1. Which receptor is primarily responsible for vasoconstriction in vascular smooth muscle?
A. Beta-1
B. Alpha-1
C. Alpha-2
D. Beta-2
Correct Answer: B — Alpha-1
Explanation: Alpha-1 receptors are located on vascular smooth muscle and cause vasoconstriction, which increases SVR, BP, and MAP.
2. Activation of alpha-2 receptors results in which physiological effect?
A. Increased heart rate
B. Bronchodilation
C. Decreased norepinephrine release
D. Increased contractility
Correct Answer: C — Decreased norepinephrine release
Explanation: Alpha-2 receptors create negative feedback by inhibiting norepinephrine release, leading to decreased sympathetic nervous system activity.
3. Which drug is a pure alpha-1 agonist?
A. Epinephrine
B. Norepinephrine
C. Phenylephrine
D. Dopamine
Correct Answer: C — Phenylephrine
Explanation: Phenylephrine (Neosynephrine) is a pure alpha-1 agonist, causing vasoconstriction without beta-1 activation.
4. A hypotensive patient with tachycardia would most benefit from which vasopressor?
A. Epinephrine
B. Dopamine
C. Norepinephrine
D. Phenylephrine
Correct Answer: D — Phenylephrine
Explanation: Phenylephrine lacks beta-1 activity, making it useful in hypotensive patients who are already tachycardic.
5. Which vasopressor is first-line for septic shock?
A. Epinephrine
B. Vasopressin
C. Norepinephrine
D. Dopamine
Correct Answer: C — Norepinephrine
Explanation: Norepinephrine (Levophed) is the first-line vasopressor for sepsis and septic shock.
6. Vasopressin increases blood pressure through which receptors?
A. Alpha-1 and beta-1
B. Beta-1 and beta-2
C. V1 and V2
D. Alpha-2 only
Correct Answer: C — V1 and V2
Explanation: V1 causes vasoconstriction, while V2 increases water reabsorption in the kidneys, both contributing to increased BP.
7. Which adverse effect is most associated with phenylephrine?
A. Tachycardia
B. Reflex bradycardia
C. Bronchospasm
D. Hyperkalemia
Correct Answer: B — Reflex bradycardia
Explanation: Phenylephrine can cause baroreceptor-mediated reflex bradycardia due to increased BP.
8. Which sedative is preferred for induction in hemodynamically unstable patients?
A. Propofol
B. Midazolam
C. Etomidate
D. Dexmedetomidine
Correct Answer: C — Etomidate
Explanation: Etomidate is BP-neutral and commonly used for RSI in unstable patients.
9. Which sedative has a reversal agent?
A. Midazolam
B. Etomidate
C. Dexmedetomidine
D. Propofol
Correct Answer: A — Midazolam
Explanation: Benzodiazepines are reversed by flumazenil.
10. Which sedative is most associated with hypotension due to sympathetic inhibition?
A. Etomidate
B. Propofol
C. Dexmedetomidine
D. Midazolam
Correct Answer: B — Propofol
Explanation: Propofol inhibits the sympathetic nervous system, leading to hypotension and bradycardia.
11. Which paralytic is classified as a depolarizing agent?
A. Rocuronium
B. Vecuronium
C. Succinylcholine
D. Pancuronium
Correct Answer: C — Succinylcholine
Explanation: Succinylcholine binds and activates nicotinic ACh receptors, causing depolarization and transient contraction.
12. Which paralytic carries a risk of hyperkalemia?
A. Rocuronium
B. Vecuronium
C. Succinylcholine
D. Cisatracurium
Correct Answer: C — Succinylcholine
Explanation: Succinylcholine causes an initial muscle contraction, leading to a transient rise in potassium.
13. The reversal agent for rocuronium is:
A. Neostigmine
B. Atropine
C. Flumazenil
D. Sugammadex
Correct Answer: D — Sugammadex
Explanation: Sugammadex reverses non-depolarizing paralytics such as rocuronium and vecuronium.
14. Which inotrope is a phosphodiesterase-3 inhibitor?
A. Dobutamine
B. Dopamine
C. Milrinone
D. Epinephrine
Correct Answer: C — Milrinone
Explanation: Milrinone inhibits PDE-3, increasing cAMP and calcium influx, leading to increased contractility and vasodilation.
15. Which inotrope is useful in patients taking beta blockers?
A. Dobutamine
B. Epinephrine
C. Dopamine
D. Milrinone
Correct Answer: D — Milrinone
Explanation: Milrinone works independently of beta receptors, making it effective in patients on beta blockers.
16. Which antiarrhythmic is a Class III potassium channel blocker?
A. Lidocaine
B. Amiodarone
C. Esmolol
D. Diltiazem
Correct Answer: B — Amiodarone
Explanation: Amiodarone prolongs repolarization by blocking potassium channels.
17. Which drug creates a transient AV node block?
A. Amiodarone
B. Atropine
C. Adenosine
D. Digoxin
Correct Answer: C — Adenosine
Explanation: Adenosine temporarily blocks conduction at the AV node and may cause brief asystole.
