This is a collection of Multiple Choice Questions which have been asked in the Canadian Royal College exams in recent years.
They have been classified into related groups of questions. 

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PREOP CONSIDERATIONS

1. Which of the following is an indication for inserting a pacemaker before induction
A. RBBB + RAD
B. RBBB + LAD
C. Type II AV Block
D. HR < 40 bpm
E. First degree AV block.

2. What is the acute effect of smoking cessation?
A. Shift of oxyhemoglobin curve to the right
B. Increased ciliary function
C. Decreased mucous production
D. Decreased pneumonia post op.

3. What is true for erythropoetin?
A. Is associated with periop hypertension
B. Only works on erythropoiesis in the bone marrow
C. Routine periop administration will decrease blood loss
D. Subcutaneous administration is ineffective

4 All are contraindications to ECT except:
A. Pacemaker
B. Pregnancy
C. Pheochromocytoma
D. MI
E. CVA.

5 Which anesthetic would be LEAST indicated for a patient with severe COPD who needs
repair of a broken first finger?
A. GA
B. Bier block
C. Axillary block
D. Interscalene block
E. Local infiltration

6. Patient presents with hypercalcemia, goiter, and hypertension for emergency
surgery. How would you control the hypertension?
A. give propanolol
B. give phentolamine
C. deepen anesthetic with more volatiles
D. ?

7. Emergency OR (laparotomy). Urine shows mild proteinuria, hyaline casts, FeNa=0.8,
urine Osm=600. This is most consistent with :
A. Gentamicin nephrotoxicity
B. Fluoride nephrotoxicity
C. Hypovolemia
D. ?

MONITORING

1. Most precise measurement of BP using NIBP vs art tracing is :
A. Systolic
B. Diastolic
C. Mean
D. Pulse pressure
E. Paradoxical pressure

2. The LEAST accurate monitor of cerebral perfusion pressure during carotid endarterectomt is:
A. EEG
B. Stump pressure
C. ?
D. ?

3. What is an index of a Swan Ganz in West zone 3?
A. The wedge tracing
B. Sampling of the blood
C. Increased variation with respiration
D. CXR

4. Risks of pilmonary catheter:
A. Older than 60
B. Hypothermia
C. Pulmonary hypertension
D. ?

5. Premature atrial contraction, all EXCEPT
A. Compensatory pause
B. Normal P wave
C. Normal QRS
D. RBBB

6. All are ECG signs of pulmonary hypertension except:
A. Biphasic p wave in v6
B. Right ventricular hypertrophy
C. RBBB
D. Tall p wave in II

7. All are ECG changes that may be seen with SAH except:
A. T wave inversions
B. U waves
C. LVH hypertrophy
D. Prolonged QT

8.. ECG in mitral valve prolapse ?
A. PACs
B. Normal
C. Ventricular tachydysrhythmias
D. ?

9. ECG monitoring
A. low frequency filter for muscle movement
B. high frequency filter for ST
C. higher band width with monitoring than diagnostic
D. high frequency filter more useful for poor electrode contact

10. If you are using a ECG to place a catheter in the right midatrium position:
A. P wave manly negative
B. P wave mainly positive
C. Biphasic p wave
D. T wave inverted

COMPLICATIONS

1. Most serious complication of the mediastinoscopy
A. Hemorrhage
B. Pneumothorax
C. Esophageal perforation
D. Recurrent laryngeal nerve injury
E. Mediastinitis

2. Regarding perioperative myocardial infarction in patients undergoing non cardiac surgery
A. Beta blockers decreases its incidence
B. It happens more often after the 3rd day postop
C. Incidence 15-20%
D. Usually symptomatic (Chest pain).

