Free Anesthesia Exam Sample Questions
See why TrueLearn is a trusted resource for thousands of medical students and residents. We understand that it’s all about the content. That’s why we have high-yield anesthesia practice questions written and screened by physician authors, which are regularly updated to ensure our SmartBanks stay up-to-date with exam blueprint changes. Below is are free anesthesia exam sample questions to showcase what we mean.
Free ABA ITE Sample Question
Which of the following electrolyte abnormalities will MOST likely occur in the setting of hyperventilation?
- A. Hyperkalemia
- B. Hyperphosphatemia
- C. Hypocalcemia
- D. Hypouricemia
The Answer and Explanation
Did you get it right? The correct answer is: C
Hypocarbia from hyperventilation can lead to hypocalcemia. Hypocalcemia can occur with respiratory alkalosis. In response to alkalosis, hydrogen ions bound to negatively charged plasma proteins, such as albumin, are released. Calcium, being positively charged, can then bind to albumin and other proteins, thereby decreasing the serum calcium concentration (particularly the free/ionized, active fraction). This is the mechanism behind paresthesias that occur with hyperventilation.
Hyperventilation causes respiratory alkalosis due to the decrease in PaCO2. If the hyperventilation becomes subacute or chronic, the kidneys decrease their bicarbonate reabsorption and increase bicarbonate secretion. This metabolic compensation acutely leads to a decrease in serum bicarbonate of 2 mmol/L per 10 mm Hg PaCO2 decrease.
Respiratory alkalosis can be caused by fear, pain, anxiety, hypoxia, drugs (progesterone or salicylates), or central nervous system (CNS) disturbances, or can be iatrogenic in mechanically ventilated patients. Acute hyperventilation can be associated with dyspnea, chest pain, palpitations, or neurologic symptoms (e.g., dizziness, weakness, paresthesias, or near-syncope).
In patients with subcritical coronary artery stenosis, the vasospasm induced by hypocarbia may be sufficient to provoke myocardial injury. Neurologic symptoms occur because hypocapnia causes reduced cerebral blood flow. Symptoms of dizziness, weakness, confusion, and agitation are common. Syncope or seizure may be provoked by hyperventilation. Paresthesias occur more commonly in the upper extremity and are usually bilateral. Perioral numbness is very common.
Figure: Calcium and albumin in acidemia and alkalemia. Illustration © TrueLearn, LLC
Incorrect Answer Explanations
Answer A: Respiratory alkalosis is likely to produce hypokalemia. Hydrogen-potassium transporters pump hydrogen ions out of cells in the setting of alkalosis to restore physiologic pH. Simultaneously, potassium is pumped intracellularly to ensure electroneutrality, thus leading to hypokalemia.
Answer B: Alkalosis can cause hypophosphatemia. A rising cellular pH stimulates the glycolytic pathway, enhancing sugar-phosphate production. This triggers increased cellular uptake of phosphorus, thus decreasing serum phosphorus concentration.
Answer D: Hypouricemia is generally not seen with respiratory alkalosis. Uric acid levels tend to remain relatively stable despite acid-base disturbances. Hypouricemia can be seen in conditions where the glomerular filtration rate (GFR) increases, such as pregnancy. Loop and thiazide diuretics are associated with increased uric acid levels.
Bottom Line
Respiratory alkalosis, such as from hyperventilation, can cause electrolyte abnormalities, such as hypocalcemia, hypokalemia, and hypophosphatemia. Hypocalcemia is caused by increased calcium binding to negatively charged plasma proteins as the proteins release hydrogen ions to restore physiologic pH.
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Subscribe & save today!Free Anesthesia BASIC Sample Question
A 26-year-old man is scheduled for a muscle biopsy of his lateral proximal thigh. The surgeon requests a lateral femoral cutaneous nerve block. When performing this block using a landmark-based technique, which of the following landmarks is MOST important to identify?
- A. Anterior inferior iliac spine
- B. Anterior superior iliac spine
- C. Femoral artery
The Answer and Explanation
Did you get it right? The correct answer is: B
The anterior superior iliac spine (ASIS) should be the initial landmark identified when performing a lateral femoral cutaneous nerve block. Even if the block is performed with ultrasound guidance, the ASIS is first identified, then the transducer is placed immediately inferior.
The lateral femoral cutaneous nerve (LFCN) provides sensory innervation to the anterolateral thigh. It has a highly variable course and usually has 2 to 5 branches. The nerve is derived from the L2-L3 nerve roots. The intraabdominal portion of the nerve travels along the lateral portion of the iliacus muscle. After crossing beneath the inguinal ligament, it becomes more superficial, passing the sartorius muscle and then piercing through the fascia lata.
An LFCN block is useful for providing analgesia for surgeries affecting the lateral thigh, including skin grafting (donor site), lateral quadriceps muscle biopsy, and hip surgery.
The LFCN is best blocked where it is located between the sartorius (medial landmark) and tensor fascia lata (lateral landmark) muscles: 1-2 cm medial and 1-2 cm inferior to the ASIS, usually at a depth of 0.5-1 cm below the skin. Accordingly, the initial landmark for performing the block is the ASIS. If the block is performed using the landmark technique, approximately 10 mL of local anesthetic is injected at the location described above. Local anesthetic is injected by fanning the needle superiorly and inferiorly to spread the anesthetic above and below the fascia lata. If a nerve stimulator is used, the position of the needle is confirmed when the patient reports tingling on the lateral thigh.
