Anzca Mcq 2014 March

Front 1

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. ?

Back 1

(Question 1 had the picture of the three container chest drain, with the suction limiting outlet the answer to the question)

Front 2

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

Back 2

E. Nystagmus

Contralateral blindness might just be spread to chiasm but not necessarily to brainstem.

Atonic pupil, diplopia, blindness might just be unilateral block.

Front 3

3. Something like: 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, rexanguinate and reinflate
E. Something else

Back 3

A

Tourniquet inflation pressures, the lesser of:

Upper limb - 200-250mmHg or 100>SBP

Lower limb - 300-350 or 2xSBP

Ref: OHA, Orthopedic Boneschool.com, ATOTW

Front 4

4. What's this?

Back 4

Aortic dissection

Front 5

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

Back 5

C

Ref: ANZCA PS43

Many individuals find it difficult to reset their body time clocks to allow for effective
daytime sleep after night duties. Daytime sleep is typically shorter and of inferior
quality compared with sleep at night
(13)
. Minimising the effects of night-time shift
work may be achieved by taking a two hour afternoon sleep prior to the night duty,
taking a 20-30 minute nap during the duty time, ensuring proper meals, and sleeping
as soon as possible after the duty(14)

Front 6

6. [New] 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

Back 6

A

Front 7

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
F. noradrenaline

Back 7

E

Need to use Direct acting agent

Norad effect might be prolonged if MAO inhibited

Also, need CVL for inotropes

Ref: OHA

Front 8

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

Back 8

C

Front 9

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

Back 9

C - most likely.

No dispute that T4 to ICE is the right level.

Light touch level varies depending on quoted source:

OHA says T4

Int J of Obs Anaes says T6

Front 10

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

Back 10

A. Stop Dabigatran for 7 days.

http://bja.oxfordjournals.org/content/107/suppl_1/i96

This article specifically refers to neuraxial anaesthesia.

Previously, it was thought the answer to this question is B, due to the following reference, but this reference refers to surgery not neuraxial anaesthesia:

"The Central European Journal of Medicine - Dabigatran in patients with atrial fibrillation: perioperative and peri-interventional management. For Major procedures ie TKR
A preoperative laboratory testing is usually not meaningful (Recommendation 3C). A dabigatran-sensitive coagulation test (Hemoclot test or ECT) may help to determine whether haemostasis is still impaired.
Dabigatran should be paused the day before the intervention (Day – 1; Recommendation 1C). The therapy should be discontinued 2 days in case of creatinine clearance 50–80 ml/min or interventions associated with a high risk of bleeding. The therapy should be paused 3–4 days before the intervention if creatinine clearance is < 50 ml/min (Recommendation 1C)."

Front 11

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-operativel
A. CXR
B. CT chest
C. MRI chest
D. PET scan
E. TOE

Back 11

B

Can't find a reference, but need to assess trachea pre-induction and assess extension to vessels

Front 12

12. A CTG recording with late prolonged decelerations. Cause:
A. GA
B. Head compression
C. Uteroplacental insufficiency
D. Acute asphyxia
E. Umbilical cord compression.

Back 12

C

GA: sustained decreased variability
Head compression: early decels
Umbilical cord compression: variable decels

Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in nonvital peripheral areas in order to divert more blood flow to vital organs such as the adrenal glands, heart, and brain. Constriction of peripheral blood vessels causes hypertension that stimulates a baroreceptor mediated vagal response which slows the heart rate. The time consumed in this two step process accounts for the delay in the timing of the deceleration relative to the contraction

Front 13

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

Back 13

D

NNT = 1/probability(with intervention) - probability(control)
8% with new treatment. Therefore 12% without.
So NNT = 1/0.12-0.08
= 1/0.04
= 25

Front 14

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

Back 14

B

Front 15

15. Increase in period bleeding EXCEPT
A. Gingko
B. Garlic
C. Ginger
D. Fish Oil
E. Echinacea

Back 15

Answer: E

Garlic, ginger, ginko and ginseng: increase bleeding
Fish oil: increases bleeding

Echinachea: no change

Front 16

16. Post op hip ORIF, commonest periop complication
A. UTI
B. PE
C. Delirium
D. AMI
E. Pneumonia

Back 16

C or E

No agreed answer amongst study group

Front 17

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

Back 17

E

Front 18

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

Back 18

D

This is moderate aortic stenosis. Needs emergency surgery.

Mean gradient (Note that this will become less sensitive as the ventricle starts to fail)
Normal: <5
Mild: <25
Moderate: 25-40
Severe: 40-50
Critical: >50

Front 19

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

Back 19

A

For Cs5:
RA placed under R clavicle, LA placed at V5, LL placed as normal
Lead ONE is for anterior ischaemia, lead TWO is for inferior / arrhythmia detection

Front 20

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

Back 20

D


BJA 2004. 93 (2): 204. Effects of Pringle manoeuvre and ischaemic preconditioning on haemodynamic stability in patients undergoing elective hepatectomy: a randomized trial
“During hepatic resection, the risk of severe intraoperative bleeding represents a major risk. To avoid massive blood loss, continuous or intermittent vascular clamping of the hepatic artery and portal vein (‘Pringle manoeuvre’) is an efficient method to reduce haemorrhage.”
Portal pedicle contains Hep Artery and Portal vein therefore D is correct. Also referred to as portal triad, which is Hep a., Portal v. and bile duct.

