Anzca Final Mcq 2012 B

Front 1

Half-life of mast cell tryptase?
A. 1 hour
B. 2 hours

Back 1

B

NICE Guidelines Anaphylaxis
“Very low-quality evidence from six observational studies including 147 patients showed that the half-life of tryptase ranged from 30 minutes to 300 minutes (median 90 minutes)”

Mayo Medical Laboratories
After anaphylaxis, mast cell granules release tryptase; measurable amounts are found in blood, generally within 30 to 60 minutes. The levels decline under first-order kinetics with half-life of approximately 2 hours.

Front 2

Best single predictor of difficult intubation in obese patient?
A. Mallampati score
B. Interincisor distance
C. Severe OSA
D. Pretracheal soft tissue volume

Back 2

D

Morbid Obesity and Tracheal Intubation. A & A March 2002 vol. 94
“In 100 morbidly obese patients, neither obesity nor body mass index predicted problems with tracheal intubation. However, a high Mallampati score (≥3) and large neck circumference may increase the potential for difficult laryngoscopy and intubation”

Obstructive sleep apnea is not a risk factor for difficult intubation in morbidly obese patients
Anesth Analg. 2009 Oct;109(4):1182-6

Front 3

Endocarditis prophylaxis is appropriate in?
A Bicuspid valve
B Congenital repair > 12 months ago
C Rheumatic heart valve
D Uncorrected cyanotic heart disease
E MVP + ?MR

Back 3

D

Front 4

Emergency caesarean section for foetal distress (and foetal acidosis on scalp probe?). what is best option to raise gastric pH preop:
A)Oral Na Citrate
B)Ranitidine IV
C)Ranitidine oral
D)Omeprazole IV
E)Omeprazole oral
F)Metoclopramide 20 IV

Back 4

A

Front 5

Most common cause of mortality post transfusion?
A. TRALI
B. Contamination/infection
C. Mismatched blood
D. GvHD
E. Anaphylaxis

Back 5

A

Front 6

Most common cause of awareness?
A. Failure to check apparatus
B. Human Error

Back 6

B

Front 7

Apnoeic oxygenation in obese patient can be increased by
A. Sniffing position
B. Prone
C. Supine
D. Lateral
E. Head up tilt

Back 7

E

"Patient positioning is of paramount importance before induction, particularly head position. A ‘sniffing the morning air’ position may be difficult to achieve due to the large soft tissue mass of the neck and chest wall, and a wedge or blanket beneath the shoulders is of benefit (‘ramped’ technique). A degree of head-up tilt may slow the rapid desaturation that can occur on lying supine. Because of the reduced FRC, preoxygenation is less effective than in lean subjects."

Front 8

Best renal protection for endoluminal AAA repair?
A. NaCl
B. NAC

Back 8

A

"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."

Front 9

Indicator in sodalime?
A. Ethyl violet
B. Potassium permangenate
C. Blue ?
D. ?
E. ?

Back 9

A

Front 10

Desflurane vaporiser heated because:
A. High SVP

Back 10

A
88.5 kPa at 20C
Heated to 39C, SVP of 1550 mmHg

Front 11

What is NOT a disadvantage of drawover vaporizer?
A. Temperature compensation
B. Cannot use sevoflurane
C. Small volume reservoir
D. Flow compensation

Back 11

B

Front 12

FOB - can see a trifurcation. Where are you?
A. Right upper lobe
B. RML
C. RLL
D. LUL
E. Lingula

Uploding Image...

Back 12

A

Front 13

White cylinder with grey shoulder?
A. CO2
B. Air
C. O2
D. N2O
E. N2

Back 13

A

www.anaesthesia.med.usyd.edu.au/resources/lectures/gas_supplies_clt/gas_supplies.html
Specific gases are assigned the following colours:
• oxygen (white), nitrous (blue)
• nitrogen (black)
• acetylene (maroon), medical ethylene (violet), medical cyclopropane (orange)
• carbon dioxide (grey), helium (brown) and argon (dark green)
• medical breathing gas mixtures containing oxygen and an inert gas must be marked with alternating white and the second gas's colour on the shoulder e.g. black + white for air, brown + white for Heliox, etc.

Wikipedia
“CO2 cylinders have a grey shoulder”

Front 14

Photograph of an Arndt endobronchial blocker. Orifice labelled 'X'. What goes in 'X'?
A. Bronchoscope

Back 14

A

Front 15

Intubating over a bougie. Rotate ETT?
A. 90 degrees anticlockwise
B. 90 degrees clockwise
C. 270 degrees anticlockwise
D. 45 degrees either direction

Back 15

A

Front 16

In an arterial line, an air bubble leads to decreased:
A. Damping coefficient
B. Resonant frequency

Back 16

B

A small air bubble can lower the natural resonant frequency and cause the monitoring system to resonate or ring, resulting in a spuriously elevated systolic blood pressure. On the other hand, a large air bubble will lead to excessive signal damping and cause underestimation of the true systolic blood pressure.

Front 17

All of the following may be associated with ulcerative colitis EXCEPT
A. cirrhosis
B. iritis
C. psoriasis
D. arthritis
E. sclerosing cholangitis

Back 17

C

Extraintestinal features of UC:
Aphthous ulcer of the mouth
Ophthalmic:
Iritis or uveitis
Episcleritis
Musculoskeletal:
Seronegative arthritis, which can be a large-joint oligoarthritis (affecting one or two joints), or may affect many small joints of the hands and feet
Ankylosing spondylitis
Sacroiliitis
Cutaneous:
Erythema nodosum, which is a panniculitis, or inflammation of subcutaneous tissue involving the lower extremities
Pyoderma gangrenosum, which is a painful ulcerating lesion
Deep venous thrombosis and pulmonary embolism
Autoimmune hemolytic anemia
Clubbing
Primary sclerosing cholangitis, a distinct disease that causes inflammation of the bile ducts and can lead to cirrhosis.

Front 18

At what valve area do you begin to get symptoms, at rest, with mitral stenosis?
A. 4.5 cm2
B. 3.5 cm2
C. 2.5 cm2
D. 1.5 cm2
E. 1.0 cm2

Back 18

D

The challenge of valvular heart disease. Cleveland Clinic Journal Of Medicine, Volume 71, Number 6, June 2004
When is it time to operate? “Mitral stenosis is most commonly caused by damage to the mitral valve from rheumatic fever, after which there typically is a long period of asymptomatic progressive valve narrowing. Symptoms at rest are rare until the mitral valve area is less than 1.5 cm2”

Front 19

75 year old with non-valvular AF usually on warfarin has their warfarin stopped for one week. What is their daily risk of stroke?
A: 1%
B: 0.1%
C: 0.01%
D: 4%
E: 10%

Back 19

C

Front 20

Abnormal Q waves are NOT a feature of the ECG in
A. an old myocardial infarction
B. left bundle branch block
C. recent transmural myocardial infarction
D. digitalis toxicity
E. Wolff-Parkinson-White syndrome

Back 20

D

Front 21

cTnI remains elevated for up to?
A. 1-2 days
B. 2-5 days
C. 5-14 days
D. 7-21 days

Back 21

C

CEACCP ‘Cardiac troponins- their use & relevance in anaesthesia & critical care medicine’
Continuing breakdown of myofibrillary-bound complex explains the prolonged elevation of both troponins for up to 10 days after infarction.

