2016A

Front 1

A 17 year old woman with Fontan’s circulation isscheduled for an appendicectomy. A TTE two weeks ago showed normal leftventricular function with no changes. After induction, she goes into atrialfibrillation with a heart rate of 150, and BP 60/30. The best immediatemanagement is:

a) Adenosine

b) Amiodarone

c) Cardioversion

d) Esmolol

e) Phenylephrine

Back 1

C. Cardioversion

Front 2

32 year old male with recent respiratory tract illness presents with weakness in his legs and arms. Diagnosis?

a. Guillian barre

b. MS

c. Myasthenia gravis

2 others that were wrong

Back 2

A. Guillain Barre

Front 3

Values for iron studies: Hb 86, MCV 72 (low), serum iron< 3, transferrin low, ferritin 190 (middle of normal range).

Consistentwith?

a) Acute phase reactant

b) Latent iron deficiency

c)

d)

e) Thalassaemia

Back 3

I think most consistent with thalassaemia (typically a microcytic, hypochromic anaemia).

Ferritin is LOW in iron deficiency.

"Latent" iron deficiency is when the Hb is normal but it heralds the onset of iron deficiency anaemia over the next weeks/months.

Front 4

A 22 year old previously healthy man was involved in amotorbike accident two weeks ago, when he sustained a spinal cord injury at T1.He now needs some sort of operation –can’t recall what. Evidence of autonomic hyperreflexia includes:

a) Pulmonary oedema

b) Atrial fibrillation

c) Bradycardia

d) Profound hypotension

e) Piloerection below T10

Back 4

c) Bradycardia

Piloerection also occurs but "below T10" isn't accurate.

Uptodate: Common clinical manifestations are headache, diaphoresis, and increased blood pressure. Flushing, piloerection, blurred vision, nasal obstruction, anxiety, and nausea may also occur. Bradycardia is common; some patients have tachycardia instead.

The severity ranges from asymptomatic hypertension to hypertensive crisis complicated by profound bradycardia and cardiac arrest or intracranial hemorrhage and seizures.

Front 5

What is the best way to avoid emergence delirium in a threeyear old child having day surgery?

a)

b) Propofol induction and sevoflurane maintenance

c)

d)

e) Sevoflurane induction and propofol maintenance

Back 5

e) Sevoflurane induction and propofol maintenance

CEACCP 2013: "While sevoflurane is a very effective induction agent, the use of isoflurane or propofol for the maintenance of anaesthesia may reduce the risk of ED."

Front 6

When to cease ticagrelor?

a) 1-2 days

b) 3-5 days

c) 5-7 days

d) 8-10 days

e) 11-12 days

Back 6

c) 5-7 days (BJA 2013)

Front 7

What is the most reliable source of temperature monitoring to accurately represent cerebral temperature when re-warming after bypass?

a) Bladder probe

b) Venous bypass lines

c) Arterial bypass line

d) Nasopharyngeal

e) Pulmonary artery catheter

Back 7

c) Arterial bypass line

Second best answer PAC.

None as accurate as jugular bulb monitoring.

Front 8

What is the blood product most likely to have bacterial contamination?

Back 8

Platelets

Front 9

What is the shelf life of platelets? (How manydays at either 2-4 degrees, 20-24 degrees, or frozen)

Back 9

Platelets can be stored for 5 days at 20-24ºC with gentle agitation.

http://www.transfusion.com.au/blood_products/components/platelets#sthash.U8g4wfPg.dpuf

Front 10

With current screening methods, which is the most likely virus to be transmitted via blood transfusion?

a) Hep A

b) Hep B

c) Hep C

d) HIV 1

e) HIV 2

Back 10

Hepatitis B virus is < HIV or HCV. No data on HAV.

Front 11

Young male with splenic injury. He gets a unit of packed cells. An hour into a laparotomy, he becomes hypoxic and febrile, and pink frothy sputum comes up the ETT. Cause?

a)

b) Haemolysis??

c) Transfusion associated acute lung injury

d) Transfusion associated circulatory overload

Back 11

c) Transfusion associated acute lung injury

Acute onset of fever, chills, dyspnoea, tachypnoea, tachycardia, hypotension, hypoxaemia and noncardiogenic bilateral pulmonary oedema leading to respiratory failure during or within 6 hours of transfusion.

