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Preface

Single best answer type multiple choice questions have been

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introduced into anaesthetic postgraduate examinations as a way of
assessing the trainee’s ability to apply knowledge to clinical practice.
Although this is more relevant for topics in clinical anesthesia, recently this
method of assessment has been extended to topics in basic sciences.

This book consists of six sets of single best answer practice papers.
Each set comprises 30 multiple choice questions drawn from physiology,
pharmacology, clinical measurement, equipment and physics relevant to
anaesthetic examinations. Each question consists of a stem describing a
clinical scenario or problem followed by five possible answer options. One
of them is the best response for the given question. Each question and
answer is accompanied by supporting notes obtained from peer-reviewed
journal articles and basic science textbooks. Alongside the previously
published book Single Best Answer MCQs in Anaesthesia (Volume I –
Clinical Anaesthesia, ISBN 978-1-903378-75-5), this book supplements
the essential study material for postgraduate anaesthetic examinations.

The main objective of this book is to provide trainees with a series of

single best answer type questions that will prepare them for this format of
postgraduate examinations. Much emphasis has been placed on the
understanding and application of basic science knowledge with regards to
clinical practice.
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We hope that a thorough revision of this book will enable trainees to

improve their understanding and core knowledge of basic sciences
relevant to anaesthesia. We believe this book will not only be an invaluable
educational resource for those who are preparing for postgraduate
examinations, but will also be of benefit to any practising anaesthetist.

Cyprian Mendonca MD, FRCA

Consultant Anaesthetist
University Hospitals Coventry and Warwickshire
Coventry, UK
v

Mahesh Chaudhari MD, FRCA, FFPMRCA

Consultant Anaesthetist
Worcestershire Royal Hospital
Worcester, UK

Arumugam Pitchiah MD, FRCA

Specialty Registrar
Welsh School of Anaesthesia
Wales, UK
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Set 1 questions

Set 1
1 Which of the following is the most effective process to maintain an
energy supply to muscles during physical exertion in trained athletes 1
(as compared to untrained individuals)?

a. Protein catabolism.
b. Effective utilisation of free fatty acids.
c. More glycogen utilisation.
d. More lactate production.
e. Gluconeogenesis by deamination.

2 A 47-year-old female is due to undergo a hysterectomy. Her pre-

operative ECG shows progressive lengthening of the PR interval
until a ventricular beat is dropped. Which of the following
conduction abnormalities is she most likely to have?

a. First degree heart block.

b. Mobitz type 1 heart block.
c. Mobitz type 2 heart block.
d. Left bundle branch block.
e. Right bundle branch block.

3 Hypoxic pulmonary vasoconstriction (HPV) in the lungs is a

compensatory mechanism to improve ventilation perfusion
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Single Best Answer MCQs in Anaesthesia

matching. In which of the following would a decrease most likely

trigger HPV?

a. Partial pressure of oxygen in the pulmonary artery.

b. Partial pressure of oxygen in the pulmonary veins.
c. Partial pressure of oxygen in the alveoli.
d. Oxygen saturation of haemoglobin in the pulmonary artery.
e. Oxygen saturation of haemoglobin in the pulmonary veins.

4 You perform an uncomplicated lumbar epidural for labour analgesia

on a 27-year-old lady of 36 weeks’ gestation with twins. Immediately
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after the test dose of 15ml 0.25% bupivacaine she lies supine and
her BP is 70/40. The most likely cause for hypotension in this patient
is:

a. Concealed ante-partum haemorrhage.

b. Intrathecal injection of local anaesthetic.
c. Dehydration.
d. Aorto-caval compression.
e. Anaphylaxis.

5 A 35-year-old patient with a BMI of 35 aspirates gastric contents on

induction of anaesthesia. One week later on the ICU, a diagnosis of
acute respiratory distress syndrome is made. Which of the following
mechanisms is most likely to contribute to the associated pulmonary
oedema?

a. Increased pulmonary capillary permeability.

b. Raised pulmonary capillary hydrostatic pressure due to fluid
overload.
c. Reduced lymphatic drainage.
d. Reduced alveolar interstitial pressure.
e. Decreased oncotic pressure in the pulmonary capillary.
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Set 1 questions

6 A 29-year-old woman on lithium for bipolar disease was brought to

the emergency department where she was found to be
unresponsive. She has a history of convulsions and her ECG shows
conduction defects with ST changes. Plasma lithium levels were
found to be 7.5mmol/L. In addition to supportive treatment, specific
management would be:

a. Haemodialysis.
b. Administration of magnesium.
c. Forced alkaline diuresis.
d. Acetazolamide administration.
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e. Diazepam infusion.

7 A 66-year-old male with hypertension and ischemic heart disease is

scheduled for an open cholecystectomy. The best technique among
the following to suppress the pressor response to laryngoscopy and
intubation would be:

a. Intravenous esmolol.
b. Morphine 0.4mg/kg prior to intubation.
c. Isoflurane.
d. Intravenous phentolamine.
e. GTN spray prior to induction.

8 A 53-year-old woman suffering from chronic back pain presents for

excision of a small lipoma on the forearm under general anaesthesia.
Her regular medication includes 100mg of morphine sulphate
continuous twice daily. In the postoperative period the optimal dose
of oral morphine to be prescribed would be:

a. 20mg every 4 hours with extra doses of 20mg for breakthrough pain.
b. 30mg every 4 hours with extra doses of 30mg for breakthrough pain.
c. 20mg every 6 hours with extra doses of 20mg for breakthrough pain.
d. 30mg every 8 hours with extra doses of 30mg for breakthrough pain.
e. 30mg every 2 hours with extra doses of 30mg for breakthrough pain.