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Afghanistan Anesthesia Technology Exit Exam study materials
Afghanistan Anesthesia Technology Exit Exam study resources

Afghanistan Anesthesia Technology Exit Exam practice questions

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Question 1Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which nerve is blocked to provide anesthesia for the anterior two-thirds of the tongue?

  1. Lingual nerve Correct answer.
  2. Glossopharyngeal nerve
  3. Hypoglossal nerve
  4. Chorda tympani nerve

Explanation

General sensation from the anterior two-thirds of the tongue travels via the lingual nerve, a branch of the mandibular division of the trigeminal nerve, so blocking it produces anesthesia of that region. The chorda tympani carries taste from the same area but is not the target for surgical anesthesia.

Question 2Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

During spontaneous breathing, which muscle is the principal generator of the tidal volume?

  1. Rectus abdominis
  2. External intercostal muscles
  3. Diaphragm Correct answer.
  4. Sternocleidomastoid

Explanation

The diaphragm accounts for roughly two-thirds to three-quarters of tidal volume during quiet breathing by descending and creating negative intrathoracic pressure. The other muscles listed are accessory or expiratory muscles recruited in labored breathing.

Question 3Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient's arterial blood gas shows pH 7.30, PaCO2 55 mmHg, and HCO3- 26 mEq/L. Which acid-base disturbance is present?

  1. Respiratory acidosis Correct answer.
  2. Metabolic alkalosis
  3. Respiratory alkalosis
  4. Metabolic acidosis

Explanation

The low pH indicates acidemia, and the elevated PaCO2 with a near-normal bicarbonate points to a respiratory cause. Retention of carbon dioxide is the defining feature of respiratory acidosis.

Question 4Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which receptor type mediates the rapid heart rate increase produced by epinephrine?

  1. Beta-2 adrenergic receptors
  2. Muscarinic M2 receptors
  3. Alpha-1 adrenergic receptors
  4. Beta-1 adrenergic receptors Correct answer.

Explanation

Beta-1 receptors predominate in the sinoatrial node and ventricular myocardium, so their stimulation increases heart rate and contractility. Beta-2 receptors mediate bronchodilation and vasodilation, while alpha-1 receptors mediate vasoconstriction.

Question 5Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which pharmacokinetic property of propofol best explains its rapid onset after an induction dose?

  1. Slow plasma protein binding
  2. Rapid redistribution from brain to other tissues Correct answer.
  3. High hepatic extraction ratio
  4. Large volume of distribution in fat

Explanation

Propofol is highly lipophilic and crosses the blood-brain barrier quickly, then rapidly redistributes away from the brain into muscle and fat, terminating its effect. This redistribution, not metabolism, drives early recovery.

Question 6Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A 70-kg patient receives 100 mg of a drug with a volume of distribution of 50 L. What is the approximate plasma concentration?

  1. 20 mg/L
  2. 5 mg/L
  3. 0.5 mg/L
  4. 2 mg/L Correct answer.

Explanation

Concentration equals dose divided by volume of distribution: 100 mg / 50 L = 2 mg/L. Body weight is irrelevant once the volume of distribution is given directly.

Question 7Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in lung volumes occurs when a patient moves from the sitting to the supine position?

  1. Functional residual capacity decreases Correct answer.
  2. Functional residual capacity increases
  3. Total lung capacity increases
  4. Residual volume decreases

Explanation

Assuming the supine position shifts the diaphragm cephalad and reduces functional residual capacity, mainly by lowering expiratory reserve volume. Total lung capacity and residual volume change little.

Question 8Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which structure must be punctured to enter the epidural space via the midline approach?

  1. Dura mater
  2. Ligamentum flavum Correct answer.
  3. Pia mater
  4. Arachnoid mater

Explanation

In the midline approach the needle passes skin, subcutaneous tissue, supraspinous and interspinous ligaments, then the ligamentum flavum before entering the epidural space. The meninges are encountered only if the needle advances into the subarachnoid space.

Question 9Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which gas law explains why a nitrous oxide cylinder maintains a constant pressure until nearly empty?

  1. Charles's law
  2. Dalton's law
  3. Henry's law
  4. Boyle's law Correct answer.

Explanation

Nitrous oxide is stored as a liquid below its critical temperature, and Boyle's law describes the inverse relationship between pressure and volume of a gas at constant temperature; the vapor pressure of the liquid keeps cylinder pressure constant until all liquid is vaporized. This explains the pressure plateau seen on a nitrous oxide cylinder gauge.