Incidence 1 in 10, 000 transfusions; most common cause of transfusion related fatalities.

Front 12

Heparin resistance defined as failure of ACT to reach 400after 500IU/kg of heparin given prior to bypass. What is your management?

A) More heparin

b) Clopidogrel

c) FFP

d)

e) Warfarin

Back 12

c) FFP - replaces depleted ATIII

Front 13

New drug, super expensive, comes on to market. Pharmacy only agrees to stock only a limited supply because otherwise different drugs wouldn’t be as available. This decision is based on? (Did NOT say “ethical principle”)

a. Non-maleficence

b. Utility

c. Beneficence

d. Autonomy

Back 13

b. Utility

Front 14

Ibuprofen dosage in 10 month old child?

a. 5

b. 10

c. 15

d. 20

e. 30 mg/kg

Back 14

AMH recommends 5-10 mg/kg

Front 15

“Normal sized six year old” has a Hb of 70g/L. What volume of packed cells would berequired to raise the level to 80g/L?

a. 80

b. 120

c. 160

d. 240ml

(Unsure of all thevolumes, but 80ml definitely there).

Back 15

A. 80ml.

Weight = 2x(age+4) = 20kg

Packed cells (mls) = wt (kg) x Hb rise required(g/L) x 0.4

http://www.rch.org.au/clinicalguide/guideline_index/Blood_Product_Prescription/

Front 16

GA with sevo 2% and N2O 66%/O2 in 10 month old. Assistant applies BIS and the reading is 67. What action to take?

a) Deepen anaesthesia

b) Observation, because BIS is not accurate at this age

c)

d) Observe, because a lower MAC is required at this age

e) Observe, because... ?

Back 16

b) Observation, because BIS is not accurate at this age

Front 17

60yo man comes to preadmission clinic. HR 60, fT4 (value given within normal range), TSH < 0.05 (NR 0.3 – 0.6). Most consistent with?

a) Autoimmune thyroiditis

b) Previous hypophysectomy

c) Clinical hypothyroidism

d) Sick euthyroid

e) Subclinical hyperthyroidism

Back 17

e. Subclinical hyperthyroidism

Front 18

55yo female for laparotomy. Values for lung studies given.FRC/FVC/DLCO low; FEV1 normal to high; FEV1/FVC ratio 88%. Predicted values given. Most likely?

a) COPD

b) Kyphoscoliosis

c) Obesity

d) Pulmonary embolus

e) Pulmonary fibrosis

Back 18

e) Pulmonary fibrosis

COPD would have low FEV1 and ratio; obesity and kyphoscoliosis would have normal DLCO; PE would have reduced DLCO but normal volumes.

Front 19

ECG showing wide complex tachyarrhythmia at 150/min.

a) AF with LBBB

b) Sinus tachycardia with LBBB

c) ? Some other answer – atrial flutter NOT an option.

d) Ventricular fibrillation

e) Venticular tachycardia

Back 19

I couldn’t quite decide between AF with LBBB or VT.

Front 20

LateralCXR similar to this given:

a) ?Lingular consolidation

b) Artefact from the patient’s arm

c) Right middle lobe consolidation

d) Left lower lobe consolidation

e) Right lower lobe consolidation

Back 20

e) Right lower lobe consolidation

Front 21

27 yo primipara with severe post partum haemorrhage. What is the target fibrinogen level? (units given, all the same)

a) 0.5

b) 1

c) 1.5

d) 2.0

e) 3.0

Back 21

d) 2.0

Front 22

Lowest current required to cause microshock:

a) 1 µA

b) 10 µA

c) 50 µA

d) 10mA

Back 22

b) 10 µA

Front 23

What is the purpose of an electrical fuse?

a)

b) To avoid circuit overload

c) To prevent electrocution

d)

e)

Back 23

b) To avoid circuit overload

(RCD is to prevent electrocution)

Front 24

If an extension cord or power-board is plugged in, what device will be inactivated…? (or something to that effect).

a) Equipotential earthing

b) Circuit breaker??

c) Fuse…?

d) Line isolation monitor

e) Residual current device

Back 24

No helpful information found but a) equipotential earthing would be my guess

Front 25

You are about to anaesthetise a patient with known MH susceptibility. The machine has been prepared according to the guidelines, however you don't have any charcoal filters. You proceed with the case and the minimum flows for the case should be:

A. 0.5 l/min

B. 2 l/min

C. 3 l/min

D. 5l/min

E. 10 l/min

Back 25

E. 10L/min.

http://www.aana.com/newsandjournal/Documents/Letters%20169-0613-p172.pdf

If charcoal filter available, reduce to 3L/min.

