Anzca Final 2015 August

Front 1

Consider the following arterial blood gases. (Ref ranges in brackets)

pH 7.28

PaCO2 36

Bicarbonate 18 mmol.l-1 (18-25)

Base excess -7 mmol.l-1 (-4- +3)

Na+ 142 mmol.l-1 (135-145)

Cl- 112 mmol.l-1 (98-110)

These blood gases are consistent with

A. acute renal failure

B. diabetic ketoacidosis

C. ethylene glycol overdose

D. intraoperative infusion of 6 litres of normal saline

E. salicylate overdose

Back 1

Answer D

Hint 1

* Anion gap is normal (AG = 142 - 112 - 18 = 12)

* Hyperchloraemia is present

* An acidaemia is present (pH<7.36) so there must be an acidosis present

* pCo2 is low hence metabolic acidosis
* Expected pCO2 = (1.5 x HCO3) + 8 (+/-2) = 27+8 = 35mmHg

* Normal Anion Gap Metabolic Acidosis (renal loss of bicarb, GIT loss of bicarb, Dilution of bicarb by saline)
* Best answer D but ? would have higher Cl

Front 2

You are performing a peribulbar block for eye surgery. You decide to add hyalase to your local anaesthetic mix. What is the recommended concentration for hyalase?

A 25 U/ml

B 50 U/ml

C 100 U/ml

D 150 U/ml

E 1500 U/ml

Back 2

Answer A 25IU

Hint 2

25 IU According to product information although with peribulbar anything from 7.5 IU/ml to 150 IU/ML has been recommended

Front 3

A 25 year old male presents for ECT at a free standing facility. He has a life threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine.

The most appropriate course of action is

A cancel the procedure, cease tranylcypramine and perform the ECT in 2 weeks

B proceed with the ECT, but induce with midazolam and remifentanil

C proceed with the ECT, but pre treat with esmolol

D proceed with the ECT with caution, but with your usual drugs

E transfer the patient to a tertiary centre for their ECT

Back 3

Answer D proceed with ECT

Hint 3

CEACCP Fortunately, interactions withanaesthetic drugs (e.g. indirect sympathomimetics causing hypertensivecrises with either tricyclic antidepressants or monoamineoxidase inhibitors; meperidine or tramadol causing serotonin syndromewith SSRIs) are uncommon as the anaesthetic drugs inquestion are not generally required during ECT.

Front 4

A patient has been suffered a cardiac arrest. They are intubated but there is no IV access. Which drug can be given down the ETT?

A Amiodarone

B Calcium

C Lignocaine

D Magnesium

E Sodium bicarbonate

Back 4

Answer C Lignocaine

Hint 4

VENAL (i.e. horrible)

V: vasopression

E: epinephrine (adrenaline)

N: naloxone

A: atropine

L: lidocaine

Front 5

A well 65 year old is having a total hip replacement under GA with sevo/nitrous/fentanyl. BP is 130/70 and stable. Before the surgeon commences reaming and cementing, the best thing to do is:

A Induce hypotension

B Raise BP with vasopressors

C Turn off nitrous

D Give steroids

E Give heparin 5000u

Back 5

C turn of nitrous

Hint 5

Stupid but is in the oxford handbook (allows 100% O2 to be given if emboli)

Front 6

Pt in ICU in their 20s is diagnosed with brain death. History is that of immunosuppression for a renal transplant but otherwise well (although brain dead, go figure). Patient has expressed a desire to be an organ donor. All these organs can be donated except

A Bone marrow

B Heart

C Lung

D Liver

E Transplanted kidney

Back 6

A: Bone Marrow

Hint 6

All others are possible. No reference found but fox news reports a transplanted kidney being transplanted 3 times

Front 7

What is the IV loading dose of paracetamol for a 16kg child?

A <15mg/kg

B 15mg/kg

C 20mg/kg

D >20mg/kg

Back 7

B 15mg/kg

Hint 7

No loading dose in children over 44 weeks. Loading dose in neonates due to higher Vd, but decreased maintenance dose.

