- Email: [email protected]
Multiple Choice Questions
Multiple Choice Questions
Intervertebral disc as a source of pain 1. The most appropriate statements concerning intervertebral discs include:
(a) Red flag symptoms include fever, weight loss, weakness in the limb, loss of bladder or bowel control, pain worse at night and saddle anaesthesia. (b) The MRI scan may reveal a prolapse of the L4 intervertebral disc. (c) Conservative management is likely to include simple analgesics and physiotherapy. (d) The symptoms are unlikely to resolve without surgery. (e) The MRI scan report notes mild disc dehydration and minor facet osteoarthritis at several lumbar levels. Her general practitioner reassures the patient these findings are ‘normal’.
2. The most appropriate statements regarding degenerative disc disease (DDD) include: (a) DDD occurs principally as a result of the ageing process. (b) The incidence of DDD in smokers is similar to that in non-smokers. (c) The aetiology of DDD is likely to be multifactorial. (d) DDD is associated with characteristic changes on magnetic resonance imaging. (e) Magnetic resonance images correlate strongly with clinical symptoms. 3. The most appropriate statements regarding the management of discogenic pain syndromes include: (a) Intradiscal chymopapain reduces inflammation within the target disc. (b) Epidural steroids are used to reduce the symptoms of discogenic pain. (c) Annuloplasty techniques are designed to reduce disc volume. (d) Nucleoplasty techniques aim to reduce nociceptor activity within target discs. (e) In the long term, conservative therapy may be as effective as surgical alternatives. 4. A 48-year-old woman presents with acute low central lumbar pain. This pain radiates down the back of her right leg to the outer aspect of her foot. Her symptoms are exacerbated by raising an extended leg beyond 308 and by bending forward. Her general
322
Predicting neurological outcome and survival after cardiac arrest 5. The most appropriate statements regarding cardiac arrests include: (a) Survival after all out-of-hospital cardiac arrests is expected to be 20%. (b) For all types of cardiac arrest, pulseless electrical activity is associated with the best outcome. (c) Immediately after the return of cardiac output, fixed dilated pupils indicate a poor prognosis. (d) Within 20 s of cardiac arrest, glucose and adenosine triphosphate stores are depleted. (e) Restoration of blood flow after cardiac arrest regenerates adenosine triphosphate stores and leads to further free radical formation. 6. A 70-year-old patient is managed by therapeutic hypothermia after cardiac arrest in hospital. Factors associated with a high specificity for poor neurological outcome are likely to include: (a) A bispectral index (BIS) of ,22 recorded 3 days after cardiac arrest. (b) Bilateral absence of N20 somatosensory evoked potentials after rewarming. (c) Absence of motor response to pain 3 days after cardiac arrest.
doi:10.1093/bjaceaccp/mks053 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 12 Number 6 2012 # The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
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(a) Each disc is composed of a nucleus pulposus and an annulus fibrosus. (b) Collagen fibres within the annulus are responsible mainly for maintaining disc hydration. (c) The nucleus pulposus contains the inflammatory cytokines interleukin-1 and tumour necrosis factor a (TNF-a). (d) Intervertebral discs are innervated by branches of the relevant spinal nerve. (e) In the normal disc, nerve fibres may be found in all parts of the disc.
practitioner checks for ‘red flag’ symptoms, requests magnetic resonance imaging (MRI) and advises conservative management. The most appropriate statements regarding this scenario include:
Multiple Choice Questions
(d) Absent pupillary reflexes 3 days after cardiac arrest. (e) Duration of cardiac arrest .20 min. 7. The most appropriate statements regarding somatosensory evoked potentials (SSEPs) include: (a) SSEPs are unlikely to require expert interpretation. (b) The median nerve is stimulated routinely. (c) Electrodes placed near the brachial plexus and cervical cord are unlikely to be required. (d) SSEP testing can be performed using a standard nerve stimulator as used in regional anaesthesia. (e) SSEPs are less likely to predict poor neurological outcome than raised blood levels of neurone-specific enolase.
(a) TH is performed for 48 –72 h. (b) Cooling occurs to a temperature of 30–328C. (c) TH prevents the secondary brain injury that occurs as a result of brain reperfusion. (d) There is level 1 evidence for implementing TH after cardiac arrests in which the primary rhythm is asystole. (e) Increased levels of neurone-specific enolase are expected after TH.
