mrcp 2014

Question 1

1. In pure respiratory acidosis, the kidney augments plasma bicarbonate (HCO3-) by
   A. Combining C02 and H20 to form HC03’
   B. producing greater amounts of titratable alkalinity.
   C. secreting H2PO4 into the tubule in exchange for HCO3-.
   D. increasing plasma aldosterone.
   E. reabsorbing all the filtered HCO3
   -.

Answer 1

a

Question 2

3. A 25-year-old female presents with significant haemorrhage secondary to a ruptured ectopic
   pregnancy. Which blood component transfusion practice is MOST LIKELY to cause harm?
   A. Transfusion of A +ve packed red cells to an AB –ve recipient
   B. Transfusion of A –ve packed red cells to an AB +ve recipient
   C. Transfusion of AB +ve fresh frozen plasma to AB –ve recipient
   D. Transfusion of B +ve cryoprecipitate to an O –ve recipient
   E. Transfusion of AB –ve platelets to an O +ve recipient

Answer 2

a

Question 3

4. Which of the following is filtered at a higher rate than it is excreted yet is more concentrated in
the urine than in the filtrate?
A. inulin.
B. glucose.
C. para-amino hippurate.
D. urea.
E. water.

Answer 3

d

Question 4

6. Regarding normal physiological changes in a healthy pregnancy, which one of the following
   changes would NOT be consistent with expected changes?
   A. 10% increase in heart rate by 12 weeks gestation
   B. 20% increase in stroke volume by 12 weeks gestation
   C. 20% increase in red cell volume by 28 weeks gestation
   D. 20% increase in anatomical dead space by 28 weeks gestation
   E. 50% increase in glomerular filtration rate by 12 weeks gestation

Answer 4

d

Question 5

11. Regarding normal coronary artery blood flow, the following statements are true
    EXCEPT which one?
    A. Total left coronary artery flow is initially decreased by tachycardia
    B. At rest, right coronary artery blood flow is greater than left coronary artery blood flow at the
    beginning of systole
    C. Flow in the left coronary artery at rest may be as high as 100 mL/min
    D. Right coronary flow is at its lowest at the beginning of diastole
    E. At rest, peak left coronary artery flow may be six times higher than peak right coronary artery
    flow

Answer 5

d

Question 6

13. Regarding peri-operative fluid management, which one of the following statements is MOST
    CORRECT?
    A. In patients with acute kidney injury, potassium-containing balanced electrolyte solutions should
    be avoided
    B. High molecular weight hydroxy-ethyl starch solutions should be avoided in severe sepsis
    C. For patients with acute kidney injury, if free water is required 5% dextrose solution should be
    avoided
    D. In patients without gastric emptying disorders, oral water is acceptable pre- operatively except
    in the last hour prior to induction of anaesthesia
    E. Elderly patients are more likely to benefit from 4% dextrose/0.18% saline fluid as maintenance

Answer 6

b

Question 7

14. At rest and during light, moderate or heavy exercise the distribution of cardiac output through
    specific vascular beds varies. For a typical 70 kg male, the following statements are true EXCEPT?
    A. During heavy exercise, the cerebral blood flow is around 750 mL/min
    B. At rest, renal blood flow is 450 mL/min per 100 g of tissue
    C. At rest, skeletal muscle receives 20% of total cardiac output
    D. During heavy exercise, coronary blood flow increases ten-fold
    E. During heavy exercise, splanchnic blood flow falls to around 1 % of total cardiac output

Answer 7

d

Question 8

14. At rest and during light, moderate or heavy exercise the distribution of cardiac output through
    specific vascular beds varies. For a typical 70 kg male, the following statements are true EXCEPT?
    A. During heavy exercise, the cerebral blood flow is around 750 mL/min
    B. At rest, renal blood flow is 450 mL/min per 100 g of tissue
    C. At rest, skeletal muscle receives 20% of total cardiac output
    D. During heavy exercise, coronary blood flow increases ten-fold
    E. During heavy exercise, splanchnic blood flow falls to around 1 % of total cardiac output

