1. MCQs: Local Anesthetics

Question # 1 (Multiple Choice) Duration of action -- subarachnoid injection of ester-type local anesthetics 

A) extremely shortB) extremely long

Question # 2 (Multiple Choice) Consequences of vasodilatory local anesthetic property: 

A) reduced systemic absorptionB) shorter duration of actionC) bothD) neither

Question # 4 (Multiple Choice) Consequences of fetal acidosis (sometimes associated with prolonged labor) on local anesthetic accumulation in the fetus 

A) reducedB) enhanced

Question # 5 (Multiple Choice) Plasma concentration of local anesthetics determined by: 

A) rate of tissue distributionB) rate of drug clearanceC) bothD) neither

Question # 7 (Multiple Choice) Enhancement of spinal anesthesia by the presence of epinephrine in local anesthetics: Reason(s) -- 

A) increased substance P releaseB) increased dorsal horn neuronal activityC) decreased local neuronal uptakeD) none of the above

Question # 8 (Multiple Choice) Ester type local anesthetics are more likely available for significant placental Dear Guest you need to login or register [click here to register] to use all feature of studytemple 

A) trueB) false

Question # 9 (Multiple Answer) Propranolol (Inderal) -- local anesthetic effect(s): 

A) inhibits bupivacaine (Marcaine) extractionB) increases lidocaine (Xylocaine) plasma clearanceC) decreases bupivacaine (Marcaine) plasma clearance

Question # 10 (Multiple Choice) Duration of action 

A) Ester-type local anesthetics -- longer duration of action compared to amidesB) Amide-type local anesthetics -- longer duration of action compared to esters

Question # 12 (Multiple Choice) Systemic toxicity: ester-type local anesthetics 

A) inversely proportional to hydrolytic rateB) directly proportional the hydrolytic rate

Question # 13 (Multiple Answer) Chemical properties -- local anesthetics 

A) weak basesB) may exist as a cationC) may exist in uncharged formD) most local anesthetics have Dear Guest you need to login or register [click here to register] to use all feature of studytemple's ranging from 6.0-7.0

Question # 14 (Multiple Answer) Local anesthetics: chemical properties 

A) many local anesthetics are chiralB) S enantiomers are often less toxic than racematesC) ropivacaine (Naropin) is an example of a pure R enantiomerD) all of the above

Question # 15 (Multiple Choice) Higher vascularity -- promotes increased, rapid local anesthetic absorption 

A) tendonB) tracheal mucosal

Question # 16 (Multiple Choice) Consequence of clonidine (Catapres) addition to local anesthetic solutions -- 

A) increase local anesthetic effectB) reduce local anesthetic effect

Question # 17 (Multiple Choice) Clearance mechanisms for local anesthetics: 

A) amides-mainly renalB) esters-rapid clearance; hydrolysisC) bothD) neither

Question # 18 (Multiple Choice) Local infection (acidotic conditions) --effect on anesthetic effectiveness 

A) increased effectivenessB) reduced effectiveness

Question # 19 (Multiple Answer) Factors that influence local anesthetic absorption and distribution: 

A) dosageB) presence of epinephrine in the local anesthetic solutionC) injection siteD) chemical properties of the drug

Question # 21 (Multiple Choice) Ester-type local anesthetic: 

A) lidocaine (Xylocaine)B) tetracaine (pontocaine)C) ropivacaine (Naropin)D) dibucaine (Nupercainal, generic)E) bupivacaine (Marcaine)

Question # 22 (Multiple Choice) Pulmonary extraction

from the venous circulation limits the amount of local anesthetic that will reach the systemic circulation 

A) trueB) false

Question # 23 (Multiple Answer) Amide-type local anesthetic 

A) cocaineB) tetracaine (pontocaine)C) prilocaine (Citanest)D) lidocaine (Xylocaine)E) bupivacaine (Marcaine)

