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

1/137

Click to flip

137 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)

1. Given the following diagram, what does X represent?

A. Amount of drainage since system was connected to patient
B. Level of resistance to drainage of pleural cavityMaximum pressure against the pleural cavity on expiration
C. Level of underwater seal applied to pleural cavity
D. Maximum pressure in pleural cavity on expiration
E. Maximum suction that can be applied to pleural cavity
C
E

2. RH28 Retrobulbar block. Sign of brainstem spread



A. Atonic pupil


B. Unilateral blindness in blocked eye


C. Contralateral blindness


D. Diplopia- past papers remembered this as dysphagia


E. Nystagmus

C


Caused by reflux of LA into the Optic Chiasm



Drowsiness/Vomiting/Convulsions/Respiratory Depression/Arrest



http://bja.oxfordjournals.org/content/75/1/93.full.pdf




but if Dysphagia - correct

3. Otherwise healthy 20 yo male undergoes surgery for an ORIF tibia for open tib fracture. The limb is exanguinated and the tourniquet correctly applied at 250mmHg. His SBP is 120. When the surgeons go to start there is a small amount of bleeding. Do you..


A. Accept that a small amount of bleeding may occur with a tourniquet


B. Reinflate at a higher pressure


C. Check coags


D. Take tourniquet down, rexanguinate and reinflate


E. Something else

A

Tourniquet question: ORIF tib/fib fracture. BP was 110/70. Tourniquet correctly applied at 250 mmHg. Options were:


A. Reinflate at a higher pressure


B. Deflate, re-exanguinate and reinflate


C. Accept that there will be a small amount of bleeding


D. ?


E. ?

C


1-2 hours ATP exhausted


3 hours Creatine Phosphatase exhausted

4. This was the CXR showing a widened mediastinum with an otherwise normal CXR, there was an electronic circuit thing at the bottom right but nothing else obvious. Aortic dissection was the answer (at least I think!)





Aortic dissection

5. Fatigue during night shifts can be minimized by:


A. Avoiding daylight


B. not sleeping during day


C short naps during shift


D use of caffeine or stimulants


E. using benzodiazepines for sleep during the day

C



file:///Users/maelcyap/Downloads/ps43-2007-statement-on-fatigue-and-the-anaesthetist.pdf



http://ceaccp.oxfordjournals.org/content/early/2013/06/18/bjaceaccp.mkt025.full.pdf+html

6.Patient with Acute Intermittent Porphyria presents to hospital with abdominal pain and requires a general anaesthetic. Which drug for PONV would you avoid?


A. Metoclopramide


B. Prochlorperazine


C. Tropisetron


D. Ondansetron


E. Droperidol

A



Oxford Handbook 212 (3rd edition)



http://ceaccp.oxfordjournals.org/content/early/2012/02/27/bjaceaccp.mks009.full.pdf+html

7. A 65 year old man having a total hip placement under general anaesthetic has continued to take his moclobemide. He becomes hypotensive shortly after induction. The best treatment would be judicious use of


A. adrenaline


B. dobutamine


C. ephedrine


D. metaraminol


E. phenylephrine

E



Moclobemide- reversible MAOI



Most dangerous- Indirect Sympathomimetics (Ephedrine/Metaraminol/Amphetamine/Cocaine)



Direct sympathomimetics- Exaggerated Effect



Serotonin Syndrome- Pethidine/Tramadol



Pancuronium-Releases stored NA



Oxford Handbook Page 285

7. Patient with depression for surgery forgets to omit his moclobemide, which agent would be BEST with hypotension under anaesthesia?


A. Noradrenaline


B. Adrenaline


C. Ephedrine


D. Metaraminol


E. Phenylephrine

E

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


A. endobronchial intubation


B. endotracheal cuff leak


C. gas sampling line leak


D. obstructive airways disease


E. spontaneous ventilatory effort

C

C

9. When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to:



A. T2


B. T4


C. T6


D. T8


E. T10

B



Oxford Handbook 756

10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is:


A. Cease dabigatran 7 days prior


B. Cease dabigatran 3 days prior


C. Cease dabigatran 3 days prior and give bridging anticoagulation


D. Cease dabigatran 24 hours prior and measure INR on day of surgery


E. Continue dabigatran and withhold on day of surgery

B



Darbigatran- Factor 10a inhibitor


At least 48 hours for spinal



MIMS

11. A 15 yo girl with newly diagnosed mediastinal mass presents for supra-clavicular lymph node biopsy under GA. The most important investigation to perform pre-operativel


A. CXR


B. CT chest


C. MRI chest


D. PET scan


E. TOE

B

12. A CTG recording with late prolonged decelerations. Cause:



A. GA


B. Head compression


C. Uteroplacental insufficiency


D. Acute asphyxia


E. Umbilical cord compression.

C



Late decelerations begin at peak of uterine contraction and recover when the contraction ends.



Caused by:


Maternal Hypotension


Pre-Eclampsia


Uterine Hyperstimulation



Head compression- Early deceleration


Umbilical cord compression- Variable deceleration



http://geekymedics.com/2011/05/29/how-to-read-a-ctg/



http://ceaccp.oxfordjournals.org/content/3/2/38.full.pdf+html

13. A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of the conventional before 1 extra patient will benefit is


A. 3


B. 4


C. 8


D. 25


E. 33

D



1/ARR


1/Probability (with intervention)-Probablity (Control)


1/0.12-0.08=1/0.04 = 25

14. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use:


A. vecuronium


B. cisatracurium


C. pancuronium


D. atracurium


E. suxamethonium

B Cisatracurium





60-70% of all anaphylaxis



Anaphylaxis to Suxamethonium- 60% to all others NMBD



Benzylisoquinolonium


Less potential for histamine release


Cisatracurium less histamine release



Peck + Hill

15. Increase in period bleeding EXCEPT


A. Gingko


B. Garlic


C. Ginger


D. Fish Oil


E. Echinacea

E



http://ceaccp.oxfordjournals.org/content/11/1/14.full

16. Post op hip ORIF, commonest periop complication



A. UTI


B. PE


C. Delirium


D. AMI


E. Pneumonia

C (Most Likely)



http://www.aagbi.org/sites/default/files/296%20Neck%20of%20Femur%20Fracture;%20Peri-operative%20Management[1].pdf

17. 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



http://ceaccp.oxfordjournals.org/content/11/1/9.full.pdf+html

18. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her:


A. Instigate low dose beta blockade


B. Defer, and refer to a cardiologist


C. Perform a transoesophageal echo to get a better look at the valve


D. Proceed to surgery with no further investigation


E. Perform a dobutamine stress echo

D



http://ceaccp.oxfordjournals.org/content/early/2013/02/25/bjaceaccp.mkt006.full.pdf+html

19 (Repeat) Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.


