Saudi Board Part One Examination – Anesthesia: free practice test

Practice question Unit: Core Anesthesia

1. ABlood:gas partition coefficient ✓ Correct answer

   A low blood:gas coefficient means rapid rise of alveolar concentration and fast induction and emergence.

2. BSaturated vapour pressure

   Vapour pressure determines vaporiser design, not uptake kinetics.

3. CMinimum alveolar concentration

   MAC measures potency, not the rate of equilibration.

4. DOil:gas partition coefficient

   Oil:gas solubility correlates with potency (MAC), not speed.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Core Anesthesia; Miller's Anesthesia, 9th ed., chapter: Inhaled Anesthetics: Uptake and Distribution

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Practice question Unit: Core Anesthesia

1. AMorphine

   Morphine is glucuronidated in the liver to active metabolites cleared renally.

2. BAlfentanil

   Alfentanil is metabolised by hepatic CYP3A4.

3. CRemifentanil ✓ Correct answer

   Remifentanil's ester linkage gives a context-sensitive half-time of about 3-4 minutes.

4. DSufentanil

   Sufentanil undergoes hepatic metabolism.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Core Anesthesia; Stoelting's Pharmacology and Physiology in Anesthetic Practice, 6th ed., chapter: Opioid Agonists and Antagonists

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Practice question Unit: Medical Disorder and Anesthesia

1. AIbutilide

   Ibutilide can be used to restore sinus rhythm in selected stable patients with pre-excited AF.

2. BVerapamil ✓ Correct answer

   Verapamil blocks the AV node and can favour rapid accessory-pathway conduction, risking ventricular fibrillation.

3. CSynchronised electrical cardioversion

   Synchronised cardioversion is appropriate when the patient is haemodynamically unstable.

4. DProcainamide

   Procainamide slows accessory-pathway conduction and is an option in stable pre-excited AF.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Medical Disorder and Anesthesia; 2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation

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Practice question Unit: Critical Care Medicine

1. AAbdominal distension

   Abdominal distension limits chest expansion and can increase plateau pressure.

2. BReduced lung compliance, as seen in ARDS or pulmonary oedema with a stiff lung

   Reduced lung compliance raises plateau pressure as well as peak pressure.

3. CPneumothorax

   A significant pneumothorax reduces respiratory-system compliance and tends to raise plateau pressure.

4. DIncreased airway resistance (e.g. bronchospasm, kinked tube) ✓ Correct answer

   A large peak-to-plateau pressure difference indicates increased airway resistance, such as bronchospasm or a kinked tube.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Critical Care Medicine; Tobin, Principles and Practice of Mechanical Ventilation, 3rd ed.

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Practice question Unit: Cardiac / Thoracic and Vascular

1. AHepatic clearance doubles

   Hepatic clearance does not predictably double; hypothermia and reduced organ perfusion may reduce it.

2. BHaemodilution lowers plasma drug concentrations ✓ Correct answer

   Circuit prime expands the circulating volume, initially diluting drugs and plasma proteins; effects vary with the drug.

3. CPlasma drug levels rise sharply because the lungs are excluded from the circulation

   An initial concentration rise is not the expected dilutional effect of adding circuit prime.

4. DNo change

   The added volume and altered protein binding mean pharmacokinetics do change.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Cardiac / Thoracic and Vascular; Kaplan's Cardiac Anesthesia, 8th ed., chapter: Cardiopulmonary Bypass Management

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Practice question Unit: Pain Management and Regional Anesthesia

1. ARopivacaine

   Ropivacaine belongs to the amide group of local anaesthetics.

2. BMepivacaine

   Mepivacaine is an amide local anaesthetic, not an ester.

3. CChloroprocaine ✓ Correct answer

   Chloroprocaine is an ester local anaesthetic, hydrolysed by plasma cholinesterases.

4. DLidocaine

   Lidocaine is an amide local anaesthetic with predominantly hepatic metabolism.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Pain Management and Regional Anesthesia; Stoelting's Pharmacology and Physiology in Anesthetic Practice, 6th ed., chapter: Local Anesthetics

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Practice question Unit: Pediatric Anesthesia

1. AMorphine ✓ Correct answer

   Immature neonatal glucuronidation reduces morphine clearance and can prolong its effects.

2. BRemifentanil

   Remifentanil is hydrolysed by nonspecific blood and tissue esterases.

3. CSevoflurane

   Most sevoflurane is eliminated through the lungs rather than glucuronidation.

4. DCisatracurium

   Cisatracurium mainly undergoes organ-independent Hofmann elimination, not hepatic glucuronidation.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Pediatric Anesthesia; Coté, A Practice of Anesthesia for Infants and Children, 6th ed., chapter: Pharmacokinetics and Pharmacology of Drugs Used in Children

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Practice question Unit: Obstetric Anesthesia

1. ARespiratory acidosis

   Normal pregnancy produces a mild compensated respiratory alkalosis, not respiratory acidosis.

2. BReduced FRC with increased oxygen consumption ✓ Correct answer

   Lower FRC reduces oxygen reserves while higher oxygen consumption exhausts them faster during apnoea.

3. CIncreased FRC with reduced oxygen consumption in the third trimester

   Pregnancy decreases FRC and increases oxygen consumption, the reverse of this option.

4. DReduced minute ventilation

   Minute ventilation generally increases in pregnancy; a reduction is not the normal adaptation.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Obstetric Anesthesia; Chestnut's Obstetric Anesthesia: Principles and Practice, 6th ed., chapter: Physiologic Changes of Pregnancy

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Practice question Unit: Neuro-Anesthesia

1. ANitrous oxide

   Nitrous oxide may increase cerebral blood flow and is not the characteristic answer to this combined profile.

2. BKetamine

   Ketamine can increase cerebral blood flow in some settings; it is not the typical flow-reducing agent here.

3. CDesflurane at 2 MAC

   At high concentrations desflurane causes cerebral vasodilatation, opposing this desired flow reduction.

4. DPropofol ✓ Correct answer

   Propofol reduces cerebral metabolism and the coupled blood flow, generally lowering intracranial pressure.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Neuro-Anesthesia; Cottrell and Patel's Neuroanesthesia, 6th ed., chapter: Anesthetic Agents and the Brain

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Practice question Unit: Crisis Management

1. ALatex

   Latex was not the leading trigger in the UK NAP6 perioperative-anaphylaxis audit.

2. BPropofol

   Propofol reactions can occur but were not the largest trigger group in NAP6.

3. CLocal anaesthetics

   Local-anaesthetic allergy was not the commonest cause in this audit.

4. DAntibiotics ✓ Correct answer

   Antibiotics were the largest identified trigger group in NAP6, ahead of neuromuscular blocking drugs.

Reference: SCFHS Saudi Board Part One Blueprint – Anesthesia (2024–27), section: Crisis Management; Royal College of Anaesthetists NAP6 (2018)

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