Anzca Final Mcqs Aug 2012

Front 1

Half-life of mast cell tryptase?

A. 1 hour

B. 2 hours

Back 1

B

Half life of 2 hours with peak at 15-60mins

Front 2

Best single predictor of difficult intubation in obese patient?

A. Mallampati score

B. Interincisor distance

C. Severe OSA

Back 2

C

Predictors:

OSA, neck circumference, pre-tracheal soft tissue

Front 3

Best aspiration prophylaxis for urgent surgery?

A. Na Citrate

B. Ranitidine

C. Omeprazole

D. Metoclopramide

E. Cisapride

Back 3

A

Front 4

Most common cause of mortality post transfusion?

A. TRALI

B. Contamination/infection

C. Mismatched blood

D. GvHD

E. Anaphylaxis

Back 4

A

Front 5

Most common cause of awareness?

Back 5

A. Failure to check apparatus

Front 6

Apnoeic oxygenation in obese patients is best aided by?

A. Sniffing position

B. Head up tilt

Back 6

B

Ramped position improves laryngoscopy

Front 7

Best renal protection for endoluminal AAA repair?

A. NaCl

B. NAC

Back 7

A

IV volume expansion = reduced of failure

No evidence for NAC

Front 8

White cylinder with grey shoulder?

A. CO2

B. Air

C. O2

D. N2O

E. N2

Back 8

A

Air = white body with black and white shoulder

O2 = white

N2O = white body with blue shoulder

Front 9

Photograph of an Arndt endobronchial blocker. Orifice labelled 'X'. What goes in 'X'?

A. Bronchoscope

Back 9

A

Front 10

Indicator in sodalime?

A. Ethyl violet

B. Potassium permangenate

C. Blue ?

D. ?

E. ?

Back 10

A

Front 11

Desflurane vaporiser heated because:

A. High SVP

Back 11

A

Front 12

What is NOT a disadvantage of drawover vaporizer?

A. Basic temperature compensation

B. Basic flow compensation

Back 12

Both disadvantages

Advantage = ?cannot use sevo for gas induction as need 2 in series to achieve the required concentration

Front 13

FOB - can see a trifurcation. Where are you?

A. RUL

B. Lingula

C. LUL

D. RML

E. RLL

Back 13

A.

All bifurcations except RUL

Front 14

A Full Size C oxygen cylinder has pressure downregulated from?

A. 16,000 kPa to 400 kPa

B. 16,000 kPa to 240 kPa

C. 11,000 kPa to 400 kPa

D. 11,000 kPa to 240 kPa

Back 14

A

Front 15

Intubating over a bougie. Rotate ETT?

A. 90 degrees anticlockwise

B. 90 degrees clockwise

C. 180 degrees anticlockwise

D. 180 degrees clockwise

Back 15

A

Front 16

Air bubble leads to decreased:

A. Damping coefficient

B. Resonant frequency

Back 16

B

Front 17

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

A. 1.5 cm2

B. 1.0 cm2

Back 17

B

<1cm = critical stenosis

Front 18

New: With regard to Digoxin toxicity which of the following is NOT a feature?

A. Atrial flutter

Back 18

Changes with dig toxicity:

SVT (inc automaticity) with slow VR (dec AV conduction)

VEBs and bigeminy

Sinus brady or slow AF

Any type of AV block

VT

ST dep

TWI in V5-6

Prolonged PR

Short QT

Front 19

Rpt: What is not associated with ulcerative colitis?

A. Psoriasis

B. Cirrhosis

C. Arthritis

D. Sclerosing cholangitis

E. Iritis

Back 19

A

Front 20

75 yo non-valvular AF. Off warfarin. What is his daily risk of stroke?

A. 0.01%

Back 20

A

5% per year/365

Front 21

ECG - Which does NOT have abnormal Q waves?

A. Digoxin toxicity

B. WPW

C. Anterior MI

D. Previous MI

Back 21

A

Front 22

cTnI remains elevated for up to?

A. 5-14 days

Back 22

A

6-10 days

Peak 12-16hrs

Elevated for 2 weeks

Front 23

Inverted PW's in lead II may be caused by?

A. Junctional rhythm

Back 23

?A

RPA notes: Lead misplacement, retrograde P waves in junctional rhythm usually during or after the QRS

Front 24

Hb 80 g/L with reticulocyte 10%:

A. Hereditary spherocytosis

Back 24

A

Front 25

Pulsus paradoxus in constrictive pericarditis:

A. Decreased BP with inspiration

B. Decreased BP with inspiration greater than normal

Back 25

B (> 10mmHg drop)

Normal = <10mmHg drop with inspiration

Front 26

Cause of visual loss in spinal surgery?

A. Optic ischaemia

B. Compression of eye

Back 26

A

ischaemic optic neuropathy = most frequent cause of blindness

arterial hypotension + inc venous/intra ocular congestion = inc resistance to flow and red O2 delivery.

Pressure on eye > arterial pressure = ischaemia

Front 27

Which type of aortic dissection is typically managed non-operatively?

A. Debakey Type I

B. Debakey Type II

C. Stanford A

D. Stanford B

E. Stanford C

Back 27

D

Front 28

Absolute CI to the sitting position in neurosurgical patient?

A. Patent VA shunt

B. Small PFO

C. Pacemaker

D. Small patent foramen ovale

E. Oesophageal stricture contraindicated for transoesophageal echocardiogram

Back 28

A

Risk of air embolism

(Has to be a large PFO)

Front 29

When do most patients with SAH rebleed?

A. 0-24 hours

Back 29

A

Peak incidence is first day after SAH

With 1.5% inc per day for the next 4/52

Occurs in 20% patient

Front 30

Unstable patient. Suspect aortic dissection. Most appropriate investigation?

