2014.2

Front 1

1. A transdermal fentanyl patch is often used for management of cancer pain. After application, the time to reach peak plasma levels is:

* A. 1hr
* B. 2hrs
* C. 4hrs
* D. 12hrs
* E: 24hrs

Back 1

E. 24 hrs

ANZCA pain book 6.5.1

"The time to peak blood concentration is generally between 24 and 72 hours after initial patch application and after the patch is removed, serum fentanyl concentrations decline gradually, with a mean terminal half‐life ranging from 22 to 25 hours" (MIMS, 2008)

Front 2

2. Pharmacological studies are undertaken in several phases. A phase 3 study involves:

* A Animal studies
* B Testing of drug on healthy volunteers
* C Observational studies on patients with disease
* D Post marketing surveillance
* E Randomised controlled trials on target population

Back 2

E. RCT in target population ("full scale evaluation")

Myles textbook p.137

Phase I: first administration in humans (usually healthy volunteers). Confirm/establish basic PK and toxicology data. (n=20-100)

Phase II: selected clinical investigations in target population, aimed at establishing dose-response ('dose finding') relationship, plus some evidence of efficacy and safety

Phase III: full scale clinical evaluation of benefits, potential risks and cost analyses

Phase IV: post marketing surveillance (thousands of patients)

Front 3

3. A pregnant patient 28/40 gestation is involved in a high-speed MVA. On admission to the DEM she complains of sudden onset severe chest pain. Her vital signs show HR 120, BP 160/100, SpO2 95% RA and her ECG shows ST depression. Most likely diagnosis is:

* A. Cardiac contusion
* B. Tension pneumothorax
* C. Aortic dissection
* D. Sternal fracture
* E. Myocardial infarction

Back 3

C. Aortic dissection (blunt chest trauma + pregnancy both risk factors)

http://www.nlm.nih.gov/medlineplus/ency/article/000181.htm

Front 4

4. A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers a cardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemia is:

* A MH
* B ARF
* C Cardiomyopathy
* D Rhabdomyolysis
* E Crush injury

Back 4

D. Rhabdo

CEACCP. NM disorders and anaesthesia.

http://ceaccp.oxfordjournals.org/content/early/2011/06/10/bjaceaccp.mkr019.full.pdf

"Inhalation anaesthetics have been implicated in the rhabdomyolysis seen in Duchenne muscular dystrophy patients secondary to

their effects of further increasing mycoplasmic calcium. It has been difficult to elucidate whether the metabolic reaction seen is

related to an anaesthesia-related rhabdomyolysis or a true malignant

hyperthermia."

Ped Anaesth study

http://anes-som.ucsd.edu/Intranet/Peds_Resources/MH/Malignant%20hyperthermia%20and%20MD.pdf

We did not find an increased risk of malignant hyperthermia susceptibility in patients with DMD or BD compared with the general population. However, dystrophic patients who are exposed to inhaled anesthetics may develop disease-related cardiac complications, or rarely, a malignant hyperthermia-like

syndrome characterized by rhabdomyolysis

Front 5

52. A 30yr old pregnant patient develops contractions at 30/40 gestation. Which of the following can not be used for tocolysis?

A. Clonidine

B. Indomethacin

C: Magnesium

D. Salbutamol

E. Nifedipine

Back 5

A - clonidine has no tocolytic effect

Indomethacin is an appropriate (first-line) tocolytic for the pregnant patient in early preterm labor (< 30 wks).. not usually recommended after 32 weeks (risk PDA constriction/closure).. emedicine

http://emedicine.medscape.com/article/260998-overview#aw2aab6b7

http://jam.customer.netspace.net.au/pdfs/3.E%20Obstetrics.pdf

Front 6

53. In a patient with intraorbital haemorrhage, following local anaesthetic injection, the adequacy of occular perfusion is best assessed by:

* A. Angiography
* B. Indirect opthalmoscopy
* C. Direct opthalmoscopy
* D. Intra-occular pressure tonometry
* E. Palpation of the globe by an experienced physician

Back 6

B

Royal college of anaesthetists and opthalmologists consensus document

http://www.rcoa.ac.uk/system/files/LA-Ophthalmic-surgery-2012.pdf

Document page 26

"Indirect ophthalmoscopy should be performed to look for evidence of central retinal artery perfusion compromise"

Front 7

54. What is the appropriate post-operative ibuprofen dosage for a one year old child tds?

* A. 5mg/kg
* B. 7.5mg/kg
* C. 10mg/kg
* D. 15mg/kg
* E. 20mg/kg

Back 7

C. 10 mg/kg

Frank Sham drug doses

Front 8

55. You are inducing a 4yr old child with Arthrogrophysis multiplex congenita. After you administer the induction agents, you find it difficult to place the laryngoscope. What is the likely complication?

