2021

EMRCS
Peri-Operative

MRCS I.V.
Peri-operative care
1/1/2021
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Peri-operative care

Question An
N.
s.
Which of the drugs listed below confers the greatest risk of malignant
hyperthermia?
A. Decamethonium halides
1 B. Suxamethonium B
C. Benzquinonium
D. Gallamine
E. Vecuronium
Which of the following preparatory regimes should be considered for a 63-
year-old man with normal renal function who requires a diagnostic
colonoscopy to investigate iron deficiency anemia for which he takes
ferrous sulphate?
A. Stop ferrous sulphate 7 days pre procedure and administration of oral
purgatives the day prior to the procedure
2 B. Administration of oral purgatives the day prior to the procedure and A
continue ferrous sulphate
C. Continue ferrous sulphate and administration of phosphate enemas
on the day
D. Cease ferrous sulphate 7 days pre procedure and administration of
phosphate enema 30 minutes pre procedure
E. No preparation required
A 72-year-old man with prostate cancer is admitted to urology with urinary
retention. He complains of back pain which is not responding to ward
analgesia. Imaging shows several lumbar vertebral body metastasis. What
is the most appropriate management?
3 A. Commence a bisphosphonate B
B. Arrange radiotherapy to the lumbar spine
C. Surgical resection and reconstruction of the vertebral body
D. Administration of pregabalin
E. Chemotherapy
A 66-year-old man is admitted following a collapse whilst waiting for a
4 bus. Clinical examination confirms a ruptured abdominal aortic aneurysm.
E
He is moribund and hypotensive. What is his ASA?
A. 1

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B. 2
C. 3
D. 4
E. 5
Which of the agents listed below is associated with the strongest anti emetic
properties?
A. Sodium thiopentone
5 B. Propofol B
C. Etomidate
D. Ketamine
E. Sevoflurane
Which of the following muscle relaxants will tend to incite neuromuscular
excitability following administration?
A. Atracurium
6 B. Suxamethonium B
C. Vecuronium
D. Pancuronium
E. None of the above
Of the agents listed below, which is the most appropriate to give a 65 year
old man with a locally unresectable gastrointestinal stromal tumor.
Biopsies confirm that it is KIT positive.
A. Imatinib
7 A
B. Infliximab
C. Trastuzumab
D. Bevacizumab
E. Cetuximab
Which of the anaesthetic agents below is most likely to induce adrenal
suppression?
A. Sodium thiopentone
8 B. Midazolam D
C. Propofol
D. Etomidate
E. Ketamine
A 63 year old man has been on the intensive care unit for a week with adult
respiratory distress syndrome complicating acute pancreatitis. He has
9 C
required ventilation and is still being mechanically ventilated. What is the
best option for maintenance of his airway?

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A. Nasotracheal tube
B. Endotracheal tube
C. Tracheostomy
D. Guedel airway
E. Laryngeal mask
Administration of neostigmine to a patient who has received a non-
depolarizing muscle relaxant is most likely to result in which of the
following?
A. Prolongation of muscle relaxation
10 D
B. Tachycardia
C. Hypertension
D. Bradycardia
E. Decreased gut peristalsis
A surgeon is considering using lignocaine as local anesthesia for a minor
procedure. Which of the following best accounts for its actions?
A. Blockade of neuronal acetylcholine receptors
11 B. Blockade of neuronal nicotinic receptors C
C. Blockade of neuronal sodium channels
D. Blockade of neuronal potassium channels
E. Blockade of neuronal calcium channels
Use of which of the following muscle relaxants is least likely to result in
histamine release?
A. Atracurium
12 B. Tubocurarine E
C. Doxacurium
D. Mivacurium
E. Suxamethonium
A 19 year old man has a skin lesion excised from his back. He is reviewed
clinically at 4 months post procedure and the surgeon notes that the scar
has begun to contract. Which of the following facilitates this process?
A. Myofibroblasts
13 A
B. Neutrophils
C. Granuloma formation
D. Macrophages
E. Fibroblasts
Which of the anesthetic agents listed below is associated with
14 hepatotoxicity? A
A. Halothane

