on Mca, Maid Cpe To, Sngoor. So Palo rat re The tnurgh Bu, Cami C2 20, "Plann the une iat of Ama by Cambridge Un re Kew York sm amber ‘nlm on ie mcm igi 70521677058 ‘© ri Pre 2005 Tipuberon incon at tosanerexepton ‘nthe pron a ences manag opto, Fes ood 205 be inte Unt ipo st Urey Pes, cante ject Marae Gavin Sth Ges Psling enone Acoli od ori est walle ram te Bh roy rior uo Pes snag othe pertene oan os fo cara erty rt mab ceed ons pason sae aea ot Sivrte dt amy cee cn estates ah tenes ee ee ‘ey clus been ia preoung tn pubiaton wo pve ears and upsets nen whe aot wh ated sancarvens pees he tine of putction kha ae ana we a Were ees ee on rms aie etna cht ni vn so, {eta fee fom aro ot aeons tana econtani ei tuk Eseries eaten inn ner cal a pletion Read rongy ese pa evens atcon te nioneter eedEditor's Note ‘The examination The Royal College of Anaesthoits sets ninety question negatively ‘marked multiple choice examination (MICO) a the fst hurdle n't final fellowship examination. This mode of examination is selected because it \sbeleved to be a cost-effective means of comparing the perférmance of large numberof candidates against the performance of cohorts from [previous years. ts regarded as an objective measure of Breadth of Knowledge with questions representative ofthe entire yas ‘The minimum requirement t0 move onto the wine phase ofthe ‘.aminaton’s."1~’ but only 14% of those hosing aT" fom the MCO ‘wl pas overall. You should be aiming fora 2 the MCQ. 70% of hese ‘aida wil go onto pass the FRCA at that sting, The pss mark Fequired 0 achieve 22 probebiy lis between 46-53% but wll vary ‘tightly from year to yar based on the pertormance ofthe yeas chor ‘ona number of previously ued decrninstor or moderator qvesone Strategies for success “wo factors will determine whether you pass this negatively marked multiple 30 BB Metabolism of halothane I greater compared to non-obese . Foroperations of normal time duration, recovery rom volatile agers is increased 1. The laryngeal aperture fr mote likely to be high and anton ._Porpheral nerve stimulation to test neuromuscular blockade ‘sidentialto non-obese inalvduals 2 Tourniquets [AL Lower limb toueniquets shouldbe inflated to 200mm Tourniquet pain canbe prevented by sympathetic bk ‘The cu width should exceed half he diameter ofthe ib 9. Soft padding should always be used beneath a tourniquet Tourniquet painis mediated > € fibres I>. Concerning the Goldman cardiac risk index ‘A. scores patient undergoing cardac surgery B. Severe aor stenosis the highest indviual scorer Cot al high-risk patient are identified D. hata low zentivity Age >70 years ia rik factor 14 setae ttn indamentnis cep ‘A {sclssicaly frontal or occipital Ie more common in women _-- smorlitay with paramedian than miine approache— 'D. Is more common in pregnant than nonpregnant patients Neary always resolves without therapy io time WEEEEE os force rare(Qs. . cricoid prossure —@ bs atvo krown as Selick’ manoeuvre ~ 1. Is digital pressure on the ercothyrold membrane CG involes the use of 20 of force . performed using thumb and middle fingers only Should be maintained until the endotracheal tube cuff is inflated if the patient vomits during induction |A. Alarge bore 1V cannula shouldbe sites 'B. Inflation ofa oistal tourniquet prior tothe proximal one reduces tourniquet pain during the procedure © Prilocaine 2% the prefrred teal anaesthetic agent with thesafesttherspantc index . The principal contraindication ls systolic hypertension . Tourniquet deflation should cur mmedbtely the ? procedure i finihed t reduce ichaemic side effects The following are signe of adequate preoperative ‘preparation ofa patient who is to undergo excision of @ Dhaeochromocytoma [AL Nasal congestion 1B. Decreased frequency of howe! mations © orthostatic hypotension D. Deceased body weight E. increased haematocrit ie A. Oral hypoglycaemic agents shouldbe replaced by sulbartaneous insulin in the second wimester Tight ajcaemic contro is mandatory G_Anintravenous sulin efsion should be commence to cover labour . Urine glucose shouldbe tested regulary te guide insulin requirements The isk of foot! acidosis during Ibouris a cantrainccaion tothe use of epidural analgesia REE 4 or tieFnattacae [as [ph. Qn. i SGime Concerning blood products for transfusion A. Plasma reduced blood (PRB) consists of red calls supended in an aifical nutrient eoltion 8, CPD blood (citrate, devtose, phosphate) cooled to 4'Ccan be ‘stored fran amos indefinite period Cryoprecpitat rch in fibrinogen ‘The halite of transfused pateets about 4 days . Fresh frozen plas (FF) must be ABO blood group compaibie with the repent oo Concerning the anaesthetic management of « child requiring the removal of an inhaled foreign body A. Hypeintation ofthe lung ital to 2 ‘ballvalve’ obstruction Is best Seen with a chest radlograph taken on inspiration 18, The maximum dose of lignocaine spray for anaesthetsing the Taryn ond races 4-5mmgik9 {G. The Stor bronchoscope hasan attachment forthe anaesthetic breathing system 'D. The Negus bronchoscape i flexible bronchoscope Sunamethonium i relatively containdcated ‘The following can occur A. Supraventrculartahyearda during extracorporeal shock wave thorny 1B. Seizures with cobra angiography CG ingivat observation ofa patient during adition therapy . Bums with MRL Hypothermia during computed tomography Patients with sickle trait [A Have protection agains Plasmodium Flciparum 1B. Have approximately 40% HosS © Mayhave ashe clei exposed to hyposia 1B. Hovea pasitve sickle test . Often get aseptic necresis ofthe femoral head[0|13.-when preparing for awake intubation, Taste fom the anterior two thd ofthe tongue transite ‘Armanimum of 6 mg/kg cocaine may be wed topically (athe chord tympani in the seventh cranil nerve Ta dprsottriey tx enacainatuadaamnartor , Sensation trom the tip of the not sated in nerve tes i nae il fi ‘hat passthrough the foramen rotundum ‘G During wans-trachea injection it i: bes to atk tne patent to {Ramsay Hunt syndrome results 8 smal ieregular pupil breathe in before injection | accommodates but doesnot react to ight, 1. Nedulised lignocaine can Be used a the ony lca: ‘anaesthetic 19)17. Anticholinesterases . After using a fibreoptic instrument, dsnfectant should be passed trough it toclean it [A Contaloing a quaternary ammonium group are mor likely 0 8. Prolong SA and AV node conduction time [0|+4. Anaphylactic reactions © Cause pupillary contrition ‘A. Are type A adverse reactions D. Rekeve bronchospasm _® frees ecuentieharacteras by a dcresie in blood E Iereae intraocae presure . Blood or serum typtase evel shoud be taken immediately 116. Considering the renimangiotensin system 2x @ pt after treatment with adrenaline . Future investigation af the patient should involve skin testing &: Splronclacdone is an sitagooks at aldrterne recat A a fl teat eee “Angiotensin stimulates the elease of aldosterone apres CoraeTetoe Wotsoh ond © Aitensncomering eneyme (8 nor: spre th ‘poisons aiyernframacday ©. Spircnolacione i a potassumsparing diuretic Mortality in severe heart file treated by ACE inhibitors [0}25, The following are true Improved by adding spironolactone A. The fresh gas lew runs though the outer tube ofa coos Mapleson D breathing syste 119, Halothane Alok in he ine tbe ofa Bani case the bag to ie vaso paws 18 Is metabolised toa greater extent than enflurane or inoflurane 2 1G Gouses Bronchoconsrcton D. ismore negatively inotropic than enflurane E. Causes allen tahyeardla 2 fresh gas tow of 42min wil produce nrmocapnia in & 60-45 ventilated patent using » Mapleson D ceult 1D. AMapieion Arequites afresh gis flow of at least ‘Tomiegimin for eontolled vetiation There iso way to huiiy the Fresh ga low withthe Mapleson Fceut (220. Destturane [0}16. Concerning the cranial nerves [A Has. blood gas solubitty of 06 B, Has a MAC value that les than that of elopropane [A The third nerve supplies levator palpebrse superiors ©. Isaoproximately 2% metabolised B. The dlstee pupil eesn with aed intracranisl presut is due D. Hor bollag pele of 32°C te compression ofthe sth cranial nerve E, asa lower molecular weight than sevoflurane 6 ARE Cao i ex THC Forte Fal REA[0)21.