1
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Chapter 28: Airway Management
CHAPTER LIST
Chapter 29: Patient Positioning and Potential
Injuries
Chapter 1: The History of Anesthesia
Chapter 30: Monitored Anesthesia Care
Chapter 2: Scope of Practice
Chapter 31: Ambulatory Anesthesia
Chapter 3: Occupational Health
Chapter 32: Office-Based Anesthesia
Chapter 4: Anesthetic Risk, Quality
Chapter 33: Nonoperating Room Anesthesia
Improvement, and Liability
Chapter 34: Anesthesia for the Older Patient
Chapter 5: Electrical and Fire Safety
Chapter 35: Neuraxial Anesthesia
Chapter 6: Genomic Basis of Perioperative
Medicine Chapter 36: Peripheral Nerve Blockade
Chapter 7: Experimental Design and Statistics Chapter 37: Anesthesia for Neurosurgery
Chapter 8: Inflammation, Wound Healing, and Chapter 38: Anesthesia for Thoracic Surgery
Infection Chapter 39: Anesthesia for Cardiac Surgery
Chapter 9: The Allergic Response Chapter 40: Anesthesia for Vascular and
Chapter 10: Mechanisms of Anesthesia and Endovascular Surgery
Consciousness Chapter 41: Obstetric Anesthesia
Chapter 11: Basic Principles of Clinical Chapter 42: Neonatal Anesthesia
Pharmacology Chapter 43: Pediatric Anesthesia
Chapter 12: Cardiac Anatomy and Physiology Chapter 44: Anesthesia for Laparoscopic and
Chapter 13: Cardiovascular Pharmacology Robotic Surgeries
Chapter 14: Autonomic Nervous System Chapter 45: Anesthesia and Obesity
Anatomy and Physiology Chapter 46: The Liver: Surgery and Anesthesia
Chapter 15: Respiratory Function in Anesthesia Chapter 47: Endocrine Function
Chapter 16: Fluids, Electrolytes, and Acid– Base Chapter 48: Anesthesia for Otolaryngologic
Physiology Surgery
Chapter 17: Hemostasis and Transfusion Chapter 49: Anesthesia for Ophthalmologic
Medicine Surgery
Chapter 18: Inhaled Anesthetics Chapter 50: The Renal System and Anesthesia
Chapter 19: Intravenous Anesthetics for Urologic Surgery
Chapter 20: Opioids Chapter 51: Anesthesia for Orthopedic Surgery
Chapter 21: Neuromuscular Blocking Agents Chapter 52: Transplant Anesthesia
Chapter 22: Local Anesthetics Chapter 53: Trauma and Burns
Chapter 23: Preoperative Patient Assessment Chapter 54: Postanesthesia Recovery
and Management Chapter 55: Acute Pain Management
Chapter 24: Rare Coexisting Diseases Chapter 56: Chronic Pain Management
Chapter 25: The Anesthesia Workstation and Chapter 57: Critical Care Medicine
Delivery Systems for Inhaled Anesthetics Chapter 58: Cardiopulmonary Resuscitation
Chapter 26: Commonly Used Monitoring
Techniques Chapter 59: Disaster Preparedness
Chapter 27: Echocardiography
2
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Chapter 1: The History of Anesthesia
Segment A: Recall-Based Single-Best-Answer MCQs
Question 1
Which medical professional performed the first successful public demonstration of ether
anesthesia for a surgical procedure at Massachusetts General Hospital in October 1846?
A. William T. G. Morton
B. Crawford Long
C. Horace Wells
D. James Young Simpson
Answer: A
Rationale: William T. G. Morton, a dentist who had studied medicine, performed the first
successful public demonstration of diethyl ether anesthesia on October 16, 1846, at
Massachusetts General Hospital (in the surgical amphitheater now known as the Ether Dome).
He administered ether to patient Edward Gilbert Abbott while surgeon John Collins Warren
excised a vascular tumor from Abbott's neck.
Question 2
In the late 19th century, local anesthesia was introduced into clinical ophthalmic practice
through the topical application of which alkaloid agent?
