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106 Cards in this Set
- Front
- Back
1. Given the following diagram, what does X represent? [three container chest drain diagram] A. ? B. Maximum pressure against the pleural cavity on expiration C. Maximimum suction available D. ? E. ? (Question 1 had the picture of the three container chest drain, with the suction limiting outlet the answer to the question) |
C Suction limiting outlet |
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2. RH28 Retrobulbar block. Sign of brainstem spread
A. Atonic pupil B. Unilateral blindness in blocked eye C. Contralateral blindness D. Diplopia- past papers remembered this as dysphagia E. Nystagmus |
C
Caused by reflux of LA into the Optic Chiasm Drowsiness/Vomiting/Convulsions/Respiratory Depression/Arrest
http://bja.oxfordjournals.org/content/75/1/93.full.pdf |
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3. Otherwise healthy 20 yo male undergoes surgery for an ORIF tibia for open tib fracture. The limb is exanguinated and the tourniquet correctly applied at 250mmHg. His SBP is 120. When the surgeons go to start there is a small amount of bleeding. Do you.. A. Accept that a small amount of bleeding may occur with a tourniquet B. Reinflate at a higher pressure C. Check coags D. Take tourniquet down, reexanguinate and reinflate E. Something else |
D
Adequate inflation pressure.
Tourniquet Pressure Upper Limb 50-100 above systolic Lower Limb 100-150 above systolic
http://ceaccp.oxfordjournals.org/content/9/2/56.full |
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4. This was the CXR showing a widened mediastinum with an otherwise normal CXR, there was an electronic circuit thing at the bottom right but nothing else obvious. Aortic dissection was the answer (at least I think!)
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5. Fatigue during night shifts can be minimized by: A. Avoiding daylight B. not sleeping during day C short naps during shift D use of caffeine or stimulants E. using benzodiazepines for sleep during the day |
C
See PS43
http://ceaccp.oxfordjournals.org/content/early/2013/06/18/bjaceaccp.mkt025.full.pdf+html |
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6.Patient with Acute Intermittent Porphyria presents to hospital with abdominal pain and requires a general anaesthetic. Which drug for PONV would you avoid? A. Metoclopramide B. Prochlorperazine C. Tropisetron D. Ondansetron E. Droperidol |
A
Oxford Handbook 2012 (3rd edition)
http://ceaccp.oxfordjournals.org/content/early/2012/02/27/bjaceaccp.mks009.full.pdf+html |
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7. A 65 year old man having a total hip placement under general anaesthetic has continued to take his moclobemide. He becomes hypotensive shortly after induction. The best treatment would be judicious use of A. adrenaline B. dobutamine C. ephedrine D. metaraminol E. phenylephrine |
E
Moclobemide- reversible MAOI
Most dangerous- Indirect Sympathomimetics (Ephedrine/Metaraminol/Amphetamine/Cocaine)
Direct sympathomimetics- Exaggerated Effect
Serotonin Syndrome- Pethidine/Tramadol
Pancuronium-Releases stored NA
Oxford Handbook Page 285 |
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8. The following capnography trace was observed in an intubated and ventilated patient. The most likely explanation for this respiratory pattern is A. endobronchial intubation B. endotracheal cuff leak C. gas sampling line leak D. obstructive airways disease E. spontaneous ventilatory effort |
C |
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9. When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to:
A. T2 B. T4 C. T6 D. T8 E. T10 |
B
Oxford Handbook 756 |
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10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is: A. Cease dabigatran 7 days prior B. Cease dabigatran 3 days prior C. Cease dabigatran 3 days prior and give bridging anticoagulation D. Cease dabigatran 24 hours prior and measure INR on day of surgery E. Continue dabigatran and withhold on day of surgery |
B
Practical Guidelines from Australian Society of Thrombosis & Haemostasis 2013 |
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11. A 15 yo girl with newly diagnosed mediastinal mass presents for supra-clavicular lymph node biopsy under GA. The most important investigation to perform pre-operatively A. CXR B. CT chest C. MRI chest D. PET scan E. TOE |
B
CEACCP 2007: Anaesthesia for Mediastinoscopy |
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12. A CTG recording with late prolonged decelerations. Cause:
A. GA B. Head compression C. Uteroplacental insufficiency D. Acute asphyxia E. Umbilical cord compression. |
C
Late decelerations begin at peak of uterine contraction and recover when the contraction ends.
