MCQs

1- A 65-year-old patient is having general anesthesia maintained with 45% nitrous oxide, 0.8%
isoflurane, and 50% oxygen. What is the approximate minimum alveolar concentration (MAC) delivered
to this patient?

A. 1.5 MAC B. 0.75 MAC C. 1.1 MAC D. 1.25 MAC E. 1.5 MAC

Answer C

2- A 65-year-old man with COPD is in the preoperative bay with a heart rate of 66 beats per minute
and an estimated stroke volume of 82 mL. He is breathing 12 times per minute with a tidal volume of
500 mL and an estimated dead space of 130 mL. What is this patient’s ventilation/ perfusion ratio?

A. 0.5 B. 0.8 C. 1.0 D. 1.2 E. 1.5

Answer D

3- 52-year-old man is being taken to the operation theater for surgical management of a comminuted
femur fracture sustained in a motor cycle accident. Patient is intubated and a postintubation chest x-ray
reveals that the tip of the endotracheal tube is 2 cm above the carina and there is a small left apical
pneumothorax. Mean arterial pressure is sustained in the 70s. Which of the following anesthetics is
contraindicated?

A. All inhalational anesthetic agents

B.1 MAC sevoflurane

C.1 MAC isoflurane with 60% oxygen

D.1 MAC halothane with 65% 0xygen

E. 0.5 MAC desflurane and 0.5 MAC nitrous oxide

4 A 53-year-old, 120-kg woman is in the recovery room following completion of a 6-hour hand-
assisted laparoscopic left nephrectomy for a renal mass. she is complaining of pain in his right lower
back and buttock. Patient has produced only 20 mL of tea-colored urine in the past hour. What is the
appropriate initial treatment for this postoperative oliguria?

A. Ringer Lactate

B. Thiazide diuretics

C. Normal Saline

D. Furosemide

E. Hemodialysis

Answer C
5 A patient with a tracheoesophageal fistula (TEF) in the distal trachea and a blind esophageal pouch
is having a ligation of the TEF and primary esophageal anastomosis via right thoracotomy. Oxygen
saturation drops and peak airway pressures increase; positive-pressure ventilation is difficult. Surgeon
releases traction on the trachea/lung and is unable to palpate the endotracheal tube (ETT) in the fistula.
SPO2 drops to 60% and breath sounds are markedly diminished. Suction catheter is difficult to pass and
you note thick mucus and clots. Next most appropriate action would be to

A. Put on pressure controlled mode of ventilation

B. Nebulize with Ventolin

C. Ask surgeon to take out gastrotomy tube

D. Replace the ETT

E. Take out ETT and put LMA of appropriate size

Answer D

6 A 5 years old child presents to the emergency department with a history of the sudden onset of
cough and choking, which has resolved prior to admission. Patient currently complains of an occasional
cough, but is in no significant distress. Chest x-ray demonstrates hyperinflation of the right lung and
mediastinal shift to the left. Which of the following physical examination findings would be most
consistent with this patient’s condition?

A. Wheezing on the right

B. Absent breath sounds on the left side

C. Generalized stridor

D. Pan-inspiratory stridor

E. Absent breath sounds on the right side

Answer A

7 A 40-year-old woman, had an uneventful anesthesia for laparoscopic cholecystectomy 2 hours prior
and is otherwise healthy. Her urine output has been minimal despite what you consider to be adequate
volume replacement. She has made only 20ml of urine since completion of surgery, and the catheter has
been flushed. Intraoperative course was unremarkable, and the last recorded vital signs were blood
pressure 132/71 mm Hg and heart rate 81 bpm. She is warm, alert, and comfortable. Which of the
following is the most likely cause of the patient’s oliguria?

