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Arab Board Anesthesia Final Clinical and Oral Exam study materials
Arab Board Anesthesia Final Clinical and Oral Exam study resources

Arab Board Anesthesia Final Clinical and Oral Exam practice questions

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Question 1General Anesthesia and Perioperative Management

A 70 kg adult is receiving a propofol infusion at 100 micrograms/kg/min. What is the hourly dose in milligrams?

  1. 600 mg/h
  2. 42 mg/h
  3. 700 mg/h
  4. 420 mg/h Correct answer.

Explanation

100 micrograms/kg/min in a 70 kg patient equals 7000 micrograms/min, or 7 mg/min. Multiplying by 60 minutes gives 420 mg/h.

Question 2General Anesthesia and Perioperative Management

Which preoperative fasting interval is currently recommended for clear fluids in healthy adults before elective surgery?

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

Explanation

Clear fluids empty rapidly from the stomach, and consensus guidance permits intake up to 2 hours before induction in healthy adults. Longer intervals are reserved for breast milk, formula, and solid food.

Question 3General Anesthesia and Perioperative Management

During a rapid sequence induction in a patient with a full stomach, which maneuver is applied immediately after loss of consciousness and before intubation?

  1. Head-down tilt with cricoid release
  2. Cricoid pressure with head-up positioning Correct answer.
  3. Nasogastric tube insertion
  4. Jaw thrust with mask ventilation

Explanation

Cricoid pressure compresses the esophagus against the vertebral body to reduce aspiration risk during the interval before the airway is secured. It is applied after induction while the patient is positioned to minimize regurgitation.

Question 4General Anesthesia and Perioperative Management

Which volatile agent is most appropriate for inhalational induction in a child because of its low blood-gas solubility and non-pungent odor?

  1. Desflurane
  2. Enflurane
  3. Isoflurane
  4. Sevoflurane Correct answer.

Explanation

Sevoflurane has low blood-gas solubility, a non-irritant odor, and smooth induction characteristics, making it the agent of choice for pediatric inhalational induction. Its favorable profile allows rapid uptake and titration.

Question 5General Anesthesia and Perioperative Management

A patient with a history of malignant hyperthermia requires general anesthesia. Which combination is safest?

  1. Propofol with rocuronium and remifentanil Correct answer.
  2. Desflurane with atracurium
  3. Sevoflurane with succinylcholine
  4. Isoflurane with vecuronium

Explanation

Malignant hyperthermia is triggered by volatile anesthetics and depolarizing muscle relaxants. A total intravenous anesthetic with propofol and non-depolarizing relaxants avoids all known triggers.

Question 6General Anesthesia and Perioperative Management

During emergence, a patient develops stridor and increased work of breathing after extubation. Which initial measure is most appropriate?

  1. Administration of intravenous furosemide
  2. Deep extubation with propofol bolus
  3. Continuous positive airway pressure with nebulized epinephrine Correct answer.
  4. Immediate reintubation with a larger tube

Explanation

Post-extubation stridor often reflects laryngeal edema, which responds to positive airway pressure and nebulized epinephrine to reduce mucosal swelling. Reintubation is reserved for failure of these measures.

Question 7General Anesthesia and Perioperative Management

Which monitor provides the earliest reliable indication of an esophageal intubation when capnography is available?

  1. Chest rise with ventilation
  2. Absent or diminishing end-tidal CO2 waveform Correct answer.
  3. Pulse oximetry desaturation
  4. Auscultation of the epigastrium

Explanation

Capnography detects esophageal placement almost immediately because no CO2 is exhaled from the stomach. Oxygen desaturation and auscultation changes occur later and are less reliable.

Question 8General Anesthesia and Perioperative Management

Which parameter is the primary target for lung-protective ventilation in a patient with acute respiratory distress syndrome under general anesthesia?

  1. Tidal volume of 12 mL/kg actual body weight
  2. Fractional inspired oxygen of 1.0 throughout
  3. Peak inspiratory pressure above 45 cmH2O
  4. Tidal volume of 6 mL/kg predicted body weight Correct answer.

Explanation

Lung-protective ventilation uses low tidal volumes based on predicted body weight to limit volutrauma in injured lungs. Plateau pressures are kept below about 30 cmH2O and oxygen is titrated to saturation.

Question 9General Anesthesia and Perioperative Management

A patient with severe aortic stenosis undergoes general anesthesia. Which hemodynamic change is most dangerous?

