Started on Thursday, 20 June 2024, 3:30 AM

State Finished
Completed on Thursday, 20 June 2024, 4:44 AM
Time taken 1 hour 14 mins
Marks 24/30
Grade 81 out of 100

Question 1
Incorrect

Mark 0 out of 1

Which of the following statements regarding the ECG and electrical activity of the heart is true?

Select one:

A. The P wave represents atrial depolarisation.

B. Ventricular tachycardia is rarely associated with cardiorespiratory arrest.

D. The P wave represents atrial contraction. ×

E. Atrial fibrillation with a ventricular rate of contraction of 150 beats per minute should be treated principally by
electrical cardioversion.

Question 2
Correct

Mark 1 out of 1

Stimulation of peripheral pain receptors (nociceptors) will result in conduction of pain signals through which of the following
type of nerve fibres:

Select one:

A. A-beta and B

B. C and A-delta ✓

C. A-alpha

D. A-gamma

E. B and A-gamma
Question 3
Partially correct

Mark 1 out of 1

The following are causes of tachycardias (sinus, SVT, AF) in the surgical patient.

Select one or more:

A. Hypokalaemia ✓

B. Hypoxaemia ✓

C. Hypermagnesaemia

D. Hypovolaemia ✓

E. Hypothyroidism ✓

Question 4
Partially correct

Mark 1 out of 1

Which of the following form the AKIN Criteria for acute kidney injury?

Select one or more:

A. 2-3 times increase of serum creatinine from baseline in 12-hours ✓

B. Doubling of serum urea within 24-hours

C. Urine output 0.5ml/kg/hr for minimum of 6-hours ✓

D. 1.5 mmol/l increase in serum potassium over 24-hours

E. Urine output of 0.3ml/kg/hr over 24-hours ✓

Question 5
Correct

Mark 1 out of 1

Non steroidal anti inflammatory drugs (NSAIDs):

Select one:

A. Are safe in patients with unstable asthma.

B. Amitriptyline is a typical example.

C. Are associated with improved platelet function.

D. Are contraindicated in critically ill patients with an acute kidney injury. ✓

E. Are not used as part of a multimodal approach.

Mark 1 out of 1

Inadequately treated pain following open aneurysm repair is likely to lead to:

Select one or more:

A. Lowered blood corticosteroids levels

B. Increased myocardial oxygen consumption ✓

C. Restricted mobility and tendency to DVT ✓

D. A lowered BP

E. Increased cough ×

Question 7
Partially correct

Mark 1 out of 1

Signs of impaired tissue perfusion in shock may include:

Select one or more:

A. Gastric mucosal alkalosis.

B. Poor urine output. ✓

C. Normal serum lactate.

D. Capillary refill time less than 2 seconds.

E. Decreased core / peripheral temperature difference. ✓

Question 8
Correct

Mark 1 out of 1

Good peri-operative analgesia:

Select one:

A. Is easy in a worried and anxious patient.

B. Is associated with multimodal, multidisciplinary approach. ✓

C. Is associated with the use of a single analgesic agent.

D. Is associated with longer hospital length stay.

E. Is easy to achieve in thoracic surgery.

Mark 1 out of 1

Cardiac output depends on:

Select one:

A. Transfer pressure to air waves.

B. Convert pressure to electricity.

C. Synthesise pressure.

D. Blood lactate levels.

E. Left ventricular end diastolic filling pressure. ✓

Question 10
Incorrect

Mark 0 out of 1

Patient controlled analgesia using morphine:

Select one:

A. Works best without patient involvement.

B. Is safe in patients with an acute kidney injury. ×

C. Is an optimal technique in a comatose patient.

D. Is associated with patient sedation and an improved VAS score.

E. Is associated with an increased Bromage score.

Question 11
Partially correct

Mark 1 out of 1

A 63 year old man becomes hypotensive 6 hours after an elective AAA repair. An epidural (fentanyl and bupivacaine) is in
place and running. Blood pressure is 80/40 and peripheries are cool. Which of the following statements are not true?

Select one or more:

A. It is too early in this mans hypotension to be caused by myocardial ischemia.

B. Bleeding is unlikely if the drains are empty. ✓

C. A CCrISP system assessment is not necessary as the most likely cause of the hypotension is bleeding. ✓

D. It is reasonable to stop the epidural as the cause of the hypotension during initial assessment.

E. 500ml colloid should be given over 15-20 minutes. ✓

Mark 1 out of 1

In medical ethics an individual's right to self-determination is termed 'justice'.

Select one:

True

False ✓

Question 13
Correct

Mark 1 out of 1

Which of the following are true regarding laparoscopic surgery?

Select one or more:

A. Medical Air is commonly used as the insufflating gas to establish and maintain pneumoperitoneum.

B. Referred pain is uncommon after laparoscopic surgery. ×

C. There is a reduction in Venous Return to the heart (pre-load) during the period of pneumoperitoneum. ✓

D. Iatrogenic injury is rarely a consideration during Laparoscopic surgery.

E. Pneumoperitoneum is associated with a reduced intra-thoracic compliance, which can lead to high airway ✓
pressures.

Question 14
Correct

Mark 1 out of 1

Central venous access is essential in measuring:

Select one:

A. Intracranial pressure

B. Intra-abdominal pressure

C. Pulmonary wedge pressures ✓

D. Ventilation pressures.

E. Systemic arterial pressures.

Mark 1 out of 1

Which of the following is/are associated with SIRS and Sepsis?

