Block 13 Gen Anesthetics Dementia Weakness MCQ's
Questions and Answers
- 1.
A 14 year old patient visits the dentist for a scheduled removal of his wisdom teeth. The dentist notes removal of two of the wisdom teeth will require surgery. The oral surgeon plans to use an anesthetic with good analgesic and sedative properties but which does not cause relaxation of the skeletal muscles. Which is the drug the surgeon will most likely use?
- A.
Enflurane
- B.
Nitrous oxide
- C.
Isoflurane
- D.
Halothane
- E.
Thiopental
Correct Answer
B. Nitrous oxideExplanation
The dentist wants to use an anesthetic with good analgesic and sedative properties but without causing relaxation of the skeletal muscles. Nitrous oxide is commonly used for dental procedures as it provides both analgesic and sedative effects while not causing muscle relaxation. Enflurane, isoflurane, and halothane are inhalation anesthetics that can cause muscle relaxation. Thiopental is an intravenous anesthetic that does not provide analgesic properties. Therefore, nitrous oxide is the most likely drug the surgeon will use.Rate this question:
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- 2.
An 11 year old boy was severely burned after playing with fireworks and had to undergo a number of surgeries and multiple skin grafting procedures. To help him cope with the pain during the long recovery period he constantly received ketamine? Which of the following is an adverse reaction most associated “only” with this general anesthetic?
- A.
Hypotension and apnea
- B.
Nausea and vomiting
- C.
Sensitize heart to catecholamines
- D.
Malignant hyperthermia
- E.
Hallucination and delirium
- F.
Life threatening hepatitis
Correct Answer
E. Hallucination and deliriumExplanation
Ketamine is a dissociative anesthetic that can cause hallucinations and delirium as an adverse reaction. This is a known side effect of ketamine and is more commonly associated with its use compared to the other options listed. The other options, such as hypotension and apnea, nausea and vomiting, sensitizing the heart to catecholamines, malignant hyperthermia, and life-threatening hepatitis, are not typically associated with the use of ketamine.Rate this question:
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- 3.
Inhaled and intravenous anesthetics depress spontaneous and evoked activity of the neurons in many regions of the brain. Which of the following is the primary molecular target for some inhaled anesthetics, benzodiazepines, etomidate, and propofol?
- A.
NMDA receptor
- B.
5NT-1 Dopamine receptor
- C.
M2 receptor
- D.
Alpha 1- receptor
- E.
Site outside the Voltage-gated Na channels
- F.
GABA-A receptor sites
Correct Answer
F. GABA-A receptor sitesExplanation
Inhaled and intravenous anesthetics such as benzodiazepines, etomidate, and propofol primarily target the GABA-A receptor sites. These anesthetics work by enhancing the inhibitory effects of the neurotransmitter GABA (gamma-aminobutyric acid) on the GABA-A receptors. This leads to increased chloride ion influx into the neurons, causing hyperpolarization and suppression of neuronal activity. By targeting the GABA-A receptor sites, these anesthetics effectively depress spontaneous and evoked activity of neurons in various regions of the brain, resulting in anesthesia.Rate this question:
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- 4.
Which of the following general anesthetics is associated with the development of threatening hepatitis that involves reactive metabolites form previous exposure to anesthetic initiating an immune-mediated response?
- A.
Isoflurane
- B.
Desfluorane
- C.
Sevoflurane
- D.
Nitrous oxide
- E.
Halothane
Correct Answer
E. HalothaneExplanation
Halothane is the correct answer because it is associated with the development of threatening hepatitis that involves reactive metabolites from previous exposure to the anesthetic initiating an immune-mediated response. This condition is known as halothane-induced hepatitis and is characterized by liver inflammation and damage. It is believed to be caused by the formation of toxic metabolites during the metabolism of halothane, which then triggers an immune response leading to hepatitis. Other general anesthetics listed in the options do not have a similar association with the development of hepatitis.Rate this question:
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- 5.
