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125 Cards in this Set
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MC157 [Mar10] New Q |
Ans B
CEACCP 2008 Low respiratory rates, short inspiratory times, low PEEP, and tidal volumes of 5 – 6 ml kg-1 usually allow adequate pulmon-ary blood flow, normocarbia, and a low PVR. |
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SC33 A 7 kg Infant with tetralogy of Fallot, post BT-shunt. Definitive repair at later date. Paralysed and vetilated. sats 85% baseline, now 70%, best treatment:
A. Increase FiO2 from 50 - 100% B. Esmolol 70 mcg C. Phenylephrine 35 mcg D. Morphine 1 mg E. 1/2 NS with 2.5% dex 70 mls |
C
Increase systematic resistance to reverse right to left shunt. |
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MN41 Von Hippel-Lindau disease is associated with:
A. increased risk of malignant hyperthermia B. meningiomas C. peripheral neuropathy D. pheochromocytomas E. poor dentition |
D. Pheo
"Management of anesthesia in patients with von Hippel-Lindau disease must consider the possible presence of pheochromocytomas" (Stoelting) von Hippel-Lindau disease (VHL) is a rare, genetic multi-system disorder characterized by the abnormal growth of tumors in certain parts of the body (angiomatosis). The tumors of the central nervous system (CNS) are benign and are comprised of a nest of blood vessels and are called hemangioblastomas (or angiomas in the eye). Hemangioblastomas may develop in the brain, the retina of the eyes, and other areas of the nervous system. Other types of tumors develop in the adrenal glands, the kidneys, or the pancreas. Symptoms of VHL vary among patients and depend on the size and location of the tumors. Symptoms may include headaches, problems with balance and walking, dizziness, weakness of the limbs, vision problems, and high blood pressure. Cysts (fluid-filled sacs) and/or tumors (benign or cancerous) may develop around the hemangioblastomas and cause the symptoms listed above. Individuals with VHL are also at a higher risk than normal for certain types of cancer, especially kidney cancer. Inheritance = Familial Autosomal dominant Features= Retinal angiomas, Haemangioblastomas, Cerebellar and visceral tumours (usually benign but can cause pressure effects) Associations = An increased incidence of Phaeochromocytoma - apparently 20%, Renal cysts, Renal cell carcinoma Anaesthesia= Treat hypertension occurring with phaeochromocytoma, Haemangioblastoma of spinal cord may limit use of spinal although epidural has been used for LSCS, Exagerrated hypertension with surgical stimulation or laryngoscopy = Treat with β blockers and/or SNP From recollection, Phaeos are associated with the Diseases of Von- Ie. Von Recklinghausen and Von Hippel Lindau. |
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MH59 70 year old post TKJR. On sub-cut heparin. Develops clinical DVT and platelets 40 (sounds like HITS type-II). Management
A. Enoxaparin B. Fondoparinux C. Heparin by infusion D. Lepirudin E. Warfarin |
Ans D
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ME45 Hypercalcaemia
A. Chovostek's sign B. C. D. E. Short QT |
Ans: E
Effects of hypercalcaemia: "Stones, Bones, Groans, Thrones and Psychiatric Overtones" Stones (renal or biliary) Bones (bone pain) Groans (abdominal pain, nausea and vomiting) Thrones (sit on throne - polyuria) Psychiatric overtones (Depression 30-40%, anxiety, cognitive dysfunction, insomnia, coma) Abnormal heart rhythms can result, and ECG findings of a short QT interval and a widened T wave suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction. Hypercalcaemia has also been known to cause an ECG finding mimicking hypothermia, known as an Osborn wave. |
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MC161 Drug eluting stent 6 months old. On aspirin and prasugrel 10mg. Elective lap cholecystectomy for biliary colic.
A. Do case while taking both. B. Do case while stopping both. C. Stop Prasugrel for 7 days, keep taking aspirin. D. Stop Prasugrel for some other different time E. Post-pone for 6 months |
Ans E
ACC/AHA Pre-op: DRUG ELUTING: Thrombosis of DES may occur late and has been reported up to 1.5 years after implantation, particularly in the context of discontinuation of antiplatelet agents before noncardiac surgery. Discontinuation of antiplatelet therapy in the early-surgery group resulted in a 30.7% incidence of MACE (all fatal) versus a 0% incidence in early-surgery patients who continued dual antiplatelet therapy perioperatively. Overall, there was no difference in MACE between patients with bare-metal stents and those with DES. The study reported that all patients with MACE had discontinued antiplatelet therapy before surgery, whereas only 46% without MACE had done so. The study also stated there was no difference in surgical risk between patients in whom antiplatelet agents were discontinued and those in whom they were not. Excessive blood loss occurred in 2 patients, 1 of whom was receiving antiplatelet agents and 1 of whom was not. ** The panel concurred with the AHA/ACC guideline recommendation for 12 months of dual-antiplatelet therapy after DES implantation in patients who are not at high risk for bleeding. **1. Before implantation of a stent, the physician should discuss the need for dual-antiplatelet therapy. In patients not expected to comply with 12 months of thienopyridine therapy, whether for economic or other reasons, strong consideration should be given to avoiding a DES. BARE METAL: A thienopyridine (ticlopidine or clopidogrel) is generally administered with aspirin for 4 weeks after bare-metal stent placement. The thienopyridines and aspirin inhibit platelet aggregation and reduce stent thrombosis but increase the risk of bleeding. Rapid endothelialization of bare-metal stents makes late thrombosis rare, and thienopyridines are rarely needed for more than 4 weeks after implantation of baremetal stents. For this reason, delaying surgery 4 to 6 weeks after bare-metal stent placement allows proper thienopyridine use to reduce the risk of coronary stent thrombosis; then, after the thienopyridine has been discontinued, the noncardiac surgery can be performed. However, once the thienopyridine is stopped, its effects do not diminish immediately. It is for this reason that some surgical teams request a 1-week delay after thienopyridines are discontinued before the patient proceeds to surgery. In patients with bare-metal stents, daily aspirin antiplatelet therapy should be continued perioperatively. The risk of stopping the aspirin should be weighed against the benefit of reduction in bleeding complications from the planned surgery. In the setting of noncardiac surgery in patients who have recently received a bare-metal stent, the risk of stopping dual-antiplatelet agents prematurely (within 4 weeks of implantation) is significant compared with the risk of major bleeding from most commonly performed surgeries. |
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AM50 For a person newly diagnosed as MH susceptible, which is true?
A. ? B. Can have had an uneventful 'triggering' anaesthetic C. Recommended to use an anaesthetic machine which has not had volatiles through it D. ? E. There have been case reports of MH occurring up to 48 h post op |
B
CAECCP Malignant Hyperthermia On average, patients found to be susceptible to MH have had three previous uneventful general anaesthetics. |
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MZ80 ABG pH 7.12, PO2 100, PCO2 65, HCO3 20.3, BE -10. Consistent with?
