19.1 Flashcards

Question 1

Q

19.1 When comparing TAVI to SAVR which complication is lower in the TAVI group:
a) Perivalvular leak
b) Heart block
c) Vascular injury
d) Reintervention rates
e) Gradient across valve

Answer

A

e) Gradient across valve

UTD Choice of intervention for severe calcific aortic stenosis:

The SAVR treatment group experienced significantly higher 30-day rates of acute kidney injury (4.4 versus 1.7 percent), atrial fibrillation (43.4 versus 12.9 percent), and transfusion requirement (41.1 versus 12.6).

The TAVI group experienced significantly higher 30-day rates of major vascular complications (6.0 versus 1.1 percent) and need for permanent pacemaker implantation (25.9 versus 6.6 percent). Moderate or severe paravalvular aortic regurgitation was more common at one year in the TAVR group (5.3 versus 0.6 percent in the SAVR group). Mean prosthetic valve gradients were significantly lower and prosthetic aortic valve areas were higher in the TAVI group.

TAVI decreased:
- AKI
- AF
- Transfusion
- Mean prosthetic valve gradient

TAVI increased:
- Major vascular complications
- Permanent pacemaker implantation
- Paravalvular regurgitation
- Need for re-intervention

Question 2

Q

19.1 Patient has AHI of 4. How bad is OSA?
a) none
b) Mild
c) Moderate
d) Severe
e) Very severe

Answer

A

Patient has AHI of 4. How bad is OSA?
a) none
b) Mild
c) Moderate
d) Severe
e) Very severe

Answer: a) None
- assuming an adult.

Apnoea–Hypopnoea Index (AHI) is an index used to indicate the severity of sleep apnea
- number of apnea and hypopnea events per hour of sleep.
- apnea at least 10 seconds and be associated with a decrease in blood oxygenation
- calculated by dividing the number of apnea events by hours of sleep.

AHI values for adults are categorized as:
Normal: AHI<5
Mild: 5≤AHI<15
Moderate: 15≤AHI<30 (CPAP recommended)
Severe: AHI≥30 (CPAP recommended)

Paediatric
●Mild OSA – RDI or AHI, 1 to 4.9
●Moderate OSA – RDI or AHI, 5 to 9.9
●Severe OSA – RDI or AHI, >10

Question 3

Q

19.1 Dental damage risk to be determined in your department. 100 cases reviewed, zero cases of dental damage. What is the 95% confidence interval?
a) 0/100
b) 1/100
c) 3/100
d) 5/100
e) 9/100

Answer

A

Answer: 3/100

Question 4

Q

19.1 Singer complains of hoarse voice Post-LMA insertion, nasoendoscopy shows one vocal cord lax, what nerve involved? (repeat)
a) Recurrent laryngeal nerve
b) Superior laryngeal
c) Vagus
d) Hypoglossal
e) Phrenic

Answer

A

Answer: a) RLN

Question 5

Q

19.1 Please interpret the following blood gas for a patient coming from ED:
pH7.2
PCO2 60
PO2 80
HCO3 18

A. Respiratory acidosis only
B. Metabolic acidosis only
C. Mixed with primary resp acidosis
D. Mixed with primary metabolic acidosis
E. Resp with metabolic compensation

Answer

A

Answer: Mixed with primary respiratory acidosis

Question 6

Q

19.1 What is the maximum tube size (internal diameter) that can fit over an aintree cathter as per the manufacturer:
A. 5
B. 5.5
C. 6
D. 6.5
E. 7

Question 7

Q

19.1 Aspirin use in healthy older adults for primary prevention
a) Reduced cardiovascular mortality
b) Increased incidence of major bleeding
c) increased cancer related death
d) lower all cause mortality
e) Reduced thromboembolic events

Answer

A

b) Increased incidence of major bleeding

Question 8

Q

19.1 Which nerve is not blocked when undertaking a superficial cervical plexus block?
a) Greater auricular nerve
b) Supraclavicular
c) Lesser occipital
d) Greater occipital
e) Transverse cervical

Answer

A

d) Greater occipital

Question 9

Q

19.1 What is the make up of Plasmalyte?
a) Na 140, K 4, Mg 0, Ca 1.5, Acetate 23, Lactate 27
b) Na 140, K 5, Mg 1.5, Ca 0, Acetate 27, Lactate 0
c) Na 140, K 4, Mg 1.5, Ca 1.5, Acetate 23, Lactate 0
d) Na 129, K 5, Mg 0, Ca 1.5, Acetate 0, Lactate 26
e) Na 129, K 5, Mg 1.5, Ca 0, Acetate 0, Lactate 0

