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Arab Board Anesthesia Final Written study materials
Arab Board Anesthesia Final Written study resources

Arab Board Anesthesia Final Written practice questions

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

During direct laryngoscopy, the recurrent laryngeal nerve is at greatest risk because it ascends in which location?

  1. The carotid sheath
  2. The submandibular triangle
  3. The tracheoesophageal groove Correct answer.
  4. The posterior triangle of the neck

Explanation

The recurrent laryngeal nerve ascends in the tracheoesophageal groove after branching from the vagus, so laryngeal and tracheal manipulation can injure it. Bilateral injury causes airway obstruction from unopposed cord adduction.

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

A patient's arterial blood gas shows pH 7.28, PaCO2 60 mmHg, and HCO3- 27 mmol/L. Which acid-base disturbance is present?

  1. Acute metabolic acidosis
  2. Chronic metabolic alkalosis
  3. Chronic respiratory alkalosis
  4. Acute respiratory acidosis Correct answer.

Explanation

An elevated PaCO2 with acidemia indicates respiratory acidosis. The small bicarbonate rise (about 1 mmol/L per 10 mmHg acute rise) is consistent with acute rather than chronic compensation.

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

Which volatile agent has the lowest blood:gas partition coefficient and therefore the fastest equilibration?

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

Explanation

A low blood:gas partition coefficient means less agent must dissolve in blood before alveolar partial pressure rises, so induction and recovery are faster. Desflurane has the lowest value among these agents.

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

A 70 kg patient receives 100 mg of a drug with a volume of distribution of 50 L. Assuming immediate complete mixing, what is the plasma concentration?

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

Explanation

Concentration equals dose divided by volume of distribution, so 100 mg / 50 L = 2 mg/L. This calculation ignores distribution and elimination kinetics.

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

Which nerve is most commonly injured during carotid endarterectomy, causing ipsilateral tongue deviation toward the side of injury?

  1. Glossopharyngeal nerve
  2. Facial nerve
  3. Vagus nerve
  4. Hypoglossal nerve Correct answer.

Explanation

The hypoglossal nerve crosses the carotid bifurcation and is at risk during carotid surgery. Injury causes tongue weakness, so the tongue deviates toward the weak side on protrusion.

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

Which statement about the Frank-Starling relationship is correct?

  1. Contractility has no effect on the Frank-Starling curve
  2. Increasing afterload increases stroke volume in a normal ventricle
  3. Increasing preload raises stroke volume until the ventricle becomes overstretched Correct answer.
  4. Stroke volume is independent of end-diastolic fiber length

Explanation

Within physiologic limits, greater end-diastolic fiber length increases force of contraction and stroke volume. Beyond optimal stretch, further increases in preload produce little or no gain.

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

Which gas law explains why a nitrous oxide cylinder pressure gauge reads a constant value while liquid remains in the cylinder?

  1. Saturated vapor pressure principle Correct answer.
  2. Graham's law
  3. Charles's law
  4. Boyle's law

Explanation

Nitrous oxide is stored as a liquid-vapor mixture, so as long as liquid remains the pressure equals its saturated vapor pressure at that temperature. The gauge therefore stays constant until the liquid is exhausted.

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

Which receptor mediates the bradycardia produced by a high dose of dexmedetomidine?

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

Explanation

Dexmedetomidine is an alpha-2 agonist that reduces sympathetic outflow, producing bradycardia and hypotension. The bradycardia reflects central sympatholysis rather than direct cholinergic stimulation.

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

A patient is given a competitive antagonist. What effect does increasing the antagonist concentration have on the agonist dose-response curve?

  1. It increases the maximal response and shifts the curve leftward
  2. It reduces the maximal response without shifting the curve
  3. It shifts the curve rightward with no change in maximal response Correct answer.
  4. It shifts the curve leftward with no change in maximal response

Explanation

Competitive antagonism is surmountable, so higher agonist concentrations can overcome blockade. This produces a parallel rightward shift with the same maximal efficacy.

