30,000 MTF-format questions mapped to the Part I syllabus, created using AI and manually reviewed by doctors training in anaesthesiology and intensive care. Every statement comes with a worked explanation — so you learn the reasoning, not just the answer. Practise free in the browser, on any device.
EDAIC-style Part 1 MTF questions from the AnesCORE question bank — one from each syllabus topic. Read the stem, decide true or false for each statement, then reveal the answer and the worked explanation.
Paper A · Anatomy
1. Regarding the blood supply to the spinal cord and its clinical relevance during aortic surgery:
A.The artery of Adamkiewicz typically arises between T9 and T12 in the majority of individuals.
B.The anterior spinal artery supplies the posterior one-third of the spinal cord, including the dorsal columns.
C.Spinal cord perfusion pressure is calculated as distal mean aortic pressure minus the higher of CSF pressure or central venous pressure.
D.Autoregulation of spinal cord blood flow is maintained during hypoxia and hypercapnia, ensuring constant perfusion.
E.CSF drainage during thoracic aortic aneurysm repair aims to reduce CSF pressure and thereby improve spinal cord perfusion pressure.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: The great radicular artery (artery of Adamkiewicz) is the major blood supply to the lower two-thirds of the spinal cord and originates between T9 and T12 in approximately 75% of cases.
B.FALSE
Why: The anterior spinal artery supplies the anterior two-thirds of the spinal cord, including the motor tracts; the posterior spinal artery supplies the dorsal sensory columns.
C.TRUE
Why: Spinal cord perfusion pressure is defined as distal mean aortic pressure minus CSF pressure or central venous pressure, whichever is greatest.
D.FALSE
Why: During hypoxia or hypercapnia, autoregulation of spinal cord blood flow is lost, and flow becomes linearly related to perfusion pressure.
E.TRUE
Why: CSF pressure often increases with aortic cross-clamping; draining CSF reduces this pressure and improves spinal cord perfusion pressure, lowering ischemic risk.
Paper A · Anatomy
2. Regarding ultrasound imaging characteristics of peripheral nerves and the technical principles of ultrasound-guided regional anesthesia:
A.Peripheral nerves are typically visualized in the long axis during ultrasound-guided regional anesthesia to optimize needle tracking.
B.The honeycomb appearance seen on ultrasound corresponds to the fascicular echotexture of a polyfascicular peripheral nerve in short-axis view.
C.An out-of-plane needle technique is visualized as a bright echogenic dot crossing the plane of the ultrasound beam.
D.Consistent evidence shows that the in-plane needle approach yields superior clinical outcomes compared with the out-of-plane approach for all regional blocks.
E.Echogenic needle designs with textured surfaces improve needle tip detection by generating stronger ultrasound reflections back toward the transducer.
▸ Show answers & explanations▾ Show answers & explanations
A.FALSE
Why: Peripheral nerves are usually viewed in short axis rather than long axis during ultrasound-guided regional anesthesia.
B.TRUE
Why: The honeycomb appearance on sonogram represents the fascicles of a polyfascicular peripheral nerve viewed in short axis.
C.TRUE
Why: In the out-of-plane technique, the needle crosses the plane of imaging and appears as an echogenic dot on the sonogram.
D.FALSE
Why: Most studies suggest that adequate visualization and correct identification of structures is more important than the specific needle approach for outcomes after regional blocks.
E.TRUE
Why: Textured surfaces on echogenic needles are manufactured to improve needle tip detection by generating more recordable echoes compared with smooth conventional needles.
Paper B · Emergency Medicine
3. Regarding the use of automated external defibrillators (AEDs) and defibrillation strategies in cardiac arrest, which of the following statements are correct?
A.A Cochrane systematic review compared CPR plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest.
B.The presence of sonographically identified cardiac activity has been shown to reliably predict resuscitation outcomes in cardiac arrest patients.
C.Automated external defibrillators have been shown to improve survival after in-hospital cardiac arrest when used promptly.
D.A period of CPR before defibrillation is recommended for all out-of-hospital cardiac arrest patients regardless of the time to first rhythm analysis.
E.Three termination of resuscitation criteria have been validated for predicting good neurologic survival after out-of-hospital cardiac arrest.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Huang et al. (2014) conducted a Cochrane systematic review comparing cardiopulmonary resuscitation plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest, examining the optimal timing of defibrillation.
