PART 1 ARAB EXAM

MAY 2024
BY ZADA HAMAD AND BASEL ABDELFATTH
1. The superior surface of the epiglottis is innervated by the

A. Hypoglossal nerve

B. Recurrent laryngeal nerve

C. Internal branch of the superior laryngeal nerve

D. External branch of the superior laryngeal nerve

ANSWER: C

2. The pressure and volume per minute delivered from the central
hospital oxygen supply are

A. 2100 psi and 650 L/min

B. 1600 psi and 100 L/min

C. 75 psi and 100 L/min

D. 50 psi and 50 L/min

ANSWER: D

3. Which of the following drugs is able to cross the blood–brain

barrier?

A. Physostigmine

B. Neostigmine

C. Pyridostigmine

D. Glycopyrrolate

ANSWER: A

4. Which of the following antibiotics augments the action of

nondepolarizing muscle relaxants?

A. Penicillin

B. Cephalosporin

C. Erythromycin

D. Streptomycin

ANSWER: D

PAGE 1
5. Which of the following opioid-receptor agonists has anticholinergic
properties? A. Morphine

B. Hydromorphone

C. Sufentanil

D. Meperidine

ANSWER: D

6. Which of the following drugs is the most appropriate agent for

acute treatment of hypertension in a preeclamptic patient?

A. Magnesium

B. Labetalol

C. Lisinopril

D. Nitroglycerine

ANSWER: B

7. The shorter duration of action of remifentanil compared with

fentanyl is primarily due to its

A. Rapid redistribution

B. Renal elimination

C. Metabolism by esterases

D. Hepatic extraction ratio

ANSWER: C

8. The sinoatrial and the atrioventricular (AV) nodes are supplied in

majority of the individuals by

A. Left anterior descending artery

B. Right coronary artery

C. Circumflex artery

D. Posterior descending artery

ANSWER: B

PAGE 2
9. Which of the following inhalational agents causes the least
coronary

vasodilation?

A. Halothane

B. Isoflurane

C. Desflurane

D. Sevoflurane

ANSWER: D

10. Cerebral perfusion pressure (CPP) (mm Hg) in a patient with

intracranial pressure (ICP) of 12 mm Hg, central venous pressure
(CVP) of 15 mm Hg, and mean arterial pressure (MAP) of 70 mm Hg
will be (different numbers)

A. 58

B. 55

C. 52

D. 48

ANSWER: B

11. The only inhalational anesthetic that can cause an isoelectric EEG
among the following is

A. Isoflurane

B. Halothane

C. Enflurane

D. Nitrous oxide

ANSWER: A

12. A 78-year-old patient with Parkinson disease under goes a cataract

operation under general anesthesia. In the recovery room, the patient has
two episodes of emesis and complains of severe nausea. Which of the
following antiemetics would be the best choice for treatment of nausea in
this patient?

A. Droperidol

PAGE 3
B. Promethazine

C. Ondansetron

D. Metoclopramid

ANSWER: C

13. The patient is administered hydromorphone intravenously, and 20

minutes later is feeling well with minimal pain complaints. At this
time, his postoperative laboratories have returned, revealing a serum
sodium value of 130 mEq/L. The most appropriate next step in the
management of his hyponatremia is

A. Hypertonic saline infusion

B. Fluid restriction

C. Demeclocycline administration

D. Insulin and glucose administration

ANSWER: B

14. The correct respiratory physiologic change associated with

pregnancy is

A. Increase in arterial Ph

B. Increase in HCO3

C. Increase in PaCO2

D. Increase in tidal volume

ANSWER: D

15. Urine output in a 6-year-old child undergoing surgery under

general anesthesia should be ______ (mL/kg/h):

A. 0.5

B. 1

C. 1.5

D. 2

ANSWER: B

PAGE 4
16. What percent desflurane is present in the vaporiz ing chamber of
a desflurane vaporizer (pressurized to 1500 mm Hg and heated to 23°
C)?

A. Nearly 100%

B. 85%

C. 65%

D. 45%

ANSWER: D

17. The pressure gauge on a size “E” compressed-gas cylinder

containing O2 reads 1600 psi. How long O2 could be delivered from
this cylinder at a rate of 2 L/min?

