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64 Cards in this Set
- Front
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Which of the following is a patient not at risk of harm from in an MRI?
a. ECG b. Arterial Line c. Laryngoscope d. Scissors e. Pulmonary artery catheter |
B
Anaesthesia for MRI - PDF Aust Anaesth 2005 Invasive blood pressure transducers: These are not ferromagnetic, and are safe to use. Transducer cables should be kept out of the magnet bore, so as to avoid image distortion. Intravenous cannulae needles: These are made from stainless steel and are safe. Pulse oximeters: Standard pulse oximeters can malfunction in the MRI suite and have also been reported to cause patient burns due to overheating. Standard ECG cables are insulated copper, and generate heat in the MRI scanner. This is especially so if the cables are allowed loop. Carbon fibre leads have less potential to heat. Laryngoscopes: Although laryngoscopes may be non-ferrous, the batteries are highly ferromagnetic and cannot be used in close proximity to the magnet. Pulmonary artery monitoring catheters and temporary transvenous pacing leads contain nonferromagnetic but electrically conductive material. Also - Heart article http://xa.yimg.com/kq/groups/22702685/2018390772/name/943.pdf http://circ.ahajournals.org/content/116/24/2878.long |
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What color label is correct for a brachial plexus nerve block infusion?
a. red b. yellow c. blue d. beige e. white |
B
NATIONAL RECOMMENDATIONS FOR USER-APPLIED LABELLING OF INJECTABLE MEDICINES, FLUIDS AND LINES http://www.safetyandquality.gov.au/wp-content/uploads/2012/03/Labelling-Recommendations-2nd-edition-February-2012.pdf NEURAL infusion = YELLOW Intra-arterial = Red Intravenous = Blue Neural tissue = Yellow Subcutaneous tissue = Beige Miscellaneous = Pink |
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What does a gas cylinder with a white body and grey shoulders contain?
a. oxygen b. medical air c. carbon dioxide d. nitrous oxide e. nitrogen |
C
From BOC Safety with Cylinders (google) pdf online |
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What is the risk/danger of suctioning a neonate’s airway
a. bleeding b. bradycardia c. meconium aspiration d. tachycardia e. hypotension |
B
Aust Resus Guidelines: http://www.resus.org.au/policy/guidelines/section_13/guideline-13-4dec10.pdf Normal newborn infants do not require suctioning of the nose, mouth or pharynx at birth. They clear their airways very effectively and suctioning can delay the normal rise in oxygenation. The airway is sometimes obstructed...however pharyngeal suction can cause laryngeal spasm, trauma to the soft tissues and bradycardia...cyanosis and delay onset of spont breathing" |
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Regarding remifintanil, which is incorrect?
a. high potency b. metabolised by pseudocholinesterase c. muscle rigidity in high doses d. weakly active metabolite e. short context sensitive half time |
B
- Metabolised by non-specific plasma / red cell esterases Stoelting |
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Regarding adenosine as an anti-arrhythmic, which is correct?
a. potentiates theophylline b. potentiates dipyridamole c. alpha blockers should not be used d. beta blockers should not be used e. it is as effective as verapamil 5mg |
E
UTD adenosine is at least as effective as verapamil Need more B beta blockers Adenosine potentiates dipyridamol (Theophylline antagonises) |
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You see a patient in the pre-op clinic. He is on propranolol for treatment of long QT syndrome. Which of the following will give the best reassurance that his treatment is effective?
a. normal QT interval on resting ECG b. no change in QT interval with valsalva c. HR less than 60 d. no arrhythmias on 24h holter monitor e. |
B
Booker 2003 "Long QT Syndrome" - all pts should be B blocked but the QTc doesn't change.. Preoperative assessment of its adequacy should determine that the heart rate does not exceed 130 min±1 during exercise; where exercise testing is impractical, there should ideally be no change in the QT interval in response to a Valsalva manoeuvre in a fully bblocked individual.56 In all patients with LQTS, serum electrolytes must be normal, as hypokalaemia, hypomagnesaemia, and hypocalcaemia all predispose to delayed ventricular repolarization. Drug therapy that unintentionally prolongs the QT interval should be avoided |
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A size C oxygen cylinder will provide a regulated flow between
a. 16000 - 400kPa b. 16000 - 240kPa c. 11000 - 400kPa d. 11000 - 240kPa e. |
A closest?
