© Fundeni Clinical Institute 1 Departement of Anaesthesia and Critical Care Carol Davila Unviersity of Medicine and Pharmacy MCQ TYPE TEST IN GENERAL ANAESTHESIA “Alt questions are multiple choice questions. Each response should be graded as true J Content of questions: physiology 01-010, pharmacology Q11-020, general physies Q21-050, _general anaesthesia Q31-Q60 1. With regard to the eardiae cycle: ‘a The fist heart sound represents the closure ofthe aortic valve * b. The second heart sound occurs atthe beginning of the T wave on the The peak of left ventricular pressure occurs with the QRS complex on the ECG {. Ventricular volume begins to inerease when the atrioventricular valves open * , ce, The peak of aortic pressure corresponds with the T wave» 2. Regarding preload, afterload and contractili a, Afterload is increased by peripheral vasoconstriction + by Increased afterload causes an increased stroke volume «. Preload can be likened to end systolic volume 4. Preload can be estimated by measurement of CVP fe Preload and afterload are the only factors affecting contractility 3. The following will cause arterioles to constrict: 2. Direct injury tothe vessel 4, Thromboxane A2 b. Decreased tissue pH . Bradykinin c¢, Decreased tissue oxygen tension 44, Regarding lung complian ‘a The normal total lung compliance is 200 emH20.mI-1 ' Static compliance is greater than dynamic eompliance ‘c. Compliance is inereased when a patient is supine 4. Ie is determined by the gradient ofthe pressure-volume curve It is greatly reduced in acute respiratory distress syndrome (ARDS) 45, Regarding the functional residual capacity (FRC): 2. Itis approximately 30 ml.kg-1 bb. Pulmonary vascular resistance is highest at FRC «It may be less than the closing capacity 4d. It is inereased under angesthesia ¢. It is decreased in pregnancyAMM RR RR (© Fandeni Clinica Institute Departement of Anaesthesia and Critical Care Carol Davila Unversity of Medicine and Pharmacy 6. Increased oxygen binding to haemoglobin occurs with: .2,3-DPG 4, Bohr effect bo HbE e. Haldane effect «. Methaemoglobin, increase minute ventilation in response to: 4. Hyperthermia ce, Anaemia 8, The membrane potential of a neurone at rest: ‘a Is more negative on the outside of the cell than the inside b. Is maintained by the active transport of potassium ions out of the cell and sodium ions into the cell ¢, Is more permeable to potassium fons than sodium ions 4. ls impermeable to anions e.1s-50mV 9. The consequences of anaerobie respiration include: 1. Activation of the Cori eycle b. Use of six ATP molecules during gluconeogenesis, ¢, Increased hepatic lactate metabolism 4. Increased renal lactate metabolism €.A build-up of NAD+ 10. With regard to glomerular filtration rate: It is calculated by measuring insulin clearance Creatinine clearance is the most accurate measure ¢. Is reduced by most anaesthetic agents 4. ls normally 120 ml.min-1 ce, Vasopressin reduces GFR 11. Concerning response to repeated drug doses: «4, Tachyphylaxis refers tothe phenomenon of rapid loss of response to repeated doses of adnug b. Tolerance occurs when loss of response occurs over a longer period of administration ¢, Desensitization occurs when incrementally larger doses of drug are required to produce the same response d. Desensitization oceurs in chronic opiate abuse ¢. Ephedrine displays tachyphylaxis© Fundeni Clinical Institute Departement of Anaesthesia and Critical Care Carol Davila Unviersity of Medicine and Pharmacy 12, The following agents are cytochrome P4S0 enzyme inhibitors: a. Cyclosporin 4, Carbamazepine . Amiodarone . Chronic alcohol ¢. Grapefivit juice 13, Propofol: 1. Has a calorie load of 1 keal.ml—1 ». Undergoes sulfuronidation within the liver , Commonly precipitates reflex tachycardia when given at induction doses 4. May cause greenish discolouration ofthe hair ¢, Has a terminal elimination half-life of S-12 hours 14, Concerning minimum alveolar concentration (MAC): a. MAC is decreased in hyperthyroidism 'b, MAC is decreased in pregnancy «. There isan inverse relationship to the oil:gas partition coefficient of agents The MAC of nitrous oxide is higher than that of halothane ¢. It is defined as a percentage of | atmosphere 15. Regarding the mechanism of action of general anaesthetics: «2. The proposed mechanism is said to be consistent with the Meyer-Briggs rule b. The rule suggests the anaesthetic agent acts by dissolving in the protein bilayer of cells ¢, GABAA and glycine are inhibitory receptors 4. Glycine receptors belong to the family of ligand-gated ion channels, e, Hydrophobic anaesthetics are less potent 16, Local anaesthetics alter nerve function by their action on sodium channels. 