2013.1 Flashcards
- The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipment is turned on
A. The double insulation of the device will prevent macroshock when the outer casing is touched
B. The electrical fuse will immediately break and disconnect the device from the power supply
C. Equipotential earthing will prevent microshock
D. The Line Isolation Monitor will alarm and disconnect power to the device
E. The RCD will rapidly disconnect the device from the power supply
B. The electrical fuse will immediately break and disconnect the device from the power supply
- EZ99 According to the current ANZCA approved standards for labeling, the appropriate colour label for an intraosseous infusion is (some remember it saying INTERosseous, not intraosseous… possibly typo, possibly trick question)
A. Yellow B. Beige C. Pink D. Blue E. Red
C. Pink
3. PP102 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 E. 800mL
C. 600 mL
Miller:
Allowable blood loss = blood volume x (initial Hb - final Hb)/initial Hb
… or can substitute Hct for Hb
Blood volume = 70 mL/kg (2100 mL for 30 kg pt)
Allowable blood loss = 2100 x (35-25/35), = 600 mL
Stoelting has a slightly different formula, with the denominator being the average of initial Hb and final Hb –> using this formula you get 700 mL
- A 30 year-old pregnant patient develops contractions at 30/40 weeks gestation which of the following cannot be used for tocolysis
A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine
A. Clonidine - not tocolytic
Indomethacin is an appropriate (first-line) tocolytic for the pregnant patient in early preterm labor (up to 32/40)
- 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 seizure and losing consciousness. Which drug should NOT be given?
A. Pethidine B. Diazepam C. Haematin D. Suxamethonium E. Pregabalin
A. Pethidine
Assume pt has had porphyric crisis.
This is a controversial question - different sources classify diazepam as safe and unsafe. The CEACCP article does not even mention diazepam.
Pethidine safe - although lowers seizure threshold, so probably not the best drug in this circumstance
Sux safe
Haematin = treatment for porphyria
A small minority of patients will experience chronic neuropathic pain, associated with an ongoing level of disease activity. Gabapentin, pregabalin, and amitryptilline are safe drugs to treat neuropathic pain
Unsafe drugs in porphyria:
- Thiopentone
- Ketamine
- Sevoflurane
- Oxycodone
- Diclofenac
- Rifampicin
- Erythromycin
- Ephedrine
- A patient with HOCM presents with dyspnoea and angina on exertion. Which of the following is the best agent to treat these symptoms
A. Glycerol trinitrate B. Metoprolol C. Morphine D. Hydrochlorthiazide E. Salbutamol
B. Metoprolol
- A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomatic with no other signs/symptoms of myocardial infarction and have an uneventful recovery. What do you do?
A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future mycocardial infarction
B. Arrange coronary angiogram as an inpatient prior to discharge
C. Inform the patient that while the result is real the significance is questionable
D. Repeat in a week’s time as a second troponin is a better indicator of long-term myocardial infarction risk
E. Ignore the result as it is likely a laboratory error
A. Arrange for cardiology follow-up and outpatient angiogram because he is at increased risk of future MI
Periop medicine short course
Metanalysis 2011 looking at vascular surgery patients found that an isolated troponin leak was strongly predictive of all-cause mortality at 30-days. The associated 30-day mortality in patients with no troponin elevation, an isolated troponin leak or PMI was 2.3%, 11.6% and 21.6%
Hence any patient with elevated perioperative troponin should be considered at risk for future adverse cardiac events.
- A 40 year-old lady with a history of a bleeding diathesis presents for a tonsillectomy. What is the most likely cause?
A. Factor V Leiden B. Protein S deficiency C. Haemophilia B D. Antithrombin III deficiency E. Protein C deficiency
C. Haemophilia B
The others are prothrombotic conditions
Haemophilia B (or hemophilia B) is a blood clotting disorder caused by a mutation of the Factor IX gene, leading to a deficiency of Factor IX. It is the second most common form of haemophilia, rarer than haemophilia A. It is sometimes called Christmas disease
- What is the most cephalad intervertebral space at which a spinal can be sited in a neonate where the risk of damage to the spinal cord is minimal
A. L1/2 B. L2/3 C. L3/4 D. L4/5 E. L5/S1
C. L3/4
Spinal cord ends at L3 in neonate
- St John’s Wort (Hypericum perforatum) potentiates the effects of
A. Dabigatran B. Heparin C. Warfarin D. Aspirin E. Clopidogrel
E. Clopidogrel
St John’s Wort induces CYP3A4:
- Increases metabolism of Dabigatrin and warfarin
- Increases conversion of clopidogrel to active form (so will potentiate the effects of clopidogrel)
- No known interaction with aspirin or heparin
- 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
D. Trigeminal, glossopharyngeal, vagus
- The sensory innervation of the respiratory passage is provided by branches of the trigeminal, glossopharyngeal and vagus nerves:
- Nose/nasal passages: nasociliary branch of V1, and the nasopalatine and infraorbital branches of V2.
- Nasopharynx/oropharynx: overlapping supply, from glossopharyngeal nerve (IX), posterior palatine branch of V2, and lingual branch of V3
- 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)
- Larynx: internal branch of the superior laryngeal nerve supplies sensation above the cords (including the superior surface of the cords); recurrent laryngeal nerve supplies sensation below the cords (including the inferior surface of the cords). Both of these nerves are branches of the vagus.
