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107 Cards in this Set
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1. You are called to see a 30 year old man with rapidly deteriorating asthma. Following appropriate medical management an endotracheal tube is inserted and he is ventilated with a mechanical ventilator with a tidal volume of 600ml and a rate of 12 breaths per minute. Five minutes later the blood pressure is unrecordable and external cardiac massage is commenced. Arterial blood is taked and shows ph 7.08, pCO2 96 mmHg, pO2 36 mmHg, SpO2 46% and bicarbonate 27 mmol/L. He is administered adrenaline, salbutamol, pancuronium, bicarbonate and calcium gluconate. The ECG shows sinus rhythm at a rate of 60 beats per minute. The patient remains pulseless and cyanosed with fixed dilated pupils and distended neck veins. The most appropriate management is to |
D
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2. A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizur and losing consciousness. Which drug should NOT be given
A. Pethidine B. Diazepam C. Haematin D. Suxamethonium E. Pregabalin |
A- decreases seizure threshold
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3. A 42 year old lady presents for right pneumonectomy with a left sided double-lumen tube. She is 132kg and 160cm. What depth, measured at the incisors, is likely to give the ideal position?
A. 24cm B. 26cm C. 28cm D. 30cm E. 32cm |
C
Millers formula: Depth= 12 + (pt height cms/10) therefore 28 in this case. |
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4. What is the most effective method of minimizing acute kidney injury following an elective open abdominal aortic aneurysm repair?
A. give IV crystalloid as a ‘preload’ before cross-clamp B. give IV mannitol before cross-clamp C. give IV frusemide before cross-clamp D. give preoperative N-acetylcysteine E. minimize aortic cross-clamp time |
E
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5. [New] Features of severe pre-eclampsia include:
A. Foetal growth retardation B. Peripheral oedema C. Systolic BP more than 160 D. Thrombocytopenia E. Severe proteinuria |
is this an all except?
if so then B oedema is no longer part of classification |
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6. [Repeat] Earliest sign of a high block in a neonate post awake caudal:
A. Increased HR B. Increased BP C. Reduced HR D. Desaturation E. Loss of consciousness |
D
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7. A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management?
A. Awake Fibreoptic Intubation B. CT scan for laryngeal fractures C. Direct laryngoscopy after topicalising with local anaesthetic D. Nasopharyngoscopy by an ENT surgeon E. Soft tissue xray of the neck |
D
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8. A 60 year old man with normal LV function is having coronary artery bypass grafting. After separation from the bypass machine he becomes hypotensive with ST elevation in leads II and aVF. The Swan Ganz Catheter showed a PCWP of 25 and CVP of 15 with normal PVR and SVR. The TOE is likely to show:
A. Early mitral inflow > inflow during atrial systole B. Inferior wall hypokinesis C. Severe MR D. TR and RV dilatation E. LV cavity obliteration at the end of systole |
B
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11. You are working in a theatre with a line isolation monitor, which is working. You touch a wire. What is going to happen?
A. equipotent earth B. the theatre floor won't conduct C. ?:D. ? E. the RCD will protect you from shock |
incomplete Q, but if you touch a live wire and the LIM is working, there should be no earthing to ground through you, as the two circuits should be equipotent (ie no difference in energy therefore no current/electron flow generated)
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12. What is the test is decreased in Iron deficiency anaemia?
A. microcytosis B. serum ferritin C. serum iron D. transferrin E. total iron binding capacity |
B serum ferritin
Serum Iron is also low but is low in Anaemia Chronic Disease too, whereas ferritin is more specific for Fe Deficiency. in Fe deficiency anaemia transferrin/Total Iron Binding Capacity is increased, as total body stores of iron are low and the carrier molecule (transferrin) is being underutilised. Therefore Transferrin SATURATION will be low also. |
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3. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from
A. 16000kpa to 400kpa B. 16000kpa to 240kpa C. 11000kpa to 400kpa D. 11000kpa to 240kpa E. 7600kpa to 240kpa |
A
BOC website |
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14. MRI Telsa 3, least likely to cause harm
A. Cochlear implant B. mechanical heart valve C. Implanted intrathecal pump D. Recently placed aortic stent E. shrapnel fragment |
B, not D as recently placed so not endotheliolised
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15-What happens when you place a magnet over a biventricular internal cardiac defibrillator
A. Switch to asynchronous pacing B. Damage the internal programming C. Nothing D. Switch off antitachycardia function E. Switch of rate responsiveness |
D, but retains PPM functions.
depends on the device |
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16-You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves
A. facial, trigeminal, glossopharyngeal B. facial, trigeminal, vagus C. glossopharyngeal, trigeminal, vagus D. trigeminal, glossopharyngeal, vagus E. trigeminal, vagus, glossopharyngeal |
D
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19 Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.
