D 1.

The landmark use in doing internal pudendal nerve block

a. Anterior superior iliac spine
b. Posterior superior iliac spine
c. Sacral Spine
d. Ischial Spine
C 2. The nerve commonly missed in doing axillary approach in brachial plexus block
a. Axillary nerve
b. Median nerve
c. Musculocutaneous nerve
d. Radial nerve
B 3. Most common complication of intercostals nerve block
a. Hemothorax
b. Pneumothorax
c. Injury to intercostal artery
d. Injury to intercostal nerve
C 4. Absolute contraindication in doing spinal anesthesia
a. Respiratory disease
b. Back problems
c. Increase intracranial pressure
d. Children
D 5. Delayed complication of spinal anesthesia
a. Difficulty of breathing
b. vomiting
c. hypotension
d. Urinary retention
A 6. Factors influencing spread of solution in epidural anesthesia EXCEPT
a. Weight of pt
b. Volume of drug
c. Height of pt
d. Drug concentration
C 7. Method of identifying epidural space
a. Hanging drop method
b. Loss of resistance technique
c. Both
d. Neither
C 8. In the pain evaluation scale for children, what is the score of the child who is crying, tense,
distressed and does not response when spoken to
a. 2
b. 3
c. 4
d. 6
D 9. Most common side effect of NSAIDs
a. kidney damage
b. liver damage
c. impaired hemostatic function
d. gastric irritation
C 10. An agonist- antagonist analgesic
a. Morphine
b. Meperidine
c. Nalbuphine
d. Tramadol
C
E
D
G
A
1. Radial Nerve
2. Cervical Plexus Nerve
3. Intercostal nerve
4. Deep peroneal nerve
5. Ulnar nerve
A. Styloid process of ulna and tendon of Palmaris longus
B. Clavicle
C. Anatomic snuff box
D. Anterior rami T1-T11
E. sternocleidomastoid muscle
F. Axillary artery
G. Dorsalis pedis artery
A

C


A
B

C

1. Use smaller volume of
local anesthetics
2. Can be performed
between L3 and L4
level
3. Easier to perform
4. Used for surgeries of
longer duration
5. Can be used for
surgeries in the
abdomen
A. Spinal block
B. Epidural block
C. Both
D. Neither
D Nerve block by injecting local anesthetic posterior to the medial malleolus
a. Superficial peroneal nerve
b. Sural Nerve
c. Saphenous nerve
d. Posterior tibial nerve
C Local anesthetic that produces peripheral vasoconstriction both at low and high dose
a. Prilocaine
b. Etidocaine
c. Cocaine
d. Lidocaine
A Absolute contraindication for epidural anesthesia
a. bleeding disorders
b. headache
c. renal disease
d. respiratory disease
D Delayed complication of spinal anesthesia
a. hypotension
b. difficulty of breathing
c. bradycardia
d. urinary retention
C Subjective CNS symptom of local anesthetic toxicity
a. twitching
b. tremors
c. numbness of the tongue
d. all of the above

T
T
F
T
The following drugs are opioid agonist (T or F)
Meperidine
Morphine Sulfate
Nalbuphine
Fentanyl
B Which of the ff will influence the spread of tetracaine in the subarachoid space by creating turbulence
a. coughing during administration of drug
b. barbotage
c. speed of injection
d. direction of needle bevel
D Which of the ff will influence the spread of anesthetic in the epidural space
a. baricity of anesthetic
b. barbotage
c. patient position
d. volume of anesthetic
D An indication for caudal epidural block
a. laparotomy
b. hip replacement
c. appendectomy
d. hypospadia surgery
A Most common complication of intercostals nerve block
a. pneumothorax
b. hypotension
c. convulsion
d. hemothorax
A An advantage of epidural anesthesia over spinal anesthesia
a. longer duration
b. more profound muscle relaxation
c. safer
d. absence of paralysis
C The most sensitive nerve fiber to local anesthetics
a. A-gamma myelinated
b. A-beta myelinated
c. small unmyelinated
d. A-alpha myelinated
A Sign of high dose toxicity of local anesthetics
a. respiratory distress
b. twitching
c. convulsion
d. shivering
B Mechanism of action of local anesthetics
a. increasing Na permeability of excitable membrane
b. binds directly within the intracellular portion of voltage gated Na channels
c. binds to Na channels in non-charged or ionized form
d. increased Na permeability prevents transmission of impulse
A Local anesthetic with shortest duration of action
a. procaine
b. lidocaine
c. tetracaine
d. bupivacaine
A Residual neuromuscular blockade after general anesthesia is detected by
a. inability to perform a head lift
b. altered mental state
c. agitation and delirium
d. dysrythmias
B Postoperative hypertension is a sign of
a. tension pneumothorax
b. distended bladder
c. sepsis
d. residual effect regional anesthesia
C Which principle of emergence from general anesthesia is correct?
