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147 Cards in this Set
- Front
- Back
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Small air bubbles in the arterial line system will reduce
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E Resonant Frequency A small air bubble markedly dampens the system but lowers natural frequency and causes an artifactual 25 mm Hg increase in systolic pressure. Air bubble in system Increases damping, reduces natural frequency and may therebyparadoxically increase resonance in system causing systolic overshoot.( lower naturalresonant frequency means more resonance) ( graphs given) http://web.squ.edu.om/med-Lib/MED_CD/E_CDs/anesthesia/site/content/v03/030263r00.HTM |
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EVAR is preferred over open AAA repair because
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A - no has higher cost B - lower operative mortality at 30 days but not long term C - need more follow up as more surveillance due to higher risk endoleak D - More re-intervention due to endoleaks E - True - as shorter ICU stay
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Version E: RB38d Post partum foot drop is most frequently caused by A.compression of the lumbosacral trunk by the foetal head or forceps B.damage to the common peroneal nerve from lithotomy position.... C.damage to the conus medullaris by misplaced spinal anaesthesia D.L4 Nerve root damage from epidural analgesia E.the excessive lumbar lordosis of pregnancy stretching nerve roots
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Version E: Answer is A See 2015 for other versions |
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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?
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D TOE - possible perforation |
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Hyperkalaemia of 7 or 8. Most appropriate therapy to decrease Potassium. d) Calcium
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A - insulin/glucose - 10 units Actrapid and 50mL 50% Glucose. |
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A: Infective endocarditis prophylaxis indicated for dental procedures in a) Aortic balloon valvuloplasty b) Bicuspid valve c) Patch Repair of VSD d) Previous Mitral valve ring annuloplasty
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D - best answer is Mitral Valve ring Annuloplasty as it contains a prosthetic component
(Wiki: Mitral valve annuloplasty is a surgical technique for the repair of leaking mitral valves. Due to various factors, the two leaflets normally involved in sealing the mitral valve to retrograde flow may not coapt properly. Surgical repair typically involves the implantation of a device surrounding the mitral valve, called an annuloplasty device, which pulls the leaflets together to facilitate coaptation and aids to re-establish mitral valve function.)
Antibiotic prophylaxis is recommended in patients with the following cardiac conditions who are undergoing certain dental procedures (see Table 2.2) or other procedures (see Table 2.3 and Table 2.4)
* prosthetic cardiac valve or prosthetic material used for cardiac valve repair * previous infective endocarditis * congenital heart disease but only if it involves:unrepaired cyanotic defects, including palliative shunts and conduits * completely repaired defects with prosthetic material or devices, whether placed by surgery or catheter intervention, during the first 6 months after the procedure (after which the prosthetic material is likely to have been endothelialised) * repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation) * rheumatic heart disease in high-risk patients
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The clinical sign that a lay person should use to decide whether to start CPR is:
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E |
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Young man has removed his buprenorphine patch on the morning of surgery. What time till PLASMA reaches half original level A. 12 hours B. 18 hours C. 24 hours D. 30 hours E. 36 hours |
Answer: A - 12 hours Reference: Acute pain management scientific evidence 2010 p163. (From 2013B) Norspan product information“After removal of a NORSPAN patch, buprenorphine concentrations decline, decreasing approximately 50% in 12 hours (range 10 - 24 h)” |
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NEW You are inducing a 20-year-old female who has an IV cannula in her antecubital fossa which was inserted in the emergency department. She complains of pain after 10mL of propofol and it becomes clear that cannula is intraarterial. The best management option is: A. Intraarterial injection of 5mL 1% lignocaine B. Intraarterial injection of 30mL Normal Saline C. Intraarterial injection of 50mg paperverine D. Intraarterial injection of 500u heparin E. Observation(this may not be worded correctly - feel free to correct) |
Lignocaine - possibly but can cause vasoconstriction and decreased blood supply (see below) N/S - no Papaverine - dose sounds reasonable per google search - probably correct answer Heparin - give to prevent thrombosis - but not arterially. From CEACCP article There is no universally accepted treatment protocol; most interventions attempt to maintain perfusion distal to the site of injury. The affected extremity should be elevated to improve venous and lymphatic drainage, and analgesia given as a priority. The extent of the injury should be identified and documented carefully and plastic surgery advice sought. As thrombosis is ultimately the cause of the tissue injury, anticoagulation with heparin should be considered in an attempt to limit the extent of the ischaemia. Other specific interventions include:Local anaesthetic injectionIA injection of lidocaine through the implicated cannula may prevent reflex vasospasm. However, this procedure may actually damage the artery and compromise the blood supply to the already affected limb. Extremity sympatholysisStellate ganglion blocks and lower-extremity sympathetic blocks will produce sustained arterial and venous vasodilatation, but the potential benefit must be weighed against the risks of the procedure.Other pharmacological therapies Calcium channel blockers have been tested with varying results. Thromboxane promotes vasoconstriction, and drugs which inhibit thromboxane (aspirin, methylprednisolone) may help to reverse the tissue ischaemia. Iloprost is a prostacycline analogue with vasodilatory and platelet-inhibiting properties and IA papaverine facilitates vascular smooth muscle relaxation; both these have been used as part of a multimodal approach to treatment with varying success. |
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NEW The most useful sign to distinguish between severe serotonin syndrome and malignant hyperthermia are A. Clonus B. Hyperthermia C. Metabolic acidosis D. Muscle rigidity E. Wheeze |
A. Clonus = SS D. Muscle rigidity = NMS |
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NEW Patient having a laparotomy. On prednisolone for 6/12, 10mg/day. What is the equivalent dose of dexamethasone? A) 2mg B) 4mg C) 6mg D) 8mg E) 10mg (or was the option 12mg?) |
Plugged into Dose Conversion Prednisone 10mg/day is 1.5mg Dex 40mg Hydrocortisone so pick 2mg/day |
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NEW In a normal adult what amount of IV potassium chloride is needed to raise the serum potassium from 2.8 to 3.8mmol/L? A 10mmol/L B 20mmol/L C 50mmol/L D 100mmol/L E 200mmol/L |
Best answer is 100 mmol - see below Medscape: In general, a 1 mEq/L drop in potassium correlates to a loss of 100-200 mEq of total body potassium Elsewhere on web: 10 mEq will raise by .1 mEq/L - so to raise by 1mEq/L multiply by 10 - so 100 mEq - i.e. 100 mmol. Maximum rate peripheral 10 mmol/hr Maximum rate CVC 20 mmol/hr |
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(I don't remember this one) In a haemodynamically stable 20 year old man with blunt chest trauma, the best screening test to diagnose cardiac injury requiring treatment is: A CXR B serum CK-MB C serum troponin D 12 lead ECG E Transthoracic Echocardiogram |
E - Per article. Others may or may not indicate damage but will not be accurate enough to tell you treatment is needed. Heart. 