Anzca Mcqs 2014-2

Front 1

2014-2
Q1
A. transdermal fentanyl patch is often used for management of cancer pain. After application, the time to reach peak plasma levels is:
A. 1hr
B. 2hrs
C. 4hrs
D. 12hrs
E. 24hrs

Back 1

E

Front 2

2014-2
Q2: Pharmacological studies are undertaken in several phases. A. phase 3 study involves:
A. Animal studies
B. Testing of drug on healthy volunteers
C. Observational studies on patients with disease
D. Post marketing surveillance
E. Randomised controlled trials on target population

Back 2

E

Front 3

2014-2
Q3: A pregnant patient 28/40 gestation is involved in a high-speed MVA. On admission to the DEM she complains of sudden onset severe chest pain. Her vital signs show HR 120, BP 160/100, SpO2 95% RA. and her ECG shows ST depression. Most likely diagnosis is:
A. Cardiac contusion
B. Tension pneumothorax
C. Aortic dissection
D. Sternal fracture
E. Myocardial infarction

Back 3

C

Front 4

2014-2
Q4: A. 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracturE. No other drugs have been given. 10 minutes later the child suffers a cardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemia is:
A. MH
B. ARF
C. Cardiomyopathy
D. Rhambdomyolysis
E. Crush injury

Back 4

D

Front 5

2014-2
Q52: A. 30yr old pregnant patient develops contractions at 30/40 gestation. Which of the following can not be used for tocolysis? (Question does NOT ask about 34/40)
A. Clonidine
B. Indomethacin
C. Magnesium
D. Salbutamol
E. Nifedipine

Back 5

A

Front 6

2014-2
Q53: In a patient with intraorbital haemorrhage, following local anaesthetic injection, the adequacy of occular perfusion is best assessed by:
A. Angiography
B. Indirect ophthalmoscopy
C. Direct ophthalmoscopy
D. Intra-occular pressure tonometry
E. Palpation of the globe by an experienced physician

Back 6

B

Front 7

2014-2
Q54:What is the appropriate post-operative ibuprofen dosage for a one year old child tds?
A. 5mg/kg
B. 7.5mg/kg
C. 10mg/kg
D. 15mg/kg
E. 20mg/kg

Back 7

C

Front 8

2014-2
Q55:You are inducing a 4yr old child with Arthrogrophysis multiplex congenitA. After you administer the induction agents, you find it difficult to place the laryngoscopE. What is the likely complication?
A. Malignant hyperthermia
B. Neuroleptic malignant syndrome
C. TMJ rigidity
D. Opioid-induced rigidity
E. Inadequate depth of anaesthesia

Back 8

C

Front 9

2014-2
Q56: What is the best measure of the anticoagulant effect of Dabigatran?
A. APTT
B. Dilute thrombin time
C. Prothrombin time
D. Bleeding time
E. TEG

Back 9

B

Front 10

2014-2
Q57: What is the ratio of compression to breaths for neonatal resuscitation?
A. 3:1
B. 15:1
C. 30:1
D. 15:2
E. 30:2

Back 10

A

Front 11

2014-2
Q60: In patients with refractory elevated ICP, bilateral decompressive craniectomy is associated with reduction in ICP and also results in:
A. Reduced duration of ventilation
B. Reduced duration of hospitalisation
C. Improved overall mortality
D. Worse long-term neurological outcome
E. Unchanged long-term neurological outcome

Back 11

D, E by association

Front 12

2014-2
Q61:Tumour lysis syndrome causes all of the following biochemical abnormalities EXCEPT:
A. Hyperkalaemia
B. Hypernatraemia
C. Hyperphosphataemia
D. Hyperuricaemia
E. Hypocalcaemia

Back 12

B

Front 13

2014-2
Q66 You are performing an interscalene nerve block using a nerve stimulator when your patient begins to hiccough. You should aim to position the tip of your needle more
A. Anterior
B. Posterior
C. Cephalad
D. Caudal
E. Superficial

Back 13

B

Front 14

2014-2
Q67 The characteristic respiratory pattern in a patient with an acute C5 spinal cord injury is
A. Rapid respiratory rate
B. Arterial hypoxaemia
C. Chest wall immobility
D. Preserved cough
E. Preserved inspiratory force

