Single Best Answer MCQs in

ANAESTHESIA

Volume II Basic Sciences

Cyprian Mendonca, Mahesh Chaudhari, Arumugam Pitchiah

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)?

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 pre-

operative 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
 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.

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.
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.

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.
9 A 9-year-old boy weighing 40kg is undergoing an appendicectomy.
He became severely hypotensive 5 minutes after the administration
of an antibiotic. He developed a rash all over his body. His blood
pressure is 65/45mmHg, his heart rate is 140 per minute and he has
weak central pulses. The most appropriate dose and route of
administering adrenaline is:

a. 0.1ml/kg of 1:10 000 adrenaline IV.

b. 0.1ml/kg of 1:100 000 adrenaline IV.
c. 0.1ml/kg of 1:1000 adrenaline IV.
d. 0.1ml/kg of 1:10 000 adrenaline IM.
e. 0.1ml/kg of 1: 20 000 adrenaline IM.

10 A 47-year-old woman is scheduled for an elective total abdominal

hysterectomy. She consents for a lumbar epidural for postoperative
analgesia. In the anaesthetic room, at 10am, it is noted from her
prescription chart that she has had a prophylactic dose of
enoxaparin the previous evening at 22:00 hours. The best
management option is:

a. To avoid the epidural and choose an alternative method of

postoperative analgesia.
b. To continue with the scheduled plan of epidural analgesia.
c. To postpone surgery to another day.
d. To estimate anti-Xa levels prior to insertion.
e. To review PT and APTT prior to insertion.

11 A patient is receiving oxygen at a rate of 10L/minute, from a size E

cylinder (volume 5L). The pressure in the cylinder is 100 bar. How
long can oxygen be delivered from this cylinder?

a. 30 minutes.
b. 40 minutes.
c. 45 minutes.
d. 50 minutes.
e. 60 minutes.
12 You are starting the first case on a Sunday morning in the
emergency theatre. After induction of general anaesthesia, despite
adequate mask ventilation using 6L/minute of oxygen flow, the
oxygen saturation begins to fall. The oxygen analyser at the common
gas outlet (fuel cell) and at the mask end of the breathing system
(paramagnetic analyser) reads inspired oxygen concentration as
21%. Despite turning the oxygen cylinder on (pressure reads 90
bar), the oxygen saturation continues to fall. The single most
important next step in the management is:

a. Immediate tracheal intubation.

b. Ventilate using a resuscitation bag and auxiliary oxygen source from
the same anaesthetic machine.
c. Change the pulse oximeter probe.
d. Disconnect the oxygen pipeline.
e. Change the oxygen cylinder on the machine.

13 A 60-year-old male patient is ventilated using volume-controlled

ventilation. The normal waveform of EtCO2 gradually (over 15
minutes) changes to the following trace (Figure 1). Which of the
following situations best describes the change in the EtCO2
waveform?

Figure 1. Volume-controlled ventilation EtCO2 waveform.

a. Spontaneous breathing.
b. Hypoventilation.
c. Malfunction of inspiratory valve.
d. Malfunction of expiratory valve.
e. Exhaustion of CO2 absorber.

14 The figure below is an arterial trace from a 70-year-old patient with

chronic obstructive airway disease, in the intensive care unit. This
trace indicates:

Figure 2. Arterial trace.

a. Presence of blood clot in the cannula.

b. An under-damped trace.
c. Compliant tubing.
d. Atrial fibrillation.
e. Kinking of the cannula.
15 You are planning to perform a gas induction with sevoflurane
(molecular weight = 200 and density = 1.5). The vaporiser dial is set
at 6%, with a fresh gas flow of 5L/minute using a Mapleson A
breathing system. How much liquid sevoflurane is required for the
first 5 minutes?

a. 3ml.
b. 5ml.
c. 7ml.
d. 9ml.
e. 11ml.

16 A 27-year-old man is keen to climb up to the summit of Mount

Everest without using additional oxygen. Which of the following is
the most significant physiological adaptation for his successful
acclimatization?

a. Increase in 2,3-DPG in red blood cells.

b. Improved ventilation perfusion matching.
c. Hyperventilation.
d. Polycythaemia.
e. Improved ability of the body to generate energy from anaerobic
metabolism.

17 A female patient with a BMI of 49 is scheduled to undergo gastric

banding surgery. A change in which of the following parameters
confers the greatest advantage when pre-oxygenating her in the
sitting (rather than supine) position?

a. Vital capacity.
b. Ventilation/perfusion matching.
c. Tidal volume.
d. Closing capacity.
e. Functional residual capacity.
18 A 39-year-old lady was admitted to intensive care from a medical
ward where she was treated for pneumonia and diabetes mellitus.
She is intubated and ventilated. Two hours following intensive
treatment the following parameters were observed (Table 1).

Table 1. Vital parameters.

HR 126/minute
BP 80/44 (55)mmHg,
CVP +5mmHg
Body surface area 2m2
Cardiac output 8L/min
Stroke volume 80ml
PA pressure 25/7(13)mmHg
PAWP 6mmHg
SvO2 65%
CaO2 15ml.dl-1

Her systemic vascular resistance would be:

a. 400dynes.s.cm-5.
b. 500dynes.s.cm-5.
c. 550dynes.s.cm-5.
d. 600dynes.s.cm-5.
e. 650dynes.s.cm-5.

19 A 70-year-old male patient with severe chronic obstructive airway

disease has been intubated and ventilated in the intensive care unit.
Before intubation and ventilation his oxygen saturation was 90%; it
is now 100%. His PaO2 has increased from 8kPa to 20kPa. His
haemoglobin is 15g/dL and pH is 7.32. His oxygen content in the
blood is:
a. Increased by 15ml/100ml.
b. Increased by 12ml/100ml.
c. Increased by 9ml/100ml.
d. Increased by 6ml/100ml.
e. Increased by 3ml/100ml.

20 A 70-year-old man is scheduled for a knee arthroplasty. Prior to

induction of general anaesthesia a femoral nerve block is
performed using a nerve stimulator. Soon after injection of 20ml of
0.5% bupivacaine, he became unresponsive. He is unconscious
and has no palpable carotid pulse. CPR is commenced. Which
one of the following best describes the specific treatment in this
scenario?

a. 1ml/kg of 10% lipid emulsion over 1 minute.

b. 1.5ml/kg of 20% lipid emulsion over 1 minute.
c. 1.5ml/kg of 20% lipid emulsion over 5 minutes.
d. 1ml/kg of 10% lipid emulsion over 1 minute.
e. 1.5ml/kg of 10% lipid emulsion over 2 minutes.

21 In a 40-year-old male (total body water of this patient is 60L) after

oral administration and absorption, drug A is distributed only in
extracellular fluid. If the terminal half-life of the drug is 500 minutes,
which one of the following most closely represents the clearance
value (ml/minute) for this drug?

a. 14.
b. 28.
c. 20.
d. 34.
e. 40.
22 A 38-year-old woman with a body mass index of 48 is to undergo an
elective laparotomy for gynaecological surgery. The induction dose
of propofol is best calculated based on:

a. Actual body weight.

b. Ideal body weight.
c. Lean body mass.
d. Body mass index.
e. Ideal body weight + 20% total body weight.

23 A 11-year-old obese girl has undergone a tonsillectomy. Later that

evening she is found pale and hypotensive. She is diagnosed with
post-tonsillectomy bleeding. She is very anxious. The preferred
method of induction would be:

a. Inhalational induction with sevoflurane with a head-down tilt.

b. Rapid sequence induction with thiopentone and suxamethonium.
c. Rapid sequence induction with thiopentone and rocuronium.
d. Rapid sequence induction with propofol and rocuronium.
e. Inhalational induction with desflurane with a head-down tilt.

24 A 35-year-old woman is brought to the emergency department

following a suspected amitriptyline overdose. She has a GCS of 6
and her blood pressure is 90/46mmHg. A 12-lead ECG is recorded;
it is highly likely to show:

a. Atrial fibrillation.
b. Sinus bradycardia with a prolonged QRS complex.
c. Sinus tachycardia with a prolonged QRS complex.
d. Complete heart block.
e. Ventricular tachycardia.

25 A 40-year-old ASA 1 male patient with a body mass index of 28 is

undergoing a complex orthopaedic procedure on the left forearm
lasting for 8 hours. The most appropriate reason for choosing
 invasive arterial blood pressure monitoring over automated non-
invasive blood pressure measurement in this patient is:

a. Automated non-invasive blood pressure monitoring would be

inaccurate in this patient.
b. Automated blood pressure monitoring is likely to result in ulnar nerve
injury.
c. Monitoring invasive blood pressure ensures adequate perfusion
pressure.
d. Hypotension can be detected early using invasive blood pressure
monitoring.
e. Automated non-invasive blood pressure monitoring for 8 hours can
result in distal oedema of the limb.

26 You encountered a difficult laryngoscopy in a patient scheduled for

an emergency laparotomy. The laryngoscopic view was grade 3.
You managed to intubate the trachea by railroading the tracheal tube
over a gum elastic bougie. Which of the following is the most reliable
method of confirming the correct placement of the tracheal tube?

a. Feeling clicks whilst advancing the bougie.

b. Distal hold up of bougie.
c. Presence of CO2 in the initial few breaths.
d. Presence of bilateral chest movement.
e. Endoscopic confirmation using a fibreoptic scope.

