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95 Cards in this Set

  • Front
  • Back
When hearing loss occurs following spinal anaesthesia it is usually in which of the following frequency ranges:

A 125 - 1000 Hz
B 1500 - 3000 Hz
C 3500 - 5500 Hz
D 6000 - 10000Hz
E > 11000Hz
A
Each of the following drugs act at the DOP (delta receptor) EXCEPT:

A. diamorphine
B. fentanyl
C. morphine
D. naloxone
E. pethidine
B
Patient burns during MRI can be associated with each of the following EXCEPT
A high intensity changing magnetic fields
B looped monitoring lines ...
C non ferromagnetic material in contact with the patient
D cosmetics worn by the patient (which do not contain metals)
E temperature monitoring with thermistor probes
D?
Preoperative assessment shows a malampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehanes is predicted. Compared to the ML score, the TMD is:
A less sensitive, less specific
B less sensitive, more specific
C more sensitive, less specific
D more sensitive, more specific
E equal sensitivity an specificity
definitely less sensitive, specificity varies depending where you read, either A or B
In performing an awake fibreoptic intubation it is MOST important that care is taken to avoid:
a. Causing any bleeding that will obstruct view
b. Oversedation as leads to posterior pharyngeal wall collapse
c. Trauma to nasal turbinates
d. Touching vocal cords as will induce coughing
e. Oral route as may bite the fibreoptic scope
B
CT reprint showing large MNG. Uppermost concerns to anaesthetist is
a. Involvement of the Right carotid artery
b. Tracheal deviation to the left
c. Tracheal deviation to the right
d. Malignant involvement of the paratracheal nodes
e. compression of upper lobe of rt.lung
D. See OHA page 555 2nd edition on Thyroidectomy - malignancy - cord palsies likely. Distortion and rigidity of surrounding structures. Possibility of intraluminal spread. Larynx may be displaced. Tumour can produce obstruction anywhere from glottis to carina
PAC seeing patient with thyroid disease. Most reassuring factor for normal thyroid function is:

A. Absence of 'hot' nodules on nuclear scan

B.?

C. Normal heart rate

D. Normal temperature

E. Absence of any antithyroid medications
C
T1 injury. Patient now 4 weeks post and going to theatre for sacral pressure area debridement. Feature most UNLIKELY to reflect autonomic dysreflexia

A. ?

B. Bradycardia

C. Severe hypotension

D. ?

E. Goose bumps below T1 level
Answer is C severe hypotension. Autonomic dysreflexia is characterised by massive, disordered automonic response to stimulation below the level of the lesion. It is rare in lesions lower than T7. Incidence increases with higher lesions. It may occur within 3wk of the original injury but is unlikely to be a problem after 9 months. The dysreflexia and its effects are thought to arise because of a loss of descending inhibitory control on regenerating presynaptic fibres.

Hypertension is the most common feature but is not universal. Other features include headache, flushing, pallor ( may be manifest above the level of lesion, nausea, anxiety, sweating, bradycardia and penile erection. Less commonly pupillary changes or Horner’s syndrome.

Dysreflexia may be complicated by seizures, pulmonary oedema, coma or death and should be treated as a medical emergency.

Stimuli to trigger

• Urological: bladder distension, UTI, catheter insertion • Obstetric • Bowel obstruction • Acute abdo • Fractures
With regard to fire in OT

A. Mainly caused by laser surgery

B. Decreased incidence since cessation of use of cyclopropane and ether

C. Need fuel, ignition source and oxidizing agent

D. ?

E. ?
Anesthesiology May 2008, 108(5): "fire triad", oxidizer, ignition source, fuel
Visual loss post-operatively

a. more common after external ocular compression

b. incidence 1 in 200,000

c. most common after spinal surgery

d. incidence independent of duration of surgery

e. more common after isovolaemic haemodilution
Perioperative Visual Loss After Nonocular Surgeries, American Journal of Ophthalmology Volume 145, Issue 4 604-610

From above reference, A:False ext compression does not cause ION (casues central retinal occlusion) and ION most common cause 85% B:False 1:125 000 CCEAP C:True- Perioperative ION has been reported after a wide variety of nonocular surgeries, including spinal surgery, cardiac surgery, radical neck dissection, and vascular, abdominal, and orthopedic procedures.[13] and [16] In the ASA Registry, 73% of cases occurred in the setting of spine surgery. D: False- duration >6 hours a major factor E: False- Hct not a factor.
Cause for hoarse voice after anterior spinal surgery

