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Multiple Choice Questions
Understanding vaporizers
1. Desflurane:
(a) Has a higher saturated vapour pressure than isoflurane
at
room temperature.
(b) Is delivered via a variable bypass flow system.
(c) Has a higher boiling point than isoflurane.
(d) Is delivered with a lower partial pressure at high
altitude
than at sea level.
(e) Has to be cooled in its vaporizer owing to its low
boiling
point.
2. The TEC-5 vaporizer:
(a) Is a temperature compensated vaporizer.
(b) Cannot be used for low-flow anaesthesia.
(c) Delivers a % concentration of volatile agent that varies
with changes in atmospheric pressure.
(d) Contains a measured flow system.
(e) Delivers a volatile agent at a partial pressure which
varies
with alterations in atmospheric pressure.
3. On an anaesthetic machine two plenum vaporizers are
avail-
able, each containing either isoflurane or sevoflurane. When
used
separately during anaesthesia, their vapour concentration is
mostly
likely to be dependent on:
(a) Changes in atmospheric pressure.
(b) Fresh gas flow rate.
(c) Minute ventilation.
(d) Differences in latent heat of vaporization.
(e) Specific gravity of the liquid.
4. Saturated vapour pressure:
(a) Is the pressure of a vapour in equilibrium with its
liquid.
(b) Of isoflurane is about 236 mm Hg at 208C.(c) Increases as
temperature of liquid decreases.
(d) Decreases as ambient pressure decreases.
(e) Equals atmospheric pressure when a liquid boils.
Cystic fibrosis and anaesthesia
5. The cystic fibrosis (CF) transmembrane regulator protein
is
related to the following statements:
(a) It has a chloride channel.
(b) It is found on the basement membrane of epithelial
cells.
(c) There is production of less viscid secretions.
(d) Abnormalities are caused by mutations in a number of
genes on chromosome 4.
(e) There is production of an increased volume of
secretions.
6. Anaesthetic management of patients with cystic fibrosis
(CF)
is mostly likely to include:
(a) Cardiopulmonary exercise tests in all patients before
elective surgery.
(b) Use of desflurane, which acts rapidly.
(c) Postoperative ventilation when FEV1 1.11.5 litre.(d)
Echocardiography to look for pulmonary hypertension.
(e) Resumption of physical therapy on the day of surgery.
7. The following statements are most likely to be appropriate
in
patients with CF:
(a) Newer airway clearance devices provide superior physical
therapy than conventional techniques.
(b) Nebulized antibiotics are equivalent to i.v. for
Pseudomonas eradication.
(c) 50% of patients will require pancreatic enzyme
replacement.
(d) 20% of patients will require surgery for nasal disease.
(e) Enteral nutritional replacement cannot bring most
patients
to within guideline recommendations for nutritional
intake.
8. The following statements are most likely to be
appropriate
regarding non-pulmonary manifestations of CF:
(a) CF-related diabetes is the commonest non-pulmonary
manifestation of CF.
(b) CF-related diabetes is strongly associated with exocrine
pancreatic dysfunction.
(c) Patients with CF-related diabetes often have superior
lung
function to those without pancreatic disease.
(d) Meconium ileus occurs in approximately 50% of
neonates with CF.
(e) The aetiology of osteoporosis in these patients relates
to
poor nutrition.
Drowning
9. Drowning is most likely to:
(a) Be the commonest cause of unintentional death
worldwide.
(b) Be more prevalent in males than females, in the UK.
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(c) Be more common in affluent countries than in countries
in which income per capita is low.
(d) Be associated with laryngospasm when there is prior loss
of consciousness.
(e) Cause cardiac arrest via hypoxia and acidosis.
10. Resuscitation of an apnoeic and pulseless victim of
drowning
is most likely to:
(a) Begin with chest compressions when following resuscita-
tion guidance.
(b) Be attempted in all victims regardless of immersion
time.
(c) Include maintenance of body temperature at 32348C.(d) Be
associated with poor outcome when duration of car-
diopulmonary resuscitation (CPR) exceeds 25 min.
(e) Include passive methods for re-warming to at least 328C,at
0.518C h21.
11. Pulmonary injury associated with drowning is most likely
to:
(a) Be less severe after saltwater immersion than freshwater
immersion.
(b) Include prophylactic antibiotic therapy after freshwater
immersion.