Back 14

A

Front 15

2014-2
Q68 Tavi vs Max medical therapy nonoperable aortic stenosis reduction in risk at 30 days of
A. AMI
B. AKI
C. Death
D. Atrial fibrillation
E. Stroke

Back 15

B, D

Front 16

2014-2
Q69 Medial peribulbar block tip max distance past equator for minimal vein injury
A. 5
B. 10
C. 15
D. 20
E. 25

Back 16

A

Front 17

2014-2
Q76: A. patient has suffered flash burns to half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burnt is:
A. 18%
B. 23%
C. 32%
D. 41%
E. 48%

Back 17

C

Front 18

2014-2
Q77: You are anaesthetising an ASA. 1 woman for a laparoscopic gynaecological procedurE. How long does it take for the PaCO2 to peak?
A. <15min
B. 15-30min
C. 30-60min
D. 60-90min
E. >90min

Back 18

B

Front 19

2014-2
Q82: Anaemia post partial gastrectomy is most likely due to:
A. folate deficiency secondary to steatorrhea
B. ongoing haemorrhage from stomal ulcer '(yes Stomal not stomach)'
C. malabsorption of iron
D. Vit B12 deficiency due to loss of intrinsic factor
E. folate deficiency due to lack of appetite

Back 19

C

Front 20

2014-2
Q83: 65year old for video assisted thoracoscopic lower lobe wedge resection. Surgeon requests lung isolation and one lung ventilation.
Predictors of intraoperative hypoxia are:
A. central rather than peripheral lesion
B. left sided lesion
C. high Aa Oxygen gradient when ventilating both lungs
D. right sided lesion
E. supine rather than lateral position

Back 20

B

Front 21

2014-2
Q94: Small air bubbles in the arterial line system will reduce
A. Dampening coefficient
B. ?Extrinsic Coefficient
C. Measured systolic pressure
D. Measured MAP
E. Resonant frequency

Back 21

E

Front 22

2014-2
Q95: RPT. Capnograph trace form a patient that is intubated and ventilateD. What does it indicate
See previous paper for a picture, it was the same
A. Endotracheal intubation
B. Gas sample line leak
C. ETT cuff leak
D. Obstructive disease
E. Spontaneous breaths

Back 22

B

Front 23

2014-2
Q98' You extubate a young woman after a dental procedure under GA. She has a history of hereditary angioedema and in recovery she develops airway oedemA. Best treatment
A. FFP
B. IV Adrenaline
C. IV corticosteroids
D. IV promethazine
E. Nebulized adrenaline

Back 23

A

Front 24

2014-2
Q99 A. previously well 65 year old female develops acute shortness of breath 3 days post hip replacement. The most appropriate investigations to confirm PE. is
A. CTPA
B. D-dimer
C. Echo
D. Ecg
E. V/Q scan

Back 24

A

Front 25

2014-2
Q100 20 year old female with 25% burns to her body. She weighs 80 kg. How much replacement fluid should she be given over the next 8 hours?
A. 4L
B. 4.8L
C. 5L
D. 6L
E. 8L

Back 25

A

Front 26

2014-2
Q101 50 y.o female with a history of mennohhragia is having a hysterectomy. Her pre-operative Hb is 95. What serum ferritin would confirm iron deficiency anaemia?
A. 30 mcg/L
B. 3 mg/L
C. 3 mcg/L
D. 0.3 mg/L
E. 3000 mcg/L

Back 26

A

Front 27

2014-2
Q102 An Adult Jehovah's Witness requires a redo hip replacement for a peritrochanteric fracturE. They request that no blood products are given. The anaesthetists decision to PROCEED. is best given by:
A. Autonomy
B. Beneficence
C. Justice
D. Nonmaleficence
E. Paternalism

Back 27

A

Front 28

2014-2
Q103 100% Saturated air @ 20 degrees is what relative humidity @ 37 degrees
A. 20%
B. 30%
C. 40%
D. 50%
E. 60%

Back 28

C

Front 29

2014-2
Q104 Maximum cumulative dose of intralipid (ml/kg)
A. 10
B. 12
C. 15
D. 20

