Multiple Choice Questions

67. In adult resuscitation:
(a) A lay person should check the carotid pulse for up to
10 sec.
(b) In the unconscious, apnoeic patient the rescuer should
seek help prior to giving rescue breaths.
(c) Up to 5 attempts to provide two effective rescue
breaths should be made.
(d) Chest compressions should be performed at a rate of
100 min–1.
(e) The pulse should be re-assessed every minute.
68. Amiodarone:
(a) Can only be given by central venous access.
(b) Is indicated for the treatment of Wolff-Parkinson-White
syndrome.
(c) Is diluted in normal saline.
(d) May be considered following the third defibrillation
attempt.
(e) May cause deranged thyroid function tests.
69. In defibrillation:
(a) Thoracic impedance decreases with subsequent shocks.
(b) Biphasic defibrillators use the same energy settings as
standard monophasic defibrillators.
(c) Automated external defibrillators can only be used by
healthcare professionals.
(d) The energy delivered should be altered to reflect the
different body size of adult patients.
(e) In pulseless VT, the shock should be synchronised.
70. A patient with symptomatic bradycardia at a
rate of 40 beats min–1 typically experiences:
(a) High blood pressure.
(b) Chest pain and dyspnoea.
(c) Facial flushing and ataxia.
(d) Should be treated with atropine 500 µg i.v.
(e) Increased risk of asystole if associated with ventricular
pauses > 2 sec.
71. The following drugs are currently used to treat
supraventricular tachycardias:
(a) Verapamil 5 mg i.v.
(b) Esmolol 40 mg over 1 min followed by infusion of 4
mg min–1.
(c) Lidocaine 50 mg over 2 min.
(d) Nifedipine 10 mg.
(e) Amiodarone 300 mg i.v. over 1 h.
72. Atrial fibrillation is associated with:
(a) Mitral stenosis.
(b) Acute alcohol intoxication.
(c) Multiple P waves on the ECG.
(d) Re-entry bypass tracts such as Wolff-Parkinson-White
syndrome.
(e) Increased cardiac output.
73. Amiodarone:
(a) May alter the effects of anticoagulants.
(b) Prolongs cardiac action potential.
(c) Causes a marked vasoconstriction.
(d) Is mainly excreted in urine.
(e) Can be administered by a peripheral intravenous cannu-
la.
74. Digoxin:
(a) Can be used in the treatment of atrial flutter.
(b) Can be used in the treatment of ventricular tachycardia.
(c) Overdose causes pathognomonic arrhythmias.
(d) Toxicity is increased by hypokalaemia.
(e) Toxicity is increased by hypocalcaemia
75. Carotid sinus massage:
(a) Involves firm rotatory pressure over the carotid sinus
against the transverse process.
(b) Activates the cardio-inhibitory centre.
(c) Can be complicated by brady/tachyarrhythmia.
(d) May cause stroke.
(e) Causes reflex inhibition of the vasomotor centre.

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© The Board of Management and Trustees of the British Journal of Anaesthesia 2002 125
Multiple choice questions
76. Broad complex tachycardias:
(a) Can be due to supraventricular tachycardia with aber-
rant conduction.
(b) Are usually better tolerated than narrow complex tachy-
cardia.
(c) QRS duration is less than 120 msec.
(d) If patient has averse signs, synchronised DC shock of
100 J is appropriate treatment.
(e) Can be treated with amiodarone 150 mg i.v. given over
10 min.
77. Indications for cardiac pacing in acute situa-
tions:
(a) Symptomatic bradycardia unresponsive to drug therapy.
(b) Symptomatic sinus nodal dysfunction/bradyarrhythmias.
(c) New bifasicular block first degree AV block.
(d) Möbitz type II second degree AV block.
(e) Alternating bundle branch block.
78. A 9-month-old infant has had a cardiac arrest:
(a) Two effective rescue breaths should be given.
(b) After 1 min of CPR, emergency help should be sought if
it has not arrived.
(c) Cardiac compressions are only started in the absence of
a palpable pulse.
(d) The compression ventilation ratio is 5:2.
(e) Two fingers can be placed in the midline one finger
breadth above the inter-nipple line over the sternum, to
perform cardiac compressions.
79. Regarding defibrillation in children:
(a) In the treatment of VF, the initial energy should be set at
4 J kg–1 body weight.
(b) It is important to remove any open source of oxygen
from the immediate vicinity when defibrillating.
(c) When using adult paddles on a child the alternate paddle
position is lateral (side-to-side).
(d) After the first three attempts at defibrillation, all further
defibrillation attempts should be at 4 J kg–1 body weight.
(e) After a change of ECG rhythm, one must then check
that spontaneous respirations have returned.
80. In a child who has sustained a cardiac arrest:
(a) Asystole is rarely due to hypoxia.
(b) Hypoxia should be treated by immediate tracheal
intubation.
126 British Journal of Anaesthesia | CEPD Reviews | Volume 2 Number 4 2002
(c) Pulseless electrical activity/EMD may be due to hypo-
volaemia, which should be rapidly treated by a fluid bolus
of 20 ml kg–1 body weight.
(d) The first dose of epinephrine should be 100 µg kg–1 if
the intra-osseous route is used.
(e) Basic life support must continue uninterrupted through-
out resuscitation except for pulse checks and defibrilla-
tion.
81. An 8-year-old boy presents in asystole, the fol-
lowing are good estimates:
(a) Body weight is 35 kg.
(b) Tracheal tube size is 6.0.
(c) The first dose of epinephrine is of 2.4 ml of 1:11,000
solution.
(d) An initial bolus of fluid for the treatment of hypo-
volaemia is 240 ml.
(e) The first dose of amiodarone is 120 mg by a single bolus
intravenously.
82. To be competent, a patient:
(a) Must understand the nature of a medical treatment.
(b) Does not need to be aware of alternative treatments.
(c) Must be able to retain the information in order to reach
a decision.
(d) Does not need to be able to communicate.
(e) Must be able to discuss treatments with their family.
83. Informed consent if the decision not for car-
diopulmonary resuscitation is made:
(a) Requires the patient to sign a consent form.
(b) Requires the doctor to be a competent communicator.
(c) Is mandatory in all cases.
(d) Does not require that the patients relatives are
informed.
(e) Requires the agreement of two doctors.
84. Advanced statements:
(a) Must be in written form.
(b) Cannot be over-ridden.
(c) Are legally binding.
(d) Do not permit patients to insist on cardiopulmonary
resuscitation.
(e) Are the same as advanced directives.