"the dose of i.v. paracetamol in neonates and infants, when postmenstrual age is between 32 and 44 weeks, should be a loading dose of 20 mg kg−1 (or 2 ml kg−1) followed with a maintenance dose of 10 mg kg−1 (or 1 ml kg−1) every 6 h, ..... In older infants and children, the dose should be 15 mg kg−1 (or 1.5 ml kg−1) every 6 h. The interval between two maintenance doses should be increased up to 12 h if the neonate's postmenstrual age is between 28 and 31 weeks."

Br. J. Anaesth. (2014) 112 (2):380-381.

oral and rectal loading doses

ORAL: 30mg/kg

RECTAL: 40mg/kg

Front 8

Intralipid initial dose in mL/kg

A 0.5

B 1

C 1.5

D 2

E 5

Back 8

C 1.5ml/kg

Hint 8

20% Intralipid

* 1.5 mL/kg as an initial bolus(e.g. about 100 mL in a 70kg adult)
* followed by 0.25 mL/kg/min for 30-60 minutes(e.g. about 600 mL over 30 minutes in a 70kg adult)
* Bolus could be repeated 1-2 times for persistent asystole(e.g. at 5 minute intervals)
* Infusion rate could be increased if blood pressure declines(e.g. double the infusion rate)

Front 9

MELD score includes INR, Creatinine and:

A Albumin

B Bilirubin

C AST

D Fibrin

Back 9

B. Bilirubin

Hint 9

The Model for End-Stage Liver Disease, or MELD, is a scoring system for assessing the severity of chronic liver disease. MELD uses the patient's values for serum bilirubin, serum creatinine, and the international normalized ratio for prothrombin time (INR) to predict survival.

Front 10

Factor V Leiden homozygote. By how much is the risk of post-operative DVT increased?

A 2x

B 5x

C 10x

D 20x

E 50x

Back 10

E: 50x

Hint 10

Factor V Leiden increases the risk of venous thrombosis 3- to 8-fold for heterozygous and 30- to 140-fold for homozygous individuals

Front 11

Kessel Blade has the blade coming off the handle at a degree of:

A 80

B 95

C 110

D 135

E 150

Back 11

C: 110

Hint 11

Various types of blades:

* MacIntosh - commonest; blade attaches to handle at 90 degrees
* Kessel - like the MacIntosh but the blade attaches at 110 degrees
* McCoy - MacIntosh like blade with a moveable distal tip segment, flexed by a lever controlled by the thumb of the hand holding the handle to displace the larynx forwards
* Magill - straight blade with U-shaped cross section
* Miller and Wisconsin blades (straight blades with curved tips)

Front 12

Surgery planned under brachial plexus block performed at axilla. Pain is felt on incision at the anterolateral right forearm. Which nerve has been insufficiently blocked?

A Radial

B Ulnar

C Median

D Musculocutaneous

E Median brachial cutaneous

Back 12

D. Musculocutaneous

Hint 12

Front 13

55M ICH, ventilated, paralysed, sedated, ICPs persistently 25mmg

A cool to < 35 degrees

B give hypertonic saline

C dexamethasone

D position 45 degrees head up

E Ventilate to PaCO2 <30

Back 13

B. give hypertonic saline

Hint 13

Front 14

Best method to prolong apnoeic oxygen saturation in obese patient:

A position head up

B place in sniffing position

C prone

D lateral

Back 14

A. Position Head Up

Hint 14

CEACCP - physiology of apnoea 2009

For severely obese patients (BMI>40 kg m−2), preoxygenation of these patients in the 25° head-up position achieves oxygen tensions >20% higher than when preoxygenation is applied in the supine position

Front 15

Neonate (born at 40 weeks, now 7 weeks old) why to reduce morphine infusion rate compared with older child

A Increased morphine crossing BBB

B Increased total body water/decreased fat

C Decreased enzymatic hepatic function

D Increased morphine-3-glucuronide (definitely M3G)

Back 15

C. Decreased enzymatic hepatic function

also A seems correct

Hint 15

CEACCP - Analgesia in neonates

Reduced doses of morphine are required in neonates because of an increased effect of the drug due to an immature blood–brain barrier, reduced protein binding (28% as opposed to 50% in the older child) producing a higher free drug level and a long duration of action because of immature liver metabolism and reduced renal excretion

Front 16

Motor evoked potentials are used to monitor spinal cord function in scoliosis surgery. Which drugs affect them the LEAST?