* A. Malignant hyperthermia
* B. Neuroleptic malignant syndrome
* C. TMJ rigidity
* D. Opioid-induced rigidity
* E. Inadequate depth of anaesthesia

Back 8

C

OHA p298: Arthrogryposis
Skin and SC tissue abnormalities, contracture deformities, micrognathia, cervical spine and jaw stiffness, congenital heart disease (10%), difficult airway and venous access, sensitive to thiopental, hypermetabolic response is probably not MH

Front 9

56. What is the best measure of the anticoagulant effect of Dabigatran?

* A. APTT
* B. Dilute thrombin time
* C. Prothrombin time
* D. Bleeding time
* E. TEG

Back 9

B. Dilute thrombin time

Horlocker article.

http://www.chumontgodinne.be/files/PradaxaPracticalquestionsFinalSept2011.pdf

In situations where an assessment of the anticoagulant activity of dabigatran is

required, the activated partial thromboplastin time (aPTT) test, which is widely available, provides an approximate indication of the anticoagulation intensity achieved with dabigatran.

If required, a more sensitive quantitative test with the diluted Thrombin Time (Hemoclot®) can be performed.

The INR is less affected by dabigatran and should therefore not be used.

Front 10

57. What is the ratio of compression to breaths for neonatal resuscitation?

* A. 3:1
* B. 15:1
* C. 30:1
* D. 15:2
* E. 30:2

Back 10

A. 3:1 (ARC neonatal resus guidelines)

Front 11

60. In patients with refractory elevated ICP, bilateral decompressive craniectomy is associated with reduction in ICP and also results in:

* A. Reduced duration of ventilation
* B. Reduced duration of hospitalisation
* C. Improved overall mortality
* D. Worse long-term neurological outcome
* E. Unchanged long-term neurological outcome

Back 11

E. No change long-term outcome

Cochrane review:

http://www.ncbi.nlm.nih.gov/pubmed/16437469

"There is no evidence to support the routine use of secondary DC to reduce unfavourable outcome in adults with severe TBI and refractory high ICP. In the pediatric population DC reduces the risk of death and unfavourable outcome."

2014 article:

http://www.ncbi.nlm.nih.gov/pubmed/24662856

Front 12

61.Tumour lysis syndrome causes all of the following biochemical abnormalities EXCEPT:

* A. Hyperkalaemia
* B. Hypernatraemia
* C. Hyperphosphataemia
* D. Hyperuricaemia
* E. Hypocalcaemia

Back 12

B. Hypernatraemia (all other changes occur)

Medscape:

http://emedicine.medscape.com/article/282171-overview#showall

Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure.

CEACCP. Intensive care management of patients with haematological malignancy.

http://ceaccp.oxfordjournals.org/content/10/6/167.full

Front 13

76. A patient has suffered flash burns to half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burnt is:

* A. 18%
* B. 23%
* C. 32%
* D. 41%
* E. 48%

Back 13

C. 32%

Rule of 9's:

Half of upper limb: 4.5

All of lower limb: 18

Anterior surface abdomen: 9

Front 14

77. You are anaesthetising an ASA 1 woman for a laparoscopic gynaecological procedure. How long does it take for the PaCO2 to peak?

* A. <15min
* B. 15-30min
* C. 30-60min
* D. 60-90min
* E. >90min

Back 14

B. 15-30 min

See: http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/anesthesia/site/content/v04/040260r00.HTM

During uneventful CO2 -pneumoperitoneum, PaCO2 progressively increases to reach a plateau 15 to 30 minutes after the beginning of CO2 insufflation in patients under controlled mechanical ventilation during gynecologic laparoscopy in the Trendelenburg position

Front 15

82. Anaemia post partial gastrectomy is most likely due to:

* A folate deficiency secondary to steatorrhea
* B ongoing haemorrhage from stomal ulcer '(yes Stomal not stomach)'
* C malabsorption of iron
* D Vit B deficiency due to loss of intrinsic factor
* E folate deficiency due to lack of appetite

Back 15

C. Iron

Front 16

83.: 65year old for video assisted thoracoscopic lower lobe wedge resection. Surgeon requests lung isolation and one lung ventilation.

