Anzca Mcq 2012 B

Front 1

Half-life of mast cell tryptase?
A. 1 hour
B. 2 hours

Back 1

B

NICE Guidelines Anaphylaxis
“Very low-quality evidence from six observational studies including 147 patients showed that the half-life of tryptase ranged from 30 minutes to 300 minutes (median 90 minutes)”

Mayo Medical Laboratories
After anaphylaxis, mast cell granules release tryptase; measurable amounts are found in blood, generally within 30 to 60 minutes. The levels decline under first-order kinetics with half-life of approximately 2 hours.

Front 2

Best single predictor of difficult intubation in obese patient?
A. Mallampati score
B. Interincisor distance
C. Severe OSA

Back 2

Pretracheal tissue Volume or Neck Circumference are best single predictors.

Morbid Obesity and Tracheal Intubation. A & A March 2002 vol. 94
“In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (≥3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation”

Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients
Anesth Analg. 2009 Oct;109(4):1182-6

Front 3

Endocarditis prophylaxis is appropriate in?
A. Unrepaired CHD

Back 3

A

Front 4

Emergency caesarean section for foetal distress (and foetal acidosis on scalp probe?). what is best option to raise gastric pH preop:
A)Oral Na Citrate
B)Ranitidine IV
C)Ranitidine oral
D)Omeprazole IV
E)Omeprazole oral
F)Metoclopramide 20 IV

Back 4

A

Given urgency of case. Most rapid acting.

If 30min, consider Ranitidine iv 50mg.

If 2hr, consider oral Ranitidine 300mg

PPI require 12hrs

Ref: Obstetric Anaesthesists' Association UK

Front 5

Most common cause of mortality post transfusion?
A. TRALI
B. Contamination/infection
C. Mismatched blood
D. GvHD
E. Anaphylaxis

Back 5

A

Ref: Transfusion.com.au

Front 6

Most common cause of awareness?
A. Failure to check apparatus

Back 6

Human error on many other versions of this question

Front 7

Apnoeic oxygenation in obese patient can be increased by
A. Sniffing position
B. Prone
C. Supine
D. Lateral
E. Head up

Back 7

E

Front 8

Best renal protection for endoluminal AAA repair?
A. NaCl
B. NAC

Back 8

A

Front 9

Indicator in sodalime?
A. Ethyl violet
B. Potassium permangenate
C. Blue ?
D. ?
E. ?

Back 9

A

Front 10

Desflurane vaporiser heated because:
A. High SVP

Back 10

A

88.5 kPa at 20C
Heated to 39C, SVP of 1550 mmHg

Front 11

What is NOT a disadvantage of drawover vaporizer?
A. Basic temperature compensation
B. Basic flow compensation

Back 11

Previously remembered version included:

Can not use Sevoflurane

Front 12

FOB - can see a trifurcation. Where are you?
A. RUL
B. ?

Back 12

A

Front 13

White cylinder with grey shoulder?
A. CO2
B. Air
C. O2
D. N2O
E. N2

Back 13

A

www.anaesthesia.med.usyd.edu.au/resources/lectures/gas_supplies_clt/gas_supplies.html
Specific gases are assigned the following colours:
• oxygen (white), nitrous (blue)
• nitrogen (black)
• acetylene (maroon), medical ethylene (violet), medical cyclopropane (orange)
• carbon dioxide (grey), helium (brown) and argon (dark green)
• medical breathing gas mixtures containing oxygen and an inert gas must be marked with alternating white and the second gas's colour on the shoulder e.g. black + white for air, brown + white for Heliox, etc.

Front 14

Photograph of an Arndt endobronchial blocker. Orifice labelled 'X'. What goes in 'X'?
A. Bronchoscope

Back 14

A

Front 15

Intubating over a bougie. Rotate ETT?
A. 90 degrees anticlockwise
B. 90 degrees clockwise
C. 270 degrees anticlockwise
D. 45 degrees either direction

Back 15

A

Front 16

Air bubble leads to decreased:
A. Damping coefficient
B. Resonant frequency

Back 16

B
increase system damping
lowers natural frequency

Front 17

All of the following may be associated with ulcerative colitis EXCEPT
A. cirrhosis
B. iritis
C. psoriasis
D. arthritis
E. sclerosing cholangitis

Back 17

C

Psoriasis/Psoriatic Arthritis is associated with Crohn's, not UC

Front 18

At what valve area do you begin to get symptoms, at rest, with mitral stenosis?
A. 4.5 cm2
B. 3.5 cm2
C. 2.5 cm2
D. 1.5 cm2
E. 1.0 cm2

Back 18

D

The challenge of valvular heart disease. Cleveland Clinic Journal Of Medicine, Volume 71, Number 6, June 2004
When is it time to operate? “Mitral stenosis is most commonly caused by damage to the mitral valve from rheumatic fever, after which there typically is a long period of asymptomatic progressive valve narrowing. Symptoms at rest are rare until the mitral valve area is less than 1.5 cm2”

Front 19

75 year old with non-valvular AF usually on warfarin has their warfarin stopped for one week. What is their daily risk of stroke?
A: 1%
B: 0.1%
C: 0.01%
D: 4%
E: 10%

Back 19

C

Front 20

Abnormal Q waves are NOT a feature of the ECG in
A. an old myocardial infarction
B. left bundle branch block
C. recent transmural myocardial infarction
D. digitalis toxicity
E. Wolff-Parkinson-White syndrome

