1- A 53year-old woman is found by arteriography to have 50% narrowing of her left renal

artery. What is the expected change in blood flow through the stenotic artery?

(A) Decrease to ½
(B) Decrease to ¼
(C) Decrease to 1⁄8

(D) Decrease to 1⁄16

(E) No change

2- A person’s electrocardiogram (ECG) has no P wave, but has a normal QRS complex and a
normal T wave. Therefore, his pacemaker is located in the:

(A) Sinoatrial (SA) node

(B) Atrioventricular (AV) node

(C) Bundle of His

(D) Purkinje system

(E) Ventricular muscle

3- If the ejection fraction increases, next cycle there will be a decrease in:

(A) Cardiac output

(B) End-systolic volume

(C) Heart rate

(D) Pulse pressure

(E) Stroke volume

4- An electrocardiogram (ECG) on a person shows ventricular extra-systoles. The extra-

systolic beat would produce:

(A) Increased pulse pressure because contractility is increased

(B) Increased pulse pressure because heart rate is increased
(C) Decreased pulse pressure because ventricular filling time is increased

1
(D) Decreased pulse pressure because stroke volume is decreased
(E) Decreased pulse pressure because the PR interval is increased

5- Which of the following lung volumes or capacities can be measured by spirometry?

(A) Functional residual capacity (FRC)

(B) Physiologic dead space
(C) Residual volume (RV)
(D) Total lung capacity (TLC)
(E) Vital capacity (Vc)

6- An infant born prematurely in gestational week 25 has neonatal respiratory distress

syndrome. Which of the following would be expected in this infant?

(A) Arterial Po2 of 100 mm Hg

(B) Collapse of the small alveoli
(C) Increased lung compliance
(D) Normal breathing rate
(E) Lecithin: sphingomyelin ratio of greater than 2:1 in amniotic fluid

7- A 2-year-old boy has a severe asthmatic attack with wheezing. He experiences rapid
breathing and becomes cyanotic. His arterial Po2 is 60 mm Hg and his Pco2 is 30 mm Hg.
Which of the following statements about this patient is most likely to be true?

(A) Forced expiratory volume1/forced vital capacity (FEV1/FVC) is increased

(B) Ventilation/perfusion (V/Q) ratio is increased in the affected areas of his lungs
(C) His arterial Pco2 is higher than normal because of inadequate gas exchange
(D) His arterial Pco2 is lower than normal because hypoxemia is causing him to hyperventilate
(E) His residual volume (RV) is decreased

8- A 49-year-old man has a pulmonary embolism that completely blocks blood flow to his
left lung. As a result, which of the following will occur?

(A) Ventilation/perfusion (V/Q) ratio in the left lung will be zero

2
(B) Systemic arterial Po2 will be elevated
(C) V/Q ratio in the left lung will be lower than in the right lung
(D) Alveolar Po2 in the left lung will be approximately equal to the Po2 in inspired air
(E) Alveolar Po2 in the right lung will be approximately equal to the Po2 in venous blood

9- Hypoxemia produces hyperventilation by a direct effect on the:

(A) Phrenic nerve

(B) J receptors
(C) Lung stretch receptors
(D) Medullary chemoreceptors
(E) Carotid and aortic body chemoreceptors

10- Sudden hypotension and a marked decrease in end-tidal CO2 during insufflation of the
peritoneum with CO2 would most likely indicate:

(A) A severe vagal reflex

(B) A capnothorax

(C) A pneumothorax

(D) A CO2 embolism

(E) None of the above

11- Shoulder pain after laparoscopy is likely the result of:

(A) Excessive abduction of the arm during surgery

(B) Brachial plexus injury from shoulder restraints used during steep Trendelenburg

(C) Diaphragmatic irritation

(D) Deltoid injury from arm restraints

(E) None of the above

12- Hypothermia is a significant risk during laparoscopy because of:

(A) Large fluid replacement requirements

3
(B) Room temperature insufflating gas

(C) Evaporative losses from the peritoneum

(D) Convection losses from the distended abdomen

(E) None of the above

13- A 44-year-old woman who had a hysterectomy six weeks ago has severe burning pain in
her lower abdomen. Palpitation along the right lateral end of the scar exacerbates burning
pain and sets off a tingling sensation. Which of the following best describes this kind of
pain?

(A) Inflammatory

(B) Myofascial

(C) Neuropathic

(D) Somatic

(E) Visceral

14- Which of the following acid-base disturbances is the least well-compensated?

