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49 Cards in this Set
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[2004 May]
The values of static vacuum and minimum gas flow recommended for satisfactory anaesthetic and surgical suction are A. 40 Kpa and 40 l.min-1 B. 40 Kpa and 60 l.min-1 C. 50 Kpa and 30 l.min-1 D. 60 Kpa and 40 l.min-1 E. 60 Kpa and 50 l.min-1 |
D. 60 Kpa and 40 l.min-1
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[Mar12][Aug12] NEW: Blood flow across which of the following is used to estimate pulmonary artery pressures during echocardiography?
A. Tricuspid valve B. Pulmonary valve C. Mitral Valve |
A. Tricuspid valve
-- But need TR. see online textbook on TOE. ----------- |
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[Mar12][Aug12] REPEAT: Air bubble in arterial line. Causes decreased:
A Damping B Resonant freq of system |
B
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[May09][Oct09] What is true regarding arterial pressure transducer systems
a. Underdamping overestimates systolic BP b. Underdamping underestimates SBP c. Compliant tubing? d. wide range of damping coefficient associated with good performance if system has high natural frequency |
A and D? see EM68
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EC17 [Apr07] Q139, [Jul07][Oct08]
You have anaesthetised a patient with a partially obstructing right main bronchus tumour. You are using Heliox (28% O2:72% He) and sevoflurane. You secure the airway with an endotracheal tube and continue with the same gas mixture. After 20 minutes the ETCO2 is 28mmHg. The capnogram waveform is normal. This probably means the patient is A. Appropriately ventilated with a low cardiac output B. Appropriately ventilated with a normal cardiac output C. Hypothermic (34C) D. Hyperventilating E. Hypoventilating |
B. Appropriately ventilated with a normal cardiac output
Anesthesia 2003. 58:156-160 Capnography is considered essential in the management of mechanically-ventilated patients. Helium, as an adjunct to mechanical ventilation, is the subject of renewed interest and used increasingly. However, helium affects the performance of infrared capnometry. We constructed a simple device to generate variable mixtures of helium, oxygen and carbon dioxide within the normal physiological range, and tested the performance of two side-stream and one in-line capnographs. We found that addition of helium to the gas mixture caused all three capnographs to underestimate the concentration of carbon dioxide. The underestimation increased as the proportion of helium increased. The maximum underestimation (30%) occurred in a 79:21 helium ⁄ oxygen mixture. Also, the answer is conveniently 40mmHg x 70% = 28mmHg which is exactly rhe same as Answer B. ----------- |
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EM04
Appropriate features of ECG measurement technique or interpretation include: A. Placement of the V2 electrode in the third left intercostal space just to the left of the midline B. Placement of the V6 electrode in the anterior axillary line C. The use of the 'diagnostic' mode when monitoring for ischaemia because a wider range of artifacts is filtered D. A lower likelihood of myocardial ischaemia if an upsloping ST segment is observed compared with a similar degree of ST depression with a downslope |
D. A lower likelihood of myocardial ischaemia if an upsloping ST segment is observed compared with a similar degree of ST depression with a downslope
~~ "The ST-segment depression seen with nontransmural ischemia typically is either horizontal (flat) or downsloping,and the ST segment is usually quite straight ... Upsloping ST depression, on the other hand, much less often represents ischemia and, in fact, is quite normal during periods of exercise or other causes oftachycardia." ➭ Downsloping ST depression is more indicative of myocardial ischaemia compared to upsloping ➭ V2: 4th intercostal space, left sternal border ➭ V6: 5th intercostal space, midaxillary line ➭ Diagnostic mode filters the least amount of information ----------- V1: 4th intercostal space, right sternal border V2: 4th intercostal space, left sternal border V3: midway between V2 and V4 V4: 5th intercostal space, midclavicular line V5: 5th intercostal space, anterior axillary line V6: 5th intercostal space, midaxillary line |
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EM08
The best method for QUANTIFYING the presence of venous air embolism in (?sitting position in) neurosurgery is: 1. PA catheter 2. ET pCO2 monitoring 3. Oesophageal stethoscope 4. Precordial Doppler |
4. Precordial Doppler