A. Chronic renal failure B. Malignant hyperthermia C. Diabetic ketoacidosis D. End-stage respiratory failure E. Ethylene glycol toxicity |
Ans B
Metabolic acidosis and respiratory acidosis |
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Cocaine overdose. What is false? (rpt Q)
A. Euphoria B. ? C. ? D. ? E. Miosis |
Cocaine DOES cause euphoria - therefore A is true. Cocaine causes pupillary dilatation (mydriasis), not miosis. Therefore ANSWER is E.
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PL30 Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique
A. 3 mg/kg B. 7 mg/kg C. 15 mg/kg D. 25 mg/kg E. 35 mg/kg |
E
Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 1990 |
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TMP-100 Compared to lignocaine, bupivacaine is
A. Twice as potent B. Three times as potent C. Four times as potent D. Five times as potent E. Same potency |
C
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TMP-101 Patient having aneurysm sugery, running on Propofol / remifentanil / NMDR. Depth of anaesthesia 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 |
SE is depth of anaesthesia
RE measures the temporalis muscle activity. This suggest paralysis is wearing off |
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TMP-114 Paralysed with atracurium. TOF is 1(25%). You give a dose of 0.1 mg/kg mivacurium to close the abdomen. When will you be back to TOF 1(25%)?
A. 5 min B. 10 min C. 30 min D. 60 min E. 90 min |
Ans B
Mivacurium 0.15 mg/kg Clinical duration is ~15 min Miller 7th ed p 877 Thus 0.1 mg/kg will be less than that. |
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EV19 Plenum Vaporiser
A.? something with fresh gas flows B. Relies on a constant flow of pressurised gas C. Out of circle D. Not temperature compensated E. volatile injected into fresh gas flow? |
A - ?
B - TRUE. Upstream gas source required to push fresh gas through the vaporizer (opposite to Draw-over vaporizer) C - ? FALSE. Don't exactly understand the question/stem. You can use a plenum vaporizer with OR without a circle (e.g. T-piece in paeds) D - FALSE. Most ARE temperature compensated E - FALSE. Not in a plenum vaporizer (Some vaporisers do inject volatile (eg Des Tec 6) but this is NOT a plenum vaporiser. |
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TMP-102 Interscalene block, patient hiccups...where do you redirect your needle?
A. Anterior B. Posterior C. Caudal D. Cranial E. Superficial |
B. - move posteriorly
Needle is tickling the phrenic nerve |
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TMP-103 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 |
Ans E
SVR = 80(MAP-CVP)/CO SVR = 80 x (100-5)/5 SVR = 1520 |
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TMP-111 Accidentally cannulate carotid artery with 5 lumen 7 Fr CVC preop for a semi urgent CABG. Most appropriate next response is to
A. Get vascular surgeon to repair it and continue with surgery and heparin B. Leave it in. Do CABG. Pull it out post op. C. Pull it out, compress. Delay surgery for 24hrs D. Pull it out compress. Continue with surgery + heparin. E. Pull it out. Compress. Continue with surgery no heparin |
Ans A is probably best of the lot
Guilbert M-C, Elkouri S, Bracco D et al. Arterial trauma during central venous catheter insertion Case series, review and proposed algorithm. J Vasc Surg 48:918-985, 2008 Postponing elective surgery will ensure that the anesthetized patient is not having an unrecognized stroke. Kron and colleagues recommend postponing elective open-heart surgery after two patients suffered serious complications when surgery was performed immediately after removal of the misplaced large sheath. Complications with catheter removal and compression 1. Massive stroke and death 2. AV fistula require surgical repair 3. Pleural effusion, lung collapse require thoracic surgery to repair arterial hole and lung decortications 4. Hematoma and uncontrolled bleeding requiring open surgery to repair jugular vein and carotid artery |
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TMP-104 Stellate ganglion (Repeat Question)
A. Anterior to scalenius anterior B. ? C. ? D. ? E. ? |
Ans A
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TMP-105 The median nerve (REPEAT)
A. can be blocked at the elbow immediately medial to the brachial artery B. can be blocked at the wrist between palmaris longus and flexor carpi ulnaris C. can be blocked at the wrist medial to flexor carpi ulnaris D. is formed from the lateral, medial, and posterior cords of the brachial plexus E. provides sensation to the ulna half of the palm |
Ans A
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TMP-115 Patient for total knee replacement under spinal anaesthetic. Continous femoral nerve catheter put in for post op pain relief. Good analgesia and range of motion 18hrs post op. 24hrs post op, patchy decreased sensation in leg and unable flex knee. What is the cause?
A. Compression neurapraxia (i think it said due to torniquet) B. DVT C. Muscle ischaemia D. Damage to femoral nerve E. Spinal cord damage |
Ans A
Inability to flex the knee is not a femoral nerve problem - it is sciatic. This problem seems to have clinical onset at about 24 hours. A: True. It is possible to be due to compression neurapraxia by tourniquet. B: False: DVT does not cause neurological symptoms C. Muscle ischaemia is unlikely to happen post 24 hours for knee replacement. D. False: The symptoms is more sciatic E False, generally bilateral distribution |
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TMP-106 A 75yo male with moderate aortic stenosis (valve area 1.1cm2).. Gets mild dyspnoea on exertion but otherwise asymptomatic. needs hip replacement.
A. Continue with surgery B. Beta block then continue C. Get myocardial perfusion scan D. Postpone surgery awaiting AVR E. Postpone surgery awaiting balloon valvotomy |
A - not severe and symptoms only on exertion
ACC/AHA 2007 guideline on perioperative cvs evaluation and care for noncardiac surgery In symptomatic aortic stenosis, elective noncardiac surgery should generally be postponed or cancelled. Such patients require aortic valve replacement before elective but necessary noncardiac surgery. If the aortic stenosis is severe but asymptomatic, the surgery should be postponed or cancelled if the valve has not been evaluated within the year. On the other hand, in patients with severe aortic stenosis who refuse cardiac surgery or are otherwise not candidates for aortic valve replacement, noncardiac surgery can be performed with a mortality risk of approximately 10%. If a patient is not a candidate for valve replacement, percutaneous balloon aortic valvuloplasty may be reasonable as a bridge to surgery in hemodynamically unstable adult patients with aortic stenosis who are at high risk for aortic valve replacement surgery and may be reasonable in adult patients with aortic stenosis in whom aortic valve replacement cannot be per-formed because of serious comorbid conditions. |
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TMP-112 (similar to above) Patient for fempop bypass (i believe it said "angioplasty"), history of CCF. Also has diabetes on oral hypoglycaemics, controlled hypertension and atrial fibrillation at rate of 80bpm .
A. Medium risk surgery, medium risk patient B. Medium risk surgery, high risk patient C. High risk surgery low risk patient D. High risk surgery, medium risk patient E. High risk surgery, high risk patient. |
Ans D
refer AHA |
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RH35 (NEW)
23.Best Approach for a Sub-Tenon's block? A. inferonasal b. inferotemporal c. medial canthus d. superior nasal e. superior temporal |
A
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TMP-107 Baby with TracheoOesophageal Fistula found by bubbling saliva and nasogastric tube coiling on xray. Best immediate management?
