2010 May Mcq

Front 1

18 year old with Fontan circulation undergoing exploratory laparotomy. On ICU ventilated, sats 70%. Which ventilator parameter would you INCREASE to improve his sats?
A. Bilevel pressure
B. Expiratory time
C. Inspiratory time
D. Peak inspiratory pressure
E. PEEP

Back 1

B. Expiratory time

Preferably spontaneous ventilation for short cases / if able.
If not, long I:E ratio, tidal vol 5-6ml/kg, adequate pulmonary blood flow, normocarbia, aim for low PVR, low PEEP.
CEACCP 2008

Front 2

A 7kg infant with Tetralogy of Fallot, post BT shunt. Definitive repair at later date. Paralysed and ventilated, sats 85% baseline, now 70%. Best treatment?
A. increase FiO2 to 100%
B. Esmolol 70mcg
C. Phenylephrine 35mcg
D. Morphine 1mg
E. N/2 + 2.5% Dex 70ml

Back 2

C. Phenylephrine 35mcg

Front 3

Von Hippel-Lindau disease associated with:
A. increased risk of MH
B. meningiomas
C. peripheral neuropathy
D. Phaeochromocytoma
E. poor dentition

Back 3

D. Diseases of von = Phaeo

Read: Anaesthesia and Uncommon Disease

Front 4

70 year old post TKR. On subcut heparin. Develops clinical DVT and platelets 40 (sounds like HITS type II). Management:
A. Enoxaparin
B. Fonoparinux
C. Heparin infusion
D. Lepirudin
E. Warfarin

Back 4

D. Do they think we're silly?

E takes too long but also can cause skin necrosis or venous limb gangrene!

Management:
- discontinue heparin from all sources (check lines / PICC etc).
- Treat with direct thrombin inhibitors (lepirudin, argatroban, bivalirudin) or danaparoid - the latter has an extremely low cross reactivity.

Front 5

Hypercalcaemia:
A. Chvostek's sign
B
C
D
E. Short QT

Back 5

E. (OHA)

A is for hypOcalcaemia.

Front 6

DES 6 months old, on aspirin and prasugrel 10mg. Elective lap chole for biliary colic.
A. Do case while taking both
B. Do case while stopping both.
C. Stop prasugrel for 7 days, continue aspirin
D. Stop prasugrel for longer
E. Postpone 6 months

Back 6

E.
Need 12 months of clopidogrel/prasugrel

Duration:
Dilatation without stent = 2-4 weeks
PCI and bare metal = 6 weeks (vital) - 3mths (elective)
PCI and DES = 12 months.
Continue aspirin lifelong

Front 7

For a person newly diagnosed as MH susceptible, which is true?
A.
B. Can have had an uneventful 'triggering' anaesthetic
C. Recommended to use an anaesthetic machine which has not had volatiles through it
D.
E. There have been case reports of MH occurring up to 48 hours post op

Back 7

B and E,
Maybe all true except C

Front 8

ABG: pH 7.12, PO2 100, PCO2 65, HCO 20, BE -10. Consistent with:
A. CRF
B. MH
C. DKA
D. End stage respiratory failure
E. ethylene glycol toxicity

Back 8

B.

Front 9

Cocaine OD. What is false?
A. Euphoria
B
C
D
E Miosis

Back 9

E. Causes mydriasis, not miosis

Front 10

Maximum dose of lignocaine with 1:100000 Adrenaline for liposuction with tumescence technique?
A. 3mg/kg
B. 7mg/kg
C. 15mg/kg
D. 25mg/kg
E 35mg/kg

Back 10

E. Wow.

Front 11

Compared with 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 11

c. 4x

Front 12

Aneurysm surgery. Propofol / remifentanil / NMDR. DOA monitoring (entropy). MAP 70, HR 70/min, SE 50, RE 70. What do you do?
A.
B. metaraminol
C. Check TOF
D. nothing
E. increase TCI

Back 12

C. as detecting difference between SE and RE (latter includes EMG ie. muscle activity)

Front 13

Paralysed with atracurium. TOF is 1 (25%). You give a dose of 0.1mg/kg mivacurium to close the abdomen. When will you be back to TOF 1 (25%)?
A. 5 min
B. 10 min
C. 30 min
D. 60 min
E. 90 min

Back 13

C. 30 min

Front 14

Plenum vapouriser.
A. Something with FGF
B. Relies on a constant flow of pressurised gas
C. Out of circle
D. Not temperature compensated
E. volatile injected into fresh gas flow

Back 14

B. Relies on an upstream gas source to push fresh gas through vapouriser (vs draw over which pulls 'draws')
Most are temperature compensated, and only Tec 6 'injects' into the fresh gas flow.

