Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/150

Click to flip

150 Cards in this Set

  • Front
  • Back

1. The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipment is turned on

A. The double insulation of the device will prevent macroshock when the outer casing is touched
B. The electrical fuse will immediately break and disconnect the device from the power supply
C. Equipotential earthing will prevent microshock
D. The Line Isolation Monitor will alarm and disconnect power to the device
E. The RCD will rapidly disconnect the device from the power supply



B - The electrical fuse will immediately break and disconnect the device from the power supply

Any conducting part of Class I equipment accessible to the user eg. metal casing, is connected to earth by earth wire. If a fault occurs which allows live supply to come into contact with an accessible part, current flows down earth wire- the new circuit has increased current which melts protective fuses and breaks the circuit- removing source of potential electrocution.

Class II- accessible conducting parts protected from live supply by double insulation

Class III- protection against electrical shock by using safety extra low voltage- not sufficient to prevent microshock therefore nto used in OT

CEACCP 2003
2. EZ99 According to the current ANZCA approved standards for labeling, the appropriate colour label for an intraosseous infusion is

A. Yellow
B. Beige
C. Pink
D. Blue
E. Red
C- Pink
3. PP102 An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is

A. 400mL
B. 500mL
C. 600mL
D. 700mL
E. 800mL
C - 600mL

MABL = EBV x (HCT start - HCT target) / HCT start

EBV = wgt x 70ml/kg

Adult = 70ml/kg
Child <1yo = 80ml/kg
Neonate = 90ml/kg
4. A 30 year-old pregnant patient develops contractions at 30/40 weeks gestation which of the following cannot be used for tocolysis

A. Clonidine
B. Indomethacin
C. Magnesium
D. Salbutamol
E. Nifedipine
A - Clonidine

Rest are used as tocolysis (Indomethacin C/I at 34/40)
5. A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain, prior to having a seizure and losing consciousness. Which drug should NOT be given?

A. Pethidine
B. Diazepam
C. Haematin
D. Suxamethonium
E. Pregabalin
A - Pethidine

Definitely unsafe = thio, etomidate, steroids, vec, panc, enflurane, hydralazine, OCP, nitrazepam, phenytoin, diclofenac, ibuprofen, amiodarone

Westmead Anaesthesia, OHCA
6. A patient with HOCM presents with dyspnoea and angina on exertion. Which of the following is the best agent to treat these symptoms

A. Glycerol trinitrate
B. Metoprolol
C. Morphine
D. Hydrochlorthiazide
E. Salbutamol
B. Metoprolol

Westmead
7. A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomatic with no other signs/symptoms of myocardial infarction and have an uneventful recovery. What do you do?

A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future mycocardial infarction
B. Arrange coronary angiogram as an inpatient prior to discharge
C. Inform the patient that while the result is real the significance is questionable
D. Repeat in a weeks time as a second troponin is a better indicator of long-term myocardial infarction risk
E. Ignore the result as it is likely a laboratory error
A - cardiology F/U and outpt angiogram

'In several non-cardiac surgery studies, troponin release has been shown to be a statistically significant independent predictor of intermediate and long-term outcomes (i.e. mortality and major cardiac events).'

CEACCP 2008
8. A 40 year-old lady with a history of a bleeding diathesis presents for a tonsillectomy. What is the most likely cause?

A. Factor V Leiden
B. Protein S deficiency
C. Haemophilia B
D. Antithrombin III deficiency
E. Protein C deficiency
C - Haemophilia B

Rest are pro-thrombotic; although Haemophilia B mostly autosomal recessive x-linked

Haemophilia A = FVIII; B - IX
9. What is the most cephalad intervertebral space at which a spinal can be sited in a neonate where the risk of damage to the spinal cord is minimal

A. L1/2
B. L2/3
C. L3/4
D. L4/5
E. L5/S1
D. L4/5

Technically spinal cord ends at L3 in neonates but anatomy is variable.

NYSORA states all spinals should be performed at L4/5 highest in neonates
10. St John's Wort (Hypericum perforatum) potentiates the effects of

A. Dabigatran
B. Heparin
C. Warfarin
D. Aspirin
E. Clopidogrel
E. Clopidogrel

Increased risk of bleeding.
Induces CYP450 enzyme - increased warfarin metabolism
11. You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves

A. facial, trigeminal, glossopharyngeal
B. facial, trigeminal, vagus
C. glossopharyngeal, trigeminal, vagus
D. trigeminal, glossopharyngeal, vagus
E. trigeminal, vagus, glossopharyngeal
D. trigeminal, glossopharyngeal, vagus
12. A patient is having an electrophysiological study and ablation for atrial fibrillation. Suddenly the blood pressure drops to 76/38 mmHg, with the heart rate at 110 in sinus rhythm. What is the best investigation to confirm the cause of hypotension?

A. Troponin
B. ST-segment elevation
C. Transoesophageal echocardiography
D. Coronary Angiogram
E. Electrocardiogram
C. Transoesophageal echocardiography

'Left atrial septal puncture can be complicated by
atrial or aortic puncture, pericardial effusions, and cardiac tamponade. This should always be considered when there is persistent hypotension after transseptal puncture and ablation. It can be rapidly excluded with TOE.'

Causes of hypotension
Vascular complications- retroperitoneal bleed
Cx of transseptal puncture- atrial, aortic perforation, cardiac tamponade
Cx of L atrial ablation- coronary obstruction
Arrhythmias- atrial, ventricular, CHB
Embolic complications- CVA
Atrial stunning

CEACCP 2012
13. Which is the most powerful predictor of atrial fibrillation post cardiac surgery.

A. Age
B. History of hypertension
C. History of CVA
D. History of diabetes
E. Time on Bypass
A - Age

Hypertension also a factor.

'After considering patients' demographics, co-morbid conditions, and severity of illness, advanced age appeared as the most powerful predictor of AF (odds ratio 1.059/year, 95% confidence interval 1.055 to 1.063).'

Am J Cardiol 2012- Prediction of new onset AF after cardiac revascularization surgery.
14. A man with a history of Parkinsons disease has undergone uncomplicated general anaesthetic for a knee replacement but develops post-operative nausea and vomiting (PONV). He received 4mg dexamethsone intraoperatively as prophylaxis. What would you use to treat his PONV in recovery?

A. Dexamethasone
B. Prochloperazine
C. Metoclopramide
D. Droperidol
E. Ondansetron
E - Ondansetron
15. Which of the following is of the least benefit in the treatment of severe anaphylaxis?