B.TRUE
Why: Salen et al. (2005) investigated whether the presence or absence of sonographically identified cardiac activity predicts resuscitation outcomes, finding it to be a useful prognostic indicator during cardiac arrest.
C.TRUE
Why: Chan et al. (2010) demonstrated that AED use was associated with improved survival after in-hospital cardiac arrest, supporting their deployment in hospital settings.
D.FALSE
Why: FALSE — Trap: The Cochrane review by Huang et al. found that the benefit of CPR before defibrillation depends on the time to defibrillation. It is not recommended for all patients regardless of time to rhythm analysis; the benefit is primarily seen when there is a prolonged response time.
E.TRUE
Why: Ruygrok et al. (2009) validated three termination of resuscitation criteria for predicting good neurologic survival after out-of-hospital cardiac arrest, providing evidence-based guidance for when resuscitation efforts may be ceased.
Paper A · Equipment
4. Concerning oropharyngeal and nasopharyngeal airway adjuncts during anaesthesia:
A.Oropharyngeal airways are sized by measuring from the corner of the mouth to the angle of the jaw or the earlobe.
B.Nasopharyngeal airways are more stimulating than oropharyngeal airways and are more likely to provoke laryngospasm.
C.Nasopharyngeal airways are designed to lift the soft palate off the pharyngeal wall to eliminate airway obstruction at that level.
D.Oropharyngeal airways are appropriate for use in conscious patients as they do not stimulate pharyngeal reflexes.
E.An inappropriately sized oropharyngeal airway can worsen airway obstruction rather than relieve it.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Correct sizing of oropharyngeal airways involves measuring from the corner of the mouth to the angle of the jaw or the earlobe, as described in Miller's Anesthesia.
B.FALSE
Why: Nasopharyngeal airways are less stimulating than oropharyngeal airways; oropharyngeal airways can precipitate coughing, retching, or laryngospasm because they contact the base of the tongue and epiglottis.
C.TRUE
Why: The nasopharyngeal airway is designed to lift the soft palate off the pharyngeal wall, thereby eliminating this mode of airway obstruction.
D.FALSE
Why: Oropharyngeal airways can precipitate coughing, retching, or laryngospasm and are not appropriate for use in conscious patients who have not had local anaesthetic applied to the airway.
E.TRUE
Why: Inappropriately sized oropharyngeal airways can actually worsen airway obstruction, making correct size selection critically important.
Paper B · General Anaesthesia
5. Regarding inhalational induction of anaesthesia in adults, which of the following statements are correct?
A.Sevoflurane is the volatile agent of choice for inhalational induction because of its low blood-gas partition coefficient and minimal airway irritation.
B.A single-breath technique using a prefilled 4-L reservoir bag containing sevoflurane 8% in oxygen can achieve induction within 20–30 seconds in cooperative patients.
C.Ether is preferred over sevoflurane for inhalational induction in resource-limited settings due to its rapid onset and pleasant odor.
D.During inhalational induction, maintenance concentrations of isoflurane are typically 3%–4% once anaesthesia is established.
E.Stage 2 of anaesthesia during inhalational induction is associated with a risk of laryngeal spasm if the pharynx or larynx is stimulated.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Sevoflurane is typically used for inhalational induction due to its low blood-gas partition coefficient and non-irritant properties, allowing smooth induction.
B.TRUE
Why: The single-breath technique with high-concentration sevoflurane in a prefilled reservoir bag enables rapid induction in cooperative patients.
C.FALSE
Why: FALSE — Trap: Ether has a very high blood-gas partition coefficient (12), making inhalational induction slow and technically challenging; it is not preferred for induction.
D.FALSE
Why: FALSE — Trap: Maintenance concentrations of isoflurane are 1%–2%, not 3%–4%, once anaesthesia has been established.
E.TRUE
Why: Complications during inhalational induction include problems during stage 2, when pharyngeal or laryngeal stimulation may trigger laryngeal spasm.
Paper B · Guidelines and Current Literature
6. Regarding the use of novel oral anticoagulants for stroke prevention in atrial fibrillation:
A.Dabigatran, rivaroxaban, apixaban, and edoxaban are now commonly utilized for thromboprophylaxis in atrial fibrillation.
B.Warfarin remains the only recommended anticoagulant for stroke prevention in atrial fibrillation according to current guidelines.
C.Stroke prevention with anticoagulation must be counterbalanced by the risk of intracranial and extracranial bleeding.