Front 21

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

Back 21

C

Renal excretion - must dose reduce.

Front 22

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

Back 22

C

Formed anteriorly by the lateral border of the pectoralis major, laterally by the lateral border of the latismus dorsi, inferiorly by the line of the 5th intercostal space and superiorly by the base of the axilla.

Front 23

23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with nucertain medication compliance. He is confused and agitated wuth 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. Neuroleptic Malignant Syndrome
D. Serotonin syndrome
E. Pain from fracture

Back 23

C

"CART" -

Confusion

Autonomic instability

Rigidity

Temperature

From DSM-IV
Severe muscle rigidity and hyperthermia associated with the use of antipsychotic medication
Two or more of the following: diaphoresis, HT, tachycardia, incontinence, dysphagia, mutism, tremor, confusion or altered GCS, leukocytosis, elevated CK.

Front 24

24. CO2 (laser??) 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

Back 24

D

Long wavelength, low frequency. Well absorbed by water.

The CO2 laser emits light at a wavelength of 10 600 nm, i.e., in the infrared part of the spectrum. As the beam is not visible, a separate aiming helium- neon laser has to be set up so that its visible red dot hits the target at the same point as the CO2 beam. This laser must always be tested before use on a patient, to ensure proper alignment. The main beam will not totally internally reflect, so to guide it mirrors have to be used. As a consequence it can only be used where a rigid system can be deployed, either with an operating microscope or with a bronchoscope with a mirrored array at the top. Tissue is vaporized by the energy of the beam and because of its wavelength there is very little absorption of energy by deep tissues. Modern CO2 lasers can be controlled to very fine limits, for example setting the beam to ablate to a depth of 0.2 mm. Haemostasis however is quite poor.

Front 25

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

Back 25

B

Front 26

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

Back 26

E

A. Categorical = qualitative
B. Subtype of categorical data where the groups can be arbitrarily assigned numbers, but the groups cannot be ranked meaningfully
C. To use parametric tests, the data must be quantitative and follow a normal distribution
D. Data that can be measured
E. Subtype of qualitative data, where the subgroups can be ranked

Front 27

27. An otherwise healthy man presents with anaemia. The test that most reliably indicates iron deficiency is decreased
A. MCV
B. serum ferritin
C. serum iron
D. serum transferrin
E. total iron binding capacity

Back 27

B

Front 28

28. Radical prostatectomy. Long operation and constant ooze. Surgeon asks if patient on 'aspirin'. You do a TEG. Shown TEG- fibrinolysis but also long r time. What treatment?

A. FFP

B. Cryoprecipitate

C. Desmopressin

D. Tranexamic acid

TEG, think it was picture of low fibrinogen

Back 28

Answer depends on what the correct wording of the question is.

- r time means low in factors

- k time is cryo

- max amplitude indicates adequacy of platelets

- the tail indicates fibrinolysis

Front 29

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

Back 29

B

Recommended maximum concentrations in operating theatre (National Occupational Health and Safety Comission, Australia)
• 25 ppm for nitrous oxide
• 0.5 ppm for volatile agents when nitrous oxide is used, 2 ppm when it is not

Front 30

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

Back 30

B

• A - False. Effectively a denervation injury which causes UP-regulation.
• B - TRUE. Organophosphate poisoning causes increases in miniature-end-plate potential (MEPP), and thus can cause DOWN-regulation of ACh receptors. Apparently continuous exposure to organophosphates can cause degeneration of pre-junctional and post-junctional structures.
• C - False. Denervation causes UP-regulation.
• D - False. As for spinal cord injury.
• E - Prolonged NMBD use can cause UP-regulation of ACh receptors.

Front 31

35. A reduction in DLCO can be caused by:
A. Asthma
B. Emphysema
C. Left to right shunt
D. Pulmonary haemorrhage
E. Bronchitis

Back 31

B

Due to large volume of air trapped in lungs and decreased surface area by destroyed alveolar walls.

Left-Right shunt and Pulmonary haemorrhage Increase DLCO

Front 32

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

Back 32

D

From BMHA 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.

Front 33

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

Back 33

Answer: D

Endotracheal tube size refers to internal diameter in mm.
French gauge requires a conversion: Fr 1 = 1/3 mm. Therefore Fr 3 = 1 mm

So, Fr12 = 4 mm

Front 34

38. (Repeat) Pneumoperitoneum cases a decrease in cardiac output at what pressure (or possibly ABOVE what pressure)
A. 10mmHg
B. 20mmHg
C. 30mmHg
D. 40mmHg
E. 50mmHg

Back 34

A

<10 mmHg: increased CO
10-20: decreased CO (unlikely to cause BP effects)
>20: greatly decreased CO

Miller says > 10.

ref: CEACCP Laparoscopic abdominal surgery

Initially, owing to autotransfusion of pooled blood from the splanchnic circulation, there is an increase in the circulating blood volume, resulting in an increase in venous return and cardiac output. However, further increases in the IAP result in the compression of the inferior vena cava, reduction in venous return and subsequent decrease in cardiac output.