a. patient with increased ICP requires faster awakening to restore mental status
b. patient after a minot outpatient procedure is awakened as rapidly and as promptly as possible
c. Patient after a minor outpatient procedure is awakened as rapidly and promptly as possible
d. Patient after a complex cardiac procedure must be immediately awakened to check if the
surgical procedure is correct
A Hypoxemia occurs commonly in patients in the PACU so all patients must
a. receive supplemental oxygen
b. receive opioid analgesics
c. be intubated immediately
d. undergo incentive spirometry
A When a patient fails to emerge from anesthesia and remains obtunded, immediately ensure
a. oxygenation and ventilation
b. volume replacement
c. normal temperature
d. analgesia
C Which of the ff postoperative pain regimen can shorten the vicious cycle of pain?
a. epidural block
b. subarachnoid block
c. Patient Controlled Analgesia (PCA)
d. PRN administration of analgesia
B Which is a routine discharge criterion from the PACU?
a. residual anesthesia
b. stable VS
c. wound healing
d. ability to ambulate
D Which pain assessment tool can be used if the patient cant communicate?
A. Verbal Rating Scale
B. Numerical Rating Scale
C. Visual Analogue Scale
D. Wong and Baker Faces Pain Scale
B In the adult the spinal cord ends the level of?
a. L1
b. L2
c. S2
d. S1
C Factors influencing the spread of anesthetic solution in the epidural space EXCEPT?
a. level of catheter insertion
b. height of the patient
c. barbotage
d. volume of local anesthetic
A Signs of HIGH dose toxicity of local anesthetics
a. respiratory distress
b. twitching
c. convulsions
d. shivering
D The ff local anesthetics are amides except
a. lidocaine
b. levobupivacaine
c. ropivacaine
d. chloroprocaine
D Which of the ff local anesthetics has the longest duration of action
a. chloroprocaine
b. mepivacaine
c. tetracaine
d. ethidocaine
Which of the ff statement is TRUE about timing of emergence from general anesthesia?
a. A patient after a minor outpatient procedure is awakened as rapidly and promptly as possible
b. All measures must be done to awaken a patient after a complex cardiac procedure to check of
the surgical procedure is correct
c. Patients with increased ICP requires faster awakening to restore mental status
d. Patient with full stomachs must not be awakened to prevent aspiration og gastric contents
D Which of the ff is NOT associated with aspiration and delirium after anesthesia?
a. hypoxemia or airway obstruction
b. cental anticholinergic syndrome
c. full bladder
d. full stomach post surgery
A Hypoxemia occurs commonly in patients in the PACU so all patients must:
a. receive supplemental oxygen
b. receive opioid analgesics
c. be intubated immediately
d. undergo incentive spirometry
A Hypnosis, a heightened and focused concentration is useful in managing pain by
a. suggestion
b. sedation
c. example
d. Gates theory
D True of biofeedback
a. gives information about level of muscle contraction
b. gives information about amount of blood flow to the area
c. uses surface electromyography
d. uses electrical stimulation of nerves in the area
B Drug used in the presence of neuropathic component in chronic pain
a. amitrptyline
b. carbamazepine
c. NSAIDS
d. steroids
B Intermittent repeated doses of Demerol will lead to accumulation of this metabolite with neurotoxic
effect
a. MGG
b. morphine
c. oxymorhone
d. norpethidine
A Nerve block used to relieve pains due to postherpetic neuralgic involving the facial n.
