APEX Anesthesia SRNA
SEE Test Review
Questions & Solutions
2025
©2025
, Question 1
Case: A 70-year-old male with severe aortic stenosis is scheduled for
emergency hip fracture repair. Given his fixed cardiac output, it is crucial
to avoid techniques that precipitate sudden hypotension. Which
anesthetic approach is most prudent?
Options:
A. Single-shot spinal anesthesia with a standard dose of local anesthetic
B. Combined spinal-epidural anesthesia with a low-dose spinal
component
C. General anesthesia with etomidate induction and invasive
hemodynamic monitoring
D. Epidural anesthesia using a rapid bolus of local anesthetic
Correct ANS: C. General anesthesia with etomidate induction and
invasive hemodynamic monitoring
Rationale: In patients with severe aortic stenosis, neuraxial techniques
may cause abrupt sympathetic blockade and hypotension. A carefully
titrated general anesthetic—using an agent such as etomidate that
provides cardiovascular stability—maintained under close invasive
monitoring minimizes hemodynamic swings.
---
Question 2
Case: A 1-year-old infant with a large ventricular septal defect (VSD) is
scheduled for inguinal hernia repair. To avoid worsening the left-to-right
shunt during induction, which intravenous induction agent should be
avoided?
Options:
A. Propofol
B. Ketamine
C. Etomidate
D. Midazolam
©2025
, Correct ANS: A. Propofol
Rationale: Propofol decreases systemic vascular resistance; in infants
with a VSD, a reduction in systemic resistance can exacerbate the left-to-
right shunt, worsening hemodynamics. Alternatives that preserve or even
increase systemic vascular tone (such as ketamine) are preferred.
---
Question 3
Case: In regional anesthesia, understanding the physicochemical
properties of local anesthetics is critical. Which property most strongly
influences the duration of action of a local anesthetic?
Options:
A. pKa
B. Lipid solubility
C. Protein binding
D. Molecular weight
Correct ANS: C. Protein binding
Rationale: The duration of action of local anesthetics correlates closely
with the degree of protein binding. Agents with high protein binding
remain at the site of action longer, thereby prolonging the block.
---
Question 4
Case: While delivering volatile anesthesia during neurosurgery, an
anesthesiologist is mindful of intracranial dynamics. Which statement
best explains the effect of volatile agents on cerebral physiology?
Options:
A. They cause cerebral vasoconstriction, thus reducing intracranial
pressure
B. They have no significant impact on cerebral blood flow
C. They cause cerebral vasodilation, potentially increasing intracranial
pressure
©2025
, D. They solely depress cerebral metabolism without affecting vascular
tone
Correct ANS: C. They cause cerebral vasodilation, potentially
increasing intracranial pressure
Rationale: Volatile agents (e.g., sevoflurane, isoflurane) typically
increase cerebral blood flow by causing vasodilation. This effect can
elevate intracranial pressure—a critical consideration during
neurosurgery.
---
Question 5
Case: During a balanced anesthetic for a middle-aged patient
undergoing major abdominal surgery, a combination of a hypnotic agent,
opioid, and neuromuscular blocker is used. This multimodal approach is
termed:
Options:
A. Total Intravenous Anesthesia (TIVA)
B. Regional Anesthesia
C. Monitored Anesthesia Care (MAC)
D. Balanced Anesthesia
Correct ANS: D. Balanced Anesthesia
Rationale: Balanced anesthesia involves using a combination of
medications—with each at reduced doses—to achieve hypnosis,
analgesia, and muscle relaxation. This approach minimizes the side
effects associated with higher doses of any single agent.
---
Question 6
Case: In a pediatric operating room, an anesthesia machine is set up for
a 2-year-old undergoing minor surgery. Which component of the
anesthesia machine is responsible for the removal of carbon dioxide from
©2025
SEE Test Review
Questions & Solutions
2025
©2025
, Question 1
Case: A 70-year-old male with severe aortic stenosis is scheduled for
emergency hip fracture repair. Given his fixed cardiac output, it is crucial
to avoid techniques that precipitate sudden hypotension. Which
anesthetic approach is most prudent?
Options:
A. Single-shot spinal anesthesia with a standard dose of local anesthetic
B. Combined spinal-epidural anesthesia with a low-dose spinal
component
C. General anesthesia with etomidate induction and invasive
hemodynamic monitoring
D. Epidural anesthesia using a rapid bolus of local anesthetic
Correct ANS: C. General anesthesia with etomidate induction and
invasive hemodynamic monitoring
Rationale: In patients with severe aortic stenosis, neuraxial techniques
may cause abrupt sympathetic blockade and hypotension. A carefully
titrated general anesthetic—using an agent such as etomidate that
provides cardiovascular stability—maintained under close invasive
monitoring minimizes hemodynamic swings.
---
Question 2
Case: A 1-year-old infant with a large ventricular septal defect (VSD) is
scheduled for inguinal hernia repair. To avoid worsening the left-to-right
shunt during induction, which intravenous induction agent should be
avoided?
Options:
A. Propofol
B. Ketamine
C. Etomidate
D. Midazolam
©2025
, Correct ANS: A. Propofol
Rationale: Propofol decreases systemic vascular resistance; in infants
with a VSD, a reduction in systemic resistance can exacerbate the left-to-
right shunt, worsening hemodynamics. Alternatives that preserve or even
increase systemic vascular tone (such as ketamine) are preferred.
---
Question 3
Case: In regional anesthesia, understanding the physicochemical
properties of local anesthetics is critical. Which property most strongly
influences the duration of action of a local anesthetic?
Options:
A. pKa
B. Lipid solubility
C. Protein binding
D. Molecular weight
Correct ANS: C. Protein binding
Rationale: The duration of action of local anesthetics correlates closely
with the degree of protein binding. Agents with high protein binding
remain at the site of action longer, thereby prolonging the block.
---
Question 4
Case: While delivering volatile anesthesia during neurosurgery, an
anesthesiologist is mindful of intracranial dynamics. Which statement
best explains the effect of volatile agents on cerebral physiology?
Options:
A. They cause cerebral vasoconstriction, thus reducing intracranial
pressure
B. They have no significant impact on cerebral blood flow
C. They cause cerebral vasodilation, potentially increasing intracranial
pressure
©2025
, D. They solely depress cerebral metabolism without affecting vascular
tone
Correct ANS: C. They cause cerebral vasodilation, potentially
increasing intracranial pressure
Rationale: Volatile agents (e.g., sevoflurane, isoflurane) typically
increase cerebral blood flow by causing vasodilation. This effect can
elevate intracranial pressure—a critical consideration during
neurosurgery.
---
Question 5
Case: During a balanced anesthetic for a middle-aged patient
undergoing major abdominal surgery, a combination of a hypnotic agent,
opioid, and neuromuscular blocker is used. This multimodal approach is
termed:
Options:
A. Total Intravenous Anesthesia (TIVA)
B. Regional Anesthesia
C. Monitored Anesthesia Care (MAC)
D. Balanced Anesthesia
Correct ANS: D. Balanced Anesthesia
Rationale: Balanced anesthesia involves using a combination of
medications—with each at reduced doses—to achieve hypnosis,
analgesia, and muscle relaxation. This approach minimizes the side
effects associated with higher doses of any single agent.
---
Question 6
Case: In a pediatric operating room, an anesthesia machine is set up for
a 2-year-old undergoing minor surgery. Which component of the
anesthesia machine is responsible for the removal of carbon dioxide from
©2025
