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137 Cards in this Set
- Front
- Back
- 3rd side (hint)
1. Given the following diagram, what does X represent? A. Amount of drainage since system was connected to patientB. Level of resistance to drainage of pleural cavityMaximum pressure against the pleural cavity on expiration C. Level of underwater seal applied to pleural cavity D. Maximum pressure in pleural cavity on expiration E. Maximum suction that can be applied to pleural cavity |
E
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2. RH28 Retrobulbar block. Sign of brainstem spread
A. Atonic pupil B. Unilateral blindness in blocked eye C. Contralateral blindness D. Diplopia- past papers remembered this as dysphagia E. Nystagmus |
C Caused by reflux of LA into the Optic Chiasm
Drowsiness/Vomiting/Convulsions/Respiratory Depression/Arrest
http://bja.oxfordjournals.org/content/75/1/93.full.pdf but if Dysphagia - correct |
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3. 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. Accept that a small amount of bleeding may occur with a tourniquet B. Reinflate at a higher pressure C. Check coags D. Take tourniquet down, rexanguinate and reinflate E. Something else |
A
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Tourniquet question: ORIF tib/fib fracture. BP was 110/70. Tourniquet correctly applied at 250 mmHg. Options were: A. Reinflate at a higher pressure B. Deflate, re-exanguinate and reinflate C. Accept that there will be a small amount of bleeding D. ? E. ? |
C 1-2 hours ATP exhausted 3 hours Creatine Phosphatase exhausted |
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4. This was the CXR showing a widened mediastinum with an otherwise normal CXR, there was an electronic circuit thing at the bottom right but nothing else obvious. Aortic dissection was the answer (at least I think!)
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Aortic dissection |
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5. Fatigue during night shifts can be minimized by: A. Avoiding daylight B. not sleeping during day C short naps during shift D use of caffeine or stimulants E. using benzodiazepines for sleep during the day |
C
file:///Users/maelcyap/Downloads/ps43-2007-statement-on-fatigue-and-the-anaesthetist.pdf
http://ceaccp.oxfordjournals.org/content/early/2013/06/18/bjaceaccp.mkt025.full.pdf+html |
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6.Patient with Acute Intermittent Porphyria presents to hospital with abdominal pain and requires a general anaesthetic. Which drug for PONV would you avoid? A. Metoclopramide B. Prochlorperazine C. Tropisetron D. Ondansetron E. Droperidol |
A
Oxford Handbook 212 (3rd edition)
http://ceaccp.oxfordjournals.org/content/early/2012/02/27/bjaceaccp.mks009.full.pdf+html |
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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 A. adrenaline B. dobutamine C. ephedrine D. metaraminol E. phenylephrine |
E
Moclobemide- reversible MAOI
Most dangerous- Indirect Sympathomimetics (Ephedrine/Metaraminol/Amphetamine/Cocaine)
Direct sympathomimetics- Exaggerated Effect
Serotonin Syndrome- Pethidine/Tramadol
Pancuronium-Releases stored NA
Oxford Handbook Page 285 |
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7. Patient with depression for surgery forgets to omit his moclobemide, which agent would be BEST with hypotension under anaesthesia? A. Noradrenaline B. Adrenaline C. Ephedrine D. Metaraminol E. Phenylephrine |
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 A. endobronchial intubation B. endotracheal cuff leak C. gas sampling line leak D. obstructive airways disease E. spontaneous ventilatory effort |
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:
A. T2 B. T4 C. T6 D. T8 E. T10 |
B
Oxford Handbook 756 |
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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: A. Cease dabigatran 7 days prior B. Cease dabigatran 3 days prior C. Cease dabigatran 3 days prior and give bridging anticoagulation D. Cease dabigatran 24 hours prior and measure INR on day of surgery E. Continue dabigatran and withhold on day of surgery |
B
Darbigatran- Factor 10a inhibitor At least 48 hours for spinal
MIMS |
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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 A. CXR B. CT chest C. MRI chest D. PET scan E. TOE |
B
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12. A CTG recording with late prolonged decelerations. Cause:
A. GA B. Head compression C. Uteroplacental insufficiency D. Acute asphyxia E. Umbilical cord compression. |
C
Late decelerations begin at peak of uterine contraction and recover when the contraction ends.
