NAGELHOUT TEST PAPER QUESTIONS AND
SOLUTIONS 2026 GRADED A+
◉ Atypical Pseudocholinesterase Activity
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number. Answer: 1. Ea, Ea
2. 0.3%
3. Decreased by ≥70%
4. Significantly prolonged; 4-24 hours
5. 16-30
◉ Esterases found in red blood cells (2). Answer: 1. RBC esterase
2. Acetylcholinesterase
◉ Acetylcholinesterase
1. Other names
2. Location. Answer: 1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
,◉ Pseudo-cholinesterase
1. Other names
2. Location. Answer: 1. Plasma, serum, benzoyl, false, butytyl,
nonspecific, Type II
2. Plasma, liver, smooth muscle, intestines, pancreas, heart, white
matter of brain
◉ Moderate neuromuscular symptoms of decreased PChE seen at
___% normal avtivity. Answer: 60%
◉ Severe neuromuscular symptoms of decreased PChE seen at ___%
normal avtivity. Answer: 20%
◉ Two steps of Succinylcholine breakdown. Answer: Succinylchoine
1. Succinylmonocholine + Choline
2. Succinylmonocholine → Succinic Acid + Choline
◉ Succinylcholine breakdown stimulated by this enzyme. Answer:
Pseudocholinesterase (plasma cholinesterase)
◉ Anesthesia drugs that are Pseudocholinesterase dependent (7).
Answer: - Succinylchoine
, - Ester local anesthetics (cocaine, procaine, chloroprocaine,
tetracaine)
- Neostigmine
- Edrophonium
◉ Anesthesia drugs that are Non-specific esterase dependent (5).
Answer: - Atracurium
- Cisatracurium
- Remifentanil
- Clevidipine
- Remimazolam
◉ Anesthesia drugs that are RBC esterase dependent (1). Answer:
Esmolol
◉ Contraindications for Succinylcholine use (13). Answer: 1.
Hyperkalemia
2. Third degree burn (≥35% tbsa, 3rd degree)
3. Severe muscle trauma
4. Neurological injury (paraplegia, quadriplegia)
5. Hyperkalemia due to renal failure
6. Severe sepsis
SOLUTIONS 2026 GRADED A+
◉ Atypical Pseudocholinesterase Activity
1. Genetic makeup
2. Frequency of the population
3. Enzyme activity
4. Duration of Succ.
5. Dibucaine number. Answer: 1. Ea, Ea
2. 0.3%
3. Decreased by ≥70%
4. Significantly prolonged; 4-24 hours
5. 16-30
◉ Esterases found in red blood cells (2). Answer: 1. RBC esterase
2. Acetylcholinesterase
◉ Acetylcholinesterase
1. Other names
2. Location. Answer: 1. True, specific, genuine, Type 1
2. Erythrocytes, nerve endings, lungs, spleen, grey matter of brain
,◉ Pseudo-cholinesterase
1. Other names
2. Location. Answer: 1. Plasma, serum, benzoyl, false, butytyl,
nonspecific, Type II
2. Plasma, liver, smooth muscle, intestines, pancreas, heart, white
matter of brain
◉ Moderate neuromuscular symptoms of decreased PChE seen at
___% normal avtivity. Answer: 60%
◉ Severe neuromuscular symptoms of decreased PChE seen at ___%
normal avtivity. Answer: 20%
◉ Two steps of Succinylcholine breakdown. Answer: Succinylchoine
1. Succinylmonocholine + Choline
2. Succinylmonocholine → Succinic Acid + Choline
◉ Succinylcholine breakdown stimulated by this enzyme. Answer:
Pseudocholinesterase (plasma cholinesterase)
◉ Anesthesia drugs that are Pseudocholinesterase dependent (7).
Answer: - Succinylchoine
, - Ester local anesthetics (cocaine, procaine, chloroprocaine,
tetracaine)
- Neostigmine
- Edrophonium
◉ Anesthesia drugs that are Non-specific esterase dependent (5).
Answer: - Atracurium
- Cisatracurium
- Remifentanil
- Clevidipine
- Remimazolam
◉ Anesthesia drugs that are RBC esterase dependent (1). Answer:
Esmolol
◉ Contraindications for Succinylcholine use (13). Answer: 1.
Hyperkalemia
2. Third degree burn (≥35% tbsa, 3rd degree)
3. Severe muscle trauma
4. Neurological injury (paraplegia, quadriplegia)
5. Hyperkalemia due to renal failure
6. Severe sepsis