-------------------------------------------------------------------------- 

Correct AnswersQuestion # 1 (Multiple Choice) Duration of action -- subarachnoid injection of ester-type local anesthetics

Answer: (B) extremely long 

CSF-no cholinesterase activity BACK

Question # 2 (Multiple Choice) Consequences of vasodilatory local anesthetic property:

Answer: (B) shorter duration of action 

Question # 4 (Multiple Choice) Consequences of fetal acidosis (sometimes associated with prolonged labor) on local anesthetic accumulation in the fetus

Answer: (B) enhanced 

ion trapping 

Question # 5 (Multiple Choice) Plasma concentration of local anesthetics determined by:

Answer: (C) both 

Question # 7 (Multiple Choice) Enhancement of spinal anesthesia by the presence of epinephrine in local anesthetics: Reason(s) --

Answer: (D) none of the above 

Question # 8 (Multiple Choice) Ester type local anesthetics are more likely available for significant

placental Dear Guest you need to login or register [click here to register] to use all feature of studytemple

Answer: (B) false 

Question # 9 (Multiple Answer) Propranolol (Inderal) -- local anesthetic effect(s):

(A) inhibits bupivacaine (Marcaine) extraction

(C) decreases bupivacaine (Marcaine) plasma clearance

Question # 10 (Multiple Choice) Duration of action

Answer: (B) Amide-type local anesthetics -- longer duration of action compared to esters 

Question # 12 (Multiple Choice) Systemic toxicity: ester-type local anesthetics

Answer: (A) inversely proportional to hydrolytic rate 

Question # 13 (Multiple Answer) Chemical properties -- local anesthetics

(A) weak bases

(B) may exist as a cation

(C) may exist in uncharged form

(D) most local anesthetics have Dear Guest you need to login or register [click here to register] to use all feature of studytemple's ranging from 6.0-7.0

Question # 14 (Multiple Answer) Local anesthetics: chemical properties

(A) many local anesthetics are chiral

(B) S enantiomers are often less toxic than racemates

Question # 15 (Multiple Choice) Higher vascularity -- promotes increased, rapid local anesthetic absorption

Answer: (B) tracheal mucosal 

Question # 16 (Multiple Choice) Consequence of clonidine (Catapres) addition to local anesthetic solutions --

Answer: (A) increase local anesthetic effect 

Question # 17 (Multiple Choice) Clearance mechanisms for local anesthetics:

Answer: (B) esters-rapid clearance; hydrolysis 

amides-hepatic 

Question # 18 (Multiple Choice) Local infection (acidotic conditions) --effect on anesthetic effectiveness

Answer: (B) reduced effectiveness 

Question # 19 (Multiple Answer) Factors that influence local anesthetic absorption and distribution:

(A) dosage

(B) presence of epinephrine in the local anesthetic solution

(C) injection site

(D) chemical properties of the drug

Question # 20 (Multiple Answer) Factors influencing local anesthetic distribution and plasma concentrations:

(A) liver function

(B) cardiovascular status

(C) extent of protein binding

(D) patient age

Question # 21 (Multiple Choice) Ester-type local anesthetic:

Answer: (B) tetracaine (pontocaine) 

Question # 22 (Multiple Choice) Pulmonary extraction from the venous circulation limits the amount of local anesthetic that will reach the systemic circulation

Answer: (A) true 

Question # 23 (Multiple Answer) Amide-type local anesthetic

(D) lidocaine (Xylocaine)

(E) bupivacaine (Marcaine)

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 Re: MCQs: Local Anesthetics

Local Anesthetics

Question # 1 (Multiple Answer) Advantage(s) of 5% lidocaine (Xylocaine)-prilocaine (Citanest) cream (eutectic mixture) 

A) no local irritationB) even absorptionC) no systemic toxicityD) higher melting point of combined drug than either lidocaine (Xylocaine) or prilocaine (Citanest) alone

Question # 2 (Multiple Choice) Local anesthetic used in greater than 50% of rhinolaryngologic cases: 

