Multiple Choice Answers Dr Katie Ayyash and Dr Chris Smales

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Number of Candiates

1. What Could be the cause of sudden dyspnoea, raised JVP, systolic and diastolic murmurs in a patient with infective endocarditis

a) PE T

b) Inferior MI F

c) Aortic valve cusp prolapse T

d) Mitral valve prolapse F

e) Acute aortic dissection F

2. What biochemical results would you expect to find on a blood gas when ureters are sutured into the bowel:

a) Hypernatraemia T

b) Hypoglycaemia F

c) Metabolic acidosis T

d) Increase in blood urea T

e) Increase in blood creatinine T

3. In the coronary circulation

a) Increased oxygen demand is mainly met by increased oxygen extraction F

b) Lactate is a significant energy supply during exercise T

c) During coronary artery disease collaterals develop in endocardium T

d) Endothelin and nitric oxide exist in vasoconstrictor and vasodilator balannce T

e) Significant right coronary artery perfusion occurs during systole T

4. The pathways of pain sensation include: a) A-delta fibres that terminate in lamina I of the dorsal horn T

b) Second order neurones that ascend in the ipsilateral spinothalamic tracts F

c) C-fibres that release histamine and serotonin F

d) Synapses in the substantia nigra of the spinal cord F

e) Descending pathways in the dorsolateral columns T

5. Adrenaline in cardiac arrest a) Increases coronary and cerebral blood flow during CPR F

b) Reduced VF amplitude and frequency F

c) Increases oxygen consumption in VF T

d) When given during VF, improves the oxygen demand-supply ratio T

e) Has been shown to improve long-term outcome after cardiac arrest F

6. The following are true regarding cerebrospinal fluid a) CSF volume is approximately 5 Litres in normal adults F

b) CSF is produced at a rate of 5 Litres per day F

c) CSF volume is renewed nearly 5 times per day T

d) CSF secretion is reduced by acetazolamine T

e) Normal CSF has an absence of polymorphs T

7. In the transfusion of blood components a) The plasma K+ of stored blood can be up to 30mmol/L T

b) Levels of coagulation factors V and VIII are still 50% normal at 7 days F

in stored blood

c) Red blood cell viability is 35 days as a SAG-M preparation T

d) Red blood cell viability is defined as 50% survival 12hrs after transfusion F

e) SAG-M blood has a haematocrit of approximately 0.45 F

8. Hypothermia causes the following physiological changes

a) Apnoea below a core temperature of 30C F

b) J waves in the ECG indicating an increased risk of ventricular fibrillation F

c) Shivering that can increase basal heat production 5-fold T

d) A 50% reduction in cardiac output at 30C T

e) Increased parasympathetic activity in the brown fat of infants F

9. Direct arterial pressure measurement

a) Critical damping is ideal to ensure optimum trace F

b) The measurement system should have a natural frequency of about 100Hz F

c) A continuous flush device delivers 15ml/hr through the cannula F

d) Rate of rise of LV pressure is most accurately demonstrated by a system T

with a high natural frequency

e) Allows beat-by-beat measurement T

10. Antibiotic prophylaxis is currently recommended for patients with structural cardiac defects undergoing

a) Dental procedures F

b) Upper gastrointestinal endoscopy F

c) Bronchoscopy F

d) Body piercing F

e) Tattooing F

11. In sepsis

a) Tumour Necrosis Factor (TNF) is a pivotal cytokine and high levels T

are associated with a poor outcome

b) Low levels of circulating TNF receptors are associated with a poor outcome F

c) High mobility group protein (HMG-B1) is an important cytokine produced F

early in sepsis

d) Disseminated intravascular coagulation (DIC) is associated with high F

levels of protein C, anti-thrombin III and high platelet counts

e) The inflammatory response can be easily controlled and manipulated F

in clinical practice

12. Magnetic resonance imaging involves

a) Use if X-rays F

b) The use of powerful magnets that is directly harmful F

c) The use of magnets that are switched on and off during the scan F

d) Alignment of atoms with an odd number of protons and neutrons T

in the patient

e) Significant heating during lengthy procedures F

13. The following are appropriate whilst checking an anaesthetic machine

a) CO2 should be present in a cylinder unless requested to be absent F

by the anaesthetist

b) The nitrous oxide pipeline should read 100kPa when connected F

c) One should check that the flow through a vapouriser is in the T

