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132 Cards in this Set

  • Front
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Bleeding patient. What is relative contraindication to Prothrombinex?
A. History of HITS
B. Von Willebrands
C. Haemophilia B
D. Warfarin overdose
E. Renal failure
F. Overdose vit K (not warfarin)
Prothrombinex has 192 units of heparin per ampoule
Indication for percutaneous closure of ASD

A. Ostium primum < 3cm
B. Ostium primum > 3cm
C. Ostium secundum < 3 cm
D. Ostium secundum > 3cm
E. Sinus venosus ASD
C
"Of these, only an ostium secundum ASD is suitable for percutaneous closure..." CEACCP 2008
Methylene blue given intravenously has the effect:

A. Pulse oximetry goes down
B. Blood Gas Pa02 decrease
C. Hypotension
D. Metabolic acidosis
E. Increased heart rate
A

Methylene blue has oxidising properties. It is used as a treatment for methhaemoglobinaemia. To quote wikipedia "...Through the methemoglobin reductase enzyme (which is NADPH dependent), it is reduced by NADPH allowing it to have an affinity for methylene blue (among other dyes). As a result, methylene blue is reduced to leucomethylene blue, which then acts to reduce the heme group from methemoglobin to hemoglobin.[23] At high doses, however, methylene blue actually induces methemoglobinemia, reversing this pathway...". Also this from A&A, a trial using methylene blue "...for treatment of a vasoplegic syndrome, which is characterized by high cardiac output, low systemic vascular resistance (SVR), and low systemic perfusion pressures, and is resistant to large doses of vasoconstrictors." (Summary: n=2 :It worked but stuffed up their cerebral oxygen saturation monitoring for a while)

The pure trivia:

it is a monoamine oxidase inhibitor, and can induce serotonin syndrome in patients already taking SSRIs if given in doses greater than 5mg/kg IV, and is structurally related to the antipsychotics.
Essential diagnostic criteria on ECG for LBBB

A. Loss of septal Q's in V5 and V6
B. RSR in V1
C. Large slurred S in V6
D. T-waves opposite to direction of QRS
E. QRS duration minimum 0.2 s
A TRUE
B FALSE
This represents RBBB
B FALSE
Also RBBB
D FALSE
An associated finding, not essential
E FALSE


Diagnostic criteria for LBBB:

Total QRS duration >0.12 s.
No secondary R wave in V1 to indicate RBBB.
No septal q wave in V5, V6 or in leads further to the left (lead I and aVL in horizontal hearts).
Patient over-warfarinised and is for surgery. Prothrombinex 50U/kg may NOT reverse an INR of 5.5 because it contains:

A. Citrate
B. Heparin
C. Anti-thrombin III
D. Not enough Factor VII
E. Not enough Factor X
D Prothrombinex has II, XI and X only

It does contain human plasma proteins < 500mg (incl VII), but VII levels are low and unquantified
Ventricular fibrillation (VF) following caudal anaesthesia in 20kg six year old child. The recommended dose of of Intralipid 20% is:

A. 10mls
B. 20mls
C. 30mls
D. 40mls
E. 50mls
Dose of Intralipid 20% is 1.5 ml/kg = 30ml
According to PS9 for sedation with Propofol for colonscopy, the staff required is/are:
a. Medical practitioner other than proceduralist
b. Nurse other than proceduralist
c. Anaesthetist in addition to the proceduralist
d. Assistant
e. Proceduralist alone
Answer is A

Propofol may be used by a medical practitioner with airway and resuscitation skills, and training in sedation for conscious sedation in ASA P 1-2 patients.
Intravenous anaesthetic agents such as propofol must only be used by a second medical practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist...From PS9
Troponin is elevated post-infarct

A. 1-2 days
B. 2-5 days
C. 5-14 days
D. 7-21 days
E ?
Elevation of troponin following infarct

It looks to be here 1- 3 days with reperfusion , or 1-6 days without.

Which would make me guess B (or C in the alt version).

However, if the stem asks for "peak elevation" then it would be 1 day with reperfusion, or 2 days without.

Would need to see the actual MCQ.
Laparoscopic cholecystectomy patient with hyperparathyroidism and ionised calcium of 2.0 mmol/l. The BEST initial treatment is:

A. Calcitonin
B. Magnesium
C. Dialysis
D. IV fluids
E. Frusemide
OHA - Initial management should be rehydration; as Ca++ inhibits ADH.

Promotion of a diuresis also increases excretion of Calcium. Texts then defer as to the next treatment; OHA says Pamidronate IV, but also states a saline diuresis with frusemide is 2nd line. Calcitonin is temporary.
Your patient given thiopentone by mistake has a porphyric (acute intermittent) crisis with abdominal pain and then seizures. What drug is contraindicated?
a. Phenytoin
b. Morphine
c. can't remember others
d. ?
e. ?
A
Fit lady for elective laparoscopic cholecystectomy seen in PreAdmission Clinic. ECG shows LAD, RSR in V1, wide slurred S in V6 and QRS duration 0.2 msec. Your options
a. Refer to cardiology
b. Crack on
c. Place permanent pacemaker
d. Place temporary pacing wires
e. Give atropine premedication

EDIT - duration was 0.13msec i.e. only slightly elongated = unifascicular block. LAD + RBBB is either LAFB of LPFB, sorry can't be bothered to look it up now. DOn't think it needs investigation though.
B
All these nerves provide some sensation to upper arm EXCEPT
a. Musculocutaneous
b. Intercostobrachial
c. Radial
d. Circumflex
e. Median antebrachial?
Musculocutaneous nerve is:

musculo- (ie motor) ABOVE the elbow THEN
sensory (as lateral cutaneous nerve of the forearm) BELOW the elbow -ie NO sensory above elbow.
Advantage if supraclavicular over interscalene nerve block for shoulder surgery
a. Less phrenic nerve block
b. Easier landmarks in obese patient
c. Arm can be in any position for block
d. Less risk pneumothorax
e. Better cover for shoulder surgery?
A probably given that phrenic nerve block is an expected outcome of the interscalene block. Doesn't matter where the arm is, and in the fat patient both might be difficult. Closer to pleura with SCB and you might miss supraclavicular with SCB as it comes off early from the superior trunk.
The basilic vein
a. Arises from the dorsum of the hand
b. Follows the superficial radial artery
c. Pierces the clavipectoral fascia
d. Becomes the brachial vein at the cubital fossa
e. Arcs around the radial side of the forearm
A: true (although cephalic vein also arises from dorsum of the hand) B; False - Travels up ulna aspect of arm C: False - Pierces the Brachial fascia midway up upper arm (Cephalic v pierces clavipectoral fascia) D: False - see above comments E: False - see comment for B Reference: Netters Atlas of Human Anatomy
Long duration of surgery, arms stretched out, head turned 30 degrees to right. On waking patient has a neurological deficit. Sensory loss over ventral lateral palm and 3 fingers, some weakness of the hand, weakness of the wrist, some paraesthesia of the forearm and weak elbow flexions. Most likely injury is

