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115 Cards in this Set

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1. A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in:

a. Reverse trendelenburg, right side up

b. Reverse trendelenburg left side up

c. Reverse trendelenburg, neutral

d. Trendelenburg right side up

e. Trendeleburg left side up
VAE occurs when operative site is higher than right atrium.
Aim to position operative site below level of heart, and if possible put patient into left lateral position to attempt to keep air in RA.
Reverse trendelenberg, either neutral or right side up?
Which of the following is NOT a side effect of cyclosporin

a. Alopecia
b. Hypertension
c. Renal impairment
d. Gum hyperplasia
ADRs can include gingival hyperplasia, convulsions, peptic ulcers, pancreatitis, fever, vomiting, diarrhea, confusion, hypercholesterolemia, dyspnea, numbness and tingling particularly of the lips, pruritus, high blood pressure, potassium retention possibly leading to hyperkalemia, kidney and liver dysfunction (nephrotoxicity[16] and hepatotoxicity), burning sensations at finger tips and an increased vulnerability to opportunistic fungal and viral infections
What is the half life of clopidogrel?

a. 6 hours
b. 14 hours
c. 24 hours
d. 7 days
Clopidogrel is a pro-drug activated in the liver by cytochrome P450 enzymes, including CYP2C19.After a single, oral dose of 75 mg, clopidogrel has a half life of approximately 6 hours. The half life of the active metabolite is about 30 minutes.
When administering adrenaline and atropine via ETT dose compared with IV should be

a. Same dose
b. Double
c. Quadruple
d. Six times
Double dose
What splitting ratio gives a 3% concentration of isoflurane

a. 1/5
b. 1/9
c. 1/?
d. 1/20
e. 1/23
1/14

http://www.cybermedicine2000.com/pharmacology2000/physics/Chemistry_Physics/physics17.htm
What transfusion related complication is the commonest cause of mortality

a. Bacterial infection
b. TRALI
c. ABO incompatibility
d.
B. TRALI
FDA: In combined Fiscal Years 2007 through 2011, Transfusion Related Acute Lung Injury (TRALI) caused the highest number of reported fatalities (43%), followed by hemolytic transfusion reactions (total of 23%) due to non-ABO (13%) and ABO (10%) incompatibilities.
Which of the following is not included in the CHADS2 AF thromboembolic risk scoring system

a. Age
b. Gender
c. Diabetes
d. Heart failure
e. Previous TIA
CHADS2:
CHF/HTN/Age>75/DM/Prev CVA or TIA

CHA2DS2-VASc
CHF/HTN/Age>75/DM/Prev CVA or TIA/Vascular Disease/Age65-74/Female gender

For both:
0 Low Risk No antithrombotic therapy (or Aspirin)
No antithrombotic therapy (or Aspirin 75-325mg daily)

1 Moderate Risk Oral anticoagulant (or Aspirin)
Oral anticoagulant, either new oral anticoagulant drug eg dabigatran or well controlled warfarin at INR 2.0-3.0 (or Aspirin 75-325mg daily, depending on factors such as patient preference)

2 or greater High Risk Oral anticoagulant
Oral anticoagulant, using either a new oral anticoagulant drug (eg rivaroxaban or dabigatran) or well controlled warfarin at INR 2.0-3.0
What is the ratio of breaths to compressions in neonatal resuscitation?

a. 1:3
b. 1:5
c. 2:15
d. 2:30
A: one breath for every three compressions

http://www.nzrc.org.nz/assets/Uploads/Neonatal-Algorithm-March-2011.pdf
What is the innervation of the hard palate

a. Greater palatine and nasopalatine
The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion.
A

The greater palatine nerve descends through the greater palatine foramen with its companion artery, and runs anteromedially to supply the mucosa of the posterior hard palate. The nasopalatine nerve descends through the incisive foramen to supply the most anterior parts of the hard palate.
Which of the following is suggesting of an inhaled foreign body in a child on chest x ray

a. Foreign body visible in front of airway

b. Hyper-expanded hemithorax

c. Collapse
B: hyper-inflated hemithorax

One of the most important signs to identify is obstructive emphysema, or overinflation of the lung or lobe distal to the airway obstruction
What is the distance from the lips to the carina in an 70kg adult male in cm

a. 21

b. 23

c. 25

d. 27

e. 29
correlates better with height than weight:
27cm??
What colour is the label for subcutaneously administered drugs

a. Pink

b. Yellow

c. Brown

d. Red

e. Blue
Beige
http://www.safetyandquality.gov.au/wp-content/uploads/2012/03/Labelling-Recommendations-2nd-edition-February-2012.pdf
How much air is the maximum to that should be used to inflate a 5 LMA classic cuff?

