ABSTRACT
X-ray d. Sigmoid volvulus causing obstruction in a 65-year-old woman e. Haemoperitoneum following blunt trauma in a 34-year-old man
7. Features of Paget’s disease include: a. Hypercalcaemia b. Raised alkaline phosphatase c. Loss of hearing d. Osteoporosis e. Low-output cardiac failure
8. With regards to tracheal tubes: a. A 15 mm connector at the proximal end is universal b. RAE is an acronym for Ring, Adair and Elwyn c. Armoured tracheal tubes cannot be cut d. A Montadon tube is used for patients with a tracheostomy e. The cuff should be filled with saline for laser surgery of the
larynx and trachea
9. During laser surgery for removal of a vocal cord polyp, a supraglottic airway fire occurs in the patient; the following therapeutic measures are appropriate: a. Immediate discontinuation of the laser b. Flooding of the supraglottic area with hypertonic saline c. Attending to the patient with an ABC approach and ventilating
with 100% oxygen d. Maintenance of a definitive airway with the existing
endotracheal tube e. High-dose intravenous steroids
10. Features of a venous air embolism (VAE) include: a. An increase in PaCO2 b. Retinal gas bubbles c. Mill-wheel murmur as a late sign d. Rise in central venous pressure e. Normal chest X-ray
11. When performing a sub-Tenon’s block: a. It is appropriate for retinal surgery b. The conjunctiva is raised in the inferonasal quadrant c. Akinesia is superior when compared with a peribulbar block d. Tenon’s capsule is white e. It requires 3-5 mL of local anaesthetic
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with moderate
b. Dilated pupils with severe hypothermia c. U-waves with severe hypothermia d. Diuresis with severe hypothermia e. Coagulopathy with moderate hypothermia
13. A man is brought to A&E with suspected organophosphate poisoning; the following is expected: a. Atrioventricular block on ECG monitoring b. Paralysis c. Mydriasis d. Sweating e. Symptoms occurring 12-24 hours following exposure
14. Brain natriuretic peptide (BNP) levels are increased with: a. Acute pulmonary embolus b. Sepsis c. Renal failure d. Old age e. Heart failure
15. A 65-year-old man presents with a suspected massive pulmonary embolus (PE); appropriate investigations and management include: a. D-dimers b. CT pulmonary angiography (CTPA) within 1 hour c. Alteplase 50 mg intravenously d. Leg ultrasound e. Intravenous heparin prior to imaging
16. The following is correct of epilepsy: a. Absence seizures are a form of partial epilepsy b. Partial seizures can progress to generalized seizures c. Febrile convulsions can lead to an increased risk of developing
epilepsy d. Consciousness is impaired in simple partial seizures e. It is most commonly idiopathic
17. False low oxygen saturation readings can be expected in the following situations: a. A 65-year-old lady undergoing a parathyroidectomy who is
administered methylene blue b. An alcoholic patient with severe jaundice c. A patient on ICU who is administered indocyanine green for
cardiac output measurement d. Following a Bier’s block with prilocaine e. A young man extracted from a house fire
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injury in Type I the affected limb c. More commonly affects women d. Is excluded by the lack of an initiating noxious event in Type I e. Is accompanied by normal plain X-rays of the affected area in
30% of patients
19. As regards the Vaughan Williams classification, the following is correct of anti-arrhythmic drugs: a. Quinidine is Class Ia b. Amiodarone is Class III c. Procainamide is Class Ia d. Flecainide is Class Ib e. Bretylium is Class Ic
20. Independent patient-related risk factors for postoperative vomiting (POV) in children include: a. Anxiety b. Age over 3 years c. Previous history of motion sickness d. Obesity e. Previous history of postoperative vomiting
21. Concerning latex allergy: a. It is more common in asthmatics b. It is associated with allergy to kiwi fruit c. It is more commonly a type I hypersensitivity reaction d. Patients should be admitted the night before surgery e. Prophylactic corticosteroids are recommended
22. A ventricular catheter used to measure intracranial pressure (ICP): a. Is the gold standard b. Can be used to administer drugs c. Is placed in the fourth ventricle d. Uses the foramen of Munro as the reference point for the
transducer e. Can be antibiotic-impregnated
