2013-A Courtesy of user emrufo Flashcards
AA22 [Sep11][Mar12][?Mar13]
The commonest initial presenting feature in anaphylaxis is
A. coughing
B. desaturation
C. hypotension
D. rash
E. wheeze
C. hypotension
AT20c [Jul07][Apr08][Aug12][Mar13]
All of the following are major complications of mediastinoscopy EXCEPT:
A. Cardiac laceration
B. Air embolism
C. Pneumothorax
D. Major haemorrhage
E. Recurrent laryngeal nerve damage
A. Cardiac laceration
Continuing Education in Anaesthesia, Critical Care & Pain | Volume 7 Number 1 2007
NA15 ANZCA version [Mar92] [Aug92] [Mar93] [Aug93] [2002-Mar] Q18, [2002-Aug] [Mar10] [Aug10] [Aug12] [Mar13]
The skin of the anterolateral part of the gluteal region, between the iliac crest and the greater trochanter, is supplied by the
A. Ilioinguinal nerve
B. Genitofemoral nerve
C. Superior gluteal nerve
D. Subcostal nerve
E. Lateral cutaneous nerve of the thigh
F. Femoral nerve
D. Subcostal nerve
Subcostal nerve = T12 intercostal = MUFFIN TOPS (see picture below)
Each nerve from T7 to T12 also gives off a lateral cutaneous branch (with anterior and posterior branches), which divides in the mid-axillary line. These branches supply the skin of the flank and back in the relevant distribution. The iliohypogastric and subcostal nerves, however, do not have a divided lateral cutaneous nerve, but continue down to supply the skin over the upper lateral buttock. The ilioinguinal nerve has no lateral cutaneous branch.
Concise Anatomy for Anaesthesia
“supplies sensory innervation to the skin over the hip.”
Wikipedia
-
A. ilioinguinal nerve - false
B. genito-femoral nerve - false
C. superior gluteal nerve - false: “The superior gluteal nerve (L4, 5, S1) accompanies the superior gluteal vessels as the only structures that pass through the upper compartment of the greater sciatic foramen (above piriformis). It supplies gluteus medius and minimus and tensor fasciae lata.” (Ellis)
D. subcostal nerve - true: “The 12th thoracic (subcostal) nerve runs along the lower border of the 12th rib below the subcostal vessels, passes behind the lateral arcuate ligament to run in front of quadratus lumborum behind the kidney and colon. The nerve then passes between transversus abdominis and internal oblique and then has a course and distribution which are similar to the lower intercostal nerves. However, there is one point of difference: the lateral cutaneous branch of the 12th nerve descends without branching to supply the skin over the lateral aspect of the buttock” (Ellis)
E. lateral cutaneous nerve of thigh - false: “The anterior branch supplies the skin over the antero-lateral aspect of the thigh down to the knee, where it links up with twigs from the intermediate cutaneous nerve of the thigh and the infrapatellar branch of the saphenous nerve to form the patellar plexus. The posterior branch penetrates the fascia lata to innervate the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh.”
NH31 ANZCA version [Apr08][Mar13]
You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves:
A. facial, trigeminal, glossopharyngeal B. facial, trigeminal, vagus C. glossopharyngeal, trigeminal, vagus D. trigeminal, glossopharyngeal, vagus E. trigeminal, vagus, glossopharyngeal
- Three major neural pathways supply sensation to airway structures (see Figure 1).
- Terminal branches of the ophthalmic and maxillary divisions of the trigeminal nerve supply the nasal cavity and turbinates.
- The oropharynx and posterior third of the tongue are supplied by the glossopharyngeal nerve.
- Branches of the vagus nerve innervate the epiglottis and more distal airway structures.
➚ Internal Branch ● SENSORY above cords Superior + inferior epiglotis ➚ Laryngeal N. ➘ External Branch ● MOTOR to cricothyroid 'eee' VAGUS
➘ Recurrent
Laryngeal N.