Front 15

Interscalene block, patient hiccups, where do you redirect your needle?
a. Anterior
b. Posterior
c. caudal
d. cranial
e. superficial

Back 15

B Posterior - as phrenic nerve is ANTERIOR to interscalene bundle

Front 16

What is the SVR in a patient with MAP 100mmHg, CVP 5, PCWP 15, CO 5L/min?
A. ?0.8
B. ?3
C. 520
D. 1280
E. 1520 dynes.sec/cm-5

Back 16

1520, as other q's.
R = change in pressure / flow (x 80 at end to change units)

Front 17

Accidentally cannulate carotid artery with 5 lumen 7 Fr CVC preop for a semi urgent CABG. Most appropriate next response is to
A. Get vascular surgeon to repair it and continue with surgery and heparin
B. Leave it in. Do CABG. Pull it out post op.
C. Pull it out, compress. Delay surgery for 24hrs
D. Pull it out compress. Continue with surgery + heparin.
E. Pull it out. Compress. Continue with surgery no heparin.

Back 17

Ouch. S**t happens. Won't let me swear in here wow!
C. Has merits. Wouldn't heparinise for sure.
B - hrmm
Can't do CABG without it though, so D/E out.
A. Do need a repair but unlikely to heparinise straight after that...

Front 18

Stellate ganglion (Repeat Question)
A. Anterior to scalenius anterior
B. ?
C. ?
D. ?
E. ?

Back 18

A.

Front 19

The median nerve (REPEAT)
A. can be blocked at the elbow immediately medial to the brachial artery
B. can be blocked at the wrist between palmaris longus and flexor carpi ulnaris
C. can be blocked at the wrist medial to flexor carpi ulnaris
D. is formed from the lateral, medial, and posterior cords of the brachial plexus
E. provides sensation to the ulna half of the palm

Back 19

A. Wow lot of repeats so far.

Front 20

Patient for total knee replacement under spinal anaesthetic. Continous femoral nerve catheter put in for post op pain relief. Good analgesia and range of motion 18hrs post op. 24hrs post op, patchy decreased sensation in leg and unable flex knee. What is the cause?
A. Compression neurapraxia (i think it said due to torniquet)
B. DVT
C. Muscle ischaemia
D. Damage to femoral nerve
E. Spinal cord damage

Back 20

Lets blame the torni!!

Front 21

A 75yo male with moderate aortic stenosis (valve area 1.1cm2).. Gets mild dyspnoea on exertion but otherwise asymptomatic. needs hip replacement.
A. Continue with surgery
B. Beta block then continue
C. Get myocardial perfusion scan
D. Postpone surgery awaiting AVR
E. Postpone surgery awaiting balloon valvotomy

Back 21

Symptomatic moderate AS = AVR indication. Thus D.

Front 22

112 (similar to above) Patient for fempop bypass (i believe it said "angioplasty"), history of CCF. Also has diabetes on oral hypoglycaemics, controlled hypertension and atrial fibrillation at rate of 80bpm .
A. Medium risk surgery, medium risk patient
B. Medium risk surgery, high risk patient
C. High risk surgery low risk patient
D. High risk surgery, medium risk patient
E. High risk surgery, high risk patient.

Back 22

D.
High risk patient = "Active cardiac condition"
Ie:
Unstable ACS
- unstable or severe angina (CCS III-IV)
- recent MI
Decompensated CCF
- NYHA class IV
- worsening or new onset HF
Significant arrhythmia
- high grade AV block
- Mobitz type II
- 3rd degree AV block
- symptomatic ventricular arrhythmia
- SVT
- symptomatic bradycardia
- newly recognised VT
Severe valvular disease
- Severe AS, symptomatic MS

vs.
Medium risk patient = clinical risk factors
- IHD
- compensated, prior HF
- DM
- CRI
- CVA

Front 23

23.Best Approach for a Sub-Tenon's block?
A. inferonasal
b. inferotemporal
c. medial canthus
d. superior nasal
e. superior temporal

Back 23

A. Cos that's what we do?

Front 24

Baby with TracheoOesophageal Fistula found by bubbling saliva and nasogastric tube coiling on xray. Best immediate management?
A. Bag and mask ventilate
B. Intubate and ventilate
C. position head up, insert suction catheter in oesophagus (or to stomach?)
D. Place prone, head down to allow contents to drain
E. Insert gastrostomy

