Preoperative Assessment & ASA
Which of the following is the most important initial step in preoperative assessment?
A. Giving oral anxiolytics
B. Airway evaluation
C. Obtaining consent
D. Taking a focused history
D. Taking a focused history
Ketamine hallucination is countered by giving:
A. Esmolol
B. Midazolam
C. Ketamine
D. Thiopentone
B. Midazolam
A number 6 endotracheal tube indicates which size?
A. 6-mm internal diameter (ID)
B. 6-mm external diameter
C. 6-mm external circumference
D. 6-mm internal circumference
A. 6-mm internal diameter (ID)
Which of the following surgeries is a common indication for spinal anesthesia?
A. Right Pneumonectomy
B. Intra-medullary Nail for Femur Fracture surgery
C. Laparoscopic Cholecystectomy surgery
D. Transposition of great vessels Correction surgery
B. Intra-medullary Nail for Femur Fracture surgery
Which one of the following statements concerning nitrous oxide is accurate?
A. It continues to be a useful component of anesthesia protocols because of its lack of cardiovascular depression.
B. Megaloblastic anemia is a common adverse effect in patients exposed to nitrous oxide for periods longer than 2 hours.
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. More than 30% of nitrous oxide is eliminated via hepatic metabolism.
A. It continues to be a useful component of anesthesia protocols because of its lack of cardiovascular depression.
A patient is classified as ASA III. What does this indicate?
A. Healthy patient
B. Mild controlled systemic disease without limitations
C. Severe systemic disease limiting activity
D. Moribund patient not expected to survive
C. Severe systemic disease limiting activity
Which intravenous anesthetic agent is most associated with adrenal suppression?
A. Ketamine
B. Propofol
C. Etomidate
D. Midazolam
C. Etomidate
During preoperative airway assessment, which finding suggests a potentially difficult intubation?
A. Mallampati class I
B. Mouth opening > 4 cm
C. Full neck extension
D. Thyromental distance < 6 cm
D. Thyromental distance < 6 cm
An otherwise healthy young patient came to undergo ingrown nail removal. He mentioned that he had dental visit for teeth extraction last week without significant events. Now the patient is only developing hypotension, with normal heart rate immediately after spinal anesthesia for his current surgery. What is the most likely mechanism for his hypotension?
A. Sympathetic blockade
B. Myocardial infarction
C. Hypovolemia from bleeding
D. Drug allergy
A. Sympathetic blockade
A 65-year-old patient undergoing abdominal surgery develops intraoperative hypotension. The anesthesiologist considers fluid resuscitation and discusses the use of colloids versus crystalloids.
Which of the following is a major disadvantage of colloids compared to crystalloids?
A. Shorter intravascular duration
B. Higher risk of coagulopathy and renal impairment
C. Less effective plasma volume expansion
D. Increased requirement for large infusion volumes
B. Higher risk of coagulopathy and renal impairment
A 25-year-old woman with a body mass index (BMI) 42 kg/m² is to be anesthetized for laparoscopic bariatric surgery. She has a history of knee pain while walking. She has no medication allergies and takes multivitamins and an oral contraceptive. Her American Society of Anesthesiologists (ASA) designation should be:
A. ASA I
B. ASA II
C. ASA III
D. ASA IV
C. ASA III
Use of this agent is associated with a high incidence of disorientation, sensory and perceptual illusions, and vivid dreams during recovery from anesthesia:
A. Diazepam
B. Fentanyl
C. Ketamine
D. Midazolam
E. Thiopental
C. Ketamine
Each of the following is a predictor of difficulty with mask ventilation EXCEPT:
A. Presence of beard
B. BMI greater than 26
C. Presence of teeth
D. Age greater than 55
C. Presence of teeth
Through which of the following would a spinal needle NOT pass during a midline placement of a subarachnoid block in the L3-L4 lumbar space?