Which of the following anesthetics produces: an increase coronary blood flow with decrease O2 consumption making it safe for use in patients with ischemic heart disease, causes less cerebral vasodilation making it ideal for neurosurgical procedures, but relaxes uterine muscle less ideal for labor or vaginal delivery. It is also less toxic to liver and has medium rate of onset and recovery.
- A.
Desfluorane
- B.
Sevoflurane
- C.
Halothane
- D.
Isoflurane
- E.
Enflurane
Correct Answer
D. IsofluraneExplanation
Isoflurane is the correct answer because it meets all the criteria mentioned in the question. It increases coronary blood flow while decreasing oxygen consumption, making it safe for use in patients with ischemic heart disease. It causes less cerebral vasodilation, making it ideal for neurosurgical procedures. However, it relaxes uterine muscle less, which makes it less ideal for labor or vaginal delivery. It is also less toxic to the liver and has a medium rate of onset and recovery.Rate this question:
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- 6.
In the manifestation of obstructed loop of vowel which general anesthetic should be avoided because it exchanges with nitrogen in any air-containing cavity in the body increasing the volume/pressure of cavity?
- A.
Propofol
- B.
Thiopental sodium
- C.
Halothane
- D.
Isoflurane
- E.
Nitrous oxide
Correct Answer
E. Nitrous oxideExplanation
Nitrous oxide should be avoided in the manifestation of an obstructed loop of bowel because it can exchange with nitrogen in any air-containing cavity in the body, leading to an increase in the volume and pressure of the cavity. This can exacerbate the obstruction and potentially cause further complications. Propofol, thiopental sodium, halothane, and isoflurane do not have this exchange effect with nitrogen and are therefore safer options in this scenario.Rate this question:
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- 7.
An autosomal dominant genetic disorder of skeletal muscle that occurs in susceptible individuals undergoing anesthesia with all halogenated anesthetics some of its characteristics are onset of tachycardia and hypertension with severe muscle rigidity, hyperthermia and hyperkalemia and hypercalcemia?
- A.
Myasthenia gravis
- B.
Halothane hepatitis
- C.
Malignant hyperthermia
- D.
Potential nephrotoxicity
- E.
Coronary steal
Correct Answer
C. Malignant hyperthermiaExplanation
Malignant hyperthermia is a correct answer because it is an autosomal dominant genetic disorder of skeletal muscle that can be triggered by the use of halogenated anesthetics. It is characterized by symptoms such as tachycardia, hypertension, severe muscle rigidity, hyperthermia, and imbalances in potassium and calcium levels. This condition can be life-threatening if not promptly treated.Rate this question:
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- 8.
A 32 year old man is taken to the emergency room after complaining that he is unable to walk. His symptoms begun 3 days earlier with “pins and needles” in both feet that gradually worsened and ascended to involve knees and the fingertips. He had difficulty maintaining proper control of the movements of his arms and feet. He reported the sensation of electric shocks through his legs and upon flexion of the neck, and has been unable to maintain an erection. The neurological examination showed hyperesthesia and hyperalgesia. He then confessed inhaling “two to three boxes of cartridges of it for the past three months.” The suspected drug most likely antagonizes the NMDA receptor also, which one is it?
- A.
Nitrous oxide
- B.
Ketamine
- C.
Propofol
- D.
Sevoflurane
- E.
Isoflurane
- F.
Nitric oxide
Correct Answer
A. Nitrous oxideExplanation
The correct answer is Nitrous oxide. The patient's symptoms of ascending numbness and tingling, difficulty with movement control, electric shock sensations, and erectile dysfunction are consistent with subacute combined degeneration of the spinal cord, which is caused by vitamin B12 deficiency. Nitrous oxide abuse can lead to vitamin B12 deficiency, as it inhibits the conversion of vitamin B12 to its active form. Nitrous oxide also antagonizes the NMDA receptor, which is involved in pain perception, explaining the hyperesthesia and hyperalgesia observed on neurological examination.Rate this question:
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- 9.