Back 24

C. Again

Front 25

A 60yo Man with anterior mediastinal mass, during induction for mediastinoscopy....lose cardiac output, decreased saturations, drop in ETCO2. Management
A. Adrenaline
B. CPR
C. CPB
D. Place prone

Back 25

D. Either awaken, or change position, or put a rigid bronch in and put tube past obstruction

Front 26

Post thyroidectomy patient, patient in PACU for 30 minutes. Develops respiratory distress. Most likely cause?
A. Hypercalcemia from taking parathyroids
B. Bilateral laryngeal nerve palsies
C. bleeding and haematoma
D. Tracheomalacia
E.

Back 26

C.

Front 27

Best way to prevent hypothermia in patient undergoing a general anaesthetic (Repeat question)
A. Prewarming of patient
B.
C.
D. Warm IV fluids

Back 27

A.

Front 28

MAIN indication for biventricular pacing is
A. complete heart block
B. congestive cardiac failure
c. VF
D.

Back 28

B

Front 29

Desflurane TEC6 vaporiser, unable to turn dial on. This is NOT because
A. vapouriser is tilted
B. Hotter than 39C
C. On battery power
D. Interlock not engaged, or not seated properly (or something like that)
E. other vapouriser is already on

Back 29

B. Causes of shutdown include:
- tilt of 10 degrees +
- power failure
- not locked
- other vapouriser on

Front 30

Desflurane vaporiser, heated because of
A. High SVP
B. High boiling poing
C. Low SVP
D. High MAC
E. Low MAC

Back 30

High SVP, A

Front 31

Myotome of C6-7 (Repeat Question)
A. Wrist flexion and extension

Back 31

A

Front 32

Most common cause of maternal cardiac arrest
A. PE
B. AFE
C. Haemorrhage
D. Preeclampsia
E. cardiomyopathy

Back 32

B.
Causes of direct and indirect maternal deaths 1997-2005
1. AFE
2. Haemorrhage
3. Hypertension
4. VTE
Indirect = Cardiac, psychiatric, infection

Front 33

Most likely change on CTG with anaesthesia for non-obstetric surgery at 32 wks
A. Loss of beat to beat variability
B. No change
C. Late decels
D. Variable Deccels
E. uterine contractions

Back 33

A. "Anaesthesia for the pregnant patient undergoing non-obstetric surgery"

Maternal anaesthesia, and thus fetal anaesthesia, and maternal/fetal hypothermia may decrease baseline FHR and beat to beat variability, but will not cause bradycardia, spont decels or those in response to a uterine contraction. These would be signs of fetal hypoxaemia or asphyxia

Front 34

What is NOT associated with ulcerative colitis? (Repeat question)
A. Cirrhosis
B. Psoriasis
C. Arthritis
D.
E.

Back 34

Probably an autoimmune thing, so psoriasis and arthritis are,
Going A.
"Hepatic steatosis is detectable in about half of the abnormal liver biopsies from patients with CD and UC; patients usually present with hepatomegaly. Fatty liver usually results from a combination of chronic debilitating illness, malnutrition, and glucocorticoid therapy." (Harrison's Ch 289 Extraintestinal manifestations section) Cirrhosis may occur secondary to sclerosing cholangitis though...
B. iritis - true: "The incidence of ocular complications in IBD patients is 1–10%. The most common are conjunctivitis, anterior uveitis/iritis, and episcleritis."
C. psoriasis - true but classically taught to be false as Crohn's has a stronger association; probably the exam answer: "Psoriasis affects 5–10% of patients with IBD and is unrelated to bowel activity." (Harrison's) "“We suggest that future studies on comorbidities in psoriasis should also focus on ulcerative colitis and not only Crohn's disease,” say Cohen et al." [1]
D. arthritis - true: "Peripheral arthritis develops in 15–20% of IBD patients, is more common in CD, and worsens with exacerbations of bowel activity. It is asymmetric, polyarticular, and migratory and most often affects large joints of the upper and lower extremities. Treatment is directed at reducing bowel inflammation. In severe UC, colectomy frequently cures the arthritis."
E. sclerosing cholangitis - definitely: "1–5% of patients with IBD have PSC, but 50–75% of patients with PSC have IBD."