Front 22

With regard to Digoxin toxicity which of the following is NOT a feature?
a. ventricular bigeminy
b. sinus arrest
c. atrial flutter
d. atrial tachycardia with variable block
e.

Back 22

C

Clinical Features
• GIT: Nausea, vomiting, anorexia, diarrhoea
• Visual: Blurred vision, yellow/green discolouration, haloes
• CVS: Palpitations, syncope, dyspnoea
• CNS: Confusion, dizziness, delirium, fatigue

Electrocardiographic Features
• Digoxin can cause a multitude of dysrhythmias, due to increased automaticity (increased intracellular calcium) and decreased AV conduction (increased vagal effects at the AV node)
• The classic dysrhythmia associated with digoxin toxicity is the combination of a supraventricular tachycardia (due to increased automaticity) with a slow ventricular response (due to decreased AV conduction), e.g. ’atrial tachycardia with block’.

Other arrhythmias associated with digoxin toxicity are:
• Frequent PVCs (the most common abnormality), including ventricular bigeminy and trigeminy
• Sinus bradycardia or slow AF
• Any type of AV block (1st degree, 2nd degree & 3rd degree)
• Regularised AF = AF with complete heart block and a junctional or ventricular

Front 23

Inverted PW's in lead II may be caused by?

Back 23

A. Junctional rhythm

"Elevation or depression of the PTa segment (the part between the p wave and the beginning of the QRS complex) can result from atrial infarction or pericarditis.
If the p-wave is enlarged, the atria are enlarged.
If the P wave is inverted, it is most likely an ectopic atrial rhythm not originating from the sinus node. "

Front 24

63. Rpt: Male with a Haemoglobin of 8g/l and reticulocyte count 10%. Possible diagnosis:
A. Untreated pernicious anaemia
B. Aplastic anaemia
C. Acute leukaemia
D. Anaemia of chronic disease
E. Hereditary spherocytosis

Back 24

E

"The normal range of values for reticulocytes in the blood depends on the clinical situation but is usually 0.5% to 1.5%. However, if a person has anaemia, the reticulocyte percentage should be higher than normal if the bone marrow's ability to produce new blood cells remains intact."

Front 25

Pulsus paradoxus in constrictive pericarditis:
A. Decreased BP with inspiration
B. Decreased BP with inspiration greater than normal

Back 25

B

Defined as an abnormally large decrease in systolic blood pressure and pulse wave amplitude during inspiration. The normal fall in pressure is less than 10 mmHg. When the drop is more than 10mm Hg, it is referred to as pulsus paradoxus.
A sign that is indicative of several conditions, including cardiac tamponade, pericarditis, chronic sleep apnoea, croup, and obstructive lung disease.
The paradox in pulsus paradoxus is that, on examination, one can detect beats on cardiac auscultation during inspiration that cannot be palpated at the radial pulse. It results from an accentuated decrease of the blood pressure, which leads to the (radial) pulse not being palpable and may be accompanied by an increase in the jugular venous pressure height (Kussmaul's sign). As is usual with inspiration, the heart rate is slightly increased, due to decreased left ventricular output.

Front 26

Which type of aortic dissection is typically managed non-operatively?
A. Debakey Type I
B. Debakey Type II
C. Stanford A
D. Stanford B
E. Stanford C

Back 26

D

eMedicine - Emergent Management of Acute Aortic Dissection
Stanford classification
“The Stanford classification divides dissections into 2 types, type A and type B. Type A involves the ascending aorta (DeBakey types I and II); type B does not (DeBakey type III).

This system helps to delineate treatment. Usually, type A dissections require surgery, while type B dissections may be managed medically under most conditions.”

Front 27

Absolute CI to the sitting position in neurosurgical patient?
A. Patent VA shunt
B. Small PFO

Back 27

A

ABSOLUTE CONTRAINDICATIONS
• Patent ventriculo-atrial shunt
• Severe cardiovascular disease
• Large patent foramen ovale or other pulmonary-systemic shunt
• Cerebral ischaemia when upright and awake
• Anaesthesia or surgical team not familiar with the position

Front 28

Acute visual loss after non-ocular surgery is most commonly caused by
A. ischaemic optic neuropathy
B. prolonged direct compression of the globe
C. cortical blindness
D. retinal artery occlusion
E. electrolyte imbalance

Back 28

A

CEACCP ‘Patient positioning in anaesthesia’
Special consideration should be given to the prone position where a head ring or horseshoe headrest is often utilized. In this position, the head may move significantly during a surgical procedure and result in direct pressure on the eye. If this pressure exceeds arterial pressure then arterial inflow may be reduced dramatically, resulting in potentially devastating retinal ischaemia.

Front 29

68. Rpt: Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours
A <5%
B 5-10%
C 10-15%
D 15-20%
E >20%

Back 29

A

CEACCP ‘Acute management of aneurysmal subarachnoid haemorrhage’
The risk of re-bleeding is greatest immediately after the initial haemorrhage, with rates of 5–10% within the first 72 h.4 It is higher in females and in those with poor clinical grade, larger aneurysms, and sentinel bleeds.
UB ‘Aneurysmal subarachnoid haemorrhage and the anaesthetist’
Ruptured aneurysms tend to re-bleed in 2–4% of cases within the first 24 h, and in 15–20% within the first 2 weeks of the initial haemorrhage. The three main predictors of mortality and dependence are impaired level of consciousness on admission, advanced age, and large volume of blood on initial head CT.

Front 30

69. Rpt: The most appropriate investigation to diagnose Type A aortic dissections in potentially unstable patients is
A. angiography
B. CAT scan
C. magnetic resonance imaging (MRI)
D. transoesophageal echocardiography…..
E. transthoracic echocardiography

Back 30

D

Transoesophageal echocardiography (TOE) has become more popular as experience and availability increase. It is useful perioperatively in the haemodynamically unstable patient. TOE images the entire thoracic aorta except for the most distal ascending aorta and a part of the arch obscured by the trachea or right main bronchus.

Front 31

70. Rpt A. Contraindication to IABP
A. Aortic regurgitation
B. Aortic stenosis

Back 31

A

Front 32

During prolonged trendelenburg positioning there is:
A. No change in ICP
B. No change in IOP
C. Increased pulmonary compliance
D. Increased myocardial work
E. No increased pulmonary venous pressures

Back 32

D

Front 33

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

Back 33

A

Front 34

Estimate GCS post head-trauma. E - Response to pain V - Mumbling incoherently M - Withdraws to pain (attempted IV cannulation)
A. 8
B. 9

Back 34

A

E2V2M4

Best Eye Response. (4)
1. No eye opening.
2. Eye opening to pain.
3. Eye opening to verbal command.
4. Eyes open spontaneously.


Best Verbal Response. (5)
1. No verbal response
2. Incomprehensible sounds.
3. Inappropriate words.
4. Confused
5. Orientated

Best Motor Response. (6)
1. No motor response.
2. Extension to pain.
3. Flexion to pain.
4. Withdrawal from pain.
5. Localising pain.
6. Obeys Commands.