● ALL intrinsic muscles EXCEPT cricothyroid
SG30 ANZCA version [1985] [1987] [Mar93] [Aug96] [Apr97] [Jul00] [2001-Apr][Mar12][Aug12][Mar13]
A patient has suffered flash burns of the upper half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burned is:
A. 18%
B. 23%
C. 32%
D. 41%
E. 48%
C. 32%
Upper half of the left upper limb = 0.5 × 9 = 4.5%
All of the left lower limb = 18%
Anterior surface of the abdomen = 0.5 × 18 = 9%
TOTAL ≈ 32%
ST32 [Apr07][Mar13]
If a new test is developed for a particular disease, the best way to determine its SPECIFICITY is to:
A. find a sample of people, some of whom have the disease and some who do not
B. find a sample of people, all of whom do not have the disease
C. find a sample of people, all of whom do not have the disease, and compare to the estimate of population prevalence
D. find a sample of people, all of whom have the disease
E. find a sample of people, all of whom have the disease, and compare to the estimate of population prevalence
B. find a sample of people, all of whom do not have the disease
Specificity is looking for the rate of false positive for a new test, ie. true negative. Therefore, if we have a population who do not have the disease, as far as we can tell, then if any “positives” come up, then they will be false positives, so we can calculate specificity as TN/FP+TN, since we know TN from the sample.
(Q96 Aug 2008) [?Aug12] [Mar13]
While of the following statements regarding patients with ankylosing spondylitis are FALSE
A amyloid renal infiltration is rarely seen
B cardiac complications occur in
From wiki:
A TRUE Amyloidosis is a very rare complication of ankylosing spondylitis in patients with severe, active, and long-standing disease. These patients generally have active spondylitis, active peripheral joint involvement, and an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein level. This may result in renal dysfunction with proteinuria and renal insufficiency or failure.[5]
B TRUE Cardiovascular involvement of clinical significance occurs in fewer than 10% of patients, typically those with severe long-standing disease. However, subclinical disease can be detected in many patients and may occur as an isolated clinical entity in association with HLA-B27[6]
C FALSE Approximately 15% of patients may present with a normochromic normocytic anemia of chronic disease.[7]
D TRUE
E TRUE Uveitis is the most common extra-articular manifestation, occurring in 20-30% of patients with ankylosing spondylitis. Of all patients with acute anterior uveitis, 30-50% have or will develop ankylosing spondylitis. The incidence is much higher in individuals who are HLA-B27–positive (84-90%).[8] –SG 10:37, 23 Oct 2008 (EDT)
++[Aug12][Mar13]
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.
B. Postpone and await arrival of PPM technician
IF URGENT
see ANZCA webinar on pacemakers (part 3); You cannot assume that a magnet will automatically switch it to asynchronous mode - the magnet function depends on what it was programmed to do. You would need to interrogate it to find out. The majority of the time it will switch it to asynchronous mode, HOWEVER some PPM have been programmed to ignore the magnet!
++[Mar12][Aug12][Mar13]
You are asked by an Obstetrician to help relax a uterus in labour and deliver for manual removal of placenta. What is a safe and effective dose of IV GTN to be delivered?
a. 5 mcg
b. 50 mcg
c. 250 mcg (or 200mcg in Aug12, 250mcg in Mar13 exam)
d. 400 mcg
e. 500 mcg
b. ?50mcg (safe) - tend to give in 50mcg boluses.
c. 200mcg? quoted dose sometimes is 100-200mcg
++[Mar12][Aug12][Mar13] NEW:Middle-aged male with severe mitral stenosis {MS) having general anaesthesia for repair of fractured ulna / radius. 10 minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70. He is normally in sinus. What do you do?
A. Adenosine B. Amiodarone C. Shock D. :Volume E. Metaraminol
Unsure if it is SVT or VT so shock!
a. Adensine - but if VT useless
b. Amiodarone - takes too lung
d. Volume - ?
e. metaraminol - ?if you think tachyarrhytmia is due to hypotension?
Depends on how this question is interpreted overall.