-Concorning intracranial pressure (ICP) ‘A. Lumbar puncture rang the height of& CSF manometer to {Semis abnormal 1. Tonsllar (cerebellar) herniation causes psiateral pupillary aitaation Lundberg 8 pressure waves may be a soem finding ‘The effect of hypocapnia-inducedcerebrl varoconstrction is maintained after 12h Intracranial pressure monitoring fof ut in fulminant hepatie faire <—— en [)22. concerning the blood supply ofthe kidney A. The renal arteries vie into arterioles then capilaries then arterioles then vasa recta 8. The afferent artercles are move sensitive than the efferent toangiotensini GAdministration of non steroidal ant-nflammatory drugs (SAID) to norma Kidnoys reduces glomerular itation rate (GFR) by 20% 1D. Symptomatic urzeia usually develope when the GFR is about 15min . nthe normal young adult renal blood flow is about 1.200 permia [)22. concerning pulmonary function tests FEVSPVC of 50% suggests a restrictive defect In obstructive alzeste, the feta ang capacity fs typ abnormally laroe FEV, reduced by reducing airway resistance 1. FRCcan be measired using heli dilution . Penceluft may rest in ung teas with longtime constants filling dring expiration [Q)24, carbon Dioxide ‘A. Dituses rapidly across cll membranes 3B. Forms carbon cin erhrccyts, ts alsplaced from hae-neplobin by onygen FBR Coenen Sy . The value of oxygen uptakeiarbon donde outputs the cespiratory quotient E_ Thetotal amount disolved in body ues is approximately 12} 9125. The following mechanizms are involved in peripheral neuropathic pain |. Spontaneous activity in large myelinated A fibres 1. Schwann call deifferentiation Phosphoryation of the AMPA receptor . Increase production of choleytckinin . Sprouting of sympathetic nerve termina nthe dorsal hom 22 cocina sont ect ® C ives sr mpetnated fibres are rwolved in slow pein transmision © Both & deta and Fores symape inthe substan el . The principal ascending paths are the spinothalamic ta e Nerve fibres for temperature fellow the seme patincay ay fibres for ain 27, maortic stenosis A. Themurmurisclanically mid-systolic 1B symptomatic iassecated with an average survival of yeas (© A trarsvalvulr pressure gradient 10Ommell in hase patients with hepatorenal syndrome Factor 7 usualy reduced inliver disease Concerning acts spinal cord! uy |A. There are usually 2 anterior spinal arteries and 1 posterior spina artery supplying the spinal cord with Blood 2, Hypergljeanma s associated with s worse neurlogical {G. Patients receiving methylprednislone within 8h of Injury have better motor and sensory funtion inthe long term 1. The aeflenic phase of injury tsvaly ends between weeks ‘and 3 months afterwards , Sixammethonium becomes safe to use again after the araflexc phase FP RENE 14a fo the Frc t [ala0. igjar. Qa -® 106 is an insensitive monitor (as. “Cement use during orthopedic surgery A. Adeasa give B. ‘The cour ofthe volatte monomer sa biohazard © more effective ta hypotensive ansesthetie technique is sed 1. The rate of hypotension caused can be reduced by washing fut the bone eauity with normal saline 1, May be directly cardotone Concerning direct measurement of arterial blood pressure ‘A. Optimal damping offers the most rapid response of the futput wavelorm to change without amplitude overshoot 1B, When the damping coefficient equal 1. the damping s3idto be optimal . For faithfl reproduction of the shape ofthe ateri waveform the fist TO harmonics ofthe heart vate ae required . An overdamped system may ead tothe recerding ofa artetactually high pase pressure Cra damping it sai to orcur when the system jst fail to ‘oscilate in response to change Concerning trans-oesophagea! echocardiography (TOE) of air embolism < 1B Regional wall motion abnormalities Indicate myocardial ischaemia & Regions! wall motion abnormalities indicat tethered rnyocarium 1. Ejection fraction can be monitored continuously EE. The appearance of regional wall mation abnormalities may represent normal vanabily Concerning coagulation studies [A The protvombin time (PT) tests the extrinsic and common coagulation pathways 1. The activated dotting time (ACT normal valu is 30-408 The Biesding times normally 29min MEER 0 fe Fnai ven —- {1D. The thromboelastogramm gives litle Information about the Speed of formation and the quality of lot The activated portal thromboplastin ime (APTH is performed using plasma, calcium, brain extract and Phospholipid When assessing degree of residual neuromuscular blockade "Norma dal volume may be acleved with 80% receptor cxcupancy ‘Ahead lift canbe sustained with 75% receptor occupancy “ain of four count wll detect 50% receptor occupancy A normal hander is posible with 80% receptor occupancy Sustained tetanus a 100-H2 simulation Indicates complete pone > 5. intheccs ©x rt A AQwave in V6 is normal ‘AQ wave in tis anormal variant —@ Left atai hypervophy causes peaked P waves — B. Digoxin causes downeloping SF depression and T wave . Wolf-arkinson-wvhite syndeome is caused by an abnormal ‘nyocarcial connection between atrium and ventile (2146. Regarding temperature measurement [AL The Bourdon gauge realy # device for measuring presure 8B. infrared tympanic membrane thermometers are In common slneal use ‘G The thermocouple isan electrical technique for measuring temperature 1. The seabeck effect may be utised EElecarial temperature measuring probes have a heat capacity proportional to thei sie 147. in Fat Embolism syndrome ‘A. bolated respiratory inuficieny is common B.A characteristic petechial rash atfects the upper extremities ©. Aleftventicular stain patern fe frequently observed on 3 Plead £6 (a ELE 605 Tortie rissirnca 1. Deterioration in arterial oxygen tension precedes chest radiographic changes. . Trvombocytopaenia and hypocalcaemia are pathognomonic of the condition |9[a8. The following treatment strategies are appropriate in ‘ardiegenic shock A. Intra sorte balloon counterpulation pump B. Surgery seadreneraicreceptor agonists B. Sodium nitroprastide E. Amiodarone yment of an acute myocardial : Inferction should include ‘A. Thrombolytic therapy if ST elevation of 0.1 vis present in asjacont chest lacs (pid analgesia if the patient has chest pain Sublingual nifedipine if he patient is typertersive ramble therapy if aortic aisection suspected @'50, the following facts about tetanus are true ‘A. Gstrcium tetacvs an obligate anaerobic, spore-besting gram-negative bacius ._Notual immunity to tetan folows infection © The clinical effects oF tetanus are caused by the toxin tetanoiyin . tetaniis an evasive organism that i noncommunicable from persan to person Q Fonin binds o-y2mineburyrc acd (GABA terminal in the 19/51. The following complications are known to occur in severe sepsis xa } —® Pervsclarthromboembolim <= Hyposiyeemia bipersycaems 3. Negative nitrogen balance Gestsintstinaloemorage 8 E[9)52. Im hypothermia ‘A. Core temperature wil be <35°C 18. AF wave may be sen at the junction of the Pwave andthe (ORS complex {Renal blood flow initial increases 1. Respiratory drive ceases ata core temperate of around 30°C E, Asjtole ually occurs below 20°C Qls2. otwtiem [A \scused by 2 spore-forming gram-negative bails Is mostly caused by the contamination of weunde with C. Iseaused bythe effects ofan exotoxin . Prevent acetylcholine releave from neree endings Incremes lower li deap tendon reflexes [Q)s¢. tm acute severe asthma which requires mechanical ventilation i A. Ini PEEP it mead at he end of inspiration pulmensshypernfaion © Hypotension on ntiating vention shoul be trate with fea eotng 8, Laci scions ra recogni complain of pareneral Sagonitadmartcn Newromueclr blocking ag caue myopathy in vant sate [055. Te following modes of ventilation may be applied to ‘non-intubated patients a ow 8. Binar © ow B. sinv . Presure support ventiation [Q]56. tn carbon monoxide poisoning ‘A. COhas 250 times the afnty for haemoglobin than O, B. Pulse eximety and PaO, become inaccurate © ARENT rmen CO levels of 6% are