Multiple Choice Questions

1. Regarding general anaesthetic activity:

(a) The activity of general anaesthetics can be easily deduced from their chemical structure. (b) Unitary theories of general anaesthetic action dominate the current literature. (c) Most general anaesthetics display a high oil:water partition coefficient. (d) Neuronal cell membranes are composed of a homogenous mixture of lipid and protein. (e) Some general anaesthetics display stereoselective activity.

6. The time that elapses between aneurysm formation and rupture is associated with:
(a) (b) (c) (d) (e) Aneurysm size. Hypertension. Smoking. Age. Acute pain.

2. On possible targets of general anaesthetics:

(a) Transmitter-gated ion channels are the only targets for general anaesthetic agents. (b) Transmitter-gated ion channels mediate the majority of fast excitatory and inhibitory neurotransmission within the CNS. (c) 5-HT3 and nicotinic acetylcholine (nAch) receptors usually inhibit the activity of CNS neurones. (d) GABAA and strychnine-sensitive glycine receptors inhibit the activity of CNS neurones. (e) GABAB receptors are considered important targets for general anaesthetics.

7. Complications after thoracic aortic cross-clamp for repair of descending aortic aneurysm include:
(a) (b) (c) (d) (e) Paraplegia. Myocardial ischaemia. Renal failure. Hepatic failure. Left ventricular overload.

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8. The following are the haemodynamic effects of aortic cross-clamping:

(a) (b) (c) (d) (e) Decrease cardiac output. Decreased CVP. Few changes in patients with good collaterals. _ O2 because of anaerobic metabolism distal to the clamp. Increased V Increased afterload of left ventricle causing cardiac problems.

3. Concerning GABAA receptors:

(a) GABA is synthesized after the enzymatic conversion of the excitatory amino acid glutamate. (b) GABAA receptors are composed of five subunits concentrically arranged around an ion channel pore. (c) GABAA receptors are permeable to mainly chloride ions. (d) To date, 18 mammalian GABAA receptor subunits have been cloned. (e) GABAA receptors are widely expressed throughout the central nervous system.

9. Hypotension after unclamping the thoracic aorta during AAA repair is a result of:
(a) (b) (c) (d) (e) Myocardial depression from washout of metabolites. Pooling of blood in the periphery because of sequestration. Citrate intoxication. Acute blood loss. Reactive hyperaemia.

4. In vitro studies:
(a) General anaesthetics compete with GABA at GABA binding sites on GABAA receptors. (b) General anaesthetics bind at distinct sites on GABAA receptors to enhance the action of GABA. (c) General anaesthetics are inactive in the absence of GABA. (d) Mutating a single amino acid within the GABAA receptor a subunit alters volatile and i.v. anaesthetic activity equally. (e) Four amino acids located in the transmembrane regions of the a subunit may contribute towards an anaesthetic binding pocket for volatile general anaesthetic agents.

10.
(a) (b) (c) (d)

OPCAB surgery:

reduces requirement for blood and blood products. protects against end-organ damage. requires the services of a perfusionist. is associated with coronary steal with isoflurane and its use should be avoided. (e) has proven long-term benefits.

11.

In monitoring a patient during OPCAB surgery:

5. In vivo studies:
(a) Knock-in mice harbour amino acid mutations within their genome. (b) Knock-in technology is associated with relatively few phenotypical changes. (c) The anaesthetic effects of etomidate are mediated by b3-containing GABAA receptors. (d) The sedative effects of etomidate are mediated by the b2-containing GABAA receptors. (e) Certain clinical features of benzodiazepine are mediated by GABAA receptors containing various a subtypes.

(a) a pulmonary artery catheter (PAC) is mandatory. (b) ischaemic changes are impossible to detect using an ECG. (c) transoesophageal echocardiography (TOE) has no value due to the position of the heart during OPCAB. (d) a reduction in SvO2 is caused by a reduction in cardiac output. (e) pulmonary artery pressures are not affected by the position of the heart.

12.

Haemodynamic changes during OPCAB surgery are:

(a) caused by an increased venous return due to the use of the Trendelenburg position.
doi:10.1093/bjaceaccp/mkl010

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Multiple Choice Questions

(b) reduced by opening the right pleural cavity. (c) a consequence of blood having to flow upwards into the ventricle. (d) the surgeons responsibility to manage. (e) reduced if MAP is maintained >70 mm Hg.