Answer

A

b) Na 140, K 5, Mg 1.5, Ca 0, Acetate 27, Lactate 0

Question 10

Q

19.1 Patient having 4th toe amputation. Which nerve must be blocked?

a. Calcaneal
b. Posterior tibial
c. Deep peroneal
d. Saphenous
e. femoral

Answer

A

b. Posterior tibial

Also, Sural and superficial pernoeal
PT, sural and SP are all branches of the sciatic nerve

Question 11

Q

19.1 Commonest cause of peri-operative stroke
a) Hypotensive
b) Embolic
c) Thrombotic
d) Hypertensive
e) Haemorrhagic

Answer

A

b) Embolic

Question 12

Q

19.1 When do spinal reflexes normally return after an acute spinal injury
a. 1-3 days
b. 7 days
c. 28-40 days
d. 120 days
e. 365 days

Answer

A

a. 1-3 days

Question 13

Q

19.1
a. Normal lungs
b. Pulmonary odema
c. Pneumothorax
d. Pleural effusion
e. Pneumonia

Answer

A

b. Pulmonary odema

Question 14

Q

19.1 Patient scheduled for elective hip operation. Has fever and productive cough. You do not proceed with case despite patient urging you to do it. This is an example of
a) Autonomy
b) Non maleficience
c) Paternalism
d) Beneficience
e) Justice

Answer

A

b) Non maleficience
c) Paternalism

Question 15

Q

19.1 Which is the most effective in treating neuropathic pain (lowest NNT)?
a. Gabapentin
b. Venlafaxine
c. Pregabalin
d. Tramadol
e. Methadone

Answer

A

d. Tramadol
TCAs have the most effective NNT of all drugs for neuropathic pain

Question 16

Q

19.1 4 year old having a GA for bone marrow biopsy in a suspected case of ALL which antiemetic to avoid
a) Droperiodol
b) Ondansetron
c) Dexamethasone
d) Metaclopramide
e) Cyclizine

Answer

A

c) Dexamethasone

?Tumour lysis syndrome?

Question 17

Q

19.1 Patient for eye block. Average axial length as determined by ultrasound?
A) 20mm
B) 23mm
C) 26mm
D) 29mm
E) 32mm

Question 18

Q

19.1 A patient with severe depression is taking moclobemide. What is the best way to anaesthetise this patient to minimize risk
a) Sevo, pethidine, phenylephrine
b) Propofol, fentanyl, ephedrine
c) Propofol fentanyl, metaraminol
d) Sevo morphine phenylephrine
e) Sevo, fentanyl, metaraminol

Answer

A

d) Sevo morphine phenylephrine

Question 19

Q

19.1 Patient on Ticagrelor has stopped for a neuraxial procedure. After how long can the maintenance dose be recommenced after the neuraxial procedure?
a. Immediately
b. After 6 hours
c. After 24hrs
d. After 5 days
e. You should not recommence it

Answer

A

b. After 6 hours
Immediately

Ticagrelor
13.4.1 Preoperative. Based on labeling and surgical/ procedural experience, the recommended time interval between discontinuation of ticagrelor therapy is 5 to 7 days (grade 1C).
Remarks: This is a new recommendation.

13.4.2 Postoperative. In accordance with ACCP recommendations, ticagrelor therapy may be reinstituted 24 hours postoperatively (grade 1A).
Remarks: This is a new recommendation.

13.4.3 Neuraxial catheters should not be maintained with ticagrelor because of the rapid onset (grade 2C).
Remarks: This is a new recommendation.

13.4.4 Ticagrelor therapy may be resumed immediately after needle placement/catheter removal, provided a loading dose of the drugs is not administered. If a loading dose is administered, we suggest a time interval of 6 hours between catheter removal and administration (grade 2C).

Question 20

Q

19.1 Patient having foam sclerotherapy for varicose vein surgery. Post-op stands up to walk, immediately collapses, with L sided weakness
a) Thromboembolic stroke
b) Paradoxical gas embolism
c) Intracranial haemorrhage
d) Anaphylaxis
e) Arrhythmia

Answer

A

b) Paradoxical gas embolism

Question 21

Q

19.1 You are giving a GA with volatile anaesthesia and rocuronium. What monitoring don’t you need
A. ETCO2
B. Oxygen monitoring
C. SpO2
D. Gas monitoring
E. ECG

Question 22

Q

19.1 You suspect anaphylaxis. When do you take tryptases (hrs)?
a) Immediately, 4, 12
b) 2, 4, 24
c) 1, 4, 24
d) immediately, 6, 24
e) 1, 6, 24

