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138 Cards in this Set
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Consider the following arterial blood gases. (Ref ranges in brackets) pH 7.28 PaCO2 36 Bicarbonate 18 mmol.l-1 (18-25) Base excess -7 mmol.l-1 (-4- +3) Na+ 142 mmol.l-1 (135-145) Cl- 112 mmol.l-1 (98-110) These blood gases are consistent with A. acute renal failure B. diabetic ketoacidosis C. ethylene glycol overdose D. intraoperative infusion of 6 litres of normal saline E. salicylate overdose |
D. intraoperative infusion of 6 litres of normal saline Metabolic acidosis. Not compensated. Hyperchloraemia NAGMA: 142-112-18 = 12 Causes: GIT, renal loss of HCO3, dilution of HCO3 by saline |
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5. A 34 year old primigravida collapses soon after delivery of her baby, the presumptive diagnosis is amniotic fluid embolus. Which ONE of the following supports this diagnosis? A. markedly raised serum tryptase B. decreased C3-C4 levels C. thrombocytosis D. raised CRP E. hyperfibrinogenemia |
B. decreased C3-C4 levels Immunological studies 2001: http://www.ncbi.nlm.nih.gov/pubmed/11275019 low serum complement levels (C3, C4) CEACCP AFE: Non -specific: - Low Hb - Low platelets, inc PT and APTT, low fibrinogen - Hypoxaemia, raised PaCO2 - CXR: Normal, cardiomegaly, pulmonary oedema - ECG: Right heart strain, rhythm abnormalities - V/Q scans: V/Q mismatch - TTE: Right or left ventricular dysfunction, low ejection fraction More specific tests: -Pulmonary blood sample: Presence of squamous cells coated with neutrophils and presence of foetal debris - Sialyl Tn antigen raised - Zinc coproporphyrin raised - Serum tryptase levels N/raised |
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You are performing a peribulbar block for eye surgery. You decide to add hyalase to your local anaesthetic mix. What is the recommended concentration for hyalase? A 25 U/ml B 50 U/ml C 100 U/ml D 150 U/ml E 1500 U/ml |
A. 25 IU/ml From product info, but actual ranges from 7.5 - 150 IU/ml |
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A 25 year old male presents for ECT at a free standing facility. He has a life threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine. The most appropriate course of action is A cancel the procedure, cease tranylcypromine 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. proceed with the ECT with caution, but with your usual drugs CEACCP Fortunately, interactions with anaesthetic drugs (e.g. indirect sympathomimetics causing hypertensive crises with either tricyclic antidepressants or monoamine oxidase inhibitors; meperidine or tramadol causing serotonin syndrome with SSRIs) are uncommon as the anaesthetic drugs in question are not generally required during ECT. Tranylcypromine is a non-selective irreverible MAO-I. Ideally discontinue 2 weeks before surgery. Issue is the profound pressor effect seen from direct and indirect acting agents. "When there is no time to consider withdrawal of MAOI, the anaesthetist must avoid meperidine (pethidine) and use only direct-acting sympathomimetics with extreme caution." |
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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 |
C. Lignocaine Drugs which can be given via ETT (NAVEL): Naloxone Atropine Vasopressin Epinephrine (Adrenaline) Lignocaine |
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A well 65 year old is having a total hip replacement under GA with sevo/nitrous/fentanyl. BP is 130/70 and stable. Before the surgeon commences reaming and cementing, the best thing to do is: A Induce hypotension B Raise BP with vasopressors C Turn off nitrous oxide D Give steroids E Give heparin 5000u |
C. Turn off nitrous oxide OHA |
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Pt in ICU in their 20s is diagnosed with brain death. History is that of immunosuppression for a renal transplant but otherwise well. Patient has expressed a desire to be an organ donor. All these organs can be donated except A Bone marrow B Heart C Lung D Liver E Transplanted kidney |
A. Bone Marrow |
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What is the IV loading dose of paracetamol for a 16kg child? A <15mg/kg B 15mg/kg C 20mg/kg D >20mg/kg |
B 15mg/kg No loading dose in children over 44 weeks. Loading dose in neonates due to higher Vd, but decreased maintenance dose. "the dose of i.v. paracetamol in neonates and infants, when postmenstrual age is between 32 and 44 weeks, should be a loading dose of 20 mg kg−1 (or 2 ml kg−1) followed with a maintenance dose of 10 mg kg−1 (or 1 ml kg−1) every 6 h, ..... In older infants and children, the dose should be 15 mg kg−1 (or 1.5 ml kg−1) every 6 h. The interval between two maintenance doses should be increased up to 12 h if the neonate's postmenstrual age is between 28 and 31 weeks."Br. J. Anaesth. (2014) 112 (2):380-381.oral and rectal loading dosesORAL: 30mg/kgRECTAL: 40mg/kg |
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28. Intralipid initial dose in mL/kg A. 0.5 B. 1 C. 1.5 D. 2 E. 5 |
C. 1.5ml/kg 20% Intralipid * 1.5 mL/kg as an initial bolus x 3 at 5 min intervals * 1.5ml/kg/h double after 5 minutes * Max dose 12ml/kg |
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MELD score includes INR, Creatinine and: A. Albumin B. Bilirubin C. AST D. Fibrin |
B. Bilirubin "BIC" For determining need for transplant / survival. |
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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 |
D. 20x Circulation 2003: "Heterozygous factor V Leiden increases the risk of developing a first DVT by 5- to 7-fold... Homozygous factor V Leiden increases the risk of developing clots to a greater degree, about 25- to 50-fold. http://circ.ahajournals.org/content/107/15/e94.full VH Alternative source: increased by 20x for post-op |
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Kessel Blade has the blade coming off the handle at a degree of: A. 80 B. 95 C. 110 D. 135 E. 150 |
C. 110 Various types of blades: * MacIntosh - commonest; blade attaches to handle at 90 degrees * Kessel - 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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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 |
D. Musculocutaneous |
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55M ICH, ventilated, paralysed, sedated, ICPs persistently 25mmg A. cool to < 35 degrees B. give hypertonic saline C. dexamethasone D. position 45 degrees head up E. Ventilate to PaCO2 <30 |
