2013.2 Flashcards
- 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
D. Cease ventilation for 30 seconds and resume at a slower rate.
- 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 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
C. 28 cm.
29 cm for patients 170 cm tall. Up or down 1 cm for every 10 cm increase/decrease in height.
- 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
E. Minimise aortic cross-clamp time
CEACCP - Elective open AAA repair (2013)
The main cause of renal complications after AAA repair is the decrease in renal blood flow, decreased renal perfusion pressure (outside autoregulation) augmented by the increasing renal vascular resistance (by 30%) associated with aortic clamping. Myoglobin release from ischaemic tissues may contribute to acute tubular necrosis by decreasing local nitric oxide release. Acute kidney injury (AKI) may also be linked to ischaemic–reperfusion injury, decreased renal cortical blood flow, prostaglandin imbalance, and increased activity of renin–angiotensin system. Postoperative dialysis rates are similar in patients who have undergone either suprarenal or infra-renal aortic cross-clamping. Intraoperative urine output does not correlate with the degree of decrease in glomerular filtration rate (GFR) or the incidence of postoperative AKI. Several drugs (dopamine, N-acetyl cysteine, mannitol, furosemide) have been used in an attempt to protect against AKI, although none has been shown consistently to be beneficial, and all diuretics should be used only after adequate fluid replacement and volume loading. Loop diuretics potentially decrease renal tubular reabsorption and oxygen demand. Mannitol can increase renal blood flow during aortic cross-clamp; however, both mannitol and dopamine use fail to return GFR to baseline levels after operation.
- Features of severe pre-eclampsia include all of the following except:
A. Fetal growth retardation B. Peripheral oedema C. Systolic BP more than 160 D. Thrombocytopenia E. Severe proteinuria
B. Peripheral oedema
(peripheral oedema is also seen in mild pre-eclampsia, and even in normal pregnancy)
Severe preeclampsia is defined assystolic blood pressure160-170 and/or diastolic blood pressure of 110mmHg or higher measured on at least two occasions over several hours, combined with proteinuria >300 mg total protein in a 24-h urine collection, or ratio of protein to creatinine >30 mg/mmol. All usually accompanied by other haematological, neurological, hepatic or renal derangement.
- [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
D. Desaturation
In awake adults the first signs of high spinal block are hypotension, bradycardia and difficulty in breathing. Hypotension is due to venous and arterial vasodilation resulting in a reduced venous return, cardiac output and systemic vascular resistance. Bradycardia is caused by sympathetic block leading to unopposed vagal tone and blockade of the cardio-accelerator fibers arising from T1-T4. Heart rate may also decrease as a result of a fall in right atrial filling. Respiratory difficulty is caused by loss of chest wall sensation caused by paralysis of the intercostal muscles. When a total spinal occurs the nerve supply to the diaphragm (cervical roots 3-5) is blocked and respiratory failure develops rapidly. Sudden respiratory arrest may also be caused by hypoperfusion of the respiratory centers in the brainstem. Other signs of total spinal include loss of consciousness and pupillary dilatation.
Numerous reports exist of infants tolerating high or total spinal anesthesia without the significant autonomic changes seen in adults. Although the reason for this finding are unclear, some suggest the cardiovascular stability in infants is due to either a smaller venous capacitance in the lower extremities (less pooling of blood), or a relative immaturity of the sympathetic nervous system which results in less dependence on sympathetic vasomotor tone.
- 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
D. Nasopharyngoscopy by an ENT surgeon
- 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
B. Inferior wall hypokinesis
Discussion with cardiac anaesthetist
a - This is a normal finding (E wave > A wave)
b - Correct answer, inferior infarct , may be due to air in artery or acute occlusion or graft failure
c - Unlikely given not existing pre-op
d - Unlikely
e - Referring to SAM, no left sided pathology from stem
- 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
B. The theatre floor won’t conduct
??? - this question is probably incompletely remembered.
- Which of the following is decreased in iron deficiency anaemia?
