Multiple Choice Questions

Childhood obesity and the anaesthetist extraction. The most appropriate statements in this context
include:
1. Ideal body weight or lean body mass is most appropriately used
when calculating the dose of:
(a) The patient must be able to understand and respond pur-
(a) Succinylcholine. posefully to verbal commands, throughout the period of
(b) Propofol. sedation.
(c) Morphine. (b) The end point is maintenance of a purposeful response after
(d) Paracetamol. repeated or painful stimulation.
(e) Neostigmine/glycopyrrolate. (c) Sedation with either midazolam or nitrous oxide in oxygen is
unlikely to be associated with over-sedation if titrated to effect.
2. The most appropriate statements regarding body mass index (d) Sedative drugs are administered as a single bolus.
(BMI) in children include: (e) Systemic opioid analgesia is likely to be administered with
a benzodiazepine.
(a) Weight and height are the only measurements required to
6. A 75-yr-old man of ASA (American Society of Anesthesiologists)
calculate BMI.
III status is scheduled for colonoscopy under conscious sedation.
(b) Centile charts of weight and height will permit the assess-
The most appropriate statements regarding this procedure include:
ment of obesity.
(c) A BMI of 22 kg m22 is normal for a 5-yr-old. (a) After an initial dose of midazolam, an additional dose is
(d) A BMI of 22 kg m22 represents obesity in a 12-yr-old. recommended if analgesia is inadequate.
(e) Since obesity has become increasingly common, the defin- (b) Administration of a specific analgesic agent is likely to be
ition for BMI obesity has changed. needed for pain.
(c) If midazolam and fentanyl are administered, then fentanyl
3. Co-morbidities in children are most likely to:
should be given after the peak effect of midazolam is
(a) Occur in obese children and also overweight children. observed.
(b) Be as common as in obese adults. (d) If a combination of midazolam and opioid is used, then the
(c) Include asthma. doses of each drug should be reduced.
(d) Include gastro-oesophageal reflux disease. (e) Inhalational sedation using nitrous oxide in oxygen is used
(e) Include ischaemic heart disease. commonly.

4. The following investigations are most likely to be required in 7. The most appropriate statements regarding propofol for proced-
the obese child presenting for surgery: ural sedation include:

(a) As a sole agent propofol appears to provide excellent sed-

(a) Arterial pressure.
ation for the majority of patients, including those undergo-
(b) Blood glucose measurement.
ing a painful procedure.
(c) Arterial or capillary blood gases.
(b) Propofol is used effectively for prolonged upper and lower
(d) ECG.
gastrointestinal endoscopic procedures requiring deep
(e) Sleep studies.
sedation.
(c) Propofol is suited to both short and long procedural sedation
Procedural sedation for adult patients: an cases accompanied by the benefit of a rapid recovery profile.
overview (d) The difference in dose required to produce conscious sed-
5. You have been asked to administer conscious sedation to a ation and general anaesthesia is wide.
healthy, 25-yr-old female patient in the hospital’s outpatient (e) Synergistic effects occur when adjuvant drugs such as ben-
department. She has dental phobia and requires a simple dental zodiazepines and opioids are administered.
doi:10.1093/bjaceaccp/mks044 219
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 12 Number 4 2012
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Multiple Choice Questions

