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158 Cards in this Set

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  • Back

A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in:
a. Reverse trendelenburg, right side up
b. Reverse trendelenburg left side up
c. Reverse trendelenburg, neutral
d. Trendelenburg right side up
e. Trendeleburg left side up

B



Heart should be above level of surgical site, left lateral position (air-lock)

Which of the following is NOT a side effect of cyclosporine
a. Alopecia
b. Hypertension
c. Renal impairment
d. Gum hyperplasia

A

Cyclosporin product information
• Indication for Cyclosporin is Alopecia
• Hypertension in up to 50%
• Impaired renal function very common
• Gum hyperplasia very common

What is the half life of clopidogrel?
a. 6 hours
b. 14 hours
c. 24 hours
d. 7 days

A

Clopidogrel product information
“After a single, oral dose of 75 mg, clopidogrel has a half-life of approximately 6 hours”

When administering adrenaline and atropine via ETT dose compared with IV should be
a. Same dose
b. Double
c. Quadruple
d. Six times

B

ARC Resus guidelines say 3-10x the dose if given via the endotracheal route
A lot of other non-referenced websites say 2x the dose

What splitting ratio gives a 3% concentration of isoflurane
a. 1/5
b. 1/9
c. 1/13
d. 1/20
e. 1/23

C

Dorsh & Dorsh
“The ratio of bypass gas to gas going to the vaporizing chamber is called the splitting ratio and depends on the ratio of resistances in the two pathways”

http://www.anesthesia2000.com/physics/Chemistry_Physics/physics17.htm
Isoflurane 3% = 1:13

What transfusion related complication is the commonest cause of mortality
a. Bacterial infection
b. TRALI
c. ABO incompatibility
d.

B

B

Which of the following is not included in the CHADS2 AF thromboembolic risk scoring system
a. Age
b. Gender
c. Diabetes
d. Heart failure
e. Previous TIA

B
B

What is the ratio of breaths to compressions in neonatal resuscitation
a. 1:3
b. 1:5
c. 2:15
d. 2:30

A
What is the innervation of the hard palate
a. Greater palatine and nasopalatine
A



http://ozradonc.wikidot.com/anatomy:focused-hard-palate

“The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion. The greater palatine nerve descends through th...

A

http://ozradonc.wikidot.com/anatomy:focused-hard-palate
“The hard palate is innervated by branches of the maxillary nerve, both of which initially pass through the pterygopalatine ganglion. The greater palatine nerve descends through the greater palatine foramen with its companion artery, and runs anteromedially to supply the mucosa of the posterior hard palate. The nasopalatine nerve descends through the incisive foramen to supply the most anterior parts of the hard palate”

Which of the following is suggesting of an inhaled foreign body in a child on chest x ray
a. Foreign body visible in front of airway
b. Hyper-expanded hemithorax
c. Collapse

B



RCH CPG – Inhaled Foreign Body

Look for:

• an opaque foreign body

• segmental or lobar collapse

• localised emphysema in expiration (ball valve obstruction)

• The CXR may be normal



Rovin JD, Rodgers BM. Pediatric fo...

B

RCH CPG – Inhaled Foreign Body
Look for:
• an opaque foreign body
• segmental or lobar collapse
• localised emphysema in expiration (ball valve obstruction)
• The CXR may be normal

Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatrics in Review 2000
Most common X-ray findings with inhaled foreign body:
• Normal – no abnormality
• Gas Trapping (due to ball-valve effect of foreign body with respiration)
• Mediastinal shift
• Atelectasis
• Lobar collapse/consolidation

What is the distance from the lips to the carina in an 70kg adult male in cm
a. 21
b. 23
c. 25
d. 27
e. 29

D



Ref: Lee's Synopsis of Anaesthesia

D

Ref: Lee's Synopsis of Anaesthesia

What colour is the label for subcutaneously administered drugs
a. Pink
b. Yellow
c. beige
d. Red
e. Blue

C or brown

National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines
Intra-arterial = Red
Intravenous = Blue
Epidural / Intrathecal / Regional = Yellow
Subcutaneous = Beige 723
Other routes = Pink

How much air is the maximum to that should be used to inflate a 5 LMA classic cuff
a. 15
b. 20
c. 25
d. 40
e. 45
D
D
Where should the tip of an IABP lie
a. 2cm distal to the left subclavian
b. 2 cm proximal to the left subclavian
c. 2cm proximal to the renal artery
d. 2 cm distal to the renal artery
A



The Carina as a Useful Radiographic Landmark for Positioning the Intraaortic Balloon Pump. Anaesthesia & Analgesia. Vol. 105, No. 3, September 2007

“Ideally, the tip of the balloon should be positioned 2–3 cm distal to the origin of t...

A

The Carina as a Useful Radiographic Landmark for Positioning the Intraaortic Balloon Pump. Anaesthesia & Analgesia. Vol. 105, No. 3, September 2007
“Ideally, the tip of the balloon should be positioned 2–3 cm distal to the origin of the left subclavian artery (LSCA)”

A 60kg female is given 50 mg of rocuronium, she is unable to be intubated, what dose of sugamadex is required to reverse the rocuronium
a. 240
b. 800
c. 960

C

Reversal of shallow neuromuscular = 2 mg/kg
Reversal of profound neuromuscular blockade = 4 mg/kg
Immediate reversal of neuromuscular blockade = 16 mg/kg

In a penetrating chest injury what part of the heart is most likely to be injured
a. Left ventricle
b. Right ventricle
c. Right coronary artery
d. Right atrium
e. Sinus node

B

What is the maximum recommended dose of Intralipid in local anesthetic toxicity (ml/kg)
a. 6
b. 8
c. 10
d. 12
e. 14

D



Association of Anaesthetists Great Britain & Ireland (AAGBI)

• Bolus 1.5ml/kg

• Infusion 0.25ml/kg/min

• Two further boluses 1.5ml/kg

• Increase infusion to 0.5ml/kg/min

• Apparently 12ml/kg max according to AAGBI

D

Association of Anaesthetists Great Britain & Ireland (AAGBI)
• Bolus 1.5ml/kg
• Infusion 0.25ml/kg/min
• Two further boluses 1.5ml/kg
• Increase infusion to 0.5ml/kg/min
• Apparently 12ml/kg max according to AAGBI

What is a contraindication to an IABP?
A. Aortic regurgitation
B. Aortic stenosis

A

An infant is born with meconium stained liquor and is apnoeic and floppy… your first step should be
a. Stimulate and dry
b. Positive pressure ventilation
c. Suction the trachea

C

ARC Guidelines – Management of the Airway in the Presence of Meconium Stained Liquor
• Suctioning before delivery makes no difference
• Routine suctioning of babies who are vigorous no longer advocated (doesn’t improve outcomes)
• No evidence to support or refute endotracheal suctioning in the non-vigorous neonate
• If tracheal suctioning is performed it must be accomplished before spontaneous or assisted respirations have commenced… stimulation to breath should not be provided beforehand

