Anzca Finals Mcqs 2013 Aug

Front 1

1.You are called to see a 30 year old man with rapidly deteriorating asthma.Following appropriate medical management an endotracheal tube is inserted andhe is ventilated with a mechanical ventilator with a tidal volume of 600ml and a rate of 12 breaths per minute. Five minutes later the blood pressure is unrecordable and external cardiac massage is commenced. Arterial blood is taken and shows ph 7.08, pCO2 96 mmHg, pO2 36 mmHg, SpO2 46% and bicarbonate 27mmol/L. He is administered adrenaline, salbutamol, pancuronium, bicarbonate andcalcium gluconate. The ECG shows sinus rhythm at a rate of 60 beats per minute.The patient remains pulseless and cyanosed with fixed dilated pupils anddistended neck veins. The most appropriate management is to

A. cease resuscitation

B. administer further adrenaline

C. insert bilateral intercostal drains

D. cease ventilation for 30 seconds and resume at a slower rate

E. increase peak inspiratory pressure

Back 1

D

Front 2

2.A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizure and losing consciousness. Which drug should NOT begiven

A. Pethidine

B. Diazepam

C. Haematin

D. Suxamethonium

E. Pregabalin

Back 2

A

Front 3

A 42 year old lady presents for right pneumonectomy with a left side ddouble-lumen tube. She is 132kg and 160cm. What depth, measured at the incisors, is likely to give the ideal position?

A. 24cm

B. 26cm

C. 28cm

D. 30cm

E. 32cm

Back 3

C

"The average depth of insertion for both male and femalepatients 170 cm tall was 29 cm, and for each 10-cm increase or decrease inheight, average placement depth was increased or decreased 1 cm."

Front 4

4. What is the most effective method of minimizing acute kidney injury following an elective open abdominal aortic aneurysm repair?

A. give IV crystalloidas a ‘preload’ before cross-clamp

B. give IV mannitol before cross-clamp

C. give IV frusemide before cross-clamp

D. give preoperative N-acetylcysteine

E. minimize aortic cross-clamp time

Back 4

E.

CEACCP 2013: Anaesthesia for elective AAArepair

Front 5

5.[New] Features of severe pre-eclampsia include:

A. Foetal growthretardation

B. Peripheral oedema

C. Systolic BP more than160

D. Thrombocytopenia

E. Severe proteinuria

Back 5

RPA = C

POW = B.

Front 6

6.[Repeat] Earliest sign of a high block in a neonate post awake caudal:

A. Increased HR

B. Increased BP

C. Reduced HR

D. Desaturation

E. Loss of consciousness

Back 6

D.

Front 7

7.A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, 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 ofthe neck

Back 7

RPA = D

Flow chart for 'suspected laryngotrachael injury' considers an unstable airway to include 'dyspnoea, inability to lie supine, or subcutaneous empysema' (none of which are described in this question). So we go down the 'stable airway' route; first on the list is 'c-spine X-ray and CXR' (not a soft tissue X-ray as such - answer E...), next is a flexible nasal laryngoscopy (possibly D..?).

If the above investigations are inconclusive - only then do a CT neck.

If an unstable airway (as above) - either tracheostomy under LA or rigid bronchoscopy under GA.

Front 8

8. A60 year old man with normal LV function is having coronary artery bypass grafting. After separation from the bypass machine he becomes hypotensive withST elevation in leads II and aVF. The Swan Ganz Catheter showed a PCWP of 25and CVP of 15 with normal PVR and SVR. The TOE is likely to show:

A. Early mitral inflow> inflow during atrial systole

B. Inferior wall hypokinesis

C. Severe MR

D. TR and RV dilatation

E. LV cavity obliteration at the end of systole

Back 8

B.

Front 9

11.You are working in a theatre with a line isolation monitor, which is working. You touch a wire. What is going to happen?

A. equipotent earth

B. the theatre floor won't conduct

C. ?

D. ?

E. the RCD will protect you from shock

Back 9

E.

LIM is a "monitor" for floating circuits, which checks they are still floating. If the LIM has not detected a leak, then no current will flow with earth-patient wire connections

http://www.howequipmentworks.com/physics/electricity/elec_safety/electrical_safety.html

AICM 7 No 11

I think this a repeat question no 32 fromAugust 200932. (NEW) In body protected OR with aLine Isolation Monitor reading 0 mA. If you touch one active wire what willhappen.a. nothing, because no connection toearth is completedb. you get shockedc. nothing because the floor is insulatedd. nothing because your shoes arenonconductivee. RCD trips Answer is A.0mA means everything is fine and properlyisolated so the circuit is not earth referenced.

Front 10

12.What is the test is decreased in Iron deficiency anaemia?

A. microcytosis

B. serum feritin

C. serum iron

D. transferin

E. total iron bindingcapacity

Back 10

B.

CEACCP: Preoperative Anaemia 2013: The most common cause of microcytic anaemia is iron deficiency, a diagnosis confirmed by low ferritin level and low saturation of transferrin

Front 11

13.A full size C oxygen cyclinder (size A in New Zealand) has pressure regulatedfrom

A. 16000kpa to 400kpa

B. 16000kpa to 240kpa

C. 11000kpa to 400kpa

D. 11000kpa to 240kpa

E. 7600kpa to 240kpa

Back 11

A.

http://www.boc.com.au/webapp/wcs/stores/servlet/en/au-boc-industrial-store/oxygen-indust-c-size-020c

Front 12

14. MRI Telsa 3, least likely to cause harm

A. Cochlear implant

B. mechanical heart valve

C. Implanted intrathecal pump

D. Recently placed aortic stent

E. shrapnel fragment

Back 12

B.

http://www.mhra.gov.uk/Publications/Safetyguidance/DeviceBulletins/CON2033018

Front 13

15-(repeat)What happens when you place a magnet over a biventricular internal cardiac defibrillator

A. Switch to asynchronous pacing

B. Damage the internal programming

C. Nothing

D. Switch off anti tachycardia function

E. Switch of rate responsiveness

Back 13

D.

