Lippicontt’s ANESTHESIA REVIEW : 1001 QNA

BAB 1 Perioperatove Evaluation and Management

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1. Scopolamine patch should be avoided in : d ? mle 70 years old  benar. Scopolamine

(anticholinergic drugs) lewat bbb, cause confusion
2. Following drugs is least likely to be effective for prophylaxis PONV : a ? ondancentron 
salah. Jawaban : metoclopramide. Metoclopramide itu prokinetic. ASA tidak menganjurkan
pemakaian metoclopramide buat premed PONV
3. Famotidine, when used for stress ulcer prophylaxis, must be avoided perioperatively in
which patient : B. ITP  benar, segolongan sama ranitidine. Can cause thrombocytopenia.
4. Antagonizes substance P in CNS premed for PONV : b ? Aprepiant  benar. Aprepitant : NK1
receptor antagonist, antagonis substansi P di CNS.
5. Associated w/ lower incidence of PONV : c. history of smoking  benar. 4 faktor : Wanita,
non-smokin, opioid postop, riw. PONV/motion sickness. (Apfel score)
6. Antiemetic action, except : c. etomidate ?  benar. Etomidate increase incidence of PONV.
7. Cefazolin as perioperative antimicrobial prophylaxis, begin within ? c ? 60 minutes before
incision  benar. Beta lactam 60 menit sebelum insisi
8. Vancomycin -:- : b/c ? 30/60 minute prior to incision ?  salah. Jawaban : 120 menit
sebelum insisi. Flouroquin juga 120 menit sebelum insisi
9. 65 y.o male, HT - DM (+), curiga SDH. to assess cardiorespiratory status, less likely to have
significant cardiopulmonary ailment during surgery : ?  jawaban : climb a flight of stairs.
Effort tolerance of around 4 METs/more suggested to be good predictor for postop outcome
10. Physical activity is graded in terms METs (metabolic equivalents). oxygen consumption of 1
MET in adult : c. 3,5 ml/kg/min ?  benar. 1 MET : take care of self (makan, toilet, dressing),
4 METS : walk up a flight of steps or a hill. 4 – 10 METS : can do heavy household work. > 10
METs : can participate in strenuous sports
11. IV infusion of unfractionated heparin should be stop how long prior to a plannes epidural :
d ? 24 hours  salah. Jawaban : kunci 2 – 4 jam sebelum epidural. Kalo dari standford 4 – 6
jam (?)
12. For emergency surgery, Warfarin can be reversed by : b ? inj. vit k  salah. Jawaban FFP.
Warfarin bisa direverse dg FFP, Inj. vit.K, prothrombin complex concentrate. Buat emergency
bisa pake FFP. Kalo inj. Vit K peak action 6 – 12 jam
13. Neuraxial block is not contraindicated for patient on which drugs : b ? LMWH  salah.
Jawaban : aspirin. Morgan : Neuraxial Blockage in the setting of anticoagulants & antiplatelet
drugs : by themselves, aspirin and other NSAIDS do not increase the risk of spinal hematoma
from neuraxial anesthesia procedures or epidural catheter removal.
14. Risk factor of OSA, expect : d. female gender benar. Kriteria “STOP – BANG” : Snoring,
tired during daytime, Observed for apnea during sleep, P high BP, BMI > 35 kg/m2, Age >50
y.o, Neck circumference > 40 cm, Gender male
15. 70 y.o male, DM (+) 20 years, elective surgery Which of the following is not a sign of
autonomic diabetic neuropathy : b ? postural hypotension  salah, jawaban : history of
urinary retention, relasi ke BPH
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16. Perioperative factors in patients undergoing dialysis prior to surgery predicts the possibility
of hypotension (due to increased volume removed) : c. change in serum potassium  salah.
Jawaban : change in body weight. Weight loss due to dialysis is attributed to actual volume
(ultrafilrate) removed from the body. High weight loss  higher circulatory volume lost 
poor compensation of hypotension.
17. History of severe asthma (+), scheduled for an appendectomy. Induction agent will cause the
least respiratory depression : a. Ketamine  benar. Ketamin menguntungkan buat pasien
dengan asma. Tapi ketamine meningkatkan sekresi mucus, bisa diberikan midazolam +
glycopyrrolate buat mengurangi efek ketaimn.