A. microcytosis B. serum feritin C. serum iron D. transferin E. total iron binding capacity
B. Serum ferritin
- A full size C oxygen cylinder (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. 16,000 to 400 kPa
- MRI Tesla 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
D. Recently placed aortic stent
Labeling/Recommendations
Most aortic stent grafts that have been tested have been labeled as “MR safe”; the Zenith AAA endovascular graft stent has been labeled as “MR unsafe.” Patients with stent grafts made from nonferromagnetic materials may be scanned immediately after implantation at 3 T or less
- 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
D. Switch off antitachycardia function
- 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
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. septal
A. Anterior 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.
20 Lowest extension of thoracic paravertebral space
A. T10 B. T12 C. L2 D. L4 E. S1
B. T12
Anatomy of the thoracic paravertebral space (CEACCP)
The thoracic paravertebral space begins at T1 and extends caudally to terminate at T12.
Although PVBs can be performed in the cervical and lumbar regions, there is no direct communication between adjacent levels in these areas. Most PVBs are therefore performed at the thoracic level.
The thoracic paravertebral space is wedge shaped in all three dimensions. The bodies of the vertebrae, intervertebral discs, and intervertebral foraminae form the medial wall. Anterolaterally, the space is bounded by the parietal pleura and the innermost intercostal membrane. Posteriorly, it is bounded by the transverse processes (TPs) of the thoracic vertebrae, heads of the ribs, and the superior costotransverse ligament. The thoracic paravertebral space is divided into a posterior subendothoracic and an anterior subserous compartment by the endothoracic fascia, the significance of which is unclear. The paravertebral space contains spinal
nerves, white and grey rami communicantes, the sympathetic chain, intercostal vessels, and fat.
- 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
E. 4.8 L CSL
The Parkland formula estimates a 24-hourly fluid volume of 4 mL/kg per %TBSA with half given in the first 8 h. This formula was devised after experiments by Baxter and Shires on rhesus monkeys using Ringer’s lactate in 1968.
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
E. Valvular regurgitation
Stoelting
Changes in the myocardium reflect sclerosis of small coronary arteries and the conduction system, replacement of cardiac muscle with fibrous tissue, and the indirect effects of systemic and pulmonary hypertension. These changes result in cardiac dysrhythmias, cardiac conduction abnormalities, and congestive heart failure. Intimal fibrosis of pulmonary arteries is associated with a high incidence of pulmonary hypertension, which may progress to cor pulmonale. Pulmonary hypertension is often present, even in asymptomatic patients. Pericarditis and pericardial effusion with or without cardiac tamponade are not infrequent. Changes in the peripheral portion of the vascular tree are common and typically involve intermittent vasospasm in the small arteries of the digits. Raynaud’s phenomenon occurs in most cases and may be the initial manifestation of scleroderma. Oral or nasal telangiectasias may be present.
Wikiecho
Systemic sclerosis cause of myocarditis
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
B. High saturated vapour pressure
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 anterolateral 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
B. Lateral cutaneous nerve of the thigh
- 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
- 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
C. Administer labetalol
- 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
Allowable blood loss = blood volume x ([initial Hct - final Hct]/initial Hct)
= (30 x 70) x ([35-25]/35)
= 2100 x (10/35)
= 600 mL
Another formula uses ‘average of initial and final Hct’ as the denominator, which would give 700 mL as the answer.
- 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
B. Heparin
- What cannot be used for tocolysis in a 34/40 pregnant woman:
A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine
B. Indomethacin - avoid after 32/40 (risk of premature closure of DA, decreased renal function/oligohydramnios, NEC and IVH in the fetus)
Answer could also be clonidine as this is not a tocolytic
- Pringles procedure for life threatening liver haemorrhage includes clamping of:
A. Hepatic artery B. Hepatic vein C. Portal pedicle D. Aorta E. Splenic Artery
C. Portal pedicle
- 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
B. Decreased anaesthetic requirement
CEACCP 2012 - Illegal substances in anaesthetic and intensive care practices:
Cannabis - The conduct of anaesthesia is little different from that of tobacco smokers, except that in acute intoxication, the effects of agitation and sedation need to be addressed
CEACCP 2002 - Drug abusers and anaesthesia:
Cannabis - CNS effects are arcane and complex. Although the main effect of THC is to produce tranquility, relaxation and, in larger doses, sedation, it also produces some euphoria and sympathetic stimulation and most subjects have an elevated heart rate following recent intake. Hallucinations have been described after large doses. Cannabis is most commonly smoked in combination with tobacco, but may also be ingested for a less intense but more prolonged effect. Chronic bronchitis and other respiratory complaints are said to be more common in cannabis than tobacco smokers.
