Anzca Mcqs 2015-1

Front 1

2015-1
6. Young man has removed his buprenorphine patch on the morning of surgery. What time till PLASMA. reaches half original level
A. 12 hours
B. 18 hours
C. 24 hours
D. 30 hours
E. 36 hours

Back 1

A

Front 2

2015-1
7. 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 2

C

Front 3

2015-1
8. 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. Sciatic
E. Superior gluteal

Back 3

B

Front 4

2015-1
17. ME47 In Conn's syndrome, the usual derangement is:
A. Hypoglycaemia, hypokalaemia and hypernatraemia
B. Hypoglycaemia, hyperkalaemia and hyponatraemia
C. Normoglycaemia, hypokalaemia and hypernatraemia
D. Normoglycaemia, hyperkalaemia and hyponatraemia
E. Hyperglycaemia, hyperkalaemia and hyponatraemia

Back 4

C

Front 5

2015-1
18. A 60 year old woman is admitted to hospital with subarachnoid haemorrhagE. Her GCS is 11, and her blood pressure is 175/110 mmHg. She is administered oral nimodipinE. The main reason for this treatment is:
A. Control her blood pressure
B. Manage acute hydrocephalus
C. Prevent delayed cerebral ischaemia
D. Reduce the risk of rebleeding
E. Treat angiographically-proven cerebral vasospasm

Back 5

C

Front 6

2015-1
19. You are the anaesthetist at a Caesarean Section for a 36/40 gestation pregnancy. The baby at birth is floppy and apnoeA. You decide that positive pressure ventilation via mask is necessary. The recommended FiO2 is:
A. 0.21
B. 0.4
C. 0.6
D. 0.8
E. 1.0

Back 6

A

Front 7

2015-1
20. You are inducing a 20-year-old female who has an IV cannula in her antecubital fossa which was inserted in the emergency department. She complains of pain after 10mL of propofol and it becomes clear that cannula is intraarterial. The best management option is:
A. Intraarterial injection of 5mL 1% lignocaine
B. Intraarterial injection of 30mL Normal Saline
C. Intraarterial injection of 50mg paperverine
D. Intraarterial injection of 500u heparin
E. Observation

Back 7

E

Front 8

2015-1
21. When is it necessary to use glycine as irrigation fluid for TURP?
A. For monopolar diathermy
B. For bipolar diathermy
C. For Nd:Yag laser
D. Greenlight laser

Back 8

A

Front 9

2015-1
23. A 69 yo man is brought into ED. by ambulance with a compound fracture of his forearm from an unwitnessed fall. Has a history of schizophrenia and depression with uncertain medication compliancE. He is confused and agitated with generalised rigidity but no hyperreflexiA. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx?
A. Heat stress from anticholinergic therapy
B. Hypoxic ischaemic encephalopathy
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
E. Pain from the compound fracture

Back 9

C

Front 10

2015-1
24. With surgical bleeding, the first clotting factor to reach a critical level is
A. I
B. II
C. VII
D. X
E. XIII

Back 10

A

Front 11

2015-1
25. EZ77 Anaesthetic and respirable gas supplies to wall outlets in the operating theatre is at pressures of
A. 200kPa
B. 400kPa
C. 500kPa
D. 750kPa
E. 1200kPa

Back 11

B

Front 12

2015-1
26. The most useful sign to distinguish between severe serotonin syndrome and malignant hyperthermia are
A. Clonus
B. Hyperthermia
C. Metabolic acidosis
D. Muscle rigidity
E. Wheeze

Back 12

A

Front 13

2015-1
33. Patient having a laparotomy. On prednisolone for 6/12, 10mg/day. What is the equivalent dose of dexamethasone?
A. 2mg
B. 4mg
C. 6mg
D. 8mg
E. 10mg (or was the option 12mg?)

Back 13

A

Front 14

2015-1
34. Axillary arm block U/S presented similar to this ultrasound imagE. Nerves marked with numbers 1-4 but not otherwise identifieD. (I don't think the numbers were in the same order as on the NYSORA. site though)
Patient having an operation of a lacerated index finger under regional anaesthesiA. Which combination will provide adequate cover?
A. 1 and 2
B. 1 and 3
C. 2 and 3
D. 2 and 4
E. 3 and 4

Back 14

Median and radial

Front 15

2015-1
35. Pl29 Child 20kg having a caudal. Has a VF arrest post non-responsive to usual treatments. What does of intralipid 20% would you give?
A. 10mL
B. 20mL
C. 30mL
D. 40mL
E. 50mL

Back 15

C

Front 16

2015-1
40. Labour epidural placed. Headache postpartum. Which of the following is inconsistent with post partum dural puncture headache.
A. Headache located frontal only
B. Presents > 24 hrs post partum
C. Presents immediately post partum
D. Associated with auditory symptoms
E. Associated with neck stiffness

Back 16

C

Front 17

2015-1
41. Eclamptic patient. Given magnesium intravenously. Which of these symptoms is often associated with magnesium administration?
A. Bradyarrhythmia
B. Cardiac arrest
C. Hypotension
D. Depressed respiratory effort
E.

