320

Multiple Choice Questions

Best Single Answer

Quoted From

“Clinical Review” – Basic Clinical

Anaesthesia by Paul K. Sikka •
Shawn T. Beaman • James A. Street,
First Edition 2015

By
A Brothers’ Anesthetists A
IRAQ
2018
 320 MCQ/Best Single Answer Anaesthesia

Part I: The Basics

1. History of Anesthesia: (Left blank, no MCQ)

2. Preoperative Evaluation:
1. A 65-year-old patient is to undergo a total knee replacement. He has a history of hypertension
(140/90 mmHg), smoking, and diabetes mellitus (blood sugar 160 mg/dl). His ASA classification
is:
A. I B. II C. III D. IV

2. A 54-year-old patient can climb stairs, walk Briskly, and take care of himself (eating/drinking)
But cannot take part in active sports like swimming Or skiing. His metabolic equivalent of task
(MET) Is most likely:
A. 1 B. 3 C. 5 D. 10

3. Maximal beneficial effects occur if smoking is Stopped for at least:

A. 4 weeks B. 6 weeks C. 8 weeks D. 12 weeks

Body mass index (BMI) is calculated as:

A. Weight in pounds/height in in2
B. Height in in. /weight in kg2
C. Weight in kg/height in in2
D. Weight in kg/height in m2

5. All of the following medications may be taken on the day of surgery, EXCEPT:
A. Metoprolol B. Simvastatin
C. Metformin D. Omeprazole

6. A 70-year-old patient had an inguinal hernia repair. Perioperative medications included

midazolam, Fentanyl, ondansetron, and a scopolamine Patch. The next day the patient is found to
be confused. The medication most likely causing the confusion is:
A. Midazolam B. Fentanyl
C. Ondansetron D. Scopolamine

7. All of the following can be used for acid suppression, EXCEPT:

A. Particulate antacid B. Metoclopramide
C. Famotidine D. Pantoprazole

8. A 76-year-old patient is scheduled for cataract surgery. He had toast and apple juice 2 h back.
The following is true:
A. One can proceed with surgery as the procedure is to be done with monitored anesthesia care
(MAC).
B. Surgery can be scheduled in 4 h from the time of eating.
C. Surgery can be scheduled in 6 h from the time of eating.
D. Surgery can be scheduled in 8 h from the time of eating.
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9. Patients on dialysis should at least have the following tested on the day of surgery:
A. Serum potassium B. Serum sodium C. Serum creatinine D. Blood urea nitrogen

10. True statement is:

A. An EKG is indicated for all patients over 50 years.
B. A chest X-ray is indicated for all patients above 50 years.
C. A Chest X-ray is indicated in a patient who smokes regularly.
D. An EKG is indicated in a patient undergoing vascular surgery.

Answers: 1. B, 2. C, 3. C, 4. D, 5. C, 6. D, 7. A, 8. C, 9. A, 10. D

3. Approach to Anesthesia:
1. The following monitor may not be used during administration of general anesthesia:
A. Pulse oximeter B. Noninvasive blood pressure cuff
C. Electrocardiogram D. Bispectral index

2. For rapid sequence intubation, the correct statement is:

A. No premedication is given
B. Midazolam or fentanyl are given as premedication as required
C. Ventilation is tested before succinylcholine is administered
D. Application of cricoid pressure reliably prevents pulmonary aspiration

3. All of the following are criteria for extubation, EXCEPT:

A. Respiratory rate less than 35 breaths/min
B. Respiratory rate greater than 7 breaths/min
C. Tidal volume > 5 ml/kg
D. Blood pressure of 80/54 mmHg

4. All of the following may trigger malignant hyperthermia, EXCEPT:

A. Sevoflurane B. Isoflurane C. Ketamine D. Succinylcholine

5. A 75-year-old patient comes to the hospital for an inguinal hernia repair. The patient had coffee
with milk and a toast 1 h ago. The following statement is true:
A. Since the patient has a full stomach, one can proceed with surgery under spinal anesthesia
B. Since the patient has a full stomach, one can proceed with surgery under conscious sedation
with local anesthesia
C. One can proceed with surgery under general anesthesia in another 3 h
D. One can proceed with surgery under general anesthesia in another 5 h

6. The true statement about total intravenous anesthesia (TIVA) when compared to complete
general anesthesia is:
A. Increased operating room pollution
B. Increased probability of awareness under anesthesia
C. Increased incidence of postoperative nausea and vomiting
D. Longer stay in postoperative anesthesia care unit

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7. The following anesthetic drug has analgesic properties:
A. Propofol B. Ketamine
C. Etomidate D. Thiopental

Answers: 1. D, 2. A, 3. D, 4. C, 5. D, 6. B, 7. B

4. Perioperative Airway Management:

1. For the following nerve block, the needle is inserted through the cricothyroid membrane:
A. Superior laryngeal B. Transtracheal
C. Glossopharyngeal D. Hypoglossal

2. The nerve that is responsible for the sensory afferent limb of the gag reflex is:
A. Superior laryngeal B. Recurrent laryngeal
C. Trigeminal D. Glossopharyngeal

3. Laryngospasm is caused by stimulation of the following nerve:

A. Superior internal laryngeal B. Superior external laryngeal
C. Recurrent laryngeal D. Glossopharyngeal

4. A patient’s mouth is sprayed with a local anesthetic prior to performing a fiberoptic intubation.
You notice that the patient becomes cyanotic. The most likely agent causing the cyanosis is:
A. Tetracaine B. Lidocaine
C. Benzocaine D. Oxymetazoline

5. The most common adverse perioperative event in:

the ASA Closed Claims review was:
A. Hypotension B. Hypoventilation
C. Upper airway obstruction D. Pulmonary aspiration

6. Sniffing position involves aligning the following axis:

A. Oral, laryngeal, and pharyngeal
B. Oral and laryngeal
C. Oral and pharyngeal
D. Laryngeal and pharyngeal

7. All of the following are criteria for extubation, EXCEPT:

A. Negative inspiratory force more than −25 cm H2O
B. Tidal volume > 5 mL/kg
C. Respiratory rate of 7 breaths/min
D. Sustained head lift for 4 s

8. All of the following are risk factors for difficult mask ventilation, EXCEPT:
A. BMI of 28 kg/m 2 B. Presence of a beard
C. Obstructive sleep apnea D. Age 60 years

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9. Predictor/s of difficult intubation is/are:
A. History of prior difficult intubation B. Long, protruding upper incisors
C. Highly arched hard palate D. All of the above

10. The correct sequence of rapid sequence induction and intubation is:
A. Premedication, preoxygenation, propofol, cricoid pressure, succinylchloine, no ventilation,
intubation
B. Preoxygenation, propofol, cricoid pressure, succinylchloine, no ventilation, intubation
C. Preoxygenation, premedication, propofol, cricoid pressure, succinylchloine, no ventilation,
intubation
D. Premedication, preoxygenation, propofol, cricoid pressure, succinylchloine, gentle
ventilation,intubation

Answers : 1. B, 2. D, 3. A, 4. C, 5. B, 6. A, 7. D, 8. 9. D, 10. B

5. Anesthesia Machine:
1. All of the following are components of the lowpressure system of the anesthesia machine,
EXCEPT:
A. Flowmeters B. Vaporizers
C. Fail-safe valve D. Common gas outlet

2. The pressure gauge of an oxygen “E” cylinder shows 1,000 psi. How long will it take for the
tank to get empty if using flows of 10 L/min?:
A. 15 min B. 30 min
C. 1 h D. 1.5 h

3. The fail-safe valve:

A. Senses pressure B. Senses flow
C. Senses both pressure and flow D. Prevents delivery of a hypoxic gas mixture

4. If the fresh gas flow is 2 L/min, the volume of gas exiting via the scavenging system should be
(L/min):
A. 0.5 B. 1
C. 1.5 D. 2

5. Characteristic of a circle system is that:

A. It is light weight. B. It conserves heat and humidity.
C. Disconnections are rare. D. It is not environmental friendly.

6. End products of the reaction in a CO2 absorbent are:

A. Carbonates B. Water and heat
C. Sodium hydroxide D. All of the above

7. Hazards of vaporizer include:

A. Tipping B. Pumping effect
C. Incorrect agent D. All of the above

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8. If the volume of gas is 500 L at 1,520 mmHg pressure, what would be the volume of gas at 760
mmHg, temperature being constant?:
A. 250 L B. 500 L
C. 1,000 L D. 2,000 L

9. During manual ventilation, with the APL valve fully open, on squeezing the reservoir bag:
A. All the gas is delivered to the patient.
B. All the gas is leaked to the atmosphere.
C. All the gas is collected by the scavenging system.
D. The pressure in the reservoir bag increases.