Answer

A

c) 1, 4, 24

Question 23

Q

19.1 What is the significance of the size of the black box in a forrest plot?
a) Weight of the study
b) Standard deviation
c) Mean
d) 95% confidence interval

Answer

A

a) Weight of the study

Question 24

Q

19.1 What nerve palsy?

a. CN 3
b. CN 4
c. CN 5
d. CN 6
e. CN 2

Answer

A

a. CN 3

Unopposed Lateral rectus (CN 6) and Superior oblique (CN 4)

Question 25

Q

19.1 What protective mask to wear in laparoscopy for patient with disseminated TB?
a) N95
b) P99
c) R95
d) None
e) Surgical mask

Question 26

Q

19.1 Aprepitant is an antiemetic that works on the receptors for:
a) Serotonin
b) Neurokinin-A
c) Dopamine
d) Substance P
e) Glycine

Answer

A

d) Substance P

Question 27

Q

19.1
a) Atrial Bigeminy
b) Ventricular Bigeminy
c) Cardiac Tamponade
d) LBBB
e) SVT

Answer

A

c) Cardiac Tamponade

Question 28

Q

19.1 Recirculation is a problem of which device:
a) Ecco2 device
b) VV ecmo
c) VA ecmo
d) Haemodialysis
e) Peritoneal Dialysis

Answer

A

b) VV ecmo

Question 29

Q

19.1 A 50-year-old woman has had a headache for the last month which is relieved by lying flat. She has had no medical procedure to her spine such as epidural, spinal or lumbar puncture. Her brain magnetic resonance imaging (MRI) scan shows diffuse meningeal enhancement and brain sagging. Her neurologist suspects spontaneous intracranial hypotension and asks you to do an epidural blood patch. No spinal imaging has been performed to confirm a cerebrospinal fluid (CSF) leak. You should

a) Perform a LP to measure the pressure
b) Do the epidural blood patch at the lumbar level
c) Refuse
d) Do a CT / MRI / myelogram and find the level of the leak and do blood patch at that level
e) Do a CT / MRI / myelogram and do blood patch lumbar level

Answer

A

b) Do the epidural blood patch at the lumbar level

Question 30

Q

19.1 Which has the highest capacity to absorb infrared radiation?
a) nitrous oxide
b) sevoflurane
c) desflurane
d) isoflurane
e) CO2

Answer

A

c) desflurane

Question 31

Q

19.1 Which is not a possible complication of a dural puncture:
a) Subdural haemorrhage
b) Cranial nerve palsy
c) Seizures
d) Encephalitis
e) Epidural vein thrombosis

Answer

A

d) Encephalitis

Question 32

Q

19.1 Increased splitting of the second heart sound on inspiration with
a) AR
b) Pul stenosis
c) HOCM
d) LBBB
e) LVH

Answer

A

b) Pul stenosis

Question 33

Q

19.1 Most effective prevention of post-herpetic neuralgia
a. Amitryptiline
b. Gabapentin
c. Anti virals
d. Pregabalin
e. Oxycodone

Answer

A

a. Amitryptiline

Opiates are not indicated in chronic phase (PHN)
Anti-virals reduce the duration and severity, but do not help w prevention of PHN
Gabapentin reduces acute phase pain intensity and area/sensitivity of allodynia but no impact on PHN
Amitriptylline 25mg for 90 days, started early in acute phase reduces PHN, level 2 evidence (ANZCA acute pain book, fourth edition 2015)
Vaccination is the most effective preventive intervention, decreasing the incidence of PHN by 66.5% (Clinical cases in anaesthesia, pg 365)

Question 34

Q

19.1 What is the pathology?

a. Obstruction
b. Patient Triggering
c. Gas trapping
d. Restrictive disease

Answer

A

c. Gas trapping

Question 35

Q

19.1 What is pathognomonic for a post dural puncture headache?
a) Frontal headache
b) Nuchal rigidity
c) Headache worse on standing
d) Photophobia
e) Cranial nerve involvement

Answer

A

c) Headache worse on standing

NYSORA PDPH:

The cardinal feature of PDPH is its postural nature, with headache symptoms worsening in the upright position and relieved, or at least improved, with recumbency. The International Headache Society (IHS) diagnostic criteria further describe this positional quality as worsening within 15 minutes of sitting or standing and improving within 15 minutes after lying. Headache is always bilateral, with a distribution that is frontal (25%), occipital (27%), or both (45%). Headaches are typically described as “dull/aching,” “throbbing,” or “pressure type.”