a. 15

b. 20

c. 25

d. 40

e. 45
Up to 40mL

Essentials of Anaesthetic Equipment pg 80
Where should the tip of an IABP lie

a. 2cm distal to the left subclavian

b. 2 cm proximal to the left subclavian

c. 2cm proximal to the renal artery

d. 2 cm distal to the renal artery
2-3 cm distal to L subclavian

Essentials Anaesthetic Equip pg201
A 60kg female is given 50 mg of rocuronium, she is unable to be intubated, what dose of sugamadex is required to reverse the rocuronium

a. 240

b. 800

c. 960
240mg (4mg/kg)


Reversal of shallow neuromuscular blockade induced by rocuronium*: Use Bridion at a dose of 2 mg/kg

Reversal of profound neuromuscular blockade induced by rocuronium*:Use Bridion at a dose of 4 mg/kg

Immediate reversal of neuromuscular blockade induced by rocuronium*: Use Bridion at a dose of 16 mg/kg
In a penetrating chest injury what part of the heart is most likely to be injured

a. Left ventricle

b. Right ventricle

c. Right coronary artery

d. Right atrium

e. Sinus node
Right Ventricle

The anatomic position of the heart in relation to the anterior chest wall is critical in determining which areas of the heart are most commonly affected by penetrating cardiac trauma. In a review of 1,802 cases of penetrating cardiac trauma from 20 reports published between 1967 and 1980, the right and left ventricles were injured 43% and 33% of the time, respectively. For the atria, right-sided lesions were found in 14% of cases and left-sided lesions in 5% of cases. Injuries to the great vessels were found to occur with a frequency equal to that of the left atrium (17). This distribution of injuries is due to the disparate exposure of the cardiac chambers to the anterior surface of the chest. The right ventricle covers the greatest portion of the anterior chest wall and represents 55% of the anterior cardiac surface. The frequency of involvement of the remaining cardiac chambers in penetrating injuries is proportional to the area of the anterior chest wall that they cover (17).
http://www.medicine.mcgill.ca/mjm/issues/v01n01/cardiac.html
What is the maximum recommended dose of Intralipid in local anesthetic toxicity (ml/kg)

a. 6
b. 8
c. 10
d. 12
e. 14
10mL/kg over first 30 mins

ASRA
❑ Lipid Emulsion (20%) Therapy (values in parenthesis are for 70kg patient)
❑ Bolus 1.5 mL/kg (lean body mass) intravenously over 1 minute (~100mL)
❑ Continuous infusion 0.25 mL/kg/min (~18 mL/min; adjust by roller clamp)
❑ Repeat bolus once or twice for persistent cardiovascular collapse
❑ Double the infusion rate to 0.5 mL/kg/min if blood pressure remains low
❑ Continue infusion for at least10 minutes after attaining circulatory stability
❑ Recommended upper limit: Approximately 10 mL/kg lipid emulsion
over the fi rst 30 minutes
What is a contraindication to an IABP?

A. Aortic regurgitation
B. Aortic stenosis
AR

Contraindications to IABP: (essentials anaes equip pg 202)
Severe AR
Aortic dissection
Major coagulopathy
Severe bilateral PVD
Bilateral fem-pop bypass graft
Sepsis
An infant is born with meconium stained liquor and is apnoeic and floppy… your first step should be

a. Stimulate and dry
b. Positive pressure ventilation
c. Suction the trachea
A: stimulate and dry

http://www.nzrc.org.nz/assets/Uploads/Neonatal-Algorithm-March-2011.pdf
Central sensitization occurs due to

a. Primary events mediated by the NMDA receptor
b. Alterations in gene expression
c. Increased magnesium
NMDA is to blame:

http://128.104.8.22/resource/fall2010%20subgroup2/readings/Topic%20I/Ji_TINS_03%20pain%20and%20LTP%20rev.pdf
What volume of FFP is required to increase fibrinogen level by 1g/L (I think it was FFP or did it say cryoprecipitate?)

a. 10-15ml/kg
b. 30ml/kg
Uptodate:
Ten units of cryo (obtained from 10 units of plasma) contain about 2 g of fibrinogen and will raise the fibrinogen level about 70 mg/dL in a 70 kg recipient
An epidural in a healthy individual causes all EXCEPT

a. Raised Co2
b. Bradycardia
c. Vasodilation
d. Dyspnea
a
Autologous transfusion results in less

a. Cost
b. Blood waste
c. Incompatible transfusion
d. Unrequired transfusion
Uptodate: patients who have made autologous donations have higher rates of transfusion. The blood is often not needed (and wasted). Risk of incompatible transfusion still exists due to clerical error.
After an infusion of normal saline causing isovolumetric haemodilution what occurs?