(c) Include corticosteroids.
(d) Exclude extracorporeal membrane oxygenation and high
frequency oscillation ECMO.
(e) Lead to a systemic inflammatory response.
12. The following factors are most likely to be associated
with
poor outcome after drowning:
(a) Warm water immersion.
(b) Immersion for longer than 5 min.
(c) Core body temperature of .348C at presentation.(d) Time to
effective resuscitation of .10 min.
(e) Duration of resuscitation ,25 min.
Dilemmas in the preoperative assessmentof children
13. Cardiological evaluation of a child with a murmur is
recom-
mended when the child:
(a) Is an infant.
(b) Has an ECG that shows an R-wave in V6. 4 mV.
(c) Has a congenital syndrome.
(d) Is asymptomatic and has no other history.
(e) Has a family history of sudden death.
14. According to recent National Institute for Health and
Clinical Excellence (NICE) guidelines, the following cardiac
lesions are associated with a high risk of developing
infective
endocarditis:
(a) Isolated atrial septal defect.
(b) Prosthetic aortic valve.
(c) Hypertrophic cardiomyopathy.
(d) Fully repaired patent ductus arteriosus.
(e) Palliative surgical correction of Tetralogy of Fallot.
15. A trainee discusses a childs immunization status with a
senior anaesthetist. The following statements are most
likely:
(a) Immunomodulatory effects of anaesthesia are permanent.
(b) Lymphopenia may represent the redistribution of lympho-
cytes to the site of trauma.
(c) Postpone immunization by 2 months in a child scheduled
for elective surgery.
(d) A delay of 48 h between inactivated vaccine and anaes-
thesia may be useful.
(e) Do not administer any vaccine in a child scheduled for
anaesthesia.
16. In children with upper respiratory tract infection (URTI),
the
following are most likely to be risk factors for perioperative
re-
spiratory complications:
(a) Parental smoking.
(b) Use of endotracheal tube.
(c) Parental denial of child having a cold.
(d) Age ,1 yr.
(e) A history of snoring.
Chronic pain problems in children andyoung people
17. Chronic pain in children is most likely to:
(a) Be recognized as a significant health problem in devel-
oped countries.
(b) Be attributable mainly to psychological factors.
(c) Be more frequent in adolescent girls than boys.
(d) Respond well to nerve blocks.
(e) Lead to defined patterns of co-morbidity.
18. Childhood neuropathic pain is most likely to:
(a) Occur in children of at least 5 yr of age.
(b) Be associated with nerve injury rather than nerve
dysfunction.
(c) Have a poor prognosis when compared with neuropathic
pain in adults.
(d) Be associated with joint hypermobility.
(e) Be implicated when there is a history of surgery and ad-
ministration of cytotoxic drugs.
19. Complex regional pain syndrome is most likely to:
(a) Occur after physical trauma.
(b) Occur in teenage girls.
(c) Require urgent referral for physiotherapy.
(d) Affect the upper and lower limbs with equal frequency.
(e) Be difficult to manage successfully when there is a
relapse.
20. Management of chronic pain in children is most likely to
adhere to the following principles:
(a) Recent onset headache is managed mainly with simple
analgesics.
(b) Migraine in childhood is similar to that in adults.
Multiple Choice Questions
240 Continuing Education in Anaesthesia, Critical Care &
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(c) Functional abdominal pain (FAP) responds to peppermint
oil supplements.
(d) Stresses of daily life can lead to increased symptoms
associated with inflammatory bowel disease.
(e) Adjunctive pain treatments in palliative care comprise
diazepam, anti-emetics, anti-epileptics and
anticonvulsants.
Basics of electricity for anaesthetists
21. The following statements are correct regarding basic
electric-
al quantities and units:
(a) The coulomb is a unit of electrical charge equivalent to
6.24 x 1018 electrons.
(b) The coulomb is a base SI unit.
(c) A 3 kW electrical appliance (running on UK mains
voltage) would require a 5 amp fuse.
(d) The definition of 1 ampere is the flow of one coulomb of
charge per second through any cross-section of the
conductor.
(e) The resistance of a conductor is a constant value that
is
not influenced by other factors.
22. The following statements are correct regarding capacitors
and
their capacitance:
(a) Capacitors used in defibrillators typically have a
capaci-
tance of 1 farad.(b) Increasing the distance between the plates
of a capacitor
increases its capacitance.