3. Respiratory change after a high abdominal or thoracic surgery
A. Decreased VC
B. Increased FRC
C. Normal FEV1/FVC

4. All are true regarding anaphylaxis except:
A. C3 C5 activation
B. IgE mediated
C. Symptoms are the same as anaphylactoid
D. History of atopy is not necessarily elicited

5 In anhepatic stage of liver transplant, all may be found except:
A. Azygous vein thrombosis
B. Decreased cardiac output

6 All are true in Negative Pressure Pulmonary Edema except:
A. Common in adults and children with upper airway obstruction
B. Common after epiglottitis and laryngospasm
C. Its severity is related to the duration and degree of the obstruction
D. Is easily treated with O2 by mask

7 All are complications associated with thoracic aortic cross clamp for repair of descending
A. Aortic aneurysm except:
B. Paraplegia
C. Myocardial ischemia
D. Renal failure
E. Hepatic failure
F. LV overload

8 All are hemodynamic effects of aortic cross clamping except:
A. Decrease cardiac output
B. Decrease CVP
C. Patients with good collaterals have little changes
D. Increased VO2 because of anerobic metabolism distal to the clamp
E. Increase afterload of LV causing cardiac problems

9 Which will increase the risk of venous air embolism?
A. Hypovolemia
B. Positive pressure ventilation
C. Decrease gradient between head and heart
D. Avoiding N2O
E. Bone wax.

10. You are seeing a patient who has been treated in hospital for 4 days for elevated ICP.
Which of the following would you expect as a result of this therapy?
A. Hypovolemia
B. Hypoglycemia
C. Hyperkalemia

11. HIV prophylaxis for mucous membrane exposure to blood of a patient with HIV
A. No prophylaxis
B. Prophylaxis for all contacts
C. Only give prophylaxis to patients exposed to blood from patients with clinical AIDS
D. No prophylaxis until anti-HIV status is known

12. Anaphylactic reaction with low BP and Tachycardia, which drug?
A. Noradrenaline
B. Ephedrine
C. Epinephrine
D. Dopamine
E. Phenylephrine.

13. Blood patch : EXCEPT
A. Recent studies indicate that 5-8 cc of blood is enough
B. Need to wait for local anesthetic to wear off prior to EBP
C. Mechanism may involve pressure in epidural and SA-space
D. Most common complication after EBP is back ache
E. Prophylactic EBP are not in widespread use

14. All are causes of the decreased incidence of thromboemblism and epidurals
EXCEPT
A. Lidocaine directly suppresses platelet aggreagtion and release
B. Morphine decreases platelet aggregation and release
C. Hemodilution of blood due to block
D. Increased blood flow to periphery

15. Hypotension after unclamping the aorta during AAA repair is due to all EXCEPT
A. Myocardial depressin from debris washout
B. Pooling of blood in the periphery due to sequestration
C. Citrate intoxication
D. Acute blood loss
E. Reactive hyperemia

16. Which of the following will increase the risk of perioperative cardiac ischaemia?
1. Increased. opioid dose
2. Isoflurane
3. Hypertension
4. Tachycardia
5. Hyperthermia

17. Least risk of ischaemia during periop period:
1. stable angina
2. MI within last 6 months
3. symptomatic aortic stenosis
4. sustained moderate persistent hypertension
5. tachycardia

18. Treatment for post-MI diastolic dysfunction:
1. inc. preload--- volume
2. pde 3 & inc. ionotropy
3. neo. to inc perfusion pressure
4. ionotropes & beta 1
5. nitroglycerine

19. If rupture of an aneurysm occurs during clipping:
1. nitroprusside
2. hydralazine
3. deeper anesthesia
4. labetalol
5. ?

20. Regarding the laser and corneal damage:
1. co2
2. yag
3. infra red

21. Regarding ECT
A. Increases CK-MB
B. Increases LDH-2
C. There is increased incidence of PVCs without preoxygenation
D. Decreased hemodynamic response if bitemporal electrodes are used
E. Less complications in the elderly

22. Most common risk of transtracheal jet ventilation :
A. Mediastinal emphysema
B. Subcutaneous emphysema
C. Pneumothorax
D. Various other wrong answers

OBS/GYN ANESTHESIA

1. Most common presenting symptom of the HELLP syndrome
A. RUQ pain
B. Jaundice
C. Headache
D. Seizures
E. Generalized edema

2. The best test of diabetes mellitus in pregnancy:
A. HbS
B. HbSC
C. HbA1c
D. HbA
E. HbC

3. What is the most common effect of Valium 5 mg to a parturient?
A. Neonatal hypothermia
B. Loss of beat to beat variability