A. anterior ischaemia


B. atrial


C. inferior


D. lateral


E. septal

A

20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of:


A. Aorta


B. Hepatic artery


C. Hepatic vein


D. Portal pedicle


E. Splenic Artery

D



Both Hepatic artery and vein

21. A 60 y.o. diabetic man has below knee amputation for ischaemic leg. His neuropathic pain is treated with oxycodone 40mg BD and paracetamol 1g QID. He is also on omeprazole 20mg BD for reflux. You decide to start him on gabapentin. Before choosing a dosing regime and starting treatment it is most important that you:


A. cease his omeprazole


B. check his hepatic transaminase level


C. check his renal function


D. CHeck his QT interval on a resting ECG


E. Decrease his oxycodone

C

22. The anterior and posterior borders of the 'triangle of safety', the preferred insertion site for an intercostal catheter, are pec major and:


A. Coracobrachialis


B. Deltiod


C. Lat Dorsi


D. Serratius Anterior


E. Trapezius

C


 

C Lat dorsi


23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with nucertain medication compliance. He is confused and agitated wuth generalised rigidity but no hyperreflexi:A. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx?


A. Heat stress from anticholinergics


B. Hypoxic ischaemic encephalopathy


C. NEM


D. Serotonin syndrome


E. Pain from fracture

C



Neuroleptic Malignant Syndrome


(D2 receptor antagonist)



F ever


E levated enzymes


V ital sign instability


E ncephalopathy


R igidity of muscles



Serotonin Syndrome



S hivering


H yperreflexia


I ncreased temperature


V ital sign instability


E ncephalopathy


R estlessness


S weating

24. CO2 penetrates surface tissue so well with little damage to underlying tissue becuase


A) Well absorbed by Hb


B) Poorly absorbed by H20


C) Widely disseminated in tissue


D) Long infrared wavelength


E) Short infrared wavelength

D

25. (NEW) An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is:


A. Inferior gluteal


B. Obturator


C. Pudendal


D. Scaitic


E. Superior gluteal

B



Obturator- Adductor muscle of the Hip


Inferior Gluteal- Gluteus maximus


Pudendal- Sensation to genitals + anal canal, Pelvic floor muscles, sphincters


Sciatic- Posterior Leg

26. (New) You are involved in research and as part of data collection you collect ASA scores. This type of data is:


A. Categorical


B. Nominal


C. Non-parametric


D. Numerical


E. Ordinal

E



26. What best describes the type of data that ASA grading scores represent?


A. Numerical


B. Ordinal


C. Nominal


D. Ratio


E. Non-parametric

B

27. An otherwise healthy man presents with anaemi:A. The test that most reliably indicates iron deficiency is decreased


A. MCV


B. serum ferritin


C. serum iron


D. serum transferrin


E. total iron binding capacity

B





MCV Low


Ferritin Low


Serum Iron Low


Transferrin Low


Total Iron Binding Capacity High



Ferritin intracellular protein-stores and releases iron

30. The maximal allowable atmospheric concentration of nitrous oxide in Australian and New Zealand operating theatres (in parts per million) is


A. 5


B. 25


C. 50


D. 100


E. 200

B



30. Recommendation regarding safe nitrous oxide exposure in operating rooms


A. 10 ppm


B. 25 ppm


C. 50ppm


D. 100 ppm


E. 200 ppm

B

31. What is associated with down regulation of nicotinic acetylcholine receptors:


A. Guillain-Barre syndrome


B. Organophospate overdose


C. Spinal cord injury


D. Stroke


E. Prolonged neuromuscular blockade

B



nAch Down-regulation


Myasthenia Gravis


Anticholinesterase poisoning


Organophosphate poisoning



nAch Up-Regulation


Spinal cord injury


Stroke


Burns


Prolonged immobility


Prolonged exposure to NMD


Multiple Sclerosis


Guillain Barre



Millers page 900 (table 29-1)

31. nicotonic ach receptor downregulation, cause?


A. organophosphate poisoning


B. long muscle relaxant use


C. ?

A

35. A reduction in DLCO can be caused by:


A. Asthma


B. Emphysema


C. Left to right shunt


D. Pulmonary haemorrhage


E. Bronchitis

B



Decreased DLCO (<80% predicted)


Obstructive Lung Disease


Parenchymal Disease


Pulmonary vascular disease


Anaemia



Increased DLCO (>120-140% predicted)


Asthma


Pulmonary haemorrhage


Polycythaemia


Left to Right shunt



Rate of Diffusion = A (C1-C2)/D

36. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is



A. Genetic test father


B. Genetic test woman


C. Muscle biopsy sibling


D. Muscle biopsy father


E. Muscle biopsy woman

E (? D)

37. (New) The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size:


A. 6


B. 8


C. 10


D. 12


E. 14

D



http://www.smiths-medical.com/userfiles/trachealtubechart.pdf



3F = 1mm diameter

37. What is the largest French gauge suction catheter whose physical diameter doesn't exceed half the internal diameter of an 8 ETT?


A. 6


B. 8


C. 10


D. 12


E. 14

D

38. (Repeat) Pneumoperitoneum causes a decrease in cardiac output at what pressure (or possibly ABOVE what pressure)


A. 10mmHg


B. 20mmHg


C. 30mmHg


D. 40mmHg


E. 50mmHg

A



Miller says >10



http://ceaccp.oxfordjournals.org/content/4/4/107.full.pdf+html



Initially increase in venous return and CO due to autotransfusion of pooled blood from splanchnic circulation.



Then decrese in VR + CO due to compression of inferior vena cava.



39. 60yo male had total knee replacement. 7 days post-operatively diagnosed with deep venous thrombosis on ultrasound. Was on LMWH. PLT dropped from 300 immediately post-op and now 150x10^9/L. All the following are acceptable treatments EXCEPT-



A. Argabotran


B. Lepirudin


C. Fondapurinax


D. Danaparoid


E. Warfarin

C


40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique:


A. 3 mg/kg


B. 7 mg/kg


C. 15 mg/kg


D. 25 mg/kg


E. 35 mg/kg

E



Lignocaine diluted into high volumes. 22-57 mg/kg



http://ceaccp.oxfordjournals.org/content/early/2011/07/12/bjaceaccp.mkr026.full.pdf+html

43. Drug to facilitate clip placement during cerebral aneurysm surgery;


A. nimodipine


B. mannitol


C. adenosine


D. hypertonic saline


E. thiopentone

C

44. Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby?