A. Non-depolarising muscle relaxants

B. Nitrous Oxide

C. Opiods

D. Propofol

E. Volatiles

Back 16

C. Opioids

Front 17

At initiation of laparoscopy/pneumoperitoneum which of the following cardiovascular parameters is LEAST likely to increase?

A. Cardiac Output

B. Mean Arterial Pressure

C. Heart rate

D. Myocardial filling pressures

E. Systemic Vascular Resistance

Back 17

D. Myocardial filling pressures

Hint 17

SVR increases

Cardiac output probably drops -> MAP drops -> increased HR and increase again in CO -> filling pressures remain low

Front 18

In order to use a 3 lead ECG setup to gain a CS5 view which of the following configurations would you use?

A. Lead I, RA lead below the clavicle, LA lead in the V5 position, LL at the hip

B. Lead I RA lead below the clavicle, LA lead at the hip LL in the V5 position

C Lead II RA lead below the clavicle, LA lead in the V5 position, LL at the hip

D Lead III RA lead below the clavicle, LA lead in the V5 position, LL at the hip

E Lead III RA lead below the clavicle, LA lead at the hip LL in the V5 position

Back 18

A

I for anterior ischaemia

II for inferior ischaemia

Hint 18

Central Subclavicular LeadThe central subclavicular (CS 5 ) lead (see Fig. 13-3 ) is particularly well suited for the detection of anterior wall myocardial ischemia. The right arm (RA) electrode is placed under the right clavicle, the left arm (LA) electrode is placed in the V 5 position, and the left leg electrode is in its usual position to serve as a neutral lead. Lead I is selected for detection of anterior wall ischemia, and lead II can be selected either for monitoring inferior wall ischemia or for the detection of arrhythmias. If a unipolar precordial electrode is unavailable, this CS 5 bipolar lead is the best and easiest alternative to a true V 5 lead for monitoring myocardial ischemia.

Front 19

According to NAP4 what is the rate of failure for emergency cannula cricothyroidotomy?

A 10

B 20

C 40

D 60

E 80

Back 19

D - 60%

Hint 19

There was a high failure rate of emergency cannulacricothyroidotomy, approximately 60%. In contrast a surgical technique for emergency surgicalairway was almost universally successful

Front 20

Arndt bronchial blocker picture what is the straight port on the multi lumen connector for?

A Connection of tracheal tube

B Passage of nylon guide wire

C Passage of fibreoptic

D Passage of bronchial blocker

E Connect circuit

Back 20

C. fibreoptic

Hint 20

Front 21

Which would be consistent with deep partial thickness burns?

A Pain to deep pressure only, decreased capillary refill or doesn’t blanch

B Blanches to pressure, very painful

C Painful to air, blanches to pressure with blisters?

D Painful to deep pressure, red and weeping/wet

E No pain, no CRT

Back 21

A - decreased sensation, no capillary refill

Hint 21

Front 22

How many vials of dantrolene should (according to guidelines from MH society) be kept at a remote hospital which has general anaesthesia services?

A 2

B 6

C 12

D 24

E 36

Back 22

E: 36 vials

Hint 22

Dantrolene stocks:The mhanz group recommends that a minimum of 24 (20mg) vials ofdantrolene are held in any anaesthetising location where triggeringanaesthesia is performed. Larger or remote hospitals should carry 36 vials.This stock level represents 2-3 x 2.5mg/kg doses for an average sized adultand is a reasonable compromise between clinical need and economy.

Front 23

Pregnant patient, progressive dyspnoea. Which would most strongly warrant further investigation?

A soft 2/6 systolic ejection murmur

B elevated JVP

C third heart sound

D orthopnoea

E peripheral oedema at ankles

Back 23

D - orthopnea

Hint 23

A,B,C,E all occur normally during pregnancy

Front 24

How long before return to normal platelet function in chronic diclofenac use.