Answer 8

d

Question 9

15. Regarding the physics of ultrasound, which one of the following statements is CORRECT?
    A. Application of a direct current causes piezoelectric materials to vibrate
    B. The speed of sound conduction through the human body is 940 m/s
    C. Differences in acoustic impedence of different tissues causing refraction of the incident beam is
    the basis of ultrasound imaging in the body
    D. For most applications in anaesthesia, e.g. vessel cannulation and regional anaesthesia, Amode
    display format is employed
    E. Anisotropy is an example of an ultrasound artifact where the echoic amplitude of a structure
    varies with the angle of insonation

Answer 9

e

Question 10

21. Regarding neonatal physiology, which one of the following statements is TRUE?
    A. A neonate has low levels of endorphins compared to adults
    B. A neonate has mature neuromuscular junctions by two weeks of age
    C. A neonate has 50% greater oxygen consumption than an adult
    D. A neonate has blunted parasympathetic reflexes
    E. A neonate has poor sympathetic response to bleeding

Answer 10

e

Question 11

19. Regarding the operation of a hydrogen electrode in order to measure pH, which one of the
    following statements is CORRECT?
    A. A special membrane is selectively permeable to H+ ions
    B. A calomel reference electrode describes a silver electrode in direct contact with silver chloride
    C. The ‘salt-bridge’ is potassium chloride
    D. A highly sensitive ammeter is required
    E. A unit difference in pH will produce a voltage of 6V

Answer 11

c

Question 12

Switzerland in the summer. You would expect all of the following changes to occur with this
endurance training, EXCEPT which one?
A. Significant increase in the resting stroke volume as well as maximal exercise stroke volume
B. Increased resting oxygen uptake, from 0.3 L/min to 0.5 L/min
C. Increased maximum oxygen uptake, from 2.8 L/min to 5.2 L/min
D. Hypertrophy of the heart, which is similar to the effects of hypertension
E. Delayed exercise-related rise in lactate

Answer 12

b

Question 13

26. Regarding capnography, which of following is the LEAST correct?
    A. Capnography is based on the principle that gases with two or more different atoms in the
    molecule will absorb infrared radiation
    B. The particular frequency of infrared radiation is selected by first passing it through a crystal
    window
    C. A reference cell increases accuracy of the system
    D. The use of infrared radiation with a wavelength of 4.28 μm for the analysis of carbon dioxide
    should reduce interference from the presence of nitrous oxide
    E. In the sidestream capnograph, a sample is drawn at about 150 mL/min

Answer 13

b

Question 14

27. A farmer slips and falls in a remote field during a hot summer. He has nothing to eat and his
    only drink is whisky from a hip flask. He is not found for 3 days. On admission to hospital he is
    peripherally cold, with a heart rate of 110 beats/min and a blood pressure of 85/40mmHg. Which of
    the following is the most potent stimulus for antidiuretic hormone release in this patient?
    A. Ingestion of alcohol
    B. Stimulation of central osmoreceptors
    C. Stimulation of aortic arch baroreceptors
    D. Pain
    E. Stress

Answer 14

c

Question 15

29. Which of the following statements are correct regarding tests of coagulation?
    A. Heparin therapy doesn’t affect prothrombin time (PT)
    B. A prolonged activated partial thromboplastin time (aPTT) may be due to hypofibrinogenaemia
    C. Haemophilia prolongs both PT and aPTT
    D. Thrombin time tests the conversion of prothrombin to thrombin
    E. Von Willebrand’s disease affects the PT but not the aPTT

Answer 15

b

Question 16

32. Which one of the following statements regarding anticoagulant agents is correct?
    A. Low molecular weight heparins have a greater ability to inhibit thrombin than to inhibit
    Factor Xa
    B. Fondaparinux is contraindicated for thromboprophylaxis in major joint replacement surgery
    C. Unfractionated heparin inhibits platelet activation by fibrin and also binds reversibly to
    antithrombin III
    D. Neuraxial blockade is acceptable 12 hours after ceasing an infusion of abciximab (ReoPro®)
    E. In heparin-induced thrombocytopenia, danaparoid (a heparinoid) should be avoided as an
    alternative agent