Front 26

You have just conducted a LUSCS under spinal anaesthesia and the baby is out. You accidentally administer IV suxamethonium instead of oxytocin. This can BEST best be described as a:

A. Misjudgement

B. Lapse

C. Mistake

D. ?

Back 26

C. Mistake

Front 27

A 2 year old with leukaemia for intrathecal chemotherapy. Previous history of post procedure nausea and vomiting. Which prophylaxis to use?

A. Haloperidol

B. Dexamethasone

C. Ondansetron

D. Promethazine

E. Metaclopramide

Back 27

A. Haloperidol - not indicated for prevention of PONV. May be indicated in severe refractory N&V associated with chemotherapy, but EPSE risk high in children. Suggest avoid (AMH).

B. Dexamethasone

C. Ondansetron

D. Promethazine - not indicated in children (AMH)

E. Metaclopramide - avoid in children unless absolutely necessary (AMH)

Front 28

Urosurgery. Surgeon wants to give methylene blue. This is contraindicated if patient is taking:

A Fluoxetine

B Droperidol

C Risperidone

D Oxybutinin

E Prazosin

Back 28

A Fluoxetine

From AMH: "Methylene blue inhibits MAO‑A in vitro, and has caused serotonin toxicity when given with serotonergic agents; avoid combinations with other drugs that may contribute to serotonin toxicity (table) or monitor clinical course carefully."

Front 29

Most common organism in septic arthritis is:

A Strep. pyrogenes

B Staph. aureus

C Neisseria spp.

D

E

Back 29

B. Staph aureus: The most common cause in adults and children > 2 years.

In young, sexually active adults, the most common cause is Neisseria gonorrheae (75%).

Front 30

Low pressure leak test. Cant remember question- something about bulb syringe to common gas outlet and where fault is:

A Check valve incorrectly seated

B Oxygen cylinder

C Pipeline gas supply

D Vaporiser incorrectly seated

Back 30

D Vaporiser incorrectly seated

The bulb test is a negative-pressure leak test to check leaks in the low-pressure system. The Oxygen cylinder and pipeline gas supply are in the high-pressure system.

Not sure about the "valve" answer.

Front 31

Obese patient. Given 100mg rocuronium at start of case. Now post tetanic count= 2. Lean body weight 60, total body weight 110kg. What is the correct dose of sugammadex?

A 120mg

B 220mg

C 240mg

D 360mg

E 440mg

Back 31

E 440mg

Based on actual body weight at 4mg/kg when 1-2 twitches have returned on the TOF. Cases of re-curarisation when dosing at ideal body weight have been reported.

http://www.ncbi.nlm.nih.gov/pubmed/26398716

Front 32

Peribulbar block, get numbness of ipsilateral upper lip. Which nerve is responsible?

A. Infraorbital

B. Trochlear

C. Facial

D.

E.

Back 32

A. Infraorbital - branch of trigeminal (CN V), maxillary division

Front 33

Post partum woman has sensory loss on anterior lateral part of her thigh. There is no motor deficit. She had an epidural and vaginal delivery with forceps. Where is the most likely location of the lesion?

a. Femoral nerve

b. Lateral femoral cutaneous nerve

c. Obturator nerve

d. Sciatic nerve

e. Lumbosacral plexus

Back 33

b. LFCN. Correct dermatome, plus other options have motor involvement.

Front 34

Neonatal resuscitation. What is the most reliable way of determining a neonates heart rate?

A) auscultate the praecordium

B) palpate umbilical stump

C) palpate carotid pulse

D) palpate femoral pulse

E) pulse oximetry

Back 34

A) Auscultate the praecordium

Front 35

How long does the PaCO2 take to reach a plateau following initiation of pneumoperitoneum?:

A)<15mins

B) 15-30

C) 30-60

D) 60-90

E) >90

Back 35

B) 15-30

Front 36

Best anaesthetic for patient with pulmonary hypertension is use of an ETT with PPV and:

A) High dose opioids and O2 and N2O

B) Isoflurane and O2

C) Isoflurane and N20

D) Propofol and O2

E) Ketamine and O2

Back 36

B) Isoflurane and O2

Not much evidence - propofol and O2 probably good too. Avoid N2O.