A. Cardiopulmonary bypass
B. Nebulised salbutamol
C. IV crystalloid
D. IV vasopressin
E. Subcutaneous adrenaline
E - Subcut adrenaline

Guidelines not recommended for subcut

Salbutamol = 2nd line Rx
CPB case reports to treat anaphylaxis refractory to adrenaline

J Invasive Cardiol 2009
16. A 70 year old patient is being treated for congestive cardiac failure. They are able to shower themselves and complete other ADLs but get dyspneoa on mowing the lawn. They are New York Heart Association classification

A. Class 1
B. Class 2
C. Class 3a
D. Class 3b
E. Class 4
B - Class 2

Class I = No limitation of physical activity
Class II = Slight limitation of physical activity. Ordinary physical activity results in fatigue, palpitation, dyspnea.
Class III = Marked limitation of physical activity. Less than ordinary activity causes symptoms.
Class IV = Symptoms at rest.

Class A = No objective evidence of CVS disease
Class B = Objective evidence of moderately severe CVS disease
Class C = Objective evidence of moderately severe CVS disease.
Class D = Objective evidence of severe CVS disease
17. The percentage of post dural puncture headaches that would resolve spontaneously by 1 week is closest to

A. 90%
B. 70%
C. 50%
D. 30%
E. 10%
B - 70%

CEACCP 2003

'The largest follow‐up of post‐dural puncture headache is still that of Vandam and Dripps in 1956. They reported that 72% of headaches resolved within 7 days, and 87% had resolved in 6 months.'
18. Which piece of airway equipment is designed for use with a fibreoptic bronchoscope

A. Aintree
B. Cook’s airway exchange catheter
C. Frova introducer
A - Aintree
19. A 50 year old lady is seen at the pre-operative assessment clinic, she is on 150mg/day methadone, what is the most likely ECG change to be found in her pre-op ECG?

A. Prolonged PR interval
B. Prolonged QTc
C. ST depression
D. U wave
E. Tented T-waves
B - Prolonged QTc
20. Current guidelines regarding cardiopulmonary resuscitation include all of the following EXCEPT

A. Allow equal time for chest compression and relaxation
B. Give 2 rescue breath before commencement of CPR
C. Chest compression at 100bpm
D. Chest compression should be at least 5cm depth
E. Chest compression to breath ratio at 30:2
B. Give 2 rescue breath before commencement of CPR
21. When a 3 lead ECG is applied correctly in the CS5 position, you will monitor lead II when you suspect which of the following conditions

A. Anterior ischemia
B. Inferior ischemia
C. Lateral ischemia
D. Atrial ischemia
E. Posterior ischemia
B - Inferior ischemia

CS5 - central subclavicular lead- good for anterior ischemia; RA under R clavicle, LA in V5 and LL usual position; lead I selected for anterior wall, II for inferior wall or arrhythmias

CB5 - central back lead- good for ischemia and supraventricular arrhythmias; RA over centre of R scapula, LA V5; lead I monitored

CM5- Central manubrium lead = RA on manubrium, LA V5
CC5- costo-costo

Miller's
22. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is:

A. Adrenaline
B. [[Dobutamine]
C. Levosimenden
D. Milrinone
E. Vasopressin
E - Vasopressin

'The response to inotropic and vasopressor agents is unpredictable and, in general, drugs such as norepinephrine and epinephrine can be hazardous in carcinoid patients... Vasoactive hormone release intra-operatively is best treated
with intravenous boluses of 20 –50mg of octreotide, titrated to haemodynamic response. Vasopressin as an alternative vasoconstrictor that may be useful if prolonged vasoconstriction is required; however, the evidence base is small.'

CEACCP 2011
23. Using the American Heart Association specification, the colours of the electrodes in a 3-lead electrocardiographic (yes the typo is what they used) is

A. Right arm = Black; Left arm = White; Left leg = Red
B. Right arm = White; Left arm = Black; Left leg = Green
C. Right arm = Black; Left arm = Green; Left leg = Red
D. Right arm = White; Left arm = Black; Left leg = Red
E. Right arm = Red; Left arm = White; Left leg = Green
D. Right arm = White; Left arm = Black; Left leg = Red
24. When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade

A. 1
B. 2
C. 3a
D. 3b
E. 4
D- 3b

3a = can lift epiglottis from posterior pharyngeal wall
3b = cannot
25. You are doing a supraclavicular brachial plexus block on an awake 35 year-old lady who is healthy with no significant past medical hsitory. Soon after injecting 20mLs of 0.375% ropivicaine she becomes agitated, has a seizure and loses consciousness. Your 1st step in management is

A. Intralipid 20% 1.5ml/kg bolus
B. Midazolam
C. Propofol
D. Establish airway and give 100% O2 via a facemask
E. Feel for radial pulse and give 100mcg adrenaline
D. Establish airway and give 100% O2 via a facemask
26. A G1P0 patient with a dilated cardiomyopathy and an ejection fraction (EF) of 35% presents for a caesarean section. The benefits of regional vs general anaesthesia are

A. Decreased heart rate
B. Decreased systolic blood pressure
C. Increased ejection fraction
D. Increased myocardial contractility
E. Decreased preload
C. Increased EF

'Regional anaesthesia used alone or in combination with general anaesthesia has the advantage of reducing after load which can improve cardiac output.'

Dilated CMO aims- avoid tachycardia, avoid effects of negative inotropic agents, prevent increases in afterload, maintain adequate preload if elevated LVEDP

CEACCP 2009- Cardiomyopathy and anaesthesia

BJA 2004- Recognition of cardiac disease in pregnancy
27. ET05 A patient has a terminal malignancy. His family doesn’t want you to tell the patient about his diagnosis and prognosis. Your decision to inform him is an example of:

A. Autonomy
B. Beneficence
C. Confidentiality
D. Non-maleficence
E. Utilitarianism
A. Autonomy
28. A septic patient has a CVP of 12mmHg, a blood pressure of 80/40mmHg and a pulse rate of 90/minute. Which is the best agent to treat their hypotension

A. Dopamine
B. Dobutamine
C. Noradrenaline
D. Adrenaline
E. Levosimenden
C. Noradrenaline
29. Which organ is least tolerant of ischaemia following removal for transplantation

A. Cornea
B. Heart
C. Liver
D. Kidney
E. Pancreas
B - heart

'Different organs exhibit different tolerances to warm and cold ischaemia, in part related to the nature of the organ and in part because of the demands on the organ after transplantation. Hence the heart, which has to function immediately upon transplantation, has the shortest tolerance to cold ischaemia, and each hour beyond the first results in a measurable reduction in survival;38 it should ideally be transplanted in <4 h. '