A. TOE

B. MRI

Back 30

A

Front 31

Contraindication to IABP?

A. AR

Back 31

A

Absolute CI: AR, Aortic dissection, Severe aorto-iliac occlusive disease

Relative: prosthetic grafts in aorta, aortic aneurysm, sepsis

Front 32

Prolonged trendelenberg position results in?

A. Increased myocardial work

Back 32

A

Front 33

Scoliosis surgery. Which tract is being monitored with SSEPs?

A. Dorsal column

Back 33

A. sensory column

Front 34

Estimate GCS post head-trauma.

E - Response to pain

V - Mumbling incoherently

M - Withdraws to pain (attempted IV cannulation)

A. 8

B. 9

Back 34

A

E2M4V2

Front 35

Incidence of headache in first week post-partum?

A. 38%

Back 35

A

Front 36

Oxycodone 20mg SR / Naloxone 20 mcg:

A. Decreased constipation

B. Reduced risk of drug misuse/abuse

Back 36

A

Front 37

Bowel surgery patient. Best method for intraoperative optimization of fluid therapy?

A. Arterial pulse pressure contour analysis

B. CVP

C. PAOP

D. UO

Back 37

A

Front 38

In what proportion of people is the AV node supplied by the R coronary artery?

Back 38

Right dominant 80%:

RCA --> post intraventricular art --> AV node

Left dominant 20%:

Left circumflex

Other sources say 85-90%

Front 39

Less blood wastage if:

A. Lower transfusion threshold

Back 39

restrictive transfusion strategies are assoc with red transfusion rates and volumes

Front 40

How long prior to a spinal anaesthetic should dabigatran be ceased?

A. 7 days

Back 40

A. 5days

ASRA guidelines

Restart 6hours after spinal or removal of catheter

QLD Guidelines -

CrCl>80 --> 2 days,

CrCl 50-80 --> 3 days,

CrCl 30-50v--> 4 days

NB. Apix/Rivaraox (DFXa inhib) - similar periop Rx as dabig (similar drug, but with less renal elim 20-30%)

Dabig: peak effect 2-3 h, EHL12-14h, 80% renal elimination

Discontinue 1-2 days prior to surg, 3-5 if CKD (CrCl<50ml/min. Longer (5-7 days) AND check APTT or TT if major surgery, spinal puncture, need for complete haemostasis

Should not be restarted within 24h of spinal / removal of epidural catheter

Front 41

Day 4 epidural. On 40 mg SC enoxeparin daily postoperatively (8 pm). When is the most appropriate time to remove the epidural?

A. Day 5 at 12 midday

B. Day 5 at 6 am

C. Day 5 at 6 pm

D. Day 6 at ?

Back 41

POW = A

RNS = A

RPA = A or B

LVP = B

B - international guidelines say 10-12

At RPA it would be 20hr post LMWH

CEACCP 2012 RA and antithrombs:

Proph LMWH - 12h before CNB, 2-4hrs after

Therap LMWH - 24h before CNB, 2-4h after

Therap UFH - discontinue 2-4h before (short t1/2), 1h after

Proph UFH - 4-6h before, 1h after

Front 42

What drug should NOT be used for tocolysis in 32/40 female?

A. Indomethacin

B. Magnesium

C. Nifedipine

D. Salbutamol

Back 42

A

Front 43

Following an eclamptic seizure the dose of MgSO4 is?

A. 1 gram

B. 4 grams

Back 43

B

and then 1-2g/hr

Front 44

At what gestation should intraoperative monitoring of the fetus occur?

A. 20/40 weeks.

Back 44

?

when viable = 24 weeks

Front 45

Trauma patient. CXR (not given): air fluid levels adjacent to heart/diaphragm/ribs.

A. Ruptured diaphragm

B. Hiatus hernia

Back 45

A

Front 46

Endocarditis prophylaxis in patient with MVR appropriate for?

A. Dental procedure ?which

B. Rigid bronchoscopy

C. Upper endoscopy with biopsy

D. D&C

E. Lithotripsy

Back 46

E

Front 47

Photograph of TOE transgastric SAX image of LV. Which artery supplies [anterior wall of LV arrowed] region?

A. LAD

B. RCA

C. PDA

D. LCx

Back 47

A

Front 48

A 20kilogram child suffered 15% full thickness burns 6 hours ago. Optimumcrystalloid resuscitation for the first hour is:

A. 160ml

B. 260ml

C. 360ml

D. 460ml

E. 660ml

Back 48

C.

Parkland Formula 20kg x 15%TBSA x 4mL = 1200mL in the first 24 hours

(1/2 in first 8 hours, 1/2 in next 16 hours)

So, 600mL in the first 8 hours SINCE TIME OF BURN. i.e. over the next 2 hours. =300mL/hr

Plus maintenance (4/2/1 rule) =60mL/hr TOTAL = 360mL/hr in the first hour.

Front 49

Incarcerated inguinal hernia in a child with a mild URTI. Most appropriate course of action?

A. Postpone for 2 weeks

B. Continue without ETT

C. Continue with careful monitoring

Back 49

C

Front 50

Congenital prolonged QT syndrome treated with propranolol. How do you confirm an adequate response?

A. HR <60 /min

B. Decreased QT interval in response to a valsalva manoeuvre

C. Normal QT interval

Back 50

B

Front 51

Meconium stained liquour but neonate delivered is vigorous. Rationale for NOT suctioning the neonate?

A. May aspirate meconium

B. May cause bradycardia

C. May cause hypertension

Back 51

B

Front 52

Patient with subdural hematoma and PPM for ?AV ablation. PPM technician >1 hour away. Surgeon wishes to proceed immediately. Do you?

