OMSITE ANESTHESIA: TEST QUESTIONS WITH ACCURATE
SOLUTIONS
1) What effect will ketamine have on the degree of regurgitation in a patient with
mitral valve prolapes with regurgitation?
A. Increase
B. Decrease
C. No effect
D. Variable -- Answer ✔✔ A.
Ketamine is discouraged in patients with mitral valve prolapse with regurgitation,
due to its sympathomimetic actions. it will increase vascular resistance and
worsen regurgitant flow.
2) Barbiturates have which of the following effects on the myocardium?
A. Directly sensitize the myocardium to arrhythmias
B. Directly increase myocardial contractility
C. Indirectly increase heart rate by inducing vasodilation
D. Indirectly increase myocardial contractility -- Answer ✔✔ C.
Barbiturates have no effect on myocardial sensitization. They decrease myocardial
contractility. Reflex tachycardia is common after an induction does of barbiturate
to compensate for the vasodilatation.
3) Ketamine's direct effect on the heart is:
A. chronotropic depression
B. chronotropic stimulation
C. inotropic depression
D. inotropic stimulation -- Answer ✔✔ C. inotropic depression
, Ketamine direct action on the myocardium is a negative inotropic effect. Its
centrally mediated sympathetic responses (indirect activation of the sympathetic
nervous system) usually override the depression. Ketamine causes an increase in
circulating catecholamines, especially norepinephrine, by inhibiting reuptake at
postganglionic sympathetic neurons.
4) Which of the following is a side effect associated with etomidate?
A. Decreased venous return and myocardial contractility
B. Intra-arterial injection causing nerve injury and gangrene
C. Adrenal suppression lasting at least 6 hours
D. Triggering of porphyria in susceptible individuals -- Answer ✔✔ C.
Etomidate maintains hemodynamic stability and has little effect on the heart.
Barbiturates are known to have severe effects associated with intra-arterial
injection. This group is also responsible for porphyria in susceptible individuals.
Etomidate causes adrenal suppression and steroid administration may be
necessary in patients already having adrenal axis suppression.
5) A 17 year-old asthmatic with a preoperative FEV1/FVC of 85% requires which
preoperative treatment prior to induction of general anesthesia?
A. Ipratropium MDI
B. Nebulized Racemic Epinephrine
C. Advair MDI
D. No treatment indicated -- Answer ✔✔ D. No treatment indicated
No treatment is required for a normal FEV1/FVC Normal = 75-85%
6) A 52 year-old obese patient with a hiatal hernia requires induction of general
anesthesia. Which premedicant could be considered to minimize the patient's risk
of respiratory problems?
A. Glycopyrrolate
B. Amitriptyline
C. Metoclopramide
D. Meperidine -- Answer ✔✔ C. Metoclopramide
, Metoclopramide would increase gastric emptying and increase esophageal
sphincter tone. This would help decrease the risk of aspiration. All other choices
decrease esophageal sphincter tone and would increase risk of aspiration.
7) A 64 year-old female presents for removal of tooth number 30 under general
anesthesia. Her past medical history is significant for rheumatic heart disease, and
subsequent mitral valve stenosis. The preoperative management of this patient
would include which of the following?
A. Decrease intravascular volume
B. Increase intravascular volume
C. Maintain a slower heart rate
D. Maintain a faster heart rate -- Answer ✔✔ C. Maintain a slower heart rate
The principal hemodynamic goals of managing patients with mitral stenosis are to
maintain a slower to normal sinus rhythm and to avoid tachycardia, larger
increases in cardiac output, and both hypovolemia and fluid overload by judicious
fluid therapy.
8) Which effect is seen with propofol?
A. Elevation of intracranial pressure
B. Increases in intraocular pressure
C. Potentiation of neuromuscular blockage
D. Increases in bronchodilation -- Answer ✔✔ D. Increases in
bronchodilation
Propofol has a direct smooth muscle effect on the bronchi, causing
bronchodilation. Propofol decreases intracranial and intraocular pressure, and it
does not potentiate neuromuscular blockade.
9) Which drug must be used with caution in a patient with a history of epilepsy?