A. codeine


B. morphine


C. paracetamol


D. parecoxib


E. tramadol

A



Excreted in breast milk and mothers may be rapid metabolisers which will make the baby more narcotised.



http://www.bfmed.org/Media/Files/Protocols/Protocol_15_revised_2012.pdf



It is from the academy of breastfeeding medicine but well referenced.


44. What is not safe to give to a breastfeeding mother during general anaesthesia?


A. Codeine


B. Morphine


C. Parecoxib


D. Tramadol


E. Paracetamol

A

44. Analgesia to avoid in breast feeding woman?


A. morphine


B. pethidine


C. codeine


D. parecoxib


E. tramadol

C


Pethidine not recommended. Norpethidine is excreted slowly in neonates.




45. A three year old girl for an elective hernia repair is seen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to:



A. Postpone surgery for 2 hours


B. Postpone surgery for 4 hours


C. Postpone surgery for 6 hours


D. Cancel surgery


E. Continue with surgery

E



http://ceaccp.oxfordjournals.org/content/6/6/215.full.pdf+html

46. In accordance with their belief that blood transfusion is wrong, a Jehovah's Witness may consent to all of the following except:


A. Cryoprecipitate


B. Immunoglubulins


C. Fresh Frozen Plasma


D. Factor VIIa


E. Prothrombinex

C



http://www.anzca.edu.au/resources/college-publications/pdfs/ANZCA%20Blue%20Book%202011%20P9.pdf



Page 126

47. 80 year old lady with fractured NOF needing ORIF. On examination had a systolic murmur. Arranged TTE which showed a calcific aortic valve with peak velocity of 4 m/s. Using the simplified Bernoulli equation, what is the peak pressure gradient across the valve:
A. 16 mmHg
B. 32 mmHg
C. 48 mmHg
D. 64 mmHg
E. 80 mmHg

D

Bernoulli principle- an increase in the flow velocity of an ideal fluid will be accompanied by a simultaneous reduction in its pressure

Simplified equation:

p1-p2= 4V^2

47. AS gradient of 4m/s, what is the mean pressure using modified bernoulli (4v squared = 64)

D

48. You have developed a new cardiac output monitor called WaCCO. You want to compare the readings with the gold standard, a pulmonary artery catheter. What is the best statistical method to present the data/results:



A. Funnel plot


B. Bland-Altman plot


C. Forest plot


D. Galbraith plot


E. Partial regression plot

B



Cross + Plunket page 214

50. A 60 year old, triple vessel disease normal LV Post CABG hypotensivem ST elevation II, avF, CVP 15 PCWP 25. Normal SVR


A. A early diastolic mitral inflow dynamic with atrial systole


B. Left inferior hypokinesis


C. Left ventricle collapse in systole


D. Right ventricle dilation and TR


E. Severe Mitral Regurg

B

51. Maximum amplitude from TEG or ROTEM decreased give
A. Cryoprecipitate
B. FFP
C. Platelets
D. Prothrombinex
E. Tranexamimic acid
C

http://www.rotem.de/en/methodology/result-interpretation/

http://lifeinthefastlane.com/education/ccc/thromboelastogram-teg/

51. With regards to ROTEM: maximal clot firmness (Increased MA: maximal amplitude on TEG) correlates best with needing to give:


A. FFP


B. Cryoprecipitate


C. Platelets


D. PCC


E. TXA

C

52. Young male, previous IVDU, now on 100mg Methadone per day has a laparotomy with an effective epidural. Amount of IV Morphine needed per HOUR:


A. 1mg


B. 2mg


C. 4mg


D. 8mg


E. 16mg

C

54. Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to


A. have dosimeter checked at least 6-monthly


B. limit exposure time to radiation


C. maximal distance from radiation source


D. stand behind transmitter of C arm


E. wear protective garments

C



Intensity radiation = 1/distance sqaured



At least 3 feet from source


6 feet or air provides 9 inches of concrete or 2.5mm lead



http://ceaccp.oxfordjournals.org/content/early/2012/11/04/bjaceaccp.mks055.full.pdf+html

57. Ibuprofen dose for one year old child tds regular post-op dose


A. 5mg/kg


B. 10


C. 15


D. 20


E. 25

B



5-10mg/kg (MIMS)

58. AICD, what does a magnet do


A. Maintain defib activity & activate asynchronous pacing


B. maintain anti tachycardia pacing & deactivate asynchronous pacing


C. Deactivate anti tachycardia pacing & activate asynchronous pacing


D. Deactivate defib & activate asynchronous pacing


E. Deactivate defib & deactivate asynchronous pacing

D





Even when the ICD has been deactivated by a magnet, pacemaker function of an ICD is not affected. Thus, in a patient with an ICD, the magnet response will always be to deactivate the ICD and the pacing behaviour will not change to an asynchronous mode.



http://bja.oxfordjournals.org/content/107/suppl_1/i16.full.pdf+html

Magnet on PPM


AOO/VOO/DOO


 


Magnet om AICD


Deactivates tachytherapy (Shocks) but pacing unaffected


 

Magnet on PPM


AOO/VOO/DOO



Magnet om AICD


Deactivates tachytherapy (Shocks) but pacing unaffected


60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AE:D. On admission to hospital his ECG was as below;


ECG - sinus, rate ~60, normal axis, borderline PR interval, RSR' in V1 and V2 with ST elevation and inverted T waves (Brugada sign)


A. Acute pericarditis


B. Brugada


C. Cocaine intoxication


D. Coronary artery spasm


E. Long QT syndrome



B



Brugada syndrome is due to a mutation in the cardiac sodium channel gene.

Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave

Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave

What does the following ECG demonstrate? [ECG provided]


A. LVH


B. Anterior infarct


C. Digoxin toxicity


D. Brugada syndrome


E. ?

D




Clinical Criteria


Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).



Family history of sudden cardiac death at <45 years old .



Coved-type ECGs in family members.



Inducibility of VT with programmed electrical stimulation .



Syncope.



