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29 Cards in this Set
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SZ14 ANZCA version [2004-Apr] Q103, [2004-Aug] Q81, [Jul06] Q75, [Apr07]
In the recovery room, following general anaesthesia for renal transplant surgery, your patient is found to have a serum potassium concentration of 6 mmol.l-1, despite having a normal potassium concentration pre-operatively. His oxygen saturation is 96% on approximately 40% oxygen via a Hudson mask. He is still unconscious, but breathing spontaneously at 8 breaths per minute. The most likely cause of his hyperkalaemia is A. beta-blockers which he received peri-operatively B. catabolic stress of surgery C. opioid induced narcosis causing carbon dioxide retention D. renal graft failure E. washed red blood cell transfusion, which he received intraoperatively |
ANSWER C
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SZ14b ANZCA version [2004-Aug] Q130, [Jul07], [mar10]
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 |
ANSWER B
Treatment of hyperkalemia * If cardiac changes (ie emergent treatment) –> CaCl2 or CaGluconate (up to 0.5ml/kg) * If acidosis & urgent treatment required –> NaHCO3 * If urgent treatment required – Insulin dextrose or urgent dialysis. I generally avoid salbutamol infusions. * If it can wait or using other treatments in the meantime –> resonium (sodium polystyrene sulphonate) * Also: dietary modification, treatment of underlying problem. Causes of postop hyperkalaemia in renal transplant * Preop hyperkalaemia * Administration of K – university of wisconsin solution, blood. * Redistribution of K – acidosis, beta blockers could do it (b2 blocker) * Cell lysis/ischaemia |
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TMP-Jul10-016
A patient is having a trans-urethral resection of the prostate (TURP) under a spinal anaesthetic. He becomes confused. ABG: Na+ 117mmol/l. Normal gas exchange. Treatment? A. 10 ml 20% Saline as fast push IV B. 3% NS 100 ml/h C. Normal saline 200 ml/h D. Frusemide 40 mg IV E. Fluid restrict 500 ml/day |
ANSWER B
Treatment according to OHA (in the order in which it is given in the book): * Alert surgeon: Stop further resection and diathermy bleeding points. Then terminate surgical procedure. * Stop IV fluids * Give frusemide 40mg and check Na+ and Hb * Support respiration and ventilation if required * Administer IV anticonvulsants if fitting * Central pontine myelinolysis may result from BOTH over-rapid correction of chronic hyponatraemia AND acute severe hyponatraemia * If the serum Na+ has fallen acutely ,120mmol/L and is assoc. with neurological signs, consider giving hypertonic saline (2N/S or 3%) to restore Na to around 125mmol/L * Give 1.2-2.4 mL/kg/hr of 3% Saline until symptoms improve or Na+ >125mmol/L. This should produce a rise in serum Na+ of 1-2 mmol/L/hr * Beware of compounding effects on Na+ by other simultaneous treatments (eg diuretics, colloids etc) * Admit to ICU/HDU for management including regular Measurement of Na+ |
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SZ11 ANZCA version [2003-Aug] Q111, [Mar06] Q94, [Jul06] Q57, [Jul07], [Apr08] [Aug09] Aug10
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 |
ANSWER B
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SZ22 ANZCA version [2005-Apr] Q129, [Mar06] Q87, [Jul06] Q88
Regarding a patient presenting for renal transplantation due to diabetic nephropathy, which of the following statements is LEAST correct? A. angiotensin-converting enzyme (ACE) inhibitors are probably best discontinued preoperatively B. dialysis is indicated if serum potassium concentration exceeds 6 mmol.1-l C. intravenous access should preferably be obtained in a forearm vein of the non-fistulous arm D. suxamethonium causes a rise in serum potassium concentration of up to 0.6 mmol.1-l E. temporomandibular joint rigidity may be present |
ANSWER C
A - True - ACEI are best discontinued preop - can impair graft renal perfusion B - True - Dialysis is routinely performed pre transplant in all cases at my hospital - potential recipients usually have 3-4 hrs notice prior to receiving their transplant. C - False - IV access preferably should not be in either forearm. While the non fistulous forearm is probably preferable to the forearm with the fistula, ideally one would try the back of the hand for induction, then CVC once asleep, to preserve the forearm veins for future Artero Venous Fistulas. For the same reasons Arterial lines are not routine for renal transplants at my hospital D - True - Sux can cause a rise in K+ of up to 0.6mmol/l. E - True - TMJ rigidity may be present (or it may not). |
