Saudi Board Anesthesia Final Written Exam (SCFHS)

Which of the following factors is associated with a decrease in the Minimum Alveolar Concentration (MAC) of volatile anesthetics?

• AChronic alcohol abuse
• BHypernatremia
• CAcute amphetamine ingestion
• DHypothermia

Which of the following features is characteristic of a Phase II neuromuscular block following succinylcholine administration?

• AAbsence of fade during train-of-four (TOF) stimulation
• BPresence of post-tetanic facilitation
• CReversibility with neostigmine during the early onset phase
• DAbsence of fade during tetanic stimulation

What is the primary mechanism of action of intravenous lipid emulsion (ILE) in the treatment of local anesthetic systemic toxicity (LAST)?

• ADirect antagonism of voltage-gated sodium channels
• BCreation of a lipid sink that extracts lipophilic local anesthetics from cardiac tissue
• CEnzymatic degradation of bupivacaine in the plasma
• DUp-regulation of beta-adrenergic receptors in the myocardium

Which of the following mechanisms best explains the sedative effect of dexmedetomidine?

• AGABA-A receptor facilitation in the cerebral cortex
• BNMDA receptor antagonism in the hippocampus
• CAgonism of presynaptic alpha-2 adrenoreceptors in the locus coeruleus
• DAntagonism of dopamine D2 receptors in the basal ganglia

An increase in which of the following variables will shift the left ventricular end-diastolic pressure-volume relationship (EDPVR) upward and to the left (decreasing compliance)?

• AAcute myocardial ischemia
• BAdministration of nitroprusside
• CDecreased intrathoracic pressure
• DModerate exercise-induced tachycardia

In West Zone 1 of the lung, which of the following relationships between pressure variables exists?

• APulmonary venous pressure > Pulmonary arterial pressure > Alveolar pressure
• BPulmonary arterial pressure > Alveolar pressure > Pulmonary venous pressure
• CAlveolar pressure > Pulmonary arterial pressure > Pulmonary venous pressure
• DPulmonary arterial pressure > Pulmonary venous pressure > Alveolar pressure

A shift of the oxyhemoglobin dissociation curve to the right is associated with which of the following conditions?

• ADecrease in temperature
• BDecrease in carbon dioxide tension (PaCO2)
• CIncrease in 2,3-diphosphoglycerate (2,3-DPG) concentration
• DIncrease in pH (alkalosis)

Renal blood flow (RBF) and glomerular filtration rate (GFR) are autoregulated within a mean arterial pressure (MAP) range of approximately:

• A40 to 100 mmHg
• B80 to 180 mmHg
• C100 to 200 mmHg
• D50 to 120 mmHg

Which of the following drugs is a potent inhibitor of the Cytochrome P450 system and can prolong the duration of action of drugs metabolized by these enzymes?

• APhenytoin
• BRifampin
• CCimetidine
• DCarbamazepine

At which anatomical level do the trunks of the brachial plexus divide into anterior and posterior divisions?

• AAs they pass through the scalene triangle
• BPosterior to the clavicle
• CIn the axilla
• DAt the lateral border of the first rib

In a full-term neonate, the spinal cord typically terminates at which vertebral level?

• AL1
• BL3
• CS2
• DT12

A patient undergoes thyroidectomy and postoperatively presents with hoarseness. Laryngoscopy reveals that one vocal cord is fixed in the paramedian position. Which nerve was most likely injured?

• ASuperior laryngeal nerve (internal branch)
• BSuperior laryngeal nerve (external branch)
• CRecurrent laryngeal nerve
• DGlossopharyngeal nerve

A full E-cylinder of oxygen contains a pressure of 1900 psi and a volume of approximately 660 liters. If the pressure gauge reads 950 psi and the patient is receiving oxygen at a flow rate of 5 L/min, how long will the cylinder last?

• A33 minutes
• B66 minutes
• C132 minutes
• D264 minutes

Modern variable-bypass vaporizers compensate for changes in temperature using which of the following mechanisms?

• AAn electronic heating element that maintains a constant liquid temperature
• BA bimetallic strip or expansion element that adjusts the proportion of bypass gas flow
• CA pressure-regulating valve that changes the splitting ratio based on atmospheric pressure
• DA wick system that increases surface area as temperature drops

Pulse oximeters measure functional oxygen saturation by detecting light absorption at which two specific wavelengths?

• A530 nm (green) and 660 nm (red)
• B660 nm (red) and 940 nm (infrared)
• C805 nm (isosbestic point) and 940 nm (infrared)
• D660 nm (red) and 805 nm (isosbestic point)

During general anesthesia, a sudden drop in the end-tidal CO2 (ETCO2) to near zero with a loss of capnography waveform is most commonly indicative of:

• AAccidental mainstem intubation
• BDeveloping malignant hyperthermia
• CEsophageal intubation or circuit disconnection
• DMild hyperventilation

Which of the following equations correctly defines Left Ventricular Coronary Perfusion Pressure (CPP)?

