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108 Cards in this Set
- Front
- Back
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 |
ANSWER D |
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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 |
ANSWER A |
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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? |
ANSWER C |
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What is the most effective method of minimizing acute kidney injury following an elective open abdominal aortic aneurysm repair? |
ANSWER E |
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Features of severe pre-eclampsia include all except: |
ANSWER B |
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Earliest sign of a high block in a neonate post awake caudal: |
ANSWER D |
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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? |
ANSWER D |
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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: |
ANSWER B |
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What is the test is decreased in Iron deficiency anaemia? |
ANSWER B |
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A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from |
ANSWER A |
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MRI Telsa 3, least likely to cause harm |
ANSWER B |
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What happens when you place a magnet over a biventricular internal cardiac defibrillator |
ANSWER D |
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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 |
ANSWER D |
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Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I. |
ANSWER A |
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Lowest extension of thoracic paravertebral space |
ANSWER B |
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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? |
ANSWER E |
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In regards to systemic sclerosis, what is the least likely cardiac manifestation? |
ANSWER E Valvular |
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The reason that desflurane requires a heated vapour chamber can be best explained by its: |
ANSWER B |
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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: |
ANSWER B |
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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 |
ANSWER D |
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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 |
ANSWER C |
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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 |
ANSWER C |
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An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except: |
ANSWER B |
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What cannot be used for tocolysis in a 34/40 pregnant woman: |
ANSWER B. |
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Pringles procedure for life threatening liver haemorrhage includes clamping of: |
ANSWER C Hepatoduodenal ligament clamping. max time 20 mins |
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Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to: |
ANSWER B if acutely intoxicated |
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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: |
ANSWER D |
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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 |
ANSWER C |
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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: |
ANSWER C ? subdural |
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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? |
ANSWER A |
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The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the |
ANSWER E |
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After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is |
ANSWER E |
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Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture |
ANSWER C |
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6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is |
ANSWER B |
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41. For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is; |
ANSWER D |
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42. A reduction in DLCO can be caused by; |
ANSWER 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: |
ANSWER C |
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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: |
ANSWER 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? |
ANSWER E |
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46 Regarding endotracheal tubes used in laser surgery: |
ANSWER D |
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49 Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion |
ANSWER 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 |
ANSWER 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? |
ANSWER D |
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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? |
ANSWER A 0 |
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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: |
ANSWER 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? |
ANSWER E |
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59. What is approximately the systolic blood pressure in an awake neonate (mmHg) |
ANSWER 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: |
ANSWER 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 |
ANSWER 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 |
ANSWER C pink |
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69. During apnoeic oxygenation under light anaesthesia, the expected rise in PaO2 would be: |
ANSWER D |
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70. In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and : |
ANSWER C RR |
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72. Absolute Contraindication to ECT |
ANSWER D raised ICP |
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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: |
ANSWER 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: |
ANSWER 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: |
ANSWER C but not exactly right acc to UTD- |
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77. (Rpt) A neonate will desaturate faster than an adult at induction because |
ANSWER 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: |
ANSWER D |
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79. [AP CXR and lateral] – ‘’showed hydropneumothorax’’ This grossly abnormal CXR is |
ANSWER 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 |
ANSWER C |
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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 |
ANSWER C |
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84 Which of the following is the best predictor of a difficult intubation in a morbidly obese patient |
ANSWER 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: |
ANSWER E- repeat |
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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: |
ANSWER 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: |
ANSWER C |
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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? |
ANSWER B |
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89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is? |
ANSWER B |
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90. Prior to seeking consent from family/relatives for DCD, it is important to confirm which of the following? |
ANSWER D |
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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: |
ANSWER 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: |
ANSWER 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: |
ANSWER C |
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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? |
ANSWER D |
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98 buprenorphine patch removed morning of surgery. What time till PLASMA reaches half original level |
ANSWER 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: |
ANSWER 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: |
ANSWER E |
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102. [Similar to 2013A Q38] Central sensitization, resulting in prolongation of post-operative pain, is caused by: |
ANSWER 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. |
ANSWER 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? |
ANSWER E |
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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: |
ANSWER E |
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106. [Repeat 2013A] The incidence and severity of vasospasm post sub arachnoid haemorrhage is greatest at: |
ANSWER C |
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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 |
ANSWER C |
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108. [Repeat 2013A] In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT: |
ANSWER E |
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109. [New] Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is: |
ANSWER B |
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110. [New] During endovascular aneurysm repair, GA is preferred due to: |
ANSWER 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: |
ANSWER 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: |
ANSWER A |
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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) |
ANSWER A Desflurane |
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119. [New] A patient's competence to give informed consent is determined by all the following EXCEPT: |
ANSWER 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? |
ANSWER A- repeat |
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121. St John's wort will reduce the effect of |
ANSWER E. warfarin. |
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122. The most important effect of Lugol's iodine administration before thyroid surgery is |
ANSWER 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 |
ANSWER 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 |
ANSWER 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 |
ANSWER C |
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127 Prothrombin VX useful in perioperative period to correct the coagulopathic defect of all except |
ANSWER B |
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133. The organ that is least tolerant of ischaemia, after removal for transplant, is: |
ANSWER 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: |
ANSWER D |
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135. Which of the following statements regarding patients with ankylosing spondylitis is FALSE? |
ANSWER 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 |
ANSWER D muscle biopsy father |
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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? |
ANSWER E |
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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: |
ANSWER 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: |
ANSWER B Increased mortality |
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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: |
ANSWER A Genitofemoral neuralgia |
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145. Regarding Le Fort fractures: |
ANSWER E |
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145. Greatest predictor of AF post CPB |
ANSWER A |
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146. 2yr child post op following stabismus surgery. ETT 4.5 used. Awake, stridor and tracheal tug. Immediate action? |
ANSWER B- showing signs of laryngospasm |
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149. Transient neurological (radicular) syndrome ONLY occurs with |
ANSWER D. Usually occurs later same day or next day |
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150. 50yo lady, attempted suicide attempt, jumped from 5th floor building. She does not open her eyes or vocalise and there is no response to pressure on her nail-bed. What is her GCS? |
ANSWER B |