Central sensitization occurs due to
a. Primary events mediated by the NMDA receptor
b. Alterations in gene expression
c. Increased magnesium

V

What volume of FFP is required to increase fibrinogen level by 1g/L
a. 10-15ml/kg
b. 30ml/kg

B

Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. British Journal of Haematology. 2004

In this study administration of 33ml/Kg of FFP increased Fibrinogen by 1g/L
“In group 2, all seven of the patients who had had low coagulation factor levels before FFP had levels above 30 IU/dl post-FFP (33 ml/kg). The median increment for group 2 for the individual coagulation factors was between 17 and 44 IU/ dl. The fibrinogen increased by a median of 1 g/l, although this was not significantly different from group 1”

An epidural in a healthy individual causes all EXCEPT
a. Raised Co2
b. Bradycardia
c. Vasodilation
d. Dyspnea

A

In the Revised Trauma Score includes GCS, Blood pressure and what other parameter?
a. HR
b. Saturation
c. Respiratory rate
d. Urine output
C

The Revised Trauma Score (RTS) is a physiologic scoring system, based on the initial vital signs of a patient. A lower score indicates a higher severity of injury

C

The Revised Trauma Score (RTS) is a physiologic scoring system, based on the initial vital signs of a patient. A lower score indicates a higher severity of injury

Autologous transfusion results in less
a. Cost
b. Blood waste
c. Incompatible transfusion
d. Unrequired transfusion

C

Autologous transfusion. BMJ. 2002 March 30; 324(7340): 772–775
“Evidence from clinical trials shows that autologous transfusion is more cost effective than allogeneic transfusion and that clinical outcomes are improved”

Apparently CEACCP article says costs are increased

After an infusion of normal saline causing isovolumetric haemodilution what occurs?
a. Increased cardiac output
b. Increase oxygen extraction
c. Capillary vasodilatation

A

Though B and C possibly too?

Isovolaemic haemodilution leads to a decrease in [Hb]. Without a significant increase in either SaO2 or paO2 (not possible in the standard state at sea level and room air), the only way to return oxygen flux to normal is through an increase in CO.

CO is a product of heart rate (HR) and stroke volume (SV), and is dependent upon preload, afterload and myocardial contractility.

Increased CO occurs through several factors:
1. Decreased blood viscosity  an increased tendency for venous return (VR)  SV and thus CO.

2. Decreased blood viscosity  SVR and afterload   CO. Poiseuille's law shows resistance in a vessel is directly related to viscosity (and length, and inversely related to radius to the fourth power).

3. Metabolic Autoregulation - Local tissue factors lead to vasodilation in order to increase regional blood flow and restore oxygen delivery to normal. Increased regional blood flow tendency for VR  CO. Any small decrease in systemic blood pressure (BP) due to the subsequent fall in SVR as regional circulations vasodilate, is quickly detected by the carotid and aortic baroreceptors, leading to an increased sympathetic outflow and thus increased HR, SV and subsequently CO.

Increased tissue O2 extraction: Local factors independent of the increase in CO also assist in maintaining tissue oxygen supply despite a fall in oxygen flux. These adaptions occur to increase the oxygen extraction by tissues. An important mediator of this is a right-ward shift in the oxyhaemoglobin dissociation curve, increasing the p50 (normal 26.6 mmHg) and thus assisting the offloading of oxygen from Hb. Also, the lower pO2 places the tissues on a steeper position of the oxyHb dissociation curve, further facilitating oxygen unloading as greater amounts of O2 are off-loaded per unit drop in pO2

Bleeding in trauma has been shown to be reduced by
a. Tranexamic acid
b. Recombinant factor VIIa
c. DDAVP
d. Prothrombinex

A

CRASH-2 – Reanalysis published 2012 in Lancet
Findings
10 096 patients were allocated to tranexamic acid and 10 115 to placebo, of whom 10 060 and 10 067, respectively, were analysed. 1063 deaths (35%) were due to bleeding. We recorded strong evidence that the effect of tranexamic acid on death due to bleeding varied according to the time from injury to treatment (test for interaction p<0•0001). Early treatment (≤1 h from injury) significantly reduced the risk of death due to bleeding (198/3747 [5•3%] events in tranexamic acid group vs 286/3704 [7•7%] in placebo group; relative risk [RR] 0•68, 95% CI 0•57–0•82; p<0•0001). Treatment given between 1 and 3 h also reduced the risk of death due to bleeding (147/3037 [4•8%] vs 184/2996 [6•1%]; RR 0•79, 0•64–0•97; p=0•03). Treatment given after 3 h seemed to increase the risk of death due to bleeding (144/3272 [4•4%] vs 103/3362 [3•1%]; RR 1•44, 1•12–1•84; p=0•004). We recorded no evidence that the effect of tranexamic acid on death due to bleeding varied by systolic blood pressure, Glasgow coma score, or type of injury.

Interpretation
Tranexamic acid should be given as early as possible to bleeding trauma patients. For trauma patients admitted late after injury, tranexamic acid is less effective and could be harmful.

The time constant of the lung is calculated by
a. Compliance x resistance
b. Compliance plus resistance
c. Compliance /resistance
d. Resistance/compliance

A

Lung Mechanics & Mechanical Ventilation - Lexington Pulmonary and Critical Care
Mathematically, the time constant is defined as compliance multiplied by the airway resistance and the resulting value has units of seconds of time

The commonest post operative complication in a patient with a # NOF is
a. UTI
b. Pneumonia
c. Delirium
d. Myocardial infarction
C

10-15% according to a BMJ article

In an infant, the intercristine line is at the level of
a. L1-L2
b. L2-L3
c. L3-L4
d. L4-L5
e. L5-S1

E

Local and regional anaesthesia in infants. CEACCP 2004
“The intercristal line is at L5/S1 (L4 in adults), the termination of the spinal cord is at L3 (L1/2 in adults) and the termination of the dura is at S3/4 (S2 in adults)”

Which of the following is a contra-indication to a left DLT
a. Left pneumonectomy
b. Tumour in the left main stem bronchus
B

Contraindications to a Left DLT
• Intra-luminal tumour of l main bronchus
• Left bronchial stent in situ
• Left tracheo-bronchial disruption
• Left pneumonectomy
• Left lung transplant
What is the commonest symptomatic cardiac condition in pregnancy
a. Mitral stenosis
b. Aortic stenosis
c. Eisenmengers
d. Tetralogy of fallot
A

Anaesthesia for Caesarean Section in Patients with Cardiac Disease. Journal of The Pakistan Medical Association
“Rheumatic heart disease at present is the most common cardiac disorder in pregnancy, with mitral stenosis (MS) as a single most prevalent lesion”
What is the ratio of MAC awake:MAC of sevoflurance
a. 0.2
b. 0.34
c. 0.5
B

Cerebral Awakening Concentration of Sevoflurane and Isoflurane Predicted During Slow and Fast Alveolar Washout. A & A November 1993 vol. 77 no. 5 1012-1017
Make awake value for sevo = 0.34

