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116 Cards in this Set
- Front
- Back
1. Given the following diagram, what does X represent? |
(Question 1 had the picture of the three container chest drain, with the suction limiting outlet the answer to the question) |
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2. RH28 Retrobulbar block. Sign of brainstem spread |
C |
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3. Something like: Otherwise healthy 20 yo male undergoes surgery for an ORIF tibia for open tib fracture. The limb is exanguinated and the tourniquet correctly applied at 250mmHg. His SBP is 120. When the surgeons go to start there is a small amount of bleeding. Do you.. |
A |
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4. What's this? |
Aortic dissection |
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5. Fatigue during night shifts can be minimized by: |
C |
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6. [New] Patient with Acute Intermittent Porphyria presents to hospital with abdominal pain and requires a general anaesthetic. Which drug for PONV would you avoid? |
A |
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7. A 65 year old man having a total hip placement under general anaesthetic has continued to take his moclobemide. He becomes hypotensive shortly after induction. The best treatment would be judicious use of |
E |
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8. The following capnography trace was observed in an intubated and ventilated patient. The most likely explanation for this respiratory pattern is |
C |
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9. When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to: |
B |
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10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is: |
B |
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11. A 15 yo girl with newly diagnosed mediastinal mass presents for supra-clavicular lymph node biopsy under GA. The most important investigation to perform pre-operativel |
B |
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12. A CTG recording with late prolonged decelerations. Cause: |
D |
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13. A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of the conventional before 1 extra patient will benefit is |
D |
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14. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use: |
B |
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15. Increase in period bleeding EXCEPT |
Answer: E |
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16. Post op hip ORIF, commonest periop complication |
C |
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17. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is: |
E |
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18. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her: |
D |
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19 (Repeat) Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I. |
A |
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20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of: |
D |
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21. A 60 y.o. diabetic man has below knee amputation for ischaemic leg. His neuropathic pain is treated with oxycodone 40mg BD and paracetamol 1g QID. He is also on omeprazole 20mg BD for reflux. You decide to start him on gabapentin. Before choosing a dosing regime and starting treatment it is most important that you: |
C |
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22. The anterior and posterior borders of the 'triangle of safety', the preferred insertion site for an intercostal catheter, are pec major and: |
C |
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23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with nucertain medication compliance. He is confused and agitated wuth generalised rigidity but no hyperreflexia. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx? |
If C is supposed to read Neuroleptic Malignant Syndrome, then C |
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24. CO2 (laser??) penetrates surface tissue so well with little damage to underlying tissue because: |
D |
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25. (NEW) An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is: |
B |
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26. (New) You are involved in research and as part of data collection you collect ASA scores. This type of data is: |
E |
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27. An otherwise healthy man presents with anaemia. The test that most reliably indicates iron deficiency is decreased |
B |
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30. The maximal allowable atmospheric concentration of nitrous oxide in Australian and New Zealand operating theatres (in parts per million) is |
B |
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31. What is associated with down regulation of nicotinic acetylcholine receptors: |
B |
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35. A reduction in DLCO can be caused by: |
B |
|
36. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermia. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is |
D |
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37. (New) The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size: |
Answer: D |
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38. (Repeat) Pneumoperitoneum cases a decrease in cardiac output at what pressure (or possibly ABOVE what pressure) |
A |
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39. 60yo male had total knee replacement. 7 days post-operatively diagnosed with deep venous thrombosis on ultrasound. Was on LMWH. PLT dropped from 300 immediately post-op and now 150x10^9/L. All the following are acceptable treatments EXCEPT- |
Answer: E |
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40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique: |
E |
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43. Drug to facilitate clip placement during cerebral aneurysm surgery; |
C |
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44. Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby? |
Probably A |
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45. A three year old girl for an elective hernia repair is seen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to: |
E |
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46. In accordance with their belief that blood transfusion is wrong, a Jehovah's Witness may consent to all of the following except: |
C |
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47. 80 year old lady with fractured NOF needing ORIF. On examination had a systolic murmur. Arranged TTE which showed a calcific aortic valve with peak velocity of 4 m/s. Using the simplified Bernoulli equation, what is the peak pressure gradient across the valve: |
D |
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48. You have developed a new cardiac output monitor called WaCCO. You want to compare the readings with the gold standard, a pulmonary artery catheter. What is the best statistical method to present the data/results: |
B |
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50. A 60 year old, triple vessel disease normal LV Post CABG hypotensivem ST elevation II, avF, CVP 15 PCWP 25. Normal SVR. Echo shows: |
B |
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51. Maximum amplitude from TEG or ROTEM decreased give |
C |
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52. Young male, previous IVDU, now on 100mg Methadone per day has a laparotomy with an effective epidural. Amount of IV Morphine needed per HOUR: |
