Palestinian Medical Council

Second part board exam

Anesthesia – 5/2024

‫ لم أقم‬،‫ في بعض األسئلة لم أتذكر الصياغة او الخيارات بشكل دقيق لكن تحريت الدقة قدر المستطاع‬- :‫مالحظة هامة‬
.‫باإلجابة على األسئلة ألنني غير متأكد من بعض اإلجابات‬
،‫ وأرجوا أال يتم سوء استخدامها لغير هدفها‬،‫ الهدف من نقل هذه األسئلة هو اإلفادة لمن سيدخل االمتحان‬-
.‫واسألكم دعوة في ظهر الغيب‬

1. A 5-month-old infant with tetralogy of Fallot is scheduled for elective inguinal

herniorrhaphy. Which of the following would require the operation to be postponed?
A. Current propranolol therapy
B. Hematocrit of 65%
C. History of "tet spells"
D. Patent ductus arteriosus
E. Room air oxygen saturation of 82%

2. Left ventricular end-diastolic volume is most likely to be underestimated by pulmonary

artery occlusion pressure in patients with
A. acute myocardial ischemia
B. aortic insufficiency
C. mitral stenosis
D. primary pulmonary hypertension
E. tricuspid stenosis

3. In a patient with surgically significant aortic insufficiency, cardiac output measured by

thermodilution will
A. be greater than right ventricular output
B. be less than left ventricular output
C. be less than cardiac output measured by the Fick method
D. be inaccurate because of decreased signal-to-noise ratio
E. underestimate net systemic arterial blood flow

4. You are called to anesthetize a patient for an emergency pericardial window for a large
pericardial effusion. Which of the following drugs is most appropriate for initiation of
anesthesia?
A. Alfentanil
B. Ketamine
C. Midazolam
D. Propofol

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E. Thiopental

5. During repair for coarctation of the aorta in a healthy 13-year-old patient, right radial
artery pressure increases from 100/60 to 105/70 mmHg after the aorta is cross clamped.
This most likely indicates that
A. collateral blood flow has decreased the hemodynamic consequences of cross-clamping
B. left ventricular hypertrophy has decreased left ventricular compliance
C. spinal cord blood flow is impaired
D. the coarctation has decreased aortic diameter less than 50%
E. the coarctation involves the origin of the right subclavian artery

6. Four days after mitral valve replacement, a 49-year-old, 70-kg woman who has had
oliguric renal failure since the operation requires insertion of a Schribner shunt for
hemodialysis. Her BUN concentration is 104 mg/dl, serum creatinine is 9.3 mg/dl, serum
sodium is 130 mEq/L, and serum potassium is 6.7 mEq/L. During the operation under
local anesthesia, diazepam 7.5 mg and morphine 10 mg are administered intravenously
to control agitation. Five minutes later while she is sleeping quietly, unifocal premature
ventricular contractions appear at a rate of 10 per minute on the ECG monitor. The most
appropriate therapy is to
A. administer calcium gluconate 250 mg intravenously
B. augment ventilation with bag and mask
C. administer lidocaine 100 mg intravenously
D. administer NaHC03 50 mEq intravenously
E. observe only

7. Which of the following best describes cardiomyopathy following therapy with

doxorubicin (Adriamycin)?
A. The initial presentation is concentric hypertrophy
B. The diagnosis is confirmed by a shortened QT interval
C. It is exacerbated by hyperoxia
D. It is resistant to inotropic agents
E. It may persist for years after therapy is discontinued

8. Left ventricular end-diastolic volume is most likely to be underestimated by pulmonary

artery occlusion pressure in patients with
A. acute myocardial ischemia
B. aortic insufficiency
C. mitral stenosis
D. primary pulmonary hypertension
E. tricuspid stenosis