4.Decreased fetal heart variability is due to
A. Fetal anencephaly
B. Maternal sleep
C. Gestational diabetes
D. Sspinal anesthesia
E. Post dates fetus

5.  What is true regarding breech delivery and epidural analgesia?
A. Does not increase the ability to convert a complete breech to an incomplete
B. Increase chance of vaginal extraction
C. Slight increase in second phase of labor
D. High dose of potent local anesthetic will increase uterine relaxation

6.  Which is true of twin gestation
A. Increased hypertension of pregnancy
B. Decreased hemorrhage
C. Shorter labor

7. Regarding herpes and pregnancy, which is true?
A. Spinal anesthesia is safe
B. There is always a history of infection in Mom
C. Most worried about transplacental infection of fetus
D. Epidural morphine reactivates genital herpes
E. ?

8. In severe preeclampsia, all of the following EXCEPT :
A. SBP >160
B. MAP >105
C. Oliguria <400cc/24h
D. Pulmonary edema
E. Proteinuria >5g/24h

9. Early decelerations can be due to:
1. maternal hypotention
2. cord compression
3. vagal.

10. Haemodynamic changes during pregnancy:
1. Decreased SVR
2. Decreased stroke volume
3. Decreased blood volume
4. Increased heart rate
5. ?


PEDIATRIC ANESTHESIA

1. Persistent Pulmonary Hypertension in the newborn is caused by all the following except:
A. Meconium Aspiration
B. Diaphragmatic Hernia
C. Acidosis
D. Polycythemia
E. Hypercarbia

2 Apgar of neonate blue, pale, limp, HR=90, irregular respiration and grimaces to suction
A. 1
B. 2
C. 3
D. 4
E. 5

3. Resuscitation of neonate, HR 90bpm, gasping after 2 minutes of PPV 100% O2.
Next step?
A. Intubate, CPR at 120 bpm
B. Naloxone 0.1 mg/kg if mum received narcotics
C. Orogastric tube to decompress stomach, then PPV
D. Intubate and EPI through ETT

4. Mottled baby post-partum, no PT pulse and cap-refill 8 seconds. No other vitals given.
Estimate % blood loss :
A. 2%
B. 5%
C. 8%
D. 10%
E. 15%

5. Congenital subglottic stenosis EXCEPT
A. severity increases with age
B. association with Down’s syndrome
C. anterior cricoid split might be required during neonatal period
D. it is characterised by biphasic stridor
E. it features concentric hypertrophy

6.. What increases the risk of post operative apnea in the ex-premature infant?
A. Ketamine sedation
B. Post conceptual age of less than 50 weeks
C. History of necrotizing eneterocolitis
D. Anemia
E. Incarcerated hernia

7. 5 ½ month baby for day surgery, mother worried about SIDS, what will make you recommend post-op admission
A. General anesthesia over 2 hours
B. Spinal anesthesia over 1 hour
C. Baby had BPD at 1 month of age
D. Only able to sleep supine
E. distant relative had a infant who died from unknown causes

8. Regarding CROUP, all are found EXCEPT
A. Dysphagia
B. Stridor
C. Retractions
D. Hoarse voice
E. Barking cough

9. Controlled hypotension in pediatric patients. All are contraindications, EXCEPT
A. Increased ICP
B. Hemoglobinopathies
C. Anemia
D. Coricosteroid dependent asthma
E. Polycythemia

10. Adolescent with Scoliosis, what is the most marked respiratory parameter change
A. Decreased Vital capacity
B. Decreased FEV1/FVC

11. You are anesthetizing a 9-year-old boy. You have given 1 mg/kg sux, and you find it difficult to open his mouth, and intubation is difficult. What is the most likely cause?
A. MH
B. Normal variant
C. Myotonia
D. The syringe was mislabeled
E. IV was interstitial

12 Which is not part of VATER
A. radial malformation
B. vertebral anomaly
C. imperforation of anus
D. Meckel’s diverticulum
E. esophageal atresia

13. Dose of Epinephrine in a 10 kg child?
A. 0.05 mg
B. 0.01 mg
C. 0.1mg
D. 1 mg
E. 0.25 mg.

14. Epiglottitis, EXCEPT :
A. Toxic appearance
B. Whispering voice, not hoarse
C. Drooling dysphagia
D. 2-3 day viral prodrome.

