Multiple Choice Questions

45. Pregnancy-induced changes in lung volumes cause:
(a) Desaturation to occur more rapidly than in non-pregnant
patients.
(b) Pre-oxygenation to be more effective.
(c) Slow rolling eye movements.
(d) An onset at the beginning of sleep.
(e) Decreased hypoxic ventilatory drive.
51. Slow wave sleep (SWS) is characterised by:

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(c) A fall in minute ventilation due to restricted diaphragmatic
(a) Delta waves on the EEG.
excursion.
(b) Secretion of growth hormone.
(d) Airway closure in the erect position in 50% of parturients at
(c) An occurrence in the latter part of a night’s sleep.
term.
(d) Increased central cholinergic activity.
(e) An increase in PaCO2.
(e) Increased arterial PaCO2.
46. In the third trimester of pregnancy:
52. Concerning sleep after surgery:
(a) A mild elevation of g-GT and ALT is abnormal.
(a) It is associated with increased SWS on the first night after
(b) Alkaline phosphatase plasma concentrations return to normal.
operation.
(c) A plasma creatinine concentration of 120 µmol l–1 is a normal
(b) It is unaffected by opioid drugs.
finding.
(c) There is increased REM sleep on postoperative nights 2–4.
(d) A plasma urate concentration of 0.5 mmol l–1 is consistent with
(d) Postoperative hypoxaemia is worse on first night after operation.
the diagnosis of pre-eclampsia.
(e) It is more disturbed after major surgery.
(e) The platelet count is frequently slightly decreased.
53. Continuous positive airway pressure may:
47. Aortocaval compression:
(a) Impair carbon dioxide elimination.
(a) Does not occur before the end of the first trimester.
(b) Increase FRC.
(b) Is symptomatic in about 10% of parturients in the third trimester.
(c) Decrease airway resistance.
(c) Can be unmasked by the institution of effective epidural analgesia.
(d) Increase cardiac output.
(d) May occur on induction of general anaesthesia despite a wedge
(e) Reduce work of breathing.
under the parturients right hip.
(e) Can cause fetal hypoxaemia. 54. Obstructive sleep apnoea:
(a) Occurs in 20% of middle-aged people.
48. The following changes occur in the gastro-intestinal
(b) Is directly related to body mass index.
system during pregnancy:
(c) Is commonly treated surgically.
(a) Gastric emptying is delayed in the third trimester.
(d) Is a cause of cardiac morbidity.
(b) Lower oesophageal sphincter pressure decreases as a result of
(e) Commonly causes cor pulmonale.
progesterone-mediated smooth muscle relaxation.
(c) Upper oesophageal sphincter pressure decreases as a result of 55. Obstructive sleep apnoea patients presenting for
progesterone-mediated smooth muscle relaxation. surgery:
(d) Gastric volume increases in labour. (a) Do not present an increased risk of difficult tracheal
(e) 80% of term parturients suffer from gastro-oesophageal reflux. intubation.
(b) May require postoperative ventilation.
49. The following changes to the coagulation system are
(c) Should all receive adequate pre-operative sedation.
normal in pregnancy:
(d) Should have the availability of CPAP in recovery.
(a) The platelet count decreases to 50 000 mm–3.
(e) Should be nursed supine postoperatively.
(b) Parturients are hypercoagulable.
(c) There is decreased fibrinolysis. 56. With respect to induction of anaesthesia in infants:
(d) Platelet function increases in pregnancy. (a) Doses of intravenous agents (on a mg kg–1 basis) are
(e) Clotting screens will usually be reported as normal. relatively high in the neonate.
(b) Malignant hyperthermia has been reported in infants.
50. Rapid eye movement (REM) sleep is characterised by:
(c) Infants with intussusception should ideally receive a ‘rapid
(a) High amplitude low frequency EEG waveforms.
sequence’ technique.
(b) Reduced skeletal muscle tone.

