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137 Cards in this Set

  • Front
  • Back

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

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

E. 24 hrs

ANZCA pain book 6.5.1

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

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

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

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

Myles textbook p.137

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

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

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

Phase IV: post marketing surveillance (thousands of patients)

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

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

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


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

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

D. Rhabdo

CEACCP. NM disorders and anaesthesia.


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

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

related to an anaesthesia-related rhabdomyolysis or a true malignant


Ped Anaesth study


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

syndrome characterized by rhabdomyolysis

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

A. Clonidine

B. Indomethacin

C: Magnesium

D. Salbutamol

E. Nifedipine

A - clonidine has no tocolytic effect

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



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

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

(B )

Royal college of anaesthetists and opthalmologists consensus document


Document page 26

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

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

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

C. 10 mg/kg

Frank Sham drug doses

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

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


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

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

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

B. Dilute thrombin time

Horlocker article.


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

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

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

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

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

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

A. 3:1 (ARC neonatal resus guidelines)

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

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

NWRTS + RMH answer:

D. WORSE long-term outcome

Cochrane review:


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

2014 article:


(St V's answer: St V's Answer: D. Worse long-term neurological outcome - DECRA trial (NEJM 2011) - decreased ICP, decreased days of ventilation and ICU stay, but worse outcome at 6 months. RESCUE study - worse functionally but no difference in mortality.)

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

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

B. Hypernatraemia (all other changes occur)



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

CEACCP. Intensive care management of patients with haematological malignancy.


66. You are performing an interscalene nerve block using a nerve stimulator when your patient begins to hiccough. You should aim to position the tip of your needle more

* A) Anterior
* B) Posterior
* C) Cephalad
* D) Caudal
* E) Superficial


Stimulating phrenic nerve (anterior)

Therefore redirect posteriorly

67. The characteristic respiratory pattern in a patient with an acute C5 spinal cord injury is

* A. Rapid respiratory rate
* B. Arterial hypoxaemia
* C. Chest wall immobility
* D. Preserved cough
* E. Preserved inspiratory force

A. Rapid respiratory rate

68. Tavi vs Max medical therapy nonoperable aortic stenosis reduction in risk at 30 days of

* A. AMI
* B. AKI
* C. Death
* D. Atrial fibrillation
* E. Stroke



Outcomes worse at 30d (TAVI vs med mx), but better 1 year survival



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

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

Systematic review:


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



69. Medial peribulbar block tip max distance past equator for minimal vein injury

* A. 5
* B. 10
* C. 15
* D. 20
* E. 25

B. 10 mm

Normal axial length 22 mm

Lindy Cass notes

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

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

C. 32%

Rule of 9's:

Half of upper limb: 4.5

All of lower limb: 18

Anterior surface abdomen: 9

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

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

B. 15-30 min

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

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

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

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

C. Iron

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

Predictors of intraoperative hypoxia are:

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


A,D and E all predictors of intraop hypoxia.

?Poor recall (possibly all except..)

CEACCP. Hypoxaemia during one-lung anaesthesia


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

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

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

E CEACCP. Blood pressure measurement


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

See previous paper for a picture, it was the same

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

B. Gas sample line leak

98.'You extubate a young woman after a dental procedure under GA. She has a history of hereditary angioedema and in recovery she develops airway oedema. Best treatment

* A. FFP
* B. IV Adrenaline
* C. IV corticosteroids
* D. IV promethazine
* E. Nebulized adrenaline



-adrenaline, corticosteroids, antihistamines no use

-1st line C1 esterase inhibitors

-if not available, use FFP

99. A previously well 65 year old female develops acute shortness of breath 3 days post hip replacement. The most appropriate investigations to confirm PE is

* B. D-dimer
* C. Echo
* D. Ecg
* E. V/Q scan


100. 20 year old female with 25% burns to her body. She weighs 80 kg. How much replacement fluid should she be given over the next 8 hours?

* A. 4L
* B. 4.8L
* C. 5L
* D. 6L
* E. 8L

A. 4L

Parkland: 4 x 80 x 25 = 8L

1/2 over first 8 hr = 4L

101. 50 y.o female with a history of mennohhragia is having a hysterectomy. Her pre-operative Hb is 95. What serum ferritin would confirm iron deficiency anaemia?