Front 35

31. What percentage of primiparous women experience a headache in the first week following delivery?
a. 3-5%
b. 5-15%
c. 15-40%
d. 40-65%
e. 65-85%

Back 35

C

CEACCP - Postpartum headache: diagnosis and management 2011
“Postpartum headache is described as a complaint of headache and neck or shoulder pain in the first 6 weeks after delivery.1 It is one of the most common symptoms with up to 39% of parturients experiencing headache in the first postpartum week”

Front 36

74. New: Oxycodone 20mg SR / Naloxone 20 mcg:
A. Decreased constipation
B. Reduced risk of drug misuse/abuse
C. decreased CO

Back 36

A

Targin is the drug concerned. BD dosing, the same as oxycontin. Available preparations are 5/2.5 mg, 10/5 mg, 20/10 mg and 40/20 mg.
Naloxone reduces bowel function disorders such as constipation that typically arise during opioid analgesic treatment with e.g. oxycodone, due to its local competitive antagonism of the opioid receptor-mediated oxycodone effect in the gut. Diarrhoea may be a possible effect of naloxone, especially at the beginning of treatment, and tends to be transient. Oral administration of naloxone is unlikely to result in a clinically relevant systemic effect due to a pronounced first-pass effect and its very low oral bioavailability upon oral administration (<3%).

Front 37

23. A 70 year old man is having a laparotomy. Which is the best method of assessing his fluid status?
a. arterial pulse pressure variation
b. CVP
c.
d. heart rate and blood pressure
e. pulmonary capillary wedge pressure

Back 37

A

Perhaps SVV or oesophageal doppler would be better?

“Accurate fluid management and resuscitation requires regular reassessment of physiological parameters and, where available, invasive haemodynamic monitoring. Historically this has been provided by pulmonary artery catheters, but these are increasingly being replaced by targeted stroke volume optimisation with oesophageal Doppler probes. Given the relative simplicity and lack
of complications, where available the latter is the recommended method of guiding fluid administration in the operating room”

"SSVV and its comparable measurement, pulse pressure variation (PPV), are not indicators of actual preload but of relative preload responsiveness. SVV has been shown to have a very high sensitivity and specificity when compared to traditional indicators of volume status (HR, MAP, CVP, PAD, PAOP), and their ability to determine fluid responsiveness.
However, limited to controlled IPPV with TV >8mL/kg and sinus rhythm."

Front 38

29. What percentage of the population have their AV node supplied by the right coronary artery?
a. 5
b. 15
c. 40
d. 40
e. 85

Back 38

E

Anatomy for Anaesthetist:
“The atrioventricular node is perfused by the right coronary artery in 80% of subjects”

Front 39

Epidural block to T2 causes all of the following EXCEPT:
A. Bradycardia
B. Vasodilatation
C. Reduced circulating catecholamines
D. Dyspnoea
E. Elevated PaCO2

Back 39

E

Front 40

Preoperative autologous blood donation results in less:
A. Cost
B. Incompatible transfusion
C. Less blood wastage
D. Less unnecessary transfusion

Back 40

B

CEACCP ‘Autologous blood transfusion’
3 methods; cell salvage, perioperative autologous donation, and acute normovolaemic haemodilution.
A – Higher than allogenic in cell salvage and PAD.
B – Correct. Theoretically less, although human error can still occur in PAD
C – Up to 50% of donated blood wasted in PAD.
D – Higher, especially in cell salvage and ANH.

Front 41

12. You see a patient in your clinic for a total knee replacement. He is 65 and has atrial fibrillation for which he takes dabigatran. He is otherwise well. A spinal anaesthetic is planned. What is the correct advice regarding his medication?
a. he should stop his dabigatran 7 days prior
b. he should stop his dabigatran 3 days prior
c. he should stop his dabigatran 3 days prior and have bridging enoxaparan
d. he should stop his dabigatran the day before and have an INR on the day of surgery
e. he should continue to take his dabigatran until the morning of surgery

Back 41

B
Spinal is same as high risk bleeding or major surgery

Front 42

24. Someone day 4 postop laparotomy with an epidural in situ. Administered enoxaparin 40mg at 8pm. When is the best time to remove the epidural catheter?
a. 6am on day 5
b. midday on day 5
c. 6pm on day 5
d. withhold the enoxaparin on day 5 and remove at 6am on day 6
e. withhold the enoxaparin on day 5 and remove at midday on day 6

Back 42

B

Aspirin / NSAID - don't worry
Clopidogrel 7 days
Prophylactic clexane 12 hours
Therapeutic clexane 24 hours
SC heparin 6 hours
IV heparin 4 hours and check APTT
Warfarin INR < 1.5

Front 43

Penetrating injury to chest. What part of the heart most likely injured?
A. RV
B. LV
C. RCA

Back 43

A
right ventricle 43%
left ventricle 34%
right atrium 16%
left atrium 7%

Front 44

Regarding a Thallium scan:
A. High NPV
B. Less useful in comparison to a DSE

Back 44

A

"The positive predictive value of reversible defects for perioperative death or MI ranged from 2% to 20% in reports that included more than 100 patients.

However, because of a very high sensitivity of abnormal stress nuclear imaging studies for detecting patients at risk for perioperative cardiac events, the negative predictive value of a normal scan has remained uniformly high at approximately 99% for MI or cardiac death."

Front 45

What is NOT a contraindication to MRI?
A. Pulmonary artery catheter
B. Arterial line
C. Scissors
D. Coiled ECG cable
E. Laryngoscope

Back 45

B

Blue Book 2005
“Invasive blood pressure transducers: These are not ferromagnetic, and are safe to use. Transducer cables should be kept out of the magnet bore, so as to avoid imagedistortion”

MRIsafety.com
“There is at least one report of a cardiovascular catheter (Swan-Ganz Triple Lumen Thermodilution Catheter) that "melted" in a patient undergoing MR imaging. This catheter contained a wire made from a conductive material that was considered to be responsible for this problem. Thus, there are realistic concerns pertaining to the use of similar devices in patients undergoing MR examinations”

Front 46

The nerve supplying area of skin between greater trochanter and iliac crest:
A. subcostal nerve
B. ilioinguinal nerve
C. genitofemoral nerve
D. femoral nerve
E. lat cutaneous femoral nerve

Back 46

A

"The anterior division of the twelfth thoracic nerve (subcostal nerve) is larger than the others; it runs along the lower border of the twelfth rib, often gives a communicating branch to the first lumbar nerve, and passes under the lateral lumbocostal arch.
It then runs in front of the Quadratus lumborum, perforates the Transversus, and passes forward between it and the Obliquus internus to be distributed in the same manner as the lower intercostal nerves.
It communicates with the iliohypogastric nerve of the lumbar plexus, and gives a branch to the Pyramidalis. It also gives off a lateral cutaneous branch that supplies sensory innervation to the skin over the hip."