** Eye involvement with uveitis and episcleritis (picture 7A-B) (see "Skin and eye manifestations of inflammatory bowel disease")
** Skin disorders such as erythema nodosum and pyoderma gangrenosum (picture 8A-C)
** A peripheral arthritis, which primarily involves large joints (with no synovial destruction), and ankylosing spondylitis; furthermore, an undifferentiated spondyloarthropathy or ankylosing spondylitis may be the presenting manifestation of ulcerative colitis (see "Arthritis associated with gastrointestinal disease")
** Sclerosing cholangitis which typically presents with an elevation in the serum alkaline phosphatase concentration
** Lung disease, ranging in severity from asymptomatic decreases in diffusing capacity to disabling bronchiectasis (see "Pulmonary complications of inflammatory bowel disease")
** Venous and arterial thromboembolism [24-28] (table 2)
** Autoimmune hemolytic anemia

Front 35

What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping? (repeat question)
A. TOFC
B. TOFratio
C. Post tetanic count

Back 35

C.

Front 36

What's the area burnt in man? Half of left upper arm, all of left leg and anterior abdomen (repeat qu).
A. 27%
B. 32%
C. 42%
D.
E.

Back 36

A. Repeat

Based on the 'rule of nines', the estimated burn surface area would be as follows:
- half of upper arm = approx 2%
- all of left leg = 18%
- anterior abdomen = approx 9% depending on what proportion is burnt; whole thorax/abdomen on either anterior or posterior is 18% - i.e. 36% for front and back
-> TOTAL = 29%

Front 37

Torsades, what's not useful? (Repeat question)
A. Amiodarone
B. Isoprenaline
C. ?
D. ?
E. ?

Back 37

A.
Amiodarone prolongs the QT interval and is widely reported as a precipitant of torsades de points. "We present two patients who had life-threatening arrhythmias, which are highly likely to be secondary to amiodarone. This class III anti-arrhythmic is commonly prescribed for the acute presentation of supra-ventricular and ventricular arrhythmias. However, occasionally its use can transform arrhythmias from benign to dangerous. These cases highlight the need for careful attention to the indications, cautions and contra-indications of amiodarone as well as the need for vigilance following initiation of anti-arrhythmic therapy." (Resuscitation, Volume 76, Issue 1, Pages 137-141 (January 2008))

Front 38

Treatment for long QTc (OR what does NOT increase the QT interval)
A. Magnesium
B. ?
C. ?
D. ?

Back 38

A. Mg

Front 39

HOCM, VF arrest on induction, what's the first priority in management?
A. defibrillate
B. amiodarone
C. Intubate and ventilate
D. Pre-cordial thump
E. adrenaline

Back 39

A.
According to the latest ARC Adult Advanced Life Support algorithm (2006), the precordial thump is the first priority for a monitored arrest, so the Answer=D.
However, one of the consultants I work with is on the ARC, and think I recall him saying the precordial thump may be removed at some point. But as the current ARC algorithm still contains the precordial thump I guess that is the answer. Realistically it would be swiftly followed by CPR and defibrillation.

Front 40

Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management?
A. adenosine 6mg
B. DCR
C. amiodarone
D. Atenolol
E. ?

Back 40

A>
ARC Guideline 11.11 - Managing Acute Dysrhythmias says that in a patient with no "adverse features" start with vagal manoeuvres. If that does not work next step is adenosine 6mg, then 12mg if required. Next step is Ca2+-channel blocker (verapamil or diltiazem). The fact that she is pregnant is not irrelevant from the treatment point of view, but main priority is the life of the mother. Consideration of effects of drugs on fetus is important, but there is no point witholding the correct treatment because of potential effects on fetus if the mother dies as a result of witholding the drug anyway.

Front 41

The intercostobrachial nerve:
A. Arises from T2 trunk
B. Is usually blocked in brachial plexus block
C. Supplies antecubital fossa
D. can be damaged by torniquet
E. Arises from inferior trunk

Back 41

D.

Front 42

Post dural puincture headache (PDPH) -(thoracic epidural) of "low pressure type". Features NOT consistent
A. headache Immediately after procedure
B. Frontal headache only
C. Starts 24hrs post
D. Auditory symptoms
E. Neck stiffness

Back 42

A=FALSE. Usually starts 24-48 hrs after dural puncture.
B=True. Typically fronto-occipital, but can be frontal, occipital or nuchal (Evidence-Based Obstetric Anaesthesia, Halpern & Douglas, BMJ Books; Blackwell, 2005; p.192)
C=True. Most commonly starts 24-48 hrs later.
D=True. Hearing loss and/or tinnitus are features.
E=True. Neck stiffness and photophobia are common.
ANSWER=A. (REFS - Oxford Handbook of Anaesthesia (2nd ed), p.707

Front 43

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 43

B

Front 44

Maternal cardiac arrest. In making the diagnosis of amniotic fluid embolism, large amount of PMNs surrounding foetal squamous cells are
A. Pathonomonic
B. Supportive
C. Only found at postmortem
D. Irrelevant
E. Incidental

Back 44

B

Front 45

Jehovah's witness patient refusing blood products. The ethical principle you are honouring if you continue with elective hip operation
A. Autonomy
B. Nonmaleficience
C. Justice
D. Paternalism

Back 45

A.

