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Multiple Choice Questions

Interpretation of the chest radiograph 6. Admission to a specialist burns unit is advisable for the follow-
ing children:
1. The following structures contribute to the cardiac margins
(a) A conscious child with no cutaneous burn covered in soot
visible on a PA chest radiograph:
from a house fire
(a) Right ventricle
(b) A partial thickness burn from hot water covering the back
(b) Left atrial appendage
(c) An erythematous burn from sun exposure on both arms
(c) Interventricular septum
(d) A burn of uncertain depth to both feet from hot water
(d) Right atrium
(e) A circumferential burn to the arm of 2% body surface area
(e) Coronary sinus
7. Analgesia for burns in children
2. Air bronchogram may be seen in the following situations:
(a) Is rarely required for those under one year of age
(a) Atelectasis
(b) Should never include NSAIDs
(b) Pneumonia
(c) Should be managed by pharmaceutical means alone
(c) Pulmonary haemorrhage
(d) School age children may be able to use patient-controlled
(d) Pulmonary oedema
(e) Normal chest radiograph
(e) Anti-emetics are not required
3. A posterior-to-anterior (PA) chest radiograph:
8. Regarding burns in children
(a) Magnifies the cardiac shadow
(a) Non accidental injury is common
(b) Is usually taken with the patient supine
(b) Most fluid resuscitation formulae overestimate requirements
(c) The scapulae are usually projected over the upper lobes
(c) Systemic antibiotics are given routinely
(d) Is adequate if 8 10 posterior ribs are visible
(d) Succinylcholine can safely be used in the first few days after
(e) Appears more diffusely opaque if over penetrated
any burn
4. The following statements are true (e) Nutritional intake is a management priority
(a) The apex of the right hemidiaphragm is usually 3 cm below
the level the left hemidiaphragm
(b) A correctly placed tracheal tube should be approximately 3 cm Cervical spine surgery and anaesthesia
above the carina
9. Alantoaxial subluxation is found in:
(c) The silhouette sign is in essence loss of a normal lung/soft
(a) Down syndrome
tissue interface
(b) Morquio syndrome
(d) The right hilum is higher than the left
(c) Rheumatoid arthritis
(e) The horizontal fissure is visible on 90% of PA chest x-rays
(d) Ankylosing spondylitis
(e) Grisels syndrome

10. Patients with traumatic cervical injury:

(a) 10% will deteriorate neurologically
Paediatric burns and the anaesthetist (b) Most deteriorate neurologically within 24 hours
(c) May develop a sub-acute, post-traumatic, ascending
5. When calculating fluid resuscitation volumes for children with
(d) Deterioration can coincide with anaesthesia
(a) Body weight is directly related to body surface area
(e) Basic airway manoeuvres are proven to worsen neurological
(b) Maintenance requirements are ignored
(c) Dextrose must always be given
(d) Colloids are preferable to crystalloids 11. Post-operative airway obstruction following cervical spine
(e) 2 ml kg21 BSA% burn21 is given in the first eight hours surgery:
following the burn (a) Can be due to haematoma

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Multiple Choice Questions

(b) Occurs up to 6 hours post-operatively 17. Regarding muscle contraction:

(c) Is more likely after combined anterior-posterior cervical (a) Isometric contraction of the isolated papillary muscle prepa-
surgery ration is equivalent to the ejection phase of systole
(d) Stridor is unusual (b) The tension generated in isometric contraction is proportional
(e) The primary management is intravenous dexamethasone and to initial fibre length
nebulised adrenaline (c) Velocity of shortening increases linearly with afterload
(d) Isotonic contraction occurs during diastole
12. Painless post-operative visual loss following anaesthesia:
(e) Catecholamine infusions may impair diastolic relaxation
(a) Can be due to corneal abrasion
(b) Can be due to ischemic optic neuropathy due to external
pressure on the eye
(c) Can be due to central retinal artery thrombosis leading to a
cherry red spot at the fovea Right ventricular failure: essentials for
(d) Can be prevented by using a horseshoe headrest the anaesthetist
(e) Diabetes, hypertension and smoking are risk factors
18. The right ventricle:
(a) Is well suited to adapting to increased afterload
(b) Isovolumetric contraction is longer than for the LV
(c) Forms the apex of the heart
Cardiac muscle physiology (d) Has a crescent shape
(e) Ejection is partly dependent on LV contraction
13. Regarding cardiac muscle anatomy:
(a) Cardiac muscle cells are multinucleate 19. Regarding therapies for RV failure:
(b) The T tubules cross at the A-I junction (a) Drugs that cause systemic vasoconstriction should be avoided
(c) Intercalated discs always occur at the Z line (b) Milrinone decreases RV afterload
(d) Gap junctions provide a high resistance pathway for the spread (c) Sildenafil has proven utility in pulmonary hypertension
of excitation between cells (d) Sildenafil is contraindicated in combination with inhaled nitric
(e) The sarcomere extends from one Z line to the next oxide
(e) Intravenous prostacyclin causes selective pulmonary
14. Regarding the cardiac action potential:
(a) The plateau phase is longer in cardiac cells than nerves
(b) Phase 1 of the cardiac action potential occurs due to calcium 20. Inhaled nitric oxide:
ion flux (a) Acts on vascular endothelium
(c) Sodium exchange transfers 3 sodium ions for 2 potassium ions (b) Activates cyclic AMP
such that there is a net inward positive current (c) Decreases systemic vascular resistance
(d) Pacemaker cells have small unstable resting potentials (d) Is often ineffective for patients with long standing pulmonary
(e) The long duration of the action potential prevents tetany from hypertension
occurring (e) Is contraindicated in cardiac transplantation