A. 90minutes

B. 140minutes

C. 250minutes

D. 320minutes

ANSWER: C

18. If the anesthesia machine is discovered Monday morn ing to have

run with 5 L/min of oxygen all weekend long, the most reasonable
course of action before ad ministering the next anesthetic would be to

A. Administer 100% oxygen for the first hour of the next case

B. Place humidifier in line with the expiratory limb

C. Avoid use of sevoflurane

D. Change the CO2 absorbent

ANSWER: D

19. Kinking or occlusion of the transfer tubing from the patient’s

breathing circuit to the closed scavenging system interface can result
in

A. Barotrauma

B. Hypoventilation

PAGE 5
C. Hypoxia

D. Hyperventilation

ANSWER: A

20. During normal laminar airflow, resistance is dependent on which

characteristic of oxygen?

A. Density

B. Viscosity

C. Molecular weight

D. Temperature

ANSWER: B

21. What is the O2 content of whole blood if the hemoglobin

concentration is 10 g/dL, the Pao2 is 60 mm Hg, and the Sao2 is 90%?

A. 10mL/Dl

B. 12.5mL/dL

C. 15mL/dL

D. 17.5mL/dL

ANSWER: B

22. An acute increase in Paco2 of 10 mm Hg will result in a decrease

in pH of

A. 0.01 pH unit

B. 0.02 pH unit

C. 0.04 pH unit

D. 0.08 pH unit

ANSWER: D

23. The anatomic dead space in a 70-kg man is

A. 50mL

B. 150mL

PAGE 6
C. 250mL

D. 500mL

ANSWER: B

24. Sedation with which of the following drugs is most likely to

resemble normal sleep?

A. Propofol

B. Midazolam

C. Dexmedetomidine

D. Ketamine

ANSWER: C

25. Which of the following intravenous anesthetics is converted from a

water-soluble to a lipid-soluble drug after exposure to the
bloodstream?

A. Propofol

B. Midazolam

C. Ketamine

D. None of the above

ANSWER: B

26. Which of the following vasopressor agents increases systemic

blood pressure (BP) indirectly by stimulating the release of
norepinephrine from sympathetic nerve fibers and directly by binding
to adrenergic receptors?

A. Vasopressin

B. Ephedrine

C. Epinephrine

D. Phenylephrine

ANSWER: B

PAGE 7
27. When one of four thumb twitches in the train-of-four (TOF)
stimulation of the ulnar nerve can be elicited, how much suppression
would there be if you were measuring a single twitch?

A. 20 to 25

B. 45 to 55

C. 75 to 80

D. 90 to 95

ANSWER: D

28. Which of the following muscle relaxants causes slight histamine

release at two to three times the ED95 (effective dose in 95% of
subjects) dose?

A. Rocuronium

B. Pancuronium

C. Atracurium

D. Cisatracurium

ANSWER: C

29. The incidence of unpleasant dreams associated with emergence

from ketamine anesthesia can be reduced by the administration of

A. Caffeine

B. Droperidol

C. Physostigmine

D. Midazolam

ANSWER: D

30. If Etomidate were accidentally injected into a left- sided radial

arterial line, the most appropriate step to take would be

A. Left stellate ganglion block

B. Administer intra-arterial clonidine

C. Slowly inject dilute (0.1 mEq/L) [HCO3–]

PAGE 8
D. Observe

ANSWER: D

31. What percentage of neuromuscular receptors could be blocked

and still allow patients to carry out a 5-second head lift?

A. 5%

B. 15%

C. 25%

D. 50%

ANSWER: D

32. The action of succinylcholine at the neuromuscular junction is

terminated by which mechanism?

A. Hydrolysis by pseudocholinesterase

B. Diffusion into extracellular fluid

C. Reuptake into nerve tissue

D. Reuptake into muscle tissue

ANSWER: B

33. The main disadvantage of Sugammadex (ORG 25969) compared

with neostigmine is

A. Recurarization

B. Contraindicated with renal failure

C. Not effective with benzylisoquinolinium relaxants

D. High incidence of allergic reactions

ANSWER: C

34. A 35-year-old patient with a history of grand mal seizures is anesthetized

for thyroid biopsy under general anesthesia consisting of 4 mg midazolam
with infusion of Propofol (150 μg/kg/min) and Remifentanil (1 μg/ kg/min).
The patient takes phenytoin for control of seizures. After 30 minutes, the
infusion is stopped and the patient is transported intubated to the recovery
room where he is arousable, but not breathing. The most reasonable course
of action would be

PAGE 9
A. Administer naloxone

B. Administer flumazenil

C. Administer naloxone and flumazenil

D. Ventilate by hand

ANSWER: D

35. In the adult, the liver is the primary organ for

A. Hemoglobin synthesis

B. Hemoglobin degradation

C. Factor VIII synthesis

D. Antithrombin III synthesis

ANSWER: D

36. Anticoagulation with low-molecular-weight heparin (LMWH) can be best

monitored through which of the following laboratory tests?

