Multiple Choice Questions

Physiology of apnoea and the benefits of (d) One tablets of chloroquine 300 mg.
preoxygenation (e) Two tablets of digoxin 250 mg.

1. Time for desaturation to occur following the onset of apnoea is 6. The following properties of a maternal drug can confer an
influenced by the following: increased risk of toxicity to a breastfeeding infant:
(a) Thyroid state of the patient. (a) Highly protein-bound.
(b) The efficacy of preoxygenation. (b) Long half-life.
(c) The muscle relaxant used. (c) Small molecular weight.
(d) Age of the patient. (d) Acidity of compound.
(e) Weight of the patient. (e) Degree of lipid solubility.
2. Time for desaturation to occur following the onset of apnoea 7. The following features increase an infant’s susceptibility to
can be delayed by: toxicity:
(a) Head down position. (a) Increased glomerular filtration rate (GFR).
(b) Insufflation of air. (b) Higher minute ventilation.
(c) Preoxygenation. (c) A thin stratum corneum.
(d) Sepsis. (d) Increased plasma protein binding.
(e) Maintaining a patent airway. (e) Immature Phase II metabolic pathways.

3. During apnoea: 8. The following drugs may be removed by haemodialysis:

(a) In a 1-month old child, the rate of decline of PaO2 is three (a) Salicylates.
times that of an adult. (b) Lithium.
(b) Increasing the oxygen fraction applied to the patent (c) Barbiturates.
airway from 90–100% more than doubles open airway (d) Tricyclic antidepressants.
apnoea. (e) Metformin.
(c) Closed-airway apnoea results in a negative intrathoracic
9. Enhanced elimination by urinary alkalinization:
pressure, hastening hypoxia.
(a) Is best for drugs with a pKa of 3.0– 7.2.
(d) Equal amounts of O2 and CO2 leave and enter the alveoli.
(b) May be enhanced by a degree of hypokalaemia.
(e) The SaO2 starts to fall at a PaO2 of 10 kPa.
(c) Is more suitable for highly protein-bound drugs.
4. Apnoeic mass movement of oxygen can: (d) Is effective in the management of quinidine poisonings.
(a) Be used without problem to ensure oxygenation without (e) Aims to promote a urine output of 5–10 ml kg21 h21.
ventilation.
(b) Reverse hypoxia.
Antibiotic resistance in the intensive
(c) Only occur with a ‘perfect’ airway. care unit
(d) Significantly extend survivable duration of apnoea and buy
time to rescue the airway. 10. Regarding resistant bacteria:
(e) Cause temporary reversal of haemoglobin desaturation. (a) Organisms with intrinsic resistance are often of low
virulence.
(b) Mutation is the most important mechanism of acquisition of
Poisoning in children resistance.
5. Significant toxicity could occur in a healthy 10 kg toddler after (c) Gene transfer is the most important method of acquisition of
ingestion of the following: resistance.
(a) Two tablets of paracetamol 500 mg. (d) Pseudomonas can become a problem in vulnerable patients
(b) Two tablets of aspirin 300 mg. managed in selection pressure environments.
(c) Two tablets of amitryptilline 50 mg. (e) MRSA is resistant to all antibiotics.

