Mahesh Chaudhari MD, FRCA, FFPMRCA Consultant Anaesthetist Worcestershire Royal Hospital Worcester, UK

Transcription

1 Preface iv Single best answer type multiple choice questions have been introduced into anaesthetic postgraduate examinations as a way of assessing the trainee s ability to apply knowledge to clinical practice. Although this is more relevant for topics in clinical anesthesia, recently this method of assessment has been extended to topics in basic sciences. This book consists of six sets of single best answer practice papers. Each set comprises 30 multiple choice questions drawn from physiology, pharmacology, clinical measurement, equipment and physics relevant to anaesthetic examinations. Each question consists of a stem describing a clinical scenario or problem followed by five possible answer options. One of them is the best response for the given question. Each question and answer is accompanied by supporting notes obtained from peer-reviewed journal articles and basic science textbooks. Alongside the previously published book Single Best Answer MCQs in Anaesthesia (Volume I Clinical Anaesthesia, ISBN ), this book supplements the essential study material for postgraduate anaesthetic examinations. The main objective of this book is to provide trainees with a series of single best answer type questions that will prepare them for this format of postgraduate examinations. Much emphasis has been placed on the understanding and application of basic science knowledge with regards to clinical practice.

2 We hope that a thorough revision of this book will enable trainees to improve their understanding and core knowledge of basic sciences relevant to anaesthesia. We believe this book will not only be an invaluable educational resource for those who are preparing for postgraduate examinations, but will also be of benefit to any practising anaesthetist. Cyprian Mendonca MD, FRCA Consultant Anaesthetist University Hospitals Coventry and Warwickshire Coventry, UK v Mahesh Chaudhari MD, FRCA, FFPMRCA Consultant Anaesthetist Worcestershire Royal Hospital Worcester, UK Arumugam Pitchiah MD, FRCA Specialty Registrar Welsh School of Anaesthesia Wales, UK

3 Set 1 questions 1 Which of the following is the most effective process to maintain an energy supply to muscles during physical exertion in trained athletes (as compared to untrained individuals)? Set 1 1 a. Protein catabolism. b. Effective utilisation of free fatty acids. c. More glycogen utilisation. d. More lactate production. e. Gluconeogenesis by deamination. 2 A 47-year-old female is due to undergo a hysterectomy. Her preoperative ECG shows progressive lengthening of the PR interval until a ventricular beat is dropped. Which of the following conduction abnormalities is she most likely to have? a. First degree heart block. b. Mobitz type 1 heart block. c. Mobitz type 2 heart block. d. Left bundle branch block. e. Right bundle branch block. 3 Hypoxic pulmonary vasoconstriction (HPV) in the lungs is a compensatory mechanism to improve ventilation perfusion

4 Single Best Answer MCQs in Anaesthesia matching. In which of the following would a decrease most likely trigger HPV? a. Partial pressure of oxygen in the pulmonary artery. b. Partial pressure of oxygen in the pulmonary veins. c. Partial pressure of oxygen in the alveoli. d. Oxygen saturation of haemoglobin in the pulmonary artery. e. Oxygen saturation of haemoglobin in the pulmonary veins. 2 4 You perform an uncomplicated lumbar epidural for labour analgesia on a 27-year-old lady of 36 weeks gestation with twins. Immediately after the test dose of 15ml 0.25% bupivacaine she lies supine and her BP is 70/40. The most likely cause for hypotension in this patient is: a. Concealed ante-partum haemorrhage. b. Intrathecal injection of local anaesthetic. c. Dehydration. d. Aorto-caval compression. e. Anaphylaxis. 5 A 35-year-old patient with a BMI of 35 aspirates gastric contents on induction of anaesthesia. One week later on the ICU, a diagnosis of acute respiratory distress syndrome is made. Which of the following mechanisms is most likely to contribute to the associated pulmonary oedema? a. Increased pulmonary capillary permeability. b. Raised pulmonary capillary hydrostatic pressure due to fluid overload. c. Reduced lymphatic drainage. d. Reduced alveolar interstitial pressure. e. Decreased oncotic pressure in the pulmonary capillary.

5 Set 1 questions 6 A 29-year-old woman on lithium for bipolar disease was brought to the emergency department where she was found to be unresponsive. She has a history of convulsions and her ECG shows conduction defects with ST changes. Plasma lithium levels were found to be 7.5mmol/L. In addition to supportive treatment, specific management would be: a. Haemodialysis. b. Administration of magnesium. c. Forced alkaline diuresis. d. Acetazolamide administration. e. Diazepam infusion. 3 7 A 66-year-old male with hypertension and ischemic heart disease is scheduled for an open cholecystectomy. The best technique among the following to suppress the pressor response to laryngoscopy and intubation would be: a. Intravenous esmolol. b. Morphine 0.4mg/kg prior to intubation. c. Isoflurane. d. Intravenous phentolamine. e. GTN spray prior to induction. 8 A 53-year-old woman suffering from chronic back pain presents for excision of a small lipoma on the forearm under general anaesthesia. Her regular medication includes 100mg of morphine sulphate continuous twice daily. In the postoperative period the optimal dose of oral morphine to be prescribed would be: a. 20mg every 4 hours with extra doses of 20mg for breakthrough pain. b. 30mg every 4 hours with extra doses of 30mg for breakthrough pain. c. 20mg every 6 hours with extra doses of 20mg for breakthrough pain. d. 30mg every 8 hours with extra doses of 30mg for breakthrough pain. e. 30mg every 2 hours with extra doses of 30mg for breakthrough pain.