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Which of the following statements is FALSE? • !When anesthesia is properly delivered, pain prevention is an important aspect of the care. • !Surgery can be performed under conditions of normal sleep. • !Patients may be iatrogenically paralyzed in the course of their surgery. • !General anesthesia is similar to a reversible coma. • !The anesthesia will eliminate all memory of the surgical experience itself. Which of the following statements regarding memories of being operated on is TRUE? • !A patient will typically not remember being introduced to the OR team. • !A patient will not remember entering the operating room. • !The anesthesia will eliminate some but not all of the memory of the surgical experience itself. • !Often, patients will wake up during the surgical procedure. • !Proper anesthesia will prevent memories of a procedure from re-forming postoperatively. There was no known way to provide anesthesia to those undergoing surgery before what year? • !1923 • !1946 • !1846 • !1885 • !1900 What substance did Horace Wells initially use for anesthesia? • !Opium • !Ketamine • !Alcohol • !Orange ether !Nitrous oxide Which substance did William Morton initially use for general anesthesia at Massachusetts General? • • • • •

Alcohol Ether Nitrous oxide Chloroform Opium

What substance was first used as obstetrical anesthesia on Queen Victoria in 1853? • • • • •

Alcohol Chloroform Nitrous oxide Opium Ether

Which of the following was FIRST used for local anesthesia? • • • • •

Nitrous oxide Cocaine Ether Opium Chloroform

Which of the following ratios MOST accurately reflects the mortality rate from general anesthesia in developed countries? • • • • •

1:75,000 1:50,000 1:100,000 1:10,000 1:25,000

Which of the following statements about anesthetic vapors is TRUE? • • • • •

Anesthetic vapors increase the tidal volume. Anesthetic vapors lead to an overall increase in minute ventilation. Anesthetic vapors decrease the breathing rate. Anesthetic vapors reduce the breathing center’s response to changes in PaCO2. Anesthetic vapors increase the brain’s response to rising carbon dioxide in the blood.

General anesthesia depresses ventilation and the brain’s response to rising carbon dioxide. Which of the following is NOT a way the anesthesiologist responds to these changes? • • •

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Assist the patient in breathing. Allow the patient to breath spontaneously, but with a reduced minute ventilation. After initial anesthesia is administered, there are no additional interventions available for the anesthesiologist to alter the patient’s PaCO2. Give the patient a respiratory stimulant. Carefully monitor the patient’s expired carbon dioxide level, and adjust the ventilation to maintain a tolerated level of carbon dioxide.

Which of the following BEST describes the relationship between alveolar ventilation and PaCO2 in a patient who has been given large doses of opioids or inhalational agents? •

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As PaCO2 increases, alveolar ventilation will decrease, but at a steeper slope compared with the awake state or compared with a patient receiving a sedative dose of opioids. As PaCO2 increases, alveolar ventilation will decrease, but at a more gradual slope compared with the awake state or compared with a patient receiving a sedative dose of opioids. As PaCO2 increases, alveolar ventilation also increases, but this occurs at a more gradual slope compared with the awake state and at a steeper slope compared with a patient receiving a sedative dose of opioids. As PaCO2 increases, alveolar ventilation also increases, but at a more gradual slope compared with the awake state or compared with a patient receiving a sedative dose of opioids. As PaCO2 increases, alveolar ventilation also increases, but at a steeper slope compared with the awake state or compared with a patient receiving a sedative dose of opioids.

Which of the following statements regarding ventilation is FALSE? • • •

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Mechanical ventilation makes it very easy to control the patient’s minute ventilation. Spontaneous ventilations are often associated with an increase in carbon dioxide and respiratory alkalosis. Whether the patient is breathing spontaneously or being mechanically ventilated, the patient's expired carbon dioxide and SaO2 must be constantly monitored. With mechanical ventilation, it is easy to overventilate a patient, which can lead to respiratory alkalosis. Mechanical ventilation requires instrumentation of the patient’s airway, increasing the risk of complications.

