{"id":7338,"date":"2025-08-10T00:01:00","date_gmt":"2025-08-10T08:01:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=7338"},"modified":"2025-10-01T11:38:25","modified_gmt":"2025-10-01T19:38:25","slug":"usmle-step-1-question-of-the-day-propofol","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-propofol","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day:\u00a0Propofol"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-propofol\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-propofol\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-propofol\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-propofol\/#Major_Takeaway\" >Major Takeaway&nbsp;<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Can you determine the most likely diagnosis for a 29-year-old man who arrives at the ER needing an evaluation for shoulder pain<\/strong><\/em><strong><em> after a fall from a ladder? Let&#8217;s learn more about the case!<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 29-year-old man is brought to the emergency department to evaluate right shoulder pain. The patient was standing on a ladder painting the exterior wall of his house. He lost balance and subsequently fell onto his right shoulder. Temperature is 37.0\u00b0C (98.6\u00b0F), blood pressure is 147\/82 mmHg, and pulse is 105\/min. Plain radiography reveals a dislocated right shoulder. A closed reduction under an intravenous anesthetic agent is performed. A single bolus of propofol is administered, which provides adequate sedation for the procedure. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>This medication increases the patient\u2019s risk of developing which of the following complications?\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Bronchoconstriction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Anterograde amnesia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Adrenal suppression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Cardiovascular depression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Methemoglobinemia<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Osmosis.org at the University College London, UK\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/DIp3u0oTLo4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 1 Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Cardiovascular depression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Bronchoconstriction<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Thiopental is an intravenous anesthetic that can cause mast cells in the airways to release histamine and result in bronchoconstriction. As a result, the medication is not typically administered to patients with a history of asthma.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Anterograde amnesia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Midazolam is a benzodiazepine with a slower onset than the other intravenous anesthetics. The medication can lead to anterograde amnesia, unable to form new memories.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Adrenal suppression<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Etomidate is a common parenteral anesthetic that potentiates the effect of GABAA. It can cause adrenal suppression but is unlikely to cause cardiovascular depression. It is preferred for patients with coronary artery disease, cardiomyopathy, cerebral vascular disease, or hypovolemia since they are at greater risk for hypotension and its associated complications.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Methemoglobinemia<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Select agents (e.g., lidocaine, prilocaine, benzocaine) can cause methemoglobinemia, especially in infants younger than 12 months of age with additional risk factors (e.g., G6PD deficiency, concurrent administration of other methemoglobin-inducing medication). However, propofol is not associated with methemoglobinemia.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Propofol is an intravenous anesthetic that can cause vasodilation and cardiovascular depression, resulting in hypotension. Common parenteral anesthetics (e.g., thiopental, midazolam, propofol, etomidate) have similar properties and mechanisms of action. They work by either stimulating GABA receptors or increasing their sensitivity to GABA molecules. These anesthetics have rapid onset (20-30 seconds) and a short duration of action. They are commonly used for induction of anesthesia and maintenance in short procedures such as tracheal intubation. Ketamine, on the other hand, blocks NMDA receptors. Ketamine also has a rapid onset but a longer duration of action. The side effects of different intravenous anesthetics and their mechanisms of action are summarized below:<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"841\" height=\"990\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/image_2e2942.png\" alt=\"PARENTERAL GENERAL ANESTHETICS\nAgent \/ Mechanism of Action \/ Side Effects \/ Notes\nThiopental (Barbiturate) \/ Facilitates GABA \/ * Cardiovascular depression * Bronchoconstriction \/ Decreases intracranial pressure with traumatic brain injury\nMidazolam \/ Facilitates GABA \/ * Cognitive dysfunctions like amnesia * Postoperative respiratory depression \/ Anticonvulsant properties\nPropofol \/ Potentiates GABA \/ * Vasodilation &amp; cardiovascular depression * Propofol infusion syndrome (bradycardia, heart failture, metabolic acidosis, rhabdomyolysis, &amp; enlarged fatty liver) \/ Induction agent of choice for most patients, anticonvulsant properties\nEtomidate \/ Stimulate GABA \/ * Adrenal suppression * Involuntary myoclonic movements \/ Preferred for patients with coronary artery disease, cerebral vascular disease, or cardiomyopathy\nKetamine \/ Blocks NMDA receptors \/ * Increases myocardial oxygen demand * Exacerbates hypertension, tachycardia &amp; arrhythmias in pheochromocyotoma * Increases CBF and ICP * Emergence reaction possible with vivid dreams, disorientation hallucination \/ Causes dissociative anesthesia\" class=\"wp-image-7340\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/image_2e2942.png 841w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/image_2e2942.png?resize=255,300 255w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2025\/08\/image_2e2942.png?resize=768,904 768w\" sizes=\"auto, (max-width: 841px) 100vw, 841px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Common intravenous anesthetics mainly act by stimulating GABA receptors or increasing their sensitivity to GABA molecules. Side effects of these medications include cardiovascular and respiratory depression, cognitive dysfunction, and bronchoconstriction.\u00a0<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/10\/Blog_Display_Ads_MD3_2023.png?w=700\" alt=\"\" class=\"wp-image-5300\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/10\/Blog_Display_Ads_MD3_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/10\/Blog_Display_Ads_MD3_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your\u00a0<em><a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/em>\u00a0and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Review a Step 1 clinical case on propofol sedation for shoulder dislocation and discover which complication is most associated with this intravenous anesthetic.<\/p>\n","protected":false},"author":202,"featured_media":7343,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1369,44],"tags":[72,1325,319,1326,1327,1323,1322,1321,1320,1324,664],"class_list":["post-7338","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-1-questions","category-step-1","tag-anesthesia","tag-anesthesia-complications","tag-anesthesiology","tag-cardiovascular-depression","tag-gaba-receptors","tag-intravenous-anesthetics","tag-ketamine","tag-propofol","tag-sedation","tag-shoulder-dislocation","tag-usmle-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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