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73 Cards in this Set

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Bleeding patient. What is relative contraindication to Prothrombinex?

A. History of HITS
B. Von Willebrands
C. Haemophilia B
D. Warfarin overdose
E. Renal failure
F. Overdose vit K (not warfarin)

A

Prothrombinex has 192 units of heparin per ampoule
Indication for percutaneous closure of ASD

A. Ostium primum < 3cm
B. Ostium primum > 3cm
C. Ostium secundum < 3 cm
D. Ostium secundum > 3cm
E. Sinus venosus ASD
C

"Of these, only an ostium secundum ASD is suitable for percutaneous closure..." CEACCP 2008
Methylene blue given intravenously has the effect:

A. Pulse oximetry goes down
B. Blood Gas Pa02 decrease
C. Hypotension
D. Metabolic acidosis
E. Increased heart rate
A
Essential diagnostic criteria on ECG for LBBB

A. Loss of septal Q's in V5 and V6
B. RSR in V1
C. Large slurred S in V6
D. T-waves opposite to direction of QRS
E. QRS duration minimum 0.2 s
A

Diagnostic criteria for LBBB:

Total QRS duration >0.12 s.
No secondary R wave in V1 to indicate RBBB.
No septal q wave in lateral leads (I, aVL, V5, V6)
Patient over-warfarinised and is for surgery. Prothrombinex 50U/kg may NOT reverse an INR of 5.5 because it contains:

A. Citrate
B. Heparin
C. Anti-thrombin III
D. Not enough Factor VII
E. Not enough Factor X
D Prothrombinex has II, IX and X only

It does contain human plasma proteins < 500mg (incl VII), but VII levels are low and unquantified
Ventricular fibrillation (VF) following caudal anaesthesia in 20kg six year old child. The recommended dose of of Intralipid 20% is:

A. 10mls
B. 20mls
C. 30mls
D. 40mls
E. 50mls
C

Dose of Intralipid 20% is 1.5 ml/kg = 30ml
According to PS9 for sedation with propofol for colonscopy, the staff required is/are:

a. Medical practitioner other than proceduralist
b. Nurse other than proceduralist
c. Anaesthetist in addition to the proceduralist
d. Assistant
e. Proceduralist alone
Answer is A

Propofol may be used by a medical practitioner with airway and resuscitation skills, and training in sedation for conscious sedation in ASA P 1-2 patients.
Intravenous anaesthetic agents such as propofol must only be used by a second medical practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist...From PS9
Troponin is elevated post-infarct

A. 1-2 days
B. 2-5 days
C. 5-14 days
D. 7-21 days
C

Rises 4-6h after onset
Peaks 12-24h
Can be elevated up to 10 days
Laparoscopic cholecystectomy patient with hyperparathyroidism and ionised calcium of 2.0 mmol/l. The BEST initial treatment is:

A. Calcitonin
B. Magnesium
C. Dialysis
D. IV fluids
E. Frusemide
D

OHA - Initial management should be rehydration; as Ca++ inhibits ADH.

Promotion of a diuresis also increases excretion of Calcium. Texts then defer as to the next treatment; OHA says Pamidronate IV, but also states a saline diuresis with frusemide is 2nd line. Calcitonin is temporary.
Your patient given thiopentone by mistake has a porphyric (acute intermittent) crisis with abdominal pain and then seizures. What drug is contraindicated?

a. Phenytoin
b. Morphine
A
Fit lady for elective laparoscopic cholecystectomy seen in PAC. ECG shows LAD, RSR in V1, wide slurred S in V6 and QRS duration 0.2 msec. Your options

a. Refer to cardiology
b. Crack on
c. Place permanent pacemaker
d. Place temporary pacing wires
e. Give atropine premedication
B

Bifascicular block
All these nerves provide some sensation to upper arm EXCEPT

a. Musculocutaneous
b. Intercostobrachial
c. Radial
d. Circumflex
e. Median antebrachial
A

musculo- (ie motor) ABOVE the elbow THEN
sensory (as lateral cutaneous nerve of the forearm) BELOW the elbow -ie NO sensory above elbow.
Advantage of supraclavicular over interscalene nerve block for shoulder surgery

a. Less phrenic nerve block
b. Easier landmarks in obese patient
c. Arm can be in any position for block
d. Less risk pneumothorax
e. Better cover for shoulder surgery
A
The basilic vein

a. Arises from the dorsum of the hand
b. Follows the superficial radial artery
c. Pierces the clavipectoral fascia
d. Becomes the brachial vein at the cubital fossa
e. Arcs around the radial side of the forearm
A