Front 37

Patient post THR who has had a PE. On maximal medicaltherapy (aside from anti-coagulation) with escalating O2 requirements and poorsats. Next treatment:

A)Radiological pulmonary embolectomy

B) Thrombolysis

C)Anti-coagulation

Back 37

A) Radiological pulmonary embolectomy

Front 38

Repeat question about trauma with suspected aorta rupture,it was clear the patient was stable, and what investigation to do, options were:

a) CT chest

b) TOE

c) Aortogram

Back 38

a) CT chest

Front 39

80 year old man with accidental overdose of metoprolol. ECG with a HR of 30bpm and narrow complexes. P waves were VERY hard to see but I'm pretty sure where there, with a 1st degree HB. What is the next best treatment?

a. Atropine 600mcg

b. Transvenous pacing

c.Transcutaneous pacing

d. Isoprenaline

e. Adrenaline 10mcg bolus

Back 39

a. Atropine 600mcg

Front 40

22 y.o male 4 weeks post complete spinal cord injury at T1. Least consistent with acute hyperreflexia?

A)Profound hypotension

B) AF

C) APO

D)Piloerection below T1

Back 40

A) Profound hypotension

Front 41

65 yo, VATS for lower lobectomy. Needs one lung ventilation.Major risk factor for hypoxaemia:

A. Large central vs smaller peripherallesion

B. Right sided surgery

C. Left sided surgery

D. Small alveolar-arterial oxygengradient on two lung ventilation

E. Lateral vs supine positioning

Back 41

B. Right sided surgery

Front 42

Q110. Complications of oral bowel preparation (all except):

A. Acute kidney injury

B. hepatic failure

C. hyponatraemia

D. myocardial ischemia

E. seizures

Back 42

B. Hepatic failure

Front 43

Glenn shunt inserts fromwhere to where? (can't recall the options)

Back 43

SVC to right pumonary artery

Front 44

Which nerve is injured the most during primary total knee replacement?

a. Common peroneal

b. Sciatic

c. Infrapatellar branch of saphenous

d. Lateral cutaneous nerve of thigh

e. Tibial

Back 44

a. Common peroneal

Front 45

What is not present with propofol infusion syndrome?

a. metabolic alkalosis

b. hyperlipidaemia

c. Enlarged liver

d. rhabdomyolysis

e. hyperkalaemia

Back 45

a. Metabolic alkalosis

Front 46

Gillick case legally refers to what in the context of consent?

A) Minors having adequate understanding of the nature and consequences of a treatment enabling them capacity to give consent

B) You cannot give pre-medications prior to signing a consent

C) Anaesthetist should be the person obtaining an anaesthetic consent

D) Elderly patient must not be delirious when giving consent

E) Appropriate consent for a labour epidural

Back 46

A. Minors being competent to consent

Front 47

Tracheal narrowing % before UAO picture manifests onspirometry?

A. 20%

B. 35%

C.50%

D. 60%

E. 80%

Back 47

C. 50%

Front 48

Dual chamber PPM. What mode would you expect with magnetapplication?

A. AOO

B. VOO

C.DOO

D. VVI

E.AAI

Back 48

C. DOO

Front 49

A patient has anaphylaxis and has positive skin prick testto Rocuronium. She has a negative skin prick test to Atracurium, Vecuronium andSuxamethonium.

Which agent is she least likely to react to on subsequentanaesthetics?

A. Mivacurium

B. Atracurium

C. Suxamethonium

D. Vecuronium

E. Pancuronium

Back 49

A. Mivacurium

Front 50

Which compound in cough medicine is most likely to causeanaphylaxis to subsequent aminosteroidal neuromuscular blockers?

Back 50

A) Pholcodine

Front 51

Patient receives packed red blood cells. 1 hour laterbecomes hypoxic, febrile, high airway pressure and copious frothy sputum.

A. ABO incompatibility

B. Sepsis

C. Transfusion related overload

D. Transfusionrelated acute lung injury

E. Transfusion related ?sepsis

Back 51

D. Transfusion related acute lung injury

Acute onset of fever, chills, dyspnoea, tachypnoea, tachycardia,hypotension, hypoxaemia and noncardiogenic bilateral pulmonary oedema leadingto respiratory failure during or within 6 hours of transfusion.

