MCQ Paper No.1

Please select True or False for the following questions.

1. A percutaneous tracheostomy:

a. Has an improved cosmetic result versus a surgical tracheostomy
b. Has an increased incidence of infection vs a surgical tracheostomy
c. There is an increased risk of bleeding with a percutaneous technique vs a surgical technique
d. Early tracheostomy (< 4 days) is associated with a significant reduction in VAP rates vs late (>7 days)
e. A minimum of 4 people are required to safely insert a tracheostomy on an ICU

2. Myxoedemic coma:

a. Hydrocortisone is often required in its management
b. Is associated with hyponatraemia
c. Is associated with hyperglycaemia
d. Is associated with hypothermia
e. Is associated with pericardial effusions

3. With regards to percutaneous tracheostomies:

a. Patients can be safely discharged to any ward
b. Ward staff can undertake the first tracheostomy tube change
c. The cuff should be inflated when patients are taking oral fluids
d. The cuff should be inflated to a pressure of 30 cm H20
e. It takes 4 days for a percutaneous stoma to become established

4. In the APACHE II scoring system the following variables are given a score:

b. Serum magnesium
c. Arterial pH
d. Platelet count
e. Blood glucose
5. Consider the following statements about lumbar puncture:

a. Lumbar puncture should be performed urgently in the diagnosis of subarachnoid haemorrhage
b. contra-indications include a platelet count of <100x109/L
c. a correctly placed needle will pass through the dura mater, arachnoid mater and pia mater in that order
d. the presence of WBC in the CSF can be due to a seizure
e. the use of ultrasound imaging to assist lumbar puncture has been shown to reduce failure rate
An 18 year old female with epilepsy presents with status epilepticus requiring anaesthesia and invasive ventilation. Despite sedation with midazolam infusion, there was still evidence of seizures on EEG. Her usual doses of levetiracetam and sodium valproate were increased. Lacosamide and subsequently phenobarbitone were added after which the seizures eventually terminated. She is allergic to phenytoin. Initial CT head and CSF analysis were normal. Sedation was ceased with no evidence of further fitting. 5 days after stopping phenobarbitone, her GCS remained 3. What is the next appropriate step to take?

MCQ Paper No.1

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