Multiple Choice Questions

1. Regarding general anaesthetic activity: 6. The time that elapses between aneurysm formation
(a) The activity of general anaesthetics can be easily deduced from their and rupture is associated with:
chemical structure. (a) Aneurysm size.
(b) Unitary theories of general anaesthetic action dominate the current (b) Hypertension.
literature. (c) Smoking.
(c) Most general anaesthetics display a high oil:water partition coefficient. (d) Age.
(d) Neuronal cell membranes are composed of a homogenous mixture (e) Acute pain.
of lipid and protein.
(e) Some general anaesthetics display stereoselective activity. 7. Complications after thoracic aortic cross-clamp for
repair of descending aortic aneurysm include:
2. On possible targets of general anaesthetics: (a) Paraplegia.
(a) Transmitter-gated ion channels are the only targets for general (b) Myocardial ischaemia.
anaesthetic agents. (c) Renal failure.
(b) Transmitter-gated ion channels mediate the majority of fast (d) Hepatic failure.
excitatory and inhibitory neurotransmission within the CNS.
(e) Left ventricular overload.
(c) 5-HT3 and nicotinic acetylcholine (nAch) receptors usually inhibit the
activity of CNS neurones. 8. The following are the haemodynamic effects of
(d) GABAA and strychnine-sensitive glycine receptors inhibit the aortic cross-clamping:
activity of CNS neurones. (a) Decrease cardiac output.
(e) GABAB receptors are considered important targets for (b) Decreased CVP.
general anaesthetics. (c) Few changes in patients with good collaterals.
(d) Increased V_ O2 because of anaerobic metabolism distal to the clamp.
3. Concerning GABAA receptors:
(e) Increased afterload of left ventricle causing cardiac problems.
(a) GABA is synthesized after the enzymatic conversion of the excitatory
amino acid glutamate. 9. Hypotension after unclamping the thoracic aorta during
(b) GABAA receptors are composed of five subunits concentrically AAA repair is a result of:
arranged around an ion channel pore. (a) Myocardial depression from washout of metabolites.
(c) GABAA receptors are permeable to mainly chloride ions. (b) Pooling of blood in the periphery because of sequestration.
(d) To date, 18 mammalian GABAA receptor subunits have been cloned. (c) Citrate intoxication.
(e) GABAA receptors are widely expressed throughout the central
(d) Acute blood loss.
nervous system.
(e) Reactive hyperaemia.
4. In vitro studies: 10. OPCAB surgery:
(a) General anaesthetics compete with GABA at GABA binding sites on (a) reduces requirement for blood and blood products.
GABAA receptors. (b) protects against end-organ damage.
(b) General anaesthetics bind at distinct sites on GABAA receptors
(c) requires the services of a perfusionist.
to enhance the action of GABA.
(d) is associated with coronary steal with isoflurane and its use
(c) General anaesthetics are inactive in the absence of GABA.
should be avoided.
(d) Mutating a single amino acid within the GABAA receptor a subunit
(e) has proven long-term benefits.
alters volatile and i.v. anaesthetic activity equally.
(e) Four amino acids located in the transmembrane regions of the 11. In monitoring a patient during OPCAB surgery:
a subunit may contribute towards an anaesthetic binding pocket for (a) a pulmonary artery catheter (PAC) is mandatory.
volatile general anaesthetic agents. (b) ischaemic changes are impossible to detect using an ECG.
(c) transoesophageal echocardiography (TOE) has no value due to the
5. In vivo studies:
position of the heart during OPCAB.
(a) Knock-in mice harbour amino acid mutations within their genome.
(d) a reduction in SvO2 is caused by a reduction in cardiac
(b) Knock-in technology is associated with relatively few phenotypical
output.
changes.
(e) pulmonary artery pressures are not affected by the position
(c) The anaesthetic effects of etomidate are mediated by b3-containing
of the heart.
GABAA receptors.
(d) The sedative effects of etomidate are mediated by the b2-containing
GABAA receptors. 12. Haemodynamic changes during OPCAB surgery are:
(e) Certain clinical features of benzodiazepine are mediated by GABAA (a) caused by an increased venous return due to the use of the
receptors containing various a subtypes. Trendelenburg position.