compatible witha smoker Y 1 Disocation of cerboryhaemoglobin is increased by administration of 100% O, by simple focemask . CO tends to displace CO, molecules to form ‘arborhaemogiobin [Q)57. concerning pneumonia A. Heinfluencee isthe commonest cause of community acquired ‘pneumonia in previously well patients Streptococcal peumania often follows avr infection IMycoplasms preumonia often occurs In epidermis 3. Cold eggatinins occur in approximately 5% of patient with ‘nycoplasma pneumonia . ove spots may cur in patient with ChlomyainPitach preumonia Ws, Tefollowing cua matte acideds exept A. Saligyate poisoning Gulla Bare syndrome = ©. Acetazolamide acminstsion D. Drrhees Cyanide poisoning 58. A low plasma urea:ereatinine ratio occurs in A lve allure Patients on diuretic therapy . Paton on corticoeteroid therapy BL Cavaie flare Pregnancy |DE0. The following statements relating to perioperative nutritional support are correct [AL fal sclutons are nondnitants and may be administered by a perisherl intravenous infusion 1. Carbohydrate calorie are more efficent than lip calories © 20% ofthe total energy can be given as protein sources 1. Essential amin acids should constitute at leat 50% of the ‘oral nitvogen conten af any given feed , Arginine sn aminoacid thot fotitate nitrogen transport, i isthe maar Fuel for enterocytes EEE ete tence(lz. fos. HED te aa A 3 1S Ted Questions Concerning anaesthesia for neurosurgery [A Nitrous ode increases cerebral blood flow Mannitol may increase bleeding . steroids given to head injured patients are able xo control Ineracranial pressive - Phenyton shoul be given toa patient with an acute subdural haematome E. Dehydration suits in the contol of intracranial presire During magnetic resonance imaging A. tis nay There is sk of miroshock through pulmonary artery Looped fibreoptc cables lead t problems with induces _D. Howinvasive blood pressure measurement simposibie The magnetic field interfres with capnemetyy Hartmann’s solution 500ml contains A. Smmol of potassium 13timmet of chiride {mol calcium «— 1. 13tmmol of sodiam E. 29mmolof lactate ‘Concerning an inhaled foreign body |A. Mos objects ledge inthe left main bronchus ‘©xR may reveal unilateral eveinlation CC Postve pressure entiation shouldbe avoided . Nitrous onde shouts not be ures Removals sualy achieved by fesble bronchoscopy a c =) Concerning anaesthesia for laparoscopic cholecystectomy ‘The stomach shoud be aspirated of contents prior tothe commencement of surgery ‘Venous return maybe reduced ‘Antic compression can lead to hypatension Theresa rik oF explosion if laparoscope diathermy sued with CO; asthe inflating gas 1. Gas flow rates should not exceed nin Concerning anaesthesia for patients with Down's syndrome. ‘A. Congenital heart disease i common 1B Atlantoanalnsabilty occurs Hypertonis common D. The incidence of eit intubation i increased . The syndrome results fom trey 23 Regarding the anaesthetic management of a patient ‘essential hypertension ‘A ‘lective surgery shouldbe postpaned inthe presence ofa ‘repeated blood pressure reading of 180/10 mmig, '. The cardiac outputs considerably great’ than na age matched normotensive patient Preoperative optimisation of blood presure greatly red the subsequent risk of stroke occurring Inthe perioperatiag erie ©. Global mpocara ichaemia is common The slope of the downstrake of the atrial waveform retlecs the compliance ofthe systemic vascular Sel The following are recognised complications of lower segment caesarean section (LSCS) performed under regional anaesthesia kecp. Amniotic fui embolism 3. ivemboliom Delayed respiratory depression Mendeton's smarome Poor condition ofthe neonate at bith when the induction of 'naesthesia to celivery interval excoeds15mla oo ICO fo th Fil REAsn 2 [0]9. imhaemophitia “a: ‘A. Atleast 30% factor Vil activity is equired for surgery “Theres no platelet defeat ‘G. The prothrombin time is abnormal but the patil thromboplastin time nara . Males and females ae affected equally | Postoperative bleeding is decreased by tanexamic acd due {its mhibitry action on fibrnayss [}10. Regarding perioperative fluid balance in paediatric actice ERO PL 'A. Maintenance fluid should include gluco in an otherwise fit 8. intravenous infusions administered to children under 5 yeos cf age should routinely be supplemented ith potasivm © tomieghn isthe inracperative Mud volume requirement of healthy cid weighing up to 10kg 1. 03-0.5 lkgh of urine production consistent with adequate hydration Transfusion with blood canbe safely deferred until over 10% of the culating blood volume has been lost [Q)11. effects of electroconvutsve therapy (ECT include A. Elevated intraocular presure 1. Decreased cerebral blood ow Hypertension intial folaved later by hypotension 1. increased intragastric pressure Anthythmios [G)12, Athigh altitudes as compared to-sea level ‘A. A higher partial pressure of anaesthetic agent is requlved to produce anaesthesia 1. Aigher set concentration of destlrane i required to produce anaesthesia . Alveolar concentration of anaesthetic agent wil ned to be higher to achieve the same degree of anaesthesia 1D, TheFluote: Mark 2 vaporiter is unsuitable fr cinial use E. Ahigher set concervation of halothane s cequited to produce anzestres MERE cai: Finca 10/13, Anaesthetic considerations for phacochromocytomn ‘A. Blood pressure stabilises after tumour removal 3. Preoperative preparation should commence with an oral antagonist —D Cardiomyopathy an accur <— Magnesium suiphate shout not be used to contol hypertension peroperatively ., Only adrenaline (epinephrine) anc noradrenaline (worepinephrive) ae secretes (9114, Concerning the anaesthetic management of a Pre-eclamptic patient [A Tota body clearance of amie local anaesthetics prolonged '. Intubation can be more dificult due too swollen tongue G Higher doses of vasopresior are required in hypotendion associated with reolona Block 1. The action of non depotarting neuromuscular blockers prolonged with the concurrent use of magnesium sulphate : Epidural anaesthesia does not alter placental perfusion 215, The following associations are correct concerning ‘endobronchial tubes A. Carles tube has no carnal bok 1B. Robertshaw tubes only avaliable ina left-sided & Bryce-Smith tube has a carnal hook Lets tubes or utvlly prefered even for most sided surgery Brompton Palster tube Is passed into the right main bronchi 10116. The aortic and pulmonary valves A Hove three cusps 1. ive rise tothe second and thir heart sounds . re thinner than the atrioventricular valves, . Are seminar valves E. Aresunported by chordae tendinese Ms forthe Final FRE[Q]17. the following antihypertensives are correctly paire/! th iv. (a20. ia. 2 cao Fira ———— ‘their primary site of action ‘A. Thiazide diuretics: distal convoluted tubule 1B. blockers renin release . Prazosin wy adrenoreceptor . ACE inhibitors: conversion of angiotensinogen. . Calcium channel blockers: Lgpe Calcium channels in vescular smooth muscle S47 antagonists A. Cause dose-related extrapyramidal effects 2. improve agetelated memory Inpaiment . Are oll prokinetic ©. Diminis the high associated with heroin abe E. Aveamsoiytic Enfiurane ‘A. Typically Copresses the respiratory rate B. Causes retoxtachytardie & Common canes anincease in bronchi secretions. . Causes hypotension mainly by fs negative otropic ef E. Has bloed go solubility of25 ‘Comparing destlurane and isoflurane ‘A. Desftrane is more sabe than isoflurane Desflrane isles scuble bod than ottarone : Desfluane sxers a greeter degre ofcculatony depre!! than sotivrane D. Desflurane is metaboited to a greater extent than isoflurane ._Desfiurone is more pungent than iolurane ‘Concerning neuromuscular transmission ‘A. Adenosine and calcitonin gene-elated peptide (CGRP) a transmitters at the neuromuscular junction ‘During fscclaton muscle fibres contact synchronous! {© The presence ofthe nerve fore determines the yperet acetylcholine rector expres bythe muscle [)22. Concerning the foetal circulation A. The saturation of foetal arterial blood is