1. Local anaesthetics ean also have an effect on calcium channels ». Sodium channels in the resting state have a high affinity for local anaesthetic c. The sodium channel is composed of a single polypeptide chain with four repeating units 4d. Local anaestheties bind directly o the extracellular portion of the sodium channel to exert the effect ce. The binding of bupivacaine to the sodium channel is irreversible 17. With reference to specific COX-2 inhibitors 4. They affect platelet function, especialy in high doses b. They have an analgesic efficacy that i lower than comparable non-specific NSAIDs . Cardiac side effects may be inereased 4. The incidence of gastrointestinal side effects appears to be reduced fe, Concurrent aspirin therapy is safe(© Funden Clinical Insitute Departement of Anaesthesia and Critical Care Carol Davila Unviersty of Medicine and Pharmacy 18, Morphi a. Is metabolized to a pharmacologically active compound bb. Reduces minute ventilation predominantly via reducing tidal volumes ¢. Has longer half-life than naloxone 4. Is licensed for intrathecal use Is an opiate 19, Atracuriu ‘Improves compliance with mechanical ventilation and reduces mortality in ARDS >, Musee relaxation may be reversed 2 minutes after an intubating dose by the administration ‘of 16 mg kg-I of sugammadex ¢. Is less associated with bronchospasm than rapacuroniam 4. Consists of 16 isomers Is approximately 99% protein bound inthe plasma 20, The following statements are correct: ‘a. Adrenaline may increase minimum alveolar concentration and increase peripheral pain threshold +, Dopamine reduces pulmonary vascular resistance ¢. Isoprenaline may cause hyperglycaemia 4. Dobutamine may be used as an alternative to exercise in cardiac stress testing ¢.Inotropes increase the force of myocardial contract 21. Which of the following statements regarding gases are true: ‘a. Avogadro's hypothesis stats that at a constant temperature and pressure, equal volumes of ideal gases contain the same number of molecules ». Avogadro's number is 2.18 * 108 ‘One mole of any gas at standard temperature and pressure will occupy 22.4 litres 4. The critical temperature is defined asthe temperature above which a gas cannot be liquefied by any pressure «, The eritical pressure is the pressure required to liquefy a vapour at its critical temperature 22, Which of the following statements regarding laminar and turbulent flow are correct? ‘In laminar flow, the flow rate is inversely proportional tothe fluid viscosity ‘In laminar flow, the flow rate is directly proportional to the fourth power of the radius ¢, Turbulent flow will always be present ifthe Reynolds number is greater than 1000 ‘Turbulent flow will always be present ifthe Reynolds number is greater than 2000 ‘In turbulent flow, the flow rate is inversely proportional tothe fluid density(© Fundeni Clinical Institute 5 Departement of Anaesthesia and Critical Care Carol Davila Unviersty of Medicine and Pharmacy 23. The following will inerease the damping of an arterial tra 1. Blood clots 4. Use of @ tourniquet on the measured limb b. Air bubbles. . An arterial eannula that is oo stiff ¢. A long arterial cannula 24, Concerning train-of-four stimulation: ‘a. The TOF ratio compares the ratio ofthe strengths ofthe first and fourth twitches b. Four twitches of 0.5 Hz each are applied over 2 seconds ¢, On administration of non-depolarizing neuromuscular blocking agent, fade occurs before the disappearance of the twitches 4. On recovery, the fourth twiteh appears first ‘¢,For upper abdominal surgery, atleast two twitches must be absent to achieve adequate surgical condition 25, Regarding a thermodiution technique