Back 29

B

Front 30

2014-2
Q105 60yo alcoholic with HTN, has abdominal pain. No findings at laparotomy. 12 hrs later: Na140 k5 cl115 HCO3 18. What is the most likely diagnosis?
A. ARF
B. Diabetic ketosis
C. Lactic acidosis
D. Methanol
E. NaCl infusion

Back 30

E

Front 31

2014-2
Q106 Diagram of a CTG (showing late decelerations). Causes:
Uteroplacental
Foetal head compression
Foetal asphyxia
Umbilical cord compression
General anaesthesia

Back 31

A

Front 32

2014-2
Q107 In a clinical trial, researchers looked at 2 groups - smokers vs. non-smokers and followed then up for a period of timE. This type of study is a
A. Cohort
B. Case study
C. Observational
D. RCT
E. ?

Back 32

A, C

Front 33

2014-2
Q110 Prothrombinex VF is useful in the perioperative period to correct the coagulopathic defect of all of the following except
A. Isolated factor II deficiency
B. Isolated factor VII deficiency
C. Isolated factor IX deficiency
D. Isolated factor X deficiency
E. Warfarin

Back 33

B

Front 34

2014-2
Q111 A. 65 year old man otherwise fit and healthy is having a TKR under GA. (O2, N2O, sevoflurane and fentanyl). His blood pressure has been stable throughout the case at 130/80. Before the orthopaedic surgeons start reaming and bone cemetation you should
A. Give heparin 5000 iu
B. Give a corticosteroid
C. Cease N2O
D. Induce hypotension
E. Give a vasopressor to increase blood pressure

Back 34

C

Front 35

2014-2
Un-numbered Questions
(Photograph and Ultrasound picture of regional block. probe held transverse against posterolateral aspect of distal humerus over triceps. shows triangular nerve in close proximity to humerus) after infitraion of 5mls of 0.75% ropivacine Numbess in:
A. lateral aspect of forearm
B. ring dorsum??
C. medial??
D. palmar aspect and distal dorsal aspect of little finger and medial half of ring finger
E. palmar aspect and distal dorsal aspect of thumb, index and medial fingers and lateral half od ring finger

Back 35

Radial

Front 36

2014-2
Lateral CXR given. Can see lower half of thorax and vertebrae but upper half is all black with clear demarcation
A. Loculated effusion
B. Artifact caused by patient's arm
C. Left lower lobe consolidation
D. Right middle lobe consolidation
E. Right lower lobe consolidation

Back 36

C

Front 37

2014-2
12 year-old with idiopathic scoliosis, most likely have associated
A. Phaemochromocytoma
B. Renal artery stenosis
C. Mitral valve prolapse
D. Diabetes insipidus
E. ? abnormality with the larynx

Back 37

C

Front 38

2014-2
Term neonate, noted to have intermittent stridor few days after birth, then parents also notice stridor during feeding and sleep. Otherwise normal and healthy. Most likely condition is
A. Cri-du-chat syndrome
B. Laryngomalacia
C. Tracheomalacia
D. Laryngocoele
E ? something to do with cord paralysis

Back 38

B

Front 39

2014-2
A. picture of an echo 4 chambers view
A. Anterior mitral valve leaflet
B. Posterior mitral valve leaflet
C ? Aortic non-coronary
D ? Tricuspid
E

Back 39

?

Front 40

2014-2
Cryoprecipate, once thawed must use within
A. 30 minutes
B. 2 hours
C. 4 hours
D. 6 hours
E. 12 hours

Back 40

Pooled 4hrs, single 6hrs

Front 41

2014-2
Glycine 1.5% used for TURP, osmolality is
A. 200
B
C
D. 300
E. 320

Back 41

A

Front 42

2014-2
Sick ICU patients seem to have moderate - severe ARDS PaO2/FIO2 ratio of 200, C.I. 1.7 (cardiac function seems okay). Decided to have ECMO, best mode is
A. AV
B. VA
C. VV
D ? arterior-arterial
E ? atrio-aortic (yes that's how they spelt it)

Back 42

B

Front 43

2014-2
Middle age women c/o pain in hands when hanging out washing. Also found to have muscle wasting on one of the hand associated with weaker radial pulse.
A. CRPS
B. Lateral medullary syndrome
C. Thoracic outlet syndrome
D. Paraneoplastic syndrome
E