Predictors of intraoperative hypoxia are:

* A central rather than peripheral lesion
* B left sided lesion
* C low Aa Oxygen gradient when ventilating both lungs
* D right sided lesion
* E supine rather than lateral position

Back 16

A,D and E all predictors of intraop hypoxia.

?Poor recall (possibly all except..)

CEACCP. Hypoxaemia during one-lung anaesthesia

http://ceaccp.oxfordjournals.org/content/10/4/117.full

Factors predictive of hypoxaemia during OLV include: ventilation of the left rather than the right lung, low oxygen partial pressure on two lungs, absence of reduction of perfusion to areas of lung pathology, and supine position rather than the lateral decubitus position

Front 17

94. Small air bubbles in the arterial line system will reduce:

* A. Dampening coefficient
* B. ?Extrinsic Coefficient
* C. Measured systolic pressure
* D. Measured MAP
* E. Resonant frequency

Back 17

C. air bubbles -> overdamped system -> reduce measured SBP (MAP stays the same)

?If resonant frequecy will reduce in this setting too

CEACCP. Blood pressure measurement

http://ceaccp.oxfordjournals.org/content/7/4/122.full

Front 18

Q95: RPT. Capnograph trace form a patient that is intubated and ventilated. What does it indicate

See previous paper for a picture, it was the same

* A. Endotracheal intubation
* B. Gas sample line leak
* C. ETT cuff leak
* D. Obstructive disease
* E. Spontaneous breaths

Back 18

B. Gas sample line leak

Front 19

Photograph and Ultrasound picture of regional block. probe held transverse against posterolateral aspect of distal humerus over triceps. shows triangular nerve in close proximity to humerus. After infiltration of 5mls of 0.75% ropivacine Numbess in:

* A lateral aspect of forearm
* B ring dorsum??
* C medial??
* D palmar aspect and distal dorsal aspect of little finger and medial half of ring finger
* E palmar aspect and distal dorsal aspect of thumb, index and medial fingers and lateral half od ring finger

Back 19

Sounds like image of radial nerve..

None of answers correspond with radial nerve sensory distribution

Options:

A. musculocutaneous nerve

B. ulnar nerve (dorsal ring finger)

C.

D. ulnar nerve

E. median nerve

Front 20

Lateral CXR given. Can see lower half of thorax and vertebrae but upper half is all black with clear demarcation

* A ?
* B Artifact caused by patient's arm
* C Left lower lobe consolidation
* D Right middle lobe consolidation
* E Right lower lobe consolidation

Back 20

Something either side of horizontal fissure.

Front 21

12 year-old with idiopathic scoliosis, most likely have associated

* A Phaemochromocytoma
* B Renal artery stenosis
* C Mitral valve prolapse
* D Diabetes insipidus
* E

Back 21

C. Mitral valve prolapse

Approximately 25% patients with idiopathic scoliosis have mitral valve prolapse, but this is rarely of clinical significance and antibiotic cover is given

CEACCP. Scoliosis surgery

http://ceaccp.oxfordjournals.org/content/6/1/13.full

Front 22

Term neonate, noted to have intermittent stridor few days after birth, then parents also notice stridor during feeding and sleep. Otherwise normal and healthy. Most likely condition is

* A Cri-du-chat syndrome
* B Laryngomalacia
* C Tracheomalacia
* D
* E

Back 22

B. Laryngomalacia

Laryngomalacia - most common cause of chronic pediatric stridor causing approximately 60% of stridor seen in newborns.

http://www2.utmb.edu/otoref/Grnds/Stridor-infants-980415/Stridor-infants-980415.html

Front 23

A picture of an echo 4 chambers view

* A Anterior mitral valve leaflet
* B Posterior mitral valve leaflet
* C
* D
* E

Back 23

.

