ANAESTHESIA CLERKSHIP MCQ EXAMINATION

Name: ________________________________ Date___________________

Select the one best answer for the following MCQs by circling the corresponding
letter.

There will be no negative marks for incorrect answers.

Please ensure that you have 50 questions.

Time allotted - 1 hour

1
1) A 70 year old male has uncontrolled hypertension and diabetes mellitus. He has a leaking
abdominal aortic aneurysm and is scheduled for emergency aneurysmorrhaphy. Which of the
following is the appropriate ASA score?
a) I
b) II
c) III
d) IV
e) V

2) Which of the following medications should be discontinued before surgery, because of possible
adverse interaction with anaesthetic drugs and surgery?
a) dimenhydrinate
b) isordil
c) pethidine
d) aspirin
e) captopril

3) Diabetes mellitus is usually the cause of all except which one of these clinical conditions?
a) delayed gastric emptying
b) hyperuricaemia
c) obesity
d) albuminuria
e) hypercreatininaemia

4) The risk of aspiration of gastric content and hence the development of Mendelson’s syndrome
In a patient who requires urgent surgery is increased by which of the following?
a) sodium citrate suspension immediately prior to induction of anaesthesia
b) clear fluids 2 hours pre-operatively in a patient with no risk factors
c) cricoid pressure at induction in a patient with increased intra-abdominal pressure
d) naso-gastric tube suction and free drainage prior to induction of anaesthesia
e) manual ventilation post induction of anaesthesia in a patient having emergency
surgery

5) Which of the following is associated with acute left ventricular failure, and for which an elective
surgery would be cancelled?
a) increased blood pressure
b) enlarged liver span
c) pulmonary oedema
d) increased jugular venous pressure
e) decreased central venous pressure

6) Which of the following signs or score predicts a difficulty with airway management and possibly
difficulty with tracheal intubation in an adult patient?
a) protruding incisors
b) mouth opening of 4 cm
c) Mallampatti score of 
d) thyromental distance of more than 6 cm
e) American Association of Anaesthetists score of 1V

2
 Name: _________________________ ______Date___________

7) Which of the following statements about the use of sodium bicarbonate (NaHCO3) is true?
a) The usual dose is 1-2 mmol/Kg body weight
b) It must be administered after massive blood transfusion
c) 1.0 ml of the 8.4% solution contains 10 mmol of the drug
d) It is administered as a secondary treatment in severe allergic reactions
e) It is the first line drug to be administered during cardiopulmonary resuscitation

8) Which of the following is the best sequence of events during rapid sequence induction of
anaesthesia?
a) pre-oxygenation, induction, muscle relaxation, intubation, cricoid pressure
b) pre-oxygenation, muscle relaxation, induction, intubation, cricoid pressure
c) pre-oxygenation, induction, intubation, muscle relaxation, cricoid pressure
d) pre-oxygenation, induction, cricoid pressure, muscle relaxation, intubation.
e) pre-oxygenation, intubation, cricoid pressure, induction, muscle relaxation.

9) Which of the following will most likely occur as a result of a massive blood transfusion?
a) severe metabolic alkalosis
b) severe metabolic acidosis
c) acute pre-renal failure
d) shift of the 02 dissociation curve to the right
e) platelets of 600 x 109 per dl.

10) Which of the following may occur with autologous blood transfusion?
a) expiration of the blood
b) transfusion related reaction
c) allergic or febrile reaction
d) massive blood loss
e) massive transfusion

11) Which of the following will occur if hypokalaemia remains uncorrected before anaesthesia and
surgery?
a) metabolic acidosis
b) cardiac dysrrhythmias
c) tenting of the T-wave
d) ST segment elevation
e) increase requirements for muscle relaxant

12) Which of the following is true with regards to the use of nitrous oxide for general anaesthesia?
a) it is an organic gas used for induction and maintenance of anaesthesia
b) it commonly causes depression of the bone marrow
c) it is use mainly to provide analgesia intra-operatively
d) it is used to speed induction during inhalational anaesthesia
e) it is used in concentration of ≥ 70% for maintenance of anaesthesia

3
13) Which of the following about propofol is true?
a) it can be used as the sole agent for induction and maintenance of anaesthesia
b) it may cause respiratory depression, but this is independent of the dose and speed
of administration
c) it cannot be used to provide sedation during regional anaesthesia
d) it cannot be used to provide sedation during radiological investigations
e) it has analgesic property and may cause bone marrow depression.

14) Immediate cervical stabilization in a patient in whom cervical injury (fracture+/- dislocation) is
suspected and who requires anaesthesia and surgery for a laparotomy, include all except which of
the following?
a) manual-in-line axial stabilization
b) Philadelphia cervical collar
c) skull callipers and weights
d) emergency anterior and possibly posterior fusion
e) limited head and neck manipulation using rolls

15) A patient with intestinal perforation secondary to an intestine tumour, is scheduled to

undergo surgery. Which of the following antibiotics will offer the best coverage against anaerobic
organisms?
a) cefuroxime
b) ceftriaxone
c) augmentin
d) metronidazole
e) trimethoprim/sulphamethoxazole

16) A patient with sickle cell disease has mild pneumonia and cholecystitis. She is scheduled for
urgent cholecystectomy. Which of the following conditions is likely to cause sickling peri-
operatively?
a) fluid hydration
b) hyperthermia
c) hypothermia
d) hyperoxia
e) decreased urine output

17) Spinal anaesthesia is usually performed with “spinal” bupivacaine. Which of the following
statement about the preparation available at this hospital if true?
a) it is available as a 3-ml ampoule of a 0.5% solution
b) it is available as a 2-ml ampoule of a 5.0% solution
c) it is available as a 4-ml ampoule of a 0.5% solution
d) sodium bicarbonate is added to make it hyperbaric to the CSF
e) the specific gravity enables more blockade of the non-dependent area

18) Which of the following represents the amount of bupivacine available in the ampoule?
a) 50mg
b) 40 mg
c) 35 mg
d) 20mg
e) 15mg
4
Name: _________________________ _______ Date___________________

19) Which of the following is the main reason for the administration of premedicant drug/s?
a) for the amnesic and vagolytic effects.
b) for the analgesic and anxiolytic effects.
c) to obtain deeper levels of anaesthesia
d) to decrease awareness peri-operatively.
e) avoidance or reduce doses of muscle relaxants.