Front 52

Antiphospholipid syndrome and pregnancy. Which conditionisn’t associated with APS?

A. Hyperthyroidism

B. Recurrent early miscarriage

C. Valvularheart disease

D. Pregnancy induced hypertension

E. Venousthromboembolism

Back 52

A. Hyperthyroidism

Recurrent early miscarriage, pre-eclampsia and VTE are all very common. Valvular heart disease (Libman-Sacks endocarditis) occurs in about 20% and most commonly affects the MV (BMJ Clinical Evidence series).

Front 53

Why shouldn’t you give a COX inhibitor in a 30/40 pregnantpatient?

A. ARF

B. APH

C. Closureof foetal ductus arteriosus

D. Pre-eclampsia

E. ?Premature labour

Back 53

C. Closure of foetal ductus arteriosus

Front 54

Cause:

A. Head compresion

B. Cord compression

C. Uteroplacental insufficiency

Back 54

C. Uteroplacental insufficiency

CTG shows late decelerations.

Reduced utero-placental blood flow can be caused by maternal hypotension, pre-eclampsia and uterine hyper-stimulation.

Front 55

For a shockable rhythm what is the recommended joules for a 10kg child?

A. 10J

B. 20J

C. 40J

D. 60J

E. 80J

Back 55

C. 40J

10J/kg

https://www.apls.org.au/sites/default/files/uploadedfiles/Algorithms%20-%20Paediatric%20Advanced%20Life%20Support.pdf

Front 56

A patient has come in with TCA overdose. Wide QRS on ECG.How do you treat them?

A. Calcium gluconate

B. Bicarbonate

C. Lignocaine

Back 56

B Bicarbonate

BMJ Clinical Evidence series.

Front 57

Baby delivery after c-section. Blue and HR dropped from 140to 90. No sats given. What do you do?

A. Intubate

B. Positive pressure mask ventilate

C. Nothing

D. Dry and stimulate

Back 57

B. PPV

Front 58

You see a patient in the pre-op clinic. He is on propranololfor treatment of long QT syndrome. Which of the following will give thebest reassurance that his treatment is effective?

a. normal QT interval on resting ECG

b.no change in QT interval with valsalva

c. HR less than 60

d. no arrhythmias on 24h holter monitor

Back 58

B. No change in QT interval with valsalva

Front 59

What gauge access does the EZ-IO gun provide?

a. 14g

b. 15g

c. 16g

d. 17g

e. 18g

Back 59

b. 15G

Front 60

Q57. You perform an interscalene block for an adult patient. After injecting 2ml of 0.75% ropivacaine, the patient has a seizure. The most likely cause of this is inadvertent injection of local anaesthetic into the:

A. dural cuff

B. external jugular vein

C. internal carotid artery

D. internal jugular vein

E. vertebral artery

Back 60

E. Vertebral artery

Front 61

Single most effective way to reduce risk of bacterial infection with peripheral IV insertion?

A. alcohol wipe

B. chlorhex hand wash

C. sterile gloves

D. change cannula every 3 days

E.

Back 61

A. Alcohol wipe

No evidence for sterile gloves as per NSW Health policy directive.

Front 62

Patient 27/40 gestation, new hypertension 169/, best medication to start

A. Atenolol

B. Hydrochlothoazide

C. Labetalol

D. Prazosin

E. Not Methydopa or Nifedipine

Back 62

C. Labetalol

Front 63

What is the osmolality of Glycine1.5% used for a TURP

150

200

250

300

350

Back 63

b) 200

Front 64

What is the oxygen consumption equivalent to 4METS in a 40yo?

4-8ml/kg/min

8-12

12-16

16-20

20-24

Back 64

c) 12-16

1 MET = 3.5 ml/kg/min

Thus 4 x 3.5 = 14ml/kg/min

Front 65

To prevent transmission of CJD, airway-contaminated equipment should be:

A. autoclaved

B. protected plastic covers

C. sterilise in ethylene oxide

D. 134 degrees celsius for 3 min

E. thrown away

Back 65

E. thrown away

Front 66

A patient is post op in PACU and complains of visual loss in the left temporal and the right nasal visual fields. Where is the lesion?

