Anzca Mcq 2010 March

Front 1

An 18 yo with Fontan Circulation undergoing exploratory laparotomy. On ICU vent, sats 70%. Which ventilator parameter would you INCREASE to improve his sats?

A. Bilevel pressure
B. Expiratory time
C. Inspiratory time
D. Peak inspiratory pressure
E. PEEP

Back 1

Ans B

CEACCP 2008
Low respiratory rates, short inspiratory times, low PEEP, and tidal volumes of 5 – 6 ml kg-1 usually allow adequate pulmon-ary blood flow, normocarbia, and a low PVR.

Front 2

A 7 kg Infant with tetralogy of Fallot, post BT-shunt. Definitive repair at later date. Paralysed and vetilated. sats 85% baseline, now 70%, best treatment:

A. Increase FiO2 from 50 - 100%
B. Esmolol 70 mcg
C. Phenylephrine 35 mcg
D. Morphine 1 mg
E. 1/2 NS with 2.5% dex 70 mls

Back 2

C

Increase systematic resistance to reverse right to left shunt.

Front 3

Von Hippel-Lindau disease is associated with:

A. increased risk of malignant hyperthermia
B. meningiomas
C. peripheral neuropathy
D. pheochromocytomas
E. poor dentition

Back 3

D. Pheo

"Management of anesthesia in patients with von Hippel-Lindau disease must consider the possible presence of pheochromocytomas" (Stoelting)

von Hippel-Lindau disease (VHL) is a rare, genetic multi-system disorder characterized by the abnormal growth of tumors in certain parts of the body (angiomatosis).
The tumors of the central nervous system (CNS) are benign and are comprised of a nest of blood vessels and are called hemangioblastomas (or angiomas in the eye). Hemangioblastomas may develop in the brain, the retina of the eyes, and other areas of the nervous system.
Other types of tumors develop in the adrenal glands, the kidneys, or the pancreas.

Symptoms of VHL vary among patients and depend on the size and location of the tumors.
Symptoms may include headaches, problems with balance and walking, dizziness, weakness of the limbs, vision problems, and high blood pressure. Cysts (fluid-filled sacs) and/or tumors (benign or cancerous) may develop around the hemangioblastomas and cause the symptoms listed above. Individuals with VHL are also at a higher risk than normal for certain types of cancer, especially kidney cancer.
Inheritance = Familial Autosomal dominant
Features= Retinal angiomas, Haemangioblastomas, Cerebellar and visceral tumours (usually benign but can cause pressure effects)
Associations = An increased incidence of Phaeochromocytoma - apparently 20%, Renal cysts, Renal cell carcinoma

Anaesthesia= Treat hypertension occurring with phaeochromocytoma, Haemangioblastoma of spinal cord may limit use of spinal although epidural has been used for LSCS, Exagerrated hypertension with surgical stimulation or laryngoscopy = Treat with β blockers and/or SNP

From recollection, Phaeos are associated with the Diseases of Von- Ie. Von Recklinghausen and Von Hippel Lindau.

Front 4

70 year old post TJR. On sub-cut heparin. Develops clinical DVT and platelets 40 (sounds like HITS type-II). Management-

A. Enoxaparin
B. Fondoparinux
C. Heparin by infusion
D. Lepirudin
E. Warfarin

Back 4

Ans D

Front 5

Drug eluting stent 6 months old. On aspirin and prasugrel 10mg. Elective lap cholecystectomy for biliary colic.

A. Do case while taking both.
B. Do case while stopping both.
C. Stop Prasugrel for 7 days, keep taking aspirin.
D. Stop Prasugrel for some other different time
E. Post-pone for 6 months

Back 5

Ans E

ACC/AHA Pre-op:
DRUG ELUTING:
Thrombosis of DES may occur late and has been reported up to 1.5 years after implantation, particularly in the context of discontinuation of antiplatelet agents before noncardiac surgery.

Discontinuation of antiplatelet therapy in the early-surgery group resulted in a 30.7% incidence of MACE (all fatal) versus a 0% incidence in early-surgery patients who continued dual antiplatelet therapy perioperatively. Overall, there was no difference in MACE between patients with bare-metal stents and those with DES. The study reported that all patients with MACE had discontinued antiplatelet therapy before surgery, whereas only 46% without MACE had done so. The study also stated there was no difference in surgical risk between patients in whom antiplatelet agents were discontinued and those in whom they were not. Excessive blood loss occurred in 2 patients, 1 of whom was receiving antiplatelet agents and 1 of whom was not.

