91. Which of the following statements about 96. Suitable analgesic techniques for day-case patients with chronic renal failure are correct? inguinal herniotomy in children include: (a) Bacterial endocarditis is rare in patients on haemodialysis. (a) Local anaesthetic infiltration by the surgeon. (b) Cardiovascular diseases are the leading cause of death. (b) Caudal epidural blockade.
Downloaded from https://academic.oup.com/bjaed/article/3/5/157/281097 by guest on 28 June 2021
(c) Pericardial effusions are usually clear transudates. (c) Ilioinguinal nerve block. (d) Ischaemic heart disease is often silent in chronic renal disease. (d) Morphine 0.2 mg kg–1 intra-operatively. (e) Aortic valve calcification is rare under the age of 50 years. (e) Paracetamol 15 mg kg–1 as required after discharge home.
92. The coagulopathy associated with CRF: 97. Pre-operative assessment of children for day- (a) Is due to a relative decrease in plasma fibrinogen. case surgery should include: (b) Is caused by defective vascular endothelial activity. (a) Full blood count for all children having adenotonsillectomy. (c) Is caused by reduced platelet aggregation. (b) Completion of a screening questionnaire. (d) Can be corrected rapidly by DDAVP administration. (c) Examination by an anaesthetist before booking a date for (e) Can be improved by platelet transfusion. surgery. (d) Cardiological referral if a heart murmur is found in a child 93. With respect to drug handling in CRF: <1 year old. (a) Loading doses of water soluble drugs should be reduced by (e) An ECG if the child has Fallot’s tetralogy. 30–50%. (b) Induction doses of propofol should be reduced by 30–50%. 98. Which of the following would contra-indicate (c) In the presence of hyperkalaemia, doses of succinylcholine should discharge after paediatric day surgery? be reduced to 0.5 mg kg–1. (a) Pain unrelieved by oral analgesia. (d) Fentanyl excretion is unchanged. (b) Failure to pass urine after grommet insertion. (e) The seizure threshold to local anaesthetics is reduced. (c) Refusal to drink after inguinal herniotomy. (d) Lower limb weakness in a 2 year old after caudal block. 94. Which of the following statements about (e) Proposed escort home to be 14-year-old brother. calcium homeostasis in CRF are correct? (a) Patients rarely develop symptoms with hypocalcaemia. 99. Concerning percutaneous dilational tracheostomy: (b) Hypocalcaemia is independent of phosphate excretion. (a) The patient is positioned as for oral intubation. (c) Hyperphosphataemia causes reduced intestinal calcium (b) It should be performed between the cricoid cartilage and the absorption. first tracheal ring. (d) Calcium carbonate is used to reduce intestinal phosphate (c) It is mostly performed in anaesthetised, ventilated and absorption. paralysed patients. (e) Calcium chloride can be used to correct the clotting (d) Bronchoscopic guidance can make the procedure safer. abnormality in CRF. (e) It was introduced by Ciaglia in 1995.
100. The following scenarios are indications for
95. Which of the following cases are suitable for tracheostomy: day surgery? (a) Prolonged ventilation (over 3 weeks) in an 8-year-old child. (a) A 12-week-old infant for inguinal herniotomy born 4 weeks (b) Emergency upper airway obstruction in a respiratory arrest prematurely. situation. (b) A 2-year-old child for laparoscopic fundoplication. (c) Airway protection in a comatose patient following severe head (c) A 5-year-old for grommet insertion with an asymptomatic VSD. injury. (d) A 4 year old with acute lymphoblastic leukaemia for lumbar (d) Anticipation of prolonged mechanical ventilation (over 2–3 weeks) puncture. in an elderly patient who has been ventilated for 5 days. (e) A 6 year old for squint surgery who lives 2 h drive from hospital. (e) Acute respiratory failure in a patient taking warfarin.
