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113 Cards in this Set
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Q1A transdermal fentanyl patch is often used for management of cancer pain. After application, the time to reach peak plasma levels is: A. 1hr B. 2hrs C. 4hrs D. 12hrs E: 24hrs |
E. MIMS: "Peak serum concentrations of fentanyl generally occur between 24 and 72 hours after the first application.The serum fentanyl concentrations attained are proportional to the Durogesic patch size. By the end of the second 72 hour application, a steady-state serum concentration is reached and is maintained during subsequent applications of a patch of the same size " |
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Q2: Pharmacological studies are undertaken in several phases. A phase 3 study involves: A Animal studies B Testing of drug on healthy volunteers C Observational studies on patients with disease D Post marketing surveillance E Randomised controlled trials on target population |
E Phase 1: small study for PK/dose on healthy sunjects Phase 2: Target population 3: Large RCT 4: Post marketing surveillance (thousands of patients)
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Q3: A pregnant patient 28/40 gestation is involved in a high-speed MVA. On admission to the DEM she complains of sudden onset severe chest pain. Her vital signs show HR 120, BP 160/100, SpO2 95% RA and her ECG shows ST depression. Most likely diagnosis is: A. Cardiac contusion B. Tension pneumothorax C. Aortic dissection D. Sternal fracture E. Myocardial infarction |
C. CEACCP: RFs for aortic dissection include pregnancy and deceleration injury. 1st phase: HT, tachycardia, chest pain 2nd phase: hypotension and tachycardia |
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Q4: A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers a cardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemia is: A MH B ARF C Cardiomyopathy D Rhambdomyolysis E Crush injury |
D. CEACCP 2011 No 4 |
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Q52: A 30yr old pregnant patient develops contractions at 30/40 gestation. Which of the following can not be used for tocolysis? (Question does NOT ask about 34/40) A. Clonidine B. Indomethacin C: Magnesium D. Salbutamol E. Nifedipine |
A. NSWpolicy PD2011_025 |
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Q53: In a patient with intraorbital haemorrhage, following local anaesthetic injection, the adequacy of occular perfusion is best assessed by: A. Angiography B. Indirect opthalmoscopy C. Direct opthalmoscopy D. Intra-occular pressure tonometry E. Palpation of the globe by an experienced physician |
Controversial: B from British ophthalmology guidelines C from other sources
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Q54:What is the appropriate post-operative ibuprofen dosage for a one year old child tds? A. 5mg/kg B. 7.5mg/kg C. 10mg/kg D. 15mg/kg E. 20mg/kg |
C. |
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Q55:You are inducing a 4yr old child with Arthrogrophysis multiplex congenita. After you administer the induction agents, you find it difficult to place the laryngoscope. What is the likely complication? A. Malignant hyperthermia B. Neuroleptic malignant syndrome C. TMJ rigidity D. Opioid-induced rigidity E. Inadequate depth of anaesthesia |
C. |
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Q56: What is the best measure of the anticoagulant effect of Dabigatran? A. APTT B. Dilute thrombin time C. Prothrombin time D. Bleeding time E. TEG |
B. Dilute thrombin time MIMS: ECT, dilute TT, TT "Ecarin clotting time (ECT), thrombin time (TT) and diluted thrombin time (dTT) are sensitive assays that increase in direct proportion to dabigatran plasma concentration without any deviation from linearity at high plasma concentrations. However, ECT is not readily available in clinical practice. Activated partial thromboplastin time (aPTT) increases in a nonlinear manner to dabigatran concentration and is less proportional at higher dabigatran concentrations (see Precautions, Effect on laboratory tests). ECT, TT and aPTT are not standardised or validated with dabigatran for commercial use. In cases of emergency, TT and aPTT are the most accessible qualitative methods for determining the presence or absence of the anticoagulant effect of dabigatran." |
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Q57: What is the ratio of compression to breaths for neonatal resuscitation? A. 3:1 B. 15:1 C. 30:1 D. 15:2 E. 30:2 |
A. |
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Q60: In patients with refractory elevated ICP, bilateral decompressive craniectomy is associated with reduction in ICP and also results in: A. Reduced duration of ventilation B. Reduced duration of hospitalisation C. Improved overall mortality D. Worse long-term neurological outcome E. Unchanged long-term neurological outcome |
D. DECRA study: shorter ICU and hospital stays, worse LT neurological outcome "In adults with severe diffuse traumatic brain injury and refractory intracranial hypertension, early bifrontotemporoparietal decompressive craniectomy decreased intracranial pressure and the length of stay in the ICU but was associated with more unfavorable outcomes. " http://www.nejm.org/doi/full/10.1056/NEJMoa1102077 |