A. anterior ischaemia B. atrial C. inferior D. lateral E. septal |
A
The central subclavicular (CS5) lead is particularly well suited for the detection of anterior myocardial wall ischemia. The right arm (RA) electrode is placed under the right clavicle, the left arm (LA) electrode is placed in the V5 position, and the left leg electrode is in its usual position to serve as a ground. Lead I is selected for detection of anterior wall ischemia, and lead II can be selected for monitoring inferior wall ischemia or for the detection of arrhythmias. If a unipolar precordial electrode is unavailable, this CS5 bipolar lead is the best and easiest alternative to a true V5 lead for monitoring myocardial ischemia. Thys DM, Kaplan JA: The ECG in Anesthesia and Critical Care. New York, Churchill Livingstone, 1987. |
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20 Lowest extension of thoracic paravertebral space
A. t10 B. t12 C. l2 D. l4 E. s1 |
B
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21 20 yr old male presents to ED with 30% burns from a fire. His approx weight is 80kg. Based on the Parkland formula, how much fluid is required in the first 8hrs from time of injury?
A. 2.4L N/S B. 3.6L N/S C. 3.6L Hartmann's D. 4.8L N/S E. 4.8L CSL |
E
Parkland Formula 4 mL/kg x BSA burned 1/2 in first 8/24, remainder in next 16/24 |
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22 In regards to systemic sclerosis, what is the least likely cardiac manifestation?
A. accelerated coronary artery disease B. atrioventricular conduction block C. myocarditis D. pericardial effusion E. valvular regurgitation |
D Valvular
Although accelerated coronary artery disease is NOT a feature (vasospastic lesions occur), myocardial infarction is a greater risk than in the general population. (UTD) |
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23 (repeat) The reason that desflurane requires a heated vapour chamber can be best explained by its:
A. Low saturated vapour pressure b) High saturated vapour pressure c) High boiling point B. ? C. ? D. Low molecular weight E. Very low solubility |
B
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24 (New but on a repeated theme)A 30 year old lady has a vaginal forceps delivery without neuroaxial blockade. The next day she is noted to have loss of sensation over the anteriolateral aspect of her left thigh. There are NO motor symptoms. The is best explained by damage to the left sided:
A. Lumbosacral trunk B. Lateral cutaneous nerve of the thigh C. Pudendal nerve D. L2/3 Nerve root E. Sciatic nerve |
B
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25.->AZ84 When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade
A. 1 B. 2 C. 3a D. 3b E. 4 |
D
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26. A healthy 20 year old patient undergoing nasal surgery under general anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrine and a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and the heart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to
A. administer glyceryl trinitrate B. administer esmolol C. administer labetalol D. administer sodium nitroprusside E. deepen anaesthesia with isoflurane |
C
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27. An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is
A. 400mL B. 500mL C. 600mL D. 700mL E. 800mL |
C
MABL = EBV (70mL/kg) x [ HCT- target HCT/ HCT] =2100 x 0.28 = 588mL |
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28. An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except:
A. Aspirin B. heparin C. morphine D. nitrates E. oxygen |
B
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29. What cannot be used for tocolysis in a 34/40 pregnant woman:
A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine |
B.
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30. Pringles procedure for life threatening liver haemorrhage includes clamping of:
A. Hepatic artery B. Hepatic vein C. Portal pedicle D. Aorta E. Splenic Artery |
C Hepatoduodenal ligament clamping. max time 20 mins
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31. Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to:
A. Intraoperative Bradycardia B. Decreased anaesthetic requirement C. Increased nausea and vomiting D. Increased risk of awareness E. Decreased BIS reliability |
B if acutely intoxicated
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32. MVA trauma patient arrives in ED BP100/60 HR 100 with the following CXR (‘’I thought it looked like an aortic dissection/rupture with a widened mediastinum’’). The most appropriate next investigation would be:
A. Aortography B. CT Chest C. MRI D. TOE E. TTE |
D
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33. A 70 year old man with slow atrial fibrillation is reviewed for insertion of a permanent pacemaker. He is otherwise well. He is on warfarin with an INR of 2.2. Prior to PPM insertion do you
A. Cease warfarin and commence dabigatran B. Cease warfarin and commence Enoxaparin C. Cease warfarin and recommence post procedure D. cease warfarin and commence heparin E. Continue warfarin |
C
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34. A 40 year old man with Marfan's has undergone a thoracoabdominal aneurysm repair. 48 hours post procedure there is blood noted in his CSF drain and he is obtunded. Your next course of action is:
A. Coagulation studies B. CSF microscopy and culture C. CT Head D. MRI Head E. MRI Spine |
C ? subdural
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36. You are anaesthetising a fit 50 year old woman for an elective laparoscopic cholecystectomy. In her pre operative assessment she has a normal cardiovascular exam and her BP is 115/75. You induce anaesthesia with 100mcg fentanyl, 100mg propofol and 50 mg rocuronium. Soon after induction her ECG looks like this (showed narrow complex tachycardia around 180-200/min – ie SVT). Her BP is now 95/50. What is the most appropriate management?