18. Which rhythm is atropine LEAST effective in treating?
A. Sinus bradycardia
B. 2nd-degree Type I AV block
C. 2nd-degree Type II AV block
D. 3rd-degree AV block
Correct Answer: D — 3rd-degree AV block
Explanation: Atropine is ineffective in complete heart block.
19. Which beta blocker is cardioselective?
A. Labetalol
B. Metoprolol
C. Esmolol
D. Propranolol
Correct Answer: C — Esmolol
Explanation: Esmolol primarily blocks beta-1 receptors and does not block alpha receptors.
20. Which vasodilator is primarily a venous dilator?
A. Hydralazine
B. Nicardipine
C. Nitroglycerin
D. Diltiazem
Correct Answer: C — Nitroglycerin
Explanation: Nitroglycerin primarily dilates veins, reducing preload.
21. Nitroglycerin is contraindicated in which condition?
A. Left-sided heart failure
B. Right-sided myocardial infarction
C. Hypertension
D. Pulmonary edema
Correct Answer: B — Right-sided myocardial infarction
Explanation: Right-sided MI patients are preload-dependent; venous dilation can cause severe hypotension.
22. Which drug directly inhibits factor X via antithrombin III?
A. Warfarin
B. Heparin
C. Aspirin
D. Clopidogrel
Correct Answer: B — Heparin
Explanation: Heparin binds antithrombin III, inhibiting factor X and preventing clot formation.
23. Which loop diuretic is more potent?
A. Lasix
B. Hydrochlorothiazide
C. Bumex
D. Spironolactone
Correct Answer: C — Bumex
Explanation: Bumetanide (Bumex) is stronger than Lasix and works in the loop of Henle.
24. Which electrolyte abnormality is most important to monitor with loop diuretics?
A. Hypercalcemia
B. Hypernatremia
C. Electrolyte imbalances
D. Hyperglycemia
Correct Answer: C — Electrolyte imbalances
Explanation: Loop diuretics increase sodium and water excretion, leading to electrolyte disturbances.
25. Which drug is a beta-1 agonist used in cardiogenic shock?
A. Milrinone
B. Dobutamine
C. Phenylephrine
D. Vasopressin
Correct Answer: B — Dobutamine
Explanation: Dobutamine stimulates beta-1 receptors, increasing heart rate and contractility to improve cardiac output.
26. Which vasopressor has both alpha-1 and beta-1 activity but is weaker at beta-1 than epinephrine?
A. Dopamine
B. Phenylephrine
C. Norepinephrine
D. Vasopressin
Correct Answer: C — Norepinephrine
Explanation: Norepinephrine is primarily an alpha-1 agonist with some beta-1 activation, but less beta-1 activity than epinephrine.
27. Excessive vasoconstriction from norepinephrine may result in which complication?
A. Bronchodilation
B. Increased end-organ perfusion
C. Decreased end-organ perfusion
D. Hyperkalemia
Correct Answer: C — Decreased end-organ perfusion
Explanation: Excessive vasoconstriction can lead to extreme hypertension and reduced perfusion to vital organs.
28. Which drug activates alpha-1, beta-1, and beta-2 receptors?
A. Dopamine
B. Epinephrine
C. Phenylephrine
D. Dobutamine
Correct Answer: B — Epinephrine
Explanation: Epinephrine stimulates alpha-1 (vasoconstriction), beta-1 (HR/contractility), and beta-2 (bronchodilation).
29. Epinephrine improves coronary perfusion during cardiac arrest primarily through which mechanism?
A. Increased contractility
B. Bronchodilation
C. Vasoconstriction
D. Decreased heart rate
Correct Answer: C — Vasoconstriction
Explanation: Alpha-1–mediated vasoconstriction increases coronary artery perfusion pressure during cardiac arrest.
30. Which vasopressor is commonly added as a second-line agent when hypotension does not respond to norepinephrine?
A. Dopamine
B. Phenylephrine
C. Vasopressin
D. Epinephrine
Correct Answer: C — Vasopressin
Explanation: Vasopressin is often used as an adjunct when patients do not respond adequately to norepinephrine and epinephrine.
31. Which receptor activation is responsible for the antidiuretic effects of vasopressin?
A. V1
B. V2
C. Alpha-1
D. Beta-1
Correct Answer: B — V2
Explanation: V2 receptors in the kidneys increase water reabsorption, contributing to increased blood pressure.
32. Decreased urine output is a known side effect of which vasopressor?
A. Phenylephrine
B. Dopamine
C. Vasopressin
D. Epinephrine
Correct Answer: C — Vasopressin
Explanation: Vasopressin has antidiuretic effects due to V2 receptor activation.
33. Which sedative is most likely to cause respiratory depression and hypotension but is considered more blood-pressure neutral than propofol?
A. Propofol
B. Midazolam
C. Etomidate
D. Dexmedetomidine
Correct Answer: B — Midazolam
Explanation: Midazolam is a benzodiazepine that enhances GABA activity. It can cause respiratory depression and hypotension, but it is noted in the PDF to be more BP neutral compared to propofol.