A. Bag and mask ventilate B. Intubate and ventilate C. position head up, insert suction catheter in oesophagus (or to stomach?) D. Place prone, head down to allow contents to drain E. Insert gastrostomy |
A - FALSE. Not unless the baby is in respiratory distress and/or hypoxic. May inflate stomach by ventilating through fistula.
B - FALSE. Just because the baby has been diagnosed with TOF is not an immediate indication for intubation in and of itself. C - TRUE. Neonates with TOF should have a "nasogastric" tube inserted into the oesophageal stump to drain secretions and prevent accumulation in the blind-end pouch. The NGT should be connected to continuous suction. The infant should be nursed prone or in the lateral position with 30 degrees head up tilt to decrease the risk of aspiration. See A Practice of Anesthesia for Infants and Children - 4th edition by Cote, Lerman, Todres; p.755. Saunders (2009) D - FALSE. Can nurse prone, but lateral with head up tilt seems to be the recommended and most commonly cited method. E - FALSE. Initial management as above (see C - TRUE), and then repair. Gastrostomy may be performed, but not best immediate management. |
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TMP-108 A 60yo Man with anterior mediastinal mass, during induction for mediastinoscopy....lose cardiac output, decreased saturations, drop in ETCO2. Management
A. Adrenaline B. CPR C. CPB D. Place prone |
D
Ans D Management of the patient with a large anterior mediastinal mass: recurring myths Curr Opin Anaesthesiol 20:1-3 2007 Should try wake up the patient. Intraoperative life-threatening airway compression has usually responded to one of two therapies: 1. Repositioning of the patient (it should be determined before induction if there is one side or position that causes less symptomatic compression) 2. Rigid bronchoscopy and ventilation distal to the obstruction (this means that an experienced bronchoscopist and rigid bronchoscopy equipment must always be immediately available in the operating room during these cases). For patients with life-threatening cardiovascular compression after induction that does not respond to lightening the anesthetic the only therapy is immediate sternotomy and surgical elevation of the mass off the great vessels. |
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TMP-116 Post thyroidectomy patient, patient in PACU for 30 minutes. Develops respiratory distress. Most likely cause?
A. Hypercalcemia from taking parathyroids B. Bilateral laryngeal nerve palsies C. bleeding and haematoma D. Tracheomalacia E. |
Ans C
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27. Best way to prevent hypothermia in patient undergoing a general anaesthetic (Repeat question)
A. Prewarming of patient B. C. D. Warm IV fluids |
Answer A
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TMP-109 MAIN indication for biventricular pacing is
A. complete heart block B. congestive cardiac failure c. VF D. |
Ans B
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EV18 Desflurane TEC6 vaporiser, unable to turn dial on. This is NOT because
A. vapouriser is tilted B. Hotter than 39C C. On battery power D. Interlock not engaged, or not seated properly (or something like that) E. other vapouriser is already on |
Answer is B
The TEC 6 desflurane vaporizer needs to warm up and the "operational" LED light needs to be illuminated before you can turn the dial to the ON position. If you try to turn it on before the "operational" light is on it will not work. I assume that any of the alarms which cause the "operational" light to go off (and subsequently halt delivery of desflurane) mean that if you turn the dial to 0% (i.e. OFF) then you will not be able to turn it back on, but I have not read that anywhere. According to Graham (BJA 1994; 72:470-73), causes of vaporizer shutdown include: a tilt of about 10 degrees or more - although extremely unlikely given the design excessive tilting of the vaporizer activates auditory and visual alarms and causes cessation of desflurane output...Pharmacology of Inhaled Anaesthetics, p212 it will not work on battery power the 9-volt battery does not supply the heaters with power or maintain the vaporizer in an operational mode...Pharmacology of Inhaled Anaesthetics, p212 the vaporizer will not work unless locked into the selectatec mount, and the selectatec mount will not allow the use of multiple vaporizers simultaneously nb. note the "Tec" refers to the use with the Select-a-Tec manifold |
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PI83 Desflurane vaporiser, heated because of
A. High SVP B. High boiling poing C. Low SVP D. High MAC E. Low MAC |
A
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31.Myotome of C6-7 (Repeat Question)
A. Wrist flexion and extension B. Finger flexion and extension C. Elbow D. Shoulder E. |
A
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SF86 Most common cause of maternal cardiac arrest
A. PE B. AFE C. Haemorrhage D. Preeclampsia E. cardiomyopathy |
B - In Australia - Amniotic FLuid Embolism
In UK - Pulmonary embolism Group consensus that Australian answer is probably best |
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SF89 Most likely change on CTG with anaesthesia for non-obstetric surgery at 32 wks
A. Loss of beat to beat variability B. No change C. Late decels D. Variable Deccels E. uterine contractions |
A
Evidence based practice of anaesthesiology (Fleischer)under conditions of very light sedation most narcotics and general anaesthetics decrease or obliterate long and short term FHR variability , hence one is left monitoring changes in baseline FHR. |
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MG05 What is NOT associated with ulcerative colitis? (Repeat question)
A. Cirrhosis B. Psoriasis C. Arthritis D. E. |
Ans B as it is rare so best answer
Talley O’Connor UC association Chronic liver disease: primary sclerosing cholangitis or cirrhosis Anaemia: blood loss and haemolysis Arthritis Skin: erythema nodosum, pyoderma gangrenosum (rare), psoriasis (rare) Psoriasis associated with ulcerative colitis and Crohn's disease. J Eur Acad Dermatol Venereol. 2009 May;23(5):561-5. Epub 2009 Jan 15. BACKGROUND: Numerous reports have demonstrated the epidemiological, pathogenic, and genetic association between psoriasis and Crohn's disease. Nevertheless, the association between psoriasis and ulcerative colitis was rarely described. Ocular changes: conjunctivitis, iritis, episcleritis |
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EM66 What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping? (repeat question)
A. TOFC B. TOFratio C. Post tetanic count |
Answer C
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TMP-118 What's the area burnt in man? Half of left upper arm, all of left leg and anterior abdomen (repeat qu).
A. 27% B. 32% C. 42% D. E. |
Ans A
Based on the 'rule of nines', the estimated burn surface area would be as follows: - half of upper arm = approx 2% - all of left leg = 18% - anterior abdomen = approx 9% depending on what proportion is burnt; whole thorax/abdomen on either anterior or posterior is 18% - i.e. 36% for front and back -> TOTAL = 29% |
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MC59b Torsades, what's not useful? (Repeat question)
A. Amiodarone B. Isoprenaline C. Magnesium D. ? E. ? |
Ans A
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38.Treatment for long QTc (OR what does NOT increase the QT interval)
A. Magnesium B. ? C. ? D. ? |
Ans A
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39.HOCM, VF arrest on induction, what's the first priority in management?