A. adenosine B. amiodarone C. DC cardioversion D. GTN E. metaraminol |
A
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37. The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the
A. isolation transformer B. line isolation monitor C. equipment has a maximum leakage current of 500 microamperes D. residual current device E. equipotentiality |
E
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38. After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is
A. normal saline infusion B. bicarbonate infusion C. mannitol D. frusemide E. haemodialysis |
E
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39. Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture
A. L1-L2 B. L2-L3 C. L3-L4 D. L4-L5 E. L5-S1 |
C
NYSORA.com Spinal cord at L2/3 in neonate, dural sac at S3 |
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40. 6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is
A. 2 hours for breast milk B. 4 hours for formula C. 5 hours for breast milk or formula D. 6 hours for solids E. 8 hours for solids, 4 hours for all fluids. |
Poor question as ANZCA guideline changeover age is 6/52.
RCH guidelines are different to ANZCA guidelines (shown below) Best choice- B For healthy adults having an elective procedure, limited solid food may be taken up to six hours prior to anaesthesia and clear fluids totalling not more than 200 mls per hour may be taken up to two hours prior to anaesthesia. For healthy children over six weeks of age having an elective procedure, limited solid food and formula milk may be given up to six hours, breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia. For healthy infants under six weeks of age having an elective procedure, formula or breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia. Only medications with a little water if required as ordered by the anaesthetist should be taken less than two hours prior to anaesthesia. |
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41. For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is;
A. Number of boluses of PCA per hour B. Respiratory rate C. Oxygen saturation D. Sedation score E. Pupil size |
D
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42. A reduction in DLCO can be caused by;
A. Asthma B. COPD C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis |
B COPD
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43. You place a thoracic epidural for a patient having an elective open AAA repair. There are 4cm in the epidural space and you aspirate blood. What is the most appropriate management plan:
A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use B. inject 5 mL lignocaine 2% with adrenaline. If there is no rise in HR be happy that it is not intravascular and secure in place and use C. Remove and postpone surgery for 24 hours D. Remove and place epidural 1 level higher E. Remove and postpone surgery for 4 hours |
C
NYSORA textbook of regional anaesth & pain Mx (online) |
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44. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use:
A. rocuronium B. suxamethonium C. pancuronium D. atracurium E. cisatracurium |
E
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45 Patient with subdural haematoma, on warfarin. INR 4.5. Needs urgent craniotomy. Vit K given already by ED resident. What further do you give for urgent reversal of this patient's INR?
A. Factor VII B. Cryoprecipitate C. FFP D. Prothrombinex E. FFP + prothrombinex |
E
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46 Regarding endotracheal tubes used in laser surgery:
A. They are more resistant to combustion when the cuff is covered in blood B. Resistant to ignition from electrocautery C. The cuff is resistant to ignition if hit by the laser D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diamater) E. Have 2 cuffs which are resistant to combustion |
D
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49 Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion
A. ? B. C. D. E. Relieved by topical local anaesthetic |
E- will be relieved by topical anaesth if Corneal abrasion.
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50 During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate
A. Carbimazole B. Beta-blocker C. Propythiouracil D. Plasmaphoresis E. Hydrocortisone |
D- least practical
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53 Two days post upper spinal surgery, patient notices parathesia of the right arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from an ulnar nerve neuropathy?
A. parasthesia in little finger B. parasthesia in the distribution of the interscalene nerve C. weakness in adductor digiti minimi D. weakness in abductor pollicis brevis E. weakness in lateral interosseus |
Answer is D
A- no, ulnar nerve territory B- no such nerve (that I can find!) C- if they meant ABDUCTOR digiti minimus then no, as supplied by ulnar, as are all intrinsic muscles of the hand except lateral two lumbricals & the three muscles of the thenar eminence (abductor pollicis brevis, flexor pollicis brevis, opponens brevis; median nerve innervates these) D. YES If abductor pollicis brevis weak, then must be C8/T1 lesion, as this muscle supplied by MEDIAN nerve but shares the nerve root origin of C8/T1 with the ulnar nerve. |
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54 A 54 year old man, is on warfarin for atrial fibrillation, has a history of alcohol abuse and liver failure with an albumin of 30 and a bilirubin of 28. What is his CHADS 2 score?
