Continuing professional development: MCQs and self-assessment

Continuing professional development: MCQs and self-assessment

Current Anaesthesia & Critical Care 20 (2009) 33–34 Contents lists available at ScienceDirect Current Anaesthesia & Critical Care journal homepage: ...

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Current Anaesthesia & Critical Care 20 (2009) 33–34

Contents lists available at ScienceDirect

Current Anaesthesia & Critical Care journal homepage: www.elsevier.com/locate/cacc

Continuing professional development: MCQs and self-assessment Question 1. The liver a) is divided into 5 lobes b) the falciparum ligament divides the quadrate and caudate lobes c) surgically it is considered as 8 segments d) joined to the inferior vena cava by 3 hepatic veins e) the only blood supply is the hepatic artery Question 2. Liver blood flow a) hepatic arterial and portal venous blood flows are reciprocally linked, i.e. a fall in portal vein flow increases hepatic artery flow b) a fall in hepatic artery flow results in increased portal vein flow c) is mediated by cardiac output d) the hepatic artery usually supplies less than 50% of the blood supply e) is compromised by a reduction in splanchnic perfusion Question 3. In the liver a) the microcirculatory unit of the liver is an acinus b) the pressure in a sinusoid is around 6 mmHg c) sinusoid pressure is lower than vena cava pressure d) total blood flow is about 1.5 l in an adult e) hepatic artery anatomy can be variable Question 4. The following metastasise commonly to the liver a) colorectal b) neuroendocrine c) pancreas d) eye e) lung Question 5. Which are correct a) VEGF antibodies can be used for colorectal metastasis b) CUSA is a city in Peru c) EGFR promotes white cell growth d) CUSCO can be used for blood less liver resection e) capecitabine can be used for colorectal metastasis Question 6. Advantages of robotic surgery include a) 360 degree range of movement b) eliminated tremor c) 3 dimensional view of the operative field d) faster procedure e) greater precision Question 7. Anaesthesia and liver blood flow a) isoflurane has more effect on the hepatic artery buffer response than sevoflurane b) hypovolaemia will reduce splanchnic flow significantly

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c) epidurals anaesthesia blocks the negative effects of a reduced cardiac output d) low dose vasopressors will reverse the hypotensive effects of epidurals on hepatic blood flow e) a mean arterial pressure of 60 mmHg or greater is recommended perioperatively Question 8. Blood loss and liver resection a) high CVP is associated with increased blood loss b) an epidural may be used to reduce CVP c) transfusion is associated with rapid recurrence of tumours d) a low CVP and hypovolaemia increase the likelihood of organ hypoperfusion e) a low CVP is associated with a longer hospital stay Question 9. Oesophageal cancers are a) associated with smoking b) increased by caffeine c) predominantly adenocarcinoma d) adenocarcinoma tend to be proximal e) age related Question 10. Common co morbidities include a) pulmonary fibrosis b) COAD c) ischaemic heart disease d) reflux e) diabetes Question 11. One lung ventilation a) results in a right to left shunt b) results in a left right shunt c) tends to increase lung compliance d) shunt is offset by pulmonary vasoconstriction e) theoretically more blood flows to the lower lung Question 12. The anaesthetic implications of radiotherapy for head and neck tumours include a) thrombocytopenia b) increased sensitivity to muscle relaxants c) reduced mouth opening d) reduced neck mobility e) laryngeal fixation Questions 13. Chemotherapeutic agents often have side effects. Which of these pairs are correct? a) bleomycin nephrotoxicity b) taxanes neurotoxicity c) methotrexate pulmonary fibrosis d) cisplatin hepatotoxicity e) 5 fluorouracil diarrhoea

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Current Anaesthesia & Critical Care 20 (2009) 33–34

Question 14. The following information or signs have high predictive value for difficult intubation a) a goatee beard b) a visible goitre c) trismus d) head and neck radiotherapy e) base of tongue tumour Question 15. Transtracheal ventilation a) there should be a clear exit for gas to escape from b) increases cord movement c) can be complicated by barotrauma d) is paced through the 2nd and 3rd tracheal rings e) does not require a suspension laryngoscope Question 16. Which of the following statements are correct? a) 90 percent of head and neck cancers are squamous cell carcinomas (SCC) b) tobacco tar is considered the prime carcinogen in squamous cell carcinomas c) thyroid cancer is three times more common in men then women d) oral squamous cell carcinomas are more common in the Indian sub-continent than Europe e) there is a strong association between Epstein Barr Virus and oral squamous cell carcinomas in South East India Question 17. Radiotherapy a) is rarely used to treat SCC’s as they are generally radioinsensitive b) can cause a restrictive ventilatory defect in the lungs c) poor oral hygiene is not associated with osteoradionecrosis of the jaw d) is commonly used synchronously with chemotherapy e) is useful in imaging the head and neck

Question 18. Intubation a) is unlikely to be difficult if previous intubation proved straightforward b) is likely to be more difficult post radiotherapy c) is likely to be more difficult with tongue base tumours d) planning needs close liaison with the surgical team e) planning must include an extubation plan Question 19. Fibre-optic intubation a) is indicated in all suspected difficult intubations b) is indicated in bleeding tongue base tumours c) is indicated in a tight laryngeal stenosis d) is indicated in trismus with poor mouth opening e) is an option with uncooperative patients Short answer questions Write short notes on the following topics: 1. oesophageal cancer pre-assessment 2. anatomy of the liver Clinical scenario You are asked to review a 68-year-old gentleman on the head and neck ward with known squamous cell carcinoma of the larynx who is suffering with worsening stridor at rest. 1. What treatments are immediately available to you to temporarily improve his symptoms? 2. What specific points in the history and examination are relevant to his airway assessment? 3. Are there any investigations you would like to see before proceeding further? 4. What is your plan for the management of his airway?