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136 Cards in this Set
- Front
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A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in: |
D
Open Anaesthesia: “place patient in left lateral decubitus and Trendelenburg” Depends if the source of embolus is still an issue. If it is still open, then A; operative site below RA to prevent inflow, RA uppermost to trap air. If it has been closed, then D; to trap air. See CEACCP article “Gas embolism in anaesthesia”. |
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Which of the following is NOT a side effect of cyclosporine
a. Alopecia b. Hypertension c. Renal impairment d. Gum hyperplasia |
A
Cyclosporin product information • No mention of alopecia • Hypertension in up to 50% • Impaired renal function very common • Gum hyperplasia very common |
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What is the half life of clopidogrel?
a. 6 hours b. 14 hours c. 24 hours d. 7 days |
A |
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When administering adrenaline and atropine via ETT dose compared with IV should be
a. Same dose b. Double c. Quadruple d. Six times |
C
ARC Resus guidelines say 3-10x the dose if given via the endotracheal route A lot of other non-referenced websites say 2x the dose |
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What splitting ratio gives a 3% concentration of isoflurane?
a. 1/5 b. 1/9 c. 1/13 d. 1/20 e. 1/23 |
C
Dorsh & Dorsh “The ratio of bypass gas to gas going to the vaporizing chamber is called the splitting ratio and depends on the ratio of resistances in the two pathways” http://www.anesthesia2000.com/physics/Chemistry_Physics/physics17.htm Isoflurane 3% = 1:13 |
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What transfusion related complication is the commonest cause of mortality
a. Bacterial infection b. TRALI c. ABO incompatibility d. |
B
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Which of the following is not included in the CHADS2 AF thromboembolic risk scoring system
a. Age b. Gender c. Diabetes d. Heart failure e. Previous TIA |
B
In practice, has been superseded by CHA2DS2-VASc score CCF (1), HTN (1), Age >75 (2), DM (1), Prior stroke or TIA (2),Vascular disease (1), Age 65-74 (1), Sex (female 1, male 0). |
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What is the ratio of breaths to compressions in neonatal resuscitation
a. 1:3 b. 1:5 c. 2:15 d. 2:30 |
A
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What is the innervation of the hard palate
a. Greater palatine and nasopalatine |
A
http://ozradonc.wikidot.com/anatomy:focused-hard-palate “The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion. The greater palatine nerve descends through the greater palatine foramen with its companion artery, and runs anteromedially to supply the mucosa of the posterior hard palate. The nasopalatine nerve descends through the incisive foramen to supply the most anterior parts of the hard palate” |
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Which of the following is suggesting of an inhaled foreign body in a child on chest x ray
a. Foreign body visible in front of airway b. Hyper-expanded hemithorax c. Collapse |
B |
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What is the distance from the lips to the carina in an 70kg adult male in cm
a. 21 b. 23 c. 25 d. 27 e. 29 |
D |
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What colour is the label for subcutaneously administered drugs
a. Pink b. Yellow c. beige d. Red e. Blue |
C
National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines Intra-arterial = Red Intravenous = Blue Epidural / Intrathecal / Regional = Yellow Subcutaneous = Beige 723 Other routes = Pink |
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How much air is the maximum to that should be used to inflate a 5 LMA classic cuff
a. 15 b. 20 c. 25 d. 40 e. 45 |
D
From the manufacturer guidelines Size 3, suitable for 30-50kg patients, max cuff volume 20mL Size 4, suitable for 50-70kg patients, max cuff volume 30mL Size 5, suitable for 70-100kg patients, max cuff volume 40mL. |
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Where should the tip of an IABP lie
a. 2cm distal to the left subclavian b. 2 cm proximal to the left subclavian c. 2cm proximal to the renal artery d. 2 cm distal to the renal artery |
A
The Carina as a Useful Radiographic Landmark for Positioning the Intraaortic Balloon Pump. Anaesthesia & Analgesia. Vol. 105, No. 3, September 2007 “Ideally, the tip of the balloon should be positioned 2–3 cm distal to the origin of the left subclavian artery (LSCA)” |
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A 60kg female is given 50 mg of rocuronium, she is unable to be intubated, what dose of sugamadex is required to reverse the rocuronium
a. 240 b. 800 c. 960 |
C
Reversal of shallow neuromuscular = 2 mg/kg Reversal of profound neuromuscular blockade = 4 mg/kg Immediate reversal of neuromuscular blockade = 16 mg/kg |
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In a penetrating chest injury what part of the heart is most likely to be injured
a. Left ventricle b. Right ventricle c. Right coronary artery d. Right atrium e. Sinus node |
B
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What is the maximum recommended dose of Intralipid in local anesthetic toxicity (ml/kg)
a. 6 b. 8 c. 10 d. 12 e. 14 |
D |
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What is a contraindication to an IABP?
A. Aortic regurgitation B. Aortic stenosis |
A
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An infant is born with meconium stained liquor and is apnoeic and floppy… your first step should be
a. Stimulate and dry b. Positive pressure ventilation c. Suction the trachea |
C
ARC Guidelines – Management of the Airway in the Presence of Meconium Stained Liquor • Suctioning before delivery makes no difference • Routine suctioning of babies who are vigorous no longer advocated (doesn’t improve outcomes) • No evidence to support or refute endotracheal suctioning in the non-vigorous neonate • If tracheal suctioning is performed it must be accomplished before spontaneous or assisted respirations have commenced… stimulation to breath should not be provided beforehand |
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Central sensitization occurs due to
a. Primary events mediated by the NMDA receptor b. Alterations in gene expression c. Increased magnesium |
B
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What volume of FFP is required to increase fibrinogen level by 1g/L
a. 10-15ml/kg b. 30ml/kg |
B
Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. British Journal of Haematology. 2004 In this study administration of 33ml/Kg of FFP increased Fibrinogen by 1g/L “In group 2, all seven of the patients who had had low coagulation factor levels before FFP had levels above 30 IU/dl post-FFP (33 ml/kg). The median increment for group 2 for the individual coagulation factors was between 17 and 44 IU/ dl. The fibrinogen increased by a median of 1 g/l, although this was not significantly different from group 1” |
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An epidural in a healthy individual causes all EXCEPT
a. Raised Co2 b. Bradycardia c. Vasodilation d. Dyspnea |
A
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In the Revised Trauma Score includes GCS, Blood pressure and what other parameter?