* A. 30 mcg/L
* B. 3 mg/L
* C. 3 mcg/L
* D. 0.3 mg/L
* E. 3000 mcg/L

C. 3 mcg/l

Ferritin normal 12-200 mcg/l (OHA p1273)


102. An Adult Jehovah's Witness requires a redo hip replacement for a peritrochanteric fracture. They request that no blood products are given. The anaesthetists decision to PROCEED is best given by:

* A. Autonomy
* B. Beneficence
* C. Justice
* D. Nonmaleficence
* E. Paternalism

A. Autonomy

103. 100% Saturated air @ 20 degrees is what relative humidity @ 37 degrees

* A. 20%
* B. 30%
* C. 40%
* D. 50%
* E. 60%

C. 40%

At 20 deg, 100% sat 20 mmHg

At 37 deg, 100% sat 47 mmHg

This case: at 37 deg, 20 / 47 = 0.42 = 42%


104. Maximum cumulative dose of intralipid (ml/kg)

* A. 10
* B. 12
* C. 15
* D. 20

B. 12 ml.kg (AAGBI guideline)


105. 60yo alcoholic with HTN, has abdominal pain. No findings at laparotomy. 12 hrs later: Na140 k5 cl115 HCO3 18. What is the most likely diagnosis?

* A. ARF
* B. Diabetic ketosis
* C. Lactic acidosis
* D. Methanol
* E. NaCl infusion

E. NaCl infusion

Non-anion gap metab acidosis (therefore not: ketones, uraemia, lactic, toxins - incl methanol)


106. Diagram of a CTG (showing late decelerations). Causes:

* A. Uteroplacental insufficiency
* B. Foetal head compression
* C. Foetal asphyxia
* D. Umbilical cord compression
* E. General anaesthesia

A. uteroplacental insuff.


107. In a clinical trial, researchers looked at 2 groups - smokers vs. non-smokers and followed then up for a period of time. This type of study is a

* A. Cohort
* B. Case study
* C. Observational
* D. RCT
* E. ?

A. Cohort


-pick groups and follow forwards to look for outcomes

110. Prothrombinex VF is useful in the perioperative period to correct the coagulopathic defect of all of the following except

* A. Isolated factor II deficiency
* B. Isolated factor VII deficiency
* C. Isolated factor IX deficiency
* D. Isolated factor X deficiency
* E. Warfarin

B. factor VII

PROTHROMBINEX-VF contains concentrated factor IX, factor II, factor X and low level of factor VII.


111. A 65 year old man otherwise fit and healthy is having a TKR under GA (O2, N2O, sevoflurane and fentanyl). His blood pressure has been stable through-out the case at 130/80. Before the orthopaedic surgeons start reaming and bone cemetation you should

* A. Give heparin 5000 iu
* B. Give a corticosteroid
* C. Cease N2O
* D. Induce hypotension
* E. Give a vasopressor to increase blood pressure

C (Oxford handbook)

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

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


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

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

LLL consolidation

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

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

C. Mitral valve prolapse

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

CEACCP. Scoliosis surgery


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

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

B. Laryngomalacia

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


A picture of an echo 4 chambers view

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


Leaflet closest to RV is anterior

Leaflet closest to RV is anterior

Cryoprecipate, once thawed must use within

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

D. 6 hours

A. Thawed Frozen Plasma expires 24 hours from the time of thawing.

B. Thawed Cryoprecipitate expires 6 hours from the time of thawing.




Glycine 1.5% used for TURP, osmolality is

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

A. 200

CEACCP. Anaesthesia for transurethral resection of the prostate


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




D. ?


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

CEACCP. Extracorporeal membrane oxygenation in adults.


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

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

C. Thoracic outlet syndrome

No best source but seems most likely of options available

See CEACCP: Anaesthesia for vascular surgery

of the upper limb


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

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

C Dorsum part of hand

Blue urticaria is a complication of

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

C. Patent blue V

Anaphylaxis and blue urticaria associated with Patent Blue V injection


Intraosseous sampling - least accurate on

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

Worst correlation is Potassium. Then Platelets and then Sodium. Listed options seem to be accurate:

A new study of intraosseous blood for laboratory analysis.