approximately 65% a c >. e 9124. Blood pressure 8 c >. eB 12125, The following transmitters are present in the dorsal horn as part of the descending (inhibitory) pain ‘control system EEN 00 Fost Fin rac — ‘Stimulation of the parasympathetic nervous system Fancuronium increases release of noradrenaline fem sympathetic ner terminals Tetanc fade and ‘train of four phenomena result fom Presynaptic acetylcholine receptor antagonism The saturation ofthe blood in he umblial veins 80% Prostaglandin £1 i used 10 aid closure of patent ductus arteriosus DA) The resusctation of an intially apnoeic neonate should begin th assisted breeths at 40-500 The placenta protects the foetue from the transfer of local anaesthetic drugs Mydeiass Urinary sphincter relaxation Bronchial smooth muscle relaxation Gal bladder contraction GG woct sphincter relaxation tn the dorsalis pes artery is often higher than inthe ‘Most ofthe decrease in bood pressure between the arterial and venous system occurs inthe capillaries Pulss paradonus isan exaggerated decreese in systo blood pressure daring expiration, Isalteced by arial astenon ‘scontoled by the raube-Heringceflex Bradt Norairenatine€ onaceted with typo 1. Substance» DB. te feu of ete von c E._ Producing hepatorenal syndrome can be distinguished rom, typovoaemls ing rine and blood anal 35% of uma verteba a herition occur at the Lats ()20, Human immunodeficiency Vieus mein pedo [A Viral CO# antigens detectable in blood soon ater fection ans produced by contact ofthe prolapsed ic ith he pi tel ces eee Set aveh . Cytomegolouius ins common cause of eye cease B. Seroconversion folowing 3 needles injury wth own Hvinfeced blood oc in aprosinately 3 of ces, . ‘apo’ sarcoma may affect the lungs {S81 dic hemiation produces pain inthe buttocks, posterior ‘thigh anterolateral ower lim, redial foot and grect ee Up 1020% of he asymptomatic population demonstrate dsc Brolapse or spinal stenosis on Cr or MR eae ‘postive straight leq aise wil produce pan inthe appropriate dtibution at 60" elevation 131. concerning multiple sclerosis [A Suxamethonium may result in hyperkalaemia {Q)27, Patines in onic renal ata 1. There an increased incidence af eplesy E: Mere ear ncened iaees of rombootopaes A. Demonte sly ans sig ©: Sie doef nor depo agen ny beard © cenmon hve loge SO Tomer an eat ated ng &. Conan have romani omoct nia ®. Shou rate ghana sera & Ate given perioperative DDAVP to improve renal function SLA -aicep tie terre tomes, ‘A. tans coneni eset th sure mu pin 1828. concerning pulmanary hypertension 2: vers oon hvebo up aaewer mst ene A. It's defined as a mean PAP >15 mmHg poe G Intravenous immunoglobulin shoul be given a8 s00n as possible after diagnosis . Cerebellar signs are common . Bulbarpaby may accur Arie in FaCO, after edministion of oxygen in» COPD Datients due to the decrease in hypoxic tive ight ventricular hypertrophy is ctrl expressed by a lft parasternal heave Pulmonary hypertension sa recognised consequence of congerita horace kyphoxcoi “ype V phosphodisterate inhibitors are useful in the ‘management of right venticuls faire (29. Concerning thyroid function c= xcept? [A 39 of patients who have receive radioactive fodine therapy {or typerthyridsm wl become hypothyroid per yes" ‘hyraine and an antthyrod drug may Be gen for 29. Cone ver disease wee Hi & Nrpathyroisim ia couse of hyperchleeroiemia © rations with rypotyridae ad ichacr heat disease TS eave urgent tyrone therapy e— Cie res reduce srum i odothyroine levee © TERRES 05 ert tnaiica ~— a WORE icocccecngmeke A. Can bie clase according to child's criteria '. Spontaneous bacterial peritonitis acurs in fewer than 24% of ates with ascites(0134. concerning subarachnoid haemorthage ‘A. The commonest site fr a bey aneurym isthe junction of the posterior communicating artery andthe internal vot Of patients who rebleed, 70% wil de a ‘©. The most favourable time to operates 1 weck after the fst biced D. tn previously well patients, unruptured aneurysms <1 mm in iamete should ve prophylactically treated ESpstolic hypertension >160mnmig inthe postoperative Period should be trsted 9135, concerning carotid endarterectomy enol [A. The perioperative morality an disabling stroke rate i: 79% B. Alavi shunts equivalent 10 a 70% stenoxs, © Regional anaesthesia has to be converted to general in approimately 2% DB, Bilateral procedures result lows of hypo drive © Asymptomatic, severe (70%) carotid stenosis should be ‘peated on pri to coronary artery bypas grafting (CABG) (9136. tm paediatric cardine surgery ‘A Prostaglandin E1 may be used for maintaining the patency of ‘the ducts arteriosus in patients with ight te left sur B.A lalod-Tausigshnt isan anastamosis between pulmonary ater and suselavian ve ‘G. Thre Rashkind procedure is usually performed vie migtine ernctemy 1D, Transpsition ofthe greot arteries requires a communication between the pulmonary anc systemic creation for survival . Tetralogy of Fallot consists of ventricular septal detec. pulmonary stenosis, overriding sorta an! right ventricular hypertrophy (Q)37. During tune E> xcept ‘A. Using distied water for rigation leads to intravascular hsemolie 8. TUR syndrome is caused by absorption of irgeting ad through open venus ines 36 as forthe mai $e [aise BIE vic: for he Hina ewe a & sSevere hyponatraemia ue tothe TUR syndrome causes widening ofthe QRS complex blader perforetion occurs slike to be intraperitoneal Loop lute ate 3 set treatment for TUR syndrome Gastric ancer [A Isassocaned with blood group A 1. eth commonest site of Gl cancer . Following resection, AFP should be monitored regulary to ddevect recurrence . lsusvallyan adenocarcinoma E.G assecated with pericous angen Concerning the formation of » tracheostomy ‘A. The thyroid isthmus usally covers the 2nd an! rd tracheal rings |B. Arracheostomy should be made betwen the 1st and 2nd tracheal ings © Cincaly relevant posttacheastomy traces! stenosis oct in upt0 8% of patients 1. A wacheostomy track has formed sutficently to change a tubesafely ater 48h The incidence of complication follwing tracheostomy i restr after a proienged period of endotracheal int Concerning assessment of the possibility of dificult intubation A. The Mallampati clasification it performed with the mouth maximal opening and the tongue protruded 1B. Inpatients with cervical disease a Mallampet clas 3 view 2high positive predictive value In ebstevic patients a Mallampati cas 3 view has a high positive predictive value 1. fxpiying the Mallampatl test in the genera surgicl population allows more than half of efit intabatonst be predicted In patents who cannot protrude thee lower incor to meet ‘thei upper incr, haf the direct laryngoxcopies wil be ialSa aoa es, pena apr wade pressure my not ratect = Jeft ventricular end-diastolic pressure in the following prifacsc A. Right via myroma B. Severe mitra stenois Severe pulmonary stenosis D. High appli postive enchexpeatory pressure . ifthe eathete pian Wests zone When monitoring neuromuscular blockade A. Glnical monitoring ofthe degree of recovery is a6 accurate a using & neve stimulator 8. Sistine head ft (59) ste moet liable clinica sign of recovery of neuromiscil fonction 1G The respiratory mules re lst sensitive to neuromuscular blockers than the small muscles of the hand Double burst stimulation requires two shot periods of tetanic stimulation separated by 25, E. Currents of up to Aare required for skin electrode ‘mulation of peripheral nerves (Q)43. Mixed venous oxygen saturation (5¥0,) ‘A. Increases in response te increased arterial 1. Is increased by peripheral shunting Rises in expanse to acute haemorrhage 1. ses in response to blood transfusion Can be meosured trom the inferior vens cava 144, The Wright respicometer [A te3.g00d device for messuring tal volumes in anaesthesia 1B i accurate for continuous flow measurement G The electronic version i atlected by moisture . Unereads a high volumes Volume measurement is aehieved by monitaring the continuous rotation of a vane + Considering inhalational anaesthetic agen ‘A. Gita temperatures the