A. 0 B. 1 C. 2 D. 3 E. 4 |
A 0
CCF/Hypertension/Age >75/ Diabetes/ Stroke,TIA, TED previously (this scores 2) |
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57 You are 2 hours into an operation. 3L of IV Crystalloid has been given. There has been minimal blood loss. The dilutional anaemia is compensated by:
A. Cellular anaerobic metabolism B: Capillary vasodilation C: Increased cardiac output D: Increased tissue oxygen extraction E: Rightwards shift of the Oxygen – Haemoglobin dissociation curve |
C
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58 You are putting in an Internal Jugular CVC. Which manoeuvre will cause maximum venous distension of the jugular vein?
A. Continuous Positive Airway Pressure (No value given) B: Breath hold at end-expiration C: Manual compression at the base of the neck D: Trendelenburg position E: Patient performs a valsalva |
E
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59. What is approximately the systolic blood pressure in an awake neonate (mmHg)
A. 55 B. 70 C. 85 D. 100 E. 115 |
B 70
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60. The volatile agent most likely to be associated with carbon monoxide production when used with a soda lime scrubber is:
A. Desflurane B. Isoflurane C. Sevoflurane D. Halothane E. Enflurane |
A desflurane
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65. A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of the conventional before 1 extra patient will benefit is
A. 3 B. 4 C. 8 D. 25 E. 33 |
D 25 but don't know the formulae
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66. According to guidelines endorsed by ANZCA, the label of an intra-osseous infusion should be
A. beige B. blue C. Pink D. Red E. yellow |
C pink
beige = subcutaneous blue = venous pink = other red = arterial yellow = perineural/nerve catheter |
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69. During apnoeic oxygenation under light anaesthesia, the expected rise in PaO2 would be:
A. 0.5 mmHg per min B. 1 mmHg per min C. 2 mmHg per min D. 3 mmHg per min E. 5 mmHg per min |
If Q was rise in PaCO2,
D 3 mmHg per min |
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70. In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and :
A. Heart Rate B. Saturation C. Respiratory Rate D. Urine Output E. Temperature |
C RR
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72. Absolute Contraindication to ECT
A. Cochlear implants B. Epilepsy C. Pregnancy D. Raised intracranial pressure E. Myocardial infarction |
D raised ICP
recent MI is also a fairly definite contraindication (in prev 6/52) |
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73. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her:
A. Instigate low dose beta blockade B. Defer, and refer to a cardiologist C. Perform a transoesophageal echo to get a better look at the valve D. Proceed to surgery with no further investigation E. Perform a dobutamine stress echo |
D emergency surgery and doesn't need intervention anyway.
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75 A 25 y.o. male has a traumatic brain injury on a construction site. GCS 7. Intubated on site and transported 1 hour to hospital. Haemodynamically stable and no other injuries. Most appropriate pre hospital fluid:
A. 4% albumin B. Dextran 70 in 0.9%N/saline C. 6% hydroxyethyl starch D. Ringers lactate E. 0.9% N/saline |
E N Saline
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76 A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP:
A. Administer Anti-D antibodies 6 hrs pre op B. Admister desmopressin one hour pre op C. Administer methylpred and IVIg 2 days pre op D. Recheck platelet count morning of surgery and if not dropped continue E. Platelet transfusion morning of surgery |
C but not exactly right acc to UTD-
For management of life-threatening bleeding, treatment options include: ■Platelet transfusions ■IVIG (1 g/kg, repeated the following day if the platelet count remains <50,000/microL) ■Pulse methylprednisolone (1 g intravenously, repeated daily for three doses) ■Recombinant human factor VIIa no mention of desmopressin, and no mention of Anti-D for use in the acute phase. |
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77. (Rpt) A neonate will desaturate faster than an adult at induction because
A. FRC decreased more B. Faster onset of induction agents C. More difficult to pre-oxygenate D. E. |
C
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78. (Rpt Jul 07) Isoflurane is administered in a hyperbaric chamber at 3 atmospheres absolute pressure using a variable bypass vaporizer. At a given dial setting and constant fresh gas flow, vapour will be produced at:
A. the indicated vapour concentration B. three times the indicated vapour concentration C. one third the partial pressure obtained at 1 atmosphere D. the same partial pressure as is obtained at 1 atmosphere E. three times the partial pressure obtained at 1 atmosphere |
D
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79. [AP CXR and lateral] – ‘’showed hydropneumothorax’’ This grossly abnormal CXR is
A. right basal pneumothorax B. right hydropneumothorax C. artifact D. right pleural effusion E. right R lower lobe atelectases |
Assuming:
B |
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80. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods takes. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality 85 The most likely diagnosis is
A. Central diabetes insipidus B. Nephrogenic diabetes insipidus C. Psychogenic polydipsia D. Cerebral salt wasting E. SIADH |
C