A 31 year old female presents with the following clinical manifestations which include fever, malaise, anorexia, nauseas, vomiting, jaundice, skin rash, liver tenderness. Fulminant hepatitis was present. Additional symptoms were elevated serum transaminases, alkaline phosphatase, bilirubin and eosinophilia. Liver transplantation was necessary due to the severity of the case. The manifestations begun 4 days after the patient had been exposed to an anesthetic. Which of the following is the most probable anesthetic that lead to this prognosis?
- A.
Nitrous oxide
- B.
Thiopental sodium
- C.
Halothane
- D.
Propofol
- E.
Ketamine
Correct Answer
C. HalothaneExplanation
The most probable anesthetic that led to this prognosis is Halothane. Halothane is known to cause drug-induced liver injury, which can manifest as fulminant hepatitis. The clinical manifestations described in the patient, such as fever, malaise, anorexia, nauseas, vomiting, jaundice, skin rash, liver tenderness, and elevated serum transaminases, alkaline phosphatase, bilirubin, and eosinophilia, are consistent with drug-induced liver injury. Additionally, the fact that the manifestations began 4 days after exposure to the anesthetic suggests a delayed hypersensitivity reaction, which is commonly associated with Halothane-induced liver injury.Rate this question:
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- 10.
A 65 year old man underwent open cholecystectomy. Anesthesia was induced with an intravenous anesthetic. He was then incubated and maintained with another anesthetic up to 1.5 % in a 1:1 mixture of nitrous oxide-oxygen. His blood pressure under the anesthesia was within normal limits and no respiratory complications were recorded. On the day postoperative he developed tachyapnea, tachycardia, and hypontesion. The second day he developed pain with fever and vomiting and a rise of liver enzymes transaminases and bilirubin to twice the normal limit. Patient tested negative for viral hepatitis. The most probable combination which caused these complications is?
- A.
Thiopentone first, nitrous oxide with propofol second
- B.
Thiopentone first, nitrous oxide with ketamine second
- C.
Thiopentone first, nitrous oxide with halothane second
- D.
Isoflurane first, nitrous oxide with thiopentone second
- E.
Halothane first, nitrous oxide with diazepam second
Correct Answer
C. Thiopentone first, nitrous oxide with halothane secondExplanation
The most probable combination that caused these complications is Thiopentone first, nitrous oxide with halothane second. This is because halothane is known to cause hepatotoxicity, which can lead to liver enzyme elevation and bilirubin rise. The symptoms of tachyapnea, tachycardia, hypotension, pain with fever, and vomiting are consistent with halothane-induced hepatotoxicity. The negative viral hepatitis test suggests that the liver complications are not due to viral infection. The use of thiopentone as the initial anesthetic and nitrous oxide as part of the maintenance anesthesia may have contributed to the overall effect, but halothane is the most likely cause of the liver complications.Rate this question:
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- 11.
While in the operating room a 48 year old diabetic man is exposed to an anesthetic agent. He suddenly develops the following: sustained muscle contraction resulting in signs of hypermetabolism, acidosis, tachycardia, hypercarbia, hypoxemia and heat production. Which of the following choices most likely the condition:
- A.
Halothane hepatitis
- B.
Conscious sedation
- C.
Malignant hyperthermia
- D.
Hyperglycemic shock
- E.
Metabolic syndrome
Correct Answer
C. Malignant hyperthermiaExplanation
The given symptoms of sustained muscle contraction, hypermetabolism, acidosis, tachycardia, hypercarbia, hypoxemia, and heat production are indicative of a condition known as malignant hyperthermia. Malignant hyperthermia is a potentially life-threatening reaction to certain medications, such as anesthetic agents, in individuals who are genetically predisposed. It is characterized by an abnormal release of calcium in the muscle cells, leading to the symptoms mentioned. This condition is particularly dangerous for individuals with diabetes as it can further complicate their metabolic status.Rate this question:
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- 12.
A 22-year old man is scheduled to undergo a laparoscopic hernia repair under general anesthesia. The patient seems very anxious in the preoperative area and a premedication administered parenterally is considered. Which of the following medications would be appropriate to prepare this patient for surgery?
- A.
Sevoflurane
- B.
Botulinum toxin
- C.