Front 14

16-REPEAT: You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves:

A. facial, trigeminal,glossopharyngeal

B. facial, trigeminal,vagus

C. glossopharyngeal,trigeminal, vagus

D. trigeminal,glossopharyngeal, vagus

E. trigeminal, vagus,glossopharyngeal

Back 14

D

Front 15

19 Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.

A. anterior ischaemia

B. atrial

C. inferior

D. lateral

E. septal

Back 15

A.

Front 16

20Lowest extension of thoracic paravertebral space

A. t10

B. t12

C. l2

D. l4

E. s1

Back 16

B.

CEACCP Paravertebral block 2010 "The thoracic paravertebral space begins at T1 and extends caudally to terminate at T12. Although PVBs can be performed in the cervical and lumbar regions, there is no direct communication between adjacent levels in these areas."

Front 17

2120 yr old male presents to ED with 30% burns from a fire. His approx weight is 80kg. Based on the Parkland formula, how much fluid is required in the first 8hr from time of injury?

A. 2.4L N/S

B. 3.6L N/S

C. 3.6L Hartmann's

D. 4.8L N/S

E. 4.8L CSL

Back 17

E.

Front 18

22 In regards to systemic sclerosis, what is the least likely cardiac manifestation?

A. accelerated coronary artery disease

B. atrioventricularconduction block

C. myocarditis

D. pericardial effusion

E. valvular regurgitation

Back 18

E.

Cardiac complications of systemicsclerosis, Rheumatology (2009) 48 (suppl 3): iii45-iii48Cardiac manifestations of SSc can affect all structures of the heart,and may result in pericardial effusion, arrhythmias, conduction system defects,valvular impairment (in rare cases), myocardial ischaemia, myocardialhypertrophy and heart failure

Front 19

23(repeat) The reason that desflurane requires a heated vapour chamber can bebest explained by its:

A. Low saturated vapour pressure

b) High saturated vapour pressure

c) High boiling point

D. Low molecular weight

E. Very low solubility

Back 19

B.

Front 20

24 (New but on a repeated theme) A 30 year old lady has a vaginal forceps delivery without neuroaxial blockade. The next day she is noted to have loss ofsensation over the anteriolateral aspect of her left thigh. There are NO motor symptoms. The is best explained by damage to the left sided:

A. Lumbosacral trunk

B. Lateral cutaneous nerve of the thigh

C. Pudendal nerve

D. L2/3 Nerve root

E. Sciatic nerve

Back 20

B.

CEACCP 2013: Postnatal neurological problems Lesions may be spinal, or at the level of the lumbosacral roots, lumbosacral trunk, or peripheral nerves. Approximately, one-third of nerve injuries are associated with motor deficit. Most commonly, the lateral femoral cutaneous nerve (no motor component, also known as meralgia paraesthetica), the femoral nerve, or both are affected as they pass the anterior superior iliac spine or inguinal ligament and the nerve is compressed with thigh flexion. Increased abdominal pressure (note fetal monitoring straps), prolonged hip flexion, diabetes, increased lumbar lordosis, and obesity are recognized as risk factors

Front 21

25.->AZ84 When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehanescale this is grade

A. 1

B. 2

C. 3a

D. 3b

E. 4

Back 21

D.

Front 22

26. [AC108] A healthy 20 year old patient undergoing nasal surgery undergeneral anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrineand a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and theheart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to

A. administer glyceryl trinitrate

B. administer esmolol

C. administer labetalol

D. administer sodium nitroprusside

E. deepen anaesthesia with isoflurane

Back 22

C.

Front 23

27.An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is

A. 400mL

B. 500mL

C. 600mL

D. 700mL

E. 800mL

Back 23

C.

MABL = EBV x (HCT – Minimum HCT) / HCT 30x70=2100 x2/7=600mL

Where EBV = 70ml/kg for child and adult, 80ml/kg for infant, 90ml/kg for neonate

or MABL =EBVx (NCT -min HCT)/ (HCT average) =700 (formula fro CEACCP)

Front 24

28.An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except:

A. Aspirin

B. heparin

C. morphin

D. nitrates

E. oxygen

Back 24

B.

Front 25

29.What cannot be used for tocolysis in a 34/40 pregnant woman:

A. Clonidine

B. Indomethacin

C. Magnesium

D. Salbutamol

E. Nifedipine

Back 25

A

Indomethacin can be used to 34 weeks as per NSW policy but whether you would use it at this stage is another question

Front 26

30. Pringles procedure for life threatening liver haemorrhage includes clamping of:

A. Hepatic artery

B. Hepatic vein

C. Portal pedicle

D. Aorta

E. Splenic Artery

Back 26

A>C as it called the hepatic pedicle

Blood loss is significantly reduced using temporary occlusion of the blood supply to the liver during parenchymal resection. This may involve total inflow occlusion of the portal vein and hepatic artery (Pringle manoeuvre). The resulting decrease in cardiac output of up to 10% and increase in left ventricular afterload of 20–30% may cause cardiovascular compromise. CEACCP 2009 Anaesthesia for Hepatic resection Surgery

Front 27

31.Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to:

A. Intraoperative bradycardia

B. Decreased anaesthetic requirement

C. Increased nausea and vomiting

D. Increased risk of awareness

E. Decreased BIS reliability

Back 27

B.

