Download Final FRC MCQ March 2015

Coventry Anaesthetic Course - RCOA Mar 2015 Questions
1. You are called to see a patient with tracheostomy . His saturation dropped from 98% to 86% on 50%
oxygen. What will be your next immediate step?
a. Call for help
b. Connect the tracheostomy tube to a circuit and do manual bagging
c. Give 100% oxygen
d. Pass suction catheter through tracheostomy tube
e. Remove tracheostomy tube
2. 74yo man with 4month history of post herpetic neuralgia. What is the best initial treatment?
a. Amitryptiline 150mg daily
b. Gabapentin up to 900mg daily
c. Oral morphine (slow release) 10mg
d. Ibuprofen 400mg TDS
e. Paracetamol 1g QDS
3. 2 year old child with meningococcal septicaemia. Sats 93% on high flow oxygen, BP 40/30 HR 220.
What is your next course of action?
a. 240ml fluid bolus, intubate using 3.5 cuffed ETT and cuff pressure <20
b. 240ml fluid bolus, intubate using 3.5 ETT inflate cuff until no leak
c. 240ml fluid bolus, intubate with 4.5 uncuffed ETT
d. 240ml fluid bolus, intubate with 4.5 uncuffed tube and use throat pack
e. Fluid resuscitate and start CPAP
4. A 64 year old man has a complete T4 spinal cord injury from an RTA several years ago. He has suffered
dusted lexis since. He also has COPD and has a scar from a tracheostomy. He is due to undergo
cystoscopy and removal of bladder stones. What is the most appropriate anaesthetic plan?
a. LMA and GA
b. No anaesthetic is required
c. Spinal anaesthetic
d. Epidural anaesthetic
e. Local anaesthetic and sedation
5. 70 year old male undergoes radical neck dissection for maligancy. Patient becomes unstable when
tumour is being dissected from carotid sheath. SBP drops to 60, HR 110, SpO2 87% and ETco2 1.9kpa.
Cause most likely is:
a. Anaphylaxis
b. Carotid sinus manipulation
c. Myocardial ischaemia
d. Tension pneomothorax
e. Venous air embolism.
6. Haemodynamically stable patient on ICU, suspect PE, best way to diagnose:
a. D-dimer
b. TOE
c. CTPA
d. V/Q scan
e. ECG
Thanks to our to our candidates from Feb 2015
Coventry Anaesthetic Course - RCOA Mar 2015 Questions
7. An 18 year old female attends alone to the maternity unit for surgical termination of pregnancy at 10
weeks. She is otherwise fit & well. On questioning, she tells the nursing staff she will get a taxi home
and a friend will "pop her head in" later this evening to check she's ok. She refuses to stay in hospital
overnight. What is the best course of action?
a. Cancel the procedure & rearrange
b. Pre-operatively ensure appropriate transport is arranged & someone can stay with her overnight.
c. Continue with the procedure as planned.
d. Continue with the procedure as planned under local anaesthesia
e. Convince the Obstetrician to administer a medical termination
8. You are anaesthetising a 2 year old for bilateral cochlear implants. The surgeon asked you how much
local anaesthetic they can use for the first incision. What is most appropriate dose of LA:
a. 3.5ml of 1% lidocaine with 1:80,000 adrenaline
b. 3.5mls of 1% lidocaine with 1:200,000 adrenaline
c. 3.5mls of 2% lidocaine with 1:200,00 adrenaline
d. 2ml of 0.5% bupivicaine with 1:200,000 adrenaline
e. 4mls of 0.25% bupivicaine with 1:200,000 adrenaline
a. A 4 year old children, 10kg, is having bilateral tympanoplasty. The surgeon wants to know how much
local anaesthetic he can inject before incision. What do you recommend per side?
a. Lidocaine 7mls 1% + adrenaline 1:80,000
b. Lidocaine 3.5mls 2% + adrenaline 1:200,000
c. Bupivocaine 0.5% 2mls + adrenaline 1:200,000
d. Bupivocaine 0.25% 4 mls + adrenaline 1:200,000
e. Lidocaine 1% 3.5mls + adrenaline 1:200,000
9. You are anaesthetising a pt with significant peripheral vascular disease for small bowel obstruction. You
decide to site an art line pre induction. After fluid resuscitation the blood pressure dropped a little on
induction but responded to a bolus of metaraminol. On transferring to theatre you notice that the art
line reads 60/40 and the NIBP reads 120/80. What is the most like cause?
a. An over damped trace
b. A faulty transducer
c. The transducer is set too high above the patient
d. Calcification of arteries
e. .........
10. A patient with the orthotopic bladder resection. He is confused and refusing oral intake on the ward.
BP, HR, and urine output are all within normal limits. Bloods results: Na 147, K 3.1, Hco3 16, Ph 7.26, Cl
116, Glu 14. What is the most appropriate treatment?
a. Potassium via central line
b. Bicarbonate and iv potassium
c. IV fluids with saline
d. Breath into a paper bag
e. Insulin sliding scale
Thanks to our to our candidates from Feb 2015
Coventry Anaesthetic Course - RCOA Mar 2015 Questions
11. A lady with bony metastasis from primary breast ca. On oxycodone 60mg qds she is experiencing
severe breakthrough pain twice a day lasting 20 minutes. When her oxycodone was increased to 80mg
bd she became very drowsy. What is the most appropriate next step?