(a) Opioid analgesia is required. (b) A nasal mask is traditionally used with the child in the supine position. (c) Cardiac arrhythmias occur during administration of sevoflurane. (d) Insertion of a throat pack is unlikely to be required when a laryngeal mask is in situ. (e) Injury to the cervical spine may occur as a complication of intraoperative positioning. 12. Effective local anaesthesia in a healthy 6-year-old girl requiring dental treatment: (a) Is affected by the increased bone density in comparison with healthy adults. (b) Is associated with slower onset of action than in adults. (c) Is unlikely to be achieved in the presence of infection. (d) Is associated with cardiac arrest. (e) Is associated with trauma to the face.
Anaesthesia for paediatric dentistry
Aortic valve stenosis: perioperative anaesthetic implications of surgical replacement and minimally invasive interventions
9. A 12-year-old girl requires the extraction of two permanent upper molars. The most appropriate statements include:
13. In an 85-year-old patient with severe symptomatic aortic stenosis:
(a) General anaesthesia for this procedure should be administered by an anaesthetist in the primary dental care setting. (b) If the child has congenital deafness there is a greater indication for general anaesthesia than if the child has normal hearing. (c) General anaesthesia for this procedure is likely to be contraindicated if the child suffers from a coagulation disorder. (d) Antibiotic prophylaxis is required if the child is known to have an isolated atrial septal defect. (e) A child with normal development is more likely to require general anaesthesia at age 12 years than at 7 years.
(a) Aortic valve replacement is recommended. (b) Balloon aortic valvuloplasty is recommended as initial treatment if the left ventricular ejection fraction is ,30%. (c) Medical therapy for symptom control improves prognosis. (d) Multidisciplinary team involvement is usually indicated before a decision not to offer surgery on the basis of prohibitive perioperative risk. (e) Transcatheter aortic valve implantation is the intervention of choice from the year 2012
10. Conscious sedation in a 14-year-old boy requiring dental treatment: (a) (b) (c) (d)
Is useful when local anaesthesia is contraindicated. Is associated with purposeful response to verbal commands. Is likely to require the use of simple airway adjuncts. Should typically involve the use of oral midazolam as the first choice of sedative agent. (e) May be delivered by the operating dentist.
14. In a 74-year-old 140 kg male with a history of syncope, dyspnoea and aortic stenosis, the most appropriate statements include: (a) Aortic valve replacement is recommended if the mean valve gradient across the aortic valve is .40 mm Hg and left ventricular ejection fraction is ,50%. (b) Aortic valve replacement is recommended if valve area is 0.9 cm2, even if the mean gradient measured is 20 mm Hg. (c) Transcatheter aortic valve implantation may be preferred to surgical aortic valve replacement in the presence of endstage liver disease.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
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8. The most appropriate statements regarding therapeutic hypothermia (TH) include:
11. A healthy 5-year-old boy requires general anaesthesia for uncomplicated extraction of six deciduous teeth. The most appropriate statements include:
Multiple Choice Questions
(d) A measured aortic valve area of 1.2 cm2 on echocardiography excludes severe aortic stenosis. (e) Elective surgery should be postponed if intraoperative transoesophageal echocardiography quantifies aortic stenosis as moderate rather than severe. 15. Haemodynamic instability during transcatheter aortic valve implantation (TAVI):
(e) Nicorandil is a cardiac arterial dilator and peripheral venodilator. 19. A 68-yr-old male patient with chronic refractory angina presents for elective left inguinal hernia repair. He has a spinal cord simulator in situ. The most appropriate statements include:
16. When anaesthetizing patients with severe aortic stenosis, haemodynamic goals are likely to include:
20. The most appropriate statements regarding spinal cord stimulation (SCS) for patients with chronic refractory angina include:
(a) (b) (c) (d) (e)
Avoiding fluid boluses because of diastolic dysfunction. Attenuation of the stress response by heavy premedication. A slow heart rate of 55 beats min21. Maintenance of contractility by using inotropes. Maintenance of myocardial perfusion pressure by the use of vasopressors.