A. Postpone and await a cardiologist review

B. Postpone and await arrival of PPM technician

C. Postpone and insert a transvenous temporary PM

D. Proceed after institution of transcutaneous pacing

E. Proceed with a magnet handy.

Back 52

RNS and RPA = E

Front 53

Which of the following does NOT occur following bilateral lung transplant?

A. Impaired mucociliary clearance

B. Impaired lymphatic drainage

C. Impaired HPV

Back 53

C

Front 54

The thoracodorsal nerve arises from

A. A Medial cord of brachialplexus

B. Lateral cord of brachialplexus

C.Posterior cord of brachial plexus

D. Dorsal scapular nerve

E. Long thoracic nerve

Back 54

C

Front 55

Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?

A. Medial brachial cutanous nerve

Back 55

A.

Medial ANTEbrachial cutaneous nerve, which is branch of medial cord.

Front 56

Buprenorphine patch taken off. Time taken for plasma concentration to halve?

Back 56

12hours

RNSH

- Norspan product info = bup. conc fall approx 50% in 12 hours.

- Elimination half life 24-37hrs

RPA

- Half life of transdermal patch is 26hours while insitu, but 12 hours half life after removing

POW

- MIMS = plasma half life of bup. = 12hrs

- CEACCP 2005: offset after patch removal is slower dueto the high affinity of buprenorphine for opioid receptors. Patients withsevere side-effects should be observed for 30 h after removal of thepatch.

- http://www.butransrems.com. After removal of Butrans, the mean buprenorphineconcentrations decrease approximately 50% in 12 hours (range 10-24 hours) withan apparent terminal half-life of approximately 26 hours.

Front 57

Incidence of fat embolism following closed femoral fracture?

A. 0-3%

B. 4-7%

C. 8-11%

D. 12-15%

E. 16-19%

Back 57

A.

RNSH - 0-3%

POW - 1-2% for 1 bone up to 33% for multiple fractures

RPA 1-3%

Front 58

Appropriate postoperative maintenance fluid in a child [can't recall situation, but something to do with head injury]:

A. 3% and 1/3 NS

B. 1/2 NS

C. Normal Saline

D. Hartmanns

E. Hartmanns with glucose

Back 58

C.

Kerry adds - RCH says: Use 0.9% NaCl (normal saline) plus dextrose as 'maintenance fluid' for any child who has:A brain injury of any sort (meningitis, encephalitis, trauma, febrile convulsion).

Boluses: NS

Maintenance: 0.45% + 1/5 (or 0.9% + 1/5)

Front 59

Which is a specific PDE inhibitor?

A. Theophylline

B. Dipyridimole

C. Milrinone

Back 59

C.

Milrinone - PDE3

Theophylline - non-selective

Front 60

Maximum dose of local infiltration of 0.5% bupivacaine in an x kg child?

Back 60

A. [dose corresponding to 2.5 mg/kg; there was no option corresponding to 2 mg/kg]

RPA = A - but pick 2mg/kg if available

RNSH = 3mg/kg

Front 61

Loading dose of IV paracetamol in x kg child?

Back 61

A. ?[dose corresponding to 20 mg/kg]

FRAC article:

Oral = 20mg/kg

IV loading = 15mg/kg

Rectal 30mg/kg

dose for neonates <10 kg is 7.5mg/kg

Front 62

Performing a caudal block in a child. What is the first sign of a total spinal anaesthetic?

A. Hypotension

B. Bradycardia

C. Desaturation

D. Tachycardia

E. Loss of consciousness

Back 62

C.

RPA = There is an Update in Anaesthesia article saying hypotension is uncommon in spinals in children under 5 and respiratory depression more commonly seen!

Front 63

Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?

A. Sedation

B. Urinary retention

Back 63

A

POW = CEACCP 2006: Clonidine 1–2 µg kg−1 and ketamine 0.5–1 mg kg−1increase the duration of analgesia by ∼5–10 h when combined with bupivacaine 0.1–0.25% or ropivacaine 0.08–0.2%.4 The combination of S+ ketamine and clonidine isreported to provide satisfactory analgesia for up to 20 h. Both agents, at a higher dose, are associated with a greater risk of sedation, apnoea (particularly neonates and infants) or nausea.

Front 64

New onset AF. For what period of time is it safe to perform DCCV without prior TOE to exclude thrombus?

A. <24 hours

B. <48 hours

Back 64

B.

Front 65

Regarding remifentanil. All of the following are true EXCEPT:

Back 65

A. Metabolized by plasma cholinesterase = false

RNSH = non-specific tissue and plasma esterase's

POW = non-specific plasma esterase's

RPA = Metabolised by red cell esterase? Esmolol?

Front 66

Off-label use of a drug refers to all of the following EXCEPT:

A. Different age-group

B. Different indication

C. Different concentration

D. Different route of administration

Back 66

C

NSW health discussion paper: Age, indication, dose or frequency, route of administration, formulation.

"‘Off-label’ prescribing occurs when a drug is prescribed for an indication, a route of administration, or a patient group that is not included in the approved product information document for that drug.” Day 2013 "Off-label prescribing" Australian Prescriber.--Farnsworth 09:24, 8 June 2014 (CDT)

Front 67

Regarding mixed venous oxygen saturations:

A. 60% is normal

B. Can be used to calculate the CO

Back 67

B.

Normal SvO2 = 65-75%

Fick equation: CO = VO2 / a-v O2

Front 68

Cerebral oximetry measures?

A. Arterial saturation

B. Mostly arterial saturation and some venous saturation

C. Capillary saturation

D. Mostly venous saturation and some arterial saturation

E. Venous saturation

Back 68

D.

Venous saturation = 70-75%

Arterial = 30-25%

Front 69

Normal systolic BP at birth?

A. Something less than 70 mmHg

B. 70 mmHg

C. 85 mmHg

D. Something more than 85 mmHg

E. 115 mmHg

Back 69

B.