Caused by: Maternal Hypotension Pre-Eclampsia Uterine Hyperstimulation
Head compression- Early deceleration Umbilical cord compression- Variable deceleration
http://geekymedics.com/2011/05/29/how-to-read-a-ctg/
http://ceaccp.oxfordjournals.org/content/3/2/38.full.pdf+html |
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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 A. 3 B. 4 C. 8 D. 25 E. 33 |
D
1/ARR 1/Probability (with intervention)-Probablity (Control) 1/0.12-0.08=1/0.04 = 25 |
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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: A. vecuronium B. cisatracurium C. pancuronium D. atracurium E. suxamethonium |
B Cisatracurium
60-70% of all anaphylaxis
Anaphylaxis to Suxamethonium- 60% to all others NMBD
Benzylisoquinolonium Less potential for histamine release Cisatracurium less histamine release
Peck + Hill |
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15. Increase in period bleeding EXCEPT A. Gingko B. Garlic C. Ginger D. Fish Oil E. Echinacea |
E
http://ceaccp.oxfordjournals.org/content/11/1/14.full |
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16. Post op hip ORIF, commonest periop complication
A. UTI B. PE C. Delirium D. AMI E. Pneumonia |
C (Most Likely)
http://www.aagbi.org/sites/default/files/296%20Neck%20of%20Femur%20Fracture;%20Peri-operative%20Management[1].pdf |
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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: A. Adrenaline B. Dobutamine C. Levosimenden D. Milrinone E. Vasopressin |
E
http://ceaccp.oxfordjournals.org/content/11/1/9.full.pdf+html |
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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: A. Instigate low dose beta blockade B. Defer, and refer to a cardiologist 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
http://ceaccp.oxfordjournals.org/content/early/2013/02/25/bjaceaccp.mkt006.full.pdf+html |
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19 (Repeat) 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 |
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20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of: A. Aorta B. Hepatic artery C. Hepatic vein D. Portal pedicle E. Splenic Artery |
D
Both Hepatic artery and vein |
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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: A. cease his omeprazole B. check his hepatic transaminase level C. check his renal function D. CHeck his QT interval on a resting ECG E. Decrease his oxycodone |
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: A. Coracobrachialis B. Deltiod C. Lat Dorsi D. Serratius Anterior E. Trapezius |
C Lat dorsi
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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 hyperreflexi:A. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx? A. Heat stress from anticholinergics B. Hypoxic ischaemic encephalopathy C. NEM D. Serotonin syndrome E. Pain from fracture |
C
Neuroleptic Malignant Syndrome (D2 receptor antagonist)
F ever E levated enzymes V ital sign instability E ncephalopathy R igidity of muscles
Serotonin Syndrome
S hivering H yperreflexia I ncreased temperature V ital sign instability E ncephalopathy R estlessness S weating |
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24. CO2 penetrates surface tissue so well with little damage to underlying tissue becuase A) Well absorbed by Hb B) Poorly absorbed by H20 C) Widely disseminated in tissue D) Long infrared wavelength E) Short infrared wavelength |
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: A. Inferior gluteal B. Obturator C. Pudendal D. Scaitic E. Superior gluteal |
B
Obturator- Adductor muscle of the Hip Inferior Gluteal- Gluteus maximus Pudendal- Sensation to genitals + anal canal, Pelvic floor muscles, sphincters Sciatic- Posterior Leg |
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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: A. Categorical B. Nominal C. Non-parametric D. Numerical E. Ordinal |
E