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

Which change in lung mechanics occurs in a patient with severe emphysema?

  1. Normal compliance with reduced chest wall compliance
  2. Increased airway resistance confined to the upper airway
  3. Increased lung compliance with loss of elastic recoil Correct answer.
  4. Decreased lung compliance with increased elastic recoil

Explanation

Emphysema destroys alveolar walls and elastin, reducing elastic recoil and raising compliance. The loss of recoil causes airway collapse during expiration and air trapping.

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

A 60 kg patient is to receive an intravenous loading dose of a drug with a volume of distribution of 0.5 L/kg and a target plasma concentration of 4 mg/L. What loading dose is required?

  1. 30 mg
  2. 240 mg
  3. 60 mg
  4. 120 mg Correct answer.

Explanation

Volume of distribution is 0.5 L/kg x 60 kg = 30 L. Loading dose equals target concentration times volume, so 4 mg/L x 30 L = 120 mg.

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

During one-lung ventilation, which mechanism is the main contributor to hypoxemia?

  1. Reduced cardiac output from high airway pressure
  2. Increased dead space in the ventilated lung
  3. Diffusion impairment across the alveolar membrane
  4. Continued perfusion of the non-ventilated lung Correct answer.

Explanation

Blood continues to flow through the collapsed lung while it is not ventilated, creating an intrapulmonary shunt. Hypoxic pulmonary vasoconstriction reduces but does not abolish this shunt.

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

Which statement about the MAC of volatile anesthetics is correct?

  1. MAC decreases with increasing age and with hypothermia Correct answer.
  2. MAC is unaffected by age but rises with hyperthermia
  3. MAC increases with pregnancy and with opioid coadministration
  4. MAC is the concentration that anesthetizes 99% of patients

Explanation

MAC is the alveolar concentration preventing movement in 50% of patients to a standard stimulus. It falls with age, hypothermia, pregnancy, and sedative or opioid coadministration.

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

A patient with a permanent pacemaker is scheduled for surgery using monopolar electrocautery. Which precaution best reduces the risk of pacemaker malfunction?

  1. Set the generator to asynchronous mode for all patients
  2. Position the return pad on the ipsilateral shoulder
  3. Place the return pad over the pacemaker generator
  4. Use bipolar cautery and place the return pad so current avoids the generator Correct answer.

Explanation

Bipolar cautery limits current spread, and return pad placement should keep current away from the generator and leads. This reduces the risk of inhibition or reprogramming.

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

Which change best explains the increased minimum alveolar concentration seen in chronic alcohol users?

  1. Increased plasma protein binding of anesthetics
  2. Cross-tolerance with upregulation of central receptors Correct answer.
  3. Reduced hepatic metabolism of volatile agents
  4. Enhanced renal clearance of volatile agents

Explanation

Chronic ethanol exposure produces central nervous system cross-tolerance, raising anesthetic requirements. Volatile agent metabolism and protein binding do not explain the change in MAC.

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

Which structure is most likely injured when a central venous catheter is inserted via the internal jugular approach too far laterally?

  1. The cervical sympathetic chain Correct answer.
  2. The brachial plexus
  3. The thoracic duct
  4. The phrenic nerve

Explanation

The cervical sympathetic chain lies posterolateral to the carotid sheath, so lateral needle passage can cause Horner syndrome. Medial passage risks carotid puncture.

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

A patient has a serum potassium of 6.8 mmol/L with peaked T waves. Which intervention most rapidly stabilizes the cardiac membrane?

  1. Oral sodium polystyrene sulfonate
  2. Intravenous insulin with glucose
  3. Inhaled salbutamol
  4. Intravenous calcium gluconate Correct answer.

Explanation

Calcium antagonizes the membrane effects of hyperkalemia within minutes without lowering serum potassium. It is given first when ECG changes are present.