Front 24

Cryoprecipate, once thawed must use within

* A 30 minutes
* B 2 hours
* C 4 hours
* D 6 hours
* E 12 hours

Back 24

D. 6 hours

http://lifeinthefastlane.com/ccc/cryoprecipitate/

http://www.childrensmn.org/manuals/lab/transfusionsvc/018717.pdf

Front 25

Glycine 1.5% used for TURP, osmolality is

* A 200
* B
* C
* D 300
* E 320

Back 25

A. 200

CEACCP. Anaesthesia for transurethral resection of the prostate

http://ceaccp.oxfordjournals.org/content/9/3/92.full

Front 26

Sick ICU patients seem to have moderate - severe ARDS PaO2/FIO2 ratio of 200, C.I. 1.7 (cardiac function seems okay). Decided to have ECMO, best mode is

A AV

B VA

C VV

D. ?

Back 26

C. VV ECMO

Veno-venous ECMO is designed to provide gas exchange, while veno-arterial ECMO provides both gas exchange and haemodynamic support

CEACCP. Extracorporeal membrane oxygenation in adults.

http://ceaccp.oxfordjournals.org/content/12/2/57

Front 27

Middle age women c/o pain in hands when hanging out washing. Also found to have muscle wasting on one of the hand associated with weaker radial pulse.

* A CRPS
* B Lateral medullary syndrome
* C Thoracic outlet syndrome
* D Paraneoplastic syndrome
* E

Back 27

C. Thoracic outlet syndrome

No best source but seems most likely of options available

See CEACCP: Anaesthesia for vascular surgery

of the upper limb

http://ceaccp.oxfordjournals.org/content/early/2013/09/02/bjaceaccp.mkt044.full.pdf

Front 28

Same radial nerve question with photos of a probe over postero-lateral upper arm and ultrasound image that show a triangular shape nerve, most likely the radial nerve. Injecting 5 ml of 0.75% [[ropivacaine] will produce sensory block over

* A Medial forearm
* B Lateral forearm
* C Dorsum part of hand
* D Plantar surface of ring and little finger
* E Plantar surface of middle and ring finger

Back 28

C Dorsum part of hand

Front 29

Blue urticaria is a complication of

* A
* B Methylene blue
* C Patent blue something
* D
* E

Back 29

C. Patent blue V

Anaphylaxis and blue urticaria associated with Patent Blue V injection

http://www.respond2articles.com/ANA/forums/1182/ShowThread.aspx

Front 30

Intraosseous sampling - least accurate on

* A Albumin
* B Urea
* C
* D Chloride
* E

Back 30

Listed options seem to be accurate:

A new study of intraosseous blood for laboratory analysis.

http://www.ncbi.nlm.nih.gov/pubmed/20807043

There was a significant correlation between intravenous and IO samples for red blood cell counts and hemoglobin and hematocrit levels but not for white blood cell counts and platelet counts. There was a significant correlation between intravenous and IO samples for glucose, blood urea nitrogen, creatinine, chloride, total protein, and albumin concentrations but NOT for sodium, potassium, CO(2), and calcium levels

Front 31

Subtenon's block - muscle most likely to have inadequate block

* A Medial rectus
* B Lateral
* C Superior
* D Superior oblique
* E Inferior

Back 31

D. Superior oblique

Ophthalmic Regional Block

Chandra M Kumar

Most patients develop akinesia with 4 to 5mL of local anaesthetic agent but the superior oblique and eyelid muscles may remain active

http://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&ved=0CDMQFjAC&url=http%3A%2F%2Fwww.researchgate.net%2Fpublication%2F7155728_Ophthalmic_regional_block%2Flinks%2F0deec52a5484f135b0000000&ei=vjgtVK-nMs-A8gWXhYCYDg&usg=AFQjCNGEcWQQ31TSfr5oxUkAdYH3HFN29A&sig2=QRCMeJPeGTzktmImvFUvjg

Front 32

In patients with inoperable AS, compared to medical treatment TAVI has significantly lower incidence in 30 days of

* A Stroke
* B
* C Mortality
* D Atrial fibrillation

Back 32

TAVI:

30 day risk of stroke 3% http://www.ncbi.nlm.nih.gov/pubmed/22391581

AF (new onset) 1:3 http://www.ncbi.nlm.nih.gov/pubmed/22177537

Systematic review:

http://www.annalscts.com/article/view/1395/2013

The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.

http://circ.ahajournals.org/content/124/3/355.full

Front 33

EVAR, best method to reduce risk of renal impairment

* A Sodium bicarbonate
* B N-acetylcysteine
* C Normal saline
* D
* E

Back 33

C. N/Saline

CEACCP. EVAR

Because the EVAR procedure involves the liberal use of contrast media to assist placement and deployment of the graft to ensure proper exclusion of the aneurysmal sac, it is worthwhile ensuring that the patients are well hydrated to prevent postoperative renal impairment. There is no current evidence to support routine use of diuretic agents during EVAR

Front 34

EVAR is preferred over open AAA repair because

* A Lower cost
* B Lower mortality
* C Less follow up
* D Less re-intervention
* E Less need for critical care

Back 34

E. Less crit care

From patient info sheet

http://www.ruh.nhs.uk/patients/services/vascular/documents/Endovascular_Aneurysm_Repair_Patient_Information.pdf

Your hospital stay following EVAR is usually about 2 days. You are cared for on a vascular surgical ward and there is usually no need for admission to the Intensive Care Unit. Following open surgical repair you would routinely be admitted to Intensive Care and your overall length of hospital stay would normally be approximately 10 days

Front 35

Laser flex tube with double cuffs - how to inflate cuff(s)?

