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EXAM 1- NAGELHOUT QUESTIONS AND
ANSWERS 2025
What are the renal effects of all anesthetics except
nitrous oxide? - .....ANSWER ...✔✔ decrease blood
pressure
decrease renal blood flow
decrease GFR
decrease UO
What anesthetic is associated with hepatotoxicity in
adults but not children? - .....ANSWER ...✔✔
Halothane
What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated? - .....ANSWER
...✔✔ All except nitrous oxide
This inhalation anesthetic blocks DNA and RNA synthesis.
- .....ANSWER ...✔✔ Nitrous Oxide
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How does Nitrous Oxide block DNA & RNA production?
- .....ANSWER ...✔✔ oxidies the Cobalt atom on
Vitamin B12
inhibits methionine synthetase
What patients are at risk with Nitrous oxide due to
possible prior Cobalamin Deficiency? - .....ANSWER
...✔✔ (1) Nutritional disorders - elderly, vegans, and
alcoholics
(2) Malabsorption disorders - prolonged use of proton
pump inhibitors (H2 antagonists), pernicious anemia,
atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm
What are the absolute contraindications to Nitrous
Oxide? - .....ANSWER ...✔✔ (1) Known deficiency of
enzyme or substrate in methionine synthase pathway
(2) Potential toxicity from expansion of gas filled space
- emphysema, pneumothorax, middle ear, surgery,
pneumocephalus, air embolus
(3) Raised intracranial pressure
What are the relative contraindications to Nitrous
Oxide? - .....ANSWER ...✔✔ (1) Pulmonary HTN
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(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
What is a putative relative contraindication to Nitrous
Oxide? - .....ANSWER ...✔✔ Risk of myocardial
ischemia
When does the risk of halothane hepatotoxity increase?
- .....ANSWER ...✔✔ after puberty
Is there a better anesthetic technique to use when
performing surgery in cancer patients? - .....ANSWER
...✔✔ (1) Local anesthetics (reduced cancer
recurrence and metastasis r/t anti-inflammatory and
direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced
recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in
cancer cells; prevents angiogenesis)
Is there any anesthetic technique you should avoid using
when performing surgery in cancer patients? -
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.....ANSWER ...✔✔ (1) Opioids (angiogenesis;
decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth
factors)
What anesthetic is contraindicated in pregnancy? -
.....ANSWER ...✔✔ Nitrous oxide (teratogenic in
animals)
When is nitrous oxide most likely to cause teratogenic
effects? - .....ANSWER ...✔✔ first trimester
What is the effect of all anesthetics in pregnant women?
- .....ANSWER ...✔✔ relax the uterus (increase risk of
postoperative miscarriage)
Would it be better to use an inhalation anesthetic or
spinal for a uterine surgery? Why? - .....ANSWER
...✔✔ spinal (less bleeding - inhalation = uterine
relaxation and more bleeding)
What are the three principle sources of waste anesthetic
gasses? - .....ANSWER ...✔✔ (1) masks
(2) high-pressure fittings
EXAM 1- NAGELHOUT QUESTIONS AND
ANSWERS 2025
What are the renal effects of all anesthetics except
nitrous oxide? - .....ANSWER ...✔✔ decrease blood
pressure
decrease renal blood flow
decrease GFR
decrease UO
What anesthetic is associated with hepatotoxicity in
adults but not children? - .....ANSWER ...✔✔
Halothane
What inhalation anesthetics trigger malignant
hyperthermia and are contraindicated? - .....ANSWER
...✔✔ All except nitrous oxide
This inhalation anesthetic blocks DNA and RNA synthesis.
- .....ANSWER ...✔✔ Nitrous Oxide
,2|Page
How does Nitrous Oxide block DNA & RNA production?
- .....ANSWER ...✔✔ oxidies the Cobalt atom on
Vitamin B12
inhibits methionine synthetase
What patients are at risk with Nitrous oxide due to
possible prior Cobalamin Deficiency? - .....ANSWER
...✔✔ (1) Nutritional disorders - elderly, vegans, and
alcoholics
(2) Malabsorption disorders - prolonged use of proton
pump inhibitors (H2 antagonists), pernicious anemia,
atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm
What are the absolute contraindications to Nitrous
Oxide? - .....ANSWER ...✔✔ (1) Known deficiency of
enzyme or substrate in methionine synthase pathway
(2) Potential toxicity from expansion of gas filled space
- emphysema, pneumothorax, middle ear, surgery,
pneumocephalus, air embolus
(3) Raised intracranial pressure
What are the relative contraindications to Nitrous
Oxide? - .....ANSWER ...✔✔ (1) Pulmonary HTN
,3|Page
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV
What is a putative relative contraindication to Nitrous
Oxide? - .....ANSWER ...✔✔ Risk of myocardial
ischemia
When does the risk of halothane hepatotoxity increase?
- .....ANSWER ...✔✔ after puberty
Is there a better anesthetic technique to use when
performing surgery in cancer patients? - .....ANSWER
...✔✔ (1) Local anesthetics (reduced cancer
recurrence and metastasis r/t anti-inflammatory and
direct effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced
recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in
cancer cells; prevents angiogenesis)
Is there any anesthetic technique you should avoid using
when performing surgery in cancer patients? -
, 4|Page
.....ANSWER ...✔✔ (1) Opioids (angiogenesis;
decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth
factors)
What anesthetic is contraindicated in pregnancy? -
.....ANSWER ...✔✔ Nitrous oxide (teratogenic in
animals)
When is nitrous oxide most likely to cause teratogenic
effects? - .....ANSWER ...✔✔ first trimester
What is the effect of all anesthetics in pregnant women?
- .....ANSWER ...✔✔ relax the uterus (increase risk of
postoperative miscarriage)
Would it be better to use an inhalation anesthetic or
spinal for a uterine surgery? Why? - .....ANSWER
...✔✔ spinal (less bleeding - inhalation = uterine
relaxation and more bleeding)
What are the three principle sources of waste anesthetic
gasses? - .....ANSWER ...✔✔ (1) masks
(2) high-pressure fittings
