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
- You are doing a supraclavicular brachial plexus block on an awake 35 year-old lady who is healthy with no significant past medical hsitory. Soon after injecting 20mLs of 0.375% ropivicaine she becomes agitated, has a seizure and loses consciousness. Your 1st step in management is
A. Intralipid 20% 1.5ml/kg bolus
B. Midazolam
C. Propofol
D. Establish airway and give 100% O2 via a facemask
E. Feel for radial pulse and give 100mcg adrenaline
D. Establish airway and give 100% O2 via a facemark
- A G1P0 patient with a dilated cardiomyopathy and an ejection fraction (EF) of 35% presents for a caesarean section. The benefits of regional vs general anaesthesia are
A. Decreased heart rate B. Decreased systolic blood pressure C. Increased ejection fraction D. Increased myocardial contractility E. Decreased preload
C and D correct - general anaesthesia causes myocardial depression as well as a reduction in SVR, whereas spinal anaesthesia will only cause a decrease in SVR (provided the block does not extend above T4), which is advantageous in patients with cardiomyopathy.
CEACCP - Cardiomyopathy and anaesthesia
Regional anaesthesia used alone or in combination with general anaesthesia has the advantage of reducing after load which can improve cardiac output
CEACCP - Pregnant women with significant medical conditions: anaesthetic implications
The UK registry of high-risk obstetric anaesthesia on cardiac disease revealed slow incremental epidural anaesthesia and incremental combined spinal-epidural (CSE) (small intrathecal dose followed by careful incremental epidural top-ups) were both shown to be popular, combining the advantages of reduction of afterload with relative haemodynamic stability
PERIPARTUM CARDIOMYOPATHY
(definition: dilated cardiomyopathy of unknown aetiology occurring in the last month of pregnancy and up to 5 months post partum resulting in LV dysfunction)
- risks: advanced maternal age, obesity, multiparous, multiple gestation, gestational hypertension, African American race
- aims:
o Minimise Afterload (epidurals useful)
o Maintain low-normal HR to decrease oxygen demand
- ET05 A patient has a terminal malignancy. His family doesn’t want you to tell the patient about his diagnosis and prognosis. Your decision to inform him is an example of:
A. Autonomy B. Beneficence C. Confidentiality D. Non-maleficence E. Utilitarianism
A. Autonomy
- A septic patient has a CVP of 12mmHg, a blood pressure of 80/40mmHg and a pulse rate of 90/minute. Which is the best agent to treat their hypotension
A. Dopamine B. Dobutamine C. Noradrenaline D. Adrenaline E. Levosimenden
C. Noradrenaline
- Which organ is least tolerant of ischaemia following removal for transplantation
A. Cornea B. Heart C. Liver D. Kidney E. Pancreas
B. Heart
BJA 2012 108 (51) i29-i42 Organ transplantation: historical perspective and current practice
Heart > Lung > liver = pancreas > kidney
4, 6, 12, 18 hours respectively
- You are performing a TAP block. If the needle is correctly positioned where will you deposit the local anaesthetic
A. Beneath the peritoneum
B. Into the transverse abdominus muscle
C. Between the transverse adominus muscle and the internal oblique muscle
D. Between the transverse abdominus muscle and the external oblique muscle
E. Between the internal oblique and the external oblique muscle
C. Between transversus abdominis and external oblique
- You are inserting a left sided double lumen tube into a 140kg 160cm woman. At what depth measured at the incisors is it most likely to be in the correct position
A. 25cm B. 26cm C. 27cm D. 28cm E. 29cm
D. 28 cm
OHA:
29 cm for 170 cm patient - add or subtract 1 cm for every 10 cm change in height
- A patient is cooled to 33 degrees Celcius in an attempt to improve neurological outcome after out-of-hospital ventricular fibrillation cardiac arrest. The evidence for this treatment comes from
A. Case Reports B. Case Control Studies C. Systematic Review D. Randomized Control Trial E. Pseudo-randomized Trial
D. RCT
2010 AHA guidelines for CPR and emergency cardiovascular care Circulation 2010 122:S768-786
NEJM 2002 346:549-566 Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest (RCT)
Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563 (Pseudo randomized trial)
- Which of the following decrease during pregnancy?
