Anzca Final Mcqs March 2011

Front 1

ME46 Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?

A: Distorted facial anatomy

B: Macroglossia

C: Glottic stenosis

D: Prognathe mandible

E: Arthritis of the neck

Back 1

B.

Front 2

MZ82 Ehlers-Danlos syndrome. Most important to specifically do all EXCEPT:

A: Avoid hyperextension of the neck

B: Damage to the teeth

C: Avoid joint hyper mobility

D: Gastro oesophageal reflex

E: Strict temperature regulation

Back 2

E.

Front 3

ET02 An 85y.o for open AAA repair. Refuses blood because of risk of vCJD. You tell him you won't anaesthetise him as the risk is too high. This is an example of:

A: Autonomy

B: Beneficence

C: Malevolence

D: Coercion

E: Paternalism

Back 3

POW - A

RNS, RPA - E

Front 4

MH61 A 35yr old African-American with sickle cell and fractured ankle for ORIF. Hb 90, Haematocrit 0.3.

A: Transfuse 2 units packed cells (?pre-op)

B: Let him cool passively to low/normal temperature

C: Spinal is safe

D: Avoid thiopentone

E: Tourniquet is absolutely contra-indicated

Back 4

C

Front 5

SN18 Absolute contraindication to sitting position for posterior fossa craniotomy for meningioma

A: Prescence of patent ventriculo-atrial drain/shunt

B: PFO

C: Oesophageal stricture so transoesophageal echo placement is out

D: ?

E: ?

Back 5

A

POW - A and B

RNS - A

RPA - A> B

Front 6

MC42 ECG- which does NOT have abnormal Q waves:

A: Digoxin toxicity

B: Anterior myocardial infartion

C: Previous AMI

D: LBBB

E: Wolff-Parkinson-White syndrome

Back 6

A.

Front 7

RB65 Coeliac plexus block. What is the complication?

A: Erectile dysfunction

B: Constipation

C: Hypertension which resolves spontaneously

D: Paralysis

E:

Back 7

POW - A and D

RPA and RNS - D

Regarding A - apparently not erectile dysfunction but is ejaculatory failure

Front 8

8. NEW. TMP-Jul10-010?? Long stem about an old #NOF patient with aortic stenosis. What is a sign/ investigation/ symptom that shows the most severity? (ie Which one of these would indicate that the lesion was severe?)

A: Thrill in Aortic area

B: Murmur in lower left sternal edge

C: Murmur radiating to carotids

D: History of ischaemic heart disease or coronary artery disease

E: history of angina/ syncope

Alternate:

D: valve area = 1.2cm2

E: gradient = 30mmHg

Back 8

A.

Many site Talley and O'Connor where thrill is meant to indicate severe AS

Front 9

9. NEW. You get a TOE on a patient with aortic stenosis. What is the finding most likely to indicate that the valve needs replacement? possibly same as TMP-Jul10-010

A: Average pressure gradient 30mmHg

B: Valve area 1.2cm(squared)

C: dyspnoea

Back 9

C

Front 10

MN46 Petit mal epilepsy - Which is true? (or words to that effect)

A: Most common in child <2 years old

B: Can precipitate seizures by hyperventilating (+/- deliberately???)

C: Often seizures last for more than 30 seconds

D: Rarely familial

E: Isoelectric EEG during seizure (burst suppression)

Back 10

B

Common in children 4-8yo

Seizures usually <20sec

15-40% is familial

Spike and wave on EEG

Front 11

11. NEW. (I know previous variants exist) Hypertension- severe- in pregnancy (or was it PET?) What NOT to use?

A: Hydrallazine

B: Nifedipine

C: Labetalol

D: Metoprolol

E: SNP

NB Magnesium was NOT an option

Back 11

POW - E

RNS - E (obstetric anaesthesia scientific evidence - SNP as last resort)

RPA - E (SNP is specifically recommended against in the ANZCA document (and ketanserin, diazoxide) - could be used cautiously)

Front 12

AC159 Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?