A. Procaine
B. Lidocaine
C. Tetracaine
D. Cocaine
3
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Answer: D
Rationale: In 1884, Austrian ophthalmologist Karl Koller discovered and demonstrated the local
anesthetic properties of cocaine when applied topically to the cornea and conjunctiva. This
landmark discovery marked the beginning of modern local and regional anesthesia in clinical
practice.
Question 3
Which major patient safety initiative, established by the American Society of Anesthesiologists
in 1984, systematically analyzes major adverse anesthetic outcomes to identify patterns of
injury and drive changes in clinical practice standards?
A. The Anesthesia Patient Safety Foundation
B. The National Surgical Quality Improvement Program
C. The ASA Closed Claims Project
D. The AANA Foundation Patient Safety Registry
Answer: C
Rationale: The American Society of Anesthesiologists (ASA) Closed Claims Project was initiated
in 1984 as a systematic database of settled malpractice claims against anesthesiologists. By
analyzing real-world adverse outcomes, the project identified major sources of perioperative
morbidity and mortality (such as unrecognized esophageal intubation and inadequate
ventilation), directly driving the mandatory adoption of pulse oximetry and end-tidal
capnography monitoring standards.
Question 4
Which pioneer introduced chloroform into obstetric practice in 1847 to alleviate labor pain,
famously administering it to Queen Victoria during the birth of Prince Leopold in 1853?
A. Robert Liston
B. John Snow
C. James Young Simpson
D. Arthur Guedel
Answer: C
4
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Rationale: James Young Simpson, a Scottish obstetrician, discovered the anesthetic properties
of chloroform in 1847 and introduced it into obstetric practice to relieve labor pain. The
administration of chloroform to Queen Victoria by John Snow during the delivery of Prince
Leopold in 1853 gave "chloroform à la reine" royal sanction, overcoming religious and social
objections to obstetric pain relief.
Segment B: Extended Matching Set
Options List (A–G):
A. Horace Wells
B. Crawford Long
C. William T. G. Morton
D. John Snow
E. William Halsted
F. Arthur Guedel
G. Virginia Apgar
Question 4 (Extended Matching Stem 1)
Identified the signs and stages of ether anesthesia based on somatic reflex patterns, eye
movements, and respiratory depth to guide safe depth of anesthesia during surgical
procedures.
Answer: F
Rationale: Arthur Guedel formulated the classic signs and stages of ether anesthesia in 1920.
His detailed description of the four stages (and the four planes of Stage III) provided
anesthesiologists with a systematic method to evaluate depth of anesthesia and patient safety
by observing physical signs such as pupil size, respiratory pattern, and eyelash reflexes.
Question 5 (Extended Matching Stem 2)
Pioneered regional nerve block techniques in the United States during the 1880s by performing
direct injections of cocaine into peripheral nerve trunks and brachial plexus roots.
Answer: E
5
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Rationale: William S. Halsted, along with his colleague Richard Hall, pioneered regional nerve
blockade in 1884–1885 by injecting cocaine solutions directly into nerve trunks, including the
mandibular nerve, brachial plexus, and peripheral nerves, laying the foundation for modern
conduction blockade.
Question 6 (Extended Matching Stem 3)
Demonstrated nitrous oxide for dental extractions in 1844, but suffered a public setback during
an 1845 demonstration at Harvard Medical School when the patient groaned during the
procedure.
Answer: A
Rationale: Horace Wells, a dentist from Hartford, Connecticut, recognized the analgesic
potential of inhaled nitrous oxide in 1844 after observing its effects at a public demonstration.
He successfully used it in his dental practice but suffered a tragic setback during a public
demonstration at Harvard Medical School/Massachusetts General Hospital in January 1845,
where the patient cried out, leading observers to deem the demonstration a failure.
Question 7 (Extended Matching Stem 4)
Developed the first standardized newborn evaluation scoring system in 1952 while working as
an anesthesiologist, establishing a rapid quantitative assessment of neonatal resuscitation
needs.
Answer: G
Rationale: Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar
Score in 1952. It provided a simple, reproducible 10-point scoring method assessed at 1 and 5
minutes post-birth (evaluating Heart rate, Respiratory effort, Muscle tone, Reflex irritability,
and Color) to quickly assess the clinical status of newborns and guide immediate resuscitation.