23. A young woman presents with a decreased conscious level and hypotension. Her urine output is 400-500 mL/h and she has a plasma sodium level of 156 mmol/L; the following is likely: a. Syndrome of inappropriate ADH secretion (SIADH) b. Cerebral salt wasting syndrome c. Diabetes insipidus (DI) d. Urinary sodium .20 mmol/L e. Addisonian crisis
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include: c. Delayed emergence from general anaesthesia d. Conjunctival burns e. Compartment syndrome of the lower limb
25. An asymptomatic patient presents for elective hernia repair with a 62 mmHg peak gradient across the aortic valve; the following is correct: a. This patient has critical aortic stenosis (AS) b. The valve area must be reduced by more than 50% to produce
this gradient c. Cardiac ischaemia occurs commonly with normal coronary
arteries d. A high left ventricular end-diastolic pressure (LVEDP) is ideal
perioperatively e. Tachycardia should be avoided
26. Electroencephalogram (EEG) rhythms have the following properties: a. Wakefulness is characterized by b-wave activity b. b-waves have a higher frequency than d-waves c. a-waves have the lowest frequency d. d-waves can be normal in children e. u-waves are seen in sleep
27. Blockade of the median nerve at the wrist results in: a. Weakness of opponens pollicis b. Weakness of adductor pollicis brevis c. Weakness of pronator teres d. Anaesthesia of the dorsal tip of the index finger e. Anaesthesia of the lateral palmar aspect of the ring finger
28. With regards to electrical safety, equipment design in the UK fulfils the following characteristics: a. Adherence to BS 5950 b. Class I: double insulation c. Class III: conducting parts connected to earth d. Type B: maximum leakage ,100 mA e. Type CF: maximum leakage ,10 mA
29. The following colour-coding applies to gas cylinders in the UK: a. Helium: brown body with white shoulders b. CO2: grey body with grey shoulders c. Air: grey body with black and white shoulders d. N2O: blue body with blue shoulders e. Cyclopropane: orange body with white checked shoulders
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elective under for Standards of as set out by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) state that: a. Airway pressure should be recorded b. A temperature probe must be available c. A single-handed anaesthetist cannot leave the patient during
anaesthesia d. A stethoscope is no longer mandatory e. If the patient elects for regional anaesthesia, continued presence
of the anaesthetist is still required
31. 2,3-Diphosphoglycerate (2,3-DPG) levels are increased in: a. High altitude b. Pregnancy c. Hyperthyroidism d. Acidosis e. Hypopituitarism
32. Blood lactate: a. Is a buffer b. Should be collected in a heparin fluoride tube c. Is assayed specifically for the D-isomer d. Provides assessment of regional perfusion e. Is hydrolysed by lactate dehydrogenase (LDH)
33. A fluid challenge: a. Can be adequately performed using packed red cells b. Resulting in a rise in central venous pressure (CVP) of ,3 mmHg
indicates an adequate circulating volume c. Resulting in a normal pulmonary artery wedge pressure (PAWP)
represents euvolemia d. Should consist of 20 mL/kg of crystalloid in the septic patient e. Should be monitored using cardiac output rather than stroke
volume
34. Clostridium difficile: a. Is a Gram-negative aerobe b. Spores are destroyed by alcohol hand gel c. Is a commensal in up to 60% of the general population d. Is eradicated by intravenous vancomycin e. Colonization can be asymptomatic
35. Meticillin-resistant Staphylococcus aureus (MRSA): a. Is a Gram-positive bacillus b. Is a facultative anaerobe c. Most commonly colonizes the respiratory tract d. Is destroyed by chlorhexidine hand wash e. Is sensitive to glycopeptide antibiotics
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Bernoulli effect contains 17 g/m3 water vapour at sea
level c. At an altitude of 5000 feet, fully saturated air at 208C contains less
water vapour compared with sea level d. Back-pressure at the outlet will reduce efficiency of gas-driven
nebulizers e. Droplets of 5 mm reach the tracheal region
37. The solutions below are correctly matched with respective sodium concentrations (in mmol/L): a. Bicarbonate 8.4%: 1000 b. Glucose 5%: 30 c. Hartmann’s: 111 d. 0.9% saline: 154 e. Gelofusine: 154
38. Cricoid pressure: a. Should consist of 10 N at induction b. Should reach a maximum of 50 N c. Is discontinued if the patient actively vomits d. Is continued for laryngeal mask insertion during management of
a difficult airway e. Risks airway obstruction when performed concurrently with a
BURP manouvere