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9. Each of the following statements concerning the activated clotting time (ACT) is true
EXCEPT:
A. The ACT is more sensitive than the activated partial thromboplastin time (APTT) to blood
heparin concentration
B. The ACT is prolonged if the specimen is not warmed during the assay
C. The ACT should be greater than 300 sec before initiating cardiopulmonary bypass
D. Hypofibrinogenemia may prolong the ACT after cardiopulmonary bypass
E. Whole blood is used for measurement of the ACT

10. A 60-year-old obese man who has an antithrombin III deficiency is scheduled for radical
prostatectomy. Prior to the operation this patient should receive
A. fresh frozen plasma
B. vitamin K
C. epsilon-aminocaproic acid
D. heparin
E. none of the above

11. A 14-month-old child has tetralogy of Fallot with dynamic obstruction to right ventricular
outflow. Which of the following is most likely to decrease cyanosis in this child?
A. Calcium
B. Epinephrine
C. Nitroglycerin
D. Nitroprusside
E. Propranolol

12. A 33-year-old woman is scheduled for emergency appendectomy under general

anesthesia. She has hypertrophic cardiomyopathy and has had two episodes of syncope
in the past year. Which of the following statements concerning anesthetic management
is true?
A. Spinal anesthesia is preferred to general anesthesia
B. Deep levels of isoflurane anesthesia are appropriate
C. Fluid administration should be restricted
D. Phenylephrine is preferred to ephedrine to treat hypotension
E. Positive end-expiratory pressure will decrease left ventricular outflow obstruction

13. Which of the following is the best method of pacing to improve cardiac output in a
patient with third-degree heart block?
A. VOO
B. AOO
C. VVI
D. DVI

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 E. Transcutaneous

14. A 66-year-old man with aortic regurgitation is brought to the operating room for aortic
valve replacement after having received morphine, scopolamine premedication. PO2 is
40 mmHg in a sample of pulmonary artery blood drawn 10 minutes after the patient
started breathing pure oxygen. This finding is compatible with
A. wedging of the catheter tip
B. left-to-right intracardiac shunt
C. increased intrapulmonary shunting
D. excessively depressed ventilation
E. normal cardiac output

15. Nitroprusside therapy for hypertension should be discontinued in the presence of

A. acute myocardial infarction
B. increasing metabolic acidosis
C. methemoglobinemia
D. mitral regurgitation
E. renal failure

16. Side effects of cyclosporine include all the following except:

A. Macrocytic anemia
B. Inhibition of humoral immunity
C. Hypertension
D. Renal fibrosis

17. The most frequently reported sign of malignant hyperthermia is:

A. Arrhythmia
B. Cyanosis
C. Sweating
D. Tachycardia
E. Rigidity

18. A 50-year-old woman with severe portal hypertension is scheduled to undergo general
anesthesia for a TIPS procedure. Which cardiovascular physiologic changes would you
expect?
A. Decreased heart rate
B. Increased SVR
C. Increased hepatic blood flow
D. Increased renal blood flow
E. Increased mixed venous oxygen content.

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19. Which of the following statements regarding the benefit of high-flow nasal cannula (HFNC)
is/are most correct?
A. HFNC can provide PEEP.
B. HFNC can improve CO2 exchange.
C. HFNC can achieve an FiO2 between 0.21 and 1.0 that is independent of patient
respiratory effort.
D. All of the above.

20. You are called emergently to the bedside of a patient in the ICU after his nurse observed an
acute desaturation event. You note the patient had a tracheostomy placed 6 days ago for
chronic respiratory failure after a prolonged course of acute respiratory distress syndrome.
You arrive at the patient’s bedside to find an O2 saturation of 88%, the trach collar seated
against the skin with the pilot balloon inflated, and the patient moving air very noisily
through his mouth. The nurse describes that during a coughing fit his trach “fell out,” but
she was able to push it back in. Which of the following would be the most inappropriate
next move?
A. Place an oxygen mask over the patient’s mouth and nose.
B. Attach an Ambu bag to the trach and support the patient’s ventilation.
C. Remove the trach and cover the ostomy site with a bandage.
D. Call for a fiberoptic bronchoscope to interrogate the tracheostomy track.
E. Attach an Ambu bag to a mask, place over the mouth and nose, and support the
patient’s ventilation.