2003 May; 89(5): 485–489.PMCID: PMC1767619Diagnosing cardiac contusion: old wisdom and new insightsK C Sybrandy,1 M J M Cramer,1 and C Burgersdijk A - CXR "Chest radiography and thoracic computed tomography provide no additional information for the diagnosis of cardiac contusion but may show associated injury of the great vessels, or skeletal or pulmonary structures" B - Serum CK "However, in multitrauma with high CK concentrations many false positive increases were found. The usefulness of CK-MB determination seemed to be restricted to the detection of myocardial trauma in case of mild non-cardiac injuries. More recent studies reported low sensitivity and specificity of CK-MB for cardiac injury in this category of mildly injured patients. Therefore, CK-MB determination is of limited value in the detection of myocardial injury. C - Troponin - Serum cardiac troponins, troponin I and troponin T, are highly specific to myocardial injury. They are myocardial regulatory contractile proteins not found in skeletal muscles and are released into the circulation only after loss of membrane integrity. The latest studies showed high accuracy of both troponin I and troponin T in the diagnosis of cardiac injury. Moreover, a normal concentration of cardiac troponin I or T has been reported by several investigators to be a strong indicator for the absence of cardiac injury in patients with blunt chest trauma D - Because of its anterior position in the thorax and proximity to the sternum, the right ventricle is far more frequently injured than the left ventricle. The ECG mainly reflects the electrical activity of the left ventricle because of its greater mass. The ECG is relatively insensitive to right ventricular electrical activity. For that reason, a cardiac contusion usually results in moderate right ventricular damage with only minor electrical changes, which can easily be missed on an ECG. E - "Contused myocardial tissue not only resembles infarcted myocardial tissue histologically but also functionally. A myocardial contusion can be recognised by localised myocardial wall dysfunction. Consequently, two dimensional echocardiography, which provides a direct view of wall motion abnormalities, has been shown in several studies to be an excellent tool in the detection of cardiac injury. In addition, echocardiography may show associated valvar lesions, intracardiac shunts or thrombosis, pericardial effusion or tamponade, and ventricular dilatation. From a practical standpoint, other important advantages of echocardiography are its non-invasive nature and its ease of use at the bedside and in the emergency department." CEACCP Article Myocardial contusion occurs more commonly than suspected;its presentation may be subtle. A fracture of the sternum or aseat-belt mark should always alert the physician to possibleunderlying cardiac contusion. Symptoms are often masked byunderlying chest wall and lung injuries. The diagnosis is con-firmed by ECG abnormalities, raised troponin T, serial elevationof the CK-MB iso-enzyme concentrations or echocardiographic abnormalities. ECG abnormalities include tachycardia, pre-mature ventricular contractions, atrial fibrillation, bundlebranch block and ST segment changes. The treatment is sup-portive and particular attention should be focused on the pre-vention of myocardial ischaemia and the management of pain |
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Which volatile agent has got minimum effect on ICP at 1 MAC a) isoflurane b) sevoflurane c) desflurane d) enflurane e) halothane |
B -- Sevo. Current Opinion in Anaesthesiology: October 2006 - Volume 19 - Issue 5 - p 504-508 |
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You are performing epidural anaesthesia on an adult patient. To minimize the chance of inserting the epidural catheter into a blood vessel you would: A. Inject saline through the epidural needle prior to threading the catheter B. Perform the procedure with the patient lateral rather than sitting (also remembered as sitting not lateral) C. Use a loss of resistance to air technique instead of loss of resistance to saline. (also remembered as saline not air) D. avoid using a combined spinal-epidural technique E. use a midline rather than a paraspinous (paramedian) approach |
Probably inject with saline best Anesth Analg 2009;108:1232–42“Injecting fluid through the epidural needle before catheter insertion decreases risk (OR 0.49)” “The risk of epidural vein cannulation was significantly higher in the sitting group (16 of 102 = 15.7%) compared with the lateral position group (4 of 107 = 3.7%)”“Adoption of the lateral recumbent head-down position for the performance of lumbar epidural blockade, in labour at term, reduces the incidence of lumbar epidural venous puncture in these obese parturients.” Canadian Journal of Anesthesia From the black bankAnesthesia& Analgesia 2009.: "The risk of intravascular placement of a lumbarepidural catheter in pregnancy may be reduced with the lateral patientposition, fluid predistension, a single orifice catheter, a wire embeddedpolyurethane epidural catheter and limiting the depth of catheter insertion to6 cm or less". Five strategies reduce therisk of epidural vein cannulation: 1. the lateralas opposed to sitting position (six trials, mean (sd) quality score = 35%[11%], odds ratio (OR) 0.53 [95% confidence interval (CI) 0.32–0.86]) 2. fluid administered through the epidural needle before catheterinsertion (8 trials, quality score 48% [18%], OR 0.49 [95% CI 0.25–0.97]) 3. single rather than multiorifice catheter (5 trials, quality score30% [6%], OR 0.64 [95% CI 0.45–0.91]) 4. a wire-embedded polyurethane compared with polyamide epiduralcatheter (1 trial, 31%, plus 4 unscored abstracts, OR 0.14 [95% CI 0.06–0.30]) 5. catheter insertion depth ≤6 cm (2 trials, 47% [11%], OR 0.27 [95% CI0.10–0.74]). The paramedian as opposedto midline needle approach and smaller epidural needle or catheter gauges donot reduce the risk of epidural vein cannulation. |
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This ECG with AAI pacing shows: The 12-lead ECG showed pacing spikes followed by p-waves, with QRS's following the p-waves with progressive prolongation of the PR until a QRS was dropped. In other word, second degree heart block (type 1, although the type was not required to answer the question). The ECG looked very much like "Example 8" from lifeinthefastlane. I think it was lifted from this website. A. Failure to capture B. CHB C. 2nd degree HB D. AF |
Probably 2nd degree HB Per LITFL: "Atrially paced patients often have evidence of 1st degree AV block or Wenckebach conduction on their paced ECG that is not apparent on their baseline tracing. This is because the sort of patients that require atrial pacing (e.g. post-op cardiac surgery) commonly have some degree of AV node dysfunction (e.g. due to age-related AV-nodal degeneration / their underlying cardiac condition / post-operative ischaemia / AV-nodal blocking drugs). When these patients are paced at a faster rate than their AV node can handle, the AV node becomes “fatigued” resulting in 1st degree AV block or Wenckebach phenomenon on the paced ECG. This abnormality is not clinically important provided that the patient’s cardiac output is not compromised." http://lifeinthefastlane.com/ecg-library/pacemaker/ |
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Timing of peak respiratory depression after intrathecal 300 mcg morphine: A. < 3.5 hours B. 3.5 – 7.5 hours C. 7 - 12.5 hours D. 12.5 -18 hours E. > 18 hours |
B - 3.5 - 7.5 hours In ANZCA Blue Book 3rd edition page 195 "Respiratory depression occurs in up to 1.2% to 7.6% of patients (Meylan et al, 2009 Level I)given intrathecal morphine. When measured in opioid-naive volunteers, respiratory depressionpeaked at 3.5 to 7.5 hours following intrathecal morphine at 200 to 600 mcg doses (Bailey et al,1993 Level IV). Volunteers given 600 mcg had significant depression of the ventilatory responseto carbon dioxide up to 19.5 hours later” |
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New (Don't remember this one) Patient with IgA deficiency. What is the main issue in anaesthesia? A. Anaphylaxis to blood products B. Renal impairment C. D. Sensitivity to opioids E. Sensitivity to muscle relaxants |
A - This is true. Patients with IgA deficiency can have anaphylaxis to blood products - esp. if sensitive with prior transfusion or pregnancy - it is to the IgA in the blood. |
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When performing regional anaesthesia for eye surgery, needle damage to the globe of the eye is more common with: A. a globe axial length of less than 25 mm B. patients aged less than 45 years C. peribulbar block using the inferotemporal approach D. peribulbar block using the medial canthus approach E. sub-Tenon block |
A - NO - globe length > 25mm B - Unknown but unlikely?? C - Peribulbar using inferotemporal - YES D - Peribulbar using medial canthus - less likely than above route E - Sub-Tenon - less likely than Peribulbar |
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Best method to assess reversal of neuromuscular blockade? A. Sustained head lift 5 sec B. Sustained leg lift 5 sec C. TOF 0.9 with accelerometer D. DBS no fade E. Tetanus 50Hz F. Tidal volumes... ? |
TOTW/FRCA: C - TOF/accelerometer Objective measurement of neuromuscular monitoring is the only way of accurately assessing residualneuromuscular blockade. CEACCP: Quantitative methods of measuring evoked responses, for the example, acceleromyography or mechanomyography, are necessary to ensure adequate recovery from block. |
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Anaphylaxis to rocuronium. Which is most likely to cause cross-reactivity ? A. Vecuronium B. Pancuronium C. Atracurium D. Cisatracurium E. None of the above -cross reactivity too variable to predict |
Likely E - none of above From Allergy 2007; 62: 471-487 Review Article: Anaphylaxis during anaesthesia:diagnostic approach "Cross Reactivity between NMBA is said to be common because of ubiquitous ammonium groups in these drugs. The estimated prevalence of cross-reactivity between NMBA is about 65% by skin tests and 80% by radioimmuno assay inhibition tests. While some pairings are common, the patterns of cross-reactivity vary considerably between patients. It is unusual that an individual isallergic to all NMBA (41, 44, 45). Cross-reactivity depends on theconfiguration of the paratope of the antibody, which might either completelycorrespond to the ammonium epitope or extend to an adjacent part of the NMBAmolecule, to the structure of the NMBA (flexibility, inter-ammonium distance)and to the relative affinities of the different NMBA for their sIgE antibodies(34, 45, 46).Alternatively, it must be kept in mindthat some patients might suffer from multiple allergies (3, 14, 16).Consequently, diagnostic approach of anaphylaxis during anaesthesia cannot beconsidered as complete when it failed to address the possibility ofcross-reactivity and/or multi-sensitization, or did not involve identificationof safe alternative regimens. This assessment, unfortunately, is fraught withdifficulties, as results of skin tests, quantification of sIgE and sIgEinhibition tests do not per se reflect the clinical outcome. In the series byThacker et al. (47), no subsequent reactions were seen if NMBA were avoided inthe subsequent anaesthesia, nor were they in patients with severe reactions ifthe original intradermal test (IDT) had been equivocal or negative. In thepatients with a severe reaction and a positive IDT to one or more NMBA, six outof 40 (15%) later anaesthesia using NMBA were associated with clinicalproblems, three being probable anaphylactic reactions. In a series by Fisherand Bowey (48), one out of 65 patients that had suffered from skin testdocumented perioperative ana- phylaxis suffered from anaphylaxis duringsubsequent general anaesthesia. Actually, this patient had presentedanaphylaxis from pancuronium and reacted subsequently to alcuronium, albeitskin tests for alcuronium, remained negative on two occasions. Therefore, itmay, in any case, be safer to avoid NMBA for such a patient in futureanaesthesia whenever possible." |
