NBME Anesthesiology Form 140 Exam
With Actual 120 Questions & Verified
Answers,Plus Rationales/Expert
Verified For Guaranteed Pass Graded
A+/ 2025/2026 /Latest Update/Instant
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1. A 60-year-old man undergoing bowel resection has a BIS (bispectral index) value
persistently at 65 while receiving sevoflurane at 1.2 MAC. Which is the most likely
interpretation?
A. Light anesthesia — increase sevoflurane
B. Deep anesthesia — decrease sevoflurane
C. Artifact — ignore BIS
D. Possible awareness risk — increase anesthetic depth or confirm clinical signs
E. Excessive opioid effect
Rationale: A BIS of ~65 indicates lighter anesthesia (target usually 40–60). Increase depth
or correlate with clinical signs; artifact is possible but should be checked.
2. Which volatile anesthetic has the lowest blood:gas partition coefficient and therefore
the fastest onset and offset?
A. Isoflurane
B. Halothane
C. Enflurane
D. Desflurane
E. Sevoflurane
Rationale: Desflurane has the lowest blood:gas solubility among common agents, causing
rapid induction/emergence.
3. A patient with myasthenia gravis undergoing thymectomy: which neuromuscular
management strategy is best?
A. High-dose succinylcholine for intubation
B. Avoid neuromuscular blockers entirely
, C. Use short-acting nondepolarizing agent titrated with peripheral nerve stimulator
D. Give large dose of reversal at induction
E. Maintain using long-acting nondepolarizer
Rationale: MG patients are sensitive to nondepolarizers; titrate with monitoring.
Succinylcholine response is variable; avoid large maintenance doses.
4. During positive-pressure ventilation, sudden hypotension and increased peak airway
pressure occur. Which is the most likely immediate cause?
A. Hypovolemia
B. Anaphylaxis
C. Tension pneumothorax
D. Pulmonary embolism
E. Bronchospasm
Rationale: Tension pneumothorax causes sudden hypotension and rise in airway pressures;
check breath sounds and tracheal deviation.
5. Which opioid has the greatest histamine release risk when given IV?
A. Fentanyl
B. Sufentanil
C. Morphine
D. Remifentanil
E. Hydromorphone
Rationale: Morphine commonly releases histamine causing hypotension and pruritus;
others have less histamine effect.
6. A patient with severe aortic stenosis for noncardiac surgery — which anesthetic
principle is most important?
A. Avoid fluid boluses
B. Maintain sinus rhythm, avoid hypotension, preserve preload
C. Strictly use neuraxial anesthesia
D. Use high-dose vasodilators to reduce afterload
E. Tachycardia is desirable
Rationale: AS patients need adequate preload, sinus rhythm, and maintain BP;
hypotension and tachycardia are dangerous.
7. Which local anesthetic has the longest duration when used for peripheral nerve
block?
A. Lidocaine
B. Chloroprocaine
C. Mepivacaine
, D. Bupivacaine
E. Prilocaine
Rationale: Bupivacaine has longer duration due to high potency and protein binding.
8. A neonate is born with meconium-stained fluid and is nonvigorous. What airway
management is indicated?
A. Routine suctioning only
B. Immediate tracheal suctioning (intubation and suctioning) before stimulation
C. Bag-mask ventilation first
D. Give naloxone
E. Delay interventions for observation
Rationale: Nonvigorous neonate with meconium requires intubation and tracheal
suctioning to reduce aspiration risk.
9. Which inhaled anesthetic is most nephrotoxic due to compound A formation with
CO2 absorbents?
A. Desflurane
B. Isoflurane
C. Sevoflurane
D. Halothane
E. Enflurane
Rationale: Sevoflurane can form compound A with some CO₂ absorbents; renal toxicity has
been a concern in animal studies.
10. In the setting of suspected malignant hyperthermia, which drug should be given
immediately?
A. Dantrolene sodium
B. Haloperidol
C. Insulin
D. Dantrolene sodium (rapid IV bolus)
E. Sodium bicarbonate only
Rationale: Dantrolene is the definitive therapy for MH; start immediately along with
supportive measures.
11. A patient on chronic ACE inhibitor therapy develops hypotension after induction.
Best immediate management?