TOE ...................... Sensitivity : 0.02ml/kg ... Specificity : Not Absolute Precordial Doppler .. Sensitivity : 0.2mg/kg .....Specificity : Moderate End Tidal N2 .......... Sensitivity : 0.1ml/kg ..... Specificity : Absolute BJA CEPD Review Vol 2, No 2, 2020 Gas embolism in Anaesthesia ----------- |
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EM08c ANZCA Version [Aug04]
Regarding venous air embolism (VAE) during posterior fossa neurosurgery A. attempts to aspirate air from the caval-atrial junction are of little value B. children are at greater risk than adults C. Doppler ultrasonography is the most specific monitor available D. end-tidal nitrogen monitoring is the most sensitive monitor available E. positive end-expiratory pressure (PEEP) should be used in patients with intra-cardiac shunts |
A. attempts to aspirate air from the caval-atrial junction are of little value
➭ children are probably at lower risk (BJA 88 (1):12-17 ➭ TOE most sensitive (can detect 0.02 ml/kg) - 10x more sensitive cf precordial doppler ➭ ETCO2 is most specific ➭ No evidence for PEEP (BJA 80(1):30-35 ----------- |
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EM08d ANZCA Version [Apr08]
The most sensitive monitor for detecting venous gas embolism during neurosurgery is a: A. Capnograph B. Praecordial Doppler transducer C. Praecordial stethoscope D. Pulmonary Artery Catheter E. Transoesophageal echocardiograph |
E. Transoesophageal echocardiograph
- From Anesthesiology 2007; 106:164-77 'Diagnosis and treatment of vascular air embolism': A. capnograph - false - The ETCO2 monitor is the most convenient and practical ASA monitor used in the operative room. A change of 2mmHg ETCO2 can be an indicator of VAE. Unfortunately it is not very specific, and its reliability in the event of systemic hypotension is difficult to assess. B. praecordial doppler transducer - false - the precordial doppler is the most sensitive of the NONINVASIVE monitors, capable of detecting as little as 0.25mL of air (0.05ml/Kg). The doppler probe (typically 2-5mHz) can be placed on either the right or left sternal border or between the right scapula and spine. The first discernible evidence of VAE is a change in the character and intensity of the emitted sound. C. Praecodial stethoscope - false - The sensitivity of the ESOPHAGEAL stethoscope has been shown to be very low in detecting a mill wheel murmur (1.7ml/kg/min) D. PAC - false - relatively insensitive monitor of air entrainment (0.25mL/kg), being inferior to the precordial doppler and far too invasive for a patient who has no other comorbitidities requiring its use. E. TOE - TRUE - This instrument is the MOST SENSITIVE monitoring device for VAE, detecting as little as 0.02mL/kg of air administered by bolus injection. It permits detection not only of venous macroemboli and microemboli, but also paradoxical arterial embolization that may result in ischemic cerebral complications. Notwithstanding, transesophageal echocardiography (TEE) has been said to be almost too sensitive, detecting virtually any amount of air in the circulation, most leading to no adverse sequelae. The counter argument is that the presence of any volume of air should alert the anesthesiologist to institute prophylactic measures, reducing the risk of further entrainment. ----------- |
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EM11
You are assessing the circulation of a patient using a pulmonary artery catheter. The mean arterial blood pressure is 100 mmHg, CVP is 5mmHg. The wedge pressure is 15 mmHg and the cardiac output is 5 L.min-1. In this patient the systemic vascular resistance (in dynes.sec.cm-5) is A. 3.2 B. 3.8 C. 150 D. 1280 E. 1520 |
E. 1520
SVR = [(MAP - RAP) ÷ CO] × 79.9 (dyne.cm.sec-5) ----------- |
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EM14a ANZCA version [2002-Aug]
The most reliable clinical sign to demonstrate reversal of neuromuscular blockade is A. ability to abduct an arm to shoulder level. B. a normal vital capacity. C. a maximum inspiratory pressure of minus 25 cm H2O D. a sustained hand grip for 5 seconds E. protrusion of the tongue |
D. a sustained hand grip for 5 seconds
Miller ➭ Fade at 200Hz is best monitor with highest sensitivity ➭ sustained head lift / hand grip > 5 seconds is best clinical assessment ➭ inspiratory force > -50 cmH2O is also clinically sensitive ----------- |
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EM14b ANZCA version [2005-Apr] Q125
The best clinical sign to demonstrate adequate reversal of neuromuscular blockade is A. maximum inspiratory pressure of 25 cmH2O B. normal vital capacity (VC) C. protrusion of the tongue D. sustained eye opening E. sustained head lift |