a. glossopharyngeal nerve palsy or lesion

b. recurrent laryngeal nerve palsy or lesion

c. superior laryngeal nerve or lesion

d. airway oedema

e. prolonged intubation
D?
Features most suspicious for myocardial ischaemia
a. ST depression 2mm during fem pop bypass in 60 yo man under spinal
b. T wave inversion in fem pop bypass in 60yo under spinal
c. 0.7mm ST elevation in fem pop bypass in 60 yo man under spinal
d. SAH in young man
e. 32 yo woman during LSCS
A. BJA 2005, 95, Priebe( author) says 80% perioperative AMI occur in early post-op period and most commonly preceded by ST depression and turn out to be non Q wave infarcts. The cumulative time of ST depression is significant
The Line Isolation Transformer
a. ?
b. ?
c. Provides low current to the line isolation monitor
d. Separates earth from the OT electrical supply (similar wording)
e. ?
Miller 6th Edition Chapter 87 (pp 3139-43) which confirms that the line isolation transformer supplies power sockets within the OT with an electrical supply which is isolated from ground - D correct
DC cardioversion - LEAST likely indicated for
A atrial fibrillation
B atrial flutter
C multifocal atrial tachycardia
D paroxysmal atrial tachycardia
E ventricular tachycardia
Cardioversion is contraindicated in MAT. Due to the multiple atrial foci, direct current (DC) cardioversion is not effective in restoring normal sinus rhythm and can precipitate more dangerous arrhythmias.
Hypercalcaemia due to hyperparathyroidism is associated with
A an elevated GFR
B prolonged QT
C short PR interval
D polyuria polydipsia
E skeletal muscle rigidity
D
Suprapubic prostatectomy bleeding excessively. Need to exclude primary hyperfibrinolysis. Most useful test would be
A clot retraction time
B plasma fibrinogen estimation
C prothrombin time
D thromboelastography
E whole blood clotting time
TEG
While of the following statements regarding patients with ankylosing spondylitis are FALSE
A amyloid renal infiltration is rarely seen
B cardiac complications occur in <10% of cases
C normovolaemia anaemia occurs in over 85% of cases
D sacroileitis is an early sign of presentation
E uveitis is the most common extra articular manifestation
A TRUE Amyloidosis is a very rare complication of ankylosing spondylitis in patients with severe, active, and long-standing disease. These patients generally have active spondylitis, active peripheral joint involvement, and an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein level. This may result in renal dysfunction with proteinuria and renal insufficiency or failure.[5]


B TRUE Cardiovascular involvement of clinical significance occurs in fewer than 10% of patients, typically those with severe long-standing disease. However, subclinical disease can be detected in many patients and may occur as an isolated clinical entity in association with HLA-B27[6]


C FALSE Approximately 15% of patients may present with a normochromic normocytic anemia of chronic disease.[7]


D TRUE


E TRUE Uveitis is the most common extra-articular manifestation, occurring in 20-30% of patients with ankylosing spondylitis. Of all patients with acute anterior uveitis, 30-50% have or will develop ankylosing spondylitis. The incidence is much higher in individuals who are HLA-B27–positive (84-90%)
COPD patient with pulmonary hypertension and acute RHF. Treatment
a. 100% oxygen will decrease the pulmonary artery pressure
b. Sildenafil will be useful for treating RHF
c. Noradrenaline is an appropriate inotrope for this patient
d. ?
e. ?
With regards to A ........ West's section on hypoxic pulmonary vasoconstriction says "When alveolar PO2 is altered in the region above 100mmHg, little change in vascular resistance is seen". Hypoxic pulmonary vasoconstriction is most prominent with PAo2 < 70mmHg. Hence A wrong

With regards to B ........ Seems the most reasonable answer

With regards to C ........ Noradrenaline will partially constrict pulmonary vasculature increasing pulmonary vascular resistance. I would choose an agent that is both an inotrope and pulmonary vasodilator (milrinone). Noradrenaline may need to be used as a pressor with milrinone but would not be used as an inotrope. On broader principles, noradrenaline is almost never used for its apparent inotropy, rather for its pressor action. Hence C wrong
Post op patient (surgery 3/7 ago). Patient dyspnoeic. V/Q scan organized which shows non segmental matched perfusion/ventilation defects. This is consistent with
a. Atelectasis

b. COPD (multiple, segmental, peripheral, bilateral, matched)

c. Pulmonary embolus (mismatched)

d. Pneumonia (reverse mismatch)

e. Pulmonary infarction (mismatched)
Answer is A atelectasis. both compression of pulmonary vessels and alveoli (matched VQ defect plus non segmental)
A 25yo primipara with an uncomplicated pregnancy presents to delivery suite in labour at term. Her membranes spontaneously rupture soon after, and it is blood-stained. At the same time, a severe foetal bradycardia appears on the CTG. What is the most likely cause of this?
A. Placenta accreta
B. Placental abruption
C. Uterine rupture
D. Vasa praevia
E. True knot in the umbilical cord
Vasa praevia (vasa previa AE) is an obstetric complication defined as "fetal vessels crossing or running in close proximity to the inner cervical os. These vessels course within the membranes (unsupported by the umbilical cord or placental tissue) and are at risk of rupture when the supporting membranes rupture."[1]

These vessels may be torn at the time of labor, delivery or when the membranes rupture. It has a high fetal mortality because of the bleeding that follows. [2] The blood lost is foetal not maternal blood hence the high mortality.

The classic triad are membrane rupture followed immediately by painless vaginal bleeding and fetal bradycardia.--SG 10:37, 23 Oct 2008
Patient with placenta acreta. Surgical management MOST likely to save her life
A B lynch suture around the uterus for external tamponade
B Rusch balloon in the uterus for internal tamponade
C ligation of the internal iliac arteries
D ligation of the uterine arteries
E subtotal or total hysterectomy
E
After a difficult thyroidectomy for thyroid carcinoma, a 63 year old woman develops stridor immediately following extubation. The most likely cause is
A hypocalcaemia
B neck oedema
C recurent laryngeal nerve palsies
D tracheomalacia
E vocal cord oedema
C - difficult thyroidectomy for malignancy suggests surgeons digging around a lot and nerves may have been involved... But agree, all are correct. In Surgery 2003 137 (3): recurrent laryngeal nerve palsies are the most common complications, about 5 % , even 19.4% in cancer
Patient with traumatic brain injury has the following readings. Global CBF flow measured at 15ml/100gm/min while the CMRO2 is measured at 3.5ml/100gm/min. There is
A appropriate coupling of cerebral perfusion and cerebral metabolism
B autoreguation of cerebral vasodilation
C cerebral hypoperfusion
D cerebral ischaemia
E reperfusion injury
D: almost normal o2-consumption but dramatic reduction in o2-delivery - clearly uncoupled and beyond just hypoperfusion
55 year old subarachnoid haemorrhage secondary to aneurysm. Patient is confused with a oculomotor (3rd cranial nerve) palsy, complains of a severe headache. This patient is in Hunt and Hess class:
A 0
B 1
C 2
D 3
E 4
D