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

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

  1. Full stomach with delayed gastric emptying Correct answer.
  2. Use of a supraglottic airway
  3. Use of total intravenous anesthesia
  4. Preoxygenation with 100% oxygen

Explanation

A full stomach with delayed emptying raises gastric volume and pressure, increasing regurgitation and aspiration risk. Rapid sequence induction with cricoid pressure is often used.

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

Which statement about the neuromuscular junction is correct?

  1. Succinylcholine acts as a competitive antagonist
  2. Non-depolarizing blockers increase acetylcholine release
  3. Acetylcholinesterase inhibitors worsen phase I block
  4. Depolarizing blockers produce prolonged depolarization with phase I block Correct answer.

Explanation

Succinylcholine binds the nicotinic receptor and causes persistent depolarization, producing phase I block. Phase II block develops with prolonged exposure and resembles non-depolarizing block.

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

Which change in the oxygen-hemoglobin dissociation curve is expected in a patient with chronic anemia?

  1. Rightward shift due to increased carbon monoxide
  2. Leftward shift due to decreased 2,3-DPG
  3. No change in the curve position
  4. Rightward shift due to increased 2,3-DPG Correct answer.

Explanation

Chronic anemia raises 2,3-DPG, shifting the curve right and improving tissue oxygen unloading. Carbon monoxide produces a leftward shift and reduces oxygen content.

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

A patient receiving a high spinal anesthetic develops bradycardia and hypotension. Which mechanism best explains the bradycardia?

  1. Direct myocardial depression from the local anesthetic
  2. Increased venous return to the heart
  3. Blockade of cardiac accelerator fibers with unopposed vagal tone Correct answer.
  4. Reflex tachycardia from baroreceptor stimulation

Explanation

High neuraxial block interrupts sympathetic cardioaccelerator fibers, leaving vagal tone unopposed. This produces bradycardia, which can progress to cardiac arrest if untreated.

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

Which statement about the physics of a Venturi mask is correct?

  1. It requires a closed circuit to function
  2. It relies on a reservoir bag to store oxygen
  3. High-velocity gas flow through a narrow jet entrains room air Correct answer.
  4. It delivers a fixed oxygen concentration independent of inspiratory flow

Explanation

A Venturi mask accelerates oxygen through a narrow jet, lowering pressure and entraining room air to produce a predictable mixture. The final FiO2 depends on the jet size and entrainment ratio.

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

A patient with severe aortic stenosis is undergoing induction. Which hemodynamic goal is most important?

  1. Increase heart rate to 100 beats per minute
  2. Maintain systemic vascular resistance and sinus rhythm Correct answer.
  3. Reduce afterload to improve forward flow
  4. Induce controlled hypotension

Explanation

In aortic stenosis, fixed outflow obstruction makes cardiac output dependent on preload and afterload. Maintaining vascular resistance and sinus rhythm preserves coronary perfusion and avoids ischemia.

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

Which mechanism best explains the prolonged action of bupivacaine compared with lidocaine?

  1. Greater renal tubular reabsorption
  2. Faster hepatic clearance
  3. Lower pKa relative to physiologic pH
  4. Higher lipid solubility and greater protein binding Correct answer.

Explanation

Bupivacaine is more lipid soluble and more highly protein bound than lidocaine, so it diffuses into nerve membranes and remains bound longer. This prolongs block duration and increases cardiotoxicity risk.

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

Which change in the capnogram is most consistent with a sudden pulmonary embolism?

  1. Gradual rise in end-tidal CO2 with a normal gradient
  2. A prolonged expiratory upstroke with a low peak
  3. Loss of the alveolar plateau with a rising end-tidal CO2
  4. Abrupt fall in end-tidal CO2 with a widened alveolar-arterial gradient Correct answer.

Explanation

Pulmonary embolism increases dead space, so exhaled CO2 falls sharply while arterial CO2 may remain normal or rise. The alveolar-arterial gradient therefore widens.