Pain from the uterus during labour is transmitted via
a. From the anterior roots of T10-L1
b. Parasympathetic fibres
c. The inferior hypogastric plexus
d. Via grey rami communicantes

C

OpenAnaesthesia
“Pain travels via sympathetic nerve fibers (going through the inferior hypogastric plexus on the way to the sympathetic chain) that originate from the dorsal roots of T10-L1 segments of the spinal cord

The features of Pierre Robin sequence include cleft palate, micrognathia and:
A. Glossoptosis
B. Craniosynostosis
C. Macroglossia
D. Microstomia
A



Wiki

PRS is characterized by micrognathia, Glossoptosis (posterior displacement or retraction of the tongue), and cleft palate

A

Wiki
PRS is characterized by micrognathia, Glossoptosis (posterior displacement or retraction of the tongue), and cleft palate

A size C oxygen cylinder that reads 5000kpa contains approximately how many litres of oxygen
a. 100
b. 150
c. 200
d. 350
e. 600

B

Full size C (13700 kPa) = 420 L
So 5000/13700 x 420 = 153L

A patient having a craniotomy has the CVP/arterial transducers at the level of the right atrium. The head is 13cm above the level of the heart. If the MAP is 80mmHg and the CVP is 5mmHg what is the cerebral perfusion pressure in mmHg
a. 60
b. 62
c. 65
d. 70
e. 75

C

After a procedure with an LMA in situ a patient complains of loss of sensation to the anterior part of the tongue. What nerve is likely damaged?
a. Facial
b. Lingual
c. Greater palatine
d. Glossopharyngeal

B



Innervation of the Tongue

Anterior 2/3rds of tongue

• Somatic afferent: lingual nerve branch of V3 of the trigeminal nerve

• Taste: chorda tympani branch of facial nerve (carried to the tongue by the lingual nerve)

Posterior 1/3...

B

Innervation of the Tongue
Anterior 2/3rds of tongue
• Somatic afferent: lingual nerve branch of V3 of the trigeminal nerve
• Taste: chorda tympani branch of facial nerve (carried to the tongue by the lingual nerve)
Posterior 1/3rd of tongue
• Somatic afferent and taste: Glossopharyngeal nerve CN IX
Motor
• All intrinsic and extrinsic muscles of the tongue are supplied by the hypoglossal nerve
• Except for one of the extrinsic muscles, palatoglossus, which is innervated by CN X

What statistical test would be best to evaluate the effects of 2 drugs in patients at 3 different points in time
a. ANOVA
b. Mantel Hantzel
c. Crusckall Wallis
d. Students t test

A

Apparently ANOVA is used to test for significant differences between the means of two or more groups. Kruskall-Wallis is the non-parametric equivalent

A man is working with electrical appliances at home with a residual current device. If he touches the active and the neutral (was it neutral or earth) wire he will suffer
a. A microshock
b. A macroshock
c. Nothing happens because the fuse blows
d. The RCD will protect him from macroshock
D

RCD will protect him from macroshock
RCD will trip with a 30 mA leakage - works on principle that current flowing to and from an appliance (in live and neutral wires) is equal. Current of 100mA required to cause VF when applied to surface of body. Only 0.05 - 0.1 mA required to cause VF when applied directly to myocardium (=microshock)
An infant with failure to thrive is noted to have an apical systolic murmur, weak pulses, with the femoral felt most easily. They most likely have
a. Patent ductus arteriosis
b. Ventriculoseptal defect
B

Neither seem quite right. Definitely not PDA though

Medscape – PDA
“In the low birth weight premature infant, the classic signs of a patent ductus arteriosus (PDA) are usually absent. The classic continuous murmur is rarely heard. A rough systolic murmur may be present along the left sternal border, but a small baby with a large patent ductus arteriosus (PDA) and significant pulmonary overcirculation may have no murmur. In that case, typically, precordial activity is increased and peripheral pulses are bounding. The increased precordial activity is caused by the large left ventricular stroke volume. Bounding pulses are caused by the relatively low systemic arterial blood pressure due to the continuous runoff of blood from the aorta into the pulmonary artery.”

Medscape – VSD
“The characteristic harsh, holosystolic murmur is loudest along the lower left sternal border (LSB), and it is well localized”
Can’t find anything about weak pulses
Which radiological finding is most consistent with atlantoaxial instability in a patient with rheumatoid arthritis
a. A 9mm gap between the anterior arch of C1 and the odontoid peg
A

Atlantoaxial subluxation occurs in 25% of patients with severe RA
Maxiumum gap between odontoid and arch of the atlas is 3mm - more than this is significant
What is the most accurate method of determining fetal heart rate in a neonate
a. Palpation of an umbilical vein pulse
b. Auscultation with a stethoscope
c. Palpation of femoral pulse
d. Pulse oximetry
B

ARC Neonatal Resuscitation
• “Heart rate can be determined by listening to the heart with a stethoscope (most reliable) or in the first few minutes after birth, by feeling for pulsations at the base of the umbilical cord”
• Pulse oximetry can provide and accurate and continuous display of the heart rate within about a minute of birth” ?more accurate than auscultation
In acute liver injury what causes the highest risk of bleeding
a. Thrombocytopenia
b. Coagulopathy
c. Portal hypertension
d. Platelet dysfunction
e.
B

can’t find anything on this
Miller
• “Perioperative hemorrhage in patients with significant liver dysfunction may occur because of bleeding diatheses or the complications of portal hypertension (or both)”
• Portal hypertension → splenomegaly → thrombocytopaenia
• “In patients with acute liver failure, plasmapheresis may have potential benefit because it promotes rapid correction of coagulopathy while minimizing volume overload”

A patient in recovery post op total hip replacement develops crushing central chest pain, ECG shows ST segment elevation (NB- no BP etc given, beta blockade was not an option). The most appropriate action is to give
a. Aspirin
b. IV GTN
c. IV heparin
d. Calcium channel blocker
e. T/L

A

Stellate ganglion blockade causes
a. Conjunctival injection
b. Dry eyes
c. Decreased axillary sweating

A, ?B, ?C

Conjunctival injection associated with Horner's Syndrome (which demonstrates successful SGB)


Decreased Axillary sweating only with thoracic sympathetic ganglion block (around T3), not covered by Stellate Ganglion (C6-T1)

Features of ventricular tachycardia DO NOT include
a. Absence of p waves
b. Monophasic waves
c. Prominent R wave in V1
d. A-V dissociation

A

• False i.e AV dissociation is a sign of VT - P-waves occurring at different rate
• Monoasic R-wave in V1 and V6 consistent with RBBB pattern VT
• Prominent R-wave in V1 = RBBB pattern VT
• AV dissociation consistent with VT

An inpatient becomes hyponatraemic 48 hours post op and has a seizure. The most appropriate treatment is
a. Fluid restriction
b. Normal saline ?ml/hr
c. Hypertonic saline
d. Salt tables
C
A child with 10% dehydration is likely to have
a. Bradycardia
b. Rapid deep breathing
B

RCH CPG Dehydration
Moderate dehydration (4-6%)
• Delayed CRT (> 2 secs)
• Increased respiratory rate
• Mild decreased tissue turgor

Severe dehydration (>/= 7%)
• Very delayed CRT > 3 secs, mottled skin
• Other signs of shock (tachycardia, irritable or reduced conscious level, hypotension)
• Deep, acidotic breathing
• Decreased tissue turgor

When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch?
A. opponens abducens
B. abductor pollicis brevis
C. adductor pollicis
D. extensor pollicis
E. flexor pollicis brevis

C

When analyising a study containing a control and two test groups, the best statistical method to use is....
A. Analysis of variance
B. Chi squared with Bonnferoni correction
C. ?
D.
E.

