Multiple Choice Questions
Intensive care management of patients (b) Can cause thrombocytopaenia.
with haematological malignancy (c) Is more common where donor and recipient are of different
genders.
1. The following are true of patients with neutropaenia or
(d) Can be graded for severity according to skin, liver and gut
thrombocytopaenia:
involvement.
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(a) In neutropaenia the white cell count will be less than 2 x109
(e) Is a common cause for intensive care unit (ICU) admission
litre21.
within the first 10 days of stem cell transplantation.
(b) Bladder catheterization is contra-indicated in neutropaenic
patients.
Paediatric neuroanaesthesia
(c) Neutropaenic patients should not be exposed to staff with
active shingles. 5. Compared with the adult population:
(d) Thrombocytopaenia can be caused by vancomycin. (a) Neonates have a higher cerebral blood flow (CBF).
(e) Patients who require platelet transfusions should have their (b) Children have a higher cerebral metabolic rate for oxygen
platelet count checked after 24 h in case HLA-matched (CMRO2).
platelets are required. (c) Moderate hypocapnia in the neonate has a greater effect on
CBF.
2. Regarding tumour lysis syndrome:
(d) CBF is not affected by cerebral perfusion pressure in young
(a) Rasburicase or allopurinol may be used to treat patients with
children.
tumour lysis syndrome.
(e) Accurate values for autoregulatory ranges for CBF in neo-
(b) Serum hyperphosphataemia, hypercalcaemia and hyperuri-
nates are unavailable.
caemia are common.
(c) It often presents with acute hyperkalaemia which may 6. In the paediatric population:
require renal replacement therapy. (a) The anterior fontanelle closes at around 1 year to 18 months.
(d) Fluid restriction is often required. (b) All cranial sutures will be closed by 2 years.
(e) It is most commonly seen after stem cell transplantation. (c) Cranial enlargement is often a sign of raised intracranial
pressure (ICP) in older children.
3. Regarding infections in patients with haematological
(d) The majority of intracranial tumours arise infratentorially.
malignancy:
(e) Acute increases in ICP can be compensated for by an
(a) Neutropaenic enterocolitis (typhlitis) has similar presenting
increase in skull size.
features to Clostridium difficile colitis.
(b) Pneumonia can be present without classical X-ray 7. Regarding paediatric neurosurgical pathology:
appearances. (a) Closure of neonatal lumbosacral meningocele is an emer-
(c) Pneumonia requiring endotracheal intubation and mechanical gency procedure.
ventilation is predictive of poor outcome. (b) Myelodysplasia is no longer thought to be associated with
(d) Antimicrobials which are active against Pseudomonas latex allergy.
species should be part of the empirical treatment of (c) Chiari malformation is associated with hydrocephalus in
pneumonia. fewer than 50% of cases.
(e) Broncho-alveolar lavage should be considered in patients (d) Craniopharyngioma is the most common intracranial tumour.
with suspected pneumonia which does not improve after (e) Posterior fossa tumours are more likely to be associated with
antimicrobial therapy. raised ICP.
4. Graft versus host disease: 8. Surgical repair of craniosynostosis:
(a) With severe skin involvement is a contra-indication to par- (a) Most commonly takes place between the ages of 5 and 10
enteral nutrition because of the risk of line infection. years.
doi:10.1093/bjaceaccp/mkq053 197
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Multiple Choice Questions
(b) Often requires blood transfusion. (b) Local anaesthetic is placed at the posterior wall of the rectus
(c) If it involves mid face anomalies, should ideally be carried abdominis.
out at a supraregional centre. (c) Local anaesthetic will not spread through the sheath due to
(d) If it involves a single suture, is often performed in children tendinous intersections.
with a craniofacial syndrome. (d) Complications include puncture of inferior epigastric
(e) Requires invasive cardiovascular monitoring. vessels.
(e) It is suitable for catheter insertion to provide prolonged
Anaesthetic implications of psychoactive analgesia.
drugs 15. Regarding ilioinguinal nerve block:
(a) The ilioinguinal nerve originates from the L1 nerve root.
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9. Tricyclic antidepressants (TCAs):
(b) The iliohypogastric nerve originates from the L2 nerve
(a) May cause arrhythmias.
(b) Enhance uptake 1. root.
(c) May cause hypotension. (c) The ilioinguinal nerve supplies the skin over the umbilicus.
(d) It has a success rate of over 90%.
(d) Raise the seizure threshold.
(e) May cause anticholinergic side-effects. (e) Femoral nerve block may be a complication.
16. Regarding transversus abdominis plane (TAP block):
10. Drugs that should be avoided in patients taking monoaminoxi-
(a) Ultrasound cannot be used for this block.
dase inhibitors (MAOIs) include:
(a) Ephedrine. (b) It provides analgesia for visceral abdominal pain.
