Anesthesia

Question 1

What is the first step in managing tachycardia according to ACLS?
A) Start antiarrhythmic infusion immediately
B) Assess patient stability (symptomatic vs. stable)
C) Give synchronized cardioversion
D) Start chest compressions

Answer 1

Answer: B) Assess patient stability (symptomatic vs. stable)

Question 2

In the ACLS algorithm, what is considered “unstable tachycardia”?
A) HR > 120 bpm
B) Chest pain, hypotension, altered mental status, signs of shock, acute heart failure
C) Palpitations only
D) HR > 200 bpm

Answer 2

Answer: B) Chest pain, hypotension, altered mental status, signs of shock, acute heart failure

Question 3

What is the treatment for unstable tachycardia?
A) Synchronized cardioversion
B) Adenosine
C) Amiodarone bolus
D) Observation only

Answer 3

Answer: A) Synchronized cardioversion

Question 4

4. For stable narrow-complex tachycardia (SVT), what is the first medication used after vagal maneuvers?
   A) Amiodarone
   B) Lidocaine
   C) Adenosine (6 mg rapid IV push, then 12 mg if needed)
   D) Epinephrine

Answer 4

Answer: C) Adenosine (6 mg → 12 mg if needed)

Question 5

For stable wide-complex tachycardia (regular), what drug can be given?
A) Adenosine (may be considered if regular & monomorphic)
B) Amiodarone 150 mg IV over 10 min
C) Procainamide infusion

Answer 5

D) All of the above

Stable wide regular and monomorphic consider Adenosine first

Question 6

1. What is the correct compression-to-breath ratio for adult CPR in BLS?
   A) 15:2
   B) 30:2
   C) 5:1
   D) Continuous compressions only

Answer 6

Answer: B) 30:2 (for both 1- and 2-rescuer CPR)

Question 7

What is the recommended compression depth for adults during CPR?
A) At least 1 inch (2.5 cm)
B) At least 1.5 inches (4 cm)
C) At least 2 inches (5 cm), but not more than 2.4 inches (6 cm)
D) As deep as possible

Answer 7

Answer: C) At least 2 inches (5 cm), but not more than 2.4 inches (6 cm)

Question 8

3. What is the recommended compression rate for adults in CPR?
   A) 80–100/min
   B) 100–120/min
   C) 120–150/min
   D) >150/min

Answer 8

Answer: B) 100–120/min

Question 9

How often should rescuers switch roles to avoid fatigue in 2-rescuer adult CPR?
A) Every 1 minute
B) Every 2 minutes (about 5 cycles of 30:2)
C) Every 5 minutes
D) Only if one rescuer feels tired

Answer 9

Answer: B) Every 2 minutes (about 5 cycles)

Question 10

What is the compression-to-breath ratio for children and infants in 1-rescuer BLS CPR?
A) 15:2
B) 30:2
C) 5:1
D) Continuous compressions

Answer 10

Answer: B) 30:2

Question 11

6. What is the compression-to-breath ratio for children and infants in 2-rescuer BLS CPR?
   A) 15:2
   B) 30:2
   C) 5:1
   D) Continuous compressions

Answer 11

Answer: A) 15:2

Question 12

What is the recommended compression depth for children?
A) At least 1 inch (2.5 cm)
B) At least 2 inches (5 cm), but less than adult depth
C) At least one-third the AP diameter of the chest (~2 inches/5 cm)
D) At least 2.4 inches (6 cm)

Answer 12

Answer: C) At least one-third the AP diameter (~2 inches/5 cm)

Question 13

What is the recommended compression depth for infants?
A) At least 1 inch (2.5 cm)
B) At least 1.5 inches (4 cm)
C) At least one-third the AP diameter (~1.5 inches/4 cm)
D) Same as adults

Answer 13

Answer: C) At least one-third the AP diameter (~1.5 inches/4 cm)

Question 14

What is the preferred technique for infant compressions in 2-rescuer CPR?
A) One-hand heel compressions
B) Two-thumb–encircling hands technique
C) Two fingers on the sternum
D) Palm compressions like adults

Answer 14

Answer: B) Two-thumb–encircling hands technique

Question 15

Polymorphic Ventricular Tachycardia (VT) is most commonly associated with which condition?
A) Congenital long QT syndrome
B) Electrolyte disturbances (low Mg²⁺, K⁺)
C) Acute ischemia/MI
D) Brugada syndrome

Answer 15

Answer: C) Acute ischemia/MI
(But remember: torsades and other etiologies like electrolyte abnormalities, drugs, and congenital syndromes must also be considered.)