Back 43

C

Front 44

2014-2
Same radial nerve question with photos of a probe over postero-lateral upper arm and ultrasound image that show a triangular shape nerve, most likely the radial nervE. Injecting 5 ml of 0.75% [[ropivacaine] will produce sensory block over
A. Medial forearm
B. Lateral forearm
C. Dorsum part of hand
D. Plantar surface of ring and little finger
E. Plantar surface of middle and ring finger

Back 44

C

Front 45

2014-2
Blue urticaria is a complication of
A
B. Methylene blue
C. Patent blue something
D
E

Back 45

C

Front 46

2014-2
Intraosseous sampling - least accurate on
A. Albumin
B. Urea
C. Na, K
D. Chloride
E.

Back 46

C

Front 47

2014-2
Subtenon's block - muscle most likely to have inadequate block
A. Medial rectus
B. Lateral
C. Superior
D. Superior oblique
E. Inferior

Back 47

D

Front 48

2014-2
EVAR, best method to reduce risk of renal impairment
A. Sodium bicarbonate
B. N-acetylcysteine
C. Normal saline
D
E

Back 48

C

Front 49

2014-2
EVAR is preferred over open AAA. repair because
A. Lower cost
B. Lower mortality
C. Less follow up
D. Less re-intervention
E. Less need for critical care

Back 49

E

Front 50

2014-2
Laser flex tube with double cuffs - how to inflate cuff(s)?
A. Inflate proximal then distal
B. Inflate distal then proximal
C
D. Inflate distal only
E. Inflate proximal only

Back 50

B

Front 51

2014-2
Forceps delivery. Loss of sensation medial thigh with loss of adduction at hip joint - resulted from injury to
A. Sciatic nerve
B. lumbosacral plexus
C. Lateral cutaneous nerve of thigh
D. Obturator nerve
E

Back 51

D

Front 52

2014-2
Called to cath lab because patient became agitated. Unstable angina having PCI,difficult right coronary stenting. Patient was hypotensive 80/40, HR 80/min in SR. What is the next best management step?
A. Transfer to operating theater immediately
B. Sedate and intubate
C ?crack on
D. Transthoracic echocardiography

Back 52

D

Front 53

2014-2
A. printout of 12-lead ECG
A. Atrial fibrillation with BBB
B. Sinus tachycardia with BBB
C. Torsades de pointes
D. VT
E. VF

Back 53

?

Front 54

2014-2
(Repeat) Diagram about 3-bottle underwater seal drain, with the height of the fluid level in the suction bottle indicates
A. Maximal suction applied to the system
B.
C.
D.
E.

Back 54

A

Front 55

2014-2
Photo of a patient with tongue deviation post cervical spinal fusion. Which nerve is damaged?
A. Glossopharyngeal nerve
B. Vagus nerve
C. Hypoglossal nerve
D. Accessory nerve
E

Back 55

C

Front 56

2014-2
Post cardiac surgery. Rhythm strip to assess pacing on AOO. What is the diagnosis?
A. Pacing spikes with loss of capture
B
C
D
E

Back 56

A

Front 57

2014-2
Young male with MVA. + femur fracture on traction. Initial CXR normal. More than 24 hours. Became confused and drowsy, BP normal, crackles both lung fields with worsening O2 saturation to 85% on ward 12 hours later despite increasing oxygen flow. He has had 40mg morphine and a femoral nerve block. Diagnosis?
A. Fat embolism
B. Compartment syndrome
C. Pulmonary embolism
D ? Pneumothorax
E ? Lung contusion
(other remembered options: LA. toxicity, aspiration)

Back 57

A

Front 58

2014-2
G5P5 in third stage labour. Found to be unresponsive, cyanosed, faint pulsE. On oxytocin induction and epidural infusion 10ml/hour. Also oozing from previous IV or blood sampling sites. Diagnosis?
A. High spinal
B. AFE
C. PE
D
E. Massive haemorrhage

Back 58

B

Front 59

2014-2
In iron deficiency anaemia, one will expect a serum ferritin level to be less than
A. 300mg/L
B. 30mg/L
C. 30mcg/L
D. 300mcg/L
E

