‫ الفصل االول‬/ ‫ المرحلة الرابعة‬/ ‫اسئلة التخذير‬

‫ بغذاد‬/ ‫كلية التقنيبت الصحية والطبية‬

1- Blood volume of pregnant women (all true except one)

a) increase progressively starting at 6-8 weeks.

b) increased by 1-1.5 liters at time of delivery
c) greater increase in red blood cell mass plasma volume compared plasma volume
d) Increased blood volume meets the mother and fetus’s metabolic demands.
e) Increased blood volume to tolerate blood loss during delivery.

2- Cardiac output of pregnancy (all true except one)

a) Cardiac output means the amount of blood pumped by the heart in one minute
b) will increase up to 40% at term
c) Most of the increase occurs in the 1st and 2nd trimesters except during labor when reach the peak
d) will return to normal 2 weeks after delivery.
e) can increase after 28 weeks of pregnancy due to mechanical changes.

3- Blood pressure during pregnancy (which one is true)

a) normally increase from pre-pregnancy levels

b) An increase in blood pressure occurs by about 8 weeks of gestation
c) A decrease in blood pressure occurs by about 28 weeks of gestation
d) By end of pregnancy, the diastolic blood pressure and mean arterial pressure reach their lowest
point
e) The overall decrease in diastolic blood pressure and mean arterial pressure is 5-10 mmHg.

4- An increased capacity of the venous system during pregnancy lead to (all true except one)

a) reduces blood flow

b) Increases the absorption of intramuscular medications
c) delaying the absorption of subcutaneous drugs.
d) increases the risk of vascular damage and bleeding during neuraxial blockade
e) reduces the required number of local anesthetics by 30%.

5- Anesthetic considerations due to respiratory changes during pregnancy (all true except one)

a) Be very gentle during laryngoscopy

b) should be pre-oxygenated with 100% O2 before induction.
c) A larger endotracheal tube may be required for intubation due to swollen tissue.
d) Hypoxia occurs due to increased oxygen consumption and decreased FRC.
e) Ensure the patient is positioned optimally for laryngoscopy.

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6- Regarding anesthesia for pregnant lady (all true except one)

a) Pregnant lady should be considered to have “full stomachs”, regardless of fasting.

b) Reduces the dose of inhaled anesthetics by up to 40%.
c) Cricoid pressure should not be released until it is confirmed that the endotracheal tube has been
placed in the trachea.
d) Do not routinely administer positive pressure ventilation, with a mask, before intubation.
e) A non-particulate antacid and Metoclopramide given before anesthesia to decrease lower
esophageal sphincter tone.

7- The highest blood volume in :

a) adult
b) Neonate
c) Infant
d) Premature
e) 5 years child

8- Cardiac output in the pediatric patient is dependent on :

a) Heart rate
b) Blood pressure
c) Respiratory rate
d) Mean arterial pressure
e) None of the above

9- Which one is true regarding the anatomical differences in the pediatric airway compared to an adult ?

a) Larger tongue and higher larynx

b) Smaller head and longer neck
c) Longer trachea and smaller epiglottis
d) Larger neck and U-shaped epiglottis
e) Smaller tongue and low larynx

10- Four years,10kg child with pulse rate equal to 70 b/min admitted to operating room for tonsillectomy
which one is true

a) Total blood volume is 1000ml

b) The correct size of endotracheal tube (ID) is 6mm
c) The depth of endotracheal insertion is 18cm
d) The dose of succinylcholine is 100mg intravenously
e) The child is bradycardic

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11- The duration of action of nondepolarizing muscle relaxant may be prolonged in infant due to

a) Immature neuromuscular junction

b) Immature renal and hepatic system
c) Immature BBB
d) Higher metabolic rate
e) Low metabolic rate

12- Renal system in pediatric (all true except one)

a) Decreased GFR at birth

b) Decreased sodium excretion at birth
c) Increased concentrating ability at birth
d) GFR reaches adult level after one year
e) ECF volume in infant is twice that of an adult

13- Temperature regulation in infant and neonate (all true except one)
a) Neonates and infants can rapidly lose heat even in warm environment
b) They are at greater risk for hypothermia due to low metabolic rate
c) Infants less than 3 months do not shiver to generate heat.
d) Monitoring the patients’ temperature before, during and after anesthesia
e) Steps to minimize heat loss include a warm operating room or warm blanket

14- Prayer sign in diabetic patient means :

a) Good control of blood sugar

b) Risk of hypoglycemia
c) Decreased epidural space compliance
d) Easy intubation
e) All the above

15- All the following are decreased in elderly except one :

a) MAC
b) Total body water.
c) Circulation level of drugs binding proteins.
d) Adipose to lean muscle ratio.
e) Muscle blood flow.