** The panel concurred with the AHA/ACC guideline recommendation for 12 months of dual-antiplatelet therapy after DES implantation in patients who are not at high risk for bleeding.
**1. Before implantation of a stent, the physician should discuss the need for dual-antiplatelet therapy. In patients not expected to comply with 12 months of thienopyridine therapy, whether for economic or other reasons, strong consideration should be given to avoiding a DES.

BARE METAL:
A thienopyridine (ticlopidine or clopidogrel) is generally administered with aspirin for 4 weeks after bare-metal stent placement. The thienopyridines and aspirin inhibit platelet aggregation and reduce stent thrombosis but increase the risk of bleeding. Rapid endothelialization of bare-metal stents makes late thrombosis rare, and thienopyridines are rarely needed for more than 4 weeks after implantation of baremetal stents. For this reason, delaying surgery 4 to 6 weeks after bare-metal stent placement allows proper thienopyridine use to reduce the risk of coronary stent thrombosis; then, after the thienopyridine has been discontinued, the noncardiac surgery can be performed. However, once the thienopyridine is stopped, its effects do not diminish immediately. It is for this reason that some surgical teams request a 1-week delay after thienopyridines are discontinued before the patient proceeds to surgery. In patients with bare-metal stents, daily aspirin antiplatelet therapy should be continued perioperatively. The risk of stopping the aspirin should be weighed against the benefit of reduction in bleeding complications from the planned surgery. In the setting of noncardiac surgery in patients who have recently received a bare-metal stent, the risk of stopping dual-antiplatelet agents prematurely (within 4 weeks of implantation) is significant compared with the risk of major bleeding from most commonly performed surgeries.

Front 6

For a person newly diagnosed as MH susceptible, which is true?

B. Can have had an uneventful 'triggering' anaesthetic
C. Recommended to use an anaesthetic machine which has not had volatiles through it
E. There have been case reports of MH occurring up to 48 h post op

Back 6

B and
E
CAECCP Malignant Hyperthermia
On average, patients found to be susceptible to MH have had three previous uneventful general anaesthetics.

Front 7

ABG pH 7.12, PO2 100, PCO2 65, HCO3 20.3, BE -10. Consistent with?

A. Chronic renal failure
B. Malignant hyperthermia
C. Diabetic ketoacidosis
D. End-stage respiratory failure
E. Ethylene glycol toxicity

Back 7

Ans B

Metabolic acidosis and respiratory acidosis

Front 8

Cocaine overdose. What is false?

A. Euphoria
E. Miosis

Back 8

E

Front 9

Aneurysm sugery. Propofol / remifentanil / NMDR. DOA monitoring (Entropy). MAP 70 , HR 70/min, State entropy 50, Response entropy 70. What do you do?

B. Metaraminol
C. Check TOF
D. Nothing
E. Increase TCI

Back 9

C

SE is depth of anaesthesia
RE measures the temporalis muscle activity. This suggest paralysis is wearing off

Front 10

Plenum Vaporiser

A.? something with fresh gas flows
B. Relies on a constant flow of pressurised gas
C. Out of circle
D. Not temperature compensated
E. volatile injected into fresh gas flow

Back 10

B

Upstream gas source required to push fresh gas through the vaporizer (opposite to Draw-over vaporizer)
Most ARE temperature compensated

Front 11

Interscalene block, patient hiccups...where do you redirect your needle?

A. Anterior
B. Posterior
C. Caudal
D. Cranial
E. Superficial

Back 11

B

Front 12

Accidentally cannulate carotid artery with 5 lumen 7 Fr CVC preop for a semi urgent CABG. Most appropriate next response is to

A. Get vascular surgeon to repair it and continue with surgery and heparin
B. Leave it in. Do CABG. Pull it out post op.
C. Pull it out, compress. Delay surgery for 24hrs
D. Pull it out compress. Continue with surgery + heparin.
E. Pull it out. Compress. Continue with surgery no heparin

Back 12

Ans A

Guilbert M-C, Elkouri S, Bracco D et al. Arterial trauma during central venous catheter insertion Case series, review and proposed algorithm. J Vasc Surg 48:918-985, 2008

Postponing elective surgery will ensure that the anesthetized patient is not having an unrecognized stroke. Kron and colleagues recommend postponing elective open-heart surgery after two patients suffered serious complications when surgery was performed immediately after removal of the misplaced large sheath.