20) Sudden blood loss of 1000mls intra-operatively in a 50 Kg patient with a pre-operative ASA score
of 1 will cause all except which of the following physiological response?
a) increase in pulse rate and decrease conscious level
b) increase in pulse rate and decrease in urine output
c) decrease cardiac output but increase in pulse rate
d) decrease in blood pressure and pulse rate
e) decrease in the central venous pressure

21) Which of the following CVP values is most likely for the patient above?
a) 0-6 cmH20
b) 8-10 cmH20
c) 11-15 cmH20
d) 16-20 cmH20
e) 21–25 cmH20

22) Which of the following best explains the use of capnography in anaesthesia?
a) to prevent rebreathing of carbon dioxide when the circle system is used
b) to confirm malignant hypertension as this is associated with high carbon dioxide
levels
c) to confirm or rule out venous air embolism
d) to prevent disconnection of the breathing circuit
e) to confirm or rule out endotracheal intubation

23) Which one of the following conditions is not usually associated with adult (acute) respiratory
distress syndrome?
a) septic shock
b) spinal shock
c) traumatic shock
d) amniotic fluid embolism
e) gastric aspiration

24) Which of the following information is not usually obtained from the ECG intra-operatively?
a) heart block
b) acute ischaemia
c) ventricular size
d) hyperkalaemia
e) presence of a pacemaker

5
25) An asthmatic patient who is scheduled for surgery, is not in respiratory distress, but a few rhonchi
are heard on auscultation of the lung fields. Which of the following anaesthetic agents is likely
to worsen the bronchospasm in this patient?
a) midazolam
b) propofol
c) ketamine
d) halothane
e) thiopentone

26) A 20 year old male is brought into the Emergency Department following a road traffic
accident. He is pulseless and is not breathing. What is the first step in the management?
a) administration of oxygen.
b) endotracheal intubation.
c) cardiac compression.
d) securing a patent airway.
e) securing intravenous access.

27) In Jamaica, poisoning and drug overdose are common with all except which of the following?
a) alcohol
b) paracetamol
c) paraquat
d) kerosene
e) psychotic agent/s

28) Activated charcoal should be used in all, except which of the following cases of poisoning.
a) phenobarbitone
b) salicylate
c) malathion
d) carbamezepine
e) digoxin

29) Which of the following is the clinical feature that suggests that a patient who has been taken to
the Emergency Department following an overdose of drugs, requires tracheal intubation?
a) PaC02 < 40 mmHg
b) seizures but has a gag reflex
c) dysrhythmias
d) unconsciousness
e) PaO2 > 70 mmHg

30) Which of the following drugs has anti-inflammatory, analgesic and antiemetic properties?
a) Diclofenac
b) Colecoxib
c) Paracetamol
d) Aspirin
e) Dexamethasone

6
31) Which of the following is a cylclooxygenase-2 (COX-2) inhibitor?
a) Diclofenac
b) Colecoxib
c) Paracetamol
d) Aspirin
e) Dexamethasone

32) Which of the following antibiotics has neuromuscular blocking property and should be avoided
Or administered cautiously in patients with impaired renal function?
a) augmentin
b) ampicillin
c) penicillin
d) gentamycin
e) cefuroxime

33) The pH of a 2.5% solution of thiopentone is which of the following?

a) 2
b) 4
c) 6
d) 8
e) 10

34) Which of the following is true about thiopentone?

a) It is a phenol derivative
b) available as a white oil-in-water emulsion
c) patients awake with “hang-over” feelings
d) patients generally awake clear-headed
e) associated with erotic dreams on awakening

35) Signs of inadequate general anaesthesia include all except which of the following?
a) eyelid movement
b) sweating
c) hyperventilation
d) limb movement
e) pupillary constriction

36) Which of the following cranial nerves is responsible for the last sense to disappear as a patient
becomes more deeply anaesthetized?
a) III
b) V
c) VII
d) VIII
e) IX

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Name: _________________________ _______ Date___________________

37) Which of the following intravenous solution is most appropriate for a neonate undergoing
bilateral hernia repair?
a) 5% dextrose solution
b) 5% dextrose 0.9% saline
c) 5% dextrose 0.2% saline
d) gelofusine
e) hetastarch

38) Local anaesthetic agents have their effects on which of the following?
a) nerve membrane
b) calcium channel
c) presynaptic nerve terminal
d) postsynaptic nerve terminal
e) gamma aminobutyric acid (GABA) receptor.

39). Which of the following is true with regards to a patient who is being prepared for regional
anaesthesia?
a) full history and examination are unnecessary
b) personality of the patient does not affect the decision to proceed
c) one only needs to prepare drugs and equipment for the regional procedure
d) lack of consent by the patient is only a relative contraindication
e) a history of neurological disease may lead to a decision not to proceed

40). Following spinal anaesthesia, a patient complains of difficulty breathing and becomes
unconscious. Which of the following also suggests total spinal blockade?
a) bronchospasm
b) hypothermia.
c) hypertension
d) tachycardia
e) convulsions

41). Which of the following is the most appropriate drug to administer to counteract the severe
vasodilatation and bradycardia associated with a high spinal blockade?
a) dopamine
b) ephedrine
c) adrenaline
d) noradrenaline
e) isoprenaline

8
42) A patient developed respiratory depression twenty minutes after the administration of 30 mg
morphine, which was titrated to effect. An arterial blood gas analysis showed the following: PaO2
– 55 mmHg; PaCO2 – 65.5 mmHg; pH - 7.25; SaO2 – 80% and base excess - +1. Which of the
following diagnosis is true for this patient?
a) Metabolic acidosis
b) Respiratory acidosis
c) Respiratory alkalosis
d) Type 1 respiratory failure
e) Type 2 respiratory failure

43) A patient who is known to have ischaemic heart disease had a witnessed cardiac arrest while
undergoing treatment in the Emergency Department. Which of the following is unlikely to
have caused or be associated with the cardiac arrest?
a) myocardial infarction
b) ventricular fibrillation
c) ventricular tachycardia
d) atrial fibrillation
e) severe angina

44). Which of the following is true with regards to cardiopulmonary resuscitation in the above
mentioned patient?
a) atropine is contraindicated
b) adrenaline 2.0 mg should be give early
c) defibrillation is usually the first line of management
d) sodium bicarbonate should be administered if the pH is 7.30
e) vasopressin 2.0 IU may be administered instead of adrenaline

45) Which of the following in its severe form is the most likely cause of pulseless electrical activity
(PEA) cardiac arrest in a patient with severe rib fractures and flail chest?
a) hypoxia
b) hypoglycaemia
c) hypovolaemia
d) hyperkalemia
e) hypokalemia

46) Which of the following is the most useful clinical test for adequate return of muscle power after
neuromuscular blockade?
a) the presence of swallowing
b) ability to clear airway
c) tidal volume of 3 mls/Kg
d) facial grimace
e) strong hand grip

9
Name: _________________________ _______ Date___________________

For questions 47 - 50 refer to the list of drugs used peri-operatively given below.

Option List:

0 a) Alcuronium l) Midazolam
1 b) Atracurium m) Morphine
2 c) Atropine n) Nalaxone
3 d) Bupivaciane o) Neostigmine
4 e) Chlorpheniramine p) Ondansetrom
5 f) Diclofenac sodium q) Pancuronium
6 g) Dimenhydrinate r) Pethidine
7 h) Fentanyl s) Propofol
8 i) Flumazenil t) Ropivacaine
9 j) Glycopyrrolate u) Suxamethonium
10 k) Lignocaine v) Thiopentone
11
12
For each of the following statements or case scenarios, choose the drug with property that is
appropriate for treatment/use or is the best match. Write the letter corresponding to that drug at the end
of the question. A drug may be used more than once

47. The drug which is available for oral, intramuscular and intravenous administration and has
sedative, muscle relaxant and amnesic properties?

48: The drug which is used to inhibit shivering in the post-operative period.