E |
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53. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is |
D |
|
54. Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to |
C |
|
57. Ibuprofen dose for one year old child tds regular post-op dose |
B |
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58. AICD, what does a magnet do |
?D |
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60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AED. On admission to hospital his ECG was as below; |
B |
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61. A 58yo with solitary hepatic metastasis from colon cancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain: |
C |
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63. A man is admitted to ICU with a Sodium of 105 mmol/L. What is the maximum his sodium should be raised in the next 24 hours |
Answer: B |
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64. What is the distance from lips to carina in a 70 Kg man? |
D
There are other answers going around that reference an Indian paper. These are wrong - the Indian paper was done to demonstrate the difference between the caucasian values given in Miller, and the general Indian population. |
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65. The action of which laryngeal laryngeal muscle opens the cords? |
B |
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66. Induction of a 4yr old child with Arthrogrophysis multiplex congenita, however you find it difficult to place the laryngoscope. What is the concern? (paraphrased question here, can’t remember all possible answers) |
E |
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70. A patient is suffering from aortic dissection with acute aortic regurgitation. BP 160/90, HR 100 & evidence of acute pulmonary oedema. What is your immediate management? |
D |
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71. Presented are a femoral arterial line trace & a central venous line (JVP) trace - looked like it was demonstrating elevated right atrial pressures... What is demonstrated by these pressure waveforms? |
Who knows, but probably tricuscpid regurg? |
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72. The MELD score is calculated using INR, Bilirubin & what? |
A |
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73. In resuscitating a newborn infant after delivery, the time at which you would like to achieve arterial oxygen saturation of 85-90%: |
E |
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74. (repeat): You inserted a central venous line and peripheral arterial line for a patient who is having a tumour removed via craniotomy. The transducers of both the lines were placed at the level of the right atrium 13cm below the level of the external auditory canal. MAP is 80mmHg, CVP 5mmHg. What is the CPP? |
B |
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75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80. |
C
Peck & Hill p183 |
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76. You are putting in a internal jugular central venous line. Which maneuvre causes maximal distension of the internal jugular vein? |
E
Valsalva - probably gives maximal distention |
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82. A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is: |
Answer: D
CEACCP: Adequate pre-operative care aims to limit the severity of these episodes but vasodilators must be prepared and close at hand. Such agents include boluses of phentolamine 1–5 mg and labetalol 5–10 mg or sodium nitroprus- side, GTN and nicardipine infusions. Sodium nitroprusside has a rapid onset and offset of action; it is not associated with toxicity when used in recommended doses. Nicardipine is a calcium chan- nel blocker which has been used as an infusion for fast titration of blood pressure. The use of isoflurane as an antihypertensive agent is a practical alternative. Magnesium sulphate infusions have recently been described (inhibits catecholamine release, exerts a direct vasodilator effect and reduces α-receptor sensitivity). |
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83. Best option to reduce risk of Ventilator induced pneumonia? |
A - 30 degrees head up B - Avoiding intubation, limiting time C - Yes D - Increasing pH increases bacteria in GIT theoretically: ?increases pneumonia E - Leave connected |
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85. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods takes. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality 85 The most likely diagnosis is A. Central diabetes insipidus B. Nephrogenic diabetes insipidus C. Psychogenic polydipsia D. Cerebral salt wasting E. SIADH |
C
Hyponatraemic |
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91. The American Heart Association (AHA) guidelines for preoperative cardiac risk assessment define a poor functional capacity as only able to exercise at a level of less than 4 metabolic equivalents (METs). Exercise capacity of 4 METs corresponds to |
A |
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92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT |
C
Miller table
A - Up B - Up C - Correct - decreases D - Up E - Up |
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93. 7 year old with closed head injury. Intubated and ventilated in ICU. Serum sodium 142. Most appropriate maintenance fluid is: |
C
(Because head injury -> want isotonic solution) |
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94. Patient with Marfan's syndrome. Thoracoabdominal aortic aneurysm repair. 24 hours later in ICU noted to be blood in CSF drain and patient obtunded. Most appropriate urgent management: |
A |
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99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury: |
C |
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100. (new) Afterload reduction is most useful in which of the following: A. aortic stenosis |
AS - worse Tetralogy of fallot - reduced afterload increases R => L shunt AR + MR - benefit Tamponade - benefit |
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101. A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management? |
D |
|
102. Preferred method for treating raised INR |
E
Prothrombinex + vit K for all Add FFP if life-threatening severe bleeding |
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103. Regarding PS31, Level II check includes: |
Service Label High pressure system - O2 cylinder, pipeline supply Low pressure system - rotatmeters, vaporizers Leak Test CO2 absorbtion Ventilator Scavenging Emergency ventilation
Level three: Changed circuit Changed vaporizer IV anaesthetic devices Intubation / LMA gear Suction Gas analysis Monitoring and alarms Humidifiers Filters
|
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107.(New) A 50 yo man with a Deep Brain Stimulator (DBS) secondary to Parkinson's disease is scheduled for elective surgery. What is the best management regarding this device? |
D |
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108. (New) Fit and well G1P0 post epidural complaining of loss of sensation over posterior leg, lateral thigh and foot with weak flexion of knee. Which best explains the findings? (Not remembered quite correctly.) |
D |
|
41. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except |
Answer: A |
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110. (New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management? |
C |
|
111. A patient is coming for an operation on his upper limb. 5mls of 0.75% ropivacaine is placed around the structure seen below. What is the most likely consequence of this?