27 A 65-year-old male patient presents with severe shortness of breath

due to extrinsic compression of the mid-trachea. Which of the
following statements best describes the reason for administering
heliox in this patient?

a. It decreases the density of the gas mixture.

b. It decreases the viscosity of the gas mixture.
c. It decreases the Reynold’s number.
d. It converts turbulent flow into laminar flow.
28 You discover that an anaesthetic machine with a sodalime absorber
and a desflurane vaporiser has not been used for the last 48 hours.
However, the fresh gas flow was left running at 2L/minute for the last
48 hours. Which of the following is the most appropriate action
before using this machine to administer anaesthesia to the first
patient on the list?

a. Use a different anaesthetic machine.

b. Change the sodalime absorber and use the same anaesthetic
machine.
c. Continuously flush the anaesthetic machine for 1 hour and then use
the machine.
d. Use high fresh gas flow for the first hour.
e. Change the vaporiser to isoflurane.

29 A 4-year-old child weighing 16kg is scheduled for an inguinal

herniotomy. You are planning to maintain the airway using a laryngeal
mask airway (LMA). Which of the following is the most suitably sized
LMA for this child?

a. Size 1½.
b. Size 2.
c. Size 2½.
d. Size 3.
e. Size 3½.

30 At the end of an elective right hemicolectomy, it is noticed that the

heat-moisture exchange (HME) filter was not used during the entire
procedure. Four days later the patient develops a lower respiratory
tract infection. Which of the following mechanisms initiates the
cascade of events leading to respiratory tract infection in this
patient?

a. Evaporation of water from mucus lining the epithelium of the trachea.

b. Loss of the mucociliary elevator mechanism.
c. The change in the isothermic saturation boundary within the airways.
d. Viscous secretions gradually occluding the tracheal tube.
Set 2 questions
1 A 27-year-old primigravida at 38 weeks’ gestation is pre-oxygenated
to undergo an emergency Caesarean section under general
anaesthesia. Which one of the following physiologic changes
mandate pre-oxygenation in this lady?

a. Reduction in functional residual capacity.

b. Increase in anatomical dead space.
c. Increase in minute ventilation.
d. Increase in the closing capacity.
e. Increased CO2 production.

2 A 66-year-old man has an echocardiogram, as part of his pre-

operative investigations. The echocardiogram report shows that he
has a left ventricular end-diastolic volume of 125ml and end-systolic
volume of 50ml. What is his left ventricular ejection fraction?

a. 40%.
b. 50%.
c. 60%.
d. 65%.
e. 55%.

3 A 38-year-old man has had a craniotomy for evacuation of subdural

haematoma following a road traffic accident. He has been admitted
to intensive care for postoperative management. He has a blood
 pressure of 184/92mmHg, his heart rate is 48/minute and his
intracranial pressure is 25mmHg. The settings on the ventilator have
been altered to deliver high minute ventilation. Which one of the
following physiological changes is attributable to the new ventilator
setting?

a. Cerebral vasodilatation.
b. Cerebral vasoconstriction.
c. Reduced cerebrospinal fluid pressure.
d. Reduced cerebral oedema.
e. Reduced cerebrospinal fluid production.

4 A 27-year-old woman has had a massive postpartum haemorrhage

due to uterine atony. Her haemoglobin is 6g/dL. She has a blood
pressure of 106/60mmHg and heart rate of 116/minute. Which one
of the following factors most significantly contributes to reduction
changes in oxygen delivery to the tissues?

a. Low partial pressure of oxygen.

b. Low arterial oxygen saturation.
c. Low arterial oxygen content.
d. Low mixed venous oxygen saturation.
e. Low cardiac output.

5 A 63-year-old male with a history of atrial fibrillation is usually on

warfarin and digoxin. He presents to the emergency department
following an overdose of warfarin. Blood results show that his
prothrombin time is prolonged. Which of the following combinations
of clotting factors could contribute to this abnormal clotting?

a. Clotting Factors II, IV, VIII, IX.

b. Clotting Factors II, VII, IX, X.
c. Clotting Factors VIII, IX, XI, XIII.
d. Clotting Factors II, VIII, X, XII.
e. Clotting Factors II, V, XII, XIII.
6 All volatile anaesthetic agents cause dose-dependent cerebral
vasodilatation. Which of the following volatile agents causes the
least cerebral vasodilatation?

a. Isoflurane.
b. Sevoflurane.
c. Desflurane.
d. Halothane.
e. Enflurane.

7 A 35-year-old male patient with a history of asthma is scheduled for

a laparotomy and bowel resection. He is taking 20mg of
prednisolone daily. As this patient requires intravenous
hydrocortisone during the peri-operative period, which one of the
following is equivalent to 20mg prednisolone?

a. 100mg of hydrocortisone.
b. 80mg of hydrocortisone.
c. 75mg of hydrocortisone.
d. 90mg of hydrocortisone.
e. 50mg of hydrocortisone.

8 A 65-year-old woman is brought to the emergency department with

major burns. She requires immediate tracheal intubation. Which of
the following muscle relaxants is the best choice for rapid sequence
induction in this patient?

a. Rocuronium 0.4mg/kg.
b. Rocuronium 0.6mg/kg.
c. Vecuronium 0.1mg/kg.
d. Atracurium 0.6mg/kg.
e. Suxamethonium 1mg/kg.
9 A 65-year-old female patient is being assessed in the pre-operative
assessment clinic. Her medical history includes hypertension and
chronic heart failure. She is already being treated with a diuretic and
an ACE inhibitor. Which of the following b-blockers is most suitable
to treat her hypertension?

a. Timolol.
b. Propranolol.
c. Labetalol.
d. Esmolol.
e. Bisoprolol.

10 A 5-year-old girl is scheduled for correction of a squint. The pre-

operative assessment reveals she is adequately starved but is
anxious. The parents state that she gets travel sick. Which one of
the following drug combinations is most effective in preventing
postoperative nausea and vomiting in this child?

a. Cyclizine 1mg/kg and ondansetron 100mg/kg.

b. Ondansetron 100mg/kg and dexamethasone 100mg/kg.
c. Ondansetron 100mg/kg and dexamethasone 200mg/kg.
d. Cyclizine 1mg/kg and metoclopramide 0.35mg/kg.
e. Ondansetron 100mg/kg alone.

11 When compared to a cylinder manifold, a vacuum-insulated

evaporator (VIE) is the most economical way to store and supply
oxygen in a large hospital. What is the single most important reason
for this?

a. In the long term, it is significantly cheaper to install a VIE.

b. Liquid oxygen is easier to store.
c. VIE does not require rigorous maintenance.
d. When evaporated, liquid oxygen occupies a large volume as gas.
e. The critical temperature of liquid oxygen is ideal to store as a liquid.
12 At the end of an unexpected prolonged procedure for carpal tunnel
release under general anaesthesia, it is noted that the patient has
developed radial nerve palsy. This persists even at 4 weeks post-
procedure. The most likely cause for this is:

a. Poor patient positioning.

b. Prolonged application of the tourniquet.
c. Inappropriately high tourniquet pressure.
d. Direct trauma due to surgery.
e. Post-tourniquet syndrome due to interstitial and intracellular
oedema.

13 A deep sea SCUBA diver is treated in a hyperbaric chamber for

acute decompression sickness. The improvement in symptoms is
best explained by:

a. Dalton’s law.
b. Pascal’s principle.
c. Charles’ law.
d. Henry’s law.
e. Boyle’s law.

14 A 4kg infant is admitted for a right inguinal herniotomy. He was born

at 28 weeks’ gestation. Gas induction was discussed with the
parents. What is the fresh gas flow (ml/minute) required to prevent
rebreathing with a T-piece circuit?

a. 600ml/ minute.
b. 1000ml/minute.
c. 1600ml/minute.
d. 2400ml/minute.
e. 3000ml/minute.
15 A DC powered operating theatre light produces 96W of energy in
the form of heat and light. In order to drive an electric current of 4
amperes through the light bulb, what should be the potential
difference across the bulb?

a. 384V.
b. 240V.
c. 96V.
d. 24V.
e. 36V.

16 A 38-year-old man has been admitted to the surgical ward for

evaluation of an acute abdomen. On the ward 1L of normal saline
has been administered over 30 minutes. This 1L of normal saline will
be distributed into the various fluid compartments. Which one of the
following statements best describes the distribution of normal
saline?

a. 300ml will remain in the intravascular compartment.

b. 500ml will remain in the intravascular compartment.
c. 300ml will be distributed in the extracellular compartment.
d. 500ml will be distributed in the extracellular compartment.
e. 600ml will be distributed to the interstitial fluid compartment.

17 A middle-aged man who has been diagnosed with severe

community-acquired pneumonia is being mechanically ventilated in
the intensive care unit. The pressure-volume graph obtained on the
ventilator is displayed below. Which one of the following
physiological attributes is indicated by the inflection points on the
above curve?

a. Minute ventilation.
b. Critical opening pressure of the alveoli.
c. Functional residual capacity.
d. Physiological dead space.
e. Expiratory reserve volume.
 Volume (dL)

Pressure (mmHg)

Figure 1. Pressure-volume graph obtained on the ventilator. A = upper

inflection point; B = lower inflection point.

18 A 29-year-old female is undergoing laparoscopic gynaecological

surgery. The surgeon has requested a head-up position. During the
procedure, a rise in arterial pressure is noted. Which one of the
following physiologic changes is responsible for the rise in arterial
pressure?

a. Increase in stroke volume caused by increased preload.

b. Decrease in heart rate caused by peritoneal stretching.
c. Increase in systemic vascular resistance caused by neurohumoral
factors.
d. Increase in intrathoracic pressures caused by pneumoperitoneum.
e. Increase in cardiac output caused by hypercarbia.
19 A 45-year-old male patient who has suffered a spinal cord
transection at the C7 level will be unable to control his body
temperature when exposed to the operating room temperature of
20°C. What is the most likely reason for this?

a. Inability to sweat.
b. Inability to shiver.
c. Inability to vasoconstrict.
d. Inability to increase cardiac output.
e. Inability to metabolise brown fat.

