Past Papers: Anesthesia Questions PDF

‫بسم هللا الرحمن الرحيم‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ــ ــ ــ ـــــ ــ ــ ــ ـــــ ــ ــ ــ ــــ ــ ــ ــ ـــ‬ ‫ن‬ ‫جزئي ‪:‬‬ ‫ الملف ينقسم إىل‬ ‫‪ : PART 1 o‬ما يزيد عىل ‪ 1000‬سؤال محلولة بشكل...

‫بسم هللا الرحمن الرحيم‬ ‫ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ ــ ــ ــ ـــــ ــ ــ ــ ـــــ ــ ــ ــ ــــ ــ ــ ــ ـــ‬ ‫ن‬ ‫جزئي ‪:‬‬ ‫ الملف ينقسم إىل‬ ‫‪ : PART 1 o‬ما يزيد عىل ‪ 1000‬سؤال محلولة بشكل صحيح بإذن هللا مع ذكر مرجع الحل لكل سؤال‬ ‫وه األسئلة المشكوك فيها ‪ ،‬أو األسئلة الناقصة أو الغي واضحة ‪،‬‬ ‫‪ : PART 2 o‬ما يزيد عىل ‪ 200‬سؤال ‪ ،‬ي‬ ‫أو األسئلة المتفق عىل حلها بهذا الشكل ولكن لم أجد لها مرجع يصححها ‪.‬هذه األسئلة معظمها محلولة‬ ‫بشكل صحيح بإذن هللا و حاولت إيضاحها من مراجع معتمدة قدر المستطاع ‪.‬‬ ‫ كل سؤال يليه صورة أو ر‬ ‫أكي من المراجع المعتمدة توضح الحل الصحيح ‪.‬‬ ‫ حاولت قدر المستطاع جعل األسئلة ذات الموضوع الواحد متتالية ‪ ،‬يليها صورة الحل من المرجع ‪.‬‬ ‫ بعض الصور ليست من المراجع المعروفة بل من كتب أخرى أو من النت ؛ فلم يتم ذكر مصدرها ‪.‬‬ ‫ُ‬ ‫شخص ‪..‬أو شك ن يف اإلجابة‬ ‫إيضاح‬ ‫و‬ ‫إضافة‬ ‫هو‬ ‫اللون‬ ‫بهذا‬ ‫تب‬ ‫ك‬ ‫ كل ما‬ ‫ي‬ ‫ كل الشكر و العرفان لمن ساهم ن يف جمع وحل هذه األسئلة ن يف السنوات السابقة ‪ ،‬والذين لوال جهودهم‬ ‫السابقة لما كان هذا الملف ‪.‬‬ ‫ً‬ ‫شخص فردي ‪ ،‬لن يخلو من أخطاء ‪..‬‬ ‫ ختاما ‪ :‬هذا الملف جهد‬ ‫ي‬ ‫ المراجع المستخدمة ن يف حل األسئلة ‪:‬‬ ‫‪Barash , Clinical Anesthesia , 7th Edition‬‬ ‫‪Miller’s , Anesthesia , 8th Edition‬‬ ‫‪Miller’s , Anesthesia , 9th Edition‬‬ ‫) ‪Basics of Anesthesia , Miller , 7th Edition ( Baby Miller‬‬ ‫‪Morgan , Clinical Anesthesiology , 5th Edition‬‬ ‫‪Stoelting’s , Pharmacology & Physiology , 5th Edition‬‬ ‫‪Stoelting’s , Anesthesia and Co-Existing Disease , 7th Edition‬‬ ‫‪Faust’s , Anesthesiology Review , 4th Edition‬‬ ‫‪Chestnut’s , Obstetric Anesthesia , 5th Edition‬‬ ‫‪Anesthesia A Comprehensive Review , 5th Edition‬‬ ‫‪Oxford Handbook Of Anesthesia , 4th Edition‬‬ ‫‪The Anesthesia Guide‬‬ ‫ن‬ ‫تنسون من دعائكم‬ ‫بالتوفيق للجميع ‪..‬ال‬ ‫ي‬ ‫‪Ahmed – 2023‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ ‫‪o‬‬ 1 AHMED, 2023 PART 1 1. Which enzyme indicate post pancreatic rejection? ABCD- Lipase Insulin Amylase Protease 2. After resection of pheochromocytoma ? ABCD- Hypoglycaemia Hypokalaemia Hypomagnesemia Decrease urine output 3. During resection of pheochromocytoma and before ligation of vessels. What is the best management to prevent precipitous hypotension is : ABCDE- Start epinephrine infusion. Decrease depth of anesthesia. Crystalloid volume expansion Phenylephrine. Transfuse salvage blood. 4. In a patient with pheochromocytoma, after resection of the tumour best fluid to be administer immediately is : ABCDE- RL NS Albumin Blood D5% (pt will be hypoglycaemic after resection) 2 AHMED, 2023 ( Anesthesia and Co-existing Diseases Stoelting’s , Page 467 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 466-467 ) ( Barash , page 1342 ) 5. Pheochromocytoma associated with : A- Right HF B- Cardiomyopathy C- MI ( Anesthesia and Co-existing Diseases Stoelting’s , Page 464 ) 3 AHMED, 2023 6. Cardiomyopathy in a patient with pheochromocytoma what is the least likely to be result of: ABCD- Sustained hypertension Decreased CBF Free radicals intoxication Catecholamine metabolism toxicity 7. Preoperative optimization for pheochromocytoma , Except : ABCD- Not more than 5 PVC per 5 min BP 160/90 is acceptable with orthostatic hypotension 80/40 Free from ST elevation for 1 week Start alpha blocker 7 to 10 days preoperative ( Miller’s , page 1171 ) ( Miller’s , page 1117 ) 4 AHMED, 2023 8. Pheochromocytoma laparoscopic resection while manipulating the tumor the patient suddenly Bp 185/115, HR : 145, What is you management: ABCD- Deepen their anesthesia to 1 Mac IV phentolamine IV iso something IV domparedol 9. Patient robotic radical excision of pheochromocytoma, had tachycardia 105/min and hypertension 190/85 how to manage ? ABCD- Prazosin Labetalol Nitroglycerin Nitroprusside All other choices may cause Tachycardia ( Barash , page 1341 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 466 ) 5 AHMED, 2023 ( Barash , page 1342 ) 6 AHMED, 2023 10. What is the number needed to treat (NNT) intramuscular morphine 10 mg to provide >50% to relief moderate to severe postoperative pain? ABCD- 1.1 1.9 2.9 4.5 ( Miller’s , page 2980 ) 11. Which test is used to monitor LMWH ABCD- PT PTT & INR 8&9 Factor Xa 12. Patient for OR bridging therapy he is in on LMWH what test will done for him on day of surgery ? ABCD- PT INR PTT Anti Xa 7 AHMED, 2023 ( Barash , page 439 ) ( Stoelting , Page 654 ) 8 AHMED, 2023 13. Patient with tibia fracture admitted for fixation, one day before surgery he developed acute MI for which he was started on LMWH. Which of the following performed before any neuraxial block? ABCD- Anti Xa factor Platelet count Platelet function aPTT Anti Xa factor used only to monitor the therapeutic effect of LMWH , not to be done before neuraxial block , if pt on LMWH and need neuraxial you just stop LMWH for 12 or 24 hrs before the block. Q here asking in general what lap test should be done before any neuraxial block , and Platelet count is the mandatory labs to be done before the block. ( Miller- Basic of Anesthesia , Page 573 ) 14. To prevent VAP – missing information I think most cost effective ? ABCD- Mouth wash Head up Frequent suction Prophylaxis antibiotic 15. To prevent VAP , Except : ABCD- Mouth wash Head up Frequent suction Prophylaxis antibiotic ( Anesthesia and Co-existing Diseases Stoelting’s , Page 551 ) ( Barash , Page 1601 ) ( Miller- Basic of Anesthesia , Page 721 ) 9 AHMED, 2023 16. Decreased FEV1/FVC ratio is seen in : A- Children B- Restrictive lung disease C- Obstructive lung disease ( Barash , Page 279 ) ( Stoelting , Page 583 ) 17. A hypertensive & DM 56 year old , for emergency subdural hematoma evacuation. After GA done, the arterial line inserted for hemodynamical monitoring and wave showed ( see image ) ECG with LVH ABCD- Pulsus tardus Pulsus parvus Pulsus bisferiens Pulsus alternans 18. What is the wave of arterial line associated with aortic regurgitation ? ABCD- Pulsus bisferiens Pulsus paradoxus Pulsus alternans Pulsus parvus ( Comprehensive Q 932, 945 ) ( Miller’s , page 1358 ) 10 AHMED, 2023 ( Miller’s , page 1358 ) ( Miller’s , page 1359 ) 11 AHMED, 2023 19. High frequency jet ventilation (HFJV) tidal volume (ml/kg): ABCD- < 1 ml/kg 1-3 ml/kg 3-5 ml/kg > 5 ml/kg ( Faust's , chapter 160, page 383 ) 20. 