Multiple Choice Questions
Abdominal cutaneous nerve entrapment (e) Pain relief at the maximal tender point, by
injection of lidocaine 2%.
syndrome
3. Appropriate statements regarding ultrasound-guided
1. A 39-year-old female with a diagnosis of endometriosis local anaesthetic injection of the anterior cutaneous
and adhesions presents to the pain clinic complaining of branches of the thoraco-abdominal nerves include:
abdominal pain, localized to the left iliac fossa, for 10 years.
Her pain is increased by walking, bending and lifting, and (a) A low-frequency transducer of 2–5 MHz is most
attenuated partly by dihydrocodeine but not by suitable for visualizing these nerves.
neuropathic analgesics. In the past, she has had 10 (b) The linea alba appears as a hypoechoic line
abdominal operations, including laparoscopic adhesiolysis, between the rectus muscles.
which have been ineffective. There are localized painful (c) The fascia surrounding the rectus muscle appears
spots on the lateral border of the rectus muscle and hyperechoic.
Carnett’s test is positive. Appropriate statements regarding (d) The injectate appears as an expanding hypoechoic
the examination include: area.
(e) The injectate is deposited anterior to the anterior
(a) Carnett’s test is carried out to identify the rectus sheath.
abdominal wall pain.
(b) If the point of maximal abdominal wall tenderness 4. A 21-year-old female is hospitalized with acute
is relieved by contraction of the abdominal wall exacerbation of abdominal cutanous nerve entrapment
muscles, then Carnett’s test is considered to be involving her right thoracic anterior cutaneous nerves, T11
positive. and T12. Her analgesic drug history includes: fentanyl patch
–1
(c) If she has an abdominal wall haematoma, then with administration at a rate of 12.5 µg h , amitriptyline
Carnett’s test is likely to be positive. 10 mg per night and gabapentin 400 mg three times a day.
(d) If she has a spigelian hernia, then Carnett’s test is In the past, she had 90% pain relief for a period of 9 months
likely to be negative. after anterior cutaneous nerve block with levobupivacaine
(e) If she has entrapment of the sixth thoracic nerve 0.5% and triamcinolone. On this admission, she has
on the left side, then Carnett’s test is likely to be required immediate-release oral morphine 20 mg every 4 h.
present. Appropriate statements regarding her management
include:
2. A 23-year-old female athlete presents with a 5-year
history of right upper quadrant pain with occasional (a) The diagnosis should be established with nerve
retrograde radiation. Pain is increased by sport activities conduction studies.
and a full stomach, but is relieved by vomiting. There is no (b) Abdominal support using binders and
history of trauma or abdominal surgery. No abnormalities transcutaneous nerve stimulation (TENS) are
have been detected on either upper gastrointestinal useful in managing acute exacerbations.
endoscopy or ultrasound imaging of her abdomen. On (c) Repeating the injection with levobupivacaine 0.5%
examination of the lateral border of the right rectus muscle and triamcinolone carries a low but serious risk of
just below the rib cage, there is a localized tender point iatrogenic neuropathic pain.
which is increased by tensing the abdominal wall muscles. (d) Neurolytic blocks using aqueous phenol 5% are
Bedside quantitative sensory testing (QST) reveals an area used in the management of acute flare-up of
of hyperalgesia surrounding the tender point. To make a abdominal cutaneous nerve entrapment
diagnosis of abdominal cutaneous nerve entrapment, syndrome.
essential criteria are likely to include: (e) Surgical neurectomy is likely to be used to treat
refractory abdominal cutaneous nerve entrapment
(a) A positive Carnett’s test. syndrome.
(b) Her gender.
(c) A history of trauma or previous abdominal surgery.
(d) Positive bedside QST changes.
1 doi: 10.1093/bjaceaccp/mkv026
CEACCP | Volume 15 Number 2 | 2015
Published by Oxford University Press on behalf of the British Journal of Anaesthesia 2015
Multiple Choice Questions
Awake intubation (c) Has analgesic, anxiolytic and amnesic properties.
–g
(d) Is likely to be injected as a bolus of 0.7er µg kg ,
–g –g7
1. A 62-year-old male with a history of heavy smoking followed by an infusion of 0.3–0.7 µg kg h when
presents with a 3-week history of progressive dyspnoea and used as sedation for awake fibre-optic intubation.
inspiratory stridor. Flexible nasendoscopy reveals a (e) Has been shown to provide superior intubating
suspicious-looking mass arising from the right vocal cord. conditions to either propofol or remifentanil.