70-80mmHg

Front 70

Epidural block to T2 causes all of the following EXCEPT:

A. Bradycardia

B. Vasodilatation

C. Reduced circulating catecholamines

D. Dyspnoea

E. Elevated PaCO2

Back 70

E

POW = Thoracic epidural provides thoracic sympathectomy and blockade of cardiac plexus T1-T4 with resultant hypotension, bradycardia and reduction in catecholamines. Dyspnoea is a subjective feeling from blockade of intercostal muscles, however an increase in PCO2 does not occur as adequate ventilation is maintained by the intact function of the diaphragm

Front 71

Preoperative autologous blood donation results in less:

A. Cost

B. Incompatible transfusion

C. Less blood wastage

D. Less unnecessary transfusion

Back 71

B

Front 72

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

A. RV

B. LV

C. RCA

Back 72

A.

RV: 43% LV: 33% RA: 14% LA: 5%

Front 73

TMP-Jul10-056

Regarding a Thallium scan:

A. High NPV

B. Less useful in comparison to a DSE

Back 73

A.

Front 74

What is NOT a contraindication to MRI?

A. Pulmonary artery catheter

B. Arterial line

C. Scissors

D. Coiled ECG cable

E. Laryngoscope

Back 74

B

Front 75

Skin between iliac crest and greater trochanter supplied by?

Back 75

A. Subcostal nerve

RPA = A (T12)

RNSH =

iliohypogastric - suprapubic skin

ilioinguinal - scrotum and upper thigh

Front 76

Regarding pyloric stenosis:

A. More common in females

B. Occurs most commonly in [some incorrect age group]

C. Acidic urine

D. Cause of hypokalemia is vomiting

Back 76

C.

More common in males

Usually occurs in 2nd to 6th week of life

Urine: initially alkaline urine to maintain serum pH, then acidic urine with depletion of electrolytes and hypovolaemia --> conserve Na+ and excrete H+

Hypokalaemia --> due to renal losses to maintain Na+

Front 77

In comparison to Mallampati test, the TMD is:

Back 77

A. Less sensitive, more specific

RNSH

- mallampati - poor sensitivity 49% and moderate specificity 80%

- TMD sensitivity 20% and specificity 94%

Front 78

Systematic review. What is NOT a weakness?

A. Systematic review author bias

B. Publication bias

C. Duplicate publication

D. Heterogeneity

E. Inclusion of historic studies

Back 78

A.

In using a rigorous process to determine what types of studies will be included in a systematic review, author bias is usually eliminated, andgreater credibilitycan be placed in the findings from the review.

?but what about the author of the systematic review and their bias?

Front 79

Traumatic liver laceration. Conservative management is indicated if?

Back 79

A. Haemodynamically stable

Front 80

Initial dose of IV GTN to relax the uterus is?

A. 5 mcg

B. 50 mcg

C. 200 mcg

Back 80

B.

RHW: Diluteinto 50mcg/ml. Give 1ml every 1-2 mins as needed up to a maximum of 10mls.

Front 81

Dilated CM (LVEF 30%). No dyspnoea with ADLs. Best management?

A. Start ACEI

B. Stop beta-blocker

Back 81

A.

Front 82

CTG [pictured] demonstrating late decelerations. Most likely cause?

A. Fetal asphyxia

B. Head compression

C. Cord compression

D. Uteroplacental insufficiency

Back 82

A.

Head compression = early decels

Cord compression = variable decels

Uteroplacental insufficiency = chronic condition, tested for by foetal size and umbilical doppler

Front 83

C6/7 muscle movements:

Back 83

A. Wrist flexion and extension

Front 84

Paraesthesia in little finger during supraclavicular block. Likely contacting?

Back 84

Ans on black bank = Medial cord

RPA - Medial cord gives off Ulnar but you should be around the trunks with a supraclav block so likely inferior trunk

RNSH

- ?lower trunk

- medial cord in axilla

Front 85

Rpt: Sensitivity 90% and Specificity 99%.

Back 85

A. False positive rate 1%

Front 86

SVRI.

A. SVR x BSA

B. SVR / BSA

Back 86

A

Front 87

PP22 Features of Pierre-Robin syndrome include cleft palate, micrognathia, and?

A. Glossoptosis

B. Microstomia

Back 87

A

Front 88

Ratio of MAC incision to MAC awake for sevoflurane?

Back 88

A. 0.34

Front 89

Rpt: Essential feature of LBBB includes?

A. Loss of QW's in V5-6

B. RSR in V1

C. Deep SW in V6

D. QRS duration > 0.2 secs

Back 89

A

Absent Q waves in Lead 1, V5-V6

Wide S wave in V1

Wide notched R wave in V5/V6

QRS > 120msec (0.12sec)

Front 90

Rpt: Best indicator of opioid induced respiratory depression?

A. Sedation score

B. RR

C. SpO2

D. HR

Back 90

A

Front 91

Rpt: Intraoperative pediatric arrest during scoliosis surgery most likely due to?

A. A delay in delivery ofblood from the blood bank

B. Inadequate intravenousaccess

C. Underestimated intra-operative blood loss

D. Underestimatedpre-operative hypovolaemia

E. Complication oftransfusion

Back 91

C.

Front 92

Rpt: Residual Current Device installed. Electricity mains remains on. Touch neutral and ground.

Back 92

A. Nothing will happen

RCD - disconnects circuit whenever current is not balanced - prevents electrocution.

Front 93

TMP-Jul10-043 Severe asthma attack. Given continuous nebs & IV hydrocortisone but not responding. PaCO2 low. SpO2 low. Next appropriate treatment?

A. IV Magnesium

B. IV Aminophylline

C. Heliox

D. IV salbutamol infusion

E. Intubate/ventilate

Back 93

A.

Front 94

Rpt: ASD murmur is due to flow through which valve?