(A) Metabolic alkalosis

(B) Respiratory alkalosis

(C) Increased anion gap metabolic acidosis

(D) Normal anion gap metabolic acidosis

15- Which of the following statements concerning use of amitriptyline to treat chronic pain
is true?

(A) It acts primarily via opioid receptors

(B) It increases serotonin levels in the brain

(C) It is rarely effective for post herpetic neuralgia

(D) Onset of action occurs after four to six weeks of treatment (E) Response depends on reversal

of depression.

4
16- A 26-year-old male patient with a history of severe ulcerative colitis, unresponsive to
conservative measures, presents for elective open total abdominal colectomy with end
ileostomy. He has been unable to eat for the last 2 weeks and was started on total parenteral
nutrition (TPN) several days prior. Intraoperative effect that should be expected and
monitored for is:

(A) Dilutional anemia

(B) Hyperglycemia

(C) Sepsis

(D) Hyperphosphatemia

(E) Hypophosphatemia

17- Preoperative administration of an alpha-adrenergic blocker for 10 days to patients with

pheochromocytoma will decrease:

(A) Episodic tachycardia

(B) Hyperglycemia

(C) Hypovolemia

(D) Nasal stuffiness

(E) Postural hypotension.

18- Fluid resuscitation during major abdominal surgery with which of the following agents is
associated with the BEST survival data?

(A) 5% Albumin

(B) 6% Hydroxyethyl starch

(C) Dextran 70

(D) None of the above

19- A 40-year-old woman with a history of Graves' disease is in the recovery room after
undergoing a CT scan under general anesthesia. While in the recovery room, her blood
pressure drops to 80/55 mm Hg, her heart rate increases to 140 bpm, and she becomes
agitated and complains of difficulty breathing and feeling hot. The most likely diagnosis for
these signs is:

(A) Thyroid storm

5
(B) Carcinoid syndrome

(C) Malignant hyperthermia (D) Pheochromocytoma.

(E) Cushing syndrome.

20- The pressure supplied by activating the emergency oxygen flush button is:

(A) 13 700 kPa.

(B) 4400 kPa.

(C) 400 kPa.

(D) 250 kPa.

)E) 10 kPa.

21- Which of the following will not affect the reading on a flowmeter?

(A) Temperature

(B) Atmospheric pressure

(C) Angle of flowmeter

(D) Setting of a vaporizer

(E) Use of a ventilator

22- Approximately how much fresh gas flow is required to prevent rebreathing when using a
Magill (Mapleson A) system for a 70-kg, spontaneously breathing patient?

(A) 0.5 L/min.

(B) 4 L/min.

(C) 5 L/min.

(D) 10 L/min.

(E) 15 L/min.

6
23- Concerning to the Laryngeal masks, which is true?

(A) They can prevent aspiration of gastric contents.

(B) The bars at the junction of the cuff and the tube prevent foreign bodies from entering the
trachea.

(C) Because of its large ID, it can be used in spontaneously breathing patients for long periods.

(D) It can be autoclaved and used repeatedly for an unlimited number of times.

(E) The standard design can be used in MRI.

24- Concerning fixed performance devices, which is true?

(A) Anesthetic breathing systems with reservoirs are fixed performance devices.

(B) Distal to the construction of a Venturi device, there is an increase in potential energy.

(C) In a Venturi mask, the higher the entrainment ratio, the higher the FiO2.

(D) A nasal oxygen catheter is a fixed performance device.

(E) Venturi masks are very well tolerated by patients.

25- Regarding to the Heat exchange humidifiers, which is not true?

(A) Inspired gases are warmed from 29°C to 34°C.

(B) Performance is improved by increasing the volume of the medium.

(C) An absolute humidity of 60–70% can be achieved.

(D) At high flows, the performance is reduced.

(E) Performance is affected by the temperature of the inspired and exhaled gases.

26- Which of the following is Paramagnetic gases?

(A) Oxygen.

(B) Sevoflurane.

(C) Nitrous oxide.

7
(D) Carbon dioxide.

(E) Halothane

27- In an invasive pressure measurement system, which of the following is correct?

(A) A clot causes high systolic and low diastolic pressures.

(B) A transducer diaphragm with very low compliance causes low systolic and high diastolic
pressures.

(C) A soft wide lumen catheter causes low systolic and high diastolic pressures.

(D) An air bubble causes low systolic and diastolic pressures.

28- A person with normal lungs has an oxygen (O2) consumption of 750 ml O2/min. The
hemoglobin (Hb) concentration is 15 g/dl. The mixed venous saturation is 25%. What is the
cardiac output?