DOI 10.1093/bjacepd/mkg091 British Journal of Anaesthesia | CEPD Reviews | Volume 3 Number 3 2003
© The Board of Management and Trustees of the British Journal of Anaesthesia 2003 91
Multiple choice questions

(d) The MAC of sevoflurane is greater in the older infant. 63.The following statements are true of Down’s syndrome:
(e) Babies should be starved for a minimum of 4 h. (a) Patients are often difficult to intubate.
(b) Postoperative stridor is often a problem.
57. Pre-operative assessment in fit infants having minor
(c) High dependency or intensive care is inappropriate post-
surgery:
operatively.
(a) Should include examination of the cardiovascular system.
(d) Hearing deficits may contribute to communication problems.
(b) Should include routine haemoglobin estimation.
(e) 25% of patients have epilepsy.
(c) Should include discussion about postoperative monitoring in the
ex-preterm baby. 64. The following are known risk factors for morbidity/
(d) Should include routine prescription of anticholinergic premedica- mortality following oesophagectomy:
tion. (a) Cardiopulmonary dysfunction.

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(e) Normally results in cancellation of surgery in the presence of (b) Renal impairment.
respiratory infection. (c) Pre-operative chemotherapy within 2 weeks of the operation.
(d) Liver dysfunction.
58. Concerning postoperative apnoea:
(e) Age.
(a) Its incidence can be reduced by the use of intravenous caffeine.
(b) All babies < 60 weeks’ PCA require apnoea monitoring and 65. The following should be monitored/used during all
oximetry postoperatively. oesophagectomies:
(c) It can be eliminated by the use of spinal anaesthesia. (a) Pulmonary artery catheter.
(d) It may go unnoticed clinically. (b) Pulse oximetry.
(e) It is more common in the anaemic ex-premature infant. (c) Epidural analgesia.
(d) Direct arterial pressure.
59. In the management of intussusception:
(e) Double lumen endotracheal tube.
(a) The most common causes of death are late diagnosis and inade-
quate resuscitation. 66. Concerning the morbidity and mortality of
(b) 70–80% require surgical intervention. oesophagectomy:
(c) Following laparotomy, analgesia can be provided by a continuous (a) Operative mortality in the best centres is < 5%.
epidural block. (b) Five-year survival is approximately 25%.
(d) Infants should receive a pre-operative transfusion if Hb is <10 (c) Respiratory complications occur in 10%.
g dl–1. (d) The incidence of pneumonia is lower following transhiatal, com-
(e) Infants should receive postoperative high dependency care. pared with transthoracic oesophagectomy.
(e) Recurrent laryngeal nerve palsy is more frequent following tran-
60. Peri-operative morbidity and mortality in infants:
shiatal, compared with transthoracic oesophagectomy.
(a) Is greater in neonates compared with older infants.
(b) Relates to the severity of congenital abnormality. 67. Concerning oesophageal cancer:
(c) Is decreasing due to the fall in incidence of cot death. (a) Squamous cell carcinoma is the most common histology type in
(d) Should be very low in pyloric stenosis and relates mainly to China.
surgery. (b) Adenocarcinoma is less common than squamous cell carcinoma
(e) Has been related to frequency of anaesthetic practice. in Europe and the US.
(c) Oesophageal cancer is a disease of middle-aged men.
61. Down’s syndrome:
(d) Metastatic spread is most commonly to the lung and liver.
(a) Is linked to chromosome 23.
(e) Most cases of oesophageal cancer are operable at the time of
(b) Has an increasing incidence with maternal age.
diagnosis
(c) Has an average life expectancy of 30 years.
(d) Affects many organ systems. 68. The following are associated with an increased risk of
(e) Involves the immune system. oesophageal cancer:
(a) Plummer-Vinson syndrome.
62. The following conditions are commonly found in
(b) Smoking.
patients with Down’s syndrome:
(c) Obesity.
(a) Atrioventricular canal defect.
(d) Peptic ulceration.
(b) Klippel-Feil syndrome.
(e) Alcoholism.
(c) Atlanto-axial instability.
(d) Hypothyroidism.
(e) Large bowel carcinoma.

92 British Journal of Anaesthesia | CEPD Reviews | Volume 3 Number 3 2003