■A low plasma sodium concentration (less than 137 meq/L) with a low urine osmolality (eg, less than one-half the plasma osmolality) is usually indicative of water overload due to primary polydipsia. ■A high-normal plasma sodium concentration (greater than 142 meq/L, due to water loss) points toward DI, particularly if the urine osmolality is less than the plasma osmolality [1]. ■A normal plasma sodium concentration is not helpful in diagnosis but, if associated with a urine osmolality more than 600 mosmol/kg, excludes a diagnosis of DI. -from UTD |
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83 A 45 year old obese man complains of headache, lower limb weakness and polyuria. On examination, his blood pressure is 150/70mmHg. He has a displaced apex beat. Bloods revealed Na145, K2.8, Cl101, HCO3 27. What is the most likely diagnosis
A. Cushings B. Diabetes C. Primary hyperaldosteronism D. Hypothyroidism E. Phaeochromocytoma |
Hyperaldosteronism:
Primary usually from adenoma causes- salt retention, hypervolaemia (therefore hypertension), causing mildly increased serum Na (145-147) Potassium wasting from cortical collecting tubule, which causes muscle weakness (usually not til K <2.5) Hydrogen ion excretion from distal tubule Mild Mg wasting |
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84 Which of the following is the best predictor of a difficult intubation in a morbidly obese patient
A. Pretracheal tissue volume B. Mallampati score C. Thyromental distance D. BMI E. Severity of OSA |
A
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85. You wish to compare a new method of BP measurement with the gold standard. The best way to do this is:
A. CUSUM analysis B. Friedman's test C. ? D. Pearson’s correlation E. Bland-Altman plot |
E- repeat
Bland and Altman plots are extensively used to evaluate the agreement among two different instruments or two measurements techniques. Bland and Altman plots allow us to investigate the existence of any systematic difference between the measurements (i.e., fixed bias) and to identify possible outliers. The mean difference is the estimated bias, and the SD of the differences measures the random fluctuations around this mean. |
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86. After intubating for an elective case you connect up the circuit and notice that you are unable to ventilate and observe high airway pressures. The next most appropriate step is to:
A. Auscultate the lungs B. Release the APL valve C. Remove the endotracheal tube and bag mask ventilate D. Turn on the ventilator E. Low positive end expiratory pressure |
A
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87. You insert a thoracic epidural in a patient for a liver resection with an upper abdominal incision. You have recently topped it up. On waking the patient appears weak, despite adequate reversal. He can breathe spontaneously and can flex his biceps but is not able to extend triceps. The level of the block is most likely to be:
A. C5 B. C6 C. C7 D. C8 E. T1 |
C
5-6 shoulder movt 6-7 elbow flexion 7-8 elbow extension 7-8 wrist flexion/extension 8-T1 finger movt see myotome dance :) http://www.youtube.com/watch?v=NHaZMFpKOMA |
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88. (repeat) You are anaesthetizing a pregnant woman for neuro-radiological coiling. At what gestation is it important to monitor uteroplacental sufficiency?
A. 22 weeks B. 24 weeks C. 26 weeks D. 28 weeks E. 32 weeks |
B
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89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is?
A. Nimodipine B. Adenosine C. Mannitol D. Hypertonic Saline E. Thiopentone |
B
Novel treatment but definitely used to facilitate permanent clip placement when temporary clip unable to be used or slips etc. |
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90. Prior to seeking consent from family/relatives for DCD, it is important to confirm which of the following?
A. Not a coroners case B. Pt will have a cardiac death within 90 minutes in the absence of life-support C. Potential organ recipient's identified and are available D. Patient's wishes have been considered E. Decision confirmed by an external committee |
A- no, if the coroner consents then the organs will be removed before autopsy
B- no time limit set on the process of death by cessation of circulation, but some organs more vulnerable to warm ischaemic time (heart>lungs>liver>kidneys>corneas) C- not necessary for process of consent from family/relatives to occur D- yes absolutely E- not necessary |
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91. You see a young man prior to surgery. He describes a history of throat swelling and difficulty breathing both spontaneously and in association with minor dental procedures. His brother has had similar episodes. The most likely mechanism is:
A. C1-esterase deficiency B. Factor V deficiency C. Low bradykinin levels D. Mast cell degranulation E. Tryptase release |
A
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92. A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers a cardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemia is:
A. Acute renal failure B. Cardiomyopathy C. Crush injury D. Malignant hyperthermia E. Rhabdomyolisis |
E
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95. You are anaesthetising a 6 month-old infant for repair of a VSD. You perform an inhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant’s oxygen saturations fall to 85%. The most appropriate next step in management:
A. give a fluid bolus B. change from sevoflurane to isoflurane C. apply CPAP D. reduce the FiO2 E. reduce sevoflurane |
C
(although some debate btwn C & E) |
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97. A 3 year old child has suffered a fractured arm. What is the most appropriate way to assess her pain?