10. On the anesthesia machine, the oxygen flowmeter should be arranged:

A. Last in the sequence, on the right.
B. First in the sequence, on the left.
C. In the middle, between the other flowmeters.
D. The order of arrangement is of insignificant consequence.

Answers: 1. C, 2. B, 3. A, 4. D, 5. B, 6. D, 7. D, 8. C, 9. C, 10. A

6. Patient Monitoring:
1. Appropriate cuff size for measuring blood pressure noninvasively should have the following
width circumference of the extremity and a bladder length that encircles the extremity:
A. Width 20 %, bladder length 30 %
B. Width 30 %, bladder length 40 %
C. Width 40 %, bladder length 60 %
D. Width 30 %, bladder length 60 %

2. Pressures in radial artery when compared to aortic pressures are:

A. Higher B. Lower
C. The same D. Either higher or lower

3. All of the following factors cause decreased pulse oxygen saturation readings, EXCEPT:
A. Hypotension B. Blue nail polish
C. Administration of methylene blue D. Presence of carboxyhemoglobin

4. The following leads on the ECG correspond to the inferior region of the heart:
A. I, aVL, V 3 B. II, III, aVF
C. I, aVF, V 3 D. II, III, aVL

5. Core body temperature can be measured at all of the following sites, EXCEPT:
A. Nasopharynx B. Rectum C. Tympanic D. Esophagus

6. Pneumothorax is most common with cannulation of:

A. Internal jugular vein B. Subclavian vein
C. Femoral vein D. Basilic vein

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7. Infection is most common with cannulation of:
A. Internal jugular vein B. Subclavian vein
C. Femoral vein D. Basilic vein

8. In the central venous tracing, absent a waves indicate:

A. Junctional rhythm B. Supraventricular tachycardia
C. Bulging of the tricuspid valve into the atrium D. Atrial fibrillation

9. The most common complication when inserting a pulmonary artery catheter is:
A. Pulmonary embolism B. Endocarditis
C. Catheter knotting D. Arrhythmia

10. The most sensitive monitor to detect myocardial ischemia is:

A. Electrocardiography B. Pulmonary artery monitoring
C. Measuring cardiac enzymes D. Transesophageal echocardiography

Answers : 1. C, 2. A, 3. D, 4. B, 5. C, 6. B, 7. C, 8. D, 9. D, 10. D

7. Fluid and Electrolyte Balance:

1. The major cation that exists extracellularly is:
A. Potassium B. Sodium C. Magnesium D. Calcium

2. Administration of excessive amounts of normal saline intravenously may lead to:

A. Hyperchloremic metabolic acidosis B. Hyperchloremic metabolic alkalosis
C. Hypochloremic metabolic acidosis D. Hypochloremic metabolic alkalosis

3. Administration of the following colloid may interfere with blood clotting:

A. Albumin B. Dextran C. Hetastarch D. Gelatin

4. Aggressive correction of low serum sodium levels may most likely lead to:
A. Brain herniation B. Ataxia
C. Respiratory failure D. Cerebral pontine demyelination

5. A serum potassium level of 8 mg/dl may be best treated with:

A. Calcium chloride B. Kayexalate C. Glucose and insulin D. Hemodialysis

6. A decrease in serum albumin levels will lead to:

A. Increase in serum ionized calcium level
B. No change in serum ionized calcium level
C. Decrease in serum ionized calcium level
D. Increase in total serum calcium level

7. Patients receiving total parenteral nutrition (TPN) may show:

A. Hyperglycemia B. Hypoglycemia
C. Hypophosphatemia D. All of the above

Answers : 1. B, 2. A, 3. C, 4. D, 5. D, 6. A, 7. D
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8. Transfusion Medicine:
1. Normal blood volume in an adult is approximately (ml/ kg):
A. 50 B. 70 C. 80 D. 100

2. All of the following are complications of massive blood transfusion, EXCEPT:

A. Hypercalcemia B. Thrombocytopenia
C. Citrate toxicity D. Hypothermia

3. ABO typing is mandatory for:

A. Fresh frozen plasma B. Platelets
C. Packed red blood cells D. All of the above

4. If the recipient’s blood group is not known and blood transfusion has to be started in an
emergency, the following blood type should be used for transfusion:
A. AB positive B. AB negative
C. O positive D. O negative

5. Administration of a unit of packed red cells will raise the hematocrit by approximately (%):
A. 1 B. 2 C. 3 D. 4

6. CPDA-1 stored blood has a shelf life of about (days):

A. 7 B. 21 C. 35 D. 48

7. Compared to fresh blood, stored blood has:

A. Lower potassium B. Increased 2,3-diphosphoglycerate
C. Decreased dextrose D. Red cell viability of 120 days

8. Warfarin inhibits the synthesis of clotting factors:

A. II, VII, IX, X B. II, V, VII, IX
C. II, V, IX, X D. V, VII, IX, X

9. Low-molecular-weight heparin effect can be monitored by measuring:

A. PTT B. PT
C. ACT D. None of the above

10. Desmopressin is preferably used to treat the following type of von Willebrand’s disease:
A. Type I B. Type 2
C. Type 3 D. Type 4

Answers : 1. B, 2. A, 3. C, 4. D, 5. C, 6. C, 7. C, 8. A, 9. D, 10. A

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 320 MCQ/Best Single Answer Anaesthesia
Part II: Anesthetic Pharmacology

9. Mechanisms of Anesthetic Action:

1. The following neurotransmitter/s is/are inhibitory:
A. GABA B. Glycine
C. Glutamate D. Both A and B

2. The following neurotransmitter/s is/are excitatory:

A. GABA B. Glycine
C. Glutamate D. Both A and B

3. Ketamine acts primarily at the following receptor:

A. N -methyl- D –aspartate B. GABA
C. Glycine D. Calcium

Answers: 1. D, 2. C, 3. A

10. Inhalational Anesthetics:

1. Rapid increase in concentration of the following agent can cause tachycardia:
A. Halothane B. Sevoflurane
C. Desflurane D. Xenon

2. Minimum alveolar concentration is affected by:

A. Concentration of the inhalational agent B. Use of opiates
C. Use of benzodiazepines D. All of the above

3. Coronary steal syndrome may most likely occur with:

A. Isoflurane B. Sevoflurane
C. Desflurane D. Nitrous oxide

4. The following inhalational agent(s) is a bronchodilator:

A. Sevoflurane B. Desflurane
C. Nitrous oxide D. A and B

5. Skeletal muscle relaxation is caused by:

A. Isoflurane B. Desflurane
C. Nitrous oxide D. A and B

Answers: 1. C, 2. D, 3. A, 4. D, 5. D

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11. Intravenous Induction Agents:
1. The following intravenous induction agent has the slowest onset of action:
A. Propofol B. Thiopental
C. Etomidate D. Ketamine

2. Greatest decrease in blood pressure can occur with the following agent:
A. Propofol B. Thiopental
C. Etomidate D. Ketamine

3. Upper airway reflexes are best suppressed by the following agent:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

4. The following agent produces bronchodilation:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

5. Pain on intravenous injection may be greatest with:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

6. The following agent suppresses adrenal steroid synthesis:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

7. The following agent has analgesic properties:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

8. Psychomimetic reactions on emergence may occur with:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

9. Induction agent with the most stable cardiovascular profile is:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

10. Following agent is contraindicated in patients with porphyria:

A. Propofol B. Thiopental
C. Etomidate D. Ketamine

Answers: 1. D, 2. A, 3. A, 4. D, 5. C, 6. C, 7. D, 8. D, 9. C, 10. B

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12. Opioids and Benzodiazepines:
1. Opioid analgesia primarily occurs via the following receptor:
A. Mu B. Delta C. Kappa D. FQ

2. Opioid with the highest potency among the following is:

A. Morphine B. Fentanyl
C. Sufentanil D. Alfentanil

3. Tolerance does not occur to the following effect of opioids:

A. Nausea B. Euphoria
C. Pruritus D. Miosis

4. Hypotension and bradycardia may be most likely seen with use of:
A. Alfentanil B. Remifentanil
C. Sufentanil D. Fentanyl

5. Flumazenil is a competitive benzodiazepine antagonist at the following receptor:

A. GABA B. NMDA
C. Mu D. Kappa

Answers: 1. A, 2. C, 3. D, 4. B, 5. A

13. Neuromuscular Blocking and Reversal Agents:

1. The major neurotransmitter involved in neuromuscular transmission is:
A. Gamma amino butyric acid B. Acetylcholine
C. Glutamic acid D. Dopamine

2. The following drug can be used for RSI in a patient with a serum potassium of 5.5 meq/L:
A. Sugammadex B. Succinylcholine
C. Rocuronium D. Cisatracurium