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26. What best describes the type of data that ASA grading scores represent? A. Numerical B. Ordinal C. Nominal D. Ratio E. Non-parametric |
B |
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27. An otherwise healthy man presents with anaemi:A. The test that most reliably indicates iron deficiency is decreased A. MCV B. serum ferritin C. serum iron D. serum transferrin E. total iron binding capacity |
B
MCV Low Ferritin Low Serum Iron Low Transferrin Low Total Iron Binding Capacity High
Ferritin intracellular protein-stores and releases iron |
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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 A. 5 B. 25 C. 50 D. 100 E. 200 |
B
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30. Recommendation regarding safe nitrous oxide exposure in operating rooms A. 10 ppm B. 25 ppm C. 50ppm D. 100 ppm E. 200 ppm |
B |
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31. What is associated with down regulation of nicotinic acetylcholine receptors: A. Guillain-Barre syndrome B. Organophospate overdose C. Spinal cord injury D. Stroke E. Prolonged neuromuscular blockade |
B
nAch Down-regulation Myasthenia Gravis Anticholinesterase poisoning Organophosphate poisoning
nAch Up-Regulation Spinal cord injury Stroke Burns Prolonged immobility Prolonged exposure to NMD Multiple Sclerosis Guillain Barre
Millers page 900 (table 29-1) |
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31. nicotonic ach receptor downregulation, cause? A. organophosphate poisoning B. long muscle relaxant use C. ? |
A |
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35. A reduction in DLCO can be caused by: A. Asthma B. Emphysema C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis |
B
Decreased DLCO (<80% predicted) Obstructive Lung Disease Parenchymal Disease Pulmonary vascular disease Anaemia
Increased DLCO (>120-140% predicted) Asthma Pulmonary haemorrhage Polycythaemia Left to Right shunt
Rate of Diffusion = A (C1-C2)/D |
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36. 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
A. Genetic test father B. Genetic test woman C. Muscle biopsy sibling D. Muscle biopsy father E. Muscle biopsy woman |
E (? 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: A. 6 B. 8 C. 10 D. 12 E. 14 |
D
http://www.smiths-medical.com/userfiles/trachealtubechart.pdf
3F = 1mm diameter |
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37. What is the largest French gauge suction catheter whose physical diameter doesn't exceed half the internal diameter of an 8 ETT? A. 6 B. 8 C. 10 D. 12 E. 14 |
D |
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38. (Repeat) Pneumoperitoneum causes a decrease in cardiac output at what pressure (or possibly ABOVE what pressure) A. 10mmHg B. 20mmHg C. 30mmHg D. 40mmHg E. 50mmHg |
A
Miller says >10
http://ceaccp.oxfordjournals.org/content/4/4/107.full.pdf+html
Initially increase in venous return and CO due to autotransfusion of pooled blood from splanchnic circulation.
Then decrese in VR + CO due to compression of inferior vena cava.
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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-
A. Argabotran B. Lepirudin C. Fondapurinax D. Danaparoid E. Warfarin |
C
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40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique: A. 3 mg/kg B. 7 mg/kg C. 15 mg/kg D. 25 mg/kg E. 35 mg/kg |
E
Lignocaine diluted into high volumes. 22-57 mg/kg
http://ceaccp.oxfordjournals.org/content/early/2011/07/12/bjaceaccp.mkr026.full.pdf+html |
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43. Drug to facilitate clip placement during cerebral aneurysm surgery; A. nimodipine B. mannitol C. adenosine D. hypertonic saline E. thiopentone |
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? A. codeine B. morphine C. paracetamol D. parecoxib E. tramadol |
A
Excreted in breast milk and mothers may be rapid metabolisers which will make the baby more narcotised.
http://www.bfmed.org/Media/Files/Protocols/Protocol_15_revised_2012.pdf
It is from the academy of breastfeeding medicine but well referenced.