A. Optic chiasm

B. Rt optic tract

C. Rt optic nerve

D. Lt optic tract

E. Lt optic nerve

Back 66

B. Rt optic tract

Front 67

Which ocular muscle is most often not paralysed with a peribulbar block?

a: Superior oblique

b: medial rectus

c: lateral rectus

d: Inferior rectus

e: superior rectus

Back 67

a: Superior oblique

Front 68

A morbidly obese pt (BMI 50) is undergoing a NOF. You place a fascia illiaca block with 15mls of 0.75% ropivacaine, induce him, relaxant GA, ETT. When the patient is turned on his side, he desaturates, becomes bradycardic, hypotensive (~BP 80/50?) ETCO2 40s. What is the most likely diagnosis?

A. LA toxicity

B. Myocardial ischaemia (definitely said ischaemia and NOT infarction)

C. Anaphylaxis

D. Tension pneumothorax

E. Fat embolism

Back 68

E. Fat embolism??

Bradycardia unlikely in anaphylaxis or LA toxicity. Dose too low and risk of toxicity very low in FIB. EtCO2 would be lower in pneumothorax.

Front 69

A 25 yo male presents to ED following a MVA with a fractured femur. He is haemodynamically stable on arrival and saturating well. He is given a total of 40mg of IV morphine for analgesia. Subsequent SpO2 90%, he is drowsy and confused, and BP is 120/80. His initial CXR on arrival was normal. What is most likely to be the cause of his desaturation?

a: Opioid overdose

b: Pulmonary contusion

c: Fat embolism syndrome

d: Pneumonia

e: Pneumothorax

Back 69

a: Opioid overdose?

FES rarely presents before 12 hours (time course not given).

Pulm contusion, pneumonia and PTx unlikely to cause drowsiness/confusion.

Front 70

65 yr old male with HT, Renal failure and Atrial Fibrillation. What is his CHADS2 Score? :

a) 0

b) 1

c) 2

d) 3

e) 4

Back 70

b) 1

Front 71

20 yr old male 80 kg in a house fire sustained 25% burns. What is his fluid resuscitation using Parkland formula for the first 8 hours?

a) 3 litres of 0.9% Saline

b) 3 litres of colloid

c) 3 litres of Hartmans solution

d) 4 litres of 0.9% Saline

e) 4 litres of Hartmans solution

Back 71

e) 4 litres of Hartmans solution

Front 72

3 yr old child with # forearm, best way to valid pain assessment

A. the reported severity from the child

B. the reported severity from the parent

C. the reported severity from the nursing staff

D. using the FLACC scale

E. the Wong-Baker Faces scale

Back 72

D. FLACC or E. the Wong-Baker Faces scale

According to the Acute Pain Management book2016, FLACC and WBFPRS would both be appropriate and there is no agreed “best”scale to use.

Front 73

Cuff pressure in an ETT to avoid damage/ischaema

a) 20 cm H2O

b) 30 cm H2O

c) 40 cm H2O

d) 50 cm H2O

Back 73

a) 20 cm H2O

Front 74

Characteristics of flow meters is such that gas flow:

A) cannot be stopped by closing the knob if glass top chamber is broken

B) is measured accurately even when the flowmeter is tilted

C) Overestimates flow rate if connected to a high resistance device such as a nebuliser

D) The ball is lifted within the parallel sided tube in the flowmeter

E) Rate should be measured at the bottom of the ball

Back 74

C) Overestimates flow rate if connected to a high resistance device such as a nebuliser

Needle valve will stop gas flow. Flowmeter must be upright. The tube is not parallel but tapered. Measure from middle of ball or top of bobbin.

Front 75

Staff suffers needlestick injury from a patient with known chronic hepatitis B. Positive antibody titres. What should they receive?

