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
analgesia
(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:

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

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(b) Occurs up to 6 hours post-operatively
(c) Is more likely after combined anterior-posterior cervical
surgery
(d) Stridor is unusual
(e) The primary management is intravenous dexamethasone and
nebulised adrenaline
12. Painless post-operative visual loss following anaesthesia:
(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
(d) Can be prevented by using a horseshoe headrest
(e) Diabetes, hypertension and smoking are risk factors
Cardiac muscle physiology
13. Regarding cardiac muscle anatomy:
(a) Cardiac muscle cells are multinucleate
(b) The T tubules cross at the A-I junction
(c) Intercalated discs always occur at the Z line
(d) Gap junctions provide a high resistance pathway for the spread
of excitation between cells
(e) The sarcomere extends from one Z line to the next
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
ion flux
(c) Sodium exchange transfers 3 sodium ions for 2 potassium ions
such that there is a net inward positive current
(d) Pacemaker cells have small unstable resting potentials
(e) The long duration of the action potential prevents tetany from
occurring
15. Regarding excitation contraction coupling:
(a) The intracellular calcium concentration at rest is greater than
that of potassium ions
(b) Intracellular calcium ion concentration is triggered by the
ryanodine receptor in a similar manner to that within skeletal
muscle
(c) Calcium interacts with the C subunit of tropomyosin
(d) Diastolic relaxation is reliant upon the presence of ATP
(e) Excitation contraction coupling is enhanced by the presence of
hydrogen ions
16. Regarding cardiac muscle metabolism:
(a) Oxygen extraction from the blood is high
(b) The myocyte relies almost entirely on glucose for energy
(c) Anaerobic metabolism may account for 10% of energy at rest
(d) Lactic acidosis may lead to cellular death.
(e) More glucose than lactate is utilised at rest
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Multiple Choice Questions
17. Regarding muscle contraction:
(a) Isometric contraction of the isolated papillary muscle prepa-
ration is equivalent to the ejection phase of systole
(b) The tension generated in isometric contraction is proportional
to initial fibre length
(c) Velocity of shortening increases linearly with afterload
(d) Isotonic contraction occurs during diastole
(e) Catecholamine infusions may impair diastolic relaxation
Right ventricular failure: essentials for
the anaesthetist
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
(d) Has a crescent shape
(e) Ejection is partly dependent on LV contraction
19. Regarding therapies for RV failure:
(a) Drugs that cause systemic vasoconstriction should be avoided
(b) Milrinone decreases RV afterload
(c) Sildenafil has proven utility in pulmonary hypertension
(d) Sildenafil is contraindicated in combination with inhaled nitric
oxide
(e) Intravenous prostacyclin causes selective pulmonary
vasodilation
20. Inhaled nitric oxide:
(a) Acts on vascular endothelium
(b) Activates cyclic AMP
(c) Decreases systemic vascular resistance
(d) Is often ineffective for patients with long standing pulmonary
hypertension
(e) Is contraindicated in cardiac transplantation
21. Regarding evaluation of the RV using echocardiography:
(a) The shape of the RV makes estimation of RV volume easy
(b) Bulging of the septum towards the LV cavity is a useful sign
of RV failure
(c) Tricuspid regurgitation can be measured using Doppler
(d) Increased hepatic venous flow suggests RV failure
(e) Thickness of the RV free wall is measured during systole to
diagnose RV hypertrophy
22. RV failure after cardiac surgery:
(a) May prevent separation from cardiopulmonary bypass
(b) Usually improves with protamine administration
(c) Is unlikely if cardioplegia was delivered through the coronary
sinus
(d) Is more commonly caused by air embolus than is the case for
LV failure
(e) Necessitates careful consideration of ventilator settings
105
 Multiple Choice Questions
An introduction to statistics I
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
(d) Interval data may be converted into categorical data
(e) Ordinal data form a subset of categorical data
24. In a 2  2 contingency table:
(a) The rows usually represent outcome
(b) The upper row usually represents the control group
(c) In order for it to be valid for statistical analysis, the obser-
vations must be independent
(d) The cells may contain either frequency or relative frequency
(%)
(e) The cells must be either exhaustive or mutually exclusive
25. Regarding a histogram:
(a) The x-axis is dimensionless
(b) The rectangles may be of different width
(c) The frequency within each class interval is always proportional
to the height of the rectangle associated with that class interval
(d) Class intervals of zero frequency must be included
(e) Class intervals may be of unequal size
26. Considering two sets of paired interval data
(a) When the data relate to two different methods of measuring
the same variable, the correlation coefficient is not a good
indicator of the comparative agreement between the two
methods
(b) The range of the Pearson correlation coefficient is between 0
and 1
(c) A p-value , 0.001 for the correlation coefficient indicates a
high correlation
(d) The square of the Pearson correlation coefficient (r2) equals
the amount of shared variance between them
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(e) The Pearson correlation coefficient is used for normally dis-
tributed data
Opioids in persistent non-cancer pain
27. Chronic pain:
(a) Is an uncommon medical condition
(b) Usually requires medical attention
(c) Is associated with a reduction in the levels of physical, psycho-
logical and social functioning
(d) Is usually treated appropriately with strong opioid medication
(e) Has minimal therapeutic options besides pharmacotherapy
28. With regard to strong opioids:
(a) The number of prescriptions for strong opioids has increased
by approximately 70% since 1998
(b) Strong opioids have excellent long-term efficacy and
safety data, relating to their use in persistent non-cancer
pain
(c) There is evidence for efficacy in the treatment of neuropathic
pain
(d) Long-term use rarely leads to physical dependence
(e) Continued use can lead to tolerance, probably mediated by the
N-methyl-D-aspartate receptor system
29. Concerning the side effects of strong opioids:
(a) Side-effects occur in approximately 80% of patients
(b) The most commonly experienced adverse effects relate to
cognitive function
(c) Strong opioids are better tolerated when delivered via the
transdermal route, rather than orally
(d) The use of strong-opioids is a contraindication to driving a
motor vehicle
(e) The prescribing doctor has a legal responsibility to inform the
DVLA if he or she thinks a patient is unfit to drive