temperature below which a Substance cannot be liquefied however much presse applies The ital temperature of nitrous onde 36.51¢ The term “vapours used to describe a substance when it ists above its ital temperature The filing ratio is the mas of gat na ind divided by mess of gas it ould ald if full The ‘pueudo-ritical temperatures that below which a gos ‘mitre may separate into is constituents ™ 9 ne (9)40. Regarding humicity ‘A. For the same mas of water vapout relative humidity decreases with temperature 'B. The hair Rygrometer measires absolute humidity witha that reduces in length with uri ‘G The hai hygrometer is inaccurate for humidities greater 70% ©. Regnauit's hygrometer ries on the pncpe ofthe dew . At normal body temperature the saturated vopoor ot waters 6akPa During cartionuimonary resusetation ‘A Usnocaine ioc) redes he teshold an ‘ect fo: ction 5. Seti recommended in cass of refactor en ‘fibjillation = © Shun Baroonte cues centr! states Potent adore stuns frethosasine and helen) may be oe sectne a acrorlng (eonepbrine) |Q)48, The following statements about circulatory shock are ‘A. near shock ofguria cuts due to a redution in ‘lomeruar fitvation rate |B. * reduction n PaO; san early ndeator of creuatonyWein » &_Neurogenic shock most commonly results fom head injury 1. Hyperalycaemia's predominantly due to sin resistance E. Fatcatabolism ic inibited [2149. The following statements about Acute Respiratory Distress Syndrome (ARDS) are truve A. Morality <33% B. Most patients die from hypoxsernia ‘© Moderate to severe pulmonary dysfunction is common ‘amongst surviving patients 1. Lung injury is homogeneous Reverse ratio vention techniquses have been shown to improve outcome 230, me following heap options ae ued during the management of tetanus e527 A. laniine 1B Magnesium © Metronidazole B. Benzypeniciin B) Hyperdart ongene — [RJ51. The following cytokines are thought tobe involved in the aetiology of Multiple Organ Dysfumction Syndrome ‘anoosy ‘A. Tumour necrosis actor INE] Upopoiysaccharde LPS) ©. Plateletactvating factor (PAF) D. Nivieoxige E. Interleukin (Lt) [Q]s2. The following statements regarding sepsis aro correct ‘A Diagnosis of systemic inflammatory response yndeome (SIS) Fequires a white blood count of = 18,000 cellstn? or <0) caller 1. Septic shock s define as spss asscaciated with organ dysfunction, hypapertusion or hypotension nterteukins and interoukie 10 are ntiinflammetory Mca forthe D. thterleukin-1 and interleukin are prointtammatory choca reperfusion inj is impicated inthe ‘inflammatory process Indiabetic ketoacidosis A. Treatment corrects hyperalcoemia more quickly than ketoacidosis B. Alarge sodium deficit exits © pleat anion gap 1317 molt 1. Total body potas i inceesed E. Ketonuria accounts fora large port of the osmotie dna ae cee the APACHE scoring system “A. Thece are 24 physiological variables B. Scores re weighted for one 1G Scores ae weighted for chronic disease DD. The system can be used 10 predict individual . Arevised Glasgow coma score ic incorporated “A. bracommon gut commensal “B. Couses naemolyticuracmie syndromeCase reports have fall in number during the past 20 years 1. ts the commonest cause of acute rena faite i chidren . Moy be treated by adjunct verocytotnin therapy [)5®. concerning near drowning in children A. Peripheral vasodilatation characterizes the dung eles 1B. Death is fequently duc to apiation of arge volumes of ligui inta the lungs Serious serum olecalyte abnormalities are common Hypovolaemia ismore likely the child was sumer in seit water than fresh mater The chances of survival are inversely related to the rectal temperature on arival at haspital en {Q)59. when assessing the Glasgow Coma Score (GCS) A flexion response to a painful stella abnormal An extension response to a painful stimulus sometimes recorded when the tespomes of tw diferent imbs fer 1. The ruts only applicable to patients who have witained & head injury . Firm pressre applied over the patients sternum constitutes ‘an appropriate painful timules Seoommal | The mare abnormal response to painful stimulus shoul be 10)60. Concerning carbon monoxide poisoning A. The halflife of COM is 250 min when breathing ai and S0min breathing 100% oxygen Bicarbonate therapy endo 1G Dantrolene sof benefit 1. Cherrpred appearance is more common than cyanosis . COMb causes pulse oximetry to tnd tonarde 85% 2 ES aterm ———— ss — Questions [@)1. Fora rapid sequence induction |. Creo pressure should be applied inline with the fourth erviea vertebral body 1B. Anasognstie tube should be removed © Asuation unit capable of generating at least ~200a shoul be immediatly avaliable 1. The BURP manceuve helps prevent arse in intragastric ico pressure should he released if laryngeal mask ‘inway (UMA) needs to be inserted 2 19)2. Laryngeal mask airways may be sterilised by ® rurocove B irradiation 1G Cherhexidine immersion D. exiyiene onde E Uiratoni cleansing far) aa aa eh pital aAatne Seep ee ad 24 Me flowing aneptat rugs ae prepared asthe sale Rated A. Rocuronium bromide ae :. Glycopyrronium suiphate E. Suxamethonium chloride (Q)5. Soda time ‘A. Ismosty made up of potaeium hydroxide Causes decomposition of wchloroettlene {© Contains 19 calcium hydronic DB. Causes decompostion of woflurane FE. Produces heat during reaction with CO, [QJ6. The dibucaine number ‘A. Represents the degree of inhibition of plasms cholinesterase by dinucsina Bi normally 75-85 40-60 in patients with the atypical enzyme D. i: 15-25 imheteronygotes tf the dibucaine numbers 70, the paralysis induced by 2 i standard dose of sxamethoniun wl not be prolonged fo. Cerebral ischaemia occurring during carotid fendartereciomy under general anaesthesta ls directly aggravated by A barbiturates 2B. Hypothermia Ketamine . Destranrcontaining solutions E Hypoventiation (Je. concerning double-lumen endotracheal tubes [As Aleftsided tube is contraindicated for operations onthe left tung ‘8 Carlens tube has its endobconchia extension angled to the fight Surgical drainage ofa postpneumonectomy empyen isan absolute indication . The left sided Robertshaw tbe has entiation sit inthe bronchial cuff The White tube i. righsdes! tobe THREE rience —— = Im the recognition and treatment of malignant hyperthermia [A inital here con be tachyearda and hypertension B. Anaverage dose of 2 5mgikg of dantrolenetrequied . Suxamethonium increases ja musce tone inal patients 1. Treatment includes dantrolene with calcium channel blocker Does of neuromuscular blocking agents shoul be reduced wen dantolene i wee {na patient presenting for renal transplantation [A Suxamethonium i contraindicated 1. loed transfusion is nikal to be of benefit {C Vecuronium elimination impaired pot transplantation 1. Stemi infection is contraindication to tra EE. Lower extromity chasms induced os part of the Opel procedure Day case surgery is appropriate for ‘A. Operations isting up t03h B. Babies <6 months okt 1G Patients on whom epidural are performed DD. Accompanied patiens who donot have a telephone E ASAlIpatonts ; oy ‘Concerning Magnetic Resonance Imaging (MRI) Modern crebral vascular aneurysm clips are MRI The anaesthetist must leave the scanner when the prooress MRI scanning is contraindicated if te patient has an pocemaer Precautions need not be taken while the scan notin ‘Only nude with an odd number of protons o respond tothe magnetic resonance moon pp ‘Complications of blood transfusion include A. Aso body temperate 1B. Appearance of hives on the patient ‘GOs fr the Final FRA[Q)17. Factors predisposing to opioid-related br © Appearance of red urine 1. Hoemobytic reactions despite giving compatible ross ‘matched blood E, Pain ‘Complications of retrobulbar blockade for cataract surgery include A. Bradycaria 1. Retinal detachment Brain stem anaesthesia D. Vitreous heemorrhage E. Optic nerve damage Recovery rooms [A The is dedicated recovery tooms were opened inthe UK B. shouls have 15 bays per operating theatre ©. Should be staffed at a atio of 5 muses per acute bay D. Were intrauced into the USA in 1985, . Were