, CHAPTER LIST
Chapter 1: Sleep Related Breathing Disorders
Chapter 2: Anesthetic Considerations for Obstructive Lung Disease
Chapter 3: Restrictive Respiratory Diseases and Lung Transplantation
Chapter 4: Ischemic Heart Disease
Chapter 5: Valvular Heart Disease
Chapter 6: Congenital Heart Disease
Chapter 7: Abnormalities of Cardiac Conduction and Cardiac Rhythm
Chapter 8: Systemic and Pulmonary Arterial Hypertension
Chapter 9: Heart Failure and Cardiomyopathies
Chapter 10: Pericardial Disease and Cardiac Trauma
Chapter 11: Vascular Disease
Chapter 12: Diseases Affecting the Brain
Chapter 13: Disorders of the Spine and Spinal Cord
Chapter 14: Diseases of the Autonomic and Peripheral Nervous Systems
Chapter 15: Diseases of Aging
Chapter 16: Diseases of the Liver and Biliary Tract
Chapter 17: Inborn Errors of Metabolism
Chapter 18: Nutritional Diseases: Obesity and Malnutrition
Chapter 19: Fluid, Electrolyte, and Acid Base Disorders
Chapter 20: Renal Disease
Chapter 21: Endocrine Disease
Chapter 22: Hematologic Disorders
Chapter 23: Skin and Musculoskeletal Diseases
Chapter 24: Infectious Diseases
Chapter 25: Diseases Related to Immune System Dysfunction
Chapter 26: Cancer
Chapter 27: Psychiatric Disease, Substances Use Disorder and Drug Overdose
Chapter 28: Anesthetic Considerations for Adults with Substance Use Disorder or Acute Intoxication
Chapter 29: Pediatric Diseases
Chapter 30: Medical Disorder in Pregnancy
Chapter 31: Chronic Pain
Chapter 32: The Critically Injured Patient
,Chapter 1: Sleep Related Breathing Disorders
--- Recall ---
1. According to the American Academy of Sleep Medicine criteria, which Apnea-Hypopnea Index (AHI) range
defines moderate obstructive sleep apnea?
A. 5 to 14 events per hour
B. 31 to 45 events per hour
C. 15 to 30 events per hour
D. Greater than 50 events per hour
2. Which minimum score on the 8-item STOP-BANG questionnaire indicates a high risk for moderate-to-severe
obstructive sleep apnea?
A. 2
B. 5
C. 3
D. 7
3. Obesity hypoventilation syndrome is formally defined by a body mass index of at least 30 kg/m² combined with
which daytime arterial blood gas finding in the absence of other hypoventilatory causes?
A. PaO2 less than 50 mmHg
B. Daytime PaCO2 greater than 45 mmHg
C. Base excess greater than +8 mEq/L
D. Arterial pH less than 7.30
4. What is the primary pathophysiologic mechanism distinguishing central sleep apnea from obstructive sleep
,apnea during polysomnography?
A. Pharyngeal collapsibility during inspiratory effort
B. Temporary cessation of neural respiratory drive with absent ventilatory effort
C. Retrognathia causing mechanical tongue base displacement
D. Intrinsic laryngospasm triggered by gastroesophageal reflux
5. Chronic intermittent nocturnal hypoxia in patients with severe obstructive sleep apnea most commonly
produces which pulmonary vascular consequence?
A. Chronic pulmonary venous desaturation without vascular remodeling
B. Pulmonary artery endothelial atrophy
C. Pulmonary vasoconstriction leading to pulmonary arterial hypertension
D. Progressive decrease in pulmonary vascular resistance
6. According to the ASA Practice Guidelines for the Perioperative Management of Patients with OSA, which factor is
considered a major component in assigning a patient's perioperative risk score?
A. History of prior general endotracheal anesthesia
B. Patient preference for regional versus general anesthesia
C. Preoperative serum blood urea nitrogen level
D. Requirement for postoperative opioid analgesia
--- Application ---
7. A 52-year-old man with severe OSA (AHI 42 events/hr) compliant with nocturnal CPAP presents for elective
laparoscopic cholecystectomy. Which instruction regarding his CPAP equipment is most appropriate?
