Multiple Choice Questions

1. With respect to lung cancer: 7. The following have been used to control
(a) Is the most common cancer among men in the UK. tetanus-induced autonomic instability:
(b) Male: female ratio is 4:1. (a) Atropine.
(c) 80% die within 1 yr of diagnosis. (b) Esmolol.
(d) The majority are non-small cell in origin. (c) Dexmedetomidine.
(e) All small cell cancers are inoperable. (d) Epidural blockade.
(e) Tramadol.
2. When considering suitability for pneumonectomy:
(a) Patients more than 80 yrs are at an increased risk of perioperative 8. Tetanus vaccine:
morbidity. (a) Is given in childhood as three separate doses 2 months apart.
(b) All patients should have an ECG. (b) Is a combined vaccine.
(c) A preoperative post bronchodilator FEV1 >1.5 litre is acceptable. (c) Is made with unmodified toxin.
(d) In-hospital mortality is 6–8% in the UK. (d) Is associated with an increased immune response when given with the
(e) Weight loss is irrelevant. diphtheria vaccine.
(e) Will eventually eradicate tetanus.
3. The following are useful for staging lung cancer and
assessing operability: 9. The following are recognized complications
(a) CT scan. of tetanus:
(b) Bronchoscopy. (a) Type I respiratory failure.
(c) PET scan. (b) Decubitus ulcers.
(d) Mediastinoscopy. (c) Bradycardia.
(e) Percutaneous CT-guided biopsy. (d) Renal failure.
(e) Hypernatraemia.
4. With regard to exercise testing:
(a) A V_ O2 max <20 ml kg 1 min 1 indicates a very high risk of 10. Tetanus:
perioperative death. (a) Is contagious.
(b) The ability to walk up five flights of stairs is consistent with (b) Has an average incubation period of 4 weeks.
a V_ O2 max >20 ml kg 1 min 1 and an FEV1 >2 litre. (c) Should be notified to the Health Protection Agency.
(c) A reduction in oxygen saturations of >4% during exercise indicates (d) Is caused by tetanolysin.
an increased risk of perioperative complications. (e) Spores can survive autoclaving at 121 C.
(d) Measurement of pulmonary artery pressures during exercise is highly
predictive of outcome after lung resection. 11. Concerning acquired TOF:
(e) V_ O2 max interpretation is without reference to sex or weight. (a) The commonest predisposing factor in adults is infection.
(b) It occurs most commonly at the cervico–thoracic junction.
5. With regard to cardiovascular fitness for (c) A tracheostomy reduces the risk of its formation.
lung resection: (d) Ingestion of button batteries is an increasing cause of TOF in children.
(a) All patients should have an echocardiogram. (e) The chronology of symptomatology is related to the causative agent.
(b) Patients who have had an MI within 10 weeks should have
a cardiology review. 12. With respect to the anaesthetic management of
(c) Patients who have had a previous CABG are not suitable an acquired TOF:
for lung resection. (a) It is an emergency procedure.
(d) Exercise tolerance is a poor indicator of overall (b) It involves the prompt isolation of the fistulae.
cardiovascular reserve. (c) Gastric distension is inevitable.
(e) Intrathoracic surgery alone presents a risk of postoperative (d) Cricoid pressure is ineffective.
cardiovascular complications. (e) It should include a period of elective postoperative ventilation.

6. The following antibiotics can be used for the 13. The following may be indicative of
treatment of tetanus: an acquired TOF:
(a) Penicillin. (a) Surgical emphysema.
(b) Chloramphenicol. (b) Recurrent chest infections.
(c) Cefuroxime. (c) Hoarseness.
(d) Ciprofloxacin. (d) Epigastric discomfort.
(e) Metronidazole. (e) Repeated failure to wean from a ventilator.

doi:10.1093/bjaceaccp/mkl023
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Multiple Choice Questions