Still can't find! Size C is the small one (e.g. on bed end) Megamedical site: C 410 L 15000kPa at 15 deg (or 2000psi) --> regulated to 45-50psi (~310-350kPa and not an option). It says its about the same as pipeline pressures (i.e. 4 bar or 400kpa) 3.36kg full, 3.14kg empty 50x11cm |
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Regarding the ‘off label’ of drugs, which is incorrect?
a. different route of administration b. different age group c. different indication d. different concentration e. different dose |
D
Off-label use is the practice of prescribing pharmaceuticals for an unapproved indication (C) or in an unapproved age group (B), unapproved dose (E) or unapproved form of administration (A) - only one missing! |
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The following is a picture of an Arndt bronchial blocker, the part labelled X is for
a. the circuit b. the guidewire c. the bronchoscope |
C - see bronch picture
http://www.cookmedical.com/cc/content/mmedia/C-AEBSP901.pdf |
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When treating serotonin syndrome, which treatment is incorrect?
a. bromocriptine b. chlorpromazine c. diazepam d. cycloheptadine e. non-depolarising neuromuscular blockers |
A
Bromocriptine = serotonin (and dopamine) AGONIST ie will worsen SS. Chlorpromazine = dopamine and serotonin ANTagonist Diazepam = benzo Cyproheptadine = antiserotonergic, antihistamine, anticholinergic, and local anaesthetic! Has been used in the management of moderate to severe cases of serotonin syndrome.. NDMB = maybe |
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You see a patient in your clinic for a total knee replacement. He is 65 and has atrial fibrillation for which he takes dabigatran. He is otherwise well. A spinal anaesthetic is planned. What is the correct advice regarding his medication?
a. he should stop his dabigatran 7 days prior b. he should stop his dabigatran 3 days prior c. he should stop his dabigatran 3 days prior and have bridging enoxaparan d. he should stop his dabigatran the day before and have an INR on the day of surgery e. he should continue to take his dabigatran until the morning of surgery |
B.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372773/ So patient = asymptomatic AF, no CVA, nil other issues - i.e. low risk as per CHADS (score 0 = minimal) The Summary of Product Characteristics provides recommendations for the management of surgical interventions in patients with atrial fibrillation undergoing treatment with dabigatran [5]. These recommendations constitute the basis of the following expert recommendation: A preoperative laboratory testing is usually not meaningful (Recommendation 3C). A dabigatran-sensitive coagulation test (Hemoclot test or ECT) may help to determine whether haemostasis is still impaired. Dabigatran should be paused the day before the intervention (Day -1;Recommendation 1C). The therapy should be discontinued 2 days in case of creatinine clearance 50–80 ml/min or interventions associated with a high risk of bleeding. The therapy should be paused 3–4 days before the intervention if creatinine clearance is <50 ml/min (Recommendation 1C). When the therapy is paused for longer than 1 day, in patients with atrial fibrillation and a CHADS2 score >2 or those who have experienced an acute ischemic cerebrovascular syndrome the clinician should consider switching to weight-adapted LMWH. The switch should be made at the earliest 12 h (creatinine clearance >50 ml/min) or 24 h (creatinine clearance <50 ml/min) after the last dose of dabigatran (Recommendation 1C). According to the international recommendations, therapeutic doses of LMWH should be concluded at the latest 24 h before the intervention. Postoperative prophylaxis of venous thrombosis should be administered in accordance with international recommendations (early mobilization, drug-based prophylaxis;Recommendation 1A) Treatment with dabigatran at the usual dose (150 or 110 mg BID) should be continued from the third postoperative day onward when appropriate hemostasis has been achieved (Recommendation 1C). The drug used for prevention of thrombosis should be discontinued when the treatment with dabigatran is reinstituted (Recommendation 1C). In cases of prolonged risk of bleeding or high-risk patients, the clinician may consider delayed reinstitution of dabigatran therapy (Recommendation 1C). RE-LY trial = Dabigatran vs Warfarin in patients with AF http://www.nejm.org/doi/full/10.1056/NEJMoa0905561 In patients with atrial fibrillation, dabigatran given at a dose of 110 mg was associated with rates of