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10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is: A. Cease dabigatran 7 days prior B. Cease dabigatran 3 days prior C. Cease dabigatran 3 days prior and give bridging anticoagulation D. Cease dabigatran 24 hours prior and measure INR on day of surgery E. Continue dabigatran and withhold on day of surgery |
Varying resources say 5 days for normal renal function for Spinal. But there was only option of 3 or 7. 7 too long so likely answer is B - 3 days |
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AICD, what does a magnet do A. Maintain defib activity & activate asynchronous pacing B. maintain anti tachycardia pacing & deactivate asynchronous pacing C. Deactivate anti tachycardia pacing & activate asynchronous pacing D. Deactivate defib & activate asynchronous pacing E. Deactivate defib & no change to any pacing |
I thought it was E. Description did not say it was a pacemaker/defibrillator - just a defib - so shouldn't be any pacing to activate. |
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(New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management? A. Incentive spirometry B. Diuresis C. Broad spectrum ABs D. Naloxone 100mcg increments E. ? |
A |
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After ingestion of 500mg/kg Aspirin. What will enhance her elimination most effectively? A. Mannitol B. Haemodialysis C. lignocaine D. ? E. BIcarbonate infusion |
B ESTIMATE OF ACUTE TOXICITYINGESTED DOSE (mg/kg) ESTIMATED TOXICITY<150 mg/kg No toxic reactionexpected150-300mg/kg Mild to moderate toxicreaction300-500 mg/kg Serious toxic reaction>500 mg/kg Potentiallylethal toxic reaction |
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Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be? A. Pulmonary embolism B. Venous air embolism C. Acute right heart failure D. Myocardial ischaemia E. Pneumothorax |
C |
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Photograph of an Arndt bronchial blocker multiport airway adapter. Orifice labelled 'X'. What goesin 'X'? A. Bronchoscope. |
Bronchoscope down straight port. Slight angle is blocker Straight angle is airway circuit |
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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 |
A - Stage 0 B - Stage 1 C - Stage 2 D - Stage 4 E - Stage 3 |
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Sick ICU patients PaO2/FIO2 ratio of 200, C.I. 1.7 (cardiac function seems okay). PCWP 26?? Decided to have ECMO, best mode is A AV B VA C VV D. ? |
Normal range of cardiac index is 2.6 - 4.2. If falls below 2.2 may be in cardiogenic shock. (per wiki) Per LIFL PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure to fractional inspired oxygen. Normal is > 500mmHg at sea level. Usually describes ARDS. Mild < 300, Mod < 200, Severe < 100 PCWP high - suggesting lung oedema? So patient seems to have both hypoxia and heart failure - would best be CPB which is VA? (repeat from 2014B - see notes there which I think may be wrong) VV - Respiratory failure VA - Respiratory or cardiac failure |
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Q47: Endovascular coiling of cerebral aneurysm under GA, patient suddenly develop hypertension. What is the most likely cause?▪ A Acute hydrocephalus▪ B Rupture of aneurysm▪ C Contrast reaction▪ D Cerebral embolism▪ E |
B - rupture - increased ICP - increased MAP |
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Q61 : 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 - True - due to lower TV - so Increased RR to compensate B - Possible but tachypnoea would happen first. Should be able to breathe without ventilator using diaphragm. C - Acute is flaccid. Though later get stiff chest wall - which actually helps with breathing. D - No as no abdominals E - No as decreased respiratory muscles |
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Q63CO2 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 - see notes in 2014B |
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Q65: MELD score consists of INR + creatinine + a) Albumin b) Bilirubin c) Urea d) AST e) Ammonia |
B - Bilirubin (2014B) |
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Q72: Optimal fluid management during laparotomy a) PPV b) TOE c) CVP d) Art pulse contour analysis e) HR |
D (2014B) |
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Q73: 50yr old man for AVR. Stable on bypass initially. first dose of cardioplegia given. MAP 25, CVP 1, MVO2 80%. What is the best management of this situation? a) Obtain IV access and crossmatch b) Commence a vasopressor (Metaraminol) and support circulation c) Increase oxygen flow rate d) Increase pump flow rate e) IV crystalloid bolus |
B - see notes in 2014B |
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Q76: Post R pneumonectomy on ward becomes acutely unwell. Hypotensive, raised JVP. What do you do ? a) turn L lateral |
A - bad side up - increased perfusion to dependant lung (2014B) |
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Q82: Healthcare worker with Hep B exposure. Known to have immunization titres. What do you do? a) booster dose of immunization b) HBV immunoglobulins c) Pegylated interferon d) Aciclovir e) Do nothing |
E (see also 2014B) |
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Q97 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 (2014B) |
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Q103 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 (2014B) |
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Consider the following blood gases. Normal ranges are in brackets.pH 7.28 PaCO2 36 Bicarbonate 18 mmol.l-1 (18-25) Base excess -7 mmol.l-1 (-4- +3) Na+ 142 mmol.l-1 (135-145) Cl- 112 mmol.l-1 (98-110) These blood gases are consistent with A. acute renal failure B. diabetic ketoacidosis C. ethylene glycol overdose D. intraoperative infusion of 6 litres of normal saline E. salicylate overdose |
Acidosis but metabolic and not respiratory. Anion Gap is normal i.e. 142 - 112- 18 = 12 D (2014B) In 2015B specific option for answer was: given 6L Normal Saline |
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Q 121 FAST scan A. Perihepatic space, perisplenic space, pericardium, pelvis B. Various combos with paracolic gutter |
A The four classic areas that are examined for free fluid are the perihepatic space (also called Morison's pouch or the hepatorenal recess), perisplenic space, pericardium, and the pelvis. (From Wikipedia) |
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Q134 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 (see 2014B) |
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6. [Repeat] Earliest sign of a high block in a neonate post awake caudal: A. Increased HR B. Increased BP C. Reduced HR D. Desaturation E. Loss of consciousness |
D (see 2013B) |
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14.MRI Telsa 3, least likely to cause harm A. Cochlear implant B. mechanical heart valve C. Implanted intrathecal pump D. Recently placed aortic stent E. shrapnel fragment |
B - as already subject to huge forces (see 2013B) |
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7. The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the A. isolation transformer B. line isolation monitor C. equipment has a maximum leakage current of 500 micro amperes D. residual current device E. equipotentiality |
E - 2013B 2015B question was slightly modified from this - but the same point that cardiac protected area is due to equipotential earthing |
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69. During apnoeic oxygenation under light anaesthesia, the expected rise in PaCO2 would be: A. 0.5 mmHg per min B. 1 mmHg per min C. 2 mmHg per min D. 3.5 mmHg per min E. 5 mmHg per min |
D - 3.5 mmHg as per 2013B |
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107. [Repeat 2013A] 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 from anyone who touches it. D. The Line Isolation Monitor will alarm and disconnect power to the device E. The RCD will immediately disconnect the device from the power supply |
B. Fuse blow |
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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 |
Actually asked for 1 month old - but that still makes them a neonate - so D is correct (2013A) |
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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 (2013A) |
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Apnoeic oxygenation in obese patient can be increased by A. Sniffing position B. Prone C. Supine D. Lateral E. Head up tilt |