E. sustained head lift
Miller ➭ Fade at 200Hz is best monitor with highest sensitivity ➭ sustained head lift / hand grip > 5 seconds is best clinical assessment ➭ inspiratory force > -50 cmH2O is also clinically sensitive ----------- |
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EM16b ANZCA version [2002-Mar] Q68, [2002-Aug] Q64, [2005-Apr] Q94, [2005-Sep] [Apr08] [Sep11] [Mar12] [Aug12]
Circuit disconnection during spontaneous breathing anaesthesia A. will be reliably detected by a fall in end-tidal carbon dioxide concentration B. will be detected early by the low inspired oxygen alarm C. will be most reliably detected by spirometry with minute volume alarms D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration E. can be prevented by using new, single-use tubing |
D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
CJA 48:847-849 (2001) A breathing circuit disconnection detected by anaesthetic agent monitoring ----------- |
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EM20
Clinical information about the likelihood of awareness during general anaesthesia CANNOT be usefully obtained using: A. Somatosensory evoked spinal cord potentials B. Electroencephalogram frequency C. Lower oesophageal contractility D. Isolated forearm technique E. Electroencephalogram latency and amplitude of evoked potentials |
A. Somatosensory evoked spinal cord potentials
- SSEPs do not measure cortical activity ----------- |
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EM28
The capnograph below is most consistent with A. a hypermetabolic state B. incomplete expiration C. the presence of a right-to-left shunt D. ventilation via a Circle System E. ventilation via a Mapleson D System |
E. ventilation via a Mapleson D System
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EM28c ANZCA version [Mar02][Aug02]
This sidestream capnograph tracing during mechanical ventilation using a circle absorber system is NOT consistent with (see actual paper for diagram) A. a stuck open expiratory valve B. a stuck open inspiratory valve C. exhaustion of soda-lime D. a leak in the inspiratory limb on the patient side of the inspiratory valve E. a leak in the inspiratory limb on the ventilator side of the inspiratory valve |
E. a leak in the inspiratory limb on the ventilator side of the inspiratory valve
The actual capnograph shows a rising CO2 during the inspiratory phase. This means that the patient is inhaling gas containing CO2. A. Stuck open exp. valve. If the expiratory valve is stuck open, during inhalation, CO2 containing gas will be entrained from the expiratory limb. So this is consistent with the capnogram. B. Stuck open insp. valve. During expiration, gas will pass into the inspiratory and the expiratory limbs of the circuit. During the next breath the inhaled gass will contain CO2. C. Exhaustion of soda lime. Not the classic appearance of a raised base line, but not impossible? D. A leak in the inspiratory limb on the patient side of the valve Same reasoning as for inspiratory valve stuck open. E. A leak in the inspiratory limb on the ventilator side of the valve The correct answer. This couldn't lead to entraining of CO2. ----------- |
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EM31
The end tidal CO2 partial pressure (PetCO2) may be greater than the arterial CO2 partial pressure (PaCO2). Causes of this do NOT include A. transitory variations in V/Q matching and deadspace B. breathing with small tidal volumes C. PaCO2 fluctuations during the respiratory cycle D. exercise E. slow emptying of long time constant alveoli containing CO2 levels approximating mixed venous CO2 |
B. breathing with small tidal volumes
Causes of a negative ETCO2 to PaCO2 gradient: ➟ pregnancy ➟ exercise ➟ large tidal volumes "Reasons for this include slow emptying of long-time constant alveoli containing CO2 levels approximating mixed venous CO2, transitory variations in V/Q matching and deadspace, the use of low frequency ventilation and PaCo2 fluctuations during the respiratory cycle" A&IC 1994 Capnography article see www.capnography.com/Physiology/Negative.htm ----------- |
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EM35c [Jul06] [Apr07]
TOE (trans-oesophageal echo): Picture of transgastric midpapillary short axis view arrow pointing to lump at the back. Is this the: A. posterolateral papillary muscle B. posteromedial papillary muscle C. anterolaterlal papillary muscle D. mitral valve outflow [note there was a handy key to the left of the image to show anterior vs inferior, left vs right] |