Question 36

Q

19.1 Paediatric trauma patient - normal blood volume 80ml/kg. At 3 hours, what blood loss should massive transfusion be considered?
a) 10ml/kg
b) 20ml/kg
c) 40ml/kg
d) 60ml/kg
e) 80ml/kg

Answer

A

c) 40ml/kg

Question 37

Q

19.1 What is an absolute contraindication to ECT therapy:
a) Cochlear
b) PPM
c) Elevated ICP
d) Epilepsy
e) Pregnancy

Answer

A

c) Elevated ICP

Question 38

Q

19.1 You are anaesthetising a patient and the ventilator pressures go up. You think it is anaphylaxis and give adrenaline. Your anaesthetic nurse then shows that the wheel of the ventilator was blocked and causing high airway pressures and subsequently fixes the problem. This is:
a) Slip
b) Lapse
c) Mistake
d) Violation
e) Deviation
f) Fixation

Answer

A

c) Mistake

Question 39

Q

19.1 70 year old male in clinic for revision total hip operation (in 10 days’ time) following blood results what is best management
Hb 110 (130-170 normal range)
Ferritin 31 (30-100 range)
Transferrin sats 21% (normal 20-80)
CRP 10 (0.1-10 normal)

a) Proceed without further
b) Blood transfuion
c) Oral iron 6 weeks and recheck
d) IV iron
e) Defer

Answer

A

c) Oral iron 6 weeks and recheck

Question 40

Q

19.1 What is the purpose of the earthing wire in the electrical outlets in OT?
a) Prevents circuit overload
b) Prevents electrocution
c) Prevents microshock
d) Prevents diathermy interference

Answer

A

c) Prevents microshock

Question 41

Q

19.1 Airway device in this picture?

A. Arndt bronchial blocker
B. Cohen bronchial blocker
C. Microlaryngoscopy tube
D. Hunsaker tube
E. Parker Flex tip ETT

Answer

A

D. Hunsaker tube

Question 42

Q

19.1 Change in renal blood flow during cross clamp in infrarenal AAA repair?
a) Increase by 20%
b) Increase by 40%
c) No Change
d) Decrease by 20%
e) Decrease by 40%

Answer

A

Decrease by 40%

Question 43

Q

19.1 Paeditric cxr with history of congential heart disease repair and what was the repair based on the cxr:

A) Av repair
B) Pv repair
C) ASD closure device
D) Parachute device
E) Right atrial appendage closure device

Answer

A

C) ASD closure device

Question 44

Q

19.1 After anterior cervical spinal surgery patient has difficulty breathing, what is the most common complication?
a) Aspiration
b) RLN injury
c) Oedema
d) Phrenic nerve injury
e) Haematoma

Answer

A

c) Oedema

Question 45

Q

19.1 Spirometry can measure:
a) TLV
b) RV
c) FRC
d) TLC
e) VC

Question 46

Q

19.1 Which anaesthetic agent invalidates the OCP
a. Sugammadex
b. Rocuronium
c. Sevoflurane
d. Dexamethasone
e. Flucloxacillin

Answer

A

a. Sugammadex

Question 47

Q

19.1 Fire from power board behind anaesthetic machine which device should you use to extinguish:
a) CO2
b) blanket
c) fire hose
d) foam extinguisher
e) wet chemical extinguisher

Question 48

Q

19.1 Cell salvage – leukodepletion filters do not protect against?
a) Vernix
b) Alpha fetoprotein
c) Foetal RBC
d) Amniotic fluid
e) Foetal squamous cell

Answer

A

c) Foetal RBC

Question 49

Q

19.1 In patients with cephalosporin cross reactivity to penicillin what is the causative component:
a. thiazolidine ring
b. Beta lactam ring
c. R1 chain on the Beta Lactam ring
d. R2 chain on the thiazelidine ring
e. ??

Answer

A

c. R1 chain on the Beta Lactam ring

The R1 side chain as an antigenic determinant appears to explain the cross-reactivity that can be seen between certain beta-lactam antibiotics, as well as within the cephalosporin family. For example, aminopenicillins such as ampicillin and amoxicillin have similar R1 side chains to the aminocephalosporins cefalexin and cefaclor, and patients with sensitisation to the amino side chain have a risk of cross-reactive allergy between amoxicillin and cefalexin but can tolerate other (non-amino) penicillins and cephalosporins without this side chain.

reason cephazolin has such a low cross reactivity with penicillin is that it shares no similar R1 or R2 side chains (or to other cephalosporins except for ceftezole!)
-> the earliest studies of penicillin and cephalosporin cross reactivity in the 1970s were tainted by the presence of trace amount of benzylpenicillin in the cephalosporins, falsely increasing the apparent degree of cross-reactivity (which is where the figure of 10% cross reactivity stems from).

