Old Exam Questions Flashcards

0
Q

Which of the following statements about the ans is most correct?
A- it is divided into the sympathetic, parasympathetic, and adrenergic systems
B- It is under voluntary control
C- Only the sympathetic nervous system is tonically active
D- The system is composed of a two neuron unit in which two myilenated axons connect at the autonomic ganglion
E- The vagus nerve is the primary source of the autonomic sensory input from the thoracic and abdominal organs

A

E

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1
Q
Which of the following is LEAST regulated by the autonomic nervous system: 
A- cardiac muscle 
B- gastrointestinal motility 
C- gland secretion 
D- neuromuscular junction 
E- vascular tone
A

D- neuromuscular junction

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2
Q

Which statement about the sympathetic nervous is most correct?
A- Ach is a precursor in the synthesis of epi
B- circulating cathecolimines cross the BBB
C- Circulating catecholimines have a shorter duration of action than those released from post-ganglionic neurons
D- It includes a chain of paired paravertebral ganglia
E- it originates from the brainstem or sacral segments of the spinal chord

A

D

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3
Q

Which of the following statements about autonomic physiology is most correct?
A- Adrenergic nerves release neurotransmitters that bind dopaminergic receptors in the heart and blood vessels
B- parasympathetic nerves innervate the heart and blood vessels
C- Sympathetic nerves release neurotransmitters that bind cholinergic receptors in the renal blood vessels
D- the distribution of neurons in the cholingeric system allows a system wide mass discharge
E- the post-ganglionic neuron from the adrenal medulla releases epi at its target organs

A

B

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4
Q

Which statement about the autonomic system is most correct?
A- Muscarinic receptors are also found at the NMJ
B- Neostigmine will cause activation of muscurinic but not nicotinic receptors
C- nicotinic receptors are blocked by atropine
D- Nicotinic receptors are located in cholinergic and adrenergic ganglia
E- the primary sympathetic neurotransmitters are Ach (80%) and norepi (20%)

A

D

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5
Q

Which statement about atropine is most correct?
A- it cant cross the BBB
B- it has a longer duration of action than glyco
C- it is known to cause myosis
D- it will cause diaherrea
E- its effects mimic those of epi

A

E

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6
Q

A patient is started on an epi infusion in the ICU. Which of the following statements is most correct?
A- Epi binds equally to alpha and beta receptors
B- its action on BP will be mediated primarily by beta receptors
C- its action on alpha-2 receptors cause release of norepi
D- The infusion will cause decrease in myocardial contracility
E- this infusion will exacerbate preexisting COPD and precipitate broncospasm

A

A

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7
Q

What statement about the metabolism of an epi infusion is most accurate?
A- it is cleaved by plasma esterases
B- it is excreted unchanged in the urine
C- it is taken up by the adrenal gland
D- it undergoes hepatic metabolism
E- it undergoes re-uptake into the nerve terminal

A

B,C or D

Maggie says D

this was Q14 on the final

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8
Q

Which statement about adrenergic receptors is MOST CORRECT?

a) they can b found both in the ganglia and at the end-organ
b) alpha receptors are only located on the presynaptic membrane
c) alpha receptors can be found in smooth muscle of skin, uterus, and intestine
d) Beta 2 receptors are primarily located in the heart and peripheral vasculature
e) the Ach receptor is an example of an alpha 1 receptor

A

C

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9
Q

Which statement is most correct about patients with a heart transplant?

a) bradycardia will respond to Tx w/ glyco
b) resting HR is slower than that of a non-transplant pt
c) phenylephrine may lead to significant bradycardia
d) tachycardia will respond to tx w/ beta blockers
e) these pts should be managed w/ IV volume restriction

A

D

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10
Q

Which statement is most correct about the mechanism of action of phenylephrine:

a) acts as a vasodilator
b) inhibits reuptake of epi
c) lowers HR, causing reflex hypertension
d) mimics the action of norepi
e) stimulates the release of catecholamines

A

d

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11
Q

Which of the following comparisons is most correct:

a) dobutamine increases SBP more than epi
b) NE causes arrhythmias more than epi
c) Isoproterenol bronchodilates more than dobutamine
d) NE increases CO more than isoproterenol
e) Vasopressin causes bowel ischemia more than NE

A

C

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12
Q

Which statement is MOST CORRECT about IV ephedrine?

a) It acts as an indirect vasodilator
b) It inhibits re-uptake
c) It is a catecholamine
d) It stimulates the release of endogenous adrenergic agonists
e) Its duration of effect is similar to that of IV epi

