General 2

Question 1

1. P50:
   a) is normally 5.5 kPa
   b) is increased at high altitude
   c) is an indicator of the position of the oxygen dissociation curve
   d) is increased in foetal blood
   e) is increased in banked red blood cells

Answer 1

1.FTTFF (decreased 2-3DPG in banked RBC’s causes a LEFT shift of curve and therefore DECREASED P50)

Question 2

2. The work of breathing:
   a) is inversely related to lung compliance
   b) increases during exercise
   c) normally requires 15% of total body oxygen consumption
   d) is increased when the subject breathes heliox instead of room air
   e) is calculated by integration of a pressure/volume loop

Answer 2

2.TTFFT

Question 3

3. Alveolar - arterial oxygen difference (A-a DO2):
   a) is normally 2-3 kPa while breathing room air
   b) is increased under anaesthesia due to increased V/Q mismatch
   c) is decreased in one lung ventilation
   d) is increased in the presence of right to left intracardiac shunts
   e) is decreased in severe exercise

Answer 3

3.TTFTF

Question 4

4. Lung compliance:
   a) is normally 0.2 L/cm H2O
   b) is decreased with loss of pulmonary surfactant
   c) is increased in emphysema
   d) is decreased after induction of general anaesthesia
   e) is different at the apices and bases of lungs

Answer 4

4.TTTTT

Question 5

5. An arterial blood sample has the following values:
pH 7.25, PCO2 4 kPa, PO2 8 kPa, base excess -5.6 mmol/L, standard bicarbonate 20 mmol/L 
These could result from:
a) an intracardiac left to right shunt
b) Acute respiratory distress syndrome
c) chronic obstructive airways disease
d) aspirin overdose
e) diabetic ketoacidosis

Answer 5

5.FTFTT

Question 6

6. The Magill (Mapleson A) breathing system:
   a) is the most efficient system for spontaneously breathing patients
   b) will work with minimal rebreathing at a fresh gas flow of 70% of minute volume
   c) makes scavenging of exhaled gases easier
   d) co-axial version is the Lack system
   e) is also efficient during controlled ventilation

Answer 6

6.TTFTF

Question 7

7. The respiratory centre in the brain stem receives input from:
   a) the aortic and carotid bodies
   b) bronchiolar stretch receptors via vagal afferents
   c) oxygen-sensitive chemoreceptors in the medulla
   d) receptors which respond to the hydrogen ion concentration in the cerebrospinal fluid
   e) mechanoreceptors of the larynx

Answer 7

7.TTFTT

Question 8

8. The carotid bodies:
   a) have cells which respond only to decrease in PaO2
   b) have the highest blood flow (ml/unit weight) in the body
   c) maximally stimulate the respiratory centre between 4-8 kPa
   d) increase the respiratory drive when mean arterial pressure decreases below 70 mmHg

Answer 8

8.FTTT

Question 9

9. Concerning pulmonary function tests:
   a) FEV1 is low in small airway disease
   b) FEV1 is also effort dependent
   c) The flow-volume loop can indentify the source of airway obstruction
   d) the diffusing capacity of the lung for carbon monoxide is decreased in emphysema
   e) FEV1 and PEFR can be used to assess the reversibility of airway obstruction

Answer 9

9.TTTFT (Lung compliance increases in emphysema because of the less elastic lung tissue)

Question 10

10. Mixed venous oxygen saturation:
    a) is normally between 65-80%
    b) is essential in calculations of shunt and oxygen extraction ratio
    c) is increased in hypothermia
    d) is decreased in low cardiac output states and in thyrotoxicosis
    e) can be continuously monitored with an oximetric Swan Ganz catheter

Answer 10

10.TTTTT

Question 11

11. With a decrease in body temperature:
    a) P50 and PaCO2 are decreased
    b) pH is increased
    c) arrhythmias are increasingly common at temperatures below 30 degrees C
    d) blood becomes more viscous
    e) the EEG becomes isoelectric at about 20 degrees C

Answer 11

11.TFTTT

Question 12

12. Concerning the pharmacokinetics of inhalational agents:
    a) agents with a high blood:gas partition co-efficient will keep alveolar
    to inspired gas (FA/FI) ratio low
    b) alveolar partial pressure rises faster in adults than in children
    c) high cardiac output slows the rate of rise of alveolar partial pressure (FA)
    d) diffusion hypoxia is due to the second gas effect
    e) the second gas effect slows the rate of rise of alveolar partial pressure (FA)

Answer 12

12.TFTFF (2nd gas effect SPEEDS UP the rate of rise of alveolar pp of the inhalational agent)

Question 13

13. The following statements regarding inhalational agents are correct:
    a) the blood gas partition co-efficient of desflurane is 0.42
    b) desflurane can cause sympathetic stimulation
    c) sevoflurane can degrade to compound A in soda lime
    d) desflurane is suitable for inhalational induction
    e) desflurane can be used in halothane vaporiser

Answer 13

13.TTTFF

Question 14

14. Nitrous oxide (N2O):
    a) has a blood:gas partition coefficient of 0.47
    b) is 34 times less soluble than N2
    c) may be associated with postoperative hearing loss
    d) inactivates methionine synthetase after prolonged administration
    e) when inhaled at 66% can double a pneumothorax in 10 minutes

Answer 14

14.TFTTT

Question 15

15. The speed of induction with inhalational agents:
    a) is quicker in patients with very high functional reserve capacity
    b) is quicker if the agent is very soluble in blood
    c) is slower in the presence of right to left shunt
    d) is unchanged in the presence of left to right shunt with normal systemic flow
    e) is quicker when used with nitrous oxide