Back 17

C

Front 18

2015-1
42. The clinical sign that a lay person should use to decide whether to start CPR is:
A. Absence of breathing
B. Loss of central pulse
C. Loss of peripheral pulse
D. Loss of consciousness
E. Obvious airway obstruction

Back 18

A

Front 19

2015-1
What is the maintenance fluid rate for a 15kg child?
A. 60ml/hr
B. 50ml/hr

Back 19

B

Front 20

2015-1
46. Patient's K+ is 7.0 what is the best initial management?
A. give Ca
B. give insulin/ dextrose

Back 20

A

Front 21

2015-1
47. Which patients require antibiotic prophylaxis?
A. Previous Mitral valve ring annuloplasty
B. Previous patch repair of vsd

Back 21

A

Front 22

2015-1
48. A 63 yo lady has a difficult thyroidectomy for cancer. Immediately post extubation she develops stridor and respiratory distress.
The most likely cause is
A. Hypocalcaemia
B. recurrent laryngeal nerve palsies
C. tracheomalacia
D. Neck oedema and haematoma
E. Vocal cord oedema

Back 22

B

Front 23

2015-1
49. New A. 23 yo has a traumatic brain injury. Which fluid is relatively contraindicated?
A. Albumin
B. Normal saline
C. CSL
D. Colloid
E. Something else

Back 23

A

Front 24

2015-1
50. 50 something yr old smoker presents for laparotomy. RFTs given, what is the cause?
FEV1, FVC. both reduced, FEV1/FVC. 98%. TLC, RV, DLCO 8 (pred = 30)
A. PE
B. Obesity
C. Bilateral phrenic nerve palsies
D. Pulmonary fibrosis
E. COPD

Back 24

D

Front 25

2015-1
51. Traumatic brain injury patient. Cerebral angiogram shows Cerebral perfusion = 15mL/100g/min, cerebral oxygen consumption 3.5mL/100g/min. This is consistent with:
A. Cerebral hyperperfusion
B. Reperfusion injury
C. Cerebral ischaemia
D. Appropriate autoregulation
E. ?cereberal vasoconstriction
Normal perfusion = 50-54 mL/100g brain tissue/min; normal CMRO2 (awake brain) = 3.5mL/100g/min, reduced in coma/anaesthesiA. 15ml blood carries 3ml O2 (assuming normal value 200ml of O2 per litre blood). Therefor ischaemia is the best choice.

Back 25

C

Front 26

2015-1
52. Frequent Repeat )ie a Marker Question: Absolute contraindication to ECT:
A. Cochlear implants
B. Epilepsy
C. Pregnancy
D. Raised intracranial pressure
E. Recent myocardial infarction

Back 26

A

Front 27

2015-1
57. FFP is given to a patient to treat hypofibrinogenaemia. The volume required to raise the fibrinogen by 1g/L is
A. 1mL/kg
B. 5mL/kg
C. 10mL/kg
D. 20mL/kg
E. 30mL/kg

Back 27

E

Front 28

2015-1
58. The diluted thrombin time measures the anticoagulant activity of
A. apixaban
B. rivaroxaban
C. dabigatran
D. warfarin
E. heparin

Back 28

C

Front 29

2015-1
59. In a trauma patient the main mechanism by which hypothermia exacerbates bleeding is by
A. altered blood viscosity
B. causing DIC
C. inhibition of clotting factors
D. potentiation of anticoagulant effect of drugs used to treat DVT
E. decreases platelet number and function

Back 29

E

Front 30

2015-1
60. A. patient having a liver resection suffers a haemodynamically significant venous air embolism. During resuscitation how do you best position the patient?
A. head up, right side down
B. head up, left side down
C. head up, no lateral tilt
D. head down, right side down
E. head down, left side down

Back 30

B

Front 31

2015-1
61. In a normal adult what amount of IV potassium chloride is needed to raise the serum potassium from 2.8 to 3.8mmol/L?
A. 10mmol/L
B. 20mmol/L
C. 50mmol/L
D. 100mmol/L
E. 200mmol/L

Back 31

E

Front 32

2015-1
62. In a haemodynamically stable 20 year old man with blunt chest trauma, the best screening test to diagnose cardiac injury requiring treatment is:
A. CXR
B. serum CK-MB
C. serum troponin
D. 12 lead ECG
E. Transthoracic Echocardiogram

Back 32

D

Front 33

2015-1
63. With regards to medical ethics, the concept of fidelity involves:
A. equitable distribution of resources
B. following a professional code of conduct
C. promoting well being
D. wise use of resources
E. witholding of futile treatments

