Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
115 Cards in this Set
- Front
- Back
|
1.You are called to see a 30 year old man with rapidly deteriorating asthma. Following appropriate medical management an endotracheal tube is inserted and he is ventilated with a mechanical ventilator with a tidal volume of 600ml and a rate of 12 breaths per minute. Five minutes later the blood pressure is unrecordable and external cardiac massage is commenced. Arterial blood is taken and shows ph 7.08, pCO2 96 mmHg, pO2 36 mmHg, SpO2 46% and bicarbonate 27mmol/L. He is administered adrenaline, salbutamol, pancuronium, bicarbonate andcalcium gluconate. The ECG shows sinus rhythm at a rate of 60 beats per minute.The patient remains pulseless and cyanosed with fixed dilated pupils anddistended neck veins. The most appropriate management is to A. cease resuscitation B. administer further adrenaline C. insert bilateral intercostal drains D. cease ventilation for 30 seconds and resume at a slower rate E. increase peak inspiratory pressure |
D. cease ventilation for 30 seconds and resume at a slower rate |
|
|
2.A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizure and losing consciousness. Which drug should NOT be given A. Pethidine B. Diazepam C. Haematin D. Suxamethonium E. Pregabalin |
?? Maybe D. as don't need to give in this situation? A. Pethidine, morphine, fentanyl all considered safe) B. Diazepam - treat convulsions with diazepam, propofol, or Mg C. Haematin is used to treat porphyrias D. safe (vec safe, atrac is controversial) E. ? Porphyria:inherited disorders of haem biosynthesis with the potential for acuteneurovisceral crises. Dx: urine PBG Crisis S+S: abdopain, CV signs (inc HR, inc BP), weakness, psych features (confusion,psychosis), pain and sensory disturbance, seizures, cutaneous lesions, dec Na, dec Mg. General triggers:fasting, dehydration, infection, drugs, stress, smoking, alcohol Anaesthetictriggers: - induction:thio, ketamine - maintenance:sevo - analgesics:oxycodone, diclofenac - antibiotics:erythromycin, rifampicin - CVdrugs: ephedrine Rx: IV Haemarginate http://ceaccp.oxfordjournals.org/content/early/2012/02/27/bjaceaccp.mks009.full.pdf+htmlhttp://ceaccp.oxfordjournals.org/content/early/2012/02/27/bjaceaccp.mks009.full.pdf+html Also OHA p210 |
|
|
A 42 year old lady presents for right pneumonectomy with a left side ddouble-lumen tube. She is 132kg and 160cm. What depth, measured at the incisors, is likely to give the ideal position? A. 24cm B. 26cm C. 28cm D. 30cm E. 32cm |
C. 28cm "The average depth of insertion for both male and female patients 170 cm tall was 29 cm, and for each 10cm increase or decrease in height, average placement depth was increased or decreased 1 cm." |
|
|
4. What is the most effective method of minimising acute kidney injury following an elective open abdominal aortic aneurysm repair? A. give IV crystalloidas a ‘preload’ before cross-clamp B. give IV mannitol before cross-clamp C. give IV frusemide before cross-clamp D. give preoperative N-acetylcysteine E. minimize aortic cross-clamp time |
E. Minimise aortic cross-clamp time CEACCP 2013: Anaesthesia for elective AAArepair |
|
|
5. Features of severe pre-eclampsia include: A. Foetal growth retardation B. Peripheral oedema C. Systolic BP >160 D. Thrombocytopenia E. Severe proteinuria |
? Maybe question is which is not a feature? Then answer is B. Peripheral oedema. Otherwise most accurate is C. systolic BP >160 OHA p782 Pre-eclampsia =HT >140/>90mmHg after 20 weeks gestation with renal involvement causing proteinuria Severe = pre-eclampsia + one of following: BP>160/110, proteinuria>5g/24h or 3+ dipstick, UO<400ml/24h, pulmonary oedema or resp compromise, epigastric or RUQ pain, hepatic rupture, plt <100, cerebral complications |
|
|
6. Earliest sign of a high block in a neonate post awake caudal: A. Increased HR B. Increased BP C. Reduced HR D. Desaturation E. Loss of consciousness |
D. Desaturation OHA p831: caudal block cx include motor block, paraesthesia, hypotension,urinary retention,inadvertent dural puncture, IV injectionhttp://www.pitt.edu/~regional/Caudal/caudal_block.htm: intrathecal injection presents with resp distress in neonatehttp://ceaccp.oxfordjournals.org/content/6/2/63.full: extremely safe! |
|
|
7.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? A. Awake Fibreoptic Intubation B. CT scan for laryngeal fractures C. Direct laryngoscopy after topicalising with local anaesthetic D. Nasopharyngoscopy by an ENT surgeon E. Soft tissue xray ofthe neck |
D. Nasopharyngoscopy by an ENT surgeon Stable airway: CXR, C-spine X-Ray then flexible nasopharyngoscopy Unstable (dyspnoea, unable to lie supine, subcut emphysema): tracheostomy under GA or rigid bronchoscopy under GA or oral intubation if neither option available. http://www.anzca.edu.au/resources/college-publications/pdfs/books-and-publications/Australasian%20Anaesthesia/australasian-anaesthesia-2005/05_Peady.pdf
Flow chart for 'suspected laryngotrachael injury' considers an unstable airway to include 'dyspnoea, inability to lie supine, or subcutaneous empysema' (none of which are described in this question). So we go down the 'stable airway' route; first on the list is 'c-spine X-ray and CXR' (not a soft tissue X-ray as such - answer E...), next is a flexible nasal laryngoscopy (possibly D..?). If the above investigations are inconclusive - only then do a CT neck. If an unstable airway (as above) - either tracheostomy under LA or rigid bronchoscopy under GA. |
|
|
8. A 60 year old man with normal LV function is having coronary artery bypass grafting. After separation from the bypass machine he becomes hypotensive with ST elevation in leads II and aVF. The Swan Ganz Catheter showed a PCWP of 25 and CVP of 15 with normal PVR and SVR. The TOE is likely to show: A. Early mitral inflow> inflow during atrial systole B. Inferior wall hypokinesis C. Severe MR D. TR and RV dilatation E. LV cavity obliteration at the end of systole |
B. Inferior wall hypokinesis |
|
|
11. You are working in a theatre with a line isolation monitor, which is working. You touch a wire. What is going to happen? A. equipotent earth B. the theatre floor won't conduct C. ? D. ? E. the RCD will protect you from shock |
E. Nothing will happen as you need 2 faults. LIM is a "monitor" for floating circuits, which checks they are still floating. If the LIM has not detected a leak, then no current will flow with earth-patient wire connections http://www.howequipmentworks.com/physics/electricity/elec_safety/electrical_safety.html
AICM 7 No 11 I think this a repeat question no 32 fromAugust 200932. (NEW) In body protected OR with aLine Isolation Monitor reading 0 mA. If you touch one active wire what will happen. a. nothing, because no connection to earth is completed b. you get shocked c. nothing because the floor is insulated d. nothing because your shoes are nonconductive e. RCD trips Answer is A.0mA means everything is fine and properly isolated so the circuit is not earth referenced. |
|
|
12.Which test is decreased in iron deficiency anaemia? A. microcytosis B. serum ferritin C. serum iron D. transferin E. total iron binding capacity |
B. serum ferritin CEACCP: Preoperative Anaemia 2013: The most common cause of microcytic anaemia is iron deficiency, a diagnosis confirmed by low ferritin level and low saturation of transferrin |
|
|
13. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from A. 16000kpa to 400kpa B. 16000kpa to 240kpa C. 11000kpa to 400kpa D. 11000kpa to 240kpa E. 7600kpa to 240kpa |
A. 16000kpa to 400kpa http://www.boc.com.au/webapp/wcs/stores/servlet/en/au-boc-industrial-store/oxygen-indust-c-size-020c |
|
|
14. MRI Telsa 3, least likely to cause harm A. Cochlear implant B. mechanical heart valve C. Implanted intrathecal pump D. Recently placed aortic stent E. shrapnel fragment |
B. mechanical heart valve (if not new ie epithelialised) Cochlear blurs image, cochlear malfunctions IT pump and recent aortic stent are relative contraindications shrapnel is absolute contra. MRIsafety.com http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2033018