A: true (although cephalic vein also arises from dorsum of the hand)
B: Travels up ulna aspect of arm
C: Pierces the brachial fascia midway up upper arm (Cephalic v pierces clavipectoral fascia)
Long duration of surgery, arms stretched out, head turned 30 degrees to right. On waking patient has a neurological deficit. Sensory loss over ventral lateral palm and 3 fingers, some weakness of the hand, weakness of the wrist, some paraesthesia of the forearm and weak elbow flexions. Most likely injury is

A. Median nerve
B. Ulnar nerve
C. C5 nerve root
D. Upper cervical trunk
E. Musculocutaneous
D if upper trunk of brachial plexus
Paediatric ALS – 20 kg, VF has had 2 shocks only. Next step

a. Adrenaline
b. Amiodarone
c. Shock 50J
d. Shock 100J
A
Patient with known severe aortic regurgitation. Auscultation reveals loud mid diastrolic murmur in aortic area. You also hear a quiet mid diastolic murmur in the apex. This is

a. Functional mitral stenosis
b. Mitral valve incompetence
c. Impaired LV function
d. Papillary muscle dysfunction
A

Austin Flint murmur
Hetastarch 130/0.4. The 0.4 means:

A. 40 mg/l
B. 40 g/l
C. 4 hydroxylations of every 10 glucose molecule
D. every 4the glucose is hydroxyethylated
C.

The 130 is the molecular weight of the starch, while the 0.4 is the molar substitution.

To clarify, the MS (molar substitution) is the ratio of hydroxyethyl groups to glucose residues
Hetastarch. What one to use for intermediate plasma expansion and intermediate plasma half life

A. 450/0.4 (10%)
B. 130/0.7 (6%)
C. 130/0.4 (6%)
C
Maternal collapse post-delivery. What is NOT consistent with amniotic fluid embolism?

a. Seizure
b. Petechial rash
c. Hypotension
d. Coagulopathy
e. Cardiac arrest
B

Occurs in 1 in every 8-30,000 pregnancies
Maternal mortality: 60-80%
Accounts for 5-10% of all maternal deaths
Of survivors, only 15% are "neurologically intact"
Trauma with # pelvis and femur. Has a splenectomy. Day 2 patient thrombocytopenia, confused and hypoxic. Diagnosis is

a. fat embolism syndrome
b. pneumcoccal pneumonia
c. thromboembolism
A
Indications for steroids in neurosurgery

a. Cerebral abscess
b. Subdural haematoma
c. Meningioma
d. SAH
e. Traumatic brain injury
C
Rate of phenytoin administration:

a. 50 mg/min
b. 70 mg/min
c. 100 mg/min
d. Over 5 minutes
e. As fast as possible
A
Hypothetical anaesthetic agent. Flows 2 L oxygen and 2L nitrous. Copper kettle vaporiser flow 0.5 L. Volatile with SVP 380 mmHg. Inspired volatile concentration

a. 2%
b. 5%
c. 10%
d. 11%
3. 15%
C

A copper kettle has a dedicated flow meter which is dialed up separately. To make your 0.5L of gas flow fully saturated with vapour at an SVP of 380mmHg, you need to double it (ie 380mmHg of vapour in 380mmHg of gas = 760mm Hg). This is mixed with the FGF which is separate; thus giving 500mL of vapour, 500mL of gas which went into the copper kettle, 2L of oxygen and 2L of nitrous.
Negative pressure leak test in a Boyles type machine. This means

a. Vaporiser leak
b. Circuit leak
c. Brain leaking out of my ears by now
d. Leak in non return valve
A
As per ANZCA Acute Pain Guidelines (2nd ed update), after a prophylactic subcutaneous dose of heparin, minimum time before you can remove epidural catheter is

a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours
e. 10 hours
C.

Different to other guidelines = 4h

Drug / Stop before CNB / Wait after CNB
UFH SC / 6 / 2
LMWH prophylaxis 12 / 2
UFH IV / 4 / 2
LMWH therapeutic 24 / 6

Wait 24h for any if blood in catheter
Do not give additional antiplatelet w/ heparin if regional anaes
Utility of BNP (brain naturietic peptide) is for

a. Dyspnoea after pneumonectomy
b. Loss of consciousness after ..
c. Confusion after CABG
A
Which patients do not get pulmonary hypertension

a. ASD
b. Chronic thromboembolism
c. Tetralogy
d. MR
e. MS
C

Some degree of RVOT obstruction thus pulmonary blood flow is decreased, and mitral valve is competent so there is no increase in LA pressure.
Drug LEAST likely to cause hypoxia in ARDS

a. Noradrenaline
b. Milrinone
c. Isoprenaline
d. Isoflurane
e. SNP
A.
Pulmonary hypertension, which will affect PVR the most

a. Isoflurane
b. Sevoflurane
c. Desflurane
d. Propofol
e. Remifentanil
C

N20 and des increase PVR
Propofol no effect
Remi small dec PVR
Iso and sevo do not adversely affect PVR
In body protected OR with a Line Isolation Monitor reading 0 mA. If you touch one active wire what will happen.