Front 35

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

Back 35

Answer: E

Warfarin (Vit K antagonist) is contraindicated in acute HIT (or if suspected HIT), as it can cause skin necrosis or venous limb gangrene.

Warfarin inhibits Vit K dependent factors II,VII,IX,X but also Protein C&S. It inhibits Protein C&S faster than the factors, so initially patient is PROthrombotic when starting warfarin.

Management of HIT:
• First task is to discontinue unfractionated heparin from ALL sources (including heparin-coated lines, etc). LMWH can also cause HIT, therefore not suitable as a replacement. Fondaparinux is an indirect Factor-Xa inhibitor (synthetic pentasaccharide), and there are some reports of it being used in HIT successfully.
• Current recommendations are to treat with DTI's (lepirudin, argatroban, bivalirudin) or danaparoid. Although danaparoid is a LMW heparinoid, there is an extremely low cross-reactivity rate with HIT antibodies, and this is rarely clinically significant.

Front 36

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

Back 36

E

"Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. JA Klein - Dermatol Surg, 1990"

CEACCP: "Doses as high as 22–57 mg kg−1 of lidocaine7–9 have been used in the context of tumescent techniques and have been shown to have safe plasma concentration profiles. Addition of non-steroidal anti-inflammatory drugs and steroids has also been used to try to improve the quality and length of analgesia."

Front 37

43. Drug to facilitate clip placement during cerebral aneurysm surgery;
A. nimodipine
B. mannitol
C. adenosine
D. hypertonic saline
E. thiopentone

Back 37

C

Front 38

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
??F. pethidine

Back 38

A

Pregnancy drug classes:

Paracetamol A

Codeine A

Morphine C

Parecoxib C

Tramadol C

From Acute Pain Management Scientific Evidence 2010:
A. There has been a death in a child of a rapid metaboliser, and other babies have shown decreased alertness, poor feeding, and lethargy
B. Morphine: Safe (The recommended opiod for use in breastfeeding mothers)
C. Paracetamol: Safe
D. Parecoxib not specifically mentioned. Celecoxib and most other NSAIDs: Safe (Ibuprofen safest)

E. Tramadol is concentrated in breast milk, but appears to be safe
F. (If this was even an option): Infants are detectably more drowsy, and norpethidine excretion in neonates is slow. Pethidine is not recommended.

Aspirin: Unsafe
Indomethacin: Associated with maternal psychosis in the post-natal period.
Fentanyl, Midaz, propofol: so safe that mothers probably don't need to discard breast milk after a GA.

Paech M, et al. Anesth Analg. 2012 Apr;114(4):837-44 states Parecoxib safe.

Front 39

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

Back 39

E

From ANZCA PS15

Healthy adults
* solids 6 hours
* clear fluids <200mL up to 2 hours

Healthy children > 6/52 for elective
* Solid food and formula up to 6 hours
* Breast milk up to 4 hours
* Clear fluids up to 2 hours

Healthy infants <6/52 for elective
* Formula and breast milk up to 4 hours
* Clear fluids up to 2 hours

Consider PPI for patients with GORD

Front 40

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

Back 40

C

Blue Book 2011: Acceptable: cryo, Hb, Ig, Albumin, clotting factors, EPO, interferon.

Front 41

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

Back 41

D

P1-P2 = 4V^2

4 * 16 = 64 mmHg

Front 42

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

Back 42

B

Front 43

50. A 60 year old, triple vessel disease normal LV Post CABG hypotensivem ST elevation II, avF, CVP 15 PCWP 25. Normal SVR. Echo shows:
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

Back 43

B

Front 44

51. Maximum amplitude from TEG or ROTEM decreased give
A. Cryoprecipitate
B. FFP
C. Platelets
D. Prothrombinex
E. Tranexamimic acid

Back 44

C

Front 45

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

Back 45

NOT SURE

Probably B

Med Calc:
100mg methadone = 400 mg morphine
400/24 = 16

PO Morph <100 ----- 1:4
PO Morph 100-300 -- 1:8
PO Morph >300 -----1:12

Front 46

53. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. 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 46

D

Front 47

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

Back 47

Most likely E

Because the intensity of scattered radiation is inversely proportional to the square of the distance from the source, the best protection is physical separation. A distance of at least 3 feet from the patient is recommended. Six feet of air provides protection the equivalent of 9 inches of concrete or 2.5 mm of lead.

Front 48

55.

10L/min via facemask. Cylinder C 15 000kPa lasts

A. 10min

B. 15min

C. 30min

D. 45min

E. 60 min

Back 48

D

Size C is 490L if pressurised to full 16400kPa

So 15000kPa is roughly 450L. So should last 45 minutes.

