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138 Cards in this Set
- Front
- Back
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EZ93 What is the chemical used in sodalime to indicate exhaustion? |
ANSWER A |
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2. Repeat- Main heat loss in anaesthetic for neonate |
ANSWER B - radiation http://www.nature.com/jp/journal/v28/n1s/full/jp200851a.html
However, consideration for the premature (28/40) + ELBW neonate sees increased loss of heat through evapouration
http://journals.lww.com/advancesinneonatalcare/Fulltext/2010/10001/Thermoregulation_and_Heat_Loss_Prevention_After.3.aspx
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AT08c [Apr97] [Jul98] [2001-Apr] Q50, [2001-Aug] Q31, [2003-Apr] Q3, [2003-Aug] Q54, [2005-Apr] Q38, [Jul05] [Mar06] |
ANSWER A |
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4. Child with murmur- what would make it more likely for you to investigate if you heard the murmur |
B. Persistent mumur of manouveres
Danger Signs of Murmurs * Loud* Late * Long * Locked (no change on position) * fiLing (diastolic) * Little kids (<1yr) * thrilL
EXCLUDE ON HISTORY
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5. Repeat- Single lumen intubation after multiple attempts of difficult intubation, you put in a bronchoscope after and the tip is in the trachea. The structure B you seen corresponding to? |
Trachealis is posterior, use this to orientate
Right upper lobe is only true trifurcation |
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7. Repeat- 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 |
ANSWER B |
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ET03 [Repeat] Jehovah's witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle: |
ANSWER A; Paternalism. Consideration that as medical specialists the risks of proceeding to surgery without the option of provision of transfusion support is too great a risk. |
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9. Patient with aortic stenosis, the signs indicate poor prognosis |
LR of signs for aortic stenosis poor prognosis. 1. Late Peak Murmur 4.42. Sustained apical impulse 4.1 3. long murmur 3.9 4. delayed carotid upstroke 3.7 5. diminished carotid pulse 2.3 6. radiation of murmur to neck 1.4
??
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Which is the best predictor of poor prognosis with aortic stenosis? |
ANSWER B: paroxysmal nocturnal dyspnoea |
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10. New- Patient indicated for prophylaxis of infective endocardititis |
ANSWER D; Cefazolin 1 hour prior (best answer available, however needs to be 30mins prior to procedure/incision)
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11. Circuit disconnection during spontaneous breathing anaesthesia |
I disagree with the below chosen answer as, if it was a dropping anaesthetic concentration, then there would be this alarm alerting us every time we attempted to wake a patient up by turning the anaesthetic agent off.
I would think that it is more likely; C
that and it also depends on which point disconnects.
ANSWER D |
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12. TMP-Jul10-036 |
Diadvantages |
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PZ130 Which drugs below does not need dose adjustment in renal failure patient |
ANSWER A
Morphine and Tramadol have active metabolites |
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14. Repeat- Child after gas induction, LMA insertion without IV cannula- desaturate to 90%. Next step of action? |
B. LMA out and Positive Pressure Mask Ventilate.
Remove offending stimulus |
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PZ128 Patient on cisapride. What drug NOT to give in recovery? |
I would suggest Droperidol was part of MCQ possible answers and therefore would be the correct answer d/t to the risk of long QT.
