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Worksheets2nd MCQ preparation
Total questions: 60
Worksheet time: 3600secs
You perform an uncomplicated lumbar epidural for labour analgesia on a 27-year-old lady of 36 weeks’ gestation with twins. Immediately after the test dose of 15ml 0.25% bupivacaine she lies supine and her BP is 70/40. The most likely cause for hypotension in this patient is:
A . Concealed ante-partum haemorrhage.
B.Intrathecal injection of local anaesthetic
c. Dehydration.
d. Aorto-caval compression.
e. Anaphylaxis.
- A 66-year-old male with hypertension and ischemic heart disease is scheduled for an open cholecystectomy. The best technique among the following to suppress the pressor response to laryngoscopy and intubation would be:
a. Intravenous esmolol
b. Morphine 0.4mg/kg prior to intubation.
c. Isoflurane.
d. Intravenous phentolamine.
e. GTN spray prior to induction.
A 9-year-old boy weighing 40kg is undergoing an appendicectomy. He became severely hypotensive 5 minutes after the administration of an antibiotic. He developed a rash all over his body. His blood pressure is 65/45mmHg, his heart rate is 140 per minute and he has weak central pulses. The most appropriate dose and route of administering adrenaline is:
a. 0.1ml/kg of 1:10 000 adrenaline IV.
b. 0.1ml/kg of 1:100 000 adrenaline IV.
c. 0.1ml/kg of 1:1000 adrenaline IV.
d. 0.1ml/kg of 1:10 000 adrenaline IM.
e. 0.1ml/kg of 1: 20 000 adrenaline IM.
- A patient is receiving oxygen at a rate of 10L/minute, from a size E cylinder (volume 5L). The pressure in the cylinder is 100 bar. How long can oxygen be delivered from this cylinder?
a. 30 minutes
b. 40 minutes.
c. 45 minutes.
d. 50 minutes.
e. 60 minutes.
- The figure below is an arterial trace from a 70-year-old patient with chronic obstructive airway disease, in the intensive care unit. This trace indicates:
a. An Over-damped trace.
b. An under-damped trace.
c. Compliant tubing.
d. Atrial fibrillation.
e. Kinking of the cannula.
A female patient with a BMI of 49 is scheduled to undergo gastric banding surgery. A change in which of the following parameters confers the greatest advantage when pre-oxygenating her in the sitting (rather than supine) position?
a. Vital capacity.
b. Ventilation/perfusion matching.
c. Tidal volume.
d. Closing capacity.
e. Functional residual capacity
A 38-year-old woman with a body mass index of 48 is to undergo an elective laparotomy for gynaecological surgery. The induction dose of propofol is best calculated based on:
a. Actual body weight
b. Ideal body weight.
c. Lean body mass.
d. Body mass index.
e. Ideal body weight + 20% total body weight.
A 4-year-old child weighing 16kg is scheduled for an inguinal herniotomy. You are planning to maintain the airway using a laryngeal mask airway (LMA). Which of the following is the most suitably sized LMA for this child?
a. Size 1½.
b. Size 2.
c. Size 2½.
d. Size 3.
e. Size 3½.
Analgesics such as fentanyl can be administered usigatransdermal route. Which one of the following properties is most important for transdermal delivery of a drug?
a. High molecular weight.
b. Long terminal half-life.
c. Non-ionised form.
d. Low potency.
e. Highly hydrophobic
For spontaneous ventilation, the Mapleson system A (Magill’s circuit) is the most efficient system. What is the single most important reason for this?
a. Requires low fresh gas flow.
b. Does not allow wastage of fresh gas flow.
c. Dead space gas is re-used.
d. Fresh gas flow is equal to alveolar ventilation.
e. It is cheap.
Pre-oxygenation during induction of anaesthesia delays the onset of critical hypoxia during the period of apnoea. Which of the following best describes the mechanism involved in pre-oxygenation?
a. It replaces nitrogen in the FRC with oxygen.
b. It increases the concentration of inspired oxygen.
c. It increases the amount of dissolved oxygen in blood.
d. It increases the peripheral oxygen saturation.
e. It decreases the shunt fraction.