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44. What is not safe to give to a breastfeeding mother during general anaesthesia? A. Codeine B. Morphine C. Parecoxib D. Tramadol E. Paracetamol |
A |
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44. Analgesia to avoid in breast feeding woman? A. morphine B. pethidine C. codeine D. parecoxib E. tramadol |
C Pethidine not recommended. Norpethidine is excreted slowly in neonates.
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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:
A. Postpone surgery for 2 hours B. Postpone surgery for 4 hours C. Postpone surgery for 6 hours D. Cancel surgery E. Continue with surgery |
E
http://ceaccp.oxfordjournals.org/content/6/6/215.full.pdf+html |
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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: A. Cryoprecipitate B. Immunoglubulins C. Fresh Frozen Plasma D. Factor VIIa E. Prothrombinex |
C
http://www.anzca.edu.au/resources/college-publications/pdfs/ANZCA%20Blue%20Book%202011%20P9.pdf
Page 126 |
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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
Bernoulli principle- an increase in the flow velocity of an ideal fluid will be accompanied by a simultaneous reduction in its pressure Simplified equation: p1-p2= 4V^2 |
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47. AS gradient of 4m/s, what is the mean pressure using modified bernoulli (4v squared = 64) |
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:
A. Funnel plot B. Bland-Altman plot C. Forest plot D. Galbraith plot E. Partial regression plot |
B
Cross + Plunket page 214 |
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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 A. A early diastolic mitral inflow dynamic with atrial systole B. Left inferior hypokinesis C. Left ventricle collapse in systole D. Right ventricle dilation and TR E. Severe Mitral Regurg |
B |
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51. Maximum amplitude from TEG or ROTEM decreased give
A. Cryoprecipitate B. FFP C. Platelets D. Prothrombinex E. Tranexamimic acid |
C
http://www.rotem.de/en/methodology/result-interpretation/ http://lifeinthefastlane.com/education/ccc/thromboelastogram-teg/ |
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51. With regards to ROTEM: maximal clot firmness (Increased MA: maximal amplitude on TEG) correlates best with needing to give: A. FFP B. Cryoprecipitate C. Platelets D. PCC E. TXA |
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: A. 1mg B. 2mg C. 4mg D. 8mg E. 16mg |
C
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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 A. have dosimeter checked at least 6-monthly B. limit exposure time to radiation C. maximal distance from radiation source D. stand behind transmitter of C arm E. wear protective garments |
C
Intensity radiation = 1/distance sqaured
At least 3 feet from source 6 feet or air provides 9 inches of concrete or 2.5mm lead
http://ceaccp.oxfordjournals.org/content/early/2012/11/04/bjaceaccp.mks055.full.pdf+html |
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57. Ibuprofen dose for one year old child tds regular post-op dose A. 5mg/kg B. 10 C. 15 D. 20 E. 25 |
B
5-10mg/kg (MIMS) |
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58. AICD, what does a magnet do A. Maintain defib activity & activate asynchronous pacing B. maintain anti tachycardia pacing & deactivate asynchronous pacing C. Deactivate anti tachycardia pacing & activate asynchronous pacing D. Deactivate defib & activate asynchronous pacing E. Deactivate defib & deactivate asynchronous pacing |
D
Even when the ICD has been deactivated by a magnet, pacemaker function of an ICD is not affected. Thus, in a patient with an ICD, the magnet response will always be to deactivate the ICD and the pacing behaviour will not change to an asynchronous mode.
http://bja.oxfordjournals.org/content/107/suppl_1/i16.full.pdf+html |
Magnet on PPM AOO/VOO/DOO
Magnet om AICD Deactivates tachytherapy (Shocks) but pacing unaffected
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60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AE:D. On admission to hospital his ECG was as below; ECG - sinus, rate ~60, normal axis, borderline PR interval, RSR' in V1 and V2 with ST elevation and inverted T waves (Brugada sign) A. Acute pericarditis B. Brugada C. Cocaine intoxication D. Coronary artery spasm E. Long QT syndrome
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B
Brugada syndrome is due to a mutation in the cardiac sodium channel gene. |
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Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave |
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What does the following ECG demonstrate? [ECG provided] A. LVH B. Anterior infarct C. Digoxin toxicity D. Brugada syndrome E. ? |
D Clinical Criteria Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
Family history of sudden cardiac death at <45 years old .
