ANESTHESIOLOGY FINAL EXAM PREP VERIFIED ANSWERS AND
QUESTIONS -MOST RECENT EDITION 2026/2027
280 Multiple Choice Questions with Answers & Explanations
Topics: Pharmacology • Airway Management • Regional Anesthesia • Monitoring •
Respiratory • Cardiovascular • Fluid Management • Obstetrics • Pediatrics •
Neuroanesthesia • Critical Care • Pain Management • Thoracic & Cardiac Surgery
Q1. Which inhalational agent has the lowest blood-gas partition coefficient?
A) Halothane
B) Isoflurane
C) Desflurane
D) Sevoflurane
Answer: C) Desflurane
Explanation: Desflurane has a blood-gas partition coefficient of 0.42, the lowest
among modern inhalational agents, resulting in the fastest emergence.
Q2. The minimum alveolar concentration (MAC) of sevoflurane in a healthy adult is
approximately:
A) 0.75%
B) 1.15%
C) 2.0%
D) 6.0%
Answer: C) 2.0%
Explanation: Sevoflurane MAC is approximately 2.0% in a 40-year-old adult. MAC
decreases with age and increases with hyperthermia.
Q3. Which opioid is best avoided in renal failure due to accumulation of active
metabolites?
A) Fentanyl
B) Morphine
C) Remifentanil
D) Methadone
Answer: B) Morphine
Explanation: Morphine-6-glucuronide (M6G) is an active metabolite that
accumulates in renal failure and can cause prolonged respiratory depression.
,Q4. Succinylcholine works by:
A) Competitive antagonism at nicotinic receptors
B) Persistent depolarization of the motor end-plate
C) Inhibiting acetylcholinesterase
D) Blocking voltage-gated sodium channels
Answer: B) Persistent depolarization of the motor end-plate
Explanation: Succinylcholine is a depolarizing neuromuscular blocker that mimics
acetylcholine and causes sustained depolarization, preventing repolarization needed
for muscle contraction.
Q5. Neostigmine reverses non-depolarizing neuromuscular blockade by:
A) Competitively binding at nicotinic receptors
B) Inhibiting acetylcholinesterase
C) Releasing acetylcholine from nerve terminals
D) Directly activating nicotinic receptors
Answer: B) Inhibiting acetylcholinesterase
Explanation: Neostigmine inhibits acetylcholinesterase, increasing acetylcholine at
the NMJ to compete with and displace the non-depolarizing blocker.
Q6. Propofol's primary mechanism of action is:
A) NMDA receptor antagonism
B) Alpha-2 adrenoreceptor agonism
C) GABA-A receptor potentiation
D) Opioid receptor agonism
Answer: C) GABA-A receptor potentiation
Explanation: Propofol potentiates GABA-A receptor-mediated chloride channel
opening, resulting in CNS depression and hypnosis.
Q7. Which drug is used to reverse the effects of sugammadex?
A) Neostigmine
B) Atropine
C) There is no reversal for sugammadex
D) Flumazenil
Answer: C) There is no reversal for sugammadex
Explanation: Sugammadex encapsulates rocuronium/vecuronium. There is currently
no approved reversal agent for sugammadex itself.
Q8. Ketamine's primary mechanism of action is:
A) GABA-A potentiation
B) NMDA receptor antagonism
, C) Mu opioid agonism
D) Alpha-2 agonism
Answer: B) NMDA receptor antagonism
Explanation: Ketamine is a non-competitive NMDA receptor antagonist. It produces
dissociative anesthesia while preserving airway reflexes and cardiovascular function.
Q9. Which benzodiazepine has the shortest context-sensitive half-time for
anesthesia?
A) Diazepam
B) Lorazepam
C) Midazolam
D) Clonazepam
Answer: C) Midazolam
Explanation: Midazolam has the shortest half-life among commonly used
benzodiazepines (~2 hours), making it preferred for perioperative use.
Q10. The reversal agent for benzodiazepines is:
A) Naloxone
B) Flumazenil
C) Sugammadex
D) Neostigmine
Answer: B) Flumazenil
Explanation: Flumazenil is a competitive GABA-A receptor antagonist that reverses
benzodiazepine effects. Its short duration may require repeat dosing.