20 A 65-year-old female patient is admitted to the intensive care unit

following a craniotomy and debulking of a posterior fossa tumour.
Her serum sodium is 120mmol/L. Which of the following is the most
important investigation in establishing the diagnosis of cerebral salt
wasting syndrome as a cause of hyponatraemia?

a. Total urinary sodium excretion.

b. Urinary sodium concentration.
c. Serum osmolality.
d. Fractional excretion of uric acid.
e. Urinary osmolality.

21 A 45-year-old male is on morphine sulphate (MST) 50mg b.d., for

the management of lower back pain. His pain control is
unsatisfactory. Now he has been prescribed buprenorphine 200mg,
every 6 hours (in addition to MST). How will this change the efficacy
of his morphine?

a. Buprenorphine will enhance the efficacy of morphine.

b. Buprenorphine will reduce the efficacy of morphine.
c. Buprenorphine will not have any effect on morphine efficacy.
d. Buprenorphine will double the efficacy of morphine.
e. Buprenorphine will halve the efficacy of morphine.
22 A 60-year-old male patient is admitted to the intensive care unit with
hypotension. His regular medications include amitriptyline 75mg per
day and morphine sulphate 100mg per day for chronic back pain.
He now needs an inotrope infusion to maintain his blood pressure.
Which of the following statements best describes the drug
interaction between amitriptyline and inotropes?

a. Amitriptyline potentiates the action of adrenaline more than

noradrenaline.
b. Amitriptyline potentiates the action of noradrenaline more than
adrenaline.
c. Amitriptyline potentiates the action of both adrenaline and
noradrenaline equally.
d. Amitriptyline potentiates the action of only noradrenaline.
e. Amitriptyline potentiates the action of only adrenaline.

23 A 14-month-old child weighing 10kg is scheduled to have bilateral

orchidopexy. Which of the following is the most appropriate drug
(dose and mixture) for performing caudal anaesthesia in this child?

a. Bupivacaine 0.25% 5ml with clonidine 15mg.

b. Bupivacaine 0.25% 10ml with clonidine 15mg.
c. Bupivacaine 0.5% 10ml with clonidine 15mg.
d. Bupivacaine 0.25% 12.5ml with clonidine 15mg.
e. Bupivacaine 0.25% 12.5ml with adrenaline 1 in 200,000.

24 Which of the following drugs when used for subtenon block has the
shortest duration of action?

a. Plain lignocaine.
b. Lignocaine with hyaluronidase.
c. Lignocaine with adrenaline.
d. Lignocaine with bupivacaine.
e. Plain bupivacaine.
25 A newly developed local anaesthetic drug is said to have very high
lipid solubility. In practical terms this translates to:

a. Prolonged duration of action.

b. Rapid onset of action.
c. More sensory block than motor block.
d. Higher potency.
e. Lower risk of cardiotoxicity.

26 Which of the following best describes the intra-arterial cannula used

for the purpose of invasive arterial blood pressure measurement?

a. It should be short, wide, stiff and with parallel walls.

b. It should be short, wide, stiff and tapered at the distal end.
c. It should be short, wide, stiff and transparent.
d. It should be made of polyurethane.
e. It should be made of teflon.

27 You are anesthetising a patient for magnetic resonance imaging

(MRI). MRI can interfere with the monitoring equipment. Which one
of the following best describes the problem of monitoring EtCO2
using side-stream capnography?

a. The EtCO2 reading is higher than the true value.

b. The rise time increases.
c. The transit time increases.
d. The EtCO2 reading is lower than the true value.
e. The waveform is distorted.

28 In a cannot intubate, cannot ventilate scenario, the patient should be

oxygenated via a cricothyroidotomy. In an adult what is the largest
size of tracheostomy tube that can be inserted through the
cricothyroid membrane?

a. Size 8.0.
b. Size 7.0.
c. Size 6.0.
d. Size 5.0.
e. Size 4.0.

29 A patient is scheduled for an emergency appendicectomy. At the

end of an uneventful procedure, a routine check reveals a skin burn
at the site of the neutral electrode of the diathermy. The most likely
explanation for this injury is:

a. Delivery of a very high frequency current to coagulate the tissues.

b. High current density at the site of the neutral electrode.
c. High impedance at the site of the neutral electrode.
d. Malfunction of the isolating capacitor.
e. Use of a floating patient circuit.

30 A Tec 5 isoflurane vaporiser is being used at a high altitude location

where the atmospheric pressure is 380mmHg. The dial is set to 1%.
The clinical effect on the patient is the same as when using it at sea
level (with the dial set to 1%). The most likely reason for this is:

a. A Tec 5 vaporiser compensates for altitude.

b. Partial pressure of isoflurane at the alveolus remains the same.
c. Blood-gas solubility of isoflurane remains the same.
d. There is no change in the boiling point of isoflurane.
e. The vapour pressure decreases at high altitude.
Set 3 questions
1 A 32-year-old lady, who is known to have type 1 diabetes mellitus,
presents to the accident and emergency department with reduced
consciousness and deep shallow breathing. Her blood results are
shown in Table 1.

Table 1. Blood results.

Sodium 136mmol/L pH 7.2

Potassium 4.0mmol/L PO2 13.2kPa
Chloride 102mmol/L PCO2 2.9kPa
Magnesium 0.8mmol/L HCO3- 12mmol/L
Blood glucose 34.8mmol/L Base excess -14.0mmol/L

Which one of the following most accurately indicates the anion gap
value in this patient?

a. 24mmol/L.
b. 20mmol/L.
c. 26mmol/L.
d. 8mmol/L.
e. 18mmol/L.
2 You are part of the obstetric and paediatric team at Lhasa, Tibet
(altitude - 10,000ft). You attend a newborn resuscitation call, for a
baby who is born at 39 weeks’ gestation, a normal delivery. The
mother has no medical problems and the baby has no obvious
congenital anomalies. Which one of the following cardiac
physiological changes is more likely to occur in this baby?

a. Low right atrial pressure.

b. High pulmonary artery pressure.
c. Higher than normal heart rate.
d. High systemic vascular resistance.
e. High stroke volume.

3 A 5-year-old child is scheduled to undergo a complex surgical

procedure on the forearm. The child weighs 20kg. The blood results
are: Hb: 13g/dL, PCV: 40%, platelets: 392 x109/L. The plastic
surgeon prefers to maintain haematocrit levels at 30% for the first
24-48 hours in the postoperative period. Assuming the blood volume
to be 70ml/kg, what would be the maximum allowable blood loss for
this child?

a. 450ml.
b. 350ml.
c. 250ml.
d. 500ml.
e. 175ml.

4 A 46-year-old man was found unconscious at home and is brought

to the emergency department by the paramedics. His blood gases
show that he is acidotic. He is suspected to have starved for almost
a week. Which of the following biochemical changes is most likely
to present in his blood?

a. Low blood glucose levels.

b. Reduced protein breakdown.
c. Increased free fatty acids.
d. Low levels of ketones.
e. Low levels of magnesium.

5 A 63-year-old male who is scheduled for a bowel resection is seen

in the pre-operative assessment clinic. He has smoked 20 cigarettes
a day for more than 30 years. Which one of the following
physiological changes is most likely to occur in this patient as
compared to a non-smoker?

a. Shift to the right of the oxygen dissociation curve.

b. Reduced FEV1.
c. Reduced closing capacity.
d. Low airway resistance.
e. Increase in FVC.

6 Concurrent administration of midazolam 5mg and propofol 150mg,

intravenously, in a 60-year-old male produces a significant hypnotic
effect which is greater than the expected combined effect of the two
drugs. This phenomenon is best described by:

a. Summation.
b. Potentiation.
c. Agonistic action.
d. Synergism.
e. Antagonism.

7 A 63-year-old male is due to undergo an emergency laparotomy for

bowel obstruction. He takes selegiline for Parkinson’s disease.
Which one of the following analgesics is safe and appropriate to use
in this patient for postoperative pain relief?

a. Pethidine.
b. Morphine.
c. Methadone.
d. Tramadol.
e. Remifentanil.
8 Acute hepatic porphyria is a rare but significant complication, which
can occur after administration of certain anaesthetic drugs in a
patient with a deficiency of a levulinic acid synthetase enzyme.
Which one of the following terms most appropriately explains this
phenomenon?

a. Supersensitivity.
b. Idiosyncrasy.
c. Hypersensitivity.
d. Tachyphylaxis.
e. Tolerance.

9 A 66-year-old female is scheduled to undergo a mastectomy with

axillary clearance. Her medical history includes hypertension and
chronic renal impairment with a glomerular filtration rate of
27ml/minute. Which one of the following analgesics is the most
appropriate to use for postoperative pain relief in this patient?

a. Morphine.
b. Fentanyl.
c. Diclofenac.
d. Tramadol.
e. Remifentanil.

10 A 59-year-old male is undergoing excision of a noradrenaline-

secreting phaeochromocytoma. Intra-operatively he develops severe
hypertension. Which one of the following drugs is most suitable in
the management of hypertension in this patient?

a. Glyceryl trinitrate.
b. Phenoxybenzamine.
c. Phentolamine.
d. Labetalol.
e. Sodium nitroprusside.
11 A 65-year-old man known to have COPD is admitted with severe
respiratory distress. What is the flow rate required to deliver 28%
oxygen through a venturi mask?

a. 4L/minute.
b. 6L/minute.
c. 8L/minute.
d. 10L/minute.
e. 15L/minute.