++TMP-Jul10-036 [Aug10][Mar11][Sep11][Aug12][Mar13]
Which is NOT a disadvantage of drawover vaporiser versus plenum vaporiser:
A. Temperature compensation (Basic temperature compensation)
B. Cannot use sevoflurane
C. Small volume reservoir
D. Flow compensation (Basic flow compensation)
E. ?
i.e. assuming what is NOT a disadvantage of the drawover (see wiki re: wording)
B>C
C. Small volume reservoir ?
A. false - draw over vaporiser only has basic temperature compensation therefore performance is affected at extreme temperatures
b. false - can use sevoflurane HOWEVER output (max concentration) is limited so cannot induce with sevoflurane unless two vaporisers are used
c. small volume reservoir - true - “The fractional oxygen concentrate delivered to a patient is dependent on O2 output of the concentrator, MV of the pt and presence of the OET (oxygen economiser tube, aka reservoir). FiO2 conc is in depended of the ventilation pattern with the OET (reservoir) in place. Without an OET, performance is impaired and final FiO2 conc depends on flow of O2, MV and ventilation pattern. 1m length of tubing (internal vol 415ml) will produce an FiO2 of 30% with O2 at 1.0l/min and 60% with 4L/min. at normal MV. USING A LARGER INFLOW RESERVOIR CAN BE CUMBERSOME.”
d. flow compensation - flow is determined by the patent
–
Basic principles behind draw-over vaporiser are same as for the plenum. However, draw-over (pullover) has a low resistance to flow and is relatively INEFFICIENT in comparison to plenum (pushover).
Plenum is used outside the circuit.
Draw-over may be used inside the breathing circuit, usually as part of a draw-over anaesthetic system. If used inside a circle breathing system, the expired vapour builds up to high concentration, hence close end tidal agent monitoring is recommended.
Fresh gas is drawn through the vaporiser because of a negative pressure generated downstream by the pt or ventilator. Flow is governed by pt’s minute volume. Output varies with flow, decreasing as flow increases - calibration needs to cover a wide range of minute volumes (less accurate at high or low flows). Advantage is that they are portable and can be used where compressed gas is unavailable
\++TMP-Oct09-030 [Mar13] Drug LEAST likely to cause hypoxia in ARDS a. Noradrenaline b. Milrinone c. Isoprenaline d. Isoflurane e. SNP
a. Noradrenaline
Comparing New instrument of BP measurement with gold std - choice of test
From wikipedia
‘Bland and Altman make the point that any two methods that are designed to measure the same parameter (or property) should have good correlation when a set of samples are chosen such that the property to be determined varies considerably. A high correlation for any two methods designed to measure the same property is thus in itself just a sign that one has chosen a wide spread sample. A high correlation does not automatically imply that there is good agreement between the two methods.
54 yo for operation. Is on warfarin for AF. History of alcohol abuse, bilirubin is ?, albumin is 30. History of DVT following flight.
What is CHADS2 score?
A 0 B 1 C 2 D 3 E ?
A 0
8 year old, 30kg girl for major operation. Haematocrit is 35%, you decide you will transfuse if haematocrit falls below 25%
What blood volume must she lose to trigger transfusion?
A 400mls B 500mls C 600mls D 700mls E ?
?
———–
[Apr09][Oct09][Mar10][Sep11][Aug12][Mar13]
Pulsus paradoxus is:
A. Reduced BP on inspiration unlike normal (ie normally increased on insp)
B. Reduced BP on inspiration exaggerated from normal
C. Reduced BP on expiration unlike normal
D. Reduced BP on expiration exaggerated from normal
E. ?
(also asked Pulsus paradoxes in constrictive pericarditis:)
B. Reduced BP on inspiration exaggerated from normal
By definition greater than 10mmHg fall.
[Aug08-138][Aug12][Mar13]
Ciliary ganglion
A sympathetic from inferior cervical ganglion
B located inferiorly within orbit
C may be damaged during a peribulbar block
D preganglionic parasympathetic supply from the supra trochlear nerve
E preganglionic parasympathetic originates from the Edinger Westpal nucleus
Ciliary ganglion
- parasymp root - from Edinger Westphal part of oculomotor nucleus by a branch from the herve to the inferior oblique muscle from the inferior division of the oculomotor n.