A: Add another antihypertensive

B: Start antiplatelet drugs

C: Start anticonvulsants

D: Do angio and stent

E: Nimodipine

Back 12

A

Front 13

13. NEW. Which have been shown to decrease vasospasm post aneurysm? All EXCEPT:

A: Antiplatelet drugs

B: Nimodipine

C: HHH therapy

D:

E:

Back 13

A

(RNS - ?only indicated if stent used - no evidence for HHH)

Front 14

14. NEW. Post operative left pneumonectomy. What to do with underwater seal drain?

A: Nurse patient in R lateral decubitus position

B: Expect to see bubbles

C: Suction every hour for 5 minutes

D: Unclamp drain once an hour for 5 minutes, leave clamp on for the rest of the time

E: Leave on free drainage

NOTE: this question looks similar to AT27

Back 14

D

Front 15

15. New? What is NOT true for PDPH following puncture

A: Prophylactic bed rest

B: Catheter in intrathecally

C:

D:

E:

Back 15

A

Front 16

16. Magnesium for treatment of pre-eclampsia. What is the therapeutic level? (I think this may be a repeat of an old question, but i remember two of the options were-

A:

B: 3 - 5

C: 5 - 7

D:

E:

Back 16

B

Front 17

17. NEW. Autonomic dysreflexia. Which ONE is true?

A: 50% of patients with a level below T6

B: Unlikely if below T10

C: Can be prevented spinal

D: Can be precipitated by light touch

E. ?

Back 17

B

Can be prevented by a spinal

Front 18

18. NEW. Ageing (adult) causes:

A: Decreased FRC

B: Decreased Cardiac output

C: Diastolic dysfunction

D: Increased creatinine

Back 18

C

Front 19

19. NEW. TEG tracing given, post cardiac surgery. Had quite slim tail (ie fibrinolysis) but broader 'shoulders'.

A: Fibrinolysis

B: Hypofibrinogenaemia

C: Platelet dysfunction

D: Heparin effect

E: Surgical bleeding

Back 19

A

Front 20

20. NEW. Really poor copy of a CXR. Looked to me like a haemopneumothorax (you could very faintly see a collapsed lung outline, there was no 'meniscus' to the fluid shadow) but other people thought it was an artefact. It did indeed look like a pneumothorax and then someone had put a piece of metal up to simulate a haemothorax, because on the lateral you couldn't see past the ribs (ie the film was cut off at the rib borders). It was terrible quality (too black, and hard to discern tissue from air), and an inadequate film (cut off apices, and poor lateral view as before)

A: Pneumothorax

B: Haemopneumothorax

C:

D:

E: Artefact.

Back 20

?B

Front 21

21. NEW? Post scoliosis repair, decreased movement bilaterally in the legs with decreased pain and temperature sensation but spared joint position sense and vibration. What is at fault?

A: Posterior spinal arteries

B: Anterior spinal arteries

C: Epidural haematoma

D: Misplaced pedicle screw

E: Lateral cord syndrome

Back 21

B

Anterior spinal artery syndrome is paralyis, impaired temp/pain but normal proprioception

Front 22

22. NEW. Anaesthetising an obese patient. Acelerometer on TOF 0.9. Could dose suxamethonium on ideal body weight or total body weight. With respect to 1mg/kg IBW vs. TBW you will see:

A: shorter onset and faster twitch recovery

B: shorter onset and similar twitch recovery

C: shorter onset and slower twitch recovery

D: similar speed of onset with similar speed of twitch recovery

E: similar onset and longer recovery

Back 22

POW and RNS - E

RPA - D

Front 23

23. NEW: The half life of the active metabolite of levosimendan (OR-1896) is:

A: 1hr

B: 8hr

C: 24hr

D: 3 days

E: 7 days

Back 23

D

Front 24

24. NEW. When compared to a non-obese patient, in an obese patient (BMI >35) when fasted for an elective procedure the gastric secretion will have:

A: more volume, higher pH

B: more volume, lower pH

C: same volume, same pH

D: less volume, lower pH

E: less volume, higher pH

Back 24

B

Front 25

25. NEW. The anterior branch of the femoral nerve supplies everything but:

A: pectinius

B: rectus femoris

C: Medial thigh

D: anterior thigh

E: sartorius

Back 25

B

Front 26

26. NEW: During interscalene block placement get medial movement of the scapula. This is secondary to stimulation of:

A: long thoracic nerve

B: dorsal scapula nerve

C: suprascapular nerve

D: supraclavicular nerve

E: accessory nerve

Back 26

B

Front 27

27. NEW. Popliteal block placed from the lateral approach:

A: Passes through semimembranosus

B: Has eversion of the foot as the end point

C: Has increased failure rate compared to a posterior approach

D: ?