B. posteromedial papillary muscle
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EM37 [Sep11][Mar12][Aug12]
Systemic vascular resistance index (SVRI) is calculated from A. systemic vascular resistance multiplied by body surface area B. systemic vascular resistance divided by body surface area C. mean aortic and central venous pressure difference divided by cardiac output D. cardiac index divided by the mean aortic and central venous pressure difference E. none of the above |
A. systemic vascular resistance multiplied by body surface area
SVR = ((MAP - CVP) *80)/CO CI = CO / BSA SVRI calculated by substituting CI for CO in the equation for SVR ie. SVRI = ((MAP - CVP) / CI ----------- |
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EM38
Optimal conditions for accurate invasive blood pressure monitoring include A. a large bore cannula, a system with a damping coefficient of 0.7 and a resonant frequency of 50 Hz B. wide bore tubing, a transducer with a frequency response range of 0 to 7 Hz, and a system with a resonant frequency of 3 Hz C. low compliance tubing, a system with a resonant frequency of 40 Hz and a damping coefficient of 1.0 D. high compliance tubing, a system with a resonant frequency of 10 Hz and a maximum phase lag E. a system with a minimum volume of fluid, a damping coefficient of 0.1 and a resonant frequency of 14 Hz |
A. a large bore cannula, a system with a damping coefficient of 0.7 and a resonant frequency of 50 Hz
- Higher resonant frequency systems can tolerate wider range of damping coefficients ----------- |
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EM39 [Apr03][Mar12][Aug12]
The presence of small bubbles of air in an invasive arterial pressure monitoring system will always decrease the A. damping coefficient of the system B. resonant frequency of the system C. recorded systolic pressure D. recorded mean pressure E. extinction coefficient of the system |
B. resonant frequency of the system
Bubbles ➭ always increase the damping coefficient ➭ always decrease the resonant frequency ➭ may cause a lower recorded systolic pressure ➭ never alter the recorded mean pressure (only dependent on static accuracy) ➭ an extinction coefficient is the fraction of light lost to scattering and absorbtion per unit distance in a participating medium - nothing to do with transducers! ----------- |
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EM40 [Sep05][Jul06]
A Swan-Ganz catheter can be unreliable for measuring pulmonary artery systolic and diastolic pressures because the length and compliance of the tubing affects the measuring system by A. reducing its resonant frequency B. reducing its frequency response C. reducing its damping coefficient D. inducing a zero error E. inducing baseline drift |
A. reducing its resonant frequency
To accurately measure systolic and diastolic pressures with a catheter transducer system, the system needs to have an appropriate dynamic response. The dynamic response can be summarised by using just 2 characteristics of the system: • resonant frequency • damping coefficient. Long compliant tubing reduces the resonant frequency AND increases the damping coefficient. Poorly worded question (from KB himself) - see wiki for more details. ----------- |
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EM41
The pulmonary artery catheter A. provides a sensitive monitor for myocardial ischaemia by measurement of pulmonary capillary wedge pressure (PCWP) B. may be safely inserted 7 days after transvenous pacemaker wire placement C. is contraindicated in patients with bifascicular conduction block on the ECG D. frequently causes significant tricuspid valve regurgitation E. when wedged, enables reliable detection of mitral valve regurgitation by noting the presence of 'v' waves |
E. when wedged, enables reliable detection of mitral valve regurgitation by noting the presence of 'v' waves
- The pulmonary artery catheter A. provides a sensitive monitor for myocardial ischaemia by measurement of pulmonary capillary wedge pressure (PCWP) False, sensitive 25%, SPECIFICITY 99% B. may be safely inserted 7 days after transvenous pacemaker wire placement False C. is contraindicated in patients with bifascicular conduction block on the ECG False Bifasicular block refers to the situation where two of the three conducting pathways are blocked. It commonly refers to a RBBB with L anterior or posterior fasicular block. D. frequently causes significant tricuspid valve regurgitation False Increase TR jet by > 1cm2 in 17% of patients. However probably not clinically significant. On the other hand it may be mathematically significant. Anesth Analg 2001;92:1117-1122 E. when wedged, enables reliable detection of mitral valve regurgitation by noting the presence of ‘v’ waves TRUE Barash: Large V waves may represent mitral regurgitation, non compliant left atrium or left to right intracardiac shunt. IT WOULD BE SENSITIVE TO THIS BUT NOT SPECIFIC. ----------- |