D.Anticoagulation must be discontinued for patients with atrial fibrillation who develop active bleeding in the ICU.
E.Aspirin monotherapy is no longer considered a viable option for stroke prevention in atrial fibrillation under any clinical scenario.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Novel oral anticoagulants including these four agents are now commonly used for thromboprophylaxis in AF.
B.FALSE
Why: FALSE — Trap: While warfarin was the mainstay in the past, novel oral anticoagulants are now commonly utilized and have largely supplemented warfarin.
C.TRUE
Why: The benefit of stroke prevention is counterbalanced by the risk of both intracranial and extracranial bleeding with anticoagulation.
D.TRUE
Why: Anticoagulation must be discontinued for AF patients with active bleeding in the ICU.
E.FALSE
Why: FALSE — Trap: The source states that aspirin alone can be considered for management based on patient preference and the clinical scenario.
Paper B · Intensive Care
7. Regarding ICU-acquired weakness and its relationship to nutritional and metabolic management in critically ill patients:
A.ICU-acquired weakness (ICUAW) encompasses both critical illness polyneuropathy and critical illness myopathy, and is independently associated with prolonged mechanical ventilation and increased mortality.
B.Early aggressive caloric supplementation within the first 48 hours of ICU admission has been shown to significantly reduce the incidence of ICU-acquired weakness.
C.Prolonged use of neuromuscular blocking agents and corticosteroids are recognized risk factors for the development of critical illness myopathy in ICU patients.
D.Respiratory muscle weakness in critically ill patients is associated with limb muscle weakness and is an independent predictor of delayed weaning from mechanical ventilation.
E.Long-term outcomes after ICU-acquired weakness show that most patients achieve complete functional recovery within 3 months of ICU discharge.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: ICUAW includes CIP and CIM, both of which contribute to difficulty weaning from mechanical ventilation, prolonged ICU stay, and increased long-term morbidity and mortality. It is one of the most common neuromuscular complications in the ICU.
B.FALSE
Why: FALSE — Trap: Early aggressive caloric supplementation has NOT been shown to reduce ICUAW; in fact, some evidence suggests that excessive early caloric loading may be harmful. Adequate protein delivery and early mobilization are more strongly associated with muscle preservation.
C.TRUE
Why: The combination of neuromuscular blocking agents and corticosteroids is a well-established risk factor for critical illness myopathy, particularly the thick-filament myopathy variant. This combination should be minimized when possible.
D.TRUE
Why: De Jonghe et al. demonstrated that respiratory weakness correlates with peripheral limb weakness and independently predicts prolonged weaning duration, highlighting the systemic nature of ICUAW.
E.FALSE
Why: FALSE — Trap: Complete functional recovery within 3 months is NOT typical; many patients with ICUAW experience persistent functional limitations, reduced quality of life, and disability lasting months to years after ICU discharge.
Paper B · Pain Medicine
8. Regarding the principles of managing pain in palliative care patients with advanced illness:
A.Clinicians should always consider the pathophysiology of the pain and treat the underlying cause when possible, such as palliative radiation for a painful bone metastasis.
B.For continuous or chronic pain, medications should be administered on an as-needed basis rather than on a scheduled dosing regimen.
C.Opioids combined with adjuvants are more effective for neuropathic pain than opioids alone, and this approach reduces both the opioid dose and systemic side effects.
D.The intravenous route of administration is preferred for pain crises in palliative care patients.
E.Screening for concerns about controlled substance use is unnecessary since addiction risk is negligible in palliative care populations.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Clinicians should always consider the pathophysiology of pain and treat the underlying cause as possible, for example using high-dose single-fraction palliative radiation for a painful bone metastasis.
B.FALSE
Why: FALSE — Trap: Scheduled dosing is recommended for continuous or chronic pain, based on the drug's half-life, whereas as-needed dosing is used for breakthrough pain and procedures.
C.TRUE
Why: Studies show that opioids combined with adjuvants are more effective for neuropathic pain than opioids alone, and this approach reduces both the opioid dose and systemic side effects.
D.TRUE
Why: The intravenous route of administration is recommended for pain crises in palliative care patients, as part of the pharmacologic principles guiding therapy.
E.FALSE
Why: FALSE — Trap: Clinicians should screen for concerns about the use of controlled substances, including a history of addiction and fears of becoming addicted, as part of the comprehensive assessment of pain in advanced illness.