A. Discontinue CPAP use for 48 hours preoperatively to assess baseline ventilation
B. Bring his personal CPAP machine and properly fitted mask to the surgical center on the day of surgery
C. Use CPAP only if supplemental oxygen fails to maintain SpO2 above 92% in the PACU
D. Switch to daytime supplemental oxygen via nasal cannula in place of nocturnal CPAP
8. A 48-year-old woman with morbid obesity (BMI 44 kg/m²) and high-risk STOP-BANG score is positioned for
,induction of general anesthesia. Which patient positioning strategy best optimizes preoxygenation and
laryngoscopy?
A. Strict flat supine position with cervical hyperextension
B. Trendelenburg position at 15 degrees
C. Ramped position aligning the external auditory meatus with the sternal notch
D. Left lateral decubitus position with head elevated 10 degrees
9. A 58-year-old man with severe OSA undergoes an open umbilical hernia repair under general anesthesia. Which
analgesic regimen best minimizes the risk of postoperative respiratory depression?
A. Intravenous patient-controlled analgesia (IV-PCA) with continuous background hydromorphone infusion
B. High-dose intraoperative fentanyl boluses with PRN intramuscular meperidine postoperatively
C. Intravenous morphine boluses titrated exclusively by scheduled respiratory rate
D. Multimodal regimen combining surgical field local infiltration, intravenous acetaminophen, and ketorolac
with minimal rescue oral opioids
10. A patient with newly diagnosed severe OSA and no prior CPAP experience undergoes an uneventful superficial
lumpectomy under local anesthesia with light oral sedation in an ambulatory surgical center. Which criterion most
strongly supports discharge home versus admission?
A. Maintenance of room-air oxygen saturation at baseline while asleep in an unassisted environment
B. Ability to tolerate a full regular solid meal in the PACU
C. Absence of pain without the administration of any oral non-opioid medications
D. Fulfilling a mandatory 12-hour observation period regardless of surgical invasiveness
11. A 60-year-old male with severe OSA is undergoing total knee arthroplasty. Which anesthetic technique is most
advantageous for reducing his perioperative pulmonary complication risk?
A. General endotracheal anesthesia with high-dose remifentanil infusion
B. General anesthesia maintained with deep sevoflurane and native airway spontaneous ventilation
C. Spinal anesthesia combined with peripheral nerve blocks and minimal conscious sedation
D. Intravenous ketamine infusion as the sole anesthetic without regional anesthesia
,12. During emergence from general anesthesia in a patient with known severe OSA and anticipated difficult
airway, which extubation strategy is safest?
A. Extubation in a deep plane of anesthesia to prevent coughing and hemodynamic surges
B. Extubation only when fully awake, responding to commands, with reversed neuromuscular blockade and in a
head-elevated position
C. Immediate extubation in the flat supine position followed by immediate administration of high-dose
intravenous fentanyl
D. Extubation under nitrous oxide sedation with placement of a soft nasal trumpet
13. A 45-year-old man with untreated severe OSA presents for an urgent open appendectomy. Which
intraoperative medication choice represents an appropriate opioid-sparing adjuvant to attenuate airway reactivity
and postoperative pain?
A. High-dose oral diazepam premedication
B. Continuous background morphine infusion
C. Intermittent intravenous droperidol boluses
D. Dexmedetomidine infusion
14. In the PACU, an un-intubated patient with moderate OSA who received intravenous hydromorphone develops
repetitive episodes of airway obstruction and desaturation to 86% on 2 L/min nasal cannula. What is the
immediate first-line management step?
A. Administer 2 mg intravenous midazolam to reduce agitation
B. Increase nasal cannula oxygen flow to 10 L/min without airway repositioning
C. Apply positive airway pressure (CPAP) via properly fitting mask and stimulate the patient to wake
D. Place the patient in a strict flat supine position and administer nebulized albuterol
15. A 62-year-old man with severe OSA (AHI 55) is recovering in the PACU after an open radical prostatectomy
requiring intravenous opioid PCA. According to ASA guidelines, what is the most appropriate postoperative
disposition?