Coved-type ECGs in family members.
Inducibility of VT with programmed electrical stimulation .
Syncope.
Nocturnal agonal respiration |
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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:
A. High CVP in anticipation of heavy blood loss B. Decreased MAP to reduce arterial bleeding C. Decreased CVP to reduce venous bleeding D. Normal MAP in anticipation of heavy blood loss E. Normal CVP to ensure adequate filling of the heart. |
C
http://ceaccp.oxfordjournals.org/content/9/1/1.full.pdf+html
During parenchymal resection hepatic inflow occlusion, the main source of bleeding is backflow from the valveless hepatic veins. The control of central and thus hepatic venous pressure is crucial to reduce the blood loss (>5cm H2O) |
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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 A. 5 mmol B. 10 mmol C. 15 mmol D. 20 mmol E. 25 mmol |
B
5-10 mmol/day (>48hrs) 2mmol/L/hr (<48hrs)
Oxford Handbook page 186
Pontine Myelinolysis Rapid correction of sodium in hyponatremia would cause the extracellular fluid to be relatively hypertonic. Free water would then move out of the brain cells to decrease this relative hypertonicity. This leads to a central pontine myelinolysis, manifesting as the paralysis. The brain appears to shrink. The demyelination of the axons (nerve fibers in the brain) damages them.
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ASK ICU NERDS |
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63. Impaired level of consciousness (possible seizures) on ward. Sodium concentration 105mmol/L, what is the maximum correction in 24hrs?
A. 8 B.10 C. 12 D. 15 E. 20 |
B |
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64. What is the distance from lips to carina in a 70 Kg man? A. 21 cm B. 23 cm C. 25 cm D. 27 cm E. 29cm |
D
Lee's Synopsis of Anaesthesia: Central Incisors to Carina Male 27cm/Female 23cm
15cm from teeth to cords, 12 cm from cords to carina
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64. What is the average tube depth from lips to carina in a male? (may have said female)
A. 22 B. 25 C. 27 D. 29 E. 19 |
C |
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65. The action of which laryngeal laryngeal muscle opens the cords? A. Cricothyroid B. Posterior cricoarytenoid C. Lateral Cricoarytenoid D. Thyroarytenoid E. Vocalis |
B
Cricothyroid muscle - Lengthens and tenses VC Posterior crycoarytenoid- Open glottis Lateral crycoarytenoid- Close glottis Interarytenoid- Close glottis Thyroarytenoid- Relax VC Vocalis- Relax VC
http://en.wikipedia.org/wiki/Larynx
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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) A. MH B. Neuroleptic malignant syndrome C. ? D. opioid induced rigidity E. TMJ rigidity |
E
Skin and soft connective tissue abnormalities, contracture deformities, micrognathia, cervical spine and jaw stiffness, congenital heart disease (10%), hypermetabolic response is probably NOT MH. Difficult airway and venous access, sensitive to thiopental.
Oxford handbook page 298 |
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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? A. Beta-blockers B. Dopamine C. Dobutamine D. Sodium nitroprusside E. Intra-aortic Balloon Pump |
D
Cardiac bosses all agree. No great evidence. Anyone has any good papers? |
CEACCP article states bet-blockers first |
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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?