(c) The introduction of a dielectric between the plates
increases the capacitance.
(d) The stored energy of a capacitor is given by the
formula:
E 12QV2.
(e) Capacitors can be directly charged using alternating
current.
23. Concerning impedance and reactance in an electrical
circuit:
(a) High frequency AC currents pass more easily through
capacitors than inductors.
(b) The change in magnetic field surrounding an inductor
when a current is applied tends to promote further current
flow through the inductor.
(c) Inductive reactance (XL) is small at low frequencies and
large at high frequencies.
(d) An inductor is used to smooth the output waveform of a
defibrillator.
(e) The unit of impedance in the Henry.
24. Regarding transformers:
(a) Transformers are based on the principles of conductance.
(b) In a step-up transformer, the voltage across the
secondary
coil is greater than the voltage across the primary coil.
(c) In a step-down transformer, there are few turns on the
primary coil than the secondary coil.
(d) In a step-down transformer, the output power is greater
than the input power.
(e) Isolation transformers are part of floating circuits.
Pus in the thorax: management ofempyema and lung abscess
25. The following factors are mostly likely to be consistent
with
pleural infection:
(a) Pneumonia with ongoing fever after 3 days of
antibiotics.
(b) Septations on thoracic ultrasound scanning.
(c) Blood stained pleural fluid.
(d) A pleural effusion .50% of the hemithorax.
(e) Pleural pH of 7.1.
26. The following statements are most likely to be
appropriate
regarding anaesthesia for thoracic surgery:
(a) Pulmonary function tests are mandatory prior to
decortication.
(b) Lung isolation must occur before mechanical positive
pressure ventilation in the presence of a broncho-pleural
fistula.
(c) After thoracotomy, nociception is high.
(d) Airway control should be achieved by a single lumen
tube during drainage of a lung abscess via video-assisted
thoracoscopy.
(e) After radical decortication, paravertebral block cannot
be
provided.
27. In the presence of a lung abscess:
(a) A chest drain is usually required.
(b) Aspiration is a common feature.
(c) Anaerobic bacteria should be covered.
(d) Mycobacterium tuberculosis should be considered.
(e) Haemoptysis is rarely of clinical concern.
28. The following statements are most likely to be correct
regard-
ing analgesia after thoracotomy:
(a) Paravertebral block is less likely to cause hypotension
than epidural block.
(b) Urinary catheterization is required after epidural
blockade.
(c) Peak expiratory flow is expected to be higher after epi-
dural block than after paravertebral block.
(d) Patient-controlled analgesia should not be used in
patients who receive paravertebral blockade.
(e) Intercostal blocks combined with intravenous opioids via
a patient-controlled analgesic device are a reasonable
option when epidural analgesia is contraindicated.
Diabetes and adult surgical inpatients
29. The following statements are most appropriate to the
compli-
cations of diabetes mellitus:
Multiple Choice Questions
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(a) Obesity is a risk factor for complications.
(b) Diabetic nephropathy is uncommon.
(c) Diabetic retinopathy is a cause of blindness.
(d) Diabetic neuropathy commonly presents as lower limb
weakness.
(e) An active lifestyle reduces the risk of complications of
diabetes.
30. The following statements are most likely to be relevant
to
drug treatment for diabetes mellitus:
(a) The ideal insulin dosage is twice daily and not more
frequently.
(b) Slow- and rapid-release preparations of insulin should
be
administered together.
(c) Rosiglitazone is recommended for management of type 2
diabetics.
(d) DPP-4 inhibitors such as saxagliptin should be
co-administered with other drugs.
(e) Insulin should be administered immediately after meals.
31. In patients with diabetes mellitus, the following
assessments
are most likely to be appropriate in the perioperative
period:
(a) HbA1C.
(b) Creatinine concentration.
(c) Absence of heart rate variability.
(d) Stiff joint syndrome.
(e) The feasibility of regional anaesthesia.
32. The principles of metabolic management in surgical,
diabetic
patients are most likely to include:
(a) Early resumption of oral intake after day surgery.
(b) Tight control of serum glucose concentration (46 mmol
litre21).
(c) Resumption of oral hypoglycaemics soon after non-
gastrointestinal surgery.
(d) Routine potassium supplementation in patients having
minor, day-case surgery.
(e) Placing a patient near the end of a theatre list.
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