** Special Clinical Problems (Textbook) MCQs

Question 1

Recommendations to protect medical staff from AIDS include:

a) gloves
b) resheathing needles
c) gowns
d) goggles
e) autoclaving breathing systems.

Answer 1

a) gloves
c) gowns
d) goggles

Question 2

A man who is paraplegic because of a T4 injury is to undergo cystoscopy. A safe and effective management could be:

a) no anaesthesia
b) diazepam sedation
c) local analgesia to urethra
d) spinal (subarachnoid) block

e) thiopentone, nitrous oxide/oxygen, halothane general anaesthetic.

Answer 2

c) local analgesia to urethra
d) spinal (subarachnoid) block

e) thiopentone, nitrous oxide/oxygen, halothane general anaesthetic.

Question 3

In anaemia:

a) Pa O2 is reduced
b) blood is more saturated than blood at Hb 12g/dL
c) 2,3-DPG is reduced
d) blood should always be transfused prior to elective operation
e) elective operation can satisfactorily proceed 12 hours after blood transfusion.

Answer 3

b) blood is more saturated than blood at Hb 12g/dL

Question 4

The following are associated with difficult intubations:

a) rheumatoid arthritis
b) ankylosing spondylitis
c) sickle cell anaemia
d) Marfan’s syndrome
e) acromegaly.

Answer 4

a) rheumatoid arthritis
b) ankylosing spondylitis
d) Marfan’s syndrome
e) acromegaly.

Question 5

Sudden blood loss of 30% during surgery results in:

a) immediate fall in CVP

b) reduced urine output despite adequate maintenance of systolic BP

c) stimulation of baroreceptors

d) should be replaced if blood loss >15% blood volume

e) transfusion is only required if blood pressure falls.

Answer 5

a) immediate fall in CVP

b) reduced urine output despite adequate maintenance of systolic BP

c) stimulation of baroreceptors

d) should be replaced if blood loss >15% blood volume

Question 6

An elderly man given atropine becomes excited and confused; appropriate treatment includes:

a) morphine
b) physostigmine
c) intubation and ventilation
d) droperidol
e) chlorpromazine

Answer 6

b) physostigmine

Question 7

In dental anaesthesia:

a) oral debris inhalation is unlikely if the patient is supine

b) intermittent methohexitone is a satisfactory technique for the operator anaesthetist

c) the number of dental GAs is steadily increasing

d) demand flow anaesthetic systems result in economy of gases

e) simple monitoring is not essential.

Answer 7

d) demand flow anaesthetic systems result in economy of gases

Question 8

In the elderly:

a) systolic hypertension is common
b) ventilatory response to CO2 is normal
c) Pa O2 is less than in young adults
d) upper-airways reflexes are impaired
e) postoperative analgesic requirements are increased.

Answer 8

a) systolic hypertension is common
c) Pa O2 is less than in young adults
d) upper-airways reflexes are impaired

Question 9

Spinal anaesthesia for fractured neck of femur repair compared with general anaesthesia:

a) decreases mortality
b) reduces hospital stay
c) decreases the incidence of thromboembolism
d) provides better immediate postoperative pain relief
e) decreases intraoperative blood loss

Answer 9

b) reduces hospital stay
c) decreases the incidence of thromboembolism
d) provides better immediate postoperative pain relief
e) decreases intraoperative blood loss

Question 10

Goldman Cardiac Risk criteria include:

a) previous cardiac surgery
b) mitral valve disease
c) hypertension
d) atrial fibrillation
e) previous myocardial infarction.

Answer 10

d) atrial fibrillation
e) previous myocardial infarction.

Question 11

Warming blood to 37°C during massive blood transfusion:

a) decreases the risk of citrate toxicity
b) increases plasma potassium concentration
c) increases plasma carbon dioxide tension
d) decreases the incidence of arrhythmia
e) increases CO2 buffering capacity of cells.

Answer 11

a) decreases the risk of citrate toxicity
d) decreases the incidence of arrhythmia
e) increases CO2 buffering capacity of cells.

Question 12

Neuropraxia:

a) is more common after long operations
b) does not occur with local anaesthetics
c) does not occur with muscle relaxants
d) only occurs when previous neuropathy is present
e) takes a long time to recover from

Answer 12

a) is more common after long operations

Question 13

Factors leading to hypothermia include:

a) vasodilation
b) exposure of abdominal contents
c) neuromuscular blockers
d) spinal anaesthesia
e) dry gases.

Answer 13

ALL answers are correct!

Question 14

Concerning hip arthroplasty:

a) methyl-methacrylate is a cardiac inotrope

b) hypoxia may be caused by marrow embolisation

c) regional techniques are associated with a greater overall survival rate

d) subcutaneous heparin will completely prevent DVTs

e) hypocapnia produced by IPPV is beneficial.

