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150 Cards in this Set
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1. The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipment is turned on
A. The double insulation of the device will prevent macroshock when the outer casing is touched B. The electrical fuse will immediately break and disconnect the device from the power supply C. Equipotential earthing will prevent microshock D. The Line Isolation Monitor will alarm and disconnect power to the device E. The RCD will rapidly disconnect the device from the power supply |
B.
Class 1 – single insulation, has an earth connector that will divert energy if insulation fails and a fuse or RCD should disconnect power supply. Class 2 – double insulation Class 3 – SELV – safety extra low voltage, ie: voltage not high enogh to cause significant harm |
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2. EZ99 According to the current ANZCA approved standards for labeling, the appropriate colour label for an intraosseous infusion is (some remember it saying INTERosseous, not intraosseous... possibly typo, possibly trick question)
A. Yellow B. Beige C. Pink D. Blue E. Red |
IA – Red
IV – Blue Neural/Regional - yellow Sub cut – Beige Other – Pink |
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PP102 An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is
A. 400mL B. 500mL C. 600mL D. 700mL E. 800mL |
Answer: 600 ml (C)
MABL = Maximum Allowable Blood Loss MABL = EBV x (Starting hematocrit - Target Hematocrit)/Starting hematocrit Millers |
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4. A 30 year-old pregnant patient develops contractions at 30/40 weeks gestation which of the following cannot be used for tocolysis
A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine |
A Clonidine
it's not a tocolytic, all others are. Indomethacin not recommended after 32/40 due to Ductus arteriosis changes. Previous q's have had patient at 34/40 when indomethacin would be correct due to gestation |
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5. A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain, prior to having a seizure and losing consciousness. Which drug should NOT be given?
A. Pethidine B. Diazepam C. Haematin D. Suxamethonium E. Pregabalin |
A-pethidine due to nor pethidine lowering seizure threshold.
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6. A patient with HOCM presents with dyspnoea and angina on exertion. Which of the following is the best agent to treat these symptoms
A. Glycerol trinitrate B. Metoprolol C. Morphine D. Hydrochlorthiazide E. Salbutamol |
Beta blockers. B Metoprolol
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7. A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomatic with no other signs/symptoms of myocardial infarction and have an uneventful recovery. What do you do?
A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future mycocardial infarction B. Arrange coronary angiogram as an inpatient prior to discharge C. Inform the patient that while the result is real the significance is questionable D. Repeat in a weeks time as a second troponin is a better indicator of long-term myocardial infarction risk E. Ignore the result as it is likely a laboratory error |
A – according to stoelting even a mildly elevated troponin is an indicator of future morbidity/mortality and should be referred to a cardiologist.
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8. A 40 year-old lady with a history of a bleeding diathesis presents for a tonsillectomy. What is the most likely cause?
A. Factor V Leiden B. Protein S deficiency C. Haemophilia B D. Antithrombin III deficiency E. Protein C deficiency |
C. Haemophilia B. All others are pro-coagulant disorders.
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9. What is the most cephalad intervertebral space at which a spinal can be sited in a neonate where the risk of damage to the spinal cord is minimal
A. L1/2 B. L2/3 C. L3/4 D. L4/5 E. L5/S1 |
D - L4/5
Spinal cord ends at L3 in neonate 1 years of age back to L1-2 |
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10. St John's Wort (Hypericum perforatum) potentiates the effects of
A. Dabigatran B. Heparin C. Warfarin D. Aspirin E. Clopidogrel |
E – clopidogrel. Reduces the effect or warfarin/heparin/dabigatran. Little effect on aspirin.
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11. You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves
A. facial, trigeminal, glossopharyngeal B. facial, trigeminal, vagus C. glossopharyngeal, trigeminal, vagus D. trigeminal, glossopharyngeal, vagus E. trigeminal, vagus, glossopharyngeal |
D
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2. A patient is having an electrophysiological study and ablation for atrial fibrillation. Suddenly the blood pressure drops to 76/38 mmHg, with the heart rate at 110 in sinus rhythm. What is the best investigation to confirm the cause of hypotension?
A. Troponin B. ST-segment elevation C. Transoesophageal echocardiography D. Coronary Angiogram E. Electrocardiogram |
C.
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13. Which is the most powerful predictor of atrial fibrillation post cardiac surgery.
A. Age B. History of hypertension C. History of CVA D. History of diabetes E. Time on Bypass |
A
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14. A man with a history of Parkinsons disease has undergone uncomplicated general anaesthetic for a knee replacement but develops post-operative nausea and vomiting (PONV). He received 4mg dexamethsone intraoperatively as prophylaxis. What would you use to treat his PONV in recovery?
A. Dexamethasone B. Prochloperazine C. Metoclopramide D. Droperidol E. Ondansetron |
E – all others can worsen effects. Dexa already given.
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15. Which of the following is of the least benefit in the treatment of severe anaphylaxis?
A. Cardiopulmonary bypass B. Nebulised salbutamol C. IV crystalloid D. IV vasopressin E. Subcutaneous adrenaline |
? E
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16. A 70 year old patient is being treated for congestive cardiac failure. They are able to shower themselves and complete other ADLs but get dyspneoa on mowing the lawn. They are New York Heart Association classification
A. Class 1 B. Class 2 C. Class 3a D. Class 3b E. Class 4 |
B Class 2
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17. The percentage of post dural puncture headaches that would resolve spontaneously by 1 week is closest to
A. 90% B. 70% C. 50% D. 30% E. 10% |
B. 70% by 1 week, 95% by 6 weeks.
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18. Which piece of airway equipment is designed for use with a fibreoptic bronchoscope
A. Aintree B. Cook’s airway exchange catheter C. Frova introducer D. ? E. ? |
A
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19. A 50 year old lady is seen at the pre-operative assessment clinic, she is on 150mg/day methadone, what is the most likely ECG change to be found in her pre-op ECG?
A. Prolonged PR interval B. Prolonged QTc C. ST depression D. U wave E. Tented T-waves |
B- most common change with methadone
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20. Current guidelines regarding cardiopulmonary resuscitation include all of the following EXCEPT
A. Allow equal time for chest compression and relaxation B. Give 2 rescue breath before commencement of CPR C. Chest compression at 100bpm D. Chest compression should be at least 5cm depth E. Chest compression to breath ratio at 30:2 |
B- BLS guidelines, resus.org.au
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21. When a 3 lead ECG is applied correctly in the CS5 position, you will monitor lead II when you suspect which of the following conditions
A. Anterior ischemia B. Inferior ischemia C. Lateral ischemia D. Atrial ischemia E. Posterior ischemia |
A, but..