Answer 16

c

Question 17

33. Regarding colloid preparations for intravenous infusion, which one of the following statements
    is CORRECT?
    A. Gelofusine® consists of urea-linked gelatin component molecules
    B. Regarding penta-starches, the ‘pent’ refers to 50% esterification with succinyl groups
    C. Dextran 70 and 110 interfere with platelet aggregation and have an anticoagulant action,
    whereas Dextran 40 does not
    D. Gelatin used for medical colloids is derived from exposing collagen from sheep bones to a
    strong alkali then boiling water
    E. Heta-starch contains molecules with mean molecular weight of 450 kDa

Answer 17

e

Question 18

34. Regarding the use of anti-depressants for pain, which of the following statements are true?
    A. The dose of amitriptyline to treat neuropathic pain is higher than the antidepressant dose
    B. The onset of analgesic action is slower than the antidepressant action
    C. Amitriptyline is licensed for use in neuropathic pain
    D. Nortriptyline is less sedating than amitriptyline
    E. SSRI’s are more effective in treating neuropathic pain than tricyclic antidepressants

Answer 18

d

Question 19

35. A patient has a CT-confirmed retroperitoneal haemorrhage. He is on warfarin for atrial
    fibrillation. His international normalised ratio (INR) is usually stable between two and three. It is now
    eight, and this may be explained by the recent commencement of a new drug. Of the following
    drugs, which is the LEAST LIKELY to be responsible for the increased INR?
    A. Clopidogrel
    B. Paracetamol
    C. Amiodarone
    D. Fluconazole
    E. Metronidazole

Answer 19

a

Question 20

39. Regarding rivaroxaban, which one of the following statements is TRUE?
    a) It is a new oral direct thrombin inhibitor
    b) It is a pro-drug
    c) At therapeutic doses, it has a superior effect on venous thromboembolism rate compared to
    enoxaparin
    d) At therapeutic doses, it produces lower rates of bleeding complications compared to enoxaparin
    e) It has a half-life of two to four hours

Answer 20

c

Question 21

41. Which of the following statements regarding sugammadex is TRUE?
    A. It is a modified alpha-cyclodextrin
    B. The drug forms complexes with steroidal neuromuscular blocking drugs with a ratio of 1:2
    C. Following sugammadex administration to reverse rocuronium-induced neuromuscular
    blockade the measured total plasma rocuronium concentration will rise
    D. The majority of the drug is metabolised and excreted by the kidneys
    E. Sugammadex exerts its effect by binding with rocuronium at the neuromuscularjunction

Answer 21

c

Question 22

45. The most common cardiovascular effect of propofol after an intravenous induction dose is
    A. bradycardia due to decreased sympathetic outflow
    B. hypotension due to decreased SVR
    C. hypotension due to decreased venous return and cardiac output
    D. hypotension due to soya bean oil induced vasodilation
    E. bradycardia due to beta blocker effects

Answer 22

b

Question 23

50. Peak plasma concentrations of propofol will be higher after a 2 mg/kg I.V induction in a patient
    with hypovolemic shock due to
    A. Decreased hepatic blood flow and clearance
    B. Decreased protein binding and increased free levels
    C. Decreased circulation time
    D. Decreased volume distribution central compartment
    E. Decreased pH and increased unionized fraction

Answer 23

d

Question 24

59. Administration of inhaled nitric oxide most commonly causes
A. pulmonary oedema.
B. methaemoglobinaemia.
C. hypotension.
D. cyanosis.
E. increased intracranial pressure

Answer 24

b

Question 25

62. The analgesic ladder;
    A. Advocates the use of codeine as a less potent but safer opioid
    B. Recommends the use of adjuvant therapy when opioids are ineffective
    C. Recommends the PRN use of opioids to minimize adverse effects
    D. Recommends use of a single agent form each “rung” of the ladder
    E. When used as advocated provides 80-90% effective analgesia

Answer 25

e

Question 26

63. Breathing system filters act via the following potential mechanisms EXCEPT;
A. Interception
B. Inertial impaction
C. Electrostatic repulsion
D. Diffusion
E. Gravitational settling

Answer 26

c

Question 27

64. The medical gases used in anaesthetic practice include medical air, xenon and Heliox. Which of
    the following statements is true?
    A. Medical air is supplied to anaesthetic machines at a pressure of 4 bar
    B. Medical air is stored in cylinders with black bodies and black and white chequered shoulders
    at a pressure of 13,700 kPa
    C. Heliox (oxygen/helium mixture) has a lower density than oxygen and therefore is useful in
    conditions where flow is likely to be laminar
    D. Xenon has a low blood/gas partition coefficient (0.39)
    E. Xenon is a less potent anaesthetic agent than nitrous oxide

