Regarding regional anaesthesia the following is/are true?

• a.
  

  It is safe to site an epidural block after a prophylactic dose of low molecular heparin (LMWH) after 6 h

  
  
• b.
  

  24 h should have elapsed before an epidural is sited after a therapeutic dose of LMWH

  
  
• c.
  

  A regional block is contraindicated in a pregnant patient with HIV infection due to the risk of infective morbidity

  
  
• d.
  

  A regional block is not advised in an otherwise healthy pregnant patient with a platelet count of 80 × 10 ⁹

  
  
• e.
  

  The platelet function must be measured with bleeding time prior to regional block with a platelet count of 80 × 10 ⁹

In a pregnant patient with severe aortic stenosis about to undergo an elective caesarean section, the following is/are true regarding anaesthetic drug administration:

• a.
  

  A general anaesthetic is usually considered the safest option

  
  
• b.
  

  A single shot spinal anaesthetic with a standard dose of local anaesthetic is acceptable

  
  
• c.
  

  An epidural anaesthetic using an incremental technique with slow administration of epidural local anaesthetic is acceptable

  
  
• d.
  

  A combined spinal epidural technique using a standard dose of spinal anaesthetic is acceptable

  
  
• e.
  

  Administration of oxytocin should be avoided if possible due to adverse effects on venous return

The following is/are the ultimate goal(s) of pharmacogenetics research:

• a.
  

  To provide guidelines to pharmaceutical companies to help develop new drugs

  
  
• b.
  

  To provide guidelines to help doctors tailor medicine to each individual’s unique genetic make-up

  
  
• c.
  

  To make medicines safer and more effective for everyone

  
  
• d.
  

  To identify individuals at risk for chronic diseases so that medical insurance companies can adjust their healthcare coverage

  
  
• e.
  

  To help predict risks of adverse drug outcomes

The β ₂ -adrenergic receptor

• a.
  

  Displays no genetic variability

  
  
• b.
  

  Displays some genetic variability but with no clinical effects

  
  
• c.
  

  Displays genetic variability but with no change in phenotype

  
  
• d.
  

  Displays genetic variability and a haplotype has been shown to affect cardiovascular outcomes after acute coronary syndromes

  
  
• e.
  

  Displays genetic variability and a haplotype has been shown to be associated with better responses to chemotherapy agents

Genetic variability of β ₂ -adrenergic receptor has been shown to influence

• a.
  

  The response to bronchodilating agents

  
  
• b.
  

  The response to tocolytics

  
  
• c.
  

  The response to β-blockers

  
  
• d.
  

  The response to vasopressors

  
  
• e.
  

  The response to ACE inhibitors

Future implications of pharmacogenetics research include(s) the following step(s):

• a.
  

  Establishing lists of candidate genes involved in pharmacokinetic and pharmacodynamics variability

  
  
• b.
  

  The study of relevant SNPs and their putative function

  
  
• c.
  

  Randomized clinical trials stratified per genotype

  
  
• d.
  

  Identification of sub-populations of patients for which targeted strategies should be provided

  
  
• e.
  

  To identify SNPs for all drugs

The neonatal effects of pethidine given for labour analgesia:

• a.
  

  are most severe if it is given 3 h or more before delivery

  
  
• b.
  

  are slight if it is given only during the last hour of labour

  
  
• c.
  

  include respiratory depression

  
  
• d.
  

  include a reduction in umbilical artery pH and base excess

  
  
• e.
  

  are due in part to an active metabolite

Epidural analgesia in labour:

• a.
  

  exacerbates neonatal metabolic acidosis

  
  
• b.
  

  is associated with lower Apgar scores than systemic analgesia

  
  
• c.
  

  is associated with improved neonatal acid-base balance

  
  
• d.
  

  if sited after starting a Syntocinon infusion, the infusion should be discontinued during epidural insertion

  
  
• e.
  

  precludes early mother-infant bonding

Maternal hyperventilation in response to pain in unmodified labour has been shown to lead to:

• a.
  

  Respiratory alkalosis

  
  
• b.
  

  Compensatory metabolic acidosis

  
  
• c.
  

  Hypoventilation episodes

  
  
• d.
  

  Haemoglobin desaturation

  
  
• e.
  

  Uterine vasoconstriction

The following is/are true regarding Entonox

• a.
  

  It is the most popular analgesic for labour in the UK

  
  
• b.
  

  Nitrous oxide passes readily across the placenta

  
  
• c.
  

  It is rapidly excreted by the newborn lungs

  
  
• d.
  

  Has been shown to have little apparent effect on Apgar scores

  
  
• e.
  

  Has been shown to have little apparent effect on acid-base balance

The effect(s) produced by raised plasma magnesium on the cardiovascular system include(s) the following:

• a.
  