stroke and systemic embolism that were similar to those associated with warfarin, as well as lower rates of major hemorrhage. Dabigatran administered at a dose of 150 mg, as compared with warfarin, was associated with lower rates of stroke and systemic embolism but similar rates of major hemorrhage. SAFETY GUIDELINES Spinal/epidural anaesthesia or lumbar/epidural puncture Not to be given for 48 hours before a procedure. Emergency lumbar/epidural puncture should only be done after specific discussion with haematologist. If traumatic puncture occurs must not be given for 24 hours after procedure Dabigatran must otherwise not be given earlier than 2 hours after epidural or spinal puncture or removal of an epidural catheter. These patients require frequent observation for neurological signs and symptoms of spinal or epidural haematoma. |
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CTG trace, with late decelerations. What is the diagnosis?
a. umbilical cord compression b. foetal asphyxia c. uteroplacental insufficiency d. meconium? e. |
C or B
Royal Women's Hospital Late decelerations are defined as uniform, repetitive decreasing of FHR with, usually, slow onset mid to end of the contraction and nadir more than 20 seconds after the peak of the contraction and ending after the contraction1. Late decelerations are caused by contractions in the presence of hypoxia. This means that they will occur with each contraction and the fetus is already hypoxic. There will be no features of a well oxygenated fetus, like early or typical variable decelerations, normal baseline variability or shouldering. They start after the start of the contraction and the bottom of the deceleration is more than 20 seconds after the peak of the contraction. Importantly, they return to the baseline after the contraction has finished. In the hypoxic fetus, this will include decelerations of less than 15bpm (and occasionally less than 5bpm)*. http://www.thewomens.org.au/uploads/downloads/HealthProfessionals/CPGs/Labour_CareLabourBirth/Guideline_CTGInterpretationAndResponse_Dec2011.pdf |
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Regarding dexmedetomidine, which is correct?
a. avoid in patients with 2nd degree heart block b. c. d. e. |
a - can cause bradycardia?
Contraindications for Dexmed: (WIKI) There are no absolute contraindications to the use of dexmedetomidine. Limiting its usefulness is the caution that the drug cannot be bolused due to concerns about peripheral α2-receptor stimulation with resulting hypertension and bradycardia, combined with its current high cost relative to generic medications such as propofol, fentanyl and midazolam which can achieve similar clinical effects |
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All of the following can be seen on an ECG with digitalis toxicity except
a. ventricular bigeminy b. sinus arrest c. atrial flutter d. atrial tachycardia with variable block e. |
Maybe C - I have can cause all kinds of arrhythmias
Unless it isn't VARIABLE block therefore D Digoxin toxicity - Wiki / study notes / Life in the fast lane Drug interactions • Quinidine – reduces elimination of dig • Amiodarone – increases dig steady state levels, therefore reduce dig dose by 50% • Diuretics – reduce GFR & cause electrolyte disturbances such as hyokalaemia Symptoms of dig toxicity – diverse, non-specific • GIT: nausea, vomiting, anorexia, diarrhoea • CNS: fatigue, confusion, insomnia, psychosis • Visual disturbance: blurred or double vision, “halos”, photophobia • Cardiac: palpitations, dizziness, chest pain • Hypokalaemia & hypercalcaemia enhance dig toxicity ECG findings of digitalis toxicity (non specific!) • Short QTc in the absence of hypercalcaemia • Atrial tachycardia with block (so D ok) • Junctional tachycardia – regularized AF • SA/AV block (?D) • Bi/trigeminy (A) • VT/VF • Combination of enhanced automaticity & impaired conduction is suggestive 3 major hallmarks of dig toxicity • accelerated junctional rhythm, also called "regularized Atrial Fibrillation" • ST segment sagging (This finding is not indicative of toxicity unless other signs present) • a shortened QT interval Digoxin can cause a multitude of dysrhythmias, due to increased automaticity (increased intracellular calcium) and decreased AV conduction (increased vagal effects at the AV node) The classic dysrhythmia associated with digoxin toxicity is the combination of a supraventricular tachycardia (due to increased automaticity) with a slow ventricular response (due to decreased AV conduction), e.g. ’atrial tachycardia with block’. Other arrhythmias associated with digoxin toxicity are: Frequent PVCs (the most common abnormality), including ventricular bigeminy and trigeminy Sinus bradycardia or slow AF Any type of AV block (1st degree, 2nd degree & 3rd degree) Regularised AF = AF with complete heart block and a junctional or ventricular escape rhythm Ventricular tachycardia, including polymorphic and bidirectional VT |