(d) Bilateral neck dissection is a risk factor. (e) Vessels supplying the posterior part of the optic nerve are subject to autoregulatory control while mean arterial pressure remains between 50 and 150 mm Hg.

19.
(a) (b) (c) (d)

During airway management:

13.
(a) (b) (c) (d) (e)

Local anaesthetic toxicity in neonates is attributable to the following:

Hepatic enzyme systems are immature for the first 3 months after birth. Local anaesthetics have a short plasma half life in neonates. The permeability of blood-brain barrier to local anaesthetics is reduced. Increased binding of local anaesthetics to plasma proteins. The larger volume of distribution of local anaesthetics prevents accumulation.

Oral injuries occur during 1 in every 100 anaesthetics. Injuries which occur are always minor and non life-threatening. Teeth are most commonly damaged in patients aged 5070 yr. Tracheal rupture may occur by over-inflation of the tracheal tube cuff. (e) Surgical emphysema may be the result of intubation-related injury.

14.

Regarding the anatomy of the lumbarsacral spine:

20.
(a) (b) (c) (d) (e)

(a) An imaginary line drawn between the two superior iliac crests (the intercristal line) is above the lower level of the spinal cord at any age. (b) The depth of the epidural space from the surface is best estimated using the formulae age weight 0.1 mm kg1. (c) The sacral hiatus is formed from the failed fusion of the 2nd to 4th posterior sacral arches. (d) The spinal cord can extend as far down as the 4th sacral vertebra in neonates. (e) Sacral anomalies are found in $5% of children.

Limb tourniquets are contraindicated in the following:

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Sickle cell disease. Diabetes. Elderly. Deep vein thrombosis. Limb infections.

21.

Concerning needles and additives:

15.

Regarding caudal blocks in children:

(a) They reliably block dermatomes below the umbilicus in all children. (b) The most reliable method of identifying the sacral hiatus is by locating the sacral cornua with the index finger. (c) The incidence of dural puncture is less than 1: 10 000. (d) Adding atropine to the local anaesthetic solution containing epinephrine 1:200 000 increases the sensitivity of the test dose. (e) 0.5 ml kg1 of levobupivacaine 0.25% or ropivacaine 0.2% will reliably block dermatomes to the level of the umbilicus in children below 20 kg.

(a) A Quincke needle should not be used for peripheral nerve blocks. (b) Pencil point needles should not be used for peripheral nerve blocks. (c) Short bevelled needles produce less nerve damage than long bevelled needles. (d) Epinephrine-containing solutions are safe in all patients for sciatic nerve block. (e) Addition of clonidine is the best method of prolonging the duration of peripheral nerve blockade.

22.

Regarding nerve location in peripheral nerve blockade:

16.

Regarding epidural additives:

(a) They can be safely used in infants under 6 months. (b) They are used to extend the height of the block. (c) Morphine can cause late onset respiratory depression because of its low water solubility. (d) Clonidine is an a2-adrenoceptor agonist which stimulates the descending norepinephric medullospinal pathway. (e) Ketamine can prolong the mean duration of a caudal block by 12 h.

(a) Injection of local anaesthetic with a minimum stimulating current 0.3 mA is safe. (b) A safe starting stimulator current is 1 amp. (c) 2 Hz is theoretically safer than 1 Hz. (d) Using a nerve stimulator will prevent nerve damage. (e) A paraesthesia technique can be used.

23.

Regarding nerve damage after nerve blockade:

17.
(a) (b) (c) (d) (e)

The following factors are associated with an increased risk of peripheral nerve injury during anaesthesia:
General anaesthesia. Hypotension. Elderly. Female. Metabolic derangements.

(a) It can present in the second week after operation. (b) It is the most common complication of regional anaesthesia. (c) Peripheral nerve blocks should only be performed in awake patients. (d) Neurotmesis is recoverable. (e) Peroneal nerve damage is more commonly reported than tibial nerve damage after knee arthroplasty.

24.

Concerning anaesthetic gas pipeline supply:

18.

Concerning postoperative blindness:

(a) The incidence is 1 in 25 000 anaesthetics. (b) The commonest cause is ischaemic optic neuropathy. (c) Some cases may improve with treatment.