  1. Reduction in systemic vascular resistance Correct answer.
  2. Moderate increase in heart rate
  3. Slight increase in contractility
  4. Mild increase in preload

Explanation

In aortic stenosis, fixed outflow obstruction makes cardiac output dependent on preload and afterload. A fall in systemic vascular resistance causes precipitous hypotension and reduced coronary perfusion.

Question 10General Anesthesia and Perioperative Management

Which agent is preferred for induction in a hemodynamically unstable trauma patient with hypovolemia?

  1. Propofol
  2. Sodium thiopental
  3. Ketamine Correct answer.
  4. Midazolam in high dose

Explanation

Ketamine preserves sympathetic tone and supports blood pressure, making it suitable in hypovolemic shock. Propofol and barbiturates cause vasodilation and myocardial depression.

Question 11General Anesthesia and Perioperative Management

What is the most appropriate initial management of suspected anaphylaxis under anesthesia?

  1. Diphenhydramine intravenously alone
  2. Epinephrine intramuscularly with fluid resuscitation Correct answer.
  3. Nebulized salbutamol alone
  4. Hydrocortisone intravenously alone

Explanation

Epinephrine is the first-line drug in anaphylaxis because it reverses vasodilation and bronchospasm. Intramuscular dosing into the lateral thigh is rapid and safe, supported by aggressive fluid resuscitation.

Question 12General Anesthesia and Perioperative Management

Which position is associated with the greatest risk of venous air embolism during surgery?

  1. Supine laparotomy
  2. Sitting craniotomy Correct answer.
  3. Prone laminectomy
  4. Lithotomy

Explanation

The sitting position creates a negative pressure gradient between the surgical field and the right heart, allowing air entrainment through open venous sinuses. Precordial Doppler and capnography aid early detection.

Question 13General Anesthesia and Perioperative Management

Which finding best confirms successful placement of a laryngeal mask airway?

  1. Audible leak at 10 cmH2O
  2. Cuff pressure above 100 cmH2O
  3. Presence of a gastric bubble on auscultation
  4. Symmetric chest rise with a square capnography waveform Correct answer.

Explanation

A sealed airway with symmetric ventilation and a normal capnography waveform indicates the mask is correctly seated over the laryngeal inlet. Leaks or gastric insufflation suggest malposition.

Question 14General Anesthesia and Perioperative Management

Which fluid is most appropriate for initial resuscitation of a patient with diabetic ketoacidosis undergoing emergency surgery?

  1. Hypertonic 3% saline
  2. Albumin 5%
  3. 5% dextrose in water
  4. Isotonic crystalloid such as 0.9% sodium chloride Correct answer.

Explanation

DKA causes profound volume depletion, and isotonic crystalloid restores intravascular volume while insulin and potassium are managed. Dextrose is added only once glucose falls to avoid hypoglycemia.

Question 15General Anesthesia and Perioperative Management

Which preoperative laboratory test is most useful before elective surgery in an otherwise healthy 30-year-old?

  1. None routinely indicated Correct answer.
  2. Full coagulation profile
  3. Serum cortisol
  4. Resting electrocardiogram

Explanation

Routine preoperative testing in healthy young patients has low yield and can lead to unnecessary interventions. Testing should be guided by history, examination, and the planned procedure.

Question 16General Anesthesia and Perioperative Management

A patient on chronic beta-blocker therapy is scheduled for surgery. What is the recommended perioperative approach?

  1. Substitute with a calcium channel blocker
  2. Continue the beta-blocker through the perioperative period Correct answer.
  3. Stop it 24 hours before surgery
  4. Withhold it until after discharge

Explanation

Abrupt beta-blocker withdrawal can precipitate tachycardia, hypertension, and myocardial ischemia. Continuation, often with a perioperative dose, maintains cardiac stability.

Question 17General Anesthesia and Perioperative Management

Which mechanism best explains the hypotension seen with spinal anesthesia?

  1. Sympathetic blockade causing vasodilation Correct answer.
  2. Increased vagal tone to the heart
  3. Direct myocardial depression
  4. Reduced circulating catecholamine stores

Explanation

Spinal anesthesia blocks sympathetic fibers, producing arteriolar and venous dilation with reduced preload and afterload. Treatment includes fluids and vasopressors.

Question 18General Anesthesia and Perioperative Management

Which parameter best guides adequacy of neuromuscular blockade reversal with sugammadex?