Baclofen
- D.
Naltrexone
- E.
Midazolam
Correct Answer
E. MidazolamExplanation
Midazolam would be an appropriate medication to prepare the anxious patient for surgery because it is a benzodiazepine with sedative and anxiolytic properties. It can be administered parenterally to induce sedation and reduce anxiety before surgery. This medication is commonly used in preoperative settings to help relax patients and facilitate a smooth transition into anesthesia. Sevoflurane is an inhalation anesthetic, botulinum toxin is used for muscle relaxation and treating certain medical conditions, baclofen is a muscle relaxant, and naltrexone is used for opioid addiction. None of these medications would be appropriate for premedication in this scenario.Rate this question:
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- 13.
A 14-year-old girl is admitted to an ambulatory surgery center for strabismus surgery to correct misalignment of her extra ocular muscles. She is otherwise healthy and all her laboratory values are within normal range. The surgery is anticipated to last approximately 90 minutes. An induction agent given intravenously is selected for procedure requiring general anesthesia. Which drug is it?
- A.
Desfluorane
- B.
Gabapentin
- C.
Cisatrocurium
- D.
Tramadol
- E.
Propofol
- F.
Etomidate
Correct Answer
E. PropofolExplanation
Propofol is the drug selected for the procedure requiring general anesthesia in this case. Propofol is commonly used as an induction agent for general anesthesia due to its rapid onset and short duration of action. It provides sedation and hypnosis, allowing for the patient to be unconscious and unaware during the surgery. It is administered intravenously and has a relatively fast onset of action, making it suitable for a 90-minute surgery. Additionally, the patient's age, health, and normal laboratory values indicate that propofol would be a safe and appropriate choice for anesthesia in this case.Rate this question:
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- 14.
A 72-year-old man is in need of repair of an abdominal aortic aneurism. Patient has a blood pressure of 165/100 mmHg, and his past medical history shows his hypertension has been poorly controlled with hydrochlorothiazide and propanolol taken daily. Patient also has angina that is occasionally treated with nitroglycerin. His EKG changes with moderate exercise. Patient arrives to the emergency department with complaints of serious back pain, two days before the scheduled surgery, and surgeon fears aneurism is leaking or expanding and decides to proceed with the surgery. Which of the following drugs would be best used for rapid anesthetic induction and maintenance?
- A.
Thiopental
- B.
Propofol
- C.
Etomidate
- D.
Ketamine
- E.
Halothane
Correct Answer
C. EtomidateExplanation
Etomidate would be the best drug for rapid anesthetic induction and maintenance in this case. The patient is scheduled for surgery to repair an abdominal aortic aneurysm, and there is concern that the aneurysm may be leaking or expanding due to the patient's sudden onset of serious back pain. Etomidate is a short-acting intravenous anesthetic that provides rapid and smooth induction of anesthesia, making it ideal for this situation. It has minimal effects on blood pressure and heart rate, which is important in a patient with poorly controlled hypertension and angina.Rate this question:
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- 15.
A 49-year-old woman underwent abdominal surgery to remove a colon cancer. The anesthesia was performed with thiopental, fentanyl and nitrous oxide. Which of the following adverse effects was the patient most likely to experience postoperatively?
- A.
Watery diarrhea
- B.
Malignant hyperthermia
- C.
Nausea and vomiting
- D.
Hallucinations
- E.
Strong pain
Correct Answer
C. Nausea and vomitingExplanation
After undergoing abdominal surgery, it is common for patients to experience nausea and vomiting as an adverse effect of anesthesia. Thiopental, fentanyl, and nitrous oxide are known to cause these side effects. Nausea and vomiting can occur due to the stimulation of the chemoreceptor trigger zone in the brain, leading to a sensation of queasiness and the urge to vomit. This is a common postoperative complication that can be managed with antiemetic medications. Watery diarrhea, malignant hyperthermia, hallucinations, and strong pain are less likely to be associated with the given anesthesia drugs and surgical procedure.Rate this question:
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- 16.