40 yr old is c/o SOB and hypotension He had hernia repair under GA , he is fully awake and moving 4 limbs His o2 saturation is 95 on room air His Aldrete score is : ABCD- 7 if his Bp less than 50 mmgh from his baseline 8 90% sat on RA TOF > 0.9 Parenteral (IV) opioids not needed ( Miller’s , page 2632 ) ( Miller’s , page 2632 ) 13 AHMED, 2023 ( Barash , page 1561 ) 27. Which of the following is the primary parasympathetic receptor in the heart? ABCD- Nicotinic Muscarinic a adrenergic â adrenergic ( Morgan , Page 349 ) 14 AHMED, 2023 28. In which region the sympathetic system leave the spinal cord ? ABCD- Thoracic and sacral Cervical and sacral Thoracic and lumbar Cervical and sacral ( Miller- Basic of Anesthesia , Page 70 ) 29. Reflecting on the O2 cascade for person breaths room air What is the partial pressure of O2 at the cellular level (mitochondrial) ? ABCD- 90-100 4-22 1 -2 More than 100 ( Miller’s , page 445 ) 30. What is the most serious immediate complication from unilateral interscalene block ? ( See Comprehensive Q 796, 862, 865, 883, 884, 889 ) ABCD- Pneumothorax Phrenic nerve block Inadvertent inter-vertebral injection Unilateral recurrent nerve damage ( Anesthesia guide , page 559 ) 15 AHMED, 2023 “ The phrenic nerve is routinely blocked (100% of the time) and, in healthy patients, rarely leads to symptoms “ (( Comprehensive Q 889 )) - Phrenic nerve block cause 25% reduction in pulmonary function 31. Which of the following is involved in transmission of pain impulse : ABCD- Cerebellum Limbic system Anterior cingulate cortex A-beta fiber ( Stoelting , Page 189 ) ( Barash , page 1614 ) 32. Which TRUE regarding interscalene block : A- Between the sternocleidomastoid muscle and the anterior scalene B- 50% spares the ulnar nerve C- Good for forearm surgery 33. Interscalene block : A- Between sternocloid & anterior scalene B- Best for forearm C- 100% phrenic nerve palsy ( Comprehensive Q 796 ) 16 AHMED, 2023 34. Pt with liver cirrhosis , for GA ORIF femur , regarding cardiovascular consideration ? ABCD- Decrease CO Increase SVR Decrease mixed venous O2 Decrease response to catecholamines 35. 75 year old male end stage liver cirrhosis , the following value will be elevated : ABCD- Cardiac output SVR Haemoglobin SVO2 ( Miller’s , page 2276 ) ( Barash , page 1305 ) 17 AHMED, 2023 36. What are the medications that increase the CBF and CMR ? ABCD- Morphine Ketamine Inhalational anaesthetics Thiopental 37. Most probable agent will decrease cerebral blood flow ( CBF ) ? ABCD- Fentanyl Thiopental Propofol Midazolam 38. IV anaesthetic affecting CBF at least is: ABCDE- Propofol Thiopental Fentanyl Midazolam Ketamine ( Miller’s , page 397 ) 18 AHMED, 2023 39. 50 years old presented for pre-op assessment for total hip replacement, Most predictor for difficult laryngoscope is : ABCD- Arched palate MP 2 Short thyromental distance Enable to protrude mandible 40. Most predictive sign of difficult laryngoscopy is : ABCDE- TMD Mallampati score Inability to protrude the jaw Mouth opening Arched palate 41. In an average adult male patient a thyromental distance suggesting increased risk for difficulty in intubation is: ABCD- 6 cm 7 cm less than 6 cm more than 7cm ( Miller’s , page 1669 ) ( Barash , page 587 ) ( Miller- Basic of Anesthesia , Page 243 ) 19 AHMED, 2023 42. In Airway assessment the most specific sign for difficult intubation is : ABCD- TMD Mallampati score Sternomental distance Mouth opening 43. In Airway assessment the most sensitive sign for difficult intubation is : ABCDE- Mallampati TM distance Sternomental distance neck movement mouth opening ( Barash , page 767 ) 44. The most prediction in obese patients for difficult intubation : ABCD- Mallampati IV Presence of beard Presence of frontal teeth Unable to prognath 45. Best predictor for difficult intubation for obese patient? ABCD- Snoring Male gender Mallampati Neck circumference ( Barash , page 1283 ) 20 AHMED, 2023 46. The most important (common?) predictor for difficult mask ventilation : ABCDE- BMI > 26 Beard Teeth less History of snoring Age > 55 47. 45 years old female coming for gastric sleeve. Which is the most predictive of difficult mask ventilation? A- Weight B- Snoring C- Female D- Laparoscopic surgery 48. Which of the following is an independent risk factor for difficult mask ventilation? ABCDE- BMI < 25 Full teeth Age > 55 Mallampati 2 Ability to prognath ( Barash , page 768 ) 49. Which of the following agents does not need dose adjustment in geriatric patients ? ABCD- Cisatricurium Etomidate Fentanyl Vecuronium 21 AHMED, 2023 50. Which med doesn’t affect geriatric pharmacokinetic ? ABCD- Propofol Remifentanil Sufentanil Morphine 51. Drugs that more likely in elderly to cause brain sensitivity : ABCD- Propofol Thiopental Etomidate Pancuronium ( Miller’s , page 2418 ) 52. 55 y pt for radical nephrectomy, what is the appropriate level to place the epidural ? ABCD- T4-5 T5-6 T7-8 T12-L1 or T10- L1 ?? ( Oxford Hand Book , page 598 ) 22 AHMED, 2023 ( Miller’s , page 2985 ) 53. Gastric motility and risk of regurgitate return to normal in pregnant after : ABCD- 2 hours 2 weeks 6 weeks 18 hours ( Chestnut’s Obstetric Anesthesia , Page 26 ) 23 AHMED, 2023 54. All nerves from sciatic nerve except ? ABCD- Tibial n. Saphenous n. Common peroneal Deep peroneal 55. Which of the following is branch of femoral nerve ? ABCD- Tibial Deep peroneal Saphenous Sural 56. 41 years old, prim gravida presented to the operating room for laparoscopic appendectomy, she is in her first trimester and having fear from losing the fetus The, latest recommendation regarding laparoscopic surgery during pregnancy is : ABCDE- Laparoscopy can be done safely during any trimester Obstetric consultation should be performed preoperatively Fetal heart monitoring should be occurred postoperatively Tocolytic agent should be used prophylactically to avoid preterm delivery Inflation of 15-20 mmHg can be safely used in pregnant patient ( Miller- Basic of Anesthesia , Page 578 ) ( Chestnut’s Obstetric Anesthesia , Page 373 ) 24 AHMED, 2023 57. Patient suspected of having PE. Hemodynamically stable, Which of the following will confirm the diagnosis ? ABCD- CT pulmonary angiography Echocardiography D dimer 12 lead ECG ( Barash , Page 1530 ) ( Morgan , Page 540 ) 58. Phenylephrine act on : ABCD- Alfa 1 Alfa 2 Beta 1 Beta 2 59. Main action of ephedrine : ABCD- Alpha 1 receptor Beta 1 receptor Beta 2 receptor Alpha 2 receptor ( Miller- Basic of Anesthesia , Page 566 ) ( Barash , Page 388 ) 25 AHMED, 2023 60. Pregnant with moderate MS having epidural for labour analgesia, after test dose bupivacaine 3ml (0.25%) her BP drop to 80/40. what is best pharmacologic management ? A- Ephedrine B- Epinephrine C- Phenylephrine ( Edmonton Notes 2011 , Page 78 ) ( Barash , Page 1162 ) 61. Which is true in amniotic fluid embolism ? ABCD- Chest pain is a common presentation Seizures is not a presentation for it It can happen in termination of pregnancy at 2nd trimester Doesn’t associate with high pulmonary vascular resistance 26 AHMED, 2023 ( Chestnut’s Obstetric Anesthesia , Page 917 ) 62. Which of the following is predictive lab test for haemorrhagic shock? ABCD- Hct 32 Serum lactate 10mg/d Blood sugar 155mg/dl k 2.5 mg/dl 27 AHMED, 2023 63. 