Combined Mock Exam Master (90 Questions)

1. An obese patient presents for elective surgery while taking phentermine. Which TWO statements are correct?Select 2

A. It should typically be stopped 4–7 days before elective surgery B. It commonly causes intraoperative hypertension that responds best to ephedrine C. It should be continued through the day of surgery to avoid withdrawal D. It is chemically similar to amphetamine

2. Which TWO drug-dosing pairings in the obese patient are correct?Select 2

A. Succinylcholine intubating dose — TBW B. Propofol induction — TBW C. Fentanyl — TBW D. Nondepolarizing muscle relaxants — IBW

3. Which TWO findings are classic for fat embolism syndrome?Select 2

A. Petechiae B. Urticaria C. Massive hematuria D. Dyspnea

4. Which TWO changes are expected with pneumoperitoneum?Select 2

A. Increased FRC B. Decreased lung compliance C. Caudad shift of the carina D. Increased peak inspiratory pressure

5. An OSA patient is at increased risk of postoperative hypoxemia. Which TWO strategies are specifically recommended?Select 2

A. Opioid-sparing techniques B. Mandatory nitrous oxide avoidance in PACU C. Routine Trendelenburg recovery D. Semi-upright positioning

6. In the beach chair position, which TWO statements are correct?Select 2

A. Cerebral perfusion is best estimated at the popliteal fossa B. Tourniquet pain is the most common cause of cerebral ischemia in this position C. The external auditory meatus is used as a reference point for cerebral perfusion pressure D. MAP at the brain may be significantly lower than MAP measured at the arm

7. Which TWO statements about tourniquet inflation are correct?Select 2

A. Tourniquet pain is usually mediated by A-alpha fibers B. Deflation commonly causes metabolic alkalosis C. Maximum recommended inflation time is 2 hours D. Typical inflation pressure is about 100 mmHg above systolic blood pressure

8. Which TWO signs are most consistent with bone cement implantation syndrome (BCIS)?Select 2

A. Increased EtCO₂ B. Severe hyperglycemia C. Hypotension D. Hypoxia

9. Which TWO are true of obesity hypoventilation syndrome (OHS)?Select 2

A. Patients often rely more on hypoxic drive for ventilation B. It is defined by BMI under 25 with nighttime apnea C. Diagnosis includes obesity plus awake hypercapnia D. These patients are less sensitive to respiratory depressant effects of anesthesia

10. Which TWO statements about CO₂ as the insufflation gas of choice are correct?Select 2

A. It is chosen because it causes less hypercarbia than room air B. It supports combustion better than helium C. It is nonflammable D. It is highly soluble in blood

11. Which TWO are characteristic of steep Trendelenburg?Select 2

A. Increased upper airway edema B. Decreased ICP C. Increased airway resistance D. Increased lung compliance

12. Which TWO findings are associated with metabolic syndrome?Select 2

A. HDL elevation as a diagnostic criterion B. Hypotension C. Elevated fasting glucose D. Central obesity

13. A patient in beach chair suddenly develops marked bradycardia and hypotension. Which TWO responses are appropriate?Select 2

A. Assume this is always due to local anesthetic systemic toxicity B. Deepen Trendelenburg further to improve surgical access C. Give hydration/vasopressors/anticholinergic therapy as indicated D. Treat for a possible Bezold-Jarisch reflex episode

14. Which TWO are risk factors for venous thromboembolism in orthopedic patients?Select 2

A. Immediate ambulation and no fracture B. Immobilization over 4 days C. Age over 60 years D. Procedures under 15 minutes

15. Which TWO are recommended ventilatory strategies during laparoscopy?Select 2

A. High tidal volume based on TBW for all obese patients B. Low tidal volume based on IBW C. Avoid recruitment maneuvers D. PEEP 5–10 cm H₂O

16. Which TWO statements about the fracture table are correct?Select 2

A. Pudendal nerve injury is a positioning risk B. It is primarily associated with atlantoaxial instability C. It eliminates all need for padding D. Common peroneal nerve injury is a positioning risk

17. Which TWO are true of rheumatoid arthritis from an airway standpoint?Select 2

A. Atlantoaxial subluxation is a concern B. Cricoarytenoid arthritis is unrelated to the airway C. Neck manipulation should be maximized to improve view D. Severe TMJ immobility can occur

18. Which TWO could contribute to hypercarbia during laparoscopy?Select 2

A. Endobronchial intubation B. Trendelenburg causing less CO₂ absorption than expected C. Hypothermia alone as the primary lecture cause D. Exhausted CO₂ absorber

19. Which TWO statements about respiratory physiology in obesity are correct?Select 2

A. Residual volume markedly increases in all patients B. Supine positioning increases FRC by 50% C. Closing capacity remains unchanged D. FRC decreases

