SURGERY-ANESTHESIOLOGY

Dr. Elpidio D. Ole

1. With a vaporizer located within the circle breathing system, which of the
following will increase the anesthetic concentration within the breathing circuit?

____a. increased tidal volume

b. increased body temperature
c. increased inspired oxygen concentration
d. decreased humidity in the patient circuit
e. decreased rubber to gas solubility of the anesthetic

2. Concerning vaporizers located within the breathing circuit, which statement is

most accurate?

____a. They can only be used for anesthetics with low vapor pressure (eg,
methoxyflurane).
b. They can only be used for anesthetics with high vapor pressure (eg,
halothane).
c. They do not alter resistance to gas flow in the circuit.
d. They must be high-efficiency vaporizers.
e. As fresh gas flow to the circuit increases, the circuit anesthetic concentration
decreases.

3. Which of the following ensures unidirectional gas flow in a circle system?

____a. unidirectional flow of fresh gas into the circuit

b. pop-off valve that allows gas flow out of the circuit
c. resistance by soda lime
d. reduced pressure in the patient’s lungs
e. inspiratory and expiratory one-way valves

4. Which item is not a component of the breathing circuit in a circle anesthetic

system?

____a. rebreathing bag

b. exhaust (pop-off) valve
c. oxygen flush valve
d. Y piece
e. inspiratory and expiratory one-way valves

5. If the inspiratory unidirectional valve in a circle system patient breathing circuit

is assembled without the valve leaflet in place, what would be the result if the
machine were put into service?
____a. no untoward results because the other unidirectional valve would function
properly
b. anesthetic overdose
c. increased concentration of carbon dioxide in the inspired gas
d. increased resistance to breathing
e. no untoward results because the rebreathing hoses would still be in place.

6. The machine dead space of a circle system (the gas volume that must be
rebreathed at each breath containing carbon dioxide from the previous expired
breath) is comprised of:

____a. the area from the inspiratory valve to the endotracheal tube connection
b. the area from the Y piece connection to the endotracheal tube
c. the entire patient breathing circuit
d. the area from the soda lime canister to the endotracheal tube connection
e. the area from the expiratory valve to the endotracheal tube connection

7. Concerning soda lime and the carbon dioxide absorption canister, which
statement is least accurate?

____a. Unused soda lime is white before the patient is connected to the circuit.
b. Soda lime becomes blue or pink after prolonged service.
c. The soda lime canister becomes warm when in service.
d. The soda lime granules are easily crushed between one’s fingers when the
granules are exhausted.
e. The soda lime granules are easily crushed between one’s fingers when the
granules are unused.

8. If the soda lime in the breathing circuit becomes exhausted during an anesthetic
procedure, you would expect to observe:

____a. only an increased respiratory rate

b. only an increased depth of breathing
c. an increased heart rate and decreased blood pressure
d. an increased heart rate and increased blood pressure
e. no physiologic changes

9. Which of the following is not a component of an active waste gas scavenging

system?

____a. a pipe through an exterior building wall connected to the pop-off valve
b. a reservoir container
c. a positive-pressure relief valve
d. a negative-pressure relief valve
e. a short length of 19-mm (inside diameter) ducting tube connected from the
pop-off valve to a reservoir container
10. A problem within an anesthetic waste gas scavenging system that could be fatal
to the patient is:

____a. exhaustion of the activated charcoal canister

b. occlusion of the tubing from the pop-off valve to the scavenger
c. overfilling of the reservoir container with spillage out of the positive-pressure
relief valve
d. disconnection of the tubing from the pop-off valve
e. occlusion of the vacuum hose from the reservoir container

11. To check for gas leaks within the breathing circuit of a circle rebreathing
system,:

____a. the circuit must be immersed in a container of water

b. the gas flow into the circuit must be measured
c. the rebreathing hoses and bag must be disconnected
d. a functional in-circuit pressure gauge is necessary
e. resistance to collapse of the reservoir bag can be assessed manually

12. A rebreathing circle anesthetic system is described as “semi-closed” when:

____a. the oxygen flow meter is partly closed

b. gas flows out through the pop-off valve
c. the vaporizer is at a low setting
d. the pop-off valve is closed
e. the oxygen flow meter is completely closed

13. The exogenous heat generated by the reaction of soda lime with carbon dioxide
is dissipated in the circle system by:

____a. frequent changing of the canister

b. using breathing hoses 3 feet long
c. using high-moisture soda lime
d. placing an ice jacket around the canister
e. replacing the soda lime because it is exhausted

14. The efficiency of carbon dioxide absorption by a soda lime canister depends on
the:

____a. length of the canister

b. volume of soda lime used
c. amount of water vapor in the expired gases
d. resistance the soda lime offers to gas flow
e. volume and distribution of gas flowing through the canister
15. In a functional anesthetic circuit,:

____a. unidirectional in-circuit valves ensure movement of oxygen from the flow
meter to the precision vaporizer
b. the reservoir bag stores fresh anesthetic gas and must accommodate the
patient’s tidal volume
c. soda lime canisters help cool the warm gas expired by the patient
d. precision out-of-circuit vaporizers receive gas flow from the reservoir bag
e. oxygen tanks and flow meters are in the patient circuit portion of a circle
system

16. Nonrebreathing anesthetic circuits:

____a. are generally used in animals weighing less than 5 kg

b. have more resistance than circle systems
c. require lower fresh gas flows than circle systems
d. produce less waste anesthetic gas pollution than circle systems
e. cannot be used for patients requiring positive-pressure ventilation

17. A characteristic of the T piece or Norman elbow anesthetic delivery system is

that it:

____a. allows economical use of anesthetic gases and vapors

b. does not require a soda lime canister
c. requires low fresh oxygen flows
d. results in minimal environmental pollution
e. can be used for closed-circuit anesthesia

18. In a Bain’s nonrebreathing circuit, the flow of fresh oxygen should be:

____a. only sufficient to meet the animal’s oxygen requirement

b. approximately 30 ml/kg/minute
c. sufficient to prevent rebreathing of expired gases
d. able to fill the reservoir bag
e. low enough to prevent gas flow out through the pop-off valve

19. When using a nonrebreathing circuit and an out-of-circuit vaporizer, the

inspired concentration of anesthetic:

____a. changes slowly with vaporizer adjustments

b. is about 20-30% lower than the vaporizer setting
c. is about 20-30% higher than the vaporizer setting
d. is the same as the vaporizer setting
e. depends on the blood:gas solubility of the anesthetic agent
20. The minimum fresh oxygen flow required for a patient rebreathing from a circle
anesthetic system is:

____a. determined by the size of the reservoir bag

b. dependent on the location of the vaporizer
c. determined by the patient’s respiratory rate and volume
d. dependent on the volume of the anesthetic circuit
e. determined by the patient’s metabolic rate

21. A dog’s metabolic requirement for oxygen is calculated as:

____a. twice the volume of carbon dioxide produced

b. 30ml/kg/minute x body surface area
c. 200ml/kg/minute x body surface area
d. kg 0.75 x 10 ml/minute
e. kg 0.5 x 5 ml/minute

22. Which breathing system could be used for closed-system/low-flow anesthesia?

____a. circle rebreathing system

b. McGill breathing system
c. Ayres T piece
d. Norman elbow
e. Bain’s breathing circuit

23. A closed anesthetic circuit is characterized by:

____a. an in-circle vaporizer with no capability of absorbing carbon dioxide

b. a circle breathing circuit, with oxygen flow into the circle at 6 times the rate
of oxygen consumption
c. an in-circle or out-of-circle vaporizer, and a circle breathing system with
oxygen flow into the circle at a rate equal to oxygen consumption
d. any inhalation anesthetic system that effectively scavenges all waste
anesthetic gas
e. a fresh nitrous oxide:oxygen concentration ratio of 1:1

24. Which of the following is not an advantage of a closed anesthetic system?

____a. economical use of anesthetic agents

b. high humidity in the inspired gas
c. slow changes in anesthetic concentration
d. conservation of body heat
e. reduced anesthetic pollution
25. Which of the following is a disadvantage of tracheal intubation?

____a. connects the patient’s airway with the anesthetic circuit

b. prevents dilution of inspired anesthetic gases with room air
c. may decrease anatomic dead space
d. may increase mechanical dead space
e. facilitates positive-pressure ventilation

26. Concerning endotracheal tube diameter and the resistance to breathing, which
statement is most accurate?

____a. Resistance to breathing is unrelated to endotracheal tube diameter.

b. Resistance to breathing is markedly increased with increased length of the
endotracheal tube.
c. Resistance to breathing is only important when positive-pressure ventilation
is employed.
d. Resistance to breathing is proportional to the endotracheal tube’s radius4
(to the fourth power).
e. Small-diameter endotracheal tubes offer far less resistance to breathing
than large-diameter tubes.