The chemoreceptors in the carotid body detect changes in the composition of blood to activate the respiratory centre in the medulla. Which one of the following changes leads to the greatest stimulation of carotid body chemoreceptors?
a. Oxygen saturation of haemoglobin.
b. Partial pressure of oxygen.
c. Oxygen content of blood.
d. pH of blood.
e. Partial pressure of CO2
The second-stage O2 pressure regulator delivers a constant O2 pressure to the rotameters of
A. 4 psi
B. 8 psi
C. 16 psi
D. 32 psi
A 72- y ear -old man with a history of myocardial infarction 12 months earlier is scheduled to undergo elective repair of a 6-cm abdominal aortic aneurysm under general anesthesia. When would this patient be at highest risk for another myocardial infarction?
A. During placement of the aortic cross-clamp
B. Upon release of the aortic cross-clamp
C. 24 hours postoperatively
D. On the third postoperative day
The RIFLE criteria are designed to predict mortality from
A. Renal failure
B. Sepsis
C. Hepatic failure
D. Acute respiratory distress syndrome
Which of the following statements concerning the distribution of alveolar ventilation (VA ) in the upright lungs is TRUE?
A. The distribution of VA is not affected by body posture
B. Alveoli at the ape x of the lungs (nondependent alveoli ) are better ventilated than those at the base
C. All areas of the lungs are ventilated equally
D. Alveoli at the base of the lungs (dependent alveoli ) are better ventilated than those at the apex
Which of the following muscle relaxants is eliminated the most by renal excretion?
A. Pancuronium
B. V ecuronium
C. Atracurium
D. Rocuronium
The principal advantage of Ryanodex over conventional formulations of dantrolene is
A. Cost
B. Speed of reconstitution and administration
C. Absence of large amounts of mannitol
D. Need f or lower dose
The duration of action of remifentanil is attributable to which mode of metabolism?
A. Spontaneous degradation in blood (Hofmann elimination)
B. Hydrolysis by nonspecific plasma esterases
C. Hydrolysis by pseudocholinesterase
D. Rapid metabolism in the large intestine
Pain at the intravenous site is LEAST with which IV drug ?
A. Diazepam
B. Etomidate
C. Ketamine
D. Propofol
A fresh gas flow rate of 2 L/min or greater is recommended for administration of sevoflurane because
A. The vaporizer cannot accurately deliver the volatile at lesser flow rates
B. It prevents the formation of fluoride ions
C. It prevents the formation of compound A
D. It diminishes rebreathing
Which of the following clotting f actors has the shortest half-life?
A. Factor II
B. Factor V
C. Factor VII
D. Factor IX
The blood volume of a 10-kg, 1- y ear -old inf ant is
A. 600 mL
B. 800 mL
C. 1000 mL
D. 1300 mL
A 65- y ear -old man involved in a motor vehicle accident (MVA ) is brought to the emergency room with a blood pressure of 60 mm Hg systolic. He is transfused with 4 units of type O, Rh negative whole blood and 4 L of normal saline solution. After the patient is brought to the operating room, his blood type is determined to be A positive. Which of the following is the most appropriate blood type f or further intraoperative transfusions ?
A. Type A, Rh-positive whole blood
B. Type O, Rh-negative RBCs
C. Type A, Rh-positive RBCs
D. Type O, Rh-negative whole blood
- Anticoagulation with low-molecular -weight heparin (LMWH) can be best monitored through which of the following laboratory tests?
A. Activated partial thromboplastin time (aPTT)
B. Anti- Xa assay
C. Thrombin time
D. Reptilase test
Heparin resistance is likely in patients with which of the following heritable conditions ?
A. Factor V Leiden mutation
B. Prothrombin G20210A gene mutation
C. Protein S deficiency
D. Antithrombin or antithrombin III ( A T3) deficiency
Pheochromocytoma would be MOST likely to coexist with which of the following ?
A. Insulinoma
B. Pituitary adenoma
C. Primary hyperaldosteronism (Conn syndrome)
D. Medullary carcinoma of the thyroid
Just before induction of general anesthesia f or an 85- y ear -old demented man with an ischemic bowel, he mentions to you that he forgot to take his green capped e y e drops. He states that not taking it daily will result in blindness. The green-capped e y e drops are
A. NaCl drops used to prevent his e y e from drying out
B. Antibiotic drops
C. Steroids
D. Used to produce miosis
A normal, health y 3- y ear -old child was involved in a motor vehicle accident
(MVA). He is coming emergently to the OR. Drug doses need to be calculated, but his weight is not known. What value should be used to estimate the 3- y ear -old child’s weight?