20. Which TWO are true of robotic laparoscopy compared with conventional laparoscopy?Select 2

A. It eliminates pneumoperitoneum B. It removes the need for positioning concerns C. It provides a 3-dimensional view D. It improves dexterity/range of motion

21. Which TWO findings fit obstructive sleep apnea rather than normal sleep physiology?Select 2

A. Decreased pulmonary vascular resistance as the hallmark listed B. Hypoxemia C. Increased HDL as the hallmark listed D. Hypercapnia

22. Which TWO statements about laparoscopic entry complications are correct?Select 2

A. Midline entry primarily threatens only the epigastric artery B. Most bowel injuries are immediately obvious intraoperatively C. Major vascular injury has high mortality D. Over half of laparoscopy-related complications are related to Veress needle or primary trocar insertion

23. Which TWO are classic tourniquet deflation effects?Select 2

A. Marked decrease in serum lactate B. Increased pH C. Increased potassium D. Increased EtCO₂

24. Which TWO weight concepts are described correctly?Select 2

A. IBW equals total body weight in all obese patients B. LBW = IBW × 1.3 in the lecture C. PBW is identical to TBW D. TBW is the actual body weight

25. Which TWO are listed postoperative or long-term issues after bariatric surgery?Select 2

A. Vitamin deficiencies, especially fat-soluble vitamins and B12 B. Hyperthyroidism as the classic late complication C. GERD or dysphagia D. Routine spontaneous pneumothorax as the classic late complication

26. Which TWO are appropriate concerns for a patient with shoulder arthroscopy?Select 2

A. Beach chair positioning can reduce cerebral perfusion pressure B. A lower-extremity tourniquet is routinely the main concern C. VAE is a potential risk D. Pneumoperitoneum is mandatory for shoulder arthroscopy

27. Which TWO are true of aspiration risk in obesity?Select 2

A. Fasting obese patients are guaranteed to have gastric pH above 4 B. Increased GERD/hiatal hernia contributes C. Obesity eliminates concern for transient LES relaxation D. Delayed gastric emptying contributes

28. Which TWO changes are associated with steep Trendelenburg plus pneumoperitoneum?Select 2

A. Improved cerebral venous drainage B. Increased CVP C. Decreased MAP D. Increased ICP

29. Which TWO findings would make you think of subcutaneous emphysema / CO₂ extravasation during laparoscopy?Select 2

A. Immediate hypernatremia as the lecture hallmark B. Crepitus on exam C. Unexplained hypercarbia D. Sudden isolated mydriasis as the lecture hallmark

30. Which TWO anesthesia statements are correct when comparing OSA and obesity itself?Select 2

A. OSA eliminates need for postoperative pulse-ox monitoring B. Obesity itself is more strongly associated with rapid desaturation than with a definitively difficult airway C. OSA increases risk of pulmonary complications D. Obesity itself guarantees impossible mask ventilation

31. A male patient weighs 80 kg and has a BMI of 28. What is the patient’s approximate height?Single best answer

A. 1.82 m B. 1.69 m C. 1.55 m D. 1.95 m

32. Male patient height = 180 cm. Using the lecture formula IBW = height (cm) − 100, what is his IBW?Single best answer

A. 80 kg B. 85 kg C. 75 kg D. 70 kg

33. Using the IBW from the prior question, what is a 6 mL/kg tidal volume?Single best answer

A. 360 mL B. 540 mL C. 420 mL D. 480 mL

34. In beach chair, the head is 20 cm above the heart. What is the pressure correction?Single best answer

A. 15 mmHg B. 10 mmHg C. 12 mmHg D. 20 mmHg

35. Match complication to EtCO₂ change.Matching

Tourniquet deflation

BCIS

Fat embolism

Endobronchial intubation

36. Place laparoscopic insufflation steps in order. Put in order

A. CO₂ insufflation

B. Veress insertion

C. Additional trocars

D. Subumbilical incision

E. Primary trocar placement

37. Patient positioned on fracture table with perineal post. Most likely compressed nerve?Single best answer

A. Median B. Femoral C. Pudendal D. Radial

38. Patient on fracture table with fibular head compression. Most likely injured nerve?Single best answer

A. Obturator B. Sural C. Common peroneal D. Tibial

39. Match fiber type with block characteristics.Matching

Type A-alpha

Type B

Type C

40. Put compartment syndrome progression in order.Put in order

A. Ischemia/pain

B. Inflammation

C. Arterial restriction

D. Venous/lymph restriction

41. Which TWO increase ICP in robotic steep Trendelenburg?Select 2

A. Decreased cerebral venous drainage B. Decreased MAP C. Increased CVP D. Increased FRC

42. Female height = 170 cm. Using the lecture formula IBW = height − 105, what is her IBW?Single best answer

A. 60 kg B. 65 kg C. 75 kg D. 70 kg

43. Match positioning to classic complication.Matching

Beach chair

Prone

Steep Trendelenburg

44. Which TWO suggest hypercarbia from malignant hyperthermia rather than routine CO₂ absorption?Select 2

A. Mild isolated EtCO₂ rise after insufflation B. Progressive worsening despite ventilation changes C. Hypercarbia easily corrected by increased minute ventilation D. CO₂ not responsive to ventilation changes

