Multiple Choice Questions

Preventing postoperative infection: the (d) Nitrous oxide can increase intracranial pressure.
anaesthetist’s role (e) Treatment with mannitol does not compromise uterine
perfusion.
1. The following are recommended as a means of reducing post-
operative surgical site infections: 6. Regarding specific neurological conditions:
(a) Maintain normothermia intraoperatively. (a) A temperature rise can cause an exacerbation of multiple
(b) Administer prophylactic antibiotics. sclerosis.
(c) Avoid nitrous oxide. (b) The Pregnancy in Multiple Sclerosis (PRIMS) study showed
(d) Wash with chlorhexidine preoperatively. no difference in relapse rates in multiple sclerosis parturi-
(e) Avoid propofol. ents receiving epidural analgesia.
(c) Epilepsy is the commonest co-existing neurological disorder
2. Prophylactic antibiotics are recommended during the following
in pregnancy.
routine surgical procedures:
(d) Major obstetric haemorrhage is a risk factor for cerebral
(a) Total hip arthroplasty.
venous thrombosis.
(b) Caesarean section.
(e) Spinal anaesthesia is contraindicated in parturients with
(c) Cholecystectomy.
benign intracranial hypertension.
(d) Non-mesh hernia repair.
(e) Mastectomy for breast carcinoma. 7. Regarding specific neurological conditions:
(a) Epidural analgesia should be considered before labour com-
3. The following classes of antibiotics may prevent bacterial
mences in parturients with spinal cord injury.
wound infection by skin commensals:
(b) Parturients with spina bifida need increased doses of local
(a) Aminoglycoside e.g. gentamicin.
anaesthetic for epidural analgesia.
(b) First or second generation cephalosporin, e.g. cephazolin/
(c) Tethering of the spinal cord is a recognized feature of
cefoxitin.
neurofibromatosis.
(c) Glycopeptide, e.g. vancomycin.
(d) Berry aneurysms are less likely to rupture during pregnancy.
(d) Third generation cephalosporin, e.g. ceftriaxone.
(e) A parturient with myasthenia gravis is most likely to experi-
(e) Penicillin þ anti b-lactamase, e.g. timentin.
ence an exacerbation in the puerperium.
4. The following antibiotics can be used as first line treatment
8. In a woman with a space occupying lesion:
against Staphylococcus aureus (fully sensitive strain):
(a) Regional anaesthesia is useful during labour.
(a) Vancomycin.
(b) Labour may lead to dangerous increases in intracranial
(b) Cephazolin.
pressure.
(c) Clindamycin.
(c) Spinal anaesthesia may be used for lower segment
(d) Timentin.
Caesarean section (LSCS).
(e) Flucloxacillin.
(d) Pregnancy is rare.
(e) Combined neurosurgical and obstetric intervention have
Anaesthetic implications of neurological been reported.
disease in pregnancy
Perioperative care for lower limb
5. Concerning the anaesthetic management of a parturient with
amputation in vascular disease
raised intracranial pressure:
(a) A rise in intracranial pressure will compromise cerebral per- 9. With regard to lower limb amputation (LLA) secondary to vas-
fusion pressure. cular disease:
(b) Esmolol is the preferred drug to prevent a hypertensive (a) 30-day mortality rates are 3%.
response to laryngoscopy. (b) Above knee amputation (AKA) carries a higher 30-day
(c) Mean arterial pressure should be maintained below 80 mm Hg. mortality rate than below knee amputation (BKA).
194 doi:10.1093/bjaceaccp/mkr034
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(c) Coronary atherosclerosis is a common finding in this patient
group.
(d) The proportion of AKA compared with BKA has fallen
over recent years.
(e) LLA is often performed as an emergent procedure.
10. Regarding pre-assessment and optimization for LLA:
(a) Cardiac symptoms may often be masked.
(b) Statins should be discontinued in the perioperative period.
(c) Haemoglobin levels should always be maintained greater
than 10 g dl21.
(d) Prophylactic low molecular weight heparin should be
omitted for 24 h prior to neuraxial block.
(e) Blood glucose should be maintained below 10 mmol litre21
perioperatively.
11. Regarding pain management in patients undergoing LLA:
(a) Phantom limb pain is a significant complication of LLA.