Size B 170L

Size C 490L

Size D 630L

Front 49

57. Ibuprofen dose for one year old child tds regular post-op dose
A. 5mg/kg
B. 10
C. 15
D. 20
E. 25

Back 49

B

MIMS 5-10mg/kg Q6-8H

Front 50

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

Back 50

None of the above.

I think they actually turn off the defibrillator, but maintain the usual pacing mode.

"With the ICD, approximately 99% of them are programmed to have their anti-tachycardia function disabled in the presence of a magnet without affecting their bradycardia pacing."

Front 51

59. To prevent transmission of CJD? Airway-contaminated equipment should be:

A. autoclaved

B. protected plastic covers

C. sterilise in ethylene oxide

D. 134degreesC for 3 min

E. thrown away

Back 51

E

Front 52

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

Back 52

B

Incomplete RBBB, ST elevation V1-V3. T-wave inversion. Positive family history. More common in SE Asians.

Front 53

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.

Back 53

C

Mortality ~3% in selected population (otherwise healthy patients with resections <50% of non-cirrhotic livers)
Child-Pugh B+C contraindicated
Pre-existing cirrhosis confers 32% chance of post-operative liver failure
Hepatic pedicle clamping - warm ischaemic time max 60 mins. If intermittent (15 on 5 off) then up to 90 mins.
Clamping makes BP go up.

Theoretical concerns re: epidurals given post-op coagulopathy

Use tranexamic acid
CVP and IABP monitoring
Temp and NMB monitoring
Monitor closely for hypoglycaemia

Aim CVP < 5 (May cause low BP and air embolism but reduces bleeding)
Minimise mean airway pressure and PEEP
Beware of IVC compression with posterior tumours -> profound hypotension

N-acetylcysteine infusions might help liver recover. Evidence is equivocal.

Avoid paracetamol until liver dysfunction has resolved post-op.
May develop ascites transiently post-op and become intravascularly dry - consider 20% albumin.
Likely to need FFP

Front 54

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

Back 54

Answer: B

OHA: Says <12mmol in 24 hours.

New European guidelines say correct by 5mmol/L acutely if symptomatic by giving hypertonic saline, then correct by 10mmol/day for first day and 8mmol/day thereafter until 130.

Because a 4 to 6 meq/L increase in serum sodium concentration appears to be sufficient to reverse the most severe manifestations of acute hyponatremia and because actual correction often exceeds what is intended, an increase of 4 to 6 meq/L in 24 hours is a reasonable therapeutic goal for all patients. Every effort should be made so that the increase in serum sodium is less than 9 meq/L in any 24-hour period.

For patients with severe symptoms, the first day's goal may be achieved in the first few hours since the daily rate rather than the hourly rate of correction is associated with osmotic demyelination.

Front 55

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

Back 55

D

15cm from teeth to cords. 12 from cords to carina.

Lee's Synopsis of Anaesthesia: The average distance from the central incisors and the carina is 27cm in an adult male and 23cm in a female. The tip of the tube moves about 4cm caudad as the neck moves from full extension to full flexion.

Front 56

65. The action of which laryngeal laryngeal muscle opens the cords?
A. Cricothyroid
B. Posterior cricoarytenoid
C. Lateral Cricoarytenoid
D. Thyroarytenoid
E. Vocalis

Back 56

B

Lee's synopsis:

Posterior cricoarytenoids: open glottis
Lateral cricoarytenoids: close glottis
Interarytenoid: close glottis
Cricothyroid: tense cords
Thyroarytenoid: Relax cords
Vocales: relax cords

Front 57

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

Back 57

E

OHA: Arthrogryposis
Skin and SC tissue abnormalities, contracture deformities, micrognathia, cervical spine and jaw stiffness, congenital heart disease (10%), difficult airway and venous access, sensitive to thiopental, hypermetabolic response is probably not MH

Front 58

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

Back 58

A

This is the case despite the AR.

The primary goal is to reduce the force of left ventricular con- traction without compromising perfusion, thus reducing shear forces and preventing further extension of the dissection or poss- ible rupture. Beta-blockers (e.g. esmolol, metoprolol) and labetalol (beta- and alpha-blocker) can be used. If further reduction in BP is required, sodium nitroprusside, glyceryl trinitrate, or hydralazine are appropriate. Beta-blockers should be given first before vasodi- lators, as the reflex catecholamine release due to vasodilatation may increase left ventricular contractions.

Front 59

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
71. Given the following femoral AL and CVP traces, what is the most likely cause? [diagram]
A. Pulmonary stenosis
B. Left Ventricular Failure
C. Tricuspid Regurgitation
D. Aortic Stenosis
E. Mitral Stenosis
71. Trace of an Arterial line and RA venous pressure. The venous pressure started escalating prior to the onset of the arterial pressure rise (all 4 regurg options, one stenotic option)

Back 59

Who knows, but probably tricuscpid regurg?