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Q61:Tumour lysis syndrome causes all of the following biochemical abnormalities EXCEPT: A. Hyperkalaemia B. Hypernatraemia C. Hyperphosphataemia D. Hyperuricaemia E. Hypocalcaemia |
B. "Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Catabolism of the nucleic acids to uric acid leads to hyperuricemia; the marked increase in uric acid excretion can result in the precipitation of uric acid in the renal tubules and renal vasoconstriction, impaired autoregulation, decreased renal flow, oxidation, and inflammation, resulting in acute kidney injury. Hyperphosphatemia with calcium phosphate deposition in the renal tubules can also cause acute kidney injury. High concentrations of both uric acid and phosphate potentiate the risk of acute kidney injury because uric acid precipitates more readily in the presence of calcium phosphate and vice versa. " Up2Date |
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Q66 You are performing an interscalene nerve block using a nerve stimulator when your patient begins to hiccough. You should aim to position the tip of your needle more A) Anterior B) Posterior C) Cephalad D) Caudal E) Superficial |
B. NYSORA: hiccough = phrenic n = too anterior scapula = thoracodorsal n or serratus anterior = too posterior |
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Q67 The characteristic respiratory pattern in a patient with an acute C5 spinal cord injury is A. Rapid respiratory rate B. Arterial hypoxaemia C. Chest wall immobility D. Preserved cough E. Preserved inspiratory force |
A. |
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Q68 Tavi vs Max medical therapy nonoperable aortic stenosis reduction in risk at 30 days of A. AMI B. AKI C. Death D. Atrial fibrillation E. Stroke |
No correct answer. PARTNER study. At 30d: TAVI increased risk vascular/bleeding/stroke At 1y: MM increased risk death and cardiac interventions No diff in AMI, AKI, AF
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Q69 Medial peribulbar block tip max distance past equator for minimal vein injury A. 5 B. 10 C. 15 D. 20 E. 25 |
C. 15mm NYSORA: "An alternative site of puncture for peribulbar anesthesia is the medial canthus. The needle is introduced at the medial junction of the lids, nasal to the lacrimal caruncle, in a strictly posterior direction to a depth of 15 mm or less. At this level, the space between the orbital wall and the globe is similar in size to that of the inferior and temporal approach and is free from blood vessels. Moreover, myopic staphyloma, an anatomic anomaly that represents a risk factor for perforation, is infrequently encountered on the nasal side of the globe." http://www.nysora.com/mobile/regional-anesthesia/sub-specialties/3029-local-regional-anesthesia-for-eye-surgery.html |
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Q76: A patient has suffered flash burns to half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burnt is: A. 18% B. 23% C. 32% D. 41% E. 48% |
C. 4.5 + 18 + 9 = 31.5 |
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Q77: You are anaesthetising an ASA 1 woman for a laparoscopic gynaecological procedure. How long does it take for the PaCO2 to peak? A. <15min B. 15-30min C. 30-60min D. 60-90min E. >90min |
B. |
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Q82: Anaemia post partial gastrectomy is most likely due to: A folate deficiency secondary to steatorrhea B ongoing haemorrhage from stomal ulcer '(yes Stomal not stomach)' C malabsorption of iron D Vit B12 deficiency due to loss of intrinsic factor E folate deficiency due to lack of appetite |
C. |
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Q83: 65year old for video assisted thoracoscopic lower lobe wedge resection. Surgeon requests lung isolation and one lung ventilation.Predictors of intraoperative hypoxia are: A central rather than peripheral lesion B left sided lesion C low Aa Oxygen gradient when ventilating both lungs D right sided lesion E supine rather than lateral position |
D. R sided lesion CEACCP 2010 Hypoxaemia during OLV: "Factors predictive of hypoxaemia during OLV include: ventilation of the left rather than the right lung, low oxygen partial pressure on two lungs, absence of reduction of perfusion to areas of lung pathology, and supine position rather than the lateral decubitus position." "Prediction of Hypoxemia: Several factors allow prediction of the risk of hypoxemia developing during OLV.5 First, the A-aO2 gradient during two-lung ventilation. Second, the side of lung collapse during OLV. The mean PaO2 level is 70 mmHg higher for left vs right thoracotomies. Third, patients with good preoperative spirometric pulmonary function tests tend to have lower PaO2 values during OLV than patients with poor spirometry. This may be related to auto-PEEP in patients with poor spirometry" (http://www.thoracic-anesthesia.com/?p=21) |
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Q94: Small air bubbles in the arterial line system will reduce A. Dampening coefficient B. ?Extrinsic Coefficient C. Measured systolic pressure D. Measured MAP E. Resonant frequency |
E. |
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Q95: RPT. Capnograph trace form a patient that is intubated and ventilated. What does it indicate? A. Endotracheal intubation B. Gas sample line leak C. ETT cuff leak D. Obstructive disease E. Spontaneous breaths |
B. |