1. Asymptomatic, mild headache, slight nuchal rigidity
2. Moderate to severe headache, nuchal rigidity, no neurologic deficit other than cranial nerve palsy
3. Drowsiness / confusion, mild focal neurologic deficit
4. Stupor, moderate-severe hemiparesis
5. Coma, decerebrate posturing
Traumatic brain injury with central diabetes insipidus. Can be managed with
A democlocydine
B desmopressin
C fludrocortisone
D fluid restriction
E frusemide
B
Called to ward for Postoperative thyroidectomy bleeding in ward. SpO2 92% on 6L, tachycardic and ?hypertensive and neck haematoma. What is the least appropriate management:
a. call and arrange CT scan of his neck
b. call OT and arrange urgent surgery
c. release staples
d. increase oxygen supply
A
Hypertensive female at 38 weeks gestation BP 180/110. CTG shows no foetal distress. First Hb 110 and second is 109. First plt count 90 then drops to 40. AST increases from 50 to ? 120. Most appropriate management is
a. deliver the baby
b. various antihypertensive medication options
c. 20mg frusemide
d.?
e.?
Depends how the question is worded and if Initial management was used. I agree that delivery is the plan as you may not get control of her BP until the placenta is out.
Post bypass 3 vessel CABG. Hypotensive and ECG shows ST elevation in II, aVF CVP 15mmHg PAP 25mmHg with normal SVR and PVR. What is most likely to be seen on TOE
a. early diastolic augmented flow ct atrial systolic flow
b. Inferior hypokinesis (of the left ventricle)
c. RV failure and TR
d. Empty left ventricle following systole
e. Mitral regurgitation
B?
The left recurrent laryngeal nerve
A hooks around the arch of the aorta anterior to the attachment of the ligamentum arteriosum
B passes under cover of the lower border of the inerior constrictor muscle before entering the larynx
C supplies the cricothyroid muscle
D supplies sensation to the whole of the laryngeal mucosa on the left side
E contains motor fibres derived from the spinal root of the accessory nerve
A false posterior to ligamentum arteriosum

B ? TRUE

C False innervates all intrinsic muscles of the larynx except the cricothyroid

D False supplies sensation to mucosa BELOW the cords (Superior laryngeal nerve above cords)

E False Vagus nerve.
The ascending aorta
A has no branches
B begins at the semilunar valve
C arises from right ventricle
D occupies the superior mediastinum
E lies inferior to the SVC
? B or D
The nerve providing sensory supply to the airway muscle below (inferor) to the vocal cords is the
A phrenic nerve
B posterior thyroid nerve
C recurrent laryngeal nerve
D superior laryngeal nerve
E tracheal nerve
C
Ciliary ganglion
A sympathetic from inferior cervical ganglion
B located inferiorly within orbit
C may be damaged during a peribulbar block
D preganglionic parasympathetic supply from the supra trochlear nerve
E preganglionic parasympathetic originates from the Edinger Westpal nucleus
E
You are seeing a 60yo man in the pre-anaesthetic clinic before his right total knee replacement. He weighs 70kg and apart from his osteoarthritis is fit and well. You discuss with him the options of a general anaesthetic with multi-modality analgesia and enoxaparin postoperatively as well as the option of an epidural for both the anaesthetic and post operative pain management. What is INCORRECT regarding the epidural?
A. It will shorten his hospital stay and accelerate his rehabilitation
B. It will give him better pain relief particularly for the CPM machine (the continuous pain machine) <--- really?? I thought CPM was continuous passive motion?
C. It will reduce his risk of myocardial ischaemia
D. There will be little difference in his risk of thromboembolism.
E. If he has no sedation, his risk of post-operative delirium and cognitive impairment will be reduced
The question asks for the incorrect answer.Taken from Acute Pain management:scientific evidence(ANZCA)summary and pg 110-115(2nd edition)

A)- True

B- True Better analgesia with all techniques of epidural anaesthesia (in particular with movement) as compared to parenteral opioids

C- False( correct answer): only true for thoracic epidurals extended for more than 24hrs, not lumbar epidural for RTKJReplacement.

D- True, only difference is with graft occlusion in peripheral vascular surgery, not orthopaedics and DVT where DVT prophylaxis has been used.

E- true

C false therefore correct answer
Effect of Injecting 5 mL of saline into the epidural space:
a. increase incidence of patchy block
b. decreased risk of epidural vein catheterisation
c. no effect
d. increased ease of threading catheter
e. ? decreased effectiveness of block
a False (compared with 2 mls - less patchy block 91% vs 67%)

b True 5mls vs 2mls NS - 2% vs 16%)

c False

d False

e False
PDPH.

a. IV caffeine treatment used to relieve symptoms.
b. Is usually frontal headache
c. Bed rest for 24 hrs is beneficial
d. no use if blood patch done after 48 hrs.
e. usually manifests within first 4 hrs.
A True as per pain bible [15] page 166.

B False usually occipital and frontal

C ? correctly remembered - as per pain bible not beneficial in preventing PDPH (symptomatic relief)

D BS!