a. Increased cardiac output
b. Increase oxygen extraction
c. Capillary vasodilatation
a
Bleeding in trauma has been shown to be reduced by

a. Tranexamic acid
b. Recombinant factor VIIa
c. DDAVP
d. Prothrombinex
TXA

CRASH-2: TXA reduces mortality if given within 8 hours of injury. Less death from bleeding if given in under 1 hour or in 1-3 hours, seems worse if given 3-8 hours...
The time constant of the lung is calculated by

a. Compliance x resistance
b. Compliance plus resistance
c. Compliance /resistance
d. Resistance/compliance
Mathematically, the time constant is defined as compliance multiplied by the airway resistance and the resulting value has units of seconds of time..
The commonest post operative complication in a patient with a # NOF is

a. UTI
b. Pneumonia
c. Delirium
d. Myocardial infarction
Chest infection

http://www.bmj.com/content/331/7529/1374.full
In an infant, the intercristine line is at the level of

a. L1-L2
b. L2-L3
c. L3-L4
d. L4-L5
e. L5-S1
L5/S1

the distance from skin to epidural space in infants >6 months is ∼1 mm kg−1. The intercristal line is at L5/S1 (L4 in adults), the termination of the spinal cord is at L3 (L1/2 in adults) and the termination of the dura is at S3/4 (S2 in adults)


http://ceaccp.oxfordjournals.org/content/4/5/148.full
Which of the following is a contra-indication to a left DLT

a. Left pneumonectomy
b. Tumour in the left main stem bronchus
Tumour in bronchus?
What is the commonest symptomatic cardiac condition in pregnancy

a. Mitral stenosis
b. Aortic stenosis
c. Eisenmengers
d. Tetralogy of fallot
e. ?
MS

?most deaths due to ischaemia though
What is the ratio of MAC awake:MAC of sevoflurance

a. 0.2
b. 0.34
c. 0.5
Sevoflurane MAC is 2%
Sevo MAC-awake is 0.67%
Ratio is 0.67/2 = 0.34
A man presents to ED after a fight with his son in law in which he is punched in the head- calculate the GCS.
a
Pain from the uterus during labour is transmitted via

a. From the anterior roots of T10-L1
b. Parasympathetic fibres
c. The inferior hypogastric plexus
d. Via grey rami communicantes
a
The features of Pierre Robin sequence include cleft palate, micrognathia and:

A. Glossoptosis
B. Craniosynostosis
C. Macroglossia
D. Microstomia
Glossoptosis

PRS is characterized by an unusually small mandible (micrognathia),[1] posterior displacement or retraction of the tongue (glossoptosis), and upper airway obstruction. Incomplete closure of the roof of the mouth (cleft palate) is present in the majority of patients, and is commonly U-shaped.
A size C oxygen cylinder that reads 5000kpa contains approximately how many litres of oxygen

a. 100
b. 150
c. 200
d. 350
e. 600
full size C (13700 kPa) = 170 L

5000/13700 x 170 = 62L
A patient having a craniotomy has the CVP/arterial transducers at the level of the right atrium. The head is 13cm above the level of the heart. If the MAP is 80mmHg and the CVP is 5mmHg what is the cerebral perfusion pressure in mmHg

a. 60
b. 62
c. 65
d. 70
e. 75
1mmHg = 1.36 cmH20
13/1.36 = 10mmHg

CPP = MAP -(greater of ICP or CVP)

cerebral MAP is 70mmHg, cerebral venous pressure is 0 (technically minus 5mmHg) so CPP will be equal to MAP = 70mmHg (don't know ICP)
After a procedure with an LMA in situ a patient complains of loss of sensation to the anterior part of the tongue. What nerve is likely damaged?

a. Facial
b. Lingual
c. Greater palatine
d. Glossopharyngeal
A: Facial

Innervation

Anterior 2/3rds of tongue

General somatic afferent: lingual nerve branch of V3 of the trigeminal nerve CN V
Taste: chorda tympani branch of facial nerve CN VII (carried to the tongue by the lingual nerve).

Posterior 1/3rd of tongue

General somatic afferent and taste: Glossopharyngeal nerve CN IX

Motor

All intrinsic and extrinsic muscles of the tongue are supplied by the hypoglossal nerve (CN XII), except for one of the extrinsic muscles, palatoglossus, which is innervated by CN X of the pharyngeal plexus.
What statistical test would be best to evaluate the effects of ? 2 drugs in patients at ? 3 different points in time

a. ANOVA
b. Mantel Hantzel
c. Crusckall Wallis
d. Students t test
ANOVA?
A man is working with electrical appliances at home with a residual current device. If he touches the active and the neutral (was it neutral or earth) wire he will suffer

a. A microshock
b. A macroshock
c. Nothing happens because the fuse blows
d. The RCD will protect him from macroshock
D: RCD will protect him from macroshock

RCD will trip with a 30 mA leakage - works on principle that current flowing to and from an appliance (in live and neutral wires) is equal.