|
|
|
15. What happens when you place a magnet over a biventricular internal cardiac defibrillator A. Switch to asynchronous pacing B. Damage the internal programming C. Nothing D. Switch off anti tachycardia function E. Switch of rate responsiveness |
D. Switch off anti tachycardia function http://www.medscape.com/viewarticle/749751_6
|
|
|
16. You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves: A. facial, trigeminal,glossopharyngeal B. facial, trigeminal,vagus C. glossopharyngeal, trigeminal, vagus D. trigeminal, glossopharyngeal, vagus E. trigeminal, vagus,glossopharyngeal |
D.trigeminal,glossopharyngeal, vagus Facial: ant 2/3tongue taste Trigeminal:ophthalmic V1, maxillary V2, mandibular V3 Glossopharyngeal:tonsils, pharynx, middle ear, post 1/3 tongue Vagus: pharynxand back of tongue 2o gag reflex |
|
|
19 Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I. A. anterior ischaemia B. atrial C. inferior D. lateral E. septal |
A. anterior ischaemia Cs5 has RA at RA,LA at V5, LL at hip (ground) http://medind.nic.in/iad/t02/i4/iadt02i4p251.pdf |
|
|
20. Lowest extension of thoracic paravertebral space A. T10 B. T12 C. L2 D. L4 E. S1 |
B. T12 CEACCP Paravertebral block 2010 "The thoracic paravertebral space begins at T1 and extends caudally to terminate at T12. Although PVBs can be performed in the cervical and lumbar regions, there is no direct communication between adjacent levels in these areas." http://ceaccp.oxfordjournals.org/content/10/5/133.full.pdf+html |
|
|
21. 20 yr old male presents to ED with 30% burns from a fire. His approx weight is 80kg. Based on the Parkland formula, how much fluid is required in the first 8hr from time of injury? A. 2.4L N/S B. 3.6L N/S C. 3.6L Hartmann's D. 4.8L N/S E. 4.8L CSL |
E. 4.8L CSL 30 x 80 x 4 = 9600L Half in 1st 8h |
|
|
22 In regards to systemic sclerosis, what is the least likely cardiac manifestation? A. accelerated coronary artery disease B. atrioventricular conduction block C. myocarditis D. pericardial effusion E. valvular regurgitation |
E. valvular regurgitation Scleroderma =impaired microcirculation and myocardial function Cardiac complications of systemic sclerosis, Rheumatology (2009) 48 (suppl 3): iii45-iii48 SSc can affect all structures of the heart,and may result in pericardial effusion, arrhythmias, conduction system defects, valvular impairment (in rare cases), myocardial ischaemia, myocardial hypertrophy and heart failure |
|
|
23. The reason that desflurane requires a heated vapour chamber can be best explained by its: A. Low saturated vapour pressure B. High saturated vapour pressure C. High boiling point D. Low molecular weight E. Very low solubility |
B. High saturated vapour pressure High vapourpressure 3-4x others, low BP (22.8oC)https://www.aana.com/newsandjournal/Documents/tec_6_vaporizer_1294_p527.pdf |
|
|
24. A 30 year old lady has a vaginal forceps delivery without neuraxial blockade. The next day she is noted to have loss of sensation over the anteriolateral aspect of her left thigh. There are NO motor symptoms. The is best explained by damage to the left sided: A. Lumbosacral trunk B. Lateral cutaneous nerve of the thigh C. Pudendal nerve D. L2/3 Nerve root E. Sciatic nerve |
B. Lateral cutaneous nerve of the thigh CEACCP 2013: Postnatal neurological problems Lesions may be spinal, or at the level of the lumbosacral roots, lumbosacral trunk, or peripheral nerves. Approximately, one-third of nerve injuries are associated with motor deficit. Most commonly, the lateral femoral cutaneous nerve (no motor component, also known as meralgia paraesthetica), the femoral nerve, or both are affected as they pass the anterior superior iliac spine or inguinal ligament and the nerve is compressed with thigh flexion. Increased abdominal pressure (note fetal monitoring straps), prolonged hip flexion, diabetes, increased lumbar lordosis, and obesity are recognized as risk factors |
|
|
25. When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade A. 1 B. 2 C. 3a D. 3b E. 4 |
D. 3b 1 : most of the cords visible 2a : posterior cord visible 2b : only the arytenoids or the very posterior origin of the cords visible. Grade 2b denotes a laryngoscopic view that is relatively common and is often associated with difficulty passing a tracheal tube. 3a : epiglottis visible and liftable 3b : epiglottis adherent to pharynx 4 : nolaryngeal structures seen |
|
|
26. [AC108] A healthy 20 year old patient undergoing nasal surgery undergeneral anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrineand a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and theheart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to A. administer glyceryl trinitrate B. administer esmolol C. administer labetalol D. administer sodium nitroprusside E. deepen anaesthesia with isoflurane |
? unsure C. labaetalol as long lasting? (study group suggested B as unopposed beta blockade) |
|
|
27. An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is A. 400mL B. 500mL C. 600mL D. 700mL E. 800mL |
C. 600ml Estimated blood volume (EBV) = 30kg x 70ml/kg = 2100ml EBV = 70ml/kg for child and adult, 80ml/kg for infant, 90ml/kg for neonate Maximum acceptable blood loss (MABL) = EBV x (Hctf - HCTi) / Hcti = 2100 x 10/35 = 600ml
|
|
|
28.An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except: A. Aspirin B. heparin C. morphine D. nitrates E. oxygen |
B. Heparin |
|
|
29. What cannot be used for tocolysis in a 34/40 pregnant woman: A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine |
A. Clonidine
Indomethacin can be used to 34 weeks as per NSW policy but whether you would use it at this stage is another question. Clonidine is not a tocolytic
|
|
|
30. Pringles procedure for life threatening liver haemorrhage includes clamping of: A. Hepatic artery B. Hepatic vein C. Portal pedicle D. Aorta E. Splenic Artery |
A. Hepatic artery The Pringle's procedure/manoeuvre involves clamping the HEPATIC pedicle (hepatic artery and portal vein) to identify the source of bleeding (A>C as it's called the hepatic pedicle, not portal pedicle) "Blood loss is significantly reduced using temporary occlusion of the blood supply to the liver during parenchymal resection. This may involve total inflow occlusion of the portal vein and hepatic artery (Pringle manoeuvre). The resulting decrease in cardiac output of up to 10% and increase in left ventricular afterload of 20–30% may cause cardiovascular compromise." CEACCP 2009 Anaesthesia for Hepatic resection Surgery
|
|
|
31.Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to: A. Intraoperative bradycardia B. Decreased anaesthetic requirement C. Increased nausea and vomiting D. Increased risk of awareness E. Decreased BIS reliability |
A. Intraoperative bradycardia (if on high dose), or B. Decreased anaesthetic requirement (since smoked immed before) Inc analgesia requirements, pre-op tachycardia (inc SNS activity, inc PNS activity), possible intraop hypotension and bradycardia with high doses, potentiatesNMB. http://bja.oxfordjournals.org/content/83/4/637.full.pdf "cannabis may enhance the sedative-hypnotic effects of other CNS depressants" When administering anesthesia to cannabis users, one can expect dose-dependent cardiovas- cular changes. With low or moderate doses, there is an increase in sympathetic activity accompanied by a drop in parasympathetic activity, leading to tachycardia and increased cardiac output. With high doses, sympathetic activity is inhibited and parasympathetic activ- ity increases, followed by bradycardia, as well as hypotension.8 Hypotension secondary to the use of cannabis responds well to fluids. On ECG, reversible changes in P and T waves, as well as ST segment changes, have been described. Yet, it is not clear if these modifications in the ECG are due to the cannabis itself or rather to reflex tachycardia. Despite the presence of ectopic supraventricular and ventricular beats, no fatal arrhythmias have been documented.