E False usually manifest 24-36 hours post puncture
A terrorist attack has taken place involving the nerve gas "VX". Some victims have arrived in the emergency department. The most appropriate management of this situation is to:
A. Strip them off and hose them down
B. Strip them off, scrub them with a brush, and hose them down
C. Leave their clothes on and hose them down
D. Leave their clothes on, scrub them with a brush, and hose them down
E. Take them to the resuscitation area and put in an IV
A
Another GCS question – open eyes to command, withdrawing from pain, confused conversation:

A. 8
B. 9
C. 10
D. 11
E. 7
Eyes 3/4 Movement 4/6 Verbal 4/5

answer D
young man in trauma, had been drinking,alcohol level >300. Multiple fractures. Initial lactate 10 then post fluid resus lactate 5.
a. 2nd lactate more important than first for prognosis
b. initial lactate high due to alcohol c. ?
d. The initial lactate result carries a mortality exceeding 20% e. ?
A. Truish in that increased lactate or no reduction in high lactate is prognostic of very poor outcome (mortality 100% in haemorrhagic trauma with patients with no improvement in lactate after 48 hours of resuscitation [18]

B. False Alcohol may increase lactate levels slightly but lactic acidosis (and a lactate of 10!!! extremely unlikely without protein malnutrition and still this is very rare.

D. Depends on reference - Multiple articles claim > 20% mortality in SIRS/sepsis however for trauma unlikely to predict outcome. See reference
A 6 month old baby is booked for an elective right inguinal hernia repair. An apropriate fasting time is
A 2 hours breast milk
B 4 hours formula milk
C 5 hours breast and formula milk
D 6 hours solids
E 8 hours solids, 4 hours all fluids
This question may well be from the ANZCA document on day surgery which includes fasting guidelines - They are as stated above (2 hours clear fluids, 4 hours breast milk for any age child, 4 hrs for formula for <6 week old, or 6hrs for formula/solids for >6 weeks old, and of course 6 hrs adult solids). D for me then
Arrest in a 10 year old. Has ventricular tachycardia after a near drowning accident. Patient is intubated and is being ventilated with 100% O2 and has IV access. A single DC monophasic shock of 60J has been given. The next step is to give
A adrenaline 10mcg/kg and DC shock 60J
B adrenaline 10mcg/kg and DC shock 120J
C amiodarone 5mg/kg
D DC shock 60J
E DC shock 120J
E (although now all shocks are 4J/kg)
Only give adrenaline after 2nd shock
6 month old baby for VSD repair. Induced with 50% N2O, O2, sevoflurane 8%. While obtaining IV access, the patient desaturates to 85%. The manouevre to increase the O2 saturations is to
A give a fluid bolus
B change from sevoflurane to isoflurane
C institute CPAP
D decrease the FiO2
E reduce the sevoflurane concentration
Notes from Children's Hospital Westmead say that even in large VSDs, the shunt is L-> R (unlike in Tetralogy), and while pulm vasc changes begin at 6-12 months, change to R->L shunt does not develop until teens. In fact, surgical repair is contraindicated if PVR/SVR <0.5 or PHT with R->L shunt ! So increasing SVR will not help sats (in fact will promote more LVF). Given question states that desat occurs while stabbing child, it is more likely to be a standard laryngospasm, so CPAP will help - hence ?C
The active metabolite of ketamine is:
a. Hydroxyketamine
b. Hydroxynorketamine
c. Ketamine glucuronide
d. Ketamine sulphonamide
e. Norketamine
E norketamine Metabolites of ketamine are norketamine and dehydronorketamine
Antidepressants are not effective/recommended for
a. Chronic headache
b. Chronic back pain
c. Chronic pain post mastectomy
d. Chronic pain post acute herpes zoster
e. Trigeminal neuralgia
E Trigeminal neuralgia --SG 12:22, 26 Oct 2008 (EDT)

It is also no use in acute herpes zoster but my reduce post herpetic neuralgia (PHN) and is usful in PHN. G
In the new edition of APMSE that's coming, they've reversed the finding about back pain. Now "There is no good evidence that antidepressants given to patients with chronic low back pain improve pain relief (Urquhart et al, 2008 Level I)." Wonder if they'll ask the question again.
They've also reversed the key message re mastectomy. "Antidepressants reduce the incidence of chronic neuropathic pain after breast surgery - This has been deleted as the information and evidence supporting it has been withdrawn."
NNT is the number of patient who need to be treated to prevent 1 additional bad outcome. The NNT is the reciprocal of the

A. absolute odds of a bad outcome

B. absolute risk of a bad outcome

C. absolute risk reduction in the bad outcome (due to the treatment)

D. odds ratio of the bad outcome (due to the treatment)

E. relative risk of the bad outcome (due to the treatment)
Answer is C

ie new antiemetic reduces risk of vomiting by 1/5th. Thus absolute risk reduction of bad outcome is 1/5th. Thus NNT is 5 inorder for 1 patient to not vomit.
Anaphylaxis, which is wrong:
A. higher incidence in females (females have a higher incidence of anaphylaxis to neuromusclar drugs)
B. ??avocados, bananas and latex (edit: cross reactivity between...)
C. vecuronium - more likely to cause an anaphylactoid reaction than anaphylaxis
D. 99% within mast cells
E. peak tryptase in 1hr
C
Sepsis resulting from the administration of blood contaminated with Yersinia
Enterocolitica typically results in a mortality of:

A. <5%
B. 20%
C. 40%
D. 60%
E. 80%
D
n obese 40-year-old woman is having laparoscopic surgery for endometriosis. She is intubated
and ventilated with a mixture of oxygen and air. The ventilator is set to provide a tidal volume of
600ml at 12 breath.min-1 with 5 cm H2O positive end-expiratory pressure (PEEP). The peak
inspiratory airway pressure is 35 cm H2O. She was stable on induction and during preparation
for surgery but 10 minutes after introduction of the pneumoperitoneum and being placed in the
Trendelenburg position, her arterial oxygen saturation (SaO2) falls to 80%. The SaO2 remains
unchanged despite ventilation with 100% oxygen. Her blood pressure is 130/80, pulse 100 min-1
and end-tidal carbon dioxide 44 mmHg. The most likely cause of her desaturation is:

A. Aspiration
B. endobronchial intubation
C. gas embolism
D. hypoventilation
E. pneumothorax
B
60 year old patient with renal failure has a total knee replacement.
Three days postop, patient develops SOB, chest pain and tachycardia.
Shown an ECG - (RBBB, R wave in VI, S wave in I, Q wave in III, t wave inversion in III (i.e. S1Q3T3). (Also had widespread ST elevation)
What is the diagnosis?
A. Myocardial infarction
B. Pulmonary embolus
C. Hyperkalemia
D. Pericarditis
E. ?
B
Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing:
A. abnormalities on magnetic resonance imaging (MRI) spectroscopy
B. calcium release from B lymphocytes in response to caffeine stimulation
C. certain mutations in the ryanodine receptor gene
D. myofibrillar necrosis on muscle biopsy
E. plasma creatine kinase (CK) levels above 800 units.l-1
?
Antidepressants have benefit in all the following except:
A. Chronic headache
B. Chronic back pain
C. Chronic pain after acute herpes zoster
D. Trigeminal neuralgia
E. Acute herpes zoster
B
It is MOST important to re-program a patient's implanted cardiac pacemaker prior to:
A. electroconvulsive therapy (ECT)
B. laser therapy to a laryngeal papilloma
C. lithotripsy of a renal calculus
D. magnetic resonance imaging of the thorax
E. percutaneous transhepatic cholangiography
C or D?
All the following are predictors of difficult intubation EXCEPT:
A. Inter-incisor distance <3cm
B. Prominent C1 spinous process
C. Prominent maxillary canines
D. Samsoon classification - Class IV
E. TMD <6cm
B
Image of an ultrasound of neck with arrow pointing to carotid artery. Regarding what is arrow pointing to:
A. This will collapse with pressure
B. With doppler will be red if probe directed caudally
C. Is part of the brachial plexus
D. Will get smaller with Valsalva
E. Should centre image over this for CVC insertion
Answer B Red-Towards scanhead/Blue-Away scanhead. Tortis (so if the probe pointing cranially then bluue is artery and red is vein-gb
BP measurement - overestimates with:
A. big (wide) cuff
B. skinny arm
C. severely peripherally vasoconstricted
D. atherosclerosis (it was arteriosclerosis)
E. slow cuff deflation
D
What is the most sensitive method for detecting intraoperative air embolism?
A. capnography
B. TOE
C. Praecordial Doppler
D. Oesophageal stethoscope
E.
B
Electrical safety. A device that detects a 10mA difference in active and neutral leads and causes turning off of the circuit within 40 ms. this is a :
A. Class 1 device
B. Equipotential earthing
C. LIM
D. Residual Current Device
E. Fuse
D
What is the best way to improve resolution on a 2D ultrasound?
A. adjust frame rate
B. increase probe frequency
C. increase 2D gain
D. ?something about waveform scatter?
E. increase TGC
B- Increased frequency increases resolution, decreases penetration.
When considering an acute myocardial infarction:
A. Aspirin and clopidogrel should not be given together
B. PCI is better than thrombolysis
C. Aspirin should not be given prior to MI confirmed with cardiac enzyme rise
D. Reperfusion can be delayed for 24hrs
E. something about confirming cardiac enzyme elevation before instituting reperfusion strategies
B
Hyperparathyroidism and increased Ca+
A. Long QT
B. Polydipsia and polyuria
C. Short PR
D. Increased GFR E.
B
Haemophilia A associated with
A. haemarthroses in infant female
B. haemarthroses in infant male
C. factor IX deficiency
D. Incr APTT but not PT
E. Incr APTT and PT
D
Carcinoid syndrome - finding on examining heart:
A. Fine inspiratory crepitations
B. Systolic murmur at apex
C. Systolic murmur at left sternal edge
D. Murmur at apex with opening snap
E. Pericardial rub
C--tricuspid regurg
You are anaesthetising a patient with acute intermittent porphyria. Which drug will most likely cause an attack of porphyria?
A. Droperidol
B. prochlorpazine
C. ondansetron
D. metoclopramide
E. tropisetron
D
Central anticholinergic syndrome, which is NOT true:
A. Will improve with neostigmine
B. Peripheral anticholinergic symptoms
C. Caused by Anti-Parkinson drugs
D. CNS depression
E. Associated with agitation, delirium, and ???
A
Old man with small cell lung ca, post lobectomy, in PACU, SOB, desaturating. Shoulder abduction and hip flexion weakness, weak but sustained handgrip. 8mg cisatrac given 90 minutes earlier, reversed with 2.5mg neostigmine and 1.2mg atropine. Most likely cause:
A. Eaton-Lambert syndrome
B. Myasthenia gravis
C. Steroid myopathy
D.
E.
A
Hyponatraemia and hypovolaemia all except
A. SIADH
B. Pancreatitis
C. Nephritis
D. Renal tubular acidosis
E. Addisons
A
After 3L normal saline, expect to see:
A. hyponatremic acidosis
B. hyponatremic alkalosis
C. hyperchloremic acidosis
D. hyperchloremic alkalosis
E. none of the above
C
Regarding serotonin syndrome
A. difficult to distinguish from NMS but it is not essential to differentiate as treatment is similar
B. Has direct antidote promethazine
C. May be contributed to by pethidine
D.
E.
A: False

bromocriptine, a central dopaminergic agonist thought to be useful in neuroleptic malignant syndrome, may cause the serotonin syndrome and therefore is contraindicated...Current Critical Care, 2008