Current of 100mA required to cause VF when applied to surface of body
Only 0.05 to 0.1 mA required to cause VF when applied directly to myocardium (= microshock)
An infant with failure to thrive is noted to have an apical systolic murmur weak pulses, with the femoral felt most easily. They most likely have

a. Patent ductus arteriosis
b. Ventriculoseptal defect
VSD

(PDA should give good upper body pulses and poor lower limb pulses?)
Which radiological finding is most consistent with atlantoaxial instability in a patient with rheumatoid arthritis

a. A 9mm gap between the anterior arch of C1 and the odontoid peg
Atlantoaxial subluxation occurs in 25% of patients with severe RA
Maxiumum gap between odontoid and arch of the atlas is 3mm - more than this is significant.
What is the most accurate method of determining fetal heart rate in a neonate

a. Palpation of an umbilical vein pulse
b. Auscultation with a stethoscope
c. Palpation of femoral pulse
d. Pulse oximetry
Auscultation?
In acute liver injury what causes the highest risk of bleeding

a. Thrombocytopenia
b. Coagulopathy
c. Portal hypertension
d. Platelet dysfunction
e.
B or A?

Hyperacute hepatic failure - within 7 days
Acute 7 to 28 days
Subacute - 28 days to 6 months

Portal hypertension due to scarring and fibrosis
A patient in recovery post op total hip replacement develops crushing central chest pain, ECG shows ST segment elevation (NB- no BP etc given, beta blockade was not an option). The most appropriate action is to give

a. Aspirin
b. IV GTN
c. IV heparin
d. Calcium channel blocker
e. T/L
Oxygen
Aspirin
Continuous ECG monitoring (risk of arrhythmias)
IV morphine
IV antiemetic
IV GTN
Stellate ganglion blockade causes

a. Conjunctival injection
b. Dry eyes
c. Decreased axillary sweating
?Dry eyes (change in tear consistency)

The stellate ganglion refers to the ganglion formed by the fusion of the inferior cervical and the first thoracic ganglion as they meet anterior to the vertebral body of C7. It is present in 80% of subjects. It usually lies on or above the neck of the first rib.

Indications

Pain syndromes

Complex regional pain syndrome type I and II
Refractory angina
Phantom limb pain
Herpes zoster
Shoulder/hand syndrome
Angina

Vascular insufficiency

Raynaud's syndrome
Scleroderma
Frostbite
Obliterative vascular disease
Vasospasm
Trauma
Emboli

Contraindications

Coagulopathy
Recent myocardial infarction
Pathological bradycardia
Glaucoma




http://www.frca.co.uk/article.aspx?articleid=100538
Features of ventricular tachycardia DO NOT include

a. Absence of p waves
b. Monophasic waves
c. Prominent R wave in V1
d. A-V dissociation
a
An inpatient becomes hyponatraemic 48 hours post op and has a seizure. The most appropriate treatment is

a. Fluid restriction
b. Normal saline ?ml/hr
c. Hypertonic saline
d. Salt tables
Hypertonic saline is warranted in patients with severe and often acute hyponatremia (serum sodium usually below 120 meq/L) who present with seizures (uptodate)

In SIADH, concentration of sodium solution administered must be greater than urinary sodium, or otherwise the salt will be lost and the water retained, making things worse!
A patient has a laparotomy for an acute abdomen, nothing in found intra-operatively. ABG reveals
a
A child with 10% dehydration is likely to have

a. Bradycardia
b. Rapid deep breathing
5% dehydration (OHA)
-loss of skin turgor
-depressed fontanelle
-sunken eyes
-normal peripheral pulses
-lethargic

10% dehydration
-mottled skin with poor capillary return
-deeply depressed fontanelle
-deeply sunken eyes
-tachycardic with weak pulses
-unresponsive




Signs of dehydration:
capillary refill >2s
tachycardia
oliguria
cool peripheries
increase in core-peripheral temp gap
sunken fontanelle
thready pulse
reduced level of consciousness
Hypotension seen late - after 30% blood volume lost
Main heat loss in anaesthetic for neonate

A. vasodilatation
B. radiation
C. convection
D. conduction
E. evaporative
Radiation
One lung ventilation- FIO2 1.0, desaturate
Increase FiO2
Ensure adequate cardiac output
Confirm DLT placement
Add PEEP to ventilated lung (5-10 cm H2O)
Warn surgeon, ventilate non-dependent lung
Apply CPAP 5-10 cmH20 to non-dependent lung using 100% O2
Intermittently inflate non-dependent lung
Return to two-lung ventilation
Surgeon can clamp appropriate PA to eliminate shunt


OHA pg 376
Neonate to drug addicts found by grandmother in the house, brought into ed, mildly jaundice, slight tachycapnic. ABG PH 7.54, PaCO2 46, pO2 74, HCO 13

A. Septicaemic
B. Pyloric stenosis
C. Opiod overdose
D. Meningitis
E. Hepatitis
a
Jehovah's witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle:

A. Paternalism
B. Maleficience
C. Autonomy
D. Beneficience
Beneficence
Patient with aortic stenosis, the signs indicate poor prognosis

A. Palpitation
B. Radiation to carotid arteries
C. Something about characteristic of murmur


Which is the best predictor of poor prognosis with aortic stenosis?

