1 ANESTHESIA DEPARTMENT DAVAO REGIONAL HOSPITAL TAGISAN NG TALINO ELIMINATION ROUND 1.

The following is FALSE with regards to the AUTONOMIC NERVOUS SYSTEM: a. Cell bodies of the preganglionic neurons occur in the lateral horns of gray matter of the 12 thoracic and first 2 lumbar segments of the spinal cord. (For this reason, the sympathetic system is also called the thoracolumbar division.) b. White rami are white because they contain unmyelinated fibers. Gray rami are gray because they contain myelinated fibers. c. Cell bodies of the preganglionic neurons occur in the gray matter of sacral segments S2 S4 and in the brainstem (with motor neurons of their associated cranial nerves III, VII, IX, and X). (For this reason, the parasympathetic system is also called the craniosacral division) d. There are three kinds of autonomic ganglia namely: A1 - paravertebral ganglia which contains sympathetic ganglia A2 - prevertebral (collateral) ganglia which contains sympathetic ganglia A3 - Terminal (intramural) ganglia receive parasympathetic fibers 2. The following is TRUE with the NERVE ACTION POTENTIAL: a. During Repolarization, the upswing is caused when positively charged sodium ions(Na+) suddenly rush through open sodium gates into a nerve cell. b. During Depolarization, the downswing is caused by the closing of sodium ion channels and the opening of potassium ion channels. this expulsion acts to restore the localized negative membrane potential of the cell. c. Refractory phase is a short period of time after the depolarization stage, during the refractory phase this particular area of the nerve cell membrane cannot be depolarized until the membrane is repolarized to its normal resting potential. d. Inhibitory synapse causes an inflow of K+ (potassium) or outflow of Cl- (chlorine) making the synaptic membrane hyperpolarized. This increase prevents depolarization of the membrane. 3. The following causes a fall in FRC . EXCEPT: a. lying supine, b. obesity, c. pregnancy , d. anaesthesia, e. old age f. 4. As regards O2 carrying capacity, the following is FALSE: a. Several factors can change the affinity of Hb for oxygen, resulting in the curve moving to the right (acidosis, temperature or 2,3-DPG) or to the left (foetal Hb, alkalosis, temperature or 2,3-DPG ) b. Movement of the curve to the right decreases the affinity of Hb for oxygen, this is physiologically useful in the tissues, where the slightly acidic environment serves to improve oxygen unloading from the blood - the Bohr Effect. c. A left shift of the curve increases the affinity of Hb for oxygen, producing a higher saturation at a given PO2. This acts to improve oxygen loading in the pulmonary capillary (slightly alkaline) and is greatly advantageous in the foetus, where the PO2 is low. d. The acute response to the low arterial PO2 resulting from high altitude is driven by the action of peripheral chemoreceptors to produce hyperventilation and 2,3 DPG , leading to a left shift of the dissociation curve.

2 5. With regards SOLUBILITY and UPTAKE of INHALATIONAL AGENTS, which is FALSE: a. The more blood-soluble the agent (high blood-gas partition coefficient), the slower the onset of effect and the slower the patient goes to sleep. Thus a very soluble agent eg. ether will dissolve in large quantities in blood before the brain levels can rise sufficiently to produce anaesthesia. b. A high cardiac output such as may be found in fever or fear will cause lesser agent to be dissolved in blood and tissues other than brain, thus a rapid onset of CNS effects. c. A high uptake means a lot of agent is disappearing into the body, blood levels rise slowly and the patient takes a long time to go to sleep by inhalation, high uptake will also mean slow recovery because during the process of induction and maintenance, a large reservoir of the agent will have accumulated in blood, fat and other tissues like muscle. At the end of a long operation, this reservoir will slowly give up its stores of anaesthetic agent and thus act like a depot, delaying recovery d. In shock, with a low cardiac output: in this case blood levels rise quickly, induction is fast and uptake is low. e. When an agent with a very low blood solubility is used (low blood/gas partition coefficient). Blood levels rise very rapidly, leading to a rapid induction of anaesthesia. When the agent is stopped the reverse happens: blood levels fall very quickly and recovery occurs after a short interval, no matter how long the agent has been used. Changes in cardiac output have little effect on the speed of induction of anaesthesia. The gas, nitrous oxide and newer agents, sevoflurane and desflurane are examples of very insoluble drugs. 6. With regards VOLATILITY and POTENCY of INHALATIONAL AGENTS, which is FALSE: a. An agent with a high boiling point will evaporate easily and therefore be more available than one that has a low boiling point. b. An agent with a low MAC, is a potent agent because only a small amount is required to produce anaesthesia. A high MAC means the agent is weak because a lot of agent is required to produce anaesthesia c. If the agent is being used alone with spontaneous breathing in a fit patient, you will need to set your vaporiser to at least three times the MAC to keep the average patient settled during surgery. d. The MAC of any agent is broadly determined by its fat solubility: the more fat soluble, the greater the potency. 7. Which of the following agent has this character: Ultra low solubility resulting in ultra rapid induction and recovery especially as it is non-irritant and sweet smelling a. Nitrous Oxide b. Ether c. Sevoflurane d. Isoflurance e. Halothane 8. The following TRIAD , should alert the anaesthetist to the possibility of an embolism EXCEPT: a. Hypotension b. Hypoxia c. Hypercapnia d. Hypocapnia 9. CAPNOGRAPHY is useful to measure CO2 , a sudden absence of capnograph tracing means : a. As a disconnection alarm for a ventilator or a breathing system b. air embolism c. sudden circulatory collapse d. malignant hyperthermia 10.This ETCO2 tracing may mean