Staging computed tomography scanning demonstrates
significant narrowing of the airway at the level of the larynx 4. Training time has become more limited over recent
with a minimum diameter of 6 mm. He is listed for years, necessitating a change in the way that advanced
microlaryngoscopy and biopsy. Appropriate statements airway techniques are taught. Appropriate statements
regarding airway management include: regarding airway training include:
(a) Awake fibre-optic intubation is absolutely (a) Training should focus on awake video laryngoscopy
contraindicated. as opposed to awake fibre-optic intubation as the
(b) Awake video laryngoscopy is absolutely former has been shown to be quicker to perform
contraindicated. and easier to learn than the latter.
(c) Conventional direct laryngoscopy is absolutely (b) Owing to numerous circumstances under which it
contraindicated. cannot be performed, awake video laryngoscopy
(d) A second anaesthetist should be present to take should not be taught as an advanced airway
sole responsibility for sedation if an awake technique.
intubation technique is performed. (c) For patients with dental abscesses resulting in
(e) Awake fibre-optic intubation cannot be achieved reduced mouth opening, awake fibre-optic
without use of topical local anaesthesia. intubation should be taught as the technique of
choice.
2. A 52-year-old male with rheumatoid arthritis presents (d) Trainees should undertake at least 5 h of manikin
with an acute abdomen requiring emergency laparotomy. training before performing fibre-optic intubation on
He has severely limited neck movement and only 1.5 cm patients.
mouth opening due to temporomandibular joint (e) It is vital that all trainees are proficient at both
involvement. After discussion with the patient, the decision awake and asleep fibre-optic intubation in elective
is taken to perform awake fibre-optic intubation. and emergency settings before completion of
Appropriate statements regarding sedation for awake training.
intubation include:
Cancer pain management: Part II:
(a) During administration of remifentanil, either
midazolam or propofol is likely to be used to reduce Interventional techniques
the possibility of unpleasant experiences, such as
recall. 1. A 67-year-old woman is referred to the pain clinic with a
(b) If either midazolam or propofol is administered, history of anorectal cancer and severe perineal pain. Dose
then the effect site concentration of remifentanil is escalation of systemic analgesics is giving intolerable side-
–l
unlikely to exceed 5 ng ml effects, such as sedation and drowsiness. Appropriate
(c) Compared with either midazolam or statements regarding interventional options include:
dexmedetomidine, propofol has been shown to
provide superior awake fibre-optic intubating (a) Intrathecal administration of opioids is likely to be
conditions. the most common interventional option.
(d) Intravenous bolus administration of anaesthetic (b) Intrathecal neurolysis with hyperbaric phenol
drugs such as midazolam is likely to lead to achieves a saddle block.
oversedation. (c) Intrathecal administration of phenol is unlikely to
(e) If either sedation or local anaesthesia is cause motor block.
contraindicated, then an alternative strategy of (d) If aqueous phenol is administered, it is likely to
acupuncture at conception vessel meridian (CV) 26 gravitate in the cerebrospinal fluid (CSF).
is likely to reduce the severity of the gag reflex. (e) Short life expectancy of the patient is likely to be
considered before proceeding with a neurolytic
3. Dexmedetomidine: block.
(a) Is a highly specific α-1 receptor antagonist. 2. A 42-year-old man with recently diagnosed pancreatic
(b) Is a respiratory stimulant. cancer attends the pain clinic complaining of severe pain in
2 BJA Education | Volume 15 Number 3 | 2015
Multiple Choice Questions
his back and abdomen. Despite consuming several End-of-life care
additional doses of strong opioids, the pain intensity is
recurrently high. Appropriate statements regarding coeliac
plexus block for his pain include: 1. An 18-year-old-woman presents to a hospital in the UK
with ischaemic bowel. It is unlikely that she will survive
(a) This block is unlikely to be done if the cancer is at without urgent laparotomy and bowel resection. She has
an early stage. tetraparesis caused by a high spinal injury, a permanent
(b) A large volume of neurolytic agent is likely to be tracheostomy to enable suctioning of secretions and
administered. indicates a refusal to undergo surgery. To have the capacity
(c) Despite the use of imaging techniques, there is a to refuse life-sustaining treatment she must:
high risk of serious side-effects such as paraplegia.