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11. Considering the transfer of resistance:
(a) Plasmids are the most important routes of transmission of
genetic information within the intensive care unit.
(b) Corynebacterium diptheriae and Vibrio cholerae are examples
of bacteria that commonly receive genetic information from
bacteriophages.
(c) Naked bacterial DNA is uncommonly found in ICU patients.
(d) Transposons can encode resistance and move between
plasmids.
(e) Acquisition of resistance may be associated with a metabolic
cost.
12. Biochemical mechanisms occurring in bacterial resistance
include:
(a) Active efflux of antibiotics.
(b) Modifications to cell wall permeability.
(c) The development of alternative biochemical pathways.
(d) Producing enzymes that break down antibiotic.
(e) Reverse chemotaxis away from areas of high antibiotic
concentration.
13. Considering common resistant organisms:
(a) Restricting glycopeptide use can reduce the incidence of VRE.
(b) Carbapenems can prevent ESBL development.
(c) Pseudomonas colonization is uncommon in burns patients.
(d) Handwashing does not reduce rates of MRSA.
(e) MRSA infections are associated with excess mortality.
14. Strategies to reduce resistance include:
(a) Promotion of handwashing and basic hygiene measures.
(b) Contact isolation and screening.
(c) Genetic typing of bacteria to determine transmission route.
(d) De-escalation and restrictive antibiotic policies.
(e) Greater use of broad spectrum agents.
Diagnosis and initial treatment of patients
with suspected pulmonary
thromboembolism
15. Regarding diagnosis of PE:
(a) Pulmonary angiography requires right heart catheterization.
(b) D-dimers are a useful screening test in the outpatient setting.
(c) Pulmonary scintigraphy is best interpreted in the light of the
clinical presentation.
(d) Ultrasonography of the leg veins in the absence of leg symp-
toms is an effective tool for exclusion of venous
thromboembolism.
(e) Echocardiography may be a first line investigation.
16. Regarding treatment and prognosis of PE:
(a) Patients who remain breathless at three months following pul-
monary embolism are at high risk of developing CTEPH.
(b) Following pulmonary embolus related to surgery, long-term
anticoagulation over a period in excess of three months is not
normally needed
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 9 Number 4 2009
Multiple Choice Questions
(c) Bleeding complications following thrombolysis are lethal in up
to 1 per 400 treatment years.
(d) Vena cava filters should be used as first line therapy in patient
with PE following surgery.
(e) Thrombolysis is associated with decreased mortality following
sub-massive PTE
Anaesthesia for robot-assisted laparoscopic
surgery
17. The following physiological changes are usually associated
with a surgical pneumo-peritoneum in the Trendelenberg position:
(a) Increased mean arterial pressure.
(b) Increased systemic vascular resistance.
(c) Increased renal blood flow.
(d) Decreased intraocular pressure.
(e) Decreased pulmonary compliance.
18. Reported complications associated with robot assisted prosta-
tectomy include:
(a) Brachial plexus neuropraxia.
(b) An increased incidence of on table cardiac arrest.
(c) Erroneous pulse oximetry readings when the probe is placed
on the ear.
(d) An incidence of robot failure requiring the procedure to be
abandoned of 10%.
(e) Facial oedema and stridor on extubation.
19. Regarding conduct of anaesthesia for robot-assisted
prostatectomy:
(a) Arterial and central venous pressure monitoring is mandatory.
(b) The patient is positioned in a steep reverse Trendelenberg
position.
(c) A laryngeal mask is appropriate for airway management.
(d) The patient should be cross matched for 8 units, as blood loss
is usually substantial.
(e) Isoflurane is the ideal inhalational agent.
20. Postoperative care after a robot-assisted prostatectomy usually
includes:
(a) Analgesia provided by a lumbar/low thoracic epidural.
(b) Routine admission to the intensive care unit.
(c) Observations for signs of compartment syndrome.
(d) Analgesia with large doses of opiates.
(e) Suitability for discharge within 24–48 h.
Transcutaneous electrical nerve stimulation
Choose one single best answer, from (a) to (e), for each question for
questions 21-25:
21. For patients with normal skin sensation transcutaneous electri-
cal nerve stimulation (TENS) should initially be given to generate:
(a) A strong painful paraesthesiae over acupuncture points.
(b) A strong non-painful paraesthesiae over vertebrae segmentally
related to the pain.
137
Multiple Choice Questions

(c) A strong painful paraesthesiae over the site of pain.
(d) A strong non-painful paraesthesiae over the site of pain.
(e) A paraesthesiae that is barely perceptible over the site of pain.
22. The purpose of conventional TENS is to:
(a) Stimulate large diameter, low threshold afferents (A-b) and
small diameter, high threshold afferents (A-d).
(b) Stimulate large diameter, low threshold afferents (A-b)
without simultaneously stimulating small diameter, high
threshold afferents (A-d).
(c) Generate muscle twitches in order to activate small diameter
muscle afferents.
(d) Stimulate small diameter, higher threshold afferents (A-d)
without simultaneously stimulating large diameter, low
threshold afferents (A-b).
(e) Directly stimulate neurones in the spinal cord.
23. The mechanism of action of conventional TENS is predomi-
nantly by:
(a) Activating structures on the descending pain inhibitory
pathways.
(b) Resetting central sensitization and reorganizing aberrant
neuronal pathways.
(c) Blocking impulses travelling in peripheral nociceptive
afferents.
(d) Long-term depression of central nociceptor cell activity.
(e) Inhibiting second order central nociceptor cell activity in
somatic receptive fields.
24. Clinical research on TENS demonstrates that:
(a) TENS is definitely effective for the relief of all chronic pains.
(b) TENS has no value as an adjunct for the relief of acute pain.
(c) TENS may be effective for the relief of chronic pain although
evidence is often inconclusive due to methodological
shortcomings.
(d) TENS should be used as a stand alone treatment for moderate
to severe pain.
(e) TENS is definitely not effective for the relief of chronic pain.
25. Suitable choice for electrode placement may include:
(a) Anterior and posterior over chest wall to treat angina pain.
(b) Over an area of diminished skin sensation to treat neuropathic
pain.
(c) On the contralateral site in the treatment of phantom pain.
(d) Over the abdomen for pain relief during childbirth.
(e) Over the anterior neck for acute tonsillitis.

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