multiple choice questions

MCQs
The MCQ section in Anaesthesia and intensive care medicine is designed to
test your knowledge of selected topics in this issue of the journal. The correct
answers are given at the foot of the page.
Henry G W Paw is Consultant in Anaesthesia and Intensive Care at York Hospital, and
Clinical Senior Lecturer at the Hull York Medical School, UK.

Vijayanand Nadella is Clinical Fellow in Anaesthesia at York Hospital.

Questions

1 Coma and cerebral ischaemia 4 P

(pages 403–404)
Assessment and management of the comatose patient:
A Locked-in syndrome is complete paralysis below
the third cranial nerve nuclei with preservation of
consciousness
B A decerebrate patient will demonstrate abnormal
flexion of the upper limbs
C Unilateral dilation of a pupil suggests raised
­intracranial pressure (ICP) with compression of
the third nerve
D Glasgow Coma Score is unreliable in assessing the
progression of coma
E Lumbar puncture should not be undertaken in
the obtunded patient until a CT scan has excluded
raised ICP
2 Cerebrospinal fluid and its circulation
(pages 405–406)
The following statements are true:
A CSF has a higher concentration of protein than plasma
B CSF is produced in the choroids plexus by ultra
filtration of plasma
C Rate of CSF production is around 0.3 ml/min
D CSF flows from the lateral ventricle to the third
ventricle through the foramen of Monro
E CSF is reabsorbed into the cerebral venous sinus
by an active process
3 Applied cerebral physiology
(pages 407–412)
Cerebral blood flow and metabolism:
A During prolonged fasting, the brain is capable of
regenerating glucose by gluconeogenesis
B The brain receives 25% of the cardiac output
C The cerebral metabolic rate for oxygen is less for
grey matter than for white matter
D The cerebral autoregulation is shifted to the right
in a hypertensive patient
E Hypothermia reduces cerebral blood flow
 harmacological and pathological modulation of
cerebral physiology
(pages 413–417)
Influence of anaesthetic drugs on cerebral physiology:
A Thiopental causes direct cerebral vasoconstriction
B Sodium nitroprusside decreases intracranial ­pressure
by releasing nitric oxide
C Isoflurane does not affect cerebral autoregulation up
to concentrations of 1 MAC
D Ketamine decreases the rate of CSF absorption
E Non-depolarizing muscle relaxants increase ­cerebral
blood flow
5 A
 naesthesia for neuroimaging and interventional
neuroradiology
(pages 423–426)
Anaesthesia and MRI safety:
A The pacemaker line is the line at which the strength
has declined to 50 Gauss
B Titanium clips and coils are considered unsafe
C In the event of cardiac arrest the magnet should be
switched off to initiate resuscitation
D Pacemakers remain a contraindication to MRI
E Pulse oximetry can be monitored reliably
6 Ion channels, receptors, agonists and antagonists
(pages 437–442)
The cell membrane and receptors:
A The resting membrane potential is due to a constant
outward leak of K+
B L-type calcium channels contribute to pacemaker activity
C γ-aminobutyric acid A receptor is a ligand-gated ion
channel
D A G-protein-coupled receptor is composed of five
transmembrane domains
E Atrial natriuretic peptide uses guanylyl cyclase-linked
receptors

Correct answers: 1 (A, C, E) 2 (B, C, D) 3 (A, D, E) 4 (A, C, D) 5 (D, E) 6 (A, C, E)

Anaesthesia and intensive care medicine 8:10 447 © 2007 Published by Elsevier Ltd.