Back 59

C

Front 60

2014-2
Treatment for patients with congenital long QT syndrome
A. Pacemaker/defibrillator
B. Accessory pathway abalation
C. Beta blocker
D. Calcium channel blocker
E

Back 60

C

Front 61

2014-2
An 18 month old child with VF arrest, shock with
A. 10J
B. 30J
C. 50J
D. 100J
E

Back 61

C

Front 62

2014-2
Endovascular coiling of cerebral aneurysm under GA, patient suddenly develop hypertension. What is the most likely cause?
A. Acute hydrocephalus
B. Rupture of aneurysm
C. Contrast reaction
D. Cerebral embolism
E

Back 62

B

Front 63

2014-2
A. patient on citalopram. Post-op in PACU given tramadol. Developed fever, tremor, restlessness, confusion, hyperreflexiA. Diagnosis is
A. Neuroleptic malignant syndrome
B. MH
C. Serotonin syndrome
D
E

Back 63

C

Front 64

2014-2
Best drug to reduce both gastric acidity and volume
A. Ranitidine
B. PPI
C. Sodium citrate
D
E

Back 64

A

Front 65

2014-2
Patient on moclobemide came in for surgery. In view of the use of vasopressor to treat hypotension one will give judicious amount of
A. ?
B. Metaraminol
C. Adrenaline
D. Noradrenaline
E. Phenylephrine

Back 65

E

Front 66

2014-2
Patient with hyperthyroidism - proceed with elective surgery only if normal level of these hormones is seen
A. TSH
B. T4
C. T3
D. T3 & T4
E

Back 66

B

Front 67

2014-2
In pregnant women the durac sac ends at
A
B. L3
C. L5
D. S1
E. S3

Back 67

S2

Front 68

2014-2
Full size oxygen cylinder providing 10L/min of oxygen flow to a patient during transport. How long will this cylinder last?
A
B
C. 45 minutes
D
E

Back 68

C

Front 69

2014-2
Something to do with Echinacea and renal transplant - I think the answer is regarding immune system, other options were bleeding risk, nephrotoxicity

Back 69

Hepatotoxicity, immune stimulation

Front 70

2014-2
Jehovah's witness having a TKR. You agree to proceed with surgery. Which ethical principle are you honouring?
A. Autonomy
B. Non-maleficence
C. Beneficence
D. Justice
E. Fidelity

Back 70

A

Front 71

2014-2
Red-man syndrome secondary to vancomycin is due to
A. Type II hypersensitivity reaction
B. Vasodilation
C. Mast cell degranulation
D. IgE. immediated response
E. Serotonin release

Back 71

C

Front 72

2014-2
A. 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP:
A. Administer Anti-D. antibodies 6 hrs pre op
B. Admister desmopressin one hour pre op
C. Administer methylpred and IVIg 2 days pre op
D. Recheck platelet count morning of surgery and if not dropped continue
E. Platelet transfusion morning of surgery

Back 72

C

Front 73

2014-2
Absolute contraindication to ECT
A. Cochlear implants
B. Epilepsy
C. Pregnancy
D. Raised intracranial pressure
E. Myocardial infarction

Back 73

A

Front 74

2014-2
Repeat Stellate ganglion block. Needle entry next to SCM muscle at C6. Which direction to advance needle ?
A. C3
B. C4
C. C5
D. C6
E. C7

Back 74

D

Front 75

2014-2
Repeat CTG with early decelerations
A. GA
B. Fetal head compression
C. Uteroplacental insufficiency
D. Acute asphyxia
E. Umbilical cord compression.