A. Median nerve
B. Ulnar nerve
C. C5 nerve root
D. Upper cervical trunk
E. Musculocutaneous
Elbow flexors (Brachialis, Biceps, Coracobrachialis) and some parasthesia of forearm is in the distribution of the musculocutaneous nerve. Ventral lateral palm amd 3 fingers is median nerve distribution. So the lesion must be proximal to the formation of the terminal nerve roots; C5 and 6 nerve root, upper trunk or lateral cord (and upper trunk is the only option available).
Paediatric ALS – 20 kg, VF has had 2 shocks only. Next step
a. Adrenaline
b. Amiodarone
c. Shock 50J
d. Shock 100J
A

This question gave no weight for the child. I think he was 5 which made him 18kg. Adrenaline was my answer but the maths didn't fit with 50 or 100kj shock anyway

In a VF paediatric arrest (witnessed) you give three stacked shocks, the first at 2J/kg the next two at 4J/kg. Hence the child needs an 80J shock (4x20kg). Then CPR for 2min, then reassess rhythm/adrenaline. I don't think you can dial up 80J on most defibrillators. You can only choose 50J or 100J. Hence you would round up to 100J. Hence answer would be D. saraht

Question doesn't say whether it's witnessed or not. The algorithm would have you giving 2 shocks anyway before adrenaline. You can dial up 70J on a Philips Heartstart - if the child was 5 this would be closest to 4J/kg
Patient with known severe aortic regurgitation. Auscultation reveals loud mid diastrolic murmur in aortic area. You also hear a quiet mid diastolic murmur in the apex. This is
a. Functional mitral stenosis
b. Mitral valve incompetence
c. Impaired LV function
d. Papillary muscle dysfunction
Sounds like they're talking about the "Austin-Flint" murmur, where the regurgitant jet strikes the anterior leaflet of the mitral vale. A

Austin Flint - Classically, it is described as being the result of mitral valve leaftlet displacement and turbulent mixing of antegrade mitral flow and retrograde aortic flow:[6]

Displacement: The blood jets from the aortic regurgitation strike the anterior leaflet of the mitral valve, which often results in premature closure of the mitral leaflets. This can be mistaken for mitral stenosi
Hetastarch 130/0.4. The 0.4 means: A. 40 mg/l B. 40 g/l C. 4 hydroxylations of every 10 glucose molecule D. every 4the glucose is hydroxyethylated E. ?
C.

The 130 is the molecular weight of the starch, while the 0.4 is the molar substitution.

To clarify, the MS (molar substitution) is the ratio of hydroxyethyl groups to glucose residues
Hetastarch. What one to use for intermediate plasma expansion and intermediate plasma half life