Complications with catheter removal and compression
1. Massive stroke and death
2. AV fistula require surgical repair
3. Pleural effusion, lung collapse require thoracic surgery to repair arterial hole and lung decortications
4. Hematoma and uncontrolled bleeding requiring open surgery to repair jugular vein and carotid artery

Front 13

Patient for total knee replacement under spinal anaesthetic. Continous femoral nerve catheter put in for post op pain relief. Good analgesia and range of motion 18hrs post op. 24hrs post op, patchy decreased sensation in leg and unable flex knee. What is the cause?

A. Compression neurapraxia
B. DVT
C. Muscle ischaemia
D. Damage to femoral nerve
E. Spinal cord damage

Back 13

A

Inability to flex the knee is not a femoral nerve problem - it is sciatic. This problem seems to have clinical onset at about 24 hours.
A: True. It is possible to be due to compression neurapraxia by tourniquet.
B: False: DVT does not cause neurological symptoms
C. Muscle ischaemia is unlikely to happen post 24 hours for knee replacement.
D. False: The symptoms is more sciatic
E False, generally bilateral distribution

Front 14

A 75yo male with moderate aortic stenosis (valve area 1.1cm2). Gets mild dyspnoea on exertion but otherwise asymptomatic. needs hip replacement.

A. Continue with surgery
B. Beta block then continue
C. Get myocardial perfusion scan
D. Postpone surgery awaiting AVR
E. Postpone surgery awaiting balloon valvotomy

Back 14

D

ACC/AHA 2007 guideline on perioperative cvs evaluation and care for noncardiac surgery
In symptomatic aortic stenosis, elective noncardiac surgery should generally be postponed or cancelled. Such patients require aortic valve replacement before elective but necessary noncardiac surgery.

If the aortic stenosis is severe but asymptomatic, the surgery should be postponed or cancelled if the valve has not been evaluated within the year.
On the other hand, in patients with severe aortic stenosis who refuse cardiac surgery or are otherwise not candidates for aortic valve replacement, noncardiac surgery can be performed with a mortality risk of approximately 10%.
If a patient is not a candidate for valve replacement, percutaneous balloon aortic valvuloplasty may be reasonable as a bridge to surgery in hemodynamically unstable adult patients with aortic stenosis who are at high risk for aortic valve replacement surgery and may be reasonable in adult patients with aortic stenosis in whom aortic valve replacement cannot be per-formed because of serious comorbid conditions.

Front 15

Patient for fempop bypass, history of CCF. Also has diabetes on oral hypoglycaemics, controlled hypertension and atrial fibrillation at rate of 80bpm.

A. Medium risk surgery, medium risk patient
B. Medium risk surgery, high risk patient
C. High risk surgery low risk patient
D. High risk surgery, medium risk patient
E. High risk surgery, high risk patient.

Back 15

Ans D
refer AHA

Front 16

Best Approach for a Sub-Tenon's block?

A. inferonasal
b. inferotemporal
c. medial canthus
d. superior nasal
e. superior temporal

Back 16

A

Front 17

Baby with TracheoOesophageal Fistula found by bubbling saliva and nasogastric tube coiling on xray. Best immediate management?

A. Bag and mask ventilate
B. Intubate and ventilate
C. position head up, insert suction catheter in oesophagus
D. Place prone, head down to allow contents to drain
E. Insert gastrostomy

Back 17

C

Front 18

A 60yo Man with anterior mediastinal mass, during induction for mediastinoscopy....lose cardiac output, decreased saturations, drop in ETCO2. Management

A. Adrenaline
B. CPR
C. CPB
D. Place prone

Back 18

D

Management of the patient with a large anterior mediastinal mass: recurring myths
Curr Opin Anaesthesiol 20:1-3 2007

Should try wake up the patient.
Intraoperative life-threatening airway compression has usually responded to one of two therapies:
1. Repositioning of the patient (it should be determined before induction if there is one side or position that causes less symptomatic compression)
2. Rigid bronchoscopy and ventilation distal to the obstruction (this means that an experienced bronchoscopist and rigid bronchoscopy equipment must always be immediately available in the operating room during these cases).

For patients with life-threatening cardiovascular compression after induction that does not respond to lightening the anesthetic the only therapy is immediate sternotomy and surgical elevation of the mass off the great vessels.