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

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

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

B. lateral rectus

Ophthalmic Regional Block

Chandra M Kumar

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


EVAR, best method to reduce risk of renal impairment

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

C. N/Saline


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

EVAR is preferred over open AAA repair because

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

E (but unsure)

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

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


proximal then distal

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


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

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

"if cuff bursts, second cuff cna be used

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

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


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

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

D. TTE to exclude tamponade

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

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

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

A printout of 12-lead ECG

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

Difference between AF/tachy with BBB and VT:

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

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


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

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

C. hypoglossal nerve tongue muscles

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

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


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

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

A. fat embolism

(cerebral signs make fat embolism the more likely diagnosis)

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

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


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

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


Ferritin normal 12-200 mcg/l (OHA p1273)

Low iron stores: ferritin <15 mcg/l


Treatment for patients with congenital long QT syndrome

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

C. Beta blocker



Also emedicine:


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

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

A. Clonidine (not a tocolytic)

Indomethacin safe until 32 weeks

18 month old child with VF arrest, shock with

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

C. 50J

DC shock in paeds 4J/kg

Average 1 yo 10 kg, 2 yo 12 kg


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

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

B. Rupture of aneurysm


Detected by: HTN, extravasation of contrast

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

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

C. Serotinin syndrome


Compared with NMS:

Very similar features mostly, differences:

serotonin syndrome: hyperreflexia, clonus

NMS: hyporeflexia


C. Serotinin syndrome

Compared with NMS:

Very similar features mostly, differences:

serotonin syndrome: hyperreflexia, clonus

NMS: hyporeflexia


Best drug to reduce both gastric acidity and volume

* A Ranitidine
* C Sodium citrate
* D
* E

A. Ranitidine

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

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

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

E. Phenylephrine

Is this use all except?

In which case, avoid metaraminol

-Moclobemide -> MAO inhibitor

-Avoid indirect sympathomimetics (ephedrine, metaraminol, amphet, cocaine)

-Use direct acting -> phenylephrine, NA, Adr, dopamine, dobutamine

Ref: OHA

Peck and Hill

ATOTW - Anaesthesia and psych drugs part 1


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

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

D T3 & T4 (TSH will improve later)



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

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

values to remain suppressed as a consequence of prolonged hyperthyroidism

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

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

not be considered a contraindication to surgery


In pregnant women the dural sac ends at

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

D. S1



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. Gas sampling line leak (repeat)

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

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

C. 45 min


Something to do with Echinacea and renal transplant - I think the answer is regarding immune system, other options were bleeding risk, nephrotoxicity


Red-man syndrome secondary to vancomycin is due to

* A Type II hypersensitivity reaction
* B Vasodilation
* C Mast cell degranulation
* D IgE immediated response
* E Serotonin release

C. Mast cell degranulation

Red man syndrome - anaphylactoid reaction (mast cell degran but not IgE mediated)


A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP:

* A Administer Anti-D antibodies 6 hrs pre op
* B Admister desmopressin one hour pre op
* C Administer methylpred and IVIg 2 days pre op
* D Recheck platelet count morning of surgery and if not dropped continue
* E Platelet transfusion morning of surgery


Acc to UTD-
For management of life-threatening bleeding, treatment options include:

■Platelet transfusions
■IVIG (1 g/kg, repeated the following day if the platelet count remains <50,000/microL)
■Pulse methylprednisolone (1 g intravenously, repeated daily for three doses)
■Recombinant human factor VIIa

no mention of desmopressin, and no mention of Anti-D for use in the acute phase.

Absolute contraindication to ECT

* A Cochlear implants
* B Epilepsy
* C Pregnancy
* D Raised intracranial pressure
* E Myocardial infarction

D. Raised ICP

(page 50 of 84 in pdf)
With the exception of raised intracranial pressure, there are no absolute contraindications to ECT although there are a number of clinical situations in which extra caution is required

Repeat Stellate ganglion block. Needle entry next to SCM muscle at C6. Which direction to advance needle ?

* A. C3
* B. C4
* C. C5
* D. C6
* E. C7


Enter at C6

Hit C6 transverse process, then angle down.