12 A 28-year-old primiparous is scheduled for an elective Caesarean

section under spinal anaesthesia. Which one of the following is
associated with the lowest incidence of postdural puncture
headache in this patient?

a. Performing the procedure in the lateral position.

b. Using a 22-gauge Sprotte needle instead of a 25-gauge needle.
c. Using a 22-gauge Quincke needle.
d. Using a 25-gauge Whitacre needle.
e. Using a 25-gauge Yale needle.

13 A 27-year-old man is scheduled for removal of a superficial foreign

body from his forearm under general anaesthesia. He is ASA 1 and
weighs 78kg with a BMI of 28. Which of the following supraglottic
airway devices would you choose for securing the airway?

a. LMA size 6, inflated up to 50ml.

b. LMA size 5, inflated up to 50ml.
c. LMA size 5, inflated up to 40ml.
d. LMA size 4, inflated up to 40ml.
e. Size 5 i-Gel® supraglottic airway.
14 A patient with cardiogenic shock is having an intra-aortic balloon
pump inserted. Which of the following will you rule out before using
the pump?

a. Acute myocardial infarction.

b. Acute mitral regurgitation.
c. Aortic regurgitation.
d. Unstable angina.
e. Ventricular arrhythmias.

15 As part of awake fibreoptic intubation, you have injected 2ml of 2%

lidocaine just below the cornu of the hyoid bone, through the
thyrohyoid ligament. Which of the following intrinsic muscles of the
larynx is likely to be paralysed?

a. Transverse arytenoid.
b. Posterior cricoarytenoid.
c. Cricothyroid.
d. Thyroarytenoid.
e. Aryepiglottics.

16 A 40-year-old male has been asked to perform a Valsalva

manoeuvre. Which one of these physiological changes is unlikely to
happen during the manoeuvre?

a. Increased pressure in the intrathoracic arteries.

b. Pooling of blood in the pulmonary vessels.
c. Lowering of the blood pressure.
d. An increase in the interatrial differential pressure.
e. Rise in heart rate.
17 A 45-year-old man with severe carbon monoxide poisoning is
receiving hyperbaric oxygen therapy in a tertiary intensive care unit.
Which one of the following physiologic changes is most likely to
occur?

a. Reduction in systemic vascular resistance.

b. Reduction in pulmonary vascular resistance.
c. Increased oxygen flux due to a significant increase in oxygen
saturation.
d. Unchanged mixed venous oxygen saturation.
e. Increased endothelial neutrophil adhesion.

18 In an adult, about 180L of water is filtered in a day, but in the

presence of normal levels of functioning anti-diuretic hormone
(ADH) about 99% of the filtered water is reabsorbed. In which one
of the following anatomical locations of the kidney is the greatest
fraction of filtered water reabsorbed?

a. Proximal convoluted tubule.

b. Ascending loop of Henle.
c. Distal tubule.
d. Cortical collecting duct.
e. Medullary collecting duct.

19 Which of the following statements best describes the functional

residual capacity?

a. Sum of expiratory reserve volume and residual volume.

b. Difference between inspiratory capacity and tidal volume.
c. Sum of expiratory reserve volume and tidal volume.
d. Sum of residual volume and tidal volume.
e. Sum of inspiratory reserve volume and tidal volume.
20 Buffers are important in maintaining the acid-base balance in the
body. Which one of the following is the most important buffer in
interstitial fluid?

a. Phosphate buffers.
b. Carbonic acid buffers.
c. Compounds containing histidine.
d. Haemoglobin.
e. Plasma proteins.

21 A 42-year-old female is admitted to the intensive care unit with

subarachnoid haemorrhage. Which one of the following drugs
would be most effective in the prevention and treatment of ischaemic
neurological deficits in this patient?

a. Nifedipine.
b. Amlodipine.
c. Nicorandil.
d. Nicardipine.
e. Nimodipine.

22 Drug A has a clearance of 200ml/minute, a duration of action of 500

minutes and is effective at a plasma concentration of 0.02mg/ml. Its
bioavailability is 100%. From the above data, which one of the
following most likely indicates the required dose in milligrams for oral
administration for drug A in an adult?

a. 2000mg.
b. 1000mg.
c. 1500mg.
d. 400mg.
e. 500mg.
23 A 69-year-old male who is a poorly controlled asthmatic falls off a
balcony and sustains pelvic trauma. His blood pressure is
60/40mmHg and heart rate is 122/minute. There is no neurological
injury and the CT scan of his head is normal. He is scheduled for
internal fixation of his pelvis. The most appropriate induction agent
would be:

a. Etomidate.
b. Thiopentone.
c. Propofol.
d. Ketamine.
e. Inhalational induction with sevoflurane.

24 Which of the following non-steroidal anti-inflammatory drugs

(NSAIDs) has the highest risk of a serious gastrointestinal side
effect?

a. Ibuprofen.
b. Ketorolac.
c. Diclofenac.
d. Indomethacin.
e. Celecoxib.

25 A 56-year-old farmer is admitted to the emergency department with

frothy secretions in his mouth, breathlessness, urinary incontinence
and sweating. On examination his heart rate is 56 per minute, blood
pressure is 110/60mm Hg and pupils are constricted. Which one of
the following drugs is the treatment of choice?

a. Physostigmine.
b. Atropine.
c. Naloxone.
d. Midazolam.
e. Edrophonium.
26 A pH of 7 = 100nmol/L of H+ ions. Which of the following
concentrations of hydrogen ions is equivalent to a pH of 9?

a. 1nmol/L.
b. 10nmol/L.
c. 90nmol/L.
d. 100nmol/L.
e. 1000nmol/L.

27 You are anaesthetising a patient at 3 atmospheres. If the flow rate

on the anaesthetic machine is 2L/minute, which one of the following
indicates the actual delivered flow rate?

a. 2L/minute.
b. Greater than 2L/minute.
c. Less than 2L/minute.
d. 4L/minute.
e. 3L/minute.

28 Humidifying inspired gases can be achieved using nebulisers and

humidifiers. The droplet size is important when selecting a nebuliser
as droplets of 1mm in size are ideal as they reach the alveoli. Which
of the following methods is the most efficient in producing droplets
of 1mm?

a. Spinning disc nebuliser.

b. Heat and moisture exchanger.
c. Heated water bath.
d. Ultrasonic nebuliser.
e. Heated Bernoulli nebuliser.
29 During low-flow anaesthesia, the inspired oxygen concentration in
fresh gas flow can be further diluted. Which of the following is most
useful in preventing the delivery of hypoxic gas mixtures during low-
flow anaesthesia using a fresh gas flow of 0.3L/minute?

a. Mechanical link 25 system.

b. Pneupac ratio system.
c. Penlon electronic system.
d. The Ritchie whistle.
e. Breath-to-breath oxygen monitoring close to the endotracheal tube.

30 Regular maintenance of electrodes in blood gas analyzers is

essential. In the CO2 electrode, which of the following components
most needs to be replaced at regular intervals?

a. The membrane covering the electrode.

b. The electrode itself.
c. The electrolyte solution.
d. The pump tubings.
e. The rinsing fluid.
Set 4 questions
1 Normally blood takes 0.75s to traverse the pulmonary capillaries at
rest. If this time is reduced to 0.2s, which one of the following gases
reaches equilibrium between the alveoli and capillary blood?

a. Oxygen.
b. Carbon dioxide.
c. Carbon monoxide.
d. Nitrous oxide.
e. Nitrogen.

2 A young male patient has a haemoglobin concentration of 10g/dL

and his peripheral oxygen saturation (SpO2) is 100%. The oxygen
carrying capacity of his blood would be:

a. 20.8ml/dL.
b. 11.1ml/dL.
c. 10.4ml/dL.
d. 13.4ml/dL.
e. 16.6ml/dL.

3 After general anaesthesia, the oxygen content of a preterm neonate

is likely to fall because of all these reasons except:

a. Possibility of apnoeic spells.

b. Low haemoglobin concentration.
c. Low oxygen reserve.
4 A 60-year-old gentleman has presented with chronic severe pain in
his right leg which could not be controlled with medication. His
chronic pain physician plans a cordotomy. Which one of the
following spinal tracts is interrupted during cordotomy?

a. Left ventral spinothalamic tract.

b. Left dorsal column.
c. Right lateral spinothalamic tract.
d. Right corticospinal tract.
e. Left lateral spinothalamic tract.

5 Which one of the following plasma proteins has the greatest effect
on plasma colloid osmotic pressure?

a. Albumin.
b. a-1 globulin.
c. a-2 globulin.
d. b globulin.
e. Gamma globulin.

6 A 60-year-old male patient with shortness of breath is diagnosed

with pulmonary fibrosis. His other medical history includes atrial
fibrillation, hyperchloesterolaemia and hypertension. Which one of
the following medications could be responsible?

a. Warfarin.
b. Simvastatin.
c. Amiodarone.
d. Atenolol.
e. Furosemide.
7 Analgesics such as fentanyl can be administered using a
transdermal route. Which one of the following properties is most
important for transdermal delivery of a drug?

a. High molecular weight.

b. Long terminal half-life.
c. Non-ionised form.
d. Low potency.
e. Highly hydrophobic.

8 A 54-year-old male patient is undergoing an emergency laparotomy

for a perforated duodenal ulcer. His medical history includes
hypertension, depression and hypothyroidism. During the intra-
operative period, a 9mg bolus of ephedrine was given to treat an
episode of hypotension. Subsequently he developed severe
tachycardia and hypertension. Which one of the following
medications could have contributed to this?

a. Doxazocin.
b. Fosinopril.
c. Thyroxine.
d. Phenelzine.
e. Aspirin.