a. HR b. Saturation c. Respiratory rate d. Urine output |
C
The Revised Trauma Score (RTS) is a physiologic scoring system, based on the initial vital signs of a patient. A lower score indicates a higher severity of injury |
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Autologous transfusion results in less
a. Cost b. Blood waste c. Incompatible transfusion d. Unrequired transfusion |
C |
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After an infusion of normal saline causing isovolumetric haemodilution what occurs?
a. Increased cardiac output b. Increase oxygen extraction c. Capillary vasodilatation |
A
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Bleeding in trauma has been shown to be reduced by
a. Tranexamic acid b. Recombinant factor VIIa c. DDAVP d. Prothrombinex |
A
CRASH-2 – Reanalysis published 2012 in Lancet Findings 10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. 1063 deaths (35%) were due to bleeding. We recorded strong evidence that the effect of tranexamic acid on death due to bleeding varied according to the time from injury to treatment (test for interaction p<0•0001). Early treatment (≤1 h from injury) significantly reduced the risk of death due to bleeding (198/3747 [5•3%] events in tranexamic acid group vs 286/3704 [7•7%] in placebo group; relative risk [RR] 0•68, 95% CI 0•57–0•82; p<0•0001). Treatment given between 1 and 3 h also reduced the risk of death due to bleeding (147/3037 [4•8%] vs 184/2996 [6•1%]; RR 0•79, 0•64–0•97; p=0•03). Treatment given after 3 h seemed to increase the risk of death due to bleeding (144/3272 [4•4%] vs 103/3362 [3•1%]; RR 1•44, 1•12–1•84; p=0•004). We recorded no evidence that the effect of tranexamic acid on death due to bleeding varied by systolic blood pressure, Glasgow coma score, or type of injury. Interpretation Tranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful. |
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The time constant of the lung is calculated by
a. Compliance x resistance b. Compliance plus resistance c. Compliance /resistance d. Resistance/compliance |
A
Time constant of the lung. The time taken for a lung unit to empty if the initial rate of emptying were to be continued. Similar concept to half life. Compliance is change in volume for a given change in pressure. As compliance increases, emptying time increases, therefore, time constant increases. Compliance is directly proportional to time constant. Resistance is impediment to flow. As resistance increases, emptying time increases, therefore, time constant increases Resistance is directly proportional to time constant. |
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The commonest post operative complication in a patient with a # NOF is
a. UTI b. Pneumonia c. Delirium d. Myocardial infarction |
C
10-15% according to a BMJ article |
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In an infant, the intercristine line is at the level of
a. L1-L2 b. L2-L3 c. L3-L4 d. L4-L5 e. L5-S1 |
E
CEACCP ‘Local and regional anaesthesia in infants’ The intercristal line is at L5/S1 (L4 in adults), the termination of the spinal cord is at L3 (L1/2 in adults) and the termination of the dura is at S3/4 (S2 in adults). |
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Which of the following is a contra-indication to a left DLT
a. Left pneumonectomy b. Tumour in the left main stem bronchus |
B
Contraindications to a Left DLT • Intra-luminal tumour of l main bronchus • Left bronchial stent in situ • Left tracheo-bronchial disruption • Left pneumonectomy • Left lung transplant |
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What is the commonest symptomatic cardiac condition in pregnancy
a. Mitral stenosis b. Aortic stenosis c. Eisenmengers d. Tetralogy of fallot |
A
Anaesthesia for Caesarean Section in Patients with Cardiac Disease. Journal of The Pakistan Medical Association “Rheumatic heart disease at present is the most common cardiac disorder in pregnancy, with mitral stenosis (MS) as a single most prevalent lesion” |
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What is the ratio of MAC awake:MAC of sevoflurance
a. 0.2 b. 0.34 c. 0.5 |
B
Cerebral Awakening Concentration of Sevoflurane and Isoflurane Predicted During Slow and Fast Alveolar Washout. A & A November 1993 vol. 77 no. 5 1012-1017 Make awake value for sevo = 0.34 |
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Pain from the uterus during labour is transmitted via
a. From the anterior roots of T10-L1 b. Parasympathetic fibres c. The inferior hypogastric plexus d. Via grey rami communicantes |
Answer C
First stage Uterine contractions likely result in myometrial ischaemia causing release of bradykinin, serotonin, histamine, and other mediators. Mechanoreceptors are also stimulated by stretching and distension of the lower uterine segment and cervix. Noxious stimuli then follow sensory nerve fibres that accompany sympathetic nerve endings, travelling through the paracervical region as well as the pelvic and inferior, middle and superior hypogastric plexi to enter the lumbar sympathetic chain. Visceral nociceptive fibres transmit these impulses to the spinal cord through the posterior nerve roots of T10-T11. Second stage Pain occurs due to distension and transient ischaemia of the vaginal canal, vulva, and perineum. These somatic impulses are transmitted by the afferent fibres of the pudendal nerve (S2-S4). Neuraxial blocks need to cover T10-S4 for adequate analgesia in both stages. |
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The features of Pierre Robin sequence include cleft palate, micrognathia and:
A. Glossoptosis B. Craniosynostosis C. Macroglossia D. Microstomia |
A
Wiki PRS is characterized by micrognathia, Glossoptosis (posterior displacement or retraction of the tongue), and cleft palate |
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A size C oxygen cylinder that reads 5000kpa contains approximately how many litres of oxygen
a. 100 b. 150 c. 200 d. 350 e. 600 |
B
Full size C (13700 kPa) = 420 L So 5000/13700 x 420 = 153L |
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A patient having a craniotomy has the CVP/arterial transducers at the level of the right atrium. The head is 13cm above the level of the heart. If the MAP is 80mmHg and the CVP is 5mmHg what is the cerebral perfusion pressure in mmHg |
D. |
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After a procedure with an LMA in situ a patient complains of loss of sensation to the anterior part of the tongue. What nerve is likely damaged?