Caused by: Maternal Hypotension Pre-Eclampsia Uterine Hyperstimulation
Head compression- Early deceleration Umbilical cord compression- Variable deceleration
http://geekymedics.com/2011/05/29/how-to-read-a-ctg/
http://ceaccp.oxfordjournals.org/content/3/2/38.full.pdf+html |
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13. 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 the conventional before 1 extra patient will benefit is A. 3 B. 4 C. 8 D. 25 E. 33 |
D
1/ARR
1/Probability (with intervention)-Probablity (Control)
1/0.12-0.08=1/0.04 = 25 |
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14. 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. vecuronium B. cisatracurium C. pancuronium D. atracurium E. suxamethonium |
B
60-70% of all anaphylaxis
Anaphylaxis to Suxamethonium- 60% to all others NMBD
Benzylisoquinolonium Less potential for histamine release Cisatracurium less histamine release
Peck + Hill |
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15. Increase in period bleeding EXCEPT A. Gingko B. Garlic C. Ginger D. Fish Oil E. Echinacea |
E
CEACCP 2010: Herbal Medicines and Anaesthesia
TGA Medicines Safety Update 2 2010 |
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16. Post op hip ORIF, commonest periop complication
A. UTI B. PE C. Delirium D. AMI E. Pneumonia |
C
Blue Book 2007
AAGBI Management of Proximal Femur Fracture Guidelines 2011 |
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17. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is: A. Adrenaline B. Dobutamine C. Levosimenden D. Milrinone E. Vasopressin |
E
CEACCP 2011: Carcinoid: the disease and its implications for Anaesthesia |
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18. 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 a cardiologist 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 |
D
CEACCP 2013: Anaesthetic Management of Patients with Hip Fractures: an Update |
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19 (Repeat) 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 |
A
Miller's
Central Subclavicular Lead The central subclavicular (CS5) lead is particularly well suited for the detection of anterior myocardial wall ischemia. The right arm (RA) electrode is placed under the right clavicle, the left arm (LA) electrode is placed in the V5 position, and the left leg electrode is in its usual position to serve as a ground. Lead I is selected for detection of anterior wall ischemia, and lead II can be selected for monitoring inferior wall ischemia or for the detection of arrhythmias. If a unipolar precordial electrode is unavailable, this CS5 bipolar lead is the best and easiest alternative to a true V5 lead for monitoring myocardial ischemia. |
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20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of: A. Aorta B. Hepatic artery C. Hepatic vein D. Portal pedicle E. Splenic Artery |
D
Both Hepatic artery and vein |
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21. A 60 y.o. diabetic man has below knee amputation for ischaemic leg. His neuropathic pain is treated with oxycodone 40mg BD and paracetamol 1g QID. He is also on omeprazole 20mg BD for reflux. You decide to start him on gabapentin. Before choosing a dosing regime and starting treatment it is most important that you: A. cease his omeprazole B. check his hepatic transaminase level C. check his renal function D. CHeck his QT interval on a resting ECG E. Decrease his oxycodone |
C |
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22. The anterior and posterior borders of the 'triangle of safety', the preferred insertion site for an intercostal catheter, are pec major and: A. Coracobrachialis B. Deltiod C. Lat Dorsi D. Serratius Anterior E. Trapezius |
C
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23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with uncertain medication compliance. He is confused and agitated with generalised rigidity but no hyperreflexia. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx? A. Heat stress from anticholinergics B. Hypoxic ischaemic encephalopathy C. NEM D. Serotonin syndrome E. Pain from fracture |
C
Neuroleptic Malignant Syndrome (D2 receptor antagonist)
