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
New: Which is a specific PDE inhibitor?
A. Theophylline
B. Dipyridimole
C. Milrinone
C. Milrinone
New: Maximum dose of local infiltration of 0.5% bupivacaine in an x kg child?
0.5 mL/kg
New: Loading dose of IV paracetamol in x kg child?
Loading dose = 20 mg/kg
Dose for neonates 10kg, dose is 15mg/kg
New: Performing a caudal block in a child. What is the first sign of a total spinal anaesthetic?
Fall in SpO2
New: Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?
A. Sedation
B. Urinary retention
A. Sedation
New: New onset AF. For what period of time is it safe to perform DCCV without prior TOE to exclude thrombus?
A.
B.
New: Regarding remifentanil. All of the following are true EXCEPT:
A. Metabolized by plasma cholinesterase
A. Metabolised by plasm cholinesterase.
False - metabolised by red cell and tissue esterases
New: Off-label use of a drug refers to all of the following EXCEPT:
A. Different age-group
B. Different indication
C. Different concentration
D. Different route of administration
C. Different concentration
Off-label use is the use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, unapproved dosage, or unapproved form of administration.
New: Regarding mixed venous oxygen saturations:
A. 60% is normal
B. Can be used to calculate the CO
B. Can be used to calculate the CO
New: Cerebral oximetry measures?
A. Arterial saturation
B. Mostly arterial saturation and some venous saturation
C. Capillary saturation
D. Mostly venous saturation and some arterial saturation
E. Venous saturation
D. Mostly venous saturation and some arterial saturation
Cerebral oximetry differs from pulse oximetry in that tissue sampling represents primarily (70-75%) venous, and less (20-25%) arterial blood. Cerebral oximetric monitoring is also not dependent upon pulsatile flow.
New: Normal systolic BP at birth?
A. Something less than 70 mmHg B. 70 mmHg C. 85 mmHg D. Something more than 85 mmHg E. 115 mmHg
B. 70 mmHg
Term neonates - SBP = 60-70 mmHg
(MAP to defend in neonates = post-conceptual age in weeks, up to ~ 48 weeks PCA)
Expected systolic BP for children older than 1 yr = 80 + (age in years x 2) mmHg
Rpt: Epidural block to T2 causes all of the following EXCEPT:
A. Bradycardia B. Vasodilatation C. Reduced circulating catecholamines D. Dyspnoea E. Elevated PaCO2
E. Elevated PaCO2
Ventilatory function preserved
Rpt: Preoperative autologous blood donation results in less:
A. Cost
B. Incompatible transfusion
C. Less blood wastage
D. Less unnecessary transfusion
B. Incompatible transfusion
Rpt: Penetrating injury to chest. What part of the heart most likely injured?
A. RV
B. LV
C. RCA
A. RV
Rpt: TMP-Jul10-056 Regarding a Thallium scan:
A. High NPV
B. Less useful in comparison to a DSE
A. High NPV
Rpt: What is NOT a contraindication to MRI?
A. Pulmonary artery catheter B. Arterial line C. Scissors D. Coiled ECG cable E. Laryngoscope
B. Arterial line
Contraindications to magnetic resonance imaging (T Dill, Heart 2008; 94:943–948)
Pulmonary artery monitoring catheters and temporary transvenous pacing leads contain non-ferromagnetic but electrically conductive material. During an MRI examination radiofrequency pulses might induce currents that could lead to thermal injuries. Therefore, it is a contraindication to examine patients with such catheters by MRI.
Rpt: Skin between iliac crest and greater trochanter supplied by?
A. Subcostal nerve
A. Subcostal nerve
Rpt: Regarding pyloric stenosis:
A. More common in females
B. Occurs most commonly in neonates in the first week of life
C. Acidic urine
D. Cause of hypokalemia is vomiting only
C. Acidic urine
Boys > girls
Peak incidence 2-8 weeks
Most K loss is via renal tract
Pathophysiology of acid-base/electrolyte changes in pyloric stenosis
Three stages:
○ Hypochloraemic, hyponatraemic metabolic alkalosis with dehydration and alkaline urine
- Gastric outlet obstruction causes loss of hydrogen chloride, water, and small amounts of sodium and potassium; bicarb formed during the production of hydrogen chloride enters the plasma, causing metabolic alkalosis - This excess bicarb appears in the urine (freely filtered but not all reabsorbed)
○ Potassium depletion with paradoxical acidic urine
- Dehydration and reduced ECF volume stimulates aldosterone secretion, and sodium reabsorption in the distal tubule in exchange for potassium - this causes a significant kaliuresis and depletion of total body potassium (most potassium loss in pyloric stenosis occurs in the urine) - Because potassium is an intracellular ion, plasma potassium is a poor guide and is usually normal - In the setting of severe dehydration, the kidney is forced to defend ECF volume in preference to pH, and sodium reabsorption in the renal tubule is maximised by exchanging for H+. There is now H+ secreted in the urine, resulting in a paradoxical aciduria that makes the metabolic alkalosis even worse.