Q11. Dexmedetomidine primarily acts on:
A) Beta-1 adrenergic receptors
B) Alpha-2 adrenergic receptors
C) Mu-opioid receptors
D) NMDA receptors
Answer: B) Alpha-2 adrenergic receptors
Explanation: Dexmedetomidine is a selective alpha-2 adrenergic agonist providing
sedation, analgesia, and anxiolysis without significant respiratory depression.
Q12. Which inhalational agent is most likely to cause hepatotoxicity?
A) Sevoflurane
B) Desflurane
C) Halothane
D) Isoflurane
Answer: C) Halothane
, Explanation: Halothane hepatitis is a rare but serious complication. Oxidative
metabolism of halothane produces trifluoroacetyl chloride, which can trigger immune-
mediated hepatitis.
Q13. Rocuronium's onset time is approximately:
A) 30 seconds
B) 60-90 seconds
C) 5 minutes
D) 10 minutes
Answer: B) 60-90 seconds
Explanation: Rocuronium has an onset of approximately 60-90 seconds at intubating
doses (0.6-1.2 mg/kg), faster than most non-depolarizing agents.
Q14. Remifentanil is unique among opioids because it is:
A) Metabolized entirely by the liver
B) Metabolized by plasma esterases
C) Excreted unchanged by the kidneys
D) Not metabolized at all
Answer: B) Metabolized by plasma esterases
Explanation: Remifentanil is hydrolyzed by nonspecific plasma and tissue esterases,
giving it an ultra-short context-sensitive half-time (~3-5 min) regardless of infusion
duration.
Q15. The MAC-awake for most volatile anesthetics is approximately what fraction
of MAC?
A) 0.1 MAC
B) 0.33 MAC
C) 0.5 MAC
D) 0.75 MAC
Answer: B) 0.33 MAC
Explanation: MAC-awake (concentration at which 50% of patients respond to
commands) is approximately 0.33 MAC for most volatile agents.
Q16. Which drug causes 'coronary steal' in patients with coronary artery disease?
A) Halothane
B) Isoflurane
C) Sevoflurane
D) Desflurane
Answer: B) Isoflurane
Explanation: Isoflurane is a potent coronary vasodilator that may cause coronary
steal syndrome by preferentially dilating non-stenotic vessels.
QUESTIONS -MOST RECENT EDITION 2026/2027
280 Multiple Choice Questions with Answers & Explanations
Topics: Pharmacology • Airway Management • Regional Anesthesia • Monitoring •
Respiratory • Cardiovascular • Fluid Management • Obstetrics • Pediatrics •
Neuroanesthesia • Critical Care • Pain Management • Thoracic & Cardiac Surgery
Q1. Which inhalational agent has the lowest blood-gas partition coefficient?
A) Halothane
B) Isoflurane
C) Desflurane
D) Sevoflurane
Answer: C) Desflurane
Explanation: Desflurane has a blood-gas partition coefficient of 0.42, the lowest
among modern inhalational agents, resulting in the fastest emergence.
Q2. The minimum alveolar concentration (MAC) of sevoflurane in a healthy adult is
approximately:
A) 0.75%
B) 1.15%
C) 2.0%
D) 6.0%
Answer: C) 2.0%
Explanation: Sevoflurane MAC is approximately 2.0% in a 40-year-old adult. MAC
decreases with age and increases with hyperthermia.
Q3. Which opioid is best avoided in renal failure due to accumulation of active
metabolites?
A) Fentanyl
B) Morphine
C) Remifentanil
D) Methadone
Answer: B) Morphine
Explanation: Morphine-6-glucuronide (M6G) is an active metabolite that
accumulates in renal failure and can cause prolonged respiratory depression.
,Q4. Succinylcholine works by:
A) Competitive antagonism at nicotinic receptors
B) Persistent depolarization of the motor end-plate
C) Inhibiting acetylcholinesterase
D) Blocking voltage-gated sodium channels
Answer: B) Persistent depolarization of the motor end-plate
Explanation: Succinylcholine is a depolarizing neuromuscular blocker that mimics
acetylcholine and causes sustained depolarization, preventing repolarization needed
for muscle contraction.