Back 75

B

Front 76

2014-2
Repeat Endocarditis prophylaxis
A. Bicuspid valve
B. Congenital repair > 12 months ago
C. Rheumatic heart valve
D. Uncorrected cyanotic heart disease
E. MVP

Back 76

D

Front 77

2014-2
Repeat CVL relatively contraindicated in:
A. LBBB

Back 77

A

Front 78

2014-2
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 78

E

Front 79

2014-2
Repeat 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 79

B

Front 80

2014-2
Repeat What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.E. have a dibucaine number 30-70?
A. 0.04%
B. 0.4%
C. 4%
D. 14%
E. 40%

Back 80

C

Front 81

2014-2
Repeat CO2 penetrates surface tissue so well with little damage to underlying tissue because
A. Well absorbed by Hb
B. Poorly absorbed by H20
C. Widely disseminated in tissue
D. Long infrared wavelength
E. Short infrared wavelength

Back 81

D

Front 82

2014-2
Repeat With regards to ROTEM: maximal clot firmness (Increased MA. maximal amplitude on TEG) correlates best with needing to give:
A. FFP
B. Cryoprecipitate
C. Platelets
D. Prothrombinex
E. Tranexamimic acid

Back 82

B, C

Front 83

2014-2
Repeat The MELD. score is calculated using INR, Bilirubin & what?
A. Creatinine
B. Albumin
C. Urea
D. AST
E. Ammonia

Back 83

A

Front 84

2014-2
- Repeat: Reduction of fraud in research - what's the MOST LIKELY to help? Backup of a well-known research institute, sole author (HOD), similar to published data...etc.

Back 84

Multiple authors

Front 85

2014-2
Repeat An 80 year old man undergoes a unilateral lumbar sympathectic blockadE. The most likely side effect that he experiences is:
A. Genitofemoral neuralgia
B. Haematuria
C. Postural hypotension
D. Lumbar radiculopathy
E. Psoas haematoma

Back 85

A

Front 86

2014-2
Repeat The most important effect of Lugol's iodine administration before thyroid surgery is
A. reduce incidence of thyroid storm
B. reduce incidence of vocal cord palsy
C. increase likelihood to identify and preserve parathyroid glands
D. pigmentation of thyroid gland to help identify thyroid gland
E. reduce vascularity of thyroid gland

Back 86

E

Front 87

2014-2
To exclude RICP in an awake patient the most reliable finding is what ?
A. No headache
B. No diplopia
C. No vomiting
D. Pulsatile retinal vein
E. No papilloedema

Back 87

D

Front 88

2014-2
- Repeat: % of those with raised troponin post SAH: 15-30%

Back 88

15-30%

Front 89

2014-2
- Repeat: Best determinant of a neonate's heart rate: Auscultate the chest.

Back 89

Auscultate

Front 90

2014-2
- Repeat: Optimal fluid management during laparotomy: Pulse pressure variation, EF on a TOE, CVP, BP and HR

Back 90

PPV

Front 91

2014-2
- Repeat: Just gone onto CPB, MAP 25, CVP 1, sVO2 80% - Give metaraminol.

Back 91

Metaraminol

Front 92

2014-2
- Repeat: Maximum recommended time for an adult tourniquet: 90 min? 120 min?

Back 92

120min

Front 93

2014-2
- Repeat: Best way to achieve cerebral perfusion during aortic arch repair: Anterograde via carotids

Back 93

Anterograde

Front 94

2014-2
- Hypotensive in cath-lab for a difficult PCI to RCA. Sweaty, increased hypotension with inspiration, raised CVP. What do you do? Take to OR immediately? Perform an ECHO? Some other options.

Back 94

Perform an echo

Front 95

2014-2
- Repeat: Post (R) pneumonectomy on the ward becomes acutely unwell, hypotensive, raised CVP. What do you do? Turn left lateral.

Back 95

L lateral

Front 96

2014-2
- Repeat: Venous air embolism. How to position the patient? Head up + R) up, Head up + L) up, Head down + R) up or Head down + L) up. [Head down and (R) side up]

Back 96

Head down cranio, head up hepatic, R side up

Front 97

2014-2
- Repeat: Diagram with 3-chamber chest drain system - X marks what? Maximum suction that can be achieveD. Sorry, can't remember the other options.

Back 97

Maximum suction

Front 98

2014-2
- Repeat: Hours for tryptase to peak?

