Multiple Choice Questions - CEACCP

Multiple Choice Questions

Understanding vaporizers 1.

2.

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. The (a) (b) (c)

TEC-5 vaporizer: Is a temperature compensated vaporizer. Cannot be used for low-flow anaesthesia. 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 available, 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.

(d) (e)

Abnormalities are caused by mutations in a number of genes on chromosome 4. 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 ¼ 1.1–1.5 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.

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.

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.

doi:10.1093/bjaceaccp/mkr051 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 11 Number 6 2011 # The Author [2011]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]

Downloaded from https://academic.oup.com/bjaed/article-abstract/11/6/239/263910/Multiple-Choice-Questions by guest on 03 October 2017

239


(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 resuscitation guidance. (b) Be attempted in all victims regardless of immersion time. (c) Include maintenance of body temperature at 32 –348C. (d) Be associated with poor outcome when duration of cardiopulmonary resuscitation (CPR) exceeds 25 min. (e) Include passive methods for re-warming to at least 328C, at 0.5–18C 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 assessment of children 13. Cardiological evaluation of a child with a murmur is recommended 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.

240

15. A trainee discusses a child’s 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 lymphocytes 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 anaesthesia 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 respiratory 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 and young people 17. Chronic pain in children is most likely to: (a) Be recognized as a significant health problem in developed 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 administration 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.

Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 6 2011



(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 electrical 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 capacitance 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 ¼ 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) (e)

In a step-down transformer, the output power is greater than the input power. Isolation transformers are part of floating circuits.

Pus in the thorax: management of empyema 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 (a) (b) (c) (d) (e)

the presence of a lung abscess: A chest drain is usually required. Aspiration is a common feature. Anaerobic bacteria should be covered. Mycobacterium tuberculosis should be considered. Haemoptysis is rarely of clinical concern.

28. The following statements are most likely to be correct regarding 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 epidural 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 complications of diabetes mellitus:

Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 6 2011 Downloaded from https://academic.oup.com/bjaed/article-abstract/11/6/239/263910/Multiple-Choice-Questions by guest on 03 October 2017

241


(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.

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.

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.

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 (4–6 mmol litre21). (c) Resumption of oral hypoglycaemics soon after nongastrointestinal surgery. (d) Routine potassium supplementation in patients having minor, day-case surgery. (e) Placing a patient near the end of a theatre list.

We no longer publish the answers to the journal’s MCQs in the journal. Instead, you are invited to take part in a web-based, self test. Please visit the journal web site: www.ceaccp.oxfordjournals.org to obtain a certificate and CME points.

242

Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 6 2011