Back 20

D

Features Digitalis toxicity: arrhythmias, VEBs

Digoxin effect on ECG: prolonged PR, sagging ST segment, VEB, arrhythmias, Short QT, T wave abnormality, U wave

Front 21

cTnI remains elevated for up to?
A. 5-14 days

Back 21

A

Front 22

With regard to Digoxin toxicity which of the following is NOT a feature?
A. Atrial flutter

Back 22

Clinical Features
• GIT: Nausea, vomiting, anorexia, diarrhoea
• Visual: Blurred vision, yellow/green discolouration, haloes
• CVS: Palpitations, syncope, dyspnoea
• CNS: Confusion, dizziness, delirium, fatigue

Electrocardiographic Features
• Digoxin can cause a multitude of dysrhythmias, due to increased automaticity (increased intracellular calcium) and decreased AV conduction (increased vagal effects at the AV node)
• The classic dysrhythmia associated with digoxin toxicity is the combination of a supraventricular tachycardia (due to increased automaticity) with a slow ventricular response (due to decreased AV conduction), e.g. ’atrial tachycardia with block’.

Other arrhythmias associated with digoxin toxicity are:
• Frequent PVCs (the most common abnormality), including ventricular bigeminy and trigeminy
• Sinus bradycardia or slow AF
• Any type of AV block (1st degree, 2nd degree & 3rd degree)
• Regularised AF = AF with complete heart block and a junctional or ventricular escape rhythm
• Ventricular tachycardia, including polymorphic and bidirectional VT

Front 23

Inverted p-waves in lead II may be caused by?
A. Junctional rhythm

Back 23

A

Junctional rhythm or ectopic pacemaker

Ref: LITFL

Front 24

Hb 80 g/L with reticulocyte 10%:
A. Hereditary spherocytosis

Back 24

A

Front 25

Pulsus paradoxus in constrictive pericarditis:
A. Decreased BP with inspiration
B. Decreased BP with inspiration greater than normal

Back 25

B

Front 26

Which type of aortic dissection is typically managed non-operatively?
A. Debakey Type I
B. Debakey Type II
C. Stanford A
D. Stanford B
E. Stanford C

Back 26

D

eMedicine - Emergent Management of Acute Aortic Dissection
Stanford classification
“The Stanford classification divides dissections into 2 types, type A and type B. Type A involves the ascending aorta (DeBakey types I and II); type B does not (DeBakey type III).

This system helps to delineate treatment. Usually, type A dissections require surgery, while type B dissections may be managed medically under most conditions.”

Front 27

Absolute CI to the sitting position in neurosurgical patient?
A. Patent VA shunt
B. Small PFO

Back 27

A

ABSOLUTE CONTRAINDICATIONS
• Patent ventriculo-atrial shunt
• Severe cardiovascular disease
• Large patent foramen ovale or other pulmonary-systemic shunt
• Cerebral ischaemia when upright and awake
• Anaesthesia or surgical team not familiar with the position

Front 28

Acute visual loss after non-ocular surgery is most commonly caused by
A. ischaemic optic neuropathy
B. prolonged direct compression of the globe
C. cortical blindness
D. retinal artery occlusion
E. electrolyte imbalance

Back 28

A

ION post common cause of post-operative blindness (Ant>Post)

Front 29

When do most patients with SAH rebleed?
A. 0-24 hours

Back 29

A

Rebleeding after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2011 Sep;15(2):241-6

“Rebleeding after initial aneurysmal subarachnoid hemorrhage (SAH) can have substantial impact on overall patient outcome. While older studies have suggested rebleeding occurs in about 4% of patients during the first day after initial aneurysmal bleed”

Front 30

Unstable patient. Suspect aortic dissection. Most appropriate investigation?
A. TOE
B. MRI

Back 30

A

Front 31

Contraindication to IABP?
A. AR

Back 31

A

Front 32

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

Back 32

D

Front 33

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

Back 33

A

Front 34

Estimate GCS post head-trauma. E - Response to pain V - Mumbling incoherently M - Withdraws to pain (attempted IV cannulation)
A. 8
B. 9

Back 34

A

Best Eye Response. (4)
1. No eye opening.
2. Eye opening to pain.
3. Eye opening to verbal command.
4. Eyes open spontaneously.


Best Verbal Response. (5)
1. No verbal response
2. Incomprehensible sounds.
3. Inappropriate words.
4. Confused
5. Orientated

Best Motor Response. (6)
1. No motor response.
2. Extension to pain.
3. Flexion to pain.
4. Withdrawal from pain.
5. Localising pain.
6. Obeys Commands.

Front 35

Incidence of headache in first week post-partum?

39%

Back 35

CEACCP - Postpartum headache: diagnosis and management 2011

“Postpartum headache is described as a complaint of headache and neck or shoulder pain in the first 6 weeks after delivery. It is one of the most common symptoms with up to 39% of parturients experiencing headache in the first postpartum week”

Front 36

Oxycodone 20mg SR / Naloxone 20 mcg:
A. Decreased constipation
B. Reduced risk of drug misuse/abuse

Back 36

A

Front 37

Bowel surgery patient. Best method for intraoperative optimization of fluid therapy?
A. Arterial pulse pressure contour analysis
B. CVP
C. PAOP
D. UO

Back 37

A

Perhaps SVV or oesophageal doppler would be better?