Picture was of probe on posterior upper arm |
??radial nerve block
B |
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112. A 40 year old man suffered a traumatic brain injury 2 days ago. He does not meet the criteria to be certified brain dead. What investigation will be most useful to assess cerbral function prior to organ donation. |
A |
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113. Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vapouriser, at a constant fresh gas flow and vapour dial setting, the vapour produced will be: |
D |
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114. What is most likely to occur if the earth/grounding plate that is attached to a patient for use with monopolar diathermy malfunctions? |
C |
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115. A 24yo primigravida, 25/40 gestation, BP 150/90 on 4 occasions. No signs of pre-eclampsia. Which antihypertensive is inappropriate? |
C |
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116. Post-spinal surgery, patient notices paraesthesia of R arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from ulnar nerve neuropathy? |
D |
|
119. According to PS09, the minimum requirement for administering propofol for conscious sedation is |
A |
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122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?) |
C |
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125. Adenosine can be used to treat |
D |
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126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step |
Answer: A
OHA:
Switch to MH safe anaesthetic Wait 15 mins and monitor for increasing heart rate / CO2 |
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127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by |
C
Royal college of anaesthetists and opthalmologists consensus document |
|
128. A patient is in Class IV Haemorrhagic Shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to: |
E
Causes of coagulopathy: Tissue injury / hypoperfusion Consumption of clotting factors Acidosis Hypothermia Dilution of clotting factors Hyperfibrinolysis |
|
129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is: |
C
4 * 20 * 15 = 1200 mL So 600mL first 8 hours, 600mL next 16 So 300mL/h for next 2 hours, then 600/16.
40+20 = 60mL/h maintenance.
4ml/kg * BSA burns over 24/hours, with 1/2 in the first 8 hours and the rest over the next 16, plus maintenance. |
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130. You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is |
B |
|
131. The normal physiological response following ECT is |
B
From CEACCP: |
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132 (repeat) ->also recalled as Q148 so one must be a mistake –see below Aspirin Overdose. What will enhance her elimination most effectively? |
B
From Oh's |
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133. A 50 year old male is having an aortic valve replacement for aortic stenosis. He is stable on bypass initially but after the first dose of cardioplegia his MAP falls to 25mmHg, CVP 1 and his mixed venous oxygen saturation is 80%. What is the best management in this situation. |
D
Can't find reference, but this seems right? |
|
134. An eighty year old man presents to the emergency department with two hours of severe abdominal pain. On examination he has a tender pulsatile 8cm mass. His GCS is 12, heart rate 104, blood pressure 80/49, Temp 35 degrees, SpO2 92%, respiratory rate is 30/min. What is the next appropriate step. |
B
Likely leaking AAA Needs emergency laparotomy PPV may worsen venous return and BP Increasing BP may result in more bleeding Ideally do as little as possible until in OT
|
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137. A PiCCO monitor may be used to measure cardiac output through use of: |
C
Swan-Ganz pulmonary artery catheter (PAC) - gold standard, but also most invasive. Uses thermodilution |
|
138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone. |
B
MIMS: "The naloxone component in a fixed combination with oxycodone is indicated for the therapy and/or prophylaxis of opiod induced constipation." |
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141. Immunity to Hepatitis B is demonstrated by the presence of |
C
http://www.cdc.gov/hepatitis/hbv/pdfs/serologicchartv8.pdf |
|
142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is |
E |
|
143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with: |
Answer: C |
|
144. SG67 20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours. |
E