Question 50

Q

19.1 Which tooth is most commonly damaged in anaesthesia practise
a. Right middle maxillary incisor
b. Left middle maxillary incisor
c. Left middle mandibular incisor
d. Right middle mandibular incisor
e. Right 2nd mandibular molar

Answer

A

b. Left middle maxillary incisor

Question 51

Q

19.1 Of all of the following muscle relaxants which has the lowest risk to cause cross-reactivity?
a) pancuronium
b) vecuronium
c) atracurium
d) rocuronium
e) suxamethonium

Answer

A

c) atracurium

BJA Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011
https://academic.oup.com/bja/article/110/6/981/245571

Anaphylaxis rates (highest to lowest)
Primary anaphylaxis: rocuronium > atracurium > vecuronium > pancuronium = cisatracurium
Cross-reactivity: suxamethonium > rocuronium > vecuronium > pancuronium > atracurium > cisatracurium

Question 52

Q

19.1 Patient post-free rotational flap sitting up in recovery BP 120/70, normal heart rate. Flap is purple with immediate cap refill. Most appropriate treatment (repeat)
a) Return to theatre
b) Heparin
c) Dextran
d) Fluid bolus
e) Intraarterial streptokinase

Answer

A

A. Return to theatre
True - first line treatment is return to theatre to salvage flap
- NB: increased cap refil time, so likely arterial failure, but still same management!

Venous congestion would be treated with either systemic heparin or leeches as a second line

Question 53

Q

19.1 What is the purpose of the earthing wire in the electrical outlets in OT?
a. Prevents circuit overload
b. Prevents electrocution
c. Prevents microshock
d. Prevents diathermy interference

Answer

A

c. Prevents microshock

Wrong it’s prevent electrocution

Question 54

Q

19.1 Elective craniotomy you induce patient with 2mg/kg propofol and 0.6mg/kg rocuronium.You have had two unsuccessful attempts at direct laryngoscopy and place an LMA which you can ventilate via but poorly. The most appropriate next step is:
a) Proceed on LMA
b) FONA
c) Repeat attempt at intubation using a CMAC
d) Intubate over airway exchange catheter
e) Wake the patient up

Answer

A

c) Repeat attempt at intubation using a CMAC

Question 55

Q

19.1 What NSAID decreases the efficacy of aspirin
a) Diclofenac
b) Parecoxib
c) Ibuprofen
d) Ketorolac
e) Celecoxib

Answer

A

c) Ibuprofen

Question 56

Q

19.1 Someone on rivaroxaban is bleeding. What is the best method to reverse bleeding?
a. Tranexamic acid
b. Idruciximab
c. Prothrombinex
d. FFP
e. haemodialysis

Answer

A

c. Prothrombinex

Question 57

Q

19.1 NAP 6 – Commonest allergen/ Worst antibiotic?
a) Teicoplainin
b) Vancomycin
c) Cefazolin
d) Amoxycillin
e) Cefoxitin

Answer

A

a) Teicoplainin

Question 58

Q

19.1 What is the shelf life of platelets?
a) 5 days at 20º C
b) 14 days at 20º C
c) 35 days at 2-6º C
d) 42 days at 2-6º C
e) 12 months at -20º C

Answer

A

a) 5 days at 20º C

Question 59

Q

19.1 Scalp block for awake craniotomy requires blockade of the following nerves:
a) Greater and lesser occipital and greater auricular
b) Trigeminal, greater and lesser occipital
c) Trigeminal, greater occipital and greater auricular
d) Facial, trigeminal and greater occipital
e) Facial, greater and lesser occipital

Answer

A

b) Trigeminal, greater and lesser occipital

Supra orbital and supratrochlear are opthalmic branches of the trigeminal nerve, Zygomatic temporal and auriculotemporal are also branches of the trigeminal nerve (maxillary and mandibular branches respectively)

Question 60

Q

19.1 Least likely to prevent agitation after ECT?
a) Remifentanil induction
b) Small dose propofol after ECT
c) Premedication with dexmedetomidine
d) Premed with olanzapine
e) Premedication with midazolam

Answer

A

a) Remifentanil induction

Question 61

Q

19.1 Patient with leg weakness post spinal and adductor canal block for TKR which nerve is least likely to be cause?
a) Sciatic
b) Femoral
c) Peroneal
d) Saphenous
e) L4/5

