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40 Cards in this Set
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PH61 [Jul07]
In a 140kg obese patient, compared to a 70 kg person A. cardiac output >20% lower B. cardiac output 10% lower C. cardiac output no different D. cardiac output 10% higher E. cardiac output >20% higher |
ANSWER E
Miller : 10ml/min per kg of fat BJA article : 20-30 ml/min per kg fat Suggesting that E is the answer |
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In a normal pregnant woman laboratory tests would show:
A. an arterial pH of 7.4 B. an increase in functional residual capacity (FRC) C. decreased oxygen consumption D. an arterial base excess of +5mmol.l-1 E. a PaCO2 of 50 mmHg |
ANSWER A
A : TRUE - respiratory acidosis (progesterone/estrogen) is balanced by compensatory excretion of bicarbonate (metabolic acidosis) resulting in normal pH B: FALSE - reduced C : FALSE - O2 consumption is proportional to CO, which increases 20% at term, 40-50% during labor D : FALSE - +3mmol/L E : FALSE - PCO2 30mmHg |
pH 7.41-7.46 (N)
pO2 105 (inc) pCO2 27-32 (dec) HCO2 19-24 (dec) |
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PH60 [Apr07] [Jul07]
What raises intra-ocular pressure (IOP)? A. metabolic acidosis B. respiratory acidosis C. miosis D. reverse trendelenberg (head up) E. carbonic anhydrase inhibitor |
ANSWER B
Similar to the factors which increase ICP. |
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PH58 [Mar06] [Jul06]
The magnesium concentration at which loss of deep tendon reflexes typically occurs is: A. 2 mmol/l B. 3.5 mmol/l C. 5 mmol/l D. 8 mmol/l E. 12 mmol/l |
ANSWER C
0.8 - 1.0 : Normal physiological range 1.7 - 3.5 : Therapeutic 2.5 - 5.0 : Early ECG changes, widen QRS, increase PQ 5.0 - loss of deep tendon reflexes 7.5 -SA and AV block, respiratory paralysis 12 - cardiac arrest |
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AP34 ANZCA Version [Mar06] Q105
In elderly patients A. opioid requirements are decreased, primarily due to age-related changes in physiology B. pain thresholds are decreased C. self-rated pain scores are lower than in younger patients D. there is a decrease in the density of unmyelinated but not myelinated nerve fibres E. there is impairment of pain inhibitory systems |
ANSWER C
* A. opioid requirements are decreased, primarily due to age-related changes in physiology - true: "Older patients require less opioid than younger patients to achieve the same degree of pain relief (Macintyre & Jarvis, 1996 Level IV; Woodhouse & Mather, 1997 Level IV; Gagliese et al, 2000 Level IV; Upton et al, 2006), however, a large interpatient variability still exists and doses must be titrated to effect in all patients. The decrease is much greater than would be predicted by age related alterations in physiology and seems to have a significant pharmacodynamic component" AND "The physiological changes associated with ageing are progressive. While the rate of change can vary markedly between individuals, these changes may decrease the dose (maintenance and/or bolus) of drug required for pain relief and may lead to increased accumulation of active metabolites" (Acute pain book 3rd ed) * B. pain thresholds are decreased - false and true: "Examples of differences in reports of acute pain are commonly related to abdominal pain (eg associated with infection, peptic ulcer, cholecystitis, or intestinal obstruction) or chest pain (eg myocardial ischaemia or infarction; pneumonia) and are in general agreement with the experimental finding of increased pain thresholds in the older person" BUT "Experimental pain thresholds to a variety of noxious stimuli are altered in older people; there is also a reduction in tolerance to pain" * C. self-rated pain scores are lower than in younger patients - perhaps: "Older men undergoing prostatectomy reported less pain on a present pain intensity scale and McGill Pain questionnaire (but not a visual analogue scale [VAS]) in the immediate postoperative period and used less PCA opioid than younger men undergoing the same procedure (Gagliese & Katz, 2003 Level III-2). In a study of pain following placement of an IV cannula (a relatively standardised pain stimulus), older patients reported significantly less pain than younger patients" AND "Reported frequency and intensity of acute pain in clinical situations may be reduced in the older person" * D. there is a decrease in the density of unmyelinated but not myelinated nerve fibres - false: "The peripheral nerves show a decrease in the density of both myelinated and, particularly, unmyelinated peripheral nerve fibres, an increase in the number of fibres with signs of damage or degeneration and a slowing of the conduction velocity" * E. there is impairment of pain inhibitory systems |