Back 98

1hr

Front 99

2014-2
- Blue urthicaria - caused by what? [Cyanotic patient]

Back 99

Patent blue V

Front 100

2014-2
- Repeat: TBI - What fluid NOT to give? Synthetic colloids, saline, albumin etc

Back 100

Albumin

Front 101

2014-2
Which population is more liable to CNS damage from Hyponatraemia?
A. Children
B. Young males
C. Young females
D. Old males
E. Old females

Back 101

Young females

Front 102

2014-2
You are anaesthetising an ASA. 1 woman for a laparoscopic gynaecological procedurE. How long does it take for the PaCO2 to peak?
A. <15min
B. 15-30min
C. 30-60min
D. 60-90min
E. >90min

Back 102

B

Front 103

2014-2
- Lat cxr of consolidation at the basE. Which lobe and which side? [Can still see diaphragm and can still see spines. Ends abruptly obliquely.]

Back 103

RML

Front 104

2014-2
- Hb 86 post TKJR in an asymptomatic patient with stable angina. Transfuse to 120, transfuse to 100, observe overnight and repeat mane.

Back 104

Repeat mane

Front 105

2014-2
- USS over the radial nervE. Previously the question was asked as what muscle action will be lost (wrist flexion/extension). This time the question was the pattern of sensory loss.

Back 105

Dorsum hand

Front 106

2014-2
Health care worker. HBV exposurE. Known to have immunisation titres. What do you do?
A. Booster dose of his immunisation
B. HBV immunoglobulins
C. Pegylated Interferon
D. Aciclovir

Back 106

Nothing

Front 107

2014-2
- HIV seroconversion post needlestick injury: 0.3%, 3%, 30%...etc

Back 107

0.3%

Front 108

2014-2
- Repeat: Craniotomy, MAP 80, transducer 13cm below, CVP given, what's the CPP

Back 108

70mmHgmmHg

Front 109

2014-2
- Repeat: Unremakable finding on a laparotomy. Has been given 3L cystalloid and minimal EBL. Physiological response to such haemodilution includes ALL EXCEPT: Increased myocardial O2 extraction. Increased tissue O2 extraction. Increased tissue flow due to decrease viscosity. Increased tissue flow due to vasodilatation.

Back 109

Increased tissue extraction

Front 110

2014-2
- Ideopathic scoliosis in a young female. Likely associated pathology: MV prolapse, renal artery stenosis, abnormality with the larynx...etc

Back 110

MV prolapse

Front 111

2014-2
- Repeat: ABG as you diagnose intraoperative MH: Acidosis/alkalosis, high pCO2, Zero BE. vs. -9 BE.
Repeat 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 111

E

Front 112

2014-2
Repeat A. 50 year old male in recovery after an anterior cervical spinal fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, spO2 96%. What is the most appropriate management ?
A. Direct laryngoscopy and intubation after inhalational induction with sevoflurane
B. Awake tracheostomy by surgeons
C. Awake fibreoptic intubation using minimal sedation
D. Direct laryngoscopy and intubation with propofol and sux
E. Retrograde intubation

Back 112

A

Front 113

2014-2
Asthmatic paediatric patient, tonsillectomy. Desaturates and stiff to bag. First thing to do?
A. Salbutamol
B. Suction
C. Ask surgeon to release gag
D. Paralysis
E. ? reintubate

Back 113

C

Front 114

2014-2
Balloon pump trace 2:1
A. Early inflation
B. Late inflation
C. Early deflation
D. Late deflation
E. ? No problem

Back 114

?

Front 115

2014-2
Repeat 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 115

D

Front 116

2014-2
- Fasting times for a 6week old (Repeat)

Back 116

<6/52 clear fluids 2hrs, breast milk 4hrs, formula 4hrs

Front 117

2014-2
- Unremarkable/negative laparotomy. 3L saline given. ABG results (Hyperchloraemic acidosis - Repeat)

Back 117

Hyperchloraemic acidosis

Front 118

2014-2
- How many hours/ minutes will the O2 cylinder last for (150 L at 10L/min => 15min is the answer to choosE. Re-worded from a similar prev question)

Back 118

5000kPa, 15min

Front 119

2014-2
- AAI paced ECG: 1) Failure to capture 2) CHB, 3) 2nd degree HB, 4) AF [I think it looked like progressive prolongation of PR interval after the spikes, hence 2nd degree HB]

Back 119

2nd degree HB

Front 120

2014-2
- Hyperkalaemia of 7 or 8. Most appropriate immediate (or was it most "effective") therapy: Insulin + Glucose vs Bicarb vs Salbutamol vs resin vs something else.