21. A patient is undergoing surgery for correction of a bronchopleural fistula. A DLT has been
placed without difficulty. During the procedure, the patient’s oxygen saturation decreases
to 85%. Which of the following is the most appropriate next step?
A. Apply CPAP to the operative lung.
B. Increase the fraction of inspired oxygen.
C. Fiberoptic confirmation of DLT placement.
D. Resume two-lung ventilation.

22. 5. An 80-year-old man is scheduled for radical prostatectomy. He denies any significant
medical history other than hypertension, for which he takes hydrochlorothiazide. He
reports a good exercise tolerance and is able to climb 4 flights of stairs without difficulty.
What would be the expected minimum alveolar concentration (MAC) of sevoflurane to
prevent movement to surgical stimulation assuming the patient has a response to
anesthesia in line with the median population?
A. 1.8%
B. 1.6%
C. 1.4%
D. 1.2%

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23. A 70-year-old patient is shivering and has chest pain in the PACU following a
cholecystectomy. Heart rate is 120 bpm, and blood pressure is 220/120 mmHg. SpO2 is 97%
at an FiO2 of 0.4. An ECG shows ST-T wave changes, which are not affected by intravenous
administration of nitroglycerin. Which of the following is the most appropriate next step?
A. Administration of esmolol
B. Administration of hydralazine
C. Administration of nitroprusside
D. Application of a warming blanket
E. Increasing FiO2

24. A 62-year-old man, who had a myocardial infarction three years ago, complicated by
congestive heart failure and renal failure, is undergoing a colectomy. A pulmonary artery
catheter demonstrates a cardiac output higher than measurements recorded during a
cardiac catheterization two months after the infarction. Which of the following most likely
contributes to the increased cardiac output?
A. Creation of an arteriovenous fistula
B. Increased hemoglobin concentration from 10 to 12 g/dl
C. Stimulation of carotid body receptors
D. Transcutaneous nitroglycerin
E. Use of a beta-adrenergic blocker to prevent myocardial reinfarction

25. Which of the following statements concerning use of temperature-corrected blood gas
measurement (pH-stat) during hypothermic cardiopulmonary bypass is true?
A. Blood gas analysis is performed at the patient's temperature
B. Carbon dioxide should not be added to the bypass circuit
C. The carbon dioxide content of the patient's blood is greater than it would be without
temperature correction
D. The incidence of postoperative neurologic deficits is increased compared with the alpha-
stat method
E. The patient's temperature should be maintained above 25°C

26. Each of the following conditions can be accurately evaluated with transesophageal
echocardiography EXCEPT
A. intimal tear at the aortic arch
B. intracardiac air
C. left atrial thrombus
D. patent foramen ovale
E. right atrial myxoma

27. Which of the following may decrease post-operative renal injury:

A. Dopamine

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 B. Dobutamine
C. Vasopressin
D. Fenoldopam

28. Regarding carotid endarterectomy, which is correct?

A. In patients with recent stroke, it is better done under regional anesthesia to avoid more
cerebral ischemia with general anesthesia
B. Deep cervical plexus block has very high risk of block phrenic nerve
C. In patients with good collaterals, it is best done under general anesthesia
D. 5-10% risk of stroke under GA.

29. Blood component with least infection risk is?

A. Albumin
B. Fresh Frozen Plasma
C. Packed Red Blood Cells
D. Platelets
E. Cryoprecipitate

30. The site of most airway resistance is?

A. Endo-tracheal tub
B. Trachea
C. Respiratory bronchioles
D. Vocal cords
E. Main bronchus

31. You have a 4 years old boy presented at 8 pm with hip dislocation, he has last meal at 1 pm,
the dislocation happened at 2 pm, what is the correct decision?
A. Proceed with regional anesthesia
B. Proceed with general endotracheal anesthesia
C. Delay for the next day as it is not urgent
D. Proceed with rapid sequence induction

32. You have a patient is the ICU post massive burn, the dietitian wants to calculate his calories
requirements, which equation should she use?
A. Curreri equation
B. Harris-Benedict equation
C. Tourmate equation

33. You have a patient is the ICU who needs CRRT, which one of the following CRRT dialysate
solution is correct?
A. Sodium concentration is 160 meq

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 B. Calcium concentration is …
C. Osmolality is ….
D. Ph is. ……..

