam
Ketamine
Xenon
Nitrous oxide
Which property of desflurane accounts for its very rapid induction and emergence from anesthesia?
Low solubility in blood
High potency
Strong analgesic effects at low concentrations
High lipid solubility causing slow equilibration
In which clinical scenario is sevoflurane highlighted as an excellent choice for smooth and rapid inhalation induction?
Pediatric and adult patients due to nonpungency and rapid alveolar concentration increases
Only adult patients because it is pungent and slow to equilibrate
Patients with cardiovascular disease because of high cardiac output
obese patients due to increased FRC
Who is considered at increased risk for halothane hepatic toxicity ?
Young healthy men with no prior exposure to anesthetics
Old patients with multiple comorbidities like congested heart failure
Middle-aged obese women and persons with a familial predisposition or personal history of toxicity
young children with marfan syndrome
Which route is identified as the most important for the elimination of inhalation anesthetics?
Biotransformation in the liver
Transcutaneous diffusion through the skin
Exhalation across the alveolar membrane
Renal excretion of unchanged anesthetic
Many factors that speed induction also speed recovery. Which combination best reflects these recovery-promoting factors?
High fresh gas flows, low circuit volume, decreased solubility, and increased ventilation
Low fresh gas flows, high circuit volume, increased solubility, and decreased ventilation
High fresh gas flows, high circuit volume, increased solubility, and decreased cerebral blood flow
Low fresh gas flows, low circuit volume, decreased solubility, and reduced cerebral blood flow
Nitrous oxide and xenon are believed to share which principal mechanism of action described?
Enhancing GABA_A receptor chloride conductance
Inhibiting NMDA receptors in the brain
Activating alpha-2 adrenergic receptors in the locus coeruleus
Blocking voltage-gated sodium channels in the cortex
Which agent has been suggested to possess neuroprotective properties against anesthetic-induced neurotoxicity and is sometimes incorporated into pediatric anesthetic management?
Ketamine
Propofol
Dexmedetomidine
Nitrous oxide
Which statement best characterizes the immunomodulatory impact of inhaled anesthetics ?
They consistently enhance immune responses, making them preferred in cancer therapy.
They have immunosuppressive effects that can be beneficial in inflammatory conditions but potentially deleterious in patients undergoing cancer therapy.
They have no measurable immunologic effects in perioperative care.
They are recommended over intravenous agents in patients with cancer due to immune stimulation.
Approximately what multiple of MAC prevents movement to surgical incision in about 95% of patients when a volatile anesthetic is the sole agent?
1.0 MAC
1.3 MAC
2.0 MAC
2.5 MAC
Hyperthermia affects MAC in what way?
Consistently increases MAC at all temperatures
Decreases MAC, but may increase MAC if temperature exceeds about 42°C
Has no effect on MAC
Increases MAC only in older adults
How does thyroid status influence MAC ?
Hyperthyroidism increases MAC; hypothyroidism decreases MAC
Effect depends on age
Hyperthyroidism decreases MAC; hypothyroidism increases MAC
Both hyperthyroidism and hypothyroidism cause no change in MAC
what is the typical effect of nitrous oxide on systemic vascular resistance (SVR) in adults under anesthesia?
Marked decrease in SVR
Marked increase in SVR
No change in SVR
Biphasic: initial increase then decrease
In adults, the use of nitrous oxide is associated with which gastrointestinal outcome postoperatively?
Reduced risk of nausea due to suppression of the chemoreceptor trigger zone
Increased risk of postoperative nausea and vomiting via activation of the chemoreceptor trigger zone and vomiting center
No change in postoperative nausea but increased diarrhea
Decreased vomiting with increased abdominal distention
Which chemical feature most directly accounts for halothane’s nonflammable, nonexplosive nature?
Presence of a halogenated alkane backbone
Strong carbon–fluorine bonds within the molecule
High vapor pressure at room temperature
Extensive hepatic metabolism to inert products
Compared with isoflurane, desflurane is considered a poor choice for inhalation induction primarily because of:
Greater pungency causing airway irritation and laryngospasm
Lower vapor pressure making titration difficult
High blood solubility delaying onset
Excessive myocardial depression during induction
What minimum fresh gas flow is suggested by some clinicians to reduce Compound A accumulation during long-duration sevoflurane anesthesia?
At least 2 L/min
At least 0.5 L/min
At least 5 L/min
At least 1 L/min
Which manufacturing or packaging modification has substantially reduced patient injury risk related to sevoflurane degradation?
Adding water during manufacturing and using a special plastic container
Switching to glass bottle packaging without added water
Using metal-lined containers to prevent evaporation
Increasing the sevoflurane concentration to reduce impurities
Barbiturates primarily affect cerebral vasculature by causing which change?
Vasodilation with increased cerebral blood flow
Vasoconstriction with decreased blood flow
No change in vascular tone or flow
Vasodilation with decreased intracranial pressure
Which drug is a specific benzodiazepine receptor antagonist that reverses central nervous system effects?
Flumazenil
Midazolam
Diazepam
Lorazepam
A patient receives repeated ketamine doses over several days for burn dressing changes. Which pharmacokinetic change is most likely?
Reduced hepatic extraction and longer half-life
Tolerance due to hepatic enzyme induction
Increased renal reabsorption of metabolites
Decreased lipid solubility and brain uptake
Which cardiovascular effect is most characteristic of etomidate given alone at induction doses?
Minimal change in cardiac output
Significant myocardial depression
Marked vasodilation with tachycardia
Histamine-mediated hypotension