Back 33

B

Front 34

2015-1
64. Repeat Mar11 What is the correct position for the tip of a PICC. in a child
A. Carina
B. Below right tracheobronchial angle
C. Above right heart border
D. Sternoclavicular junction
e) ?? can't remember
http://www.anzca.edu.au/communications/anzca-e-newsletter/e-news-articles/Coroners%20report%20PICC%20line%20AR%20summary%20Feb%2010.doc/view

Back 34

A

Front 35

2015-1
65. New Image of a lateral C-spine Xray. Asked what the diagnosis was.
[Terrible image quality. When will anzca learn that you can't just photocopy an x-ray!! Seemed to have anterior atlantoodental interval >9mm.]
A. Atlantoaxial instability
B. Retropharyngeal haematoma (?or abscess)
C. Tear drop fracture
D. Epiglottitis
E. unilateral facet joint dislocation

Back 35

A

Front 36

2015-1
66. Repeat 2011 + 2012
According to the ANZCA. endorsed guidelines, what is the correct colour for the label for a subcutaneous ketamine infusion
A. Pink
B. Red
C. Beige
D. Blue
E. Yellow
Beige. An infusion is colour coded based on its route of administration.

Back 36

C

Front 37

2015-1
77. New Prior to nasal intubation you spray Lignocaine/Phenylephrine preparation (CoPhenylcainE. into the nosE. Some lands in the eyE. What happens?
A. Ecchymosis
B. Myosis
C. Midriasis
D. Proptosis
E. Nistagmus

Back 37

C

Front 38

2015-1
78. New (but same question with different numbers previously) You trial a new drug to prevent PONV. It is 50% more effective than the current drug. Four percent of people still experience PONV with the new drug. How many people need to receive the new drug in place of the current drug to have one person less suffering from PONV? (Unsure about my numbers below, but the correct answer is there!)
A. 2
B. 8
C. 15
D. 25
E. 33

Back 38

D

Front 39

2015-1
79. Repeat Aug12 What does a white cylinder with a Grey coloured shoulders/neck contain?
A. Medical air
B. Carbon Dioxide
C. Helium
D. Oxygen
E. Argon

Back 39

B

Front 40

2015-1
80. New The best solution to ensure asepsis prior to neuraxial anaesthesia is
A. 0.5% Chlorhexidine
B. 0.5% Chlorhexidine with 70% alcohol
C. 5% Povidine Iodine
D. 5% Povidine Iodine with 70% alcohol
E. 10% Povidine Iodine
PS28 recommends 0.5% chlorhexidine in alcohol

Back 40

B

Front 41

2015-1
81. Repeat Mar11 and Sep11, but with important difference to the recalled answers.
You are anaesthetising a 25 year male for an open appendicectomy. He has a Fontans circulation on a background of tricuspid atresiA. The best strategy to manage his ventilation intraoperatively would be:
A. Ensure adequate PEEP
B. Decrease Inspiratory time
C. Shorten I:E. Ratio from 1:3 to 1:1.2
D. Increase Inspiratory time but with reduced inspiratory pressures
E. Ensure adequate spontaneous ventilation
Definitely said "with reduced inspiratory pressures", which could make it a contender for the answer. Thoughts?

Back 41

B

Front 42

2015-1
82. Repeat Apr09
You are anaesthetising a 70 year old woman for CABG with a pulmonary artery catheter in situ. After separation from bypass you notice frank, copious blood rising in the endotracheal tube. Your immediate action should be to:
A. Check ACT
B. Insert a double lumen tube
C. Reinstate bypass
D. Administer protamine
E. Pull back the pulmonary artery catheter several centimetres

Back 42

C

Front 43

2015-1
88. Repeat IC67 Penetrating injury to chest. What part of the heart most likely injured?
A. RV
B. LV
C. RCA
D. LA
E. RA
RV = most anterior / exposed (from EMST)

Back 43

A

Front 44

2015-1
89. Repeat Aug13
General anaesthesia is preferred for endoluminal stenting because:
A. Ischaemic renal pain
B. Prolonged periods of apnoea required
C. Painful aorta
D. Major risk of haemorrhage
E. Trash foot pain

Back 44

D

Front 45

2015-1
90. PI81
Which volatile agent has got minimum effect on ICP at 1 MAC
A. isoflurane
B. sevoflurane
C. desflurane
D. enflurane
E. halothane
B. -- Sevo. Current Opinion in Anaesthesiology: October 2006 - Volume 19 - Issue 5 - p 504-508

Back 45

B

Front 46

2015-1
97. New
You are inserting a right internal jugular vein CVL. Why is it important to avoid turning the patient's head extremely to the left?
A. Uncomfortable for the patient
B. Increases risk of internal carotid artery puncture
C. Compresses internal jugular vein and makes it more difficult to puncture
D. Distorts the anatomy, making the vein more difficult to correctly identify
E. Increases risk of external jugular vein puncture