F ever E levated enzymes V ital sign instability E ncephalopathy R igidity of muscles
Serotonin Syndrome
S hivering H yperreflexia I ncreased temperature V ital sign instability E ncephalopathy R estlessness S weating |
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24. CO2 penetrates surface tissue so well with little damage to underlying tissue because A) Well absorbed by Hb B) Poorly absorbed by H20 C) Widely disseminated in tissue D) Long infrared wavelength E) Short infrared wavelength |
D
- Water absorbs infrared light - Hb absorbs visible light (esp green) - Melanin absorbs visible and UV
ATOTW (255) 2012: The Basic Principles of Laser Technology |
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25. (NEW) An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is: A. Inferior gluteal B. Obturator C. Pudendal D. Scaitic E. Superior gluteal |
B
Obturator- Adductor muscle of the Hip Inferior Gluteal- Gluteus maximus Pudendal- Sensation to genitals + anal canal, Pelvic floor muscles, sphincters Sciatic- Posterior Leg |
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26. (New) You are involved in research and as part of data collection you collect ASA scores. This type of data is: A. Categorical B. Nominal C. Non-parametric D. Numerical E. Ordinal |
E
Categorical Data Nominal- no numerical significance (Blood Groups) Ordinal- data may be ranked (ASA) |
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27. An otherwise healthy man presents with anaemia. The test that most reliably indicates iron deficiency is A. MCV B. serum ferritin C. serum iron D. serum transferrin E. total iron binding capacity |
B
MCV Low Ferritin Low Serum Iron Low Transferrin Low Total Iron Binding Capacity High
MCV not specific to Iron deficiency Ferritin is an acute phase reactant Serum Iron not as sensitive as ferritin, and may be affected by Iron replacement.
Most sensitive indicator is ferritin Most specific indicator is Serum Iron:TIBC ratio (i.e. transferrin saturation index).
In otherwise healthy person - ?ferritin |
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30. The maximal allowable atmospheric concentration of nitrous oxide in Australian and New Zealand operating theatres (in parts per million) is A. 5 B. 25 C. 50 D. 100 E. 200 |
B
BOC Gases: Product Information N2O (Worksafe Exposure Standard TLV TWA) |
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31. What is associated with down regulation of nicotinic acetylcholine receptors: A. Guillain-Barre syndrome B. Organophospate overdose C. Spinal cord injury D. Stroke E. Prolonged neuromuscular blockade |
B
nAch Down-regulation Myasthenia Gravis Anticholinesterase poisoning Organophosphate poisoning
nAch Up-Regulation Spinal cord injury Stroke Burns Prolonged immobility Prolonged exposure to NMD Multiple Sclerosis Guillain Barre
Millers page 900 (table 29-1) |
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35. A reduction in DLCO can be caused by: A. Asthma B. Emphysema C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis |
B
Decreased DLCO (<80% predicted) Obstructive Lung Disease Parenchymal Disease Pulmonary vascular disease Anaemia
Increased DLCO (>120-140% predicted) Asthma Pulmonary haemorrhage Polycythaemia Left to Right shunt |
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36. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has 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 |
D
British Malignant Hyperthermia Association |
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37. (New) The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size: A. 6 B. 8 C. 10 D. 12 E. 14 |
D
French Gauge = Diameter (mm) x 3 Hence Max Fr = 4mm x 3 = 12 Fr
http://www.smiths-medical.com/userfiles/trachealtubechart.pdf |
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38. (Repeat) Pneumoperitoneum causes a decrease in cardiac output at what pressure (or possibly ABOVE what pressure) A. 10mmHg B. 20mmHg C. 30mmHg D. 40mmHg E. 50mmHg |
A
Miller says >10
http://ceaccp.oxfordjournals.org/content/4/4/107.full.pdf+html
Initially increase in venous return and CO due to autotransfusion of pooled blood from splanchnic circulation.
Then decrese in VR + CO due to compression of inferior vena cava.