Front 28

32.MVA trauma patient arrives in ED BP100/60 HR 100 with the following CXR (‘’Ithought it looked like an aortic dissection/rupture with a widened mediastinum’’). The most appropriate next investigation would be:

A. Aortography

B. CT Chest

C. MRI

D. TOE

E. TTE

Back 28

B.

Front 29

33.A 70 year old man with slow atrial fibrillation is reviewed for insertion of a permanent pacemaker. He is otherwise well. He is on warfarin with an INR of 2.2. Prior to PPM insertion do you

A. Cease warfarin and commence dabigatran

B. Cease warfarin and commence Enoxaparin

C. Cease warfarin and recommence post procedure

D. cease warfarin and commence heparin

E. Continue warfarin

Back 29

E.

Front 30

34.A 40 year old man with Marfan's has undergone a thoracoabdominal aneurysm repair. 48 hours post procedure there is blood noted in his CSF drain and he is obtunded. Your next course of action is:

A. Coagulation studies

B. CSF microscopy andculture

C. CT Head

D. MRI Head

E. MRI Spine

Back 30

C.

J Vasc Surg. 2009 Jan;49(1):29-34; Complications of spinal fluid drainage in thoracoabdominal aortic aneurysm repair: a report of 486 patients treated from 1987 to 2008. Major complication after lumbar CSF drainage is subdural haematoma caused by excessive traction leading to tearing of dural veins. Mortality occurs due to intracranial haemorrhage and requires urgent neurosurgical intervention. Mortality 0.6%.

Front 31

36.You are anaesthetising a fit 50 year old woman for an elective laparoscopic cholecystectomy. In her pre operative assessment she has a normal cardiovascular exam and her BP is 115/75. You induce anaesthesia with 100mcg fentanyl, 100mg propofol and 50 mg rocuronium. Soon after induction her ECG looks like this (showed narrow complex tachycardia around 180-200/min – ie SVT). Her BP is now 95/50. What is the most appropriate management?

A. adenosine

B. amiodarone

C. DC cardioversion

D. GTN

E. metaraminol

Back 31

A.

Front 32

37.The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the

A. isolation transformer

B. line isolation monitor

C. equipment has a maximum leakage current of 500 micro amperes

D. residual current device

E. equipotentiality

Back 32

E.

http://www.rch.org.au/bme_rch/electrical_safety/#body Equipotential earthing is installed in rooms classified as 'Cardiac Protected' electrical areas. Equipotential earthing in treatment areas used for cardiac procedures is intended to minimise any voltage differences between earthed parts of equipment and any other exposed metal in the room.

Front 33

38. After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is

A. normal saline infusion

B. bicarbonate infusion

C. mannitol

D. frusemide

E. haemodialysis

Back 33

E.

Emerg Med J 2002;19:206-209 An evidence based flowchart to guide the management of acute salicylate (aspirin) overdose. >500mg/kg indication for gastric lavage if in last 1hr followed by activated charcoal every 4 hours. If patient shows signs of severity (coma, ARF, Pulmonary oedema) recommended to proceed to haemodialysis.

Front 34

39. Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture

A. L1-L2

B. L2-L3

C. L3-L4

D. L4-L5

E. L5-S1

Back 34

D.

Front 35

40.6 week old baby is booked for elective right inguinal hernia repair. Anappropriate 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,

F. 4 hours for all fluids.

Back 35

B.

PS15

<6/52 then milk and formula up to 4hours prior and clear fluids 2hours prior

>6/52 6hours for formula and food, 4hours for breast milk, 2hours for clear fluids

Front 36

41.(repeat) For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is;

A. Number of boluses of PCA per hour

B. Respiratory rate

C. Oxygen saturation

D. Sedation score

E. Pupil size

Back 36

D.

Front 37

42.A reduction in DLCO can be caused by;

A. Asthma

B. COPD

C. Left to right shunt

D. Pulmonary haemorrhage

E. Bronchitis

Back 37

B>E

emphysema (as part of COPD) will reduce DLCO

Front 38

43. You place a thoracic epidural for a patient having an elective open AAA repair. There are 4cm in the epidural space and you aspirate blood. What is the most appropriate management plan:

A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use

B. inject 5 mL lignocaine 2% with adrenaline. If there is no rise in HR be happy that it is not intravascular and secure in place and use

C. Remove and postpone surgery for 24 hours

D. Remove and place epidural 1 level higher

E. Remove and postpone surgery for 4 hours

Back 38

C

Alternatively,continue with case but withhold giving heparin for 1/24. Group consensus.

Interesting article:http://update.anaesthesiologists.org/wp-content/uploads/2009/10/Epidural-Anaesthesia.pdf

Front 39

44. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing.What would be the most appropriate drug to use:

A. rocuronium

B. suxamethonium

C. pancuronium

D. atracurium

E. cisatracurium

Back 39

E.

Front 40

45 (repeat) Patient with subdural haematoma, on warfarin. INR 4.5. Needs urgent craniotomy. Vit K given already by ED resident. What further do you give for urgent reversal of this patient's INR?

A. Factor VII

B. Cryoprecipitate

C. FFP

D. Prothrombinex

E. FFP + prothrombinex

Back 40

E.