Segment D: Sequencing / Ordering Items
Question 9
Order the historical milestone introductions of the following airway devices and direct visual
laryngoscopes into clinical practice, from earliest to most recent:
A. Introduction of the flexible fiberoptic bronchoscope for difficult airway management
(Murphy / Ikeda)
B. Development of the curved laryngoscope blade to fit the vallecula (Macintosh)
6
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
C. Widespread clinical introduction and commercial availability of the Laryngeal Mask Airway
(Brain)
D. Development of the straight laryngoscope blade with a light bulb at the tip (Magill / Jackson)
Answer: D, B, A, C
Rationale: Direct rigid laryngoscopy began evolving in the early 20th century with straight
blades developed by Jackson and Magill (1920s). Sir Robert Macintosh introduced the curved
blade designed to sit in the epiglottic vallecula in 1943. Flexible fiberoptic bronchoscopy was
adapted for difficult endotracheal intubation in the late 1960s (Ikeda/Murphy). Archie Brain
invented and clinically introduced the Laryngeal Mask Airway (LMA) in the 1980s (commercial
release 1988), revolutionizing supraglottic airway management.
Question 10
Place in chronological sequence the introduction of these inhaled anesthetic agents into clinical
practice, from earliest to most recent:
A. Isoflurane
B. Diethyl ether
C. Sevoflurane
D. Halothane
Answer: B, D, A, C
Rationale: Diethyl ether was publicly demonstrated for clinical anesthesia in 1846. Halothane,
the first nonflammable halogenated hydrocarbon, was introduced in 1956. Isoflurane was
synthesized in 1965 and entered widespread clinical practice in 1981. Sevoflurane was
synthesized in the late 1960s but did not enter routine global clinical use until the 1990s
(approved in the US in 1995).
Question 11
Sequence the historical development of standard safety monitoring requirements adopted by
the American Society of Anesthesiologists (ASA), from earliest to most recent:
A. Mandatory intraoperative end-tidal carbon dioxide monitoring (capnography) standard
B. Establishment of the ASA Physical Status Classification system
7
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Chapter 28: Airway Management
CHAPTER LIST
Chapter 29: Patient Positioning and Potential
Injuries
Chapter 1: The History of Anesthesia
Chapter 30: Monitored Anesthesia Care
Chapter 2: Scope of Practice
Chapter 31: Ambulatory Anesthesia
Chapter 3: Occupational Health
Chapter 32: Office-Based Anesthesia
Chapter 4: Anesthetic Risk, Quality
Chapter 33: Nonoperating Room Anesthesia
Improvement, and Liability
Chapter 34: Anesthesia for the Older Patient
Chapter 5: Electrical and Fire Safety
Chapter 35: Neuraxial Anesthesia
Chapter 6: Genomic Basis of Perioperative
Medicine Chapter 36: Peripheral Nerve Blockade
Chapter 7: Experimental Design and Statistics Chapter 37: Anesthesia for Neurosurgery
Chapter 8: Inflammation, Wound Healing, and Chapter 38: Anesthesia for Thoracic Surgery
Infection Chapter 39: Anesthesia for Cardiac Surgery
Chapter 9: The Allergic Response Chapter 40: Anesthesia for Vascular and
Chapter 10: Mechanisms of Anesthesia and Endovascular Surgery
Consciousness Chapter 41: Obstetric Anesthesia
Chapter 11: Basic Principles of Clinical Chapter 42: Neonatal Anesthesia
Pharmacology Chapter 43: Pediatric Anesthesia
Chapter 12: Cardiac Anatomy and Physiology Chapter 44: Anesthesia for Laparoscopic and
Chapter 13: Cardiovascular Pharmacology Robotic Surgeries
Chapter 14: Autonomic Nervous System Chapter 45: Anesthesia and Obesity
Anatomy and Physiology Chapter 46: The Liver: Surgery and Anesthesia
Chapter 15: Respiratory Function in Anesthesia Chapter 47: Endocrine Function
Chapter 16: Fluids, Electrolytes, and Acid– Base Chapter 48: Anesthesia for Otolaryngologic
Physiology Surgery
Chapter 17: Hemostasis and Transfusion Chapter 49: Anesthesia for Ophthalmologic
Medicine Surgery
Chapter 18: Inhaled Anesthetics Chapter 50: The Renal System and Anesthesia
Chapter 19: Intravenous Anesthetics for Urologic Surgery