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39. 60yo male had total knee replacement. 7 days post-operatively diagnosed with deep venous thrombosis on ultrasound. Was on LMWH. PLT dropped from 300 immediately post-op and now 150x10^9/L. All the following are acceptable treatments EXCEPT-
A. Argabotran B. Lepirudin C. Fondapurinax D. Danaparoid E. Warfarin |
E
Warfarin (Vitamin K antagonist) can cause skin necrosis or limb gangrene in acute/suspected HITS secondary to microthrombosis
http://bja.oxfordjournals.org/content/90/5/676.full.pdf+html
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40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique: A. 3 mg/kg B. 7 mg/kg C. 15 mg/kg D. 25 mg/kg E. 35 mg/kg |
E
Lignocaine diluted into high volumes. 22-57 mg/kg
http://ceaccp.oxfordjournals.org/content/early/2011/07/12/bjaceaccp.mkr026.full.pdf+html |
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43. Drug to facilitate clip placement during cerebral aneurysm surgery; A. nimodipine B. mannitol C. adenosine D. hypertonic saline E. thiopentone |
C |
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44. Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby? A. codeine B. morphine C. paracetamol D. parecoxib E. tramadol |
A
Excreted in breast milk and mothers may be rapid metabolisers which will make the baby more narcotised.
Australian Prescriber 2011
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44. Analgesia to avoid in breast feeding woman? A. morphine B. pethidine C. codeine D. parecoxib E. tramadol |
Pethidine not recommended. Norpethidine is excreted slowly in neonates.
PCEA Pethidine appears acceptable
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45. A three year old girl for an elective hernia repair is seen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to:
A. Postpone surgery for 2 hours B. Postpone surgery for 4 hours C. Postpone surgery for 6 hours D. Cancel surgery E. Continue with surgery |
E
http://ceaccp.oxfordjournals.org/content/6/6/215.full.pdf+html |
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46. In accordance with their belief that blood transfusion is wrong, a Jehovah's Witness may consent to all of the following except: A. Cryoprecipitate B. Immunoglubulins C. Fresh Frozen Plasma D. Factor VIIa E. Prothrombinex |
C
Office of the Public Advocate |
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47. 80 year old lady with fractured NOF needing ORIF. On examination had a systolic murmur. Arranged TTE which showed a calcific aortic valve with peak velocity of 4 m/s. Using the simplified Bernoulli equation, what is the peak pressure gradient across the valve: A. 16 mmHg B. 32 mmHg C. 48 mmHg D. 64 mmHg E. 80 mmHg |
D
Bernoulli principle- an increase in the flow velocity of an ideal fluid will be accompanied by a simultaneous reduction in its pressure
Simplified equation:
p1-p2= 4V2 |
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48. You have developed a new cardiac output monitor called WaCCO. You want to compare the readings with the gold standard, a pulmonary artery catheter. What is the best statistical method to present the data/results:
A. Funnel plot B. Bland-Altman plot C. Forest plot D. Galbraith plot E. Partial regression plot |
B
Bland-Altman Plot is a test of agreement Cross + Plunket page 214 |
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50. A 60 year old, triple vessel disease normal LV Post CABG hypotensive, ST elevation II, avF, CVP 15 PCWP 25. Normal SVR A. A early diastolic mitral inflow dynamic with atrial systole B. Left inferior hypokinesis C. Left ventricle collapse in systole D. Right ventricle dilation and TR E. Severe Mitral Regurg |
B |
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51. Maximum amplitude from TEG or ROTEM decreased give A. Cryoprecipitate B. FFP C. Platelets D. Prothrombinex E. Tranexamimic acid |
C
http://www.rotem.de/en/methodology/result-interpretation/
http://lifeinthefastlane.com/education/ccc/thromboelastogram-teg/ |
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52. Young male, previous IVDU, now on 100mg Methadone per day has a laparotomy with an effective epidural. Amount of IV Morphine needed per HOUR: A. 1mg B. 2mg C. 4mg D. 8mg E. 16mg |
E
100mg Methadone = 400mg IV Morphine 400mg/24 = 16
Med Calc |
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54. 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 from radiation source D. stand behind transmitter of C arm E. wear protective garments |
C
Intensity radiation = 1/distance squared
At least 3 feet from source 6 feet or air provides 9 inches of concrete or 2.5mm lead
http://ceaccp.oxfordjournals.org/content/early/2012/11/04/bjaceaccp.mks055.full.pdf+html |
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57. Ibuprofen dose for one year old child tds regular post-op dose A. 5mg/kg B. 10 C. 15 D. 20 E. 25 |
B
5-10mg/kg (MIMS) |
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58. AICD, what does a magnet do A. Maintain defib activity & activate asynchronous pacing B. maintain anti tachycardia pacing & deactivate asynchronous pacing C. Deactivate anti tachycardia pacing & activate asynchronous pacing D. Deactivate defib & activate asynchronous pacing E. Deactivate defib & deactivate asynchronous pacing |
?D
Even when the ICD has been deactivated by a magnet, pacemaker function of an ICD is not affected. Thus, in a patient with an ICD, the magnet response will always be to deactivate the ICD and the pacing behaviour will not change to an asynchronous mode.