49 year old with BP= 85/50, RR=32, tachycardia confused and anxious which shock class according to ATLS classification for hemorrhagic shock : ABCD- Class 1 Class 2 Class 3 Class 4 ( Miller- Basic of Anesthesia , Page 725 ) 64. Predictive of post-operative acute respiratory failure in patient with myasthenia gravis and thymoma : ABCD- Currant daily dose of steroid Duration of myasthenia symptoms Pre-op Total lung capacity Size of thymoma ( Miller’s , page 1270 ) ( Edmonton Notes 2011 , Page 401 ) 28 AHMED, 2023 65. Myasthenia gravis, which is true : ABCDE- Hereditary autoimmune destruction of postsynaptic acetylcholine receptor Must with muscles supplied by cranial nerves Hall mark of disease is muscle fatigue after sustained contraction Male > female Antibodies found in low percentage of patient ( Barash , Page 616 ) 66. Regarding myasthenia syndrome all true except : ABCDE- Sensitive to non depolarizing NMB Sensitive to depolarizing NMB Post titanic potentiation Improve with muscle movement Decrease response to EMG 67. Patient known case of myasthenia Syndrome (Eaten lambert Syndrome), which of the following is true : ABCDE- Inherited Autosomal dominant disorder. Associated with large cell cancer. Treated with acetylcholinesterase. Affects female more than males. Associated with muscle pain. ( Barash , Page 618 ) 29 AHMED, 2023 68. A 48y old male patient for laparoscopic cholecystectomy, she is known myasthenia gravis, she is on pyridostigmine, the anesthesiologist told her that she might stay in the ICU postop, which of the following statement is correct regarding this patient : A- Patient has an autoimmune disorder involving antibodies against B-units of post synaptic muscarinic receptors of Ach. B- Patient has an autoimmune disease due to congenital defect in the muscarinic Ach receptors in the neuromuscular junction C- Patient has deficiency in release of Ach in the skeletal muscles while respiratory muscles are intact D- This patient must stop predinsolone and pyridostigmine before surgery E- Tracheal intubation in this patient can often be accomplishes without neuromuscular blockers ( Barash , Page 617 ) ( Miller’s , page 1270 ) ( Miller’s , page 1270 ) 30 AHMED, 2023 69. Case you found out its Myasthenia gravis pt about Muscle relaxant ? ABCD- Its hereditary disease The fade from NDMR is explained as Calcium is entrapped in the junction Double the sux will always cause fade ( phase ll block ) Autoimmune against presynaptic receptor of muscarinic ( Miller’s , page 1270 ) ( Miller’s , page 1616 ) ( Morgan , Page 205 ) 31 AHMED, 2023 70. Child with myasthenia gravis present with for emergency laparoscopic appendectomy. Which of the following is CORRECT regarding the disease A- Need higher dose of depolarizing muscle relaxant (b/c resistant to sux ) B- Resistant to non-depolarizing muscle relaxant C- Nerve stimulator monitoring should be connected to the patient in case of extubating the patient. D- Can be extubated without the need for the reversal. ( Barash , Page 618 ) 71. 24 year old with Myasthenia Gravis for Mastectomy. To decrease post-op pulmonary complications ? ABCD- Usual reversal dose Larger potent inhalational dose for muscle relaxation Smaller dose of Sux Use smaller and frequent doses of NDMR 72. Myasthenia Gravis case : A- Give high dose of Sch B- NDMR is contraindicated C- Increase Ach receptor ( Barash , Page 617 ) 32 AHMED, 2023 73. Which of the following will cause up-regulation of acetylcholine receptors? ABCD- Myasthenia gravis Guillain Barre syndrome Anticholinesterase poisoning Organophosphate poisoning ( Miller’s , page 988 ) 74. What happens to the pulmonary vascular resistance at low lung volumes? ABCD- No change Increased Decreased Increased then decreased ( Miller- Basic of Anesthesia , Page 477 ) ( Miller’s , page 681 ) 33 AHMED, 2023 75. Pressure compliance loop of respiratory what does A reflect? ABCD- Asthma Emphysema Normal lung Lung fibrosis 76. Common electrolyte abnormality after renal transplant ? ABCD- Hyperkalemia Hypokalemia Hypercalcemia Hypocalcemia ( Miller- Basic of Anesthesia , Page 626 ) 34 AHMED, 2023 77. In renal transplantation : ABCDE- Should use Suxamethonium Muscle stimulator monitoring is mandatory CVP and arterial BP ALWAYS necessary Loss should be replaced by Hartmann solution Hypotension treated by alpha agonist and don’t give fluid ( Miller- Basic of Anesthesia , Page 627 ) ( Barash , Page 1468 ) ( Miller’s , page 2267 ) ( Barash , Page 1468 ) 35 AHMED, 2023 78. What’s the maximum cold ischemia time (in hour) for transported kidney for renal transplantation ? ABCD- 1 hr 3 hrs 24 hrs 12 hrs ( Miller’s , page 2297 ) 79. 7 years old boy a renal transplant recipient, the most appropriate time to infuse furosemide and mannitol: ABCD- At skin incision After first anastomosis After uretric anastomosis After skin closure. ( Barash , Page 1468 ) 80. 21 years old male with history of unexplained proteinuria booked for renal biopsy , What is the most common contraindication for renal biopsy ? ABCD- DM High creatinine Single kidney Controlled HTN 36 AHMED, 2023 81. Which of the following independent predictor for perioperative renal failure? ABCD- Male gender Female gender Congestive heart failure Age >50 ( Miller’s , page 1204) ( Stoelting , Page 430 ) 82. What molecules are reabsorbed completely in renal system in normal Patient ? ABCD- Sodium Glucose Chloride Potassium ( Stoelting , Page 420 ) 37 AHMED, 2023 83. A 55 years old woman was scheduled for laparotomy and proceed procedure, the case was extended for eight hours with extensive intraoperative bleeding. postoperatively patient required ICU admission for close monitoring. 