2012.2 Flashcards
AA23 0r AA13 Half-life of mast cell tryptase?
A. 1 hour
B. 2 hours
B. 2 hours
CEACCP - Anaesthesia-related anaphylaxis: investigation and follow-up (2013)
Rpt: Best single predictor of difficult intubation in obese patient?
A. Mallampati score
B. Interincisor distance
C. Severe OSA
A. Mallampati score
Rpt: Endocarditis prophylaxis is appropriate in?
A. Unrepaired CHD
A. Unrepaired CHD
Rpt: Best aspiration prophylaxis for urgent surgery?
A. Na Citrate B. Ranitidine C. Omeprazole D. Metoclopramide E. Cisapride
A. Na citrate
Rpt: Most common cause of mortality post transfusion?
A. TRALI B. Contamination/infection C. Mismatched blood D. GvHD E. Anaphylaxis
A. TRALI
Rpt: Most common cause of awareness?
A. Failure to check apparatus
A. Failure to check apparatus
human error
Rpt: Apnoeic oxygenation in obese patients is best aided by?
A. Sniffing position
B. Head up tilt
B. Head-up tilt
Rpt: Best renal protection for endoluminal AAA repair?
A. NaCl
B. NAC
A. NaCl
New: White cylinder with grey shoulder?
A. CO2 B. Air C. O2 D. N2O E. N2
A. CO2
All medical gas cylinders have white bodies in Australia.
Shoulder colours:
- O2 - white
- Air - black and white
- N2O - blue
- Entonox - blue and white
- CO2 - grey (or green)
- Helium - brown
- Heliox - brown and white
New: Photograph of an Arndt endobronchial blocker. Orifice labelled ‘X’. What goes in ‘X’?
A. Bronchoscope
B. Bronchial blocker
C. Breathing circuit connection
D. ETT
??
EZ93 Indicator in sodalime?
A. Ethyl violet B. Potassium permangenate C. Blue ? D. ? E. ?
A. Ethyl violet
Rpt: Desflurane vaporiser heated because:
A. High SVP
A. High SVP
Rpt: What is NOT a disadvantage of drawover vaporizer?
A. Basic temperature compensation
B. Basic flow compensation
B. Basic flow compensation
Rpt: FOB - can see a trifurcation. Where are you?
A. RUL
B. ?
A. RUL
Rpt: A Full Size C oxygen cylinder has pressure downregulated from?
A. 16,000 kPa to 400 kPa
B. 16,000 kPa to 240 kPa
C. 11,000 kPa to 400 kPa
D. 11,000 kPa to 240 kPa
A. 16,000 (or 15,000) to 400 kPa
Rpt: Intubating over a bougie. Rotate ETT?
A. 90 degrees anticlockwise
A. 90 degrees anticlockwise
Rpt: Air bubble leads to decreased:
A. Damping coefficient
B. Resonant frequency
B. Resonant frequency
New: At what valve area do you begin to get symptoms, at rest, with mitral stenosis?
A. 1.5 cm2
A. 1.5 cm2
New: With regard to Digoxin toxicity which of the following is NOT a feature?
A. Atrial flutter
A. Atrial flutter
Cardiac side effects of digoxin
• Arrhythmias and conduction abnormalities such as PVC, bigemini, all forms of AV block, junctional rhythm, and atrial or ventricular tachycardia
Toxicity
• Bradycardia requing pacing
Rpt: What is not associated with ulcerative colitis?
A. Psoriasis
A. Psoriasis
Rpt: 75 yo non-valvular AF. Off warfarin. What is his daily risk of stroke?
A. 0.01%
A. 0.01%
Rpt: ECG - Which does NOT have abnormal Q waves?
A. Digoxin toxicity
B. WPW
C. Anterior MI
D. Previous MI
A. Digoxin toxicity
LITFL - WPW
- PR interval 110ms
- ST Segment and T wave discordant changes – i.e. in the opposite direction to the major component of the QRS complex
- Pseudo-infarction pattern can be seen in up to 70% of patients – due to negatively deflected delta waves in the inferior / anterior leads (“pseudo-Q waves”), or as a prominent R wave in V1-3 (mimicking posterior infarction)
Rpt: cTnI remains elevated for up to?
A. 5-14 days
A. 5-14 days
Rpt: Inverted P waves in lead II may be caused by?
A. Junctional rhythm
A. Junctional rhythm
Rpt: Hb 80 g/L with reticulocyte 10%:
A. Hereditary spherocytosis
A. Hereditary spherocytosis
haemolytic anaemia due to intrinsic defect in red cell membrane proteins
Rpt: Pulsus paradoxus in constrictive pericarditis:
A. Decreased BP with inspiration
B. Decreased BP with inspiration greater than normal
B. Decreased BP with inspiration greater than normal
Surgery
New: Cause of visual loss in spinal surgery?