(b) Pre-emptive analgesia with epidural infusions has shown
consistent reduction in chronic phantom limb pain.
(c) Significant preoperative pain is common.
(d) Local anaesthetic infusions via sciatic nerve catheters can
improve postoperative pain control.
(e) The routine use of non-steroidal anti-inflammatory drugs is
recommended.
12. In patients undergoing LLA:
(a) A single shot spinal anaesthetic is an appropriate regional
technique.
(b) The use of regional anaesthesia is associated with a
reduction in late POCD.
(c) Angiotensin-converting enzyme (ACE) inhibitors should
always be continued on the day of surgery.
(d) Preoperative assessment of exercise tolerance is often
problematic.
(e) A Quality Improvement Framework is in development to
reduce mortality.
Novel techniques of local anaesthetic
infiltration
13. Concerning incisional local anaesthetic infiltration at the end
of surgery:
(a) The most important layer to infiltrate is the skin.
(b) It provides analgesia for 6– 8 h.
(c) It reduces pain scores following both laparoscopic and open
cholecystectomies.
(d) It increases the risk of wound infection.
(e) The addition of NSAIDs, epinephrine and steroids has been
used to prolong the length and quality of analgesia.
14. Systems under investigation to provide ‘sustained release’
local anaesthetics include:
(a) Loading into liposomes.
(b) Incorporation into a degradable polymer matrix.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 5 2011
Multiple Choice Questions
(c) Structural modification so as to increase vascular uptake.
(d) Inclusion in cyclodextrins.
(e) Modifying the local anaesthetic so as to contain a perma-
nent charge.
15. Continuous local anaesthetics infiltration technique using a
catheter has been proven to have:
(a) Minimal or no impact on the duration of hospital stay.
(b) Better results if the catheter is in deep muscle layer than in
subfascial planes.
(c) Higher rates of wound infection.
(d) Potential of local anaesthetic toxicity with higher rate of
infusion.
(e) Higher satisfaction rates with patients.
16. With regards to tumescent techniques:
(a) 1% lidocaine is the most commonly used local anaesthetic.
(b) High hydrostatic pressure within the tissues results in blood
vessel compression and delays systemic absorption of local
anaesthetic.
(c) A maximum dose of lidocaine 10 mg kg21 can be used in
the context of tumescent analgesia.
(d) Addition of epinephrine when performing a tumescent tech-
nique is hazardous.
(e) Tumescent techniques have been shown to result in reduced
hospital stays when compared with epidural analgesia fol-
lowing knee arthroplasty.
Ultrasound-guided peripheral upper limb
nerve blocks for day-case surgery
17. When undertaking ultrasound-guided peripheral nerve block of
the upper limb:
(a) The nerves are normally hypoechoic.
(b) The short-axis view shows the nerves in cross section.
(c) A low-frequency transducer provides optimal views.
(d) The out-of-plane (OOP) approach shows the needle in cross
section.
(e) Local anaesthetic is hyperechoic.
18. Considering the sonoanatomy of the peripheral nerves of the
upper limb:
(a) The median nerve in the forearm is viewed between flexor
digitorum superficialis and flexor digitorum profundus
muscles.
(b) The ulnar nerve in the forearm is normally lateral to the artery.
(c) The musculocutaneous nerve at the elbow is medial to the
tendon of biceps brachii muscle.
(d) The superficial radial nerve in the forearm is medial to the
artery.
(e) Anatomical variants are relatively infrequent.
19. Concerning regional anaesthesia for ambulatory upper limb
surgery:
(a) It improves patient satisfaction.
195
Multiple Choice Questions
(b) Ultrasound guidance can limit the extent of motor block.
(c) An arm tourniquet limits the operation time to 30 min in
the awake patient.
(d) Ultrasound guidance can reduce the volume of local anaes-
thetic required.
(e) Distal forearm block avoids motor block of the digital
flexors and extensors.
20. Concerning the innervation of the hand:
(a) The ulnar nerve does not innervate deep structures of the
hand.
(b) The superficial radial nerve supplies bony structures.
(c) The median nerve has a dorsal branch.
(d) The superficial radial nerve supplies the intrinsic muscles of
the hand.