101. Complications of percutaneous tracheostomy 107. Pain behaviour is:
include: (a) An exaggerated response to painful stimulus. (a) Intra- and postoperative bleeding. (b) Seen only in chronic pain conditions. (b) Tracheal stenosis. (c) An indication of the patients’ attempts to mislead the clinician. (c) An increased incidence of pneumonia. (d) Influenced by the patient’s knowledge and beliefs about their (d) Hypoxaemia due to creation of an airway leak during the condition. procedure. (e) Everything the patient says and does. (e) Voice changes. 108. Concerning affective disorders: 102. With regard to laser safety: (a) Approximately 40–50% of pain patients suffer depression.
Downloaded from https://academic.oup.com/bjaed/article/3/5/157/281097 by guest on 28 June 2021
(a) Reflected laser beams are not dangerous. (b) Patients’ assessment of the effects of pain, and of their ability to (b) Safety is covered by specific health and safety legislation in the UK. exert control over it, rules the pain–depression cycle. (c) A low oxygen concentration should be used in the anaesthetic gas (c) Increased anxiety levels are associated with increased pain report. mixture. (d) Anger is a powerful predictor of pain severity. (d) Spectacle wearers are protected from the laser beam. (e) In chronic pain patients, affective disorders require specific (e) Only a laser protection supervisor can use a laser in an NHS treatment before rehabilitation can commence. operating theatre. 109. Concerning pain report: 103. In laser surgery: (a) It is the main determinant of disability from pain. (a) Endotracheal tubes designed for laser surgery are made of PVC. (b) It is chiefly a feature of the depression and anxiety reported by the (b) Only the visible beam is dangerous. patient. (c) Volatile anaesthetic agents cannot be used. (c) In acute pain, it is best explained by nociception. (d) Laser treatment of laryngeal carcinoma is often used prior to (d) In chronic pain, it is best explained by psychological factors. radiotherapy. (e) Pain can be measured on the visual analogue scale. (e) Laser endotracheal tubes can catch fire. 110. Breast cancer: 104.With regard to lasers: (a) Is responsible for 5% of cancer deaths in women. (a) Laser is an acronym for light amplification by the synchronous (b) Is more common in women with previous benign breast disease. emission of radiation. (c) Is associated with the BRCA-2 gene. (b) Semiconductor lasers are able to generate a greater power output (d) Can metastasise to bone. than carbon dioxide lasers. (e) Risk is influenced by oral contraceptive therapy. (c) Helium–neon lasers generate light in the red part of the spectrum. 111. Regarding anaesthetic management of patients for (d) The ruby laser can generate a continuous light output. breast surgery: (e) The argon laser emits green light. (a) The incidence of postoperative nausea and vomiting is 5–10%. 105.With regard to light from a laser: (b) Full blood count is indicated if surgery is planned after recent (a) The beam is an incoherent beam of light. chemotherapy. (b) The beam diverges very little. (c) Mastectomy with latissimus dorsi reconstruction involves significant (c) The beam consists of a very narrow range of light frequencies. blood loss. (d) The energy of the beam is given by E = hν. (d) Premedication with a benzodiazepine is rarely indicated. (e) The SI unit for the power of the laser beam is the Joule. (e) Endotracheal intubation is mandatory for airway management.
112. Regarding paravertebral anaesthesia for breast
106.With regard to the management of airway fires: surgery: (a) The FiO2 should be reduced immediately by adding nitrous oxide (a) It reduces postoperative pain and PONV. to the circuit. (b) Optimum analgesia is achieved using combinations of local anaes- (b) The surgeon should flood the operation site with saline. thetic and opioids. (c) An endoscopic assessment of the airway should take place after (c) The transverse process of the vertebra is a key identifying land- the fire has been extinguished. mark. (d) Steroids are of no value in preventing airway oedema. (d) It cannot usually be continued as postoperative analgesia. (e) Respiratory problems are uncommon. (e) Horner’s syndrome is a recognised complication.
158 British Journal of Anaesthesia | CEPD Reviews | Volume 3 Number 5 2003