49. The drug which is a competitive antagonist at the opioid receptors

50. The drug which will cause increase in the intraocular pressure, and bradycardia if administered
in repeated dose

THE END

10
42. Which anaesthetic induction agent is said to have antiemetic effect and does not cause a “hang-
over effect post-operatively?

43. The drug that may be used to reverse the effects of opioids in case of overdose or increased
sensitivity?

44. The drug that is used to treat post-operative nausea and vomiting when the commonly used agent
is ineffective?

45. The drug that may be used peri-operatively as part of the management for an allergic reaction?

46. The drug that may be used in the treatment of patients with tetanus which will decrease muscle
spasm and anxiety, but can cause respiratory depression.

Previous set

47. Which of the opioid agents is contraindicated for use post-operatively on the convalescence ward.

48: The drug that may be used to reverse the effects of benzodiazepine in case of overdose or
increased sensitivity

49. The drug that is commonly used to counteract nausea and vomiting post-operatively

50. The drug that may be used peri-operatively as part of the management for an allergic reaction?

The drug which inhibits the enzyme cyclooxygenase and may cause renal dysfunction in some
patients

The drug which has a vagolytic action and therefore can cause tachycardia and hypertension

Answers H, I, G, E, F, Q

11
Name: _________________________ _______ Date___________________

For questions 47 - 50 refer to the list of drugs used peri-operatively given below.

Option List:

13 a) Midazolam l) Lignocaine
14 b) Trimeprazine tartrate m) Bupivaciane
15 c) Propofol n) Ropivacaine
16 d) Thiopentone o) Atropine
17 e) Fentanyl p) Glycopyrrolate
18 f) Morphine q) Neostigmine
19 g) Pethidine r) Nalaxone
20 h) Suxamethonium s) Flumazenil
21 i) Alcuronium t) Chlorpheniramine
22 j) Atracurium u) Ondansetrom
23 k) Pancuronium v) Dimenhydrinate
24
25
For each of the following drug description or case scenario, choose the drug with property that is the
best match. Write the letter corresponding to that drug at the end of the question: A drug may be used
more than once and there may be more than one answer for a question.

42. Which anaesthetic induction agent is said to have antiemetic effect and does not cause a “hang-
over effect post-operatively?

43. The drug that may be used to reverse the effects of opioids in case of overdose or increased
sensitivity?

44. The drug that is used to treat post-operative nausea and vomiting when the commonly used agent
is ineffective?

45. The drug that may be used peri-operatively as part of the management for an allergic reaction?

12
Questions 46- 50 refer to the figure below: Posterior-anterior chest X- ray. For each of the following
questions, choose the corresponding number in the diagram that is the answer or the best match. Write
the number at the end of the question:

46. The area/structure where a tracheostomy tube will be visualised?

47. Which area/structure will become distended during ventilation if the tracheal tube is misplaced?

48. In which area of the lung will the transverse fissure be seen prominently in a patient with cardiac
failure?

49, Which area of the lung will there be absent lung markings in keeping with a collapse, in a patient
with a penetrating injury to the upper anterior left side of the chest.

50. Intestinal perforation may be associated with the accumulation of air in which area/structure?

THE END

13
Alternative Qs for the pictorial diagram

Name: _________________________ _______ Date___________________

Questions 46- 50 refer to the figure below: Posterior-anterior chest X- ray. For each of the following
questions, choose the corresponding number in the diagram that is the answer or the best match. Write
the number at the end of the question:

46. In which area/structure can the tracheal tube be visualised normally.

47. The area/structure that will be obliterated in a patient with a right pleural effusion of about 600mls.

48. The area/structure that may be fractured in the driver of a motor vehicle who sustained a blunt
injury to the chest during a head–on collision with another.

49. The area that will show change/s in keeping with puncture of the pleura of the lung during right-
sided central placement of a CVP catheter.

50. The area/structure that will increase the risk of aspiration if distended.

THE END

14
 Answers for MCQ Set 4

Re- Edited July, 2006 with new answers Used march 30, 2007 & revised again Qs 6, 47-50
Changed April & July ‘08 . Used Dec ’08, Feb ‘09

1) D 6) A 11) B 16) C 21) A 26) D 31) B 36) D 41) B

2) D 7) A 12) D 17) C 22) C/E 27) B 32) D 37) C 42) E
3) B 8) D 13) A 18) D 23) B 28) C 33) E 38) A 43) D
4) E 9) A 14) D 19) B 24) C 29) D 34) C 39) E 44) C
5) D/C 10) A 15) D 20) D 25) E 30) E 35) E 40) E 45) A

46) B, 47) E, 48) S, 49) V, 50) T OR

46) B 47) L 48) R, 49) A/N, 50 U -- April 2008

Old version
1) D 6) C 11) B 16) D 21) A 26) D 31) B 36) D 41) E
2) D 7) D 12) D 17) C 22) C 27) B 32) D 37) C 42) E
3) B 8) D 13) E 18) A 23) A 28) C 33) E 38) A 43) B
4) E 9) B 14) D 19) B 24) C 29) D 34) C 39) C 44) B
5) D 10) A 15) D 20) D 25) E 30) C 35) E 40) B 45) A

CXR Check  46) 1 47) 5 48) 6/9/8/10 49) 12/13 50) 2

Answers for set 9 start w/ 7 y o child

1. B 13. A 25. D 37. B

2. B 14. E 26. D 38. A 49. V
3. D 15. C 27. D 39. D 50. C
4. B 16. B 28. B 40. B
5. A 17. A 29. C 41. E
6. C 18. A 30. E 42.D
7. D 19. D 31. A 43. D
8. E 20. D 32. E 44. E
9. D 21. C 33. E 45. A
10. E 22. D 34. E 46. O
11. B 23. E 35. B 47. A
12. E 24. D 36. C 48. A

Q 25- CPR regime changed. Stack of 3 defibrillation no longer

Used July & Sept ’08, Changes made to Qs 2, 4, 8, 15, 16, 25, 46, 47. there are three ABG Qs (16,
26, 41) – but all different. Set 9 see below

15
For questions 46 - 50 refer to the list of drugs used peri-operatively given below.

Option List:

26 a) Midazolam l) Lignocaine
27 b) Trimeprazine tartrate m) Bupivaciane
28 c) Propofol n) Ropivacaine
29 d) Thiopentone o) Atropine
30 e) Fentanyl p) Glycopyrrolate
31 f) Morphine q) Neostigmine
32 g) Pethidine r) Nalaxone
33 h) Suxamethonium s) Flumazenil
34 i) Alcuronium t) Chlorpheniramine
35 j) Atracurium u) Ondansetrom
36 k) Pancuronium v) Dimenhydrinate
37
38
For each of the following drug description or case scenario, choose the drug with property that is the
best match. Write the letter corresponding to that drug at the end of the question: A drug may be used
more than once and there may be more than one answer for a question.