Front 41

46 (repeat) Regarding endotracheal tubes used in laser surgery:

A. They are more resistant to combustion when the cuff is covered in blood

B. Resistant to ignition from electrocautery

C. The cuff is resistant to ignition if hit by the laser

D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diamater)

E. Have 2 cuffs which are resistant to combustion

Back 41

D.

Front 42

49 Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion

A. ?

B.

C.

D.

E. Relieved by topical local anaesthetic

Back 42

E

Front 43

50 During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate

A. Carbimazole

B. Beta-blocker

C. Propythiouracil

D. Plasmaphoresis

E. Hydrocortisone

Back 43

LVP D

RPA D

POW A>D

Plasmaphoresis takes several days to work

OHCM acute management of storm include carbimazole in, no mention of plasmapheresis

Front 44

53 (repeat) Two days post upper spinal surgery, patient notices parathesia of the right arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from an ulnar nerve neuropathy?

A. parasthesia in little

finger

B. parasthesia in the distribution of the interscalene nerve

C. weakness in adductor digiti minimi

D. weakness in abductor pollicis brevis

E. weakness in lateral interosseus

Back 44

D.

Front 45

54 A 54 year old man, is on warfarin for atrial fibrillation, has a history of alcohol abuse and liver failure with an albumin of 30 and a bilirubin of 28. What is his CHADS 2 score?

A. 0

B. 1

C. 2

D. 3

E. 4

Back 45

A

Front 46

57 You are 2 hours into an operation. 3L of IV Crystalloid has been given. There has been minimal blood loss. The dilutional anaemia is compensated by:

A. Cellular anaerobic metabolism

B: Capillary vasodilation

C: Increased cardiac output

D: Increased tissue oxygen extraction

E: Rightwards shift of the Oxygen – Haemoglobin dissociation curve

Back 46

C: Increased cardiac output

Front 47

58 You are putting in an Internal Jugular CVC. Which manoeuvre will cause maximum venous distension of the jugular vein?

A. Continuous Positive Airway Pressure (No value given)

B: Breath hold atend-expiration

C: Manual compression atthe base of the neck

D: Trendelenburg position

E: Patient performs a valsalva

Back 47

E.

Front 48

59.(repeat) What is approximately the systolic blood pressure in an awake neonate (mmHg)

A. 55

B. 70

C. 85

D. 100

E. 115

Back 48

B.

Front 49

60. (repeat) The volatile agent most likely to be associated with carbon monoxide production when used with a soda lime scrubber is:

A. Desflurane

B. Isoflurane

C. Sevoflurane

D. Halothane

E. Enflurane

Back 49

A. Desflurane

Front 50

61.A 40yo female with primary pulmonary hypertension is to have a laparoscopic cholecystectomy. Her preoperative pulmonary artery pressure is 80/60mmHg. During the procedure she suddenly desaturates to 87%, BP 80/40mmHg, and ETCO2 45mmHg. Likely findings on TOE will include:

A: Increased LV wall thickness, abnormal septal wall motion, TR, RA dilation

B: Increased RV:LV area, abnormal septal wall motion, increased LV wall thickness, RA dilation

C: Increased RV:LV area, abnormal septal wall motion, TR, RA dilation

D: Increased RV:LV area, abnormal septal wall motion, TR, PR

E: Increased RV:LV area, TR, PR, RA dilation

Back 50

C.

Front 51

62The principal resistance to airflow in an ETT is:

A: density of the gas

B: diameter of the tube

C: length of the tube

D: temperature of the gas

E: viscosity of the gas

Back 51

B.

Front 52

65.A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of theconventional before 1 extra patient will benefit is

A. 3

B. 4

C. 8

D. 25

E. 33

Back 52

D.

So incidence is 12% vs 8%. Thus ARR = 0.04 and NNT = 25

Front 53

66.(repeat) According to guidelines endorsed by ANZCA, the label of an intra-osseous infusion should be

A. beige

B. blue

C. Pink

D. Red

E. yellow

Back 53

C.

Front 54

69.(repeat) rise in CO2 per minute during apnoea

A. 0.5 mmHg per min

B. 1 mmHg per min

C. 2 mmHg per min

D. 3 mmHg per min

E. 5 mmHg per min

Back 54

D.

Front 55

70.(repeat) In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and:

A. Heart Rate

B. Saturation

C. Respiratory Rate

D. Urine Output

E. Temperature

Back 55

C. Respiratory Rate

Front 56

72. (repeat) absolute Contraindication to ECT

A. Cochlear implants

B. Epilepsy

C. Pregnancy

D. Raised intracranial pressure

E. Myocardial infarction

Back 56

D. Raised intracranial pressure

Front 57

73. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her:

A. Instigate low dose beta blockade

B. Defer, and refer to acardiologist

C. Perform a transoesophageal echo to get a better look at the valve

D. Proceed to surgery with no further investigation

E. Perform a dobutamine stress echo

Back 57

D.

Front 58

75A 25 y.o. male has a traumatic brain injury on a construction site. GCS 7.Intubated on site and transported 1 hour to hospital. Haemodynamically stable and no other injuries. Most appropriate pre hospital fluid:

A. 4% albumin

B. Dextran 70 in0.9%N/saline

C. 6% hydroxyethylstarch

D. Ringers lactate

E. 0.9% N/saline

Back 58

E.

Avoid hypotonic solutions, and those containing dextrose. CEACCP Traumatic Brain Injury 2013 The SAFE Study 2007 Albumin Vs Saline in Traumatic Brain Injury (post-hoc analysis of original study): 42 vs 22% mortality at 2 years in severe brain injury GCS 3-8.