9 There are a number of drugs that inhibit the various iso-enzymes of

the phosphodiesterase (PDE) enzyme. Which of the following PDE
inhibitors has an antiplatelet effect?

a. Milrinone.
b. Clopidogrel.
c. Enoximone.
d. Dipyridamole.
e. Amrinone.
10 A young female patient that is suspected to have deliberately self-
harmed is admitted to the emergency department. She gives a
history of severe depression and was found with an empty bottle of
aspirin. An arterial blood gas analysis was performed on arrival to
the accident and emergency department. Which of the following
parameters suggests an aspirin overdose?

a. PaO2 of 10kPa.
b. PaCO2 of 2.9kPa.
c. pH of 7.32.
d. BE of 4mmol/L.
e. K+ of 5.0mmol/L.

11 Which one of the following most accurately represents the

precautions taken to minimise the risk of fire and explosion in the
theatre environment?

a. The relative humidity in theatre should be at least 85%.

b. Substitution of cotton fabric with nylon.
c. Use of only CO2 as insufflation gas during laparoscopic surgery.
d. Maintaining a 10cm zone of risk around the anaesthetic machine.
e. Maintaining a maximum number of six air changes per hour.

12 A young male has developed a spontaneous pneumothorax. On

arrival to the accident and emergency department a chest drain has
been inserted. Which one of the following features of the
underwater seal chest drain system is most essential to facilitate
safe and effective drainage?

a. The drain should be at least 100cm below the level of the chest.
b. The diameter of the drain tube should be as small as possible.
c. The volume of the drain tube should be more than 50% of the
patient’s maximal inspiratory volume.
d. The drain tube should be at least 10cm below the surface of water.
e. A suction of up to -50cm H2O should be applied.
13 Which one of the following is the most appropriate technique to
effectively disinfect a fibreoptic endoscope?

a. Formaldehyde gas sterilisation.

b. Ethylene oxide sterilisation.
c. Immersion in quaternary ammonium compound solution for 20
minutes.
d. Immersion in 2% glutaraldehyde solution.
e. Steam sterilisation.

14 For spontaneous ventilation, the Mapleson system A (Magill’s

circuit) is the most efficient system. What is the single most
important reason for this?

a. Requires low fresh gas flow.

b. Does not allow wastage of fresh gas flow.
c. Dead space gas is re-used.
d. Fresh gas flow is equal to alveolar ventilation.
e. It is cheap.

15 Medical monitoring equipment is classified according to the means

of protection it provides against electric shock. Which of the
following statements best describes class 2 equipment?

a. Any conducting part that is accessible to the user is connected to

the earth without a fuse in the mains plug.
b. It is double insulated equipment and is connected to the earth with
a fuse in the main plug.
c. It is double insulated equipment and the earth wire is not essential.
d. It is internally powered equipment with minimal risk of electric shock.
e. It is double insulated equipment with no risk of microshock.
16 Pre-oxygenation during induction of anaesthesia delays the onset of
critical hypoxia during the period of apnoea. Which of the following
best describes the mechanism involved in pre-oxygenation?

a. It replaces nitrogen in the FRC with oxygen.

b. It increases the concentration of inspired oxygen.
c. It increases the amount of dissolved oxygen in blood.
d. It increases the peripheral oxygen saturation.
e. It decreases the shunt fraction.

17 An obese 80-year-old gentleman presents for a cystoscopy. He is

previously fit and well. General anaesthesia is induced and the
airway is secured with an LMA. He is breathing 28% oxygen
spontaneously. Ten minutes later his oxygen saturation decreases
from 99% to 96%. Which of the following statements best
describes the reason for this?

a. Increased sensitivity to hypoxia and hypercarbia in the elderly.

b. Increased residual volume in the elderly.
c. Absorption atelectasis.
d. Reduced FRC due to supine position and general anaesthesia.
e. The loss of auto-PEEP due to the presence of the LMA.

18 A young female is undergoing reconstructive free flap surgery as

part of the removal of a malignant tumour. The surgeon is very
concerned about flap survival. Which of the following describes the
best way to promote blood flow and tissue perfusion in the free flap?

a. Maintaining a MAP >65mmHg with vasopressors.

b. Transfusing blood early to improve oxygen delivery.
c. Aiming for a core/peripheral temperature difference of >2°C.
d. Aiming for a haematocrit of 30% by administering boluses of
intravenous fluids.
e. Routine use of a vasodilator such as hydralazine.
19 The cardiac cycle describes the relationship between the electrical
and mechanical events within the heart over time. Which of the
following events is most likely to coincide with the second heart
sound?

a. Isovolumetric relaxation and the ST segment of the ECG.

b. A rise in atrial pressure and the V wave of jugular venous pressure.
c. The dicrotic notch of the aortic pressure trace and the y descent of
the jugular venous pressure.
d. The end of the T wave on the ECG and a fall in atrial pressure.
e. Passive filling of the ventricles and the T wave on the ECG.

20 A 60-year-old male patient presents with a history of crushing

central chest pain which started 9 hours ago and lasted for over
an hour. Blood tests are taken immediately. Which of the following
cardiac enzymes is the most sensitive marker in acute coronary
syndrome?

a. Aspartate aminotransferase (AST).

b. Creatine kinase-MB (CK-MB).
c. Lactic dehydrogenase (LDH).
d. Troponin I.
e. Troponin C.

21 A 20-year-old female patient with a recent diagnosis of lymphoma is

receiving chemotherapy. Which one of the following would be the
most effective regime in the prevention of nausea/vomiting?

a. Metoclopramide 10mg IV and cyclizine 50mg IV.

b. Droperidol 1.25mg IV and prochlorperazine 12.5mg IV.
c. Metoclopramide 10mg IV and ondansetron 8mg IV.
d. Ondansetron 8mg IV and dexamethasone 8mg IV.
e. Prochlorperazine 12.5mg IV and dexamethasone 8mg IV.
22 A 45-year-old man of Afro-Caribbean descent presents with three
elevated blood pressure measurements of 165/105 over a 6-week
period. Which of the following would be the most appropriate
medication to start treatment with?

a. Ramipril.
b. Valsartan.
c. Doxazosin.
d. Carvedilol.
e. Amlodipine.

23 A patient with severe refractory depression is scheduled for a

mastectomy due to breast cancer. She is on phenelzine for her
depression. What is the most appropriate management regarding
her phenelzine?

a. Continue phenelzine to the day of surgery and omit the morning

dose.
b. Discontinue phenelzine 2 weeks prior to surgery and start fluoxetine.
c. Discontinue phenelzine 2 weeks prior to surgery, start moclobemide
and omit moclobemide on the day of surgery.
d. Discontinue phenelzine 2 weeks prior to surgery.
e. Discontinue phenelzine 2 weeks prior to surgery, start moclobemide
and continue till surgery.

24 A 29-year-old female patient with porphyria presents for an

emergency laparotomy for a ruptured ectopic pregnancy. Her heart
rate is 92/minute and blood pressure is 110/60mmHg. Which one
of the following anaesthetic drugs is most unsafe in this patient?

a. Isoflurane.
b. Thiopentone.
c. Propofol.
d. Ketamine.
e. Suxamethonium.
25 A 21-year-old ASA1 patient needs an intravenous infusion of drug A.
The following are the available data for drug A: 1) the desired
steady-state plasma concentration is 0.2mg/ml; 2) the volume of
distribution at steady state is 5000ml; 3) the clearance is
200ml/minute. Which one of the following correctly represents the
intravenous loading dose for drug A?

a. 1000mg.
b. 400mg.
c. 200mg.
d. 40mg.
e. 2000mg.

26 A piece of medical monitoring equipment is designed to have a

leakage current of less than 50mA and contains a floating circuit.
Which of the following classes does this equipment belong to?

a. Class BF.
b. Class CF.
c. Class B.
d. Class II F.
e. Class I.

27 A study is conducted to compare the efficacy of 5% hypertonic

saline and 20% mannitol in reducing intracranial pressure (ICP) in
patients with traumatic brain injury. Mean ICP values are available for
two groups before and after the intervention. Assuming that the ICP
values are normally distributed (Gaussian distribution), which of the
following statistical tests would be most appropriate in comparing
the two groups?
a. Wilcoxon signed rank test.
b. Student’s t-test.
c. ANOVA paired test.
d. Paired student’s t-test.
e. Mann-Whitney U test.
28 A 60-year-old male patient is undergoing a craniotomy and blood
pressure is being invasively monitored via an arterial cannula
inserted through the left radial artery. Half way through the
procedure you wish to perform a square wave test (fast flush test)
to ensure that the arterial system is optimally damped. Which of the
following describes under-damping of the system?

a. The waveform settles to zero without any oscillations.

b. The waveform settles to zero after several oscillations.
c. The waveform settles to zero after 2 or 3 oscillations.
d. The waveform never settles to zero.
e. The waveform settles to zero after one oscillation.

29 You are performing an interscalene nerve block using a peripheral

nerve locator on a 25-year-old woman with a BMI of 23. Which of
the following is the most suitable needle for this block?

a. A 22G, 50mm long insulated needle.

b. A 20G, 100mm long insulated needle.
c. A 22G, 25mm long non-insulated needle with a non-cutting tip.
d. A 22G, 50mm long insulated needle with a non-cutting tip.
e. A 22G, 25mm long insulated needle with a non-cutting tip.