A. defibrillate B. amiodarone C. Intubate and ventilate D. Pre-cordial thump E. adrenaline |
Ans A
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40.Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management?
A. adenosine 6mg B. DCR C. amiodarone D. Atenolol E. ? |
Ans A
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RU19 [Mar10] [Aug10] The intercostobrachial nerve:
A. Arises from T2 trunk B. Is usually blocked in brachial plexus block C. Supplies antecubital fossa D. can be damaged by torniquet E. Arises from inferior trunk |
Ans D
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42. Post dural puincture headache (PDPH) -(thoracic epidural) of "low pressure type". Features NOT consistent
A. headache Immediately after procedure B. Frontal headache only C. Starts 24hrs post D. Auditory symptoms E. Neck stiffness |
ANSWER=A.
A=FALSE. Usually starts 24-48 hrs after dural puncture. B=True. Typically fronto-occipital, but can be frontal, occipital or nuchal (Evidence-Based Obstetric Anaesthesia, Halpern & Douglas, BMJ Books; Blackwell, 2005; p.192) C=True. Most commonly starts 24-48 hrs later. D=True. Hearing loss and/or tinnitus are features. E=True. Neck stiffness and photophobia are common. (REFS - Oxford Handbook of Anaesthesia (2nd ed), p.707 |
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SF87 [Mar10] [Aug10] Labour epidurals increase maternal and foetal temperature. This results in neonatal
A. Increased sepsis B. Increased investigations for sepsis C. increased non shivering thermogenesis D. Increased need for resuscitation E. Cerebral palsy |
Ans B
Chestnut's Obstetric Anesthesia: Principles and Practice (4th Edn), Chestnut et al. 2009; p457 Labour epidural analgesia is associated with an increase in maternal core body temperature, but also with an increased neonatal temperature and fetal heart rate. Several studies have shown that labour epidural analgesia is associated with increased neonatal neonatal sepsis evaluations, but no increase in neonatal sepsis. |
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SF88 [Mar10] [Aug10] Maternal cardiac arrest. In making the diagnosis of amniotic fluid embolism, large amount of PMNs surrounding foetal squamous cells are
A. Pathonomonic B. Supportive C. Only found at postmortem D. Irrelevant E. Incidental |
Ans B
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ET03 Jehovah's witness patient refusing blood products. The ethical principle you are honouring if you continue with elective hip operation
A. Autonomy B. Nonmaleficience C. Justice D. Paternalism |
Ans A
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ET01 An 86yo with severe dementia and multiple medical problems.. Surgeons want to operate for faecal peritonitis/bowel perforation, and believe he will die without the surgery. Your decision NOT proceed with surgery is supported by which ethical principle?
A. Dignity B. Competence C. Non-maleficience D. Paternalism E. Futility |
C
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47.Inserted DLT. FOB down tracheal lumen. What feature is most helpful in identifying Left vs Right main bronchus
A. Trachealis muscle B. "there are 3 lobes in right lung" C. LMB longer than right D. Angle of RMB vs left E. Three segments of RUL |
A - False. Trachealis muscle divides at carina and continues in each main bronchus, so not particularly helpful. Trachealis was only located posteriorly connecting the ends of the C-shaped cartilage.
B - False. While there are indeed 3 lobes in the right lung, that fact is not helpful to determine which is right or left main bronchus. C - True. The LMB is about 5cm long before it gives off any subsequent lobar bronchi, whereas the RMB gives off a lobar bronchus (the RUL bronchus) about 2.5cm from the carina. This can help to determine between RMB and LMB. D - False. While there is a difference in the angle (from the vertical) of the LMB and RMB, I don't know if this would be significantly appreciable bronchoscopically. E - True. The RUL bronchus has a trifurcation for each of the RUL segments, and this may also be useful in determining which side you are on. |
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48.You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is:
A. Right upper lobe B. Right Middle Lobe C. Right lower lobe D. Left lower lobe E. Lingula |
Ans A
A true trifurcation is where the RUL bronchus divides into segmental bronchi. |
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PC50 Elimination Half life of Tirofiban
A. 2hrs B. 8hrs C. 12hrs D. 24hrs E. 15 minutes |
A
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50.POISE trial showed
A. Increase CVA B. Anaphylaxis C. renal failure D. Increased AMI |
Answer is A
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51.Why is codeine not used in paeds
A. Poor taste B. High inter-individual pharmacokinetic variability C. Not licensed for <10yo D. not as effective as adult when given in ?weight adjusted dose? |
B - TRUE. Variations in CYP2D6 function affect how much codeine is converted to morphine, and therefore how effective it is, but also how "sensitive" patients are to codeine.
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52.Patient on table for phaeochromocytoma with GA and epidural insitu. Pt on phenoxybenzamine and metoprolol preop, high dose nitroprusside and phentolamine. BP still high ?250/-. Next step
A. IV hydralazine B. IV Magnesium C. Propofol D. Epidural lignocaine bolus E. Esmolol |
A - FALSE. Duration of action may be a problem, as once tumour is out you may need a vasopressor and won't want the hydralazine hanging around. Plasma half-life is 2-3 hours (significantly more in renal impairment, but may be less in "rapid acetylators"). Anyway, 4 half-lives is 8-12 hours (less if you're a fast acetylator.
B - TRUE. C - False. Not the best option. D - False. Epidural bolus will not negate the effects of circulating vasoactive catecholamines. E - False. Esmolol for tachycardia, but not for BP control. |
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53.25 yo primip ?38/40 gestation with beta thalassemia trait for epidural. BP 140/95, mild proteinuria ...something else... Best test before you will put in epidural
A. Coagulation screen B. Hb C. Platelet count D. skin bleeding time E. |
Answer is C. Thalassemia trait is a red-herring. No effect on clotting/epidural placement. Money is on pre-eclampsia Main thing to look at is the platelet count.
