6.

Which nerve fibers are likely to be the first blocked after administration of local
anesthetic?
A. A delta fibers
B. B Fibers
C. A Alpha fibers
D. C Fibers
E. D Fibers

7. Which of the f ollowing has the longest duration of action?

A. Procaine
B. Tetracaine
C. Bupivacaine
D. Lidocaine
E. Cocaine

8. What is the max dose of tetracaine plain to give to a pt weighing 70 kg?

A. 175 mg
B. 350 mg
C. 105 mg
D. 560 mg
E. 280 mg

9. What is the max dose of bupivacaine with epi to give to a pt weighing 60 kg?
A. 180 mg
B. 150 mg
C. 300 mg
D. 90 mg
E. 120 mg

10. You perform an ankle block for amputation of a toe secondary to nonhealing
diabetic ulceration and sepsis. The block technique looked good but the patient almost
jumped off the OR table when the surgeon made the incision. What went wrong?
A. The technique must have been wrong, try again.
B. The acidic environment of the foot cause a greater concentration of
ionized anesthetic, which can not cross cell membrane.
C. The basic environment of the foot cause a greater concentration of
ionized anesthetic, which can not cross cell membrane.
D. Pt must have a tolerance to local anesthetics, try again using a larger
dose.
E. Change another class of local anesthetics.

11. How does epinephrine prolong spinal anesthesia?

A. By blocking passage of sodium ions into nerve cells
B. Through beta1 agonistic effects
 C. Through vasoconstriction and decreasing vascular absorption
D. Through alpha agonistic effects
E. All the above

12. What would you expect a pt to say to you as an early sign of toxicity due to
accidental vascular injection during administration of spinal anesthesia?
A. “My legs are starting to feel really numb….”
B. “I can’t feel my tongue anymore… weird.”
C. “It feels a little hard to breathe... is this normal with an epidural?”
D. “I feel thirsty... is this normal with an epidural?.”
E. "Ow! ow! Ouch!!! What the heck are you hitting back there?"

13. How would you perform local anesthesia on a patient with a known
pseudocholinesterase deficiency?
A. Administer local anesthesia with Bupivacaine
B. This has no effect on local anesthetics, only on succinylcholine.
C. Administer local anesthesia with Procaine
D. Patient may not receive any local anesthetics
E. Administer local anesthesia with Lidocaine

14. You are the SRNA caring for a pt about to undergo local anesthesia, and were
planning to use Rpivacaine. On their medication list you see Fluoxetine, Insulin,
Cardizem and nexium. Will any of these effect your plan of care?
A. I will use a higher dose of Ropivacaine due to induction of P450
B. I will plan to use Tetracaine due to inhibition of cytochrome P450
C. Use ropivicaine due to inhibition of pseudocholinesterase
D. Use higher dose of tetracaine due to induction of pseudocholinesterase
E. Use higher dose of ropivicaine due to induction of pseudocholinesterase

A 53-year-old woman presents for a right radical mastectomy. Her past medical history is notable
for hypertension, which is poorly controlled on metoprolol. Her blood pressure is 160/95 mmHg.
She does not have end-organ damage. Which of the following is this patient’s American Society of
Anesthesiologists Physical Status?
A. Ⅰ
B. Ⅱ
C. Ⅲ
D. Ⅳ
E. Ⅴ

A 52-year-old man is undergoing a craniotomy in the sitting position. During the surgery, the
surgeon notes the entrainment of air through an open sinus. The patient’s blood pressure
decreases. You believe that the patient is experiencing air embolism. An arterial blood gas reveals
a PaCO2 of 50 mmHg. Which of the following is the expected end-tidal carbon dioxide?
 A. 0 mmHg
B. 30 mmHg
C. 50 mmHg
D. 70 mmHg
E. 90 mmHg

In the adult, which of the following is the narrowest part of the airway?
A. Vocal cords
B. Cricoid cartilage
C. Thyroid cartilage
D. Arytenoids cartilage
E. First tracheal ring