○ Shock, lactic acidosis and starvation ketosis
If treatment is delayed, hypovolaemic shock and lactic acidosis develop (which is superimposed on the metabolic alkalosis)
Rpt: In comparison to Mallampati test, the TMD is:
A. Less sensitive, more specific
A. Less sensitive, more specific
Rpt: Systematic review. What is NOT a weakness?
A. Systematic review author bias B. Publication bias C. Duplicate publication D. Heterogeneity E. Inclusion of historic studies
??? A. Systematic review author bias
This is potentially a problem, although there are strict protocols that generally have to be adhered to in conducting a systematic review, which should hopefully exclude author bias.
Rpt: Traumatic liver laceration. Conservative management is indicated if?
A. Haemodynamically stable
A. Haemodynamically stable
Rpt: Initial dose of IV GTN to relax the uterus is?
A. 5 mcg
B. 50 mcg
C. 200 mcg
B. 50 mcg
Rpt: Dilated CM (LVEF 30%). No dyspnoea with ADLs. Best management?
A. Start ACEI
B. Stop beta-blocker
A. Start ACEi
Rpt: CTG [pictured] demonstrating late decelerations. Most likely cause?
A. Fetal asphyxia
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency
D. Uteroplacental insufficiency
Early decels - head compression
Variable decels - cord compression
Early decelerations are usually benign and associated with the sleep cycle and often in the range of 4-8 cm of cervical dilatation. They are caused by head compression and in general are a normal physiological response to a mild increase in intracranial pressure. Importantly they are uniform in shape and start and finish with the contraction. They may be said to mirror the contraction.
Variable decelerations are a repetitive or intermittent decreasing of FHR with rapid onset and recovery. Time relationships with contraction cycle may be variable but most commonly occur simultaneously with contractions. The significance of variable decelerations depends on the overall clinical picture and specific features of the decelerations themselves, as well as other features of the CTG. Variable decelerations in association with other non-reassuring or abnormal features change the category of the deceleration to ‘complicated’.
Complicated variable decelerations are defined by their features as well as the other features of the CTG. These additional features indicate the likelihood of fetal hypoxia and the definition includes one or more of the following:
- Rising baseline rate or fetal tachycardia
- Reduced or absent baseline variability
- Slow return to baseline FHR after the end of the contraction
- Onset of the nadir after the peak of the contraction
- Large amplitude (by 60bpm or to 60bpm) and /or long duration (60 seconds)
- Loss of pre- and post-deceleration shouldering (abrupt brief increases in FHR baseline)
- Presence of post deceleration smooth overshoots (temporary increase in FHR above baseline)
Prolonged decelerations are defined as a decrease of FHR below the baseline of more than 15 bpm for longer than 90 seconds but less than 5 minutes.
Late decelerations are defined as uniform, repetitive decreasing of FHR with, usually, slow onset mid to end of the contraction and nadir more than 20 seconds after the peak of the contraction and ending after the contraction. Late decelerations are caused by contractions in the presence of hypoxia. This means that they will occur with each contraction and the fetus is already hypoxic. There will be no features of a well oxygenated fetus, like early or typical variable decelerations, normal baseline variability or shouldering. They start after the start of the contraction and the bottom of the deceleration is more than 20 seconds after the peak of the contraction. Importantly, they return to the baseline after the contraction has finished. In the hypoxic fetus, this will include decelerations of less than 15bpm (and occasionally less than 5bpm).
Rpt: Paraesthesia in little finger during supraclavicular block. Likely contacting?