A. the reported severity from the child B. the reported severity from the parent C. the reported severity from the nursing staff D. using the FLACC scale E. the Wong-Baker Faces scale |
FLACC until about 4-5 years old, then Wong baker faces can be used for children able to self-report
(ANZCA Acute Pain Mx 2010) |
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98 buprenorphine patch removed morning of surgery. What time till PLASMA reaches half original level
A. 12 hours B. 18 hours C. 24 hours D. 30 hours E. 36 hours |
E?
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96. A 30-year old patient, who takes paroxetine, has suffered a traumatic amputation. The most appropriate medication to reduce her developing chronic post-operative pain is:
A. amitriptyline B. dextromethorphan C. gabapentin D. tramadol E. pethidine |
C
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101. [Repeat - 2013A Q48] The clinical sign that a lay person should use to decide whether to start CPR is:
A. Absent central pulse B. Absent peripheral pulse C. Loss of consciousness D. Obvious airway obstruction E. Absence of breathing |
E
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102. [Similar to 2013A Q38] Central sensitization, resulting in prolongation of post-operative pain, is caused by:
A. Increased intra-cellular gene expression B. Increased intra-cellular magnesium C. Low frequency activation of A-delta fibres D. Primary activation of N-methyl-D-aspartate receptor E. Increased glycine as a major neurotransmitter |
A
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103. [New] A 15yo girl with a newly diagnosed mediastinal mass presents for lymph node biopsy under general anaesthesia. The most important investigation to perform preoperatively is.
A. CXR B. CT chest C. MRI chest D. PET scan E. Transthoracic echocardiogram |
B
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104. [New] A 63yo woman with chronic AF has a history of hypertension, Type 2 Diabetes Mellitus and has previously had a CVA. What is her annual risk of stroke without anticoagulation?
A. <1% B. 1.9% C. 2.8% D. 4% E. 8.5% |
CHADs2 score:
Hypertension- 1 Diabetes- 1 Prev. stroke -2 score= 4, yearly risk = 8.5% 0-1.9 1- 2.8 2- 4.0 3- 5.9 4- 8.5 |
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105. [New] A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is:
A. increase PEEP to 20cmH20 B. increase tidal volume to 10mls/kg C. initiate nitrous oxide therapy D. commence high flow oscillatory ventilation E. ventilate in the prone position |
E
PROSEVA study Among patients with severe ARDS, does prone positioning reduce all-cause mortality at 28 days when compared to supine-only positioning? Among patients with severe ARDS (P:F ratio <150 mmHg), prone positioning reduces 28-day mortality. (17% reduction in all cause mortality) |
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106. [Repeat 2013A] The incidence and severity of vasospasm post sub arachnoid haemorrhage is greatest at:
A. 0 -24 hours B. 2 - 4 days C. 6 - 8 days D. 10 - 12 days E. greater than 2 weeks |
C
but rebleed highest in first 24 hrs |
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107. [Repeat 2013A] The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipment is turned on
A. The double insulation of the device will prevent macroshock when the outer casing is touched B. The electrical fuse will immediately break and disconnect the device from the power supply C. Equipotential earthing will prevent microshock from anyone who touches it. D. The Line Isolation Monitor will alarm and disconnect power to the device E. The RCD will immediately disconnect the device from the power supply |
A- no double insulation is present on Class 2 equipment not Class 1
B- there isn't a fuse in the piece of equipment per se. C- Correct: From RCH Electrical Safety site: Class I equipment is fitted with a three core mains cable containing a protective earth wire. Exposed metal parts on class I equipment are connected to this earth wire. Should a fault develop inside the equipment and the exposed metal comes into contact with the mains, the earthing conductor will conduct the fault current to ground. Regular testing procedures ensure that earthing conductors are intact, as the integrity of the earth wire is of vital importance D- no the LIM is external to the piece of equipment, and DOES NOT disconnect the equipment from power, just alarms when equipotentiality of the two monitored circuits is disrupted, indicating current leakage, possibly through faulty equipment. E- RCD disconnects after 40ms, not immediately. In hospital RCD trips at leakage of 10mAmps. RCDs are present in the external circuit, not in the piee of equipment itself (walls/ towers of theatre) |
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108. [Repeat 2013A] In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT:
A. Allow equal time for chest compression and relaxation B. Chest compression at 100bpm C. C. Chest compression should be at least 5cm depth D. D. Give 2 rescue breath before commencement of CPR E. Chest compression to breaths ratio at 30:2 |