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PH01 [1986]
At an altitude of 14,000 feet (4,200m), ambient pressure is 450mmHg. Breathing air, a normal man has an alveolar pO2 of: A. 40 mmHg B. 50 mmHg C. 55 mmHg D. 60 mmHg E. 80 mmHg |
ANSWER A
PiO2 = FiO2 × (Pb - 47) PiO2 = 0.21 × (450-47) = 84 PAO2 = PiO2 - (PaCO2 / R) PAO2 = 84 - (35 / 0.8) = 40mmHg (Assuming PaCO2 lower because of hyperventilation) |
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PH04
In a healthy person lying quietly on his back, the intracranial pressure (referred to the level of the interventricular foramen) is in the range: A. 0-5 cmH2O B. 5-15 cmH2O C. 15-30 cmH2O D. 2-3 mmHg E. 15-18 mmHg |
Answer: B
Conversion: 10.2cm H2O = 7.3mmHg, so 5-15cm H20 would be 3.5-11mmHg |
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PH05 [1986] [1987]
Normal maternal blood gases: A. pH 7.4 B. Bicarbonate 31mmol/l C. pCO2 50mmHg D. Metabolic alkalosis E. None of the above |
ANSWER A
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PH06 [1988] [Mar92]
What is the main lung function derangement in pregnancy? A. Decreased tidal volume B. Decreased VC C. Decreased FRC D. Decreased airway resistance E. ? |
ANSWER ??
Increased Respiratory Rate 15% Decreased FRC 20% (decreased ERV & RV) Increased Tidal Volume 30-40% Increased Minute Volume 50% Increased Alveolar Ventilation 70% decreased ariway resistance |
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PH06b [Mar93]
Typical physiological changes in pregnancy at term, compared to the non-pregnant state include a twenty percent A. Increase in alveolar ventilation B. Increase in tidal volume C. Increase in vital capacity D. Reduction in arterial pH E. Reduction in functional residual capacity |
ANSWER E
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PH07 [1986] [Apr96]
Which of the following is NOT a normal pressure measurement? A. Pulmonary artery: 25/10 mmHg B. Aortic root: 120/0 mmHg C. Right ventricle 25/8 mmHg D. Right atrium: 5 mmHg E. Left atrium: 3 mmHg |
ANSWER B and C
RAP 5-10/0 RVP 25/0 PAP 25/8 LAP 5-10/0 LVP 120/0 MAP 120/80 |
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PH08 [1986] [Mar93]
The cardiovascular response to rise in intrathoracic pressure to 40 mmHg include: 1. Reduced venous return 2. Increased peripheral vascular resistance (vasoconstriction) 3. Arterial hypotension 4. Bradycardia |
ANSWER ???
The Valsalva manoeuvre. There are 4 phases: 1. pulse rate steady. Small increase in blood pressure (augmented VR). 2. increased HR. Vasoconstriction. Slight decrease in BP (diminished VR). 3. Steady HR. Drop in BP. 4. Increase in BP, with compensatory bradycardia. Hence, all changes listed do occur. |
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MZ77 ANZCA version Apr07
Consider the following blood gases. Normal ranges are in brackets. pH 7.28 PaCO2 36 Bicarbonate 18 mmol.l-1 (18-25) Base excess -7 mmol.l-1 (-4- +3) Na+ 142 mmol.l-1 (135-145) Cl- 112 mmol.l-1 (98-110) These blood gases are consistent with A. acute renal failure B. diabetic ketoacidosis C. ethylene glycol overdose D. intraoperative infusion of 6 litres of normal saline E. salicylate overdose |
ANSWER D
Normal abion gap Metabolic Acidosis Causes include 1. Diarrhoea leading to HCO3 loss 2. ATN leading to HCO3 loss 3. Acetazolamide (carbonic anhydrase inhibitor) 4. TPN 5. hyperchloremic (NS) 6. Addisons 7. Hyperparathyroidism |
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MC65 ANZCA version [Jul97])
Characteristic cardio-pulmonary effects of pulmonary thrombo-embolism include A. hypoxaemia due to excess perfusion of lung units with a low V/Q ratio B. hypercarbia due to an increase in physiological dead-space C. reverse splitting of the second heart sound D. an increase in compliance of the left ventricle E. an increase in coronary blood flow to the right ventricle during systole |
ANSWER A
A - True : PE causes a diffuse inflammatory reaction of the lung, perfusion of poorly ventilated V/Q units causing hypoemia B - False - Normal to low PaCO2, presumably due to hyperventilation due to tightly regulated PaCO2 and increased ventilation due to activation of J receptors C - False - P2 before A2 in delayed LV ejection eg severe AS or coarctation or ↑ LV load eg large PDA. P2 is LOUD in pulm hypertension and is not typically described as being earlier (enough to reverse the splitting). D - False - ↑ PVR → ↑ RV size → deviates septum → ↓ LV compliance E - False : acute pulmonary hypertension increases right ventricular afterload and wall tension, with coronary ischemia |
PE physiology (Nunn p551)
