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150 Cards in this Set

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


A. The double insulation of the device will prevent macroshock when the outer casing is touched


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


C. Equipotential earthing will prevent microshock


D. The Line Isolation Monitor will alarm and disconnect power to the device


E. The RCD will rapidly disconnect the device from the power supply

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






Because the earthed equipment casing will provide a low resistance pathway for conduction resulting in high electrical current. This assumes that there isn't an isolation transformer in the circuit. There is also a fuse in the case.




Class I : Equipment in this class makes use of the wire from equipment case to earth to provide protection.


Class II equipment relies on at least two layers of insulation to provide protection.


Class III equipment uses low voltages provided by batteries or special power supplies to be "safe". Lower voltages are considered to be safer than high voltages.

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


A. Yellow


B. Beige


C. Pink


D. Blue


E. Red

C. Pink




A: neuraxial


B: subcutaneous


D: Venous


E: Arterial

3. An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is


A. 400mL


B. 500mL


C. 600mL


D. 700mL


E. 800mL

C. 600mL




MABL = EBV x (HCT – Minimum HCT) / HCT


= 30x70x (35-25/35)


=600




Where EBV = 70ml/kg for child and adult, 80ml/kg for infant, 90ml/kg for neonate





4. A 30 year-old pregnant patient develops contractions at 30/40 weeks gestation - which of the following cannot be used for tocolysis


A. Clonidine


B. Indomethacin


C. Magnesium


D. Salbutamol


E. Nifedipine

A. Clonidine




Not a tocolytic.


“Transplacental passage of indomethacin has been shown to be minimal early in gestation, although it crosses freely near term. This is one reason indomethacin has always been considered an attractive tocolytic agent before 32weeks.” http://www.gyncph.dk/procedur/ref/obstet/indometacin%202012.pdf


5.A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain, prior to having a seizure and losing consciousness. Which drug should NOT be given?


A. Pethidine


B. Diazepam


C. Haematin


D. Suxamethonium


E. Pregabalin

?? Recent article suggests all are safe.


Choose between A and B




From OHEIA:


- probably safe: pethidine


- controversial: diazepam




Porphyrias: inherited disorders of haem synthesis.


CEACCP Porphyrias 2012:


"Seizures can be safely terminated with benzodiazepines"


"Gabapentin, pregabalin, amitriptylline are safe drugs to treat neuropathic pain"


"Sux and all NDMR are safe"


"Pethidine (meperidine) = safe"


General treatment: remove precipitants, give haem arginate, supportive measures




Micromedix: "Haem is given IV as its derivatives: haematin or haem arginate (reportedly more stable as the salt)"


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


A. Glycerol trinitrate


B. Metoprolol


C. Morphine


D. Hydrochlorthiazide


E. Salbutamol

B. Metoprolol




Beta blockers useful to reduce HR and negative inotropy improves coronary perfusion


HOCM goals: low NHR, SR, good preload/volume, high N SVR, low ventricular contractility (do notuse inotropes) OHA p72


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


A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future mycocardial infarction


B. Arrange coronary angiogram as an inpatient prior to discharge


C. Inform the patient that while the result is real the significance is questionable


D. Repeat in a weeks time as a second troponin is a better indicator of long-term myocardial infarction risk


E. Ignore the result as it is likely a laboratory error

A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future mycocardial infarction




"Kimand colleagues7 measured cTnI on the first 3 postoperative days in patients undergoing major vascular surgery; 12% had an elevated cTnI on routine postoperative surveillance although only 3% had AMI according to WHO criteria.They found that a raised cTnI was associated with a six-fold increased risk of death and a 27-fold increased risk of MI in the 6 months following surgery.There was a dose–response relationship between postoperative cTnI concentration and mortality. Landesberg and colleagues demonstrated a substantial increase in perioperative cardiac risk when even minor elevations in cTn occur in patients having undergone vascular surgery. A relationship existed between the finding of ischaemia with continuous ECG monitoring and elevations of troponin; the more prolonged the ischaemia the greater the cTn increase. Those with the greatest cTn concentrations had increased chance of a subsequent cardiac event and worse long-term mortality. Even minor elevations in cTn during first three postoperative days predicted increased risk."


CEACCP 2008: Cardiac troponins:their use and relevance in anaesthesia and critical care


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


A. Factor V Leiden


B. Protein S deficiency


C. Haemophilia B


D. Antithrombin III deficiency


E. Protein C deficiency

C. Haemophilia B




Factor IX deficiency (X-linked recessive so usually only males affected)




A. B. D. E. Thrombophilia



9. What is the most cephalad intervertebral space at which a spinal can be sited in a neonate where the risk of damage to the spinal cord is minimal


A. L1/2


B. L2/3


C. L3/4


D. L4/5


E. L5/S1

C. L3/4




Termination of spinal cord at L3.


Termination of sac at S3

10. St John's Wort (Hypericum perforatum) potentiates the effects of


A. Dabigatran


B. Heparin


C. Warfarin


D. Aspirin


E. Clopidogrel

E. Clopidogrel




via induction of CYP450 2C9

11. You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves:


A. facial, trigeminal, glossopharyngeal


B. facial, trigeminal, vagus


C. glossopharyngeal, trigeminal, vagus


D. trigeminal, glossopharyngeal, vagus


E. trigeminal, vagus, glossopharyngeal



Trigeminal, glossopharyngeal, vagus




Trigeminal:Terminal branches of ophthalmic and maxillary divisions of trigeminal nervesupply nasal turbinates and cavity. Anterior ethmoid nerve (arises fromolfactory n CN1) innervates nares and ant 1/3 of nasal septum.




Glossopharyngeal:Oropharynx and posterior 1/3 of tongue




Vagus: epiglottis and distal airway

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


A. Troponin


B. ST-segment elevation


C. Transoesophageal echocardiography


D. Coronary Angiogram


E. Electrocardiogram

C. Transoesophageal echocardiography




DDx:


- pericardial effusion


- perforation: artial, aortic


- cardiac tamponade




http://ceaccp.oxfordjournals.org/content/early/2012/05/26/bjaceaccp.mks032.full

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


A. Age


B. History of hypertension


C. History of CVA


D. History of diabetes


E. Time on Bypass

A. Age




http://eurheartj.oxfordjournals.org/content/30/4/410.full


Atrial fibrillation following cardiac surgery: Clinical features and preventative strategies


The overall incidence of post-operative AF depends on arrhythmia recording method with the best diagnostic value using continuous ECG monitoring techniques. Advanced age has been shown the best predictive clinical factor, whereas other features, including ECG and echocardiographic parameters, lack a high specificity and positive prediction value.

14. A man with a history of Parkinsonsdisease has undergone uncomplicated general anaesthetic for a knee replacement but develops post-operative nausea and vomiting (PONV). He received 4mg dexamethsone intraoperatively as prophylaxis. What would you use to treat his PONV in recovery?


A. Dexamethasone


B. Prochloperazine


C. Metoclopramide


D. Droperidol


E. Ondansetron

E. Ondansetron




Avoid: droperidol, metoclopramine, prochlorperazine


If dexamethasone given as prophylaxis, give alternative in recovery.



15.Which of the following is of the least benefit in the treatment of severe anaphylaxis?


A. Cardiopulmonarybypass


B. Nebulised salbutamol


C. IV crystalloid


D. IV vasopressin


E. Subcutaneous adrenaline

E. subcutaneous adrenaline






Evidence of less reliable absorption of subcutaneous adrenaline secondary to local vasoconstriction. http://www.rch.org.au/clinicalguide/guideline_index/Anaphylaxis/


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


A. Class 1


B. Class 2


C. Class 3a


D. Class 3b


E. Class 4

B. Class 2




1. No symptoms


2. Symptoms with activity beyond ADLs


3. Symptoms with ADLs


4. Symptoms at rest

17. The percentage of post dural puncture headaches that would resolve spontaneously by 1 week is closest to


A. 90%


B. 70%


C. 50%


D. 30%


E. 10%

B.

B. 70%




72% within 7 days


87% within 6 m


93% within 12m




http://bja.oxfordjournals.org/content/91/5/718.full



18. Which piece of airway equipment is designed for use with a fibreoptic bronchoscope


A. Aintree intubation catheter


B. Cook’s airway exchange catheter


C. Frova introducer


D. ?


E. ?

A. Aintree intubation catheter




Aintree intubation catheter is a Bougie designed foruse with a FOB which passes through it. It’s an adaptation of a Cook exchangecatheter with a wider internal diameter so the FOB (paediatric) fits.


