MCQ Anaesthesia

1
The following statements about Induction Drugs are true EXCEPT
A

Thiopentone may cause laryngospasm / asthma due to histamine release

Propofol causes hypotension due to decreased pre-load

Diazepam has better IM absorption than Midazolam

Thiopentone causes hypotension due to effects on both the myocardium and

peripheral vasculature

Answer
2
Regarding Laryngeal airways
A

Size 2 for a 30 kg child would be suitable

Blind intubation down an intubating LMA has a stated success rate of 90%

They are considered a definitive airway

Do not tend to leak unless airway pressures are greater than 25mmHg

Answer

The following are all TRUE with regards to Suxamethonium EXCEPT:

It causes decreased lower oesophageal tone

Gentamicin causes increased sensitivity to Suxamethonium

It is contra-indicated for use if within 48 hours of spinal cord injury

Dosage should be reduced by 25% in pregnancy

Answer

Which of the following is TRUE with regards to local anaesthetics:

o-toluidine is a metabolite of procaine

Amides cause more frequent allergic reactions than esters

The safe maximal dose of Bupivacaine plain is 4mg/kg

Seizures due to LA toxicity are usually self-limiting

Answer

Regarding neuromuscular blockers all true EXCEPT

Atracurium undergoes Hoffman degradation

Pancuronium causes tachycardia

Vecuronium haemodynamically stable

Atracurium is steroid based

Answer
6
Contraindications for blind nasotracheal intubation include all EXCEPT
A

Spontaneous breathing

Basal skull fracture

Coagulopathy

Maxillary fracture

Answer

With regard to end-tidal CO2 monitoring which is CORRECT

ETCO2 will be 2-5mmHg > PaCO2 because of water vapour in expired air

ETCO2 will be 1-3mmHg > PaCO2 because of water vapour in expired air

ETCO2 will be 1-2 mmHg < PaCO2 because of inherent leak from the circuit

ETCO2 will be 3-5mmHg < PaCO2 because of physiological dead space

Answer

A 6 year old child has a 10cm laceration on his right calf that is amenable to
closure in the ED. Which of the following is a safe maximal dose of local
anaesthetic in this child?

15ml of 1% plain lignocaine

20mls of 1% lignocaine with adrenaline

15mls of 0.5% bupivacaine

12mls of 0.5% bupivacaine and adrenaline

Answer

Regarding local anaesthetics which is TRUE?

Bupivacaine is more cardiotoxic than lignocaine

Prilocaine has greater CNS toxicity than lignocaine

Allergic reactions are more common with amides than esters

EMLA cream causes vasodilation at the site of application

Answer

10

Portable C size O2 cylinders carried on a hospital bed

Hold 420 L and would last 28 minutes running at 15 L/min

Hold 1387 L and would last 46 minutes running at 15 L/min

Hold 250 L and would last 17 minutes running at 15 L/min

Hold 120 L and would last 20 minutes running at 6 L/min

Answer

11

With regard to vecuronium all of the following are true EXCEPT

Undergoes 50% biliary excretion

It cannot be mixed in the same IV line with thiopentone

Histamine release causing anaphylactoid reactions is very uncommon

The induction dose is three times the maintenance dose

Answer

12

Drugs that interact with neuromuscular blocking agents (increased or

decreased neuromuscular blockade) include all of the following EXCEPT:

Lithium

Chloramphenicol

Tetracycline

Gentamycin

Answer

13

Which of the following in NOT a common adverse effect of Suxamethonium

Increased bronchial secretions

Raised intracranial pressure

Raised intraocular pressure

Prolonged apnoea

Answer

14

Which statement is FALSE regarding Regional Anaesthesia

Ankle nerve blocks include the following nerves: Tibial, Deep peroneal,
Superficial peroneal, Sural and Saphenous

The maximum dose of Ropivacaine in children 1-12 years old is

0.5 ml / kg of a 0.5 % solution

Regional anaesthesia include the following blocks : Peripheral nerve,

Hematoma, Biers (IV arm), Neural plexus and Epidural blocks

The maximum dose of plain Lignocaine is 5 mg / kg and with Adrenaline

added it is 7 mg /kg

Answer

15

Regarding ketamine which of the following are absolute contraindications

Head Injury

Recent meal

Pre-hospital setting

None of the above

Answer

16

Regarding ketamine, which of the following is TRUE ?