B: False

No direct antidote
Cyproheptadine and chlorpromazine potentially antagonize serotonin in the CNS, but there are no controlled trials of these agents...chlorpromazine may be contraindicated in neuroleptic malignant syndrome because of its antidopaminergic properties (important as they are hard to distinguish)...Current Critical Care, 2008
Benzodiazepines generally are considered useful for the serotonin syndrome. They are anticonvulsants, are not associated with serotonin release, and are anxiolytic and sedating. Dantrolene uncouples excitation-contract in skeletal muscles and has been used in malignant hyperthermia, neuroleptic malignant syndrome, and serotonin syndrome. There are case reports of benefit from dantrolene in serotonin syndrome but no controlled trials...Current Critical Care, 2008
Probably as distractor, as it can be used to help flushing in carcinoid syndrome

C: True

Meperidine-induced serotonin syndrome in a susceptible patient, Br. J. Anaesth., September 2009; 103: 369 - 370.
Tramadol, pethidine, fentani(y)l (and congeners), methadone, dextromethorphan, dextropropoxyphene, pentazocine...all possible
What increases the risk of threading an epidural catheter into a blood vessel?
A. not doing a CSE
B. injecting saline prior to threading catheter
C. LOR to saline instead of air
D. paramedine instead of midline approach
E. sitting position instead of lateral
E
38yo obese female with DM, other comorbidities, undergoing LSCS with spinal anaesthetic with a 27G whitacre needle, having this and that, blah, blah. then two days later complains of numbness on a small patch on lateral aspect of mid-thigh. On full neuro exam - no other signs/symptoms.
A. conus medullaris injury
B. L2 nerve root compression
C. L3 root lesion
D. L4 root lesion
E. meralgia paraesthetica
E
Each of the following statements regarding the haemodynamic changes during pneumoperitoneum
for laparoscopy is true EXCEPT:

A. in patients with severe cardiac disease changes are qualitatively similar to those in normal patients
B. right atrial pressure is NOT a reliable indicator of cardiac filling
C. they are well tolerated by morbidly obese patients
D. they are well tolerated in cardiac transplant patients with good ventricular function
E. they are well tolerated in patients with low cardiac output secondary to low preload
A - true statement (not the answer); direct quote from Miller
B - true statement (not the answer); direct quote from Miller
C - direct quote from Miller
D - direct quote from Miller
E - FALSE - The most severe haemodynamic changes are patients with depleted intravascular volume
At what level of intra-abdominal pressure does cardiac output fall? (this exam was definitely cardiac output rather than BP as in other exams)
A. 10 mmHg
B. 20 mmHg
C. 30 mmHg
D. 40 mmHg
E. 50 mmHg
A, from CEACCP 2004 4(4):107-110 – Laparoscopic Abdominal Surgery. M Perrin & A Fletcher
Prolonged Trendelenburg (head-down) positioning causes:

A. no change in intracranial pressure
B. no change in intraocular pressure
C. no change in pulmonary venous pressure
D. increased myocardial work
E. increased pulmonary compliance
From Miller - "The head-down position increases central venous, intracranial, and intraocular pressures". That's A, B and ?perhaps C out. (I have to say that pulmonary venous pressure as opposed to central venous pressure is a variable we know little about. I guess we can assume it to follow pulmonary artery wedge pressure) "The cephalic movement of abdominal viscera against the diaphragm also decreases functional residual capacity and pulmonary compliance" eliminating E. Unfortunately no direct quote on this page supporting D, though it is the only one left.

The Acta Anaes Scand paper (see ref below if link fails) shows PAWP changes (again ruling out C), though against D the heart rate, stroke volume and mean arterial pressure all stayed pretty much the same. Accepting that cardiac work is approximated by HRxSVxMAP suggests that there is no increase in myocardial work, and therefore no right answer. However for my money, A, B, C and E are more clearly wrong than D, which is what I would choose if the question arose tomorrow. Note that the answers to the black bank version below are all based on the understanding that there is pneumoperitoneum as well, which was not in the official question
Clinical scenario where patient develops venous air embolus in sitting position. What is NOT part of your
immediate management?
A. Tell surgeon and flood site with saline
B. Put pressure on neck veins
C. Aspirate central venous catheter
D. Give iv fluids
E. Valsalva manoeuvre
E
Maximum time for arterial tourniquet for upper limb
A. 60 min
B. 90 min
C. 120 min
D. 150 min
E. 180 min
C
20 year old male, 8 hrs post admission for motorbike accident, # femur now in traction. Had femoral nerve block, plus 40 mgs dose morphine IV. Admission CXR normal. Now decreasing level of consciousness, decreasing sats (~85%) despite 6 lts O2, crackles both lungs. what is it?
A. Fat embolus syndrome
B. Pulmonary contusion
C. ?narcotized (drowsy and hypoventilating)
D. Pneumothorax
E. Aspiration
B?
You are performing an awake nasal fibreoptic intubation and wish to topicalise the airway. Which nerves do you need to anaesthetise from proximal to distal..
A. Trigeminal, then glosspharyngeal, then vagal (different combinations of the nerves given in different orders)
B. Facial, trigeminal, vagal
C. Facial, trigeminal, glossopharyngeal
D. Trigeminal, vagal, glossopharyngeal
E. ?
A
A thoracic epidural inserted for pain relief:
A. Allows earlier return of bowel function
B. Prevents wasting of total body protein
C. Does NOT reduce the incidence of MI
D. Epidural opioids alone provide better analgesia than systemic opioids alone
E. Addition of adrenaline significantly reduces local anesthetic dose requirement
ANZCA Pain Book - A,B,E have merit, A best answe
Man with peripheral vascular disease, post unilateral lumbar sympathectomy injection - most likely Cx:
A. orthostatic hypotension
B. genitofemoral nerve neuralgia
C. ?L2-L4 paraesthesia
D. psoas haematoma
E.
complications of lumbar symphatectomy-paralytic ileus,imjury to genitofemoral nerve, ureteric injury, major vessel and bowel injury