Front 46

An 86yo with severe dementia and multiple medical problems.. Surgeons want to operate for faecal peritonitis/bowel perforation, and believe he will die without the surgery. Your decision NOT proceed with surgery is supported by which ethical principle?
A. Dignity B. Competence C. Non-maleficience D. Paternalism E. Futility

Back 46

E!

Front 47

Inserted DLT. FOB down tracheal lumen. What feature is most helpful in identifying Left vs Right main bronchus
A. Trachealis muscle
B. "there are 3 lobes in right lung"
C. LMB longer than right
D. Angle of RMB vs left
E. Three segments of RUL

Back 47

A - False. Trachealis muscle divides at carina and continues in each main bronchus, so not particularly helpful. BUT ..I thought trachealis was only located posteriorly connecting the ends of the C-shaped cartilage. If you know whats the front and whats the back wouldnt this make it easy to figure out L from R ? - Isoma
B - False. While there are indeed 3 lobes in the right lung, that fact is not helpful to determine which is right or left main bronchus.
C - True. The LMB is about 5cm long before it gives off any subsequent lobar bronchi, whereas the RMB gives off a lobar bronchus (the RUL bronchus) about 2.5cm from the carina. This can help to determine between RMB and LMB.
D - ? False. While there is a difference in the angle (from the vertical) of the LMB and RMB, I don't know if this would be significantly appreciable bronchoscopically. Anyone?
E - True. The RUL bronchus has a trifurcation for each of the RUL segments, and this may also be useful in determining which side you are on.

Front 48

You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is:
A. Right upper lobe
B. RML
C. RLL
D. LUL
E. Lingula

Back 48

A. RUL

Front 49

Elimination Half life of Tirofiban
A. 2hrs
B. 8hrs
C. 12hrs
D. 24hrs
E. 15 minutes

Back 49

A. 2 hours

Front 50

POISE trial showed
A. Increase CVA
B. Anaphylaxis
C. renal failure
D. Increased AMI

Back 50

A. Increased mortality with CVA despite less MI.

Front 51

Why is codeine not used in paeds
A. Poor taste
B. High inter-individual pharmacokinetic variability
C. Not licensed for <10yo
D. not as effective as adult when given in ?weight adjusted dose?

Back 51

B.

A - as far as I am aware it doesn't have a particularly nasty taste, and is used in cough suppressants, so FALSE.
B - TRUE. Variations in CYP2D6 function affect how much codeine is converted to morphine, and therefore how effective it is, but also how "sensitive" patients are to codeine.
C - Painstop was used in children when I was an RMO a few years ago and contains codeine, and as far as I know it is still used, but I don't know the specific licensing info for codeine in paeds. It is not used in our hospital, but mostly because we use oxycodone instead.
D - ? False. It's crap in children just like it's crap in adults isn't it!

Front 52

Patient on table for phaeochromocytoma with GA and epidural insitu. Pt on phenoxybenzamine and metoprolol preop, high dose nitroprusside and phentolamine. BP still high ?250/-. Next step
A. IV hydralazine
B. IV Magnesium
C. Propofol
D. Epidural lignocaine bolus
E. Esmolol

Back 52

OHA: IV magnesium, of course - it's the wonder drug!!

Beware drugs with a long duration as once the tumour is out, there is a risk of prolonged hypotension. Epidural bolus will not help as they are circulating catechols from the phaeo. Esmolol is used for HR control, not BP control here.

Front 53

25 yo primip ?38/40 gestation with beta thalassemia trait for epidural. BP 140/95, mild proteinuria ...something else... Best test before you will put in epidural
A. Coagulation screen
B. Hb
C. Platelet count
D. skin bleeding time
E.