(A) 2500 ml/min

(B) 5000 ml/min

(C) 7500 ml/min

(D) 10,000 ml/min

)E) 20,000 ml/min

29- What is the most important pathway for the respiratory response to systemic arterial CO2
(PCO 2)?

(A) CO2 activation of the carotid bodies

(B) Hydrogen ion (H+) activation of the carotid bodies

(C) CO2 activation of the chemosensitive area of the medulla

(D) H+ activation of the chemosensitive area of the medulla (E) CO2 activation of receptors in

the lungs

30- Which of the following occurs during atelectasis of one lung?

8
 (A) Increase in arterial Pco2

(B) A 40% decrease in Po2

(C) Normal blood flow in the lung with atelectasis

(D) Slight decrease in arterial content

31- With the development of congestive heart failure and no other pathologies, which of the
following mechanism is most important in preventing pulmonary edema?

(A) Retention of salt and water by the kidneys.

(B) Increase alveolar pressure due to forceful ventilation

(C) Increase in surfactant

(D) Washout of interstitial proteins due to increase in fluid filtration from capillaries

32- A patient has nerve damage to the nerve that innervates the external intercostal muscle.
Which of the following would be affected?

(A) Normal inhalation

(B) Normal exhalation

(C) Forced inhalation

(D) Forced exhalation

33- Which electrolyte imbalance is associated with increased neuromuscular excitability

and is a common complication of kidney dysfunction?

(A) Hypokalemia

(B) Hyponatremia

(C) Hypocalcemia

(D) Hypophosphatemia

9
 34- During anesthesia, maintaining adequate kidney perfusion is crucial. Which of the
following is the primary determinant of renal blood flow?

(A) Cardiac output

(B) Systemic vascular resistance

(C) Sodium concentration

D) PH levels

10
35- The most common cause of mortality associated with administration of blood is:

(A) A transfusion-related acute lung injury (TRALI)

(B) Non-ABO hemolytic transfusion reaction

(C) Microbial infection

(D) Anaphylactic reaction

36- Which of the following is the most common cause of postpartum hemorrhage?

)A) Uterine a tony

)B) Placental abruption

(C) Uterine rupture

)D) Cervical laceration

37- In obstetric anesthesia, which airway management technique is preferred in cases of

unanticipated difficult intubation?

)A) Surgical approach

(B) Nasotracheal intubation

(C) Laryngeal mask airway (LMA)

(D) Fiberoptic intubation

38- Which of the following is NOT an advantage of using regional anesthesia for cesarean
section?

(A) Faster recovery time compared to general anesthesia

)B) Reduced risk of aspiration pneumonia compared to general anesthesia

(C) Better control of blood pressure during surgery compared to general anesthesia

(D) Lower risk of fetal depression compared to general anesthesia

11
39- What is the most common cause of difficult intubation in obstetric patients?

(A) Obesity

(B) Short neck

(C) Large breasts

(D) Mallampati class III or IV airway

40- What is the recommended position for pregnant patients undergoing cesarean section under
regional anesthesia?

(A) Supine position with left uterine displacement

(B) Trendelenburg position with right uterine displacement

(C) Lateral decubitus position with left uterine displacement

)D) Prone position with right uterine displacement

41- What is the most common side effect of neuraxial anesthesia during labor?

(A) Maternal hypotension

(B) Maternal hypertension

(C) Neonatal respiratory depression

(D) Neonatal bradycardia

42- Which of the following is not a component of lethal triad due to massive hemorrhage?

(A) Acidosis

(B) Hypothermia

(C) Coagulopathy

(D) Hypercarbia

43- Which is not a sign of pre-eclampsia with severe features?

(A) SBP> 160 mmHg

(B) Platelets < 150000 x10%/L

(C) Pulmonary edema

12
(D) Visual disturbances

44- A 6-yr-old boy with spina bifida and a chronic indwelling urinary catheter has severe
hypotension and hypoxemia during augmentation cystoplasty. Which of the following is the
most likely cause?

(A) Autonomic neuropathy

(B) Disseminated intravascular coagulation

(C) Latex allergy

(D) Urinary sepsis

(E) Venous air embolism

45- Which of the following statements concerning brain stem auditory evoked responses is true
?

(A) They monitor cortical function

(B) They are affected by changes in paCo2

(C) They are affected by mild hypothermia

(D) They are more resistant to anesthetic effects than somatosensory evoked responses

(E) They are abolished coincident with flattening of the EEG.

46- All of the following situations impair cerebral autoregulation except:

(A) Higher doses of volatile anesthetic agents

(B) Hypercapnia

(C) Traumatic brain injury

(D) Propofol

47- Cerebral blood flow changes the most, with which one of the following maneuvers?

