*anzca Final Mcq March 2015

Front 1

Young manhas removed his buprenorphine patch on the morning of surgery. What time tillPLASMA reaches half original level

A. 12 hours

B. 18 hours

C. 24 hours

D. 30 hours

E. 36 hoursbecareful!

this question has been asked previously about both fentanyl andbuprenorphine! read it carefully on the day!

Back 1

A

Front 2

A 58yo withsolitary hepatic metastasis from colon cancer scheduled for resection of R lobeof liver. In order to manage the risk of intra-operative haemorrhage, it ismost important to maintain:

A. High CVPin anticipation of heavy blood loss

B.Decreased MAP to reduce arterial bleeding

C.Decreased CVP to reduce venous bleeding

D. NormalMAP in anticipation of heavy blood loss

E. NormalCVP to ensure adequate filling of the heart.

Back 2

C

Front 3

An 80yo manis having a transuretheral bladder resection, the surgeon is using diathermyclose to the lateral bladder wall which results in patient thigh adduction. Thenerve involved is:

A. Inferiorgluteal

B.Obturator

C. Pudendal

D. Scaitic

E. Superiorgluteal

Back 3

B

Front 4

In Conn'ssyndrome, the usual derangement is:

A.Hypoglycaemia, hypokalaemia and hypernatraemia

B. Hypoglycaemia,hyperkalaemia and hyponatraemia

C.Normoglycaemia, hypokalaemia and hypernatraemia

D.Normoglycaemia, hyperkalaemia and hyponatraemia

E.Hyperglycaemia, hyperkalaemia and hyponatraemia

Back 4

C

Front 5

A 60 yearold woman is admitted to hospital with subarachnoid haemorrhage. Her GCS is 11,and her blood pressure is 175/110 mmHg. She is administered oral nimodipine.The main reason for this treatment is:

A. Controlher blood pressure

B. Manageacute hydrocephalus

C. Preventdelayed cerebral ischaemia

D. Reducethe risk of rebleeding

E. Treatangiographically-proven cerebral vasospasm

Back 5

C

Front 6

You are theanaesthetist at a Caesarean Section for a 36/40 gestation pregnancy. The babyat birth is floppy and apnoea. You decide that positive pressure ventilationvia mask is necessary. The recommended FiO2 is:

A. 0.21

B. 0.4

C. 0.6

D. 0.8

E. 1.0

Back 6

A - RPA (first inflation then 100% if no response)

For term infants, air should be used initially with supplemental oxygen reserved for those whose saturations do not meet the lower end of the targets despite respiratory support [Class A, expert consensus opinion].

Front 7

You areinducing 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 after10mL of propofol and it becomes clear that cannula is intraarterial. The bestmanagement 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

Back 7

E

Front 8

When is itnecessary to use glycine as irrigation fluid for TURP?

A: Formonopolar diathermy

B: Forbipolar diathermy

C: ForNd:Yag laser

D:Greenlight laser

I'm 90%sure bipolar diathermy was not an option, making monopolar the best answer.

Back 8

A

Front 9

A 69 yo manis brought into ED by ambulance with a compound fracture of his forearm from anunwitnessed fall. Has a history of schizophrenia and depression with uncertainmedication compliance. He is confused and agitated with generalised rigiditybut no hyperreflexia.Obs - HR120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx?

A. Heatstress from anticholinergic therapy

B. Hypoxicischaemic encephalopathy

C.Neuroleptic malignant syndrome

D.Serotonin syndrome

E. Painfrom the compound fracture

Back 9

C

Front 10

Withsurgical bleeding, the first clotting factor to reach a critical level is

A. I

B. II

C. VII

D. X

E. XIII

Back 10

A - factor 1 = fibrinogen

Front 11

Anaestheticand respirable gas supplies to wall outlets in the operating theatre is atpressures of

A. 200kPa

B. 400kPa

C. 500kPa

D. 750kPa

E. 1200kPa

Back 11

B

Front 12

The mostuseful sign to distinguish between severe serotonin syndrome and malignanthyperthermia are

A. Clonus

B.Hyperthermia

C.Metabolic acidosis

D. Musclerigidity

E. Wheeze

Back 12

A

Front 13

Patienthaving a laparotomy. On prednisolone for 6/12, 10mg/day. What is the equivalentdose of dexamethasone?

A) 2mg

B) 4mg

C) 6mg

D) 8mg

E) 10mg (orwas the option 12mg?)

Back 13

A

Front 14

Axillaryarm block U/S presented similar to this ultrasound image. Nerves marked with numbers 1-4.

Patienthaving an operation of a lacerated index finger under regional anaesthesia.Which combination will provide adequate cover?

A) 1 and 2

B) 1 and 3

C) 2 and 3

D) 2 and 4

E) 3 and 4

Back 14

A

Front 15

Child 20kghaving a caudal. Has a VF arrest post non-responsive to usual treatments. Whatdoes of intralipid 20% would you give?

A) 10mL

B) 20mL

C) 30mL

D) 40mL

E) 50mL

Back 15

C

1.5ml/kg

Front 16

Labourepidural placed. Headache postpartum. Which of the following is inconsistentwith post partum dural puncture headache.

(a)Headache located frontal only

(b)Presents > 24 hrs post partum

(c)presents immediately post partum

(d)associated with auditory symptoms

(e)associated with neck stiffness

Back 16

C

Front 17

Eclampticpatient. Given Magnesium intravenously. Which of these symptoms is oftenassociated with magnesium administration?

