Multiple Choice Questions

21. The brachial plexus: (c) Rectal bioavailability is the same as oral.
(a) Has roots arising from C5–T1 spinal segments. (d) Maximum daily dose is 150 mg kg–1.
(b) Consists of 3 cords lying between the scalene muscles. (e) Rarely causes liver failure after recommended doses.
(c) Does not give rise to the axillary nerve.
26. NSAIDs:
(d) Superior and inferior cords join to make the median nerve.
(a) Are often used in infants less than 6 months of age.
(e) Travels behind the subclavian artery in the supraclavicular region.
(b) Act by inhibition of cyclo-oxygenase.
22. With respect to an axillary block: (c) Are contra-indicated by a history or the presence of wheeze.
(a) The median nerve lies anterior and superior to the axillary artery. (d) May increase blood loss after surgery.
(b) The musculocutaneous nerve supplies motor branches to the (e) Can be given concurrently with paracetamol.
biceps and sensation to the lateral forearm.
(c) The triceps is the only muscle supplied by the radial nerve. 27. Concerning the use of opioids in infancy:
(a) They can often be given orally.
(d) Elbow reconstruction cannot be performed under this block alone.
(b) They should never be combined with NSAIDs.
(e) It provides sympathetic block to upper limb.
(c) Codeine is very effective at all ages.
23. Regarding local anaesthetic agents in a brachial (d) Morphine elimination is prolonged in the neonate.
plexus block: (e) Rarely cause side-effects.
(a) Absorption is more rapid in an axillary compared to an interscalene
block due to the proximity of the axillary vein. 28. The following are complications of positive
(b) A safe dose of lidocaine is 7 mg kg–1 if epinephrine 5 µg ml–1 is pressure ventilation:
added. (a) Pneumothorax.
(c) A block with ropivacaine has a shorter duration than that with (b) Pneumonia.
bupivacaine if the same concentration is used. (c) Reduced glomerular filtration rate.
(d) A catheter technique can only be employed effectively with a supra- (d) Splanchnic vasoconstriction.
clavicular block.
(e) Reduced intracranial pressure.
(e) Adding epinephrine aids identification of an intravascular injection of
local anaesthetic agent. 29. When ventilating patients:
(a) BIPAP is appropriate for paralysed patients.
24. With respect to brachial plexus blockade:
(b) Tidal volumes of 10–12 ml kg–1 are desirable in ARDS.
(a) Injection of local anaesthetic is performed even if minimal muscle
stimulation is achieved at 2 mA. (c) The mode of ventilation has no bearing on time to wean.

(b) The interscalene approach only blocks the plexus up to the C6 (d) Changes in PEEP can improve oxygenation.
root. (e) Compliance is defined as the change in pressure per unit volume
(c) The phrenic nerve is blocked in up to 50% of successful intersca- change.
lene blocks.
(d) Only SpO2 monitoring is necessary when performing regional 30. The following modes of ventilation rely on
nerve blocks. spontaneous respiration:
(e) There is no need for the patient to fast prior to surgery if a region- (a) Proportional pressure support (PPS).
al technique is to be performed. (b) Autoflow.
25. Paracetamol: (c) Biphasic positive pressure support (BIPAP).
(a) Is safe for neonatal analgesia. (d) Pressure support ventilation (PSV).
(b) Neonates do not require reduced doses. (e) Automatic tube compensation (ATC).

British Journal of Anaesthesia | CEPD Reviews | Volume 2 Number 2 2002

60 © The Board of Management and Trustees of the British Journal of Anaesthesia 2002
 Multiple choice questions

31. Regarding synchronous intermittent (d) At 100 Hz releases endogenous opioids under some conditions.
mandatory ventilation (SIMV): (e) Should usually be used for prolonged periods to maintain efficacy.
(a) Atelectrauma is caused by high peak pressure.
(b) Peak pressure causes less damage than plateau pressure. 37. TENS stimulation:
(a) Cannot be used over the anterior aspect of the neck.
(c) Peak pressure is independent of inspiratory flow rate.
(b) Is contra-indicated in epilepsy.
(d) Spontaneous respiration is not possible during the
expiratory phase of a ventilator breath. (c) Can be safely used in those with cardiac pacemakers.

(e) SIMV is associated with slower weaning than BIPAP. (d) Is safe in early pregnancy.
(e) Cannot be used over painful metastases.
32. Co-morbid conditions associated with
38. TENS stimulation:
subarachnoid haemorrhage include:
(a) Has a good evidence base for use in postoperative pain.
(a) Essential hypertension.
(b) Produces a placebo effect that fades within a week.
(b) Ischaemic heart disease.
(c) Is of no proven benefit in labour pain.
(c) Coarctation of the aorta.
(d) Can alter myocardial metabolism.
(d) Polycystic kidney disease.
(e) Is not effective for dysmenorrhoea.
(e) Aortic aneurysm.
39. During seated craniotomy:
33. The risk of an aneurysm rebleeding is
(a) PEEP 10 cmH2O prevents air entering the venous system.
increased by:
(a) Seizures. (b) Using PEEP may make PAE more likely.

(b) Hydrocephalus. (c) Fluid loading should be avoided.

(c) Physical activity. (d) Continuous jugular venous compression should be used.

(d) An increase in ICP associated with a fall in MAP. (e) Central venous access is not necessary.

(e) An equivalent increase in both ICP and MAP. 40. End-tidal capnography:
(a) Is the most sensitive monitor available for detecting VAE.
34. The treatment of delayed cerebral ischaemia
includes: (b) A fall in the end-tidal carbon dioxide is specific for detecting air
(a) Fluid restriction. embolism.

(b) Blood transfusion to maintain a normal haematocrit and oxygen (c) Does not suffer from electrocautery interference.
carrying capacity. (d) Accurately quantifies the volume of air entrained.
(c) Induced hypertension. (e) Can replace precordial Doppler as a monitor for VAE.
(d) Clipping of the aneurysm.
41. In the event of VAE:
(e) Nimodipine. (a) Children are more likely to suffer adverse effects than adults.

35. During anaesthesia: (b) Central venous pressure falls.

(a) Mannitol should be given at induction. (c) Pulmonary artery pressures fall.
(b) MAP should always be maintained at its pre-induction level. (d) Pulmonary oedema may occur.
(c) Hyperventilation should be employed to reduce ICP. (e) PAE only occurs in the presence of a patent foramen ovale.
(d) TIVA reduces operative time.
42. With respect to treatment of a VAE:
(e) Hypothermia protects against cerebral ischaemia. (a) The wound should be flooded with hydrogen peroxide.

36. TENS stimulation: (b) The patient should be turned to the right lateral position.
(a) Excites C fibres. (c) Air can be rapidly aspirated from a PA catheter.
(b) Produces analgesia within 5–10 min. (d) Nitrous oxide should be discontinued immediately.
(c) At 40–150 Hz causes painful paraesthesia. (e) A central venous catheter should be inserted immediately.

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