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EM45
When stimulating the ulnar nerve at the wrist to monitor neuromuscular blockade, A. supramaximal currents in excess of 80mA will stimulate the adductor pollicis directly B. the sensitivity for assessment of neuromuscular blockade is the same as when stimulating the facial muscles C. adult size large ECG dot electrodes require the same current as paediatric size ECG dot electrodes D. monitoring in the presence of an upper motor neuron lesion will underestimate the neuromuscular block E. double burst stimulation is a reliable way to estimate the degree of blockade |
D. monitoring in the presence of an upper motor neuron lesion will underestimate the neuromuscular block
- A False Appears to be a safety feature...Miller B False Facial muscles less sensitive therefore may underestimate block Response may better reflect extent of muscular paralysis of the layrngeal adductor muscles (and the diaphragm?)...Miller C False Different conducting area requires different currents D True BEST ANSWER UMN → resistance to NMB because of upregulation of AChRc's (Stoelting p200) UMN → peripheral nerve stimulator underestimates degree of blockade [present at the muscles of ventilation, not the ulnar nerve NMJs](Stoelting p200) E False Assess light block only ----------- |
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EM46
The risk of complications with insertion of a Swan-Ganz catheter is increased in all of the following EXCEPT A. Coagulopathy B. left bundle branch block C. prosthetic right heart valve D. recently inserted endocardial pacemaker leads E. aortic stenosis |
E. aortic stenosis
- long wiki debate. ----------- |
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EM48
In a patient being ventilated under general anaesthesia, end tidal CO2 monitoring would allow detection of all of the following EXCEPT A. circuit disconnection B. a malfunctioning inspiratory valve C. venous air embolism D. hypovolaemic shock E. endobronchial intubation |
E. endobronchial intubation
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EM52b ANZCA version [2003-Apr] Q67, [2003-Aug] Q69, [Jul06] Q61
The following capnograph tracing is most likely to represent A. partial obstruction of sampling tube B. sticking ventilator bellows C. incomplete neuromuscular blockade D. air entrainment into sampling tube E. partial obstruction of endotracheal tube |
D. air entrainment into sampling tube
- From wiki: "In summary, when there is a loose connection between an end-tidal CO, sampling line and the CO, analyzer (Saracap), the CO, excretion waveform is very unusual and consists of a long plateau followed by a brief peak, rather than the usual square CO, excretion waveform. The long CO, plateau is caused by entrainment of room air through the leaky connection by the continuous CO, analyzer suction, and the brief CO, peak is caused by the next PIP, which transiently pushes undiluted end-tidal gas through the sampling line into the CO, analyzer. Because the 0, and N,O values digitally displayed by the Saracap are mean exhalation values, the 0, and N20 concentrations are a function of both the size of the leak and the PIP." (Zuspan J, Martin M, Benumof JL. End-tidal CO2 excretion waveform and error with gas sampling line leak. Anesth Analg 1988;67:581) ----------- |
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EM53 [2004]
The effect of Ketamine on the bispectral (BIS) index is A. to lower the BIS reading B. to raise the BIS number C. to initially raise, then lower the BIS reading D. to initially lower, then raise the BIS reading E. unpredictable |
B. to raise the BIS number
C. to initially raise, then lower the BIS reading - also true with Propofol TIVA. Stan - C Previous grp B. Me - E! " Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE–SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis." British Journal of Anaesthesia 2005 94(3):336-340 ----------- " Ketamine administered under sevoflurane anaesthesia causes a significant increase in BIS, RE and SE without modification of the RE–SE gradient. This increase is paradoxical in that it is associated with a deepening level of hypnosis." British Journal of Anaesthesia 2005 94(3):336-340 |
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EM54