A

Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?
A: Distorted facial anatomy
B: Macroglossia
C: Glottic stenosis
D: Prognathe mandible
E: Arthritis of the neck

B

Acromegalic Features Influencing Intubation Performance
Many typical acromegalic features are suggested to cause a difficult airway in these patients. The most discussed changes are:
• macroglossia,
• prognathism,
• enlargement and distortion of glottic structures with additional folds, and hypertrophy of laryngeal and pharyngeal soft tissue.

Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive
B: Start antiplatelet drugs
C: Start anticonvulsants
D: Do angio and stent
E: Nimodipine
A
Main heat loss in anaesthetic for neonate
A. vasodilatation
B. radiation
C. convection
D. conduction
E. evaporative
B
Patient with aortic stenosis, the signs indicate poor prognosis
A. Palpitation
B. Radiation to carotid arteries
C. Paroxysmal nocturnal dyspnoea
D. Angina
E. Syncope
C

Evaluation and Management of Patients With Aortic Stenosis. Circulation. 2002; 105: 1746-1750
“Survival is nearly normal until the classic symptoms of angina, syncope, or dyspnea develop.1 However, only 50% of patients who present with angina survive 5 years, whereas 50% survival is 3 years for patients who present with syncope and 2 years for patients who present with dyspnea or other manifestation of congestive heart failure”
Circuit disconnection during spontaneous breathing anaesthesia
A. will be reliably detected by a fall in end-tidal carbon dioxide concentration
B. will be detected early by the low inspired oxygen alarm
C. will be most reliably detected by spirometry with minute volume alarms
D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
E. can be prevented by using new, single-use tubing
D
Which drugs below does not need dose adjustment in renal failure patient
A. Buprenorphine
B. Morphine
C. Tramadol
D. ?
E. ?
A
Fat: blood coefficient- N2O, Desflurane, Sevoflurane, Isoflurane
A. N2O ~ D > S > I
B. N2O > D > S > I
C. D > N2O > S > I
D. N2O > D > S ~ I
E . D > N2O > I > S
D
The average expected depth of insertion of an oral endotracheal tube, from the lip, in a normal newborn infant is
A. 7.5 cm
B. 8.5 cm
C. 9.5 cm
D. 10.5 cm
E. 11.5 cm

C



Rule of 6


Depth of insertion = weight + 6


Term Neonate weight ~3.5kg

What is the average distance from the lips to carina in an average 70kg adult male?
A. 21 cm
B. 23
C. 25
D. 27
E. 29
C



 

C

Patient with severe Rheumatoid arthritis. Has C1/C2 instability. Most likely C-spine Xr finding would be
A. Anterior Atlantoodental interval >9
B. Increased sagittal diameter
C. Posterior atlantodental interval >14
D. Midpart of C1 over C2
E. Tear drop sign of C2
A

Most common type of atlanto-axial instability is anterior AAS (80%), where C1 moves forward on C2 from destruction of transverse lig
Which nerves need to blocked to anaesthetise the hard palate:
A. Superior labial nerve and greater palatine nerve
B. Greater palatine nerve and nasopalatine nerve
C. Inferior orbital nerve and nasopalatine nerve
D. Glossopharyngeal nerve and…
E. Anterior ethmoidal nerve and…
B



 

B

Patient complains of numbness of the anterior third of his tongue following GA with LMA. Which nerve is involved?
A. Glossopharyngeal
B. Facial nerve
C. Superior vagus
D Mandibular n.
D



More specifically the lingual nerve (branch on mandibular)



Innervation of the Tongue

Anterior 2/3rds of tongue

• Somatic afferent: lingual nerve branch of V3 of the trigeminal nerve

• Taste: chorda tympani branch of facial ne...

D

More specifically the lingual nerve (branch on mandibular)

Innervation of the Tongue
Anterior 2/3rds of tongue
• Somatic afferent: lingual nerve branch of V3 of the trigeminal nerve
• Taste: chorda tympani branch of facial nerve (carried to the tongue by the lingual nerve)
Posterior 1/3rd of tongue
• Somatic afferent and taste: Glossopharyngeal nerve CN IX
Motor
• All intrinsic and extrinsic muscles of the tongue are supplied by the hypoglossal nerve
• Except for one of the extrinsic muscles, palatoglossus, which is innervated by CN X

Increased risk of post-partum haemorrhage in:
A. Nulliparous patient
B. Patient < 20 years old
C. Factor V Leiden deficiency
D. Oligohydramnios
E. Prolonged labour
E
Chest Xray findings in a child who has inhaled a foreign body:
A. Opaque mass overlying the airway
B. Hyper-expanded lung fields
C. Unilateral pulmonary oedema
D. Collapsed lung base
E. Mediastinal shift
B



RCH CPG – Inhaled Foreign Body

Look for:

• an opaque foreign body

• segmental or lobar collapse

• localised emphysema in expiration (ball valve obstruction)

• The CXR may be normal



Rovin JD, Rodgers BM. Pediatric fo...

B

RCH CPG – Inhaled Foreign Body
Look for:
• an opaque foreign body
• segmental or lobar collapse
• localised emphysema in expiration (ball valve obstruction)
• The CXR may be normal

Rovin JD, Rodgers BM. Pediatric foreign body aspiration. Pediatrics in Review 2000
Most common X-ray findings with inhaled foreign body:
• Normal – no abnormality
• Gas Trapping (due to ball-valve effect of foreign body with respiration)
• Mediastinal shift
• Atelectasis
• Lobar collapse/consolidation

Which of the following are feature of Conn’s syndrome?
A. Normoglycaemia, hypernatremia , hypokalemia
B. Hypoglycaemia, hypernatremia, hypokalemia
C. Hyperglycaemia, hyponatremia, hyperkalemia
D. Normoglycaemia, hyponatremia, hyperkalemia
E. Hypoglycaemia, hyponatremia, hyperkalemia
A
Unequal consolidation on CXR can be caused by all except:
A. Pleural effusion
B. Pulmonary infarction
C. Pulmonary haemorrhage
D. APO
E. Pneumonia

D



Nb Unilateral Pulmonary Oedema can occur with rapid reexpansion of one lung.