Answer

A

d) Saphenous
Purely sensory

Question 62

Q

19.1 A CF patient is undergoing a CPET study what is the BORG scale used for:
a) VO2 max
b) Oxygen consumption
c) Lactate threshold
d) Subjective exertional scale
e) CO2 production

Answer

A

d) Subjective exertional scale

Question 63

Q

19.1 You need to give cyro to patient with blood type A and have run out of A typed cryo. What is the next best blood group
a) AB +
b) O -
c) O +
d) B -
e) B +

Question 64

Q

19.1 You are in ICU and have accidently cannulated the carotid artery with a 7Fr. Vascular surgeons unavailable for 4 hours. What do you do?
a. Remove cannula and put pressure
b. Heparinise patient until surgeon available
c. Leave in, and heparinise via CVC until surgeon available
d. Leave in and heparanise for 24hours
e. Remove after 24 hours and put pressure

Answer

A

b. Heparinise patient until surgeon available

Answer 58

A

e) 10 L/min

Answer 59

A

The answer is -30

ANKI 2019.1 does not give -30 as an option but stated that the axis is 90degrees from lead II as it is an equipontetial lead. Lead II is at 60 degrees therefore 90 degrees from 60 is -30 also the answer is -30 see Super Axis Man SAM

https://litfl.com/super-axis-man-sam/

Answer 60

A

b) Lingual

Answer 61

A

a. 70%

Sensitivity = TP/ TP+FN
Specificity= FP/FP + TN
PPV= TP/ TP + FP
NPV= TN/TN +FN

Answer 62

A

b) 60ml/hr

14G 45mm long 330ml/min flow rate
16G 30mm long 220ml/min flow rate
18G 30mm long 105ml/min flow rate
20G 30mm long 60ml/min flow rate
22G 25mm long 35ml/min flow rate
24G 19mm long 20ml/min flow rate

Answer 63

A

a) Aortic Regurgutation - widened pulse pressure
AS - slurred upstroke aortic curve
HOCM - rabbit ears, double peak

Answer 64

A

a) Not safe

ok in second trimester. NOT SAFE FOR 1st and 3rd trimester

Answer 65

A

Image B) Biggest P-wave

Answer 66

A

c) Labetalol

Answer 67

A

b) Lung protection ventilation strategies

Answer 68

A

a) Decreased mortality due to blood loss

Answer 69

A

d. 100ml 3% saline

Answer 70

A

a) Bivalirudin

Answer 71

A

D) Haemothorax

Answer 72

A

a) SVC to right pulmonary artery

BT shunt: subclavian artery to pulm artery
Glenn: SVC to pulm artery
Fontan: IVC to pulm artery
Sano shunt: RV to pulm artery

Answer 73

A

a) 4 yrs
APMSE 2015, pg 415:
Self-report of pain is preferred when feasible, and is usually possible by 4 y of age, dependent upon the child’s cognitive and emotional maturity.

Answer 74

A

e. Paraesthesia

Dyasthesia: An unpleasant abnormal sensation, whether spontaneous or evoked.

Allodynia: Pain due to a stimulus that does not normally provoke pain.

Hyperalgesia: Increased pain from a stimulus that normally provokes pain.

Hyperesthesia: Increased sensitivity to stimulation, excluding the special senses.

Paresthesia: An abnormal sensation, whether spontaneous or evoked.

Answer 75

A

a. Decreased mortality

Decreased all cause mortality and death due to bleeding

Answer 76

A

D) 8
E2, V2, M4

Answer 77

A

c) Sick euthyroid

Hyperthyroidism
T4 up, T3 up, THBR up, TSH normal or low

1ry hypothyroidism
T4 low T3 low or normal, THBR low, TSH up

2ry hypothyroidism
T4 low, T3, low, THBR low, TSH low

Sick euthyroid (decreased conversion of T4 to T3 in peripheries)
T4 normal, T3 low, THBR normal, TSH normal

Pregnancy
T4 elevated
T3 normal, THBR low, TSH normal

Answer 78

A

B) Sciatic nerve

Answer 79

A

b) No difference

Answer 80

A

c) no anticoagulation

Answer 81

A

c) Glycolysis

Answer 82

A

c. 40ml/kg

Massive transfusion defined as
- replacement of >1 blood volume in 24hrs
- >50% of blood volume in 4hrs
- in children transfusion of >40ml/kg
> blood volume in children over 1 month old is approximately 80ml/kg

Answer 83

A

a) Hypoglycaemia

Concerns center on hypotonia and altered metabolism of fat and carbohydrates (hypoglycemia). Weak skeletal musculature is associated with a poor cough and an increased incidence of aspiration pneumonia. Disturbances in thermoregulation, often characterized by intraoperative hyperthermia and metabolic acidosis, occur, but a relationship to malignant hyperthermia has not been established.