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

A patient is breathing room air. What is the approximate alveolar partial pressure of oxygen (PAO2), calculated with the alveolar gas equation using a respiratory quotient of 0.8 and an arterial PaCO2 of 40 mmHg?

  1. 100 mmHg Correct answer.
  2. 150 mmHg
  3. 40 mmHg
  4. 60 mmHg

Explanation

The alveolar gas equation is PAO2 = FiO2 x (Patm - PH2O) - PaCO2/R. On room air this gives 0.21 x (760 - 47) - 40/0.8, approximately 150 - 50 = 100 mmHg.

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

Which nerve is most at risk of injury during surgical dissection close to the posterior border of the sternocleidomastoid muscle in the neck?

  1. Accessory nerve Correct answer.
  2. Recurrent laryngeal nerve
  3. Hypoglossal nerve
  4. Phrenic nerve

Explanation

The accessory nerve (cranial nerve XI) exits the skull and runs close to the posterior border of sternocleidomastoid before crossing the posterior triangle. It is therefore vulnerable during neck surgery or lymph node dissection in this region, producing shoulder weakness if injured.

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

A drug is given as a continuous infusion and reaches steady state. Which pharmacokinetic change most increases the time taken to reach steady state during that infusion?

  1. A larger volume of distribution Correct answer.
  2. A smaller volume of distribution
  3. A shorter elimination half-life
  4. A higher clearance

Explanation

The time to reach steady state during a constant infusion depends on the elimination half-life, and half-life is proportional to volume of distribution divided by clearance. A larger volume of distribution lengthens the half-life and therefore prolongs the approach to steady state.

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

In a circle breathing system, which component is responsible for removing carbon dioxide from the exhaled gas?

  1. The reservoir bag
  2. The unidirectional valves
  3. The adjustable pressure-limiting valve
  4. The soda lime canister Correct answer.

Explanation

Soda lime contains calcium and sodium hydroxide that chemically absorb carbon dioxide as gas passes through the canister. The other components of the circle system serve to store gas, direct flow, or vent excess pressure, not to remove carbon dioxide.

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

A patient with chronic kidney disease has a plasma albumin of 20 g/L. For a highly protein-bound acidic drug, which change in unbound fraction and initial free drug effect is expected?

  1. Increased unbound fraction with no change in early free drug effect
  2. Increased unbound fraction with an enhanced early free drug effect Correct answer.
  3. Decreased unbound fraction with an enhanced early free drug effect
  4. Decreased unbound fraction with reduced free drug effect

Explanation

Hypoalbuminemia reduces binding sites, so a larger proportion of an acidic drug circulates unbound. The transient rise in free drug concentration increases the early pharmacological effect before redistribution and clearance restore equilibrium.

Question 31Preoperative Assessment, Risk Evaluation and Optimization

A 68-year-old man is scheduled for elective open cholecystectomy. Using the Revised Cardiac Risk Index (RCRI), which combination of his findings would place him in the highest reported risk category for major perioperative cardiac events?

  1. Age over 70 years and hypertension
  2. Controlled type 2 diabetes and age 60 years
  3. Current smoker with a body mass index of 34 kg/m2
  4. History of myocardial infarction and a serum creatinine of 2.3 mg/dL Correct answer.

Explanation

The RCRI assigns one point each for ischemic heart disease, heart failure, cerebrovascular disease, insulin-treated diabetes, preoperative creatinine above 2.0 mg/dL, and high-risk surgery. Two or more points correspond to the highest risk tier (roughly 7% or greater for major cardiac events). Age and hypertension are not RCRI variables.

Question 32Preoperative Assessment, Risk Evaluation and Optimization

Which functional capacity threshold, expressed in metabolic equivalents (METs), is generally considered adequate to proceed with major non-cardiac surgery without further cardiac stress testing?