3. Longest acting muscle relaxant among the following is:

A. Cisatracurium B. Atracurium
C. Vecuronium D. Pancuronium

4. Glycopyrrolate is combined with neostigmine to reverse neuromuscular blockade to reduce the

following side effects of neostigmine:
A. Muscarinic B. Nicotinic
C. Beta-adrenergic D. Alpha-adrenergic

5. Sugammadex has the highest affinity for:

A. Vecuronium B. Pancuronium
C. Rocuronium D. Cisatracurium

Answers: 1. B, 2. C, 3. D, 4. A, 5. C

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14. Antiemetics:
1. The following drug does not prolong the QTc interval on the electrocardiogram:
A. Ondansetron B. Dolasetron
C. Droperidol D. Palonosetron

2. Metoclopramide is contraindicated in patients with:

A. Asthma B. Parkinsonism
C. Depression D. Rheumatoid arthritis

3. Aprepitant prevents nausea and vomiting by inhibiting the following receptors:

A. Neurokinin B. Bradykinin
C. Cytokinin D. Kallikrein

4. Use of the following agent intraoperatively may prevent postoperative nausea and vomiting:
A. Desflurane B. Etomidate
C. Propofol D. Remifentanil

Answers: 1. D, 2. B, 3. A, 4. C

15.NSAIDs and Alpha-2 Adrenergic

Agonists:
1. All of the following drugs are available in the United States for intravenous administration,
EXCEPT:
A. Ibuprofen B. Acetaminophen
C. Ketorolac D. Celecoxib

2. Celecoxib inhibits the enzyme:

A. Cyclooxygenase-1
B. Cyclooxygenase-2
C. Both A & B
D. Phosphodiesterase

3. Pain is mediated primarily by:

A. Cyclooxygenase-1 enzyme pathway
B. Cyclooxygenase-2 enzyme pathway
C. Both A & B
D. Alpha-2 adrenergic receptor antagonism

4. The following is not an effect of dexmedetomidine:

A. Sedation B. Anxiolysis
C. Tachypnea D. Bradycardia

Answers: 1. D, 2. B, 3. B, 4. C

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16.Diuretics:
1. The following diuretic can cause pulmonary edema on initiation of therapy:
A. Furosemide B. Mannitol
C. Acetazolamide D. Spironolactone

2. The following diuretic is specifically used to decrease production of aqueous humor:

A. Furosemide B. Mannitol
C. Acetazolamide D. Thiazide

3. This diuretic may be used in patients with advanced liver disease to spare potassium:
A. Furosemide B. Mannitol
C. Acetazolamide D. Spironolactone

4. This diuretic may be used in the presence of hypocalcemia:

A. Furosemide B. Mannitol
C. Acetazolamide D. Thiazide

5. This diuretic may cause ototoxicity:

A. Furosemide B. Mannitol
C. Acetazolamide D. Thiazide

Answers: 1. B, 2. C, 3. D, 4. D, 5. A

17.Cardiovascular Pharmacology:
1. The most strongest arteriolar dilator among the following is:
A. Nitroglycerin B. Nitroprusside
C. Hydralazine D. Verapamil

2. The following is involved primarily in causing the effects of nitroglycerin:

A. Nitrogen oxide B. Adenylyl cyclase
C. Nitric oxide D. Cytochrome oxidase

3. The neurotransmitter that is mainly responsible for function of the sympathetic nervous system
is;
A. Dopamine B. Serotonin
C. Epinephrine D. Norepinephrine

4. Bronchodilation occurs by stimulation of the following receptor:

A. Alpha-1 B. Alpha-2
C. Beta-1 D. Beta-2

5. Calcium channel blocker with the most cardiac depressant effects is:
A. Verapamil B. Diltiazem
C. Nifedipine D. Nicardipine

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6. The adrenergic agonist commonly associated with the fight/flight response is:
A. Epinephrine B. Norepinephrine C. Dopamine D. Serotonin

7. Heparin binds to the following to cause anticoagulation:

A. Factor VIII B. Plasmin C. Thrombin D. Antithrombin

Answers: 1. B, 2. C, 3. D, 4. D, 5. A, 6. A, 7. D

18. Local Anesthetics:

1. Nerve conduction is quickest in the following nerve fiber:
A. A-alpha B. A-gamma C. B D. C

2. Potency of a local anesthetic is most closely related to:

A. p K a B. Protein binding C. Lipid solubility D. Structure

3. Duration of action of a local anesthetic is most closely related to:

A. p K a B. Protein binding C. Lipid solubility D. Structure

4. For epidural anesthesia, the fastest acting local anesthetic is:

A. Lidocaine B. Prilocaine C. Procaine D. Chloroprocaine

5. The most lipid-soluble local anesthetic among the following is:

A. Lidocaine B. Mepivacaine C. Bupivacaine D. Ropivacaine

6. EMLA cream is a mixture of:

A. Procaine and lidocaine B. Procaine and bupivacaine
C. Prilocaine and lidocaine D. Prilocaine and bupivacaine

7. All are true statements regarding addition of epinephrine to a local anesthetic, EXCEPT:
A. Increases the duration of the block
B. Makes the block more dense
C. Increases toxicity of the local anesthetic
D. Epinephrine has a local anesthetic effect by itself

8. Transient neurologic symptoms can occur with:

A. Lidocaine B. Ropivacaine C. Bupivacaine D. All of the above

9. Local anesthetic with the highest potential for toxicity is:

A. Ropivacaine B. Levobupivacaine C. Bupivacaine D. Tetracaine

10. Intralipid is used for treatment of local anesthetic toxicity because it:
A. Inhibits the generation of action potential
B. Increases clearance of local anesthetic
C. Decreases absorption of local anesthetic into the blood stream
D. Raises the pH/ p K a of the local anesthetic

Answers: 1. A, 2. C, 3. B, 4. D, 5. C, 6. C, 7. C, 8. D, 9. C, 10. B
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19. Allergic Reactions:
1. In the general population, allergic reactions most commonly occur due to:
A. Antibiotics B. Muscle relaxants C. Latex D. Opioids

2. The most common cause/causes of intraoperative anaphylaxis is/are:

A. Antibiotics B. Muscle relaxants C. Latex D. Opioids

3. Allergic reactions are least likely to the following colloid:

A. Albumin B. Dextran C. Hetastarch D. Gelatin

4. A protamine reaction most likely causes:

A. Systemic hypertension
B. Pulmonary hypotension
C. Systemic and pulmonary hypotension
D. Systemic hypotension and pulmonary hypertension

5. Mainstay treatment for an anaphylactic reaction is:

A. Intravascular volume expansion
B. Administration of epinephrine
C. Administration of H 1 receptor blockers
D. Correction of hypotension by using norepinephrine infusion

Answers: 1. A, 2. B, 3. C, 4. D, 5. B

20. Drug Interactions:

1. Respiratory depressant effects of opioids and benzodiazepines, when administered concurrently
are:
A. Additive B. Synergistic C. Antagonistic D. Competitive

2. The following drug most likely prolongs neuromuscular blockade produced by succinylcholine:
A. Vecuronium B. Cisatracurium C. Midazolam D. Neostigmine

3. Minimum alveolar concentration (MAC) of volatile inhalational agents is increased by:

A. Acute exposure to alcohol
B. Chronic exposure to alcohol
C. Hyperthyroidism
D. Aminoglycoside antibiotics

4. Neuromuscular blockade is prolonged by:

A. Local anesthetics B. Chronic exposure to phenytoin C. Carbamazepine D. Calcium

5. In critically ill patients, the QT interval may be prolonged by:

A. Dexamethasone B. Metoclopramide C. Ondansetron D. Gentamicin

Answers: 1. B, 2. D, 3. B, 4. A, 5. C

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Part III: Regional Anesthesia & Pain Management

21.Spinal and Epidural Anesthesia:

1. The most common side effect of spinal anesthesia is:
A. Nausea B. Hypotension C. Bradycardia D. Urinary retention

2. While performing spinal anesthesia, the first ligament that is encountered is:
A. Supraspinous
B. Ligamentum flavum
C. Anterior longitudinal ligament
D. Posterior longitudinal ligament

3. Highest incidence of post-dural puncture headache

occurs with the following similar gauge needles:
A. Quincke B. Sprotte
C. Whitacre D. Pencil point

4. The most important factor in the spread of spinal

local anesthetic solution is:
A. Addition of epinephrine B. Vertebral level of injection
C. Height of the patient D. Baricity

