A new intravenous anaesthetic is found to have a very large volume of distribution. This drug is most likely to have which of the following properties?
Hydrophilic with a high degree of plasma protein binding
Hydrophilic with a large non-ionized fraction
Hydrophilic with a low degree of tissue protein binding
Lipophilic with a high degree of tissue protein binding
Each of the following drugs causes enhanced activity of the gamma-aminobutyric acid receptor EXCEPT:
Etomidate
Midazolam
Ketamine
Propofol
What is the primary purpose of denitrogenation prior to anesthetic induction?
Improving matching of ventilation and perfusion
Increasing oxygen reserve in the functional residual capacity
Increasing contribution of second gas effect to rate of induction
Maximising arterial oxygen content
Which one of the following factors exerts the greatest effect on the extent of spread of local anesthetic following subarachnoid block with hyperbaric Bupivacaine?
Patient position
Barbotage
Added epinephrine
Total dose of drug
Which one of the following best describes the reason for the rapid offset of effect of the induction agents?
Ester hydrolysis
Liver metabolism
Renal excretion
Redistribution
If 50% Nitrous oxide is inhaled for 3 days
The lymphocyte count falls
Vit B12 deficiency anaemia develops
Megaloblastic bone marrow changes occur
Peripheral neuropathy develops
Which one of the following structures is not encountered during direct laryngoscopy?
Vallecula
Cricoid Cartilage
Epiglottis
Arytenoid Cartilage
Regarding the comparative consideration of epidural ad spinal anaesthesia, which one of the following is CORRECT?
A postdural puncture headache is a potential complication that occurs with both spinal and epidural techniques
The epidural space is identified by puncture of the dura and free flow of cerebral spinal fluid
The lumbar puncture for spinal anesthesic should be performed above L1 to avoid trauma to the cauda equina
Epidural anaesthesia is usually faster in onset than spinal anaesthesia
The narrowest portion of the neonate's airway is at the level of the
Glottis
Pharynx
Trachea
Cricoid
All but one of the following are contraindications to succinylcholine. Indicate the exception
Cervical spinal cord injury (1 week ago)
Malignant hyperthermia susceptibility
Monoamine oxidase administration
Burn injury (24 hours ago)
A 17-year-old boy develops pulmonary edema after resolution of postoperative laryngospasm. While breathing 100% oxygen, SpO2 is 80%. Which of the following is the most appropriate management?
Administration of albuterol
Positive-pressure ventilation
Infusion of nitroglycerin
Administration of furosemide
Which one of the following conditions is not associated with upregulation of the postjunctional acetylcholine receptors at the neuromuscular junction?
Myasthenia gravis
Burn injuries
Prolonged bed rest
Prolonged use of neuromuscular blocking agents
The right lung has
One fissure
No Sibson’s fascia
Seven bronchopulmonary segments
Two pulmonary veins
At 30°C
Oxygen consumption is one-third that at 37°C
Active rewarming should be commenced
Oxygen solubility is raised
Carbon dioxide solubility is reduced
If 50% nitrous oxide is inhaled for 3 days
Vit. B12 deficiency anaemia develops
Methionine svnthetase activity is reduced
A volatile liquid is allowed to equilibrate with a mixture of gases. The resulting partial pressure of the vapour will depend on
Atmospheric pressure
The surface area of the liquid
Ambient temperature
The volume of liquid
A 36-year-old woman is receiveing general anesthesia for a diagnostic laparoscopy in the Trendelenburg position with carbon dioxide insufflation. During a 15-minute period after induction. her SpO2 decreases from 99% to 90% and PetCO2 increases from 38 to 43 mmHg. FiO2 is 0.3; all ventilator settings have been constant. Which of the following is the most likely cause of the decrease in SpO2?
Carbon dioxide embolus
Decreased diaphragmatic excursion
Compression of the vena cava
Pnemnothorax
Which one of the following best explains the failure of nondepolarizing neuromuscular blocking agents to produce fasciculation?
Absence of acetylcholine receptor activation
Binding in the ion channel of the acetylcholine receptor
Binding to agonist and antagonist sites on the acetylcholine receptor
Binding to presynaptic and postsynaptic acetylcholine receptors
About Nitrous oxide we can say
N2O forbidden in low flow anesthesia
It can stabile the patient with increased intracranial pressure
N2O reduces the preen house effect
It leads to a reduction of supplementary opioids and anesthetics
Hypotension is least likely to occur following induction with which of the following anesthetic agents?
Methohexital
The complete absence of a capnographic waveform immediately following endotracheal intubaion may indicate all but one of the following. Indicate the exception:
Cardiac arrest
Endobronchial intubation
Complete airway obstruction
Esophageal intubation
All but one of the following conditions will cause the capnograph to give a reading that is much lower than the arterial CO2. Indicate the exception.
Exhausted CO2 absorber soda lime
Pulmonary embolus
Severe bronchospasm
Early signs and symptoms of local anesthetic toxicity include all but one of the following. Indicate the exception:
Tinnitus
Perioral numbness
Dizziness
Hypertension
Which one of the following most closely describes the MAC of three commonly-used volatile anesthetic agents?