A. Functional Residual Capacity B. Forced Expiratory Volume in one second C. Tidal Volume D. Respiratory Rate E. Vital Capacity
A. FRC
- You are anaesthetizing a patient with chronic renal failure for removal of a Tenkoff catheter and have intubated using rocuronium at a dose of 1.2mg/kg. You are immediately unable to intubate or ventilate and you decide to reverse the patient with sugammadex. What dosage would you use
A. 2mg/kg B. 4mg/kg C. 8mg/kg D. 12mg/kg E. 16mg/kg
E. 16 mg/kg
- During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate
A. Carbimazole B. Beta-blocker C. Propythiouracil D. Plasmapheresis E. Hydrocortisone
A. Carbimazole (takes too long to work)
- A young female patient with anorexia nervosa, had just started eating again. After three days she develops dyspnea and is found to have cardiac failure. Which of the following is the most important to correct
A. Potassium B. Chloride C. Phosphate D. Glucose E. Sodium
E. Phosphate
Wiki - refeeding syndrome
Any individual who has had negligible nutrient intake for more than 5 consecutive days is at risk of refeeding syndrome. Refeeding syndrome usually occurs within four days of starting to feed. Patients can develop fluid and electrolyte disorders, especially hypophosphatemia, along with neurologic, pulmonary, cardiac, neuromuscular, and hematologic complications.
During prolonged fasting the body aims to conserve muscle and protein breakdown by switching to ketone bodies derived from fatty acids as the main energy source. The liver decreases its rate of gluconeogenesis thus conserving muscle and protein. Many intracellular minerals become severely depleted during this period, although serum levels remain normal. Importantly, insulin secretion is suppressed in this fasted state and glucagon secretion is increased.[4]
During refeeding, insulin secretion resumes in response to increased blood sugar; resulting in increased glycogen, fat and protein synthesis. This process requires phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up. Formation of phosphorylated carbohydrate compounds in the liver and skeletal muscle depletes intracellular ATP and 2,3-diphosphoglycerate in red blood cells, leading to cellular dysfunction and inadequate oxygen delivery to the body’s organs. Refeeding increases the basal metabolic rate. Intracellular movement of electrolytes occurs along with a fall in the serum electrolytes, including phosphate, potassium and magnesium. Glucose, and levels of the B1 vitamin thiamine may also fall. Cardiac arrhythmias are the most common cause of death from refeeding syndrome, with other significant risks including confusion, coma and convulsions and cardiac failure.
- A pregnant woman is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestational age should you monitor foetal heart rate to ensure adequate uteroplacental blood flow
A. 20 weeks B. 24 weeks C. 28 weeks D. 30 weeks E. 32 weeks
B. 24 weeks
- What is the mechanism of central sensitisation?
A. Increased intracellular magnesium B. Antagonism of the NMDA receptor C. Glycine is the major neurotransmitter involved D. Recurrent a-delta fibre activation E. Alteration in gene expression
E. Alteration in gene expression
- Which of the following is the best predictor of a difficult intubation in a morbidly obese patient
A. Pretracheal tissue volume B. Mallampati score C. Thyromental distance D. BMI E. Severity of OSA
? Mallampati score (I would go with this based on the paper below), ? pretracheal tissue volume
Myatt J, Trends in Anaesthesia and Critical Care (2010) - Airway management in obese patients
MP score:
In the study by Juvin et al. a Mallampati score of 3 or 4 was the only independent risk factor for difficult intubation in obese patients with a specificity and positive predictive value of 62% and 29% respectively. This reflected the findings of another study of 100 morbidly obese patients (BMI > 40 kg/m2), where the product of the graded laryngoscopy view and number of intubation attempts was used to define difficult intubation. Mallampati score of 3 or 4 was also significantly associated with difficult tracheal intubation in the study by Gonzalez et al.