E: Can be performed supine or prone

Back 27

E

Front 28

28. NEW. During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring?

A: Dorsal column

B: Spinothalamic tract

C: Lateral Corticospinal tract

D: Cerebrospinal tract

E: Anterior horn cells

Back 28

A

Front 29

29. NEW. During lumbar plexus block placement, which of the following indicates inappropriate needle placement?

A: hip flexion

B: hip adduction

C: knee extension

D: knee flexion

E: lumbar extension

Back 29

D

C = appropriate response

Front 30

30. NEW. Flow with the O2 flush button pressed and volatile agent turned on will give you:

A: 20-30l/min O2

B: 30-70l/min O2

C: volatile agent + 30l/m O2

D: volatile agent + 40l/m O2

E: volatile agent + 50l/min O2

Back 30

B

Front 31

31. NEW. Which of the following causes the most heat loss in a neonate?

A: conduction

B: convection

C: evaporation

D: radiation

E: vasodilation

Back 31

D

Power and Kam

conduction 3%, convection 34%, evaporation 24%, radiation 39%

Front 32

32. NEW. 75 year old with non-valvular AF usually on warfarin has their warfarin stopped for one week. What is their daily risk of stroke?

A: 1%

B: 0.1%

C: 0.01%

D: 4%

E: 10%

Back 32

C

Front 33

33. NEW. If type and Rh specific blood is given to a patient, how safe is the transfusion (Can't quite remember wording, but similar to what is in Dr Brandis' physiology viva book)?

A: ?

B: ?

C: 97%

D: 98.6%

E: 99.8%

Back 33

E

Front 34

34. NEW. Patient with Marfan's and 2 hours of severe chest pain, mild hypertension and ECG showing ischaemia. The next best step is urgent:

A: CT

B: TOE

C: ?

D: Angiography and PCI

E: Thrombolysis

Back 34

?CT if stable

?TOE if unstable

Front 35

35. New. What percentage of patients with SAH are troponin positive?

A: <5%

B: 15-30%

C: 40-60%

D: 70-90%

E: 100%

Back 35

B

Front 36

36. NEW. What is the major cause of death in a patient with perforation of the pharynx, oesophagus or trachea?

A: failure to intubate

B: failure to ventilation

C: sepsis

Back 36

C

Front 37

37. New (?). Eisenmengers syndrome:

A: decrease Hb to <180 with venesection

B: Give high FiO2

C: Pulmonary vasodilators will treat the pulmonary hypertension

D: terminal RV failure usually occurs in the 3rd-4th decade

Back 37

D

Front 38

38. NEW. Your registrar gives a Duchenne patient 1mg/kg of suxamethonium. What are you most worried about?

A: hyperkalaemia

B: rhabomyolysis

C: MH

Back 38

A

Front 39

39. NEW. Fontan patient having an open appendicectomy. What do you want?

A: long I time and PEEP

B: long I time

C: short I time

D: raised ETCO2

E: spontaneous ventilation

Back 39

C or E

Front 40

40. NEW. What makes tramadol less effective?

A: ondansetron

B: prochlorperazine

C: metoclopramide

Back 40

A.

Ondansetron makes tramadol less effective; offsets 5-HT effect

Front 41

41. NEW. 75 year old male with normal renal function for an endoluminal aortic repair. What is the best protection to prevent the development of renal dysfunction?

A: NaCl

B: NAC

C: mannitol

D: dopamine

E: dialysis

Back 41

A

Front 42

42 NEW. Very sick patient on CVVHF. On norad, changed to adrenaline with no improvement in haemodynamic variables. What is your next step?

A: change to another inotrope

B: check their response to a synacthen test

C: give hydrocortisone

Back 42

C

Front 43

43. NEW. What is the most common way to measure end tidal gas concentrations on our anaesthetic machines?

A: mass spectometry

B: Raman scattering

C: ultrasonic

D: infrared

E: piezoelectric

Back 43

D

Front 44

44. NEW. Multiple attempts to place ETT during difficult intubation causing pharyngeal and oesophageal perforations. Most likely cause of death?

A: Failure to intubate

B: Failure to ventilate

C: Bleeding

D: Sepsis

Back 44

D

Front 45

45. NEW. How far to insert PICC line in a kid beyond the carina

A: At the carina

B: 1cm below

C: 1cm above

Back 45

A

Front 46

AB50: TRALI most likely after transfusion of...

