Multiple Choice Questions

1. With respect to lung cancer:

1. Is the most common cancer amongmen in the UK.
2. Male: female ratio is 4:1.
3. 80% die within1 yr of diagnosis.
4. The majority are non-small cell in origin.
5. All small cell cancers are inoperable.

2. When consideringsuitability for pneumonectomy:

1. Patients morethan 80 yrs areat an increased risk of perioperativemorbidity.
2. All patientsshould have an ECG.
3. A preoperative post bronchodilatorFEV₁>1.5 litre is acceptable.
4. In-hospital mortality is6–8%in the UK.
5. Weight loss is irrelevant.

3. The followingare useful for staging lung cancer and assessingoperability:

1. CTscan.
2. Bronchoscopy.
3. PET scan.
4. Mediastinoscopy.
5. PercutaneousCT-guided biopsy.

4. With regard to exercise testing:

1. A max <20 ml kg^–1min^–1indicates a very high riskof perioperative death.
2. The abilityto     

Multiple Choice Questions

An alternative approach to acid–base abnormalities in critically ill patients

1. Regarding blood gases:

1. pH is measured directly.
2. Standardbicarbonate is derived directly from the Henderson-Hasselbalchequation.
3. Cooling causes Pa_CO2 to increase.
4. Standard baseexcess is measured at a haemoglobin of 5 g dl^–1.
5. Bloodgas analysers default to analyse samples at 37°C.

2.According to Stewart's approach, the following are independentdeterminants of plasma pH:

1. PCO₂.
2. Weak acids.
3. Lactate.
4. Bicarbonateconcentration.
5. A_TOT.

3. In critically ill patients:

1. Hypoalbuminaemiacan cause alkalosis.
2. Large volumes of 0.9% saline increasesthe SID.
3. Hypovolaemiaincreases the SID.
4. Compared to 0.9%saline, resuscitationwith 4% albumin increasesmortality.
5. Massiveblood transfusioncan lead to metabolic alkalosis.

4. Regardingacid-base balance:

1. Albumin is the principal extracellularweakacid.
2. The kidney handles an acid load through H⁺ excretion.
3. In plasma there are more anions than cations thus creatingananion gap of 10     

Multiple Choice Questions

Interpretation of the chest radiograph

1. The following structures contribute to the cardiac marginsvisible on a PA chest radiograph:

1. Right ventricle
2. Left atrialappendage
3. Interventricular septum
4. Right atrium
5. Coronarysinus

2. Air bronchogram may be seen in the following situations:

1. Atelectasis
2. Pneumonia
3. Pulmonary haemorrhage
4. Pulmonary oedema
5. Normalchest radiograph

3. A posterior-to-anterior (PA) chestradiograph:

1. Magnifies thecardiac shadow
2. Is usually taken withthe patient supine
3. Thescapulae are usually projected overthe upper lobes
4. Is adequateif 8–10 posterior ribs arevisible
5. Appears more diffuselyopaque if over penetrated

4. The following statements are true

1. The apex of the righthemidiaphragmis usually 3 cm below thelevel the left hemidiaphragm
2. A correctlyplaced tracheal tube should be approximately 3cmabove thecarina
3. The silhouette sign is in essence lossof a normallung/softtissue interface
4. The right hilum ishigher thanthe     

Multiple Choice Questions

1. Concerning the skeletal muscle sarcolemmal membrane potential:

1. Thecell is hyperpolarized by increased temperature.
2. On depolarization,the Nernst potential for Na⁺ is reached.
3. Cl^– currentshave no significant role under physiologicalconditions.
4. Aplateau potential is maintained by Ca²⁺ current through dihydropyridinechannels.
5. Repolarization is achieved principally by K⁺ current.

2. Excitation-contraction coupling in skeletal muscle:

1. Involvesa sarcolemmal Ca²⁺ current.
2. Results in Ca²⁺ release throughthe SERCA pump.
3. Involves interaction between dihydropyridineand ryanodine receptors.
4. Is enhanced by high intracellularMg²⁺ concentration.
5. Is inhibited in malignant hyperthermia.

3. Concerning skeletal muscle proteins:

1. Actin is the mostabundant.
2. Myosin is the largest.
3. Myosin is the major constituentofthick filaments.
4. Titin is a key structural element of thinfilaments.
5. Z proteins are formed from nebulin.

4. Duringskeletal muscle contraction:

1. Unfolding of actin strandsexposesthe myosin binding sites.
2. Ca²⁺ ions bind to troponinC.
3. ATPis required     

Multiple Choice Questions

1. The following are synthesized in the liver:

1. Anti-thrombinIII.
2. C-reactive protein.
3. Angiotensinogen.
4. ApolipoproteinB.
5. Cholecystokinin.

2. The following are indicationsfor liver transplantation:

1. Haemochromatosis.
2. Intentional paracetamoloverdose.
3. Hepatocellular carcinoma(single 9 cm-lesion).
4. Cirrhosissecondary to hepatitis B.
5. Budd–Chiari disease.