Front 47

In infants with congenital pyloric stenosis
A. dehydration is associated with early hyponatremia
B. plasma chloride levels seldom fall below 85 mmol.1-I
C. renal conservation of hydrogen and potassium ions occurs
D. the urine is initially alkaline, then may become acidic
E. vomiting causes a loss of potassium ions

Back 47

D

• More common in males
• Typically 3-6wks of age
• Increased HCO3 load to distal tubule of kidney results in an alkaline urine initially. With Extreme K losses, H+ ions exchanged for K in kidney  paradoxical acidotic urine
• Main source of k loss from body is from the kidney →resulting hypokalaemia

Front 48

Preoperative assessment shows a Mallampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehane is predicted. Compared to the ML score, the TMD is
A less sensitive, less specific
B less sensitive, more specific
C more sensitive, less specific
D more sensitive, more specific
E equal sensitivity an specificity

Back 48

B

Front 49

Recognised weaknesses of systematic reviews include all of the following EXCEPT
A. publication bias
B. duplicate publication
C. study heterogeneity
D. inclusion of outdated studies
E. systematic review author bias

Back 49

From Myles and Gin, weaknesses of meta-analyses:
Publication bias – negative studies are less likely to be submitted, or accepted, for publication (A)
Duplicate publication – and therefore double-counting (B)
Heterogeneity – different interventions, different clinical circumstances (C)
Inclusion of historical (outdated) studies (D)

Front 50

What drug should NOT be used for tocolysis in 32/40 female?
A. Indomethacin
B. Magnesium
C. Nifedipine
D. Salbutamol

Back 50

A

Front 51

Following an eclamptic seizure the dose of MgSO4 is?
A. 1 gram
B. 4 grams

Back 51

B

Magnesium sulphate is now the treatment of choice for the treatment of convulsions and for the prevention of recurrent fits. Its exact mechanism of action is not known. However, it is thought to reduce the intense cerebral vasospasm which may be the cause of convulsions. A loading dose of 4 g is given over 5–10 min, followed by an infusion of 1 g.h–1.

Front 52

92. Blunt liver trauma can be treated non surgically if
A. No peritoneal signs
B. Low Grade injury on CT scan
C. Severe COPD
D. Haemodynamically stable
E. US confirms <500mls peritoneal fluid collection (i thought this was a paracentesis result)

Back 52

D

From EMST manual:
Indications for operating on spleen/liver trauma,
failure to respond to resuscitation
continued major haemorrhage > 40 ml/kg/24 hrs
suspicion of associated hollow visceral injury
severe concomitant HI, where haemodynamic instability is deleterious

Front 53

Initial dose of IV GTN to relax the uterus is?
A. 5 mcg
B. 50 mcg
C. 200 mcg

Back 53

B

Nitroglycerin provides reliable smooth muscle relaxation, rapid onset, and a short plasma half-life (1 to 3 minutes). Nitroglycerin has been administered for various obstetric emergencies without clinically significant side effects.

Dose: 50 to 100 µg

Nitroglycerin most likely produces uterine smooth muscle relaxation by releasing nitric oxide, and it may require the presence of placental tissue to be effective.

Front 54

94.New- You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?
A. amiodarone 100mg bd
B. digoxin 250mcg daily
C. enalapril 2.5mg bd
D. metoprolol 100mg bd
E. diltiazem slow release 240mg daily

Back 54

C

Angiotensin-converting enzyme inhibitors are recommended for all patients with current or prior symptoms of HF and reduced LVEF, unless contraindicated.
Use of 1 of the 3 beta blockers proven to reduce mortality (i.e., bisoprolol, carvedilol, and sustained release metoprolol succinate) is recommended for all stable patients with current or prior symptoms of HF and reduced LVEF, unless contraindicated.
Angiotensin II receptor blockers (see Table 3) are recommended in patients with current or prior symptoms of HF and reduced LVEF who are ACEIintolerant.
Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HF and reduced LVEF should be avoided or withdrawn whenever possible (e.g., nonsteroidal anti-inflammatory drugs, most antiarrhythmic drugs, and most calcium channel blocking drugs).

Front 55

CTG [pictured] demonstrating late decelerations. Most likely cause?
A. Fetal asphyxia
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency

Back 55

A

Perinatology.Com - Fetal Heart Rate Monitoring
“Early decelerations appear to be caused by vagal discharge produced when the head is compressed by uterine contractions. The onset and depth of early decelerations mirror the shape of the contraction, and tend to be proportional to the strength of the contraction.

Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in nonvital peripheral areas in order to divert more blood flow to vital organs such as the adrenal glands, heart, and brain. Constriction of peripheral blood vessels causes hypertension that stimulates a baroreceptor mediated vagal response which slows the heart rate. The time consumed in this two step process accounts for the delay in the timing of the deceleration relative to the contraction”

Front 56

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

Back 56

D

Front 57

A diagnostic test has a sensitivity of 90% and a specificity of 99% in detecting a certain disease. From this we can conclude that
A. the false positive rate of this test is 1%
B. the false negative rate of this test is 1%
C. the positive predictive value of this test is 90%
D. the negative predictive value of this test is 90%
E. this test would be a useful screening test for this disease

Back 57

A

Sensitivity = TPR
FNR = 1-sens SNOUT
Specificity = TNR
FPR = 1-spec SPIN

Front 58

SVRI.
A. SVR x BSA
B. SVR / BSA

Back 58

A

Front 59

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

Back 59

A

The 3 main features are cleft palate, micrognathia (a small jaw) and glossoptosis (airway obstruction caused by backwards displacement of the tongue base).
Craniosynostosis is a condition in which one or more of the fibrous sutures in an infant skull prematurely ossifies, changing the growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures.
Macroglossia – unusually large tongue.
Microstomia – unusually small mouth

Front 60

What is the ratio of MAC awake:MAC of sevoflurance
a. 0.2
b. 0.34
c. 0.5

Back 60

B

MAC-Awake values for sevoflurane and isoflurane obtained by slow washout were 0.34 ± 0.05 and 0.31 ± 0.05 (mean ± SD), respectively, when MAC-Awake was expressed as a ratio to age-adjusted MAC. MAC-Awake values obtained by fast washout (0.22 ± 0.07 MAC for sevoflurane, 0.22 ± 0.05 MAC for isoflurane) were significantly smaller than those obtained by slow washout. Anesthetic concentrations in the brain at first eye opening calculated with end-tidal concentrations during fast alveolar washout (0.34 ± 0.08 MAC for sevoflurane, 0.30 ± 0.08 MAC for isoflurane) were nearly equal to MAC-Awake obtained by slow alveolar washout. The difference in MAC-Awake between fast and slow alveolar washout could be explained by arterial-to-cerebral and end-tidal-to-arterial anesthetic differences.

Front 61

Essential diagnostic criteria on ECG for LBBB
A. Loss of septal Q's in V5 and V6
B. RSR in V1
C. Large slurred S in V6
D. T-waves opposite to direction of QRS
E. QRS duration minimum 0.2 s

Back 61

A

Diagnostic criteria for LBBB:
• 1) Total QRS duration >0.12 s.
• 2) No secondary R wave in V1 to indicate RBBB. 

• 3) No septal q wave in V5, V6 or in leads further to the left (lead I and aVL in horizontal hearts).

