ABSTRACT
T-wave inversion on ECG d. Have increased vagal tone e. Have second-degree heart block which resolves on exercise in
one-third of individuals
21. Regarding medical errors: a. The majority are due to human error b. The most common type of error is ‘knowledge-based’ c. Boredom is a contributing factor for ‘skill-based errors’ d. A drug error is an example of a ‘skill-based error’ e. Latent errors are a form of human error
22. Electroconvulsive therapy (ECT): a. Consists of a pulsatile sine wave of 35 J b. Induces a tonic-clonic seizure c. Has a long parasympathetic phase d. Has a short sympathetic phase e. Should be preceded by administration of muscle relaxants
23. When using CURB-65 as a severity assessment score for community-acquired pneumonia (CAP): a. Confusion is a prognostic factor b. Urine output is a prognostic factor c. Maximal possible score is 5 d. A score greater than 3 warrants ICU involvement e. It is predictive of mortality
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
(CJD): cause of the iatrogenic
b. Prion proteins are destroyed by formaldehyde c. Sterilization of contaminated equipment can only be achieved
using ethylene oxide following disinfection d. Effective sterilization can be achieved by autoclaving at 1388C
for 18 minutes following disinfection e. Cerebellar ataxia is a common early feature
25. A 70-year-old male is admitted to ICU following a laparotomy for a perforated duodenal ulcer; he has a history of ischaemic heart disease and is hypotensive. An oesophageal Doppler probe is inserted: a. A reduced aortic waveform height with rounded apex suggests
left ventricular failure b. The flowtime corrected (FTc) is directly proportional to the
systemic vascular resistance c. Normal range for peak velocity is 90-120 cm/s in this patient d. A fluid challenge would be an appropriate response for an FTc
of 300 ms e. Inotropic therapy would be appropriate for this patient if the peak
velocity is 40 cm/s
26. With regard to infections: a. The mortality associated with meticillin-resistant Staphylococcus
aureus (MRSA) is higher than for meticillin-sensitive S. aureus (MSSA)
b. The mortality associated with vancomycin-resistant enterococcus (VRE) is higher than for vancomycin-sensitive enterococcus (VSE)
c. Selective decontamination of the digestive tract (SDD) has demonstrated a reduction in incidence of ventilator-acquired pneumonia
d. Antibiotic cycling does not reduce mortality in ICU e. Restrictive antibiotic strategies have been shown to reduce
mortality
27. The Wright respirometer: a. Is used for measuring forced expiratory volumes b. Consists of a vane moved by gas flow c. Has a vane that rotates in both directions d. Measures continuous flow accurately e. Produces an electrical output for analysis
28. Following a traction injury to the upper brachial plexus affecting the C5-6 nerve roots, the following is likely: a. Pronation of the forearm b. Loss of sensation over the medial surface of the arm c. Medial rotation of the arm d. Claw hand deformity e. Loss of arm abduction
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
arterioles c. Prostaglandins d. Hypotension e. Pregnancy
30. Carboprost is: a. A prostaglandin E2 analogue b. Used for first-trimester abortion c. Administered intravenously d. Administered to a total dose of 8 mg e. Reported to cause bronchospasm
31. Concerning meta-analysis: a. It involves combining trials b. Power of trials are not increased c. Horizontal lines represent confidence intervals d. Lines on a forest plot must cross the line of equivalence to be
considered ‘significant’ e. The size of the central mark on the plot represents power
32. Treatment goals recommended in the management of advanced heart failure include: a. Right atrial pressure ,1 mmHg b. Mixed venous oxygen saturation .60% c. Cardiac index .5 L min21 m22
d. Early institution of non-invasive ventilation for respiratory compromise
e. Systemic vascular resistance 800-1200 dyn s21 cm25
33. Following an elective right hemicolectomy in a 70-year-old man: a. Nasogastric tubes are a cause of ileus b. Epidural analgesia reduces mortality c. Epidural analgesia reduces frequency of postoperative respiratory
failure d. Early oral intake is contraindicated e. Clonidine can shorten the duration of ileus