Question 10Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A vaporizer delivers a set concentration because the gas passing through it becomes saturated. Which factor most directly determines the saturated vapor pressure of a volatile agent?

  1. Barometric pressure
  2. Fresh gas flow rate
  3. Temperature of the liquid Correct answer.
  4. Carrier gas composition

Explanation

Saturated vapor pressure depends on the volatile agent and its temperature, rising as temperature increases. Flow rate and carrier gas affect the amount delivered but not the saturated vapor pressure of the liquid.

Question 11Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which safety feature prevents delivery of a hypoxic gas mixture from an anesthesia machine?

  1. Scavenging system
  2. Oxygen failure alarm
  3. Pressure relief valve
  4. Hypoxic guard with nitrous oxide cut-off Correct answer.

Explanation

A hypoxic guard links the oxygen and nitrous oxide flow controls so that nitrous oxide is reduced or cut off when the oxygen fraction would fall below a safe minimum. Oxygen failure alarms warn of supply loss but do not limit nitrous oxide delivery.

Question 12Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which parameter is the best indicator of adequate alveolar ventilation during spontaneous ventilation?

  1. Respiratory rate
  2. PaO2
  3. PaCO2 Correct answer.
  4. Oxygen saturation

Explanation

Alveolar ventilation is inversely related to PaCO2, so arterial carbon dioxide is the primary index of how effectively the alveoli are being ventilated. Oxygenation is reflected by PaO2 and saturation, which depend more on inspired oxygen and shunt.

Question 13Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which mechanism best explains the increased sensitivity to non-depolarizing neuromuscular blockers in a patient with hepatic cirrhosis?

  1. Enhanced receptor sensitivity
  2. Increased renal excretion of the drug
  3. Impaired hepatic metabolism and reduced clearance Correct answer.
  4. Reduced volume of distribution

Explanation

Many non-depolarizing blockers depend on hepatic metabolism and biliary excretion, so cirrhosis prolongs their effect through reduced clearance. This prolongs the duration of action rather than altering receptor sensitivity.

Question 14Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient with a history of malignant hyperthermia requires anesthesia. Which agent is safest to use?

  1. Sevoflurane
  2. Desflurane
  3. Succinylcholine
  4. Propofol Correct answer.

Explanation

Malignant hyperthermia is triggered by volatile anesthetics and succinylcholine, so a total intravenous technique with propofol is the safest choice. Volatile agents and depolarizing blockers must be avoided.

Question 15Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in cardiac output occurs during the induction of general anesthesia with propofol?

  1. Increase in systemic vascular resistance
  2. Increase in heart rate
  3. Increase in cardiac output
  4. Decrease in cardiac output Correct answer.

Explanation

Propofol causes vasodilation and myocardial depression, leading to a fall in systemic vascular resistance and cardiac output with mild bradycardia. The result is hypotension, not an increase in output.

Question 16Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which nerve is at greatest risk of injury during carotid endarterectomy, causing hoarseness if damaged?

  1. Recurrent laryngeal nerve Correct answer.
  2. Facial nerve
  3. Greater occipital nerve
  4. Hypoglossal nerve

Explanation

The recurrent laryngeal nerve runs in the tracheoesophageal groove near the carotid sheath and can be injured during carotid surgery, producing vocal cord paresis and hoarseness. The hypoglossal nerve is also nearby but causes tongue deviation rather than hoarseness.

Question 17Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which physiologic change explains the rapid onset of a spinal anesthetic compared with an epidural?

  1. Use of a larger needle
  2. Direct injection into cerebrospinal fluid Correct answer.
  3. Larger local anesthetic dose
  4. Higher lipid solubility of the drug

Explanation

A spinal anesthetic deposits local anesthetic directly into cerebrospinal fluid, giving immediate access to the nerve roots. An epidural must diffuse across the dura, which delays onset.

Question 18Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which lung unit has the lowest ventilation-perfusion ratio?

  1. Main bronchus
  2. Base of the lung in an upright patient Correct answer.
  3. Apex of the lung in an upright patient
  4. Trachea

Explanation

In the upright lung, gravity increases perfusion more than ventilation at the base, so the base has a low ventilation-perfusion ratio. The apex has a relatively high ratio because perfusion is reduced more than ventilation.