Back 46

C

Front 47

2015-1
98. New
Patient two hours after bilateral crush injuries to lower limbs. What would you expect to see?
A. Hypocalcaemia
B. Hypokalaemia
C. Hypophosphataemia
D. Hypouricaemia
E. Metabolic alkalosis

Back 47

A

Front 48

2015-1
99. Repeat TMP11B30 Tmp11b25
Delivery of neonatE. Meconium liqour. Baby floppy, blue, apnoeic, pulse rate 90bpm. What is the next step in managment?
A. Commence PPV
B. Suction the trachea
C. Commence CPR
D. Dry and stimulate

Back 48

B

Front 49

2015-1
103. ?New, but certainly previous questions on this themE. You inject 10ml ropivicaine into a T5 paravertebral block. Patient becomes bradycardic, hypotensive and apnoeiC. What is the cause.
A. Contralateral spread
B. Intrathecal spread
C. Inadvertent intravascular injection
D. Local anaesthetic toxicity

Back 49

B

Front 50

2015-1
110. Repeat medical therapy vs TAVI in inoperable patients. At 30 days, decreased risk of:
A.
B. Myocardial infact
C. Death
D. Stroke
E. Atrial fibrillation

Back 50

E, AKI

Front 51

2015-1
111. Repeat
Glycine used during urology case. Osm is:
A.
B. 200
C. 250
D. 300
E.

Back 51

B

Front 52

2015-1
112. New
Volatile analysis in most anaesthetic machines is done via which method?
A. Gas chromatography
B. Infrared analyser
C. Raman spectometry
D
E

Back 52

B

Front 53

2015-1
114. New
What is not a constituent of Prothrombinex VF?
A. Antithrombin III
B. Factor II
C. Factor X
D. Protein C
E. Heparin

Back 53

D

Front 54

2015-1
142. Repeat Aug09 q12
50yo lady for elective laparoscopic cholecystectomy seen in PreAdmission Clinic. No symptoms of heart disease, walks her dog for 30 minutes each day. ECG [no image — described in words] shows LAD, RSR in V1, wide slurred S in V6 and QRS duration 0.13ms. Your options:
A. Give atropine premedication
B. She needs a permanent pacemaker
C. She needs temporary pacing wires
D. Continue with the case
E. Refer to cardiology OP prior to doing the case

Back 54

D

Front 55

2015-1
143. Similar to TMP-Jul10-012, TMP-144, Apr08 q127 You are performing epidural anaesthesia on an adult patient. To minimize the chance of inserting the epidural catheter into a blood vessel you would:
A. Inject saline through the epidural needle prior to threading the catheter
B. Perform the proceedure with the patient lateral rather than sitting
C. Use a loss of resistance to air technique instead of loss of resistance to saline.
sorry, can’t recall the other options

Back 55

A

Front 56

2015-1
144. Repeat Mar13 q18 Failed intubation. Difficult ventilation. Rescued with a Classic(R) LMA. Decide to use a bronchoscope to intubate down the LMA. Which device will allow you to intubate the patient safety?
A. Aintree catheter
B. Airway exchange catheter
C. Gumelastic bougie
D. Some angiogram wire I’ve never heard of!
E. Two paediatric endotracheal tubes side-by-side

Back 56

A

Front 57

2015-1
150. New
Blalock-Taussig shunt inserts into the right pulmonary artery, originating from the:
A. Right subclavian artery
B. IVC
C. SVC
D. Aorta
E. Axillary artery
Unnumbered.

Back 57

A

Front 58

2015-1
X1. New. Time taken for insulin to reduce K+ in hyperkalaemia
A. 2 mins
B. 4 mins
C. 10 mins
D. 20 mins
E. 30 mins
A, B. and C. definitely those times. ?D. was 20 mins or not.

Back 58

D

Front 59

2015-1
X2 Repeat Increased risk with eye block:
A. Peribulbar done medial canthus
B. Peribulbar done inferior-temporal
C. Sub-tenons
D. <45 years age
E. Another clearly wrong

Back 59

A

Front 60

2015-1
X3 Repeat 2/12 old baby. Initially on 30th centile and now on 5th. Murmur, systolic, loud at apex. Pulses are weak, "most easily felt at the femoral".
A. VSD
B. Co-arctation
C. Venous hum
D. PDA

Back 60

A

Front 61

2015-1
X4New Some diathermy pads have two separate electrodes on the patient pad, each with it's own cable back to the machine. Why?
A. In case one fails the other can serve as a back-up
B. One for coag and one for cutting
C. For bipolar? - worded slightly differently
D. For capacitance measurement - again wording not right
E. For return electrode monitoring