Trans-cranial doppler monitoring of middle cerebral artery flow velocity A. enables easy comparison of bilateral flow B. enables diagnosis of embolism during carotid endarterectomy C. distinguishes between changes in intracranial pressure (ICP) and changes in intracranial vessel tone D. shows flow reversal if the ICP is less than the diastolic arterial pressure E. has a lower failure rate in females |
B. enables diagnosis of embolism during carotid endarterectomy
➭ TCD is used for detection of embolism ➭ 'doppler' only assess flow - unable to determine changes in pressure ➭ TCD has higher failure rate in females due to smaller acoustic window ----------- |
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EM55
The h wave is seen on the CVP waveform A. following the x descent, prior to the v wave B. during tachcardia C. following the y descent prior to the a wave D. with tricuspid regurgitation E. with pericardial restriction. |
C. following the y descent prior to the a wave
- See Miller 7th ed. Table 40.3 a wave - end diastole - atrial contraction c wave - early systole - isovolumetric ventricular contraction, tricuspid motion towards RA v wave - late systole - systolic filling of the atrium h wave - mid to late diastole - diastolic plateau x descent mid systole - atrial relaxation, descent of the base, systolic collapse y descent - early diastole - early ventricular filling, diastolic collapse "In contrast, bradycardia causes each wave to become more distinct. Separate x and x' descents are visible, and an additional mid- to late diastolic plateau wave (h wave) becomes evident, following the y descent, prior to the a wave." Getting the most out of a CVP catheter Jonathan B. Mark ASA Refresher Course ----------- |
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EM56
Following trauma, aortic arch injury should be suspected in the presence of a: A. Cervical spine injury B. Fractured left first rib C. Left-sided pneumothorax D. Splenic rupture E. Thoracic spine injury |
B. Fractured left first rib
- C. left HEMOTHORAX not pneumothorax = suspicion. ----------- |
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EM57 [Jul07][Apr08][Oct08]
same as MC160 The strongest indication for the use of transoesophageal echocardiography during major non-cardiac surgery is A. recent myocardial infarction (less than six weeks old) B. acute significant intr-operative ST-segment depression on the ECG C. massive intra-operative blood loss D. a history of severe valvular heart disease E. unexplained significant intra-operative hypotension |
E. unexplained significant intra-operative hypotension
Miller - Indications for TOE ----------- |
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EM58
During a transoesophageal echocardiography (TOE) examination the end-diastolic area is found to be 15 cm2 and the end-systolic area 10 cm2. Based on these measurements one could calculate this patient's A. area ejection fraction area 33% B. area ejection fraction to be 67% C. ejection fraction to be 50% D. ejection fraction to be 67% E. fractional area change to be 50% |
A. area ejection fraction area 33%
EF = EDA-ESA/EDA ----------- |
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EM60
PiCCO provides continuous measurement of: The PiCCO monitor (Pulsion Medical Systems) combines pulse contour analysis and transpulmonary thermodilution to provide a continuous measurement of A. cardiac output B. cardiac output and intermittent assessment of intrathoracic blood volume C. cardiac output and intermittent assessment of extravascular lung water D. cardiac output and intermittent assessment of intrathoracic blood volume and extravascular lung water |
D. cardiac output and intermittent assessment of intrathoracic blood volume and extravascular lung water
PiCCO technology provides clinicians with the following clinical measurements, many of which can be displayed as absolute or indexed values: via continuous pulse contour analysis • Continuous pulse contour cardiac analysis (PCCO) • Arterial blood pressure (AP) • Heart rate (HR) • Stroke volume (SV) • Stroke volume variation (SVV) • Systemic vascular resistance (SVR) • Index of left ventricular contractility via intermittent transpulmonary thermodilution • Transpulmonary cardiac output (C.O.) • Intrathoracic blood volume (ITBV) • Extravascular lung water (EVLW) (Not Available in United States) • Cardiac function index (CFI) ----------- |
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EM61