Answer 14

b) hypoxia may be caused by marrow embolisation

Question 15

Concerning postoperative nausea and vomiting:

a) it is more common in women than men
b) the incidence is 80% with general anaesthesia
c) it is more common with thiopentone than with propofol
d) butyrophenones can decrease the incidence
e) it is more common with ear surgery

Answer 15

a) it is more common in women than men
c) it is more common with thiopentone than with propofol
d) butyrophenones can decrease the incidence
e) it is more common with ear surgery

Question 16

Concerning day-case surgery:

a) only ASA grade one patients are suitable

b) the operation should be performed in such a way that no postoperative opiods are needed

c) the patient should be accompanied home by an adult

d) a laparoscopic procedure is not suitable

e) tracheal intubation is not appropriate.

Answer 16

c) the patient should be accompanied home by an adult

Question 17

Agents used to decrease the pressure response to intubation include:

a) ACE inhibitors
b) calcium antagonists
c) thiopentone
d) beta-blockers
e) fentanyl.

Answer 17

ALL answers are correct!

Question 18

In patients with pacemakers:

a) diathermy use should be avoided
b) hypovolaemia is poorly tolerated
c) electrolytes should be ‘normalised’ prior to surgery
d) suxamethonium should be avoided
e) use of volatile agents can cause deterioration of function

Answer 18

a) diathermy use should be avoided
b) hypovolaemia is poorly tolerated
c) electrolytes should be ‘normalised’ prior to surgery
d) suxamethonium should be avoided

Question 19

TURP syndrome:

a) is associated with hypokalaemia
b) may present with convulsions
c) is prevented by spinal anaesthesia
d) is caused by blood loss
e) requires treatment with diuretics.

Answer 19

b) may present with convulsions
e) requires treatment with diuretics.

Question 20

The most common site of laryngeal granuloma after short-term intubation is:

a) the piriform fossa
b) the epiglottis
c) anterior one-third of the vocal cords
d) posterior one-third of the vocal cords
e) trachea

Answer 20

d) posterior one-third of the vocal cords

Question 21

A patient with vomiting, respiratory distress, cyanosis, epigastric tenderness and subcutaneous emphysema in the neck may be suffering from:

a) ruptured oesophagus
b) ruptured diaphragm
c) ruptured trachea
d) spontaneous pneumothorax
e) pulmonary embolus

Answer 21

a) ruptured oesophagus
b) ruptured diaphragm
c) ruptured trachea

Question 22

In patients with porphyria:

a) griseofulvin may precipitate an acute attack
b) glycine should not be used during TURP
c) dysautonomia may occur
d) preoperative fluid restriction is beneficial
e) fentanyl may safely be used.

Answer 22

a) griseofulvin may precipitate an acute attack
c) dysautonomia may occur
e) fentanyl may safely be used.

Question 23

For a patient suffering from Parkinson’s disease on L-dopa, the following agents should NOT be used:

a) enflurane
b) droperidol
c) nitrous oxide
d) morphine
e) fentanyl.

Answer 23

b) droperidol

Question 24

Cricoid pressure:

a) is effective in the presence of a nasogastric tube

b) requires a complete cricoid cartilage to be effective

c) should be performed with the neck extended

d) should be performed after 5 minutes’ pre-oxygenation

e) compresses the oesphagus against the cervical vertebrae.

Answer 24

b) requires a complete cricoid cartilage to be effective

c) should be performed with the neck extended

e) compresses the oesphagus against the cervical vertebrae.

Question 25

In the elderly:

a) chest wall compliance is decreased

b) vital capacity is decreased by 20mL each year

c) closing volume is less than FRC

d) PaO2 is lower than in the young

e) in a 70-year-old the alveolar/arterial oxygen difference is about 2.7kPa

Answer 25

a) chest wall compliance is decreased
b) vital capacity is decreased by 20mL each year

d) PaO2 is lower than in the young

e) in a 70-year-old the alveolar/arterial oxygen difference is about 2.7kPa

Question 26

The stress response to surgery may include:

a) postoperative oliguria for 12–24 hours
b) increased potassium excretion
c) decreased sodium excretion
d) increased nitrogen excretion
e) an ebb and flow period.

Answer 26

ALL answers are correct!

Question 27

Regarding myasthenia gravis:

a) IgE antibodies are found in 85% of patients

b) muscle weakness improves with exercise

c) muscle weakness is worsened by gentamicin

d) plasma exchange produces rapid remission

e) thymectomy is the treatment of choice in patients over 50.

Answer 27

c) muscle weakness is worsened by gentamicin

d) plasma exchange produces rapid remission

e) thymectomy is the treatment of choice in patients over 50.

Question 28

In the myasthenic syndrome there is:

a) sensitivity to depolarising muscle relaxants
b) sensitivity to non-depolarising muscle relaxants
c) post-tetanic potentiation
d) improvement with repeated muscle activity
e) decreased voltages on EMG.

Answer 28

b) sensitivity to non-depolarising muscle relaxants

d) improvement with repeated muscle activity
e) decreased voltages on EMG.

Question 29

Glycine:

a) is isotonic
b) is used in ankylosing spondylitis
c) is used in sickle cell anaemia
d) is used in Marfan’s syndrome
e) is used in acromegaly

Answer 29

a) is isotonic
b) is used in ankylosing spondylitis
d) is used in Marfan’s syndrome
e) is used in acromegaly