Front 19

Post thyroidectomy patient, patient in PACU for 30 minutes. Develops respiratory distress. Most likely cause?
A. Hypercalcemia from taking parathyroids
B. Bilateral laryngeal nerve palsies
C. bleeding and haematoma
D. Tracheomalacia

Back 19

Ans C

Front 20

Best way to prevent hypothermia in patient undergoing a general anaesthetic (Repeat question)

A. Prewarming of patient
D. Warm IV fluids

Back 20

Answer A

Front 21

Desflurane vaporiser, heated because of

A. High SVP
B. High boiling poing
C. Low SVP
D. High MAC
E. Low MAC

Back 21

A

Front 22

Most common cause of maternal cardiac arrest

A. PE
B. AFE
C. Haemorrhage
D. Preeclampsia
E. cardiomyopathy

Back 22

Ans A

Front 23

Most likely change on CTG with anaesthesia for non-obstetric surgery at 32 wks

A. Loss of beat to beat variability
B. No change
C. Late decels
D. Variable Deccels
E. uterine contractions

Back 23

A

Evidence based practice of anaesthesiology (Fleischer)under conditions of very light sedation most narcotics and general anaesthetics decrease or obliterate long and short term FHR variability , hence one is left monitoring changes in baseline FHR.

Front 24

What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping?

A. TOFC
B. TOFratio
C. Post tetanic count

Back 24

Answer C

Front 25

Torsades, what's not useful?

A. Amiodarone
B. Isoprenaline

Back 25

A

Front 26

HOCM, VF arrest on induction, what's the first priority in management?

A. defibrillate
B. amiodarone
C. Intubate and ventilate
D. Pre-cordial thump
E. adrenaline

Back 26

A

Front 27

Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management?

A. adenosine 6mg
B. DCR
C. amiodarone
D. Atenolol

Back 27

A

Front 28

The intercostobrachial nerve:

A. Arises from T2 trunk
B. Is usually blocked in brachial plexus block
C. Supplies antecubital fossa
D. can be damaged by torniquet
E. Arises from inferior trunk

Back 28

Ans D

Front 29

Post dural puincture headache (PDPH) -(thoracic epidural) of "low pressure type". Features NOT consistent

A. headache Immediately after procedure
B. Frontal headache only
C. Starts 24hrs post
D. Auditory symptoms
E. Neck stiffness

Back 29

A

Front 30

Inserted DLT. FOB down tracheal lumen. What feature is most helpful in identifying Left vs Right main bronchus

A. Trachealis muscle
B. "there are 3 lobes in right lung"
C. LMB longer than right
D. Angle of RMB vs left
E. Three segments of RUL

Back 30

C and E

The LMB is about 5cm long before it gives off any subsequent lobar bronchi, whereas the RMB gives off a lobar bronchus (the RUL bronchus) about 2.5cm from the carina. This can help to determine between RMB and LMB.

The RUL bronchus has a trifurcation for each of the RUL segments, and this may also be useful in determining which side you are on.

Front 31

You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is:

A. Right upper lobe
B. RML
C. RLL
D. LUL
E. Lingula

Back 31

Ans A

A true trifurcation is where the RUL bronchus divides into segmental bronchi.

Front 32

Elimination Half life of Tirofiban

A. 2hrs
B. 8hrs
C. 12hrs
D. 24hrs
E. 15 minutes

Back 32

A

Front 33

POISE trial showed

A. Increased CVA
B. Anaphylaxis
C. renal failure
D. Increased AMI

Back 33

Answer is A

Front 34

Patient on table for phaeochromocytoma with GA and epidural insitu. Pt on phenoxybenzamine and metoprolol preop, high dose nitroprusside and phentolamine. BP still high ?250/-. Next step

A. IV hydralazine
B. IV Magnesium
C. Propofol
D. Epidural lignocaine bolus
E. Esmolol

Back 34

B

Front 35

25 yo primip 38/40 gestation with beta thalassemia trait for epidural. BP 140/95, mild proteinuria. Best test before you will put in epidural

A. Coagulation screen
B. Hb
C. Platelet count
D. skin bleeding time

Back 35

C

- If plt>100, proceed.
- If plt<100, do coags.
- If plt 80-100, and coags normal - regional is OK.