Back 94

A. Pulmonary valve

Flow murmur due to inc RH volume/pressures

Front 95

Rpt: Best position for IABP is 1-2 cm:

A. Distal to Left SCA

B. Proximal to Left SCA

C. Distal to artery of Adamkiewicz

D. Distal to renal artery

E. Proximal to renal artery

Back 95

A

Front 96

Rpt: Blood flow across which valve is used to estimate PASP during echocardiography examination?

Back 96

A. TV

Front 97

Rpt: Cephalothin spectrum of activity does NOT cover?

Back 97

A. Pseudomonas (need a 4th gen)

Covers strep and staph

Not enterococci or lysteria

Covers gram -ve: ecoli and most kelbsiella

Not serratia, enterobacter, pseudomonas

Front 98

Rpt: With regard to CHADS2 score. All EXCEPT?

Back 98

A. Gender

C - CCF

H - HTN

A - Age >75

D - DM

S2 - Hx of stroke / TIA (2 points)

Front 99

Rpt: 60kg female given 50mg rocuronium. Dose of sugammadex to reverse?

Back 99

A. 960 mg

(16mg / kg)

Front 100

Rpt: Serum c/Ca++ 2.05 mmol/L in CKD patient. Most likely cause?

Back 100

A. Secondary hyperparathyroidism

Front 101

Rpt: Post CEA seizure. In order to prevent further seizures?

A. Add/start antihypertensive

B. Start anticonvulsant

Back 101

A

Hyperperfusion synderome - dramatic inc in CBF after CEA --> ipsilateral headache, HTN, seizures, focal neurology. Rx = aggressively reduce BP

Front 102

Rpt: According to ANZCA-endorsed labelling standards a brachial plexus catheter should be labelled?

A. Pink

B. Blue

C. Yellow.

D. Beige

E. Red

Back 102

A. Yellow

Yellow = nerves

Beige = s/c

Pink = misc

Blue = IV

Red = IA

Front 103

Rpt: Conn's syndrome?

A. Hypernatremia, hypokalemia, normoglycemia

Back 103

A

Primary hyperaldosteronism:

-HTN due to Inc Na+ and extra cellular volume

-Low K+ and alkalosis due to renal excretions

Front 104

Rpt: Area burnt? (1/2 upper limb + anterior abdomen + whole lower limb)

Back 104

A. 32%

Front 105

Rpt: Dural Sac ends at what level in a neonate?

A. L1

B. L3

C. L5

D. S1

E. S3

Back 105

E.

Conus medullaris L2-3 (adults L1) --> LP below L2-3

Dural sac ~ S3 (adults S1)

Front 106

Rpt: SpO2 90%. No IV access. Place LMA and laryngospasm. Most appropriate course of action?

A. Increase inhaled sevoflurane concentration with LMA in situ

B. Increase inhaled sevoflurane concentration after removing LMA

C. Intralingual suxamethonium (no dose stated)

D. Intramuscular suxamethonium (no dose stated)

E. Intramuscular atropine (no dose stated)

Back 106

B.

Remove irritants

Deepen anaesthesia

Muscle relaxation

Front 107

Rpt: Clopidogrel half-life?

Back 107

A. 6 hrs

Front 108

Rpt: Which of the following is not a MAJOR complication following mediastinoscopy?

A. Air embolism

B. Cardiac laceration

C. PTX

D. Tracheal compression

Back 108

B

Front 109

Rpt: What sign most suggests a significant murmur in a child?

A. 4/6 loudness

B. vibratory/flutter sound

Back 109

A

Front 110

Rpt: Thermoneutral zone in 1 month old child?

A. 26-28 degr C

B. 29-31 degr C

C. 32-34 degr C

Back 110

C

34-36 for a neonate

Front 111

Rpt: Indicative of severe AS?

A. Palpitations

B. Fatigue

C. PND

D. Angina

E. Syncope

Back 111

C

Front 112

Rpt: Risk factor for PPH?

A. Prolonged labour

B. Age <20 yrs old

C. Primiparity

D. FV Leiden Deficiency

E. Oligohydramnios

Back 112

A

Front 113

Rpt: Muscle observed when monitoring the NMJ and stimulating ulner nerve?

A. Adductor pollicis

B. Abductor pollicis brevis

C. Flexor pollicis brevis

Back 113

A

Front 114

Rpt july 2007: The correct ranking of Fat/Blood partition co-efficients, in order of increasing solubility in fat, for sevo, des, iso and N20?

A. N2O< Des < Sevo = Iso

B. N2O = Des < Sevo <Iso

C. N20 < S <D < I

D. D< N20 < S < I

E. D < N20 = S < I

Back 114

A

N2O > Des > Sevo~Iso

N2O 1.4

Des 29

Sevo 80

Iso 98

Front 115

Rpt: Induction/LMA in ?kg child. Develops SVT. Most appropriate course of action?

Back 115

A. Adenosine 100 mcg/kg

POW - OHCA (paeds): If inshock and no IV access – DC shock. If have IV asccess give 50mcg / kg, then100mcg / kg, then 250mcg / kg.

Front 116

Rpt: Clinically the most significant murmur in pregnancy is?

Back 116

A. MS

Front 117

Rpt: Required for diagnosis of Neuroleptic Malignant Syndrome?

A. Muscle rigidity

B. Elevated CK

Back 117

A

Severe muscle rigidity, inc temp, plus 2 or more of: confusion, inc HR, tremor, incontinence, reduced speech, inc BP, inc WCC, inc CK.

Front 118

Rpt: Hyponatremic child intubated/ventilated in ICU following seizure. Treatment?

Back 118

A. Hypertonic saline (no dose/infusion rate given)

Give 3%NaCl until Na+ is >125 or until seizures stop. Give 4ml/kg over 15-20min.