http://bja.oxfordjournals.org/content/107/suppl_1/i16.full.pdf+html |
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60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AED. On admission to hospital his ECG was as below; ECG - sinus, rate ~60, normal axis, borderline PR interval, RSR' in V1 and V2 with ST elevation and inverted T waves (Brugada sign) A. Acute pericarditis B. Brugada C. Cocaine intoxication D. Coronary artery spasm E. Long QT syndrome
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B
Brugada syndrome is due to a mutation in the cardiac sodium channel gene. |
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Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave |
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What does the following ECG demonstrate? [ECG provided] A. LVH B. Anterior infarct C. Digoxin toxicity D. Brugada syndrome E. ? |
Clinical Criteria Documented ventricular fibrillation (VF) or polymorphic ventricular tachycardia (VT).
Family history of sudden cardiac death at <45 years old .
Coved-type ECGs in family members.
Inducibility of VT with programmed electrical stimulation .
Syncope.
Nocturnal agonal respiration |
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61. A 58yo with solitary hepatic metastasis from colon cancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain:
A. High CVP in anticipation of heavy blood loss B. Decreased MAP to reduce arterial bleeding C. Decreased CVP to reduce venous bleeding D. Normal MAP in anticipation of heavy blood loss E. Normal CVP to ensure adequate filling of the heart. |
C
http://ceaccp.oxfordjournals.org/content/9/1/1.full.pdf+html
During parenchymal resection hepatic inflow occlusion, the main source of bleeding is backflow from the valveless hepatic veins. The control of central and thus hepatic venous pressure is crucial to reduce the blood loss (>5cm H2O) |
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63. A man is admitted to ICU with a Sodium of 105 mmol/L. What is the maximum his sodium should be raised in the next 24 hours A. 5 mmol B. 10 mmol C. 15 mmol D. 20 mmol E. 25 mmol |
B
5-10 mmol/day (>48hrs) 2mmol/L/hr (<48hrs)
Oxford Handbook page 186
Pontine Myelinolysis Rapid correction of sodium in hyponatremia would cause the extracellular fluid to be relatively hypertonic. Free water would then move out of the brain cells to decrease this relative hypertonicity. This leads to a central pontine myelinolysis, manifesting as the paralysis. The brain appears to shrink. The demyelination of the axons (nerve fibers in the brain) damages them.
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64. What is the distance from lips to carina in a 70 Kg man? A. 21 cm B. 23 cm C. 25 cm D. 27 cm E. 29cm |
D
Lee's Synopsis of Anaesthesia: Central Incisors to Carina Male 27cm/Female 23cm
15cm from teeth to cords, 12 cm from cords to carina
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65. The action of which laryngeal muscle opens the cords? A. Cricothyroid B. Posterior Cricoarytenoid C. Lateral Cricoarytenoid D. Thyroarytenoid E. Vocalis |
B
Cricothyroid muscle - Lengthens and tenses VC Posterior cricoarytenoid- Open glottis Lateral cricoarytenoid- Close glottis Interarytenoid- Close glottis Thyroarytenoid- Relax VC Vocalis- Relax VC
http://en.wikipedia.org/wiki/Larynx
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66. Induction of a 4yr old child with Arthrogrophysis multiplex congenita, however you find it difficult to place the laryngoscope. What is the concern? (paraphrased question here, can’t remember all possible answers) A. MH B. Neuroleptic malignant syndrome C. ? D. opioid induced rigidity E. TMJ rigidity |
E
Skin and soft connective tissue abnormalities, contracture deformities, micrognathia, cervical spine and jaw stiffness, congenital heart disease (10%), hypermetabolic response is probably NOT MH. Difficult airway and venous access, sensitive to thiopental.