A 25-year-old woman requires cesarean section during epidural anesthesia. Prior to the injection of
local anesthetic, the anesthesiologist administers a test dose of 3 mL lidocaine 1.5% with
epinephrine 1∶200,000. The patient complains of tinnitus and a rapid heart rate. Which of the
following is the most likely cause of her symptoms?
A. Anaphylaxis
B. Intravascular injection
C. Intrathecal injection
D. Eclampsia
E. anxiety

A 24-year-old woman requires surgery on her left hand because of a fracture. Her past anesthetic
history is notable for severe nausea and vomiting following sinus surgery 1 year ago. She would
like to avoid general anesthesia if possible. Which of the following regional anesthetic technique
would you recommend for this patient?
A. Spinal block
B. Epidural block
C. Interscalene block
D. Supraclavicular block
E. Axillary block

Of the current inhalation agents, which undergoes significant biotransformation in the carbon
dioxide absorbent?
A. Isoflurane
B. Nitrous oxide
C. Helium
D. Desflurane
E. sevoflurane

A 24-year-old suffers a gunshot wound to his abdomen. Upon arrival in the operating room, his
blood pressure is 90/60 mmHg and his heart rate is 110 beats per minutes. The surgeon would like
to perform an urgent exploratory laparotomy. Which of the following induction agents would be
the best choice for this patients?
A. Propofol
B. Thiopental
C. Fentanyl
D. Ketamine
E. Midazolam

The nondepolarizing neuromuscular blocker vecuronium competes with which of the following
molecules to result in neurmuscular blockade?
A. Calcium
B. Sodium
C. Acetylcholine
D. Gamma-aminobutyric acid
E. Glycine

A 23-year-old man is the post-anesthesia care unit following an open reduction and internal
fixation of a femour fracture. He has received 20 mg morphine for the operation. He complains of
pain. His respiratory rate is 24 breaths per minute, his heart rate is 110 beats per minute, and his
blood pressure is 140/85 mmHg. Which of the following is the most appropriate therapy for this
patient？
A. Labetalol
B. Morphine
C. Midazolam
D. Naloxone
E. Vecuronium

A 24-year-old requests epidural anesthesia for labor pain. She reports an allergy to suntan lotion
and says she must buy products that contain no para-aminobenzoic acid. Which of the following
local anesthetics is contraindicated for this patient?
A. Bupivacaine
B. Lidocaine
C. Ropivacaine
D. Chlonoprocaine
E. Levobupivacaine

A 22-year-old man suffers a motor vehicle accident and is brought to the operating room for
exploratory laparotomy. His blood pressure is 70/30 mmHg and his heart rate is 112 beats per
minute. You believe that he is hypovolemic and you would like to administer a vasopressor to
increase his blood pressure until you are able to administer additional fluid therapy. Which of the
following vasopressors would you choose?
A. Ephedrine
B. Epinephrine
C. Norepinephrine
D. Dopamine
 E. Phenylephrine

A 53-year-old man with prostatic cancer is scheduled for a radical prostatectomy. He has a history
of coronary artery disease, and his angina is well controlled with nitroglycein. Which of the
following additional preoperative therapeutic agents would be beneficial in this patient？
A. Beta-blocker
B. Opioid
C. Steroid
D. Calcium channel blocker
E. Aspirin

A 46-year-old woman who weighs 122 kg requires a hysterectomy for abnormal uterine bleeding.
A rapid-sequence induction is chosen because she has several gastroesophageal reflux. This
patient is given 100% oxygen to breathe for 5 minutes prior to induction. During the
laryngoscopy, the patient is apneic for 1 minute. At the time of placement of the endotracheal
tube, the oxygen saturation has decreased to 86%. A decrease in which of the following lung
capacities is the cause of this rapid desaturation？
A. Total lung capacity
B. Vital capacity
C. Functional residual capacity
D. Tidal capacity
E. Forced expiratory capacity