A. Medial cord
A. Medial cord
or probably actually lower trunk at that level
Rpt: Sensitivity 90% and Specificity 99%.
A. False positive rate 1%
A. False positive rate 1%
Rpt: SVRI.
A. SVR x BSA
B. SVR / BSA
A. SVR x BSA
Rpt: PP22 Features of Pierre-Robin syndrome include cleft palate, micrognathia, and?
A. Glossoptosis
B. Microstomia
A. Glossoptosis
Rpt: (See PI56)Ratio of MAC incision to MAC awake for sevoflurane?
A. 0.34
A. 0.34
Rpt: Essential feature of LBBB includes?
A. Loss of QW’s in V5-6
B. RSR in V1
C. Deep SW in V6
D. QRS duration > 0.2 secs
A. Loss of Q waves in V5-6
LITFL:
- Normally the septum is activated from left to right, producing small Q waves in the lateral leads.
- In LBBB, the normal direction of septal depolarisation is reversed (becomes right to left), as the impulse spreads first to the RV via theright bundle branchand then to the LV via the septum.
- This sequence of activation extends the QRS duration to > 120 msand eliminates the normal septal Q waves in the lateral leads.
- The overall direction of depolarisation (from right to left) produces tall R waves in the lateral leads (I, V5-6) and deep S waves in the right precordial leads (V1-3), andusually leads to left axis deviation.
- As the ventricles are activated sequentially (right, then left) rather than simultaneously, this produces a broad or notched (‘M’-shaped) R wave in the lateral leads.
Diagnostic criteria:
• QRS duration of> 120 ms
• Dominant S wave in V1
• Broad monophasic R wave in lateral leads (I, aVL, V5-V6)
• Absence of Q waves inlateral leads (I, V5-V6; small Q waves are still allowed in aVL)
Prolonged R wave peak time > 60ms inleftprecordialleads (V5-6)
Rpt: Best indicator of opioid induced respiratory depression?
A. Sedation score
B. RR
C. SpO2
D. HR
A. Sedation score
Rpt: Intraoperative pediatric arrest during scoliosis surgery most likely due to?
A. Underappreciated degree of blood loss
A. Underappreciated degree of blood loss
Rpt: RCD installed. Electricity mains remains on.
Touch neutral and ground.
A. Nothing will happen
A. Nothing will happen
Rpt: TMP-Jul10-043 Severe asthma attack. Given continuous nebs & IV hydrocortisone but not responding. PaCO2 low. SpO2 low. Next appropriate treatment?
A. IV Magnesium B. IV Aminophylline C. Heliox D. IV salbutamol infusion E. Intubate/ventilate
A. IV magnesium
Rpt: ASD murmur is due to flow through which valve?
A. Pulmonary valve
A. Pulmonary valve
Rpt: Best position for IABP is 1-2 cm:
A. Distal to Left SCA B. Proximal to Left SCA C. Distal to artery of Adamkiewicz D. Distal to renal artery E. Proximal to renal artery
A. Distal to left subclavian artery
Rpt: Blood flow across which valve is used to estimate PASP during echocardiography examination?
A. TV
A. Tricuspid valve
Rpt: Cephalothin spectrum of activity does NOT cover?
A. Pseudomonas
A. Pseudomonas
Rpt: With regard to CHADS2 score. All EXCEPT?
A. Sex
A. Sex
although CHA2DS2-VAS score has sex as the second ‘S’
Rpt: 60kg female given 50mg rocuronium. Dose of sugammadex to reverse?
A. 960 mg
A. 960 mg
16 mg/kg
Rpt: Serum Ca++ 2.05 mmol/L in CKD patient. Most likely cause?
A. Secondary hyperparathyroidism
A. Secondary hyperparathyroidism
Rpt: Post CEA seizure. In order to prevent further seizures?
A. Add/start antihypertensive
B. Start anticonvulsant
A. Add/start antihypertensive
Rpt: According to ANZCA-endorsed labelling standards a brachial plexus catheter should be labelled?
A. Yellow
A. Yellow
Rpt: Conn’s syndrome?
A. Hypernatremia, hypokalemia, normoglycemia
A. Hypernatraemia, hypokalaemia, normoglycaemia
Rpt: Area burnt? (1/2 upper limb + anterior abdomen + whole lower limb)
A. 32%
A. 32%
1/2 upper limb = 4.5
Anterior abdomen = 9
Whole lower limb = 18
Total = 31.5
Rpt: Dural Sac ends at what level in a neonate?
