100+ Free ACVAA Practice Questions

Monitoring

Multiparameter monitoring — pulse oximetry (SpO2), capnography (EtCO2 waveform — rebreathing, obstruction, decreased cardiac output), ECG arrhythmia recognition (VPCs, AV block, atrial fibrillation, ventricular tachycardia), direct (arterial catheter) and indirect (oscillometric, Doppler) blood pressure, temperature, BIS/entropy depth monitors, neuromuscular monitoring (train-of-four, double-burst, post-tetanic count — ulnar/peroneal/facial nerve stimulation), arterial blood gas interpretation (pH, PaO2, PaCO2, HCO3, base excess, A-a gradient), anesthetic depth assessment.

Sedatives, Tranquilizers & Opioids

Alpha-2 agonists (dexmedetomidine 1-5 µg/kg IV/IM, medetomidine, xylazine, detomidine, romifidine; reversal — atipamezole, yohimbine), phenothiazines (acepromazine — alpha-1 blockade causing vasodilation and hypotension; boxer sensitivity), benzodiazepines (midazolam, diazepam; flumazenil reversal), full mu-opioid agonists (hydromorphone, methadone, morphine, fentanyl, oxymorphone — histamine release with morphine), partial agonists (buprenorphine — ceiling effect, high receptor affinity, long duration in cats), agonist-antagonists (butorphanol, nalbuphine), tramadol limitations in dogs (poor M1 metabolism), naloxone reversal.

Inhalant Anesthetics

Minimum alveolar concentration (MAC) — isoflurane ~1.3% dog / ~1.6% cat; sevoflurane ~2.4% dog / ~2.6% cat; desflurane ~7.2% dog / ~9.8% cat. Blood/gas solubility (desflurane 0.42 < sevoflurane 0.65 < isoflurane 1.4) — lower solubility means faster onset/recovery. MAC-altering factors (age, hypothermia, pregnancy, opioids, alpha-2 reduce MAC; hyperthermia, chronic stimulants increase). Vapor pressure and variable-bypass vs desflurane heated vaporizer, circle rebreathing vs non-rebreathing (Mapleson D/F, Bain) systems, soda lime CO2 absorption, Compound A with sevoflurane and low fresh gas flow.

Species-Specific Anesthesia

Small animal (cat-specific dysphoria with opioids, morphine vomiting and histamine release), equine (recovery myopathy/neuropathy prevention, GGX/guaifenesin-ketamine-xylazine triple drip, hypoxemia from V/Q mismatch in lateral recumbency, V/Q gradient), ruminants (regurgitation and bloat risk, local-heavy protocols, paravertebral and inverted-L blocks for laparotomy), camelids, swine (malignant hyperthermia with ryanodine receptor RYR1 mutation, stress cardiomyopathy), rabbits (obligate nasal breathers, difficult glottic visualization, high atropinesterase), avian (air sac cannulation, high isoflurane sensitivity), reptiles (temperature-dependent pharmacokinetics, IPPV for prolonged apnea), zoo and wildlife (BAM — butorphanol/azaperone/medetomidine; TKX; thiafentanil for ungulate capture).

Pain Management & Analgesia

Multimodal analgesia, NSAIDs (carprofen, meloxicam, robenacoxib, deracoxib; grapiprant — EP4 prostaglandin receptor antagonist; renal and GI adverse effects — avoid in dehydration or renal disease), opioids (systemic, epidural, CRI), NMDA antagonists (ketamine CRI 2-10 µg/kg/min for central sensitization, amantadine), alpha-2 CRIs (dexmedetomidine), gabapentinoids, tricyclic antidepressants, monoclonal antibodies — lokivetmab (Librela, anti-NGF) for canine osteoarthritis and frunevetmab (Solensia, anti-NGF) for feline OA pain, validated pain scales (Colorado State University Acute Pain Scale, Glasgow Composite Measure Pain Scale, UNESP-Botucatu feline scale, feline grimace scale), cancer and chronic pain.

Regional & Local Anesthesia

Ultrasound- and nerve-stimulator-guided peripheral nerve blocks (brachial plexus for forelimb, RUMM — radial/ulnar/median/musculocutaneous at distal humerus, sciatic/femoral/saphenous for pelvic limb, transversus abdominis plane — TAP, intercostal, paravertebral), neuraxial anesthesia (lumbosacral epidural in dogs with loss-of-resistance technique, caudal epidural in horses and cattle), retrobulbar block for enucleation, dental blocks (infraorbital, maxillary, middle mental, inferior alveolar/mandibular), local infiltration (lidocaine max ~10 mg/kg dog, ~5 mg/kg cat; bupivacaine 2 mg/kg), intratesticular and intraperitoneal for castration/OVH, liposomal bupivacaine (Nocita) extended-release.

Induction Agents & TIVA

Propofol (rapid onset and offset, GABAergic; feline Heinz-body formation with repeated dosing; avoid in egg/soy-allergic patients), alfaxalone (neuroactive steroid GABA modulator — cardiovascular-sparing induction for cats, dogs, rabbits, and small mammals; IM-capable), ketamine (NMDA antagonist — dissociative anesthesia, sympathomimetic with increased HR/BP and cardiac output; combined with benzodiazepine or alpha-2 to smooth induction), etomidate (excellent cardiovascular stability — valuable for cardiac patients; adrenocortical suppression, hemolysis from propylene glycol vehicle), thiopental historical barbiturate use, TIVA (propofol or alfaxalone CRI ± ketamine/fentanyl), target-controlled infusion.