A. Excessive peritoneal insufflation

B. Postsurgical ADH hypersecretion due to surgical stress.

C. Preoperative fluid restriction

D. Hypercarbia due to excessive CO2 insufflation

E. Gross surgical volume depletion

Answer B

8 A 62-year-old woman is undergoing a craniotomy and craniofacial surgery to remove a tumor on

the right side of her face and head extending into her maxillary sinuses and temporal bone. During the
procedure she becomes suddenly bradycardic, with a heart rate of 43 bpm. Her anesthesia consisted of
remifentanil, Propofol, and nitrous oxide. What is the most likely cause?

A. Occulo cardiac reflex

B. Accumulation of remifentanil and Propofol

C. Trigeminal Cardiac reflex

D. Allergic reaction to antibiotic prophylaxis

E. Rise in ICP due to fluids given intraoperatively

Answer C

9 A 42-year-old woman is having surgery for a brain tumor near the optic chiasm. During the
anesthesia, it is noted that her urine output increases to 150 mL/hour and her serum sodium level
increases to 146 mEq/L. She has lost minimal blood during the procedure and the anesthesiologist is
administering her fluids as normal saline at her maintenance rate. Which one of the following
statements is correct?

A. Her elevated sodium level is probably secondary to the fact that she is getting normal saline, which is
a hyponatremic solution (153 mEq/L).

B. Diabetes insipidus (DI) should be entertained as a reason for excessive urine output once the
patient’s urine output increases to 200 mL/hr.

C. Chronic hypernatremia is generally well tolerated.

D. Surgery around the pituitary gland is associated with hypersecretion of ADH, which leads to central
DI.

E. Intraoperative management of DI includes the administration of hypertonic solutions to attenuate the

pituitary ADH secretion.

Answer C
10 Upon evaluating your patient’s epidural placed 3 days ago for a trans-hiatal esophagectomy, you
notice that she is jaundiced with a mild fever of 38 degrees C. Her hemoglobin is 7 mg/dL. She looks well
otherwise. She received two units of blood intraoperatively for an estimated blood loss of 700 mL. You
suspect that she is having a delayed hemolytic transfusion reaction. Which of the following statements
would be true about this patient?

A. The transfused blood was old and largely hemolyzed.

B. It is type III hypersensivity reaction

C. Patient was given incompatible blood group

D. Patient was given unnecessary Blood.

E. The blood bank failed to detect antibodies.

Answer E

11 A 66-year-old woman is undergoing a total hip replacement under general anesthesia. Shortly after
the femoral prosthesis is placed, you notice that the patient’s end-tidal CO 2 is 24 mm Hg. Which of the
following is LEAST likely to be the cause?

A. Hyperventilation

B. Hyperthermia

C. Hypoperfusion

D. Hypothyroidism

E. Fat embolism

Answer D

12 A 65-year-old man with a history of diabetes and end stage renal disease is undergoing a total hip
replacement. At the end of the case he is placed on pressure support ventilation at 10 cm H2O /5 cmH2O
and is noted to have a respiratory rate of 40. He is then switched to spontaneous ventilation and is
noted to be apneic. What is the most likely explanation?

A. Hypocapnia

B. Cheyne-Stokes respiration

C. Hyperglycemia

D. Auto-triggering of pressure support ventilation

E. Opioid overdose

Answer D

13 You are called to the bedside of a patient in the post anesthesia care unit (PACU) with stridor and
moderate respiratory distress who underwent a total thyroidectomy for a multinodular goiter that day.
Patient was asymptomatic upon admission to the PACU and had been alert until 15 minutes ago. As you
review the chart, obtain a brief history, and examine the patient, the patient’s distress worsens and
oxygen saturation begins to fall despite receiving 100% inspired oxygen. Most likely cause of her
symptoms is