* A Inflate proximal then distal
* B Inflate distal then proximal
* C
* D Inflate distal only
* E Inflate proximal only

Back 35

A. proximal then distal

(see ref below), but some sources infer use of distal cuff if prox cuff ruptures..?E.

http://books.google.com.au/books?id=3U5DAAAAQBAJ&pg=PA160&lpg=PA160&dq=laser+flex+cuff+inflate+both+cuffs&source=bl&ots=Yty1fjgmCl&sig=QtAnUNFKWBOClnTAOCmSdHfehPY&hl=en&sa=X&ei=zA41VOr_FMyA8gXAyYLQDw&ved=0CCcQ6AEwAQ#v=onepage&q=laser%20flex%20cuff%20inflate%20both%20cuffs&f=false

http://www.csen.com/cuff.pdf (search 'laser')

CEACCP laser. http://e-safe-anaesthesia.org/e_library/04/Lasers_and_surgery_CEACCP_2003.pdf

"if cuff bursts, second cuff cna be used

Front 36

Forceps delivery. Loss of sensation medial thigh with loss of adduction at hip joint - resulted from injury to

* A Sciatic nerve
* B lumbosacral plexus
* C Lateral cutaneous nerve of thigh
* D Obturator nerve
* E

Back 36

D.

Front 37

Called to cath lab because patient became agitated. Unstable angina having PCI,difficult right coronary stenting. Patient was hypotensive 80/40, HR 80/min in SR. What is the next best management step?

* A Transfer to operating theater immediately
* B Sedate and intubate
* C ?crack on
* D Transthoracic echocardiography

Back 37

D. TTE to exclude tamponade

(stem sounds like possible complication - "became agitated", "difficult RCA stenting")

Likely management stay and stabilise.. (therefore B or D)

Probably not A (doesn't sound like need to move immediately) or C (needs to be stabilised first).

Front 38

A printout of 12-lead ECG

* A Atrial fibrillation with BBB
* B Sinus tachycardia with BBB
* C Torsades de pointes
* D VT
* E VF

Back 38

.

Front 39

Repeat) Diagram about 3-bottle underwater seal drain, with the height of the fluid level in the suction bottle indicates

* A Maximal suction applied to the system
* B
* C
* D
* E

Back 39

.

Front 40

Photo of a patient with tongue deviation post cervical spinal fusion. Which nerve is damaged?

* A Glossopharyngeal nerve
* B Vagus nerve
* C Hypoglossal nerve
* D Accessory nerve
* E

Back 40

C. hypoglossal nerve tongue muscles

Front 41

Post cardiac surgery. Rhythm strip to assess pacing on AOO. What is the diagnosis?

* A Pacing spikes with loss of capture
* B
* C
* D
* E

Back 41

.

Front 42

Young male with MVA + femur # on traction. More than 24 hours. Became confused and drowsy, BP normal, crackles both lung fields with worsening O2 saturation despite increasing oxygen flow. Diagnosis?

* A Fat embolism
* B Compartment syndrome
* C Pulmonary embolism
* D
* E

Back 42

A. fat embolism

(cerebral signs make fat embolism the more likely diagnosis)

Front 43

G5P5 in third stage labour. Found to be unresponsive, cyanosed, faint pulse. On oxytocin induction and epidural infusion 10ml/hour. Also oozing from previous IV or blood sampling sites. Diagnosis?

* A High spinal
* B AFE
* C PE
* D
* E Massive haemorrhage

Back 43

B. AFE

(RF for

Front 44

In iron deficiency anaemia, one will expect a serum ferritin level to be less than

* A 300mg/L
* B 30mg/L
* C 30mcg/L
* D 300mcg/L
* E

Back 44

Ferritin usually in ng/ml

(which is mcg/L)

Iron deficiency = <30mcg/L

Front 45

Treatment for patients with congenital long QT syndrome

* A Pacemaker/defibrillator
* B Accessory pathway abalation
* C Beta blocker
* D Calcium channel blocker
* E

Back 45

C. Beta blocker

CEACCP:

http://ceaccp.oxfordjournals.org/content/8/2/67.full.pdf

Also emedicine:

http://emedicine.medscape.com/article/157826-treatment

Front 46

What can not be used for tocolysis in a 30/40 (NOT 34/40) pregnant lady?