Repeat CTG with early decelerations

* A. GA
* B. Fetal head compression
* C. Uteroplacental insufficiency
* D. Acute asphyxia
* E. Umbilical cord compression

B. Fetal head compression


Repeat Endocarditis prophylaxis

* A Bicuspid valve
* B Congenital repair > 12 months ago
* C Rheumatic heart valve
* D Uncorrected cyanotic heart disease

D. Uncorrected cyanotic heart disease

Patient indications

1. Prosthetic heart valve

2. Congenital heart disease, only if:

-unrepaired cyanotic (incl palliative shunts/conduits)

-prosthetic materials in repair (first 6 mths)

-repaired defects with residual defect

3. Heart transplant

4. Previous IE

5. Rh heart disease (indigenous only)

Repeat CVL relatively contraindicated in:



Possibility of CHB


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. 35 mg.kg

Repeat 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

B. Assess TOF

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

* A. 0.04%
* B. 0.4%
* C. 4%
* D. 14%
* E. 40%

C. 4%

(ref: Peck and Hill table, ch 4)

Repeat CO2 penetrates surface tissue so well with little damage to underlying tissue because

* A. Well absorbed by Hb
* B. Poorly absorbed by H20
* C. Widely disseminated in tissue
* D. Long infrared wavelength
* E. Short infrared wavelength


A & B wrong. (well absorbed by water).

C. ?widely disseminated (dissipates in tissue, doesn't really penetrate)

D. correct (long infrared wavelength)

E. wronf

Repeat 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. Prothrombinex
* E. Tranexamimic acid

C. platelets

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

* A. Creatinine
* B. Albumin
* C. Urea
* D. AST
* E. Ammonia

A. Creatinine






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

D. findings reproduced at another institution

From ANZCA bulletin:


A, C, E not reliable strategies

B. multiple authors (if their involvement is verified)

Repeat An 80 year old man undergoes a unilateral lumbar sympathectic blockade. The most likely side effect that he experiences is:

* A. Genitofemoral neuralgia
* B. Haematuria
* C. Postural hypotension
* D. Lumbar radiculopathy
* E. Psoas haematoma

A. Genitofemoral neuralgia

Ch 39.

Cousins & Bridenbaugh's

Common complications of neurolytic lumbar sympathetic blockadea include puncture of major vessel or renal pelvis, subarachnoid injection, neuralgia—genitofemoral nerve (5% to 10% pain in the groin), somatic nerve damage—neuralgia (1%), perforation of a disk, stricture of the ureter after phenol or alcohol injection, infection from catheter technique (extremely rare), ejaculatory failure (bilateral block in young males), and chronic back pain.

Repeat The most important effect of Lugol's iodine administration before thyroid surgery is

* A. reduce incidence of thyroid storm
* B. reduce incidence of vocal cord palsy
* C. increase likelihood to identify and preserve parathyroid glands
* D. pigmentation of thyroid gland to help identify thyroid gland
* E. reduce vascularity of thyroid gland

E. Reduces vascularity

To exclude raised ICP in an awake patient the most reliable finding is what ?

* A. No headache
* B. No diplopia
* C. No vomiting
* D. Pulsatile retinal vein
* E. No papilloedema

D. Pulsatile retinal vein (Unsure)

Repeat (march 2011). What percentage of patients with SAH are troponin positive?

A: <5%
B: 15-30%
C: 40-60%
D: 70-90%
E: 100%

B. 15-30%

Contin Educ Anaesth Crit Care Pain (2008) 8 (2): 62-66. states 20%

Repeat: Best determinant of a neonate's heart rate: Auscultate the chest.


Repeat: Optimal fluid management during laparotomy: Pulse pressure variation, EF on a TOE, CVP, BP and HR

Pulse contour analysis

(PPV or SVV)

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

A or D..

Can't find reference, but this seems right?

Repeat: Maximum recommended time for an adult tourniquet: 90 min? 120 min?

Aim for <90 min

(definitely no more than 120 min - maximum)

63. Repeat- The most effective method for cerebral protection in aortic arch aneurysm repair

A. Systemic hypothermia 20degrees
B. Antegrade perfusion to carotid arteries
C. Retrograde perfusion to jugular veins
D. Thiopentone
E. Steroid (?)


Repeat: Awaits renal transplant. Why would you ask them to stop Echinacia? Immune suppression, hepatotoxic, coagulopathy, nephrotoxic. Something else?

Immune suppression.