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When performing cardioversion for new onset atrial fibrillation, what is the safe maximum time between onset and cardioversion without anticoagulation?
a. 12 hours b. 24 hours c. 36 hours d. 48 hours e. 72 hours |
D
CHEST Guidelines |
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A 72 year old lady is admitted with an acute subdural hematoma. She had a pacemaker installed 8 weeks ago after AV nodal ablation. It is in DDD mode. The pacemaker technician is over an hour away. The neurosurgeon wants to proceed to surgery immediately. What is your response?
a. delay until reviewed by pacemaker technician b. delay until reviewed by cardiologist c. proceed with external pacing d. proceed with internal pacing wires inserted e. proceed but have a magnet available |
C
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You wish to compare a new method of blood pressure measurement with the current gold-standard. Which is the best statistical test to perform?
a. Bland Altman plot b. linear correlation c. d. e. |
A
Wiki Method of data plotting used in analyzing the agreement between two different assays. Any 2 methods that are designed to measure the same parameter should have good correlation when a set of samples are chosen. A high correlation doesn't necessarily imply good agreement. Compares 2 clinical measurements that each provide some errors in their measure. It can also be used to compare a new measurement technique with a gold standard. Limits of agreement (bias +/- 1.96 SD of difference). |
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ECG recording devices have a high internal impedance. This is because
a. it protects against microshock b. the display device has a high impedance c. it protects against interference from diathermy d. it limits interference from changes in thoracic impedance e. something about an earth loop |
D
Davis and Kenny |
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A neonate is inadvertently given a total spinal. What would be the first sign?
a. hypotension b. bradycardia c. loss of consciousness d. tachycardia e. apnoea |
E
http://www.pedsanesthesia.org/meetings/2010winter/syllabus/pdfs/pblds/Table%20-%2013.pdf What physiological signs would indicate an inadvertent intrathecal injection of local anesthetic in a pediatric patient? How is this different than an adult? In awake adults the first signs of high spinal block are hypotension, bradycardia and difficulty in breathing. Hypotension is due to venous and arterial vasodilation resulting in a reduced venous return, cardiac output and systemic vascular resistance. Bradycardia is caused by sympathetic block leading to unopposed vagal tone and blockade of the cardio-accelerator fibers arising from T1-T4. Heart rate may also decrease as a result of a fall in right atrial filling. Respiratory difficulty is caused by loss of chest wall sensation caused by paralysis of the intercostal muscles. When a total spinal occurs the nerve supply to the diaphragm (cervical roots 3-5) is blocked and respiratory failure develops rapidly. Sudden respiratory arrest may also be caused by hypoperfusion of the respiratory centers in the brainstem. Other signs of total spinal include loss of consciousness and pupillary dilatation. Numerous reports exist of infants tolerating high or total spinal anesthesia without the significant autonomic changes seen in adults. Although the reason for this finding are unclear, some suggest the cardiovascular stability in infants is due to either a smaller venous capacitance in the lower extremities (less pooling of blood), or a relative immaturity of the sympathetic nervous |
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A 74 year old pedestrian is hit by a car and suffers multiple rib fractures. His CXR shows an area in the left lower zone with an air fluid level abutting the left heart border and the left chest wall. This is likely to represent
a. a hiatus hernia b. a subpulmonic pneumothorax c. a diaphragmatic rupture d. e. |
C
Could be A except usually this crosses the midline. |
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What is the least appropriate measure to minimize the use of homologous blood transfusion?
