Neuroanaesthesia (Textbook) MCQs

Question 1

After head injury, increased intracranial pressure (ICP) is indicated by:

a) a fall in systemic blood pressure
b) a reduction of the Glasgow coma score
c) an increase in heart rate
d) an increase in Pa CO2
e) small pupils.

Answer 1

b) a reduction of the Glasgow coma score
d) an increase in Pa CO2

Question 2

In the diagnosis of brainstem death:

a) lack of EEG activity is essential
b) caloric tests must be performed bilaterally
c) the admitting consultant must certify death
d) lack of stretch reflexes in all limbs is essential
e) the pupils must be fixed and dilated

Answer 2

NONE of the answers are correct!

Question 3

A patient with a head injury becomes unconscious and develops signs of
raised ICP. Management in the acute phase includes:

a) craniotomy
b) treatment with mannitol
c) obtaining an electroencephalogram
d) performing an immediate lumbar puncture
e) ordering a digital subtraction angiogram.

Answer 3

a) craniotomy
b) treatment with mannitol

Question 4

The management of air embolism during posterior fossa surgery may include:

a) positioning the patient on the right side
b) administration of mannitol
c) raising cerebral venous pressure
d) discontinuation of nitrous oxide
e) rapid infusion of fluid

Answer 4

c) raising cerebral venous pressure
d) discontinuation of nitrous oxide
e) rapid infusion of fluid

Question 5

Regional cerebral metabolism is increased by

a) halothane
b) mannitol
c) pain
d) ketamine
e) sodium thiopentone.

Answer 5

c) pain

Question 6

In the diagnosis of brainstem death:

a) consultation with a neurologist is needed
b) an EEG must be flat for 24 hours
c) convulsions pre-empt the diagnosis
d) spinal reflexes may be present
e) blood must be sent for drug screening

Answer 6

d) spinal reflexes may be present

Question 7

The following statements are true:

a) CSF should be examined if a brain tumour is suspected
b) CSF is characteristically normal in trigeminal neuralgia
c) CSF protein greater than 1.5g may be found in motor neurone disease
d) CSF protein is raised in untreated meningococcal meningitis
e) CSF cell count is increased in Guillain–Barré syndrome

Answer 7

b) CSF is characteristically normal in trigeminal neuralgia

d) CSF protein is raised in untreated meningococcal meningitis

Question 8

Diplopia may occur in:

a) myasthenia gravis
b) retrobulbar neuritis
c) cerebellar hemisphere disease
d) Horner’s syndrome
e) multiple sclerosis.

Answer 8

a) myasthenia gravis

e) multiple sclerosis.

Question 9

In L5–S1 disc prolapse with sciatica in the right leg:

a) loss of the knee jerk occurs on the right
b) loss of sensation in the medial right calf occurs
c) incontinence requires further surgical investigation
d) plaster of paris cast is the preferred early treatment
e) scoliosis is commonly associated.

Answer 9

c) incontinence requires further surgical investigation

Question 10

Suitable anaesthetic techniques for patients with raised intracranial pressure are:

a) nitrous oxide, oxygen and fentanyl; controlled ventilation
b) nitrous oxide, oxygen, thiopentone and atracurium
c) ketamine
d) halothane, nitrous oxide and oxygen; spontaneous ventilation
e) premedication with morphine

Answer 10

a) nitrous oxide, oxygen and fentanyl; controlled ventilation

b) nitrous oxide, oxygen, thiopentone and atracurium

Question 11

Following a head injury, signs which suggest the need for urgent craniotomy include:

a) reduced conscious level
b) dilated pupil
c) hypotension
d) convulsions
e) CSF rhinorrhoea

Answer 11

b) dilated pupil

Question 12

A patient with paraplegia of recent onset with injury at T4 may have:

a) hypotension on IPPV
b) adductor spasm
c) bradycardia
d) hypothermia
e) urinary retention.

Answer 12

a) hypotension on IPPV
c) bradycardia
d) hypothermia
e) urinary retention.

Question 13

The following are reliable indications of air embolism:

a) a change in respiratory rate
b) arryhthmias
c) hypertension
d) delta waves on EEG
e) a mill wheel murmur

Answer 13

a) a change in respiratory rate
b) arryhthmias

Question 14

In the early detection of air embolus, the following are useful:

a) ECG
b) ultrasound
c) end-tidal CO2
d) fall in blood pressure
e) change in ventilatory pattern.

Answer 14

a) ECG
b) ultrasound
c) end-tidal CO2

Question 15

The following may contribute to the development of a postoperative cauda equina syndrome:

a) age
b) the use of adrenalin in epidurals
c) Trendelenberg position
d) spinal barbotage
e) marked intraoperative haemodilution.

Answer 15

a) age
b) the use of adrenalin in epidurals
e) marked intraoperative haemodilution.

Question 16

Immediately after complete transection of the spinal cord, the following occur:

a) flaccid paralysis with loss of sensation and reflexes
b) loss of motor function and sensation with no loss of reflexes
c) spasticity and increased reflexes
d) loss of sensation but no loss of power
e) loss of power but no loss of sensation.

Answer 16

a) flaccid paralysis with loss of sensation and reflexes

Question 17

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 years to recover from.

Answer 17

a) is more common after long operations

Question 17

In patients with increased ICP requiring a general anaesthetic, the following are especially dangerous:

a) fentanyl, nitrous oxide/oxygen and controlled ventilation
b) ketamine
c) spontaneous ventilation with nitrous oxide/oxygen and halothane
d) thiopentone/atracurium/ nitrous oxide/oxygen
e) a total intravenous technique using propofol and remifentanil.

Answer 17

b) ketamine

c) spontaneous ventilation with nitrous oxide/oxygen and halothane

e) a total intravenous technique using propofol and remifentanil.

Question 18

In a patient with a T4 injury, a safe technique for cystoscopy includes:

a) no anaesthesia
b) topical urethral local anaesthetic
c) spinal anaesthesia
d) thiopentone induction followed by nitrous oxide/oxygen/isoflurane anaesthesia
e) a total intravenous technique using propofol and remifentanil

Answer 18

c) spinal anaesthesia

d) thiopentone induction followed by nitrous oxide/oxygen/isoflurane anaesthesia

e) a total intravenous technique using propofol and remifentanil