15. Regarding spinals in children compared to adults :
A. Less hypotension in children
B. Bloody taps are more common in children
C. Children should be positioned on their side for procedure of spinal

16. 6 year old ? hospitalized awaiting appy with Hx of sickle-cell disease. Likely post-op :
A. More prone to dehydration
B. Increased post-op requirement for analgesics
C. More prone to hypothermia
D. More prone to dehydration
E. ?


BLOOD & BLOOD PRODUCTS

1. All are true regarding “type and screen” except:
A. Can always replace the full crossmatch
B. More useful for surgery where transfusion is unlikely

2 Blood in CPDA
A. increased lactate in RBC due to anaerobic metabolism
B. increased K in RBC due to Na-K pump block
C. storage gives the same problems as aging
D. RBC don’t metabolize glucose
E. 2,3DPG (?)

3. Massive transfusion and bleeding
A. increased consumption at trauma/surgical site
B. packed RBC have no platelets
C. decreased levels of 2,3DPG result in increased platelet destruction
D. destruction of platelets in IV filter
E. increased uptake of damaged platelets in reticuloendothelial system.

4a. IgA deficiency EXCEPT
A. incidence 1/600
B. no anaphylaxis withblood products
C. problems with cross match
D. patient may produce IgG and IgE
E. more susceptible to pulmonary infections

4b. All are true regarding IgA deficiency EXCEPT
A. incidence of 1/600
B. IgE and IgM are produced
C. Decreased problems with blood products
D. Increased problems with cross match
E. Increased pulmonary infections

5. Cryoprecipitate best for correction deficiency of
A Factor I
B factor V
C factor XIII
D factor VII

6. Hemolytic reaction - all except:
1. hypotention
2. muscle rigidity
3. coagulopathy
4. fever
5. hemoglobinuria

7. Autologous blood EXCEPT
1. more common in surgery which does not need transfusion
2. dec. chance of AB. Reaction
3. eliminates chance of a hemolytic reaction
4. put into common blood bank pool
5. dec. blood given ( autologous or else)


REGIONAL ANESTHESIA

1. At what level is the Supraclavicular Brachial Plexus Block done:
A. Trunks
B. Divisions
C. Cords
D. Roots
E. Branches

2. Regarding Brachial plexus Block
A. Sensation comes back to the proximal portion first
B. Abduction of the arm increases the diffusion of the agent
C. There is no need to block the Intercostobrachialis if a tourniquet is being used
D. The needle has entered the sheet if the stimulation is 1.5 mA
E. The musculocutaneous gives the sensation to the median part of the forearm

3. Which block increases the plasma concentration of local anesthetic the most?
A. Intercostal
B. Caudal
C. Subcutaneous
D. Spinal
E. Epidural

4. Which nerve you don’t need to block for an awake fiberoptic intubation
A. Hypoglossal
B. Lingual
C. Glosopharyngeal
D. Trigeminal
E. Vagus

5. Which nerve need not be blocked for knee arthroscopy?
A. Posterior Tibial
B. Femoral
C. Lateral Cutaneous of the Thigh
D. Obturator
E. Sciatic.

6. After blocking the Sciatic Nerve, what else needs to be blocked for ankle surgery?
A. Saphenous
B. Posterior Tibial
C. Superficial Peroneal
D. Sural
E. Deep Peroneal

7.  Which is true of a “Differential Epidural Block” for chronic pain?
A. Can be used to predict the usefulness of surgery or a neurolytic block
B. Is based on the difference in conductivity in nerve fibers
C. Amides should be used

8. Respiratory failure after high thoracic epidural, what is the mechanism
A. midbrain hypoperfusion

9. All of the following will decrease with a spinal to T5 except:
A.  Resting ventilation
B. Cardiac output
C. Myocardial O2 consumption
D. Coronary flow
E. Hepatic flow