- symp root - from superior cervical ganglion by branches of the internal carotid nerve
- sensory root - from a branch of the nasociliary nerve, with cell bodies in the trigeminal ganglion
- branches - short ciliary nerves to the eye
[Aug12][Mar13]
Absolute CI for ECT -
A Increased ICP
B Recent MI
C Pregnancy
A Increased ICP - Clinical memorandum 12 RANZCP -- From Clinical Memorandum #12 Royal Australian New Zealand College of Psychiatrists: 3.1 With the exception of raised intracranial pressure, there ar eno absolute contraindications to ECT… Situations of high risk: - Hypertension - MI - Bradyarrhythmias - Cardiac pacemakers - Intracranial pathology - Aneurysms - Epilepsy - Osteoporosis - Skull defect - Retinal Detachment - Concurrent medical illness -----------
[Aug12][Mar13]
Most effective way to reduce renal failure in AAA surgery
A Minimize cross clamp time
A
———–
[Aug12][Mar13]
NEW: What gestation to monitor uteroplacental flow
A 20 weeks
B 24 weeks
C 28 weeks
D 32 weeks
E 36 weeks
From Chestnut’s Ch17: ‘Continuous FHR monitoring (using transabdominal Doppler ultrasonography) is feasible beginning at approximately 18-20 weeks gestation. However, technical problems may limit the use of continuous FHR monitoring between 18 and 22 weeks gestation. Transabdominal monitoring may not be possible during abdominal procedures or when the mother is very obese; use of transvaginal Doppler ultrasonography may be considered in selected cases.
FHR variability, which is typically a good indicator of feral well-being, is present by 25-27 weeks gestation. Changes in the baseline FHR and FHR variability caused by anaesthetic agents or other drugs must be distinguished from changes that result from feral hypoxia. Persistent severe feral bradycardia typically indicates true fetal compromise.
Intraop FHR monitoring requires someone who can interpret the tracing. A pal should be in place that addresses how to proceed in the event of persistent non reassuring feral status, including whether to perform emergency caesarean delivery. The greatest value of intraop FHR monitoring is that it allows for optimisation of the maternal condition if the fetes shows sign of compromise.’
[Aug12][Mar13]
Peak incidence of vasospasm post SAH -
A 0-2 days
B 3-5 days
C 6-8 days
D ?
From UpToDate
‘Vasospasm causes symptomatic ischaemia and infarction in ~20-30% of patients with aneurysmal SAH - it is the leading cause of death and disability after aneurysm rupture. It typically begins no earlier than day 3 after haemorrhage, reaching a peak at days seven to eight. The onset of clinical vasospasm is characterised by a decline in neurologic status, including the onset of focal neurologic abnormalities.’
[Aug12][Mar13]
Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?
A. Medial brachial cutanous nerve B. Lower trunk C. Ulnar nerve D. ? E. ?
B
C8,T1 join to form the LOWER TRUNK -> divides to anterior and posterior division -> ANTERIOR division forms the MEDIAL CORD. From the Medial cord -> medial pectoral nerve, medial cutaneous nerve of arm (or medial brachial cutaneous nerve) and MEDIAL ANTEBRACHIAL CUTANEOUS NERVE (or medial cutaneous nerve of the forearm.
[Aug12][Mar13]
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
See RAH presentation.
[Aug12][Mar13]
What is the incidence of fat embolism following a unilateral closed femoral fracture?
A 1-3%
B 4-7%
C 8 - ?%
[Aug12][Mar13]
New: Thoracodorsal nerve arises from?
A Inferior trunk
B Lateral cord
C dorsal scapular n
D posterior cord
Thoracodorsal (middle subscapular) nerve arises from the posterior cord and receives innervation from C6,7,8. It innervates the Latissimus dorsi muscle.
[Aug12][Mar13]
What drug should NOT be used for tocolysis in 32/40 female?
A. Indomethacin B. Magnesium C. Nifedipine D. Salbutamol E. Clonidine (in Mar13 exam)
B. Magnesium and
A. Indomethacin even ?D. salbutamol
-
B>A and D?
See Chestnut. Table 34-4.
