54. The following factors predispose to arrhythmias during anaesthesia for
dentistry: (a) Adenotonsillar hypertrophy. (b) I.V. induction. (c) Sevoflurane ...
Multiple Choice Questions
54.
The following factors predispose to arrhythmias during anaesthesia for dentistry:
(a) (b) (c) (d) (e)
Adenotonsillar hypertrophy. I.V. induction. Sevoflurane anaesthesia. Hypercarbia. Stimulation of the facial nerve.
55.
Conscious sedation:
(a) Is adequate once verbal contact with the patient is lost. (b) May be achieved via the trans-nasal route. (c) Is most safely achieved using a combination of two different drugs in order to achieve a synergistic effect. (d) May only be administered by an anaesthetist on the specialist register of the General Medical Council. (e) Should only be considered where general anaesthesia is contraindicated.
56. (a) (b) (c) (d) (e)
57.
(a) (b) (c) (d) (e)
58. (a) (b) (c) (d) (e)
59. (a) (b) (c) (d) (e)
60.
The following may increase the chance of aspiration under a general anaesthetic for dental extraction: The supine position. Placement of an oropharyngeal pack. The use of a gag or bite-block. Extreme patient anxiety. Recovery from anaesthesia in a head-up tilt position.
Dental extraction may be most appropriately performed under conscious sedation in the following patients: A patient with known allergy to local anaesthetic. A cooperative patient for extraction of four impacted wisdom teeth. An ASA class I young adult. A 3-yr-old child for extraction of a single tooth. A severely mentally handicapped adult.
Regarding syndromes associated with cleft lip and palate: In Treacher Collins syndrome, intubation gets easier as the child gets older. Cleft lip and palate usually occur in isolation. They may be familial. They include described chromosomal defects. They may necessitate other surgery before lip or palate repair.
Surgical repair of cleft lip and palate: Is essential to establish normal feeding. May cause significant postoperative pain. Is usually carried out in the neonatal period. Hardly ever requires revision. May lead to upper airway obstruction.
Patients with the Pierre Robin Sequence:
(a) May fail to thrive, owing to airway obstruction. (b) Rarely have clinically obvious airway obstruction. doi 10.1093/bjaceaccp/mki027
(c) Often require tracheostomy at birth. (d) Should be investigated for other anomalies. (e) Should not be given opioid analgesia postoperatively.
61.
Regarding patients with cleft lip and/or palate:
(a) Difficult airway is more common than a difficult laryngoscopy. (b) The incidence is approximately 1 in 1000. (c) The prone position may assist airway maintenance in upper airway obstruction. (d) A cleft palate is not reliably diagnosed antenatally. (e) Direct laryngoscopy is more difficult with a large left-sided alveolar cleft.
62.
Pain management programmes:
(a) Aim primarily to reduce the intensity of the pain that the patient feels. (b) May involve the patient’s family. (c) May be in-patient or out-patient based. (d) Usually involve increasing the patient’s analgesic medication. (e) Primarily rely on physical therapies to bring about behavioural change.
63.
People with chronic pain:
(a) May have fear of movement that exacerbates their disability. (b) Are generally very similar in terms of their pre-morbid coping strategies and personality. (c) Can commonly be managed successfully by a sole practitioner. (d) Need psychological assessment before entering a PMP. (e) Often benefit functionally from taking the opportunity to considerably increase their level of activity when symptoms are quiescent.
64.
Cognitive behavioural intervention for chronic pain patients:
(a) (b) (c) (d)
May go on for many years. Is a form of psychoanalysis. Is known to have lasting effects over many decades. Involves encouraging patients to challenge their beliefs about their condition. (e) Involves getting the patient to understand that emotions are not related to thoughts and behaviour.
65.
During a pain management programme:
(a) Educational sessions are usually delivered by a doctor and a physiotherapist. (b) Patients are introduced to a graded exercise programme. (c) ‘Pacing’ involves activity level being predicted by pain intensity. (d) Patients are encouraged to regularly visit their GP or hospital doctor for advice. (e) Patients are discouraged from planning ahead for possible exacerbations in pain because it may depress their mood.
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 3 2005 ª The Board of Management and Trustees of the British Journal of Anaesthesia [2005]. All rights reserved. For Permissions, please email:
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101
Multiple Choice Questions
66.