a. isovolumetric haemodilution b. intraoperative cell salvage c. autologous blood banking d. e. lowering the ‘trigger’ for blood product administration |
e
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A 70 year old man is having a laparotomy. Which is the best method of assessing his fluid status?
a. arterial pulse pressure variation b. CVP c. d. heart rate and blood pressure e. pulmonary capillary wedge pressure |
A
Lots of debate! ACRM - oesophageal Doppler or vigileo |
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Someone day 4 postop laparotomy with an epidural in situ. Administered enoxaparin 40mg at 8pm. When is the best time to remove the epidural catheter?
a. 6am on day 5 b. midday on day 5 c. 6pm on day 5 d. withhold the enoxaparin on day 5 and remove at 6am on day 6 e. withhold the enoxaparin on day 5 and remove at midday on day 6 |
B
ASRA guidelines |
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An infant presents with pyloric stenosis, which is correct?
a. female sex b. premature c. hyperkalaemic metabolic alkalosis from GI losses d. urinary acidification e. |
D
Mostly male Not more in premature Hypokalaemia metabolic alkalosis The excess loss of Cl depletes extracellular chloride and with the luminal loss of Hydrogen ions produces a metabolic alkalosis. The kidney tries to initially maintain blood pH by excreting an alkaline urine. HCO3 is excreted with Na and K until the overall volume deficit triggers an expansion of the extracellular volume rather than maintenance of pH. Na is resorbed, but K is lost via an aldosterone mediated mechanism and this leads to excretion of H ion resulting in "paradoxical aciduria" in an alkalotic patient. |
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What is the correct loading dose for IV paracetamol in an XXkg 3 year old?
a. (homeopathic) b. (closer) c. 15mg/kg (given as actual dose, I just can’t remember the weight) d. 20mg/kg (as above) e. 30mg/kg |
C
http://www.frca.co.uk/article.aspx?articleid=100635 For IV - no loading dose given, just 15mg/kg We usually give 30mg/kg PO |
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A 70 year old lady is scheduled for a cholecystectomy. She takes citalopram but is otherwise well. The following medications are relatively contraindicated, EXCEPT?
a. clonidine b. metoprolol c. omeprazole d. tramadol e. pethidine |
A.
2C19 SSRI potentiate beta blockers (beware clonidine as hypothermia etc) |
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Following a double lung transplant, which statement is incorrect?
a. there is loss of ciliary motility b. impaired lymph clearance c. d. impaired HPV e. the response to increased pCO2 is lost |
E
OHA Recover lymphatic At 1 month If altered co2 response normalizes after 1 month Sputum clearance impaired HPV impaired Cough impaired Post lung transplant: Because certain nerve connections to the lungs are cut during the procedure, transplant recipients cannot feel the urge to cough or feel when their new lungs are becoming congested. They must therefore make conscious efforts to take deep breaths and cough in order to clear secretions from the lungs.[10] Their heart rate responds less quickly to exertion due to the cutting of the vagus nerve that would normally help regulate it.[11] They may also notice a change in their voice due to potential damage to the nerves that coordinate the vocal cords. |
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What percentage of the population have their AV node supplied by the right coronary artery?