The older literature[4] suggested that modified chest leads such as CS5 (RA electrode placed under the right clavicle and LA electrode placed in the V5 position) or CB5 (RA electrode over the center of the right scapula and LA electrode in the V5 position) may be suitable for detection of anterior wall myocardial ischemia; however, these leads are currently considered not accurate enough and are not recommended for monitoring myocardial ischemia. |
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22. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is:
A. Adrenaline B. [[Dobutamine] C. Levosimenden D. Milrinone E. Vasopressin |
E
In patients with severe hypotension that is not treatable with somatostatin, the drug of choice is either angiotensin or vasopressin. Millers Vasopressin as an alternative vasoconstrictor that may be useful if prolonged vasoconstriction is required; however, the evidence base is small. CEACCP |
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23. Using the American Heart Association specification, the colours of the electrodes in a 3-lead electrocardiographic (yes the typo is what they used) is
A. Right arm = Black; Left arm = White; Left leg = Red B. Right arm = White; Left arm = Black; Left leg = Green C. Right arm = Black; Left arm = Green; Left leg = Red D. Right arm = White; Left arm = Black; Left leg = Red E. Right arm = Red; Left arm = White; Left leg = Green |
D
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24. When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade
A. 1 B. 2 C. 3a D. 3b E. 4 |
Cormack and Lehane system should be subdivided
further into 3a and 3b (denoting, respectively, only epi- glottis visible and only epiglottis visible but adherent to the posterior pharyngeal wall). 2a (part of the cords visible) and 2b (only the arytenoids or the very posterior origin of the cords visible) Answer D Laryngoscopy view: Cormack and Lehane  This classification describes the best view possible at laryngoscopy.  Grade I: complete glottis visible  Grade II: anterior glottis not seen  Grade III: epiglottis seen, but not glottis  Grade IV: epiglottis not seen |
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25. You are doing a supraclavicular brachial plexus block on an awake 35 year-old lady who is healthy with no significant past medical hsitory. Soon after injecting 20mLs of 0.375% ropivicaine she becomes agitated, has a seizure and loses consciousness. Your 1st step in management is
A. Intralipid 20% 1.5ml/kg bolus B. Midazolam C. Propofol D. Establish airway and give 100% O2 via a facemask E. Feel for radial pulse and give 100mcg adrenaline |
D. ABCs first then treat seizure cause
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26. A G1P0 patient with a dilated cardiomyopathy and an ejection fraction (EF) of 35% presents for a caesarean section. The benefits of regional vs general anaesthesia are
A. Decreased heart rate B. Decreased systolic blood pressure C. Increased ejection fraction D. Increased myocardial contractility E. Decreased preload |
C – increased ejection fraction
DCM = too much preload, too little contractility, any afterload is not helpful Although the main reason to avoid a GA is to avoid direct myocardial depression, a reduction in afterload will most certainly increase ejection fraction in the failing heart. http://cvpharmacology.com/clinical%20topics/heart%20failure-3.htm |
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27. ET05 A patient has a terminal malignancy. His family doesn’t want you to tell the patient about his diagnosis and prognosis. Your decision to inform him is an example of:
A. Autonomy B. Beneficence C. Confidentiality D. Non-maleficence E. Utilitarianism |
A
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28. A septic patient has a CVP of 12mmHg, a blood pressure of 80/40mmHg and a pulse rate of 90/minut:E. Which is the best agent to treat their hypotension
A. Dopamine B. Dobutamine C. Noradrenaline D. Adrenaline E. Levosimenden |
C
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29. Which organ is least tolerant of ischaemia following removal for transplantation
A. Cornea B. Heart C. Liver D. Kidney E. Pancreas |
B
Removal of the organs is performed under cold protection by applying ice to the surgical field. Organs are removed according to their susceptibility to ischemia, with the heart first and the kidney last in a multiorgan donor. B – Millers |
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30. You are performing a TAP block. If the needle is correctly positioned where will you deposit the local anaesthetic
A. Beneath the peritoneum B. Into the transverse abdominus muscle C. Between the transverse adominus muscle and the internal oblique muscle D. Between the transverse abdominus muscle and the external oblique muscle E. Between the internal oblique and the external oblique muscle |
C – Layers are ext oblique, int oblique then tranversus abdominis, then peritoneum.
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31. You are inserting a left sided double lumen tube into a 140kg 160cm woman. At what depth measured at the incisors is it most likely to be in the correct position
A. 25cm B. 26cm C. 27cm D. 28cm E. 29cm |
D
2009 BJA Article 170cm = 29cm M = F, every +/- 10cm correlates to +/- 1cm |
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32. A patient is cooled to 33 degrees Celcius in an attempt to improve neurological outcome after out-of-hospital ventricular fibrillation cardiac arrest. The evidence for this treatment comes from
A. Case Reports B. Case Control Studies C. Systematic Review D. Randomized Control Trial E. Pseudo-randomized Trial |
D
DTwo large RCTs, one European, one Melbourne based “Randomised Hypothermia after cardiac arrest study” |
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33. Which of the following decrease during pregnancy
A. Functional Residual Capacity B. Forced Expiratory Volume in one second C. Tidal Volume D. Respiratory Rate E. Vital Capacity |
A
By term approx 20% decrease in FRC, other lung parameters remain the same |
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34. You are anaesthetizing a patient with chronic renal failure for removal of a Tenkoff catheter and have intubated using rocuronium at a dose of 1.2mg/kg. You are immediately unable to intubate or ventilate and you decide to reverse the patient with sugammadex. What dosage would you use
A. 2mg/kg B. 4mg/kg C. 8mg/kg D. 12mg/kg E. 16mg/kg |
E
Normal reversal = 2mg/kg, deep 4mg/kg, CICO 16mg/kg |
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35. During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate
A. Carbimazole B. Beta-blocker C. Propythiouracil D. Plasmaphoresis E. Hydrocortisone |
D
Plasmaphoresis is used for refractory thyroid storm – needs repeating with only 20% of the T4 pool being removed each session. |
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36. A young female patient with anorexia nervosa, had just started eating again. After three days she develops dyspnea and is found to have cardiac failure. Which of the following is the most important to correct
A. Potassium B. Chloride C. Phosphate D. Glucose E. Sodium |
? C Phosphate
refeeding syndrome and low PO4 can certainly present with heart failure, but would be important to correct hypokalaemia and hypoglycemia too (B and E are definitely wrong). New NICE guidelines have been published and suggest feeding can start in tandem with electrolyte replacement (this is in contrast to previous guidelines) but there have been no RCTs on refeeding so evidence is weak. |
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37. A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestational age should you monitor foetal heart rate to ensure adequate uteroplacental blood flow
A. 20 weeks B. 24 weeks C. 28 weeks D. 30 weeks E. 32 weeks |
B- because at this point foetus is viable
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38. 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 |
A- wrong, decreased
B- wrong, activation of NMDA C- Glutamate is main NT D- c fibres E- CORRECT BJA recent article “When does acute pain become chronic?” |
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39. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient
A. Pretracheal tissue volume / neck circumference B. Mallampati score C. Thyromental distance D. BMI E. Severity of OSA |
A
Directly from a study from Anaesthesia 2003 “Prediction of difficult laryngoscopy in obese patients by ultrasound quantification of anterior neck tissue” |
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40. A female patient with a history of COPD presents for lung volume reduction surgery, which of the following is a contraindication for surgery (? indicates a poor prognosis)
A. Age > 60 years B. Chronic asthma C. Evidence of bullous disease on CT scan D. FEV < 25% E. Long-term prednisolone 10mg/day |
D
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41. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except
A. Bisphosphates B. Calcitonin C. Frusemide D. Sodium Chloride E. IV crystalloids |
A – doesn’t effect excretion, works to inhibit osteoclastic bone resorption
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42.What potentiates/interacts with adenosine
A. Aspirin B. Warfarin C. Clopidogrel D. Dabigatran E. Dipyrimadole |
E (potentiates the action of adenosine therefore require a decreased dose)
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43. A 2 year-old child has just undergone strabismus surgery. They had an URTI 1/52 prior to surgery. They had an uneventful general anaesthetic with a 4.5mm cuffed ETT, was extubated and sent to recovery. 20 minutes later they develop respiratory distress. Their saturations are 96% on room air, and there is noticeable tracheal tug. What is the most appropriate initial management that will help with their respiratory distress
A. Apply CPAP via a facemask B. Propofol 1mg/kg C. Dexamethasone 0.4mg/kg D. Gas induction and reintubate E. Nebulized adrenaline (1:1000) 0.5mL/kg |
A
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44. Which antihypertensive is not safe to use in pregnancy
A. Aspirin B. Enalapril C. Metoprolol D. Hydralazine E. Nifedipine |
B ACEi contraindicated in pregnancy due to associations with foetal defects (including cardiac/renal failure/ growth restriction)
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45. Which has the weakest evidence for prevention of postoperative infection
A. Intraoperative low inspired O2 B. Intraoperative blood transfusion C. Intraoperative hypothermia D. Intraoperative hyperglycaemia E. Cigarette smoking |
E
CeACCP article “preventing post operative infection: the anaesthetist’s role” Smoking is a risk factor for infection (as are all others) |
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46. During a cerebral aneurysm clipping, the anaesthetist can assist with the placement of the clip by giving the patient which drug immediately prior to clipping
A. Nimodipine B. Thiopentone C. Hypertonic saline D. Adenosine E. Mannitol |
B, or D, adenosine. Previous version of Q said 'permanent' clip, in which case adenosine can be used to induce temporary cardiac standstill.