A) prilocaine (Citanest)B) cocaineC) mepivacaine (Carbocaine)D) bupivacaine (Marcaine)E) tetracaine (pontocaine)

Question # 3 (Multiple Choice) Mechanism(s) of local anesthetic action in epidural anesthesia: 

A) Dear Guest you need to login or register [click here to register] to use all feature of studytemple local anesthetic action on nerve roots and spinal cord following local anesthetic diffusion across the duraB) diffusion of local anesthetic into paravertebral regions through the intervertebral foraminaC) bothD) neither

Question # 4 (Multiple Answer) Rationale for adding epinephrine to a local anesthetic solution: 

A) reduced local anesthetic systemic absorptionB) increased anesthetic concentration near nerve fibersC) reduced duration of conduction blockadeD) all of the above

Question # 5 (Multiple Choice) Zone of differential motor blockade may average up to four segments below the sensory level 

A) epiduralB) spinal

Question # 6 (Multiple Choice) Duration of sensory anesthesia is likely to be extended for abdominal regional anesthesia 

A) trueB) false

Question # 7 (Multiple Choice) Primary side effect/toxicities associated with local anesthetic use: 

A) allergic reactionsB) systemic toxicityC) bothD) neither

Question # 9 (Multiple Answer) Agents added to local anesthetics that prolonged local anesthetic duration of action 

A) epinephrineB) phenylephrine (Neo-Synephrine)C) dextran

Question # 10 (Multiple Choice) typically a zone of differential sympathetic nervous system blockade 

A) epiduralB) spinal

Question # 11 (Multiple Answer) Preferred local anesthetics for local infiltration: 

A) lidocaine (Xylocaine)B) ropivacaine (Naropin)C) bupivacaine (Marcaine)

Question # 12 (Multiple Choice) Neurotoxicity associate with local anesthesia: sensory anesthesia, bowell & bladder sphincter dysfunction, paraplegia -- may because by nonhomogeneous local anesthetic distribution 

A) anterior spinal artery syndromeB) cauda equina syndromeC) transient radicular irritation

Question # 13 (Multiple Choice) Neurotoxicity -- moderate/severe lower back, buttocks, posterior side pain 

A) cauda equina syndromeB) transient radicular irritationC) anterior spinal artery syndrome

Question # 14 (Multiple Answer) Factors that influence lidocaine (Xylocaine) metabolism: 

A) pregnancy-induced hypertensionB) hepatic diseaseC) reduced liver blood   flow D) volatile anesthetics

Question # 15 (Multiple Choice) Most common cause of toxic plasma local anesthetic concentrations 

A) incorrect dosageB) accidental Dear Guest you need to login or register [click here to register] to use all feature of studytemple intravascular injection during peripheral or block or epidural anesthesia

Question # 16 (Multiple Choice) Common eutectic mixture of local anesthetics (EMLA) 

A) tetracaine (pontocaine) and epinephrineB) lidocaine (Xylocaine) and tetracaine (pontocaine)C) prilocaine (Citanest) and bupivacaine (Marcaine)D) tetracaine (pontocaine) and bupivacaine (Marcaine)E) lidocaine (Xylocaine) and prilocaine (Citanest)

Question # 17 (Multiple Choice) Most frequent local anesthetic clinical use: 

A) treatment of grand mal seizureB) analgesiaC) management of cardiac arrhythmiasD) regional anesthetiaE) management of increased intracranial pressure

Question # 18 (Multiple Choice) Lidocaine (Xylocaine) effect on ventilation response to hypoxia 

A) enhanced responseB) depressed responseC) no effect

Question # 19 (Multiple Answer) Clinical use(s) of EMLA Dear Guest you need to login or register [click here to register] to use all feature of studytemple: 

A) arterial cannulationB) venipunctureC) myringotomyD) lumbar puncture

Question # 20 (Multiple Answer) Allergic reactions to local anesthetics: 