|
|
|
32. MVA trauma patient arrives in ED BP100/60 HR 100 with the following CXR (‘’I thought it looked like an aortic dissection/rupture with a widened mediastinum’’). The most appropriate next investigation would be: A. Aortography B. CT Chest C. MRI D. TOE E. TTE |
B. CT chest (if not HD unstable) D. TOE (if HD unstable) CEACCP Dx and Mgt of Aortic dissection. http://ceaccp.oxfordjournals.org/content/9/1/14.full.pdf+html ECG, Imaging: (not appropriate for unstable patient) aortography(gold std), CT, MRI Echo: TTE only good for some sections, TOE useful preop in unstable patient |
|
|
33. A 70 year old man with slow atrial fibrillation is reviewed for insertion of a permanent pacemaker. He is otherwise well. He is on warfarin with an INR of 2.2. Prior to PPM insertion do you A. Cease warfarin and commence dabigatran B. Cease warfarin and commence Enoxaparin C. Cease warfarin and recommence post procedure D. cease warfarin and commence heparin E. Continue warfarin |
C. Cease warfarin and recommence post procedure CHADS2 score is 1. Low risk. (Need bridging if score 3+) But does warfarin need to be stopped for PPM insertion? |
|
|
34. A 40 year old man with Marfan's has undergone a thoracoabdominal aneurysm repair. 48 hours post procedure there is blood noted in his CSF drain and he is obtunded. Your next course of action is: A. Coagulation studies B. CSF microscopy andculture C. CT Head D. MRI Head E. MRI Spine |
C. CT head ? intracranial haemorrhage. CT is sensitive early. J Vasc Surg. 2009 Jan;49(1):29-34; Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. Major complication after lumbar CSF drainage is subdural haematoma caused by excessive traction leading to tearing of dural veins. Mortality occurs due to intracranial haemorrhage and requires urgent neurosurgical intervention. Mortality 0.6%.
|
|
|
36.You are anaesthetising a fit 50 year old woman for an elective laparoscopic cholecystectomy. In her pre operative assessment she has a normal cardiovascular exam and her BP is 115/75. You induce anaesthesia with 100mcg fentanyl, 100mg propofol and 50 mg rocuronium. Soon after induction her ECG looks like this (showed narrow complex tachycardia around 180-200/min – ie SVT). Her BP is now 95/50. What is the most appropriate management? A. adenosine B. amiodarone C. DC cardioversion D. GTN E. metaraminol |
A. adenosine |
|
|
37.The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the A. isolation transformer B. line isolation monitor C. equipment has a maximum leakage current of 500 micro amperes D. residual current device E. equipotentiality |
E. Equipotentiality http://www.rch.org.au/bme_rch/electrical_safety/#body Equipotential earthing is installed in rooms classified as 'Cardiac Protected' electrical areas. Equipotential earthing in treatment areas used for cardiac procedures is intended to minimise any voltage differences between earthed parts of equipment and any other exposed metal in the room. |
|
|
38. After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is A. normal saline infusion B. bicarbonate infusion C. mannitol D. frusemide E. haemodialysis |
E. Haemodialysis Most EFFICIENT. Bicarbonate infusion is 1st line however. Steps - ABC - Decontamination - activated charcoal- w/in 6h ingestion - Elimination- Urinary alkalinisation w/ IV NaHCO3 (may require KCl supplementation)- Haemodialysis considered for clinical deterioration or ARF despite maximal therapy S+S: N+V,tinnitus, áRR, metabolic acidosis, coma, seizures,death (>500mg/kg)
|
|
|
39. Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture A. L1-L2 B. L2-L3 C. L3-L4 D. L4-L5 E. L5-S1 |
C. L3-L4 Adults: L1-2 Neonates: L3 From anatomy for the anaesthetist:The relations of the cord to the vertebral column differ greatly in foetal, infant and adult life (Fig. 98). Up to the third fetal month, the cord extends the length of the vertebral canal. The vertebrae then grow considerably faster than the cord, so that the cord terminates in the newborn at the lower border of the 3rd lumbar vertebra and, in the adult, on average, at the disc between the 1st and 2nd lumbar vertebral bodies. However, there is considerable variation in this level (Fig. 99); frequently the cord ends opposite the body of L1 or 2, or, rarely T12 or even L3.
|
|
|
40. 6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is A. 2 hours for breast milk B. 4 hours for formula C. 5 hours for breast milk or formula D. 6 hours for solids E. 8 hours for solids, F. 4 hours for all fluids. |
B. 4 hours for formula
PS15 <6/52: breastmilk and formula up to 4 hours prior and clear fluids 2hours prior
>6/52 6 hours for formula and food, 4 hours for breast milk, 2 hours for clear fluids |
|
|
41. For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is; A. Number of boluses of PCA per hour B. Respiratory rate C. Oxygen saturation D. Sedation score E. Pupil size |
D. Sedation score |
|
|
42. A reduction in DLCO can be caused by; A. Asthma B. COPD C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis |
B. COPD |
|
|
43. You place a thoracic epidural for a patient having an elective open AAA repair. There are 4cm in the epidural space and you aspirate blood. What is the most appropriate management plan: A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use B. inject 5 mL lignocaine 2% with adrenaline. If there is no rise in HR be happy that it is not intravascular and secure in place and use C. Remove and postpone surgery for 24 hours D. Remove and place epidural 1 level higher E. Remove and postpone surgery for 4 hours |
C. Remove and postpone surgery for 24 hours (conservative answer) In reality, I would A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use |
|
|
44. 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: A. rocuronium B. suxamethonium C. pancuronium D. atracurium E. cisatracurium |
E. cisatracurium |
|
|
45. Patient with subdural haematoma, on warfarin. INR 4.5. Needs urgent craniotomy. Vit K given already by ED resident. What further do you give for urgent reversal of this patient's INR? A. Factor VII B. Cryoprecipitate C. FFP D. Prothrombinex E. FFP + prothrombinex |
E. FFP + prothrombinex |
|
|
46. Regarding endotracheal tubes used in laser surgery: A. They are more resistant to combustion when the cuff is covered in blood B. Resistant to ignition from electrocautery C. The cuff is resistant to ignition if hit by the laser D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diameter) E. Have 2 cuffs which are resistant to combustion |
D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diameter) Eg. Coviden Laser 6mmID is 8.5mmOD whereas Portex PVC 6mmID is 8.2mm |
|
|
49. Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion A. ? B. C. D. E. Relieved by topical local anaesthetic |