A. Aortic Stenosis B. Aortic Regurgitation C. Pulmonary Regurgitation D. Tricuspid Regurgitation E. Mitral Regurgitation |
D
http://lifeinthefastlane.com/education/ccc/cvp-measurement/ |
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71. Given the following femoral AL and CVP traces, what is the most likely cause? [diagram]
A. Pulmonary stenosis B. Left Ventricular Failure C. Tricuspid Regurgitation D. Aortic Stenosis E. Mitral Stenosis |
C |
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72. The MELD score is calculated using INR, Bilirubin & what? A. Creatinine B. Albumin C. Urea D. AST E. Ammonia |
A
Med Calc
Model End Stage Liver Disease Disease severity scoring system applied to ADULT livers to improve organ allocation in transplants
MELD + MELD-Na
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* 40 or more — 71.3% mortality |
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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%: A. 2mins B. 3mins C. 4mins D. 5mins E. 10mins |
E
Australian Resuscitation Council
http://www.resus.org.au/policy/guidelines/section_13/13_1.htm |
From Paul Craven's Resus tutorial:
Target sats |
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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? A. 62mmHg B. 65mmHg C. 70mmHg D. 75mmHg E. 80mmHg |
B (70mmHg-5mmHg) = 65mmHg
Recommended arterial transducer to be at the level of the tragus
About 11mmHg difference between heart and tragus
http://lifeinthefastlane.com/education/ccc/cerebral-perfusion-pressure-in-tbi/ |
Kirkman MA 2014 BJA |
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75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80.
A. 0.04 B. 0.4 C. 4 D. 14 E. 40 |
C
Peck & Hill page 183 |
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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? A. CPAP B. Breath hold at end expiration C. Manual compression at the base of the neck D. Trendelenberg position E. Valsalva manoeuvre |
E
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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: A. Epidural Lignocaine B. IV Esmolol C. IV Hydralazine D. IV Magnesium E. IV Propofol |
D
Phaechromocytoma-CEACCP (2003)
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. Nurse in supine position B. Early spontaneous ventilation through ETT C. Oral hygiene D. Use antacids E. Regularly change breathing circle |
C |
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83. Best way to reduce ventilator induced pneumonia? A. Nurse in Supine Position B. Early spontaneous ventilation through ETT C. Oral hygiene D. Use anti-acids E. Regularly change breathing circuits |
C
file:///Users/maelcyap/Downloads/ANZICS%20VAP%20Statement%20Consultation%20Version_25032013.pdf
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85. A 37 year old 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. 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 Increased H20 intake due to dry mouth (caused by drugs) Hyponatraemia (serum) Hyposmolar (serum) Polyuria Dilute Urine (urine osmolality Normovolaemic
CDI (Inadequate ADH Secretion) Hypernatraemia Hyperosmolar Polyuria Dilute Urine (urine osmolality Responsive to ADH
NDI (Kidney resistant to ADH) Normal to high Na Normal to high osmolality Polyuria Dilute urine (urine osmolality Non-responsive to ADH
Cerebral Salt Wasting Excessive Na secretion by Kidneys due to brain trauma/tumour) Hyponatraemia Hyposmolar Polyuria Elevated urinary Na (urine osmolality>plasma osmolality) Hypovolaemic
SIADH (Inappropriate ADH secretion) Hyponatraemia Hyposmolar Oliguria Elevated urinary Na (urine osmolality>plasma osmolality) Normal to expanded volume
http://lifeinthefastlane.com/education/ccc/siadh-versus-cerebral-salt-wasting/
http://lifeinthefastlane.com/education/ccc/central-diabetes-insipidus/
http://lifeinthefastlane.com/investigations/hyponatraemia/ |
www.sydpath.stvincents.com.au/tests/Sodium.htm |
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86. Photograph of an Arndt bronchial blocker multiport airway adapter. Orifice labelled 'X'. What goes in 'X'?