A. Admission to a step-down unit or monitored bed with continuous pulse oximetry and respiratory monitoring
B. Immediate discharge home after 60 minutes if alert and tolerating clear liquids
, C. Transfer to an unmonitored general surgical ward without pulse oximetry
D. Routine transfer to the intensive care unit with mandatory 24-hour mechanical ventilation
16. A 38-year-old woman with severe OSA presents for elective outpatient laparoscopic tubal ligation.
Preoperatively, she is anxious. Which premedication strategy is most prudent?
A. 10 mg oral diazepam and 100 mcg oral fentanyl
B. Non-pharmacologic reassurance and avoidance of routine high-dose preoperative sedative-hypnotics
C. 4 mg intravenous midazolam administered in the unmonitored holding area
D. 50 mg intramuscular meperidine and 25 mg promethazine
--- Analysis ---
17. An arterial blood gas drawn from a 56-year-old man with BMI 48 kg/m² on room air reveals: pH 7.36, PaCO2
54 mmHg, PaO2 61 mmHg, HCO3- 30 mEq/L. What is the primary clinical interpretation of these data?
A. Acute uncompensated respiratory acidosis typical of acute asthma
B. Primary metabolic alkalosis with compensatory alveolar hypoventilation
C. Normal arterial blood gas parameters for an obese adult
D. Chronic compensated respiratory acidosis consistent with obesity hypoventilation syndrome
18. A preoperative polysomnography report for a 50-year-old surgical candidate reveals: total sleep time 360 min,
total obstructive apneas 120, total hypopneas 90, lowest nocturnal SpO2 72%, oxygen desaturation index (ODI)
34/hr. What is the calculated AHI and corresponding severity classification?
A. AHI 35 events/hr; Severe OSA
B. AHI 15 events/hr; Mild OSA
C. AHI 25 events/hr; Moderate OSA
D. AHI 55 events/hr; Severe OSA
19. Which preoperative finding on 12-lead electrocardiogram in a patient with longstanding untreated severe OSA
most strongly suggests secondary pulmonary vascular disease and right ventricular strain?
A. Tall, peaked T waves across leads V2 to V4
, B. Left axis deviation with ST-segment depression in lead aVL
C. Right bundle branch block with right axis deviation and tall peaked P waves in lead II (P pulmonale)
D. Delta waves with shortened PR interval
20. Which medication is **LEAST** appropriate for postoperative analgesia in an ambulatory patient with severe
OSA and known baseline hypoxemia following laparoscopic hernia repair?
A. Intravenous ketorolac
B. Patient-controlled intravenous morphine with continuous basal infusion
C. Intravenous acetaminophen
D. Transversus abdominis plane (TAP) block with bupivacaine
21. In a PACU patient with severe OSA recovering from open abdominal surgery, which pattern of oxygenation and
ventilation on continuous capnography and pulse oximetry indicates impending severe opioid-induced ventilatory
failure?
A. Normal ETCO2 waveform with transient isolated desaturation during swallowing
B. Hyperventilation with ETCO2 decreasing from 40 mmHg to 28 mmHg
C. Stable respiratory rate of 16 breaths/min with sudden isolated artifactual pulse oximeter drop
D. Rising end-tidal CO2 with progressive bradypnea and cyclical prolonged obstructive apneas
--- True/False ---
22. Administration of high-flow supplemental oxygen via nasal cannula completely eliminates the risk of fatal
respiratory arrest in postoperative patients with severe obstructive sleep apnea who receive systemic opioids.
23. Patients with diagnosed obstructive sleep apnea who consistently use their prescribed nocturnal CPAP device
have a significantly lower incidence of perioperative cardiovascular and respiratory complications compared to
untreated OSA patients.
--- Fill-in-the-Blank ---
24. In the STOP-BANG screening questionnaire, the high-risk cutoff for neck circumference is greater than _______
,inches in male patients.
25. On diagnostic polysomnography, severe obstructive sleep apnea is defined by an Apnea-Hypopnea Index
greater than _______ events per hour.
--- Matching ---
26. Match each sleep-disordered breathing condition or diagnostic tool in Column A to its definitive clinical or
diagnostic characteristic in Column B.
Match each item in Column A to the single best corresponding item in Column B.