• ACPP = Mean Arterial Pressure - Right Atrial Pressure
• BCPP = Diastolic Arterial Pressure - Left Ventricular End-Diastolic Pressure
• CCPP = Systolic Arterial Pressure - Left Ventricular End-Diastolic Pressure
• DCPP = Mean Arterial Pressure - Pulmonary Capillary Wedge Pressure

Which of the following metabolic disturbances is a hallmark feature of Propofol Infusion Syndrome (PRIS)?

• ARespiratory alkalosis
• BMetabolic acidosis and rhabdomyolysis
• CHypokalemia and hypophosphatemia
• DHypotriglyceridemia

Remifentanil's ultra-short duration of action and lack of accumulation are due to its metabolism by:

• APseudocholinesterase (butyrylcholinesterase)
• BNon-specific tissue and plasma esterases
• CCytochrome P450 3A4 in the liver
• DRenal excretion of unchanged drug

Sugammadex encapsulates and inactivates which of the following neuromuscular blocking drugs with the highest affinity?

• ACisatracurium
• BPancuronium
• CRocuronium
• DSuccinylcholine

According to the American Society of Anesthesiologists (ASA) guidelines, which of the following is the strongest predictor of difficult mask ventilation?

• AMale sex
• BPresence of a beard
• CHistory of asthma
• DMallampati Class II airway

During a rapid sequence induction, you are unable to intubate the trachea after three attempts, and face mask ventilation has become impossible. The patient's oxygen saturation is dropping rapidly. What is the most appropriate next step in management?

• AAttempt intubation with a different blade size
• BPerform emergency front-of-neck access (e.g., cricothyroidotomy)
• CAdminister an additional dose of rocuronium
• DPlace a supraglottic airway device (e.g., LMA)

A patient develops malignant hyperthermia during general anesthesia. What is the recommended initial dose of intravenous dantrolene?

• A1 mg/kg
• B2.5 mg/kg
• C5 mg/kg
• D10 mg/kg

During general anesthesia with sevoflurane, a patient develops severe bronchospasm with a wheeze, rising peak airway pressures, and a sloping capnogram. What is the most appropriate initial pharmacological treatment?

• AIntravenous administration of 100 mcg of epinephrine
• BInhalation of an aerosolized beta-2 agonist (e.g., albuterol) through the breathing circu…
• CIntravenous administration of 100 mg of hydrocortisone
• DIntravenous administration of 50 mg of diphenhydramine

A patient experiences local anesthetic systemic toxicity (LAST) during a regional block. Following initial airway management and seizure control, what is the correct bolus dose of 20% lipid emulsion therapy?

• A1.5 mL/kg over 1 minute
• B0.25 mL/kg over 10 minutes
• C5 mL/kg as a rapid push
• D10 mL/kg over 30 minutes

You notice that the arterial line pressure waveform of a patient in the OR has become overdamped. How will this affect the displayed systolic and diastolic blood pressures?

• ASystolic pressure will be falsely elevated; diastolic pressure will be falsely depressed
• BSystolic pressure will be falsely depressed; diastolic pressure will be falsely elevated
• CBoth systolic and diastolic pressures will be falsely elevated
• DBoth systolic and diastolic pressures will be falsely depressed

Which of the following clinical risk factors is included in the Revised Cardiac Risk Index (RCRI) for preoperative risk stratification?

• AAge greater than 65 years
• BHistory of ischemic heart disease
• CControlled essential hypertension
• DMild chronic obstructive pulmonary disease (COPD)

Which of the following is the most sensitive non-invasive monitor for detecting a venous air embolism (VAE)?

• APrecordial Doppler ultrasound
• BTransesophageal echocardiography (TEE)
• CCapnography (ETCO2)
• DElectrocardiogram (ECG)

A patient develops severe laryngospasm during extubation. After applying 100% oxygen with continuous positive airway pressure (CPAP) and performing jaw thrust with bilateral post-styloid pressure (Larson's maneuver), the airway remains obstructed. What is the most appropriate next step?

• APerform an emergency tracheostomy
• BAdminister a low dose of succinylcholine (e.g., 0.1 to 0.5 mg/kg IV)
• CIntubate the patient immediately without muscle relaxants
• DAdminister a dose of sugammadex

When applying cricoid pressure (Sellick's maneuver) during rapid sequence induction, what is the recommended force that should be applied to the cricoid cartilage once the patient loses consciousness?

• A10 Newtons (approx. 1 kg)
• B30 Newtons (approx. 3 kg)
• C50 Newtons (approx. 5 kg)
• D100 Newtons (approx. 10 kg)

The Apfel score is used to predict the risk of postoperative nausea and vomiting (PONV). Which of the following is one of the four risk factors included in this score?

• AMale sex
• BHistory of motion sickness or prior PONV
• CActive tobacco smoking
• DShort duration of surgery

A patient with a chronic spinal cord injury at the T4 level undergoes cystoscopy. Intraoperatively, the patient suddenly becomes severely hypertensive (BP 210/110 mmHg) and bradycardic (HR 42 bpm). What is the pathophysiology of this condition?