Back 61

E

Front 62

2015-1
X5New Cisatracurium left out of fridge for 4 days. It’s efficacy is now:
A. 60%
B. 70%
C. 90%
D. 50%
E. 99%
99% (can be left out of fridge for 21 days)

Back 62

E

Front 63

2015-1
X6?New
In which type of von willebrand's disease is DDAVP contraindicated?
A. Type 1
B. Type 2a
C. Type 2b
D. Type 3
E. None of the above

Back 63

C

Front 64

2015-1
X7Repeat
This ECG with AAI pacing shows:
The 12-lead ECG showed pacing spikes followed by p-waves, with QRS's following the p-waves with progressive prolongation of the PR until a QRS was droppeD. In other word, second degree heart block (type 1, although the type was not required to answer the question).
The ECG looked very much like "Example 8" from lifeinthefastlanE. I think it was lifted from this websitE. (Did you get copyright permission, ANZCA??)
A. Failure to capture
B. CHB
C. 2nd degree HB
D. AF

Back 64

C

Front 65

2015-1
X8 New The NAP4 audit showed that the most common cause of airway problems/complications/disasters in INTENSIVE. CARE. is:
A. Aspiration
B. Dislodged tracheostomy tube
I really can't recall the exact wording or options, but it definitely specified "in the intensive care unit"

Back 65

B

Front 66

2015-1
Repeat SF29d
X9 The target serum magnesium level in a patient with pre-eclampsia receiving a magnesium infusion is
A. 1-2 mmol/l
B. 2-3.5 mmol/l
C. 3-6 mmol/l
D. 4-6 mmol/l
E. 5-8 mmol/l
"I remembered C+D. being an option for 4-5mmol/L just to make it more confusing..."

Back 66

B

Front 67

2015-1
X10 Repeat TMP-Jul10-013 Timing of peak respiratory depression after intrathecal 300 mcg morphine:
A. < 3.5 hours
B. 3.5 – 7.5 hours
C. 7 - 12.5 hours
D. 12.5 -18 hours
E. > 18 hours

Back 67

B

Front 68

2015-1
X11New What part of a modern anaesthesia machine allows jet ventilation to be performed using the oxygen flush button?
A. Non-return valve downstream of the vaporisers
B. Pressure-limiting valve at the outlet
C. The presence of a common gas outlet
D. Presence of auxillary oxygen flowmeter

Back 68

A

Front 69

2015-1
X12Repeat Aug14
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 69

C

Front 70

2015-1
X13New
Patient with IgA. deficiency. What is the main issue in anaesthesia?
A. Anaphylaxis to blood products
B. Renal impairment
C.
D. Sensitivity to opioids
E. Sensitivity to muscle relaxants

Back 70

A

Front 71

2015-1
X14Repeat but recalled answers not the same
Cryo "should be used within" or "must be used within" or "is most effective if used within" (can't recall exactly):
A. 30 minutes
B. 3 hours
C. 6 hours

Back 71

C

Front 72

2015-1
X15 New
Designing a study on PONV. What is the advantage of designing a study incorporating multivariate analysis?
A. Less type 1 error
B. Less complex
C. Less difficult to interpret
D. Less confounding
E. Fewer patients required

Back 72

D

Front 73

2015-1
X16 New
Bleeding intraopratively. TEG shown. What should be used to treat?
The image itself was useless because there was no normal reference to compare it to. However there were numerical figures at the bottom of the image, but difficult to read on the photocopied paper. Normal R, K, angle and MA. vales. LY30 and LY60 were low, CL30 and CL60 high.
It didn't take me long to Google the TEG image that ANZCA. lifted for this question! I'm almost certain it was Figure 1B. from: Pepperell 2014, "Clinical Application of Fibrinolytic Assays".
Only the bottom image was shown, not the top reference version
A. TXA
B. Platelets
C. Cryo
D. FFP
E

Back 73

A

Front 74

2015-1
X17Repeat EZ96
A. Size C oxygen cylinder (in New Zealand, "A") that reads 5000kpa contains approximately how many litres of oxygen
A. 100
B. 150
C. 200
D. 350
E. 600

Back 74

B

Front 75

2015-1
X18New
4-chamber TTE. view. What lesion is present?
Image showed mitral regurg. Think the image was from this here (but was black-and-white of course)
A. mitral regurgitation

Back 75

A

Front 76

2015-1
X19Repeat Appropriate infection control measures when anaesthetising a patient with iatrogenic variant-CJD, the airway equipment should be:
A. thrown away
B. plastic sheath, reuse
C. sterilization with ethylene oxide
D. sterilization with heat at 134 degrees for 3 minutes.
E. autoclave
Can't recall the exact answers, but have copied them across from previous recalled version of this MCQ.