a. Facial b. Lingual c. Greater palatine d. Glossopharyngeal |
B |
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What statistical test would be best to evaluate the effects of ? 2 drugs in patients at ? 3 different points in time
a. ANOVA b. Mantel Hantzel c. Crusckall Wallis d. Students t test |
A
Apparently ANOVA is used to test for significant differences between the means of two or more groups. Kruskall-Wallis is the non-parametric equivalent |
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A man is working with electrical appliances at home with a residual current device. If he touches the active and the neutral (was it neutral or earth) wire he will suffer
a. A microshock b. A macroshock c. Nothing happens because the fuse blows d. The RCD will protect him from macroshock |
D
RCD will protect him from macroshock RCD will trip with a 30 mA leakage - works on principle that current flowing to and from an appliance (in live and neutral wires) is equal. Current of 100mA required to cause VF when applied to surface of body. Only 0.05 - 0.1 mA required to cause VF when applied directly to myocardium (=microshock) |
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An infant with failure to thrive is noted to have an apical systolic murmur, weak pulses, with the femoral felt most easily. They most likely have
a. Patent ductus arteriosis b. Ventriculoseptal defect |
B
Pansystolic (Holosystolic) murmur along lower left sternal border(depending upon the size of the defect) +/- palpable thrill. Heart sounds are normal. Larger VSDs may cause a parasternal heave, a displaced apex beat. An infant with a large VSD will fail to thrive and become sweaty and tachypnoeic with feeds. The restrictive VSDs (smaller defects) are associated with a louder murmur and more palpable thrill (grade IV murmur). Larger defects may eventually be associated with pulmonary hypertension due to the increased blood flow. Over time this may lead to an Eisenmenger phenomenon: Eisenmenger syndrome refers to any untreated congenital cardiac defect with intracardiac communication that leads to pulmonary hypertension, reversal of flow, and cyanosis.[1, 2, 3] The previous left-to-right shunt is converted into a right-to-left shunt secondary to elevated pulmonary artery pressures and associated pulmonary vascular disease. |
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Which radiological finding is most consistent with atlantoaxial instability in a patient with rheumatoid arthritis
a. A 9mm gap between the anterior arch of C1 and the odontoid peg |
A
Atlantoaxial subluxation occurs in 25% of patients with severe RA Maxiumum gap between odontoid and arch of the atlas is 3mm - more than this is significant |
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What is the most accurate method of determining fetal heart rate in a neonate
a. Palpation of an umbilical vein pulse b. Auscultation with a stethoscope c. Palpation of femoral pulse d. Pulse oximetry |
B
ARC Neonatal Resuscitation • “Heart rate can be determined by listening to the heart with a stethoscope (most reliable) or in the first few minutes after birth, by feeling for pulsations at the base of the umbilical cord” • Pulse oximetry can provide and accurate and continuous display of the heart rate within about a minute of birth” ?more accurate than auscultation |
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In acute liver failure what causes the highest risk of bleeding
a. Thrombocytopenia b. Coagulopathy c. Portal hypertension d. Platelet dysfunction e. |
B
can’t find anything on this Miller • “Perioperative hemorrhage in patients with significant liver dysfunction may occur because of bleeding diatheses or the complications of portal hypertension (or both)” • Portal hypertension → splenomegaly → thrombocytopaenia • “In patients with acute liver failure, plasmapheresis may have potential benefit because it promotes rapid correction of coagulopathy while minimizing volume overload” |
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A patient in recovery post op total hip replacement develops crushing central chest pain, ECG shows ST segment elevation (NB- no BP etc given, beta blockade was not an option). The most appropriate action is to give
a. Aspirin b. IV GTN c. IV heparin d. Calcium channel blocker e. T/L |
A
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Stellate ganglion blockade causes
a. Conjunctival injection b. Dry eyes c. Decreased axillary sweating |
A
UB ‘Cervical Sympathetomy and Stellate Ganglion Block Chron ic Pain Physcians 2000’ Successful sympathetic blockade to the head and neck structures can be easy to recognize clinically and documented by the presence of Horner’s syndrome, which includes myosis (pinpoint pupil), ptosis (dropping of the upper eyelid) enophthalmos; also associated with that are conjunctival injection, nasal congestion and facial anhydrosis. The stellate ganglion (or cervicothoracic ganglion or inferior cervical ganglion) is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion. Stellate ganglion is located at the level of C7, anterior to the transverse process of C7, anterior to the neck of the first rib, and just below the subclavian artery. |
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Features of ventricular tachycardia DO NOT include
a. Absence of p waves b. Monophasic waves c. Prominent R wave in V1 d. A-V dissociation |
A
• False i.e AV dissociation is a sign of VT - P-waves occurring at different rate • Monoasic R-wave in V1 and V6 consistent with RBBB pattern VT • Prominent R-wave in V1 = RBBB pattern VT • AV dissociation consistent with VT |
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An inpatient becomes hyponatraemic 48 hours post op and has a seizure. The most appropriate treatment is
a. Fluid restriction b. Normal saline ?ml/hr c. Hypertonic saline d. Salt tables |
C
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A child with 10% dehydration is likely to have
a. Bradycardia b. Rapid deep breathing |
B
RCH CPG Dehydration Moderate dehydration (4-6%) • Delayed CRT (> 2 secs) • Increased respiratory rate • Mild decreased tissue turgor Severe dehydration (>/= 7%) • Very delayed CRT > 3 secs, mottled skin • Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension) • Deep, acidotic breathing • Decreased tissue turgor |
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When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch?
A. opponens abducens B. abductor pollicis brevis C. adductor pollicis brevis D. extensor pollicis E. flexor pollicis brevis |
C
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When analyising a study containing a control and two test groups, the best statistical method to use is....
A. Analysis of variance B. Chi squared with Bonnferoni correction C. ? D. E. |
A
ANOVA provides a statistical test of whether or not the means of several groups are equal, and therefore generalizes t-test to more than two groups. Doing multiple two-sample t-tests would result in an increased chance of committing a type I error. For this reason, ANOVAs are useful in comparing (testing) three or more means (groups or variables) for statistical significance. |
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Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?