A. 450/0.4 (10%)
B. 130/0.7 (6%)
C. 130/0.4 (6%)
D. ?
E. ?
I'm presuming they mean Voluven[1]. 130/0.4
Maternal collapse post-delivery. What is NOT consistent with Amniotic fluid embolism?
a. Seizure
b. Petechial rash
c. Hypotension
d. Coagulopathy
e. Cardiac arrest
B
Trauma with # pelvis and femur. Has a splenectomy. Day 2 patient thrombocytopenia, confused and hypoxic. Diagnosis is
a. fat embolism syndrome
b. pneumcoccal pneumonia
c. thromboembolism
A?
Indications for steroids in neurosurgery
a. Cerebral abscess
b. Subdural haematoma
c. Meningioma
d. SAH
e. Traumatic brain injury
C, but possibly 2 right answers to this question. "Steroids are used for brain tumours or abscesses with significant surrounding vasogenic oedema". Neurosurgery: an introductory text Peter McL. Black, Eugene Rossitch. Pg 83
Rate of phenytoin administration:
a. 50 mg/min
b. 70 mg/min
c. 100 mg/min
d. Over 5 minutes
e. As fast as possible
A Admin by slow IVI (max 50 mg/min) into large vein via catheter (from MIMS)
Hypothetical anaesthetic agent. Flows 2 L oxygen and 2L nitrous. Copper kettle vaporiser flow 0.5 L. Volatile with SVP 380 mmHg. Inspired volatile concentration (no numbers were exactly correct)
a. 2%
b. 5%
c. 10%
d. 11%
3. 15%
It's 10% (C). Reading the explanation in Morgan and Mikhail, if 0.5L of gas enters the vapouriser, 1L exits, with a volatile concentration of 50%. This is diluted by 4L of FGF, so you have a total of 5L of gas. 500mL in 5L is 10%. Doesn't make sense? A copper kettle has a dedicated flow meter which is dialed up separately. To make your 0.5L of gas flow fully saturated with vapour at an SVP of 380mmHg, you need to double it (ie 380mmHg of vapour in 380mmHg of gas). This is mixed with the FGF which is separate; thus giving 500mL of vapour, 500mL of gas which went into the copper kettle, 2L of oxygen and 2L of nitrous.
Negative pressure leak test in a Boyles type machine. This means
a. Vaporiser leak
b. Circuit leak
c. Brain leaking out of my ears by now
d. Leak in non return valve
A
As per ANZCA Acute Pain Guidelines (2nd ed update), after a prophylactic subcutaneous dose of heparin, minimum time before you can remove epidural catheter is
a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours
e. 10 hours
C. From update guidelines "Thromboprophylaxis with SC heparin is not a contraindication to neuraxial blockade. To identify heparin-induced thrombocytopenia, a platelet count should be done prior to removal of an epidural catheter in patients who have had more than 4 days of heparin therapy. Epidural catheters should be removed a minimum of 6 hours after the last heparin dose and not less than 2 hours before the next dose."
LMWH - wait 12 hrs after dose to insert
Utility of BNP (brain naturietic peptide) is for
a. Dyspnoea after pneumonectomy
b. Loss of consciousness after ..
c. Confusion after CABG
Both BNP and NT-proBNP levels in the blood are used for screening, diagnosis of acute congestive heart failure (CHF) and may be useful to establish prognosis in heart failure and in Anesthesiology, preoperative BNP independently predicts in-hospital ventricular dysfunction, hospital length of stay (HLOS) and mortality up to 5 years after primary CABG surgery. So hard to know without the real question. Other things I've read suggest that BNP can help differentiate dyspnoea due to cardiac failure from other causes. After pneumonectomy, there is a sudden increase in PVR, so perhaps this is indicative of whether the right heart is coping. I think the key is dyspnoea; when the real answers appear (in the next exam no doubt) its utility is to suggest whether the dyspnoea is related to cardiac failure or something else.
Which patients do not get pulmonary hypertension
a. ASD
b. Chronic thromboembolism
c. Tetralogy
d. MR
e. MS
Must be C as you have some degree of RVOT obstruction thus pulmonary blood flow is decreased, and your mitral valve is competent so there is no increase in LA pressure.
Drug LEAST likely to cause hypoxia in ARDS
a. Noradrenaline
b. Milrinone
c. Isoprenaline
d. Isoflurane
e. SNP
A. All the others would bugger up your HPV.
Pulmonary hypertension, which will affect PVR the most
a. Isoflurane
b. Sevoflurane
c. Desflurane
d. Propofol
e. Remifentanil
In Eger's book Pg 87 it is clear that all volatiles inhibit HPV much to the same extent, and produced lower arterial oxygen partial pressures and higher shunt fractions than did anaesthesia with propofol. But drops the PVR with normal gas exchange but abnormal vasculature? It also begs the question, in which direction? This article seems to suggest that propofol doesn't change PVR much, Des may raise it, and Sevo and Iso both decreased it with Sevo decreasing it to a greater amount than Iso. This article seems to suggest remi decreases PVR in the cat... but I can't find any studies in humans. So with only one article to go on I suspect B, Sevo might be the answer.
In body protected OR with a Line Isolation Monitor reading 0 mA. If you touch one active wire what will happen.
a. nothing, because no connection to earth is completed
b. you get shocked
c. nothing because the floor is insulated
d. nothing because your shoes are nonconductive
e. RCD trips
A. 0mA means everything is fine and properly isolated so the circuit is not earth referenced.
Best way prevent first phase of heat loss after induction
a. Prewarming the patient with forced air warming
b. Warm blankets
c. Warm fluids
d. Warm theatre
e. Humidified gases
A
pre-warming eliminates the gradient between core and peripheries thus the redistribution phase does not occur.
Best way to assess fluid resuscitation after burns is
a. Urine output
b. mixed venous sats
c. blood pressure
d. cvp
e. capillary refill
Monitoring fluid status — Confirmation of adequate resuscitation is more important than strict adherence to Parkland or any fluid resuscitation formula. Monitoring urine output using an indwelling bladder catheter (eg, Foley catheter) is a readily available means of assessing fluid resuscitation. Hourly urine output should be maintained at 0.5 mL/kg in adults and 1.0 mL/kg in children who weigh less than 25 kg. Patients with minimal or no urine output following severe burns, despite fluid resuscitation, generally do not survive.
Emergence delirium in a kid in recovery. To treat
a. Fentanyl 1mc/kg
b. Midazolam 0.1 mg/kg
c. Propofol
d. Clonidine 1mc/kg
e. Sucrose
?Not sucrose, all others appropriate
Pain in 3 year old, best objective tool
a. FLACC (crying limbs activity consolability)
b. Wong baker Faces pain
c. Self reporting
d. Mum reporting
e. Nurse reporting
A.
Wong Baker faces (revised) for 4 to 12 years. Any form of self reporting usually not possible until the age of 4. From APMSE 3rd edition.
Best time to collect serum tryptase after suspected anaphylaxis
a. within 15 minutes
b. 1 - 3 hours
c. 3 - 6 hours
d. 12 - 24 hours
e. greater than 36 hours
?
Suspect drug cardiac toxicity Auscultation findings which support this are
a. Bibasal crackles
b. Systolic murmur LSE
c. Systolic murmur Apex
d. ?
e. ?
?
Patient with Hemophilia A with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for ot
a. FVIIa
b. High dose FVIII concentrate
c. FFP
d. Cryo
e. Platelets
A The whole reason why novoSeven exists in the first place. A particular therapeutic conundrum is the development of "inhibitor" antibodies against factor VIII due to frequent infusions. These develop as the body recognises the "normal form" factor VIII as foreign, as the body does not have its own "copy". The problem is that in these patients, factor VIII infusions are ineffective. Recently[update] activated factor VII (NovoSeven) has become available as a treatment for haemorrhage in patients with haemophilia and factor inhibitors.
Pregnant women whose paternal uncle has MH. Nobody has been tested. What's the best test to exclude MH in this patient?
a. Genetic test lady
b. genetic test dad of lady
c. muscle biopsy lady
d. muscle biopsy dad
D
Not all patients can have a biopsy, these include children less than 10-12yrs (30kgs), pregnant women, and patients on prolonged steroid therapy. If the proband cannot be tested, eg a young child or deceased, then the nearest most appropriate relative is tested. In the case of a young child this would be the parents. Once the proband has been confirmed as MH susceptible, a blood sample taken at the time of the biopsy will be screened to see if they carry one of the genetic mutations that can be used to test for MH. At present only around 60% of families carry one of these mutations of which there are currently 27
A woman is being treated for pre-eclampsi. She is given 10 grams Magnesium sulphate in 1 h, instead of 1 gr per 1 h, Mg level 5-6, and patient is hyporeflexia. The best treatment is:
a. calcium
b. IV fluid
c. Furosemide
d. ?
A
Disease associated with malignant hyperthermia
a. central core disease
b. myasthenia gravis
c. myotonia congenita
d. ?
A
.Appropriate infection control measures when anaesthetising a patient with suspected variant-CJD, the airway equipment should be
a.thrown away
b.plastic sheath, reuse
c.sterilization with ethylene oxide
d. sterilization with heat at 134 degrees for 3 minutes
e. Autoclave
A
Timing of worst coagulopathy after liver transplant
a. 1-2 days
b. 3-4 days
c. 5-6 days
etc
A?
Anaesthetic management in patient with cardiac tamponade
a. bradycardia for the ventricle filling time
b. inotropes
c. volume loading
B, C
Doing an awake CEA. Patient becomes confused & combative after carotid clamped and opened. Priority is...
a) tell surgeon to release clamp
b) tell surgeon to place shunt
c) induce GA
d) give midazolam
B
You intubate a young male patient for a left thoracotomy with a 39FG Robert Shaw tube. When you inflate both cuffs and ventilate the bronchial lumen you get left sided ventilation. When you attempt to ventilate the tracheal lumen the pressures are very high and you get no air entry. Yet when you deflate both cuffs you can ventilate the patient through the tracheal lumen. The most appropriate step to take next is:
A. Change to a 41FG tube
B. Change to a 37FG tube
C. Deflate both cuffs and insert further cm and recheck
D. Deflate both cuffs and withdraw a few cm and recheck
E. Pull ETT out and start again.
Sounds like D, with both cuffs in LMB. Pull back so tracheal cuff above carina and bronchial cuff still in LMB. Real answer is use a FOB.
Patient with IV in right arm, has mediastinal mass and SVC compression undergoing mediastinal biopsy, suddenly uncontrolled surgical bleeding in mediastinum. Next step in management prior to thoractomy: A. insert femoral cannulae and place on bypass
B. insert IV in left arm
C. insert IV into foot
D. insert jugular CVC
E. trendelenburg
C If hemorrhage originates from a tear in the superior vena cava, volume replacement and drug treatment may be lost into the surgical field unless they are administered through a peripheral intravenous line placed in the lower extremity...Miller
ASA grading was introduced to
A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk
C - Specifically noted not to predict anaesthetic/surgical risk
Pulsus paradoxus is:
A. Reduced BP on inspiration unlike normal (ie normally increased on insp)
B. Reduced BP on inspiration exaggerated from normal
C. Reduced BP on expiration unlike normal
D. Reduced BP on expiration exaggerated from normal
E. ?
B; remember pulsus paradoxus is NOT a paradox in itself. The BP falls, but by greater than 10mmHg.