3.Concerning hepatic ischaemia-reperfusion injury (IRI):

1. Itcanresult in primary non-function of a liver graft.
2. The firstphase of hepatic IRI involves activation of Kupffercells.
3. Neutrophilsplay a minor role in the late phase.
4. Microcirculatory failureresults from increased nitric oxideproduction.
5. Ischaemicpre-conditioning involves a deliberate brief periodof ischaemiabefore prolonged ischaemia.

4. Hepatic artery thrombosis:

1. Hasan incidence of 4–6%after paediatric liver transplantation.
2. May present     

Multiple Choice Questions

99. Hypertension in surgical patients:

1. Is associated with cardiovascularinstability for both pressureand heart rate.
2. Increases therisk of hypertensive crises in response to stimuli.
3. May contributeto increased postoperative cardiac morbidity,but not mortality.
4. Can be ignored if it is purely systolic.
5. Should be treatedpreoperatively if >180/110 mm Hg on morethan two occasions.

100. The anaesthetic management of hypertensive patientsshould:

1. Bedecided exclusively on the blood pressure.
2. Includea thoroughinvestigations of target organ involvement.
3. Disregard‘whitecoat’ hypertension as irrelevant.
4. Includemeasurementof more than one blood pressure before thepatientpresentsfor surgery.
5. Involve the use of balanced anaesthesia.

101. The preoperative evaluation should include:

1. The searchfor evidence of secondary hypertension.
2. The rapid, i.v. correctionof hypokalaemia where present.
3. A detailed examination of thepatients on-going medication witha view to replacing diureticsand ß-blockers by ACE     

Multiple Choice Questions

106. With respect to the history of nitrous oxide:

1. It was discoveredin the middle of the 19th century.
2. It was discovered by HumphreyDavy.
3. It used to be known as dephlogisticated nitrous air.
4. Nitrous oxide was first made by adding iron to nitric acid.
5. Nitrous oxide was used as a form of entertainment at countryfairs.

107. Concerning clinical applications of nitrousoxide:

1. It canbe used safely one week after intraocular SF₆instillation.
2. Nitrous oxide mediated changes in middle earpressure maydisruptossicular chain repair.
3. During laparoscopy,combustionmay occur if the concentrationof nitrous oxide inthe pneumoperitoneumexceeds 29%.
4. Nitrous oxide will causean increase in the sizeof a carbondioxide gas embolus.
5. Theteratogenicity of nitrousoxide is due only to impairedDNAsynthesis.

108. Concerning the physical properties:

1. Nitrousoxide doesnot support combustion.
2. The     

Multiple Choice Questions

50. The regulation of blood pressure:

1. Principally involves thearterial baroreceptors on a minute-to-minutebasis.
2. Involvesthe renin–angiotensin–aldosterone but notthe atrialnatriuretic peptide system.
3. Includes the regulation of reninsolely by the concentrationof sodium in the distal tubule.
4. Is modulated by nitric oxide, a modulation that is impairedin hypertensive patients.
5. Involves sodium balance in the longterm.

51. The pathophysiology of hypertension:

1. Necessarilyincludesan increase in both cardiac output andsystemic vascularresistance.
2. Most of the time includes a degree of vascularremodelling.
3. Consistently includes a narrowing of the pulsepressure resultingfrom vascular remodelling.
4. Is contributedto by increasedautonomic activity and resettingof baroreflexes.
5. Is not     

Multiple Choice Questions

1. In assessing the severity of aortic stenosis:

1. The pressuregradient across the valve is the most accuratemethod.
2. Angiographyis not always required.
3. Exercise tolerance is a good measureof severity.
4. The pressure gradient measured at angiographywill be higherthan that found on the echocardiogram.
5. Thepressure gradient severity tends to be over estimated inpregnancy.

2. Important factors in the intraoperative care of thepatientwith aortic stenosis include:

1. Avoiding hypotension.
2. Maintainingsystemic vascular resistance.
3. Avoiding tachycardias.
4. Neverusing regional anaesthesia.
5. Avoiding intubation.

3. When considering the aetiology of aortic stenosis:

1. Aorticsclerosis is a benign variant.
2. Stenosis is common withoutcalcification.
3. Bicuspid valves are more common in youngerpatients.
4. Rheumatic disease is a common cause of isolatedaortic stenosis.
5. Bicuspid valves are best seen on echo indiastole.