(A) Change of PaCO2from 40-60 mmHg .

(B) Change of PaO2 from 120-70 mmHg

13
(C) Change in the MAC of sevoflurane from 0.5-1.5

(D) Change in propofol infusion dose from 50mcg/kg/min to 100mcg/kg/min

48- A 25 y/o male with h/o congenital heart disease is scheduled for a posterior fossa tumor
resection. He had a Fontan repair. All of the following anesthetic considerations for
craniotomy are true in these patients EXCEPT:

(A) Maintain systemic flow and pressure

(B) Maintain a hypovolemic state

(C) Maintain moderate alkalosis

(D) Minimize increases in pulmonary vascular resistance

49- Which patient has the most risk factors for developing delirium ?

(A) A 23-year-old male who underwent general anesthesia for laparoscopic cholecystectomy and
refusing to answer questions in the PACU .

)B) A 69-year-old diabetic female patient undergoing a toe amputation .

(C) A 77-year-old woman on multiple medications for depression and mild cognitive impairment
undergoing a hysterectomy.

(D) A 67-year-old man with malnutrition and alcohol use disorder undergoing a CABG

50- A 48-year-old woman underwent a posterior fossa craniotomy, in the sitting position.
Monitoring included precordial Doppler, arterial blood pressure, central venous pressure (
CVP), and urine output. Furosemide was used Intraoperative for cerebral decompression
and the operation was uneventful. In the recovery room, she was awake with stable vital
signs when the CVP suddenly increased from 6 to 25 mm Hg without any change in blood
pressure. Shortly thereafter premature ventricular contractions are noted. After
administering lidocaine 1mg / kg intravenously, the most appropriate action is:

(A) Position the patient head down, right side up and aspirate the CVP

(B) Withdraw the CVP catheter 5 cm

(C) Infuse potassium chloride

(D) Administer furosemide rapidly

(E) Ask the neurosurgeon to evaluate the patient immediately

14
51- A 58-year-old woman with rheumatoid arthritis and hyperactive gag reflex requires awake
intubation prior to cervical spine stabilization. Which of the following regional nerve blocks
is most appropriate?

(A) Deep cervical plexus

(B) Glossopharyngeal nerve

(C) Hypoglossal nerve

(D) Superior laryngeal nerve

(E) Trigeminal nerve

52- A 4-month-old child is undergoing a craniotomy for craniosynostosis under general

anesthesia. Suddenly the systolic BP drops from 75 mmHg to 30 mmHg and the EtCO2
decreases from 35 to 6 mmHg. Which of the following maneuvers is LEAST likely to have a
beneficial effect?

(A) Administration of a fluid bolus

(B) Administration of a vasopressor

)C) Application of PEEP

(D) Aspiration of the central line

(E) Flooding of the wound with saline

53- Which of the following statements concerning autonomic hyper-reflexia is true?

(A) It occurs within 24 hours after injury

(B) It occurs with lesions below T 10

(C) It occurs with reflex increase in parasympathetic outflow

(D) It is characterized by paroxysmal hypotension and tachycardia

(E) It is prevented by blocking afferent visceral pathways

15
54- A 70-year-old man is scheduled for a knee arthroplasty. Prior to induction of general
anesthesia, a femoral nerve block is performed using a nerve stimulator. Soon after injection
of 20ml of 0.5% bupivacaine, he became unresponsive. He is unconscious and has no
palpable carotid pulse. CPR is commenced. Which one of the following best describes the
specific treatment in this scenario?

(A) 1ml/kg of 10% lipid emulsion over 1 minute .

(B) 1.5ml/kg of 20% lipid emulsion over 1 minute .

(C) 1.5ml/kg of 20% lipid emulsion over 5 minutes .

(D) 1ml/kg of 10% lipid emulsion over 1 minute.

)E) 1.5ml/kg of 10% lipid emulsion over 2 minutes

55- A 40-year-old ASA 1 male patient with a body mass index of 28 is undergoing a complex
orthopedic procedure on the left forearm lasting for 8 hours. The most appropriate reason
for choosing invasive arterial blood pressure monitoring over automated noninvasive blood
pressure measurement in this patient is:

(A) Automated non-invasive blood pressure monitoring would be inaccurate in this patient.

(B) Automated blood pressure monitoring is likely to result in ulnar nerve injury.

(C) Monitoring invasive blood pressure ensures adequate perfusion pressure.

(D) Hypotension can be detected early using invasive blood pressure monitoring.