27. Which of the following is not a reliable indication of successful intubation?

____a. condensation inside the tube with expiration

b. tube placement confirmed with a laryngoscope
c. no tube evident on palpation of the esophagus at the level of the larynx
d. movement of a piece of lint held at the tube end with expiration or
inspiration
e. chest wall movement upon manual compression of the reservoir bag

28. If you were to measure halothane concentration in a circle system during the
first 5 minutes of anesthesia, which of the following would be true?

____a. concentrations of expired halothane would be lower than concentrations of

inspired halothane
b. concentrations of expired halothane would be higher than concentrations of
inspired halothane
c. concentrations of inspired halothane would be higher than concentrations of
halothane in the vaporizer
d. concentrations of expired halothane would be equal to concentrations of
inspired halothane
e. concentrations of inspired halothane would be lower than the
concentrations of expired halothane
Questions 29 through 32

You are presented with a healthy, 1-year-old, 7-kg female Dachshund to be

anesthetized for elective ovariohysterectomy. You have premedicated the dog with
acepromazine, fentanyl and atropine, and induced anesthesia with thiopental. The
anesthetized dog is intubated and breathing spontaneously.

29. Which inhalation agent provides the most rapid recovery from anesthesia?

_____a. nitrous oxide

b. halothane
c. methoxyflurane
d. isoflurane
e. enflurane

30. Which breathing circuit and fresh gas flow rate are most appropriate for this
patient?

_____a. modified Ayres T piece with an oxygen flow rate of 2L/minute

b. circle absorber system with an in-circuit vaporizer and an oxygen flow rate
of 1L/minute
c. circle absorber system with an out-of-circuit vaporizer and an oxygen flow
rate of 250 ml/minute
d. Bain nonrebreathing circuit with an oxygen flow rate of 2.5 L/minute
e. Bain circuit with a low-flow technique, using an oxygen flow rate of
50ml/minute

31. After achieving an appropriate level of anesthesia, you consider reducing the
fresh gas flow to 100 ml/minute. What effect will this have?

_____a. this will not influence patient safety and is more economical
b. this will not affect the anesthetic level
c. this will lower the inspired oxygen concentration to hypoxic levels
d. this will raise the patient’s PaCO2
e. this will increase the anesthetic level

32. While the oxygen flow rate is low (100 ml/minute), the plane of anesthesia
becomes light. The dog begins ventilating rapidly, causing loops of intestine to
prolapse through the abdominal incision. The most appropriate course of action is
to:

_____a. increase the vaporizer setting by 1% for 5 minutes

b. administer a second intravenous dose of thiopental
c. increase the oxygen flow rate to 500 ml/minute and increase the vaporizer
setting by 1% for 5 minutes
d. compress the reservoir bag to empty it and increase the vaporizer setting by
 1% for 5 minutes
e. decrease the oxygen flow rate to 50 ml/minute and increase the vaporizer
setting by 3% for 10 minutes

33. Which of the following values is least likely to change when the depth of
anesthesia is changed?

_____a. blood pressure

b. expired concentration of carbon dioxide
c. jaw muscle tone
d. oxygen saturation of lingual tissues (pulse oximetry)
e. minute ventilation

34. In dogs, which of the following indicates a deep plane of anesthesia?

_____a. a brisk palpebral reflex, with the cornea covered by the third eyelid
b. a high respiratory rate, with deep breaths
c. a systolic blood pressure of 118 mm Hg and a strong pulse
d. pink mucous membranes and slight withdrawal of the limb upon pinching
of the toe
e. a dry visible cornea, with a dilated pupil

35. In horses, which of the following indicates a deep plane of anesthesia?

_____a. mean arterial pressure of 60 mm Hg, respiratory rate of 6/minute, corneal

reflex present
b. mean arterial pressure of 75 mm Hg, respiratory rate of 4/minute,
spontaneously closes eye
c. mean arterial pressure of 60 mm Hg, respiratory rate of 3/minute, periodic
nystagmus
d. mean arterial pressure of 76 mm Hg, respiratory rate of 6/minute, brisk
palpebral reflex
e. mean arterial pressure of 70 mm Hg, respiratory rate of 4/minute,
spontaneously closes eye, lacrimation

36. An esophageal stethoscope:

_____a. should be placed just cranial to the thoracic inlet

b. is useful for assessing cardiac function
c. should be positioned to auscultate the loudest heart and lung sounds
d. requires considerable technical training for competent use
e. should be placed just cranial to the esophageal sphincter

37. Bradycardia in anesthetized dogs and cats:

_____a. may be due to excessive vagal tone at light anesthetic levels

 b. may be caused by hyperthermia
c. results in inadequate ventricular filling in diastole
d. should always be treated with isoproterenol
e. is commonly observed with hypercapnia

38. During ovariectomy in a dog anesthetized with halothane, the heart rate drops
from 120 to 50 beats/minute. Which of the following is most appropriate for
treatment of bradycardia?

_____a. ketamine intravenously at 6-10 mg/kg

b. atropine intravenously at 0.01-0.02 mg/kg
c. epinephrine intravenously at 0.5-1.0 mg/kg
d. dopamine intravenously at 5-10 µg/kg/min
e. isoproterenol intravenously at 0.5-1.0 mg/kg

39. In cats, a heart rate of 30 beats/minute is considered dangerously low. When

used at recommended dosages, the drug most likely to cause bradycardia is:

_____a. thiopental
b. ketamine
c. xylazine
d. tiletamine-zolazepam
e. propofol

40. Tachycardia during anesthesia:

_____a. may be due to hyperkalemia

b. may be due to hypercapnia
c. should be treated with lidocaine
d. should be treated with isoproterenol
e. is a sign of deep anesthesia

41. Which drug is most likely to predispose to catecholamine-induced cardiac

arrhythmias?

_____a. acepromazine
b. methoxyflurane
c. ketamine
d. halothane
e. fentanyl

42. In dogs, premature ventricular contractions observed during anesthesia should

be treated:

_____a. if they are observed during intubation in a dog anesthetized with

thiopental
 b. when groups of 6 or more are frequently observed
c. if even a single premature ventricular contraction is observed during
ovariectomy
d. if the heart rate is 120 beats/minute
e. when single premature ventricular contractions are observed more than 3
times/minute

43. An appropriate drug to use in treatment of premature ventricular contractions

during anesthesia is:

______a. lidocaine
b. bupivacaine
c. xylazine
d. ephedrine
e. atropine

44. Palpation of the arterial pulse provides an indication of:

______a. systolic arterial pressure

b. mean arterial pressure
c. systolic and diastolic pressure
d. the difference between systolic and diastolic pressures
e. the difference between systolic pressure and no blood pressure

45. Arterial blood pressure:

______a. reflects only the amount of vasoconstriction present

b. may appear spuriously high if an overly wide cuff is used for indirect
measurement
c. is more accurately measured using the Doppler indirect method than
using an arterial catheter and pressure transducer
d. depends on cardiac output, total peripheral resistance and circulating
blood volume
e. indicates the adequacy of tissue perfusion

46. Which of the following is not used to detect the arterial pulse for indirect
determination of blood pressure?

______a. pulse oximetry

b. Doppler ultrasound
c. oscillometry
d. palpation
e. auscultation
47. Indirect blood pressure measurement techniques use a pneumatic cuff and a
method to detect pressure changes, sound or blood flow. As compared with direct
measurements of blood pressure via an arterial catheter, indirect methods:

_______a. are just as reliable and automated

b. accurately measure both systolic and diastolic pressures
c. accurately measure mean arterial pressure
d. are not influenced by the size of the cuff or the animal’s limb
e. are influenced by the animal’s position

48. When indirectly measuring blood pressure,:

_______a. a loose cuff yields more accurate readings than a snugly applied cuff
b. the cuff should be placed distal to the site of pulse palpation or
auscultation
c. the cuff width should be 30-40% of limb circumference
d. a loose cuff yields spuriously low readings
e. an overly narrow cuff yields spuriously low readings

49. In a laterally recumbent anesthetized dog, systolic arterial pressure is highest in

the:

_______a. aorta
b. carotid artery
c. renal artery
d. femoral artery
e. cranial tibial artery

50. If a transducer used to measure the blood pressure (eg, Doppler crystal, direct
pressure transducer, aneroid manometer is applied to an animal and located lower
than the level of the heart,:

_______a. the systolic and diastolic pressure readings will be spuriously high
b. the systolic and diastolic pressure readings will be spuriously low
c. the systolic and diastolic pressure readings will be accurate
d. only the diastolic pressure reading will be spuriously high
e. only the diastolic pressure reading will be spuriously low

51. Mean arterial pressure is:

_______a. equal to the pulse pressure

b. equal to diastolic pressure plus one-third of the difference between
systolic and diastolic pressures
c. the difference between the average systolic and diastolic pressures
d. not as important as systolic pressure
e. a measure of perfusion
52. An anesthetized animal would be considered hypotensive if the:

_______a. systolic arterial pressure were below 120 mm Hg

b. systolic arterial pressure were below 100 mm Hg
c. diastolic arterial pressure were below 80 mm Hg
d. diastolic arterial pressure were below 60 mm Hg
e. mean arterial pressure were below 60 mm Hg

53. Appropriate treatment for hypotension during inhalational anesthesia includes

any of the following except:

_______a. administration of a vasopressor (eg, dobutamine)

b. decreasing the concentration of inspired anesthetic
c. intravenous administration of boluses of fluid at 10-20 ml/kg
d. administration of a stimulant (eg, doxapram)
e. administration of a beta-adrenergic agonist (eg, dobutamine)

54. Cardiac output:

_______a. is the product of heart rate x arterial blood pressure

b. is increased by most general anesthetics
c. is increased by most inhalational anesthetics
d. may be monitored using the Doppler unit placed on a front or hind limb
e. may decrease with bradycardia

55. A drug with a positive inotropic effect:

_______a. increases the action of another drug

b. causes enzyme inhibition
c. increases the heart rate
d. increases the force of cardiac contractions
e. increases the plasma iron concentration

56. A vasoconstrictor drug that exerts little or no inotropic effect is:

_______a. epinephrine
b. ephedrine
c. isoproterenol
d. phenylephrine
e. dopamine

57. In small doses, dopamine:

_______a. dilates renal arteries

b. stimulates alpha receptors
 c. increases the heart rate
d. increases the respiratory rate
e. causes bradycardia

58. When administered for hemostasis in an animal anesthetized with halothane,

which drug is most likely to cause premature ventricular contractions?

_______a. epinephrine
b. phenylephrine
c. dopamine
d. dobutamine
e. ephedrine

59. The objective of administering a positive inotrope to a hypotensive anesthetized

animal is to:

_______a. increase the blood pressure

b. increase the heart rate
c. increase tissue perfusion
d. decrease hemoglobin saturation with oxygen
e. decrease production of carbon dioxide

60. Anatomic dead space:

_______a. cannot change during anesthesia
b. usually is greater than the tidal volume
c. can increase during anesthesia
d. is the same as mechanical dead space
e. decreases as the duration of anesthesia increases

61. Anatomic dead space includes the:

_______a. terminal bronchioles

b. respiratory bronchioles
c. alveolar ducts
d. alveolar sacs
e. alveoli

62. Which tidal volume (Vt) and respiratory rate produce the most ventilation?

_______a. Vt 160 ml, respiratory rate of 15/minute

b. Vt 250 ml, respiratory rate of 12/minute
c. Vt 400 ml, respiratory rate of 8/minute
d. Vt 160 ml, respiratory rate of 10/minute
e. Vt 250 ml, respiratory rate of 15/minute
63. An average tidal volume for a dog at a light anesthetic level is:

_______a. 200 ml/kg/breath

b. 12 ml/kg/breath
c. 30 ml/kg/breath
d. kg 0.75 x 10 ml/breath
e. 5 ml/kg/breath

64. The best indicator of adequacy of ventilation in anesthetized animals is:

_______a. respiratory rate

b. mucous membrane color
c. PaCO2
d. pH of arterial blood
e. tidal volume

65. The effect of increased arterial carbon dioxide levels in an otherwise normal
anesthetized animal is:

_______a. a decrease in respiratory rate

b. a decrease in respiratory depth
c. a sudden decrease in blood pressure
d. a sudden decrease in heart rate
e. injected mucous membranes

66. Lung compliance is a measure of:

_______a. the resistance to lung inflation by manual compression of the reservoir

bag
b. the amount of pressure required to inflate the lung
c. the difference in pressure between the ventilator and the rebreathing
circuit
d. the change in lung volume for each unit of transpulmonary pressure
change
e. end-inspiratory pressure indicated on the pressure gauge located in the
breathing circuit

67. Carbon dioxide acts on the heart by causing:

_______a. decreased cardiac output

b. increased cardiac output
c. decreased ventricular filling in diastole
d. increased venous return
e. decreased afterload
68. Concerning carbon dioxide, which statement is most accurate?

_______a. Gas inspired from an anesthetic breathing circuit does not normally
contain carbon dioxide.
b. Markedly increased arterial carbon dioxide levels increase the anesthetic
requirement.
c. Carbon dioxide is neutralized by soda lime in a Bain circuit.
d. Carbon dioxide levels cannot change without changing blood oxygen
levels.
e. Carbon dioxide is less soluble than oxygen and so levels are most likely to
increase in animals with interstitial lung disease.

69. An appropriate treatment to combat hypercapnia in anesthetized small animals

is:

_______a. ephedrine to stimulate ventilation

b. dobutamine to increase the heart rate
c. increased flow rate of oxygen
d. decreased anesthetic depth
e. addition of nitrous oxide to the inspired gas

70. During anesthesia, arterial carbon dioxide levels generally:

_______a. increase with increasing anesthetic depth

b. decrease with increasing anesthetic depth
c. are not influenced by anesthetic depth
d. increase as respiratory minute volume increases
e. decrease as arterial oxygen levels increase

71. In a nonanesthetized animal ventilating normally, you would expect the PaCO2
to be:

________a. approximately 25 mm Hg
b. approximately 40 mm Hg
c. approximately 55 mm Hg
d. twice the value of PaO2
e. half the value of PaO2

72. An increase in arterial carbon dioxide levels during anesthesia in an otherwise

healthy animal:

________a. decreases the plasma bicarbonate level below 20 mmol/L

b. increases the base excess above 3 mEq/L
c. has no effect on blood pH
d. increases the blood pH
e. decreases the blood pH
73. Hypoventilation during anesthesia:

________a. results in decreased arterial carbon dioxide levels

b. may result in hypoxemia if the patient is breathing room air
c. indicates arterial carbon dioxide levels of 25-30 mm Hg
d. does not affect oxygenation
e. results in a marked decrease in body temperature

74. Oxygenation of tissues depends upon the:

________a. oxygen-carrying capacity of the blood

b. saturation of hemoglobin
c. oxygen content of arterial blood and blood flow
d. body temperature
e. arterial oxygen level

75. Carbon dioxide crosses the alveolar membrane with greater ease than oxygen
because:

________a. of its greater density

b. of its greater solubility in plasma
c. the temperature in the lung is lower than in the rest of the body
d. of its greater diffusion coefficient
e. of its lesser viscosity

76. Primary variables of the hemoglobin-oxygen dissociation curve are:

________a. PaO2 and pH

b. PaCO2 and PaO2
c. PaO2 and hemoglobin saturation
d. hemoglobin saturation and PaCO2
e. PaCO2 and oxygen saturation

77. The position of the hemoglobin-oxygen dissociation curve is shifted to the left by:

________a. decreased blood pH

b. decreased body temperature
c. increased blood 2,3 diphosphoglycerate levels
d. increased arterial carbon dioxide levels
e. increased hemoglobin levels

78. Which of the following does not affect arterial oxygenation?

________a. inspired concentration of oxygen

b. cardiac output
c. minute ventilation
 d. atelectasis
e. blood pressure

79. In an otherwise normal anesthetized dog maintaining a normal body

temperature and blood pH, hemoglobin saturation falls below 90% when arterial
oxygen tension (PaO2 ) falls below:

________a. 60 mm Hg
b. 70 mm Hg
c. 80 mm Hg
d. 90 mm Hg
e. 100 mm Hg

80. In a spontaneously ventilating dog anesthetized with halothane delivered in

oxygen (30ml/kg/minute) using a circle anesthetic system, the PaO2 is likely to be:

________a. <50 mm Hg
b. <90 mm Hg
c. <120 mm Hg
d. >300 mm Hg
e. >600 mm Hg

81. Which arterial oxygen tension (PaO2 ) would markedly alter the arterial oxygen
content?

________a. 560 mm Hg
b. 300 mm Hg
c. 200 mm Hg
d. 140 mm Hg
e. 70 mm Hg

82. Which of the following is least likely to increase the tissue oxygen delivery in an
anesthetized horse breathing 90% oxygen and with a PaO2 of 65 mm Hg and a
PaCO2 of 45 mm Hg?