Cochrane review on Magnesium in preterm labour (2002) found ‘no evidence of a clinically important tocolytic effect for magnesium sulphate; it did not have any substantial effect of the proportion of women delivering within 48 hours, either overall, or in any subgroup analysis. Moreover, there was no evidence of any substantial improvements in neonatal morbidity. IN CONTRAST, MgSO4 was associated with an INCREASE IN FETAL AND PAEDIATRIC DEATHS. The higher death rate was present in the SUBGROUP where the maintenance dose of MgSO4, as in the study’s protocol, was high, rather than low.’
Indomethacin can cause premature closure of ductus arteriosus in the fetus if given in 3rd trimester
Depends on reference. NSW health policy directive states that BEFORE 34/40 there are 5 classes of tocolytic agents available in Australia currently: CCB, Beta-agonists, nitric oxide donors, prostaglandin synthetase inhibitors and magnesium sulphate. The evidence to support the use of magnesium sulphate as a first line tocolytic is poor so it is not recommended.
The use of beta-agonists (like salbutamol) or multiple tocolytics is associated with a high incidence of serious adverse drug reactions. Both nitric oxide donors (like GTN) and prostaglandin synthetase inhibitors (like indomethacin) MAY HAVE A ROLE PRIOR TO 28 WEEKS.
[Mar10][Aug12][Mar13]
You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is: A. Right upper lobe B. RML C. RLL D. LUL E. Lingula <br>
see wiki Mar10 exam
[Mar13]
(similar to TMP-Mar10-079 but more info/different info?)
Head Trauma patient with unilateral dilated pupil, no direct (?and consensual) response to light whats the diagnosis ?
A.Global injury B.Optic nerve injury C.Horners syndrome D.Transtentorial herniation E. Injury to Pons (?)
D. Transtentorial herniation
[May09][Mar13]
18/12 old undergoing routine SV GA under LMA. Sudden onset SVT with HR 220 BP 84/60 ETCO2 32 SpO2 98.Management: A. Adenosine 100mcg B. DCR 2J/kg C. DCR 4J/kg D. Amiodarone 5mg/kg E. CPR
D. Amiodarone 5mg/kg - See www.resus.org.au Guideline 12.5 A. False - incorrect dose. at 18/12 estimated weight is ~11kg (2(age+4)). Dose is 0.1-0.3mg/kg. Otherwise adenosine is FIRST LINE, with amiodarone being second line. B. False - Patient is not severely hypotensive yet! From above ref: 'SVT may cause severe hypotension or pulseless in which case synchronised DC shock should be given immediately in a dose of 0.5-1.0 J/kg (mono phasic shock or biphasic shock) but up to 2J/kg if necessary'. C. False - see B D. TRUE. see A. E. False - bit premature...
AA24 ANZCA Version [Jul07][Apr08][Mar13]
Investigation of a suspected anaphylactic reaction requires measurement of tryptase levels. Correct statements regarding tryptase include all except:
A. 99% of body tryptase is in mast cells
B. a concentration of greater than 20 ng/mL suggests an anaphylactic reaction
C. blood samples should be repeated 24 to 48 hours after the reaction
D. maximum blood concentrations occur within 1 hour of the reaction
E. tryptase concentrations rise after both anaphylactic and anaphylactoid reactions
C - False and answer to choose;
Samples should be taken immediately, 1 hour after reaction and 6 or up to 24 hours after reaction
ref 2004 CEACCP article
The CEACCP article from Aug 04 answers these questions, it states
A. 8% cross reactivity between cephlasporins and penicillin
B. Colloids can precipitate histamine release and make the situation worse and are recommend to avoid
C. Tryptase is elevted in both- making this option incorrect
D. Collect blood immediately, at 1hr and a third sample between 6 and 24 hrs
AM09e ANZCA version [Apr08] [Mar12-Q122][Aug12][Mar13]
The diagnosis of neuroleptic malignant syndrome requires the presence of:
A. Diaphoresis B. elevated plasma creatinine kinase (some recalled just ↑ CK) C. hypertension D. muscle rigidity E. tachycardia
D. Muscle rigidity and possibly B. ↑ CK if CK = creatine kinase NOT creatinine kinase (only using Levenson's crier for dx of NMS) -- DSM IV-TR criteria: Severe muscle rigidity and elevated temperature associated with use of neuroleptic medication as well as two or more of the following - - diaphoresis - dysphagia - tremor - incontinence - changes in level of consciousness ranging from confusion to coma - mutism - tachycardia - elevated or labile BP - leukocytosis - laboratory evidence of muscle injury