Frova is basically a Bougie with the option to ventilate down it.

19.A 50 year old lady is seen at the pre-operative assessment clinic, she is on 150mg/day methadone, what is the most likely ECG change to be found in her pre-op ECG?


A. Prolonged PR interval


B. Prolonged QTc


C. ST depression


D. U wave


E. Tented T-waves

B. Prolonged QTc




May prolong QT as high dose

20. Current guidelines regarding cardiopulmonary resuscitation include all of the following EXCEPT


A. Allow equal time for chest compression and relaxation


B. Give 2 rescue breaths before commencement of CPR


C. Chest compression at 100bpm


D. Chest compressions should be at least 5cm depth


E. Chest compression to breath ratio at 30:2

B. Give 2 rescue breaths before commencement of CPR



21.When a 3 lead ECG is applied correctly in the CS5 position, you will monitor lead II when you suspect which of the following conditions


A. Anterior ischemia


B. Inferior ischemia


C. Lateral ischemia


D. Atrial ischemia


E. Posterior ischemia

B. Inferior ischemia




CS5 = normalapplication.


CM5 =clavicle / manubrium / v5. Chooselead I. Detects up to 80% of left ventricle ischaemia.




Cs5:


R arm --> R clavicle


L arm --> V5


L leg --> ground




Lead I = Anterior Ischaemia


Lead II = Inferior Ischaemia (2 "I"s)

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


A. Adrenaline


B. Dobutamine


C. Levosimenden


D. Milrinone


E. Vasopressin

E. Vasopressin




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


CEACCP Carcinoid "Avoidvasocontrictors and inotropes as they can paradoxically worsen hypotension.Options of small doses of phenylephrine and vasopressin may work."

23. Using the American Heart Association specification, the colours of the electrodes in a 3-lead electrocardiogram is


A. Right arm = Black;Left arm = White; Left leg = Red


B. Right arm = White;Left arm = Black; Left leg = Green


C. Right arm = Black;Left arm = Green; Left leg = Red


D. Right arm = White; Left arm = Black; Left leg = Red


E. Right arm = Red; Leftarm = White; Left leg = Green

D. Right arm = White; Left arm = Black; Left leg = Red




White is right.


Smoke over fire.


Clouds over green grass.

24. When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade


A. 1


B. 2


C. 3a


D. 3b


E. 4

D. 3b




3a - only epiglottis, but liftable


3b - only epiglottis and not liftable

25. You are doing a supraclavicular brachial plexus block on an awake 35 year-old lady who is healthy with no significant past medical history. Soon after injecting 20mLs of 0.375% ropivacaine she becomes agitated, has a seizure and loses consciousness. Your 1st step in management is


A. Intralipid 20% 1.5ml/kg bolus


B. Midazolam


C. Propofol


D. Establish airway and give 100% O2 via a facemask


E. Feel for radial pulse and give 100mcg adrenaline

D. Establish airway and give 100% O2 via a facemask

26. A G1P0 patient with a dilated cardiomyopathy and an ejection fraction (EF) of 35% presents for a caesarean section. The benefits of regional vs general anaesthesia are


A. Decreased heart rate


B. Decreased systolic blood pressure


C. Increased ejection fraction


D. Increased myocardial contractility


E. Decreased preload

C. Increased ejection fraction




C due to decreased after load


C>D




HD goals: maintain SR, adequate volume loading, normal SVR, avoid myocardial depression (inotropic support frequently required with dobutamine or milrinone)

27. A patient has a terminal malignancy. His family doesn’t want you to tell the patient about his diagnosis and prognosis. Your decision to inform him is an example of:


A. Autonomy


B. Beneficence


C. Confidentiality


D. Non-maleficence


E. Utilitarianism

A. Autonomy




Wiki: it is the capacity of a rational individual to make an informed, un-coerced decision.

28. A septic patient has a CVP of 12mmHg, a blood pressure of 80/40mmHg and a pulse rate of 90/minute. Which is the best agent to treat their hypotension


A. Dopamine


B. Dobutamine


C. Noradrenaline


D. Adrenaline


E. Levosimenden

C. Noradrenaline




MAP = (HRxSV) + SVR


CVP 12 - implies preload adequate, and presumably SV is normal.


HR 90 =reasonable for CO. (ie. neither tachy, nor brady).


Therefore decreased SVR is the probable culprit, which also fits the pathophysiology of sepsis.


Sepsis: Aim for MAP65mmHg. Norad recommended as 1st choice. Adrenaline to be added as 2ndchoice. Or can add vasopressin. Dopamine is an alternative only in highlyselected patients.


29. Which organ is least tolerant of ischaemia following removal for transplantation


A. Cornea


B. Heart


C. Liver


D. Kidney


E. Pancreas

B. Heart




Heart 4h


Lungs 6-8h


Liver/Pancreas 12h


Kidneys 18h




Different organs exhibit different tolerances to warm and cold ischaemia, in part related to the nature of the organ and in part because of the demands on the organ after transplantation. Hence the heart, which has to function immediately upon transplantation, has the shortest tolerance to cold ischaemia, and each hour beyond the first results in a measurable reduction in survival; it should ideally be transplanted in <4 h. This in turn mandates that heart retrieval cannot begin until a suitable recipient has been identified, admitted to transplant centre, and indeed prepared for surgery. Although lungs are slightly more tolerant, with good function to be expected as long as cold ischaemia is <6–8 h, similar principles very often apply. Kidneys, in contrast, need not work immediately and the recipient can be supported on dialysis until they do work. Nevertheless, there is an increased recognition that even kidneys fare better if transplanted as quickly as possible, and ideally within 18 h. The liver and pancreas lie in between and are best transplanted within 12 h.



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


A. Beneath the peritoneum


B. Into the transverse abdominus muscle


C. Between the transverse adominus muscle and the internal oblique muscle


D. Between the transverse abdominus muscle and the external oblique muscle


E. Between the internal oblique and the external oblique muscle

C. Between the transverse adominus muscle and the internal oblique muscle




"The aim of a TAP block is to deposit local anaesthetic in the plane between the internal oblique and transversus abdominis muscles targeting the spinal nerves in this plane." http://www.nysora.com/jnysora/volume12/3170-tapblock.html

31. You are inserting a left sided double lumen tube into a 140kg 160cm woman. At what depth measured at the incisors is it most likely to be in thecorrect position


A. 25cm


B. 26cm


C. 27cm


D. 28cm


E. 29cm

D. 28cm




170cm tallpatient is 29cm. Add or subtract 1cm depth for each 10cm height.




"The average depth of insertion for both male and female patients 170 cm tall was 29 cm, and for each 10-cm increase or decrease in height, average placement depth was increased or decreased 1 cm."


Brodsky JB, Benumof JL, Ehrenwerth J. Depth of placement of left double-lumen endobronchial tubes. Anesth Analg 1991; 73: 570–2

32. A patient is cooled to 33 degrees Celcius in an attempt to improve neurological outcome after out-of-hospital ventricular fibrillation cardiac arrest. The evidence for this treatment comes from


A. Case Reports


B. Case Control Studies


C. Systematic Review


D. Randomised Controlled Trial


E. Pseudo-randomisedTrial

C. Systemic Review




Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation




http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004128.pub3/abstract;jsessionid=3306DE06583F0982B1B23B47BF2AB005.f03t02

33. Which of the following decrease during pregnancy


A. Functional Residual Capacity


B. Forced Expiratory Volume in one second


C. Tidal Volume


D. Respiratory Rate


E. Vital Capacity

A. Functional Residual Capacity

34.You are anaesthetising a patient with chronic renal failure for removal of a Tenkoff catheter and have intubated using rocuronium at a dose of 1.2mg/kg. You are immediately unable to intubate or ventilate and you decide to reverse the patient with sugammadex. What dosage would you use


A. 2mg/kg


B. 4mg/kg


C. 8mg/kg


D. 12mg/kg


E. 16mg/kg

E. 16mg/kg


Adult dosage guides


(a) Reversal of shallow neuromuscular blockade induced by rocuronium* Use Bridion at a dose of 2 mg/kg (reversal likely within 1.2 and 1.5 minutes)


(b) Reversal of profound neuromuscular blockade induced by rocuronium* Use Bridion at a dose of 4 mg/kg (reversal likely within 2.3 and 3.3 minutes)


(c) Immediate reversal of neuromuscular blockade induced by rocuronium* Use Bridion at a dose of 16 mg/kg (reversal likely within 5.7 and 6.7 minutes)

35. During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options is NOT appropriate


A. Carbimazole


B. Beta-blocker


C. Propythiouracil


D. Plasmaphoresis


E. Hydrocortisone

D. plasmaphoresis


(could argue A. carbimazole not useful as PO only plus takes 3-4 weeks to be effective)


https://www.aace.com/files/hyper-guidelines-2011.pdf




Endocrine practitioner 2010 Jul-Aug; 16(4): 673-3. Successful treatment of thyroid storm with plasmapheresis. Medscape – rarely as a life saving measure plasmapheresis has been used to treat thyroid storm in adults.




www.anaesthesia.med.usyd.edu.au/resources/lectures/thyroid_tmc.html Carbimazole: Prodrug. Rapid onset of anti-thyroid effect but clinical effect takes 3-4 weeks due to fact does not block peripheral conversion of T3 to T4. Therefore, stores must be depleted first. Also only available in PO form.