What is the mechanism of central sensitisation?
A. Increased intracellular magnesium
B. Antagonism of the NMDA receptor
C. Glycine is the major neurotransmitter involved
D. Recurrent a-delta fibre activation
E. Alteration in gene expression
E
What is the resus dose of atropine and adrenaline when given via ETT compared to IV
A. x 0.5
B. No change
C. x 2
D. x 4
E. x 6

D

ARC Resus guidelines say 3-10x the dose if given via the endotracheal route
A lot of other non-referenced websites say 2x the dose

A home handyman leaves his electricity turned on whilst fiddling with wires [repairing a power outlet]. He has a RCD. What happens if he touches the neutral and ground wires?
A. Nothing will happen
B. Receives macroshock
C. Protected from macroshock by RCD
D. Protected from microshock by domestic fuse
E Receives microshock

A

Nothing will happen as not touching active lead. RCD will activate when current leak detected between Active and Neutral wires.

If a patient experiences parasthesia in the little finger during supraclavicular brachial plexus block, the needle is in proximity to the
A. posterior cord
B. middle trunk
C. Ulnar nerve
D. lower trunk
E. medial cord

D



Sensation in this area is C8 distribution, supplied by the ulnar nerve, medial cord, lower trunk


 


Supraclavicular Nerve Block performed at trunks

D

Sensation in this area is C8 distribution, supplied by the ulnar nerve, medial cord, lower trunk



Supraclavicular Nerve Block performed at trunks

What is the best predictor of severe bleeding in cirrhosis?
A. Thrombocytopaenia
B. Hypofibrinogenaemia
C. Prolonged PT
D. Hypoalbuminaemia
E. Pulmonary hypertension

A (other answers B or D)

OHA says that bleeding is more likely due to thrombocytopaenia than clotting factor deficiency



A lot of other sites just say it is a multi-factorial process



In chronic liver disease and cirrhosis, more likely due to portal hypertension --> varices and local vascular factors rather than haemostatic factors.

What is the dose of FFP required to increase fibrinogen levels by 1 g/L
A. 2 ml/kg
B. 5
C. 10
D. 20
E. 30

E

Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. British Journal of Haematology. 2004

In this study administration of 33ml/Kg of FFP increased Fibrinogen by 1g/L
“In group 2, all seven of the patients who had had low coagulation factor levels before FFP had levels above 30 IU/dl post-FFP (33 ml/kg). The median increment for group 2 for the individual coagulation factors was between 17 and 44 IU/ dl. The fibrinogen increased by a median of 1 g/l, although this was not significantly different from group 1”

FFP dose to increase fibrinogen by 1 mg/l
a. 10 mls/kg
b. 20 mls/kg
c. 30 mls/lg
d. 40 mls/kg

C

Efficacy of standard dose and 30 ml/kg fresh frozen plasma in correcting laboratory parameters of haemostasis in critically ill patients. British Journal of Haematology. 2004

In this study administration of 33ml/Kg of FFP increased Fibrinogen by 1g/L
“In group 2, all seven of the patients who had had low coagulation factor levels before FFP had levels above 30 IU/dl post-FFP (33 ml/kg). The median increment for group 2 for the individual coagulation factors was between 17 and 44 IU/ dl. The fibrinogen increased by a median of 1 g/l, although this was not significantly different from group 1”

What is the oxygen concentration in a standard bottle of heliox?
21%
25%
30%
33%
28% was NOT an option

Heliox 28% in Australia. 21% is available overseas



A Review of the use of Heliox in the Critically Ill. Critical Care and Resuscitation 2006; 8: 64-72
“Mixtures with oxygen are colour coded brown with white shoulders while pure helium cylinders are brown alone. Heliox28 is a recently released dedicated delivery system with a fixed concentration of 28% O2 and 72% helium”

TGA also lists 28% on product information page
https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=EEA07D98531013F5CA2577DD0001BE19&agid=(PrintDetailsPublic)&actionid=1

A C size oxygen cylinder (A size in New Zealand) reads 5000kPa. How much oxygen remains?
A. 50 Litres
B. 150 litres
C. 500
D. 750
E. 1500

B

Full size C (13700 kPa) = 420 L
So 5000/13700 x 420 = 153L

Patient undergoing partial hepatic resection develops Venous Air Embolism. Best position should be
A. Head down left side up
B. Head down right side up
C. Head up right side up
D. Head up left side up


C
Principle is raise heart above level of surgical site, to increase venous pressure and reduce further entrainment of air.



Left lateral to prevent air lock

What is the ratio of compressions to breaths in neonatal resus?
A. 3:1
A
Which drug has the best evidence for reducing blood loss in trauma?
A. Aminocaproic acid
B. Novo 7
C. Prothrombinex
D. Tranexamic acid
E. Aprotinin
D

CRASH-2 Trial
The pain of the first stage of labour is transmitted by:

A. Grey rami communicantes

B. T10-L1 anterior roots
C. The hypogastric plexus

D. Inhibitory nerves to the internal vesical sphincter

E. Parasympathetic nerves

C

OpenAnaesthesia
“Pain travels via sympathetic nerve fibers (going through the inferior hypogastric plexus on the way to the sympathetic chain) that originate from the T10-L1 segments of the spinal cord

You are asked by an Obstetrician to help relax a uterus in labour and deliver for manual removal of placenta. What is a safe and effective dose of IV GTN to be delivered?
A. 5 mcg
B. 50 mcg
C. 250 mcg
D. 400 mcg
E. 500 mcg

B

Safety of Intravenous Glyceryl Trinitrate in Management of Retained Placenta. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2008. Vol 37 Issue 1
“A retrospective chart review of all anaesthesia consultations for retained placenta at 28 weeks' gestational age or more was performed to determine the safety and efficacy of intravenous glyceryl trinitrate therapy in the management of retained placenta. Of the 33 patients who received glyceryl trinitrate, 1 received a total dose of 50 μg and the remainder received 100 to 200 μg. All placentas were extracted within 4 minutes of the first bolus. The systolic and diastolic blood pressures and the haematocrit fell by a mean of 8.1 ±5.3 mmHg, 6.0 ± 3.5 mmHg, and 2.6 ± 1.7%, respectively (mean difference ± SD, p<0.05 for each). The pulse rose by a mean of 7.7 ±4.5 bpm (p<0.001). Only 1 patient required ergometrine for continued atony. None of the patients required transfusions or operative therapy other than dilatation and curettage. The use of glyceryl trinitrate in doses of 200ug or less for retained placenta appears efficacious and safe, and may obviate the need for general anaesthesia for uterine relaxation”

Dose of GTN IV to relax uterus?
a. 25 mcg
b. 50 mcg
c. 250 mcg
d. 500 mcg
e. 750 mcg
B

ANZJOG Volume 37, Issue 1, pages 20–24, February 1997 : 50 - 200 mcg , 200mcg is mentioned a few places. I will check the O&G textbooks for a proper reference. --Methoxyflurane 06:45, 21 April 2012 (CDT)

Middle-aged male with severe MS having general anaesthesia for repair of fractured ulna / radius. 10 minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70. He is normally in sinus. What do you do?
A. Adenosine
B.Amiodarone
C. Shock
D. Volume
E. Metaraminol

C (some answers D)

With increasing stenosis, passive filling of LV becomes more difficult and atrial contraction becomes more important. This contribution of atrial kick increases from 15-40%. So such an arrhythmia will be poorly tolerated and needs raid reversion to SR

The ratio of MAC to MAC Awake for sevoflurane is:
A. 0.22
B. 0.33
B

A lady with a Fontan’s circulation for tricuspid atresia presents for caesarian section. What is the best way of maintaining her cardiac output?
A. Trendelenburg
B. Epidural contraindicated
C. Allow pCO2 to rise to 50 to vasodilate her
D. Short inspiratory time
E. Allow hypovolaemia

D (or A)



Spontaneously breathing best with raised legs to maintain venous return.