Back 76

A

Front 77

2015-1
X20New A. variant on the theme of the previous question referring to PS9. Minimum requirements to provide sedation. This time asked who is necessary to provide conscious sedation, using propofol
A. Medical practitioner trained in use of propofol
B. Medical practitioner trained in use of propofol + their assistant

Back 77

B

Front 78

2015-1
X21Repeat Intubation view: Little space between epiglottis and posterior pharyngeal wall. What is the modified C&L classification?
A. 2A
B. 2B
C. 3A
D. 3B
E. 4

Back 78

D

Front 79

2015-1
X22New What feature most increases vasospasm in setting of SAH?
A. Size of aneurysm
B. Age of patient
C. Position of Aneurysm
D. large amount of blood on CT
E. GCS on arrival to ED

Back 79

D

Front 80

2015-1
X23?Repeat Line isolation monitor alarming at 5ma – what do to?
A. Disconnect non essential equipment 1 by 1 to identify fault
B. Ignore it

Back 80

A

Front 81

2015-1
X24New Maintenance fluid rate in 15kg child – mls/hr
A. 40mls/hr
B. 50mls/hr
C. 90mls/hr
D. 300mls/hr
(Options above may not be correctly remembered..)

Back 81

B

Front 82

2015-1
X25New "Hypothermia makes bleeding in trauma worse because..."
A. Reduced platelet function AND. Number
B. Reduced activity of clotting factors
(can't remember other options but one about platelets definitely said function AND. number...)

Back 82

A

Front 83

2015-1
X26Repeat Most effective (?quickest) way to reduce serum K+ level in hyperkalaemia 8.0meq/L?
A. Calcium gluconate
B. Resonium
C. Salbutamol NEB
D. 15 units actrapid and 50 mls of 50% Dextrose
E. Sodium bicarbonate ?50mmol
Definitely said to reduce serum or plasma levels, so calcium not the answer.

Back 83

D

Front 84

2015-1
X27New
ECG rhythm strip. Showed regular pacing spike followed by wide QRS complexes. But once there is a narrow QRS occurring without a pacing spike, followed shortly-after by a pacing spike but no capturE. Can't find anything matching it on Google.
What does ECG show?
A. AAI with failure to capture
B. AAI with failure to sense
C
D. VVI with failure to capture
E. VVI with failure to sense
VVI with failure to sense, I think is the answer. The narrow QRS complex was an intrinsic beat, but the pacer didn't sense so paced shortly after at its regular interval. The myocardium was still refractory so there was no capture, but failure to sense was the original problem.

Back 84

E

Front 85

2015-1
X28Repeat SC31
Relative contraindications to mediastinoscopy include
A. Cervical spondylosis
B. Emphysema
C. Mediastinal lymphadenopathy
D. Poor left ventricular function
E. Superior vena cava syndrome
A. and E. were definitely options. I am assuming B, C. and D. were the same options as previously asked, but can't recall so I could be wrong.

Back 85

A

Front 86

2015-1
X29New
How should you dose suxamethonium for intubation in an obese patient?
A. Lean body weight
B. Ideal body weight
C. Ideal body weight + 25%
D. Actual body weight
E. Actual body weight + 25%

Back 86

D

Front 87

2015-1
X30Repeat AB55 Time to onset of TRALI with transfusion?
A. 2 hours
B. 4 hours
C. 12 hours
D. 24 hours
E. 48 hours

Back 87

B

Front 88

2015-1
X31Repeat Apr08 Mar11 When performing regional anaesthesia for eye surgery, needle damage to the globe of the eye is more common with:
A. A globe axial length of less than 25 mm
B. Patients aged less than 45 years
C. Peribulbar block using the inferotemporal approach
D. Peribulbar block using the medial canthus approach
E. Sub-Tenon block

Back 88

D

Front 89

2015-1
X32?Repeat Sep 11 ?MB38 Best method to assess reversal of neuromuscular blockade?
A. Sustained head lift 5 sec
B. Sustained leg lift 5 sec
C. TOF 0.9 with accelerometer, definitely specified, with accelerometer
D. DBS no fade
E. Tetanus 50Hz
F. Tidal volumes... ?

Back 89

C

Front 90

2015-1
X33 Repeat PP93 The Neonatal Facial Coding Scale (NFCS), used to assess pain in neonates, includes all of the following EXCEPT
A. Brow bulge
B. Chin quiver
C. Closed mouth
D. Deep nasolabial fold
E. Eyes squeezed shut

Back 90

C

Front 91

2015-1
X34Repeat Aug14 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 91

B

Front 92

2015-1
X35Repeat Aug14 Small air bubbles in the arterial line system will ALWAYS REDUCE. the
A. Dampening coefficient
B. Extrinsic Coefficient
C. Measured systolic pressure
D. Measured MAP
E. Resonant frequency

Back 92

E

Front 93

2015-1
X36Repeat Mar12 Aug14
A. patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in:
A. Reverse trendelenburg, right side up
B. Reverse trendelenburg left side up
C. Reverse trendelenburg, neutral
D. Trendelenburg right side up
E. Trendeleburg left side up