  1. Greater than or equal to 1 MET
  2. Greater than or equal to 2 METs
  3. Greater than or equal to 4 METs Correct answer.
  4. Greater than or equal to 10 METs

Explanation

A functional capacity of 4 METs or more (for example, climbing a flight of stairs briskly) is accepted as adequate for major surgery and generally allows surgery to proceed without additional stress testing. Lower capacity in a patient with clinical risk factors prompts further evaluation.

Question 33Preoperative Assessment, Risk Evaluation and Optimization

A patient with a permanent pacemaker is scheduled for surgery using monopolar electrocautery. Which precaution most directly reduces the risk of device malfunction?

  1. Placing the return electrode far from the pacemaker generator
  2. Positioning the return electrode on the ipsilateral thigh
  3. Increasing the electrocautery current to shorten burn duration
  4. Using a magnet to convert the device to asynchronous mode when indicated Correct answer.

Explanation

Applying a magnet over the generator, when clinically appropriate, converts most pacemakers to an asynchronous mode and prevents inappropriate inhibition from electromagnetic interference. Return electrode placement and current settings also matter, but magnet application directly addresses inhibition risk.

Question 34Preoperative Assessment, Risk Evaluation and Optimization

A patient on chronic warfarin therapy for a mechanical mitral valve requires urgent surgery that cannot be delayed for bridging. Which strategy is most appropriate for reversal?

  1. Give fresh frozen plasma at 5 mL/kg
  2. Administer vitamin K subcutaneously alone
  3. Give intravenous vitamin K plus a prothrombin complex concentrate Correct answer.
  4. Withhold warfarin for 24 hours and proceed

Explanation

For urgent reversal of warfarin in a patient with a mechanical valve, intravenous vitamin K combined with a prothrombin complex concentrate rapidly restores clotting factors. This achieves faster and more complete correction than plasma alone and avoids the delay of simply withholding the drug.

Question 35Preoperative Assessment, Risk Evaluation and Optimization

Which preoperative laboratory finding is most characteristic of primary hyperaldosteronism (Conn syndrome)?

  1. Hyperkalemia with metabolic acidosis
  2. Hypokalemia with metabolic acidosis and hypotension
  3. Hypokalemia with metabolic alkalosis and hypertension Correct answer.
  4. Hyperkalemia with metabolic alkalosis and hypotension

Explanation

Excess aldosterone promotes renal sodium retention and potassium excretion, producing hypertension, hypokalemia, and a metabolic alkalosis. These patients require careful potassium and blood pressure optimization before anesthesia.

Question 36Preoperative Assessment, Risk Evaluation and Optimization

A 55-year-old with type 1 diabetes is scheduled for major surgery as the first case of the morning. Which perioperative glucose management approach is generally recommended?

  1. Give the usual full dose of long-acting insulin and allow the patient to fast
  2. Reduce the long-acting insulin dose and use a variable-rate intravenous insulin infusion with hourly glucose checks Correct answer.
  3. Omit all insulin and check glucose only after surgery
  4. Start a variable-rate intravenous insulin infusion only if glucose exceeds 300 mg/dL

Explanation

For major surgery in type 1 diabetes, a reduced basal insulin dose combined with a variable-rate intravenous insulin infusion and frequent glucose monitoring best maintains euglycemia and prevents ketoacidosis. Complete insulin omission risks ketosis, while full dosing during fasting risks hypoglycemia.

Question 37Preoperative Assessment, Risk Evaluation and Optimization

Which preoperative finding best predicts a difficult mask ventilation in an adult?

  1. Age over 55 years, body mass index over 26 kg/m2, and a beard Correct answer.
  2. Thyromental distance greater than 6.5 cm
  3. Interincisor opening greater than 5 cm
  4. Mallampati class I airway

Explanation

The classic predictors of difficult mask ventilation include age over 55, elevated body mass index, presence of a beard, edentulous state, and snoring. These features impair the seal and airway patency during bag-mask ventilation.