A) Aciclovir

B) Hepatitis B vaccine boosters

C) Immunoglobulins

D) No treatment

E) Pegylated interferon

Back 75

D) No treatment

Front 76

What are the clinical features associated with Horner's Syndrome

a) proptosis, miosis, anhidrosis

b) proptosis, mydriasis, anhidrosis

c) ptosis, miosis, anhidrosis

d) ptosis, mydriasis, anhidrosis

e) ptosis, miosis, hyperhidrosis

Back 76

c) ptosis, miosis, anhidrosis

Front 77

Severe traumatic brain injury in infant in ICU. Minimum CPP aim should be:

a) 30

b) 40

c) 50

d) 60

e) 70

Back 77

b) 40mmHg

BTF Guidelines, 2012

Front 78

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

A: Shortened hospital stay

B: Shortened period of mechanical ventilation

C: No change in neurological outcome

D: Improvement in neurological outcomes
E: Improved overall mortality

Back 78

B: Shorter period of mechanical ventilation

DECRA trial 2011

Front 79

In preadmission clinic with a patient with a tracheostomy. To enable patient to talk you would:

A: Deflate tracheostomy cuff, insert one way valve, insert fenestrated piece

B: Deflate tracheostomy cuff, remove one way valve, insert fenestrated piece

C: Inflate tracheostomy cuff, remove one way valve, insert fenestrated piece

D: Inflate tracheostomy cuff, insert one way valve, insert fenestrated piece

Back 79

A: Deflate tracheostomy cuff, insert one way valve, insert fenestrated piece

Front 80

NNT for a drug ('Nonimoto') for treatment of PONV? Rate of PONV with placebo is 36% and rate of PONV with drug is 12%

a. 4

b. 8

c. 16

d. 24

e. 36

Back 80

d. 24

NNT = 1/ARR

Front 81

Hyperkalaemic patient with QRS beginning to widen. What is the best initial therapy?

a. calcium gluconate

b. frusemide

c. salbutamol

d. insulin

e. resonium

Back 81

a. Calcium gluconate

Front 82

Laserflex tube. How should you inflate the cuffs?

a.Proximal only. Distal left deflated in case proximal ruptured

b. Distal only. Proximal left deflatedin case distal ruptured

c. Any order

d. Proximal then distal

e. Distal then proximal

Back 82

a. Proximal only. Distal left deflated in case proximal ruptured

Front 83

Female singer underwent GA with LMA. Next day complains of voice/singing impairment. What nerve is affected?

a. lingual

b. hypoglossal

c. glossopharyngeal

d. recurrent laryngeal

e. superior laryngeal

Back 83

d. Recurrent laryngeal

Front 84

Patient with SAH. Opens eyes spontaneously, obeys commands but is confused. Cannot move left limbs. What WFNS grade is she?

a. 1

b. 2

c. 3

d. 4

e. 5

Back 84

c. 3

Front 85

Endocarditis prophylaxis for dental extraction needed for what history?

a. bileaflet aortic valve

b. mitral valve prolapse

c. mitral annuloplasty

d. aortic valvuloplasty

e. patch of VSD in childhood

Back 85

c. Mitral annuloplasty

Front 86

NMS vs serotonin syndrome schizophrenic pt post op. Which supports serotonin syndrome?

A) confusion

B) elevated CK

C) elevated WCC

D) hypertonia

E) myoclonus

Back 86

E) Myoclonus

Front 87

NAP4 showed in ICU biggest cause of airway problem:

A) barotrauma

B) ETT blocked

C) tracheostomy dislodged

D) bleeding post-trache insertion

E) aspiration

Back 87

C) Tracheostomy dislodged

Front 88

Question on man getting punched in the throat. Sore throat, quiet voice, some dyspnoea. Able to lie flat. What is your next management?

a. Soft tissue xray of neck to exclude thyroid cartilage and hyoid fractures

b. Nasendoscopy by ENT

c. CT scan

d. Direct laryngoscopy and intubation after gas induction

e. Awake trache

Back 88

b. Nasendoscopy by ENT

Xray is to identify air in pre-tracheal space, not cartilage fractures.

Front 89

What gives the highest risk of TRALI post transfusion ofFFP?

a. Male donors

b. Female donors of child bearing age

Back 89

b. Female donors of child bearing age

TRALI occurs fromHLA/HNA antibodies in donor plasma. Main source of HLA/HNA antibodies is donorplasma from a donorwith hx of transfusion (excluded since april 2004) and female donors with hx of pregnancy (antibodies in 10-15%)

Front 90

What symptoms are consistent with post op cognitive decline?

A. Decreased short term memory

B. Decreased executive function

C. Delirium

D. High sedation scores

Back 90

B. Decreased executive function

Front 91

Which protective mask to wear in laparoscopy for patient with desseminated TB?

a. N95

b. P99

c. R95

d. None

e. Surgical mask

Back 91

a. N95