Which of the following statements regarding anesthesia is FALSE? • • • • •

The decrease in peripheral resistance caused by modern anesthetic vapors may allow the heart to contract more fully. Modern anesthetic vapors will reduce the contractility of the heart, reducing cardiac output. Induction drugs, such as thiopentone and propofol, have profound effects in reducing cardiac contractility. Modern anesthetic vapors frequently reduce peripheral resistance, which can cause a drop in blood pressure. Use of opioids will lead to a slowing of the heart rate but have little effect on contractility.

Which of the following statements about cardiac function and vapors is FALSE? • • • • •

Isoflurane and desflurane both cause a profound drop in peripheral resistance. Older vapors, such as halothane and isoflurane, will result in a continual drop in cardiac output, particularly as the vapor’s concentration is increased. Inhalation of most vapors will result in a decrease in heart rate. Essentially all vapors cause a decrease in mean arterial pressure. The decrease in peripheral resistance from certain vapors can have beneficial cardiac effects but may also result in decreased blood flow to organs and hypotension.

Ketamine is used occasionally as an induction anesthetic. Which of the following statements about ketamine is FALSE? • • • • •

Ketamine decreases blood pressure. In addition to its induction effects, ketamine acts as a painkiller, so fewer opioids have to be used to prevent excessive sedation. Ketamine increases blood pressure. Ketamine increases the heart rate. Upon waking after receiving ketamine, patients may experience emergence phenomena.

Which of the following statements regarding general anesthesia is FALSE? • •

• • •

Ephedrine, phenylephrine, epinephrine, and norepinephrine are all used to increase blood pressure and decrease heart rate. Etomidate is occasionally used in patients with brain trauma because it has little effect on the cardiovascular system and maintains cerebral oxygen delivery. Rapid heart rates can increase the work of the heart and increase its need for oxygen. Low blood pressure can reduce blood flow and thus, oxygen supply to vital organs. A blood pressure that is too high can lead to strokes and increase cardiac function.

Hemostasis is the balance between bleeding and blood-clotting; which of the following will not impact hemostasis? • • • • •

Anesthesia drugs Leukemia Anticoagulants Hemophilia A Massive trauma

Which of the following is FALSE regarding heparin use? • • • • •

Large doses of heparin are used in vascular surgery to prevent clotting during the repair of blood vessels. The effects of heparin cannot be medically reversed. Heparin can cause profound bleeding if not managed properly. Heparin is often used in cardiac surgery. It is up to the anesthesiologist to give the heparin, monitor its effects and reverse it as the surgery is ending.

which of the following statements about anesthesia and acid-base balance is FALSE? • • • •

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Anesthesia typically has an adverse effect on acid-base status. Kidney disease patients require acid-base status monitoring during surgery. It is the duty of the anesthesiologist to monitor acid-base status and to correct adverse changes during surgery. Though anesthesia itself does not adversely affect the acid-base status, it has an impact on cardiac and respiratory function, which, in turn, influences acidbase balance. The anesthesiologist must aggressively resuscitate patients who have become volume depleted through trauma and bleeding disorders.

Which of the following statements about the oxygen dissociation curve is CORRECT? • • • • •

An increase in BPG will move the oxygen dissociation curve to the left. An increase in temperature moves the dissociation curve to the left. A decrease in pH will move the oxygen dissociation curve to the left. A decrease in BPG moves the oxygen dissociation curve to the left. A decrease in temperature moves the dissociation curve to the right.

Which of the following statements about anesthesia and acid-base balance is FALSE? • • • • •

Under-ventilation can allow carbon dioxide to increase. Anesthetic drugs themselves have a profound impact on the body’s pH. Overbreathing, resulting from hyperventilation causes a drop in blood carbon dioxide. If bicarbonate is reduced in a patient with mild respiratory acidosis and metabolic acidosis is present, all body functions are adversely affected. Mild respiratory acidosis is usually well-tolerated.

Which of the following statements about anesthesia and acid-base balance is FALSE? • • • • •

Kidney disease is particularly relevant to acid-base regulation and can cause metabolic acidosis through a loss in the production of buffers. Hypovolemia leads to metabolic acidosis through a reduction in blood supply to tissues. Hypoxemia is defined as low oxygen delivery in the blood. Reduction in blood flow can cause hypoxia. Hypoxia but not hypoxemia can cause tissue acidosis.