Fist described by Horence Nightingale [Q)16. During brachial plenus blockade The interscalene approach commonly less to inadequate blockade ofthe ulnar nervec The axillary approach may lead to Horner syedrome ‘©The supraclavicular approach commonly leeds to nedequate blockade ofthe anilery ne> ©. Bilateral interscalene blocks shoul! be wed or blateral shoulder manipulation surgery Te ailary approach common oi blockade of the median nen, isto nadequate include ‘A. The use of caldum channel blockers 2B. Ls'vagorcopy . The presence of 5-lockade ©. Repid administration of the cpiote E, Use of suxamethonium PTE cos ere ocuronium excep! A, Causes a tachycardia 1B. le physically incompatible with thiopentone LD Has two known active metabolites — 1 30% excreted in urine E eospis03mo%g 1119. Compound A A. fsa metabolte of sevoflurane and trichloroethyione 1B isaho known 98 flworomethy|-2.2-diuoco-1-tflaromethy) vinyl ether {G, Protistion is lessened by cooling the sd ime 1. Conivaindicates the use of sevalurane at fresh gs flows <2000m I. reduction is greater in the presence of baralyme than os lime 1020. xenon [A Ssron explosive, colourest and odouriess BB. Hasa Mac greater than nitrous oxide © tra moderate ersiovarular depressant D. avery dense gar . Has 2 Bloodias coefficient that lat than that of ritrous oxide 21. Concerning myocardial contractility 'A. Measuring myocardial contractlty requires that ‘preload’ afterload’ and heart ate ae constant ‘The fst cerivaive ofthe arterial presure has been used a measure of myocardial eontractity Inthe elated heart, ratio of tft ventricular end systlic resure and volume ina preload independent measure of contractity D. nthe normal heart agents that increase contractility decreste usiopy E, Dopecemine has no activity and doesnot inreace ‘yocadil contractility122. Concerning nitric oxide ‘A: Nici oxide ts synthesised from L-arginine in endothelial cell ‘chic adenosine monophosphate Po ‘nth the formation of menace Inhaled nitric oxide " an appropiate conceniaton sfonjoen on. in the stomach &. oretl cls are mainly uated around the py 8. Chet ctl secrete gastin : epsinagen an HC ore secrete by the parietal cls D. Pepsinagen secretion i inceated by vogal timation © Gastric distension leads to increased ail scrovan i 24 conaringthetings octet ‘A. Type alveolar epithelia cats re particulary sensitive to damage from high encenvations ot osmen 8. Puinonayvosclrresstance cn be mebaved in Gnseee © Ino asic bjt nthe et greatesn the upper lang. D. In an anaesthetised and paralyed abject inthe et lateral position, ventilation is greatest inthe upper hang . In an anaesthetied subject in the let lateral postion, blood flow is greatest in the lower ling (2125, Concerning pain = Xtepsh ‘A. Hyporalgesia is an increased response toa stimulus thats normally inf '®. Hyperalgesia develops in normal people after eutsneous iniury : Alodynia is pain custo stimulus that does not normally evoke pain 3 REY as or fairnca = Nitric oxide mediates vascular smooth muscle reakation va Nitric oxide powerful relaxes bronchial smooth muscle Sytemicaly absorbed nitric oxide fe metabolised fo nitate s supplied from eynders premixed with lateral positon, ventilation s . Both A delta and ¢ fibres are connected to nackeptors consisting a free nerve endings © sot 4 dita and Ctibre nocitptors progrestvaly increase their excitation threshold in response to repeated noxious simul (726, Radiofrequency ablation [AL Uses a heated probe to proaice a laion 1. induces a target temperature typically 45°C G Produciog 2 smal eson equiescurent flow toa smal secondary electrode . Lesions ae usualy conical and are formed Sm from the probe tip Requires homegencous tissue to produce a eliable lesion []27. Concerning acute myocardial infarction (M1) 'A. Wo diagnosis on ECG requires >t mm SF ele standard leads ST elevation i the ECG and history suggestive of cute Ml wl be supported by angiographic evidence n >20% ofcave Thvembolssre-establishes early coronary low (equivalent te unaffectea arteries) a more than 75% of cases 1. Renal failure isa significant rk actor for cardiowescu death after elective general anaesthesia ‘months after asuccessuly thrembolsed Ml approx ‘one third of coronary arteries will have e-ocluded ion in the (028. Concerning myasthenia gravis (MG) [A Pregnancy may precipitate weakness A preoperative short course of high-dose coroners sed 9 optimise patients . There sa potetiated respons to tetane stimulation . Patents presenting for thymectomy can expect their MG to lmprowe inthe postoperative period . Patient taking in excess of 75019 of pytidostignine orally er day ae at Increased rk of renuiring pesperatve ‘rentiation ‘eee for he Fa0399 [9)29. n Duchenne muscular dystrophy ‘A. Muscle innervation simpaired | Inheritance autosomal recessive & Proximal muscles are particule atiected Breath generally occ betwen the ages of 4 and SO years Pneumonia is the commonest eause ofewh (2). myasthenic synaiom A Complicate about 10% of bronchogenic carcinomas More commoniy affects feral & Commonly invoives bubr muscles . Symptoms are improved ty anticholinestrases Produces resistance to suxamethoniam {)31. cystic fibrosis ‘A. Causes sweat to have an abnormally low sodium ‘concentration Isautesomal recessive © Causes respiratory secret lorie concentration B. twaszocated with natal polyps E sasociated with intestinal obstruction ons tohave an abrornally iow (Q)32, Acute tiverfaiture A Causes hypertension due o encephalopsthy '. more commoniy associated in the UX with an infective lasers ()11. Te Following are true ‘A. The left handed laryngoscope developed by Penion is for use by letvhanded ansesthetits B. When terising anaesthetic equipment, boiling is sukoble for those items made from rubber When wsing the oxygen fish of an anaethetic machine, the {tesh ges flow and volaties become dilsted with oxygen 'D. The Britsh standard taper for vecheal ube saaptons 22mm 5 Qn. ‘A. Regional anaesthesia has been shown to reduce the incidence of postoperative stroke 3. Postoperative IAS are mast lkly tobe due to miercemboh . Seizures ae a complication of regional ansesthesa D. Stump pressures cefoct adequacy of cerebral perfusion lateral endarterectomy cates or of carts ody function Tl occa ———— fons. Qu aus. %6. Phacochromocytoma surgery ‘A. Preoperatvay f-bockors are the fr lie of treatinent 8B. Patients may have eatecholamine induced myocarditis © The hafiie of plasma catecholamines approximately 45+ 1. Untreated patients suffer from chronic hypovelaemia E. blockers can coute natal sutfnese ince sn ote righ A. fight main bronchus intubation ‘A decrease in cardiac output, but only ifthe patient is supine land horizontal or hese up 2 & Proumothorax ©. An increase in arterial earbon donde tension if nitrous oxide ‘sthe insulating gas Compartment syndrome Published recommendations for the sefe conduct of ‘obstetric anaesthesia in the UK state ‘A. That the anaesthetit must under na circumstances leave hisher patent ‘Consent for any procedure must be vritten Patients undergoing regional enaestheic techniques should Spend a least 30min in recovery = D. Allobstetric units should have at feast 4 units of Uuncrossmatches O negative blood . The time from informing the anaesthetist to the stort of emergency operative delivery should mot ‘ceed 15min ‘Anatomical variations associated with difficult intubation include ‘An increased posterior depth ofthe mandible ‘reduced anterior depth of the menliie ‘An absent atlanto-aial gop An increased atlanto-ociptal gop ‘A thyromental stance em[0)17. Context-sensitive half-time is ‘A. Dependent upen duration of the infusion Dependent upon excretion ‘© Longer for fentiny than fr alfentanil after an intusion lasting 1h D. Constant for renientani! shorter if te dation of the infusion i long and the s0prent volume of distribution at steady nate x ge rather than smal (Q}18. with regard to vitamins A. Aiswatersohibie Thiamine defcercy can cause heat faiure © G12 decency cues detective ONA syntess D. BI deficiency lass to Wernicke-Korsatotf