Front 119

Rpt: Weakness of proximal and distal muscles following an URTI 10/7 ago. No sensory involvement. T 37.8 degr C.

Most likely diagnosis?

Back 119

A. Guillain-Barre

Progressive bilateral weakness in legs and arms over 2-4 weeks

Areflexia

Mild sensory changes with no level

CN involvement

Spontaneous recovery 2-4weeks

ANS dysfunction

No fever at onset

Front 120

Rpt: Post-operative develops severe CP and ST elevation in PACU. Most appropriate initial treatment?

A. ASA

B. beta-blocker

C. IV heparin infusion

Back 120

A. ASA = Aspirin

Front 121

Rpt: Circuit disconnect during spontaneous breathing may be detected by?

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

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

C. Will be most reliably detected byspirometry with minute volume alarms

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

E. Canbe prevented by using new, single-use tubing

Back 121

D. An unexpected drop in ET agent

or C?

Front 122

Time-constant? [formula]

Back 122

A. Resistance x Compliance

Front 123

Rpt: Neonate - main resistance in circle is due to?

Back 123

A. ETT

Front 124

Rpt: Iron deficiency anaemia:

A. Low ferritin, low serum iron

B. Low ferritin, low TIBC

C. Elevated ferritin, low marrow iron

D. Elevated ferritin, ?

E. Elevated ferritin, ?

Back 124

A.

Iron def anaemia:

Low serum iron, low retic count, low ferritin, low transferrin saturation.

High transferrin and TIBC - inc production in liver = attempt to carry as much of the little iron that is available.

Front 125

Rpt: Long-standing T6 paraplegia. Which is INCORRECT?

A. Flaccid paralysis

B. Poikilothermia

C. Labile BP

Back 125

A. = involuntary spasms due to overactive SNS

Poikilothermia is the inability to maintain constant core temp.

Front 126

Rpt: Lap chole on citalopram. What is NOT relatively contraindicated?

A. Omeprazole

B. Clonidine

C. Pethidine

D. Tramadol

E. Midazolam

Back 126

RNS = E>B

POW = B>E

RPA = B

Omeprazole - may inc serum conc of SSRI via in of CYP219

Clonidine - [RNSH - case report in BJA]

SSRIs may interact with MAOIs or methylene blue and cause serotonin syndrome. Common causative agents: Tramadol, Pethidine, and care with indirect acting sympathomimetics. Fluoxetine also a potent inhibitor of CYP450 enzymes – 2D6 (Codeine), 2C19 (Plavix) and CYP 3A4 (Midazolam and Omeprazole)

Front 127

Rpt: Most effective treatment for post-sevoflurane agitation following grommets in a 4yo child?

A. 1 mg/kg propofol

B. 1 mcg/kg fentanyl

C. 1 mcg/kg clonidine

D. ?dose midazolam

E. Sucrose

Back 127

POW = A

RPA = B>A less n/v than fentanyl but better with increase prolific dose of 2.5mg/kg in tittered aliquots

RNSH = A. or B if higher dose. [2.5mcg/kg fentanyl causes significant red. in emergence]

Front 128

Rpt: What is NOT useful in the treatment of Torsades?

A. Isoprenaline

B. Procainamide

C. DCCV

D. Electrical pacing

Back 128

B. Prolongs QT

Front 129

Rpt: MS and tachyarrhythmia; hypotension? What management?

Back 129

A. DCCV

Front 130

Rpt: Little space between epiglottis and posterior pharyngeal wall. Modified C&L classification?

Back 130

A. IIIa

Grade I = most glottis

Grade II = (a) some of glottis (b) Only posterior extremity of glottis seen or only arytenoid cartilages

Grade III = (a) only epiglottis lifted off the wall (b) only epiglottis with no space

Grade IV = no laryngeal structures

Front 131

2 similar Rpts involving: Numb tongue and impaired taste sensation post LMA anaesthesia.

A. Facial Nerve

B. Mandibular division of CNV

C. Lingual Nerve

Back 131

C.

Facial nerve = taste

Mandibular division of CNV = sensory ant 2/3 tongue

Lingual nerve (branch of V3)= mucosa ant 2/3

Front 132

Rpt: Lateral approach to popliteal block.

A. Passes through semimembranosis

B. May be performed supine or prone

C. Adequate for ankle surgery

D. Less effective in comparison to posterior approach

E. Eversion is an endpoint for nerve stimulation

Back 132

B.

A. Passes through Biceps femoris

B. May be performed supine or prone [NYSORA describes both approaches]

C. Adequate for ankle surgery [Need femoral branches as well (or at least saphenous branches)]

D. Less effective in comparison to posterior approach [RPA = true, RNSH = both are comparable]

E. Eversion is an endpoint for nerve stimulation [RPA Eversion for common peroneal but you'll also seek inversion (and plantarflexion) for Tibial]

Front 133

Rpt: Risk factors for postoperative ulnar nerve injury?

Back 133

A. Contralateral arm

RPA - Often have subclinical palsy contralat

POW - say main RF is diabetes

RNSH - RF = male, DM, inc age, thin, prolonged hospital stay

Front 134

Risk factors for postoperative ulnar nerve injury?

A. is more common in diabetics

B. is more common in women

C. is often associated with contralateral clinical neuropathy

D. isusually found to be the result of excess external pressure

E. usually presents within 24 hours

Back 134

A [POW]

Front 135

Rpt July 2007 Q35: In a rotameter the:

A. Bobbin spins inside a tube that has parallel sides

B. Flow is laminar at high flow rates

C. Height of the bobbin is proportional to the pressure drop across the bobbin

D.Pressure drop across the bobbin is constant at varying flows

E. Resistance increases with increasing gas flow

Back 135

D

Pressure drop across the bobbin is constant at varying flows

Read from the middle of the ball

Front 136

Rpt: SAH. Hyponatremia. Elevated urinary Na concentration. Most likely cause?