15. Regarding excitation contraction coupling: 21. Regarding evaluation of the RV using echocardiography:
(a) The intracellular calcium concentration at rest is greater than (a) The shape of the RV makes estimation of RV volume easy
that of potassium ions (b) Bulging of the septum towards the LV cavity is a useful sign
(b) Intracellular calcium ion concentration is triggered by the of RV failure
ryanodine receptor in a similar manner to that within skeletal (c) Tricuspid regurgitation can be measured using Doppler
muscle (d) Increased hepatic venous flow suggests RV failure
(c) Calcium interacts with the C subunit of tropomyosin (e) Thickness of the RV free wall is measured during systole to
(d) Diastolic relaxation is reliant upon the presence of ATP diagnose RV hypertrophy
(e) Excitation contraction coupling is enhanced by the presence of
22. RV failure after cardiac surgery:
hydrogen ions
(a) May prevent separation from cardiopulmonary bypass
16. Regarding cardiac muscle metabolism: (b) Usually improves with protamine administration
(a) Oxygen extraction from the blood is high (c) Is unlikely if cardioplegia was delivered through the coronary
(b) The myocyte relies almost entirely on glucose for energy sinus
(c) Anaerobic metabolism may account for 10% of energy at rest (d) Is more commonly caused by air embolus than is the case for
(d) Lactic acidosis may lead to cellular death. LV failure
(e) More glucose than lactate is utilised at rest (e) Necessitates careful consideration of ventilator settings

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Multiple Choice Questions

An introduction to statistics I (e) The Pearson correlation coefficient is used for normally dis-
tributed data
23. Regarding data:
(a) A parameter is a measurable characteristic of a sample
(b) A variable is a measurable characteristic of a population
(c) A parameter has a fixed value Opioids in persistent non-cancer pain
(d) Interval data may be converted into categorical data
27. Chronic pain:
(e) Ordinal data form a subset of categorical data
(a) Is an uncommon medical condition
24. In a 2  2 contingency table: (b) Usually requires medical attention
(a) The rows usually represent outcome (c) Is associated with a reduction in the levels of physical, psycho-
(b) The upper row usually represents the control group logical and social functioning
(c) In order for it to be valid for statistical analysis, the obser- (d) Is usually treated appropriately with strong opioid medication
vations must be independent (e) Has minimal therapeutic options besides pharmacotherapy
(d) The cells may contain either frequency or relative frequency
28. With regard to strong opioids:
(a) The number of prescriptions for strong opioids has increased
(e) The cells must be either exhaustive or mutually exclusive
by approximately 70% since 1998
25. Regarding a histogram: (b) Strong opioids have excellent long-term efficacy and
(a) The x-axis is dimensionless safety data, relating to their use in persistent non-cancer
(b) The rectangles may be of different width pain
(c) The frequency within each class interval is always proportional (c) There is evidence for efficacy in the treatment of neuropathic
to the height of the rectangle associated with that class interval pain
(d) Class intervals of zero frequency must be included (d) Long-term use rarely leads to physical dependence
(e) Class intervals may be of unequal size (e) Continued use can lead to tolerance, probably mediated by the
N-methyl-D-aspartate receptor system
26. Considering two sets of paired interval data
(a) When the data relate to two different methods of measuring 29. Concerning the side effects of strong opioids:
the same variable, the correlation coefficient is not a good (a) Side-effects occur in approximately 80% of patients
indicator of the comparative agreement between the two (b) The most commonly experienced adverse effects relate to
methods cognitive function
(b) The range of the Pearson correlation coefficient is between 0 (c) Strong opioids are better tolerated when delivered via the
and 1 transdermal route, rather than orally
(c) A p-value , 0.001 for the correlation coefficient indicates a (d) The use of strong-opioids is a contraindication to driving a
high correlation motor vehicle
(d) The square of the Pearson correlation coefficient (r2) equals (e) The prescribing doctor has a legal responsibility to inform the
the amount of shared variance between them DVLA if he or she thinks a patient is unfit to drive

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