A

d

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13
Q

A woman gets a spinal for a scheduled c/s. She then gets hTN, nausea, chest is “numb” and her hands get weak bilaterally. Which statement is MOST CORRECT about the tx for this pt?

a) give ephedrine bc it has anti-emetic properties
b) ephedrine bc it will prevent bradycardia from the high spinal
c) ephedrine bc it will prevent fetal acidosis
d) phenylephrine bc it can be used as an infusion
e) phenylephrine bc it will prevent tachycardia during the surgery

A

A

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14
Q

A pt is post-lung transplant and is doing poorly in the ICU w/inc PA pressures, tachycardia, heart failure, and systemic HTN. Which drug will increase contractility w/o inc the BP or HR?

a) dobutamine
b) dopamine
c) epi
d) Milrinone
e) NE

A

D

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15
Q

Which statement about dopamine is MOST correct?

a) at high doses it will protect the heart from arrhythmias
b) at low doses it has been shown to dec risk of renal injury
c) it can bind to all adrenergic and cholinergic receptors
d) it inc BP at lower doses - vasodilator at high doses
e) it will inc contractility but also myocardial O2 demand

A

This was Q 22 on the final. the answer is not B

Maggie says E

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16
Q

A pt w/ a Dibucaine # of 7 is about to have anesthesia for electroconvulsive therapy (ECT). The induced seizure causes sig muscle activity as well as major inc in HR and BP. The entire procedure is only 1-2 min. Which statement is most correct?

a) Esmolol must be avoided in this pt
b) Etomidate cannot be used as an induction agent
c) Labetalol is a poor choice due to its duration of action
d) Remifentanil will have a prolonged duration of action in this pt
e) Sux should be used to prevent generalized seizure activity

A

c

17
Q

What is the best definition of bioavailability?

a) the amount of drug metabolized by the liver
b) the amt of drug that enters systemic circulation
c) the lethal dose of a drug
d) the maximum effect a drug can achieve
e) the toxic dose of a drug

A

b

18
Q

What is the BEST definition of pharmacokinetics?

a) properties of a drug that make it medically effective
b) the way in which drugs bind and interact w/ receptors
c) process of how drug is absorbed, distrib, metab & elim by body
d) the study of the origin, nature, properties, and action of drugs and their effects on living organisms

A

c

19
Q

Which of the statements about biotransformation is correct?

a) it is the process by which drugs become more hydrophobic
b) drugs can be excreted in the urine w/o any biotransformation
c) for most drugs, it is limited by hepatic enzyme activity
d) Phase I reactions are known as conjugation reactions
e) Phase II reactions are typically catalyzed by the CYP enzyme

A

B

20
Q

In the two-compartment model, what process is responsible for the Beta phase decline in serum concentration after an IV bolus?

a) Bioavailability
b) Elimination
c) First-pass effect
d) Protein binding
e) Redistribution

A

B

21
Q

Which of the following best describes first order kinetics?

a) elimination is a fixed quantity of drug per unit of time
b) looks like a straight line on a concentration v time plot
c) most drugs exhibit first-order kinetics at very high plasma [ ]
d) quantity of drug eliminated per unit of time is dependent on [ ]
e) the % of existing drug that is metabolized changes over time

A

d

22
Q

Which drug undergoes biotransformation via plasma esterase?

a) Etomidate
b) Ketamine
c) Methohexital
d) Propofol
e) Thiopental

A

A

23
Q

Which statement is MOST CORRECT about Ketamine?

a) binds to the alpha-2-adrenergic receptor
b) causes adrenal suppression
c) effect mediated by NMDA
d) Inappropriate for pts with severe bronchospasm
e) no significant analgesic properties

A

C

24
Q

Which MOST correctly pairs the drug w/ its effect/side effect?

a) Etomidate - Myoclonic twitches
b) Ketamine - bacterial contamination
c) Midazolam - Porphyria
d) Propofol - Hallucinations
e) Thiopental - improves SSEP amplitude

A

A

25
Q

Which is most correct regarding opioid use and misuse?

a) OD should be treated w/ small doses of flumazenil
b) withdrawal is a life threatening condition if not properly treated
c) withdrawal syndrome lasts approx 6 weeks
d) Sx of withdrawal include GI upset, mydriasis, & piloerection
e) tolerance develops after 72 hrs of usage

A

d

26
Q

Which statement about Remifentanil metabolism is most correct?

a) it is cleaved by plasma esterase
b) it is excreted unchanged in the urine
c) it is metabolized in the lungs
d) it undergoes hepatic metabolism
e) it undergoes Hoffman elimination

A

A

27
Q

Which common PACU sx is best treated w/ meperidine?