36. A young female patient with anorexia nervosa, had just started eating again.After three days she develops dyspnoea and is found to have cardiac failure. Which of the following is the most important to correct


A. Potassium


B. Chloride


C. Phosphate


D. Glucose


E. Sodium

C. Phosphate




Refeedingsyndrome

37. A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestational age should you monitor foetal heart rate to ensure adequate uteroplacental blood flow


A. 20 weeks


B. 24 weeks


C. 28 weeks


D. 30 weeks


E. 32 weeks

B. 24 weeks


CEACCP Anaesthesia for non-obstetric procedures during pregnancy 2012

38. What is the mechanism of central sensitisation?


A. Increased intracellular magnesium


B. Antagonism of the NMDA receptor


C. Glycine is the major neurotransmitter involved


D. Recurrent A-delta fibre activation


E. Alteration in gene expression

E. Alteration in gene expression




A. opposite


B. agonism


C. glutamate


D. ?C-fibre

39. Which of the following is the best predictor of a difficult intubation in amorbidly obese patient


A. Pretracheal tissue volume


B. Mallampati score


C. Thyromental distance


D. BMI


E. Severity of OSA

A. Pretracheal tissue volume




(old question – neck circumference)


Neck circumference, though now there is a question of the utility of pretracheal tissue thickness as a possible surrogate as measured by ultrasound. Morbid Obesity and Tracheal Intubation (Anesth Analg 2002)

40.A female patient with a history of COPD presents for lung volume reduction surgery, which of the following is a contraindication for surgery (? indicates a poor prognosis)


A. Age > 60 years


B. Chronic asthma


C. Evidence of bullous disease on CT scan


D. FEV < 25%


E. Long-term prednisolone 10mg/day

B. Chronic asthma




A. no, >75y


C. indication for surgery


D. indication for surgery FEV1<35%


E. not high dose




Unfavourable:>75y, comorbid illness which would increase surgical mortality, CAD, pulm HT,FEV<20% or DLCO<20%


Exclusion: high dose systemic steroids


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


A. Bisphosphates


B. Calcitonin


C. Frusemide


D. Sodium Chloride


E. IV crystalloids

A. Bisphosphonates




Bisphosphonates: inhibit osteoclast activity thereby causing a fall in plasma calcium. But, also produces a decrease in renal excretion of calcium.


Calcitonin: produced by parafollicular cells of the thyroid, acting to oppose the effects of parathyroid hormone. Works via 3 mechanisms: inhibition of intestinal calcium absorption, inhibition of bone osteoclast activity, and inhibition of renal tubular cell resorption of calcium, thereby increasing urinary excretion


Frusemide: potent loop diuretic acting at the Na/K/2CL cotransporter in the thick ascending limb of the loH. Twofold action: allows for aggressive fluid loading and also some effect on decreased renal calcium resorption. NaCl - Renal excretion of Na results in concurrent Ca excretion via increased RBF.


IVT - Increased renal Ca excretion


42. What potentiates/interacts with adenosine


A. Aspirin


B. Warfarin


C. Clopidogrel


D. Dabigatran


E. Dipyrimadole

E. Dipyridamole potentiates adenosine




(also carbamazepine)


MIMS say severe reaction with dipyridamole:


1. This drug blocks the cellular uptake of adenosine, thereby increasing the concentration of adenosine at its receptors.


2. By enhancing the effects of intravenous adenosine, dipyridamole may make the recommended initial bolus dose of adenosine unsafe.


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


A. Apply CPAP via a facemask


B. Propofol 1mg/kg


C. Dexamethasone 0.4mg/kg


D. Gas induction and reintubate


E. Nebulised adrenaline (1:1000) 0.5mL/kg

A. Apply CPAP via a facemask




CEACCP 2008 Tracheal extubation. Laryngospasm: Most common cause of upper airway obstruction and mostly in children due to extubation in light planes of anaesthesia.


Mx; Oxygen, jaw thrust, clear secretions, CPAP, propofol (20% induction dose) and sux (0.5mg/kg to relieve obstruction)


Oedema: Risk factors: difficult intubation, surgery > 1h or coughing on ETT




CEACCP 2007 Acute Stridor in Children. Clinical signs generally occur within 30mins of extubation and respond well to treatment with nebulised epinephrine (0.5ml/kg 1:1000) and iv dexamethasone 0.25mg/kg, warm humdified oxygen or heliox.

44. Which antihypertensive is not safe to use in pregnancy


A. Aspirin


B. Enalapril


C. Metoprolol


D. Hydralazine


E. Nifedipine

B. Enalapril




"Enalapril has been assigned to pregnancy category D by the FDA for use during the second and third trimesters and to category C during the first trimester. Animal and human data have revealed evidence of embryolethality and teratogenicity associated with ACE inhibitors. There are no controlled data in human pregnancy. Congenital malformations have been reported with the use of ACE inhibitors during the first trimester of pregnancy, while fetal and neonatal toxicity, death, and congenital anomalies have been reported with the use of ACE inhibitors during the second and third trimesters of pregnancy"

45. Which has the weakest evidence for prevention of postoperative infection


A. Intraoperative low inspired O2


B. Intraoperative blood transfusion


C. Intraoperative hypothermia


D. Intraoperative hyperglycaemia


E. Cigarette smoking

B.

B. Intraoperative blood transfusion




C/D/E are causes of post-op infection


A is protective except for bowel




? Question is really "Which is least likely to prevent post-op infection"






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


A. Nimodipine


B. Thiopentone


C. Hypertonic saline


D. Adenosine


E. Mannitol

D. Adenosine



47. The POISE trial showed that the perioperative administration of metoprolol XR resulted in decreased


A. Perioperative mortality


B. Hypotension


C. Congestive CardiacFailure


D. Myocardial Infarction


E. Stroke

D. Myocardial Infarction




POISE trial: Metoprolol: increased deaths, inc stroke, dec non-fatal MI


48. In paediatric trauma, the Broselow tape is used to estimate


A. Blood loss


B. Weight and drug dosages


C. Urine output


D. Abdominal girth


E. Head circumference

B. Weight and drug dosages



49. Which of the following should be used by a lay person to indicate that they should commence CPR


A. Absence of central pulse


B. Absence of peripheral pulse


C. Loss of consciousness


D. Absence of breathing


E. Obvious airway obstruction

D.




It is loss of consciousness and abnormal breathing

50. A patient presents for dilation of a pharyngeal stenosis post-laryngopharyngectomy 12 months earlier. After inducing anaesthesia you site a size 7 reinforced ETT in the stoma. Over the next 30 minutes the patient gradually desaturations. Despite hand bag ventilation and an increased FiO2 of 1.0 the saturations remain at 88%. This is due to


A. Endobronchial intubation


B. Aspiration


C. Tension Pneumothorax


D. Circuit leak


E. Blockage of ETT withsecretions

A. Endobronchial intubation

51. PiCCO determines cardiac output utilising


A. Thermodilution


B. Pulse contouranalysis


C. Thermodilution and pulse contour analysis


D. ? Doppler


E. ?

C. Thermodilution and pulse contour analysis



52. During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring


A. Anterior horn


B. Anterior corticospinal tract


C. Dorsal column


D. Spinothalamic tract


E. Lateral corticospinal tract

C. Dorsal column

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


A. 18%


B. 23%


C. 32%


D. 41%


E. 48%

C. 32%




½ * 9 + 18 + 9 =31.5

54. Complications of mediastinoscopy include all of the following except


A. Air embolism


B. Cardiac laceration


C. Pneumothorax


D. Recurrent laryngeal nerve palsy


E. Tracheal compression

B. Cardiac laceration

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


A. Amiodarone


B. Adenosine


C. IV fluid bolus


D. Adrenaline


E. Direct cardioversion

E. Direct cardioversion

56. The time constant of the alveoli is


A. Resistance multiplied by compliance


B. Resistance divided by compliance


C. Resistance plus compliance


D. Resistance minus compliance


E.