• ALoss of sympathetic tone below the level of the spinal cord lesion
• BUninhibited sympathetic discharge reflexively triggered by noxious stimuli below the lesi…
• CAcute release of catecholamines from a pheochromocytoma
• DParasympathetic overactivity caused by bladder distension

Which class of drugs is most frequently implicated in IgE-mediated anaphylaxis during general anesthesia?

• ANeuromuscular blocking drugs
• BIntravenous induction agents (e.g., propofol)
• CVolatile anesthetics
• DCrystalloid fluids

During a shared-airway laser laryngoscopy, an airway fire erupts in the endotracheal tube. What is the immediate first action the anesthesia provider should take?

• APour sterile water into the patient's airway
• BStop ventilation and disconnect the breathing circuit from the endotracheal tube
• CPerform emergency cricothyroidotomy
• DIncrease the inspired oxygen concentration to 100%

In the operating room, which lead combination provides the highest sensitivity (approximately 80-90%) for detecting myocardial ischemia on a 5-lead ECG?

• ALead II and Lead III
• BLead II and Lead V5
• CLead aVL and Lead aVF
• DLead I and Lead V1

When using Bispectral Index (BIS) monitoring to reduce the risk of intraoperative awareness under general anesthesia, what is the recommended target range for the BIS index?

• A0 to 20
• B20 to 40
• C40 to 60
• D60 to 80

Following cardiopulmonary bypass, a patient requires neutralization of heparin. What is the standard dosing guideline for protamine sulfate administration?

• A1 mg of protamine per 100 units of heparin administered
• B5 mg of protamine per 100 units of heparin administered
• C0.1 mg of protamine per 100 units of heparin administered
• D10 mg of protamine per 100 units of heparin administered

Pulse Pressure Variation (PPV) is a dynamic index used to predict fluid responsiveness. Which of the following conditions must be met for PPV to be a valid predictor?

• AThe patient must be breathing spontaneously
• BThe patient must have a cardiac arrhythmia like atrial fibrillation
• CThe patient must be mechanically ventilated with a tidal volume of at least 8 mL/kg of id…
• DThe chest wall must be open

During the first hour of general anesthesia, a rapid drop in core body temperature is primarily caused by:

• AEvaporative heat loss from open surgical wounds
• BConvective heat loss to the cold operating room air
• CRedistribution of heat from the core to the peripheral compartment
• DInhibition of thyroid hormone secretion by volatile anesthetics

Which of the following parameters is one of the five clinical domains assessed in the modified Aldrete score for PACU discharge?

• APain level
• BOxygen saturation
• CUrine output
• DCore body temperature

Which of the following cardiovascular changes occurs physiologically during a normal pregnancy at term?

• ADecrease in cardiac output
• BIncrease in systemic vascular resistance (SVR)
• CIncrease in blood volume by approximately 45%
• DDecrease in heart rate

A patient develops a severe post-dural puncture headache (PDPH) following an accidental dural puncture with a 17-gauge Touhy needle. Conservative management fails, and an epidural blood patch is performed. What is the recommended volume of autologous blood that should be injected?

• A5 to 10 mL
• B15 to 20 mL
• C30 to 40 mL
• D50 mL

Which of the following anatomical characteristics is typical of the pediatric airway compared to the adult airway?

• AA larynx that is positioned more caudally (lower)
• BA narrow, short, U-shaped epiglottis
• CA larger tongue relative to the oral cavity
• DThe narrowest portion of the airway is the vocal cords

Why is the cardiac output of neonates and infants highly dependent on their heart rate?

• AThey have an underdeveloped autonomic nervous system
• BTheir stroke volume is relatively fixed due to a non-compliant left ventricle
• CThey have low circulating catecholamine levels
• DTheir baroreceptor reflex is hyperactive

During a craniotomy for a traumatic brain injury, the surgeon requests hyperventilation to reduce brain bulk. What is the recommended target range for arterial carbon dioxide tension (PaCO2) to avoid excessive cerebral vasoconstriction and ischemia?

• A20 to 25 mmHg
• B30 to 35 mmHg
• C35 to 40 mmHg
• D40 to 45 mmHg

During a craniotomy in the sitting position, you suspect a venous air embolism. After notifying the surgeon to flood the surgical field, what is the most appropriate next action to take?

• APlace the patient in the Trendelenburg position
• BAspirate air from the distal port of a multi-orificed central venous catheter
• CIncrease the head elevation to 45 degrees
• DAdminister a large fluid bolus of hypotonic saline

Which of the following factors is known to impair hypoxic pulmonary vasoconstriction (HPV) during one-lung ventilation, potentially worsening shunt and hypoxemia?

• AAdministration of volatile anesthetics at concentrations greater than 1 MAC
• BIntravenous infusion of propofol
• CCorrection of metabolic acidosis
• DMaintenance of normal cardiac output