Update in Anaesthesia - Enhanced recovery after surgery - current trends in perioperative care
“Accurate fluid management and resuscitation requires regular reassessment of physiological parameters and, where available, invasive haemodynamic monitoring. Historically this has been provided by pulmonary artery catheters, but these are increasingly being replaced by targeted stroke volume optimisation with oesophageal Doppler probes. Given the relative simplicity and lack
of complications, where available the latter is the recommended method of guiding fluid administration in the operating room”

Front 38

In what proportion of people is the AV node supplied by the R coronary artery?

Back 38

Anatomy for Anaesthetist:
“The atrioventricular node is perfused by the right coronary artery in 80% of subjects”

Front 39

Epidural block to T2 causes all of the following EXCEPT:
A. Bradycardia
B. Vasodilatation
C. Reduced circulating catecholamines
D. Dyspnoea
E. Elevated PaCO2

Back 39

E

Front 40

Preoperative autologous blood donation results in less:
A. Cost
B. Incompatible transfusion
C. Less blood wastage
D. Less unnecessary transfusion

Back 40

B

Front 41

You see a patient in your clinic for a total knee replacement. He is 65 and has atrial fibrillation for which he takes dabigatran. He is otherwise well. A spinal anaesthetic is planned. What is the correct advice regarding his medication?
a. he should stop his dabigatran 7 days prior
b. he should stop his dabigatran 3 days prior
c. he should stop his dabigatran 3 days prior and have bridging enoxaparan
d. he should stop his dabigatran the day before and have an INR on the day of surgery
e. he should continue to take his dabigatran until the morning of surgery

Back 41

B

NYSORA

Front 42

Day 4 epidural. On 40 mg SC enoxeparin daily postoperatively (8 pm). When is the most appropriate time to remove the epidural?
A. Day 5 at 12 midday
B. Day 5 at 6 am
C. Day 5 at 6 pm
D. Day 6 at ?

Back 42

A

American Society of Regional Anaesthesia (ASRA) guidelines of neuraxial anaesthesia and anticoagulation
“An indwelling epidural catheter should be removed 10-12 hours after the last dose of LMWH”

And at least two hours before next dose

Front 43

Penetrating injury to chest. What part of the heart most likely injured?
A. RV
B. LV
C. RCA

Back 43

A
right ventricle 43%
left ventricle 34%
right atrium 16%
left atrium 7%

Front 44

Regarding a Thallium scan:
A. High NPV
B. Less useful in comparison to a DSE

Back 44

A

Front 45

What is NOT a contraindication to MRI?
A. Pulmonary artery catheter
B. Arterial line
C. Scissors
D. Coiled ECG cable
E. Laryngoscope

Back 45

B

Blue Book 2005
“Invasive blood pressure transducers: These are not ferromagnetic, and are safe to use. Transducer cables should be kept out of the magnet bore, so as to avoid imagedistortion”

MRIsafety.com
“There is at least one report of a cardiovascular catheter (Swan-Ganz Triple Lumen Thermodilution Catheter) that "melted" in a patient undergoing MR imaging. This catheter contained a wire made from a conductive material that was considered to be responsible for this problem. Thus, there are realistic concerns pertaining to the use of similar devices in patients undergoing MR examinations”

Front 46

The nerve supplying area of skin between greater trochanter and iliac crest:
A. subcostal nerve
B. ilioinguinal nerve
C. genitofemoral nerve
D. femoral nerve
E. lat cutaneous femoral nerve

Back 46

A

labelled as Last Thoracic nerve on diagram

Front 47

In infants with congenital pyloric stenosis
A. dehydration is associated with early hyponatremia
B. plasma chloride levels seldom fall below 85 mmol.1-I
C. renal conservation of hydrogen and potassium ions occurs
D. the urine is initially alkaline, then may become acidic
E. vomiting causes a loss of potassium ions

Back 47

D

• More common in males
• Typically 3-6wks of age
• Increased HCO3 load to distal tubule of kidney results in an alkaline urine initially. With H+ ions exchanged for K in kidney - paradoxical acidotic urine
• Main source of k loss from body is from the kidney →resulting hypokalaemia

Front 48

Preoperative assessment shows a Mallampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehane is predicted. Compared to the ML score, the TMD is
A less sensitive, less specific
B less sensitive, more specific
C more sensitive, less specific
D more sensitive, more specific
E equal sensitivity an specificity

Back 48

B

Front 49

Recognised weaknesses of systematic reviews include all of the following EXCEPT
A. publication bias
B. duplicate publication
C. study heterogeneity
D. inclusion of outdated studies
E. systematic review author bias

Back 49

E

Front 50

What drug should NOT be used for tocolysis in 32/40 female?
A. Indomethacin
B. Magnesium
C. Nifedipine
D. Salbutamol

Back 50

A

Other remembered options include Clonidine, which would be more correct.

Front 51

Following an eclamptic seizure the dose of MgSO4 is?
A. 1 gram
B. 4 grams

Back 51

B

The regimen recommended by the Collaborative Eclampsia Trial is 4-5 g MgSO4 intravenously over 5 min

Front 52

An indication for NON-operative management of blunt liver trauma in adults is
A. absence of peritoneal signs
B. a haemodynamically stable patient
C. a haemopertitoneum of LESS than 500 ml
D. a LOW grade injury on CT scan
E. severe chronic obstructive airway disease

Back 52

B

Front 53

Initial dose of IV GTN to relax the uterus is?
A. 5 mcg
B. 50 mcg
C. 200 mcg

Back 53

B

Front 54

Dilated CM (LVEF 30%). No dyspnoea with ADLs. Best management?
A. Start ACEI
B. Stop beta-blocker

Back 54

A

Front 55

CTG [pictured] demonstrating late decelerations. Most likely cause?
A. Fetal asphyxia
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency

Back 55

A

Perinatology.Com - Fetal Heart Rate Monitoring
“Early decelerations appear to be caused by vagal discharge produced when the head is compressed by uterine contractions. The onset and depth of early decelerations mirror the shape of the contraction, and tend to be proportional to the strength of the contraction.

Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in nonvital peripheral areas in order to divert more blood flow to vital organs such as the adrenal glands, heart, and brain. Constriction of peripheral blood vessels causes hypertension that stimulates a baroreceptor mediated vagal response which slows the heart rate. The time consumed in this two step process accounts for the delay in the timing of the deceleration relative to the contraction”

Front 56

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

Back 56

D

Front 57

A diagnostic test has a sensitivity of 90% and a specificity of 99% in detecting a certain disease. From this we can conclude that
A. the false positive rate of this test is 1%
B. the false negative rate of this test is 1%
C. the positive predictive value of this test is 90%
D. the negative predictive value of this test is 90%
E. this test would be a useful screening test for this disease

Back 57

A

False Positive Rate = 1 - specificity
False Negative Rate = 1 - sensitivity

Front 58

SVRI.
A. SVR x BSA
B. SVR / BSA

Back 58

A

Front 59

The features of Pierre Robin sequence include cleft palate, micrognathia and:
A. Glossoptosis
B. Craniosynostosis
C. Macroglossia
D. Microstomia

Back 59

A

Front 60

What is the ratio of MAC awake:MAC of sevoflurance
a. 0.2
b. 0.34
c. 0.5

Back 60

B

Front 61

Essential diagnostic criteria on ECG for LBBB
A. Loss of septal Q's in V5 and V6
B. RSR in V1
C. Large slurred S in V6
D. T-waves opposite to direction of QRS
E. QRS duration minimum 0.2 s

Back 61

A

Diagnostic criteria for LBBB:
• 1) Total QRS duration >0.12 s.
• 2) No secondary R wave in V1 to indicate RBBB. 

• 3) No septal q wave in V5, V6 or in leads further to the left (lead I and aVL in horizontal hearts).

Front 62

A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestation should intraoperative monitoring of the fetus occur?
A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 30 weeks
E. 32 weeks

Back 62

B

24-26 weeks according to CEACCP 2006
From 18-22 weeks foetal heart rate monitoring is feasible
From 25 weeks heart rate variability can be observed
Though would seem no point monitoring until fetus is viable (i.e. 24wks)

Front 63

When instructing ward staff on monitoring for respiratory depression in a patient using PCA (patient controlled analgesia) you would advise that early respiratory depression is best detected by monitoring
A. frequency of boluses on PCA machine
B. pulse oximetry
C. pupil size
D. respiratory rate
E. sedation scores

Back 63

E

Front 64

Trauma patient. CXR (not given): air fluid levels adjacent to heart/diaphragm/ribs.
A. Ruptured diaphragm
B. Hiatus hernia

Back 64

A

B is also possible

Front 65

Intraoperative pediatric arrest during scoliosis surgery most likely due to?
A. Underappreciated degree of blood loss

Back 65

A

Front 66

Endocarditis prophylaxis in patient with MVR appropriate for?
A. Dental procedure
B. Rigid bronchoscopy
C. Upper endoscopy with biopsy
D. D&C
E. Lithotripsy

Back 66

A

2008 Update - prophylaxis no longer required for GI/GU surgery.

Front 67

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

Back 67

D

RCD would protect from macroshock within 40ms

Front 68

Severe asthma attack. Given continuous nebs & IV hydrocortisone but not responding. PaCO2 low. SpO2 low. Next appropriate treatment?
A. IV Magnesium
B. IV Aminophylline
C. Heliox
D. IV salbutamol infusion
E. Intubate/ventilate

Back 68

A

Front 69

Atrial septal defect, where is the murmur heard the loadest?
A. PV
B. MV
C. ASD
D. AV
E. TV

Back 69

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”

Front 70

Best position for IABP is 1-2 cm:
A. Distal to Left SCA
B. Proximal to Left SCA
C. Distal to artery of Adamkiewicz
D. Distal to renal artery
E. Proximal to renal artery

Back 70

A

Image courtesy of Radiopedia.org

Front 71

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

Back 71

A

Front 72

The diagram below is of a transgastric short axis view obtained during a transoesophageal echocardiography examination. Which letter corresponds to the area supplied by the right coronary artery?
A. A
B. B
C. C
D. D
E. E

Back 72

A

Front 73

Cephalothin doesn't cover:
a. Proteus
b. E coli
c. Staph
d. Strep
e. Pseudomonas

Back 73

E

Front 74

CHADS2 score. Which is not a feature?
A. Age
B. Gender
C. Diabetes mellitus
D. Stroke
E. CCF

Back 74

B

CCF +1
HT +1
Age > 75, +1
DM +1
Stroke/TIA/arterial thrombus event, +2 (but NOT deep vein thrombosis)

However, gender is included in CHA2DS2-VaSc

Front 75

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

Back 75

C

Reversal of shallow neuromuscular = 2 mg/kg
Reversal of profound neuromuscular blockade = 4 mg/kg
Immediate reversal of neuromuscular blockade = 16 mg/kg

Front 76

Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism

Back 76

B

Front 77

Meconium stained liquour but neonate delivered is vigorous. Rationale for NOT suctioning the neonate?