(c) Injection into the peritoneal cavity may result in a prolonged
(b) Pethidine.
block.
(c) Morphine.
(d) Bupivacaine with 1:200 000 adrenaline. (d) Low volume and high concentrations of local anaesthetic are
recommended.
(e) Ketamine.
(e) The triangle of Petit is bounded by the external oblique, the
11. Selective serotonin reuptake inhibitors: iliac crest and lattissimus dorsi muscle.
(a) May impair platelet function.
(b) Are a contraindication to use of pethidine.
(c) May cause the serotonergic syndrome when administered Antiplatelet drugs, coronary stents
with tramadol. and non-cardiac surgery
(d) Inhibit presynaptic serotonin reuptake.
17. Regarding antiplatelet agents used in cardiology:
(e) Are generally not stopped before elective surgery.
(a) Both aspirin and clopidogrel are prodrugs.
12. The following are known side-effects of antipsychotic drugs: (b) The duration of action of aspirin and clopidogrel is 5 –10
(a) Tardive dyskinesia. days.
(b) Parkinsonian symptoms. (c) Cangrelor is a reversible short-acting thienopyridine.
(c) Urinary retention. (d) Cangrelor may be suited to bridging therapy in situations
(d) Diarrhoea. when long-acting thienopyridines must be stopped before
(e) Precipitation of neuroleptic malignant syndrome. non-cardiac surgery.
(e) The antiplatelet activity of tirofiban and eptifibatide lasts
24 h after cessation of therapy.
Nerve blocks of the anterior abdominal
wall 18. Regarding percutaneous coronary intervention (PCI):
(a) The number performed annually exceeds the number of
13. Regarding abdominal wall anatomy:
coronary artery bypass grafts 3-fold.
(a) The nerve supply to the umbilicus is the posterior rami of
(b) Bare metal stents have reduced the incidence of stent
T10.
re-stenosis compared with drug-eluting stents.
(b) Transversus abdominis is the most superficial muscle.
(c) Drug-eluting stents have reduced the incidence of late stent
(c) The transversus abdominis plane is between the transversus
thrombosis compared with bare metal stents.
abdominis muscle and the external oblique muscle.
(d) Drug-eluting stents slowly release antiplatelet drugs to
(d) The arcuate line is found one third of the distance from the
prevent late stent thrombosis.
umbilicus to the pubic crest.
(e) After insertion of a drug-eluting stent, patients are
(e) The rectus abdominis is divided by the linea alba.
required to take aspirin for life and clopidogrel for at
14. Regarding rectus sheath block: least 12 months.
(a) The depth of the rectus sheath can be accurately predicted.
198 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 10 Number 6 2010
Multiple Choice Questions
19. In non-cardiac surgery after stent insertion: Anaesthesia for electroconvulsive therapy
(a) Surgery should be delayed at least 6 weeks after insertion of
a bare metal stent. 21. Physiological responses to electroconvulsive therapy (ECT)
(b) Surgery should be delayed at least 12 weeks after include:
drug-eluting stent insertion. (a) An early sympathetic discharge lasting 10– 15 s.
(c) After recent stent insertion, withdrawal of all anti-platelet (b) 30– 40% increases in systolic blood pressure.
agents increases the relative risk of coronary thrombosis by (c) A short-lived reduction in ventricular function.
90:1. (d) An increase in intracranial pressure.
(d) Clopidogrel use has been shown to increase perioperative (e) A decrease in tissue oxygen consumption.
morbidity in most surgical procedures because of 22. Regarding long-term effects of ECT:
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bleeding. (a) Mortality is around 1 in 8000 procedures.
(e) Clopidogrel should be stopped at least 5 days before spinal (b) Short-term memory impairment only occasionally lasts more
or neurosurgery. than a few weeks.
20. Regarding perioperative monitoring of antiplatelet agents: (c) ECT commonly affects non-memory cognitive functions
(a) The R time of a thromboelastogram is the most useful (e.g.) intelligence, judgement).
parameter when monitoring platelet function. (d) Anterograde and retrograde amnesia can occur.
(b) Thromboelastography is a suitable tool for monitoring the (e) Joint dislocations are a major cause of morbidity.
antiplatelet effects of aspirin and clopidogrel. 23. Regarding anaesthesia technique:
(c) Modified thromboelastography is a suitable tool for monitor- (a) Etomidate is associated with longer seizure duration.
ing the antiplatelet effects of GPIIb/IIIa inhibitors. (b) Neuromuscular blocking agents should be avoided because
(d) Optical platelet aggregometry is a useful point-of-care of effects on seizure activity.
clinical test. (c) Glycopyrrolate is preferred over atropine.
(e) Modified thromboelastography may be used to monitor the (d) Bite blocks should be avoided because of the risk of trauma.
antiplatelet effects of cangrelor. (e) Hyperventilation lowers the seizure threshold.
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