Chapter 20: Opioids Chapter 51: Anesthesia for Orthopedic Surgery
Chapter 21: Neuromuscular Blocking Agents Chapter 52: Transplant Anesthesia
Chapter 22: Local Anesthetics Chapter 53: Trauma and Burns
Chapter 23: Preoperative Patient Assessment Chapter 54: Postanesthesia Recovery
and Management Chapter 55: Acute Pain Management
Chapter 24: Rare Coexisting Diseases Chapter 56: Chronic Pain Management
Chapter 25: The Anesthesia Workstation and Chapter 57: Critical Care Medicine
Delivery Systems for Inhaled Anesthetics Chapter 58: Cardiopulmonary Resuscitation
Chapter 26: Commonly Used Monitoring
Techniques Chapter 59: Disaster Preparedness
Chapter 27: Echocardiography
2
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Chapter 1: The History of Anesthesia
Segment A: Recall-Based Single-Best-Answer MCQs
Question 1
Which medical professional performed the first successful public demonstration of ether
anesthesia for a surgical procedure at Massachusetts General Hospital in October 1846?
A. William T. G. Morton
B. Crawford Long
C. Horace Wells
D. James Young Simpson
Answer: A
Rationale: William T. G. Morton, a dentist who had studied medicine, performed the first
successful public demonstration of diethyl ether anesthesia on October 16, 1846, at
Massachusetts General Hospital (in the surgical amphitheater now known as the Ether Dome).
He administered ether to patient Edward Gilbert Abbott while surgeon John Collins Warren
excised a vascular tumor from Abbott's neck.
Question 2
In the late 19th century, local anesthesia was introduced into clinical ophthalmic practice
through the topical application of which alkaloid agent?
A. Procaine
B. Lidocaine
C. Tetracaine
D. Cocaine
3
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Answer: D
Rationale: In 1884, Austrian ophthalmologist Karl Koller discovered and demonstrated the local
anesthetic properties of cocaine when applied topically to the cornea and conjunctiva. This
landmark discovery marked the beginning of modern local and regional anesthesia in clinical
practice.
Question 3
Which major patient safety initiative, established by the American Society of Anesthesiologists
in 1984, systematically analyzes major adverse anesthetic outcomes to identify patterns of
injury and drive changes in clinical practice standards?
A. The Anesthesia Patient Safety Foundation
B. The National Surgical Quality Improvement Program
C. The ASA Closed Claims Project
D. The AANA Foundation Patient Safety Registry
Answer: C
Rationale: The American Society of Anesthesiologists (ASA) Closed Claims Project was initiated
in 1984 as a systematic database of settled malpractice claims against anesthesiologists. By
analyzing real-world adverse outcomes, the project identified major sources of perioperative
morbidity and mortality (such as unrecognized esophageal intubation and inadequate
ventilation), directly driving the mandatory adoption of pulse oximetry and end-tidal
capnography monitoring standards.
Question 4
Which pioneer introduced chloroform into obstetric practice in 1847 to alleviate labor pain,
famously administering it to Queen Victoria during the birth of Prince Leopold in 1853?
A. Robert Liston
B. John Snow
C. James Young Simpson
D. Arthur Guedel
Answer: C
4
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Rationale: James Young Simpson, a Scottish obstetrician, discovered the anesthetic properties
of chloroform in 1847 and introduced it into obstetric practice to relieve labor pain. The
administration of chloroform to Queen Victoria by John Snow during the delivery of Prince
Leopold in 1853 gave "chloroform à la reine" royal sanction, overcoming religious and social
objections to obstetric pain relief.
Segment B: Extended Matching Set
Options List (A–G):
A. Horace Wells
B. Crawford Long
C. William T. G. Morton
D. John Snow
E. William Halsted
F. Arthur Guedel
G. Virginia Apgar
Question 4 (Extended Matching Stem 1)
Identified the signs and stages of ether anesthesia based on somatic reflex patterns, eye
movements, and respiratory depth to guide safe depth of anesthesia during surgical
procedures.