A: Distorted facial anatomy B: Macroglossia C: Glottic stenosis D: Prognathe mandible E: Arthritis of the neck |
B
Acromegalic Features Influencing Intubation Performance Many typical acromegalic features are suggested to cause a difficult airway in these patients. The most discussed changes are: • macroglossia, • prognathism, • enlargement and distortion of glottic structures with additional folds, and hypertrophy of laryngeal and pharyngeal soft tissue. |
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Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive B: Start antiplatelet drugs C: Start anticonvulsants D: Do angio and stent E: Nimodipine |
A
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Main heat loss in anaesthetic for neonate
A. vasodilatation B. radiation C. convection D. conduction E. evaporative |
B
A - Vasodilatation is not a mechanism of heat loss, but it does promote heat loss by speeding up redistribution of heat from the core to the peripheries. B – 40%. Heat can be transferred without the presence of a medium. Thermal radiation is a form of electromagnetic radiation similar to light C – 30%. Convection refers to the movement of molecules away from a warm object as a consequence of their reduced density as they gain heat and expand. This creates convection currents, which transfer heat away from the object D – 5%. Conduction of heat occurs between two objects in direct contact where a temperature gradient exists between them. E – 15%. Evaporation refers to latent heat losses, i.e. when a liquid converts to a gas, it needs to gain energy to do so and this energy in the form of heat is taken from the patient. Respiration – 10%. A form of evaporative heat loss. |
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Patient with aortic stenosis, the signs indicate poor prognosis
A. Palpitation B. Radiation to carotid arteries C. Paroxysmal nocturnal dyspnoea D. Angina E. Syncope |
C
Evaluation and Management of Patients With Aortic Stenosis. Circulation. 2002; 105: 1746-1750 “Survival is nearly normal until the classic symptoms of angina, syncope, or dyspnea develop.1 However, only 50% of patients who present with angina survive 5 years, whereas 50% survival is 3 years for patients who present with syncope and 2 years for patients who present with dyspnea or other manifestation of congestive heart failure” |
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Circuit disconnection during spontaneous breathing anaesthesia
A. will be reliably detected by a fall in end-tidal carbon dioxide concentration B. will be detected early by the low inspired oxygen alarm C. will be most reliably detected by spirometry with minute volume alarms D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration E. can be prevented by using new, single-use tubing |
D
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Which drugs below does not need dose adjustment in renal failure patient
A. Buprenorphine B. Morphine C. Tramadol D. ? E. ? |
A
Buprenorphine – undergoes hepatic N-dealkylation by cytochrome P450 isozymes CYP3A4 (accounts for 65% of metabolism) and CYP2C8 (accounts for 30%) to form the active metabolite nor-buprenorphine. Both compounds then undergo glucuronide conjugation and excretion into the bile. About 10% of the metabolites are eliminated in the urine. Both N-dealkylated and conjugated metabolites are detected in the urine, but most of the drug is excreted unchanged in the faeces. Due to the mainly hepatic elimination, there is no risk of accumulation in patients with renal impairment. |
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Fat: blood coefficient- N2O, Desflurane, Sevoflurane, Isoflurane
A. N2O ~ D > S > I B. N2O > D > S > I C. D > N2O > S > I D. N2O > D > S ~ I E . D > N2O > I > S |
D - except signs are backwards
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The average expected depth of insertion of an oral endotracheal tube, from the lip, in a normal newborn infant is
A. 7.5 cm B. 8.5 cm C. 9.5 cm D. 10.5 cm E. 11.5 cm |
C
Miller: Premature 6-7 Term 8-10 Infants Age/2 + 12 In neonates of various weights (ie to include prems) the formula to remember is weight plus 6. Thus average newborn weight is 3.5kg so average length is 9.5 cm. |
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What is the average distance from the lips to carina in an average 70kg adult male?
A. 21 cm B. 23 C. 25 D. 27 E. 29 |
C
Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients. Indian J Anaesth. 2011 Sep-Oct; 55(5): 488–493 “The mean (SD) lip-carina distance, i.e., total airway length was 24.32 (1.81) cm and 21.62 (1.34) cm in males and females, respectively” |
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Patient with severe Rheumatoid arthritis. Has C1/C2 instability. Most likely C-spine Xr finding would be
A. Anterior Atlantoodental interval >9 B. Increased sagittal diameter C. Posterior atlantodental interval >14 D. Midpart of C1 over C2 E. Tear drop sign of C2 |
A
Most common type of atlanto-axial instability is anterior AAS (80%), where C1 moves forward on C2 from destruction of transverse lig |
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Which nerves need to blocked to anaesthetise the hard palate:
A. Superior labial nerve and greater palatine nerve B. Greater palatine nerve and nasopalatine nerve C. Inferior orbital nerve and nasopalatine nerve D. Glossopharyngeal nerve and… E. Anterior ethmoidal nerve and… |
B
http://ozradonc.wikidot.com/anatomy:focused-hard-palate “The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion. The greater palatine nerve descends through the greater palatine foramen with its companion artery, and runs anteromedially to supply the mucosa of the posterior hard palate. The nasopalatine nerve descends through the incisive foramen to supply the most anterior parts of the hard palate” |
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Patient complains of numbness of the anterior third of his tongue following GA with LMA. Which nerve is involved?
A. Glossopharyngeal B. Facial nerve C. Superior vagus D Mandibular n. |
D
More specifically the lingual nerve (branch on mandibular) Innervation of the Tongue Anterior 2/3rds of tongue • Somatic afferent: lingual nerve branch of V3 of the trigeminal nerve • Taste: chorda tympani branch of facial nerve (carried to the tongue by the lingual nerve) Posterior 1/3rd of tongue • Somatic afferent and taste: Glossopharyngeal nerve CN IX Motor • All intrinsic and extrinsic muscles of the tongue are supplied by the hypoglossal nerve • Except for one of the extrinsic muscles, palatoglossus, which is innervated by CN X |
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Increased risk of post-partum haemorrhage in:
A. Nulliparous patient B. Patient < 20 years old C. Factor V Leiden deficiency D. Oligohydramnios E. Prolonged labour |
E
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Chest Xray findings in a child who has inhaled a foreign body:
A. Opaque mass overlying the airway B. Hyper-expanded lung fields C. Unilateral pulmonary oedema D. Collapsed lung base E. Mediastinal shift |
D
RCH CPG – Inhaled Foreign Body Look for: • an opaque foreign body • segmental or lobar collapse • localised emphysema in expiration (ball valve obstruction) • The CXR may be normal Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatrics in Review 2000 Most common X-ray findings with inhaled foreign body: • Normal – no abnormality • Gas Trapping (due to ball-valve effect of foreign body with respiration) • Mediastinal shift • Atelectasis • Lobar collapse/consolidation |
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Which of the following are feature of Conn’s syndrome?