A. 8 kg
B. 10 kg
C. 12 kg
D. 14 kg
You have been asked to review a 67-year-old patient on the fourth postoperative day, who is complaining of severe back pain and increasing numbness in both legs developing over the previous few hours. He has had an epidural in situ since his operation; the epidural infusion was switched off 8 hours ago as his blood pressure had been low. For the last few hours his temperature has been 38°C. Your first step in the management of this patient should be:
a. Give an epidural top-up using 0.5% bupivacaine.
b. Remove the epidural catheter and start morphine PCA.
c. Arrange for an MRI scan of the spine.
d. Arrange for surgical review as soon as possible.
e. Start multimodal analgesia and broad spectrum antibiotics.
A 48-year-old male lorry driver presents with severe right-sided sciatica which he has suffered from for the last 9 months. He has already tried treatment with analgesics, physiotherapy and acupuncture. His MRI scan shows moderate disc prolapse at the L5-S1 level. He does not wish to undergo any surgical intervention. The most suitable treatment is:
a. Stronger opioid medication.
b. Facet joint injection.
c. Epidural steroid injection.
d. Traction therapy to the lumbar spine.
e. Six weeks’ bed rest.
Which of the following statements concerning the sympathetic nervous system (SNS) is TRUE?
A. The preganglionic fibers originate in the gray column of the 2 lower cervical, 12 thoracic, and first lumbar segments of the spinal cord.
B. There are 22 paired sympathetic ganglia.
C. Preganglionic fibers only synapse with postganglionic fibers in ganglia at the level of exit.
D. Preganglionic fibers may also synapse in a ganglion to fibers that can then traverse to the adrenal gland.
E. All preganglionic fibers are unmyelinated fibers.
In the capnograph, dead space ventilation occurs during which interval?
A. A–B
B. B–C
C. C–D
D. D–E
E. C–E
The physiologic response to electroconvulsive therapy (ECT) may include which of the following?
A.Hypertrichosis
B.Hypotension
C.Polyuria
D.Increase in cerebral blood flow
E.Hyperhidrosis
Absorption of cerebrospinal fluid (CSF) takes place through
(A) ependymal cells
(B) arachnoid villi
(C) the piamater
(D) the foramen of Monro
(E) the foramen of Magendie
The correct order of solubilities in blood, from greatest to least, among the volatile anesthetics is
(A) halothane > isoflurane > sevoflurane > desflurane
(B) sevoflurane > isoflurane > desflurane > halothane
(C) desflurane > isoflurane > sevoflurane > halothane
(D) desflurane > halothane > sevoflrane > isoflurane
(E) sevoflurane > halothane > desflurane > isoflurane
A 40-year-old woman p resents with a corrected QT interval (QTc) prolonged to 500msec. She is
(A) at increased risk for perioperative morbidity and mortality related to cardiac arrhythmias
(B) recommend to receive amiodarone
(C) likely to be hypocalcemic
(D) at risk for Wolf-Parkinson-White syndrome
(E) at risk to require intraoperative pacemaker therapy
During pregnancy, the disproportion ate increase in plasma volume versus erythrocyte volume accounts for
A. Increase in the mean arterial pressure
B. Increase in stroke volume
C. Increase in cardiac output
D. Relative anemia of pregnancy
Which of the following statements regarding blood pressure during carotid surgery is TRUE?
A. It should be maintained 20% below baseline throughout surgery.
B. It should be maintained as close to baseline as possible throughout surgery.
C. It should be maintained as close to baseline as possible except during carotid cross-clamping, when it should be increased 20%.
D. It should be maintained 20% below baseline except during carotid cross-clamping, when it should be increased to 20% above baseline.
E. It should be maintained 20% above baseline throughout surgery
Which of the following is TRUE regarding the diffusing capacity for carbon monoxide (DLCO)?
A. A preoperative DLCO less than 60% of predicted indicates high risk of mortality after lung resection.
B. DLCO testing is of little clinical use.
C. DLCO correlates well with forced expiratory volume in 1 second (FEV1).
D. It is impaired by interstitial lung disease
E. Predicted postoperative diffusing capacity percent is a poor predictor of mortality after lung resection
- Which of the following statements is TRUE regarding changes seen when a patient is positioned in the lateral decubitus position?
A. Blood flow to the nondependent lung is significantly greater than it is to the dependent lung.
B. The distribution of blood flow is turned by 180 degrees compared with the supine position.
C. An awake, spontaneously breathing patient will demonstrate poor ventilation–perfusion matching in the dependent lung.
D. Ventilation in the dependent lung is greater than in the nondependent lung.
E. The nondependent hemidiaphragm is displaced higher into the chest.
The area of the myocardium most vulnerable to ischemia is the:
A. Right ventricle
B. Apex of the left ventricle
C. Interventricular septum
D. Portion of the right atrium containing the sinoatrial node
E. Subendocardial region of the left ventricle
Under normal conditions, approximately what is the oxygen saturation of blood entering the coronary sinus?
