A 35-year-old male presents with a perforated duodenal ulcer, requiring an emergency laparotomy. He tells you that his father had a reaction to anaesthesia with high temperatures. With regards to malignant hyperpyrexia (MH):

1. 
   

   a. The patient’s risk of having MH is 25%

   
   
2. 
   

   b. A mutation on chromosome 3 is responsible

   
   
3. 
   

   c. Abnormal ryanodine receptors prevent calcium release into the cytoplasm

   
   
4. 
   

   d. Presentation may be delayed

   
   
5. 
   

   e. Previous history of uneventful anaesthesia is reassuring

You are on call for emergency theatres and preassess a 6-year-old child coming to theatre for a suspected appendicitis. You plan a rapid sequence induction. What are essential components of a rapid sequence induction?

1. 
   

   a. Cricoid pressure

   
   
2. 
   

   b. Predetermined dose of induction agents

   
   
3. 
   

   c. Cuffed endotracheal tube

   
   
4. 
   

   d. Capnography trace

   
   
5. 
   

   e. Suction

NAP3 investigated the perioperative complications of central neuraxial blockade (CNB).

Which of the following are true?

1. 
   

   a. Staphylococcus aureus is an organism commonly associated with epidural abscesses

   
   
2. 
   

   b. Major complications are more commonly seen following spinal anaesthetics than with epidurals

   
   
3. 
   

   c. Back pain is a more common symptom of vertebral canal haematoma than leg weakness

   
   
4. 
   

   d. The incidence of permanent injury following perioperative epidural in adults is less than 8 per 100 000

   
   
5. 
   

   e. The incidence of paraplegia and death following CNB is approximately 1 per 100 000

The following are considered cyanotic congenital heart diseases:

1. 
   

   a. Coarctation of the aorta

   
   
2. 
   

   b. Tetralogy of Fallot

   
   
3. 
   

   c. Double outlet right ventricle with pulmonary stenosis

   
   
4. 
   

   d. Atrioventricular septal defect

   
   
5. 
   

   e. Transposition of great arteries with large VSD

Regarding metabolic equivalents (METs):

1. 
   

   a. One MET represents the oxygen consumption of an adult at rest

   
   
2. 
   

   b. One MET is equivalent to 2.5 ml.kg^–1.min^–1 oxygen consumption

   
   
3. 
   

   c. Patients should be able to perform more than 5 METS to undertake major surgery

   
   
4. 
   

   d. Patients should be able to climb at least one flight of stairs to undertake major surgery

   
   
5. 
   

   e. MET values of activities range from 0.9 to 23 ml.kg^–1.min^–1

A 42-year-old male is on the CEPOD list for an acute appendicectomy. Preassessment reveals a history of myasthenia gravis (MG). The following statements regarding MG are true:

1. 
   

   a. In the performance of a rapid sequence induction the dose of suxamethonium remains unchanged

   
   
2. 
   

   b. The underlying pathophysiology is decreased release of acetylcholine from the presynaptic nerve terminal

   
   
3. 
   

   c. Myasthenic syndrome and myasthenia gravis are interchangeable terms

   
   
4. 
   

   d. Neuromuscular monitoring will demonstrate improved post-tetanic count following tetanic stimulation

   
   
5. 
   

   e. Arterial line siting is recommended for general anaesthesia as autonomic dysfunction is commonly seen

A 72-year-old woman presents to your pain clinic with a 12-month history of pain along her left chest wall following an episode of shingles. Her GP has given her a diagnosis of postherpetic neuralgia (PHN). With regard to PHN:

1. 
   

   a. It is rare in younger patients (<50 years)

   
   
2. 
   

   b. It most commonly involves thoracic dermatomes

   
   
3. 
   

   c. In 20% of patients the ophthalmic division of the trigeminal nerve is involved

   
   
4. 
   

   d. It occurs in 5% following herpes zoster

   
   
5. 
   

   e. It is more common in older men

The following are accepted strategies to increase the viability and number of transplantable organs:

1. 
   

   a. Hormone resuscitation

   
   
2. 
   

   b. Fluid loading to achieve a central venous pressure of 8–12 mmHg

   
   
3. 
   

   c. Ventilation with a high positive end expiratory pressure of 10–15 cmH₂O

   
   
4. 
   

   d. Vasopressin used at doses of 0.5–4 U.h⁻¹ in septic patients

   
   
5. 
   

   e. Noradrenaline as a first-line measure in treating hypotension

A 30-year-old male is involved in a house fire. Which of the following are true with regards to a total body surface area (TBSA) percentage burn?

1. 
   

   a. Burns to the anterior surface of his chest, the whole of his right arm, his perineum, and the anterior surface of his right leg would cause a 30% TBSA burn

   
   
2. 
   

   b. Burns to both arms and his back would result in a 45% TBSA burn

   
   
3. 
   

   c. Burns to his anterior chest, his back, and his perineum would cause a 37% TBSA burn

   
   
4. 
   

   d. Burns to both legs and his back would cause a 54% TBSA burn

   
   
5. 
   

   e. Burns to his head and perineum would cause a 15% TBSA burn

You have been asked to anaesthetize a gentleman with a BMI of 60 for a gastric banding procedure. Which of the following statements are true?

1. 
   

   a. Laparoscopic techniques have a lower morbidity and mortality in the short term compared to open techniques

   
   
2. 
   

   b. A raised BMI in isolation is a predictor of difficult intubation

   
   
3. 
   

   c. The incidence of obstructive sleep apnoea in bariatric patients approaches 80%

   
   
4. 
   

   d. Peripheral nerve injuries are more common in this group of patients

   
   
5. 
   

   e. Suxamethonium, if used, should be dosed on ideal rather than actual body weight

Regarding paediatric day-case services:

1. 
   

   a. Ex-premature neonates are not suitable in the first three months of life

   
   
2. 
   

   b. Anaesthetists should have child protection training

   
   
3. 
   

   c. Access to paediatricians is essential

   
   
4. 
   

   d. A centre must have the ability to ventilate children postoperatively

   
   
5. 
   

   e. Play specialists must be available on units

Features suggestive of a difficult intubation include:

1. 
   

   a. Ability to protrude mandibular incisors in front of maxillary incisors

   
   
2. 
   

   b. The presence of a high-arched palate

   
   
3. 
   

   c. Sternomental distance >12.5 cm

   
   
4. 
   

   d. Previous radiotherapy to the neck

   
   
5. 
   

   e. Pierre Robin syndrome

Pain after thoracic surgery can be considerable and forms one of the commonest causes of postoperative chronic pain. Paravertebral nerve blocks may provide adequate analgesia for thoracic surgery. Regarding placement of paravertebral blocks:

1. 
   

   a. The most prominent cervical spinous process is at C7

   
   
2. 
   

   b. The lower tip of the scapula is usually in line with T6

   
   
3. 
   

   c. Total spinal anaesthesia is a recognized common complication

   
   
4. 
   

   d. Paravertebral muscle pain may occur

   
   
5. 
   

   e. The paravertebral space is defined by the vertebral body, the intervertebral disc and intervertebral foramen medially, visceral pleura anterolaterally and the superior costotransverse ligament posteriorly

A 79-year-old male suffered an out of hospital VF arrest. Following return of spontaneous circulation (ROSC), he had three coronary stents inserted in the cath lab. On his admission to ICU, his ABP was 75/32 mmHg, HR 96 min^–1 in sinus rhythm and CVP 12 cmH₂O. The following are true regarding his management on the ICU:

1. 
   

   a. Dobutamine is the first line of treatment as the patient is in cardiogenic shock

   
   
2. 
   

   b. Noradrenaline is a first-line treatment if serum lactate is elevated

   
   
3. 
   

   c. Adrenaline will be useful for its vasoconstrictive properties

   
   
4. 
   

   d. An intra-aortic balloon pump (IABP) should be considered early in this patient

   
   
5. 
   

   e. Dobutamine will help in case of diastolic dysfunction

With acute fatty liver of pregnancy (AFLP):

1. 
   

   a. The incidence is higher in multiple pregnancies

   
   
2. 
   

   b. Maternal mortality is approximately 50%

   
   
3. 
   

   c. Regional anaesthesia is contraindicated

   
   
4. 
   

   d. It can occur concurrently with pre-eclampsia

   
   
5. 
   

   e. The radiological appearance of the liver may be normal

You are assisting in the preassessment clinic and have been asked to review the CPET results of a patient for pneumonectomy for lung cancer. The following are true regarding CPET in thoracic surgery patients:

1. 
   

   a. All patients undergoing pneumonectomy should have a CPET

   
   
2. 
   