Chronic cardiac chest pain 17. The most appropriate statements regarding patients with chronic refractory angina include: (a) The estimated annual mortality rate is expected to be 7– 10%. (b) Patients are most likely to return to work within 1 year of the commencement of sickness absence. (c) In a week, 15 anginal attacks, often of Canadian Cardiovascular Society (CCS) class III–IV in severity are expected to occur. (d) Patients are most likely to be managed by procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). (e) Patients are unlikely to benefit from a psychoeducation programme for self-management of pain. 18. The most appropriate statements regarding optimal medical therapy in patients with chronic angina include: (a) Ivabradine is recommended as first-line therapy. (b) b-Blockers are used in combination with a calcium channel antagonist. (c) Ranolazine blocks slow calcium channels in the myocardium. (d) Statins are thought to reduce mortality.
324
(a) SCS is most often offered to patients within the first 6 months of the treatment of angina pectoris. (b) SCS involves implanting an electrode lead into the epidural space placed at the level of the seventh cervical vertebra (C7) to the fourth thoracic vertebra (T4). (c) SCS reduces anginal symptoms mainly by increased oxygen delivery by coronary vasodilation. (d) A successful trial of transcutaneous electric nerve stimulation (TENS) is a requirement before SCS insertion. (e) SCS works by the same mechanism as enhanced external counterpulsation.
Angio-oedema: an overview of differential diagnosis and clinical management 21. Angioedema is: (a) Associated with life-threatening airway swelling. (b) Likely to be due to an inherited defect. (c) Likely to be caused by excessive activation of the classic complement pathway. (d) Mediated by the release of histamine and bradykinin. (e) Associated with cardiovascular collapse. 22. In the treatment of hereditary angioedema: (a) Epinephrine, corticosteroids and antihistamines play an important role. (b) Infusion of plasma-derived C1 esterase inhibitor concentrates is recommended. (c) Fresh frozen plasma is likely to aggravate an acute attack. (d) Anabolic androgens are the agents of choice for long-term prophylaxis in children. (e) Tracheostomy is performed in severe cases.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
(a) Is frequently attributable to haemorrhage. (b) Is likely to be managed conservatively by observation. (c) Should be anticipated during induction of general anaesthesia. (d) Should be anticipated during rapid ventricular pacing. (e) Should not be managed with cardiopulmonary bypass owing to the poor perioperative risk profile.
(a) Preoperative cardiological referral is unlikely to be required in the presence of Canadian Cardiovascular Society Class III or IV symptoms. (b) A local or regional anaesthetic procedure is likely to be performed. (c) On the day of surgery, bisoprolol and ramipril are omitted. (d) There is likely to be an increased risk of infection after spinal block at the lumbar level, between vertebrae 3 and 4. (e) Monopolar diathermy is unlikely to be used by the surgeon.
Multiple Choice Questions
23. The most appropriate statements regarding anaesthesia in patients with hereditary angioedema include: (a) C1 inhibitor concentrate is administered around the time of surgery. (b) Dental procedures and surgery are likely to precipitate an attack. (c) Laryngeal mask airways are used safely for minor procedures. (d) Anaesthesia should be cancelled during menstruation. (e) Measurement of cuff leak pressure is likely to be a useful indicator of airway oedema. 24. Acquired angioedema:
Complex endovascular aortic aneurysm repair 25. Complex endovascular repair is most likely to: (a) Be considered in patients deemed unfit for open surgery. (b) Require the same degree of preoperative assessment as for open surgery. (c) Be associated with a similar degree of postoperative stress as open surgery. (d) Be performed under regional anaesthesia. (e) Lead to clinically significant postoperative coagulopathy. 26. After complex endovascular aneurysm repair, acute kidney injury is most likely to: (a) Require renal replacement therapy. (b) Occur when there is chronic kidney disease. (c) Be reduced by the administration of sodium bicarbonate therapy in low-risk patients. (d) Be observed in 40% of patients. (e) Be associated with a reduction in long-term survival. 27. After endovascular aneurysm repair, postimplantation syndrome is most likely to: (a) Be life-threatening. (b) Be an immune response. (c) Occur in ,5% of all cases undertaken worldwide.
28. The most appropriate statements regarding endovascular repair of juxtarenal aneurysms include: (a) Heparinization is most likely to be reversed with protamine at the end of the procedure. (b) Development of a type 1 endoleak is most likely to necessitate conversion to open surgery. (c) Endovascular repair is most likely to be offered to emergency patients. (d) N-acetylcysteine is most unlikely to reduce the incidence of contrast-induced nephropathy. (e) The result of a cardiopulmonary exercise test is the main factor determining the decision to repair an abdominal aortic aneurysm.