18. Following drugs can significantly prolong QT interval : ? a. Aprepitant ?  salah. Jawaban :
droperidol. Antipsikotik temenya haloperidol.
19. Test to confirm coagulation after stopping LMWH : ?  jawaban : ga ada test conventional
yg bisa dipake to quantify the clinical effects of LMWH on the coagulation system. Anti-
factor Xa estimation bisa dipake in specific patients to monitor the coagulative effect of
LMWH.
20. Effect of combined midazolam + fentanyl : ? d. noncompetitively antagonistic  salah.
Jawaban : synergic. Bekerja di reseptor yg berbeda. Greater sedation and respiratory
depression. Midazolam (benzodiazepine) berikatan dengan reseptor GABA A . Fentanil
(opioid) berikatan dengan reseptor G-protein coupled (reseptor opioid). Ada berbagai
macam reseptor opioid : mu, kappa, delta, sigma.
21. Preoperative anesthetic evaluation is likely to bring down the incidence of all the following,
except : ? d. direct procedural cost  benar. Preoperative evaluation eventually lowers
indirect costs that may be incurred to treat the worsening aliment, postoperatively.
22. For elective procedures, an anesthesia provider must obtain informed consent preferably
written consent : b. during preoperative anesthetic evaluation  benar.
23. An optimal preoperative evaluation is designed : d. all of the above  benar. Sreccn for and
properly manage comorbid conditions, assess the risk of anesthesia and surgery and lower
it, identify patient who may require special anesthetic or postoperative care.
24. ASA classification for risk stratification is validated for predicting morbidity associated with
the following, except : d. surgical procedure  benar

Kriteria ASA

25. A healthy pregnant patient in labor has which ASA classification : b. II  benar.
26. 26 Sedative, as premedication, must be avoided in which of the following patient : d.
patients with alcohol abuse  salah. Jawaban : brain tumor patients. Morgan: hypercapnia
secondary to respiratory depression increase ICP.
27. ASRA (American Society of Regional Anesthesia) guidelines, which of the following drugs can
be continued preoperatively in patient planned for neuraxial blockage for an elective
procedure : a. Aspirin  benar. ASRA guidline : Warfarin : at least 5 hari. Clopidogrel : 7 – 10
hari. LMWH therapeutic does : at least 24 jam, profilaksis dose at least 12 jam.
28. ASA, a controlled HTN patient w/ no target end-organ : b. ASA II  benar
29. A brain-dead organ donor undergoing laparotomy for kidney-harvesting : c. ASA V  salah.
Jawaban : ASA VI
30. A moribund patient who is not expected to survive w/o the operation : b. ASA IV  salah.
Jawaban : ASA V
31. Uncontrolled HT, DM, and angina, wo is undergo a laparoscopic cholecystectomy : b. ASA III
 benar.
32. 65 y.o male, history of mitral valve replacement 2 years back presents for a knee
replacement. On warfarin since the time of valve replacement. ASRA guidelines, the ideal
time to stop his warfarin prior to surgery : ? c. 5 days  benar. INR < atau sama dengan 1.4
is desirable to perform the surgery.
33. 26 y.o female, history of rheumatic mitral stenosis, scheduled for SC. Just prior to surgery,
diagnosed to AF w/ on hemodynamic instability. The first step in preparation for surgery
is : ? a. perform an echo to rule out left – atrial clot  benar. AF lebih dari 48 jam sebaiknya
dipastikan tidak ada clot atrial kiri sebelum pemberian rate/rhythm control untuk mencegah
embolic conseguences.
34. 72 y.o w/ HT and angina at moderate activity history is to undergo a laparoscopic
cholecystectomy. Due to decreased effort tolerance and a significant blockage of left
anterior descending coronary artery on stress thallium, a pre procedure coronary
intervention is planned. Which of the following procedures performed prior to the elective
surgery is least likely to delay the laparoscopic surgery : ? a. coronary artery bypass graft
(CABG)  salah. Jawaban : percutaneous ballon dilatation. Drug-eluting stent : 1 tahun
(continue dual antiplatelet medication), bare-metallic stent : 4 minggu, CABG : HIGHLY
RISKY. Ballon dilatation : 2- 3 minggu.