  1. Presence of four twitches on train-of-four
  2. Single twitch height equal to baseline
  3. Train-of-four ratio of 0.9 or greater Correct answer.
  4. Sustained head lift for 3 seconds

Explanation

A train-of-four ratio of at least 0.9 indicates adequate recovery from neuromuscular blockade. Clinical signs alone are less sensitive than quantitative monitoring.

Question 19General Anesthesia and Perioperative Management

Which complication is most specifically associated with the use of nitrous oxide during prolonged anesthesia?

  1. Hepatic necrosis
  2. Diffusion into air-filled spaces Correct answer.
  3. Malignant hyperthermia
  4. Renal tubular acidosis

Explanation

Nitrous oxide is more soluble than nitrogen and diffuses into closed gas spaces faster than nitrogen leaves, expanding pneumothorax, bowel gas, or a middle-ear cavity. It is avoided when such spaces exist.

Question 20General Anesthesia and Perioperative Management

A patient with a full stomach requires emergency surgery. Which induction strategy best minimizes aspiration risk?

  1. Awake fiberoptic intubation after sedation
  2. Deep sedation without airway protection
  3. Inhalational induction with spontaneous ventilation
  4. Rapid sequence induction with cricoid pressure and prompt intubation Correct answer.

Explanation

Rapid sequence induction minimizes the interval between loss of airway reflexes and tracheal intubation, reducing aspiration risk. Cricoid pressure provides additional protection during the vulnerable period.

Question 21General Anesthesia and Perioperative Management

Which finding suggests a diagnosis of malignant hyperthermia during anesthesia?

  1. Decreased end-tidal CO2 with hypotension
  2. Isolated hypertension with hyperkalemia
  3. Unexplained rise in end-tidal CO2 with masseter rigidity Correct answer.
  4. Bradycardia with hypothermia

Explanation

Malignant hyperthermia presents with hypermetabolism, including rising end-tidal CO2 despite adequate ventilation, muscle rigidity, tachycardia, and hyperthermia. Masseter rigidity after succinylcholine is an early clue.

Question 22General Anesthesia and Perioperative Management

Which agent is the preferred induction choice for a patient with a known egg allergy undergoing general anesthesia?

  1. Sevoflurane with a history of anaphylaxis to it
  2. Sodium thiopental in a patient with egg allergy
  3. Succinylcholine
  4. Propofol Correct answer.

Explanation

Propofol is generally safe in egg allergy because the concern relates to soy or egg lecithin in older formulations, and current evidence supports its use. Alternative agents are chosen only if a specific reaction is documented.

Question 23General Anesthesia and Perioperative Management

Which parameter is used to calculate the oxygen flow required for a circle system with a 2 L/min fresh gas flow?

  1. End-tidal carbon dioxide alone
  2. Peak inspiratory pressure
  3. Fresh gas flow relative to metabolic oxygen consumption Correct answer.
  4. Tidal volume alone

Explanation

In a circle system, fresh gas flow must meet or exceed metabolic oxygen consumption to prevent hypoxia. Low flows require monitoring of inspired oxygen and end-tidal CO2.

Question 24General Anesthesia and Perioperative Management

Which of the following is the most appropriate management of a patient with suspected local anesthetic systemic toxicity after a peripheral nerve block?

  1. Naloxone bolus
  2. Immediate administration of flumazenil
  3. Neostigmine administration
  4. Lipid emulsion therapy with airway support Correct answer.

Explanation

Local anesthetic systemic toxicity is treated with airway support, seizure control, and intravenous lipid emulsion, which sequesters the local anesthetic. Early recognition and prompt lipid rescue improve outcomes.

Question 25General Anesthesia and Perioperative Management

Which postoperative complication is most strongly associated with the use of long-acting neuraxial opioids?

  1. Hyperkalemia
  2. Delayed respiratory depression Correct answer.
  3. Renal failure
  4. Immediate hypertension

Explanation

Neuraxial opioids can spread rostrally and depress ventilation hours after administration, so monitoring for delayed respiratory depression is essential. Risk is higher with lipophilic agents and high doses.

Question 26General Anesthesia and Perioperative Management

A 70 kg adult is receiving mechanical ventilation. Which tidal volume is most consistent with current lung-protective ventilation for a patient without ARDS at risk of postoperative pulmonary complications?

  1. 700 mL
  2. 840 mL
  3. 140 mL
  4. 420 mL Correct answer.

Explanation

Lung-protective ventilation uses tidal volumes of about 6 mL/kg of predicted body weight, which for a 70 kg adult is roughly 420 mL. Larger volumes increase alveolar overdistension and ventilator-induced lung injury, while very small volumes risk hypoventilation and atelectasis.

