Multiple Choice Questions

Preventing postoperative infection: theanaesthetist’s role

1. The following are recommended as a means of reducing post-

operative surgical site infections:

(a) Maintain normothermia intraoperatively.

(b) Administer prophylactic antibiotics.

(c) Avoid nitrous oxide.

(d) Wash with chlorhexidine preoperatively.

(e) Avoid propofol.

2. Prophylactic antibiotics are recommended during the following

routine surgical procedures:

(a) Total hip arthroplasty.

(b) Caesarean section.

(c) Cholecystectomy.

(d) Non-mesh hernia repair.

(e) Mastectomy for breast carcinoma.

3. The following classes of antibiotics may prevent bacterial

wound infection by skin commensals:

(a) Aminoglycoside e.g. gentamicin.

(b) First or second generation cephalosporin, e.g. cephazolin/

cefoxitin.

(c) Glycopeptide, e.g. vancomycin.

(d) Third generation cephalosporin, e.g. ceftriaxone.

(e) Penicillin þ anti b-lactamase, e.g. timentin.

4. The following antibiotics can be used as first line treatment

against Staphylococcus aureus (fully sensitive strain):

(a) Vancomycin.

(b) Cephazolin.

(c) Clindamycin.

(d) Timentin.

(e) Flucloxacillin.

Anaesthetic implications of neurologicaldisease in pregnancy

5. Concerning the anaesthetic management of a parturient with

raised intracranial pressure:

(a) A rise in intracranial pressure will compromise cerebral per-

fusion pressure.

(b) Esmolol is the preferred drug to prevent a hypertensive

response to laryngoscopy.

(c) Mean arterial pressure should be maintained below 80 mm Hg.

(d) Nitrous oxide can increase intracranial pressure.

(e) Treatment with mannitol does not compromise uterine

perfusion.

6. Regarding specific neurological conditions:

(a) A temperature rise can cause an exacerbation of multiple

sclerosis.

(b) The Pregnancy in Multiple Sclerosis (PRIMS) study showed

no difference in relapse rates in multiple sclerosis parturi-

ents receiving epidural analgesia.

(c) Epilepsy is the commonest co-existing neurological disorder

in pregnancy.

(d) Major obstetric haemorrhage is a risk factor for cerebral

venous thrombosis.

(e) Spinal anaesthesia is contraindicated in parturients with

benign intracranial hypertension.

7. Regarding specific neurological conditions:

(a) Epidural analgesia should be considered before labour com-

mences in parturients with spinal cord injury.

(b) Parturients with spina bifida need increased doses of local

anaesthetic for epidural analgesia.

(c) Tethering of the spinal cord is a recognized feature of

neurofibromatosis.

(d) Berry aneurysms are less likely to rupture during pregnancy.

(e) A parturient with myasthenia gravis is most likely to experi-

ence an exacerbation in the puerperium.

8. In a woman with a space occupying lesion:

(a) Regional anaesthesia is useful during labour.

(b) Labour may lead to dangerous increases in intracranial

pressure.

(c) Spinal anaesthesia may be used for lower segment

Caesarean section (LSCS).

(d) Pregnancy is rare.

(e) Combined neurosurgical and obstetric intervention have

been reported.

Perioperative care for lower limbamputation in vascular disease

9. With regard to lower limb amputation (LLA) secondary to vas-

cular disease:

(a) 30-day mortality rates are 3%.

(b) Above knee amputation (AKA) carries a higher 30-day

mortality rate than below knee amputation (BKA).

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(c) Coronary atherosclerosis is a common finding in this patient

group.

(d) The proportion of AKA compared with BKA has fallen

over recent years.

(e) LLA is often performed as an emergent procedure.

10. Regarding pre-assessment and optimization for LLA:

(a) Cardiac symptoms may often be masked.

(b) Statins should be discontinued in the perioperative period.

(c) Haemoglobin levels should always be maintained greater

than 10 g dl21.

(d) Prophylactic low molecular weight heparin should be

omitted for 24 h prior to neuraxial block.

(e) Blood glucose should be maintained below 10 mmol litre21

perioperatively.

11. Regarding pain management in patients undergoing LLA:

(a) Phantom limb pain is a significant complication of LLA.