________a. a blood transfusion to raise the hemoglobin concentration by 20%

b. intravenous dobutamine infusion at 3µg/kg/minute
c. positive-pressure ventilation to reduce the PaCO2 to 40 mm Hg
d. a reduction in the alveolar halothane level from 1.8 to 1.1 volume %

e. intravenous administration of a bolus of fluid at 20 ml/kg and ephedrine

at 0.1mg/kg

83. A dog has a PaO2 of 80 mm Hg and a packed cell volume (PCV) of 17%.
Concerning the values in this dog, which statement is most accurate?
________a. These values are within normal limits.
b. The PCV is low, but it is unrelated to the arterial oxygen concentration.
c. The hemoglobin saturation is probably less than 90%.
d. Increasing the PaO2 to 160 mm Hg would double the arterial oxygen
concentration.
e. Increasing the PCV to 34% would double the arterial oxygen
concentration.

84. An anesthetized dog has a PaCO2 of 55 mm Hg and a PaO2 of 90 mm Hg. What

do these blood gas values indicate?

________a. hypoventilation
b. hyperventilation
c. hypoxemia
d. normal ventilation
e. hypocapnia

85. An anesthetized dog breathing 33% oxygen has a PaCO2 of 39 mm Hg, a PaO2 of
43 mm Hg and a blood pH of 7.39. What is the most appropriate course of action?

________a. increase blood carbon dioxide levels to create greater ventilatory drive
b. administer sodium bicarbonate intravenously
c. increase the flow rate of oxygen
d. replace the soda lime in the canister
e. continue with the procedure, as these values indicate no need for
changes in the anesthetic protocol

86. Which of the following is not an effect of carbon dioxide on the brain?

________a. increases cerebral blood flow

b. decreases neuronal activity
c. increases cerebrospinal fluid pressure
d. causes inert gas-like narcotic effect
e. decreases cerebral blood pressure

87. Intracranial pressure is not reduced by:

________a. drainage of cerebrospinal fluid

b. intravenous administration of mannitol at 0.25-1 g/kg
c. hyperventilation to a PaCO2 of 25-30 mm Hg
d. intravenous administration of dexamethasone sodium phosphate at
0.25-1 mg/kg
e. anesthetic induction with ketamine and maintenance with halothane
88. Concerning anesthesia of patients with liver disease, which statement is most
accurate?

________a. Hypoproteinemia may result in increased thiobarbiturate binding to

albumin.
b. Methoxyflurane is the inhalational anesthetic of choice.
c. Ascites due to hyperproteinemia may be a problem.
d. Isoflurane is the inhalational anesthetic of choice.
e. Parenteral anesthetics should not be administered.

89. During general anesthesia, urine formation and excretion are decreased by:

________a. increased vasopressin secretion

b. increased aldosterone secretion
c. decreased glucocorticoid secretion
d. decreased thyroid function
e. direct effects of the anesthetic agent on the renal tubules

90. The protein present in highest concentrations in blood is:

________a. albumin
b. globulin
c. hemoglobin
d. fibrinogen
e. transferrin

91. Which blood protein is primarily responsible for oncotic pressure?

________a. fibrinogen
b. albumin
c. globulin
d. hemoglobin
e. transferring

92. Intravenous infusion of lactated Ringer’s solution:

________a. should be used only in animals with subnormal blood pressure

b. should be given in amounts equal to the amount of blood lost
c. is needed only in the event of actual blood loss
d. should be avoided in patients with congestive heart failure
e. may reduce the plasma albumin concentration below 3.5 g/dl

93. An anesthetized dog has a packed cell volume of 34% and a total plasma protein
level of 2.9 g/dl. What is the most appropriate intravenous fluid to administer?
________a. balanced electrolyte solution
b. 5% dextrose in water
c. plasma
d. whole blood
e. hypertonic saline

94. Concerning intravenous fluid therapy during anesthesia, which statement is

most accurate?

_________a. The aim is to maintain intravascular and extravascular fluid volume at

a level that provides for optimal cardiovascular stability.
b. Third-space fluid loss refers to loss of fluid into the intracellular space.
c. Fluid therapy is commonly used during anesthesia of dogs and cats but
has little value in intraoperative management of large animals because
of their size.
d. Intravascular fluid deficit is characterized by such signs as a reduced
heart rate and increased arterial blood pressure.
e. Fluid should be administered at a maintenance rate of 3 ml/kg/hour.

95. Central venous pressure:

_________a. does not change with ventilatory excursions

b. cannot fall below zero
c. can be used to estimate blood pressure
d. is useful in monitoring the response to fluid therapy
e. measures blood flow in central veins

96. Hypothermia, a common complication of general anesthesia, particularly in

small animals, results is:

_________a. shivering during surgery

b. increased awareness to pain
c. increased blood pressure
d. decreased anesthetic requirement
e. hypoventilation

97. Hypothermia can cause any of the following except:

_________a. bradycardia
b. increased metabolic rate
c. decreased response to hypercapnia
d. decreased response to hypoxia
e. peripheral vasoconstriction

98. In general anesthesia of 10-week-old kittens,:

_________a. the anesthetic requirement (minimal alveolar concentration) for
halothane is almost 0
b. PaO2 is higher than in adults
c. it is usually necessary to increase the dosage of most premedicants
d. hypothermia is a common problem
e. the patients are easily intubated following intravenous injection of
thiopental

Questions 99 through 107

You are presented with an 8-year-old pregnant Boxer that has been in labor for 12
hours. The bitch has not delivered any pups, and ultrasonographic examination
reveals 1 pup positioned at the cervix and 2 other pups in the uterus. The bitch has
had some vulvar bleeding for 3 days. It is 3:00 in the morning and you must
anesthetize this dog for a cesarean section. The animal is somewhat distressed and
has pale but pink mucous membranes, a heart rate of 120 beats/minute, and bouts
of panting.

99. The dog is breathing room air, the packed cell volume is 28%, and the mucous
membranes are pale pink. The most likely finding in this patient is:

_________a. less than 81% saturation of hemoglobin

b. over 100% saturation of hemoglobin (normal)
c. over 92% saturation of hemoglobin, which would allow adequate
oxygenation of arterial blood
d. adequate saturation of hemoglobin but hypoxia associated with the low
packed cell volume
e. a PaO2 of 130 mm Hg

100. If this dog’s packed cell volume were 42% instead of 28%, one would expect
the:

_________a. hemoglobin saturation to be approximately 100%

b. arterial oxygen tension (PaO2 ) to increase by 50%
c. arterial oxygen tension (PaO2 ) to be over 105 mm Hg
d. increased packed cell volume to cause a 50% increase in arterial
oxygen content
e. arterial oxygen content to increase because of an increased PaO2

101. During your pre-anesthesia physical examination, the dog becomes further
distressed, and the heart rate increases to 160 beats/minute. A lead-II
electrocardiogram shows a regular pattern, with a P wave before all QRS
complexes. The most appropriate course of action is to:

_________a. premedicate the dog with a parasympatholytic (eg, atropine)

b. administer intravenous lidocaine to treat the ventricular tachycardia
 c. digitally compress the eyeballs during anesthetic induction to slow the
heart rate
d. premedicate the dog with an opioid (eg, oxymorphone), which will
produce sedation and may slow the heart rate
e. induce general anesthesia with intravenous thiopental as originally
planned, as these electrocardiographic findings are normal

102. You assume the pups are dead and consider inducing general anesthesia with
intravenous thiopental at 10mg/kg. Considering that this is an 8-year-old Boxer that
has been in labor for 12 hours, what is the most appropriate course of action?