(d) Thoracic splanchnectomy is a viable alternative (a) Be able to retain and use the relevant information
option. to arrive at a decision.
(e) Effectiveness is likely to be high if there is a past (b) Be assessed by an independent mental capacity
history of radiotherapy. advocate (IMCA).
(c) Be capable of physically discontinuing the
3. Appropriate statements regarding percutaneous treatment and not be reliant upon others to do
vertebroplasty include: this for her.
(d) Sign a consent form in the presence of a witness.
(a) The primary mechanism of action is stabilization of (e) Have had capacity in all other previous relevant
the microfracture sites within the vertebral body. circumstances.
(b) Leakage from injection of bone cement into the
vertebral body is likely to be clinically 2. A patient is admitted to the intensive care unit after
undetectable. cardiac arrest outside a hospital in the UK. Owing to
(c) Compared with vertebroplasty, kyphoplasty is hypoxic brain injury, the consultant believes that
likely to have superior analgesic efficacy. withdrawal of ventilation is in the patient’s best interests.
(d) Vertebroplasty is likely to be used to treat bone Persons legally capable of making medical decisions on
pain attributable to metastatic disease, behalf of those who lack capacity are likely to include:
osteoporosis and multiple myeloma.
(e) Vertebroplasty is likely to be used to treat (a) The nominated next of kin as the sole decision-
radicular pain as well as axial pain maker.
(b) Any person with lasting power of attorney (LPA)
4. A 72-year-old retired shipyard worker has been referred status for that patient.
to the pain service for consideration of percutaneous (c) An Independent Mental Capacity Advocate (IMCA).
cordotomy. He has a persistent cough, breathlessness and a (d) A court-appointed deputy.
chest radiograph showing features suggestive of pleural (e) The named physician.
plaques. There is severe right-sided chest wall pain,
between the level of the right nipple and the xiphisternum. 3. A patient with metastatic malignant melanoma develops
Owing to a diagnosis of pleural mesothelioma, he has been pneumonia with hypoxia, hypotension and oliguria on a
informed that the tumour is not resectable. Appropriate medical ward in the UK. Serial bedside observations
statements regarding cordotomy to this patient include: demonstrate that the patient is deteriorating despite
antibiotics, oxygen and intravenous fluids. The medical
(a) Cordotomy creates a lesion in the lateral team is concerned and do not think that cardiopulmonary
spinothalamic tract, ipsilateral to the pain on the resuscitation is in the best interests of the patient.
patient’s right side. Cardiopulmonary resuscitation:
(b) Successful cordotomy is likely to resolve the pain
completely. (a) Must be attempted if the patient makes a positive
(c) Cordotomy is likely to be performed caudal to the wish to have this process.
fifth cervical level. (b) Must be attempted if the next of kin insists that
(d) Pain attributable to deafferentation is a potential cardiopulmonary resuscitation is provided.
complication if the patient lives for at least (c) Must be attempted unless there is a valid form in
another year. the patient’s notes stating that resuscitation is not
(e) Loss of pain and temperature sensation but to be attempted.
preservation of motor function are likely to be (d) Should be discussed with the patient before a
observed on the patient’s right side. decision to not attempt cardiopulmonary
resuscitation is reached.
(e) Is likely to be an unpredictable event.
3 BJA Education | Volume 15 Number 3 | 2015
Multiple Choice Questions
(e) Immediate closure of the medical gas supply to the
4. In the UK, assisted suicide by clinicians: operating theatre.
(a) Is generally supported by doctors when their views 3. Immediately after the fire is extinguished the power
are ascertained in a national survey. supply to the operating theatre is interrupted, presumably
(b) Is illegal under the Suicide Act of 1961. as a consequence of involvement of the electrical control
(c) Has been successfully prosecuted as attempted panel. There is no surgical lighting and no devices in
murder. operation for patient monitoring. The theatre emergency
(d) Prevents administration of high doses of sedatives lighting is not activated, and the anaesthetic machine,
in critically ill patients, as death may be hastened. which was plugged into a blue power socket, enters a
(e) Is likely to benefit over 5000 people who travel battery backup mode. Appropriate actions for the
from the UK to the Dignitas clinic in Switzerland to management of this situation are likely to include:
end their lives each year.
(a) Immediate transfer of all essential equipment to
instantaneous circuits.