Question 27General Anesthesia and Perioperative Management

A patient with chronic stable angina on long-term metoprolol presents for elective hernia repair. Which perioperative plan for the beta-blocker is most appropriate?

  1. Continue the beta-blocker through the perioperative period Correct answer.
  2. Give an extra dose only if the heart rate exceeds 100 bpm intraoperatively
  3. Stop it 48 hours before surgery to reduce bradycardia
  4. Replace it with a calcium channel blocker on the morning of surgery

Explanation

Abrupt withdrawal of chronic beta-blockade can precipitate rebound tachycardia, hypertension, and myocardial ischemia, so therapy should be continued perioperatively, including the morning of surgery. Routine initiation of beta-blockers on the day of surgery is discouraged, but continuation of established therapy is recommended.

Question 28General Anesthesia and Perioperative Management

A patient undergoing major abdominal surgery with an arterial line shows a sudden fall in systolic pressure with a widened pulse pressure and a brisk, bounding pulse. Which cause best fits this hemodynamic pattern?

  1. Acute blood loss with hypovolemia
  2. Vasodilation from neuraxial blockade or sepsis Correct answer.
  3. Cardiac tamponade
  4. Tension pneumothorax

Explanation

A distributive picture from vasodilation produces a low diastolic pressure with a widened pulse pressure and a compensatory increase in heart rate and contractility, giving a bounding pulse. Obstructive and hypovolemic causes instead produce a narrow pulse pressure with poor peripheral perfusion.

Question 29General Anesthesia and Perioperative Management

A patient with a full stomach requires emergency general anesthesia. Which maneuver most effectively reduces the risk of aspiration during induction?

  1. Placing the patient in the Trendelenburg position during induction
  2. Performing a slow inhalational induction with the patient supine
  3. Applying cricoid pressure with rapid-sequence induction and avoiding mask ventilation Correct answer.
  4. Ventilating with a supraglottic airway before intubation

Explanation

Rapid-sequence induction with cricoid pressure and avoidance of positive-pressure mask ventilation minimizes gastric insufflation and reduces the window for regurgitation before the airway is secured. The head-up or ramped position may be added, but Trendelenburg and supraglottic ventilation increase aspiration risk.

Question 30General Anesthesia and Perioperative Management

During a robotic prostatectomy in steep Trendelenburg, peak airway pressures rise progressively and the patient becomes hypoxemic. Which combination of changes best explains this deterioration?

  1. Bronchospasm from histamine release with reduced dead space and increased compliance
  2. Reduced pulmonary vascular resistance with increased venous return and alveolar recruitment
  3. Increased functional residual capacity with diaphragmatic flattening and improved compliance
  4. Reduced functional residual capacity with cephalad displacement of the diaphragm and dependent atelectasis Correct answer.

Explanation

Steep head-down positioning shifts the abdominal contents against the diaphragm, lowering functional residual capacity and promoting atelectasis in dependent lung regions, which raises airway pressures and impairs oxygenation. Pneumoperitoneum compounds these effects by further reducing compliance.

Question 31Regional Anesthesia and Acute Pain Management

A 70 kg adult is to receive a single-shot interscalene brachial plexus block. Which local anesthetic volume is most appropriate for this technique?

  1. 20 mL Correct answer.
  2. 60 mL
  3. 5 mL
  4. 2 mL

Explanation

Interscalene block is performed with a moderate-to-large volume, typically about 15-25 mL of local anesthetic, to spread along the plexus and reach the C5-C7 roots. Very small volumes give patchy spread and very large volumes add toxicity risk without benefit.

Question 32Regional Anesthesia and Acute Pain Management

Which nerve block provides the most reliable anesthesia for a shoulder reduction in the emergency department when a single injection is preferred?

  1. Adductor canal block
  2. Popliteal sciatic block
  3. Femoral nerve block
  4. Interscalene brachial plexus block Correct answer.

Explanation

The interscalene block targets the C5-C6 roots and superior trunk, which supply the shoulder via the suprascapular and axillary nerves. It is the standard single-injection block for shoulder surgery and reduction.

Question 33Regional Anesthesia and Acute Pain Management

During an ultrasound-guided supraclavicular brachial plexus block, which structure lies immediately adjacent to the plexus and must be avoided during needle advancement?

  1. The trachea
  2. The thyroid gland
  3. The thoracic duct on the right side
  4. The pleura Correct answer.

Explanation

The supraclavicular approach places the needle close to the dome of the pleura, so pneumothorax is the classic complication. Continuous ultrasound visualization and an in-plane approach reduce this risk.