35. Which is the following us not seen as a result of primary renal disease in patients w/ chronic
renal failure : ? b. hypercoagulable state  salah. Jawaban : hyperproteinemia,
36. 2 y.o rencana tonsilektomi. Minum susu formula 2 jam sebelumnya. Sesuai ASA, optimal
NPO status wold be to wait another : b. 2 hours  salah. Jawaban : 6 jam.

Buku anestesi perdatin

37. 45 y.o scheduled for an abdominal hysterectomy. She states that her aunt had a severe
reaction to anesthesia and was in the ICU for 1 week. Oba yg harus dihindari untuk GA : ? c.
sevo / d. etomidate  jawaban : Sevofluran. Yang dimaksud severe reaction : hipertermia
malignant. MH has a genetic component, and runs in families. Volatile agent and
succinylcholine should be avoided in this patient.
38. Operasi elektif harus ditunda setelah miokard infark paling tidak : ? a. 30 hari  salah.
Jawaban : 6 minggu. Risk of reinfarction is app. 5.5% for surgeries between 0 – 3 months, 2.5
% between 3 – 6 months. 2 % after 6 months (agak aneh)
39. The most significant risk factor for developing pulmonary complication : ? a. site of surgery
(abdominal/thoracic)  benar.
40. Max INR before preceding for elective surgery should be : ?  jawaban : 1.4. Sebenernya ga
ada patokan khusus INR, tapi rekomendasinya INR < atau sama dengan 1.4 harus tercapai
untuk renccana elektif, kalo cito bisa INR bisa dikoreksi dengan FFP (agak aneh)
41. 73 y.o riw. Stroke hemiparesis dextra 5 tahun lalu. Saat ini masih ada kelemahan pada sisi
kanan, pasien rencana laparoscopic cholecystectomy under GA. Untuk monitor the train of
four muscle twitches for estimating neuromuscular blockage sebaiknya dimana : ? c. left
ulnar nerve-innervated muscle  benar. Sisi tubuh yg stroke ototnya akan atrofi,
extrajunctional receptors are the synthesized at the muscke sites, which remain resistant to
the effects of NMB for varying degrees. Tapi, otot yg paralisis bisa memberikan respon
berlebih kalo distimulasi secara langsung w/ a nerve stimulator. Jadi hasilnya ga akurat.
42. 32 y.o kecelakaan lalu lintas due to alcohol intoxication. Rencana open fracture reduction of
an ankle fracture. High blood alcohol. Compared to a patient who is not intoxicated w/
alcohol, you would expect the MAC of sevo to be : ? b. lower  benar. MAC lower pada
pasien : sedatives, aniolyrics, alcohol intoxication, hypothermia, extreme of age,
moribund/sick patients, obtunded consciousness.

43. 55 y.o asthma + heart failure history, rencana hernia repair. PF ada wheezing, following
treatment w/ Albuterol, elektrolit yg harus dicek : a. Potasium  benar. semua beta 2
agonist are known to cause internalization of potassium ( from plasma to cell), thus causing
hypokalemia.
44. Smoking cessation for 24 hours before a scheduled surgery will lead to : ? d. decrease in
level of carboxyhemoglobin  benar. Reduced level of COHb increases level of oxygenated
Hb, which decreases the risk if myocardial ischemia and perioperative cardiac morbidity.
Delayed benefits (cessation more than 8 weeks) are known to improve airway immunologic
and ciliary function.
45. Which of the following test is likely to detect clinically relevant bleeding tendency most
efficiently : ?  jawaban : Thromboelastogram (TEG). TEG has the highest positive
predictive value.
46. As per AHA guidelines, which of the following is not a major clinical risk predictor in a patient
w/ cardiac disease scheduled for non cardiac surgery : ? c. presence of congestive cardiac
failure  salah. Jawaban : uncontrolled systolic hypertension. Uncontrolled systolic
hypertension w/o target end-organ damage is a minor predictor/risk factor. It can be usually
controlled w/ obat antihipertensi intraoperative
47. Glycopyrrolate, when giben preoperatively, can cause except : ? d. takikardia  salah.
Jawaban : bronkokonstriksi. Masuk golongan antikolinergik (kaya atropine)
48. Following is true about metoclopramide : c. can cause extrapyramidal side effect  benar.
Blocks the dopaminergic receptors to cause parkinsonism-like extrapyramidal side effects.