E
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109. [New] Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is:
A. distal tibial above medial malleolus is preferred due to easy access B. drug reaction time is the same as central venous route C. 12G used to ensure adequate flow D. bicarbonate cannot be infused due to bone damage E. fat embolism is common complication |
A- no proximal tibial or proximal humerus
B- ? yes C- no- RCH guidelines say use 18G cannula, GOSH guidelines say use 16G cannula D -can't find a reference E- can happen but is rare |
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110. [New] During endovascular aneurysm repair, GA is preferred due to:
A. risk of uncontrolled haemorrhage B. renal ischaemia is painful C. aorta traction is painful D. long duration of apnoea is needed E. contrast used can cause CVS instability |
D
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111. [Repeat 2013A Q26] A 35yo G1P0 with a dilated cardiomyopathy presents for a Caesarean section. She has an ejection fraction of 35%. The benefits of a regional anaesthetic over a general anesthetic in this patient may include:
A. decreased heart rate B. decreased systolic blood pressure C. increased ejection fraction D. decreased preload E. increased myocardial contractility |
C
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112. [New] In attempting to make a precise diagnosis of parathyroid adenoma, you would expect all of the following are found in hyperparathyroid disease EXCEPT:
A. decreased urinary calcium B. extraosseous calcifications C. increased plasma calcium D. increased urinary phosphate E. renal calculi |
A
extraosseous calcifications can happen due to pseudogout ( calcification of extraarticular cartilage) bones, stones, abdominal moans and psychic groans. from hypercalcaemia |
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115. Patient is intubated and ventilated, the ETCO2 trace below is caused by
A. Endobronchial intubation B. ETT cuff leak C. Gas sample line leak D. Spontaneous ventilation E. obstructive airway disease |
see images
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116. Which general anaesthetic agent contributes the most to green house gas? (Now I'm not 100% sure on the stem recall, but I got the impression it was asking for the agent that is the absolute worse for green house gases (desflurane), not so much which one do we use the most and thus ends up contributing the most to the total green house gas volume (iso or sevo)
A. Desflurane B. Isoflurane C. Sevoflurane D. Propfol E. N2O |
A Desflurane
(article on respective Greenhouse gas contributions) |
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119. [New] A patient's competence to give informed consent is determined by all the following EXCEPT:
A. Ability to communicate a choice B. Ability to apply reasoning C. Ability to understand consequences D. The provision of significant information E. ?? |
D? depending on what E was, as this question is querying the PATIENTs' competence, not their capacity (I think), and to give informed consent the degree of information given IS a factor.
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120. [Repeat] A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomatic with no other signs/symptoms of myocardial infarction and have an uneventful recovery. What do you do?
A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future myocardial infarction B. Arrange coronary angiogram as an inpatient prior to discharge C. Inform the patient that while the result is real the significance is questionable D. Repeat in one week’s time as a second troponin is a better indicator of long-term myocardial infarction risk E. Ignore the result as it is likely a laboratory error |
A- repeat
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121. St John's wort will reduce the effect of
A. aspirin B. clopidogrel C. dabigatran D. heparin E. warfarin |
E. warfarin.
TGA Alert- St John's wort induces CytochromeP450 enzymes and so decreases the effect of Warfarin, digoxin, theophylline Increases serotonergic effects of SSRIs with increased risk of sideffects. Potentiates clopidogrel as it is a prodrug which requires conversion by p450 enzyme to become active. |
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122. The most important effect of Lugol's iodine administration before thyroid surgery is
A. reduce incidence of thyroid storm B. reduce incidence of vocal cord palsy C. increase likelihood to identify and preserve parathyroid glands D. pigmentation of thyroid gland to help identify thyroid gland E. reduce vascularity of thyroid gland. |
E
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123. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed
A. Inferior trunk B. Ulnar nerve C. Median brachial cutaneous nerve D. Anterior division E. Posterior cord |
A- inferior trunk, to anterior division to medial cord to medial cutaneous nerve of the forearm.