A. chest pain
B. paroxysmal nocturnal dyspnoea
C. syncope
D.
E.
Severe AS = AVA < 1.0cm2 or gradient > 50mmHg

Symptoms - in order of worsening prognosis:
Exertional dyspnoea
Angina
Breathlessness
?Syncope in here
Sudden death
Patient indicated for prophylaxis of infective endocardititis

A. amoxicillin orally 2 hours prior
B. amoxicillin IV 1 hourly prior
C. amoxicillin IV just before incision
D. cefazolin IV 1 hour prior
30-60 mins prior:
amoxil 2g PO/IV/IM, cefazolin 1g IV/IM


Patients at greatest risk of IE:

Prosthetic cardiac valve or prosthetic material for valve repair
Previous IE
Unrepaired congenital cyanotic heart disease
Completely repaired congential heart defect with prosthetic material withing 6 months of repair
Repaired congential cyanotic heart disease with residual defects adjacent to prosthetic material
Cardiac transplant recipients who develop valvulopathy
Which drugs below does not need dose adjustment in renal failure patient

A. Buprenorphine
B. Morphine
C. Tramadol
D. ?
E. ?
Buprenorphine - hepatic metabolism, biliary excretion.
Patient on cisapride. What drug NOT to give in recovery?

A. Tramadol
B. ?
C. ?
Cisapride - risk of long QT.
Avoid:
droperidol
Which herbal supplement reacts with tramadol?

A. Ephedra
B. St John's wort
St John's Wort
72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is

A. IVC filter
B. Refer him for a pulmonary embolectomy
C. Supportive (fluids and inotropes)
D. Thrombolysis
E. Warfarin
Is haemodynamically unstable.
Unsuitable for thrombolysis as is within 30 days of surgery.
Only other option is emergency embolectomy.
The test to diagnose pulmonary embolism

A. CT pulmonary angiogram
B. Echocardiogram
C. Electrocardiogram
D. Ventilation-perfusion scan
CTPA
Finding on haemophilia A patient

A. Female haemarthrosis
B. Male haemarthrosis
C. Normal PT, abnormal APTT
D. Abnormal PT, normal APTT
Haemophilia A is an X-linked defect in factor VIII activity

Elevated APTT, normal platelet count/INR/TT/fibrinogen
LSCS for foetal distress, meconium stained liquor. Management of baby

A. Intrapartum suctioning
B. Intrapartum suctioning and post partum tracheal suction
C. Post partum tracheal suctioning
D. Routine neonatal care
E. Intubate
As amniotic fluid is NOT clear:
-provide warmth
-position; clear airway of necessary
-dry, stimulate, reposition
(OHPA pg 516)
An elderly lady has a closed neck of femur fracture and presents to ED. She is in chronic AF and on warfarin. INR is 2.6 and she is not bleeding. It is 9am and she is scheduled for repair the following day. According to current guidelines, how should her warfarin be reversed?

A. Prothrombinex 25IU/kg immediately and then 2 units FFP immediately prior to surgery
B. No immediate treatment then 2 units FFP immediately prior to surgery
C. Vitamin K 1mg IV immediately
D. Vitamin K 10mg IV immediately
E. Withhold warfarin
Surgery is not for 24 hours and she is not bleeding. Give 1mg IV Vitamin K
Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours

A. <5%
B. 5-10%
C. 10-15%
D. 15-20%
E. >20%
First 24 hours: 4% rebleed rate, then 1.5% per day for next 4 weeks.
Post delivery neonate did not breath post stimulation by midwife, not vigorous, heart rate drop from 140 to 90bpm. Next step of action

A. 100% oxygen
B. Positive pressure ventilation
C. Intubation
D. CPR
E. Adrenaline
As apnoeic and HR less than 100:
-give positive pressure ventilation
(if HR falls below 60, ensure adequate lung inflation, add chest compression, consider adrenaline)
(OHPA pg 516)
The safe maximal pressure for endotracheal cuff at the lateral side of the trachea

A. 0-10 cm water
B. 10-20 cm water
C. 20-30 cm water
D. 30-40 cm water
E. 40-50 cm water
15cmH20 (EAA pg 69)
others say 20-30
Patient with mastocytosis. Intraop would probably be:

A. Severe hypotension
Hypotension due to degranulation


Mastocytosis is a group of rare disorders of both children and adults caused by the presence of too many mast cells (mastocytes) and CD34+ mast cell precursors in a person's body
Complication of celiac plexus block

A. Hypertension
B. Failure of erection
C. Constipation
D. Paraplegia
E. L3,4 lumbar pain
Both ED and paraplegia

Complications

Severe hypotension may result, even after unilateral block.
Bleeding due to aorta or inferior vena cava injury by the needle.
Intravascular injection (should be prevented by checking the needle position with radio-opaque dye).
Upper abdominal organ puncture with abscess/cyst formation.
Paraplegia from injecting phenol into the arteries that supply the spinal cord (prevented by checking the needle position with radio-opaque dye).
Sexual dysfunction (injected solution spreads to the sympathetic chain bilaterally).
Intramuscular injection into the psoas muscle.
Lumbar nerve root irritation (injected solution tracks backwards towards the lumbar plexus).