A. CSW

B. SIADH

Back 136

B

CSW = low serum Na, high serum osmol, high or norm urine osmol, hypovolemic.

SIADH = hypotonic hypoNa+, urine osmol>serum osmol, urine Na >18, normovolemia.

Front 137

Rpt: Urgent reversal of INR 4.5. Intern already gave vitamin K.

A. FFP

B. Prothrombinex

C. Prothrombinex AND FFP

Back 137

C.

If warfarin related reversal:

PTX 25-50units/kg

FFP 150-300ml to provide factor 7

Front 138

Rpt: Major cause of death following difficult intubation with perforated oesophagus?

A. Sepsis

B. Failure to intubate

C. Failure to ventilate

Back 138

A. is consensus

Front 139

Rpt: Labour epidurals may cause maternal fever. This leads to:

Back 139

A. Increased investigations for neonatal sepsis

Front 140

Rpt: ASA grading was introduced in order to:

Back 140

A. Standardize description of physical status

Front 141

Rpt: Lignocaine vs bupivacaine potency:

Back 141

A. Four times

Front 142

Rpt: Best agent to decrease both gastric volume and gastric acidity?

A. Omeprazole

B. Ranitidine

C. Metoclopramide

D. Cisapride

E. Na citrate

Back 142

B

Front 143

Rpt: Cholecystectomy.

A. Most likely to get gas embolism at initial CO2 insufflation

Back 143

A

Front 144

Rpt: Diastolic dysfunction is NOT caused by?

A. Adrenaline

B. Constrictive pericarditis

Back 144

A

Front 145

Rpt: AFE early cause of death?

A. Pulmonary HTN

Back 145

A

Front 146

Rpt: Nerve block anterior 2/3rds of ear?

Back 146

A. Auriculotemporal nerve.

Front 147

Rpt: Fixed, dilated pupil in trauma patient?

Back 147

A. Transtentorial herniation

Front 148

Rpt: Central anticholinergic syndrome, INCORRECT statement?

A. Neostigmine will reverse

Back 148

A

Requires physostigmine

Front 149

Rpt: MH diagnosis?

Back 149

A. Muscle rigidity

Front 150

1) Indication for IE prophylaxis in pt with CHD:

a) Gastroscopy with biopsy

b) Dental with RCT

C) D&C

Back 150

B.

Indications:

Prosthetic valve

Previous IE

CHD if: unrepaired cyanotic defect, 6months after repair, repair with residual defects

Cardiac transplant and vavuloplasty

RHD in indigenous patient

Front 151

List of other questions:

2) Repeat: Indication for IE pro - Uncorrected CHD

3) Half life of Clopidogrel - 6 hrs

4) TRALI

5) CHADS2

6) Nerve block cathetre colour code

7) Penetrating injury of chest - RV

Back 151

:)

Front 152

8) Meconium stain liquor - Suction Trachea

9) Time constant - RXC

10) Dura in child ends at -S3

11) GCS calculation

12) Pirrer robins syndrome

13) Adductor pollicis

Back 152

:)

Front 153

14) Post endaretrectomy with seziure -Add antiHT

15) Severity of AS - pnd

16) Neonate Loss of heat - Radiation

17) Circuit disconnection -End tidal agent

18) FAT: BLOOD

19) Mallampatti vs Thyromental

Back 153

18) N2O < D < S > I

19) less sensitive and more specific

Front 154

20)Thallium role in prediction of perioerative MI

21) PPH - Prolonged labour

22) ( ME 47)Features of Conn synd

23) ( ez 94)Handyman with neutral and ground - Nothing will happen

24)( ru12) Paraesthesia in little finger - Lower trunk

IC97 Bleeding in trauma - Tranexamic acid

Back 154

22) Hyperaldosterone, Inc Na+, Low K+, normal BSL

TXA - Crash2 study

Front 155

26) Optimal dose of GTN - 50 MCG

27) Sever MS with tachy and hypo - DC shock

28) MAC Awake : MAC Sevo - 0.34

29) PCA monitoring - Secation score

30) 50 mg Rocuronium - Reversal with 960 mg Suggamadex

31) Post hyponatremia sezuire in child - Hypertonic Saline

Back 155

:)

Front 156

32) ( EZ79) Circuit resistance in neonate -ETT

33) PA pressure across which valve in ECHO - Tricuspid

34) Monitoring in Preg beat to beat variablit - 24 wks

35) SE of cyclosporin - Alopecia

36) ( q 122) Diagnosis of NMS - Diaphorosis

37) Cepahlothin not efffective against - Pseudomonas

Back 156

36) Major: rigidity, fever, inc CK.

Minor: Inc HR, BP, and RR. Diaphoresis, leucocytosis.

Front 157

38) Dialated cardiomyopathy with no symp -ACE inhibitors

39) Child with WPW syndrome with intraop tachy , drug of choice - Amiodarone

40) Haemophilia A patient will have - Nml PT and Abnml aPTT

41) Cause of hypoxia in OLV - Blood flow to upper lung

41) Compairing New instrument of BP measurement with gold std - choice of test

42) Air bubble in IA line - decreased RF

Back 157

39) NOT dig, BBlocker, Ca blocker, adenosine (risk of VF with last)

Front 158

43) LBBB in ECG features

44) Tip of IABP - 2 CM distal to lt subclavian

45) 70 yrs post hip with crusing chest pain - aspirin

46) Feature of long standing cord paralysis all except - paraplegia

47) SVRI - SVR X BSA

48) ( AT 27) Left sided pneumonectomy , for chest drain -

Back 158

46) flaccid paralysis

Front 159

49) ETT over bougie - rotate anticlockwise

50) SSEP monitors - Dorsal column

51) Death in esophageal perforation - Sepsis

52) Role of C6-7 - Wrist flexion and extension

53) Modified CM score for laryngoscopy - 3a

54) Iron deficinecy - Low ferretin , Increased TIBC

Back 159

:)