Repeat: Post (R) pneumonectomy on the ward becomes acutely unwell, hypotensive, raised CVP. What do you do? Turn left lateral.

Turn left lateral

(pneumonectomy side dependent)

Repeat: Venous air embolism. How to position the patient?

a. Head up + R) up

b. Head up + L) up

c. Head down + R) up

d. Head down + L) up

Head down and right side up

(remove air lock from RVOT)

Repeat: TBI - What fluid NOT to give? Synthetic colloids, saline, albumin etc


(SAFE study)

Which population is more liable to CNS damage from Hyponatraemia?

* A. Children
* B. Young males
* C. Young females
* D. Old males
* E. Old females

A. Children


Hb 86 post TKJR in an asymptomatic patient with stable angina.

a. Transfuse to 120

b. transfuse to 100

c. observe overnight and repeat mane

C. Observe


RBC transfusion should not be dictated by a haemoglobin ‘trigger’ alone, but should be based on assessment of the patient’s clinical

status. In the absence of acute myocardial or cerebrovascular ischaemia, postoperative transfusion may be inappropriate for patients with a haemoglobin level of >80 g/L


Health care worker. HBV exposure. Known to have immunisation titres. What do you do?

* A. Booster dose of his immunisation
* B. HBV immunoglobulins
* C. Pegylated Interferon
* D. Aciclovir

The source patient should be tested for hepatitis B surface antigen (HBsAg) as soon as possible. No further action is required if the test is negative. If the injured person has not been immunised and the result is likely to be delayed, a dose of HBV vaccine is given immediately, with subsequent doses at one and six months. A single dose (400 IU) of hepatitis B immunoglobulin should also be given as soon as possible (preferably within 72 hours).

If the injured person has been vaccinated against HBV and seroconversion has been documented, then no further action is required. When seroconversion has not been documented, a booster dose of hepatitis B vaccine should be given immediately and, if surface antibodies cannot be measured within 72 hours, a dose of HBIG given.


HIV seroconversion post needlestick injury:

a. 0.3%

b. 3%

c. 30%..

a. 0.3% (1:313)


Repeat: Craniotomy, MAP 80, transducer 13cm below, CVP given, what's the CPP

65mmHg (study group)

CPP = 70 mmHg

during craniotomy ICP =0 as head open. if head up 13cm - then CVP is negative - so CPP = 70mmHg

Repeat: Unremakable finding on a laparotomy. Has been given 3L cystalloid and minimal EBL. Physiological response to such haemodilution includes ALL EXCEPT:

a. Increased myocardial O2 extraction.

b. Increased tissue O2 extraction.

c. Increased tissue flow due to decrease viscosity.

d. Increased tissue flow due to vasodilatation.

a. myocardial O2 extraction

(high O2 extraction at rest from heart)

Idiopathic scoliosis in a young female. Likely associated pathology: MV prolapse, renal artery stenosis, abnormality with the larynx...etc

MV prolapse

ABG as you diagnose intraoperative MH: Acidosis/alkalosis, high pCO2, Zero BE vs. -9 BE.


-mixed resp and metabolic acidosis (low bicarb, negative BE)

-CO2 elevated

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

E. 4.8L CSL

A 50 year old male in recovery after an anterior cervical spinal fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, spO2 96%. What is the most appropriate management ?

* A. Direct laryngoscopy and intubation after inhalational induction with sevoflurane
* B. Awake tracheostomy by surgeons
* C. Awake fibreoptic intubation using minimal sedation
* D. Direct laryngoscopy and intubation with propofol and sux
* E. Retrograde intubation

A. inhalational induction

Asthmatic paediatric patient, tonsillectomy. Desaturates and stiff to bag. First thing to do?

* A. Salbutamol
* B. Suction
* C. Ask surgeon to release gag
* D. Paralysis
* E. ? reintubate

C. ask surgeon to release gag

Balloon pump trace 2:1

* A. Early inflation
* B. Late inflation
* C. Early deflation
* D. Late deflation
* E. ? No problem


See diagrams for each..


Repeat 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. IV Magnesium

Fasting time for a 6 week old..