(a) Nitrous oxide is supplied at 4.1 bar. (b) Unidirectional (one-way) valves are present. (c) Schrader probes have collars with unique diameters to prevent misconnection to the wrong gas service. (d) The integrity of the oxygen pipeline after repair may be tested with an oxygen gas analyser fitted at the common gas outlet.

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Multiple Choice Questions

(e) Anaesthetists are responsible for ensuring gas delivery from the central gas source to the common gas outlet.

31.
(a) (b) (c) (d) (e)

Cerebral autoregulation is maintained by:

Propofol. Sevoflurane. Isoflurane. Nitrous oxide. Nitrous oxide and propofol together.

25.

In modern anaesthetic machines:

(a) A computer-controlled, self-checking machine need not be manually checked before use. (b) Fresh gas flow in an electronic flowmeter system depends entirely on a source of electrical power. (c) Oxygen control knobs are always white and positioned at the extreme left of the flowmeter bank, by international convention. (d) A pressure relief valve (set at 3040 kPa) situated downstream of the back bar protects the machine against back-pressure surges. (e) Automated anaesthetic record keeping (AARK) is invariably more accurate than a handwritten record.

32.

In pregnant women:

26.

Concerning anaesthetic gas cylinders:

(a) The pin-index system is a fail-safe method for preventing misconnection to the anaesthetic machine. (b) The pin-index system applies to cylinders up to size G. (c) Bourdon gauges must be calibrated for each specific gas service. (d) Primary regulators reduce high cylinder pressures to a machine working pressure just above atmospheric pressure. (e) Aluminium cylinders may be safely used on anaesthetic machines in MRI locations.

(a) Presence of cardiac symptoms such as dyspnoea, heart murmurs and peripheral oedema are always pathological. (b) ECG changes such as axis deviation, premature beats and ST-segment abnormalities may be normal. (c) Radiological investigations should be minimized, especially during the first trimester. (d) Supine hypotensive syndrome occurs from the third trimester. (e) If resuscitation is deemed necessary, appropriate guidelines should be followed along with left lateral tilt to avoid supine hypotension.

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33.

With regard to drug effects in pregnancy:

27.
(a) (b) (c) (d) (e)

Nitrous oxide:
Increases CBF. Decreases CMRO2. Maintains autoregulation when used with propofol. Maintains carbon dioxide reactivity. Is an NMDA antagonist.

(a) Drugs have the greatest teratogenic effects on the human embryo during the first trimester. (b) Analgesia for procedures in pregnancy is essential to avoid deleterious effects of stress on both mother and the fetus. (c) All NSAIDs can be safely given to pregnant women. (d) Surgery carries an increased risk in abortion and growth retardation in the fetus. (e) MAC of volatile anaesthetics is increased by 30% during pregnancy.

34.

Regarding surgery in pregnancy:

28.
(a) (b) (c) (d) (e)

Mild hypothermia:
Is beneficial in severe head injury. Reduces mortality in head injuries. Is beneficial during the operation in aneurysm clipping. Improves outcome when used immediately after cardiac arrest. Is usually used for 24 h after aneurysm clipping.

29.
(a) (b) (c) (d) (e)

Hyperventilation:
Causes cerebral vasoconstriction. Decreases CBF. Decreases cerebral blood volume. Increases ICP. Has been proven to be of benefit in head injuries.

(a) Elective surgery can be performed during pregnancy. (b) Emergencies can be performed irrespective of gestational age if the condition carries a high risk to the mothers life. (c) Fetal well-being should be assessed before and after surgery and if possible continuously during the procedure by Doppler. (d) Surgery during the second trimester is preferable as it has less risk of teratogenicity and abortion. (e) All elective surgery should be deferred until after 6 weeks postpartum to allow the physiological changes of pregnancy to resolve.

35.

With regard to anaesthesia in pregnancy:

30.
(a) (b) (c) (d) (e)

Triple-H therapy includes:

Hypocapnia. Hypervolaemia. Hypertension. Haemodilution. Hypothermia.

(a) Airway management can be technically difficult because of anatomical and physiological variations. (b) Aspiration prophylaxis is recommended from the beginning of the second trimester. (c) General anaesthesia is preferable to regional anaesthesia during pregnancy. (d) Aortocaval compression is less pronounced in the lateral position compared with the wedged position. (e) Thromboprophylaxis is essential in postoperative pregnant patients.

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