(a) Anaesthesia narrows the upper airway by decreasing tone in thyrohyoid. (b)
Topical anaesthesia decreases upper airway resistance. (c) Alcohol increases ...
Multiple Choice Questions
17. Features of the respiratory centres include: (a) The main respiratory centres are in the medulla. (b) The dorsal area of the medulla discharges mainly on expiration. (c) The respiratory centres dilate the pharynx during the inspiratory phase. (d) The Boetzinger complex is expiratory. (e) The pons sets the lung volume at which inspiration is terminated. 18. The ventilatory response to changes in blood gases: (a) Includes a profound increase in central chemoreceptor activity to hypoxaemia. (b) Includes a linear response to increasing hypoxaemia. (c) Includes very high values of PaCO2 depressing ventilation. (d) Is reduced during non-REM sleep compared with wakefulness. 19. With respect to the effect of anaesthesia on the airways: (a) Anaesthesia narrows the upper airway by decreasing tone in thyrohyoid. (b) Topical anaesthesia decreases upper airway resistance. (c) Alcohol increases airway resistance. (d) Ketamine increases lower airway resistance. (e) Diaphragmatic recovery from neuromuscular blockade may precede recovery of the upper airway. 20. With respect to the respiratory muscles: (a) They are involved in the maintenance of posture. (b) They may be weakened by the action of anaesthetic agents, leading to a fall in FRC of 200–500 ml in adults over the first 40 s after induction. (c) Changes in chest wall tone reduce airways resistance during anaesthesia. (d) Expiratory contractions may spontaneously occur during anaesthesia. 21. V/Q mismatch during anaesthesia: (a) Leads to an increased spread of V/Q mismatch. (b) Is reduced during IPPV in normal subjects compared with the awake state. (c) Leads to a shunt fraction of 14% during a spontaneously breathing anaesthetic.
60
(d) Is diminished by adding PEEP to the lungs during anaesthesia. (e) Occurs during ketamine anaesthesia when combined with IPPV and paralysis. 22. Heat and moisture exchangers are contra-indicated when patients have: (a) (b) (c) (d) (e)
Copious secretions. Hypothermia. Hyperthermia. Tenacious sputum. Active chest infection.
23. According to the International Standard BS EN ISO 9360-1:2000, the humidity output of heat and moisture exchangers must be: (a) (b) (c) (d)
At least 30 g m–3. At least 100% RH at 34°C. At least 75% RH at 37°C. Declared by the manufacturer.
24. According to the International Standard BS EN ISO 8185:1998, the humidity output of medical humidifiers must be: (a) At least 33 g m–3 when used with patients whose upper airways have been bypassed. (b) At least the equivalent of 75% RH at 37°C when used with patients whose upper airways have been bypassed. (c) 100% RH at 37°C. (d) Declared by the manufacturer. 25. The following are known to be associated with a difficult airway: (a) (b) (c) (d) (e)
Acromegally. Down’s syndrome. A Wilson score of 1. Ludwig’s angina. Myasthenia gravis.
26. The following predicts a difficult laryngoscopy: (a) Absence of a Delilken sign. (b) Patel distance of 8 cm. (c) Wilson score of 6. (d) Savva distance of 13 cm. (e) Obesity.
27. NSAIDs (COX-1 and COX-2 inhibitors) are contraindicated in: (a) (b) (c) (d) (e)
Chronic renal failure. Asthma. Chronic obstructive airways disease. History of peptic ulcers. History of allergy to aspirin.
33. Treatment of renal failure secondary to raised intraabdominal pressure includes:
28. The analgesic: (a) (b) (c) (d)
Codeine is metabolised to morphine in the liver. Codeine can be given safely with NSAIDs. Piroxicam has a high activity for the COX-1 enzyme. Paracetamol can be given in a dose of 15 mg kg–1, 6-hourly in children. (e) Tramadol acts only at opioid receptors. 29. Which of the following are true: (a) The maximum dose of bupivacaine in a 70 kg patient is 120 mg. (b) 20 ml of 0.25% bupivacaine contains 50 mg of the drug. (c) A VAS score of 4–5 cm is generally accepted as indicating acceptable analgesia. (d) Oxycodone is antagonised by naloxone. (e) NSAIDs should be avoided in children. 30. Recent statistics for fracture of the hip show that: (a) (b) (c) (d)
(c) Decrease the time to administration of first dose of intramuscular opiate. (d) Reduce the total number of intramuscular injections in the first 24 h postoperatively.
60% occur in females. The mean age at diagnosis is 80 years. Mortality is less than 5%. the mean length of hospital stay is 21 days.
36. A similar cardiovascular picture to that of abdominal compartment syndrome is produced by:
31. Regional anaesthesia for hip fracture: (a) Has been shown to reduce mortality at 6 months. (b) Reduces the incidence of postoperative deep vein thrombosis. (c) Reduces the overall incidence of postoperative pulmonary embolism. (d) Does not effect overall operating time. 32. Triple nerve block and lateral cutaneous nerve block when combined with general anaesthesia for hip fracture surgery: (a) Have not been shown to reduce the length of overall hospital stay. (b) Have been shown to reduce the overall rate of postoperative complications.
(a) Haemorrhagic shock. (b) Constrictive pericarditis. (c) Sepsis. (d) Tension pneumothorax. (e) Anaphylaxis 37. Concerning abdominal decompression syndrome: (a) Aggressive fluid loading reduces its severity. (b) Its development may lead to cardiac arrest. (c) Effective management may require more than one anaesthetist. (d) The cardiovascular effects are due to the sudden change from a low to a high systemic vascular resistance. (e) It does not develop following pretreatment with mannitol.
British Journal of Anaesthesia | CEPD Reviews | Volume 1 Number 2 2001
61
Multiple choice questions
Multiple Choice Answers reduced during anaesthesia causing a rapid fall in lung volume, (c) reduced stretch on the airways and hence increased airway resistance. (d) Volatile agents may produce active abdominal muscle contraction during anaesthesia.
17. Features of the respiratory centres include: (a) True; (b) False; (c) True; (d) True; (e) True (a) The respiratory centres lie in the medulla and pons, with the predominant control in the medulla. (b) The medulla can be divided into a dorsal part, which is mainly inspiratory and (c) a ventral area, which contains some inspiratory neurons that also dilate the pharynx, but is predominantly expiratory, (d) including the Botzinger complex. (e) The pons adjusts the respiratory rhythm, including setting the lung volume at which inspiration is terminated.
21. V/Q mismatch during anaesthesia (a) True; (b) False; (c) True; (d) True; (e) True (a) V/Q mismatch occurs more frequently during anaesthesia leading to a spread of V/Q ratios, (b) compared to the awake state. (c) This produces a shunt fraction of 1% awake, 11% during a spontaneously breathing anaesthetic and 14% during IPPV. (d) The fall in lung volume leads to increased airway collapse, which may be improved by PEEP. (e) Ketamine produces little V/Q mismatch during spontaneously breathing anaesthesia, but this is not the case during IPPV.
18. The ventilatory response to changes in blood gases (a) False; (b) False; (c) True; (d) True (a) Central chemoreceptors are predominantly influenced by changes in blood PaCO2 and pH. (b) Peripheral chemoreceptors are very sensitive to hypoxaemia with a rapidly rising (non-linear) response to PaO2
