NBSTSA Surgical Pharmacology & Anesthesia 2 — Questions and Answers
Question 1: Which type of anesthesia involves injection of anesthetic into the subarachnoid space?
- Epidural anesthesia
- Spinal anesthesia (Correct answer)
- Bier block
- Nerve block
Correct answer: Spinal anesthesia
Spinal anesthesia (intrathecal anesthesia) involves injection of local anesthetic directly into the subarachnoid space where cerebrospinal fluid is present.
Question 2: Which neuromuscular blocking agent is depolarizing and has the fastest onset?
- Rocuronium
- Vecuronium
- Atracurium
- Succinylcholine (Correct answer)
Correct answer: Succinylcholine
Succinylcholine is the only depolarizing neuromuscular blocker in clinical use, with the fastest onset (60 seconds) and shortest duration, ideal for rapid sequence intubation.
Question 3: The surgical technologist notices heparin and thrombin are both on the sterile back table. The greatest risk is:
- Thrombin becoming inactive if mixed with heparin
- Accidental IV injection of thrombin causing systemic coagulation (Correct answer)
- Heparin contaminating the bone wax supply
- Mixing the two agents in the same basin
Correct answer: Accidental IV injection of thrombin causing systemic coagulation
Thrombin must never be injected intravenously as it causes widespread intravascular coagulation and death; it is only for topical hemostatic use.
Question 4: Which irrigation solution, if absorbed in large quantities during TURP procedures, can cause hyponatremia and TUR syndrome?
- Normal saline (0.9% NaCl)
- Lactated Ringer's
- Glycine 1.5% (Correct answer)
- Sterile water
Correct answer: Glycine 1.5%
Glycine 1.5% is a non-electrolyte hypotonic irrigant used in TURP; absorption of large volumes can cause dilutional hyponatremia and TUR syndrome.
Question 5: Protamine sulfate is administered intraoperatively to:
- Reverse the effects of heparin (Correct answer)
- Promote clotting at the surgical site
- Treat anaphylaxis
- Reverse neuromuscular blockade
Correct answer: Reverse the effects of heparin
Protamine sulfate is the specific reversal agent for heparin anticoagulation, forming an inactive complex with heparin molecules.
Question 6: Which agent is used as a topical hemostatic on the sterile field and is derived from bovine thrombin combined with gelatin?
- Surgicel (oxidized cellulose)
- Gelfoam with thrombin (Correct answer)
- Bone wax
- Silver nitrate sticks
Correct answer: Gelfoam with thrombin
Gelfoam (absorbable gelatin sponge) saturated with thrombin creates an effective topical hemostatic agent that promotes clot formation when applied to bleeding surfaces.
NBSTSA Surgical Pharmacology & Anesthesia 2
Which type of anesthesia involves injection of anesthetic into the subarachnoid space?