a. stellate ganglion
b. celiac plexus
c. brachial plexus
d. cervical plexus
B Bradycardia after spinal surgery is a result of
a. hypotension
b. sympathetic blockade of cardiac accelerator
c. parasympathetic blockade
d. hypoxia
B Landmark for doing caudal block
a. ASIS
b. PSIS
c. ischial spine
d. iliac crest
A A sign of LOW dose toxicity of local anesthetic
a. tremors
b. respiratory depression
c. cardiac arrest
d. apnea
D The ff are esters except:
a. procaine
b. cocaine
c. tetracaine
d. bupivacaine
A An effect of hypothermia after general anesthesia
a. delays emergence
b. emergence delirium
c. upper airway obstruction
d. dyspnea
C All of the ff are routine discharge criteria from PACU EXCEPT
a. adequate pain control
b. stable VS
c. evidence of wound healing
d. residual effect of SAB
C Most suitable drug for chronic pain management
a. meperidine
b. nalbuphine
c. morphine sulfate
d. NSAIDs
B Pharmacologic management for nociceptive type of pain
a. morphine
b. NSAIDs
c. meperidine
d. oxycodone
C To maintain an effective analgesic concentration the drug should be administered:
a. only when necessary (patient complains of pain)
b. only in the presence of background pain (pain on movement)
c. on a time contingent basis
d. as often as possible
C A patient with a one year history of breast cancer complains of pain in the cervical vertebra radiating to
the arms. The possible cause of cancer pain is:
a. tumor itself
b. tumor compressing on a nerve
c. bone metastasis
d. cancer therapy
D A patient was asked to assess the severity of his pain by stating a number from 0-10
a. visual analogue scale
b. verbal description scale
c. verbal rating scale
d. numerical rating scale
C Objective CNS sign of local anesthetic toxicity
a. tinnitus
b. drowsiness
c. muscular twitching
d. dizziness
C 80% of the mechanism of opioids:
a. Inhibition of the release of glutamate
b. inhibition of the release of substance P
c. coupling with the G protein receptors
d. inhibition of release of endorphins
C All are immediate complication of spinal anesthesia EXCEPT:
a. hypotension
b. bradycardia
c. headache
d. nausea
D This factor influence the spread of local anesthetic in the subarachnoid space by creating turbulence
a. baricity
b. speed of injection
c. direction of needle bevel
d. barbotage
A Local anesthetic with possible allergic reaction
a. chloroprocaine
b. prilocaine
c. etidocaine
d. dibucaine
B Drug that exhibits analgesic, antidepressant and sedative properties:
a. amitrptyline
b. carbamazepam
c. ketorolac
d. NSAIDS
B Which of the ff receptors are already considered as non-opioid receptors because its occupancy cant be
reversed by opioid antagonists
a. mu receptors
b. sigma receptors
c. kappa receptors
d. delta receptors
C Factor that affect absorption of local anesthetic to the systemic circulation
a. metabolism,
b. tissue redistribution
c. choice of drug
d. excretion
C Needle puncture during epidural anesthesia is just like doing spinal puncture without piercing this
structure
a. ligamenttum flavum
b. posterior longitudinal ligament
c. dura
d. interspinous ligament
B From which of the ff NSAIDs can Reyes syndrome be elicited
a. acetaminophen
b. acetylsalicylic acid
c. fentanyl
d. tramadol
C Opiate with transdermal preparation
a. morphine sulphate
b. meperidine
c. fentanyl
d. tramadol
D Local anesthetic with the lowest systemic toxicity
a. benzocaine
b. lidocaine
c. prilocaine
d. chloroprocaine
C Which of the ff drugs exert analgesic property through NMDA receptors antagonism
a. midazolam
b. acetaminophen
c. ketamine
d. clonidine
A Cervical epidural anesthesia is usually performed by inserting needle at this space
a. C4
b. C5
c. C6
d. C7
B Nerve block for pancreatic cancer pain control
a. intercostal
b. celiac plexus
c. stellate ganglion
d. lumbar sympathetic
D Which of the ff opioids has a ceiling effect?
a. morphine
b. Demerol
c. fentanyl
d. nalbuphine
C Mechanism of action of local anesthetic
a. cause transient increase in Na permeability
b. blocks slow Ca channel
c. prevent transient increase in permeability to Na
d. Facilitate slow Ca channel
D State of heightened concentration used to manipulate the perception of pain through suggestion:
a. progressive muscle relaxation
b. guided imagery
c. biofeedback
d. hypnosis
A The neuropathic component of chronic pain can be treated with
a. carbamazepine
b. diclofenac
c. steroid
d. aspirin
A Which will accumulate with repeates doses of Demerol
a. norpethidine
b. oxymorphine
c. diamorphine
d. oxycodone
B Possible case of pain in the cervical vertebra radiating to the arms in breast Ca
a. bone metastasis
b. nerve compression
c. radiation
d. chemotherapy
A A nociceptive type of pain
a. peripheral
b. psychologic
c. central
d. chemotherapy
C Which of the ff is associated with agitation and delirium after anesthesia?