Question 16

Which statement correctly matches the etiology of polymorphic ventricular tachycardia (VT)?

A) Normal QT → most often due to congenital long QT syndrome
B) Prolonged QT → most often ischemia-related (acute MI)
C) Normal QT → most often ischemia-related (acute MI)
D) Prolonged QT → rarely due to electrolyte or drug causes

Answer 16

Answer: C) Normal QT → ischemia-related (acute MI).

📌 Board-style distinction:

Polymorphic VT with normal QT → often ischemia-related (acute MI).

Polymorphic VT with prolonged QT (torsades) → usually electrolyte/drug/congenital.

Question 17

What is the first-line treatment for torsades de pointes (polymorphic VT with prolonged QT)?

A) Amiodarone IV bolus
B) Procainamide infusion
C) IV Magnesium sulfate 1–2 g over 15 minutes
D) Synchronized cardioversion only

Answer 17

Answer: C) IV Magnesium sulfate 1–2 g over 15 minutes

Question 18

A patient develops stable AFib with RVR (HR 150) during IV sedation in your oral surgery office. BP is stable, patient is alert. What is the MOST appropriate first step?
A) Immediate synchronized cardioversion
B) Start amiodarone bolus and infusion
C) Stop the procedure, provide oxygen/monitoring, call EMS for transfer
D) Give IV diltiazem 20 mg bolus immediately

Answer 18

Answer: C) Stop the procedure, provide oxygen/monitoring, call EMS for transfer

Question 19

In the hospital/ACLS setting, what is the FIRST-LINE pharmacologic treatment for stable AFib with RVR?
A) Epinephrine 1 mg IV
B) IV metoprolol or IV diltiazem
C) Synchronized cardioversion
D) IV amiodarone as first-line

Answer 19

Answer: B) IV metoprolol or IV diltiazem

Question 20

What is the correct IV dosing for metoprolol in stable AFib with RVR (hospital setting)?
A) 1 mg IV every minute for 15 min
B) 2.5–5 mg IV over 2 min, may repeat q5 min up to 15 mg total
C) 10 mg IV bolus every 10 min, no max dose
D) Continuous infusion 5 mg/min until rate controlled

Answer 20

Answer: B) 2.5–5 mg IV over 2 min, may repeat q5 min up to 15 mg total

Question 21

What is the mechanism of action of Tranexamic Acid (TXA)?
A) Promotes platelet release of thromboxane A2
B) Directly converts fibrinogen to fibrin
C) Blocks conversion of plasminogen to plasmin, inhibiting fibrinolysis
D) Provides a scaffold for clot formation

Answer 21

Answer:
C) Blocks conversion of plasminogen to plasmin, inhibiting fibrinolysis

Question 22

Which hemostatic agent acts by providing a scaffold for platelet aggregation and clot formation?
A) Tranexamic Acid
B) Gelfoam (Absorbable Gelatin Sponge)
C) Surgicel (Oxidized Cellulose)
D) Collagen Plug

Answer 22

Answer:
B) Gelfoam (Absorbable Gelatin Sponge)

Question 23

Which topical agent achieves hemostasis by oxidizing hemoglobin, forming a brown/black artificial clot, and has mild bactericidal properties due to its low pH?
A) Surgicel (Oxidized Regenerated Cellulose)
B) Gelfoam
C) Tranexamic Acid
D) Epinephrine-soaked gauze

Answer 23

Answer:
A) Surgicel (Oxidized Regenerated Cellulose)

Question 24

Which absorbable local hemostatic agent is completely resorbed in about 4–6 weeks?
A) Tranexamic Acid
B) Gelfoam
C) Surgicel
D) Bone wax

Answer 24

Answer:
B) Gelfoam

Question 25

Which local hemostatic material is typically absorbed in 1–2 weeks and has mild antimicrobial action? A) Gelfoam B) Surgicel C) Collagen plug D) Tranexamic Acid

Answer 25

Answer: B) Surgicel

Question 26

How does the Larson maneuver (laryngospasm notch maneuver) relieve laryngospasm? A) Directly abducts the vocal cords mechanically B) Stimulates pain receptors → triggers reflex neural pathways → relaxes vocal cords → spasm breaks in a few breaths C) Compresses the cricoid cartilage to prevent airway collapse D) Provides forward displacement of mandible to open the airway

Answer 26

Answer: B) Stimulates pain receptors → triggers reflex neural pathways → relaxes vocal cords → spasm breaks in a few breaths