A. Resistance multiplied by compliance






Time constant = time taken for an exponential process to be 63% complete (or complete if it continues at its inital rate).


An exponential process will be 95% complete after 3 time constants.

57. The MAC awake:MAC ratio of sevoflurane is closest to


A. 0.22


B. 0.34


C. 0.45


D. 0.76


E. 1.00

B. 0.34

58. Abnormal Q waves occur in all the following EXCEPT


A. Digitalis toxicity


B. LBBB


C. Recent transmural MI


D. Wolff-Parkinson-White


E. Previous MI

A. Digitalis toxicity




Dig tox: premature ventricular complexes, bigeminy, all forms of AV block, junctional rhythm, AV tachycardia

59. Patient complains of numbness in the anterior 2/3 of tongue after GA with LMA. Most likely nerve injured is


A. Glossopharyngeal


B. Facial nerve


C. Mandibular


D. Superior vagus


E. Maxillary nerve

C. Mandibular




Lingual is terminal branch of mandibular (V3 of CNV).




Facial nerve supplies taste.

60. A 70 year old man with non-valvular atrial fibrillation is taken off his warfarin for 7 days prior to surgery and has no bridging therapy. His daily risk of stroke is


A. 0.001%


B. 0.01%


C. 0.1%


D. 4%


E. 10%

B. 0.01%




Patients with non-valvular AF have a 5% annual riskof stroke. 5%/365

61. In patient with ankylosing spondylitis which of the following is INCORRECT


A. Amyloid renal infiltration is rarely seen


B. Cardiac complications occur in < 10%


C. Normocyctic anaemia occurs in 85% of cases


D. Uveitis is the most common extra-articular presentation


E. Sacroilitis is an early sign of presentation

C. Normocyctic anaemia occurs in 85% of cases




(only 15% are anaemic)



62. Which of the following are NOT useful in the management of Torsades de Pointes


A. Isoprenaline


B. Procainamide


C. DCCV


D. Electrical pacing


E. Magnesium

B. – prolongs QT

B. Procainamide




(prolongs QT)

63. Compared with a plenum vaporiser what is NOT a disadvantage of draw-over vaporiser


A. Basic temperature compensation


B. Basic flow compensation


C. Cannot use sevoflurane


D. Small volume reservoir


E. ?

C. Cannot use sevoflurane




Can use but need more wicks and to use in sequence


Drawover vapouriser:


- variable output


- gas is drawn into chamber by patient's respiratory effort


- so performance is affected by patient's minute ventilation


- performance is affected by temperature



64. The desflurane vaporiser is heated because of its


A. High SVP


B. High boiling point


C. Low SVP


D. High MAC


E. Low MAC

A. High SVP




Low BP 23oC. Very volatile, gas at room temp.


Tec6 heats to 39oC at 2atm.




The main problemwith des is that is has a high saturated vapour pressure at room temperature(700mmHg at 20°C). It boils at just 22.8°C (if you’ve ever spilled any you’llknow how quickly it disappears as it evaporates) compare with sevoflurane at58.5°C or isoflurane at 48.5°C. What this means is that small changes inambient temperature will cause marked changes in the performance of a vaporizerand great difficulty in controlling the delivered concentration of desflurane

65. The thermoneutral zone in a neonate in degrees celcius is


A. 26-28


B. 28-30


C. 30-32


D. 32-34


E. 34-36

D. 32-34




Adults: 27-31




(Higher than 34 for prem)


Source: Power and Kam p418

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


A. Fluid bolus prior to aortic clamping


B. Fluid bolus after aortic clamp release


C. Frusemide


D. Minimize cross-clamp time


E. Mannitol

D. Minimize cross-clamp time

67. Which type of aortic dissection can be managed conservatively/non-operatively


A. Debakey 1


B. Debakey 2


C. Stanford A


D. Stanford B


E. Stanford C

D. Stanford B




Debakey 1, 2, Stanford A: ascending


Debakey 3, Stanford B: descending (after origin of L subclavian artery)


Diagnosis and management ofaortic dissection, CEACCP, 2009“Stanford Type Ainvolves the ascending aorta but may extend into the arch and descending aorta(DeBakey type I and II).Type B involvesthe descending aorta only (DeBakey type III).Usually, type Adissections require surgery, while type B dissections are best managed conservativelywith medical treatment under most conditions.”

68. The most likely cause of death after pharyngeal, oesophageal or tracheal perforation is


A. Air embolus


B. Hemorrhage


C. Failure to intubate


D. Failure to ventilate


E. Sepsis

E. Sepsis

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


A. RSR in V1


B. Minimum duration QRS of 0.2 secs


C. Deep slurred S wave in V6


D. Loss of septal Q waves in V5 and V6


E. T waves opposite direction to main direction of QRS

D. Loss of septal Q waves in V5 and V6

70. If a patient experiences parasthesia in the little finger during supraclavicular brachial plexus block, the needle is in proximity to the


A. Posterior cord


B. Middle trunk


C. Ulnar nerve


D. Lower trunk


E. Medial cord

D. Lower trunk




RTDCB




Interscalene at level of roots


Supraclavicular at level of trunks



71. Which of the following are feature of Conn's syndrome?


A. Hypoglycaemia, hyponatremia, hyperkalemia


B. Hypoglycaemia, hypernatremia, hypokalemia


C. Normoglycaemia, hypernatremia , hypokalemia


D. Normoglycaemia, hyponatremia, hyperkalemia


E. Hyperglycaemia, hyponatremia, hyperkalemia

C. Normoglycaemia, hypernatremia , hypokalemia




Conn’s = Primaryhyperaldosteronism (usually due to tumour of adrenal cortex)


Causes dec K, inc pH, HT, polyuria, inc Na

72. Commonest valvular heart disease seen in pregnancy is


A. Aortic stenosis


B. Aortic regurgitation


C. Mitral Stenosis


D. Mitral regurgitation


E. Tricuspid reguritation

C. Mitral stenosis




CEACCP 2009 http://ceaccp.oxfordjournals.org/content/9/2/44.full

73. Incidence and severity of vasospasm following sub-arachnoid haemorrhage is seen maximally at


A. 0-24 hrs


B. 2-4 days


C. 6-8 days


D. 7-10 days


E. 2 weeks

D. 6-8 days




CEACCP 2013 Days4-10 highest risk.

74. The predominant pathology seen in restrictive heart disease is


A. Diastolic dysfunction


B. Systolic dysfunction


C. Valvular dysfunction


D. ?


E. ?

A. Diastolic dysfunction

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


A. Hypotension


B. Bradycardia


C. Desaturation


D. Tachycardia


E. Loss of consciousness

C. Desaturation

76. Which of the following is an absolute contraindication to electroconvulsive therapy


A. Cochlear implant


B. Epilepsy


C. Pregnancy


D. Raised Intracranial Pressure


E. Recent myocardial infarct

E. Recent myocardial infarct




Absolute CI: MI or CVA in past 3 months, increased ICP




Relative: Cochlear (unilateral), uncontrolled CCF, DVT (until anticoagulated), untreated cerebral aneurysm, unstable major #, severe OP, retinal detachment, glaucoma, phaeochromocytoma

77. Prolonged Trendelenberg (head-down) positioning causes which of the following


A. No change in intracranial pressure


B. No change in intraocular presssre


C. No change in pulmonary venous pressure


D. Increased myocardial work


E. Increased pulmonary compliance

D. Increased myocardial work

78. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed


A. Posterior cord


B. Anterior division


C. Median brachial cutaneous nerve


D. Ulnar nerve


E. Inferior trunk

E. Inferior trunk




Medial cutaneous n (C8, T1)


aka median antebrachial n

79. A 29 year old female undergoes craniotomy for posterior fossa tumour. Which of the following is an absolute contraindication to the sitting position


A. Patent ventriculo-atrial shunt


B. Previous back surgery


C. Pacemaker


D. Small patent foramen ovale


E. Oesophageal stricture contraindicated for transoesophageal echocardiogram

A. Patent ventriculo-atrial shunt




- Patent ventriculo-atrial shunt


- Severe cardiovascular disease


- Large patent foramen ovale or otherpulmonary-systemic shunt


- Cerebral ischaemia when upright and awake


- Anaesthesia or surgical team not familiar with theposition




From AIC, 2005, Anaesthesia for neurosurgery insitting position

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


A. Loudness 4/6


B. Decreases on inspiration


C. Vibratory quality


D. Ejection systolic murmur


E. Louder on supine

A. Loudness 4/6




Pathological murmur:


- loud


- diastolic, pansystolic, late systolic


- symptomatic


- precordial thrill


- harsh/variable quality


- rarely varies with posture

81. The autonomic supply of the ciliary ganglion is such that it


A. Receives its sympathetic nerve supply from the cervical ganglion


B. Receives its parasympathetic nerve supply from the trochlear nerve


C. Is located inferiorly in the orbit


D. Is at risk from injury during peribulbar nerve block


E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus

E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus




Parasympathetic from vagus


Ciliary ganglionis parasympathetic ganglion (only PS synapse in ganglion but Symp and sensorypass through).Pre-synaptic fromEdinger-Westphal nucleus which joins with oculomotor nucleus to form oculomotornerve (CNIII).