a. hypovolemia
b. nausea
c. full bladder
d. vomiting
A Which is common in the PACU requiring patients to receive supplemental O2?
a. hypoxemia
b. hyptension
c. hypovolemia
d. laryngeal spasm
A Hypothermia after general anesthesia results to:
a. delayed emergence
b. agitation
c. upper airway obstruction
d. dyspnea
A A test used to rule out residual neuromuscular blockade after general anesthesia?
a. head or leg lift
b. body temperature
c. pain score
d. response to verbal command
A Postoperative hypotension is a sign of
a. hypovolemia
b. bladder distention
c. pneumothorax
d. residual neuromuscular blockade
D Which is the least priority in postanesthesia care?
a. residual effects of anesthesia
b. hypothermia
c. pain
d. wound healing
D A patient can be discharged from the PACU if:
a. nauseated but with no vomiting
b. numerical scale is 10
c. responding to very painful stimulus
d. O2 saturation at room air
A Before departing from the OR suite and upon arrival at the PACU, the first in the checklist of patient
evaluation is
A. Patent airway
B. ECG tracing
C. level of spinal block
D. NSAIDs
A Which can delay emergence from general anesthesia?
a. opioids
b. COX inhibitiors
c. subarachnoid block
d. NSAIDs
A Postoperative nausea and vomiting can be prevented by:
a. avoiding gastric distention during ventilation
b. tramadol immediately before skin closure
c. NGT insertion during induction of anesthesia
d. air insufflations through the NGT after extubation
A Any patient with hypoventilation or delayed awakening after a general anesthetic should be evaluated
for:
a. residual neuromuscular blockade
b. cerebral infarction
c. electrolyte imbalance
d. residual analgesics
C Which of the ff local anesthetic undergoes hepatic enzymatic degradation
a. cocaine
b. prilocaine
c. etidocaine
d. procaine
A A patient in obvious pain who is not sufficiently focused to a pain rating scale requires:
a. immediate pain relief
b. questioning family members
c. referral to surgery
d. neurological evaluation
A Which of not recommended for chronic use due to metabolites that can cause CNS manifestatiosn
a. morphine
b. nalbuphine
c. meperdiine
d. fentanyl
C Which is a weak opioid for miniinal to moderate pain but causes excessive nausea and vomiting
a. nalbuphine
b. meperidine
c. tramadol
d. fentanyl
C Severe pain is managed by:
a. paracetamol
b. nalbuphine
c. morphine
d. aspirin
C During the depolarization phase, the ff event is prominent
a. Na channel resets
b. K channel closes
c. Na channel opens allowing Na to leave the cell
d. remaining K outside diffuses away
A Which is anticipatedly blocked at the lowest possible concentration of local anesthetics
a. B fibers (pain)
b. C fibers (postganglionic)
c. small sized A fibers
d. medium sized A fibers
B Bupivacaine will have intermediate onset of action at
a. higher concentration
b. lower concentration
c. concentration does not matter
d. low pKa
C The least tocxic level of local anesthetics is found in one of the ff sites of injection
a. intravascular
b. peritonsillar
c. intercostals
d. subcutaneous
A Which mechanism of action will explain the effect of the state of acidosis affecting the efficiency of the
local anesthetic?