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Q98' You extubate a young woman after a dental procedure under GA. She has a history of hereditary angioedema and in recovery she develops airway oedema. Best treatment A. FFP B. IV Adrenaline C. IV corticosteroids D. IV promethazine E. Nebulized adrenaline |
A. FFP (old treatment). Prefer C1 INH or bradykinin antagonist now (less risk from blood products). Congenital lack of C1 INH inhibitor. Steroids, adrenaline, antihistamines don't work |
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Q99 A previously well 65 year old female develops acute shortness of breath 3 days post hip replacement. The most appropriate investigations to confirm PE is A. CTPA B. D-dimer C. Echo D. Ecg E. V/Q scan |
A. CTPA |
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Q100 20 year old female with 25% burns to her body. She weighs 80 kg. How much replacement fluid should she be given over the next 8 hours? A. 4L B. 4.8L C. 5L D. 6L E. 8L |
A. 4L 4 x 25 x 80 = 8L Half in 1st 8h |
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Q101 50 y.o female with a history of mennohhragia is having a hysterectomy. Her pre-operative Hb is 95. What serum ferritin would confirm iron deficiency anaemia? A. 30 mcg/L B. 3 mg/L C. 3 mcg/L D. 0.3 mg/L E. 3000 mcg/L |
C. 3 mcg/L (normal range is 15-200mcg/L) (B and E are the same, know it is a whole number) |
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Q102 An Adult Jehovah's Witness requires a redo hip replacement for a peritrochanteric fracture. They request that no blood products are given. The anaesthetists decision to PROCEED is best given by: A. Autonomy B. Beneficence C. Justice D. Nonmaleficence E. Paternalism |
A. |
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Q103 100% Saturated air @ 20 degrees is what relative humidity @ 37 degrees A. 20% B. 30% C. 40% D. 50% E. 60% |
C. 40% Sat air at 37oC contains 44g/L H2O Sat air at 20oC contains 18g/L. RH = actual / saturated = 18 / 44 = 41% |
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Q104 Maximum cumulative dose of intralipid (ml/kg) A. 10 B. 12 C. 15 D. 20 |
B. 12ml/kg 1.5ml/kg/min bolus x 3. 15ml/kg/h infusion, double after 5 mins. Max 12ml/kg 20% intralipid |
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Q105 60yo alcoholic with HTN, has abdominal pain. No findings at laparotomy. 12 hrs later: Na140 k5 cl115 HCO3 18. What is the most likely diagnosis? A. ARF B. Diabetic ketosis C. Lactic acidosis D. Methanol E. NaCl infusion |
E. NaCl infusion |
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Q106 Diagram of a CTG (showing late decelerations). Causes: A. Uteroplacental insufficiency B. Foetal head compression C. Foetal asphyxia D. Umbilical cord compression E. General anaesthesia |
A. |
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Q107 In a clinical trial, researchers looked at 2 groups - smokers vs. non-smokers and followed then up for a period of time. This type of study is a A. Cohort B. Case study C. Observational D. RCT E. ? |
A. |
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Q110 Prothrombinex VF is useful in the perioperative period to correct the coagulopathic defect of all of the following except A. Isolated factor II deficiency B. Isolated factor VII deficiency C. Isolated factor IX deficiency D. Isolated factor X deficiency E. Warfarin |
B. Prothrombinex contains factors II, IX, X, ATIII, heparin, Na, PO4, Cl, citrate. Also very small amounts of factors V and VII in "human plasma proteins" |
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Q111 A 65 year old man otherwise fit and healthy is having a TKR under GA (O2, N2O, sevoflurane and fentanyl). His blood pressure has been stable through-out the case at 130/80. Before the orthopaedic surgeons start reaming and bone cemetation you should A. Give heparin 5000 iu B. Give a corticosteroid C. Cease N2O D. Induce hypotension E. Give a vasopressor to increase blood pressure |
C. OHA p 469 |
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12 year-old with idiopathic scoliosis, most likely have associated A. Phaemochromocytoma B. Renal artery stenosis C. Mitral valve prolapse D. Diabetes insipidus E. ? abnormality with the larynx |
C. 75% scoliosis is idiopathic. Can cause restrictive respiratory prob --> hypoxia, hypercarbia, pulm HT |
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Term neonate, noted to have intermittent stridor few days after birth, then parents also notice stridor during feeding and sleep. Otherwise normal and healthy. Most likely condition is A Cri-du-chat syndrome B Laryngomalacia C Tracheomalacia D Laryngocoele E ? something to do with cord paralysis |