↑ PVR Physical occlusion Platelet activation in thrombus → 5HT and TXA2 release → vasoconstriction → ↑ PVR Respiratory lesion ↑ alveolar deadspace ↑ A-a gradient Normal to low PaCO2 (in SV) because ↑ RR ? due to J-receptor stimulation + hypoxia ↓ PaO2 Deranged V/Q relationships ↓ CO → low mixed venous O2 Bronchospasm due to 5HT release from platelets ↓ pulmonary compliance (still unknown mechanism) |
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MZ48 ANZCA [Jul97] [Apr98] [Aug99])
Patho-physiological features of patients with morbid obesity include A. a blood volume:body weight ratio which is similar to that of patients with normal body weight B. an increased blood pressure and systemic vascular resistance compared to that of patients with normal body weight C. decreased gastric motility due to increased gastrin secretion D. cardiac pathology resulting from excess body mass and increased metabolic demand E. cardiac pathology resulting mainly from fatty infiltration or fatty change of the heart |
ANSWER D
Patho-physiological features of patients with morbid obesity include A. FALSE : "Total blood volume is increased in the obese but on a volume/weight basis is less than that in non-obese individuals B. FALSE : "hypertension is presumably caused by an increased cardiac output forced into an unaltered peripheral resistance" C. FALSE : gastrin is a prokinetic hormone D. TRUE : cardiac pathology resulting from excess body mass and increased metabolic demand - true by default E. FALSE : The morbidly obese individual is at risk of a specific form of obesity-induced cardiac dysfunction, although the belief is that this is secondary to fatty infiltration of the heart ('cor adiposum') is no longer valid |
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MC153 [Jul07] ANZCA version
When viewing the central venous pressure trace: A. an accentuated "a" wave supports the diagnosis of atrial fibrillation B. a steeper than normal "x" descent supports the diagnosis of tricuspid regurgitation C. blunted "a" and "v" waves are associated with extensive right ventricular infarction D. flattened "x" and "y" descents are associated with pericardial constriction E. a monophasic pattern with obliteration of the "y" descent supports the diagnosis of pericardial tamponade |
ANSWER E
A - False : In atrial fibrillation, a waves will be absent, and in atrioventricular dissociation, a waves will be dramatically increased ("cannon waves") as the atrium contracts against a closed tricuspid valve. B - False : In tricuspid regurgitation, the c wave and x descent will be replaced by a large positive wave of regurgitation as the blood flows back into the right atrium during ventricular contraction C - False : Prom a and v waves with RV infarction due to (a wave) increased atrial pressure from contraction into stiff RV (kind of like increased RA afterload) and v waves increased as often assoc TR hence increased filling RA. D - False : Pericardial constriction – tall a and v waves, steep x and y descents E - True :In cardiac tamponade, all pressure will be elevated, and the y descent will be nearly absent |
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PH53 ANZCA version [2001-Aug] Q59
In assessing the adequacy of oxygen delivery to meet the body's oxygen demands the best indicator is A. arterial PO2 B. arteriovenous oxygen content difference C. oxygen flux calculation D. mixed venous PO2 E. cardiac output |
ANSWER D
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MZ77 ANZCA version Apr07
Consider the following blood gases. Normal ranges are in brackets. pH 7.28 PaCO2 36 Bicarbonate 18 mmol.l-1 (18-25) Base excess -7 mmol.l-1 (-4- +3) Na+ 142 mmol.l-1 (135-145) Cl- 112 mmol.l-1 (98-110) These blood gases are consistent with A. acute renal failure B. diabetic ketoacidosis C. ethylene glycol overdose D. intraoperative infusion of 6 litres of normal saline E. salicylate overdose |
ANSWER E
Normal AG metabolic acidosis |
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ANZCA Version Jul07
Intra-ocular pressure is increased by A. head-up B. hypothermia C. metabolic acidosis D. miosis E. respiratory acidosis |
ANSWER E
Increases ICP -Respiratory acidosis -MAP -Hypoxaemia -Straining -Blinking -Mydriasis Decreases ICP -metabolic acidosis -Miosis |
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PH60 [Apr07] [Jul07]
What raises intra-ocular pressure (IOP)? A. metabolic acidosis B. respiratory acidosis C. miosis D. reverse trendelenberg (head up) E. carbonic anhydrase inhibitor |
ANSWER B
Increases ICP -Respiratory acidosis -MAP -Hypoxaemia -Straining -Blinking -Mydriasis Decreases ICP -metabolic acidosis -Miosis |
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MC65 [Apr96] [Apr97] [Jul97] [2002-Mar] Q53, [2002-Aug] Q63, [2004-Apr] Q58, [2004-Aug] Q84, [Jul05] [Mar06] [Jul07]