A. L1 B. L3 C. L5 D. S1 E. S3
E. S3
Truffier’s line crosses the midline of the vertebral column at the L4-5 or L5-S1 interspace, well below the termination of the spinal cord making this landmark applicable in all pediatric patients. The dural sac in neonates and infants also terminates in a more caudad location compared to adults, usually at about the level of S3 compared to the adult level of S1.
Rpt: SpO2 90%. No IV access. Place LMA and laryngospasm. Most appropriate course of action?
A. Increase inhaled sevoflurane concentration with LMA in situ
B. Increase inhaled sevoflurane concentration after removing LMA
C. Intralingual suxamethonium (no dose stated)
D. Intramuscular suxamethonium (no dose stated)
E. Intramuscular atropine (no dose stated)
B. Increase inhaled sevoflurane concentration after removing LMA
Rpt: Clopidogrel half-life?
A. 6 hrs
A. 6 hours
Rpt: Which of the following is not a MAJOR complication of mediastinoscopy?
A. Air embolism
B. Cardiac laceration
C. PTX
D. Tracheal compression
B. Cardiac laceration
?? –> possible, but probably the least common complication of the ones listed
Rpt: What sign most suggests a significant murmur in a child?
A. 4/6 loudness
B. ????vibratory/flutter sound
A. 4/6 loudness
Rpt: Thermoneutral zone in 1 month old child?
A. 26-28 degr C
B. 29-31 degr C
C. 32-34 degr C
C. 32-34 C
Rpt: Indicative of severe AS?
A. Palpitations B. Fatigue C. PND D. Angina E. Syncope
C. PND
Asymptomatic patients, even with critical aortic stenosis, have an excellent prognosis for survival, with an expected death rate of less than 1% per year; only 4% of sudden cardiac deaths in severe aortic stenosis occur in asymptomatic patients.
Among symptomatic patients with medically treated, moderate-to-severe aortic stenosis, mortality rates from the onset of symptoms are approximately 25% at 1 year and 50% at 2 years. More than 50% of deaths are sudden. In patients in whom the aortic valve obstruction remains unrelieved, the onset of symptoms predicts a poor outcome with medical therapy; the approximate time interval from the onset of symptoms to death is 1.5-2 years for heart failure, 3 years for syncope, and 5 years for angina.
Rpt: Risk factor for PPH?
A. Prolonged labour
B. Age
A. Prolonged labour
Rpt: Muscle observed when monitoring the NMJ and stimulating ulnar nerve?
A. Adductor pollicis
B. Abductor pollicis brevis
C. Flexor pollicis brevis
A. Adductor pollicis
Rpt: Fat:blood coefficients?
A. N2O~Des > Sevo > Iso
B. N2O > Des > Sevo~Iso
C. Sevo~Iso > Des > N2O
C. Sevo~Iso > Des > N2O
Fat:blood coefficients
- N2O: 2.3
- Des: 27
- Iso: 45
- Sevo: 48
Rpt: Induction/LMA in ?kg child. Develops SVT. Most appropriate course of action?
A. Adenosine 100 mcg/kg
A. Adenosine 100 mcg/kg
Rpt: Clinically the most significant murmur in pregnancy is?
A. MS
A. MS
Rpt: Required for diagnosis of NMS?
A. Muscle rigidity
B. Elevated CK
A. Muscle rigidity
Rpt: Hyponatremic child intubated/ventilated in ICU following seizure. Treatment?
A. Hypertonic saline (no dose/infusion rate given)
A. Hypertonic saline
Rpt: Weakness of proximal and distal muscles following an URTI 10/7 ago. No sensory involvement. T 37.8 degr C. Most likely diagnosis?
A. Guillain-Barre
A. Guillain-Barre
Guillain–Barré syndrome (GBS), sometimes Landry’s paralysis or Guillain–Barré–Strohl syndrome, is an acute polyneuropathy, a disorder affecting the peripheral nervous system. Ascending paralysis, weakness beginning in the feet and hands and migrating towards the trunk, is the most typical symptom, and some subtypes cause change in sensation or pain, as well as dysfunction of the autonomic nervous system. It can cause life-threatening complications, in particular if the respiratory muscles are affected or if the autonomic nervous system is involved. The disease is usually triggered by an infection.