Anaesthesia for living donor renal transplant nephrectomy 29. Compared with cadaveric transplantation for end-stage renal failure, living donor renal transplantation is most likely to be preferred because: (a) There is time to optimize the recipient before surgery. (b) Graft survival is improved. (c) Organs for grafting are fully human leucocyte antigen (HLA)-compatible. (d) It is easier to find a matching organ in the living donor pool than in the cadaver donor pool. (e) Ischaemic time is minimized. 30. Anaesthetic interventions for donor nephrectomy are most likely to include: (a) Invasive blood pressure monitoring and central venous pressure monitoring. (b) Heparinization before clamping of the renal artery. (c) Large-bore venous access. (d) Paravertebral blockade. (e) Careful supine positioning. 31. The most likely postoperative complications in living donors include: (a) (b) (c) (d)
Thromboembolism. End-stage renal failure. Proteinuria of .300 mg day21. Hypertension (systolic blood pressure .145 mm Hg, diastolic blood pressure .95 mm Hg). (e) Decreased life-expectancy as a result of increased all-cause mortality.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
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(a) Most commonly presents in the first two decades of life. (b) Is associated with a positive family history. (c) Presents with the same clinical symptoms as hereditary angioedema. (d) Responds better to antifibrinolytic drugs than hereditary angioedema. (e) Is associated with haematological malignancy.
(d) Last for ,24 h. (e) Lead to multiorgan failure.
Multiple Choice Questions
32. The most appropriate statements regarding renal transplantation involving living donors include: (a) Compared with open surgery, laparoscopic techniques for harvesting a kidney from a living donor are shorter. (b) During organ harvesting, conversion to open surgery after initial laparoscopy occurs in at least 10% of cases.
(c) In the UK in 2012, .30% of all renal transplants are expected to involve a living donor. (d) Living donors are classed as ‘complicated’ when they require a right-sided nephrectomy (e) In the UK, anaesthesia for renal transplantation involving living donors is often performed by senior trainee anaesthetists with remote consultant supervision.
We no longer publish the answers to the MCQs in the journal. Instead, you are invited to take part in a web-based, self test. Please visit the journal web site: www.ceaccp.oxfordjournals.org to obtain a certificate and CME points.
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
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Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
Intervertebral disc as a source of pain 1. The most appropriate statements concerning intervertebral discs include:
(a) Red flag symptoms include fever, weight loss, weakness in the limb, loss of bladder or bowel control, pain worse at night and saddle anaesthesia. (b) The MRI scan may reveal a prolapse of the L4 intervertebral disc. (c) Conservative management is likely to include simple analgesics and physiotherapy. (d) The symptoms are unlikely to resolve without surgery. (e) The MRI scan report notes mild disc dehydration and minor facet osteoarthritis at several lumbar levels. Her general practitioner reassures the patient these findings are ‘normal’.
2. The most appropriate statements regarding degenerative disc disease (DDD) include: (a) DDD occurs principally as a result of the ageing process. (b) The incidence of DDD in smokers is similar to that in non-smokers. (c) The aetiology of DDD is likely to be multifactorial. (d) DDD is associated with characteristic changes on magnetic resonance imaging. (e) Magnetic resonance images correlate strongly with clinical symptoms. 3. The most appropriate statements regarding the management of discogenic pain syndromes include: (a) Intradiscal chymopapain reduces inflammation within the target disc. (b) Epidural steroids are used to reduce the symptoms of discogenic pain. (c) Annuloplasty techniques are designed to reduce disc volume. (d) Nucleoplasty techniques aim to reduce nociceptor activity within target discs. (e) In the long term, conservative therapy may be as effective as surgical alternatives. 4. A 48-year-old woman presents with acute low central lumbar pain. This pain radiates down the back of her right leg to the outer aspect of her foot. Her symptoms are exacerbated by raising an extended leg beyond 308 and by bending forward. Her general
322
Predicting neurological outcome and survival after cardiac arrest 5. The most appropriate statements regarding cardiac arrests include: (a) Survival after all out-of-hospital cardiac arrests is expected to be 20%. (b) For all types of cardiac arrest, pulseless electrical activity is associated with the best outcome. (c) Immediately after the return of cardiac output, fixed dilated pupils indicate a poor prognosis. (d) Within 20 s of cardiac arrest, glucose and adenosine triphosphate stores are depleted. (e) Restoration of blood flow after cardiac arrest regenerates adenosine triphosphate stores and leads to further free radical formation. 6. A 70-year-old patient is managed by therapeutic hypothermia after cardiac arrest in hospital. Factors associated with a high specificity for poor neurological outcome are likely to include: (a) A bispectral index (BIS) of ,22 recorded 3 days after cardiac arrest. (b) Bilateral absence of N20 somatosensory evoked potentials after rewarming. (c) Absence of motor response to pain 3 days after cardiac arrest.