Back 53

C. Platelet count. The thalassaemia trait doesn't mean anything, but the mild pre-eclampsia does.

Thalassaemia trait:
Normally, hemoglobin is composed of four protein chains, two α and two β globin chains arranged into a heterotetramer. In thalassemia, patients have defects in either the α or β globin chain (unlike sickle-cell disease, which produces a specific mutant form of β globin), causing production of abnormal red blood cells.
Mild thalassemia : patients with thalassemia traits do not require medical or follow-up care after the initial diagnosis is made. Patients with β-thalassemia trait should be warned that their condition can be misdiagnosed for the common Iron deficiency anemia. They should eschew empirical use of Iron therapy; yet iron deficiency can develop during pregnancy or from chronic bleeding. Counseling is indicated in all persons with genetic disorders, especially when the family is at risk of a severe form of disease that may be prevented.
Severe thalassemia : Patients with severe thalassemia require medical treatment and a blood transfusion regimen was the first measure effective in prolonging life.


Oxford Handbook 2nd edn - p.744.
- If plt>100, proceed.
- If plt<100, do coags.
- If plt 80-100, and coags normal - regional is OK.

Front 54

Another pregnant lady ?39/40 with BP185/115 , 4+proteinuria, clonus. IDC placed, 10mLs of dark coloured urine only for the last few hours. Initial management
A. 500mL Crystalloid bolus
B. IV hydralazine
C. IV Magnesium
D. insert epidural

Back 54

SEVERE pre-eclampsia by numbers + symptoms.
I would give IV magnesium + IV hydralazine.
Be careful of platelets/HELLP with EDB.
Can fluid overload especially if oliguric.

B. IV hydralazine initially while getting mag sulph ready (to prevent eclampsia, not for BP control)

Front 55

The BEST agent to decrease gastric volume AND increase gastric pH before semi-urgent procedure
A. Omeprazole
B. Cimetidine
C. Ranitidine
D. Sodium citrate
E. ?

Back 55

C. Ranitidine.

Front 56

Most common congenital heart disease (repeat)
A. VSD
B. PDA
C. ?
D. ?

Back 56

A. VSD
Stoelting:
ACYANOTIC defects:
- VSD=35%,
- ASD=9%,
- PDA=8%,
- Pulm. stenosis=8%,
- Aortic stenosis=6%,
- Coarctation=6%,
- Atrioventricular septal defect=3%

CYANOTIC defects:
- Tetralogy=5%,
- Transposition=4%

Front 57

Active 4 year old. Ts & As. Continuous murmur, disappears on lying down (repeat)
A. Venous hum

Back 57

A it is! See murmurs in children...

Front 58

Acetylcholine receptors are down regulated in
A. Guillain-Barre syndrome
B. Organophosphate poisoning
C. Spinal cord injury
D. Stroke
E. Prolonged NMBD use

Back 58

A - False. Effectively a denervation injury which causes UP-regulation.
B - TRUE. Organophosphate poisoning causes increases in miniature-end-plate potential (MEPP), and thus can cause DOWN-regulation of ACh receptors. Apparently continuous exposure to organophosphates can cause degeneration of pre-junctional and post-junctional structures.
C - False. Denervation causes UP-regulation.
D - False. As for spinal cord injury.
E - Prolonged NMBD use can cause UP-regulation of ACh receptors.

Front 59

Myaesthenia gravis - features predicting need for post op ventilation EXCEPT
A. Prolonged disease
B. High dose Rx
C. Previous respiratory crisis
D. Increased sensitivity to NMB's
E. bulbar dysfunction

Back 59

D. This just means we have to be careful instead! All patients with MG are sensitive, not a prognostic indicator.

The CEPD risk factors for IPPV postop (thymectomy) are:
1/ FVC<2.9L;
2/ Concommitant COAD;
3/ Acute fulminant crisis or respiratory involvement (grade 3);
4/ Myasthenic crisis (grade 4);
5/ Duration of disease >6yrs
6/ Pyridostigmine dose >750mg/d
7/ Major body cavity surgery
8/ Bulbar palsy that is predictive of intra and postop airway protection.

Front 60

Diagnositic Utility of BNP best in (repeat)
A. SOB post pneumonectomy dyspnoea
B. Confusion post CABG

Back 60

A. To differentiate cardiac failure vs respiratory cause.

Front 61

Innervation of Larynx (repeat)
A. the ineternal branch of the superior branch of the...
B.
C.
D.
E. Cuff compression of recurrent laryngeal nerve against thryoid can cause palsy

Back 61

E.
The larynx is innervated by branches of the vagus nerve on each side.
Sensory innervation to the glottis and laryngeal vestibule is by the internal branch of the superior laryngeal nerve.
The external branch of the superior laryngeal nerve innervates the cricot