39. The jugular foramen transmits the following structures: a. Hypoglossal nerve b. Glossopharyngeal nerve c. Vagus nerve d. Internal jugular vein e. Middle meningeal artery
40. With respect to fentanyl, alfentanil demonstrates a: a. Shorter half-life b. Lower volume of distribution c. Lower fraction bound to plasma protein d. Lower lipid solubility e. Higher pKa
41. N-acetylcysteine is administered via the following routes: a. Oral b. Intramuscular c. Nebulized d. Intravenous e. Subcutaneous depot
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with a with a GCS of 6 is correct: a. Serum salicylate levels do not determine prognosis b. Immediate management should include nasogastric tube
placement and activated charcoal administration c. Urinary alkalinization is appropriate d. Haemofiltration is indicated for salicylate levels .3.3 mmol/L e. Hypoglycaemia is likely
43. Concerning diabetes mellitus: a. Diagnostic criteria include fasting plasma glucose of 6.0 mmol/L
b. Diagnosis can be made using HbA1c values c. For diagnosis of impaired glucose tolerance, random plasma
glucose must be 11.1 mmol/L d. For major surgery, perioperative steroid cover is indicated e. It is the single biggest risk factor for spinal infection following
epidural drug delivery
44. Appropriate drug treatment for a patient with an acute exacerbation of asthma includes: a. Ipratropium b. Theophylline c. Sodium cromoglycate d. Salbutamol e. Aminophylline
45. Concerning computed tomography (CT): a. It involves ionizing radiation b. It involves application of radiofrequency pulses c. ‘Omnipaque’ is an iodinated contrast agent d. ‘Omnipaque’ is a hyperosmolar contrast agent e. The biological effects of radiation are measured in Grays (Gy)
46. Serum urea and electrolytes should be measured in the following patients presenting for elective surgery: a. A hypertensive 61-year-old scheduled for middle ear drainage b. A 25-year-old on lithium therapy scheduled for tooth extraction c. An asthmatic 65-year-old scheduled for varicose veins surgery d. A 35-year-old onmetolazone therapy scheduled for bronchoscopy e. A neonate presenting for herniorrhaphy
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is made at a lower temperature
b. Standard bicarbonate is corrected for an abnormal partial
pressure of CO2 (PCO2) c. Excess heparin will lower the pH of the sample d. The base excess is the amount of strong acid or base required to
titrate a litre of blood to a pH of 7.4 and PCO2 of 5.3 kPa at 378C e. The Siggard-Andersen nomogram plots log arterial bicarbonate
against plasma pH
48. The Wilson scoring system: a. Comprises four predictive factors b. Scores buck teeth c. Scores each factor on a three-point scale d. Is predictive of a difficult airway if the total score is greater than 4 e. Scores weight
49. A 25-year-old primigravida who is 10 weeks pregnant requires an appendicectomy and undergoes a rapid sequence induction using thiopentone and suxamethonium. She suffers from a prolonged period of paralysis after the operation, lasting more than 1 hour; the following statements apply: a. She is likely to be heterozygous for cholinesterase genes b. Mivacurium administration at induction would have avoided
this situation c. The normal genotype is Eu:Eu for cholinesterase d. Pregnancy may result in prolonged paralysis e. Dibucaine number increases with reduction of cholinesterase
activity
50. Concerning obstructive sleep apnoea (OSA): a. Apnoea is defined as cessation of airflow for greater than 5 s b. Is defined as more than 10 episodes of apnoea or hypopnoea
per hour of sleep c. An Apnoea Hypopnoea Index (AHI) of 5 is considered normal d. Grade 1 is defined by an AHI of 10-30 e. Grade 4 patients are prone to cor pulmonale
51. Activated protein C (APC): a. Is a glycoprotein b. Recombinant form is administered continuously as an infusion
over 48 hours c. Is vitamin K-dependent d. Is inactivated by thrombin e. Deficiency leads to a paradoxical bleeding diathesis
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b. Atrial fibrillation c. Wound crepitus d. Fever e. Wound drainage
53. The HELLP syndrome: a. Occurs in approximately 3% of pregnant women b. Shows reduced risk of development in smokers c. Presents preterm in 80% of sufferers d. Shows reduced perinatal mortality with maternal
administration of dexamethasone e. Requires arterial hypertension as a prerequisite for diagnosis
54. The following statements are correct of statistical definitions: a. A false positive is a type I error b. A false negative rejects the null hypothesis when it is true c. A true positive is the ability of the test to be positive in the