A. Normoglycaemia, hypernatremia , hypokalemia B. Hypoglycaemia, hypernatremia, hypokalemia C. Hyperglycaemia, hyponatremia, hyperkalemia D. Normoglycaemia, hyponatremia, hyperkalemia E. Hypoglycaemia, hyponatremia, hyperkalemia |
A
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Unequal consolidation on CXR can be caused by all except:
A. Pleural effusion B. Pulmonary infarction C. Pulmonary haemorrhage D. APO E. Pneumonia |
A
B, C, E definitely can cause unequal (i.e. asymmetric) consolidation. For D, APO can be unequal in certain circumstances eg re-expansion of pneumothorax, unilateral PE, unilateral venous occlusion. For A, effusion cannot cause consolidation, but can be unequal. Bottom line: Pulmonary oedema CAN be unilateral, pleural effusion IS NOT CONSOLIDATION |
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What is the mechanism of central sensitisation?
A. Increased intracellular magnesium B. Antagonism of the NMDA receptor C. Glycine is the major neurotransmitter involved D. Recurrent a-delta fibre activation E. Alteration in gene expression |
E
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What is the resus dose of atropine and adrenaline when given via ETT compared to IV
A. x 0.5 B. No change C. x 2 D. x 4 E. x 6 |
D
ARC Resus guidelines say 3-10x the dose if given via the endotracheal route |
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A home handyman leaves his electricity turned on whilst fiddling with wires [repairing a power outlet]. He has a RCD. What happens if he touches the neutral and ground wires?
A. Nothing will happen B. Receives macroshock C. Protected from macroshock by RCD D. Protected from microshock by domestic fuse E Receives microshock |
A
No flow from neutral to ground |
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If a patient experiences parasthesia in the little finger during supraclavicular brachial plexus block, the needle is in proximity to the
A. posterior cord B. middle trunk C. Ulnar nerve D. lower trunk E. medial cord |
D
Sensation in this area is C8distribution, supplied by the ulnar nerve, medial cord, lower trunk |
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What is the best predictor of severe bleeding in cirrhosis?
A. Thrombocytopaenia B. Hypofibrinogenaemia C. Prolonged PT D. Hypoalbuminaemia E. Pulmonary hypertension |
A
OHA says that bleeding is more likely due to thrombocytopaenia than clotting factor deficiency A lot of other sites just say it is a multi-factorial process ‘Among patients with cirrhosis, 40% had an abnormal bleeding time (> 10 min), and 42% had a platelet count < 100,000/microliters. Patients with severe liver failure (class C) had a lower platelet count and a more prolonged bleeding time than patients in classes A and B. Bleeding time was significantly inversely correlated to platelet count, fibrinogen, prothrombin activity and packed cell volume, and directly correlated to serum bilirubin and D-dimer. However, in class C patients, only a significant inverse correlation between bleeding time and fibrinogen was observed.’ |
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What is the dose of FFP required to increase fibrinogen levels by 1 g/L
A. 2 ml/kg B. 5 C. 10 D. 20 E. 30 |
E
Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. British Journal of Haematology. 2004 In this study administration of 33ml/Kg of FFP increased Fibrinogen by 1g/L “In group 2, all seven of the patients who had had low coagulation factor levels before FFP had levels above 30 IU/dl post-FFP (33 ml/kg). The median increment for group 2 for the individual coagulation factors was between 17 and 44 IU/ dl. The fibrinogen increased by a median of 1 g/l, although this was not significantly different from group 1” |
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What is the oxygen concentration in a standard bottle of heliox?
21% 25% 30% 33% 28% was NOT an option |
A
Peck, Hill & Williams 21% oxygen, 79% Helium |
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A C size oxygen cylinder (A size in New Zealand) reads 5000kPa. How much oxygen remains?
A. 50 Litres B. 150 litres C. 500 D. 750 E. 1500 |
B
Full size C (13700 kPa) = 420 L So 5000/13700 x 420 = 153L |
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Patient undergoing partial hepatic resection develops Venous Air Embolism. Best position should be
A. Head down left side up B. Head down right side up C. Head up right side up D. Head up left side up |
B
Open Anaesthesia: “place patient in left lateral decubitus and Trendelenburg” |
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What is the ratio of compressions to breaths in neonatal resus?
A. 3:1 |
A
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Which drug has the best evidence for reducing blood loss in trauma?
A. Aminocaproic acid B. Novo 7 C. Prothrombinex D. Tranexamic acid E. Aprotinin |
D
CRASH-2 Trial |
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The pain of the first stage of labour is transmitted by:
A. Grey rami communicantes B. T10-L1 anterior roots C. The hypogastric plexus D. Inhibitory nerves to the internal vesical sphincter E. Parasympathetic nerves |
C
OpenAnaesthesia “Pain travels via sympathetic nerve fibers (going through the inferior hypogastric plexus on the way to the sympathetic chain) that originate from the T10-L1 segments of the spinal cord |
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You are asked by an Obstetrician to help relax a uterus in labour and deliver for manual removal of placenta. What is a safe and effective dose of IV GTN to be delivered?
A. 5 mcg B. 50 mcg C. 250 mcg D. 400 mcg E. 500 mcg |
B
Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2008. Vol 37 Issue 1 “A retrospective chart review of all anaesthesia consultations for retained placenta at 28 weeks' gestational age or more was performed to determine the safety and efficacy of intravenous glyceryl trinitrate therapy in the management of retained placenta. Of the 33 patients who received glyceryl trinitrate, 1 received a total dose of 50 μg and the remainder received 100 to 200 μg. All placentas were extracted within 4 minutes of the first bolus. The systolic and diastolic blood pressures and the haematocrit fell by a mean of 8.1 ±5.3 mmHg, 6.0 ± 3.5 mmHg, and 2.6 ± 1.7%, respectively (mean difference ± SD, p<0.05 for each). The pulse rose by a mean of 7.7 ±4.5 bpm (p<0.001). Only 1 patient required ergometrine for continued atony. None of the patients required transfusions or operative therapy other than dilatation and curettage. The use of glyceryl trinitrate in doses of 200ug or less for retained placenta appears efficacious and safe, and may obviate the need for general anaesthesia for uterine relaxation” |
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Middle-aged male with severe MS having general anaesthesia for repair of fractured ulna / radius. 10 minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70. He is normally in sinus. What do you do?
A. Adenosine B.Amiodarone C. Shock D. Volume E. Metaraminol |
C
With increasing stenosis, passive filling of LV becomes more difficult and atrial contraction becomes more important. This contribution of atrial kick increases from 15-40%. So such an arrhythmia will be poorly tolerated and needs raid reversion to SR |
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The ratio of MAC to MAC Awake for sevoflurane is:
A. 0.22 B. 0.33 |
B
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A lady with a Fontan’s circulation for tricuspid atresia presents for caesarian section. What is the best way of maintaining her cardiac output?