16- Risk factors for postoperative pneumonia in elderly include (all true except one)
a) history of stroke.
b) Weight loss of less than 10% in previous 6 months
c) underlying lung disease.
d) long-term steroid use
e) inability to carry out the activities of daily living

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17- anesthetic plan for elderly patient (all true except one)
a) anesthetic technique is based on patient choice and anesthesiologist experiencing
b) analgesia may be challenging due to pharmacokinetic and pharmacodynamics changes.
c) MAC for inhalational agents is increases with age, about 4% per decade after 40 years of age.
d) Risk of post operative delirium.
e) prolong the action of some relaxants.

18- All the following are risk factors for delirium postoperatively in elderly except one
a) Visual impairment.
b) Underlying dementia
c) Alcohol abuse
d) Elevated hemoglobin level
e) Advance age.

19- What happens to the volume of distribution of lipophilic drugs in geriatric patients ?

a) It decreases
b) It increases
c) It remains the same
d) It varies depending on the drug
e) All the above

20- All the following can complicate pain assessment in geriatric patient except one

a) Dementia
b) Delirium
c) problems with hearing
d) Problems with vision
e) Weight of the patient

21- Treatment of post operative delirium in geriatric (all true except one)

a) Start with treating underlying cause

b) Diazepam has no role in treatment
c) Oral haloperidol for acute control is the preferred treatment
d) Droperidol is used with good result
e) Chlorpromazine is used with good result

22- Poor glucose control in elderly patient prepared for surgery (blood sugar higher than 200 mg/dL) is
associated with
a) Risk of aspiration
b) Poor wound healing
c) Cardiac and cerebral events
d) Autonomic dysfunction
e) All the above

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23- All the following are positive effects of ketamine on respiratory system except one

a) Reduction in bronchial smooth muscle tone

b) Maintain patent airway.
c) Less respiratory depression
d) Anti-tussive.
e) Preserved laryngeal reflexes.

24- All the following methods used to decrease the effect of anesthesia on respiratory system except one
a) Oxygen can be continued into the postoperative period in patients at risk of hypoxia.
b) Atropine and glycopyrrolate given before induction reduce the quantity of saliva in the airway.
c) Head down position before induction helps to reduce the fall in the FRC.
d) Positive end-expiratory pressure (PEEP) helps to maintain alveolar patency and prevent hypoxia.
e) In obese patients, extubation onto a CPAP mask may prevent airway collapse and atelectasis.

25- All the following anesthetic drugs cause a dose-dependent reduction in minute ventilation except one
a) Nitrous oxide.
b) Propofol
c) Thiopental
d) etomidate.
e) Isoflurane.

26- Anesthesia affects gas exchange by (all true except one)

a) Change in FRC
b) Change in ventilation.
c) Change in perfusion.
d) Hypoxic pulmonary vasoconstriction.
e) Duration of anesthesia

27- Which induction agent causes respiratory depression and increased bronchospasm ?

a) Thiopentone
b) Propofol
c) Ketamine
d) All the above
e) None of the above

28- The adult trachea bifurcates into right and left bronchi at

a) Second thoracic spine

b) Third thoracic spine
c) Fourth thoracic spine
d) Fifth thoracic spine
e) Six thoracic spines

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29- What is the best method for verifying tube placement?

a) Auscultation of the stomach

b) Waveform EtCO2 with numeric reading
c) Esophageal detector device
d) Rising or stable O2 saturation
e) Movement of the chest with respiration

30- Regarding airway assessment for difficult intubation (Which one is true)

a) Class I and II difficult to intubate.

b) Thyromental distance more than 4.5cm.
c) Mallampati Class III: The only hard palate is visible.
d) For mallampati score patient in sitting position
e) Normal Interincisor gab: >6 cm.