- A patient is having an electrophysiological study and ablation for atrial fibrillation. Suddenly the blood pressure drops to 76/38 mmHg, with the heart rate at 110 in sinus rhythm. What is the best investigation to confirm the cause of hypotension?
A. Troponin B. ST-segment elevation C. Transoesophageal echocardiography D. Coronary Angiogram E. Electrocardiogram
C. TOE
- Which is the most powerful predictor of atrial fibrillation post cardiac surgery.
A. Age B. History of hypertension C. History of CVA D. History of diabetes E. Time on Bypass
A. Age
‘ Post-op AF in the setting of coronary artery bypass graft surgery CABG has been associated with increases in health care costs estimated around $10000 per patient affected. Procedural risk factors of post-operative AF include valve surgery, pulmonary vein venting, bicaval venous cannulation, and longer cross-clamp times. Patient risk factors for post-op AF include male gender, renal dysfunction, congestive heart failure, and left atrial enlargement, the most powerful predictor, however, remains age.’
http://www.jafib.com/published/published.php?cont=abstract&id=482
- A man with a history of Parkinsons disease has undergone uncomplicated general anaesthetic for a knee replacement but develops post-operative nausea and vomiting (PONV). He received 4mg dexamethsone intraoperatively as prophylaxis. What would you use to treat his PONV in recovery?
A. Dexamethasone B. Prochloperazine C. Metoclopramide D. Droperidol E. Ondansetron
E. Ondansetron
Dex has already been used. All others are dopamine antagonists.
- Which of the following is of the least benefit in the treatment of severe anaphylaxis?
A. Cardiopulmonary bypass B. Nebulised salbutamol C. IV crystalloid D. IV vasopressin E. Subcutaneous adrenaline
E. subcutaneous adrenaline
Anaphylaxis during cardiac surgery: implications for clinicians A&A Feb 2008 vol 106 no 2 pp 392-403
All mentioned excepted E.
- A 70 year old patient is being treated for congestive cardiac failure. They are able to shower themselves and complete other ADLs but get dyspneoa on mowing the lawn. They are New York Heart Association classification
A. Class 1 B. Class 2 C. Class 3a D. Class 3b E. Class 4
B. Class 2
NYHA Classification
Class I: Symptoms with more than ordinary activity
Class II: Symptoms with ordinary activity
Class III: Symptoms with minimal activity
Class IIIa: No Dyspnea at rest
Class IIIb: Recent Dyspnea at rest
Class IV: Symptoms at rest
- The percentage of post dural puncture headaches that would resolve spontaneously by 1 week is closest to
A. 90% B. 70% C. 50% D. 30% E. 10%
B. 70%
BJA 2003 Post dural puncture headache: pathogenesis, prevention and treatment
The largest follow‐up of post‐dural puncture headache is still that of Vandam and Dripps in 1956. They reported that 72% of headaches resolved within 7 days, and 87% had resolved in 6 months. The duration of the headache has remained unchanged since that reported in 1956.
Ninety per cent of headaches will occur within 3 days of the procedure, and 66% start within the first 48 h. Rarely, the headache develops between 5 and 14 days after the procedure.
18. Which piece of airway equipment is designed for use with a fibreoptic bronchoscope A. Aintree B. Cook’s airway exchange catheter C. Frova introducer D. ? E. ?
A. Aintree intubating catheter
- A 50 year old lady is seen at the pre-operative assessment clinic, she is on 150mg/day methadone, what is the most likely ECG change to be found in her pre-op ECG?
A. Prolonged PR interval B. Prolonged QTc C. ST depression D. U wave E. Tented T-waves
B. Prolonged QTc
- Current guidelines regarding cardiopulmonary resuscitation include all of the following EXCEPT
A. Allow equal time for chest compression and relaxation
B. Give 2 rescue breath before commencement of CPR
C. Chest compression at 100bpm
D. Chest compression should be at least 5cm depth
E. Chest compression to breath ratio at 30:2
B. Giving 2 rescue breaths before commencement of CPR
- When a 3 lead ECG is applied correctly in the CS5 position, you will monitor lead II when you suspect which of the following conditions
A. Anterior ischemia B. Inferior ischemia C. Lateral ischemia D. Atrial ischemia E. Posterior ischemia
B. Inferior ischaemia
The central subclavicular (CS5) lead is particularly well suited for the detection of anterior myocardial wall ischemia. The right arm (RA) electrode is placed under the right clavicle, the left arm (LA) electrode is placed in the V5 position, and the left leg electrode is in its usual position to serve as a ground.
Lead I is selected for detection of anterior wall ischemia, and lead II can be selected for monitoring inferior wall ischemia or for the detection of arrhythmias. If a unipolar precordial electrode is unavailable, this CS5 bipolar lead is the best and easiest alternative to a true V5 lead for monitoring myocardial ischemia.
Thys DM, Kaplan JA: The ECG in Anesthesia and Critical Care. New York, Churchill Livingstone, 1987.
- You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is:
A. Adrenaline B. Dobutamine C. Levosimenden D. Milrinone E. Vasopressin
E. Vasopressin
- Using the American Heart Association specification, the colours of the electrodes in a 3-lead electrocardiographic is
A. Right arm = Black; Left arm = White; Left leg = Red
B. Right arm = White; Left arm = Black; Left leg = Green
C. Right arm = Black; Left arm = Green; Left leg = Red
D. Right arm = White; Left arm = Black; Left leg = Red
E. Right arm = Red; Left arm = White; Left leg = Green
D. Whitey righty, smoke over fire
- 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
D. 3b