ANSWER A (from other groups) |
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16. Repeat- Which herbal supplement reacts with tramadol? |
ANSWER B
Alternative Medications;
G's bleed
Ephedra is sympathomimetic + causes hEpatitis
St John's = serotonin
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17. Repeat- Fat: blood coefficient- N2O, D, S, I |
N2O 2.3 E 36 S 47 H 51 |
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18. Repeat- Immunology mediated heparin induced thrombocytopenia- intravascular thrombosis |
HITTS
Type 1 * non-immune* platelet aggregation unduced by heparin * less severe * early presentation (1st injection) * spontaneous recovery * immune * PF4:Heparin antibodies (IgG) * delayed presentation 1-2 weeks from injection * low platelets and thrombin/fibrin activation = clots * life threatening |
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19. Repeat- Half life or tirofiban? |
A |
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TMP-131 Repeat- Troponin can be detected for how long: |
A
inhibits fibrinogen cross-linking 50% platelet activity returns at 4hrs |
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21. Repeat- Neonate intubation- at lips |
DEPTH Mouth (Nose) |
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22. New - 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 |
ANSWER B * stroke in less than 3months, * closed head or facial trauma within 3 months, * suspected aortic dissection , * ischemic stroke within 3 months(except in ischemic stroke within 3hours time), * active bleeding diathesis, * uncontrolled high blood pressure (>180 systolic or >100 diastolic), * known structural cerebral vascular lesion viz av malformations. * Current anticoagulant use, * invasive or surgical procedure in the last 2 weeks, * prolonged cardiopulmonary resuscitation (CPR) defined as more than 10 minutes, * known bleeding diathesis, * pregnancy, * hemorrhagic or diabetic retinopathies, * active peptic ulcer, * controlled severe hypertension. |
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23. Repeat- The test to diagnose pulmonary embolism |
ANSWER A |
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24. Repeat- Finding on haemophilia A patient |
ANSWER C |
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25.tmp11b25 New- LSCS for foetal distress, meconium stained liquor. Management of baby |
ANSWER ?C (Depends on effort of baby) |
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26. Repeat- 36yo male with sickle cell anaemia Hct 0.3 with close foot fracture, what is true |
ANSWER B |
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27. New- 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? |
ANSWER C |
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28. Repeat- Marfan syndrome. All EXCEPT- |
Cardiac Manifestations of Marfan Syndrome * MVP* AR * Aortic dissection * Conduction abnormalities |
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29. New- Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours |
ANSWER A
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30.TMP11B30 New- Post delivery neonate did not breath post stimulation by midwife, not vigorous, heart rate drop from 140 to 90bpm. Next step of action |
ANSWER B |
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31. New- The safe maximal pressure for endotracheal cuff at the lateral side of the trachea |
ANSWER C
BMJ 1984
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32. Repeat- Allergy to penicillin- cross reaction to neuromuscular blocker |
? |
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33. New- Patient with mastocytosis. Intraop would probably be: |
A
management Premeds; steroid, anti-histamines low histaminergic stimuli |
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34. Repeat- Complication of celiac plexus block |
ANSWER D |
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35. New- 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 |
ANSWER A
L2/3 nerve roots
sensation to thigh hip flexion |
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36. Repeat- Nerve supply to the upper eyelid- |
A |
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37 |
ANSWER D |
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38 ANZCA Version [Jul07]Q.150 |
ANSWER D |
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39 |
ANSWER A |
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40 The QT interval may be prolonged by each of the following EXCEPT |
ANSWER C |
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41. Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures? |
ANSWER A |
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42. Repeat- Post local anaesthetic block in difficult intubate patient- patient seizure. What would you give? |
ANSWER A |
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43 |
ANSWER D |
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44. Repeat- Allergic question, which is true |
ANSWER ??? |
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45 |
ANSWER A |
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46. New- After transfusion of 5 unit of FFP what is least likely to occur |
ANSWER D |
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47. Severe asthmatic- tachycapnia, HR120, speaking in words, pH 7.45, pCO2 46, pO2 96, HCO3 24. Then given nebulised salbutamol continuously, nebulised ipratropium bromide, and hydrocortisone- The next step: |
ANSWER Magnesium |
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48. AC62b ANZCA version [2003-Apr] Q144, [2004-Apr] Q98, [2004-Aug] Q44, [Jul06] Q23 |
ANSWER B
it really is our fault |
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49. New- There is evidence to avoid BIS <40 for more than 5minutes because |
ANSWER C |
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50. New- Most common cause of paediatric post anaesthesia cardiac arrest |
ANSWER B
I have a table which says it is cardiac cause in nature, so still not sure.