B. Laryngomalacia A. Cri-du-chat: inherited, mental retardation, laryngomalacia, CHD. B. Laryngomalacia is the most common cause of chronic stridor. Issues to note:It results from prolapse of the epiglottis/arytenoids/aryepiglottic folds during inspiration due to a developmental delay in maturation of these supporting structures of the larynx.It is worse with crying, upper respiratory tract infections, after feeding and when supine.It usually resolves by 1-2 years of age. Vocal cord paralysis is the second most common cause of stridor in infants. Issues to note:When due to a central nervous system lesion (eg Arnold-Chiari malformation, raised intracranial pressure, hypoxic ischaemic encephalopathy (HIE), cerebral haemorrhage) it is usually bilateral and associated with marked respiratory distress but a normal cry.After trauma during birth (usually traction) or at intubation it is usually unilateral with a hoarse cry and little or no respiratory distress.Vocal cord paralysis is the second most common cause of stridor in infants. Issues to note: When due to a central nervous system lesion (eg Arnold-Chiari malformation, raised intracranial pressure, hypoxic ischaemic encephalopathy (HIE), cerebral haemorrhage) it is usually bilateral and associated with marked respiratory distress but a normal cry. After trauma during birth (usually traction) or at intubation it is usually unilateral with a hoarse cry and little or no respiratory distress. C. Tracheomalacia is a weakness in the walls of the trachea. Issues to note: Inadequate cartilaginous support of the trachea leads to collapse in expiration. Tracheomalacia usually appears after the first few weeks of life but can be a problem in the neonatal period. Vascular rings and slings can cause external compression of the airway. The stridor is often worse with feeding. OHA http://www.health.vic.gov.au/neonatalhandbook/conditions/stridor.htm |
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A picture of an echo 4 chambers view: A Anterior mitral valve leaflet B Posterior mitral valve leaflet C ? Aortic non-coronary D ? Tricuspid E |
Ant leaflet is closest to R side. Posterior leaflet close to free wall / coronary sinus |
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Cryoprecipate, once thawed must use within: A 30 minutes B 2 hours C 4 hours D 6 hours E 12 hours |
D. Cryo contains fibrinogen, factors VIII and XIII and fibronectin |
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Glycine 1.5% used for TURP, osmolality is: A 200 B C D 300 E 320 |
A. CEACCP (220mosm/kg) |
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Sick ICU patients seem to have moderate - severe ARDS PaO2/FIO2 ratio of 200, C.I. 1.7 (cardiac function seems okay). Decided to have ECMO, best mode is A AV B VA C VV D ? arterior-arterial E ? atrio-aortic (yes that's how they spelt it) |
C. VV LITFL. ECMO for acute, severe, life-threatening respiratory and/or cardiac failure that is refractory to conventional management - poor gas exchange - compliance < 0.5mL/cmH2O/kg - P:F ratio < 100 - shunt fraction > 30% (PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure to fractional inspired oxygen. Normal is >500.) TYPES VV = veno-venous for resp failure VA = veno-arterial: peripheral or central for cardiac (+/- resp) failure) Veno-pulmonary artery ECMO (provides short-term right ventricular and respiratory support following LVAD insertion) high (2 venous cannulae) vs low flow (1 venous cannula) |
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Middle age women c/o pain in hands when hanging out washing. Also found to have muscle wasting on one of the hand associated with weaker radial pulse. A CRPS B Lateral medullary syndrome C Thoracic outlet syndrome D Paraneoplastic syndrome E |
C. Thoracic outlet syndrome is a group of disorders that occur when the blood vessels or nerves in the space between your collarbone and your first rib (thoracic outlet) become compressed. This can cause pain in your shoulders and neck and numbness in your fingers. Common causes of thoracic outlet syndrome include physical trauma from a car accident, repetitive injuries from job- or sports-related activities, certain anatomical defects (such as having an extra rib), and pregnancy. |
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Radial nerve question with photos of a probe over postero-lateral upper arm and ultrasound image that show a triangular shape nerve, most likely the radial nerve. Injecting 5 ml of 0.75% [[ropivacaine] will produce sensory block over A Medial forearm B Lateral forearm C Dorsum of hand D Plantar surface of ring and little finger E Plantar surface of middle and ring finger |
C. |
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Blue urticaria is a complication of A B Methylene blue C Patent blue V D E |
C. Patent blue V |
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Intraosseous sampling - least accurate on: A Albumin B Urea C ? Na or K D Chloride E |
C. Na or K Correlated for RBC, Hb, Hct but not for WCC, plt. Correlated for glucose, urea, nitrogen, creatinine, chloride, total protein, and albumin concentrations but NOT for sodium, potassium, CO2, and calcium levels
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Sub- Tenon's (episcleral) block - muscle most likely to have inadequate block A Medial rectus B Lateral C Superior D Superior oblique E Inferior |
D. |
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EVAR, best method to reduce risk of renal impairment A Sodium bicarbonate B N-acetylcysteine C Normal saline D E |
C. Adequate hydration |
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EVAR is preferred over open AAA repair because A Lower cost B Lower mortality C Less follow up D Less re-intervention E Less need for critical care |
E. |
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Laser flex tube with double cuffs - how to inflate cuff(s)? A Inflate proximal then distal B Inflate distal then proximal C D Inflate distal only E Inflate proximal only |
B Inflate distal then proximal From Melbourne course. Want to inflate distal cuff to ensure it has a good seal. Then if proximal cuff is punctured you can rely on distal cuff.