Tremor, rigidity, slowing of motor function. Diskinesia, akathisisa, tardive dyskinesia.
49. Following occurs during the preoxygenation of patient : ? c. increase in CO2 clearance from
lungs  salah, jawaban : denitrogenation. Preoksigenasi berperan untuk meningkatkan
safe apnea time by denitrogenating Functional Residual Capacity (FRC) and increasing
dissolved oxygen content in the blood. It does not alter any physical measurements of lungs,
makanya ga ada pengaruhnya ke FRC atau closing volume/capacity
50. Following agents is associated w/ the highest incidence of hepatitis post operatively : a.
Halothane.  benar.
51. Inhalation agent of choice in a 2 y.o for ophthalmologic surgery : c. Sevoflurane  benar.
Sebenernya halothane bisa dipake, tapi lebih aman Sevoflurane.
52. Following is true of nitrous oxide : ? c. supresses EEG pattern in the cerebral cortex  salah,
jawaban : precipitates vit. B12 deficiency anemia. Nitrous oxide inhibit enzyme Methionine
Synthase, inhibiting DNA synthesis and precipitating B12 deficiency  megaloblastic
anemia. Nitrous oxide juga bisa berikatan dengan reseptor NMDA, meningkatkan pulmonary
vascular resistance.
53. Antiemetic effect of propofol is thought to occur due to : ? a. depressant effect on the
chemoreceptor trigger zone.  salah, jawaban : all of the above. Depressant effect on the
chemoreceptor trigger zone, inhibition of dopamine activity, inhibition of glutamate
release. Bisa dipake buat kasus PONV refrakter dalam dan diberikan dalam dosis kecil.
54. Preferred intravenous agent of induction of anesthesia for maintaining spontaneous
breathing and airway tone : c. ketamine  benar. Propofol dan benzodiazepine ada efek
depresi pernafasan.
55. Succinylcholine is contraindicated in patient w/ : c. myasthenia gravis  salah, jawaban :
Duchene muscular dystrophy. Anestesi perdatin : awal pemberian SCh menimbulkan
fasikulasi : kontraksi otot menyeluruh. SCh juga menyebabkan peningkatan konsentrasi
plasma Kalium. Pembukaan kanal natrium berkelanjutan akibat fasikulasi disertai kebocoran
kalium akan meningkatkan konsetrasi plasma kalium, bisa hiperkalemia  aritmia. Jadi bisa
fatal pada pasien luka bakar, dystrophy dan paraplegia, muscle wasting akibat insufisiensi
arteri kronis, imobilisasi lama, trauma berat serta cedera kepala tertutup.
56. 75 y.o w/ HTN (+) is to undergo laparoscopic colectomy for Ca colon. Continuing of which of
the following antihypertensives drugs, preoperatively, in the geriatric age group, can be
 associated w/ profound hypotension on induction of GA : ?  jawaban : angiotensin-
converting-enzyme (ACE) inhibitor. Dari beberapa penelitian menunjukan hipotensi saat
induksi GA pada pasien yg diberika ACE inhibitor preoperative, terutama geriatir. Makanya
disarankan tunda pemberian ACE inhibitor pada pasien geriatric atau operasi besar. Anestesi
perdatin : penggunaan ACE dan ARB preoperative masih jadi perdebatan, kalo dikasih
peningkatan insiden hipotensi intrabedah. Kalo distop  peningkatan resiko hipertensi
intraoperative dan pemggunaan antihipertensi parenteral. (jadi gimana dong ☹).
57. Following findings in the preoperative evaluation cannot be attributed to obesity w/ OSA in a
patient planned for bariatric surgery : ? d. dementia  benar. Obes morbid + OSA 
persisten hipoksia  increased pulmonary vascular resistance  pulmonary artery
hypertension. Pasien obes juga resiko lebih tinggi buat masalah cardiac  cardiac
hypertrophy dan cardiac failure. Compression neuropathies juga bisa ditemukan pada pasien
obes morbid.
