2013-B- First Half Flashcards
1
Q
- You are called to see a 30 year old man with rapidly deteriorating asthma. Following appropriate medical management an endotracheal tube is inserted and he is ventilated with a mechanical ventilator with a tidal volume of 600ml and a rate of 12 breaths per minute. Five minutes later the blood pressure is unrecordable and external cardiac massage is commenced. Arterial blood is taked and shows ph 7.08, pCO2 96 mmHg, pO2 36 mmHg, SpO2 46% and bicarbonate 27 mmol/L. He is administered adrenaline, salbutamol, pancuronium, bicarbonate and calcium gluconate. The ECG shows sinus rhythm at a rate of 60 beats per minute. The patient remains pulseless and cyanosed with fixed dilated pupils and distended neck veins. The most appropriate management is to
A. cease resuscitation B. administer further adrenaline C. insert bilateral intercostal drains D. cease ventilation for 30 seconds and resume at a slower rate E. increase peak inspiratory pressure
A
D. Cease ventilation.
2
Q
2. A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizur and losing consciousness. Which drug should NOT be given A. Pethidine B. Diazepam C. Haematin D. Suxamethonium E. Pregabalin
A
OK: Pethidine, Diazepam, Suxamethonium, Pregabalin, Hematin.
Hematin is used for treatment and reduces duration and severity of attach. Gabapentin reduces chronic pain. Diazepam assists with control of seizures. ?Suxamethonium – safe in porphyria, but no indication for it’s use in this situation?
Pethidine useful for pain, but norpethidine likely to be epileptogenic.
Therefore, E
3
Q
3. A 42 year old lady presents for right pneumonectomy with a left sided double-lumen tube. She is 132kg and 160cm. What depth, measured at the incisors, is likely to give the ideal position? A. 24cm B. 26cm C. 28cm D. 30cm E. 32cm
A
C. 28cm (Height/10 + 12)
4
Q
- What is the most effective method of minimizing acute kidney injury following an elective open abdominal aortic aneurysm repair?
A. give IV crystalloid as a ‘preload’ before cross-clamp
B. give IV mannitol before cross-clamp
C. give IV frusemide before cross-clamp
D. give preoperative N-acetylcysteine
E. minimize aortic cross-clamp time
A
E
5
Q
Features of severe pre-eclampsia include: A. Foetal growth retardation B. Peripheral oedema C. Systolic BP more than 160 D. Thrombocytopenia E. Severe proteinuria
A
C. BP>160
6
Q
6. [Repeat] Earliest sign of a high block in a neonate post awake caudal: A. Increased HR B. Increased BP C. Reduced HR D. Desaturation E. Loss of consciousness
A
Don’t know. Maybe desaturation
7
Q
- A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management?
A. Awake Fibreoptic Intubation
B. CT scan for laryngeal fractures
C. Direct laryngoscopy after topicalising with local anaesthetic
D. Nasopharyngoscopy by an ENT surgeon
E. Soft tissue xray of the neck
A
A
8
Q
- A 60 year old man with normal LV function is having coronary artery bypass grafting. After separation from the bypass machine he becomes hypotensive with ST elevation in leads II and aVF. The Swan Ganz Catheter showed a PCWP of 25 and CVP of 15 with normal PVR and SVR. The TOE is likely to show:
A. Early mitral inflow > inflow during atrial systole
B. Inferior wall hypokinesis
C. Severe MR
D. TR and RV dilatation
E. LV cavity obliteration at the end of systole
A
C?
9
Q
11. You are working in a theatre with a line isolation monitor, which is working. You touch a wire. What is going to happen? A. equipotent earth B. the theatre floor won't conduct C. ?: D. ? E. the RCD will protect you from shock
A
Floating circuit means you shouldn’t be shocked. Neither wire of the floating circuit is connected to ground. Note it is NOT the RCD, nor the non-conducting earth, nor the equipotent earth that protects you.
10
Q
12. What is the test is decreased in Iron deficiency anaemia? A. microcytosis B. serum feritin C. serum iron D. transferin E. total iron binding capacity
A
TIBC = increased. Ferritin Decreased. Iron decreased. Transferrin saturation decreased.