The paradox in pulsus paradoxus is that, on clinical examination, one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse.[1] It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable
What antibiotics are required for bacterial endocarditis prophylaxis in a woman with MV prolapse for cholecystectomy.
A. None
B. gentamicin
C. ampicillin and gentamicin
D. ampicillin
E. cephazolin
Trickly wording! "Widely accepted indications for antibiotic prophylaxis are contaminated and clean-contaminated surgery and operations involving the insertion of an artificial device or prosthetic material." Australian Prescriber. So this patient would likely get cephazolin, but not for BE prophylaxis. The new guidelines state that the following patients should be given BE prophylaxis;

Prosthetic valve or valve repair material
pHx of BE
Unrepaired cyanotic congenital heart disease
Partially repaired cynanotic CHD with defect over the repair
Repaired CHD within the 1st 6 months of repair
Heart transplant with valvulopathy
Plasma glucose level compared to blood glucose level
a)32% higher
b)14% higher
c)same
d)14%lower
e)32% lower
B Because red blood cells (erythrocytes) have a higher concentration of protein (e.g., hemoglobin) than serum, serum has a higher water content and consequently more dissolved glucose than does whole blood. To convert from whole-blood glucose, multiplication by 1.15 has been shown to generally give the serum/plasma level.
You are called for a labour epidural. The woman is extremely distressed and in the middle of your consent process states “Just take my pain away” . You:
A. Place epidural then when calmed return to advise her of risks and complications
B. Explain she has to hear all the potential complications and refuse to place epidural without consent
C. Take consent from partner
D. Perform spinal to relieve pain, then consent her for epidural
E. Go away and return when she is more cooperative
I'll go B Management of Regional Analgesia for Labour and PS26
Pre-eclamptic woman BP 180/110. Aim to drop BP to
a) 150-160
b) 140-150
c) 120-130
d) 110-120
e) 100-110
B "Blood pressure should be lowered to levels of SBP 140-150/DBP 90-100 at a rate of 10-20 mmHg every 10-20 minutes" Management of Pre-eclampsia and Eclampsia ANZCA
4 yr old presents for elective surgery, otherwise fit healthy, murmur at left sternal edge on auscultation heard in systole and diastole, disappears on lying down. Most likely cause:
A. HOCM
B. VSD
C. PDA
D. venous hum
E. ASD
A FALSE
Relieved with squatting and passive leg raise
B FALSE
Relieved with Valsalva
C FALSE
A Continuous murmur
D TRUE
Characteristic
E FALSE
Neonate born to known drug abusing mother brought to emergency department by grandmother, unwell lethargic, slightly jaundiced, ABG shows following:

pH 7.52
Na 135
Cl 87
K 3
pCO2 38

Which of the following is the Diagnosis?
A) Septicaemia
B) Hepatitis
C) Pyloric stenosis
D) Pneumonia
E) Opioid withdrawal
Pyloric stenosis

Explanation of biochemistry results

vomiting leads to a loss of water and Hydrogen and chloride ions to a large degree. And a variable degree of Na and K ion losses also…. Ie patient becomes alkalotic (high plasma HCO3 levels) the increased bicarb load to the distal tubule of kidney results in alkaline urine and a loss of sodium and water also. Ie alkaline urine. Dehydration and stress leads to activation of RAS, resulting in attempted sodium conservation but significant loss of potassium from the urine. This is the main source of potassium loss from the body resulting in Hypo K. ADH secretion and water retention, Na loss in gastric contents and sodium loss linked to HCO3 in kidneys contribute to the hypo Na. As they deteriorate the kidneys now try to maintain K and Na by exchanging with H ions resulting in a worsening alkalosis and paradoxical acidic urine.
A patient has a suspected anaphylactic reaqction under GA. What is the best time to perform the tryptase test?
A><1 hour
B>1 to 3 hours
C>3 to 6 hours
D>numerous other options
?
You are anaesthetising a patient with multiple sclerosis. The best way to avoid a flare up of this patients multiple sclerosis following the anaesthetic is to
A. Avoid dehydration
B. Avoid overheating the patient
C. ?
D. ?
B "...increases in body temperature should be avoided. Demyelinated fibres are extremely sensitive to increases in temperature; an increase of as little as 0.5 C may completely block conduction"...Morgan and Mikhail p588
70 y old patient with AF (rate 80/min) in pre-admission clinic booked for ant resection. (it was not mentioned if AF was old or new or if on patient was on any medication) What management?
A. Crack on
B. Echocardiography and Cardioversion
C. Immediate Cardioversion
D. ?
E. ?
A
Ketamine for acute pain relief
A. an appropriate dose is 0.5 -1 mg/kg
B. Midazolam does not help in unpleasant dreams / delirium
C. Morphine is contraindicated
D. Hallucinations are common
E. Subcut is better than IV
A. FALSE

Usual dose is 0.1 - 0.3mg/kg/hour (or as an initial bolus)

B. FALSE

Midazolam is useful

C. FALSE

Need an opioid for best effect

D. TRUE

Don't know about it being common, but...