31- Unanticipated difficult intubation (which one is true)

a) Allow up to 2 intubation attempts if SPO2 permit
b) Attempts 4 LMA insertion.
c) Maximize laryngeal view by extension of the neck.
d) Maximize laryngeal view by head flexion.
e) Consider long or straight blade

32- Causes of hypoxia under general anesthesia (all true except one)

a) Pneumothorax.
b) High spinal.
c) Anaphylaxis.
d) adequate reversal of muscle relaxant
e) Drugs like opioids

33- Management of hypoxia during anesthesia (all true except one)

a) Hypoxia under GA means SPO2 less than 98%

b) Check position of tracheal tube
c) Reposition of probe of oximeter.
d) Check blood pressure.
e) Fluid replacement.
34- Hypocapnia (which one is true)

a) occurs when levels of O2 in the blood less than 35mmHg

b) Also called hypocalcemia
c) Caused by hypoventilation.
d) Increased risk of coronary artery vasospasm
e) increased ICP.

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35- Physiological effects of hypercapnia (all true except one)

a) systemic hypertension
b) Hypotension in very high PaCO2
c) respiratory alkalosis
d) bronchodilation
e) Hyperkalemia.

36- For renal surgery in patient with renal disease (all true except one)
a) general anesthesia with positive pressure ventilation using muscle relaxation is recommended.
b) Rapid sequence intubation is preferred in patients with chronic renal failure.
c) The induction agent of choice in renal disease is Propofol
d) A limb with an arteriovenous fistula must be used for intravenous infusions
e) Atracurium is the preferred muscle relaxant

37- Systemic effects of renal failure (all true except one)

a) Fluid overload.
b) Hypokalemia.
c) Hypertension.
d) Atherosclerosis.
e) Coagulopathy.

38- Functions of kidney (all true except one)

a) Regulation of sodium in the blood
b) Regulation of blood volume
c) Regulation of blood pH
d) Detoxification of drugs
e) production of Renin

39- Anemia in patient with liver disease may be secondary to (all true except one)
a) Blood loss
b) Hemolysis
c) Bone marrow depression
d) Nutritional deficiency
e) Low albumin level

40- The liver receives ……………. of cardiac output

a) 10%
b) 15%
c) 20%
d) 25%
e) 50%

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41- Severe pre-eclampsia (which one is true)
a) Systolic blood pressure less than 170 mmHg or diastolic blood pressure less than 110 mmHg
b) is a multisystem disease which results from impaired trophoblast cell invasion during late
development of the fetus
c) First line management for hypertension is magnesium
d) Associated with proteinuria
e) associated with thrombocytosis

42- Risk factors of aspiration under general anesthesia (all true except one)
a) Full stomach
b) delayed emptying due to opioids
c) laparoscopic surgery
d) lithotomy position
e) Deep anesthesia

43- Associated symptoms with severe preeclampsia (all true except one)
a) Headache
b) visual disturbance
c) Vomiting
d) Papilledema
e) Spleen tenderness

44- Anesthetic management of patient with DM (all true except one)

a) They are not contraindicated for regional anesthesia in the diabetic patient
b) Aim for blood glucose intraoperatively between 180 and 200 mg/dl.
c) Oral hypoglycemics should be stopped before 24hrs.
d) Avoid severe hyperglycemia (over 250 mg/dl) to minimize dehydration and metabolic upset
e) Syndrome of stiff joints may occur and has been associated with difficult tracheal intubation

45- A postoperative glycemic range for diabetic patient in acute care setting is
a) 108 -180 mg/dl.
b) 140-180 mg/dl.
c) 72 mg/dl.
d) 80-100mg/dl.
e) 180-220mg/dl

46- Hypoglycemia during anesthesia (which one is true)

a) Means blood glucose less than 120 mg/dl
b) Exacerbated by excessive alcohol intake
c) Once detected give 1mg IM or IV of Glucagon
d) Not exacerbated by liver disease
e) The warning signs perioperatively is pallor, light-headedness, tachycardia and confusion

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47- Patient with ischemic heart disease. Which anesthetic drug should be avoided?

a) Clonidine,
b) Propofol.
c) Etomidate.
d) Ketamine.
e) Fentanyl.

48- risk factors for causing ischemia in recovery room (all true except one)

a) Anemia
b) hypoalbuminemia
c) Pain
d) Hypothermia
e) shivering

49- The Goldman Cardiac Risk Index for non-cardiac surgery includes all the following except one
a) history of ischemic heart disease
b) history of congestive cardiac failure
c) history of cerebrovascular disease
d) preoperative treatment with insulin
e) a raised serum sodium

50- eighty years man admitted to operating room for emergency laparotomy surgery, after history and
examination he had previous MI before 5 months and uncontrolled hypertension (Goldman Cardiac Risk
Index Score is
a) more than 25
b) more than 30
c) less than 25
d) less than 20
e) none of the above