(a)Bradyarrhythmia

(b) Cardiacarrest

(c)Hypotension

(d) Depressedrespiratory effort

(e)

Back 17

D > A

Magpietrial

Most toleast: Flushed, N/V, injection problems, weakness, absent or reduced reflexes, respiratorydepression, thirst, headache, hypotension or palpitation or tachycardia,

Front 18

Theclinical sign that a lay person should use to decide whether to start CPR is:

(a) absenceof breathing

(b) loss ofcentral pulse

(c) loss ofperipheral pulse

(d) loss ofconsciousness

(e) obviousairway obstruction

Back 18

A or D

Front 19

What is themaintenance fluid rate for a 15kg child?

a) 60ml/hr

b) 50ml/hr

Back 19

B 4:2:1 rule

Front 20

Patient'sK+ is 7.0 what is the best initial management?

a) give Ca

b) giveinsulin/ dextrose

Back 20

A

Front 21

Whichpatients require antibiotic prophylaxis?

a) PreviousMitral valve ring annuloplasty

b) Previouspatch repair of vsd

Back 21

A - best answer

B - if in the last 6 months

Front 22

A 63 yolady has a difficult thyroidectomy for cancer. Immediately post extubation shedevelops stridor and respiratory distress.The mostlikely cause is

A)Hypocalcaemia

B)recurrent laryngeal nerve palsies

c)tracheomalacia

d) Neckoedema and haematoma

e) Vocalcord oedema

Back 22

B>D

Front 23

A 23 yo hasa traumatic brain injury. Which fluid is relatively contraindicated?

a) Albumin

b) Normalsaline

c) CSL

d) Colloid

e)Something else

Back 23

A

Front 24

50something yr old smoker presents for laparotomy. PFTs given, what is the cause?FEV1, FVCboth reduced, FEV1/FVC 98%. TLC, RV, DLCO 8 (pred = 30)

(a) PE

(b) Obesity

(c)Bilateral phrenic nerve palsies

(d)Pulmonary fibrosis

(e) COPD

Back 24

D

Front 25

Traumaticbrain injury patient. Cerebral angiogram shows Cerebral perfusion =15mL/100g/min, cerebral oxygen consumption 3.5mL/100g/min. This is consistentwith:

(a)Cerebral hyperperfusion

(b)Reperfusion injury

(c)Cerebral ischaemia

(d)Appropriate auto regulation

(e) ?cerebral vasoconstriction

Back 25

C

Normalperfusion = 50-54 mL/100g brain tissue/min; normal CMRO2 (awake brain) =3.5mL/100g/min, reduced in coma/anaesthesia. 15ml blood carries 3ml O2 (assuming normalvalue 200ml of O2 per litre blood). Therefor ischaemia is the best choice.

Front 26

Absolutecontraindication to ECT:

A. Cochlearimplants

B. Epilepsy

C.Pregnancy

D. Raisedintracranial pressure

E. Recentmyocardial infarction

Back 26

D

Option E was definitely RECENT myocardial infarction, which I think makes it the best answer. Although previously has been recalled without the word "recent", which might have made D the better choice.

Front 27

FFP isgiven to a patient to treat hypofibrinogenaemia. The volume required to raisethe fibrinogen by 1g/L is

A 1mL/kg

B 5mL/kg

C 10mL/kg

D 20mL/kg

E 30mL/kg

Back 27

E

Front 28

The dilutedthrombin time measures the anticoagulant activity of

A apixaban

Brivaroxaban

Cdabigatran

D warfarin

E heparin

Back 28

C

Front 29

In a traumapatient the main mechanism by which hypothermia exacerbates bleeding is by

A alteredblood viscosity

B causingDIC

Cinhibition of clotting factors

Dpotentiation of anticoagulant effect of drugs used to treat DVT

E decreasesplatelet number and function

Back 29

C

Front 30

A patienthaving a liver resection suffers a haemodynamically significant venous airembolism. During resuscitation how do you best position the patient?

A head up,right side down

B head up,left side down

C head up,no lateral tilt

D headdown, right side down

E headdown, left side down

Back 30

E

Front 31

In a normaladult what amount of IV potassium chloride is needed to raise the serumpotassium from 2.8 to 3.8mmol/L?

A 10mmol/L

B 20mmol/l

C 50mmol/L

D 100mmol/L

E 200mmol/L

Back 31

E

Front 32

In ahaemodynamically stable 20 year old man with blunt chest trauma, the bestscreening test to diagnose cardiac injury requiring treatment is:

A CXR

B serumCK-MB

C serumtroponin

D 12 leadECG

ETransthoracic Echocardiogram

Back 32

D

if unstable need TTE

Front 33

63. With regards to medical ethics, theconcept of fidelity involves:

A equitabledistribution of resources

B followinga professional code of conduct

C promotingwell being

D wise useof resources

Ewitholding of futile treatments

Back 33

B

maybe C

Front 34

What is thecorrect position for the tip of a PICC in a child

a) Carina

b) Belowright tracheobronchial angle

c) Aboveright heart border

d)Sternoclavicular junction

e) ??can't remember

Back 34

A

Front 35

Image of alateral C-spine Xray. Asked what the diagnosis was.