(b) Pre-emptive analgesia with epidural infusions has shown

consistent reduction in chronic phantom limb pain.

(c) Significant preoperative pain is common.

(d) Local anaesthetic infusions via sciatic nerve catheters can

improve postoperative pain control.

(e) The routine use of non-steroidal anti-inflammatory drugs is

recommended.

12. In patients undergoing LLA:

(a) A single shot spinal anaesthetic is an appropriate regional

technique.

(b) The use of regional anaesthesia is associated with a

reduction in late POCD.

(c) Angiotensin-converting enzyme (ACE) inhibitors should

always be continued on the day of surgery.

(d) Preoperative assessment of exercise tolerance is often

problematic.

(e) A Quality Improvement Framework is in development to

reduce mortality.

Novel techniques of local anaestheticinfiltration

13. Concerning incisional local anaesthetic infiltration at the end

of surgery:

(a) The most important layer to infiltrate is the skin.

(b) It provides analgesia for 6–8 h.

(c) It reduces pain scores following both laparoscopic and open

cholecystectomies.

(d) It increases the risk of wound infection.

(e) The addition of NSAIDs, epinephrine and steroids has been

used to prolong the length and quality of analgesia.

14. Systems under investigation to provide ‘sustained release’

local anaesthetics include:

(a) Loading into liposomes.

(b) Incorporation into a degradable polymer matrix.

(c) Structural modification so as to increase vascular uptake.

(d) Inclusion in cyclodextrins.

(e) Modifying the local anaesthetic so as to contain a perma-

nent charge.

15. Continuous local anaesthetics infiltration technique using a

catheter has been proven to have:

(a) Minimal or no impact on the duration of hospital stay.

(b) Better results if the catheter is in deep muscle layer than in

subfascial planes.

(c) Higher rates of wound infection.

(d) Potential of local anaesthetic toxicity with higher rate of

infusion.

(e) Higher satisfaction rates with patients.

16. With regards to tumescent techniques:

(a) 1% lidocaine is the most commonly used local anaesthetic.

(b) High hydrostatic pressure within the tissues results in blood

vessel compression and delays systemic absorption of local

anaesthetic.

(c) A maximum dose of lidocaine 10 mg kg21 can be used in

the context of tumescent analgesia.

(d) Addition of epinephrine when performing a tumescent tech-

nique is hazardous.

(e) Tumescent techniques have been shown to result in reduced

hospital stays when compared with epidural analgesia fol-

lowing knee arthroplasty.

Ultrasound-guided peripheral upper limbnerve blocks for day-case surgery

17. When undertaking ultrasound-guided peripheral nerve block of

the upper limb:

(a) The nerves are normally hypoechoic.

(b) The short-axis view shows the nerves in cross section.

(c) A low-frequency transducer provides optimal views.

(d) The out-of-plane (OOP) approach shows the needle in cross

section.

(e) Local anaesthetic is hyperechoic.

18. Considering the sonoanatomy of the peripheral nerves of the

upper limb:

(a) The median nerve in the forearm is viewed between flexor

digitorum superficialis and flexor digitorum profundus

muscles.

(b) The ulnar nerve in the forearm is normally lateral to the artery.

(c) The musculocutaneous nerve at the elbow is medial to the

tendon of biceps brachii muscle.

(d) The superficial radial nerve in the forearm is medial to the

artery.

(e) Anatomical variants are relatively infrequent.

19. Concerning regional anaesthesia for ambulatory upper limb

surgery:

(a) It improves patient satisfaction.

Multiple Choice Questions

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(b) Ultrasound guidance can limit the extent of motor block.

(c) An arm tourniquet limits the operation time to 30 min in

the awake patient.

(d) Ultrasound guidance can reduce the volume of local anaes-

thetic required.

(e) Distal forearm block avoids motor block of the digital

flexors and extensors.

20. Concerning the innervation of the hand:

(a) The ulnar nerve does not innervate deep structures of the

hand.

(b) The superficial radial nerve supplies bony structures.

(c) The median nerve has a dorsal branch.

(d) The superficial radial nerve supplies the intrinsic muscles of

the hand.

