Multiple Choice Questions
Diagnosis of death
1. Regarding cardiorespiratory death:
(a) Cardiorespiratory death can be diagnosed as soon as asys-
tole is confirmed.
(b) It requires two clinicians for diagnosis.
(c) Monitoring such as ECG and direct intra-arterial pressure
monitoring can help confirm asystole, but is not necessary
for confirmation of death.
(d) The person is declared dead after 5 min of confirmed asys-
tole followed by confirmation of the absence of pupillary
responses and lack of corneal reflexes and response to
painful stimulus.
(e) Death is recorded as the time that asystole is first documented.
2. Brainstem death:
(a) Can be diagnosed in a spontaneously ventilating patient.
(b) Can be diagnosed by any consultant acting alone.
(c) Is impossible to diagnose in a sedated patient.
(d) Cannot be diagnosed after hypoxic brain injury.
(e) Is confirmed after one set of ‘brain-stem tests’.
3. Regarding brainstem tests:
(a) The pupillary reflexes examine the function of the facial
nerve and the trigeminal nerve.
(b) Oculo-vestibular reflexes are examined by injecting warm
saline into the middle ear.
(c) A plasma potassium of less than 4.0 mmol litre21 should be
corrected before brainstem death testing.
(d) Apnoea testing need only be completed once.
(e) Motor response in the arms in response to nail bed pressure
excludes brainstem death.
Donation after circulatory death
4. Contraindications to renal donation after cardiac death (DCD)
include:
(a) Creutzfeldt-Jakob disease (CJD).
(b) Age .70 yr.
(c) Hepatitis C infection.
(d) Suspicious death.
(e) Acute tubular necrosis.
5. Regarding the Maastricht criteria for DCD:
(a) Most DCD donors are category III.
(b) Uncontrolled DCD donation should never be considered.
(c) Most DCDs occur in the intensive care unit (ICU).
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(d) Further information regarding category II patients is
required prior to consideration for DCD.
(e) Category IV patients have the best organ outcomes.
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6. Regarding organs from DCD:
(a) DCD kidneys cost the NHS more than donation after brain
death (DBD) kidneys.
(b) DCD kidneys function as quickly as DBD kidneys.
(c) DCD livers make a significant contribution to the donor
pool.
(d) Warm ischaemic time of .60 min is a contraindication for
liver transplantation.
(e) Pancreatic transplantation is often performed in combination
with kidney transplantation.
7. Regarding DCD:
(a) A patient should only be considered for DCD if they are
registered on the Organ Donor Register.
(b) The family can stipulate conditions regarding potential
organ recipients.
(c) Under some circumstances families can spend up to 5 min
with the patient following death prior to organ retrieval.
(d) The relatives can stop the donation process at any stage.
(e) An opt-out system for organ donation is soon to be
implemented in the UK.
Neurogenic pulmonary oedema
8. Neurogenic pulmonary oedema (NPO) may be the cause of
hypoxia in the following cases:
(a) An 18-yr-old male found hanged who was intubated at the
scene and has become progressively more hypoxic after
admission to the ICU.
(b) A gunshot wound to the head.
(c) A 58-yr-old female who has suffered a myocardial infarc-
tion and has been admitted to the coronary care unit
(CCU). Her Glasgow Coma Scale (GCS) is 15/15 and there
is no history of loss of consciousness.
(d) A 39-yr-old male who self-presented to the emergency
department following a fire at work and exhibits evidence
of hot gas and smoke inhalation.
(e) A patient in status epilepticus.
9. The following statements are true of the healthy lung:
(a) A typical pulmonary artery pressure is 65/40 mm Hg.
(b) Fluid accumulation in the alveolus is prevented by high
lymphatic hydrostatic pressure.
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(c) The net osmotic and oncotic pressures of the proteins and
salts in the plasma counteract the capillary hydrostatic
pressure.
(d) There is a sophisticated system to direct blood flow through
the pulmonary capillary bed, which can protect against high
right-sided heart pressures.
(e) Gas exchange takes place across a blood– gas barrier that
measures 0.2–0.4 mm.
10. The following are key components in the management of
hypoxia in the presence of traumatic brain injury prior to transfer
to a neurosciences centre:
(a) Permissive hypercapnia as part of protective lung
ventilation.
(b) Aiming for a high cardiac output state with peripheral
vasodilation.
(c) Intubation, sedation, paralysis, and invasive monitoring.
(d) Broad-spectrum antibiotics.
(e) Diuretic therapy.
11. Pulmonary oedema forming in the presence of pre-eclampsia
may be attributable to the following:
(a) Iatrogenic fluid overload.
(b) Primary endothelial cell dysfunction.
(c) Liver dysfunction.
(d) Raised right sided and pulmonary artery pressures.
(e) Cardiomyopathy.
Anaesthesia and childhood epilepsy
12. Regarding epilepsy:
(a) It occurs in 2% of the population.
(b) It is more common in adults than in children.
(c) 70% of patients will become seizure free within 5 yr of
starting treatment.
(d) The longer the period of remission the less likely epilepsy
is to recur.
(e) It is related to loss of presynaptic g-aminobutyric acid
(GABA) inhibition.
13. With regard to antiepileptic drugs (AEDs):
(a) Phenobarbitone, phenytoin and carbamazepine are enzyme
inducers.
(b) Carbamazepine, and ethoxamide are hepatotoxic.
(c) They may cause blood hypercoagulability and increase
thromboembolic risk.
(d) Felbamate can cause asymptomatic non anion gap meta-
bolic acidosis.
(e) They should be continued in the perioperative period as
they have short half-lives.
14. In perioperative anaesthetic management of an epileptic child,
which of the following is correct?
(a) In a child with tuberous sclerosis, preoperative echocardio-
graphy is required.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 3 2011
Multiple Choice Questions
(b) No sedative premedication is allowed if intraoperative
electrocorticography (ECoG) is planned.
(c) Sedative premedication should be given in normal doses to
anxious children when no intraoperative ECoG is planned.
(d) Regional anaesthetic techniques are contraindicated.
(e) There is a higher blood loss and need for transfusion in
younger children undergoing epilepsy surgery compared
with adults.
15. In paediatric epilepsy surgical management:
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(a) Multiple anaesthetics are usually required.
(b) Venous air embolism can complicate placement of grid and
strip.
(c) Hemispherectomy carries the highest morbidity.
(d) Awake craniotomy is never feasible.
(e) Postoperative admission to the high dependency unit
(HDU) should be planned after corpus callosotomy.
Consent issues for children: a law unto
themselves?
16. Consent for a child to undergo anaesthesia can be obtained
from:
(a) Any adult accompanying the child to hospital.
(b) Grandparents if the child lives with them.
(c) The biological father as biological fathers can always give
consent.
(d) A 15-yr-old with mild learning difficulties.
(e) A 14-yr-old who fully understands the proposed treatment
and anaesthesia.
17. The following usually have parental responsibility:
(a) All parents.
(b) Mothers and only married fathers.
(c) Fathers whose names appear on the birth certificate.
(d) Married step-parents.
(e) Mothers under 16-yr-old.
18. In an emergency situation, the following statements regarding
consent issues are correct:
(a) A signed consent form is necessary in order to proceed.
(b) Parents should be contacted before any treatment is given to
an unaccompanied child.
(c) An accompanying teacher may give consent.
(d) The child’s best interests are paramount in determining how
and when treatment is given if an adult with parental
responsibility is not present.
(e) If there is nobody available with parental responsibility,
treatment cannot be given until the Trust’s legal team agree.
19. Regarding refusal of treatment, the following is/are correct:
(a) If a parent refuses treatment for their child they cannot be
overruled.
(b) A ‘Gillick competent’ child’s refusal of treatment cannot be
overruled.
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Multiple Choice Questions

(c) Someone over the age of 18 yr can legally refuse life-saving
treatment against their parents’ wishes.
(d) Courts will normally not base a decision on the child’s best
interest but on the parents’ wishes.
(e) In an emergency, doctors have the right to treat children
regardless of the wishes of those with parental responsibility.
Information technology in anaesthesia and
critical care
21. When implementing an anaesthetic information management
system (AIMS) in a department:
(a) Technical barriers are the biggest obstacle.
(b) Training staff causes significant delays.
(c) The cost cannot be recouped.
(d) Continued technical support is required.
(e) There is not much to choose from between different AIMS.
22. Regarding anaesthetic information management system
(AIMS):

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20. Regarding clinical information systems (CIS) in critical care:
(a) They undoubtedly reduce charting and documentation time.
(b) Being electronic, they are always accurate.
(c) They can improve patient safety by means of electronic
prescribing.
(d) The cost is insignificant within current healthcare budgets.
(e) They facilitate audit.
(a) They are fully automated such that the anaesthetist does not
have to enter any data at all and can concentrate on other
tasks.
(b) They comply with the legal requirement to keep an anaes-
thetic record.
(c) They are uncommon at present.
(d) They may give reminders to the anaesthetist.
(e) They may help in patient management.

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114 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 3 2011