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10. C. FFP is the fluid portion obtained from a single unit of whole blood that is frozen

within 6 hours of collection. All coagulation factors, except platelets, are present in

FFP, which explains the use of this component in the treatment of hemorrhage. FFP is

also indicated in antithrombin III deficiency and isolated-factor deficiencies. A

transfusion of FFP carries the same risk of infection as transfusing a whole blood.

11. C. Hemolytic reactions occur when the wrong blood type is administered to a

patient. The immediate signs of acute hemolytic transfusion reactions include lumbar

and substernal pain, fever, chills, dyspnea, flushing of the skin, and hypotension. The

appearance of free hemoglobin in plasma or urine is presumptive evidence of a

hemolytic reaction. Acute renal failure reflects precipitation of stromal and lipid

contents (not free hemoglobin) of hemolyzed erythrocytes in distal renal tubules.

Acute hemolytic transfusion reactions are usually due to ABO blood incompatibility,

and the most common cause is misidentification of the patient, blood specimen, or

transfusion unit (clerical error).

12. D. Blood transfusion suppresses cell-mediated immunity, which may place surgical

patients at risk for postoperative infection. The association with long-term prognosis

in cancer surgery is unclear, but there is a suggestion of a correlation between tumor

recurrence and blood transfusions. Removing most of the white blood cells from

blood and platelets (leukoreduction) reduces the incidence of nonhemolytic febrile

transfusion reactions and the transmission of leukocyte-associated viruses.

Preoperative blood transfusions appear to improve graft survival in renal transplant

patients.

13. C. One of the leading causes of transfusion-related fatalities in the United States is

bacterial contamination, which is most likely to occur in platelet concentrates.

Platelet-related sepsis can be fatal and occurs as frequently as 1 in 5,000

transfusions. Platelets are stored at 20 to 24°C instead of 4°C, which probably

accounts for the greater risk of bacterial growth than with other blood products. Any

patient in whom a fever develops within 6 hours of receiving platelet concentrates

should be considered to be possibly manifesting platelet-induced sepsis, and

empirical antibiotic therapy should be instituted.

14. D. Advantages of crystalloid solutions are that they are nontoxic, reaction-free, and

inexpensive. Colloid solutions are composed of large-molecular-weight substances

that remain in the intravascular space longer than crystalloids, and typically, the

initial volume of distribution is equivalent to the plasma volume. The synthetic

colloids and processed albumin have minimal or no risks of infection. Colloids are

more expensive than crystalloids, but have fewer risks than blood products.

15. B. Normal saline (0.9% NaCl) is slightly hypertonic and contains more chloride

than extracellular fluid. Administration of large volumes of normal saline solution

can lead to a hyperchloremic non–anion gap metabolic acidosis. Administration of

large amounts of lactated Ringer solution may result in a metabolic alkalosis because

of increased bicarbonate production from the metabolism of lactate.

16. C. Hespan is colloid containing starch and saline. All of the other options contain

potassium. Many patients with hyperkalemia, including patients with renal failure,

routinely receive normal saline because it contains no potassium.

17. B. The storage time (70% viability of transfused erythrocytes 24 hours after

transfusion) is 21 to 35 days, depending on the storage medium. Changes that occur

in blood during storage reflect the length of storage and the type of preservative

used.

18. C. Mixing of packed red blood cells with lactated Ringer solution can cause

clotting as the citrate in the blood product can bind with calcium in the lactated

Ringer. The other options are all false. The hematocrit of 1 unit of packed red blood

cells is 70% to 80%. Transfusion of a single unit will increase an adult’s hemoglobin

concentration by about 1 g/dL. The objective in transfusion of packed red blood cells

is to increase the blood’s oxygen-carrying capacity. Although transfusion of packed

red blood cells increases intravascular fluid volume, they should not be used

routinely for this purpose given the risks associated with transfusion.

19. D. The incidence of infection from blood transfusions has markedly decreased.

Although many factors account for the marked decreased incidence of transmission

of infectious agents via blood transfusion, the most important one is improved

methods for testing of donor blood. Currently, hepatitis C, HIV, and West Nile virus

are tested by nucleic acid technology.