A 10-year-old boy diagnosed to have strabismus, for surgical correction, was anesthetized with halothane. Succinyl choline was administered to facilitate endotracheal intubation. Twenty minutes later masseter muscle tone remains increased so that his teeth compress the endotracheal tube. Even other skeletal muscle tone was found to be increased. His body temperature is 39 C (102.2 F), pulse is 125/minute and respiration rate is 20. In this situation which of the following skeletal muscle relaxant is used to treat this condition?
- A.
Centrally acting muscle relaxant
- B.
Non-depolarization blocker
- C.
Depolarization blocker
- D.
Raynodine receptor blocker
Correct Answer
D. Raynodine receptor blockerExplanation
In this situation, the increased muscle tone and other symptoms suggest malignant hyperthermia, which is a potentially life-threatening condition triggered by certain anesthetic agents, such as halothane, and succinylcholine. The correct answer, Raynodine receptor blocker, refers to dantrolene, which is the specific treatment for malignant hyperthermia. Dantrolene acts by blocking the ryanodine receptors in the sarcoplasmic reticulum, preventing the release of calcium ions and reducing muscle contraction. This helps to reverse the increased muscle tone and hypermetabolic state associated with malignant hyperthermia.Rate this question:
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- 17.
A 55 year old patient is seen in the ER having been found wandering around apparently lost in a shopping mall. His wife says that this problem has not happened before, although her husband has been having episodes where his memory fails. He seems well for a while then another episode happens. He never seems to recover completely and his condition is gradually worsening in almost a stepwise fashion. General neurological exam is normal. The most likely diagnosis is:
- A.
Vascular dementia
- B.
Frontotemporal dementia
- C.
Alcoholism
- D.
Alzheimer’s
- E.
PCA (posterior cerebral artery) stroke
Correct Answer
A. Vascular dementiaExplanation
The patient's symptoms of memory loss, gradual worsening of condition, and stepwise progression suggest a vascular etiology. The presence of episodes where his memory fails and his inability to fully recover further support the diagnosis of vascular dementia. The normal general neurological exam indicates that there is no focal neurological deficit, ruling out a stroke. Frontotemporal dementia typically presents with behavioral changes and personality alterations rather than memory loss. Alcoholism can cause cognitive impairment, but the stepwise progression and absence of other signs of alcoholism make it less likely. Alzheimer's disease typically presents with a more insidious onset and gradual decline rather than stepwise progression.Rate this question:
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- 18.
A 25-year-old College student noticed weakness while walking that developed over a couple of weeks. So he saw the doctor at the student health center. When asked by the doctor, he is not very clear when it started, but he thinks that the weakness is slowly getting worse and now he says the right arm is also getting weak. He says that the legs feel quite heavy and stiff all the time. He says he has no known illnesses. He smokes a packet of cigarettes a day and drinks about one or two beers a day. He does not use any other medications or recreational drugs. His father is a Hypertensive and his mother is a Diabetic. Both are healthy and on regular medication. So the doctor in the health center examined him and sent him to the City hospital. The Internist there examined him and found that he has a spastic paraparesis and there is wasting in the right hand. The student has no sensory loss anywhere and his bladder and bowel functions are good. So the Internist got a battery of Investigations done and found that all of them are normal, except an abnormal finding in the CSF analysis. What is the most probable CSF change that may be found in the disease he is suffering from?
- A.
Elevated level of Protein
- B.
Reduced level of Glucose
- C.
Elevated level of Chlorides
- D.
Elevated Leukocyte count
- E.
Reduced level of VEGF
Correct Answer
E. Reduced level of VEGFExplanation
The most probable CSF change that may be found in the disease the student is suffering from is a reduced level of VEGF. This is because the patient presents with symptoms of spastic paraparesis and wasting in the right hand, which suggests a neurological disorder. VEGF (vascular endothelial growth factor) is a protein that promotes the growth of new blood vessels and plays a crucial role in maintaining the health of nerve cells. A reduced level of VEGF in the CSF could indicate impaired neurovascular function, which could contribute to the development of the patient's symptoms.Rate this question:
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