Environmental emergencies in theatre (b) Immediate clinical assessment of the patient.
and critical care areas: power failure, fire, (c) Use of candles to re-establish lighting.
and explosion (d) Open the electrical control panel cover to attempt
to diagnose and fix the problem.
(e) Alert other operating theatres in the complex to
1. A 79-year-old man with multiple medical comorbidities, the difficulties experienced.
including chronic obstructive pulmonary disease requiring
domiciliary oxygen therapy, is undergoing drainage of a 4. Appropriate statements regarding the power supply to
neck abscess. Recognizing his parlous respiratory status, healthcare facilities and clinical equipment include:
you have a further discussion with an inexperienced trainee
surgeon about the possible airway management and (a) All essential equipment, such as infusion pumps,
anaesthesia techniques for the case. Factors that are likely anaesthetic machines and external defibrillators,
to increase the risk of operating theatre fire in this scenario should be connected to an uninterrupted power
include: supply (UPS) at all times, regardless of whether
they have a battery backup.
(a) Use of halogenated anaesthetic agents for (b) Areas such as operating theatres, critical care units
maintenance of anaesthesia. and emergency departments are unlikely to
(b) Tracheal intubation. require access to a UPS.
(c) Local anaesthesia with continuous flow oxygen at (c) Interruption of the main power supply is likely to
–1
6–8 litres min via face mask. disrupt the medical gas supply.
(d) Pooling alcohol containing surgical preparation (d) Electrical anaesthetic machines are likely to have
solutions within surgical drapes. battery storage sufficient to supply the full range
(e) Use of hydrogen peroxide as part of the surgical of functions, such as ventilation, gas delivery,
technique. monitoring of gases and blood pressure.
(e) In the event of a complete power failure,
2. Before incision, the neck abscess is well isolated from the mechanical ventilation should be discontinued if
patient’s mouth and nose by occlusive surgical drapes. The the patient does not have complex ventilatory
–
patient receives sedation and inhales oxygen at 3 litres min requirements, such as inverse ratio ventilation and
1
via nasal prongs attached to the anaesthetic machine. To positive end-expiratory pressure of >10 cm H20.
obtain haemostasis of venous blood after incision and
drainage, the bipolar diathermy device is plugged into a
socket and switched on. Immediately after this task, a Placental structure, function and drug
burning smell and flames are observed to originate from transfer
the theatre’s electrical control panel. Steps that are
appropriate in the initial management of this situation are
1. Appropriate statements regarding placental structure
likely to include:
and blood flow include:
(a) Activation of the fire alarm.
(a) The cytotrophoblast layer of the chorion comes
(b) Using a carbon dioxide fire extinguisher.
into direct contact with maternal blood.
(c) Using a foam fire extinguisher.
(b) The ovarian arteries supply maternal blood to the
(d) Evacuation of the operating theatre after packing
uterus.
the wound and suspension of the operation.
4 BJA Education | Volume 15 Number 3 | 2015
Multiple Choice Questions
(c) Sixty percent of uterine blood flow passes to the (b) Tachyarrhythmia in the presence of a plasma
–1
placenta. digoxin concentration of 3.5 ng ml . (Normal
–1 –1
(d) The intervillous space at term is filled with foetal range is <2 ng ml ; in heart failure <1 ng ml ).
blood. (c) Atrial fibrillation in the presence of a serum
–1
(e) Uteroplacental blood flow is directly related to the potassium concentration of 2.7 mmol litre .
mean uterine perfusion pressure. (d) Atrioventricular nodal re-entrant tachycardia in
the absence of electrolyte abnormalities.
2. Appropriate statements concerning the functions of the (e) Atrial fibrillation lasting longer than 12 months, in
placenta include: the presence of left atrial dilatation, moderate
mitral regurgitation and therapy with sotalol.
(a) The syncytiotrophoblast secretes peptide
hormones. 2.
(b) Foetal uptake of oxygen is favoured by the acidity
of maternal blood compared with foetal blood.
(c) Facilitated diffusion is necessary to meet foetal
demands for glucose.
(d) Transfer of IgG antibodies cross the placenta
occurs mainly by active transport.
(e) Human chorionic gonadotrophin production peaks
at approximately 12 weeks of gestation.
3. Appropriate statements regarding drug transfer across
the placenta include:
(a) The syncytiotrophoblast is the rate-limiting barrier.
Appropriate treatment options for this arrhythmia include:
(b) More than half of all drugs cross the placenta by
passive diffusion.