Characteristic cardio-pulmonary effects of pulmonary thromboembolism include: A. hypoxaemia due to excess perfusion of lung units with a low V/Q ratio B. hypercarbia due to an increase in physiological dead-space C. reverse splitting of the second heart sound D. an increase in compliance of the left ventricle E. an increase in coronary blood flow to the right ventricle during systole |
ANSWER A
PE physiology (Nunn p551) * ↑ PVR 1. Physical occlusion 2. Platelet activation in thrombus → 5HT and TXA2 release → vasoconstriction → ↑ PVR * Respiratory lesion o ↑ alveolar deadspace o ↑ A-a gradient + Normal to low PaCO2 (in SV) because ↑ RR ? due to J-receptor stimulation + hypoxia * ↓ PaO2 o Deranged V/Q relationships o ↓ CO → low mixed venous O2 * Bronchospasm due to 5HT release from platelets * ↓ pulmonary compliance (still unknown mechanism) |
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MZ48 [Apr97] [Jul97] [Apr98] [Aug99] [2004-Aug] Q127, [2005-Apr] Q71, [Jul05] [Apr07] [Jul07]
Patho-physiological features of patients with morbid obesity include: A. A blood volume:body weight ratio which is similar to that of patients with normal body weight B. An increased blood pressure and systemic vascular resistance compared to that of patients with normal body weight C. Decreased gastric motility due to increased gastrin secretion D. Cardiac pathology resulting from excess body mass and increased metabolic demand E. Cardiac pathology resulting mainly from fatty infiltration or fatty change of the heart |
ANSWER D
A. FALSE: less than normal may be as low as 47ml/kg B. FALSE: BP increases but SVR declines because of increased CO C. FALSE: gastrin, HCl, pepsin, trophic action on stomach and intestine. However the decreased motility seen with gastrin is related to intragastric acid that can be inhibited by proton pump inhibitors. Lastly motility may be increased in obesity making the association incorrect. D. TRUE : Obesity ⇒ Increased blood volume ⇒ Increased stroke volume ⇒ Increased cardiac output ⇒ LV enlargement ⇒ LV wall stress ⇒ LV systolic and diastolic dysfunction ⇒ LV failure E. FALSE: Stoelting 447: "Increases in epicardial fat are common in obese individuals, but fatty infiltration of the myocardium is uncommon and not responsible for congestive heart failure." |
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MC153 [Jul07]
When viewing the central venous pressure trace: A. an accentuated "a" wave supports the diagnosis of atrial fibrillation B. a steeper than normal "x" descent supports the diagnosis of tricuspid regurgitation C. blunted "a" and "v" waves are associated with extensive right ventricular infarction D. flattened "x" and "y" descents are associated with pericardial constriction E. a monophasic pattern with obliteration of the "y" descent supports the diagnosis of pericardial tamponade |
ANSWER E
A - False * In atrial fibrillation, a waves will be absent, and in atrioventricular dissociation, a waves will be dramatically increased ("cannon waves") as the atrium contracts against a closed tricuspid valve. B - False * In tricuspid regurgitation, the c wave and x descent will be replaced by a large positive wave of regurgitation as the blood flows back into the right atrium during ventricular contraction C - False * Prom a and v waves with RV infarction due to (a wave) increased atrial pressure from contraction into stiff RV (kind of like increased RA afterload) and v waves increased as often assoc TR hence increased filling RA. D - False * Pericardial constriction – tall a and v waves, steep x and y descents E - True In cardiac tamponade, all pressure will be elevated, and the y descent will be nearly absent |
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PH 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 |
ANSWER C
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PH61 [Jul07] In a 140kg obese patient, compared to a 70 kg person
A. cardiac output >20% lower B. cardiac output 10% lower C. cardiac output no different D. cardiac output 10% higher E. cardiac output >20% higher |
ANSWER D
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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 |
ANSWER A or B
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MR44 ANZCA version [2003-Aug] Q148, [2004-Aug] Q89, [2005-Apr] Q85, [Mar06] Q82, [Jul06] Q70, [Mar10]
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 |
ANSWER C