4. The continuity equation:

1. Contains the cross-sectional     

Multiple Choice Questions

134. The following end-tidal concentrations of anaesthetic agentsare likely to ensure lack of postoperative recall in an otherwiseunmedicated patient at sea-level:

1. Nitrous oxide 70% in a 30-yr-oldpatient.
2. Nitrous oxide 65% + isoflurane 0.6% in a 30-yr-oldpatient.
3. Sevoflurane 2% in a 30-yr-old patient.
4. Nitrousoxide 50% + sevoflurane 1% in a 2-yr-old patient.
5. Nitrousoxide 35% + isoflurane 0.5% in an 80-yr-old patient.

135.The following situations are associated with an increaseinthe risk of awareness:

1. Thyrotoxicosis.
2. ß-blockade.
3. Cardiac surgery.
4. Surgical procedures of long duration.
5. Anaesthesiawith spontaneous ventilation.

136. The following, occurringintraoperatively, are associatedwith awareness:

1. Patient movement.
2. Pupillary constriction.
3. Facial flushing.
4. Sweating.
5. Hypotension.

137. Concerning the anatomy and complications of centralvenouscatheterization:

1. The right and left internal jugularveins arealways     

Multiple Choice Questions

Anaesthesia for hepatic resection surgery

1. The following are indications for hepatic resectionsurgery:

1. Carcinoma of the gall bladder.
2. Partial liver transplantation.
3. Hepatic metastases from gastric carcinoma.
4. Hepatocellularcarcinoma.
5. Colo-rectal hepatic and pulmonary metastases.

2. During the resection phase of surgery:

1. Fluid transfusionshould be liberal.
2. Cardiac output may fall.
3. Air embolismis possible.
4. Hypoglycaemia suggests early liver failure.
5. Endtidal carbon dioxide may rise.

3. During the immediatepost operative period:

1. Confusionis most likely due to encephalopathy.
2. The formation of ascitesmay cause hypovolaemia.
3. Epiduralanalgesia is mandatory.
4. Abnormalliver function tests areindicative of liver failure.Hyperphosphataemiais common.

Laryngeal mask airway and other supraglottic airway devices in paediatric practice

4. Paediatric sizes of the LMA:

1. Were modelled on infantand child larynxes.
2. Should only be used in babies over 3 kg.
3. Should always be inserted deflated and without rotation.
4. Canprolapse the epiglottis over the laryngeal inlet.
5. Have     

Multiple Choice Questions

81. In the fetal circulation:

1. The stroke volume of the leftventricle is the same as the strokevolume of the right ventricle.
2. Deoxygenated blood arrives at the placenta via the umbilicalvein.
3. Cardiac output is defined as the volume of blood ejectedbythe left ventricle in one minute.
4. Only 12% of the rightventricular output enters the pulmonarycirculation.
5. The eustachianvalve directs the more highly oxygenated blood,streaming alongthe dorsal aspect of the superior vena cavainto the left atrium.

82. Regarding fetal blood:

1. The P₅₀ value is 5 kPa.
2. Thehaemoglobinconcentration in the term fetus is usually 8     

Multiple Choice Questions

128. Glycoprotein IIb/IIIa inhibitors:

1. Reduce platelet aggregation.
2. Improve outcome with thrombolysis.
3. Reduce the risk of non-fatalMI in NSTEMI patients undergoingcoronary angioplasty.
4. Canonly be administered on a single occasion to any patient.
5. Needto be reversed before major surgery.

129. The troponins:

1. Havea greater sensitivity than CK-MB indiagnosis of MI.
2. May bedetected in serum 5 days after infarction.
3. When detected inserum invariably reflect irreparable myocardialdamage.
4. Willbe significantly elevated in serum within 1 hof MI.
5. Havea prognostic role in critical illness.

130. Regarding reperfusiontherapy:

1. rt-PA is invariably superiorto streptokinase.
2. Thrombolysisis indicated within 24 h ofpresentation.
3. PTCA is only indicatedin STEMI.
4. PTCA is asuperior treatment to thrombolysis inSTEMI.
5. PTCA is contraindicatedin cardiogenic shock.

131.The following     

Multiple Choice Questions

1. Concerning gastric emptying:

1. It directly determines risk ofaspiration.
2. Mendelson suggested it is delayed in labour.
3. Liquidsempty from the stomach at a constant rate.
4. Gastric pH <2.5 is exceptional in healthy fasting adults.
5. Opioid analgesicsaccelerate gastric emptying.

2. Concerning pre-operativefasting:

1. Residual gastric volumeis inversely related to fastingtimefor liquids.
2. Breast milkingestion mandates a 6 h fast.
3. Feeding in labour preventsketosis but causes increased gastricvolume.
4. Women in thethird trimester of pregnancy have delayedgastricemptying.
5. Current UK guidelines permit chewing gumup to induction ofanaesthesia.