A) common > 10% of adverse reactions due to allergic mechanismsB) high-risk with ester-type agents which are metabolized to p-aminobenzoic acid-related compoundsC) cross-sensitivity between esters and amide-type local anesthetics are commonD) intradermal testing for possible allergy to local anesthetics should use preservative-free drug

Question # 21 (Multiple Answer) Factors which increase local anesthetic CNS toxicities: 

A) hypokalemiaB) rate of injectionC) patient receiving mexiletine (Mexitil) when lidocaine (Xylocaine) is usedD) high PaCO2 (reduced local anesthetic seizure threshold)

Question # 22 (Multiple Choice) Least likely to exhibit cross-sensitivity with amide or ester local anesthetics. 

A) lidocaine (Xylocaine)B) tetracaine (pontocaine)C) mepivacaine (Carbocaine)D) bupivacaine (Marcaine)E) dyclonine (Dyclone)

Question # 23 (Multiple Answer) Factor(s) that reduce lidocaine (Xylocaine) seizure threshold. 

A) hypoxemiaB) hyperkalemiaC) acidosis

Question # 24 (Multiple Choice) Local anesthetic which produces localized vasoconstriction and anesthesia 

A) tetracaine (pontocaine)B) lidocaine (Xylocaine)C) cocaineD) prilocaine (Citanest)E) chloroprocaine (Nesacaine)

Question # 25 (Multiple Choice) Agents not recommended for Bier block: 

A) chloroprocaine (Nesacaine)B) mepivacaine (Carbocaine)C) bupivacaine (Marcaine)D) all the above

Question # 26 (Multiple Answer) Manifestation of systemic toxicity 

A) CNS toxicityB) cardiovascular toxicityC) neurological symptoms

Question # 27 (Multiple Choice) Most commonly used local anesthetic for rhinolaryngologic cases 

A) ropivacaine (Naropin)B) bupivacaine (Marcaine)C) mepivacaine (Carbocaine)D) cocaineE) tetracaine (pontocaine)

Question # 28 (Multiple Answer) Commonly use local anesthetics for topical/surface Dear Guest you need to login or register [click here to register] to use all feature of studytemple: 

A) chloroprocaine (Nesacaine)B) lidocaine (Xylocaine)C) tetracaine (pontocaine)D) cocaineE) procaine (Novocain)

Question # 29 (Multiple Answer) Clinical Dear Guest you need to login or register [click here to register] to use all feature of studytemple suggestive of local anesthetic allergies: 

A) rashB) laryngeal edemaC) bronchospasmD) urticariaE) possibly hypotension

Question # 30 (Multiple Choice) Local anesthetic most likely to cause cyanosis secondary to reduced oxygen transport: 

A) lidocaine (Xylocaine)

B) bupivacaine (Marcaine)C) dibucaine (Nupercainal, generic)D) prilocaine (Citanest)E) procaine (Novocain)

Question # 31 (Multiple Choice) This amide-type local anesthetic is used to assess the possible presence of atypical cholinesterase 

A) ropivacaine (Naropin)B) bupivacaine (Marcaine)C) dibucaine (Nupercainal, generic)D) procaine (Novocain)E) chloroprocaine (Nesacaine)

Question # 32 (Multiple Choice) Toxicities associated with systemic epinephrine absorption following local anesthetic use with epinephrine included in the local anesthetic solution 

A) hypertensionB) arrhythmiasC) bothD) neither

Question # 33 (Multiple Choice) ropivacaine (Naropin):less cardiotoxic then bupivacaine (Marcaine) 

A) trueB) false

Question # 34 (Multiple Answer) Factor(s) which determine extent of systemic local anesthetic absorption: 

A) initial doseB) injection site vascularityC) intrinsic drug propertiesD) whether or not epinephrine was used to provide local vasoconstriction

Question # 35 (Multiple Answer) Lidocaine (Xylocaine) cardiotoxicity -- electrophysiological characteristics 

A) ECG -PR interval prolongationB) increased conduction velocityC) reduced phase 4 depolarizationD) reduced automaticity