_________a. give the calculated dose of thiopental and expect induction to take 10-
20 seconds
b. assume the dog is hypovolemic and has a low plasma protein level, and
give one-third of the calculated dose of thiopental and expect a slow
induction
c. increase the thiopental dose by one-third for very rapid induction so as
to prevent struggling
d. delay anesthesia and administer quinidine at 0.5 mg/kg by slow
intravenous infusion until the cardiac arrhythmia is resolved
e. thiopental for induction of anesthesia because of thiopental’s adverse
effects on fetuses and neonates

103. The dog has become well sedated from the premedicants. However, she is still
panting, her mucous membranes remain pale and the blood urea nitrogen level is
elevated. You decide that thiopental induction is a poor choice and instead induce
general anesthesia using an inhalation anesthetic with oxygen delivered via face
mask. The most appropriate agent to use is one with:

_________a. high blood solubility, such as isoflurane, to achieve rapid induction

b. low blood solubility, such as methoxyflurane, to achieve rapid
induction
c. high blood solubility, such as methoxyflurane, to achieve rapid
induction
d. low blood solubility, such as isoflurane, to achieve rapid induction
e. low blood solubility, such as nitrous oxide, to achieve slow induction

104. Concerning the speed of a mask induction in this patient, which statement is
most accurate?

_________a. Because this is an older and possibly hypovolemic dog that may have
poor cardiac function, mask induction may be relatively slow.
b. Induction of anesthesia can be facilitated by using a 5-L reservoir bag
instead of a 3-L bag on the anesthetic circuit.
c. Because this dog is pregnant, the anesthetic requirement is increased.
d. The volume within the anesthetic circuit and the rate of fresh oxygen
 flow do not affect the speed of mask induction.
e. Mask inductions are not appropriate for cesarean sections.

105. Which anesthetic technique is least likely to cause anesthesia-related depression

of the pups?

_________a. inhalational technique using isoflurane

b. parenteral technique using propofol
c. parenteral technique using fentanyl and diazepam
d. induction with intravenous ketamine and diazepam, and maintenance
with isoflurane
e. epidural technique using lidocaine

106. Surgery has commenced. During exteriorization of the uterus, the dog’s heart
rate decreases from 110 to 50 beats/minute. The blood pressure (110 mm Hg
systolic) and respiratory rate (16 beats/minute) do not change. What is the most
appropriate course of action?

_________a. no changes in the anesthetic regimen are necessary because this is a

normal heart rate in this clinical situation
b. decrease the vaporizer setting to reverse the bradycardia caused by
overly deep anesthesia
c. decrease traction on the uterus and administer atropine intravenously
at 0.01 mg/kg to reverse the vagus-mediated bradycardia
d. rapidly infuse lactated Ringer’s solution as an intravenous bolus at
5ml/kg and infuse dobutamine intravenously at 3µg/kg/minute to
reverse the bradycardia associated with hypovolemia and decreased
venous return from uterine traction
e. inject epinephrine intravenously at 0.1 mg/kg to reverse the
bradycardia associated with hypoxemia

107. You deliver 2 live pups and a dead pup via cesarean section. Concerning care of
the delivered pups, what is the most appropriate initial course of action?

_________a. try to revive the dead pup by catheterizing the cephalic vein and
infusing epinephrine while administering cardiopulmonary
resuscitation
b. catheterize the cephalic vein of the 2 live pups and infuse 5% dextrose
solution at 10 ml/kg to prevent hypoglycemia
c. place the 2 live pups in an enclosure on a warm-water blanket to
prevent hypothermia
d. try to revive the deeply anesthetized 2 live pups by nasal insufflation of
oxygen and intravenous infusion of lactated Ringer’s solution at
0.5ml/kg with added furosemide
e. euthanize the 2 live pups because they are likely to have sustained
serious brain damage associated with the dam’s hypoxemia and general
 anesthesia.
ANSWERS
SURGERY-ANESTHESIOLOGY

1. d- Premedication agents, such as atropine, are used to minimize undesirable

reflex autonomic activity.

2. d- Atropine acts by competitive antagonism of acetylcholine at muscarinic

receptors. This competition can be overcome by increasing the concentration of
acetylcholine at receptor sites (as seen following administration of
anticholinesterases).

3. a- Atropine stimulates the vagus center in the brain, which can slow the heart rate
initially in response to IV administration of small doses.

4. b- Glycopyrrolate causes less of an increase in heart rate than atropine.

5. e- A 10% solution = 10 g/100ml = 10,000 mg/100 ml = 100 mg/ml.

6. b- Phenothiazine tranquilizers are sympatholytic (cause vasodilation).

7. d

8. c- Acepromazine can cause persistent paraphimosis or priapism in adult intact

male horses. Working stallions are at more risk for these problems.

9. a

10. c- Guaifenesin causes muscle relaxation by its action on internuncial neurons in

the spinal cord. It has no recognized analgesic properties and so should not be used
as a sole agent for restraint for surgery.

11. a- Diazepam is a centrally acting muscle relaxant.

12. d- Overdosage of guaifenesin is associated with skeletal muscle rigidity, and

often cardiac arrest preceding respiratory arrest by several minutes. The
therapeutic dosage is 100 mg/kg.

13. c- 350 ml x 50 mg/ml = 17,500 mg/250 kg = 70 mg/kg.

14. e- Atracurium blocks postsynaptic acetylcholine receptors at the neuromuscular

junction, and so causes paralysis of the intercostal muscles and diaphragm.

15. b- Atracurium’s molecular stability depends on an alkaline pH and low

temperature. This method of limiting the drug’s action is known as Hoffman
elimination.
16. c- Succinylcholine is a depolarizing neuromuscular-blocking agent that initially
causes rigidity, tachycardia and hypertension. It has a short duration of action
because it is metabolized by plasma cholinesterase. Atracurium is a nondepolarizing
blocker and causes relaxation alone. Some muscle groups are more susceptible (eg,
extraocular and limb muscles) than others (eg, facial muscles, diaphragm), so
different doses are required to achieve equivalent relaxation.

17. a- Neostigmine inhibits acetylcholine esterase, causing increased levels of

acetylcholine at such receptors. This increases preganglionic muscarinic activity,
slowing the heart rate. Atropine (0.04 mg/kg IV) should be given immediately before
neostigmine.

18. d- These drugs are classified as alpha-2 adrenergic agonists.

19. b- Alpha-2 agonists cause second-degree atrioventricular block and bradycardia,

resulting in decreased cardiac output. Hyperglycemia, increased urine output and
increased intrauterine pressure also occur. Respiratory function is depressed due to
sedation.

20. a

21. c- Intravenous atropine rapidly antagonizes the xylazine-induced bradycardia.

An alpha-2 adrenergic antagonist, such as yohimbine, will only partially antagonize
the bradycardia and will decrease the sedative-analgesic (desirable) effects of
xylazine.

22. e

23. c- Pure opioid agonists exert their effects via agonism of mu opiate receptors.

24. d- Assuming the potency of morphine (mg/kg basis) is 1, the potency of fentanyl
is 100X, oxymorphone 10X, butorphanol 2X and meperidine 0.5-0.25X.

25. b- Naloxone (Narcan), a pure opioid antagonist, has no narcotic/agonistic effect

of its own.

26. c- Opioid mu agonists generally cause respiratory depression, especially after

intravenous or repeated intramuscular administration.

27. b- Opiates alter the perception of pain by the central nervous system. Human
patients may still be “aware” of the pain without being “in pain.”

28. b- In dogs, either oxymorphone or fentanyl is commonly given to allow

intubation. They are usually administered in combination with diazepam. The
induction is slow (2-5 minutes) and causes respiratory depression. Therefore, it
should be preceded by 5 minutes of pre-oxygenation via face mask.
29. d- Apart from bradycardia, there is minimal cardiac depression from
intravenous oxymorphone and fentanyl.

30. a- Nalorphine and naloxone are opioid antagonists and butorphanol is a partial
antagonist; therefore, all would combat the bradycardia. Atropine would also
combat bradycardia without antagonizing the desirable sedative or analgesic
properties of fentanyl.

31. c- Butorphanol is a mixed (kappa) agonist and (mu) antagonist, so is associated

with less respiratory depression.

32. c- Opioids can cause central nervous system stimulation in horses, especially if
administered intravenously and without other tranquilizers/sedatives.

33. b- Naloxone is a mu receptor antagonist that can reverse respiratory depression.

34. c- In healthy dogs, there is a high incidence (up to 40% of cases) of transient
ventricular arrhythmias following anesthetic induction with intravenous
thiobarbiturates. This does not usually cause clinical problems in healthy patients.

35. b- Thiobarbiturates owe their short duration of action to almost immediate

distribution from the plasma to well-perfused tissue, and then to fat depots.
Therefore, there is rapid recovery of consciousness after a single anesthetic dose.

