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Retired NBME 15 Answers

nbme15/Block 3/Question#3 (reveal difficulty score)
A 3-year-old boy with chronic otitis media is ...
Low blood solubility ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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Important aspects of volatile (gas) anesthetics: (FA2020 p549):

  • MAC (minimum alveolar concentration): essentially the ED50 for inhaled anesthetics, this is the minimum concentration of anesthetic that causes a response in 50% of patients
  • LOW MAC means HIGH potency - more potent drugs would have a lower minimum amount needed to be present in the alveoli in order to exert their effect.
  • LOW MAC is related to HIGH lipid solubility (higher oil/gas partition coefficient) - more lipid soluble agents tend to be more potent because of their increased ability to cross the BBB
  • MACs are additive (i.e. one gas at 1.5 MAC = two gases at 0.75 their respective MACs)
  • Blood/gas partition coefficient: an expression of solubility; anesthetics with a low blood gas partition coefficient have a rapid onset/offset
  • i.e. LESS plasma solubule anesthetic = FASTER onset/offset
  • This is because less plasma soluble agents will "fill up" their maximum amount in the blood reservoir quicker and thus are pushed down their concentration gradient into the brain quicker; i.e. they quickly saturate the blood and will move on to affecting the brain quicker
  • MAC and blood/gas partition coefficient also tend to be inversely related -- higher MAC = lower blood/gas partition coefficient and vice versa; thus many of the more potent anesthetics have a longer time for onset/offset
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cheesetouch  FA2018 P532 +1
randi  FA2019 p536 +



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