(E) Automated non-invasive blood pressure monitoring for 8 hours can result in distal edema of the limb.

56- Pulsatile tinnitus in ear is due to:

(A) Malignant otitis media

(B) Osteoma

(C) Mastoid reservoir

(D) Glomus jugular tumor

57- In blast injury, most organ affected is:

(A) Aorta

(B) Eardrum
16
(C) Lung

(D) All the above

58- Which of the following is not true about carbon monoxide poisoning?

(A) It shift the oxygen hemoglobin dissociation curve to left

(B) It kills cytochrome

(C) It increase displacement of oxygen from hemoglobin

(D) Direct action occurs on central nervous system

59- What is the most common cause of fire in operating theater?

(A) Electrosurgical units

(B) LASER

(C) Fibro-optic instruments

(D) Anesthesia chemical

60- Nasotracheal intubation:

(A) is preferred for the unconscious patient without cervical spine injury

(B) is preferred for patients with suspected cervical spine injury

(C) Maximize neck manipulation

(D) Is contraindicated in patient who is breathing spontaneously

Good luck

17
61- Which of the following statements about head injuries is false?

(A) The majority of deaths from auto accidents are due to head injuries

(B) Head injury alone produces shock

(C) A rapid and complete neurological examination is part of the initial evaluation of the trauma patient

(D) Optimizing arterial oxygenation is part of initial therapy

62- During laparoscopic surgery for cholecystectomy the least common complication:

(A) Tachycardia and hypertension

(B) Increase airway pressure

(C) Hypercapnea

(D) Bradycardia

63- During lab cholecystectomy patient developed Bradycardia, all the following causes of
Bradycardia except:

(A) Hypertension

(B) Air embolism

(C) Vagal inhibition

(D) Vagotonic drugs

64- The clamping of the thoracic aorta in aneurysm repair is followed by:

(A) Immediate hypotension

(B) Immediate hypertension

(C) Cardiac arrest

(D) Loss of blood pressure in the right arm

18
65- Lung protection strategies for patients with ARDS involve all of the following EXCEPT:

(A) Smaller ventilatory tidal volumes of 6 cc/kg or less

(B) Limitation of distending pressures on the ventilator to <30 cm/H 2 O

(C) Sufficient positive end-expiratory pressures (PEEP) to avoid alveolar collapse

(D) Permissive hypocapnia

(E) PH correction with NaHCO 3

66- A 65-year-old female with a history of severe aortic stenosis requires urgent laparoscopic
cholecystectomy. An important hemodynamic goal during anesthetic care is: (A) Decreased
afterload

(B) Slow heart rate

(C) Decreased preload

(D) High heart rate

(E) Decreased contractility

67- Which one of the following interventions is most likely to result in preservation of renal
function during aortic aneurysm surgery?

(A) Administration of furosemide

(B) Keeping aortic cross clamp time less than 120 min

(C) Administration of dopamine

(D) Endovascular approach to aortic aneurysm repair

(E) Administration of mannitol

68- Increased amplitude of V waves in a central venous pressure recording indicates:

(A) Junctional rhythm

(B) Atrial fibrillation

19
(C) Tricuspid regurgitation

(D) Hypovolemia

(E) Heart block

69- 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

70- 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

71- Insulin has which o the following metabolic effects?

(A) Stimulates gluconeogenesis

(B) Stimulates glycolysis

(C) Stimulates protein catabolism

(D) Stimulates glycogenolysis

72- Which o the following physiologic effects chronic stress has?

(A) Increased levels of TSH

(B) Decreased levels of cortisol

(C) Decreased levels o catecholamine

20
(D) Increased gluconeogenesis

21
73- What blood product is most likely to induce citrate toxicity?

(A) Cryoprecipitate

(B) Packed red blood cells

(C) Fresh frozen plasma

(D) Platelets

(E) Whole blood

74- Which of the following factors increases MAC or an individual undergoing GA?

(A) Acute alcohol intoxication

(B) Acute cocaine intoxication

(C) Hyperthyroidism

(D) Pregnancy

75- Which of the following is NOT a component of the post-anesthetic discharge scoring
system (PADSS) used to evaluate the suitability of a patient to be discharged from an
ambulatory surgical facility?

(A) Drinking

(B) Ambulation

(C) Absence of nausea and vomiting

(D) Pain control

76- A patient has significant hepatic and renal impairment. To avoid dosage adjustment due
to this impairment, which opioid would be the best choice or intraoperative analgesia? (A)
Methadone

(B) Fentanyl

(C) Remifentanil

(D) Sufentanil
 21
77- Sustained administration of an opiate agonist (days to weeks) leads to loss of drug effect.
This is best described as:

(A) Tolerance

(B) Dependence

(C) Withdrawal

(D) Addiction

78- In which of the following circumstances should the induction dose of barbiturates
reduced?