Oxford handbook page 298 |
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70. A patient is suffering from aortic dissection with acute aortic regurgitation. BP 160/90, HR 100 & evidence of acute pulmonary oedema. What is your immediate management? A. Beta-blockers B. Dopamine C. Dobutamine D. Sodium nitroprusside E. Intra-aortic Balloon Pump |
A
CEACCP 2009: Diagnosis and Management of Aortic Dissection |
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71. Presented are a femoral arterial line trace & a central venous line (JVP) trace - looked like it was demonstrating elevated right atrial pressures... What is demonstrated by these pressure waveforms?
A. Aortic Stenosis B. Aortic Regurgitation C. Pulmonary Regurgitation D. Tricuspid Regurgitation E. Mitral Regurgitation |
D |
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72. The MELD score is calculated using INR, Bilirubin & what? A. Creatinine B. Albumin C. Urea D. AST E. Ammonia |
A
Model for End-Stage Liver Disease: Initially used to predict death within 3 months of TIPS. Subsequently used to prognosticate and prioritise for Liver transplantation.
MELD = 3.78×ln[serum bilirubin (mg/dL)] + 11.2×ln[INR] + 9.57×ln[serum creatinine (mg/dL)] + 6.43×aetiology (0: cholestatic or alcoholic, 1- otherwise)
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73. In resuscitating a newborn infant after delivery, the time at which you would like to achieve arterial oxygen saturation of 85-90%: A. 2mins B. 3mins C. 4mins D. 5mins E. 10mins |
E
Neonatal Resuscitation Guidelines |
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74. (repeat): You inserted a central venous line and peripheral arterial line for a patient who is having a tumour removed via craniotomy. The transducers of both the lines were placed at the level of the right atrium 13cm below the level of the external auditory canal. MAP is 80mmHg, CVP 5mmHg. What is the CPP? A. 62mmHg B. 65mmHg C. 70mmHg D. 75mmHg E. 80mmHg |
B
CPP = Perfusion Pressure - ICP (or CVP, whichever is greater) CPP = (80 - 13/1.3) - 5 CPP = 70 - 5 = 65mmHg
Assuming cranium open (therefore ICP=0) |
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75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80.
A. 0.04 B. 0.4 C. 4 D. 14 E. 40 |
C
Peck, Hill & Williams pg 183-184 |
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76. You are putting in a internal jugular central venous line. Which maneuvre causes maximal distension of the internal jugular vein? A. CPAP B. Breath hold at end expiration C. Manual compression at the base of the neck D. Trendelenberg position E. Valsalva manoeuvre |
?D |
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82. A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is: A. Epidural Lignocaine B. IV Esmolol C. IV Hydralazine D. IV Magnesium E. IV Propofol |
D
OHA page 588 |
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83. Best option to reduce risk of Ventilator induced pneumonia?
A. Nurse in supine position B. Early spontaneous ventilation through ETT C. Oral hygiene D. Use antacids E. Regularly change breathing circle |
C
VAP Bundle includes: 1) Prevent Colonisation - Oral hygiene - stress ulcer prophylaxis only when indicated 2) Prevent Aspiration - Nurse semi-recumbent - Subglottic secretion drainage - Maintain cuff pressure 20-30 cmH2O 3) Minimise duration of ventilation - Minimise time intubated - Early mobilisation/optimise sedation & analgesia 4) Endotracheal suction, circuit care - humidification & heat inspired gases - avoid routine ventilator circuit changes - ET suction only when secretions present
ANZICS Statement Prevention VAP in Mechanically Ventilated Patients |
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85. A 37 year old female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods taken. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality. The most likely diagnosis is
A. Central diabetes insipidus B. Nephrogenic diabetes insipidus C. Psychogenic polydipsia D. Cerebral salt wasting E. SIADH |
C
Hypoosmolar hyponatraemia not likely due to hyper-proteinaemia/lipidaemia/glycaemia
Euvolaemic Hyponatraemia DDx: SIADH, Psychogenic Polydipsia, Excessive administration of hypotonic solutions
Abnormally high urinary sodium (>100) points to SIADH |
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86. Photograph of an Arndt bronchial blocker multiport airway adapter. Orifice labelled 'X'. What goes in 'X'?