Front 36

Another pregnant lady 39/40 with BP185/115 , 4+proteinuria, clonus. IDC placed, 10mLs of dark coloured urine only for the last few hours. Initial management

A. 500mL Crystalloid bolus
B. IV hydralazine
C. IV Magnesium
D. insert epidural

Back 36

B

Front 37

The BEST agent to decrease gastric volume AND increase gastric pH before semi-urgent procedure

A. Omeprazole
B. Cimetidine
C. Ranitidine
D. Sodium citrate
E. ?

Back 37

C. Ranitidine

Front 38

Most common congenital heart disease

A. VSD
B. PDA

Back 38

A

ACYANOTIC defects: VSD=35%, ASD=9%, PDA=8%, Pulm. stenosis=8%, Aortic stenosis=6%, Coarctation=6%, Atrioventricular septal defect=3%

CYANOTIC defects: Tetralogy=5%, Transposition=4%

Front 39

Acetylcholine receptors are down regulated in

A. Guillain-Barre syndrome
B. Organophosphate poisoning
C. Spinal cord injury
D. Stroke
E. Prolonged NMBD use

Back 39

B

Front 40

Innervation of Larynx

A. the internal branch of the superior branch of the...
E. Cuff compression of recurrent laryngeal nerve against thryoid can cause palsy

Back 40

E

Front 41

Trauma pt, Head Injury GCS 5, high ICPs, best management for ortho procedure

A. Propofol/fentanyl
B. Propofol / nitrous
C. Other options with volatiles

Back 41

A

Front 42

Drug NOT used to treat acute intermittent porphyria - question was: person with AIP given ?something and triggered a seizure, what not to use

A. Morphine
B. Phenytoin

Back 42

B

Front 43

Regarding anticholinesterases:

A. pyridostigmine has slow onset of effect
B. physostigmine does not rely on renal metabolism/excretion
C. neostigmine cannot reverse centrally acting cholinergics
D. edrophonium is less reliable in reversal

Back 43

C

Front 44

Paternal uncle has MH, pregnant lady, how best to test for MH

A. muscle biopsy on pregnant lady
B. negative muscle biopsy of her father
C. genetic testing of pregnant lady

Back 44

A if early gestation

Front 45

The nerve supplying area of skin between greater trochanter and iliac crest:

A. subcostal nerve
B. ilioinguinal nerve
C. genitofemoral nerve
D. femoral nerve
E. lat cutaneous femoral nerve

Back 45

A

Fundamentals of Regional Anaesthesia
Subcostal: sends fibre to the first lumbar nerve and its lateral cutaneous branch runs over the iliac crest to innervate the skin of the lateral aspect of the buttock as far as the greater trochanter
B. Ilioinguinal: enters the inguinal canal accompanies the spermatic cord and supplies the skin of the rrot of the penis and anterior part of the scrotum, mons pubis and labium majorum.
C. Genitofemoral: two branches.
a. Genital branch enters the inguinal canal and supply the spermatic cord and innervate the same cutaneous area as the ilioinguinal nerve.
b. Femoral branch: skin over the femoral triangle.
D. Femoral: supplies the muscles and the skin of the anterior compartment of the thigh
E. Lateral cutaneous nerve:
a. Anterior branch: supplies the skin over the antero-lateral aspect of the thigh down to the knee
b. Posterior branch: the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh

Front 46

Pyloric stenosis

A. alkaline then acid urine

Back 46

A

Front 47

Which can deliver minute ventilation of greater than 5L/min using a 14 G cannula used for needle cricothyroidotomy

A. jet ventilation using pressure 400KPA
B. oxygen flush button on anaesthetic machine
C. oxygen tubing on oxygen port on anaesthetic machine at 12L/min
E. none of the above

Back 47

A

Front 48

Young man in trauma, hypotensive ?BP70/40. CXR widened mediastinum. Fast STRONGLY POSITIVE. "best way to assess the widened mediastinum is"

A. intraop TOE
B. TTE

Back 48

A

Front 49

IV paracetamol

A. late plasma levels around the same as oral
B. highly protein bound
C. ?30%? renally excreted
D. VD 10L/kg

Back 49

A

Front 50

Head trauma patient with unilateral dilated pupil, what's the diagnosis ?

A.Global injury
B.Optic nerve injury
C.Horners syndrome
D.Tenstentorial herniation

Back 50

D

Front 51

Question about CO2 Laser. Does not cause deep tissue damage because

a. High Frequency
b. Penumbra effect
c. Dissipation of energy

Back 51

C

Characteristics of the CO2 laser and its uses
The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water and by all biologic tissues high in water content. The extinction length of this wavelength is about 0.03¬mm in water and in soft tissue.

