Multiple Choice Questions		X-rays
Clinical Scenario		ECG's

Multiple Choice Questions

1. Hypotension may be caused by:

   a)	Neostigmine
   b)	Spinal anaesthesia
   c)	IPPV
   d)	Hypovolaemia
   e)	Vecuronium.




2. The oxygen-haemoglobin dissociation curve is shifted to the right by:

   a)	Alkalosis
   b)	Hypothermia
   c)	Nitric oxide
   d)	Respiratory depression
   e)	Fetal haemoglobin.




3. In the neonate:

   a)	The cricoid cartilage is the narrowest part of the upper airway
   b)	The spinal cord ends at L1
   c)	Free drug levels may be higher due to lower plasma albumin levels
   d)	Shivering is effective in increasing body temperature
   e)	Greater chest wall compliance decreases the FRC.




4. The following statements regarding obesity are true:

   a)	A person with a BMI of 20-25kg/m is considered obese
   b)	Oxygen consumption increases with obesity
   c)	A blood pressure cuff that is too small will underestimate the blood pressure
   d)	Intramuscular opioid is the analgesic method of choice in an obese patient
   e)	There is a significant risk of DVT in obese surgical patients.




5. The physiological response to major surgery includes:

   a)	Hyperglycaemia
   b)	Decreased protein metabolism
   c)	Increased sympathetic nervous system activity
   d)	An increase in urine output due to a reduction in ADH secretion
   e)	Increased fibrinogen levels.




6. Thiopentone:

   a)	Possibly exerts some of its effects via the GABA A receptor complex
   b)	Dose requirements are lower in shocked patients
   c)	Reduces cerebral oxygen utilisation
   d)	Is safe in porphyria because it has no effect on ALA synthase
   e)	Followed by suxamethonium is absolutely contra-indicated in patients with open eye injuries.




7. Ketamine:

   a)	Has active metabolites
   b)	Clearance is reduced by halothane
   c)	Preserves cerebrovascular responsiveness to CO2
   d)	Is relatively contra-indicated as the sole agent in patients with ischaemic heart disease
   e)	May be added to solutions used for caudal anaesthesia to prolong analgesia.




8. With regard to volatile agents:

   a)	Enflurane is the agent of choice in a patient with epilepsy
   b)	Isoflurane is more extensively metabolised than halothane
   c)	Ether causes sympathetic stimulation
   d)	Sevoflurane's high blood-gas partition coefficient allows for faster induction of anaesthesia than with halothane
   e)	Desflurane has a boiling point of 23.5°C thus cannot be used in a standard vaporiser.




9. The following drugs cause recognised interactions:

   a)	Alcohol and midazolam
   b)	Aminophylline and erythromycin
   c)	Vecuronium and gentamicin
   d)	Verapamil and propranolol
   e)	Halothane and adrenaline (epinephrine).




10. The hazards of intra-operative blood transfusions include:

    a)	Coagulopathy
    b)	A shift in the oxygen-haemoglobin dissociation curve
    c)	Hypokalaemia
    d)	Metabolic alkalosis
    e)	Malaria.




11. Non-depolarising neuromuscular blockade:

    a)	Can be monitored by means of double- burst stimulation
    b)	Does not show post-tetanic facilitation
    c)	Is achieved by competitive agonists of postsynaptic acetylcholine receptors at the neuromuscular junction
    d)	Is antagonised by volatile inhalational agents
    e)	Is characterised by fasciculations.




12. A pulse oximeter:

    a)	Utilises the Beer-Lambert law
    b)	Reliably detects SpO2 of 50%
    c)	Is reliable when monitoring patients extracted from house fires
    d)	Is unaffected by pigmented skin
    e)	Is considered an essential monitor during anaesthesia.




13. With regard to anaesthetic breathing systems:

    a)	The Lack system is a co-axial form of the Mapleson D system
    b)	The Mapleson A system is inefficient when used for spontaneous ventilation
    c)	Mapleson's classification describes the T- piece as a Mapleson C system
    d)	The Jackson-Rees modification of Ayre's T- piece has low resistance to expiration
    e)	With circle systems, the lowest fresh gas flow that can safely be used is 800ml/ minute.




14. The following statements about the Rotameter are true:

    a)	It is a constant pressure variable orifice flow meter
    b)	Viscosity is the most important determinant of flow at high flow rates
    c)	Small changes in temperature cause significant inaccuracies in flow measurement
    d)	Static electricity may cause inaccuracies in flow meters
    e)	CO2 can safely be administered via a properly calibrated air Rotameter.




15. In obstetric anaesthesia:

    a)	A sensory block to T9-10 is adequate for Caesarean Section under regional blockade
    b)	Sodium citrate 0.3 molar is a suitable antacid
    c)	The risk of hypoxia (maternal) is higher than in non-pregnant patients
    d)	The incidence of post-dural puncture head- ache is reduced with pencil point needles
    e)	NSAIDS are useful for post-operative analgesia in healthy patients following Caesarean Section.




16. When performing regional blocks:

    a)	An axillary brachial plexus block is appropriate for shoulder surgery
    b)	The tourniquet can be released 10 minutes after injection of local anaesthetic for a Bier's block
    c)	There is a greater risk of pneumothorax with the supraclavicular than axillary approach to a brachial plexus block
    d)	A 3-in-1 block is an appropriate technique for blocking the lumbar plexus
    e)	Spinal opioids can cause itching.




17. With regard to hepatitis and HIV:

    a)	The risk of transmission of HBV through a needlestick injury is similar to that for HIV
    b)	Immunisation against HBV is effective provided that boosters are received every 2 years
    c)	HIV is killed by immersion in hypochlorite solution
    d)	HIV-infected patients commonly present for abdominal surgery
    e)	HIV can cause myocarditis.




18. Problems with intubation are more common in patients:

    a)	With a thyromental distance of > 6.5cm
    b)	Having a Caesarean Section near term
    c)	With rheumatoid arthritis
    d)	With acromegaly
    e)	With Down's syndrome.




19. In the neck:

    a)	The thyroid cartilage is palpable at the level of C6
    b)	The internal laryngeal nerve pierces the thyrohyoid membrane
    c)	The vagus nerve lies outside the carotid sheath
    d)	The common carotid artery bifurcates at level C6
    e)	The subclavian artery passes anterior to scalenus anterior above the first rib.




20. Tension pneumothorax:

    a)	May follow cannulation of the internal jugular vein
    b)	Is diagnosed only on PA erect chest X-ray
    c)	May cause tracheal deviation
    d)	Is treated definitively by IPPV to maintain oxygenation
    e)	Should be considered as a cause of cardiac arrest.

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