E. FALSE

S/c is not better than; but can be used instead of IV. "however SC infusion is also used, especially in palliative care, with a bioavailability (similar to IM) of approximately 90% (Clements et al, 1982)." From APMSE
TRALI most likely after transfusion of
A. Red Blood Cells
B. Platelets
C. FFP
D. ?
E. ?
FFP
What is the appropriate LMA size for an 8kg child:
A. 1
B. 1.5
C. 2
D. 2.5
E. 3
<5kg = size 1
5-10kg = size 1.5
10-20kg = size 2
20-30kg = size 2.5
30+kg = size 3
Aneurysm clipping. Best monitor of depth of block during this is:
A. TOFR
B. TOFC
C. DBS
D. PTC
PTC

Used to assess profound block, useful in surgery where small movements may be hazardous (eg. neuro, opthalmic)
Which volatile has the minimum effect on ICP at 1 MAC
A. Isoflurane
B. Sevoflurane
C. Desflurane
D. Enflurane
E. Halothane
From Current Opinion in Anaesthesiology: October 2006 - Volume 19 - Issue 5 - p 504-508

"Cerebral blood volume and intracranial pressure.

Sevoflurane is the least vasoactive substance among all volatile anesthetics with nearly no impact on cerebral blood volume and intracranial pressure in concentrations below 1.0 MAC [3,9,10]."
he absorption of fluid into the circulation during transurethral prostatectomy (TURP) is NOT related to
A. prostate size
B. height of the irrigation fluid bag
C. duration of surgery
D. surgical technique
E. type of irrigation fluid
A. prostate size - true: "Large prostatic glands have rich venous networks that promote intravascular absorption of irrigation solution" (Yao and Artusio's Anesthesiology, 6ED, p.808)
B. height of the irrigation fluid bag - true: "The hydrostatic pressure of the irrigation solution is an important determinant of the solution absorption rate" (Yao and Artusio's Anesthesiology, 6ED, p.808)
C. duration of surgery - true: If the solution is absorbed at a constant rate, the longer the operation, the greater the amount absorbed
D. surgical technique - true: "The violation of the prostatic capsule during surgery promotes entry of irrigation solution into the periprostatic and retroperitoneal spaces." (Yao and Artusio's Anesthesiology, 6ED, p.808)
E. type of irrigation fluid - false and the answer to choose: As described below, fluid is absorbed through the venous networks rather than across a semi-permeable membrane. The makeup of the fluid DOES affect the likelihood of TURP syndrome as it may alter electrolyte homeostasis, BUT it will not affect the volume of fluid absorbed.
In patients undergoing thoracotomy, techniques which reduce the incidence of intraoperative atrial fibrillation include
A. hyperventilation
B. pre-operative loading with digoxin
C. rocuronium, rather than pancuronium
D. thoracic epidural bupivacaine
E. thoracic epidural morphine
?
During laparoscopic surgery, pneumoperitoneum usually results in a fall in cardiac output when intra-abdominal pressure exceeds
A 10mmHg
B 20mmHg
C 30mmHg
D 40mmHg
E 50mmHg
CO falls from 10mmHg
BP falls above 20mmHg
A fourteen-year-old girl is scheduled to have a termination of pregnancy. With regard to consent for this procedure, which of the following statements most truly reflects the law in Australasia?
A. A fourteen-year-old girl is able to give consent independently of her parents/guardians if she is considered, by her treating doctors, to be of sufficient maturity to understand the issues.
B. A fourteen-year-old girl is able to give consent independently of her parents/guardians, only if a court deems her sufficiently mature.
C. Minors are not able to give consent, independently of parents/guardians, until sixteen years of age.
D. Minors are not able to give consent, independently of parents/guardians, until eighteen years of age.
E. Only life-saving treatment may be administered to a fourteen-year-old without parental/guardian consent.
A
A multi-trauma patient opens his eyes and withdraws to painful stimuli, but does not respond to voice. He is moaning but makes no comprehensible sounds. His Glasgow Coma Score is
A. 5
B. 6
C. 7
D. 8
E. 9
E2
V2
M4
= GCS 8
Respiratory function in quadriplegics is improved by
A. abdominal distension
B. an increase in chest wall spasticity
C. interscalene nerve block
D. the upright position
E. unilateral compliance reduction
B
An INCORRECT statement regarding the autonomic nervous system is that
A. autonomic dysfunction is a predictor for worse long term survival after myocardial infarction
B. heart rate responses are primarily mediated through the sympathetic nervous system
C. inhalation anaesthetics all impair autonomic reflex responses
D. autonomic dysfunction is a predictor for haemodynamic instability following anaesthetic induction
E. low heart rate variability is associated with worse cardiac outcomes following non-cardiac surgery
?
Correct statements regarding expiratory-inspiratory flow-volume loops include all of the following EXCEPT
A. in obstructive disease the expiratory curve has a scooped out or concave appearance
B. in restrictive disease expiratory flows are usually decreased in relation to lung volume
C. in restrictive disease the expiratory curve has a convex appearance
D. the expiratory curve is largely effort independent
E. the inspiratory curve is effort dependent
?
Carbon dioxide is the most common gas used for insufflation for laparoscopy because it
A. is cheap and readily available
B. is slow to be absorbed from the peritoneum and thus safer
C. is not as dangerous as some other gases if inadvertently given intravenously
D. provides the best surgical conditions for vision and diathermy
E. will not produce any problems with gas emboli as it dissolves rapidly in blood
E-ish
Lowering intra-ocular pressure by applying pressure to the globe (e.g. Honan balloon) is typically contraindicated in a patient having
A. a revision corneal graft
B. a revision trabeculectomy
C. an extra-capsular lens extraction
D. a redo vitrectomy
E. repeat retinal cryotherapy
B
Following a cadaveric renal transplant under general anaesthesia, your patient's plasma K+ increases to 6.0 mmol.l-1 in recovery after being 5.0 mmol.l-1 pre and intra-operatively. This patient requires
A. an intravenous infusion of CaCl2 (10 mls over 20 minutes)
B. arterial blood gases to ascertain the acid/base status
C. potassium exchange resins rectally
D. sodium bicarbonate infusion (50- 100 mEq over 5- 10 minutes)
E. urgent haemodialysis
B
Factors associated with post-operative ulnar nerve palsy include all of the following EXCEPT
A. male gender
B. sternal retraction for cardiac surgery
C. cardiopulmonary bypass for cardiac surgery
D. internal jugular vein catheterisation
E. diabetes mellitus
?D
32 year old with early acute liver failure (not paracetamol related). Management includes
A. prophylactic antibiotics
B. N-acetyl cysteine as general liver protection
C. avoid early intubation so can assess for encephalopathy
D. INR> 3 means should be considered for transplant??
E. avoid saline as resuscitation fluid
?
Carcinoid syndrome - finding on examining heart:
A. Fine inspiratory crepitations
B. Systolic murmur at apex
C. Systolic murmur at left sternal edge
D. Murmur at apex with opening snap
E. Pericardial rub
?
Central anticholinergic syndrome, which is NOT true:
A. Will improve with neostigmine
B. Peripheral anticholinergic symptoms
C. Caused by Anti-Parkinson drugs
D. CNS depression
E. Associated with agitation, delirium, and ???
?
The intraoperative hypothermia for aneurysm surgery trial (IHAST) showed that cooling to a target temperature of 33°C