Can cause life threatening hypotension

Is safe for use in all age groups

Can be used in cases of known CSF flow obstruction

Is absolutely contraindicated in severe cardiovascular disease

Answer

17

Which statement concerning inhaled anaesthetics is INCORRECT?

Agents with a low blood solubility have a slow onset

of action

Onset of anaesthesia is more rapid with increased ventilation rate

Inhaled anaesthetics decrease brain metabolic rate

Inhaled anaesthetics increase cerebral blood flow

Answer

18

Which of the following is INCORRECT with regard to local anaesthetics?

They are weak bases

Those with a lower pKa have a faster onset of action

Higher protein binding is associated with a longer duration of action

Bupivacaine is a suitable local anaesthetic for IV regional anaesthesia

Answer

19

All are true EXCEPT

Sevoflurane causes bronchodilatation

Vecuronium is not frequently used as an induction agent in ED

Sevoflurane rarely causes airway irritation

Rocuronium should be avoided in hyperkalaemia

Answer

20

Regarding malignant hyperthermia, which of the following is TRUE?

Children most commonly affected

Is not affected by genetic predisposition

Lower limb muscles particular commonly affected

Fever is always an early sign

Answer

21

Causes of increased end tidal CO2 include all EXCEPT:

Rebreathing

Malignant hyperpyrexia

Sepsis

Shock

Answer

22

Difficult intubation is anticipated in all of the following EXCEPT:

Modified Mallampati scoring system grade 4

Thyromental distance < 6.5cm

Wilson risk factor scoring system greater than 2

(weight, head and neck movement, jaw movement, receding mandible, buck
teeth)

Sternomental distance > 12.5

Answer

23

Use of patient controlled analgesia

Causes lower incidence of opioid side effects

Is opioid sparing compared to intermittent dosing

Reduces length of hospital stay

Results in better patient satisfaction with pain relief

Answer

24

In preparing for a rapid sequence intubation

The induction dose of vecuronium is 0.1mg/kg

The Murphy eye allows bilateral ventilation in case of a RMB intubation

Presence of a gag reflex does not imply a protected airway

Pre-oxygenation requires at least 5 minutes 100% O2 or 8 quick breaths

Answer

25

With regard to gas supply in hospital, which of the following is FALSE?

Full oxygen cylinders in have 400 times greater pressure than that of wallsourced oxygen through a regulator

Wall-sourced regulators are only accurate if within 10 degrees of vertical

The ball flow meter reading changes if there is obstruction to oxygen outflow

According the Australian Standards Association, 4 suction ports are required

for each resuscitation area in the emergency department

Answer

26

With regard to Opioids which of the following is FALSE?

Droperidol, naltrexone and naloxone can be used for opioid-induced pruritis

Respiratory rate is a good predictor of early opioid induced respiratory

depression

Intra-articular opioids may produce up to 24 hours of analgesia

Opioids are less effective and take longer to act than NSAIDs for acute
renal colic

Answer

27

Thiopentone is associated with all of the following EXCEPT

Neuronal demyelination inpatients with porphyria

Decreased cerebral blood flow

Increased cerebral metabolic rate

Skin necrosis if given intra-arterial

Answer

28

Which of the following is TRUE regarding rapid sequence intubation

There is good evidence for cricoid pressure

In paediatrics ETT size is approximated by age/4 + 2

Vecuronium is incompatible with Thiopentone

Rocuroniums duration of action is less than 10 mins

Answer

29

Regarding Anaesthetic agents

Thiopentone has a larger volume of distribution than propofol

Dose of induction agent is calculated by weight, and other patient factors are
relatively unimportant

A 6yr child should be given 10mg midazolam if given orally for procedural
sedation

There is less nausea + vomiting associated with ketamine use when the
patient is fasted

Answer

30

Which of the following is TRUE regarding paediatric airway management?