Anaesthetic considerations (of sedative drugs) - Recent administration of sedatives decreases MAC of inhaled anaesthetics and reduces the requirement for IV induction agents.
- MVA trauma patient arrives in ED BP100/60 HR 100 with the following CXR (‘’I thought it looked like an aortic dissection/rupture with a widened mediastinum’’). The most appropriate next investigation would be:
A. Aortography B. CT Chest C. MRI D. TOE E. TTE
D. TOE (in theatre)
If pt haemodynamically stable, CT angiogram of chest/great vessels would be appropriate.
- A 70 year old man with slow atrial fibrillation is reviewed for insertion of a permanent pacemaker. He is otherwise well. He is on warfarin with an INR of 2.2. Prior to PPM insertion do you
A. Cease warfarin and commence dabigatran
B. Cease warfarin and commence Enoxaparin
C. Cease warfarin and recommence post procedure
D. cease warfarin and commence heparin
E. Continue warfarin
C. Cease warfarin and recommence post-procedure.
- A 40 year old man with Marfan’s has undergone a thoracoabdominal aneurysm repair. 48 hours post procedure there is blood noted in his CSF drain and he is obtunded. Your next course of action is:
A. Coagulation studies B. CSF microscopy and culture C. CT Head D. MRI Head E. MRI Spine
B. CT head
- You are anaesthetising a fit 50 year old woman for an elective laparoscopic cholecystectomy. In her pre operative assessment she has a normal cardiovascular exam and her BP is 115/75. You induce anaesthesia with 100mcg fentanyl, 100mg propofol and 50 mg rocuronium. Soon after induction her ECG looks like this (showed narrow complex tachycardia around 180-200/min – ie SVT). Her BP is now 95/50. What is the most appropriate management?
A. adenosine B. amiodarone C. DC cardioversion D. GTN E. metaraminol
A. Adenosine
- The electrical requirement that distinguishes a “cardiac protected area” from a “body protected area” is the
A. isolation transformer B. line isolation monitor C. equipment has a maximum leakage current of 500 microamperes D. residual current device E. equipotentiality
E. Equipotentiality
- After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is
A. normal saline infusion B. bicarbonate infusion C. mannitol D. frusemide E. haemodialysis
E. Haemodialysis
Toxicology Handbook (2nd ed):
Risk stratification:
300 mg/kg - severe intoxication; metabolic acidosis, altered mental state, seizures
> 500 mg/kg - potentially lethal
Haemodialysis effectively removes salicylate but is rarely required if early decontamination (activated charcoal) and urinary alkalinisation (with bicarb) are implemented. Consider this intervention in the following circumstances:
- Urinary alkalinisation not feasible
- Serum salicylate levels rising to > 4.4 mmol/L despite decontamination and urinary alkalisation
- Severe toxicity as evidenced by altered mental status, academia or renal failure
- Very high serum salicylate levels (acute poisoning: > 7.2 mmol/L, chronic poisoning: > 4.4 mmol/L
- The threshold to dialyse is lower in the elderly
- Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture
A. L1-L2 B. L2-L3 C. L3-L4 D. L4-L5 E. L5-S1
C. L3-4
Draw an imaginary line between the top of the iliac crests. This intersects the spine at approximately the L3-4 interspace (mark this if necessary)
o The conus medullaris finishes near L3 at birth, but at L1-2 by adulthood
o Aim for the L3-4 or L4-5 interspace (Pete Howe reckons L3/4 is the answer)
- 6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is
A. 2 hours for breast milk B. 4 hours for formula C. 5 hours for breast milk or formula D. 6 hours for solids E. 8 hours for solids, 4 hours for all fluids.