B. give hypertonic saline ICP >20-25mmHg 1st line: normal everything, 15-30 degrees head up, low N CO2 2nd line: check everything, then administer mannitol 0.25-1g/kg or HTS 5% 1-2ml/kg 3rd line: cooling, barbituate coma, decompressive crani, CSF drainage, futility CEACCP TBI 2013 http://ceaccp.oxfordjournals.org/content/early/2013/02/24/bjaceaccp.mkt010/F1.large.jpg |
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Best method to prolong apnoeic oxygen saturation in obese patient: A. Position head up B. Place in sniffing position C. Prone D. Place lateral |
A. Position head up CEACCP Physiology of apnoea 2009 "For severely obese patients (BMI>40 kg m−2), preoxygenation of these patients in the 25° head-up position achieves oxygen tensions >20% higher than when preoxygenation is applied in the supine position" |
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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 |
A. Increased morphine crossing BBB C. Decreased enzymatic hepatic function CEACCP Analgesia in neonates Reduced doses of morphine are required in neonates because of an increased effect of the drug due to an immature blood–brain barrier, reduced protein binding (28% as opposed to 50% in the older child) producing a higher free drug level and a long duration of action because of immature liver metabolism and reduced renal excretion (maybe not A as effect of M6G crossing?) |
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85. 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. Opioids D. Propofol E. Volatiles |
C. Opioids |
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86. 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 |
D. Myocardial filling pressures Inc SVR > initial inc MAP IVC is compressed > dec preload > dec CO > dec MAP (later) Inc HR can occur and may do to compensate for reduced CO CEACCP Laparoscopic surgery 2011 |
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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 |
A. Lead I, RA lead below the clavicle, LA lead in the V5 position, LL at the hip A or C A for anterior ischaemia (best answer) C for inferior ischaemia |
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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 |
D. 60 NAP4: There was a high failure rate of emergency cannula cricothyroidotomy, approximately 60%. In contrast a surgical technique for emergency surgical airway was almost universally successful |
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Arndt bronchial blocker picture what is the straight port on the multi lumen connector for? A. Connection of tracheal tube B. Passage of nylon guide wire C. Passage of fibreoptic scope D. Passage of bronchial blocker E. Connect circuit |
C. Passage of fibreoptic scope |
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Which would be consistent with deep partial thickness burns? A. Pain to deep pressure only, decreased capillary refill or doesn’t blanch B. Blanches to pressure, very painful C. Painful to air, blanches to pressure with blisters? D. Painful to deep pressure, red and weeping/wet E. No pain, no cap refill |
A. Pain to deep pressure only, decreased capillary refill or doesn’t blanch B. Superficial dermal partial C. Superficial dermal partial D. Mid dermal partial e. Full thickness http://www.vicburns.org.au/burns-assessment/burn-depth/different-burn-depth-characteristics.html |
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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 |
E. 36 vials Dantrolene stocks: The MHANZ group recommends that a minimum of 24 (20mg) vials of dantrolene are held in any anaesthetising location where triggering anaesthesia is performed. Larger or remote hospitals should carry 36 vials.This stock level represents 2-3 x 2.5mg/kg doses for an average sized adult and is a reasonable compromise between clinical need and economy. |
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Pregnant patient, progressive dyspnoea. Which would most strongly warrant further investigation? A. soft 2/6 systolic ejection murmur B. elevated JVP C. third heart sound D. orthopnoea E. peripheral oedema at ankles |
D. Orthopnea All others occur in normal pregnancy |
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How long before return to normal platelet function in chronic diclofenac use. A 12hrs B 1-2d C 4d D 7d E 10d |
A. 12h, or B. 1-2d Diclofenac: t1/2 = 1-2h BJA 2011: "- NSAIDs, by themselves, represent no significant risk for the development of spinal haematoma in patients having epidural or spinal anaesthesia. - Allow platelet function to recover before neuraxial block after administration of ticlopidine, clopidogrel, and platelet GP IIb/IIIa receptor antagonists. The time to normal platelet aggregation after discontinuation of therapy is 14 days for ticlopidine, 5–7 days for clopidogrel, and 7–10 days for prasugrel. For the platelet GP IIb/IIIa inhibitors, the duration ranges from 8 h for eptifibatide and tirofiban to 48 h after abciximab administration." http://bja.oxfordjournals.org/content/107/suppl_1/i96/T2.expansion.html BJA 2011 "Ex vivo tests of platelet aggregation, such as second-wave aggregation to ADP or epinephrine after a single dose of drug, show prolongation for 3 days after piroxicam, 2 days after naproxen, diclofenac, and indomethacin, and about 1 day after ibuprofen. With chronic administration, the time taken for return of normal platelet function may be considerably longer, due to accumulation of products such as the S(+) enantiomer of ibuprofen in adipose tissue" http://bja.oxfordjournals.org/content/107/3/302.full |
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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 |
B. 4 hours The transfusion should normally be completed within four hours of the product leaving approved controlled storage (or sooner if specified on the pack / transfusion report). |
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You arrive to a code blue for a 5 year old child 16kg in a shockable rhythm. CPR has commenced, he has had TWO shocks already. What is the next step: A. Adrenaline B. Amiodarone C. IV fluid bolus D. Shock 50j E. Shock 100j |
A. Adrenaline 10mcg/kg |
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143. FAST scan includes
A. Pelvis, pericardium, perihepatic, perisplenic B. Pelvis, pericardium, perihepatic, paracolic C. Lung, pericardium, perihepatic, perisplenic D. More combinations of above |
A: pelvis, pericardium, perihepatic, perisplenic
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 |
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144. You arrive in the emergency department to treat a man with an attempted hanging. He has a LMA in situ, it is easy to ventilate (or something like that) Sa 98% HR 120, BP 130/80 GCS 5 initially. What is the next single most important thing to do.