Question 38Preoperative Assessment, Risk Evaluation and Optimization

A patient with severe aortic stenosis is being evaluated before elective surgery. Which perioperative principle is most important to communicate to the surgical team?

  1. Maintenance of sinus rhythm and systemic vascular resistance is critical Correct answer.
  2. Tachycardia is desirable to maintain cardiac output
  3. Spinal anesthesia at any level is preferred for all procedures
  4. Aggressive preload reduction improves ventricular function

Explanation

In severe aortic stenosis, the hypertrophied left ventricle is preload-dependent and poorly tolerant of afterload reduction and tachycardia. Preserving sinus rhythm, adequate preload, and systemic vascular resistance is essential to avoid ischemia and hemodynamic collapse.

Question 39Preoperative Assessment, Risk Evaluation and Optimization

Which of the following is an established risk factor for postoperative pulmonary complications after major abdominal surgery?

  1. Preoperative ambulation
  2. Well-controlled asthma with normal spirometry
  3. Use of regional anesthesia
  4. Current cigarette smoking Correct answer.

Explanation

Current smoking is a well-established, modifiable risk factor for postoperative pulmonary complications, and cessation several weeks before surgery reduces risk. Asthma that is well controlled, regional anesthesia, and preoperative mobility are not risk factors.

Question 40Preoperative Assessment, Risk Evaluation and Optimization

A patient with obstructive sleep apnea is scheduled for ambulatory surgery. Which feature most strongly increases the risk of perioperative respiratory complications and warrants extended monitoring?

  1. A body mass index of 25 kg/m2
  2. Use of a mandibular advancement device
  3. Concurrent opioid administration for pain control Correct answer.
  4. An apnea-hypopnea index of 6 events per hour

Explanation

Opioids depress the arousal response and compound upper airway obstruction in patients with sleep apnea, increasing the risk of postoperative respiratory events. This interaction is a key determinant of monitoring needs and disposition.

Question 41Preoperative Assessment, Risk Evaluation and Optimization

Which statement about the American Society of Anesthesiologists Physical Status (ASA-PS) classification is correct?

  1. It is determined solely by the planned surgical procedure
  2. It replaces the need for procedure-specific risk assessment
  3. It is a purely subjective grading of a patient's overall health that is not procedure-specific Correct answer.
  4. It assigns a precise numerical estimate of operative mortality

Explanation

The ASA-PS is a subjective assessment of a patient's overall health status and is not specific to the procedure or a quantitative mortality prediction. It is used as a general descriptor alongside, not instead of, procedure-specific risk tools.

Question 42Preoperative Assessment, Risk Evaluation and Optimization

A patient is taking a monoamine oxidase inhibitor (MAOI) for depression. Which perioperative concern is most relevant when planning anesthesia?

  1. Enhanced renal excretion of local anesthetics
  2. Profound bradycardia with all volatile anesthetics
  3. Risk of hypertensive crisis with sympathomimetic agents and certain opioids Correct answer.
  4. Increased sensitivity to nondepolarizing muscle relaxants

Explanation

MAOIs inhibit monoamine breakdown and can predispose to hypertensive crisis when sympathomimetics or certain opioids such as meperidine are administered. Careful drug selection and planning are essential.

Question 43Preoperative Assessment, Risk Evaluation and Optimization

Which preoperative measure is recommended for a patient with poorly controlled hypertension before elective surgery?

  1. Routinely cancel surgery for any blood pressure above 140/90 mmHg
  2. Delay surgery until blood pressure is optimized only if there is end-organ involvement or very severe elevation Correct answer.
  3. Discontinue all antihypertensive medications for one week
  4. Proceed immediately regardless of blood pressure

Explanation

Mild to moderate hypertension does not usually justify delaying elective surgery, but very severe elevation or evidence of end-organ damage warrants optimization. Continuing antihypertensive therapy is generally preferred.

Question 44Preoperative Assessment, Risk Evaluation and Optimization

Which preoperative assessment is most appropriate for a patient with a history of anaphylaxis to a neuromuscular blocking agent?