Answer: F
Rationale: Arthur Guedel formulated the classic signs and stages of ether anesthesia in 1920.
His detailed description of the four stages (and the four planes of Stage III) provided
anesthesiologists with a systematic method to evaluate depth of anesthesia and patient safety
by observing physical signs such as pupil size, respiratory pattern, and eyelash reflexes.
Question 5 (Extended Matching Stem 2)
Pioneered regional nerve block techniques in the United States during the 1880s by performing
direct injections of cocaine into peripheral nerve trunks and brachial plexus roots.
Answer: E
5
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
Rationale: William S. Halsted, along with his colleague Richard Hall, pioneered regional nerve
blockade in 1884–1885 by injecting cocaine solutions directly into nerve trunks, including the
mandibular nerve, brachial plexus, and peripheral nerves, laying the foundation for modern
conduction blockade.
Question 6 (Extended Matching Stem 3)
Demonstrated nitrous oxide for dental extractions in 1844, but suffered a public setback during
an 1845 demonstration at Harvard Medical School when the patient groaned during the
procedure.
Answer: A
Rationale: Horace Wells, a dentist from Hartford, Connecticut, recognized the analgesic
potential of inhaled nitrous oxide in 1844 after observing its effects at a public demonstration.
He successfully used it in his dental practice but suffered a tragic setback during a public
demonstration at Harvard Medical School/Massachusetts General Hospital in January 1845,
where the patient cried out, leading observers to deem the demonstration a failure.
Question 7 (Extended Matching Stem 4)
Developed the first standardized newborn evaluation scoring system in 1952 while working as
an anesthesiologist, establishing a rapid quantitative assessment of neonatal resuscitation
needs.
Answer: G
Rationale: Virginia Apgar, an anesthesiologist at Columbia University, developed the Apgar
Score in 1952. It provided a simple, reproducible 10-point scoring method assessed at 1 and 5
minutes post-birth (evaluating Heart rate, Respiratory effort, Muscle tone, Reflex irritability,
and Color) to quickly assess the clinical status of newborns and guide immediate resuscitation.
Segment D: Sequencing / Ordering Items
Question 9
Order the historical milestone introductions of the following airway devices and direct visual
laryngoscopes into clinical practice, from earliest to most recent:
A. Introduction of the flexible fiberoptic bronchoscope for difficult airway management
(Murphy / Ikeda)
B. Development of the curved laryngoscope blade to fit the vallecula (Macintosh)
6
, Clinical Anesthesia Question Bank — Barash, Cullen & Stoelting 9th Ed.
C. Widespread clinical introduction and commercial availability of the Laryngeal Mask Airway
(Brain)
D. Development of the straight laryngoscope blade with a light bulb at the tip (Magill / Jackson)
Answer: D, B, A, C
Rationale: Direct rigid laryngoscopy began evolving in the early 20th century with straight
blades developed by Jackson and Magill (1920s). Sir Robert Macintosh introduced the curved
blade designed to sit in the epiglottic vallecula in 1943. Flexible fiberoptic bronchoscopy was
adapted for difficult endotracheal intubation in the late 1960s (Ikeda/Murphy). Archie Brain
invented and clinically introduced the Laryngeal Mask Airway (LMA) in the 1980s (commercial
release 1988), revolutionizing supraglottic airway management.
Question 10
Place in chronological sequence the introduction of these inhaled anesthetic agents into clinical
practice, from earliest to most recent:
A. Isoflurane
B. Diethyl ether
C. Sevoflurane
D. Halothane
Answer: B, D, A, C
Rationale: Diethyl ether was publicly demonstrated for clinical anesthesia in 1846. Halothane,
the first nonflammable halogenated hydrocarbon, was introduced in 1956. Isoflurane was
synthesized in 1965 and entered widespread clinical practice in 1981. Sevoflurane was
synthesized in the late 1960s but did not enter routine global clinical use until the 1990s
(approved in the US in 1995).
Question 11
Sequence the historical development of standard safety monitoring requirements adopted by
the American Society of Anesthesiologists (ASA), from earliest to most recent:
A. Mandatory intraoperative end-tidal carbon dioxide monitoring (capnography) standard
B. Establishment of the ASA Physical Status Classification system
7