A. Bronchoscope B. ? C. ? |
A |
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91. The American Heart Association (AHA) guidelines for preoperative cardiac risk assessment define a poor functional capacity as only able to exercise at a level of less than 4 metabolic equivalents (METs). Exercise capacity of 4 METs corresponds to |
A
Ref: AHA guidelines on periop CV evaluation 2007 |
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92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT |
C |
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Answer: C |
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A
Risk of Intracranial Haemorrhage secondary to excessive CSF drainage |
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99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury: |
A
C3-C5 partial phrenic nerve weakness/paralysis of diaphragm. Reduced VC to 10-30%, weak cough, 80% require ventilation w/in 48hrs. No intercostal function. Diaphragmatic breathing w collapse of chest initially (until intercostal paralysis develops in few days).
Ref: CEACCP July 2013 initial mx of acute spinal cord injury |
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100. (new) Afterload reduction is most useful in which of the following: |
Answer: E
Avoid fall SVR with AS Problem with filling in Tamponade Afterload reduction leads to increased Right to Left Shunt in TOF May help in MR Most useful in AR (increased forward fraction) |
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Answer: E
Tracheostomy under LA gold standard for securing airway. Then GA ETT (inhal or IV dep on pt) or GA rigid bronchoscopy. |
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Answer: E
MJA Update Warfarin Reversal 2013 |
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Answer: machine check |
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Answer: E
Confusing wording......
check at: 1hr - measure peak tryptase 4hr - may remain elevated if peak missed 24hr - exclude mastocytosis, baseline level
Ref: http://www.anzaag.com/Mgmt%20Resources.aspx |
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Answer: D
Turn off if patient able to tolerate - note that EMI from unipolar can still cause current down leads. Use Bipolar, short burst on lowest current If require Unipolar, best use hand held or with plate furthest away as possible.
CEACCP 2009: Anaesthesia for DBS.... |
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122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?)
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125. Adenosine would be useful for terminating which arrhythmia?
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Answer E.
WPW |
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126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step: |
Answer A or ?B, depending on nature of "difficulty" and surgery
OEIA / CEACCP 2003 / MHAUS - If emergency surgery should continue with non-MH triggers i.e., TIVA. If elective, safest to abandon surgery pending further investigation. |
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127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by:
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Answer B |
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128. A patient is in Class IV Haemorrhagic Shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to: |
Answer: E
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129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is: |
Answer C
Mainentance IVF = 4ml/kg/hr for 1st 10kg, 2mg.kg/hr for next 10kg, 1ml/kg/hr for remaining kg (N/2 + 5%)
Total = 360ml/hr |
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130. You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is |
B
Response Entropy may be picking EMG interference, hence check TOFR and treat accordingly. |
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131. The normal physiological response following ECT is:
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Answer B
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132 (repeat) Aspirin Overdose. What will enhance her elimination most effectively?
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Answer B
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133. A 50 year old male is having an aortic valve replacement for aortic stenosis. He is stable on bypass initially but after the first dose of cardioplegia his MAP falls to 25mmHg, CVP 1 and his mixed venous oxygen saturation is 80%. What is the best management in this situation? |
Answer A
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134. An eighty year old man presents to the emergency department with two hours of severe abdominal pain. On examination he has a tender pulsatile 8cm mass. His GCS is 12, heart rate 104, blood pressure 80/49, Temp 35 degrees, SpO2 92%, respiratory rate is 30/min. What is the next appropriate step. |
Answer B
Because. Just because. |
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137. A PiCCO monitor may be used to measure cardiac output through use of:
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Answer C |
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138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone. |
Answer B
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141. Immunity to Hepatitis B is demonstrated by the presence of:
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Answer C
HBsAb +ve = immunity via immunisation or exposure HBsAg +ve = active infection HBcAb = suggests previous exposure |
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142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is:
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Answer C
Bleeding in cirrhosis has greater dependence on mechanical factors than on coagulopathy.
