Apex Mock Exam 4 Questions 2026/2027 | Actual Questions
and Answers Latest Updated 2026/2027 (Graded A+)
• Question
Which pharmacologic concepts BEST describe the effect of Naloxone at the mu
receptor? Select 2 Efficacy Reversibility Potentiation Affinity
Correct Answer: Reversibility Affinity
Competitive antagonist (can be reversed by adding more agonist)
• Question
Identify the factors that are MOST likely to increase the gradient between PaCO2 and
EtCO2. Select 3 Tracheostomy Increasing length of tubing in circle system Face mask
Amniotic fluid embolism Hypervolemia Ipratropium
Correct Answer: I. Face mask
II. Amniotic fluid embolism
III. Ipratropium
Physiologic dead space = anatomic dead space + alveolar dead space
Anatomic Vd is increased by anything that increases the volume of the airway conduit
Alveolar Vd is increased by anything that reduces pulmonary blood flow.
# of ways this Q could have been asked: What increases dead space? What increases
zone 1 in the lung? What increases the PaCO2-EtCO2 gradient? What increases
ventilation in excess of perfusion?
Physiologic dead space is increased by: Decreased pulm blood flow Decreased CO PE
COPD old age Face mask Positive pressure ventilation HME Neck extension
Anticholinergics cause bronchodilation (Ipratropium)
Because Vd begins at the y-piece in the circle system, it is not affected by increasing
length of tubing in the circle system
• Question
What is the largest ETT that can be passed through a size 3 LMA classic?
A. 6.0
B. 6.5
C. 7.0
D. 7.5
Correct Answer: A. 6.0
,LMA 1->3.5ETT LMA 1.5->4.0 ETT LMA 2->4.5 ETT LMA 2.5-> 5.0 ETT LMA 3-> 6.0 ETT
LMA 4-> 6.0 ETT LMA 5-> 7.0 ETT LMA 6-> 7.0 ETT
• Question
What is the antidote for central anticholinergic syndrome?
A. Pyridostigmine
B. Glycopyrrolate
C. Physostigmine
D. Atropine
Correct Answer: C. Physostigmine
Central anticholinergic syndrome caused by anticholinergics capable of crossing BBB
(atropine & scopolamine-NOT glyco)
Signs of toxicity: restlessness, combativeness, confusion, & delerium The elderly & pts
w/ uncontrolled pain are at increased risk of developing central anticholinergic
syndrome
Neostigmine, pyridostigmine, & physostigmine are cholinesterase inhibitors (increase
Ach in the synaptic cleft), but only physostigmine diffuses across BBB.
• Question
Select the statement that BEST describes the age related autonomic nervous system
changes in the elderly
A. The response to beta stimulation decreases
B. Parasympathetic tone increases
C. Baroreceptor sensitivity is unchanged
D. Sympathetic tone decreases
Correct Answer: A. The response to beta stimulation decreases
Key age related ANS changes in elderly include: SNS tone increases (increased NE in
plasma), however the response to beta stimulation is reduced PNS tone decreases
Baroreceptor sensitivity decreases
• Question
CV changes that accompany a normal pregnancy include an increased: Select 3 SVR SV
plasma volume DBP HR SBP
Correct Answer: I. SV
II. plasma volume
III. HR
Several weeks after conception, SVR decreases with a compensatory rise in CO & RAAS
activity (sodium retention—> increased plasma volume)
, A reduction in SVR causes the DBP to decline. SBP is unchanged
Key cardiovascular changes during pregnancy:
CO: (Inc 40%) -SV (Inc 30%) -HR (Inc 15%)
Peripheral circulation: -SBP- no change -DBP- (Dec 15%) -SVR- (Dec 15%) Intravascular
fluid volume: (Inc 35%) -plasma volume (Inc 45%) -erythrocyte volume (Inc 20%)
• Question
A 4 y/o pt who weighs 15kg experiences cardiac arrest. What is energy setting for the
first defibrillation attempt?
Correct Answer: 30J
1st shock: 2 J/kg 2nd shock: 4 J/kg Subsequent shocks: 4-10 J/kg
• Question
Choose the BEST methods to restore CO in heart transplant recipient. Select 2 Atropine
Ephedrine Isoproterenol 500ml 0.9% NACL bolus
Correct Answer: Isoproterenol 500ml 0.9% NACL bolus
CO is the product of SV & HR The transplanted heart is severed from autonomic
influence, so HR is determined by intrinsic rate of phase 4 depolarization of the SA node
(100-120bpm)
Since the HR is fixed, CO becomes dependent on preload. CO adjusts according to the
position on the Starling curve—increasing preload augments CO until a point is reached
where the ventricular myocytes become overstretched & cardiac output fails
Anesthetic considerations include maintaining adequate preload to optimize the
Frank-Starling mechanism. Isoproterenol and dilute epinephrine should be available to
augment HR Indirect acting vasopressin's, such as ephedrine, partially rely on
endogenous catecholamine stores in the post-synaptic sympathetic neuron & are
therefore less effective
Atropine reduces vagal tone by acting as a competitive antagonist of the cardiac M2
receptor. In the absence of vagal input, atropine has no effect
and Answers Latest Updated 2026/2027 (Graded A+)
• Question
Which pharmacologic concepts BEST describe the effect of Naloxone at the mu
receptor? Select 2 Efficacy Reversibility Potentiation Affinity
Correct Answer: Reversibility Affinity
Competitive antagonist (can be reversed by adding more agonist)
• Question
Identify the factors that are MOST likely to increase the gradient between PaCO2 and
EtCO2. Select 3 Tracheostomy Increasing length of tubing in circle system Face mask
Amniotic fluid embolism Hypervolemia Ipratropium
Correct Answer: I. Face mask
II. Amniotic fluid embolism
III. Ipratropium
Physiologic dead space = anatomic dead space + alveolar dead space
Anatomic Vd is increased by anything that increases the volume of the airway conduit
Alveolar Vd is increased by anything that reduces pulmonary blood flow.
