Multiple Choice Questions
Anaesthesia for shoulder surgery
1. Regarding the innervation of the shoulder:
(a) Shoulder surgery can be carried out using brachial plexus
block alone.
(b) The supraclavicular nerves arise from the lower trunk of the
brachial plexus.
(c) The suprascapular nerve innervates a significant part of the
shoulder joint.
(d) Cutaneous analgesia over the shoulder region is a reliable sign
of successful block.
(e) The axillary nerve is reliably blocked using an axillary
brachial plexus block.
2. Regarding interscalene block:
(a) Can be used as the sole anaesthetic technique for shoulder
surgery.
(b) Requires a distal motor response with a peripheral nerve stimu-
lator to provide a successful block.
(c) May occasionally cause total spinal anaesthesia.
(d) Will invariably cause hemidiaphragmatic paresis.
(e) Is suitable for ultrasonic location.
3. Regarding shoulder surgery:
(a) Neurological injuries as a result of surgery are extremely rare.
(b) The Bezold –Jarisch reflex may cause intraoperative
hypertension.
(c) Brachial plexus bock may cause long term neurological dys-
function in up to 2% of patients.
(d) Postoperative intra-articular analgesia with local anaesthetic
provides excellent analgesia after arthroscopic surgery.
(e) Cerebral ischaemia has been reported with patients in the
deck-chair position.
Portable ventilators
4. Most ambulances:
(a) Are fitted with inverters to provide a 240 V AC electrical supply.
(b) Have a 12 V DC outlet.
(c) Carry a pair of code HX oxygen cylinders.
(d) Deplete gas cylinders simultaneously and at an equal rate.
(e) Automatically switch between cylinders when one is empty.
5. During transport of a ventilated patient, the rate of oxygen con-
sumption depends on:
(a) Cylinder pressure.
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(b) Minute volume.
(c) The portable ventilator used.
(d) Bias flow.
(e) I:E ratio.
6. If a ventiPAC is set on ‘No Air Mix’ with inspiratory time 1 s,
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expiratory time 2 s, and 0.5 litres s – 1 inspiratory flow rate:
(a) The patient’s minute ventilation will be 10 litres.
(b) The rate of cylinder gas consumption will be 10 litres min – 1.
(c) The rate of cylinder depletion will be halved by setting ‘Air
Mix’ mode.
(d) A CD cylinder will last 44 min.
(e) A D cylinder will be adequate for a 30 min transfer.
Air leaks, pneumothorax, and chest drains
7. Regarding pneumothorax and air leaks:
(a) In a spontaneously breathing patient with a pneumothorax, the
pneumothorax needs to be drained if it occupies more than
15 –20% of the hemithorax.
(b) Resolution of a pneumothorax is speeded up by oxygen
therapy.
(c) The presence of air emphysema is a reliable sign of the devel-
opment of a pneumothorax.
(d) Large bore surgical drains are required in a spontaneously
breathing patient with a pneumothorax to drain adequate
volumes of air quickly.
(e) In the presence of a pneumothorax a drain should be considered
before a general anaesthetic procedure and major surgery.
8. Regarding pneumothorax and air leaks:
(a) An AP chest X-ray remains the gold standard for the diagnosis
of a pneumothorax.
(b) The radiological diagnosis of a pneumothorax is easier in the
ventilated ICU patient than the spontaneously breathing patient.
(c) Ultrasound is a recognized imaging technique to test for the
presence of pneumothorax.
(d) Tension pneumothorax is a recognized cause of cardiovascular
collapse.
(e) Pneumothorax and air collections may be accompanied by
venous air embolism.
9. Regarding pneumothorax and air leaks:
(a) Surgical emphysema, when generalized, spreads all over the
body symmetrically.
doi:10.1093/bjaceaccp/mkn043