58. All of the following medications can be administered via an epidural anesthesia, except : ? c.
alfentanil  salah, jawaban Remifentanil. Remifentanil di pasaran ada campuran Glycine
sebagai preservative, yg bisa menimbulkan direct neurotoxicity. Makanya ga bisa central
neuraxial blockade
59. Ondancentron cause its antiemetic effect by acting as an : ? b. antagonist at 5-HT 2 receptors.
 salah, jawaban antagonist 5-HT3 receptors.
60. Statement is false regarding scopolamine patch applied preoperatively : ? b. decreases the
risk of nausea  salah, jawaban adds to the analgesia. Scopolamin itu antimuskarinik yg
bisa lewat BBB dan plasenta  ada efek sedasi dan confusion terutama pada geriatric.
BUKAN sebagai analgesik
61. Overdose w/ dexmedetomidine results in : d. hypotension and bradycardia  benar.
Dexmedetomidine itu agonist alfa 2 reseptor, afinitasnya 8x lebih kuat dari klonidine.
62. Abrupt withdrawal of steroids can lead to : c. Addisonian crisis  benar. Tandanya :
refractory shock w/ electrolyte and glucose abnormalities.
63. Promethazine primarily inhibits receptors : ? c. muscarinic  salah, jawaban : Dopamine.
Mims : derifat phenothiazine dengan efek antihistamin, sedasi, antiemetic, anti-motion
sickness, antikolinergik. It blocks the postsynaptic mesolimbic dopaminergic receptors in the
brain, exhibits a strong alfa-adrenergic blocking activity and depresses the release of
hypothalamic and hypophyseal hormones.
64. Surgeries are associated w/ an increased risk of PONV, except : a. shoulder arthroscopy 
benar.
65. Abrupt stoppage of total parenteral nutrition (TPN) would most likely cause : ? a.
hypoglycemia  benar.

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66. Glycopyrrolate cause all of the following, except : ? d. lowers lower esophageal sphincter
tone  salah, jawaban : sedation. Antimuskarinik dengan sturktur quarternary ammonium,
which prevents it from crossing BBB. Jadi ga ada efek sedasinya.
67. Herbal medication should be stopped before surgery at least : ? a. 3 days ?  salah,
jawaban : 7 hari
68. Antibiotics can prolong the action of neuromuscular-blocking drugs : ? a. gentamicin 
benar. Gentamisisn itu aminoglikosida yg ngeblok acetycholine release from the presynaptic
terminal and reduce post synaptic responsiveness. Jadi bisa prolong efek NMB yg non-depol.
69. Estrogen in birth control pills increases the perioperative risk of : ? b. thromboembolism 
benar. Esterogen can lead to hypercoagulable state, jadi bisa resiko tromboemboli. Faktor
resiko tromboemboli lainnya : operasi besar, multiple trauma (hip fracture), lower
extremity paralysis, increasing age, cardiac or respiratory failure, prolonged immobility,
central venous lines, variety of hematologic conditions
70. 42 y.o schedule for hernia repair under GA. Riw. Pengobatan fluoxetine, alprazolam, lithium
for bipolar. Preoperative tampak confused, tremors and is ataxic. Next step : ? a. cancel the
case / d. consult a psychiatrist  salah, jawaban : order a lithium blood level. Kemungkinan
intoksikasi lithium karena litium therapeutic indexnya sempit. Intoksikasi bisa akut, akut on
kronik, kronik. Intoksikasi kronik biasanya pada penggunaan litium jangka Panjang. Gejala
bisa ringan, sedang, berat.
71. 34 y.o undergo an appendectomy under GA. He is taking MOAI for depression.
Intraoperative BP drops to 72/36, a medication is administered. BP increases to 220/120.
The most likely medicine that was administered is : d. Norepinefrin  salah, jawaban
Ephedrine. Pasien dengan terapi MAOI endogen NE nya akan tinggi. Kalo dikasih terapi
dengan indirect-acting drugs kaya Efedrin responnya akan berlebihan. Lebih baik diterapi
dengan direct-acting drugs seperti Fenilefrin. Efedrin berikatan dengan reseptor Alfa dan
Beta. Sebenernya ada direct nya juga, but primary mode of action is indirectly achieved by
inhibiting neural NE reuptake and displacing more NE from storage vesicles. Akhirnya NE ada
di synapse longer to bind postsynaptic alpha and beta receptors.