A. Apply rigid collar with manual inline stabilisation B. Check for subcutaneous emphysema C. Fibre optic examination of airway D. Lateral c-spine xray E. Remove LMA and intubate |
B. Check for subcutaneous emphysema
Major signs and symptoms are suggestive of significant airway injury. These major diagnosticcriteria are: 1. Subcutaneous emphysema (which may develop some time after the initial injury); 2. Dyspnoea; 3. Stridor; and 4. Inability to tolerate the supine position Blue Book 2005 http://www.anzca.edu.au/resources/college-publications/pdfs/books-and-publications/Australasian%20Anaesthesia/australasian-anaesthesia-2005/05_Peady.pdf |
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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. 1atm (100kPa) B. 2atm (200kPa) C. 3atm (300kPa) D. 4atm (400kPa) E. 5atm (500kPa) |
D. 4 atm
(which is the wall supply pressure) |
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The adverse event that leads to the most medico legal claims against anaesthetists is:
A. Dental damage from airway management B. Eye injury C. Non-obstetric epidural complications D. Obstetric epidural complications E. Peripheral nerve injury |
A. Dental damage
CEACCP 2006: Dental injury 1% Ocular injury 0.1% Peripheral nerve injury (GA) 0.4% http://ceaccp.oxfordjournals.org/content/6/2/67.full http://ceaccp.oxfordjournals.org/content/6/2/67/T1.expansion.html |
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65 year old lady with osteoarthritis, for TKR in 2 weeks time. She has Fe deficiency anaemia, with Hb 105, Ferritin 30mcg/l. The best management would be: A. Oral Fe tablets until surgery B. Oral Multivitamin containing Fe until surgery C. IV Fe infusion D. Blood transfusion E. Check Hb on day of surgery and don't proceed if <95 |
C. IV Fe infusion |
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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 |
B. 21-40 www.transfusion.com.au |
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You are assessing a patient for intubation. MP 3 and thyromental distance 6cm. Compared with MP, TMD is? More or less specific |
TMB less sensitive, more specific |
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You are about the anaesthetise a patient BMI 38 for bariatric surgery. Plan to give 1mg/kg of sux. Compared with ideal body weight, total body weight dosing results 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. Similar onset, longer duration Lemmens HJ, Brodsky JB. The dose of succinylcholine in morbid obesity. Anesth Analg 2006; 102: 438–42 http://www.ncbi.nlm.nih.gov/pubmed/16428539 |
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A man undergoing transcatheter aortic valve replacement has this ECG. What is the best way of managing this: A. Atropine B. Transcutaneous pacing C. Adrenaline D. Isoprenaline E. Transvenous pacing |
E. Transvenous pacing Complete heart block. CEACCP 2012 "The transvenous pacing wire can be used in the case of complete heart block, and this (or epicardial wires after transapical approach) is left in situ immediately after operation in case of delayed heart block." http://ceaccp.oxfordjournals.org/content/early/2012/07/05/bjaceaccp.mks037.full |
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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 |
C. Non-maleficence |
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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 |
A. Continuous, and B. Numerical |
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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. ? |
No correct answer. For RCT , Patients randomly allocated to treatment versus gold standard. Closest is A |
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Clinical phase III trial means: A. dose finding B. In patients WITHOUT the disease C. Randomised controlled trial in patients D. Post marketing study E. ? |
C. Randomised controlled trial in patients Phase 1: Dose finding, safety + SE Phase 2: Efficacy in people with disease, further dose finding and safety Phase 3: Patients with the disease, RCT Phase 4: Post-marketing surveillance |
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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 |
B. 70mg BD (conservative) or C. 100mg BD oMEDD = 70 * 3 = 210mg Divided into 2 = 105mg. Realistically would give less SR + breakthrough |
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Neurosurgery in the sitting position. What is the most sensitive way to detect venous air embolism? A. Precordial Doppler B. PA Catheter C. TOE D. ET CO2 E. ? |
C. TOE TOE > ET N2 > precordial Doppler > ET CO2 |
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65 male patient in ICU with severe, overwhelming sepsis, Hb 75, INR 1.5, CvSO2 70%. What product do you give? A. Nothing B. 1 unit red cells C. 1 unit red cells and PTX D. 1 unit red cells and FFP E. 2 bags FFP |
A. Nothing Surviving sepsis: - Once tissue hypoperfusion has resolved and in the absence of extenuating circumstances, such as myocardial ischemia,severe hypoxemia, acute hemorrhage, or ischaemic coronary artery disease, we recommend that red blood cell transfusion occur when the hemoglobin concentration decreases to < 7.0 g/dL to target a hemoglobin concentration of 7.0 to9.0 g/dL in adults (grade 1B) - We suggest that fresh frozen plasma not be used to correct laboratory clotting abnormalities in the absence of bleeding or planned invasive procedures (grade 2D). http://www.sccm.org/Documents/SSC-Guidelines.pdf |
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What is the structure that attaches to the shaded area: A. Scalenus medius B. Scalenus anterior C. SCM D. Parietal pleura E. Articular surface with clavicle |
A. Scalenus medius |
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Praecordial thump indicated when A. Witnessed, monitored: VT B. Witnessed monitored: VF C. Witnessed but unmonitored arrest D. Witnessed monitored asystole |
A: Witnessed, monitored VT http://resus.org.au/guidelines/ |
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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 |
D. Metoprolol Rate control with B-blocker unless LV impairment then use diltiazem or amiodarone |
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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 |
C. 3 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" |
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Child for elective procedure (insertion of grommets), maternal great-grandfather had MH. What is the most reassuring that he doesn’t have MH A. Exposure to halothane age 2 without incident B. Maternal grandfather negative IVCT C. Mother negative genetic test D. No other reports in family despite multiple exposure E. Normal serum CK E. The boy has recently been shown to have a normal serum creatine kinase E. Normal serum CK |
B. Maternal grandfather negative IVCT |
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Ankle bock what supplies plantar foot A. deep peroneal B. posterior tibial C. superficial peroneal D. sural E. saphenous |
B. Posterior tibial |
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Interscalene block – what is most likely to be missed: A. Medial cutaneous nerve of forearm B. Radial nerve C. Median nerve D. Axillary nerve |
A. Medial cutaneous nerve of forearm Interscalene misses C8/T1 / inferior trunk. Medial cut. n FA comes off medial cords. |
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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. Propothiouracil E. Potassium Iodide |
D. Propylthiouracil |
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65 year old, 3 days postop, hypoxia, VQ scan shows non-segmental, matched perfusion and ventilation defects. A. Asthma B. Pneumonia C. PE D. Atelectasis E. Pulmonary infarction F. Emphysema |
B. Pneumonia or D. Atelectasis |
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45 year old man with left lung cancer. Otherwise well and CT shows no metastasis. FEV1 2.3 L and FVC 3.4 L. Do you? A Proceed with either pneumonectomy or lobectomy B Lobectomy only C Assess split function (Refer for V/Q scanning) D Formal cardiopulmonary exercise testing E cancel all surgery |