30 An electromagnetic radiation has a wavelength of 10-9 and

frequency of 1018 and it is in the ultraviolet spectrum. In which one
of the following applications is this electromagnetic radiation most
suitable for use?

a. As an X-ray.
b. As a LASER.
c. In an infrared analyser.
d. In a paging system.
e. In refractometry.
Set 5 questions
1 The chemoreceptors in the carotid body detect changes in the
composition of blood to activate the respiratory centre in the
medulla. Which one of the following changes leads to the greatest
stimulation of carotid body chemoreceptors?

a. Oxygen saturation of haemoglobin.

b. Partial pressure of oxygen.
c. Oxygen content of blood.
d. pH of blood.
e. Partial pressure of CO2.

2 Urea plays an important role in the counter-current mechanism in

the kidney. In which part of the nephron is urea reabsorbed
maximally?

a. Proximal tubule in the cortex.

b. Distal tubule in the cortex.
c. Collecting duct.
d. Proximal tubule in the medulla.
e. Distal tubule in the medulla.
3 During the cardiac cycle, which one of the following leads to most
of the ventricular filling?

a. Atrial electrical systole.

b. Passive flow of the blood from atrium to ventricle.
c. Atrial mechanical systole.
d. Rise in pulmonary artery pressure.
e. Drop in intrathoracic pressure.

4 Calcium homeostasis is essential for normal function of the human

body. Which one of the following has the most important role in the
regulation of the serum calcium level?

a. Active vitamin D.
b. Parathyroid hormone.
c. Calcitonin.
d. Renal tubular absorption.
e. Dietary calcium level.

5 Which one of the following statements on the composition of

cerebrospinal fluid (CSF) is most accurate?

a. The partial pressure of CO2 is 42mmHg.

b. Concentration of protein is very low as compared to that in plasma.
c. Glucose concentration is the same as that in plasma.
d. The pH of CSF is slightly higher than 7.4.
e. Cholesterol concentration is higher than that in plasma.

6 A 64-year-old woman is admitted to intensive care with severe

septicaemia. She is treated with a multitude of antibiotics. A few
days later she develops diarrhoea and the stool sample analysis
confirms Clostridium difficile infection. Which one of the following
would be the most appropriate in the treatment of diarrhoea?
a. Intravenous clarithromycin.
b. Oral metronidazole.
c. Intravenous metronidazole.
d. Oral vancomycin.
e. Intravenous teicoplanin.

7 A 32-year-old male is admitted to intensive care following a severe

chest infection. He is intubated and ventilated. He is sedated with an
intravenous infusion of propofol and to facilitate positive pressure
ventilation, an atracurium infusion was started 12 hours ago. His
other medications include rifampicin, amoxicillin and clarithromycin.
A few days later his urine appeared greenish. Which of the following
is the most likely cause for urine discolouration?

a. Atracurium infusion.
b. Sepsis.
c. Propofol infusion.
d. Severe septicaemia.
e. Rifampicin.

8 A 26-year-old lady had an epidural analgesia for labour. She has a

past history of cardiac arrhythmias; however, pregnancy has been
uneventful. Following delivery she complains of severe headache,
which is relieved on lying down. Which one of the following would
be the most appropriate next step in the management of headache?

a. Epidural blood patch.

b. Oral fluids and paracetamol.
c. Synthetic ACTH.
d. Caffeine 300mg.
e. Desmopressin 4g.

9 A 40-year-old male is admitted to coronary care following a history

of palpitations and syncope. On admission, his heart rate is
140/minute and blood pressure is 110/78mmHg. A twelve-lead
 ECG shows regular narrow complex tachycardia. P waves are
clearly noted on the ECG. Carotid sinus massage and adenosine
6mg have been tried, with failure to control the heart rate. Which
one of the following would be the most appropriate next step in
management?

a. Verapamil 10mg IV.

b. Repeat adenosine 6mg IV.
c. Amiodarone 300mg IV.
d. Repeat adenosine 12mg IV.
e. Electrical cardioversion.

10 A 34-year-old man weighing 96kg has undergone an

appendicectomy. He has been prescribed oral morphine for
postoperative pain relief on the ward. Considering the bioavailability
of morphine, which one of the following would be the effective dose
at target site after oral ingestion of 10mg morphine?

a. 1mg of morphine.
b. 3mg of morphine.
c. 6mg of morphine.
d. 5mg of morphine.
e. 10mg of morphine.

11 A 78-year-old patient, weighing 68kg is anaesthetised for a hernia

repair. He is breathing spontaneously through a laryngeal mask airway.
Anaesthesia is maintained with 1.5 MAC of isoflurane and nitrous
oxide (60%) and oxygen (40%) using a fresh gas flow of 0.8L/
minute. Analgesia is provided with incremental boluses of fentanyl. His
heart rate is 58 bpm, oxygen saturation is 95% and EtCO2 is 8kPa.
Which of the following is the most likely cause for the raised EtCO2?

a. Malignant hyperthermia.
b. Exhausted sodalime.
c. Malfunction of inspiratory unidirectional valve of circle system.
d. Malfunction of expiratory unidirectional valve of circle system.
e. Hypoventilation.
12 A 45-year-old male patient is undergoing a mastoidectomy under
general anaesthesia. He is ventilated using a circle absorber system
and low-flow anaesthesia. Which of the following is the single most
important factor in preventing a critical incident related to a
breathing system disconnection?

a. Pulse oximeter.
b. Capnography.
c. Electronic airway pressure monitor.
d. Vigilant anaesthetist continuously monitoring chest wall excursion.
e. Spirometry.

13 A 56-year-old female patient is scheduled for a posterior fossa

craniotomy in the sitting position. Which of the following is the most
sensitive monitor in detecting intra-operative venous air embolism?

a. Oesophageal stethoscope.
b. Transoesophageal echocardiography.
c. Right atrial pressure monitoring.
d. Precordial Doppler.
e. End-tidal CO2 monitoring.

14 You are planning to administer a volatile anaesthetic using a

completely closed breathing system where all the exhaled gases are
re-breathed after absorption of CO2. Which of the following
monitoring is the most essential?

a. Monitoring inspired oxygen concentration using a fuel cell at the

common gas outlet.
b. Monitoring inspired oxygen concentration very close to the
endotracheal tube.
c. Monitoring inspired CO2 concentration to detect hypercapnia.
d. Monitoring inspired concentration of volatile anaesthetic agent at the
common gas outlet.
e. Monitoring end-tidal CO2 concentration.
15 A 50-year-old male patient is ready to be transferred from a district
general hospital to a neurosurgical centre by ambulance. He is
mechanically ventilated to achieve a minute volume of 5L/minute,
using a portable ventilator, which consumes 5L/minute of oxygen to
drive the ventilator. The total journey time is about 45 minutes. The
ventilator requires 20 bar of pressure to operate. How many E-sized
oxygen cylinders would be needed to complete the journey?

a. One.
b. Two.
c. Three.
d. Four.
e. Five.

16 Narcosis due to deep sea diving is a well-known phenomenon.

Which one of the following gases is least likely to cause narcosis
during deep sea diving?

a. Nitrogen.
b. Oxygen.
c. Neon.
d. Carbon dioxide.
e. Helium.

17 The hepatic acinus is roughly divided into three zones that

correspond to distance from the arterial blood supply. Which of the
following zones is likely to be damaged as a result of paracetamol
overdose?

a. Zone 1.
b. Zone 2.
c. Zone 3.
d. All zones.
e. Zone 1 and zone 3 only.
18 As part of human thermoregulation, at an environmental temperature
of 39°C, which one of the following is the most effective process in
maintaining normal body temperature?

a. Radiation.
b. Conduction.
c. Convection.
d. Evaporation.
e. Radiation and convection.

19 A number of factors affect cerebral blood flow. In which of the

following factors will a small change (in percentage terms) result in
the greatest change in cerebral blood flow?

a. Partial pressure of oxygen.

b. Partial pressure of CO2.
c. Intracranial pressure.
d. Body temperature.
e. Blood pressure.

20 Blood pressure regulation is multi-factorial. Which one of the

following is the least likely to cause sustained hypertension in a 41-
year-old female?

a. Long-term use of oral contraceptives.

b. Sustained increase in the secretion of hormones in the zona
glomerulosa in the adrenal cortex.
c. Sustained increase in the secretion of hormones in the zona
fasciculata and zona reticularis in the adrenal cortex.
d. Sustained increase in the secretion of hormones in the posterior
pituitary gland.
e. Sustained increase in the secretion of hormones in the adrenal
medulla.
21 A 72-year-old male is listed for a laparoscopic cholecystectomy. He
has severe rheumatoid arthritis, well-controlled atrial fibrillation and
polymyalgia rheumatica. He has been on amiodarone, methotrexate,
simvastatin and leflunomide for the last 12 years. On the basis of the
above information, which one of the following would be the most
appropriate pre-operative investigation?

a. Transoesophageal echocardiogram.
b. Pulmonary function tests.
c. Coagulation screen.
d. Electromyogram.
e. Muscle biopsy.

22 A 40-year-old male is due to undergo a maxillary reconstruction

procedure. During induction of general anaesthesia, thiopentone is
accidentally injected into the arterial cannula port. This is noticed
immediately and further injection stopped. 4ml of 2.5% thiopentone
has been injected through the arterial cannula. What should be the
most appropriate next step in managing this situation?

a. Leave the arterial line in situ, inject procaine and perform a stellate
ganglion block.
b. Leave the arterial line in situ, administer intravenous heparin and
perform a stellate ganglion block.
c. Leave the arterial line in situ, administer a therapeutic dose of
LMWH and postpone surgery.
d. Flush the cannula with heparin, and remove immediately.
e. Flush the cannula with saline, remove immediately, and perform a
stellate ganglion block.