E. Relieved by topical local anaesthetic Acuteangle-closure glaucoma: severely painful, haloes around point light sources,photophobia, watering, systemically unwell. Fixed pupil, oedema. âVACorneal abrasion:pain varies, photophobia, watering. Pupil normal, oedema, fluoroscein staining. |
|
|
50. During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate A. Carbimazole B. Beta-blocker C. Propythiouracil D. Plasmaphoresis E. Hydrocortisone |
D. Plasmaphoresis PTU orcarbimazole (may be given PR) stop hormone synthesis. Lugol’s solution blocks hormone release. b-blockerscontrol tachycardia. Can consider adding dexamethasone. Others for severe refractory thyroid storm: stable iodide, lithium, glucocorticoids, cholestyramine |
|
|
53 . Two days post upper spinal surgery, patient notices paraesthesia of the right arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from an ulnar nerve neuropathy? A. parasthesia in little finger B. parasthesia in the distribution of the interscalene nerve C. weakness in adductor digiti minimi D. weakness in abductor pollicis brevis E. weakness in lateral interosseus |
D. weakness in abductor pollicis brevis LOAbF muscles innervated by the median nerve in the hand via C8-T1 (lateral lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis) |
|
|
54 A 54 year old man, is on warfarin for atrial fibrillation, has a history of alcohol abuse and liver failure with an albumin of 30 and a bilirubin of 28. What is his CHADS 2 score? A. 0 B. 1 C. 2 D. 3 E. 4 |
A. 0 CHF HT Age >65 DM Stroke/TIA x2 CHA2DS2VASc CHF HT Age>=65 DM Stroke/TIA/TE (2) Vascular disease Age>=75 Sex female |
|
|
57. You are 2 hours into an operation. 3L of IV Crystalloid has been given. There has been minimal blood loss. The dilutional anaemia is compensated by: A. Cellular anaerobic metabolism B: Capillary vasodilation C: Increased cardiac output D: Increased tissue oxygen extraction E: Rightwards shift of the Oxygen – Haemoglobin dissociation curve |
C: Increased cardiac output |
|
|
58 You are putting in an Internal Jugular CVC. Which manoeuvre will cause maximum venous distension of the jugular vein? A. Continuous Positive Airway Pressure (No value given) B: Breath hold atend-expiration C: Manual compression atthe base of the neck D: Trendelenburg position E: Patient performs a valsalva |
D. Trendelenberg position (Valsalva will in 1st phase as long as it is held) A. 10cmH20 PEEP = 7mmHg. Constant, controllable. B. End-expiratory pressure will be -4 in spontaneously ventilating patients, and likely equal to PEEP in positive pressure ventilation. CVP is quoted as being 0-5 in spent venting and up to 10mmHg in PPV by Oh's. C. Not practical to occlude the internal jugular with manual compression during central line insertion D. Roughly 5.5 cm from sternal angle to right atrium. Say another 5cm to insertion point. Therefore 10cmH2O difference if upside down (=7mmHg). HOWEVER, I think the column of blood actually runs from the feet to the jugular, and is therefore longer than this calculation would imply. E. This will produce a large increase in pressure while it is held. |
|
|
59. What is approximately the systolic blood pressure in an awake neonate (mmHg) A. 55 B. 70 C. 85 D. 100 E. 115 |
B. 70 OHA p802 SBP 50-90http://www.health.vic.gov.au/neonatalhandbook/procedures/blood-pressure.htm SBP 70-80 |
|
|
60. The volatile agent most likely to be associated with carbon monoxide production when used with a soda lime scrubber is: A. Desflurane B. Isoflurane C. Sevoflurane D. Halothane E. Enflurane
|
A. Desflurane http://www.ncbi.nlm.nih.gov/pubmed/15932634: Dex > En > Iso(sevo and halo shouldproduce none)
|
|
|
6. A 40yo female with primary pulmonary hypertension is to have a laparoscopic cholecystectomy. Her preoperative pulmonary artery pressure is 80/60mmHg. During the procedure she suddenly desaturates to 87%, BP 80/40mmHg, and ETCO2 45mmHg. Likely findings on TOE will include: A: Increased LV wall thickness, abnormal septal wall motion, TR, RA dilation B: Increased RV:LV area, abnormal septal wall motion, increased LV wall thickness, RA dilation C: Increased RV:LV area, abnormal septal wall motion, TR, RA dilation D: Increased RV:LV area, abnormal septal wall motion, TR, PR E: Increased RV:LV area, TR, PR, RA dilation |
C. Increased RV:LV area, abnormal septal wall motion, TR, RA dilation Desat--> inc PulmP --> RV and RA dilation, Right sided pressures increase,abnormal wall motion |
|
|
62. The principal resistance to airflow in an ETT is: A: density of the gas B: diameter of the tube C: length of the tube D: temperature of the gas E: viscosity of the gas |
B: diameter of the tube Proportional toradius ^4 and length |
|
|
65.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 theconventional before 1 extra patient will benefit is A. 3 B. 4 C. 8 D. 25 E. 33 |
D. 25 8% PONV now 12% PONVpreviously ARR of 4% NNT = 1/ARR = 1/ (1/25) = 25 |
|
|
66. According to guidelines endorsed by ANZCA, the label of an intra-osseous infusion should be A. beige B. blue C. Pink D. Red E. yellow |
C. Pink A. beige subcut B. blue venous C. Pink - any other D. Red arterial E. yellow neuraxial/regional |
|
|
69. Rise in CO2 per minute during apnoea A. 0.5 mmHg per min B. 1 mmHg per min C. 2 mmHg per min D. 3 mmHg per min E. 5 mmHg per min |
D. 3 mmHg per min |
|
|
70. In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and: A. Heart Rate B. Saturation C. Respiratory Rate D. Urine Output E. Temperature |
C. Respiratory Rate http://www.trauma.org/archive/scores/rts.html |
|
|
72. Absolute Contraindication to ECT A. Cochlear implants B. Epilepsy C. Pregnancy D. Raised intracranial pressure E. Myocardial infarction |
D. Raised intracranial pressure |
|
|
73. 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: A. Instigate low dose beta blockade B. Defer, and refer to acardiologist C. Perform a transoesophageal echo to get a better look at the valve D. Proceed to surgery with no further investigation E. Perform a dobutamine stress echo |
D. Proceed to surgery with no further investigation - HD goals for AS:full, forward (high N SVR) low N HR, maintain SR - LV-aorticgradient: mild <20mmHg, mod 20-50, severe >50 |
|
|
75. A 25 y.o. male has a traumatic brain injury on a construction site. GCS 7. Intubated on site and transported 1 hour to hospital. Haemodynamically stable and no other injuries. Most appropriate pre hospital fluid: A. 4% albumin B. Dextran 70 in 0.9% N/saline C. 6% hydroxyethylstarch D. Ringers lactate E. 0.9% N/saline |
E. 0.9% N/saline Avoid hypotonic solutions, and those containing dextrose. CEACCP Traumatic Brain Injury 2013 The SAFE Study 2007 Albumin Vs Saline in Traumatic Brain Injury (post-hoc analysis of original study): 42 vs 22% mortality at 2 years in severe brain injury GCS 3-8.