38. The drug that can be used to counteract the side effects of suxamethonium intra-operatively.
39. The drug that may be included in the treatment regime of a patient with tetanus.
40: The drug that causes prolonged sedation when given as a premedicant and has antiemetic
property.
41. The drug that is commonly used to counteract nausea and vomiting post-operatively
42. The drug that may be associated with a total spinal anaesthesia, in a patient undergoing caesarean
section, if inadvertent cephalad spread occurs.
43. The drug with anticonvulsant, antiemetic and anaesthetic properties
44. The drug which may be used in the treatment of organophosphate poisoning.
45. The antidote for benzodiazepine overdose

Alternatives to the EMQ with drug list

38. The drug that has sedative, anxiolytic and muscle relaxation properties.
39. The drug that may be used to counteract allergic reaction
40. 630 mg of which drug can be safely given to a patient whose body weight is 90 Kg, especially if
not given alone?
41. The drug that will counteract sinus bradycardia, but may cause central excitation syndrome.
42. The drug that has anticonvulsant property, will decrease cerebral oxygen consumption and is an
appropriate anaesthetic agent in a patient with head injury.
43. The muscle relaxant with vagolytic action
44. The non-depolarising muscle relaxant that is most likely to trigger an allergic reaction.
45. The local anaesthetic agent that is least cardiotoxic

Set 9 below used 15/6/06, July & Sept ‘08

16
1) A 7 year old child with a small congenital ventricular septal defect is scheduled to undergo left
inguinal hernia repair. She was admitted to hospital one year ago for lower respiratory tract
infection and mild congestive cardiac failure. She had been compliant with her medication
(frusemide) which was discontinued two months ago. Which of the following is the appropriate
ASA score?
a) I
b) II
c) III
d) IV
e) V

2) Which of the following medication is appropriate to be administered to this 7 year old child prior
to surgery?
a) dimenhydrinate
b) midazolam
c) pethidine
d) aspirin
e) frusemide

3) Which of the following will not reduce the risk of aspiration of gastric content and hence the
Mendelson’s syndrome in patient scheduled for surgery?
a) Clear fluids 2 hours pre-operatively in a patient with no risk factors
b) cricoid pressure during rapid sequence induction of anaesthesia
c) nasogastric tube drainage prior to rapid sequence induction of anaesthesia
d) Clear fluids 4 hours pre-operatively in a patient with oesophageal stricture
e) sodium citrate suspension and/or histamine-2 blocker pre-operatively

4) Diabetes mellitus may be the cause or associated with all except which one of these clinical
conditions?
a) delayed gastric emptying
b) hyperuricaemia
c) obesity
d) albuminuria
e) hypercreatininaemia

5) Which of the following symptoms/signs is not usually associated with upper airway obstruction?
a) crepitations
b) rhonchi
c) stridor
d) croup
e) cough

6) Which of the following is associated with acute cardiogenic shock?

a) increased blood pressure
b) enlarged liver span
c) increased jugular venous pressure
d) decreased central venous pressure
e) warm dry peripheries

17
 7). A 60 year old patient with controlled hypertension is scheduled for PUERP/TURP. Urinalysis
showed glycosuria. The pre-operative investigation must include all except which of the
following?
a) chest radiograph.
b) electrocardiogram.
c) haematological study.
d) echocardiogram
e) glucose tolerance test.

8). The above mentioned patient has consented to a spinal anaesthesia Which of the following is true
with regards to the preparation for this technique?
a) a full history and examination are unnecessary
b) the personality of the patient does not affect the decision to proceed
c) one only needs to prepare drugs and equipment for the regional procedure
d) a lack of consent by the patient is a relative contraindication
e) a history of neurological disease may lead to a decision not to proceed

9). Which of the following is the most appropriate drug and dose for the spinal anaesthesia?
a) 10 mls.of 1% ‘plain’ lignocaine
b) 10 mls. of 1% ‘heavy’ lignocaine
c) 3 mls. of 0.5% ‘plain’ bupivaciane
d) 3 mls. of 0.5% ‘heavy’ bupivaciane
e) 3 mls. of 0.5% ‘plain’ ropivacaine

10). Fifteen minutes after the administration of the spinal anaesthesia, the patient complains of
difficulty breathing and becomes unconscious. Which of the following also suggests a total spinal
blockade?
a) bronchospasm
b) hypothermia.
c) Hypertension
d) tachycardia
e) convulsions

11). Which of the following is the most appropriate drug to administer for the treatment of
cardiovascular collapse due to a high spinal blockade?
a) dopamine
b) ephedrine
c) adrenaline
d) noradrenaline
e) isoprenaline

hi 12). Which of the following is true about hyperkalemia

a) A common ECG change is flattened the T-waves
b) It is usually caused by diuretic (e.g. frusemide)
c) It is unlikely to cause cardiac dysrrthymias or asytole
d) Insulin and glucose are ineffective for treatment of this condition
e) Calcium chloride may be given to counteract its effect on the myocardium

18
 13). Which of the following will most likely occur as a result of a massive blood transfusion?
a) metabolic alkalosis
b) metabolic acidosis
c) polycythemia
d) pre-renal failure
e) hyperthermia
.
14) Restlessness post-operatively is most likely due to all except which of the following?
a) pain
b) anxiety
c) poor positioning
d) distended urinary bladder
e) adequate reversal of muscle relaxants

. 15). Which of the following will cause tachycardia when administered or done intra-operatively?
a) vagal stimulation
b) phenylephrine
c) pancuronium
d) halothane
e) pressure on the eyeball

16). An elderly patient developed respiratory depression twenty minutes after the administration of
100 mg of pethidine intramuscularly. Analysis of an arterial blood sample showed the following:
PaO2 65 mmHg; PaCO2 – 75.5 mmHg; pH - 7.25; SaO2 – 85% and base excess +2. Which of the
following is true with regards to the acid-base status of the patient?
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic acidosis
d) mixed respiratory-metabolic acidosis
e) compensated metabolic acidosis

17) Which of the following is the most unlikely cause of pulseless electrical activity in a trauma
victim with a penetrating chest injury?
a) severe hypoxia
b) severe hypercarbia
c) cardiac tamponade
d) severe hypokalemia
e) tension pnuemothorax

18). A severe allergic reaction intra-operatively, post-induction of anaesthesia may be diagnosed by

which of the following clinical signs?
a) skin wheals and hypotension
b) tachycardia and hypertension
c) erythemia and wheals along the vein
d) cardio-vascular instability
e) rhonchi and crepitations

19
19). A patient with sickle cell disease has mild pneumonia and cholecystitis. She is scheduled for
urgent cholecystectomy. Which of the following conditions is likely to cause sickling peri-
operatively?
a) balanced intravenous fluid
b) decreased urine output
c) hyperthermia
d) hypothermia
e) hyperoxia

20). Which of the following is the most potent analgesic agent?

a) pethidine
b) morphine
c) panadiene-F
d) fentanyl
e) rofecoxib

21). Which of the following about the pulse oximeter is true?

a) there are three light emitting diodes
b) oxyhaemoglobin absorb light at wavelengths 940 and 660 nm
c) the plethysmographic wave form can be used to assess cardiac rhythm
d) hyperthermic extremities will cause low values
e) the mean arterial pressure can be determine from the plethysmographic wave form.