82. Regarding Thallium Stress Testing in predicting perioperative cardiac events


A. A positive result requires further investigation with a pulmonary artery catheter


B. It has a high negative predictive value


C. It has a low negative predictive value


D. It has a high positive predictive value


E. Thallium Stress testing is considered inferior to Dobutamine Stress Echo

B. It has a high negative predictive value




New AHAguidelines published 2014 in Circulation.


Thallium stresstesting:


- mod-large areasof myocardial ischaemia a/w inc riskperiop MI or death


- normal studyhas very high NPV


- old MI on restimaging is of low PV




( http://content.onlinejacc.org/article.aspx?articleid=1893784)




Up-to-date:Thallium-Dipyridamole stress testing – Sensitivity 83%, Specificity 49%,NPV98%, PPV 18%. Preferred in arrhythmias as dobutamine can induce arrhythmias

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


A. Factor VIIa


B. FFP


C. Cryoprecipitate


D. Prothrominex


E. Prothrombinex and FFP

E.Prothrombinex and FFP




Raised INR +life-threatening bleeding: vit K 5-10mg + Prothrombinex-VF + FFP




Raised INR +non-critical bleeding: Vit K 5-10mg + Prothrombinex




Raised INR +minor bleeding: vit K 1mg or withhold warfarin only




https://www.mja.com.au/journal/2013/198/4/update-consensus-guidelines-warfarin-reversal

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


A. Give naloxone


B. Dry and stimulate


C. Start chest compressions


D. Give positive pressure ventilation


E. Suction the trachea

E. Suction the trachea

85. A 70 year old lady suffered a subdural haematoma. She is currently confused and the neurosurgeon wants to take her to theatre for urgent decompression. She is a vague historian, but from notes you find out she had ablation and pacemaker put in 7 months ago - DDD mode. Cardiac technician in 1 hour away and the surgeon wants to proceed. What do you do


A. Postpone until cardiology review


B. Postpone until pacemaker checked by technician


C. Postpone until temporary pacemaker inserted


D. Proceed after having implemented external pacing


E. Proceed with magnet available

E. Proceed with magnet available




http://bja.oxfordjournals.org/content/107/suppl_1/i16.full Periop mgt of pts with cardiacimplantable electronic devices 2013




Pace/Sense/Response/Programmability/Anti-tachycardia

86. New blood pressure measuring device is developed. Best was to compare it to the current gold standard


A. SCUSUS


B. Bland Altman Plot


C. Kendall Coefficient of Concordance


D. Pearsons coefficient


E. Friedmans ??

B. Bland Altman Plot




CEACCP StatisticsI 2007

87. What happens when you place a magnet over a biventricular internal cardiac defibrillator


A. Switch to asynchronous pacing


B. Damage the internal programming


C. Nothing


D. Switch off antitachycardia function


E. Switch of rate responsiveness

D. Switch off antitachycardia function




http://bja.oxfordjournals.org/content/107/suppl_1/i16.full Periop mgt of pts with cardiacimplantable electronic devices 2013

88. A 54 year-old patient is on warfarin for AF. They have a history of alcohol abuse and liver failure with a bilirubin of 28 and an albumin of 30. He also has a history of DVT following a flight. What is his CHADS2 score


A. 0


B. 1


C. 2


D. 3


E. 4

A. 0




CHF


HT


Age>75


DM


Stroke/TIA/VTE




0 - 1.9


1 - 2.8


2 - 4


3 - 5.9


4 - 8.5



89. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from


A. 16000kpa to 400kpa


B. 16000kpa to 240kpa


C. 11000kpa to 400kpa


D. 11000kpa to 240kpa


E. ?

A.16000kpa to 400kpa






Capacity is 450LO2 at 15000kPa




http://www.boc-healthcare.com.au/internet.lh.lh.aus/en/images/HCD130_Cylinder%20identification%20chart350_72667.pdf

90. What is approximately the systolic blood pressure in an awake neonate
(mmHg)


A. 55


B. 70


C. 85


D. 100


E. 115

B. 70






NETS handbook andvarious sources: 70 at term, less if prem, 80 week 2, 85 week 4.


Generally SBP= 80+age*2

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


A. Inhaled helium/oxygen


B. IV aminophylline


C. IV magnesium


D. IVsalbutamol


E. Intubation and ventilation

C. IV magnesium




CEACCP 2008 Management of life threatening asthma in adults




Initialtreatment: O2, inh salbutamol, inh ipratropium, prednisone +/- hydrocortisone




Then add: IVmagnesium 2g over 20min, contact senior




Then add: inc frequency of salbutamol, regularipratropium




Then add: onadvice of ICU IV salbutamol, IV aminophylline, I+V+IPPV

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


A. LUL


B. Lingula


C. RUL


D. RML


E. RLL

C. RUL




http://lifeinthefastlane.com/ccc/bronchoscopic-anatomy/

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


A. Remove LMA and increase inspired Sevoflurane concentration


B. Increase inspired Sevoflurane concentration through the LMA


C. Give sublingual Suxamethonium


D. Give intramuscular Atropine


E. Give intramuscular Suxamethonium

A. Remove LMA and increase inspired Sevoflurane concentration

94. Ulcerative colitis is associated with all of the following EXCEPT:


A. Cirrhosis


B. Iritis


C. Psoriasis


D. Arthritis


E. Sclerosing cholangitis

C. Psoriasis




UCextraintestinal features:


- Cirrhosis


- aphthousmouth ulcers


- ophthalmic:iritis, uveitis, episceritis


- MSK:arthritis (seroneg), ank spond, sacroiliitis - Cutaneous:erythema nodulosum, pyoderma granulosum


- DVT/PE


- Haemolyticanaemia


- Clubbing


- Primarysclerosing cholangitis

95. Regarding rotameters


A. The bobbin is contained in a tube with parallel sides


B. There is laminar flow at high flows


C. The height of the bobbin is directly proportionate to the pressure drop across the bobbin.


D. There is a constant pressure difference across the bobbin at all flows.


E. Resistance increases at high flows

D. There is a constant pressure difference across the bobbin at all flows.




Frca.co.uk:constant pressure, variable orifice flowmeters; cone-shaped tubes, laminar atlow flows, turbulent at high flows; at low flows the gap acts like a tube, athigh flows the gap acts like an orifice; calibrated for each gas

96. You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?


A. Amiodarone 100mg bd


B. Digoxin 250mcg daily


C. Enalapril 2.5mg bd


D. Metoprolol 100mg bd


E. Diltiazem slow release 240mg daily

C. Enalapril 2.5mg bd




Heart failuredefinitions:


- I: HFwith dec EF


- II:HF with preserved EF


- III:HF with preserved EF, borderline


- IV:HF with preserved EF, improved




Heart failurefunctional classifications:


- A: atrisk


- B:structural evidence but no symptoms


- C:structural evidence and symptoms


- D:refractory




HFTreatment:


- A:control RFs


- B:ACE-i/ARB, b-blockers, control other RFs


- C:ACE-i/ARB + b-blocker + loop diuretic/hydral-nitrate/aldosterone antagonist


- D: heart transplant, advanced care measures

97. The best clinical indicator of severe aortic stenosis is


A. Presence of a thrill


B. Mean pressure gradient of 30mmHg


C. Area 1.2cm2


D. Slow rising pulse


E. ESM radiating to the carotids

A. Presence of a thrill




CEACCP

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


A. Tricuspid valve


B. Pulmonary valve


C. Mitral valve


D. Aortic valve


E. Atrial Septal Defect

B. Pulmonary valve




L --> R shunt through atria, then excess bloodthrough R ventricle and passing through normal PV.