E (2012B) |
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Preoperative assessment shows a Mallampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehane is predicted. Compared to the ML score, the TMD is A less sensitive, less specific B less sensitive, more specific C more sensitive, less specific D more sensitive, more specific E equal sensitivity an specificity |
B (and previously asked other than 2012B) |
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Off-label use of a drug refers to all of the following EXCEPT: A. Different age-group B. Different indication C. Different concentration D. Different route of administration |
C - 2012B |
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What is the innervation of the hard palate a. Greater palatine and nasopalatine |
A - 2012A |
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22. New - 72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is A. IVC filter B. Refer him for a pulmonary embolectomy C. Supportive (fluids and inotropes) D. Thrombolysis E. Warfarin |
B - see 2011B |
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90. New- Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is: A. Low C3, C4 B. Increase complement C. Increase tryptase D. Increase histamine? E. petechial rash |
ANSWER per 2011B A Serum complement is low Tryptase can be normal or raised Histamine is raised but not measured |
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You are about the anaesthetise a patient BMI 38 for bariatric surgery. Plan to give 1m/kg of sux. Compared with Ideal body weight, total body weight dosing resulst in: A shorter onset, shorter duration B shorter onset, similar duration C shorter onset, longer duration D similar onset, shorter duration E similar onset, longer duration |
E The Dose of Succinylcholine in Morbid Obesity. A & A February 2006 vol. 102 no. 2 438-442• No difference in time of onset between IBW, LBW or TBW• Recovery intervals shorter for patients dosed based on IBW and LBW rather than TBW (see also 2011A) |
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If type and Rh specific blood is given to a patient, how safe is the transfusion (Can't quite remember wording, but similar to what is in Dr Brandis' physiology viva book)? A: ? B: ? C: 97% D: 98.6% E: 99.8% |
E |
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Bleeding patient. What is relative contraindication to Prothrombinex? A. History of HITS B. Von Willebrands C. Haemophilia B D. Warfarin overdose E. Renal failure F. Overdose vit K (not warfarin) |
A - because it has Heparin in it - 2009B |
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Regarding College Professional Document PS9 – sedation for colonoscopy – the following equipment must be present (NB: The wording was 'present', not 'ready access to' as used for defib in PS9) a. Defibrillator b. Mechanical ventilator c. Anaesthetic machine d. Suxamethonium e. Dantrolene |
A - 2009B |
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Paediatric ALS – 20 kg, VF has had 2 shocks only. Next step a. Adrenaline b. Amiodarone c. Shock 50J d. Shock 100J |
A (2009B) |
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70 year old man having lung resection for SCC of left lung FEV1 2.3L (? % predicted), FVC 3.5L (? % predicted). Do you...A. Accept for lobectomy or pneumonectomyB. Decline pneumonectomy, proceed to lobectomyC. Cardiopulmonary exercise testingD. Differential V/Q scanE. Decline both pneumonectomy and lobectomy AIf FEV1 > 2.0l for pnemonectomy and >1.5l for lobectomy canproceed unless diffuse pathology on imaging or unexplained SOB (for unexplainedSOB, perform DLCO, if less than 80%, treat as below, if >80%, proceed to OT)If FEV1 less than above, estimate post-op DLCO and FEV1. If either are<40% perform CPET. |
Need to review sources for this from 2009A |
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Asking the patient to look up and in during a retrobulbar block increases the risk of injury to: A. Inferior oblique B. Superior oblique C. optic nerve D. globe E. ophthalmic artery |
C (2009A) From “Regional anaesthesia for eye surgery” Regional Anesthesia and Pain Medicine, Vol 30, No 1 (January–February), 2005: pp 72–82:The Atkinson “up and in” position of the gaze was abandoned when Liu et al. and Unsöld et al. confirmed that it increased the risk of optic nerve injury |
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Post op patient (surgery 3/7 ago). Patient dyspnoeic. V/Q scan organized which shows non segmental matched perfusion/ventilation defects. This is consistent with a. Atelectasis b. COPD c. Pulmonary embolus d. Pneumonia e. Pulmonary infarction |
Answer is A Atelectasis - non-segmental matched defects COPD - multiple segmental matched defects PE - classically affects a bronchi pulmonary segment and there is a VQ mismatch (decr flow, high ventilation) Pneumonia there is reverse mismatch - ie increased flow, decreased ventilation In pulm infarction there is a mismatched segmental defect |
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Another GCS question – open eyes to command, withdrawing from pain (Black Bank for 2015 just says responds to pain), confused conversation: A. 8 B. 9 C. 10 D. 11 E. 7 |
Similar to question asked in 2015B. (This was from 2008B). If same then answer is 11 (D) DBest Eye Response. (4) 1. No eye opening. 2. Eye opening to pain. 3. Eye opening to verbal command. 4. Eyes open spontaneously. Best Verbal Response. (5) 1. No verbal response 2. Incomprehensible sounds. 3. Inappropriate words. 4. Confused 5. Orientated Best Motor Response. (6) 1. No motor response. 2. Extension to pain. 3. Flexion to pain. 4. Withdrawal from pain. 5. Localising pain. 6. Obeys Commands. |
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The most sensitive monitor for detecting venous gas embolism during neurosurgery is a: A. capnograph B. praecordial Doppler transducer C. praecordial stethoscope D. pulmonary artery catheter E. transoesophageal echocardiograph |
Answer is E |
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Old man with small cell lung ca, post lobectomy, in PACU, SOB, desaturating. Shoulder abduction and hip flexion weakness, weak but sustained handgrip. 8mg cisatrac given 90 minutes earlier, reversed with 2.5mg neostigmine and 1.2mg atropine. Most likely cause: A. Eaton-Lambert syndrome B. Myasthenia gravis C. Steroid myopathy D.E. |
A A – TrueEaton Lambert syndrome• Proximal muscle weakness• Autonomic dysfunction• Frequently associated with SCLC B – False – Myasthenia is fatiguing C – False – proximal myopathy, not sudden onset |
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6 year old boy coming for routine operation. Maternal Great Grandfather has had a malignant hyperthermia reactionunder GA. Which of the following is most likely to rule out that the 8 year old will NOT suffer a MH reaction A. 8 year old has negative resting CK level B. 8 year old has had a previous operation before with no problems C. mother has had negative genetic testing D. maternal grandfather has had negative muscles testing E. father has had an operation before with no problems OR A 4 year old boy (D) presents for insertion of grommets. Hismaternal great-grandfather (A) is known to have had an episode of malignant hyperthermia (MH). Which of the following is the strongest evidence that the boy is NOT susceptible to MH? A. the boy was exposed to halothane at age 2 years with no sequelae B. the boy has recently been shown to have a normal serum creatinine kinase C. the boy's grandfather (B) has had a negative muscle-contracture test for MH D. the boy's mother (C) has had negative molecular genetic testing for MH E. there have been NO other episodes of MH in the family despite exposure to known triggers on multiple occasions |
D - see 2008A C - see 2007B I think 2015B was a mixture of these options |
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You are commencing general anaesthesia for a 2-year-oldchild to allow biopsy of an anterior mediastinal mass. A pre-operative CT scan demonstrated compression of the lower trachea and the carina by the mass. During inhalational induction, the child desaturates to 70% due to airway compression by the mass. You should A. apply continuous positive airway pressure (CPAP) via facemask B. arrange urgent median sternotomy C. intubate the patient and allow spontaneous ventilation D. intubate the patient and provide positive pressure ventilation E. place the patient in the prone position |
E (2007B) |
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A 25-year-old male presents for ECT (electroconvulsiveshock therapy) at a free-standing facility. He has a life¬threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine (Parnate). You should A. cancel the procedure, cease the tranylcypramine and perform the ECT in 2 weeks B. proceed with the ECT, but induce with midazolam and remifentanil C. proceed with the ECT, but pre-treat with esmolol D. proceed with the ECT with caution, but with your usual drugs E. transfer the patient to a tertiary centre for their ECT |
D (from 2006B) Tranylcypramine (a MAOI) The concern is that there will be an exaggerated response to sympathetic stimulation with a MAOI. With ECT there is a vagal response, followed by an overwhelming sympathetic surge, which could cause a hypertensive crisis. A – Morgan and Mikhail Ch 27 – "The practice of discontinuing MAO inhibitors at least 2 weeks prior to elective surgery is no longer recommended. With the exception of tranylcypromine, these agents produce irreversible enzyme inhibition; the 2-week delay allows sufficient regeneration of new enzyme. Studies suggest that patients may be safely anesthetized, at least for ECT, without this waiting period” B – Midazolam may supress seizures C – Esmolol pre-treatment could lead to an exagerrated initial vagal response D – This seems sensible E – Unnecessary |
