STOELTING’S ANESTHESIA
PHARMACOLOGY & PHYSIOLOGY
MASTER CLASS MCQ EXAM BANK (6TH
EDITION)
Master your anesthesia boards with this comprehensive, high-yield bank of
expert-curated multiple-choice questions designed specifically for
Stoelting’s Pharmacology & Physiology in Anesthetic Practice (6th
Edition). Every premium question features rigorous clinical scenarios
paired with clear correct answers and deeply detailed, bolded rationales to
reinforce complex mechanisms instantly. Perfect for residents, CRNAs, and
medical students looking to ace their course assessments and pass their
professional licensing exams on the first try.
Section 1: Inhaled Anesthetics (Questions 1-10)
1. Which of the following inhaled anesthetics has
the lowest blood-gas partition coefficient,
contributing to the fastest rate of alveolar
induction and recovery?
A) Isoflurane
B) Sevoflurane
C) Desflurane
D) Halothane
Answer: C) Desflurane
Rationale: Desflurane has a blood-gas partition
coefficient of approximately 0.42, which is lower
than sevoflurane (0.65), isoflurane (1.4), and
halothane (2.4). A lower blood-gas solubility
,means less anesthetic dissolves in the blood,
leading to faster equilibration between alveolar
and brain partial pressures.
2. A patient with underlying severe pulmonary
hypertension is scheduled for surgery. Which
inhaled agent should be avoided or used with
extreme caution due to its tendency to increase
pulmonary vascular resistance (PVR)?
A) Sevoflurane
B) Nitrous Oxide
C) Desflurane
D) Isoflurane
Answer: B) Nitrous Oxide
Rationale: Nitrous oxide activates the
sympathetic nervous system and directly
increases pulmonary vascular resistance, which
can critically exacerbate pulmonary
hypertension and right ventricular strain. Volatile
agents typically cause mild pulmonary
vasodilation or leave PVR unchanged.
3. The formation of Compound A, a potentially
nephrotoxic vinyl ether, is a distinct hazard
associated with the degradation of which volatile
anesthetic in carbon dioxide absorbents?
A) Isoflurane
,B) Desflurane
C) Sevoflurane
D) Halothane
Answer: C) Sevoflurane
Rationale: Sevoflurane undergoes degradation in
the presence of strong bases (such as
potassium hydroxide or sodium hydroxide found
in traditional CO2 absorbents like Baralyme or
soda lime) to produce Compound A. This
reaction is enhanced by low fresh gas flow rates,
high absorbent temperatures, and dry absorbent.
4. Carbon monoxide production within a
desiccated carbon dioxide absorbent is highest
during the administration of which volatile
anesthetic?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Halothane
Answer: B) Desflurane
Rationale: Desflurane contains a CHF2-O- moiety
that breaks down into significant amounts of
carbon monoxide when exposed to completely
dry (desiccated) barium or sodium hydroxide
absorbents. The order of carbon monoxide
, production is desflurane ≥ isoflurane >
sevoflurane.
5. Which mechanism explains the "second gas
effect" where the administration of a high
concentration of nitrous oxide accelerates the
uptake of a companion volatile agent?
A) Nitrous oxide increases cardiac output, delivering
more volatile agent to tissues.
B) Rapid absorption of a large volume of nitrous
oxide concentrates the remaining gases in the
alveoli and augments inward fresh gas flow.
C) Nitrous oxide chemically binds to volatile agents
in the gas phase.
D) Nitrous oxide decreases the blood solubility of the
second gas.
Answer: B) Rapid absorption of a large volume of
nitrous oxide concentrates the remaining gases in
the alveoli and augments inward fresh gas flow.
