17 - ANESTHETICS

Item Number: correct answer: 2 category: Anesthetics

1. All of the following factors influence the rate of induction of anesthesia

with an inhaled anesthetic EXCEPT:

1. aqueous solubility of the anesthetic

2. patient history of malignant hyperthermia

3. ventilation rate

4. tension of gas administration

5. pulmonary blood flow rate

For questions 2 - 9, choose the correct answer from the following list. Each

answer may be used once, more than once, or not at all.

Anesthetic Partition Minimum Alveolar

Coefficient Concentration (MAC)

1. halothane 2.30 0.75

2. enflurane 1.80 1.68

3. nitrous oxide 0.47 105.00

4. isoflurane 1.40 1.15

5. methoxyflurane 12.00 0.16

Item Number: correct answer: 3 category: Anesthetics

2. The blood:gas partition coefficient is the ratio of anesthetic concentration

in blood compared to gas phase. Greater solubility in blood results in slower

onset of anesthesia and higher partition coefficient value. Which anesthetic

has the fastest onset of action?

Item Number: correct answer: 5 category: Anesthetics

3. The minimum alveolar concentration (MAC) is the concentration of anesthetic at

1 atmosphere of pressure that produces immobility in 50% of patients exposed

to a noxious stimulus. Which anesthetic is most potent by this measure?

Item Number: correct answer: 3 category: Anesthetics

4. A good analgesic at subanesthetic doses

Item Number: correct answer: 3 category: Anesthetics

5. The anesthetic that may be most safely used in a patient with a history of

malignant hyperthermia?

Item Number: correct answer: 1 category: Anesthetics

6. Anesthetic associated with the highest incidence of hepatitis.

Item Number: correct answer: 2 category: Anesthetics

7. The anesthetic which should be avoided in patients with a seizure disorder

because tonic-clonic seizures are associated with its use.

Item Number: correct answer: 4 category: Anesthetics

8. The halogenated anesthetic which is advantageous in patients with

cardiovascular disease because it maintains cardiac output, produces systemic

and coronary vasodilation, and catecholamine dependent arrhythmias are

uncommon.

Item Number: correct answer: 5 category: Anesthetics

9. This anesthetic has become obsolete due to its potential for causing

nephrotoxicity.

For questions 10 - 13, choose the correct answer from the following list. Each

answer may be used once, more than once, or not at all.

1. thiopental

2. propofol

3. ketamine

4. etomidate

5. fentanyl

Item Number: correct answer: 4 category: Anesthetics

10. The intravenous anesthetic with excitatory effects on the central nervous

system but produces the least cardiovascular disturbance among intravenous

anesthetics.

Item Number: correct answer: 2 category: Anesthetics

11. Anesthetic that must be administered in a lipid diluent due to poor aqueous

solubility.

Item Number: correct answer: 3 category: Anesthetics

12. In contrast to most anesthetics, this agent produces cardiac stimulation,

resulting in increased blood pressure, heart rate and cardiac output.

Item Number: correct answer: 5 category: Anesthetics

13. Anesthetic frequently used for analgesia during surgery. Large doses induce or

maintain anesthesia but mechanical ventilation required due to profound

central respiratory depression.

Item Number: correct answer: 4 category: Anesthetics

14. True statement regarding thiopental:

1. causes increased EEG activity

2. contraindicated in a patient with epilepsy

3. provides analgesia

4. associated with dose-dependent respiratory depression

5. provides adequate skeletal muscle relaxation alone

Item Number: correct answer: 2 category: Anesthetics

15. False statement regarding propofol as an anesthetic:

1. pharmacokinetic half-life does NOT correlate with duration of central

nervous system depression

2. provides adequate skeletal muscle relaxation alone

3. vasodilation may produce a decline in blood pressure. Can be minimized

by decreasing dose.

4. safe alternative for patients predisposed to malignant hyperthermia

5. high lipophilicity provides rapid and smooth onset, dose titratability,

and rapid recovery from anesthesia

Item Number: correct answer: 1 category: Anesthetics

16. FALSE statement regarding ketamine as an anesthetic:

1. contraindicated in a patient with asthma because it may cause

bronchoconstriction

2. recovery from anesthesia associated with emergence phenomenon of

hallucinations and vivid dreams

3. produces dissociative anesthetic state, whereby patient appears awake

but is unconscious

4. produces analgesia

Item Number: correct answer: 4 category: Anesthetics

17. Correct statements regarding etomidate include all EXCEPT:

1. inhibits adrenocortical function

2. no adverse effects from adrenocortical inhibition during short-term use

3. produces minimal cardiovascular effects

4. potent hypnotic with excellent analgesic properties

5. safe alternative for a patient with unstable cardiovascular status

Item Number: correct answer: 3 category: Anesthetics

18. TRUE statement regarding midazolam as an adjunct to anesthesia:

1. provides analgesia

2. provides adequate skeletal muscle relaxation alone

3. useful for ameliorating seizure activity

4. produces cardiovascular stimulation

5. contraindicated in patients with asthma or COPD

Item Number: correct answer: 2 category: Anesthetics

19. FALSE statement regarding bupivacaine, a local anesthetic with a molecular

structure that includes an amide linkage.

1. undergoes hepatic metabolism

2. rapidly hydrolyzed by plasma esterase enzymes

3. contraindicated in a patient with a history of allergy to lidocaine

4. higher dose necessary to induce epidural anesthesia than spinal

anesthesia

5. higher risk of systemic side effects when used for epidural anesthesia

compared to spinal anesthesia

Item Number: correct answer: 4 category: Anesthetics

20. FALSE statement regarding local anesthetics:

1. produce effects by inhibiting voltage gated sodium channels

2. inhibition of sodium channels enhanced by repetitive depolarizations

3. small nerve fibers more susceptible than large nerve fibers

4. all sensory functions of a nerve affected equally at onset of anesthesia

5. vasoconstriction prolongs duration of action

Item Number: correct answer: 5 category: Anesthetics

21. Treatment of malignant hyperthermia includes all of the following EXCEPT:

1. cessation of anesthetic and changing of rubber tubing to anesthesia

machine

2. administration of dantrolene sodium 1mg/kg by rapid intravenous infusion

until symptoms subside

3. hyperventilation of patient with 100% oxygen

4. administration of fluids and diuretics to control myoglobinemia and

hyperkalemia

5. lidocaine is indicated for arrhythmias