24 hours post ICU Admission patient developed Acute Renal Failure. Which of the following is the parameter that indicates that the case of ARF is prerenal ? ABCD- Renal failure Index > 2 Urinary osmolality > 350 Urinary osmolality < 350 Urine/Plasma Creatinine < 350 ( Morgan , Page 1310 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 429 ) ( Miller’s , page 2229 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 429 ) 38 AHMED, 2023 84. What the Best indicators of postoperative acute renal failure : ABCD- Gradually progressive deterioration of renal functions test Patient present with anemia and hypotension Patient came with good urine out put Isolated kidney failure came with mortality 10% ( Miller’s , page 2229 ) 85. Which of the following part of renal system is a compensatory mechanism that reduces extracellular volume ABCD- Increase atrial natriuretic peptide Decrease angiotensin II Decrease renin Increase Aldosterone 86. Atrial natriuretic peptide (ANP) : A- Vasodilator B- Aldosterone ( Stoelting , Page 424 ) 39 AHMED, 2023 87. Renal auto regulation range in terms of GFR and renal blood flow: ABCD- 80-180 mmHg 50-190 mmHg 40-200 mmHg 30-150 mmHg ( Barash , Page 1403 ) ( Stoelting , Page 422 ) 88. Which of the following is a feature of neonatal versus adult Renal ? ABCD- Increased GFR Decreased renovascular resistance Decreased permeability of glomeruli Increased Na Loss and Decreased Na resorption 40 AHMED, 2023 ( Barash , Page 1183 ) 89. Pt with chronic renal disease what will happen ? ABCD- Rightward shift of oxyhemoglobine dissociation curve Hypomagnesemia Hyperglycemia Hypokalemia 41 AHMED, 2023 90. 35 year old male ASA I in the PAC for renal donor procedure, asking you for the most common cause of mortality ? ABCD- Pulmonary embolism Myocardial ischemia Renal failure Massive bleeding ( Miller’s , page 2302 ) 91. 35 years old female underwent right liver lobe transplant surgery from a living donor, which of the fallowing is most common post-operative complication : ABCD- Pneumothorax Pleural effusion Incisional hernia Pulmonary embolism ( Miller’s , page 2305 ) 42 AHMED, 2023 92. Hepatic Cell Carcinoma (HCC) patient undergoing liver transplant, metabolic derangement of neohepatic phase ? ABCD- Hypokalemia Metabolic acidosis Hypocalcemia Metabolic alkalosis 93. Reperfusion phase of liver transplant. What do you expect ? ABCD- Hypokalemia Metabolic acidosis Metabolic alkalosis Hypocalcemia ( Miller’s , page 2283 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 357 ) 43 AHMED, 2023 94. About liver transplantation (stage before perfusion) ( Anhepatic ) ?? ABCD- Hypokalemia ( I will choose it if the Q is except ! ) Hypotension Hypocalcemia Metabolic acidosis ( Anesthesia and Co-existing Diseases Stoelting’s , Page 357 ) 95. 32 years’ female with cirrhotic liver underwent liver transplant, during anhepatic phase the patient became hypotensive and the monitor showed prolonged QT interval. The most likely diagnosis is: ABCDE- Citrate intoxication ( Hypocalcemia will cause prolong QT ) Hypomagnesemia Metabolic acidosis Hypokalemia Acute decompression of ascites ( Anesthesia and Co-existing Diseases Stoelting’s , Page 417 ) 44 AHMED, 2023 96. Citrate intoxication commonly seen with : ABCD- Liver transplant surgery Hyperthermic patient Hyperparathyroidism Hyperthyroidism 97. What does signs of citrate intoxications include ? ABCD- Hypertension Narrow Pulse Pressure Decreased Central Venous Pressure Decreased inter ventricular and diastolic pressure 98. Citrate toxicity can cause all except : ABCD- Narrow pulse pressure Increase central venous pressure Increase LVEDP Hypertension ( Miller’s , page 1850 ) 45 AHMED, 2023 99. Patient with Hepatitis C Cirrhosis Bilirubin 50 (umol/l) Prothrombin time is 5 Albumin 30 (g/l) INR is 2 Mild Ascites Mild behavioural change Incidence for perioperative mortality is : ABCD- Up to 10 Up to 30 Up to 50 No risk Albumin 30g/L = 3g/dL Bilirubin 1mg/dL = 0.058umoL/L so 50umol/l equal 2.9 mg/dL so the pt Child Pugh score is C 100. 6 months old end stage liver disease, mild ascites, drowsy, bilirubin 30 mmol/dl, albumin 28, INR 2.0, Child Pugh score : A- A B- B C- C D- D mmol/dl * 18 = mg/dl 101. Patient for Child Pugh scoring had INR 2.5, large ascites, PTT is high, GCS 11/15, bilirubin 2.5 A- Class A B- Cass B C- Class C Drowsy, Low GCS, behavioural changes = Encephalopathy ( Anesthesia and Co-existing Diseases Stoelting’s , Page 354, 356 ) ( Barash , Page 1316 ) 46 AHMED, 2023 102. After you finished induction of first case on your list nurse asked for attention to do surgical checklist before the surgeon comes to save time.. What will you do ? ABCD- Tell her you cannot do it without the surgeons Tell her this is not the appropriate time. Tell her no need since it was done before induction. Proceed with checklist since you were waiting for surgeon. 103. WHO for Surgery checklist to reduce mortality and complications, Which of the following should be included in the checklist : A- BMI B- Surgical site C- Aspiration prophylaxis 104. According to JCI protocol for prevent error : ABCD- Pre-set admission bed Time-out in OR Health assurance Surgical site marking 105. 26 y/o is going for hernia repair, pt. has been seen in pre-anesthesia clinic 60 days ago, according to JCI what is the best answer ? ABCD- History and physical examination should be done within 30 days History and physical examination is not mandatory Pt. should be seen 6 hours before surgery No need to see the pt. again as long as he has been seen within 60 days 106. Regarding antibiotics administration guideline for surgical site infection prevention (SSIP) : ABCD- Antibiotic should be given within 60 min of skin incision Administration should be given 60 min prior to skin incision Combination of antibiotic should NOT be used Administration should be infusion over 60 min The Ideal answer should be : WITHIN 60 min PRIOR to skin incision, not after skin incision! 47 AHMED, 2023 107. According to JCI preop evaluation time: ABCD- 30 days 5 days 24 hours Immediately before surgery ( Barash , Page 609 ) ( Miller’s , page 1086 ) ( Miller’s , page 99 ) ( Barash , Page 95 ) 48 AHMED, 2023 108. According to BLS guidelines 2 rescuers in case of a comatose patient: ABCDE- Assess the patient, activate EMD and ask for defibrillator, assess the pulse, and start CPR. Assess the patient, give two breaths, and start CPR. Give 2 breaths, assess the patient and start CPR. Assess patient, give two breaths, activate EMS and get AED. Give 2 breaths, assess the patient, activate EMS, get AED and start CPR. 109. What is the maximum time allowed for interruption during CPR: ABCDE- 10 sec 20 sec 30 sec 40 sec 50 sec ( Miller- Basic of Anesthesia , Page 791 ) 110. Which of the following is a sign of effective CPR ABCD- PETCO2 > 10 mmhg Patient temperature < 32 c Measured urine output of 1 ml/kg per hour Diastolic intra- arterial pressure 1 year carotid artery …. < 1 year brachial artery , PALS ) ( Miller- Basic of Anesthesia , Page 797 ) 50 AHMED, 2023 115. CPR in neonate ETT : A- NaHco3 vasopressor B- Epinephrine 0.1 mg/kg ( ETT Dose ) , IV dose 0.01 mg/kg C- Same dose of IV ( Barash , Page 1692 ) 116. A 32 years old G3P2+0 in labour, while in the bed she developed VF with hypoxia, regarding ACLS guidelines for such a case : ABCD- Baby should be delivered in the first 5 minutes CPR is done on the lower sternal border Fetal heart monitoring should continue during CPR Put the patient supine on a hard board ( Chestnut’s Obstetric Anesthesia , Page 1228 ) 117. SVT elective while synchronize cardioversion, the patient developed VF. What would be the appropriate next step : ABCDE- Administer Amiodarone. Start CPR. Continue with synchronized mode. Change to unsynchronized mode. Do nothing. 