If intubated and ventilated, shorten insp time to reduce effect of increased intrathoracic pressure on venous return.

What is the cerebral perfusion pressure if MAP 80, CVP 5, both at the level of the RA with the tragus 13 cm above the RA?
A. 62 mmHg
B. 65
C. 75
D. 80
B

1mmHg = 1.36cmH20
80 x 1.36 = 108.8cmH20
108.8 – 13 = 95.8cmH20
95.8/1.36 = 70.4mmHg (i.e. the MAP at level of the head)
CPP = MAP-CVP
CPP = 70-5 = 65mmHg
What is the best way to measure neonatal heart rate during resus?
A. Palpate a femoral artery
B. Palpate a carotid artery
C. Auscultate the precordium
D. Palpate the umbilical stump
C

ARC Neonatal Resuscitation
• “Heart rate can be determined by listening to the heart with a stethoscope (most reliable) or in the first few minutes after birth, by feeling for pulsations at the base of the umbilical cord”
• Pulse oximetry can provide and accurate and continuous display of the heart rate within about a minute of birth” ?more accurate than auscultation
A term primip with meconium-stained liquor has a caesarian section. On initial assessment the neonate if pale and floppy with a heart rate of 90 bpm. Initial treatment should be:
A. Positive pressure ventilation
B. Dry and stimulate
C. Suction the trachea
D. Start CPR
C

ARC Guidelines – Management of the Airway in the Presence of Meconium Stained Liquor
• Suctioning before delivery makes no difference
• Routine suctioning of babies who are vigorous no longer advocated (doesn’t improve outcomes)
• No evidence to support or refute endotracheal suctioning in the non-vigorous neonate
• If tracheal suctioning is performed it must be accomplished before spontaneous or assisted respirations have commenced… stimulation to breath should not be provided beforehand
The most common clinically significant valvular lesion in pregnancy is:
A. MS
B. MR
C. AS
D. AR
E. TR
A
During prolonged trendelenburg positioning there is:
A. No change in ICP
B. No change in IOP
C. Increased pulmonary compliance
D. Increased myocardial work
E. No increased pulmonary venous pressures
D
How do you calculate the inspiratory time constant for lungs
A. resistance multiplied by compliance
B. resistance divided by compliance
C. compliance divided by resistance
D. resistance minus compliance
E. resistance plus compliance
A

Lung Mechanics & Mechanical Ventilation - Lexington Pulmonary and Critical Care
Mathematically, the time constant is defined as compliance multiplied by the airway resistance and the resulting value has units of seconds of time
What is the best indicator of pending respiratory depression when using a morphine PCA
A. Respiratory rate
B. Sedation score
C. Reduced saturations
B
A 60kg 17 year old female given 50 mg rocuronium for RSI. You can’t intubate or ventilate. What is the appropriate dose of sugammadex?
A. 300mg
B. 600mg
C. 920mg
D. 1300mg
C

Well actually 960mg
Reversal of shallow neuromuscular = 2 mg/kg
Reversal of profound neuromuscular blockade = 4 mg/kg
Immediate reversal of neuromuscular blockade = 16 mg/kg
What is the maximum dose of Intralipid during LA toxicity resus?
8ml/kg
A. 10
B. 12
C. 16
B

Poisons Information Centre of Ireland
“A recommended upper limit is 10mL/kg but no maximum dose has been established”

Association of Anaesthetists Great Britain & Ireland (AAGBI)
• Bolus 1.5ml/kg
• Infusion 0.25ml/kg/min
• Two further boluses 1.5ml/kg
• Increase infusion to 0.5ml/kg/min
What is the immediate compensation for the dilutional anaemia when 3 litres of normal saline is given at the start of a case?
A. Increased CO
B. Capillary dilatation
C. Increased oxygen delivery
D. Right shift in the oxygen dissociation curve
A

Though B too?

Isovolaemic haemodilution leads to a decrease in [Hb]. Without a significant increase in either SaO2 or paO2 (not possible in the standard state at sea level and room air), the only way to return oxygen flux to normal is through an increase in CO.

CO is a product of heart rate (HR) and stroke volume (SV), and is dependent upon preload, afterload and myocardial contractility.

Increased CO occurs through several factors:
1. Decreased blood viscosity  an increased tendency for venous return (VR)  SV and thus CO.

2. Decreased blood viscosity  SVR and afterload   CO. Poiseuille's law shows resistance in a vessel is directly related to viscosity (and length, and inversely related to radius to the fourth power).

3. Metabolic Autoregulation - Local tissue factors lead to vasodilation in order to increase regional blood flow and restore oxygen delivery to normal. Increased regional blood flow tendency for VR  CO. Any small decrease in systemic blood pressure (BP) due to the subsequent fall in SVR as regional circulations vasodilate, is quickly detected by the carotid and aortic baroreceptors, leading to an increased sympathetic outflow and thus increased HR, SV and subsequently CO.

Increased tissue O2 extraction: Local factors independent of the increase in CO also assist in maintaining tissue oxygen supply despite a fall in oxygen flux. These adaptions occur to increase the oxygen extraction by tissues. An important mediator of this is a right-ward shift in the oxyhaemoglobin dissociation curve, increasing the p50 (normal 26.6 mmHg) and thus assisting the offloading of oxygen from Hb. Also, the lower pO2 places the tissues on a steeper position of the oxyHb dissociation curve, further facilitating oxygen unloading as greater amounts of O2 are off-loaded per unit drop in pO2
The following electrolytes are from an alcoholic 12 hours post laparotomy. What is the diagnosis? Na 141, K 4, Cl 114, HCO3 19
A. DKA
B. Methanol
C. Lactate
D. NaCl resus

D

AG = (141 + 4 ) – (114 + 19)


AG = 145 - 133


AG = 12 (normal anion gap)

Alcoholic patient undergoes unremarkable anaesthesia for explorative laparotomy for investigation of abdominal pain. No pathology is found. However, in recovery the following electrolyte disturbances found:
Na 140
K 5.0
CL 115
HCO 18

What is the most likely cause
A. Acute renal failure
B. Lactatic acidosis
C. Methanol ingestion
D. Chloride [N/saline resuscitation]
E DKA

D

AG = (140 +5) – (115-18)
AG = 12
So mildly elevated, but the rest are all high anion gap acidosis causes

The plasma half-life of clopidogrel is:
A. 6 hrs
B. 14 hrs
C. 24 hrs
D. 7 days
E. 14 days