20. A. Both surgeons and anesthesiologists tend to underestimate blood loss.

Measurement of blood in the surgical suction container is only one component of

estimating blood loss. Blood lost in sponges, “lap” pads, and occult bleeding under

the drapes must be accounted for. The use of irrigating solutions often complicates

the assessment of blood loss. A soaked “lap” pad can hold up to 100 to 150 mL of

blood.

21. B. Febrile reactions are the most common adverse nonhemolytic reaction and occur

with 0.5% to 1% of transfusions. The most likely cause is an interaction between the

recipient’s antibodies and the antigen present on the leukocytes of platelets of the

donor. The patient’s temperature rarely increases above 38°C, and the condition is

treated by slowing the infusion and administering antipyretics. Severe febrile

reactions accompanied by chills and shivering may require discontinuation of the

blood transfusion.

22. D. A directed (or designated) blood donation is one in which a patient selects

his/her own blood donor(s) for an anticipated, nonemergency transfusion. The donor

is typically a friend or relative to the patient. Patients undergoing elective procedures

with a high probability of blood transfusion can donate their own blood 4 to 5 weeks

prior to surgery, and this is referred to as a predeposited donation. Blood salvage

refers to the collection of shed blood intraoperatively, which is then concentrated,

washed, and transfused back to the patient. For normovolemic hemodilution, blood is

removed just prior to surgery and replaced with crystalloid or colloid. The blood is

stored for up to 6 hours, and then be given back to the patient after blood loss.

23. C. Routine typing of blood is performed to identify the antigens (A, B, Rh) on the

membranes of erythrocytes. Naturally-occurring antibodies (anti-B, anti-A) are

formed whenever erythrocyte membranes lack A or B antigens (or both). These

antibodies are capable of causing rapid intravascular destruction of erythrocytes that

contain the corresponding antigens.

24. D. CPDA-1 is the most commonly added preservative added to blood products. It

contains citrate as an anticoagulant, phosphate as a buffer, dextrose as a red blood

cell energy source, and adenine needed for the maintenance of red cell ATP levels.

The potassium found in blood comes from the breakdown of red blood cells.

25. A. The citrate in the blood preservative is metabolized to bicarbonate by the liver

and can cause a metabolic alkalosis following a large-volume transfusion. Underresuscitation and bleeding are likely to cause a metabolic acidosis, whereas

hypoventilation causes a respiratory acidosis.

26. D. Hypothermia, uremia, and dilution from massive transfusion are all potential

reasons for coagulopathy in this patient. A fibrinogen greater than 150 mg/dL should

be adequate for clotting.

27. B. According to the “4-2-1 rule,” 75 mL/h would be the maintenance rate. This is

calculated as 40 + 20 + 15 = 75 mL/h (Table 5-2).

Table 5-2 Formula for calculation of maintenance fluid requirement

Weight upto 10 kg 4 mL/kg/h

11–20 kg Add 2 mL/kg/h

21 kg and above Add 1 mL/kg/h

28. D. Hypocalcemia as a result of citrate binding of calcium is rare because of

mobilization of calcium stores from the bone, and the ability of the liver to rapidly

metabolize citrate to bicarbonate. Therefore, arbitrary administration of calcium in

the absence of objective evidence of hypocalcemia is not indicated. Supplemental

calcium may be needed when (1) the rate of blood infusion is more rapid than 50

mL/min, (2) hypothermia or liver disease interferes with the metabolism of citrate, or

(3) the patient is a neonate.

29. A. Fresher blood (<5 days of storage) has been recommended for critically ill

patients in an effort to improve the delivery of oxygen (2,3-diphosphoglycerate

concentrations are better maintained with fresher blood). More recently, some

evidence suggests that administration of younger blood (i.e., stored <14 days) is

associated with better outcomes including decreased mortality rate and fewer

postoperative complications, especially with major surgery.

30. C. In an emergency situation that requires transfusion before type and compatibility

testing can be performed, O-negative packed red blood cells may be administered.

Even if the patient’s blood type becomes known and available, after 2 units of type

O-negative packed red blood cells have been transfused, subsequent transfusions

should continue with O-negative blood. RhoGAM is not indicated since the patient’s

blood type is Rh+.

Anesthetic Pharmacology

Mian Ahmad and Ashish Sinha

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 lightheadedness, 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 neuromuscularblocking 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?

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