The narrowest part of the airway is at the vocal cords at C3-4 level

The formula for ETT insertion distance is Age/4 + 12

A size 3 LMA is most appropriate for an average-sized 5yr old

An over-inserted ETT is equally likely to go down the right and left main
bronchus

Answer

31

Regarding agents and associations, which is FALSE?

Prilocaine and methaemoglobinaemia

Suxamethonium and malignant hyperthermia

Neostigmine and cholinergic features

Propofol and emesis

Answer

32

Regarding paediatric intubation, which is TRUE?

A straight (Miller) blade is recommended in all children under 8 years

Children desaturate faster than adults once apnoea is induced

LMAs are not useful in the management of the neonatal airway

Needle cricothyroidotomy should be avoided in all children under 10 years

Answer

33

Regarding local anaesthetics, which is TRUE

Cardiac arrhythmias commonly occur with low plasma levels of local

anaesthetic agents

The maximum safe dose of lignocaine is 7mg/kg

Prilocaine undergoes hepatic elimination

Carpal tunnel syndrome is a contraindication to ulnar nerve block

Answer

34

Which of the following is NOT an adverse effect of propofol

Decreased preload

Laryngospasm

Sexual disinhibition

Metabolic acidosis

Answer

35

Anaesthetics is BEST described as

Boring

Tedious

Sitting down all day eating Tim tams and whinging

All of the above

Answer

36

With respect to malignant hyperthermia which is FALSE

Higher incidence in those with muscular dystrophies

50% of cases have had a previous uneventful GA

50% autosomal dominant

Initially causes a metabolic alkalosis

Answer

37

Each of these factors influences pulse oximetry readings EXCEPT

Dark coloured nail polish

Methaemoglobinaemia (>10%)

Hypothermia

Jaundice (total bilirubin level > 100)

Answer

38

Which answer is TRUE?

The level of the vocal cords is the narrowest part of a childs airway

Best estimation of ETT size for a child correlates with the childs weight

An ETT which fits snugly through the vocal cords will be right size for a child

A size 3 Mac laryngoscope would be appropriate for an 8yr old child

Answer

39

All of the following can precipitate malignant hyperthermia EXCEPT

Volatile anaesthetic agents

Ester type local anaesthetic agents

Caffeine

Cardiac glycosides

Answer

40

Which of the following statements is TRUE regarding procedural sedation

ASA class III patient with an abscess for incision and drainage is a good
candidate for an ED procedural sedation

Soy allergy is a contraindication to propofol

Mallampatti class III implies the entire uvula is visible

The high incidence of emergence phenomena precludes the use of

ketamine in adults

Answer

41

Which of the following drugs is NOT used in the treatment of local

anaesthetic adverse events

Diphenhydramine

Dantrolene

Methylene blue

Intralipid

Answer

42

Which of the following paediatric drug doses is INCORRECT?

Suxamethonium 1.5 mg/kg IV

Ketamine 3-4 mg/kg IV

Morphine 0.1mg/kg IV

Thiopentone 4mg/kg IV

Answer

43

In regards to ketamine use for procedural sedation in the paediatric

population, which of the following statements is INCORRECT?

It has sedative, amnesic & analgesic effects

Emergence reactions are common

It is contraindicated in children < 3 months of age

It can be given initially at 1.0 - 1.5 mg/kg IV

Answer

44

Which of the following is FALSE regarding opioids

Fentanyl is not contraindicated in severe renal failure

Fentanyl has a shorter duration of action than morphine

Pethidine is contraindicated in patients taking MAOI antidepressants

Fit, young patients typically have increased susceptibility to opioids

Answer

45

Which of the following statements is TRUE:

Entonox is contraindicated in acute renal failure

Propofol carries a greater risk of apnoea than midazolam

Thiopentone undergoes rapid hepatic metabolism

Bioavailability of oral midazolam is approximately 70%

Answer

46

When performing procedural sedation and analgesia, fentanyl would be

expected to have more than its usual clinical effect in case of:

pregnancy

acidosis

obesity

Chronic opioid treatment

Answer

47

The following statement regarding airway and ventilation management is

TRUE:

When performing rapid-sequence intubation in a patient known to be allergic

to suxamethonium, rocuronium would be the muscle relaxant of choice

Non-invasive ventilatory assistance decreases pulmonary compliance

There is no role for non-invasive ventilation in the treatment of a patient with

respiratory failure due to community-acquired pneumonia

Midazolam has a faster onset of sedation, as compared to propofol

Answer

48

Which of the following is FALSE regarding local anaesthetics

True allergy is more common in esters than amides

The dose of prilocaine for a Biers block is 6mg/kg

Lignocaine is less cardio-toxic than bupivacaine

Biers block cuff inflation should be not < 20mins and not > 1 hour.