correct direction

d) One should tests for leaks on the “back bar” or rotameters by occluding F

the pressure relief valve

e) Conical fittings of breathing systems should fitted with F

firm pressure

14. Myasthenia gravis

a) Is a disease of the presynaptic terminal of the neuromuscular junction F

b) Is usually associated with anti-acetylcholine receptor antibodies T

c) Commonly presents with sensory symptoms F

d) Patients are sensitive to depolarising neuromuscular blocking agents T

e) Plasma exchange is a useful long-term treatment F

15. Regarding elective aortic aneurysm repair

a) Prognosis from suprarenal and infrarenal aneurysms is equal T

b) All aneurysms greater than 4cm should be operated upon F

c) The use of a thoracic epidural has been shown to reduce hospital stay T

d) Preoperative ITU may have a role in the management of these patients T

e) All patients should have an echocardiogram prior to surgery F

16. Compliance of the lung

a) Is greater when measured under static conditions than under dynamic T

conditions

b) Is decreased when liquid ventilation is employed F

c) Is greater at the apices than the bases of the lungs of an upright man F

d) Is increased by breathing a gas mixture containing 79% helium

and 21% oxygen T

e) Is less at total lung capacity than at functional residual capacity T

17. Acclimatisation to an altitude of 5,000 metres usually results in an increased:

a) Red cell concentration of 2,3 dihydrophoglycerate T

b) Bicarbonate concentration in the cerebrospinal fluid F

c) Diffusing capacity for carbon monoxide T

d) Blood viscosity T

e) Cardiac output at rest F

18. Activated coagulation time

a) Is measured by the “Hemochron” ACT T

b) Is normally maintained at x3 normal ratio for cardiopulmonary bypass F

c) Is measured following in vitro factor X activation F

d) Is measured at 20C F

e) Is prolonged by haemodilution T

19. Sudden onset of complete heart block is associated with

a) An increase in stroke volume T

b) Variable intensity of the first heart sound T

c) Variable loudness of the first heart sound T

d) Cannon waves visible in the neck T

e) Syncope T

20. The following are recognised associations

a) Thrombocytosis and chronic myeloid leukaemia T

b) Beta thalassaemia major and raised total body iron T

c) Aplastic anaemia and Down’s syndrome F

d) Multiple myeloma and gout T

e) Polycythaemia and renal carcinoma T

21. Primary hyperparathyroidism is associated with

a) Renal calculi T

b) Ectopic calcification T

c) Increased serum phosphate F

d) An increase in serum alkaline phosphatase T

e) Peptic ulceration T

22. A urine specific gravity of 1.030 is compatible with

a) Diabetes insipidus F

b) Pre-renal failure T

c) Dehydration T

d) Normal renal function T

e) Chronic renal failure F

23. Tramadol

a) Supresses monoamine reuptake activity T

b) Acts on kappa opioid receptors T

c) Is moderately addictive F

d) Has active metabolites T

e) Is potentiated by carbamazepine F

24. Inotropes

a) Adrenaline may only be administered centrally F

b) The half life of adrenaline is 2-5 minutes T

c) Sodium bicarbonate inactivates adrenaline F

d) Noradrenaline is a part alpha agonist F

e) Noradrenaline may cause a contractile effect on the gravid uterus F

25. Physiological changes likely after brainstem death include:

a) Hypoglycaemia F

b) Pulmonary oedema T

c) Hyperkalaemia F

d) Hypothermia T

e) Elevation in circulating thyroid hormones F

26. Methicillin resistant Staphlococcus Aureus (MRSA)

a) Is a gram positive aerobic rod F

b) Is associated with excess mortality in critical care patient T

c) May be assumed to be eradicated after 3 clear swabs for infection T

control purposes

d) Eradication of carriage is with mupirocin nasal ointment and T

octenisan baths

e) In the UK 10% of staph aureus is methicillin resistant F

27. Regarding commonly used analgesics

a) Codeine is metabolised to morphine in the liver T

b) Codeine can be given safely with NASIDS T

c) Piroxicam has a high activity for the COX-1 enzyme F

d) Paracetamol can be given in a dose of 15mg/kg 6-hourly in children T

e) Tramadol acts only at opioid receptors F

28. The following increase cerebral blood flow

a) Sevoflurane T

b) GTN T

c) Propofol F

d) Mannitol T

e) Atracurium F

29. Which of the following statements regarding H1N1 viral pneumonitis is correct?

a) Fever may be absent in 30% of patients T

b) Studies show oseltaivir is well absorbed enterically in critically ill patients T