Neck circumference:
Neck circumference is generally measured at the level of the superior border of the cricoid cartilage. Large-neck circumference has been shown in several studies to be a predictor of difficult intubation in morbidly obese patients. In the study by Brodsky et al., a neck circumference of 40 cm was associated with a 5% probability of problematic intubation (described as grade of laryngoscopy view multiplied by intubation attempts ≥3), whereas at 60 cm, the probability was 35% (P = 0.02). Furthermore, a large-neck circumference was significantly associated with male gender (P
40. A female patient with a history of COPD presents for lung volume reduction surgery, which of the following is a contraindication for surgery (? indicates a poor prognosis)
A. Age > 60 years
B. Chronic asthma
C. Evidence of bullous disease on CT scan
D. FEV
D. FEV
- A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except
A. Bisphosphates B. Calcitonin C. Frusemide D. Sodium Chloride E. IV crystalloids
A. Bisphosphonates
Australian prescriber (bisphosphonates):
Pyrophosphate is a normal by-product of metabolism. Bisphosphonates are analogues of pyrophosphate which have potent inhibitory effects on bone resorption. They are effective drugs in bone disorders characterised by increased bone resorption, such as Paget’s disease, osteoporosis, hypercalcaemia of cancer, multiple myeloma and bony metastases.
Wiki (calcitonin):
The hormone participates in calcium (Ca2+) and phosphorus metabolism. In many ways, calcitonin counteracts parathyroid hormone (PTH).
More specifically, calcitonin lowers blood Ca2+ levels in four ways:
- Inhibits Ca2+ absorption by the intestines
- Inhibits osteoclast activity in bones
- Stimulates osteoblastic activity in bones.
- Inhibits renal tubular cell reabsorption of Ca2+ allowing it to be excreted in the urine.
However, effects of calcitonin that mirror those of PTH include the following:
- Inhibits phosphate reabsorption by the kidney tubules
42.What potentiates/interacts with adenosine
A. Aspirin B. Warfarin C. Clopidogrel D. Dabigatran E. Dipyridamole
E. Dipyridamole
Wiki - dipyridamole:
- Dipyridamole inhibits the phosphodiesterase enzymes that normally break down cAMP (increasing cellular cAMP levels and blocking the platelet aggregation response to ADP) and/or cGMP (resulting in added benefit when given together with nitric oxide [NO] or statins).
- It inhibits the cellular reuptake of adenosine into platelets, red blood cells and endothelial cells leading to increased extracellular concentrations of adenosine.
- A 2 year-old child has just undergone strabismus surgery. They had an URTI 1/52 prior to surgery. They had an uneventful general anaesthetic with a 4.5mm cuffed ETT, was extubated and sent to recovery. 20 minutes later they develop respiratory distress. Their saturations are 96% on room air, and there is noticeable tracheal tug. What is the most appropriate initial management that will help with their respiratory distress
A. Apply CPAP via a facemask B. Propofol 1mg/kg C. Dexamethasone 0.4mg/kg D. Gas induction and reintubate E. Nebulized adrenaline (1:1000) 0.5mL/kg
E. Nebulised adrenaline (1:1000) 0.5 mL/kg
Post-extubation stridor - dexamethasone 0.6 mg/kg + nebulised adrenaline 0.5 mL/kg 1:1000 is the usual treatment.
- Which antihypertensive is not safe to use in pregnancy
A. Aspirin B. Enalapril C. Metoprolol D. Hydralazine E. Nifedipine
B. Enalapril
Also, aspirin is not an antihypertensive
- Which of the following is least likely to contribute to postoperative infection?
A. Intraoperative low inspired O2 B. Intraoperative blood transfusion C. Intraoperative hypothermia D. Intraoperative hyperglycaemia E. Cigarette smoking
A. Low FiO2
46. During a cerebral aneurysm clipping, the anaesthetist can assist with the placement of the clip by giving the patient which drug immediately prior to clipping
A. Nimodipine B. Thiopentone C. Hypertonic saline D. Adenosine E. Mannitol
D. Adenosine
Adenosine cardiac arrest is a relatively novel method for decompression of intracranial aneurysms to facilitate clip application. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of proximal vessels is not desirable or not possible.