Question 19Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which drug is a specific antidote for benzodiazepine overdose?

  1. Neostigmine
  2. Flumazenil Correct answer.
  3. Atropine
  4. Naloxone

Explanation

Flumazenil is a competitive benzodiazepine receptor antagonist used to reverse benzodiazepine sedation. Naloxone reverses opioids, while atropine and neostigmine act on muscarinic and cholinesterase targets respectively.

Question 20Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which factor most increases the risk of aspiration pneumonitis during induction of anesthesia?

  1. Preoxygenation before induction
  2. Use of a supraglottic airway
  3. Head-up positioning
  4. Full stomach with delayed gastric emptying Correct answer.

Explanation

A full stomach with delayed emptying increases gastric volume and pressure, raising the risk of regurgitation and aspiration during induction. Rapid sequence induction with cricoid pressure is often used in this situation.

Question 21Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which statement correctly describes the effect of a depolarizing neuromuscular blocker at the motor end plate?

  1. It blocks presynaptic calcium channels
  2. It competes with acetylcholine at the receptor
  3. It inhibits acetylcholinesterase
  4. It causes persistent depolarization of the motor end plate Correct answer.

Explanation

Succinylcholine binds nicotinic receptors and produces a sustained depolarization, causing initial fasciculations followed by flaccid paralysis. Non-depolarizing agents act by competitive antagonism instead.

Question 22Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in oxygen delivery occurs when cardiac output falls while arterial oxygen content remains constant?

  1. Oxygen delivery decreases Correct answer.
  2. Oxygen delivery is unchanged
  3. Oxygen delivery increases
  4. Oxygen consumption increases

Explanation

Oxygen delivery equals cardiac output multiplied by arterial oxygen content, so a fall in cardiac output reduces delivery if content is unchanged. Consumption may rise relative to delivery, widening the oxygen extraction ratio.

Question 23Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which structure is located at the level of the cricothyroid membrane?

  1. Epiglottis
  2. Cricoid cartilage Correct answer.
  3. Thyroid cartilage
  4. Vocal cords

Explanation

The cricothyroid membrane lies between the thyroid cartilage above and the cricoid cartilage below, and the cricoid ring marks its lower border. This avascular membrane is the site for emergency cricothyrotomy.

Question 24Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which property of a local anesthetic determines its speed of onset?

  1. pKa relative to tissue pH Correct answer.
  2. Molecular weight
  3. Lipid solubility
  4. Protein binding

Explanation

Local anesthetics cross membranes in their uncharged form, and the proportion of uncharged drug depends on the pKa relative to tissue pH. An agent whose pKa is closer to physiologic pH has more uncharged base and a faster onset.

Question 25Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which electrolyte disturbance most commonly predisposes to ventricular arrhythmias in the perioperative period?

  1. Hypochloremia
  2. Hypokalemia Correct answer.
  3. Hypernatremia
  4. Hypercalcemia

Explanation

Hypokalemia increases myocardial excitability and prolongs repolarization, predisposing to ventricular ectopy and arrhythmias, particularly with catecholamine or digoxin exposure. Sodium and chloride disturbances rarely cause ventricular arrhythmias.

Question 26Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which nerve supplies motor innervation to the diaphragm?

  1. Recurrent laryngeal nerve
  2. Intercostal nerve
  3. Vagus nerve
  4. Phrenic nerve Correct answer.

Explanation

The diaphragm receives its motor supply from the phrenic nerve, which arises from cervical roots C3 to C5. This is why lesions above C3 spare spontaneous ventilation, while higher cervical cord injury abolishes it.

Question 27Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A 60-kg patient is given 30 mg of a drug that distributes only into plasma, with a plasma volume of about 3 L. What is the approximate resulting plasma concentration?

  1. 10 mg/L Correct answer.
  2. 1 mg/L
  3. 0.1 mg/L
  4. 30 mg/L

Explanation

Concentration equals dose divided by volume of distribution: 30 mg / 3 L = 10 mg/L. When a drug is confined to plasma, the plasma volume is the relevant volume term.

Question 28Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which receptor type mediates the chronotropic and inotropic effects of epinephrine on the heart?