drome ©. Cholecalcferol 25 hycronylated in the Kiney i (Q)19. Ketamine A. Ismetobolied inthe iver to an active metabolite B. san imicazoledeivative © Emergence phenomena may be reduced by co-adiinistration ‘of benzodiazepines and opioids DB. Bronchoconsrcten may occur Recovery israpid wi redistribution Thiopentone EXP A. 4 80% protein bound 1B Follows fstorder ints which may become zero order at higher doses & Is iven rectally a 95 0 10% solution ® injected ina areily shout be fllowed by bryaluronidowe 2 Causes a tachycards due toa decrease in vagal tone [)22. Htypocapnis may cause A. Increased placental ood iow 8. Hyperalcsemia CE 0c: nn —— (Qj22. iz. [alas © Hypokalaemia 1B. Reduced cerebral blocd flow E Conlon ‘Concerning the splanchnic circulation ‘A. The adult liver normally receives approximately 13 of ts blood supply from the cosa ax Bradrenergic receptors cause mesenteric arteriolar ‘asolatation Positive end-expiratory pressure (PEEP) decreases porta blood flow 1. Arcades of orteroles supplying mucosal vl terminate and branch 2 the tp supplying wel onygenated blood to the The slanchnic venous system can contain V3 of the total blood volume Absorption A. Of fatocurs after broakdown into monolycerdes 1B. Ofbile sats ocr inthe jejunum Of carbohyérate it manly By active transport ©. Of ran isin the eum Of is inthe termina leum oxygen Delivery is approximately 1,000 nmin B. Consumption is approximately 250mimin The lings store aporoximately 200% afer a subject has breathe! 100% oxygen . Consumption can be measured by spirometry D0, = 9° (Ca0,~ G0) Concerning cellular receptors ‘A loloxone reverses the analgesia produced by acupuncture B. Ketamine acts on the HMDA receptor Mu opioid receptors stimulate aderyy cose D. Histamine ecepters are not present in the CNS . Caffeine an adenosine rector antagonist30. Dystophia myotonien 2 KE 1, tasked wth caromyopsthy LG Cone: saree romeo way [Q)26. codeine ‘A. Hasan ral bioavaiabiy of approximately 50% 1. lsmetabolised by demethylation o morphine Cannot be metabolised to morphine by 78 of the Caucasian ‘G fscaused by an abnormality of alum metabolism population 1. Myotona is precipitated by cold . Combined paracctamo plus codeine preparations produce Causes delayed gastric emptying de to impaiced smooth ‘anetfectindstinguishabe from the use of codeine muscle motiiy| ‘lone . Metaboliem to morphine antaganised by trcyic antdepresants 31. Sarcoidosis ‘A. Causes imphopenia 8. bb commoner in males than females Typically causes unilateral lymphadenopathy D. ecsgnosed using the Keim test, Con be mimicked by beim poisoning [9)27. concerning the heart in an erect PA chest radiogram ‘A. Kerley 8" lines are distended pulmonary Iymphatic vessels 3. Redistibutin of pulmonary veel size occurs With LA pressures of 16-2SS% is asoiated with an 32. Concerning myasthenia gravis ‘A. Volatile agents lead to 2 redction in twitch height Sensitivity to suxamethonium is incresed © Allnon-depolarsing agents lead to an increased degre of neoromutcular Block 1. The presence of circulating ant-acetychotine ceptor antibodies is a reliable agnostic ign [E.Antichoiinesterase therapy should be recommenced 48) ater surgery . A ‘cottage oat shaped cardiac shouette ocurs with otal ‘anomalous pulmonary venous drainage 10)28. Concerning patients with epilepsy ‘A. The slecroencephalegram (EG) epresents the summation of cerebral synaptic acy 1 Carbamazapine san enzyme inhibitor © Rapid intravenous loeding of phenytoin cuses hypotension ©. Enflurane suse to produce cortical EEG changes for mapping epileptic fut . Droperidol and haloperidol should be asides 33. Haemophilia A ‘A. The gene for haerephi i losted on chromosome? B. (sasocsed wih» poonges tied tne © 50% of hasmopia camer warrant heemetloi ophyans oro main surgey = - D. Deamino-D-arginine vasopressin can provide prophylaxis in iit haemophia or mse srgey Factor il ually hs a al iteo 12h (2128. Hepatic a ‘A. ts the commones ype of va heres Spreed aly facta Hasan nabaton me of approxima 6 noms Can ead oa shronicerr ste Hasan acate mol of Sporn mately 10% 24, Regarding thromboembolism in pregmancy x cept ‘A. Pulmonary thromboembaism's th commonest caus of Imateal death nthe UK | The incidence of faa! puimonary tiomboembolism has bean ‘ncreising over he ast decade TCO Far he Final RCA COS or Fa FRE© Approximately 90% of deep vein thrombosis affects the lft side in pregnancy '. The activated partial thromboplastin ne san wnveiae ‘monitor of heparin activ in pregnancy Ventilation perfusion scanning is eontraindcated in pregnancy [Q)35. ENT and maxitiotacal surgery <= xcept —® Ate tort tatre oles the rose 2 ‘efor acre rent compte sopsatin of the Ios compos foe he at © Ghanging he endowacea abe neces ring inygecomy Terry chien reqting operation fr Biedngfolloing tonlectomy and adendcteny somone 0 Hotta sly eed by npn ype 8 (236. in gastrointestinal surgery ‘A. A Hartman's procedure involves bowel resection and 8. An antevioe resection ithe operation of choice for {orcinomas ofthe lower tid of the rectum © Athreo-stage oesophagectomy usually inveives an inion on the left side ofthe neck A pharyngeo! pouch most commonly ocurs between the inferior constrictor ofthe pharynx and ccapharyngeus E. Barretrs oesophagus occurs due to persistent gente. ‘esophageal refx . (0137. tm obstetrics Tcoyss may be produced with 9-2 adrenoceptor agonits ‘Therapeutic serum levels of magnesium are emg Shyer winitrate may be used intravanouny to obtain uterine relaxation '. A foetus inthe ocput posterior positon will require Ceesarean section . The death rate asociated with Coeserean section is ‘approximately tin 2.900 WEEE 146s ort inarmcn 39. a ER eterna Concerning anaesthesia for thyrold surgery ‘The skin over the thyroid is supplied by the brachial plexus Regional anaesthesia moy impair respiratory function Laryngospasm occurring 24h postoperatively i kel to be ‘hue toners inritation D. The majority of retrostrna goitresraquire a sternal incision . Thyroid carcinoma i asserted with phacochromacytoma Indications to proceed to surgery in necrotising enterocolitis include A. Proumapertoneum intestinal gangrene © Interinal sbsuction DB. Gastrointestinal haemonthage Abdominal tenderers ‘The stress response to surgery involves the following changes A. lnceeased thyroid stimulating hormone (TSH) secretion 1B. Decreased insulin secretion CG lnceased tenn secretion D, Incested aldosterone wecretion . increated testosterone sacetion ‘Concerning the electrocardiogram (ECG) {.tprovides continvou monitoring ofthe crevaion 8 Standard ieadi sth bet monte of wor decendng foronar artery tertny Rover hy ertve ontor of myocardial ichasia . Chis monitoring request left arm electrode tobe nce ‘nthe arteroreitary trae th nec space Leads V4.¥6 monitor he Grutor rr eioy ‘when measuring gas flows [A. The Wright’ respirometer isan anemometer The Detex Utima monitor utiles a vane flow meter The Wright's resplemeter maacures lin both rections a58 EEG cov ior . Flow can be measured sing theristors }. the following drugs have cyclic AMP-dependent positive . Flow can be measured ing ultrasound Inctropic effects at clinical doses Digoxin (43. Regarding the gas laws Slucagon <—= 1G Calcium sats D. Thyroxine E. Aminophyiine ‘A. Charles’ awe states that at constant pressure the volume of & sien mass of gos varies directly with the abuolute temperature The third gas aw states that at constant temperature volume ‘aries inversely with pressure The following are accepted diagnostic criteria for acute Adiabatic changes are thors that involve changes inthe sate respiratory distress Syndrome (ARDS) Sta.ges without transfer of heat with the surroundings Unilateral tse puimonac infitrats on the chest ay Dalton’ law states that equal volumes of gaze atthe some etree fironey ritiotesen aia temperature and pressure contain equal numbers of molecu ala ES bate WDISEPE eal a 7abeet Pulmonary capitary wedge pressure (PCWP) =20mmig Known triggering event otk factor (O]s8, Athigh altitudes Pulmonary infection 1 A iri by apc ira ccna Attconepton