Nocturnal agonal respiration

61. A 58yo with solitary hepatic metastasis from colon cancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain:



A. High CVP in anticipation of heavy blood loss


B. Decreased MAP to reduce arterial bleeding


C. Decreased CVP to reduce venous bleeding


D. Normal MAP in anticipation of heavy blood loss


E. Normal CVP to ensure adequate filling of the heart.

C



http://ceaccp.oxfordjournals.org/content/9/1/1.full.pdf+html



During parenchymal resection hepatic inflow occlusion, the main source of bleeding is backflow from the valveless hepatic veins. The control of central and thus hepatic venous pressure is crucial to reduce the blood loss (>5cm H2O)

63. A man is admitted to ICU with a Sodium of 105 mmol/L. What is the maximum his sodium should be raised in the next 24 hours


A. 5 mmol


B. 10 mmol


C. 15 mmol


D. 20 mmol


E. 25 mmol

B



5-10 mmol/day (>48hrs)


2mmol/L/hr (<48hrs)



Oxford Handbook page 186



Pontine Myelinolysis


Rapid correction of sodium in hyponatremia would cause the extracellular fluid to be relatively hypertonic. Free water would then move out of the brain cells to decrease this relative hypertonicity. This leads to a central pontine myelinolysis, manifesting as the paralysis. The brain appears to shrink.


The demyelination of the axons (nerve fibers in the brain) damages them.



ASK ICU NERDS

63. Impaired level of consciousness (possible seizures) on ward. Sodium concentration 105mmol/L, what is the maximum correction in 24hrs?



A. 8


B.10


C. 12


D. 15


E. 20

B

64. What is the distance from lips to carina in a 70 Kg man?


A. 21 cm


B. 23 cm


C. 25 cm


D. 27 cm


E. 29cm

D



Lee's Synopsis of Anaesthesia:


Central Incisors to Carina


Male 27cm/Female 23cm



15cm from teeth to cords, 12 cm from cords to carina



64. What is the average tube depth from lips to carina in a male? (may have said female)



A. 22


B. 25


C. 27


D. 29


E. 19

C

65. The action of which laryngeal laryngeal muscle opens the cords?


A. Cricothyroid


B. Posterior cricoarytenoid


C. Lateral Cricoarytenoid


D. Thyroarytenoid


E. Vocalis

B



Cricothyroid muscle - Lengthens and tenses VC


Posterior crycoarytenoid- Open glottis


Lateral crycoarytenoid- Close glottis


Interarytenoid- Close glottis


Thyroarytenoid- Relax VC


Vocalis- Relax VC



http://en.wikipedia.org/wiki/Larynx



66. Induction of a 4yr old child with Arthrogrophysis multiplex congenita, however you find it difficult to place the laryngoscope. What is the concern? (paraphrased question here, can’t remember all possible answers)


A. MH


B. Neuroleptic malignant syndrome


C. ?


D. opioid induced rigidity


E. TMJ rigidity

E



Skin and soft connective tissue abnormalities, contracture deformities, micrognathia, cervical spine and jaw stiffness, congenital heart disease (10%), hypermetabolic response is probably NOT MH. Difficult airway and venous access, sensitive to thiopental.



Oxford handbook page 298

70. A patient is suffering from aortic dissection with acute aortic regurgitation. BP 160/90, HR 100 & evidence of acute pulmonary oedema. What is your immediate management?


A. Beta-blockers


B. Dopamine


C. Dobutamine


D. Sodium nitroprusside


E. Intra-aortic Balloon Pump

D



Cardiac bosses all agree. No great evidence. Anyone has any good papers?

CEACCP article states bet-blockers first

71. Presented are a femoral arterial line trace & a central venous line (JVP) trace - looked like it was demonstrating elevated right atrial pressures... What is demonstrated by these pressure waveforms?



A. Aortic Stenosis


B. Aortic Regurgitation


C. Pulmonary Regurgitation


D. Tricuspid Regurgitation


E. Mitral Regurgitation

D



http://lifeinthefastlane.com/education/ccc/cvp-measurement/

71. Given the following femoral AL and CVP traces, what is the most likely cause? [diagram]



A. Pulmonary stenosis


B. Left Ventricular Failure


C. Tricuspid Regurgitation


D. Aortic Stenosis


E. Mitral Stenosis

C

72. The MELD score is calculated using INR, Bilirubin & what?


A. Creatinine


B. Albumin


C. Urea


D. AST


E. Ammonia

A



Med Calc



Model End Stage Liver Disease


Disease severity scoring system applied to ADULT livers to improve organ allocation in transplants



MELD + MELD-Na



* 40 or more — 71.3% mortality
* 30–39 — 52.6% mortality
* 20–29 — 19.6% mortality
* 10–19 — 6.0% mortality
* <9 — 1.9% mortality

73. In resuscitating a newborn infant after delivery, the time at which you would like to achieve arterial oxygen saturation of 85-90%:


A. 2mins


B. 3mins


C. 4mins


D. 5mins


E. 10mins

E



Australian Resuscitation Council



http://www.resus.org.au/policy/guidelines/section_13/13_1.htm

From Paul Craven's Resus tutorial:



Target sats
------- 60-70 @1min
------- 65-85 @2min
------- 70-90 @3min
------- 75-90 @4min
------- 80-90 @5min
------- 85-90 @10min

74. (repeat): You inserted a central venous line and peripheral arterial line for a patient who is having a tumour removed via craniotomy. The transducers of both the lines were placed at the level of the right atrium 13cm below the level of the external auditory canal. MAP is 80mmHg, CVP 5mmHg. What is the CPP?


A. 62mmHg


B. 65mmHg


C. 70mmHg


D. 75mmHg


E. 80mmHg

B (70mmHg-5mmHg) = 65mmHg



Recommended arterial transducer to be at the level of the tragus



About 11mmHg difference between heart and tragus



http://lifeinthefastlane.com/education/ccc/cerebral-perfusion-pressure-in-tbi/

Kirkman MA 2014 BJA

75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80.



A. 0.04


B. 0.4


C. 4


D. 14


E. 40

C



Peck & Hill page 183

76. You are putting in a internal jugular central venous line. Which maneuvre causes maximal distension of the internal jugular vein?


A. CPAP


B. Breath hold at end expiration


C. Manual compression at the base of the neck


D. Trendelenberg position


E. Valsalva manoeuvre

E



82. A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is:


A. Epidural Lignocaine


B. IV Esmolol


C. IV Hydralazine


D. IV Magnesium


E. IV Propofol

D



Phaechromocytoma-CEACCP (2003)



Such agents include boluses of phentolamine 1–5 mg and labetalol 5–10 mg or sodium nitroprus- side, GTN and nicardipine infusions. Sodium nitroprusside has a rapid onset and offset of action; it is not associated with toxicity when used in recommended doses. Nicardipine is a calcium chan- nel blocker which has been used as an infusion for fast titration of blood pressure. The use of isoflurane as an antihypertensive agent is a practical alternative. Magnesium sulphate infusions have recently been described (inhibits catecholamine release, exerts a direct vasodilator effect and reduces α-receptor sensitivity).