A. Bronchoscope B. ? C. ? |
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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 |
Answer: A |
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92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT |
Answer: C |
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Answer: C |
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Answer: A |
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99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury: |
Answer: A C3-C5 partial phrenic nerve weakness/paralysis of diaphragm. Reduced VC to 10-30%, weak cough, 80% require ventilation w/in 48hrs. No intercostal function. Diaphragmatic breathing w collapse of chest initially (until intercostal paralysis develops in few days). Ref: CEACCP July 2013 initial mx of acute spinal cord injury |
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100. (new) Afterload reduction is most useful in which of the following: |
E |
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D |
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Answer: E*
Ref: Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. An update of consensus guidelines for warfarin reversal. MJA 2013;198(4):198–199. Red Cross transfusion.com.au |
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Answer: machine check |
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E check at 1hr, 4hr and >24hrs |
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Answer: D
Ref: CEACCP, Vol 9 (5), Pp. 157-161. "Anaesthesia and deep brain stimulation" |
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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.) |
lateral femoral cutaneous nerve
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109 Patient with metastatic cancer. What's not useful to increase Ca excretion? |
Bisphosphonates reduce the resorption of bone. |
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Answer: A Ref: Pulmonary atelectasis in anaesthesia and critical care, CEACCP Dec, 2013. |
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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. |
Angiography |
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Answer: D |
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Answer: C
Ref: CEACCP, Vol 6, (2) 67-70 Injury during anaesthesia |
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Answer: C
ACE-I cause fetal malformations if given 2nd & 3rd trimesters (Ref: Williams Obstetrics, 23rd Ed, p989) |
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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? |
Answer: D
"The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8-T1 radiculopathies." Ref: Global Spine J. 2014 Feb;4(1):1-6. Differentiating c8-t1 radiculopathy from ulnar neuropathy: a survey of 24 spine surgeons. |
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119. According to PS09, the minimum requirement for administering propofol for conscious sedation is
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A
PS09 pp8: "Intravenous anaesthetic agents such as propofol must only be used by a second medical or dental practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist." But also see Scenario 2 of Appendix 1 of PS09: the assistant can be shared between both ends for conscious sedation in ASA 1-2 patients only. Therefore best answer would be a medical or dental practitioner trained in its use with an assistant who may be shared with the proceeduralist. --Farnsworth 06:17, 8 June 2014 (CDT) |
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122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?)
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125. Adenosine would be useful for terminating which arrhythmia?
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E. WPW |
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126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step: |
Answer A
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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:
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B |
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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: |
Answer: E
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129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is: |
Answer C
Mainentance IVF = 4ml/kg/hr for 1st 10kg, 2mg.kg/hr for next 10kg, 1ml/kg/hr for remaining kg (N/2 + 5%)
Total = 360ml/hr |
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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 |
Answer: B
http://bja.oxfordjournals.org/content/93/5/645.full.pdf |
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131. The normal physiological response following ECT is:
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Answer B
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132 (repeat) Aspirin Overdose. What will enhance her elimination most effectively?
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Answer B
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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? |
Answer A or D
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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. |
Answer B
Because. Just because. |
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137. A PiCCO monitor may be used to measure cardiac output through use of:
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Answer C |
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138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone. |
Answer B
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141. Immunity to Hepatitis B is demonstrated by the presence of:
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Answer C
HBsAb +ve = immunity via immunisation or exposure HBsAg +ve = active infection HBcAb = suggests previous exposure |
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142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is:
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E
Unclear, however best predictor of surgical complications (including haemorrhage) is Child's class, including prolonged PT.
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143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with: |
C |
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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? |
Answer E
Some debate over whether to use 3 0r 4ml/kg (modified Parkland) however, question specifically asks for Parkland.