Column A (Match This) Column B (Choose From)
1. Mild Obstructive Sleep Apnea A. Absence of respiratory effort and airflow during
sleep
2. Moderate Obstructive Sleep Apnea B. BMI ≥ 30 kg/m² with daytime awake PaCO2 >
45 mmHg
3. Obesity Hypoventilation Syndrome C. AHI 5 to 14 events per hour
4. Central Sleep Apnea D. AHI 15 to 30 events per hour
E. Epworth Sleepiness Scale score < 4
F. AHI > 50 events per hour with isolated daytime
hypocapnia
27. Match each perioperative pharmacological agent in Column A to its appropriate clinical role in patients with
obstructive sleep apnea in Column B.
Match each item in Column A to the single best corresponding item in Column B.
, Column A (Match This) Column B (Choose From)
1. Dexmedetomidine A. High-risk analgesic modality contraindicated in
unmonitored OSA patients
2. Ketorolac B. Selective relaxant binding agent ensuring rapid,
complete reversal of rocuronium
3. Continuous Morphine Basal PCA C. Alpha-2 agonist providing sedation and
analgesia without respiratory depression
4. Sugammadex D. Non-steroidal anti-inflammatory reducing
systemic opioid requirements
E. Potent mu-opioid agonist used as first-line
sedative in outpatient holding
F. Inhaled pulmonary vasodilator for acute
bronchospasm
--- Case Study / Scenario ---
28. A 54-year-old male with a BMI of 46 kg/m², untreated severe OSA (STOP-BANG score 7/8), and systemic
hypertension presents for an elective open ventral hernia repair. During preoperative airway assessment, he is
noted to have a Mallampati class IV airway, thyromental distance of 5.5 cm, and a 19-inch neck circumference.
(a) Which preoxygenation and patient positioning strategy should be executed prior to anesthetic induction?
(b) Which airway management technique is most appropriate for establishing an endotracheal airway in this
patient?
(c) What intraoperative and emergence anesthetic strategies should be implemented to minimize postoperative
airway compromise?
29. A 61-year-old female with diagnosed severe OSA (AHI 48 events/hr, noncompliant with home CPAP due to
claustrophobia) and daytime hypersomnolence undergoes an elective laparoscopic hysterectomy under general
Chapter 1: Sleep Related Breathing Disorders
Chapter 2: Anesthetic Considerations for Obstructive Lung Disease
Chapter 3: Restrictive Respiratory Diseases and Lung Transplantation
Chapter 4: Ischemic Heart Disease
Chapter 5: Valvular Heart Disease
Chapter 6: Congenital Heart Disease
Chapter 7: Abnormalities of Cardiac Conduction and Cardiac Rhythm
Chapter 8: Systemic and Pulmonary Arterial Hypertension
Chapter 9: Heart Failure and Cardiomyopathies
Chapter 10: Pericardial Disease and Cardiac Trauma
Chapter 11: Vascular Disease
Chapter 12: Diseases Affecting the Brain
Chapter 13: Disorders of the Spine and Spinal Cord
Chapter 14: Diseases of the Autonomic and Peripheral Nervous Systems
Chapter 15: Diseases of Aging
Chapter 16: Diseases of the Liver and Biliary Tract
Chapter 17: Inborn Errors of Metabolism
Chapter 18: Nutritional Diseases: Obesity and Malnutrition
Chapter 19: Fluid, Electrolyte, and Acid Base Disorders
Chapter 20: Renal Disease
Chapter 21: Endocrine Disease
Chapter 22: Hematologic Disorders
Chapter 23: Skin and Musculoskeletal Diseases
Chapter 24: Infectious Diseases
Chapter 25: Diseases Related to Immune System Dysfunction
Chapter 26: Cancer
Chapter 27: Psychiatric Disease, Substances Use Disorder and Drug Overdose
Chapter 28: Anesthetic Considerations for Adults with Substance Use Disorder or Acute Intoxication
Chapter 29: Pediatric Diseases
Chapter 30: Medical Disorder in Pregnancy
Chapter 31: Chronic Pain
Chapter 32: The Critically Injured Patient
,Chapter 1: Sleep Related Breathing Disorders
--- Recall ---
1. According to the American Academy of Sleep Medicine criteria, which Apnea-Hypopnea Index (AHI) range
defines moderate obstructive sleep apnea?