The coeliac plexus is also known as the solar plexus. It is the main junction for autonomic nerves supplying the upper abdominal organs (liver, gall bladder, spleen, stomach, pancreas, kidneys, small bowel, and 2/3 of the large bowel). The celiac plexus proper consists of the celiac ganglia with a network of interconnecting fibers. The ganglia lie on each side of L1 (aorta lying posteriorly, pancreas anteriorly and inferior vena cava laterally).


http://www.frca.co.uk/article.aspx?articleid=100539
Post epidural and LSCS, the next day patient have persistent paraesthesia anterior thigh. What other injuries would indicate more of nerve roots instead of peripheral nerve injuries

A. Weakness on hip flexion and thigh adduction
B. Weakness on knee flexion and plantar flexion
C. Urinary incontinence
D. Foot drop
Anterior thigh is L2(-L3)/ femoral nerve and lateral cutaneous nerve.

L2 supplies:iliacus/gracilis/psoas major and minor/pectineus, which flex and adduct at hip joint
Post carotid enderactomy in the ward, patient seizure. Noted patient operation side is more severe stenosis and post op difficult to control blood pressure. What would prevent seizure most

A. Add on antihypertensive
B. Start anti convulsant
Hyperperfusion syndrome caused by areas of brain protected by tight carotid being exposed to hypertensive BP (headaches, haemorrhagic CVA).
Labetalol 5-10mg IV boluses, hydralazine infusion if SBP >160


CEA indicated for stenosis >70%; combined CVA/death rate 2-5%
Post local anaesthetic block in difficult intubate patient- patient seizure. What would you give?

A. Midazolam 5mg
B. thiopentone
C. propofol
D. Suxamethonium
LAST - local anaesthetic systemic toxicity
A - maintain airway (do not HAVE to intubate)
B - 100% O2, adequate ventilation
control seizure with benzodiazepine/ thio/ propofol (though probably benzo in this case)
Carcinoid patient intraop hypotension-

A. ocreotide
Carcinoid tumours release 5HT, bradykinin, histamine, substance P, prostaglandins, vasoactive intestinal peptide. Only have systemic effects if are post-hepatic or can bypass liver as otherwise are broken down in liver.
Octreotide prevents release of mediators (100mcg sc tds for 2/52 preop then 100mcg slow IV at induction, then 10-20 mcg boluses slow IV for hypotension)
Allergic question, which is true

A. Collect tryptase 8hours
B. RAST test most sensitive/ specific
C. Absent of trytase exclude anaphylactic
D. Skin and intradermal test- sensitivity, specificity
Tryptase - neutral protease released from mast cells during degranulation.
Half life 3 hours.
Levels post-resuscitation, 3 and 24 hours

Skin testing more sensitive/specific than lab testing. Must be done 4-6 weeks post to allow IgE regeneration.
After transfusion of 5 unit of FFP what is least likely to occur

A. Haemolytic reaction
B. Hypocalcaemia
C. Infection
D. Hyperkalaemia
Hopefully infection?
There is evidence to avoid BIS <40 for more than 5minutes because

A. Safe cost
B. Increase incident of hypotension
C. Increase post op mortality
D. Decrease volatile (?) for poor cardiac output patient
E. Decrease the incidence of awareness
BIS <45 associated with increased postop mortality
Most common cause of paediatric post anaesthesia cardiac arrest

A. Drug error
B. Respiratory cause
C. Multifactorial
D. Cardiac problem (?)
?Respiratory
Post cervical spine op, there is bulging noted under the incision site.. Patient desaturated, combative, keep pulling off the oxygen facemask. Next course of action

A. Rapid sequence induction
B. Gas induction
C. Needle aspiration of the bulge at the neck
Need to release haematoma to decompress trachea - needle aspiration seems a little high risk in a combative patient...
What drug known to cause prolong QT and risk of Torsades de Pointes

A. Metoclopramide
B. Droperidol
C. Tranexamic acid
Droperidol

(TXA = seizures, metoclopramide = oculogyric crisis)
During cardiac catheterisation (?) patient become BP 80/60, HR 110, CVP 16. What is the next most important investigation

A. Echocardiogram
B. CXR
C. Electrocardiogram
Hypotension/tachycardia/elevated CVP = possible tamponade.
Needs echo and pericardiocentesis
Intraop hyperfibrinolysis- how to diagnose (euglobulin lysis time NOT an option in the answer)

A. TEG
B. PT
C. APTT
TEG

TEG values:
Reaction time (time to 2mm amplitude) = clotting time
Kinetics (from 2 to 20mm amplitude) = clot kinetics
Alpha angle (clot strengthening) = clot strengthening
Maximum Amplitude = maximum strength
Lysis

Long R: heparin effect (protamine) or factor deficiencies (FFP)
Small angle: give cryo
Reduced MA: need platelets
Early lysis: need TXA
75yo patient seen for femoral bypass surgery, no significant cardiac risk factor. He will be admitted 3 days prior to operation. You decided NOT to start on beta blocker and you are justified because:

A. There is increase mortality and morbidity
B. There is not enough time to safely start beta blocker
C. The beta blocker may make the patient claudication worst
D. ?
Excess of mortality and ischaemic CVA vs placebo

POISE
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
both ACEI and beta-blockers have been shown to improve survival in heart failure. enalapril dose here more appropriate than metoprolol dose
A line isolation monitor protects against microshock

A. only if the warning current is set at 10mA
B. only if the warning current is set at 30mA
C. under no circumstances
D. only if the equipment used is grounded
E. only if it monitors all the equipment in the region
???