A 31-year-old woman suffers a blow to the head and develops an epidural hemotoma. Initially, she
does not experience symptoms. The expanding hematoma displaces which of the following from
the head, preventing an initial increase in intracranial pressure?
A. Blood
B. Brain tissue
C. Cerebrospinal fluid
D. Plasma
E. Bone

A 41-year-old woman suffers a stab wound to the chest shortly following a meal. She is brought to
the operating room for urgent surgical repair. The anesthesiologist chooses a rapid-sequence
induction to limit the time period for aspiration. During rapid-sequence induction, an assistant
pushes on which of the following structures to occlude the esophagus, limiting passive
regurgitation?
A. Thyroid cartilage
B. Tracheal ring
C. Cricoid cartilage
D. Mandible
E. Hyoid bone
A 7-year-old boy requires left nephrectomy for removal of a Wilms’ tumor. His weight is 29.5 kg.
His initial hemoglobin is 13.6 g/dL. The anesthesiologist allows the boy’s hemoglobin to decrease
to 8 g/dL before considering transfusion. Which of the following is the estimated allowable blood
loss in this patient?
A. 250 mL
B. 500 mL
C. 825 mL
D. 1050 mL
E. 1200 mL

A 34-year-ols man with HIV requires an appendendectomy for presumed appendicitis. He currently
does not have an intravenous catheter. Which of the following must be worn when placing an
intravenous catheter in this patient?
A. Gloves
B. Hat
C. Mask
D. Sterile gown
E. Face shield

A 21-year-old man requires ureteroscopy for removal of a kidney stone. Two years ago, he
suffered a diving accident and is a C8 quadriplegic. The surgeon believes that the patients does not
require anesthesia because he is unable to experience sensation below the lesion. The
anesthesiologist states that the patient does require anesthesia to prevent which of the following
complications?
A. Spinal shock
B. Nausea and vomiting
C. Pain
D. Autonomic hyperreflexia
E. Bladder perforation

A 35-year-old man is extremely claustrophobic and requires general anesthesia for a magnetic
resonance imaging examination of his neck. Which of the following items does the
anesthesiologist NOT have to remove before entering the MRI suite？
A. Stethoscope
B. Ballpoint pen
C. Bank card
D. Watch
E. Shoes

The pain of the second stage of labor is conveyed by which of the following nerves?
A. Paracervical
B. Uioinguinal
C. Pudendal
D. Genitofemoral
 E. Lliohypogastric

A 4-year-old boy requires repair of a right inguinal hernia. Which of the following induction
techniques is the preferred method in this patient?
A. intravenous induction with propofol
B. Inhalation induction with sevoflurane
C. Rectal induction with methohexital
D. Intramuscular induction with ketamine
E. Oral induction with midazolam

A 6-year-old boy is undergoing surgery for strabismus. During the procedure, his end-tidal carbon
dioxide, heart rate and blood pressure are increasing. You suspect that the patient is experiencing
malignant hyperthermia and draw an arterial blood gas. Which of the following would you expect
on his arterial blood gas analysis？
A. Metabolic alkalosis
B. Respiratory acidosis
C. Hypokalemia
D. Anemia
E. Hypochloremia

A 52-year-old man remains weak following a left hemicolectomy for cancer. The anesthesiologist
decides to ventilate the patient in the postoperative period. Which of the following modes of
ventilation carries the greatest risk of barotrauma in a spontaneously ventilating patient?
A. Pressure support
B. Synchronized intermittent mandatory
C. Intermittent mandatory
D. T-piece
E. Continuous positive airway pressure

A 53-year-old man has severe back pain 2 year following a fall. He has had numerous diagnostic
procedures, and physicians are unable to find a cause of pain. Which of the following medications
may be helpful in this patient?
A. Nifedipine
B. Amitriptyline
C. Ondansetron
D. Caffeine
E. Midazolam

To be sure that an endotracheal tube is located in the trachea, which of the following must be
documented?
A. Bilateral breath sounds
B. Visualization that the tube has passed through the vocal cords
C. Misting in the endotracheal tube
D. Presence of end-tidal carbon dioxide
E. Visualization of the chest rising