Desflurane 6%: Sevoflurane !%; Isoflurane 2%
Desflurane 2%: Sevoflurane 6%; Isoflurane 1%
Desflurane 6%: Sevoflurane 2%; Isotlurane 1%
Desflurane 2%: Sevoflurane 1%: Isoflurane 6%
In a patient receiving pressure support ventilation, pressure support breaths are triggered by achieving which of the following preset milestones? ??
An increase in airway pressure
A decrease in airway pressure
An inspiratory flow rate
An inspired volume
In the early detection of an air embolism, the following is useful
PetCO2
ECG
Fall in blood pressure
Change in ventilatory pattern
A direct relationship to the azygos vein
All but one of the following describe the CO2 absorber. Indicate the exention
Changes colour as the soda lime becomes exhausted
Is required if a circle circuit is being used
Provides a waveform of exhaled carbon dioxide
Allows for economical use of anaesthetic gases
Two hours after a laparoscopic cholecystectomy, an obese 45-year-old woman is receiving intravenous patient-controlled analgesia with morphine. Her SpO2 is 92% on room air. Which ONE of the following is the most likely?
Absorption of carbon dioxide from the abdomen
Hypoventilation
Impaired oxygen diffusion
Increased dead space
About N2O we can say
It leads to a reduction of supplementary opioids and anesthetia
The use prevents vomiting!
N2O is forbidden in low flow anesthsia
N2O reduces the green house effect
Suxamethonium does not cross the placenta because of
Placental cholinesterase
High protein binding
It being an elongated molecule
Its high degree of ionization
Isoflurane
Has a similar boiling point to enflurane
Has a MAC of 0.56% in oxygen
Has a lower blood/gas coefficient than halothane
Is extensively metabolised
After induction of anesthesia, the anesthesiologist is unable to intubate the patient. Which one of the following is the most important management priority?
Ensuring that intubation is achieved as soon as possible
Ensuring that bag-mask ventilation is achievable
Inserting a laryngeal mask
Ensuring that the patient does not awaken until intubation is successfully achieved
The abbreviation “MAC” stands for
Minimal alveolar concentration
Minimal arterial concentration
Maximal arterial concentration
Maximal alveolar concentration
Shivering can lead to all but one of the following. Indicate the exception:
Interference with monitor signal interpretation
Increased oxygen consumption ,
Increased anesthesia requirements
Decreased carbon dioxide production
(Var 4 10) All but one of the following are disadvantages of general anesthesia for Caesarian section. Indicate the exception ???
Increased rise of inspiration in the pregnant patient
Increases risk of unawareness under anesthesia
Exacerbation of ?
Pressure support ventilation
Delivers a specified volume regardless of airway pressure
Can only be used in a spontaneously breathing patient
Can not be used in conjunction with continuous positive airway pressure
Increases the work of breathing
The following commonly contributes to poor oxygenation during general anaesthesia
Atelectasis
Hyperventilation
Hypersensitive chemoreceptors
Increased metabolic rate
The trachea
Begins at C4 and ends at T6
Is supplied entirely by the bronchial arteries
Is lined by transitional epithelium
Is narrowest at the level of the cricoid in a child
An adult breathing 100% oxygen at sca level may suffer from
Permanent visual damage
Convulsions
Retrosternal chost pain
Immediately after complete transection of the spinal cord, the following occur
Loss of sensation but no loss of power
Flaccid paralysis with loss of sensation end reflexes
Loss of motor function and sensation with no loss of reflexes
Loss of power but no loss of sensation
All but one of the following are contraindications to post-operative epidural analgesia. Indicate the exception
Multiple sclerosis
Hypertrophic obstructive cardiomyopathy
Lumbar disc disease
The primary toxic effect of Bupivacaine on the cardiovascular system is
Blockade of norepinephrine release
Coronary vasoconstriction
Delay of ventricular repolarization
Increased atrial excitability
Redistribution from the brain to which of the following sites is primarily responsible for emergence after a single dose of Propotol?
Fat
Skeletal muscle
Lung
Liver
About the MAC we can say ???
To low level (< 0,7 MAC) can lead to awareness
To high level (> 1,3 MAC) can lead to postoperative delirium
To low level (< 1,3 MAC) can lead to postoperative vomiting
The MAC depends on the gender and the body weight of the patient
Insufficient maternal concentration
You see a patient in the preoperative assessment clinic prior to her laparatomy for colon cancer. If the patient has an epidural inserted for post-operative pain she is likely to experience all but one of the following. Indicate the exception
Reduced adrenal activation
Improved respiratory function
Excellent post-operative pain control
All but one of the following are ways to confirm endotracheal intubation. Indicate the exception
Auscultation of both lung fields and over the stomach
Easy advancement of the endotracheal tube without resistance
Visualisation of the endotracheal tube through tube through the vocal cords
Presence of a stable CO2 trace on the end-tidal capnography