A. 5 to 14 events per hour
B. 31 to 45 events per hour
C. 15 to 30 events per hour
D. Greater than 50 events per hour
2. Which minimum score on the 8-item STOP-BANG questionnaire indicates a high risk for moderate-to-severe
obstructive sleep apnea?
A. 2
B. 5
C. 3
D. 7
3. Obesity hypoventilation syndrome is formally defined by a body mass index of at least 30 kg/m² combined with
which daytime arterial blood gas finding in the absence of other hypoventilatory causes?
A. PaO2 less than 50 mmHg
B. Daytime PaCO2 greater than 45 mmHg
C. Base excess greater than +8 mEq/L
D. Arterial pH less than 7.30
4. What is the primary pathophysiologic mechanism distinguishing central sleep apnea from obstructive sleep
,apnea during polysomnography?
A. Pharyngeal collapsibility during inspiratory effort
B. Temporary cessation of neural respiratory drive with absent ventilatory effort
C. Retrognathia causing mechanical tongue base displacement
D. Intrinsic laryngospasm triggered by gastroesophageal reflux
5. Chronic intermittent nocturnal hypoxia in patients with severe obstructive sleep apnea most commonly
produces which pulmonary vascular consequence?
A. Chronic pulmonary venous desaturation without vascular remodeling
B. Pulmonary artery endothelial atrophy
C. Pulmonary vasoconstriction leading to pulmonary arterial hypertension
D. Progressive decrease in pulmonary vascular resistance
6. According to the ASA Practice Guidelines for the Perioperative Management of Patients with OSA, which factor is
considered a major component in assigning a patient's perioperative risk score?
A. History of prior general endotracheal anesthesia
B. Patient preference for regional versus general anesthesia
C. Preoperative serum blood urea nitrogen level
D. Requirement for postoperative opioid analgesia
--- Application ---
7. A 52-year-old man with severe OSA (AHI 42 events/hr) compliant with nocturnal CPAP presents for elective
laparoscopic cholecystectomy. Which instruction regarding his CPAP equipment is most appropriate?
A. Discontinue CPAP use for 48 hours preoperatively to assess baseline ventilation
B. Bring his personal CPAP machine and properly fitted mask to the surgical center on the day of surgery
C. Use CPAP only if supplemental oxygen fails to maintain SpO2 above 92% in the PACU
D. Switch to daytime supplemental oxygen via nasal cannula in place of nocturnal CPAP
8. A 48-year-old woman with morbid obesity (BMI 44 kg/m²) and high-risk STOP-BANG score is positioned for
,induction of general anesthesia. Which patient positioning strategy best optimizes preoxygenation and
laryngoscopy?
A. Strict flat supine position with cervical hyperextension
B. Trendelenburg position at 15 degrees
C. Ramped position aligning the external auditory meatus with the sternal notch
D. Left lateral decubitus position with head elevated 10 degrees
9. A 58-year-old man with severe OSA undergoes an open umbilical hernia repair under general anesthesia. Which
analgesic regimen best minimizes the risk of postoperative respiratory depression?
A. Intravenous patient-controlled analgesia (IV-PCA) with continuous background hydromorphone infusion
B. High-dose intraoperative fentanyl boluses with PRN intramuscular meperidine postoperatively
C. Intravenous morphine boluses titrated exclusively by scheduled respiratory rate
D. Multimodal regimen combining surgical field local infiltration, intravenous acetaminophen, and ketorolac
with minimal rescue oral opioids
10. A patient with newly diagnosed severe OSA and no prior CPAP experience undergoes an uneventful superficial
lumpectomy under local anesthesia with light oral sedation in an ambulatory surgical center. Which criterion most
strongly supports discharge home versus admission?
A. Maintenance of room-air oxygen saturation at baseline while asleep in an unassisted environment
B. Ability to tolerate a full regular solid meal in the PACU
C. Absence of pain without the administration of any oral non-opioid medications
D. Fulfilling a mandatory 12-hour observation period regardless of surgical invasiveness
11. A 60-year-old male with severe OSA is undergoing total knee arthroplasty. Which anesthetic technique is most
advantageous for reducing his perioperative pulmonary complication risk?