A. May aspirate meconium
B. May cause bradycardia
C. May cause hypertension

Back 77

B

It does not alter outcome (ARC Guidelines neonatal resus, level II evidence)
And certainly can cause vagal response

Front 78

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

Back 78

A

Cerebral Reperfusion Syndrome: Triad of headache, seizures, focal neurology.

Front 79

National labelling standards endorsed by ANZCA. What colour should the label on a brachial plexus catheter infusion be?
A. Red
B. Blue
C. Beige
D. Yellow
E. Pink

Back 79

D

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

Front 80

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

Back 80

A

Hyperaldosteronism leads to increased Na reabsorption in exchange for K+. No effect on glucose.

Front 81

A patient has suffered flash burns of the upper half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burned is
A. 18%
B. 23%
C. 32%
D. 41%
E. 48%

Back 81

C

Rule of 9’s: 4.5 + 18 + 9

Front 82

Dural Sac ends at what level in a neonate?
A. L1
B. L3
C. L5
D. S1
E. S3

Back 82

E

NYSORA
“The dural sac in neonates and infants also terminates in a more caudad location compared to adults, usually at about the level of S3 compared to the adult level of S1”

Front 83

SpO2 90%. No IV access. Place LMA and laryngospasm. Most appropriate course of action?
A. Increase inhaled sevoflurane concentration with LMA in situ
B. Increase inhaled sevoflurane concentration after removing LMA
C. Intralingual suxamethonium (no dose stated)
D. Intramuscular suxamethonium (no dose stated)
E. Intramuscular atropine (no dose stated)

Back 83

B

Front 84

Incarcerated inguinal hernia in a child with a mild URTI. Most appropriate course of action?
A. Postpone for 2 weeks
B. Continue without ETT
C. Continue with careful monitoring

Back 84

C

Front 85

What is the half life of clopidogrel?
a. 6 hours
b. 14 hours
c. 24 hours
d. 7 days

Back 85

A

Front 86

Patient with subdural hematoma and PPM for ?AV ablation. PPM technician >1 hour away. Surgeon wishes to proceed immediately. Do you?
A. Postpone and await a cardiologist review
B. Postpone and await arrival of PPM technician
C. Postpone and insert a transvenous temporary PM
D. Proceed after institution of transcutaneous pacing.
E. Proceed with a magnet handy.

Back 86

E

Does depend how urgent surgery is and how much info you have re. pacemaker, mode, magnet response

If it is urgent, I would crack on with magnet in case there was inappropriate inhibition and you need asynchronous mode ASAP

Transcutaneous pacing should be available but not necessarily started

Front 87

Which of the following does NOT occur following bilateral lung transplant?
A. Impaired mucociliary clearance
B. Impaired lymphatic drainage
C. Impaired HPV

Back 87

C

Anesthetic Challenges in Patients After Lung Transplantation. The Internet Journal of Anesthesiology

“Hypoxic pulmonary vasoconstriction is intact in the pulmonary allograft so during an episode of rejection, pulmonary blood flow may be directed away from the transplanted lung”

Front 88

20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid fluid volume resuscitation for the first hour is
A. 160 ml
B. 260 ml
C. 360 ml
D. 460 ml
E. 660 ml

Back 88

E

Parkland formula 4 x kg x TBSA%

half in first 8 hours and half in 16 hours
Plus maintenance 4/2/1 rule
4 x kg x % = 1200ml
Half in 1st 8rs = 600ml
But 6hrs already passed, so 600ml in 2hrs = 300ml/h

Plus need to give maintenance fluid via 4/2/1 rule = 60ml/hr

600 + 60 = 660ml

Front 89

Complications of mediastinoscopy include all of the
following EXCEPT
A. air embolism
B. cardiac laceration
C. pneumothorax
D. recurrent laryngeal nerve palsy
E. tracheal compression

Back 89

B

Plummer et al. Anaesthesia for telescopic procedures in the thorax BJA 1998
Major complications of mediastinoscopy

• Haemorrhage
• Pneumothorax
• Recurrent laryngeal nerve injury
• Air embolism
• *Compression of vessels
• Aorta → reflex bradycardia
• Innominate artery ( R brachiocephalic trunk)
• Right carotid → hemiparesis
• Right subclavian → loss of right radial pulse
• Compression of trachea

Front 90

What sign most suggests a significant murmur in a child?
A. 4/6 loudness
B. ????vibratory/flutter sound

Back 90

A

Front 91

Thoracodorsal nerve arises from?

Back 91

The thoracodorsal nerve is a branch of the posterior cord of the brachial plexus, and is made up of fibres from the posterior divisions of all three trunks of the brachial plexus.
It derives its fibers from the sixth, seventh, and eighth cervical nerves.