doi:10.1093/bjaceaccp/mks053 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 12 Number 6 2012 # The Author [2012]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: [email protected]
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
(a) Each disc is composed of a nucleus pulposus and an annulus fibrosus. (b) Collagen fibres within the annulus are responsible mainly for maintaining disc hydration. (c) The nucleus pulposus contains the inflammatory cytokines interleukin-1 and tumour necrosis factor a (TNF-a). (d) Intervertebral discs are innervated by branches of the relevant spinal nerve. (e) In the normal disc, nerve fibres may be found in all parts of the disc.
practitioner checks for ‘red flag’ symptoms, requests magnetic resonance imaging (MRI) and advises conservative management. The most appropriate statements regarding this scenario include:
Multiple Choice Questions
(d) Absent pupillary reflexes 3 days after cardiac arrest. (e) Duration of cardiac arrest .20 min. 7. The most appropriate statements regarding somatosensory evoked potentials (SSEPs) include: (a) SSEPs are unlikely to require expert interpretation. (b) The median nerve is stimulated routinely. (c) Electrodes placed near the brachial plexus and cervical cord are unlikely to be required. (d) SSEP testing can be performed using a standard nerve stimulator as used in regional anaesthesia. (e) SSEPs are less likely to predict poor neurological outcome than raised blood levels of neurone-specific enolase.
(a) TH is performed for 48 –72 h. (b) Cooling occurs to a temperature of 30–328C. (c) TH prevents the secondary brain injury that occurs as a result of brain reperfusion. (d) There is level 1 evidence for implementing TH after cardiac arrests in which the primary rhythm is asystole. (e) Increased levels of neurone-specific enolase are expected after TH.
(a) Opioid analgesia is required. (b) A nasal mask is traditionally used with the child in the supine position. (c) Cardiac arrhythmias occur during administration of sevoflurane. (d) Insertion of a throat pack is unlikely to be required when a laryngeal mask is in situ. (e) Injury to the cervical spine may occur as a complication of intraoperative positioning. 12. Effective local anaesthesia in a healthy 6-year-old girl requiring dental treatment: (a) Is affected by the increased bone density in comparison with healthy adults. (b) Is associated with slower onset of action than in adults. (c) Is unlikely to be achieved in the presence of infection. (d) Is associated with cardiac arrest. (e) Is associated with trauma to the face.
Anaesthesia for paediatric dentistry
Aortic valve stenosis: perioperative anaesthetic implications of surgical replacement and minimally invasive interventions
9. A 12-year-old girl requires the extraction of two permanent upper molars. The most appropriate statements include:
13. In an 85-year-old patient with severe symptomatic aortic stenosis:
(a) General anaesthesia for this procedure should be administered by an anaesthetist in the primary dental care setting. (b) If the child has congenital deafness there is a greater indication for general anaesthesia than if the child has normal hearing. (c) General anaesthesia for this procedure is likely to be contraindicated if the child suffers from a coagulation disorder. (d) Antibiotic prophylaxis is required if the child is known to have an isolated atrial septal defect. (e) A child with normal development is more likely to require general anaesthesia at age 12 years than at 7 years.
(a) Aortic valve replacement is recommended. (b) Balloon aortic valvuloplasty is recommended as initial treatment if the left ventricular ejection fraction is ,30%. (c) Medical therapy for symptom control improves prognosis. (d) Multidisciplinary team involvement is usually indicated before a decision not to offer surgery on the basis of prohibitive perioperative risk. (e) Transcatheter aortic valve implantation is the intervention of choice from the year 2012
10. Conscious sedation in a 14-year-old boy requiring dental treatment: (a) (b) (c) (d)
Is useful when local anaesthesia is contraindicated. Is associated with purposeful response to verbal commands. Is likely to require the use of simple airway adjuncts. Should typically involve the use of oral midazolam as the first choice of sedative agent. (e) May be delivered by the operating dentist.