5. A 34-year-old patient receives a bupivacaine spinal anesthesia. After placement of the spinal
the heart rate drops to 20 bpm and the blood pressure to 50/42 mmHg. Initial step in management
is administration of::
A. Ephedrine B. Phenylephrine
C. Epinephrine D. Oxygen and Trendelenburg position

Answers: 1. B, 2. A, 3. A, 4. D, 5. C

22. Peripheral Nerve Blocks:

1. The following nerve may not be blocked while performing an interscalene block:
A. Musculocutaneous B. Ulnar C. Radial D. Medial

2. Highest incidence of pneumothorax is seen with the following block:

A. Interscalene B. Supraclavicular C. Infraclavicular D. Axillary

3. The following nerve may not be blocked while performing an axillary nerve block:
A. Musculocutaneous B. Ulnar C. Radial D. Medial

4. The following local anesthetic solution is most commonly used to perform an intravenous
regional block:
A. Lidocaine 2 % B. Ropivacaine 0.25 %
C. Lidocaine 2 % with 1:200,000 epinephrine D. Lidocaine 0.5 %

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5. Anatomical location of femoral artery, vein, and nerve from the medial to lateral is in the
following order:
A. Vein, nerve, artery B. Artery, vein, nerve
C. Vein, artery, nerve D. Nerve, vein, artery

6. Epidural spread of local anesthetic can most commonly occur with the following nerve block:
A. Sciatic B. Femoral C. Popliteal D. Lumbar plexus

7. Landmarks to perform a sciatic nerve block via the classic approach include:
A. Lesser trochanter, posterior superior iliac spine, and greater trochanter
B. Iliac crest, posterior superior iliac spine, and greater trochanter
C. Iliac crest, greater trochanter, and sacral hiatus
D. Greater trochanter, posterior superior iliac spine, and sacral hiatus

8. The deep peroneal nerve supplies sensation to the:

A. Anterior aspect of the foot
B. Web space between the great toe and the second toe
C. Anterior and medial aspect of the foot
D. Web space between the second and the third toe

Answers: 1. B, 2. B, 3. A, 4. D, 5. C, 6. D, 7. D, 8. B

23. Ultrasound-Guided Peripheral Nerve

Blocks: (Left blank, no MCQ)

24. Pain Management:

1. Allodynia is:
A. Painful response to a non-painful stimulus
B. Decreased response to a painful stimulus
C. Increased response to a painful stimulus
D. Pain in an area that lacks sensation

2. Physiologic pain produced by a noxious stimuli that occurs without tissue damage is defined as:
A. Neuropathic pain B. Functional pain C. Referred pain D. Nociceptive pain

3. Tolerance does not occur due to the following effect of opioids:

A. Nausea B. Pruritus C. Analgesia D. Constipation

4. Opioid-induced itching can be best treated with:

A. Buprenorphine B. Diphenhydramine C. Nalbuphine D. Butorphanol

5. Radiofrequency lesioning:
A. Involves destruction of the nerve tissue
B. Involves passage of current to the tissue
C. Is performed after a positive diagnostic nerve block
D. All of the above

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 320 MCQ/Best Single Answer Anaesthesia
6. Signs of a successful Stellate ganglion block include:
A. Hypertension B. Vasoconstriction
C. Nasal congestion D. Decrease in limb temperature

7. Mirror box therapy can be employed for:

A. Trigeminal neuralgia
B. Phantom limb pain
C. Pancreatic cancer pain
D. Facet joint pain

8. After an initial injection, if the pain is not relieved, epidural steroid injections can be repeated
in:
A. 2–4 weeks B. 8–12 weeks
C. 3 months D. 6 months

Answers: 1. A, 2. D, 3. D, 4. C, 5. D, 6. C, 7. B, 8. A

25. Orthopedic Anesthesia:

1. Beach chair position can be associated with the following:
A. Errors in blood pressure monitoring
B. Increased bleeding
C. Easy access to the airway
D. Hypertension

2. An intravenous regional block is recommended for procedures lasting about:

A. 30 min B. 1 h
C. 2 h D. 3 h

3.For surgery on the medial aspect of the leg, the following nerve block is usually performed in
addition to other nerve blocks:
A. Sciatic B. Femoral
C. Saphenous D. Deep peroneal

4. Best treatment/prevention of tourniquet pain is:

A. Spinal anesthesia B. Intravenous opioids
C. Peripheral nerve block D. Release of tourniquet

5. A 62-year-old patient is undergoing total kneearthroplasty under spinal anesthesia. About 30

minintraoperatively, the patient becomes tachypneic and restless and the blood pressure drops from
154/88 mmHg to 90/42 mmHg. The most likely diagnosis is :
A. Air embolism B. Hypotension due to excessive blood loss
C. Pain D. Fat embolism

Answers: 1. A, 2. B, 3. C, 4. D, 5. D

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 320 MCQ/Best Single Answer Anaesthesia
Part IV: Specialty Anesthesia

26. Cardiac Anesthesia:

1. Preload is closely represented by:
A. End-systolic volume B. End-diastolic volume
C. Stroke volume D. Cardiac index

2. Coronary perfusion pressure is:

A. Diastolic BP – LVEnd systolic pressure
B. Diastolic BP – LVEnd diastolic pressure
C. Systolic BP – LVEnd systolic pressure
D. Pulse pressure

3. The sinoatrial node is most commonly supplied by the:

A. Right coronary artery B. Left coronary artery
C. Left circumflex artery D. Posterior descending artery

4. A 25-year-old man is brought to the trauma center after sustaining a gunshot wound to the chest.
The patient has narrow pulse pressure, jugular venous distention, muffled heart sounds, and pulsus
paradoxus. The most likely diagnosis is:
A. Cardiogenic shock B. Tension pneumothorax
C. Cardiac tamponade D. Right ventricle perforation

5. A 58-year-old man underwent coronary artery bypass grafting. Initial output from the
mediastinal chest tube was 350 ml/h. The drainage then appeared to stop, but the mean arterial
pressure dropped to 40 mmHg, and the CVP increased to 18 mmHg. The most appropriate next
step is:
A. Placement of intra-aortic balloon pump
B. Administration of intravenous norepinephrine infusion
C. Administration of packed red blood cells
D. Surgical exploration of the mediastinum

6. The primary aim to insert an intra-aortic balloon pump is to:

A. Increase myocardial contractility B. Decrease afterload
C. Increase coronary blood flow D. Increase preload

7. Anticoagulation in a patient with heparin-induced thrombocytopenia can be achieved by using:

A. Purified heparin B. Argatroban
C. Enoxaparin D. Ticlopidine

8. Fall in the platelet count during cardiopulmonary bypass is most likely due to:
A. Hemolytic transfusion reaction
B. Sequestration
C. Dilutional thrombocytopenia
D. Heparin-induced thrombocytopenia

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 320 MCQ/Best Single Answer Anaesthesia
9. The most sensitive indicator of left ventricular myocardial ischemia is:
A. ST-segment changes in lead V5 of the ECG
B. Appearance of V waves on the pulmonary capillary wedge pressure tracing
C. Sustained elevation of the pulmonary capillary wedge pressure
D. Wall-motion abnormalities on the echocardiogram

10. Preferable anesthetic to use in a patient with hypertrophic cardiomyopathy scheduled for left
ventricular myectomy under general anesthesia is:
A. Ketamine B. Isoflurane
C. Halothane D. Fentanyl-N2O

Answers: 1. B, 2. B, 3. A, 4. C, 5. D, 6. C, 7. B, 8. B, 9. D, 10. C

27. Vascular Anesthesia:

1. The most common site of abdominal aortic aneurysm is:
A. Suprarenal B. Infrarenal
C. Pararenal D. Aorto-iliac

2. Congestive heart failure during aortic surgery is more likely to occur with:
A. Aortic cross clamping B. Aortic cross un-clamping
C. Induction of anesthesia D. Aortic graft placement

3. Most significant predictor of postoperative renal failure in patients undergoing AAA repair is:
A. Long aortic cross-clamping time
B. Decreased renal perfusion pressure
C. Large size aneurysm
D. Existing preoperative renal dysfunction

4. All are true statements regarding carotid endarterectomy, EXCEPT:

A. The most common site of stenosis is the origin of internal carotid artery
B. The most common cause of mortality is myocardial infarction
C. Postoperative stroke can be prevented by using electroencephalography
or somatosensory evoked potential monitoring
D. Postoperatively, hypertension is more common than hypotension

5. True statement regarding anesthetic management of carotid endarterectomy is:

A. Blood pressure should be maintained within 10 % of baseline
B. Hypotension is desirable to provide the surgeon with a bloodless field for surgery
C. Surgery can be performed by performing an interscalene block
D. The most common cause of mortality is stroke

