Primary FRCA MCQ CourseThanks to Dr Mendonca & Dr Kerr for the MCQs and answers.

Dr Chetan Parcha

SpR anaesthetics, UHCW

19th Jan 2011

1. The cerebral blood flow of a normal person is increased:

a) when the arterial PCO2 increases from 5.3 to 8.0 kPa

b) significantly when the body is accelerated upwards

(positive ‘G’) and results in a ‘red out’upwards movement causes blood to rush to the feet, causing black out

c) if the mean arterial blood pressure rises from 90 to 110

mmHg

autoregulated between MAP of 50 to 150 mmHg

d) if the intracranial pressure is increasedinitially there would be ‘spatial compensation’ and

increased venous return

e) during physiological sleep TFFFF

2. Stimulation of the 10th cranial nerve causes:

a) slowing of A – V conduction

b) coronary vasoconstriction

mediated via adrenergic α 1 and 2 receptors

(ß 2 vasodilates)

c) increased secretion of gastric acid

d) miosis is mediated via the 3rd cranial nerve

e) relaxation of the pylorus

TFTFT

3. Action of nor adrenaline may be terminated by:

a) monoamine oxidase in the nerve terminal

b) catechol-O-methyltransferase in the liver

c) catechol-O-methyltransferase is predominantly extraneuronal

d) dopa decarboxylase converts L–dopa to dopamine

e) neuronal reuptake

TTFFT

4. The intraocular pressure:

a) Is normally less than 5mmHg (normally 10-21 mmHg)

b) is lowered by the administration of suxamethonium

c) increases with coughing

d) may be normal in closed-angle glaucoma

may be normal in open-angle glaucoma, closed angle

glaucoma is a medical emergency characterised by an acute rise in intra ocular pressure

e) can be lowered by the use of acetazolamide

FFTFT

5. In a typical night’s sleep

a) There are 5 episodes of REM sleep

b) Each REM sleep period lasts 120 mins

lasts 60-90 minutes

c) An adult spends 50% of sleep in REM

spend 30% of sleep in REM

d) In REM sleep, rapid, irregular, high amplitude waves are seen

low amplitude waves are seen

e) Skeletal muscle relaxation occurs

TFFFT

6. The velocity of conduction of a nerve action potential:

a) is inversely related to the cross-sectional area of the axon

is directly related to the cross-sectional area of the axon

b) is faster in a myelinated fibre than in an unmyelinated one

c) is decreased by cooling the nerve

d) can exceed 100 m/s in humans

e) is highest in pre-ganglionic autonomic fibres

pre-ganglionic autonomic fibres contain B fibres where

the conduction varies between 3 – 15 m/s

FTTTF

7. Blood supply of the spinal cord

a) arises from a single anterior and posterior spinal artery

arises from a single anterior and 2 posterior spinal arteries

b) anterior spinal artery arises from the basilar artery

anterior spinal artery arises from paired vertebral arteries

c) posterior spinal artery supplies the posterior 2/3rd of the cord

posterior spinal artery supplies the posterior 1/3rd of the cord

d) Artery of Adamkiewicz arises from right posterior intercostal

artery

left in most people

e) Vaso corona are communicating vessels between the anterior

and posterior spinal arteries

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8. The tracts in the spinal cord serve the following functions:

a) Lateral spinothalamic tract carries touch sensation

carries pain and temperature

b) Posterior columns carry touch and proprioception

and vibration

c) Anterior spinothalamic tract carries pain sensation

ant spinothalamic - contralateral touch and pressure

d) Pain fibres are carried by the fasciculus gracilis in the posterior column

post column – ipsilat touch, vibration, proprioception

e) The pyramidal tract (lateral corticospinal tract) is the crossed motor tract descending from the cerebral cortex

FTFFT

9. The pupillary light reflex:

a) Is mediated by the trochlear nerve

Oculomotor

b) Is evidenced by constriction of both pupils when light is shone on one eye in the normal individual

c) Is absent in the Argyll Robertson pupil

bilateral small pupils, “accommodate but don’t react”. Syphilis

d) Relay occurs near the midbrain at the Edinger-Westphal nucleus

II → EPN of III → III → ciliary ganglion → pupil

e) Long ciliary nerves carry the impulse to the papillary muscleShort ciliary nerves