(b) There are no clinical indications to drain air emphysema in the
absence of a significant pneumothorax.
(c) Air emphysema may be seen after facial fractures.
(d) Air emphysema may follow oesophageal rupture.
(e) Pericardial tamponade can result from air leaks into the
pericardium.
10. Regarding pneumothorax and air leaks:
(a) In more complicated cases of pneumothorax, failure of the
lung to expand within 48 h of the chest drain warrants referral
to thoracic surgery for surgical intervention.
(b) Massive air leaks may be stabilized by one lung ventilation.
(c) Regarding central venous catheterization, the internal jugular route
is a safe route of access in terms of the risk of pneumothorax.
(d) Aspiration of air from an introducer needle during subclavian
central venous access procedures is diagnostic that a pneu-
mothorax will develop.
(e) The lung may not completely collapse following a traumatic
or surgical opening in the visceral or parietal pleura.
Assessment of neuropathic pain
11. Chronic neuropathic pain should be suspected in a patient
reporting pain with the following features:
(a) Dynamic mechanical allodynia.
(b) No evidence of neurological dysfunction.
(c) Pain related to a 3-week-old injury.
(d) Sensory loss.
(e) Hyperalgesia.
12. Accepted causes of neuropathic pain include:
(a) Post-thoracotomy pain.
(b) Diabetic neuropathy.
(c) Irritable bowel syndrome.
(d) Persistent low mood.
(e) Multiple sclerosis.
13. Recognized neuropathic pain mechanisms include:
(a) Nociceptor sensitization.
(b) Reduced serotonin receptor activity.
(c) NMDA receptor activation.
(d) Mast cell activation.
(e) Increased expression of sodium channels.
Tracheal extubation
14. Postextubation laryngospasm:
(a) Is a protective reflex.
(b) Can be precipitated by insertion of an oropharyngeal airway.
(c) Can be treated with 1:1000 racemic epinephrine
nebulizations.
(d) The incidence in children after adenotonsillectomy is 20%.
(e) Laryngeal adductor neurons have a higher activation threshold
during expiration.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 8 Number 6 2008
Multiple Choice Questions
15. Tracheal tube exchange catheters:
(a) Can be used for respiratory monitoring.
(b) Should be considered when an awake intubation has been
performed.
(c) Can be kept in place for 3 days.
(d) Can be used for jet ventilation.
(e) Should be used in all obese patients.
16. Postobstructive pulmonary oedema:
(a) Pathophysiology includes increased right heart filling.
(b) Haemoptysis can be a prominent feature.
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(c) Is a very rare condition.
(d) Needs immediate reintubation.
(e) Usually occurs in patients with cardiopulmonary disease.
17. The following criteria may be used to assess suitability for
extubation in ICU:
(a) Cuff leak volume test.
(b) Maximum negative inspiratory pressure .30 cm of H2O.
(c) Endotracheal suctioning every 2 h or less.
(d) Peak expiratory cough flows.
(e) Vital capacity .10 ml kg – 1 ideal body weight.
18. The following assist with a smooth emergence and minimal
cardiovascular stimulation:
(a) Intravenous lidocaine 1%.
(b) Intracuff lidocaine 2% with 1.4% sodium bicarbonate.
(c) High inspired oxygen fraction during transfer to recovery.
(d) Intravenous magnesium.
(e) Oral calcium channel blockers.
Clinical tests: sensitivity and specificity
19. A receiver operating characteristic (ROC) curve:
(a) Is a plot of the false positive rate (x-axis) of a test and the true
positive rate (y-axis).
(b) Demonstrates how an increase in the false positive rate results
in a decrease in the false negative rate.
(c) Has an area under the curve (AUC) of 1.0 for a perfect clinical
test.
(d) Has an area under the curve (AUC) of zero if tossing a coin is
used to determine whether or not a patient has a condition of
interest.
(e) Allows different clinical tests for the same condition to be
compared.
20. The sensitivity of a clinical test:
(a) Refers to the ability of a test to identify patients without the
disease.
(b) Equals true positives/(true positives þ false positives).
(c) Depends on the prevalence of the disease in the population.
(d) Should be as high as possible when screening for a serious,
preventable or treatable condition.
(e) Defines how likely it is that a patient who tests positive has the
condition.
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Multiple Choice Questions

21. The specificity of a clinical test:
(a) Refers to the ability of a test to identify patients without the
disease.
(b) Equals true negatives/(true negatives þ false positives).
(c) Does not depend on the prevalence of the disease in the
population.
(d) Should be as high as possible when screening for a serious,
preventable or treatable condition.
(e) Says more about the test than it does about a patient who tests
negative.
(b) The infecting organism gains access via an intact skin.
(c) Incubation period after inoculation is 48 h.
(d) The primary chancre is usually a painful, soft nodule.
(e) Gumma formation occurs in secondary syphilis.
24. Following statements are true regarding investigations for
syphilis:
(a) Serology is positive in all cases of tertiary syphilis.
(b) VDRL test may show prozone phenomenon.
(c) The Wassermann reaction (WR) is not specific for syphilis.
(d) In the rapid plasma reagin (RPR) test antigen antibody

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22. The positive predictive value of a clinical test: complexes are formed.
(a) Is influenced by the prevalence of the disease. (e) The CSF in syphilis has a decreased cell count and low protein
(b) Will increase as the disease prevalence decreases. concentration.
(c) Equals true positives/(true positives þ false positives).
25. Which of the following is the most appropriate pharmacother-
(d) May be calculated using the Fisher’s exact test.
apy in syphilis during pregnancy?
(e) Equals sensitivity/(1-specificity).
(a) Erythromycin.
(b) Levofloxacin.
Syphilis in pregnancy (c) Metronidazole.
(d) Penicillin.
23. Which of the following statements relating to syphilis are correct?
(e) Tetracycline.
(a) Treponema pertenue is a causative organism.

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230 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 8 Number 6 2008