A

Clopidogrel product information
“After a single, oral dose of 75 mg, clopidogrel has a half-life of approximately 6 hours”

Isoflurane vaporiser giving 3%. What is the splitting ratio?
A. 1:3
B. 1:9
C. 1:13
D. 1:20
E. 1:27
C

Well, almost

Dorsh & Dorsh
“The ratio of bypass gas to gas going to the vaporizing chamber is called the splitting ratio and depends on the ratio of resistances in the two pathways”

http://www.anesthesia2000.com/physics/Chemistry_Physics/physics17.htm
Isoflurane 3% = 1:14

The line between the iliac crests in a neonate corresponds to:
A. L2/3
B. L3/4
C. L4/5
D. L5/S1
E. S1/2

D

Local and regional anaesthesia in infants. CEACCP 2004
“The intercristal line is at L5/S1 (L4 in adults), the termination of the spinal cord is at L3 (L1/2 in adults) and the termination of the dura is at S3/4 (S2 in adults)”

In a neonate the main resistance in a circle system with CO2 absorber
A. APL valve
B. Expiratory and inspiratory unidirectional valves
C. tubing
D. ETT
E. HME filter

D

Blood flow across which of the following is used to estimate pulmonary artery pressures during echocardiography?
A. Tricuspid valve
B. Pulmonary valve
C. Mitral Valve
A

Which patient do you not put a left-sided Robert-Shaw DLT into?
A. Left pneumonectomy
B. Left main bronchial lesion
C. There is a right-sided broncho-pleural fistula
D. The patient has shunt > 10%
E. The left lung is to be collapsed

B

Contraindications to a Left DLT
• Intra-luminal tumour of l main bronchus
• Left bronchial stent in situ
• Left tracheo-bronchial disruption
• Left pneumonectomy
• Left lung transplant

An infant born at 32 weeks gestational age comes at 6 weeks for elective bilateral inguinal hernia repair. The parents expect to take him home that day. What do you tell them?
A. He cannot have surgery until he is 3 months old
B. They can take him home that day
C. They can take him home with apnoea monitoring overnight
D. He needs to stay in hospital for apnoea monitoring

D

A machine with a soda lime absorber was left on overnight with oxygen running at 6 litres per minute. In the morning a desflurane vaporiser is connected. What toxic substance may be produced?
A. Substance A
B. Carbon monoxide
C. Carbon dioxide
D. Calcium hydroxide
E. Substance B

B

A post-op child being given 2.5%D + 1/2NS on the ward seizes, is intubated and ventilated and transferred to ICU. Sodium is 116. What do you do?
A. Give phenytoin
B. Give hypertonic saline
C. Give normal saline
D. Give frusemide
E. Give normal saline

B

Which is not a side effect of cyclosporine?
A. Alopecia
B. Gingival hyperplasia
C. Hypertension
D. Renal impairment

A

Cyclosporin product information
• No mention of alopecia
• Hypertension in up to 50%
• Impaired renal function very common
• Gum hyperplasia very common

New national labelling standards endorsed by ANZCA. What colour should the label on a subcutaneous ketamine infusion be?
A. Red
B. Blue
C. Beige
D. Yellow
E. Pink
C (Ketamine Yellow)

National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines
Intra-arterial = Red
Intravenous = Blue
Epidural / Intrathecal / Regional = Yellow
Subcutaneous = Beige 723
Other routes = Pink
ANZCA professional documents, ketamine labels should be
A. Pink
B. Green
C. Grey
D. Yellow
E. Black
D

National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines
Intra-arterial = Red
Intravenous = Blue
Epidural / Intrathecal / Regional = Yellow
Subcutaneous = Beige 723
Other routes = Pink
Poor prognosis of AS
A. PND
B. Chest pain
C. Palpitation
D. Syncope
E. Malaise
A
Required for diagnosis of Neuroleptic Malignant Syndrome
A. Diaphoresis
B. ↑ CK
C. Rigidity
D. Hypertenion
E. ↑ HR

C

An international consensus study of neuroleptic malignant syndrome diagnostic criteria using the Delphi method. J Clin Psychiatry. 2011 Sep
Consensus was reached on the fifth round regarding the following criteria: recent dopamine antagonist exposure, or dopamine agonist withdrawal; hyperthermia; rigidity; mental status alteration; creatine kinase elevation; sympathetic nervous system lability; tachycardia plus tachypnea; and a negative work-up for other causes. The panel also reached a consensus on the relative importance of these criteria and on the following critical values for quantitative criteria: hyperthermia,>100.4°F or>38.0°C on at least 2 occasions; creatine kinase elevation, at least 4 times the upper limit of normal; blood pressure elevation,≥25% above baseline; blood pressure fluctuation,≥20 mm Hg (diastolic) or≥25 mm Hg (systolic) change within 24 hours; tachycardia,≥25% above baseline; and tachypnea,≥50% above baseline

According to DSM-V
Rigidity is a must have characteristic

2 yo 15kg child following seizure on surgical ward. Admitted with appendicitis and perforation. 60ml/hr of ½ N. Saline 5%dextrose
Na+ 119
K+ 4.5
HCO3- 19
Cl- 90

Best treatment would be
A. Desmopressin
B. Frusemide
C. 3% normal saline
D. Normal Saline
E. Fluid restrict
C

Atrial septal defect, where is the murmur heard the loadest?
A. PV
B. MV
C. ASD
D. AV
E. TV

A

“ASD with moderate-to-large left-to-right shunts result in increased right ventricular stroke volume across the pulmonary outflow tract creating a crescendo-decrescendo systolic ejection murmur. This murmur is heard in the second intercostal space at the upper left sternal border”

Young infant with Failure to Thrive. Born on the 20th percentile now is on the 5th percentile. Found to have a systolic murmur, tachynpnoea with weak femoral pulse. The most likely diagnosis is
a. Coarctation
b. HOCM
c. PDA
d. AS

A

Professional guide to diseases – Coarctation of Aorta
• Cardinal Features: resting systolic hypertension, absent or diminished femoral pulses, wide pulse pressure
• Signs in 1st year of life: tachypnoea, pallor, tachycardia, failure to thrive, cardiomegaly, pulmonary oedema, hepatomegaly

Myasthenia gravis, Eaton Lambert Syndrome What happens with exercise?
a. MG better, EL worse
b. EL better, MG worse
c. Both EL and MG get worse
d. Both EL and MG get better
B
Cephalothin doesn't cover:
a. Proteus
b. E coli
c. Staph
d. Strep
e. Pseudomonas
E

Regarding PS9 safe provision of anaesthesia for Colonoscopy:
A. Medical Practitioner to providing sedation with a skilled assistant who is not assisting the proceduralist.
B. Medical practitioner alone
C. Specialist Anaesthetist
D. Skilled nurse with airway experience
E. Skilled bogan

A

Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures (PS9 2010)
“5.1 - Except for very light conscious sedation and/or analgesic techniques such as inhaled nitrous oxide or low dose oral sedation, there must be a minimum of three appropriately trained staff present: the proceduralist, the medical or dental practitioner administering sedation and monitoring the patient, and at least one additional staff member to provide assistance to the proceduralist and/or the practitioner providing sedation as required”

You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?
a. Frusemide
b. Amiodarone
c. ACE
d. Digoxin
e. Biventricular pacemaker

C

Young child with WPW undergoes general anaesthesia. Intra operatively developed tachycardia. HR 220, BP 80/40. Best drug to cardiovert
A. Adenosine
B. Amiodarone
C.