Front 60

72. The MELD score is calculated using INR, Bilirubin & what?
A. Creatinine
B. Albumin
C. Urea
D. AST
E. Ammonia

Back 60

A

INR, bilirubin and creatinine

Front 61

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

Back 61

E

ARC guidelines: 10 mins

1min 60-65

2min 65-70

3min 70-75

4min 75-80

5min 80-85

10min 85-90

Measured off R arm because of PDA

Front 62

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

Back 62

C

MAP at heart = 80

MAP at head = 70

CVP at heart = 5

CVP at head = -5 but collapsed, so is actually zero

Therefore, CPP = 70-0 =70

Front 63

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

Back 63

C

96% people normal

4% heterozygous (slightly prolonged block)

<1% homozygous (very prolonged block)

Peck & Hill

Front 64

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

Back 64

E

Valsalva - probably gives maximal distention

Front 65

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

Back 65

Answer: D

CEACCP: Adequate pre-operative care aims to limit the severity of these episodes but vasodilators must be prepared and close at hand. Such agents include boluses of phentolamine 1–5 mg and labetalol 5–10 mg or sodium nitroprus- side, GTN and nicardipine infusions. Sodium nitroprusside has a rapid onset and offset of action; it is not associated with toxicity when used in recommended doses. Nicardipine is a calcium chan- nel blocker which has been used as an infusion for fast titration of blood pressure. The use of isoflurane as an antihypertensive agent is a practical alternative. Magnesium sulphate infusions have recently been described (inhibits catecholamine release, exerts a direct vasodilator effect and reduces α-receptor sensitivity).

Front 66

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

Back 66

C

A - 30 degrees head up

B - Avoiding intubation, limiting time

C - Yes

D - Increasing pH increases bacteria in GIT theoretically: ?increases pneumonia

E - Leave connected

Front 67

85. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods takes. 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 diabetes insipidus

C. Psychogenic polydipsia

D. Cerebral salt wasting

E. SIADH

Back 67

C

Hyponatraemic
Hyposmolar
Large urine output
Dilute urine

A. Central diabetes insipidus: caused by inadequate secretion of ADH. Polyuria, hypernatremia, hyperosmolarity, dilute urine
B. Nephrogenic diabetes insipidus: Resistance to action of ADH on the kidneys. Polyuria, high normal or hypernatraemia, high normal or hyperosmolarity, dilute urine
C. Hyponatraemia, hyposmolarity, low urine osmolarity, increased urine output.
D. Cerebral salt wasting follows CNS injury, and is like SIADH except that there is evidence of hypovolaemia
E. Hyponatraemia, hyposmolarity, urine osmolarity >100 (normal minimum 40-100). Urine output determined usually by water intake, but given SIADH causes fixed ADH secretion urine output instead becomes dependant on salt intake (and excretion) only.

Front 68

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. light housework such as dishwashing
B. heavy work around the house such as moving heavy objects
C. jogging 2km
D. brisk walking on level ground (6km/hr)
E. slow walking on level ground (3km/hr)

Back 68

A

Front 69

92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT
A. arterial pressure
B. vasopressin secretion
C. inotropic action
D. systemic vascular resistance
E. venous resistance

Back 69

C

Miller table

A - Up

B - Up

C - Correct - decreases

D - Up

E - Up

Front 70

93. 7 year old with closed head injury. Intubated and ventilated in ICU. Serum sodium 142. Most appropriate maintenance fluid is:
A. 0.3% saline plus 3% glucose
B. 0.45% saline plus 5% glucose
C. 0.9% Saline
D. Hartman's solution
E. Hartman's plus 5% glucose

Back 70

C

Front 71

94. Patient with Marfan's syndrome. Thoracoabdominal aortic aneurysm repair. 24 hours later in ICU noted to be blood in CSF drain and patient obtunded. Most appropriate urgent management:
A. CT head
B. Coagulation screen
C. CSF culture
D. MRI brain
E. MRI spine

Back 71

A

Front 72

99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury:
A. increased respiratory rate
B. arterial hypoxaemia
C. chest wall immobility
D. ?
E. ?

Back 72

???

In reality, probably all of the above. Starts with chest wall immobility below C5, then arterial hypoxaemia, then tachypnoea.

Front 73

100. (new) Afterload reduction is most useful in which of the following:

A. aortic stenosis
B. tetralogy of fallot
C. cardiac tamponade
D. Mitral incompetence
E. aortic incompetence

Back 73

D or E.

AS - worse

Tetralogy of fallot - worse

AR + MR - benefit

Tamponade - benefit

Front 74

101. 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 of the neck

Back 74

D

Front 75

102. Preferred method for treating raised INR
A. FFP
B. FFP + prothrombinex
C. FFP + vitamin K
D. prothrombinex
E. prothrombinex + vitamin K

Back 75

Answer: E.

But only if it's a situation of raised INR with no bleeding, INR>10, and high bleeding risk.