A. Activated partial thromboplastin time (aPTT)

B. Anti-Xa assay

C. Thrombin time

D. Reptilase test

ANSWER: B

37. Which of the following peripheral nerves is MOST likely to become

injured in patients who are under general anesthesia?

A. Ulnar nerve

B. Median nerve

C. Radial nerve

D. Common peroneal nerve

ANSWER: A

38. The spinal cord of newborns extends to the

A. L1 vertebra

PAGE 10
B. L2-L3 vertebrae

C. L4-L5 vertebrae

D. S1 vertebra

ANSWER: B

39. A Eutectic Mixture of Local Anesthetics (EMLA) cream is a mixture of

which local anesthetics?

A. Lidocaine 2.5% and prilocaine 2.5%

B. Lidocaine 2.5% and benzocaine 2.5%

C. Prilocaine 2% and benzocaine 2%

D. Lidocaine 4%

ANSWER: A

40. Which of the following drugs does NOT pass the placenta easily?

A. Etomidate

B. Ephedrine

C. Atropine

D. Glycopyrrolate

ANSWER: D

41. Calculate cerebral perfusion pressure from the follow ing data: blood
pressure (BP) 100/70, heart rate (HR) 65 beats/min, and ICP 15 mm Hg.

A. 60 mm Hg

B. 65 mm Hg

C. 70 mm Hg

D. 75 mm Hg

ANSWER: B

42.For each 1° C decrease in body temperature, how much

will CMRO2 be diminished?
A. 3%

PAGE 11
B. 5%

C. 6%

D. 10%

ANSWER: C

43. The CBF autoregulatory curve is shifted to the right by

A. Hypoxia

B. Volatile anesthetics

C. Hypercarbia

D. Chronic hypertension

ANSWER: D

44. Autoregulation is abolished by

A. Hyperbaric oxygen

B. Cardiopulmonary bypass with a core temperature of 27° C

C. Chronic hypertension

D. 3% Isoflurane

ANSWER: D

45. The “snap” felt just before entering the epidural space represents
passage through which ligament?

A. Posterior longitudinal ligament

B. Ligamentum flavum

C. Supraspinous ligament

D. Interspinous ligament

ANSWER: B

46. The stellate ganglion lies in closest proximity to which of the

following vascular structures? (In exam asked about lateral)

A. Common carotid artery

B. Internal carotid artery

PAGE 12
C. Vertebral artery

D. Aorta

ANSWER: C

47. A 69-year-old man with a history of diabetes mellitus and chronic

renal failure is to undergo placement of a dialysis fistula under
regional anesthesia. During nee dle manipulation for a supraclavicular
brachial plexus block, the patient begins to cough and complain of
chest pain and shortness of breath. The MOST likely diagnosis is

A. Angina

B. Pneumothorax

C. Phrenic nerve irritation

D. Intravascular injection of local anesthetic

ANSWER: B

48. A healthy 27-year-old woman stepped on a nail and is to undergo

débridement of a wound on her right great toe. She is anxious about
general anesthesia but agrees to an ankle block with mild sedation.
Which nerves must be adequately blocked in order to perform the
surgery?

A. Deep peroneal, posterior tibial, saphenous, sural

B. Deep peroneal, saphenous, superficial peroneal, sural

C. Deep peroneal, posterior tibial, superficial peroneal, sural

D. Deep peroneal, superficial peroneal, posterior tibial, saphenous

ANSWER: D

49. Which section of the brachial plexus is blocked with a

supraclavicular block?

A. Roots/trunks

B. Trunks/divisions

C. Cords

D. Branches

PAGE 13
ANSWER: B

50. Which of the following would hasten the onset and increase the
clinical duration of action of a local an esthetic, and provide the
GREATEST depth of mo tor and sensory blockade when used for
epidural anesthesia?