A. Proceed with either pneumonectomy or lobectomy 1. FEV1>2.0 do either 2. FEV1>1.5: lobectomy 3. If <1.5 (lobectomy) or <2.0 (pneumon) then do lung scan and calculate ppo FEV1 and DLCO. If >40% --> proceed. 4. If <40% exercise testing: if VO2 max>15ml/kg/min --> proceed CEACCP: Assessment of suitability for lung resection 2006: http://ceaccp.oxfordjournals.org/content/6/3/97.full.pdf |
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You are called to the cardiac catheter lab to assist when a 55-year-old man with unstable angina becomes restless during difficult placement of a right coronary artery stent. When you arrive he is conscious and responding to voice. He is sweating with a pulse of 60 beats per minute in sinus rhythm, blood pressure measured from arterial catheter of 80/50 mmHg and Sp02 of 97%. The arterial pressure wave has an exaggerated fall with inspiration. The most appropriate next clinical intervention would be to A. administer atropine B. commence an adrenalin infusion C. perform a quick transthoracic echocardiograph D. sedate and intubate E. transfer to operating theatre immediately |
C. perform a quick TTE ?Pericardial effusion / tamponade |
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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 |
C. lithotomy stirrups Lithotomy stirrups vs full calf supports have been shown to have no difference |
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You are called to review a patient in recovery who is short of breath after resection of a lung SCC. He is weak, cannot flex hips or lift arms. He was given atracurium (35mg) which was reversed 90 minutes ago. This is most consistent with: A. Eaton lambert B. Myasthenia gravis C. Steroid induced myopathy D. Limb girdle muscular dystrophy E. Myotonic dystrophy |
A. Eaton Lambert Eaton–Lambert syndrome (myasthenic syndrome) is proximal myopathy associated with small cell carcinoma. Reduction in acetylcholine released from presynaptic motor nerve terminals in these patients causes increased sensitivity to all neuromuscular blocking drugs. In contrast to myasthenia gravis, the muscle weakness improves with exercise and is not reversed by acetyl cholinesterase inhibitor therapy |
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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 |
Includes ALL, except B. Checking the breathing circuit if it has been changed (level 3) PS31 Level 1: detailed check before machine put into service Level 2: at the start of each anaesthetic list Level 3: before each patient Level 2: Check - gas supplies inc cylinder - gas flows and vapourisers - breathing system: CO2, leaks, integrity of circle system - ventilator - scavenging system - IV/LA delivery pumps - suction - airway equipment - monitors and alarms - humidifiers and filters Level 3: Check - vapouriser if it has been changed - breathing system if changed - IV/LA pumps - other apparatus: suction, etc |
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Rate of CO2 rise with apnoea in normal adult. |
12mmHg in first minute, then 3.4mmHg per minute after |
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Which is least likely to have a difficult airway? A. Apert syndrome B. Downs syndrome C. Treacher Collins syndrome D. Hurler syndrome E. Pierre Robin Sequence |
B. Downs syndrome Although Downs does have a risk of difficult airway, not as bad as other options. Flagged difficult airway in OHA: - Apert - Hurler syndrome Mentioned difficult airway: - Treacher Collins "difficult airway reported" - Downs "careful airway assessment" |
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When to send tryptase after suspected anaphylaxis: A. 1 hr B. 4 hrs C. ? D. ? E. 24 hrs |
A. 1hr Send tryptase at 1, 4, >24 h |
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Patient unstable with PE after joint replacement (tachycardiac and hypotensive), already heparinised. A. Thrombolysis B. Referral for thrombectomy C. Supportive care including fluids and inotropes D. E. |
B. Referral for thrombectomy |
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Prothrombinex is relatively contraindicated in a bleeding patient with: |
Contraindications: - allergy to heparin - history of HIT - evidence of active thrombosis - evidence of DIC |
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Subtenon is relatively contraindicated in: A. Long axial length B. Previous scleral band which remains in situ C. Inferonasal pterygium D. E. |
B. Previous scleral band which remains in situ The technique is relatively contraindicated where there is a history of scleral disease with possible scarring and friability of the sclera. Previous retinal detachment surgery can be associated with scleral buckles and adhesions, which may hinder dissection or spread of anaesthetic solution, and increase the risk of globe perforation in the quadrant dissected. |
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50 year old male AVR for AS. Stable on CPB but immediately after first dose of cardioplegia, MAP 25, CVP 1, MV O2 Sats 80%. Immediate treatment A: Metaraminol B: Start an adrenaline infusion C: Infuse IV crystalloid D: Change pump flow rates E: Increase O2 flow rate |
A. Metaraminol Adjusting blood pressure • Vary pump flow rate – not commonly used. Low flows compromise perfusion. High flows increase blood trauma. Can be used briefly for periods of very low or high blood pressure. • Increasing SVR – the primary control of BP in most cases. Phenylephrine or metaraminol boluses. Norepinephrine (noradrenaline) or vasopressin can be used when SVR becomes less responsive to these. Vasopressin therapy is currently popular for ‘vasoplegia’ secondary to cardiopulmonary bypass. • Decreasing SVR – anaesthesia. Within reason! It is easy to use vasodilators and vasoconstrictors. Dialling up very high or very low volatile agents produces a slow response and does not treat the cause if adequate anaesthesia is assured. Opioids are quite useful – remifentanil produces particularly stable conditions. Vasodilators – GTN boluses or infusions, phentolamine, sodium nitroprusside. |
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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. |
E. Monophasic 360, 360, 360 or Biphasic 200, 200, 200 |
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21. What is not a sign of damage to a part of the sympathetic tract? [In the context of surgery where something sympathetic related could be damaged] A: Blepharoptosis B: Exopthalmos C: Facial flushing D: Miosis E: Anhydrosis |
B. Exopthalmus Signs of sympathetic trunk damage (Horner's syndrome): - ptosis - miosis - anhidrosis - enophthalmos (sunken eye, optional) - flushing (due to dilation of blood vessels under the skin, optional) Blepharoptosis is a low lying eyelid, may be part of a congenital Horner's syndrome. |
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Providing sedation for endoscopy. What must you have? A. Anaesthetic machine B. Suxamethonium C. Mechanical ventilator D. Defibrillator E. Dantrolene |
D. Defibrillator |
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Abdominal compartment syndrome is diagnosed when intra-abdominal pressures are consistently greater than A: 12mmHg B: 20mmHg C: 24mmHg D: E: |
B. 20mmHg LITFL ACS is diagnosed with persistent pressures >20mmHg and new organ failure. Grade of IAH (severity) Normal = IAP 5-7 mmHg Grade I = IAP 12–15 mmHg Grade II = IAP 16–20 mmHg Grade III = IAP 21–25 mmHg Grade IV = IAP >25 mmHg |
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Patient with respiratory failure, low PaO2/FiO2 ratio, cardiac index of 1.7, PCWP of 25. Which mode of ECMO would be most appropriate? A: VA B: VV C: AV D: E: |
B. VV CI is OK. VA-ECMO can be considered in patients with systolic arterial pressure lower than 85 mm Hg, cardiac index lower than 1.2 litre min−1 m−2, despite adequate preload, more than two inotropes in use, intra-aortic balloon counterpulsation, and systemic signs of low cardiac output |
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When to stop dabigatran (for non valvular AF) in a patient with normal renal function prior to THR planned to be done under spinal? A: 7 days B: 3 days C: 3 days, bridge with clexane D: 5 days E: Continue until day of surgery |
D. 5 days
Recent ASRA guidelines.