8. You are asked to provide sedation for a 35-yr-old man requiring (b) Useful topical therapies include 5% lidocaine plaster and
endoscopic retrograde cholangiopancreatography (ERCP) in the 8% capsaicin patch.
radiology department. The most appropriate statements regarding (c) Interventions such as sympathetic blocks and intrathecal
sedation for this patient include: steroids are first line treatments.
(d) Antidepressants do not have proven efficacy.
(a) Systemic analgesia is not required normally. (e) Opioids are as effective as antidepressants for PHN.
(b) Use of two or more drugs reduces the incidence of overdose
and respiratory depression.
Pre-hospital trauma care and aero-medical
(c) Loss of verbal communication necessitates the same level
transfer: a military perspective
of care as general anaesthesia.
(d) Supplemental oxygen may be administered to prevent 13. There are six casualties after an army Land Rover has been
hypoventilation. struck by a roadside bomb. The most appropriate statements con-
(e) Use of continuous waveform capnography to monitor ad- cerning priorities for treatment and evacuation include:
equacy of ventilation is recommended.
(a) Application of triage is confined to military operations.
(b) An individual patient will have their triage category
Post-herpetic neuralgia
re-assessed on several occasions.
9. The most appropriate pathophysiological features of post- (c) It is unethical to annotate the torso of these patients.
herpetic neuralgia (PHN) include: (d) Patients on a stretcher are classified as T1 (Triage category
1, requiring immediate treatment and evacuation).
(a) Damage involving small but not large diameter nerve fibres. (e) Apnoeic patients will receive Basic Life Support in this
(b) Continuous and paroxysmal pain. situation.
(c) Allodynia, which is normally associated with normal
thermal threshold. 14. An army vehicle has been struck by a roadside bomb. In a
(d) Hyperalgesia. soldier with high amputations of both legs, the most appropriate
(e) Profound sensory loss corresponding to the area of greatest statements concerning damage control resuscitation include:
pain.
(a) Damage control resuscitation describes a sequential package
10. The most appropriate statements concerning risk factors for of care.
PHN include: (b) Damage control resuscitation is commenced at the point of
wounding.
(a) Presence of prodrome increases the risk of developing PHN. (c) Once i.v. access is secured, 2 litre of Hartmann’s solution
(b) Severity of rash is unlikely to be an important risk factor. are administered during transfer to hospital.
(c) PHN is associated with old age. (d) Damage control resuscitation aims to correct the coagulopa-
(d) There is no gender preference for developing PHN. thy of trauma.
(e) Poor coping strategies are likely to increase the perception (e) Damage control resuscitation is completed before the com-
of pain. mencement of surgery.
11. The most appropriate statements concerning prevention of PHN 15. Intra-osseous access is:
include:
(a) Used safely in young children, but is unsuitable for resusci-
(a) Primary varicella vaccine decreases the incidence of tation in adults.
chicken pox but increases the risk of reactivation of shingles. (b) The route of last resort.
(b) Antiviral drugs reduce acute pain severity and duration. (c) Confined to the long bones.
(c) Addition of steroids to antiviral treatment does not prevent (d) Suitable for administration of crystalloids but not blood
PHN. products, which should be given intravenously.
(d) Anticonvulsants and antidepressants have no role in (e) Associated with a high incidence of long term morbidity.
prevention.
(e) Antiviral treatment should be given to all those who 16. A soldier has multiple injuries including bilateral above knee
develop herpes zoster. amputations, open book pelvic fractures, orbital fractures with air
12. The most appropriate statements regarding treatment of PHN in both globes and pneumocephalus. Following damage control
include: surgery, he remains anaesthetized and requires repatriation by air
for specialist tertiary treatment. The most appropriate statements
(a) Pregabalin is similar to gabapentin in efficacy. regarding this transfer include:

220 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 4 2012
 Multiple Choice Questions

(a) The patient is likely to be repatriated immediately after

surgery. (a) It is the ionized calcium concentration rather than total
(b) According to Charles’ law, intra-cranial gas will expand calcium concentration which influences physiological
with increasing altitude. effects.
(c) Compared with other remote settings, intensive care during (b) The normal value of ionized calcium is 2.12 –2.65 mmol
level flight is unlikely to be different. litre21.
(d) The physiological condition of the patient is likely to be (c) Calcitonin plays a major role in calcium homeostasis.
maintained in equilibrium by the transfer team. (d) Parathyroid hormone (PTH) regulates calcium absorption
(e) Prophylaxis of duodenal ulceration is unlikely to be required. from the gastrointestinal tract.
(e) The kidneys reabsorb 98–99% of filtered calcium.
Ultrasound in critical care
17. Typical echocardiographic features of massive pulmonary em- 22. The most appropriate statements concerning magnesium
bolism include: therapy include:

(a) Dilated right ventricle. (a) Magnesium reverses cerebral vasospasm.