  1. Beta-2 adrenergic
  2. Beta-1 adrenergic Correct answer.
  3. Alpha-1 adrenergic
  4. Muscarinic M2

Explanation

Cardiac beta-1 receptors increase heart rate and contractility when stimulated. Alpha-1 receptors cause vasoconstriction, and beta-2 receptors mediate bronchodilation and vasodilation.

Question 29Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which statement best describes the mechanism of action of propofol?

  1. It blocks voltage-gated sodium channels
  2. It activates alpha-2 adrenergic receptors
  3. It antagonizes NMDA receptors
  4. It enhances GABA-A receptor chloride conductance Correct answer.

Explanation

Propofol potentiates the inhibitory neurotransmitter GABA at GABA-A receptors, increasing chloride conductance and neuronal hyperpolarization. This produces hypnosis and dose-dependent cardiorespiratory depression.

Question 30Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient is breathing through a tube whose internal diameter is halved while gas flow remains laminar. According to Poiseuille's law, how does the resistance to flow change?

  1. It increases sixteen-fold Correct answer.
  2. It increases four-fold
  3. It remains unchanged
  4. It doubles

Explanation

Poiseuille's law states resistance is inversely proportional to the fourth power of the radius. Halving the radius reduces the fourth power term by a factor of 16, so resistance rises sixteen-fold.

Question 31Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which statement about the uptake of a volatile anesthetic is correct?

  1. Increasing alveolar blood solubility speeds induction
  2. Lowering cardiac output slows induction
  3. Increasing alveolar blood solubility slows the rise of alveolar partial pressure Correct answer.
  4. Decreasing fresh gas flow always speeds induction

Explanation

A more blood-soluble agent is taken up extensively by blood, so the alveolar partial pressure rises slowly toward the inspired value. This slows the rate at which the brain partial pressure rises, delaying induction.

Question 32Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which factor most directly determines the speed of onset of a local anesthetic?

  1. Its molecular weight
  2. Its rate of hepatic metabolism
  3. Its pKa relative to tissue pH Correct answer.
  4. Its degree of protein binding

Explanation

The pKa determines the fraction of drug in the uncharged, diffusible base form at tissue pH, which governs how quickly it penetrates the nerve membrane. A pKa closer to physiologic pH produces a larger uncharged fraction and faster onset.

Question 33Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient has a serum potassium of 6.8 mmol/L with peaked T waves on the ECG. Which immediate measure both stabilizes the myocardium and shifts potassium intracellularly?

  1. Intravenous potassium chloride
  2. Oral sodium polystyrene sulfonate
  3. Intravenous furosemide alone
  4. Intravenous calcium gluconate followed by insulin with glucose Correct answer.

Explanation

Calcium antagonizes the membrane effects of hyperkalemia, while insulin with glucose drives potassium into cells. Together they treat the immediate arrhythmic risk and lower serum potassium.

Question 34Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in functional residual capacity occurs when a patient is placed in the Trendelenburg position under general anesthesia?

  1. It increases to equal total lung capacity
  2. It increases markedly
  3. It remains identical to the awake sitting value
  4. It decreases compared with the supine position Correct answer.

Explanation

Trendelenburg positioning shifts the abdominal contents and diaphragm cephalad, further reducing functional residual capacity already lowered by anesthesia. The result is a greater tendency to atelectasis and airway closure.

Question 35Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in the oxyhemoglobin dissociation curve is produced by a rise in 2,3-diphosphoglycerate?

  1. A shift that prevents oxygen unloading in tissues
  2. No change in curve position
  3. A leftward shift with increased hemoglobin affinity for oxygen
  4. A rightward shift with reduced hemoglobin affinity for oxygen Correct answer.

Explanation

Raised 2,3-DPG reduces hemoglobin's affinity for oxygen, shifting the curve to the right. This favors oxygen unloading at the tissues, which is beneficial in anemia or chronic hypoxia.

Question 36Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which statement correctly describes the site of action of depolarizing neuromuscular blockers?

  1. They block presynaptic calcium channels
  2. They inhibit acetylcholinesterase in the synaptic cleft
  3. They act at the nicotinic acetylcholine receptor of the motor end plate Correct answer.
  4. They act at muscarinic receptors on the heart

Explanation

Depolarizing blockers such as succinylcholine bind nicotinic acetylcholine receptors at the motor end plate and cause sustained depolarization. This prevents repolarization and further excitation until the drug diffuses away.