45. Order the response when insufflation causes severe vagal bradycardia (HR suddenly drops from 70 to 32).Put in order

A. Reinflate abdomen

B. Deinsufflate abdomen

C. Consider atropine

D. Tell surgeon to stop

46. During an interscalene block hot-spot question, the roots most classically targeted are:Single best answer

A. T1–T4 B. C8–T2 C. C5–C7 D. C3–C5

47. Match weight scalar to drug.Matching

IBW

LBW

TBW

48. Which TWO favor phenylephrine over ephedrine in the phentermine patient with refractory hypotension?Select 2

A. Phenylephrine is direct-acting B. Ephedrine is preferred because it is purely direct acting C. Phentermine eliminates alpha receptor responsiveness D. Catecholamine depletion may blunt indirect-acting drug response

49. Order the progression of concern for severe untreated OHS.Put in order

A. Chronic hypoxemia

B. Pulmonary hypertension

C. Cor pulmonale

D. RV failure concern

50. Which TWO increase risk of subcutaneous emphysema during laparoscopy?Select 2

A. Increased number of ports B. Low intra-abdominal pressure C. High BMI as the classic risk factor D. Increased operative time

51. Match condition to likely ventilation concern.Matching

OSA

OHS

Steep Trendelenburg

Pneumoperitoneum

52. Male height = 190 cm. Using PBW = 50 + 0.91(height − 152.4), what is the closest answer?Single best answer

A. 74 kg B. 92 kg C. 84 kg D. 81 kg

53. Which TWO suggest BCIS rather than fat embolism?Select 2

A. Long-bone fracture within 72 hours B. Occurs around cementing time C. Decreased EtCO₂ D. Classic petechial rash

54. Rheumatoid arthritis airway hot spot: instability at C1–C2 refers to:Single best answer

A. Cricoarytenoid arthritis B. Odontoid fracture only C. Atlantoaxial subluxation D. TMJ ankylosis

55. Order the anesthetic response to suspected endobronchial intubation after insufflation.Put in order

A. Check breath sounds

B. Withdraw ETT if needed

C. Recognize cephalad carina shift risk

D. Confirm rising EtCO₂/PIP concern

56. Match position to surgical exposure.Matching

Reverse Trendelenburg

Trendelenburg

Lateral jackknife

57. Which TWO are classic nitrous oxide controversies in laparoscopy?Select 2

A. Prevents bowel distention B. May increase PONV C. Diffuses into closed air spaces D. Eliminates combustion concerns

58. Match complication to emergency action.Matching

Acute compartment syndrome

Refractory hypoxia during laparoscopy

Severe vagal bradycardia with insufflation

59. Which TWO are true regarding tourniquet pain?Select 2

A. Classically mediated by A-alpha motor fibers B. Usually relieved permanently by increasing MAC 0.2 alone C. Associated with C fibers D. Often begins about 60 minutes after inflation

60. Morbidly obese patient, robotic pelvic case, steep Trendelenburg, rising EtCO₂, increasing PIP, facial crepitus. Which TWO are MOST likely?Select 2

A. Immediate diagnosis is malignant hyperthermia B. This pattern excludes CO₂-related complications C. Endobronchial migration should still be considered D. Subcutaneous emphysema

61. Morbidly obese patient with OSA desaturates rapidly during induction. Which TWO best explain this?Select 2

A. Increased oxygen reserve B. Increased oxygen consumption C. Increased closing capacity is specifically listed as unchanged D. Reduced FRC

62. During cemented hip arthroplasty: sudden hypotension, hypoxia, falling EtCO₂. Which TWO concerns are most likely?Select 2