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B. Sevoflurane
C. Propofol
D. Ketamine
[Link]
Which of the following would be the optimal fluid management option for
a 45-year-old man due to undergo an elective right hemicolectomy?
A. Remain 'nil by mouth' for at least 6 hours pre-operatively and avoid
intra venous fluids
B. Remain 'nil by mouth' for at least 6 hours pre-operatively and receive
supplementary intravenous 5% dextrose to replace lost calories
15 D
C. Allow him free access to oral fluids only until 30 minutes prior to
surgery
D. Administer a carbohydrate based loading drink 3 hours pre
operatively, and avoid intravenous fluids
E. Administer a carbohydrate based loading drink 6 hours pre-
operatively and administer 5% dextrose saline thereafter
Which of the following anaesthetic agents is least likely to be associated
with depression of myocardial contractility?
A. Propofol
16 B. Etomidate B
C. Sodium thiopentone
D. Ether
E. None of the above
A 23 year old man is undergoing an open inguinal hernia repair as a day
case procedure and is being given sevoflurane. What is the best option for
maintaining his airway during the procedure?
A. Insertion of endotracheal tube
17 D
B. Insertion of nasotracheal tube
C. Insertion of nasopharyngeal airway
D. Insertion of laryngeal mask
E. Use of Guedel airway
Which of the following anaesthetic agents has the strongest analgesic
effect?
A. Sodium thiopentone
18 B
B. Ketamine
C. Midazolam
D. Etomidate

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E. None of the above

Which of the following is a recognized feature of ketamine when used as
an anaesthetic agent?
A. Malignant hyperpyrexia
19 B. Adrenal suppression D
C. Myocardial depression
D. Dissociative anesthesia
E. Marked respiratory depression
A 48 year old man is due to undergo a laparotomy for small bowel
obstruction. What is the best option for maintaining his airway?
A. Insertion of cuffed endotracheal tube
20 B. Insertion of uncuffed endotracheal tube A
C. Insertion of laryngeal mask
D. Insertion of nasopharyngeal airway
E. Percutaneous tracheostomy
Which statement relating to the peri operative management of patients with
diabetes mellitus is false?
A. They should be placed first on the operating list
B. An intravenous sliding scale should be used in all cases
21 C. Potassium supplementation is likely to be required in diabetics on a B
sliding scale
D. Electrolyte abnormalities are more common after major visceral
resections
E. Blood glucose monitoring is required during general anaesthesia
Which of the following muscle relaxants is an agent that is degraded by
hydrolysis and may produce histamine release?
A. Atracurium
22 B. Panciuronium A
C. Curare
D. Suxamethonium
E. Vecuronium
A 22 year old fit and well male undergoes an emergency appendicectomy.
He is given suxamethonium. An inflamed appendix is removed and the
patient is returned to recovery. On arrival in the recovery area; the patient
23 B
develops a tachycardia of 120 bpm and a temperature of 40 oC. He has
generalised muscular rigidity. What is the most likely diagnosis?
A. Acute dystonic reaction

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B. Malignant hyperthermia
C. Pelvic abscess
D. Epilepsy
E. Serotonin syndrome
A 23 year old man with a 4cm lipoma on his flank is due to have this
removed as a daycase. He is otherwise well. What is his ASA?
A. 2
24 B. 3 C
C. 1
D. 5
E. 4
A 3 year old is involved in trauma and is hemodynamically unstable. Initial
attempts at intravenous access are proving unsuccessful. What is the best
course of action?
A. Insert a femoral venous central line
25 C
B. Insert a right internal jugular central line
C. Insert an intra osseous infusion system
D. Insert a 14 G cannula into the antecubital fossa
E. Insert a Broviac line
A 58 year old woman presented to the Emergency Department with a large
fluctuant swelling the site of a recent insect bite. She is anxious,
tachycardic, and pyrexial. An ECG shows atrial fibrillation. She is noted to
have a goitre. The swelling at the site of the bite requires surgical drainage.
Which of the following classes of drug would be most appropriate as part
26 of her preoperative preparation for surgery? E
A. Alpha 1 adrenoceptor agonist
B. Alpha 2 adrenoceptor agonist
C. Alpha adrenoceptor blocker
D. Beta adrenoceptor agonist
E. Beta adrenoceptor blocker
A 55 year old man requires a flexible sigmoidoscopy to investigate bright
red rectal bleeding. What is the most appropriate preparation?
A. Single phosphate enema the day prior to the procedure
27 B. Single phosphate enema 30 minutes pre procedure B
C. Oral sodium picosulphate the day prior to the procedure
D. Oral sodium picosulphate 30 minutes prior to the procedure
E. Rectal lavage with saline 1 hour pre procedure