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SZ27 ANZCA Version 2006-Mar Q100, [Jul06] Q22
The following measures have been shown to reduce intraoperative blood loss in some surgical situations, EXCEPT A. arterial hypotension (MAP = 50 mmHg) B. controlled ventilation C. hypothermia (less than 34°C) D. maintenance of a low central venous pressure E. regional anaesthesia |
ANSWER C
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AC151 ANZCA Version [Jul06] Q112, [Apr07]
Which of the following contributes the LEAST to motor neuropathy following the lithotomy position? A. age B. BMI (body mass index) >25 C. diabetes D. peripheral vascular disease E. smoking |
ANSWER B
Risk factors for lower extremity neuropathies, especially peroneal: * Surgical Factors * Improper lithotomy position * Extreme high lithotomy position * Prolonged maintenance of lithotomy (>2 hours) * Patient Factors * Hypotension * Thin body habitus * Old age * History of vascular diseasae * Diabetes * Smoking |
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RH23 ANZCA version [Apr99] [Aug99] [2001-Aug] Q12, [2002-Mar] Q30, [2003-Aug] Q29, [2005-Apr] Q44, [Apr07]
Advantages of local anaesthesia for middle ear surgery compared with general anaesthesia do NOT include A. avoidance of problems with middle ear pressure B. a drier surgical field C. ability to monitor facial nerve integrity D. ability to monitor hearing E. substantial reduction in post-operative nausea and vomiting |
ANSWER C
# A. avoidance of problems with middle ear pressure - true: Assuming you have problems with middle ear pressure with GA, LA would avoid this. # B. a drier surgical field - true: ENT surgeons will use adrenaline in the LA and have a drier surgical field. # C. ability to monitor facial nerve integrity - false and answer to choose: CN VII can be monitored under GA or LA, but LA frequently tracks around to block the facial nerve rendering monitoring impossible. # D. ability to monitor hearing - true: hard to monitor hearing under GA # E. substantial reduction in post-operative nausea and vomiting - true: "The group that received the GAN block also had a less frequent incidence of vomiting requiring intervention (7 versus 19) during their entire hospitalization or at home (P = 0.027). The GAN-Block group also had more patients who never experienced vomiting (13 of 20 versus 5 of 20, P = 0.026). In this cohort, a peripheral nerve block decreased the overall incidence of postoperative vomiting thereby reducing associated costs. |
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AC108a ANZCA version [2001-Aug] Q60 (Similar question reported in [Jul00])
A healthy 20 year old patient undergoing nasal surgery under general anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrine and a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and the heart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to A. deepen anaesthesia with isoflurane B. administer labetalol C. watch and observe D. administer glyceryl trinitrate E. administer sodium nitroprusside |
ANSWER B
"Hypertension induced by topically applied α agonist may not require treatment. The duration of action of phenylephrine is short, and hypertension may resolve spontaneously before treatment is started. Severe hypertension needs to be treated, but therapy must not reduce the ability of a stressed myocardium to increase contractility or heart rate." - Only labetalol has been associated with death. Esmolol has only been associated with pulmonary oedema due to its short half life. "The two β-blocking agents used to control hypertension intraoperatively in reviewed cases were esmolol and labetalol. Both drugs were associated with the development of pulmonary edema. Only labetalol use was associated with death. Esmolol's brief duration of β-blocking activity may have been responsible for pulmonary edema not progressing to cardiac arrest and death." - The hypotensive actions of GTN, SNiP and Isoflurane are predominantly due to peripheral vasodilatation and hence would be appropriate. B-blockade results in negative cardiac inotropy with unapposed peripheral alpha vasoconstriction (ie. In pheochromcytomas) and hence are inappropriate. |
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AZ80 ANZCA version [2005-Sep] Q107, [Jul07] Mar10 Aug10
Which of the following is NOT an absolute contraindication to magnetic resonance imaging? A. cardiac pacemaker B. cerebral aneurysm clips C. cochlear implant D. implanted defibrillator E. prosthetic heart valve |
ANSWER E