See Oxford Handbook 2nd edn - p.744. - If plt>100, proceed. - If plt<100, do coags. - If plt 80-100, and coags normal - regional is OK. |
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54. pregnant lady ?39/40 with BP185/115 , 4+proteinuria, clonus. IDC placed, 10mLs of dark coloured urine only for the last few hours. Initial management
A. 500mL Crystalloid bolus B. IV hydralazine C. IV Magnesium D. insert epidural |
Ans B
By definition she has SEVERE pre-eclampsia. A - False. Although they are usually intravascularly deplete, IV fluids should be given cautiously as these women are prone to develop pulmonary oedema. Volume expansion alone can reduce SVR and systolic BP. Oliguria should be treated with careful IV fluid challenge. The BJA CEACCP article (see below) states that a bolus of 250ml crystalloid should be given, but if no improvement (in urine output) a CVC should be inserted before any further fluid given. Then be guided by CVP and urine output. Crystalloid decreases plasma oncotic pressure, while colloids increase it and have a greater tendency to cause pulmonary oedema. However, if CVP low, can use colloid. I say false because 500ml is probably a bit too large as a bolus initially. B - TRUE. Initial management should aim to reduce the BP. This is the best of the options, although the CEACCP article also states that careful volume expansion should precede the use of vasodilators, so as not to drop the BP too much. That is not one of the options though, and I think this is the best option. C - False. Initial attempts to reduce BP and improve urine output should probably precede Mg administration. Anyway, giving someone with minimal urine output a large bolus of IV Mg increases the chances of Mg toxicity. Should give IV fluids before giving Mg. D - False. Epidurals are desirable in pre-eclampsia but in severe pre-eclampsia you should try and reduce the BP first, and always check the platelet count +/- coags BEFORE placing epidural. -REFS: The diagnosis and management of pre-eclampsia. BJA CEACCP 2003; 3(2):38-42. Also see ANZCA obstetric anaesthesia: scientific evidence 2008 pages 15 and 18 |
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TMP-113 The BEST agent to decrease gastric volume AND increase gastric pH before semi-urgent procedure
A. Omeprazole B. Cimetidine C. Ranitidine D. Sodium citrate E. ? |
C. Ranitidine
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56.Most common congenital heart disease (repeat)
A. VSD B. PDA C. ? D. ? |
Answer is A. (Ref: Stoelting's Anesthesia & Co-Existing Disease - 5th edn; p.44)
ACYANOTIC defects: VSD=35%, ASD=9%, PDA=8%, Pulm. stenosis=8%, Aortic stenosis=6%, Coarctation=6%, Atrioventricular septal defect=3% CYANOTIC defects: Tetralogy=5%, Transposition=4% |
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57. Well and active 4 year old having tonsils and adenoids out. The patient has a continuous murmur, disappears on lying down. Most likely to be:
A. Venous hum B. PDA C. VSD |
Ans A
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Acetylcholine receptors are down regulated in
A. Guillain-Barre syndrome B. Organophosphate poisoning C. Spinal cord injury D. Stroke E. Prolonged NMBD use |
Ans B
A - False. Effectively a denervation injury which causes UP-regulation. B - TRUE. Organophosphate poisoning causes increases in miniature-end-plate potential (MEPP), and thus can cause DOWN-regulation of ACh receptors. Apparently continuous exposure to organophosphates can cause degeneration of pre-junctional and post-junctional structures. C - False. Denervation causes UP-regulation. D - False. As for spinal cord injury. E - Prolonged NMBD use can cause UP-regulation of ACh receptors. REFS: Miller (7th edn) - p.358 |
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58.Myaesthenia gravis - all options are features predicting need for post op ventilation EXCEPT
A. Prolonged disease B. High dose Rx C. Previous respiratory crisis D. Increased sensitivity to NMB's E. bulbar dysfunction |
Ans D
Reference: CEPD Reviews 2002 p88- and OHA 246- Consider D-Increased sensitivity to NMB's The CEPD risk factors for IPPV postop (thymectomy) are: 1/ FVC<2.9L; 2/ Concommitant COAD; 3/ Acute fulminant crisis or respiratory involvement (grade 3); 4/ Myasthenic crisis (grade 4); OHA adds: 5/ Duration of disease >6yrs 6/ Pyridostigmine dose >750mg/d 7/ Major body cavity surgery 8/ Bulbar palsy that is predictive of intra and postop airway protection. All patients with myasthenia gravis should be sensitive to muscle relaxants so this in itself is not a useful indicator. |
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59.Diagnositic Utility of BNP best in (repeat)
A. SOB post pneumonectomy dyspnoea B. Confusion post CABG |
Ans A
Distinguishing pulmonary edema due to acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) from hydrostatic or cardiogenic edema is challenging in critically ill patients. B-type natriuretic peptide (BNP) can effectively identify congestive heart failure in the emergency room setting but, despite increasing use, its diagnostic utility has not been validated in the intensive care unit (ICU). |
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60.Innervation of Larynx (repeat)
A. the internal branch of the superior branch of the... B. C. D. E. Cuff compression of recurrent laryngeal nerve against thryoid can cause palsy |
Ans E
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61.Which is not a branch of the mandibular nerve (repeat)
A. Auricultemporal B. Great Auricular C. ? |
Ans B
Great auricular nerve is a branch of cervical plexus |
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62.Reason not to operate liver injury(repeat)
A. Haemodynamically stable B. Low grade injury on CT C. ? |
Ans A
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64.Most distant anatomy seen on grade III laryngoscopy
A. soft palate B. hard palate C. Epiglottis D. arytenoid cartillage E. opening to ? |
Ans C
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65. Trauma pt, Head Injury with GCS 5, high ICPs, best management for ortho procedure(repeat)
A. Propofol/fentanyl B. Propofol / nitrous C. Other options with volatiles |
Ans A
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66.Drug NOT used to treat acute intermittent porphyria - question was: person with AIP given ?something and triggered a seizure, what not to use (repeat)
A. Morphine B. Phenytoin |
Ans B
Reference: [1] and Harper's Illustrated Biochemistry Suggest B-Phenytoin but morphine while safe to use but will not be used to treat a convulsion so make sure you read the question... Treatment of seizures in porphyriacs is a difficult situation given that most anticonvulsants are contraindicated (such as phenytoin, carbamazepine, thiopentone) because they induce hepatic P450 enzymes. (This consumes heme and thus reduces the negative feedback on ALA synthesase which is then free to generate heme/porphyrins products.) Drugs considered safe to use in convulsing porphyriacs include: midazolam, propofol, gabapentin and magnesium. |
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67.Regarding anticholinesterases:
A. pyridostigmine has slow onset of effect B. physostigmine does not rely on renal metabolism/excretion C. neostigmine cannot reverse centrally acting cholinergics D. edrophonium is less reliable in reversal? |
Ans C
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68.rpt question about multiple sclerosis (rpt):
A. exacerbated with heat |
Ans A
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69.rpt question about signs seen in sarin poisoning (rpt):
A. mm fasciculation B. dry skin |
Ans A
Sarin organophosphate |
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70.nerve to block for painful meralgia parasthetica
A. lateral femoral cutaneous nerve B. femoral nerve |
Ans A
Wiki This chronic neurological disorder involves a single nerve, namely the lateral cutaneous nerve of thigh (also called the Lateral femoral cutaneous nerve). |
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71.paternal uncle has MH, pregnant lady, how best to test for MH (rpt q)
A. muscle biopsy on pregnant lady B. negative muscle biopsy of her father C. genetic testing of pregnant lady |
B
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72.The nerve supplying area of skin between greater trochanter and iliac crest:
A. subcostal nerve B. ilioinguinal nerve C. genitofemoral nerve D. femoral nerve E. lat cutaneous femoral nerve |
A
Fundamentals of Regional Anaesthesia A. Subcostal: sends fibre to the first lumbar nerve and its lateral cutaneous branch runs over the iliac crest to innervate the skin of the lateral aspect of the buttock as far as the greater trochanter B. Ilioinguinal: enters the inguinal canal accompanies the spermatic cord and supplies the skin of the rrot of the penis and anterior part of the scrotum, mons pubis and labium majorum. C. Genitofemoral: two branches. a. Genital branch enters the inguinal canal and supply the spermatic cord and innervate the same cutaneous area as the ilioinguinal nerve. b. Femoral branch: skin over the femoral triangle. D. Femoral: supplies the muscles and the skin of the anterior compartment of the thigh E. Lateral cutaneous nerve: a. Anterior branch: supplies the skin over the antero-lateral aspect of the thigh down to the knee b. Posterior branch: the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh |
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73.Hydroxyethylstarch with intermediate volume replacement/ duration(rpt):
A. 6% HES 130/0.4 |
Ans A
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74.Pyloric stenosis (rpt Q)
A. alkaline then acid urine B. ? C. ? |
Ans A
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75.Which can deliver minute ventilation of greater than 5L/min using a 14 G cannula used for needle cricothyroidotomy
A. jet ventilation using pressure 400KPA B. oxygen flush button on anaesthetic machine C. oxygen tubing on oxygen port on anaesthetic machine at 12L/min D. E. none of the above |
Unclear, stem may be incorrect.