A. Supraspinous ligament
B. Interspinous ligament
C. Posterior longitudinal ligament
D. Dura mater
C. Posterior longitudinal ligament
The MOST sensitive early sign of malignant hyperthermia (MH) during general anesthesia is:
A. Tachycardia
B. Hypertension
C. Fever
D. Increased end-expiratory CO₂ tension (PECO₂)
D. Increased end-expiratory CO₂ tension (PECO₂)
Which of the following factors is the greatest predictor of sleep apneas in an adult?
A. Neck circumference
B. Micrognathia
C. Weight
D. BMI
A. Neck circumference
Total intravenous anesthesia with fentanyl has been selected for a frail 72-year-old woman about to undergo cardiac surgery. Which one of the following statements about this anesthesia protocol is accurate?
A. Intravenous opioids will provide useful cardiostimulatory effects.
B. Opioids control the hypertensive response to surgical stimulation.
C. Marked relaxation of skeletal muscles is anticipated.
D. Patient awareness may occur during surgery, with recall after recovery.
E. The patient is likely to experience pain during surgery.
D. Patient awareness may occur during surgery, with recall after recovery.
A 2-year-old child is undergoing elective surgery under general anesthesia. The endotracheal tube is appropriately sized, inserted, and well secured. Initial ventilation is normal with equal bilateral air entry.
During surgery, after minimal repositioning by the surgeon, the anesthesiologist notices a sudden drop in oxygen saturation and decreased air entry on the left side, with increased airway pressure.
What is the most likely explanation for this event?
A. Accidental endobronchial (right mainstem) intubation
B. Bronchospasm
C. Pneumothorax
D. Equipment failure
A. Accidental endobronchial (right mainstem) intubation
Three days after knee arthroscopy under spinal anesthesia, a 55-year-old patient complains of double vision and difficulty hearing. The other likely finding would be:
A. Headache
B. Fever
C. Weakness in legs
D. Mental status changes
A. Headache
A 20-year-old male patient scheduled for hernia surgery was anesthetized with halothane and nitrous oxide, with atracurium 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.
This unusual complication of anesthesia is most probably due to:
A. Activation of brain dopamine receptors.
B. A genetically determined myopathy.
C. Block of autonomic ganglia.
D. Pheochromocytoma.
E. Release of acetylcholine from parasympathetic nerve endings.
B. A genetically determined myopathy.
A 75-year-old woman with a history of pulmonary embolism is scheduled for a right lower lobectomy for lung cancer. She is receiving dalteparin (Fragmin) for deep vein thrombosis (DVT) prophylaxis. How long after her last dose should one wait before placement of a thoracic epidural?
A. 12 hours
B. 24 hours
C. 72 hours
D. No waiting is necessary since the dose for prophylaxis is low
A. 12 hours
Which one of the following inhalation anesthetics has a low blood gas partition coefficient but is not used for induction of anesthesia because of its pungency, which causes patients to hold their breath?
A. Desflurane
B. Enflurane
C. Halothane
D. Isoflurane
E. Sevoflurane
A. Desflurane
A 22-year-old patient is anesthetized for resection of a temporal lobe tumor. Preoperatively, he is lethargic and confused. After induction of general anesthesia, which of the following would be the MOST appropriate drug to control systemic arterial BP (160/100) during direct laryngoscopy and tracheal intubation?
A. Esmolol
B. Nitroprusside
C. Hydralazine
D. Isoflurane
A. Esmolol
A 30-year-old woman at 39 weeks of gestation is scheduled for an elective cesarean section. She has no significant medical history, and her pregnancy has been uncomplicated. The anesthesiologist recommends spinal anesthesia instead of general anesthesia. What is the main reason for preferring spinal anesthesia in this patient?
A. It provides faster induction than general anesthesia
B. It reduces the risk of aspiration and airway complications
C. It completely eliminates the need for monitoring
D. It causes less hypotension than general anesthesia
B. It reduces the risk of aspiration and airway complications
The patient should be treated immediately with:
A. Atropine
B. Baclofen
C. Dantrolene
D. Edrophonium
E. Succinylcholine
C. Dantrolene