   b. Patients with peak VO₂ above 15 ml.kg^–1.min^–1 can have resection up to pneumonectomy

   
   
3. 
   

   c. Predicted postoperative peak VO₂ measurements of less than 10 ml.kg^–1.min^–1 are associated with significantly increased risk of mortality and morbidity after lung resection

   
   
4. 
   

   d. The ability to climb five flights correlates with a VO₂ max >20 ml.kg^–1.min^–1

   
   
5. 
   

   e. The anaerobic threshold is approximately 80% of VO₂ max in untrained individuals

Sickle cell disease is a common disorder of haemoglobin. Regarding sickle cell disease:

1. 
   

   a. It results from a mutation on chromosome 13

   
   
2. 
   

   b. The pathological amino-acid substitution is valine for glutamic acid

   
   
3. 
   

   c. An abnormal β-globin chain is produced

   
   
4. 
   

   d. A Sickledex^® test will differentiate between sickle cell disease and sickle cell trait

   
   
5. 
   

   e. Sickle cell trait confers a degree of protection against Plasmodium falciparum malaria

You have a 3-year-old child listed for tonsillectomy. The following are true regarding the paediatric airway:

1. 
   

   a. The larynx is situated at C5–C6

   
   
2. 
   

   b. The epiglottis is large and U-shaped

   
   
3. 
   

   c. The airway is widest at the cricoid ring

   
   
4. 
   

   d. Respiration is predominantly diaphragmatic

   
   
5. 
   

   e. The functional residual capacity is lower than the closing capacity

A 14-year-old is undergoing an urgent laparoscopic appendicectomy. Intraoperatively, persistent tachycardia is noted with a rising end tidal CO₂. The temperature has risen from 37.8 to 38.5 °C in 20 minutes. Malignant hyperpyrexia is suspected. You should immediately:

1. 
   

   a. Increase the set respiratory rate

   
   
2. 
   

   b. Ask the surgeon to stop operating and deflate the abdomen

   
   
3. 
   

   c. Call for senior help

   
   
4. 
   

   d. Administer 2 mg.kg^–1 dantrolene IV stat

   
   
5. 
   

   e. Cover the patient in ice

Which of the following factors in a patient’s history would concern you with regards to increased risk of aspiration?

1. 
   

   a. Alcohol

   
   
2. 
   

   b. Trauma

   
   
3. 
   

   c. Dehydration

   
   
4. 
   

   d. Diabetes

   
   
5. 
   

   e. Cleft palate

You are a covering a renal list with local supervision. The list includes a living donor renal transplant. With regard to the donor in a living donor renal transplant:

1. 
   

   a. The presence of a consultant surgeon and consultant anaesthetist is mandatory during the donor nephrectomy

   
   
2. 
   

   b. Hypertension is a contraindication to donating a kidney

   
   
3. 
   

   c. Diabetes mellitus is a contraindication to donating a kidney

   
   
4. 
   

   d. Routine antibiotic prophylaxis is required during the nephrectomy

   
   
5. 
   

   e. Invasive monitoring is usually appropriate

Prostaglandin infusion is a useful medical treatment in the following congenital heart conditions:

1. 
   

   a. Transposition of the great arteries

   
   
2. 
   

   b. Tricuspid atresia

   
   
3. 
   

   c. Patent ductus arteriosus

   
   
4. 
   

   d. Pulmonary stenosis

   
   
5. 
   

   e. Large VSD

The following volumes of local anaesthetic boluses are appropriate in a 60 kg man:

1. 
   

   a. 20 ml of 2% lignocaine in an epidural top-up

   
   
2. 
   

   b. 15 ml of 0.5% levobupivacaine in a femoral block

   
   
3. 
   

   c. 10 ml of hyperbaric prilocaine 2% in spinal anaesthesia for a hip replacement

   
   
4. 
   

   d. 30 ml of lignocaine 1% with adrenaline as infiltration in a hernia wound

   
   
5. 
   

   e. 10 ml of lignocaine 1% with adrenaline for a ring block

A 13-year-old boy presents for elective correction of idiopathic scoliosis. Use of intraoperative neurophysiological monitoring using somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) is planned. SSEPs and MEPs are significantly affected by:

1. 
   

   a. Nitrous oxide

   
   
2. 
   

   b. Volatile anaesthetic agents

   
   
3. 
   

   c. Opioids

   
   
4. 
   

   d. Hypothermia

   
   
5. 
   

   e. Hypotension

You preassess a 42-year-old female for a laparoscopic cholecystectomy. She informs you that she ‘woke up’ during her last anaesthetic and asks about the risks of this happening again. According to the 5^th National Audit Project on accidental awareness during general anaesthesia:

1. 
   

   a. Estimated incidence of awareness under general anaesthesia is 1:1900

   
   
2. 
   

   b. Cardiothoracic anaesthesia and caesarean sections have the highest incidence of awareness

   
   
3. 
   

   c. Females had a higher incidence of awareness

   
   
4. 
   

   d. Awareness incidence is highest during induction of anaesthesia

   
   
5. 
   

   e. Higher ASA grade was associated with a higher incidence of awareness

A 60-year-old male is ventilated on the ICU with a presumed diagnosis of Guillain–Barré syndrome (GBS). Which of the following are true?

1. 
   

   a. The early administration of antibiotics improves outcome in these patients

   
   
2. 
   

   b. Whilst plasmapheresis may reduce the severity of GBS, the duration of illness remains unaffected

   
   
3. 
   

   c. Autonomic disturbance is a common feature in patients with more than five days of symptoms

   
   
4. 
   

   d. Exposure to Epstein–Barr virus is a risk factor in the development of GBS

   
   
5. 
   

   e. Ventilatory support is required in the majority of patients with GBS

A 42-year-old male with acromegaly is on your trauma list for an open reduction and internal fixation of a fractured ankle. Regarding acromegaly:

1. 
   

   a. Diagnosis with acromegaly is likely to have been made in his second decade

   
   
2. 
   

   b. Performance of an ECG is unlikely to be of value

   
   
3. 
   

   c. Meticulous attention to patient positioning is required due to the increased risk of an unstable cervical spine

   
   
4. 
   

   d. He is at increased risk of exophthalmos

   
   
5. 
   

   e. Regional anaesthesia is contraindicated in this case

A 22-year-old female is listed for a diagnostic laparoscopy. The gynaecology registrar casually mentions that she has a history of a form of myotonic dystrophy. The following is true in the management of this patient:

1. 
   

   a. Use of suxamethonium is contraindicated due to the risk of severe hyperkalaemia

   
   
2. 
   

   b. Local anaesthetic injected directly into muscles will not prevent muscle contraction

   
   
3. 
   

   c. Persistent episodes of skeletal muscle contraction may lead to hypertrophy of flexor muscle groups

   
   
4. 
   

   d. Dantrolene should be considered in the treatment of severe muscle contraction

   
   
5. 
   

   e. The condition commonly presents in the second decade of life

You are asked to anaesthetize a patient with known cerebral palsy for a baclofen pump insertion as part of their management of spastic paraparesis. Regarding cerebral palsy (CP):

1. 
   

   a. A rapid sequence induction should be performed with a reduced dose of rocuronium

   
   
2. 
   

   b. The increased incidence of gastro-oesophageal reflux is as a result of lower oesophageal sphincter tone

   
   
3. 
   

   c. It accounts for up to one-third of cases of motor impairment in childhood

   
   
4. 
   

   d. Up to half of affected children have some form of epilepsy

   
   
5. 
   

   e. Pulmonary function tests would demonstrate an obstructive pattern

A 92-year-old female is listed for a wide local excision of an angiosarcoma of the left leg plus a split skin graft. The patient has refused a regional anaesthetic and therefore requires general anaesthesia. The following are true:

1. 
   

   a. A MAC value of 0.6 for isoflurane would be appropriate

   
   
2. 
   

   b. Intravenous opioids, but not benzodiazepines, exhibit an age-related increase of their elimination half-life

   
   
3. 
   

   c. Use of TIVA is a relative contraindication due to the risk of greater cardiovascular instability

   
   
4. 
   

   d. Higher free-drug concentrations are as a result of reduced protein binding

   
   
5. 
   

   e. The lower blood-gas solubility coefficient of desflurane reduces the risk of postoperative cognitive dysfunction

Ultrasound is commonly used in modern anaesthetic practice. Which of the following statements are true?