36. a- Thiobarbiturates can produce prolonged recovery because of saturation of

muscle and fat storage depots and their subsequent release and slow metabolism
and elimination. Hypoproteinemia, dehydration, acidosis and hypothermia all
exacerbate this problem.

37. d- Thiobarbiturates decrease intracranial and intraocular pressure, and usually

cause no change or an increased heart rate.

38. d- Apnea is commonly seen following thiopental induction of anesthesia,

especially with a high inspired oxygen level. Giving 2-3 normal breaths per minute
ensures that the patient remains oxygenated, receives some halothane and allows the
arterial carbon dioxide to rise to a level sufficient to stimulate spontaneous
ventilation. If no halothane were administered, this dog would be awake in 10-15
minutes. Propofol also causes postinduction apnea.

39. e- Thiobarbiturates cause perivascular irritation and tissue sloughing, and are
associated with prolonged recovery in dehydrated, emaciated, hypoproteinemic
animals. They produce relatively good muscle relaxation at anesthetic doses.
40. d- Similar to thiobarbiturates, propofol depresses seizure activity, decreases
intraocular pressure, and causes muscle relaxation.

41. c- Hypotension can be observed following administration of propofol in healthy

patients. This effect is exacerbated by dehydration. Propofol does not directly alter
the heart rate or myocardial contractility.

42. a- Typically, propofol does not cause excitement in recovery. Patients are
quickly ambulatory and not ataxic. Recovery is due in part to rapid metabolism.

43. c- In the commercially available product, propofol is dissolved in a nonirritant

milky oil emulsion and can be given intramuscularly (requires large volume) as well
as intravenously. It is stable at room temperature but contains no preservative
agents.

44. d- Ketamine can be administered intramuscularly, though this causes pain.

45. a- Ketamine stimulates the cardiovascular system, increasing myocardial oxygen

consumption, and also increases intraocular and intracranial pressures.

46. b

47. d- Rapid induction of anesthesia and maintenance of laryngeal function are

desirable in brachycephalic dogs. In addition, a rapid recovery is desirable. Though
not producing the fastest induction and smoothest recovery (thiopental or propofol
would be better), ketamine would be acceptable.

48. c- Ketamine is a dissociative agent.

49. d- Sympathomimetics (eg, dopamine, dobutamine) are usually administered to

stimulate cardiovascular function.

50. b- Hypnotic agents include pentobarbital, thiopental, thiamylal, propofol and

chloral hydrate. Tiletamine is the dissociative agent in Telazol (tiletamine-
zolazepam).

51. e- A neuroleptanalgesic combination usually consists of a sedative/tranquilizer

(eg, acepromazine) and an opioid analgesic (eg, fentanyl).

52. a- Ketamine produces mild visceral analgesia in people.

53. d

54. b
55. e- The kidney is the major excretory organ for almost all sedative and hypnotic
drugs. Because they have high lipid solubility and are poorly ionized, they are
metabolized by the liver before excretion. Ketamine is excreted without metabolism
via the kidney in dogs and cats.
56. e

57. c- The epidural space is located immediately outside of the dura mater.

58. b- An appropriate dose of epidural local anesthetic produces excellent analgesia

and hind limb muscle paralysis/relaxation.

59. a- Bupivacaine produces both sensory and motor blockade of 2-3 times’ longer
duration than lidocaine or mepivacaine.

60. d- Epidural anesthetics should not be administered when there is trauma,

bleeding or infection at the injection site.

61. a- Preganglionic sympathetic blockade causes vasodilation in the anesthetized

region.

62. e- Local anesthetic analgesia persists approximately as long as muscle paralysis/

relaxation. The longest duration of effect is from bupivacaine, which lasts 4-6 hours.

63. b- Bupivacaine has the lowest placental transfer of any of the commonly used
local anesthetics agents. This is due to its high protein binding in maternal blood.

64. d- If the same dose as required for epidural anesthesia is administered into the
cerebrospinal fluid, the anesthetic will move far cranially and could cause
respiratory muscle paralysis.

65. a- In spinal anesthesia, the anesthetic agent is administered into the

cerebrospinal fluid, which circulates in the subarachnoid space.

66. c

67. b- Giving the same dose as a spinal injection that was calculated for epidural
administration would produce excellent analgesia and incur no more risk of adverse
effects (as compared with epidural administration). This is not the situation for local
anesthetics administered into the cerebrospinal fluid.

68. e- Epidural drugs are also occasionally administered into the cerebrospinal fluid
and so should be preservative fee. Though the volume of drug administered
epidurally is important (hence the different concentrations), this is not the only
reason that the solution is packaged in a vial.
69. b- Epidural morphine reduces the anesthetic requirement to produce analgesia
in the hind limbs, and also to a lesser extent in the forelimbs.

70. a- Isoflurane causes respiratory depression in dogs and horses, is relatively less
arrhythmogenic, and is excreted virtually unchanged. It is one-sixth as potent as
methoxyflurane and two-thirds as potent as halothane.

71. d- The anesthetic requirement is reduced by increasing age, hypothermia,

concurrent use of other central nervous system depressants and pregnancy.

72. d- MAC values for these anesthetics in dogs: 0.9 volume % for halothane, 215
volume % for nitrous oxide and 1.4 volume % for isoflurane, versus 0.23 volume %
for methoxyflurane. Propofol is not an inhalational anesthetic agent.

73. c- Mask inductions are slow (undesirable if rapid airway control is desirable),
with speed of induction dependent on drug solubility (insoluble agents produce
faster induction) and ventilation (hyperventilation produces faster induction). Mask
induction can be expensive, especially with isoflurane (about $5 for induction in a
dog).

74. d- Highly soluble agents (eg, methoxyflurane) have slow equilibration times and,
therefore, slow induction and recovery times.

75. c- About 50% of an inhaled dose of methoxyflurane and 25% of a dose of

halothane are metabolized. Other agents have minimal metabolism.

76. d- In decreasing order of the likelihood of arrhythmogenesis: halothane >

methoxyflurane > isoflurane, desflurane and nitrous oxide.

77. c- Dose-dependent ventilatory and cardiovascular depression occurs.

Respiratory depression increases arterial carbon dioxide tension.

78. c- The minimum alveolar concentration (MAC) of nitrous oxide in dogs is

approximately 215 volume%, so under normal conditions (1 atmosphere of
pressure), it cannot alone produce anesthesia.

79. b- Nitrogen oxide is the most insoluble of the commonly used inhalation agents.

80. d- 1. 3 -1.5 times the MAC (0.23 volume %) produces a surgical plane of
anesthesia.

81. c- Fluoride ions produced by metabolism of methoxyflurane are nephrotoxic.

82. c- When nitrous oxide is given with halothane, the peak blood concentration of
halothane is attained more rapidly than if halothane were used alone. Concurrent
use of nitrous oxide causes halothane to be taken up at an accelerated rate, known
as the second-gas effect. Answer b describes diffusion hypoxia.

83. c- The greater an agent’s alveolar concentration, the more rapid is its
absorption. Uptake is also dependent on blood solubility. An anesthetic that is very
soluble is rapidly taken up by the blood. Cardiac output determines the blood flow
through the lungs and therefore the quantity absorbed. The correct ratio of inspired
air to lung perfusion (ventilation/perfusion ratio) ensures optimal anesthetic uptake.

84. c- The ideal agent, producing rapid induction and recovery, would have low
blood solubility and low lipid solubility, rapidly achieving equilibrium (partial
pressure) between gas, blood and tissue phases/compartments. Solubility is an index
of the capacity of the blood or tissue to retain anesthetic.

85. b- A small amount of vapor entering tissue in which the agent is not soluble
causes a high vapor tension. Therefore, during anesthetic recovery, arterial and
brain concentrations drop to negligible levels within minutes and the patient
awakens rapidly.

86. c

87. b- The duration of anesthesia determines the saturation level of body tissues.
Anesthetics that are highly soluble in fatty tissues take longer to be expelled from
the tissues. If pulmonary blood flow or ventilation is inadequate, inhalation agents
cannot be cleared through the lungs and recovery is delayed. If the agent is highly
soluble in the blood, it is not removed quickly. An example is methoxyflurane, which
is highly soluble in blood and has a long recovery period.

88. d- Up to 20% of the inhaled dose of halothane is metabolized. Isoflurane causes

more respiratory depression in dogs and horses. Methoxyflurane and isoflurane are
arrhythmogenic, though significantly less so than halothane. Halothane is by far the
cheapest commonly used inhalation agent.