Answers: 1. B, 2. A, 3. D, 4. C, 5. A

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28. Thoracic Anesthesia:
1. Factors decreasing functional residual capacity include all, EXCEPT:
A. Change from upright to supine position B. Obesity
C. Pregnancy D. Infant compared to an adult

2. The FEV1/FVC ratio is decreased in:

A. Chronic obstructive pulmonary disease B. Acute respiratory distress syndrome
C. Sarcoidosis D. Radiation lung fibrosis

3. Normal mixed venous oxygen saturation is (%):

A. 60 B. 75 C. 90 D. 100

4. Ciliary transport returns to normal within following weeks after cessation of smoking:
A. 1 B. 2 C. 4 D. 8

5. Hypoxic pulmonary vasoconstriction is inhibited by all of the following, EXCEPT:

A. Nitroprusside B. Diltiazem C. Propofol D. Sevoflurane (2 MAC)

6. On initiation of single-lung ventilation with a double-lumen endotracheal tube, high peak airway
pressures are seen. Your next step would be to:
A. Add PEEP to the ventilated lung
B. Add CPAP to the non-ventilated lung
C. Suction the endotracheal tube to clear any secretions
D. Insert a fiberoptic scope

7. In an anesthetized patient in the lateral decubitus position with a closed chest, the:
A. Nondependent lung is better ventilated and perfused
B. The dependent lung is better ventilated and perfused
C. The dependent lung is better perfused, and the nondependent lung is better ventilated
D. The dependent lung is better ventilated, and the nondependent lung is better perfused

8. High-risk patients for lung resection have all the following parameters, EXCEPT:
A. Postoperative predicted FEV1 < 800 ml
B. Postoperative predicted diffusion capacity of carbon monoxide of 80 %
C. PaO2 less than 50 mmHg
D. PaCO2 more than 45 mmHg

9. For mediastinoscopy, the pulse oximeter should be placed on the:

A. Right hand B. Left hand C. Right or left hand D. Right or left foot

10. For single-lung ventilation, advantage of using a bronchial blocker over a double-lumen tube
is:
A. Patient can be taken to the ICU without changing the endotracheal tube
B. Rapid deflation of the lung
C. Ease of placement
D. Bulky

Answers: 1. D, 2. A, 3. B, 4. D, 5. C, 6. D, 7. C, 8. B, 9. A, 10. A
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 320 MCQ/Best Single Answer Anaesthesia

29. Neuroanesthesia:
1. Change in cerebral blood flow (100 g/min) for each 1 mmHg change in PaCO 2 is:
A. 1 ml B. 3 ml C. 5 ml D. 10 ml

2. The mean arterial pressure is 70 mmHg, the intracranial pressure is 12 mmHg, and the central
venous pressure is 14 mmHg. The calculated cerebral perfusion pressure (mmHg) is:
A. 44 B. 56 C. 58 D. 96

3. The following drug increases intracranial pressure:

A. Propofol B. Etomidate C. Pancuronium D. Succinylcholine

4. The administration of the following solution should be avoided in head injury patients:
A. Albumin B. Hetastarch C. Dextrose D. O − red blood cells

5. If you need to perform a wake-up test, intraoperatively, to assess neurologic function, you would
prefer to use the following volatile agent:
A. Isoflurane B. Halothane C. Sevoflurane D. Desflurane

6. Sedation may increase intracranial pressure by causing:

A. Hypercapnia B. Hypocapnia C. Hypoxia D. Acidosis

7. Nitrous oxide affects intracranial pressure by:

A. Increasing it B. Decreasing it
C. No effect D. Initial increase, followed by a decrease

8. The HHH therapy to treat cerebral vasospasm consists of:

A. Hypertension, hypervolemia, and hemodilution
B. Hypertension, hypervolemia, and hypocapnia
C. Hypertension, hypocapnia, and hemodilution
D. Hypertension, hypervolemia, and hypercapnia

9. The following therapy is not used to treat high intracranial pressure:

A. Mannitol B. Hypotonic saline C. Furosemide D. Hyperventilation

10. Cushing’s triad seen in a head injury patient consists of:

A. Hypotension, tachycardia, and irregularrespiration
B. Hypotension, bradycardia, and tachypnea
C. Hypertension, bradycardia, and irregular respiration
D. Hypertension, tachycardia, and bradypnea

Answers : 1. A, 2. B, 3. D, 4. C, 5. D, 6. A, 7. A, 8. A, 9. B, 10. C

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 320 MCQ/Best Single Answer Anaesthesia
30. Ambulatory Anesthesia:
1. Factors that can delay patient discharge from the ambulatory surgery center include all,
EXCEPT:
A. Male gender
B. Age of 70 years
C. Long duration of surgery with general anesthesia
D. Lack of presence of an escort to take the patient home

2. Risks factors that increase the complication rate for surgeries performed in the ambulatory
surgical center include all, EXCEPT:
A. Extremes of age B. Morbid obesity
C. Site and duration of the surgery D. Administering a peripheral nerve block

3. The following pediatric premature patient may not have a surgical procedure in an ambulatory
care setting:
A. Post-gestational age <60 weeks B. Post-gestational age <70 weeks
C. Post-gestational age <80 weeks D. Post-gestational age <90 weeks

4. Patients having surgery in an ambulatory surgical center should not have a body mass index
(kg/m 2 ) greater than:
A. 28 B. 30 C. 35 D. 38

Answers: 1. A, 2. D, 3. A, 4. C

31. Non-operating Room Anesthesia:

1. Patients that an anesthesiologist can be called upon to administer anesthesia outside the main
operating room include:
A. Pediatric patients B. Patients unable to lay still
C. ASA III and IV patients D. All of the above

2. The most commonly used anesthetic induction agent for cardioversion is:
A. Etomidate B. Propofol C. Midazolam D. Thiopental

3. A 44-year-old patient is to undergo colonoscopy in the endoscopic suite. The patient had a
similar procedure 1 week ago without the presence of an anesthesiologist, and the procedure was
listed as failed. Your most likely choice of anesthesia technique would be:
A. Intravenous sedation with midazolam and fentanyl
B. General endotracheal tube anesthesia
C. Intravenous sedation with propofol
D. General anesthesia with laryngeal mask airway

4. Contraindications of magnetic resonance imaging (MRI) include all of the following,

EXCEPT:
A. Automated implanted cardiac defibrillators B. Metallic splinters in the eye
C. Pacemakers D. Claustrophobia
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 320 MCQ/Best Single Answer Anaesthesia

5. True statement for non-operating room anesthesia procedures is:

A. As these procedures are short, only a brief preanesthetic evaluation may suffice.
B. Since most procedures are performed under intravenous sedation, the anesthesia machine and
emergency airway equipment may only be brought from the main operating room when needed.
C. Patients need not be NPO before short procedures.
D. All procedures in remote locations should have the same patient preparation and recovery
parameters as procedures in the main operating room.

Answers : 1. D, 2. B, 3. C, 4. D, 5. D

32. Hepatic and Gastrointestinal Diseases:

1. The following is most likely an indicator of significant liver dysfunction:
A. Serum albumin 3.0 mg/dL B. Serum bilirubin 3 mg/dL
C. Prothrombin time 16 s D. Deficiency of factor VIII

2. Oxygen is supplied to the liver by:

A. Portal vein B. Hepatic artery
C. Both A and B D. Portal artery

3. Patients with cirrhosis of liver have:

A. Increased cardiac output B. Peripheral vasoconstriction
C. Preserved renal function D. Deficiency of factor VIII

4. Initial step in management of CO 2 embolism is:

A. Immediate irrigation of the wound with saline
B. Turning the patient to left lateral decubitus position
and aspirating air from a central venous line
C. Maintenance of blood pressure and cardiac output
D. Stop insufflation

5. Obesity hypoventilation syndrome is characterized by all of the following, EXCEPT :

A. Hypercarbia B. Hypoxia
C. Anemia D. Pulmonary hypertension

Answers: 1. C, 2. C, 3. A, 4. D, 5. C

33. Renal and Urinary Tract Diseases:

1. Renin is secreted by the:
A. Proximal tubule B. Renal capillary system
C. Macula densa D. Juxtaglomerular apparatus

2. The effects of the following muscle relaxant are minimally affected by renal failure:
A. Cisatracurium B. Rocuronium
C. Succinylcholine D. Vecuronium

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 320 MCQ/Best Single Answer Anaesthesia
3. All of the following metabolic abnormalities may be commonly present in a patient with renal
failure, EXCEPT:
A. Hypocalcemia B. Hypophosphatemia
C. Hypermagnesemia D. Hyperuricemia