34. According to the RIFLE classification of acute kidney injury: a. The risk class describes a .2 times increase in serum creatinine b. The risk class describes a urine output of ,0.5 mL kg21 h21 for
6 hours c. The injury class describes a urine output of ,0.5 mL kg21 h21 for
12 hours d. The system is predictive of mortality in hospital patients e. Acute kidney injury is defined as a 30% increase in creatinine from
baseline in less than 48 hours
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
with has 3 days ago and has been ventilation. You are alerted to her as she has suddenly become distressed, her oxygen saturations are 80%, her heart rate is 130/min and she is diaphoretic; you cannot hear breath sounds on her chest; initial management would include: a. Removal of the inner cannula b. Rapid sequence induction with endotracheal intubation c. Deflation of the tracheostomy tube cuff d. Removal of the tracheostomy and replacement with an
endotracheal tube through the stoma site e. Removal of the tracheostomy and replacement with a smaller
tracheostomy tube
36. A 24 kg child is booked for elective squint correction; the following breathing apparatus would be suitable: a. Bain circuit for spontaneous ventilation using fresh gas flow
100 mL kg21 min21
b. Magill system for controlled ventilation c. Humphrey ADE system for controlled ventilation with fresh gas
flow of 3 L/min d. Humphrey ADE system for spontaneous ventilation e. The Lack system for spontaneous ventilation
37. Concerning sleep-related breathing disorders (SRBD) in children: a. 80% of sufferers have symptoms managed by adenotonsillectomy b. Adenotonsillectomy should be performed at specialist centres c. Repeated overnight arterial desaturations below 80% are indica-
tive of severe obstructive sleep apnoea (OSA) d. If severe obstructive sleep apnoea is suspected, a chest radiograph
is helpful e. When accompanied by weight ,15 kg, further investigations are
warranted
38. Methods to locate the epidural space include: a. Gutierrez’s hanging drop technique b. Macintosh’s indicator c. Ultrasonic localization d. Campbell-Howell method e. Odom’s indicator
39. The National Patient Safety Agency Rapid Response Alert (2008) on reducing the risk of overdose following midazolam injection in adults: a. Reported approximately 500 patient safety incidents in one year b. Recommend the storage and use of high-strength midazolam is
restricted to areas where use has been formally risk-assessed c. Require the use of flumazenil to be formally audited d. Recommend organizational policy for sedation e. Recommend overall responsibility be assumed by a senior
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
sphincter tone c. Metoclopramide causes agitation d. All dopamine antagonists can cause dystonic reactions e. Ondansetron causes a bradycardia
41. Following deflation of a tourniquet applied to the lower limb for a period of 3 hours, there is: a. An increase in the serum lactate levels b. A rise in serum potassium levels, which peak after 30 minutes of
deflation c. A rise in end-tidal CO2, which peaks within 1 minute d. No association with irreversible muscle damage e. Increased fibrinolysis
42. The following are systemic effects of abdominal compartment syndrome (ACS): a. Reduced cardiac output b. Reduced pulmonary artery occlusion pressure (PAOP) c. Hypercapnia d. Reduced glomerular filtration rate (GFR) e. Increased intracranial pressure
43. Intra-aortic balloon pumps (IABPs): a. Are relatively contraindicated in patients with aortic regurgitation b. Are absolutely contraindicated in patients with abdominal aortic
aneurysms c. Reduce left ventricular systolic pressure d. Are positioned just proximal to the origin of the subclavian artery e. Inflate immediately following end-diastole
44. Appropriate recruitment manoeuvres for patients in ICU: a. Include application of 30-40 cmH2O continuous positive airway
pressure (CPAP) for 40 s b. Include application of 20 cmH2O CPAP for 20 minutes c. Have been demonstrated to improve survival in acute lung injury
(ALI) d. Are most beneficial for patients ventilated for more than 3 days e. Consist of nocturnal pressure-supportive ventilation with
spontaneous ventilation during daytime hours