Here's the article. http://ovidsp.tx.ovid.com.ezproxy.anzca.edu.au/sp-3.10.0b/ovidweb.cgi?T=JS&PAGE=fulltext&D=ovft&AN=00000539-201311000-00025&NEWS=N&CSC=Y&CHANNEL=PubMed |
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47. The POISE trial showed that the perioperative administration of metoprolol XR resulted in decreased
A. Perioperative mortality B. Hypotension C. Congestive Cardiac Failure D. Myocardial Infarction E. Stroke |
D
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48. In paediatric trauma, the Broselow tape is used to estimate
A. Blood loss B. Weight and drug dosages C. Urine output D. Abdominal girth E. Head circumference |
B Colour coding which correlates to height – approx weight and drug doses for each colour.
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49. Which of the following should be used by a lay person to indicate that they should commence CPR
A. Absence of central pulse B. Absence of peripheral pulse C. Loss of consciousness D. Absence of breathing E. Obvious airway obstruction |
D Two definite pathways conscious + breathing vs conscious + not breathing
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50. A patient presents for dilation of a pharyngeal stenosis post laryngopharyngectomy 12 months earlier. After inducing anaesthesia you site a size 7 reinforced ETT in the stoma. Over the next 30 minutes the patient gradually desaturations. Despite hand bag ventilation and an increased FiO2 of 1 the saturations remain at 88%. This is due to
A. Endobronchial intubation B. Aspiration C. Tension Pneumothorax D. Circuit leak E. Blockage of ETT with secretions |
A
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51. PiCCO determines cardiac output utilizing
A. Thermodilution B. Pulse contour analysis C. Thermodilution and pulse contour analysis D. ? Doppler E. ? |
C. Phillips product information.
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52. During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring
A. Anterior horn B. Anterior corticospinal tract C. Dorsal column D. Spinothalamic tract E. Lateral corticospinal tract |
C SEPs Measure the integrity of the sensory pathways in the dorsal column of the spinal cord by stimulating a peripheral sensory nerve and measuring the electrical response in the brain.
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53. 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% |
C- lower limb = 18%, anterior abdomen 9%, half upper arm 4.5% Rule of nines (for adults)
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54. 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 |
B
CEAPP article “Anaesthesia for mediastinoscopy” |
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55. A 70 year old man with severe mitral stenosis and normally in sinus rhythm, is going for an ORIF of fractured radius and uln:::A. Soon after induction of GA, he develops a tachyarrhythmia with BP 70/40mmHg and HR 130bpm. The most appropriate immediate action is
A. Amiodarone B. Adenosine C. IV fluid bolus D. Adrenaline E. Direct cardioversion |
E- indicates acute decompensation
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56. The time constant of the alveoli is
A. Resistance multiplied by compliance B. Resistance divided by compliance C. Resistance plus compliance D. Resistance minus compliance E. |
A- r x c
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57. The MAC awake:MAC ratio of sevoflurane is closest to
A. 0.22 B. 0.34 C. 0.45 D. 0.76 E. 1.00 |
B
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58.Abnormal Q waves occur in all the following EXCEPT
A. Digitalis toxicity B. LBBB C. Recent transmural MI D. Wolff-Parkinson-White E. Previous MI |
A- ST segment is abnormal.
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59. Patient complains of numbness in the anterior 2/3 of tongue after GA with LMA. Most likely nerve injured is
A. Glossopharyngeal B. Facial nerve C. Mandibular D. Superior vagus E. Maxillary nerve |
C mandibular
Lingual supplies TOUCH sensation to ant 2/3 of tongue. Lingual is a branch of the MANDIBULAR nerve which is a division of the TRIGEMINAL nerve (Cranial nerve V) FACIAL n. does supply taste to ant 2/3 of tongue via chorda tympani, which actually joins the LINGUAL nerve near the mastoid bone. So LINGUAL is final common pathway, with FACIAL nerve supplying taste, and TRIGEMINAL via MANDIBULAR supplying touch . |
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60. A 70 year old man with non-valvular atrial fibrillation is taken off his warfarin for 7 days prior to surgery and has no bridging therapy. His daily risk of stroke is
A. 0.001% B. 0.01% C. 0.1% D. 4% E. 10% |
Not really enough info to use CHADS2 here but we know patients with non-valvular AF have a yearly 5% stroke risk – divide by 365 to get daily risk = 0.01%
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61. In patient with ankylosing spondylitis which of the following is INCORRECT
A. Amyloid renal infiltration is rarely seen B. Cardiac complications occur in < 10% C. Normocyctic anaemia occurs in 85% of cases D. Uveitis is the most common extra-articular presentation E. Sacroilitis is an early sign of presentation |
C
Anaemia of chronic disease occurs in ~ 15%, not 85%. Ref. Oxford Handbook of Med Other manifestations: Age 2nd-3rd decade, M:F=3:1, HLA B27 (90%), p/w Sacroiliitis, Bamboo spine, Back pain, morning stiffness, improved by exercise, Schober test, Acute Anterior Uveitis 30%(unilateral), Cataracts, Aortic Regurg, BBBs, 3rd Degree HB, IBD, Restrictive lung disease both extrinsic and ILD. Amyloidosis |
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62. Which of the following are NOT useful in the management of Torsades de Pointes
A. Isoprenaline B. Procainamide C. DCCV D. Electrical pacing E. Magnesium |
B Procainamide
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63. Compared with a plenium vaporizer what is NOT a disadvantage of draw-over vaporizer (repeat but still not quite remembered correctly)
A. Basic temperature compensation B. Basic flow compensation C. Cannot use sevoflurane D. Small volume reservoir E. ? |
Can use sevoflurane with some modifications. Sevoflurane has been used in draw-over, but its use is hampered by a need to deliver high percentages which are at the upper limits of simple vaporiser performance capabilities, as well as its high cost. Using additional wicks to maximise output can be helpful, but latent heat of vaporisation rapidly cools the system and lowers performance. Two OMV vaporisers are required to provide adequate concentrations for induction.22
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64. The desflurane vaporizer is heated because of its
A. High SVP B. High boiling point C. Low SVP D. High MAC E. Low MAC |
A
The main problem with desflurane is that it has a high saturated vapor pressure at room temperature (700mmHg at 20°C). It boils at just 22.8°C (if you’ve ever spilled any you’ll know how quickly it disappears as it evaporates) compare with sevoflurane at 58.5°C or isoflurane at 48.5°C. What this means is that small changes in ambient temperature will cause marked changes in the performance of a vaporizer and great difficulty in controlling the delivered concentration of desflurane. |
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65. The thermoneutral zone in a neonate in degrees celcius is
A. 26-28 B. 28-30 C. 30-32 D. 32-34 E. 34-36 |
32-34 in Term infants. 34 – 36 for low birth weight.
Power And Kam. P418 |
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66. Which of the following is most effective way to reduce renal failure in AAA surgery
A. Fluid bolus prior to aortic clamping B. Fluid bolus after aortic clamp release C. Frusemide D. Minimize cross-clamp time E. Mannitol |
D
The incidence of renal failure after AAA surgery is 5.4% of which 0.6% require haemodialysis. Infra-renal cross clamping reduces renal blood flow by up to 40% through the alteration of the renin-angiotensin system. Loop diuretics (e.g. furosemide), dopamine, mannitol, fenoldapam and N-acetylcysteine are proposed renal protective agents. There is no Level 1 evidence to support their use. The mainstay of renal preservation is by adequate fluid resuscitation and the avoidance of nephrotoxins (NSAID’s, ACEI, aminoglycosides). Anaesthesia for Adbo vasc surgery, AICM, 2007, 8,6, |
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67. Which type of aortic dissection can be managed conservatively/non-operatively
A. Debakey 1 B. Debakey 2 C. Stanford A D. Stanford B E. Stanford C |
D
Stanford Type A involves the ascending aorta but may extend into the arch and descending aorta (DeBakey type I and II). Type B involves the descending aorta only (DeBakey type III). Usually, type A dissections require surgery, while type B dissections are best managed conservatively with medical treatment under most conditions. Hebbali, Diagnosis and management of aortic dissection, CEACCP, 2009 |
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68. The most likely cause of death after pharyngeal, esophageal or tracheal perforation is
A. Air embolus B. Hemorrhage C. Failure to intubate D. Failure to ventilate E. Sepsis |
Retained gastric contents, saliva, bile, and other substances may enter the mediastinum, resulting in mediastinitis. Sepsis rapidly ensues.