11
Q
13. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from A. 16000kpa to 400kpa B. 16000kpa to 240kpa C. 11000kpa to 400kpa D. 11000kpa to 240kpa E. 7600kpa to 240kpa
A
Supply 400kPa.
Cylinders filled to 13700kPa, maximum limit 20,000kPa
BOC supplies at 16,000kPa
12
Q
MRI Telsa 3, least likely to cause harm A. Cochlear implant B. mechanical heart valve C. Implanted intrathecal pump D. Recently placed aortic stent E. shrapnel fragment
A
B - mechanical heart valve
Cochlear implants have a magnet that holds external component to the subcutaneous receiver - magnet may move and cause injury.
Heart valves undergo minimal heating and torque - safe but may cause artefact
Recently placed (< 6 weeks) large stents may move under 3T MRI however once they are securely incorporated into tissues they are safe.
http://www.mrisafety.com/safety_article.asp?subject=23
Olive, D., Don’t Get Sucked in: Anaesthesia for Magnetic Resonance Imaging. Australian Anaesthesia 2005.
13
Q
15-What happens when you place a magnet over a biventricular internal cardiac defibrillator A. Switch to asynchronous pacing B. Damage the internal programming C. Nothing D. Switch off antitachycardia function E. Switch of rate responsiveness
A
D. Switch off antitachycardia function
14
Q
16-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
A
D. trigeminal, glossopharyngeal, vagus
15
Q
19 Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I. A. anterior ischaemia B. atrial C. inferior D. lateral E. septa
A
D Lateral
16
Q
20 Lowest extension of thoracic paravertebral space A. t10 B. t12 C. l2 D. l4 E. s1
A
T12
17
Q
21 20 yr old male presents to ED with 30% burns from a fire. His approx weight is 80kg. Based on the Parkland formula, how much fluid is required in the first 8hrs from time of injury? A. 2.4L N/S B. 3.6L N/S C. 3.6L Hartmann's D. 4.8L N/S E. 4.8L CSL
A
E/D
18
Q
22 In regards to systemic sclerosis, what is the least likely cardiac manifestation? A. accelerated coronary artery disease B. atrioventricular conduction block C. myocarditis D. pericardial effusion E. valvular regurgitation
A
E Valves
19
Q
23 (repeat) The reason that desflurane requires a heated vapour chamber can be best explained by its: A. Low saturated vapour pressure B. High saturated vapour pressure C. High boiling point D. Low molecular weight E. Very low solubility
A
B. High SVP
20
Q
24 (New but on a repeated theme)A 30 year old lady has a vaginal forceps delivery without neuroaxial blockade. The next day she is noted to have loss of sensation over the anteriolateral aspect of her left thigh. There are NO motor symptoms. The is best explained by damage to the left sided: A. Lumbosacral trunk B. Lateral cutaneous nerve of the thigh C. Pudendal nerve D. L2/3 Nerve root E. Sciatic nerve
A
B. Lateral cutanous nerve of thigh
21
Q
25.->AZ84 When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade A. 1 B. 2 C. 3a D. 3b E. 4
A
??
22
Q
- A healthy 20 year old patient undergoing nasal surgery under general anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrine and a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and the heart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to
A. administer glyceryl trinitrate B. administer esmolol C. administer labetalol D. administer sodium nitroprusside E. deepen anaesthesia with isoflurane
A
B. administer esmolol
23
Q
27. An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is A. 400mL B. 500mL C. 600mL D. 700mL
A
D
24
Q
28. An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except: A. Aspirin B. heparin C. morphine D. nitrates E. oxygen
A
B. Heparin
25
Q
29. What cannot be used for tocolysis in a 34/40 pregnant woman: A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine
A
B?
But also C - mag sulf is useless and associated with increased
26
Q
31. Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to: A. Intraoperative Bradycardia B. Decreased anaesthetic requirement C. Increased nausea and vomiting D. Increased risk of awareness E. Decreased BIS reliability
A
B. Decreased anaesthetic requirement
