Exam 1- Nagelhout UPDATED Questions
and CORRECT Answers
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - CORRECT ANSWER - What are the renal effects of all anesthetics except
nitrous oxide?
Halothane - CORRECT ANSWER - What anesthetic is associated with hepatotoxicity in
adults but not children?
All except nitrous oxide - CORRECT ANSWER - What inhalation anesthetics trigger
malignant hyperthermia and are contraindicated?
Nitrous Oxide - CORRECT ANSWER - This inhalation anesthetic blocks DNA and RNA
synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - CORRECT ANSWER - How does Nitrous Oxide block
DNA & RNA production?
(1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - CORRECT ANSWER - What patients are
at risk with Nitrous oxide due to possible prior Cobalamin Deficiency?
(1) Known deficiency of enzyme or substrate in methionine synthase pathway
,(2) Potential toxicity from expansion of gas filled space - emphysema, pneumothorax, middle
ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - CORRECT ANSWER - What are the absolute
contraindications to Nitrous Oxide?
(1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - CORRECT ANSWER - What are the relative contraindications to
Nitrous Oxide?
Risk of myocardial ischemia - CORRECT ANSWER - What is a putative relative
contraindication to Nitrous Oxide?
after puberty - CORRECT ANSWER - When does the risk of halothane hepatotoxity
increase?
(1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-inflammatory and direct
effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents angiogenesis) -
CORRECT ANSWER - Is there a better anesthetic technique to use when performing
surgery in cancer patients?
(1) Opioids (angiogenesis; decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - CORRECT ANSWER - Is
there any anesthetic technique you should avoid using when performing surgery in cancer
patients?
Nitrous oxide (teratogenic in animals) - CORRECT ANSWER - What anesthetic is
contraindicated in pregnancy?
, first trimester - CORRECT ANSWER - When is nitrous oxide most likely to cause
teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - CORRECT ANSWER -
What is the effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - CORRECT
ANSWER - Would it be better to use an inhalation anesthetic or spinal for a uterine
surgery? Why?
(1) masks
(2) high-pressure fittings
(3) exhalation valves - CORRECT ANSWER - What are the three principle sources of
waste anesthetic gasses?
<25 ppm - CORRECT ANSWER - Regulations in the USA require nitrous oxide levels to
be _________________.
<2 ppm - CORRECT ANSWER - Regulations in the USA require halogenated gas levels
to be _____________.
False (exception dexmedetomidine) - CORRECT ANSWER - T/F: All intravenous
anesthetics consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - CORRECT ANSWER - Which of the
inhalation anesthetics has analgesic effects?
(1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
and CORRECT Answers
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - CORRECT ANSWER - What are the renal effects of all anesthetics except
nitrous oxide?
Halothane - CORRECT ANSWER - What anesthetic is associated with hepatotoxicity in
adults but not children?
All except nitrous oxide - CORRECT ANSWER - What inhalation anesthetics trigger
malignant hyperthermia and are contraindicated?
Nitrous Oxide - CORRECT ANSWER - This inhalation anesthetic blocks DNA and RNA
synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - CORRECT ANSWER - How does Nitrous Oxide block
DNA & RNA production?
(1) Nutritional disorders - elderly, vegans, and alcoholics
(2) Malabsorption disorders - prolonged use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - CORRECT ANSWER - What patients are
at risk with Nitrous oxide due to possible prior Cobalamin Deficiency?
(1) Known deficiency of enzyme or substrate in methionine synthase pathway
,(2) Potential toxicity from expansion of gas filled space - emphysema, pneumothorax, middle
ear, surgery, pneumocephalus, air embolus
(3) Raised intracranial pressure - CORRECT ANSWER - What are the absolute
contraindications to Nitrous Oxide?
(1) Pulmonary HTN
(2) Prolonged anesthesia (>6 hr)
(3) First trimester of pregnancy (tetragenic)
(4) High risk of PONV - CORRECT ANSWER - What are the relative contraindications to
Nitrous Oxide?
Risk of myocardial ischemia - CORRECT ANSWER - What is a putative relative
contraindication to Nitrous Oxide?
after puberty - CORRECT ANSWER - When does the risk of halothane hepatotoxity
increase?
(1) Local anesthetics (reduced cancer recurrence and metastasis r/t anti-inflammatory and direct
effects)
(2) Neuraxial anesthesia (immunosuppressive - reduced recurrence & metastasis)
(3) NSAIDS (COX-2 and prostaglandin inhibition in cancer cells; prevents angiogenesis) -
CORRECT ANSWER - Is there a better anesthetic technique to use when performing
surgery in cancer patients?
(1) Opioids (angiogenesis; decreased long-term survival; inhibit natural killer cells)
(2) Volatile anesthetics (activates insulin-like growth factors) - CORRECT ANSWER - Is
there any anesthetic technique you should avoid using when performing surgery in cancer
patients?
Nitrous oxide (teratogenic in animals) - CORRECT ANSWER - What anesthetic is
contraindicated in pregnancy?
, first trimester - CORRECT ANSWER - When is nitrous oxide most likely to cause
teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - CORRECT ANSWER -
What is the effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) - CORRECT
ANSWER - Would it be better to use an inhalation anesthetic or spinal for a uterine
surgery? Why?
(1) masks
(2) high-pressure fittings
(3) exhalation valves - CORRECT ANSWER - What are the three principle sources of
waste anesthetic gasses?
<25 ppm - CORRECT ANSWER - Regulations in the USA require nitrous oxide levels to
be _________________.
<2 ppm - CORRECT ANSWER - Regulations in the USA require halogenated gas levels
to be _____________.
False (exception dexmedetomidine) - CORRECT ANSWER - T/F: All intravenous
anesthetics consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - CORRECT ANSWER - Which of the
inhalation anesthetics has analgesic effects?
(1) Analgesia
(2) Rapid uptake and elimination
(3) Little cardiac or respiratory depression
