Multiple Choice Questions

99. Hypertension in surgical patients: 105. Protein catabolism is promoted by:

(a) Is associated with cardiovascular instability for both pressure and (a) Cortisol.
heart rate. (b) Growth hormone.
(b) Increases the risk of hypertensive crises in response to stimuli. (c) Insulin-like growth factor-I.
(c) May contribute to increased postoperative cardiac morbidity, but not (d) Insulin.
mortality. (e) Glutamine.
(d) Can be ignored if it is purely systolic.
(e) Should be treated preoperatively if >180/110 mm Hg on more than
106. The acute phase response includes:
two occasions. (a) Hypothermia.
(b) Decreased plasma albumin.
100. The anaesthetic management of hypertensive (c) Hepatic sequestration of copper.
patients should: (d) Increased C-reactive protein.
(a) Be decided exclusively on the blood pressure. (e) Neutrophil leucocytosis.
(b) Include a thorough investigations of target organ involvement.
(c) Disregard ‘white coat’ hypertension as irrelevant.
107. The increased risk of local anaesthetic toxicity in
(d) Include measurement of more than one blood pressure before the neonates:
patient presents for surgery. (a) Applies to amethocaine gel.
(e) Involve the use of balanced anaesthesia. (b) Is partly attributable to reduced hepatic clearance of amide local
anaesthetic agents.
101. The preoperative evaluation should include: (c) Is further increased in the presence of a left-to-right intra-cardiac
(a) The search for evidence of secondary hypertension. shunt.
(b) The rapid, i.v. correction of hypokalaemia where present. (d) Is due to increased protein binding capacity in neonates.
(c) A detailed examination of the patients on-going medication with a view (e) Is ameliorated by concurrent general anaesthesia.
of replacing diuretics and b-blockers by ACE inhibitors.
(d) The introduction of rapidly active antihypertensive agents with a view 108. Concerning local anaesthetic techniques in infants:
to proceeding with elective surgery on the next day. (a) The neonatal spinal cord terminates at the level S3/4.
(e) Consideration of extended monitoring in case of left ventricular (b) An 18G epidural needle is an appropriate size for a 5 kg baby.
hypertrophy and strain. (c) Awake subarachnoid block is useful for long operations.
(d) Injecting local anaesthetic slowly has no advantages.
102. The haemodynamic responses of hypertensive (e) A test dose of local anaesthetic is useful.
patients to anaesthesia and surgery are
characterized by: 109. Peripheral nerve block in infants:
(a) Exaggerated hypo- and hypertension in response to vasoactive drugs. (a) Is safer than central block.
(b) Hypertension after laryngoscopy that is suppressed by local anaesthesia. (b) Is less efficacious than central block.
(c) Bradycardia in response to laryngoscopy and intubation. (c) Needs a higher dose of local anaesthetic.
(d) Excessive hypotension in patients chronically treated with b-blockers. (d) Does not produce motor block.
(e) Greater stability if the antihypertensive medication is continued. (e) Does not require the use of a nerve stimulator.

103. Hypertensive crises during anaesthesia, surgery, 110. Concerning epidural anaesthesia in infants:
and recovery: (a) The younger the child, the lower should be the approach to accessing the
(a) Are never associated with myocardial damage. epidural space.
(b) Can always be controlled by sublingual nifedipine. (b) Epidural catheter techniques can be used in the septic infant.
(c) Require treatment based on associated clinical features such as tachycardia (c) Thoracic epidural blocks need a lower dose of local anaesthetic.
and myocardial ischaemia. (d) Additives such as clonidine are unsafe in neonates.
(d) Can cause an haemorrhagic but not ischaemic stroke. (e) The commonest serious adverse effect is site infection.
(e) Only occur in patients with diastolic hypertension.
111. Concerning subarachnoid block in infants:
104. There is increased secretion of the following (a) It can safely be performed in the conscious neonate.
hormone(s) in response to major surgery: (b) Is contraindicated in the presence of severe respiratory disease.
(a) Arginine vasopressin. (c) A relatively large volume of local anaesthetic per kg is needed when
(b) Norepinephrine. compared with an adult.
(c) Thyroxine. (d) Causes hypotension in neonates.
(d) Testosterone. (e) Has a more rapid onset and shorter duration of anaesthesia than a caudal
(e) Renin. epidural block.

DOI 10.1093/bjaceaccp/mkh046 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004
ª The Board of Management and Trustees of the British Journal of Anaesthesia 2004 169
Multiple Choice Questions