23 A 42-year-old male with severe pneumonia is intubated and

ventilated for more than a week in the intensive care unit. He has
now been transferred to the operating theatre for placement of a
nasojejunal tube under endoscopic guidance in view of establishing
enteral feeding. Which one of the following would be the most
appropriate drug to facilitate enteral feeding?
a. Prochlorperazine.
b. Erythromycin.
c. Dexamethasone.
d. Cyclizine.
e. Ondansetron.

24 A 28-year-old gravida 4 para 3 is undergoing a category 2

Caesarean section. The baby has been delivered, two boluses of
oxytocin 5U have already been administered followed by an infusion
of 40U of oxytocin in 500ml normal saline at 125ml/hour. The
obstetrician says the uterine tone is poor. Which one of the following
would be the most appropriate step?

a. 20U oxytocin intravenous bolus.

b. Inhaled salbutamol.
c. Intramuscular oxytocin and ergometrine.
d. Intravenous prostaglandin F.
e. Intravenous prostaglandin E.

25 A 79-year-old male patient with type 2 diabetes and chronic renal

impairment is scheduled for incision and drainage of a peri-anal
abscess. His regular medication includes enalapril, spironolactone,
gliclazide and simvastatin. On the ward he has been prescribed
diclofenac and co-codamol for his pain. On investigating his renal
parameters, which one of the following electrolyte abnormalities is
most likely to present?

a. Hyperkalaemia.
b. Hypokalaemia.
c. Hypernatraemia.
d. Hypomagnesaemia.
e. Hypocalcaemia.
26 A 76-year-old female patient with ischaemic heart disease is
undergoing a laparotomy for a small bowel resection. Invasive
arterial blood pressure is being monitored through a 20-gauge
arterial cannula in the left radial artery. The transducer system is
secured on a drip stand and zeroed with reference to the mid-axillary
point. On request from the surgeon, the table is lowered by 10cm
and the recorded mean arterial pressure (MAP) is 70mmHg. Which
of the following is the true blood pressure at this time?

a. 75mmHg.
b. 80mmHg.
c. 60mmHg.
d 62.4mmHg.
e. 77.6mmHg.

27 Which of the following is the most common complication of direct

laryngoscopy and tracheal intubation?

a. Dental trauma.
b. Oesophageal intubation.
c. Pulmonary aspiration.
d. Subglottic stenosis.
e. Laryngospasm.

28 Which of the following properties of ultrasound is most useful in

diagnostic imaging techniques?

a. Frequency of ultrasound wave.

b. Speed of propagation of ultrasound wave.
c. Absorption of ultrasound by tissues.
d. Reflection of ultrasound beam at tissue interfaces.
e. Wavelength of ultrasound wave.
29 During an elective ophthalmic procedure you have been using an
atracurium infusion with neuromuscular monitoring. At the end of the
procedure, which of the following train-of-four (TOF) responses
best suggests administration of neostigmine and glycopyrrolate for
reversing the block?

a. One twitch on TOF stimulation.

b. Two twitches on TOF stimulation.
c. Train-of-four ratio >0.4.
d. Four twitches on TOF response.
e. Three twitches on TOF response.

30 A 67-year-old male patient is undergoing a total hip replacement

under general anaesthesia. The airway is secured with a tracheal
tube, and anaesthesia is maintained with sevoflurane (3%) and
nitrous oxide (60%), and oxygen (40%) using a fresh gas flow of
0.3L/minute. Although the sevoflurane dial is set at 3%, the agent
analyser indicates an inspired sevoflurane concentration of 1.8%.
Which of the following is the most appropriate explanation for the
difference between the dial setting and the inspired concentration?

a. Malfunctioning vaporiser.
b. Malfunctioning agent analyser.
c. Ventilator malfunction.
d. Increased uptake of volatile agent by the patient.
e. The dilutional effect of rebreathing.
Set 6 questions
1 A 36-year-old primigravida, with a history of polyhydramnios delivers
a baby at 34 weeks’ gestation. The midwife notices that the baby
chokes and persistently coughs on attempted feeding. Which of the
following anatomical tracheo-oesophageal fistulae is most likely to
be the cause for these symptoms in the neonate?

a. The upper segment ends as a blind pouch and the lower segment
communicates with the trachea.
b. The upper segment communicates with the trachea and the lower
segment ends as a blind pouch.
c. Both upper and lower segments end as blind pouches.
d. The upper segment communicates with the lower part of the trachea
and the lower segment arises from the carina.
e. The two segments join together and communicate with the lower
part of the trachea.

2 A 60-year-old female patient underwent a laparotomy with extensive

small bowel resection. She has now developed an entero-cutaneous
fistula. As a result she is on parenteral nutrition via a central venous
catheter inserted through the internal jugular vein. Which of the
following complications is most likely in this patient?

a. Venous thrombosis.
b. Symptomatic liver disease.
c. Osteoporosis.
d. Osteomalacia.
e. Catheter infection.
3 You are performing spinal anaesthesia on a 65-year-old male patient
in the right lateral position for an inguinal hernia repair. As you
advance the spinal needle, he complains of sharp stabbing pain in
his right leg. The next most appropriate step in the management is:

a. Abandon the procedure.

b. Advance the needle further inwards in the same direction.
c. Withdraw the needle and redirect more medially.
d. Withdraw the needle and direct laterally.
e. Inject more local anaesthetic.

4 During exercise, blood flow to muscles increases significantly.

Which one of the following is most likely to contribute to the initial
rise in skeletal muscle blood flow at the beginning of exercise?

a. Vasodilatation of blood vessels due to local metabolites.

b. Increased sympathetic discharge to peripheral vessels.
c. Increase in cardiac output.
d. Increase in arterial blood pressure.
e. Increase in heart rate.

5 You have administered 2L of colloid solution to an anaesthetised 43-

year-old healthy male. Which one of the following blood vessels will
best accommodate the change in circulatory volume?

a. Systemic arteries.
b. Systemic veins.
c. Systemic capillaries.
d. Pulmonary capillaries.
e. Pulmonary veins.

6 A 20-year-old male patient is scheduled for an emergency

appendicectomy. There is a family history of suxamethonium apnoea.
When he was investigated for suxamethonium apnoea, blood tests
revealed a dibucaine number of 20 and a genotype of Ea: Ea
 (homozygous atypical). Which of the following muscle relaxants is
most suitable for rapid sequence induction in this patient?

a. Suxamethonium 1mg/kg.
b. Rocuronium 0.9mg/kg.
c. Rocuronium 0.3mg/kg.
d. Rocuronium 0.6mg/kg.
e. Rocuronium 0.5mg/kg.

7 A 45-year-old female patient is scheduled for extraction of one pre-

molar tooth under local anaesthesia and sedation. She has
hypertension which is treated with atenolol 50mg. After establishing
baseline monitoring, fentanyl 75µg was administered in aliquots
every 2-3 minutes. She also received 0.5mg of midazolam.
Subsequently, the surgeon infiltrated 3ml of 3% prilocaine with
felypressin. At this stage she required another 50µg of fentanyl
intravenously. She became very rigid and complained of difficulty in
breathing with tightness in her chest. Which of the following drugs
is the most likely cause for this?

a. Midazolam.
b. Felypressin.
c. Prilocaine.
d. Fentanyl.
e. Atenolol.

8 Inhalational anaesthetic agents affect systemic vascular resistance

(SVR). Which one of the following agents has the least effect on
SVR?

a. Isoflurane.
b. Sevoflurane.
c. Desflurane.
d. Enflurane.
e. Halothane.
9 Protein binding of a local anaesthetic determines its duration of
action. Which one of the following sequences correctly indicates the
level of protein binding of local anaesthetics in a decreasing order?

a. Procaine > bupivacaine > lignocaine > prilocaine.

b. Bupivacaine > lignocaine > prilocaine > procaine.
c. Prilocaine > bupivacaine > lignocaine > prilocaine.
d. Lignocaine > bupivacaine > prilocaine > procaine.
e. Bupivacaine > lignocaine > procaine > prilocaine.

10 Which one of the following mechanisms best explains the reason for
using sodium nitrite in the management of cyanide toxicity?

a. It increases methaemoglobinaemia.
b. It produces increased hepatic sulphydryl groups.
c. It increases the conversion to cyanocobalamin.
d. It displaces cyanide from haemoglobin.
e. It enhances oxidative phosphorylation.

11 The graph below describes the relationship between true blood

pressure and measured blood pressure through an invasive arterial
cannula connected to a transducer system (Figure 1). Line A
represents the ideal response. Lines B and C represent false
readings due to a calibration error. The error represented by line C
can best be corrected by:

a. Zeroing the system.

b. Replacing the transducer cable.
c. Performing a three-point calibration.
d. Performing a two-point calibration.
e. Performing a square wave test.
Figure 1. The relationship between true blood pressure and measured
blood pressure through an invasive arterial cannula connected to a
transducer system.

12 You are planning to perform inhalational induction using sevoflurane

on an adult patient weighing 68kg. Which of the following is the
most efficient breathing system for this purpose?

a. Mapleson D system.
b. Mapleson A system.
c. Mapleson B system.
d. Mapleson C System.
e. The Bain system.
13 A 45-year-old female presents for a laparoscopic cholecystectomy.
General anaesthesia using intravenous induction followed by
maintenance with volatile agents is planned. In view of avoiding
awareness, which of the following monitors is most useful?

a. Isolated forearm technique.

b. Bispectral index.
c. Minimum alveolar concentration (MAC) of volatile anaesthetic agent.
d. Lower oesophageal contractility.
e. Late cortical evoked responses.