51 AHMED, 2023 ( Miller- Basic of Anesthesia , Page 797 ) 118. 70 kg female patient had hyponatremia Na 115 mmol/L The aim to correct hyponatremia to 130 mmol/L in 24 hr using IV NaCl 0.9% What is the rate (ml/hr) ? ABCD- 141 131 151 121 because its female , Female TBW = 0.5 if the pt Male this will be the right answer , Male TBW = 0.6 52 AHMED, 2023 ( Morgan , Page 1120 ) 119. What is the normal HbA1c in insulin dependent diabetic ? ABCD- 0% 3% 6% 9% ( Miller- Basic of Anesthesia , Page 501 ) 53 AHMED, 2023 120. Pediatric airways different from adult in : ABCD- Long, sometimes floppy epiglottis. Longer trachea and neck. The narrowest point in the airway is the vocal cord. Larynx located more posterior. 121. Ped vs. Adult airway ABCD- Epiglottis is longer and more narrow Larynx is posterior Narrowest vocal cord Longer trachea ( Barash , Page 763 ) ( Barash , Page 1217 ) ( Morgan , Page 879 ) 54 AHMED, 2023 122. Child with TOF for dental rehabilitation, which is true? ABCD- Avoid ketamine Avoid prolonged fasting hours Rt to Lt shunt will speed up of inhalation induction Tet spells are negligible in preoperative mortality and mortality ( Anesthesia and Co-existing Diseases Stoelting’s , Page 138 ) ( Miller- Basic of Anesthesia , Page 456) ( Morgan , Page 471 ) ( Morgan , Page 426 ) 55 AHMED, 2023 123. Which of the following is inappropriate for management of “tet spell” in TOF : ABCDE- 100% of O2. Phenylephrine. Metoprolol. Dopamine infusion. Fluid administration. ( Comprehensive , Q 970 ) 124. Down syndrome case of TOF going for dental extraction under GA, no known allergy, which one is the best antibiotic prophylaxis to be given 1 hour before OR ? 15 kg A- Cefazolin 750 mg IV B- Clindamycin 300 mg IV.. if the patient allergic, so B is the answer C- C and D were oral AB ( Miller’s , page 2849 ) 56 AHMED, 2023 125. Long case about TOF what will happen to anesthesia : ( R-L shunt ) ABCD- Decrease inhalational Decrease IV Decrease both Nothing change 126. long case about severe VSD what will happen during the induction of anesthesia ABCD- Decrease inhalational Decrease IV Decrease both Nothing change 127. 22 months old baby for adenotonsillectomy, case of ASD (left to right shunt). Regarding the speed of induction: ABCD- No effect Inhalation induction delayed I.V induction delayed Both inhalation & IV induction delayed 128. 22 months old kc VSD ( L-R shunt), for Adenotonsillectomy, consideration for GA induction: ABCD- No effect on speed of induction Delayed inhalational induction Delayed IV induction Delayed both IV and inhalation ( Morgan , Page 426 ) ( Morgan , Page 471 ) 57 AHMED, 2023 129. Elderly going for ERCP had midazolam and 20 mg scopolamine immediately after develop dizziness and confusion ? ABCD- Cholinergic crisis Anti cholinergic crisis Central anti cholinergic syndrome sedation 130. 42 years old man came restlessness, confused then unconsciousness, during endoscopic retrograde cholangiopancreatography (ERCP) under monitored anesthesia care (MAC) and sedation, he received 2mg midazolam and 42 mg Scopolamine What is the most appropriate management: ABCD- Edrophonium Neostigmine Physostigmine Pyridostigmine ( Stoelting , Page 694 ) ( Miller’s , page 379 ) 58 AHMED, 2023 131. 42 years old lady came for pre-operative assessment for thoracotomy she newly diagnosed myasthenia gravis and she has increasing muscle weakness after administration of Edrophonium. What is the most likely diagnosis : ABCD- Myasthenic crisis Myasthenic syndrome Cholinergic crisis Anticholinergic crisis ( Anesthesia and Co-existing Diseases Stoelting’s , Page 523 ) ( Barash , Page 616 ) 132. 32 years old female came for evaluation for thymomectomy and she diagnosed recently with myasthenia gravis on Edrophonium, she is complaining of muscle weakness. What is the most appropriate management: ABCD- Atropine Glycopyrrolate Neostigmine Physostigmine ( Anesthesia and Co-existing Diseases Stoelting’s , Page 631 ) ( Barash , Page 1066 ) 59 AHMED, 2023 133. About Sarin gas affect : ABCD- Cholinergic ( I think this is right b/c its muscarinic and nicotinic ) Muscarinic Cholinesterase Nicotinic 134. Sarine gas site of effect : A- Nicotinic receptors B- Muscarinic receptors C- Anticholinesterase inhibitor ( synaptic cleft ) ( Acetylcholinesterase inhibitor ) ( Miller- Basic of Anesthesia , Page 764 ) ( Miller’s , page 2494 ) 60 AHMED, 2023 135. 67y/o female, morbid obese,c/o chest pain and SOB. She was admitted to ICU as a case of unstable angina. She has Hx. Of dilated cardiomyopathy and B. Asthma on regular Symbicort. Bp 90/50, HR 110, Spo2 91, RR 20 Which of the following is most appropriate cause? ABCD- Atelectasis Plural effusion Pulmonary edema Pulmonary embolism ( Barash , Page 1066 ) 136. Male patient undergoing procedure in lithotomy position. Which of the following true regarding this position ? A- Common peroneal nerve injury is the most common one in lithotomy position 137. Common nerve injury (78%) in lithotomy position ? ABCD- Common Peroneal Obturator Femoral Pudendal ( Miller’s , page 1248 ) ( Miller- Basic of Anesthesia , Page 333 ) ( Comprehensive Q 565 ) 61 AHMED, 2023 138. Most common injury nerve in lithotomy/ Trendelenburg position ABCD- Ulnar Medial Radial External popliteal ( Miller- Basic of Anesthesia , Page 330 ) ( Comprehensive Q 423 ) 139. A 23 year old female patient , day one post partum complaining of difficult in climbing up stairs associated with numbness, she had a working epidural that lasted for 14 hours. She mentioned that the fetal head was entrapped in the pelvis for 4 hours, the most likely diagnosis is : ABCDE- Obturator nerve injury Common peroneal nerve injury Lumbosacral trunk injury Femoral nerve injury Sciatic nerve injury ( Chestnut’s Obstetric Anesthesia , Page 744 ) 62 AHMED, 2023 140. Female post day one SVD with epidural, complaining of foot drop ( didn’t mention any other signs or symptoms) what's the reason: ABCD- Femoral Neuropathy Meralgia paresthetica Cephalopelvic disproportion Residual Local Anesthesia 141. Patient who had prolonged labour and delivery with epidural analgesia, complaining of drop foot and numbness over the L5 dermatome, on examination she lost foot dorsiflexion. The cause of this palsy is: ABCDE- Compression on the obturator nerve Compression on lumbosacral trunk Femoral nerve palsy Sciatic nerve palsy Common peroneal nerve palsy 142. Pregnant with weaknesses of dorsi ankle flexion and numbness of anterior leg shaft with foot drop no sensation. one day post partum , she had epidural for labour delivery with long second stage what is the most likely diagnosis ? ABCD- Compression of lumbosacral Common peroneal nerve palsy Obturator nerve palsy Sciatic nerve palsy ( Chestnut’s Obstetric Anesthesia , Page 742-743 ) 63 AHMED, 2023 143. Neurologists examined female post labour epidural delivery and write common peroneal nerve injury is the diagnosis. What is the clinical sign ? ABCD- Foot dorsiflexion and toe extension Foot extension and toe dorsiflexion Foot planter flexion toe spasm Absent Knee jerk ( Miller’s , page 1261 ) 144. 