Cold ischemic times
Heart 4h
Lungs 6h
Liver and pancreas 8-12h
Kidneys <18h

Warm ischemic times
Liver < 30min
Pancreas < 30min
Lung < 1h
Kidney < 2h

BJA Suppl 2012
30. You are performing a TAP block. If the needle is correctly positioned where will you deposit the local anaesthetic

A. Beneath the peritoneum
B. Into the transverse abdominus muscle
C. Between the transverse adominus muscle and the internal oblique muscle
D. Between the transverse abdominus muscle and the external oblique muscle
E. Between the internal oblique and the external oblique muscle
C. Between the transverse adominus muscle and the internal oblique muscle
31. You are inserting a left sided double lumen tube into a 140kg 160cm woman. At what depth measured at the incisors is it most likely to be in the correct position

A. 25cm
B. 26cm
C. 27cm
D. 28cm
E. 29cm
D - 28cm

Average depth of L DLT in 170cm tall man or woman 28-29cm. Change of approx 1cm for each 10cm change in height.

Minerva anestesiologica 2008; G Merli- Recommendations for airway control and difficult airway management in thoracic procedures

J Brodsky- L DLT: Clinical experience w/ 1170 pts
32. A patient is cooled to 33 degrees Celcius in an attempt to improve neurological outcome after out-of-hospital ventricular fibrillation cardiac arrest. The evidence for this treatment comes from

A. Case Reports
B. Case Control Studies
C. Systematic Review
D. Randomized Control Trial
E. Pseudo-randomized Trial
C. Systematic review of RCT's

Cochrane study
33. Which of the following decrease during pregnancy

A. Functional Residual Capacity
B. Forced Expiratory Volume in one second
C. Tidal Volume
D. Respiratory Rate
E. Vital Capacity
A - FRC

Increased CO, blood volume, plasma volume and RBC volume
Decreased TPR

Increased TV, RR, MV
Decreased FRC, ERV, RV and hence TLC
Rest eseentially same
34. You are anaesthetizing a patient with chronic renal failure for removal of a Tenkoff catheter and have intubated using rocuronium at a dose of 1.2mg/kg. You are immediately unable to intubate or ventilate and you decide to reverse the patient with sugammadex. What dosage would you use

A. 2mg/kg
B. 4mg/kg
C. 8mg/kg
D. 12mg/kg
E. 16mg/kg
E. 16mg/kg
35. During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate

A. Carbimazole
B. Beta-blocker
C. Propythiouracil
D. Plasmaphoresis
E. Hydrocortisone
D - Plasmapheresis

Rx
Support ABCs, IVF incl glucose, normalise electrolytes
Treat hyperthermia with cooling
Anti-thyroids- PTU or carbimazole via NGT
Potassium iodide- inhibits release of thyroid; must be given after PTU or will increase thyroid hormone levels
Propranolol or other beta blocker
Glucocorticoids for adrenal insufficiency and decrease T4 release and conversion
Consider plasmapheresis or dialysis if conventional treatments fail

Avoid NSAIDs and aspirin- displaces thyroid from protein
36. A young female patient with anorexia nervosa, had just started eating again. After three days she develops dyspnea and is found to have cardiac failure. Which of the following is the most important to correct

A. Potassium
B. Chloride
C. Phosphate
D. Glucose
E. Sodium
C - Phosphate

Refeeding syndrome
HypoPO4 - heart failure, arrhythmia, CMO shock
HypoK - hypotension, arrhythmias, cardiac arrest
HypoMg- arrhythmias
HypoNa- heart failure
37. A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestational age should you monitor foetal heart rate to ensure adequate uteroplacental blood flow

A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 30 weeks
E. 32 weeks
B. 24 weeks

Warrick
CEACCP 2012- Anesthesia for non-obstetric procedures during pregnancy
38. 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. Alteration in gene expression

Power and Kam
39. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient
A. Pretracheal tissue volume (old question – neck circumference)
B. Mallampati score
C. Thyromental distance
D. BMI
E. Severity of OSA
A. Pretracheal tissue volume (old question – neck circumference)
40. A female patient with a history of COPD presents for lung volume reduction surgery, which of the following is a contraindication for surgery (? indicates a poor prognosis)

A. Age > 60 years
B. Chronic asthma
C. Evidence of bullous disease on CT scan
D. FEV < 25%
E. Long-term prednisolone 10mg/day

D FEV < 25%

Indications
Emphysema w/ destruction and hyperinflation
FEV1 < 35%
Marked restriction in ADLs

Contraindications
Abnormal body weight
Co-existing major medical problems
Smoker
Cancer
>70yo

41. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except

A. Bisphosphates
B. Calcitonin
C. Frusemide
D. Sodium Chloride
E. IV crystalloids
A - bisphosphonates

All are treatments for hypercalcemia. Bisphophonates inhibit osteoclasts. Rest increase excretion.
42.What potentiates/interacts with adenosine

A. Aspirin
B. Warfarin
C. Clopidogrel
D. Dabigatran
E. Dipyrimadole
E. Dipyrimadole

Dipyridamole inhibits cellular uptake of adenosine into platelets, RBCs and endothelial cells- increases adenosine levels extracellularly. May have reduced or exaggerated response with adenosine.

Westmead
43. A 2 year-old child has just undergone strabismus surgery. They had an URTI 1/52 prior to surgery. They had an uneventful general anaesthetic with a 4.5mm cuffed ETT, was extubated and sent to recovery. 20 minutes later they develop respiratory distress. Their saturations are 96% on room air, and there is noticeable tracheal tug. What is the most appropriate initial management that will help with their respiratory distress

A. Apply CPAP via a facemask
B. Propofol 1mg/kg
C. Dexamethasone 0.4mg/kg
D. Gas induction and reintubate
E. Nebulized adrenaline (1:1000) 0.5mL/kg
A - CPAP

Post-URTI increased risk of excess secretions, airway obstruction, laryngospasm, b/c

Postpone surgery
Significant URTI- 2 wks
LRTI- 4 wks
Bronchiolitis- 6 wks
44. Which antihypertensive is not safe to use in pregnancy

A. Aspirin
B. Enalapril
C. Metoprolol
D. Hydralazine
E. Nifedipine
B - Enalapril

Category D- congenital malformations, renal failure, skull hypoplasia
45. Which has the weakest evidence for prevention of postoperative infection

A. Intraoperative low inspired O2
B. Intraoperative blood transfusion
C. Intraoperative hypothermia
D. Intraoperative hyperglycaemia
E. Cigarette smoking
A. Intraoperative low inspired O2