22). Which of the following diagnosis cannot be made from an analysis of arterial blood gases?
a) metabolic alkalosis
b) respiratory acidosis
c) type 2 respiratory failure
d) hypochloraemic alkalosis
e) compensated metabolic acidosis

23). Which of the following is an example of a fixed performance oxygen system?

a) face mask
b) nasal cannula
c) head box
d) oxygen tent
e) ventimask

24). Which of the following is not usually done when rapid sequence induction of anaesthesia is
performed for a patient about to undergo emergency surgery?
a) pre-oxygenation
b) suction of nasogastric tube
c) muscle relaxation
d) manual ventilation
e) tracheal intubation

20
25). A patient who had a ventricular fibrillation (VF) arrest is being resuscitated. He is given two
shocks at 200 Joules, but the monitor still displays VF. What is the next step in the management of
this patient?
a) administer vasopressin
b) give adrenaline 1.0 mg IV
c) defibrillate again with 200 Joules, to give a stack of three (3) shocks
d) resume CPR for one minute after adrenaline is administered, then reassess the rhythm
e) establish another intravenous access for the administration of an anti-arrhythmic agent

26). An arterial blood gases analysis showed a PaO2 of 60 mmHg, PaCO2 of 54 mmHg and a pH of
7.50. In which of the following patients is this most likely?
a) a patient on oxygen therapy via a face mask with rebreathing bag
b) a patient on oxygen therapy via a face mask without a rebreathing bag
c) an asthmatic patient after treatment for an acute attack of asthma
d) a patient with chronic obstructive airway disease
e) an ASA 1 patient pre-induction of anaesthesia

27). A 20 year old male is brought into the Emergency Department following a fall from the roof of a
building (a height of about 60 feet). He is pulseless and is not breathing. The first step in the
management involves which of the following?
a) administration of oxygen.
b) endotracheal intubation.
c) cardiac compression.
d) securing a patent airway.
e) securing intravenous access.

28. After stabilization of the patient, he is noted to have peri-orbital discoloration and drainage of
CSF from the ears. Which of the following investigations will give pertinent information
regarding his neurological status?
a) skull and chest radiograph
b) computed tomography
c) serial limb radiographs
d) haematological blood tests
e) serial blood chemistry

29. The patient above responds to command by incomprehensible speech, to pain by flexion, but does
not open his eyes. Which of the following is the appropriate Glasgow coma score for him?
a) 10
b) 8
c) 6
d) 4
e) 2
30). Intra-operatively, there is a sudden blood loss of 1000mls due to inadvertent laceration of an
anomalous vessel. Which of the following will be the immediate effect of this loss?
a) diaphoresis
b) increase in pulse rate
c) increase in blood pressure
d) decrease in urine output
e) decrease in the intravascular volume
21
31. Which of the following values given for the CVP, is most likely for the patient mentioned above?
a) 0- 6 cmH20
b) 8-12 mmHg
c) 15- 20 cmH20
d) 22 - 25 cmH20
e) 26 - 30 mm Hg

32) A patient who is fearful of transfusion related infection is scheduled to undergo hip
replacement. Which of the following will not help to decrease homologous blood transfusion?
a) surgical techinque
b) anaesthesia technique
c) hypotensive anaesthesia
d) normovolaemic haemodilution
e) erythropoietin post-operatively

33). In the recovery room, an asthmatic patient developed such severe respiratory distress, such that
tracheal intubation and manual ventilation had to be performed. Which of the following
anaesthetic agent is best avoided in this patient?
a) midazolam
b) propofol
c) ketamine
d) halothane
e) thiopentone

34). A patient is persistently hypertensive post-operatively. Which of the following is unlikely to be a

cause?
a) The blood pressure cuff size is more than a third of the length of the arm
b) The patient had uncontrolled blood pressure pre-operatively
c) The patient may have undiagnosed pheochromocytoma
d) The patient is in severe pain and may be hypoventilating causing CO2 retention
e) The anaesthetic agents used for regional anaesthesia intra-operatively and continued post-
operatively

35). Which one of the following conditions does not usually cause adult (acute) respiratory
distress syndrome?
a) septic shock
b) spinal shock
c) traumatic shock
d) amniotic fluid embolism
e) gastric aspiration

36) Which of the following information cannot be obtained from an ECG taken pre-operatively?
a) cardiac dysrhythmias
b) ventricular size
c) cardiac output
d) hypokalaemia
e) presence of a pacemaker

22
37). Which of the following about the laryngeal mask airway (LMA) is true?
a) protects the airway from aspiration
b) causes less physiological disturbance than an endotracheal tube
c) should only be used in adult because of the anatomy of the airway
d) has no place in the management of a difficult airway
e) is associated with a high incidence of aspiration

38). Bioethical principles by which medicine must be practised include all except which of the
following?
a) legal competence
b) distributive justice
c) patient’s autonomy
d) beneficence
e) non-maleficience

39). Which of the following clinical conditions have the lowest risk of regurgitation of gastric content
and hence the risk of acid aspiration syndrome?
a) abdominal ascites
b) oesophageal stricture
c) oesophageal achalasia
d) twelve weeks gestation
e) intestinal obstruction

40). Which of the following test is not done on blood donated for allogenic transfusion
a) VDRL
b) HTLV-3
c) HBs Ag
d) HCV
e) Antibody screening

41). Arterial blood gases analysis showed a PaO2 of 120 mmHg and PaC02 of 60 mmHg. In which of
the following patients is this most likely?
a) an asthmatic patient with an acute attack
b) an ASA 1 patient pre-induction of anaesthesia
c) a patient on oxygen therapy via a T-piece system
d) a patient with chronic obstructive airway disease with an acute event
e) a patient on oxygen therapy via a face mask with a rebreathing bag

42) A patient who is known to have ischaemic heart disease had a witnessed cardiac arrest while
undergoing an investigation in the Radiology Department. Which of the following is unlikely to
have caused or be associated with the cardiac arrest?
a) myocardial infarction
b) ventricular fibrillation
c) ventricular tachycardia
d) atrial fibrillation
e) severe angina

23
43). Which of the following is true with regards to cardiopulmonary resuscitation in the above
mentioned patient?
a) atropine is contraindicated
b) adrenaline 2.0 mg should be give early
c) defibrillation should only be done after effective CPR
d) vasopressin 20 IU may be administered instead of adrenaline
e) sodium bicarbonate should be administered if the pH is 7.32

44). A multi-trauma patient developed pulseless electrical activity pre-induction of anaesthesia for
emergency laparotomy. Which of the following is the most likely cause?
a) pulmonary embolism
b) tension pneumothorax
c) severe hypothermia
d) severe hyperkalaemia
e) severe haemorrhage

45). Which of the following may occur with autologous blood transfusion?
a) Clerical error
b) transfusion related reaction
c) allergic reaction
d) massive blood loss
e) massive transfusion

46). A patient developed massive bleeding during surgery for the excision of a retroperitoneal
tumour. The patient continued to bleed postoperatively even though six (6) units of blood was
transfused. Which of the following blood result is not in keeping with the suspected diagnosis of
disseminated intravascular coagulation?
a) increased fibrin degradation product
b) decreased fibrinogen
c) prolonged prothrombin time
d) increased D-dimer
e) increased platelet count

24
 For questions 46 - 50 refer to the list of drugs used peri-operatively given below.

Option List:

39 a) Midazolam l) Lignocaine
40 b) Trimeprazine tartrate m) Bupivaciane
41 c) Propofol n) Ropivacaine
42 d) Thiopentone o) Atropine
43 e) Fentanyl p) Glycopyrrolate
44 f) Morphine q) Neostigmine
45 g) Pethidine r) Nalaxone
46 h) Suxamethonium s) Flumazenil
47 i) Alcuronium t) Chlorpheniramine
48 j) Atracurium u) Ondansetrom
49 k) Pancuronium v) Dimenhydrinate
50
51
For each of the following drug description or case scenario, choose the drug with property that is the
best match. Write the letter corresponding to that drug at the end of the question: A drug may be used
more than once and there may be more than one answer for a question.