Question # 36 (Multiple Choice) Local anesthetic lipophilicity and effectiveness of epinephrine on local anesthesia: 

A) more lipophilic anesthetics benefit most by epinephrine in addition to local anesthetic solutionsB) more lipophilic anesthetics benef ileast by epinephrine in addition to local anesthetic solutions

Question # 37 (Multiple Choice) Neurotoxicity following local anesthesia: lower extremity paresis-- predisposing conditions may include advanced age and peripheral vascular disease 

A) transient radicular irritationB) cauda equina syndromeC) anterior spinal artery syndrome

Question # 39 (Multiple Answer) Frequently used amide-type local anesthetic for Bier block 

A) chloroprocaine (Nesacaine)B) prilocaine (Citanest)C) bupivacaine (Marcaine)D) ropivacaine (Naropin)

--------------------------------------------------------------------------

Correct Answers

Question # 1 (Multiple Answer) Advantage(s) of 5% lidocaine (Xylocaine)-prilocaine (Citanest) cream (eutectic mixture)

(A) no local irritation

(B) even absorption

(C) no systemic toxicity

Question # 2 (Multiple Choice) Local anesthetic used in greater than 50% of rhinolaryngologic cases:

Answer: (B) cocaine 

Question # 3 (Multiple Choice) Mechanism(s) of local anesthetic action in epidural anesthesia:

Answer: (C) both 

Question # 4 (Multiple Answer) Rationale for adding epinephrine to a local anesthetic solution:

(A) reduced local anesthetic systemic absorption

(B) increased anesthetic concentration near nerve fibers

Question # 5 (Multiple Choice) Zone of differential motor blockade may average up to four segments below the sensory level

Answer: (A) epidural 

Question # 6 (Multiple Choice) Duration of sensory anesthesia is likely to be extended for abdominal regional anesthesia

Answer: (B) false 

Question # 7 (Multiple Choice) Primary side effect/toxicities associated with local anesthetic use:

Answer: (C) both 

Question # 9 (Multiple Answer) Agents added to local anesthetics that prolonged local anesthetic duration of action

(A) epinephrine

(B) phenylephrine (Neo-Synephrine)

(C) dextran

Question # 10 (Multiple Choice) typically a zone of differential sympathetic nervous system blockade

Answer: (B) spinal 

Question # 11 (Multiple Answer) Preferred local anesthetics for local infiltration:

(A) lidocaine (Xylocaine)

(B) ropivacaine (Naropin)

(C) bupivacaine (Marcaine)

Question # 12 (Multiple Choice) Neurotoxicity associate with local anesthesia: sensory anesthesia, bowell & bladder sphincter dysfunction, paraplegia -- may because by nonhomogeneous local anesthetic distribution

Answer: (B) cauda equina syndrome 

Question # 13 (Multiple Choice) Neurotoxicity -- moderate/severe lower back, buttocks, posterior side pain

Answer: (B) transient radicular irritation 

Question # 14 (Multiple Answer) Factors that influence lidocaine (Xylocaine) metabolism:

(A) pregnancy-induced hypertension

(B) hepatic disease

(C) reduced liver blood flow

(D) volatile anesthetics

Question # 15 (Multiple Choice) Most common cause of toxic plasma local anesthetic concentrations

Answer: (B) accidental direct intravascular injection during peripheral or block or epidural anesthesia 

Question # 16 (Multiple Choice) Common eutectic mixture of local anesthetics (EMLA)

Answer: (E) lidocaine (Xylocaine) and prilocaine (Citanest) 

Question # 17 (Multiple Choice) Most frequent local anesthetic clinical use:

Answer: (D) regional anesthetia 

Question # 18 (Multiple Choice) Lidocaine (Xylocaine) effect on ventilation response to hypoxia

Answer: (B) depressed response 

Question # 19 (Multiple Answer) Clinical use(s) of EMLA Dear Guest you need to login or register [click here to register] to use all feature of studytemple:

(A) arterial cannulation

(B) venipuncture

(C) myringotomy

(D) lumbar puncture

Question # 20 (Multiple Answer) Allergic reactions to local anesthetics:

(B) high-risk with ester-type agents which are metabolized to p-aminobenzoic acid-related compounds

(D) intradermal testing for possible allergy to local anesthetics should use preservative-free drug

Question # 21 (Multiple Answer) Factors which increase local anesthetic CNS toxicities:

(B) rate of injection

(C) patient receiving mexiletine (Mexitil) when lidocaine (Xylocaine) is used

(D) high PaCO2 (reduced local anesthetic seizure threshold)

Question # 22 (Multiple Choice) Least likely to exhibit cross-sensitivity with amide or ester local anesthetics.

Answer: (E) dyclonine (Dyclone) 

dyclonine (Dyclone) -- ketone structure 

Question # 23 (Multiple Answer) Factor(s) that reduce lidocaine (Xylocaine) seizure threshold.

(A) hypoxemia

(B) hyperkalemia

(C) acidosis

Question # 24 (Multiple Choice) Local anesthetic which produces localized vasoconstriction and anesthesia

Answer: (C) cocaine 

Question # 25 (Multiple Choice) Agents not recommended for Bier block:

Answer: (D) all the above 

Question # 26 (Multiple Answer) Manifestation of systemic toxicity

(A) CNS toxicity

(B) cardiovascular toxicity

(C) neurological symptoms

Question # 27 (Multiple Choice) Most commonly used local anesthetic for rhinolaryngologic cases

Answer: (D) cocaine 

Question # 28 (Multiple Answer) Commonly use local anesthetics for topical/surface Dear Guest you need to login or register [click here to register] to use all feature of studytemple:

(B) lidocaine (Xylocaine)

(C) tetracaine (pontocaine)

(D) cocaine

Question # 29 (Multiple Answer) Clinical Dear Guest you need to login or register [click here to register] to use all feature of studytemple suggestive of local anesthetic allergies:

(A) rash

(B) laryngeal edema

(C) bronchospasm

(D) urticaria

(E) possibly hypotension

Question # 30 (Multiple Choice) Local anesthetic most likely to cause cyanosis secondary to reduced oxygen transport:

Answer: (D) prilocaine (Citanest) 

Question # 31 (Multiple Choice) This amide-type local anesthetic is used to assess the possible presence of atypical cholinesterase

Answer: (C) dibucaine (Nupercainal, generic) 

Question # 32 (Multiple Choice) Toxicities associated with systemic epinephrine absorption following local anesthetic use with epinephrine included in the local anesthetic solution

Answer: (C) both 

Question # 33 (Multiple Choice) ropivacaine (Naropin):less cardiotoxic then bupivacaine (Marcaine)

Answer: (A) true 

pure S-enantiomer 

Question # 34 (Multiple Answer) Factor(s) which determine extent of systemic local anesthetic absorption:

(A) initial dose

(B) injection site vascularity

(C) intrinsic drug properties

(D) whether or not epinephrine was used to provide local vasoconstriction

Question # 35 (Multiple Answer) Lidocaine (Xylocaine) cardiotoxicity -- electrophysiological characteristics

(A) ECG -PR interval prolongation

(C) reduced phase 4 depolarization

(D) reduced automaticity

Question # 36 (Multiple Choice) Local anesthetic lipophilicity and effectiveness of epinephrine on local anesthesia:

Answer: (B) more lipophilic anesthetics benef ileast by epinephrine in addition to local anesthetic solutions 

Question # 37 (Multiple Choice) Neurotoxicity following local anesthesia: lower extremity paresis-- predisposing conditions may include advanced age and peripheral vascular disease

Answer: (C) anterior spinal artery syndrome 

Question # 39 (Multiple Answer) Frequently used amide-type local anesthetic for Bier block

(B) prilocaine (Citanest