IF BLEEDING:

- Life-threatening bleed, INR>1.5 --> give K/P/F

- Significant bleed, INR>2 --> give K/P

- Minor bleed, INR>4.5 --> give K

- Other --> nothing. W/H warfarin

IF NOT BLEEDING:

- INR <4.5 --> nothing. W/H warfarin

- INR <10 & low bleeding risk --> nothing

- INR <10 & high bleeding risk --> give K

- INR >10 & low bleeding risk --> give K

- INR >10 & high bleeding risk --> give K/P

Legend: K=VitK, P=Prothrombinex, F=FFP

Front 76

103. Regarding PS31, Level II check includes:
(Multiple options, can’t remember exactly)

Back 76

Service Label

High pressure system - O2 cylinder, pipeline supply

Low pressure system - rotatmeters, vaporizers

Leak Test

CO2 absorbtion

Ventilator

Scavenging

Emergency ventilation

Level three:

Changed circuit

Changed vaporizer

IV anaesthetic devices

Intubation / LMA gear

Suction

Gas analysis

Monitoring and alarms

Humidifiers

Filters

Front 77

107.(New) A 50 yo man with a Deep Brain Stimulator (DBS) secondary to Parkinson's disease is scheduled for elective surgery. What is the best management regarding this device?
A. Place diathermy pad as far away from DBS as possible
B. Turn off DBS and commence with oral Levodopa
C. Turn off DBS during surgery and turn on prior to extubation
D. Use Bipolar diathermy

Back 77

D

CEACCP

Front 78

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.)
A. Femoral neve
B. Obturator nerve
C. Sciatic nerve
D. Lumbosacral plexus
E. Peroneal nerve

Back 78

D

Front 79

109. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except
A. Bisphosphates
B. Calcitonin
C. Frusemide
D. Sodium Chloride
E. IV crystalloids

Back 79

Answer: A

A. Inhibit bone resorption and reduce serum calcium levels, but do not enhance excretion.
B. Promotes urinary calcium excretion
C. Reduce calcium resorption in loop of Henle
D. Increases urinary calcium excretion
E. Increases excretion

Front 80

110. (New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management?
A. Incentive spirometry
B. Diuresis
C. Broad spectrum ABs
D. Naloxone 100mcg increments
E. ?

Back 80

A. Atelectasis most likely.

Bibasal creps: unlikely to be bilateral pneumonia, besides, it's too early.

RR14: unlikely to be opioid narcosis

Febrile: unlikely to be simple APO

Front 81

111. A patient is coming for an operation on his upper limb. 5mls of 0.75% ropivacaine is placed around the structure seen below. What is the most likely consequence of this?
A. Unable to abduct fingers
B. Unable to extend wrist
C. Unable to oppose little finger and thumb
D. Unable to pronate arm
E. Unable to [unsure of 5th option]
[Also please note that the picture was very poorly produced. You could make out a triangle structure and the humerus but nothing else]

Picture was of probe on posterior upper arm

Back 81

B.

Probably radial nerve because it supplies EXTENSOR compartment of the arm

Front 82

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 cerbral function prior to organ donation.
A. Electroencephalogram
B. Somatosensory evoked potentials
C. Auditory evoked potentials
D. Motor evoked potentials
E. BIS

F. Intra-arterial angiography

Back 82

F.

Angiography - demonstrating no intracranial blood flow.

As per ANZICS document.

Front 83

113. Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vapouriser, at a constant fresh gas flow and vapour dial setting, the vapour produced will be:
A the indicated vapour concentration
B three times the indicated vapour concentration
C one third the partial pressure obtained at 1 atmosphere
D the same partial pressure as is obtained at 1 atmosphere
E three times the partial pressure obtained at 1 atmosphere

Back 83

D

Front 84

114. What is most likely to occur if the earth/grounding plate that is attached to a patient for use with monopolar diathermy malfunctions?
A electrocution
B electrical interference with monitors
C electrical burns
D ignition of gases/volatiles
E microshock

Back 84

C

e.g. if plate only partially in contact with patient

Front 85

115. A 24yo primigravida, 25/40 gestation, BP 150/90 on 4 occasions. No signs of pre-eclampsia. Which antihypertensive is inappropriate?
A. diazoxide
B. metoprolol
C. enalapril
D. hydralazine
E. nifedipine

Back 85

C

ACEI bad for foetus!

Front 86

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?
A. paraesthesia in little finger
B. paraesthesia in the distribution of the interscalene nerve
C. weakness in adductor digiti minimi
D. weakness in the abductor pollicis brevis
E. weakness in lateral interosseus

Back 86

D.

Median nerve supplies LOAF

Lumbricals x2

Opponens pollicis

Abductor pollicis brevis

Flexor pollicis brevis

Hint: "brevis" sounds like "bread" hence "LOAF".

Front 87

119. According to PS09, the minimum requirement for administering propofol for conscious sedation is
A. Medical practitioner with a skilled assistant that is seperate from the assistant to the proceduralist
B. Medical practitioner
C. Nurse supervised by proceduralist with recent ALS training
D. Specialist anaesthetist
E. Nurse with advanced airway skills

Back 87

A

Front 88

122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?)
A. More difficult to preoxygenate
B. More rapid detection of hypoxia
C. FRC decreased more than adults
D. Drugs work more rapidly
E. Persistent L->R shunt (or was it right to left?)