Front 52

Patient with diastolic dysfunction. Is it caused by:
a. Restrictive cardiomyopathy
b. Dilated cardiomyopathy

Back 52

A

Front 53

Supine hypotension syndrome

a. high SVR
b. tachycardia

Back 53

A

Sharma S. Shock and Pregnancy. eMedicine.com. URL: http://www.emedicine.com/med/topic3285.htm
Aortocaval compression is thought to be the cause of supine hypotensive syndrome. Supine hypotensive syndrome is characterized by pallor, bradycardia, sweating, nausea, hypotension and dizziness and occurs when a pregnant woman lies on her back and resolves when she is turned on her side.

Front 54

Most likely to result in myocardial infarction

A. intraop myocardial ischaemia
B. post op myocardial ischaemia

Back 54

B

From Landesberg G: The Pathophysiology of peri-op MI: the facts and perspectives. J Cardiothoracic and Vac Anaes 2003: 17(1): 90-100
Peri-op myocardial ischaemia peaks in the early post-op period and is significantly associated with MI and cardiac complications. Intraop ischaemia is less common and infrequently associated with post-op MI. Peri-op MI is almost exclusively preceded by ST depression type ischaemia. (STEMI is uncommon)
Peri-op MI is mostly silent (only 50% have any sx) and occur in first 24-48 hours post-op pick with cont. ECG monitoring and ST trend analysis and troponin.
http://bja.oxfordjournals.org/cgi/content/full/95/1/3

Front 55

Awake patient with diabetes insipidus

A. Euvolaemic
E. urinary Na <20

Back 55

E
not enough ADH and large consequent free water diuresis with low urinary sodium and hypernatraemia

Front 56

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

Back 56

C

Front 57

BP measurement - overestimates with:

A. big (wide) cuff
B. skinny arm
C. severely peripherally vasoconstricted
D. atherosclerosis (it was arteriosclerosis - yes indeed)
E. slow cuff deflation

Back 57

D

Front 58

A device that detects a 10mA difference in active and neutral leads and causes turning off of the circuit within 40 ms. this is a :

A. Class 1 device
B. Equipotential earthing
C. LIM
D. Residual Current Device
E. Fuse

Back 58

Ans D
CEACCP electrical safety in the operating theatre

A. Class 1 Device: Any conducting part of Class I equipment accessible to the user, such as the metal casing, is connected to earth by an earth wire. If a fault occurs, this allows the live supply to come into contact with an accessible part, current flows down the earth wire. This new circuit has a lower resistance, resulting in an increased current which melts the protective fuses and breaks the circuit, removing the source of potential electrocution.
B. Equipotential earthing: the terminals of each piece of equipment in a stack can be connected to each other bringing them all to the same potential.
C. Line isolation monitor: measures the potential for current flow from the isolated power supply to the ground. i.e. active and neutral should have the same current. If there is a fault, a device is grounded then the current through to neutral would decrease. There is then a current able to flow through the line isolation monitor and sounds an alarm.
D. Residual current device: If the current in the live and neutral conductors is the same, the magnetic fluxes cancel themselves out. However, if they are different (due to excessive current leakage) there is a resultant magnetic field. This induces a current in the third winding causing the relay to break the circuit.
E. Fuse: a material that melts with increased current and breaks the circuit.

Front 59

Asystolic aortic arch repair. The best method for cerebral protection is:

A. anterograde perfusion via coronary vessel
B. retrograde perfusion via jugular vein
C. thiopentone IV
D. hypothermia to 20 degrees celcius

Back 59

D

Front 60

Performing a bronchoscopy. The best way to orient the scope is:

A. angle of the bronchus
B. length of the bronchus
c. RUL

Back 60

C

Front 61

Paediatric VF arrest. Which is true?

A. if resistant to defibrillation should give amiodarone 5mg/kg
C. commonly associated with respiratory arrest
D. is the most common form of arrest in this patient group
E. should defibrillate with 5J/kg

Back 61

A

ARC
Persistent or refractory VF or VT may be treated with antiarrhythmics such as amiodarone 5 mg/kg iv

DC shock is 2J/kg then 4 J/kg thereafter
The most common arrest scenario in children is bradycardia proceeding to asystole (a response to severe hypoxia and acidosis.
VF is relatively uncommon, but may complicated hypothermia, TCA poisoning and those children with pre-existing cardiac disease.

Front 62

OLV hypoxaemia. After 100% O2 and FOB next step is:

A. CPAP 5cm top lung
B. CPAP 10cm top lung
C. PEEP 5cm bottom lung
D. CPAP 5cm top + PEEP 5cm bottom

Back 62

A