Free CMSRN Anesthetist Questions and Answers — Questions and Answers
Question 1: Which of the following catecholamines DOES NOT occur naturally?
- Dopamine
- Isoproterenol (Correct answer)
- Dobutamine (Correct answer)
- Epinephrine
- Norepinephrine
Correct answer: Isoproterenol
Dopamine, Epinephrine, and Norepinephrine are naturally occurring catecholamines produced by the body. Isoproterenol is a synthetic catecholamine that acts as a beta-adrenergic agonist, primarily used as a bronchodilator and cardiac stimulant. Dobutamine is also a synthetic catecholamine, primarily a beta-1 agonist.
Question 2: Except for the following, all of the following list phosphodiasterase inhibitors:
- Positive inotrope
- Decrease SVR
- Vasoconstrictor (Correct answer)
- Increase cAMP bypreventing breakdown
Correct answer: Vasoconstrictor
Phosphodiesterase inhibitors (PDEIs) like milrinone are known for their positive inotropic effects (increasing cardiac contractility) and their ability to cause vasodilation, which decreases systemic vascular resistance (SVR). They achieve this by preventing the breakdown of cyclic AMP (cAMP), leading to increased intracellular calcium in cardiac cells and smooth muscle relaxation in blood vessels. Therefore, 'Vasoconstrictor' is the characteristic that does NOT describe the action of phosphodiesterase inhibitors.
Question 3: Which vasopressor is recommended in obstetric situations?
- Phenylephrine
- Ephedrine (Correct answer)
- Ephinephrine
- Norepinephrine
Correct answer: Ephedrine
Ephedrine is often the preferred vasopressor in obstetric situations, particularly for treating hypotension during spinal or epidural anesthesia. It has both alpha and beta-adrenergic effects, causing vasoconstriction and increased heart rate. Importantly, ephedrine is less likely to cause uterine vasoconstriction and fetal acidosis compared to pure alpha-agonists like phenylephrine, making it a safer choice for the mother and fetus.
Question 4: Pheochromocytoma can be treated with either of the following medications: <br>Phenoxybenzamine ______<br> Phentolamine _______
- Competitive alpha-1 antagonist and Strong Alphar Blocker
- Strong Alpha blocker and Competitive alpha-1 antagonist (Correct answer)
- Both Competitive alpha-1 antagonist
- Both Strong alpha blocker
Correct answer: Strong Alpha blocker and Competitive alpha-1 antagonist
Phenoxybenzamine is a non-competitive, irreversible alpha-adrenergic blocker, making it a 'strong alpha blocker' that provides sustained blockade. Phentolamine is a competitive alpha-1 and alpha-2 adrenergic antagonist, meaning it is a 'competitive alpha-1 antagonist.' Both are used in managing pheochromocytoma to control hypertension caused by excessive catecholamine release.
Question 5: Of the following, which one is not a side effect of atropine, a cholinoreceptor blocker?
- Mydriasis
- Increased pulse
- Urinary retention (Correct answer)
- Constipation
Correct answer: Urinary retention
Atropine is a muscarinic cholinoreceptor blocker, and its anticholinergic effects include mydriasis (pupil dilation), increased pulse (tachycardia), and constipation (due to decreased gastrointestinal motility). Urinary retention is also a well-known anticholinergic side effect, resulting from the relaxation of the detrusor muscle and contraction of the internal urethral sphincter. Therefore, based on established pharmacological knowledge, urinary retention *does* occur as a side effect of atropine.
Question 6: Which of the following does not occur as an ACE side effect?
- Cough
- Rash
- Congestion (Correct answer)
- Angiodema
Correct answer: Congestion
Angiotensin-converting enzyme (ACE) inhibitors are commonly associated with side effects such as a persistent dry cough (due to bradykinin accumulation), skin rash, and angioedema, a potentially life-threatening swelling. Congestion, particularly nasal congestion, is not a typical or direct side effect of ACE inhibitors. In fact, these medications are often used to manage conditions like heart failure, which can involve pulmonary congestion.
Question 7: Which of the scenarios does not result from the vasodilator nifedipine
- Vertigo
- Nausea
- Flush appearance
- Sexual dysfunction (Correct answer)
Correct answer: Sexual dysfunction
Nifedipine, a dihydropyridine calcium channel blocker, primarily causes vasodilation, leading to side effects like vertigo, nausea, and a flushed appearance. Sexual dysfunction is not a common or direct side effect associated with nifedipine. While some antihypertensive medications can cause sexual dysfunction, nifedipine is generally not known for this particular adverse effect.
Question 8: Which of the following doesn't result from the sympathoplegic pharmacotherapy?
- Dry oral cavity
- lethargic behavior
- Hypertension (Correct answer)
- Asthma
Correct answer: Hypertension
Sympathoplegic pharmacotherapy involves drugs that reduce sympathetic nervous system activity, often used to treat hypertension. Their effects include dry oral cavity (due to decreased salivary secretions), lethargic behavior (sedation), and potentially asthma exacerbation (if non-selective beta-blockers are used). Hypertension is the opposite of the intended effect of these medications, as they are designed to lower blood pressure.
Question 9: Which of these does not result from the loop diuretics?
- Hypotension
- Alkalosis
- Potassium deficits
- Nausea (Correct answer)
Correct answer: Nausea
Loop diuretics, such as furosemide, are potent diuretics that commonly lead to side effects like hypotension (due to fluid volume depletion), metabolic alkalosis (from increased hydrogen ion excretion), and potassium deficits (hypokalemia). While gastrointestinal upset can occur with many medications, nausea is not a primary or characteristic side effect of loop diuretics in the same way as electrolyte imbalances or blood pressure changes.
Question 10: Which of the following does barbiturates not treat?
- Anxiety
- Seizures
- Hypotension (Correct answer)
- Insomnia
Correct answer: Hypotension
Barbiturates are central nervous system depressants primarily used to treat conditions such as anxiety, seizures, and insomnia due to their sedative and anticonvulsant properties. While they can cause hypotension as a side effect, especially with overdose or rapid intravenous administration, they are not used as a treatment for hypotension. In fact, they would worsen low blood pressure.
Question 11: Which of the following conditions is not managed with methadone and dextromethorphan, two opioid analgesics?
- Pain (Correct answer)
- Pulmonary edema
- Sedation
- Cough suppresion
Correct answer: Pain
Methadone is a potent opioid analgesic used for severe pain management and opioid dependence. Dextromethorphan, while an opioid derivative, is primarily used as a cough suppressant and has minimal to no analgesic properties at therapeutic doses. Therefore, pain is a condition that is managed by methadone but not by dextromethorphan, meaning it is not a shared therapeutic indication for both drugs.
Free CMSRN Anesthetist Questions and Answers
Which of the following catecholamines DOES NOT occur naturally?