using a Swan—Ganz technique for cardiac output ‘measurement, which of the following are true? a. Requires a specialized arterial cannula 'b, Requires the eatheter to be correctly placed in the pulmonary artery , Cardiac output calculations are based on the Stewart-Hamilton equation ‘&. Cardiae output is directly proportional tothe area under the temperature-time curve produced fe, May be inaccurate inthe presence of tricuspid regurgitation 26, Regarding the definitions of pulmonary function tests: 4a. The peak expiratory flow rat isthe maximal flow rate that can be developed by forced expiratory effort following full inspiration by. Maximal mid-expiratory flow rate is measured at 50% exhalation during a forced ‘exhalation from TLC {FEV1 is the volume exhaled after I second and is usually around 50-60% of the FC in healthy individuals In obstructive airways disease both FEVI and FVC are reduced, with a reduced FEVI/ FVC rat ¢. In restrictive lung disease both FEV1 and FC are reduced, with a normal or increased FEVI/FVC ratio 27, Soda lime absorbs carbon dioxide in an exothermic reaction and is utilized in many breathing circuits. Which of the following regarding this process are true? a, Soda lime is capable of absorbing up to 25 litres of carbon dioxide per 100 g Colour change is an indicator of soda lime exhaustion ¢ Intermittent use allows soda lime to “regenerate! . Barbiturates @. Catecholamines , Benzodiazepines 30. Pulse oximet a. Relies on the Beer—Lambert law '. Uses a diode that flashes $0 times a second «. Traditionally use LEDS emiting light of two wavelengths, which are 660 nm and 940 nm {. Requires two photodetectors, and allows compensation for ambient ight , Uses the difference in light absorption of oxyhaemoglobin and carboxyhaemoglobin 31. Regarding metabolic equivalents (METS): ‘2. One MET represents the oxygen consumption of an adult at rest ’b. One MET is equivalent to 2.5 ml kg-1.min-I oxygen consumption Patients should be able to perform more than 5 METS to undertake major surgery 4. Patients should be able to climb at least one flight of stairs to undertake major surgery MET values of activities range from 0.9 to 23 ml-kg-I.min-1 a. Ability to protrude mandibular incisors in front of maxillary incisors b. The presence of a high-arched palate c, Stemomental distance >12.5 em 4. Previous radiotherapy to the neck ¢. Pierre Robin syndrome 43. Sickle eell disease is a common disorder of haemoglobin. Regarding sickle cell disease: 4. It results from a mutation on chromosome 13. ', The pathological amino-acid substitution is valine for glutamic acid c. An abnormal B-globin chain is produced LA Sickledex test wll differentiate between sickle cell disease and sickle cell trait Sickle eell trait confers a degree of protection against Plasmodium falciparum malaria| | | (© Fundeni Clinical institute 7 Departement of Anaesthesia and Critical Care Carol Davila Unversity of Medicine and Pharmacy 434, Which of the following factors in a patient's history would concern you with regards to increased risk of aspiration? a. Aleohol 4, Diabetes b. Trauma . Cleft palate ¢. Dehydration 35, Laparoscopy is frequently used for diagnostic and therapeutic procedures, Which of the following statements concerning laparoscopic surgery are true? ‘a, Shoulder pain is common after surgery as diaphragmatic irritation causes referred pain ‘over the C5-C7 dermatomes ', CO2 is used as an insufflation gas as itis safer than medical air . Brain tumours are relative contraindications to laparoscopy 4. Typical insufflation pressures are 35-40 mmHg, Laparoscopy mandates general anaesthesia 36, What are the causes of a preoperative microeytic anaemia? ‘Renal failure ‘4. Phenytoin b. Bone marrow failure «. Acute blood loss, c. Pregnancy 37. You have been asked to anaesthetize a patient for a resection of a small bowel tumour, “Suspected to be earcinoid, Which of the following statements are true? a. Autonomic symptoms are more common with GI tumours than pulmonary tumours '. The patient is at high risk of mitral valve disea Ingestion of blue cheese or chocolate may preci 4. Atracurium should be avoided c. Noradrenaline infusion may cause