(a) Digoxin.
(c) Infective processes affecting the placenta are likely
(b) Metoprolol.
to increase passive diffusion of drugs.
(c) Direct current cardioversion.
(d) The transfer of steroids across the placenta occurs
(d) Amiodarone.
by active transport.
(e) Diltiazem.
(e) The transfer of norepinephrine across the placenta
is carrier-mediated and saturable.
3. A 61-year-old male with no known previous medical
history is listed for an elective inguinal hernia repair. His
4. Appropriate statements concerning the placental
preadmission electrocardiogram (ECG) is shown below. On
transfer of anaesthetic drugs include:
the day of surgery you note an irregular pulse rate of
–1
105 beats min and a blood pressure of 165/95 mm Hg.
(a) Maximal uptake of meperidine by foetal tissues
occurs 5–6 h after a maternal intramuscular dose.
(b) Nitrous oxide is likely to cross slowly.
(c) Atropine crosses the placenta more rapidly than
glycopyrrolate.
(d) Atracurium crosses the placenta readily.
(e) Foetal acidosis is likely to lead to foetal
accumulation of local anaesthetic agents.
Supraventricular tachyarrhythmias and
their management in the perioperative
period Appropriate statements regarding immediate management
include:
1. After application of direct current cardioversion, sinus
rhythm is likely to be observed in patients with arrhythmias (a) Check serum electrolytes; if they are normal,
that include: proceed with induction of general anaesthesia.
(a) Multifocal atrial tachycardia.
5 BJA Education | Volume 15 Number 3 | 2015
Multiple Choice Questions
(b) Repeat the ECG; if the heart rate is 60– (d) Increased coding of messenger ribonucleic acid
–1
90 beats min , proceed with induction of general (mRNA) secondary to prolonged noxious stimuli
anaesthesia. helps to attenuate the development of chronic
(c) Cancel the operation, then refer to a cardiologist pain.
for investigation and preoptimization. (e) Aβ fibres are likely to carry pain signals to the
(d) Sedate the patient and electively cardiovert with spinal cord.
direct current.
(e) Control the rate with metoprolol and then proceed 2. Appropriate statements regarding pain mechanisms in
to induction of general anaesthesia. the spinal cord include:
4. You are a new general anaesthetic consultant and have (a) During an initial attempt at peripheral venous
intubated the trachea of a 41-year-old female brittle cannulation, pain signals are likely to be conducted
asthmatic for an urgent laparoscopic appendectomy. from primary afferent neurones to the secondary
During the operation the patient develops persistent afferent neurones, once glutamate attaches to the
arrhythmia in the presence of normal blood pressure and a N-methyl-D-aspartate (NMDA) receptors.
normal end-tidal carbon dioxide trace. Electrocardiography (b) Severity of pain experience is likely to be
is performed as shown below. determined by higher brain function.
(c) A right hemitransection at the level of the sixth
thoracic vertebra (T6) is likely to allow the patient
to undergo an incision and drainage of abscess
around the right femoral vein, without the need
for anaesthesia.
(d) Central sensitization is likely to develop in a
patient with chronic diabetic leg ulcer.
(e) Nociceptive transmission is likely to be reduced
once wide-dynamic-range (WDR) neurones are
activated.
3. Appropriate statements in relation to the pain matrix
include:
Appropriate courses of action are likely to include: (a) The pain matrix is a unique network of neurones
conducting pain signals from the site of tissue
(a) Administer 6 mg of adenosine into a large proximal injury to the brain.
vein followed by a 20 ml of normal saline. (b) The second-order perceptual matrix is the main
(b) Check serum electrolytes from a sample of venous centre in the brain. It interprets pain signals and
blood. identifies the exact painful location.
(c) Consult the on-call cardiologist. (c) The reticular formation controls the secretion of
(d) Administer a loading dose of diltiazem 0.25 mg kg
– prostaglandins in descending inhibitory pathways.
1
. (d) In an individual with chronic pain, the
(e) Cautiously administer metoprolol in 0.5 mg periaqueductal grey matter is an area responsible
boluses. for mood [affective and coping mechanisms
(motivational component)] .
(e) Neuroplasticity is brain reorganization by multiple
Transition from acute to chronic pain neuronal mechanisms in the development of
chronic pain.