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


A. 4.5 cm2


B. 3.5 cm2


C. 2.5 cm2


D. 1.5 cm2


E. 1.0 cm2

E. 1.0 cm2




Symptoms onexertion 1.5cm2, at rest 1.0cm2.


1.5-2 cm2 may only have symptoms if severelystressed.


Normal valve areais 4-6.https://www.openanesthesia.org/mitral_stenosis/


Circulation 2005: Symptoms at rest correlate to class IV NYHA disease. This occurs in severe disease at valve area <1cm2 . This is different to onset of ANY symptoms with exertion that can begin with mild disease.


OHCA: Symptom free until valve area 1.6-2.5cm ”


ACC/AHA PracticeGuidelines. Guidelines for the Management of Patients With Valvular Heart Disease: The normal mitral valve area is 4.0 to 5.0 cm2. Narrowing of the valve area to <2.5 cm2 must occur before development of symptoms. A mitral valve area>1.5 cm2 usually does not produce symptoms at rest. However, if there is an increase in transmitral flow or a decrease in the diastolic filling period,there will be a rise in left atrial pressure and development of symptoms. Thus,the first symptoms of dyspnea in patients with mild MS are usually precipitated by exercise, emotional stress, infection, pregnancy, or atrial fibrillation with a rapid ventricular response


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


A. An increased incidence of myocardial ischaemia


B. Decreased leukocyte chemotactic response


C. Elevation of plasma homocysteine levels


D. Megaloblastic anaemia


E. Reversible inhibition of methionine synthetase

E. Reversible inhibition of methionine synthetase




CEACCP 2005 Nitrous Oxide: Prolonged administration of nitrous oxide causes irreversible inhibition of methionine synthetase, which results in interference with DNA synthesis in both leukocytes and erythrocytes.


101. The diagnosis of neuroleptic malignant syndrome requires the presence of


A. Diaphoresis


B. Elevated plasma creatine kinase


C. Hypertension


D. Muscle rigidity


E. Tachycardia

D. Muscle rigidity




Need 3 major (fever,rigidity, inc CK) or


2 major and 3 minor (inc HR, inc/dec BP, dec GCS, diaphoresis, leukocytosis)






102. Regarding tryptase level testing for suspected anaphylaxis, all are true EXCEPT:


A. Levels peak within 1 hour


B. Increased with anaphylactoid and anaphylactic reactions


C. 99% of the body’s stores are found in mast cells


D. Levels of > 20ng/mL are suggestive of anaphylaxis


E. Test should be repeated at 24-48 hours

No real best answer.


E. is the least correct.




CEACCP 2004


Tryptase levels peak within 1h


99% tryptase within mast cells


Increased with both anaphylactic and anaphylactoid (non-IgE mediated) reactions.






ANZAAG


Take tryptase at 1h, 4h, >24h

103. An 18 month old boy presents for surgery for an incarcerated inguinal hernia. On examination you note that he has had an URTI for approximately one week. Your advice regarding surgery should be


A. Postpone the surgery for two weeks


B. Proceed with surgery under spinal anaesthetic


C. Proceed with surgery with a full course of antibiotics to treat the URTI


D. Undertake surgery, but avoid the use of an ETT


E. Proceed with surgery with careful monitoring

E. Proceed with surgery with careful monitoring




Emergency surgeryso proceed.


Generally, ifpost-viral (at end of cold) proceed.


If current URTI,postpone 2 weeks.


If LRTI, postpone4 weeks.


If bronchiolitis, postpone 6 weeks.

104. The incidence of fat embolism syndrome following a unilateral closed femoral fracture is


A. 0 -3%


B. 4 – 7%


C. 8 -11%


D. 12 – 15%


E. 16 - 19%

A. 0-3%




CEACCP 2007 fat embolism "patients with a single long bone fracture have a 1–3% chance of developing the syndrome, but it has been reported in up to 33% of patients with bilateral femoral fractures."


105. The thoracodorsal nerve arises from




A. Medial cord of brachial plexus


B. Lateral cord of brachial plexus


C. Posterior cord of brachial plexus


D. Dorsal scapular nerve


E. Long thoracic nerve

C. Posterior cord of brachial plexus




(Along with upper and lower subscapular nerves)

106. Neurosurgery operation in the sitting position. MAP 80mmHg, CVP 5mmHg, the transducers are located 13cm below the external auditory meatus. What is the CPP?


A. 62 mmHg


B. 65 mmHg


C. 67 mmHg


D. 70 mmHg


E. 75 mmHg

D. 70mmHg


CPP = MAP - (ICP or CVP). Presume ICP = 0 secondary to open cranial vault. Therefore MAP = 80 - (13 x 1.3) (conversion from mmHg to cmH2O) = 70. Therefore CPP = 70 - 0 = 70




107. A man attending his daughter's wedding is involved in fight with his son-in-law. He does not know where he is, opens eyes to voice, but removes tie when instructed. What is his GCS?


A. 10


B. 11


C. 12


D. 13


E. 14

D. 13




E3


V4


M6

108. Which of the following drugs is least likely to cause hypoxia in ARDS


A. Noradrenaline


B. Milrinone


C. Isoprenaline


D. Isoflurane


E. Sodium nitroprusside

A. Noradrenaline

109. What is the best predictor of poor prognosis with aortic stenosis?


A. Chest pain


B. Paroxysmal nocturnal dyspnoea


C. Syncope


D. Palpitations


E. Fatigue

B. PND




50% survival rates:


Angina = 5y


Syncope = 3y


Heart failure (indicated by PND) = 2y



110. Pierre-Robin sequence is characterized by cleft palate, micrognathia and


A. Craniosynostosis


B. Macroglossia


C. Glossoptosis


D. Microstomia


E. ?

C. Glossoptosis




All caused by mandibular hypoplasia resulting in tongue falling against posterior wall

111. After 3 litres of normal saline, the dilutional anaemia is initially offset by


A. Increased cardiac output


B. Increased oxygen extraction


C. Capillary vasodilation


D. ?


E. ?

A. Increased cardiac output

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


A. Ca(OH)2


B. Carbon dioxide


C. Carbon monoxide


D. Compound A


E. Compound B

C. Carbon monoxide




Stoelting: DIE(Des, Iso, En) produce CO from CF2 moiety.


Influenced by dry absorbant, high T,FGF, type of absorbant

113. 2ml of 0.75% ropivacaine is injected for an interscalene block. Soon after the patient loses consciousness. The most likely place of inadvertent injection is


A. Subdural


B. Internal jugular vein


C. Common carotid artery


D. External jugular vein


E. Vertebral artery

A. Subdural




A>E as first is LOC


If presentation with seizures etc, most likely VA injection

114. An 18 month old infant is undergoing a routine spontaneously breathing GA with an LMA. They have a sudden onset of SVT with a heart rate of 220 and a BP of 84/60 with an ETCO2 of 32 and SpO2 of 98. The best management strategy is


A. Adenosine 100mcg/kg


B. DCR 2J/kg


C. DCR 4J/kg


D. Amiodarone 5mg/kg


E. CPR

A. Adenosine 100mcg/kg




Resus.org.auguideline 12.5:


1st line adenosine 100-300mcg/kg.


2ndline amiodarone 5mg/kg.


If pulseless or severe hypotension, DCR 0.05-2J/kg.