A. Acute hemorrhagic stroke B. Decreased cardiac output C. Bronchospasm alone as the sole explanation D. BCIS

63. Robotic pelvic case with severe steep Trendelenburg. At extubation, which TWO concerns are most important?Select 2

A. Delayed extubation may be prudent B. Immediate nitrous washout syndrome C. Decreased aspiration risk D. Airway edema

64. Order the physiologic sequence after tourniquet deflation.Put in order

A. Increased potassium

B. Increased EtCO₂

C. Decreased pH

D. Hypotension

65. Match complication to likely trigger.Matching

BCIS

Fat embolism

Vagal celiac reflex

Subcutaneous emphysema

66. RA patient for cervical surgery. Which TWO are major airway concerns?Select 2

A. Cricoarytenoid involvement B. Hypermobile TMJ C. Atlantoaxial instability D. Routine neck extension is preferred

67. Which TWO support possible endobronchial migration during laparoscopy?Select 2

A. Cephalad carina shift risk B. Falling BMI C. Rising PIP D. Increased HDL

68. Male height = 175 cm. Using PBW = 50 + 0.91(height − 152.4), what is the closest answer?Single best answer

A. 74 kg B. 78 kg C. 71 kg D. 66 kg

69. Which TWO favor fat embolism over BCIS?Select 2

A. Occurs only intraoperatively B. Petechiae C. Long-bone fracture history D. Cementing trigger

70. Manage refractory hypoxia in laparoscopy: put the steps in order.Put in order

A. Verify ETT

B. 100% oxygen

C. Deinsufflate

D. Neutral positioning

71. In an OHS patient, which TWO issues make opioids especially risky?Select 2

A. Increased ventilatory reserve B. Reduced hypercapnia risk C. Respiratory depressant sensitivity D. Hypoxic-drive issues

72. Match drug to dosing scalar.Matching

Propofol induction

Remifentanil

Sugammadex

73. Shoulder arthroscopy in beach chair. Which TWO are recognized risks?Select 2

A. Pneumoperitoneum injury B. VAE C. Tourniquet syndrome D. Reduced CPP

74. Which TWO are diagnostic components or criteria of metabolic syndrome?Select 2

A. Hypokalemia B. Decreased triglycerides C. Elevated fasting glucose D. Central obesity

75. Put compartment syndrome progression in order.Put in order

A. Pain

B. Inflammation

C. Venous restriction

D. Arterial restriction

76. Which TWO suggest malignant hyperthermia rather than routine CO₂ absorption?Select 2

A. CO₂ worsening despite ventilation changes B. Stable temperature and no progression as the primary concern C. Progressive unexplained hypercarbia D. Easily corrected hypercarbia

77. Fibular head compression most classically injures which nerve?Single best answer

A. Common peroneal B. Femoral C. Median D. Tibial

78. Which TWO increase aspiration risk in obesity?Select 2

A. GERD B. Decreased gastric volume C. Delayed gastric emptying D. Increased LES tone

79. Match position to concern.Matching

Prone

Beach chair

Steep Trendelenburg

80. Which TWO support CO₂ as the insufflation gas?Select 2

A. Supports combustion B. Lower molecular weight than all alternatives is the stated reason C. Soluble in blood D. Nonflammable

81. Tourniquet pain: which TWO are true?Select 2

A. A-alpha mediated B. Usually abolished by low-dose opioid alone C. Begins around 60 minutes D. C-fiber mediated

82. Steep Trendelenburg increases which TWO?Select 2

A. CVP B. Lung compliance C. Cerebral venous drainage D. ICP

83. Put the Veress sequence in order.Put in order

A. CO₂ insufflate

B. Incision

C. Veress needle

D. Primary trocar

84. Which TWO favor subcutaneous emphysema?Select 2

A. Decreased PIP only B. Immediate brady-asystole as the hallmark C. Crepitus D. Hypercarbia

85. Which TWO are true of obesity respiratory physiology?Select 2

A. Lung compliance increased B. Oxygen consumption reduced C. FRC reduced D. Supine worsens FRC

86. Match syndrome to classic clue.Matching

OSA

OHS

BCIS

87. Which TWO are true of robotic surgery?Select 2

A. Eliminates positioning issues B. Eliminates insufflation C. 3D visualization D. Improved dexterity

88. Obese patient + steep Trendelenburg + rising PIP + facial swelling. Which TWO major concerns fit best?Select 2

A. Reduced ICP B. CO₂ extravasation C. Improved FRC D. Airway edema

89. Which TWO distinguish the phentermine issue?Select 2

A. Phenylephrine may be preferred B. Continue on day of surgery C. Ephedrine is always preferred D. Stop 4–7 days preop

90. Morbidly obese patient, robotic prostatectomy, steep Trendelenburg, rising EtCO₂, falling compliance, facial crepitus, worsening airway pressures. Which TWO are MOST likely?Select 2

A. Diagnosis is automatically MH B. Endobronchial migration remains in differential C. This excludes CO₂-related complication D. Subcutaneous emphysema

Combined Mock Exam Master (90 Questions)

Block 1

Block 2

Block 3