Front 59

76 A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days.Platelets 40 and blood group A+. Management of her ITP:

A. Administer Anti-Dantibodies 6 hrs pre op

B. Admister desmopressin one hourpre op

C. Administer methylpred and IVIg 2 days pre op

D. Recheck plateletcount morning of surgery and if not dropped continue

E. Platelet transfusionmorning of surgery

Back 59

C.

Front 60

77.(Rpt) A neonate will desaturate faster than an adult at induction because

A. FRC decreased more

B. Faster onset of induction agents

C. More difficult to pre-oxygenate

D.

E.

Back 60

A

For a variety of reasons:

1. Decreased FRC with an increased closing capacity, resulting in airway closure during anaesthesia and a subsequent intrapulmonary shunt (managed with CPAP)

2. Increased metabolic O2 requirement (3-4x adult)

Front 61

78. (Rpt Jul 07) Isoflurane is administered in a hyperbaric chamber at 3 atmospheres absolute pressure using a variable bypass vaporizer. At a given dial settingand constant fresh gas flow, vapour will be produced at:

A. the indicated vapourconcentration

B. three times theindicated vapour concentration

C. one third the partialpressure obtained at 1 atmosphere

D. the same partial pressure as is obtained at 1 atmosphere

E. three times thepartial pressure obtained at 1 atmosphere

Back 61

D.

The partial pressure is the SVP which is independent of ambient pressure. The vapor concentration will be 1/3 of that at sea level.

Front 62

79. [AP CXR and lateral] – ‘’showed hydropneumothorax’’ This grossly abnormal CXR is

A. right basalpneumothorax

B. right hydropneumothorax

C. artifact

D. right pleural effusion

E. right R lower lobeatelectases

Back 62

B.

Front 63

80. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods taksen. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality 85 The most likely diagnosis is

A. Central diabetes insipidus

B. Nephrogenic diabetesinsipidus

C. Psychogenic polydipsia

D. Cerebral salt wasting

E. SIADH

Back 63

C.

Front 64

83 A 45 year old obese man complains ofheadache, lower limb weakness and polyuria. On examination, his blood pressure is 150/70mmHg. He has a displaced apex beat. Bloods revealed Na145, K2.8, Cl101, HCO3 27. What is the most likely diagnosis

A. Cushings

B. Diabetes

C. Primary hyperaldosteronism

D. Hypothyroidism

E. Phaeochromocytoma

Back 64

A/C

lots of debate which one......

Front 65

84 (repeat)Which of the following is the best predictor of a difficult intubation in amorbidly obese patient

A. Pretracheal tissue volume

B. Mallampati score

C. Thyromental distance

D. BMI

E. Severity of OSA

Back 65

A.

Front 66

85. (repeat) You wish to compare a new method of BP measurement with the goldstandard. The best way to do this is:

A. CUSUM analysis

B. Friedman's test

C. ?

D. Pearson’s correlation

E. Bland-Altman plot

Back 66

E. Bland-Altman plot

Front 67

86. After intubating for an elective case you connect up the circuit and noticethat you are unable to ventilate and observe high airway pressures. The next most appropriate step is to:

A. Auscultate the lungs

B. Release the APL valve

C. Remove the endotracheal tube and bag mask ventilate

D. Turn on the ventilator

E. Low positive endexpiratory pressure

Back 67

RPA A

LVP A

POW A>C

Front 68

87.You insert a thoracic epidural in a patient for a liver resection with an upperabdominal incision. You have recently topped it up. On waking the patient appears weak, despite adequate reversal. He can breathe spontaneously and canflex his biceps but is not able to extend triceps. The level of the block is most likely to be:

A. C5

B. C6

C. C7

D. C8

E. T1

Back 68

C.

Front 69

88.(repeat) You are anaesthetizing a pregnant woman for neuro-radiologicalcoiling. At what gestation is it important to monitor uteroplacentalsufficiency?

A. 22 weeks

B. 24 weeks

C. 26 weeks

D. 28 weeks

E. 32 weeks

Back 69

B.

Front 70

89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is?

A. Nimodipine

B. Adenosine

C. Mannitol

D. Hypertonic Saline

E. Thiopentone

Back 70

B.

Front 71

91.You see a young man prior to surgery. He describes a history of throat swelling and difficulty breathing both spontaneously and in association with minor dental procedures. His brother has had similar episodes. The most likelymechanism is:

A. C1-esterase deficiency

B. Factor V deficiency

C. Low bradykinin levels

D. Mast cell degranulation

E. Tryptase release

Back 71

A.

Front 72

92.A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers acardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemiais:

A. Acute renal failure

B. Cardiomyopathy

C. Crush injury

D. Malignant hyperthermia

E. Rhabdomyolisis

Back 72

E.

Front 73

95. You areanaesthetising a 6 month-old infant for repair of a VSD. You perform aninhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant’s oxygen saturations fall to 85%. The most appropriate next step in management:

A. give a fluid bolus

B. change fromsevoflurane to isoflurane

C. apply CPAP

D. reduce the FiO2

E. reduce sevoflurane

Back 73

RPA E

LVP E

POW C/ E

Front 74

96.A 30-year old patient, who takes paroxetine, has suffered a traumatic amputation. The most appropriate medication to reduce her developing chronic post-operative pain is:

A. amitriptyline

B. dextromethorphan

C. gabapentin

D. tramadol

E. pethidine

Back 74

C.