Levenson's criteria (3 major, or 2 major and 4 minor criteria are needed for dx) Major criteria - fever - rigidity - elevated creatine kinase (CK) Minor criteria - tachycardia - abnormal BP - altered consciousness - diaphoresis - leukocytosis
AM49 ANZCA Version [Apr 08][Mar13]
Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing:
A. abnormalities on magnetic resonance imaging (MRI) spectroscopy
B. calcium release from B lymphocytes in response to caffeine stimulation
C. certain mutations in the ryanodine receptor gene
D. myofibrillar necrosis on muscle biopsy
E. plasma creatine kinase (CK) levels above 800 units.l-1
D. myofibrillar necrosis on muscle biopsy
false hence answer
-
A. MRI spectroscopy - true - Nuclear magnetic resonance spectroscopy measures the concentrations of ATP, phosphocreatine and other phosphomonoesters, along with pH, both in vivo and non invasively, in muscle and other tissue. Several studies have shown delayed reconstitution of pH, ATP, and increased phosphocreatine in MH patients during and after graded exercise. A recent study reports 100% concordance between abnormalities in adenosine triphosphate and high-energy phosphates produced by a specific exercise protocol and the results of muscle biopsy.
B. Ca release from B lymphocytes in response to caffeine stimulation- true - Recently, Sei et al.22 have shown RYR-1 receptors on B lymphocytes in humans. This implied that these cells might demonstrate changes in calcium flux similar to those demonstrated in muscle. They found that lympho- cytes from MH patients, when incubated with 4-chloro- m-cresol, showed increased intracellular calcium con- centrations. However, halothane did not affect intracellular calcium concentrations.
C. mutations in ryanodine receptor gene - true - Most recently, the demonstration that a mutation in the gene that encodes the calcium release channel (the ryanodine receptor, RYR-1) underlies porcine MH in- creased the expectation of a simple DNA-based test for MH in humans as well.
D. myofibrillar necrosis on muscle biopsy - false
E. plasma creatine kinase levels above 800 u/L - true- Creatine kinase concentrations are chronically in- creased in perhaps 50% of MH patients.
“Another approach has been the use of nuclear magnetic resonance spectroscopy to measure ATP, pH, creatine phosphate and other high-energy phosphates non-invasively. With exercise, MH susceptibles demonstrate a greater depletion of high-energy phosphates and fall in pH, compared to normals.”
Caffeine stimulated release of calcium from B Lymphocytes
- “The B lymphocytes from MH patients also display exaggerated changes in cellular calcium levels upon exposure to caffeine and other calcium-release agents compared to normals.”
Resting CK >800
Muscle contraction on exposure to halothane
- caffeine/halothane contracture test (CHCT) continues to be the gold standard
ASA Abstracts 2001
Histopathological Examination Does Not Improve Differentiation between Malignant Hyperthermia Susceptible and Normal Patients
Frank Wappler, M.D.; Franziska von Breunig, M.D.; Marko Fiege, M.D.; Ralf Weisshorn, M.D.; Jochen Schulte am Esch, M.D. Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany
In contrast to the results of recent investigations in a small population of MH patients, histological differences between MHS and MHN could not be demonstrated. Histological investigations can neither improve MH diagnosis nor contribute to a better definition of the MHE status. Therefore, the IVCT remains the only reliable test method in diagnosis of MH susceptibility. However, histological examinations might be helpful to determine unknown neuromuscular diseases (e. g. central core disease, carnitine deficiency syndrome) in patients undergoing IVCT.
Anorexic patient admitted for treatment. She is commenced on a normal diet. She because progressively dyspnoeic and ?admitted to ICU shortly after??
What must derangement do you correct?