1. 
   

   a. Linear probes typically operate at frequencies between 5 and 18 MHz

   
   
2. 
   

   b. The lower the frequency, the better the resolution of detail

   
   
3. 
   

   c. The higher the frequency, the lower the penetration

   
   
4. 
   

   d. Curvilinear probes operate at high frequencies allowing for greater tissue penetration

   
   
5. 
   

   e. Time gain compensation increases gain at selected tissue depths

A 32-year-old female with a history of migraine presents with a sudden onset severe headache. She has recently changed job and admits to feeling increasingly stressed. On examination she has slight weakness in her non-dominant hand. The following are true:

1. 
   

   a. Brief neurological deficit is common in migraine

   
   
2. 
   

   b. Migraine is more common in females

   
   
3. 
   

   c. Pizotifen is second line in the acute treatment of migraine

   
   
4. 
   

   d. Oramorph should be given early in the treatment of migraine

   
   
5. 
   

   e. Neuroimaging is not indicated in this patient

The following potential injuries and/or clinical consequences are correctly associated with the relevant description of positioning for neurosurgery:

1. 
   

   a. Foot drop: lateral position

   
   
2. 
   

   b. Brachial plexus injury: prone position

   
   
3. 
   

   c. Venous air embolism: sitting position

   
   
4. 
   

   d. Ocular complications: lateral position

   
   
5. 
   

   e. Ischaemic optic neuropathy: use of a horseshoe headrest

The following are true with regards to the difference in body surface area of a child compared to an adult:

1. 
   

   a. The Lund–Browder chart divides the body into areas of 9% total body surface area (TBSA)

   
   
2. 
   

   b. According to the Lund–Browder chart the head of a 1-year-old child makes up 17% TBSA compared to 7% in an adult

   
   
3. 
   

   c. One thigh of a 1-year-old child is half the TBSA of that of an adult

   
   
4. 
   

   d. The neck and buttocks make up the same TBSA regardless of age

   
   
5. 
   

   e. The Lund–Browder chart does not take into account amputated body parts when estimating a percentage burn

Laparoscopy is frequently used for diagnostic and therapeutic procedures. Which of the following statements concerning laparoscopic surgery are true?

1. 
   

   a. Shoulder pain is common after surgery as diaphragmatic irritation causes referred pain over the C5–C7 dermatomes

   
   
2. 
   

   b. CO₂ is used as an insufflation gas as it is safer than medical air

   
   
3. 
   

   c. Brain tumours are relative contraindications to laparoscopy

   
   
4. 
   

   d. Typical insufflation pressures are 35–40 mmHg

   
   
5. 
   

   e. Laparoscopy mandates general anaesthesia

A 50-year-old male with Type II diabetes presents for a day-case hernia repair. Regarding diabetic medications in patients for day-case surgery:

1. 
   

   a. Metformin should be stopped 48 hours before surgery

   
   
2. 
   

   b. Sulfonylureas should be omitted on the morning of surgery

   
   
3. 
   

   c. Glucagon-like-peptide 1 analogues should be omitted on the day of surgery

   
   
4. 
   

   d. Gliptins should be omitted on the day of surgery

   
   
5. 
   

   e. Metformin should be restarted three days after surgery

Regarding cerebrospinal fluid (CSF) analysis:

1. 
   

   a. Low glucose and high protein is consistent with tuberculous meningitis

   
   
2. 
   

   b. Low glucose may be consistent with viral meningitis

   
   
3. 
   

   c. Raised lymphocytes may be a feature of bacterial meningitis

   
   
4. 
   

   d. Normal CSF glucose is equal to serum levels

   
   
5. 
   

   e. Normal CSF pressure may be up to 30 cmH₂O

The following are appropriate starvation times in a patient with presumed normal gastric emptying undergoing elective surgery:

1. 
   

   a. Carbonated drinks: four hours

   
   
2. 
   

   b. Breast milk: two hours

   
   
3. 
   

   c. Water: two hours

   
   
4. 
   

   d. Tea without milk: four hours

   
   
5. 
   

   e. Formula milk: six hours

The following features are true when considering heart block:

1. 
   

   a. In bifascicular block, a right bundle branch block and first-degree atrioventricular block are present

   
   
2. 
   

   b. In isolated left anterior fascicular block, the QRS width is greater than 0.12 seconds

   
   
3. 
   

   c. Left posterior fascicular block is associated with right axis deviation

   
   
4. 
   

   d. Left posterior fascicular block is more common than left anterior fascicular block

   
   
5. 
   

   e. Left bundle branch block is present in trifascicular block

Implantable pacemakers have revolutionized the management of chronic cardiac arrhythmias. In the five letter classification system for pacemakers, e.g. VVI00:

1. 
   

   a. The first letter is the chamber sensed

   
   
2. 
   

   b. The second letter is chamber sensed

   
   
3. 
   

   c. The third letter refers to programmability

   
   
4. 
   

   d. The fourth letter refers to programmability

   
   
5. 
   

   e. The fifth letter refers to programmability

Amniotic fluid embolism:

1. 
   

   a. Amniotic fluid substances observed in the blood is pathognomonic

   
   
2. 
   

   b. Has a mortality between 20 and 40%

   
   
3. 
   

   c. Can present as cardiac arrest

   
   
4. 
   

   d. Age over 35 years is a risk factor

   
   
5. 
   

   e. Can present as an isolated coagulopathy

The most valid single test for post-thoracotomy respiratory complications is the predicted postoperative FEV1 percentage (ppo FEV1%). Regarding the ppo FEV1%:

1. 
   

   a. For lobectomy, the calculation uses the number of bronchopulmonary segments removed compared with the total number in one lung

   
   
2. 
   

   b. The percentage predicted volumes are corrected for age and sex, but not height

   
   
3. 
   

   c. Absolute limits for ppo FEV1 of 0.8 l is always used as the lower limit of acceptability for resection

   
   
4. 
   

   d. Patients with a ppo FEV1% >40% have minor postresection respiratory complications

   
   
5. 
   

   e. Patients with ppo FEV1% <30% should never have lung resection

There are many causes of preoperative anaemia. What are the causes of a microcytic anaemia?

1. 
   

   a. Renal failure

   
   
2. 
   

   b. Bone marrow failure

   
   
3. 
   

   c. Pregnancy

   
   
4. 
   

   d. Phenytoin

   
   
5. 
   

   e. Acute blood loss

You are urgently called to delivery suite to assist in the resuscitation of a neonate. Physiology of the neonate is characterized by:

1. 
   

   a. Obligatory nose breathing

   
   
2. 
   

   b. Increase in alveolar ventilation predominantly achieved by increase in tidal volume

   
   
3. 
   

   c. Relatively fixed stroke volume

   
   
4. 
   

   d. Low levels of vitamin-K-dependent clotting factors at birth

   
   
5. 
   

   e. Normal maintenance fluid requirement of 80 ml.kg^–1.h^–1

Regarding anaphylaxis:

1. 
   

   a. It is an example of an IgE-mediated type IV hypersensitivity reaction

   
   
2. 
   

   b. It only occurs in atopic individuals

   
   
3. 
   

   c. A rash must be present to confirm diagnosis

   
   
4. 
   

   d. Epipens deliver the same intramuscular dose of adrenaline as that recommended in the 2015 ALS algorithm

   
   
5. 
   

   e. Anaphylactic reactions to neuromuscular blocking agents can only occur after previous exposure to the drug

During an elective orthopaedic operating list a patient is scheduled to have an achilles tendon repair for which the patient has to be placed in the prone position. Complications directly from prone positioning include:

1. 
   

   a. Compartment syndrome

   
   
2. 
   

   b. Hypotension

   
   
3. 
   

   c. Visual loss

   
   
4. 
   

   d. Aspiration

   
   
5. 
   

   e. Neuropraxia

With regard to adult conscious sedation:

1. 
   

   a. During moderate sedation patients respond normally to verbal stimulation

   
   
2. 
   

   b. When a combination of a benzodiazepine and an opioid is to be used, it is appropriate to administer the benzodiazepine first

   
   
3. 
   

   c. The AAGBI recommend that capnography is used for all sedated patients

   
   
4. 
   

   d. Oxygen should be administered to all sedated patients

   
   
5. 
   

   e. The elimination half-life of midazolam is significantly increased in renal failure

These factors help prevent respiratory distress syndrome of the neonate:

1. 
   

   a. Cortisol

   
   
2. 
   

   b. Thyroxine

   
   
3. 
   

   c. Insulin

   
   
4. 
   

   d. Hypothermia

   
   
5. 
   

   e. β-Adrenergic drugs

A 29-year-old patient is listed for an ORIF of the wrist. He asks about the possibility of surgery under local anaesthetic and you discuss a brachial plexus block. The following are true about the anatomy of the brachial plexus:

1. 
   

   a. The ulnar nerve is a branch of the lateral cord

   
   
2. 
   

   b. The median nerve receives supply from both the medial and lateral cord

   
   
3. 
   

   c. The radial nerve has no sensory supply in the arm

   
   
4. 
   

   d. The suprascapular nerve is a branch of the upper trunk

   
   
5. 
   

   e. The musculocutaneous nerve is a branch of the posterior cord

A 72-year-old male is listed for an elective AAA repair. You note in preassessment that the patient has undergone cardiopulmonary exercise testing. The report highlights a borderline anaerobic threshold. Regarding anaerobic threshold:

1. 
   

   a. The anaerobic threshold will not vary with patient motivation

   
   
2. 
   

   b. The peak VO₂ will not vary with patient motivation

   
   
3. 
   

   c. Varies greatly with age

   
   
4. 
   

   d. An anaerobic threshold of at least 15 ml.kg^–1.min^–1 is required to safely undertake significant surgery

   
   
5. 
   

   e. Patients with anaerobic thresholds less than 11 ml.kg^–1.min^–1 may benefit from postoperative critical care

A 55-year-old female presents to your pain management clinic with a six-month history of continuous pain in her wrist following a fractured distal radius. Her GP wonders if this is complex regional pain syndrome. Which of the following signs or symptoms form part of the criteria for the diagnosis?