a. 5 b. 15 c. 40 d. 40 e. 85 |
E 80-85%
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Picture of a TOE transgastric view. Looking at LV with the wall furthermost from the USS probe labeled ‘A’. Which coronary vessels supplies this area?
a. left circumflex b. left marginal branch of the circumflex c. left anterior descending d. right coronary artery e. |
C
http://echocardiography.com |
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What percentage of primiparous women experience a headache in the first week following delivery?
a. 3-5% b. 5-15% c. 15-40% d. 40-65% e. 65-85% |
C
39% CEACCP differentiation of postpartum headache |
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A 20kg child is brought to your emergency department 6 hours after suffering burns to 15% of their body surface area. What is the amount of fluid you will administer in the first hour?
a. 260ml b. 360ml c. 460ml d. 660ml e. 860ml |
B
Replacement: 6 hr x 60ml/hr = 360 ml Maintenance: 4, 2, 1 = 60ml/hr Burns: Parkland = % x wt x 4 = 1200 (first day) so 600 ml in first 8 hr = 75ml/hr |
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What is the incidence of fat embolisation syndrome following a closed femoral fracture?
a. 0-3% b. 4-6% c. 6-15% d. 15-30% e. over 45% |
A 1%
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When measuring cerebral oximetry the blood you are measuring is
a. aterial b. mainly aterial c. mainly venous d. venous e. capilliary |
C
75% venous |
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A 23 year old man takes his buprenorphine patch off prior to surgery. When can you expect the plasma level to be half?
a. 6 hours b. 12 hours c. 24 hours d. 36 hours e. 48 hours |
B
MIMS |
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What is the half life of tryptase?
a. 1 hour b. 6 hours c. 12 hours d. 24 hours e. 48 hours |
b (2?)
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Uneventful surgery, someone goes into rapid AF and is hypotensive. What is the correct treatment?
a. 50J unsynchronised monophasic shock b. 200J unsynchronised monophasic shock c. 500mcg digoxin slowly d. 5mg verapamil e. 6mg adenosine |
If it's AF to cardiovert you would use SYNCHRONISED shock or risk VF - ACC Guidelines
If B - synchronized monophasic Direct-current cardioversion involves delivery of an electrical shock synchronized with the intrinsic activity of the heart, usually by sensing the R wave of the ECG. This technique ensures that electrical stimulation does not occur during the vulnerable phase of the cardiac cycle, from 60 to 80 ms before to 20 to 30 ms after the apex of the T wave (263). Electrical cardioversion is used to normalize all abnormal cardiac rhythms except ventricular fibrillation. The term defibrillation implies an asynchronous discharge, which is appropriate for correction of ventricular fibrillation but not for AF Would most likely give Verapamil or B blocker if rate was causing hypotension. Dig may work? Digoxin. Although intravenous digoxin may effectively slow the ventricular rate at rest, there is a delay of at least 60 minutes before onset of a therapeutic effect in most patients, and a peak effect does not develop for up to 6 h. Digoxin is no more effective than placebo in converting AF to sinus rhythm (255,257,258) and may prolong the duration of AF. The efficacy of digoxin is reduced in states of high sympathetic tone, a common precipitant of paroxysmal AF. |
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Regarding mixed venous blood oxygen saturation, which statement is correct?
a. it is collected from the right atrium b. it is used to calculate cardiac output c. it can be used to accurately measure the mixed venous pO2 d. it has no impact on the A-a gradient e. it is usually 40% |
D
a - no, Pulm artery b - yes c - not 'accurate' d - hmmmm yes? e - 75% When a threat to normal oxygen supply/demand occurs, the body attempts to compensate, and its success is immediately reflected by SvO2. If the SvO2 value is normal, there is sufficient oxygen supply available to the tissues. However, if the SvO2 value is low, then either the oxygen supply is insufficient or the oxygen demand is elevated. Regardless of the cause, a decrease in SvO2 indicates that the body has called upon its last line of defense to preserve oxygen balance and therapeutic interventions may be appropriate. http://ht.edwards.com/resourcegallery/products/swanganz/pdfs/svo2edbook.pdf |
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A 6 week old child is scheduled for surgery for repair of an incarcerated hernia. He has a mild URTI. Which is the correct statement?