Question 37Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient with cirrhosis has hypoalbuminemia and is given a highly protein-bound drug. What is the expected effect on the unbound fraction?

  1. It stays the same because total drug is unchanged
  2. It decreases, reducing drug effect
  3. It increases only if renal function is normal
  4. It increases, potentially enhancing pharmacologic effect Correct answer.

Explanation

Less albumin means fewer binding sites, so a larger fraction of drug circulates unbound and pharmacologically active. This can intensify effects and toxicity even at the same total measured concentration.

Question 38Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which change in cardiac output accompanies the administration of a spinal anesthetic to a high thoracic level?

  1. It rises because of bradycardia
  2. It falls because of sympathetic blockade and reduced venous return Correct answer.
  3. It is unchanged because the heart is not blocked
  4. It rises because of increased systemic vascular resistance

Explanation

High neuraxial block interrupts sympathetic outflow, causing vasodilation and reduced venous return. The fall in preload and afterload lowers cardiac output and can produce hypotension and bradycardia.

Question 39Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

Which statement about the Mapleson breathing systems is correct?

  1. The Mapleson A system is most efficient for controlled ventilation
  2. The Mapleson A system requires fresh gas flow near the patient's minute ventilation to prevent rebreathing during spontaneous breathing Correct answer.
  3. The Mapleson D system is most efficient for spontaneous ventilation
  4. All Mapleson systems require a carbon dioxide absorber

Explanation

The Mapleson A (Magill) system is efficient for spontaneous ventilation, needing fresh gas flow near minute ventilation to avoid rebreathing. During controlled ventilation its efficiency falls and the D system becomes preferable.

Question 40Basic and Applied Sciences Relevant to Anesthesia (Anatomy, Physiology, Pharmacology, Physics/Equipment)

A patient receiving a non-depolarizing neuromuscular blocker is given a drug that inhibits acetylcholinesterase at the neuromuscular junction. What is the expected result?

  1. Reduced sensitivity of the postsynaptic receptor to acetylcholine
  2. Direct activation of postsynaptic nicotinic receptors by the inhibitor
  3. Increased acetylcholine at the end plate, which competitively reverses the block Correct answer.
  4. Depletion of presynaptic acetylcholine stores, worsening the block

Explanation

Non-depolarizing blockers act as competitive antagonists at the nicotinic receptor of the motor end plate. Inhibiting acetylcholinesterase raises the concentration of acetylcholine in the synaptic cleft, so acetylcholine outcompetes the blocker and transmission is restored. This is the basis for neostigmine reversal of competitive neuromuscular blockade.

Question 41Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

A patient is scheduled for elective surgery. According to standard fasting guidelines for healthy adults, clear liquids may be taken up to how long before induction of anesthesia?

  1. 4 hours
  2. 8 hours
  3. 6 hours
  4. 2 hours Correct answer.

Explanation

Standard preoperative fasting guidance permits clear liquids up to 2 hours before anesthesia because they empty rapidly from the stomach. Longer intervals apply to breast milk and light meals. This reduces aspiration risk while avoiding unnecessary dehydration.

Question 42Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

Which airway finding most strongly predicts a difficult laryngoscopy during the preoperative airway examination?

  1. Neck circumference of 35 cm in a tall patient
  2. Mallampati class III with a short thyromental distance Correct answer.
  3. Mallampati class I with full visibility of tonsillar pillars
  4. Presence of a single healthy maxillary central incisor

Explanation

A high Mallampati class combined with a reduced thyromental distance reflects limited oral opening and reduced submandibular space, both of which predict difficult direct laryngoscopy. Individual features have modest predictive value, but combinations raise risk substantially.

Question 43Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

An adult patient reports a previous episode of severe nausea and vomiting after general anesthesia. Which strategy best reflects appropriate preoperative planning?

  1. Avoid all opioid analgesia and use only inhalational agents
  2. Withhold all preoperative fluids to reduce gastric volume
  3. Cancel the procedure until gastroenterology clearance is obtained
  4. Include a multimodal antiemetic plan and minimize known emetogenic triggers Correct answer.

Explanation

A history of postoperative nausea and vomiting is a strong predictor of recurrence, so prophylaxis should be planned in advance. Multimodal antiemetics plus reduction of emetogenic triggers (volatile agents, opioids, nitrous oxide) is the recommended approach.