Product information Features and benefits Laser-Flex Cuffed:• Dual cuffs of extra large diameter and individualinflation lines for maximum safety.• The pilot balloons with self-sealing valves areclearly marked “proximal” and “distal”.• Murphy Eye incorporated in a soft atraumatic tipas an additional safety feature.For adequate protection during laser surgery,both cuffs must be filled with isotonic saline. http://www.healthcare21.eu/wp-content/uploads/2014/07/Covidien-ETT-Brochure.pdf
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Forceps delivery. Loss of sensation medial thigh with loss of adduction at hip joint - resulted from injury to A Sciatic nerve B lumbosacral plexus C Lateral cutaneous nerve of thigh D Obturator nerve E |
D. |
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Called to cath lab because patient became agitated. Unstable angina having PCI,difficult right coronary stenting. Patient was hypotensive 80/40, HR 80/min in SR. What is the next best management step? A Transfer to operating theatre immediately B Sedate and intubate C ?crack on D Transthoracic echocardiography |
D. ? tamponade |
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A printout of 12-lead ECG A Atrial fibrillation with BBB B Sinus tachycardia with BBB C Torsades de pointes D VT E VF |
? |
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(Repeat) Diagram about 3-bottle underwater seal drain, with the height of the fluid level in the suction bottle indicates |
Maximal suction applied to the system |
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Photo of a patient with tongue deviation post cervical spinal fusion. Which nerve is damaged? A Glossopharyngeal nerve B Vagus nerve C Hypoglossal nerve D Accessory nerve E |
C. Hypoglossal nerve Hypoglossal nerve= CNX11, innervates tongue muscles. Glossopharyngeal = CN IX, sensory to tympanic membrane, post 1/3 of tongue, upper pharynx; taste to post 1/3 tongue Vagus = CN X, cricothyroid Accessory nerve = CN XI, motor to SCM and trapezius m |
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Post cardiac surgery. Rhythm strip to assess pacing on AOO. What is the diagnosis? A Pacing spikes with loss of capture B C D E |
? Pace / Sense / Inhibit |
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Young male with MVA + femur # on traction. Initial CXR normal. More than 24 hours. Became confused and drowsy, BP normal, crackles both lung fields with worsening O2 saturation to 85% on ward 12 hours later despite increasing oxygen flow. He has had 40mg morphine and a femoral nerve block. Diagnosis? A Fat embolism B Compartment syndrome C Pulmonary embolism D ? Pneumothorax E ? Lung contusion(other remembered options: LA toxicity, aspiration) |
A. Fat embolism FES: major features: - resp: tachypnoea, bilat creps, diffuse shadowing CXR - neuro: confusion, drowsiness - petechial rash |
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G5P5 in third stage labour. Found to be unresponsive, cyanosed, faint pulse. On oxytocin induction and epidural infusion 10ml/hour. Also oozing from previous IV or blood sampling sites. Diagnosis? A High spinal B AFE C PE D E Massive haemorrhage |
B. |
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In iron deficiency anaemia, one will expect a serum ferritin level to be less than A 300mg/L B 30mg/L C 30mcg/L D 300mcg/L E |
C. 30 mcg/L (normal is 20-200mcg/L) |
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Treatment for patients with congenital long QT syndrome A Pacemaker/defibrillator B Accessory pathway abalation C Beta blocker D Calcium channel blocker E |
C. Beta-blocker Long QT syndrome is caused by malfunction of cardiac ion channels impairing ventricular repolarisation. Start of Q to end of T >0.44ms. Can result in to polymorphic VT (Torsades des pointes) then degenerate into VF and death. Treatment or Torsades: DC cardioversion (HD compromise), Mg 2g over 2 mins, transvenous pacing to increase HR if Mg-resistant. LT prevention: beta-blockers, L cardiac sympathetic denervation if intolerant of beta-blockers, cardiac pacemakers to increase HR, AICD. |
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An 18 month old child with VF arrest, shock with A 10J B 30J C 50J D 100J E |
C. Weight ~ 11kg. Go above rather than below. 4J / Kg |
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Endovascular coiling of cerebral aneurysm under GA, patient suddenly develops hypertension. What is the most likely cause? A Acute hydrocephalus B Rupture of aneurysm C Contrast reaction D Cerebral embolism E |
B. Rupture of aneurysm CEACCP: "Vascular rupture or perforation may be: (i) spontaneous; (ii) due to hypertension during laryngoscopy, emergence, inadequate depth of anaesthesia, or associated with the use of vasoactive drugs; or (iii) brought about by the microcatheter, guide wire, coil, or injection of contrast. Clinical signs of a rise in ICP or a sudden rise in blood pressure with or without a fall in heart rate should alert the anaesthetist to this possibility. Extravasation of contrast may also be seen. The goals are to increase coagulability by reversing heparin, decrease bleeding by lowering blood pressure (to the level before the bleed), control ICP with hyperventilation, head elevation, steroids and osmotic agents, control seizures, and initiate cerebral protection. Once the bleeding is controlled, the pressure may be raised to check for leaks. " |
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A patient on citalopram. Post-op in PACU given tramadol. Developed fever, tremor, restlessness, confusion, hyperreflexia. Diagnosis is A Neuroleptic malignant syndrome B MH C Serotonin syndrome D E |
C. Serotonin syndrome SHIVERS: Shivering Hyperreflexia Increased temperature Vital sign instability Encephalopathy Restlessness Sweating |
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Best drug to reduce both gastric acidity and volume A Ranitidine B PPI C Sodium citrate D E |