Which statement about the use of Entropy depth of anaesthetic monitoring is true? A. artefacts caused by cardiac pacemaker produce a high RE (Response Entropy) value B. RE only assesses the EEG (electroencephalogram) range from 32-47Hz (high frequency) C. SE (State Entropy) values range from 0 - 100 D. SE is a stable indicator of the effects of hypnotics on the cortex E. the RE algorithm filters the EMG (electromyogram) component |
D. SE is a stable indicator of the effects of hypnotics on the cortex
➭ Pacemakers and diathermy are filtered ➭ RE assesses EEG and EMG; range .8-47Hz. RE range 0-100 ➭ SE range 1-32Hz, values 0-91 (or 92?) ----------- |
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EM62 ANZCA version [2005-Sep] Q148
The capnograph below was recorded from a 70 kg anaesthetised patient, being ventilated via a circle system. The fresh gas flow into the circuit was 6 l.min-1. The tracing is consistent with each of the following EXCEPT A. bronchospasm B. decreased carbon dioxide production C. high minute volume ventilation D. hypotension E. leaks in the side arm sampling tube |
A. bronchospasm
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EM63
Which capnograph suggests a tension capnothorax during laparoscopic fundoplication? A. increasing baseline but otherwise normal B. rebreathing with increasing baseline C. change in shape of capnograph with decreasing height and became triangular shaped ie progessively more upsloping phase 3 but falling peak D. ? E. slowly rising baseline with normal expiration but slow flattened inspiration |
C. change in shape of capnograph with decreasing height and became triangular shaped ie progessively more upsloping phase 3 but falling peak
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EM64
Oxygen cannot be measured by: A. fuel cell B. mass spectrometry C. infra-red spectrophotometry D. Paramagnetic analysis E. Raman scattering |
C. infra-red spectrophotometry
➭ Need two or more different atoms to absorb infrared radiation ----------- |
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EM66 [Apr09][Oct09][Mar2010][Aug2010][?Aug12]
What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping? A. TOF count B. TOF ratio C. Post tetanic count D. DBS E. ? |
C. Post tetanic count (PTC)
- Used to assess profound block ----------- |
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EM67 [Oct09]
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. 15-22mm
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EM68 [May09][Aug09]
In an arterial line system A. Overdamping exaggerates mean B. Underdamping increases mean C. Underdamping underestimates systolic D. wide range of damping coefficient associated with good performance if system has high natural frequency E. Compliant tubing is good |
D. wide range of damping coefficient associated with good performance if system has high natural frequency.
However from Miller: Most catheter-transducer systems are underdamped but have an acceptable natural frequency that exceeds 12 Hz. If the system's natural frequency is lower than 7.5 Hz, the pressure waveform is often distorted, and no amount of damping adjustment can restore the monitored waveform to adequately resemble the original waveform.[47] If, on the other hand, the natural frequency can be increased sufficiently (e.g., 24 Hz), damping will have minimal effect on the monitored waveform, and faithful reproduction of intravascular pressure is achieved more easily (Figs. 40-6 and 40-7). In other words, the lower the natural frequency of the monitoring system, the more narrow the range of damping coefficients that can be tolerated to ensure faithful reproduction of the pressure wave. For example, if the monitoring system's natural frequency is 10 Hz, the damping coefficient must be between 0.45 and 0.6 for accurate monitoring of the pressure waveform. If the damping coefficient is too low, the monitoring system will be underdamped, resonate, and display factitiously elevated systolic blood pressure; if the damping coefficient is too high, the system will be overdamped, systolic pressure will be falsely decreased, and fine detail in the pressure trace will be lost. ie. The higher the natural frequency of the system it will tolerate a wider range of damping… not the other way around… so does that make D false too? poorly remembered. - by exclusion. A. false - From Common Errors in Clinical Measurement. Anaes Int Care Med 05 Vol 6 Issue 12: "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." B. false - see A C. false - see A. E. False - see A. ----------- |
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TMP-101 [Mar10][Aug10][?Aug12] Aneurysm sugery. Propofol/remifentanil/NMDR. DOA monitoring (Entropy). MAP 70 , HR 70/min, State entropy 50, Response entropy 70. What do you do?