The distending pressure of the left ventricle will not be accurately represented by pulmonary artery occlusion pressure (PAOP) under the following conditions:
(a) A ventilator delivers a peak airway pressure of 30 cm H2O, and PEEP of 10 cm H2O, inducing a respiratory swing on the PAOP trace equivalent to 13 cm H2O. (b) The pressure on the surface of the cardiac fossa is the same as atmospheric pressure. (c) A fluid challenge increases PAOP but not left ventricular end-diastolic volume. (d) A fluid challenge increase left ventricular end-diastolic volume but not PAOP. (e) The peak pressure gradient across the mitral valve during diastole is >10 mm Hg.
67.
Left ventricular stroke work derived from pulmonary artery catheter data:
(a) Represents the work done by the ventricle. (b) Will more accurately represent work done by the left ventricle after the patient has received a b-adrenergic receptor antagonist. (c) Will more accurately represent work done by the left ventricle after the patient’s SVR and blood pressure decrease by half and the cardiac output has doubled during development of sepsis. (d) Will remain as accurate if diastolic compliance changes. (e) Will remain as accurate if the rate of initial myocardial relaxation at the beginning of diastole decreases.
68.
A patient with septic shock and acute lung injury requires a norepinephrine infusion at a rate of 0.7 mg kg 1 min 1 and is ventilated with PEEP of 15 cm H2O.
(a) A radial arterial line will accurately reflect renal perfusion pressure. (b) The central venous pressure will assist assessment of preload. (c) Optimal tissue perfusion will not be achieved unless systemic vascular resistance is maintained within normal limits. (d) Myocardial hypertrophy lowers preload. (e) Decreasing airway pressure increases afterload.
69.
Regarding correct placement of pulmonary artery catheters:
(d) ACE inhibitors should be continued in the perioperative period. (e) Hypertension is an indication for perioperative b-blockade.
72.
Regarding preoperative testing:
(a) Dobutamine exercise stress testing is the non-invasive test of choice. (b) Surgery should be delayed for at least 4--6 weeks after coronary angiography. (c) Surgery should be delayed for 6 weeks after CABG. (d) Diabetes is considered to be a major factor in clinical prediction of risk. (e) Age >70 yr is considered to be a significant factor during risk assessment.
73. (a) (b) (c) (d) (e)
74.
The following structures pass through the superior orbital fissure: Second cranial nerve. Fourth cranial nerve. Sixth cranial nerve. Ophthalmic artery. Superior ophthalmic vein.
With respect to local anaesthesia for intra-ocular surgery:
(a) Five centimetre needles are in common use. (b) Severe chronic obstructive pulmonary disease can be a contraindication. (c) The superonasal region of the orbit is relatively avascular. (d) Raised intra-ocular pressure leads to doming of the vitreous into the anterior chamber. (e) The maximum pressure for a Honan balloon is 40 mm Hg.
75.
The following enhance the safety of local anaesthesia:
(a) Asking the patient to look upwards and away from an inferotemporal needle. (b) Using short needles. (c) Retrobulbar intraconal injection. (d) Facilities available for resuscitation. (e) The bevel of the needle facing away from the globe.
76.
The following statements are true:
(a) Once correctly placed in West zone III, only physical displacement can result in the tip occupying West zone II. (b) Correct placement can be confirmed with a lateral chest x-ray. (c) Increasing PEEP may result in West zone III becoming smaller. (d) Left ventricular failure will tend to increase West zone III. (e) Hypovolaemia will tend to decrease West zone III.
(a) A The depth from the orbital rim to the optic foramen is around 50 mm. (b) The lateral orbital walls are parallel with each other. (c) The axis of the orbit is parallel to the axis of the eye. (d) Tenon’s capsule is a relatively thick membrane. (e) The rectus muscles penetrate Tenon’s capsule.
70.
77.
Acute lower limb ischaemia:
(a) (b) (c) (d)
Should be treated with high-dose low-molecular weight heparin. Requires surgery within 6 h. Is associated with a 30-day mortality >30%. Carries greater perioperative risk than chronic critical limb ischaemia. (e) Is always attributable to peripheral vascular disease.
71.
The sensory nerves to the globe pass within the cone. Cranial nerves IV and VI pass intraconally. The long and short ciliary nerves enter the orbit via the inferior orbital fissure. The inferior orbital vein passes through the inferior orbital fissure to drain into the cavernous sinus. (e) Inadvertent injection of local anaesthetic into the inferior orbital vein can cause cardiorespiratory collapse.
Regarding perioperative drug therapy:
(a) b-Blockers should be given to all patients. (b) b-Blockers should be titrated to achieve a heart rate