A. Trendelenburg B. Epidural contraindicated C. Allow pCO2 to rise to 50 to vasodilate her D. Short inspiratory time E. Allow hypovolaemia |
A
CEACCP ‘The Fontan circulation’ Best answer A – There is some data suggesting the best way to manage hypotension (at least in epidural caesarean) with Fontan is trend/antitrend and fluids. B – No, careful titration and volume repletion can offset the decreased SVR and relative hypovolaemia. This is possibly better than IPPV. C – No, hypercarbia will increase PVR and be bad. Second coice D – Yes if IPPV necessary. Ideally spontaneous breathing is best. But if the patient were intubated and paralysed, low respiratory rates, short inspiratory times, low PEEP, and tidal volumes of 5–6 ml.kg-1 usually allow adequate pulmonary blood flow, normocarbia, and a low PVR. Hyperventilation tends to impair pulmonary blood flow, despite the induced respiratory alkalosis, because of the increased mean intrathoracic pressure. E – No, this will decrease CVP, the driving pressure for pulmonary circulation |
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What is the cerebral perfusion pressure if MAP 80, CVP 5, both at the level of the RA with the tragus 13 cm above the RA?
A. 62 mmHg B. 65 C. 75 D. 80 |
Probably 70mmHg
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What is the best way to measure neonatal heart rate during resus?
A. Palpate a femoral artery B. Palpate a carotid artery C. Auscultate the precordium D. Palpate the umbilical stump |
C
ARC Neonatal Resuscitation • “Heart rate can be determined by listening to the heart with a stethoscope (most reliable) or in the first few minutes after birth, by feeling for pulsations at the base of the umbilical cord” • Pulse oximetry can provide and accurate and continuous display of the heart rate within about a minute of birth” ?more accurate than auscultation |
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A term primip with meconium-stained liquor has a caesarian section. On initial assessment the neonate if pale and floppy with a heart rate of 90 bpm. Initial treatment should be:
A. Positive pressure ventilation B. Dry and stimulate C. Suction the trachea D. Start CPR |
C
ARC Guidelines – Management of the Airway in the Presence of Meconium Stained Liquor • Suctioning before delivery makes no difference • Routine suctioning of babies who are vigorous no longer advocated (doesn’t improve outcomes) • No evidence to support or refute endotracheal suctioning in the non-vigorous neonate • If tracheal suctioning is performed it must be accomplished before spontaneous or assisted respirations have commenced… stimulation to breath should not be provided beforehand |
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The most common clinically significant valvular lesion in pregnancy is:
A. MS B. MR C. AS D. AR E. TR |
A
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During prolonged trendelenburg positioning there is:
A. No change in ICP B. No change in IOP C. Increased pulmonary compliance D. Increased myocardial work E. No increased pulmonary venous pressures |
D
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How do you calculate the inspiratory time constant for lungs
A. resistance multiplied by compliance B. resistance divided by compliance C. compliance divided by resistance D. resistance minus compliance E. resistance plus compliance |
A
Lung Mechanics & Mechanical Ventilation - Lexington Pulmonary and Critical Care Mathematically, the time constant is defined as compliance multiplied by the airway resistance and the resulting value has units of seconds of time |
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What is the best indicator of pending respiratory depression when using a morphine PCA
A. Respiratory rate B. Sedation score C. Reduced saturations |
B
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A 60kg 17 year old female given 50 mg rocuronium for RSI. You can’t intubate or ventilate. What is the appropriate dose of sugammadex?
A. 300mg B. 600mg C. 920mg D. 1300mg |
C
Well actually 960mg Reversal of shallow neuromuscular = 2 mg/kg Reversal of profound neuromuscular blockade = 4 mg/kg Immediate reversal of neuromuscular blockade = 16 mg/kg |
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What is the maximum dose of Intralipid during LA toxicity resus?
A. 8ml/kg B. 10 C. 12 D. 16 |
C
Association of Anaesthetists Great Britain & Ireland (AAGBI) • Bolus 1.5ml/kg • Infusion 0.25ml/kg/min • Two further boluses 1.5ml/kg • Increase infusion to 0.5ml/kg/min Maximum 12 mL/kg |
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What is the immediate compensation for the dilutional anaemia when 3 litres of normal saline is given at the start of a case?
A. Increased CO B. Capillary dilatation C. Increased oxygen delivery D. Right shift in the oxygen dissociation curve |
A
Isovolaemic haemodilution leads to a decrease in [Hb]. Without a significant increase in either SaO2 or paO2 (not possible in the standard state at sea level and room air), the only way to return oxygen flux to normal is through an increase in CO. |
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NEW Alcoholic patient undergoes unremarkable anaesthesia for explorative laparotomy for investigation of abdominal pain. No pathology is found. However, in recovery the following electrolyte disturbances found:
Na 140 K 5.0 CL 115 HCO 18 What is the most likely cause A. Acute renal failure B. Lactatic acidosis C. Methanol ingestion D. Chloride [N/saline resuscitation] E DKA |
D
Anion gap (140 + 5) – (115 + 18) = 12 With modern analysers, upper limit of normal is (10-12). Used to be 16. A. Renal failure increases the anion gap due to accumulation of organic acids B. Raised anion gap C. Raised anion gap D. Correct E. Raised anion gap Other causes of raised anion gap: MUDPILES (methanol, uremia, diabetic ketoacidosis, propylene glycol, alcohol, lactic acidosis, ethylene glycol, rhabdomyolysis, salicylates) Other causes of normal anion gap: HARD-UP (Hyperalimentation, Acetazolamide and other carbonic anhydrase inhibitors, Renal tubular acidosis, Diarrhoea, Ureteroenteric fistula, Pancreaticoduodenal fistula) Hyperalimentation refers to a state where quantities of food consumed are greater than appropriate. It includes overeating, as well as other routes of administration such as in parenteral nutrition. |
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The plasma half-life of clopidogrel is:
A. 6 hrs B. 14 hrs C. 24 hrs D. 7 days E. 14 days |
A
Clopidogrel product information “After a single, oral dose of 75 mg, clopidogrel has a half-life of approximately 6 hours” |
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Isoflurane vaporiser giving 3%. What is the splitting ratio?