* A Clonidine
* B Indomethacin
* C Salbutamol
* D
* E

Back 46

A. Clonidine (not a tocolytic)

Indomethacin safe until 32 weeks

Front 47

18 month old child with VF arrest, shock with

* A 10J
* B 30J
* C 50J
* D 100J
* E

Back 47

C. 50J

DC shock in paeds 4J/kg

Average 1 yo 10 kg, 2 yo 12 kg

http://www.resus.org.au/public/arc_paediatric_cardiorespiratory_arrest.pdf.

Front 48

Endovascular coiling of cerebral aneurysm under GA, patient suddenly develop hypertension. What is the most likely cause?

* A Acute hydrocephalus
* B Rupture of aneurysm
* C Contrast reaction
* D Cerebral embolism
* E

Back 48

.

Front 49

Ibuprofen dose for children

* A 10mg/kg
* B 15mg/kg
* C 20mg/kg
* D 25mg/kg
* E

Back 49

A. 10 mg/kg

Front 50

A patient on citalopram. Post-op in PACU given tramadol. Developed fever, tremor, restlessness, confusion, hyperreflexia. Diagnosis is

* A Neuroleptic malignant syndrome
* B MH
* C Serotonin syndrome
* D
* E

Back 50

From DSM-IV
Severe muscle rigidity and hyperthermia associated with the use of antipsychotic medication
Two or more of the following: diaphoresis, HT, tachycardia, incontinence, dysphagia, mutism, tremor, confusion or altered GCS, leukocytosis, elevated CK.

Very similar features mostly, differences:

serotonin syndrome: hyperreflexia, clonus

NMS: hyporeflexia

http://www.medsafe.govt.nz/profs/PUArticles/Dec2012Neuroleptic.htm

Front 51

Best drug to reduce both gastric acidity and volume

* A Ranitidine
* B PPI
* C Sodium citrate
* D
* E

Back 51

A. Ranitidine

Na citrate (good for reducing acidity, but may incr volume)

Front 52

Patient on moclobemide came in for surgery. In view of the use of vasopressor to treat hypotension one will give judicious amount of

* A
* B Metaraminol
* C Adrenaline
* D Noradrenaline
* E Phenylephrine

Back 52

E.

Moclobemide -> MAO inhibitor

Avoid indirect action (ephedrine, metaraminol)

Use direct acting -> phenylephrine

Ref: OHA

Peck and Hill

ATOTW - Anaesthesia and psych drugs part 1

.

Front 53

Patient with hyperthyroidism - proceed with elective surgery only if normal level of these hormones is seen

* A TSH
* B T4
* C T3
* D T3 & T4
* E

Back 53

D T3 & T4 (TSH will improve later)

See:

http://www.sassit.co.za/journals/peri-operative%20care/endocrine/perioperative%20management%20of%20the%20thyrotoxic%20patient.pdf

Ideally, thyrotoxic patients should be as close as possible to clinical and

biochemical euthyroidism before going to surgery. It is common for TSH

values to remain suppressed as a consequence of prolonged hyperthyroidism

in patients who have otherwise normalized their T4 and T3 values on

therapy [31]. The TSH level in this case will eventually increase, and should

not be considered a contraindication to surgery

.

Front 54

In pregnant women the dural sac ends at

* A
* B L3
* C L5
* D S1
* E S3

Back 54

D. S1

Nysora:

http://www.nysora.com/mobile/regional-anesthesia/sub-specialties/3422-spinal-anesthesia-in-children.html

Front 55

The following capnography trace was observed in an intubated and ventilated patient. The most likely explanation for this respiratory pattern is

* A endobronchial intubation
* B endotracheal cuff leak
* C gas sampling line leak
* D obstructive airways disease
* E spontaneous ventilatory effort

Back 55

C. Gas sampling line leak (repeat)

Front 56

Full size oxygen cylinder providing 10L/min of oxygen flow to a patient during transport. How long will this cylinder last?

* A
* B
* C 45 minutes
* D
* E

Back 56

.