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 Multiple Choice Questions

(b) reduced by opening the right pleural cavity. (d) Bilateral neck dissection is a risk factor.
(c) a consequence of blood having to flow upwards into (e) Vessels supplying the posterior part of the optic nerve are subject to
the ventricle. autoregulatory control while mean arterial pressure remains between 50
(d) the surgeon’s responsibility to manage. and 150 mm Hg.
(e) reduced if MAP is maintained >70 mm Hg.
19. During airway management:
13. Local anaesthetic toxicity in neonates is attributable (a) Oral injuries occur during 1 in every 100 anaesthetics.
to the following: (b) Injuries which occur are always minor and non life-threatening.
(a) Hepatic enzyme systems are immature for the first 3 months after birth. (c) Teeth are most commonly damaged in patients aged 50–70 yr.
(b) Local anaesthetics have a short plasma half life in neonates. (d) Tracheal rupture may occur by over-inflation of the
(c) The permeability of blood-brain barrier to local anaesthetics is reduced. tracheal tube cuff.
(d) Increased binding of local anaesthetics to plasma proteins. (e) Surgical emphysema may be the result of intubation-related
(e) The larger volume of distribution of local anaesthetics prevents injury.
accumulation.
14. Regarding the anatomy of the lumbar–sacral spine: 20. Limb tourniquets are contraindicated in the
(a) An imaginary line drawn between the two superior iliac crests following:
(the intercristal line) is above the lower level of the spinal cord at (a) Sickle cell disease.
any age. (b) Diabetes.
(b) The depth of the epidural space from the surface is best estimated using the (c) Elderly.
formulae age þ weight · 0.1 mm kg
1. (d) Deep vein thrombosis.
(c) The sacral hiatus is formed from the failed fusion of the 2nd to 4th posterior (e) Limb infections.
sacral arches.
(d) The spinal cord can extend as far down as the 4th sacral vertebra in 21. Concerning needles and additives:
neonates. (a) A Quincke needle should not be used for peripheral nerve blocks.
(e) Sacral anomalies are found in 5% of children. (b) Pencil point needles should not be used for peripheral nerve blocks.
(c) Short bevelled needles produce less nerve damage than long bevelled
15. Regarding caudal blocks in children: needles.
(a) They reliably block dermatomes below the umbilicus in all children. (d) Epinephrine-containing solutions are safe in all patients for sciatic nerve
(b) The most reliable method of identifying the sacral hiatus is by locating the block.
sacral cornua with the index finger.
(e) Addition of clonidine is the best method of prolonging the duration of
(c) The incidence of dural puncture is less than 1: 10 000. peripheral nerve blockade.
(d) Adding atropine to the local anaesthetic solution containing epinephrine
1:200 000 increases the sensitivity of the test dose. 22. Regarding nerve location in peripheral nerve blockade:
(e) 0.5 ml kg
1 of levobupivacaine 0.25% or ropivacaine 0.2% will reliably block (a) Injection of local anaesthetic with a minimum stimulating
dermatomes to the level of the umbilicus in children below 20 kg. current 0.3 mA is safe.
(b) A safe starting stimulator current is 1 amp.
16. Regarding epidural additives:
(c) 2 Hz is theoretically safer than 1 Hz.
(a) They can be safely used in infants under 6 months.
(d) Using a nerve stimulator will prevent nerve damage.
(b) They are used to extend the height of the block.
(c) Morphine can cause late onset respiratory depression because of its (e) A paraesthesia technique can be used.
low water solubility. 23. Regarding nerve damage after nerve blockade:
(d) Clonidine is an a2-adrenoceptor agonist which stimulates the descending
(a) It can present in the second week after operation.
norepinephric medullospinal pathway.
(b) It is the most common complication of regional
(e) Ketamine can prolong the mean duration of a caudal block by 12 h.
anaesthesia.
17. The following factors are associated with an increased (c) Peripheral nerve blocks should only be performed in awake patients.
risk of peripheral nerve injury during anaesthesia: (d) Neurotmesis is recoverable.
(a) General anaesthesia. (e) Peroneal nerve damage is more commonly reported than tibial nerve
(b) Hypotension. damage after knee arthroplasty.
(c) Elderly.
24. Concerning anaesthetic gas pipeline supply:
(d) Female.
(a) Nitrous oxide is supplied at 4.1 bar.
(e) Metabolic derangements.
(b) Unidirectional (one-way) valves are present.
18. Concerning postoperative blindness: (c) Schrader probes have collars with unique diameters to prevent miscon-
(a) The incidence is 1 in 25 000 anaesthetics. nection to the wrong gas service.
(b) The commonest cause is ischaemic optic neuropathy. (d) The integrity of the oxygen pipeline after repair may be tested with
(c) Some cases may improve with treatment. an oxygen gas analyser fitted at the common gas outlet.

Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 2 2006 91
Multiple Choice Questions

(e) Anaesthetists are responsible for ensuring gas 31. Cerebral autoregulation is maintained by:
delivery from the central gas source to the common (a) Propofol.
gas outlet. (b) Sevoflurane.
(c) Isoflurane.
25. In modern anaesthetic machines:
(d) Nitrous oxide.
(a) A computer-controlled, self-checking machine need not be manually
(e) Nitrous oxide and propofol together.
checked before use.
(b) Fresh gas flow in an electronic flowmeter system depends entirely on 32. In pregnant women:
a source of electrical power. (a) Presence of cardiac symptoms such as dyspnoea, heart murmurs and
(c) Oxygen control knobs are always white and positioned at the extreme peripheral oedema are always pathological.
left of the flowmeter bank, by international convention. (b) ECG changes such as axis deviation, premature beats and ST-segment
(d) A pressure relief valve (set at 30–40 kPa) situated downstream of the back abnormalities may be normal.
bar protects the machine against back-pressure surges. (c) Radiological investigations should be minimized, especially during the
(e) Automated anaesthetic record keeping (AARK) is invariably more accu- first trimester.
rate than a handwritten record. (d) Supine hypotensive syndrome occurs from the third trimester.
26. Concerning anaesthetic gas cylinders: (e) If resuscitation is deemed necessary, appropriate guidelines
(a) The pin-index system is a fail-safe method for preventing should be followed along with left lateral tilt to avoid supine
misconnection to the anaesthetic machine. hypotension.
(b) The pin-index system applies to cylinders up to size G.
33. With regard to drug effects in pregnancy:
(c) Bourdon gauges must be calibrated for each specific gas service.
(a) Drugs have the greatest teratogenic effects on the human embryo
(d) Primary regulators reduce high cylinder pressures to a machine
during the first trimester.
working pressure just above atmospheric pressure.
(b) Analgesia for procedures in pregnancy is essential to avoid deleterious
(e) Aluminium cylinders may be safely used on anaesthetic machines in
effects of stress on both mother and the fetus.
MRI locations.
(c) All NSAIDs can be safely given to pregnant women.
27. Nitrous oxide: (d) Surgery carries an increased risk in abortion and growth retardation
(a) Increases CBF. in the fetus.
(b) Decreases CMRO2. (e) MAC of volatile anaesthetics is increased by 30% during pregnancy.
(c) Maintains autoregulation when used with propofol.
(d) Maintains carbon dioxide reactivity. 34. Regarding surgery in pregnancy:
(e) Is an NMDA antagonist. (a) Elective surgery can be performed during pregnancy.
(b) Emergencies can be performed irrespective of gestational
28. Mild hypothermia: age if the condition carries a high risk to the mother’s life.
(a) Is beneficial in severe head injury. (c) Fetal well-being should be assessed before and after surgery and if
(b) Reduces mortality in head injuries. possible continuously during the procedure by Doppler.
(c) Is beneficial during the operation in aneurysm clipping. (d) Surgery during the second trimester is preferable as it has
(d) Improves outcome when used immediately after cardiac arrest. less risk of teratogenicity and abortion.
(e) Is usually used for 24 h after aneurysm clipping. (e) All elective surgery should be deferred until after 6 weeks
29. Hyperventilation: postpartum to allow the physiological changes of pregnancy to resolve.
(a) Causes cerebral vasoconstriction.
35. With regard to anaesthesia in pregnancy:
(b) Decreases CBF.
(a) Airway management can be technically difficult because of anatomical
(c) Decreases cerebral blood volume.
and physiological variations.
(d) Increases ICP.
(b) Aspiration prophylaxis is recommended from the beginning of the
(e) Has been proven to be of benefit in head injuries.
second trimester.
30. Triple-H therapy includes: (c) General anaesthesia is preferable to regional anaesthesia
(a) Hypocapnia. during pregnancy.
(b) Hypervolaemia. (d) Aortocaval compression is less pronounced in the lateral position com-
(c) Hypertension. pared with the wedged position.
(d) Haemodilution. (e) Thromboprophylaxis is essential in postoperative
(e) Hypothermia. pregnant patients.

92 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 2 2006