A. 1:3 B. 1:9 C. 1:13 D. 1:20 E. 1:27 |
C
Well, almost Dorsh & Dorsh “The ratio of bypass gas to gas going to the vaporizing chamber is called the splitting ratio and depends on the ratio of resistances in the two pathways” http://www.anesthesia2000.com/physics/Chemistry_Physics/physics17.htm Isoflurane 3% = 1:14 |
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The line between the iliac crests in a neonate corresponds to:
A. L2/3 B. L3/4 C. L4/5 D. L5/S1 E. S1/2 |
D
Local and regional anaesthesia in infants. CEACCP 2004 “The intercristal line is at L5/S1 (L4 in adults), the termination of the spinal cord is at L3 (L1/2 in adults) and the termination of the dura is at S3/4 (S2 in adults)” |
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In a neonate the main resistance in a circle system with CO2 absorber
A. APL valve B. Expiratory and inspiratory unidirectional valves C. tubing D. ETT E. HME filter |
D
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Blood flow across which of the following is used to estimate pulmonary artery pressures during echocardiography?
A. Tricuspid valve B. Pulmonary valve C. Mitral Valve |
A
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Which patient do you not put a left-sided Robert-Shaw DLT into?
A. Left pneumonectomy B. Left main bronchial lesion C. There is a right-sided broncho-pleural fistula D. The patient has shunt > 10% E. The left lung is to be collapsed |
B
Contraindications to a Left DLT • Intra-luminal tumour of l main bronchus • Left bronchial stent in situ • Left tracheo-bronchial disruption • Left pneumonectomy • Left lung transplant |
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An infant born at 32 weeks gestational age comes at 6 weeks for elective bilateral inguinal hernia repair. The parents expect to take him home that day. What do you tell them?
A. He cannot have surgery until he is 3 months old B. They can take him home that day C. They can take him home with apnoea monitoring overnight D. He needs to stay in hospital for apnoea monitoring |
D
CEACCP ‘Paediatric day-case anaesthesia’ Healthy, term infants may be anaesthetised for minor procedures as day-cases provided paediatric anaesthetists are involved and in-patient neonatal care is available, if required. Pre-term or former preterm infants are not suitable for day care as they are at risk of postoperative apnoeic episodes necessitating in-patient observation. The age at which former pre-term infants may be safely managed as day-cases is unknown but most authorities will not contemplate it until the child is at least 50 weeks’ post conceptual age, or older if there is evidence of chronic lung disease (e.g. bronchopulmonary dysplasia). Option A would only make the infant 44 weeks post-conceptual age. |
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A machine with a soda lime absorber was left on overnight with oxygen running at 6 litres per minute. In the morning a desflurane vaporiser is connected. What toxic substance may be produced?
A. Substance A B. Carbon monoxide C. Carbon dioxide D. Calcium hydroxide E. Substance B |
B
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A post-op child being given 2.5%D + 1/2NS on the ward seizes, is intubated and ventilated and transferred to ICU. Sodium is 116. What do you do?
A. Give phenytoin B. Give hypertonic saline C. Give normal saline D. Give frusemide E. Give normal saline |
B
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Which is not a side effect of cyclosporine?
A. Alopecia B. Gingival hyperplasia C. Hypertension D. Renal impairment |
A
Cyclosporin product information • No mention of alopecia • Hypertension in up to 50% • Impaired renal function very common • Gum hyperplasia very common |
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New national labelling standards endorsed by ANZCA. What colour should the label on a subcutaneous ketamine infusion be?
A. Red B. Blue C. Beige D. Yellow E. Pink |
C
National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines Intra-arterial = Red Intravenous = Blue Epidural / Intrathecal / Regional = Yellow Subcutaneous = Beige 723 Other routes = Pink |
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Poor prognosis of AS
A. PND B. Chest pain C. Palpitation D. Syncope E. Malaise |
A
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Required for diagnosis of Neuroleptic Malignant Syndrome
A. Diaphoresis B. ↑ CK C. Rigidity D. Hypertenion E. ↑ HR |
C
An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry. 2011 Sep Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia,>100.4°F or>38.0°C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation,≥25% above baseline; blood pressure fluctuation,≥20 mm Hg (diastolic) or≥25 mm Hg (systolic) change within 24 hours; tachycardia,≥25% above baseline; and tachypnea,≥50% above baseline According to DSM-V Rigidity is a must have characteristic |
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Atrial septal defect, where is the murmur heard the loadest?
A. PV B. MV C. ASD D. AV E. TV |
A
“ASD with moderate-to-large left-to-right shunts result in increased right ventricular stroke volume across the pulmonary outflow tract creating a crescendo-decrescendo systolic ejection murmur. This murmur is heard in the second intercostal space at the upper left sternal border” |
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Young infant with Failure to Thrive. Born on the 20th percentile now is on the 5th percentile. Found to have a systolic murmur, tachynpnoea with weak femoral pulse. The most likely diagnosis is
a. Coarctation b. HOCM c. PDA d. AS |
A
Professional guide to diseases – Coarctation of Aorta • Cardinal Features: resting systolic hypertension, absent or diminished femoral pulses, wide pulse pressure • Signs in 1st year of life: tachypnoea, pallor, tachycardia, failure to thrive, cardiomegaly, pulmonary oedema, hepatomegaly |
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Myasthenia gravis, Eaton Lambert Syndrome What happens with exercise?
a. MG better, EL worse b. EL better, MG worse c. Both EL and MG get worse d. Both EL and MG get better |
B
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Cephalothin doesn't cover:
a. Proteus b. E coli c. Staph d. Strep e. Pseudomonas |
E
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Regarding PS9 safe provision of anaesthesia for Colonoscopy:
A. Medical Practitioner to providing sedation with a skilled assistant who is not assisting the proceduralist. B. Medical practitioner alone C. Specialist Anaesthetist D. Skilled nurse with airway experience E. Skilled bogan |
A
Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (PS9 2010) “5.1 - Except for very light conscious sedation and/or analgesic techniques such as inhaled nitrous oxide or low dose oral sedation, there must be a minimum of three appropriately trained staff present: the proceduralist, the medical or dental practitioner administering sedation and monitoring the patient, and at least one additional staff member to provide assistance to the proceduralist and/or the practitioner providing sedation as required” |
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You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?