[Terribleimage quality. Seemed to have anterior atlantoodental interval >9mm.]

a)Atlantoaxial instability

b)Retropharyngeal haematoma (?or abscess)

c) Teardrop fracture

d)Epiglottitis

e) unilaterfacet joint dislocation

Back 35

A

Front 36

66. Repeat 2011 + 2012

Accordingto the ANZCA endorsed guidelines, what is the correct colour for the label fora subcutaneous ketamine infusion

a) Pink

b) Red

c) Beige

d) Blue

e) Yellow

Back 36

C

Beige: An infusion is colour coded based on it's route of administration.

Front 37

Prior tonasal intubation you spray Lignocaine/Phenylephrine preparation (CoPhenylcaine)into the nose. Some lands in the eye. What happens?

a)Ecchymosis

b) Myosis

c)Midriasis

d)Proptosis

e)Nistagmus

Back 37

C

Front 38

78. You trial anew drug to prevent PONV. It is 50% more effective than the current drug. Fourpercent of people still experience PONV with the new drug. How many people needto receive the new drug in place of the current drug to have one person lesssuffering from PONV?

a) 2

b) 8

c) 15

d) 25

e) 33

Back 38

D

Front 39

79. Repeat Aug12What does awhite cylinder with a Grey coloured shoulders/neck contain?

a) Medicalair

b) CarbonDioxide

c) Helium

d) Oxygen

e) Argon

Back 39

B

Front 40

The bestsolution to ensure asepsis prior to neuraxial anaesthesia is

A. 0.5%Chlorhexidine

B. 0.5%Chlorhexidine with 70% alcohol

C. 5% PovidineIodine

D. 5%Povidine Iodine with 70% alcohol

E. 10%Povidine Iodine

Back 40

B

PS28 recommends 0.5% chlorhexidine in alcohol

Front 41

You areanaesthetising a 25 year male for an open appendicectomy. He has a Fontanscirculation on a background of tricuspid atresia. The best strategy to managehis ventilation intraoperatively would be:

A. Ensureadequate PEEP

B. DecreaseInspiratory time

C. ShortenI:E Ratio from 1:3 to 1:1.2

D. IncreaseInspiratory time but with reduced inspiratory pressures

E. Ensureadequate spontaneous ventilation

Back 41

B -if ventilated

E- ?? best

D definitely said "with reduced inspiratory pressures", which could make it a contender for the answer. Thoughts?

Front 42

You areanaesthetising a 70 year old woman for CABG with a pulmonary artery catheter insitu. After separation from bypass you notice frank, copious blood rising inthe endotracheal tube. Your immediate action should be to:

A. CheckACT

B. Insert adouble lumen tube

C.Reinstate bypass

D.Administer protamine

E. Pullback the pulmonary artery catheter several centimetres

Back 42

C - ?unless full reversal of heparin otherwise the CPB will clot (devil and the deep blue sea scenario)

Front 43

Penetratinginjury to chest. What part of the heart most likely injured?

A. RV

B. LV

C. RCA

D. LA

E. RA

Back 43

A - RV = most anterior / exposed (from EMST)

Front 44

89. Repeat Aug13Generalanaesthesia is preferred for endoluminal stenting because:

A.Ischaemic renal pain

B.Prolonged periods of apnoea required

C.Painful aorta

D.Major risk of haemorrhage

E.Trash foot pain

Back 44

B

StupidMCQ. Answer could either be B or D depending on who you read. Breath-holds areshort according to most sources. "Patient comfort" due to prolongedprocedure would be best answer (CEACCP) but definitely wasn't an option. Manycentres do these under regional, so question reflects lack of research bywriter.

Front 45

90. PI81Whichvolatile agent has got minimum effect on ICP at 1 MAC

a)isoflurane

b)sevoflurane

c)desflurane

d)enflurane

e)halothane

Back 45

B

Sevo. Current Opinion in Anaesthesiology: October 2006 - Volume 19 - Issue 5 - p 504-508

Front 46

97. NewYouare inserting a right internal jugular vein CVL. Why is it important to avoidturning the patient's head extremely to the left?

a)Uncomfortable for the patient

b)Increases risk of internal carotid artery puncture

c)Compresses internal jugular vein and makes it more difficult to puncture

d)Distorts the anatomy, making the vein more difficult to correctly identify

e)Increases risk of external jugular vein puncture

Back 46

B - KS

C>D - RPA

Extreme extension of the neck and rotation of the head are avoided as these manoeuvres tend to collapse the vein. 07 No 1 Cannulation of central veins A&ICM.pdf The head should be slightly turned away from the side of cannulation for better access (excessive turning should be avoided as it changes the relationship of the vein and artery and can collapse the vein). 
TOTW 138

Front 47

Patient twohours after bilateral crush injuries to lower limbs. What would you expect tosee?

a)Hypocalcaemia

b)Hypokalaemia

c)Hypophosphataemia

d)Hypouricaemia

e)Metabolic alkalosis

Back 47

A

I remembered this is "which would you NOT expect to see", but I could be wrong.

CEACCP Compartment injury 6 No 4 Efflux of intracellular contents into the circulation follows myocyte injury. This can result in the rapid development of hyperkalaemia, hyperuricaemia and hyperphosphataemia. A metabolic acidosis develops in severe rhabdomyolysis secondary to lactic acid production from ischaemic muscle and the release of other organic acids. Hypocalcaemia is frequently recorded in early rhabdomyolysis owing to calcium accumulation in damaged muscle. During the recovery phase, hypercalcaemia can develop as a result of secondary hyperparathyroidism and the extrusion of calcium from recovering muscle cells.