72. All the following are true about diabetic patient, except : ? a. patient should take ½ atau 1/3
insulin dose the morning of the surgery  salah, jawaban patient should continue their
oral hypoglicemic agents the morning of the surgery. Pasien tetep dalam kondisi puasa.
Metformin seharusnya distop 48 jam sebelum operasi sudah menghindari kondisi asidosis
laktat durante operasi. Kalau insulin pump tetep dikasih untuk memenuhi kebutuhan insulin
basal
73. Digoxin toxicity is most likely exacerbated by : ? d. hypocalcemia  salah, jawaban
hipokalemia. Digoksin itu inotrop uang bekerka di miokardial cell dengan menghambat
pompa Na/K ATPase. Kalsium masuk ke sel, tapi K keluar dari sel. Signs and symptoms of
Digoxin toxicity : drownsiness/confusion, nausea/vomiting, loss of appetite, diarem
disturbed color vision (yellow/green halos around objects), agitasi, aritmia. EKGnya
bradikari, prolong PR interval, akselerasi irama junctional.
 74. The most common complication of inserting a CVC is : ? b. thrombosis/c. cardiac arrhytmias
 jawaban Cardiac arrhytmias. Mungkin yg dimaksud soal CVC di vena jugular. Kalo wire tip
dari katetermya masuk ke atrium kanan, bisa menyebabkan aritmia. Jadi harus ditarik agar
tidak mengenai atrium kanan.
75. Cephalexin administered preoperative. Within 5 minutes of starting the antibiotic, the
patient start to wheezing and develops tachycardia, BP drops to 78/42. Next step woulb be
to administer : c. Epinephrine  benar. Pasien mengalami syok anafilaksis.
76. All of the following may occur with an interscalene block, except : ? a. subarachnoid injection
 salah, jawaban Median nerve blockage. Kunci jawaban : Komplikasi blok interskalenus :
blok ganglion stellata, phernic nerve, recurrent laryngeal, horner syndrome, vertebral artery
injection, epidual/subarachnoid/subdural injection, dan pneumothorax. Ulnar nerve
biasanya terhindar sewaktu melakukan blok interskalenus. Buku Perdatin : Blok
interskalenus memberikan anestesi pada bahu, lengan dan siku. Bisa digunakan untuk
operasi pada daerah bahu dan humerus, serta insersi arteriovenous graft untuk hemodialisis.
77. An axillary nerve block would not produce loss of sensation of the : ? d. none of the above 
salah, jawaban Lateral aspect of the forearm. Lateral forearm dipersarafi nervus
muskulokutenus, saat blok axilaris yg terkena nervus ulnaris, radialis, medialis. Blok
muskulokutaneus dilakukan dengan teknik lain.

Dari buku Perdatin Bab 45 hal 451.

78. The femoral nerve lies : ? d. lateral to femoral artery  benar. VAN – vein, artery, nerve
79. All of the following nerves are blocked by an ankle block, except : ? a. sural  salah,
jawaban : anterior tibial. Nerve yg terblok saat ankle block : deep peroneal, saphenous,
posterior tibial, sural, superficial peroneal. Buku Peratin : 5 saraf terpisah, 2 saraf profundus
(Tibialis dan Peroneus profunda) dan 3 saraf superfisial (sural, saphenous, peronealis
superfisialis). N. Saphenous asal dari n.femoralis, sisanya dari n.sciatic.
80. Sore throat is : ? a. more common after using an ET  benar. Insidensi laryngitis lebih
banyak pada pasien dengan ETT dibanding LMA. Kejadian tersebut dipengaruhi keterampilan
operator, ukuran cuff, ukuran ETT, tekanan cuff. Kebanyakan kasus sore throat bisa hilang
sendiri.