a. Cardiac oscillations b. Obstructive airways disease c. Soda lime depleted in circle system d. Curare cleft 11.What does a pulse oximeter measure? a. The oxygen content of the blood b. The oxygen saturation of haemoglobin in arterial blood c. The amount of oxygen dissolved in the blood d. The oxygen saturation of haemoglobin in venous blood 12.In HYPERKALEMIA, ECG changes include EXCEPT: a. tall peaked T waves b. widened QT intervals c. widened QRS complexes d. QRS complexes merge into the T waves to produce a sine wave pattern 13.With regards to muscle relaxants used in patients with severe renal disease , the following is TRUE: a. Atracurium is should be used cautiously as it undergoes spontaneous Hoffman degradation at body temperature b. Vecuronium and mivacurium are unsafe to use in renal failure as large percentages are excreted renally c. Gallamine , pancuronium, alcuronium, pipecuronium, curare and doxacurium should be used leniently d. Potentiation of neuromuscular blockade may occur in the presence of a metabolic acidosis, hypokalaemia, hypermagnesaemia, or hypocalcaemia and with medications such as aminoglycosides. 14.The following effects are the reason(s) why NSAIDs are contraindicated in patients with RENAL FAILURE: a. decreased elimination of the fluoride ions b. have metabolites which may accumulate in patients with renal failure c. all decrease renal blood flow and may precipitate complete renal failure d. less analgesic and has excitatory and convulsant properties 15.Which among the following discharge criteria is FALSE: a. oxygen saturation > 95% on air b. patient conscious and maintaining a clear airway c. adequate analgesia d. stable pulse and blood pressure 16.Lumbar plexus (3-in-1) block includes the following EXCEPT: a. femoral nerve, b. obturator nerve , c. posterior cutaneous nerve of the thigh d. lateral cutaneous nerve of the thigh 17.The main danger to diabetics is low blood sugar levels (blood glucose < 4mmol/l), the following can cause this EXCEPT: a. Renal failure, b. Fasting, c. Alcohol, d. Liver failure, e. Septicaemia

4 18.The following should not be used in diabetic patients as it contains a substance which may be converted to glucose by the liver and cause hyperglycaemia a. Saline solution b. Ringers lactate solution c. Dextran solution d. Mannitol 19.The following is TRUE to pediatric patients: a. The surface area:body weight ratio is double in infants compared to adults resulting in greater heat loss b. Oxygen consumption relative to body weight is the same (6-7 mls/kg/min), no need to double the volume of oxygen taken in and transported. c. the alveolar ventilation must be increased which is largely achieved by increasing tidal volume d. Cardiac output must also be doubled to carry the oxygen around the body - this is achieved by increasing venous return as babies have a very limited ability to increase stroke volume. 20.There are anatomical differences in pediatric patients which are relevant, which of the following is not TRUE: a. The larynx is situated at a higher level relative to the vertebrae - C3 in the infant compared to C6 in the adult; b. the epiglottis is V shaped and relatively wider, c. the cricoid cartilage forms the narrowest part of the larnyx before puberty d. The spinal cord and dura mater reach lower levels in neonates (L3 and S3)