Front 48

99. Delivery ofneonate. Meconium liqour. Baby floppy, blue, apnoeic, pulse rate 90bpm. What isthe next step in management?

a) CommencePPV

b) Suctionthe trachea

c) CommenceCPR

d) Dry andstimulate

e)

Back 48

B

Front 49

103. ?New, but certainly previousquestions on this theme.You inject10ml ropivicaine into a T5 paravertebral block. Patient becomes bradycardic,hypotensive and apnoeic. What is the cause.

A.Contralateral spread

B.Intrathecal spread

C.Inadvertent intravascular injection

D. Localanaesthetic toxicity

Back 49

B

Front 50

110. RepeatMedicaltherapy vs TAVI in inoperable patients. At 30 days, decreased risk of:

A

BMyocardial infarct

C Death

D Stroke

E Atrialfibrillation

Back 50

A ?

B same

C increased

D increased

E same

Only thing decreased at 30days from PARTNER trial was symptoms Definitely said DECREASED risk at 30 DAYS. No correct answer! Decreased risk of death at 1 year but not 30 days (although was probably still the answer they were looking for). Some people say AF is the answer, although there's of evidence that this isn't correct either (very high AF rates in both groups if continuously monitored). No correct answer, so good luck choosing!

Front 51

111. RepeatGlycineused during urology case. Osm is:

A.

B. 200

C. 250

D. 300

E

Back 51

B

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2980658/

The osmolality of 1.5% glycine is 230 mOsm/L(hypotonic) as compared to serum osmolality of 290 mOsm/L. Glycine is used because it is electrically non-conductive. This prevents dispersion of the diathermy current.

Front 52

112. NewVolatileanalysis in most anaesthetic machines is done via which method?

A Gaschromatography

B Infraredanalyser

C Raman spectrometry

D

E

Back 52

B - dragger use IR - best answer

?C

Front 53

114. NewWhat is nota constituent of Prothrombinex VF?

A.Antithrombin III

B. FactorII

C. Factor X

D. ProteinC

E. Heparin

Back 53

D

Factor VII definitely not an option MIMS; Factors II, IX, X antithrombin III, and a small amount of heparin.

Front 54

142. Repeat Aug09 q1250yo ladyfor elective laparoscopic cholecystectomy seen in PreAdmission Clinic. Nosymptoms of heart disease, walks her dog for 30 minutes each day. ECG [no image— described in words] shows LAD, RSR in V1, wide slurred S in V6 and QRSduration 0.13 msec. Your options:

A. Giveatropine premedication

B. Sheneeds a permanent pacemaker

C. Sheneeds temporary pacing wires

D. Continuewith the case

E. Refer tocardiology OP prior to doing the case

Back 54

D

Bifascular block LAD and RBBB OHA Preoperative management

1. First degree heart block in the absence of symptoms is common. No investigation or treatment is necessary is asymptomatic.

2. Second or third degree heart block may need pacemaker insertion. If surgery is urgent this may be achieved quickly by inserting a temporary transvenous wire prior to definitive insertion.

3. Bundle branch, bifascicular, or trifascicular block will rarely progress to complete heart block during anaesthesia and so it is not normal practice to insert pacing wire unless there have been episodes of syncope.

Indications for preoperative pacing

1. symptomatic first degree heart block

2. symptomatic second degree Mobitz I heart block

3. Second degree Mobitz II heart block

4. Third degree heart block

5. Symptomatic bifascicular block or symptomatic first degree heart block plus bifascicular block (trifascicular block)

6. Slow rate unresponsive to drugs

Front 55

143. Similar to TMP-Jul10-012, TMP-144, Apr08 q127You areperforming epidural anaesthesia on an adult patient. To minimize thechance of inserting the epidural catheter into a blood vessel you would:

A. Injectsaline through the epidural needle prior to threading the catheter

B. Performthe procedure with the patient lateral rather than sitting

C. Use aloss of resistance to air technique instead of loss of resistance to saline.

Back 55

A

Front 56

144. Repeat Mar13 q18Failedintubation. Difficult ventilation. Rescued with a Classic(R) LMA.Decide to use a bronchoscope to intubate down the LMA. Which device willallow you to intubate the patient safety?

A. Aintreecatheter

B. Airwayexchange catheter

C.Gumelastic bougie

D. Someangiogram wire I’ve never heard of!

E. Twopaediatric endotracheal tubes side-by-side

Back 56

A

Front 57

150. NewBlalock-Taussigshunt inserts into the right pulmonary artery, originating from the:

a) Rightsubclavian artery

b) IVC

c) SVC

d) Aorta

e) Axillaryartery

Back 57

A

Front 58

New. Time taken for insulin to reduce K+in hyperkalaemia

A. 2 mins

B. 4 mins

C. 10 mins

D. 20 mins

E. 30 mins

Back 58

D

A, B and C definitely those times. ?D was 20 mins or not.

LITFL 15mins

Front 59

Increasedrisk with eye block:

A:Peribulbar done medial canthus

B:Peribulbar done inferior-temporal

C:Sub-tenons

D: <45years age

E: Anotherclearly wrong

Back 59

B

Front 60

2/12 oldbaby. Initially on 30th centile and now on 5th. Murmur, systolic, loud at apex.Pulses are weak, "most easily felt at the femoral".