Question 34Regional Anesthesia and Acute Pain Management

Which complication is most characteristic of the supraclavicular brachial plexus block compared with other upper limb approaches?

  1. Pneumothorax Correct answer.
  2. Recurrent laryngeal nerve block
  3. Phrenic nerve palsy
  4. Horner syndrome

Explanation

Because the needle tip lies near the pleural dome, pneumothorax is the signature risk of the supraclavicular approach. Phrenic palsy and Horner syndrome occur with interscalene blocks more than with supraclavicular blocks.

Question 35Regional Anesthesia and Acute Pain Management

An axillary brachial plexus block is planned. Which nerve often requires a separate, deliberate block because it runs outside the axillary sheath?

  1. Ulnar nerve
  2. Median nerve
  3. Radial nerve
  4. Musculocutaneous nerve Correct answer.

Explanation

The musculocutaneous nerve leaves the sheath early and travels within the coracobrachialis, so it is frequently spared unless specifically blocked. The other three cords lie within the axillary neurovascular bundle.

Question 36Regional Anesthesia and Acute Pain Management

A patient requires wrist surgery on the volar surface. Which block is best suited to anesthetize the median nerve at the wrist?

  1. Superficial cervical plexus block
  2. Radial nerve block at the wrist
  3. Ulnar nerve block at the wrist
  4. Median nerve block at the wrist Correct answer.

Explanation

The median nerve supplies the volar aspect of the lateral three and a half digits and is blocked at the wrist between the flexor carpi radialis and palmaris longus tendons. This matches the surgical field described.

Question 37Regional Anesthesia and Acute Pain Management

Which local anesthetic property best explains why ropivacaine produces less motor block than bupivacaine at equipotent concentrations?

  1. Greater differential sensory-to-motor blockade Correct answer.
  2. Faster hepatic clearance
  3. Lower lipid solubility
  4. Higher protein binding

Explanation

Ropivacaine shows a greater differential block, preferentially blocking sensory fibers with relatively less motor involvement than bupivacaine. This makes it attractive when preserving motor function matters.

Question 38Regional Anesthesia and Acute Pain Management

What is the maximum recommended dose of bupivacaine for a peripheral nerve block in a healthy adult, expressed as a total dose?

  1. 1 mg/kg
  2. 6 mg/kg
  3. 2-2.5 mg/kg Correct answer.
  4. 0.5 mg/kg

Explanation

Bupivacaine is limited to roughly 2-2.5 mg/kg (often capped near 150-175 mg) because of its cardiotoxicity. Exceeding this raises the risk of refractory ventricular arrhythmia.

Question 39Regional Anesthesia and Acute Pain Management

A patient develops seizures and ventricular arrhythmia after an interscalene block. Which intervention is the definitive treatment for local anesthetic systemic toxicity?

  1. Intravenous calcium chloride
  2. Intravenous lipid emulsion Correct answer.
  3. Intravenous naloxone
  4. Intravenous flumazenil

Explanation

Intravenous lipid emulsion is the specific antidote for local anesthetic systemic toxicity, acting as a lipid sink and supporting cardiac function. It is given alongside standard resuscitation and airway management.

Question 40Regional Anesthesia and Acute Pain Management

Which finding is an early warning sign of local anesthetic systemic toxicity during a nerve block?

  1. Perioral numbness and tinnitus Correct answer.
  2. Hypertension and tachycardia only
  3. Delayed wound healing
  4. Immediate motor paralysis of the limb

Explanation

Early LAST typically presents with CNS excitation such as perioral tingling, tinnitus, and metallic taste before progression to seizures and cardiovascular collapse. Recognizing these prodromal symptoms allows early lipid emulsion therapy.

Question 41Regional Anesthesia and Acute Pain Management

A femoral nerve block is performed for analgesia after total knee arthroplasty. Which adverse effect is most concerning compared with an adductor canal block?

  1. Quadriceps weakness and fall risk Correct answer.
  2. Pneumothorax
  3. Horner syndrome
  4. Phrenic nerve palsy

Explanation

Femoral nerve block reliably weakens the quadriceps, increasing the risk of falls and delaying ambulation. The adductor canal block preserves more quadriceps strength while providing comparable knee analgesia.

Question 42Regional Anesthesia and Acute Pain Management

Which nerve block is preferred for postoperative analgesia after anterior cruciate ligament reconstruction when early quadriceps activation is desired?