45. The following statements regarding echocardiography are correct: a. Pulse repetition frequency is the number of pulses generated by the
transducer in 1 minute b. Acoustic frequency is 3.5-7.5 MHz c. Transoesophageal technique utilizes higher frequencies than
transthoracic d. The reflector in the Doppler method is the red cell e. transducers
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
in cold water expected b. A gasp reflex c. Apnoea d. Bradycardia e. Peripheral vasoconstriction
47. A 66-year-old man presents for emergency surgery with an intimal tear of his descending thoracic aorta; the following is correct: a. He has a type A aortic dissection b. He has a type B aortic dissection c. He is at risk of paraplegia d. A normal ECG is present in 50% of patients with coronary
involvement e. This condition is usually preceded by an aortic aneurysm
48. Cook’s modification of the Cormack and Lehane classification for difficult airway assessment describes the following: a. There are six grades b. Grades 3 and 4 are subdivided into A and B depending on the
structures seen c. Grades 3B and 4 represent a ‘difficult airway’ d. Grades 2 and 3A indicate the requirement of a gum elastic bougie e. It is assessed on indirect laryngoscopy
49. A 34-year-old primigravida develops eclampsia in the second stage of labour; the following is correct: a. This is an indication for emergency caesarean section b. Spinal anaesthesia is absolutely contraindicated c. Immediate management is intravenous infusion of 4 g of
magnesium sulphate d. Therapeutic levels of magnesium are in the range of 2-4 mmol/L e. In eclampsia one-third of fits occur postpartum
50. The following is correct of cardiac enzymes: a. Troponins are found only in cardiac muscle b. Serum troponin levels are independent of renal function c. CK-MB is a mitochondrial enzyme d. LDH-1 isoenzyme is found predominantly in cardiac muscle e. Raised troponin I is exclusively indicative of myocardial
infarction (MI)
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
back within the last 3 hours; correct: a. His condition is associated with the use of intrathecal
5% lidocaine b. He requires urodynamic studies urgently c. Spinal immobilization is not necessary d. Computed tomography is the imaging modality of choice e. Surgical correction should commence from within 12 hours of
onset of symptoms
52. Treatment of poisoning with activated charcoal: a. Requires a charcoal : poison weight ratio of 2 : 1 b. Is indicated for benzodiazepines c. Is indicated for lithium d. Is indicated for tricyclic antidepressants e. Is indicated for theophyllines
53. Pulmonary artery catheters (PACs): a. Allow direct measurement of cardiac output b. Calculate cardiac output using Fourier analysis c. Are inaccurate when measuring cardiac output in the presence of
tricuspid regurgitation d. Have demonstrated benefit for critically ill patients e. Can be modified to allow pacing
54. Workplace exposure limits (parts per million, ppm) over 8 hours are: a. Halothane: 10 b. Sevoflurane: 50 c. Nitrous oxide: 50 d. Isoflurane: 25 e. Enflurane: 25
55. Coronary blood flow: a. Is approximately 80 mL/100 g/min b. Approximates 10% of total cardiac output at rest c. Is under predominant control of the autonomic nervous system d. Is related to the difference between aortic systolic pressure and
left ventricular end-diastolic pressure (LVEDP) e. Is autoregulated
56. Signs of hypomagnesaemia include: a. Tremor b. Hyperreflexia c. Convulsions d. Shortened QT interval on the ECG e. T-wave flattening
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
(FRC): induction position in patients with high thoracic
spinal cord injury c. Is caused by application of PEEP d. Is found in asthmatics e. Is seen in the first trimester of pregnancy
58. Drugs safe to use in porphyria include: a. N2O b. Phenytoin c. Bupivacaine d. Aspirin e. Etomidate
59. A patient presents with a thyrotoxic crisis; appropriate management includes: a. Dantrolene 1 mg/kg intravenously b. Propanolol 1-5 mg intravenously c. Aspirin 75 mg orally d. Potassium iodide 200-600 mg intravenously e. Thyroxine 0.1-0.2 mg orally