A potassium
B sodium
C phosphate
D magnesium?
C?
AZ03 [Jul07][Apr08][Aug12][Mar13]
The BEST indication of a difficult intubation in morbid obesity:
A. Mallampatti Score
B. Neck circumference
C. Limited neck movement
D. TMD
E. Body weight
F. Increased pretracheal soft tissue
B. Neck circumference
F. for Mar13 exam
JB Brodsky, HJM Lemmens, JG Brock-Utne, MVierra, LJ Saidman, Morbid Obesity and Tracheal Intubation. Anesth Analg 2002;94:732–6
➮ Factors looked at included: “height, weight, neck circumference, width of mouth opening, sternomental distance, thyromental distance and Mallampati score”
➮ “Logistic regression identified neck circumference as the best single predictor of problematic intubation. Mallampati score inclusion did not further improve the model in our limited study with only 12 problematic intubations. In patients with a large neck, the view during direct laryngoscopy was poorer.”
Can’t intubate, can’t ventilate situation after giving rocuronium (1.2mg/kg)
What does of sugammadex do you give?
A 2mg/kg
B 4mg/kg
C16mg/kg
C
Carcinoid tumour resection. Patient is hypotensive and octreotide commenced. Patient remains hypotensive. Next treatment option?
A adrenaline B levosimendan C milronone D vasopressin E ?
D
Class I device. There is a fault which leads to an active wire touching the outside casing. What will happen when the power switches on?
A nothing because of double insulation (or something about double insulation)
B RCD will interrupt power supply
C
B
Drug NOT to use to treat hypertension in pregnancy
A aspirin
B …
C
A
During pregnancy all of which of the following respiratory mechanics decrease?
A minute ventilation B tidal volume C functional residual capacity D ?? E ??
C
Eaton lambert syndrome feature
A initial improvement with repeated exercise
A
ECG lead placement (3-lead)
- combination of red white black and green in various places.
- white over right, smoke over fire.
- ———-
EM16b ANZCA version [2002-Mar] Q68, [2002-Aug] Q64, [2005-Apr] Q94, [2005-Sep] [Apr08] [Sep11] [Mar12] [Aug12] [?Mar13]
Circuit disconnection during spontaneous breathing anaesthesia
A. will be reliably detected by a fall in end-tidal carbon dioxide concentration
B. will be detected early by the low inspired oxygen alarm
C. will be most reliably detected by spirometry with minute volume alarms
D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
E. can be prevented by using new, single-use tubing
D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
CJA 48:847-849 (2001)
A breathing circuit disconnection detected by anaesthetic agent monitoring
EM68 [May09][Aug09][Mar13]
In an arterial line system A. Overdamping exaggerates mean B. Underdamping increases mean C. Underdamping underestimates systolic D. wide range of damping coefficient associated with good performance if system has high natural frequency E. Compliant tubing is good
D. wide range of damping coefficient associated with good performance if system has high natural frequency.
However from Miller: Most catheter-transducer systems are underdamped but have an acceptable natural frequency that exceeds 12 Hz. If the system’s natural frequency is lower than 7.5 Hz, the pressure waveform is often distorted, and no amount of damping adjustment can restore the monitored waveform to adequately resemble the original waveform.[47] If, on the other hand, the natural frequency can be increased sufficiently (e.g., 24 Hz), damping will have minimal effect on the monitored waveform, and faithful reproduction of intravascular pressure is achieved more easily (Figs. 40-6 and 40-7). In other words, the lower the natural frequency of the monitoring system, the more narrow the range of damping coefficients that can be tolerated to ensure faithful reproduction of the pressure wave. For example, if the monitoring system’s natural frequency is 10 Hz, the damping coefficient must be between 0.45 and 0.6 for accurate monitoring of the pressure waveform. If the damping coefficient is too low, the monitoring system will be underdamped, resonate, and display factitiously elevated systolic blood pressure; if the damping coefficient is too high, the system will be overdamped, systolic pressure will be falsely decreased, and fine detail in the pressure trace will be lost.