Line isolation systems (isolation transformer + line isolation monitor) protect persons from electrocution by turning a normal “grounded system” (that exists outside the operating room) which only needs a single fault to cause electrocution into a “protected” system in which two faults are needed to deliver a shock. The line isolation monitor determines the degree of isolation between the two power wires and the ground and predicts how much current could flow if a second short-circuit were to develop. An alarm goes off if an unacceptably amount of current to the ground is possible (i.e. the "isolated" system is no longer isolated, but rather is grounded, thus only one additional fault could result in a shock).
Patient ingested 500mg/kg aspirin. In ICU, the most effective method to remove aspirin

A. IV fluid
B. Haemodialysis
C. Sodium bicarbonate infusion
D. Frusemide
Depends on plasma levels:
if >500mg/L, urinary alkalinisation using Sodium bicarbonate

if >700mg/L, haemodialysis
The most effective method for cerebral protection in aortic arch aneurysm repair

A. Systemic hypothermia 20degrees
B. Antegrade perfusion to carotid arteries
C. Retrograde perfusion to jugular veins
D. Thiopentone
E. Steroid (?)
?

DHCA 18 degrees - OHA says must be cooled to less than 20 degrees pre DHCA
Interscalene block after injection of 2ml bupivacaine- patient seizure. Most likely injected to

A. Dural cuff
B. Vertebral arteries
C. Internal carotid arteries
D. Jugular veins
E. Subarachnoid (?)
Vertebral artery
Post intubation, you manual ventilate and noted patient high airway pressure. What would you do next

A. Open the APL valve
B. Auscultate the lung
C. Switch to ventilator
Auscultate lungs
?bronchospasm
?endobronchial intubation
Modified Cormack and Lehane grade - You cannot see beyond the epiglottis and there is a little space between the epiglottis and the posterior pharyngeal wall (? remembered as epiglottis touching posterior pharyngeal wall)

A. 2a
B. 2b
C. 3a
D. 3b
E. 4
3b?

Cook TM, A new practical classification of laryngeal view (2000, Anaesthesia 55: 274–279)

Most of cords visible 1
Posterior cord visible 2a Direct Easy
Only arytenoids visible 2b
Epiglottis visible and liftable 3a
Epiglottis adherent to pharynx 3b
No laryngeal structures seen 4
Most safe side to insert subtenon block

A. Inferonasal
B. Inferotemporal
C. Medial
D. Superonasal
E. Superotemporal
Inferonasal
Diastolic dysfunction Not caused by

A. Adrenaline
B. Myocardial fibrosis
C. Aortic stenosis
D. Hypertension
?Adrenaline


http://ceaccp.oxfordjournals.org/content/9/1/29.short
Compared to retrobulbar block, peribulbar block is associated with

A. More bleeding
B. More risk to optic nerve
C. More akinetic eye
D. Less block to orbicularis oculi
??
Peribulbar:
more gradual onset
less potential for complications retrobulbar haemorrhage or globe penetration
Lumbosacral trunk does not supply:

A. Subcostal nerve
B. Ilioinguinal n
C. Iliohypogastric n
D. Femoral n
E. Genitofemoral n (?)
These all arise from lumbar plexus:
Subcostal = T12
Iliohypogastric & Ilioinguinal = T12/L1
Genitofemoral = L1/L2
Femoral = L2/3/4
Trauma patient best indicator of good resuscitation (?)-

A. Lactate level
B. Heart rate
C. Blood pressure
D Acidosis (?)
?lactate
Pregnant patient seatbelt, driver- involved in car accident. Suddenly developed severe central chest pain, HR 110, BP 154/80, RR 26, Sat 100%. The most likely cause?