60. The following statements are correct for dystrophia myotonica: a. It is the most common of the myotonic syndromes b. Nerve block techniques abolish abnormal contractions c. Mitral valve prolapse occurs in up to 20% of patients d. Nerve stimulator use is mandatory e. Patients are more likely to require a caesarean section
61. Concerning coning: a. A unilateral constricted pupil is an early sign of uncal herniation b. Central herniation can result in decorticate posturing c. Central herniation can result in decerebrate posturing d. It may follow lumbar puncture e. Cheyne-Stokes respiration is a sign of cerebellar compression
62. Vancomycin: a. Is a glycopeptide b. Exerts bactericidal activity against Gram-positive and Gram-
negative bacteria c. Can be administered orally d. Levels should be between 2 and 4 mg/L for therapeutic efficacy e. Causes ‘red man syndrome’ due to peripheral vasodilatation
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
and þ908 syndrome c. Posterior myocardial infarction is diagnosed by dominant
R-waves and ST depression in V1-V3 d. Thrombolysis is indicated with 2 mm ST change in 1 limb lead e. Bifascicular block is characterized by left bundle branch block
and left axis deviation
64. The sciatic nerve: a. Is formed from the anterior primary rami of L4-S3 b. Divides into tibial and common peroneal nerves c. Division is commonly at its point of exit from the greater sciatic
foramen d. Branches include the posterior cutaneous nerve of the thigh e. Can be blocked by anterior or posterior approaches
65. The isobestic points of oxyhaemoglobin and deoxyhaemoglobin are: a. 660 nm b. 590 nm c. 940 nm d. 805 nm e. 490 nm
66. The following agents reduce intraocular pressure (IOP): a. Topical adrenaline b. Acetazolamide c. Intravenous ketamine d. Propofol e. Intravenous atropine
67. Regarding hypoxia: a. It is defined as a PaO2 ,8 kPa b. Histotoxic hypoxia occurs in CO poisoning c. Stagnant hypoxia occurs in cyanide poisoning d. Ischaemic hypoxia occurs in cardiac failure e. Hypoxic hypoxia occurs in hypoventilation
68. A 60-year-old male with a history of rheumatic fever presents for emergency abdominal surgery. At preoperative assessment, he is found to have a mid-diastolic murmur, atrial fibrillation and an enlarged left atrial appendage on chest X-ray; the following statements are appropriate: a. Systemic vascular resistance should be kept low b. A transmitral pressure gradient of 20 mmHg during diastole is
normal c. Diastolic pressure should be maintained d. Normal mitral valve area is 4-6 cm2
e. Left ventricular end-diastolic pressure (LVEDP) is a good of
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
magnesium in pre-eclampsia with epidural analgesia for major
abdominal surgery c. POISE: No difference in mortality with metoprolol vs placebo for
non-cardiac surgery d. B-Aware: Bispectral index (BIS)-guided anaesthesia reduced
awareness by over 50% in high-risk adults e. PAC-Man: Increased mortality in critically ill patient with use of
pulmonary artery catheters (PACs)
70. Minitracheostomy: a. Is preferably performed through the higher tracheal rings b. Is the preferred method for emergency airway access c. Uses airway tubes typically sized 8 mm d. Incorporates a cuffed tube e. Is declining in use
71. A man is brought to A&E following a crush injury of both legs and pelvis; immediate investigations should include: a. Urine testing for myoglobin b. Arterial blood gas c. X-ray series of both legs d. Cross-matching 10 units of packed red cells e. Internal iliac arteriography
72. Concerning laryngoscope blades: a. Miller possesses a curved tip b. Polio Macintosh is mounted at 1208 to the handle c. McCoy is hinged at the tip, allowing elevation of the tongue d. Macintosh blades are available as left-handed versions e. The Soper is a straight version of the Macintosh
73. Desflurane: a. Contains seven fluorine atoms b. Has a single chiral centre c. Has a blood : gas partition coefficient of 4.2 d. Has the highest saturated vapour pressure (SVP) (at 208C) of
the halogenated anaesthetic volatile agents e. Sensitizes the myocardium to catecholamines
74. The following changes occur during whole blood storage: a. Decreased adenosine triphosphate (ATP) concentrations b. Progressive increase in potassium levels c. Increased free 2,3-diphosphoglycerate (2,3-DPG) concentration d. Addition of adenine increases shelf-life to 35 days e. Platelets are non-functional at 6 hours