Q5. Neostigmine reverses non-depolarizing neuromuscular blockade by:
A) Competitively binding at nicotinic receptors
B) Inhibiting acetylcholinesterase
C) Releasing acetylcholine from nerve terminals
D) Directly activating nicotinic receptors
Answer: B) Inhibiting acetylcholinesterase
Explanation: Neostigmine inhibits acetylcholinesterase, increasing acetylcholine at
the NMJ to compete with and displace the non-depolarizing blocker.
Q6. Propofol's primary mechanism of action is:
A) NMDA receptor antagonism
B) Alpha-2 adrenoreceptor agonism
C) GABA-A receptor potentiation
D) Opioid receptor agonism
Answer: C) GABA-A receptor potentiation
Explanation: Propofol potentiates GABA-A receptor-mediated chloride channel
opening, resulting in CNS depression and hypnosis.
Q7. Which drug is used to reverse the effects of sugammadex?
A) Neostigmine
B) Atropine
C) There is no reversal for sugammadex
D) Flumazenil
Answer: C) There is no reversal for sugammadex
Explanation: Sugammadex encapsulates rocuronium/vecuronium. There is currently
no approved reversal agent for sugammadex itself.
Q8. Ketamine's primary mechanism of action is:
A) GABA-A potentiation
B) NMDA receptor antagonism
, C) Mu opioid agonism
D) Alpha-2 agonism
Answer: B) NMDA receptor antagonism
Explanation: Ketamine is a non-competitive NMDA receptor antagonist. It produces
dissociative anesthesia while preserving airway reflexes and cardiovascular function.
Q9. Which benzodiazepine has the shortest context-sensitive half-time for
anesthesia?
A) Diazepam
B) Lorazepam
C) Midazolam
D) Clonazepam
Answer: C) Midazolam
Explanation: Midazolam has the shortest half-life among commonly used
benzodiazepines (~2 hours), making it preferred for perioperative use.
Q10. The reversal agent for benzodiazepines is:
A) Naloxone
B) Flumazenil
C) Sugammadex
D) Neostigmine
Answer: B) Flumazenil
Explanation: Flumazenil is a competitive GABA-A receptor antagonist that reverses
benzodiazepine effects. Its short duration may require repeat dosing.
Q11. Dexmedetomidine primarily acts on:
A) Beta-1 adrenergic receptors
B) Alpha-2 adrenergic receptors
C) Mu-opioid receptors
D) NMDA receptors
Answer: B) Alpha-2 adrenergic receptors
Explanation: Dexmedetomidine is a selective alpha-2 adrenergic agonist providing
sedation, analgesia, and anxiolysis without significant respiratory depression.
Q12. Which inhalational agent is most likely to cause hepatotoxicity?
A) Sevoflurane
B) Desflurane
C) Halothane
D) Isoflurane
Answer: C) Halothane
, Explanation: Halothane hepatitis is a rare but serious complication. Oxidative
metabolism of halothane produces trifluoroacetyl chloride, which can trigger immune-
mediated hepatitis.
Q13. Rocuronium's onset time is approximately:
A) 30 seconds
B) 60-90 seconds
C) 5 minutes
D) 10 minutes
Answer: B) 60-90 seconds
Explanation: Rocuronium has an onset of approximately 60-90 seconds at intubating
doses (0.6-1.2 mg/kg), faster than most non-depolarizing agents.
Q14. Remifentanil is unique among opioids because it is:
A) Metabolized entirely by the liver
B) Metabolized by plasma esterases
C) Excreted unchanged by the kidneys
D) Not metabolized at all
Answer: B) Metabolized by plasma esterases
Explanation: Remifentanil is hydrolyzed by nonspecific plasma and tissue esterases,
giving it an ultra-short context-sensitive half-time (~3-5 min) regardless of infusion
duration.
Q15. The MAC-awake for most volatile anesthetics is approximately what fraction
of MAC?
A) 0.1 MAC
B) 0.33 MAC
C) 0.5 MAC
D) 0.75 MAC
Answer: B) 0.33 MAC
Explanation: MAC-awake (concentration at which 50% of patients respond to
commands) is approximately 0.33 MAC for most volatile agents.
Q16. Which drug causes 'coronary steal' in patients with coronary artery disease?
A) Halothane
B) Isoflurane
C) Sevoflurane
D) Desflurane
Answer: B) Isoflurane
Explanation: Isoflurane is a potent coronary vasodilator that may cause coronary
steal syndrome by preferentially dilating non-stenotic vessels.