A 12hrs

B 1-2d

C 4d

D 7d

E 10d

Back 24

C 4 days

Hint 24

Ex vivo tests of platelet aggregation, such as second-wave aggregation to ADP or epinephrine after a single dose of drug, show prolongation for 3 days after piroxicam, 2 days after naproxen, diclofenac, and indomethacin, and about 1 day after ibuprofen. With chronic administration, the time taken for return of normal platelet function may be considerably longer, due to accumulation of products such as the S(+) enantiomer of ibuprofen in adipose tissue

Front 25

How long after starting a unit of FFP does it have to be completed

A 2hrs

B 4

C 6

D 8

E 10hrs

Back 25

B. 4 hours

Hint 25

The transfusion should normally be completed within four hours of the product leaving approvedcontrolled storage (or sooner if specified on the pack / transfusion report).

Front 26

You arrive to a code blue for a 5 year old child 16kg in a shockable rhythm. CPR has commenced, he has had TWO shocks already. What is the next step:

A Adrenaline

B Amiodarone

C Iv fluid bolus

D Shock 50j

E Shock 100j

Back 26

A: Adrenaline 10mcg/kg

Hint 26

Front 27

143. FAST scan includes A Pelvis, pericardium, perihepatic, perisplenic B Pelvis, pericardium, perihepatic, paracolic C Lung, pericardium, perihepatic, perisplenic D More combinations of above

Back 27

A: pelvis, pericardium, perihepatic, perisplenic

Hint 27

The four classic areas that are examined for free fluid are the perihepatic space (also called Morison's pouch or the hepatorenal recess), perisplenic space, pericardium, and the pelvis

Front 28

144. You arrive in the emergency department to treat a man with an attempted hanging. He has a LMA in situ, it is easy to ventilate (or something like that) Sa 98% HR 120, BP 130/80 GCS 5 initially. What is the next single most important thing to do. A Apply rigid collar with manual inline stabilisation B Check subcutaneous emphysema C Fibre optic examination of airway D Lateral c-spine xray E Remove LMA and intubate

Back 28

B. Check subcutaneous emphysema

Hint 28

Easy to do and major sign of laryngotrachael seperation

Front 29

ou are supplying oxygen from the variable flow meter on the wall at 6L/min. The tubing becomes obstructed. What is the pressure reached in the tubing A 1atm (100kPa) B 2atm (200kPa) C 3atm (300kPa) D 4atm (400kPa) E 5atm (500kPa)

Back 29

D 4 atm

Hint 29

Would return to O2 wall supply which is 4atm

Front 30

The adverse event that leads to the most medico legal claims against anaesthetists is: A Dental damage from airway management B Eye injury C Non-obstetric epidural complications D Obstetric epidural complications E Peripheral nerve injury

Back 30

A. Dental damage

Hint 30

According to MDA

48% Anaesthesia – dental issues

17% Anaesthesia – CNS/CVS & potential

medium/high value matters

12% Anaesthesia – nerve & musculo

skeletal injuries – direct /pressure/

positioning

5% Anaesthesia – inadequate pain

relief/awareness

3% Medication related

3% Consent issues

1% Diagnosis

1% General duty of care

1% Treatment

9% Other

Front 31

65 year old lady with osteoarthritis, for TKR in 2 weeks time. She has Fe deficiency anaemia, with Hb 105, Ferritin 30mcg/l. The best management would be:

A Oral Fe tablets until surgery

B Oral Multivitamin containing Fe until surgery

C IV Fe infusion

D Blood transfusion

E Check Hb on day of surgery and don't proceed if <95

Back 31

C IV iron infusion

Front 32

What is the expected rise in platelets from one unit of pooled leucodepleted plates in a 70kg patient?

A 10-20

B 21-40

C 40-60

D 60-80

E 80-100

Back 32

B 21-40

Hint 32

www.transfusion.com.au

Front 33

You are assessing a patient for intubation. MP3 and thyromental distance 6cm. Compared with MP, TMD is?

More or less specific

Back 33

Front 34

You are about the anaesthetise a patient BMI 38 for bariatric surgery. Plan to give 1m/kg of sux. Compared with Ideal body weight, total body weight dosing resulst in:

A shorter onset, shorter duration

B shorter onset, similar duration

C shorter onset, longer duration

D similar onset, shorter duration

E similar onset, longer duration

Back 34

E Similar onset, longer duration

Hint 34

Lemmens HJ, Brodsky JB. The dose of succinylcholine in morbidobesity. Anesth Analg 2006; 102: 438–42

Front 35

man undergoing transcatheter aortic valve replacement has this ECG. What is the best way of managing this:

A Atropine

B Transcutaneous pacing

C Adreline

D Isoprenaline

E Transvenous pacing

Back 35

e. Transvenous pacing

Hint 35

CEACCP

The transvenous pacing wire can be used in thecase of complete heart block, and this (or epicardial wires aftertransapical approach) is left in situ immediately after operation incase of delayed heart block.