OHA p867. Couldargue for CSL but as slightly hypotonic, small árisk cerebral oedema |
|
|
76. A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP: A. Administer Anti-Dantibodies 6 hrs pre op B. Admister desmopressin one hour pre op C. Administer methylpred and IVIg 2 days pre op D. Recheck platelet count morning of surgery and if not dropped continue E. Platelet transfusion morning of surgery |
C. Administer methylpred and IVIg 2 days pre op OHA p220: need to raise plt count to >100; then says for ITP plts should be reserved for major haemorrhage therefore use steroids or high dose IVIg initially |
|
|
77. A neonate will desaturate faster than an adult at induction because A. FRC decreased more B. Faster onset of induction agents C. More difficult to pre-oxygenate D. E. |
A. FRC decreased more For a variety of reasons: 1. Decreased FRC with an increased closing capacity, resulting in airway closure during anaesthesia and a subsequent intrapulmonary shunt (managed with CPAP) 2. Increased metabolic O2 requirement (3-4x adult) |
|
|
78. Isoflurane is administered in a hyperbaric chamber at 3 atmospheres absolute pressure using a variable bypass vaporiser. At a given dial settingand constant fresh gas flow, vapour will be produced at: A. the indicated vapourconcentration B. three times theindicated vapour concentration C. one third the partialpressure obtained at 1 atmosphere D. the same partial pressure as is obtained at 1 atmosphere E. three times thepartial pressure obtained at 1 atmosphere |
D. The partial pressure is the SVP which is independent of ambient pressure. The vapour concentration will be 1/3 of that at sea level. https://www.openanesthesia.org/vaporizer_output_at_altitude/It will deliverthe same partial pressure, but the concentration will be lower. |
|
|
79. [AP CXR and lateral] – ‘’showed hydropneumothorax’’ This grossly abnormal CXR is A. right basalpneumothorax B. right hydropneumothorax C. artifact D. right pleural effusion E. right R lower lobeatelectases |
B. |
|
|
80. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods taken. 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. Psychogenic polydipsia Kidneys working to produce maximally dilute urine |
|
|
83 A 45 year old obese man complains of headache, lower limb weakness and polyuria. On examination, his blood pressure is 150/70mmHg. He has a displaced apex beat. Bloods revealed Na145, K2.8, Cl101, HCO3 27. What is the most likely diagnosis A. Cushings B. Diabetes C. Primary hyperaldosteronism D. Hypothyroidism E. Phaeochromocytoma |
C. Primary hyperaldosteronism (could argue for A) A. Causes obesity, proximal muscle weakness, hypokalemia, hypertension. (also thin, easily bruised skin, osteopenia, glucose intolerance, heart failure, coronary artery disease, CVA, AMI, thromboembolic events, agitation, anxiety, paranoia, infections, headache) B. Unlikely. C. Increased Na resorption and K excretion. Hypertension: headaches, facial flushing. Hypokalemia: muscle weakness, polyuria and polydipsia, constipation, dysrhythmias. Cardiomegaly. D. Does not cause obesity, marked HT, nor hypokalemia E. Causes hypertension, but not electrolyte disturbances etc |
|
|
84. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient A. Pretracheal tissue volume B. Mallampati score C. Thyromental distance D. BMI E. Severity of OSA |
A. Pretracheal tissue volume |
|
|
85. (repeat) You wish to compare a new method of BP measurement with the goldstandard. The best way to do this is: A. CUSUM analysis B. Friedman's test C. ? D. Pearson’s correlation E. Bland-Altman plot |
E. Bland-Altman plot
Bland-Altman is amethod of data plotting used in analysing the agreement between 2 differentassays. CUSUM (cumulativesum control chart): used for monitoring change detection Friedman test:non parametric version of ANOVA, detects differences in treatments acrossmultiple test attempts Pearson correlation: shows linear relationship between 2 sets of data;“can I draw a line to represent the data?”; results between -1 and 1 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0037908 |
|
|
86. After intubating for an elective case you connect up the circuit and notice that you are unable to ventilate and observe high airway pressures. The next most appropriate step is to: A. Auscultate the lungs B. Release the APL valve C. Remove the endotracheal tube and bag mask ventilate D. Turn on the ventilator E. Low positive endexpiratory pressure |
A. Auscultate the lungs |
|
|
87.You insert a thoracic epidural in a patient for a liver resection with an upper abdominal incision. You have recently topped it up. On waking the patient appears weak, despite adequate reversal. He can breathe spontaneously and can flex his biceps but is not able to extend triceps. The level of the block is most likely to be: A. C5 B. C6 C. C7 D. C8 E. T1 |
C. C7 C5/6 “pick upsticks”, C7/8 “lay them straight” Myotome distributions of the upper and lower extremity are: C1/C2-neck flexion/extension C3-neck lateral flexion C4-shoulder elevation C5-shoulder abduction C6-elbow flexion/wrist extension C7-elbow extension/wrist flexion C8-thumb extension T1-finger abduction L2-hip flexion L3-knee extension L4-ankle dorsi-flexion L5-great toe extension S1-ankle plantar-flexion S2-knee flexion |
|
|
88. You are anaesthetizing a pregnant woman for neuro-radiologicalcoiling. At what gestation is it important to monitor uteroplacentalsufficiency? A. 22 weeks B. 24 weeks C. 26 weeks D. 28 weeks E. 32 weeks |
B. 24 weeks http://www.frca.co.uk/Documents/185%20Anaesthesia%20in%20pregnancy%20for%20non-obstetric%20surgery.pdf “when foetus is of a viable age”CEACCPAnaesthesia for non-obstetric surgery during pregnancy |
|
|
89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is? A. Nimodipine B. Adenosine C. Mannitol D. Hypertonic Saline E. Thiopentone |
B. Adenosine For CV standstill |
|
|
90. Priorto seeking consent from family/relatives for DCD, it is important to confirmwhich of the following? A. Not a coroner's case B. Pt will have acardiac death within 90 minutes in the absence of life-support C. Potential organ recipient's identified and are available D. Patient's wishes have been considered E. Decision confirmed by an external committee |
B. Pt will have a cardiac death within 90 minutes in the absence of life-support, OR D. Patient's wishes have been considered , OR E. Decision by external committee 1.need medical suitability -includes fulfilling criteria 2. consider wishes of pt 3. formal consent Australian National Protocol DCD 2010 http://www.donatelife.gov.au/sites/default/files/files/DCD%20protocol%20020311-0e4e2c3d-2ef5-4dff-b7ef-af63d0bf6a8a-1.PDF A - coroner can give permission B – “will” – death within 90 minutes is not guaranteed Alternative answer: E. Decision confirmed by an external committee - DCD may only be considered after an independent decision has been taken to withdraw cardio-respiratory support- This is the FIRST thing that needs to be done, BEFORE medical suitability and consent.DCD may be an option when, in the judgment of the treating intensivist, the patient meets the following criteria:• no absolute contraindication to donation • the patient is likely to die within 90 minutes of withdrawal of cardio- respiratory support• the patient is not brain dead and is unlikely to progress to brain death. An early discussion with the Organ and Tissue Donation Agency (OTDA) should occur to seek advice on the medical suitability of a potential donor. - A systolic blood pressure (SBP)≤ 50mmHg is currently considered to bethe most useful determinant of onset of ‘warm ischaemic time’. |
|
|
91. You see a young man prior to surgery. He describes a history of throat swelling and difficulty breathing both spontaneously and in association with minor dental procedures. His brother has had similar episodes. The most likelymechanism is: A. C1-esterase deficiency B. Factor V deficiency C. Low bradykinin levels D. Mast cell degranulation E. Tryptase release |
A. C1-esterase deficiency C1 esterase deficiency causes decreased breakdown of bradykinin which causes angioedema. Treat with C1 INH or bradykinin antagonist http://www.rch.org.au/clinicalguide/guideline_index/C1_Esterase_Inhibitor_Deficiency/ B. Factor V deficiency: very rare bleeding disorder, recessive inheritance. Treated with FFP. Does not cause angioedema. C. Bradykinin levels can be high in ACE-I treatment related angioedema, or in C1-esterase inhibitor deficiency.ACE-I angioedema is treated with nebulised / SC adrenaline and airway interventions as required. D. This occurs in IgE and non-IgE mediated anaphylaxis. Treatment is with removal of trigger, fluids, adrenaline, steroids, bronchodilators and supportive measures. E. This also occurs in IgE mediated anaphylaxis. Testing as soon as practical, then at 4/24 and >24/24 to confirm cause. Honorable mention to idiopathic angioedema, 2nd most common cause, diagnosis of exclusion. Can rarely affect the airway. Treat with anti-histamines and steroids. |
|
|
92. A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers acardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemiais: A. Acute renal failure B. Cardiomyopathy C. Crush injury D. Malignant hyperthermia E. Rhabdomyolisis |
E. Rhabdomyolisis Duchenne muscular dystrophy (DMD) has anincidence of 1 in 3500 live male births.2 It is an X-linked recessive inherited disorder,with abnormal or absent dystrophin, and this results in chronic muscle fibrenecrosis, degeneration, and regeneration. Degeneration occurs in cardiac andsmooth muscle and also in skeletal muscle.Infants with DMD may appear normal atbirth; weakness begins in childhood generally before the age of 8, and israpidly progressive. The muscles around the pelvis and thighs are affectedfirst, the child presenting with difficulty managing stairs and standing fromsitting. By adolescence, patients are usually wheelchair-bound and succumb tocardiac or pulmonary manifestations of the disease in their late 20s to early30s.1 Heterozygous females, although not manifestingthe disease, have an increased cardiac risk later in life. |