CEACCP 2011- Postoperative infection
46. During a cerebral aneurysm clipping, the anaesthetist can assist with the placement of the clip by giving the patient which drug immediately prior to clipping

A. Nimodipine
B. Thiopentone
C. Hypertonic saline
D. Adenosine
E. Mannitol
D- adenosine- one study from Journal Neurosurgical Anesthesia 2011 gave adenosine to achieve sinus pause before clipping

Good brain- volatiles will decrease CMRO2 and therefore CBF
Bad brain- volatiles will increase CBF due to vasodilation- CMRO2 already low
Sevo does not impair autoregulation until MAC 1.5- lower for other volatiles

Textbook of neuroanesthesia and critical care
47. The POISE trial showed that the perioperative administration of metoprolol XR resulted in decreased

A. Perioperative mortality
B. Hypotension
C. Congestive Cardiac Failure
D. Myocardial Infarction
E. Stroke
D - MI
48. In paediatric trauma, the Broselow tape is used to estimate

A. Blood loss
B. Weight and drug dosages
C. Urine output
D. Abdominal girth
E. Head circumference
B - Weight and drug doses
49. Which of the following should be used by a lay person to indicate that they should commence CPR

A. Absence of central pulse
B. Absence of peripheral pulse
C. Loss of consciousness
D. Absence of breathing
E. Obvious airway obstruction
D Absence of breathing
50. A patient presents for dilation of a pharyngeal stenosis post laryngopharyngectomy 12 months earlier. After inducing anaesthesia you site a size 7 reinforced ETT in the stoma. Over the next 30 minutes the patient gradually desaturations. Despite hand bag ventilation and an increased FiO2 of 1 the saturations remain at 88%. This is due to

A. Endobronchial intubation
B. Aspiration
C. Tension Pneumothorax
D. Circuit leak
E. Blockage of ETT with secretions
A - Endobronchial intubation
51. PiCCO determines cardiac output utilizing

A. Thermodilution
B. Pulse contour analysis
C. Thermodilution and pulse contour analysis
D. ? Doppler
C - Thermodilution and pulse contour analysis
52. During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring

A. Anterior horn
B. Anterior corticospinal tract
C. Dorsal column
D. Spinothalamic tract
E. Lateral corticospinal tract
C. Dorsal column

CEACCP 2012- Predicting neuro outcome and survival
53. A patient has suffered flash burns of the upper 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 burned is

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

Abdomen- not entire body means do half
54. Complications of mediastinoscopy include all of the following except

A. Air embolism
B. Cardiac laceration
C. Pneumothorax
D. Recurrent laryngeal nerve palsy
E. Tracheal compression
B. Cardiac laceration

CEACCP 2007- Anesthesia for mediastinoscopy
55. A 70 year old man with severe mitral stenosis and normally in sinus rhythm, is going for an ORIF of fractured radius and ulna. Soon after induction of GA, he develops a tachyarrhythmia with BP 70/40mmHg and HR 130bpm. The most appropriate immediate action is

A. Amiodarone
B. Adenosine
C. IV fluid bolus
D. Adrenaline
E. Direct cardioversion
E - Direct cardioversion
56. The time constant of the alveoli is

A. Resistance multiplied by compliance
B. Resistance divided by compliance
C. Resistance plus compliance
D. Resistance minus compliance
A
57. The MAC awake:MAC ratio of sevoflurane is closest to

A. 0.22
B. 0.34
C. 0.45
D. 0.76
E. 1.00
B 0.34
58.Abnormal Q waves occur in all the following EXCEPT

A. Digitalis toxicity
B. LBBB
C. Recent transmural MI
D. Wolff-Parkinson-White
E. Previous MI
A- Digitalis toxicity

Dig- TWI, reverse tick ST segments, prolonged PR, arrhythmias
WPW- short PR, wide QRS, delta wave

Causes
Physiological- dextrocardia, right mediastinal shift (PTx)
Myocardial damage
Altered conduction- LBBB, WPW
Ventricular enlargement- COPD, PE
59. Patient complains of numbness in the anterior 2/3 of tongue after GA with LMA. Most likely nerve injured is

A. Glossopharyngeal
B. Facial nerve
C. Mandibular
D. Superior vagus
E. Maxillary nerve
C - mandibular
60. A 70 year old man with non-valvular atrial fibrillation is taken off his warfarin for 7 days prior to surgery and has no bridging therapy. His daily risk of stroke is

A. 0.001%
B. 0.01%
C. 0.1%
D. 4%
E. 10%
B
61. In patient with ankylosing spondylitis which of the following is INCORRECT

A. Amyloid renal infiltration is rarely seen
B. Cardiac complications occur in < 10%
C. Normocyctic anaemia occurs in 85% of cases
D. Uveitis is the most common extra-articular presentation
E. Sacroilitis is an early sign of presentation
C - normocytic anemia
62. Which of the following are NOT useful in the management of Torsades de Pointes

A. Isoprenaline
B. Procainamide
C. DCCV
D. Electrical pacing
E. Magnesium
B - Procainamide

Avoid Class I antiarrhythmics (Ib eg. lignocaine, phenytoin may be ok)
63. Compared with a plenium vaporizer what is NOT a disadvantage of draw-over vaporizer

A. Basic temperature compensation
B. Basic flow compensation
C. Cannot use sevoflurane
D. Small volume reservoir
C - Cannot use sevo

The rest of the options are known disadvantages (Nil temp compensation- cools vapour, increase in MV dilutes vapour)

Previously could not use draw-over vaporizer to deliver sufficient concentrations of sevo for inh induction- BJA 2012- Modification of a draw-over vaporizer for use with sevo demonstrated can

Draw-over vaporiser
- preferred in battlefield due to cheap, simple, potable
- Gas drawn into vaporising chamber by patient's inspiratory effort
- Can be used within circle systems

Plenum vaporiser = chamber
- gas passes through vaporiser under pressure
- split streams
- high resistance therefore positioned out of circle
64. The desflurane vaporizer is heated because of its

A. High SVP
B. High boiling point
C. Low SVP
D. High MAC
E. Low MAC
A. High SVP
65. The thermoneutral zone in a neonate in degrees celcius is

A. 26-28
B. 28-30
C. 30-32
D. 32-34
E. 34-36
D - 32-34C

TNZ = ambient temp range with nil change in metabolism

Adults 25-30C

Brandis
66. Which of the following is most effective way to reduce renal failure in AAA surgery

A. Fluid bolus prior to aortic clamping
B. Fluid bolus after aortic clamp release
C. Frusemide
D. Minimize cross-clamp time
E. Mannitol
D