Emedicine, Oesphageal rupture. |
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69. An essential criteria for diagnosis of left bundle branch block (LBBB) on ECG is
A. RSR in V1 B. Minimum duration QRS of 0.2 secs C. Deep slurred S wave in V6 D. Loss of septal Q waves in V5 and V6. E. T waves opposite direction to main direction of QRS, |
D. Loss of septal Q waves in V5 and V6.
Yes, but typically written as Loss of Q in I, V5 and V6 (This is more essential than E.) |
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70. 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 lower trunk
The block is performed at the level of the distal trunks and origin of the divisions, where the brachial plexus is confined to its smallest surface area. Cords are named in relation to level of axillary artery. NYSORA website |
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71. Which of the following are feature of Conn's syndrome?
A. Hypoglycaemia, hyponatremia, hyperkalemia B. Hypoglycaemia, hypernatremia, hypokalemia C. Normoglycaemia, hypernatremia , hypokalemia D. Normoglycaemia, hyponatremia, hyperkalemia E. Hyperglycaemia, hyponatremia, hyperkalemia |
C. Primary hyperaldosteronism
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72 Commonest valvular heart disease seen in pregnancy is
A. Aortic stenosis B. Aortic regurgitation C. Mitral Stenosis D. Mitral regurgitation E. Tricuspid regurgitation |
C
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73. Incidence and severity of vasospasm following sub-arachnoid haemorrhage is seen maximally at
A. 0-24 hrs B. 2-4 days C. 6-8 days (note 5-7 days in the old question) D. 7-10 days E. 2 weeks |
D
Mentioned in previous questions and in Barash clinical Anaesthesia. Other references quote max vasospasm at 4-10 days. |
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74. The predominant pathology seen in restrictive heart disease is
A. Diastolic dysfunction B. Systolic dysfunction C. Valvular dysfunction D. ? E. ? |
A
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75. What is the first sign/symptom seen with an inadvertent total spinal whilst performing caudal anaesthesia in a neonate
A. Hypotension B. Bradycardia C. Desaturation D. Tachycardia E. Loss of consciousness |
C
Haemodynamic changes are minimal in total spinals in neonates, mainly due to immature SNS. Case reports in literature often list apnoea as first sign of total spinal and the need for ventilation and occasional pharmacologic intervention for blockade of cardiac acceleratory fibres. Smith’s Anaesthesia for infants and children, p465 |
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76. Which of the following is an absolute contraindication to electroconvulsive therapy
A. Cochlear implant B. Epilepsy C. Pregnancy D. Raised Intracranial Pressure E. Recent myocardial infarct |
D
NOT E- RECENT MI not ANY MI. Ding, A&A, 2002. Advised to wait 3-6 months post MI. No data to support this. Chief psychiatrist from WA issued statement in 2010 that Recent MI and Raised ICP are contraindications. Cochlear implant relative contraindication. |
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77. Prolonged Trendelenburg (head-down) positioning causes which of the following
A. No change in intracranial pressure B. No change in intraocular presssre C. No change in pulmonary venous pressure D. Increased myocardial work E. Increased pulmonary compliance |
D increased venour return, increased MAP increased PAP
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78. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed
A. Posterior cord B. Anterior division C. Median brachial cutaneous nerve D. Ulnar nerve E. Inferior trunk |
E.
inferior trunk Nerve not blocked is medial cutaneous nerve of forearm. It’s origins are: C8, T1 Inf trunk Ant division Medial Cord Medial cutaneous nerve NB: Trunks divide into Ant/Post divisions so there are three Anterior divisions. |
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79. A 29 year old female undergoes craniotomy for posterior fossa tumour. Which of the following is an absolute contraindication to the sitting position
A. Patent ventriculo-atrial shunt B. Previous back surgery C. Pacemaker D. Small patent foramen ovale E. Oesophageal stricture contraindicated for transoesophageal echocardiogram |
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 From AIC, 2005, Anaesthesia for neurosurgery in sitting position |
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80. A 4 year old child booked for minor surgery is seen in pre-admission clinic where a murmur is detected. Which feature will warrant further investigation
A. Loudness 4/6 B. Decreases on inspiration C. Vibratory quality D. Ejection systolic murmur - E. Louder on supine |
A- implies thrill
CEACCP, Pre-op Ax of kids, 2011 |
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81. The autonomic supply of the ciliary ganglion is such that it
A. Receives its sympathetic nerve supply from the cervical ganglion – initially thoracic spinal nerves then superior cervical ganglion B. Receives its parasympathetic nerve supply from the trochlear nerve – No occulomotor C. Is located inferiorly in the orbit – No, located posteriorly D. Is at risk from injury during peribulbar nerve block, No at risk during retrobulbar. E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus |
E
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82. Regarding Thallium Stress Testing in predicting perioperative cardiac events
A. A positive result requires further investigation with a pulmonary artery catheter B. It has a high negative predictive value C. It has a low negative predictive value D. It has a high positive predictive value E. Thallium Stress testing is considered inferior to Dobutamine Stress Echo |
B
With regard to E. they are considered by most to be close to equal, though Stress Echo may be slightly better. Carries high NPV. Emedicine review of Cardiac tests. |
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83. An elderly gentleman on warfarin has suffered a subdural haematom:::A. His INR on admission was 4.5. The resident in Ed has already given him 2.5mg of Vit K. To reverse his coagulopathy prior to urgent surgery you should give him
A. Factor VIIa B. FFP C. Cryoprecipitate D. Prothrominex E. Prothrombinex and FFP |
E
Depends on degree of haematoma, however as per MJA consensus warfarin guidelines, 2013, in pts with INR > 1.5 with life threatening bleeding (including intracranial), (see text box in notes) |
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84. During caesarean section a meconium stained floppy apnoeic baby is delivered. When the midwife gives you the baby, it is apnoeic, cyanotic with heart rate of 90 bpm. What do you do next
A. Give naloxone B. Dry and stimulate C. Start chest compressions D. Give positive pressure ventilation E. Suction the trachea |
E
resus.org.au |
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85. A 70 year old lady suffered a subdural haematoma. She is currently confused and the neurosurgeon wants to take her to theatre for urgent decompression. She is a vague historian, but from notes you find out she had ablation and pacemaker put in 7 months ago - DDD mode. Cardiac technician in 1 hour away and the surgeon wants to proceed. What do you do
A. Postpone until cardiology review B. Postpone until pacemaker checked by technician C. Postpone until temporary pacemaker inserted D. Proceed after having implemented external pacing E. Proceed with magnet available |
E
In general, aim for PPM to have been checked in last 12 months, AICD in last 6 months. Application of a magnet to a modern pacemaker produces an asynchronous mode of pacing to protect a patient from the effects of EMI. The asynchronous rate obtained depends on the programming of the device, the remaining battery life, and defaults that vary by manufacturer. BJA, 2011, Periop Mx of pt’s with implantable cardiac devices |
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86. New blood pressure measuring device is developed. Best was to compare it to the current gold standard
A. SCUSUS, B. Bland Altman Plot, C. Kendall Coefficient of Concordance, D. Pearsons coefficient, E. Friedmans |
B
A. SCUSUS, ??? No mention of this test B. Bland Altman Plot, Yes can be used C. Kendall Coefficient of Concordance, No assesses agreement around raters for non parametric data. It’s the normalization of the Friedman test. D. Pearsons coefficient, No measures linear correlation between two variables E. Friedmans ??, No, see C. |
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87. What happens when you place a magnet over a biventricular internal cardiac defibrillator
A. Switch to asynchronous pacing, B. Damage the internal programming, C. Nothing, D. Switch off antitachycardia function, E. Switch of rate responsiveness, |
D- will mostly switch off antitachycardia function, but depends on specific pacemaker. safest to get it checked.