A. 10%
B. 25%
C. 50%
D. 75%
E. 90%
For each degree of Celsius decrease in body temperature, metabolic rate is decreased by approximately:
A. 1%
B. 2%
C. 4%
D. 8%
E. 10%
Nitric oxide dilates pulmonary vascular beds via:
A. Production of cyclic adenosine monophosphate (cAMP)
B. Inhibition of cAMP
C. Production of cyclic guanosine monophosphate (cGMP)
D. Inhibition of cGMP
E. None of the above
A 60-year-old female patient is admitted to the neurosurgical unit with a subarachnoid haemorrhage secondary to a ruptured intracranial aneurysm. Which of the following is the most serious complication that could occur during the subsequent 3 days?
a. Re-bleeding.
b. Cerebral vasospasm.
c. Hypertension
d. Hydrocephalus.
e. Pulmonary oedema.
In which of the following conditions is chronic post-surgical pain most commonly seen?
a. Cholecystectomy.
b. Mastectomy.
c. Amputation of limb.
d. Thoracotomy.
e. Hernia repair.
Which figure of esophageal atresia (EA) or tracheoesophageal fistula (TEF) is the MOST common?
A.
B.
C
D
Which of the following drugs does NOT pass the placenta easily?
A. Etomidate
B. Ephedrine
C. Atropine
D. Glycopyrrolate
A study was conducted to determine if there was a difference in the prevalence of diabetes mellitus among health care workers in Riyadh. The results showed that 30 out of 100 doctors were diabetic as compared to 50 out of 200 nurses. Remember: (doctors – Nurses) (Diabetic- nondiabetic) Which is the most appropriate statistical test?
A. a.t-test
B. ANOVA
C. Chi-square.
D. Correlation
What approach should physicians use in taking care of uncooperative, self-abusing, or disruptive patients from a low socioeconomic group?
A. Establish authority in the patient–doctor relationship by using stern language.
B. Refrain from following up on such patients when possible.
C. Ensure that personal biases do not taint clinical judgment.
D. Allow patients’ self-destructive behaviors to subside before administering treatment.
In which of these situations keeping the confidentiality is most important:
A. Pneumonia
B. Giving birth
C. Dangue fever
D. HIV
Best describe autonomy:
A. patient has right to take decisions about life and bodies.
B. physician has right to take decision.
C. health care should have distributed equally.
E. pt has right to complaint if not satisfied.
Patient 67 years old known IHD came to OR for emergency obstructed hernia.
In the holding area you reviewing the patient file and find an ECG.
A. It is normal ECG and shift the patient to OR because it is an emergency procedure
B. Enxiety disorder need 1mg midazolam or B blocker.
C. It is a kind of heart block which need transcutaneous pacing.
D. Atrial fibrillation need cardioversion
Patient 36 years old 38 weeks gestation G3 P2 the obstetrician resident called for emergency CS due to fetal distress and show you the CTG.
A. It is an acceleration which need bed side CS.
B. You need to shift the patient immediately without any delay.
C. you need to order bed side pelvic US to make sure a life baby before going to OR.
D. Call the senior obstetric Oncall and discuss with him the plan
Which one of the following is not typically seen in malignant hyperthermia?
A. Hyperkalaemia
B. Hyperthermia
C. Hypercapnia
D. Hypercalcaemia
Which one of the following actions is unlikely to improve the laryngoscopic view in a patient who is a difficult intubation?
A. Neck flexion and head extension
B. Neck extension and head flexion
C. External laryngeal manipulation
D. Use of a different sized laryngoscope blade
Which one of the following statements is correct for a patient presenting for emergency repair of an abdominal aortic aneurysm?
A. Induction of anaesthesia should take place immediately the patient presents at hospital.
B. An epidural should be inserted prior to commencing anaesthesia.
C. Surgery should be delayed until cross-matched blood is available in the operating theatre.
D. Arterial and central venous monitoring are required.
E. A metabolic alkalosis may occur following revascularization.
Which one of these statements is correct? Drawover vaporizers:
A. have high internal resistance.
B. have temperature compensation.
C. vapour output varies with minute volume.
D. are driven by bellows.
A patient who opens his eyes and withdraws to pain, and has confused speech has a GCS of:
A. 7
B. 8
C. 9
D. 10