Absolute Contraindications * electronically, magnetically, and mechanically activated implants: * cardiac pacemakers * ferromagnetic or electronically operated stapedial implants * hemostatic clips (CNS) * metallic splinters in the orbit Relative Contraindications * electronically, magnetically, and mechanically activated implants: * other pacemakers, e.g., - for the carotid sinus; - insulin pumps and nerve stimulators; - lead wires or similar wires * non-ferromagnetic stapedial implants * cochlear implants * prosthetic heart valves (in high fields, if dehiscence is suspected) * hemostatic clips (body) * makeup and tattoos * congestive heart failure * pregnancy (claustrophobia) |
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AZ03 ANZCA Version [Jul07]
The single best predictor of difficult intubation in a morbidly obese patient is A. body weight B. history of snoring C. Mallampatti score D. neck circumference E. thyro-mental distance |
ANSWER D
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AZ78 ANZCA Version [2006-Mar] Q124 [Jul07]
A 25-year-old 80 kg male with no other health problems is undergoing ECT (electroconvulsive shock therapy) for severe depression. Anaesthesia for his first 2 treatments consisted of thiopentone 350 mg and suxamethonium 50 mg. The treating psychiatrist is concerned at the limited duration of seizure activity with treatment despite maximal seizure stimulus. An acceptable seizure duration would be best be achieved by: A. adjunctive use of remifentanil to reduce the dose of induction agent B. clonidine premedication C. hypoventilating the patient to reduce seizure threshold D. pretreatment with lignocaine to reduce seizure threshold E. using propofol instead of thiopentone for induction of anaesthesia |
ANSWER A
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AZ04 ANZCA Version[Jul07]
Which of the following statements regarding infection control is FALSE? A. devices to be used in the upper airway that may cause bleeding must remain sterile until used B. provided there is an adequate filter between the patient and the breathing circuit, the circuit can be re-used for subsequent patients on an operating list C. when performing central neural blockade, the anaesthetist must adopt a full aseptic technique D. when performing central venous cannulation, the anaesthetist must adopt a full aseptic technique E. when performing vascular cannulation, the anaesthetist must wash hands and should wear gloves |
ANSWER A
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AZ02 ANZCA Version [Jul07]
A healthy female patient is undergoing a laparoscopic sterilisation under a relaxant based general anaesthetic. Which of the following monitors does NOT have to be in continuous use? A. Capnograph B. Electrocardiogram C. Oximeter D. Oxygen analyser E. Ventilator disconnect alarm |
ANSWER B
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TMP-Jul10-009
Predictive factors for perioperative mortality in an elderly patient (except): A. Aortic stenosis B. Diabetes mellitus C. Elevated creatinine D. Cognitive dysfunction E. Type of surgery |
ANSWER D
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TMP-Jul10-011
Elderly patient. Indications for pre femoro-popliteal bypass angiogram include all EXCEPT: A. Severe heart failure B. Suspicion of left main coronary artery disease C. Symptomatic tachyarrhythmia D. Unstable angina E. Stable angina with positive thallium scan |
ANSWER C
The more recent article: ACC/AHA Guideline Update (Eagle et al. JACC Vol. 39, No. 3, 2002 February 6, 2002:542–53) Lists options A, B, D, and E as indications for a coronary angiogram. Here are the relevant parts: Class I: Patients With Suspected or Known CAD 1. Evidence for high risk of adverse outcome based on noninvasive test results. 2. Angina unresponsive to adequate medical therapy. 3. Unstable angina, particularly when facing intermediate- risk* or high-risk* noncardiac surgery. Hence D indicated 4. Equivocal noninvasive test results in patients at high clinical risk† undergoing high-risk* surgery. Hence B is indicated Class IIa 1. Multiple markers of intermediate clinical risk† and planned vascular surgery (noninvasive testing should be considered first).Hence A is indicated 2. Moderate to large ischemia on noninvasive testing but without high-risk features and lower left ventricular ejection fraction. 3. Nondiagnostic noninvasive test results in patients at intermediate clinical risk† undergoing high-risk* noncardiac surgery.Hence E is indicated 4. Urgent noncardiac surgery while convalescing from acute MI. |
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Black Bank March 2011
41. NEW. 75 year old male with normal renal function for an endoluminal aortic repair. What is the best protection to prevent the development of renal dysfunction? A: NaCl B: NAC C: mannitol D: dopamine E: dialysis |
ANSWER E