? Bridging depends upon risk of embolus BJA article suggests 5 half-lives with bridging (4 days) anti-Xa --> 3 days DTI --> 5d anti-platelets --> 7d (eg clopidogrel)
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What do you expect to happen if you put a magnet over an AICD? A: Turn off antitachycardia feature, no change to pacing B: Turn defib off, asynchronous pacing C: Turn defib off, no change to pacing (or, continue synchronous pacing) D: No change to defib, asynchronous pacing E: |
A. Turn off antitachycardia feature, no change to pacing |
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Young patient, recently diagnosed with phaeochromocytoma. Not on any medications. Presents to ED tachycardic (~140) with SBP 220. Best initial treatment: A: Phenoxybenzamine B: Phentolamine C: Esmolol D: GTN E: |
B. Phentolamine Both phenoxybenzamine and phentolamine are a blockers, but phentolamine is faster. Must give alpha blocker before beta blocker as blockade of β 2 vasodilatory receptors leads to unopposed stimulation and worsening ofhypertension. GTN / SNP more 2nd line options |
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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 <200g E: |
C: Use laser CEACCP Anaesthesia for TURP 2009: "A higher rate of absorption is produced by several factors. 1. The pressure of the irrigation fluid. The height of the bagshould be kept as low as possible to achieve adequate flow offluid. 70cm are usually satisfactory. However, thesurgeon will frequently stop and drain the bladder to removechippings; during this time, the hydrostatic pressure within thebladder is low. 2. Low venous pressure, e.g. if the patient is hypovolaemic orhypotensive. 3. Prolonged surgery, especially >1 h, although this is nowuncommon. 4. Large blood loss, implying a large number of open veins. 5. Capsular perforation, or bladder perforation, allowing a largevolume of irrigation fluid into the peritoneal cavity, where it israpidly absorbed." "Newer techniques of prostatic resection use different types ofenergy (heat, laser, ultrasound, or microwave) to vaporize prostatictissue and coagulate surrounding blood vessels. These techniquesare reported to cause less haemorrhage than conventional TURP,but specimens for histology cannot be obtained. Since diathermy isnot used, normal saline may be used as the irrigating solution,minimizing the risk of the TURP syndrome." |
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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. |
D. Recurrent laryngeal nerve |
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What is the most sensitive monitor for detecting venous air embolus during neuroanaesthesia? A. transoesophageal electrocardiography (yes - it said electro) B. precordial Doppler C. precordial stethoscope D. capnography E. ? |
B. precordial Doppler CEACCP Gas embolism 2002 - TOE most sensitive (10x doppler) 0.02ml/kg - ET N2 0.1ml//kg - precordial Doppler 0.2ml/kg - ETCO2 0.4ml/kg |
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115. 50% burns in a patient weighing 70 kg, how much fluid to give in first 8 hours? |
7L Modified Parkland formula: 50 x 70 x 4 = 14000ml Half in 1st 8 hours = 7L |
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116. Patient with a large anterior mediastinal mass, develops hypoxia on induction, best management? A. Prone position B. Intubate and ventilate with IPPV C. Intubate and try to keep spontaneously breathing D. Deliver CPAP |
C. Intubate and try to keep spontaneously breathing CEACCP 2007 Mediastinoscopy |
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Question about most common symptom associated with post-op cognitive dysfunction A. Short term memory loss B. Agitation C. Hallucinations D. Decreased executive function E. Delirium |
D. decreased executive function ? post-op cognitive decline (POCD) rather than delirium? POCD requires pre- and post-neuropsychiatric testing. http://bja.oxfordjournals.org/content/103/suppl_1/i41.full "POCD refers to deterioration in cognition temporally associated with surgery. While the diagnosis of delirium requires a detection of symptoms, the diagnosis of POCD requires preoperative neuropsychological testing (baseline) and a determination that defines how much of a decline is called cognitive dysfunction. The spectrum of abilities referred to as cognition is diverse, including learning and memory, verbal abilities, perception, attention, executive functions, and abstract thinking. It is possible to have a decrement in one area without a deficit in another." |
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Awareness incidence with GA under muscle relaxant from NAP5 A. 1:1000 B. 1:3000 C. 1:8000 D. 1:10,000 E. 1:50,000 |
C. 1:8000 1:670 for GA LSCS 1:8000 with NMBD 1:8000 for cardiac surgery 1: 136000 without NMBD 2/3 of cases during induction or emergence http://www.ncbi.nlm.nih.gov/pubmed/25204697 |
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119. Propofol infusion syndrome involves all of the following except: A. Rhabdomyolysis B. Hepatomegaly C. Splenomegaly D. ST elevation |
C. Splenomegaly Acute refractory bradycardia progressing to asystole and one of: (1) metabolic acidosis (2) rhabdomyolysis (3) hyperlipidaemia (4) enlarged or fatty liver ECG: Brugada like pattern (coved type = convex-curved ST elevation in V1-V3), RBBB, arrhythmia, heart block LITFL |
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120 Pre-operative bowel prep: A. Reduces mortality B. Reduces wound infection rates C. Reduces anastamotic leak rates D. Reduces re-operation rates E. Facilitates colonoscopy |
E. Facilitates colonoscopy Cochrane review: "Mechanical bowel preparation for elective colorectal surgery" 2011 |
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Bowel surgery. What is the best way to assess fluid status. A. Arterial pressure variation |
Dynamic variables better than static. Dynamic include: - LiDCO: SVV, PPV, SPV - PICCO: SVV, global EDV, intrathoracic blood vol - TOE: SVC collapsibility index - TTE: IVC collapsibility index - Oesophageal Doppler: DVV Static include: - CVP - PAOP - RVEDV - LVED area - global EDV - intrathoracic blood volume |
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RFTs with FEV1 normal, FVC normal, FEV1/FVC ratio 89%, DLCO 44%, RV and TLC both 80-90% (I remember this not mentioning pulmonary haemorrhage; and TLC or RV were 98%) A. Asthma B. COPD C. Pulmonary haemorrhage D. Pulmonary fibrosis E. Pulmonary arterial hypertension |
D. Pulmonary fibrosis FEV/FVA >80 is normal or restrictive DLCO 44% is significantly impaired RV 98% is normal. RV/TLC 80-90% is slightly restricted So main problem is transfer of gases. A. Should be obstructive pattern with dec ratio B. Should be obstructive pattern with dec ratio C. Will have increased DLCO E. ? |
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123. You arrive at the delivery of a term neonate with resuscitation in progress. At 2 minutes, saturations are 70%, child is breathing, has been dried and is warm. A HR was also given which was more than 60. What do you do? A. Observe B. Mask ventilation C. 100% oxygen D. ? |