Which of the following statements about nitrous oxide is TRUE? • • • •

It is the original sedative vapor used in anesthesia. It is a gas that is a weak anesthetic. It can produce satisfactory anesthesia for major surgery on its own. It is useful as an inhalational induction drug.

Which of the following properties does nitrous oxide have? • • • • •

Strong anesthetic effect High fat solubility Rapid action onset Delayed action offset No analgesic effect

Which of the following reasons explains why nitrous oxide is no longer used as the mainstream anesthetic? • • • • •

Its rapid action offset The absence of any narcotic effect Its inadequate anesthetic action when used for major procedures Its accumulation in body gas spaces, resulting in healing problems The need for supplementation with other anesthetic agents

Which of the following statements about anesthetic vapors is TRUE? • • • •

They have excellent analgesic properties. They are all useful for inhalational induction of anesthesia. They are all extremely fat-soluble, so they last for only a short time. They vary in potency and effect on the heart.

Which of the following is a common feature between all old and new vapors? • • • • •

Low safety level High fat solubility Absence of analgesic properties In the gas state at room temperature Rapid onset and offset of action

In what way does sevoflurane differ from desflurane? • • • • •

Drug-induced amnesia properties Presence of analgesic properties Suitability for inhalation induction Nausea and vomiting risk Malignant hyperthermia risk

Which of the following statements about propofol is TRUE? • • • •

It produces profound analgesia, so it can be used without supplemental opioids. It can produce profound hypotension. It is very easy to use and has a very wide safety margin. It has little or no effect on the heart.

Which of the following combined anesthesia induction drugs may cause myocardial depression? • • • • •

Ketamine and etomidate Thiopental and propofol Etomidate and thiopental Propofol and etomidate Propofol and ketamine

Which of the following statements about ketamine is TRUE? • • • • •

It has no analgesic properties. It may cause hypotension. It is not suitable for unstable patients. It may increase the heart rate. It causes adrenal suppression.

Which of the following statements about succinylcholine is TRUE? • • • •

It produces relaxation by an irreversible depolarizing block. It rarely, if ever, causes allergic reactions. The function is reversed by acetylcholinesterase. It is a useful amnestic when applied on its own.

Which of the following features does a modern anesthetic have? • • • • •

Major cardiovascular effects Absence of analgesic properties Slow action onset Contraindication in patients requiring prolonged ventilation Production of intense psychological experiences

How does succinylcholine differ from rocuronium? • • • • •

By its analgesic properties By its amnesia-causing properties By its ability to generate brief muscle contractions By its ability to pass neuromuscular junction By its ability to reach the neuromuscular end plate

Which of the following features do the newest nondepolarizing muscle relaxants have? • • • • •

Competition with acetylcholine Action similar to that of the normal neurotransmitter Action irreversibility Action termination by pseudocholinesterase Inability to pass across the neuromuscular junction

Which of the following statements about succinylcholine is TRUE? • • • •

It can help reverse an asthma attack. It causes decreased intracranial pressure. It can trigger malignant hyperthermia. It can help relieve muscle pain.

hich of the following is a contraindication of succinylcholine? • • • • •

History of head trauma History of atrial fibrillation History of aspiration pneumonia Absolute pseudo-cholinesterase deficiency Nauseated patient

Which of the following conditions is the MOST likely to be experienced after succinylcholine administration? • • • • •

Asthma attack Muscle pain Arrhythmia Vomiting Headache

Which of the following statements about non-depolarizing muscle relaxants is TRUE? • • • • •

All of them have significant cardiovascular effects. They do not compete with acetylcholine. A single dose is usually inadequate to maintain surgical paralysis. When administered, muscle fasciculations are noted. Acetylcholinesterase inhibitor administration favors their action.

