MCQS Neuromuscular Blocker

Total Marks:08
1. Which of the following is correct regarding drug interactions with nondepolarizing
neuromuscular blockers (NMBs)?
A. Desflurane reduces the effects of nondepolarizing NMBs.
B. Cholinesterase inhibitors increase the effects of nondepolarizing NMBs.
C. Aminoglycosides increase the effects of nondepolarizing NMBs.
D. Calcium channel blockers reduce the effects of nondepolarizing NMBs.

2. A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to

produce skeletal muscle paralysis. This NMB drug affected small, rapidly contracting muscles of
the face and eyes first and diaphragm muscles last. The effect of this drug was easily reversed
with neostigmine. Which of the following neuromuscular blockers was most likely administered
to this patient?
A. Rocuronium.
B. Succinylcholine.
C. Diazepam.
D. Tubocurarine

3. Characteristics of phase I depolarizing neuromuscular blockade due to succinylcholine include

A. Easy reversibility with nicotinic receptor antagonists
B. Marked muscarinic blockade
C. Muscle fasciculation’s only in the later stages of block
D. Reversibility by acetylcholinesterase (AChE) inhibitors
E. Sustained tension during a period of tetanic stimulation

4. A muscarinic receptor antagonist would probably not be needed when a cholinesterase

inhibitor was given for reversal of the skeletal muscle relaxant actions of a nondepolarizing
drug if the NM blocking agent used was
A. Cisatracurium
B. Mivacurium
C. Pancuronium
D. Tubocurarine
E. Vecuronium

5. The clinical use of succinylcholine, especially in patients with diabetes, is associated with
A. Antagonism by pyridostigmine during the early phase of blockade
B. Aspiration of gastric contents
C. Decreased intragastric pressure
D. Histamine release in a genetically determined population
E. Metabolism at the neuromuscular junction by acetylcholinesterase
6. Myalgias are a common postoperative complaint of patients who receive large doses of
succinylcholine, possibly the result of muscle fasciculations caused by depolarization. Which
drug administered in the operating room can be used to prevent postoperative pain caused by
succinylcholine?
A. Atracurium
B. Baclofen
C. Dantrolene
D. Diazepam
E. Lidocaine

7. Which of the following is correct regarding the neuromuscular blockers (NMBs)?

A. Nondepolarizing NMBs are administered orally.
B. Cholinesterase inhibitors reduce the effects of nondepolarizing NMBs.
C. Nondepolarizing NMBs affect diaphragm muscles first.
D. Effects of depolarizing neuromuscular blockers can be reversed using cholinesterase
inhibitors

8. A patient was administered a neuromuscular blocker (NMB) prior to a surgical procedure to

produce skeletal muscle paralysis. This NMB drug caused initial skeletal muscle fasciculations
before the onset of paralysis. The effect of this drug could not be reversed with neostigmine.
Which of the following neuromuscular blockers was most likely administered to this patient?
A. Cisatracurium.
B. Succinylcholine.
C. Diazepam.
D. Tubocurarine.
 SEQS:
Total Marks:10
1: Describe the mechanism of action of Non depolarizing skeletal muscle relaxants 2
2: Classify Skeletal muscle relaxants according to their mechanism of action 2
[Link] the pharmacological action of non-depolarizing skeletal muscle relaxants 2
4: Describe the mode of action of succinylcholine 2
5: Enumerate therapeutic uses of Periphery acting skeletal muscle relaxants 2
SEQs General Anesthetics:
1: Define the term Blood: Gas: partition co-efficient and minimum alveolar
concentration 2
2: Enlist the molecular targets of action of anesthetics drugs and describe their
associated toxicities 2
3: List the main pharmacokinetic characteristics of commonly used Intravenous
and inhaled Anesthetics agents 2
4: Name the major inhalation and intravenous anesthetics drugs 2

SEQs Local anesthetics:

1: Classify Local Anesthetics 2
2: Describe the mechanism of action of local anesthetics 2
3: Describe the major toxic effects of Local Anesthetics 2
4: Explain the relationship among Tissue PH, drug pKa and the rate of onset of
local anesthetics action 2

SEQs Opioids:
1: Write pharmacodynamics classification of opioids analgesics 2
2: Describe cardinal signs and treatment of opioids drug overdose. 2
3: Describe the classification, mode of action and therapeutics uses of opioids
2
MCQS General anesthetics