hypote 38 Complications and physiological changes associated with mali include: 1, Hyperkalaemia 4, Disseminated intravascular coagulation b. Myoglobinuria , Compartment syndrome ©. Vas0e 39, Regarding blood products: 4. Whole blood has a shelPlife of 35 days by, Packed red cells may be stored for up t0 30 days «Platelets ean be stored for upto five days at 4 °C 4. platelet transfusion requires ABO compatibility eA platelet transfusion requires Rh compatibility forall patientsi j | (© Fundeni Clinical Institute 8 Departement of Anaesthesia and Critical Care Carol Davila Unversity of Medicine and Pharmacy 40. A 25-year-old woman with a diagnosis of myasthenia gravis is listed for an appendicectomy on the emergeney list. Anaesthetic considerations includ 1a. An increased dose of succinylcholine may be needed for rapid sequence induction Only one-fifth of the normal dose of atracurium should be used for ongoing muscle relaxation during the operation ¢, Disease duration of greater than six years isa predictor of the need for postoperative ventilation 4, Dose requirement of pyridastigmine of greater than 750 mg per day isa predictor of the need for postoperative ventilation ¢, Reversal of non-depolarizing muscle blockade with one-tenth of the normal dose of neostigmine is recommended 41. The effects of smoking include: 1, Reduetion in postoperative nausea and vomiting b. Increased airway reactivity «. Hepatic enzyme inhibition 4. Shift of the oxyhaemoglobin dissociation curve to the right, Hypertension 42, In the patient undergoing elective surgery who has atrial fibrillation: ‘a. A slow ventricular response may be an indication for pacemaker insertion ' Routine f-blockers should be omitted due to the isk of hypotension intraoperatively ¢. Digoxin doses should be reduced by a quarter if converted from oral to intravenous formulation 4. Patients receiving digoxin should have their levels measured on the day of surgery ¢. All medications should be converted to intravenous on the day of surgery 43, Hypocalcacmia may present with: a. Chovstek’s sign on non-invasive blood pressure cuff inflation ». Perioral tingling «Increased QT interval 4. Facial spasm upon tapping on the submandibular gland o, Seizures 44, When assessing a patient with diabetes preoperatively, itis important to consider that they are at risk of the followin; a. Difficult intubation 4. Ischaemic heart disease b. Peripheral neuropathy , Autonomic dysfunction «. Renal disease(© Fundeni Clinical Institute Departement of Anaesthesia and Critical Care Carol Davila Unviersty of Medicine and Pharmacy 45, Regarding the causes of anaphylaxis under anaesthesia: 1 Rocuronium causes more reactions than suxamethonium ’, Propofol causes fewer reactions than etomidate ¢, Neuromuscular blocking agents are attributable for 40% of reactions 4. Colloids cause less than 5% of reactions ¢ Remifentanil causes more anaphylactic reactions than morphine 46, A 85-year-old female i listed for a total abdominal hysterectomy. Your anaesthetic plan includes the administration of a TAP block. The following are true: a Innervation of the anterolateral abdominal wall arses from the anterior rami of spinal nerves T7 to LI bi. The anterior divisions of T7111 enter the abdominal wall between the internal oblique and transversus abdominis muscles €. The iliohypogastric nerve (L1) divides between the internal and external oblique muscles giving off cutaneous branches 4. The posterior edge of the triangle of Petit is the latissimus dorsi muscle fe, Spread of local anaesthetic to the femoral nerve isnot possible as there is not ‘ continuous plane to this nerve 47. The following can improve the absorption of local anaesthetics used in regional blockade: 1, Bicarbonste 4. Local infection b. Adrenaline . High pH c. Clonidine 48, Regarding transfusion compatibility: 2 Blood group 0 is considered a ‘universal recipient” ’. Blood group AB is considered a ‘universal donor ©. Group B+ can be given toa B- recipient 4. Group B- can be given toa B+ recipient finan emergency Group OF blood canbe transfused 49. The following nerve blocks may be appropriate for a woman undergoing a hysterectomy ‘with a Pfannenstiel