NAGELHOUT EXAM QUESTIONS
AND VERIFIED ANSWERS
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - ANSWER What are the renal effects of all anesthetics except
nitrous oxide?
Halothane - ANSWER What anesthetic is associated with hepatotoxicity in
adults but not children?
All except nitrous oxide - ANSWER What inhalation anesthetics trigger
malignant hyperthermia and are contraindicated?
Nitrous Oxide - ANSWER This inhalation anesthetic blocks DNA and RNA
synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - ANSWER How does Nitrous Oxide block
DNA & RNA production?
(1) Nutritional disorders - elderly, vegans and alcoholics
(2) Malabsorption disorders - use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - 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 - 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 - ANSWER What are the relative contraindications to
Nitrous Oxide?
Risk of myocardial ischemia - ANSWER What is a putative relative
contraindication to Nitrous Oxide?
after puberty - 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) - 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) - ANSWER Is
there any anesthetic technique you should avoid using when performing surgery
in cancer patients?
Nitrous oxide (teratogenic in animals) - ANSWER What anesthetic is
contraindicated in pregnancy?
first trimester - ANSWER When is nitrous oxide most likely to cause
teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - ANSWER What
is the effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) -
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 - ANSWER What are the three principle sources of waste
anesthetic gasses?
<25 ppm - ANSWER Regulations in the USA require nitrous oxide levels to
be ________________.
, <2 ppm - ANSWER Regulations in the USA require halogenated gas levels to
be _____________.
False (exception dexmedetomidine) - ANSWER T/F: All intravenous
anesthetics consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - ANSWER Which of the
inhalation anesthetics has analgesic effects?
(1) Analgesia
(2) Quick uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - ANSWER What are the advantages of Nitrous
Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - ANSWER What are the disadvantages of Nitrous
Oxide?
(1) Moderate muscle relaxation
AND VERIFIED ANSWERS
decrease blood pressure
decrease renal blood flow
decrease GFR
decrease UO - ANSWER What are the renal effects of all anesthetics except
nitrous oxide?
Halothane - ANSWER What anesthetic is associated with hepatotoxicity in
adults but not children?
All except nitrous oxide - ANSWER What inhalation anesthetics trigger
malignant hyperthermia and are contraindicated?
Nitrous Oxide - ANSWER This inhalation anesthetic blocks DNA and RNA
synthesis.
oxidies the Cobalt atom on Vitamin B12
inhibits methionine synthetase - ANSWER How does Nitrous Oxide block
DNA & RNA production?
(1) Nutritional disorders - elderly, vegans and alcoholics
(2) Malabsorption disorders - use of proton pump inhibitors (H2 antagonists),
pernicious anemia, atrophic gastritis, postgastrectomy, Crohn's disease
(3) Infection - bacterial overgrowth, tapeworm - 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 - 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 - ANSWER What are the relative contraindications to
Nitrous Oxide?
Risk of myocardial ischemia - ANSWER What is a putative relative
contraindication to Nitrous Oxide?
after puberty - 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) - 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) - ANSWER Is
there any anesthetic technique you should avoid using when performing surgery
in cancer patients?
Nitrous oxide (teratogenic in animals) - ANSWER What anesthetic is
contraindicated in pregnancy?
first trimester - ANSWER When is nitrous oxide most likely to cause
teratogenic effects?
relax the uterus (increase risk of postoperative miscarriage) - ANSWER What
is the effect of all anesthetics in pregnant women?
spinal (less bleeding - inhalation = uterine relaxation and more bleeding) -
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 - ANSWER What are the three principle sources of waste
anesthetic gasses?
<25 ppm - ANSWER Regulations in the USA require nitrous oxide levels to
be ________________.
, <2 ppm - ANSWER Regulations in the USA require halogenated gas levels to
be _____________.
False (exception dexmedetomidine) - ANSWER T/F: All intravenous
anesthetics consistently produce adverse neurodevelopmental consequences.
Nitrous oxide (50% NO = 15 mg IV morphine) - ANSWER Which of the
inhalation anesthetics has analgesic effects?
(1) Analgesia
(2) Quick uptake and elimination
(3) Little cardiac or respiratory depression
(4) Nonpungent
(5) Reduces MAC of the more potent agents
(6) Minimal biotransformation - ANSWER What are the advantages of Nitrous
Oxide?
(1) Expansion of closed air spaces
(2) Requires high concentrations
(3) Amount of oxygen delivered is reduced
(4) Diffusion hypoxia, teratogenic increases
(5) PONV
(6) Supports combustion
(7) Immune suppression - ANSWER What are the disadvantages of Nitrous
Oxide?
(1) Moderate muscle relaxation
