Anorexia nervosa

A 30-year-old woman presents for elective surgery. She is 170 cm tall, weighs 35 kg and has a long history of an eating disorder. The following statements about this patient are true EXCEPT for which one?

a) She is more likely to have mitral valve prolapse than a similar patient with a normal

body mass index (BMI)

b) She is more likely to be bradypnoeic and bradycardic than a similar patient with a

normal BMI

c) She is likely to be anaemic and leucopaenic

d) Her gastric emptying time is likely to be slower compared to a similar patient with a

normal BMI

e) Common electrocardiogram (ECG) findings in this patient would include

atrioventricular block, QT prolongation, ST segment depression and T-wave

inversion

Muscles of the larynx

Which one of the following options is a TRUE statement regarding the intrinsic muscles of the larynx?

a) The cricothyroids are the only muscles to tense the cords

b) The posterior cricoarytenoids, supplied by the recurrent laryngeal nerve, adduct the

cords

c) Vocalis is supplied by the recurrent laryngeal nerve but is not considered an

intrinsic muscle of the larynx

d) Thyrohyoid elevates the larynx

e) The internal laryngeal nerve supplies only one of these muscles

Mixed venous oxygen saturations

Regarding mixed venous oxygen saturations, which one of the following statements is CORRECT?

a) In septic shock, SvO2 is unlikely to be normal or supranormal

b) With a ventricular septal defect, a reduction in SvO2will be observed

c) If oxygen flux is fixed, elevated oxygen consumption results in increased SvO2

d) If arterial oxygen saturation, haemoglobin and oxygen consumption are constant,

SvO2 varies directly with cardiac output

e) Cyanide toxicity causes a reduction in SvO2

Cardiovascular autonomic reflexes

The following are eponymous cardiovascular reflexes EXCEPT which one?

a) Anrep effect: acute increase in afterload causes reduction in stroke volume then

reflex restitution

b) Cushing’s reflex: raised intracranial pressure causes hypertension and reflex

bradycardia

c) Bainbridge reflex: an increase in venous pressure causes tachycardia

d) Bowman effect: as heart rate increases, contractility increases

e) Bezold–Jarish reflex: seen in myocardial ischaemia – stimulation of ventricular

receptors cause bradycardia and hypotension

Tissue donation

There are a number of absolute contraindications to tissue donations. These include the following circumstances EXCEPT for which one?

a) A patient with a family history of Creutzfeldt–Jacob disease (CJD)

b) A patient with Alzheimer’s disease

c) A patient with multiple sclerosis

d) A patient who has had a previous transplant requiring immunosuppressive

treatment even if that treatment was not being received at the time of death

e) Donation of corneas and sclera from a patient who has died with a proven

diagnosis of metastatic carcinoma of the colon

Hydrogen ion measurement

During arterial blood gas analysis, representation of quantity of hydrogen ions

present in the sample may be displayed as pH, hydrogen ion concentration or both.

The following statements are correct equivalences EXCEPT which one?

a) pH 7.6 = 25 nanomol/L

b) pH 7.4 = 40 nanomol/L

c) pH 7.3 = 50 nanomol/L

d) pH 7.2 = 63 nanomol/L

e) pH 7.0 = 114 nanomol/L

Narrow-complex tachycardia

A previously fit and well 52-year-old patient develops a regular narrow-complex tachycardiain recovery, but is otherwise stable with a blood pressure of 125/85mmHg. Youapply oxygen on high flow via a facemask, perform a 12-lead ECG and start carotid sinus massage, which fails to correct the tachycardia. You give adenosine 6mg intravenously,which fails to alter the rhythm, followed by a further adenosine 12mg intravenously, again with no improvement.What would you do next?

a) Give digoxin 500 mcg intravenously

b) Give amiodarone 300mg loading dose intravenously

c) Give verapamil 2.5mg intravenously over two minutes

d) Give adenosine 12mg intravenously

e) Perform synchronised DC cardioversion