A: VSD

B:Co-arctation

C: Venoushum

D: PDA

Back 60

A

Front 61

Somediathermy pads have two separate electrodes on the patient pad, each with it'sown cable back to the machine. Why?

A: In caseone fails the other can serve as a back-up

B: One forcoag and one for cutting

C: Forbipolar? - worded slightly differently

D: Forcapacitance measurement - again wording not right

E: Forreturn electrode monitoring

Back 61

D

Front 62

Cisatracuriumleft out of fridge for 4 days. It’s efficacy is now:

A. 60%

B. 70%

C. 90%

D. 50%

E. 99%

Back 62

E

99% (can be left out of fridge for 21 days)

Front 63

In whichtype of von willebrand's disease is DDAVP contraindicated?

A. Type 1

B. Type 2a

C. Type 2b

D. Type 3

E. None ofthe aboveDose is0.3mcg/kg

Back 63

C - KSMC as can cause a transient thrombocytopenia

D - is unresponsive but not contraindicated

Front 64

This ECGwith AAI pacing shows:The12-lead ECG showed pacing spikes followed by p-waves, with QRS's following thep-waves with progressive prolongation of the PR until a QRS was dropped.

A. Failureto capture

B. CHB

C. 2nddegree HB

D. AF

Back 64

C. 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.

Front 65

The NAP4audit showed that the most common cause of airwayproblems/complications/disasters in INTENSIVE CARE is:

A.Aspiration

B.Dislodged tracheostomy tube

I reallycan't recall the exact wording or options, but it definitely specified "inthe intensive care unit"

Back 65

B

At least one in four major airwayevents in a hospital are likely to occur in ICU or the ED. The outcome of theseevents is particularly adverse. Analysis of the cases has identified repeatedgaps in care that include: poor identification of at-risk patients, poor orincomplete planning, inadequate provision of skilled staff and equipment tomanage these events successfully, delayed recognition of events, and failedrescue due to lack of or failure of interpretation of capnography. The projectfindings suggest avoidable deaths due to airway complications occur in ICU andthe ED.

Front 66

Repeat SF29dThe targetserum magnesium level in a patient with pre-eclampsia receiving a magnesiuminfusion is

A. 1-2mmol/l

B. 2-3.5mmol/l

C. 3-6mmol/l

D. 4-6mmol/l

E. 5-8mmol/l

Back 66

B

"I remembered C+D being an option for 4-5mmol/L just to make it more confusing..."

Front 67

Repeat TMP-Jul10-013Timing ofpeak respiratory depression after intrathecal 300 mcg morphine:

A. < 3.5hours

B. 3.5 –7.5 hours

C. 7 - 12.5hours

D. 12.5 -18hours

E. > 18hours

Back 67

B - 6hr

Front 68

New What part of a modernanaesthesia machine allows jet ventilation to be performed using the oxygenflush button?

A.Non-return valve downstream of the vaporisers

B.Pressure-limiting valve at the outlet

C.The presence of a common gas outlet

D.Presence of auxillary oxygen flowmeter

Back 68

A - KSMC

Exact wording and options not recalled, but A and B were certainly options, and I think A (non-return valve downstream of vaporiser) was the answer. Pretty sure D is actually the correct answer (least pressure drop across the flowmeter and essentially connected to wall O2 supply...) The question definitely specified "allows jet ventilation VIA THE OXYGEN FLUSH BUTTON", so D can't be the answer.

Front 69

Repeat Aug14Red-mansyndrome secondary to vancomycin is due to

A Type IIhypersensitivity reaction

BVasodilation

C Mast celldegranulation

D IgEimmediated response

E Serotoninrelease

Back 69

C

Front 70

NewPatientwith 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

Back 70

A

Front 71

Cryo"should be used within" or "must be used within" or"is most effective if used within" (can't recall exactly):

A 30minutes

B 3 hours

C 6 hours

Back 71

C - 4 hours was NOT an option"

Front 72

Designinga study on PONV. What is the advantage of designing a study incorporatingmultivariate analysis?

ALess type 1 error

BLess complex

CLess difficult to interpret

DLess confounding

EFewer patients required

Back 72

E

Front 73

NewBleedingintraopratively. TEG shown. What should be used to treat?

A TXA

B Platelets

C Cryo

D FFP

E

Back 73

A.

The image itself was useless because there was no normal reference to compare it to. However there were numerical figures at the bottom of the image, but difficult to read on the photocopied paper. Normal R, K, angle and MA vales. LY30 and LY60 were low, CL30 and CL60 high. It didn't take me long to Google the TEG image that ANZCA lifted for this question! I'm almost certain it was Figure 1B from: Pepperell 2014, "Clinical Application of Fibrinolytic Assays

Front 74

Repeat EZ96A size Coxygen cylinder (in New Zealand, "A") that reads 5000kpa containsapproximately how many litres of oxygen

a. 100

b. 150

c. 200

d. 350

e. 600

Back 74

B

Front 75

4-chamber TTEview. What lesion is present?

A. mitralregurgitation

Back 75

A

Image showed mitral regurg. Think the image was from this here (but was black-and-white of course)

Front 76

Appropriateinfection control measures when anaesthetising a patient with iatrogenicvariant-CJD, the airway equipment should be:

a. thrownaway

b. plasticsheath, reuse

c.sterilization with ethylene oxide


d. sterilizationwith heat at 134 degrees for 3 minutes.

e.autoclave

Back 76

A.