* A. in obstructive disease the expiratory curve has a scooped out or concave appearance - true * B. in restrictive disease expiratory flows are usually decreased in relation to lung volume - some people are saying this is incorrect: Expiratory flows are decreased, as are lung volumes... this seems to be true to me. It would also make sense because in restrictive disease, the compliance of the lungs is decreased, so exp flow (a passive process) would be decreased more so than the actual lung volumes. * C. in restrictive disease the expiratory curve has a convex appearance - this sounds the most incorrect to me: the shape of the curve is similar to a normal flow-volume loop, just with a smaller magnitude * D. the expiratory curve is largely effort independent - true * E. the inspiratory curve is effort dependent - true |
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Plasma glucose level compared to blood glucose level
a)32% higher b)14% higher c)same d)14%lower e)32% lower |
ANSWER B
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NZ03 ANZCA version [2003-Aug] Q123, [2004-Apr] Q79, [Jul06] Q79, [Apr07] Q123, [Mar10]
Pre-ganglionic sympathetic fibres pass to the A. otic ganglion B. carotid body C. ciliary ganglion D. coeliac ganglion E. all of the above |
ANSWER D
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92. 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 ion and folate therapy E. associated with increased 2,3-DPG levels in blood cells |
ANSWER E
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93. Histamine release in anaphylaxis does NOT cause:
A. Tachycardia B. Myocardial depression C. Coronary artery vasodilatation D. Prolonged PR interval E. Decreased impulse conduction |
ANSWER B
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79. 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 |
ANSWER B
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56. 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. ? |
ANSWER B
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28. (NEW) Utility of BNP (brain naturietic peptide) is for
a. Dyspnoea after pneumonectomy b. Loss of consciousness after .. c. Confusion after CABG |
ANSWER A
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. |
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33. (NEW) 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 |
ANSWER A
pre-warming eliminates the gradient between core and peripheries thus the redistribution phase does not occur. |
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34. (NEW) Best way to assess fluid resuscitation after burns is
a. Urine output b. mixed venous sats c. blood pressure d. cvp e. capillary refill |
ANSWER A
Blue Book 2005 - "End points of resuscitation The optimal end points for burns resuscitation continue to generate much debate. Despite the administration of fluid therapy according to prescribed guidelines, problems frequently noted at the end of the burn resuscitation are generalized oedema, decreased efficiency of pulmonary gas exchange, hypoalbuminaemia and intermittent episodes of hypotension and oliguria. Some problems may indicate over resuscitation, whereas others are suggestive of ongoing hypovolaemia. Clinical examination, together with assessment of end organ perfusion (urine output 1⁄2 to 1 ml/kg/hr; intact sensorium), is the minimum assessment possible to guide burn resuscitation. Pulmonary artery catheters and other more invasive forms of monitoring of haemodynamic parameters have not been shown to improve outcome in surgical, medical or burns patients. Both subcutaneous and splanchnic oxygenation are sensitive indicators of evolving haemorrhagic shock, and have been used in burn care to monitor tissue oxygenation indices during burn shock and resuscitation.15 Recently, Rivers et al investigated the use of central venous oxygen saturation (ScvO2) as part of a package to guide therapy for severe sepsis, and showed an improvement in outcome when it was used in a single centre.16 However, the role of ScvO2 to guide resuscitation of burn shock is not established. A single centre Australasian study is planned. |
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64. 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 |
ANSWER B
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TMP-103 [Mar10] [Aug10]
What is the SVR in a patient with MAP 100mmHg, CVP 5, PCWP 15, CO 5L/min? A. ?0.8 B. ?3 C. 520 D. 1280 E. 1520 dynes.sec/cm-5 |
ANSWER E
# SVR = (Systemic A-V Pressure difference) / Flow # Therefore SVR = (100-5)/5 = 95/5 = 19 mmHg/L/min # To convert to dynes.sec/cm5 then multiply by 80; this gives us 1520 dynes.sec/cm5. |
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TMP-Jul10-045 How quickly does the CO2 rise in the apnoeic patient ?
A. 1 mmHg per min B. 2 mmHg per min C. 3 mmHg per min D. 4 mmHg per min E. 5 or ?8 mmHg per min |
ANSWER C
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TMP-Jul10-018 The STRONGEST stimulus for ADH secretion:
A. High serum osmolality B. Low serum osmolality C. Hypovolaemia D. High serum Na E. |
ANSWER C
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