A. Optic ischaemia
B. Compression of eye
A. Optic ischaemia (ischaemic optic neuropathy)
TMP-Jul10-015 Which type of aortic dissection is typically managed non-operatively?
A. Debakey Type I B. Debakey Type II C. Stanford A D. Stanford B E. Stanford C
D. Standford B
(from radiopaedia.org)
DeBakey classification
The DeBakey classification divides dissections into:
• type I:involves ascending and descending aorta (= Stanford A)
• type II:involvesascending aortaonly (= Stanford A)
• type III:involves descending aorta only, commencing after the origin of the left subclavian artery(= Stanford B)
Standford classification
Along with theDeBakey classification, theStanford classificationis used to separateaortic dissectionsinto those that need surgical repair, and those that usually require only medical management. The Stanford classification divides dissections by the most proximal involvement:
- type A:A affectsascendingaorta andarch
- accounts for ~60% of aorticdissections
- needs surgical management
- may result in:
- coronary artery occlusion
- aortic incompetence
- rupture into pericardial sac with resultingcardiac tamponade
type B:Bbeginsbeyondbrachiocephalic vessels
• accounts for ~40% of aortic dissections
• dissectioncommencesdistal to the left sub-clavian artery
medical management with blood pressure control
Rpt: SN18 Absolute CI to the sitting position in neurosurgical patient?
A. Patent ventriculo-atrial shunt
B. Small PFO
A. Patent ventriculo-atrial shunt
Rpt: When do most patients with SAH rebleed?
A. 0-24 hours
A. 0-24 hours
Rpt: Unstable patient. Suspect aortic dissection. Most appropriate investigation?
A. TOE
B. MRI
A. TOE
Rpt: Contraindication to IABP?
A. AR
A. Aortic regurgitation
Contraindications: - Absolute: ○ Aortic regurgitation ○ Aortic dissection ○ Aortic stents - Relative: ○ Uncontrolled sepsis ○ AAA ○ Severe PVD ○ Major arterial reconstruction surgery
Rpt: SG65 Prolonged trendelenburg position results in?
A. Increased myocardial work
A. Increased myocardial work
Rpt: Scoliosis surgery. Which tract is being monitored with SSEPs?
A. Dorsal column
A. Dorsal column
Rpt: Estimate GCS post head-trauma. Eye opens to pain, mumbling incoherently, withdraws to pain (attempted IV cannulation)
A. 8
B. 9
A. 8
E2, V2, M4
New: Oxycodone 20mg SR / Naloxone 20 mcg:
A. Decreased constipation
B. Reduced risk of drug misuse/abuse
A. Decreased constipation
probably decreased risk of intravenous misuse, but marketed for decreased constipation
New: Bowel surgery patient. Best method for intraoperative optimization of fluid therapy?
A. Arterial pulse pressure contour analysis
B. CVP
C. PAOP
D. UO
A. Arterial pulse contour analysis
New: In what proportion of people is the AV node supplied by the R coronary artery?
A. 85%
B. 60%
C. 40%
D. 15%
A. 85%
New: Less blood wastage if:
A. Lower Hb threshold for transfusion
A. Lower Hb threshold for transfusion
New: How long prior to a spinal anaesthetic should dabigatran be ceased?
A. 7 days
A. 7 days
Although other sources say 48 h if CrCl > 80 mL/min or 96 h if CrCl 30-50 mL/min
New: Day 4 epidural. On 40 mg SC enoxeparin daily postoperatively (8 pm). When is the most appropriate time to remove the epidural?
A. Day 5 at 12 midday
B. Day 5 at 6 am
C. Day 5 at 6 pm
D. Day 6 at ?
A. Day 5 at 12 midday
(Wait 12 hours, so 8am at the earliest. If you turn the infusion off at 8am and then leave it in another 4 hours you’ll have a chance to assess analgesia without the epidural before you take it out)
New: What drug should NOT be used for tocolysis in 32/40 female?
A. Indomethacin
B. Magnesium
C. Nifedipine
D. Salbutamol
A. Indomethacin
New: Following an eclamptic seizure the dose of MgSO4 is?
A. 1 gram
B. 4 grams
B. 4 g
8 mL 50%
New: At what gestation should intraoperative monitoring of the fetus occur?
A. 20/40
B. 24/40
C. 26/40
D. 28/40
B. 24/40
New: Trauma patient. CXR (not given): air fluid levels adjacent to heart/diaphragm/ribs.
A. Ruptured diaphragm
B. Hiatus hernia
A. Ruptured diaphragm
New: Endocarditis prophylaxis in patient with prosthetic mitral valve appropriate for?