FTTTF

10. The pyramidal tract

a) is named after the cells in the cortex where it

originates

originate from motor area of cortex, corticospinal tracts

aggregate to form pyramids in the medulla before decussation

b) has 1 million fibres, 80-90% of which decussate in

the medulla

c) arises from precentral gyrus (motor area) of the

cortex

d) is concerned with fine movements

e) will degenerate after decortication

FTTTT

11. Unilateral transection of dorsal nerve roots C3-T2 produces:

a) motor paralysisventral roots are motor, dorsal is sensory

b) loss of sensation

c) loss of reflexes

d) loss of sympathetic and sudomotor tone

sympathetic fibres arises from anterior horn of the cord (

T1 – L2) and leave via the ventral root

e) hypotonia

seen in lower motor neurone lesion

Pneumonic AVM FTTFF

12. Autonomic nervous system

a) regulates voluntary bodily functions by means of reflex pathways

regulates involuntary bodily functions by reflex pathways

b) parasympathetic fibres are present in the 3,5,9,10th cranial nerves

parasympathetic in CN 3,7,9,10; CN 5 is sensory to the face

c) Sympathetic preganglionic fibres secrete noradrenalineAch in both symp and psymp preganglionic fibres

d) 5th cranial nerve carries parasympathetic fibres to the otic ganglion

CN 9 carries parasympathetic fibres to the otic ganglion

e) the juxtaglomerular apparatus has no sympathetic innervation

the renin secreting granular cells of juxtaglomerular apparatus have sympathetic innervation

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13. Regarding the innervation of the eye:

a) the sensory supply is via the facial nerve

sensory supply is via short and long ciliary nerves which are

branches of the nasociliary nerve (branch of ophthalmic n.)

b) motor supply to orbicularis oculi is via the oculomotor nerve

via the facial nerve

c) the sympathetic supply is via the superior cervical ganglion

d) the ciliary ganglion lies within the extraocular muscle cone

e) parasympathetic stimulation contracts ciliary muscle

FFTTT

14. Regarding temperature regulation:

a) The thermoregulatory centre is mainly situated in the anterior hypothalamus

b) Blood temperature is the most sensitive stimulus to the thermoregulatory centre

c) Core temperature is generally 0.5-1.0°C higher than the oral temperature

d) There is a diurnal fluctuation of temperature in normal individualsLowest at night, highest mid-afternoon

e) Thyroid-stimulating hormone (TSH) secretion is depressed at high body temperatures

TTTTT

15. Regarding basal ganglia:

a) Comprised of globus pallidus, putamen, caudate nucleus, thalamus and substantia nigraComprised of globus pallidus, putamen, caudate nucleus, subthalamic nucleus and substantia nigra

b) Loss of dopamine can lead to Parkinsons disease

c) Chorea is characterised by continuous slow writhing movementChorea is characterised by continuous rapid involuntary dancing movement

d) Huntington’s disease is characterised by loss of GABA and cholinergic neurons

e) Paralysis agitans is characterised by rigidity (cogwheel and lead pipe) = Parkinson’s

FTFTT

16. In a resting nerve fibre

a) RMP can be calculated from Nernst equationE = RT/ zF x log10 (ion outside cell / ion inside cell)

b) trans-membrane potential is 30 mVtrans-membrane potential is - 70 mV

c) trans membrane chloride flux is passive

d) intra and extracellular calcium concentrations are equalextracellular calcium concentrations are higher

(2.7 vs.< 1 mmol / lt.)

e) no energy substrate is required during the latent phaseATP substrate is required during the latent phase

TFTFF

17. A typical mammalian motor neurone:

a) innervates only one skeletal muscle cell

innervates one or more skeletal muscle fibres

b) is myelinated

c) has its cell body in the ventral (anterior) horn of the

spinal cord

d) might receive an input directly from Group Ia afferent

fibres in the spinal cord

e) would be stimulated by application of glycine to its cell

bodywould be inhibited by application of glycine which

hyperpolarises the cell by increasing Cl - influx

FTTTF

18. Spinal shock is characterized by the following:

a) hypotension, best treated with rapid fluid resuscitation

hypotension is best treated with alpha adrenergic drugs

b) if lesion is above T1, bradycardia can accompany the

hypotension

c) if the lesion is above T5, autonomic hyperreflexia can occur

d) it can persist for up to 3 weeks

e) high dose steroids have conclusively shown to improve

outcome

FTTTF

19. The blood-brain barrier:

a) results in certain molecules in the blood taking longer to equilibrate with

tissue fluid in the brain than with tissue fluid elsewhere

b) permits CO2 to pass freely

c) is more permeable to water-soluble substances than fat-soluble substances

is more permeable to fat-soluble substances

d) is more permeable in neonates than in adults

e) is readily crossed by dopamine

is impermeable to dopamine

TTFTF

20. A reflex action:

a) may be carried out by skeletal, smooth or cardiac

muscle or by glands

b) is not influenced by higher centres in the brain

reflexes are regulated by higher centres in the cortex

c) results from activity in at least two central nervous synapses in seriesresults from nervous synapses at spinal level which may be

