Rwanda Resident Quiz
November 2008
Pain Management and Airway
Pain:
1.
Which statement is false?
a. C- fibres are non-myelinated
b. C- fibres transmit sharp, localized pain
c. C- fibres respond to chemical, mechanical and thermal stimuli
d. C- fibre conduction is 0.5 to 1 metre/ second.
2.
Central sensitization may involve all of the following except:
a. Activation of second messenger systems in the post-synaptic neuron
b. Suppression of the expression of C- fos genes.
c. Death of inhibitory interneurons
d. Sprouting of A- beta fibres to lamina II
3.
Match the term with the definition:
a. Pain
b. Allodynia
c. Hyperesthesia
d. Hyperalgesia
_______ pain due to a stimulus which does not normally produce pain
_______ increased sensitivity to stimulation, excluding the special senses
_______ an unpleasant sensory and emotional experience associated with actual or potential damage, or described in terms of
such damage.
_______ an increased response to a stimulus that is normally painful
4.
After surgery which of the following responses is unlikely?
a. neuro-endocrine stress response – catabolic state
b. hyper-coagulability, thrombosis
c. over activity of the parasympathetic nervous system
d. possible persistent pain
5.
All of the following are contraindications to epidural except:
a. uncorrected hypovolemia
b. anemia, but euvolemia
c. raised intracranial pressure
d. systemic sepsis
6 . Regarding intrathecal opioids, which statement is true:
a. fentanyl is more hydrophilic than morphine
b. morphine with preservative can be safely used in the intrathecal space
c. 0.5 mg morphine is a safe intrathecal dose
d. respiratory depression is possible during the first 24 hours after intrathecal morphine.
7. Provided safe protocols and practices are in place, which of the following patients might be most suitable for PCA (patient
controlled analgesia)
a. A 35 year old woman for tubal ligation
b. A 75 year old male with mild to moderate dementia for hysterectomy
c. A 45 year old female for hemicolectomy
d. A 25 year old male for fractured tibial repair who thinks post-operative opioids will lead to addiction
8. Which statement about gabapentin is false:
a. gabapentin binds to the GABA receptor
b. gabapentin was developed as an anticonvulsant
c. gabapentin may reduce peri-operative pain
d. gabapentin has a binding site on the NMDA receptor
9.
A patient has a severe crush injury to his foot. The bones are well healed but he describes severe persistent burning pain.
Which of the following is most likely to be wrong?
a. The patient’s problems are all psychological.
b. The patient’s pain may have affected his family, social and work relationships
c. This patient might benefit from multimodal analgesia
d. Gabapentin may be a suitable medication for this patient.
10. Which statement about methadone is false?
a. methadone is a mu agonist and an NMDA antagonist
b. methadone has greater oral bioavailability than morphine
c. methadone has a duration of analgesia of 8 to 12 hours
d. methadone should only be used to treat opioid addicts
11. All of the following are possible side effects to methadone except:
a. ventricular arrhythmias
b. constipation
c. increased hair growth
d. nausea
12. Which of the following statements about cancer pain treatment is true?
a. cancer pain is best treated with PRN medication
b. the dose of medication for cancer pain should not need to change once a good dose has been found
c. pain which is burning, lancinating and associated with allodynia is likely neuropathic
d. you should begin treating cancer pain with morphine.
Airway:
1.
The larynx is composed of nine cartilages. There are three paired and three unpaired cartilages. Name the unpaired
cartilages.
A. arytenoid, epiglottic, thyroid
B. corniculate, thyroid, cricoid
C. corniculate, cuneiform, epiglottic
D. epiglottic, thyroid, cricoid
E. cricoid, corniculate, cuneiform
2.
The vocal cords form a triangular opening called the “glottic opening”. Choose the CORRECT statement.
A. The anterior commissure is the widest part of the glottic opening.
B. The posterior commissure is the narrowest part of the glottic opening.
C. The anterior commisure is formed by the attachment of the vocal ligaments to the cricoid cartilage.
D. The anterior commisure is formed by the attachment of the vocal ligaments to the thyroid cartilage.
E. The posterior commisure is formed by the attachment of the vocal ligaments to the cricoid cartilage.
3.
Choose the correct Mallampati description of a Mallampati Class III airway.
A. Visualization of the soft palate and complete uvula.
B. Visualization of the soft palate, complete uvula and tonsillar pillars.
C. Soft palate is not visible.
D. Visualization of the soft palate and base of uvula.
4.
What is the most common factor resulting in a failed airway?
A. Morbid obesity
B. Distorted airway anatomy
C. Failure to predict a difficult airway
D. Upper airway obstruction
E. Not being familiar with the light wand technique
5.
What is the most correct definition of a failed airway?
A. Two failed attempts at orotracheal intubation by a senior Rwandan anesthesia resident, but able to maintain oxygen
saturations
B. Three failed attempts at orotracheal intubation by a second year internal medicine resident doing an elective in
anesthesia
C. Two failed attempts at orotracheal intubation by staff Rwandan anesthesiologist, but able to maintain oxygen
saturations above 90%
D. Two failed attempt at orotracheal intubation by a visiting Canadian senior anesthesia resident, and unable to maintain
oxygen saturations above 90% in a young, healthy male during induction for appendicitis
6.
Choose the CORRECT statement
A. As an airway expert, you have time if you cannot intubate and cannot oxygenate or ventilate.
B. As an airway expert, you have no time if you cannot intubate and cannot oxygenate or ventilate.
C. As an airway expert, you have time if can intubate but cannot oxygenate or ventilate.
D. As an airway expert, you have no time if you cannot intubate but can oxygenate and ventilate.
7.
Your first patient of the day is an obese, 52 year old man with facial hair and no teeth. His wife reports that he snores at night
and even has periods of apnea. Which of the following is most likely to be difficult?:
A. Bag mask ventilation
B. Laryngoscopy and intubation
C. Extraglottic device placement
D. Cricothyrotomy
8.
Your second patient of the day is an emergency case of a man involved in a motorcycle accident. He sustained a blow to the
anterior neck and now has a large hematoma. He has a mandibular fracture and severe facial trauma. There is restricted mouth
opening. The paramedics suspect a cervical spine injury and have applied a rigid cervical spine collar. This patient has
predictors of difficult:
A. Bag mask ventilation
B. Laryngoscopy and intubation
C. Extraglottic device placement
D. Cricothyrotomy
E. All of the above
9.
Your third patient of the day is a 34 year old woman with rheumatoid arthritis. She has restricted mouth opening of only 3
cm. She also reports difficulty extending her cervical spine because of pain her neck. Choose two of the following that are
most likely to be difficult?:
A. Bag mask ventilation
B. Laryngoscopy and intubation
C. Extraglottic device placement
D. Cricothyrotomy
10. Your fourth patient of the day is a short, 48 year old woman with prominent front teeth, a large tongue, small mandible and
short neck. On examination, she has a thyromental distance of 4 cm and a Mallampati Class III. Which of the following is
most likely to be difficult:
A. Bag mask ventilation
B. Laryngoscopy and intubation
C. Extraglottic device placement
D. Cricothyrotomy