  Stable blood pressure and no significant change in haemodynamic variables.

  
  
• b.
  

  Increased cardiac output and stroke volume.

  
  
• c.
  

  Increased risk of hypotension during epidural analgesia.

  
  
• d.
  

  The need for larger doses of phenylephrine to maintain arterial pressure during epidural or spinal analgesia.

  
  
• e.
  

  Cardiac toxicity, with cardiac arrest at concentrations around 7 mmol/L.

Elevated plasma magnesium concentrations produce the following physiological change(s):

• a.
  

  Decreased acetylcholine release at the motor endplate that may contribute to neuromuscular weakness.

  
  
• b.
  

  Direct depression of central respiratory drive, decreasing the CO ₂ response curve.

  
  
• c.
  

  Reduction in intracranial pressure through cerebral vasoconstriction.

  
  
• d.
  

  Clinically relevant inhibition of platelet function that contributes to increased bleeding during operative delivery.

  
  
• e.
  

  Reductions in catecholamine release and activity that are of value in hypertensive emergencies.

In pre-eclampsia, magnesium:

• a.
  

  has been proven to be superior to phenytoin or diazepam for the prevention of convulsions in pre-eclampsia and for the control of recurrent convulsions in eclamptic patients,

  
  
• b.
  

  has no direct anticonvulsant activity in the brain and prevents convulsions primarily by inhibiting neuromuscular activity through inhibition of acetylcholine release,

  
  
• c.
  

  may contribute to inadequate uterine contraction, resulting in prolonged labour and an increased risk of postpartum haemorrhage,

  
  
• d.
  

  decreases foetal heart rate variability and may be associated with hypotonia in the neonate,

  
  
• e.
  

  has a very narrow therapeutic index

In premature labour, magnesium:

• a.
  

  Is more effective than placebo in delaying labour for 48 h,

  
  
• b.
  

  Has proven risks of cardiac failure if combined with calcium antagonists,

  
  
• c.
  

  Should be given in higher doses than those traditionally used for management of pre-eclampsia

  
  
• d.
  

  Has been associated in recent meta-analyses with a reduction in the risk of cerebral palsy in the premature neonate

  
  
• e.
  

  Has been largely discarded as a tocolytic in the USA.

The following conditions significantly increase maternal mortality rates:

• a.
  

  asthma.

  
  
• b.
  

  pulmonary hypertension.

  
  
• c.
  

  mitral valve prolapse.

  
  
• d.
  

  sickle cell disease.

  
  
• e.
  

  psychiatric illness.

Epidural analgesia during labour is contraindicated in women with:

• a.
  

  cardiac conditions that lead to a fixed cardiac output.

  
  
• b.
  

  untreated streptococcal pneumonia.

  
  
• c.
  

  paraplegia with spinal transection at T7.

  
  
• d.
  

  multiple sclerosis.

  
  
• e.
  

  schizophrenia who do not consent to the procedure.

General anaesthesia for caesarean section:

• a.
  

  should be avoided in myotonic disorders.

  
  
• b.
  

  is the method of choice for a mother with a history of crack-cocaine and heroin abuse.

  
  
• c.
  

  must be avoided in epileptic patients as it provokes seizures.

  
  
• d.
  

  always requires the use of suxamethonium.

  
  
• e.
  

  is unsafe if an uncorrected coagulopathy exists.

An obese parturient is more likely than a normal patient to demonstrate

• a.
  

  Difficulty of tracheal intubation

  
  
• b.
  

  Hypoxaemia during induction of general anaesthesia

  
  
• c.
  

  Hypertension

  
  
• d.
  

  Increased incidence of venous thromboembolism

  
  
• e.
  

  A decreased in rate of lower segment caesarean section with increasing BMI

The following statement(s) is/are true about pregnancy:

• a.
  

  Gastrointestinal motility and stomach acidity is unchanged during labour

  
  
• b.
  

  Resuscitation of pregnant patients should follow appropriate guidelines which include left lateral tilt to avoid supine hypotension.

  
  
• c.
  

  Pregnancy-induced changes in lung volumes cause desaturation to occur more rapidly than in non-pregnant patients during induction of general anaesthesia

  
  
• d.
  

  The stomach is pushed up against the left hemi-diaphragm by the gravid uterus in late pregnancy, which contributes to the risk of aspiration during induction of general anaesthesia.

  
  
• e.
  

  There is a reduced risk of difficult airway in pregnant patients who undergo general anaesthesia for emergency surgery.

The following statements are true regarding regional anaesthesia:

• a.
  

  Ephedrine is a better pressor to use in the mother for treatment of hypotension post spinal anaesthesia compared to phenylephrine because the former is better at maintaining utero-placental blood flow

  
  
• b.
  