4 * 80 * 30 = 9600 over 24 hours. 4.8L CSL in first 8 hours. |
|
145 The thoracic paravertebral space is continuous down to |
B |
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146. To best visualise a superficial peripheral nerve you should use a |
B
USRA http://www.usra.ca/transducer.php
For superficial structures (e.g. nerves in the interscalene, supraclavicular and axillary regions), it is ideal to use high frequency transducers greater than or equal to 7 MHz. Transducers in the range of 10-15 MHz are preferred but depth of penetration is often limited to 2-3 cm below the skin surface. |
|
149 You have administered a regional anaesthetic to a primiparous woman for an emergency caesarean section. Soon after delivery of the baby, the woman complains of chest pain and dyspnoea, then loses consciousness. What is the most likely cause of her loss of consciousness? |
C
There are a few papers that mention AFE occuring within 30 minutes of delivery. |
|
150. The faster rate to desaturation observed in morbidly obese patients is due to: |
B |
|
[Nonum 1] In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would- |
A
CEACCP management of tracheostomy:
If the tube is cuffed, the fenestration lies above the cuff. Deflation of the cuff during spontaneous respiration (with the fenestrated inner tube in place) allows air to pass caudally through the tracheostomy lumen and fenestration, as well as around the tracheostomy tube, and up through the larynx. This encourages maximal airflow through the upper airways during speech. A one-way speaking valve can also be used with the tracheostomy tube to maximize speech. This allows air to be entrained through the tube during inspiration. The valve then closes during expiration such that exhaled air must pass through the natural airway and vocal cords to exit the lungs, thus aiding phonation. |
|
[Nonum 2] Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common? |
B
CEACCP http://ceaccp.oxfordjournals.org/content/6/6/235.full.pdf+html
Anterior 80% Vertical 10-20% Posterior 5% Lateral no number, presumably rare |
|
[Nonum 3] A 13kg child booked for elective procedure. Has had 100mL of clear fluid 2 hours ago. Management? |
D
PS15 |
|
[Nonum 4] Radical prostatectomy. Long operation and constant ooze. Surgeon asks if patient on 'aspirin'. You do a TEG. Shown TEG- fibrinolysis but also long r time. What treatment? |
Check TEG pictures
if long r time = give FFP, if hyperfibrinolysis = give TXA |
|
[Nonum 5] Which is least likely to fraudulent research reduction strategy? |
???A |
|
[Nonum 6] With respect to the triangle of safety and intercostal chest drain (ICC) insertion, if pectoralis major and the 4th - 5th intercostal space form two borders what forms the other? |
A
http://thorax.bmj.com/content/58/suppl_2/ii53.full
Insertion should be in the “safe triangle” illustrated in fig 3⇓. This is the triangle bordered by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, a line superior to the horizontal level of the nipple, and an apex below the axilla. |
|
[Nonum 7] Small picture trying to show USS probe on inferio-posterior R arm of a teenager's arm with an associated USS image of a very triangular looking peripheral nerve between two muscle fascia (radial N). |
D |
|
[Nonum 8] USS picture of an axillary brachial plexus nerve block with all four nerve unlabelled, the humerus, brachioradialis and biceps brachii marked. |
Review images |
|
[Nonum 9] Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be? |
C
Pulmonary Hypertension is defined as a mean pulmonary artery pressure (PAP) >25mmHg at rest with a pulmonary capillary wedge pressure <12mmHg. Pulmonary hypertension is considered moderately severe when mean PAP >35mmHg. Right ventricular failure is unusual unless mean PAP is >50mmHg. Raised pulmonary vascular resistance (PVR) places an additional pressure load on the right ventricle. The right heart is poorly designed to deal with these increases in afterload. A rise in PVR and hence right ventricular afterload can put the right heart into failure. Left ventricular failure can then ensue, due to both reduced volume reaching the left heart, and septal interdependence. |
|
[Nonum 10] Paediatric intubation of 20kg, 5.5 doesnt fit, 4.5 doesn't fit, what next? |
?A
Pedisafe estimates 5mm tube should fit
ETT size (age/4)+4 Weight = (age+4) x 2 |
|
[Nonum 11] Trauma patient undergoes delayed ORIF tibia. Nerve block given. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium also given (long stem to confuse us). Suddenly bradycardic, ETCO2 45, MAP 50mmHg. This is most likely to be? |
E
(Bradycardia not likely with other causes) |