B. Mask ventilation ANZCOR Neonatal resus flowchart. Sats are fine. HR is not. HR needs to be >100. Start PPV. Consider adding oxygen if HR remains <100. Targeted pre-ductal saturations: - 1min: 65-75 - 2 min: 65-86 - 3 min: 70-90 - 4 min: 75-90 - 5 min: 80-90 - 10 min: 85-90 ARC |
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Which nerves need to be blocked to anaesthetise the hard palate: A. Superior labial nerve and greater palatine nerve B. Greater palatine nerve and nasopalatine nerve C. Inferior orbital nerve and nasopalatine nerve D. Glossopharyngeal nerve and… E. Anterior ethmoidal nerve and… |
B. Greater palatine nerve and nasopalatine nerve |
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X36. Obese male in 60's one day post laparotomy. Management includes: fluid running at 40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: Temperature 38.8C, 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. Return to theatre |
?A. Incentive spirometry ? D. Naloxone ? atelectasis Sit up. Increase O2. DB+C ?Remove PCA button. ?Consider naloxone. |
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An ICU patient is intubated and ventilated post some kind of abdominal surgery. NGT in situ with ongoing high output. Currently on CSL 60mL/hr. ABG: pH 7.66, HCO3 35 mmol/l, Cl- 78, pCO2 32. What to do to improve acid base status? (various combinations of the following) A. minute ventilation -?keep same/?reduce B. keep current IV fluids/ keep CSL but increase rate/ change to NS C. Start PPI D. Start acetazolamide |
Alkalosis. HCO3>26 so metabolic alkalosis. Low Cl- Low N pCO2. Change IVF to NS and increase rate. Keep ventilation the same, or increase slightly. PPI would reduce acid secretion which would make things worse. Acetazolamide could be used, rarely done LITFL |
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What does this TEG show? |
Hyperfibrinolysis. Will have normal clot formation but then dissolved fast. Give TXA. |
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Pathognomonic for post dural puncture headache: A. Worse on standing B. Occipital area only C. D. E. |
A. Worse on standing |
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What is the GCS. Opens eyes to voice. Responds "purposefully" to pain. Speaks, but confused. |
E = 3 V = 4 M = 4 or 5 GCS = 11 or 12 |
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What is the smallest ETT that can be railroaded over an aintree catheter? A. 5.5 B. 6.0 C. 6.5 D. 7.0 E. |
D. 7.0 According to manufacturer. (Can fit 6.5mm but it's tight) |
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SAH, all associated with poor prognosis except: A. Pulmonary oedema B. Stunned myocardium C. Fever D. Delayed ischaemia E. |
?A. Pulmonary oedema ?B. Stunned myocardium A. Pulmonary cx are common and include APO. Treatment is supportive. No mention of poor prognosis. B. "elevated troponin I, CK-MB, and ST depression are associated with poor outcome and DND" But stunned myocardium is reversible. C. Fever may cause delayed neurological deficit (DND) D. DCI may cause DND CEACCP Acute mgt of SAH |
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Most common cause of foot drop after prolonged labour: A: Lumbosacral plexus compression by fetal head/forceps B: Common peroneal nerve injury due to lithotomy position C: D: E: |
A: Lumbosacral plexus compression by fetal head/forceps "Another common cause of problems is the fetal head compressing the lumbosacral trunk where it crosses the posterior pelvic brim before descending in front of the sacral ala. Foot drop is a notable consequence of these mechanics." Lithotomy position causes deep peroneal nerve damage. CEACCP Post-natal neurological complications 2013 |
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In an adult, the spinal cord ends at the caudal end of which vertebral body? A: L1 B: L2 C: T12 D: S2 |
A. L1 |
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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 |
C. Student t-test
(Melbourne course, Dr Noonan) Student t test used to check whether the means of the 2 groups are equal for parametric data. Mann-Whitney U test is a non-parametric test and equivalent to student t. Bland Altman is a plot used to compare results from 2 tests. |
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In Tetralogy of Fallot, the degree of cyanosis is best predicted by the: A. Size of the VSD B. Location of the VSD C. Degree of RV outflow obstruction D. Degree of pulmonary arterial hypertension E. Degree of systemic arterial hypertension |
C. The degree of RV outflow obstruction VSD is usually non-restrictive, and shunt direction depends upon degree of obstruction. Severe = R>L with more cyanosis |
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Best method (or most accurate) assessment of fluid status A: Arterial pulse contour analysis B: BP + HR C:? D: EJECTION fraction of ventricle via TOE E: Pulmonary capillary wedge pressure |
A: Arterial pulse contour analysis |
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134. The risk of developing auto or intrinsic positive end-expiratory pressure during positive pressure ventilation of an anaesthetised patient may be reduced by increasing the A: Expiratory time B: Inspiratory time C; Respiratory rate D: Tidal volume E: Amount of positive pressure ventilation |
A. Expiratory time |
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133. A 60yo lady who had a mastectomy and axillary LN clearance has started to vomit in PARU. Patient given prophylactic 8mg ondansetron + 4mg dexamethasone and feeling nauseous in recovery. Best next treatment is A: Cyclizine 50mg B: Dexamethasone 4mg C: Metoclopramide 10mg D: Droperidol 0.625mg E: Ondansetron 4mg |
D: Droperidol 0.625mg |
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Reduction in risk of blood transfusion reaction with group specific ABO + Rh matching, but not cross matched A: B: C: D: 98.? E: 99.8 |
E. 99.8% Miller's 8th edition, ch 61 "ABO-Rh typing alone results in a 99.8% chance of a compatible transfusion, the addition of an antibody screen increases the safety to 99.94%, and a crossmatch increases this to 99.95%" |
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Sux left out of fridge for 1 week. How much has its efficacy reduced A: 2% B: 5% C:10% D: ? E: ? |
A. 2% 5% loss of potency over 3 months at 20 degrees. (frca.co.uk) 2% per month of 50mg/ml solution in Emerg Jour 2007 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2660020/ |
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All features are associated with chronic pain, except A: Increasing patient age B: Low level of anxiety about surgery C: Minor pain post-op D: Care not to damage intercostal nerves E: Performance of a paravertebral block |