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124. You are pre assessing A 70 year old patient treated for congestive cardiac failure. They are able to shower themselves and complete other ADLs but get dyspneoa on mowing the lawn. They are New York Heart Association classification
A. Class 1 B. Class 2 C. Class 3a D. Class 3b E. Class 4 |
B if any symptoms at all, then can't be class 1
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126 Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to
A. have dosimeter checked at least 6-monthly B. limit exposure time to radiation C. maximal distance from radiation source D. stand behind transmitter of C arm E. wear protective garments |
C
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127 Prothrombin VX useful in perioperative period to correct the coagulopathic defect of all except
A. Isolated factor II deficiency B. Isolated factor VII deficiency C. Isolated factor IX deficiency D. Isolated factor X deficiency E. Warfarin |
B
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133. The organ that is least tolerant of ischaemia, after removal for transplant, is:
A. Cornea B. Heart C. Kidney D. Liver E. Pancreas |
B heart
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134. 75yo woman with an ejection systolic murmur presents for elective total knee joint replacement. Focussed transthoracic echocardiogram is performed. The feature most consistent with severe aortic stenosis is:
A. Mean gradient across aortic valve of 30mmHg B. Peak gradient across aortic valve of 40mmHg C. Peak velocity across aortic valve of 4.2m/s D. Aortic valve area of 1.2cm2 E. Calcification and restriction of the aortic valve |
Echocardiographic features of severity in AS:
mean gradient > 40mmHg peak velocity > 4m/sec Valve area < 1.0 cm squared |
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135. Which of the following statements regarding patients with ankylosing spondylitis is FALSE?
A. amyloid renal infiltration is rarely seen B. cardiac complications occur in less than 10% of cases C. normochromic anaemia occurs in over 85% of cases D. sacroileitis is an early sign of presentation E. uveitis is the most common extra-articular manifestation |
C anaemia not a feature usually
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136. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermia. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is
A. Genetic test father B. Genetic test woman C. Muscle biopsy sibling D. Muscle biopsy father E. Muscle biopsy woman |
D muscle biopsy father
condition is autosomal dominant and best to avoid any anaesthetic if possible during pregnancy. |
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139. During the first stage of labour, pain from uterine contractions + cervical dilatation is from nerve roots: A.-E. ( multiple options of thoracic - lumbar roots )
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T10- L2
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140. A test has a sensitivity + specificity of 90% for a disease with a prevalence of 10%. What is the positive predictive value?
A. 10% B. 50% C. 82% D. 90% E. 99% |
The former is simply the product of the sensitivity and the prevalence:
Sensitivity (S)= Number who have disease(D) and who screened +ve/ number who have disease Prevalence (P)= Number who have disease/ total number screened PPV= SxP/ (SxP)+(1-specificity)x(1-prevalence) = 900/ 900+ (1-90)x(1-10) =9.09 |
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.141. A female with type 1 von Willebrand disease presents for a dilation and curettage. She is a Jehovah’s Witness. In regards to desmopression to prevent haemorrhage in this patient all of the following are true EXCEPT:
A. It is a synthetic substance and therefore acceptable to Jehovah's Witnesses B. It is likely to reduce haemorrhage in this patient C. It should be given as an infusion 30 minutes prior to surgery D. The effect will last 5 days E. The dose is 0.3μg/kg |
D
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142. A 25 week post conceptual age infant is being ventilated in the Neonatal Intensive Care Unit. To reduce the risk of retinopathy of prematurity, they are being ventilated to a target oxygen saturation of 85-89% instead of 91-95%. This is associated with:
A. Increased acute lung injury B. Increased mortality C. Increased sepsis D. Reduced intracerebral haemorrhage E. Reduced necrotizing enterocolitis |
B Increased mortality
BOOST 2 trial NEJM |
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144. An 80 year old man undergoes a unilateral lumbar sympathectic blockade. THe most likely side effect that he experiences is:
A. Genitofemoral neuralgia B. Haematuria C. Postural hypotension D. Lumbar radiculopathy E. Psoas haematoma |
A Genitofemoral neuralgia
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145. Regarding Le Fort fractures:
A. External signs correlate with internal skeletal damage B. Le Fort fractures don't usually occur in combination (for example I and II) C. Patients with a Le Fort I fracture should NOT undergo nasal intubation D. Patients with a Le Fort II fracture should have evaluation of the base of skull prior to nasal intubation E. Le Fort III fracture is associated with fracture of the cribiform plate |
A- no
B- no, they often occur in combination C- Le Fort 1 is an isolated lower Maxillary fracture and often need nasal intubation to facilitate assessment of teeth occlusion by surgeons D- yes, but more commonly associated with Le Fort III fractures E- Yes and most likely correct answer. Cribiform plate is on ethmoid bone and can be fractured in extensive midline injuries. E- |