Rpt: Post-operative develops severe chest pain and ST elevation in PACU. Most appropriate initial treatment?
A. Aspirin
B. beta-blocker
C. IV heparin infusion
A. Aspirin
Rpt: Circuit disconnect during spontaneous breathing may be detected by?
A. An unexpected drop in ETagent
A. An unexpected drop in ETagent
Rpt: Time-constant?
A. Resistance x compliance
A. Resistance x compliance
Rpt: Neonate - main resistance in circle is due to?
A. ETT
A. ETT
Rpt: Iron deficiency anaemia:
A. Low ferritin, low serum iron B. Low ferritin, low TIBC C. Elevated ferritin, low marrow iron D. Elevated ferritin, ? E. Elevated ferritin, ?
A. Low ferritin, low serum iron
Rpt: Long-standing T6 paraplegia. Which is INCORRECT?
A. Flaccid paralysis
B. Poikilothermia
C. Labile BP
A. Flaccid paralysis
Rpt: Lap chole on citalopram. What is NOT relatively contraindicated?
A. Omeprazole B. Clonidine C. Pethidine D. Tramadol E. ?Midazolam
B. Clonidine
E. Midazolam
(neither contraindicated)
Rpt: Most effective treatment for post-sevoflurane agitation following grommets in a 4yo child?
A. 1 mg/kg propofol B. 1 mcg/kg fentanyl C. 1 mcg/kg clonidine D. ?dose midazolam no evidence E. Sucrose
A. 1 mg/kg propofol
Rpt: What is NOT useful in the treatment of Torsades?
A. Isoprenaline
B. Procainamide
C. DCCV
D. Electrical pacing
B. Procainamide
Rpt: MS and tachyarrhythmia; hypotension?
A. DCCV
A. DCCV
Rpt: Little space between epiglottis and posterior pharyngeal wall. Modified C&L classification?
A. IIIa
A. IIIa
2 similar Rpts involving: Numb tongue and impaired taste sensation post LMA anaesthesia.
A. Facial Nerve
B. Mandibular division of CN V
C. Lingual
C. Lingual nerve
Tongue: anterior two thirds – general sensation provided by lingual branch of V3 (taste from chorda tympani branch of VII); posterior third – general sensation and taste both provided by glossopharyngeal nerve (IX)
The lingual nerve is a branch of the mandibular nerve, which in turn is a branch of the trigeminal nerve, and it is this nerve that supplies sensory innervation to the anterior two thirds of the tongue. The chorda tympani branch of the facial nerve, which supplies taste sensation to the anterior two thirds of the tongue, also runs with the lingual nerve. The lingual nerve passes between the lateral and medial pterygoid muscles then passes the ramus of the mandible before crossing obliquely to the side of the tongue and passing medially to the inferior surface of the tongue base and the medial aspect of the mandible close to the third molar.
The most likely mechanism of lingual nerve injury is mechanical compression between the shaft of the LMA and the lower incisors or excessive cuff pressure.
Rpt: Lateral approach to popliteal block.
A. Passes through semimembranosis
B. May be performed supine or prone
C. Adequate for ankle surgery
D. Less effective in comparison to posterior approach
E. Eversion is an endpoint for nerve stimulation
Stimulation of tibial nerve results in plantar flexion and inversion.
Stimulation of common peroneal results in dorsiflexion and eversion.
B. May be performed supine or prone
Entry point is the groove between biceps femoris tendon and vastus lateralis.
A popliteal sciatic block alone would not be sufficient for ankle surgery (need saphenous as well).
As effective as posterior (proximal) sciatic nerve block for surgery below the knee.
Inversion/plantar flexion: tibial nerve
Eversion: superficial peroneal nerve
Dorsiflexion: deep peroneal nerve
Rpt: Risk factors for perioperative nerve injury?