a) nausea
b) pain
c) shivering
d) tachycardia
e) urinary retention

A

C

28
Q

Which drug has the LONGEST context-sensitive half-time?

a) Fentanyl
b) Ketamine
c) Midazolam
d) Propofol
e) Remifentanil

A

Not B…i think it is A
this is Q 36 on the final

Maggies says A

29
Q

A child with status asthmaticus is intubated and ventilated in the PICU and has been at 1.6% of vol. anesthetic for 24hrs. Which of the following is most correct.

a) equilibrium occurs more rapidly w/soluble agents
b) Just knowing Fi is enough to determine Pcns
c) concentration of agent in the brain is independent of lambda
d) the concentration in the brain = concentration in blood
e) to determine Pcns, you need to know the partition coefficients for of Brian:Blood and Blood:Gas

A

Not C…this is #37 on the final

Maggie says B

30
Q

Which statement is most correct about uptake and induction?

a) cardiac output is unrelated to uptake
b) induction = process of moving the agent from lungs to blood
c) pulmonary artery blood flow is a factor that effects uptake
d) the goal of induction is for FA=1
e) uptake is highest with insoluble agents

A

C

31
Q

A pt under GA w/ 1.1% Iso moves upon incision. No other drugs have been given. Which is most correct?

a) the pt is prob taking a drug that increases MAC
b) there is prob an equipment malfunction w/ vaporizer or monitor
c) this is the normal pt response at this concentration
d) the pt is likely to have awareness
e) this pt should be switched to a diff volatile anesthetic

A

Not A…this is #39 on the final

Maggie says C

32
Q

In which of the following is nitrous oxide most contraindicated?

a) 22 yo F having a cholecystectomy w/ hx of MH
b) 32 yo F having a craniotomy for a tumor done in sitting position
c) 44 yo M w/ iron deficiency anemia having L2-L5 laminectomy
d) 29 yo M w/ hx of PONV having lap appendectomy
e) 73 yo M w/ HTN and CAD to have a total hip replacement

A

B

33
Q

What is the substance that is oxidized by nitrous?

a) Ach
b) Folic acid
c) Hgb
d) tyrosine hydroxydase
e) vitamin B12

A

E

34
Q

Which statement about the treatment of MH is most correct?

a) IV injection of Na Bicarb is often necessary
b) if treated early, pts can be discharged after 12hr of observation
c) respiratory acidosis commonly occurs
d) rigidity can be treated by paralysis with NDMRs
e) treatment includes dobutamine 2.5 mg/kg IV

A

Not E…was #42 on final

Maggie says A

35
Q

In which pt is Sux MOST APPROPRIATE?

a) 17 yo man w/ congenital myotonia - presents for appendectomy with full stomach
b) 32 yo F with known NMS presents for urgent operative laparoscopy for ectopic pregnancy
c) burn pt presents for skin graft 10 days after original injury
d) pt scheduled for closed reduction of a humerus fx w/ dibucaine number of 46
e) pt w/ ESRD w/no dialysis in three days and current serum K=6.5, presents for AV graft thrombectomy

A

Not D…was #43 on final

Maggie says B

36
Q

A 43yo F presents for open appendectomy. Which is inappropriate for a short case like this?

a) Cisactracurium
b) Pancuronium
c) Rocuronium
d) Sux
e) Vec

A

B

37
Q

Which statement about LAs is most correct?

a) bicarb speeds the onset of action by increasing affinity for the binding site
b) epi speeds the onset of action by causing vasoconstriction and limiting systemic absorption
c) LAs are weak acids and bind to their target most effectively when they are charged
d) LAs must cross the cell membrane and bind to K channels inside the cell
e) Motor fibers are blocked last and recover first bc of their large diameter

A

e

38
Q

Which statement about adverse effects to LAs is most correct?

a) Allergy to lidocaine is more likely that allergy to tetracaine
b) amide LAs primarily undergo hepatic metabolism
c) neurotoxicity typically occurs shortly after cardiotoxicity
d) neurologic manifestations of lidocaine toxicity include euphoria, tremors, and hallucinations
e) the treatment for benzocaine OD is intralipid infusion

A

B

39
Q

Which of the following statements about MH is most correct?

A. Diagnosis is ruled out only by muscle biopsy testing
B. Genetic defect w/ X linked inheritance
C. Hypermetabolic process that occurs at the NMJ
D. Muscle rigidity commonly seen unless pt has NMB
E. Occurs within 10 min of giving the triggering agent

A

Either A or B?

41
Q

T or F. LA’s must cross the cell membrane and bind to NA channels inside the cell

A

True

42
Q

T or F. Excessive doses of Neostigmine can lead to weakness in certain pts?

A

True