  1. Lateral femoral cutaneous block
  2. Adductor canal block Correct answer.
  3. Sciatic nerve block
  4. Femoral nerve block

Explanation

The adductor canal block targets the saphenous nerve in the mid-thigh, providing knee analgesia while largely sparing quadriceps strength. This supports early rehabilitation after ACL reconstruction.

Question 43Regional Anesthesia and Acute Pain Management

A popliteal sciatic nerve block is planned for foot surgery. Which additional block is usually required to anesthetize the medial aspect of the ankle?

  1. Deep peroneal nerve block
  2. Saphenous nerve block Correct answer.
  3. Sural nerve block
  4. Superficial peroneal nerve block

Explanation

The saphenous nerve, a terminal branch of the femoral nerve, supplies the medial ankle and is not covered by a sciatic block. Adding a saphenous block completes anesthesia for the medial foot.

Question 44Regional Anesthesia and Acute Pain Management

A transversus abdominis plane (TAP) block provides analgesia primarily for which region?

  1. Perineum
  2. Visceral abdominal organs
  3. Anterior abdominal wall Correct answer.
  4. Lower limbs

Explanation

The TAP block deposits local anesthetic in the fascial plane between the internal oblique and transversus abdominis muscles, anesthetizing the anterior abdominal wall nerves. It provides somatic, not visceral, analgesia.

Question 45Regional Anesthesia and Acute Pain Management

Which approach to the thoracic paravertebral block is associated with a lower risk of pneumothorax?

  1. Midline thoracic epidural approach
  2. Intercostal nerve block at the angle of the rib
  3. Ultrasound-guided in-plane approach Correct answer.
  4. Landmark-based loss of resistance to air

Explanation

Direct ultrasound visualization of the pleura and needle tip with an in-plane technique reduces the risk of pleural puncture compared with landmark methods. It also improves spread reliability.

Question 46Regional Anesthesia and Acute Pain Management

A patient with rib fractures has severe pain limiting deep breathing. Which regional technique best provides unilateral thoracic analgesia while minimizing hemodynamic disturbance?

  1. Pudendal block
  2. Thoracic paravertebral block Correct answer.
  3. Lumbar plexus block
  4. Bilateral interscalene blocks

Explanation

Thoracic paravertebral block produces unilateral somatic analgesia of the chest wall with less hypotension than thoracic epidural. This improves respiratory mechanics in rib fracture patients.

Question 47Regional Anesthesia and Acute Pain Management

In an ultrasound-guided interscalene block, which sign indicates the needle tip is too close to the nerve roots and should be repositioned before injection?

  1. Visible spread around the plexus
  2. Paresthesia in the fingers
  3. Loss of resistance to saline
  4. Nerve swelling or a sudden high injection pressure Correct answer.

Explanation

Nerve swelling or an abrupt rise in injection pressure suggests intraneural injection and mandates immediate needle withdrawal. Injecting under these conditions risks permanent nerve injury.

Question 48Regional Anesthesia and Acute Pain Management

Which nerve stimulator response confirms needle proximity to the femoral nerve during a femoral block?

  1. Hamstring contraction at 2 mA
  2. Adductor contraction at 0.2 mA
  3. Quadriceps contraction with patellar movement at 0.3-0.5 mA Correct answer.
  4. Calf plantar flexion at 1 mA

Explanation

Femoral nerve stimulation produces quadriceps contraction with patellar rise, ideally at a current of 0.3-0.5 mA. This confirms proximity without intraneural placement.

Question 49Regional Anesthesia and Acute Pain Management

A patient receiving a continuous peripheral nerve catheter develops a leaking, erythematous site with fever. What is the most appropriate next step?

  1. Remove the catheter and evaluate for infection Correct answer.
  2. Increase the infusion rate
  3. Flush the catheter with air
  4. Continue infusion and observe

Explanation

Signs of local infection at a catheter site warrant prompt removal and assessment for deeper infection or systemic sepsis. Continuing the infusion risks progression of infection.

Question 50Regional Anesthesia and Acute Pain Management

Which patient factor most increases the risk of local anesthetic systemic toxicity during a peripheral nerve block?

  1. Previous appendectomy
  2. Well-controlled hypertension
  3. Mild asthma
  4. Low body weight with high milligram-per-kilogram dose Correct answer.

Explanation

Toxicity risk scales with the milligram-per-kilogram dose, so low body weight with a large absolute dose raises plasma concentrations. Dose reduction and careful aspiration are essential in such patients.