B. 4 hours for formula
ANZCA guidelines (from PS 15 - Recommendations for the Perioperative Care of Patients Selected for Day Care Surgery):
- Children > 6 weeks: limited solid food and formula milk up to 6 hours, breast milk up to 4 hours, clear fluids up to 2 hours
- Infants
- For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is;
A. Number of boluses of PCA per hour B. Respiratory rate C. Oxygen saturation D. Sedation score E. Pupil size
D. Sedation score
- A reduction in DLCO can be caused by;
A. Asthma B. COPD C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis
B. COPD
Diffusing capacity (or DLCO) is the carbon monoxide uptake from a single inspiration in a standard time (usually 10 sec). Since air consists of very minute or trace quantities of CO, 10 seconds is considered to be the standard time for inhalation, then rapidly blow it out (exhale). The exhaled gas is tested to determine how much of the tracer gas was absorbed during the breath. This will pick up diffusion impairments, for instance in pulmonary fibrosis.[16] This must be corrected for anemia (because rapid CO diffusion is dependent on hemoglobin in RBC’s; a low hemoglobin concentration, anemia, will reduce DLCO) and pulmonary hemorrhage (excess RBC’s in the interstitium or alveoli can absorb CO and artificially increase the DLCO capacity). Atmospheric pressure and/or altitude will also affect measured DLCO, and so a correction factor is needed to adjust for standard pressure. Online calculators are available to correct for hemoglobin levels and altitude and/or pressure where the measurement was taken.
- You place a thoracic epidural for a patient having an elective open AAA repair. There are 4cm in the epidural space and you aspirate blood. What is the most appropriate management plan:
A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use
B. inject 5 mL lignocaine 2% with adrenaline. If there is no rise in HR be happy that it is not intravascular and secure in place and use
C. Remove and postpone surgery for 24 hours
D. Remove and place epidural 1 level higher
E. Remove and postpone surgery for 4 hours
D. Remove and place epidural 1 level higher
- You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use:
A. rocuronium B. suxamethonium C. pancuronium D. atracurium E. cisatracurium
E. Cisatracurium
Although if this is elective, surgery should be deferred until she has had proper work-up for her anaphylaxis
45 Patient with subdural haematoma, on warfarin. INR 4.5. Needs urgent craniotomy. Vit K given already by ED resident. What further do you give for urgent reversal of this patient’s INR?
A. Factor VII B. Cryoprecipitate C. FFP D. Prothrombinex E. FFP + prothrombinex
E. FFP (150-300 mL) + Prothrombinex (50 units/kg)
if Prothombinex unavailable, give FFP 15 mL/kg
46 Regarding endotracheal tubes used in laser surgery:
A. They are more resistant to combustion when the cuff is covered in blood
B. Resistant to ignition from electrocautery
C. The cuff is resistant to ignition if hit by the laser
D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diamater)
E. Have 2 cuffs which are resistant to combustion
D. Have an external diameter which is larger than a normal PVC endotracheal tube
49 Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion
A. ? B. C. D. E. Relieved by topical local anaesthetic
E. (Corneal abrasion is) relieved by topical LA.
50 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. Propylthiouracil D. Plasmapheresis E. Hydrocortisone
A. Carbimazole (takes too long to work)
Thyroid storm management (outpatient management):
Block hormone synthesis and release:
o Propylthiouracil 200mg orally 4-6/24 (blocks hormone formation and block conversion to T3 OR
o Carbimazole 20mg 8/24 AND
o Lugols iodine solution 0.5ml orally TDS to block hormone release AND
Decrease conversion of thyroxine (T4) to triiodothyronine (T3):
o Dexamethasone 4mg IV 12/24
Control tachycardia and rate dependent heart failure:
o Propanolol 40-80 mg orally 6/24 OR
o Esmolol 250-500 mcg/kg IV, as a loading dose, followed by 50-100mcg/kg/minute OR
o Metoprolol 5mg IV over 2-3mins, repeated if necessary at 5min intervals up to a total of 15mg
Restore hydration
Give sedation if needed
Oh’s manual:
Plasmapheresis can be used
53 Two days post upper spinal surgery, patient notices parathesia of the right arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from an ulnar nerve neuropathy?
A. parasthesia in little finger B. parasthesia in the distribution of the interscalene nerve C. weakness in adductor digiti minimi D. weakness in abductor pollicis brevis E. weakness in lateral interosseus
D. Weakness of abductor pollicis brevis
54 A 54 year old man, is on warfarin for atrial fibrillation, has a history of alcohol abuse and liver failure with an albumin of 30 and a bilirubin of 28. What is his CHADS 2 score?
A. 0 B. 1 C. 2 D. 3 E. 4
A. 0