Miller- maintenance of intravascular volume is the most effective means of renal protection during and after aortic cross-clamping.
67. Which type of aortic dissection can be managed conservatively/non-operatively

A. Debakey 1
B. Debakey 2
C. Stanford A
D. Stanford B
E. Stanford C
D. Stanford B

Standford
A = involves ascending aorta
B = does not

DeBakey
I = ascending aorta, arch, descending
II = ascending aorta only
III = descending aorta distal to L subclavian artery
68. The most likely cause of death after pharyngeal, esophageal or tracheal perforation is

A. Air embolus
B. Hemorrhage
C. Failure to intubate
D. Failure to ventilate
E. Sepsis
E. Sepsis

Uptodate
69. An essential criteria for diagnosis of left bundle branch block (LBBB) on ECG is

A. RSR in V1
B. Minimum duration QRS of 0.2 secs
C. Deep slurred S wave in V6
D. Loss of septal Q waves in V5 and V6
E. T waves opposite direction to main direction of QRS
D - loss of Q waves in V5 and V6

Criteria
QRS > 0.12s
Broad, monomorphic R waves in I and V6 with no Q waves
Broad, monomorphic S waves in V1
70. 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. Lower trunk
71. Which of the following are feature of Conn's syndrome?

A. Hypoglycaemia, hyponatremia, hyperkalemia
B. Hypoglycaemia, hypernatremia, hypokalemia
C. Normoglycaemia, hypernatremia , hypokalemia
D. Normoglycaemia, hyponatremia, hyperkalemia
E. Hyperglycaemia, hyponatremia, hyperkalemia
C. Normoglycaemia, hypernatremia , hypokalemia
72 Commonest valvular heart disease seen in pregnancy is

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral Stenosis
D. Mitral regurgitation
E. Tricuspid reguritation
C. Mitral Stenosis
73. Incidence and severity of vasospasm following sub-arachnoid haemorrhage is seen maximally at

A. 0-24 hrs
B. 2-4 days
C. 6-8 days (note 5-7 days in the old question)
D. 7-10 days
E. 2 weeks
C. 6-8 days (note 5-7 days in the old question)
or

D. 7 - 10 days

Days 4-10 highest risk

CEACCP 2013
74. The predominant pathology seen in restrictive heart disease is

A. Diastolic dysfunction
B. Systolic dysfunction
C. Valvular dysfunction
A. Diastolic dysfunction


CEACCP 2009
75. What is the first sign/symptom seen with an inadvertent total spinal whilst performing caudal anaesthesia in a neonate

A. Hypotension
B. Bradycardia
C. Desaturation
D. Tachycardia
E. Loss of consciousness
C. Desaturation

Less sympathetic tone. Likely to present w/ respiratory SEs cf. CVS
76. Which of the following is an absolute contraindication to electroconvulsive therapy

A. Cochlear implant
B. Epilepsy
C. Pregnancy
D. Raised Intracranial Pressure
E. Recent myocardial infarct
D. Raised Intracranial Pressure

With a space occupying lesion
Many references state nil absolute CIs at all
77. Prolonged Trendelenburg (head-down) positioning causes which of the following

A. No change in intracranial pressure
B. No change in intraocular presssre
C. No change in pulmonary venous pressure
D. Increased myocardial work
E. Increased pulmonary compliance
D. Increased myocardial work
78. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed

A. Posterior cord
B. Anterior division
C. Median brachial cutaneous nerve
D. Ulnar nerve
E. Inferior trunk
E. Inferior trunk
79. A 29 year old female undergoes craniotomy for posterior fossa tumour. Which of the following is an absolute contraindication to the sitting position

A. Patent ventriculo-atrial shunt
B. Previous back surgery
C. Pacemaker
D. Small patent foramen ovale
E. Oesophageal stricture contraindicated for transoesophageal echocardiogram
A and D (if large)

BJA 1999
AAIC 2005
80. A 4 year old child booked for minor surgery is seen in pre-admission clinic where a murmur is detected. Which feature will warrant further investigation

A. Loudness 4/6
B. Decreases on inspiration
C. Vibratory quality
D. Ejection systolic murmur
E. Louder on supine
A. Loudness 4/6
81. The autonomic supply of the ciliary ganglion is such that it

A. Receives its sympathetic nerve supply from the cervical ganglion
B. Receives its parasympathetic nerve supply from the trochlear nerve
C. Is located inferiorly in the orbit
D. Is at risk from injury during peribulbar nerve block
E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus
E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus
82. Regarding Thallium Stress Testing in predicting perioperative cardiac events

A. A positive result requires further investigation with a pulmonary artery catheter
B. It has a high negative predictive value
C. It has a low negative predictive value
D. It has a high positive predictive value
E. Thallium Stress testing is considered inferior to Dobutamine Stress Echo
B

ACC/AHA guidelines 2007 pg e440

High sensitivity
Low PPV
High NPV (00%)

83. An elderly gentleman on warfarin has suffered a subdural haematoma. His INR on admission was 4.5. The resident in Ed has already given him 2.5mg of Vit K. To reverse his coagulopathy prior to urgent surgery you should give him

A. Factor VIIa
B. FFP
C. Cryoprecipitate
D. Prothrominex
E. Prothrombinex and FFP

E. Prothrombinex and FFP
84. During caesarean section a meconium stained floppy apnoeic baby is delivered. When the midwife gives you the baby, it is apnoeic, cyanotic with heart rate of 90 bpm. What do you do next

A. Give naloxone
B. Dry and stimulate
C. Start chest compressions
D. Give positive pressure ventilation
E. Suction the trachea
E. Suction the trachea
85. A 70 year old lady suffered a subdural haematoma. She is currently confused and the neurosurgeon wants to take her to theatre for urgent decompression. She is a vague historian, but from notes you find out she had ablation and pacemaker put in 7 months ago - DDD mode. Cardiac technician in 1 hour away and the surgeon wants to proceed. What do you do

A. Postpone until cardiology review
B. Postpone until pacemaker checked by technician
C. Postpone until temporary pacemaker inserted
D. Proceed after having implemented external pacing
E. Proceed with magnet available
E. Proceed with magnet available
86. New blood pressure measuring device is developed. Best way to compare it to the current gold standard

A. SCUSUS
B. Bland Altman Plot
C. Kendall Coefficient of Concordance
D. Pearsons coefficient
E. Friedmans ??
B. Bland Altman plot

For comparing 2 different methods of measuring the same variable- Bland Altman
Correlation (comparing two independent variables eg. height and weight)- Pearson (normal distribution), Spearman or Kendall (not normal)