a. Frusemide b. Amiodarone c. ACE d. Digoxin e. Biventricular pacemaker |
C
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Young child with WPW undergoes general anaesthesia. Intra operatively developed tachycardia. HR 220, BP 80/40. Best drug to cardiovert
A. Adenosine B. Amiodarone C. |
B
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Finding on haemophilia A patient
A. Female haemarthrosis B. Male haemarthrosis C. Normal PT, abnormal APTT D. Abnormal PT, normal APTT |
C
Patients with hemophilia A have a normal prothrombin time (PT), thrombin clotting time, and bleeding time and a prolonged partial thromboplastin time (aPTT). The definitive diagnosis relies on the assay for factor VIII coagulant activity. Hemophilia A is an X-linked recessive hereditary disorder characterized by a deficient or defective factor VIII coagulant. Factor VIII, activated by thrombin, is a cofactor that markedly enhances, by several thousandfold, activated factor IX on the surface of platelets to form a functional factor X-activating complex. The protein is produced predominantly in the liver as well as in the spleen, endothelium, and reticuloendothelial cells. The disorder occurs in roughly 1 out of every 10,000 live male births. Carriers of the deficiency have over 50% of normal factor VIII levels and are generally asymptomatic. |
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32 y/o male. Weakness distal and prox muscles, infection 10 days ago, no sensory involvement, temp 37.8, facial weakness. Cause:
A. Guillian Barre B. Myasthenia Gravis D. Poliomyelitis E. ?Acute encephalitis F. ?Polymyositis |
A
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What gestation to monitor uteroplacental flow
A 20 weeks B 24 weeks C 28 weeks D 32 weeks E 36 weeks |
B
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Cause of hypoxia in 1 lung ventilation?
A Blood to non-ventilated lung B V/Q mismatch in ventilated lung C ?hypoxic pulm vasoconstriction |
A
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Endocarditis prophylaxis
A Bicuspid valve B Congenital repair > 12 months ago C Rheumatic heart valve D Uncorrected cyanotic heart disease E MVP + ?MR |
D
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Area burnt in adult male - upper half of upper limb, anterior abdo, whole left leg:
A 23% [changed figure compared to prev years] B 32% |
B
Around 31.5% according to rule of 9’s technique (i.e 4.5 upper arm, 9 ant abdo, 18 whole leg) |
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Best position for tip of IABP is 1-2 cm:
A Distal to Left subclavian artery B Proximal to Left subclavian artery |
A
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VT features:
A monophasic V6 B QRS > 0.14 C Right axis deviation |
B
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70 y/o postop in recovery following hip surgery. Develops severe chest pain, ST elevation. Immediate mx:
A Beta blocker B Aspirin C GTN infusion D Heparin infusion |
B
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The muscles of the upper eyelid receive a somatic nerve
supply from the A. oculomotor nerve and a parasympathetic supply from the superior vagus nerve B. oculomotor nerve and a sympathetic supply from the superior cervical ganglion C. ophthalmic division of the trigeminal nerve and a parasympathetic supply from the superior vagus nerve D. ophthalmic division of the trigeminal nerve and a sympathetic supply from the superior cervical ganglion E. ophthalmic division of the facial nerve only |
B
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A line isolation monitor protects against microshock
A. only if the warning current is set at 10mA B. only if the warning current is set at 30mA C. under no circumstances D. only if the equipment used is grounded E. only if it monitors all the equipment in the region |
C
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The commonest initial presenting feature in anaphylaxis is
A. coughing B. desaturation C. hypotension D. rash E. wheeze |
C
CEACCP anaphylaxis. Commonest presenting feature is absent pulse or hypotension 28% Next is difficult lung inflation 26% Flushing 21% |
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Following a left sided pneumonectomy, a left intercostal drain is placed and connected to an underwater drainage system. In the postoperative period:
A. a leakage of air is expected from the drain B. the patient should be nursed in the right lateral decubitus position C. the underwater seal drain should be left on continuous free drainage D. the underwater seal drain should be left on continuous free drainage, and connected to wall suction for 5 minutes every hour E. the underwater seal drain should remain clamped and be released for a short period every hour |
E
No negative ICP Do not allow to lie in lateral with operative side down |
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Most safe side to insert subtenon block
Most safe side to insert subtenon block A. Inferonasal B. Inferotemporal C. Medial D. Superonasal E. Superotemporal |
A
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Levosemendin:
A. Increases contractility and myocardial oxygen consumption B. Increases SVR C. Binds to troponin C and induces a conformational change D. Increases contractility by increasing calcium influx E. Causes coronary vasodilation but NOT peripheral vasodilation |
C
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During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring?
A: Dorsal column B: Spinothalamic tract C: Lateral Corticospinal tract D: Cerebrospinal tract E: Anterior horn cells |
A
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What is the major cause of death in a patient with perforation of the pharynx, oesophagus or trachea?
A: failure to intubate B: failure to ventilation C: sepsis |
C
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You are asked to see a 60-year-old male 2 days following a cervical laminectomy because he has new neurological symptoms in his right arm. The surgical team think these may be due to poor patient positioning. The sign that would most help differentiate a C8-T1 nerve root injury from an ulnar nerve injury is
A. loss of sensation in the index finger B. loss of sensation in the little finger C. weakness of the abductor digiti minimi muscle D. weakness of the abductor pollicis brevis muscle E. weakness of the first dorsal interosseous muscle |
D
Abductor pollicis brevis is innervated by the median nerve (C5-T1) |
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An infant is anaesthetised and ventilated using an endotracheal tube and circle breathing system with CO2 absorber. The item which causes the most resistance to breathing is the
A. airway pressure limiting (APL) valve B. circuit hosing C. endotracheal tube D. heat and moisture exchange filter E. inspiratory and expiratory valves |
C
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When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch?
A. opponens abducens B. abductor pollicis brevis C. adductor pollicis brevis D. extensor pollicis E. flexor pollicis brevis |
C
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In congenital diaphragmatic hernia
A. there is hyperplasia of pulmonary arterioles in the hypoplastic lung B. right-sided lesions are more pathologically significant C. vasodilator drugs are contraindicated D. right-sided lesions through the foramen of Bochdalek are the most common E. intrapulmonary shunts are the major cause of cyanosis |
A
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What will not increase A-a gradient
a. decreased cardiac output b.. Increased FiO2 c. Decreased FiO2 d. increased shunt |
C
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Wolf Parkinson White Syndrome:
a. PR interval lenghtened b. [Something about delta wave] c. DCR is less effective d. Central IV access may precipitate arrythmias |
D
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