Answer 15

15.FFTTT

Question 16

16. With reference to the skeletal muscle myofilaments:
    a) actin is the major constituent of thin filaments
    b) myosin and tropomyosin combine to form the thick filaments
    c) troponin is a constituent of thin filaments
    d) tropomyosin prevents the interaction between actin and myosin in the resting state
    e) troponin C has 4 calcium binding sites

Answer 16

16.TFTTT

Question 17

17. The following receptors are part of a ligand-gated ion channel:
    a) opioid m receptor
    b) muscarinic cholinoceptors
    c) nicotinic cholinoceptors
    d) GABA A receptor
    e) GABA B receptor

Answer 17

17.FFTTF

Question 18

18. Drugs with anti-emetic activity:
    a) must cross the blood-brain barrier to be effective
    b) include agents which are selective dopamine D1 receptor antagonists
    c) include histamine H1 receptor agonists
    d) are ineffective orally
    e) include propofol

Answer 18

18.FFFFT (most do in fact cross the BBB and act directly on the Vomiting Centre but the CTZ is outside the BBB and DA and 5HT3 blockers antgonise these NT’s peripherally)

Question 19

19. Concerning the rate of diffusion of a gas:
    a) it is a result of the random movement of the gas molecules
    b) it is proportional to the tension gradient
    c) it depends upon the gas temperature
    d) it is inversely related to the square root of the gas density at constant
    temperature
    e) carbon dioxide diffuses more rapidly than oxygen

Answer 19

19.TTFFT

Question 20

20. Concerning the use of lasers:
    a) most lasers use light of wavelengths in the visible and infrared spectrum
    b) the CO2 laser is strongly absorbed by water, blood and tissues
    c) the Nd-Yag laser is absorbed mostly by pigments
    d) nitrous oxide should be avoided during the use of a laser near the airway
    e) endotracheal tube cuffs should be inflated with saline or water

Answer 20

20.TTTTT

Question 21

21. Concerning pacemakers:
    a) AOO is a fixed rate type of pacemaker
    b) VVI is the most common type of synchronous pacemaker
    c) failure to capture is never seen with hyperkalaemia
    d) unipolar electrocautery is prefered in patients with a pacemaker
    e) the ground plate of the electrocautery should be placed as far as possible from the pacemaker

Answer 21

21.TTFFT

Question 22

22. Regarding defibrillation:
    a) the greater the time interval between onset of ventricular fibrillation and defibrillation, the less the success of defibrillation
    b) 5-40 joules should be applied to the heart if the chest is open
    c) paddles should be of 13 cm in diameter in adults
    d) defibrillation is most effective when the electric shock is delivered during inspiration
    e) the myocardium is refractory to defibrillation in hypothermia

Answer 22

22.TTTFT

Question 23

23. Regarding acid-base balance:
    a) chronic obstructive airways disease patients have high serum bicarbonate levels
    b) the normal anion gap is 20-25 mmol/L
    c) mixed venous pH is always lower than arterial pH
    d) the pKa for bicarbonate buffer is 6.1
    e) kidneys cannot produce urine with a pH

Answer 23

23.TFTTT

Question 24

24. Baroreceptors:
    a) in the carotid sinus are innervated by the vagus nerve
    b) are stretch receptors
    c) reset the threshold for firing in chronic hypertension
    d) are made less sensitive by volatile agents
    e) also respond to the changes in blood pH and PaCO2

Answer 24

24.FTTTF

Question 25

25. Ablation of the stellate ganglion causes:

a) dilatation of the ipsilateral pupil
b) vasodilatation of the ipsilateral arm
c) posteral hypotension
d) loss of consensual light reflex
e) loss of ipsilateral lacrimation

Answer 25

25.FTFFT

Question 26

26. Asystole:
    a) occurs in about 25% of hospital patients
    b) is likely to follow bradycardia associated with mobitz type II AV block
    c) only rarely follows ventricular fibrillation
    d) when unresponsive to high dose adrenaline (5 mg) should be treated by external pacing
    e) may respond to precordial thump after basic life support

Answer 26

26.FTFFF

Question 27

27. Regarding coronary blood flow:
    a) subendocardium is more vulnerable to ischaemia than epicardium
    b) adenosine and dipyridamole are coronary vasodilators
    c) myocardial oxygen consumption and coronary blood flow bear a linear relationship
    d) coronary blood flow may be improved by slowing the heart rate
    e) the normal myocardial oxygen extraction ratio is 70%

Answer 27

27.TTTTT

Question 28

28. The following are true of local anaesthetic toxicity:
    a) as plasma levels gradually rise, cardiotoxicity is an early likely event
    b) lidocaine toxicity causes its earliest symptoms at levels of 5 mg/ml
    c) profound vasodilatation is the mechanism of hypotension
    d) emergency treatment involves treating convulsions and administering antiarrhythmic agents

Answer 28

28.FTTF

Question 29

29. The following statements about acetylcholine are true:
    a) its synthesis requires ATP
    b) it is broken down by choline acetyltransferase in the synaptic cleft
    c) it is broken down to acetic acid and choline
    d) it is released only by preganglionic fibres in the autonomic nervous system
    e) it acts by diffusing through channels in the postsynaptic membrane

Answer 29

29.TFTFF

Question 30

30. The dinamap non-invasive blood pressure monitor:
    a) uses a double cuff oscillotonometric system
    b) needs to be at the same level as the patient
    c) is accurate even when an abnormal rhythm is present
    d) gives a more accurate measure of the diastolic than systolic pressure
    e) is more accurate than a manual oscillotonometer

Answer 30

30.FFFFF