Paper A · Pharmacology
9. Regarding the elimination half-time of intravenous anaesthetic drugs:
A.Elimination half-time is the most reliable pharmacokinetic parameter for predicting the duration of action of most anaesthetic drugs in clinical practice.
B.In a single-compartment model, elimination half-time accurately represents the time required for drug concentration to fall to half its initial value after administration.
C.The elimination half-life depends on both the volume of distribution and the clearance of the drug.
D.For most lipophilic anaesthetic drugs, elimination half-time is a superior predictor of recovery compared with context-sensitive half-time.
E.When a drug infusion is discontinued, the rate of decrease in plasma concentration is largely dependent on the clearance rate as reflected by the terminal elimination half-life.
▸ Show answers & explanations▾ Show answers & explanations
A.FALSE
Why: The elimination half-time has limited clinical utility for predicting drug disposition of most anaesthetic agents because it does not account for intercompartmental distribution, which is a major determinant of plasma concentration changes in multicompartmental models.
B.TRUE
Why: In a single-compartment model, elimination is the only process that can alter drug concentration, so the elimination half-time directly reflects the time for the concentration to decrease by 50%.
C.TRUE
Why: The terminal elimination half-life (t1/2β) is determined by the volume to be cleared (distribution volume) and the efficiency of the metabolic clearance system.
D.FALSE
Why: Context-sensitive half-time is a more clinically useful parameter than elimination half-time for lipophilic drugs because it accounts for the duration of infusion and the redistribution of drug from peripheral tissues.
E.TRUE
Why: After stopping an infusion, the rate at which plasma concentration declines is largely governed by clearance, which is reflected in the terminal elimination half-life value.
Paper A · Pharmacology
10. Regarding the classification and mechanisms of class I antiarrhythmic agents:
A.Class I antiarrhythmic drugs block the fast inward sodium current responsible for the rapid upstroke of the action potential.
B.Class IC agents such as flecainide and propafenone produce a marked decrease in phase 0 depolarization and markedly slow conduction.
C.Class IB agents such as lidocaine and mexiletine increase the action potential duration and are effective in atrial arrhythmias.
D.Class I antiarrhythmic drugs depress automaticity, particularly in Purkinje fibers.
E.The Vaughan Williams classification perfectly predicts the clinical antiarrhythmic effect of all agents with no overlap between classes.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: The major effect of class I agents is blockade of the fast inward sodium current responsible for the rapid upstroke and conduction of the action potential.
B.TRUE
Why: Class IC agents have the most pronounced effect on phase 0 depolarization, causing a marked decrease and significantly slowed conduction velocity.
C.FALSE
Why: Class IB agents shorten the action potential duration and are primarily effective in ventricular arrhythmias, not atrial arrhythmias.
D.TRUE
Why: Class I drugs depress automaticity, with a particular effect on Purkinje fiber automaticity, in addition to their sodium channel blocking effects.
E.FALSE
Why: There is substantial overlap in pharmacologic and electrophysiologic effects among the classes, and the linkage between observed effects and clinical antiarrhythmic effect is often tenuous.
Paper A · Physics and Clinical Measurement
11. Regarding SI derived units relevant to anaesthetic and intensive care practice:
A.The SI unit of force, the newton, is defined as the force required to give a mass of 1 kg an acceleration of 1 m s⁻².
B.The SI unit of pressure is the pascal, and 1 kPa is approximately equal to 7.5 mmHg.
C.The SI unit of power is the joule, defined as the energy transferred when a force of 1 N moves an object by 1 m.
D.Weight is correctly classified as a type of mass and is measured in kilograms within the SI system.
E.Momentum is defined as mass multiplied by velocity and has the SI unit kg m s⁻¹.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: One newton is defined as the force required to accelerate a 1 kg mass at 1 m s⁻², which follows directly from Newton's second law (F = ma).
B.TRUE
Why: Pressure is defined as force per unit area with the pascal as its SI unit; the conversion 1 kPa ≈ 7.5 mmHg is commonly used in medical practice.
C.FALSE
Why: The SI unit of power is the watt, not the joule. The joule is the unit of energy or work; power is the rate of doing work (watts = joules/second).
D.FALSE
Why: Weight is the force of gravitational attraction on a body and is measured in newtons, not kilograms. Mass is measured in kilograms; weight = mass × gravitational acceleration.
E.TRUE
Why: Momentum is the product of mass and velocity, giving it the derived SI unit kg m s⁻¹. Force can also be expressed as the rate of change of momentum.