34. Which sedative is most appropriate for maintaining sedation in a non-intubated patient with anxiety?
A. Propofol
B. Etomidate
C. Dexmedetomidine
D. Rocuronium
Correct Answer: C — Dexmedetomidine
Explanation: Dexmedetomidine is indicated for sedation in non-intubated patients because it provides anxiolysis without causing respiratory depression.
35. Which sedative is preferred for ongoing sedation in intubated patients due to rapid offset?
A. Etomidate
B. Midazolam
C. Dexmedetomidine
D. Propofol
Correct Answer: D — Propofol
Explanation: Propofol has rapid onset and offset, making it ideal for continuous sedation in intubated patients.
36. Which sedative allows patients to be weaned from the ventilator without causing respiratory depression?
A. Propofol
B. Midazolam
C. Dexmedetomidine
D. Etomidate
Correct Answer: C — Dexmedetomidine
Explanation: Dexmedetomidine does not cause respiratory depression and is ideal for sedation during extubation.
37. Bradycardia associated with dexmedetomidine is due to which mechanism?
A. Direct myocardial depression
B. Beta-1 blockade
C. Inhibition of sympathetic nervous system
D. Vasodilation
Correct Answer: C — Inhibition of sympathetic nervous system
Explanation: Alpha-2 activation inhibits norepinephrine release, reducing sympathetic tone and causing bradycardia.
38. Which sedative is contraindicated for continuous infusion due to adrenal suppression?
A. Propofol
B. Midazolam
C. Dexmedetomidine
D. Etomidate
Correct Answer: D — Etomidate
Explanation: Etomidate causes adrenal suppression and should not be used as a continuous infusion.
39. Which paralytic blocks nicotinic acetylcholine receptors without causing initial muscle contraction?
A. Succinylcholine
B. Rocuronium
C. Neostigmine
D. Atropine
Correct Answer: B — Rocuronium
Explanation: Rocuronium is a non-depolarizing paralytic that prevents receptor activation without initial contraction.
40. Monitoring Train-of-Four is most important with which medication?
A. Etomidate
B. Propofol
C. Rocuronium
D. Dexmedetomidine
Correct Answer: C — Rocuronium
Explanation: Non-depolarizing paralytics like rocuronium can cause prolonged paralysis and require Train-of-Four monitoring.
41. Which paralytic has the shortest duration and is fully reversible within 10–15 minutes?
A. Rocuronium
B. Vecuronium
C. Succinylcholine
D. Cisatracurium
Correct Answer: C — Succinylcholine
Explanation: Succinylcholine has rapid onset and short duration, making it ideal for RSI.
42. Which inotrope has minimal alpha-1 activity and some beta-2 activity?
A. Milrinone
B. Epinephrine
C. Dopamine
D. Dobutamine
Correct Answer: D — Dobutamine
Explanation: Dobutamine is primarily a beta-1 agonist with some beta-2 effects and minimal alpha-1 activity.
43. Hypotension from milrinone is primarily due to which effect?
A. Decreased heart rate
B. Vasodilation
C. Bradycardia
D. Reduced preload
Correct Answer: B — Vasodilation
Explanation: Milrinone causes vasodilation in addition to increased contractility, which can lead to hypotension.
44. Ventricular ectopy is a major adverse effect of which inotrope?
A. Dobutamine
B. Dopamine
C. Milrinone
D. Epinephrine
Correct Answer: C — Milrinone
Explanation: Milrinone can cause ventricular ectopy including VTach and SVT.
45. Which antiarrhythmic drug slows repolarization by blocking potassium efflux?
A. Lidocaine
B. Amiodarone
C. Diltiazem
D. Esmolol
Correct Answer: B — Amiodarone
Explanation: Amiodarone delays repolarization by blocking potassium channels.
46. Which drug is useful for identifying an underlying rhythm during SVT?
A. Amiodarone
B. Adenosine
C. Digoxin
D. Diltiazem
Correct Answer: B — Adenosine
Explanation: Adenosine transiently blocks the AV node, allowing visualization of the underlying rhythm.
47. A few seconds of asystole is a known effect of which medication?
A. Amiodarone
B. Esmolol
C. Adenosine
D. Digoxin
Correct Answer: C — Adenosine
Explanation: Adenosine can briefly stop AV conduction, resulting in transient asystole.
48. Which beta blocker also blocks alpha-1 receptors?
A. Esmolol
B. Metoprolol
C. Labetalol
D. Propranolol
Correct Answer: C — Labetalol
Explanation: Labetalol is non-cardioselective and blocks beta-1, beta-2, and alpha-1 receptors.
49. Which antiarrhythmic works primarily on Purkinje fibers?
A. Amiodarone
B. Diltiazem
C. Digoxin
D. Lidocaine
Correct Answer: D — Lidocaine
Explanation: Lidocaine primarily acts on ventricular Purkinje fibers and is used for VTach.
50. Digoxin lowers heart rate through which mechanism?
A. Beta-1 blockade
B. Calcium channel inhibition
C. Vagal stimulation
D. Potassium channel blockade
Correct Answer: C — Vagal stimulation
Explanation: Digoxin increases parasympathetic (vagal) tone, slowing SA and AV node conduction.