cuneate ster atachng whether ta ere ceaieal A TEC 6 vaporiser will deliver the same partial pressure as al Bott's eye movements should be present ALTE aor der thames Beeps c eon name A ea Se Bats near eared cnatnsien Be reese nes a ‘The following tosts indicate inadequate or partial reve ‘2f neuromuscular blocka ‘A. Ahead lftsstained for 3 seconds {8 Amaximum inspiratory pressure of -20€mH,0 © Lack of handgrip human immunodeficiency virus (HV) D. Aposttetanie count of 8 which dos not contain anti IV antibodies may be E. Anateral PCO, >654P ve for p24 antigen a infection by HIV is associated wth an acute wesion illness in 60% of patents sath saat presence of pnevmocyts cari preumonia (PEP) [A Utilise a platinum cathode shes HIV rom other immunaceiieny disorders '. Curren flow depends on uptake of oxygen atthe anode fs characteriticaly associated with fever and 9 ‘Commonly incorporates potassium chloride as the electrolyte ee J Raleron batters eth erptococeu otormars hy preset © ieioan depends onthe peri of tine exposed 1209060 eet cares Fer tha Pina PRCA[Qst., the following cause tactic acidosis A. Garters syodiome B. Metformin © Thianine decency B. Corticosteroids Anaemia [Q]s2. Regarding burns ‘A. The presence ofa sien atonal nu ected with 3 10% mortality < 8. Samet eid vie nay ptt wh Carbon monoxide naan afin for hoemoslbin tines that onygen ©. Drowsiness cers 2 crboxyheragobin vl blew Morale in patents ath mop burs hs rencines vel unchanged othe ot SO yeas [R)53. Regarding Guitian Barre syndrome A. tumay Le purely sensory . Approximetely 2 third of patients require ventilatory support ©. Ifasseciated with preceding Campylobacter jojunt ener ‘aries e worse progaarie Antibodies to Campitabecter jejuni occur more commen in patients with the axonal form ofthe cscase . SF opening presure at lumbar punctures ypcally elevated [Q]s6. the following are associate! with acute pancreatitis ‘A. Metronidarote 1B. Campylobacter infection © Duodenal ucertion D. Systemiclupus erythematosus Pregnancy [Q]J55. Regarding nutrition in ronal failure ‘A. Endogenous urea canbe converted t amin acids B.A high carbohydrate load i considered Benfica! 7 G Low osmolality feeds are better toe 1. Ahigh protein det is eauired E, Aiming acde can be administered via dialysate solutions ‘The first letter ofthe pacemaker code relates to the chamber sensed 2. May be unipolar or bipolar €. Ganbe reprogrammed by diathermy 1. May be inhibited by suxomethonium E. threshold valve af 10V for a temporary pacemakers (G57, uring an asthma attack |. A notmal P2CO; is 8 900% prognostic marker B. There flow dependent colagse ofthe smal aways The transfer factor for carbon menoxide may increase 1. Mechanical ventilation with low inpiratony low rate Inereases gas trapping Hypotension during venation should be managed with Inotropes a fis [9'58. High-frequency jet ventilation _@ caries aveotar gas appinge— B. Does not require the himification of inspired gaves ©. Canonlyachiove adequate alveolar ventiation the td ‘olume b greater than he anatomical dead space [ehieves an increase alveolar minute ventilation mainly Increasing ventilatory frequency , Issued to the ventilatory management of patients wth ‘cute severe asthma, [a)59. concerning sedation in the intensive Care Unit [A The us of alfentanil infusions should be avoided in renal failure 2, Sepsis impairs the metabolism of bonzodiazepinns CC. Morphine undergoes extrahepatic metabolism HELE ost rncswore, 7 WEEE os forthe Frac D+ The clearance of remifentanil is independent of The cane ot independent of renal and Propofol undergoes minimal metabolism [Rjs0. Concerning the underwater sea 2 usa for chest drainage 50% of the patient's maximal inspiratory vol . 5 = 10cm below the surface of the water for afety nn A fluid trap can be safely placed bet tare underwater seal e Questions ‘Concerning pacemakers “A. Demand pacemakers cannot be converted to feed rate 1. Bipolar ciathermy should not be used @ 1G Volatile agent donot affect pacemaker activity 3. AVI code denotes pacing and sensing of both chambers Rate responsive devices cam inteate pacing rate in respon fo changes in respiration 2 following are anaesthetic implications fora aortic stenesis x7 ‘The myocardium is susceptible to lchaemia in the coronary artery disease ‘The presence of ata fibilation I hight signiiant radycaraia induces hypotension Inotropes should not be used <— Left ventricular Hypertrophy cn be seen, lecsrocardiographally bs 2ehovo-1,1.2-ftuoroethy dfluromethyl Isa yellowish volatile quid ts odourless Has a MACof 1.68 1s 50% supplied bythe vertebral arteries i normally be 50°00 Amin halothane NCOs forthe Final FRAwomen, 64 MREERI 405 or ena ee [Q)s. TURP syndrome Be. air. (aie. A. Leads to hypernatremia B. May be amiorated by giving hypotonic IV infusions May bo avoided by measuring ethan! in the exhaled breath ofthe patient «— . shoul not occur ifthe height of the irigating fui is tinitea 10 1m above the patient . should not occur the resection time js limited to 120min uring one-lung ventilation A. Inthe lateral petition hypoxaemis ie due to neeased dead space the upp hing 8. Hypoxaemia is greatest when therein pre-existing tung dsoase © Maintenance of postive end-expiratory presture tothe ventilated lung hele reduce hyponoerie 3. typoraemia general wort about 1Omin ater onset of ‘one-lung ventiaton . Pulmonary artery ligation ofthe upper lng can be used to \secease hypoxsemia uring neurosuraical anaesthesia the following are regarded as providing an early and sensitive alr embotisn A. Pulmonary artery flotation (Swan-Gana) catheter B. “Millarhee murmue (© Transcranial doppler ultrasonography 1. Capnoaraphy E. Flecvocardiagrom ‘The following preoperative findings prediet enically significant pulmonary complications following hang resection A. Aa arterial omen tension in al (P80) <9 An arterial carbon dlovide tension (°9CO) “ORF a & A Forces to opacity (VQ) <70%6 af the predicted value D. A Forced expired volume in 1s 65V) =1 Tare E Armaximum breathing capa (EC) 50% ofthe predicted Qs. (0110. Postoperative nausea and vomiting 12h ‘uration ©. should be accompanied by heparin therapy . Is given by n intravenous single bolus dose regime (48. Recommended management of acute respiratory distress ‘syndrome (ARDS) includes A. Permissive hypercapnia . Extracorporeal membrane oxygenation (ECMO) © Early ute of cortzosteroids DB. Diuretie E. Mechanical ventiatior [a}49, tm severe pancreatitis ‘A. Calcium replacement shouldbe tt ted against total serum ® Eatynascjjural teeing is tecommended 'G Pethidine sthe analgei agent of choke 1. Prophylactic high-dose broad spectrum antibiotics have been shown to reduce mortality ‘8 2-cm pancreatic pseudocyst should be drained under Cr or ‘ultrasound guidance [Q)30. The following pulmonary eathotor measurements are ‘compatible with a diagnosis of septic shock A. Cardiac index = 20Uminim? 2B. Central venous presure = 2 mmHg . Sytemicvaclar resistance — 750 hymes em 55 ©. Pulmonary opillary wedge presure ~ 19mmHg Pulmonary vascular resistance ~ 300 dynes cm = °* [Q)s1. The following cause a metabolic acidosis with an Increased anion gap Trauma $8 Rena tubular acidosis TARY ofr noice & Ureteroertorostomios D. Hypokalaemia ) Diamhoea and vomiting [0}s2. Regarding near drowning A. mmersion fly crested int cold water (°C) drops core ermperstie by 70 3B. Temporatutetlated cerebral protection occurs before any significant risk of aspiration and hypoxia ‘G Hypothermia fa good prognosticsign nan uneenslous owning vietin . Early advanced ife support isthe mst important factor ia good outcome 5. Steroids probably improve outcome (9]53. tm acute severe asthma [A titroglycern hasbeen show to improve bronchespasm 3. Magnesium reduces bronchoconstriion {© Aminophyline increases elophvagmat The following clinical conditions are associated with a Prolonged QT interval on the electrocardiogram (ECS) A. Hyperparsthyrigio 8 Hypothermia © Povcorsie . chacmic heart cisease Romane-Ward syndrome Section 2 - Answers exam Exam 2 Exam Bo ram 5, 105, 1 139 188