Genitofemoral Neuralgia occurs in 5% of all blocks. This causes pain in the L1 groin area and is thought to be due to bruising of the L1 nerve root by the needle passing by it. More than 90% of cases recover spontaneously after 6 weeks
Patient has IDDM and stable angina. Present for cataract extration. Surgeon was not willing to do it with topical LA, but you accidently block the WRONG eye. After explanation and apologising to pt, what do you do next?
A. cancel surgery and re schedule on a day that is convenient to patient
B. cancel surgery, do not rebook case until an incident form has been processed and you are aware of the outcome of the enquiry
C. give a GA
D. block the other eye (topical) and continue (edit: i think this stem was proceed with eye block to correct side - definitely a block I agree)
E. proceed under topical LA (edit: convince the surgeon to do the correct eye with topical anaethesia)
?
Globe perforation with eye blocks is most likely with:
A. Axial length <25mm
B. Medial canthus peribulbar injection
C. Inferotemperal peripulbar injection
D. Age < 40 years
E. Sub-Tenons
Bit of a tricky question. Perhaps it's C? Trying to decide between C and D. Curr Opin Anaesthesiol 15:503±509 says medial canthal is safer than inferotemporal. I'm trying to think whether <40 would be more likely given the possibility of different indications for eye surgery in this age group.
Retrobulbar block is least likely to block which muscle?
A. Lateral rectus
B. Superior oblique
C. Levator palpebrae superioris
D. Inferior rectus
E. Medial rectus
B - Ripart,J. Regional anesthesia for eye surgery, Regional anesthesia and pain medicine, 2005; vol 30(1):pp72-82
Each of the following statements regarding cardiac tamponade as a complication of central venous
lines is true, EXCEPT:
A. catheters with multiple lumens carry greater risk
B. for a left sided catheter, placement of the tip at the mid-point of the brachiocephalic vein is
safe
C. it usually occurs within the first week following insertion
D. placement of the catheter tip above the junction of the right atrium and superior vena cava
will avoid this complication
E. visceral chest pain with drug infusion is an early symptom
A: TRUE..."Stiffer catheters are more likely to perforate. Stiffness is a function of the composition of the catheter (Silastic probably being safest) and the number of the lumen (a function of the greater diameter and presence of ‘septa’ within the catheter)."

B: TRUE..."Zone C (mid‐point, left innominate vein). This is a suitable site for the tip when the catheter is introduced from the left internal jugular or subclavian vein, and reduces the risk of SVC perforation." (In reference to a diagram of the heart and great vessels showing various "zones" for the CVC tip)

C: TRUE..."Most cases occur in the first week after insertion"

D: FALSE (and answer to choose)..."the pericardium may ascend alongside the medial wall of the SVC by up to 5 cm (mean 3 cm). Thus, placement just proximal to the atrium does not obviate the risk of tamponade".

E: TRUE..."This results in two warning signs: visceral‐type chest pain on infusion of drugs or parenteral nutrition solutions and a curved appearance of the distal catheter seen on chest x‐ray"
When using osmotic agents to reduce intracranial pressure (ICP), the patient's serum
osmolality should not be allowed to exceed:
A. 280 mosmol/L
B. 300 mosmol/L
C. 320 mosmol/L
D. 340 mosmol/L
E. 360 mosmol/L
Answer C

"As mannitol is entirely excreted in the urine, there is a risk of acute tubular necrosis, particularly if serum osmolarity exceeds 320 mOsmol/l. Therefore, plasma osmolarity has to be monitored during therapy with hyperosmotic agents" ...Managing elevated intracranial pressure. Curr Opin Anaesthesiol 17:371–376. 2004.