inci a, Rectus sheath block 4. Lumbar plexus block b. Iiohypogastric nerve block ¢. Iioinguinal block ¢, Transversus abdominis plane block ‘50, When assessing a smoker preoperatively, the following advice is appropriate: The risk of wound infection is reduced if cigarette smoking is stopped four weeks preoperatively 6: Cigarette smoking should be avoided for at least several hours preoperatively(© Fundeni Clinical institute 10 Departement of Anaesthesia and Critical Care ‘Carol Davila Unviersity of Medicine and Pharmacy ¢, Stopping smoking for several hours preoperatively reduces the effects on the oxyhaemoglobin dissociation curve 4. Sputum production is likely o be increased in the postoperative period There isan increased risk of postoperative lower respiratory tract infection 51, The following are correet with reference to permanent pacemakers: a. In three- or five-letter nomenclature codes, the first letter refers to the chamber bun five-letter nomenclature, the fourth letter refers to the presence or absence of antitachycardia functions ¢. The code DDD refers to a response to both trigger and inhibit 4. Ifthe fourth etter isa P, this refers tothe ability to undergo rate modulation ce. The letter D always refers to both atrium and ventriele nsed 52, Which of the following are the strongest predictors of a difficult intubation in an obese patient? 1a. Male gender 4, Obstructive sleep apnoea '. Females with large breasts . Central obesity . Short neck ‘53, Regarding the perioperative management of a pat coronary stents: ‘Elective surgery should be postponed until the period of dual antiplatelet therapy has been completed '. Continuation of aspirin is a contraindication to central neuraxial blockade ¢-In procedures with a low risk of bleeding, dual antiplatelet therapy can be continued throughout the perioperative period 1d. The risk of stent thrombosis is greater with drug-eluting stents when compared with bare metal stents ¢, Clopidogrel must be stopped preoperatively ‘34, The following drugs are known to inerease intraocular pressure: 4. Ondansetron a, Suxamethonium . Metoclopramide b. Rocuronium c, Ketamine 155, Which of the following biochemical abnormalities are associated with Addison’s disease? a. Hyperkalaemia d. Hypoglycaemia b. Hyponatraemia . Hypochloraemia c. Hyperealeaemia(© Fundeni Clinical Institute an Departement of Anaesthesia and Critical Care carol Davila Unviersty of Medicine and Pharmacy 56. You have reviewed a patient preoperatively for emergency surgery who has a pacemaker in situ, Appropriate management includes: 2. Not proceeding with surgery until the pacemaker is deactivated bb Ensuring an alternative method of pacing is available ¢, Instructing the surgeons they must avoid monopolar diathermy _ Instructing the surgeons they must avoid bipolar diathermy ¢. Placing a magnet over the pacemaker 57. Concerning anaesthetic drugs and the elderly: «. Reduced doses of neuromuscular drugs are required, owing to reduced muscle mass b. MAC values of inhalational agents are reduced by 20-30% c. Brreceptor sensitivity is reduced, resulting in a reduction in response to exogenous B-agor 4, Intravenous and inhalational anaesthetic agents can suppress the cardiac and smooth muscle contractility €. Duration of action of opioids and benzodiazepines exhibits an age-related inerease in the climination half-life 58, Concerning noradrenaline: ‘a. Coronary blood flow is increased b. Fetal oxygenation may be reduced c. Hepatic blood flow is increased 4d. Monoamine oxidase inhibitors do not affect metabolism € It is recommended as the first-line vasopressor in sepsis 59, The following are indications for insertion of a permanent pacemaker prior to elective surgery: a. Asymptomatic Mobitz type I atrioventricular block 'b. Mobitz type II atrioventricular block with trifascieular block c. Atrial fibrillation with slow ventricular rate 4, First-degree atrioventricular block ©. Asymptomatic third-degree atrioventricular block. 60, The following are signs of a developing total spinal: a. Increasing anxiety or sense of panic b. Hypotension and bradycardia «Tingling inthe fingers 4. Sudden whispering voice ¢. Respiratory arest