A. General endotracheal anesthesia with high-dose remifentanil infusion
B. General anesthesia maintained with deep sevoflurane and native airway spontaneous ventilation
C. Spinal anesthesia combined with peripheral nerve blocks and minimal conscious sedation
D. Intravenous ketamine infusion as the sole anesthetic without regional anesthesia
,12. During emergence from general anesthesia in a patient with known severe OSA and anticipated difficult
airway, which extubation strategy is safest?
A. Extubation in a deep plane of anesthesia to prevent coughing and hemodynamic surges
B. Extubation only when fully awake, responding to commands, with reversed neuromuscular blockade and in a
head-elevated position
C. Immediate extubation in the flat supine position followed by immediate administration of high-dose
intravenous fentanyl
D. Extubation under nitrous oxide sedation with placement of a soft nasal trumpet
13. A 45-year-old man with untreated severe OSA presents for an urgent open appendectomy. Which
intraoperative medication choice represents an appropriate opioid-sparing adjuvant to attenuate airway reactivity
and postoperative pain?
A. High-dose oral diazepam premedication
B. Continuous background morphine infusion
C. Intermittent intravenous droperidol boluses
D. Dexmedetomidine infusion
14. In the PACU, an un-intubated patient with moderate OSA who received intravenous hydromorphone develops
repetitive episodes of airway obstruction and desaturation to 86% on 2 L/min nasal cannula. What is the
immediate first-line management step?
A. Administer 2 mg intravenous midazolam to reduce agitation
B. Increase nasal cannula oxygen flow to 10 L/min without airway repositioning
C. Apply positive airway pressure (CPAP) via properly fitting mask and stimulate the patient to wake
D. Place the patient in a strict flat supine position and administer nebulized albuterol
15. A 62-year-old man with severe OSA (AHI 55) is recovering in the PACU after an open radical prostatectomy
requiring intravenous opioid PCA. According to ASA guidelines, what is the most appropriate postoperative
disposition?
A. Admission to a step-down unit or monitored bed with continuous pulse oximetry and respiratory monitoring
B. Immediate discharge home after 60 minutes if alert and tolerating clear liquids
, C. Transfer to an unmonitored general surgical ward without pulse oximetry
D. Routine transfer to the intensive care unit with mandatory 24-hour mechanical ventilation
16. A 38-year-old woman with severe OSA presents for elective outpatient laparoscopic tubal ligation.
Preoperatively, she is anxious. Which premedication strategy is most prudent?
A. 10 mg oral diazepam and 100 mcg oral fentanyl
B. Non-pharmacologic reassurance and avoidance of routine high-dose preoperative sedative-hypnotics
C. 4 mg intravenous midazolam administered in the unmonitored holding area
D. 50 mg intramuscular meperidine and 25 mg promethazine
--- Analysis ---
17. An arterial blood gas drawn from a 56-year-old man with BMI 48 kg/m² on room air reveals: pH 7.36, PaCO2
54 mmHg, PaO2 61 mmHg, HCO3- 30 mEq/L. What is the primary clinical interpretation of these data?
A. Acute uncompensated respiratory acidosis typical of acute asthma
B. Primary metabolic alkalosis with compensatory alveolar hypoventilation
C. Normal arterial blood gas parameters for an obese adult
D. Chronic compensated respiratory acidosis consistent with obesity hypoventilation syndrome
18. A preoperative polysomnography report for a 50-year-old surgical candidate reveals: total sleep time 360 min,
total obstructive apneas 120, total hypopneas 90, lowest nocturnal SpO2 72%, oxygen desaturation index (ODI)
34/hr. What is the calculated AHI and corresponding severity classification?
A. AHI 35 events/hr; Severe OSA
B. AHI 15 events/hr; Mild OSA
C. AHI 25 events/hr; Moderate OSA
D. AHI 55 events/hr; Severe OSA
19. Which preoperative finding on 12-lead electrocardiogram in a patient with longstanding untreated severe OSA
most strongly suggests secondary pulmonary vascular disease and right ventricular strain?