Paper A · Physiology and Biochemistry
12. Regarding the pathophysiology of oxygen delivery and consumption in circulatory shock:
A.In healthy adults at rest, systemic oxygen delivery is approximately 1000 mL/min while oxygen consumption is about 250 mL/min, creating a physiological oxygen reserve.
B.When systemic oxygen delivery decreases, oxygen consumption immediately falls in direct proportion, indicating supply dependency at all levels of DO₂.
C.Cardiac output is determined by the product of heart rate and stroke volume, with stroke volume being influenced by preload, afterload, and myocardial contractility.
D.The unifying feature of all forms of shock, regardless of aetiology, is acute circulatory failure associated with inadequate cellular oxygen utilisation.
E.In septic shock, early goal-directed therapy targeting supranormal oxygen delivery values has been shown to consistently reduce mortality across all patient populations.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Under normal resting conditions, DO₂ is approximately 1000 mL/min and VO₂ is about 250 mL/min, meaning the excess oxygen supply serves as a reserve that is not required to meet baseline metabolic demand.
B.FALSE
Why: When DO₂ decreases, VO₂ initially remains unchanged due to increased oxygen extraction, demonstrating supply independence. VO₂ only falls when DO₂ drops below a critical threshold, at which point supply dependency occurs.
C.TRUE
Why: The relationship CO = HR × SV is fundamental, and stroke volume is modulated by three key determinants: preload, afterload, and contractility. Alterations in any of these contribute to different types of circulatory shock.
D.TRUE
Why: Despite the many clinical contexts in which the term shock is used, the common pathophysiological hallmark is acute circulatory failure leading to inadequate oxygen utilisation at the cellular level.
E.FALSE
Why: While Rivers et al. (2001) demonstrated benefit of early goal-directed therapy in severe sepsis and septic shock, subsequent large trials have not consistently shown that targeting supranormal DO₂ values reduces mortality across all populations.
Paper B · Preoperative Assessment
13. Concerning procedure-related risk factors for postoperative pulmonary complications, which statements are accurate?
A.Upper abdominal, thoracic, and aortic surgeries are associated with increased risk of postoperative pulmonary complications.
B.Emergency surgery and prolonged procedure duration are recognized procedure-related risk factors for postoperative pulmonary complications.
C.Residual neuromuscular blockade is not considered a procedure-related risk factor for postoperative pulmonary complications.
D.Neurosurgical procedures are not associated with an elevated risk of postoperative pulmonary complications.
E.General anesthesia is considered a procedure-related risk factor for postoperative pulmonary complications.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Procedure type including head-and-neck, thoracic, upper abdominal, and aortic surgery are identified as procedure-related risk factors for pulmonary complications.
B.TRUE
Why: Emergency procedures and long-duration procedures are both listed among the procedure-related risk factors for pulmonary complications.
C.FALSE
Why: FALSE — Trap: Residual neuromuscular blockade IS listed as a procedure-related risk factor for postoperative pulmonary complications, alongside general anesthesia and emergency procedures.
D.FALSE
Why: FALSE — Trap: Neurosurgical procedures ARE listed among the procedure types associated with increased pulmonary complication risk, along with head-and-neck, thoracic, upper abdominal, and aortic procedures.
E.TRUE
Why: General anesthesia is explicitly listed as a procedure-related risk factor for postoperative pulmonary complications.
Paper B · Regional Anaesthesia
14. Regarding peripheral nerve blocks for foot and ankle surgery:
A.Popliteal blockade is the technique of choice for foot surgery in the presence of infection or swelling at the ankle.
B.Peripheral nerve blocks for lower limb surgery avoid the cardiovascular and respiratory side effects associated with neuraxial and general anaesthesia.
C.For ambulatory foot and ankle surgery, mepivacaine or lidocaine may be more appropriate than bupivacaine due to their faster onset and reliable surgical anaesthesia.
D.A sural nerve block is necessary for all forefoot surgeries including hallux valgus correction.