monosynaptic or polysynaptic

d) may involve simultaneous contraction of some skeletal

muscles and relaxation of others

e) can be monosynaptic or polysynaptic

TFFTT

21. A synapse

a) Occurs when an axon reaches its target cell

(at a junction of a neurone)

b) Transmits information to the postsynaptic cell

c) Is a unidirectional system

d) Separates the presynaptic and postsynaptic membranes with a 5-10nm synaptic cleft30-50nm wide

e) The synaptic cleft stores numerous vesicles called synaptic vesicles

Synaptic vesicles stored in presynaptic nerve terminal in synaptic button

T T T F F

22. Among the cranial nerves:

a) The abducens nerve has the longest intracranial course

b) The oculomotor nerve supplies the superior rectus muscle

LR6 SO4

c) The ophthalmic division of the trigeminal nerve forms the afferent for the oculo-cardiac reflexAff: trigeminal, eff:vagus

d) The glossopharyngeal nerve supplies the anterior surface of the epiglottisand the posterior third of the tongue

e) The accessory nerve is purely a motor nerve

T T T T T

23. In normal cerebrospinal fluid, the:

a) chloride concentration is higher than in blood(115-125mmol/l)

b) glucose concentration is the same as in plasmaglucose concentration lower than plasma( 4.8 vs. 8.0 mmol/lt. )

c) PCO2 is higher than in mixed venous blood(6.6 vs 5.3 KPa)

d) pH is the same as in arterial blood

pH is lower than arterial blood

( 7.32 vs. 7.40 )

e) bicarbonate concentration is the same as in arterial

bloodbicarbonate concentration is lower than arterial blood

( 23 vs. 25 mmol/lt.) TFTFF

24. Brain stem contains:

a) midbrain, pons and medulla

b) reticular formation

c) nuclei of II – XII cranial nerves

nuclei of III – XII cranial nerves

d) cortico-spinal tract and dorsal columns

e) control centres for eye movement

TTFTT

25. Ptosis results from:

a) parasympathetic block

parasympathetic nerves have no motor supply to

orbit

b) sympathetic block

c) facial nerve block

d) trigeminal nerve block

trigeminal nerve is sensory to the face

e) oculomotor nerve block

FTTFT

26. Neurotransmitters include:

a) Acetylcholineb) 5-hydroxytryptamine (5-HT)c) Gamma aminobutyric acid (GABA)

d) Nitric oxidee) Enkephalins

polypeptide NTs, produce analgesia by reducing excitability

TTTTT

27. Painful stimulus to the leg

a) results in a monosynaptic withdrawal reflex‘withdrawal reflex’ is a polysynaptic reflex

b) causes extension in the ipsilateral legcauses contraction of flexors and relaxation of extensors

in the ipsilateral leg

c) causes flexion in the contralateral legmay cause flexion or extension in the contralateral leg to facilitate withdrawal of affected limb

d) results in relaxation of opposing muscles in the ipsilateral leg

e) the posterior root ganglion is involved

FFFTT

28. Signs of a Horner’s syndrome include:

a) dry forehead

b) conjuctival injection/ bloodshot conjunctiva

c) ptosis

d) exophthalmos

e) miosis

TTTFT

29. Resting membrane potential of a cell is maintained by

a) passive Cl - influx

b) active K+ efflux by Na+ - K+ ATPase pump

Na+ - K+ ATPase pump results in active efflux of Na+ in exchange for K+

c) active Ca++ efflux by Na+ - Ca++ pump

d) passive HCO3- influx

HCO3 – is not only impermeable to cell membranes but also lacks ionic channels for entry to the cell ( unlike Na+ K+ Cl -

and Ca++ )

e) passive Na+ efflux

Na+ efflux is active via the Na+ - K+ ATPase pumpTFTFF

30. Action potential in a nerve axon

a) requires calcium conductance

requires sodium conductance

b) is slowed by the presence of a myelin sheath

is speeded up by presence of a myelin sheath

c) requires activation of voltage gated sodium channels

d) requires the Na/K ATPase pump

e) can occur up to 120 meters/sec in C fibres

can occur up to 120 meters/sec in A alpha fibres, C fibres conduct at the rate of 0.5 – 2 meters/sec

FFTTF

The Mantra for passing MCQs

• Practice

– Practice

• Practice

• Thank you and Good Luck.