a. nothing, because no connection to earth is completed
b. you get shocked
c. nothing because the floor is insulated
d. nothing because your shoes are nonconductive
e. RCD trips
A

0mA means everything is fine and properly isolated so the circuit is not earth referenced.
Best way prevent first phase of heat loss after induction

a. Prewarming the patient with forced air warming
b. Warm blankets
c. Warm fluids
d. Warm theatre
e. Humidified gases
A

pre-warming eliminates the gradient between core and peripheries thus the redistribution phase does not occur.
Best way to assess fluid resuscitation after burns is

a. Urine output
b. mixed venous sats
c. blood pressure
d. cvp
e. capillary refill
A
Emergence delirium in a kid in recovery. To treat
a. Fentanyl 1mcg/kg
b. Midazolam 0.1 mg/kg
c. Propofol
d. Clonidine 1mc/kg
e. Sucrose
a-d
Pain in 3 year old, best objective tool

a. FLACC (crying limbs activity consolability)
b. Wong baker Faces pain
c. Self reporting
d. Mum reporting
e. Nurse reporting
A.

Wong Baker faces (revised) for 4 to 12 years. Any form of self reporting usually not possible until the age of 4. From APMSE 3rd edition.
Best time to collect serum tryptase after suspected anaphylaxis

a. within 15 minutes
b. 1 - 3 hours
c. 3 - 6 hours
d. 12 - 24 hours
e. greater than 36 hours
a

Immediately, 1h and 6-24h
Patient with Hemophilia A with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for OT

a. FVIIa
b. High dose FVIII concentrate
c. FFP
d. Cryo
e. Platelets
A
Pregnant women whose paternal uncle has MH. Nobody has been tested. What's the best test to exclude MH in this patient?

a. Genetic test lady
b. genetic test dad of lady
c. muscle biopsy lady
d. muscle biopsy dad
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. Once the proband has been confirmed as MH susceptible, a blood sample taken at the time of the biopsy will be screened to see if they carry one of the genetic mutations that can be used to test for MH. At present only around 60% of families carry one of these mutations of which there are currently 27
A woman is being treated for pre-eclampsia. She is given 10 grams Magnesium sulphate in 1 h, instead of 1g per 1 h, Mg level 5-6, and patient is hyporeflexic. The best treatment is:

a. calcium
b. IV fluid
c. Furosemide
A

Ca gluconate 1g over 10mins
Disease associated with malignant hyperthermia

a. central core disease
b. myasthenia gravis
c. myotonia congenita
A
Appropriate infection control measures when anaesthetising a patient with suspected variant-CJD, the airway equipment should be

a. thrown away
b. plastic sheath, reuse
c. sterilization with ethylene oxide
d. sterilization with heat at 134 degrees for 3 minutes
e. Autoclave
A
Timing of worst coagulopathy after liver transplant

a. 1-2 days
b. 3-4 days
c. 5-6 days
A
Anaesthetic management in patient with cardiac tamponade

a. bradycardia for the ventricle filling time
b. inotropes
c. volume loading
B, C

Full, fast (90-140), tight (high SVR for coronary perfusion
Doing an awake CEA. Patient becomes confused & combative after carotid clamped and opened. Priority is...

a) tell surgeon to release clamp
b) tell surgeon to place shunt
c) induce GA
d) give midazolam
B
You intubate a young male patient for a left thoracotomy with a 39FG Robert Shaw tube. When you inflate both cuffs and ventilate the bronchial lumen you get left sided ventilation. When you attempt to ventilate the tracheal lumen the pressures are very high and you get no air entry. Yet when you deflate both cuffs you can ventilate the patient through the tracheal lumen. The most appropriate step to take next is:

A. Change to a 41FG tube
B. Change to a 37FG tube
C. Deflate both cuffs and insert further cm and recheck
D. Deflate both cuffs and withdraw a few cm and recheck
E. Pull ETT out and start again.
C

Bronchial cuff isolating L main bronchus but herniating and partially obstructing R main bronchus
Patient with IV in right arm, has mediastinal mass and SVC compression undergoing mediastinal biopsy, suddenly uncontrolled surgical bleeding in mediastinum. Next step in management prior to thoractomy:

A. insert femoral cannulae and place on bypass
B. insert IV in left arm
C. insert IV into foot
D. insert jugular CVC
E. trendelenburg
C

If hemorrhage originates from a tear in the superior vena cava, volume replacement and drug treatment may be lost into the surgical field unless they are administered through a peripheral intravenous line placed in the lower extremity...Miller
ASA grading was introduced to

A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk
C

Specifically noted not to predict anaesthetic/surgical risk
Pulsus paradoxus is:

A. Reduced BP on inspiration unlike normal (ie normally increased on insp)
B. Reduced BP on inspiration exaggerated from normal
C. Reduced BP on expiration unlike normal
D. Reduced BP on expiration exaggerated from normal
E. ?
B

> 10 mm Hg fall
What antibiotics are required for bacterial endocarditis prophylaxis in a woman with MV prolapse for cholecystectomy.

A. None
B. gentamicin
C. ampicillin and gentamicin
D. ampicillin
E. cephazolin
E

For routine skin cover

Prosthetic valve or valve repair material
PHx BE
Unrepaired cyanotic congenital heart disease
Partially repaired cynanotic CHD + defect over the repair
Repaired CHD within the 1st 6 months of repair
Heart transplant with valvulopathy
Rheumatic heart disease in Indigenous
Plasma glucose level compared to blood glucose level

a) 32% higher
b) 14% higher
c) same
d) 14%lower
e) 32% lower
B

Because RBCs have a higher concentration of protein (e.g., hemoglobin) than serum, serum has a higher water content and consequently more dissolved glucose than does whole blood.

To convert from whole-blood glucose, multiplication by 1.15 has been shown to generally give the serum/plasma level.
You are called for a labour epidural. The woman is extremely distressed and in the middle of your consent process states “Just take my pain away” . You:

A. Place epidural then when calmed return to advise her of risks and complications
B. Explain she has to hear all the potential complications and refuse to place epidural without consent
C. Take consent from partner
D. Perform spinal to relieve pain, then consent her for epidural
E. Go away and return when she is more cooperative
A
Pre-eclamptic woman BP 180/110. Aim to drop BP to

a) 150-160
b) 140-150
c) 120-130
d) 110-120
e) 100-110
B

"Blood pressure should be lowered to levels of SBP 140-150/DBP 90-100 at a rate of 10-20 mmHg every 10-20 minutes" Management of Pre-eclampsia and Eclampsia ANZCA
4 yr old presents for elective surgery, otherwise fit healthy, murmur at left sternal edge on auscultation heard in systole and diastole, disappears on lying down. Most likely cause:

A. HOCM
B. VSD
C. PDA
D. venous hum
E. ASD
D

HOCM- relieved with squatting and passive leg raise
VSD- relieved with Valsalva
PDA- a continuous murmur
Neonate born to known drug abusing mother brought to emergency department by grandmother, unwell lethargic, slightly jaundiced, ABG shows following:

pH 7.52 Na 135 Cl 87 K 3 pCO2 38

Which of the following is the Diagnosis?

A) Septicaemia
B) Hepatitis
C) Pyloric stenosis
D) Pneumonia
E) Opioid withdrawal
C

Vomiting = loss water, H+ Cl-, Na, K = alkalotic
Inc HCO to kidney- loss of Na and water = alkalotic urine
Dehydration activates RAAS- loss of K in urine
Worsening hypoNa and hypoK- kidneys exchange for H+ =
acidic urine

Remains alkalotic due to inability to excrete HCO3 for Cl
You are anaesthetising a patient with multiple sclerosis. The best way to avoid a flare up of this patients multiple sclerosis following the anaesthetic is to

A. Avoid dehydration
B. Avoid overheating the patient
B

"...increases in body temperature should be avoided. Demyelinated fibres are extremely sensitive to increases in temperature; an increase of as little as 0.5 C may completely block conduction"...Morgan and Mikhail p588
70 y old patient with AF (rate 80/min) in pre-admission clinic booked for ant resection. (it was not mentioned if AF was old or new or if on patient was on any medication) What management?