Front 75

97.A 3 year old child has suffered a fractured arm. What is the most appropriateway to assess her pain?

A. the reported severity from the child

B. the reported severity from the parent

C. the reported severity from the nursing staff

D. using the FLACC scale

E. the Wong-Baker Facesscale

Back 75

D.

APMSE 3e p391 Face, Legs, Activity, Crying, Consolability

Front 76

98 buprenorphine patch removed morning of surgery. What time till PLASMA reaches half original level

A. 12 hours

B. 18 hours

C. 24 hours

D. 30 hours

E. 36 hours

Back 76

A.

APMSE 3e p212

RPA D

Front 77

101. [Repeat - 2013A Q48] The clinical sign that a lay person should use to decide whether to start CPR is:

A. Absent central pulse

B. Absent peripheral pulse

C. Loss of consciousness

D. Obvious airway obstruction

E. Absence of breathing

Back 77

E

“unconscious and not breathing normally”

Front 78

102. [Similar to 2013A Q38] Central sensitization, resulting in prolongation of post-operative pain, is caused by:

A. Increased intra-cellular gene expression

B. Increasedintra-cellular magnesium

C. Low frequencyactivation of A-delta fibres

D. Primary activation of N-methyl-D-aspartate receptor

E. Increased glycine asa major neurotransmitter

Back 78

A>D

Front 79

103.[New] A 15yo girl with a newly diagnosed mediastinal mass presents for lymphnode biopsy under general anaesthesia. The most important investigation toperform preoperatively is.

A. CXR

B. CT chest

C. MRI chest

D. PET scan

E. Transthoracicechocardiogram

Back 79

RPA B

LVP B

POW B> C

Front 80

104.[New] A 63yo woman with chronic AF has a history of hypertension, Type 2 Diabetes Mellitus and has previously had a CVA. What is her annual risk of stroke without anticoagulation?

A. <1%

B. 1.9%

C. 2.8%

D. 4%

E. 8.5%

Back 80

E

Use CHADS2

0 = 1.9%

1= 2.8

2= 4%

3=5.9%

4=8.5%

5=12.5%

6=18.5%

Front 81

105.[New] A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is:

A. increase PEEP to 20cmH20

B. increase tidal volume to 10mls/kg

C. initiate nitrous oxide therapy

D. commence high flow oscillatory ventilation

E. ventilate in the prone position

Back 81

E.

OSCILLATE 2013 – worsened mortallity

Prone – 28 and 90 day mortallity improvement

Front 82

106.[Repeat 2013A] The incidence and severity of vasospasm post sub arachnoid haemorrhage is greatest at:

A. 0 -24 hours

B. 2 - 4 days

C. 6 - 8 days

D. 10 - 12 days

E. greater than 2 weeks

Back 82

POW C and D

RPA C

CEACCP– 4 to 10 days

Front 83

107.[Repeat 2013A] The insulation on the power cord of a piece of class 1 equipmentis faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipmentis turned on

A. The double insulation of the device will prevent macroshock when the outer casing is touched

B. The electrical fuse will immediately break and disconnect the device from the power supply

C. Equipotential earthing will prevent microshock from anyone who touches it.

D. The Line IsolationMonitor will alarm and disconnect power to the device

E. The RCD will immediately disconnect the device from the power supply

Back 83

B

A: this refers to a class 2 device

B: correct because the earthed equipment casing will provide a low resistance pathway for conduction resulting in high electrical current. This assumes that there isn't an isolation transformer in the circuit. There is also a fuse in the case.

Front 84

108.[Repeat 2013A] In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT:

A. Allow equal time forchest compression and relaxation

B. Chest compression at 100bpm

C. Chest compression should be at least 5cm depth

D. Give 2 rescue breath before commencement of CPR

E. Chest compression to breaths ratio at 30:2

Back 84

D.

Front 85

109.[New] Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is:

A. distal tibial abovemedial malleolus is preferred due to easy access

B. drug reaction time is the same as central venous route

C. 12G used to ensure adequate flow

D. bicarbonate cannot be infused due to bone damage

E. fat embolism iscommon complication

Other answers:

A. proximaltibia preferred. Distal tibia alternate site in older children and adults only

B. within 1sec but similar to 18G peripheral cannula

C. 15G

D. all IVdrugs can be given at same doses

E. extremelyrare as marrow mostly blood in children – fat in adults

Back 85

B

Front 86

110. [New] During endovascular aneurysm repair, GA is preferred due to:

A. risk of uncontrolled haemorrhage

B. renal ischaemia is painful

C. aorta traction is painful

D. long duration of apnoea is needed

E. contrast used cancause CVS instability

Back 86

POW A/D

RPA A/D

LVP D>A

As per STG answers. No reference. ?CEACCP

Front 87

111.[Repeat 2013A Q26] A 35yo G1P0 with a dilated cardiomyopathy presents for a Caesarean section. She has an ejection fraction of 35%. The benefits of a regional anaesthetic over a general anesthetic in this patient may include:

A. decreased heart rate

B. decreased systolic blood pressure

C. increased ejection fraction

D. decreased preload

E. increased myocardial contractility

Back 87

C.

Front 88

112.[New] In attempting to make a precise diagnosis of parathyroid adenoma, you would expect all of the following are found in hyperparathyroid disease EXCEPT:

A. decreased urinary calcium

B. extraosseous calcifications

C. increased plasma calcium

D. increased urinary phosphate

E. renal calculi

Back 88

A.