presence of the disease d. The positive predictive value is also known as precision rate e. Sensitivity is the ability to correctly identify people without a
disease
55. The following agents are nephrotoxic: a. Amphotericin b. Captopril c. Furosemide d. Cimetidine e. Phenytoin
56. An increased alveolar-arterial (A-a) gradient is expected in: a. Ageing b. Cardiopulmonary bypass c. Tetralogy of Fallot d. A large ventricular septal defect e. Bronchoconstriction
57. Concerning the neonatal circulation: a. It changes from a parallel to a series system b. Permanent closure of the foramen ovale (FO) takes 4 hours c. The ductus arteriosus (DA) closes in response to decreasing
prostaglandin E (PGE) levels d. The ductus venosus (DV) closes 4 weeks after birth e. Pulmonary artery pressure (PAP) decreases to adult values in
2 weeks
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2 awake adult is approximately
b. _VO2 in the anaesthetized patient is approximately 3 mL/kg/min c. Mass movement of O2 can maintain SaO2 for over 1 hour d. Application of 100% O2 via a patent airway prevents the
development of acidosis e. _VO2 in the term parturient is approximately 3 mL/kg/min
59. Regarding severity scoring systems: a. APACHE II is measured during the first 24 hours of admission b. SOFA has been validated for trauma patients c. WFNS Scale is used to assess outcome of head injury d. SAPS III predicts physiological status at ICU discharge e. MODS is performed on a daily basis
60. When using intercostal chest drains: a. Large-bore drains are more effective than small-bore drains for
air drainage b. No evidence exists that clamping a drain at removal is beneficial c. Large-bore drains are effective for bronchopleural fistulae d. If applied, suction pressure should be 210 to 220 mmHg e. The most common point of insertion is in the mid-axillary line
61. Concerning perioperative acute renal failure (ARF): a. Incidence is increasing b. Is less likely with endovascular than an open repair of abdominal
aortic aneurysms c. Pharmacological interventions are not effective in protecting renal
function d. Low-dose dopamine does not offer clinically significant renal
protection e. N-acetylcysteine is protective against radiocontrast nephropathy
62. The listed murmurs are associated with the corresponding pathology: a. Ejection: aortic stenosis b. Pansystolic: mitral regurgitation c. Pansystolic: ventricular septal defect d. Diastolic: mitral stenosis e. Continuous: patent ductus arteriosus
63. The Fick principle can be used to measure: a. Cardiac output b. Renal blood flow c. Diffusion across a membrane d. Cerebral blood flow e. Oxygen consumption
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c. Esmolol d. Propranolol e. Sotalol
65. Ideal characteristics of nerve stimulator devices for performing regional nerve blockade include: a. Constant-current output b. Constant-voltage output c. Current magnitude up to 5 A d. Square wave unipolar stimulus e. Stimulus duration of 1-2 ms
66. Concerning peribulbar anaesthesia: a. Complications include subarachnoid injection b. The inferolateral approach involves the junction of maxilla
and zygoma c. The junction of the cornea and iris is called the limbus d. It carries less risk when axial length is .27 mm e. Medial approach is performed medial to the caruncle
67. A 32-year-old man undergoing a craniotomy in the sitting position develops a massive venous air embolism (VAE); the following statements regarding positioning the patient are correct: a. He should be placed in the Durant position b. Trendelenburg will exacerbate the symptoms of VAE c. He should be right lateral decubitus d. The aim is to drive the embolus through the right ventricle e. VAE cannot occur in the supine position
68. Complications seen following recovery from drowning include: a. Seizures b. ARDS c. Rhabdomyolysis d. Hyperthermia e. Pneumothorax
69. The following are correct for the LeFort classification system: a. Grade IV fractures are associated with base-of-skull fractures b. It applies to mandibular and maxillary fractures c. Grade I describes transverse fractures of mid-lower maxilla d. Grade II describes cribriform plate disruption e. Grade III describes fractures continuing from the top of the
nose to the base of the maxilla
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a b. ACTH release from the anterior pituitary c. Sodium retention d. Hypokalaemia e. Cortisol levels .1500 mmol/L