?A. Ranitidine Reducing gastric volume: - Preoperative fasting - Nasogastric aspiration - Prokinetic premedication Reducing pH of gastric contents: - Antacids - H2 histamine antagonists - Proton pump inhibitors http://ceaccp.oxfordjournals.org/content/early/2013/11/21/bjaceaccp.mkt053/T1.expansion.html |
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Patient on moclobemide came in for surgery. In view of the use of vasopressor to treat hypotension one will give judicious amount of A. ? B. Metaraminol C. Adrenaline D. Noradrenaline E. Phenylephrine |
E. Phenylephrine Use as direct acting. CEACCP |
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Patient with hyperthyroidism - proceed with elective surgery only if normal level of these hormones is seen A TSH B T4 C T3 D T3 & T4 E |
D. UTD: There are no published studies evaluating the risks of nonthyroid surgery in hyperthyroid patients. In our experience, patients with subclinical hyperthyroidism (low TSH, normal free T4 and T3) can typically proceed with elective surgeries. 2011 |
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In pregnant women the durac sac ends at A B L3 C L5 D S1 E S3 |
D. S1 Open Anaesthesa ~ S2 NYSORA S1 |
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Full size C oxygen cylinder providing 10L/min of oxygen flow to a patient during transport. How long will this cylinder last? A B C 45 minutes D E |
C. 45mins Size C = 450 L Size D = 1900 L (both ~15000kPa when full) |
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Jehovah's witness having a TKR. You agree to proceed with surgery. Which ethical principle are you honouring? A Autonomy B Non-maleficence C Beneficence D Justice E Fidelity |
A. Autonomy |
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Red-man syndrome secondary to vancomycin is due to A Type II hypersensitivity reaction B Vasodilation C Mast cell degranulation D IgE immediated response E Serotonin release |
C. Mast cell degranulation Red man syndrome is an infusion-related reaction peculiar to vancomycin. Red man syndrome, an anaphylactoid reaction, is caused by the degranulation of mast cells and basophils, resulting in the release of histamine independent of preformed IgE or complement. The extent of histamine release is related partly to the amount and rate of the vancomycin infusion. |
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A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP: A Administer Anti-D antibodies 6 hrs pre op B Admister desmopressin one hour pre op C Administer methylpred and IVIg 2 days pre op D Recheck platelet count morning of surgery and if not dropped continue E Platelet transfusion morning of surgery |
C. Methylpred and IVIg OHA p220: "In ITP, plt transfusions should be reserved for major haemorrhage. Preparation for surgery involves the use of steroids or high-dose immunoglobulins initially". |
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Absolute contraindication to ECT A Cochlear implants B Epilepsy C Pregnancy D Raised intracranial pressure E Myocardial infarction |
D. Absolute: recent AMI or CVA, phaeo, intracranial mass lesion, intracranial or aortic aneurysm. Relative: uncontrolled angina, CCF, severe OP, major bone fracture, glaucoma, retinal detachment. ECT is possible in pregnancy OHA p 292 |
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Stellate ganglion block. Needle entry next to SCM muscle at C6. Which direction to advance needle ? A. C3 B. C4 C. C5 D. C6 E. C7 |
D. C6 FRCA TOTW 256: "The patient is in a supine position with slight extension of the neck. The head is turned to the oppositeside. The needle is introduced between the trachea and the carotid sheath at the level of the cricoidcartilage and Chassaignac's tubercle (C6) to avoid any potential injury to the pleura. Thesternocleidomastoid muscle and carotid artery are pushed laterally while simultaneously palpating theChassaignac's tubercle. The skin and subcutaneous tissue are pressed firmly onto the tubercle, theneedle is directed medially and inferiorly towards the body of C6, to hit it and then withdrawn by 1-2mm to rest outside the longus colli muscle." |
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Repeat CTG with early decelerations A. GA B. Fetal head compression C. Uteroplacental insufficiency D. Acute asphyxia E. Umbilical cord compression. |
B. Early = foetal head compression Late = uteroplacental insufficiency Variable = umbilical cord compression |
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Endocarditis prophylaxis A Bicuspid valve B Congenital repair > 12 months ago C Rheumatic heart valve D Uncorrected cyanotic heart disease E MVP |
D. |
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CVL relatively contraindicated in: |
A. LBBB Guide wire may precipitate RBBB superimposed on LBBB i.e. CHB |
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Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique A. 3 mg/kg B. 7 mg/kg C. 15 mg/kg D. 25 mg/kg E. 35 mg/kg |
E. 35mg/kg |
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You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is A. give 0.5 mg metaraminol iv B. use NMT to assess train of four ratio C. change to volatile anaesthetic D. do nothing E. increase propofol TCI concentration by 0.5 |
B |
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What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.e. have a dibucaine number 30-70? A. 0.04% B. 0.4% C. 4% D. 14% E. 40% |
C |
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Repeat CO2 penetrates surface tissue so well with little damage to underlying tissue because A. Well absorbed by Hb B. Poorly absorbed by H20 C. Widely disseminated in tissue D. Long infrared wavelength E. Short infrared wavelength |
D |