83. Best option to reduce risk of Ventilator induced pneumonia?



A. Nurse in supine position


B. Early spontaneous ventilation through ETT


C. Oral hygiene


D. Use antacids


E. Regularly change breathing circle

C

83. Best way to reduce ventilator induced pneumonia?


A. Nurse in Supine Position


B. Early spontaneous ventilation through ETT


C. Oral hygiene


D. Use anti-acids


E. Regularly change breathing circuits

C



file:///Users/maelcyap/Downloads/ANZICS%20VAP%20Statement%20Consultation%20Version_25032013.pdf




85. A 37 year old female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods taken. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality. The most likely diagnosis is



A. Central diabetes insipidus


B. Nephrogenic diabetes insipidus


C. Psychogenic polydipsia


D. Cerebral salt wasting


E. SIADH

C


Psychogenic Polydipsia


Increased H20 intake due to dry mouth (caused by drugs)


Hyponatraemia (serum)


Hyposmolar (serum)


Polyuria


Dilute Urine (urine osmolality


Normovolaemic



CDI (Inadequate ADH Secretion)


Hypernatraemia


Hyperosmolar


Polyuria


Dilute Urine (urine osmolality


Responsive to ADH



NDI (Kidney resistant to ADH)


Normal to high Na


Normal to high osmolality


Polyuria


Dilute urine (urine osmolality


Non-responsive to ADH



Cerebral Salt Wasting


Excessive Na secretion by Kidneys due to brain trauma/tumour)


Hyponatraemia


Hyposmolar


Polyuria


Elevated urinary Na (urine osmolality>plasma osmolality)


Hypovolaemic



SIADH (Inappropriate ADH secretion)


Hyponatraemia


Hyposmolar


Oliguria Elevated urinary Na (urine osmolality>plasma osmolality)


Normal to expanded volume



http://lifeinthefastlane.com/education/ccc/siadh-versus-cerebral-salt-wasting/



http://lifeinthefastlane.com/education/ccc/central-diabetes-insipidus/



http://lifeinthefastlane.com/investigations/hyponatraemia/

www.sydpath.stvincents.com.au/tests/Sodium.htm

86.


Photograph of an Arndt bronchial blocker multiport airway adapter. Orifice labelled 'X'. What goes in 'X'?



A. Bronchoscope


B. ?


C. ?

91. The American Heart Association (AHA) guidelines for preoperative cardiac risk assessment define a poor functional capacity as only able to exercise at a level of less than 4 metabolic equivalents (METs). Exercise capacity of 4 METs corresponds to
A. light housework such as dishwashing
B. heavy work around the house such as moving heavy objects
C. jogging 2km
D. brisk walking on level ground (6km/hr)
E. slow walking on level ground (3km/hr)

Answer: A
Ref: AHA guidelines on periop CV evaluation 2007

92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT
A. arterial pressure
B. vasopressin secretion
C. inotropic action
D. systemic vascular resistance
E. venous resistance

Answer: C

Pneumoperitoneum causes
A. Dec arterial pressure (dec preload -> dec CO)
B. Inc vassopressin (2 inc IAP)
C.
D. Inc SVR (inc IAP -> compression of abdo aorta and prod of vasopressin + RAA system)
E. Inc venous resistance (compression IVC)

Ref: CEACCP 11(5) anaesthesia for laparoscopic surgery


93. 7 year old with closed head injury. Intubated and ventilated in ICU. Serum sodium 142. Most appropriate maintenance fluid is:
A. 0.3% saline plus 3% glucose
B. 0.45% saline plus 5% glucose
C. 0.9% Saline
D. Hartman's solution
E. Hartman's plus 5% glucose

Answer: C

(If greater than 142 then use 0.45% or 0.2% normally. Use isotonic w brain injury/risk of cerebral oedema)
Ref: Ch 99 Oh's Intensive Care Manual 2009


94. Patient with Marfan's syndrome. Thoracoabdominal aortic aneurysm repair. 24 hours later in ICU noted to be blood in CSF drain and patient obtunded. Most appropriate urgent management:
A. CT head
B. Coagulation screen
C. CSF culture
D. MRI brain
E. MRI spine

Answer: A

99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury:
A. increased respiratory rate
B. arterial hypoxaemia
C. chest wall immobility
D. ?
E. ?

Answer: A




C3-C5 partial phrenic nerve weakness/paralysis of diaphragm. Reduced VC to 10-30%, weak cough, 80% require ventilation w/in 48hrs. No intercostal function. Diaphragmatic breathing w collapse of chest initially (until intercostal paralysis develops in few days). Ref: CEACCP July 2013 initial mx of acute spinal cord injury

100. (new) Afterload reduction is most useful in which of the following:
A. ?
B. ?
C. Tetralogy of Fallot
D. mitral valve incompetence
E. aortic valve incompetence

100. something about pharmacologically induced reduction in afterload (? which condition would not benefit from this)
A. aortic stenosis
B. tetralogy of fallot
C. cardiac tamponade
D. Mitral incompetence
E. aortic incompetence

E


101. TMP-Jul10-044 A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management?
A. Awake Fibreoptic Intubation
B. CT scan for laryngeal fractures
C. Direct laryngoscopy after topicalising with local anaesthetic
D. Nasopharyngoscopy by an ENT surgeon
E. Soft tissue xray of the neck

D


102. Preferred method for treating raised INR
A. FFP
B. FFP + prothrombinex
C. FFP + vitamin K
D. prothrombinex
E. prothrombinex + vitamin K

Answer: E*



Ref: Tran HA, Chunilal SD, Harper PL, Tran H, Wood EM, Gallus AS. An update of consensus guidelines for warfarin reversal. MJA 2013;198(4):198–199.