Back 88

A

Front 89

125. Adenosine can be used to treat
A. Atrial fibrillation
B. Atrial flutter with variable block
C. WPW syndrome
D. Ventricular tachycardia
E. Torsades

Back 89

C

Front 90

126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step
A. Continue surgery with tiva propofol
B. Abandon surgery
C. Wait for co2 to rise restart surgery after 30 min
D. Continue with inhalational agents
E. Give calcium as potassium may have raised.

Back 90

Answer: A

OHA:

Switch to MH safe anaesthetic

Wait 15 mins and monitor for increasing heart rate / CO2

Front 91

127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by:

A. angiography

B. direct ophthalmoscopy

C. indirect ophthalmoscopy

D. intra-ocular pressure tonometry

E. palpation of the globe by an experienced clinician

Back 91

B.

Ref: ANZCA Podcast on eye surgery - to assess central retinal artery pulsations

Front 92

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:

A. acidosis

B. dilution of clotting factors

C. hypothermia

D. systemic release of tissue factor

E. tissue hypoperfusion

Back 92

E

Protein C inhibits Fx V and VIII

V+VIII="intrinsic tenase"

TF+VII="extrinsic tenase"

These convert X to Xa

It's too early for dilution of clotting factors.

Front 93

129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is:

A. 160ml

B. 260ml

C. 360ml

D. 460ml

E. 660ml

Back 93

C.

Parkland Formula

20kg x 15%TBSA x 4mL = 1200mL in the first 24 hours (1/2 in first 8 hours, 1/2 in next 16 hours)

So, 600mL in the first 8 hours SINCE TIME OF BURN. i.e. over the next 2 hours.

=300mL/hr

Plus maintenance (4/2/1 rule)

=60mL/hr

TOTAL = 360mL/hr in the first hour.

Front 94

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

A. give 0.5 mg metaraminol iv

B. use NMT to assess train of four ratio

C. change to volatile anaesthetic

D. do nothing

E. increase propofol TCI concentration by 0.5

Back 94

E

Probably some muscle activity but may be early sign of light anaesthesia

Can also increase Remi if possible

Front 95

131. The normal physiological response following ECT is

A. transient tachycardia followed by bradycardia and hypotension

B. transient bradycardia followed by tachycardia and hypertension

C. unpredictable

D. transient tachycardia followed by bradycardia and hypertension

E. tachycardia and hypotension

Back 95

B

Front 96

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.

A. Metaraminol bolus

B. Commence an adrenaline infusion

C. Increase oxygen flow rate

D. Increase pump flow rate

E. IV crystalloid bolus

Back 96

A

He was stable on bypass so the hypotension and low CVP unlikely due to cardiac output or volume issue.

Front 97

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.

A. Commence a vassopressor to support the circulation and improve end organ perfusion.

B. Obtain IV access and crossmatch

C. Intubate to secure the airway and prevent aspiration

D. Perform an abdominal ultrasound to confirm diagnosis

E. Ventilate with a bag valve mask to improve saturations

Back 97

B

Can't commence vasopressor without IV!

Don't need to intubate because GCS>8

Front 98

137. A PiCCO monitor may be used to measure cardiac output through use of:

A. Lithium Dilution Cardiac Output (LiDCO)

B. Pulse contour analysis

C. Pulse contour analysis and thermodilution

D. Thermodilution

E. Thermodilution and aortic flow doppler

Back 98

C

Front 99

138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone.

A. Less potential for abuse

B. Less constipation

C. Less sedation

D. Less respiratory depression

E. Less pruritus

Back 99

B. Primary effect

Also less potential for abuse.

Front 100

141. Immunity to Hepatitis B is demonstrated by the presence of

A. Hepatits B core antibodies

B. Hepatits B core antigens

C. Hepatits B surface antibodies

D. Hepatits B surface antigens

E. Any of the above

Back 100

C

Front 101

142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is

A. Dysfibrinogenaemia

B. Hypoalbuminaemia

C. Prolonged Prothrombin time

D. Portal Hypertension

E. Thrombocytopaenia

Back 101

E.

Thrombocytopenia is best PREDICTOR of bleeding (Oxford Handbook).

Whereas, INR is a good sign of hepatic function.

Front 102

143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with:

A. calcitonin

B. frusemide

C. intravenous fluids

D. magnesium

E. mythramycin

Back 102

C.

Strategies include:

1. Increase excretion: fluids, frusemide

2. Reduce resorption/absorption: bisphosphonate, calcitonin

Front 103

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.

A. 2.6L N/saline

B. 3.6L N/saline

C. 3.6L CSL

D. 4.8L N/saline

E. 4.8L CSL

Back 103

E.

But what about maintenance?!?!

Front 104

145 The thoracic paravertebral space is continuous down to

A. T10

B. T12

C. L2

D. L4

E. S1

Back 104

B.

Thoracic paravertebral space is contiguous with adjacent levels.

Paravertebral space also exists in C and L spine but are not contiguous with adjacent levels.