c) Myocarditis and pericarditis is common F

d) Inhaled Zanamivir is recommended in critically ill patients F

e) High dose systemic steroids are recommended in hypoxic patients with F

respiratory failure

30. Regarding fulminant hepatic failure

a) Infections are common among patients with hepatic failure and are F

usually associated with marked pyrexia and leucocytosis

b) Maybe caused by tetracycline T

c) It is defined as hepatic encephalopathy within 8 days of onset F

d) Monitoring of intra-cranial pressure may be indicated T

e) Coagulopathy should be corrected with clotting factors and fresh F

frozen plasma

31. Pin-index systems on cylinders

a) Is present in cylinders of all sizes F

b) Is a fail-safe method for preventing misconnection F

c) Is 2&5 for oxygen and 3&5 for nitrous oxide T

d) The pin is present on the valve block and matching holes on the yoke F

of the anaesthetic machine

e) Bodok seal provides a gas tight joint between the valve and yoke of the T

anaesthetic machine

32. Regarding cleaning of medical equipment

a) Decontamination is the process that destroys micro-organisms F

including spores

b) Pasteurisation is an example of disinfection T

c) Autoclaving removes spores T

d) Steam sterilisation is done at 121C for 20 minutes at 2 bar above F

atmospheric pressure

e) Ethylene oxide is toxic and explosive T

33. Maxillary nerve block at pterygopalatine fossa causes anaesthesia of:

a) Upper molar T

b) Lower molar F

c) Soft palate T

d) Anterior 2/3rd of tongue F

e) Conjunctiva F

34. Alfentanil compared to fentanyl

a) Has a larger volume of distribution F

b) Is more potent F

c) Has a longer half life F

d) Is more lipid soluble F

e) Has a slower clearance T

35. Agglutination will occur if the following donor blood is given to the following recipients

a) Group O to group AB F

b) Group A to group O T

c) Group AB to group A T

d) Group A to group AB F

e) Group O to group A F

36. Metronidazole

a) Is commonly used in infections due to aerobic bacteria F

b) May cause peripheral neuropathy T

c) Has a high (>75%) bioavailability T

d) Acts on the bacterial cell wall F

e) Is highly protein bound F

37.Nerves that run in the superior orbital fissure include:

a) Lacrimal T

b) Frontal T

c) Supraorbital F

d) Nasociliary T

e) Infraorbital F

38. The following cross the placenta in significant amounts

a) Intravenous fentanyl T

b) Intravenous neostigmine F

c) Intravenous midazolam T

d) Epidural bupivacaine F

e) Intravenous ketamine T

39. The following are true of nerves

a) Pain and temperature sensation are transmitted via A-delta and B-fibres F

b) Somatic motor nerves are B-fibres F

c) Post ganglionic sympathetic nerves are C-fibres T

d) Touch sensation is transmitted by A beta fibres T

e) Preganglionic autonomic nerves are B-fibres T

40. The following are appropriate for cerebrospinal fluid

a) Protein 400mg/L T

b) Glucose 6mmol/L F

c) Chloride 80mmol/L F

d) Pressure 8cmH2O T

e) Less than 5 lymphocytes per mm3 T

41. Regarding the brachial artery

a) It lies medial to biceps T

b) It can be palpated over most of its course T

c) It is crossed by the median cubital vein T

d) It ends at the lower border of teres major by dividing into radial and F

ulnar arteries

e) It lies lateral to the median nerve in the cubital fossa T

42. ADH secretion is increased by:

a) Nausea T

b) Morphine T

c) Alcohol F

d) Increased blood volume F

e) Hypoxia T

43. Regarding the blood supply to the spinal cord

a) The anterior spinal artery supplies the anterior third F

b) The posterior spinal artery arises from the vertebral artery F

c) The artery of Adamkiewicz is more common on the right F

d) There is only one posterior spinal artery F

e) The only direct supply comes from the anterior and posterior F

spinal arteries

44. In the stomach

a) Gastric distension leads to increased acid secretion T

b) Parietal cells are mainly situated around the pylorus T

c) Chief cells secrete gastrin F

d) Pepsinogen and HCL are secreted by the parietal cells F

e) Pepsinogen secretion is increased by vagal stimulation T

45. NICE guidelines regarding venous thromboembolism

a) Recommend that aspirin can be used as an alternative F

b) Do not recommend warfarin T

c) Recommend unfractionated heparin in patients with renal failure T

d) Recommend that all patients should receive information on signs and T

symptoms of deep vein thrombosis and pulmonary embolism

before discharge

e) Recommend low molecular weight heparin for hip fracture patients T

46. Laryngeal masks maybe sterilised by

a) Autoclave T

b) Chlorhexidine immersion F

c) Ethylene oxide F

d) Ultrasonic cleansing F

e) Gamma irradiation F

47. The following will result from parasympathetic stimulation of the bronchi

a) Increased airway resistance T

b) Increased secretions T

c) Increased elastic work of breathing F

d) Increased resistive work of breathing T

e) Increased alveolar compliance F

48. Cerebral ischaemia occurring during carotid endarterectomy under general anaesthesia is directly aggravated by:

a) Dextran-containing solutions T

b) Hypothermia T

c) Hypoventilation T

d) Ketamine T

e) Barbiturates F

49. A Clarke electrode

a) Has an electrolyte medium of aluminium hydroxide F

b) Has a silver/silver chloride cathode F

c) Relies on a similar reaction to with the mitochondrion T

d) Requires a battery T

e) Has a copper electrode F

50. Dystrophia myotonica

a) Is a sex-linked recessive disorder F

b) Suxamethonium may make ventilation difficult T

c) Occurs in about 1 in 20,000 of UK population T

d) Is associated with cataracts T

e) May have cardiac conduction abnormalities T

51. Complications of patients fed enteral nutrition include:

a) Sinsuitis F

b) Pneumomediastinum F

c) Pneumonitis T

d) Diarrhoea T

e) Hypomagnesaemia T

52. Haemophilia

a) Treatment may include DDAVP T

b) Inheritance is autosomal dominant F

c) Is caused by a lack of factor VIII production in the liver T

d) Is suggested by a prolonged APTT T

e) Is characterised by purpura and bruising F

53. Regarding humidification

a) Larger nebulised droplets are a source of cross infection T

b) Hot element humidifiers are suitable for use with volatile agents F

c) The water bath method is inefficient because of the large bubble size F

d) Latent heat of vaporisation reduces efficiency of the hot rod humidifier T

e) Droplets produced by nebulisers may form pools of water if over 5m T

54. In paediatric burns

a) The head is 10% body surface area (BSA) T

b) The head has a larger BSA than adults T

c) The arms are the same as adults for BSA T

d) Each leg is 14% BSA T

e) The torso BSA is similar to adults T

55. Regarding drug pharmacokinetics in obese patients

a) The volume of distribution of atracurium is increased T

b) Glomerular filtration rate (GFR) is increased F

c) Volume of distribution of midazolam is increased F

d) There is an increased fraction of total body water T

e) Renal blood flow is increased T

56. Which of the following suggests a diagnosis of pre-renal failure in an oliguric patient

a) Urine specific gravity > 1.018 T

b) No urinary sedimentation F

c) Urinary Na > 20mmol/L F

d) Urine : plasma creatinine ratio > 20 F

e) Urine osmolality of 280 mosm/Kg F

57. Pulmonary hypertension has the following features

a) Pulmonary systolic pressure must be above 40mmHg F

b) Calcium blockers can reduce the pressure T

c) RBBB is a common feature of the ECG T

d) Primary disease is more common in males F

e) May follow COPD T

58. Acute tetanus due to clostridium tetani

a) Is treated with human tetanus immunoglobulin T

b) Is diagnosed by culture of clostridium F

c) May cause paralysis and need artificial ventilation T

d) Usually gets worse for 10 days following onset T

e) Beta blockers are used to treat sympathetic over activity T

59. Weil’s disease

a) Is treated with doxycycline, erythromycin and penicillin F

b) Transmitted in the urine of livestock and rats to human water supplies T

c) Caused by leptospira which are aerobic gram positive bacilis T

d) Mortality is 50% T

e) Causes vasulitis affecting all major organ systems T

60. The following drugs are bound to alpha-1-acid glycoprotein

a) Phenytoin F

b) Ibuprofen F

c) Lidocaine T

d) Warfarin T

e) Sulphonamides T