Red Cross transfusion.com.au


103. Regarding PS31, Level II check includes:
(Multiple options, can’t remember exactly)

Answer: machine check
http://www.anzca.edu.au/resources/professional-documents/pdfs/ps31bp-2012-guidelines-on-checking-anaesthesia-delivery-systems-background-paper.pdf


104. Anaphylaxis, when to check tryptase
A. Within 15 minutes of event
B. Between 1 hour and 3 hour
C. Between 4 hour and 6 hour
D. Between 6 hour and 12 hour
E. After 24 hour

E


check at 1hr, 4hr and >24hrs
Ref: http://www.anzaag.com/Mgmt%20Resources.aspx


107.(New) A 50 yo man with a Deep Brain Stimulator (DBS) secondary to Parkinson's disease is scheduled for elective surgery. What is the best management regarding this device?
A. Place diathermy pad as far away from DBS as possible
B. Turn off DBS and commence with oral Levodopa
C. Turn off DBS during surgery and turn on prior to extubation
D. Use Bipolar diathermy

Answer: D



Ref:


CEACCP, Vol 9 (5), Pp. 157-161. "Anaesthesia and deep brain stimulation"

108. (New) Fit and well G1P0 post epidural complaining of loss of sensation over posterior leg, lateral thigh and foot with weak flexion of knee. Which best explains the findings? (Not remembered quite correctly.)
A. Femoral neve
B. Obturator nerve
C. Sciatic nerve
D. Lumbosacral plexus
E. Peroneal nerve

lateral femoral cutaneous nerve

109 Patient with metastatic cancer. What's not useful to increase Ca excretion?
A. Bisphosphonates.
B. ?

Bisphosphonates reduce the resorption of bone.


110. (New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management?
A. Incentive spirometry
B. Diuresis
C. Broad spectrum ABs
D. Naloxone 100mcg increments
E. ?

Answer: A


Ref: Pulmonary atelectasis in anaesthesia and critical care, CEACCP Dec, 2013.


111. A patient is coming for an operation on his upper limb. 5mls of 0.75% ropivacaine is placed around the structure seen below. What is the most likely consequence of this?
A. Unable to abduct fingers
B. Unable to extend wrist
C. Unable to oppose little finger and thumb
D. Unable to pronate arm
E. Unable to [unsure of 5th option]
[Also please note that the picture was very poorly produced. You could make out a triangle structure and the humerus but nothing else]

B

112. A 40 year old man suffered a traumatic brain injury 2 days ago. He does not meet the criteria to be certified brain dead. What investigation will be most useful to assess cerbral function prior to organ donation.
A. Electroencephalogram
B. Somatosensory evoked potentials
C. Auditory evoked potentials
D. Motor evoked potentials
E. BIS

Angiography


113. Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vapouriser, at a constant fresh gas flow and vapour dial setting, the vapour produced will be:
A the indicated vapour concentration
B three times the indicated vapour concentration
C one third the partial pressure obtained at 1 atmosphere
D the same partial pressure as is obtained at 1 atmosphere
E three times the partial pressure obtained at 1 atmosphere

Answer: D


114. What is most likely to occur if the earth/grounding plate that is attached to a patient for use with monopolar diathermy malfunctions?
A electrocution
B electrical interference with monitors
C electrical burns
D ignition of gases/volatiles
E microshock

Answer: C



Ref: CEACCP, Vol 6, (2) 67-70


Injury during anaesthesia


115. A 24yo primigravida, 25/40 gestation, BP 150/90 on 4 occasions. No signs of pre-eclampsia. Which antihypertensive is inappropriate?
A. diazoxide
B. metoprolol
C. enalapril
D. hydralazine
E. nifedipine

Answer: C



ACE-I cause fetal malformations if given 2nd & 3rd trimesters (Ref: Williams Obstetrics, 23rd Ed, p989)

116. Post-spinal surgery, patient notices paraesthesia of R arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from ulnar nerve neuropathy?
A. paraesthesia in little finger
B. paraesthesia in the distribution of the interscalene nerve
C. weakness in adductor digiti minimi
D. weakness in the abductor pollicis brevis
E. weakness in lateral interosseus

Answer: D



"The ulnar nerve innervates all intrinsic hand muscles, except the abductor and flexor pollicis brevis, opponens pollicis, and lateral two lumbricals, which are innervated by C8 and T1 via the median nerve. By examining these five muscles, one can clinically differentiate cubital tunnel syndrome from C8-T1 radiculopathies."


Ref: Global Spine J. 2014 Feb;4(1):1-6.


Differentiating c8-t1 radiculopathy from ulnar neuropathy: a survey of 24 spine surgeons.

119. According to PS09, the minimum requirement for administering propofol for conscious sedation is
A. Medical practitioner with a skilled assistant that is seperate from the assistant to the proceduralist



B. Medical practitioner



C. Nurse supervised by proceduralist with recent ALS training



D. Specialist anaesthetist



E. Nurse with advanced airway skills



119. According to PS09 professional document which is most correct with respect to the minimum requirements for propofol anaesthesia in the endoscopy suite?
A. Medical practitioner and a qualified assistant in anaesthesia
B. Medical Practitioner
C. RN
D. RN with airway skills
E. Clinical Anaesthetic Specialist

A



PS09 pp8: "Intravenous anaesthetic agents such as propofol must only be used by a second medical or dental practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist." But also see Scenario 2 of Appendix 1 of PS09: the assistant can be shared between both ends for conscious sedation in ASA 1-2 patients only. Therefore best answer would be a medical or dental practitioner trained in its use with an assistant who may be shared with the proceeduralist. --Farnsworth 06:17, 8 June 2014 (CDT)

122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?)



A. More difficult to preoxygenate
B. More rapid detection of hypoxia
C. FRC decreased more than adults
D. Drugs work more rapidly
E. Persistent L->R shunt (or was it right to left?)


C



CEACCP Basic Principles of Anaesthesia for Neonates and Infants 2001 - Higher oxygen consumption, greater ratio of alveolar ventilation to FRC, same FRC but closer to closing volume = rapid desaturation on cessation of ventilation

125. Adenosine would be useful for terminating which arrhythmia?



A. AF
B. Atrial Flutter with variable block
C. Torsades
D. VT
E. WPW

E. WPW

Oxford Emergencies in Anaesthesia pg 506 - Adenosine slows conduction through the AV node, therefore is useful in terminating SVTs including WPW. May differentiate between SVT and VT

126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step:

A. Continue surgery with tiva propofol
B. Abandon surgery
C. Wait for co2 to rise restart surgery after 30 min
D. Continue with inhalational agents
E. Give calcium as potassium may have raised

Answer A



127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by:



A. angiography
B. direct ophthalmoscopy
C. indirect ophthalmoscopy
D. intra-ocular pressure tonometry
E. palpation of the globe by an experienced clinician

B

Controversial past question, which seems to have caused a lot of upset amongst candidates. Very few published sources but a lot of anectdotal reports. Have cut and pasted this summary from Blackbank:

A. angiography - fluoroscein angiography would be gold standard, but time consuming to organise
B. direct ophthalmoscopy - provides 15x magnification to allow a view of the fundus is required to look for central retinal artery or vein occlusion. General consensus is that the essential clinical diagnosis depends on the viewing of a pulsatile artery by this method.
C. indirect ophthalmoscopy - gives a wider field of view but less magnification than direct. Given ischaemia due to pressure is an issue, ?greater assessment of the retina would be preferable.
D. intra-ocular pressure tonometry - helpful, but diagnosis is clinical. Pressure may be raised but if arterial and venous supply are intact, it's not going to change management
E. palpation of the globe by an experienced clinician - additional pressure will compromise what is already potentially a tenuous blood supply.