71. Glucose-6-phosphate dehydrogenase (G6PD) deficiency: a. Confers resistance to malaria b. Is more common in females c. Is an autosomal recessive disorder d. Is a contraindication for suxamethonium e. Causes haemolysis in patients on ciprofloxacin therapy
72. The filling ratio: a. Is defined as the mass of gas in a cylinder divided by the mass
of gas that would fill the cylinder b. Is defined as the mass of gas in a cylinder divided by the mass
of liquid that would fill the cylinder c. Is applicable to substances below their critical temperature d. Is 0.75 for nitrous oxide in tropical climates e. Is 0.67 for nitrous oxide in temperate climates
73. Bupivacaine: a. Exhibits biphasic central nervous system effects b. Has a lower rate of systemic absorption when adrenaline is added c. Is highly protein-bound d. Has 80 mg/mL dextrose added to produce a ‘heavy’ version e. Has a direct vasodilatory effect
74. A patient undergoing a thoracotomy with one-lung ventilation (OLV) becomes hypoxic; the following management is appropriate: a. Insufflation of oxygen into the collapsed lung b. Application of continuous positive airway pressure (CPAP) to the
collapsed lung c. Administration of a pulmonary vasodilator d. Application of 10-15 cmH2O positive end-expiratory pressure
(PEEP) to the collapsed lung e. Return to two-lung ventilation
75. The Association of Anaesthetists of Great Britain and Ireland guidelines for management of suspected perioperative anaphylaxis include: a. Adrenaline 50 mg intravenously for adults b. Chlorphenamine 20 mg intravenously c. Intravenous salbutamol for persistent bronchospasm d. Reporting of perioperative cases to the MHRA e. Administration of metaraminol if adrenaline infusion is
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with: vaginal delivery c. Increased duration of labour d. Back pain e. Maternal pyrexia
77. The following is correct of the oesophageal Doppler: a. FTc is cumulative flow time b. Peak velocity of aortic blood is a good estimate of myocardial
contractility c. Stroke volume is the area under the waveform d. The aortic diameter is measured e. FTc is normally 330-360 ms
78. The following are correct for hepatic encephalopathy: a. Scoring consists of five grades b. Stupor is consistent with Grade 2 c. Cerebral oedema is the leading cause of death d. Dietary protein restriction is recommended e. Definitive diagnosis is made with brain imaging
79. Features indicative of a proximal bronchial carcinoma include: a. Pleuritic chest wall pain b. Superior vena cava obstruction c. Hoarse voice d. Enophthalmos e. Haemoptysis
80. Clinical features of hypocalcaemia include: a. Tetany b. Hypotension c. Prolonged QT interval d. Convulsions e. Perioral paraesthesiae
81. Examples of non-cutting spinal needles include: a. Sprotte b. Quincke c. Whitacre d. Greene e. Tuohy
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when isosmolar b. 0.18% sodium chloride/glucose 4% is isosmolar c. 0.45% sodium chloride/glucose 5% is hypotonic d. 0.9% sodium chloride/glucose 5% is hyperosmolar and isotonic
with reference to a cell membrane e. 10% glucose is hyperosmolar and hypotonic with reference to a
cell membrane
83. According to the DeBakey classification for aortic dissections: a. There are five types b. Type II involves the distal part of the abdominal aorta c. Types III and IV are classified according to whether the dissection
extends above and beyond the diaphragm d. Type I involves the ascending and descending aorta e. Type III is subdivided into A and B
84. Recognized side-effects of erythropoietin (EPO) include: a. Red cell aplasia b. Hypertension c. Heart failure d. Bronchoconstriction e. Altered coagulation
85. An infant presents for correction of a cleft palate; the following statements are correct: a. Continuous nasal discharge warrants postponement of surgery b. Intubation becomes more difficult with age in Pierre Robin
sequence c. Polycythaemia is common d. Specific guidelines recommend optimal timing of surgery e. Low-grade infections preoperatively should not be treated with
antimicrobial therapy
86. The following statements regarding WFNS grading system for subarachnoid haemorrhage (SAH) are correct: a. WFNS is an acronym for ‘World Federation of Neuroscientists
Scale’ b. Grade 1 represents GCS 15 without any motor deficit c. Grade 1 is associated with over 80% recovery d. Grade 3 indicates the presence of a motor deficit e. Grade 5 indicates greatest severity on the scale
87. Dysphagia is a feature of: a. Diabetes b. Chagas’ disease c. Scleroderma d. Plummer-Vinson syndrome e.