The block can also be performed using ultrasound; the probe is initially placed 2 cm medial and inferior to the ASIS and adjusted until the LFCN is identified lateral to the sartorius muscle and medial to the tensor fascia lata muscle. When local anesthetic is injected, it should be observed to spread in the plane between the sartorius and tensor fascia lata.
Schematized coronal view of the right hemipelvis. The red X shows the spot approximately 2 cm medial and inferior to the ASIS, where local anesthetic may be injected in order to perform the LFCN block. Note that the injection occurs where the nerve is located, between the sartorius and tensor fascia latae (TFL) muscles.
Incorrect Answer Explanations:
Answer A: The ASIS is the initial landmark identified when performing a lateral femoral cutaneous nerve block.
Answer C: The femoral artery is located too far medially from the site of an LFCN block and is not necessary to identify before or during the block.
Bottom Line:
The anterior superior iliac spine (ASIS) is an important landmark for performing a lateral femoral cutaneous nerve block. The nerve can reliably be anesthetized by injecting approximately 1-2 cm medial and 1-2 cm inferior to the ASIS at a depth of 0.5-1 cm from the skin.
Insight:
Damage to the lateral femoral cutaneous nerve can lead to pain and paresthesias on the lateral upper thigh, which may extend down toward the lateral knee. This condition is called meralgia paresthetica and is most commonly caused by entrapment and compression of the nerve as it passes between the inguinal ligament and the ilium. It may also be caused by direct nerve damage, trauma, or diabetic neuropathy.
For more information, see:
American Board of Anesthesiology Keyword. “Lat Fem Cut N: Ext Landmarks (B)”
Barash, Clinical Anesthesia, 6th Edition. Pages 987-988, 992, 1189.
Hadzic’s Textbook of Regional Anesthesia and Acute Pain Management, 1st Edition. Pages 558-559.
The New York School of Regional Anesthesia, Truncal and Cutaneous Blocks, 2013.
Duke RAP Video Series: Femoral Nerve and LFCN Blocks
Free Anesthesia ADVANCED Exam Sample Question
A 31-year-old male with type I diabetes is admitted to the ICU after surgery for Fournier gangrene. Following 30 mL/kg of crystalloid administration, the patient’s vital signs are:
- Heart rate: 90
- Blood pressure: 80/45 mmHg
- Cardiac index: 3.0 L/min/m2
- CVP: 8
- SaO2: 98%
- SvO2: 78%
Which of the following is the BEST strategy for providing vasopressor support?
- A. Epinephrine first then add vasopressin if MAP remains below goal
- B. Norepinephrine first then add vasopressin if MAP remains below goal
- C. Vasopressin first then add epinephrine if MAP remains below goal
- D. Vasopressin first then add norepinephrine if MAP remains below goal
The Answer and Explanation
The correct answer is: B
According to the 2016 Surviving Sepsis Campaign guidelines, norepinephrine is recommended as the first line vasopressor to achieve a MAP of ≥65 mm Hg. If adequate MAP is not achieved, vasopressin or epinephrine is recommended as a second-line pressor.
The 2016 Surviving Sepsis Campaign emphasized that sepsis and septic shock are medical emergencies for which resuscitation and treatment should be begun immediately. The recommended initial management for sepsis-related hypoperfusion is the administration of at least 30 mL/kg of IV crystalloid within the first three hours. Following this initial resuscitation, additional fluid administration should be guided by the frequent reassessment of the patient’s hemodynamic status.
For patients with septic shock, vasopressor therapy should be started to initially target a MAP ≥ 65 mm Hg. Norepinephrine is recommended as the first-choice vasopressor since it is associated with reduced mortality and is less likely to cause arrhythmias or splanchnic ischemia than other pressors including dopamine, epinephrine, and vasopressin. If norepinephrine infusion does not raise MAP to target, the guidelines suggest adding either vasopressin or epinephrine.
Incorrect Answer Explanations:
Answers A, C & D: Epinephrine and vasopressin are not recommended as the first-line vasopressor for patients with septic shock.
Bottom Line
The 2016 Surviving Sepsis Campaign recommends norepinephrine as the first-line vasopressor for patients with septic shock after initial fluid resuscitation. If norepinephrine administration does not raise the MAP to the initial target of ≥65 mm Hg, the guidelines suggest adding either vasopressin or epinephrine.
TrueLearn Insight
The Surviving Sepsis guidelines have gone through several revisions with changes to the second-line vasopressor agent. In the first guidelines, vasopressin was suggested as the second line agent. In the second definitions, the vasopressin dose was decreased and epinephrine was suggested as the second line agent. In the third definitions, either vasopressin and epinephrine are suggested as second-line options. Throughout all the guideline changes, norepinephrine has remained the initial agent of choice for septic shock.
For more information, see:
American Board of Anesthesiology Keyword. “Septic Shock: Vasopressin rx”
Rhodes A, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017 Mar;45(3):486-552.
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