Answer

49

According to updated guidelines for use of ketamine in ED procedural

sedation, which of the following statements is NOT correct?

Ketamine use is now permitted in children 3-12 months of age

Head trauma is an absolute contraindication to ketamine use

Routine prophylactic anticholinergics are no longer recommended

IV ketamine results in faster recovery & less emesis

Answer

50

Which is FALSE regarding local anaesthetic agents?

Most allergic reactions are to aminoamide compounds

Early signs of toxicity include circumoral tingling, dizziness & tinnitus

The safe maximum dose of lignocaine with adrenaline is 7mg/kg

In the setting of toxicity, class IB antidysrhythmic agents are contraindicated

Answer

51

At what level are the vocal cords most likely to lie in a young child?

C2-3

C3-4

C4-5

C5-6

Answer

52

Which of the following ventilator settings is most appropriate after intubation

for airway protection after an isolated traumatic brain injury.

Tidal volume 12 mL/kg

I:E ratio 2:1

Respiratory rate 8/min

PEEP 5 cmH20

Answer

53

Which of the following is TRUE about opioids and opioid-like drugs?

Tramadol is a kappa opioid receptor antagonist.

Methadone can cause QT prolongation

Fentanyl is more likely than morphine to cause histamine release

Buprenorphine has SNRI activity

Answer

54

With regards to the paediatric airway which of the following is TRUE

The choice of endotracheal tube size is different for cuffed and uncuffed
tubes

The epiglottis is more anterior and caudal in the child

The shorter trachea results in higher rates of right main bronchus intubation
compared to left

Children have a relatively larger functional residual capacity than adults

Answer

55

Which of the following is NOT a contraindication to Biers Block

Hypertension

Sickle cell disease

Cellulitis

Children younger than 8 years

Answer

Answers
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.

C
B
C
D
D
A
D
D
A
A
C
B
D
B
D
A
A
D
D
A
D
D
D
C
C
B
C
C
C
D
D
B
B
B
D
D
D
D
B
B
A
B
B
D
B
A

47.
48.
49.
50.
51.
52.
53.
54.

A
B
B
A
B
D
B
A

55. D

Katzung & Trevors Pharmacology Ch 25

Tintinalli page 266
Essentials of Anaesthetic Equipment Al-Shaikh/Stacy
nd
How to survive in anaesthesia 2 Edition Robinson and Hall
ANZCA acute pain management scientific evidence
Dunn
Dunn
nd
Acute Pain Management: Scientific evidence 2 Edition
Dunn. Emergency Medicine Manual
Dunn
th
Dunn 4 ed p 52
th
Dunn 4 ed p 65
th
Dunn 4 Ed Chapter 2: Anaesthetics
Tintinalli 6th Ed Chapter Section 3, Part 15: Paediatric airway management
Trevors anaesthesia list
Dr Clare Falzon
Cameron p 33
Dunne p.65
Dunne, p 69
Cameron p704-709
Dunn p1029
Textbook of Paediatric Emergency Medicine chpt 20
Textbook of Paediatric Emergency Medicine chpt 20
(decreased susceptibility, ie: may require larger doses) Dunn p42-43
Dunn p50-52
th
Emergency Medicine: A comprehensive Study Guide (Tintinalli), 6 ed., table
1, p.276
rd
Cameron, Textbook of Adult Emergency Medicine, 3 edition, Chapter 2.1
Dunn, p 46-8

th

38-

Dunn 5 edition page 39

th
Dunn 5 edition page 149-150
th
Harwood and Nuss Pediatrics chapter pg 1092 5 edition Cuffed ETT tubes are one
size smaller (age/4 +3)
th
Tintinalli 6 edition under Biers block. Not appropriate for children under age of 5.