A. Sternal fracture
B. Aortic dissection
C. Pneumothorax
D. Rib fracture
E. Myocardial infarction
?fracture
ASD murmur heard at

A. ASD
B. Tricuspid valve
C. Pulmonary valve
D. Mitral valve
E. Aortic valve
wide, fixed split S2
pulmonary ESM
Apnoeic oxygenation in obese patient can be increased by

A. Sniffing position
B. Prone
C. Supine
D. Lateral
E. Head up
?apparently nobody knows...
Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is:

A. Low C3, C4
B. Increase complement
C. Increase tryptase
D. Increase histamine?
E. petechial rash
Increased tryptase
Young pregnant patient with moderate mitral stenosis, normal LV function. The best delivery method

A. Epidural anaesthesia LSCS
B. Spinal with LSCS
C. Epidural analgesia and normal vaginal delivery
D. GA LSCS
E. Normal vaginal delivery with remifentanil PCA
Either epidural NVD or LSCS
Need to maintain sinus rhythm, avoid increases in preload or falls in afterload

Usually due to rheumatic heart disease.
mild>2cm2, mod 1-2cm2, severe<1cm2
Neonate desaturate faster than adult at induction because

A. FRC decrease more
B. Faster onset of induction agents
C. More difficult pre-oxygenation
A

FRC (awake) same as adult (30mL/kg) but higher O2 consumption per kg and FRC under anaesthesia lower so smaller O2 reservoir
Closing volume greater than FRC

Neonate = newborn up to 44 weeks post-conceptual age
The cause of hypoxia in one lung ventilation

A. Blood flow through non ventilated lung
B. Impairment of hypoxic pulmonary vasoconstriction
C. Ventilation perfusion mismatched (?)
A: shunt through non-ventilated lung
Suxamethonium dosage higher in neonates compare to adult because

A. Increased volume of distribution
B. Increased pseudocholinesterase activity
C. More receptors
D. Higher cardiac output (?)
E. Decreased sensitivity of nicotinic ACH receptors to suxamethonium
F. Faster diffusion away from neuromuscular junction
A: Increased volume of distribution due to greater TBW

Neonatal dose 3mg/kg
Indicates autonomic neuropathy except

A. Sinus arrhythmia
B. Gastric reflux
C. Postural hypotension
A: sinus arrhythmia is normal, LOSS of it is a sign of AN

signs:
postural hypotension
erectile dysfunction/ejaculatory failure
nocturnal diarrhoea
urinary retention
gastroparesis is ?specific to DM

postural BP drop >20/10
ECG - loss of respiratory variation in HR
Best indicator of return function of laryngeal muscle

A. Sustained head lift 5 sec
B. Sustained leg lift 5 sec
C. TOF 0.9
D. DBS no fade
E. Tetanus 50Hz
Head lift?
A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is

A. altered thermoregulation
B. chorioamnionitis
C. urinary tract infection
D. inflammatory response
E. neuraxial infection
Altered thermoregulation (OHOA)
Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have

A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism
Secondary (low calcium, high PTH) due to lack of vit D and CRF

(primary is from solitary adenoma or gland hyperplasia; tertiary has elevated calcium AND PTH following gland hyperplasia after prolonged period of secondary hyperparathyroidism)
Pre eclamptic patient post LSCS continue on Mg infusion in ICU. Found to be in respiratory depressed. Next management

A. Calcium gluconate
B. IV fluid
C. Frusemide
IV calcium gluconate or chloride
What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.e. have a dibucaine number 30-70?

A. 0.04%
B. 0.4%
C. 4%
D. 14%
E. 40%
4%?
(A-Z says 5%)
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
adductor pollicis
When intubating over a bougie / awake fibreoptic, which direction do you rotate the tube to stop it catching on structures in the glottis

A. no change from normal
B. 90 degrees clockwise
C. 90 degrees counterclockwise
D. 180 degrees
E. try either direction
a
Advantages of off-pump CABG over on-pump CABG

A. decreased transfusion rate
B. decreased mortality
C. decreased cost
D. increased graft patency
E. less cognitive impairment
F. less stroke
ROOBY trial
-no difference in outcomes
-graft patency better in on-pum-fewer grafts than planned more likely with off-pump
After coronary artery bypass graft surgery, the FRC is

A. increased 40%
B. increased 20%
C. unchanged
D. decreased 20%
E. decreased 40%
a
A 60 year old man 24 hours post CABG is confused, oliguric, with BP 80/40, pulse 120. The most appropriate and useful investigation is

A. electrocardiogram
B. echocardiogram
C. chest x-ray
D. arterial blood gas
E. coronary angiogram
echo - does he have tamponade?
Iron deficiency

A. decreased serum ferritin, increased serum iron
B. decreased serum ferritin, absence of bone marrow iron
C. decreased serum ferritin, normal serum iron
D. increased serum ferritin, decreased serum iron
E. increased serum ferritin, decreased total iron binding capacity
decreased iron, decreased ferritin, increased TIBC (OHM)
Why should NSAIDs be avoided in pregnant women >30 weeks gestation?

A. cause neonatal acute renal failure
B. increased antepartum haemorrhage
C. increased rate of pre-eclampsia
D. cause closure of the fetal ductus arteriosus
E. increase preterm labour
Avoid in 3rd trimester due to risk of closure of ductus and fetal pulmonary hypertension
A 62 year old man has chronic renal failure. You notice his total serum calcium is 2.05 mmol/L. This is because he has

A. high serum vitamin D
B. hypoparathyroidism
C. primary hyperparathyroidism
D. secondary hyperparathyroidism
E. tertiary hyperparathyroidism
secondary hyperparathyroidism