Multiple Choice

Short Answers

Multiple Choice

1. Cardiovascular physiology:

   a)	The first heart sound indicates the start of isometric contraction.
   b)	In heart failure increasing heart rate will improve myocardial oxygenation.
   c)	Cardiac output (CO) = Heart rate (HR) x Systemic Vascular Resistance (SVR).
   d)	Diabetes mellitus (DM) may give rise to an abnormal Valsalva response.
   e)	Pulmonary artery (PA) catheter measurements are reliable in mitral stenosis.




2. Breathing circuits:

   a)	The Mapleson A system is efficient during controlled ventilation.
   b)	During spontaneous ventilation, the Mapleson A system requires a fresh gas flow (FGF) of 150ml/kg/min.
   c)	During controlled ventilation a Bain circuit requires a FGF of 70-100ml/kg/min.
   d)	During spontaneous ventilation a Lack circuit will conserve dead space gas.
   e)	The Jackson-Rees modification of the Ayres T piece has a closed bag at the end of the expiratory limb.




3. Circle systems:

   a)	Fresh soda lime contains mainly calcium carbonate.
   b)	Fresh soda lime contains no water.
   c)	Plenum vaporisers cannot be used in the circle due high internal resistance.
   d)	A circle system contains 2 one way valves.
   e)	Circle systems are economical because low flows can be used from the start of a procedure.




4. Trauma:

   a)	All trauma patients should have their airway assessed and secured before having a long bone fracture reduced.
   b)	A patient who opens their eyes, withdraws their arm and groans to pain has a Glasgow coma score (GCS) of 11.
   c)	A patient with suspected extradural haematoma and a positive diagnostic peritoneal lavage (DPL) should have an urgent neurosurgical opinion before any further intervention.
   d)	All trauma patients who are intubated should have a nasogastric tube passed.
   e)	Management of a tension pnemothorax should include chest X ray (CXR) before needle decompression.




5. Ophthalmic anaesthesia:

   a)	The oculo-cardiac reflex is mediated by the sympathetic nerve supply.
   b)	Suxamethonium is absolutely contraindicated in penetrating eye injury.
   c)	An intra-ocular pressure (IOP) of 25mmHg is normal.
   d)	Patients with myopia have greater risk of orbit puncture with peribulbar blocks.
   e)	Ketamine is an appropriate induction agent in a penetrating eye injury.




6. Renal physiology:

   a)	Renal blood supply is normally 10% of cardiac output.
   b)	The juxtaglomerular complex produces angiotensin.
   c)	Aldosterone promotes potassium (K+) excretion in the proximal tubule.
   d)	Atrial nautrietic peptide (ANP) blocks the effect of aldosterone.
   e)	Erythropoietin production is increased in hypoxia.




7. Paediatric physiology:

   a)	Infants have a lower functional residual capacity (FRC) than adults.
   b)	Stroke volume is relatively fixed.
   c)	An appropriate maintenance fluid requirement for a 26kg child would be 46mls/hr.
   d)	Infants have a lower closing volume than adults.
   e)	Alveolar minute ventilation (MV) is approximately 60ml/kg/min.




8. Paediatric anaesthesia:

   a)	In spontaneous respiration with an Ayres T piece, a FGF of 2-3 x minute volume is required.
   b)	An appropriate resuscitation dose of fluid is 10mls/kg.
   c)	Thiopentone can be given by intraosseous injection.
   d)	Pyloric stenosis is a surgical emergency and should be operated on as soon as is possible.
   e)	The maximum dose of bupivacaine is 2mg/kg per 4 hours.




9. Pre-operative assessment:

   a)	A patient with 2:1 heart block should receive an atropine premed.
   b)	A morphine infusion is the best form of post- op analgesia in a patient for a gastrectomy with TB bronchiectasis.
   c)	Patients with oesophageal reflux should receive a rapid sequence induction (RSI).
   d)	Patients having a thyroidectomy should have a CXR.
   e)	Patients having non urgent surgery should be postponed by 6 weeks following an myocardial infarct (MI).




10. Causes of electro-mechanical dissociation (EMD) include:

    a)	Tension pneumothorax
    b)	Cardiac tamponade
    c)	Pulmonary emboli
    d)	Cardiac ischaemia
    e)	Hyperthermia




11. The following are correct doses with respect to paediatric resuscitation:

    a)	First dose adrenaline:	0.1ml/kg of 1:10,000
    b)	Second dose adrenaline:	1.0ml/kg of 1:100,000
    c)	Atropine:	40mcg/kg
    d)	Initial defibrillation:	2 joules/kg
    e)	Bicarbonate:	1ml/kg of 8.4% solution




12. The following inotropes are correctly matched with their receptors:

    a)	Noradrenaline:	a1, b
    b)	Isoprenaline:	a1, a2
    c)	1-2mcg/kg/min dopamine:	b
    d)	Salbutamol:	b 2
    e)	Adrenaline:	a 2




13. Ketamine:

    a)	Acts at the NMDA receptor.
    b)	Is related to phencyclidine.
    c)	Acts in one arm brain circulation time.
    d)	Is a trigger for malignant hyperpyrexia (MH).
    e)	Increases post operative nausea and vomiting (PONV).




14. The following will give rise to in increase in body sodium (Na⁺):

    a)	Angiotensin I
    b)	Captopril
    c)	Anti diuretic hormone (ADH)
    d)	ANP
    e)	Fludrocortisone




15. Concerning the neuromuscular junction (NMJ):

    a)	Na+/K+ ATPase consumes 1/3 of the body's metabolic energy.
    b)	The acetylcholine (Ach) receptor has 5 subunits.
    c)	Ach binds to the b subunit of the Ach receptor.
    d)	NMJ function is normal until 75-80% of receptors are blocked.
    e)	The resting membrane potential is -70mV.




16. Immediate management of anaphylaxis should include:

    a)	Oxygen
    b)	Adrenaline
    c)	Steroids
    d)	Antihistamines
    e)	Salbutamol




17. The following are safe to use in patients taking monoamine oxidase inhibitors (MAOI's):

    a)	Metaraminol
    b)	Pethidine
    c)	Ephedrine
    d)	Diclofenac
    e)	Paracetamol




18. The following local anaesthetics are correctly paired with their maximum doses:

    a)	Plain bupivacaine:	2mg/kg
    b)	Bupivacaine with adrenaline:	4mg/kg
    c)	Plain lignocaine:	6mg/kg
    d)	Lignocaine with adrenaline:	7mg/kg
    e)	Plain prilocaine:	6mg/kg




19. The following local anaesthetics are amides:

    a)	Bupivacaine
    b)	Lignocaine
    c)	Cocaine
    d)	Amethocaine
    e)	Chloroprocaine




20. The following muscle relaxants are safe in a patient with a history of scoline apnoea:

    a)	Atracurium
    b)	Mivicurium
    c)	Vecuronium
    d)	Pancuronium
    e)	Gallamine




21. Pulse oximetry may be inaccurate in the presence of the following:

    a)	Sickle cell disease
    b)	Methaemoglobinaemia
    c)	Nail varnish
    d)	Thalasaemia
    e)	Carboxyhaemoglobin

(Continued ...)

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