Multiple Choice Questions - CEACCP

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(e) Characteristic findings in the Brown-Sequard syndrome are. Multiple Choice Questions. British Journal of Anaesthesia | CEPD Reviews | Volume 2 Number 5  ...
Multiple Choice Questions

85. The motor neurone: (a) Originates in the dorsal horn of the spinal cord. (b) Extends over a distance of up to 1 m. (c) Contains nodes of Ranvier which delay conduction. (d) Innervates only one muscle cell. (e) Nerve terminal is known as the motor end plate. 86. The acetylcholine receptor: (a) Lies in the pits of the postjunctional folds. (b) Consists of 6 subunits. (c) Two of the subunits are known as β and Ω. (d) In fetal life, a γ-subunit replaces the ε- subunit. (e) The ion channel of the receptor is 40 nm in diameter at its entrance. 87. Acetylcholinesterase: (a) Is attached to the muscle by thin stalks of collagen. (b) Lies mainly in the junctional clefts. (c) Destroys acetylcholine within 100 msec of its release. (d) Is synthesised by choline acetyltransferase. (e) Breaks down most of the acetylcholine at the neuromuscular junction before it reaches the nicotinic receptor. 88. Extrajunctional receptors: (a) Are the same as the fetal type of acetylcholine receptor. (b) Have a shorter half-life than junctional receptors. (c) Have a shorter opening time than junctional receptors. (d) Are present in normal active muscle. (e) Can be found anywhere on the muscle membrane. 89. In advanced obstruction from a perilaryngeal tumour: (a) The patient has difficulties in breathing at night. (b) Awake fibre-optic intubation should be performed. (c) It is not necessary to perform a CT scan. (d) Respiratory failure may occur. (e) An inhalation induction should be performed if the surgeon is inexperienced at doing a tracheostomy under local anaesthesia. 90. Fibre-optic nasendoscopy: (a) Involves spraying the vocal cords with local anaesthesia. (b) Is essential in the investigation of stridor. (c) Can be performed without local anaesthesia to the nose. (d) Is performed with a 4 mm diameter, 600 mm length fibrescope. (e) Predicts which patients will be easy to intubate. DOI 10.1093/bjacepd/02.05.157

91. During an inhalational induction for stridor: (a) If the patient stops breathing, ventilation should be assisted manually. (b) Sevoflurane always provides deep enough anaesthesia for laryngoscopy. (c) Under light anaesthesia, insertion of a nasopharyngeal airway is preferable to that of an oral airway. (d) Halothane may provide better conditions for intubation than sevoflurane. (e) In the event of failure to intubate, tracheostomy can be performed. 92. Awake fibre-optic intubation: (a) Is a potentially dangerous technique in advanced airway obstruction. (b) Can dislodge tumour or cause bleeding. (c) Allows better visualisation of abnormal anatomy than direct laryngoscopy. (d) Is an ideal technique for the patient with advanced laryngeal tumours. (e) requires a calm, co-operative patient. 93. In a patient with stridor from a retrosternal thyroid mass: (a) An inhalational induction is suitable because an emergency tracheostomy can be performed in the event of failure to intubate. (b) A CT scan will allow exact measurements of the site and dimensions of the tracheal compression. (c) In a patient with a thyroid carcinoma, it is usually possible to pass a larger tracheal tube than is suggested by the CT scan measurements. (d) Rapid sequence induction is contra-indicated. (e) A rigid bronchoscope should be available at induction of anaesthesia. 94. Regarding the neurological deficit in acute spinal cord injury: (a) The presence of good anal tone is an ominous sign. (b) The presence of priapism is an ominous sign. (c) In complete transection, the presenting lesion is a spastic paralysis. (d) The neurological level of the injury is described as the lowest segmental level that is functionally intact. (e) Characteristic findings in the Brown-Sequard syndrome are

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Multiple choice questions

ipsilateral upper motor neuron and dorsal column sensory deficits with a contralateral sensory deficit to pain and temperature. 95. In acute spinal cord injury, the following may be of benefit: (a) Hyperthermia. (b) Hydrocortisone 200 mg intravenously. (c) Hyperglycaemia. (d) Induced hypotension during surgery. (e) Hypercarbia during surgery. 96. Regarding respiratory function following acute spinal cord injury: (a) A patient with a lesion at C7 is likely to need immediate assisted ventilation. (b) Intercostal muscle spasticity improves respiratory function. (c) Accessory muscle function is lost with a lesion at C5. (d) Lung volumes are usually starting to improve by day 2. (e) Following surgery to stabilise the spine, respiratory function will improve if the patient with a high cervical injury is positioned semi-erect. 97. For a SCUBA diver breathing air at a depth of 40 m: (a) Ambient pressure is 4 ATA. (b) The density of the air breathed is 5 times greater than at the surface. (c) The diver’s lung volume will be less than at the surface. (d) CNS oxygen toxicity is likely to occur. (e) Nitrogen narcosis is likely to occur.

(e) Patients with decompression sickness should be evacuated by air to a specialist treatment centre. 100. Regarding the diagnosis of ventilator associated pneumonia: (a) The chest X-ray is highly specific. (b) Quantitative culture of secretions is required. (c) Blood cultures are useful for identifying responsible organisms. (d) All invasive diagnostic techniques rely on bronchoscopy. (e) It can be diagnosed using clinical criteria alone. 101. Ventilator-associated pneumonia is: (a) An uncommon nosocomial infection in the intensive care unit. (b) Commonly caused by anaerobic organisms. (c) Usually caused by haematogenous spread of organisms. (d) Associated with an increase in mortality. (e) More likely in patients with underlying lung disease. 102. Regarding the prevention of ventilator associated pneumonia: (a) Heavy sedation is beneficial. (b) Selective decontamination of the digestive tract (SDD) has no role. (c) Nasal intubation should be the preferred route of airway management. (d) Gastric stasis should be avoided. (e) Patients should be nursed in the semi-recumbent position.

98. A SCUBA diver who makes a rapid breath-hold ascent from 20 m may develop: (a) Decompression sickness. (b) Cerebral arterial gas embolism. (c) Ear ‘squeeze’. (d) High pressure nervous syndrome. (e) Pneumomediastinum.

103. Filter material can generally remove particles with a diameter of 0.02 µm more easily than particles with a diameter of 0.2 µm because they: (a) Have lower mass. (b) Have lower velocity. (c) Undergo greater Brownian motion. (d) Have a higher surface area to volume ratio. (e) Are more dense.

99. Regarding therapy of diving injuries: (a) Nitrogen narcosis should be treated by recompression. (b) Management and mechanism of cerebral arterial gas embolism and decompression illness are identical. (c) First aid for diving injuries should include administration of 100% surface oxygen. (d) Patients breathe 100% oxygen at ambient pressure for the duration of the recompression treatment.

104. In general terms, compared to a small breathing system filter, a large breathing system filter: (a) Has a greater resistance to gas flow. (b) Has a larger dead-space. (c) Has a better filtration performance. (d) Blocks more easily with expelled sputum. (e) Is more likely to affect triggering of ventilators.

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British Journal of Anaesthesia | CEPD Reviews | Volume 2 Number 5 2002

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