A. Increasing the volume of local anesthetic

B. Increasing the concentration of local anesthetic

C. Increasing the dose

D. Placing the patient in the head-down position

ANSWER: C

51. The reason that Ropivacaine is marketed as pure S enantiomers is

because the S form is associated with

A. Increased potency

B. Longer duration

C. Reduced cardiac toxicity

D. Reduced incidence of anaphylaxis

ANSWER: C

52. Accidental injection of air into a peripheral vein would be LEAST

likely to result in arterial air embolism in a patient with which of the
following anatomic cardiac defects?

A. Patent ductus arteriosus

B. Eisenmenger syndrome

C. Tetralogy of Fallot

D. Tricuspid atresia

ANSWER: A

53. Hypothyroidism and hyperthyroidism could develop in patients

receiving which of the following anti dysrhythmic drugs?

A. Amiodarone

B. Verapamil

PAGE 14
C. Procainamide

D. Lidocaine

ANSWER: A

54. In a normal person, what percentage of the cardiac output is

dependent on the “atrial kick”?

A. 25%

B. 35%

C. 45%

D. 55%

ANSWER: A

55. Normal resting myocardial O2 consumption is

A. 2.0 mL/100 g/min

B. 3.5 mL/100 g/min

C. 8 mL/100 g/min

D. 15 mL/100 g/min

ANSWER: C

56. Normal resting coronary artery blood flow is

A. 10 mL/100 g/min

B. 40 mL/100 g/min

C. 75 mL/100 g/min

D. 120 mL/100 g/min

ANSWER: C

57. Which of the following terms refers to myocardial relaxation or

diastole?

A. Inotropy

B. Chronotropy

C. Dromotropy

PAGE 15
D. Lusitropy

ANSWER: D

58. A 45-year-old patient with hypertrophic cardio myopathy is

anesthetized for skin grafting after suffering third-degree burns on his
legs. As skin is harvested from his back, his heart rate rises and his
systolic blood pressure falls to 85 mm Hg. Which of the following
interventions is LEAST likely to improve this patient’s hemodynamics?

A. Administration of esmolol

B. Fluid bolus

C. Dobutamine infusion

D. Administration of sufentanil

ANSWER: C

59. Normal or increased PR interval, short QT interval

A. Hypokalemia

B. Hyperkalemia

C. Hyponatremia

D. Hypercalcemia

ANSWER: D

60. Left ventricular end diastolic pressurs is Most closely

approximated by:

A. arterial blood pressure

B. central venous pressure

C. pulmonary artery systolic pressure

D. pulmonary capillary wedge pressure

E. right atrial pressure

ANSWER: D

61. The first-pass effect refers to

(A) the biotransformation of a drug in its vehicle of administration

PAGE 16
(B) the change of a drug by enzymes in muscle

(C) biotransformation of a drug as it passes through the intestinal mucosa

and liver

(D) the drug lost by urinary excretion

(E) the drug lost by fecal excretion

ANSWER: C

62. An expected cardiovascular change after ketamine administration

is

(A) elevated diastolic pressure, normal systolic pressure

(B) elevated diastolic and systolic pressure

(C) decreased diastolic and systolic pressure

(D) decreased diastolic pressure, increased systolic pressure

(E) no change in blood pressure

ANSWER: B

63. The normal bony vertebral column is made up of how many total
vertebrae?

(A) 27

(B) 29

(C) 31

(D) 33

(E) 35

ANSWER: D

64. Which one of the following is the most common cause of severe
postpartum hemorrhage?

(A) Lacerations

(B) Retained placental tissue

(C) Coagulopathy

(D) Uterine atony

PAGE 17
(E) Uterine inversion

ANSWER: D

65. In order for an epidural to relieve the second stage of

labor, the epidural must cover which one of these
dermatomes?
(A) T10-L1

(B) T11-T12

(C) L2-L4

(D) L3-L5

(E) S2-S4

ANSWER: E

66. How many minutes after an intravenous injection does the brain
concentration of propofol peak:

A. 1

B. 4

C. 6

D. 8

E. 11

ANSWER: A

67. When diaphragm function is impaired in patients with cervical

spinal cord transection, which of the following act as primary
inspiratory muscles:

A. Intercostal muscles

B. Cervical strap muscles

C. Abdominal muscles

D. Intervertebral muscles of the shoulder girdle

E. Sternocleidomastoid muscles

ANSWER: B

PAGE 18
68. Which of the following statements is FALSE about the CO2
diffusing capacity of the lungs (DLCO) (Not the same question)

A. Decreased hemoglobin concentration decreases the DLCO.

B. DLCO values increase two to three times normal during exercise.

C. DLCO is decreased in obstructive disease states.

D. Decreased alveolar PCO2 increases DLCO.

E. Low DLCO is related to loss of lung volume or capilary bed perfusion

ANSWER: D

69. The involuntary myoclonus seen during induction with etomidate

is:

A. not associated with cortical seizure activity

B. unaffected by prior administration of opioid analgesics

C. unaffected by prior administration of benzodiazepines

D. extremely uncommon

E. best treated with intravenous phenytoin

ANSWER: A

70. Which of the following laboratory tests would be most useful in the
assessment of acute hepatic synthetic f u n c t i o n?

A. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST)

B. Serum bilirubin

C. Serum albumin

D.Prothrombintime

E. Alkaline phosphatase

ANSWER: D

71. Most common location of Carcinoid tumor: ilium vs. duodenum

72. Cardiovascular changes of obese woman: Increased cardiac output

PAGE 19
73. Morbid obesity: ASA 3

74. Hyperparathyroidism causes Activation of osteoclast

75. Calculate Anion Gap: 19

76. Oxyhemoglobin Dissociation Curve shift to the left: when blood go

through Pulmonary circulation

77. One of the following suggest difficult airway: Unable to reach the chest

78. Changes in pregnancy: Anemia

79. Herniated disc: L5

80. Osmoregulation not Volume-regulation: Thirst

81. About Isoflurane true: Maintain stable cardiac rhythm

82. A question cerebral blood flow: ACE-i

83. A question about Glycopyrrolate: longer duration vs. tachycardia

84. Diazepam and Midazolam: half-life shorter

85. About protein channels: Glucose and amino acids

86. Resting membrane potential: K out of cells

87. Bone cement: Ventricular arrhythmias

88. Fat embolism: 72 hours

89. MgSO4 Potentiate NMB

90. Bronchus intubation: Increase peak pressure

91. A question about oxygen Peripheral: 16% O2 of Air

92. Diaphragm and adductor pollicis: More sensitive to NDMR

93. Epidural: Increase risk of instrumental delivery

94. About pRBCs: pH of blood 7.1

95. Jackson rees: 3 * flow

96. High cardiac risk: Decompensated HF

97. Pregnant with new onset Left axis deviation: Normal physiological
changes

PAGE 20
98. Vaporizer

99. Resting Tidal Volume: 6ml/kg

100. ECG question: Mobitz 2

101. Steady-state in infusion: pKa

102. Epidural: Reassurance

103. Most Cardiotoxic: Bubvicaine

104. Naloxone not given for: PONV

105. Thyroid causes hypercalcemia

106. PDA closure: Increased PaO2

107. Metabolic alkalosis: NG tube

108. Chronic HTN: Decrease sympathetic response

109. From apex to base changes: Increase Chest compliance

110. Laparoscopic surgery for obese:

111. Tramadol: Inhibits reuptake Serotonin and norepinephrine

112. About benzodiazepines: CNS receptors

113. Muscular rigidity: Naloxone?

114. MgSO4: respiratory depression

115. Metabolism Isoflurane

116. Flourine ions: Inrcrease metabolism

117. Lower motor neuron lesion: ?

118. Highly ionized drug: excreted by kidney

119. Mesentric and myentric : sympathetic and parasympathetic

120. Least volume CSF

121. Autonomic hyperreflexia: Irrigation

122. Pancuronium: inhibition of reuptake of norepinephrine

123. Physiologic antagonism

PAGE 21
124. Phase 2 antagonize anticholinesterase-i

125. APL and expiratory valve

126. O2 flush causes patient awareness

127. Fail valve

128. Affects emergence: solubility

129. Flumazenil side effect: Nausea and vomiting

130.

131. EF 50 – 55%

132. MAC decrease in 2 and 3 trimester

133. Mechanism of decreasing ICP: Shifting of CSF to spinal

134. Asthma : PaCo2 60

135.

PAGE 22
PAGE 23
PAGE 24
PAGE 25