A. ? B. Metaraminol C. Check TOF D. Nothing E. Increase TCI. |
C or E? (either NMB wearing off or anaesthesia lightens)
-- RE- fast acting including higher frequencies- to 47 Hz, which includes the frontalis muscle SE- always less or equal to SE. estimates hypontic effect on brain see wiki debate - some say E. but for aneurysm surgery - you want them still ! ?Is TOF the most appropriate way to assess deep block - argument that it should be PTC. ----------- |
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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 |
E. 1520 dynes.sec/cm-5
SVR=80*(MSBP-CVP)/CO = 80*((100-5)/5) = 80*19 = 1520 dynes.sec/cm-5 (multiply by 80 to convert mmHg/L/min to dynes.sec/cm-5) ----------- |
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TMP-Jul10-006
A 50 year old man with multiple fractures. The BEST parameter to monitor volume resuscitation is: A. Heart rate B. LVEDV C. PCWP D. RVEDV E. Changes in R atrial pressure during inspiration |
E. Changes in R atrial pressure during inspiration (wiki discussion - which I agree with)
vs B (previous grp) - ----------- |
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TMP-Mar12-032 [Aug12]
What is the ratio of MAC awake:MAC of sevoflurance a. 0.2 b. 0.34 c. 0.5 |
b. 0.34
-- ref: 'Cerebral Awakening Concentration of Sevoflurane and Isoflurane Predicted during Slow and Fast Alveolar washout' Anesthesia and Analgesia 1993. Mac awake for sevo was the same for both slow and fast washout. ----------- |
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TMP-Mar12-037
A patient having a craniotomy has the CVP/arterial transducers at the level of the right atrium. The head is 13cm above the level of the heart. If the MAP is 80mmHg and the CVP is 5mmHg what is the cerebral perfusion pressure in mmHg a. 60 b. 62 c. 65 d. 70 e. 75 |
d. 70
-- 1mmHg = 1.36 cmH2O 13/1.36 = 10mmHg CPP = MAP - ICP or CVP whichever is greater (normally) In head up/sitting position with a craniotomy - Need to take into consideration hydrostatic pressure (ρgh) ICP is open to atmosphere therefore ICP = zero CVP corrected for height is negative due to subtraction of the hydrostatic gradient (-5) Thus CPP = (MAP - ρgh) - the maximum of (ICP-ρgh), (CVP-ρgh) or Patm, where ρgh is hydrostatic pressure at height from skull to BP measurement site, Patm =0 ref: http://www.apsf.org/newsletters/html/2008/summer/11_modified_calculation.htm ----------- |
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TMP-Sep11-111 **?
see also EM14 Best indicator of return function of laryngeal muscle A. Sustained head lift 5 sec B. Sustained leg lift 5 sec C. TOF 0.9 D. DBS no fade E. Tetanus 50Hz |
?C. TOF 0.9
Previous group stated A. Sustained head lift. It all depends on wording of question. Safe to extubate or return of laryngeal muscle function - not the same! RV articles have stated that laryngeal muscles have faster onset of block than respiratory muscles when it is time to intubate and corrugator supercilii mm monitoring reflects best when to intubate. With regards to extubation the suggestion is to monitor adductor pollicis with TOF 0.9. (rather than 0.7 which is what was previously thought). Larygneal muscles 'recover' faster than respiratory muscles however from Anesth Analg 2004;98:1729-33 -- "findings indicate that NMB at various intrinsic laryngeal mm is variable and that recovery of laryngeal block determined using methods measuring response of adducting laryngeal muscles cannot be taken as representative for other intrinsic muscles. In humans, the ability to open vocal cords after NMB returns later than ability to close the vocal cords" ----------- |
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EC16
CORRECT statements regarding the assessment of glomerular filtration rate (GFR) include A. GFR can be measured accurately by determining clearance of creatinine B. GFR can be measured directly by determining the clearance of insulin C. GFR can be measured accurately by determining clearance of urea D. some creatinine is secreted in the tubule |
D. some creatinine is secreted in the tubules
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EC02
Paramagnetic gases include: A. Oxygen B. Nitrous oxide C. Carbon dioxide D. Halothane (Comment: The only two paramagnetic gases of relevance are NO and O2 - KB) |
A. Oxygen
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