Multiple Choice Questions

The prematurely born infant andanaesthesia

1. The premature infant:

(a) Is one born before 36 weeks gestational age.

(b) Is unlikely to present with problems associated with

prematurity if born after 35 weeks.

(c) Can be categorized by the post conceptional age and birth

weight.

(d) Has a thermoneutral temperature of 348C.

(e) Weighing 1200 g is categorized as VLBW.

2. Concerning preterm physiology:

(a) The extent of physiological immaturity is dependent on birth

weight.

(b) Babies born after 34 weeks gestational age are not prone to

bronchopulmonary dysplasia.

(c) Apnoea of less than 20 s duration is not significant.

(d) Hypoxia can lead to reversion to fetal circulation.

(e) Detection of hypoglycaemia is more important than the

detection of hyperglycaemia.

3. When anaesthetizing the preterm baby:

(a) Pressure controlled ventilation suits preterm lungs better than

volume controlled ventilation.

(b) Two pulse oximeters are beneficial only for babies with a

PDA.

(c) A baby with NEC should have a rapid sequence induction to

prevent aspiration.

(d) The tracheal length is 5 cm.

(e) A 3 mm tube should suffice for a preterm baby.

4. In the preterm baby:

(a) Gastro-oesophageal reflux contributes to respiratory problems.

(b) There is less sensitivity to pain due to underdeveloped pain

pathways.

(c) Paracetamol pharmacokinetics are unaltered by the gestational

age.

(d) At the ex-premature stage, anaemia should be corrected

before elective surgery to reduce the risk of postoperative

apnoea.

(e) At the ex-premature stage there is insufficient evidence

to support the routine use of spinal anaesthesia for

herniotomy.

Spinal cord stimulation and its anaestheticimplications

5. Mechanisms of action of spinal cord stimulators include:

(a) Stimulating GABA release.

(b) Stimulating lateral spinothalamic tracts.

(c) Stimulating nitric oxide release.

(d) Stimulating opioid release.

(e) Stimulating adenosine release.

6. In patients with an implanted pacemaker:

(a) Spinal cord stimulators can trigger pacemaker malfunction.

(b) Pacemakers should be in bipolar mode.

(c) Spinal cord stimulators should be in unipolar mode.

(d) Spinal cord stimulators are an absolute contraindication.

(e) Pacemakers can interfere with spinal cord stimulator function.

7. Indications for spinal cord stimulation include:

(a) Complex regional pain syndrome.

(b) Post-spinal cord transection pain.

(c) Failed back surgery syndrome.

(d) Post-amputation pain.

(e) Postoperative pain.

Cervical cord injury and critical care

8. The diaphragm:

(a) Contracts downwards increasing intrathoracic volume.

(b) Contracts more efficiently when its radius of curvature is large.

(c) Is supplied by nerve roots C2, C3 and C4.

(d) May be paced.

(e) Is impaired by flaccid abdominal muscles.

9. Lung volumes after cervical cord injury:

(a) Maximum reduction of FEV1 occurs immediately post injury.

(b) FVC continues to decrease after the initial insult.

(c) TLC is associated with the level of injury.

(d) An obstructive pattern is seen.

(e) Compliance is reduced in both the chest wall and the lungs.

10. The following are recognized complications of SCI:

(a) DVT in association with femoral venous lines.

(b) Increased gastric emptying.

(c) Poor thermal regulation.

(d) Aspiration pneumonia.

(e) Hypotension and hypertension.

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11. Sympathetic hyperreflexia:

(a) Is caused by over activity of the parasympathetic system.

(b) Is only triggered by specific stimuli such as urinary retention.

(c) Can manifest as malignant hypertension.

(d) Can cause arrhythmias.

(e) Is easy to treat.

12. Neurogenic Shock:

(a) Presents as bradycardia and hypotension after a SCI.

(b) May result in hypothermia.

(c) Responds only to fluid.

(d) Occurs with lesions above T4.

(e) Can alert clinicians to the presence of a spinal cord injury.

Severe community-acquired pneumonia

13. Regarding aetiology of CAP:

(a) Streptococcus pneumoniae is the most common cause.

(b) Legionella frequently affects younger people.

(c) Staphylococcus aureus pneumonia can occur as a complication

of influenza.

(d) Atypical pathogens are mainly extracellular.

(e) Haemophilus influenzae is most common in patients with

COPD.

14. Regarding treatment of CAP:

(a) Penicillin resistance to Streptococcus pneumoniae in the UK is

increasing.

(b) PVL – MRSA is resistant to vancomycin.

(c) Rifampicin is active against Legionella.