89. a- Painful stimulation of lightly anesthetized patients causes catecholamine

release, which can lead to ventricular arrhythmias in halothane-anesthetized
patients. The increasing anesthetic depth can eliminate these arrhythmias.

90. b- 5 ml halothane/500 ml 02 (per minute) = 1% vaporizer setting. 5ml halothane/

120ml 02 (per minute) = 4.2% vaporizer setting. Each setting would result in a
similar anesthetic depth. This illustrates the importance of fresh gas flow in
determining anesthetic delivery to the circuit.

91. d- With in-circuit vaporizers, output is dependent on ventilation (increases with

increasing ventilation). In-circuit vaporizers are of simple “flow over liquid” design,
and generally use less anesthetic than out-of-circuit (precision) vaporizers. The
vapor pressure of halothane at 20 C is 243 mm Hg. At sea level (760 mm Hg),
243/760 = 32%, which means a 32% concentration of halothane can be achieved.
There is a similar situation for isoflurane. Out-of-circuit precision vaporizers only
deliver a 5% maximum for these agents.
92. d- Uptake of anesthetic is improved with increased ventilation. The
“centralized” circulation of neonates ensures rapid delivery of anesthetic to the
brain.

93. d- Halothane markedly lowers the arrhythmogenic dose of epinephrine in dogs.

94. e- Nitrous oxide is a liquid when stored under pressure at room temperature.
Halothane is a vapor, not a gas, and therefore is not stored under pressure. Gases
that can be liquefied at room temperature are purchased by weight. Pressure is an
accurate index of quantity for nonliquefiable compressed gases.

95. b

96. c- The pressure in the cylinder begins to drop when all of the liquid nitrous oxide
has been vaporized and the gas loses pressure. Cylinders must be watched
thereafter for rapid emptying. Another cause of decreased pressure is chilling of the
cylinder.

97. a- All except oxygen are liquefied at room temperature under pressure. As such,
they are safely handled as liquids in cylinders.

98. c- Gas cylinders for various agents are identified by a unique color, thread size
and thread diameter. “E” cylinders also have a pin index combination.

99. a- The emergency oxygen flush valve bypasses the vaporizer to deliver only
oxygen to the circuit. It should be used to fill the circuit as part of the preanesthetic
“pressure check” before all anesthetic procedures.

100. b
 ANSWERS
SURGERY-ANESTHESIOLOGY

1. a- Increased ventilation increases the anesthetic concentration within the circuit.

2. e- With in-circuit vaporizers, increasing fresh gas flow “washes” anesthetic out
through the pop-off valve, decreasing the concentration within the circuit.

3. e- Both one-way valves must be patent to ensure unidirectional gas flow.

4. c- The oxygen flush valve is located between the source of compressed oxygen and
the fresh gas inlet of the circuit.

5. c- Without a patent inspiratory valve, exhaled gas would move into the
inspiratory side of the rebreathing hose, so the patient would inspire gas containing
carbon dioxide.

6. b- If the one-way valves are patent, there is unidirectional gas flow from the Y
piece connector.

7. d- Soda lime granules become harder when they are exhausted.

8. d- Hypercapnia results in sympathetic nervous system stimulation.

9. a

10. b- Occlusion of the tubing from the pop-off valve to the scavenger would cause
pressure in the breathing circuit to increase.

11. d- To check the circuit for leaks, it should be pressurized to 20-30 cm H2O, and
the manometer observed for 1 minute for pressure change. A pressure decrease
indicates a leak.

12. b- If the pop-off valve were closed, pressure would increase. It is possible to close
the pop-off valve in a low-flow system where the oxygen flow equals the patient’s
oxygen consumption (a closed circuit).

13. b

14. e- Theoretically, the volume of the soda lime container should be at least twice
the patient’s tidal volume.
15. b- The reservoir bag is the compliant (collapsible) part of the circuit and usually
should have a volume of about 5 times the patient’s tidal volume (approximately the
functional residual capacity).

16. a- These circuits require high fresh gas flows and so are not economical for
larger patients.

17. b- Both are examples of nonrebreathing circuits, so high fresh gas flow is
necessary to prevent rebreathing of expired carbon dioxide.

18. c- Fresh gas flow rates of approximately 200 ml/kg/minute are necessary to
prevent rebreathing of carbon dioxide.

19. d- With nonrebreathing circuits, there is no drop in anesthetic concentration

from the vaporizer to the patient.

20. e- For semi-closed circuits, oxygen flow is usually 30ml/kg/minute. However, for
closed or low-flow circuits, the fresh oxygen flow can be as low as 4-6ml/kg/minute
for dogs.

21. d- This is approximately 4-6ml/kg/minute in dogs.

22. a- For closed-circuit anesthesia, the system must incorporate a soda lime carbon
dioxide absorber.

23. c

24. c- The other answers are all advantages of closed-circuit/ low-flow systems. The
closed system permits inhalation of warm gases, maintenance of a constant
anesthetic level, economical use of volatile agents, and maintenance of high humidity
of inspired gases.

25. d- An endotracheal tube extending out well beyond the animal’s nose increases
dead space.

26. d

27. e- With this maneuver, stomach inflation/deflation can be mistaken for chest
excursion.

28. a- Early in anesthesia, the patient removes most of the anesthetic from the
inspired gas and exhales gas with a low anesthetic concentration. This gas goes back
around the circuit and dilutes the concentration of gas coming from the vaporizer.

29. d- The ideal agent, producing rapid induction and recovery, would have low
blood solubility and low lipid solubility, rapidly achieving equilibrium (partial
pressure) between gas, blood and tissue phases/compartments. Solubility is an index
of the capacity of the blood or tissue to retain anesthetic.

-A small amount of vapor entering tissue in which the agent is not soluble
causes a high vapor tension. Therefore, during anesthetic recovery, arterial and
brain concentrations drop to negligible levels within minutes and the patient
awakens rapidly.

30. c- See answer 20.

31. a- See answers 20 and 24.

32. c- See answer 24.

33. d- Tissue oxygen saturation (SaO2 , measured with pulse oximetry) will not
change perceptibly unless there is a marked change in tissue perfusion or
hemoglobin saturation with oxygen. Neither will change enough within the range of
clinical anesthetic levels to change SaO2 , especially if the animal is breathing a high
inspired concentration of oxygen.

34. e

35. a- A corneal reflex can persist even at deep levels of anesthesia. Loss of the
corneal reflex is a sign of very deep anesthesia. Repeated testing of the corneal reflex
can damage the cornea.

36. c- The esophageal stethoscope should be positioned in the esophagus at the level
where heart and lung sounds are best heard. These sounds allow evaluation of heart
and respiratory rates, neither of which alone is a useful guide to anesthetic depth.

37. a

38. b- The bradycardia is most likely due to excessive vagal tone and could be
treated with intravenous atropine. It should also respond to cessation of the noxious
stimulus (ie, release of traction on the ovary).

39. c- Alpha-2 adrenergic agonists cause marked bradycardia. In dogs and cats,
they should be used after premedication with an anticholinergic drug, such as
atropine.

40. b- A high blood carbon dioxide level causes cardiovascular stimulation,

mediated via the sympathetic nervous system.

41. d- In decreasing order of the likelihood of arrhythmogenesis: halothane >

methoxyflurane > isoflurane, desflurane and nitrous oxide.
42. b- In healthy dogs, there is a high incidence (up to 40% of cases) of transient
ventricular arrhythmias following anesthetic induction with intravenous
thiobarbiturates. This does not usually cause clinical problems in healthy patients.
- Painful stimulation of lightly anesthetized patients causes catecholamine
release, which can lead to ventricular arrhythmias in halothane-anesthetized
patients. The increasing anesthetic depth can eliminate these arrhythmias.

43. a

44. d- Assessment of pulse quality does not enable you to estimate systolic or
diastolic pressure.

45. d- Arterial pressure = cardiac output x peripheral resistance. Cardiac output =

heart rate x stroke volume.

46. a- The response time of pulse oximeters is currently not fast enough to enable
them to be used with a pneumatic cuff to detect blood pressure.

47. e- Currently available indirect methods all have inaccuracies associated with
cuff size, limb size, the amount of hair covering the site, and the animal’s position.
Some of these effects can be standardized for more repeatable measurements. In
general, indirect methods most reliably determine systolic arterial pressure.

