SELF-ASSESSMENT QUESTIONS

Dr Rob Law, Consultant Anaesthetist Royal Shrewsbury Hospital, Shrewsbury, UK and Dr Ed Hammond, Royal Devon and Exeter Healthcare NHS Trust, Barrack Road, Exeter, Devon, EX2 5DW, UK.

Question 1

Epiglottitis

A. Is commonest in children between six months and three years

B. There may be no systemic upset in the child

C. Cannulation is mandatory before attempting to control the airway

D. Staphylococcus is the usual causative organism

E. Intubation for 24hours is usual

Question 2

When assessing the airway preoperatively

A. The Mallampati grading accurately predicts difficult intubation

B. Mallampati grade 4 indicates a view of the soft palate

C. Wilson grade C accurately predicts difficult intubation

D. The ability to put chin on chest is a reliable indication of ease of intubation

E. Vertebro-basilar insufficiency may be detected

Question 3

Porphyria

A. Can be induced by alcohol, pregnancy and muscular activity

B. Is characterised by the induction of the enzyme daminolaevulinic acid synthetase

C. Anaesthesia does not induce the erythropoetic forms of the disease

D. The use of tourniquets is contraindicated

E. Barbiturate anaesthesia must be avoided

Question 4

The American Society of Anesthesiologists (ASA) Physical Status

A. Predicts postoperative outcome

B. Was instituted in response to malpractice claims

C. ASA Class II would include a well-controlled asthmatic

D. ASA Class IV indicates a condition which impedes activity but does not represent a threat to life

E. Postscript E indicates an elective case

Question 5

In ketoacidotic diabetic coma

A. Large volume administration of dextrose-containing solutions are required in resuscitation

B. Potassium supplementation will be required

C. The hourly insulin requirement can be calculated by dividing the daily requirement by 24

D. Bicarbonate therapy is needed with an arterial pH above 7.0

E. Artificial ventilation may be required

Question 6

The Glasgow Coma Scale

A. Indicates the severity of head injury

B. May be used as a prognostic guide

C. A score of 2 is incompatible with survival

D. If the patient’s best motor response is flexion to pain, this scores 3 points

E. Was first described by Dr Fergus Glasgow in 1973

Question 7

The following are early signs of inadvertent oesophageal intubation

A. ST depression on electrocardiogram (ECG)

B. Bradycardia

C. Absence of waveform on capnograph

D. Absence of breath sounds on auscultation of lung apices

E. Oxyhaemoglobin desaturation detected on pulse oximetry

Question 8

Postoperative shivering

A. Is due to the use of volatile anaesthetic agents

B. May cause hypoxia in recovery

C. May be arrested by a single dose of 25mg pethidine intravenously

D. Does not occur after spinal anaesthesia

E. The incidence of shivering with extradural analgesia is reduced by the concurrent use of an opiate

Question 9

Intravenous regional anaesthesia (Bier’s block)

A. Can safely be performed using 0.25% bupivacaine without adrenaline

B. Provides good quality postoperative analgesia

C. Depends on the use of a double-cuff tourniquet inflated to 50mmHg above systolic pressure

D. The tourniquet can safely be deflated 20minutes after injection

E. An advantage of the technique is that it can be employed by unsupervised casualty officers

Question 10

The following agents may be used safely in a patient with asthma

A. Vecuronium

B. Ketamine

C. Atracurium

D. Tubocurarine

E. Isoflurane

Question 11

The following commonly occur in pulmonary embolism

A. Left bundle branch block

B. Dyspnoea

C. Raised systolic blood pressure

D. Bradycardia

E. Cannon waves in the JVP

Question 12

The following are recognised complications of massive transfusion of stored blood

A. Hypokalaemia

B. Hypernatraemia

C. Tetany

D. Hypothermia

E. Thrombocytopaenia

Question 13

The following tests are useful during acute investigation of a case of suspected anaphylaxis