Back 93

A

Front 94

2015-1
X37Repeat Mar11
During interscalene block placement get medial movement of the scapulA. This is secondary to stimulation of:
A. long thoracic nerve
B. dorsal scapula nerve
C. suprascapular nerve
D. supraclavicular nerve
E. accessory nerve

Back 94

B

Front 95

2015-1
X38Repeat Aug14
Blue urticaria is a complication of
A
B. Methylene blue
C. Patent blue V
D. Anaphylaxis
E

Back 95

C

Front 96

2015-1
X39Repeat RH35
Subtenon’s block. What is the BEST position to insert block?
A. Inferonasal
B. Inferotemporal
C. Superonasal
D. Superotemporal
E. Medial / canthal

Back 96

A

Front 97

2015-1
X40Repeat Mar13 Aug13
Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture
A. L1-L2
B. L2-L3
C. L3-L4
D. L4-L5
E. L5-S1

Back 97

D

Front 98

2015-1
X41New With respect to a patient with Multiple sclerosis, which of the following alters the risk of a flair post partum
A. An epidural
B. A spinal
C. A flair in the year pre-partum
D. A general anaesthetic
E. Breast feeding
I'm pretty sure the stem said "alters the risk", i.E. the correct answer could be something which either increases or decreases the risk. Although someone else remembered it as "increases" the risk.

Back 98

C

Front 99

2015-1
X42 Repeat Mar14 125 - Adenosine can be used to terminate an arrhythmia due to:
A. Atrial fibrillation
B. Atrial flutter
C. WPW
D. ??VT
E. ??Torsades
Definitely said "terminate" the arrhythmia, so the only possible answer I think can be WPW. In AF/flutter it may help diagnose, but not terminatE. Adenosine is considered safe in ORTHODROMIC. SVT in WPW by some authors (but not all) -- may have increased risk but is still the best answer. Never use adenosine in antidromic SVT though!!

Back 99

C

Front 100

2015-1
X43 Repeat Aug12 Mast cell tryptase half life:
A. 1 hours
B. 3 hours
C. 6 hours
D. 12 hours
CEACCP 2014 -- 2 hours, but was not an option.

Back 100

B

Front 101

2015-1
X44 New Best indicator of Severe pulm HT:
mean PA. pressure 45mmHg
orthopnoea PND
ex tol less than 4 mets
fev1, ...

Back 101

ex tol less than 4 mets

Front 102

2015-1
X45Repeat Sep11
Young pregnant patient with mild mitral regurgitation and moderate mitral stenosis, normal LV function. The best delivery method:
A. Epidural anaesthesia LSCS
B. Spinal with LSCS
C. Epidural analgesia and normal vaginal delivery
D. GA LSCS
E. Normal vaginal delivery with remifentanil PCA

Back 102

C

Front 103

2015-1
X46 Repeat Contained one of the following St John wort questions from Mar13 or Aug13. Can't remember which one! St John's Wort (Hypericum perforatum) potentiates the effects of
A. Dabigatran
B. Heparin
C. Warfarin
D. Aspirin
E. Clopidogrel

Back 103

E

Front 104

2015-1
St John's wort will reduce the effect of
A. Aspirin
B. Clopidogrel
C. Dabigatran
D. Heparin
E. Warfarin

Back 104

C, E

Front 105

2015-1
X47 ?New, but based on MH59
7/7 post laparotomy platelet down to 40, no bleeding or bruising, but has painful swollen lower leg, most appropriate tx?
Fondaparinux,
lepirudin,
IV heparin,
clexane,
warfarin

Back 105

Fondaparinux

Front 106

2015-1
X48 ?Repeat -- similar to Mar13/Aug13 Type 1 diabetes fasting since 2200, insulin infusion commenced 0700, BSL 7, what is MOA. of insulin?
Skeletal uptake
liver uptake
inhib glucagon (release)
inhib glycogenolysis

Back 106

inhib glucagon release

Front 107

2015-1
X49 Repeat Mar14
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 107

E

Front 108

2015-1
X50 New
Acute intermittent porphyria, signs except:
abdominal pain
hypotension
confusion
tachycardia
peripheral neuropathy

Back 108

Hypotension

Front 109

2015-1
X51 New
Audit in department of prevalence of acute myocardial ischaemia in vascular surgery. What type of data is this?
Nominal
ordinal
categorical
non-parametric
numerical

Back 109

categorical

Front 110

2015-1
X52 New
Preop clinic carotid endarterectomy asks about GA. vs LA, you tell her:
GA. and LA. has similar risk of stroke
GA. has slightly increased risk of stroke than LA
LA. has slightly increased risk of stroke than GA
GA. has significantly increased risk of stroke than LA
LA. has significantly increased stroke than GA

Back 110

GA. and LA. has similar risk of stroke

Front 111

2015-1
X53 New
Threshold for micro shock:
1uA
10uA
1mA
5mA
10mA

Back 111

10ua

Front 112

2015-1
X54New
Asystolic arrest adrenaline just given, how often do you give adrenaline?
Note, question asked about the asystole, i.E. the non-shockable side of the ALS algorithm.