1.A new halogenated gas anesthetic has a blood:gas partition coefficient of 0.5 and a
MAC value of 1%. Which prediction about this agent is most accurate? (Refer to Table
25–1 for comparison of agents.)
(A) Equilibrium between arterial and venous gas tension will be achieved very slowly
(B) It will be metabolized by the liver to release fluoride ions
(C) It will be more soluble in the blood than isoflurane
(D) Speed of onset will be similar to that of nitrous oxide
(E) The new agent will be more potent than halothane
2. Which statement concerning the effects of anesthetic agents is most accurate?
(A) Bronchiolar smooth muscle contraction occurs during halothane anesthesia
(B) Chest muscle rigidity often follows the administration of fentanyl
(C) Mild, generalized muscle twitching occurs at high doses of isoflurane
(D) Severe nausea and vomiting has been reported after the use of propofol
(E) The use of thiopental preceding inhalation anesthetics may prolong
postanesthesia recovery
3. A 23-year-old man has a pheochromocytoma, blood pressure of 190/120 mm Hg, and
hematocrit of 50%. Pulmonary function and renal function are normal. His
catecholamines are elevated, and he has a well-defined abdominal tumor on MRI. He has
been scheduled for surgery. Which one of the following agents should be avoided in the
anesthesia protocol?
(A) Desflurane
(B) Fentanyl
(C) Isoflurane
(D) Midazolam
(E) Sevoflurane
4. Which statement concerning nitrous oxide is most accurate?
(A) A useful component of anesthesia protocols because it lacks
cardiovascular depression
(B) Anemia is a common adverse effect in patients exposed to nitrous oxide for
periods longer than 2 h
(C) It is the most potent of the inhaled anesthetics
(D) There is a direct association between the use of nitrous oxide and malignant
hyperthermia
(E) Up to 50% of nitrous oxide is eliminated via hepatic

[Link] statement concerning anesthetic MAC (minimum anesthetic concentration) value

is most accurate?
(A) Anesthetics with low MAC value have low potency
(B) MAC values increase in elderly patients
(C) MAC values give information about the slope of the dose-response curve
(D) Methoxyflurane has an extremely low MAC value
(E) Simultaneous use of opioid analgesics increases the MAC for inhaled anesthetics
6. Total intravenous anesthesia with fentanyl has been selected for a frail elderly
woman about to undergo cardiac surgery. Which statement about this anesthesia
protocol is most accurate?
(A) Fentanyl’s effects can be reversed with naloxone after the procedure
(B) Marked relaxation of skeletal muscles is anticipated
 (C) Opioids such as fentanyl provide useful hypotensive effects
(D) Patient awareness is rare during surgery, with minimal recall after recovery

MCQS Local anesthetics:

1. Characteristic properties of local anesthetics include all of the following except

(A) An increase in membrane refractory period
(B) Blockade of voltage-dependent sodium channels
(C) Effects on vascular tone
(D) Preferential binding to resting channels
(E) Slowing of axonal impulse conduction

2. Which statement about the speed of onset of nerve blockade with local anesthetics is
correct?
(A) Faster in hypercalcemia
(B) Faster in myelinated fibers
(C) Faster in tissues that are infected
(D) Slower in hyperkalemia
(E) Slower in the periphery of a nerve bundle than in the center of a bundle
3. The most important effect of inadvertent intravenous administration of a large dose of
lidocaine is
(A) Bronchoconstriction
(B) Methemoglobinemia
(C) Renal failure
(D) Seizures
(E) Tachycardia
4. All of the following factors influence the action of local anesthetics except
(A) Acetylcholinesterase activity in the region of the injection site
(B) Blood flow through the tissue in which the injection is made
(C) Dose of local anesthetic injected
(D) The use of vasoconstrictors
(E) Tissue pH
5. You have a vial containing 10 mL of a 2% solution of lidocaine. How much lidocaine is
present in 1 mL?
(A) 2 mg
(B) 5 mg
(C) 10 mg
(D) 20 mg
(E) 50 mg
6. Which statement about the toxicity of local anesthetics is correct?
(A) Bupivacaine is the safest local anesthetic to use in patients at risk for cardiac
arrhythmias
(B) In overdosage, hyperventilation (with oxygen) is helpful to correct acidosis
and lower extracellular potassium
 (C) Intravenous injection of local anesthetics may stimulate ectopic cardiac pacemaker
activity
(D) Most local anesthetics cause vasoconstriction
(E) Serious cardiovascular reactions are more likely to occur with tetracaine than with bupivacaine

Opoids MCQS:

[Link] most appropriate oral medication for his increasing pain is

(A) Buprenorphine
(B) Codeine plus aspirin
(C) Hydromorphone
(D) Pentazocine
(E) Tramadol
2. It is possible that this patient will have to increase the dose of the analgesic as his
condition progresses as a result of developing tolerance. However, tolerance will not
develop to a significant extent with respect to
(A) Biliary smooth muscle
(B) Emesis
(C) Pupillary constriction
(D) Sedation
(E) Urinary retention
3. You are on your way to take an examination and you suddenly get an attack of
diarrhea. If you stop at a nearby drugstore for an over-the-counter opioid with
antidiarrheal action, you will be asking for
(A) Codeine
(B) Dextromethorphan
(C) Diphenoxylate
(D) Loperamide
(E) Nalbuphine
4. An emergency department patient with severe pain thought to be of gastrointestinal
origin received 80 mg of meperidine. She subsequently developed a severe reaction
characterized by tachycardia, hypertension, hyperpyrexia, and seizures. Questioning
revealed that the patient had been taking a drug for a psychiatric condition. Which drug
is most likely to be responsible for this untoward interaction with meperidine?
(A) Alprazolam
(B) Bupropion
(C) Lithium
(D) Phenelzine
(E) Mirtazapine
5. Genetic polymorphisms in certain hepatic enzymes involved in drug metabolism are
established to be responsible for variations in analgesic response to
(A) Buprenorphine
(B) Codeine
(C) Fentanyl
(D) Methadone
(E) Tramado