CEACCP 2007- Statistics I
87. What happens when you place a magnet over a biventricular internal cardiac defibrillator

A. Switch to asynchronous pacing
B. Damage the internal programming
C. Nothing
D. Switch off antitachycardia function
E. Switch of rate responsiveness
D. Switch off antitachycardia function
88. A 54 year-old patient is on warfarin for AF. They have a history of alcohol abuse and liver failure with a bilirubin of 28 and an albumin of 30. He also has a history of DVT following a flight. What is his CHADS2 score

A. 0
B. 1
C. 2
D. 3
E. 4
C = 2
89. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from

A. 16000kpa to 400kpa
B. 16000kpa to 240kpa
C. 11000kpa to 400kpa
D. 11000kpa to 240kpa
A

Contains 450L oxygen at 15,000kpa
90. What is approximately the systolic blood pressure in an awake neonate
(mmHg)

A. 55
B. 70
C. 85
D. 100
E. 115
B

Sources vary from SBP 70-100
SBP = 80 + age x 2
91. A 25 year male with a history of asthma who is usually on fluticonasone and salbutamol nebs presents with an acute exacerbation. On examination you see he is distressed, RR 26 bpm. On auscultation: poor air entry and polyphonic wheeze bilaterally. ABG: pH 7.45, pCO2 27, pO2 75, HCO3 24. He has been treated with salbutamol and ipratropium nebules and intrasvenous hydrocortison:E. What is the next step in his treatment

A. Inhaled helium/oxygen
B. IV aminophylline
C. IV magnesium
D. IVsalbutamol
E. Intubation and ventilation
C. IV magnesium

CEACCP 2008
92. You are doing an awake fibreoptic intubation and having difficulty identifying the anatomy of where you are. Then you observe a trifurcation. The lobe of the lung to which this airway is connected is

A. LUL
B. Lingula
C. RUL
D. RML
E. RLL
C. RUL
93. A 35kg 5 year old girl is having elective surgery for suturing of a superficial leg laceration. After induction with N2O/Sevoflurane/O2 and in absence of any visible veins you have placed an appropriately sized LMA. Following this her SpO2 immediately drop to 90%. What is your initial management

A. Remove LMA and increase inspired Sevoflurane concentration
B. Increase inspired Sevoflurane concentration through the LMA
C. Give sublingual Suxamethonium
D. Give intramuscular Atropine
E. Give intramuscular Suxamethonium
A. Remove LMA and increase inspired Sevoflurane concentration
94. Ulcerative colitis is associated with all of the following EXCEPT:

A. Cirrhosis
B. Iritis
C. Psoriasis
D. Arthritis
E. Sclerosing cholangitis
C. Psoriasis
95. Regarding rotameters

A. The bobbin is contained in a tube with parallel sides
B. There is laminar flow at high flows
C. The height of the bobbin is directly proportionate to the pressure drop across the bobbin.
D. There is a constant pressure difference across the bobbin at all flows.
E. Resistance increases at high flows
D. There is a constant pressure difference across the bobbin at all flows.
96. 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. Amiodarone 100mg bd
B. Digoxin 250mcg daily
C. Enalapril 2.5mg bd
D. Metoprolol 100mg bd
E. Diltiazem slow release 240mg daily
C. Enalapril 2.5mg bd
97. The best clinical indicator of severe aortic stenosis is

A. Presence of a thrill
B. Mean pressure gradient of 30mmHg
C. Area 1.2cm2
D. Slow rising pulse
E. ESM radiating to the carotids
A. Presence of a thrill

98. Atrial Septal Defect murmur is heard due to blood flow through

A. Tricuspid valve
B. Pulmonary valve
C. Mitral valve
D. Aortic valve
E. Atrial Septal Defect

B. Pulmonary valve

99. At what valve area do you begin to get symptoms at rest, with mitral stenosis?

A. 4.5 cm2
B. 3.5 cm2
C. 2.5 cm2
D. 1.5 cm2
E. 1.0 cm2

E: 1.0 cm2









Symptomatic ON EXERTION <1.5cm2


Symptomatic AT REST <1cm2

100. Nitrous oxide anaesthesia may cause all of the following EXCEPT

A. An increased incidence of myocardial ischaemia
B. Decreased leukocyte chemotactic response
C. Elevation of plasma homocysteine levels
D. Megaloblastic anaemia
E. Reversible inhibition of methionine synthetase

E. Reversible inhibition of methionine synthetase
101. The diagnosis of neuroleptic malignant syndrome requires the presence of

A. Diaphoresis
B. Elevated plasma creatine kinase
C. Hypertension
D. Muscle rigidity
E. Tachycardia
D best answer
102. Regarding tryptase level testing for suspected anaphylaxis, all are true EXCEPT:

A. Levels peak within 1 hour
B. Increased with anaphylactoid and anaphylactic reactions
C. 99% of the body’s stores are found in mast cells
D. Levels of > 20ng/mL are suggestive of anaphylaxis
E. Test should be repeated at 24-48 hours
E. Test should be repeated at 24-48 hours
103. An 18 month old boy presents for surgery for an incarcerated inguinal hernia. On examination you note that he has had an URTI for approximately one week. Your advice regarding surgery should be

A. Postpone the surgery for two weeks
B. Proceed with surgery under spinal anaesthetic
C. Proceed with surgery with a full course of antibiotics to treat the URTI
D. Undertake surgery, but avoid the use of an ETT
E. Proceed with surgery with careful monitoring
E
104. The incidence of fat embolism syndrome following a unilateral closed femoral fracture is

A. 0 -3%
B. 4 – 7%
C. 8 -11%
D. 12 – 15%
E. 16 - 19%
A. 0 -3%

CEACCP 2007
105. The thoracodorsal nerve arises from

A. A Medial cord of brachial plexus
B. Lateral cord of brachial plexus
C. Posterior cord of brachial plexus
D. Dorsal scapular nerve
E. Long thoracic nerve
C. Posterior cord of brachial plexus
106. Neurosurgery operation in the sitting position. MAP 80mmHg, CVP 5mmHg, the transducers are located 13cm below the external auditory meatus. What is the CPP? *Note - I specifically remember that 70mmHg was an option*

A. 62 mmHg
B. 65 mmHg
C. 67 mmHg
D. 72 mmHg
E. 75 mmHg
B
107. A man attending his daughter's wedding is involved in fight with his son-in-law. He does not know where he is, opens eyes to voice, but removes tie when instructed. What is his GCS?