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SZ26 [Apr07]
A 40 pack year smoker complains of progressive dyspnoea. He has had stridor for the last 3 weeks, worsening in the last week. He is awoken at night with breathlessness. In the emergency department he has moderate stridor is sitting upright and has saturations of 95%. Your next step in management is: A. Awake fibreoptic B. CT neck C. Nasendoscopy with topical anaesthesia D. Assessment after gaseous anaesthetic induction E. Tracheostomy under local anaesthesia |
ANSWER C
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SZ25 [Apr07]
A six year old boy requires return to theatre for arrest of post-tonsillectomy haemorrhage. When anaesthetising for this procedure it is important to: A. avoid sedative premedication prior to induction B. avoid volatile anaesthesic agents C. have duplicate suction apparatus and ETTs available D. use an uncuffed endotracheal tube in this age group E. RSI |
ANSWER C
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SZ24 ANZCA version [2004-Aug] Q101 [Jul 07]
Of the options below, the best anaesthetic method for ophthalmic examination under anaesthesia in a co-operative mentally retarded adult (without aspiration risk) is intravenous induction and A. intermittent positive pressure ventilation via endotracheal tube B. intermittent positive pressure ventilation via laryngeal mask airway C. spontaneous ventilation with inhalational agents via facemask D. spontaneous ventilation with inhalational agents via laryngeal mask airway E. ketamine and spontaneous ventilation via cut-down Hudson mask |
ANSWER C
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SZ23 [Mar06] Q102
Regarding decontamination of anaesthetic equipment A. alcohol is sporicidal B. disinfection is sporicidal C. phenol is sporicidal D. sterilisation with ethylene oxide requires 5-12 hours to work E. sterilisation with glutaraldehyde requires 5-8 exposure hours to work |
ANSWER D
This question was from CEA article on disinfection BJA CEA Vol4 No4 2004 (see Reference below) * Disinfection, alcohol and phenol are all NOT sporicidal - ie. A,B,C all wrong. * High-disinfection is sporicidal. * Ethylene oxide requires 5 - 12 hours * Gluteraldehyde requires immersion in 2% solution for 10 hours to sterilise. 20 minutes is adequate to disinfect endoscopes. Depending on temperature, ethylene oxide will sterilise in 5 hours. So it seems that this would be the best answer. |
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SZ21 ANZCA version [2004-Aug] Q144, [2005-Apr] Q80
In maxillo-facial trauma A. external soft tissue signs correlate with actual skeletal disruption B. Le Forte fractures rarely occur in combination (e.g. Le Forte 1 and 2) C. Le Forte 1 fractures should NOT be intubated nasally D. Le Forte 2 fractures require base of skull evaluation before nasal intubation E. Le Forte 3 fractures involve a fracture of the cribriform plate |
ANSWER D
Le Fort classification I - Transvers fractures of the mid-lower maxilla II - Triangular fracture from top of the nose to the base of the maxilla III - Severe fractures with disruption of facial bones from the skull. Cribriform plate disruption and CSF leak common. In reality, the Le Fort classification is an oversimplification of maxillary fractures. In most instances, maxillary fractures are a combination of the various Le Fort types. Fracture lines often diverge from the described pathways and may result in mixed-type fractures, unilateral fractures, or other atypical fractures. In addition, in very high-energy blows, maxillary fractures may be associated with fractures to the mandible, cranium, or both (ie, panfacial). Perform repair of any significant maxillary fracture requiring reduction and fixation in the operating room with the patient under general anesthesia. Because of the need for MMF [maxillo-mandibular fixation], intubate the patient with a nasotracheal tube. |
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SZ20 ANZCA version [2004-Aug] Q100, , [2005-Apr] Q84, [Apr07]
In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by A. angiography B. direct ophthalmoscopy C. indirect ophthalmoscopy D. intra-ocular pressure tonometry E. palpation of the globe by an experienced clinician |
ANSWER B
Management of retrobulbar haemorrhage the use of direct ophthalmoscopy to assess pulsation of the central retinal artery. |
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SZ19 ANZCA version [2004-Aug] Q122, [2005-Apr] Q68, [Mar06] Q29, [Jul06] Q3