Front 36

A patient presents for THR with a febrile illness, but wishes to proceed despite the risks. You can justify your decision to defer the case based on:

A Automony

B Beneficence

C Non-maleficence

D Paternalism

E Utilitarianism

Back 36

C. Non-maleficence

Front 37

You collect ropivacaine levels post-operatively. This type of data is:

A Continuous

B Numerical

C Ordinal

D Nominal

E Categorical

Back 37

A Continuous

Hint 37

its continuous numerical data

Front 38

Randomised controlled trial means:

A Patients randomly allocated to treatment groups

B Patients randomly allocated to treatment or placebo

C Patients allocated systematically

D Neither the patient nor the investigator knows which group the patient is in

E ?

Back 38

A. Does not need placebo. Can be comparing new intervention to another (gold standard)

Front 39

Clinical phase III trial means:

A dose finding

B In patients WITHOUT the disease

C Randomised controlled trial in patients

D Post marketing study

E ?

Back 39

C. RCTs

Hint 39

Front 40

Cancer patient on subcutaneous morphine, 70mg in 24 hours. Converting this to an oral dose of long acting morphine. What is a reasonable starting dose?

A 25mg bd

B 70mg bd

C 100mg bd

D 150mg bd

E 200mg bd

Back 40

B. 70mg BD

Hint 40

3x for reduced bioavailibity then reduce to be safe with variability

Front 41

Neurosurgery in the sitting position. What is the most sensitive way to detect venous air embolism?

A Praecordial doppler

B PA Catheter

C TOE

D ET CO2

E ?

Back 41

C TOE

Hint 41

The transesophageal echocardiography is the most sensitive monitoring; it can detect 0.02 ml/kg of air injected by bolus administration or air bubbles as small as 5-10 microns.[35]Precordial doppler ultrasound is the most sensitive non-invasive monitoring which can detect as little as 0.05 ml/kg of air.[36]End tidal nitrogen (ETN2) can show the changes 30-90 seconds earlier than end-tidal carbon dioxide (ETCO2) changes.[37]End-tidal carbon dioxide (ETCO2) is the most common and easily available monitoring, which will reveal sudden decrease in level in event of VAE

Front 42

Modified from previous - CS5 – what are the lead arrangements and lead examined. No information about what you are looking for (ie region or rhythm vs. ischaemia)

A RA at R subclavian, LA at V5, LL at L hip, lead I

B RA at R subclavian, LA at hip, LL at V5, lead I

C RA at R subclavian, LA at V5, LL at L hip lead II

D RA at R subclavian, LA at left hip, LL at V5 lead III

E RA at R subclavian, LA at V5, LL at L hip, lead III

Back 42

A RA at R subclavian and LA at V5, LL lower than this

want to monitor V5 for ant ischaemia

Hint 42

Millers 8th ed

Modified chest leads such as CS 5 (the RA electrode is placed under the right clavicle, and the LA electrode is placed in the V 5 position) or CB 5 (the RA electrode is placed over the center of the right scapula, and the LA electrode is placed in the V 5 position) may be suitable for the detection of anterior wall myocardial ischemia; however, these modified leads are currently not recommended for monitoring myocardial ischemia.

Front 43

70kg man , burns to 50% of body, according to parkland, how much fluid in first 8 hours

A 2.4

B 3.6

C 4.6

D 7L

E 14L

Back 43

d 7L

Hint 43

4x70x50 = 14L in 24 hours

1/2 in 1st 8 hrs = 7L

Front 44

You arrive at the delivery of a term neonate with resuscitation in progress. At 2 minutes, saturations are 70%, child is breathing, has been dried and is warm. A HR was also given which was more than 60. What do you do?

A Observe

B Mask ventilation

C 100% oxygen

D ?