14. In a 74-year-old 140 kg male with a history of syncope, dyspnoea and aortic stenosis, the most appropriate statements include: (a) Aortic valve replacement is recommended if the mean valve gradient across the aortic valve is .40 mm Hg and left ventricular ejection fraction is ,50%. (b) Aortic valve replacement is recommended if valve area is 0.9 cm2, even if the mean gradient measured is 20 mm Hg. (c) Transcatheter aortic valve implantation may be preferred to surgical aortic valve replacement in the presence of endstage liver disease.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
323
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
8. The most appropriate statements regarding therapeutic hypothermia (TH) include:
11. A healthy 5-year-old boy requires general anaesthesia for uncomplicated extraction of six deciduous teeth. The most appropriate statements include:
Multiple Choice Questions
(d) A measured aortic valve area of 1.2 cm2 on echocardiography excludes severe aortic stenosis. (e) Elective surgery should be postponed if intraoperative transoesophageal echocardiography quantifies aortic stenosis as moderate rather than severe. 15. Haemodynamic instability during transcatheter aortic valve implantation (TAVI):
(e) Nicorandil is a cardiac arterial dilator and peripheral venodilator. 19. A 68-yr-old male patient with chronic refractory angina presents for elective left inguinal hernia repair. He has a spinal cord simulator in situ. The most appropriate statements include:
16. When anaesthetizing patients with severe aortic stenosis, haemodynamic goals are likely to include:
20. The most appropriate statements regarding spinal cord stimulation (SCS) for patients with chronic refractory angina include:
(a) (b) (c) (d) (e)
Avoiding fluid boluses because of diastolic dysfunction. Attenuation of the stress response by heavy premedication. A slow heart rate of 55 beats min21. Maintenance of contractility by using inotropes. Maintenance of myocardial perfusion pressure by the use of vasopressors.
Chronic cardiac chest pain 17. The most appropriate statements regarding patients with chronic refractory angina include: (a) The estimated annual mortality rate is expected to be 7– 10%. (b) Patients are most likely to return to work within 1 year of the commencement of sickness absence. (c) In a week, 15 anginal attacks, often of Canadian Cardiovascular Society (CCS) class III–IV in severity are expected to occur. (d) Patients are most likely to be managed by procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG). (e) Patients are unlikely to benefit from a psychoeducation programme for self-management of pain. 18. The most appropriate statements regarding optimal medical therapy in patients with chronic angina include: (a) Ivabradine is recommended as first-line therapy. (b) b-Blockers are used in combination with a calcium channel antagonist. (c) Ranolazine blocks slow calcium channels in the myocardium. (d) Statins are thought to reduce mortality.
324
(a) SCS is most often offered to patients within the first 6 months of the treatment of angina pectoris. (b) SCS involves implanting an electrode lead into the epidural space placed at the level of the seventh cervical vertebra (C7) to the fourth thoracic vertebra (T4). (c) SCS reduces anginal symptoms mainly by increased oxygen delivery by coronary vasodilation. (d) A successful trial of transcutaneous electric nerve stimulation (TENS) is a requirement before SCS insertion. (e) SCS works by the same mechanism as enhanced external counterpulsation.
Angio-oedema: an overview of differential diagnosis and clinical management 21. Angioedema is: (a) Associated with life-threatening airway swelling. (b) Likely to be due to an inherited defect. (c) Likely to be caused by excessive activation of the classic complement pathway. (d) Mediated by the release of histamine and bradykinin. (e) Associated with cardiovascular collapse. 22. In the treatment of hereditary angioedema: (a) Epinephrine, corticosteroids and antihistamines play an important role. (b) Infusion of plasma-derived C1 esterase inhibitor concentrates is recommended. (c) Fresh frozen plasma is likely to aggravate an acute attack. (d) Anabolic androgens are the agents of choice for long-term prophylaxis in children. (e) Tracheostomy is performed in severe cases.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
(a) Is frequently attributable to haemorrhage. (b) Is likely to be managed conservatively by observation. (c) Should be anticipated during induction of general anaesthesia. (d) Should be anticipated during rapid ventricular pacing. (e) Should not be managed with cardiopulmonary bypass owing to the poor perioperative risk profile.
(a) Preoperative cardiological referral is unlikely to be required in the presence of Canadian Cardiovascular Society Class III or IV symptoms. (b) A local or regional anaesthetic procedure is likely to be performed. (c) On the day of surgery, bisoprolol and ramipril are omitted. (d) There is likely to be an increased risk of infection after spinal block at the lumbar level, between vertebrae 3 and 4. (e) Monopolar diathermy is unlikely to be used by the surgeon.