48. c- An overly wide cuff yields spuriously low readings. An overly narrow cuff and
a loose cuff yield spuriously high readings.

49. e- As the pressure wave travels distally, impedance causes the systolic pressure
to increase, though mean arterial pressure tends to decrease.

50. a- Hydrostatic force (gravity) causes false elevation in pressure, proportional to

the height difference (1.36 mm Hg/cm difference).

51. b- Mean arterial pressure is the mean perfusion pressure (not blood flow). It is
the area under the pressure wave form. About one-third of the cardiac cycle is
systole, two-thirds is diastole. Therefore, to calculate mean arterial pressure, systolic
and diastolic pressure must be weighted.
52. e- Hypotension is usually defined as a systolic pressure below 80-90 mm Hg,
which would generally result in a mean arterial pressure below 60-65 mm Hg.

53. d- Doxapram increases the metabolic rate of the brain, and may stimulate
ventilation. It does not directly improve cardiovascular function unless its
administration has caused or follows hypoxemia.

54. e- Cardiac output = heart rate x stroke volume.

55. d
56. d- Phenylephrine and methoxamine are regarded as pure alpha-adrenergic
stimulators. Isoproterenol has powerful positive inotropic and chronotropic
myocardial effects, causing increased cardiac output. Peripheral vascular dilatation
and reduced resistance are other prominent effects of this beta-adrenergic
stimulant. Ephedrine causes central nervous system-mediated release of
norepinephrine; therefore, its effects are similar to those caused by norepinephrine
administration, including increased stroke volume, presumably from increased
contractility.

57. a- At a dosage of 1-3 µg/kg/minute, dopamine increases renal output by

increasing glomerular filtration via dilatation of the afferent arterioles.

58. a- Phenylephrine may be given in reasonable doses without fear of ventricular

irritability. However, epinephrine is likely to cause premature ventricular
contractions.

59. c- We assume that a hypotensive patient has poor tissue perfusion (not always a
true assumption). The objective of therapy is to improve tissue perfusion with
oxygenated blood.

60. c- Anatomic dead space comprises the area of the respiratory tract not involved
in gas exchange, including the oronasal cavity and conducting airways. In healthy
unanesthetized animals, it is equal to about one-third of the tidal volume but
increases during anesthesia, particularly as a result of atelectasis.

61. b

62. e- The minute volume depends on both tidal volume and respiratory rate (Vt x
respiratory rate).

63. b- An average range is 10-15 ml/kg/breath.

64. c- Minute ventilation and arterial carbon dioxide levels are equivalent measures
of the effectiveness of ventilation.

65. e- Increased arterial carbon dioxide levels increase the depth and usually the
rate of ventilation, increase heart rate, cardiac output and blood pressure, and cause
injection of the mucous membranes.

66. d- Compliance is a measure of static pressure-volume relationships (L/cm),

whereas resistance is a measure of dynamic pressure flows (L/cm H20/second).

67. b- Carbon dioxide causes cardiac epinephrine to be released from the

sympathetic nerve endings, resulting in increased cardiac output.
68. a

69. d- In general, anesthetic drugs cause dose-dependent respiratory depression.

70. a

71. b- PaCO2 is used to assess ventilation, while PaO2 is used to assess oxygenation.

72. e- CO2 + H20 H2CO3 H+ + HCO3. Large changes in blood bicarbonate

levels produce only small changes in blood pH. Changes in hydrogen ion
concentration have a direct effect on blood pH.

73. d

74. c- Oxygen delivery is related to cardiac output, hemoglobin concentration, and

the percent saturation with oxygen.

75. d

76. c- See answer 77.

77. b- Shifting of the oxyhemoglobin curve to the left increases the affinity of oxygen
for hemoglobin, reducing tissue oxygen availability. As blood pH decreases, the
oxygen dissociation curve shifts to the right. Carbon dioxide and lactic acid
liberated during metabolism cause this phenomenon (the Bohr effect). Increasing
body temperature above normal, an increased organic phosphate level (2,3-DPG
and ATP) and an acidic pH all cause a shift to the right.

78. e

79. a
80. d

81. e- When the PaO2 is above 100 mm Hg, all of the hemoglobin (which carries over
97% of the oxygen) is saturated.

82. c- Reducing the PaCO2 by 5 mm Hg would only raise the PaO2 by about 5 mm
Hg. Answers b, d and e would raise cardiac output, which would improve
ventilation/ perfusion in the lung.

83. e

84. a

85. c- This dog is likely cyanotic and, if not anesthetized, may be unconscious due to
hypoxemia.
86. e- Cerebral blood flow and pressure are enhanced by increasing PaCO2 or
decreased by decreasing PaCO2. Brain volume increases as more blood flows into the
closed cranial cavity, which also increases cerebrospinal fluid pressure. Carbon
dioxide is an anesthetic at higher concentrations (eg, 30%), though it causes marked
cardiovascular responses.

87. e- In animals with increased intracranial pressure, drainage of cerebrospinal

fluid is dangerous because of possible herniation of the brainstem. Mannitol causes
a rapid osmolar fluid shift from the intracellular to the intravascular compartment.
Dexamethasone restores or preserves the blood-brain barrier and prevents cerebral
edema. Ketamine can increase blood pressure; halothane depresses the brain’s
autoregulatory control of blood pressure.

88. d- Because of its low metabolism, isoflurane is the inhalation anesthetic of choice.
Hypoproteinemia causes ascites, and a low albumin level results in less binding of
thiobarbiturate, resulting in relatively more unbound anesthetic drug, which will
cross into the brain to produce a relatively deeper anesthetic level.

89. a- Vasopressin, also called antidiuretic hormone, is secreted in greater quantity

during anesthesia, thus suppressing urine formation. Aldosterone regulates
excretion of sodium and potassium.

90. c

91. b- Oncotic pressure depends on the number of molecules present in a fluid.

Approximately 70% of the plasma colloid oncotic pressure is derived from albumin
because one unit (by weight) of albumin contains almost twice as many molecules as
one unit of globulin (3 times more than fibrinogen). The concentration of plasma
albumin is about twice that of globulin.

92. e

93. c- During anesthesia, the plasma protein level should be maintained above 3-3.5
g/dl to prevent pulmonary edema.

94. a

95. d- Because the resting intrathoracic pressure is negative, central venous pressure
can fall below zero in hypovolemic animals.

96. d- The anesthetic requirement is reduced by increasing age, hypothermia,

concurrent use of other central nervous system depressants and pregnancy.

97. b
98. d- Neonatal animals have a large surface area relative to volume, causing high
heat loss to the environment.

99. c- See question 79.

100. d- See answer 81.

101. d- The dog has sinus tachycardia, most likely related to stress, pain or
hypovolemia. Further increasing the heart rate (eg, with atropine) will likely
decrease ventricular filling and, therefore, cardiac output. Slowing the heart rate to
a more normal level (eg, 80-120 beats/minute for an adult Boxer) by use of sedation,
analgesia and a drug with direct negative chronotropic effects (Apart from
bradycardia, there is minimal cardiac depression from intravenous oxymorphone
and fentanyl.) is desirable before anesthetic induction. Thiopental generally
increases heart rate (In healthy dogs, there is a high incidence (up to 40% of cases)
of transient ventricular arrhythmias following anesthetic induction with
intravenous thiobarbiturates. This does not usually cause clinical problems in
healthy patients.)

102. b- See answer 88. Hypovolemia will result in increased plasma concentration
(for a dose calculated in mg/kg). Therefore, reduce the amount of the initial bolus
dose. Induction will be slower in hypovolemic animals with lower cardiac output
(reduced circulation time).

103. d- Mask inductions are slow (undesirable if rapid airway control is desirable),
with speed of induction dependent on drug solubility (insoluble agents produce
faster induction) and ventilation (hyperventilation produces faster induction). Mask
induction can be expensive, especially with isoflurane (about $5 for induction in a
dog).

- Highly soluble agents (eg, methoxyflurane) have slow equilibration times and,
therefore, slow induction and recovery times.

104. a- Increasing the anesthetic circuit volume or decreasing the oxygen flow slows
the rate of rise of anesthetic concentration in the circuit, which slows the rate of
induction. Pregnancy decreases the anesthetic requirement.

105. e- Bupivacaine has the lowest placental transfer of any of the commonly used
local anesthetics agents. This is due to its high protein binding in maternal blood.
Epidural anesthesia produces minimal concentrations of anesthetic in blood, and
therefore also in the placenta.

106. c- See answer 38.

107. c- See answer 98.