A. Increasing patient age C. Minor pain post-op Preoperative factors - Pain, moderate to severe, lasting >1 mth - Repeat surgery - Psychological vulnerability (eg catastrophising) - Preoperative anxiety - Female gender - Younger age (adults) - Workers’ compensation - Genetic predisposition - Inefficient diffuse noxious inhibitory control - Type of surgery: amputation, thoracotomy, THR, TKR, mastectomy, CABG, inguinal hernia Intraoperative factors - Surgical approach with risk of nerve damage - Avoidance of nitrous oxide anaesthesia Postoperative factors - Pain (acute, moderate to severe) - Radiation therapy to area - Neurotoxic chemotherapy - Depression - Psychological vulnerability - Neuroticism - Anxiety APMSE 4th edition p18-19 |
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FEV1 3.3 (predicted 4.3), for left lower lobectomy A: Proceed with pneumonectomy and lobectomy B: Proceed with lobectomy only, not for pneumonectomy C: Not for surgery D: Send for cardio-pulmonary testing E: Send for VQ scan |
A: Proceed with pneumonectomy and lobectomy |
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Class I equipment, active wire touching casing. What happens when electricity / power supply is switched on A: Nothing B: The electrical fuse will immediately break and disconnect the device from the power supply C: The Line Isolation Monitor will alarm and disconnect power to the device D: The double insulation of the device will prevent macroshock when the outer casing is touched E: The RCD will immediately / rapidly disconnect the device from the power supply |
B: Fuse will blow Class I equipment has an earth wire with a lower resistance, so current will flow down this and melt the fuse if active wire touches casing. |
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Risk of bone cement implantation syndrome increased with A: Increasing age B: Male gender C: ? D: ? E: Previous exposure to cement |
A. increasing age Numerous patient-related risk factors have been implicated in the genesis of BCIS including - old age - poor pre-existing physical reserve - impaired cardiopulmonary function - pre-existing pulmonary hypertension - osteoporosis - bony metastases - concomitant hip fractures particularly pathological or intertrochanteric fractures. - no previous cementing http://bja.oxfordjournals.org/content/102/1/12.full |
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Risk of anaphylaxis recurring post-rocuronium anaphylaxis is greatest with A: Cisatracurium B: Atracurium C: Vecuronium D: Pancuronium E: Unknown due to variable cross-sensitivity |
E. Unknown due to variable cross-sensitivity ? Either Vec or Panc as they share the same structure, or unknown. VH says Vec |
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You have a fire emanating from your anaesthetic machine. The most appropriate treatment is: A. fire blanket B. CO2 extinguisher C. wet chemical extinguisher D. fire hose E. foam extinguisher |
B. CO2 extinguisher CO2 for an electrical fire +/- dry powder http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3590534/ |
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A 30 year old woman is admitted to ICU after a 500mg/kg aspirin overdose. What is the most effective therapy to enhance her elimination of aspirin? A. Frusemide B. Haemodialysis C. Mannitol D. 0.9% sodium chloride E. Sodium bicarbonate |
B. Haemodialysis Haemodialysis is most effective. Bicarb is first line to alkalinise urine. Also decontamination with activated charcoal if ingestion within 1 hour of presentation. |
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2. 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. Nothing |
B. Rupture of aneurysm TOTW: Haemorrhagemay be spontaneous, iatrogenic or caused by anaesthetic factors (BP surges,inadequate depth of anaesthesia, poor control of BP at emergence) [10]. It maybe identified by recognition of contrast extravasation or physiological changes(hypertension with or without bradycardia). |
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3. A 70 year old is is intubated and ventilated post-laparotomy. He has CSL running @60ml/hr, with an NGT on suction with continuing high output. His ABG shows an appropriate pO2, pCO2 32, pH 7.66, Na 144, K 3.5, Cl 76. He has a normal creatinine and raised urea. How should you improve his acid base status? (Had a very very very long stem, with very long answers, but this was the gist, and I'm pretty confident with the answers except the first 2 fluid options). A. Leave minute ventilation unchanged, (?leave fluids unchanged), commence PPI B. Leave minute ventilation unchanged, (?leave fluids unchanged), commence acetazolamide C. Increase minute ventilation, change IVF to normal saline, commence PPI D. Increase minute ventilation, increase the fluid rate, commence acetazolamide E. Increase minute ventilation, leave fluids unchanged, commence acetazolamide |
B. Leave minute ventilation unchanged, (?leave fluids unchanged), commence acetazolamide ? Increasing MV will worsen alkalosis, so should leave it unchanged. Also CO2 is low normal already. PPI is would decrease acid secretion and make worse? Acetazolamide can be used in rare circumstances. Hypochloraemic so makes sense to switch to NaCl. |
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18. Anatomy of 1st rib: A. Anterior surface for clavicle B. Attachment for scalenus anterior C. Attachment for scalenus medius D. Attachment for SCM E. Groove created by parietal pleura |
Attachment of scalenus medius in past |
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20. Precordial thump for A. monitored pulseless VF if defibrillator not immediately available B. monitored pulseless VT if defibrillator not immediately available C. unwitnessed cardiac arrest D. witnessed onset of asystole caused by AV conduction disturbance E. unwitnessed unmonitored cardiac arrest |
B. monitored pulseless VT if defibrillator not immediately available (Australian Resuscitation Council) |
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38. 60 year old male with history of HTN presents with abrupt onset of severe chest pain and diagnosis of aortic dissection is considered. Conscious with HR of 150/min. BP 80/40. Most appropriate investigation to confirm diagnosis in this situation: A. CXR B. ECG C. MRI D. thoracic aortogram E. TTE |
E. TTE Unstable. Best to confirm diagnosis is TOE as this will show high thoracic and arch dissection. TTE can show low thoracic and abdominal dissection. (If he was stable --> CT) |
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39. The peripheral nerve most commonly injured in patients undergoing general anaesthesia is the A. common peroneal nerve B. lingual nerve C. optic nerve D. radial nerve E. ulnar nerve |
E. ulnar nerve |
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76. (picture) 78 year old undergoing catheter angiography with pressure in Ao and LV and ECG characteristic of A. Aortic coarctation B. Aortic dissection C. Aortic stenosis D. Aortic regurgitation E. Mitral regurgitation |
AS: loss of dicrotic notch, slow upstroke AR: extra large dicrotic notch, further wave reflected (so may have 3 peaks per beat) |
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131. An 18month old child is brought to the emergency department with fever, rash, periodic respiration. The arterial blood gas profile which best fits this clinical picture is A. pH 7.16, PCO2 52mmHg, PO2 68mmHg, HCO3 18mmol/L B. pH 7.23, PCO2 24mmHg, PO2 94mmHg, HCO3 10mmol/L C. pH 7.24, PCO2 68mmHg, PO2 37mmHg, HCO3 27mmol/L D. pH 7.48, PCO2 43mmHg, PO2 82mmHg, HCO3 31mmol/L E. pH 7.58, PCO2 24mmHg, PO2 88mmHg, HCO3 22mmol/L |