# of ways this Q could have been asked: What increases dead space? What increases
zone 1 in the lung? What increases the PaCO2-EtCO2 gradient? What increases
ventilation in excess of perfusion?
Physiologic dead space is increased by: Decreased pulm blood flow Decreased CO PE
COPD old age Face mask Positive pressure ventilation HME Neck extension
Anticholinergics cause bronchodilation (Ipratropium)
Because Vd begins at the y-piece in the circle system, it is not affected by increasing
length of tubing in the circle system
• Question
What is the largest ETT that can be passed through a size 3 LMA classic?
A. 6.0
B. 6.5
C. 7.0
D. 7.5
Correct Answer: A. 6.0
,LMA 1->3.5ETT LMA 1.5->4.0 ETT LMA 2->4.5 ETT LMA 2.5-> 5.0 ETT LMA 3-> 6.0 ETT
LMA 4-> 6.0 ETT LMA 5-> 7.0 ETT LMA 6-> 7.0 ETT
• Question
What is the antidote for central anticholinergic syndrome?
A. Pyridostigmine
B. Glycopyrrolate
C. Physostigmine
D. Atropine
Correct Answer: C. Physostigmine
Central anticholinergic syndrome caused by anticholinergics capable of crossing BBB
(atropine & scopolamine-NOT glyco)
Signs of toxicity: restlessness, combativeness, confusion, & delerium The elderly & pts
w/ uncontrolled pain are at increased risk of developing central anticholinergic
syndrome
Neostigmine, pyridostigmine, & physostigmine are cholinesterase inhibitors (increase
Ach in the synaptic cleft), but only physostigmine diffuses across BBB.
• Question
Select the statement that BEST describes the age related autonomic nervous system
changes in the elderly
A. The response to beta stimulation decreases
B. Parasympathetic tone increases
C. Baroreceptor sensitivity is unchanged
D. Sympathetic tone decreases
Correct Answer: A. The response to beta stimulation decreases
Key age related ANS changes in elderly include: SNS tone increases (increased NE in
plasma), however the response to beta stimulation is reduced PNS tone decreases
Baroreceptor sensitivity decreases
• Question
CV changes that accompany a normal pregnancy include an increased: Select 3 SVR SV
plasma volume DBP HR SBP
Correct Answer: I. SV
II. plasma volume
III. HR
Several weeks after conception, SVR decreases with a compensatory rise in CO & RAAS
activity (sodium retention—> increased plasma volume)
, A reduction in SVR causes the DBP to decline. SBP is unchanged
Key cardiovascular changes during pregnancy:
CO: (Inc 40%) -SV (Inc 30%) -HR (Inc 15%)
Peripheral circulation: -SBP- no change -DBP- (Dec 15%) -SVR- (Dec 15%) Intravascular
fluid volume: (Inc 35%) -plasma volume (Inc 45%) -erythrocyte volume (Inc 20%)
• Question
A 4 y/o pt who weighs 15kg experiences cardiac arrest. What is energy setting for the
first defibrillation attempt?
Correct Answer: 30J
1st shock: 2 J/kg 2nd shock: 4 J/kg Subsequent shocks: 4-10 J/kg
• Question
Choose the BEST methods to restore CO in heart transplant recipient. Select 2 Atropine
Ephedrine Isoproterenol 500ml 0.9% NACL bolus
Correct Answer: Isoproterenol 500ml 0.9% NACL bolus
CO is the product of SV & HR The transplanted heart is severed from autonomic
influence, so HR is determined by intrinsic rate of phase 4 depolarization of the SA node
(100-120bpm)
Since the HR is fixed, CO becomes dependent on preload. CO adjusts according to the
position on the Starling curve—increasing preload augments CO until a point is reached
where the ventricular myocytes become overstretched & cardiac output fails
Anesthetic considerations include maintaining adequate preload to optimize the
Frank-Starling mechanism. Isoproterenol and dilute epinephrine should be available to
augment HR Indirect acting vasopressin's, such as ephedrine, partially rely on
endogenous catecholamine stores in the post-synaptic sympathetic neuron & are
therefore less effective
Atropine reduces vagal tone by acting as a competitive antagonist of the cardiac M2
receptor. In the absence of vagal input, atropine has no effect