46. The drug that is commonly used to counteract the side effects of suxamethonium intra-
operatively, especially when repeated doses are given.

47. The drug that may be included in the treatment regime of a patient with tetanus to reduce muscle
spasm.

48: The drug that has sedative, anxiolytic and muscle relaxation properties

49. The drug that is commonly used to counteract nausea and vomiting post-operatively

50. The drug with anticonvulsant, antiemetic and anaesthetic properties

25
Answers for set 9

13. B 13. A 25. C 37. B 48. A

14. B 14. E 26. D 38. A 49. V
15. D 15. C 27. D 39. D 50. C
16. B 16. B 28. B 40. B
17. A 17. A 29. C 41. E
18. C 18. A 30. E 42.D
19. D 19. D 31. A 43. D
20. E 20. D 32. E 44. E
21. D 21. C 33. E 45. A
22. E 22. D 34. E 46. A
23. B 23. E 35. B 46. O or E
24. E 24. D 36. C 47. A

Used July & Sept ’08,

Q 25- CPR regime changed. Stack of 3 defibrillation no longer
Changes made to Qs 2, 4, 8, 15, 16, 25, 46, 47. There are three (3) ABG Qs (16, 26, 41)– but all
different

Qs for set 10 see below OR see separate file

The Paper below is a new one developed 13/3/09 hybrid of paper 4.

Q 1 remains the same

See other file –Med Std-GPA with the paper below

TIPS

 Avoid negative questions

 The student should be able to state the possible answers without looking at the
options when a clinical scenario is given

26
 ANAESTHESIA CLERKSHIP MCQ EXAMINATION

Name: ________________________________ Date___________________

Select the one best answer for the following MCQs by circling the corresponding
letter.

There will be no negative marks for incorrect answers.

Please ensure that you have 50 questions.

Time allotted - 1 hour

27
1. A 70 year old male has uncontrolled hypertension and diabetes mellitus. He has a leaking
abdominal aortic aneurysm and is scheduled for emergency aneurysmorrhaphy. Which of the
following is the appropriate ASA score?
a) I
b) II
c) III
d) IV
e) V

2) A 56 year old gentlemen had a myocardial infarction 2 years ago. He has stabilized with
medications and is able to walk at a moderate speed without getting dyspnoeic. Which of the
following medications should be discontinued before anaesthesia and surgery?
a) Aspirin
b) Atenolol
c) captopril
d) Isordil
e) Simvastatin

3) A 80 year old patient with diabetes mellitus for 30 years, presents with ruptured appendix. On
examination she is moderately dehydrated with moderate abdominal distension and marked
rebound tenderness. Surgery scheduled to be done within one hour. Which of the following medical
conditions had serious implications with regards to anaesthesia?
a) albuminuria
b) delayed gastric emptying
c) hyperuricaemia
d) hypercholesterolaemia
e) peripheral neuropathy

4) Which of the following management decisions will decrease the risk of developing Mendelson’s
syndrome and is appropriate for the above mentioned patient?
a) Delay surgery until the stomach is empty
b) Inhalational induction of anaesthesia
c) Nasogastric tube suctioned and on free drainage
d) Manual ventilation post induction of anaesthesia
e) Cricoid pressure after the muscle relaxant is administered

5) A 40 year old male who is non-compliant with his anti-hypertensive medications is scheduled for
elective inguinal hernia repair. On admission he is assessed as being in left ventricular failure
(LVF). Which of the following clinical signs is directly due to the LVF?
a) enlarged liver span
b) increased blood pressure
c) bilateral basal crepitations
d) increased jugular venous pressure
e) decreased central venous pressure

28
 Name_________________________________________ Date_______________

6) Which of the following signs or scores predicts a difficulty with airway management in an adult
patient?
a) protruding incisors
b) mouth opening of 4 cm
c) Mallampatti score of II
d) thyromental distance of more than 6 cm
e) American Association of Anaesthetists score of 1V

7) A 90 Kg patient had a cardiac arrest under anaesthesia and is being resuscitated for the past 20
minutes. The decision is made to administer sodium bicarbonate (NaHCO3). Which of the following
is the correct dose for the patient?
a) 140 mmols
b) 180 “
c) 220 “
d) 260 “
e) 300 “

8) A 22 year old female fainted about two hours after dinner. In the emergency room, she is noted to
be pale, tachycardic and clammy with a blood pressure of 80/40 mmHg. On examination, her
abdomen is mildly distended and painful to palpation. Her last menstrual period was three months
earlier. Which of the following is the best sequence of events for induction of anaesthesia?
a) pre-oxygenation, induction, muscle relaxation, intubation, cricoid pressure
b) pre-oxygenation, muscle relaxation, induction, intubation, cricoid pressure
c) pre-oxygenation, induction, intubation, muscle relaxation, cricoid pressure
d) pre-oxygenation, induction, cricoid pressure, muscle relaxation, intubation.
e) pre-oxygenation, intubation, cricoid pressure, induction, muscle relaxation.

9) A 45 year old female with no known chronic illness was involved in a motor vehicle accident, in
which she sustained multiple fractures. She was transfused ten units of blood over a 24 hour period.
Which of the following clinical abnormalities would most likely occur in this patient?
a) severe metabolic alkalosis
b) severe metabolic acidosis
c) acute post-renal failure
d) shift of the 02 dissociation curve to the left
e) platelets of 600 x 109 per dl.

10) A 70 year old patient with severe osteoarthritis is scheduled to undergo right total hip replacement.
He has donated three units of blood over the three weeks prior to surgery. Which of the following
events may occur related to the blood donated?
a) transfusion related reaction
b) ABO incompatibility
c) allergic reaction
d) febrile reaction
e) fluid overload

29
11) A 60 year patient who has diabetes for 10 years was admitted with a 2-day history of a painful
swollen right foot, fever and feeling unwell. The repeat blood chemistry after fluid and
intravenous insulin therapy were; Na+ -138, K+ - 2.7, Cl - 99, CO2 -22, Urea - 7.0, creatinine -
110, glucose - 12 mmol. She requires a below-knee amputation, but refuses regional anaesthesia.
Which of the following clinical conditions is likely to occur if she has general anaesthesia with
these chemistry results?
a) metabolic acidosis
b) cardiac dysrrhythmias
c) hyperactive bowel sounds
d) decrease urine output
e) increase requirements for muscle relaxant

12) Which of the following statements regarding the use of nitrous oxide for general anaesthesia
is correct?
a) it is an organic carrier gas
b) it commonly causes depression of the bone marrow
c) it is used mainly to provide analgesia intra-operatively
d) it is used to speed induction during inhalational anaesthesia
e) it is used in concentration of ≥ 70% for maintenance of anaesthesia

13) Which of the following statements regarding the use of propofol is correct?
a) it can be used as the sole agent for induction and maintenance of anaesthesia
b) it may cause respiratory depression, but this is independent of the dose and speed of
administration
c) it cannot be used to provide sedation during regional anaesthesia
d) it cannot be used to provide sedation during radiological investigations
e) it has analgesic property and may cause bone marrow depression.