a. postpone for two weeks b. continue but with a spinal anaesthetic only c. continue but without using an endotracheal tube d. he requires antibiotics e. continue, but with careful monitoring |
E (it's incarcerated)
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A 6 year old child is ventilated in ICU following a head injury. His plasma Na is 142. Which is an appropriate choice of maintenance fluid?
a. 0.3% NaCl with 3.3% dextrose b. 0.9% Nacl c. Hartmans solution with 5% dextrose d. N/2 with 5% dextrose e. |
B
NZ guidelines: Fluid Management in the Paediatric Head Injured Patient Hyponatraemia The most serious and frequently seen electrolyte abnormality is that of hyponatraemia (Na< 135mmol/L). Purported mechanisms include SIADH, cerebral salt wasting and overzealous fluid resuscitation. The effects of hyponatraemia are those of cerebral oedema as fluid crosses the blood-brain-barrier into the cerebral parenchyma worsening cerebral swelling. Symptoms can include headache, anorexia, nausea, weakness, lethargy, confusion, disorientation, blurred vision, cramps, coma and seizure. Symptoms often mimic those of the head injury / concussion itself. The consequence of this can lead to extremely rapid neurological decline and has been associated with death or worsened neurological outcome. Although the head injured child may have associated pulmonary and gastrointestinal injuries that may complicate electrolyte homeostasis, our experience suggests that: All paediatric head injured patients that require intravenous fluid for maintenance or resuscitation MUST receive 0.9% NaCl +/- 10mmol KCL/500mL. This has been shown on numerous occasions to be the most important prophylactic measure to prevent the development of hyponatraemia. Avoid hypotonic solutions, e.g. 0.18% Sodium Chloride and 4% Dextrose or 5% Dextrose, which may impair cerebral compliance. Infants require blood glucose checks 4 hourly as there is a significant risk of hypoglycaemia and subsequent seizure. Serum sodium and potassium need assessment 12 hourly when in the Neurosurgical High Dependency Unit (HDU) ie Moderate – Severe Head Injuries. This can be changed to daily if parenteral fluids are still required when the patient is on the ward. If the serum sodium remains low despite parenteral 0.9% NaCl then: • a thorough review of fluid status is warranted • reduce fluid intake • check serum and urine sodium and osmolality http://www.nslhd.health.nsw.gov.au/ppg/PD2011_024.pdf = normal maintenance fluids, beware cerebral oedema and consider using 2/3 rate. |
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What is an absolute contraindication to ECT?
a. cochlear impant b. epilepsy c. raised intracranial pressure d. pregnancy e. recent myocardial infarction |
E
C- use others methods to decrease CI: |
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In the morbidly obese, which is the best predictor of a difficult airway?
a. Malampatti score b. intra incisor distance c. pretracheal soft tissue volume d. e. |
C or neck circumference?
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You are performing a supraclavicular block and the patient still has sensation over the little finger. Which area has been missed?
a. upper trunk b. lower trunk c. lower cord d. e. ulnar nerve |
ahh that lower trunk..or cord (whatever). C7-T1
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Endocarditis prophylaxis is appropriate in:
A. Unrepaired CHD |
A as per new guidelines or within 6 months reparied CHD
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Best aspiration prophylaxis for urgent surgery?
A. Na Citrate B. Ranitidine C. Omeprazole D. Metoclopramide E. Cisapride |
B
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Most common cause of mortality post transfusion?
A. TRALI B. Contamination/infection C. Mismatched blood D. GvHD E. Anaphylaxis |
A
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Most common cause of awareness?
A. Failure to check apparatus |
A
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Apnoeic oxygenation in obese patients is best aided by?
A. Sniffing position B. Head up tilt |
B - see article on Apnoic oxygenation
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Best renal protection for endoluminal AAA repair?