34. You have a critical patient in the ICU who needs renal dialysis, what is the LEAST useful
strategy to decrease hemodynamic instability during dialysis?
A. Make dialysis 4 times per week 3 hours each session
B. Low efficiency dialysis
C. Not performing full dialysis session

35. 10-week pregnant women presented with palpitations, she has free past history,
hemodynamics are stable, ECG showed A. Fib, she is already on unknown anticoagulant,
transthoracic echo showed normal anatomy, what is the best next step?
A. Cardioversion
B. Nifedipine
C. Amiodarone 300 mg
D. Beta blockers

36. The minimum requirements for safe performance, this is the definition of?
A. Standard
B. Guidelines
C. Protocol
D. Precautions

37. All of the following increase V/Q ratio except:

A. Increase PaO2
B. Increase PAO2
C. Decrease PaCO2
D. Decrease EtCO2
E. Hypoxic pulmonary vasoconstriction may compensate for V/Q mismatch in these
conditions.

38. You have a patient with end-stage liver disease and COPD who presents for TIPS surgery
under general isoflurane surgery, what is the expected ABGs of this patient?
A. pH: xxx PaO2:xxxxx PaCO2: xxxxxxx HCO3: xxxxxx
B. pH: xxx PaO2:xxxxx PaCO2: xxxxxxx HCO3: xxxxxx
C. pH: xxx PaO2:xxxxx PaCO2: xxxxxxx HCO3: xxxxxx
D. pH: xxx PaO2:xxxxx PaCO2: xxxxxxx HCO3: xxxxxx

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39. You have a 75 kg man with a serum sodium level of 165, if you want to use D5W%, what is
the optimal infusion rate?
A. 50 ml/hr
B. 100 ml/hr
C. 125 ml/hr
D. 150 ml/hr
E. 175 ml/hr

40. What is the incubation period of H1N1, if the infection happened one week ago?
A. 7 days
B. 10 days
C. 14 days
D. 21 days

41. Which of the following is the LEAST sensitive indicator for assessing efficacy of
resuscitation?
A. Arterial blood lactate level
B. Urine output
C. Severity of acidosis

42. When performing ABGs, what is correct?

A. Alpha stat is associated with a higher risk of cerebral ischemia
B. In Ph stat CO2 is added to make CO2 level 40 mmHg
C. In alpha stat the sample is heated

43. You have a patient breathing spontaneously and has pulmonary catheter, LVEDV by PCWP is
80 ml, at the same time LVEDV by echo is 118, this patient is most likely have:
A. Aortic regurgitation
B. Acute MI
C. mitral stenosis
D. Pulmonary hypertension

44. Regarding combination of remifentanil and propofol:

A. Has lower risk of nausea and vomiting than general anesthesia
B. This combination may induce porphyria reaction
C. Has higher degree of hypotension than general isoflurane anesthesia

45. In patients with end-stage liver disease:

A. Loading dose of thiopental should be reduced
B. Maintenance dose of propofol is based on lean body weight
C. Succinylcholine duration is unlikely to be significantly increased

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 46. Following protamine administration, profound pulmonary hypertension is most likely
initiated by release of
A. epinephrine
B. histamine
C. leukotriene
D. norepinephrine
E. thromboxane