Can't recall the exact answers, but have copied them across from previous recalled version of this MCQ.

Front 77

A varienton the theme of the previous question referring to PS9. Minimum requirements toprovide sedation. This time asked who is necessary to provide conscioussedation, using propofol.

A. medicalpractitioner trained in use of propofol

B. medicalpractitioner trained in use of propofol + their assistant

Back 77

B

Front 78

Intubation view:Little space between epiglottis and posterior pharyngeal wall. What is themodified C&L classification?

A 2A

B 2B

C 3A

D 3B

E 4

Back 78

C

Front 79

Whatfeature most increases vasospasm in setting of SAH?

A. Size ofaneurysm

B. Age ofpatient

C. Positionof Aneurysm

D. largeamount of blood on CT

E. GCS onarrival to ED

Back 79

D

Front 80

Lineisolation monitor alarming at 5ma – what do to?

A.Disconnect non essential equipment 1 by 1 to identify fault

B. Ignoreit

Back 80

A

Front 81

Maintenancefluid rate in 15kg child – mls/hr

A. 40mls/hr

B. 50mls/hr

C. 90mls/hr

D.300mls/hr

Back 81

B

Front 82

"Hypothermiamakes bleeding in trauma worse because..."

A. Reducedplatelet function AND Number

B. Reducedactivity of clotting factors

Back 82

B

main thing to increase bleeding (can't remember other options but one about platelets definitely said function AND number...) hypothermia reduces function of plt and function of clotting factors

Front 83

Mosteffective (?quickest) way to reduce serum K+ level in hyperkalaemia 8.0meq/L?

A. Calciumgluconate

B. Resonium

C.Salbutamol NEB

D. 15 unitsactrapid and 50 mls of 50% Dextrose

E. Sodiumbicarbonate ?50mmol

Back 83

D - KSMC LIFL

Definitely said to reduce serum or plasma levels, so calcium not the answer.

Front 84

ECG rhythmstrip. Showed regular pacing spike followed by wide QRS complexes. But oncethere is a narrow QRS occurring without a pacing spike, followed shortly-afterby a pacing spike but no capture.

What doesECG show?

A. AAI withfailure to capture

B. AAI withfailure to sense

C

D. VVI withfailure to capture

E. VVI withfailure to sense

Back 84

?

VVI with failure to sense, I think is the answer. The narrow QRS complex was an intrinsic beat, but the pacer didn't sense so paced shortly after at its regular interval. The myocardium was still refractory so there was no capture, but failure to sense was the original problem.

Front 85

Repeat SC31Relativecontraindications to mediastinoscopy include

A.Cervical spondylosis

B.Emphysema

C.Mediastinal lymphadenopathy

D.Poor left ventricular function

E.Superior vena cava syndrome

Back 85

E

A and E were definitely options. I am assuming B, C and D were the same options as previously asked, but can't recall so I could be wrong.

Front 86

How shouldyou dose suxamethonium for intubation in an obese patient?

a) Leanbody weight

b) Idealbody weight

c) Idealbody weight + 25%

d) Actualbody weight

e) Actualbody weight + 25%

Back 86

D

Front 87

Repeat AB55 Time to onset of TRALIwith transfusion?

a)2 hours

b)4 hours

c)12 hours

d)24 hours

e)48 hours

Back 87

A - RPA

B - KS

P Kam article “during or within 6hours”

Front 88

Repeat Apr08 Mar11 When performingregional anaesthesia for eye surgery, needle damage to the globe of the eye ismore common with:

A. a globeaxial length of less than 25 mm

B. patientsaged less than 45 years

C.peribulbar block using the inferotemporal approach

D.peribulbar block using the medial canthus approach

E.sub-Tenon block

Back 88

C

Front 89

?Repeat Sep 11 ?MB38

Best method to assessreversal 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... ?

Back 89

D - RPA

E - KS

Front 90

Repeat PP93 The Neonatal Facial Coding Scale (NFCS), usedto assess pain in neonates, includes all of the following EXCEPT

A. browbulge

B. chinquiver

C. closedmouth

D. deepnasolabial fold

E. eyessqueezed shut

Back 90

C

p345 3rd ed ANZCA Pain: Scientific evidence Facial actions monitored:

(1) brow lowering (lowering and drawing together of the brow can result in brow bulge)

(2) eyes squeezed shut

(3) deepening of the naso-labial furrow (fold)

(4) open lips (any separation of the lips is an occurrence)

(5) vertical mouth stretch

(6) horizontal mouth stretch

(7) taut tongue (cupping of the tongue)

(8) chin quiver (high frequency vibration of the chin and lower jaw)

(9) lip pursing (tightening the muscles around the lips to form an "oo") In addition a tenth activity was monitored in preterm infants:

(10) tongue protrusion (this is a "no pain" response in full term infants)

Front 91

What is thebest measure of the anticoagulant effect of Dabigatran?