A. 10
B. 11
C. 12
D. 13
E. 14
D. 13
108. Which of the following drugs is least likely to cause hypoxia in ARDS

A. Noradrenaline
B. Milrinone
C. Isoprenaline
D. Isoflurane
E. Sodium nitroprusside
A
109. What is the best predictor of poor prognosis with aortic stenosis?

A. Chest pain
B. Paroxysmal nocturnal dyspnoea
C. Syncope
D. Palpitations
E. Fatigue
B. Paroxysmal nocturnal dyspnoea
110. Pierre-Robin sequence is characterized by cleft palate, micrognathia and

A. Craniosynostosis
B. Macroglossia
C. Glossoptosis
D. Microstomia
C. Glossoptosis
111. After 3 litres of normal saline, the dilutional anaemia is initially offset by

A. Increased cardiac output
B. Increased oxygen extraction
C. Capillary vasodilation
A. Increased cardiac output
112. Anaesthetic Machine is left on all weekend with flow rate of oxygen at 6 litres/min. A Desflurane vaporiser is placed on it on Monday morning without changing the CO2 absorber. What is the most likely toxic product produced?

A. Ca(OH)2
B. Carbon dioxide
C. Carbon monoxide
D. Compound A
E. Compound B
C. Carbon monoxide
113. 2ml of 0.75% ropivacaine is injected for an interscalene block. Soon after the patient loses consciousness. The most likely place of inadvertent injection is

A. Subdural
B. Internal jugular vein
C. Common carotid artery
D. External jugular vein
E. Vertebral artery
E
114. An 18 month old infant is undergoing a routine spontaneously breathing GA with an LMA. They have a sudden onset of SVT with a heart rate of 220 and a BP of 84/60 with an ETCO2 of 32 and SpO2 of 98. The best management strategy is

A. Adenosine 100mcg/kg
B. DCR 2J/kg
C. DCR 4J/kg
D. Amiodarone 5mg/kg
E. CPR
A. Adenosine 100mcg/kg
115. 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. Adductor pollicis brevis
116. A middle-aged male with severe mitral stenosis having general anaesthesia for repair of fractured ulna/radius. Ten minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70/-. He is normally in sinus rhythm. What do you do

A. Adenosine
B. Amiodarone
C. Shock
D. Volume
E. Metaraminol
C. Shock
117. Circuit disconnection during spontaneous breathing anaesthesia

A. Will be reliably detected by a fall in end-tidal carbon dioxide concentration
B. Will be detected early by the low inspired oxygen alarm
C. Will be most reliably detected by spirometry with minute volume alarms
D. May be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
E. Can be prevented by using new, single-use tubing
D. May be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
118. ET04 An 85 year old patient with a bleeding disorder (? haemophilia) suffers a fractured neck of femur (#NOF). You discuss the possibility of a needing a blood transfusion but despite your explanation they refuse because they are scared of CJD infection post transfusion. Subsequently you decide not to proceed with the case because of the high risk of bleeding. The ethical principle that this is an example of is

A. Paternalism
B. Coercion
C. Justice
D. Beneficience
E. Autonomy
A. Paternalism
119. A type I diabetic is fasting pre-operatively and you decide to place them on an IV insulin infusion to optimize their perioperative glycaemic control. Their BSL is 7 mmol/L. By what mechanism does the insulin infusion decrease their BSL

A. Stimulates glucose uptake into the liver
B. Stimulates glucose uptake into skeletal muscle
C. Inhibits glucose production in the liver
D. Decreases glucose absorption from the gastrointestinal tract
E. Inhibit glucagon release
B
120. Patient has undergone a bilateral lung transplant. All of following are impaired EXCEPT

A. Mucociliary clearance
B. Cough reflex distal to anastomosis
C. Hypoxic pulmonary vasoconstriction
D. Response to CO2
E. Lymphatic drainage
C- HPV intact

Internet Journal of Anesthesiology- Anaesthetic challenges in patients after lung transplantation 2009
121. Patient with history of long QT syndrome treated with long term propranolol. How do you know the treatment is effective

A. Normal QTc
B. No further prolongation of QT in response to valsalva manoeuvre
B

CEACCP 2008
122. A neonate is born with meconium stained liquor but is vigorous and crying. The reason for not suctioning the pharynx is

A. Hypertension
B. Hypotension
C. Bradycardia
D. Tachycardia
C- bradycardia

Neoresus.org- Over vigorous suctioning can cause laryngospasm, bradycardia, trauma
123. What organism most commonly causes meningitis post spinal anaesthesia

A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Streptococcus salivarius
E. Escherichia coli
D. Streptococcus salivarius
124. A male patient has a haemoglobin of 8g/dL and reticulocyte count 10%. The most likely diagnosis is

A. Untreated pernicious anaemia
B. Aplastic anaemia
C. Acute leukaemia
D. Anaemia of chronic disease
E. Hereditary spherocytosis
E. Hereditary spherocytosis
125. An advantage of supraclavicular block over an interscalene nerve block for shoulder surgery

A. Less phrenic nerve block
B. Easier landmarks in obese patient
C. Arm can be in any position for block
D. Less risk pneumothorax
E. Better cover for shoulder surgery
A. Less phrenic nerve block
126. A patient with a head injury is found to have a unilateral dilated pupil with no direct or consensual response to light. What is the most likely diagnosis

A. Global injury
B. Optic nerve injury
C. Horners syndrome
D. Transtentorial herniation
E. Injury to the pons
D. Transtentorial herniation
127. In an arterial line system

A. Overdamping exaggerates mean pressure
B. Underdamping increases mean pressure
C. Underdamping underestimates systolic pressure
D. Wide range of damping coefficient associated with good performance if system has high natural frequency
E. Compliant tubing is good
D. Wide range of damping coefficient associated with good performance if system has high natural frequency
128. The commonest postoperative complication in a patient with a neck of femur fracture (#NOF) is

A. UTI
B. Pneumonia
C. Myocardial Infarction
D. Delirium
D
129. Which of the following is an advantage of a bronchial blocker of a double lumen tube

A. Able to isolate separate lobes
B. Significantly easier to deflate non-ventilated lung
C. Better suited to pneumonectomy
D. Less pressure on bronchial tissue
E. Lower incidence of tube malpositioning
A - cannot do this w/ DLT

Disadvantages of BB- unable to ventilate lungs separately, poor airway protection, not as satisfactory lung deflation
130. Laser endotracheal tubes

A. More resistant to ignition when covered in blood
B. Resistant to electrosurgical cautery
C. Wont ignite when touched by laser
D. Have larger external diameter for same internal diameter relative to standard PVC tubes
E. Have double cuffs which are resistant to puncture by laser
D
131. Pulsus paradoxus in cardiac tamponade, the blood pressure decreases