Consider A or E depending on wording of question, whether is says 5L/min or flow or 5L/min of ventilation. |
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76.congenital diaphragmatic hernia (rpt)
A. "there is hyperplasia of pulmonary arterioles" B. |
Ans A
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77.young man in trauma, hypotensive ?BP70/40. CXR widened mediastinum. Fast STRONGLY POSITIVE. "best way to assess the widened mediastinum is" (rpt)
A. intraop TOE B. TTE |
Ans A
Transthoracic echocardiography (TTE) is easily available and the ascending aorta and aortic arch can be visualized well. In obese or chest trauma patients, image quality may be inadequate due to poor echo windows. Transoesophageal echocardiography (TOE) has become more popular as experience and availability increase. It is useful perioperatively in the haemodynamically unstable patient. TOE images the entire thoracic aorta except for the most distal ascending aorta and a part of the arch obscured by the trachea or right main bronchus. Echocardiography can be used with high accuracy for decision-making in acute dissection. |
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78.IV paracetamol
A. late plasma levels around the same as oral B. highly protein bound C. ?30%? renally excreted D. VD 10L/kg |
Ans A
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79.Head Trauma patient with unilateral dialated pupil, wahts the diagnosis ?
A.Global injury B.Optic nerve injury C.Horners syndrome D.Tenstentorial herniation E..... |
Ans D
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80. Question about CO2 Laser. Does not cause deep tissue damage because
a. High Frequency b. Penumbra effect c. ? Dissipation of energy d e. |
Ans C
Characteristics of the CO2 laser and its uses The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water and by all biologic tissues high in water content. The extinction length of this wavelength is about 0.03¬mm in water and in soft tissue. |
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81. Patient with diastolic dysfunction. Is it caused by:
a. Restrictive cardiomyopathy b. Dilated cardiomyopathy c. d. e. |
Ans A
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82. supine hypotension syndrome (rpt)
a. high SVR b. tachycardia |
A
Sharma S. Shock and Pregnancy. eMedicine.com. URL: http://www.emedicine.com/med/topic3285.htm Aortocaval compression is thought to be the cause of supine hypotensive syndrome. Supine hypotensive syndrome is characterized by pallor, bradycardia, sweating, nausea, hypotension and dizziness and occurs when a pregnant woman lies on her back and resolves when she is turned on her side. |
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83.Non-normally distributed pain scores. What is the best way to describe spread of data?
A. Inter-quartile range B. Standard deviation C. Standard error of the mean D. ? E. ? |
Ans A
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84.What term means the number of people who are correctly identified as not having a disease:
A. Sensitivity B. Specificity C. Positive predictive value D. Negative predictive value |
B?
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85.If a test is negative, what proportion will not have the disease:
A. Sensitivity B. Specificity C. Positive Predictive Value D. Negative Predisctive Value |
Ans D
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86. Cryoppt: insufficient (rpt)
A. F9 B. F13 |
A
Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate fibrinogen concentrate available for intravenous use. |
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AC90 Most likely to result in myocardial infarction (rpt):
A. intraop myocardial ischaemia B. post op myocardial ischaemia |
B
From Landesberg G: The Pathophysiology of peri-op MI: the facts and perspectives. J Cardiothoracic and Vac Anaes 2003: 17(1): 90-100 Peri-op myocardial ischaemia peaks in the early post-op period and is significantly associated with MI and cardiac complications. Intraop ischaemia is less common and infrequently associated with post-op MI. Peri-op MI is almost exclusively preceded by ST depression type ischaemia. (STEMI is uncommon) Peri-op MI is mostly silent (only 50% have any sx) and occur in first 24-48 hours post-op pick with cont. ECG monitoring and ST trend analysis and troponin. http://bja.oxfordjournals.org/cgi/content/full/95/1/3 |
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88.Awake patient with diabetes insipidus
A. Euvolaemic B. C. D. E. urinary Na <20 |
E
not enough ADH and large consequent free water diuresis with low urinary sodium and hypernatraemia |
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TMP-128 Indication for percutaneous closure of ASD
a. Primun < 3cm b. Primun > 3cm c. Secundum < 3 cm d. Secundum > 3cm e. sinus venosus ASD |
Ans C
CEACCP Anaesthesia for percutaneous closure of atrial septal defects 2008 Only an ostium secundum ASD is suitable for percutaneous closure. If the defect is very large (>3 cm) or complicated (associated with other abnormalities), or an incomplete rim is detected, referral for surgical closure is indicated. |
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90.Timing of worst coagulopathy after liver transplant
a. 1-2 days b. 3-4 days c. 5-6 days |
?A
Oh manual would do COAG tds for first day I guess many of the clotting factors plasma half life are <24 hours and many patients for liver transplant has poor liver function to start with. For the new liver to start making new factors take >1day. |
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91.ASA grading was introduced to
A. predict intraop anaesthetic risk B. Predict intraop surgical and anaesthetic risk C. Standardise the physical status classification of patients D. Predict periop anaesthetic risk E. Predict periop anaesthetic and surgical risk |
C
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92.Pulsus paradoxus is: (the Q was something like - severe asthmatic - when take BP you would find)
A. Reduced BP on inspiration unlike normal (ie normally increased on insp) B. Reduced BP on inspiration exaggerated from normal C. Reduced BP on expiration unlike normal D. Reduced BP on expiration exaggerated from normal E. ? |
B
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92.Respiratory function in quadriplegics is improved by
A. abdominal distension B. an increase in chest wall spasticity C. interscalene nerve block D. the upright position E. unilateral compliance reduction |
B
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93.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 |
B
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94.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 |
B see http://www.nationalasthma.org.au/uploads/content/211-spirometer_handbook_naca.pdf |
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95.Carbon dioxide is the most common gas used for insufflation for laparoscopy because it
A. is cheap and readily available B. is slow to be absorbed from the peritoneum and thus safer C. is not as dangerous as some other gases if inadvertently given intravenously D. provides the best surgical conditions for vision and diathermy E. will not produce any problems with gas emboli as it dissolves rapidly in blood |
C
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SZ14b Following a cadaveric renal transplant under general anaesthesia, your patient's plasma K+ increases to 6.0 mmol.l-1 in recovery after being 5.0 mmol.l-1 pre and intra-operatively. This patient requires