Front 105

146. To best visualise a superficial peripheral nerve you should use a

A. low frequency probe at 90 degrees to the skin

B. high frequency probe at 90 degrees to the skin

C. low frequency probe at 45 degrees to the skin

D. high frequency probe at 45 degrees to the skin

E. low frequency probe at 75 degrees to the skin

Back 105

B

Front 106

148: (Repeat). 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 106

B - since the question asks about "enhancing" elimination.

Haemodialysis is the most effect to ELIMINATE aspirin but doesn't "enhance" the body's elimination.

Front 107

149. After an uneventful Caesarean section under regional anaesthesia a healthy primigravida complains of chest pain and shortness of breath before rapidly losing consciousness. What is the most likely cause?

A. Inadvertent administration of suxamethonium

B. Pulmonary embolism

C. Amniotic fluid embolism

D. Anaphylaxis to oxytocin

E. Venous air embolism

Back 107

B

PE risk is higher than AFE risk. Plus PE risk is even higher in LSCS. Plus AFE chest pain rare.

PE risk 1:1000 to 1:3000

PE risk increases 2-8 fold for LSCS

AFE risk 1:8000 to 1:80000

Front 108

150. The faster rate to desaturation observed in morbidly obese patients is due to:

A. Decreased residual volume

B. Decreased functional residual capacity

C. Decreased diffusion capacity

D. Increased closing capacity

E. Increased pulmonary blood volume

Back 108

B

Front 109

[Nonum 1] In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would-

A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece

B. Deflate tracheostomy cuff, remove one-way valve, insert fenestrated piece

C. Inflate tracheostomy cuff, remove one-way valve, insert fenestrated piece

D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece

E. ?

Back 109

A

Front 110

[Nonum 2] Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common?

A. Posterior

B. Vertical

C. Lateral

D. Subaxial

E. ?

Back 110

B

Anterior subluxation 80%

Vertical / Lateral 10-20%, with the majority being Vertical.

Posterior 5%

Subaxial <2%

Front 111

[Nonum 3] A 13kg child booked for elective procedure. Has had 100mL of clear fluid 2 hours ago. Management?

A. Delay surgery for 2hours

B. Delay surgery for 4hours

C. Delay surgery for 6hours

D. Proceed with surgery

E. Cancel surgery

Back 111

D

Front 112

[Nonum 5] Which is least likely to fraudulent research reduction strategy?

A. Published in a peer review journal

B. Multiple authors

C. Departmental director sole author

D. Research findings similar to other published studies

E. Backing of a major research institute

Back 112

A is good but may not reduce fraud

B is good

C is high risk for fraud

D is neither good or bad

E is bad

Front 113

[Nonum 6] With respect to the triangle of safety and intercostal chest drain (ICC) insertion, if pectoralis major and the 4th - 5th intercostal space form two borders what forms the other?

A. Latissimus dorsi

B. Serratus anterior

C. Midaxillary Line (maybe wasn't an option)

D. Posterior Axillary Line (maybe wasn't an option)

E. Trapezius

Anatomy for insertion of intercostal chest drain - triangle bordered by axilla, pectoralis major and ...?

A: Latissimus dorsi

E. Trapezius

Back 113

A

Front 114

[Nonum 7] Small picture trying to show USS probe on inferio-posterior R arm of a teenager's arm with an associated USS image of a very triangular looking peripheral nerve between two muscle fascia (radial N).

Blockade of this nerve would result in?

A. Reduced pronation

B. Reduced hand grip.

C. Reduced elbow flexion

D. Reduced wrist extension

E. ?

Alt: US picture of radial nerve at upper arm, which motion blocked (wrist extension, pronation)

Alt: Picture showing USS probe in the lower lateral arm near elbow (ie radial nerve) - nerve block confirmed by?

A. Thumb adduction

B. Pronation

Back 114

D

Front 115

[Nonum 8] USS picture of an axillary brachial plexus nerve block with all four nerve unlabelled, the humerus, brachioradialis and biceps brachii marked.

(Good quality image provided)

What is the structure labelled 1.?

A. Musculocutaneous nerve

B. was Radial N

C. was Ulnar N

D. was Median N

Back 115

A was the answer

Front 116

[Nonum 9] Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be?

A. Pulmonary embolism

B. Venous air embolism

C. Acute right heart failure

D. ?

E. ?

Back 116

B?

Any of the above really.

Front 117

[Nonum 10] Paediatric intubation of 20kg, 5.5 doesnt fit, 4.5 doesn't fit, what next?

A. 4.0 tube

B. LMA

C. flex bronch

D. ?

E. ?

Back 117

A?

Front 118

Trauma patient undergoes delayed ORIF FEMUR. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium Femoral Nerve Block, turned lateral. Suddenly BRADYCARDIC, ETCO2 45, MAP 50mmHg. This is most likely to be ..?

A. PE

B. Fat embolism

C. Anaphylaxis

D. LA Toxicity

E. ?

Back 118

D. LA Toxicity

PE and Fat Embolism should cause decreased ETCO2

Anaphylaxis causes tachycardia