A. APTT

B. Dilutethrombin time

C.Prothrombin time

D. Bleedingtime

E. TEG

Back 91

B

Front 92

Repeat Aug14Small airbubbles in the arterial line system will ALWAYS REDUCE the

A.Dampening coefficient

B.Extrinsic Coefficient

C. Measuredsystolic pressure

D. MeasuredMAP

E. Resonantfrequency

Back 92

E

Front 93

Repeat Mar12 Aug14A patientundergoing liver surgery has a venous air embolism, what is the mostappropriate position to place them in:

a. Reversetrendelenburg, right side up

b. Reversetrendelenburg left side up

c. Reversetrendelenburg, neutral

d.Trendelenburg right side up

e.Trendeleburg left side up

Back 93

D

Front 94

Repeat Mar11Duringinterscalene block placement get medial movement of the scapula. This issecondary to stimulation of:

A: longthoracic nerve

B: dorsalscapula nerve

C:suprascapular nerve

D:supraclavicular nerve

E:accessory nerve

Back 94

B

Front 95

Repeat Aug14Blueurticaria is a complication of

A

B Methyleneblue

C Patentblue V

DAnaphylaxis

E

Back 95

C

Front 96

Repeat RH35Subtenon’sblock. What is the BEST position to insert block?

A.Inferonasal

B.Inferotemporal

C.Superonasal

D.Superotemporal

E. Medial /canthal

Back 96

A

?worst followed by Superonasal is vascular and the next worst insertion

Front 97

Repeat Mar13 Aug13Mostcephalic interspace in neonate to perform spinal while minimising thepossibility of spinal cord puncture

A. L1-L2

B. L2-L3

C. L3-L4

D. L4-L5

E. L5-S1

Back 97

D

Front 98

Withrespect to a patient with Multiple sclerosis, which of the following alters therisk of a flair post partum

a) AnEpidural

b) A spinal

c) A flairin the year pre-partum

d) Ageneral anaesthetic

e) Breastfeeding

Back 98

C

I'm pretty sure the stem said "alters the risk", i.e. the correct answer could be something which either increases or decreases the risk. Although someone else remembered it as "increases" the risk.

Front 99

Repeat Mar14 125Adenosinecan be used to terminate an arrhythmia due to:

A. Atrialfibrillation

B. Atrialflutter

C. WPW

D. ??VT

E. ??Torsafes

Back 99

C

Definitely said "terminate" the arrhythmia, so the only possible answer I think can be WPW. In AF/flutter it may help diagnose, but not terminate. Adenosine is considered safe in ORTHODROMIC SVT in WPW by some authors (but not all) -- may have increased risk but is still the best answer. Never use adenosine in antidromic SVT though!!

Front 100

Repeat Aug12Mast celltryptase half life:

A. 1 hours

B. 3 hours

C. 6 hours

D. 12 hours

Back 100

A

CEACCP 2014 -- 2 hours, but was not an option.

Front 101

Bestindicator of Severe pulm HT:

A. mean PApressure 45mmHg

B. orthopnoeaPND

C. ex tol lessthan 4 mets

D. fev1, ...

Back 101

C

Front 102

Repeat Sep11Youngpregnant patient with mild mitral regurgitation and moderate mitral stenosis,normal LV function. The best delivery method:

A. Epiduralanaesthesia LSCS

B. Spinalwith LSCS

C. Epiduralanalgesia and normal vaginal delivery

D. GA LSCS

E. Normalvaginal delivery with remifentanil PCA

Back 102

C

Front 103

Repeat Contained one of the following StJohn wort questions from Mar13 or Aug13. Can't remember which one!
St John'sWort (Hypericum perforatum) potentiates the effects of

A.Dabigatran

B. Heparin

C. Warfarin

D. Aspirin

E.Clopidogrel

Back 103

E

Front 104

St John'swort will reduce the effect of

A. aspirin

B.clopidogrel

C.dabigatran

D. heparin

E. warfarin

Back 104

E

Note — two very similar but different questions!! St. John's wort: - decreases effectiveness of digoxin, antihistamines, immunosuppressants, warfarin, anticonvulsants - potentiates sedatives, clopidogrel, antidepressants

Front 105

?New, but based on MH597/7 postlaparotomy platelet down to 40, no bleeding or bruising, but has painfulswollen lower leg, most appropriate tx?

A. Fondaparinux,

B. lepirudin,

C. IV heparin,

D. clexane,

E. warfarin

Back 105

A

Front 106

?Repeat -- similar to Mar13 Q113/Aug13 Type1 diabetes fasting since 2200, insulin infusion commenced 0700, BSL 7, what isMOA of insulin?

A. Skeletaluptake

B. liveruptake

C. inhibglucagon (release)

D. inhibglycogenolysis

Back 106

C - KS

D - RPA

Front 107

Repeat Mar14A threeyear old girl for an elective hernia repair is seen immediately prior tosurgery. It is revealed she had 100mL of apple juice 2 hours ago. The bestcourse of action is to:

A. Postponesurgery for 2 hours

B. Postponesurgery for 4 hours

C. Postponesurgery for 6 hours

D. Cancelsurgery

E. Continuewith surgery

Back 107

E

Front 108

Acuteintermittent porphyria, signs except:

A. abdominalpain

B. hypotension

C. confusion

D. tachycardia

E. peripheralneuropathy

Back 108

B

Front 109

Audit indepartment of prevalence of acute myocardial ischaemia in vascular surgery.What type of data is this?

A. Nominal

B. Ordinal

C. Categorical

D. non-parametric

E. numerical

Back 109

C - KSMC Probably true but best is probably binary ie yes or no

Front 110

Preopclinic carotid endarterectomy asks about GA vs LA, you tell her:

A. GA andLA has similar risk of stroke

B. GA hasslightly increased risk of stroke than LA

C. LA hasslightly increased risk of stroke than GA

D. GA hassignificantly increased risk of stroke than LA

E. LA hassignificantly increased stroke than GA

Back 110

A

Front 111

Thresholdfor micro shock:

A. 1uA

B. 10uA

C. 1mA

D. 5mA

E. 10mA

Back 111

B

Front 112

Asystolicarrest adrenaline just given, how often do you give adrenaline?