1. 
   

   a. Tremor

   
   
2. 
   

   b. Hypoaesthesia

   
   
3. 
   

   c. Hyperalgesia

   
   
4. 
   

   d. Oedema

   
   
5. 
   

   e. Hypohydrosis

Regarding the diagnosis and perioperative care of patients with epilepsy:

1. 
   

   a. It is defined as one or more epileptic seizures not caused by any immediately identifiable cause

   
   
2. 
   

   b. In established epilepsy investigated using electroencephalography, epileptiform activity is seen in up to 50% of cases

   
   
3. 
   

   c. Intravenously injectable forms of both sodium valproate and phenytoin are available for use perioperatively in poorly controlled epilepsy

   
   
4. 
   

   d. In the management of status epilepticus, lorazepam at 0.1 mg.kg^–1 is recommended as a first-line benzodiazepine

   
   
5. 
   

   e. Cerebral venous thrombosis is a recognized complication associated with status epilepticus

The following statements are true:

1. 
   

   a. A burn unit has immediate access to operating theatres

   
   
2. 
   

   b. A burn unit offers the highest level of critical care

   
   
3. 
   

   c. A burn unit offers a separately staffed, discrete ward

   
   
4. 
   

   d. A burn facility equates to a standard plastic surgical ward for the care of non-complex burn injuries

   
   
5. 
   

   e. A burn facility equates to a specialized burns/plastic surgical ward for the care of moderate complexity burn injuries

You have been asked to anaesthetize a patient for a resection of a small bowel tumour, suspected to be carcinoid. Which of the following statements are true?

1. 
   

   a. Autonomic symptoms are more common with GI tumours than pulmonary tumours

   
   
2. 
   

   b. The patient is at high risk of mitral valve disease

   
   
3. 
   

   c. Ingestion of blue cheese or chocolate may precipitate a carcinoid attack

   
   
4. 
   

   d. Atracurium should be avoided

   
   
5. 
   

   e. Noradrenaline infusion may cause hypotension

With regard to the management of meningitis in children (over three months):

1. 
   

   a. Early empirical antibiotic therapy is with ceftriaxone

   
   
2. 
   

   b. Neuroimaging is mandatory for all cases

   
   
3. 
   

   c. Notification of meningitis to public health authorities is mandatory in all cases

   
   
4. 
   

   d. Signs of raised ICP in children may include abnormal posturing, focal neurological defects and doll’s eye movements

   
   
5. 
   

   e. Large resuscitative fluid requirement is an indication for intubation

Regarding airway assessment, the following form part of Wilson’s criteria:

1. 
   

   a. Obesity

   
   
2. 
   

   b. Restricted jaw movement

   
   
3. 
   

   c. Previous difficult intubation

   
   
4. 
   

   d. Thyromental distance <6 cm

   
   
5. 
   

   e. Receding mandible

Advantages of using ultrasound in the practice of regional anaesthesia when compared to a landmark-based technique are:

1. 
   

   a. Faster onset of sensory blockade

   
   
2. 
   

   b. Improved success rates

   
   
3. 
   

   c. Decrease in neurological complications

   
   
4. 
   

   d. Decrease risk of inadvertent vascular puncture

   
   
5. 
   

   e. Decrease risk of complete hemidiaphragmatic paresis while performing brachial plexus blockade

Whilst anaesthesia is now a very safe endeavour, informing patients regarding the perioperative risk posed by surgery is a vital part of informed consent. Several scoring systems may be used for this. The Goldman Cardiac Risk Index includes:

1. 
   

   a. MI within the last year

   
   
2. 
   

   b. Age >70 years

   
   
3. 
   

   c. Severe aortic stenosis

   
   
4. 
   

   d. Creatinine >200 μmol.l^–1

   
   
5. 
   

   e. Active endocarditis

A 60 kg previously fit and well adult patient was admitted to ICU with severe sepsis secondary to pneumonia. He has been started on increasing doses of both noradrenaline and adrenaline following fluid resuscitation. His CVP is 12 cmH₂O and MAP is maintained at 70 mmHg with a HR of 130 min^–1. His serum lactate however has been doubled to 5 mmol.l^–1 over the last 6 hours. He is passing about 35 ml of urine hourly. The following measures may help reduce his rising serum lactate.

1. 
   

   a. Start vasopressin infusion to achieve a MAP of 75 mmHg

   
   
2. 
   

   b. Increase noradrenaline infusion rate to achieve a MAP of 75 mmHg

   
   
3. 
   

   c. Increase adrenaline infusion rate to achieve a MAP of 75 mmHg

   
   
4. 
   

   d. Reduce adrenaline infusion rate and increase the noradrenaline if needed

   
   
5. 
   

   e. Start renal-dose dopamine infusion to increase his urine output

Cardiac disease in pregnancy:

1. 
   

   a. Pre-existing hypertrophic cardiomyopathy has a worse prognosis than pre-existing dilated cardiomyopathy

   
   
2. 
   

   b. Is the most common overall cause of death

   
   
3. 
   

   c. Peripartum cardiomyopathy can present up to six months post delivery

   
   
4. 
   

   d. The largest cause of cardiac-related maternal death is myocardial infarction

   
   
5. 
   

   e. Women with severe chest pain should have radiological investigations undertaken

Thalassaemia is an inherited disorder of haemoglobin. Regarding thalassaemia:

1. 
   

   a. Thalassaemias have an autosomal dominant pattern of inheritance

   
   
2. 
   

   b. Cooley’s anaemia is the major clinical phenotype of α-thalassaemia

   
   
3. 
   

   c. Bart’s hydrops fetalis syndrome is the major clinical phenotype of β-thalassaemia

   
   
4. 
   

   d. Penicillin may also precipitate haemolysis

   
   
5. 
   

   e. It is not associated with difficult laryngoscopy

You are asked to assess a neonate prior to cardiac surgery. On examination you note the child is blue. The following conditions cause cyanosis:

1. 
   

   a. Tetralogy of Fallot

   
   
2. 
   

   b. Transposition of the great vessels

   
   
3. 
   

   c. Isolated pulmonary stenosis

   
   
4. 
   

   d. Patent ductus arteriosus

   
   
5. 
   

   e. Ventricular septal defect

Complications and physiological changes associated with malignant hyperpyrexia include:

1. 
   

   a. Hyperkalaemia

   
   
2. 
   

   b. Myoglobinuria

   
   
3. 
   

   c. Vasodilatation

   
   
4. 
   

   d. Disseminated intravascular coagulation

   
   
5. 
   

   e. Compartment syndrome

During an elective urology case the surgeons ask for the patient to be placed in the Lloyd–Davis position. What would be the potential complications?

1. 
   

   a. Atelectasis

   
   
2. 
   

   b. Pulmonary oedema

   
   
3. 
   

   c. Visual loss

   
   
4. 
   

   d. Compartment syndrome

   
   
5. 
   

   e. Alopecia

When using low-frequency jet ventilation (LFJV) for airway surgery:

1. 
   

   a. Gas is normally delivered intermittently at a rate of 20–30 breaths per minute

   
   
2. 
   

   b. LFJV utilizes the Venturi effect

   
   
3. 
   

   c. It is useful for patients who have upper airway obstruction

   
   
4. 
   

   d. Adequacy of ventilation is best assessed using ETCO₂

   
   
5. 
   

   e. A MAC of 1.5–2.0 should be maintained

Which of the following conditions are associated with a difficult airway?