  Overall, mortality after general anaesthesia is greater than for regional anaesthesia for caesarean section delivery

  
  
• c.
  

  When compared to single-shot spinal anaesthesia, a combined spinal-epidural technique for caesarean section for an obese parturient permits more control over the duration of surgery

  
  
• d.
  

  High risk pregnant patients e.g. morbidly obese parturient, should have a functioning epidural catheter placed early in labour.

  
  
• e.
  

  Spinal anaesthesia should not be used for emergency caesarean section because it is slower than general anaesthesia.

Factors that are shown to help in improving fetal outcome are:

• a.
  

  Displacement of the uterus by turning the patient to the left lateral position during fetal bradycardia

  
  
• b.
  

  Increased decision-to-delivery interval

  
  
• c.
  

  Continuous foetal monitoring after insertion of epidural/combined spinal epidural for labour analgesia

  
  
• d.
  

  Giving 100% oxygen to the mother during fetal distress

  
  
• e.
  

  Good communication between obstetricians, midwives and anaesthetists for high-risk pregnancies.

The following statement(s) is/are true about changes to the haematological system during pregnancy:

• a.
  

  the increase in clotting activity is highest during the second trimester

  
  
• b.
  

  all coagulation factors increase during pregnancy

  
  
• c.
  

  platelet count is often less then 100 × 10 ⁹ L ⁻¹

  
  
• d.
  

  fibrinolysis is reduced

  
  
• e.
  

  neuraxial haematomas are common in obstetric anaesthesia

The following statement(s) is/are true about von Willebrand disease:

• a.
  

  There are three types of von Willebrand disease

  
  
• b.
  

  Transmission is recessive

  
  
• c.
  

  laboratory diagnosis only needs von Willebrand factor measurement

  
  
• d.
  

  Women with vWd in pregnancy generally have good pregnancy outcomes

  
  
• e.
  

  Neuraxial blocks are safe in all types of vWd

Thromboembolic disease:

• a.
  

  Affects 100 per 1,000,000 pregnancies

  
  
• b.
  

  is more common following vaginal rather then cesarean delivery

  
  
• c.
  

  the risk of thromboembolism is greatest in the first trimester

  
  
• d.
  

  LMWH is commonly used for thromboprophylaxis in pregnancy

  
  
• e.
  

  Inherited thrombophilias increase the risk of thromboembolism in pregnancy

Which of the following statement(s) is/are true about ergometrine?

• a.
  

  Ergometrine causes nausea and vomiting

  
  
• b.
  

  Ergometrine is associated with pyrexia

  
  
• c.
  

  Pre-eclampsia is a contra-indication to ergometrine

  
  
• d.
  

  Ergometrine can be given rectally

  
  
• e.
  

  Ergometrine should not be given to an asthmatic

Donor blood

• a.
  

  Has immediate good oxygen carrying capacity

  
  
• b.
  

  Can cause hypokalaemia

  
  
• c.
  

  Can cause hypocalcaemia

  
  
• d.
  

  Should be warmed during transfusion

  
  
• e.
  

  Is more expensive than the disposable kit for the cell salvage machine

Jehovah’s witnesses

• a.
  

  Will refuse all blood products

  
  
• b.
  

  Have no increased risk of dying in pregnancy compared to a non-Jehovah’s witness

  
  
• c.
  

  Should be delivered at home

  
  
• d.
  

  Should have an active third stage

  
  
• e.
  

  Will all refuse cell salvage

Which of the following statement(s) is/are true about surgical techniques for major haemorrhage

• a.
  

  Insertion of tamponade balloons does not require general anaesthesia

  
  
• b.
  

  Rusch/Bakri balloons are deflated immediately after bleeding ceases

  
  
• c.
  

  Compression sutures must be removed before subsequent pregnancies

  
  
• d.
  

  Bilateral ligation of the uterine arteries will not cause complete cessation of bleeding

  
  
• e.
  

  Subtotal hysterectomy should be performed in persistently bleeding women

There are accurate estimates of the following type of nerve injury after neuraxial analgesia during childbirth?

• a.
  

  Direct trauma to the spinal cord from the epidural or spinal needle.

  
  
• b.
  

  Palsy of a lower extremity peripheral nerve.

  
  
• c.
  

  Spinal cord compression from a spinal-epidural hematoma.

  
  
• d.
  

  Spinal cord compression from an epidural abscess.

  
  
• e.
  

  Abducens nerve palsy.

Meningitis associated with neuraxial procedures is caused by which of the following organisms?

• a.
  

  Streptococcus salivarius

  
  
• b.
  

  Streptococcus pneumoniae

  
  
• c.
  

  Neisseria meningitis

  
  
• d.
  

  Haemophilus influenza

  
  
• e.
  

  Staphylococcus aureus