Answer 27

a

Question 28

66. Regarding a vacuum-insulated evaporator (VIE), which of the following statements are true?
    A. A VIE should be sited in the open air more than 2 metres from any combustible material
    B. A VIE should be large enough to provide 30days of average oxygen consumption for the site
    it supplies
    C. A VIE is constructed of an inner carbon steel shell and an outer stainless steel shell
    separated by a vacuum
    D. The pressure in a VIE is greater at the top than the bottom of the VIE
    E. All oxygen leaving a VIE to enter the pipeline supply of a hospital is heated

Answer 28

e

Question 29

67. Regarding the circle system, which of the following is true?
    A. Increasing the length of the inspiratory and expiratory limbs will alter the circuit dead space
    B. Circuit dead space will not be altered by failure of the expiratory unidirectional valve
    C. Placement of the fresh gas inlet between the patient and the expiratory unidirectional valve
    will allow re-breathing
    D. The adjustable pressure-limiting (APL) valve should be sited between the fresh gas inlet and
    the inspiratory unidirectional valve
    E. To maximize the lifespan of the CO2 absorber, the CO2 absorption canister should be
    located before the APL valve in the circle

Answer 29

c

Question 30

68. Regarding pipelines and medical suction, which of the following is true?
    A. All piped gases are supplied to theatre at 4 kPa
    B. Piped suction systems must generate a minimum of 80 kPa of negative pressure
    C. The gas outlet at the wall consists of non-interchangeable screw-thread (NIST) connections
    specific for each gas
    D. Piped suction systems must have a minimum flow rate of 20 L/min
    E. The gas outlet at the machine consists of Schrader sockets specific for each gas

Answer 30

b

Question 31

69. You devise a new cardiovascular monitor that requires light to be shone through blood at two
    different wavelengths at which absorption of light is unaffected by the relative proportions of
    oxyhaemoglobin and deoxyhaemoglobin. Which ONE of the following combinations of light
    wavelengths would be best?
    A. 545nm and 850nm
    B. 530nm and 815nm
    C. 585nm and 855nm
    D. 570nm and 905nm
    E. 590nm and 805nm

Answer 31

e

Question 32

70. Some basic knowledge of diathermy is required by the anaesthetist to ensure it is used safely.
    Which ONE of the following statements is true regarding diathermy?
    A. Bipolar diathermy uses a smaller power
    B. Diathermy usually uses direct current
    C. The frequency of the current is usually in the range of 0.5–1.0 Hz
    D. An alternating sine wave pattern is used for coagulation and a pulsed damped sine wave for
    cutting
    E. Pacemakers must be switched off before diathermy is used

Answer 32

a

Question 33

72. As the anaesthetist on a mountain rescue team, you are asked if there are any risks involved
    with using Entonox in cylinders as a form of analgesia for a rescue operation. What would be the
    most appropriate response?
    (a) The barometric pressure will lower nitrous oxide delivery
    (b) At a temperature of –10° C it would be safer to use a cylinder supply of Entonox than a pipeline
    supply
    (c) There is a risk of giving inadequate analgesia
    (d) Entonox is not a useful form of analgesia
    (e) There is a risk of giving a hypoxic mixture

Answer 33

e

Question 34

79. Regarding anaesthesia with the circle system,
    A. Calcium hydroxide is found in soda lime and is re-formed during the reaction with carbon
    dioxide
    B. Low-flow anaesthesia with a circle system is safe in patients who are intoxicated
    C. During low-flow anaesthesia, carboxyhaemoglobin levels may approach 3–4%
    D. A 500 g canister of soda lime can absorb > 120 L of carbon dioxide gas
    E. Prolonged low-flow anaesthesia with sevoflurane produces proteinuria, glycosuria and
    enzymuria, which can be detrimental to patients with pre-existing biochemical evidence of
    renal dysfunction