Magnets over ICDs will inhibit ability to discharge in some brands. It won’t effect PM function, ie into asynchronous mode. In Medtronic, magnet deactivates device. St Jude and Boston have the option to program a magnet to switch it off, but depends on how it is initially setup, so may not do anything. BJA, 2011, Periop Mx of pt’s with implantable cardiac devices |
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88. A 54 year-old patient is on warfarin for AF. They have a history of alcohol abuse and liver failure with a bilirubin of 28 and an albumin of 30. He also has a history of DVT following a flight. What is his CHADS2 score
A. 0 B. 1 C. 2 D. 3 E. 4 |
A
CHADS: CCF HTN > 140/90 or Rx HTN Age > 75 DM Prev TIA/CVA |
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89. A full size C oxygen cyclinder (size A in New Zealand) has pressure
regulated from
A. 16000kpa to 400kpa B. 16000kpa to 240kpa C. 11000kpa to 400kpa D. 11000kpa to 240kpa E. ? |
A
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90. What is approximately the systolic blood pressure in an awake neonate
(mmHg)
A. 55 B. 70 C. 85 D. 100 E. 115 |
B
Depends on age and gestational age: Essentially 70 awake and asleep at term. Diastolic 40 - 50. By Week 2 it’s 80. Week 4, 85. Preterm, 48 – 60 > 32 weeks. As per neonatal handbook. NETS handbook. |
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91. A 25 year male with a history of asthma who is usually on fluticonasone and salbutamol nebs presents with an acute exacerbation. On examination you see he is distressed, RR 26 bpm. On auscultation: poor air entry and polyphonic wheeze bilaterally. ABG: pH 7.45, pCO2 27, pO2 75, HCO3 24. He has been treated with salbutamol and ipratropium nebules and intravenous hydrocortisone. What is the next step in his treatment?
A. Inhaled helium/oxygen B. IV aminophylline C. IV magnesium D. IVsalbutamol E. Intubation and ventilation |
C
See Global Initiative for Asthma 2012 document downloaded from the website: http://www.ginasthma.org Page 76 has a flow chart for care in the acute setting |
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92. You are doing an awake fibreoptic intubation and having difficulty identifying the anatomy of where you are. Then you observe a trifurcation. The lobe of the lung to which this airway is connected is
A. LUL B. Lingula C. RUL D. RML E. RLL |
C
See http://lifeinthefastlane.com/education/ccc/bronchoscopic-anatomy/ which is a summary page on Tracheo-bronchial anatomy as viewed from the fibreoptic scope. |
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93. A 35kg 5 year old girl is having elective surgery for suturing of a superficial leg laceration. After induction with N2O/Sevoflurane/O2 and in absence of any visible veins you have placed an appropriately sized LM:::A. Following this her SpO2 immediately drop to 90%. What is your initial management?
A. Remove LMA and increase inspired Sevoflurane concentration B. Increase inspired Sevoflurane concentration through the LMA C. Give sublingual Suxamethonium D. Give intramuscular Atropine E. Give intramuscular Suxamethonium |
A
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94. Ulcerative colitis is associated with all of the following EXCEPT:
A. Cirrhosis B. Iritis C. Psoriasis D. Arthritis E. Sclerosing cholangitis |
C
Ann Rheum Dis doi:10.1136/annrheumdis-2012-202143 Psoriasis, psoriatic arthritis and increased risk of incident Crohn's disease in US women |
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95. Regarding rotameters
A. The bobbin is contained in a tube with parallel sides B. There is laminar flow at high flows C. The height of the bobbin is directly proportionate to the pressure drop across the bobbin. D. There is a constant pressure difference across the bobbin at all flows. E. Resistance increases at high flows |
D
From www.frca.co.uk The flowmeters that are commonly used on anaesthetic machines are constant pressure, variable orifice flowmeters (tradename ”Rotameters”). These are cone shaped tubes that contain a bobbin and are specific for each gas. The gas enters the bottom of the tube applying a force on the bobbin. The bobbin then moves up the tube until the force from below pushing it up is cancelled out by the gravitational force of the bobbin pulling it down. At this point it remains at that level and there is a constant pressure across the bobbin (pressure is force divided by area, and the area is constant). At low flows, the bobbin is near the bottom of the tube and the gap between the bobbin and wall of the flowmeter acts like a tube, gas flow is laminar and hence the viscosity of the gas is important. As flow rate increases, the bobbin rises up the flowmeter and the gap increases until it eventually acts like an orifice. At this point the density of the gas affects its flow. As flow changes from laminar to turbulent within the flowmeter: -individual gases have different densities and viscosities and therefore the flow past the bobbin will vary for each individual gas. -the flow changes from being directly proportional to pressure to proportional to the square root of pressure and hence the graduations on the flowmeters are not uniform. |
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96. 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. Amiodarone 100mg bd B. Digoxin 250mcg daily C. Enalapril 2.5mg bd D. Metoprolol 100mg bd E. Diltiazem slow release 240mg daily |
C
AHA 2009 Updated Treatment for CCF states Level 1a evidence that “ACE inhibitors are recommended for all patients with current or prior symptoms of heart failure and reduced LVEF unless contraindicated”. It also states Bblockers reduce mortality and are also recommended, but as we discussed, the dose of Metoprolol here is very high, and at one week prior to surgery the ACEi seems the better option. |
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97. The best clinical indicator of severe aortic stenosis is
A. Presence of a thrill B. Mean pressure gradient of 30mmHg C. Area 1.2cm2 D. Slow rising pulse E. ESM radiating to the carotids |
A
From http://www.uthsc.edu/cardiology/articles/quantification%20of%20valvular%20AS%20ACCJR03.pdf “Unfortunately, physical examination is not reliable for evaluating aortic stenosis severity, except at the extremes of the disease spectrum. Physical examination findings that are specific for severe aortic stenosis include a systolic thrill at the right upper sternal border with a 4/6 systolic crescendodecrescendo murmur, a single S2 and a slow and diminished carotid upstroke (pulsus parvus et tardus). Conversely, severe aortic stenosis reliably can be excluded when there is no systolic murmur or when a normal physiologic split S2 is clearly appreciated”. |
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98. Atrial Septal Defect murmur is heard due to blood flow through
A. Tricuspid valve B. Pulmonary valve C. Mitral valve D. Aortic valve E. Atrial Septal Defect |
B
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99. 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 |
D- mod-severe mitral stenosis can cause NYHA class 3 or 4 symptoms, at or below a valve area of 1.5cm2. See article below from Cleveland Clinic.
http://webcache.googleusercontent.com/search?q=cache:-2cRbNs9KG4J:www.sjhg.org/wp-content/uploads/2012/10/whentodosurginvalvularheartdisease6-04.pdf+&cd=1&hl=en&ct=clnk&gl=au&client=firefox-a (download pdf to view properly) whentodosurginvalvularheartdisease6-04.pdf |
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100. Nitrous oxide anaesthesia may cause all of the following EXCEPT
A. An increased incidence of myocardial ischaemia B. Decreased leukocyte chemotactic response C. Elevation of plasma homocysteine levels D. Megaloblastic anaemia E. Reversible inhibition of methionine synthetase |
E
its irreversible |
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101. The diagnosis of neuroleptic malignant syndrome requires the presence of
A. Diaphoresis B. Elevated plasma creatine kinase C. Hypertension D. Muscle rigidity E. Tachycardia |
D
Both B&D are correct, so I suspect the question read Creatinine and not Creatine making Muscle Rigidity the correct answer. Leevensons Criteria require 3 major features to be present or 2 major and 4 minor. The MAJOR features being: fever, muscle rigidity and increased Creatine Kinase. The MINOR features being: tachycardia, labile BP, altered GCS, diaphoresis and Leukocytosis. |
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102. Regarding tryptase level testing for suspected anaphylaxis, all are true EXCEPT:
A. Levels peak within 1 hour B. Increased with anaphylactoid and anaphylactic reactions C. 99% of the body’s stores are found in mast cells D. Levels of > 20ng/mL are suggestive of anaphylaxis E. Test should be repeated at 24-48 hours |
A- levels peak within 1-2 hours
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103. An 18 month old boy presents for surgery for an incarcerated inguinal hernia. On examination you note that he has had an URTI for approximately one week. Your advice regarding surgery should be
A. Postpone the surgery for two weeks B. Proceed with surgery under spinal anaesthetic C. Proceed with surgery with a full course of antibiotics to treat the URTI D. Undertake surgery, but avoid the use of an ETT E. Proceed with surgery with careful monitoring |
E as surgery is urgent.