Complications & Crisis Management

Hypotension (MAP <60 mmHg — most common complication; causes include inhalant-induced vasodilation, hypovolemia, depressed contractility; treat with fluid bolus, reduce inhalant, ephedrine 0.05-0.1 mg/kg, dopamine 5-10 µg/kg/min, norepinephrine for vasodilatory shock, dobutamine for contractility), hypoxemia (SpO2 <95% — V/Q mismatch, hypoventilation, diffusion impairment, R-to-L shunt, low FiO2), hypercapnia (EtCO2 >45), hypothermia (shivering, prolonged recovery), arrhythmias (lidocaine 2 mg/kg for VPC/VT in dogs — use with caution in cats), regurgitation and aspiration, malignant hyperthermia (dantrolene 2.5 mg/kg), anaphylaxis (epinephrine), drug errors.

Pre-Anesthetic Assessment & Planning

ASA physical status classification (I — healthy; II — mild systemic disease; III — severe systemic disease; IV — constant threat to life; V — moribund, not expected to survive without surgery; E — emergency modifier), history and physical exam, breed-specific concerns (brachycephalic airway — BOAS; Doberman von Willebrand; sighthound prolonged thiopental recovery; boxer acepromazine sensitivity with vasovagal bradycardia; collies/Australian shepherds and MDR1/ABCB1 mutation affecting ivermectin, loperamide, acepromazine, butorphanol clearance), minimum database (CBC, chemistry, UA), fasting guidelines, premedication selection, geriatric/pediatric/obese/pregnant considerations, comorbid cardiac (MMVD, HCM, DCM), renal, hepatic, endocrine (diabetes, HAC, hyperthyroidism) disease.

Ventilation & Respiratory Support

Controlled vs assisted ventilation (IPPV intermittent positive-pressure ventilation, pressure-controlled PCV 10-15 cmH2O, volume-controlled VCV 10-15 mL/kg, SIMV synchronized intermittent mandatory ventilation), tidal volume and respiratory rate settings (10-12 breaths per minute in most species), positive end-expiratory pressure (PEEP) for atelectasis, recruitment maneuvers, end-tidal CO2 monitoring (35-45 mmHg target), one-lung ventilation for thoracic surgery, airway management (endotracheal intubation with Murphy-eye tube, cuff pressure 20-25 cmH2O), laryngeal mask airway, tracheostomy, pulmonary mechanics.

Fluid Therapy

Crystalloids (lactated Ringer's, Plasma-Lyte 148, Normosol-R, 0.9% saline), colloids (hydroxyethyl starch Vetstarch — AKI concerns especially in cats and septic patients; albumin), hypertonic saline 7.5% for rapid volume expansion, blood products (packed RBC, fresh whole blood, FFP, cryoprecipitate), intraoperative rates (historic 10 mL/kg/hr dog and 5 mL/kg/hr cat now favoring goal-directed lower rates of 3-5 mL/kg/hr to avoid interstitial edema), shock resuscitation (shock bolus 10-20 mL/kg titrated), acid-base disturbances (metabolic acidosis, respiratory acidosis).

Emergency & CPR (RECOVER)

RECOVER (Reassessment Campaign on Veterinary Resuscitation) guidelines — BLS: 100-120 compressions per minute, depth 1/3 to 1/2 chest width, lateral recumbency for most dogs and cats (dorsal for barrel-chested), 2-minute uninterrupted cycles, IPPV 10 breaths per minute with tidal volume ~10 mL/kg. ALS: epinephrine low-dose 0.01 mg/kg IV q3-5 min, atropine 0.04 mg/kg for vagal/asystole, vasopressin 0.8 U/kg as alternative, ECG rhythm diagnosis (asystole, PEA, VF/pulseless VT — defibrillation 4-6 J/kg monophasic, 2-4 J/kg biphasic), EtCO2 >15 mmHg suggests effective chest compressions and helps identify ROSC, post-cardiac-arrest care (oxygen, neuroprotection).

Cardiac & High-Risk Patient Anesthesia

Myxomatous mitral valve disease (MMVD — avoid tachycardia and bradycardia; support preload and afterload), hypertrophic cardiomyopathy (HCM — avoid tachycardia and hypovolemia; maintain preload and SVR; avoid inotropes that worsen outflow obstruction), dilated cardiomyopathy (DCM — support contractility with dobutamine or pimobendan; avoid myocardial depressants; diastolic failure support), patent ductus arteriosus, pericardial effusion with tamponade (pericardiocentesis before induction), septic shock, major trauma, intracranial disease (avoid hypercapnia to prevent cerebral vasodilation and raised ICP; maintain CPP = MAP − ICP).

Neuromuscular Blockade

Non-depolarizing neuromuscular blockers — atracurium (Hofmann elimination — organ-independent breakdown; histamine release), cisatracurium (stereoisomer — less histamine release), vecuronium, rocuronium (rapid onset). Depolarizing — succinylcholine (rare veterinary use; MH trigger). Train-of-four (TOF) monitoring at ulnar, peroneal, or facial nerve with 4 supramaximal stimuli at 2 Hz over 2 seconds; target TOF ratio ≥0.9 for safe extubation. Reversal: neostigmine 0.02-0.04 mg/kg with glycopyrrolate or atropine to block muscarinic effects; sugammadex 2-16 mg/kg for selective encapsulation of rocuronium and vecuronium, providing rapid and reliable reversal.