128. A patient is in Class IV Haemorrhagic Shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to:

A. acidosis
B. dilution of clotting factors
C. hypothermia
D. systemic release of tissue factor
E. tissue hypoperfusion

Answer: E



Acidosis, hypothermia and trauma induced coagulopathy are the lethal triad of major haemorrhage following trauma but Acute Trauma Coagulopathy is independent of resuscitation efforts
CEACCP 2014 - “Trauma patients were coagulopathic on arrival at the emergency department (ED) and the incidence of coagulopathy increased with severity of injury independent of the volume of pre-hospital resuscitation fluid. Those who arrived coagulopathic had an increased mortality compared with non-coagulopathic patients. This coagulopathy is termed acute trauma coagulopathy (ATC) and is another mechanism of coagulopathy under the umbrella term of TIC. The mechanisms of ATC are yet unproven but appear to be related to tissue hypoperfusion, leading to up-regulation of the vascular endothelium and subsequent alterations in coagulation pathways. This coincides with massive activation of coagulation with consumption of clotting factors, noticeably factor V and fibrinogen, activation of the Protein C pathway, and increased fibrinolysis”

129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is:

A. 160ml
B. 260ml
C. 360ml
D. 460ml
E. 660ml

Answer C

Parkland formula = 4ml/kg/day x %BSA with half in first 8 hours (CSL) from time of burn



4 x 20 x 15 = 1200ml / 2 = 600mL in 8 hours, but only 2hrs remaining so 300ml/hr



Mainentance IVF = 4ml/kg/hr for 1st 10kg, 2mg.kg/hr for next 10kg, 1ml/kg/hr for remaining kg (N/2 + 5%)
40 + 20 = 60ml/hr



Total = 360ml/hr

130. You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is

A. give 0.5 mg metaraminol iv
B. use NMT to assess train of four ratio
C. change to volatile anaesthetic
D. do nothing
E. increase propofol TCI concentration by 0.5

Answer: B



http://bja.oxfordjournals.org/content/93/5/645.full.pdf

131. The normal physiological response following ECT is:



A. transient tachycardia followed by bradycardia and hypotension
B. transient bradycardia followed by tachycardia and hypertension
C. unpredictable
D. transient tachycardia followed by bradycardia and hypertension
E. tachycardia and hypotension

Answer B



Millers pg 2477 - Initial PNS discharge: bradycardia, potential asystole, premature atrial or ventricular contractions; followed by SNS discharge: tachycardia, hypertension, PVCs or VT, which peaks at 2mins.

132 (repeat) Aspirin Overdose. What will enhance her elimination most effectively?



A. Mannitol
B. Haemodialysis
C. lignocaine
D. ?
E. BIcarbonate infusion

Answer B



Dargin, Wallace & Jones 2002 - Urinary alkalisation with 1L 1.26% NaHCo3 infusion over 3hrs indicated in moderate poisoning, but HDx more effective and indicated in severe poisoning

133. A 50 year old male is having an aortic valve replacement for aortic stenosis. He is stable on bypass initially but after the first dose of cardioplegia his MAP falls to 25mmHg, CVP 1 and his mixed venous oxygen saturation is 80%. What is the best management in this situation?

A. Metaraminol bolus
B. Commence an adrenaline infusion
C. Increase oxygen flow rate
D. Increase pump flow rate
E. IV crystalloid bolus

Answer A or D



Cardioplegia induces transient hypotension secondary to K-related vasodilation, best managed with alpha blockade.



Millers 7th ed pg 1916 - "Initiation of CPB is often associated with a period of hypotension, which can be managed with the administration of an alpha-agonist into the venous reservoir of the ECC circuit. Any hypotension and hypertension that occur despite adequate flow and SvO2 can be treated by adjusting the patient’s SVR with vasoconstrictors or vasodilators”



Should be on full flows so D is incorrect

134. An eighty year old man presents to the emergency department with two hours of severe abdominal pain. On examination he has a tender pulsatile 8cm mass. His GCS is 12, heart rate 104, blood pressure 80/49, Temp 35 degrees, SpO2 92%, respiratory rate is 30/min. What is the next appropriate step.

A. Commence a vassopressor to support the circulation and improve end organ perfusion.
B. Obtain IV access and crossmatch
C. Intubate to secure the airway and prevent aspiration
D. Perform an abdominal ultrasound to confirm diagnosis
E. Ventilate with a bag valve mask to improve saturations

Answer B



Because. Just because.

137. A PiCCO monitor may be used to measure cardiac output through use of:



A. Lithium Dilution Cardiac Output (LiDCO)
B. Pulse contour analysis
C. Pulse contour analysis and thermodilution
D. Thermodilution
E. Thermodilution and aortic flow doppler

Answer C

Litton & Morgan 2012 The PiCCO Monitor: a review. The PiCCO (Pulse index Continuous Cardiac Output) device is one such alternative, integrating a wide array of both static and dynamic haemodynamic data through a combination of trans-cardiopulmonary thermodilution and pulse contour analysis.

138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone.

A. Less potential for abuse
B. Less constipation
C. Less sedation
D. Less respiratory depression
E. Less pruritus

Answer B



Targin product information, although there is less potential for abuse given antagonist activity when administered IV

141. Immunity to Hepatitis B is demonstrated by the presence of:



A. Hepatits B core antibodies
B. Hepatits B core antigens
C. Hepatits B surface antibodies
D. Hepatits B surface antigens
E. Any of the above

Answer C



HBsAb +ve = immunity via immunisation or exposure


HBsAg +ve = active infection


HBcAb = suggests previous exposure

142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is:



A. Dysfibrinogenaemia
B. Hypoalbuminaemia
C. Prolonged Prothrombin time
D. Portal Hypertension
E. Thrombocytopaenia

E







Unclear, however best predictor of surgical complications (including haemorrhage) is Child's class, including prolonged PT.