Back 112

Note, question asked about the asystole, i.e. the non-shockable side of the ALS algorithm. Every 2 cycles (4mins)

Front 113

Hepatictumour resection, purpose of reducing CVP?

Back 113

Reduce venous bleeding

Front 114

TMP-Jul10-035 Child-Pugh score. Components ?

A. Bilirubin / albumen / INR (yes INR, not PT),ascites, encephalopathy

B. Variousother options including AST/ALT, GGT, PT

C. ?

D. ?

E. ?

Back 114

A

Front 115

Repeat Aug14Laser flextube with double cuffs - how to inflate cuff(s)?

A Inflateproximal then distal

B Inflatedistal then proximal

C ?Inflate both with saline?

D Inflatedistal only

E Inflateproximal only

Back 115

E

In the product information says inflate distal..?

Front 116

?Repeat or at least similar to MC118Patientwith HOCM has HR 60, SBP 70 post induction, what to do:

A. givevolume

B. adrenaline

C. metaraminol

D. ?beta-blocker

Back 116

C

Front 117

NewThefollowing changes occur in aging except:increasedCSF volume, ...

Back 117

-

Front 118

Repeat Aug12 97Paediatricparacetamol loading dose PR mg/kg:

A. 7.5

B. 10

C. 15

D. 20...

Back 118

D

20mg/kg was highest dose option available

Front 119

?Repeat of Mar14 q108Postpartumpost epidural with peripheral neurology.

Back 119

Answer in this case was probably lumbosacral plexus palsy, but be warned there are many variations on this type question with different answer depending on the neurology description.

Front 120

?New Question not recalled, but the keypoint was:Posteriorcord of brachial plexus --> weakness of wrist extension

Back 120

-

Front 121

(New) (with variation to answers – oldversion included below) (2014.2) (2012.1) Endocarditis prophylaxis

ABicuspid valve

BCongenital repair > 12 months ago

CRheumatic heart valve

DUncorrected cyanotic heart disease

EMVP + ?MR

Back 121

D

Front 122

(New) Variation of sugammadex question.1mg/kg rocuronium given in 70kg patient. Now CICO. What is the total dose ofsugammadex that you will give?

Back 122

70x16=1120mg

Front 123

(New) Max size vessel for CVC insertion

(New) Why don’t you turn head too much inawake pt for CVC insertion?

(New) How do you prevent breath stakingin COPD

(New) Biggest risk factor for vasospasmpost SAH?

(New) CVC just inserted into patient. LIMthen goes off. What do you do?

(New) Pneumoperitoneum created, sinusbrady down to 20BPM. What to do?

(New) Cell salvage results in less what?

Back 123

-

Front 124

(Repeat) (2014.2) Tavi vs Max medicaltherapy nonoperable aortic stenosis reduction in risk at 30 days of

A.AMI

B.AKI

C.Death

D.Atrial fibrillation

E.Stroke

Back 124

C

Front 125

(Repeat) (2013.2) 6 week old baby is bookedfor elective right inguinal hernia repair. An appropriate fasting time is

A.2 hours for breast milk

B.4 hours for formula

C.5 hours for breast milk or formula

D.6 hours for solids

E.8 hours for solids, 4 hours for all fluids.

Back 125

D - KSMC assuming 6 weeks and older category

Front 126

(Repeat) (2014.1) (New) The size (in Frenchgauge) of the largest suction catheter which can be passed through a size 8endotracheal tube which will take up not greater than half the internaldiameter is size:

A.6

B.8

C.10

D.12

E.14

Back 126

D

Front 127

(Repeat) (10-March-Bank) (10-August-Bank) 70year old post TKJR. On sub-cut heparin. Develops clinical DVT and platelets 40.Management▪

A.Enoxaparin

B.Fondoparinux

C.Heparin by infusion

D.Lepirudin

E.Warfarin

Back 127

B

Front 128

(Repeat) (2013.2) A 20 year old man waspunched in the throat 3 hours ago at a party. He is now complaining of severepain, difficulty swallowing, has a hoarse voice and had has some haemoptysis.What is your next step in his management?▪

A.Awake Fibreoptic Intubation

B.CT scan for laryngeal fractures

C.Direct laryngoscopy after topicalising with local anaesthetic

D.Nasopharyngoscopy by an ENT surgeon

E.Soft tissue xray of the neck

Back 128

D

Front 129

(Repeat) (2012.1) What gestation to monitoruteroplacental flow in lady having coiling?

A20 weeks

B24 weeks

C28 weeks

D32 weeks

E36 weeks

Back 129

B

Front 130

(Repeat) A nulliparous woman in labour for 8hours with epidural analgesia has a fever 37.6 degrees. The most likely reasonfor this is

A.altered thermoregulation

B.chorioamnionitis

C.urinary tract infection

D.inflammatory response

E.neuraxial infection

Back 130

D

Front 131

(Repeat) What is not an element of ChildPugh score?

a.GGT

b.Albumin

c.Bilirubin

d.INR

e.Encephalopathy

Back 131

A