Answer 34

c

Question 35

80. A patient on the intensive care unit is being ventilated in a volume-controlled mode with a FiO2
    of 0.6. Arterial blood gas analysis reveals a PaO2 of 50 mmhg and a PaCO2 of 32 mmhg. Which
    ONE of the following is the best intervention aimed at increasing the PaO2 and minimizing adverse
    effects?
    A. Increase the FiO2 to 1
    B. Increase the tidal volume
    C.Increase the frequency
    D.Increase the inspiratory time
    E. Increase the expiratory time

Answer 35

d

Question 36

82. Which of the following is the most accurate description of the flow in a Rotameter?
    A. I t demonstrates turbulent flow throughout
    B. Calibration depends on both density and viscosity
    C. It demonstrates laminar flow throughout
    D. It demonstrates variable pressure throughout
    E. For any given flow rate setting, the Reynolds number increases towards the top of the
    Rotameter

Answer 36

b

Question 37

83. A heat moisture exchanger incorporating a standard high efficiency particulate air (HEPA) filter
    has a pore size as small as or smaller than all of the following pathogens, EXCEPT which one?
    A. Mycobacterium tuberculosis
    B. Staphylococcus aureus
    C.Legionella pneumophilia
    D.Mycoplasma pneumoniae
    E. Pseudomonas aeruginosa

Answer 37

e

Question 38

86. Which one of the following options is a TRUE statement regarding the intrinsic muscles of the
    larynx?
    A. The cricothyroids are the only muscles to tense the cords
    B. The posterior cricoarytenoids, supplied by the recurrent laryngeal nerve, adduct the cords
    C.Vocalis is supplied by the recurrent laryngeal nerve but is not considered an intrinsic muscle
    of the larynx
    D.Thyrohyoid elevates the larynx
    E. The internal laryngeal nerve supplies only one of these muscles

Answer 38

a

Question 39

87. Which one of the following statements regarding the anatomy of the brachial plexus is TRUE?
    A. The median nerve derives contributions from spinal nerve roots C5 to C8
    B. The upper, middle and lower trunks each have divisions that unite to form the posterior cord
    C.The axillary and radial nerves are both derived from the lateral cord
    D.The medial cutaneous nerves of the arm and forearm are branches of the ulnar nerve
    E. The lateral cutaneous nerve of the forearm is a terminal branch of the radial nerve

Answer 39

B

Question 40

88. Regarding the arterial supply of the spinal cord, the following statements are true EXCEPT
    which one?
    A. There are two posterior spinal arteries and one anterior spinal artery, all derived from the
    vertebral arteries
    B. The great anterior radicular artery (spinal artery of Adamkiewicz) most often arises at T10 on
    the left
    C.Some radicular arteries derive their supply from intercostal arteries
    D.The pia mater does not cover the spinal vasculature
    E. The anterior inferior spinal cord is more vulnerable to ischaemia than the posterior cord

Answer 40

d

Question 41

89. The following nerves must be anaesthetised when performing regional anaesthesia of the foot.
    Which nerve is readily amenable to location using the peripheral nerve stimulator?
    A. Superficial peroneal nerve
    B. Deep peroneal nerve
    C.Tibial nerve
    D.Sural nerve
    E. Saphenous nerve

Answer 41

c

Question 42

90. One complication at the time of insertion of surgical or percutaneous dilational tracheostomy is
    bleeding. The following are true of peritracheal anatomy EXCEPT?
    A. The left brachiocephalic vein crosses from left to right, anterior to the trachea
    B. The inferior thyroid veins run in the tracheoesophageal groove but form an anterior plexus
    C.About 50% of people will have a thyroid ima artery
    D.The thyroid isthmus lies anterior to the trachea at the level of the second and third tracheal
    rings
    E. The jugular venous arch lies anterior to the trachea superior to the manubrium

Answer 42

c

Question 43

90. One complication at the time of insertion of surgical or percutaneous dilational tracheostomy is
    bleeding. The following are true of peritracheal anatomy EXCEPT?
    A. The left brachiocephalic vein crosses from left to right, anterior to the trachea
    B. The inferior thyroid veins run in the tracheoesophageal groove but form an anterior plexus
    C.About 50% of people will have a thyroid ima artery
    D.The thyroid isthmus lies anterior to the trachea at the level of the second and third tracheal
    rings
    E. The jugular venous arch lies anterior to the trachea superior to the manubrium

Answer 43

c