Mansour 1997 Abdominal operations in patients with cirrhosis: Still a major surgical challenge - “Three factors that contributed to increased morbidity and mortality in their patients: a prolongation ofthe prothrombin time longer than 2.5 seconds, the presence of ascites, and the need for an emergency operation. In our group of patients, we found that the presence of ascites, encephalopathy, prolonged prothrombin time, and elevated blood urea nitrogen level as independent variables were predictors of mortality."

143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with:

A. calcitonin
B. frusemide
C. intravenous fluids
D. magnesium
E. mythramycin

C

144. SG67 20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours?

A. 2.6L N/saline
B. 3.6L N/saline
C. 3.6L CSL
D. 4.8L N/saline
E. 4.8L CSL

Answer E



BJA 2001 - A burn greater than 15% of the total body surface in adults and 10% in children requires intravenous fluid resuscitation. The Parkland formula, developed in 1971 and now widely used in the UK, predicts a total fluid requirement of 3-4 ml kg-1(% burn)-1. The resulting volume of fluid is given over the 24 h from the time of the burn (not from the time of presentation) with half the volume given in the first 8 h and the remaining half in the subsequent 16 h. Lactated Ringer’s solution is the fluid of choice.
Parkland formula = 4 x 30 x 80 = 9600mL = 4.8L in first 8hrs.



Some debate over whether to use 3 0r 4ml/kg (modified Parkland) however, question specifically asks for Parkland.



Hilton, Peter John, and Martin Hepp. "The Immediate Care of the Burned Patient." BJA CEPD Reviews 1, no. 4 (2001): 113-116.
Hettiaratchy, Shehan, and Remo Papini. "Initial Management of a Major Burn: IIassessment and Resuscitation." Bmj 329, no. 7457 (2004): 101-103.

145 The thoracic paravertebral space is continuous down to:

A. T10
B. T12
C. L2
D. L4
E. S1

Answer B



CEACCP 2010 - "The thoracic paravertebral space begins at T1 and extends caudally to terminate at T12"



Tighe, S, M D Greene, and N Rajadurai. "Paravertebral Block." Continuing Education in Anaesthesia, Critical Care & Pain 10, no. 5 (2010): doi:10.1093/bjaceaccp/mkq029

28. 54 year old radical prostatectomy with ongoing blood loss during the procedure. Surgeon complains of ooze and asks if the patient is on aspirin. Thromboelastograph shown below. Most appropriate therapy:


A. rFVII


B. cryoprecipitate


C. FFP


D. platelets


E. tranexamic acid

B

32. Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common direction of subluxation in RA


A. lateral


B. oblique


C. posterior


D. rotated


E. vertical


D. Subaxial

C

33. MS patient requires GA. Most likely precipitant of deterioration:


A. hyperthermia


B. hypocarbia


C. Non-depolarising muscle relaxant


D. TIVA


E. volatile anaesthetic agent




Choice B may have been "decreased cardiac output"

A

41. 6 year old 20kg anaesthetised and paralaysed for appendicectomy. First attempt- vocal cords seen. size 5.5 uncuffed. 2nd attempt with 4.5. Next appropriate step


A. administer nebulised adrenaline


B. attempt 4.0 tube


C. examine trachea with fibreoptic bronchoscope


D. LMA


E. soften 4.5 tube and attempt reinsertion

D

49. 40 year old, pulmonary artery hypertension 80/60 pre-op. Lap cholecystectomy. Sudden SPO2 87, sBP 80/40, etPCO2 45. Cause?


A. gas emboli


B. Left heart failure


C. myocardial ischaemia


D. pneumothorax


E. right heart failure

E

Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be?


A. Pulmonary embolism


B. Venous air embolism


C. Acute right heart failure


D. ?


E. ?

C

53. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is


A. Genetic test father


B. Genetic test woman


C. Muscle biopsy sibling


D. Muscle biopsy father


E. Muscle biopsy woman

E

55. 10L/min via facemask. Cylinder C 15 000kP lasts


A. 10min


B. 15min


C. 30min


D. 45min


E. 60 min

D

59. ?To prevent transmission of CJD? Airway-contaminated equipment


A. autoclave


B. protected plastic covers


C. sterilise in ethylene oxide


D. 134degreesC for 3 min


E. thrown away

E

89. A 63 year old woman with chronic AF has a history of HTN, T2DM and has had a previous CVS. Her annual risk of stroke without anticoagulation is


A. <1%


B. 1.9%


C. 2.8%


D. 4%


E. 8.5%

E

An 85y.o for an open AAA repair. Refuses blood because of risk vCJD. You tell him you won't anaesthetise him as the risk is too high. This is an example of


A. Autonomy


B. Beneficence


C. Justice


D. Coercion


E. Paternalism

E

148: (Repeat). After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is
A. normal saline infusion
B. bicarbonate infusion
C. mannitol
D. frusemide
E. haemodialysis

E

149 (?repeat -not sure) You have administered a regional anaesthetic to a primiparous woman for an emergency caesarean section. Soon after delivery of the baby, the woman complains of chest pain and dyspnoea, then loses consciousness. What is the most likely cause of her loss of consciousness?


A. Administration of suxamethonium


B. Anaphylaxis to oxytocin


C. Amniotic fluid embolus


D. Pulmonary Embolus


E. Eclamptic seizure

D or C

150. The faster rate to desaturation observed in morbidly obese patients is due to:


A. Decreased residual volume


B. Decreased functional residual capacity


C. Decreased diffusion capacity


D. Increased closing capacity


E. Increased pulmonary blood volume

B

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


A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece


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


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


D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece


E. ?

A

Which is least likely to fraudulent research reduction strategy?


A. Published in a peer review journal


B. Multiple authors


C. Departmental director sole author


D. Research findings similar to other published studies


E. Backing of a major research institute

C

Small picture trying to show USS probe on inferio-posterior R arm of a teenager's arm with an associated USS image of a very triangular looking peripheral nerve between two muscle fascia (radial N).Blockade of this nerve would result in?A. Reduced pronation


B. Reduced hand grip.


C. Reduced elbow flexion


D. Reduced wrist extension


E. ?

D

Trauma patient undergoes delayed ORIF FEMUR. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium Femoral Nerve Block, turned lateral. Suddenly BRADYCARDIC, ETCO2 45, MAP 50mmHg. This is most likely to be ..?


A. PE


B. Fat embolism


C. Anaphylaxis


D. LA Toxicity


E. ?

D