Multiple Choice Questions

Preoperative cardiopulmonary exercise

testing
1. Regarding patients functional capacity:
(a) The Duke Activity Status Index allows calculation of predicted
peak VO
2
.
(b) 1 metabolic equivalent (MET) represents a VO
2
of
3.5 ml kg
21
min
21
.
(c) 4 METs are equivalent to climbing 2 ights of stairs.
(d) Patients often underestimate their level of tness.
(e) The ability to achieve 4 METs is advisable when contemplat-
ing undertaking major surgery.
2. Cardiopulmonary exercise testing:
(a) Has a mortality of 24/1000.
(b) Is unsuitable for the majority of arthritic patients.
(c) Is safe to perform in signicantly anaemic patients.
(d) Requires a steady rate of ergometer pedalling.
(e) Monitors the 12 lead ECG during exercise.
3. Regarding cardiopulmonary exercise testing:
(a) It involves unloaded cycling.
(b) Monitoring is not required in the recovery period.
(c) The anaerobic threshold can only be reached at extreme levels
of exercise.
(d) An anaerobic threshold above 11 ml kg
21
min
21
is associated
with low postoperative mortality after major surgery.
(e) It can differentiate the cause of dyspnoea.
Anaesthetic preconditioning
4. Preconditioning:
(a) Is an evolutionary conserved response.
(b) Can be ischaemic in origin.
(c) Can be mimicked by pharmacological agents.
(d) Is not useful clinically.
(e) Has level 1 evidence of benet in non-cardiac surgery.
5. Mechanisms of preconditioning include:
(a) An increase in T4.
(b) Receptor activation by volatile agents.
(c) An increase in cAMP.
(d) Changes in gene expression.
(e) Intermittent substrate supply interruption.
6. Preconditioning has been shown to:
(a) Reduce mortality during cardiac surgery.
(b) Reduce biochemical and echocardiographic evidence of myo-
cardial injury.
(c) Reduce intensive care stay.
(d) Increase myocardial lactate.
(e) Decrease neutrophil accumulation in the lungs.
Anaesthesia for minimally invasive
oesophagectomy
7. Regarding the epidemiology of oesophageal cancer:
(a) Squamous cell carcinoma is the commonest cell type in the UK.
(b) It is more common in men than women.
(c) Adenocarcinmoma is decreasing in incidence in the UK.
(d) Gastro-oesophageal reux disease is associated with
adenocarcinoma.
(e) It is increasing in incidence throughout the whole of Europe.
8. Problems with mechanical ventilation during minimally invasive
oesophagectomy (MIO) may be due to:
(a) Capnothorax.
(b) Inadvertent injury to the airway during surgical dissection.
(c) Misplaced double-lumen tube.
(d) Pneumothorax.
(e) Misplaced naso-gastric tube.
9. Regarding one-lung anaesthesia during oesophagectomy:
(a) Duration of one-lung anaesthesia has been shown to increase
the risk of ARDS.
(b) If a bronchial blocker is used, blockade of the left main
bronchus is usual.
(c) For a right thoracoscopy, a right-sided double-lumen tube
should be used.
(d) One-lung anaesthesia may be performed in the prone position
in MIO.
(e) Correct positioning of a double-lumen tube should be con-
rmed with a breoptic bronchoscope.
Anaesthesia for the uncooperative child
10. Regarding anxiety around anaesthesia in children:
(a) It is important to establish oneself as an authority gure when
communicating with children.
doi:10.1093/bjaceaccp/mkq007 63
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 10 Number 2 2010
# The Author [2010]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.
All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

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(b) Parental presence at induction of anaesthesia is an effective
method for reducing anxiety at induction.
(c) Anxiety at induction is usually related to preoperative anxiety.
(d) Anxiety at induction can produce postoperative behavioural
problems.
(e) It is difcult to prevent.
11. Regarding midazolam:
(a) It is the most commonly used sedative premedication in UK
paediatric practice.
(b) Following oral administration, its sedative effect peaks at
10 min and begins to wane after 25 min.
(c) It produces excellent anxiolysis at induction of anaesthesia and
reduces postoperative behavioural disturbances.
(d) Its bitter taste can be effectively disguised by mixing it with
fruit juices.
(e) The usual oral dose is 1.0 mg kg
21
.
12. Regarding the combatant or aggressive child:
(a) They frequently have neurological disability, mental health or
behavioural disorders.
(b) Anxiolytics are of no value.
(c) Restraint should only be used as a last resort.
(d) The rst duty is to avoid injury to the staff.
(e) Ketamine 2 mg kg
21
i.m. will produce satisfactory sedation in
5 min.
Airway stents : anaesthetic implications
13. Patients with intrathoracic metastases who require airway
stenting:
(a) Are usually unt for anaesthesia.
(b) Will need awake intubation prior to induction.
(c) Need pulmonary function tests to assess preoperative suit-
ability for stenting procedures.
(d) May have problems with muscle relaxants.
(e) Should always have i.v. access secured in a lower limb.
14. Patients with airway stents in situ:
(a) Are usually taking anti-platelet medication.
(b) Should only be anaesthetized by thoracic anaesthetists.
(c) Intubation is best avoided if possible when anaesthetized.
(d) Knowing the position of existing stent is paramount.
(e) Often require repeated interventions for long-term stent
patency.
15. Respiratory compromise in the early postoperative period after
airway stenting:
(a) Can respond well to inhalation of helium/oxygen mixtures.
(b) Is likely to need inhalational induction.
(c) Can be mistaken for incomplete reversal of neuromuscular
blockade.
(d) Is usually due to bronchospasm.
(e) Should be avoided by prophylactic use of steroids.
Optimal volaemic status and predicting
uid responsiveness
16. Static parameters of preload include:
(a) Central venous pressure (CVP).
(b) Pulse pressure variation (PPV).
(c) Superior vena cava (SVC) collapsibility index.
(d) Pulmonary artery occlusion pressure (PAOP).
(e) Left ventricular end-diastolic area (LVEDA).
17. Regarding cardiopulmonary interactions:
(a) During spontaneous breathing, venous return is reduced during
inspiration.
(b) During positive pressure ventilation, venous return is reduced
during inspiration.
(c) During positive pressure ventilation, right ventricular afterload
increases during inspiration.
(d) During positive pressure ventilation, the decrease in right ven-
tricular stroke volume reaches its minimum during expiration.
(e) During positive pressure ventilation, the decrease in left ventri-
cular stroke volume reaches its minimum during inspiration.
18. The following are true:
(a) A SVC collapsibility index .38% predicts a volume response.
(b) While using trans-oesophageal Doppler during a hip replace-
ment, a Flow Time corrected (FTc) of 420 ms strongly predicts
a preload response.
(c) A stroke volume variation (SVV) of 14% predicts a positive
response to a uid challenge.
(d) PAOP and LVEDA correlate well to preload response.
(e) A passive leg raise resulting in an increase in mean arterial
pressure (MAP) indicates a likely increase in cardiac output
following a uid challenge.
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Visit the web site: www.ceaccp.oxfordjournals.org to obtain a certicate and CME points. Please see the editorial in Volume 7, Number 1
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Multiple Choice Questions
64 Continuing Education in Anaesthesia, Critical Care & Pain j Volume 10 Number 2 2010

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