|
|
95. You are anaesthetising a 6 month-old infant for repair of a VSD. You perform an inhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant’s oxygen saturations fall to 85%. The most appropriate next step in management: A. give a fluid bolus B. change fromsevoflurane to isoflurane C. apply CPAP D. reduce the FiO2 E. reduce sevoflurane |
E. reduce sevoflurane dec vasodilation to inc SVR and therefore reverse the shunt
|
|
|
96.A 30-year old patient, who takes paroxetine, has suffered a traumatic amputation. The most appropriate medication to reduce her developing chronic post-operative pain is: A. amitriptyline B. dextromethorphan C. gabapentin D. tramadol E. pethidine |
C. Gabapentin A. amitriptyline - care with TCA B.dextromethorphan “cough suppressant” C. gabapentin D. tramadol interacts with SSRI E. pethidine addictive, no use for chronic, interacts with SSRI |
|
|
97. A 3 year old child has suffered a fractured arm. What is the most appropriate way to assess her pain? A. the reported severity from the child B. the reported severity from the parent C. the reported severity from the nursing staff D. using the FLACC scale E. the Wong-Baker Faces scale |
E. the Wong-Baker Faces scale May be used from age 3-8. If inconsolable, FLACC scale may be more useful "Self-report isgold standard. Visual Analoguescale and Wong-Baker faces scale are self-report tools which are able to beused from 3+. FLACC painassessment is observational: facial expression, leg movement, activity, cry,consolability. 2m-7y http://www.frca.co.uk/Documents/289%20Paediatric%20Pain%20-%20Physiology,%20Assessment%20and%20Pharmacology.pdf (internet consensus is D?) |
|
|
98. Buprenorphine patch removed morning of surgery. What time till PLASMA reaches half original level A. 12 hours B. 18 hours C. 24 hours D. 30 hours E. 36 hours |
A. 12 hours From ANZCA pain blue book: After application of the patch, steady state is achieved by day 3; after removal of the patch, buprenorphine concentrations decrease by about 50% in 12 hours (range 10 to 24 hours) (MIMS, 2008). APMSE 3e p212
Acute pain management scientific evidence 2010 p163. |
|
|
101. The clinical sign that a lay person should use to decide whether to start CPR is: A. Absent central pulse B. Absent peripheral pulse C. Loss of consciousness D. Obvious airway obstruction E. Absence of breathing |
E. Absence of breathing “unconscious and not breathing normally”
|
|
|
102. Central sensitisation, resulting in prolongation of post-operative pain, is caused by: A. Increased intra-cellular gene expression B. Increasedintra-cellular magnesium C. Low frequencyactivation of A-delta fibres D. Primary activation of N-methyl-D-aspartate receptor E. Increased glycine asa major neurotransmitter |
A. Increased intra-cellular gene expression Sub P, NMDA, AMPA,glutamate, NK1https://juniorprof.wordpress.com/2008/07/07/what-is-central-sensitization/ |
|
|
103. A 15yo girl with a newly diagnosed mediastinal mass presents for lymph node biopsy under general anaesthesia. The most important investigation toperform preoperatively is. A. CXR B. CT chest C. MRI chest D. PET scan E. Transthoracicechocardiogram |
B. CT chest |
|
|
104.A 63yo woman with chronic AF has a history of hypertension, Type 2 Diabetes Mellitus and has previously had a CVA. What is her annual risk of stroke without anticoagulation? A. <1% B. 1.9% C. 2.8% D. 4% E. 8.5% |
E. 8.5% CHADS = 0+1+0+1+2 = 4
Use CHADS2 0 = 1.9% 1= 2.8 2= 4% 3=5.9% 4=8.5% 5=12.5% 6=18.5% |
|
|
105. A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and Pa02/Fi02 is less than 150. The next step to improve oxygenation is: A. increase PEEP to 20cmH20 B. increase tidal volume to 10mls/kg C. initiate nitrous oxide therapy D. commence high flow oscillatory ventilation E. ventilate in the prone position |
E. ventilate in the prone position Paralyse thenprone. Consider nitric oxide (probably inhaled prostacyclin is better) and ECMOand HFOV for refractory hypoxaemia. http://bestpractice.bmj.com/bestpractice/monograph/374/treatment/step-by-step.html OSCILLATE 2013 – worsened mortallity Prone – 28 and 90 day mortallity improvement |
|
|
106. The incidence and severity of vasospasm post sub arachnoid haemorrhage is greatest at: A. 0 -24 hours B. 2 - 4 days C. 6 - 8 days D. 10 - 12 days E. greater than 2 weeks |
C. 6-8 days CEACCP– 4 to 10 days |
|
|
107. The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipmentis turned on A. The double insulation of the device will prevent macroshock when the outer casing is touched B. The electrical fuse will immediately break and disconnect the device from the power supply C. Equipotential earthing will prevent microshock from anyone who touches it. D. The Line Isolation Monitor will alarm and disconnect power to the device E. The RCD will immediately disconnect the device from the power supply |
B. The electrical fuse will immediately break and disconnect the device from the power supply Class 1 has aprotective earth wire to conduct the fault to the ground. A: this refers to a class 2 device B: correct because the earthed equipment casing will provide a low resistance pathway for conduction resulting in high electrical current. This assumes that there isn't an isolation transformer in the circuit. There is also a fuse in the case. |
|
|
108. In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT: A. Allow equal time for chest compression and relaxation B. Chest compression at 100bpm C. Chest compression should be at least 5cm depth D. Give 2 rescue breath before commencement of CPR E. Chest compression to breaths ratio at 30:2 |
D. Give 2 rescue breath before commencement of CPR |
|
|
109. Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is: A. distal tibial above medial malleolus is preferred due to easy access B. drug reaction time is the same as central venous route C. 12G used to ensure adequate flow D. bicarbonate cannot be infused due to bone damage E. fat embolism is a common complication
Other answers: A. proximal tibia preferred. Distal tibia alternate site in older children and adults only B. within 1sec but similar to 18G peripheral cannula C. 15G D. all IVdrugs can be given at same doses E. extremelyrare as marrow mostly blood in children – fat in adults |
B. drug reaction time is the same as central venous route A: option but not“best” site C: 18G D: can infuse all E: rare |
|
|
110. During endovascular aneurysm repair, GA is preferred due to: A. risk of uncontrolled haemorrhage B. renal ischaemia is painful C. aorta traction is painful D. long duration of apnoea is needed E. contrast used cancause CVS instability |
D. long duration of apnoea is needed, or A. risk of uncontrolled haemorrhage Pt must hold breath but not really for that long. CEACCP: allows easy conversion to open and placement of balloon
|
|
|
111. A 35yo G1P0 with a dilated cardiomyopathy presents for a Caesarean section. She has an ejection fraction of 35%. The benefits of a regional anaesthetic over a general anesthetic in this patient may include: A. decreased heart rate B. decreased systolic blood pressure C. increased ejection fraction D. decreased preload E. increased myocardial contractility |
C. increased ejection fraction Goals: avoidmyocardial depression; maintain normovolaemia; avoid ventricular afterload;avoid sudden hypotension with regional |
|
|
112.[New] In attempting to make a precise diagnosis of parathyroid adenoma, you would expect all of the following are found in hyperparathyroid disease EXCEPT: A. decreased urinary calcium B. extraosseous calcifications C. increased plasma calcium D. increased urinary phosphate E. renal calculi |
A. decreased urinary calcium Bones, stones,groans, psychic moans Increased Se Ca++ leads to increased urinary Ca++ despite increased PTH causing increased reabsorption in tubule |
|
115.Patient is intubated and ventilated, the ETCO2 trace below is caused by A. Endobronchialintubation B. ETT cuff leak C. Gas sample line leak D. Spontaneousventilation E. obstructive airwaydisease |
C. Gas sample line leak |
|
|
116.Which general anaesthetic agent contributes the most to green house gas? A. Desflurane B. Isoflurane C. Sevoflurane D. Propfol E. N2O |
A. Desflurane (Now I'm not 100% sure on the stem recall, but I got the impression it was askingfor the agent that is the absolute worse for green house gases (desflurane), not so much which one do we use the most and thus ends up contributing the most to the total green house gas volume (iso or sevo)) Global warming potential- des > sevo > iso Blue Book 2013 |
|
|
119. A patient's competence to give informed consent is determined by all the following EXCEPT: A. Ability to communicate a choice B. Ability to apply reasoning C. Ability to understand consequences D. The provision of significant information E. ?? |
D. The provision of significant information Informed consent is valid if four elements have been satisfied: 1.patient is competent to 2.full information on risks, benefits and alternatives has been provided. 3.consent is freely given; and 4.consent is specific to the procedure. Test for competency 1- Does the person understand? 2 - Does the person believe what they are being told? 3 - Can the person make a judgment based on this information?