ANZCA guidelines:

<6wks: CF 2 hr, breast/formula 4 hr

>6 wks: CF 2 hr, breast 4 hr, formula/solid 6 hr

AAI paced ECG:

1) Failure to capture

2) CHB

3) 2nd degree HB

4) AF


Hyperkalaemia of 7 or 8.

Most appropriate immediate (or was it most "effective") therapy:

a. Insulin + Glucose

b. Bicarb

c. Salbutamol

d. Resin

e. Something else


Ca Cl 10% 10ml - cardioprotective but won't lower K

Insulin/dextrose and Salbutamol lower K (shift K extracell to intracell)

Correct INR range for a patient with a mechanical valve

2.5 - 3.5

Flow volume loop diagram

* A. Variable intra-thoracic obstruction
* B. Variable extra-thoracic obstruction
* C. Restrictive pattern
* D. Obstructive pattern
* E. Fixed obstruction


Draw each loop..


4 METS is how many ml O2 / min

1 MET = 3.5 ml.kg.min

4 METs = 14 ml.kg.min

A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is:

* A. increase PEEP to 20cmH20
* B. increase tidal volume to 10mls/kg
* C. initiate nitrous oxide therapy
* D. commence high flow oscillatory ventilation
* E. ventilate in the prone position

E. Prone position

Repeat 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. T11

B. T4

Repeat 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. Ordinal

Repeat During a pneumoperitoneum, at what level of intra-abdominal does cardiac output fall?

* A. 10 mmHg
* B. 20 mmHg
* C. 30 mmHg
* D. 40 mmHg
* E. 50 mmHg

A. 10 mmHg

Repeat 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. Oral hygiene

Repeat 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. Codeine

Repeat A patient is in Class 4 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

B. dilution of clotting factors - not diluted (just loss)

D. systemic release tissue factor - yes

E. most likely the answer

Repeat 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

B. brady, then tachy and HTN

Repeat 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. ?


Repeat What is NOT a contraindication to MRI?

* A. Pulmonary artery catheter
* B. Arterial line
* C. Scissors
* D. Coiled ECG cable
* E. Laryngoscope


Repeat 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 gene expression

Repeat Which volatile contributes most to greenhouse gases / environmental pollutant ?

* A Desflurane
* B N2O
* C Sevoflurane
* D Isoflurane
* E Halothane

A. Desflurane

Repeat The clinical sign that a lay person should use to decide whether to start CPR is:

* A. Absent central pulse
* B. Absent peripheral pulse
* C. Loss of consciousness
* D. Obvious airway obstruction
* E. Absence of breathing



Indications: not responsive and not breathing normally

Repeat A patient's competence to give informed consent is determined by all the following except:

* A. Ability to communicate a choice
* B. Ability to apply reasoning
* C. Ability to understand consequences
* D. The provision of significant information
* E. ?


First line treatment for acute attack of hereditary angioedema

* B Adrenaline
* C Steroids
* D C1 inhibitor concentrate
* E anti-histamine

D. 1st line = C1 inhibitor concentrate

If not available -> FFP

Adrenaline, steroids, anti-hist not effective

Repeat Adult male who is intubated and ventilated, with CVL in situ. Just before surgeon starts the Line Isolation Monitor alarms about a leak at 5mA. What do you do?

* A. stop procedure and move to a safe location
* B. sequentially remove non essential monitors from the circuit until fault is identified
* C. unplug the CVL to electrically isolate it until fault is identified
* D. ensure the patient is earthed
* E. Check the diathermy pad


Repeat Patient with Haemophilia A with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for OT

* a. FVIIa
* b. High dose FVIII concentrate
* c. FFP
* d. Cryo
* e. Platelets


Mec stained liquor post LSCS Did not state if infant flat or vigorous

* A. Suction
* B. Routine care

A. Suction

55 year old subarachnoid haemorrhage secondary to aneurysm. Patient is confused with a oculomotor (3rd cranial nerve) palsy, complains of a severe headache. This patient is in Hunt and Hess class:

* A 0
* B 1
* C 2
* D 3
* E 4

D: 3

Confused and cranial nerve palsy.

If just palsy and no confusion = class2

Repeat In a 140kg obese patient, compared to a 70 kg person

* A. cardiac output >20% lower
* B. cardiac output 10% lower
* C. cardiac output no different
* D. cardiac output 10% higher
* E. cardiac output >20% higher