25 y/o female with decrease in hip adduction and internal rotation and numbness on the inner thigh after epidural and prolonged delivery 2 days back You diagnosis is : ABCD- Obturator nerve palsy Sciatic nerve palsy Lumbosacral trunk compression Common peroneal nerve palsy ( Chestnut’s Obstetric Anesthesia , Page 743 ) 64 AHMED, 2023 ( Anesthesia Oral Board , page 204 ) ( Comprehensive Q 561 - 566 ) 65 AHMED, 2023 145. What hemodynamic changes will occur when euvolemic patient positioned in Trendelenburg and head down ? ABCD- Decrease blood flow with circle of Willis Peripheral vascular resistance decrease in lower extremities Decrease oxygen consumption Cardiac output will increase 146. Female 35y for sleeve after putting the patient on Trendelenburg position Patient start desaturate What is the cause? ABCD- Air embolism Pulse oximeter error PE Inadvertent right endobronchial intubation ( Morgan , Page 524 ) ( Barash , Page 1421 ) ( Comprehensive Q 466 ) 66 AHMED, 2023 147. Which is absolute contraindication of lithotripsy : ABCD- Cardioverter defibrillator Pace maker Aortic aneurysm Bleeding tendency 148. Absolute contraindication for lithotripsy : ABCD- Severe AS area less than 0.4 cm Cerebral aneurysm Thoracic aneurysm Abdominal pacemaker ( Faust's , chapter 167, page 403 ) ( Barash , Page 1432 ) 67 AHMED, 2023 149. 60 years old male came to ER with SOB, Fever Physical: hypotension Low Spo2 (85%) on 15L O2 Tachycardia (130) Tachypnea (40) Fever (temp 38) Bilateral Chest Crackles. Received 4L Fluid bolus and initial dose of antibiotics, NE infusion started One of the following can improve outcome: ABCD- Selenium Hydrocortisone Methylprednisolone Activated protein C ( Barash , Page 1593 ) ( Barash , Page 1591 ) 68 AHMED, 2023 150. Vital Capacity def: A- Amount of air that full expired after forced inspiration 151. What is the best description of residual volume? A- Volume remaining in the lung after maximum expiration 152. What is the term for maximum amount of air a person can exhale after a maximum inhalation: ABCD- Tidal volume Vital capacity Inspiratory capacity Total lung volume ( Morgan , Page 498 ) 153. What is the best statement that define total lung capacity : ABCD- Total volume in lung after maximal inspiration Volume inspired and expired in relaxed breathing Volume remaining in the lung after forced expiration Volume exhaled after maximal inspiration 154. Q about lung volumes graph letter C represent what in the graph? ABCD- Tidal volume Residual volume Vital capacity Functional residual capacity 69 AHMED, 2023 ( Morgan , Page 496 ) ( Morgan , Page 496 ) ( Stoelting , Page 561 ) 70 AHMED, 2023 155. 14 years old girl, for scoliosis repair under general anesthesia, she have history of thoracic scoliosis with Cobb’s angle 60 What is the best predictor of post-operative respiratory complication? ABCD- Vital capacity less than 40% DLCO2 less than 50 FEV1 65% FVC 75% ( Miller’s , page 2403 ) ( Anesthesia and Co-existing Diseases Stoelting’s , Page 43 ) 156. A 17 year old woman undergoing scoliosis correction surgery, what is a possible complication ? ABCD- Blindness HTN PE Upper and lower airway edema ( Morgan , Page 609 ) ( Miller- Basic of Anesthesia , Page 546) 71 AHMED, 2023 157. 18 years old male presented for spinal surgery for correction of scoliosis, how would you detect spinal cord ischemia in SSEPs : ABCDE- Increase amplitude, Decrease latency Decrease amplitude, Decrease latency Decrease amplitude, Increase latency Increase amplitude, Increase latency Decrease amplitude, Normal latency ( Comprehensive , Q 741 ) 158. What is the major difference between the pharmacological effect of IV lidocaine and swallowed lidocaine ? ABCD- Hepatic clearance Renal clearance Intravascular volume First pass hepatic metabolism 159. First pass hepatic metabolism is more by which route : ABCD- Nasal mucosa Sublingual Rectal Oral 72 AHMED, 2023 ( Anesthesia and Co-existing Diseases Stoelting’s , Page 523 ) ( Barash , Page 158 ) ( Miller’s , page 526 ) 160. Rectal administration of medications : A- Administration into proximal rectum is transported via portal vein B- Administration into lower rectum reaches systemic circulation after first pass through the liver C- Best predicted response perioperatively D- Lower rectum has less irritation ( Stoelting , Page 23 ) 73 AHMED, 2023 161. Regarding anatomic distribution about ventral remi of sciatic nerve : ABCD- T12 to S3 S1 to S3 L4 to S3 T12 to L4 162. Regarding nerve supply of the foot all are true EXCEPT: ABCDE- Medial side is supplied by sciatic nerve and femoral nerve Big toe is supplied by sciatic nerve only Sciatic nerve is from L4,5 and S1,2,3 Femoral nerve is from L2,3,4 Posterior tibial verve is from femoral nerve ( Miller’s , page 1737 ) ( Barash , Page 953 ) 163. 70 years old going for CABG, he has jugular bulb venous inserted, what is the concentration of venous mixed that indicate cerebral ischemia : ABCD- 40 50 60 70 164. Jugular venous O2 tension indicate for cerebral ischemia ABCD- < 50% < 55 < 60 < 70 74 AHMED, 2023 ( Barash , Page 1505 ) ( Barash , Page 1006 ) ( Miller’s , page 3106 ) ( Barash , Page 420 ) 75 AHMED, 2023 165. About mixed venous O2 saturation, what is the correct statement : ABCDE- Higher in the SVC compared to IVC Higher in the IVC compared to SVC Same among major veins. Low when there is greater tissue blood uptake. Low when there is less tissue oxygenation. ( Miller’s , page 1549 ) 76 AHMED, 2023 166. Pulse oximeter : A- Contain both red & infrared B- Wave length used 600-900 C- Wave length used 800-900 167. A potential source of artefacts in pulse measurement and can decrease the reading: ABCD- Jaundice Polycythaemia Hemoglobin K Intra-aortic balloon bump 168. Which of the following is the least to affect SpO2 probe (pulse oximeter): ABCDE- Fluorescent light Infrared light Surgical light Camera flash light Fibreoptic surgical light 169. Regarding pulse oximeter , which gives false elevation reading: ABCDE- Hemoglobin S Hemoglobin F Methylene blue dye Fluroscene dye Carboxyhaemoglobin ( Morgan , Page 124 ) 77 AHMED, 2023 ( Miller’s , page 1547 ) ( Miller’s , page 1548 ) 170. Regarding CVP waveform Which of the following(YAVC) will relate to it's anatomical function : ABCD- Mid systole corresponds to Y Early systole corresponds to A Late systole corresponds to V wave End diastole corresponds to C ( Barash , Page 711 ) 78 AHMED, 2023 171. 