ie. The higher the natural frequency of the system it will tolerate a wider range of damping… not the other way around… so does that make D false too? poorly remembered. - by exclusion. A. false - From Common Errors in Clinical Measurement. Anaes Int Care Med 05 Vol 6 Issue 12: "Damping of the pressure waveform due to poor positioning of the cannula, or the use of overly compliant tubing, underestimates systolic pressure and overestimates diastolic pressure. The mean pressure is still reasonably accurate." B. false - see A C. false - see A. E. False - see A. -----------
ET02 [Mar11] [Mar13]
An 85y.o for open AAA repair. Refuses blood because of risk of vCJD. Despite explanation trying to convince him he still refuses. You tell him you won’t anaesthetise him as the risk is too high (and that it is not in his best interest - this was in Mar 13 exam). This is an example of:
A: Autonomy B: Beneficence C: Malevolence D: Coercion E: Paternalism
n ‘J Med Ethics 2004;30:286–290’ - not available through ANZCA so here is the relevant part:
“Consider the case of a patient, Mr A, who is due to undergo surgical repair of a 10 cm abdominal aortic aneurysm, but who refuses intraoperative blood transfusion, because he is worried about the infinitesimally small risk of contracting variant Jakob-Creutzfeld disease (vCJD) through transfusion. The anaesthetist may explore these fears in a preoperative visit, and may discuss alternative methods of fluid replacement or conservation during this potentially very bloody operation. If the patient still refuses blood transfu-sion, however, the anaesthetist is faced with a conundrum— it would be morally and professionally very difficult to justify proceeding without potential recourse to transfusion, because of the markedly greater risk of severe patient morbidity or mortality. This example differs from the problems posed by blood refusing Jehovah’s Witnesses, in that such patients refuse blood on the basis of a strongly held religious belief, a belief that to them, forms a core value, and is therefore to be respected. Mr A, however, although making an autonomous decision about an admittedly possible but realistically negligible risk is undoubtedly making a poor decision, and one that may be viewed as being at odds with his normal beliefs and values. The easiest course is to respect Mr A’s decision, and proceed. Alternatively, the anaesthetist may respect Mr A’s decision, but refuse to anaesthetise him because of the substantially increased perioperative risk to Mr A. Hard cases make hard decisions, however, and in this case, the anaesthetist would be justified in coercing Mr A into accepting blood; untreated, a 10 cm aneurysm would be likely to rupture within a year, with a 90% mortality if this occurred outside hospital, an occurrence that the anaesthetist may decide does not conform with Mr A’s values (Mr A being an otherwise happy family man). The anaesthetist may feel that Mr A has attached undue weight to the risk of vCJD, and may continue to try and convince Mr A to accept blood.”
EZ98 [Mar12][Mar13]
A machine with a soda lime absorber was left on overnight with oxygen running at 6 litres per minute. In the morning a desflurane vaporiser is connected. What toxic substance may be produced?
A. Substance A B. Carbon monoxide C. Carbon dioxide D. Calcium hydroxide E. Substance B
From Stoelting:
‘Carbon monoxide formation reflects degradation of volatile anaesthetics that contain a CHF2 moiety (des, enf and iso) by the sting bases in desiccated CO2 absorbents. Factors which influence magnitude of carbon monoxide production from volatile anaesthetics include:
- dryness of CO2 absorbent with hydration preventing formation
- high temperatures of CO2 absorbent as during low fresh gas flows and/or increased metabolic production of CO2
- PROLONGED HIGH FRESH GAS FLOWS THAT CAUSE DESICCATION (DRYNESS) OF THE CO2 ABSORBENT, and
- type of absorbent
Desflurane produces the highest carbon monoxide concentration (then enf and iso).
Female patient requires DLT, she weighs ?kg and is 160cm tall. What mark would best correspond at the teeth to indicate correct placement?
A 24cm
B 26cm
C..
D?
28cm
Intraosseous infusion (according to ANZCA guidelines) should be labelled:
A beige B red C pink D blue E yellow
C
Management that is least useful in SEVERE anaphylaxis?
A cardiopulmonary bypass B nebulized salbutamol C IV vasopressin D corticosteroids E subcutaneous adrenaline
?