(A) Neonates

(B) Plasma pH o 7.25

(C) Plasma pH o 7.55

(D) Patients taking barbiturates regularly

79- Which of the following best describes the effect of barbiturates on the pulmonary system?

(A) Profound apnea lasting 8–10 minutes

(B) Brief period of apnea lasting 30–45 seconds

(C) Increase in the rate of salivation

(D) Bronchospasm

80- Propofol infusion syndrome (PRIS) has been described after prolonged and high-dose
infusions of propofol. PRIS is characterized by:

(A) Hypokalemia

(B) Metabolic alkalosis

(C) Splenomegaly

(D) Rhabidomyolysis

23
81- How does flumazenil act to reverse the effects of benzodiazepines?

(A) Competitive antagonist

(B) Uncompetitive antagonist

(C) Chemical antagonist

(D) Noncompetitive antagonist

82- A 25 years old man with a previous history of asthma referred for vasectomy surgery
under general anesthesia. After induction and ETT insertion, he developed bronchospasm.
The suitable volatile anesthetic in bronchospasm is:

(A) Disflurane

(B) Isoflurane

(C) Halothane

(D) Enflurane

83- Use of N2O with opioids can produce:

(A) Increased HR, increased BP, increased CO

(B) Increased HR, decreased BP, decreased CO

(C) Decreased HR, increased BP, increased CO

(D) Decreased HR, decreased BP, decreased CO

84- Incidence of volatile anesthetics induced hepatitis:

(A) Halothane > Isoflurane > Desflurane >Enflurane

(B) Halothane > Desflurane > Isoflurane > Enflurane

(C) Halothane > Enflurane > Desflurane >Isoflurane (D)

Halothane > Enflurane > Isoflurane > Desflurane

24
85- When you return to OR after 2 days holyday, you observed that flash O2 was open for 2
days, the first step that you will do:

(A) Change canister

(B) Check O2 supply

(C) Check N2o supply

(D) Recheck pulse oxymeter

86- O2 flow during o2 flush:

(A) 3 – 10 L/m

(B) 20 – 30 L/m

(C) 35 – 75 L /m

(D) 50 – 100 L/m

87- One day post subtotal thyroidectomy, the patient developed progressive inspiratory
stridor. The first management is:

(A) Dexamethasone injection

(B) Endotracheal intubation

(C) Tracheostomy

(D) Calcium injection

88- Regard to resuscitate a patient with class IV hemorrhage and unknown blood group, after
transfusion of 10 units (O -) packed RBC they informed you about his blood group (A+). If you
want to continue transfusion, the suitable blood group for him:

(A) A+ whole blood

(B) A+ packed RBC

(C) O+ whole blood

(D) O- packed RBC

25
89- A young female referred for elective GYN surgery. She developed severe ventricular
arrhythmia after epidural anesthesia by bupivacaine. Which of the following managements is
not effective?

(A) Airway management and maintenance of oxygenation

(B) Correction of acidosis

(C) Use of amiodarone

(D) Use of intralipid 20%

90- In a pediatric patient who referred for surgery under halothane anesthesia, the maximum
dose of subcutaneous epinephrine is:

(A) 10 – 15 μg/kg every 10 minutes

(B) 10 – 15 μg/kg every 20 minutes

(C) 4 – 6 μg/kg every 10 minutes

(D) 4 – 6 μg/kg every 20 minutes

91- A healthy 30 year-old man is receiving general anesthesia. During the case, he becomes
light and bucks on the endotracheal tube. His next blood pressure reading from the cuff is
175/90 mm Hg (baseline 120/80 mm Hg). What is the effect of this increase in systemic blood
pressure on his cerebral blood flow (assuming no change in intracranial pressure?

(A) Cerebral vasodilation with increased cerebral blood low

(B) Cerebral vasoconstriction with increased cerebral blood low

(C) Cerebral vasoconstriction with decreased cerebral blood low

(D) Cerebral vasoconstriction with no change in cerebral blood low

92-Which of the following syndromes is most likely associated with difficult airway
management based on mandibular hypoplasia? (A) Apert syndrome

(B) Klippel-Feil syndrome

(C) Pierre-Robin sequence

(D) Beckwith-Wiedemann syndrome

(E) Hurler syndrome

26
93- A 2-week-old neonate born at 26 weeks gestation weighs 1.5 kg. Which of the following is
the best estimate of circulating blood volume?