A. an intravenous infusion of CaCl2 (10 mls over 20 minutes) B. arterial blood gases to ascertain the acid/base status C. potassium exchange resins rectally D. sodium bicarbonate infusion (50- 100 mEq over 5- 10 minutes) E. urgent haemodialysis |
B
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97. Carcinoid syndrome - finding on examining heart:
A. Fine inspiratory crepitations B. Systolic murmur at apex C. Systolic murmur at left sternal edge D. Murmur at apex with opening snap E. Pericardial rub |
C
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98.Histamine release in anaphylaxis does NOT cause:
A. Tachycardia B. Myocardial depression C. Coronary artery vasodilatation D. Prolonged PR interval E. Decreased impulse conduction] |
B
H1 via PLC Coronary constriction Bronchoconstriction Slow AV node Release of prostacyclin H2 via cAMP Inotropy Coronary dilation Bronchodilation Tachyarrhythmia Increase PR Ventricular irritability Decrease VF threshold Shift in pacemaker rate CNS stimulation Increase H+ secretion by parietal cells Both H1&2 increase capillary leakage |
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99.Pre-ganglionic sympathetic fibres pass to the
A. otic ganglion B. carotid body C. ciliary ganglion D. coeliac ganglion E. all of the above |
D
Ciliary ganglion: PSNS ganglion in posterior orbit papillary constriction and ciliary accommodation Otic ganglion: small PSNS in infratemporal fossa (one of four PSNS ganglion of head and nexk- also ciliary, submandibular, pterygopalatine) Carotid chemoreceptor CNIX, aortic body is via CNX |
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100.Branches of the mandibular nerve do NOT include the
A. auriculotemporal nerve B. long buccal nerve C. lingual nerve D. great auricular nerve E. chorda tympani nerve |
D
The chorda tympani is a nerve that branches from the facial nerve (cranial nerve VII) inside the facial canal, just before the facial nerve exits the skull via the stylomastoid foramen. Chorda tympani is a branch of the facial nerve (the seventh cranial nerve) that serves the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain. |
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101. In a trial, 75 patients with an uncommon, newly described complication and 50 matched patients without this complication are selected for comparison of their exposure to a new drug. The results show:
Complication present Complication absent Exposed to new drug 50 25 NOT exposed 25 25 From this data A. the relative risk of this complication with drug exposure CANNOT be determined B. the odds ratio of this complication with drug exposure CANNOT be determined C. the relative risk of this complication with drug exposure is 2 D. the odds ratio of this complication with drug exposure is 1.33 E. none of the above |
Ans A
Cohort studies: A longitudinal study where some cases are exposed and the others are not. They are followed up and the incidence of disease in each pup compared. Almost always prospective but it is possible to perform a cohort study entfre1y retrospectively. Risk analysis often with relative risk or odds ratio. Case control studies: The disease status is know and a retrospective analysis is made to determine whether there was a difference in exposure to risk factors. Risk analysis with odds ratio. Risk: the number with an even divided by the total number at risk of the event. Odds: the number with an even divided by the number without. Relative risk: ratio of the risk of an even between the two groups Above if it was a cohort study: RR: 50/75/(25/50)=1.333 OR: (50:25)/(25/25) = 2 This is a retrospective case control study. Patient with complication were identified and matched to look at the exposure. Therefore, you can’t define an incidence rate and therefore not able to calculate RR. However, you can still calculate an odds ratio. |
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102.BP measurement - overestimates with:
A. big (wide) cuff B. skinny arm C. severely peripherally vasoconstricted D. atherosclerosis E. slow cuff deflation |
D
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103. A device that detects a 10mA difference in active and neutral leads and causes turning off of the circuit within 40 ms. this is a :
A. Class 1 device B. Equipotential earthing C. LIM D. Residual Current Device E. Fuse |
Ans D
CEACCP electrical safety in the operating theatre A. Class 1 Device: Any conducting part of Class I equipment accessible to the user, such as the metal casing, is connected to earth by an earth wire. If a fault occurs, this allows the live supply to come into contact with an accessible part, current flows down the earth wire. This new circuit has a lower resistance, resulting in an increased current which melts the protective fuses and breaks the circuit, removing the source of potential electrocution. B. Equipotential earthing: the terminals of each piece of equipment in a stack can be connected to each other bringing them all to the same potential. C. Line isolation monitor: measures the potential for current flow from the isolated power supply to the ground. i.e. active and neutral should have the same current. If there is a fault, a device is grounded then the current through to neutral would decrease. There is then a current able to flow through the line isolation monitor and sounds an alarm. D. Residual current device: If the current in the live and neutral conductors is the same, the magnetic fluxes cancel themselves out. However, if they are different (due to excessive current leakage) there is a resultant magnetic field. This induces a current in the third winding causing the relay to break the circuit. E. Fuse: a material that melts with increased current and breaks the circuit. |
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104.Post-transfusion hepatitis in Australia is associated with
A. jaundice in over 50% of patients B. development of chronic disease in less than 10% of patients C. hepatitis B in the majority of patients D. the presence of antigen or antibody to hepatitis C E. elevation of serum alkaline phosphatase |
C "Post-Transfusion Hepatitis" is an old term for Hepatitis B Hep B 1 in 764,000Hep C 1 in 1,935,000 Miller transfusion Therapy chap 55 A: Less than 1/3 in with hep C develop jaundice. B: 23% development chronic hepatitis with hep C. Hep C accounts for >90% of post transfusion hepatitis C: Hep B is the majority of patients D: Traditionally associated with hep C but now less with nucleic acid testing |
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105.In a patient requiring FFP where the patient’s blood group is unknown, it is ideal to give FFP of group
A. A B. B C. AB D. O E. Blood group of FFP in this situation does not matter |
C
AB should not have antibodies against ABO antigens |
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106.Features of the transurethral resection of the prostate (TURP) syndrome include all of the following EXCEPT
A. agitation B. angina C. bradycardia D. nausea E. tinnitus |
E
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107.The most frequently reported clinical sign in malignant hyperpyrexia is
A. arrhythmia B. cyanosis C. sweating D. tachycardia E. rigidity |
D
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SZ80 Which of the following is not an absolute contra-indication for MRI?