Back 44

A. Observe

Hint 44

Front 45

65 male patient in ICU with severe, overwhelming sepsis, Hb 75, INR 1.5, CvSO2 70%. What product do you give?

A Nothing

B 1 unit red cells

C 1 unit red cells and PTx

D 1 unit red cells and FFPE

2 bags FFP

Back 45

A. Nothing

Hint 45

Front 46

what is the structure that attaches to the shaded area:

A Scalenus medius

B Saclenus anterior

C SCM

D Parietal pleura

E Articular surface with clavicle

Back 46

A. Scalenus medius

Front 47

Praecordial thump indicated when

A Witnessed, monitored: VT

B Witnessed monitored VF

C Witnessed but unmonitored arrest

D Witnessed monitored asystole

Back 47

A: Witnessed, monitored VT

Hint 47

http://resus.org.au/guidelines/

Front 48

85 F for fracture hip, otherwise well, normal ECG day prior, electrolytes normal. Otherwise well other than now in AF with HR 110-145, BP 130/80 what do you do:

A Amiodarone

B DC Cardioversion post induction GA

C Digoxin

D Metoprolol

E Anticoagulate

Back 48

D. Metoprolol

Hint 48

Rate control with B-blocker unless LV impairment then use diltiazem or amiodarone

Front 49

How many weeks of anticoagulation prior to elective DCR per AHA/ACC

A 1 week

B 2 weeks

C 3 weeks

D 4 weeks

E 5 weeks

Back 49

C. 3 weeks

Hint 49

For patients with AF or atrial flutter of 48 hours’ duration or longer, or when the duration of AF is unknown, anticoagulation with warfarin (INR 2.0 to 3.0) is recommended for at least 3 weeks before and 4 weeks after cardioversion

Front 50

Child for elective procedure, maternal GREAT-grandfather had MH. What is the most reassuring that he doesn’t have MH

A Exposure to halothane age 2 without incident

B Maternal grandfather negative IVCT

C Mother negative genetic test

D No other reports in family despite multiple exposure

E Normal serum CK

Back 50

B. Maternal grandfather negative IVCT

Hint 50

A. incorrect as many have normal anaesthetics prior to MH

C. incorrect as not or genes known

Front 51

Ankle bock what supplies plantar foot

A deep peroneal

B posterior tibial

C superficial peroneal

D sural

E saphenous

Back 51

B. posterior tibial

Hint 51

Front 52

Interscalene block – what is most likely to be missed:

A Medial cutaneous nerve of forearm

B Radial nerve

C Median nerve

D Axillary nerve

Back 52

A. Medial cutaneous nerve of forearm

Hint 52

interscalene misses C8 T1 and inferior trunk - sole supply of MCN forearm

Front 53

Pregnant woman, 33 weeks, thyroid storm for an urgent caesarean section, already been treated with steroid. What next?

A Carbimazole

B Esmolol

C IV magnesium

D Propothyiouracil

E Potassium Iodide

Back 53

D PTU

Front 54

65 year old, 3 days postop, hypoxia, VQ scan shows non-segmental, matched perfusion and ventilation defects.

A Asthma

B Emphysema

C PE

D Atelectasis

E Pulmonary infarction

Back 54

D Atelectasis

Hint 54

low likelihood of PE, infarction more likely to be segmental

if pneumonia is an option choose pneumonia

Front 55

45 year old man with left lung cancer. Otherwise well and CT shows no metastasis. FEV1 2.3 L and FVC 3.4 L. Do you?

A Proceed with either pneumonectomy or lobectomy

B Lobectomy only

C Assess split function (Refer for V/Q scanning)

D Formal cardiopulmonary exercise testing

E cancel all surgery

Back 55

A. Proceed with either pneumonectomy or lobectomy

Hint 55

Front 56

You are called to the cardiac catheter lab to assist when a 55-year-old man with unstable angina becomes restless during difficult placement of a right coronary artery stent. When you arrive he is conscious and responding to voice. He is sweating with a pulse of 60 beats per minute in sinus rhythm, blood pressure measured from arterial catheter of 80/50 mmHg and Sp02 of 97%. The arterial pressure wave has an exaggerated fall with inspiration. The most appropriate next clinical intervention would be to

A. administer atropine

B. commence an adrenalin infusion

C. perform a quick transthoracic echocardiograph

D. sedate and intubate

E. transfer to operating theatre immediately

Back 56

C perform a quick TTE

Hint 56

?pericardial effusion / tamponade

Front 57

Lithotomy position for laparoscopy. What is not a risk factor for compartment syndrome lower leg?

