Multiple Choice Questions

58. The glomerular filtrate: mismatch rather than diffusion across alveolar capillaries.
(a) Passes through two layers to enter Bowmans capsule. (d) Does not bind to iron atoms in the ferric state.
(b) Contains albumen. (e) Scarcity is responsible for the green house effect.
(c) Allows the passage of molecules less than 70 kDa.
64. Oxygen toxicity:
(d) Contains glucose in a concentration similar to that in
the afferent arteriole. (a) May cause convulsions.
(e) Is produced at a rate of 200 ml min1. (b) May result from damage to sulphydryl-containing
enzymes.
59. Mannitol: (c) May occur after 10 h of exposure at 1 atmosphere pres-
(a) Is a plant derivative. sure.
(b) Reduces the effective sodium concentration in the renal (d) Is treated by xanthene oxidase inhibitors.
tubule. (e) Occurs mainly via superoxide anions in humans.
(c) Increases blood viscosity.
65. Blind nasal intubation is contra-indicated in the
(d) Increases the amount of water more than the amount of
following circumstances:
sodium excreted.
(e) Should be used with furosemide in rhabdomyolysis. (a) Horizontal fracture of the lower maxilla.
(b) Le Fort III facial fractures.
60. Bumetanide: (c) In the presence of Battles sign.
(a) Inhibits the Na+K+2Cl co-transporter in the descending (d) In the presence of Cullens sign.
loop of Henle. (e) In the presence of peri-orbital haematoma, but normal
(b) Is secreted into the tubular lumen. skull X-rays.
(c) Increases oxygen consumption in the nephron.
66. The following are indications for urgent endotra-
(d) Can reduce ventricular preload.
cheal intubation:
(e) Causes a metabolic acidosis.
(a) Glasgow Coma Score less than 10.
61. Thiazide diuretics: (b) Glasgow Coma motor score of 2.
(a) Are vasodilators. (c) Le Fort III facial fractures.
(b) Affect chloride transport in the distal tubule. (d) Patient agitation when supine.
(c) Can reduce plasma cholesterol. (e) Facial surgical emphysema.
(d) Are indicated for treatment of ascites in liver failure.
67. In the UK, isolated Le Fort fractures are
(e) May cause gout.
commonly associated with the following
62. The P50 of the haemoglobin oxygen complications:
dissociation curve: (a) Airway obstruction.
(a) Increases in acidosis. (b) Cervical spine injury.
(b) Is affected by carbon monoxide. (c) Life-threatening haemorrhage.
(c) For myoglobin is less than that for haemoglobin. (d) Intracranial hypertension.
(d) May be related to glycolysis within erythrocytes. (e) Negative pressure pulmonary oedema.
(e) Alters with changes in haemoglobin concentration.
68. The following statements are true:
63. Oxygen: (a) All complex facial fractures should be surgically repaired
(a) Is an inert gas. within 24 h of injury.
(b) Is a paramagnetic gas. (b) Trismus is a contra-indication to using the intravenous
(c) Alveolar-arterial gradient usually reflects regional V/Q route for induction of anaesthesia.

British Journal of Anaesthesia | CEPD Reviews | Volume 1 Number 4 2001

The Board of Management and Trustees of the British Journal of Anaesthesia 2001 125
Multiple choice questions and answers
(c) Intermaxillary fixation (IMF) may allow adequate mouth
opening at the end of operation.
(d) Submental intubation is a recognised alternative to tra-
cheostomy in some elective maxillofacial trauma.
(e) Submental intubation is associated with more anaerobic
infections than standard tracheostomy.
69. First aid
(a) Wet towels are an effective way of cooling the burn
wound.
(b) Ice packs are used to cool the burn wound and stop the
burning process.
(c) Human albumin solution is the most popular resuscitation
fluid.
(d) To extinguish burning clothing the victim should be rolled
on the ground.
(e) Cling film is a useful emergency dressing.
70. Intravenous fluid resuscitation
(a) Is unnecessary for superficial burns.
(b) Is unnecessary for electrical burns.
(c) Fluid volumes should be reduced in patients with smoke
inhalation.
(d) Fluid requirements are maximal in the first hours after the
injury.
(e) Adequacy is poorly assessed without invasive monitoring.
71. Inhalation injury
(a) Should be suspected in patients with facial burns.
(b) Almost always presents with stridor.
(c) Pulse oximetery may give false low readings.
(d) Always requires early intubation.
(e) May cause respiratory failure without airway compromise.
72. Carbon monoxide poisoning
(a) Causes a right shift of the oxyhaemoglobin dissociation
curve.
(b) Levels of 60% or greater are usually fatal.
(c) Hyperbaric oxygen is the treatment of choice.
(d) COHb has a half-life of 4 h when breathing air.
(e) Abnormal COHb levels could indicate airway oedema.
73. After induction of general anaesthesia for a
Caesarean section and initial attempts at
tracheal intubation have failed:
(a) The patient should be turned into the left lateral
position.
(b) The patient must always be woken up.
126 British Journal of Anaesthesia | CEPD Reviews | Volume 1 Number 4 2001
(c) Anaesthesia should be deepened to avoid vomiting.
(d) A head down position is advisable to prevent aspiration.
(e) A laryngeal mask airway is appropriate.
74. When a cricothyrotomy has been performed:
(a) It is not possible to ventilate using a bag through a
4.0 mm cannula.
(b) With a 13G cannula, exhalation occurs through the mouth.
(c) Posterior tracheal wall damage is a risk.
(d) Surgical emphysema cannot occur if a resuscitation bag
is used for ventilation.
(e) Cricoid pressure cannot be maintained.
75. When using the laryngeal mask airway in a failed
intubation drill:
(a) Cricoid pressure should be temporarily released.
(b) A size 3 is most appropriate for women.
(c) The airway reflexes should be obtunded with a small
dose of intravenous induction agent.
(d) It can form a conduit for subsequent tracheal intubation.
(e) The patient should be paralysed after successful
insertion.
76. Carbon monoxide:
(a) In smokers may result in COHb values of 25%.
(b) Shifts the oxygen haemoglobin curve to the left.
(c) Induces cytochrome oxidase.
(d) Clearance is greater in men than in women.
(e) Concentrations of approximately 5% reduce onset time
of exercise induced angina.
77. Smoking cessation:
(a) Returns the rate of decline in FEV1 to near normal levels.
(b) Of 12 months duration may increase postoperative
pulmonary complication rates.
(c) Of 12 h duration has minimal effect on maximal work
capacity.
(d) Improves airway reactivity over 210 days.
(e) Rates can be doubled using nicotine replacement
therapy.
78. Smoking:
(a) Is protective against Crohns disease.
(b) Is a strong risk factor for arterial thrombosis.
(c) Reduces the risk of postoperative nausea and vomiting.
(d) Reduces end-organ responsiveness to barbiturates.
(e) Causes a reduction in plasma volume.