The most correct statement regarding the Child-Pugh score for liver disease is that A. a high-risk score is not possible with normal aminotransferase levels B. a high-risk score is possible without encephalopathy C. a prothrombin time greater than 10 seconds above normal confers extra points to the raw score D. it has not been validated for non-shunt and non-transplant laparotomies E. it was originally developed for patients undergoing hepatic transplantation |
ANSWER B
* A False - AST/ALT not part of classification * B True - could score 13/15 without encephalopathy (>9 is Class C) * C False - more than 6 secs scores a 3 (see below) * D False - it was initially used in the context of non-shunt & non-transplant laparotomies * E False |
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SZ12 ANZCA version [2001-Apr] Q148 (type K)
In patients with a single lung transplant, obliterative bronchiolitis 1. is a more common cause of death than either rejection or infection of the transplanted lung 2. is usually a complication occurring more than six months after transplantation 3. can also affect their native, non-transplanted lung 4. typically presents with a cough suggestive of a mild respiratory tract infection |
ANSWER 2 and 4
Obliterative bronchiolitis (chronic rejection) * Chronic rejection characterized by obliterative bronchiolitis commonly presents 6-18 months after transplantation. * The diagnosis of obliterative bronchiolitis is based on physiologic and pathologic criteria. * A sustained decrease in FEV1 generally is followed by fiberoptic bronchoscopy and transbronchial biopsy to exclude rejection. * The incidence of obliterative bronchiolitis is highest during the first 2 years following lung transplantation. However, the risk of obliterative bronchiolitis may increase to 60-80% 5-10 years after the lung transplantation procedure. It is the most important complication that adversely affects the long-term survival of graft recipients. * Symptoms occur secondary to the airflow obstruction that progresses over time. o These patients develop exertional dyspnea, a nonproductive cough, wheezing, and/or low-grade fever. o Although the symptoms resemble bronchial asthma, the limited response to bronchodilator and corticosteroid therapy makes these ineffective. * Obliterative bronchiolitis has a variable course. o The disease may be progressive, it may plateau, or it may progress gradually in a stepwise fashion. Therefore, early detection of this complication is paramount. o Obliterative bronchiolitis is staged according to the level of airflow obstruction as measured by FEV1. Four stages are described, based on severity, from grade 0 to grade III, as follows: + Stage 0 – FEV1 greater than 80% of baseline + Stage I – FEV1 66-80% of baseline + Stage II – FEV1 51-65% of baseline + Stage III – FEV1 50% or less of baseline o Pathologically, bronchiolar inflammation and narrowing of the lumen are present, and bronchiectasis is present in larger airways. o The active lesions demonstrate lymphocytic inflammation and the formation of granulation tissue. Fibrotic tissue compromises the airway lumen in a constrictive fashion. o In advanced stages, collagen is deposited and fibrosis of the bronchiolar wall can cause occlusion of the lumen. |
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SZ09 ANZCA version [2001-Aug] Q75, [2002-Mar] Q20, [2003-Aug] Q44, [2004-Apr] Q5
In cadaveric donor renal transplantation the intra-operative measure most likely to improve immediate graft function and transplant outcome is A. administration of 200 mg frusemide intravenously prior to unclamping of the newly grafted kidney B. aggressive intra-operative volume expansion to central venous pressures of 10-15 mmHg C. administration of 50g mannitol intravenously prior to unclamping of the newly grafted kidney D. use of a low dose dopamine infusion (2 microgramug.kg-1.min-1) perioperatively E. administration of 0.8 g.kg-1 albumin intravenously prior to unclamping of the newly grafted kidney |
ANSWER B
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SZ08 ANZCA version [2001-Aug] Q92, [2002-Mar] Q48
The LEAST effective method of protecting the spinal cord during surgery on the descending thoracic aorta is A. reducing the duration of ischaemia B. lowering the CSF (cerebrospinal fluid) pressure C. spinal cord hypothermia D. administration of thiobarbiturate E. use of shunts to bypass the aortic cross-clamp |
ANSWER D
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SZ05 [Aug94]
Cold, pulseless right arm. Causes: A. Recent myocardial infarction B. Subacute bacterial endocarditis C. Atrial fibrillation D. Polycythaemia rubra vera |
ANSWER ALL
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SZ04 [Sep90] [Aug96]
The most appropriate level of spinal anaesthesia for TURP: A. T8 B. T10 C. L4 D. S1 E. ? |
ANSWER B
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