Front 160

55) Popliteal by lateral approach - Foot eversion

56) ( EZ93) Chemical for sodalime change - Ethyl Voilet

57) Pathological Murmur in child - 4/6

58) FOB see trifurcation - RT UL

59) Consent/ Ethics question

60) Not a disadv of flow over vaporiser -

Back 160

:)

Front 161

61) All need reduced dose in renal failure except -Bupernorphine

62) Post induction larungospasm in child - Increase sevo and remove LMA

63) Investigation of choice in dissection of aorta in hemodynamic unstable adult - Aortogram

64) Peak incidence of vasospam post SAH -

65) Risk of stroke in pt with AF per day - 0.01 %

66) Absent q wave feature of all except - Digitalis toxicity

Back 161

63) ?TOE

64) 6-10days

Front 162

67) Sever asthma with all treatment given - Magnesium

68) Most cause of awareness -

69) Post cervical spine op distress in recovery - inhalation innduction

70) Most effective way to reduce renal failure in AAA surgery - Minimize cross clamp time

71) CO2 is used in pneumoperitoneum - less effect if venous air emboism

72) Malignant hyperthermia most common sign - Tacy

Back 162

68) human error

Front 163

73) Best indicator for trauma resus - Lactate

74) ASD murmur across - Pulmonary valve

75) Method to improve aponic oxygenation - Head up

76) Finding against AFE -

77) Nerve injury following LMA with loss of sensation in ant 2/3rd - Branch of Mandibular nerve

78) Loss of taste and sensation in ant 2/3 - Lingual / Corda tympani

Back 163

:)

Front 164

79) Mode of monitoring in neuro surgery - PTC

80) Termoneutral zone in 1 mth old neonate -

81) Supply of carotid sinus - Glossopharyngeal nerve

82) Weakness of systemic reivew all except -

83) All used to prolong preg except - Indomethacin

84) Absolute C/I for sitting position surgery - Small PFO vs/ Shunt

Back 164

:)

Front 165

85) Drug must be given based on IBW -

86) Supply of skin between greater trochanter and _ : subcostal

87) Thraco dorsal is branch of posterior cord

88) Pt on diabigatram for AF coming surgery after 10 day , most appropriate thing to do -

89) Conservative mgtm in aortic dissection - Stanford B

90) Low serum sodium with high urinnary sodium -

Back 165

:)

Front 166

91) Plasma glu vs Blood glu

92) First sign of total spinal in neonate

93) Arndt blocker ( Pic)

94) RCA supply AV node in how many persantage of population

94) Artery suppling anterion papillary muscle ( Pic)

95) CTG corresponds to - ( pic)

Back 166

:)

Front 167

96) Best agent to decrease the gastric volume - H2 blocker

97) Exact loading dose of iv paracetamol -

98) Percentage of women get post partal headche -

99) Histamine causes all except - Myocardial depression

100) All can cause injury during MRI except - IA line

101) SE 99, SP 90 - FP 1

Back 167

:)

Front 168

102) Effect of trendelenburg - increased myocardial work

103) Pyloric stenosis kid can present with - Acidification of urine

104) 12 yrs old had eaten and trauma - RSI with ETTT

105) Maintenance Fluid of choice for child on ventilator in ICU with closed head injury

106) Most common cause of post op visual loss - ION

107) ( MZ Q96 AUG 08) Feauture of AS all except - Anemia > 85%

Back 168

:)

Front 169

108) ( NH Q 139 AUG 08) Ciliary ganglion - parasympathetic fibre from EW nucleus

109) Thoracic epidural helps with all except - circulating catecholamine levels

110) Witnessed VF - Defib

111) Motor cyclist RTA with chest Xray suggestive of gas with fluid level in Left thorax - Rupture diaphragm

112) Best inndicator for difficult intubation in obesity - increased soft tissue in suprathyroid region

113) Low venous oxygen does not affect?

Back 169

:)

Front 170

114) 40 mg Oxycodone + 20 mg Naloxone combined tabalet, useful for-

115) ?? about what would exclude a child from MH

116) Larger area of back to be resected in 25 kg child surgeon wants to use 0.5% bupivacaine - volume allowed?

117) COX inhibitor ?

118) Absolute CI for ECT - Increased ICP VS Resent MI

119) Complication of Mediastinoscopy all except - Cardiac laceration

Back 170

:)

Front 171

120) Entropy with difference in SE and RE -

121) Rotameter with circular bobbin - pressure drop across in constant

122) Lung transplant preserved function - HPV

123) Percentage area of Burns in Half of upper arm, full lower leg and ant abdominal wall - 32

124) PONV??

125) Pressure range allowed for type c cylinder - Different range

Back 171

:)

Front 172

126) Cylinder with grey shoulder and white body - Air/ Co2/ N2o/Nitrous

127) True about remifenatly all except -

128) ? GABA

129) ( Aug 2005)Caused of inverted P wave in lead 2 includes all except -

130) All associated with Ulcerative colitis except - Psoriasis

131) Muscles which separate vocal cords - Post cycricaretyenoids ???

Back 172

:)

Front 173

132) Constant sparing of medial aspect of fore arm sensation following brachial plexus block is indicative of sparing of -

133) 20 kg child suffered 15% burns 6 hrs after amt of fluid to be given?

134) When will palsma bupernorphine level ll fall to half after discontinuation of cutaneous patch?

135) Time till cardiovesion can be comfortably done after new onset AF without ECHO- 24, 48, 72 hrs

Back 173

:)

:)