Select one or more:

A. Increased TNF-alpha and IL-6. ✓

B. Increased splanchnic circulation.

C. Increased Reactive Oxygen Species (ROS). ✓

D. Hypercoagulability ✓

E. Mitochondrial dysfunction. ✓

Question 16
Correct

Mark 1 out of 1

Which of the following are core principles of effective end-of-life care?

Select one or more:

A. For the patient (wherever possible) to achieve a sense of control ✓

B. Adequate pain and other symptom management ✓

C. To have burdens relieved and their “affairs put in order” ✓

D. Strengthen bonds with loved ones ✓

E. Avoid inappropriate prolongation of the dying process ✓

Question 17
Correct

Mark 1 out of 1

A 75 year old patient on a surgical ward develops a shock state 5 nights after a left nephrectomy.

Select one:

A. The CVP will be low after pulmonary embolism.

B. Fluid resuscitation should only occur if the CRT is 4 seconds or more.

C. If BP can be maintained with fluid boluses any search for cause of the shock can be deferred.

D. CVP may show a temporary elevation following a rapid fluid bolus. ✓

E. An acute coronary event can be ruled out if the serum troponin level is not raised.
Question 18
Partially correct

Mark 1 out of 1

Which of the following is/are associated with elective Endovascular Repair (EVAR) of Abdominal Aortic Aneurism (AAA)?

Select one or more:

A. Spinal Cord Ischaemia ✓

B. Graft migration ✓

C. Comparable in-hospital mortality (compared with elective open AAA repair) ×

D. Abdominal Compartment Syndrome ×

E. Endoleak ✓

Question 19
Correct

Mark 1 out of 1

Intraclavicular central venous cannulation:

Select one:

A. Uses the external jugular vein.

B. is the most common access route in UK practice.

C. Uses the axillae vein.

D. uses the subclavian vein ✓

E. Does not expose the patient to sepsis.

Question 20
Correct

Mark 1 out of 1

Patients at a significantly high cardiac risk during non-cardiac surgery include those with:

Select one or more:

A. Stable angina ×

B. MI in the past 5 months ✓

C. Atrial fibrillation with a ventricular rate of 90bpm.

D. Asymptomatic mitral regurgitation.

E. Decompensated heart failure. ✓

Mark 0 out of 1

Consider the following interaction:

Select one:

True ×

False

Question 22
Partially correct

Mark 1 out of 1

Which of the following are direct functions of the kidney?

Select one or more:

A. Lactate metabolism

B. Inhibition of erythropoietin

C. Excretion of water soluble metabolites ✓

D. Sodium homeostasis ✓

E. Vitamin-D synthesis ✓

Question 23
Incorrect

Mark 0 out of 1

The cyclical reaction of intrusion and avoidance characterise post traumatic stress disorder.

Select one:

True

False ×
Question 24
Correct

Mark 1 out of 1

Following a revision hip replacement surgery, an eighty-year-old man developed acute kidney failure. He is currently in
significant pain in the operative site. Which of the following analgesic is best avoided?

Select one:

A. Morphine

B. Paracetamol

C. Diclofenac ✓

D. Codeine

E. Tramadol

Question 25
Correct

Mark 1 out of 1

Acute confusional states:

Select one or more:

A. Are worse during the day.

B. Can be contributed to by sedative and anticholinergic drugs. ✓

C. Are simply managed by restraining.

D. Are manifest by loss of contact between the patient and surroundings. ✓

E. Should be treated initially by large does of psychotic drugs.

Question 26
Partially correct

Mark 1 out of 1

A 60 year old diabetic man undergoes a right hemi colectomy. He is hypotensive after the operation (100/65 compared to a
normal of 145/80) which is thought to be due to his epidural. On day 4 he develops confusion, signs of severe sepsis and
requires ICU support. You saw him before his transfer to ICU and there were no obvious abdominal signs other than mild
distension. The ICU consultant calls you to see him as they are worried about anastomotic leakage. Anastomotic leakage:

Select one or more:

A. Was probably caused by the post-operative hypotension.

B. Is best managed on ICU with large drains placed down to the area of the bowel anastomosis. ×

C. Is a relevant diagnosis.

D. Commonly presents with non-specific signs. ✓

E. Is best managed by re-operation. ×

Mark 1 out of 1

Skills useful in communicating bad news to patients include:

Select one or more:

A. Summarising ✓

B. Sympathy ×

C. Silent pauses ✓

D. Active listening ✓

E. Using correct medical terminology

Question 28
Correct

Mark 1 out of 1

Pain:

Select one:

A. Is associated with improved glycemic control.

B. Is associated with increased plasma cortisol levels. ✓

C. Is associated with improved peri-operative morbidity.

D. Is conducted by alpha-1 nerve fibres.

E. Is a pleasant sensory and emotional experience associated with surgery.

Question 29
Correct

Mark 1 out of 1

Patients for whom mask Oxygen therapy is inadequate:

Select one:

A. Can always be detected at an early stage by pulse oximetry.

B. Can be predicted by pre-operative pulmonary function tests.

C. May show distress, dyspnoea, exhaustion, sweating and confusion. ✓

D. Tire and arrest in a predictable and often prolonged manner.

E. Are detected only by blood gas analysis.

Mark 1 out of 1

The mortality rate for patients with septic shock is:

Select one:

A. 75%

B. 10%

C. 40% ✓

D. 15%

E. 60%

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