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A 38-year-old primigravida presents with progressivedyspnoea in late pregnancy. The strongest indicator for further investigation would be A. a 2/6 systolic ejection murmur B. a raised JVP (jugular venous pressure) C. a third heart sound D. orthopnoea E. peripheral oedema |
(From 2006B) Answer is probably B. A - no - can have murmurs in pregnancy and this would be a soft murmur BStoelting's Anesthesia and Coexisting Disease“The presence of congestive heart failure is suggested by hepatomegaly and jugular venous distention, as these changes do not accompany normal pregnancy” C - NO Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition“Any cause of a significant increase in the volume load on the ventricle(s) can cause an S3. Examples include valvular regurgitation, high-output states (anemia, pregnancy, arteriovenous fistula, or thyrotoxicosis), left-to-right intracardiac shunts, complete A-V block, renal failure, and volume overload from excessive fluids or blood transfusion” D - Sudden onset orthopnoea is not common and should be investigated but women can have orthopnoea in pregnancy and it is physiological. E - Peripheral Oedema common in pregnancy |
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MODIFIED Similar to 2015A What is the dose of Hyalase per mL for Peribulbar Block A. 25 IU/mL B. 50 IU/mL C. 100 IU/mL D. 150 IU/mL E. 1500 IU/mL |
Check |
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MODIFIED What is dose of IV paracetamol loading in 16 kg child A. B. 160mg C. 240mg D. 320 mg E. |
If you assume its 15mg/kg then answer is C. |
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MODIFIED Dose of intralipid per kg A 0.5 B 1 C 1.5 D 2 E 5 |
1.5 mL/kg |
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MODIFIED 70kg man with 50% burns. How much fluid in first 8 hours A 2.4 B 3.6 C 4.6 D 7L E 14L |
Parkland 70 * 50 * 4mL = 14,000mL Half in first 8 hours = 7L |
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NEW Predictors of poor outcome after SAH? a. Pulmonary Oedema b. Cerebral salt wasting c. fever d. Hydrocephalus SAH, all associated with poor prognosis except:A: Pulmonary oedema B: Stunned myocardium C: Fever D: Delayed ischaemia E: |
Googlig: Several factors are related through mortality and poor outcome in aSAH (rebleeding, hydrocephalus, symptomatic vasospasm, older age, black people, female, intraventricular and intracerebral hemorrhage, delayed cerebral infarction (especially if multiple), aneurysm location, hyperglycemia, fever, anemia, and other systemic complications such as pneumonia and sepsis) |
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NEW According to ANZCA professional standards, a LEVEL 2 machine check includes: A: Ensuring that there are no leaks both when the vaporisers are being used and when they are not being used. B: Checking the breathing circuit if it has been changed C: Checking the inspiratory and expiratory valves D: Checking the (?external) scavenging system E: Checking the reserve oxygen cylinder is adequately filled for its intended purpose |
A. Check for leaks with vap in on and off position D and E also correct |
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NEW Motor evoked potentials are used to monitor spinal cord function in scoliosis surgery. Which drugs affect them the LEAST? A. Non-depolarising muscle relaxants B. Nitrous Oxide C. Opiods D. Propofol E. Volatiles |
C - Opioids CEACCP article: "All anaesthetic vapours reduce MEP amplitude in a dose-dependent manner. Anaesthetic vapour concentrations more than 0.5 MAC are generally not compatible with reliable monitoring. As a result, total i.v. anaesthesia with propofol is the anaesthetic technique of choice when assessing MEPs. However, propofol also causes a dose-dependent depression of cortically evoked responses of a smaller magnitude, which affects the reliability of neurophysiological monitoring especially when baseline responses are initially small." Miller: " In healthy human volunteers receiving 3 μg/kg fentanyl,the amplitude and latency of motor evoked responses to transcra-nial stimulation were not significantly affected" Stoelting: " Stoelting's Anesthesia and Co-Existing Disease, 5Th Edition However,many anesthetic drugs, especially volatile anesthetics and ni-trous oxide, interfere with the monitoring of evoked potentialsand neuromuscular blockers cannot be used if motor evokedpotentials are being monitored. Therefore, total intravenousanesthesia with an opioid and propofol or an opioid/propo-fol/low-dose (0.33 MAC) volatile anesthetic combination areusually chosen to provide general anesthesia." |
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NEW Kessel Blade has the blade coming off the handle at a degree of: A 80 B 95 C 110 D 135 E 150 |
MacIntosh (commonest; blade attaches to handle at 90 degrees)— Kessel (like the MacIntosh but the blade attaches at 110 degrees)— McCoy (MacIntosh like blade with a moveable distal tip segment, flexed by a lever controlled by the thumb of the hand holding the handle to displace the larynx forwards)— Magill (straight blade with U-shaped cross section)— Miller and Wisconsin blades (straight blades with curved tips) |
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NEW 85 F for fracture hip, otherwise well, normal ECG day prior, electrolytes normal. Otherwise well other than now in AF with HR 110-145, BP 130/80 what do you do: A Amiodarone B DC Cardioversion post induction GA C Digoxin D Metoprolol E Anticoagulate |
B - needs surgery, within 48 hours so safe to cardiovert. |
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NEW Young guy who is brain dead. Parents want to donate organs. He has already had a kidney transplant himself and was on immunosuppressants. What can't you transplant: a. Bone b. Heart c. Lung d. Liver e. Transplanted kidney (Black Bank says Bone Marrow - but I'm sure it wasn't bone "Marrow") |
Unknown - doesn't say which drugs - commonly Steroids/Azathioprine/Cyclosporin for kidney - which can be nephrotoxic. But also cause OP in bone - transplanted bone becomes more OP anyway so perhaps this??? |
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NEW Cancer patient on subcutaneous morphine, 70mg in 24 hours. Converting this to an oral dose of long acting morphine. What is a reasonable starting dose? A 25mg bd B 70mg bd C 100mg bd D 150mg bd E 200mg bd |
70mg S/C multiply by 3 gives 210mg So 100mg BD closest BUT this is a total and ideally you would reduce it slightly so you have some room for breakthrough. Also cross tolerance etc. So maybe 70 mg BD is better answer for long acting and the rest you'd give as breakthrough? |
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NEW ICU, ventilated, paralysed, sedated, ICPs persistently 25mmg. What do do next? A cool to < 35 degrees B give hypertonic saline C dexamethasone D position 45 degrees head up E Ventilate to PaCO2 <30 |
Hypertonic Saline?? (Cooling usually does not work (IHAST), Dex only works with tumours, no more head up as may compromise MAP, Not meant to lower PaCO2 that much) |
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How to diagnose post-op cognitive dysfunction? a. Impaired higher thinking b. Memory loss c. d. e. |
A. Impaired higher thinking |
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75 year old lady 2 weeks pre-op TKR patient, anaemic (Hb 105, Fer <30), recent TKR 6 months ago, what to do? [no option to defer surgery or identify and treat cause] A Oral iron B IV iron C Check Hb on day of surgery and cancel if still low D Multivitamin with iron E Packed cells preoperatively |
?? Iron Transfusion - she is clearly iron deficient given ferritin < 30 and oral iron will take 3 months or more. |
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Patient with RFTs FEV1 87% pred FVC 98% pred FEV1/FVC 85% DLCO 44% RV 80-90% TLC 80-90% What did they have: a. Asthma b. COPD c. Interstitial Fibrosis d. Pulmonary Artery HTN e. |
Only DLCO is reduced - so maybe it is Pulmonary HTN?? |
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Which would be consistent with deep partial thickness burns?(various combinations of whether painful or not, whether blanches or not, and how it looks +/- presence of blisters) A Pain to deep pressure only, decreased capillary refill or doesn’t blanch? B Blanches to pressure, very painful C Painful to air, blanches to pressure with blisters? D Painful to deep pressure, red and weeping/wetE No pain, no CRT See vicburns.org – looks like options were taken from there |
A. http://www.vicburns.org.au/burns-assessment/burn-depth/different-burn-depth-characteristics.html
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You should suspect an aortic dissection if injury to: a. Thoracic fracture b. c. |
Thoracic fracture mentioned in googling. |
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A patient presents for THR with a febrile illness, but wishes to proceed despite the risks. You can justify your decision to defer the case based on: A Automony B Beneficence C Non-maleficence D Paternalism E Utilitarianism |
Non-malificence - first do no harm - because likely risk of infection if systemically unwell when operate? Paternalism (or parentalism) is behavior, by a person, organization or state, which limits some person or group's liberty or autonomy for that person's or group's own good.[1] Paternalism can also imply that the behavior is against or regardless of the will of a person, or also that the behavior expresses an attitude of superiority Beneficence - for the greater good of patient |
