University Of Khartoum Faculty of Medicine Department of Anaesthesia Anaesthesia- 5" Year Final Examination 2014-2015 R Select the best option in cach question. by darkening the appropniate place in the attached answer sheet using a pencil 1. Choose the most correct answer about the Junctional cleft. a) It is the gap between the nerve terminal and the —prejunctional_-~— muscle membrane. b) The postsynaptic membrane contains clusters of nicotinic and muscarinic acetylcholine receptors _/¢) The junctional cleft acetylcholinesterase responsible for the contains true which is breakdown of acetylcholine d) Each receptor on the postsynaptic membrane contains 4 acetylcholine molecules. e) Activation causes ion channel opening with the influx of Na*, K’, Ca’’, and Mn**; and a change in the potential from -90 to -50 mv. . All the suxamethonium except. following are true about a) It is a depolarizing muscle relaxant. b) It is metabolized by true cholinesterase. ¢) Common side effects. include bradycardia, myalgia (muscle pain), hyperkalemia and anaphylaxis. d) Suxamethonium is a non-competitive muscle relaxant. Me) Inherited factors play an important role in suxamethonium metabolism. 3. The following are correct. about premedication except. a) Premedication refers to the administration of drugs in the period 1-2 hours in the perioperative period. b) Hyoscine, ketamine, droperidol and diazepam can also be used as premedicant drugs. ¢) Benzodiazepines exert their action on GABA receptors. d) Morphine is not a suitable analgesic to be used for the pain of acute cholecystitis. e) H2 receptor blockers used in anaesthesia include ranitidine and famotidine. 4. Which of the following anesthetics causes significant intraoperative arrhythmias. a) Isoflurane. b) Halothane. ©) Sevoflurane. d) Desflurane. e) Enflurane. [Pagel5. Which of the following inhalational agents has bad smell. a) Halothane. b) Sevoflurane. ¢) Isoflurane. d) Nitrous oxide. e) Oxygen. 6. The inhalational anaesthetic that can cause hepatitis is. a) Desflurane. b) Enflurane. ©) Halothane. ~ 4) Sevoflurane e) Nitrous oxide. 7. Nitrous oxide is contraindicated in. a) Closed heart operations. b) Neurosurgery. ¢) Intestinal obstruction. d) Mastectomy. e) Inguinal hernia. 8. The most dangerous complication in anaesthesia is. a) Hypercarbia. b) Hypoxia. c) Peripheral nerve injury. 4) Postspinal headache. e) Hypotension. 9. Rapid sequence induction is indicated in. a) All babies. b) Cardiac patients. ~ ¢) Emergency operations. d) Spinal anaesthesia. e) Fasting patients. 10.All of the following are side effects of ‘oxygen therapy EXCEPT. a) Absorption atelectasis. b) Increased pulmonary compliance. ¢) Decreased vital capacity. 11.Which of d) Endothelial damage. IS narcosis. ie f the following conditions would ot adversely affect the accuracy of a pulse " oximeter reading. va) Pneumonia. b) Carbon monoxide poisoning. c) Nail polish d) Anaemia. e) Poor perfusion. 12.Which of the following statements best describes the mechanism of action of benzodiazepines. a) Benzodiazepines receptor in the spinal cord. b) They inhibit GABA transaminase leading to increased levels of GABA ¢) They block glutamate receptors in hierarchical neuronal pathways in the brain d) Benzodiazepines increase the frequency of opening of CI’ channels which are coupled to GABA A receptors e) They are direct-acting GABA receptor agonists in the CNS. 13.To attempt reduction of a dislocated shoulder joint when ketamine is used alone it will cause. a) Respiratory depression. 1b) Skeletal muscle rigidity. ¢) Hypotension 4) Bradycardia e) Analgesia 14.Which of the following drugs produces Tespiratory depression which can be reversed by flumazenil, a) Fentanyl. b) Propofol. ¢) Ketamine activate GABA B- [Page2y A) Midazolam. e) Enflurane. 15. The following drugs are potent triggers for malignant hyperthermia EXCEPT. a) Suxamethonium. b) Isoflurane ¢) Halothane v4) Calcium. e) Sevoflurane. 16.All of the following are false about propofol EXCEPT. a) Has a pka of 7. b) Has a pH of 11. ©) Causes hypotension due to myocardial depression. d) Has 98% protein binding. e) Increases systemic vascular resistance 17.All of the following are false about ketamine EXCEPT. a) Itisa direct inotrope. -b) It causes bronchodilatation. ¢) It is less likely to see the emergence phenomenon in females. d) It reduces pharyngeal secretions. e) The route of administration is only intravenous 18.Epinephrine added to a solution of lidocaine for local anaesthesia will. a) Cause cyanosis locally, b) Increase the risk of convulsions. 2 ¢) Increase the duration of _local anesthesia. d) Increase the absorption of lidocaine. e) Decrease the heart rate when absorped 19.All of the following are reasons to add a vasoconstrictor to a local anaesthetic EXCEPT, a) Lower blood flow to injection site. 7») Increase anesthetic blood level. ¢) Increase duration of local anaesthetic. d) Lower anaesthetic toxicity ) Improve the field of vision for treatment. 20. Postoperative pain. v 8) If unrelieved is more dangerous in Patients with coronary artery disease. b) Is most severe on the second day of surgery. ¢) Usually involves one type of pain. d) Is better treated with one medication. e) Cannot be assessed objectively. 21. 70 year old lady is booked for knee replacement under epidural anaesthe: The most effective analgesic technique for the first postoperative day would be. a) Systemic NSAIDs and paracetamol as required. b) Morphine 10 mg 6 hourly. c) Intravenous PCA (patient-controlled analgesia) using pethidine. d) Epidural combination of bupivacaine and fentanyl as required. e) Femoral nerve block. 22. An 8 year old child was carried into casualty, you realized that she was unconscious and had a respiratory rate of about 6 breaths/ minute. Your immediate response would be. a) Put the child in the recovery position then take a detailed history from her parents. b) Send her for a CT scan of the brain. v¢) Maintain her airway and assist her breathing with an Ambu bag while taking a brief history d) Call the registrar of anaesthesia to intubate the child and put her on the |Page3