115. When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch


A. Opponens abducens


B. Abductor pollicis brevis


C. Adductor pollicis brevis


D. Extensor pollicis


E. Flexor pollicis brevis

C. Adductor pollicis brevis




Ulnar nerve:flexor carpi ulnaris, median half of FDP, all muscles of hand except LOAF




Median nerve: all muscles of ant forearm except flexor carpi ulnaris(and half FDP); LOAF hand muscles – lateral 2 lumbricals, opponens pollicis,abductor pollicis brevis, flexor pollicis brevis

116. A middle-aged male with severe mitral stenosis having general anaesthesia for repair of fractured ulna/radius. Ten minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70/-. He is normally in sinus rhythm. What do you do


A. Adenosine


B. Amiodarone


C. Shock


D. Volume


E. Metaraminol

C. Shock

117. Circuit disconnection during spontaneous breathing anaesthesia


A. Will be reliably detected by a fall in end-tidal carbon dioxide concentration


B. Will be detected early by the low inspired oxygen alarm


C. Will be most reliably detected by spirometry with minute volume alarms


D. May be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration


E. Can be prevented by using new, single-use tubing

D. May be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration

118. ET04 An 85 year old patient with a bleeding disorder (? haemophilia) suffers a fractured neck of femur (#NOF). You discuss the possibility of a needing a blood transfusion but despite your explanation they refuse because they are scared of CJD infection post transfusion. Subsequently you decide not to proceed with the case because of the high risk of bleeding. The ethical principle that this is an example of is


A. Paternalism


B. Coercion


C. Justice


D. Beneficience


E. Autonomy

A. Paternalism

119. A type I diabetic is fasting pre-operatively and you decide to place them on an IV insulin infusion to optimise their perioperative glycaemic control. Their BSL is 7 mmol/L. By what mechanism does the insulin infusion decrease their BSL


A. Stimulates glucose uptake into the liver


B. Stimulates glucose uptake into skeletal muscle


C. Inhibits glucose production in the liver


D. Decreases glucose absorption from the gastrointestinal tract


E. Inhibit glucagon release

B. Stimulates glucose uptake into skeletal muscle




Insulin:


- facilitates uptake into adipose and skeletal muscle via GLUT-4, (brain andliver don’t need GLUT-4);


- Stimulates glycogenolysis


- promotes synthesis of FFAin liver


- inhibits fat catabolism

120. Patient has undergone a bilateral lung transplant. All of following are impaired EXCEPT


A. Mucociliary clearance


B. Cough reflex distal to anastomosis


C. Hypoxic pulmonary vasoconstriction


D. Response to CO2


E. Lymphatic drainage

C. Hypoxic pulmonary vasoconstriction

121. Patient with history of long QT syndrome treated with long term propranolol. How do you know the treatment is effective


A. Normal QTc


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


C. ?


D. ?


E. ?

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




BJA 2003 Long QT Syndrome and Anaesthesia



Or HR<130 when exercising

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


A. Hypertension


B. Hypotension


C. Bradycardia


D. Tachycardia


E. ?

C. Bradycardia

123. What organism most commonly causes meningitis post spinal anaesthesia


A. Staphylococcus epidermidis


B. Staphylococcus aureus


C. Streptococcus pneumonia


D. Streptococcus salivarius


E. Escherichia coli

D. Streptococcus salivarius




CEACCP 13 No 2 Postnatal neurological problems 2013



Most common epidural abscess staph aureus

124. A male patient has a haemoglobin of 8g/dL and reticulocyte count 10%. The most likely diagnosis is


A. Untreated pernicious anaemia


B. Aplastic anaemia


C. Acute leukaemia


D. Anaemia of chronic disease


E. Hereditary spherocytosis

E. Hereditary spherocytosis




Normal reticcount is 0.5-2%.



High retic countdue to: bleeding, haemolytic anaemia, haemolytic disease of the newborn




If the BM isunable to keep up with the anaemia by producing retics, then there is somedegree of BM dysfunction, tumour, or deficiency of nutrients eg: aplasticanaemia, Fe-def anaemia, pernicious anaemia, radiation therapy, BM failure 2oinfection or cancer, low EPO (eg severe kidney injury).

125. An advantage of supraclavicular block over an interscalene nerve block for shoulder surgery


A. Less phrenic nerve block


B. Easier landmarks in obese patient


C. Arm can be in any position for block


D. Less risk pneumothorax


E. Better cover for shoulder surgery

A. Less phrenic nerve block




IS block phrenicnerve at risk if LA spreads anterior to anterior scalene m. Avoid by usinglower volumes, lower down in neck, and preventing spread anteriorly.

126. A patient with a head injury is found to have a unilateral dilated pupil with no direct or consensual response to light. What is the most likely diagnosis


A. Global injury


B. Optic nerve injury


C. Horners syndrome


D. Transtentorial herniation


E. Injury to the pons

D. Transtentorial herniation




A. ?


B. Visual acuity only


C. Ptosis, meiosis, anhydrosis


E. Constriction of pupils

127. EM68 In an arterial line system


A. Overdamping exaggerates mean pressure


B. Underdamping increases mean pressure


C. Underdamping underestimates systolic pressure


D. Wide range of damping coefficient associated with good performance if system has high natural frequency


E. Compliant tubing is good

D. Wide range of damping coefficient associated with good performance if system has high natural frequency






Miller's Anaesthesia Chapter 40 The accuracy of a directly recorded arterial pressure waveform is determined by the natural frequency and damping coefficient of the pressure monitoring system. Optimal dynamic response of the system will be achieved when the natural frequency is high, thereby allowing accurate pressure recording across a wide range of damping coefficients.

128. The commonest postoperative complication in a patient with a neck of femur fracture (#NOF) is


A. UTI


B. Pneumonia


C. Myocardial Infarction


D. Delirium


E. ?

D. Delirium




30-50%


AustralianAnaesthesia 2007:


- deliriumincidence up to 50%


- periopMI 40%


- principlecause of death is cardiac failure/MI (peak at 2d), PE (peak 2ndpost-op week), pneumonia (late)


- 12month mortality 25%

129. Which of the following is an advantage of a bronchial blocker of a double lumen tube


A. Able to isolate separate lobes


B. Significantly easier to deflate non-ventilated lung


C. Better suited to pneumonectomy


D. Less pressure on bronchial tissue


E. Lower incidence of tube malpositioning

A. Able to isolate separate lobes

130. Laser endotracheal tubes


A. More resistant to ignition when covered in blood


B. Resistant to electrosurgical cautery


C. Wont ignite when touched by laser


D. Have larger external diameter for same internal diameter relative to standard PVC tubes


E. Have double cuffs which are resistant to puncture by laser

D. Have larger external diameter for same internal diameter relative to standard PVC tubes

131. Pulsus paradoxus in cardiac tamponade, the blood pressure decreases


A. Every second beat


B. In expiration when increase is normal


C. In expiration more than normal subjects


D. In inspiration when increase is normal


E. In inspiration more than normal subjects

E. In inspiration more than normal subjects




http://www.kerrybrandis.com/wiki/mcqwiki/index.php?title=Pulsus_paradoxus"


Under normal conditions, arterial blood pressure fluctuates throughout the respiratory cycle, falling with inspiration and rising with expiration. Therefore, during inspiration the fall in the left ventricular stroke volume is reflected as a fall in the systolic blood pressure. The converse is true for expiration. During quiet respiration, the changes in the intrathoracic pressures and blood pressure are minor. The accepted upper limit for fall in systolic blood pressure with inspiration is 10 mmHg. The “paradox” refers to the fact that heart sounds may be heard over the precordium when the radial pulse is not felt. This is due to an exaggeration of the normal mechanisms mentioned above. Moreover, the clinical method of assessment of this "pulse" is by measurement of the "systolic blood pressure".

132. You are anesthetising a patient for a laparotomy who has a history of pulmonary hypertension. Regarding the patients anaesthetic management


A. An alpha-agonist is the inotrope of choice


B. Hypothermia is protective against a rise in pulmonary artery pressure


C. Isoflurane will tend to decrease pulmonary artery pressure


D. Ketamine is an appropriate anaesthetic agent


E. ? RHF

C. Isoflurane will tend to decrease pulmonary artery pressure




Alpha-agonist is vasopressor of choice


RHF is a concern.


All AAs are safe, iso may cause pulmonary vasodilation.


Nitrous may inc PVR.


Systemic vasoconstrictor such as NA, phenylephrine, metaraminol.


Ketamine generally contraindicated.


TOTW 228 2011: http://www.frca.co.uk/Documents/228%20Anaesthesia%20for%20the%20Patient%20with%20Pulmonary%20Hypertension.pdf

133. In a patient with severe rheumatoid arthritis, which radiological finding is most consistent with severe atlantoaxial instability (? C1/C2 instability)


A. A 9mm gap between the anterior arch of C1 and the odontoid peg


B. Increased saggital diameter


C. Posterior atlanto dental interval of > 14mm


D. Midpart of C1 over C2


E. Tear drop sign of C2

A. A 9mm gap between the anterior arch of C1 and the odontoid peg




Atlanto-axialinstability (AAI) occurs when subluxation or dislocation causes the odontoidprocess or posterior arch of the atlas to impinge on the spinal cord. Transverseligament holds dens against the anterior arch of C1, preventing anteriortranslocation of C1 on C2 (~80% AAI). Ondontoid prevents posteriortranslocation (~5%). Others due to vertical/lateral.