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Signs of injury to sympathetic chain include all except: a. Miosis b. Anhydriosis c. Blepharoptosis d. Facial vasodilation e. Exophthalmos |
A - Yes B - Yes C - Yes D - Yes E - May get ENOPHTHALMOS but not this - so E is correct |
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You collect ropivacaine levels post-operatively. This type of data is: A Continuous B Numerical C Ordinal D Nominal E Categorical F Non-parametric (was definitely an option) |
Has to be numerical - you could take averages, rank them, sort them, put them on a distribution curve etc. But if continuous was an option then that was probably more correct. |
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Most errors with blood transfusion are due to: a. Errors at patient bedside with identification b. Lab errors c. Wrong labelling d. e. |
A. Medscape: "The most frequent error leading to transfusion of ABO-incompatible blood is failure of the final patient identification check at the bedside, leading to transfusion of properly labeled blood to a recipient other than the one intended.[4,6,10,12] In a recent report from Ireland's hemovigilance system, more than half of all adverse reactions to blood transfusion were caused by the patient being given the wrong blood component.[13] The relative distribution of errors in our cases and survey results are similar to those in other reports, with failures in pretransfusion verification of patient identification comprising a majority of all errors, followed by laboratory errors, and errors in sample collection and labeling. Although laboratory errors were higher than those reported by Honig and Bove,[14] increased awareness of the necessity to detect and report any errors that could potentially result in an ABO-incompatible transfusion may, in part, account for the higher figure. |
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NEW You arrive at the delivery of a term neonate with resuscitation in progress. At 2 minutes, saturations are 70%, child is breathing, has been dried and is warm. A HR was also given which was more than 60. What do you do? a. Nothing but monitor b. Intubate c. CPAP with 100% FiO2 d. e. |
This is within normal range so just monitor. |
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Patient has central venous saturation 71%, Hb is 75. INR is 1.5 and they are septic. What should you do: a. nothing b. 1 unit PRBC c. 1 unit PRBC + 25 - 50 Prothrombinex d. 1 unit PRBC + 2 units FFP e. 2 units FFP |
On basis of below - answer is probably do nothing as sats and Hb within guidelines and patient is NOT bleeding. Surviving Sepsis Guidelines say central venous sats > 70% Once tissue hypoperfusion has resolved and in the absence of extenuatingcircumstances, such as myocardial ischemia, severe hypoxemia, acute hemorrhage, orischemic heart disease, we recommend that red blood cell transfusion occur only whenhemoglobin concentration decreases to <7.0 g/dL to target a hemoglobin concentration of7.0 –9.0 g/dL in adults (grade 1B). 3. Fresh frozen plasma not be used to correct laboratory clotting abnormalities in theabsence of bleeding or planned invasive procedures (grade 2D). |
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Smallest tube that will fit over Aintree Catheter a. 5.5 b. 6.0 c. 6.5 d. 7.0 e. 7.5 |
Size 7.0 per product information |
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How many vials of dantrolene should (according to guidelines from MH society) be kept at a remote hospital which has general anaesthesia services? A 2 B 6 C 12 D 24 E 36 |
Answer is 36 Per PS55 " An initial supply of dantrolene sufficient for commencing the treatment of asuspected case of malignant hyperpyrexia should be readily accessible to allanaesthetising locations within the institution. The minimum supply is twenty-four 20 mg ampoules of dantrolene. Additional doses must be readily availableon request. Large hospitals and isolated hospitals should have thirty-six 20 mgampoules of dantrolene readily available; this is sufficient to treat a 70 kg adultwith up to 10 mg/kg." |
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According to NAP4 what is the rate of failure for emergency cannula cricothyroidotomy? A 10 B 20 C 40 D 60 E 80 |
From NAP 4 summary: " There was a high failure rate of emergency cannula cricothyroidotomy, approximately 60%." |
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NAP 5 incidence of awareness with NMBD a. b. c. d. 1 in 8000 e. |
Per NAP 5: " The estimated incidence of patient reports ofAAGA was ~1:19,000 anaesthetics. However, thisincidence varied considerably in different settings.The incidence was ~1:8,000 when neuromuscularblockade was used and ~1:136,000 without it. Twohigh risk surgical specialties were cardiothoracicanaesthesia (1:8,600) and Caesarean section(~1:670)." |
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What is the most common cause of claims against anaesthetists? A Dental damage B Eye damage C Non-obstetric nerve damage D Obstetric epidural related E Non-obstetric epidural related |
Per CEACCP "Injury during anaesthesia": "Dental injury occurs during1% of general anaesthetics andis the commonest cause forlitigation against anaesthetists" |
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Most common peripheral neuropathy: a. b. c. d. e. Ulnar Nerve |
Per CEACCP "Injury during anaesthesia" "The ulnar nerve is damaged most commonly (0.33% of generalanaesthetics); this is three times as common as injury to othernerves. Other nerves at high risk during general anaesthesiainclude the brachial plexus, lumbosacral roots, radial, sciaticand common peroneal nerves. The mechanism of injury to super-ficial nerves is usually compression of the vasa vasorum andsubsequent ischaemia." |
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Pregnant woman, 33 weeks, thyroid storm for an urgent caesarean section, already been treated with steroid. What next? A Carbimazole B Esmolol C IV magnesium D Propothyiouracil E Potassium Iodide |
Answer is probably Carbimazole Per up-to-date: "Antithyroid drugs during pregnancy — Propylthiouracil used to be the drug of choice during pregnancy because it causes less severe birth defects than methimazole. But experts now recommend that propylthiouracil be given during the first trimester only. This is because there have been rare cases of liver damage in people taking propylthiouracil. After the first trimester, women should switch to methimazole for the rest of the pregnancy. For women who are nursing, methimazole is probably a better choice than propylthiouracil (to avoid liver side effects)." |
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A patient has been suffered a cardiac arrest. They are intubated but there is no IV access. Which drug can be given down the ETT? A Amiodarone B Calcium C Lignocaine D Magnesium E Sodium bicarbonate |
Drugs that can be given down ETT: vasopressin, epinephrine, naltraxone, atropine, lidocaine It is VENAL (i.e., horrible/despicable) to run a code without IV or IO access. |
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Symptoms associated with Propofol infusion syndrome include all except: a. b. c. d. e. ST elevation |
NOT E which I put but what? Per LITFL: Propofol-related Infusion Syndrome is a life-threatening condition characterised by acute refractory bradycardia progressing to asystole and one or more of:(1) metabolic acidosis(2) rhabdomyolysis(3) hyperlipidaemia(4) enlarged or fatty liver. Patients get a Brugada like ECG pattern (coved type = convex-curved ST elevation in V1-V3), RBBB, arrhythmia, heart blockblood gas: unexplained lactic acidosis; hyperkalaemia (if rhabdomyolysis or renal failure) |
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All are difficult to intubation except: a. Apert b. Ds c. Hurler d. Treacher Collins e. Pierre Robin |
Answer is Apert as noted below ONLY BMV Hypoplastic mandible (micrognathia) – difficult intubation § Pierre Robin sequence § Treacher Collins § Hemifacial microsomia (Goldenhar syndrome) Midface hypoplasia – difficult bag-mask ventilation § Apert syndrome § Crouzon syndrome§ Pfeiffer syndrome § Saethre-Chotzen syndrome Macroglossia – difficult bag-mask ventilation AND difficult intubation § Hurler’s/Hunter’s syndrome (mucopolysaccharidoses) § Beckwith-Wiedemann syndrome § Down’s syndrome |
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Risk factors for compartment syndrome with lithotomy include all except: a. Systemic HTN b. Hypotension c. Peripheral Vascular Disease d. Obesity e. On Black Bank as: Lithotomy position for laparoscopy. What is not a risk factor for compartment syndrome lower leg? A) obesity B) male gender C) lithotomy stirrups D) pmh hypertension E) intraoperative hypotension |
Answer is likely A - Systemic HTN Per article on Well Leg Compartment Syndrome: "Box 1 Risk factors for development of well leg compartment syndrome Intraoperative hypotension Blood loss/hyopvolaemia Peripheral vascular disease Prolonged operation Muscular calves High body mass index |
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Risks for Bone Cement Implantation Syndrome include all except: a. b. c. d. e. Previous bone cement |