B (other answers A)
Finding on haemophilia A patient
A. Female haemarthrosis
B. Male haemarthrosis
C. Normal PT, abnormal APTT
D. Abnormal PT, normal APTT
C
32 y/o male. Weakness distal and prox muscles, infection 10 days ago, no sensory involvement, temp 37.8, facial weakness. Cause:
A. Guillian Barre
B. Myasthenia Gravis
D. Poliomyelitis
E. ?Acute encephalitis
F. ?Polymyositis
A
What gestation to monitor uteroplacental flow
A 20 weeks
B 24 weeks
C 28 weeks
D 32 weeks
E 36 weeks
B
Cause of hypoxia in 1 lung ventilation?
A Blood to non-ventilated lung
B V/Q mismatch in ventilated lung
C ?hypoxic pulm vasoconstriction
A
Endocarditis prophylaxis
A Bicuspid valve
B Congenital repair > 12 months ago
C Rheumatic heart valve
D Uncorrected cyanotic heart disease
E MVP + ?MR
D
Area burnt in adult male - upper half of upper limb, anterior abdo, whole left leg:
A 23% [changed figure compared to prev years]
B 32%
B

Around 31.5% according to rule of 9’s technique (i.e 4.5 upper arm, 9 ant abdo, 18 whole leg)
Best position for tip of IABP is 1-2 cm:
A Distal to Left subclavian artery
B Proximal to Left subclavian artery
A
VT features:
A monophasic V6
B QRS > 0.14
C Right axis deviation
B
70 y/o postop in recovery following hip surgery. Develops severe chest pain, ST elevation. Immediate mx:
A Beta blocker
B Aspirin
C GTN infusion
D Heparin infusion
B

The muscles of the upper eyelid receive a somatic nerve
supply from the
A. oculomotor nerve and a parasympathetic supply from the superior vagus nerve
B. oculomotor nerve and a sympathetic supply from the superior cervical ganglion
C. ophthalmic division of the trigeminal nerve and a parasympathetic supply from the superior vagus nerve
D. ophthalmic division of the trigeminal nerve and a sympathetic supply from the superior cervical ganglion
E. ophthalmic division of the facial nerve only

B

A line isolation monitor protects against microshock
A. only if the warning current is set at 10mA
B. only if the warning current is set at 30mA
C. under no circumstances
D. only if the equipment used is grounded
E. only if it monitors all the equipment in the region
C
The commonest initial presenting feature in anaphylaxis is
A. coughing
B. desaturation
C. hypotension
D. rash
E. wheeze
C

Following a left sided pneumonectomy, a left intercostal drain is placed and connected to an underwater drainage system. In the postoperative period:
A. a leakage of air is expected from the drain
B. the patient should be nursed in the right lateral decubitus position
C. the underwater seal drain should be left on continuous free drainage
D. the underwater seal drain should be left on continuous free drainage, and connected to wall suction for 5 minutes every hour
E. the underwater seal drain should remain clamped and be released for a short period every hour

E

Most safe side to insert subtenon block

A. Inferonasal
B. Inferotemporal
C. Medial
D. Superonasal
E. Superotemporal

A

Levosimendin:
A. Increases contractility and myocardial oxygen consumption
B. Increases SVR
C. Binds to troponin C and induces a conformational change
D. Increases contractility by increasing calcium influx
E. Causes coronary vasodilation but NOT peripheral vasodilation

C

During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring?
A: Dorsal column
B: Spinothalamic tract
C: Lateral Corticospinal tract
D: Cerebrospinal tract
E: Anterior horn cells

A

What is the major cause of death in a patient with perforation of the pharynx, oesophagus or trachea?
A: failure to intubate
B: failure to ventilation
C: sepsis

C

You are asked to see a 60-year-old male 2 days following a cervical laminectomy because he has new neurological symptoms in his right arm. The surgical team think these may be due to poor patient positioning. The sign that would most help differentiate a C8-T1 nerve root injury from an ulnar nerve injury is
A. loss of sensation in the index finger
B. loss of sensation in the little finger
C. weakness of the abductor digiti minimi muscle
D. weakness of the abductor pollicis brevis muscle
E. weakness of the first dorsal interosseous muscle

D

An infant is anaesthetised and ventilated using an endotracheal tube and circle breathing system with CO2 absorber. The item which causes the most resistance to breathing is the
A. airway pressure limiting (APL) valve
B. circuit hosing
C. endotracheal tube
D. heat and moisture exchange filter
E. inspiratory and expiratory valves

C
When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch?
A. opponens abducens
B. abductor pollicis brevis
C. adductor pollicis brevis
D. extensor pollicis
E. flexor pollicis brevis

C

In congenital diaphragmatic hernia
A. there is hyperplasia of pulmonary arterioles in the hypoplastic lung
B. right-sided lesions are more pathologically significant
C. vasodilator drugs are contraindicated
D. right-sided lesions through the foramen of Bochdalek are the most common
E. intrapulmonary shunts are the major cause of cyanosis

A

What will not increase A-a gradient
a. decreased cardiac output
b.. Increased FiO2
c. Decreased FiO2
d. increased shunt
C
Wolf Parkinson White Syndrome:
a. PR interval lenghtened
b. [Something about delta wave]
c. DCR is less effective
d. Central IV access may precipitate arrythmias

D

Pulmonary Hypertension possible except in:




A Tetralogy of Fallot

A

Contraindication to Intra-aortic Balloon pump:


A AR


B AS


C MR

A

The following movements are supplied by C6-7




A Wrist flexion + extension

A

What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.e. have a dibucaine number 30-70?:




A 4%

A

Patient with mastocyotosis, intraoperatively would most likely:




A hypotension

A

Complication of Caelic plexus block:




A paraplegia

A

All can prolong the QT interval except:




A Magnesium

A

Carcinoid patient develops hypotension intraop:




A octreotide

A

Features of longstanding paraplegia includes all except:




A flaccid paralysis

A

Sensitivity 90%, specificity 99%-




A False positive 1%

A

SVRI =




A SVR x BSA

A

Inserting ETT over bougie:




A turn 90 deg counter clockwise

A

A 62 year old man has chronic renal failure. You notice his total serum calcium is 2.05 mmol/L. This is because he has:




A Secondary hyperparathyroidism

A

Half life of tirofiban:




A 2hrs

A

Coeliac plexus block - complication:




A paralysis

A

Addison's features except:




A Glucose 12 mmol/L

A

TURP syndrome - NA 119, Mx:




A Hypertonic saline @ 100ml/hr

A