14 You are planning to evaluate three fluid warmers in a laboratory

setting. You need to accurately monitor the temperature of the fluid
and would like to detect a very small difference of up to 0.001°C.
Which of the following temperature measurement devices is most
suitable for this research?

a. Mercury thermometer.
b. Infrared thermometer.
c. Platinum resistance thermometer.
d. Thermistor.
e. Bourdon gauge thermometer.

15 You are planning to undertake research to evaluate the intubating

conditions of a new non-depolarising muscle relaxant. Which of the
following peripheral muscle and nerve combinations is most
appropriate for this purpose?

a. Ulnar nerve and adductor pollicis.

b. Facial nerve and orbicularis occuli.
c. Tibial nerve and abductor hallucis.
d. Common peroneal nerve (lateral popliteal) and extensor hallucis
longus.
e. Facial nerve and orbicularis oris.
16 Airway resistance varies along different parts of the respiratory tract.
In which of the following areas is the airway resistance greatest?

a. Trachea.
b. Terminal bronchioles.
c. Medium-sized bronchi.
d. Alveoli.
e. Alveolar ducts.

17 A 28-year-old male is admitted to the ICU after taking a drug

overdose. He is comatose and about to be intubated. His PaCO2
was 5.3kPa ten minutes ago, but you discover it is now 9kPa. Which
one of the following statements is most likely to be true about this
patient?

a. The pH of his CSF is likely to fall more slowly than the pH of his
blood.
b. The pH of his blood is likely to fall more slowly than the pH of his
CSF.
c. The pH of his blood and CSF will not change because he will rapidly
eliminate bicarbonate in the urine in response to the rise in PaCO2.
d. The pH of his blood will fall immediately without any change in the
pH of his CSF.
e. The pH of his blood will fall and the pH of his CSF will rise over the
next 24 hours.

18 A patient ingests antifreeze and needs to eliminate the ingested acid.

Renal elimination of the protons of this excess acid is primarily
accomplished by which of the following mechanisms?

a. Increased urinary ammonium excretion.

b. Increased urinary excretion of phosphates.
c. Hyperventilation.
d. Increased urinary free hydrogen ion concentration.
e. Increased urinary sulfate excretion.
19 A number of conditions affect the structure or concentration of
haemoglobin in blood. Which one of the following conditions is most
likely to be associated with a reduced level but normal structure of
haemoglobin in the blood?

a. Thalassaemia.
b. Anaemia due to chronic blood loss.
c. Blood transfusion reaction.
d. Haemolytic anaemia.
e. Sickle cell anaemia.

20 A 29-year-old female has puffy skin, a hoarse voice and complains

of an intolerance to cold. Her plasma thyroid stimulating hormone
(TSH) level is low and this increases significantly if she is given
thyrotropin releasing hormone (TRH). Which one of the following is
the most likely diagnosis in this woman?

a. Hypothyroidism due a primary abnormality in the pituitary gland.

b. Hyperthyroidism due to a thyroid tumour.
c. Hypothyroidism due to a thyroid tumour.
d. Hyperthyroidism due to a primary abnormality in the hypothalamus.
e. Hypothyroidism due to a primary abnormality in the hypothalamus.

21 A 78-year-old male patient with arthritis, hypertension and

congestive cardiac failure is scheduled to have an open
prostatectomy. He is on bendrofluazide 5mg o.d., and amiloride
20mg o.d. He is seen in the pre-operative assessment clinic and
routine blood tests have been ordered. The most likely abnormal
biochemical finding in the blood is:

a. Hyponatraemia.
b. Hyperuricaemia.
c. Hyperphosphataemia.
d. Hypomagnesaemia.
e. Hypercalcaemia.
22 A 64-year-old male is listed for excision of a ganglion on the wrist.
He suffers from rheumatoid arthritis and asthma. He takes his
salbutamol inhaler 200µg t.d.s. and prednisolone 15mg once a
day. He has been on these drugs for over 2 years. Which of the
following is the most appropriate with regard to his peri-operative
management?

a. Prednisolone 15mg on the morning of surgery.

b. Hydrocortisone 100mg at induction.
c. Hydrocortisone 50mg at induction and 50mg 6 hours
postoperatively.
d. Prednisolone 15mg on the morning of surgery and hydrocortisone
50mg at induction.
e. Hydrocortisone 100mg at induction and 50mg 6 hours
postoperatively.

23 A 62-year-old male patient with end-stage liver disease and cirrhosis

is scheduled for an emergency laparotomy. Which of the following
non-depolarising neuromuscular blocking agents is most suitable for
this patient?

a. Vecuronium.
b. Pancuronium.
c. Mivacurium.
d. Rocuronium.
e. Atracurium.

24 A 46-year-old male is diagnosed with a vascular occlusion in his left

leg. He is taken to the emergency theatre for an embolectomy and
femoral cross-over graft surgery. He is known to have end-stage
renal disease and is on daily peritoneal dialysis. He is in the
 anaesthetic room for induction. His ECG shows a prolonged PR
interval and tall T waves. His blood results are shown in Table 1.

Table 1. Blood results.

Na+ K+ Urea Creatinine

139mmol/L 7.2mmol/L 15mmol/L 182µmol/L

Which of the following is the next immediate step in the management

of hyperkalaemia?

a. Intravenous 10ml of 10% calcium chloride over 5 minutes.

b. Intravenous salbutamol 250µg.
c. Intravenous insulin 50 units over an hour.
d. Intravenous furosemide 20mg.
e. Intravenous sodium bicarbonate 50mmols over an hour.

25 A 30-year-old male is due to undergo an urgent laparotomy. He has

a family history of suxamethonium apnoea. Induction with propofol
and rocuronium is planned. In the event of an unanticipated failed
intubation, which of the following is the most appropriate in
reversing the neuromuscular blockade?

a. Intravenous neostigmine 0.07mg/kg and glycopyrrolate 0.01mg/kg.

b. Intravenous neostigmine 0.1mg/kg and glycopyrrolate 0.05mg/kg.
c. Intravenous sugammadex 16mg/kg.
d. Intravenous sugammadex 4mg/kg.
e. Intravenous edrophonium 0.1mg/kg.

26 You are anaesthetising a patient at high altitude where atmospheric

pressure is 380mm Hg. If the set concentration on the isoflurane
 vaporiser is 2%, in reality which one of the following indicates the
correct concentration of vapour delivered in the inspiratory flow to
the patient?

a. 1%.
b. 2%.
c. 3%.
d. 4%.
e. 0.5%.

27 A defibrillator has a capacitor with a potential of 4000 Volts and a

charge of 0.2 coulombs. What will be the maximum stored energy in
this defibrillator?

a. 100J.
b. 150J.
c. 360J.
d. 400J.
e. 460J.

28 A 60-year-old female patient is scheduled to undergo a vaginal

hysterectomy in the lithotomy position under general anaesthesia.
The anticipated surgical duration is 75 minutes. Which one of the
following characteristics of a ProSeal® LMA makes it most suitable
over a classic LMA?

a. Presence of a flexible wire reinforced airway tube.

b. Better haemodynamic stability as compared to a classic LMA.
c. Reduced incidence of cough and sore throat in the postoperative
period.
d. Improved airway seal, enabling positive pressure ventilation.
e. Shorter and reinforced tube with an integral bite block.
29 A 72-year-old male patient is scheduled to undergo a total hip
replacement under spinal anaesthesia. You have administered spinal
anaesthesia using 2.6ml of 0.5% heavy bupivacaine. Which of the
following is least useful in assessing the height of block?

a. Peripheral oxygen saturation.

b. Bispectral index monitoring.
c. Checking the level of touch sensation.
d. Monitoring blood pressure.
e. Checking the level of cold sensation.

30 A 68-year-old male patient is undergoing a total knee replacement.

The airway is secured with an i-Gel® supraglottic airway.
Anaesthesia is maintained with sevoflurane 2.5% in oxygen and
nitrous oxide with a total fresh gas flow of 0.8L/minute through a
circle breathing system. The patient is breathing spontaneously.
About an hour after starting the procedure, the patient showed signs
of being in a light plane of anaesthesia, despite the sevoflurane dial
set at 3%. The inspired sevoflurane is 2.6% and expired sevoflurane
is 1.2%. Which of the following is the most likely cause for the gross
difference in the inspired and expired concentration of sevoflurane?

a. Malfunction of the vaporiser.

b. Malfunction of the vapour analyser.
c. Increased uptake of sevoflurane by the patient.
d. Suboptimal positioning of the i-Gel® airway resulting in air
entrainment.
e. Use of low fresh gas flow.
This book comprises six sets of single best answer practice papers. Each set

contains 30 single best answer questions on physiology, pharmacology,

clinical measurement and physics. The scenarios are based on the application

of a wide knowledge of basic sciences relevant to the clinical practice of

anaesthesia. The best possible answer to a given question is substantiated by

detailed explanation drawn from recent journal articles and textbooks of

anaesthesia and basic sciences. These questions enable the candidates to

assess their knowledge in basic sciences and their ability to apply it to clinical

practice.

Alongside the previously published book Single Best Answer MCQs in

Anaesthesia (Volume I – Clinical Anaesthesia, ISBN 978-1-903378-75-5), this

book is an ideal companion for candidates sitting postgraduate examinations

in anaesthesia, intensive care medicine, and pain management. It will also be

a valuable educational resource for all trainees and practising anaesthetists.