E.When performing a popliteal sciatic nerve block, a needle length of 25–50 mm is generally recommended.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: The source explicitly states that popliteal blockade is the technique of choice in the presence of infection or swelling at the ankle, as it allows nerve blockade proximal to the affected area while avoiding needle passage through infected or edematous tissue. (Clinical Anesthesia p.2323)
B.TRUE
Why: The source confirms that peripheral blockade avoids the cardiovascular and respiratory side effects, as well as urinary retention, associated with neuraxial and general anaesthesia. (Clinical Anesthesia p.2323)
C.TRUE
Why: The source notes that additional onset time is required with bupivacaine and ropivacaine, making mepivacaine and lidocaine more appropriate in the ambulatory setting. (Clinical Anesthesia p.2323)
D.FALSE
Why: FALSE — Trap: The source explicitly states that sural nerve block is not necessary for hallux valgus surgery. Including it as mandatory misrepresents the block requirements for forefoot procedures. (Clinical Anesthesia p.2323)
E.FALSE
Why: FALSE — Trap: The source lists suggested needle lengths for sciatic nerve blocks as 80–150 mm depending on the approach. Recommending 25–50 mm, which is the range for interscalene blocks, could result in insufficient depth for sciatic nerve access. (Essentials of Equipment in Anaesthesia, Critical Care and Peri-operative Medicine p.224)
Paper B · Special Anaesthesia
15. Regarding the use of sevoflurane for inhalational induction in day-case anaesthesia, which of the following statements are correct?
A.Sevoflurane is the preferred volatile agent for inhalational induction in paediatric patients undergoing day-case procedures.
B.A single-breath technique using sevoflurane 8% in oxygen can achieve induction of anaesthesia within 20–30 seconds in cooperative patients.
C.Maintenance concentrations of sevoflurane during established anaesthesia typically range from 4% to 6% in day-case surgery.
D.Inhalational induction with sevoflurane is indicated in patients with upper airway obstruction such as epiglottitis.
E.During inhalational induction, nitrous oxide 50% in oxygen is used initially before introducing sevoflurane in the single-breath technique.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Sevoflurane is typically used for inhalational induction in paediatric anaesthesia due to its favourable airway properties and rapid onset.
B.TRUE
Why: The single-breath technique with a prefilled reservoir bag containing sevoflurane 8% in oxygen results in smooth induction within 20–30 seconds.
C.FALSE
Why: FALSE — Trap: Maintenance concentrations of sevoflurane are 2%–3%, not 4%–6%. The higher range would risk excessive depth and delayed recovery.
D.TRUE
Why: Upper airway obstruction, including epiglottitis, is a recognised indication for inhalational induction to preserve spontaneous ventilation.
E.FALSE
Why: FALSE — Trap: The single-breath technique uses sevoflurane 8% in oxygen or nitrous oxide 50% in oxygen as alternative carrier gases, but nitrous oxide 50% is not the initial mixture before sevoflurane—it is an alternative to oxygen alone.
Paper A · Statistics and Research
16. Concerning statistical power, type II error, and sample size considerations in the design of clinical trials in anaesthesia research:
A.Statistical power is defined as the probability of correctly rejecting the null hypothesis when a true treatment effect of a specified magnitude exists, and it is equal to 1 minus the type II error rate.
B.Increasing the sample size of a clinical trial decreases statistical power and increases the probability of committing a type II error.
C.A trial with low statistical power may fail to detect a clinically important treatment effect, resulting in a false-negative conclusion that the intervention is ineffective.
D.When multiple subgroup analyses are performed in a clinical trial, the risk of finding a statistically significant result by chance alone increases, even if no true treatment effect exists in any subgroup.
E.The number needed to treat (NNT) is a measure of statistical power and is used to determine the required sample size for a clinical trial.
▸ Show answers & explanations▾ Show answers & explanations
A.TRUE
Why: Power is the probability of detecting a true effect of a given size and is mathematically defined as 1 − β, where β is the type II error rate (the probability of failing to reject a false null hypothesis). Adequate power (typically 80% or 90%) is essential in trial design.
B.FALSE
Why: Increasing the sample size increases statistical power and decreases the probability of a type II (false-negative) error; the statement reverses this relationship and is false.
C.TRUE
Why: An underpowered trial has a high type II error rate, meaning it is likely to miss a real treatment effect. This can lead to the erroneous conclusion that an effective intervention has no benefit, potentially depriving patients of useful therapies.
D.TRUE
Why: Performing multiple subgroup analyses inflates the overall type I error rate, so an apparently significant result can arise by chance even when no true effect exists in any subgroup.
E.FALSE
Why: The NNT is a measure of clinical effect size (the number of patients who need to be treated to prevent one additional adverse outcome), not a measure of statistical power. Sample size calculations depend on the expected effect size, the chosen alpha level, the desired power, and the variability of the outcome measure.
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