14) A patient who is involved in a road traffic accident is suspected to have cervical injury (fracture+/-
dislocation). She became unresponsive about 20 minutes after admission to the Emergency
Department, and assessed to have a cardiopulmonary arrest. Which of the following management
strategies is not appropriate for immediate cervical stabilization to facilitate tracheal intubation.
a) manual-in-line axial stabilization
b) Philadelphia cervical collar
c) skull callipers and weights
d) emergency anterior and possibly posterior fusion
e) limited head and neck manipulation using rolls

15) A patient with multiple intestinal perforations secondary to gun shot to the abdomen, is scheduled
to undergo surgery. Which of the following antibiotics will offer the best coverage against
anaerobic organisms?
a) cefuroxime
b) ceftriaxone
c) augmentin
d) metronidazole
e) trimethoprim/sulphamethoxazole

30
16) A 15 year old patient with sickle cell disease has cholecystitis and is scheduled for urgent
cholecystectomy. Which of the following conditions is likely to cause sickling peri-operatively?
a) hyperoxia
b) hyperthermia
c) hypothermia
d) fluid overload
e) decreased urine output

17) Which of the following is the main reason for the administration of premedicant drug/s in the
above mentioned patient?
a) for the amnesic and vagolytic effects.
b) for the analgesic and anxiolytic effects.
c) to obtain deeper levels of anaesthesia
d) to decrease awareness peri-operatively.
e) avoidance or reduce doses of muscle relaxants.

18) Spinal anaesthesia is usually performed with “spinal/heavy” bupivacaine. Which of the following
statements about the preparation available at this hospital if correct?
a) it is available as a 3-ml ampoule of a 0.5% solution
b) it is available as a 2-ml ampoule of a 5.0% solution
c) it is available as a 4-ml ampoule of a 0.5% solution
d) sodium bicarbonate is added to make it hyperbaric to the CSF
e) the specific gravity enables more blockade of the non-dependent area

19) Which of the following represents the amount of bupivacine available in the ampoule for spinal
anaesthesia?
a) 50mg
b) 40 mg
c) 35 mg
d) 20mg
e) 15mg

20) Local anaesthetic agents have their effects on which of the following?
a) nerve membrane
b) calcium channel
c) presynaptic nerve terminal
d) postsynaptic nerve terminal
e) gamma aminobutyric acid (GABA) receptor.

21) A 80 Kg patient with a pre-operative ASA score of 1 underwent myomectomy. Blood loss intra-
operatively was 1000mls and intravascular volume was adequately replaced. In the postanaesthesia
care room, the per-vaginal loss was estimated to be another 1000mls. Which of the following pairs
of physiological responses is not likely to be manifested?
a) increase in pulse rate and decrease conscious level
b) increase in pulse rate and decrease in urine output
c) decrease cardiac output but increase in pulse rate
d) decrease in blood pressure and pulse rate
e) increase in the central venous pressure and urine output
31
22) Which of the following CVP values is most likely for the patient above?
a) 0-6 cmH20
b) 8-10 cmH20
c) 11-15 cmH20
d) 16-20 cmH20
e) 21–25 cmH20

23) Which of the following statements about the capnography is the main reason for its use in
patients under anaesthesia?
a) to prevent rebreathing of carbon dioxide when the circle system is used
b) to confirm malignant hypertension as this is associated with high carbon dioxide
levels
c) to confirm or rule out venous air embolism
d) to prevent disconnection of the breathing circuit
e) to confirm or rule out endotracheal intubation

24) A patient who had an upper respiratory tract infection, fell from a building 50 feet high at the
construction site where he works. On examination in hospital, his respiratory rate was 8/minute,
pulse rate 40/minute and low volume. Sensations were impaired below the neck. Which of
the following conditions is the most likely diagnosis?
a) septic shock
b) spinal shock
c) traumatic shock
d) cardiogenic shock
e) anaphyllactic shock

25) What of the following management strategies is the first step in the emergency management of the
patient above should he deteriorate?
a) administer oxygen.
b) cardiac compression
c) secure intravenous access
d) secure a patent airway.
e) administer adrenaline

26) An 80 year old patient known to be hypertensive and diabetic with an abdominal aortic aneurysm
presented with an acute abdomen. He gives a history of a cardiac event 2 years previously, but is
unable to recall pertinent details about the diagnosis and treatment. A leaking of the aortic
aneurysm now diagnosed. An electrocardiogram (ECG) was not obtained prior to surgery, but
ECG (as well as other) monitoring were done intra-operatively. Which of the following
information is not usually obtained from the ECG intra-operatively?
a) heart block
b) acute ischaemia
c) ventricular size
d) hyperkalaemia
e) presence of a pacemaker

32
27) Which of the following physiologic conditions is a sign that the depth of general anaesthesia is
adequate for surgery?
a) eyelid movement
b) sweating
c) hypoventilation
d) limb movement
e) pupillary constriction

28) Which of the following cranial nerves is responsible for the last sense to disappear as a patient
becomes more deeply anaesthetized?
a) III
b) V
c) VII
d) VIII
e) IX

29) Which of the following analgesic agents is a cyclooxygenase-2 (COX-2) inhibitor and may
induce renal failure?
a) Diclofenac
b) Celecoxib
c) Paracetamol
d) Aspirin
e) Dexamethasone

30) Which of the following drugs has anti-inflammatory, analgesic and antiemetic properties?
f) Diclofenac
g) Colecoxib
h) Paracetamol
i) Aspirin
j) Dexamethasone

31) Which of the following antibiotics has neuromuscular blocking property and should be avoided
or administered cautiously in patients with impaired renal function, and which may augment the
effect of muscle relaxant/s administered intra-operatively?
a) Augmentin
b) Ampicillin
c) Penicillin
d) Gentamycin
e) Cefuroxime

32) A patient was brought to the Emergency Department having suspected to have taken an overdose
of her medications. Which of the following drug overdose is activated charcoal inappropriate as
part of the management?
a) phenobarbitone
b) salicylate
c) malathion
d) carbamezepine
e) digoxin

33
33) Which of the following clinical features or signs suggests that the patient above who has taken an
overdose of a drug, requires tracheal intubation?
a) seizures with a gag reflex
b) PaC02 < 40 mmHg
c) dysrrhythmias
d) unconsciousness
e) PaO2 > 70 mmHg

34) An asthmatic patient is on the operating table and is being prepared for the scheduled anaesthesia
and surgery. She complains of chest tightness but is not in respiratory distress. A few rhonchi are
heard on auscultation of the lung fields. Which of the following anaesthetic agents is best avoided
as it is likely to worsen this condition intra-operatively?
a) midazolam
b) propofol
c) ketamine
d) isoflurane
e) thiopentone