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Which of the following statements relating to pre-operative fluid

management is false?
A. 5% dextrose should be given cautiously in the elderly
B. Patients undergoing elective colonic resections may continue to
28 drink water up to 2 hours prior to surgery E
C. Normal saline increases the risk of hyperchloremic acidosis
D. A 70kg man will need approximately 100mmol of sodium daily
E. Carbohydrate rich beverages and loading drinks can cause ileus
therefore should be avoided
A 6 year old child requires long term drug therapy to treat a rare genetic
disorder. The drug must be given intravenously. Recently, there have been
issues with the child pulling at current system of the Hickman line and the
parents are requesting an alternative. What is the best option?
29 A. Triple lumen subclavian line B
B. Portacath device
C. Intermittent cannulation as needed
D. PICC line
A. Broviac line
An 83 year old man is admitted for an abdomino-perineal excision of the
colon and rectum for a distal rectal tumour. His co-mobidities include
diabetes. His renal function is normal. What is the best form of
thromboprophylaxis?
A. None
30 C
B. Compression stockings alone for 4 weeks
C. Daily low dose low molecular weight heparin for 4 weeks
D. Daily high dose low molecular weight heparin for 4 weeks
A. Daily administration of high dose unfractionated heparin until
discharge
A surgeon is considering using lignocaine to provide local anaesthesia for
a minor surgical procedure. Which of the following may attenuate its
action?
A. Hyperkalaemia
31 E
B. Administration with adrenaline
C. Administration with bupivicaine
D. Administration with sodium bicarbonate
E. Use in tissues which are infected

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The following are contra indications to the use of lignocaine for local
anaesthesia except:
A. Accelerated idioventricular rhythm
32 B. Current treatment with flecainide E
C. 3rd degree heart block without pacemaker
D. Severe sino atrial block
A. Protein C deficiency
A 32 year old man requires venous access for chemotherapy for acute
myeloid leukaemia. What is the best option?
A. Groshong line
33 B. Internal jugular central line (triple lumen) A
C. 14 G cannula in the dorsum of the hand
D. 18 G cannula in the non dominant hand
E. Sub cuticular catheter
Which of the following statements relating to use of tourniquets in surgery
is false?
A. The use of an esmarch bandage tourniquet to exsanguinate the limb
reduces the incidence of neuropraxia.
B. Excessive inflation pressures are amongst the commonest causes of
34 A
nerve injury related to tourniquet use.
C. Tourniquet deflation causes a fall in CVP.
D. Children require lower inflation pressures than adults.
E. In patients developing neuropraxia related to tourniquets the radial
nerve is most frequently affected.
In relation to patients with type 1 diabetes mellitus undergoing surgery,
which of the following statements is untrue?
A. They should not receive oral carbohydrate loading drinks as part of
enhanced recovery programmes
B. When a variable rate insulin infusion is required 0.45% sodium
chloride and 5% dextrose with either 0.15% or 0.3% potassium are
35 D
the fluids of choice
C. Hourly intraoperative blood glucose measurements are required
D. Insulin infusions are only required in patients who will miss more
than two meals or who are nil by mouth for greater than 12 hours
E. Blood glucose levels persistently greater than 12 should initiate a
change in therapy

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Which of the following agents is least suitable for a 23 year old man with
burns and bilateral tibial fractures after being trapped in a car accident for
2 hours?
A. Suxamethonium
36 A
B. Atracurium
C. Vecuronium
D. Pancuronium
E. Propofol
A 72 year old man is due to undergo an inguinal hernia repair. He suffers
from COPD and has an exercise tolerance of 10 yards. He also has pitting
oedema to the thighs. What is his ASA?
A. 5
37 D
B. 1
C. 3
D. 4
E. 2
A patient receives atropine as pre medication prior to a laparotomy. Which
of the following is least likely to occur?
A. Pupillary dilation
38 B. Dry mouth D
C. Urinary retention
D. Bradycardia
E. Decreased salivation
A 5-year-old boy undergoes a closure of a loop colostomy. What
thromboprophylaxis should be used?
A. None
39 B. Daily low dose low molecular weight heparin for 2 weeks A
C. Daily low dose low molecular weight heparin until discharged
D. Unfractionated heparin and compression stockings
E. Oral dabigatran for 4 weeks
In relation to operating in the elderly which statement is false?
A. A 30-minute increment in operation length is associated with
increase in mortality in patients over the age of 80
40 B. Hypoalbuminaemia is associated with increased mortality E
C. Statins given preoperatively reduce perioperative cardiac events
D. Elevated brain (or B-type) natriuretic peptide (BNP) levels before
undergoing non cardiac surgery is associated with high risk of

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cardiac mortality and all-cause mortality

E. Beta blockers should be stopped acutely prior to surgery due to risk
of perioperative hypotension

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