(A) 105 mL

(B) 120 mL

(C) 135 mL

(D) 150 mL

(E) 200 mL

94- Compared to a healthy adult, which of the following best describes the use of
succinylcholine in a healthy 1-year-old?

(A) The intubating dose is unchanged.

(B) Fasciculations are more pronounced.

(C) It should not be administered routinely.

(D) It should not be administered intramuscularly.

(E) The duration of action is longer.

95- A 5-year-old girl with sickle cell disease presents to the OR for lap. Cholecystectomy. She
has a history of recurrent bone and abdominal pain. Her hemoglobin level is 7.4 g/dL. Which
of the following is most likely to increase the risk of postoperative complications in this
patient?

(A) Blood transfusion

(B) Respiratory alkalosis

(C) Ventilation with 100% FiO 2

(D) Epidural analgesia

(E) Minimizing IV fluids

96- Which of the following physiologic parameters is lower in a healthy 3-month-old compared
to an adult (normalized for weight)?

(A) MAC for sevoflurane

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(B) Oxygen consumption

(C) Glomerular filtration rate (GFR)

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(D) Blood volume

(E) Total body water

97- A 4-month-old born at 28 weeks gestational age requires surgery to repair an inguinal
hernia. A spinal anesthetic is planned. Compared to a healthy adult, which of the following is
true regarding spinal anesthesia in this patient?

(A) The spinal cord terminates higher relative to the spinal column.

(B) The dural sac terminates higher relative to the spinal column.

(C) There is a greater risk of bradycardia.

(D) The duration of surgical anesthesia is shorter.

(E) There is a greater risk of hypotension.

98- A 7-year-old boy, post adeno-tonsillectomy 8 hours ago. He is restless and spitting up
blood. ENT surgeon wants to take him back emergently to the operating room. Which of the
following maneuvers would be LEAST appropriate for this anesthetic?

(A) Awake fiberoptic intubation

(B) Aggressive volume resuscitation prior to induction

(C) Rapid-sequence induction

(D) Orogastric aspiration prior to extubation (E) Awake extubation.

99- A 1-month-old boy is brought to the emergency room with projectile vomiting &
diagnosed as pyloric stenosis, confirmed with ultrasonography. Which of the following
electrolyte disturbances would be LEAST likely?

(A) Hyperchloremia
(B) Metabolic alkalosis
(C) Hyponatremia
(D) Hypokalemia
(E) Hypoglycemia

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 (D)
100- Which of the following diseases is associated with resistance to depolarizing
neuromuscular blockade?

(A) Myasthenic syndrome

(B) Myasthenia gravis
(C) Myotonic dystrophy
(D) Duchenne muscular dystrophy
(E) Multiple sclerosis

101- Lambert-Eaton myasthenia syndrome is characterized by all except:

(A) Proximal fatigability, relieved by exercise.

(B) Proximal fatigability, relieved by rest.

(C) It could be associated with small-cell lung cancer.

(D) The sensitivity to nondepolarizing muscle relaxants is increased.

(E) Reversal agents have a poor response or no effect.

102- Regarding Duchene muscular dystrophy. ALL are true except:

(A) Succinylcholine is formally contraindicated because of the risk of lethal hyperkalemia.

(B) Myotonic crisis can be triggered by surgical manipulation.

(C) The use of nondepolarizing muscle relaxants is contraindicated.

(D) Reversal agents can precipitate skeletal muscle contraction by facilitating depolarization of the
endplate.

(E) Volatile anesthetic exposure has been associated with rhabdomyolysis .

103- A 65-year-old patient is mechanically ventilated in the intensive care unit (ICU) after an
open nephrectomy. How far should the suction catheter be inserted into the endotracheal
tube for suctioning?

(A) To the midlevel of the endotracheal tube

(B) To the tip of the endotracheal tube

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(C) Just proximal to the carina

(D) Past the carina

104- A 52-year-old male complains of nausea and a headache at work. He subsequently has
an acute decline in wakefulness. His coworkers bring him to the emergency department. On
evaluation, he opens his eyes to speech, makes incomprehensible sounds & withdraws from
pain. Select the patient’s GCS from the list below:

(A) 6 (B)

(C) 8

(D) 9

105- Potential complications associated with total parenteral nutrition (TPN) include all of the
following EXCEPT:

(A) Ketoacidosis

(B) Hyperglycemia

(C) Hypoglycemia

(D) Hypophosphatemia

106- The RIFLE criteria are designed to predict mortality from:

(A) Renal failure

(B) Sepsis

(C) Hepatic failure

(D) Acute respiratory distress syndrome

107- 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 blood pressure
during direct laryngoscopy and tracheal intubation?