Front 62

A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestation should intraoperative monitoring of the fetus occur?
A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 30 weeks
E. 32 weeks

Back 62

B

24-26 weeks according to CEACCP 2006
From 18-22 weeks foetal heart rate monitoring is feasible
From 25 weeks heart rate variability can be observed
Though would seem no point monitoring until fetus is viable (i.e. 24wks)

Front 63

When instructing ward staff on monitoring for respiratory
depression in a patient using PCA (patient controlled
analgesia) you would advise that early respiratory depression is best detected by monitoring
A. frequency of boluses on PCA machine
B. pulse oximetry
C. pupil size
D. respiratory rate
E. sedation scores

Back 63

E

Front 64

Trauma patient. CXR (not given): air fluid levels adjacent to heart/diaphragm/ribs.
A. Ruptured diaphragm
B. Hiatus hernia

Back 64

A
B is also possible

Front 65

Intraoperative pediatric arrest during scoliosis surgery most likely due to?
A. Underappreciated degree of blood loss

Back 65

A

Front 66

Endocarditis prophylaxis in patient with MVR appropriate for?
A. Dental procedure
B. Rigid bronchoscopy
C. Upper endoscopy with biopsy
D. D&C
E. Lithotripsy

Back 66

A

2007 AHA Endocarditis Prophylaxis
• All dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa
• Procedures on respiratory tract
• Procedures on infected skin, skin structures, or musculoskeletal tissue
• Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures including vaginal delivery and hysterectomy
• Note: AN prophylaxis is not recommended for bronchoscopy unless the procedure entails incision of the respiratory mucosa

Front 67

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

Back 67

B

If the question was live and neutral (assuming no incidental leakage to earth), macroshock (answer B)
If the question was live and earth (or live alone with earth leakage), the RCD will trip to protect him (answer C)
If the question was neutral and earth, he is safe, and the fuse won’t blow (answer A).

Front 68

Severe asthma attack. Given continuous nebs & IV hydrocortisone but not responding. PaCO2 low. SpO2 low. Next appropriate treatment?
A. IV Magnesium
B. IV Aminophylline
C. Heliox
D. IV salbutamol infusion
E. Intubate/ventilate

Back 68

A

Front 69

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

Back 69

A

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

Front 70

Best position for IABP is 1-2 cm:
A. Distal to Left SCA
B. Proximal to Left SCA
C. Distal to artery of Adamkiewicz
D. Distal to renal artery
E. Proximal to renal artery

Back 70

A

Front 71

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

Back 71

A

Front 72

The diagram below is of a transgastric short axis view obtained during a transoesophageal echocardiography examination. Which letter corresponds to the area supplied by the right coronary artery?
A. A
B. B
C. C
D. D
E. E

Back 72

A

Front 73

Cephalothin doesn't cover:
a. Proteus
b. E coli
c. Staph
d. Strep
e. Pseudomonas

Back 73

E

Front 74

CHADS2 score. Which is not a feature?
A. Age
B. Gender
C. Diabetes mellitus
D. Stroke
E. CCF

Back 74

B
CCF +1
HT +1
Age > 75, +1
DM +1
Stroke/TIA/arterial thrombus event, +2 (but NOT deep vein thrombosis)

Front 75

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

Back 75

C

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

Front 76

Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have
A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism

Back 76

B

Total plasma calcium concentration is reduced in CRF. Renal production of calcitriol (1,25-(OH)2D3) declines causing decreased intestinal absorption of calcium. Phosphate excretion is impaired as GFR falls below 20 ml min–1 and hyperphosphataemia develops. As phosphate concentrations increase, calcium phosphate is deposited in soft tissues such as skin and blood vessels further lowering plasma calcium concentration. Hyperphosphataemia also has a negative effect on 1-α-hydroxylase, the enzyme responsible for renal calcitriol production.
Both hypocalcaemia and hyperphosphataemia are potent stimuli to parathormone secretion, leading to hyperplasia of the parathyroid gland and secondary hyperparathyroidism. This causes increased osteoclast and osteoblastic activity causing osteitis fibrosa cystica. Patients usually tolerate hypocalcaemia remarkably well, whilst oral calcitriol is prescribed and calcium carbonate is used both as an intestinal phosphate binder and a source of calcium.

Front 77

Meconium stained liquour but neonate delivered is vigorous. Rationale for NOT suctioning the neonate?

A. May aspirate meconium
B. May cause bradycardia
C. May cause hypertension

Back 77

B

It does not alter outcome (ARC Guidelines neonatal resus, level II evidence)
And certainly can cause vagal response

Front 78

Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive
B: Start antiplatelet drugs
C: Start anticonvulsants
D: Do angio and stent
E: Nimodipine

Back 78

A

Postoperative cerebral hyperperfusion syndrome is an abrupt increase in blood flow with loss of autoregulation in the surgically reperfused brain and is manifested as headache, seizure, focal neurologic signs, brain oedema, and possibly intracerebral haemorrhage. It is believed to result from blood flow to the brain which is greatly in excess of its metabolic need. It may not occur until several days after surgery.
Post-CEA hypertension is significantly associated with adverse events. The causes are not well understood, but surgical denervation of the carotid sinus baroreceptors is probably contributory. Post operative hypotension and bradycardia do not appear to correlate with outcomes.
Therefore aggressive treatment of hypertension to reduce cardiac work, cerebral hyperpefusion and neck haematoma seems logical.

Front 79

National labelling standards endorsed by ANZCA. What colour should the label on a brachial plexus catheter infusion be?
A. Red
B. Blue
C. Beige
D. Yellow
E. Pink

Back 79

D

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

Front 80

Which of the following are feature of Conn’s syndrome?
A. Normoglycaemia, hypernatremia , hypokalemia
B. Hypoglycaemia, hypernatremia, hypokalemia
C. Hyperglycaemia, hyponatremia, hyperkalemia
D. Normoglycaemia, hyponatremia, hyperkalemia
E. Hypoglycaemia, hyponatremia, hyperkalemia

Back 80

A

Primary hyperaldosteronism is one of the more common causes of secondary hypertension. The term Conn's syndrome is used for primary hyperaldosteronism secondary to an adrenal adenoma secreting aldosterone.
2 major groups of primary hyperaldosteronism:
due to adrenal adenoma (aldosteronoma)
due to bilateral adrenal hyperplasia (of the zona glomerulosa)
Aldosterone acts in kidney to increase Na+ reabsorption and increase K+ and H+ secretion. Therefore:
Hypertension
Hypokalaemia
Metabolic alkalosis
Hypomagnesemia and hypoglycaemia may also be present
Usually won’t cause hypernatraemia unless free water intake restricted.

Front 81

A patient has suffered flash burns of the upper half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burned is
A. 18%
B. 23%
C. 32%
D. 41%
E. 48%

Back 81

C

Rule of 9’s: 4.5 + 18 + 9

Front 82

Dural Sac ends at what level in a neonate?
A. L1
B. L3
C. L5
D. S1
E. S3

Back 82

E

NYSORA
“The dural sac in neonates and infants also terminates in a more caudad location compared to adults, usually at about the level of S3 compared to the adult level of S1”

Front 83

SpO2 90%. No IV access. Place LMA and laryngospasm. Most appropriate course of action?
A. Increase inhaled sevoflurane concentration with LMA in situ
B. Increase inhaled sevoflurane concentration after removing LMA
C. Intralingual suxamethonium (no dose stated)
D. Intramuscular suxamethonium (no dose stated)
E. Intramuscular atropine (no dose stated)

Back 83

B

Front 84

Incarcerated inguinal hernia in a child with a mild URTI. Most appropriate course of action?
A. Postpone for 2 weeks
B. Continue without ETT
C. Continue with careful monitoring

Back 84

C

Front 85

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

Back 85

A

Prodrug activated by P450 system. Active metabolite has 6-8 hour half life with hepatic metabolism.
Thienopyridine class antiplatelet agent which works by irreversibly inhibiting a receptor called P2Y12, an adenosine diphosphate (ADP) chemoreceptor on platelet cell membranes.
Therefore duration of action is related to platelet half life, ie 5-7 days.