1. Appropriate statements regarding nociceptive processes
in the periphery include: 4. Appropriate statements regarding prevention of the
transition from acute to chronic pain include:
(a) The developed ‘neurogenic inflammation’ is likely
to reduce the intensity of pain. (a) The most effective method is to use multimodal
(b) Activation of the sympathetic nervous system is pharmacotherapy.
likely to reduce the intensity of nociceptive (b) Even in patients with cardiovascular disease,
transmission. cyclooxygenase II inhibitors should be prescribed if
(c) Release of tumour necrosis factor (TNF) is likely to there is a high risk of developing chronic pain.
enhance the transition from acute to chronic pain.
6 BJA Education | Volume 15 Number 3 | 2015
Multiple Choice Questions
(c) Compound analgesia without biopsychosocial (e) Death of the patient from acquired
assessment is indicated to manage patients at high immunodeficiency syndrome 2 months after
risk of developing chronic pain. surgery.
(d) Regular and prolonged assessments of patients are
likely to be required even if the patients have 3. In the operating theatre and in intensive care, several
acute but not chronic pain. procedures are considered to be exposure-prone owing to
(e) Two weeks after a severe injury caused by an poor visibility of the fingertips, the presence of sharp
explosion during a military operation, a young objects, tissue contamination and unrecognized injury.
soldier undergoes bilateral amputation above his Appropriate statements regarding existing restrictions
knees. Despite uneventful surgical recovery and relating to exposure-prone procedures include:
optimum multimodal pharmacotherapy, persistent
severe pain is perceived. On further review, his (a) All healthcare workers infected with hepatitis C
opioid dose should be escalated. are prohibited from performing exposure-prone
procedures.
(b) Healthcare workers who are positive for the
UK healthcare workers infected with hepatitis B e antigen are prohibited from
blood-borne viruses: guidance on risk, undertaking tracheal intubation of patients.
transmission, surveillance, and (c) A healthcare worker who is negative for the
hepatitis B e antigen and who has a hepatitis B
management 3
viral DNA level >10 genome equivalents ml is
–1
prohibited from inserting a chest drain into a
1. As the governance lead for your hospital in the UK, trauma patient with a flail segment.
you are preparing a teaching session on transmission of (d) Healthcare workers who are positive for HIV are
blood-borne infection and sharps injury to various permitted to perform peripheral and central
members of staff in the theatre environment. Appropriate venous cannulation.
statements that you are likely to make include: (e) If an exposure-prone procedure is undertaken by a
healthcare worker who is positive for the hepatitis
(a) Hepatitis B is the most common blood-borne virus B e antigen, it is necessary to inform the patient
transmitted from infected patients to healthcare and to organize monitoring by an occupational
workers. health physician.
(b) Most (40%) occupational exposures to blood-
borne viruses occur in the operating theatre. 4. At 11.30 p.m., a female cleaner mops around the bed-
(c) The most common form of occupational exposure space on the intensive care unit when she notices a suture
to blood-borne viruses is percutaneous exposure. needle lying on the floor. On picking up the needle for
(d) Nursing staff are the members of staff most disposal, she accidentally incurs a needle-stick injury and
commonly exposed to the risk of blood-borne virus alerts the medical team on the intensive care unit
transmission. immediately. The patient who occupied the bed space is
(e) Emergency procedures are associated with an known to be infected with HIV. Appropriate information for
increased risk of exposure to blood-borne viruses. this healthcare worker would include:
2. A 30-year-old man undergoing emergency colorectal (a) Attend the occupational health department as
surgery is known to be positive for human soon as possible the next morning to receive post-
immunodeficiency virus (HIV). During placement of a exposure prophylaxis (PEP).
central venous line, the anaesthetist sustains an (b) PEP should be taken for the next 28 days.
inadvertent needle-stick injury. In the root cause analysis of (c) The benefit of PEP is a 50% reduction in acquisition
the incident, factors associated with increased risk of HIV of HIV.
transmission from the infected source patient to the (d) Allow sampling of blood for baseline viral testing.
anaesthetist are considered. They are likely to include: (e) Attend the occupational health service for a year
after completing the recommended course of PEP.
(a) A hollow-bore needle rather than a solid-suture
needle.
(b) Visible blood of the patient on the needle.
(c) Aspiration of blood from the right internal jugular
vein of the patient.
(d) Penetration of the anaesthetist’s skin without
bleeding.
7 BJA Education | Volume 15 Number 3 | 2015