a. Ibandruic acid 50mg
b. Transmucosal fentanyl
c. Increase Oxycodone to 120mg
d. Paracetamol 1g qds
e. Ibuprofen 400mg tds
12. A 78 year old male with continuing neuropathic pain following an episode of shingles four months ago
presents to pain clinic. Which is the most reasonable initial approach from the following:
a. Amitryptilline 150mg/day
b. Carbamazepine 100mg TDS
c. Gabapentin 900mg/day
d. Ibuprofen 400mg TDS
e. Morphine SR 10mg BD
13. An ICU patient with tracheostomy suddenly desaturates to 80% on 60% oxygen. What is the next
immediate appropriate action?
a. Call for help
b. 100% o2
c. Pass a suction catheter down
d. Take the tracheostomy out
e. Ventilate with a mapleson's c circuit
14. Post-op patient in recovery, complaining of nausea, fast AF 140 bpm, BP 92/40. Management:
a. IV digoxin 0.5mg
b. Antiemetics
c. DC cardioversion
d. Amiodarone 300mg
e. Magnesium 2g IV over 20 mins
15. You need to anaesthetise a woman who doesn't speak English for a Cat 3 section. What is the best way
of taking a history and providing info?
A. Language line
b. O+g registrar who has some understanding of the patients language
c. Husband
d. Patients 11 year old daughter who is bi-lingual
e. Written translated materials
16. 70 yr old with depression on phenelzine, bendroflumethiazide and enalapril undergoes laparotomy for
severe peritonitis. Intra-op, BP drops to 65/30, HR 100, no response to fluid. Most appropriate:
a. Ephedrine
b. Metaraminol
c. Norad
d. Phenylephrine
e. Vasopressin
Thanks to our to our candidates from Feb 2015
Coventry Anaesthetic Course - RCOA Mar 2015 Questions
17. Patient with history of asthma, RSI for appendicectomy, develops severe bronchospasm and ETCO2
trace is low. Best treatment:
a. IV aminophylline 250mg
b. IV adrenaline 50-100mcg
c. IV adrenaline 500mcg
d. Adrenaline 500 mcg IM
e. IV salbutamol 250 mcg
18. Patient admitted to ICU with severe pancreatitis, best way of assessing severity?
a. Abdominal USS
b. CT abdo
c. Serial amylase
d. Serial Ca
e. Exploratory laparotomy
19. 34/40 induction of labour, previous C section, previous IUFD. Becomes hypotensive, pale and collapses.
Most likely cause?
a. Ruptured uterus
b. AFE
c. Aortocaval compression
d. Analphylaxis
e. Septic shock
20. 66 yr old patient pre-op for CABG, wants to know re risk factors for stroke. Which of these is the
biggest risk factor for stroke?
a. Hypertension
b. Previous stroke
c. Asymptomatic carotid bruit
d. Proximal atheroma aorta
e. IDDM
21. 60 yr old with OSA, AF, INR 1.9 for elective hernia repair. Best management:
a. Controlled ventilation with des + remi + inguinal field block
b. Controlled vent with sevo + remi + inguinal field block
c. Spontaneous vent with prop + remi _ inguinal field block
d. SV with sevo plus inguinal field blcok
e. SV + prop plus PCA
22. Best way of effectively pre-O2 a patient with BMI 35 for RSI
a. O2 6l/min circle, supine, 3 min
b. O2 6l/min mapleson A, 30 degrees head up 4 vital capacity breaths
c. O2 6l/min mapleson A supine 3 mins
d. O2 6l/min mapleson A 30 degrees up 3 mins
e. O2 6l/min Bain circuit, supine, 3 min
Thanks to our to our candidates from Feb 2015
Coventry Anaesthetic Course - RCOA Mar 2015 Questions
23. 60 year old male, vomiting, severe headache, photophobia in ED. Best next step?
a. Intubate and ventilate
b. Transfer to ICU
c. CT head
d. Refer neurosurgeons
e.....
24. You have anaesthetised a 45 year old lady for abdominal hysterectomy. You are asked to see her two
hours later because she has passed no urine. Her blood pressure has been 85/45 and 105/60. The
cause of her lack of urine is most likely due to:
a. Hypotension
b. Blocked catheter
c. Nsaid nephropathy
d. Poor preoperative fluid status
e. Bilateral ureteric damage intraoperatively
25. Adult with history of burns around face, mouth and suspected of inhalational burns. Patient is agitated
and confused. Regional burns unit is 35 miles away. Best way of transferring patient is:
a. On High flow oxygen, with IV fluids
b. Intubate and ventilate, with IV fluids
c. Anaesthetic trainee escort in case of airway emergencies
d. ....
e. ....
Thanks to our to our candidates from Feb 2015
Coventry Anaesthetic Course - RCOA Mar 2015 Questions
MTF MCQ
1. A pregnant lady has multiple sclerosis. The following are true or false:
a. Her symptoms are more likely to relapse during pregnancy.
b. Any neurological deficit is a contraindication to spinal anaesthesia.
c. She is more likely to have a c section
d. ...
e. ...
2. Syncope
a. is more often due to heart disease
b. associated with Bradycardia
c. May be precipitated by failure of vision
d. can be indirectly due to retention of urine
e. due to decrease in urine output.
3. To calculate P(A-a)O2 the following are required:
a. CvO2- CaO2
b. resp quotient
c. FIO2
d. QT
e. Haematocrit
4. Parkinsons disease is associated with the following:
a. increased pigmentation substantia nigra
b. resting tremor
c. increased dopamine levels
d. ....
e. ....
5. Electroconvulsive therapy is
a. indicated in endogenous severe depression
b. contraindicated in well controlled grand mal epilepsy
c. contraindicated in the presence of a pacemaker
d. contraindicated in a patient with a brain tumour
e. contraindicated in patients above the age of 60 years
Thanks to our to our candidates from Feb 2015