From the ANZCA Neuroanaesthesia Podcast Handout - Section on Hypertonic Therapy

"Mannitol (or sometimes hypertonic saline 1.6-20% (HTS) in trauma), ± loop diuretics if the above measures by themselves are not enough or on surgeon’s request" "Renal failure may occur, especially if dehydrated, pre-existing renal failure or osmolality >320 in adults. Some work suggests that even higher osmolality may be tolerated if dehydration is meticulously avoided."
A patient is ventilated and invasively monitored in intensive care following a traumatic brain injury. Systemic
arterial blood pressure is 140/80 mmHg with a mean pressure of 100 mmHg. Central venous pressure is
8 mmHg and intracranial pressure is 15 mmHg. The cerebral perfusion pressure (CPP) for this patient is:

A. 72 mmHg
B. 85 mmHg
C. 92 mmHg
D. 125 mmHg
E. 132 mmHg
B
Patient on ward, collapsed. Nurse calls code blue when finds pt unresponsive. No signs of life. After ensuring airway is clear, 1st action

A. DCR x3 200J
B. DCR x1 200J
C. precordial thump
D. CPR
E. Adrenaline 1mg
A: False

At the very least, the guidelines are clear on a single shock only if defib immediately available

B: False

In-hospital arrest on ward, defib likely available on trolley...One should use it and diagnose rhythm as 1st action. But we are not told the rhythm, and a single shock (200J with biphasic) is indicated only with VF/pulseless VT, followed by 2 min CPR.
This contrasts with my notes if unwitnessed...not specified on the ARC site...Kingfed

C: False

In a monitored arrest, where the rhythm is VF/VT, and a defibrillator is not immediately available, a precordial thump may be administered..ARC

D: True

In-hospital arrest on ward, defib likely available on trolley...One should use it and diagnose rhythm as 1st action. But we are not told the rhythm, and shocks are not indicated in asystole or PEA.
My teaching notes say 'For unwitnessed collapse (even if defibrillator is present) give 2 min CPR (for coronary perfusion) prior to DC shock'...Kingfed

E: False
Improved neurological outcome has been demonstrated with the use of hypothermia soon after::

A. asystolic cardiac arrest
B. Cerebrovascular accident
C. Perinatal complications causing ischaemic encephalopathy
D. rupture of an inracranial aneurysm
E. traumatic brain injury
A: False

For VF arrest

B: False

There is currently no evidence from randomised trials to support routine use of physical or pharmacological strategies to reduce temperature in patients with acute stroke. Large randomised clinical trials are needed to study the effect of such strategies...[1]

C: True

There is evidence that induced hypothermia (cooling) of newborn babies who may have suffered from a lack of oxygen at birth reduces death or disability, without increasing disability in survivors....Cooling for newborns with hypoxic ischaemic encephalopathy

D: False

No evidence

E:False

The jury is still out on TBI...
Reductions in risk of mortality were greatest and favorable neurologic outcomes much more common when hypothermia was maintained for more than 48 h. However, this evidence comes with the suggestion that the potential benefits of hypothermia may likely be offset by a significant increase in risk of pneumonia...Journal of Neurotrauma

disagree with C see australian resus guidelines :suggest insufficient data, may reduce degree of brain injury in some....ch
12 year old child with hip dislocation at 4pm. Ate 1 hour after injury. Now 11 pm. Best anaesthetic:
A. RSI with ETT
B. delay until next day then treat elective
C. inhalational induction and continue with face mask
D. Reduce immediately with iv sedation
E. inhalational induction and continue with face mask
A
child for grommets with clear runny nose, coryza. dry cough, clear chest, otherwise well, no fever. management:
A. delay 2 weeks
B. delay 1 week
C. crack on with ETT (haha i'd like to see an mcq that says "crack on"! but yes, proceed with...)
D. crack on with face mask
E.
D. The ideal anaesthestic if you decide to do the child with URTI is "minimally invasive". I.e. if you can use a face mask use one, if you can use an LMA use one as instrumentation of the reactive airway can get you into trouble
When using a T piece for a small child, which is not an advantage?
A. Can use low gas flows
B. Feel compliance
C. Assess tidal volume
D. Can rapidly change levels of CPAP
E. low resistance
A

Could it be that this question was not negative, ie. what IS an advantage? In that case it would be option E, as all the other options are wrong with classic T-piece. --Stmz 02:15, 24 Aug 2008 (EDT) Depends if they are referring to classic T-piece or Jackson-Rees modification to T-piece.

http://www.frca.co.uk/article.aspx?articleid=100146
Haemoglobin in infants:
A. 30% fetal Hb at birth, adult levels by 3 months
B. 70% fetal Hb at birth, negligible amounts by 6 months
C. Hb 90 at 6 months normal doesn't need Ix
D. Hb 200 at birth unless delayed cord clamping
E. ?
B??
Clonidine is
A. Alpha 2 agonist centrally that acts presynaptically
B. Alpha 1 agonist
C. Alpha 2 antagonist
D. Alpha 1 antagonist
E. ?
A
Levosimendan:
A. Increases contractility and myocardial oxygen consumption
B. Increases SVR
C. Binds to troponin C and induces a conformational change
D. Increases contractility by increasing calcium influx
E. Causes coronary vasodilation but NOT peripheral vasodilation
C

This article from Anaesthesia in 2006 quotes it exactly :
"Levosimendan causes conformational changes in cardiac troponin C during systole,
leading to sensitisation of the contractile apparatus to calcium ions"
Gabapentin:

A. Adjust dose in renal failure
B. Adjust dose in hepatic failure
C. ?
D. ?
E. ?
A (is renally excreted unchanged)
What is 1 MET uptake of oxygen DUKE'S ?
A. 1-2 ml O2/kg/min
B. 2-3 ml O2/kg/min
C. 3-4 ml O2/kg/min
D. 5-6 ml O2/kg/min
E. 7-8mls O2/kg/min
C 3.5 ml/kg/min
Numbers needed to treat is the inverse of:
A. ?
B. reduction of absolute risk
C. absolute decrease in relative risk
D. relative risk
E. odds ratio
B - NNT = 1/Absolute Risk Reduction