Front 89

115.Patient is intubated and ventilated, the ETCO2 trace below is caused by

A. Endobronchialintubation

B. ETT cuff leak

C. Gas sample line leak

D. Spontaneousventilation

E. obstructive airwaydisease

Back 89

C.

Front 90

116.Which general anaesthetic agent contributes the most to green house gas? (Now I'm not 100% sure on the stem recall, but I got the impression it was askingfor the agent that is the absolute worse for green house gases (desflurane),not so much which one do we use the most and thus ends up contributing the mostto the total green house gas volume (iso or sevo)

A. Desflurane

B. Isoflurane

C. Sevoflurane

D. Propfol

E. N2O

Back 90

A.

Front 91

119.[New] A patient's competence to give informed consent is determined by all the following EXCEPT:

A. Ability to communicate a choice

B. Ability to apply reasoning

C. Ability to understand consequences

D. The provision of significant information

E. ??

Back 91

D.

Informed consent is valid if four elements have been satisfied:

1.patient is competent to

2.full information on risks, benefits and alternatives has been provided.

3.consent is freely given; and

4.consent is specific to the procedure.

Test for competency

1- Does the person understand?

2 - Does the person believe what they are being told?

3 - Can the person make a judgment based on this information?

Front 92

120.[Repeat] A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomaticwith no other signs/symptoms of myocardial infarction and have an uneventfulrecovery. What do you do?

A. Arrange for a cardiology follow-up and outpatient angiogram becausehe is at increased risk of future myocardial infarction

B. Arrange coronaryangiogram as an inpatient prior to discharge

C. Inform the patientthat while the result is real the significance is questionable

D. Repeat in one week’stime as a second troponin is a better indicator of long-term myocardialinfarction risk

E. Ignore the result asit is likely a laboratory error

Back 92

A.

Front 93

121. St John's wort will reduce the effect of

A. aspirin

B. clopidogrel

C. dabigatran

D. heparin

E. warfarin

Back 93

E.

"It also induces the P450 2C9 isoform that results in the reduction in effect of warfarin and NSAIDs." Also potentiates the effect of clopidogrel via same enzyme system Herbal medicine and anaesthesia CEACCP 2010

Front 94

122.The most important effect of Lugol's iodine administration before thyroidsurgery is

A. reduce incidence ofthyroid storm

B. reduce incidence ofvocal cord palsy

C. increase likelihood to identify and preserve parathyroid glands

D. pigmentation ofthyroid gland to help identify thyroid gland

E. reduce vascularity of thyroid gland.

Back 94

E.

Lugol's iodine* 5% iodine and 10% potassium iodide distilled in water* administered preoperatively to reduce the release of thyroid hormone and thevascularity -3 drops twice daily beginning 10 days preop-in thyroid storm it can be given IV 0.5-1gm every 8-12 hours. However, more rapid control of the hyperthyroid state can be achieved with betablockers, thionamides.

Front 95

123.(repeat) Performed a brachial plexus block. Normal sensation still remains inmedial forearm. Which part of brachial plexus is most likely to have been missed

A. Inferior trunk

B. Ulnar nerve

C. Median brachialcutaneous nerve

D. Anterior division

E. Posterior cord

Back 95

A.

Front 96

124.(repeat) You are pre assessing A 70 year old patient treated for congestivecardiac failure. They are able to shower themselves and complete other ADLs butget dyspneoa on mowing the lawn. They are New York Heart Associationclassification

A. Class 1

B. Class 2

C. Class 3a

D. Class 3b

E. Class 4

Back 96

B.

Front 97

126 Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to

A. have dosimeter checked at least 6-monthly

B. limit exposure time to radiation

C. maximal distance fromradiation source

D. stand behind transmitter of C arm

E. wear protective garments

Back 97

RPA and RNSH say C

??

STG boys think E, Im not convinced… hard to go past B

Front 98

127Prothrombin VX useful in perioperative period to correct the coagulopathicdefect of all except

A. Isolated factor IIdeficiency

B. Isolated factor VII deficiency

C. Isolated factor IXdeficiency

D. Isolated factor Xdeficiency

E. Warfarin

Back 98

B.

Front 99

129.(Repeat Q) A 70 year old male presents for right lower lobectomy. Preoperativespirometry shows an FEV1 of 2.4L and an FVC of 4.2L. The predictedpost-operative FEV1 is:

A. 1.0

B. 1.3

C. 1.5

D. 1.7

E. 1.9

Back 99

D.

For lobectomy, the simple calculation uses the number of bronchopulmonary segments removed compared with the total number (19) in both lungs.

CEACCP 2006 Assessment of suitability for lung resection

Front 100

130.(Repeat Q) You see a Type 1 diabetic woman preoperatively at 0700hrs who hasbeen starved since 2200hrs for surgery today. You decide to start her on aGlucose-Insulin-Potassium infusion. Insulin decreases glucose levels by:

A. Stimulates glucose uptake into the liver

B. Stimulates glucose uptake into skeletal muscle

C. Inhibits glucose production in the liver

D. Decreases glucose absorption from the gastrointestinal tract

E. Inhibit glucagon release

Back 100

POW C.

RNSH C

Front 101

133.(repeat) The organ that is least tolerant of ischaemia, after removal for transplant, is:

A. Cornea

B. Heart

C. Kidney

D. Liver

E. Pancreas

Back 101

B.

Front 102

134.75yo woman with an ejection systolic murmur presents for elective total kneejoint replacement. Focussed transthoracic echocardiogram is performed. Thefeature most consistent with severe aortic stenosis is:

A. Mean gradient acrossaortic valve of 30mmHg

B. Peak gradient acrossaortic valve of 40mmHg

C. Peak velocity across aortic valve of 4.2m/s

D. Aortic valve area of1.2cm2

E. Calcification andrestriction of the aortic valve

Back 102

C.