(e) The ulnar nerve innervates the medial half of the fourth and

all of the fifth digits.

Anaesthesia for laparoscopic surgery

21. Laparoscopic surgery may induce the following haemo-

dynamic changes:

(a) Increased preload.

(b) Increased cardiac output.

(c) Increased pulmonary vascular resistance.

(d) Decreased peripheral vascular resistance.

(e) Decreased renal perfusion pressure.

22. Regarding well leg compartment syndrome:

(a) It may present postoperatively with myoglobinuria.

(b) It is increased with patients with muscular lower limbs.

(c) Peripheral vascular disease is a risk factor.

(d) It can be minimized by using ‘Lloyd Davis’ stirrups.

(e) It can be minimized by avoiding the use of intermittent

compression stockings.

23. Regarding raised intra-abdominal pressure:

(a) It may increase intracranial pressure.

(b) It may result in artificially low central-venous pressure

readings.

(c) It is an independent cause of acute kidney injury.

(d) It rarely affects hepatic blood flow.

(e) It does not cause physiological changes until above

15 mm Hg.

24. Concerning the effects of laparoscopic surgery on the respirat-

ory system:

(a) Functional residual capacity is raised.

(b) Total lung compliance is reduced.

(c) The flow characteristics of volume-controlled ventilation

make it a superior mode of ventilation in patients compared

with pressure-controlled ventilation.

(d) Laparoscopic surgery is contraindicated in patients with

severe respiratory disease.

(e) Laparoscopic surgery is contraindicated in patients with

right-to-left cardiac shunt.

Postpartum headache: diagnosis andmanagement

25. Which of the following are common causes of postpartum

headache:

(a) Non-specific headache.

(b) PRES.

(c) Meningitis.

(d) Post-dural puncture headache.

(e) Caffeine withdrawal.

26. Which of the following statements are true:

(a) Headache is a concerning feature in a patient with pre-

eclampsia in pregnancy.

(b) Approximately 25% of cases of PRES occur in pregnant

patients.

(c) There is an association between dural puncture and the

development of subdural haematoma.

(d) The incidence of subarachnoid haemorrhage is decreased in

pregnancy.

(e) The incidence of cerebral infarction is approximately 19 per

100 000 deliveries.

27. The following are true about post-dural puncture headache:

(a) It may occur in 50% of patients who experience uninten-

tional puncture on insertion of an epidural.

(b) It can occur after an uneventful procedure.

(c) It can be managed prophylactically.

(d) Conservative management is completely ineffective.

(e) Resolution is better when an epidural blood patch is per-

formed within 24 h of diagnosis.

28. The following are true about epidural blood patches (EBP):

(a) EBP should be first line of treatment in all patients

complaining of a headache post epidural for labour

analgesia.

(b) There is no risk of recurrence of headache following the

procedure.

(c) Written consent is essential.

(d) Blood cultures should be routinely performed.

(e) Injection of blood may result in the patient experiencing a

bradycardia.

Resolution in ultrasound imaging

29. Axial resolution is:

(a) The minimum distance that can be differentiated between

two reflectors located perpendicular to the direction of

travel of sound.

(b) Equal to the spatial pulse length

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(c) Improved by using a high-frequency transducer.

(d) Improved if wavelength is short.

(e) Improved by having an increased number of cycles in a

pulse of ultrasound.

30. Lateral resolution in an image containing pulses of ultrasound

scanned across a plane of tissue is:

(a) The minimum distance that can be distinguished between

two reflectors located perpendicular to the direction of

travel of ultrasound.

(b) Improved by using low-frequency transducers.

(c) High when wavelength is long.

(d) Using transducers of wide apertures.

(e) Improved when the near zone length is short.

31. Temporal resolution is improved:

(a) By increased depth of penetration.

(b) By increased number of focal points.

(c) By increased number of scan lines per frame.

(d) Using panoramic imaging.

(e) When using M mode imaging.

32. The number of shades distinguishable on an image is high

when:

(a) Compression is high.

(b) Dynamic range is wide.

(c) Colour is used.

(d) Each pixel of the computer image memory has many bits.

(e) A coupling gel is applied to the surface of a transducer.

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Multiple Choice Questions

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