MCQ 1

1. Regarding pulse oximetry

a. It monitors the oxygen content in the peripheral circulation T
b. Surrounding lighting affects its reading F
c. Recording value is overestimated in patients with increased
methaemoglobin level F (false high in carboxyhemoglobin, false low in
methaemoglobin)
d. Perfusion index is derived from the oximetry F
e. It is based on the infrared technology T
2. Concerning serum osmolality
f. Hypernatremia increases osmolality T
g. Serum glucose is the highest contributor to its osmolality F na
h. It governs the intravascular oncotic pressure F (oncotic pressure governs
by protein)
i. High osmolality causes cellular dehydration T (high osmolality = more Na
in blood water escapes from cells)
j. Lower value is usually associated with high urine osmolality F
3. Arterial gases of 7.35, PaCO2 30 mmHg alkali and Base Excess -8 indicates
k. Compensated moderate mixed respiratory and metabolic acidosis F
l. Compensated mild respiratory alkalosis F
m. Compensated moderate metabolic acidosis T
n. Compensated moderate metabolic acidosis with mild respiratory alkalosis
T
o. Compensated mild respiratory alkalosis with moderate metabolic acidosis
F
4. Regarding intravenous anaesthetic agents
p. Propofol has the fastest onset of action among hypnotic agents T (LOC
within 15 minutes)
q. Sodium thiopental is relatively contraindicated in asthmatic patients T
(thiopental causes laryngospasm)
r. Morphine is the preferred analgesic to blunt the stress response to
laryngoscope F (fentanyl to obtund the sympathetic effect) (morphine got
slow onset)
s. Esmeron is one of the most commonly used non-competitive muscle
relaxant F (Esmeron = rocuronium) (rocuronium = non-depolarizing =
competitive inhibitor)
t. Ketamine is suitable for paediatric patients T (can give IM)
5. Concerning inhalational anaesthetic agents
u. MAC value of 1 indicates that 100% of patients will not move to surgical
stimulus F (MAC 1=50% patient not moving on surgical stimulus)
v. All volatile anaesthetic agents require vaporizer T
1

w. Induction with Sevoflurane is appropriate T (Sevoflurane is the only

inhalational induction agent)
x. Patients wake up faster with Desflurane T
y. Nitrous oxide is appropriate to be used as sole anaesthetic agent F (MAC
is 104%, had to mix with oxygen)
1. Regarding airway assessment prior to anaesthesia
a. Mallampati classification assessing the degree of mouth opening F
b. Short neck is associated with difficult mask ventilation T
c. Obesity is an independent risk factor for difficult laryngoscope F
d. Stridor indicates an upper airway obstruction T
e. Denture needs to be removed F (no need remove denture during airway
assessment)
2. The findings below are true for preoperative cardiovascular assessment
f. Presence of third heart sound prompts a referral to cardiology team T
g. Persistent hypertension must be optimized prior to elective surgery T
h. It is safe to proceed with elective surgery within 3 months after myocardial
infarction F (6 months)
i. Echocardiography is indicated for a newly diagnosed murmurs T
j. Oral hypoglycemic agents must be discontinued prior to elective surgery T
(higher risk of hypoglycemia with OHA)
3. Post operative nausea and vomiting
k. Affects smokers more than non-smokers F (smoker got less post-op
nausea and vomiting)
l. Occurs more in female than male patients T
m. Is prevented by intravenous propofol T (propofol has antiemetic effect,
ethomidate has emetic effect)
n. Is reduced by hydration T
o. Is associated with pain T
4. Patient is safe for discharge from post anaesthesia care unit when she/he is
p. passing out urine T (especially in spinal anesthesia patient)
q. blood pressure of 170/90 mmHg F (< 140/90)
r. comfortable but drowsy F (post-op drowsy has to think hypoxia,
hypercarbia, CO2 narcosis, hyper/hyponatremia, hypoglycemia, stroke,
sepsis)
s. breathing at 30 breath/minute F (may be due to metabolic acidosis of
APO)
t. complain of minimal bleeding from surgical site T
5. Regarding peri-operative assessment of pain
u. Visual analogue scales are available for both adult and children T
v. Pain is the vital sign T
w. Pain intensity should always be scored on movement F
2

x. A score of 8 on numerical rating scale is acceptable F (mild pain 0-4)

