CME—Education and Self-Assessment

Current Anaesthesia & Critical Care (2002) 13, 229^231 doi:10.1054/cacc.2002.0412, available online at http://www.idealibrary.com on

CME

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Education and Self-Assessment MCQs and SelfAssessment The answers to these MCQs will be published in the next issue.

Question 3 Answer True or False. Multiple organ failure: a) Is the most common cause of death in intensive care

Question 1

b) Septicaemia is the most common presentation

Answer True or False. Hospital-acquired infections:

c) Occurs when normal organ homeostasis cannot be maintained by the patient

a) Occur in 10% of all ITU admissions b) Are directly related to the age of the patient c) Is related to poor hand-washing practice d) Is greatly exacerbated by endotracheal intubation e) Selective decontamination of the gut has proven bene¢ts

Question 2 Answer True or False. Concerning the scoring systems used in ITU: a) Apache III is a simpli¢ed version of Apache II b) The greater the Apache score, the better the prognosis c) Scoring systems are now capable of being used to direct individual patient management d) The Simpli¢ed Acute Physiology Score is derived from 17 variables e) A lung injury score of 3 is indicative of mild-to-moderate lung injury

c) Is seen in pericardial tamponade d) Occurs in a pneumothorax e) Only a¡ects the right side of the heart

Question 6 Answer True or False. Type 2 respiratory failure: a) Leads to hypercapnia

d) Is closely associated with cytokine release

b) Is commonly caused by morbid obesity

e) May only occur in one system

c) Is commonly caused by acute lung injury

Question 4

d) Rarely occurs as an acute progression from type 1 failure

Answer True or False. Concerning the use of antibiotics in critical care: a) Cost is an important factor in the choice of antibiotic b) Gram-negative bacteria are a major problem in intensive care units c) Resistant fungal sepsis in still uncommon d) Di¡erentiation between infection and colonization is often very di⁄cult e) Hospital antibiotic policies have little impact on the emergence of resistant organisms

e) Occurs in patients with neuromuscular problems

Question 7 AnswerTrue or False.The following ‘initial’ ventilator settings are appropriate for intensive care: a) Respiratory rate of15 breaths per minute b) An inspiratory £ow rate of 60l/min c) A PEEP of 0 d) Tidal volumes of 15 ml/kg

Question 5

e) An I: E ratio of 1:2

Answer True or False. Obstructive shock:

Question 8

a) Is common

AnswerTrue or False. Liver failure:

b) May be due to a pulmonary embolism

a) Can be classi¢ed using the ChildPugh system

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b) Is rarely caused by ischaemia c) Encephalopathy is associated with a normal intracranial pressure

CURRENT ANAESTHESIA & CRITICAL CARE

b) Uses the volume of oxygen consumed c) Estimates the volume of carbon dioxide produced

d) N-acetylcysteine should be given prophylactically

d) Both inspired and expired minute volumes must be measured

e) May lead to an ARDS-like syndrome

e) The energy expended is calculated with the de Weir formula

Question 9 Answer True or False. Sedation on ITU: a) Accumulation of active metabolites is a problem with the benzodiazepines b) The pethidine metabolite norpethidine is a CNS sedative c) Clearance of fentanyl after prolonged infusion is prolonged d) The Ramsay sedation scale has two levels of assessment e) Sedation usually provides adequate analgesia unless painful stimuli are imposed

Answer True or False. Indications for neuro-muscular blockade in critical care include: a) Patients with high oxygen requirements b) Acute intubation and stabilization c) Tetanus d) Inappropriately high respiratory drive e) Reduction of the rate of sedative agent administration

Answer True or False. Concerning Malaria:

a) Measures the rate of oxidation of metabolic substrates

c) Hypothermia is a common complication d) Muscle rigidity if present responds to dantrolene e) Water intoxication is common after amphetamine overdosage

Question 15 AnswerTrue or False. Botulism:

a) Hyponatraemia is common

a) Is rarely lethal

b) Patients with Plasmodium falciparum have paroxysms of fever

b) Is a food-borne disease

c) Cerebral malaria causes seizures

c) Can cause parasympathetic symptoms

d) Leucocytosis is a feature of malaria

d) Late onset cases are usually more seriously ill

e) An exchange transfusion may be necessary if the patient is severely ill

e) Magnesium protects against the e¡ect of the toxin

Question 16 Answer True or False. With regard to multiple trauma: a) Hypothermia frequently masks hypovolaemia b) Tissue oxygen debt does not lead to late onset organ dysfunction c) A haemoglobin of 8 g/dl 1 is an acceptable level for oxygen delivery d) Rhabdomyolysis may occur following limb injuries e) Prophylactic antibiotics are of limited use

AnswerTrue or False.The following are common nephrotoxins: a) Phenytoin b) Propofol c) Radiographic contrast d) Narcotics e) Herbal medicines

Question 17 AnswerTrue or False.The following are recognized features of a pulmonary embolism: a) Pleuritic chest pain b) A normal chest X-ray

Question 11 Answer True or False. Indirect calorimetry:

b) Increase central dopamine release

Question 12

Question 13 Question 10

a) May lead to hallucinations

Question 14 Answer True or False. Overdosage with amphetamine or related compounds:

c) Preference for sitting upright d) ECG signs of left ventricular strain e) Raised levels of D-dimers

CME ^ EDUCATION AND SELF-ASSESSMENT

Question 18 AnswerTrue or False. Aprotinin: a) Is a synthetic speci¢c protease inhibiitor b) Its e¡ects are concentration dependent

d) Correlates with the xenon method of calculating cerebral blood £ow e) Is stable during patient motion

Short Answer Questions Write short notes on:

d) Has a half-life of 4 h

1) Anaesthesia for removal of Phaeochromocytoma

Question 19 AnswerTrue or False.The following are used as neuroprotective agents: a) Frusemide b) Nimodepine

2) Measures that can be taken to minimize central venous catheter-related infections 3) List the potential neurological complications arising from obstetric regional anaesthesia 4) The physiological roles of albumin

Clinical Scenario

c) Dexamethasone

Clinical Scenario 1

d) Midazolam

You are in the obstetric theatre caring for a lady having a routine Caesarean section under epidural anaesthesia.The baby is delivered and has an immediate apgar score of 7.The midwife suddenly notices that the baby goes blue and apnoeic when its mouth is closed.There is no paediatrician present because of an emergency in the next theatre. The midwife asks for your help and advice.

e) Morphine

Question 20 Answer True or False. Nearinfra-red spectroscopy: a) Uses light in the 1000 ^1200 nm wavelength b) Measures cytochrome aa3 concentrations c) Measures myoglobin

3. Describe the condition embryologically. 4. What pre-operative investigations are necessary? 5. What is the surgical treatment?

c) It causes kallikrein inhibition

e) Prevents inappropriate platelet activation by Cathepsin G

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6. Describe a safe anaesthetic technique

Clinical Scenario 2 A 40 -year-old man is scheduled on your list for uvulopharyngopatatoplasty [UPPP]. He was found to be mildly hypertensive on clerking [170/110], and his haemoglobin is raised at 18 g/dl. His body mass index [BMI] is 40.When you see him pre-operatively you ¢nd him asleep. He is making severe paradoxical attempts to breathe, and gasps into wakefulness as you arrive at his bed.While you question him you notice that he is still struggling to stay awake.

1. What is the likeliest diagnosis? 2. What is the calculation for the BMI? 3. What are the anaesthetic problems of patients with this problem? 4. What would you do tonight?

1. What is the likely cause?

5. What formal investigations are necessary?

2. What is the immediate treatment?

6. What is the appropriate treatment of this man?