Answer 84

A

d) Propothyiouracil

Propylthiouracil inhibits hormone synthesis and prevents T4 to T3 conversion and so is usually the first-line therapy. It can be administered enterally or per rectum, with a 600 mg loading dose, followed by 200–250 mg 4–6 hourly. Inhibition of thyroid hormone synthesis can alternatively be achieved with carbimazole (20–30 mg enterally t.d.s.) or i.v. methimazole (20 mg 4–6 hourly) where enteral intake is impossible.7

Corticosteroids (hydrocortisone 100 mg 6 hourly i.v. or equivalent) are routinely given, as they also inhibit peripheral conversion of T4.7 Other agents include Lugol’s iodine, which inhibits the release of stored hormone and cholestyramine, to bind thyroid hormone within the gut and reduce enterohepatic recirculation.7

Beta-blockers are recommended to minimize peripheral clinical effects, e.g. propranolol 80–120 mg enterally 6 hourly, or i.v. equivalent, is appropriate. Where beta-blockade is contraindicated enteral or i.v. diltiazem can be used.7 In thyroid storm, cardiac failure is often secondary to a persistent high output state. Therefore, although beta-blockers should always be administered cautiously, the observed reduction in heart rate may confer clinical improvement in this group. Cardiac output monitoring can be useful to aid drug titration, especially where i.v. preparations are being given.

Answer 85

A

De Winter T waves prox LAD

Answer 86

A

a) Medial canthus

*Myopics are at much greater risk of globe perforation from traditional inferotemporal approach of peribulbar due to increased risk of staphylomata
*Avoid major orbital haemorrhage by injecting into the less vascular orbital compartments: inferotemporal or nasal sites
*Globe rupture higher risk with inferolateral approach

Answer 87

A

D. Acute fatty liver of pregnancy

Answer 88

A

b) Chronic lung disease

dominant R wave in v1 w t-wave inversion and ST depression in V1-3 -> RV hypertrophy with strain,
giant p waves - R atrial dilatation,

Answer 89

A

a) Paracetamol

Answer 90

A

e) warfarin

Answer 91

A

c) DC cardioversion

ANZCOR Rx for unstable AF: synchronised DC cardioversion

Answer 92

A

c) Nasopharynx no, that lags behind brain temp as brain receives more CO from CBP circuit. Therefore circuit temp more approximates brain.
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/j.1365-2044.2005.04112.x#:~:text=However%2C%20it%20appears%20that%20any,may%20cause%20marked%20brain%20injury.

Answer 93

A

c) Allow the eye to proptose

Answer 94

A

a) Hypophosphataemia

Ferric carboxymaltose (Ferinject) for iron-deficiency anaemia
https://www.nps.org.au/radar/articles/ferric-carboxymaltose-ferinject-for-iron-deficiency-anaemia

In this set of patients administered FCM (n = 5799), treatment-related side effects that occurred in more than 1% of the group included:
- nausea (3.1%)
- hypophosphataemia (1.9%)
- injection-site reactions (1.6%)
- headache (1.4%)
- hypertension (1.3%)
- dizziness (1.2%)

Answer 95

A

B) junctional bradycardia

Answer 96

A

D. Gilberts

Answer 97

A

E. Oxygen as per SpO2 as per normal
HB level of 10 is normal in smokers

Answer 98

A

a) Doing an epidural on a patient who is labouring normally with a normal pregnancy and no comorbidities

Answer 99

A

D) deep posterior

Answer 100

A

D. 60 mins

Answer 101

A

C. 60mg
4mg/kg

Answer 102

A

A) Ischaemic optic neuropathy

Answer 103

A

B) 30 mins

Answer 104

A

e) Overexpansion

Answer 105

A

E) 100mg hydrocortisone IV followed by infusion 200mg/24hrs

Answer 106

A

B) bicuspid AV with significantly dilated Aortic root

Answer 107

A

A. Emphysema

Answer 108

A

c) 5 years

BJA Trigeminal Neuralgia
1st line carbamazepine
- S.E. drowsiness, dizziness, liver dysfunction requiring monitoring
- NNT 1.8, less strong evidence for other anti-neuropathics