a. the ionized fraction of the local anesthetic is increased by the acidic area therefore penetration is
inefficient
b. penetration of the membrane is better because of the increase on the ionized form
c. the local anesthetic pKa is lower than the physiologic pH
d. the quality of anesthetic is enhanced by the acidic state extracellularly
B The S enantiomer of bupivacaine affoers the ff advantage over the R enantiomer
a. convulsion threshold is lower
b. cardiotoxicty is less
c. QRS widening is more pronounced
d. the toxic level of equivalent dose with R is more with levebupivacaine
A A sign of local anesthetic overdose
a. respiratory arrest
b. twitching
c. convulsion
d. vomiting
D The least ominous of local anesthetic toxicity
a. tonic clonic convlusion
b. cessation of seizure activity
c. respiratory depression
d. respiratory arrest
D Cocaine abuse can lead to
a. hypotension
b. massive vasodilatation
c. sympathetic blockade
d. severe adrenergic potentiation
C Which local anesthetic has the least potential for cardiotoxocity
a. tetracaine
b. lidocaine
c. levobupivacaine
d. dextrobupivacaine
B If bupivacaine is more potent than procaine, therefore
a. procaine is more toxic than bupivacaine
b. procaine produces more convulsive episodes
c. the convulsive dose of bupivacaine is higher than procaine
d. more procaine is required to produce convulsion
A Allergic reaction from ester local anesthetics is due to
a. para amino benzoic acid
b. plasma cholinesterease
c. carboxylase
d. amide linkage
B Local anesthetic with antiarrythimic effect
a. lidocaine
b. bupivacaine
c. levobupivacaine
d. racemic bupivacaine
A Methemoglobinemia is associated with:
a. prilocaine
b. etidocaine
c. levobupivacaine
d. racemic bupivacaine
A An objective sign of local anesthetic toxicity
a. convulsion
b. metallic taste
c. tinnitus
d. light headedness
C Dural sac ends at the level of
a. L2
b. L4
c. S2
d. S4
A Imaginary line connecting superior iliac crest as landmark for subarachnoid block
a. Tuffiers line
b. Cartiers line
c. Perrieres line
d. Tangiers line
B Which has the greatest effect on level of sensory block produced by tetracaine
a. coughing during placement of drug
b. barbotage
c. patient weight
d. patient position
B Absolute contraindication for spinal anesthesia
a. respiratory distress
b. coagulopathies
c. chronic back pain
d. children
D Level of spinal anesthesia for caesarean section
a. saddle block
b. low spinal (T10)
c. high spinal (T4)
d. mid spinal (T6)
D Nausea and vomiting occurring during spinal anesthesia is most likely caused by
a. parasympathetic activity
b. phrenic nerve paralysis
c. motor block
d. dyspnea
B Post spinal headache is due to
a. referred pain
b. CSF leakage to the epidural space
c. hematoma
d. back muscle strain
B The snap felt just before entering epidural space represents passage through which ligament?
a. posterior longitudinal
b. ligamentum flavum
c. supraspinous
d. interspinous
B Thoracic epidural block for upper abdominal operation is usually injected at the lvelof
a. T6
b. T4
c. T9
d. T12
D Cervical epidural block for neck surgery is injected at the level of
a. C7
b. C5
c. C6
d. C4
D Nerve blocked during caudal anesthesia
a. lumbo sacral plexus
b. coccygeal plexus
c. S4-S5
d. all of the above
A Landmark for caudal block
a. sacral hiatus
b. sacral cornua
c. tip of coccyx
d. all of the above
B An immediate complication of subarachnoid block
a. hypotension
b. nausea
c. bradycardia
d. respiratory arrest
A Epinephrine added to tetracaine results to
a. prolonged duration of block
b. shortened duration of block
c. decreased potency of block
d. increased potency of block
D Which has the greatest to level of sensory block after epidural injection of bupivacaine
a. patient position
b. patient height
c. volume of anesthesia
d. baricity
A The score in visual analogue scale of pain that would signify that analgesia is adequate
a. 2-3
b. 4-5
c. 6-7
d. 8-10
B Advantage of Paracetamol, except
a. doesnt cause respiratory depression
b. anti-inflammatory
c. no hemodynamic effects
d. doesnt slow gastric emptying
C Mechanism of NSAIDs
a. inhibition of lipooxygenase
b. inhibition of phospholipase
c. inhibition of COX
d. all of the above
C Which of the ff is not a side effect of opioids
a. decreased gastric emptying and reduced intestinal motility (constipation )
b. nausea and vomiting
c. renal impairment
d. contraction of sphincter of oddi
D Which of the ff opioids is considered the prototypical opioid agonist to which all others are compared
a. meperidine
b. nalbuphine
c. fentanyl
d. morphine
D Mechanism of action of Tramadol
a. a weak mu receptor agonist
b. inhibits serotonin reuptake
c. inhibits noradrenaline reuptake
d. all of the above
B Site of action of opioids
a. site of injury
b. Lamina II of the gray matter of the spinal cord
c. thalamic nuclei
d. all of the above
A Landmark for doing caudal-epidural block
a. ASIS
b. PSIS
c. sacral spine
d. sacral cornu
A The only available intravenous COX 2 inhibitor
a. Valdecoxib
b. Parecoxib
c. Celecoxib
d. Etoricoxib
B The greater the lipid solubility of local anesthesia
a. greater the amount needed
b. the faster the onset
c. the longer the duration
d. the more potent
C The onset of action of local anesthesia is determined by
a. its vasodilator property
b. the charged form of local anesthesia
c. the uncharged form of local anesthesia
d. protein binding
B At high concentrations, most local anesthetics cause _______ on the blood vessels
a. vasodilation
b. vasoconstriction
c. no effect
d. depend on pKa
A Subjective symptoms of CNS toxicity to local anesthetics
a. tinnitus
b. shivering
c. tremor
d. unconciousness
B Peripheral vascular effect of local anesthetic toxicity
a. high dose lead to vasoconstriction
b. cocaine cause vasodilation at high dose
c. low dose stimulate myoorganic contraction
d. mechanism id sue to inhibition of uptake of NE

F
T
F
F
A patient can be discharged from the PACU if: (T or F)
Drowsy but responds to painful stimuli
Pulse oximeter reading at 97% while breathing room air
BP is >30% of baseline
Still in pain but analgesic is given
E
F
A
B?