A. Give IV hydralazine
B. Start epinephrine infusion
C. Give IV phenylephrine or ephedrine and consider vasopressin if refractory
D. Give propranolol
E. Increase inhalational anesthetic
With Actual 120 Questions & Verified
Answers,Plus Rationales/Expert
Verified For Guaranteed Pass Graded
A+/ 2025/2026 /Latest Update/Instant
Download Pdf
1. A 60-year-old man undergoing bowel resection has a BIS (bispectral index) value
persistently at 65 while receiving sevoflurane at 1.2 MAC. Which is the most likely
interpretation?
A. Light anesthesia — increase sevoflurane
B. Deep anesthesia — decrease sevoflurane
C. Artifact — ignore BIS
D. Possible awareness risk — increase anesthetic depth or confirm clinical signs
E. Excessive opioid effect
Rationale: A BIS of ~65 indicates lighter anesthesia (target usually 40–60). Increase depth
or correlate with clinical signs; artifact is possible but should be checked.
2. Which volatile anesthetic has the lowest blood:gas partition coefficient and therefore
the fastest onset and offset?
A. Isoflurane
B. Halothane
C. Enflurane
D. Desflurane
E. Sevoflurane
Rationale: Desflurane has the lowest blood:gas solubility among common agents, causing
rapid induction/emergence.
3. A patient with myasthenia gravis undergoing thymectomy: which neuromuscular
management strategy is best?
A. High-dose succinylcholine for intubation
B. Avoid neuromuscular blockers entirely
, C. Use short-acting nondepolarizing agent titrated with peripheral nerve stimulator
D. Give large dose of reversal at induction
E. Maintain using long-acting nondepolarizer
Rationale: MG patients are sensitive to nondepolarizers; titrate with monitoring.
Succinylcholine response is variable; avoid large maintenance doses.
4. During positive-pressure ventilation, sudden hypotension and increased peak airway
pressure occur. Which is the most likely immediate cause?
A. Hypovolemia
B. Anaphylaxis
C. Tension pneumothorax
D. Pulmonary embolism
E. Bronchospasm
Rationale: Tension pneumothorax causes sudden hypotension and rise in airway pressures;
check breath sounds and tracheal deviation.
5. Which opioid has the greatest histamine release risk when given IV?
A. Fentanyl
B. Sufentanil
C. Morphine
D. Remifentanil
E. Hydromorphone
Rationale: Morphine commonly releases histamine causing hypotension and pruritus;
others have less histamine effect.
6. A patient with severe aortic stenosis for noncardiac surgery — which anesthetic
principle is most important?
A. Avoid fluid boluses
B. Maintain sinus rhythm, avoid hypotension, preserve preload
C. Strictly use neuraxial anesthesia
D. Use high-dose vasodilators to reduce afterload
E. Tachycardia is desirable
Rationale: AS patients need adequate preload, sinus rhythm, and maintain BP;
hypotension and tachycardia are dangerous.
7. Which local anesthetic has the longest duration when used for peripheral nerve
block?
A. Lidocaine
B. Chloroprocaine
C. Mepivacaine
, D. Bupivacaine
E. Prilocaine
Rationale: Bupivacaine has longer duration due to high potency and protein binding.
8. A neonate is born with meconium-stained fluid and is nonvigorous. What airway
management is indicated?
A. Routine suctioning only
B. Immediate tracheal suctioning (intubation and suctioning) before stimulation
C. Bag-mask ventilation first
D. Give naloxone
E. Delay interventions for observation
Rationale: Nonvigorous neonate with meconium requires intubation and tracheal
suctioning to reduce aspiration risk.
9. Which inhaled anesthetic is most nephrotoxic due to compound A formation with
CO2 absorbents?
A. Desflurane
B. Isoflurane
C. Sevoflurane
D. Halothane
E. Enflurane
Rationale: Sevoflurane can form compound A with some CO₂ absorbents; renal toxicity has
been a concern in animal studies.
10. In the setting of suspected malignant hyperthermia, which drug should be given
immediately?
A. Dantrolene sodium
B. Haloperidol
C. Insulin
D. Dantrolene sodium (rapid IV bolus)
E. Sodium bicarbonate only
Rationale: Dantrolene is the definitive therapy for MH; start immediately along with
supportive measures.
11. A patient on chronic ACE inhibitor therapy develops hypotension after induction.
Best immediate management?
A. Give IV hydralazine
B. Start epinephrine infusion
C. Give IV phenylephrine or ephedrine and consider vasopressin if refractory
D. Give propranolol
E. Increase inhalational anesthetic