(e) The ulnar nerve innervates the medial half of the fourth and
all of the fifth digits.
Anaesthesia for laparoscopic surgery
21. Laparoscopic surgery may induce the following haemo-
dynamic changes:
(a) Increased preload.
(b) Increased cardiac output.
(c) Increased pulmonary vascular resistance.
(d) Decreased peripheral vascular resistance.
(e) Decreased renal perfusion pressure.
22. Regarding well leg compartment syndrome:
(a) It may present postoperatively with myoglobinuria.
(b) It is increased with patients with muscular lower limbs.
(c) Peripheral vascular disease is a risk factor.
(d) It can be minimized by using ‘Lloyd Davis’ stirrups.
(e) It can be minimized by avoiding the use of intermittent
compression stockings.
23. Regarding raised intra-abdominal pressure:
(a) It may increase intracranial pressure.
(b) It may result in artificially low central-venous pressure
readings.
(c) It is an independent cause of acute kidney injury.
(d) It rarely affects hepatic blood flow.
(e) It does not cause physiological changes until above
15 mm Hg.
24. Concerning the effects of laparoscopic surgery on the respirat-
ory system:
(a) Functional residual capacity is raised.
(b) Total lung compliance is reduced.
(c) The flow characteristics of volume-controlled ventilation
make it a superior mode of ventilation in patients compared
with pressure-controlled ventilation.
(d) Laparoscopic surgery is contraindicated in patients with
severe respiratory disease.
196 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 5 2011
(e) Laparoscopic surgery is contraindicated in patients with
right-to-left cardiac shunt.
Postpartum headache: diagnosis and
management
25. Which of the following are common causes of postpartum
headache:
(a) Non-specific headache.
(b) PRES.
(c) Meningitis.
(d) Post-dural puncture headache.
(e) Caffeine withdrawal.
26. Which of the following statements are true:
(a) Headache is a concerning feature in a patient with pre-
eclampsia in pregnancy.
(b) Approximately 25% of cases of PRES occur in pregnant
patients.
(c) There is an association between dural puncture and the
development of subdural haematoma.
(d) The incidence of subarachnoid haemorrhage is decreased in
pregnancy.
(e) The incidence of cerebral infarction is approximately 19 per
100 000 deliveries.
27. The following are true about post-dural puncture headache:
(a) It may occur in 50% of patients who experience uninten-
tional puncture on insertion of an epidural.
(b) It can occur after an uneventful procedure.
(c) It can be managed prophylactically.
(d) Conservative management is completely ineffective.
(e) Resolution is better when an epidural blood patch is per-
formed within 24 h of diagnosis.
28. The following are true about epidural blood patches (EBP):
(a) EBP should be first line of treatment in all patients
complaining of a headache post epidural for labour
analgesia.
(b) There is no risk of recurrence of headache following the
procedure.
(c) Written consent is essential.
(d) Blood cultures should be routinely performed.
(e) Injection of blood may result in the patient experiencing a
bradycardia.
Resolution in ultrasound imaging
29. Axial resolution is:
(a) The minimum distance that can be differentiated between
two reflectors located perpendicular to the direction of
travel of sound.
(b) Equal to the spatial pulse length
 Multiple Choice Questions

(c) Improved by using a high-frequency transducer. 31. Temporal resolution is improved:

(d) Improved if wavelength is short. (a) By increased depth of penetration.
(e) Improved by having an increased number of cycles in a (b) By increased number of focal points.
pulse of ultrasound. (c) By increased number of scan lines per frame.
(d) Using panoramic imaging.
30. Lateral resolution in an image containing pulses of ultrasound
(e) When using M mode imaging.
scanned across a plane of tissue is:
(a) The minimum distance that can be distinguished between 32. The number of shades distinguishable on an image is high
two reflectors located perpendicular to the direction of when:
travel of ultrasound. (a) Compression is high.
(b) Improved by using low-frequency transducers. (b) Dynamic range is wide.
(c) High when wavelength is long. (c) Colour is used.
(d) Using transducers of wide apertures. (d) Each pixel of the computer image memory has many bits.
(e) Improved when the near zone length is short. (e) A coupling gel is applied to the surface of a transducer.

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