Single Best Answer MCQs in Anaesthesia

Volume I Clinical Anaesthesia

Mendonca, Cyprian, Chaudhari, Mahesh, James, Josephine

• Publisher: tfm Publishing Ltd
• Year: 2010
• Print ISBN: 9781903378755
• eBook ISBN: 9781908986634
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The single best answer format of questions is invaluable in assessing a trainee's clinical skills and problem-solving abilities. It allows the trainee to demonstrate application of their knowledge to clinical practice. This book comprises six sets of practice papers. Each set contains 30 single best answer questions which cover topics including clinical anaesthesia, pain and intensive care. The questions are based on the recent changes introduced to the written part of the final FRCA examination. The best possible answer to a given clinical scenario is substantiated by a detailed explanation drawn from recent review articles and textbooks in clinical anaesthesia. These questions will enable candidates to assess their clinical knowledge and skills in problem-solving, data interpretation and decision making. This book is essential study material for candidates sitting postgraduate examinations in anaesthesia and intensive care medicine. It is not only an essential guide for trainees but also an invaluable educational resource for all anaesthetists.

Set 1 questions

1

A 60-year-old male patient is admitted to the emergency department. He was working on his car in a garage and was found unconscious by his wife, with the garage door almost shut and the car engine running. On assessment, his GCS is 7, oxygen saturation is 99% and mucous membranes are ‘cherry red’ in colour. Which of the following actions is most appropriate in the immediate management?

a.	Take a full history from his wife to confirm the facts.
b.	Arrange for a CT of the brain to precisely diagnose the cause of unconsciousness.
c.	Arrange for urgent transfer to a neuro-intensive care unit.
d.	Intubate and ventilate the patient with 100% oxygen.
e.	Oxygenate with a non-rebreathing mask whilst arterial blood gas results are performed.

2

A 59-year-old male has undergone a left upper lobectomy for a neoplasm. The peri-operative course was uncomplicated. He has a history of COPD and 50-pack-per-year history of smoking. His routine medications include a salbutamol inhaler and uniphyllin 300mg b.d. On the second postoperative day, in the high dependency unit, the patient suddenly develops atrial fibrillation with a ventricular rate of 140 to 170 beats/min. His blood pressure falls to 80/30mmHg from a near normal level for his age. The most appropriate immediate management is:

a.	Check the serum K^+ and Mg^+ levels.
b.	Commence oxygen 6L/min using a non-rebreathing mask.
c.	Give amiodarone 5mg/kg boluses over 30 minutes.
d.	Synchronised DC shock.
e.	Intravenous digoxin.

3

A 21-year-old male has had an extraction of an impacted third molar tooth under general anaesthetic. Postoperatively he continues to bleed from the surgical site. Despite surgical exploration and packing, bleeding continues. His coagulation screen reveals both a prolonged bleeding time and activated partial thromboplastin time (APTT), but the prothrombin time (PT) and platelet count are within normal limits. The patient mentions that his father bruises quite easily. The most likely diagnosis is:

a.	Haemophilia A.
b.	Haemolytic uraemic syndrome.
c.	Haemophilia B.
d.	von Willebrand’s disease.
e.	Laden V deficiency.

4

A 45-year-old man with a history of gall stones presents to the emergency department complaining of severe constant epigastric pain radiating to the back and flanks, and vomiting. Examination reveals pyrexia, abdominal distension, rebound tenderness and discolouration of the flanks. Which of the following blood tests would be most useful in the diagnosis of acute pancreatitis?

a.	Serum amylase.
b.	Serum trypsinogen.
c.	Serum lipase.
d.	Serum transaminases.
e.	Serum calcium.

5

A 39-year-old male is due to undergo haemorrhoidectomy. He suffered a complete spinal cord transection at T6 level 2 years ago. His medications include paracetamol q.d.s., gabapentin 600mg t.d.s., omeprazole and clonazepam. He intermittently uses a GTN spray for the management of symptoms related to autonomic hyper-reflexia. The patient has no particular preference regarding anaesthetic technique. Which anaesthetic technique would be most suitable?

a.	General anaesthesia with rapid sequence induction.
b.	Spinal anaesthesia.
c.	No need for any anaesthesia.
d.	Light general anaethesia.
e.	Combined spinal epidural (CSE).

6

An 83-year-old female presents to the pain clinic with a 10-week history of severe pain in her left eye. The pain is continuous and is associated with a burning sensation. She also had a skin rash in the painful area which began after a week of onset of the pain. She has been treated with an intermittent course of steroid medication for the management of her poorly controlled COAD. The most likely cause of her pain is:

a.	Trigeminal neuralgia.
b.	Atypical facial pain.
c.	Atypical presentation of trigeminal neuralgia.
d.	Late signs and symptoms of polymyalgia rheumatica.
e.	Post-herpetic neuralgia.

7

A 33-year-old female is due to undergo an emergency laparotomy for a ruptured ectopic pregnancy. She has had a previous general anaesthesic when she was told she might suffer from a possible allergy to an anaesthetic agent. She suffers from hay fever and has a history of allergic reactions to multiple medications including antibiotics and NSAIDs. Her previous anaesthetic notes are not available. Which one of the following is most appropriate for intravenous induction of anaesthesia?

a.	Thiopenton...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Preface
• Acknowledgements
• Abbreviations
• Set 1 Questions
• Set 2 Questions
• Set 3 Questions
• Set 4 Questions
• Set 5 Questions
• Set 6 Questions
• Set 6 Answers