1. 
   

   a. Achondroplasia

   
   
2. 
   

   b. Hurler’s syndrome

   
   
3. 
   

   c. Hunter’s syndrome

   
   
4. 
   

   d. Beckwith–Wiedemann syndrome

   
   
5. 
   

   e. Goldenhar syndrome

A male baby is born at 29 weeks’ gestation, three weeks after spontaneous rupture of membranes. His breathing effort is poor, requiring assisted ventilation. After intubation, his umbilical artery blood gas sample shows: p. 7.18, p_aCO₂ 8.5 kPa, p_aO₂ 6.5 kPa, despite high FiO₂ of 0.8. Which of the following is considered appropriate in his management:

1. 
   

   a. Echocardiogram

   
   
2. 
   

   b. Increasing PEEP

   
   
3. 
   

   c. Intravenous antibiotics

   
   
4. 
   

   d. Surfactant

   
   
5. 
   

   e. 100% O₂ for 24 hours

Regarding blood products:

1. 
   

   a. Whole blood has a shelf-life of 35 days

   
   
2. 
   

   b. Packed red cells may be stored for up to 30 days

   
   
3. 
   

   c. Platelets can be stored for up to five days at 4 °C

   
   
4. 
   

   d. A platelet transfusion requires ABO compatibility

   
   
5. 
   

   e. A platelet transfusion requires Rh compatibility for all patients

Electroconvulsive therapy (ECT) is a recognized treatment modality in cases of severe or medication-resistant depression. Regarding ECT:

1. 
   

   a. An initial tachycardia and rise in blood pressure is common

   
   
2. 
   

   b. Propofol is the preferred induction agent as it allows the longest seizure duration

   
   
3. 
   

   c. Etomidate is contraindicated as an induction agent as it raises the seizure threshold

   
   
4. 
   

   d. An increased dose of suxamethonium may be required in cachectic patients

   
   
5. 
   

   e. Following ECT, myalgia is common

A 72-year-old female comes to your pain management clinic via her GP. She complains of 12 months of right-sided facial pain below the eye. She describes the ‘stabbing’ pain as brief but severe and that it can be provoked by a light touch to the skin. Which of the following would be an appropriate first line in her management?

1. 
   

   a. Acyclovir

   
   
2. 
   

   b. 5% lidocaine plaster

   
   
3. 
   

   c. Carbamazepine

   
   
4. 
   

   d. Gabapentin

   
   
5. 
   

   e. 0.075% capsaicin cream

Regarding patients with myotonic dystrophy and their perioperative management:

1. 
   

   a. Myotonic dystrophy is inherited in an autosomal dominant pattern

   
   
2. 
   

   b. Prolonged muscle relaxation can be precipitated by the use of non-depolarizing muscle relaxants

   
   
3. 
   

   c. The use of regional anaesthesia may prevent prolonged myotonic muscle contraction

   
   
4. 
   

   d. Reversal of non-depolarizing muscle relaxants using neostigmine is recommended

   
   
5. 
   

   e. Troublesome muscle spasm may be alleviated by using phenytoin 3–5 mg.kg^–1 intravenously

A 25-year-old woman with a diagnosis of myasthenia gravis is listed for an appendicectomy on the emergency list. Anaesthetic considerations include:

1. 
   

   a. An increased dose of succinylcholine may be needed for rapid sequence induction

   
   
2. 
   

   b. Only one-fifth of the normal dose of atracurium should be used for ongoing muscle relaxation during the operation

   
   
3. 
   

   c. Disease duration of greater than six years is a predictor of the need for postoperative ventilation

   
   
4. 
   

   d. Dose requirement of pyridostigmine of greater than 750 mg per day is a predictor of the need for postoperative ventilation

   
   
5. 
   

   e. Reversal of non-depolarizing muscle blockade with one-tenth of the normal dose of neostigmine is recommended

Regarding the intracranial pressure waveform:

1. 
   

   a. ‘C’ waves have an amplitude of <20 mmHg

   
   
2. 
   

   b. ‘B’ waves have an amplitude of <50 mmHg

   
   
3. 
   

   c. ‘Ramp’ waves are variations of ‘B’ waves

   
   
4. 
   

   d. ‘A’ waves last 5–20 minutes

   
   
5. 
   

   e. ‘A’ waves are most common in patients with intracranial tumours

The moorLD12-BI can be employed in the assessment of burn wounds. Regarding the moorLD12-BI:

1. 
   

   a. It is a laser Doppler blood-flow imaging system

   
   
2. 
   

   b. It can be used to treat partial thickness burns

   
   
3. 
   

   c. It can predict wound healing in burns

   
   
4. 
   

   d. It is used to guide fluid therapy in burns

   
   
5. 
   

   e. It is non-invasive

You have been asked to anaesthetize a patient for a laparoscopic cholecystectomy. His medical history is remarkable for pulmonary hypertension (PH) and moderate COPD. Concerning PH:

1. 
   

   a. Milrinone and dobutamine are safe to use in PH

   
   
2. 
   

   b. Central neuraxial anaesthesia is not recommended in PH

   
   
3. 
   

   c. Maintaining a normal SVR is essential in safely anaesthetizing a patient with PH

   
   
4. 
   

   d. Metaraminol is contraindicated due to hypersensitive pulmonary α-1 receptors

   
   
5. 
   

   e. Ketamine may raise pulmonary vascular resistance

Thyrotoxic storm may be treated using:

1. 
   

   a. Propanolol

   
   
2. 
   

   b. Hydrocortisone

   
   
3. 
   

   c. Lugol’s solution via the Jod–Basedow mechanism

   
   
4. 
   

   d. Amiodarone

   
   
5. 
   

   e. Ibuprofen

The effects of smoking include:

1. 
   

   a. Reduction in postoperative nausea and vomiting

   
   
2. 
   

   b. Increased airway reactivity

   
   
3. 
   

   c. Hepatic enzyme inhibition

   
   
4. 
   

   d. Shift of the oxyhaemoglobin dissociation curve to the right

   
   
5. 
   

   e. Hypertension

In the patient undergoing elective surgery who has atrial fibrillation:

1. 
   

   a. A slow ventricular response may be an indication for pacemaker insertion

   
   
2. 
   

   b. Routine β-blockers should be omitted due to the risk of hypotension intraoperatively

   
   
3. 
   

   c. Digoxin doses should be reduced by a quarter if converted from oral to intravenous formulation

   
   
4. 
   

   d. Patients receiving digoxin should have their levels measured on the day of surgery

   
   
5. 
   

   e. All medications should be converted to intravenous on the day of surgery

Regarding interscalene brachial plexus block:

1. 
   

   a. It provides reliable anaesthesia and analgesia for procedures involving the proximal humerus and shoulder joint

   
   
2. 
   

   b. It effectively blocks proximal nerve roots and the distal cervical plexus

   
   
3. 
   

   c. If using ultrasound, a high-frequency (10–13 MHz) probe is used to scan the neck for plexus visualization

   
   
4. 
   

   d. C5, C6 and C7 nerve roots are seen as hyperechoic round images in between the scalene muscles

   
   
5. 
   

   e. There is level 1a evidence to confirm phrenic nerve blockade is almost always seen with high volume (20 ml or more) local anaesthetic injection

The liver is the principle site of drug metabolism in the human body. Regarding drug metabolism:

1. 
   

   a. Phase 2 metabolism involves conjugation of drugs with hydrophobic groups

   
   
2. 
   

   b. Cytochrome enzymes are found in the kidney

   
   
3. 
   

   c. Oxidation, reduction, hydrolysis and hydration are part of phase 1 drug metabolism

   
   
4. 
   

   d. Morphine-3-glucuronide is an active metabolite of morphine formed by liver drug metabolism

   
   
5. 
   

   e. Cytochrome P450 contains a haem–iron centre

The following statements are correct regarding the pathophysiology of sepsis:

1. 
   

   a. Multiple organ failure secondary to sepsis is the most common cause of death in ICU

   
   
2. 
   

   b. Oxygen delivery is usually the main problem in severe sepsis

   
   
3. 
   

   c. Nitric oxide production is increased during sepsis, whilst ATP production is reduced

   
   
4. 
   

   d. Endogenous antioxidant systems become overwhelmed in sepsis

   
   
5. 
   

   e. Antioxidants have been shown to improve survival in young septic patients

In pregnant women with pre-existing spinal cord injury:

1. 
   

   a. Pre-emptive epidural anaesthesia reduces the effects of autonomic dysreflexia

   
   
2. 
   

   b. Contractions may still be felt if a complete spinal cord lesion is between T5 and T10

   
   
3. 
   