Portal Hypertension leading portosystemic shunting (varices/haemorrhoids) are more likely to bleed than cf without Portal hypertension, even with raised INR.
Journal of Hepatology 2012: Assessment of risk for non-hepatic surgery in cirrhotic patients. Bhangui et al
Journal of Hepatology 2010: Haemostasis & Thrombosis in patients with liver disease. Lisman et al |
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143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with: |
C
Treatment of hypercalcaemia: Fluid +/- Frusemide +/- Bisphosphonate +/- Calcitonin +/- Dialysis |
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144. SG67 20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours? |
Answer E
Some debate over whether to use 3 0r 4ml/kg (modified Parkland) however, question specifically asks for Parkland.
Hilton, Peter John, and Martin Hepp. "The Immediate Care of the Burned Patient." BJA CEPD Reviews 1, no. 4 (2001): 113-116. |
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145 The thoracic paravertebral space is continuous down to: |
Answer B
Tighe, S, M D Greene, and N Rajadurai. "Paravertebral Block." Continuing Education in Anaesthesia, Critical Care & Pain 10, no. 5 (2010): doi:10.1093/bjaceaccp/mkq029 |
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108. (New) Fit and well G1P0 post epidural complaining of loss of sensation over posterior leg, lateral thigh and foot with weak flexion of knee. Which best explains the findings? (Not remembered quite correctly.) |
Answer: D
Obstetrical Lumbosacral Plexopathy most common nerve injury post delivery. Caused by compression of lumbosacral plexus at pelvic brim by fetal head during delivery. |
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109 Patient with metastatic cancer. What's not useful to increase Ca excretion?
A. Bisphosphonates. B. ? |
A |
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Answer: ?
Multiple potential causes. Atelectasis secondary to oversedation with PCA. If only mildly sedated, would encourage incentive spirometry, rather than give naloxone.
Pulmonary oedema unlikely to be cause given minimal fluid administration
Would encourage surgical review and surgical complication as cause of pyrexia. |
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[Also please note that the picture was very poorly produced. You could make out a triangle structure and the humerus but nothing else] |
Answer: |
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112. A 40 year old man suffered a traumatic brain injury 2 days ago. He does not meet the criteria to be certified brain dead. What investigation will be most useful to assess cerebral function prior to organ donation. |
?A
ANZICS Statement Determination of Brain Death states if clinically cannot diagnose, need to demonstrate absence of cortical blood flow
4-vessel Cerebral DSA > SPECT/Radionuclide > CTA > TCD
EEG may be used as ancillary test in US |
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D
Variable bypass vapourisers are calibrated to deliver a set partial pressure at 1atm --> indicated concentration.
Hence at 3atm, partial pressure delivered remains the same, however concentration is now only 1/3 of indicated. |
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Answer: C
Diathermy plate acts as an "indifferent" or "return" electrode. Poor contact or malfunction can lead to heating and burns either at pad sites or sites elsewhere. |
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C
ACE-I cause fetal malformations if given 2nd & 3rd trimesters (Ref: Williams Obstetrics, 23rd Ed, p989) |
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116. Post-spinal surgery, patient notices paraesthesia of R arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from ulnar nerve neuropathy? |
D
Ulna Nerve: - intrinsic muscles of hand (including intersseous muscles) + sensory palmar ulna 1.5 fingers Median Nerve: - LOAF muscles (Lateral 2 lumbricals, Opponens pollicis, Abductor pollicis brevis, flexor pollicis brevis) |
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119. According to PS09 professional document which is most correct with respect to the minimum requirements for propofol anaesthesia in the endoscopy suite? |
B
PS09 pp8: "Intravenous anaesthetic agents such as propofol must only be used by a second medical or dental practitioner trained in their use because of the risk of unintentional loss of consciousness. These agents must not be administered by the proceduralist." But also see Scenario 2 of Appendix 1 of PS09: the assistant can be shared between both ends for conscious sedation in ASA 1-2 patients only. Therefore best answer would be a medical or dental practitioner trained in its use with an assistant who may be shared with the proceduralist. --Farnsworth 06:17, 8 June 2014 (CDT) |