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With regards to ROTEM: maximal clot firmness (Increased MA: maximal amplitude on TEG) correlates best with needing to give: A. FFP B. Cryoprecipitate C. Platelets D. Prothrombinex E. Tranexamimic acid |
Increased MA indicates hypercoagulation. If decreased: give platelets. |
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The MELD score is calculated using INR, Bilirubin & what? A. Creatinine B. Albumin C. Urea D. AST E. Ammonia |
A |
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An 80 year old man undergoes a unilateral lumbar sympathectic blockade. The most likely side effect that he experiences is: A. Genitofemoral neuralgia B. Haematuria C. Postural hypotension D. Lumbar radiculopathy E. Psoas haematoma |
A. Genitofemoral neuralgia Nerves of lumbar plexus (T12-L4): iliohypogastric, ilioinguinal, genitofemoral, LFCN, psoas, iliacus, femoral, obturator. Complications of lumbar plexus block: Bleeding, intravascular injection, intrathecal or epidural injection, perforation of viscera, groin pain (genitofemoral nerve injury CEACCP: Sympathetic plexus blocks. |
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The most important effect of Lugol's iodine administration before thyroid surgery is A. reduce incidence of thyroid storm B. reduce incidence of vocal cord palsy C. increase likelihood to identify and preserve parathyroid glands D. pigmentation of thyroid gland to help identify thyroid gland E. reduce vascularity of thyroid gland |
E. Reduce vascularity |
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To exclude raised ICP in an awake patient the most reliable finding is what ? A. No headache B. No diplopia C. No vomiting D. Pulsatile retinal vein E. No papilloedema |
D. Pulsatile retinal vein https://en.wikipedia.org/wiki/Non-invasive_intracranial_pressure_measurement_methods |
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Which population is more liable to CNS damage from Hyponatraemia? A. Children B. Young males C. Young females D. Old males E. Old females |
A. Children
The majority of morbidity associated with uncorrected symptomatic hyponatremia is due to brain damage. Important risk factors for hyponatremic brain damage have been defined as: Gender (women of childbearing age) Age (prepubescent children) Physical factors including discrepancy between skull size and brain size Actions of multiple hormones (particularly vasopressin and estrogen) Presence of hypoxia (low oxygen)
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You are anaesthetising an ASA 1 woman for a laparoscopic gynaecological procedure. How long does it take for the PaCO2 to peak? A. <15min B. 15-30min C. 30-60min D. 60-90min E. >90min |
B |
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Health care worker. HBV exposure. Known to have immunisation titres. What do you do? A. Booster dose of his immunisation B. HBV immunoglobulins C. Pegylated Interferon D. Aciclovir |
B. Hepatitis B Immunoglobulin (Given IM) If vaccinated with known titres, then no need for treatment. If unvaccinated or titres unknown, then give IVIg as well as vaccination. http://www0.health.nsw.gov.au/policies/pd/2005/pdf/PD2005_311.pdf
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20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours. A. 2.6L N/saline B. 3.6L N/saline C. 3.6L CSL D. 4.8L N/saline E. 4.8L CSL |
E. 4.8L CSL 80 x 30 x 4 = 9600ml in 24 h. Half in 1st 8 hours. CSL preferred. |
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A 50 year old male in recovery after an anterior cervical spinal fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, spO2 96%. What is the most appropriate management ? A. Direct laryngoscopy and intubation after inhalational induction with sevoflurane B. Awake tracheostomy by surgeons C. Awake fibreoptic intubation using minimal sedation D. Direct laryngoscopy and intubation with propofol and sux E. Retrograde intubation |
A. (C if not combative) |
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Asthmatic paediatric patient, tonsillectomy. Desaturates and stiff to bag. First thing to do? A. Salbutamol B. Suction C. Ask surgeon to release gag D. Paralysis E. ? reintubate |
?C POW = B or C C consensus in the end |
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Balloon pump trace 2:1 A. Early inflation B. Late inflation C. Early deflation D. Late deflation E. ? No problem |
POW = E Kerry Brandis.com = B IABP scenarios: http://lifeinthefastlane.com/cardiovascular-curveball-007/ PDF: http://cdn.lifeinthefastlane.com/wp-content/uploads/2009/11/intra-aortic-balloon-pump.pdf |
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A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is: A. Epidural Lignocaine B. IV Esmolol C. IV Hydralazine D. IV Magnesium E. IV Propofol |
D. IV Magnesium TOTW 151 suggests Mg. Propofol may be quicker (not mentioned, also may persist post-removal). Esmolol no use for HT, used for isolated tachycardia. Options for HT: phentolamine, SNP, GTN, volatile, CCB. |
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Flow volume loop diagram A. Variable intra-thoracic obstruction B. Variable extra-thoracic obstruction C. Restrictive pattern D. Obstructive pattern E. Fixed obstruction |
https://ainotes.wikispaces.com/Spirometry+Criteria |
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A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is: A. increase PEEP to 20cmH20 B. increase tidal volume to 10mls/kg C. initiate nitrous oxide therapy D. commence high flow oscillatory ventilation E. ventilate in the prone position |
E. Ventilate in prone position (PROSEVA trial) |
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When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to: A. T2 B. T4 C. T6 D. T8 E. T11 |
B |
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Repeat You are involved in research and as part of data collection you collect ASA scores. This type of data is: A. Categorical B. Nominal C. Non-parametric D. Numerical E. Ordinal |