A. Every second beat
B. In expiration when increase is normal
C. In expiration more than normal subjects
D. In inspiration when increase is normal
E. In inspiration more than normal subjects
E. In inspiration more than normal subjects
132. You are anesthetizing a patient for a laparotomy who has a history of pulmonary hypertension. Regarding the patients anaesthetic management

A. An alpha-agonist is the inotrope of choice
B. Hypothermia is protective against a rise in pulmonary artery pressure
C. Isoflurane will tend to decrease pulmonary artery pressure
D. Ketamine is an appropriate anaesthetic agent
E. ? RHF
A
133. In a patient with severe rheumatoid arthritis, which radiological finding is most consistent with severe atlantoaxial instability (? C1/C2 instability)

A. A 9mm gap between the anterior arch of C1 and the odontoid peg
B. Increased saggital diameter
C. Posterior atlantodental interval of > 14mm
D. Midpart of C1 over C2
E. Tear drop sign of C2
A. A 9mm gap between the anterior arch of C1 and the odontoid peg
134. You are called to the labour ward to assist in the manual removal of a retained placenta in a healthy woman. The obstetrician asks you to administer intravenous glycerol trinitrate. An initial safe dose, that you would expect to be effective, would be

A. 5mcg
B. 50mcg
C. 250mcg
D. 500mcg
E. 1000mcg
B. 50mcg
135. What is the most accurate method of determining foetal heart rate in a neonate

A. Palpation of an umbilical vein pulse
B. Auscultation with a stethoscope
C. Palpation of the femoral artery
D. Pulse oximetry
B
136. Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing

A. Abnormalities on magnetic resonance imaging (MRI) spectroscopy
B. Calcium release from B lymphocytes in response to caffeine stimulation
C. Certain mutations in the ryanodine receptor gene
D. Myofibrillar necrosis on muscle biopsy plasma
E. Creatine kinase (CK) levels above 800 units/L
E
137. A 60 year-old man with anterior mediastinal mass, is having a mediaastinoscopy. During induction they lose cardiac output, desaturate and drop their ETCO2. What is the best management strategy

A. Adrenaline
B. CPR
C. CPB
D. Place prone
D. Place prone


138. Which is true of Eaton-Lambert syndrome that differentiates it from myasthenia gravis?

A. Immune antibodies against post-synaptic ion channels
B. Associated with thymoma
C. Repeated exercise causes weakness to initially improve
D. Good response to edrophonium
E. Resistant to non-depolarizing muscle relaxants
C. Repeated exercise causes weakness to initially improve
139. A 55 year-old man presents to the emergency department with an obviously infected heel ulcer - BP 100/60, PR 110/minute, temperature 35.8, Na 125, K 2.7, BSL 55, Creatinine 180. Which do you give first/most urgently?

A. Antibioitcs
B. Crystalloid
C. Insulin
D. Potassium
E. Adrenaline
B
140. A new test has been developed to diagnose a disease. To determine the SPECIFICITY of this new test it should be administered to

A. A mixed series of patients ie. some known to be suffering from the disease and some known to NOT be suffering from it
B. A series of patients known to NOT be suffering from the disease
C. A series of patients known to NOT be suffering form the disease and an estimate of the prevalence of the disease in the population obtained
D. A series of patients known to be suffering from the disease
E. A series of patients known to be suffering from the disease and an estimate of the prevalence of the disease in the population obtained
B. A series of patients known to NOT be suffering from the disease
141. During one lung ventilation, hypoxaemia can occur. The cause for this is:

A. Loss of hypoxic pulmonary vasoconstriction
B. Perfusion of the unventilated lung
C. Ventilation perfusion mismatch of the ventilated lung
D. Atelectasis of the ventilated lung
E. Upper lobe collapse of the ventilated lung
B. Perfusion of the unventilated lung
142. A child with intra-operative blood loss. A cardiac arrest is most likely because of

A. A delay in delivery of blood from the blood bank
B. Inadequate intravenous access
C. Underestimated intra-operative blood loss
D. Underestimated pre-operative hypovolaemia
E. Complication of transfusion
C
143. The lumbar plexus supplies all of the following EXCEPT:

A. Subcostal nerve
B. Obturator nerve
C. Lateral cutaneous femoral nerve
D. Long saphenous nerve
E. Iliohypogastric nerve
A. Subcostal nerve
144. The symptom indicating poorest prognosis in an adult patient with aortic stenosis

A. Chest pain
B. Malaise
C. Palpitations
D. Paroxysmal nocturnal dyspnoea
E. Syncope
D. Paroxysmal nocturnal dyspnoea
145. A 50 year old male in recovery after an anterior cervical fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, SpO2 96%. What is the most appropriate management

A. Aspirate the collection with a 19G needle and syringe
B. Awake fibreoptic intubation with minimal sedation
C. Direct laryngoscopy and intubation after sevoflurane/O2 gaseous induction
D. Direct laryngoscopy and intubation after propofol/suxamethonium induction
E. Intubation via intubating LMA
C
146. Regarding post dural puncture headache, all of the following are true, EXCEPT:

A. If puncture with the tuohy needle during epidural insertion, subsequent blood patch is 30-50% effective
B. Caffeine is often used to treat mild headache
C. Subdural haemorrhage can occur rarely
E. Unlikely to be post dural puncture headache if the headache is only in the occipital area
E. Unlikely to be post dural puncture headache if the headache is only in the occipital area
147. A 70 year-old male presents for right lower lobectomy. Preoperative spirometry shows FEV1 2.4L (4.2L predicted), FVC 4L (5L predicted). The predicted post-operative FEV1 is:

A. 1.0L
B. 1.3L
C. 1.7L
D. 1.9L
E. 2.2L
C. 1.7L
148. What is the most important immediate treatment for a cardiac arrest due to ventricular fibrillation in a patient with hypertrophic obstructive cardiomyopathy?

A. Adrenaline
B. Amiodarone
C. Defibrillation
D. Intubation, ventilation and oxygenation
E. Precordial thump
C. Defibrillation
149. Hypercalcaemia due to hyperparathyroidism is associated with

A. A shortened PR interval
B. A prolonged QTc interval
C. Muscle rigidity
D. Polyuria and polydipsia
E. Increased glomerular filtration rate
D. Polyuria and polydipsia
150. The cause of early mortality (early - within 30 minutes) in a pregnant women with amniotic fluid embolism is

A. Bronchospasm
B. Hypovolaemia
C. Malignant arrhythmia
D. Pulmonary hypertension
E. Pulmonary oedema
D. Pulmonary hypertension