A) obesity

B) male gender

C) lithotomy stirrups

D) pmh hypertension

E) intraoperative hypotension

Back 57

C. lithotomy stirrups vs full calf supports have been shown to have no difference

Front 58

You are called to review a patient in recovery who is short of breath after resection of a lung SCC. He is weak, cannot flex hips or lift arms. He was given atracurium (35mg) which was reversed 90 minutes ago. This is most consistent with:

A Eaton lambert

B Myasthenia gravis

C Steroid induced myopathy

D Limb girdle muscular dystrophy

E Myotonic dystrophy

Back 58

A Eaton Lambert

Hint 58

Eaton–Lambert syndrome (myasthenic syndrome) is proximal myopathy associated with small cell carcinoma. Reduction in acetylcholine released from presynaptic motor nerve terminals in these patients causes increased sensitivity to all neuromuscular blocking drugs. In contrast to myasthenia gravis, the muscle weakness improves with exercise and is not reversed by acetyl cholinesterase inhibitor therapy

Front 59

According to ANZCA professional standards, a LEVEL 2 machine check includes:

A: Ensuring that there are no leaks both when the vaporisers are being used and when they are not being used.

B: Checking the breathing circuit if it has been changed

C: Checking the inspiratory and expiratory valves

D: Checking the (?external) scavenging system

E: Checking the reserve oxygen cylinder is adequately filled for its intended purpose

Back 59

A. check for leaks

Front 60

Rate of CO2 rise with apnoea in normal adult.

Back 60

12mmHg in first minute, then 3.4mmHg per minute after

Front 61

Which is least likely to have a difficult airway?

A: Apert syndrome

B: Downs syndrome

C: Treacher Collins syndrome

D: Hurler

E: ?

Back 61

? Apert

Hint 61

Hypoplastic mandible (micrognathia) – difficult intubation

* Pierre Robin sequence
* Treacher Collins
* Hemifacial microsomia (Goldenhar syndrome)
* Apert syndrome
* Crouzon syndrome
* Pfeiffer syndrome
* Saethre-Chotzen syndrome
* Hurler’s/Hunter’s syndrome (mucopolysaccharidoses)
* Beckwith-Wiedemann syndrome
* Down’s syndrome

Front 62

When to send tryptase after suspected anaphylaxis:

A. 1 hr

B. 4 hrs

C. ?

D. ?

E. 24 hrs

Back 62

A 1hr

Front 63

Patient unstable with PE after joint replacement (tachycardiac and hypotensive), already heparinised.

A: Thrombolysis

B: Referral for thrombectomy

C: Supportive care including fluids and inotropes

D:

E:

Back 63

B. referral for thrombectomy

Front 64

Prothrombinex is relatively contraindicated in a bleeding patient with:

Back 64

A past history of HITS

Front 65

Subtenon is relatively contraindicated in:

A: Long axial length

B: Previous scleral band which remains in situ

C: Inferonasal pterygium

D:

E:

Back 65

B. Previous scleral band

Hint 65

The technique is relativelycontraindicated where there is a history of scleral diseasewith possible scarring and friability of the sclera. Previousretinal detachment surgery can be associated with scleralbuckles and adhesions, which may hinder dissection orspread of anaesthetic solution, and increase the risk of globeperforation in the quadrant dissected.

Front 66

On CPB. MAP drops very low after first dose cardioplegia. Mixed venous sats 80%. What to do?

A: Metaraminol

B: Start an adrenaline infusion

C: Give fluid

D: Change pump flow rates

E:

Back 66

A. Metaraminol

Hint 66

Adjusting blood pressure

• Vary pump flow rate – not commonly used. Low flows compromise perfusion. High flows increase blood trauma. Can be used briefly for periods of very low or high blood pressure.

• Increasing SVR – the primary control of BP in most cases. Phenylephrine or metaraminol boluses. Norepinephrine (noradrenaline) or vasopressin can be used when SVR becomes less responsive to these. Vasopressin therapy is currently popular for ‘vasoplegia’ secondary to cardiopulmonary bypass.