Back 46

FFP

Front 47

TMP-Jul10-024 A 78 year old man with past difficult intubation for arm surgery. Supraclavicular block with 25 mls 0.5% bupivacaine. Shortly after begins convulsing. INITIAL management?

A. Midazolam 5mg

B. Intralipid 20% 1.5 ml/kg

C. Thiopentone 150mg

D. Suxamethonium 50mg

E. Propofol 50mg

Back 47

A

Front 48

TMP-Jul10-033 Subtenon’s block. What is the worst position to insert block?

A. Inferonasal

B. Inferotemporal

C. Superonasal

D. Supertemporal

E. Medial / canthal

Back 48

E

Front 49

TMP-Jul10-036 Which is NOT a disadvantage of drawover vaporiser versus plenum vaporiser:

A. Temperature compensation

B. Cannot use sevoflurane

C. Small volume reservoir

D. Flow compensation

E. ?

Back 49

B

Front 50

TMP-Jul10-048 Amniotic fluid embolism. Cause of death in first half hour ?

A. Pulmonary hypertension

B. Malignant arrhythmia

C. Pulmonary oedema

D. Hypovolaemic shock

E.

Back 50

A

Front 51

TMP-Jul10-054 Malignant hyperthermia. The number of people in the community at any given time with a predisposition is called the:

A. Prevalence

B. Incidence

C.

D.

E.

Back 51

A

Front 52

TMP-Jul10-056 Thallium scan:

A. High negative predictive value

B.High positive predictive value

C. Notas good as a dobutamine stress echocardiography

D.

E.

Back 52

A

Front 53

TMP-Jul10-004 Exponential decline / definition of time constant (with various options)

A. time for exponential process to reach log(e) of its initial value

B. Time until exponential process reaches zero

C. Time to reach 37% of initial value

D. Time to reach half if its initial value

E. 69% of half life

Back 53

C

Front 54

TMP-Jul10-010 The best clinical indicator of SEVERE Aortic stenosis

A. Presence of thrill

B. Mean Gradient 30mmHg

C. Area 1.2 cm2

D. Slow rising pulse and ESM radiating to carotids

E. Shortness of breath

Back 54

A

Front 55

TMP-Jul10-016 TURP – patient under spinal. Confused. ABG: Na+ 117 / normal gas exchange. Treatment ?

A. 10 ml 20% Saline as fast push IV

B. 3% NS 100 ml/h

C. Normal saline 200 ml/h

D. Frusemide 40 mg IV

E. Fluid restrict 500 ml/day

Back 55

B

Front 56

TMP-Jul10-042 Patient post anterior cervical fusion. Patient in recovery. Confused and combative. Nurse concerned about haematoma. Taken to theatre: Most appropriate way of securing airway:

A. Gas induction / laryngoscopy / intubate

B. Awake tracheostomy

C. Awake fibreoptic intubation using minimal sedation

D. Thiopentone, suxamethonium, direct laryngoscopy and intubation

E. Retrograde intubation

Back 56

A

Front 57

TMP-Jul10-043 Young asthmatic male in emergency department. RR 26, pCO2 27, SAO2 92%, struggling talking in sentences. Given nebulised salbutamol, and ipratropium, 200mg IV hydrocortisone. After 30 minutes - no improvement. Further management:

A. IV salbutamol

B. IV aminophylline

C. IV magnesium

D. Intubate and ventilate

E. ???IV adrenaline?

Back 57

C

Front 58

TMP-Jul10-045 How quickly does the CO2 rise in the apnoeic patient ?

A. 1 mmHg per min

B. 2 mmHg per min

C. 3 mmHg per min

D. 4 mmHg per min

E. 5 or ?8 mmHg per min

Back 58

C

Front 59

TMP-Jul10-051 Visual loss with pupillary reflexes retained. Likely cause ?

A. Retinal detachment

B. Occipital mass (! I don't think this option was on the 2011 paper??)

C. Frontal mass

D. Chiasmal mass

E. Optic neuritis

Back 59

B

Pathgnomonic for cortical blindness

Front 60

TMP-Jul10-062 In pregnancy the dural sac ends at:

A. T12

B. L2

C. L4

D. S2

E. S4

Back 60

D