A. Placement of orthodontic bracket B. Rigid bronchoscopy C. Upper endoscopy with biopsy D. D&C E. Lithotripsy
E. Lithotripsy
Prophylactic antibiotics should be given for dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa (e.g. extraction, root canal, replacing avulsed teeth)
New: Photograph of TOE transgastric SAX image of LV. Which artery supplies [anterior wall of LV arrowed] region?
A. LAD
B. RCA
C. PDA
D. LCx
A. LAD
New: ?15% full thickness burns 6 hrs ago in a child weighing 20kg. How much fluid to give in first hour?
A. ?600 mls
B.
Modified Parkland: 3 x weight x % burn
= 3 x 20 x 15
= 900 mL over 24 h
450 mL in first 8 hours
2 hours left to give 450 mL, so 225 mL/h
…+ maintenance (= 60 mL/h)
= 285 mL in first hour
New: Incarcerated inguinal hernia in a child with a mild URTI. Most appropriate course of action?
A. Postpone for 2 weeks
B. Continue without ETT
C. Continue with careful monitoring
B. Continue with careful monitoring (and an ETT)
New: Congenital prolonged QT syndrome treated with propranolol. How do you confirm an adequate response?
A. HR
B. No change in QT interval in response to a Valsalva manoeuvre
Long QT syndrome and anaesthesia (BJA 2003)
Preoperatively, all patients with known LQTS should be on maintenance β‐blocker therapy, which must be continued up to and including the day of surgery. Preoperative assessment of its adequacy should determine that the heart rate does not exceed 130 min–1 during exercise; where exercise testing is impractical, there should ideally be no change in the QT interval in response to a Valsalva manoeuvre in a fully β‐blocked individual…
…Positive pressure ventilation strategies should ensure that sustained high intrathoracic pressures are avoided, as this mimics a Valsalva manoeuvre, which can prolong the QT interval in patients who are not completely β‐blocked.
New: Meconium stained liquour but neonate delivered is vigorous. Rationale for NOT suctioning the neonate?
A. May aspirate meconium
B. May cause bradycardia
C. May cause hypertension
B. May cause bradycardia
New: Patient with subdural hematoma and PPM for ?AV ablation. PPM technician >1 hour away. Surgeon wishes to proceed immediately. Do you?
A. Postpone and await a cardiologist review
B. Postpone and await arrival of PPM technician
C. Postpone and insert a transvenous temporary PM
D. Proceed after institution of transcutaneous pacing
E. Proceed with a magnet handy.
E. Proceed with a magnet handy
If the patient is not pacemaker-dependent, no need to reprogram to asynchronous mode. Just have a magnet handy (which should switch the PPM to asynchronous mode, although this is not 100% reliable) in the event that EMI causes inappropriate sensing.
New: Which of the following does NOT occur following bilateral lung transplant?
A. Impaired mucociliary clearance
B. Impaired lymphatic drainage
C. Impaired HPV
C. Impaired HPV
Anesthetic Challenges in Patients After Lung Transplantation
Airway reactivity does not appear to be increased. Mucociliary clearance is impaired in pulmonary allograft, which together with immunosuppression and impaired cough, place the patient at an increased risk for perioperative pneumonia. Meticulous hygiene and sterile techniques can reduce exposure of these immune-compromised patients to infectious organisms. Antibiotics should continue during the time of the operation, as should the application of immunosuppressive medications. Stress doses of steroids will be required in most cases. Hypoxic pulmonary vasoconstriction is intact in the pulmonary allograft so during an episode of rejection, pulmonary blood flow may be directed away from the transplanted lung. In patients with SLT, 60% to 70% of pulmonary perfusion is directed toward the transplanted lung.
New: Thoracodorsal nerve arises from?
Posterior cord of the brachial plexus
New: Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?
A. Medial antebrachial cutanous nerve
A. Medial antebrachial cutaneous nerve
New: Buprenorphine patch taken off. Time taken for plasma concentration to halve?
30 hours
New: Incidence of fat embolism following closed femoral fracture?
1-3%
CEACCP - Fat embolism (2007)
The majority (95%) of cases occur after major trauma. Fat embolism syndrome is a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is most commonly associated with fractures of long bones and the pelvis, and is more frequent in closed, rather than open, fractures. The incidence increases with the number of fractures involved. Thus, patients with a single long bone fracture have a 1–3% chance of developing the syndrome, but it has been reported in up to 33% of patients with bilateral femoral fractures.
New: Appropriate postoperative maintenance fluid in a child [can’t recall situation, but something to do with head injury]:
A. 3% and 1/3 NS B. 1/2 NS C. Normal Saline D. Hartmanns E. Hartmanns with glucose
C. Normal saline