14. With regard to preoperative assessment of the 20. Indications for the use of NMBDs in the critically ill
cardiac surgical patient: include:
(a) Canadian Cardiovascular Society class IV angina pectoris always indicates (a) To decrease intracranial pressure.
the presence of significant coronary artery disease. (b) To increase peak airway pressure.
(b) Advanced age is the single most important patient-related predictor (c) To decrease lung compliance.
of death. (d) Facilitate prone ventilation.
(c) Normal serum concentrations of urea and creatinine indicate normal (e) Tetanus.
renal function.
(d) Risk models, such as EuroSCORE, should be used to decide whether or 21. With regard to succinylcholine:
not a patient is suitable for surgery. (a) The risk of anaphylaxis is similar to other NMBDs.
(e) The presence of chronic pulmonary disease increases the risk of (b) The hyperkalaemic response after denervation or burn injury peaks
perioperative stroke. at 3 weeks.
(c) The hyperkalaemic response does not occur if the baseline plasma
15. The following data are obtained at cardiac potassium is normal.
catheterization; mean arterial pressure (MAP) (d) Cardiac arrest after its administration is more common in acute renal
65 mm Hg, left ventricular end-diastolic pressure failure patients.
2 mm Hg, mean right atrial (RA) pressure 5 mm Hg, (e) Cardiac arrest is more common in patients given succinylcholine
mean pulmonary artery pressure (PA mean) 15 mm Hg, on the first day of artificial ventilation.
pulmonary capillary wedge pressure (PCWP) 5 mm Hg,
22. With regard to non-depolarizing neuromuscular
cardiac output (CO) 5.0 litre min 1, heart rate (HR)
blocking agents:
90 min 1. The following statements are true: (a) The 3-OH metabolite of pancuronium has 20% of the neuromuscular
(a) The systemic vascular resistance (SVR) is 960 dyne s cm 5. blocking potency of the parent drug.
(b) The transpulmonary gradient (TPG) is 15 mm Hg. (b) The 17-OH metabolite of rocuronium has similar neuromuscular
(c) The right ventricular stroke volume (SV) is 90 ml.
blocking potency to the parent drug.
(d) The pulmonary vascular resistance (PVR) is 2 Wood units. (c) The 3-OH metabolite of vecuronium is at least half as potent as
(e) The aortic valve is competent. the parent drug.
(d) The metabolites of mivacurium are inactive.
16. The following increase the risk of death and
(e) Vecuronium is mainly eliminated in the urine.
complications after cardiac surgery:
(a) A serum creatinine concentration of 180 mmol litre 1. 23. With respect to atracurium and cisatracurium:
(b) A history of femoro-popliteal bypass surgery.
(a) These drugs have similar pharmacokinetic profiles in the critically ill
(c) Class III angina requiring sublingual glyceryl trinitrate. to healthy patients.
(d) A LV ejection fraction of 55%. (b) The plasma laudanosine concentration after an equipotent dose of
(e) Myocardial infarction 2 months before surgery.
cisatracurium is five times higher than after atracurium.
(c) Cisatracurium and atracurium undergo the same degree of
17. The Glasgow coma scale:
disposition by Hofmann degradation.
(a) Reliably predicts outcome after coma.
(d) Plasma laudanosine concentrations are higher in acute renal failure
(b) Is a rapid and reproducible scoring system.
patients than in critically ill patients with normal renal
(c) Should only be used for traumatic brain injury.
function.
(d) Predicts 50% mortality for GCS <8 in traumatic
(e) Laudanosine crosses the blood–brain barrier.
brain injury.
(e) Of <12 is classified as minor injury.
24. Critical Illness neuromyopathy is more common
18. Concerning Total intravenous anaesthesia: in ITU patients:
(a) If they suffer from asthma.
(a) Propofol has a linear context-sensitive half-life.
(b) If they are receiving corticosteroids.
(b) The half-life can be predicted by the drug dosage.
(c) If they do not have neuromuscular monitoring.
(c) It requires a decrease of 80% from effect-site concentration
(d) If they are receiving aminosteroidal rather than
for emergence.
benzylisoquinolinium NMBDs.
(d) Is not influenced by renal impairment.
(e) If they are septic.
(e) Can always be modelled using zero-order kinetics.

19. The following are causes of respiratory failure: 25. Tracheal intubation at the scene of trauma is
(a) Hypercapnia. associated with:
(b) Prolonged neuromuscular block. (a) failure in more than 50% of cases.
(c) Hyperthyroidism. (b) a high success rate if attempted using a blind nasal route.
(d) Pickwickian syndrome. (c) a high success rate if a Combitube is used.
(e) Uraemia. (d) no neck movement if MILS is applied.
(e) a poor prognosis.

136 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006
 Multiple Choice Questions

26. Cricoid pressure: (c) Is associated with sulphonylureas.

(a) should be applied before induction. (d) Occurs with alcohol intoxication.
(b) can cause airway obstruction. (e) Always causes an acidosis.
(c) inhibits insertion of an ILMA.
(d) can improve the laryngeal view.
29. Metformin:
(e) is contraindicated in patients with a C-spine injury.
(a) Works only in the presence of insulin.
(b) Is contraindicated in patients undergoing coronary angiography.
27. Indications for orotracheal intubation after
(c) Is contraindicated in congestive cardiac failure.
trauma include:
(d) Decreases peripheral glucose uptake.
(a) facial burns.
(e) Is safer than phenformin.
(b) laryngotracheal disruption with airway obstruction.
(c) nasal bleeding.
(d) to enable wide-bore i.v. access to be established 30. Concerning lactate:
(e) Glasgow Coma Score (GCS) less than 8. (a) It can only be converted to pyruvate.
(b) 2500 mmol are produced per day.
28. Hyperlactaemia: (c) It is involved in the Cori cycle.
(a) Increases the anion gap. (d) It is easily cleared with haemofiltration.
(b) May be reduced with dichloroacetate. (e) It can be used as a substrate for oxidative metabolism by the heart.

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