81. A patient w/ hypertrophic obstructive cardiomyopathy (HOCM) presents w/ dyspnea and
angina on exertion. Which of the following is the best agent to treat these symptoms : ? 
jawaban : Metoprolol. In, HOCM, obstruction of the ventricular outflow tract can occur from
systolic anterior motion of the mitral valve against the hypertrophied septum, In patient w/
a severe HOCM, myocardial depression is beneficial, which can be obtained by beta-blocker
or CCB. AHA Journal ; HOCM merupakan penyakit genetic dengan karakteristik kavitas kecil
di ventikel kiri and marked hypertrophy of the myocardium w/ myocyte disarray.
82. St. John wort (Hypericum perforatum) potentiates the effects of : ?  jawaban :
Clopidogrel. Bunga St. John wort biasa dipake sebagai obat tradisional sebagai CYP2C19 dan
CYP3A4 inducer. Clopidogrel diaktifkan oleh Cytochrome P450, jadi kalo digabung bisa
enhances pharmacodynamic response of Clopidogrel. Bunga ini menurunkan efek warfarin
dan heparin, ada efek sedikit pada Aspirin.
83. The most powerful predictor of AF post cardiac surgery is : ? d. time on bypass  salah,
jawaban : age.
84. Patient w/ Parkinson disease undergoes a GA. Plan to treat nausea would include all of the
following, except : c. Metoclopramide  benar. Karateristik Parikson : Loss of dopamine in
the nigrostriatum, resulting bradykinesia, rigidity, postural instability,, and pill-rolling resting
tremor. Metoclopramide (dan droperidol) punya agen antidopaminergic yg signifikat, jadi
harus dihindari.
85. 65 y.o is being treated for congestive cardiac failure. Able to take a shower but gets dyspneic
on mowing the lawn. NYHA berapa : ? c. 3a  salah. Jawaban class 2.
NYHA :
86. Persentase of postdural puncture headaches that would resolve spontaneously by 1 week is
app : ?  jawaban : 70%. PDPH 53% resolve in 4 days, 72% in 7 days, 85% within 6 weeks.
87. 46 y.o lady is seen at the pre operative assessment clinic. She is taking 180mg/day
methadone. The most likely change to be found in her pre op ECG is : ? b. prolonged QTc 
benar.
88. You are about to anesthetize a 55 y.o who is undergoing liver resection for removal of
metastatic carcinoid tumor. The drug of choice to treat intraoperative hypotension is : ? 
jawaban : Octreotide. Reseksi Karsinoid atau debulking tumor bisa menyebabkan Krisis
Karsinoid dengan gejala flushing, hipotensi, bronkospasme, asidosis, dan VT. Octreotide
merupakan analog penghambat hipotalamus hormone somatostatin diindikasikan untuk
mengobati gejala yg timbul akibat tumor neuroendokrin (terutama karsinoid) dan
akromegali. Patient who received Octreotide experienced no significant intraoperative
complications.
89. You are performing an interscalene brachial plexus block on an awake 40 y.o patient who is
healthy w/ no significant medical history. Soon after injecting 20 ml of 0.25% bupivacaine
the patient becomes agitated, has a seizures, and lose of consciousness. Your first step in
management is : ? administer intralipid  salah, jawaban : establish airway and give 100%
O2 via a face mask. Kemungkinan besar anestesi masuk ke arteri vertebra/Subarachnoid/
subdural dalam jumlah besar, komplikasi paling sering dari blok interskalenus. Bila muncul
komplikasi, pastikan ABC aman dan treat the seizure.
90. Patient w/ dilated cardiomyopathy exhibit all of the following, except : c. increased preload
 salah, jawaban : Afterload should be maximized. Pasien dengan dilated cardiomyopathy
sangat sensitive dengan perubahan afterload. Karena itu, afterload harus diminimalisir untuk
maintain stroke volume (? Cari lagi)
91. A septic patient has a CVP of 10 mmHg, a blood pressure of 80/40 mmHg, pulse 96bpm. The
best agent to treat the hypotension is : ?  jawaban : Noradrenalin. Pada kasus sepsis
shock terapi bisa menggunakan NE atau Dopamine untuk hipotensi persisten. Tapi
Dopamine bisa memperberat asidosis pada sirkulasi splangnik. Jadi pada kasus yg dipilih NE
92. Following organs is least tolerant of ischemia for removal for transplantation : ? b. heart 
benar. Jantung paling rentan iskemik karena tingginya kebutuhan oksigen. Hyperkalemic
crystalloid cardioplegia at 4oC for a max. 4 hours is used to preserve the heart. Thus,
reducing the ischemic time of donor hearts will decrease morbidity and costs of cardiac
transplantations.