   c. Potential cardiovascular complications occurring during labour include hypotension, bradycardia and cardiac arrest

   
   
4. 
   

   d. Epidural catheters should be taken out as soon as possible after delivery

   
   
5. 
   

   e. Suxamethonium should not be used

With regards to the cardiac assessment of patients listed for lung resection:

1. 
   

   a. Elective pulmunory resection is regarded as an ‘intermediate-risk’ procedure in terms of perioperative cardiac ischaemia

   
   
2. 
   

   b. The overall incidence of documented post-thoracotomy ischemia is 5%

   
   
3. 
   

   c. Post-thoracotomy ischaemia peaks on the second to third day

   
   
4. 
   

   d. Patients with intermediate clinical predictors of increased cardiac risk who have adequate functional capacity do not need further cardiac investigations

   
   
5. 
   

   e. CT coronary angiography is highly sensitive, but it is less specific

Hypocalcaemia may be detected following thyroid surgery. Hypocalcaemia may present with:

1. 
   

   a. Chovstek’s sign on non-invasive blood pressure cuff inflation

   
   
2. 
   

   b. Perioral tingling

   
   
3. 
   

   c. Increased QT interval

   
   
4. 
   

   d. Facial spasm upon tapping on the submandibular gland

   
   
5. 
   

   e. Seizures

Neonates compared with adults are resistant to suxamethonium because:

1. 
   

   a. Pseudocholinesterase is 50% more active in neonates

   
   
2. 
   

   b. Neonates have more motor end plates per kg

   
   
3. 
   

   c. Suxamethonium is excreted by the neonate

   
   
4. 
   

   d. Neonates have a larger extracellular volume per kg

   
   
5. 
   

   e. Neonates have a greater proportion of haemoglobin F

A 45-year-old female is undergoing laparoscopic cholecystectomy. She has been induced with propofol and fentanyl, paralyzed with rocuronium and anaesthesia maintained with isoflurane in an oxygen/air mix. She has also received co-amoxiclav at induction. On insufflation of the abdomen the non-invasive blood pressure becomes 36/18 mmHg. Causes include:

1. 
   

   a. Pneumoperitoneum

   
   
2. 
   

   b. Too small a blood pressure cuff

   
   
3. 
   

   c. Hypovolaemia

   
   
4. 
   

   d. Anaphylaxis

   
   
5. 
   

   e. Air embolism

Whilst following up a patient postoperatively they describe explicit recall. Factors from their intraoperative period that could have contributed include:

1. 
   

   a. Emergency anaesthesia

   
   
2. 
   

   b. Paralysis

   
   
3. 
   

   c. Hypotension

   
   
4. 
   

   d. Opioids

   
   
5. 
   

   e. TIVA

During a rapid sequence induction (RSI):

1. 
   

   a. A force of 40 N should be applied to the cricoid cartilage

   
   
2. 
   

   b. Up to four attempts should be should be made at initial intubation

   
   
3. 
   

   c. In some circumstances a second dose of suxamethonium may be appropriate if initial intubation is not successful

   
   
4. 
   

   d. In an anaesthetized patient O₂ consumption remains relatively constant at approximately 250 ml.min^–1

   
   
5. 
   

   e. Anaemia causes a significant decrease in the time taken for deoxygenation during an RSI

A 72-year-old gentleman is listed for a TURP. Which of the following are true?

1. 
   

   a. Glycine 1.5% is an isotonic irrigation fluid

   
   
2. 
   

   b. Irrigation fluid is usually absorbed by the patient at a rate of 20 ml.min^–1

   
   
3. 
   

   c. The irrigation fluid should be kept at high pressure

   
   
4. 
   

   d. Risk of TURP syndrome increases with prostates weighing over 50 mg

   
   
5. 
   

   e. Preoperative hypertension increases the risk of TURP syndrome

These factors help keep the ductus arteriosus open:

1. 
   

   a. Acidosis

   
   
2. 
   

   b. Low partial pressure of O₂ in the blood passing through the ductus

   
   
3. 
   

   c. Alkalosis

   
   
4. 
   

   d. Pulmonary hypertension

   
   
5. 
   

   e. Prostaglandin

The following is true about local anaesthetic toxicity:

1. 
   

   a. Sudden alteration in mental status with or without tonic–clonic convulsions

   
   
2. 
   

   b. Sinus bradycardia can occur

   
   
3. 
   

   c. Ventricular arrhythmia is a common presentation

   
   
4. 
   

   d. Intercostal block carries the highest rate of absorption of the LA drugs

   
   
5. 
   

   e. The first line of action is to draw blood for analysis

You have been asked to assist in the creation of an anaesthetic preassessment clinic at your hospital. Cardiopulmonary exercise testing requires the following:

1. 
   

   a. An adequately ventilated room with full resuscitation equipment and two members of staff

   
   
2. 
   

   b. A metabolic cart and treadmill

   
   
3. 
   

   c. Gas flows and volumes quantified by a pressure differential pneumotachograph

   
   
4. 
   

   d. A 12-lead ECG, non-invasive blood pressure and SpO₂ monitors

   
   
5. 
   

   e. Duration of exercise between 5 and 15 minutes

You are performing a sciatic nerve block as part of your management of a total knee replacement. You favour the inferior approach. Which of the following statements regarding sciatic nerve blocks are true?

1. 
   

   a. The inferior approach is also known as the Raj approach

   
   
2. 
   

   b. Landmarks to the inferior approach include posterior superior iliac spine and the greater trochanter

   
   
3. 
   

   c. The inferior approach is unlikely to block the posterior cutaneous nerve of the thigh

   
   
4. 
   

   d. As the sciatic nerve is large, adrenaline may be a useful adjunct

   
   
5. 
   

   e. The sciatic nerve at the inferior approach is commonly 40–80 mm deep

A 65-year-old man with a history of chronic low back pain is taking slow-release oral morphine 70 mg twice daily. Which of the following patches would offer dose equivalence?

1. 
   

   a. Buprenorphine 5 μg.h^–1

   
   
2. 
   

   b. Buprenorphine 10 μg.h^–1

   
   
3. 
   

   c. Buprenorphine 20 μg.h^–1

   
   
4. 
   

   d. Fentanyl 50 μg.h^–1

   
   
5. 
   

   e. Fentanyl 75 μg.h^–1

Considerations in managing patients with acromegaly presenting for pituitary surgery include:

1. 
   

   a. Up to 70% of patients will have significant obstructive sleep apnoea

   
   
2. 
   

   b. There is an increased risk of nerve entrapment syndromes

   
   
3. 
   

   c. Exophthalmos secondary to retro-orbital fat deposits is seen in one-third of patients

   
   
4. 
   

   d. Cervical and supraclavicular fat pads make central venous cannulation more difficult

   
   
5. 
   

   e. The onset of disease is likely to have been rapid

You are referred a 75-year-old man for assessment regarding the need for invasive ventilation. He presents with a three-day-long history of diarrhoea and vomiting, an ascending motor paralysis and areflexia. He now has respiratory compromise, thought to be due to Guillain–Barré syndrome (GBS). Which of the following statements regarding GBS are true?

1. 
   

   a. The most likely pathogen responsible for this presentation is Campylobacter jejuni

   
   
2. 
   

   b. Weakness that is more proximal than distal is characteristic

   
   
3. 
   

   c. Wide fluctuations in blood pressure and pulse may ensue following intubation

   
   
4. 
   

   d. Ventilatory support is required in approximately half of patients

   
   
5. 
   

   e. A vital capacity of less than 50 ml.kg^–1 is an indication for endotracheal intubation

The following statements regarding chlorhexidine are true:

1. 
   

   a. 2% Chlorhexidine gluconate in 70% isopropyl alcohol is recommended for all skin preparation prior to invasive procedures

   
   
2. 
   

   b. 1% Chlorhexidine cannot be used in surgery involving the inner or middle ear because it is ototoxic

   
   
3. 
   

   c. Chlorhexidine is not sporicidal

   
   
4. 
   

   d. The activity of chlorhexidine is reduced in the presence of blood

   
   
5. 
   

   e. Chlorhexidine is a cationic molecule

Concerning the intraoperative management of one-lung ventilation during oesophagectomy:

1. 
   

   a. One-lung ventilation can be achieved with a single lumen ETT

   
   
2. 
   

   b. Hypoxia may be treated by clamping the pulmonary artery of the dependent lung

   
   
3. 
   

   c. Right-sided double-lumen tubes are most commonly used

   
   
4. 
   

   d. Malpositioned tubes do not have any major implications

   
   
5. 
   

   e. The tube is rotated through 180° after it passes through the vocal cords

Concerning myxoedema coma:

1. 
   

   a. Downregulation of sympathetic receptors makes patients very sensitive to vasopressors and inotropes

   
   
2. 
   

   b. Thyroid imaging is essential for diagnosis

   
   
3. 
   

   c. Patients are typically hypernatraemic

   
   
4. 
   

   d. Low contractility and reduced cardiac index lead to reflex tachycardia

   
   
5. 
   

   e. Steroid administration and aggressive re-warming with active measures are important resuscitative measures

You are asked to assess a patient preoperatively who is dialysis dependent. The following are important to note:

1. 
   

   a. The presence and location of fistulae

   
   
2. 
   

   b. When the patient is usually dialyzed

   
   
3. 
   

   c. Whether the patient is fluid restricted

   
   
4. 
   

   d. The presence of peripheral neuropathy

   
   
5. 
   

   e. Volume status of the patient

Regarding regional anaesthesia in paediatric patients:

1. 
   

   a. It is usually performed after general anaesthesia has been administered

   
   
2. 
   

   b. The maximum allowable local anaesthetic dose should be based on a patient’s total body weight

   
   
3. 
   

   c. If using ultrasound-guided blocks, lower-frequency probes will be more suitable

   
   
4. 
   

   d. Penile block performed using a landmark approach has a reported failure rate of 10–15%

   
   
5. 
   

   e. Systemic absorption of local anaesthetic after ilioinguinal and iliohypogastric blocks performed using ultrasound is higher than after landmark approach

Over the last 50 years, liver transplantation has provided a pathway for survival in end-stage liver failure. Regarding liver transplantation:

1. 
   

   a. The commonest reason for liver transplantation worldwide is for fulminant liver failure secondary to paracetamol overdose

   
   
2. 
   

   b. Venovenous bypass can be used to enable liver removal from the patient

   
   
3. 
   

   c. Reperfusion syndrome will typically cause the patient’s temperature to rise

   
   
4. 
   

   d. During the anhepatic phase, hypercalaemia can be an issue

   
   
5. 
   

   e. Hepatic artery thrombosis occurs in 20% of patients in the early postoperative phase and may necessitate superurgent retransplantation

The following are true regarding the diagnosis and definition of acute respiratory distress syndrome (ARDS):

1. 
   

   a. It can be classified into mild, moderate and severe according to the degree of hypoxaemia

   
   
2. 
   

   b. The onset of ARDS must be acute: within seven days of the insulting event

   
   
3. 
   

   c. The presence of bilateral lung opacities that are not explained by consolidation or effusion

   
   
4. 
   

   d. There is no need to exclude high pulmonary capillary wedge pressure

   
   
5. 
   

   e. The need for PEEP >10 cmH₂O is predictive of poor outcome

Regarding cardiac arrests in pregnant women:

1. 
   

   a. They may occur during labour with no warning

   
   
2. 
   

   b. They have an incidence of around 1:30 000 pregnancies

   
   
3. 
   

   c. If the fetus is over 20 weeks’ gestation then it is recommended that perimortem caesarean section be performed within 10 minutes of maternal arrest

   
   
4. 
   

   d. They are increasing in frequency

   
   
5. 
   

   e. If in a shockable rhythm require a lower-level electrical shock than in a non-pregnant individual

A patient with emphysema is listed for lung reduction surgery. The inclusion criteria for lung volume reduction surgery (LVRS) include the following:

1. 
   

   a. A predicted FEV1 between 15 and 35%

   
   
2. 
   

   b. PAP <70 mmHg

   
   
3. 
   

   c. p_aCO₂ <8 kPa

   
   
4. 
   

   d. Age <75 years

   
   
5. 
   

   e. Prednisone requirement <20 mg.day^–1

Rheumatoid arthritis can affect the atlantoaxial joint, and may manifest as atlantoaxial subluxation. Regarding the subtypes of atlantoaxial subluxation:

1. 
   

   a. Anterior subluxation involves destruction of the odontoid peg

   
   
2. 
   

   b. Anterior subluxation involves destruction of transverse and apical ligaments

   
   
3. 
   

   c. Anterior subluxation is the rarest form of atlantoaxial subluxation secondary to rheumatoid arthritis

   
   
4. 
   

   d. Vertical subluxation leads to compression of the cervicomedullary junction

   
   
5. 
   

   e. Posterior subluxation is worsened by neck extension

Inhalational induction in children with sevoflurane is faster because of their:

1. 
   

   a. Increased MAC

   
   
2. 
   

   b. Increased cardiac output per kg compared to adults

   
   
3. 
   

   c. Increased minute ventilation per kg compared to adults

   
   
4. 
   

   d. Increased tissue solubility

   
   
5. 
   

   e. Small functional residual capacity

The following may cause malignant hyperpyrexia:

1. 
   

   a. Ketamine

   
   
2. 
   

   b. Etomidate

   
   
3. 
   

   c. Enflurane

   
   
4. 
   

   d. Nitrous oxide

   
   
5. 
   

   e. Suxamethonium

You have chosen to anaesthetize a patient using TIVA for a prolonged case and decide to employ the BIS (bispectral) monitor. Regarding BIS monitoring:

1. 
   

   a. It uses EEG

   
   
2. 
   

   b. A higher reading is associated with deeper anaesthesia

   
   
3. 
   

   c. The target reading is >60

   
   
4. 
   

   d. The range is 0–100

   
   
5. 
   

   e. Sensors can be placed anywhere on the face

A 72-year-old patient is on your list for TURP. Regarding the glycine irrigation fluid commonly used during a TURP procedure:

1. 
   

   a. It is a 0.5% solution

   
   
2. 
   

   b. It is suspended in 0.9% saline

   
   
3. 
   

   c. It is metabolized in the liver by oxidation

   
   
4. 
   

   d. One of its metabolites is ammonium

   
   
5. 
   

   e. Glycine is an inhibitory neurotransmitter

The following is true regarding congenital heart diseases:

1. 
   

   a. The treatment of a patent ductus arteriosus is always medical

   
   
2. 
   

   b. Coarctation of the aorta is the most common cardiac defect in Turner syndrome

   
   
3. 
   

   c. Complete atrioventricular septal defect is the most common cardiac anomaly in Down’s syndrome

   
   
4. 
   

   d. Left to right shunts lead to cyanosis

   
   
5. 
   

   e. Right to left shunts lead to symptoms of heart failure

You are assisting with a liver transplant and the most recent thromboelastograph (TEG) implies the patient requires fresh frozen plasma. Regarding fresh frozen plasma (FFP):

1. 
   

   a. It contains all clotting factors, albumin and γ-globulin

   
   
2. 
   

   b. It must be transfused to an ABO-compatible donor

   
   
3. 
   

   c. The usual starting dose is 5 ml.kg^–1

   
   
4. 
   

   d. Transfusion of FFP for children born after 1995 is derived from unpaid American donors

   
   
5. 
   

   e. Cryoprecipitate is precipitated from FFP and contains high levels of factor VIII, fibrinogen and von Willebrand factor

You have been asked to perform a coeliac plexus block on a patient with pancreatic cancer. Regarding coeliac plexus blocks:

1. 
   

   a. The plexus lies posterior to the aorta

   
   
2. 
   

   b. The plexus has contributions from the vagus and phrenic nerves

   
   
3. 
   

   c. Paraplegia occurs in approximately 1:5000

   
   
4. 
   

   d. Common complications include urinary retention and constipation

   
   
5. 
   

   e. Damage to the L3 nerve root may occur

Regarding anaesthesia for awake craniotomy:

1. 
   

   a. Inability to lie flat is an absolute contraindication

   
   
2. 
   

   b. The surgery can be performed using a regional technique as the sole technique, with the patient awake throughout

   
   
3. 
   

   c. The patient can be sedated or anaesthetized during intraoperative mapping of the tumour

   
   
4. 
   

   d. On each side of the scalp, nine nerves can be targeted for an anatomical scalp block

   
   
5. 
   

   e. The greater auricular nerve is blocked just anterior to the auricle at the level of the temporomandibular joint

The following statements regarding thermal burns are true:

1. 
   

   a. Full thickness burns are painful

   
   
2. 
   

   b. Deep dermal burns have no hair follicles

   
   
3. 
   

   c. Superficial burns are painful

   
   
4. 
   

   d. Deep dermal burns are also known as second-degree burns

   
   
5. 
   

   e. Areas of erythema should be counted in burns assessment

You have been asked to anaesthetize a Jehovah’s witness for a laparotomy for a vascular tumour. He has declined blood transfusion on religious grounds. Concerning other strategies that may be employed intraoperatively:

1. 
   