• Decreasing SVR – anaesthesia. Within reason! It is easy to use vasodilators and vasoconstrictors. Dialling up very high or very low volatile agents produces a slow response and does not treat the cause if adequate anaesthesia is assured. Opioids are quite useful – remifentanil produces particularly stable conditions. Vasodilators – GTN boluses or infusions, phentolamine, sodium nitroprusside.

Front 67

According to the current (2010) ARC ALS guidelines, what is the correct dose for the first three shocks of a shockable rhythm?

A: Biphasic 50, 100, 150

B: Biphasic 100, 150, 200

C: Biphasic 100, 200, 200

D: Monophasic 120, 240, 360

E: Monophasic 360, 360, 360.

Back 67

E. monophasic 360 360 360

Hint 67

All others are incorrect

Biphasic 200 200 200

Front 68

What is not a sign of damage to a part of the sympathetic system? [In the context of surgery where something sympathetic related could be damaged]

A: Blepharoptosis

B: Exopthalmos

C: Facial flushing

D: Miosis

E:

Back 68

B exopthalmus

Hint 68

Enopthalmus is a sign of sympathetic trunk damage

Miosis, ptosis, anhidrosis

Front 69

Providing sedation for endoscopy. What must you have?

A: Anaesthetic machine

B: Suxamethonium

C: Mechanical ventilator

D: Defibrillator

E: Laryngoscope

Back 69

D. Defibrillator - ready access to...

Also Laryngoscope, sux?

Hint 69

?laryngoscope as well (states need for advanced airway equipment)

Front 70

Abdominal compartment syndrome is diagnosed when intra-abdominal pressures are consistently greater than

A: 12mmHg

B: 20mmHg

C: 24mmHg

D:

E:

Back 70

B 20mmHg

Front 71

Patient with respiratory failure, low PaO2/FiO2 ratio, cardiac index of 1.7, PCWP of 25. Which mode of ECMO would be most appropriate?

A: VA

B: VV

C: AV

D:

E:

Back 71

B:VV

Hint 71

VA-ECMO can be considered in patients with systolic arterial pressure lower than 85 mm Hg, cardiac index lower than 1.2 litre min−1 m−2, despite adequate preload, more than two inotropes in use, intra-aortic balloon counterpulsation, and systemic signs of low cardiac output

Front 72

When to stop dabigatran (for non valvular AF) in a patient with normal renal function prior to THR planned to be done under spinal?

A: 7 days

B: 3 days

C: 3 days, bridge with clexane

D: 5 days

E: Continue until day of surgery

Back 72

C. 3 days Bridge with clexane

Hint 72

2-3 half lives is lower recommendation

6 half-lives is safer

BJA article suggests 5 halflives with bridging (4 days)

Front 73

What do you expect to happen if you put a magnet over an AICD?A: Turn off antitachycardia feature, no change to pacing

B: Turn defib off, asynchronous pacing

C: Turn defib off, no change to pacing (or, continue synchronous pacing)

D: No change to defib, asynchronous pacing

E:

Back 73

C. turn defib off, no change to pacing

Front 74

Young patient, recently diagnosed with phaeochromocytoma. Not on any medications. Presents to ED tachycardic (~140) with SBP 220. Best initial treatment:

A: Phenoxybenzamine

B: Phentolamine

C: Esmolol

D: GTN

E:

Back 74

A. phentolamine

Hint 74

phenoxybenzamine takes to long to work. esmolol contraindicated until alpha blockade established.

GTN or SNP also options (2nd line)

Front 75

Technique to minimise absorption of irrigation fluid during TURP:

A: Fluid no more than 60cm above the patient

B: Use NS rather than glycine

C: Use laser

D: Limited resection of gland only if gland <200g

E:

Back 75

A. bag height <= 60cm

Front 76

Recent case with LMA. Now has hoarse voice. Nasendoscopy shows one vocal cord in the paramedian position. What is the site of injury?

A: Lingual n.;

B: Vagus n.;

C: Superior laryngeal n.;

D: Recurrent laryngeal n.

E:

Back 76

D Recurrent laryngeal nerve