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(D)
(A) Esmolol

(B) Nitroprusside

(C) Hydralazine

(D) Isoflurane

108- The following blood gases would best be explained by which disorder? pH 7.18, Paco2
25 mm Hg, HCO3 − 11 mEq/L ;-

(A) Aspirin overdose

(B) Nasogastric suction

(C) Chloride wasting diarrhea

(D) Hyperaldosteronism

109- A 78-year-old man with a 125-pack-year smoking history is brought to the ICU after total
laryngectomy for treatment of his laryngeal squamous cell carcinoma. In the ICU his
tracheostomy tube becomes totally occluded and cannot be cleared with suctioning. The
most appropriate course of action while waiting for the ENT surgeon would be;-

(A) Bag mask or laryngeal mask airway until help arrives

(B) Attempt to intubate with GlideScope or direct laryngoscopy

(C) Oral or nasal fiberoptic intubation

(D) Remove tracheostomy tube and intubate laryngectomy stoma with an endotracheal tube

110- Data from the ARDS network trial (ARDS Net) showed increased mortality from:

(A) Atelectrauma

(B) Volutrauma

(C) Barotrauma

(D) Inhaled nitric oxide

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111- Local anesthetics block nerve conduction by:
(A) Closing calcium channels

(B) Decreasing intracellular calcium concentration

(C) Decreasing potassium conductance

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(D)

Causing extrusion of intracellular potassium

(E) Inhibiting cellular influx of sodium

112- Which of the following parts of the infant’s airway determines the appropriate diameter
of a nasotracheal tube?

(A) Nares

(B) Glottis

(C) Vocal cords

(D) Cricoid cartilage

(E) Third tracheal ring

113- Which order of systemic local anesthetic toxicity is correct?

(A) Intercostal > caudal > epidural > sciatic > brachial plexus

(B) Epidural > caudal > intercostal > sciatic>brachial plexus

(C) Intercostal > epidural > caudal > brachial plexus > sciatic

(D) Caudal > intercostal > brachial plexus > epidural > sciatic

(E) Intercostal > caudal > epidural > brachial plexus >sciatic

114- Chassaignac’s tubercle is located at:

(A) The spinous process of C6

(B) The spinous process of C7

(C) The anterior tubercle of the transverse process of C6

(D) The sternoclavicular articulation

115- The first function to be lost during the onset of spinal anesthesia is:

(A) Touch
(B) Motor power

(C) Temperature sensation

(D) Vibration

(E) Autonomic activity

116- Severe hypotension associated with high spinal anesthesia is caused primarily by:

(A) Decreased cardiac output secondary to decreased preload

(B) Decreased systemic vascular resistance

(C) Decreased cardiac output secondary to bradycardia

(D) Decreased cardiac output secondary to decreased myocardial Contractility

117- If the recurrent laryngeal nerve were transected bilaterally, the vocal cords would:

(A) Be in the open position

(B) Be in the closed position

(C) Be in the intermediate position (i.e., 2-3 mm apart)

(D) Not be affected unless the superior laryngeal nerve were also Injured

118- According to the 2016 American Society of Regional Anesthesia and Pain Medicine
(ASRA) practice advisory on infectious complications of regional anesthesia and pain
medicine, the MOST important action to maintain aseptic technique and prevent
crosscontamination during regional anesthesia techniques is:

(A) Wearing a surgical gown

(B) Hand washing

(C) Using soap and water instead of alcohol-based antiseptics

(D) Using povidone-iodine (e.g., Betadine) instead of alcohol-based chlorhexidine to scrub

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119- A 55-year-old man presents for trans-urethral resection of prostate (TURP) for suspicion
of cancer. He is on Apixaban since having history of DVT .He requests regional anaesthesia
as he experienced significant postoperative nausea and vomiting after his last general
anesthesia. What is the best course of action?

(A) Stop Apixaban 2 days before surgery, proceed with spinal anesthesia

(B) Recommend proceeding with general anesthesia

(C) Stop Apixaban 2 days before surgery, bridge with IV heparin, proceed with general
anaesthesia or SA.

(D) Stop Apixaban, wait 24 hours from last dose and proceed with spinal anaesthesia

(E) Proceed with spinal anesthesia

120- The most common origin of the artery of Adamkiewicz is:

(A) Between T4 and T6

(B) At T7

(C) Between T8 and L3

(D) At L4

(E) At L5
Best wishes

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