Multiple Choice Questions
23. The most appropriate statements regarding anaesthesia in patients with hereditary angioedema include: (a) C1 inhibitor concentrate is administered around the time of surgery. (b) Dental procedures and surgery are likely to precipitate an attack. (c) Laryngeal mask airways are used safely for minor procedures. (d) Anaesthesia should be cancelled during menstruation. (e) Measurement of cuff leak pressure is likely to be a useful indicator of airway oedema. 24. Acquired angioedema:
Complex endovascular aortic aneurysm repair 25. Complex endovascular repair is most likely to: (a) Be considered in patients deemed unfit for open surgery. (b) Require the same degree of preoperative assessment as for open surgery. (c) Be associated with a similar degree of postoperative stress as open surgery. (d) Be performed under regional anaesthesia. (e) Lead to clinically significant postoperative coagulopathy. 26. After complex endovascular aneurysm repair, acute kidney injury is most likely to: (a) Require renal replacement therapy. (b) Occur when there is chronic kidney disease. (c) Be reduced by the administration of sodium bicarbonate therapy in low-risk patients. (d) Be observed in 40% of patients. (e) Be associated with a reduction in long-term survival. 27. After endovascular aneurysm repair, postimplantation syndrome is most likely to: (a) Be life-threatening. (b) Be an immune response. (c) Occur in ,5% of all cases undertaken worldwide.
28. The most appropriate statements regarding endovascular repair of juxtarenal aneurysms include: (a) Heparinization is most likely to be reversed with protamine at the end of the procedure. (b) Development of a type 1 endoleak is most likely to necessitate conversion to open surgery. (c) Endovascular repair is most likely to be offered to emergency patients. (d) N-acetylcysteine is most unlikely to reduce the incidence of contrast-induced nephropathy. (e) The result of a cardiopulmonary exercise test is the main factor determining the decision to repair an abdominal aortic aneurysm.
Anaesthesia for living donor renal transplant nephrectomy 29. Compared with cadaveric transplantation for end-stage renal failure, living donor renal transplantation is most likely to be preferred because: (a) There is time to optimize the recipient before surgery. (b) Graft survival is improved. (c) Organs for grafting are fully human leucocyte antigen (HLA)-compatible. (d) It is easier to find a matching organ in the living donor pool than in the cadaver donor pool. (e) Ischaemic time is minimized. 30. Anaesthetic interventions for donor nephrectomy are most likely to include: (a) Invasive blood pressure monitoring and central venous pressure monitoring. (b) Heparinization before clamping of the renal artery. (c) Large-bore venous access. (d) Paravertebral blockade. (e) Careful supine positioning. 31. The most likely postoperative complications in living donors include: (a) (b) (c) (d)
Thromboembolism. End-stage renal failure. Proteinuria of .300 mg day21. Hypertension (systolic blood pressure .145 mm Hg, diastolic blood pressure .95 mm Hg). (e) Decreased life-expectancy as a result of increased all-cause mortality.
Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012
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(a) Most commonly presents in the first two decades of life. (b) Is associated with a positive family history. (c) Presents with the same clinical symptoms as hereditary angioedema. (d) Responds better to antifibrinolytic drugs than hereditary angioedema. (e) Is associated with haematological malignancy.
(d) Last for ,24 h. (e) Lead to multiorgan failure.
Multiple Choice Questions
32. The most appropriate statements regarding renal transplantation involving living donors include: (a) Compared with open surgery, laparoscopic techniques for harvesting a kidney from a living donor are shorter. (b) During organ harvesting, conversion to open surgery after initial laparoscopy occurs in at least 10% of cases.
(c) In the UK in 2012, .30% of all renal transplants are expected to involve a living donor. (d) Living donors are classed as ‘complicated’ when they require a right-sided nephrectomy (e) In the UK, anaesthesia for renal transplantation involving living donors is often performed by senior trainee anaesthetists with remote consultant supervision.
We no longer publish the answers to the MCQs in the journal. Instead, you are invited to take part in a web-based, self test. Please visit the journal web site: www.ceaccp.oxfordjournals.org to obtain a certificate and CME points.
Downloaded from http://ceaccp.oxfordjournals.org/ by guest on September 1, 2015
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Continuing Education in Anaesthesia, Critical Care & Pain j Volume 12 Number 6 2012