Front 86

Patient with subdural hematoma and PPM for ?AV ablation. PPM technician >1 hour away. Surgeon wishes to proceed immediately. Do you?
A. Postpone and await a cardiologist review
B. Postpone and await arrival of PPM technician
C. Postpone and insert a transvenous temporary PM
D. Proceed after institution of transcutaneous pacing.
E. Proceed with a magnet handy.

Back 86

E

Does depend how urgent surgery is and how much info you have re. pacemaker, mode, magnet response

If it is urgent, I would crack on with magnet in case there was inappropriate inhibition and you need asynchronous mode ASAP

Transcutaneous pacing should be available but not necessarily started

Front 87

Which of the following does NOT occur following bilateral lung transplant?
A. Impaired mucociliary clearance
B. Impaired lymphatic drainage
C. Impaired HPV

Back 87

C

Anesthetic Challenges in Patients After Lung Transplantation. The Internet Journal of Anesthesiology
“Hypoxic pulmonary vasoconstriction is intact in the pulmonary allograft so during an episode of rejection, pulmonary blood flow may be directed away from the transplanted lung”

Front 88

20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid fluid volume resuscitation for the first hour is
A. 160 ml
B. 260 ml
C. 360 ml
D. 460 ml
E. 660 ml

Back 88

C

Parkland formula 4 x kg x % of bur half in first 8 hours and half in 16 hours
Plus maintenance 4/2/1 rule

60mL/h maint + 4 * 15 * 20 = 1200mL
600 mL first 8 hours, 6 hours already gone. Therefore 300mL per hour for 2 hours, plus 60mL/h maint, = 360

Front 89

Complications of mediastinoscopy include all of the
following EXCEPT
A. air embolism
B. cardiac laceration
C. pneumothorax
D. recurrent laryngeal nerve palsy
E. tracheal compression

Back 89

B

Plummer et al. Anaesthesia for telescopic procedures in the thorax BJA 1998
Major complications of mediastinoscopy

• Haemorrhage
• Pneumothorax
• Recurrent laryngeal nerve injury
• Air embolism
• *Compression of vessels
• Aorta → reflex bradycardia
• Innominate artery ( R brachiocephalic trunk)
• Right carotid → hemiparesis
• Right subclavian → loss of right radial pulse
• Compression of trachea

Front 90

What sign most suggests a significant murmur in a child?
A. 4/6 loudness
B. ????vibratory/flutter sound

Back 90

A

Front 91

Thoracodorsal nerve arises from?

Back 91

The thoracodorsal nerve is a branch of the posterior cord of the brachial plexus, and is made up of fibres from the posterior divisions of all three trunks of the brachial plexus.
It derives its fibers from the sixth, seventh, and eighth cervical nerves.

Anatomy for Anaesthetist – ‘Branches of the Posterior Cord’
“The nerve to latissimus dorsi (thoracodorsal nerve) (C6–8) arises between the upper and lower subscapular nerves. It accompanies the subscapular vessels along the posterior axillary wall and supplies latissimus dorsi”

Front 92

Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?
A. Medial antebrachial cutanous nerve

Back 92

Medial cutaneous nerve of forearm actually (= median antebrachial nerve)
Smallest branch of brachial plexus, arises from medial cord, derived from C8-T1

Front 93

Thermoneutral zone in 1 month old infant ?
A. 26 – 28 degrees Celcius
B. 28 – 30 degrees Celcius
C. 30 – 32 degrees Celcius
D. 32 – 34 degrees Celcius
E. 34-46 degrees celcius

Back 93

D

Adult = 25-28
Neonate = 32-35

Front 94

Indicative of severe AS?
A. Palpitations
B. Fatigue
C. PND
D. Angina
E. Syncope

Back 94

C

Front 95

Risk factor for PPH?
A. Prolonged labour
B. Age <20 yrs old
C. Primiparity
D. FV Leiden Deficiency (yes it said deficiency!)
E. Oligohydramnios

Back 95

A

Front 96

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

Back 96

C

Front 97

Fat:blood coefficients?
A. N2O~Des > Sevo > Iso
B. N2O > Des > Sevo~Iso
C. Sevo~Iso > Des > N2O

Back 97

C

Sevo ~Iso > Des > N2O

Front 98

18/12 old undergoing routine SV GA under LMA. Sudden onset SVT with HR 220 BP 84/60 ETCO2 32 SpO2 98.Management:
A. Adenosine 100mcg/kg
B. DCR 2J/kg
C. DCR 4J/kg
D. Amiodarone 5mg/kg
E. CPR

Back 98

A

Front 99

Clinically the most significant murmur in pregnancy is?
A. MS

Back 99

A

Front 100

Required for diagnosis of Neuroleptic Malignant Syndrome
A. Diaphoresis
B. ↑ CK
C. Rigidity
D. Hypertenion
E. ↑ HR

Back 100

C

According to DSM-IV rigidity must be present.

Front 101

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

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

Back 101

C

Front 102

32 y/o male. Weakness distal and prox muscles, infection 10 days ago, no sensory involvement, temp 37.8, facial weakness. Cause:
A. Guillian Barre
B. Myasthenia Gravis
D. Poliomyelitis
E. ?Acute encephalitis
F. ?Polymyositis

Back 102

A

"An acute polyneuropathy, a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom, and some subtypes cause change in sensation or pain, as well as dysfunction of the autonomic nervous system."

MG: Antibody to NAChR, fatiguability, weakness, treat with anticholinesterase and immune suppression. Can cause bulbar weakness. Eye symptoms common.
Eaton-Lambert: similar to MG, but antibody to pre-synaptic Ca channels. Exercise improves strength, analagous to PTC.

Front 103

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

Back 103

A

Front 104

Circuit disconnection during spontaneous breathing anaesthesia
A. will be reliably detected by a fall in end-tidal carbon dioxide concentration
B. will be detected early by the low inspired oxygen alarm
C. will be most reliably detected by spirometry with minute volume alarms
D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
E. can be prevented by using new, single-use tubing

Back 104

D

Front 105

A 23 year old man takes his buprenorphine patch off prior to surgery. When can you expect the plasma level to be half?
a. 6 hours
b. 12 hours
c. 24 hours
d. 36 hours
e. 48 hours

Back 105

B

Norspan product information
“After removal of a NORSPAN patch, buprenorphine concentrations decline, decreasing approximately 50% in 12 hours (range 10 - 24 h)”

Front 106

How do you calculate the inspiratory time constant for lungs
A. resistance multiplied by compliance
B. resistance divided by compliance
C. compliance divided by resistance
D. resistance minus compliance
E. resistance plus compliance

Back 106

A

Front 107

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

Back 107

D

BJA (1999) 83 (1): 50-57
For an infant of 9 months, whose peak flow is approximately 10L/min, the pressure decrease across the systems tested by Orkin, Siegal and Rovenstein should be less than 0.25 cm H2O. In contrast, the pressure decrease across a 3.5-mm tracheal tube in a 3-month-old infant with a peak flow of approximately 6L/min should be approximately 2.5 cm H2O. These values suggest that the resistance of the tracheal tube in a young infant is at least 10 times that of the circle system.

Front 108

Iron deficiency anaemia:
A. Low ferritin, low serum iron
B. Low ferritin, low TIBC
C. Elevated ferritin, low marrow iron
D. Elevated ferritin, ?
E. Elevated ferritin, ?