93. 1.2 mg/kg of rocuronium to do an intubation. Unable to intubate, decide to reverse the
paralysis w/ sugammadex. The dosage you would use is : ? a. 2 mg/kg  salah, jawaban : 16
mg/kg. Sugammadex itu obat reversal untuk NMB non-depolarisasi (rocuronium,
pancuronium, vecuronium). For normal reversal, that is, with two twithes, the dose is 2
mg/kg. When the blockade is deeper, the dose must be increased. When reserving following
a failde intubation, a dose of 8 mg/kg Sugammadex will effectively reverse Rocuronium
given at 0.6 mg/kg. Jadi kalo Rocuroniumnya dikasih 1.2 mg/kg, Sugammadex nya 16mg/kg
94. Young female patient w/ anorexia nervosa just started eating again. After 4 days, she
develops dyspnea and is found to have cardiac failure. Which of the following is most
important to correct : ? a. Potassium  salah, jawaban : Phosphate. Pemberian nutrisi
 enteral/parenteral pada kasus prolonged periods of starvation memicu peningkatan insulin
dari Pankreas yg bisa menyebabkan kondisi anabolic dan perpindahan intraselular dari
Fosfat, Magnesium, Kalium. Of these derangements, hypophosphatemia leads to the mosy
severe conditions, including cardiac failure. (Cari lagi)
95. Pregnant lady is to undergo GA for acute app. At what gestational age should you monitor
fetal heart rate : ? a. 16 weeks  salah, jawaban 24 weeks. Kunci jawaban : fetal heart rate
and uterine monitoring should be performed during induction, emergence, recovery, and if
possible, during the surgery in any pregnancy of more than 24 weeks’ gestation, The fetus
become viable at this gestation age. (Cari lagi)
96. Which of the following I sthe best predictor of a difficult intubation in morbidly obese
patient : ? d. thyromental distance  salah, jawaban : pretracheal tissue volume. Pada
kasus morbidly obese kemungkinan besar akan sulit ventilasi dan sulit intubasi. Prediktor
untuk difficulty is a short, thick neck (prethraceal tissue volume) and history of OSA
97. Patient w/ COPD presents for volume-reduction surgery. Which of the following is a
contraindication for surgery : ? d. evidence of bullous disease  salah, jawaban : FEV < 25%.
High risk patient for pulmonary resection :
- PaCO2 > 45 mmHg atau PaO2 < 50 mmHg on room air
- FEV <25%
- FEV1 <2.1 preoperativly atau < 0.8 L atau <40% of predicted postoperative
- FEV1/FVC < 50% predicted
- Max. breathing capacity (50% of predicted
- Max VO2 <10ml.kg/min
(cari lagi, kontraindikasi)
98. All of the following help increase the excretion of calcium, except : ? d. IV crystalloid 
salah, jawaban : Biphosphonates. Biophosphonates dipake untuk terapi osteoporosis, dia
menghambat resopsi osteoclastic. Jadi ga ada hubungannya sama ekskresi kalsium
99. Contraindication to use during pregnancy : ?  jawaban : Enalapril. Kalo dipake di awal
gestasi menyebabkan multidefek pada fetal : cardiac, pulmonary, renal dan muskuloskeletal
100. During scoliosis surgery, monitoring of somatosensory-evoked potentials indicates
monitoring of : ?  jawaban : Dorsal Colum. Somatosensory-evoked potential biasanya
dipake untuk monitoring n.tibialis posterior selama operasi spinal dan dipake untuk assess
integrity of the dorsal columns of the spinal cord.
101. Desflurane vaporizer is heated because of desflurane’s : ? b. high boiling point  salah,
jawaban High vapor pressure.
102. The most effective way to reduce renal failure in a patient having an abdominal aortic
aneurysm repair : ? a. fluid bolus prior to aortic clamping  salah, jawaban minimization of
cross-clamp time