From OHA page 770. ‘Anaesthesia in the presence of an URTI is associated with increased complications in younger children….excess secretions, airway obstruction, largyngospasm and bronchoconstriction. The risk is increased 5-fold using an LMA and 10-fold with intubation. Children with moderate to severe infections should be postponed. Those with productive cough, purulent chest or nasal secretions, pyrexia and signs of viraemia or constitutional illness including diarrhoea and vomiting. The child with the mild cold if a difficult problem. The history in these cases is crucial. It is important to decide if the child is at the beginning or the end of a URTI. A child deemed to be post viral, apyrexial, with no chest signs and constitutionally well is probably fit for surgery even if they have a runny nose. Otherwise, postpone for 2 weeks. 4 weeks if LRTI or 6 weeks if bronchiolitis.” |
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104. The incidence of fat embolism syndrome following a unilateral closed femoral fracture is
A. 0 -3% B. 4 – 7% C. 8 -11% D. 12 – 15% E. 16 - 19% |
A
See CEACCP 2007 “Fat Embolism”. Patients with a single long bone fracture have a 1-3% chance of developing the syndrome, but it has been reported in up to 33% of patients with bilateral femoral fractures. |
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105. The thoracodorsal nerve arises from
A. A Medial cord of brachial plexus B. Lateral cord of brachial plexus C. Posterior cord of brachial plexus D. Dorsal scapular nerve E. Long thoracic nerve |
C
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106. Neurosurgery operation in the sitting position. MAP 80mmHg, CVP 5mmHg, the transducers are located 13cm below the external auditory meatus. What is the CPP? *Note - I specifically remember that 70mmHg was an option*
A. 62 mmHg B. 65 mmHg C. 67 mmHg D. 72 mmHg E. 75 mmHg |
E
CPP= MAP- ICP or ICP whichever is higher I don't believe position of transducer for MAP needs to be corrected for as they're both (CVP/MAP) at the same height! |
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107. A man attending his daughter's wedding is involved in fight with his son-in-law. He does not know where he is, opens eyes to voice, but removes tie when instructed. What is his GCS?
A. 10 B. 11 C. 12 D. 13 E. 14 |
D
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108. Which of the following drugs is least likely to cause hypoxia in ARDS
A. Noradrenaline B. Milrinone C. Isoprenaline D. Isoflurane E. Sodium nitroprusside |
A
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109. What is the best predictor of poor prognosis with aortic stenosis?
A. Chest pain B. Paroxysmal nocturnal dyspnoea C. Syncope D. Palpitations E. Fatigue |
B
Angina symptoms tend to die within 5 years, those with syncope within 3 years, those with signs of cardiac failure within 2 years. |
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110. Pierre-Robin sequence is characterized by cleft palate, micrognathia and
A. Craniosynostosis B. Macroglossia C. Glossoptosis D. Microstomia E. ? |
C
repeat |
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111. After 3 litres of normal saline, the dilutional anaemia is initially offset by
A. Increased cardiac output B. Increased oxygen extraction C. Capillary vasodilation D. ? E. ? |
A
From Miller, Ch 57. The hypervolumetric haemodilution will lower PaO2 but compensatory mechanisms occur to ensure surplus Oxygen delivery to the tissues continues. A sudden reduction of [RBC] – reduction in viscosity – reduced peripheral resistance- and so increased VR with increased CO results. |
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112. Anaesthetic Machine is left on all weekend with flow rate of oxygen at 6 litres/min. A Desflurane vaporiser is placed on it on Monday morning without changing the CO2 absorber. What is the most likely toxic product produced?
A. Ca(OH)2 B. Carbon dioxide C. Carbon monoxide D. Compound A E. Compound B |
C
From Stoelting. DIE (Des, Enf, Iso) produce Carbon Monoxide from their CHF2 moeity. Factors which influence the magnitude of this CO production include; dryness of absorbent, high temp of absorbent, FGF, type of absorbent. |
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113. 2ml of 0.75% ropivacaine is injected for an interscalene block. Soon after the patient loses consciousness. The most likely place of inadvertent injection is
A. Subdural B. Internal jugular vein C. Common carotid artery D. External jugular vein E. Vertebral artery |
E
NYSORA website NYSORA: “The neck is a very vascular area, and care must be exercised to avoid needle placement or injection into the vascular structures. Of particular importance is to avoid the vertebral artery, and branches of the thyrocervical trunk: inferior thyroid artery, suprascapular artery, and transverse cervical artery.” |
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114. An 18 month old infant is undergoing a routine spontaneously breathing GA with an LMA. They have a sudden onset of SVT with a heart rate of 220 and a BP of 84/60 with an ETCO2 of 32 and SpO2 of 98. The best management strategy is
A. Adenosine 100mcg/kg B. DCR 2J/kg C. DCR 4J/kg D. Amiodarone 5mg/kg E. CPR |
A
Predicted weight = 2(age+4) = 11Kg. Adenosine is first line according to www.resus.org.au Guideline 12.5 at a dose of 01-0.3 mg/kg. Amiodarone is second line at 5mg/Kg. When SVT is pulseless or accompanied by severe hypotension, DCR is indicated at 0.5-1.0J/Kg up to 2 j/Kg if needed. |
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115. 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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116. A middle-aged male with severe mitral stenosis having general anaesthesia for repair of fractured ulna/radius. Ten minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70/-. He is normally in sinus rhythm. What do you do
A. Adenosine B. Amiodarone C. Shock D. Volume E. Metaraminol |
C
He is haemodynamically compromised. This situation shows example of DECOMPENSATED MITRAL STENOSIS. This is when there is development of AF or Pulm hypertension. (maggie wong tute RWH). |
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117. 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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118. ET04 An 85 year old patient with a bleeding disorder (? haemophilia) suffers a fractured neck of femur (#NOF). You discuss the possibility of a needing a blood transfusion but despite your explanation they refuse because they are scared of CJD infection post transfusion. Subsequently you decide not to proceed with the case because of the high risk of bleeding. The ethical principle that this is an example of is
A. Paternalism B. Coercion C. Justice D. Beneficence E. Autonomy |
D
Beneficence patient refusing transfusion is example of Autonomy. Not proceeding due to risk of bleeding is ?beneficence, ?paternalism. From the Journal of Medical Ethics Vol 11, Issue 4 “The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit”. However, beneficience is taking an action that best serves the need of the patient. |
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119. A type I diabetic is fasting pre-operatively and you decide to place them on an IV insulin infusion to optimize their perioperative glycaemic control. Their BSL is 7 mmol/L. By what mechanism does the insulin infusion decrease their BSL
A. Stimulates glucose uptake into the liver B. Stimulates glucose uptake into skeletal muscle C. Inhibits glucose production in the liver D. Decreases glucose absorption from the gastrointestinal tract E. Inhibit glucagon release |
B
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120. Patient has undergone a bilateral lung transplant. All of following are impaired EXCEPT
A. Mucociliary clearance B. Cough reflex distal to anastomosis C. Hypoxic pulmonary vasoconstriction D. Response to CO2 E. Lymphatic drainage |
C
repeat HPV is not affected by autonomic denervation and is fully preserved as a local tissue phenomenon. |
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121. Patient with history of long QT syndrome treated with long term propranolol. How do you know the treatment is effective
A. Normal QTc B. No further prolongation of QT in response to valsalva manoeuvre C. ? D. ? ? |
A- no because B-blockers don’t change QT interval