2nd line: Surgical
1. peripheral
> laser therapy, alcohol injections, or neurectomy
> 6-12 months relief
> less invasive in patients unfit for surgery
> may cause dysaesthesias

at gasserian ganglion
> gasserian ganglion can be ablated using
- thermal (radiofrequency),
- chemical (glycerol, phenol, alcohol), or
- mechanical (balloon compression) techniques.
  > 4-5 years in 50%, local and sedation. high incidence dysaesthesias, sensory loss
  > Balloon compression can lead to arrhythmias, aseptic meningitis, and temporary diplopia.
posterior fossa
> microvascular decompression (MVD)
> major neuro sx
- 60-70% 5yr ongoing relief, relapse rate at the end of 10 yr is about 30–40%
  > gamma knife
- destructive procedure that aims at delivering a focused beam of radiation to trigeminal nerve root in the posterior fossa where there is a proven vascular compression
- 69% at relief 1yr, may not persist, can be repeated

Answer 109

A

c) clinical diagnosis of exclusion

Numerous laboratory tests have been proposed and studied in the context of AFE. None of them are specific enough for making the diagnosis, but they can still aid and guide management.

Standard tests, including full blood count, liver and renal function tests, electrolytes and arterial blood gases do not aid in diagnosis, but remain useful in management. Coagulation studies will demonstrate low fibrinogen with prolonged prothrombin and partial thromboplastin times, whereas thrombocytopaenia is a rare finding initially. Thromboelastography may support diagnosis and should be used whenever available. Arterial blood gases will almost inevitably show hypoxaemia and changes in acid–base balance.

Electrocardiogram may show sinus tachycardia, bradycardia, various dysrhythmias, right ventricular strain, and ST-segment and T-wave changes. Recently, transthoracic and transoesophageal echocardiography have been used to aid in diagnosis. Reported findings are acute right ventricular failure, severe pulmonary hypertension, and a cavity-obliterated left ventricle during the early phase of AFE. Occasionally, intracardiac thrombi or emboli can be seen.

Multiple biomarkers have been suggested to increase the likelihood of AFE diagnosis in conjunction with the clinical features. The complement fractions, C3 and C4, have been found to be low in patients with AFE

Answer 110

A

b) Cease because risk of Hypoglycaemia

Wrong. Continue. DPP4i no risk of hypoglycemia.

Answer 111

A

c) Elevated IGF1 with GH non supression

Answer 112

A

d) Long and Short ciliary nerves

Answer 113

A

a. 80ml bolus 0.9% normal saline

20ml/kg bolus followed by
maintenance fluid in the form of:
- 0.45% saline with glucose 5% and
- 10 mmol potassium chloride per 500 ml bag is given
- rate of 150 ml/kg/day

Answer 114

A

E. Caudal aspect of the posterior tonsillar pillar
- need access to the base of the posterior tonsillar pillars (palatopharyngeal arch)
- blocks glossopharyngeal nerve

B. Penetrate the cricothyroid membrane
- transtracheal injection
- blocks RLN

C. inferior to the greater cornu of the hyoid bone
- superior laryngeal nerve
- provides sensation to the laryngeal structures above the vocal cords and lies inferior to the greater cornu of the hyoid bone

Answer 115

A

a) Adductor pollicis longus

Answer 116

A

c) 38 degrees

Answer 117

A

a. Variable intrathoracic lesion

Answer 118

A

c) Vasopressor

Answer 119

A

d) 1:19000

GA: 1:19 000
GA + NMB: 1:8 200
GA + No NMB: 1:135, 900
GA for LSCS: 1:670
GA fo CTS: 1:8 600
GA for Paeds: 1:61 100

Answer 120

A

b) The intervention may be statistically significant even though the confidence intervals between the two cross

Confidence Intervals
The other major areas of statistical inference are the estimation of parameters with associated confidence intervals (CIs). In statistics, a CI is an interval estimate of a population parameter. A CI describes how likely it is that the population parameter is estimated by any particular sample statistic such as the mean. (The technical definition of the CI of the mean is more rigorous. A 95% CI implies that if the experiment were done over and over again, 95 of each 100 CIs would be expected to contain the true value of the mean.) CIs are a range of the following form: summary statistic ± (confidence factor) × (precision factor).

Answer 121

A

c. 12 hours

Propofol PI:
“As usual for fat emulsions, the infusion of Fresofol 1% via one infusion system must not exceed 12 hours. After 12 hours, the infusion system and reservoir of Fresofol 1% must be discarded or replaced if necessary.”

Answer 122

A

b. Middle cerebral artery occlusion

Answer 123

A

b) Organ dysfunction from dysregulated host response to infection

Answer 124

A

A. Decreased acute kidney injury

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