3. Concerning aspiration:

1. Mendelson'sobstetric patients whoaspirated liquid gastriccontents hada high mortality rate.
2. The ProSeal^TM LMA     

Multiple Choice Questions

Anaesthesia for paediatric ear, nose and throat surgery

1. Children undergoing tonsillectomy
   1. Require a pre-operative clottingscreen.
   2. The commonest reason for unexpected admission followingintendedday-stay surgery is bleeding.
   3. May have presentedwith failure to thrive.
   4. May be administered dexamethasoneintra-operatively to decreasethe risk of post-operative infection.
   5. Should always receive anti-emetics.
2. A child with a post-tonsillectomybleed
   1. Should be returned totheatre and intubated immediately.
   2. The airway can be safelymanaged with a laryngeal mask.
   3. Theinsertion of an interosseousneedle may be required.
   4. Two suctioncatheters should alwaysbe available.
   5. Blood should be cross-matched.
3. Obstructive sleep apnoea in children
   1. Is associated witha greaterincidence of post-operative complications.
   2. Is associatedwitha smaller risk of airway obstruction duringanaesthesia.
   3. Decreasesthe ventilatory response to CO₂.
   4. Can always bediagnosed bya right ventricular strain patternon the ECG.
   5. Can cause behavioural     

Multiple Choice Questions

1. Regarding the management of severe rhabdomyolysis:

1. (a) Acidificationof the urine is helpful.
2. (b) Diuretic therapy is of provenbenefit.
3. (c) Bicarbonate infusion may be useful.
4. (d) Compoundsodium lactate is the ideal resuscitation fluid.
5. (e) Largevolumes of fluid may be required.

2. The following metabolicderangements are observed in earlyrhabdomyolysis:

1. (a) Hyperphosphataemia.
2. (b) Hypocalcaemia.
3. (c) Metabolic alkalosis.
4. (d) Hyperuricaemia.
5. (e) Hypokalaemia.

3. Regarding the diagnosis of rhabdomyolysis:

1. (a)Myoglobin isalways detectable in the urine.
2. (b) Serum creatininekinaseis a sensitive marker of muscledamage.
3. (c) Routinedipsticktesting of urine reliably differentiatesbetween haematuriaand haemoglobinuria.
4. (d) Measuring serum myoglobin is useful.
5. (e) The initial clinical sign of rhabdomyolysis may be discolouration     

Multiple Choice Questions

27. A blood transfusion may lawfully be administered to:

1. Anadult Jehovah's Witness undergoing elective surgery if theanaesthetistfeels it would be in the patient's best interests.
2. An adultpatient in an emergency whose Jehovah's Witness statusis uncertain.
3. An unconscious adult patient who is carrying an advance directiveindicating his Jehovah's Witness status and refusing transfusionof blood products.
4. A child of Jehovah's Witness parents forwhom a specific issueorder has been obtained.
5. A child ofJehovah's Witness parents in an emergency.

28. The followingmay reduce intraoperative blood transfusionrequirements:

1. Highstarting packed cell volume.
2. High percentageof hypochromaticred cells.
3.      

Multiple Choice Questions

27. Regarding post-dural puncture headache (PDPH):

1. The incidenceof PDPH is lower with 29G needles than 25G needles.
2. PDPH mostcommonly presents 5–14 days after the procedure.
3. PDPHcan be treated with the 5-HT_1D receptor agonist Sumatriptan.
4. To be effective, epidural blood patch must be performed within72 h.
5. Epidural blood patch may cause failure of subsequentepiduralanalgesia.

28. Transient neurological symptoms:

1. Aremore common after intrathecalbupivacaine than lidocaine.
2. Aremore common when patientsare placed in lithotomy.
3. May progressto permanent neurologicaldysfunction.
4. Are more common withglucose containing solutionsof local anaesthetics.
5. Rarelypersist longer than 1 month.

29. Ropivacaine:

1. Is an esterlocal anaesthetic agent.
2. Is licensedfor     

Multiple Choice Questions

Jet ventilation

1. High-frequency jet ventilation:

1. In comparison with standardmechanical ventilation causes alarger fall in cardiac output.
2. Is associated with smaller airway pressures compared to standardventilation.
3. Removes carbon dioxide efficiently at high frequencies.
4. Should be used for a limited time only.
5. Is the ventilatorymode of choice in an obstructed airway.

2. High-frequencyjet ventilation:

1. Requires intravenous anaesthesia.
2. Requiresa tracheal catheter to deliver gases.
3. Can onlyimprove arterialoxygen saturation by increasing theoxygenconcentration inthe jet gases.
4. Allows continuous CO₂ monitoringthrough aside-port in thejet cannula.
5. Is contraindicatedin children.

3. During high-frequency jet ventilation:

1. Hypothermia mayoccur.
2. Barotrauma may