Which of the following is a possible complication of rocuronium? • • • • •

Renal failure Malignant hyperthermia Muscle rigidity Asthma attack due to histamine release Prolonged paralysis, even after surgery

Which of the following features do acetylcholinesterase inhibitors have? • • • • •

The tendency to act mainly on nicotinic receptors The need for simultaneous administration of an M-blocking agent The propensity to cause tachycardia Increasing acetylcholine release in the neuromuscular junction Decreasing acetylcholine concentration in the neuromuscular junction

How does sugammadex differ from acetylcholinesterase inhibitors? • • • • •

By directly affecting the muscle relaxant drug By acting only on muscarinic receptors By exhibiting minimal effects with large doses of muscle relaxants By a slow onset of action By being cost-effective

Which of the following statements about sugammadex is TRUE? • • • • •

Its mechanism of action is irreversible. It has a linear chemical structure. It prevents the breakdown of acetylcholine. It has a strong effect on muscarinic receptors. At least 5 minutes is required for the onset of its action.

Which statement about chronic pain is TRUE? • • • •

It is an extremely common condition. It occurs most in people with a "low pain threshold." It requires intervention by doctors only. It is easily managed with opioids.

Which of the following statements about pain is TRUE? • • • • •

Pain is caused only after actual tissue damage. All types of pain are usually managed by opioids. Pain is mainly an unpleasant sensory experience. There are 2 subcategories of pain. Everyone can experience chronic pain.

Which of the following statements about chronic pain is TRUE? • • • • •

Approximately 30% of people are completely incapacitated by chronic pain. It is pain that lasts for more than 1 year. It is the most prevalent cause of disability worldwide. Surgical pain is a characteristic example of chronic pain. Its perception is different between people of different cultural backgrounds.

Which of the following is expected to increase when someone is in pain? • • • • •

Functional residual capacity Effectiveness of the immune system Alveolar ventilation Myocardial oxygen consumption Arterial oxygen content

Which of the following statements about opioids is TRUE? • • • •

They are the first-line drugs in the management of chronic pain. They have few side effects and are well tolerated by nearly all patients. They are second-line agents in the management of chronic pain. When part of an anesthetic, they provide a major component of the amnesia required for anesthesia.

Which of the following statements about analgesic drugs is TRUE? • • • • •

Analgesic drugs reversibly eliminate sensation. Paracetamol, NSAIDs, and opioids may result in tolerance, physical dependency, and addiction. Opioids act by increasing the production of enkephalins and endorphins. Analgesic drugs act only on the brain and spinal cord by reducing the perception of pain. Paracetamol, NSAIDs, and opioids are not the only drugs that can relieve pain.

Which of the following opioids is the most potent? • • • • •

Oxycodone Methadone Morphine Meperidine Sufentanil

Which of the following effects is MOST likely caused by a slow-onset, very longacting opioid, administered at normal doses? • • • • •

Tolerance Addiction Dysphoria Muscle rigidity Diarrhea

Which of the following statements about opioids is TRUE? • • • • •

Upon cessation of opioids, physical withdrawal symptoms may develop. Muscle rigidity is a relatively common side effect of opioids. Opioids act only on the brain by reducing the perception of pain. Respiratory arrest is usually seen with low doses of opioids. Opioids are mainly used for chronic pain relief.

Which of the following is MOST likely to be seen in a patient using opioids for relief of acute pain after surgery? • • • •

Physical withdrawal upon cessation of the drug and addiction Drug tolerance and physical withdrawal upon cessation of the drug Addiction only Drug tolerance and addiction

Which of the following statements about postoperative nausea and vomiting (PONV) is TRUE? • • • • •

Patients with a history of motion sickness have a higher chance of developing nausea and vomiting. An APFEL score of less than 3 indicates that the patient should only take a 5HT antagonist as prophylaxis for PONV. 5-HT antagonists are not effective as antiemetics when used alone. It is better to treat PONV than to prevent it. An APFEL score of greater than or equal to 3 indicates that the patient should receive at least 4 antiemetic drugs.

Which of the following statements about the APFEL score is TRUE? • • • • •

By using the APFEL score, one can calculate for a patient a chance of up to 90% of developing PONV. According to the APFEL score, the chance of getting PONV increases by 20% when opioids are necessary postoperatively for pain relief. According to the APFEL score, women have a lower chance of developing PONV than men do. According to the APFEL score, smokers cannot take antiemetic drugs for PONV prevention. According to the APFEL score, past history of PONV is the most important risk...