- The POISE trial showed that the perioperative administration of metoprolol XR resulted in decreased
A. Perioperative mortality B. Hypotension C. Congestive Cardiac Failure D. Myocardial Infarction E. Stroke
D. Myocardial infarction
but increased strokes and death
- In paediatric trauma, the Broselow tape is used to estimate
A. Blood loss B. Weight and drug dosages C. Urine output D. Abdominal girth E. Head circumference
B. Weight and drug dosages
- Which of the following should be used by a lay person to indicate that they should commence CPR
A. Absence of central pulse B. Absence of peripheral pulse C. Loss of consciousness D. Absence of breathing E. Obvious airway obstruction
D. Absence of breathing
ARC 2010
Rescuers must start CPR if the victim is unresponsive and not breathing normally. Even if the victim takes occasional gasps, rescuers should start CPR.
- A patient presents for dilation of a pharyngeal stenosis post laryngopharyngectomy 12 months earlier. After inducing anaesthesia you site a size 7 reinforced ETT in the stoma. Over the next 30 minutes the patient gradually desaturates. Despite hand bag ventilation and an increased FiO2 of 1 the saturations remain at 88%. This is due to
A. Endobronchial intubation B. Aspiration C. Tension Pneumothorax D. Circuit leak E. Blockage of ETT with secretions
A. Endobronchial intubation
- PiCCO determines cardiac output utilizing
A. Thermodilution B. Pulse contour analysis C. Thermodilution and pulse contour analysis D. ? Doppler E. ?
C. Thermodilution and pulse contour analysis
PiCCO® enables continuous hemodynamic monitoring using a femoral or axillary artery catheter and a central venous catheter. Employing patented algorithms, PiCCO combines real-time continuous monitoring through pulse contour analysis with intermittent thermodilution measurement via the transpulmonary method.
- During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring
A. Anterior horn B. Anterior corticospinal tract C. Dorsal column D. Spinothalamic tract E. Lateral corticospinal tract
C. Dorsal column
- 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%
Half of L. upper limb = 4.5 (assuming front and back = 2.25 + 2.25)
Lower limb = 18 (9+9 - front and back)
Anterior abdomen = 9
- Complications of mediastinoscopy include all of the following except
A. Air embolism B. Cardiac laceration C. Pneumothorax D. Recurrent laryngeal nerve palsy E. Tracheal compression
B. Cardiac laceration
theoretically possible but the least likely of the options
- A 70 year old man with severe mitral stenosis and normally in sinus rhythm, is going for an ORIF of fractured radius and ulna. Soon after induction of GA, he develops a tachyarrhythmia with BP 70/40mmHg and HR 130bpm. The most appropriate immediate action is
A. Amiodarone B. Adenosine C. IV fluid bolus D. Adrenaline E. Direct cardioversion
E. Direct cardioversion
- The time constant of the alveoli is
A. Resistance multiplied by compliance B. Resistance divided by compliance C. Resistance plus compliance D. Resistance minus compliance E.
A. Resistance multiplied by compliance
- The MAC awake:MAC ratio of sevoflurane is closest to
A. 0.22 B. 0.34 C. 0.45 D. 0.76 E. 1.00
B. 0.34
58.Abnormal Q waves occur in all the following EXCEPT
A. Digitalis toxicity B. LBBB C. Recent transmural MI D. Wolff-Parkinson-White E. Previous MI
A. Digitalis toxicity
LITFL - WPW:
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).
LITFL - LBBB:
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 in lateral leads (I, V5-V6; small Q waves are still allowed in aVL)
Prolonged R wave peak time > 60ms in left precordial leads (V5-6)
- Patient complains of numbness in the anterior 2/3 of tongue after GA with LMA. Most likely nerve injured is
A. Glossopharyngeal B. Facial nerve C. Mandibular D. Superior vagus E. Maxillary nerve
C. Mandibular nerve