35) A severe allergic reaction intra-operatively, post-induction of anaesthesia may be diagnosed

because of which of the following clinical signs?
a) skin wheals and hypotension
b) tachycardia and hypertension
c) erythemia and wheals along the vein
d) cardio-vascular instability
e) rhonchi and crepitations

36) A patient developed massive bleeding during surgery for the excision of a retroperitoneal
tumour. She continues to bleed postoperatively even though six (6) units of blood was transfused.
Which of the following blood result is not in keeping with the suspected diagnosis of
disseminated intravascular coagulation?
a) decreased fibrin degradation product
b) decreased fibrinogen
c) prolonged prothrombin time
d) increased D-dimer
e) increased platelet count

37) Which of the following diagnosis cannot be made from an analysis of arterial blood gases?
a) metabolic alkalosis
b) respiratory acidosis
c) type 2 respiratory failure
d) hypochloraemic alkalosis
e) compensated metabolic acidosis

38) Which of the following oxygen delivery apparatuses is a fixed performance system?
a) face mask
b) nasal cannula
c) head box
d) oxygen tent
e) ventimask
34
39) Which of the following oxygen delivery systems is best for a COPD patient post- operatively?
a) face mask with rebreathing bag
b) nasal cannula with high flow oxygen
c) tracheal intubation and mechanical ventilation
d) face mask with oxygen flow at least 10 ml/hour
e) ventimask with oxygen flow set as rcommended

40) A patient who is fearful of transfusion related infection has refused blood transfusion. She is
scheduled to undergo excision of a thoracic tumour. Which of the following management strategies
is most beneficial in reducing blood loss intra-operatively?
a) erythropoietin pre-operatively
b) hypotensive anaesthesia
c) regional anaesthesia technique/s
d) normovolaemic haemodilution
e) used of diathermy

41) Which of the following about the laryngeal mask airway (LMA) is correct?
a) protects the airway from aspiration
b) causes less physiological disturbance than an endotracheal tube
c) should only be used in adult because of the anatomy of the airway
d) has no place in the management of a difficult airway
e) is associated with a high incidence of aspiration

42) A 30 year old male patient was admitted after being severely beaten by a known assailant. On
admission he had periorbital discoloration, and drainage from the ear and nose. He responds to
command by incomprehensible speech, flexes to pain , but does not open his eyes. Which of the
following is the appropriate Glasgow coma score for him?
a) 11
b) 9
c) 7
d) 5
e) 3

43) Which of the following management decisions is inappropriate for the patient above?
a) X-ray of head and neck
b) Emergency computed tomographic scan
c) Book patient for emergency neurosurgery
d) Passage of a nasogastric tube
e) Prophyllactic antibiotic therapy

44) Which of the following conditions is not likely to cause marked restlessness or hypertension post-
operatively?
a) pain
b) anxiety
c) poor positioning
d) distended urinary bladder
e) adequate reversal of muscle relaxants

35
45) The recovery room/post anaesthesia care unit nurse called for assessment of an elderly patient
about whom she had some concerns. 75 mg of Pethidine was administered intramuscularly about
20 minutes ago when she complained of pain. Oxygen therapy was still in progress. Her cardio-
respiratory status was clinically assessed and an arterial blood sample sent for analysis. The
results were: PaO2 65 mmHg; PaCO2 – 75.5 mmHg; pH - 7.20; SaO2 – 85% and base excess +2.
Which of the following is correct regarding the acid-base status of the patient?
a) respiratory alkalosis
b) respiratory acidosis
c) metabolic acidosis
d) mixed respiratory-metabolic acidosis
e) compensated metabolic acidosis

46) Which of the following treatment strategies is most appropriate for the patient above?
a) discontinue oxygen therapy
b) administer flumazenil
c) administer nalaxone
d) administer sodium bicarbonate
e) tracheal intubation and manual ventilation

47) Which of the following clinical conditions is the most likely cause of pulseless electrical activity
in a patient with end stage renal failure who missed two dialysis sessions and now requires
emergency anaesthesia and surgery for repair of fractures sustained in a road traffic accident?
a) hypothermia
b) severe hypoxia
c) hyperkalaemia
d) severe hypercarbia
e) severe hypervolaemia

48) For which of the following administrations is a CVP catheter not necessary?
a) incompatible drugs
b) hyperalimentation
c) high dose potassium chloride
d) multiple anaesthesia agents
e) fluids and assessment of intravascular volume status

49) Which of the following statement regarding body fluid is true?

a) total body water comprises ~70% of the body weight in an adult patient
b) a preterm as compared to a term infant has a lower percent of the body weight as water
c) obese women have a higher percentage of their body weight as water
d) the volume of the extracellular fluid (ECF) compartment is 2/3rd. of the body water.
e) plasma volume in an adult is 3-3.5 liters.

50) Bioethical principles by which medicine must be practised include all except which of the
following?
a) legal competence
b) distributive justice
c) patient’s autonomy
d) non-maleficience
e) beneficence
36
 ANWERS

1. D 15. D 29 B 43 D
2. A 16 C 30 E 44 E
3. B 17 B 31 D 45 B
4. C 18 C 32 C 46 C
5. C 19 D 33 D 47 C
6. A 20 A 34 E 48 D
7. B 21 D 35 A 49 E
8. D 22 A 36 A? 50 A
9. B 23 E 37 E
10. E 24 B 38 E
11. B 25 D 39 E
12. D 26 C 40 E
13. A 27 E 41 B
14. D 28 D 42 B?

37
 15. Alternate questions
Q3

A 20 year old male patient presents with a 24 hour history of central abdominal pain,
vomiting, diarrhoea and fever. On examination he is moderately dehydrated with mild
abdominal distension and rebound tenderness. He is scheduled for emergency laparotomy.
Which of the following management decisions will increase his risk of developing
Mendelson’s syndrome?
a) Delayed surgery
b) Preinduction suction of the nasogastric tube
c) Rapid sequence induction of anaesthesia
d) Criocoid pressure post indcution
e) Manual ventilation post induction

A 60 year old male presents with a 3-day history of abdominal distension, constipation and no flatus.
On examination he is moderately dehydrated, ill-looking, febrile, and has marked abdominal distension
and rebound tenderness. He is scheduled for emergency laparotomy. Which of the following
management decisions will decrease his risk of developing Mendelson’s syndrome and is appropriate
for the patient?
f) Delayed surgery
g) Oral ranitidine
h) Nasogastric tube suctioned and spigotted
i) Rapid sequence induction of anaesthesia
j) Manual ventilation post induction

39). Which of the following is correct regarding a patient being prepared for regional
anaesthesia?
f) full history and examination are unnecessary
g) personality of the patient does not affect the decision to proceed
h) one only needs to prepare drugs and equipment for the regional procedure
i) lack of consent by the patient is only a relative contraindication
j) a history of neurological disease may lead to a decision not to proceed

40). Following spinal anaesthesia for Caesarian section, the patient complains of difficulty breathing
and becomes unconscious. Which of the following suggests a total spinal blockade?
a) bronchospasm
b) hypothermia.
c) hypotension
d) tachycardia
e) convulsions

41). Which of the following is the most appropriate drug to administer to counteract the cardiovascular
effects associated with a high spinal blockade?
a) dopamine
b) ephedrine
c) adrenaline
d) noradrenaline
e) isoprenaline

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