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115 Cards in this Set
- Front
- Back
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? |
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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
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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.
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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
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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 |
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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. |
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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 |
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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 |
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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. |
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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 |
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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?? |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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An epidural in a healthy individual causes all EXCEPT
a. Raised Co2 b. Bradycardia c. Vasodilation d. Dyspnea |
a
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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.
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After an infusion of normal saline causing isovolumetric haemodilution what occurs?
a. Increased cardiac output b. Increase oxygen extraction c. Capillary vasodilatation |
a
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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... |
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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..
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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 |
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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 |
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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?
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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 |
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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 |
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A man presents to ED after a fight with his son in law in which he is punched in the head- calculate the GCS.
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a
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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
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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. |
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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 |
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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) |
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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. |
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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?
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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) |
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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?) |
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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. |
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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?
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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 |
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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 |
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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 |
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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
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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! |
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A patient has a laparotomy for an acute abdomen, nothing in found intra-operatively. ABG reveals
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a
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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 |
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Main heat loss in anaesthetic for neonate
A. vasodilatation B. radiation C. convection D. conduction E. evaporative |
Radiation
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One lung ventilation- FIO2 1.0, desaturate
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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 |
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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
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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
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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 |
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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 |
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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.
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Patient on cisapride. What drug NOT to give in recovery?
A. Tramadol B. ? C. ? |
Cisapride - risk of long QT.
Avoid: droperidol |
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Which herbal supplement reacts with tramadol?
A. Ephedra B. St John's wort |
St John's Wort
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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. |
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The test to diagnose pulmonary embolism
A. CT pulmonary angiogram B. Echocardiogram C. Electrocardiogram D. Ventilation-perfusion scan |
CTPA
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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 |
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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) |
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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
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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.
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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) |
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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 |
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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 |
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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 |
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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 |
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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% |
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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) |
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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) |
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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. |
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After transfusion of 5 unit of FFP what is least likely to occur
A. Haemolytic reaction B. Hypocalcaemia C. Infection D. Hyperkalaemia |
Hopefully infection?
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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
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Most common cause of paediatric post anaesthesia cardiac arrest
A. Drug error B. Respiratory cause C. Multifactorial D. Cardiac problem (?) |
?Respiratory
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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...
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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) |
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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 |
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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 |
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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 |
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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
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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). |
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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 |
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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 |
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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
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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 |
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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 |
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Most safe side to insert subtenon block
A. Inferonasal B. Inferotemporal C. Medial D. Superonasal E. Superotemporal |
Inferonasal
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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 |
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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 |
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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 |
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Trauma patient best indicator of good resuscitation (?)-
A. Lactate level B. Heart rate C. Blood pressure D Acidosis (?) |
?lactate
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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
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ASD murmur heard at
A. ASD B. Tricuspid valve C. Pulmonary valve D. Mitral valve E. Aortic valve |
wide, fixed split S2
pulmonary ESM |
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Apnoeic oxygenation in obese patient can be increased by
A. Sniffing position B. Prone C. Supine D. Lateral E. Head up |
?apparently nobody knows...
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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
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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 |
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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 |
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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
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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 |
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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 |
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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?
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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)
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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) |
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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
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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%) |
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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
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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
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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 |
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After coronary artery bypass graft surgery, the FRC is
A. increased 40% B. increased 20% C. unchanged D. decreased 20% E. decreased 40% |
a
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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?
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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)
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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
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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
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