Multiple Choice Questions - CEACCP

Multiple Choice Questions

1. Total body water content: (a) (b) (c) (d)

Is highest in infants aged 1–3 months of age. Is divided equally at birth between the ECF and ICF. Achieves adult proportions at puberty. Varies according to the proportion of adipose tissue rather than muscle mass. (e) Is lower in females than in males.

2. Concerning renal function at birth: (a) The glomerular filtration rate is only 25% of an adult’s. (b) Renal function matures slowly after birth over the first 6 months of life. (c) The neonate has difficulty in retaining sodium. (d) Neonates have an increased obligatory water loss. (e) Hyponatraemia will develop rapidly if sodium-free solutions are administered.

3. Concerning dehydration in children: (a) Tachycardia is a reliable indicator of hypovolaemia in children. (b) Blood pressure is a poor indicator of hypovolaemia in children. (c) Severe dehydration should be corrected slowly to prevent fluid overload. (d) 0.18% saline in 4% dextrose is an appropriate replacement fluid. (e) Adequate correction of dehydration shown by a urine output of 0.5 ml kg–1 h–1.

4. The following solutions can cause intra-operative hyperglycaemia: (a) (b) (c) (d) (e)

0.45% saline in 5% dextrose. 0.45% saline in 2.5% dextrose. Ringer’s lactate. Gelofusin. Blood.

5. Concerning the epidemiology of malignant hyperthermia: (a) The population prevalence of the genetic susceptibility is estimated to be between 1:5000 and 1:10,000. (b) If a patient has had previous uneventful anaesthesia with a triggering drug, they can not be susceptible to MH. (c) It is a sex-linked recessive disorder. (d) Fatal reactions do not occur in industrialised countries. (e) Reactions can occur at any age.

6. Concerning the pathophysiology of malignant hyperthermia: (a) The genetic defect is present in all the striated muscles of an affected individual. (b) All the features of an MH reaction can be explained by a failure of regulation of intracellular calcium ion homeostasis. DOI 10.1093/bjacepd/mkg007

(c) Binding of ryanodine to its receptor leads to the catastrophic fall in intracellular calcium levels. (d) Triggering of an MH reaction is independent of the concentration of trigger agent at its site of action. (e) Muscle breakdown leads to hyperkalaemia that may be lifethreatening.

7. In the context of general anaesthetic practice, malignant hyperthermia is the most likely cause of: (a) (b) (c) (d) (e)

Hypercapnoea and tachycardia. Postoperative pyrexia. Generalised muscle rigidity following succinylcholine. Unheralded cardiac arrest. A postoperative creatine kinase concentration twice the upper limit of normal.

8. Drugs that can be used safely in a patient known to be susceptible to malignant hyperthermia include: (a) (b) (c) (d) (e)

Lidocaine solution containing 1 in 200,000 epinephrine. Nitrous oxide. Desflurane. Atropine. Ketamine.

9. In the treatment of a malignant hyperthermia reaction: (a) Hyperventilation should be avoided as it causes vasoconstriction, limiting heat loss. (b) As long as dantrolene is available, sevoflurane may be substituted for isoflurane until completion of surgery because it is a weaker trigger of MH. (c) Dantrolene 1 mg kg–1 should be given intravenously every 15 min. (d) Calcium channel blockers (e.g. verapamil) are useful. (e) Recrudescence of the signs of an MH reaction can occur up to several hours after their initial resolution.

10. With regard to accidental electrocution: (a) The risk of ventricular fibrillation increases with increasing current frequency. (b) The risk of ventricular fibrillation is greater with alternating current. (c) The use of battery operated equipment avoids the risk of ventricular fibrillation. (d) The risks of electrocution is reduced by earthing the patient. (e) All electrical equipment in the operating theatre should be earthed.

11. Concerning surgical diathermy: (a) Bipolar operates at a higher power output than unipolar. (b) Should not be used if the patient has a pacemaker. (c) Bipolar requires a neutral plate.