traditional teaching is that kids arrest because of breathing issues |
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51. New- Post cervical spine op, there is bulging noted under the incision sit:E. Patient desaturated, combative, keep pulling off the oxygen facemask. Next course of action |
ANSWER A |
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52. New- What drug known to cause prolong QT and risk of Torsades de Pointes |
ANSWER B |
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53. New- During cardiac catheterisation (?) patient become BP 80/60, HR 110, CVP 16. What is the next most important investigation |
ANSWER A |
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54. Intraop hyperfibrinolysis- how to diagnose (euglobulin lysis time NOT an option in the answer) |
ANSWER A |
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55. New- 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: |
ANSWER A |
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56. New- 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? |
ANSWER C |
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57.EZ80 Repeat- A line isolation monitor protects against microshock |
ANSWER C |
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58. AT27 [Apr07] Q108 |
ANSWER E |
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59.RB53 Repeat- Post dural punture headache |
ANSWER D |
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60. New- Patient ingested 500mg/kg aspirin. In ICU, the most effective method to remove aspirin |
ANSWER B |
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61. Repeat- The most effective method of decrease renal impairment in AAA surgery |
Maintain renal flow |
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62. |
ANSWER C |
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63. Repeat- The most effective method for cerebral protection in aortic arch aneurysm repair |
ANSWER A |
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SF53 ANZCA version [2001-Apr] Q6, [2001-Aug] Q4, [2003-Aug] Q66, [2004-Apr] Q55, [Mar 10],[Aug10] |
ANSWER C |
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65. Repeat- Most common signs of malignant hyperthermia- |
ANSWER A |
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66. New- The below would increase A-a oxygen gradient Except |
ANSWER B |
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TMP-104 [Mar10] [Aug10] |
ANSWER A |
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68. Repeat- Patient cough during interscalene block- insertion needle should be directed- |
ANSWER posterior |
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69. New- Interscalene block after injection of 2ml bupivacaine- patient seizure. Most likely injected to |
ANSWER B |
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70. New- Post intubation, you manual ventilate and noted patient high airway pressure. What would you do next |
ANSWER B |
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71 |
ANSWER B |
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72. New- 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) |
Grade I: Complete glottis visible. |
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73 |
ANSWER C |
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74. Repeat- Most safe side to insert subtenon block |
ANSWER A |
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75. Compared to retrobulbar block, peribulbar block is associated with |
ANSWER D
I would argue that this is not correct.
Retrobulbar does not block CN7 so is able to close eye w/ orbicularis oculi, unable to open due to CN3 blockade |
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76. Repeat- Diastolic dysfunction Not caused by |
ANSWER A |
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ANZCA Version [Apr07] |
ANSWER C |
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78. Lumbarsacral nerve does not supply: |
ANSWER A |
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79. Repeat- Relative humidity of fully saturated air at 20degree and 37 degrees- |
Absolute humidity |
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80.IC90 Repeat- Trauma patient best indicator of good resuscitation (?)- |
ANSWER A
urine output in burns patient is not completely resuscited until pH has normalised. |
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81. New- 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? |
ANSWER A
i think this is wrong. I believe it is Answer B
increased risk for traumatic deceleration aortic dissection in pregnancy. |
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82. New- ASD murmur heard at |
ANSWER C |
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84 |
ANSWER D |
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83. |
ANSWER D |
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85 TMP-Jul10-044 |
ANSWER E |
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86 |
ANSWER C |
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87. New- Apnoeic oxygenation in obese patient can be increased by |
ANSWER E
prolongs the time to desaturation |
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88 |
ANSWER A |
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89 TMP-Jul10-048 |
ANSWER A |
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90. New- Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is: |
ANSWER E
I disagree, AFE results in complement consumption, some tryptase/histamine release,
as there is the development of coagulopathy, there may be development of rash but not initially
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91 TMP-Jul10-049 |
ANSWER A |
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92 |
ANSWER A
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93 |
ANSWER A |
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ST19 ANZCA version [2002-Mar] Q62, [2002-Aug] Q59, [2005-Apr] Q58, [2005-Sep] Q50 |
ANSWER A |
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95 TMP-121 [Apr08] [Aug08] |
ANSWER C |
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96 TMP-Jul10-062 [Aug10] |
ANSWER D |
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97 |
ANSWER A |
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98 |
ANSWER C |
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99 MC157 [Mar10] [Aug10] |
ANSWER B
goal to keep the intrathoracic pressure and hence transpulmonary pressure low. thereby minimising the restriction to flow.