Rationale: When a massive volume of nitrous
oxide is rapidly absorbed from the alveoli into
the blood, the total volume of remaining alveolar
gas decreases. This concentrates the companion
volatile agent (the concentration effect) and
creates a negative pressure relative to the
PHARMACOLOGY & PHYSIOLOGY
MASTER CLASS MCQ EXAM BANK (6TH
EDITION)
Master your anesthesia boards with this comprehensive, high-yield bank of
expert-curated multiple-choice questions designed specifically for
Stoelting’s Pharmacology & Physiology in Anesthetic Practice (6th
Edition). Every premium question features rigorous clinical scenarios
paired with clear correct answers and deeply detailed, bolded rationales to
reinforce complex mechanisms instantly. Perfect for residents, CRNAs, and
medical students looking to ace their course assessments and pass their
professional licensing exams on the first try.
Section 1: Inhaled Anesthetics (Questions 1-10)
1. Which of the following inhaled anesthetics has
the lowest blood-gas partition coefficient,
contributing to the fastest rate of alveolar
induction and recovery?
A) Isoflurane
B) Sevoflurane
C) Desflurane
D) Halothane
Answer: C) Desflurane
Rationale: Desflurane has a blood-gas partition
coefficient of approximately 0.42, which is lower
than sevoflurane (0.65), isoflurane (1.4), and
halothane (2.4). A lower blood-gas solubility
,means less anesthetic dissolves in the blood,
leading to faster equilibration between alveolar
and brain partial pressures.
2. A patient with underlying severe pulmonary
hypertension is scheduled for surgery. Which
inhaled agent should be avoided or used with
extreme caution due to its tendency to increase
pulmonary vascular resistance (PVR)?
A) Sevoflurane
B) Nitrous Oxide
C) Desflurane
D) Isoflurane
Answer: B) Nitrous Oxide
Rationale: Nitrous oxide activates the
sympathetic nervous system and directly
increases pulmonary vascular resistance, which
can critically exacerbate pulmonary
hypertension and right ventricular strain. Volatile
agents typically cause mild pulmonary
vasodilation or leave PVR unchanged.
3. The formation of Compound A, a potentially
nephrotoxic vinyl ether, is a distinct hazard
associated with the degradation of which volatile
anesthetic in carbon dioxide absorbents?
A) Isoflurane
,B) Desflurane
C) Sevoflurane
D) Halothane
Answer: C) Sevoflurane
Rationale: Sevoflurane undergoes degradation in
the presence of strong bases (such as
potassium hydroxide or sodium hydroxide found
in traditional CO2 absorbents like Baralyme or
soda lime) to produce Compound A. This
reaction is enhanced by low fresh gas flow rates,
high absorbent temperatures, and dry absorbent.
4. Carbon monoxide production within a
desiccated carbon dioxide absorbent is highest
during the administration of which volatile
anesthetic?
A) Sevoflurane
B) Desflurane
C) Isoflurane
D) Halothane
Answer: B) Desflurane
Rationale: Desflurane contains a CHF2-O- moiety
that breaks down into significant amounts of
carbon monoxide when exposed to completely
dry (desiccated) barium or sodium hydroxide
absorbents. The order of carbon monoxide
, production is desflurane ≥ isoflurane >
sevoflurane.
5. Which mechanism explains the "second gas
effect" where the administration of a high
concentration of nitrous oxide accelerates the
uptake of a companion volatile agent?
A) Nitrous oxide increases cardiac output, delivering
more volatile agent to tissues.
B) Rapid absorption of a large volume of nitrous
oxide concentrates the remaining gases in the
alveoli and augments inward fresh gas flow.
C) Nitrous oxide chemically binds to volatile agents
in the gas phase.
D) Nitrous oxide decreases the blood solubility of the
second gas.
Answer: B) Rapid absorption of a large volume of
nitrous oxide concentrates the remaining gases in
the alveoli and augments inward fresh gas flow.
Rationale: When a massive volume of nitrous
oxide is rapidly absorbed from the alveoli into
the blood, the total volume of remaining alveolar
gas decreases. This concentrates the companion
volatile agent (the concentration effect) and
creates a negative pressure relative to the