Anatomy for Anaesthetist – ‘Branches of the Posterior Cord’
“The nerve to latissimus dorsi (thoracodorsal nerve) (C6–8) arises between the upper and lower subscapular nerves. It accompanies the subscapular vessels along the posterior axillary wall and supplies latissimus dorsi”

Front 92

Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?
A. Medial brachial cutanous nerve

Back 92

Medial cutaneous nerve of forearm actually (= median antebrachial nerve)
Smallest branch of brachial plexus, arises from medial cord, derived from C8-T1

Front 93

Thermoneutral zone in 1 month old infant ?
A. 26 – 28 degrees Celcius
B. 28 – 30 degrees Celcius
C. 30 – 32 degrees Celcius
D. 32 – 34 degrees Celcius
E. 34 - 46 degrees celcius

Back 93

D

Adult = 25-28
Neonate = 32-34

Front 94

Indicative of severe AS?
A. Palpitations
B. Fatigue
C. PND
D. Angina
E. Syncope

Back 94

C

Front 95

Risk factor for PPH?
A. Prolonged labour
B. Age <20 yrs old
C. Primiparity
D. FV Leiden Deficiency (yes it said deficiency!)
E. Oligohydramnios

Back 95

A

Ref: RANZCOG

Front 96

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
D. extensor pollicis
E. flexor pollicis brevis

Back 96

C

Front 97

Fat:blood coefficients?
A. N2O~Des > Sevo > Iso
B. N2O > Des > Sevo~Iso

Back 97

B

Front 98

18/12 old undergoing routine SV GA under LMA. Sudden onset SVT with HR 220 BP 84/60 ETCO2 32 SpO2 98.Management:
A. Adenosine 100mcg/kg
B. DCR 2J/kg
C. DCR 4J/kg
D. Amiodarone 5mg/kg
E. CPR

Back 98

A

Front 99

Clinically the most significant murmur in pregnancy is?
A. MS

Back 99

A

Front 100

Required for diagnosis of Neuroleptic Malignant Syndrome
A. Diaphoresis
B. ↑ CK
C. Rigidity
D. Hypertenion
E. ↑ HR

Back 100

C

Leveson Criteria: All major or 3 major + 4 Minor

Front 101

2 yo 15kg child following seizure on surgical ward. Admitted with appendicitis and perforation. 60ml/hr of ½ N. Saline 5%dextrose
Na+ 119
K+ 4.5
HCO3- 19
Cl- 90

Best treatment would be
A. Desmopressin
B. Frusemide
C. 3% normal saline
D. Normal Saline
E. Fluid restrict

Back 101

C

Symptomatic hyponatraemia - treat with hypertonic saline.

Front 102

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

Back 102

A

Front 103

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

Back 103

B

Front 104

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

Back 104

D

Front 105

A 23 year old man takes his buprenorphine patch off prior to surgery. When can you expect the plasma level to be half?
a. 6 hours
b. 12 hours
c. 24 hours
d. 36 hours
e. 48 hours

Back 105

B

Norspan product information
“After removal of a NORSPAN patch, buprenorphine concentrations decline, decreasing approximately 50% in 12 hours (range 10 - 24 h)”

Front 106

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

Back 106

A

Front 107

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

Back 107

D

Front 108

Iron deficiency anaemia:
A. Low ferritin, low serum iron
B. Low ferritin, low TIBC
C. Elevated ferritin, low marrow iron
D. Elevated ferritin, ?
E. Elevated ferritin, ?

Back 108

A

Front 109

Long-standing T6 paraplegia. Which is INCORRECT?
A. Flaccid paralysis
B. Poikilothermia
C. Labile BP

Back 109

A

Front 110

You see a patient in the pre-op clinic. He is on propranolol for treatment of long QT syndrome. Which of the following will give the best reassurance that his treatment is effective?
a. normal QT interval on resting ECG
b. no change in QT interval with valsalva
c. HR less than 60
d. no arrhythmias on 24h holter monitor

Back 110

B

Long QT syndrome and anaesthesia. BJA 2003
“The mainstay of treatment of congenital LQTS since 1975 has been beta‐block”
“The dose of β‐blocker is determined by ensuring a reduction in maximal heart rate on treadmill exercise testing to 130 beats min–1 or less… where exercise testing is impractical, there should ideally be no change in the QT interval in response to a Valsalva manoeuvre”
“The QTc is unchanged despite efficacy of treatment, although QTD is higher in patients who do not respond to β‐block

Front 111

Lap chole on citalopram. What is NOT relatively contraindicated?
A. Omeprazole
B. Clonidine
C. Pethidine
D. Tramadol
E. ?Midazolam

Back 111

B

Citalopram shares CYP3A4 metabolism with midazolam
Citalopram shares CYPC19 metabolism with omeprazole
Tramadol and pethidine with citalopram may be relatively contraindicated due to serotonin syndrome concerns

Front 112

Most effective treatment for post-sevoflurane agitation following grommets in a 4yo child?
A. 1 mg/kg propofol
B. 1 mcg/kg fentanyl
C. 1 mcg/kg clonidine
D. ?dose midazolam
E. Sucrose

Back 112

B

Reference from paeds textbook (coats,) says opioids are most effective

Front 113

What is NOT useful in the treatment of Torsades?
A. Isoprenaline
B. Procainamide
C. DCCV
D. Electrical pacing
(Amiodarone was not an option)

Back 113

B

Procainamide prolongs the QT interval

Front 114

Incidence of fat embolism following closed femoral fracture?
A. 0 -3%
B. 4 – 7%
C. 8 -11%
D. 12 – 15%
E. 16 - 19%

Back 114

A

Fat Embolism - CEACCP 2007
“Any single long bone 1-3%”
“It has been reported in up to 33% of patients with bilateral femoral fractures”

Front 115

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

Back 115

C

Front 116

Little space between epiglottis and posterior pharyngeal wall. Modified C&L classification?