27 years acutely unstable. His CVP wave showed absent A and augmented C. Possible diagnosis will be : ABCD- Atrial fibrillation Tricuspid stenosis Cardiac tamponade Complete heart block 172. Most likely complication of CVP ABCD- Pain Limb edema Endocarditis Compartment syndrome 173. Indication of CVP line cannulation ( Miller’s , page 1369 ) ABCD- Transvenous Cardiac Pacing Minor surgery Patient with fat embolism Arterial sample taking ( Miller’s , page 1368 ) ( Miller’s , page 1365 ) ( Miller’s , page 1362 ) 79 AHMED, 2023 174. Most initial hemodynamic change in ECT ABCD- Tachycardia and hypertension Bradycardia and hypotension Transient asystole Tachypnea and sweating 175. 32 years old patient had ECT, they give him Suxamethonium and etomidate. What was the indication for Suxamethonium: ABCD- To reduce fracture incidence To prevent tongue bite To increase seizure threshold To prevent EEG fluctuation 176. Regarding Electroconvulsive therapy (ECT)which of the following is FALSE: ABCDE- Inhibition of the ECT seizures determine the efficacy of ECT Excessive anesthetic dosage may have anticonvulsant effect The objective of anesthesia is leave the patient unaware of muscle paralysis The goal of anesthesia is to promote prolonged , deep GA Seizure intensity and generalization throughout the brain greatly affects therapeutic impact 177. Most common complication of Electroconvulsive therapy (ECT) : ABCDE- Dental damage Aspirations Bronchospasm Laryngospasm Hypertension ( Anesthesia and Co-existing Diseases Stoelting’s , Page 616 ) 80 AHMED, 2023 ( Barash , Page 887 ) ( Faust's , chapter 171, page 411 ) 178. Pt 16 y/o male rescued from fire hotel he stayed around 40 mins in the room. He has second degree burn over the thigh and some of hair burned off. Now he is on 15 L mask O2 still restless and requiring analgesia for pain Vitals : BP 130/80 HR 90 o2SAT 100 % What is your management? ABCD- IV Fluids Immediate Intubation Morphine for pain ATLS secondary survey 179. Case of 20 y old his house got burned came to ER with signs of CO Poisoning, stable saturation on room air , BP 120/80 and tachycardic, he has second degree burn and screaming and shouting in the ER u came what will you do first ?? ABCD- Run IV fluid fast Intubate and support his airway before it collapse Give morphine 10mg IV state Evaluate then push to OR to debride the wound 81 AHMED, 2023 180. 30 y old pt who suffered inhalational injury due to burn in the building which he was left in the building for 120min pt presented with headache blurred vision N&V chest pain pt is tachypnea, what will u do to this pt that you will see in this pt HR 90 BP 120/80 sat100% on face mask ? ABCD- Intubate immediately Nothing as carbon monoxide is not high enough to cause respiratory effect Change to BIPAP Administer nitric oxide 181. 4 years old child was involved in a house fire. On presentation he was awake and spontaneously breathing. Carbonaceous material around his nostrils and mouth spoged. What is the first important initial step to do? ABCD- Administer IV fluid Immediate intubation Administer 100 % oxygen Send for the carboxy-hemoglobin level 182. 32 year old male found unconscious by the fire department in a room where he inhaled 0.1% CO for a prolonged period , his RR 42 breath/min but he is not cyanotic. CO increases his MV by which mechanism? ABCDE- Left shift of the oxygen Hemoglobin dissociation curve Increase CO2 production Lactic acidosis Decreasing Pao2 Producing methemoglobin ( Miller- Basic of Anesthesia , Page 741 ) ( Comprehensive , Q 113 ) 82 AHMED, 2023 ( Barash , Page 1515 ) 83 AHMED, 2023 ( Emergencies in Anesthesia , Page 132 ) ( Morgan , Page 1307 ) ( Emergencies in Anesthesia , Page 400 ) ( Barash , Page 1516 ) ( Barash , Page 1515 ) 84 AHMED, 2023 183. 20 years old going for appendectomy under GA, Which will follow positioning the pt in sniffing position for direct Laryngoscopy ? ABCD- Atlanto-occipital flexion Cervical extension and atlanto-occipital flexion Cervical flexion and atlanto-occipital extension Dervical extension and atlanto-occipital extension 184. Regarding to patient positioning prior to intubation , the optimal position can be all of the following EXCEPT : (All are proper for intubation EXCEPT) ABCDE- Magill position (same sniffing) Sniff position Over extension of the head and neck In female you push the breast away from the laryngeal scope handle Use of PI pillow ( Miller’s , page 1653 ) 185. 50 year old patient for laparoscopic surgery, how Co2 inflation participate in lowering the patient’s temperature: ABCD- Radiation Convection Conduction Evaporation ( Barash , Page 1269 ) 186. After inducing general anesthesia, after one hour the hypothermia happened. Mechanism of action for the heat from the patient to the OR theatre or to the environment is : ABCD- Radiation and conduction Radiation and convection Evaporation and conduction Evaporation and convection 85 AHMED, 2023 187. A 55 year old male with BMI 32 in the recovery room post total colectomy which lasted for 4 hours with a temperature of 35.4 C , Causes of heat loss includes : ABCDE- Evaporation accounts for 70% of his heat loss Convection is heat loss by direct contact with OR table Long surgery Male gender Obesity 188. 36 years old for sleeve, Best way to avoid hypothermia is: ABCD- Humidified airway Increase room temperature ( Correct if Q about Pediatric Pt ) Intravenous warm IV fluid Force warming air around skin ( Correct because Q is about Obese Pt, See Miller’s P 2213 ) ( Miller’s , page 2213 ) 189. After one hour of starting surgery , you measure body temp from oesophageal prop 35.8 C what is mostly likely cause ? ABCD- Redistribution core temp to peripheral Cannot be prevented by re-warming Patient contact to linen Patient contact to table 190. 