Front 103

135.(repeat) Which of the following statements regarding patients with ankylosingspondylitis is FALSE?

A. amyloid renalinfiltration is rarely seen

B. cardiac complicationsoccur in less than 10% of cases

C. normochromic anaemia occurs in over 85% of cases

D. sacroileitis is an earlysign of presentation

E. uveitis is the mostcommon extra-articular manifestation

Back 103

C.

Front 104

136.(repeat) A healthy 25 year old woman is 18 weeks pregnant. Her paternal unclehas had a confirmed episode of malignant hyperthermia.She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is

A. Genetic test father

B. Genetic test woman

C. Muscle biopsy sibling

D. Muscle biopsy father

E. Muscle biopsy woman

Back 104

D

Not all patients can have a biopsy, these include children less than 10-12yrs (30kgs), pregnant women, and patients on prolonged steroid therapy. If the proband cannot be tested, eg a young child or deceased, then the nearest most appropriate relative is tested. In the case of a young child this would be the parents." British MH Association

Front 105

139.During the first stage of labour, pain from uterine contractions + cervicaldilatation is from nerve roots:

A.-E.( multiple options of thoracic - lumbar roots (sorry can't remember theexact ones, thought it was a repeat question so didn't write it all down)

Back 105

Front 106

140.A test has a sensitivity + specificity of 90% for a disease with a prevalenceof 10%. What is the positive predictive value?

A. 10%

B. 50%

C. 82%

D. 90%

E. 99%

Back 106

If the prevalence, sensitivity, and specificity are known, the positive predictive value can be obtained from the following identity:

Therefore PPV=0.9x0.1/0.9x0.1 + (1-0.9)(1-0.1)=0.09/0.09+0.09=50%

Front 107

141.A female with type 1 von Willebrand disease presents for a dilation andcurettage. She is a Jehovah’s Witness. In regards to desmopression to preventhaemorrhage in this patient all of the following are true EXCEPT:

A. It is a synthetic substance and therefore acceptable to Jehovah's Witnesses

B. It is likely toreduce haemorrhage in this patient

C. It should be given asan infusion 30 minutes prior to surgery

D. The effect will last 5 days

E. The dose is 0.3μg/kg

Back 107

D.

Front 108

142.A 25 week post conceptual age infant is being ventilated in the Neonatal Intensive Care Unit. To reduce the risk of retinopathy of prematurity, they arebeing ventilated to a target oxygen saturation of 85-89% instead of 91-95%.This is associated with:

A. Increased acute lunginjury

B. Increased mortality

C. Increased sepsis

D. Reduced intracerebralhaemorrhage

E. Reduced necrotizingenterocolitis

Back 108

B.

Front 109

144.An 80 year old man undergoes a unilateral lumbar sympathectic blockade. THemost likely side effect that he experiences is:

A. Genitofemoral neuralgia

B. Haematuria

C. Postural hypotension

D. Lumbar radiculopathy

E. Psoas haematoma

Back 109

A.

Front 110

145.Regarding Le Fort fractures:

A. External signscorrelate with internal skeletal damage

B. Le Fort fracturesdon't usually occur in combination (for example I and II)

C. Patients with a LeFort I fracture should NOT undergo nasal intubation

D. Patients with a Le Fort II fracture should have evaluation of thebase of skull prior to nasal intubation

E. Le Fort III fractureis associated with fracture of the cribiform plate

Back 110

POW D.

RNSH E

LVP E

RPA

Clinical Anaesthesiology Mikhail pg 782, consider nasal intubation with caution given potential for base of skull fractures

Front 111

145.(repeat) Greatest predictor of AF post CPB

A. advanced age

B. history ofhypertension

C. history of CVA

D. history of CCF

E. prolonged CPB

Back 111

A.

Front 112

146. 2yr child post op following stabismus surgery. ETT 4.5 used. Awake,stridor and tracheal tug. Immediate action?

A. inhalationalinduction

B. CPAP with facemask

C. propofol 1mg/kg

D. dexamethasone0.4mg/kg

E. adrenaline nebuliser1:1000 0.5ml/kg

Back 112

B.

CEACCP 2008, Tracheal extubation. Laryngospasm: Most common cause of upper airway obstruction and mostly in children due to extubation in light planes of anaesthesia. Mx; Oxygen, jaw thrust, clear secretions, CPAP, propofol (20% induction dose) and sux (0.5mg/kg to relieve obstruction) Oedema: Risk factors: difficult intubation, surgery > 1h or coughing on ETT CEACCP 2007 Acute Stridor in Children. Clinical signs generally occur within 30mins of extubation and respond well to treatment with nebulised epinephrine (0.5ml/kg 1:1000) and iv dexamethasone 0.25mg/kg, warm humdified oxygen or heliox.

Front 113

149.Transient neurological (radicular) syndrome ONLY occurs with

A. Hyperbaric localanaesthetics

B. Intrathecallignocaine

C. Lithotomy positioning

D. Following complete resolution of motor blockade

E. When there has been adense motor block with spinal anaesthetic

Back 113

D.

Front 114

150.50yo lady, attempted suicide attempt, jumped from 5th floor building. She doesnot open her eyes or vocalise and there is no response to pressure on hernail-bed. What is her GCS?

A. 2

B. 3

C. 5

D. 8

E. 12

Back 114

B.