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
fashion rhabdomyolysis c. Exhibits anticipation d. Is not safely managed with administration of nitrous oxide e. Is confirmed by in vitro contraction of vastus muscle under
separate exposure to halothane and theophylline
76. Indications for an interpleural block include: a. Fractured rib b. Chronic pancreatitis c. Laparoscopic cholecystectomy d. Mastectomy e. Shoulder surgery
77. The coagulation disorders below are associated with the following laboratory test results: a. Haemophilia A and normal thrombin time (TT) b. Haemophilia A and increased bleeding time c. Haemophilia B and increased activated partial thromboplastin
time (APTT) d. Disseminated intravascular coagulation (DIC) and increased
fibrinogen e. von Willebrand’s disease and increased bleeding time
78. Acute respiratory distress syndrome (ARDS) consists of: a. A direct exogenous insult b. A fibroproliferative phase c. PaO2/FiO2 300 mmHg (40 kPa) d. Unilateral infiltrates on chest X-ray e. Mortality of 30-50%
79. Common aetiologies of acute pancreatitis include: a. Microlithiasis b. Trauma c. Chronic alcoholism d. Hypothermia e. Hypocalcaemia
80. The following cannot be measured by spirometry: a. Vital capacity (VC) b. Expiratory reserve volume (ERV) c. Residual volume (RV) d. Functional residual capacity (FRC) e. Total lung capacity (TLC)
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
sodium of 6-8 hours c. Starch-based colloids have higher rates of adverse reactions
than gelatins d. Dextrans will lower the erythrocyte sedimentation rate (ESR) e. Molecular weight (MW) of gelofusine is 15-20 kDa
82. Turbulent flow is proportional to: a. Radius4
b. (Pressure gradient)21
c. Reynolds number d. Length e. (Density of fluid)21
83. The stellate ganglion: a. Is part of the parasympathetic chain b. Lies either side of the vertebral column c. Is the fusion of 1st and 2nd thoracic ganglia d. Can be blocked at Chassaignac tubercle e. Blockade results in ptosis
84. The following are side-effects of propofol administration: a. Green hair b. Bradycardia c. Convulsions d. Acidosis e. Hypercholesterolaemia
85. Maternal death: a. Describes the death of a woman up to 48 hours after her
pregnancy b. When ‘indirect’ describes death due to medical intervention c. Is most commonly due to pre-eclampsia d. When ‘coincidental’ describes death unrelated to pregnancy e. In the UK, the incidence is about 7 per 100 000 maternities
86. The positions in Generic Pacemaker Code (NBG) relate to the following functions: a. I – Chamber sensed b. II – Chamber paced c. III – Response to sensing d. IV – Programmability e. V – Shock chamber
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
c. 10 200 cmH2O d. 750 mmHg e. 7500 Torr
88. The following agents can be used for intravenous regional anaesthesia (IVRA): a. Bupivacaine b. Lidocaine c. Lidocaine with adrenaline d. Prilocaine e. Guanethidine
89. Fetal haemoglobin (HbF) a. Consists of two a and two b chains b. Binds 2,3-DPG less avidly than HbA c. Has a P50 of 2.4 kPa d. Forms 50% of circulating haemoglobin at birth e. May persist
90. A sensorimotor neuropathy is a feature of: a. Charcot-Marie-Tooth disease b. Syringomyelia c. Leprosy d. Motor neuron disease e. Diphtheria
3 . P ra c tic
e P a p e r 3 : Q u e stio
n s
1a. True 1b. True 1c. False 1d. False 1e. True The term ‘fat embolism’ describes the presence of fat globules in lung parenchyma and the peripheral circulation after long bone injury (closed more frequently than open) or major trauma; it is often asymptomatic. Non-traumatic causes include pancreatitis, diabetes and osteomyelitis. A consequence is fat embolism syndrome, which produces a distinct pattern of clinical symptoms and signs. Clinical presentation is typically 24-72 hours after injury and is characterized by a triad of respiratory changes, neurological abnormalities and a petechial rash. Various diagnostic criteria exist, the most commonly used are Gurd’s criteria and Schonfeld’s criteria; the latter score petechiae, chest X-ray, hypoxaemia, fever, tachycardia and tachypnoea. The presence of fat globules in the urine is a non-specific finding following trauma. Mortality is 5-15%.