so reducing the inspiratory time does this. |
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100 |
ANSWER A |
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101. New- Young pregnant patient with moderate mitral stenosis, normal LV function. The best delivery method |
ANSWER C
however commonly it would be an assisted delivery to avoid active pushing. consideration of minimising uterotonic agents (ergotamine, PGE2) |
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102 |
ANSWER E |
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103 |
A patient with pulmonary hypertension secondary to lung disease presents for a laparotomy. Regarding this patient's anaesthetic management |
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104. New- Neonate desaturate faster than adult at induction because |
Answer A
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105. New- The cause of hypoxia in one lung ventilation |
ANSWER A |
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106. New- Suxamethonium dosage higher in neonates compare to adult because |
ANSWER A |
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107 TMP-107 [Mar10] [Aug10] |
ANSWER C |
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108 NV42 [Apr07] [Jul07] |
ANSWER B |
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109 |
ANSWER A |
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110. New- Indicates autonomic neuropathy except |
ANSWER A |
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111. Repeat- Best indicator of return function of laryngeal muscle |
ANSWER D
i went with C TOF 0.9 |
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112 MC59b ANZCA version [2003-Apr] Q125, [2003-Aug] Q85, [2005-Sep] Q69, [Mar06] Q48 [Mar10] [Aug10] |
ANSWER A |
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113. New- A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is |
ANSWER D |
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114 Can01-113 What nerve supplies sensation to the larynx above the vocal cords: |
ANSWER B |
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115 |
ANSWER B |
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116. ? Post op pneumonectomy short of breath- investigation |
??
AF is common so ECG advised CXR for possible tension/effusion Echo for RV failure |
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AC155 [Apr07] |
ANSWER B |
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118 MN38 ANZCA version [2004-Apr] Q124, [2005-Apr] Q100, [2005-Sep] Q94, [Jul07] [Apr08] [Aug08] [Aug09][Mar10] [Aug10] |
ANSWER B
consideration of the zone of apposition of the diaphragm. supine is better. |
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119.92.Pulsus paradoxus is: (the Q was something like - severe asthmatic - when take BP you would find) |
ANSWER B
abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. |
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120. New- Pre eclamptic patient post LSCS continue on Mg infusion in ICU. Found to be in respiratory depressed. Next management |
ANSWER C |
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121. New- Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have |
ANSWER B |
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122. Repeat- How to estimate weight in child- |
(Age+4) x2 |
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123 SG59 [Apr07] |
ANSWER D |
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124 AZ (Q120 Aug 2008) Preoperative assessment shows a malampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehanes is predicted. Compared to the ML score, the TMD is: |
ANSWER B |
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125. New- Compare to Myasthenia gravis, which symptoms is more likely to be Eaton Lambert syndrome? |
EATON LAMBERT SYNDROME |
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126 AM41 ANZCA version [2004-Aug] Q15, [Mar06] Q11, [Jul07] |
ANSWER D |
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127 RH26b ANZCA version [2004-Apr] Q126, [Jul07] |
ANSWER B |
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128 PR04 ANZCA version [1985] [Mar95] [Apr97] [Jul97] [Apr98] [Jul98] [2002-Aug] Q11, [2003-Apr] Q39, [2005-Sep] Q46, [Mar06] Q25 |
ANSWER C 4% heterozygous for pseudocholinesterase |
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129 ST22 ANZCA version [2002-Aug] Q81, [2004-Apr] Q88, [2004-Aug] Q78 |
ANSWER E |
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130 AA22 ANZCA version [2005-Apr] Q106 |
ANSER C |
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131. New - When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch? |
ANSWER C |
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132. New - When intubating over a bougie / awake fibreoptic, which direction do you rotate the tube to stop it catching on structures in the glottis |
ANSWER C |
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133. New - Advantages of off-pump CABG over on-pump CABG |
ANSWER A
increased rate of redo in off-pump!!! |
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134. New - After coronary artery bypass graft surgery, the FRC is |
ANSWER E |
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135. New - 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 |
ANSWER B |
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136. Iron deficiency |
ANSWER B |
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137. New - Why should NSAIDs be avoided in pregnant women >30 weeks gestation? |
ANSWER D |
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138. 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 |
ANSWER D |