Back 120

Insulin/glucose

Front 121

2014-2
Correct INR range for a patient with a mechanical valve
A
B
C
D
E

Back 121

Older gen AV 2.5-3.5, MVR 2.5-3.5, current gen AV 2-3

Front 122

2014-2
Flow volume loop diagram
A. Variable intra-thoracic obstruction
B. Variable extra-thoracic obstruction
C. Restrictive pattern
D. Obstructive pattern
E. Fixed obstruction

Back 122

?

Front 123

2014-2
4 METS is how many ml O2 / min

Back 123

14ml/02/min

Front 124

2014-2
A. 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is:
A. increase PEEP to 20cmH20
B. increase tidal volume to 10mls/kg
C. initiate nitrous oxide therapy
D. commence high flow oscillatory ventilation
E. ventilate in the prone position

Back 124

E

Front 125

2014-2
Repeat 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. T11

Back 125

B

Front 126

2014-2
Repeat 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 126

E

Front 127

2014-2
Repeat During a pneumoperitoneum, at what level of intra-abdominal does cardiac output fall?
A. 10 mmHg
B. 20 mmHg
C. 30 mmHg
D. 40 mmHg
E. 50 mmHg

Back 127

B

Front 128

2014-2
Repeat 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 128

C

Front 129

2014-2
Repeat 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

Back 129

A

Front 130

2014-2
Repeat A. patient is in Class 4 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 130

D

Front 131

2014-2
Repeat 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 131

B

Front 132

2014-2
Repeat 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 132

A

Front 133

2014-2
Repeat What is NOT a contraindication to MRI?
A. Pulmonary artery catheter
B. Arterial line
C. Scissors
D. Coiled ECG cable
E. Laryngoscope

Back 133

B

Front 134

2014-2
Repeat What is the mechanism of central sensitisation?
A. Increased intracellular magnesium
B. Antagonism of the NMDA. receptor
C. Glycine is the major neurotransmitter involved
D. Recurrent a-delta fibre activation
E. Alteration in gene expression

Back 134

E

Front 135

2014-2
Repeat Which volatile contributes most to greenhouse gases / environmental pollutant ?
A. Desflurane
B. N2O
C. Sevoflurane
D. Isoflurane
E. Halothane

Back 135

B

Front 136

2014-2
Repeat The clinical sign that a lay person should use to decide whether to start CPR is:
A. Absent central pulse
B. Absent peripheral pulse
C. Loss of consciousness
D. Obvious airway obstruction
E. Absence of breathing

Back 136

E

Front 137

2014-2
Repeat A. patient's competence to give informed consent is determined by all the following except:
A. Ability to communicate a choice
B. Ability to apply reasoning
C. Ability to understand consequences
D. The provision of significant information
E. ?

Back 137

D

Front 138

2014-2
?? First line treatment for acute attack of hereditary angioedema
A. FFP
B. Adrenaline
C. Steroids
D. C1 inhibitor concentrate
E. anti-histamine

Back 138

D

Front 139

2014-2
Repeat Adult male who is intubated and ventilated, with CVL in situ. Just before surgeon starts the Line Isolation Monitor alarms about a leak at 5mA. What do you do?
A. stop procedure and move to a safe location
B. sequentially remove non essential monitors from the circuit until fault is identified
C. unplug the CVL to electrically isolate it until fault is identified
D. ensure the patient is earthed
E. Check the diathermy pad

Back 139

C

Front 140

2014-2
Repeat Patient with Haemophilia A. with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for OT
A. FVIIa
B. High dose FVIII concentrate
C. FFP
D. Cryo
E. Platelets

Back 140

A

Front 141

2014-2
Mec stained liquor post LSCS Did not state if infant flat or vigorous
A. Suction
B. Routine care

Back 141

Suction if flat, routine if vigorous

Front 142

2014-2
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

Back 142

D

Front 143

2014-2
Repeat In a 140kg obese patient, compared to a 70 kg person
A. cardiac output >20% lower
B. cardiac output 10% lower
C. cardiac output no different
D. cardiac output 10% higher
E. cardiac output >20% higher

Back 143

E