Patient factors
- Extremes of body habitus (thin, obese)
- Old age
- Male sex
- History of vascular disease, diabetes, smoking
- Coagulopathy, or presence of haematoma near nerve
- Infection/abscess near nerve
- Pre-existing generalised neuropathy
- Hereditary predisposition
- Structural anomaly/congenital abnormality (e.g. constriction at thoracic outlet or condylar groove, arthritic narrowing of joint space)
Surgical factors
- Neurosurgery, cardiothoracic surgery, general surgery, orthopaedic surgery
- Use of tourniquets and tight fitting casts
- Rib retraction (e.g. in thoracic and cardiac surgery - may stretch brachial plexus)
- Pneumonectomy, axillary lymph node dissection –> can stretch long thoracic nerve (motor deficit of serratus anterior muscle, disrupted scapula movement)
- Long hospital stay
Anaesthetic factors and positioning
- Direct needle damage during regional anaesthesia; LA can directly cause nerve toxicity (esp. high concentration LAs)
- Inadequate padding
- Poor positioning
- Perioperative hypotension, hypovolaemia
- Hypothermia (high incidence of nerve injury after induced hypothermia)
Rpt: SAH. Hyponatremia. Elevated urinary Na concentration. Most likely cause?
A. CSW
B. SIADH
A. Cerebral salt wasting
B. SIADH
(either could be correct, depending on volume status and urine output)
SIADH - Diagnostic criteria:
□ Hyponatraemia
□ Hypo-osmolality (serum osm 20 mmol/L, urine osm > 100 (urine osm often > serum osm)
□ Hypothyroidism and adrenal insufficiency excluded as causes
□ No use of diuretics within a week of testing
Causes: drugs, CNS, chest, malignancy
Cerebral salt wasting syndrome can be mistaken for SIADH as the biochemical picture is similar. Like SIADH it results in a hypotonic hyponatraemia, high urinary sodium, and high urine osmolality. The distinguishing features are that in CSWS the patient is hypovolaemic, with polyuria. It is rare and typically associated with recent intracranial surgery. The process is usually self-limiting and treated with isotonic saline.
Rpt: Urgent reversal of INR 4.5. Intern already gave vitamin K.
A. FFP
B. Prothrombinex
C. Prothrombinex AND FFP
C. Prothrombinex and FFP
Warfarin reversal
Prothrombinex-VF, a three-factor PCC, is the only product currently in routine use in Australia and New Zealand for warfarin reversal. Due to its low levels of factor VII, the Warfarin Reversal Consensus Guidelines published in 2004 recommended that it be supplemented with FFP.
Prothrombinex-VF is able to completely reverse an excessive INR within 15 minutes, but the infused clotting factors have half-lives similar to endogenous clotting factors. Therefore, vitamin K 5–10 mg should be given intravenously with the PCC to sustain the reversal effect. The intravenous route achieves a more rapid response compared with oral administration, with an onset of action seen within 6–8 hours. However, both routes achieve a similar correction of INR by 24 hours.
Rpt: Major cause of death following difficult intubation with perforated oesophagus?
A. Sepsis
B. Failure to intubate
C. Failure to ventilate
A. Sepsis
Rpt: Labour epidurals may cause maternal fever. This leads to:
A. Increased investigations for neonatal sepsis
A. Increased investigations for neonatal sepsis
Rpt: ASA grading was introduced in order to:
A. Standardize description of physical status
A. Standardize description of physical status
Rpt: Bupivacaine vs lignocaine potency:
A. Four times
A. Four times
Rpt: Best agent to decrease both gastric volume and gastric acidity immediately prior to surgery?
A. Omeprazole B. Ranitidine C. Metoclopramide D. Cisapride E. Na citrate
B. (Effervescent) ranitidine
Rpt: Cholecystectomy.
A. Most likely to get gas embolism at initial CO2 insufflation
A. Most likely to get gas embolism at initial CO2 insufflation
Rpt: Diastolic dysfunction is NOT caused by?
A. Adrenaline
B. Constrictive pericarditis
A. Adrenaline
Rpt: AFE early cause of death?
A. Pulmonary HTN
A. Pulmonary hypertension
Rpt: Nerve block anterior 2/3rds of ear?
A. Auriculotemporal nerve.
A. Auriculotemporal nerve (branch of mandibular nerve)
posterior third supplied by lesser occipital nerve from C2
Rpt: Fixed, dilated pupil in trauma patient?
A. Transtentorial herniation
A. Transtentorial herniation
Rpt: Central anticholinergic syndrome, INCORRECT statement?
A. Neostigmine will reverse
A. Neostigmine will reverse
Rpt: MH diagnosis?
A. Muscle rigidity
A. Muscle rigidity