A. Tall, peaked T waves across leads V2 to V4
, B. Left axis deviation with ST-segment depression in lead aVL
C. Right bundle branch block with right axis deviation and tall peaked P waves in lead II (P pulmonale)
D. Delta waves with shortened PR interval
20. Which medication is **LEAST** appropriate for postoperative analgesia in an ambulatory patient with severe
OSA and known baseline hypoxemia following laparoscopic hernia repair?
A. Intravenous ketorolac
B. Patient-controlled intravenous morphine with continuous basal infusion
C. Intravenous acetaminophen
D. Transversus abdominis plane (TAP) block with bupivacaine
21. In a PACU patient with severe OSA recovering from open abdominal surgery, which pattern of oxygenation and
ventilation on continuous capnography and pulse oximetry indicates impending severe opioid-induced ventilatory
failure?
A. Normal ETCO2 waveform with transient isolated desaturation during swallowing
B. Hyperventilation with ETCO2 decreasing from 40 mmHg to 28 mmHg
C. Stable respiratory rate of 16 breaths/min with sudden isolated artifactual pulse oximeter drop
D. Rising end-tidal CO2 with progressive bradypnea and cyclical prolonged obstructive apneas
--- True/False ---
22. Administration of high-flow supplemental oxygen via nasal cannula completely eliminates the risk of fatal
respiratory arrest in postoperative patients with severe obstructive sleep apnea who receive systemic opioids.
23. Patients with diagnosed obstructive sleep apnea who consistently use their prescribed nocturnal CPAP device
have a significantly lower incidence of perioperative cardiovascular and respiratory complications compared to
untreated OSA patients.
--- Fill-in-the-Blank ---
24. In the STOP-BANG screening questionnaire, the high-risk cutoff for neck circumference is greater than _______
,inches in male patients.
25. On diagnostic polysomnography, severe obstructive sleep apnea is defined by an Apnea-Hypopnea Index
greater than _______ events per hour.
--- Matching ---
26. Match each sleep-disordered breathing condition or diagnostic tool in Column A to its definitive clinical or
diagnostic characteristic in Column B.
Match each item in Column A to the single best corresponding item in Column B.
Column A (Match This) Column B (Choose From)
1. Mild Obstructive Sleep Apnea A. Absence of respiratory effort and airflow during
sleep
2. Moderate Obstructive Sleep Apnea B. BMI ≥ 30 kg/m² with daytime awake PaCO2 >
45 mmHg
3. Obesity Hypoventilation Syndrome C. AHI 5 to 14 events per hour
4. Central Sleep Apnea D. AHI 15 to 30 events per hour
E. Epworth Sleepiness Scale score < 4
F. AHI > 50 events per hour with isolated daytime
hypocapnia
27. Match each perioperative pharmacological agent in Column A to its appropriate clinical role in patients with
obstructive sleep apnea in Column B.
Match each item in Column A to the single best corresponding item in Column B.
, Column A (Match This) Column B (Choose From)
1. Dexmedetomidine A. High-risk analgesic modality contraindicated in
unmonitored OSA patients
2. Ketorolac B. Selective relaxant binding agent ensuring rapid,
complete reversal of rocuronium
3. Continuous Morphine Basal PCA C. Alpha-2 agonist providing sedation and
analgesia without respiratory depression
4. Sugammadex D. Non-steroidal anti-inflammatory reducing
systemic opioid requirements
E. Potent mu-opioid agonist used as first-line
sedative in outpatient holding
F. Inhaled pulmonary vasodilator for acute
bronchospasm
--- Case Study / Scenario ---
28. A 54-year-old male with a BMI of 46 kg/m², untreated severe OSA (STOP-BANG score 7/8), and systemic
hypertension presents for an elective open ventral hernia repair. During preoperative airway assessment, he is
noted to have a Mallampati class IV airway, thyromental distance of 5.5 cm, and a 19-inch neck circumference.
(a) Which preoxygenation and patient positioning strategy should be executed prior to anesthetic induction?
(b) Which airway management technique is most appropriate for establishing an endotracheal airway in this
patient?
(c) What intraoperative and emergence anesthetic strategies should be implemented to minimize postoperative
airway compromise?
29. A 61-year-old female with diagnosed severe OSA (AHI 48 events/hr, noncompliant with home CPAP due to
claustrophobia) and daytime hypersomnolence undergoes an elective laparoscopic hysterectomy under general