Question 27

What is the Larson maneuver and how does it work? A) Firm pressure over the cricoid cartilage to prevent gastric aspiration during intubation B) Backward, upward, and rightward pressure on the thyroid cartilage to improve the glottic view during laryngoscopy C) Firm, painful pressure applied to the “laryngospasm notch” (between earlobe, mastoid process, and angle of mandible) to break laryngospasm D) Bilateral jaw thrust to mechanically open the airway

Answer 27

Answer: C) Firm, painful pressure applied to the “laryngospasm notch” (between earlobe, mastoid process, and angle of mandible) to break laryngospasm

Question 28

What component of the non-rebreather mask prevents inhalation of exhaled gases? A. Venturi valve B. One-way valves on the side ports and reservoir bag C. Nasal prongs D. Nebulizer attachment

Answer 28

✅ Answer: B. One-way valves

Question 29

What FiO₂ (fraction of inspired oxygen) can a non-rebreather mask deliver? A. 21% B. 40–60% C. 60–80% D. 90–100%

Answer 29

✅ Answer: D. 90–100% (depending on fit and oxygen flow)

Question 30

What oxygen flow rate is typically required for a non-rebreather mask to function properly? A. 1–2 L/min B. 3–5 L/min C. 6–8 L/min D. 10–15 L/min

Answer 30

✅ Answer: D. 10–15 L/min

Question 31

What component of the non-rebreather mask prevents inhalation of exhaled gases? A. Venturi valve B. One-way valves on the side ports and reservoir bag C. Nasal prongs D. Nebulizer attachment

Answer 31

✅ Answer: B. One-way valves

Question 32

In which clinical scenario would a non-rebreather mask be preferred? A. Stable COPD exacerbation B. Patient requiring low-flow oxygen supplementation C. Severe hypoxemia, shock, or trauma D. Long-term home oxygen therapy

Answer 32

✅ Answer: C. Severe hypoxemia, shock, or trauma

Question 33

What is a potential complication if the reservoir bag of a non-rebreather mask collapses completely during inspiration? A. Delivery of room air instead of high FiO₂ B. Excessive CO₂ removal C. Hyperinflation of lungs D. Barotrauma

Answer 33

✅ Answer: A. Delivery of room air instead of high FiO₂

Question 34

What is the initial IV/IO dose of adenosine for a 12-year-old weighing ~100 lbs (45 kg)? A. 0.05 mg/kg (max 3 mg) B. 0.1 mg/kg (max 6 mg) C. 0.2 mg/kg (max 12 mg) D. 0.3 mg/kg (max 18 mg)

Answer 34

✅ Answer: B — 0.1 mg/kg, maximum 6 mg. Since this patient is ≥50 kg, you can also follow adult dosing: 6 mg rapid IV push → may repeat with 12 mg if not effective. ⚠️ Key notes: Always give as a rapid IV push (1–2 seconds) followed immediately by a saline flush. Use a proximal IV site if possible. Continuous ECG monitoring is required during administration.

Question 35

What is the recommended IV bolus dose of labetalol in children (PALS)? A. 0.05–0.1 mg/kg IV over 1 min (max 5 mg) B. 0.2–1 mg/kg IV over 2 min (max 40 mg) C. 2–5 mg/kg IV over 5 min (max 100 mg) D. 1–2 mg/kg IV push (no max)

Answer 35

✅ Answer: B — 0.2–1 mg/kg IV over 2 minutes, max 40 mg per dose.

Question 35

Which of the following is the correct method of administration for adenosine? A. Slow IV push over 1 minute B. IM injection into the thigh C. Rapid IV push (1–2 sec) with immediate saline flush D. Oral tablet

Answer 35

✅ Answer: C — rapid IV push with immediate saline flush.

Question 36

What is the usual IV infusion range for labetalol in pediatric hypertensive emergencies? A. 0.01–0.05 mg/kg/hr B. 0.25–3 mg/kg/hr C. 5–10 mg/kg/hr D. Continuous infusion not recommended in children

Answer 36

✅ Answer: B — 0.25–3 mg/kg/hr.

Question 37

What is the maximum daily dose of labetalol in children? A. 100 mg/day B. 200 mg/day C. 300 mg/day D. No max, titrate to effect

Answer 37

✅ Answer: C — 300 mg/day.

Question 38

Which of the following is a contraindication for labetalol use in children? A. Hypertension B. Asthma or bronchospasm C. Anxiety D. Migraine

Answer 38

✅ Answer: B — Contraindicated in asthma, bradycardia, heart block, heart failure.