? Acidosis or alkalosis? Fever + rash indicate possible sepsis hence most likely acidosis. Periodic breathing?? meaning not breathing much? Or Cheyne-Stoke-like breathing? If sepsis and acidosis, expect rapid breathing with low CO2 A. Combined met and resp acidosis B. Met acidosis with resp compensation C. Resp acidosis with no compensation (ie acute cause?). Hypoxic. D. Metabolic alkalosis with some resp compensation (?not common) E. Respiratory alkalosis with minimal metabolic compensation |
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X24. TTE with apical 5 chamber view with marker on valve in LVOT. What is this? A Aortic valve B Mitral valve C Pulmonary valve D Tricuspid Valve E |
A. Aortic valve |
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X25. TOE transgastric short axis view of LV. Label on anterior wall. What coronary territory is it? A. LCx B. LAD C. PDA D. RCA E. ? |
B. LAD Anterior wall = LAD Inferior wall = RCA Posterior wall = LCx |
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X104 [Repeat] 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 |
A. 2mg 4mg dex = 25mg pred = 100mg hydrocort |
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x105 [Repeat] What has got minimum effect on ICP at 1 MAC ? A. Isoflurane B. Sevoflurane C. Desflurane D. Enflurane E. Halothane |
B. Sevoflurane |
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x107 [Repeat] You are performing epidural anaesthesia on an adult patient. To minimize the chance of inserting the epidural catheter into a blood vessel you would do what ? A. Inject saline through the epidural needle prior to threading the catheter B. Perform the procedure with the patient lateral rather than sitting C. Use a loss of resistance to air technique instead of loss of resistance to saline. D. E. |
A. Inject saline through the epidural needle prior to threading the catheter, and B. Perform the procedure with the patient lateral rather than sitting Anaesth & analg 2009 systematic review Five strategies reduce the risk of epidural vein cannulation: 1. the lateral as opposed to sitting position 2. fluid administered through the epidural needle before catheter insertion 3. single rather than multiorifice catheter 4. a wire-embedded polyurethane compared with polyamide epidural catheter 5. catheter insertion depth < or =6 cm Things that don't help: The paramedian as opposed to midline needle approach and smaller epidural needle or catheter gauges do not reduce the risk of epidural vein cannulation. |
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x108 [Repeat] The most useful sign to distinguish between severe serotonin syndrome and malignant hyperthermia are what ? A. Clonus B. Hyperthermia C. Metabolic acidosis D. Muscle rigidity E. Wheeze |
A. Clonus |
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x111 [Repeat] What is the timing of peak respiratory depression post 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 |
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x112 [Repeat] The clinical sign that a lay person should use to decide whether to start CPR is what? A. Absent central pulse B. Absent peripheral pulse C. Loss of consciousness D. Obvious airway obstruction E. Absence of breathing |
E. Absence of breathing Unconscious with abnormal breathing |
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x115 [Repeat] CO2 LASER 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. Long infrared wavelength CO2 has a wavelength of 10600nm, well absorbed by water. |
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x116 [Repeat] 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 E. No treatment |
E. No treatment Qld health: If the exposed person has (or previously had) an HbsAb level ≥ 10 IU/L (immunised), then the risk of acquisition is negligible. Non responders to immunisation require hep b Ig within 72h of exposure |
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x117 [Repeat] 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. Less need for critical care |
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x118 [Repeat] 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. Rapid respiratory rate |
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x119 [Repeat] 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. Resonant frequency LITFL |
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x120 [Repeat] 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 papaverine D. Intraarterial injection of 500u heparin E. Observation |
A. Intraarterial injection of 5mL 1% lignocaine OHA p 950: stop injection, administer 1% lignocaine 5mL, papaverine 40mg, flush with heparinised saline. |
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x121 [Repeat] Which of the following is not an absolute contra-indication for MRI? A. Cochlear implant B. Heart valve prosthesis C. ICD D. Pacemaker E. Intracranial clips |
B. Heart valve prosthesis |
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x122 [Repeat] 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 |
E. 200mmol/L http://www.cicm.org.au/CICM_Media/CICMSite/CICM-Website/Resources/Publications/CCR%20Journal/Previous%20Editions/September%201999/05-Sept_1999_Hypokalaemia.pdf "If the serum potassium level is greater than 3mmol/L, 100 -200 mmol of potassium are required toraise it by 1 mmol/L; 200 - 400 mmol are required toraise the serum potassium level by 1 mmol/L when thepotassium concentration is less than 3mmol/L" |
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x123 Post CABG with respiratory compromise A. CPAP B. Bilevel C. High flow O2 D. Physiotherapy E. |
B. Bilevel |
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x124 [Repeat] Asthmatic paediatric patient, tonsillectomy. Desaturates and stiff to bag. First thing to do? A. Salbutamol B. Suction C. Ask surgeon to ease on the Boyle Davis gag. D. Paralysis E. |
C. Ask surgeon to ease on the Boyle Davis gag. |
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x125 [Repeat] What antibiotics are required for bacterial endocarditis prophylaxis in a woman with MV ?ring for ?cholecystectomy. A. None B. gentamicin C. ampicillin and gentamicin D. ampicillin E. cephazolin |
D. ampicillin |
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x126 [Repeat] 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 |
D. 12 lead ECG |
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x127 ?? Features of obstructive sleep apnoea include all but what ?? or a question very similar A. ? Snoring B. ? Tired during the day C. ? Observed apnoea D. ? Hypertension E. ? BMI > 25 |
E. ? BMI > 25 STOP-BANG BMI >35 |
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x128 [Repeat] 40 year old, pulmonary artery 80/60 pre-op. Lap cholecystectomy. Sudden SPO2 87, sBP 80/40, etPCO2 45. Cause? A. Gas emboli B. Left heart failure C. Myocardial ischaemia D. Pneumothorax E. Right heart failure |
E. Right heart failure |