B
1. Most versatile local anesthetic
2. methemoglobinemia
3. ventricular arrhythmia
4. lowest systemic toxicity
5. limited to topical use only
a. bupivacaine
b. chloroprocaine
c. cocaine
d. tetracaine
e. lidocaine
f. prilocaine
B
F
D
A
G
1. Atropine sulphate
2. nalbuphine
3. midazolam
4. diphenhydramine
5. fentanyl
a. antihistamine
b. anticholinergic
c. anticholinesterase
d. anterograde amnesia
e. antagonist
f. agonist-antagonist
g. opioid
A

C

C

B
1. Use for post op analgesic in pediatric
patients
2. May be given at any level of spinal
column
3. Use the hanging drop technique to
determine placement
4. Sudden click or give indicates
successful puncture
a. caudal anesthesia
b. spinal anesthesia
c. epidural anesthesia
D Unopposed retching and nausea after spinal anesthesia is due to:
a. bradycardia
b. full stomach
c. ulcer
d. unopposed vagal stimulation of the gut
A Best spinal anesthesia level for hemorrhoidectomy
a. saddle block
b. low spinal
c. mid spinal
d. high spinal
C Thoracic epidural needle insertion for midthoracic epidural anesthesia is usually at
a. T3
b. T5
c. T7
d. T9
B Hypotension following spinal anesthesia is due to
a. sympathetic denervation
b. profound vasodilation
c. antonomic denervation
d. high levels of neural blockade
C What physiochemical property of local anesthesia determines its potency
a. The greater the ionized form the less the potency
b. The greater the protein binding the greater the potency
c. The less the lipid solubility the less the potency
d. the less the non-ionized form the greater the potency
C Dermatomes involved when level of neuraaxial block is high spinal anesthesia
a. sacral, lumbar up to T6
b. all lumbar and sacral
c. sacral and lumbar up to T4
d. sacral and lumbar up to T10
B Most popular position for the performance of spinal or epidural anesthesia
a. prone
b. lateral decubitus
c. sitting
d. jack knife
A The mechanism of action of nalbuphine
A. Preferential affinity to mu receptor
B. Preferential affinity to delta receptor
C. Preferential affinity to kappa receptor
D. all of the above
C Which local anesthetic exhibit biphasic effect on vascular smooth muscle
a. cocaine
b. etidocaine
c. chloroprocaine
d. dibucaine
B What is the mechanism of low dose local anesthesia or CNS toxicity
a. inhibition of excitatory pathway
b. inhibition of inhibitory pathway
c. excitation of excitatory pathway
d. excitation of inhibitory pathway
B Structure traversed by the spinal needle during lumbar puncture in the median approach EXCEPT
a. dura
b. posterior longitudinal ligament
c. ligamentum flavum
d. supraspinous ligament
B Demerol and tramadol should not be given to patients receiving
a. GABA inhibitors
b. MAO inhibitors
c. 5HT3 antagonist
d. H2 atagonist
B Which of the ff statement is the local anesthesia toxicity
a. an expected complication
b. due to intravascular injection
c. due to allergic reaction
d. a common occurrence
A An analgesic with opioid and non opioid action
a. nalbuphine
b. meperidine
c. morphine
d. tramadol
B Enzyme that concerts arachidonic acid to prostlandin
A. LOX
B. COX
C. phospholipase
D. all of the above
B Caudal anesthesia is a form of
a. spinal anesthesia
b. epidural anesthesia
c. local block
d. peripheral block
A Spinal anesthesia can be safely made at the ff interspace except
a. L1 and L2
b. L2 and L3
c. L3 and L4
d. L4 and L5
B The recommended method of pain evaluation in children
a. visual analogue scale
b. nominal five point scale
c. pain faces scale
d. percentage scale
D All of the ff conditions are contraindicated to the use of NSAIDs except
a. gastritis
b. anti platelet medications
c. moderate to severe dehydration
d. respiratory depression
A Chronic use of this opioid results in neurotoxicity due to its metabolite
a. meperidine
b. morphine
c. fentanyl
d. oxycodone
A Drug that blocks phospholipase thus inhibiting inflammation
a. steroids
b. aspirin
c. paracetamol
d. opioid