British Journal of Anaesthesia | CEPD Reviews | Volume 3 Number 1 2003 © The Board of Management and Trustees of the British Journal of Anaesthesia 2003

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Multiple choice questions

(d) Burns may result from poor contact between the neutral plate and the patient (e) Burns may result from poor contact between the active electrode and the patient.

12. With respect to the classification of medical electrical equipment: (a) (b) (c) (d) (e)

Class I is represented by the symbol of two concentric squares. Class III can be connected to the mains. Type CF must have a maximum leakage current of < 25 µA. Type B can be of Class I, II or III. Class I requires a single fuse.

13. Isolated circuits: (a) (b) (c) (d) (e)

Are possible due to mutual inductance. Eliminates the risk of electrocution. Are earthed only on the mains side. A single transformer can isolate an entire operating theatre. Will still result in electrocution if the patient comes into contact with the live wire and is accidentally earthed.

14. Cardiac output is: (a) Left ventricular end diastolic volume minus the left ventricular end systolic volume multiplied by the heart rate. (b) Approximately 5 litre h–1. (c) Increased by increasing the afterload. (d) Reliably estimated by blood pressure. (e) Not an important variable in preventing organ dysfunction during severe illness.

15. Invasive haemodynamic monitoring provided by pulmonary artery catheterisation: (a) Directly measures systemic vascular resistance. (b) May allow identification of mitral valve closure during the cardiac cycle. (c) Measures left atrial pressure. (d) Can be complicated by VT,VF or complete heart block. (e) From the femoral approach, would produce a wedged trace at approximately 55–70 cm.

16. Concerning the measurement of cardiac output: (a) Peripheral venous lithium injection as a dilutional technique does not correlate well with central venous thermodilution methods. (b) Oesophageal echo uses a modified Fick principle to enable quantification. (c) Possible complications of the NICO include radial artery damage. (d) The PiCCO updates data every 60 sec. (e) Dysphagia is a possible contra-indication to use of transoesophageal echo.

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17. The following are true of phaeochromocytomas: (a) Phenylethanolamine-N-methyl transferase is the rate limiting enzyme in catecholamine production. (b) They tend to present in the elderly. (c) Alpha blockade is the main-stay of treatment. (d) They mainly secrete epinephrine. (e) The diagnosis of malignancy is made clinically rather than pathologically.

18. The following are associated with phaeochromo cytomas: (a) (b) (c) (d) (e)

Hypothyroidism. Medullary thyroid carcinomas. Neurofibromatosis. Cataracts. Cerebellar haemangioblastomas.

19. The following are true of the management of phaeochromocytomas: (a) Medical treatment is never an option. (b) All pregnancies should be allowed to go to term. (c) Postoperative hypotension may be resistant to norepinephrine administration. (d) Intensive cardiovascular monitoring is essential in the immediate postoperative period. (e) Hypertensive crisis does not occur during laparoscopic removal.

20. Concerning the physiological control of thermoregulation: (a) (b) (c) (d) (e)

It involves afferent input from cutaneous cold and heat receptors. The spinal cord is a passive conduit of afferent thermal signals. The hippocampus is an important control centre. Vasoconstriction is triggered by core temperature > 37°C. Shivering is activated at a specific threshold temperature.

21. Regarding the effect of anaesthesia on thermoregulation: (a) During the first hour, general anaesthesia causes a net loss of heat from the body. (b) Vasoconstriction threshold temperature is reduced. (c) Shivering threshold temperature is increased. (d) Hypothermia after induction is initially due to redistribution of heat within the body. (e) Spinal and epidural anaesthesia have no effect on thermoregulation.

22. Mild, peri-operative hypothermia: (a) Protects against ischaemic myocardial events in the postoperative period. (b) Reduces blood loss and requirement for blood transfusion. (c) Has no known influence on postoperative respiratory function. (d) Does not effect surgical wound healing. (e) May delay readiness for discharge from recovery room.

British Journal of Anaesthesia | CEPD Reviews | Volume 3 Number 1 2003

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