Back 112

Every 2nd cycle

Front 113

2015-1
New
X55 Hepatic tumour resection, purpose of reducing CVP?

Back 113

Haemorrhage

Front 114

2015-1
X56?New -- or ?correctly recalled version of TMP-Jul10-035
Which is NOT included in the Child-Pugh score?
GGT

Back 114

GGT

Front 115

2015-1
X57Repeat Aug14
Laser flex tube with double cuffs - how to inflate cuff(s)?
A. Inflate proximal then distal
B. Inflate distal then proximal
C. ?Inflate both with saline?
D. Inflate distal only
E. Inflate proximal only

Back 115

B - Ryan, A - Jing

Front 116

2015-1
X58?Repeat or at least similar to MC118
Patient with HOCM has HR 60, SBP 70 post induction, what to do:
give volume
adrenaline
metaraminol
?beta-blocker

Back 116

Give volume

Front 117

2015-1
X59New
The following changes occur in aging except:
increased CSF volume, ...

Back 117

Increased CSF volume

Front 118

2015-1
X60Repeat Aug12 97
Paediatric paracetamol loading dose PR mg/kg:
7.5
10
15
20...
20mg/kg was highest dose option available

Back 118

30-40mg/kg

Front 119

2015-1
X61?Repeat of Mar14 q108
Postpartum post epidural with peripheral neurology. Answer in this case was probably lumbosacral plexus palsy, but be warned there are many variations on this type question with different answer depending on the neurology description.

Back 119

Lumbosacral plexus palsy

Front 120

2015-1
X62 ?New Question not recalled, but the key point was:
Posterior cord of brachial plexus --> weakness of wrist extension

Back 120

Posterior cord of brachial plexus

Front 121

2015-1
X63 (New) (with variation to answers – old version included below) (2014.2) (2012.1) Endocarditis prophylaxis
Bicuspid valve
Congenital repair > 12 months ago
Rheumatic heart valve
D. Uncorrected cyanotic heart disease
E. MVP + ?MR

Back 121

D

Front 122

2015-1
X64 (Repeat) (2014.2) 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 122

B, D

Front 123

2015-1
X65 (Repeat) (2013.2) 6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is
A. 2 hours for breast milk
B. 4 hours for formula
C. 5 hours for breast milk or formula
D. 6 hours for solids
E. 8 hours for solids, 4 hours for all fluids.

Back 123

D

Front 124

2015-1
X66 (Repeat) (2014.1) (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 124

D

Front 125

2015-1
X67 (Repeat) (10-March-Bank) (10-August-Bank) 70 year old post TKJR. On sub-cut heparin. Develops clinical DVT and platelets 40. Management
A. Enoxaparin
B. Fondoparinux
C. Heparin by infusion
D. Lepirudin
E. Warfarin

Back 125

D

Front 126

2015-1
X68 (Repeat) (2013.2) 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 XR of the neck

Back 126

E

Front 127

2015-1
X69 (Repeat) (2012.1) What gestation to monitor uteroplacental flow in lady having coiling?
A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 32 weeks
E. 36 weeks

Back 127

B

Front 128

2015-1
X70 (Repeat) A. nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is
A. altered thermoregulation
B. chorioamnionitis
C. urinary tract infection
D. inflammatory response
E. neuraxial infection

Back 128

D

Front 129

2015-1
X71 (Repeat) What is not an element of Child Pugh score?
A. GGT
B. Albumin
C. Bilirubin
D. INR
E. Encephalopathy

Back 129

A

Front 130

2015-1
X72 (New) Variation of sugammadex question. 1mg/kg rocuronium given in 70kg patient. Now CICO. What is the total dose of sugammadex that you will give?

Back 130

16mg/kg

Front 131

2015-1
X73 (New) Max size vessel for CVC. insertion

Back 131

Max 50%

Front 132

2015-1
X75 (New) How do you prevent breath staking in COPD

Back 132

Prolong expiratory time

Front 133

2015-1
X76 (New) Biggest risk factor for vasospasm post SAH?

Back 133

Volume of blood

Front 134

2015-1
X77 (New) CVC. just inserted into patient. LIM then goes off. What do you do?

Back 134

Disconnect

Front 135

2015-1
X78 (New) Pneumoperitoneum created, sinus brady down to 20BPM. What to do?

Back 135

Release

Front 136

2015-1
X79 (New) Cell salvage results in less what?

Back 136

Transfusion RBC