A. Serum histamine

B. Serum N-methylhistamine

C. Serum tryptase

D. Serum IgA

E. Serum complement

Question 14

During anaphylaxis

A. Bronchospasm will occur in more than 75% patients

B. Bronchospasm may be the only presenting feature

C. Disseminated intravascular coagulation (DIC) may occur

D. More than 10% of reactions involve upper airway oedema

E. Cardiovascular collapse may be the only clinical feature

Question 15

In the patient with an ejection systolic murmer

A. The patient with aortic stenosis has an increased risk of perioperative mortality

B. Two dimensional echocardiography is used to assess gradient across the valve

C. Aortic gradients greater than 25mmHg are regarded as significant

D. The patient will require antibiotic cover perioperatively

E. An aortic gradient less than 50mmHg excludes severe aortic stenosis

Question 16

The following clinical associations are correct

A. Plasma potassium 2.6mmol/l - ST depression on ECG

B. Plasma sodium 114mmol/l - bronchial carcinoma

C. Plasma calcium (corrected) 3mmol/l - prolonged QT interval on ECG

D. CSF glucose 1mmol/l with plasma glucose 6mmol/l - bacterial meningitis

E. Serum albumin 60g/l - trauma

Question 17

Considering malignant hyperthermia during anaesthesia

A. Sevoflurane is a precipitant

B. The incidence is about 1 in 50,000 anaesthetics

C. Inheritance is by an autosomal dominant mechanism

D. Mannitol is added to vials of dantrolene to aid management of haemoglobinuria

E. Profound muscle weakness can result from the effect of dantrolene on calcium transport

Question 18

In a patient with sickle cell anaemia

A. About 50% of their haemoglobin will be in the HbS form

B. Exchange transfusion is appropriate prior to major vascular surgery

C. Folate is contra-indicated perioperatively as it may provoke an aplastic crisis

D. The Hb-O ₂ dissociation curve is shifted to the right

aiding tissue O ₂ unloading

E. The use of any tourniquet is absolutely contraindicated

Question 19

During anaesthesia for a patient with severe mitral stenosis

A. Sinus rhythm is critical since atrial contraction contributes 60% of ventricular filling

B. If a-v pacing is required a long P-R interval is appropriate

C. Afterload reduction is appropriate even if systemic blood pressure is normal

D. Increased pulmonary vascular resistance is not a likely problem

E. There will often be a marked discrepancy between PA diastolic and PA wedge pressures

Question 20

In a patient with severe aortic stenosis undergoing a general anaesthetic

A. There is a direct relationship between calculated aortic valve area and blood flow across the valve

B. A peak aortic valve gradient of 30mmHg is not compatible with the diagnosis

C. A faster heart rate will be important to help left ventricular filling

D. A reduction in systemic vascular resistance has little effect on ventricular emptying

E. Episodes of myocardial ischaemia should be treated with GTN

Question 1.

You are the anaesthetist covering an obstetric unit. You and the obstetrician are called urgently to a patient. A primigravida woman with an antenatal diagnosis of intra-uterine growth retardation is being induced at 35 weeks gestation. She has received prostin pessaries overnight, and after starting the syntocinon infusion, develops prolonged late decelerations on the cardiotocograph (CTG) trace. Her cervix is 3cm dilated, she is contracting strongly and has received only intramuscular pethidine as analgesia.

● Describe the significance of the tracing

● How would you manage this patient?

● Outline the physiology of fetal oxygenation

Question 2.

You are asked to anaesthestise a 25 year old man for an appendicectomy. He is a smoker who has recently had a chest infection that has been treated with antibiotics by his general practitioner. He still has a productive cough but is not short of breath and on examination he has some coarse crepitations in both lung fields. His pre-operative chest X-ray is entirely normal. After an uneventful procedure under general anaesthesia you extubate him and transfer him to the recovery ward. You are called back to recovery because his oxygen saturations are only 87% despite a high inspired oxygen concentration and he is complaining that he is having difficulty breathing. You examine him and order a chest X-ray (shown). What is the diagnosis and how would you treat it?

Question 3.

What pathology is demonstrated in each of these three CT scans?