   a. Cell salvage is acceptable to all Jehovah’s witnesses

   
   
2. 
   

   b. Consultant anaesthetic involvement may be desirable, but not essential in the management of these cases

   
   
3. 
   

   c. Anaesthetists have no obligation to anaesthetize a Jehovah’s witness for elective surgery

   
   
4. 
   

   d. An advanced directive can be changed by the patient intraoperatively if undergoing regional anaesthesia

   
   
5. 
   

   e. Tranexamic acid may be useful intraoperatively

The following are required for day surgery to proceed safely:

1. 
   

   a. The patient should have an adult at home for 24 hours following surgery

   
   
2. 
   

   b. BMI under 35

   
   
3. 
   

   c. Patients must be able to eat and drink within 36 hours

   
   
4. 
   

   d. Age under 85 years

   
   
5. 
   

   e. Patients with epilepsy are not suitable for day case surgery due to sleep–wake disturbance

When assessing a patient with renal disease for theatre it is important to anticipate that the patient may have the following:

1. 
   

   a. Delayed gastric emptying

   
   
2. 
   

   b. Altered metabolism of atracurium

   
   
3. 
   

   c. Thrombocytopenia

   
   
4. 
   

   d. Hyperkalaemia

   
   
5. 
   

   e. A decreased free fraction of protein-bound drugs

Regarding epidural analgesia in abdominal surgery:

1. 
   

   a. There is enough evidence to suggest there is a decrease in postoperative thromboembolic complications

   
   
2. 
   

   b. Effective epidural analgesia may decrease the incidence of chronic postsurgical pain

   
   
3. 
   

   c. Has immunomodulatory effects and hence may reduce the risk of cancer recurrence

   
   
4. 
   

   d. Postoperative cognitive dysfunction is higher in patients receiving epidural analgesia

   
   
5. 
   

   e. Neurological complications are higher when performed in anaesthetized patients

To enable surgery on the still heart in a bloodless field, patients undergoing cardiac surgery are typically placed onto a cardiopulmonary bypass circuit. During cardiac surgery:

1. 
   

   a. Cardioplegia is typically inserted into the descending aorta to perfuse the coronaries and cause cardiac standstill

   
   
2. 
   

   b. Cardioplegia solution is a hyperkalaemic solution

   
   
3. 
   

   c. The aim for cardioplegia is for the heart to arrest in systole

   
   
4. 
   

   d. Roller pumps can provide pulsatile flow

   
   
5. 
   

   e. Prior to going onto cardiopulmonary bypass the ACT must be >300 s

The following statements are true regarding nutritional support for critically ill patients:

1. 
   

   a. Overfeeding can easily happen with both enteral and parenteral feeding

   
   
2. 
   

   b. Total parenteral nutrition (TPN) can be associated with bacterial translocation

   
   
3. 
   

   c. It is better to underfeed than overfeed

   
   
4. 
   

   d. Postpyloric feeding does not increase the incidence of diarrhoea

   
   
5. 
   

   e. It is better to target lower caloric intake during an acute phase of illness than during recovery

With pregnancy-related diabetes:

1. 
   

   a. A woman should be routinely screened for gestational diabetes if her BMI is greater than 30

   
   
2. 
   

   b. Pre-eclampsia is more prevalent

   
   
3. 
   

   c. Metformin is contraindicated due to the risk of lactic acidosis developing

   
   
4. 
   

   d. During labour, women with pre-existing diabetes should receive an insulin and dextrose infusion

   
   
5. 
   

   e. Epidural analgesia is recommended for diabetic mothers in labour due to an increased risk of requiring obstetric intervention

Which of the following enhance hypoxic pulmonary vasoconstriction?

1. 
   

   a. Nitrous oxide

   
   
2. 
   

   b. Thoracic epidural

   
   
3. 
   

   c. Almitrine

   
   
4. 
   

   d. Propofol

   
   
5. 
   

   e. Opioids

Patients have the right to refuse treatment. Regarding advance directives and Jehovah’s Witnesses, which of the following are true?

1. 
   

   a. It is a legally binding document

   
   
2. 
   

   b. It can be made by anyone over the age of 14 years

   
   
3. 
   

   c. It must be updated in order for the patient to change their wishes

   
   
4. 
   

   d. It is only kept with the patient

   
   
5. 
   

   e. It can be disregarded in an emergency situation

You are anaesthetizing a child for a cleft palate repair. Regarding cleft lip and palate:

1. 
   

   a. Cleft palate cannot occur without cleft lip

   
   
2. 
   

   b. History of apnoea during feeds may indicate chronic airway obstruction

   
   
3. 
   

   c. Bilateral cleft lip predicts difficult laryngoscopy

   
   
4. 
   

   d. Difficulty with mask ventilation is common

   
   
5. 
   

   e. Airway obstruction after cleft lip and palate repair may be treated with insertion of a nasopharyngeal airway

With regards to suxamethonium apnoea:

1. 
   

   a. E1f E1f homozygotes have plasma cholinesterase present

   
   
2. 
   

   b. Diagnostic testing involves the use of benzylcholine

   
   
3. 
   

   c. Dibucaine inhibits plasma cholinesterase

   
   
4. 
   

   d. Fresh frozen plasma is routinely used in the management

   
   
5. 
   

   e. Methotrexate inhibits plasma cholinesterase activity

You are asked to review your patient in recovery who has a core temperature of 36 °C. Regarding perioperative hypothermia:

1. 
   

   a. The preoperative phase starts on arrival in the anaesthetic room

   
   
2. 
   

   b. Loss of behavioural response is a contributor

   
   
3. 
   

   c. The postoperative phase ends 12 hours after leaving the anaesthetic room

   
   
4. 
   

   d. A higher ASA grade is associated with a higher risk of preoperative hypothermia

   
   
5. 
   

   e. Fluid warmers are recommended when giving fluid volumes greater than 500 ml

You are on ICU performing a broncheoalveolar lavage. A medical student asks you to describe the bronchial anatomy. Which of the following are true?

1. 
   

   a. The left main bronchus is shorter than the right main bronchus

   
   
2. 
   

   b. The left main bronchus is wider than the right main bronchus

   
   
3. 
   

   c. The left main bronchus is more oblique than the right main bronchus

   
   
4. 
   

   d. The left lower lobe bronchus gives off the lingular bronchus

   
   
5. 
   

   e. The middle lobe bronchus bifurcates into the posterior and lateral lobes

Twenty-four hours after birth, a male neonate is found centrally cyanosed with no signs of respiratory distress. His blood pressure is 90/60 mmHg with a pulse rate of 140 bpm. Chest examination reveals a precordial heave and ejection systolic murmur in the second intercostal space. ECG shows signs of right ventricular hypertrophy and right axis deviation. The options for treatment are:

1. 
   

   a. Balloon atrial septostomy

   
   
2. 
   

   b. Prostaglandin infusion

   
   
3. 
   

   c. Indomethacin

   
   
4. 
   

   d. Pulmonary artery banding

   
   
5. 
   

   e. Modified Blalock–Taussig shunt

You have been informed that your Trust is investigating a ‘Never Event’ in which you were involved. According to NHS England, the following are ‘Never Events’:

1. 
   

   a. Wrong site surgery

   
   
2. 
   

   b. Wrong site block for pain control

   
   
3. 
   

   c. Wrong route of administration of medication

   
   
4. 
   

   d. Feeding with misplaced naso- or orogastric tubes

   
   
5. 
   

   e. Retained throat pack inserted by anaesthetist

A 50-year-old male presents to your pain clinic for management of his chronic lower back pain. A positive response to two diagnostic local anaesthetic blocks of the medial branches in his lumbar spine makes him suitable for further treatment with radiofrequency denervation. With regard to radiofrequency (RF) denervation procedures in the lumbar spine:

1. 
   

   a. RF procedures use high-frequency alternating current

   
   
2. 
   

   b. A permanent thermal lesion of the nerve is produced by direct heating via the needle tip

   
   
3. 
   

   c. Continuous RF is selective for sensory nerve fibres

   
   
4. 
   

   d. Pulsed RF does not produce significant heating of tissues

   
   
5. 
   

   e. Pulsed RF has a better side-effect profile

Regarding the pharmacological management of Parkinson’s disease, the following drugs are correctly matched to their parent group:

1. 
   

   a. Anticholingergic agents: amantidine

   
   
2. 
   

   b. Dopamine agonists: entacapone

   
   
3. 
   

   c. Catechol-O-methyl transferase inhibitors: apomorphine

   
   
4. 
   

   d. Monoamine oxidase B inhibitors: selegeline

   
   
5. 
   

   e. Atypical agents: ropinorole