D A unidimensional tool of measuring pain intensity
a. visual analogue scale
b. numerical rating scale
c. pain faces cale
d. all of the above
C Which of the ff inflammatory chemicals also acts as an ALLOGEN
a. thromboxane
b. leukotrienes
c. prostaglandin
d. all of the above
B Acts on the central cyclooxygenase
a. ibuprofen
b. paracetamol
c. aspirin
d. all of the above
D The ff local anesthetic exhibits vasoconstricting effect at low and high doses
a. lidocaine
b. bupivacanine
c. ropivacaine
d. cocaine
B Intermediate onset of action
a. chloroprocaine
b. lidocaine
c. bupivacaine
d. procaine
A Objective sign of CNS toxicity
a. convulsion
b. dizziness
c. drowsiness
d. lightheadedness
B Local anesthetic belonging to amide group
a. procaine
b. lidocaine
c. cocaine
d. tetracaine
A Local anesthetic that is converted to O-toluidine in the liver
a. procaine
b. etidocaine
c. lidocaine
d. cocaine
A Local anesthetic wtih antiarrythmic effect
a. Lidocaine
b. Tetracaine
c. Etidocaine
d. Cocaine
D Potency of local anesthetic is measured by its
a. pka
b. protein binding
c. water binding
d. lipid solubility
B Local anesthetic that causes unidirectional block and re-entry of cardiac arrhythmia
a. Lidocaine
b. Bupivacaine
c. Etidocaine
d. Cocaine
D T6 is at the level of
a. nipple
b. subcostal
c. umbilicus
d. xiphoid process
C Not an indication of spinal anesthesia
a. hemorrhodectomy
b. cesarian section
c. modified radical mastectomy
d. mermiorhapy
D The line joining the highest points of iliac crest (ASIS) crosses
a. L1 interspace
b. L2interspace
c. L3interspace
d. L4 interspace
A This allows pt to titrate analgesics according to their needs
a. patient controlled analgesia (PCA)
b. intravenous on a per need basis
c. transdermal therapeutic system
d. oral on a time contiguous basis
B Ideal level of block for appendectomy
a. high spinal
b. midspinal
c. low spinal
d. saddle block
C Upon doing pinprick test, the sensory block is at the level of the nipple (T4). What is the level of motor
block?
a. T6
b. T8
c. T2
d. T10
C Postural hypotension is due to:
a. parasympathetic block
b. motor block
c. sympathetic block
d. sensory block
B Immediate management for orthostatic hypotension
a. head up position
b. iv hydration
c. head down position
d. vasoconstriction
B Immediate management for bradycardia
a. vasoconstriction
b. atropine
c. IV fluid
d. sedation
A To maintain an effective analgesic concentration, drugs must be administered:
a. on a time contingent basis
b. as often as possible
c. when pain complains of pain
d. presence of background pain
A The segment of local anesthetic responsible for allergic reaction
a. intermediate link
b. aromatic ring
c. terminal amine
d. terminal ester
D Longest duration of action
a. chloroprocaine
b. mepivacaine
c. tetracaine
d. etidocaine
D Most toxic
a. procaine
b. mepivacaine
c. tetracaine
d. cocaine
D Delayed complication of spinal anesthesia
a. hypotension
b. hypertension
c. nausea
d. headache
C T10 is at the level of
a. xiphoid process
b. subcostal line
c. umbilicus
d. nipple lime
B Not a content of the epidural space
a. vascular network
b. CSF
c. loose alvelolar tissue
d. fatty tissue
A Landmark for thoracic epidural anesthesia
a. ASIS
b. PSIS
c. C7 spine
d. interior border of scapula
D Indication for caudal epidural block
a. herniorrahpy
b. hip surgery
c. appendectomy
d. hypospadia surgery in children
D Absolute contraindication to spinal anesthesia
a. back problem
b. children
c. anemia
d. increase ICP
C Not associated with agitation and delirium after anesthesia
a. hypoxemia
b. central structure
c. full bladder
d. full stomach postop
A Emergence delirium is common in all except
a. healthy young patients
b. COPD patients
c. patients who are anxious before surgery
d. patients who awaken restrained
C Medication that can delay emergence
a. H2 blockers
b. paracetamol
c. opioids
d. COX inhibitors
B Property of paracetamol
a. selective COX inhibitor