No mention of previous bone cement. But if they mean that its a revision then that's not a risk factor. Per BJA Article: Patient risk factors: Numerous patient-related risk factors have been implicatedin the genesis of BCIS including old age,poor pre-existing physical reserve,impaired cardiopulmonaryfunction,pre-existing pulmonary hypertension osteoporosis,bony metastases, and concomitant hipfractures,particularly pathological or intertrochanteric fractures. These latter three factors are associated withincreased or abnormal vascular channels throughwhich marrow contents can migrate into the circulation.Patients with a patent foramen ovale or atrial-septal defectmay be at increased risk of paradoxical emboli and neuro-logical sequelae. Surgical risk factors Patients with a previously un-instrumented femoral canalmay be at higher risk of developing the syndrome thanthose undergoing revision surgery |
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Maximum oxygen via NP at 3L a. 24% b. 28% c. d. e. |
Per attached around 30% |
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Surgery planned under brachial plexus block performed at axilla. Pain is felt on incision at the anterolateral right forearm. Which nerve has been insufficiently blocked? A Radial B Ulnar C Median D Musculocutaneous E Median brachial cutaneous (also remembered as axillary) |
The axillary technique does not reliably block the musculocutaneous nerve (which provides cutaneous sensation via the lateral cutaneous nerve of the forearm), because at the axillary entry point it has left the sheath and is embedded in the coracobrachialis muscle. Thus, the lateral forearm may not be blocked by the axillary technique |
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Picture of LV trace and aortic trace for pressures. What was the pathology: a. b. c. Aortic Stenosis d. e. |
Graph looked similar to this so likely AS: |
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You arrive in the emergency department to treat a man with an attempted hanging. He has a LMA in situ, it is easy to ventilate (or something like that) Sa 98% HR 120, BP 130/80 GCS 5 initially. What is the next single most important thing to do. A Apply rigid collar with manual inline stabilisation B Check subcutaneous emphysema C Fibre optic examination of airway D Lateral c-spine xray E Remove LMA and intubate |
?? Hard collar as cervical spine is not protected? and they are ventilating well on LMA so no urgency to change? |
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Sick patient with lots of information and ABG. ICU patient, intubated and ventilated (post some kind of abdominal surgery). NG in situ with ongoing high output. Currently on CSL 60mL/hr. ABG provided (pH 7.66, HCO3 in 30s, Cl78, pCO2 32) Options revolved around: * Increasing or reducing MV (the CO2 was high) * Increasing or leaving fluid the same (Urea was high) * Giving Acetazolamide (Bicarb was high) |
I chose option to reduce MV and then increase fluid and give acetazolamide. |
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Child who was 18 months old, sick, periodic breathing. Choice was first: * Acidotic or Alkalotic and they had to be Acidotic * Then choice was CO2 high or low. Had to be high due to periodic breathing * Then choice of Bicarb low or normal or high. Assumed low as compensation for raised CO2? |
I chose as given. |
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TOE transgastric short axis view of LV. Label on anterior wall. What coronary territory is it? A LCx B LAD C D RCA E ? |
?? LV - ?? LAD |
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What is the expected rise in platelets from one unit of pooled leucodepleted plates in a 70kg patient? A 10-20 B 21-40 C 40-60 D 60-80 E 80-100 |
One unit (one standard adult dose) of Platelets Apheresis or Pooled Leucocyte Depleted would be expected to increase the platelet count of a 70 kg adult by 20–40 x 109 /L - See more at: http://www.transfusion.com.au/blood_products/components/platelets/use#sthash.BL9bUBDy.dpuf |
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How long after starting a unit of FFP does it have to be completed A 2hrs B 4 C 6 D 8 E 10hrs |
Per Austin Health might be 4 hours?? Googled and found somewhere use within 30 minutes if out of fridge (2 - 6 degrees) but once thawed then use within 24 hours. Austin Health guidelines state: " FFP should be administered no faster than one unit over 1/2hour in the non-emergencysetting. The administration of one FFP unit must be completed within 4 hours ofcommencement." |
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Which drug worst with renal failure a. Apixaban b. Dabigatran c. Rivoroxiban d. e. |
Dabigatran - 80% renally excreted - confirm numbers. |
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Technique to minimise absorption of irrigation fluid during TURP: A: Fluid no more than 60cm above the patient B: Use NS rather than glycine C: Use laser D: Limited resection of gland only if gland <200gE: |
Found height should be less than 70cm but other options related to size, laser etc. Can't really remember question.... |
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What can a precordial thump be used for?
A Witnessed, monitored: VT B Witnessed monitored VF C Witnessed but unmonitored arrest D Witnessed monitored asystole |
According to the 2010 American Heart Association Advanced Cardiac Life Support Guidelines, “The precordial thump may be considered for patients with witnessed, monitored, unstable VT (including pulseless VT) if a defibrillator is not immediately ready for use, but it should not delay CPR and shock delivery. - See more at: http://www.jwatch.org/na32170/2013/10/03/precordial-thump-rarely-benefit#sthash.cbfhF069.dpuf |
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How to avoid auto-PEEP developing a. b. c. d. e. Increase expiratory time. |
Auto-PEEP is gas trapped in alveoli at end expiration, due to inadequate time for expiration, bronchoconstriction or mucus plugging. It increased the work of breathing. |
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Tetralogy of Fallot - what makes cyanosis worse? a. Pul Art HTN b. Degree of RV outflow tract obstruction c. Location VSD d. Size VSD e. |
From google search: "The extent of cyanosis is dependent on the amount of narrowing of the pulmonary valve and right ventricular outflow tract. A narrower outflow tract from the right ventricle is more restrictive to blood flow to the lungs, which in turn lowers the arterial oxygen level since more oxygen-poor blood is shunted from the right ventricle to the aorta." |
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Patient in ED. Urgent treatment of Pheochromocytoma. Tachycardic at 140. Which drug? a. GTN b. Esmolol c. Labetalol d. Phenoxybenzamine e. Phentolamine |
Normally Phenoxybenzamine - but it causes reflex tachycardia and patient already very tachy - so would you use Phentolamine? |
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Best shocks a. b. c. Monophasic 200,300,360 d. e. Black bank as: According to the current (2010) ARC ALS guidelines, what is the correct dose for the first three shocks of a shockable rhythm? A: Biphasic 50, 100, 150 B: Biphasic 100, 150, 200 C: Biphasic 100, 200, 200 D: Monophasic 120, 240, 360 E: Monophasic 360, 360, 360. |
All Biphasic options were increasing. Answer is probably C - Guideline 11.4 Electrical Therapy For Adult Advanced Life Support Monophasic: the energy level for adults should be set at maximum (usually 360Joules) for all shocks. [Class A; LOE III-2]2 Biphasic waveforms: the default energy level for adults should be set at 200J for allshocks. Other energy levels may be used providing there is relevant clinical data for aspecific defibrillator that suggests that an alternative energy level provides adequateshock success (eg. Usually greater than 90%). [Class A; LOE II]3 |
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You are supplying oxygen from the variable flow meter on the wall at 6L/min. The tubing becomes obstructed. What is the pressure reached in the tubing A 100kpa B 200kpa C 300 D 400 E 600 |
D - 400kPA - this is what pressure is at wall normally? |
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Nerve that supplies bottom of foot a. Deep Peroneal b. Posterior Tibial c. Sural d. Saphenous e. Superficial Peroneal |
B - Posterior Tibial divides to Medial Plantar and Lateral Plantar |
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Pathognomic feature of PDPH a. Increase in severity when upright |
Surely this? |
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Most common symptom Epidural Abscess: a. back pain |
Emedicine: "Back or neck pain is the most common symptom in individuals with spinal epidural abscess, occurring in 70%-100% of cases. The classic diagnostic triad of fever, spinal pain, and neurological deficits is present in only 10-15% of cases at first physician contact and must not be relied on for diagnosis." |
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One vocal cord is paramedian and lower than the other side. What nerve damaged? Recent case with LMA. Now has hoarse voice. Nasendoscopy shows one vocal cord in the paramedian position. What is the site of injury? A: Lingual n.; B: Vagus n.; C: Superior laryngeal n.; D: Recurrent laryngeal n. E: |
Damage to RLN makes cords sit paramedian |
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Patient has had 4mg Dex and 8mg Ondansetron in OT. VOmiting in PACU what should you give? a. Ondansetron b. Dex c. Cyclizine 50mg d. Droperidol 0.625mg e. Metoclopramide |
Answer should be D. Droperidol (per ANZCA 2014 Consensus Guidelines) |
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Contraindication to Sub-Tenons a. b. c. Globe > 25mm d. Scleral Buckle e. inferonasal Pterygium |
Might be scleral buckle? |
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Lowest vertebrae that spinal cord extends to a. T12 b. L1 c. L2 d. L3 e. L4 |