  1. Skin testing to identify safe alternatives before surgery Correct answer.
  2. Proceeding without allergy evaluation
  3. Using the same agent at a reduced dose
  4. Premedication with antihistamines alone

Explanation

For a patient with a history of anaphylaxis to a neuromuscular blocking agent, allergy testing, including skin testing, can identify cross-reactive and safe alternative agents. This reduces the risk of a recurrent reaction during anesthesia.

Question 45Preoperative Assessment, Risk Evaluation and Optimization

Which of the following is a recognized risk factor for postoperative nausea and vomiting (PONV) in adults?

  1. Non-smoking status Correct answer.
  2. Male sex
  3. Age over 60 years
  4. Use of regional anesthesia

Explanation

The simplified Apfel score identifies female sex, non-smoking status, history of PONV or motion sickness, and postoperative opioid use as risk factors. Non-smoking status is the only listed predictor.

Question 46Preoperative Assessment, Risk Evaluation and Optimization

A patient with chronic kidney disease is scheduled for elective surgery. Which preoperative optimization strategy is most appropriate?

  1. Withhold all antihypertensive agents
  2. Proceed regardless of electrolyte abnormalities
  3. Routinely administer large volumes of normal saline
  4. Ensure adequate hydration and review nephrotoxic medications Correct answer.

Explanation

In chronic kidney disease, maintaining hydration, avoiding nephrotoxins, and correcting significant electrolyte abnormalities help reduce perioperative renal injury. Routine large-volume saline is not recommended because of the risk of hyperchloremic acidosis and volume overload.

Question 47Airway Management

A patient with a documented history of malignant hyperthermia requires general anesthesia. Which volatile agent is considered safe to use?

  1. None; all volatile agents are contraindicated Correct answer.
  2. Desflurane
  3. Sevoflurane
  4. Isoflurane

Explanation

All potent volatile anesthetics (sevoflurane, desflurane, isoflurane, halothane) are triggers for malignant hyperthermia. A trigger-free technique using total intravenous anesthesia with propofol and a non-depolarizing relaxant is recommended.

Question 48Airway Management

Which finding is the most reliable clinical confirmation of correct tracheal tube placement after intubation?

  1. Auscultation of equal breath sounds bilaterally
  2. Sustained waveform capnography over several breaths Correct answer.
  3. Misting of the tube with each expiration
  4. Chest rise with each positive-pressure breath

Explanation

Sustained waveform capnography is the most reliable single indicator of tracheal placement because it requires exhaled CO2 from the lungs over multiple breaths. The other signs can be present with esophageal intubation or are less specific.

Question 49Airway Management

During rapid sequence induction in an adult, which cricoid force is conventionally applied?

  1. 50 N throughout induction and intubation
  2. 20 N throughout induction and intubation
  3. 10 N in the awake patient and 30 N after loss of consciousness Correct answer.
  4. 30 N in the awake patient and 10 N after loss of consciousness

Explanation

The classic teaching is to apply about 10 N of cricoid pressure in the awake or lightly sedated patient, increasing to about 30 N once consciousness is lost. This balances patient comfort against aspiration protection during the interval before the airway is secured.

Question 50Airway Management

A patient with a large epiglottic cyst and stridor is being assessed for airway management. Which principle best guides the plan?

  1. Rapid sequence induction with cricoid pressure and a videolaryngoscope
  2. Inhalational induction in the sitting position with maintenance of spontaneous ventilation Correct answer.
  3. Deep sedation with propofol followed by direct laryngoscopy
  4. Awake fiberoptic intubation after topical anesthesia with the surgeon scrubbed and ready

Explanation

In a partially obstructed upper airway, preserving spontaneous ventilation avoids losing airway tone and converting partial obstruction into complete obstruction. Inhalational induction with the patient positioned for comfort is the classic safe approach, with surgical backup available.