Back 116

IIIa

Front 117

involving: Numb tongue and impaired taste sensation post LMA anaesthesia.
A. Facial Nerve
B. Mandibular division of CNV
C. Lingual Nerve

Back 117

C

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

Front 118

Lateral approach to popliteal block.
A. Passes through semimembranosis
B. May be performed supine or prone
C. Adequate for ankle surgery
D. Less effective in comparison to posterior approach
E. Eversion is an endpoint for nerve stimulation

Back 118

B & E (Preferably tibial stimulation observe as it is more medial)

• No, passes through biceps femoris. Semimembranosus is on the medial side of the nerve
• Usually performed supine
• Need to block femoral branches too for the medial aspect of ankle
• Can’t find anything on this – wouldn’t think so?
• According to NYSORA end-point is twitching of the foot, which can be either dorsiflexion/eversion (from common peroneal branch of sciatic), or plantarflexion/inversion (from tibial branch of sciatic).

Front 119

Factors associated with post-operative ulnar nerve palsy
include all of the following EXCEPT
A. male gender
B. sternal retraction for cardiac surgery
C. cardiopulmonary bypass for cardiac surgery
D. internal jugular vein catheterisation
E. diabetes mellitus

Back 119

C

Front 120

In a rotameter the
A. bobbin spins inside a tube that has parallel sides
B. flow is laminar at high flow rates
C. height of the bobbin is proportional to the pressure drop across the bobbin
D. pressure drop across the bobbin is constant at varying flows
E. resistance increases with increasing gas flow

Back 120

D
F = MA mass of bobbin and A is gravity both should be constant
P = F/A area of the bobbin does not change

Front 121

Appropriate postoperative maintenance fluid in a child [can't recall situation, but something to do with head injury]:
A. 3% and 1/3 NS
B. 1/2 NS
C. Normal Saline
D. Hartmanns
E. Hartmanns with glucose

Back 121

C

Front 122

Young woman with subarachnoid haemorrhage, hyponatraemia and increased urinary sodium (did not specify if high sodium concentration or total amount lost). What is likely cause?
A. cerebral salt wasting syndrome
B. SIADH
C. HHH therapy
D. Excess NS administration
E. diabetes insipidus

Back 122

B

CEACCP 2008
CSWS is usually caused by brain injury/trauma or cerebral lesion, tumor, or hematoma. CSWS is a diagnosis of exclusion and may be difficult to distinguish from the syndrome of inappropriate antidiuretic hormone (SIADH), which develops under similar circumstances and also presents with hyponatremia. The main clinical difference is that of total fluid status of the patient: CSWS leads to a relative or overt hypovolemia whereas SIADH is consistent with a normal to hypervolemic range. Random urine sodium concentrations tend to be lower than 100 mEq/L in CSWS and greater in SIADH. If blood-sodium levels increase when fluids are restricted, SIADH is more likely.

The biochemical criteria for CSWS are:
(i) low or normal serum sodium
(ii) high or normal serum osmolality
(iii) high or normal urine osmolality
(iv) increased haematocrit, urea, bicarbonate, and albumin as a consequence of hypovolaemia.

However, these criteria are often inconclusive. In CSWS, total daily urine sodium excretion is greater than intake, whereas it is usually equal to intake in SIADH, that is, overall sodium balance is negative in CSWS and generally neutral in SIADH.

Front 123

Regarding mixed venous blood oxygen saturation, which statement is correct?
a. it is collected from the right atrium
b. it is used to calculate cardiac output
c. it can be used to accurately measure the mixed venous pO2
d. it has no impact on the A-a gradient
e. it is usually 40%

Back 123

B

Normal range for SvO2 is 60 – 80%
Is collected from PA

CO can be calculated by a modification of the Fick equation, where
VO2 = (CO x CaO2) – (CO x CvO2 )
Where CO = Cardiac Output, Ca = Oxygen concentration of arterial blood and Cv = Oxygen concentration of mixed venous blood

VO2 = Arterial Oxygen Transport – Venous, Oxygen Transport
= (CO x CaO2 x 10) – (CO x CvO2 x 10)
= CO x (CaO2 – CvO2) x 10
= CO (Hb x SaO2 x 13.8) – CO (Hb x SvO2 x 13.8)
= CO x Hb x 13.8 x (SaO2 – SvO2)

VO2 = CO x Hb x 13.8 x (SaO2 – SvO2)
VO2 = Oxygen consumption
CO = cardiac output
SaO2 = arterial O2 sats
SvO2 = venous O2 sats

Front 124

Cerebral oximetry measures?
A. Arterial saturation
B. Mostly arterial saturation and some venous saturation
C. Capillary saturation
D. Mostly venous saturation and some arterial saturation
E. Venous saturation

Back 124

D

The Official Journal of the Anesthesia Patient Safety Foundation. Spring 2009
“Cerebral oximetry differs from pulse oximetry in that tissue sampling represents primarily (70-75%) venous, and less (20-25%) arterial blood”

Cerebral Oximetry: Monitoring the Brain as the Index Organ. Anesthesiology 2011
“Sco2 is weighted for approximately 70–75% venous blood”

Front 125

Ciliary ganglion
A sympathetic from inferior cervical ganglion
B located inferiorly within orbit
C may be damaged during a peribulbar block
D preganglionic parasympathetic supply from the supra trochlear nerve
E preganglionic parasympathetic originates from the Edinger Westpal nucleus

Back 125

E

Front 126

Normal systolic BP at birth?
A. Something less than 70 mmHg
B. 70 mmHg
C. 85 mmHg
D. Something more than 85 mmHg
E. 115 mmHg