(b) Dilated right pulmonary artery. (b) Magnesium decreases bleeding time.
(c) Paradoxical septal wall motion. (c) Respiratory muscle weakness is associated with
(d) Dilated right atrium. hypermagnesaemia.
(e) Collapsed inferior vena cava. (d) Magnesium increases uterine tone.
(e) Hypermagnesaemia is associated with hyporeflexia.
18. In the critical care setting, ultrasound is a useful imaging mo-
dality to: 23. The most appropriate statements regarding potassium include:

(a) Differentiate post-renal failure from other causes of renal failure. (a) Common cardiac arrhythmias associated with hypokalaemia
(b) Identify free intraperitoneal gas. include ventricular extrasystoles and atrial fibrillation.
(c) Assess a patient with a low Glasgow Coma Scale.
(b) 2% of potassium is in the extracellular fluid.
(d) Facilitate peripheral arterial or venous access. (c) Cellular uptake is stimulated by insulin.
(e) Reduce the need for seeking a specialist opinion. (d) Acidosis potentiates hypokalaemia.
19. In critical care setting, thoracic ultrasound: (e) The main reservoir of potassium is skeletal muscle.
24. Hypercalcaemia causes:
(a) Has limited use in differentiating lung pathologies because
an aerated lung causes multiple artefacts.
(a) Prolonged QT-interval.
(b) Is insensitive for the detection of small pleural effusions. (b) Anaemia.
(c) Is highly recommended before aspirating a pleural effusion.
(c) Shortened PR-interval.
(d) Is known to detect alveolar-interstitial syndrome. (d) Lethargy.
(e) Can only visualize a pneumothorax with the patient sitting (e) Peptic ulceration.
upright.

20. Level 1 training in ultrasound imaging is most likely to:

Care bundles in intensive care
(a) Include theoretical training. 25. A care bundle:
(b) Follow a curriculum.
(c) Be supervised by other Level 1 practitioners when they (a) Comprises 8– 10 evidence based interventions.
have gained experience of 6 months in ultrasound. (b) Assesses how well individual interventions are performed.
(d) Include performing 100 echo scans before being deemed (c) Does not permit any variation from the schedule.
competent. (d) Is a powerful audit tool.
(e) Include multiple forms of assessments. (e) Is comprised only of interventions with a high level of sup-
porting evidence.
Cations: potassium, calcium, 26. Care bundle use:
and magnesium
21. The most appropriate statements regarding calcium metabolism (a) Is uniform across the UK.
include: (b) Is uniform internationally.

Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 4 2012 221
Multiple Choice Questions

(c) Is subject to European Union (EU) directive. (d) Anaesthetic agents are potentially teratogenic.
(d) Is licensed by the Food and Drug Administration (FDA). (e) Neostigmine does not cross the placenta.
(e) Is subject to biennial review.
32. The most appropriate statements regarding regional anaesthesia
27. Care bundles are constructed: in pregnancy compared with regional anaesthesia in the non-
pregnant state include:
(a) From well-validated individual elements.
(b) From elements whose combined effect is known to be (a) Higher doses of intrathecal local anaesthetic are required.
additive. (b) Epidural loss of resistance is easier to detect.
(c) To apply primarily to nursing interventions. (c) The risk of local anaesthetic toxicity is reduced.
(d) To include both compulsory and optional elements. (d) Protein binding of local anaesthetics is increased.
(e) By government-appointed experts and opinion-leaders. (e) Sympathetic activity is reduced in pregnancy.
28. The sepsis care bundle:
Cellular oxygen utilization in health
(a) Includes guidance on appropriate antibiotics for Gram nega- and sepsis
tive sepsis.
(b) Includes guidance on the use of vasopressors. 33. Mitochondria are most likely to be involved in:
(c) Includes guidance on management of acute kidney injury.
(d) Specifies interventions to be completed in the first 72 h post (a) Apoptosis.
admission to hospital. (b) Oxidative phosphorylation.
(e) Allows clinical discretion regarding the use of activated (c) Glycolysis.
protein C. (d) Lipid metabolism.
(e) Steroid biosynthesis from cholesterol.