Back 108

A

Front 109

Long-standing T6 paraplegia. Which is INCORRECT?
A. Flaccid paralysis
B. Poikilothermia
C. Labile BP

Back 109

A

Front 110

You see a patient in the pre-op clinic. He is on propranolol for treatment of long QT syndrome. Which of the following will give the best reassurance that his treatment is effective?
a. normal QT interval on resting ECG
b. no change in QT interval with valsalva
c. HR less than 60
d. no arrhythmias on 24h holter monitor

Back 110

B

Long QT syndrome and anaesthesia. BJA 2003
“The mainstay of treatment of congenital LQTS since 1975 has been beta‐block”
“The dose of β‐blocker is determined by ensuring a reduction in maximal heart rate on treadmill exercise testing to 130 beats min–1 or less… where exercise testing is impractical, there should ideally be no change in the QT interval in response to a Valsalva manoeuvre”
“The QTc is unchanged despite efficacy of treatment, although QTD is higher in patients who do not respond to β‐block

Front 111

Lap chole on citalopram. What is NOT relatively contraindicated?
A. Omeprazole
B. Clonidine
C. Pethidine
D. Tramadol
E. ?Midazolam

Back 111

B

Citalopram shares CYP3A4 metabolism with midazolam
Citalopram shares CYPC19 metabolism with omeprazole
Tramadol and pethidine with citalopram may be relatively contraindicated due to serotonin syndrome concerns

Front 112

Most effective treatment for post-sevoflurane agitation following grommets in a 4yo child?
A. 1 mg/kg propofol
B. 1 mcg/kg fentanyl
C. 1 mcg/kg clonidine
D. ?dose midazolam
E. Sucrose

Back 112

B

Reference from paeds textbook (coats,) says opioids are most effective

Front 113

What is NOT useful in the treatment of Torsades?
A. Isoprenaline
B. Procainamide
C. DCCV
D. Electrical pacing
(Amiodarone was not an option)

Back 113

B

Procainamide prolongs the QT interval

Front 114

Incidence of fat embolism following closed femoral fracture?
A. 0 -3%
B. 4 – 7%
C. 8 -11%
D. 12 – 15%
E. 16 - 19%

Back 114

A
Fat Embolism - CEACCP 2007
“Any single long bone 1-3%”
“It has been reported in up to 33% of patients with bilateral femoral fractures”

Front 115

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

Back 115

C

Front 116

140. (Sep 2011)- Modified Cormack and Lehane grade - You cannot see beyond the epiglottis and there is a little space between the epiglottis and the posterior pharyngeal wall
A. 2a
B. 2b
C. 3a
D. 3b
E. 4

Back 116

C

Front 117

involving: Numb tongue and impaired taste sensation post LMA anaesthesia.
A. Facial Nerve
B. Mandibular division of CNV
C. Lingual Nerve

Back 117

C

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

Front 118

Lateral approach to popliteal block.
A. Passes through semimembranosis
B. May be performed supine or prone
C. Adequate for ankle surgery
D. Less effective in comparison to posterior approach
E. Eversion is an endpoint for nerve stimulation

Back 118

B

A. No, needle passes through biceps femoris, semimembranosis is posterior.
B. Yes
C. No, will miss the medial aspect innervated by the saphenous (femoral) nerve.
D. No
E. No, eversion is a common peroneal nerve effect. Plantar flexion is sciatic/tibial nerve

Front 119

Factors associated with post-operative ulnar nerve palsy
include all of the following EXCEPT
A. male gender
B. sternal retraction for cardiac surgery
C. cardiopulmonary bypass for cardiac surgery
D. internal jugular vein catheterisation
E. diabetes mellitus

Back 119

C

See CEACCP ‘Perioperative peripheral nerve injuries’ and http://www.anesthesia-analgesia.org/cgi/reprint/91/6/1358

Ulnar nerve palsy is the most common form of neuropraxia.
Risk factors
Male
Diabetes (due to preexisting neuropathy)
Positioning
Operations with midline sternotomy (e.g. cardiac surgery)
Direct trauma e.g. needles such as IJ cannulation
Thermal injury e.g. diathermy
Surgical trauma e.g. orthopaedics
Option C - False - Ulnar nerve palsy is described with cardiac surgery, but this is related to sternotomoy and retraction, not bypass usage per se.

Front 120

In a rotameter the
A. bobbin spins inside a tube that has parallel sides
B. flow is laminar at high flow rates
C. height of the bobbin is proportional to the pressure drop across the bobbin
D. pressure drop across the bobbin is constant at varying flows
E. resistance increases with increasing gas flow

Back 120

D
F = MA mass of bobbin and A is gravity both should be constant
P = F/A area of the bobbin does not change

Front 121

40. A 6 year old child is ventilated in ICU following a head injury. His plasma Na is 142. Which is an appropriate choice of maintenance fluid?
a. 0.3% NaCl with 3.3% dextrose
b. 0.9% Nacl
c. Hartmans solution with 5% dextrose
d. N/2 with 5% dextrose
e.

Back 121

B

UB ‘Head injury - ICU management’. Not a paeds paper but quite good.
The maintenance fluid of choice is normal saline with supplemental potassium
The stress response in trauma patients, including those with severe TBI, generates a hypercatabolic state leading to rapid muscle protein breakdown and hyperglycaemia.

Front 122

Young woman with subarachnoid haemorrhage, hyponatraemia and increased urinary sodium (did not specify if high sodium concentration or total amount lost). What is likely cause?
A. cerebral salt wasting syndrome
B. SIADH
C. HHH therapy
D. Excess NS administration
E. diabetes insipidus

Back 122

A or B. Need to know if patient is euvolaemic

A. Cerebral salt wasting follows CNS injury, and is like SIADH except that there is evidence of hypovolaemia
B. SIADH: Hyponatraemia, hyposmolarity, urine osmolarity >100 (normal minimum 40-100). Urine output determined usually by water intake, but given SIADH causes fixed ADH secretion urine output instead becomes dependant on salt intake (and excretion) only.
C. No
D. No
E. No: Central diabetes insipidus: caused by inadequate secretion of ADH. Polyuria, hypernatremia, hyperosmolarity, dilute urine
(Nephrogenic diabetes insipidus: Resistance to action of ADH on the kidneys. Polyuria, high normal or hypernatraemia, high normal or hyperosmolarity, dilute urine)

Front 123

Regarding mixed venous blood oxygen saturation, which statement is correct?
a. it is collected from the right atrium
b. it is used to calculate cardiac output
c. it can be used to accurately measure the mixed venous pO2
d. it has no impact on the A-a gradient
e. it is usually 40%

Back 123

D

A – No, pulmonary artery. If it comes from a CVC it is central venous blood, not mixed.
B – No, it can be used to estimate CO trends, but not calculate.
C – No, too many variables to shift O2-Hb dissoc curve either way. It could estimate this though.
D – I think this is right, SvO2 should not effect A-a gradient in the absence of lung pathology.
E – No, Normal is 75% (i.e. tissue oxygen extraction 25%)

Front 124

Cerebral oximetry measures?
A. Arterial saturation
B. Mostly arterial saturation and some venous saturation
C. Capillary saturation
D. Mostly venous saturation and some arterial saturation
E. Venous saturation

Back 124

D


Cerebral NIRS devices measure mean tissue oxygen saturation and, as such, reflect haemoglobin saturation in venous, capillary, and arterial blood comprising the sampling volume. For cerebral cortex, average tissue haemoglobin is distributed in a proportion of 70% venous and 30% arterial.
The use of cerebral NIRS as a trend monitor with interventions designed to preserve cerebral saturation values close to their individual baseline values has produced a significantly lower incidence of adverse clinical events in patients undergoing coronary artery bypass (CAB) surgery.