y. Acute pain assessment is completed by the use of complex pain
questionnaires F
6. Regarding local anaesthetic (LA) agents
z. The degree of ionization depends on the pKa of LA agent T
aa. Amide local anaesthetics are the most commonly used T (amide example
lignocaine, bupivacaine)
bb. Bupivacaine is the most potent T (need smaller dose with bupivacaine to
achieve same effect)
cc. High dose is associated with central nervous system depression F
dd. Lignocaine is both lipid and water soluble T
7. Regional anaesthesia
ee. is the preferred anaesthetic technique for lower limb surgeries T
ff. improves post operative pulmonary function T
gg. reduces the risk of deep vein thrombosis T (vasodilatation)
hh. is indicated for patient with coagulopathy F
ii. is safe in septic patients F
8. Regarding analgesics
jj. NSAIDs is not suitable for use during the surgical operation F
kk. Morphine is suitable to use in asthmatic patients F
ll. Pethidine is commonly used in management of acute pain F
mm.
Paracetamol is most commonly used in children T
nn. Ketamine provides analgesia T (can use in burn case too)
9. Transferring critically ill patients requires
oo. physiological stability T
pp. endotracheal intubation T
qq. secured central venous access T
rr. invasive monitoring T (Intra-arterial BP, CVP)
ss. communication with the patient's family T
10. Concerning infection in ICU
tt. Hand washing is the most effective preventive measure T
uu. Narrow spectrum antibiotics should be commenced within 6 hours of
diagnosis F (1 hour)
vv. Blood culture is the definitive diagnosis for septicaemia F
ww.
Ventilator associated pneumonia occurs as early as 24 hours F
(after 48 hours)
xx. Multi drug resistant bacteria are common complication T
11. Systemic inflammatory response syndrome (SIRS)
yy. Is an abnormal immunological response F (normal response)
zz. Is diagnosed when heart rate is more than 100 beats/minute F (>90)
3

aaa.
Is diagnosed when temperature is less than 36 C T
bbb.
Is diagnosed when respiratory rate is less than 20 breath/minute F
(>20)
ccc.
Is diagnosed when white cell count is more than 4,000 cells/mm 3 F
(< 4)
12. Signs of circulatory failure are
ddd.
Mean arterial blood pressure less than 60 mmHg T
eee.
Urine output more than 1 ml/kg/Hr F
fff. Altered conscious level T
ggg.
Serum lactate less than 1 mmol/L F
hhh.
Mottled skin T
13. An appropriate premedication in term pregnant lady going for caesarean section
iii. Oral sodium citrate T (increase pH)
jjj. Oral H2 blocker T (ranitidine increase pH)
kkk.
Oral maxolon T
lll. Oral anticholinesterase F
mmm.
Oral benzodiazepine F
14. Regarding the following statements
nnn.
Hypokalemia causes paralytic ileus T
ooo.
Plain abdominal radiograph commonly detect blunt pancreatic
injury F
ppp.
Cupola sign indicates pneumomediastinum F (pneumoperitoneum)
qqq.
CT scan for intestinal obstruction requires intravenous contrast T
rrr. Majority of renal injury is due to penetrating injury F (blunt injury)
15. Splenic injury
sss.
Is less common than renal injury F
ttt. Is graded by ultrasound jury F
uuu.
Is complicated by infarction T
vvv.
Has rib fracture as an associated finding T
www.
Requires CT scan as mandatory examination in haemodynamically
unstable patients F
MCQ 2
1. The following devices protect the airway from soiling in an anaesthetized patients
a. Larygeal Mask Airways F
b. Cuffed Endotracheal Tube T
c. Guedel airway F
d. Nasogastric tube F (relax LES)
e. Armoured Tube T (for long surgery)
4

