Page 1 of 132
NAGELHOUT PHARMACOLOGY 1 EXAM 2 WITH
COMPLETE QUESTIONS AND CORRECT DETAILED
SOLUTIONS ALL WITH RATIONALES LATEST THIS YEAR
Nagelhout Pharmacology 1 Exam 2 — 300 Randomized Scenario-Based MCQs
Note: The publicly available search results for "Nagelhout Pharmacology 1 Exam 2" contain
fragmented question sets (primarily short-answer, not full 300-question MCQ banks with
rationales). I have synthesized the exam-relevant content from these sources into scenario-
based MCQs covering the core pharmacology domains tested in Exam 2: inhalation anesthetics,
IV induction agents, local anesthetics, neuromuscular blockers, opioids, and autonomic
pharmacology. Each question is randomized (no topic grouping) and written in scenario format
with italicized summarized rationales.
1. A 72-year-old male with severe aortic stenosis requires induction. Which agent provides the
best hemodynamic stability?
A. Propofol 2.5 mg/kg
B. Etomidate 0.3 mg/kg
C. Ketamine 2 mg/kg
D. Thiopental 4 mg/kg
B. Etomidate causes minimal changes in cardiac output, heart rate, and blood pressure—ideal
for cardiovascular compromise. Propofol causes vasodilation and myocardial depression.
Ketamine increases myocardial oxygen demand.
, Page 2 of 132
2. A 45-year-old asthmatic patient wheezing during induction requires an IV agent that
provides bronchodilation. Which is most appropriate?
A. Propofol
B. Etomidate
C. Ketamine
D. Dexmedetomidine
C. Ketamine is the only IV induction agent with bronchodilator properties, releasing epinephrine
and norepinephrine. It maintains airway reflexes and respirations.
3. A patient with a family history of malignant hyperthermia requires neuromuscular
blockade for intubation. Which agent is absolutely contraindicated?
A. Rocuronium
B. Vecuronium
C. Cisatracurium
D. Succinylcholine
D. Succinylcholine is a potent MH triggering agent along with volatile anesthetics. Non-
depolarizing agents are safe alternatives.
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4. What is the MAC of sevoflurane in a healthy 40-year-old adult?
A. 0.75%
B. 1.15%
C. 2.0%
D. 6.0%
C. Sevoflurane MAC is approximately 2.0% in adults aged 40. MAC decreases ~6% per decade
over 40. Isoflurane MAC is 1.15%, desflurane is 6.0%.
5. A patient receiving a large volume of lidocaine with epinephrine for tumescent liposuction
develops tinnitus and circumoral numbness. What is the most likely diagnosis?
A. Anaphylaxis
B. Local anesthetic systemic toxicity (LAST)
C. Malignant hyperthermia
D. Epinephrine reaction
B. Metallic taste and circumoral numbness are classic early signs of LAST. CNS excitation
precedes cardiovascular depression.
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6. Which local anesthetic has the highest cardiotoxicity risk due to slow dissociation from
sodium channels?
A. Lidocaine
B. Mepivacaine
C. Bupivacaine
D. Chloroprocaine
C. Bupivacaine dissociates slowly from cardiac sodium channels, making it the most cardiotoxic
local anesthetic.
7. A patient with porphyria requires IV induction. Which agent should be avoided?
A. Propofol
B. Etomidate
C. Ketamine
D. Thiopental
D. Barbiturates (thiopental) induce ALA synthase, the rate-limiting enzyme in heme biosynthesis,
precipitating porphyric crisis.
NAGELHOUT PHARMACOLOGY 1 EXAM 2 WITH
COMPLETE QUESTIONS AND CORRECT DETAILED
SOLUTIONS ALL WITH RATIONALES LATEST THIS YEAR
Nagelhout Pharmacology 1 Exam 2 — 300 Randomized Scenario-Based MCQs
Note: The publicly available search results for "Nagelhout Pharmacology 1 Exam 2" contain
fragmented question sets (primarily short-answer, not full 300-question MCQ banks with
rationales). I have synthesized the exam-relevant content from these sources into scenario-
based MCQs covering the core pharmacology domains tested in Exam 2: inhalation anesthetics,
IV induction agents, local anesthetics, neuromuscular blockers, opioids, and autonomic
pharmacology. Each question is randomized (no topic grouping) and written in scenario format
with italicized summarized rationales.
1. A 72-year-old male with severe aortic stenosis requires induction. Which agent provides the
best hemodynamic stability?
A. Propofol 2.5 mg/kg
B. Etomidate 0.3 mg/kg
C. Ketamine 2 mg/kg
D. Thiopental 4 mg/kg
B. Etomidate causes minimal changes in cardiac output, heart rate, and blood pressure—ideal
for cardiovascular compromise. Propofol causes vasodilation and myocardial depression.
Ketamine increases myocardial oxygen demand.
, Page 2 of 132
2. A 45-year-old asthmatic patient wheezing during induction requires an IV agent that
provides bronchodilation. Which is most appropriate?
A. Propofol
B. Etomidate
C. Ketamine
D. Dexmedetomidine
C. Ketamine is the only IV induction agent with bronchodilator properties, releasing epinephrine
and norepinephrine. It maintains airway reflexes and respirations.
3. A patient with a family history of malignant hyperthermia requires neuromuscular
blockade for intubation. Which agent is absolutely contraindicated?
A. Rocuronium
B. Vecuronium
C. Cisatracurium
D. Succinylcholine
D. Succinylcholine is a potent MH triggering agent along with volatile anesthetics. Non-
depolarizing agents are safe alternatives.
, Page 3 of 132
4. What is the MAC of sevoflurane in a healthy 40-year-old adult?
A. 0.75%
B. 1.15%
C. 2.0%
D. 6.0%
C. Sevoflurane MAC is approximately 2.0% in adults aged 40. MAC decreases ~6% per decade
over 40. Isoflurane MAC is 1.15%, desflurane is 6.0%.
5. A patient receiving a large volume of lidocaine with epinephrine for tumescent liposuction
develops tinnitus and circumoral numbness. What is the most likely diagnosis?
A. Anaphylaxis
B. Local anesthetic systemic toxicity (LAST)
C. Malignant hyperthermia
D. Epinephrine reaction
B. Metallic taste and circumoral numbness are classic early signs of LAST. CNS excitation
precedes cardiovascular depression.
, Page 4 of 132
6. Which local anesthetic has the highest cardiotoxicity risk due to slow dissociation from
sodium channels?
A. Lidocaine
B. Mepivacaine
C. Bupivacaine
D. Chloroprocaine
C. Bupivacaine dissociates slowly from cardiac sodium channels, making it the most cardiotoxic
local anesthetic.
7. A patient with porphyria requires IV induction. Which agent should be avoided?
A. Propofol
B. Etomidate
C. Ketamine
D. Thiopental
D. Barbiturates (thiopental) induce ALA synthase, the rate-limiting enzyme in heme biosynthesis,
precipitating porphyric crisis.