A. Hematoma

B. Bilateral recurrent laryngeal nerve injury

C. Hypocalcemia

D. Bilateral superior laryngeal nerve injury

E. laryngeal spasm

Answer A

14 Which of the following choices of endotracheal tube (ETT) size and position is most appropriate?

A. 3-year-old—4.5 ETT without cuff taped at 13 cm at the mouth

B. 10-year-old—7.0 ETT without cuff taped at 15 cm at the mouth

C. 12-month-old—3.0 ETT without cuff taped at 7 cm at the mouth

D. 6-year-old—6.5 ETT with cuff taped at 12 cm at the mouth

E. 2-year-old—4.5 ETT with cuff taped at 8 cm at the mouth

Answer A

15 Severe postintubation hypertension should be avoided in all cases. In some patients it is particularly
likely to precipitate cardiovascular collapse. Patients with which of the following conditions would tend
to BEST tolerate hypertension during airway management in the operating room?

A. Coronary artery disease

B. Ventricular septal defect

C. Mitral regurgitation

D. Aortic insufficiency

E. Aortic stenosis

Answer E

16 A 37-year-old woman with a past medical history significant for gastroesophageal reflux disease
(GERD) presents for excision of a breast mass. She takes no medications. In the holding area, you
examine her airway and find the following—Mallampati class III, poor mouth opening (2 to 3 cm), short
hyomental distance but adequate thyromental distance, poor mandibular prognathism, good dentition,
free range of motion of her neck. You decide to perform a rapid sequence intubation. Which of the
following medications would be the BEST choice to administer prior to going to the operating room?

A. 20 mg omeprazole IV

B. 40 mg omeprazole PO

C. 150 mg ranitidine IV

D. 30 mL sodium citrate PO

E. 150 mg ranitidine PO

Answer D

17 56-year-old woman with a history of rheumatoid arthritis calls you with complaints of significant
hoarse speech 2 days following a laparoscopic cholecystectomy. Two attempts were required for
intubation. Most appropriate next step in management is

A. Inform the patient that the hoarseness will resolve within one week.

B. Ask the patient to present to the surgeon who performed the laparoscopic cholecystectomy.

C. Instruct the patient to follow up with her rheumatologist.

D. Send the patient to an interventional pulmonologist for foreign body workup.

E. Arrange for ENT consultation to treat Arytenoid dislocation.

Answer E

18 A patient under general endotracheal anesthesia with rocuronium and Propofol TIVA for
endoscopic sinus surgery has a rising end-tidal CO 2 with increasing baseline. Ventilatory settings are
unchanged. Gas flows are increased and the capnogram remains unchanged. An alarm alerts for
“reversed flow.” Most likely etiology is

A. Incompetent expiratory valve

B. Exhausted Soda lime

C. Malignant hyperthermia

D. Incompetent inspiratory valve

E. underlying Obstructive Respiratory Disease

Answer A
19 What is the correct order of the following opioids in regards to lipophilic properties, from most to
least lipophilic?

A. Sufentanil—Morphine—Fentanyl—Remifentanil

B. Sufentanil—Remifentanil—Alfentanil—Fentanyl

C. Remifentanil—Alfentanil—Fentanyl—Sufentanil

D. Sufentanil—Fentanyl—Alfentanil—Morphine

E. Morphine—Remifentanil—Alfentanil—Sufentanil

Answer D

20 A 49-year-old woman is undergoing liver transplantation for end-stage liver disease. Prior to
unclamping of the portal vein, hepatic artery, and vena cava, metabolic acidosis was treated with
bicarbonate, ionized Ca 2+ was normalized, and potassium was less than 5 mEq/L. When the vessels
were unclamped, the patient developed a junctional heart rhythm, blood pressure decreased to 70/40
mm Hg, and pulmonary artery catheter measurements showed markedly decreased systemic vascular
resistance (SVR) and increased right ventricular filling pressure. Although there was no change in cardiac
output, the electrocardiogram now shows peaked T waves. What is the most probable cause of this
patient’s acute deterioration?

A. Reperfusion of donor liver

B. Transfusion reaction

C. Manipulation of the donor liver

D. Pulmonary or air embolism

E. Primary rejection

Answer A