E. Ordinal |
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During a pneumoperitoneum, at what level of intra-abdominal does cardiac output fall? A. 10 mmHg B. 20 mmHg C. 30 mmHg D. 40 mmHg E. 50 mmHg |
A. 10mmHg |
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Best option to reduce risk of ventilator induced pneumonia? A. Nurse in supine position B. Early spontaneous ventilation through ETT C. Oral hygiene D. Use antacids E. Regularly change breathing circle |
C |
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Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby? A. codeine B. morphine C. paracetamol D. parecoxib E. tramadol |
A |
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A patient is in Class 4 haemorrhagic shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to: A. acidosis B. dilution of clotting factors C. hypothermia D. systemic release of tissue factor E. tissue hypoperfusion |
E. Tissue hypoperfusion |
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The normal physiological response following ECT is A. transient tachycardia followed by bradycardia and hypotension B. transient bradycardia followed by tachycardia and hypertension C. unpredictable D. transient tachycardia followed by bradycardia and hypertension E. tachycardia and hypotension |
B. Bradycardia (even asystole) then tachycardia and hypertension |
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In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would- A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece B. Deflate tracheostomy cuff, remove one-way valve, insert fenestrated piece C. Inflate tracheostomy cuff, remove one-way valve, insert fenestrated piece D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece E. ? |
A. |
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What is NOT a contraindication to MRI? A. Pulmonary artery catheter B. Arterial line C. Scissors D. Coiled ECG cable E. Laryngoscope |
B. |
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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. |
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Repeat Which volatile contributes most to greenhouse gases / environmental pollutant ? A Desflurane B N2O C Sevoflurane D Isoflurane E Halothane |
A. Desflurane |
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The clinical sign that a lay person should use to decide whether to start CPR is: A. Absent central pulse B. Absent peripheral pulse C. Loss of consciousness D. Obvious airway obstruction E. Absence of breathing |
E. Absence of breathing
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A patient's competence to give informed consent is determined by all the following except: A. Ability to communicate a choice B. Ability to apply reasoning C. Ability to understand consequences D. The provision of significant information E. ? |
D |
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First line treatment for acute attack of hereditary angioedema A FFP B Adrenaline C Steroids D C1 inhibitor concentrate E anti-histamine |
D. C1 inhibitor concentrate (or Incatibant - bradykinin antagonist) (previous treatment was FFP) http://www.allergy.org.au/images/stories/pospapers/ASCIA_HP_Position_Paper_HAE_2012.pdf page 41 flowchart |
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Adult male who is intubated and ventilated, with CVL in situ. Just before surgeon starts the Line Isolation Monitor alarms about a leak at 5mA. What do you do? A. stop procedure and move to a safe location B. sequentially remove non essential monitors from the circuit until fault is identified C. unplug the CVL to electrically isolate it until fault is identified D. ensure the patient is earthed E. Check the diathermy pad |
B. Sequentially remove monitors (usually it is due to the last one plugged in). https://www.openanesthesia.org/line_isolation_monitor/ |
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Patient with Haemophilia A with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for OT a. FVIIa b. High dose FVIII concentrate c. FFP d. Cryo e. Platelets |
A. Factor VIIa (eg NovoSeven) If low titres, usually can be overcome with higher doses of factor VIII. But high titres need alternatives: FEIBA or rFVIIa |
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55 year old subarachnoid haemorrhage secondary to aneurysm. Patient is confused with a oculomotor (3rd cranial nerve) palsy, complains of a severe headache. This patient is in Hunt and Hess class: A 0 B 1 C 2 D 3 E 4 |
D. 3 Hunt & Hess scale: 1. Asymptomatic, mild headache, slight nuchal rigidity 2. Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy 3. Drowsiness / confusion, mild focal neurologic deficit 4. Stupor, moderate-severe hemiparesis 5. Coma, decerebrate posturing |
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Repeat In a 140kg obese patient, compared to a 70 kg person A. cardiac output >20% lower B. cardiac output 10% lower C. cardiac output no different D. cardiac output 10% higher E. cardiac output >20% higher |
E. |
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Lateral CXR given. Can see lower half of thorax and vertebrae but upper half is all black with clear demarcation A. Loculated effusion B. Artifact caused by patient's arm C. Left lower lobe consolidation D. Right middle lobe consolidation E. Right lower lobe consolidation |
LLL often loss of hemidiaphragm, and sharp delineation by oblique fissure. Also loss of vertebrae getting darker as move inferiorly.
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Hb 86 post TKJR in an asymptomatic patient with stable angina. A. Transfuse to 120 B. Transfuse to 100 C. Observe overnight and repeat mane. |
C. Observe overnight and repeat mane. http://www.blood.gov.au/system/files/documents/pbm-module-2-qrg.pdf Transfusion guidelines suggest in absence of acute myocardial or cerebral ischaemia, if Hb>80 then do not transfuse. |