|
|
|
120.[Repeat] A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomaticwith no other signs/symptoms of myocardial infarction and have an uneventfulrecovery. What do you do? A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future myocardial infarction B. Arrange coronary angiogram as an inpatient prior to discharge C. Inform the patient that while the result is real the significance is questionable D. Repeat in one week’s time as a second troponin is a better indicator of long-term myocardialinfarction risk E. Ignore the result as it is likely a laboratory error |
A. Arrange for a cardiology follow-up and outpatient angiogram becausehe is at increased risk of future myocardial infarction http://ceaccp.oxfordjournals.org/content/8/2/62.full ?? “Up to 60% of patients undergoing vascular procedures have severecoronary artery disease and fewer than 10% have normal coronary arteries. Thecause of cTn increase in this subset of surgical patients is therefore likelyto be MI (a high pre-test probability). The question is when, and in whom,should we be measuring postoperative troponins and what diagnostic threshold,if any, should we be using to aid in diagnosis of perioperative MI and riskstratification. This is more than an academic question as cTn increases of anyaetiology in the sick patient acts as a prognostic indicator for survival." http://circ.ahajournals.org/content/127/23/2253.full re VISION study 2012 --> ? C |
|
|
121. St John's wort will reduce the effect of A. aspirin B. clopidogrel C. dabigatran D. heparin E. warfarin |
E. warfarin "It also induces the P450 2C9 isoform that results in the reduction in effect of warfarin and NSAIDs." Also potentiates the effect of clopidogrel via same enzyme system Herbal medicine and anaesthesia CEACCP 2010 - dec oncentration/efficacy: cyclosporin,warfarin, digoxin, theophylline, HIV drugs, anticonvulsants (phenytoin,carnamazepine, phenobarbitone) - inc risk SE (eg serotonin syndrome): TCA,SSRIs |
|
|
122.The most important effect of Lugol's iodine administration before thyroid surgery is A. reduce incidence of thyroid storm B. reduce incidence ofvocal cord palsy C. increase likelihood to identify and preserve parathyroid glands D. pigmentation of thyroid gland to help identify thyroid gland E. reduce vascularity of thyroid gland. |
E. reduce vascularity of thyroid gland. http://bja.oxfordjournals.org/content/85/1/15.full.pdf Lugol's iodine* 5% iodine and 10% potassium iodide distilled in water* administered preoperatively to reduce the release of thyroid hormone and the vascularity -3 drops twice daily beginning 10 days preop -in thyroid storm it can be given IV 0.5-1gm every 8-12 hours. However, more rapid control of the hyperthyroid state can be achieved with betablockers, thionamides.
|
|
|
123. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed A. Inferior trunk B. Ulnar nerve C. Median brachial cutaneous nerve D. Anterior division E. Posterior cord |
A. Inferior trunk Medial forearm ismedial antebrachial cutaneous n: C8/T1, inferior trunk, anterior division,medial cord.
|
|
|
124. You are pre assessing a 70 year old patient treated for congestivecardiac failure. They are able to shower themselves and complete other ADLs butget dyspneoa on mowing the lawn. They are New York Heart Association classification A. Class 1 B. Class 2 C. Class 3a D. Class 3b E. Class 4 |
B. Class 2 Class I: No symptoms Class II: Symptoms with more than ordinary activity Class III: Symptoms with minimal activity (eg ADLs) Class IV: Symptoms at rest |
|
|
126. 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 A. have dosimeter checked at least 6-monthly B. limit exposure time to radiation C. maximal distance fromradiation source D. stand behind transmitter of C arm E. wear protective garments |
C. maximal distance fromradiation source |
|
|
127. Prothrombin VX useful in perioperative period to correct the coagulopathic defect of all except A. Isolated factor IIdeficiency B. Isolated factor VII deficiency C. Isolated factor IX deficiency D. Isolated factor X deficiency E. Warfarin |
B. Isolated factor VII deficiency Prothrombinex VF:2, 9, 10, (small amounts 5 and 7), ATIII, heparin, electrolytes http://www.csl.com.au/docs/552/566/Prothrombinex-VF%20AU%20PI%2012.00.pdf |
|
|
129. A 70 year old male presents for right lower lobectomy. Preoperative spirometry shows an FEV1 of 2.4L and an FVC of 4.2L. The predicted post-operative FEV1 is: A. 1.0 B. 1.3 C. 1.5 D. 1.7 E. 1.9 |
D. 1.7L Total lung segments = 19 (10 on R, 9 on L) R lung: 3, 2, 5 L lung: 3, 2, 4 ppo FEV1 = (19-5)/19 *2.4 = 1.76 For lobectomy, the simple calculation uses the number of bronchopulmonary segments removed compared with the total number (19) in both lungs. Easy calculation = 4/5 * 2.4 = 1.9 CEACCP 2006 Assessment of suitability for lung resection |
|
|
130.(Repeat Q) You see a Type 1 diabetic woman preoperatively at 0700hrs who hasbeen starved since 2200hrs for surgery today. You decide to start her on a glucose-Insulin-Potassium infusion. Insulin decreases glucose levels by: A. Stimulates glucose uptake into the liver B. Stimulates glucose uptake into skeletal muscle C. Inhibits glucose production in the liver D. Decreases glucose absorption from the gastrointestinal tract E. Inhibit glucagon release |
B. Stimulates glucose uptake into skeletal muscle Insulin convertsglucose into glycogen in liver (glycogenolysis) and forces glucose into muscleand fat cells via activation of GLUT-4 transporter |
|
|
133. The organthat is least tolerant of ischaemia, after removal for transplant, is: A. Cornea B. Heart C. Kidney D. Liver E. Pancreas |
B. Heart Cold ischemic time for Heart 4 h Lung 6 h Liver and pancreas 8 h Small bowel 12 h Kidney 48 h |
|
|
134. 75yo woman with an ejection systolic murmur presents for elective total knee joint replacement. Focussed transthoracic echocardiogram is performed. The feature most consistent with severe aortic stenosis is: A. Mean gradient acrossaortic valve of 30mmHg B. Peak gradient acrossaortic valve of 40mmHg C. Peak velocity across aortic valve of 4.2m/s D. Aortic valve area of1.2cm2 E. Calcification and restriction of the aortic valve |
C. Peak velocityacross aortic valve of 4.2m/s Severe AS: AVA <1.0 Mean gradient 40-50 Peak gradient > 65 Peak velocity: Mild <2.5 Mod 2.5-3.5 Severe > 3.5 http://ceaccp.oxfordjournals.org/content/5/1/1.full AS and non-cardiac surgery OHA p62http://www.echopedia.org/index.php/Classification_of_valve_stenosis_and_regurgitation |
|
|
135. Which of the following statements regarding patients with ankylosing spondylitis is FALSE? A. amyloid renal infiltration is rarely seen B. cardiac complications occur in less than 10% of cases C. normochromic anaemia occurs in over 85% of cases D. sacroileitis is an early sign of presentation E. uveitis is the most common extra-articular manifestation |