Back 126

B

Depends on birth weight, gestation
OHA says “normal systolic blood pressure is 70-90mmHg”

NETS Victoria - Neonatal Handbook (which references Nuntnarumit P, Yang W, Bada-Ellzey HS. Blood pressure measurements in the newborn. Clin Perinatol 1999)

Front 127

Urgent reversal of INR 4.5. Intern already gave vitamin K.
A. FFP
B. Prothrombinex
C. Prothrombinex AND FFP

Back 127

C

MJA Update 2013: Warfarin Reversal

Front 128

Major cause of death following difficult intubation with perforated oesophagus?
A. Sepsis
B. Failure to intubate
C. Failure to ventilate

Back 128

A

Front 129

Which is a specific PDE inhibitor?
A. Theophylline
B. Dipyridimole
C. Milrinone

Back 129

C

Theophylline = methylxanthine, nonselective phosphodiesterase inhibitor
Dipyridimole = Can find mentions of PDE 5 PDE 10 and PDE 11
Milrinone = phosphodiesterase-3 inhibitor

Front 130

Maximum dose of local infiltration of 0.5% bupivacaine in an x kg child?
A. dose corresponding to 2.5 mg/kg; there was no option corresponding to 2 mg/kg

Back 130

A

Front 131

Loading dose of IV paracetamol in x kg child?
A. dose corresponding to 20 mg/kg

Back 131

A

Front 132

Performing a caudal block in a child. What is the first sign of a total spinal anaesthetic?

Back 132

hypotension and bradycardia are rare
desaturation usually first signs

Front 133

Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?
A. Sedation
B. Urinary retention

Back 133

A

Front 134

New onset AF. For what period of time is it safe to perform DCCV without prior TOE to exclude thrombus?
A. <24 hours
B. <48 hours

Back 134

B

Cardioversion of Atrial Fibrillation for Maintenance of Sinus Rhythm: A Road to Nowhere. Circulation 2009
“The current treatment guidelines suggest it is permissible to cardiovert patients without continued anticoagulation in those for whom it is known that the duration of AF is <48 hours”

Front 135

Regarding remifintanil, which is incorrect?
a. high potency
b. metabolised by pseudocholinesterase
c. muscle rigidity in high doses
d. weakly active metabolite
e. short context sensitive half time

Back 135

B

Metabolised by non-specific tissue and plasma esterase

Front 136

Off-label use of a drug refers to all of the following EXCEPT:
A. Different age-group
B. Different indication
C. Different concentration
D. Different route of administration

Back 136

C

Off-label use of medicines: consensus recommendations for evaluating appropriateness. MJA 2006; 185 (10): 544-548
“Examples include use in a different indication, patient age range, dose or route”

Use of “Off Label” or Drugs beyond Licence in Pain Medicine. ANZCA Faculty of Pain Medicine
“The term “off-label use” may pertain to an unapproved indication, route of administration, age group, or dose. The term does NOT relate to any prescribing conditions outlined by the PBS”

Front 137

Labour epidurals increase maternal and foetal temperature. This results in neonatal
A. Increased sepsis
B. Increased investigations for sepsis
C. increased non shivering thermogenesis
D. Increased need for resuscitation
E. Cerebral palsy

Back 137

B

Front 138

ASA grading was introduced to
A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk

Back 138

C

Front 139

Compared to lignocaine, bupivacaine is
A. Twice as potent
B. Three times as potent
C. Four times as potent
D. Five times as potent
E. Same potency

Back 139

C

Front 140

Best agent to decrease both gastric volume and gastric acidity?
A. Omeprazole
B. Ranitidine
C. Metoclopramide
D. Cisapride
E. Na citrate

Back 140

B

Front 141

Young female having cholecystectomy. Venous air embolus:
A. Mechanical ventilation and PEEP is part of treatment strategy
B. Most likely to occur at initial gas insufflation, but can occur at any time
C. Inert gas (argon, xenon) is safer
D.
E.

Back 141

B

Miller 7th ed. p. 2188
"This complication develops principally during the induction of pneumoperitoneum, particularly in patients with previous abdominal surgery."

Front 142

Diastolic dysfunction is NOT caused by:
A Adrenaline
B Aortic stenosis
C Hypertension
D myocardial fibrosis
E ?

Back 142

A

Also increases lusitropy (active relaxation)

Front 143

Amniotic fluid embolism. Cause of death in first half hour ?
A. Pulmonary hypertension
B. Malignant arrhythmia
C. Pulmonary oedema
D. Hypovolaemic shock
E.

Back 143

A

Front 144

Nerve block for anaesthesia over anterior 2/3 of ear?
A. C2
B. Mandibular nerve
C. Maxillary nerve
D. Ophthalmic nerve
E. Vagus

Back 144

B

Auriculotemporal Nerve supplies anterior 2/3

Branch of the Mandibular Nerve

Front 145

Central anticholinergic syndrome, which is NOT true:
A. Will improve with neostigmine
B. Peripheral anticholinergic symptoms
C. Caused by Anti-Parkinson drugs
D. CNS depression
E. Associated with agitation, delirium, and ???

Back 145

A

Front 146

In an acute malignant hyperthermia episode
A. the serum creatine kinase level peaks within one hour
B. the peak serum creatine kinase level is a good indicator of the amount of muscle involved
C. elevated creatine kinase levels contribute to acute renal failure
D. the serum myoglobin level does NOT peak for at LEAST 24 hours
E. muscle rigidity occurs in 75% of cases

Back 146

E