A. Propofol
B. Fentanyl
C. Deximedetomidine
D. Methohexital -- Answer ✔✔ D. Methohexital
SOLUTIONS
1) What effect will ketamine have on the degree of regurgitation in a patient with
mitral valve prolapes with regurgitation?
A. Increase
B. Decrease
C. No effect
D. Variable -- Answer ✔✔ A.
Ketamine is discouraged in patients with mitral valve prolapse with regurgitation,
due to its sympathomimetic actions. it will increase vascular resistance and
worsen regurgitant flow.
2) Barbiturates have which of the following effects on the myocardium?
A. Directly sensitize the myocardium to arrhythmias
B. Directly increase myocardial contractility
C. Indirectly increase heart rate by inducing vasodilation
D. Indirectly increase myocardial contractility -- Answer ✔✔ C.
Barbiturates have no effect on myocardial sensitization. They decrease myocardial
contractility. Reflex tachycardia is common after an induction does of barbiturate
to compensate for the vasodilatation.
3) Ketamine's direct effect on the heart is:
A. chronotropic depression
B. chronotropic stimulation
C. inotropic depression
D. inotropic stimulation -- Answer ✔✔ C. inotropic depression
, Ketamine direct action on the myocardium is a negative inotropic effect. Its
centrally mediated sympathetic responses (indirect activation of the sympathetic
nervous system) usually override the depression. Ketamine causes an increase in
circulating catecholamines, especially norepinephrine, by inhibiting reuptake at
postganglionic sympathetic neurons.
4) Which of the following is a side effect associated with etomidate?
A. Decreased venous return and myocardial contractility
B. Intra-arterial injection causing nerve injury and gangrene
C. Adrenal suppression lasting at least 6 hours
D. Triggering of porphyria in susceptible individuals -- Answer ✔✔ C.
Etomidate maintains hemodynamic stability and has little effect on the heart.
Barbiturates are known to have severe effects associated with intra-arterial
injection. This group is also responsible for porphyria in susceptible individuals.
Etomidate causes adrenal suppression and steroid administration may be
necessary in patients already having adrenal axis suppression.
5) A 17 year-old asthmatic with a preoperative FEV1/FVC of 85% requires which
preoperative treatment prior to induction of general anesthesia?
A. Ipratropium MDI
B. Nebulized Racemic Epinephrine
C. Advair MDI
D. No treatment indicated -- Answer ✔✔ D. No treatment indicated
No treatment is required for a normal FEV1/FVC Normal = 75-85%
6) A 52 year-old obese patient with a hiatal hernia requires induction of general
anesthesia. Which premedicant could be considered to minimize the patient's risk
of respiratory problems?
A. Glycopyrrolate
B. Amitriptyline
C. Metoclopramide
D. Meperidine -- Answer ✔✔ C. Metoclopramide
, Metoclopramide would increase gastric emptying and increase esophageal
sphincter tone. This would help decrease the risk of aspiration. All other choices
decrease esophageal sphincter tone and would increase risk of aspiration.
7) A 64 year-old female presents for removal of tooth number 30 under general
anesthesia. Her past medical history is significant for rheumatic heart disease, and
subsequent mitral valve stenosis. The preoperative management of this patient
would include which of the following?
A. Decrease intravascular volume
B. Increase intravascular volume
C. Maintain a slower heart rate
D. Maintain a faster heart rate -- Answer ✔✔ C. Maintain a slower heart rate
The principal hemodynamic goals of managing patients with mitral stenosis are to
maintain a slower to normal sinus rhythm and to avoid tachycardia, larger
increases in cardiac output, and both hypovolemia and fluid overload by judicious
fluid therapy.
8) Which effect is seen with propofol?
A. Elevation of intracranial pressure
B. Increases in intraocular pressure
C. Potentiation of neuromuscular blockage
D. Increases in bronchodilation -- Answer ✔✔ D. Increases in
bronchodilation
Propofol has a direct smooth muscle effect on the bronchi, causing
bronchodilation. Propofol decreases intracranial and intraocular pressure, and it
does not potentiate neuromuscular blockade.
9) Which drug must be used with caution in a patient with a history of epilepsy?
A. Propofol
B. Fentanyl
C. Deximedetomidine
D. Methohexital -- Answer ✔✔ D. Methohexital