4. End-stage renal failure is associated with a GFR of less than (mL/min/1.73 m 2 ):

A. 90 B. 60 C. 30 D. 15

5. Glycine solutions used for irrigation during TURP can cause:

A. Hyperglycemia B. Excitatory CNS effects
C. Hyperammonemia D. Infections

6. Compensatory mechanism/s for anemia in patients with chronic kidney disease include:
A. Increase in cardiac output
B. Increase in tissue blood flow
C. Rightward shift of hemoglobin-oxygen dissociation curve
D. All of the above

Answers: 1. D, 2. A, 3. B, 4. D, 5. C, 6. D

34. Endocrine Diseases:

1. Treatment of diabetic ketoacidosis with insulin will most likely cause:

A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hyponatremia

2. All of the following are signs of autonomic imbalance in a diabetic patient, EXCEPT:
A. Gastroparesis B. Bradycardia
C. Orthostatic hypotension D. Lack of sweating

3. In a hyperthyroid patient the following inhalational agent may be avoided during surgery:
A. Desflurane B. Sevoflurane
C. Isoflurane D. Halothane

4. Following thyroidectomy, total airway obstruction can occur with damage to:
A. Superior laryngeal nerve, unilaterally
B. Recurrent laryngeal nerve, unilaterally
C. Recurrent laryngeal nerve, bilaterally
D. Superior laryngeal nerve, bilaterally

5. Minimum alveolar concentration of a volatile inhalational agent in a hypothyroid patient is:

A. Increased B. Decreased
C. Unchanged D. Increased or decreased

6. The parathyroid hormone regulates the plasma level of:

A. Calcium B. Phosphate
C. Both calcium and phosphate D. Neither calcium nor phosphate

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 320 MCQ/Best Single Answer Anaesthesia
7. Hypoparathyroidism may cause all of the following, EXCEPT:
A. Tetany B. Laryngospasm
C. Hypotension D. Shortening of the QT interval

8. Rapid correction of plasma sodium in a patient with SIADH can most likely lead to:
A. Diffuse cerebral degeneration B. Brain herniation
C. Central pontine myelinolysis D. Cerebral edema

9. Perioperative steroid replacement should be given to all patients who have taken steroids in the
last:
A. 1 month B. 3 months
C. 6 month D. 1 year

10. Blood pressure in patients with pheochromocytoma should be controlled with:

A. Alpha blockers
B. Beta blockers
C. Alpha blockers, then followed with addition of beta blockers
D. Beta blockers, then followed with addition of alpha blockers

Answers : 1. B, 2. B, 3. A, 4. C, 5. C, 6. C, 7. D, 8. C, 9. B, 10. C

35. Neurological and Neuromuscular

Diseases:
1. Autonomic hyperreflexia may be completely abolished by:
A. Liberal local anesthesia B. Spinal anesthesia
C. Epidural anesthesia D. General anesthesia

2. The following type of anesthesia may be more likely to cause exacerbations of symptoms in a
patient suffering from multiple sclerosis:
A. Local anesthesia B. Spinal anesthesia
C. Epidural anesthesia D. General anesthesia

3. In patients suffering from myasthenia gravis:

A. Neostigmine is commonly used to differentiate a cholinergic from a myasthenic crisis.
B. There is overexpression of acetylcholine receptors.
C. Duration of action of succinylcholine may be shortened.
D. Patients may be more resistant to the action of succinylcholine.

4. Mainstay of treatment of malignant hyperthermia is the administration/institution of:

A. Calcium channel blockers B. Furosemide
C. Active cooling D. Dantrolene

5. The following medication is contraindicated in patients suffering from parkinsonism:

A. Metoclopramide B. Verapamil
C. Digoxin D. Bromocriptine

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 320 MCQ/Best Single Answer Anaesthesia
6. Phenytoin, when used to treat seizure disorders, may have the following effect on non-
depolarizing neuromuscular blockade:
A. Cause phase 1 block B. Cause phase 2 block
C. Shorten D. Prolong

7. A cerebrovascular accident is most commonly the following in nature:

A. Hemorrhagic B. Embolic
C. Thrombotic D. Traumatic

Answers: 1. B, 2. B, 3. D, 4. D, 5. A, 6. C, 7. C

36. Ophthalmic Surgery:

1. First step in the management of an oculocardiac reflex is:
A. Administration of atropine
B. Administration of glycopyrrolate
C. Communicating with the surgeon
D. Maintaining the airway, breathing, and circulation

2. The following drug prolongs the action of succinylcholine:

A. Acetazolamide B. Echothiophate
C. Cyclopentolate D. Scopolamine

3. The following muscle relaxant may not be used for inducing general anesthesia in a patient with
traumatic open eye injury:
A. Succinylcholine B. Midazolam
C. Pancuronium D. Diazepam

4. The most common ophthalmic injury during anesthesia is:

A. Retinal ischemia B. Ischemic optic neuropathy
C. Cortical blindness D. Corneal abrasion

5. The strategies to prevent high intraocular pressure during anesthesia include all, EXCEPT:
A. Avoid pressure on the eye globe
B. Prevent coughing
C. Adequate depth of anesthesia before laryngoscopy
D. Administration of succinylcholine to provide muscle relaxation

Answers: 1. C, 2. B, 3. A, 4. D, 5. D

37. Ear, Nose, and Throat Surgery:

1. The following anesthetic agent may be best avoided during tympanoplasty:

A. Desflurane B. Ketamine
C. Nitrous oxide D. Etomidate

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 320 MCQ/Best Single Answer Anaesthesia
2. A 4-year-old patient underwent tonsillectomy and is discharged home. Eight hours later the
patient is brought to the emergency room with bright red blood oozing from the mouth. The patient
is taken to the operating room. Your induction plan would be
A. Inhalation induction with sevoflurane
B. Premedicate the child followed by intravenous induction
C. Rapid sequence intravenous induction
D. Order type and cross, premedicate, followed by intravenous induction

3. The following laser is most commonly used to vaporize superficial tissues:

A. CO 2 B. KTP
C. Nd:YAG D. STP

4. First step in managing a case of an airway fi re in the operating room would be to:
A. Stop the oxygen flow B. Call for help
C. Pour saline down the airway D. Remove the endotracheal tube

5. Laryngospasm occurs due to spasm of the:

A. Recurrent laryngeal nerve B. Superior laryngeal nerve
C. Glossopharyngeal nerve D. Hypoglossal nerve

6. A 6-year-old patient is extubated in the operating room after undergoing tonsillectomy.

Immediately after extubation the oxygen saturation starts to fall, the patient is very difficult to
ventilate, and positive pressure with 100 % oxygen does not relieve the airway obstruction. The
next step would be to:
A. Ventilate the child with oxygen and sevoflurane
B. Intubate the child
C. Administer rocuronium
D. Administer succinylcholine

Answers: 1. C, 2. C, 3. A, 4. D, 5. B, 6. D

38. Obstetric Anesthesia:

1. The following respiratory parameter has the greatest change during pregnancy:
A. Tidal volume B. Respiratory rate
C. Functional residual capacity D. Residual volume

2. In pregnancy, cardiac output increases the maximum during:

A. Second trimester B. Third trimester
C. Labor D. Immediately after delivery of the baby

3. A 38 week pregnant women becomes bradycardic and hypotensive when she lies supine. Initial
treatment consists of:
A. Administering ephedrine B. Intravenous fluids
C. Oxygen and ephedrine D. Left uterine displacement

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 320 MCQ/Best Single Answer Anaesthesia
4. Analgesia should be provided for the following sensory level during the second stage of labor:
A. T8–S1 B. T10–S1 C. T8–S4 D. T10–S4

5. A 32-year-pregnant patient is undergoing a cesarean section under spinal anesthesia. After

administering the spinal anesthesia the patient is laid supine from the sitting position, and her blood
pressure drops to 40/20 mmHg and the heart rate drops to 24 beats per minute. You would:
A. Administer ephedrine
B. Administer phenylephrine
C. Administer epinephrine
D. Put the patient supine with left uterine displacement

6. Minimum recommended platelet count to perform a neuraxial block in a pregnant patient is (mm
3 ):
A. 100,000 B. 80,000 C. 75,000 D. 70,000

7. HELLP syndrome of preeclampsia is characterized by:

A. Hemolysis, elevated liver enzymes, low platelets
B. Hemolysis, elevated liver enzymes, proteinuria
C. Low hemoglobin, elevated liver enzymes, proteinuria
D. Low hemoglobin elevated liver enzymes, low platelets

8. Definite treatment of preeclampsia is:

A. Administer magnesium sulfate
B. Delivery of the baby
C. Keep the blood pressure below 140/90 mmHg
D. Diuresis to prevent edema