A. NaCl B. NAC |
A
CEACCP Endoluminal - contrast |
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What is NOT a disadvantage of drawover vaporizer?
A. Basic temperature compensation B. Basic flow compensation |
a
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FOB - can see a trifurcation. Where are you?
A. RUL B. ? |
a
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Intubating over a bougie. Rotate ETT?
A. 90 degrees anticlockwise |
a
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Air bubble leads to decreased:
A. Damping coefficient B. Resonant frequency |
A - increased damping therefore decreased damping coefficient
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Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?
A. Sedation B. Urinary retention |
A
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Which is a specific PDE inhibitor?
A. Theophylline B. Dipyridimole C. Milrinone |
C
Theophylline = competitive non-selective PDE inhibitor Dipyridamole = PDE5 Milrinone = PDE 3 |
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Major cause of death following difficult intubation with perforated oesophagus?
A. Sepsis B. Failure to intubate C. Failure to ventilate |
A
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Urgent reversal of INR 4.5. Intern already gave vitamin K.
A. FFP B. Prothrombinex C. Prothrombinex AND FFP |
C - 25U/kg + FFP (Low in 7)
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Normal systolic BP at birth?
A. Something less than 70 mmHg B. 70 mmHg C. 85 mmHg D. Something more than 85 mmHg E. 115 mmHg |
B
80 + (age x 2) ?? Only if under 2 OHA 50-90 |
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SAH. Hyponatremia. Elevated urinary Na concentration. Most likely cause?
A. CSW B. SIADH |
B
CSW = hyponatraemia + dehydration Random urine sodium concentrations tend to be lower than 100 mEq/L in CSWS and greater in SIADH SIADH = hyponatraemia + normovolaemia + Laboratory findings in diagnosis of SIADH include: Euvolemic hyponatremia <134 mEq/L, and POsm <275 mOsm/kg OR ( POsm - Serum [Urea]mmol/l < 280 mOsm/kg ) Urine osmolality >100mOsm/kg of water during hypotonicity Urine sodium concentration >40 mEq/L with normal dietary salt intake |
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Risk factors for postoperative ulnar nerve injury?
A. Contralateral arm |
Risk factors include:
• diabetes • elderly • pre-existing neuropathy • thin patients (esp for ulnar/common peroneal nerve injury) • Peri-operative risk factors: - hypotension - hypovolaemia - hypoxia - electrolyte disturbance - induced hypothermia Ulnar nerve (most common, 28% of all injuries) • patients who have a post-op ulnar neuropathy often have abnormal nerve conduction on the other side • more likely to have a delayed onset of symptoms, median onset time 3 days • padding was used in 27% of ulnar nerve injuries in the closed claims analysis • male : female 3:1 (possibly because cubital tunnel is narrower or the nerve unusually mobile) • generally older patients, essentially unheard of in children • increased risk in thin patients • high risk in CABG (up to 15%) • risk if forearm is extended & pronated or with extreme flexion of elbow across chest (stretch around medial epicondyle & compression of ulnar nerve by medial and arcuate ligaments) • to prevent place forearm in supination, avoid extremes of elbow flexion (LE notes) |
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Lateral approach to popliteal block.
A. Passes through semimembranosis B. May be performed supine or prone C. Adequate for ankle surgery D. Less effective in comparison to posterior approach E. Eversion is an endpoint for nerve stimulation |
B is true
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What is NOT useful in the treatment of Torsades?
A. Isoprenaline B. Procainamide C. DCCV D. Electrical pacing |
B Class Ib
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Risk factor for PPH?
A. Prolonged labour B. Age <20 yrs old C. Primiparity D. FV Leiden Deficiency (yes it said deficiency!) E. Oligohydramnios |
A
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Endocarditis prophylaxis with MVR
A. Dental B. rigid bronch C. Upper endo with biopsy D. D&C E. lithotripsy |
Lithotripsy
Dental if involves gingival |