A. cochlear implant B. heart valve prosthesis C. ICD D. pacemaker E. intracranial clips |
B probably best answer, but:
A - absolute contraindication http://www.mrisafety.com/SafetyInfov.asp?SafetyInfoID=170 B - may exert force on heart, but often safe (best answer) C and D - "relative contraindication" but under specific circumstances, still an absolute contraindication in most cases/centres http://www.mrisafety.com/SafetyInfov.asp?SafetyInfoID=167 E - definitely a relative contraindication - non-ferromagnetic/MRI safe clips now very common http://www.mrisafety.com/SafetyInfov.asp?SafetyInfoID=229 Still, only reported fatality of patient with aneurysm clip was due to incorrect identification of clip as being MRI safe when it was not |
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109.Reverse splitting of the second heart sound occurs with:
A. LBBB B. Pulmonary hypertension C. Acute pulmonary embolus D. ASD E. Severe MR |
A
Reverse splitting of S2 with delayed LV outflow LBBB or severe AS Normally the A2 precedes P2 because LV empties first |
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110. Atrial fibrillation:
A. Cardioversion results in longer life expectency than rate control B. Need to stay on warfarin following cardioversion C. Pt with HR <80 generally do not require anticoagulation D. |
B
Warfarin 3 weeks prior and one month post Rate control has equal morbidity to cardioversion in those >65 years Anticoagulation is required regardless of rate |
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111.Scoliosis surgery. what is incorrect
A. one third of the blood loss occurs postoperatively B. major blood loss is frequently accompanied by a consumptive coagulopathy C. surgery will halt progression of the restrictive lung deficit D. the major neurological deficits that occur are usually due to damage to the posterior columns of the spinal cord E. the use of aprotinin reduces blood loss |
D
Anaesthesia for correction of scoliosis in children A True: About a third of the blood loss occurs in the postoperative period. B True: The coagulopathy is both dilutional and consumptive C True: Surgical correction does not reverse the restrictive lung deficit but will halt its progression D False: most vulnerable to ischaemic injury are the motor pathways supplied by the anterior spinal artery E True: The serine protease inhibitor aprotinin is the most studied and the most effective, halving blood loss in high-risk patients |
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112.About transient neurological syndrome..
A. Comprises pain localised to the back B. Diagnosis is confirmed by typical finding on neurological examination C. Associated with consistent abnormalities on magnetic resonance imaging and electrophysiological studies (EPS) D. associated with long term deficits in 5% of cases E. May occur with lignocaine, bupivacaine, prilocaine and procaine. |
E
This phenomenon is associated with pain or sensory abnormalities in the lower back, buttock, or lower extremities. The symptoms of burning pain and dysethesthia in the L5 and S1 dermatomes usually start after the effects of spinal anesthesia have concluded and may last up to hours to four days. No evidence of persistent deficits http://journals.lww.com/anesthesia-analgesia/Fulltext/2005/06000/Transient_Neurologic_Symptoms_After_Spinal.47.aspx |
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113. Epidural infection...
Serious post operative epidural infection A. Is rarely due to staphylococcal species B. Is associated with epidural catheter discconection C. Occurs with an incidence in the range of 1-2 per 10,000 D. Is usually reported in obstetric cases E. Mandates surgical drainage if an abscess is present |
C
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Regarding epidural abscess which is wrong
A. diagnosis is dependent on triad of back pain, fever and paralysis B. occurs at a rate of 1:1000-3000 C. Worse outcomes if advanced age D. Usually gram positive cocci E. Expectant management may be appropriate |
D B - much less than this if include spontaneous and still lower if neuraxial (1:10000 epidural, 1:50000 spinal) C - not sure, maybe? D - true at least 60-80% are G+ (most staph) E - if expectant means non-surgical, then yes, but should be treated with antibiotics. Reasons not to operate - established paralysis > 24-36h, comorbidity/age, diffuse multilevel infection NB doesn't specify if post neuraxial block or epidural abscess overall including spontaneous |
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114. Difference between cardiac protected and body protected area
A. Equipotential earthing B. isolation transformer C. line isolation monitor D. Max leakage current to patient limit 500 microamperes E. Residual current device |
A
equipotential earth required for cardiac protected area to protect against microshock |
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115. Which hormone is not released during surgery?
A. cortisol B. C. TSH D. growth hormone |
C
Catecholamine, corticosteroids, GH, glucagon all increased. GH only anabolic hormone. TSH unchanged. Thyroxine may be increased by sympathetic stimulation, but catabolic effect. |
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116. Asystolic aortic arch repair. The best method for cerebral protection is:
A. anterograde perfusion via coronary vessel B. retrograde perfusion via jugular vein C. thiopentone IV D. hypothermia to 20 degrees celcius |
D
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117. Specificity most closely means
A. chance of a positive test in people with the disease B. chance of a negative test in people without disease C. chance of... |
B
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118. Negative predictive value most closely means
A. chance of a positive test in people with the disease B. chance of a negative test in people without disease C. chance of... |
No Ans
NPV the probability of people don’t have the disease given a negative test |
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119. Performing a bronchoscopy. The best way to orient the scope is: (see Q48)
A. angle of the bronchus B. length of the bronchus c. RUL |
C
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120. Symptoms of hypercalcaemia include: (see Q5)
A. B. C. seizures D. short ST segment |
Ans: ?short QT
Effects of hypercalcaemia: "Stones, Bones, Groans, Thrones and Psychiatric Overtones" Stones (renal or biliary) Bones (bone pain) Groans (abdominal pain, nausea and vomiting) Thrones (sit on throne - polyuria) Psychiatric overtones (Depression 30-40%, anxiety, cognitive dysfunction, insomnia, coma) Abnormal heart rhythms can result, and ECG findings of a short QT interval and a widened T wave suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction. Hypercalcaemia has also been known to cause an ECG finding mimicking hypothermia, known as an Osborn wave. |
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121. Paediatric VF arrest. Which is true?
A. if resistant to defibrillation should give amiodarone 5mg/kg B. C. commonly associated with respiratory arrest D. is the most common form of arrest in this patient group E. should defibrillate with 5J/kg |
A
ARC Persistent or refractory VF or VT may be treated with antiarrhythmics such as amiodarone 5 mg/kg iv DC shock is 2J/kg then 4 J/kg thereafter The most common arrest scenario in children is bradycardia proceeding to asystole (a response to severe hypoxia and acidosis. VF is relatively uncommon, but may complicated hypothermia, TCA poisoning and those children with pre-existing cardiac disease. |
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RU19 Intercostobrachial nerve
A. Is often damaged by torniquet B. supplies sensation to cubital fossa C. is blocked by interscalene brachial plexus block D. ? E. ? |
A
The intercostobrachial and the medial brachial nerves originate in the lower nexk and upper thorax and become cutaneous on medial upper arm. Both must be blocked proximal to the axilla for shoulder surgery or for any upper extremity procedure that involves use of a pneumatic tourniquet. The Intercostobrachial nerve derives from T2 posteromedial aspect of the arm Medial brachial cutaneous nerve derives from C8 and T1 shoulder |
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123. OLV hypoxaemia. After 100% O2 and FOB next step is: (rpt)
A. CPAP 5cm top lung B. CPAP 10cm top lung C. PEEP 5cm bottom lung D. CPAP 5cm top + PEEP 5cm bottom |
C
Miller A CEACCP |