10.  What is the percent incidence of phrenic nerve block with an interscalene block?
A. 100%
B. 90%
C. 50%
D. 10%
E. 1%

11.  Retrobulbar block, what decreases complications
A. less axial lenth
B. scleral buckling
C. needle with cutting bevel
D. gaze up and inward
E. puncture deep along axial length

12. Regarding the brachial plexus, which is true?
A. Situated behind the middle interscalene
B. Plexus is in front the subclavian artery
C. Does not innervate the latissimu dorsi
D. Arises from the posterior roots of C5-C8, T1
E. Innervates the shoulder joint

13. Interscalene block for shoulder arthroscopy. 96 hours post op, patient has loss of shoulder abduction, decreased sensation from shouder to elbow. Otherwise normal exam. Nerve injured?
A. Posterior cord of brachial plexus
B. Axillary
C. Radial
D. Musculocutaneous
E. Suprascapular

14. What block is needed for knee arthroscopy
a. popliteal sciatic and lumbosacral plexus
b. transgluteal sciatic and lumbosacral plexus

15. Caudal
A less likely to get blood than in adults
B more difficult in children than adults because of anatomy
C once through the membrane the needle should not be advanced more thal 1 cm
D more hypotension than adults
E no continuous perfusion for age less than 5 years

16. Tetracaine in spinal
A isobaric lasts less long
B lithotomy position increases level

17. Celiac plexus block is useful in the treatment of cancer pain in all of the foll.
EXCEPT?
A. liver
B. kidney
C. stomach
D. pancreas
E. small intestine

18. What structure is not injured during a stellate block, anterior approach?
A. posterior longitudinal ligament
B. esophagus
C. vertebral artery
D. pleura
E. dura mater

19. What is true regarding nerve blocks?
A. Block of the deep cervical plexus results in the blockage of the phrenic nerve
B. Supraclavicular technique gives more pneumothoraces than the phrenic nerve block
C. Celiac plexus rarely results in hypotension
D. Block of the ulnar nerve at the condylargroove does not result in neurits
E. If musculocutaneous mised, there will be a patchy lock over the medial aspect of the forearm

ANAESTHESIA : OTHER

1. Which is found in both acute and chronic forms of reflex sympathetic dystrophy (RSD)?
A. Burning pain
B. Dysesthesia
C. Thick hair growth
D. Cortical bone thickening
E. Ankylosis

2. a 92 year old lady has postop. lobar pneumonia and respiratory failure. She has told her physician that she wants to be left alone to die. Her physician prescribes a 1 week course of penicilin. What principle of medical ethics has been breached?
A. beneficence
B. autonomy
C. nonmaleficence
D. ?

3. FRC and positioning
A FRC decrease will increase V/Q mismatch
B lithotomy greatly decreases FRC
C 20 degree Trendelenburg.

4. Concerning pollution in the OR, which is true?
A. Acceptable levels of halogenated agents alone, 2 ppm
B. Safe levels of halogenated and nitrous 1ppm
C. Time weighted average of 30 ppm nitrous to be safe
D. Safe levels of nitrous 100 ppm alone
E. Don’t need to measure levels if scavenging present

5. Regarding ICP, which is true?
A. Plateau waves on the ICP tracing are a normal finding
B. ICP may be measured sub-durally, intra-parenchymally and intra-ventricularly
C. Normal ICP is 15-20 mmHg

6. All are true regarding treatment of increased ICP in a patient with a supratentorial mass EXCEPT 
A. removal of 100 cc CSF by lumbar drain
B. mannitol
C. hyperventilation
D. lasix.

7. What occurs during bronchopulmonary lavage with normal saline?
A. hypercarbia during OLV
B. hypoxemia during fill of the lung with NS
C. hypoxemia during suctioning of the lung
D. hypoxemia during 2 lung ventilation
E. hemolysis

8. An advantage of the CO2 laser:
1. Decreased oedema
2. ?
3. ?
4. ?
5. ?

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http://www.AnaesthesiaMCQ.com Last updated Saturday, 23 July 2005 02:02 PM - Kerry Brandis, 2001