A. Crack on
B. Echocardiography and Cardioversion
C. Immediate Cardioversion
A
Ketamine for acute pain relief

A. an appropriate dose is 0.5 -1 mg/kg
B. Midazolam does not help in unpleasant dreams / delirium
C. Morphine is contraindicated
D. Hallucinations are common
E. Subcut is better than IV
D
TRALI most likely after transfusion of
A. Red Blood Cells
B. Platelets
C. FFP

E. ?
C
Which volatile has the minimum effect on ICP at 1 MAC

A. Isoflurane
B. Sevoflurane
C. Desflurane
D. Enflurane
E. Halothane
B

Sevoflurane is the least vasoactive substance among all volatile anesthetics with nearly no impact on cerebral blood volume and intracranial pressure in concentrations below 1.0 MAC [3,9,10]."
In patients undergoing thoracotomy, techniques which reduce the incidence of intraoperative atrial fibrillation include

A. hyperventilation
B. pre-operative loading with digoxin
C. rocuronium, rather than pancuronium
D. thoracic epidural bupivacaine
E. thoracic epidural morphine
D
During laparoscopic surgery, pneumoperitoneum usually results in a fall in cardiac output when intra-abdominal pressure exceeds

A 10mmHg
B 20mmHg
C 30mmHg
D 40mmHg
E 50mmHg
A

CO falls from 10mmHg
BP falls above 20mmHg
Factors associated with post-operative ulnar nerve palsy include all of the following EXCEPT

A. male gender
B. sternal retraction for cardiac surgery
C. cardiopulmonary bypass for cardiac surgery
D. internal jugular vein catheterisation
E. diabetes mellitus
C
32 year old with early acute liver failure (not paracetamol related). Management includes

A. prophylactic antibiotics
B. N-acetyl cysteine as general liver protection
C. avoid early intubation so can assess for encephalopathy
D. INR> 3 means should be considered for transplant??
E. avoid saline as resuscitation fluid
E
Carcinoid syndrome - finding on examining heart:

A. Fine inspiratory crepitations
B. Systolic murmur at apex
C. Systolic murmur at left sternal edge
D. Murmur at apex with opening snap
E. Pericardial rub
C
The intraoperative hypothermia for aneurysm surgery trial (IHAST) showed that cooling to a target temperature of 33°C

A. did NOT improve neurological outcome in WFNS (World Federation of Neurosurgical Surgeons) in grade I-III patients
B. did NOT improve neurological outcome in WFNS grade IV-V patients
C. improved neurological outcome in WFNS grade I-III
D. improved neurological outcome in WFNS grade III
E. improved neurological outcome in WFNS grade IV-V
A
12 year old child with hip dislocation at 4pm. Ate something 1 hour after injury. Now 11 pm. Best anaesthetic:

A. RSI with ETT
B. delay until next day then treat elective
C. inhalational induction and continue with face mask
D. Reduce immediately with iv sedation
E. inhalational induction and continue with face mask
A
What is 1 MET uptake of oxygen DUKE'S ?

A. 1-2 ml O2/kg/min
B. 2-3 ml O2/kg/min
C. 3-4 ml O2/kg/min
D. 5-6 ml O2/kg/min
E. 7-8mls O2/kg/min
C

1 MET = 3.5 mL O2/kg/min
Anaemia in chronic renal failure is characteristically

A. due to haemolysis in the renal vascular bed
B. normochromic and microcytic
C. due to defective haemoglobin synthesis
D. responsive to iron and folate therapy
E. associated with increased 2,3-DPG levels in blood cells
E
Which drug is an example of a specific PDE III inhibitor:

a. Aminophyline
b. Sildenafil
c. Milrinone
d. Dipyridamole
C
The tapered connector between the ETT and machine is

a.12-20mm
b. 15-22mm
c. 20-30mm
d. 22-30mm
e. 25-35mm
B
Art line system

a. Overdamped exaggerates mean
b. Underdamping increases mean
c. Underdamping underestimates systolic
d. Long random option about multiple damping coefficients in an optimal system
e. Compliant tubing is good
None

Damping of the pressure waveform due to poor positioning of the cannula, or the use of overly compliant tubing, underestimates systolic pressure and overestimates diastolic pressure. The mean pressure is still reasonably accurate.
Mechanism of action of antiepileptics in chronic pain, which is false?

a. Phenytoin workes at Na channels
b. Gabapentin increases gaba in cns
c. Carbamazepine works at Na channels
d. Valproate increases GABA in the CNS
e. lamotrogine acts at Ca channel
E

Lamotrigine works on Na channels
Obstructive sleep disorder in children

A. is associated with pulmonary hypertension and dysfunction of left and right ventricles
B. has obesity as a major risk factor
C. is rarely seen in children less than 8 years old
D. is four times more prevalent in boys than girls
E. does NOT usually require tonsillectomy for its management
A

Children with long-standing OSA syndrome who become chronically hypoxaemic and hypercarbic may develop acute respiratory failure and right ventricular failure." (Anaesthesia 1998; 53:571-579)

"Children usually present between 3 and 7 years of age"

"In contrast with adult OSA, in children there is an equal prevalence of affected boys and girls"