47. A 65-kg patient is receiving volume-controlled ventilation with a tidal volume of 400 mL
and frequency of 14 breaths per minute. The measured peak airway pressure is 18 cm
H2O, with a plateau pressure of 12 cm H2O, and the PEEP is 2 cm H2O. What is the static
compliance of the patient’s lung compliance?
A. 40 mL/cm H2O
B. 67 mL/cm H2O
C. 25 mL/cm H2O
D. 25 cm H2O/L
E. 15 cm H2O/L
F. 40 cm H2O/L

48. You have an old age in lithotomy position breathing spontaneously with LMA, which of the
following is correct?
A. MV/Vd is constant
B. Dead space/ closing space is decreased
C. FRC/MV is decreased

49. A young male patient was brought to ER due to convulsions while celebrating at a party, the
most common cause is?
A. Hyponatremia
B. Hypoglycemia
C. Epilepsy
D. Hypocalcemia

50. Before performing a contrast enhanced brain MRI in a patient with GFR of 20, you should
remember that a common complications of these patient receiving contrast material is?
A. Contrast induced nephropathy
B. Hypothyroidism
C. Diabetes insipidus

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51. You have a patient presented with decrease level of consciousness, he is breathing rapidly,
review of his drugs shows aspirin, metformin , nifedipine, he was taken his drugs 2 hours
ago, what is the acid-base disorder in this patient
A. Metabolic acidosis and respiratory acidosis
B. Metabolic acidosis and respiratory alkalosis
C. Metabolic alkalosis and respiratory acidosis
D. Metabolic alkalosis and respiratory alkalosis
E. All of them may occur

52. Airway management in Klippel–Feil syndrome is most likely to be challenging because of

A. Micrognathia
B. Macroglossia
C. Subglottic stenosis
D. Cervical spine fusion

53. A question shows ECG, it has prolonged QT interval, the question mentions that patient has
underwent blood transfusion recently, the treatment of this ECG is:
A. Calcium gluconate
B. Procainamide
C. Amiodarone

54. Patient undergoing sleeve gastrectomy, near the end of surgery, there is high airway
resistance, desaturation and hypotension, what is the best management:
A. Deflate the abdomen
B. Insert chest tube on right side
C. Add PEEP

55. A patient with a history of recent abuse of drug (type of Cannabinoids), what is anesthetic
considerations?
A. Increase risk of neuroleptic malignant syndrome
B. Increase MAC
C. Hyperdynamic state

56. Patient in ICU has central line develops fever, blood tests revealed candemia, what is the
best next step:
A. Start antibiotics
B. Change central line over wire
C. Change central line to new locations, irrespective of culture results
D. Change central line if suspected to be the source

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57. Most common cause of paraplegia after surgery:
A. Spinal cord embolism
B. Thrombosis
C. Hypotension
D. Stroke

58. Which drug has similar effects to ketamine:

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

59. All of the following can cause hypoxemia, except:

A. Shivering
B. Hypotension
C. Hypothermia
D. Acidosis

60. Absolute contraindication for spinal anesthesia is:

A. Severe hypovolemia
B. Coagulopathy
C. Systemic sepsis
D. Aortic stenosis

61. Regarding neuroleptic malignant syndrome, one is false:

A. 20% lipid emulsion should be given

62. Regarding pheochromocytoma, one is true:

A. Alpha blockers may decrease mortality

63. What is the most predicted physiological changes following ECT therapy?
A. Parasympathetic stimulation followed by sympathetic stimulation

64. Contraindication for spinal anesthesia for CS

A. Patient with severe psychiatric disorder

65. Opioid side effect most resistant for tolerance is:

A. Constipation and miosis

66. Question about patient has ICD and is to undergo ESWL

67. Question about indications for thoracotomy

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68. Patient with rivaroxaban overdose needs urgent surgery
69. Question about pregnant lady with moderate aortic stenosis
70. Question about ulnar nerve injury
71. Question about sedation for anxious patients
72. A question about hyperdynamic obstructive cardiomyopathy
73. Question about morphine metabolites
74. Lowest acceptable hemoglobin level before transfusion in healthy patient?

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