112. Concerning hypnotic agents in obese patients: (c) Succinylcholine is best avoided because of its effect on intracranial
(a) Propofol accumulates more in obese patients owing to its lipophilic pressure.
properties. (d) Fluid resuscitation with glucose-containing solutions may produce
(b) In a TCI system using Marsh kinetics, TBW has to be used. hypothermia, which should not be treated as it is beneficial for
(c) Induction dose of propofol is better calculated on IBW rather then cerebral protection.
on TBW. (e) Urine output is a poor indicator of fluid status and cardiac output
(d) Maintenance dose of propofol can be calculated on TBW. because the patients may have received mannitol.
(e) Midazolam initial and continuous dosage can be safely calculated
from TBW. 118. The following physiological changes occur when a
patient is placed in the prone position:
113. Concerning neuromuscular blocking agents in (a) Reduction of intracranial pressure.
obese patients: (b) Minimal effect on intraocular pressure if head position is optimal.
(a) Rapid sequence induction is still considered standard. (c) Improved oxygenation in all patients.
(b) Succinylcholine should be calculated on LBM. (d) Increase in functional residual capacity.
(c) When avoiding the use of succinylcholine, rocuronium 0.9 mg kg 1 (e) Reduced stroke volume.
TBW is a good alternative.
(d) Mivacurium can be calculated on TBW. 119. Perioperative ulnar neuropathy:
(e) Rocuronium should be avoided because of reports of anaphylactic (a) Is more common in women.
reactions. (b) Is often associated with an associated contralateral clinical neuropathy.
(c) Will usually present within 24 h.
114. Concerning volatile agents in obese patients: (d) In >50% of patients the cause is found to be excess external
(a) MAC values have to be adjusted according to age, body temperature pressure.
and body weight in obese patients. (e) Was associated with the use of trichloroethylene.
(b) Sevoflurane will give rise to higher fluoride concentrations in morbidly
obese patients and should be avoided. 120. The Trendelenburg position:
(c) Patients with the metabolic syndrome should not receive desflurane (a) Always improves cardiovascular parameters in hypovolaemia patients.
because of the risk of hepatitis. (b) Results in a net increase in central blood volume of >20%.
(d) Isoflurane has less organ toxicity compared with halothane and enflurane (c) Was first described by Willy Meher in 1881.
and is a better choice in morbidly obese patients. (d) Classically requires a 45 head down tilt.
(e) Because of its lack of metabolism and a low fat solubility, nitrous oxide (e) May result in brachial plexus injuries.
is useful in obese patients.
121. The following factors are associated with an
115. When resuscitating severely head-injured patients: increased risk of eye injury under anaesthesia:
(a) Securing the airway is important because >60% of spontaneously (a) Duration of anaesthesia >4 h.
breathing patients may hypoxaemic. (b) Male.
(b) The combination of hypoxaemia and hypotension doubles mortality. (c) ASA III--IV.
(c) GCS <12 and an unstable cervical spine fracture are indications for (d) Operations performed on a Monday.
endotracheal intubation. (e) Lateral position.
(d) A CT scan must be performed immediately to diagnose and evacuate
haematomas. 122. Compartment syndrome in the lithotomy position:
(e) Fluid restriction of 2 litre is mandatory in order to minimize cerebral (a) Is not present if a pedal pulse is present.
oedema. (b) Is present if the difference between diastolic pressure and compartment
pressure is <30 mm Hg.
116. When treating long bone fractures in patients (c) Occurs in 1 in 8500 anaesthetics.
who have sustained a severe head injury: (d) Is associated with the use of intermittent calf compression stockings.
(a) Early fixation may be associated with improved outcome. (e) Is associated with prolonged anaesthetics.
(b) Early fixation of fractures may be detrimental if associated with large
blood loss and prolonged resuscitation. 123. Neostigmine:
(c) For delayed fixation, most suitable time for surgery is within 48 h (a) Exerts a direct action on the neuromuscular junction causing skeletal
after the injury. muscle contraction.
(d) Secondary brain insults are less frequent when lower limb tourniquets (b) Causes mydriasis.
are used. (c) Causes bronchodilatation and an increase in physiological dead space.
(e) In those patients with significant brain lesions, intracranial pressure (d) Causes a decrease in cardiac output.
monitoring may reduce the incidence of cerebral hypoperfusion. (e) Crosses the blood--brain barrier easily.

117. In patients who have suffered multiple injuries: 124. Concerning the anticholinergic agents:
(a) Outcome is significantly worse when the injuries are associated with (a) Atropine and glycopyrronium have no effect on nicotinic receptors.
a head injury. (b) They block the muscarinic receptors competitively.
(b) Intracranial lesions must be excluded when there is persistent hypotension (c) Central anticholinergic syndrome can be antagonized using
despite fluid resuscitation. neostigmine.

170 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 5 2004
 Multiple Choice Questions

(d) They can precipitate urinary retention. (c) Is the treatment of choice in a cholinergic crisis in myasthenia
(e) They enhance gastric emptying and increase lower oesophageal gravis.
sphincter tone. (d) Inhibits plasma cholinesterase in addition to acetylcholinesterase.
(e) Has a more rapid onset of action than neostigmine.
125. The following statements are true:
(a) Acetylcholinesterase is found in erythrocytes.
127. Concerning poisoning by nerve agents in chemical
(b) Remifentanil is mainly metabolized by butyrylcholinesterase.
warfare:
(c) Neostigmine binds to the esteratic site of acetylcholinesterase.
(a) Pyridostigmine is used as preventive treatment.
(d) Butyrylcholinesterase metabolizes diamorphine.
(b) The initial cholinergic phase lasts 24--48 h.
(e) Acetylcholine is hydrolysed by acetylcholinesterase, releasing
(c) Non-depolarizing neuromuscular blocking agents may have a protective
acetic acid and choline.
effect on the nicotinic receptors at the neuromuscular junction.
126. Edrophonium: (d) Magnesium may be used as it increases presynaptic acetylcholine
(a) Is more potent than neostigmine. release.
(b) Has a brief duration of action compared with neostigmine. (e) Pralidoxime can cause laryngospasm and muscle rigidity.

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