AAI defined asAADI of >3mm. >9mm is associated with inc risk neurological injury.Subluxation in upto 70% of RA pts, but only 25% dislocation. Due to synovial C1/2 joint, anddestruction of transverse ligament. http://www.wheelessonline.com/ortho/atlantoaxial_subluxation_in_rahttp://emedicine.medscape.com/article/1265682-overview#a3http://ceaccp.oxfordjournals.org/content/6/6/235.full.pdf+html






PADI is the distance between posterior surface of the odontoid and the anterior margin of the posterior ring of the atlas. At all cervical levels cord requires minimum canal width of 10mm; CSF 2mm, dura 2mm. Thus, minimum PADI of 14mm is needed to avoid cord compression

134. You are called to the labour ward to assist in the manual removal of a retained placenta in a healthy woman. The obstetrician asks you to administer intravenous glycerol trinitrate. An initial safe dose, that you would expect to be effective, would be


A. 5mcg


B. 50mcg


C. 250mcg


D. 500mcg


E. 1000mcg

B. 50mcg

135. What is the most accurate method of determining foetal heart rate in a neonate


A. Palpation of an umbilical vein pulse


B. Auscultation with a stethoscope


C. Palpation of the femoral artery


D. Pulse oximetry


E. ?

B. Auscultation with a stethoscope

136. Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing


A. Abnormalities on magnetic resonance imaging (MRI) spectroscopy


B. Calcium release from B lymphocytes in response to caffeine stimulation


C. Certain mutations in the ryanodine receptor gene


D. Myofibrillar necrosis on muscle biopsy plasma


E. Creatine kinase (CK) levels above 800 units/L

E. Creatine kinase (CK) levels above 800 units/L




Miller and


ANZCA Blue Book 2005 MH Investigation for the Uninitiated


Overall, the balance of opinion leads to the conclusion that serum CK levels are not sensitive or specific enough to be useful for diagnosis in individual patients.


137. A 60 year-old man with anterior mediastinal mass, is having a mediaastinoscopy. During induction they lose cardiac output, desaturate and drop their ETCO2. What is the best management strategy


A. Adrenaline


B. CPR


C. CPB


D. Place prone


E. ?

D. Place prone




Due to severeairway obstruction as a result of their mass impinging on airway. Stoeltingsuggests placing prone or lateral in this case.

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


A. Immune antibodies against post-synaptic ion channels


B. Associated with thymoma


C. Repeated exercise causes weakness to initially improve


D. Good response to edrophonium


E. Resistant to non-depolarizing muscle relaxants

C. Repeated exercise causes weakness to initially improve




The Eaton-Lambert Syndrome (ELS) is a rare condition in which weakness results from a pre-synaptic abnormality of ACh release at the neuromuscular junction. It is classically associated with small cell carcinoma of the lung although recent evidence suggests up to 50% may be free from underlying malignancy. The clinical presentation is that of proximal weakness with absent reflexes, sometimes with bulbar and facial muscle involvement. Importantly the weakness tends to improve with muscle contraction, unlikeMG. ELS treatment consists of treatment of underlying malignancy if present,improving neuromuscular transmission with drugs, and immunosuppression.

139. A 55 year-old man presents to the emergency department with an obviously infected heel ulcer - BP 100/60, PR 110/minute, temperature 35.8, Na 125, K 2.7, BSL 55, Creatinine 180. Which do you give first/most urgently?


A. Antibioitcs


B. Crystalloid


C. Insulin


D. Potassium


E. Adrenaline

B. Crystalloid






HONK

140. A new test has been developed to diagnose a disease. To determine the SPECIFICITY of this new test it should be administered to


A. A mixed series of patients i.e. some known to be suffering from the disease and some known to NOT be suffering from it


B. A series of patients known to NOT be suffering from the disease


C. A series of patients known to NOT be suffering form the disease and an estimate of the prevalence of the disease in the population obtained


D. A series of patients known to be suffering from the disease


E. A series of patients known to be suffering from the disease and an estimate of the prevalence of the disease in the population obtained

B. A series of patients known to NOT be suffering from the disease

141. During one lung ventilation, hypoxaemia can occur. The cause for this is:


A. Loss of hypoxic pulmonary vasoconstriction


B. Perfusion of the unventilated lung


C. Ventilation perfusion mismatch of the ventilated lung


D. Atelectasis of the ventilated lung


E. Upper lobe collapse of the ventilated lung

B. Perfusion of the unventilated lung

142. A child with intra-operative blood loss. A cardiac arrest is most likely because of


A. A delay in delivery of blood from the blood bank


B. Inadequate intravenous access


C. Underestimated intra-operative blood loss


D. Underestimated pre-operative hypovolaemia


E. Complication of transfusion

C. Underestimated intra-operative blood loss




A&A 2007Review of anaesthesia-related cardiac arrest.Most common causeis hypovolaemia due to underestimation of blood loss.

143. The lumbar plexus supplies all of the following EXCEPT:


A. Subcostal nerve


B. Obturator nerve


C. Lateral cutaneous femoral nerve


D. Long saphenous nerve


E. Iliohypogastric nerve

A. Subcostal nerve

144. The symptom indicating poorest prognosis in an adult patient with aortic stenosis


A. Chest pain


B. Malaise


C. Palpitations


D. Paroxysmal nocturnal dyspnoea


E. Syncope

D. PND


145. A 50 year old male in recovery after an anterior cervical fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, SpO2 96%. What is the most appropriate management


A. Aspirate the collection with a 19G needle and syringe


B. Awake fibreoptic intubation with minimal sedation


C. Direct laryngoscopy and intubation after sevoflurane/O2 gaseous induction


D. Direct laryngoscopy and intubation after propofol/suxamethonium induction


E. Intubation via intubating LMA

C. Direct laryngoscopy and intubation after sevoflurane/O2 gaseous induction




Combative = gas induction


Non-combative =AFOI


Aim to keep spont venting

146. RB67 Regarding post dural puncture headache, all of the following are true, EXCEPT:


A. If puncture with the tuohy needle during epidural insertion, subsequent blood patch is 30-50% effective


B. Caffeine is often used to treat mild headache


C. Subdural haemorrhage can occur rarely


D. ?


E. Unlikely to be post dural puncture headache if the headache is only in the occipital area

A. If puncture with the tuohy needle during epidural insertion, subsequent blood patch is 30-50% effective - blood patches ~70% effective, increasing to ~90% effective with 2nd patch







B. True


C. ?true


E. Headache is typically occipital or frontal. Varies with posture.

147. A 70 year-old male presents for right lower lobectomy. Preoperative spirometry shows FEV1 2.4L (4.2L predicted), FVC 4L (5L predicted). The predicted post-operative FEV1 is:


A. 1.0L


B. 1.3L


C. 1.7L


D. 1.9L


E. 2.2L

D. 1.9L




Easiest method: pre-op FEV1 * (5 - #lobes resected)/5


= 2.4 * (5-1)/5 = 1.9L




More complex method: lung segments


Right: 3 / 2 /4


Left: 3 / 2 / 5


TOTAL = 19




Hence ppo FEV1 = (19-14)/19 * pre-op FEV1 = ~0.8*2.4 =1.9L

148. What is the most important immediate treatment for a cardiac arrest due to ventricular fibrillation in a patient with hypertrophic obstructive cardiomyopathy?


A. Adrenaline


B. Amiodarone


C. Defibrillation


D. Intubation, ventilation and oxygenation


E. Precordial thump

C. Defibrillation

149. Hypercalcaemia due to hyperparathyroidism is associated with


A. A shortened PR interval


B. A prolonged QTc interval


C. Muscle rigidity


D. Polyuria and polydipsia


E. Increased glomerular filtration rate

D. Polyuria and polydipsia

150. The cause of early mortality (early - within 30 minutes) in a pregnant women with amniotic fluid embolism is


A. Bronchospasm


B. Hypovolaemia


C. Malignant arrhythmia


D. Pulmonary hypertension


E. Pulmonary oedema

D. Pulmonary hypertension




Early (phase 1,<30min) is pulm HT due to pulm art vasospasm from immunologically stimulatingAFE, causing pulmHT, RHF and collapse, hypoxaemia and hypotension.




Late (phase 2,>30min) is LVF and pulm oedema, DIC causing haemorrhage, uterine atony.