1. Regarding monitoring during anaesthesia

a. Pulse oximetry reading is underestimated by a nail varnish T
b. An ambient light in operation light influences an SpO2 reading F
c. Electric cautery is known to disrupt an ECG signal T
d. Indirect blood pressure measurement depends on the cuff size T
e. End tidal CO2 measures CO2 content in the plasma F
2. Concerning intravenous anaesthetic agents
f. Propofol induces loss of consciousness within 1 arm-brain circulation T
(15 seconds)
g. Midazolam induces rapid onset of anaesthesia T
h. Ketamine is suitable for patients with hypertension F
i. Sodium thiopentone does not cross the blood brain barrier F
j. Etomidate does not cause hypotension F
3. During the visit to see the patients before the surgery, the following finding should
prompt an immediate medical referral
k. a blood pressure of 160/85 mmHg F
l. Mobitz type 1 heart block on ECG F (unless is Mobitz 2)
m. Gallop rhythm on auscultation T
n. crepitations on auscultation T
o. allergic to the antibiotics F
4. At the induction of anaesthesia for an adult patient
p. Cricoid pressure should be applied before consciousness is lost T
q. Suxamethonium should only be used in rapid sequence intubation F
r. Pre-oxygenation is indicated in all patients T
s. Inhalational induction is widely used in pediatric population T
t. Propofol is suitable induction agent in a hypotensive patient F ketamine
5. Concerning peri-operative analgesia
u. Intravenous opioids are suitable for mild to moderate pain F
v. Ketamine has an analgesic property T thiopental, propofol and etomidate
x
w. Hallucination is one of the side effect of morphine T
x. Patient receiving haemodialysis should not be given NSAIDs T
y. Diclofenac (NSAIDs) is contraindicated for asthmatic patients T
6. Patient is safe for discharge from post anaesthesia care unit when
z. Aldrete activity score is 8 F (>9)
aa. PADSS activity score is 8 F (>9)
bb. blood pressure measurement is 170/90 mmHg F
cc. breathing at 8 breath per minute F
dd. complaining of pain F
7. Signs of an acute respiratory failure includes
5

ee. respiratory rate of more than 30 breaths per minute T

ff. SpO2 <90% under room air T
gg. ABG shows respiratory acidosis T
hh. Use of accessory muscle T
ii. Drowsiness T
8. Signs of an inadequate tissue perfusion are
jj. systolic blood pressure less than 90 mmHg T
kk. urine output less than 0.5 ml/kg/day T
ll. hyperglycaemia F
mm.
mottled skin T
nn. decreased serum lactate level F
9. Concerning fluids and electrolytes
oo. 60% of the body mass is water in an adult male T
pp. intravascular volume is 5% of total body weight T (15% is interstitial fluid)
qq. Potassium is largely an extracellular electrolytes F
rr. Calcium is largely an extracellular electrolytes F
ss. Isotonic fluids stay longer in intravascular than interstitial space F
10. An obese patient is more likely to be
tt. Hypoxaemic T (splinting diaphragm)
uu. hypercarbic post-operatively T
vv. hypertensive T
ww.
difficult to intubate T
xx. anaesthetic drug overdose T (if calculate according to body weight, then
he might get overdose) (drug dose has to be calculated according to ideal
body weight not the actual body weight
11. pH 7.25 acidic, PaCO2 50 acidic, SBE -8 indicates hco3 16 acidic
yy. a partially compensated metabolic acidosis F
zz. a partially compensated respiratory acidosis F
aaa.
a mixed metabolic and respiratory acidosis T
bbb.
a predominantly metabolic acidosis T
ccc.
a moderate respiratory and severe metabolic acidosis T
12. Criteria for admission to ICU are
ddd.
patient's financial circumstances F
eee.
availability of treatment T
fff. poor prognosis F
ggg.
requirement for organ support T
hhh.
Legal medical directive from patients F
1. Concerning inotropes
Adrenaline stimulates both alpha and beta adreno-receptors T
Noradrenaline increases myocardial oxygen demand T
6

Dopamine stimulates beta-2 more than beta-1 receptors F

Dobutamine is normally present in the body F
Dopamine is the first choice of treatment for septicaemic shock F (septic
shock: noradrenaline dobutamine adrenaline vasopressin)
Regarding local anaesthetic agents
Bupivacaine has a slower onset compared to lignocaine T
Lignocaine is preferred because of its long acting duration F
EMLA topical anaesthetic mixture is effective after 30 minutes of application F
(1 hour)
Ropivacaine is lipid soluble but not water soluble F
The degree of ionization depends on the pH of the drug solution T
Possible causes of post operative confusion or altered conscious state include
Hypoxaemia T
Hypernatremia T
Hypocapnia T (can cause cerebral vasoconstriction)
Pain T
Hypoglycaemia T
Regional anaesthesia
is the most employed anaesthetic technique for lower limb surgeries T
improves post operative pulmonary function T
reduces the risk of deep vein thrombosis T
is indicated for patient with coagulopathy F
reduces hospital stay T
Hypokalaemia
Hyperpolarizes the membrane T
Shortens the QRS F
Shortens the PR interval T
Depresses the ST segment T
Prolongs the QT interval T
Ascites is detected radiologically by
Ultrasound T
Computed tomography (CT) scan F
Magnetic resonance imaging (MRI) F
Angiogram F
PET scan F
Traumatic solid organ injuries is routinely diagnosed by
MRI F
Ultrasound T
Fluoroscopy F
CT scan T
7

Plain radiograph F