Chapter 6 Review Questions
			
1) Nitrous oxide is contraindicated in ALL BUT ONE of the following settings. Indicate the exception:
a) Total hip arthroplasty in the lateral position
b) Laparotomy for bowel obstruction
c) Multiple trauma with pneumothorax
d) Patient with history of severe post operative nausea and vomiting

2) Which class of drugs is most commonly responsible for intraoperative anaphylactic (or anaphylactoid) reactions?
a) Opioid analgesic agents
b) Induction agents
c) Muscle relaxants	
d) Volatile anesthetic agents

3) Other than analgesia, what is the most important clinical effect of the opioid analgesics?
a) Cardiac depression
b) Sedation
c) Nausea and vomiting
d) Respiratory depression

4) Which ONE of the following describes an advantage of sevoflurane over desflurane?
a) Lower lipid solubility therefore quicker onset and offset of effect
b) Less pungent therefore more practical for mask induction
c) Can be used with lower flows therefore more economical
d) Mild sympathomimetic effect minimizes hypotension

5) Which ONE of the following best describes the reason for the rapid OFFSET of effect of the induction agents? 
a) Ester hydrolysis
b) Liver metabolism
c) Redistribution
d) Renal excretion

6) ALL BUT ONE of the following conditions predisposes the patient to prolonged effect of non-depolarizing muscle relaxants. Indicate the exception:
a) Hyperkalemia
b) Hypothermia
c) Gentamycin administration
d) Myasthenia gravis

7) ALL BUT ONE of the following are contraindications to succinylcholine. Indicate the exception:
a) Cervical spinal cord injury (1 week ago)
b) Monoamine oxidase administration
c) Malignant hyperthermia susceptibility
d) Burn injury (24 hours ago)

8) Which of the following is the correct MAXIMUM safe dose of bupivacaine (plain):
a) 1 mg/kg
b) 2 mg/kg
c) 5 mg/kg
d) 7 mg/kg

9) ALL BUT ONE of the following describes a feature of phenylephrine. INDICATE THE EXCEPTION:
a) Phenylephrine causes (reflex) bradycardia.
b) Phenylephrine can be safely used in patients with cocaine intoxication.
c) Phenylephrine acts directly at the alpha adrenergic receptor.
d) Phenylephrine improves cardiac performance in cardiogenic shock.

10) ALL BUT ONE of the following are effects of the synthetic opioids (fentanyl, sufentanil and remifentanil). Indicate the exception:
a) Muscle rigidity
b) Biliary spasm
c) Myocardial depression
d) Bradycardia

11) Which ONE of the following most closely describes the MAC of three commonly-used volatile anesthetic agents?
a) Desflurane 6%; Sevoflurane 1%; Isoflurane 2%
b) Desflurane 2%; Sevoflurane 6%; Isoflurane 1%
c) Desflurane 1%; Sevoflurane 2%; Isoflurane 6%
d) Desflurane 6%; Sevoflurane 2%; Isoflurane 1%
e) Desflurane 2%; Sevoflurane 1%; Isoflurane 6%
f) Desflurane 1%; Sevoflurane 6%; Isoflurane 2%

12) Which of the following opioids are most commonly administered into the intrathecal (spinal) space?
a) Morphine and sufentanil
b) Fentanyl and sufentanil
c) Morphine and fentanyl
d) Fentanyl and remifentanil

13) Which ONE of the following receptors is NOT targeted in the treatment or prevention of post-operative nausea and vomiting?
a) GABA
b) Histamine
c) Serotonin
d) Dopamine

14) Which ONE of the following sets correctly describes the cholinergic effects of neostigmine?
a) Bradycardia and bronchospasm
b) Mydriasis and confusion
c) Urinary retention and constipation
d) Dry mouth and dry eyes

15) Which of the following correctly describes an important principle in the use of ketorolac as an adjunct for post-operative pain?
a) IV therapy should be minimized to less than 5 days.
b) Ketorolac must not be given to patients with renal insuffciency.
c) Potentiation of opioid effect is a risk.
d) Gastrointestinal bleeding is not a concern with the Cox 1 inhibitors such as ketorolac.

16) What is the main advantage of the use of glycopyrrolate compared to atropine to counteract the cholinergic effects of anticholinesterase administration?
a) Faster onset of action
b) Does not cross the blood brain barrier
c) More effective anticholinergic activity
d) Safe in patients with narrow angle glaucoma

Answers: 1a, 2c, 3d, 4b, 5c, 6a, 7b, 8b, 9d, 10c, 11d, 12c, 13a, 14a, 15b, 16b