B- CORRECT. as per CEACCP 2008 Vol8 No2 p. 67-70. It’s one of the diagnostic test to assess a patient with known long QT syndrome preoperatively. |
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122. A neonate is born with meconium stained liquor but is vigorous and crying. The reason for not suctioning the pharynx is
A. Hypertension B. Hypotension C. Bradycardia D. Tachycardia ? |
C
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123. What organism most commonly causes meningitis post spinal anaesthesia
A. Staphylococcus epidermidis B. Staphylococcus aureus C. Streptococcus pneumonia D. Streptococcus salivarius Escherichia coli |
D. as per further reading: see article below
Baer E. Post-dural puncture bacterial meningitis. Anesthesiology 2006;105: 381–93. Table 4. Occurrence of Causative Organisms Tabulated in Table 1 Organism* n No growth 46 S. salivarius 30 Viridans streptococcus 29 Not specified 12 -Hemolytic strep 11 Staphylococcus aureus 9 Pseudomonas aeruginosa 8 S. mitis 6 S. sanguis 5 Purulent meningitis 4 None (LP after antibiotics) 3 E. faecalis 3 Streptococcus 2 Gram nonhemolytic strep 1 S. uberis 1 S. cremoris 1 S. micro-aerophilia 1 S. oralis 1 Group D streptococcus 1 Staph epidermidis 1 Corynebacterium xerosis 1 Abiotrophia defectiva 1 Acinetobacter species 1 N. meningitidis 1 * Organism designations are those used by the authors of the case reports. |
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124. A male patient has a haemoglobin of 8g/dL and reticulocyte count 10%. The most likely diagnosis is
A. Untreated pernicious anaemia B. Aplastic anaemia C. Acute leukaemia D. Anaemia of chronic disease Hereditary spherocytosis |
E
A- megaloblastic anaemia on blood film; increased MCV, Increased MCH, decreased reticulocytes B- pancytopaenia due to bone marrow failure C- no- will have abnormal band of WCC, no change in reticulocyte count necessarily D- microcytic (i think) E- correct answer. Increased peripheral reticulocytes. Howell-Jolly bodies on blood film. spherical RBC’s withOUT central pallor. Fragile RBCs with high turnover (ie also causes splenomegaly) cause increased reticulocyte count. |
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125. An advantage of supraclavicular block over an interscalene nerve block for shoulder surgery
A. Less phrenic nerve block B. Easier landmarks in obese patient C. Arm can be in any position for block D. Less risk pneumothorax E. Better cover for shoulder surgery |
A- less phrenic nerve block, although still happens.
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126. A patient with a head injury is found to have a unilateral dilated pupil with no direct or consensual response to light. What is the most likely diagnosis
A. Global injury B. Optic nerve injury C. Horners syndrome D. Transtentorial herniation Injury to the pons |
A-no- bilat dilated pupils
B-no, optic nerve is SENSORY. so, would still have consensual response intact if optic nerve damaged C- no- ptosis/miosis/anhydrosis D- YES if causes compression of 3rd cranial nerve ipsilateral to injury- OCULOMOTOR nerve is the motor nerve supplying ciliary muscles. therefore gives the BLOWN PUPIL of any unilateral head injury. eg. extradural haematoma causing transtentorial herniation. E- no ‘pontine pupils’ are bilaterally pinpoint and reactive. |
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127. EM68 In an arterial line system
A. Overdamping exaggerates mean pressure B. Underdamping increases mean pressure C. Underdamping underestimates systolic pressure D. Wide range of damping coefficient associated with good performance if system has high natural frequency Compliant tubing is good |
A- no, underestimates
B- no, no change to mean pressure shown C- no, OVERestimates (makes it bouncy) D- yes. optimal damping coefficient- 0.64. If natural resonant frequency high, you can get accurate values of BP @ almost any coefficient value. Usual resonant frequency of our systems are 10-15 Hz- need frequencis of 10-20,000 Hz to negate the importance of the coefficient value. Impractical in anaesthetics as would have to be very stiff & short, or VERY expensive. (paraphrased from mcq.com site) |
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128. The commonest postoperative complication in a patient with a neck of femur fracture (#NOF) is
A. UTI B. Pneumonia C. Myocardial Infarction D. Delirium ? |
D
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129. Which of the following is an advantage of a bronchial blocker of a double lumen tube
A. Able to isolate separate lobes B. Significantly easier to deflate non-ventilated lung C. Better suited to pneumonectomy D. Less pressure on bronchial tissue Lower incidence of tube malpositioning |
notes taken from OHA 3rd Ed p 370-4
A- Yes is an advantage as DLT can only isolate entire lung. B- No- DLT easier as just open non-ventilating lung to air to deflate, whereas bronchial blocker air has to slowly drain out thru central tubing C-no, as have to withdraw blocker back to allow surgical access in pneumonectomy D- ? don’t know but likely not E- maybe. 80% of DLT’s malpositioned but still give adequate clinical lung isolation. (don’t know if this number is lower when fibroptic scope routinely used) |
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130. Laser endotracheal tubes
A. More resistant to ignition when covered in blood B. Resistant to electrosurgical cautery C. Wont ignite when touched by laser D. Have larger external diameter for same internal diameter relative to standard PVC tubes Have double cuffs which are resistant to puncture by laser |
howequipmentworks.com
A- no less resistant - laryngoscope, 1994, Jul;104(7):829-3 B-not sure C- no can still ignite if gets a ‘direct hit’ from laser beam D- YES larger external diameter as have an extra wrapping of metal foil or other fire-retardant material on them E- double cuffs but their point is to warn of puncture (methylene blue crystals) or have N Saline to give extra protection against fire. ref- Lasers and Surgery, BJA CEPD Reviews/ Vol8 No 5 2003 ref- Fire Safety in the Operating Room, Curr Op in Anaesthesiology, 2008, 21:790-95 |
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131. Pulsus paradoxus in cardiac tamponade, the blood pressure decreases
A. Every second beat B. In expiration when increase is normal C. In expiration more than normal subjects D. In inspiration when increase is normal E In inspiration more than normal subjects |
E
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132. You are anesthetizing a patient for a laparotomy who has a history of pulmonary hypertension. Regarding the patients anaesthetic management
A. An alpha-agonist is the inotrope of choice B. Hypothermia is protective against a rise in pulmonary artery pressure C. Isoflurane will tend to decrease pulmonary artery pressure D. Ketamine is an appropriate anaesthetic agent ? RHF |
A- YES
B- No C-No D- some sources say yes! (don’t KNOW) E- ? RHF is a major concern.. Insignificant alpha-1 activity in lungs, so won't increase PHT. Isoflurane may or may not decrease PHT depending on study |
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133. In a patient with severe rheumatoid arthritis, which radiological finding is most consistent with severe atlantoaxial instability (? C1/C2 instability)
A. A 9mm gap between the anterior arch of C1 and the odontoid peg B. Increased saggital diameter C. Posterior atlantodental interval of > 14mm D. Midpart of C1 over C2 Tear drop sign of C2 |
A- Yes. Indicates Anterior subluxation. Present in 80 % of RA- affected pts. C1 (the RING or ATLAS) moves anteriorly on C2 (which is the AXIS and has the odontoid PEG or DENS ). distance btwn anterior arch of C1 & odontoid peg >4mm on lateral Xray view indicates severe instability
B- no C- not sure what the posterior interval cutoff is D- doesn’t make sense E- indicates a hyperextension fracture of C2, NOT C1/C2 instability ref- ‘Anaesthesia for the adult patient with rheumatoid arthritis’, CEACCP, Vol 6 No 6 2006, p 235-39. |
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134. You are called to the labour ward to assist in the manual removal of a retained placenta in a healthy woman. The obstetrician asks you to administer intravenous glycerol trinitrate. An initial safe dose, that you would expect to be effective, would be
A. 5mcg B. 50mcg C. 250mcg D. 500mcg 1000mcg |
B- 50 mcg.