9. All of the following may lead to maternal hemorrhage:

A. Placenta previa B. Placenta accrete C. Placenta increta D. All of the above

Answers : 1. A, 2. C, 3. D, 4. D, 5. C, 6. C, 7. A, 8. B, 9. D

39. Pediatric Anesthesia:

1. Neonates desaturate more rapidly than adults because they have this:
A. Higher metabolic rate B. Lower closing volumes
C. Higher tidal volumes D. Lower functional residual capacity

2. In preterm neonates, elective surgery should be deferred until the following postgestational age:
A. 40 weeks B. 45 weeks C. 50 weeks D. 60 weeks

3. Minimum alveolar concentration (MAC) of volatile anesthetics is highest for:

A. Preterm neonate B. Full-term neonate
C. Infant of 3 months age D. Infant of 12 months age

4. Airway should be rapidly secured in a patient with:

A. Croup B. Epiglottitis C. Eaton–Lambert syndrome D. Stridor

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 320 MCQ/Best Single Answer Anaesthesia
5. This is the commonest metabolic abnormality in patients with pyloric stenosis:
A. Hypochloremic metabolic acidosis B. Hypokalemic metabolic acidosis
C. Hypochloremic metabolic alkalosis D. Hyperkalemic metabolic alkalosis

6. In a patient with tetralogy of Fallot, this is the volatile agent of choice for induction:
A. Sevoflurane B. Isoflurane C. Halothane D. Desflurane

7. All of the following are used in the treatment of a tet spell in a patient with tetralogy of Fallot,
EXCEPT:
A. Phenylephrine B. Propranolol C. Fluid administration D. Hydralazine

Answers: 1. A, 2. D, 3. C, 4. B, 5. C, 6. C, 7. D

40. Critical Care:

1. Shock in sepsis is of the following type:
A. Cardiogenic B. Vasodilator C. Toxic D. Hypovolemic

2. Nitric oxide is a pulmonary:

A. Vasoconstrictor B. Vasodilator
C. Neither A nor B D. Artery pressure autoregulator

3. All of the following are end points in resuscitation of shock, EXCEPT:

A. Systolic blood pressure of >90 mmHg B. Mean arterial pressure of > 65 mmHg
C. Urine output of >0.5 ml/kg/min D. Lactate of <6 mmol/L

4. Preferred type of ventilation in a patient with ARDS would be:

A. Intermittent mandatory B. Pressure support C. Airway pressure release D. PEEP

5. Administration of oxygen to neonates may most likely cause:

A. Retinal hemorrhage B. Corneal detachment
C. Myopia D. Retinopathy

6. ARDS is characterized by:

A. Increased capillary permeability
B. Increased capillary hydrostatic pressure
C. Increased surfactant concentration
D. PaO 2 /FiO 2 ratio <400

7. A patient with atrial fi brillation, with HR 160/min and BP 84/54 mmHg, is treated with:
A. Esmolol B. Diltiazem C. Lidocaine D. Cardioversion

8. Gradual lengthening of the PR interval followed by a dropped beat is characteristic of:

A. 1st-degree AV block B. 2nd-degree type I AV block
C. 2nd-degree type II AV block D. 3rd-degree AV block

Answers: 1. B, 2. B, 3. D, 4. C, 5. D, 6. A, 7. D, 8. B

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41. Postoperative Anesthesia Care:
1. The most frequent cause of delayed emergence in the PACU is:
A. Hypotonia B. Hypoventilation C. Hypotension D. Hypothermia

2. Criteria for transporting a patient out of the operating room include all, EXCEPT:
A. Patient with an LMA still in place
B. TV of 300 ml/breath and respiratory rate of 25 breaths/min in a 65 kg patient
C. Patient with a blood pressure of 84/32
D. Oxygen saturation of 96 %

3. Extrapyramidal reactions are most likely to occur with the administration of:
A. Ondansetron B. Metoclopramide C. Droperidol D. Promethazine

4. A 35-year-old patient is brought to the PACU after undergoing an appendectomy. His

anesthetics included propofol 140 mg, isoflurane 2.0 MAC, vecuronium 6 mg, and morphine 6
mg. In the PACU the patient’s temperature is 33.5 C and is shivering. The most likely cause of his
shivering is:
A. Use of isoflurane B. Presence of infection and dehydration
C. Use of unwarmed fluids D. Use of morphine

5. A 47-year-old patient is brought to the PACU after drainage of a gluteal abscess under MAC
anesthesia. The patient is not fully responsive and has labored and sonorous breathing. His BP is
136/82, HR is 89/min and O 2 saturation is 92 %. Your initial step in management would be to:
A. Change the nasal cannula to a non- rebreathing bag
B. Increase the FiO 2
C. Do a jaw thrust and head-tilt maneuver
D. Use a ambu bag

6. A 29-year-old patient is undergoing a left knee hardware removal under general endotracheal
anesthesia. At the end of the procedure the patient is extubated. A few moments later you hear
highpitched crowing noises from the patient’s airway. The BP is 140/86, HR is 92/min and the O
2 saturation is 88 % and dropping. Your initial response would be to:
A. Insert an oral airway B. Suction the airway to remove secretions
C. Give succinylcholine D. Positive airway pressure with a mask

7. The most common cause of postoperative hypoxemia following general anesthesia is a decrease
in:
A. Functional residual capacity
B. Tidal volume
C. Residual volume
D. Inspiratory capacity

Answers: 1. B, 2. C, 3. C, 4. A, 5. C, 6. D, 7. A

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Part V: Special Anesthesia Topics

42. Obesity:
1. BMI can be calculated by the following formula:
A. Weight (pounds)/height 2 (cm)
B. Weight 2 (kg)/height (cm)
C. Weight 2 (pounds)/height (m)
D. Weight (kg)/height 2 (m)

2. Correct formula for measuring ideal body weight (kg) (IBW) is:
A. Height (cm)—100 B. Height (m)—50
C. Height (m)—15 D. Height (cm)—50

3. A morbid obese patient has a BMI of:

A. 25–29 B. 30–34
C. 35–39 D. Greater than 40

4. Drugs that are used in a morbidly obese patient should preferably be:
A. Highly lipophilic drugs
B. Water-soluble drugs
C. Metabolized in the liver
D. Excreted by the kidneys

Answers: 1. D, 2. A, 3. D, 4. B

43. The Elderly Patient:

1. Elderly patients, compared to younger patients, have a:

A. Normal resting cardiac output
B. Similar maximal heart rate
C. Decrease in SVR
D. Similar beta-adrenergic response

2. Elderly patients, compared to younger patients, have a:

A. Similar FRC B. Increase in PaCO 2
C. Similar PaO 2 D. Similar total lung capacity

3. Incidence of post dural puncture headache in elderly patients, when compared to younger
patients, is:
A. Similar B. Higher C. Lower D. Variable

4. Pharmacological treatment of postoperative delirium includes, mainly, the administration of:

A. Midazolam B. Clonidine C. Lorazepam D. Haloperidol

Answers: 1. A, 2. A, 3. C, 4. D

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44. Pulmonary Aspiration and Postoperative Nausea and
Vomiting:
1. Prominent risk factor for developing pneumonitis is a gastric pH of:
A. Less than 2.5 B. 2.5–3.0 C. 3.1–3.5 D. Greater than 3.5

2. Correct statement about pulmonary aspiration is:

A. A chest radiograph taken immediately after aspiration is diagnostic of pulmonary aspiration
B. Risk of pulmonary aspiration is higher in children than adults
C. The ASA Task force recommends the routine use of metoclopramide or H 2 blockers to prevent
the effects of pulmonary aspiration
D. Patients with pulmonary aspiration should be routinely treated with antibiotics and steroids

3. All of the following are risk factors for developing PONV EXCEPT:
A. Anxiety B. Nonsmoker C. Female patient D. Laparoscopic surgery

4. A 46-year-old female patient underwent a laparoscopic surgery under general anesthesia.

Intraoperatively, she received 8 mg of dexamethasone, 8 mg of ondansetron for prophylaxis
against nausea and vomiting. Postoperatively, the patient is complaining of nausea. Your initial
step in management would be to:
A. Give an additional 4 mg of dexamethasone B. Give an additional 4 mg of ondansetron
C. Treat pain D. Give 20 mg of propofol

5. All of the following statements about PONV are correct, EXCEPT:

A. Treatment of PONV should consists of two or more drugs
B. Adequate perioperative hydration can prevent nausea and vomiting
C. Effective treatment of pain can prevent nausea and vomiting
D. Dexamethasone is an effective rescue agent for the treatment of nausea and vomiting

Answers: 1. A, 2. B, 3. B, 4. C, 5.