(d) Atypical pathogens are sensitive to beta lactam antibiotics.

(e) Vancomycin has a high soft tissue penetration.

15. The variables used for risk stratification using the pneumonia

severity index include:

(a) Age .65 years.

(b) Neoplasia.

(c) Haemoglobin less than 8 g dl21.

(d) Respiratory rate . 30 min21.

(e) Pleural effusion.

16. Regarding CURB-65 score:

(a) It is scored on the basis of core, additional and pre-existing

prognostic factors.

(b) Respiratory rate scores higher than hypotension.

(c) Hypoxaemia is a core adverse prognostic factor.

(d) Antibiotics should be considered if the score is .2.

(e) Score .3 mandates admission to the intensive care unit.

17. Regarding CAP:

(a) Empyema is a common cause of persistent pyrexia.

(b) ARDS can occur as a complication of severe CAP.

(c) Pneumococcal vaccination reduces mortality in high risk

patients.

(d) Serological testing is useful in the diagnosis of Legionella

infection.

(e) High CRP levels may be more specific marker than raised

temperature or white cell count.

Anaesthesia for transurethral resection ofthe prostate

18. In trans-urethral resection of the prostate (TURP) syndrome:

(a) The serum sodium should be normalized as rapidly as

possible.

(b) Intravenous magnesium may be helpful.

(c) It may present up to 12 hours postoperatively.

(d) The action of non-depolarizing neuromuscular blocking drugs

may be shortened.

(e) Patients with low serum sodium but normal serum osmolality

are likely to be asymptomatic.

19. Concerning glycine:

(a) A solution of 1.5% has an osmolality of 280 mosmol kg21.

(b) It is an essential amino acid.

(c) It is metabolized in the kidneys and liver by demethylation to

ammonia.

(d) It is an excitatory neurotransmitter in the retina.

(e) High plasma levels may cause seizures.

20. Concerning complications of transurethral resection of the

prostate (TURP):

(a) Warm irrigating solution causes vasodilation and may worsen

blood loss.

(b) Laser prostatectomy causes less haemorrhage than traditional

TURP.

(c) Ethanol may be added to the irrigating solution to aid esti-

mation of volume absorbed.

(d) Prostatic malignancy is associated with greater blood loss than

benign prostatic hyperplasia.

(e) Urokinase released from the prostatic bed may cause systemic

fibrinolysis.

21. Concerning anaesthetic technique for trans-urethral resection of

the prostate (TURP):

(a) Parasympathetic fibres supplying the prostate and prostatic

urethra arise from the vagus nerve.

(b) A spinal block to T5 is required to prevent discomfort from

peritoneal irritation during surgery.

(c) Penile erection may occur under light planes of general

anaesthesia.

(d) Spinal anaesthesia must be avoided in ischaemic heart disease.

(e) Postoperative pain is seldom severe enough to require systemic

opioids.

Perioperative myocardial protection

22. The following agents possess myocardial protective properties:

Multiple Choice Questions

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(a) Desflurane.

(b) Glibenclamide.

(c) Morphine.

(d) Xenon.

(e) Fentanyl.

23. The following are true:

(a) Hibernation is reversed by inotropes.

(b) Stunning is reversed by coronary revascularization.

(c) The smart heart demonstrates reduced activity whist it repays

its oxygen debt.

(d) Hibernation lasts for 2–3 hours following a brief ischaemic

episode.

(e) Stunning can be prevented by calcium channel blockers.

24. Concerning cardioplegia:

(a) The potassium concentration is approximately 30 mmol

litre21.

(b) May include glutamate.

(c) Retrograde cardioplegia is applied via the aortic root.

(d) Anterograde cardioplegia requires a patent aortic valve.

(e) Retrograde cardioplegia optimally protects the right ventricle.

25. Anaesthetic preconditioning:

(a) Involves inducing anaesthesia with thiopentone.

(b) Can cause coronary steal.

(c) Involves a brief episode of coronary artery occlusion.

(d) Causes opening of mitochondrial KATP channels.

(e) Reduces the production of reactive oxygen species during

reperfusion.

26. Concerning perioperative myocardial protection:

(a) Statins cause decreased platelet activity.

(b) High thoracic epidurals reduce mortality post CABG by

causing vasodilatation and attenuating the stress response.

(c) Dose of b-blocker should be titrated to achieve a heart rate of

70–80 beats min21.

(d) Mivazerol reduces overall mortality in vascular patients.

(e) Propofol exhibits antioxidant properties.

We no longer publish the answers to the MCQs in the journal. Instead, you are invited to take part in a web-based, self test. Visit the jour-

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Multiple Choice Questions

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