b. effective for acute pain
c. results in gastric ulceration
d. serotonin reuptake inhibitor
A An adverse effect of opioids
a. pruritus
b. impairs platelet function
c. analgesia
d. gastric ulceration
C A weak opioid
a. morphine
b. fentanyl
c. tramadol
d. pethidine
D Parameters of the objective pain scale except
a. BP
b. movement
c. crying
d. O2 saturation
D Factors influencing analgesic needs except
a. site of operation
b. patients personality
c. sex
d. none of the above
C Most common adverse effect of short term NSAID administration
a. acute renal failure
b. prolonged bleeding time
c. gastric irritation
d. arrhythmia
B Most common adverse effect of tricyclicamines
a. bundle branch block
b. drying of saliva
c. sedation
d. obesity
D Nalbuphines analgesic effect is due to binding of what receptor
a. Mu1
b. Mu2
c. delta
d. kappa
C Tramadol and Meperidine should not be given with
a. Ca channel blocker
b. Beta blocker
c. MaO inhibitor
d. nitrate
D Peripheral vascular effect of local anesthesia
a. low dose cause vasodilation
b. cocaine is vasodilating
c. with direct pulmonary vasodilation effect
d. high dose inhibitory to myogenic activity
B Characteristic of Bupivacaine toxicity
a. acidosis and hypoxia has no effect
b. more difficult to resuscitate and can be fatal
c. pregnant women are not susceptible
d. no cardiac effect
C Local anesthetic with ester linkage
a. bupivacaine
b. Mupivacaine
c. tetracaine
d. lidocaine
B Best anesthetic technique for inguinal hernioraphy
a. caudal block
b. subarachnoid block
c. epidural block
d. general anesthesia
C Effect of increase pCO2 on CNS toxicity of local anesthetic
a. pCO2 is directly related to convulsive threshold
b. decrease cerebral blood flow
c. decrease plasma protein binding of local anesthetic
d. decrease cationic form of local anesthetic
B True of Mininum Concentration of local anesthetic (Cm)
a. same as MAC in general anesthesia
b. minimum concentration of local anesthetic to produce conduction blockade
c. requires lower Cm for motor fibers
d. requires higher Cm for sensory fibers
D Last fibers to be blocked by local anesthetics
a. small nerve fibers
b. small unmyelinated fibers
c. small unmyelinated A delta fibers
d. large myelinated A gamma, A beta ot A alpha fibers
A The local anesthetic which has the least vasodilating effect
a. mepivacaine
b. lidocaine
c. ropivacaine
d. procaine
B The uptake of the local anesthetic into the nerve is dependent on
a. vascularity of the area
b. distance, ph, and anesthetic properties
c. degree of vasodilation
d. any of the above
C Increasing the dosage of the local anesthetic correlates with
a. increase onset time
b. decreased duration of action
c. enhanced quality of block
d. less toxicity
D Local anesthetic that can be used for subarachnoid block except
a. lidocaine
b. bupivacaine
c. tetracaine
d. cocaine
A Low dose toxicity of CNS is manifested by:
a. generalized convulsion
b. cessation of seizure
c. respiratory depression
d. respiratory arrest
D Cardiotoxicity is brought by the ff events except
a. blocking cardiac Na channels
b. blocking K and Ca channels
c. blocking sympathetic cardiac innervations
d. positive inotropic action
A The ff locala anesthetic produces intense vasoconstriction by preventing NE reuptake by the tissue
binding site
a. cocaine
b. lidocaine
c. mepivacaine
d. etidocaine
A Absolute contraindication to spinal anesthesia
a. infection at puncture site
b. upper respiratory infection
c. fever
d. hypertension
D True of spinal anesthesia
a. acts on substance of SC
b. anesthetic acts on spinal nerve roots
c. anesthetic deposited in the epidural space
d. parasympathetic block is produced
A Advantage of epidural block
a. longer duration of block
b. large volume of anestethic agent used
c. technically easier to perform
d. complete block is achieved
B Method of identifying the epidural space
a. resistance to injection
b. loss of resistance
c. CSF flow
d. sudden gice