Anaesthesia for non-obstetric procedures 34. The proton motive force is most likely to be utilized in:
during pregnancy
(a) Heat production.
29. The most appropriate statements regarding fetal safety include: (b) Carnitine shuttle.
(c) Mitochondrial membrane transport.
(a) Maternal hypercapnia results in uterine vasodilation.
(d) ATP (Adenosine triphosphate) synthesis.
(b) Maternal hypocapnia causes a shift of the oxyhaemoglobin
(e) Diffusion of oxygen.
dissociation curve to the left.
(c) Tocolytic therapy is indicated if premature labour occurs. 35. The most appropriate cellular processes in sepsis include:
(d) There is an overall miscarriage rate of 20% for all surgery
during pregnancy. (a) Cytochrome C release from the inner mitochondrial
(e) Surgery that cannot be postponed until after delivery should membrane.
be carried out in the second trimester if possible. (b) Increased mitochondrial permeability.
(c) Nitric oxide synthase production.
30. The most appropriate statements regarding maternal physiology
(d) Increased oxygen utilization.
include:
(e) Increased reactive oxygen species.
(a) The normal range for PaCO2 during pregnancy is 3.7–4.2 kPa. 36. Antibiotics that have the potential to inhibit mitochondrial
(b) Epidural space volume is increased in pregnancy. function are most likely to include:
(c) Aortocaval compression occurs from 24 weeks.
(d) Lower oesophageal sphincter tone is reduced. (a) Ciprofloxacin.
(e) Increased minute ventilation leads to slower inhalational (b) Amoxycillin.
induction. (c) Tetracycline.
31. The most appropriate statements concerning anaesthetic agents (d) Chloramphenicol.
include: (e) Cefuroxime.

(a) Nitrous oxide exacerbates respiratory complications after Bone cement and the implications
extubating a patient with an oedematous airway. for anaesthesia
(b) Volatile anaesthetic agents increase uterine blood flow.
(c) Compared with the non-pregnant state, a lower dose of thio- 37. The most appropriate statements regarding bone cements
pentone may be required in pregnancy. include:

222 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 4 2012
 Multiple Choice Questions

(a) Intense heat is generated during the formation of bone cement. 39. Interventions which are likely to reduce the severity of bone
(b) Chemical binding occurs between the components of bone cement implantation syndrome (BCIS) include:
cement.
(c) Bone cements are radiolucent. (a) Thorough lavage of the intramedullary canal of the femoral
(d) Polymethyl methacrylate (PMMA) is the major constituent shaft.
of bone cement. (b) Performing uncemented hip arthroplasty in high risk
(e) Use of antibiotic laden bone cement affects the mechanical patients.
properties of the cement. (c) Maintenance of normothermia.
(d) Avoidance of hypovolaemia.
38. The most appropriate statements concerning bone cement im-
(e) Drilling of a venting hole during cemented hip
plantation syndrome (BCIS) include:
arthroplasties.

(a) BCIS is a well understood phenomenon. 40. The use of antibiotics in the bone cement is associated
(b) BCIS is associated with pulmonary hypertension and right with:
ventricular failure.
(c) General anaesthesia reduces the severity of BCIS. (a) Systemic toxicity.
(d) Cardiac output monitoring has no advantage over standard (b) Bone cement implantation syndrome.
haemodynamic monitoring in detection of haemodynamic (c) Allergic reactions.
changes during the pericementation period. (d) Hypotension.
(e) BCIS is an irreversible phenomenon. (e) Antibiotic resistance.

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Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 4 2012 223