45. Acid Base Balance: (Left blank, no MCQ)

46. Trauma:

1. The most common cause of mortality for people aged less than 35 years in the United States is:
A. Myocardial infarction B. Cancer C. Trauma D. Stroke

2. Three components of the Glascow Coma Scale are:

A. Motor response, verbal response, eye opening
B. Motor response, verbal response, pain response
C. Consciousness, motor response, verbal response
D. Consciousness, motor response, eye opening

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3. Most important concern for a malpositioned intraosseous catheter inserted for fluid resuscitation
is the likely hood of:
A. Infection B. Bleeding
C. Kinking of the catheter D. Compartment syndrome

4. Patients with traumatic injury at the following vertebral level will most likely to be intubated:
A. C-3, 4, 5 B. C-6, 7, 8
C. C-7, 8, T-1 D. C-8, T-1, 2

5. A patient is brought to the emergency room with acontusion on the right chest. His blood
pressure is 76/50 mmHg, heart rate is 112/min, oxygen saturation is 84 %, and the patient
complains of dyspnea. In the next 5 min, the blood pressure drops further to 68/44 mmHg and the
oxygen saturation to 78 %. You initial step in management would be to:
A. Administer epinephrine B. Administer albuterol
C. Insert a needle into the right second intercostal space D. Administer fluids via a rapid infuser

Answers: 1. C, 2. A, 3. D, 4. A, 5. C

47. Spine Surgery:

1. Blood supply to the lower 2/3rds of the anterior spinal cord is by the:
A. Vertebral artery B. Artery of Adamkiewicz C. Circle of Willis D. Basilar artery

2. Commonest cause of visual loss during spine surgery in the prone position is:
A. Corneal abrasion B. Central retinal artery occlusion
C. Ischemic optic neuropathy D. Damage to the optic lens

3. The following agent has the greatest effect on somatosensory evoked potentials:
A. Propofol B. Vecuronium C. Nitrous oxide D. Isoflurane

4. Autonomic hyperreflexia following spinal cord injury is usually seen after:

A. 1 month B. 3 months C. 6 months D. 12 months

Answers: 1. B, 2. C, 3. D, 4. B

48. Robotic Surgery:

1. Compared to traditional open surgeries, roboticassisted surgeries have:

A. Similar blood loss B. Similar pain medication requirements
C. Similar cosmetic results D. Faster recovery times

2. All of the following are true statements regarding robotic-assisted surgery, EXCEPT:
A. The robot is large and once in place is fixed in position.
B. Air is used for intraoperative insufflation.
C. The operating room size generally has to be bigger to accommodate the robot.
D. The surgeon has loss of touch sensation while performing the surgery.

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3. A 58-year-old patient is undergoing a roboticassisted radical prostatectomy under general
anesthesia. Anesthesia is best maintained by:
A. Oxygen, nitrous oxide, and an inhalational agent
B. Oxygen, air, and an inhalational agent
C. Oxygen, air, inhalational agent, and a muscle relaxant
D. Oxygen, air, inhalational agent, and a propofol infusion

Answers: 1. D, 2. B, 3. C

49. Patient Positioning and Common Nerve Injuries:

1. Commonest perioperative nerve injury is of the following nerve:
A. Ulnar B. Radial C. Common peroneal D. Sciatic

2. Commonest perioperative lower extremity nerve injury is of the following nerve:

A. Femoral B. Common peroneal C. Sciatic D. Deep peroneal

3. Signs of common peroneal nerve injury are:

A. Foot drop, loss of plantar flexion of toes, and incapability to evert the foot
B. Foot drop, loss of dorsal extension of toes, and incapability to invert the foot
C. Foot drop, loss of dorsal extension of toes, and incapability to evert the foot
D. Loss of plantar flexion and dorsal extension of toes and incapability to invert the foot

4. Venous air embolism can most frequently occur with the following position:
A. Prone B. Lateral decubitus C. Reverse Trendelenburg D. Sitting

Answers: 1. A, 2. B, 3. C, 4. D

50. Substance Abuse:

1. Chronic alcohol abuse causes MAC of inhalational volatile agents to:
A. Increase B. Decrease
C. Remain the same D. Decrease or remain the same

2. Chronic opioid abuse does not cause tolerance to its following effect:
A. Pruritus B. Sense of euphoria
C. Respiratory depression D. Constipation

3. A 36-year-old patient presents to the operating room for an appendectomy under general
anesthesia. He gives a history of cocaine abuse. His vitals are BP, 180/100 mmHg; heart rate, 120
beats/min; and oxygen saturation, 98 % on room air. Best drug among the following to manage his
vitals is:
A. Metoprolol B. Phentolamine C. Nitroglycerine D. Esmolol

4. It is recommended that smoking should be stopped before surgery for at least:

A. 3 days B. 1 week C. 2 weeks D. 8 weeks

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5. The most common drug abused by anesthesiologists is:
A. Midazolam B. Fentanyl C. Propofol D. Nitrous oxide

Answers: 1. A, 2. D, 3. C, 4. D, 5. B

51. Awareness Under Anesthesia:

1. Patients having the following surgery may have the highest risk of intraoperative awareness
under anesthesia:
A. Cesarean section under general anesthesia B. Trauma
C. Cardiac surgery D. Neurosurgery

2. Increased incidence of intraoperative awareness under anesthesia is more likely to occur in all
of the following patients, EXCEPT:
A. Chronic alcoholic user B. Chronic drug abuser
C. Chronic use of neurodepressant drugs D. Sevoflurane end-tidal concentration of 2.0

3. Target range of BIS number for general anesthesia should be:

A. 20–30 B. 20–40 C. 40–60 D. 50–70

Answers: 1. B, 2. D, 3. C

52. Infectious Diseases:

1. Vaccinations exist for all of the following viruses, EXCEPT:
A. Influenza B. Varicella C. Hepatitis C D. Hepatitis B

2. Chronic liver disease is most likely to develop with infection with the following virus:
A. Hepatitis C B. Hepatitis B
C. Human immunodeficiency virus D. Herpes virus

3. Following is the most common cause of death due to infection:

A. Tuberculosis B. Human immunodeficiency virus
C. Hepatitis C D. Lower respiratory tract infections

4. Effective hand hygiene is important in preventing spread of infections:

A. True. B. False.
C. Is irrelevant. D. Double gloving has been shown superior to hand hygiene.

Answers: 1. C, 2. A, 3. D, 4. A

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53. Alternative Medicine and Anesthesia:
1. Most herbal supplements should be stopped before surgery for at least:
A. 3–7 days B. 7–14 days C. 14–28 days D. Continued preoperatively

2. The following herbal drug may increase the risk of perioperative bleeding:
A. Echinacea B. Ephedra C. Kava kava D. Ginkgo

3. The following herbal drug may potentiate anesthetic action:

A. Kava kava B. Garlic C. Saw palmetto D. Echinacea

4. Acupressure applied at the following site may reducethe risk of postoperative nausea and
vomiting:
A. Knee B. Scalp C. Wrist D. Neck

Answers: 1. B, 2. D, 3. A, 4. C.

54. Cosmetic Surgery: (Left blank, no MCQ)

55. Hazards of Working in the Operating Room:

1. Long-term exposure of operating room personnel to volatile inhalational anesthetic agents may
lead to all, EXCEPT:
A. Cognitive dysfunction B. Neurodegenerative changes
C. Hepatitis D. Anemia

2. As per the US Nuclear Regulatory Commission, the maximal annual radiation exposure should
be the following rem/year:
A. 5 B. 50 C. 100 D. 500

3. The following vaccine is strongly recommended for healthcare workers:

A. Hepatitis B B. Hepatitis C C. HIV D. Influenza

4. Following an airway fi re, the first step the anesthesiologist should do is:
A. Stop the gas flows
B. Stop the ventilation and disconnect the circuit
C. Remove the endotracheal tube and reintubate
D. Saline lavage down the endotracheal tube

Answers: 1. D, 2. A, 3. A, 4. B

56. Operating Room Management: (Left blank, no MCQ)

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57. Residency Requirements and Guidelines:
1. All of the following are core competencies of the Accreditation Council for Graduate Medical
Education (ACGME), EXCEPT:
A. Patient care B. Medical knowledge
C. Communication skills D. Previous anesthesia training

2. Anesthesia residents are restricted to the following maximum number of work hours per week:
A. 40 B. 80 C. 100 D. 120

3. True statement regarding anesthesia residency is:

A. Anesthesia residents can choose a specific clinical rotation any number of times.
B. Anesthesia residents can choose specific clinical cases any number of times.
C. Completing a scholarly activity is mandatory before graduating from anesthesia residency.
D. Anesthesia residents have an absolute right to do moonlight duty if they choose to do so.

Answers: 1. D, 2. B, 3. C

GOOD LUCK

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