Hilton, Peter John, and Martin Hepp. "The Immediate Care of the Burned Patient." BJA CEPD Reviews 1, no. 4 (2001): 113-116. |
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145 The thoracic paravertebral space is continuous down to: |
Answer B
Tighe, S, M D Greene, and N Rajadurai. "Paravertebral Block." Continuing Education in Anaesthesia, Critical Care & Pain 10, no. 5 (2010): doi:10.1093/bjaceaccp/mkq029 |
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28. 54 year old radical prostatectomy with ongoing blood loss during the procedure. Surgeon complains of ooze and asks if the patient is on aspirin. Thromboelastograph shown below. Most appropriate therapy: A. rFVII B. cryoprecipitate C. FFP D. platelets E. tranexamic acid |
B |
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32. Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common direction of subluxation in RA A. lateral B. oblique C. posterior D. rotated E. vertical D. Subaxial |
C |
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33. MS patient requires GA. Most likely precipitant of deterioration: A. hyperthermia B. hypocarbia C. Non-depolarising muscle relaxant D. TIVA E. volatile anaesthetic agent Choice B may have been "decreased cardiac output" |
A |
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41. 6 year old 20kg anaesthetised and paralaysed for appendicectomy. First attempt- vocal cords seen. size 5.5 uncuffed. 2nd attempt with 4.5. Next appropriate step A. administer nebulised adrenaline B. attempt 4.0 tube C. examine trachea with fibreoptic bronchoscope D. LMA E. soften 4.5 tube and attempt reinsertion |
D |
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49. 40 year old, pulmonary artery hypertension 80/60 pre-op. Lap cholecystectomy. Sudden SPO2 87, sBP 80/40, etPCO2 45. Cause? A. gas emboli B. Left heart failure C. myocardial ischaemia D. pneumothorax E. right heart failure |
E |
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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? A. Pulmonary embolism B. Venous air embolism C. Acute right heart failure D. ? E. ? |
C |
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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 A. Genetic test father B. Genetic test woman C. Muscle biopsy sibling D. Muscle biopsy father E. Muscle biopsy woman |
E |
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55. 10L/min via facemask. Cylinder C 15 000kP lasts A. 10min B. 15min C. 30min D. 45min E. 60 min |
D |
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59. ?To prevent transmission of CJD? Airway-contaminated equipment A. autoclave B. protected plastic covers C. sterilise in ethylene oxide D. 134degreesC for 3 min E. thrown away |
E |
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89. A 63 year old woman with chronic AF has a history of HTN, T2DM and has had a previous CVS. Her annual risk of stroke without anticoagulation is A. <1% B. 1.9% C. 2.8% D. 4% E. 8.5% |
E |
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An 85y.o for an open AAA repair. Refuses blood because of risk vCJD. You tell him you won't anaesthetise him as the risk is too high. This is an example of A. Autonomy B. Beneficence C. Justice D. Coercion E. Paternalism |
E |
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148: (Repeat). 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 |
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149 (?repeat -not sure) 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? A. Administration of suxamethonium B. Anaphylaxis to oxytocin C. Amniotic fluid embolus D. Pulmonary Embolus E. Eclamptic seizure |
D or C |
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150. The faster rate to desaturation observed in morbidly obese patients is due to: A. Decreased residual volume B. Decreased functional residual capacity C. Decreased diffusion capacity D. Increased closing capacity E. Increased pulmonary blood volume |
B |
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In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would- A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece B. Deflate tracheostomy cuff, remove one-way valve, insert fenestrated piece C. Inflate tracheostomy cuff, remove one-way valve, insert fenestrated piece D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece E. ? |
A |
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Which is least likely to fraudulent research reduction strategy? A. Published in a peer review journal B. Multiple authors C. Departmental director sole author D. Research findings similar to other published studies E. Backing of a major research institute |
C |
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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).Blockade of this nerve would result in?A. Reduced pronation B. Reduced hand grip. C. Reduced elbow flexion D. Reduced wrist extension E. ? |
D |
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Trauma patient undergoes delayed ORIF FEMUR. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium Femoral Nerve Block, turned lateral. Suddenly BRADYCARDIC, ETCO2 45, MAP 50mmHg. This is most likely to be ..? A. PE B. Fat embolism C. Anaphylaxis D. LA Toxicity E. ? |
D |
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