Question 44Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

Which laboratory value most directly affects the decision to postpone elective surgery because of bleeding risk?

  1. Platelet count of 45,000/mm³ Correct answer.
  2. Serum sodium of 138 mmol/L
  3. Hemoglobin of 13 g/dL
  4. Fasting glucose of 110 mg/dL

Explanation

A platelet count below roughly 50,000/mm³ substantially increases bleeding risk with surgery and anesthesia, and correction or postponement is usually considered. The other values are within or near normal ranges and do not independently mandate delay.

Question 45Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

A patient with well-controlled asthma is undergoing elective surgery. Which preoperative finding suggests the surgery should be delayed for optimization?

  1. Use of a salbutamol inhaler twice weekly
  2. Recent upper respiratory infection with wheezing and reduced peak flow Correct answer.
  3. Peak expiratory flow at 90 percent of personal best
  4. Occasional dry cough with normal peak flow

Explanation

Active wheezing with reduced peak flow indicates poorly controlled or acutely worsened airway disease, which raises the risk of bronchospasm and should prompt optimization before elective anesthesia. Stable, well-controlled asthma does not require delay.

Question 46Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

Which preoperative instruction is appropriate for a patient taking warfarin who is scheduled for elective surgery and requires interruption of anticoagulation?

  1. Stop warfarin on the morning of surgery without further planning
  2. Coordinate with the prescriber about stopping warfarin several days ahead and bridging if indicated Correct answer.
  3. Double the warfarin dose the day before surgery
  4. Continue warfarin unchanged and proceed with neuraxial anesthesia

Explanation

Warfarin has a long half-life and its effect must be allowed to wear off over several days, guided by INR and the thrombotic risk of the patient. Bridging with a short-acting anticoagulant may be needed for high-risk patients, so coordination with the prescribing clinician is essential.

Question 47Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

During preoperative evaluation, a patient reports a prior anaphylactic reaction to succinylcholine. Which preoperative planning step is most important?

  1. Give a small test dose to confirm the reaction
  2. Premedicate with a corticosteroid and proceed with the same agent
  3. Document the allergy and select an alternative neuromuscular blocking agent Correct answer.
  4. Use the same agent but at a reduced dose

Explanation

A documented anaphylactic reaction to a neuromuscular blocking agent is a contraindication to re-exposure, and a structurally different agent should be chosen. Cross-reactivity between agents is possible, so the allergy must be clearly documented and communicated.

Question 48Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

Which patient characteristic is most consistent with an American Society of Anesthesiologists physical status classification of III?

  1. A patient with mild systemic disease without functional limitation
  2. A patient with severe systemic disease that limits activity Correct answer.
  3. A healthy patient with no systemic disease
  4. A patient who is brain-dead and being prepared for organ donation

Explanation

ASA physical status III denotes severe systemic disease with functional limitation, such as poorly controlled diabetes with complications or end-stage renal disease. Class II reflects mild systemic disease without functional limitation, and class I reflects a healthy patient.

Question 49Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

A patient with a body mass index of 42 kg/m² is scheduled for abdominal surgery. Which preoperative consideration is most relevant to anesthesia planning?

  1. Increased risk of difficult mask ventilation and rapid oxygen desaturation Correct answer.
  2. Reduced risk of aspiration because of increased gastric tone
  3. Decreased incidence of obstructive sleep apnea
  4. Lower requirement for opioid dosing based on total body weight

Explanation

Obesity increases the likelihood of difficult mask ventilation and difficult laryngoscopy, and reduced functional residual capacity leads to faster desaturation during apnea. Careful positioning, preoxygenation, and appropriate drug dosing are key planning steps.

Question 50Preoperative Assessment, Patient Evaluation, and Anesthesia Planning

A patient with end-stage renal disease on hemodialysis is scheduled for surgery the day after a dialysis session. Which preoperative electrolyte concern is most important to review?

  1. Serum albumin
  2. Serum potassium Correct answer.
  3. Serum calcium
  4. Serum chloride

Explanation

Hyperkalemia is a common and dangerous complication in patients with end-stage renal disease and can provoke arrhythmias under anesthesia. Potassium should be checked, especially when surgery follows dialysis by a prolonged interval.