A. did NOT improve neurological outcome in WFNS (World Federation of Neurosurgical Surgeons) in grade I-III patients
B. did NOT improve neurological outcome in WFNS grade IV-V patients
C. improved neurological outcome in WFNS grade I-III
D. improved neurological outcome in WFNS grade III
E. improved neurological outcome in WFNS grade IV-V
?
12 year old child with hip dislocation at 4pm. Ate something 1 hour after injury. Now 11 pm. Best anaesthetic:
A. RSI with ETT
B. delay until next day then treat elective
C. inhalational induction and continue with face mask
D. Reduce immediately with iv sedation
E. inhalational induction and continue with face mask
?A
What is 1 MET uptake of oxygen DUKE'S ?
A. 1-2 ml O2/kg/min
B. 2-3 ml O2/kg/min
C. 3-4 ml O2/kg/min
D. 5-6 ml O2/kg/min
E. 7-8mls O2/kg/min
?
What is 1 MET uptake of oxygen DUKE'S ?
A. 1-2 ml O2/kg/min
B. 2-3 ml O2/kg/min
C. 3-4 ml O2/kg/min
D. 5-6 ml O2/kg/min
E. 7-8mls O2/kg/min
1 MET = 3.5 mL O2/kg/min
Anaemia in chronic renal failure is characteristically
A. due to haemolysis in the renal vascular bed
B. normochromic and microcytic
C. due to defective haemoglobin synthesis
D. responsive to iron and folate therapy
E. associated with increased 2,3-DPG levels in blood cells
due to cytokine-driven inhibition of red cell production, and erythropoietin deficiency
Which drug is an example of a specific PDE III inhibitor:
a. Aminophyline
b. Sildenafil
c. Milrinone
d. Dipyridamole
e. ?
C
The tapered connector between the ETT and machine is
a.12-20mm
b. 15-22mm
c. 20-30mm
d. 22-30mm
e. 25-35mm
B
Art line system
a. Overdamped exaggerates mean
b. Underdamping increases mean
c. Underdamping underestimates systolic
d. Long random option about multiple damping coefficients in an optimal system
e. Compliant tubing is good
Got this from Anaesthesia and Intensive Care Volume 6, Issue 12, Pages 405-407 (1 December 2005)

Damping of the pressure waveform due to poor positioning of the cannula, or the use of overly compliant tubing, underestimates systolic pressure and overestimates diastolic pressure. The mean pressure is still reasonably accurate.

This would suggest that A, B, C, E are incorrect - leaving D which might be the correct one depending on what the answer really is
Preoperative assessment shows a Mallampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehane is predicted. Compared to the ML score, the TMD is
A less sensitive, less specific
B less sensitive, more specific
C more sensitive, less specific
D more sensitive, more specific
E equal sensitivity an specificity
?
Codeine phosphate
A. is converted by the liver to its active metabolite, oxycodone
B. is not associated with tolerance on chronic use
C. is not effective as an analgesic in approximately 20% of Causcasians
D. is poorly absorbed from the gastrointestinal tract
E. when given orally has approximately 5% of the analgesic potency of intramuscular morphine
?
Doing an awake CEA. Patient becomes confused & combative after carotid clamped and opened. Priority is...
a) tell surgeon to release clamp
b) tell surgeon to place shunt
c) induce GA
d) give midazolam
B: shunt
You intubate a young male patient for a left thoracotomy with a 39FG Robert Shaw tube. When you inflate both cuffs and ventilate the bronchial lumen you get left sided ventilation. When you attempt to ventilate the tracheal lumen the pressures are very high and you get no air entry. Yet when you deflate both cuffs you can ventilate the patient through the tracheal lumen. The most appropriate step to take next is:

A. Change to a 41FG tube
B. Change to a 37FG tube
C. Deflate both cuffs and insert further cm and recheck
D. Deflate both cuffs and withdraw a few cm and recheck
E. Pull ETT out and start again.
D: sounds like tracheal cuff is also down L main bronchus
A patient comes to see you in clinic for a pneumonectomy for SCLS. His spirometry shows an FEV1 of 2.5L (>40% predicted). What do you advise about his fitness for surgery?
A. He is not fit for the procedure
B. He is fit for the procedure
C. He needs referral for formal exercise testing
D. He needs a blood gas
B

OHA p 353 FEV1 > 55% predicted for pneumonectomy and >40% predicted for lobectomy and exercise testing useful in borderline cases.
On bypass, for mitral stenosis repair immediately after cardioplegia the following happens:

MAP to 25
SvO2 80%
CVP1

Next step in management:
A) metaraminol
B) give volume
C) increase pump flows
D) adrenaline infusion
E)
A
Redo CABG following median sternotomy surgeon states he has accidentally cut a vein graft, immediately followed by ST elevation on ECG and VF, next action.
A) External defibrillation 200J (Biphasic)
B) Heparin IV then femoral cutdowns for bypass
C) Hand ventilate with 100% oxygen
D) GTN infusion
E) metaraminol
B
(A unlikely to be effective as surgeon has made part of heart ischaemic
Mitral valve replacement for Mitral stenosis. Pulmonary artery catheter in situ. Following separation from bypass, copious frank haemoptysis via ETT. Next step in management"
A) Insert double lumen tube
B) Go back on bypass
C) Give protamine
D) Deflate and pull back PAC
E) Perform fibreoptic bronchoscopy
B
Young man on the ward post ORIF # tib/fib. On morphine PCA, high demands/bolus given ratio, used 40mg morphine in last 2 hours (or something else high). Is a bit drowsy but has severe constant leg pain. Next step in management
A. admit to intensive care
B. increase bolus dose morphine PCA
C. decrease lockout interval of PCA
D. organise urgent orthopaedic review
E. give more morphine until comfortable (or something else rubbish)
D: ?compartment syndrome
Patient with IV in right arm, has mediastinal mass and SVC compression undergoing mediastinal biopsy, suddenly uncontrolled surgical bleeding in mediastinum. Next step in management prior to thoractomy:
A. insert femoral cannulae and place on bypass
B. insert IV in left arm
C. insert IV into foot
D. insert jugular CVC
C
ASA grading was introduced to
A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk
C
Why does a proseal LMA provide a better airway seal?
A. More stable position due to oesophageal tube
B. Doral cuff pushes ventral cuff...?
C. Presence of oesophageal lumen
D. Higher cuff pressure
E. ?
B
Which of the following is the most frequent complication after use of LMA?
A. dysphagia
B. dysarthria
C. sore throat
D. hoarse voice
E. dry mouth
Dry mouth 62-64%
Sore throat 13%
Dysphagia 11.5%
Dysarthria 5.3%
Features of eaton lambert include all EXCEPT...
a) Associated with SCLC
b) improvement with exercise
c) defect in ACh release from motor end plate
d) dry mouth
e) Fatigue with exercise
E
Pulsus paradoxus is:
A. Reduced BP on inspiration unlike normal (ie normally increased on insp)
B. Reduced BP on inspiration exaggerated from normal
C. Reduced BP on expiration unlike normal
D. Reduced BP on expiration exaggerated from normal
E. ?
B
What antibiotics are required for bacterial endocarditis prophylaxis in a woman with MV prolapse for cholecystectomy.
A. None
B. gentamicin
C. ampicillin and gentamicin
D. ampicillin
E. cephazolin
A
Male 60’s sudden onset of chest pain , L arm weakness and hoarse voice, ECG is unchanged from old (T inversion laterally), CXR normal, BP135/80, Pulse 110/min. Next step in management:
A)Aspirin
B)SNP infusion
C)GTN infusion
D)Metoprolol
E)Heparin
D: ?dissection
Plasma glucose level compared to blood glucose level
a)32% higher
b)14% higher
c)same
d)14%lower
e)32% lower
B
You are on call for a maternity hospital. Your junior registrar calls you after having inserted a labour epidural in an extremely anxious 19 yo parturient, and obtained blood in the catheter. He informs you the epidural space was found by LOR at 6cm and the catheter has been inserted to 12 cm. Your first instruction should be:

A. Flush with saline then check again for blood (NOT an option - option was just flush with saline and secure and use)
B. Aspirate again for blood
C. Give 3mls 2% lidnocaine with 1:200 000 adrenaline
D. Pull back 2cm and check again for blood
E. Remove epidural and start again
D
Pre-eclamptic woman BP 180/110. Aim to drop BP to

a) 150-160
b) 140-150
c) 120-130
d) 110-120
e) 100-110
B
Highest likelihood of motor block with labour epidural analgesia:

A)Nurse initiated epidural topups

B)Anaesthetist initiated epidural topups

C)PCEA

D)Continuous epidural infusion

E)All associated with same motor block
possibly D
Trauma pregnant patient (?32wks) BP 70/40, P 50, intubated in emergency department, next management step:

A)L tilt pelvis

B)IV fluid bolus

C)Arrange urgent caesarean section

D)Vasopressor options (?Adrenaline, Metaraminol)
A - though can be difficult so whole patient tilt may be better
Emergency caesarean section for foetal distress (and foetal acidosis on scalp probe?). what is best option to raise gastric pH preop:

A)Oral Na Citrate

B)Ranitidine IV

C)Ranitidine oral

D)Omeprazole IV

E)Omeprazole oral

F)Metoclopramide 20 IV
A
Which distinguishes C8-T1 from an ulnar nerve lesion at elbow?
A. Paraethesia of the 5th digit
B. Paraesthesia over index finger
C. Flexor carpi ulnaris function
D. Paraesthesia/sensory loss over medial forearm
E. Adductor pollicis function
Answer is D. The medial cutaneous nerve of the forearm arises from the medial cord of the brachial plexus which is prior to the formation of the ulnar nerve.
Asking the patient to look up and in during a retrobulbar block increases the risk of injury to:
A. Inferior oblique
B. Superior oblique
C. optic nerve
D. globe
E. ophthalmic artery
C
A man presents for an ankle fusion. Which of the following combinations will provide the best block:
A. Sciatic nerve
B. Common peroneal and saphenous
C. Tibial and saphenous
D. ?Sural and tibial
E. Ankle block
A Sciatic nerve would be probably be the best option - it splits into the common peroneal and tibial somewhere in the popliteal fossa and is indicated for surgery involving lower leg, ankle foot. You might miss part of the saphenous nerve innervation but you might get away with it...
Stellate ganglion block associated with all except:

A. Ptosis
B. Miosis
C. Sweating
D. Facial flushing
E. Nasal stuffiness
C
18yo patient in a psych unit, being treated for frequent vomiting. Collapses and found unconscious.
ABG's:

pH 7.22
CO2 40
PO2 100
HCO3 16
Na 138
K 4.0
Cl 105

Diagnosis is:
A. anorexia nervosa
B. diabetic ketoacidosis
C RTA
D. Normal saline administration
E) Gastric outlet obstruction
High anion gap metabolic acidosis with normal chloride - only one that fits is DKA. B
Trauma patient with GCS 6 with hard collar. HR and BP unstable. What is the best way of clearing neck?
A. CT
B. Cervical spine trauma series
C. MRI
D. Leave had collar indefinitely??
E. Clinically
CT
Patient (?48h post) SAH following bloods:

Na 155
Plasma osmolality 350
urine osmolality 250

Management includes:
A)DDAVP (?nasally)
B)Water restriction
basically hypernatremia with high plasma osmolality N=280 and low urine osmolality (ranges from 50-1400, but average is 500-800), suggests DI ie inadequate ADH secretion - therefore treatment DDVAP
2 month old systolic murmur heard at apex no change with posture, now on 5th centile for weight after being on 30th at birth, mother states has difficulty feeding. Peripheral pulses reduced femoral more than upper body. Most likely cause:
A. HOCM
B. VSD
C. PDA
D. venous hum
E. ASD
C
4 yr old presents for elective surgery, otherwise fit healthy, murmur at left sternal edge on auscultation heard in systole and diastole, disappears on lying down. Most likely cause:
A. HOCM
B. VSD
C. PDA
D. venous hum
E. ASD
Answer : D

Venous Hum - systolic + diastolic components, not really a murmur. Benign medical condition where 20% of the blood flow travels to the brain and back to the heart. Due to the large amount of blood it can move quite fast causing the vein walls to vibrate which can create a humming noise to be heard by the patient.The murmur disappears when the patient is in the supine position. Tally&O'connor 3rd Ed p79-83
18/12 old undergoing routine SV GA under LMA. Sudden onset SVT with HR 220 BP 84/60 ETCO2 32 SpO2 98.Management:
A. Adenosine 100mcg
B. DCR 2J/kg
C. DCR 4J/kg
D. Amiodarone 5mg/kg
E. CPR
Textbook of pediatric emergency procedures - Christopher King, Fred M. Henretig, Brent R King - 2007 SVT table - Adenosine (100,200,400 mcg/kg/min) then syncronised cardioversion (0.5,1,2 J/kg) That would suggest in its current form that B may be correct
What is the appropriate LMA size for an 8kg child:
A. 1
B. 1.5
C. 2
D. 2.5
E. 3
<5kg = 1, 5-10kg = 1.5, 10-20kg = 2, 20-30kg = 2.5, 30-50kg = 3.0, 50-70kg = 4.0, 70-100kg = 5.0, >100kg = 6
Neonate born to known drug abusing mother brought to emergency department by grandmother, unwell lethargic, slightly jaundiced, ABG shows following:

pH 7.52
Na 135
Cl 87
K 3
pCO2 38

Which of the following is the Diagnosis?
A) Septicaemia
B) Hepatitis
C) Pyloric stenosis
D) Pneumonia
E) Opioid withdrawl
Hypokalaemic, hypochloraemic metabolic alkalosis; classic for pyloric stenosis. The other stuff is probably a distraction.
15kg child found fitting on paeds ward ?24h ?48h postop while on infusion of 60ml/h ½ NS + Dextrose. Now intubated. Na is 119, next management step:
A) frusemide
B) hypertonic saline
C) Normal saline at 20ml/hr
D) Water restrict
E) Phenytoin
B. Symptomatic hyponatraemia = hypertonic saline.
A man on PCA controlled with 2 mg morphine bolus is having a lot of pruritus. You decide to switch him to fentanyl. Which dose is the most appropriate bolus to be equi-analgesic with morphine 2mg:
A. 10mcg
B. 20mcg
C. 40mcg
D. 60mcg
E. 80mcg
20mcg?
A patient with chronic pain using morphine PCA after lower limb orthopaedic surgery. Daily usage of IV morphine works out at about 400mg/day. What dose of oral methadone would you start him on to replace the morphine?
A. 60mg/day
B. 120mg/day
C. 400mg/day
D. 600mg/day
E: 1200mg/day
Methadone replacement depends on dose of oral morphine
Daily Dose : Conversion Ratio
<100mg 3:1
100 - 300mg 5:1
300 - 600mg 10:1
600mg - 800mg 12:1
800mg - 1000mg 15:1
>1000mg 20:1

400mg IV = 1200mg oral.

20:1 conversion so 60mg of methadone per day = A
For muscle relaxant,placing the nerve stimulator to stimulate FHB (Flexor hallicus brevis) compared to Abductor pollicis brevis is likely to

A. show a slower recovery to NMB
B. show the same recovery
C. show a faster recovery to NMB Cannot remember other options
Monitoring neuromuscular block: an update Anaesthesia Volume 64, Issue s1, Pages 82-89 says the two sites are clinically equivalent. B
Aneursym clipping, BEST monitor of depth of block during this is
A. TOFR
B. TOFC
C. DBS
D. PTC
D: PTC - want v profound NM blockade
Closed circuit anaesthesia with 70%N2O,70kg man (low flow i think) what is the uptake of N2O after 90 mins anaesthesia:
A. less than 50ml/min
B. 100ml/min
C. 200ml/min
D. 500ml/min
E. 1000 ml/min
Severinghaus equation (Miller 87) – uptake = solubility x CO x A-V difference x proportion of inspired gas mix.

Old question - uptake is 1000 divided by the square root of the time administered in minutes (which works out roughtly to be B)
Rapid infusion of mannitol IV initially causes:
A. Raised ICP
B. Reduced CBF
C. Reduced K
D. Reduced Na
A. The physical bolus of Mannitol causes an initially transient increase, then decreases as interstitial water is drawn out
Granisitron, which is incorrect:

A) Decreased serotonin release
B) Metabolism by carbamoyl ?...
C) 5HT3 antagonism
A
Who has got minimum effect on ICP at 1 MAC
a)isoflurane
b)sevoflurane
c)desflurane
d)enflurane
e)halothane
isoflurane
Young woman with subarachnoid haemorrhage, hyponatraemia and increased urinary sodium (did not specify if high sodium concentration or total amount lost). What is likely cause?
A. cerebral salt wasting syndrome
B. SIADH
C. HHH therapy
D. Excess NS administration
E. diabetes insipidus
CSWS is usually caused by brain injury/trauma or cerebral lesion, tumor, or hematoma. CSWS is a diagnosis of exclusion and may be difficult to distinguish from the syndrome of inappropriate antidiuretic hormone (SIADH), which develops under similar circumstances and also presents with hyponatremia. The main clinical difference is that of total fluid status of the patient: CSWS leads to a relative or overt hypovolemia whereas SIADH is consistent with a normal to hypervolemic range. Random urine sodium concentrations tend to be lower than 100 mEq/L in CSWS and greater in SIADH . If blood-sodium levels increase when fluids are restricted, SIADH is more likely.
Which of the following can be used to describe the spread of non-parametric data?
A. standard deviation
B. interquartile range
C. confidence interval
D. standard error
E. variance coefficient
B (CEACCP 7(4): 127-130, answer on p129)