To dilute into 1000mL of N Saline/CSL; Draw up entire 50mg in 10mL ampoule. Take out 10mL from 1000mL bag, then inject the GTN. This gives dilution of 50mcg/mL. OR, Draw up 1mL (5mg) of GTN from 10mL ampoule, and inject into 100mL N Saline bag. This also gives same dilution (50mcg/mL) |
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135. What is the most accurate method of determining foetal heart rate in a neonate
A. Palpation of an umbilical vein pulse B. Auscultation with a stethoscope C. Palpation of the femoral artery D. Pulse oximetry ? |
B as per group discussion
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136. Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing
A. Abnormalities on magnetic resonance imaging (MRI) spectroscopy B. Calcium release from B lymphocytes in response to caffeine stimulation C. Certain mutations in the ryanodine receptor gene D. Myofibrillar necrosis on muscle biopsy plasma Creatine kinase (CK) levels above 800 units/L |
unsure still- possibly A
Serum CK levels are not sensitive or specific enough to be useful for diagnosis in individual patients. (does rise however) (Australian Anaesthesia 2005 p42) |
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137. A 60 year-old man with anterior mediastinal mass, is having a mediaastinoscopy. During induction they lose cardiac output, desaturate and drop their ETCO2. What is the best management strategy
A. Adrenaline B. CPR C. CPB D. Place prone ? - Maybe rigid bronchoscope? |
D
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138. Which is true of Eaton-Lambert syndrome that differentiates it from myasthenia gravis?
A. Immune antibodies against post-synaptic ion channels B. Associated with thymoma C. Repeated exercise causes weakness to initially improve D. Good response to edrophonium Resistant to non-depolarizing muscle relaxants |
A- no presynaptic Voltage gated calcium channels affected
B-no- mostly associated with lung cancer- it’s a paraneoplastic phenomenon. MG is associated with thymoma (10-30%) C-YES called Lambert’s sign. D- No, edrophonium is a acetylcholinesterase INHIBITOR so decreases the breakdown of ACh to make more available at post-synaptic receptors. in ELS, not enough ACh made so doesn’t have the dramatic effect that giving it to MG patients will have. E- NO both are sensitive to NDNMBs |
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139. A 55 year-old man presents to the emergency department with an obviously infected heel ulcer - BP 100/60, PR 110/minute, temperature 35.8, Na 125, K 2.7, BSL 55, Creatinine 180. Which do you give first/most urgently?
A. Antibioitcs B. Crystalloid C. Insulin D. Potassium Adrenaline |
B- crystalloid, as per HONK management
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140. A new test has been developed to diagnose a diseas:E. To determine the SPECIFICITY of this new test it should be administered to
A. A mixed series of patients i.:E. some known to be suffering from the disease and some known to NOT be suffering from it B. A series of patients known to NOT be suffering from the disease C. A series of patients known to NOT be suffering form the disease and an estimate of the prevalence of the disease in the population obtained D. A series of patients known to be suffering from the disease A series of patients known to be suffering from the disease and an estimate of the prevalence of the disease in the population obtained |
B
Spec = TN / (TN + FP) If the patient is disease negative, how likely is it that the TEST will be negative? Sens = TP / (TP + FN) If the patient is Disease positive, how likely is it that the TEST will be positive? |
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141. During one lung ventilation, hypoxaemia can occur. The cause for this is:
A. Loss of hypoxic pulmonary vasoconstriction B. Perfusion of the unventilated lung C. Ventilation perfusion mismatch of the ventilated lung D. Atelectasis of the ventilated lung E. Upper lobe collapse of the ventilated lung |
B but all of above can be a factor. depends on timing of hypoxia. initial hypoxia is due to residual perfusion of unventilated lung, and one of the rescue manoeuvres is to clamp off the relevant pulmonary artery to decrease shunt through unventilated lung,
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142. A child with intra-operative blood loss. A cardiac arrest is most likely because of
A. A delay in delivery of blood from the blood bank B. Inadequate intravenous access C. Underestimated intra-operative blood loss D. Underestimated pre-operative hypovolaemia Complication of transfusion |
Anaesth & Analg, Vol. 105, No. 2, August 2007. - review of anaesthesia-related cardiac arrest. Showed underestimation of blood loss leading to hypovolaemic shock most common cause of arrest related to anaesthetic (23%). Types of surgery most related; craniotomy & spinal surgery.
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143. The lumbar plexus supplies all of the following EXCEPT:
A. Subcostal nerve B. Obturator nerve C. Lateral cutaneous femoral nerve D. Long saphenous nerve Iliohypogastric nerve |
A
subcostal |
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144. The symptom indicating poorest prognosis in an adult patient with aortic stenosis
A. Chest pain B. Malaise C. Palpitations D. Paroxysmal nocturnal dyspnoea E Syncope |
D
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145. A 50 year old male in recovery after an anterior cervical fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, SpO2 96%. What is the most appropriate management
A. Aspirate the collection with a 19G needle and syringe B. Awake fibreoptic intubation with minimal sedation C. Direct laryngoscopy and intubation after sevoflurane/O2 gaseous induction D. Direct laryngoscopy and intubation after propofol/suxamethonium induction E Intubation via intubating LMA |
C
Safest if he wasn’t combative would be awake fibreoptic (B). However may have to choose C- gas induction then direct laryngoscopy. |
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146. RB67 Regarding post dural puncture headache, all of the following are true, EXCEPT:
A. If puncture with the tuohy needle during epidural insertion, subsequent blood patch is 30-50% effective B. Caffeine is often used to treat mild headache C. Subdural haemorrhage can occur rarely D. ? E. Unlikely to be post dural puncture headache if the headache is only in the occipital area |
A- sort of true. of those patched, 70-80% immediate success, but 10-20% will need repeat patch
B- Yes in some centres but need more than 300mg/day and at those levels it passes into breastmilk so most women probably wouldn’t choose it. C-yes, and can be cranial not spinal, and can cause an extended PDPH. SO all PDPH’s probably need good imaging. D- E- No (so therefore correct answer). Headache is most commonly fronto-occipital, but can be an isolated occipital headache. typically midline/bilateral and frontal-occipital. Symptoms may also include visual or hearing changes. Rarely, oculomotor or trigeminal nerve paresis may be seen. ref- Anaesthetic Tute Of The Week, RWH handbook. |
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147. A 70 year-old male presents for right lower lobectomy. Preoperative spirometry shows FEV1 2.4L (4.2L predicted), FVC 4L (5L predicted). The predicted post-operative FEV1 is:
A. 1.0L B. 1.3L C. 1.7L D. 1.9L 2.2L |
From Miller p.1821:
RUL 6 subsegments RML 4 RLL 12 LUL 10 LLL 10 with no mention of the left lingula. Therefore PPO = Preop x [(42-12)/42] = 2.4 x 0.71 =1.70 C is correct |
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148. What is the most important immediate treatment for a cardiac arrest due to ventricular fibrillation in a patient with hypertrophic obstructive cardiomyopathy?
A. Adrenaline B. Amiodarone C. Defibrillation D. Intubation, ventilation and oxygenation E. Precordial thump |
C
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149. Hypercalcaemia due to hyperparathyroidism is associated with
A. A shortened PR interval B. A prolonged QTc interval C. Muscle rigidity D. Polyuria and polydipsia E. Increased glomerular filtration rate |
D
A- Millers’ says it causes PR shortening, and OHA says ‘abnormal PR’ (p.304)- but UTD says nothing about PR B- overall action potential shortened (ie QT shortened), but conduction remains normal. C- no D- YES E- no they get renal failure |
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150. The cause of early mortality (early - within 30 minutes) in a pregnant women with amniotic fluid embolism is
A. Bronchospasm B. Hypovolaemia C. Malignant arrhythmia D. Pulmonary hypertension E. Pulmonary oedema |
D
Phase 1- Amniotic fluid & foetal cells enter maternal circulation. Pulm art vasospasm due to highly immunogenic nature of fluid, causes pulmonary hypertensions, RH failure and collapse, hypoxaemia & hypotension. Phase 2- after 30 mins, IF they survive phase 1: Left ventricular failure & pulmonary oedema. DIC causing haemorrhage & uterine atony. |