Ends at L1/L2 - so this is closest to end of vertebral body of L1 |
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X1 – man undergoing transcatheter aortic valve replacement, ECG shown with two broad complex beats (LBBB pattern) and clear p waves approx. Rate of 100 but no ventricular beats. What is the best way of managing this (I think it was this ECG, but correct me please if I am wrong. complete heart block --> p-wave systole (aka ventricular standstill -- CPR was NOT an option)
A Atropine B Transcutaneous pacing C Adrenaline D Isoprenaline E Transvenous pacing |
Atropine - P wave is firing but ventricles at standstill so probably won't help Transvenous - probably too long Transcutaneous pacing - probably best answer |
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Suxamethonium left out of fridge for a week. Efficacy reduced by a. 2% b. c. d. e. |
Can be stored out of fridge for 2 weeks so shouldn't even really be 2% less. Or did I read it wrong and this is what is left??? I think I read it wrong and this was what was left. Was probably an option for 99% which was right :( |
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TEG picture same as 2015A which increased lysis. What is problem? a. Hyperfibrinolysis |
As noted |
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Some question with an option: myocardial filling |
?? |
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TOE image - what was arrow pointing to? a. Aortic Valve? |
I thought arrow was pointing to the little bit that I thought was the aortic valve |
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Best design of RCT/ Randomised controlled trial means: A Patients randomly allocated to treatment groups B Patients randomly allocated to treatment or placebo C Patients allocated systematically D Neither the patient nor the investigator knows which group the patient is in E ? |
first is better as eliminated placebo effect |
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When check Tryptase. Lots of options but only 2 said at 24 hours. Others were 48 hours?? Best seemed to be 1 hr, 4 hr and 24 hr Other 24 hour one was at 15 minutes. |
As noted - I would have liked to pick as it happened, 2 hours and 24 hrs? |
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How before return to normal platelet function in chronic diclofenac use. A 12hrs B 1-2d C 4d D 7d E 10d |
Best answer is probably B 1 - 2 days Article: As predicted, a single oral dose of aspi-rin abolished the second wave of aggregation in re-sponse to ADP and epinephrine, and it produced along-lasting effect that persisted for 5 to 8 days. Ad-ditionally, piroxicam, naproxen, diclofenac, and in-domethacin blocked ADP- or epinephrine-inducedsecond-wave aggregation, and the abnormality per-sisted 3 days after piroxicam was discontinued and 2days after naproxen, diclofenac, and indomethacinwere discontinued. Ibuprofen and diflunisal pro-duced a weaker but definite effect, which normal-ized within 24 hours of ingestion |
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Flow volume loop |
Picture was of Fixed Obstruction |
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Diagnosis of intra-abdominal compartment syndrome with pressures above? a. 6 b. 12 c. 20 |
So maybe above 12mmHg? E-medicine: In an excellent group of articles, Burch et al developed a grading system.[9] Patients with higher-grade abdominal compartment syndrome have end-organ damage, which is evidenced by splenic hypercarbia and elevated lactate levels, even if they appear clinically stable. The following grading system has become accepted if IAH is present: Grade I: 10-15 cm H 2 O Grade II: 15-25 cm H 2 O Grade III: 25-35 cm H 2 O Grade IV, greater than 35 cm H 2 OEnd-organ damage has been observed with IAP as low as 10 cm H2 O, and multiple studies have found damage at values ranging from 20-40 cm H2 O. Disparity exists because abdominal compartment syndrome never occurs as an isolated event. |
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CS5 lead placement In order to use a 3 lead ECG setup to gain a CS5 view which of the following configurations would you use? A. Lead I, RA lead below the clavicle, LA lead in the V5 position, LL at the hip B. Lead I RA lead below the clavicle, LA lead at the hip LL in the V5 position C Lead II RA lead below the clavicle, LA lead in the V5 position, LL at the hip D Lead III RA lead below the clavicle, LA lead in the V5 position, LL at the hip E Lead III RA lead below the clavicle, LA lead at the hip LL in the V5 position |
I picked A - looking for anterior ischaemia via Lead 1. |
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What attaches to 1st rib in picture shown? A Scalenus medius B Saclenus anterior C SCM D Parietal pleura E Articular surface with clavicle |
The answer was scalenus medius - based on what they had shaded. |
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Neonate (born at 40 weeks, now 7 weeks old) why to reduce morphine infusion rate compared with older child A Increased morphine crossing BBB B Increased total body water/decreased fat C Decreased enzymatic hepatic function D Increased morphine-3-glucuronide (definitely M3G) |
Hepatic enzyme function is decreased until about 2 - 3 months. Neonates do make more m3G than m6G, morphine does cross BBB more and they do have increased total body water - but these things are not so true at 7 weeks old in term infant. So best answer might be C? |
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Chronic pain after mastectomy is not related to: a. age b. low levels of anxiety before c. intercostal injury d. blocks |
Googling seems to indicate age is unrelated. |
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Factor V Leiden homozygote. By how much is the risk of post-operative DVT increased? A 2x B 5x C 10x D 20x E 50x |
Googling: Heterozygotes have a three to five times increased risk of thrombosis. Homozygotes are much less common but have a much higher thrombotic risk, around eight times increased risk. Medscape: Factor V Leiden increases the risk of venous thrombosis 3- to 8-fold for heterozygous and 30- to 140-fold for homozygous individuals. Stoelting: As the sole source of hypercoagulability, factor V Leiden isviewed as having low to intermediate procoagulant risk.Patients who are heterozygous for factor V Leiden have a five- to sevenfold increased risk of VTE, while the risk of homozygouscarriers is increased up to 80-fold Another paper: Risk for VTE in adults. The risk for VTE is increased three- to eightfold in factor V Leiden heterozygotes and nine to 80-fold in homozygotes [Rosendaal & Reitsma 2009]. In a comprehensive meta-analysis of 84 studies, a heterozygous factor V mutation was associated with a fivefold increased relative risk for idiopathic VTE (i.e., a spontaneous VTE in the absence of obvious provoking factors). A homozygous mutation was associated with a nine- to tenfold increase in risk [Gohil et al 2009]. |
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At initiation of laparoscopy/pneumoperitoneum which of the following cardiovascular parameters is LEAST likely to increase? A. Cardiac Output B. Mean Arterial Pressure C. Heart rate D. Myocardial filling pressures E. Systemic Vascular Resistance |
Answer is most likely HR - bradycardia can happen with pneumoperitoneum and also others all increase so compensatory effect. CEACCP article: "Increased IAP affects venous return (VR), systemic vascular resistance (SVR) and myocardial function. Initially, owing to autotransfusion of pooled blood from the splanchnic circulation, there is an increase in the circulating blood volume, resulting in an increase in venous return and cardiac output. However, further increases in the IAP result in the compression of the inferior vena cava, reduction in venous return and subsequent decrease in cardiac output. The SVR is increased because of direct effects of the IAP, but also because of an increase in the release of circulating catecholamines, especially epinephrine and norepinephrine. This change in SVR is generally greater than the reduction in cardiac output, maintaining or even increasing systemic blood pressure. The increasing SVR, systolic and diastolic blood pressures and tachycardia, result in a large increase in myocardial workload. Consequently, myocardial ischaemia may result. Further increases in IAP may decrease cardiac output with a subsequent fall in blood pressure, an effect more pronounced in patients who are hypovolaemic or have cardiovascular disease. Some other random googling: However, despite a decrease in intracardiac blood volume, intracardiac filling pressures may be elevated due to pressure transmitted across the diaphragm to the heart. |
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How many weeks of anticoagulation prior to elective DCR per AHA/ACC A 1 week B 2 weeks C 3 weeks D 4 weeks E 5 weeks |
For patients with AF or atrial flutter of 48 hours’ duration or longer, or when the duration of AF is unknown, anticoagulation with warfarin (INR 2.0 to 3.0) is recommended for at least 3 weeks before and 4 weeks after cardioversion, regardless of the CHA2DS2-VASc score and the method (electrical or pharmacological) used to restore sinus rhythm (From AHA guidelines) |
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You area trialling a new drug for hypertension in one group of patients and comparing it to placebo (given to another group). In three months time you will measure the blood pressure and want to compare the two groups. Which test would be most appropriate? A: Chi squared B: Fishers exact test C: Student's t-test D: Mann-whitney U test E: Bland Altman test |
Students T-test |