C. normochromic anaemia occurs in over 85% of cases Only 15% A – Yes, about 4% B – Yes, about 10%. 2.5% AR, 1%MR, 0.5% mitral valve prolapse, 0.5% pericarditis, 4.5% AV block, 3% BBB C – No, anaemia of chronic disease/inflammation in 15%. Anemia of chronic disease is often a mild normocytic anemia, but can sometimes be more severe, and can sometimes be a microcytic anemia;thus, it often closely resembles iron-deficiency anemia.In response to inflammatory cytokines, increasingly IL-6,the liver produces increased amounts of hepcidin. Hepcidin in turn causes increased internalisation of ferroportin (iron transporter) molecules on cell membranes which prevents release of iron stores, and decreased plasma iron levels. D – Yes E – Yes Complications: · cardiaccomplications: aortitis -> aortic ring distortion -> AR; conduction block · pulmonaryfibrosis upper lobes · amyloidosisis very rare · neurological2o fractures of fused spine · osteoporosis |
|
|
136. 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 A. Genetic test father B. Genetic test woman C. Muscle biopsy sibling D. Muscle biopsy father E. Muscle biopsy woman |
D. Muscle biopsy father Not all patients can have a biopsy, these include children less than 10-12yrs (30kgs), pregnant women, and patients on prolonged steroid therapy. If the proband cannot be tested, eg a young child or deceased, then the nearest most appropriate relative is tested. In the case of a young child this would be the parents." British MH Association Autosomal dominant. If uncle carries gene then can test for same gene in father. · If positive, he is ruled MH susceptible and woman can be offered gene test. · If negative, he needs to have IVCT to rule out MHIf father negative ® woman is not MHIf fatherpositive ® woman also needs gene testing +/- musclebiopsy IVCT. “Best” test ie absolutely confirmatory is muscle biopsy of the woman. But should test father first. |
|
|
139.During the first stage of labour, pain from uterine contractions + cervicaldilatation is from nerve roots: A.-E. multiple options of thoracic - lumbar roots |
1st stage: Pain is from visceral afferents carried via T10-L1 nerve roots, Ad and C fibres 2nd stage: In addition somatic pain from stretch (vagina, perineum) carried viaS2-S4 |
|
|
140. A test has a sensitivity + specificity of 90% for a disease with a prevalence of 10%. What is the positive predictive value? A. 10% B. 50% C. 82% D. 90% E. 99% |
B. 50% PPV = TP/ (TP +FP) NPV= (TN / (TN + FN) Can draw up a 2x2 table with sens and spec and adjust numbers for prevalence of actual positives. |
|
|
141. A female with type 1 von Willebrand disease presents for a dilation and curettage. She is a Jehovah’s Witness. In regards to desmopression to prevent haemorrhage in this patient all of the following are true EXCEPT: A. It is a synthetic substance and therefore acceptable to Jehovah's Witnesses B. It is likely to reduce haemorrhage in this patient C. It should be given as an infusion 30 minutes prior to surgery D. The effect will last 5 days E. The dose is 0.3μg/kg |
D. The effect will last 5 days t1/2 = 8-10h in vWD Type 1: quant def Type 2: qual def (2b do not respond to desmopressin) Type 3: completeabsence |
|
|
142. A 25 week post conceptual age infant is being ventilated in the Neonatal Intensive Care Unit. To reduce the risk of retinopathy of prematurity, they are being ventilated to a target oxygen saturation of 85-89% instead of 91-95%.This is associated with: A. Increased acute lung injury B. Increased mortality C. Increased sepsis D. Reduced intracerebral haemorrhage E. Reduced necrotising enterocolitis |
B. Increased mortality BOOST 2 SpO2 85-89% reduced retinopathy of prematurity, increases mortality International randomized controlled trial 2500 premature infants http://www.nejm.org/doi/full/10.1056/NEJMoa1302298#t=articleDiscussion |
|
|
144. An 80 year old man undergoes a unilateral lumbar sympathetic blockade. The most likely side effect that he experiences is: A. Genitofemoral neuralgia B. Haematuria C. Postural hypotension D. Lumbar radiculopathy E. Psoas haematoma |
A. Genitofemoral neuralgia SE: “Bleeding, intravascular injection, intrathecal orepidural injection, perforation of viscera, groin pain (genitofemoral nerveinjury)”http://ceaccp.oxfordjournals.org/content/10/3/88.full |
|
|
145. Regarding Le Fort fractures: A. External signs correlate with internal skeletal damage B. Le Fort fractures don't usually occur in combination (for example I and II) C. Patients with a LeFort I fracture should NOT undergo nasal intubation D. Patients with a Le Fort II fracture should have evaluation of the base of skull prior to nasal intubation E. Le Fort III fracture is associated with fracture of the cribiform plate |
E. Le Fort III fractureis associated with fracture of the cribiform plate Le Fort #:fracture of middle third of face Type 1:horizontal maxillary # = “floating palate” Type 2: pyramidal# = “floating maxilla” Type 3:craniofacial dysfunction = “floating face” Can have any combination. Must fracture pterygoid plates |
|
|
145. Greatest predictor of AF post CPB A. advanced age B. history ofhypertension C. history of CVA D. history of CCF E. prolonged CPB |
A. advanced age “Age is consistently theindependent factor most strongly associated with POAF. For every decade thereis a 75% increase in the odds of developing POAF and based on age alone, anyoneolder than 70 years is considered to be at high risk for developing AF.”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697424/ |
|
|
146. 2yr child post op following stabismus surgery. ETT 4.5 used. Awake,stridor and tracheal tug. Immediate action? A. inhalationalinduction B. CPAP with facemask C. propofol 1mg/kg D. dexamethasone0.4mg/kg E. adrenaline nebuliser1:1000 0.5ml/kg |
?Laryngospasm B. CPAP with facemask (propofol dose is 0.5mg/kg) CEACCP 2008, Tracheal extubation. Laryngospasm: Most common cause of upper airway obstruction and mostly in children due to extubation in light planes of anaesthesia. Mx; Oxygen, jaw thrust, clear secretions, CPAP, propofol (20% induction dose) and sux (0.5mg/kg to relieve obstruction) Oedema: Risk factors: difficult intubation, surgery > 1h or coughing on ETT CEACCP 2007 Acute Stridor in Children. Clinical signs generally occur within 30mins of extubation and respond well to treatment with nebulised epinephrine (0.5ml/kg 1:1000) and iv dexamethasone 0.25mg/kg, warm humdified oxygen or heliox. |
|
|
149. Transient neurological (radicular) syndrome ONLY occurs with A. Hyperbaric local anaesthetics B. Intrathecal lignocaine C. Lithotomy positioning D. Following complete resolution of motor blockade E. When there has been a dense motor block with spinal anaesthetic |
D. Following complete resolution of motor blockade Transient neurological symptoms have been defined as pain in the lower extremities (buttocks, thighs and legs) after an uncomplicated spinal anesthesia and after an initial full recovery during the immediate postoperative period (less than 24 h). Normal nerve conduction studies. Usually resolves in<72h. RF: lignocaine,lithotomy position, more profound motor blockhttp://ceaccp.oxfordjournals.org/content/5/2/37.full |
|
|
150. 50yo lady, attempted suicide attempt, jumped from 5th floor building. She doesnot open her eyes or vocalise and there is no response to pressure on hernail-bed. What is her GCS? A. 2 B. 3 C. 5 D. 8 E. 12 |
B. 3 E 1 V 1 M 1
E nil / pain /speech / spont V nil /incomprehensible / inappropriate / confused / oriented M nil / ext topain / flex to pain / withdrawal pain / localises to pain / obeys commands |
