Chapter 1
1.1
A 49-year old woman is seen in the preop clinic, prior to having a laparoscopic cholecystectomy. She has a BMI = 39 kg/m2, type 2 diabetes and hypertension. She is currently taking metformin, ramipril, aspirin and simvastatin. She will require the following investigations:
a. T: She is diabetic, hypertensive and obese, all of which increase the risk of ischaemic heart disease.
b. F: She does not meet any of the criteria for requiring a CXR.
c. T: Diabetes may impair renal function affecting both her FBC and U + Es.
d. F: She does not have a history of coagulopathy, and is not on warfarin. Low-dose aspirin does not necessitate a coagulation screen.
1.2
Difficulty with tracheal intubation is suggested by finding:
a. F: <7 cm suggests difficulty.
b. T: This is Mallampati grade III, which suggests difficulty.
c. F: This does not suggest a reduced view at laryngoscopy.
d. T: An increased BMI suggests difficulty with intubation.
1.3
The following are common risks (1:10 to 1:100) of anaesthesia:
a. T: The risk can be stratified using the Apfel score.
b. T: A common side effect of opioids, anticholinergics, and neuraxial blockade.
c. F: Occurs approximately in 1 in 1000 cases.
d. F: Occurs in less than 1 in 10 000 cases.
1.4
The following factors increase the risk of VTE:
a. F: Age >60 years increases the risk.
b. T: Obesity increases the risk.
c. T: As well as those taking oestrogen containing oral contraceptive pills.
d. T: The risk is significantly higher until approximately 30 days after surgery.
1.5
In the assessment of the cardiovascular system:
a. T: Anaesthesia and surgery with a blood pressure this high risks serious complications such as perioperative myocardial infarction or stroke.
b. T: Echocardiography can be used to assess heart valve anatomy, function and pressure gradients across the valves.
c. T: Dobutamine can be given to raise heart rate and contractility, simulating exercise while an echo is being performed to assess the ventricular muscle’s response.
d. F: Cardiopulmonary exercise (CPX) testing assesses the body’s ability to increase oxygen delivery to tissues to meet demand.
Chapter 2
2.1
When using a circle anaesthetic breathing system:
a. F: CO2 is absorbed by the soda lime.
b. T: Oxygen and vapour in the circuit are rebreathed.
c. F: Absorption of anaesthetic by the patient and fresh gas flow will affect the concentration in the circle and therefore it must be monitored independently.
d. F: A circle can be used both for spontaneous and controlled ventilation.
2.2
Oximeters
a. F: They become increasingly unreliable below an SpO2 of 90%.
b. F: They give no indication of ventilation as hypoventilation can be compensated for by increasing the inspired oxygen concentration.
c. T: This is what they are measuring but they are most accurate above a SpO2 of 90%.
d. F: They overestimate saturation in the presence of carboxyhaemoglobin and underestimate in the presence of methaemoglobin.
2.3
Capnometers
a. F: It absorbs infrared light.
b. F: It is lower, in health by 0.7 kPa or 5 mmHg, but can increase in the presence of certain diseases, such as COPD.
c. T: Is inversely proportional to alveolar ventilation.
d. F: The gap between arterial and end-tidal carbon dioxide increases (end-tidal falls), mainly due to the development of increased areas of ventilation/perfusion mismatch.
2.4
Medical gases
a. F: It is supplied at a pressure of 400 kPa or 4 bar.
b. F: The pipelines carrying N2O are coloured blue.
c. F: They only control flow, not pressure.
d. T: At room temperature nitrous oxide becomes a liquid when it is under high pressure, unlike oxygen, which is always a gas at room temperature.
2.5
Supra-glottic airway devices
a. F: As they sit above the larynx, they do not isolate and seal the airway. This is only achieved by a cuffed tracheal tube.
b. F: They can be used to provide positive pressure ventilation provided the airway pressures are kept reasonably low (<25 cmH2O).
c. F: Only the i-gel® has a moulded gel cuff, others have an inflatable cuff.
d. F: There are a wide range of sizes available, suitable for neonates weighing <5 kg upwards.
Chapter 3
3.1
Using an IV drug to induce anaesthesia
a. T: As does thiopentone.
b. F: This is why it can be used as an infusion for TIVA.
c. F: Thiopentone induces anaesthesia very smoothly; these effects are seen with etomidate.
d. F: Ketamine causes profound analgesia.
3.2
Suxamethonium
a. F: It is the only depolarizing neuromuscular blocking drug.
b. T: This is why it is used for RSI.
c. F: It cannot be reversed; recovery occurs after metabolism by pseudocholinesterase.
d. F: It causes an increase in plasma potassium, which can be life-threatening in some conditions.
3.3
Local anaesthetic drugs
a. F: They enter the nerves in the unionized form but it is the ionized form that blocks sodium channels.
b. T: Small diameter nerves are blocked before large ones.
c. T: Bupivacaine is particularly cardiotoxic.
d. F: The maximum safe dose is 3 mg/kg. This is the dose with adrenaline.
3.4
Morphine
a. T: NSAIDs are more effective for treating pain from bone and soft tissue injuries.
b. F: The peak effect occurs in 5 to 10 min.
c. F: It is a Schedule 2 drug.
d. F: It causes pupillary constriction (miosis) due to its action on the Edinger–Westphal nucleus.
3.5
Inhalational anaesthesia