Front 125

Ciliary ganglion
A sympathetic from inferior cervical ganglion
B located inferiorly within orbit
C may be damaged during a peribulbar block
D preganglionic parasympathetic supply from the supra trochlear nerve
E preganglionic parasympathetic originates from the Edinger Westpal nucleus

Back 125

E

Front 126

Normal systolic BP at birth?
A. Something less than 70 mmHg
B. 70 mmHg
C. 85 mmHg
D. Something more than 85 mmHg
E. 115 mmHg

Back 126

B

Depends on birth weight, gestation
OHA says “normal systolic blood pressure is 70-90mmHg”

NETS Victoria - Neonatal Handbook (which references Nuntnarumit P, Yang W, Bada-Ellzey HS. Blood pressure measurements in the newborn. Clin Perinatol 1999)

Front 127

Urgent reversal of INR 4.5. Intern already gave vitamin K.
A. FFP
B. Prothrombinex
C. Prothrombinex AND FFP

Back 127

C

Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. MJA 2004

Cease warfarin therapy, give 5.0–10.0 mg vitamin K1 intravenously, as well as Prothrombinex-HT (25–50 IU/kg) and fresh frozen plasma (150–300 mL), assess patient continuously until INR < 5.0, and bleeding stops.§
OR
If fresh frozen plasma is unavailable, cease warfarin therapy, give 5.0–10.0 mg vitamin K1 intravenously, and Prothrombinex-HT (25–50 IU/kg), assess patient continuously until INR < 5.0, and bleeding stops.§
OR

If Prothrombinex-HT is unavailable, cease warfarin therapy, give 5.0–10.0 mg vitamin K1 intravenously, and 10–15 mL/kg of fresh frozen plasma, assess patient continuously until INR < 5.0, and bleeding stops.§

Front 128

Major cause of death following difficult intubation with perforated oesophagus?
A. Sepsis
B. Failure to intubate
C. Failure to ventilate

Back 128

A

Front 129

Which is a specific PDE inhibitor?
A. Theophylline
B. Dipyridimole
C. Milrinone

Back 129

C

Theophylline = methylxanthine, nonselective phosphodiesterase inhibitor
Dipyridimole = Can find mentions of PDE 5 PDE 10 and PDE 11
Milrinone = phosphodiesterase-3 inhibitor

Front 130

Maximum dose of local infiltration of 0.5% bupivacaine in an x kg child?
A. dose corresponding to 2.5 mg/kg; there was no option corresponding to 2 mg/kg

Back 130

A

"From anaesthesia UK site, toxic dose
2mg/kg plain
2.5mg/kg with adrenaline"

Front 131

Loading dose of IV paracetamol in x kg child?
A. dose corresponding to 20 mg/kg

Back 131

A

Front 132

20. A neonate is inadvertently given a total spinal. What would be the first sign?
a. hypotension
b. bradycardia
c. loss of consciousness
d. tachycardia
e. apnoea

Back 132

E

No clear answer that I could find but:
One source said infants are much more resistant the haemodynamic effects of total spinal, so A and B are likely wrong.
As most caudal blocks are done in anaesthetised (but spontaneously breathing) infants, C is probably not correct.
Total spinal causes bradycardia, so D is wrong.
Therefore, correct answer E.

Front 133

Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?
A. Sedation
B. Urinary retention

Back 133

A

CEACCP ‘Epidural analgesia for children’
Associated with a greater risk of sedation, apnoea (particularly neonates and infants) or nausea

Front 134

New onset AF. For what period of time is it safe to perform DCCV without prior TOE to exclude thrombus?
A. <24 hours
B. <48 hours

Back 134

B

Cardioversion of Atrial Fibrillation for Maintenance of Sinus Rhythm: A Road to Nowhere. Circulation 2009
“The current treatment guidelines suggest it is permissible to cardiovert patients without continued anticoagulation in those for whom it is known that the duration of AF is <48 hours”

Front 135

Regarding remifintanil, which is incorrect?
a. high potency
b. metabolised by pseudocholinesterase
c. muscle rigidity in high doses
d. weakly active metabolite
e. short context sensitive half time

Back 135

B

Metabolised by non-specific tissue and plasma esterase

Front 136

Off-label use of a drug refers to all of the following EXCEPT:
A. Different age-group
B. Different indication
C. Different concentration
D. Different route of administration

Back 136

C
Off-label use of medicines: consensus recommendations for evaluating appropriateness. MJA 2006; 185 (10): 544-548
“Examples include use in a different indication, patient age range, dose or route”

Use of “Off Label” or Drugs beyond Licence in Pain Medicine. ANZCA Faculty of Pain Medicine
“The term “off-label use” may pertain to an unapproved indication, route of administration, age group, or dose. The term does NOT relate to any prescribing conditions outlined by the PBS”

Front 137

Labour epidurals increase maternal and foetal temperature. This results in neonatal
A. Increased sepsis
B. Increased investigations for sepsis
C. increased non shivering thermogenesis
D. Increased need for resuscitation
E. Cerebral palsy

Back 137

B

Front 138

ASA grading was introduced to
A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk

Back 138

C

Front 139

Compared to lignocaine, bupivacaine is
A. Twice as potent
B. Three times as potent
C. Four times as potent
D. Five times as potent
E. Same potency

Back 139

C

Front 140

Best agent to decrease both gastric volume and gastric acidity?
A. Omeprazole
B. Ranitidine
C. Metoclopramide
D. Cisapride
E. Na citrate

Back 140

B

Front 141

Young female having cholecystectomy. Venous air embolus:
A. Mechanical ventilation and PEEP is part of treatment strategy
B. Most likley to occur at initial gas insufflation, but can occur at any time
C. Inert gas (argon, xenon) is safer
D.
E.

Back 141

B

Miller 7th ed. p. 2188
"This complication develops principally during the induction of pneumoperitoneum, particularly in patients with previous abdominal surgery."

Front 142

Diastolic dysfunction is NOT caused by:
A Adrenaline
B Aortic stenosis
C Hypertension
D myocardial fibrosis
E ?

Back 142

A

Front 143

Amniotic fluid embolism. Cause of death in first half hour ?
A. Pulmonary hypertension
B. Malignant arrhythmia
C. Pulmonary oedema
D. Hypovolaemic shock
E.

Back 143

A

Front 144

Nerve block for anaesthesia over anterior 2/3 of ear?
A. C2
B. Mandibular nerve
C. Maxillary nerve
D. Ophthalmic nerve
E. Vagus

Back 144

B

Front 145

Central anticholinergic syndrome, which is NOT true:
A. Will improve with neostigmine
B. Peripheral anticholinergic symptoms
C. Caused by Anti-Parkinson drugs
D. CNS depression
E. Associated with agitation, delirium, and ???

Back 145

A

Front 146

In an acute malignant hyperthermia episode
A. the serum creatine kinase level peaks within one hour
B. the peak serum creatine kinase level is a good indicator of the amount of muscle involved
C. elevated creatine kinase levels contribute to acute renal failure
D. the serum myoglobin level does NOT peak for at LEAST 24 hours
E. muscle rigidity occurs in 75% of cases

Back 146

E