3 hrs anesthesia temperature: ( If he means 3rd phase ) A- Equilibration between heat production and loss ( Comprehensive Q 597 ) AHMED, 2023 ( Faust's , chapter 161, page 386 ) ( Miller’s , page 1622 ) For more about Hypothermia and heat loss , see ( Miller’s , page 1627 – 1639 ) 86 ( Miller’s , page 1628 ) ( Miller’s , page 1638 ) ( Barash , Page 321 ) ( Morgan , Page 1184 ) 87 AHMED, 2023 191. At what Temperature the EEG become flat : ABCD- 16 18 27 30 ( Miller’s , page 391 ) ( Morgan , Page 578 ) 192. Thermoregulation in neonate? A- Parasympathetic innervation to brown fat is the driving mechanism in Heat production B- Non shivering heat production is primarily in adult & Pediatric C- Brown fat composed of 2-6% ( Comprehensive Q 609 ) ( Stoelting , Page 847 ) 88 AHMED, 2023 193. A 16 years old male undergoing left open nephrectomy , when monitoring temperature for this patient which is TRUE: ABCD- There is no difference in taking tympanic temperature between Rt. And Lt. Ear Tympanic temperature can be used for continuous temperature monitoring Temperature will increase by a maximum of 2 degrees Celsius after regional anesthesia Folley’s catheter with temperature sensor is ideally used in this case to monitor temperature E- If the Esophageal temperature probe is advanced in the stomach , the recorded temperature will be higher than the core temperature and its change is slower. ( Stoelting , Page 94 ) ( Miller’s , page 1643 ) 89 AHMED, 2023 194. 25 years old victim of motor vehicle accident. What are the parameters if you want to check his GCS: ABCDE- Mouth opening, motor response, verbal response Mouth opening, verbal response, eye opening Eye opening, motor response, verbal response Eye opening, mouth opening, Motor response Verbal response ,motor response, reflexes 195. Patient victim of RTA. He opens his eyes on commands, moaning with unrecognizable words and localizing pain, What is his GCS: A- 10 B- 14 C- 6 ( Barash , Page 1018 ) ( Miller- Basic of Anesthesia , Page 729 ) 196. First muscle to be relaxed after 0.6 mg of rocuronium : ABCD- Biceps Arytenoid Adductor hallucis Flexor policies longed ( Comprehensive Q 227 ) 90 AHMED, 2023 197. During pregnancy which will be decrease at full term ABCD- Lung compliance Airway resistance Inspiratory reserve volume Expiratory reserve volume 198. Which one of the following is decreased during pregnancy: ABCD- Vt FRC FVC CO 199. Coagulation factor that decrease during pregnancy is : ABCD- XI VII I V 200. Which of the following factors does not increase in pregnancy: remain unchanged ? ABCDE- Factor XI Factor VIII Factor XIII Factor VII Factor V 201. All are changes in pregnancy except : ABCD- Increased cardiac output at term Increased TV Decreased red call mass Decreased SVR 202. Regarding physiological changes in pregnancy all are true except : ABCDE- FRC decrease by 20% from pre pregnancy state. Stroke volume, Heart rate and Cardiac output increased. Systemic Vascular Resistance and blood pressure increased Platelets stable. Blood volume increased by 45%. 91 AHMED, 2023 ( Chestnut’s Obstetric Anesthesia , Page 24 ) ( Miller- Basic of Anesthesia , Page 554 ) ( Chestnut’s Obstetric Anesthesia , Page 20 ) ( Chestnut’s Obstetric Anesthesia , Page 22 ) 92 AHMED, 2023 203. What will happen to liver of the pregnant lady : ABCD- Nothing will change in the blood flow Increase blood flow to the liver Decrease blood flow due to compression especially in the third trimester Liver become congested and increase in the protein 204. During pregnancy which is true regarding the hepatic and biliary changes? A- Plasma protein concentrations are increased B- Blood flow to the liver doesn’t change significantly with pregnancy C- The risk for gallbladder disease is low during pregnancy with incomplete gallbladder emptying and changes in bile composition D- Plasma cholinesterase activity is decreased approximately 60% , thru the 10 th week of gestation up to 6 weeks postpartum 205. Plasma cholinesterase activity during pregnancy : ABCD- Increase 20% Decrease 20% Not affected ?Postpartum? 206. Highest plasma cholinesterase concentration during pregnancy, at which period? ( Chestnut’s Obstetric Anesthesia , Page 31 ) ( Chestnut’s Obstetric Anesthesia , Page 26 ) 93 AHMED, 2023 ( Barash , Page 1145 ) ( Miller’s , page 2333 ) 207. Case about obese patient lab surgery, developed oliguria intra op A- Due to hypovolemia B- Intra-abdominal pressure increase vasopressin C- ADH increase due to lap. Surgery ( Barash , Page 1263 ) ( Comprehensive Q 396 ) 94 AHMED, 2023 208. Anatomical or physiological risk factor for difficult airway in pregnant ABCD- Breast enlargement Increase FRC Increase LES Decrease O2 consumption ( Chestnut’s Obstetric Anesthesia , Page 686 ) 209. Which of the following the strongest predictor of PONV ? ABCDE- Age anxiety Obesity Female gender Hx of PONV ( Morgan , Page 283 ) ( Miller’s , page 2950 ) ( Miller’s , page 2954 ) 95 AHMED, 2023 ( Comprehensive Q 522 ) 210. Management of PONV in patient who had 2 drugs of antiemetic in ambulatory surgery but he is still vomiting ABCD- Ephedrine IM 0.5mg/kg Give the same modal for Q 6 hour Give the same drug Maintain hydration ASAP 211. What is the appropriate management for patient with persistent nausea and vomiting after ambulatory procedure? A- IV fluid and maintenance dose B- Prescribing the previous used antiemetic and giving it within 6hours of previous administration C- Administration of 10ml/kg isotonic electrolyte solution. D- Ephedrine 0.5mg intramuscular ( Comprehensive Q 216 ) 96 AHMED, 2023 ( Miller’s , page 2637 ) 212. How to reduce serotonin chemoreceptor should use : ABCD- Droperidol 5HT 3 receptor Histamine Dopamine D2 receptor ( Stoelting , Page 696 ) 97 AHMED, 2023 213. Antiemetic work on CRTZ? A- 5HT3 B- Droperidol C- Metoclopramide 214. Anti-emetic act on the chemotactic trigger zone: A- Dopamine B- Histamine C- Droperidol I think all work on CRTZ ! something missing in the Q ( Morgan , Page 282 ) ( Morgan , Page 284, 285 ) ( Stoelting , Page 841 ) 215. 30 y female smoke 60 Pac/Year with hx of N&V post OR, u anesthetize her for Lap-chole What’s her percentage to have N&V? ABCD- 20% 30% 40% 60% 216. Female for carpal tunnel surgery under local anesthesia , she is smoker , with hx of PONV, What is APFEL score ? ABCD- 10 % 20 % 40 % 60 % 98 AHMED, 2023 ( Miller’s , page 2635 ) ( Miller’s , page 2958 ) 217. 50 years old female post Renal transplant on immunosuppression by cyclosporin and steroid, came for knee arthroplasty , she had history of PONV, What is the best management ? ABCD- Metoclopramide Avoid regional anesthesia Proceed total intravenous anesthesia Proceed Inhalation anesthesia ( Barash , Page 1577 ) ( Miller’s , page 2947 ) 99 AHMED, 2023 ( Miller’s , page 2962 ) ( Barash , Page 1485 ) 218. What causes increase peaked pressure without plateau pressure? A- Bronchospasm B- Laparoscopic surgery C- Endobronchial intubation ( Morgan , Page 79 )