2015.1 Flashcards
Young man has removed his buprenorphine patch on the morning of surgery. What time till PLASMA reaches half original level
A. 12 hours
B. 18 hours
C. 24 hours
D. 30 hours
E. 36 hours
D. 30 hours
A 58yo with solitary hepatic metastasis from coloncancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain:
A. High CVP in anticipation of heavy blood loss
B. Decreased MAP to reduce arterial bleeding
C. Decreased CVP to reduce venous bleeding
D. Normal MAP in anticipation of heavy blood loss
E. Normal CVP to ensure adequate filling of the heart.
C. Decreased CVP to reduce venous bleeding
An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is:
A. Inferior gluteal
B. Obturator
C. Pudendal
D. Scaitic
E. Superior gluteal
B. Obturator
In Conn’s syndrome, the usual derangement is:
A. Hypoglycaemia, hypokalaemia and hypernatraemia
B. Hypoglycaemia, hyperkalaemia and hyponatraemia
C. Normoglycaemia, hypokalaemia and hypernatraemia
D. Normoglycaemia, hyperkalaemia and hyponatraemia
E. Hyperglycaemia, hyperkalaemia and hyponatraemia
C. Normoglycaemia, hypokalaemia and hypernatraemia
A 60 year old woman is admitted to hospital with subarachnoid haemorrhage. Her GCS is 11, and her blood pressure is 175/110mmHg. She is administered oral nimodipine. The main reason for this treatment is:
A. Control her blood pressure
B. Manage acute hydrocephalus
C. Prevent delayed cerebral ischaemia
D. Reduce the risk of rebleeding
E. Treat angiographically-proven cerebral vasospasm
C. Prevent delayed cerebral ischaemia
You are the anaesthetist at a Caesarean Section for a 36/40 gestation pregnancy. The baby at birth is floppy and apnoeic. You decide that positive pressure ventilation via mask is necessary. The recommended FiO2is:
A. 0.21
B. 0.4
C. 0.6
D. 0.8
E. 1.0
A. 0.21
You are inducing a 20-year-old female who has an IV cannula in her antecubital fossa which was inserted in the emergency department. She complains of pain after 10mL of propofol and it becomes clear that cannula is intra-arterial. The best management option is:
A. Intra-arterial injection of 5mL 1% lignocaine
B. Intra-arterial injection of 30mL Normal Saline
C. Intra-arterial injection of 50mg paperverine
D. Intra-arterial injection of 500u heparin
E. Observation
E. Observation
When is it necessary to use glycine as irrigation fluid for TURP?
A: For monopolar diathermy
B: For bipolar diathermy
C: For Nd:Yag laser
D: Greenlight laser
A. For monopolar diathermy
A 69 yo man is brought into ED by ambulance with a compound fracture of his forearm from an unwitnessed fall. Has a history of schizophrenia and depression with uncertain medication compliance. He is confused and agitated with generalised rigidity but no hyperreflexia. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8. Likely Dx?
A. Heat stress from anticholinergic therapy
B. Hypoxic ischaemic encephalopathy
C. Neuroleptic malignant syndrome
D. Serotonin syndrome
E. Pain from the compound fracture
C. Neuroleptic malignant syndrome
With surgical bleeding, the first clotting factor to reach a critical level is
A. I
B. II
C. VII
D. X
E. XIII
A. I (fibrinogen)
Anaesthetic and respirable gas supplies to wall outlets in the operating theatre is at pressures of
A. 200kPa
B. 400kPa
C. 500kPa
D. 750kPa
E. 1200kPa
B. 400 kPa
The most useful sign to distinguish between severe serotonin syndrome and malignant hyperthermia is
A. Clonus
B. Hyperthermia
C. Metabolic acidosis
D. Muscle rigidity
E. Wheeze
C. Metabolic acidosis
Patient having a laparotomy. On prednisolone for 6/12, 10mg/day. What is the equivalent dose of dexamethasone?
A) 2mg
B) 4mg
C) 6mg
D) 8mg
E) 10mg
A. 2 mg
Axillary arm block U/S presented. Nerves marked with numbers 1-4 but not otherwise identified.
Patient having an operation of a lacerated index finger under regional anaesthesia. Which combination will provide adequate cover?
A) 1 and 2 (radial and median)
B) 1 and 3 (radial and ulnar)
C) 2 and 3 (median and ulnar)
D) 2 and 4 (median and musculocutaneous)
E) 3 and 4 (ulnar and musculocutaneous)
A. Radial and median
Child 20kg having a caudal. Has a VF arrest post, non-responsive to usual treatments. What dose of intralipid 20% would you give?
A) 10mL
B) 20mL
C) 30mL
D) 40mL
E) 50mL
C. 30 mL (1.5 mL/kg)
Labour epidural placed. Headache postpartum. Which ofthe following is inconsistent with post partum dural puncture headache.
(a) Headache located frontal only
(b) Presents > 24 hrs post partum
(c) presents immediately post partum
(d) associated with auditory symptoms
(e) associated with neck stiffness
C. Presents immediately postpartum
Eclamptic patient. Given Magnesium intravenously. Which of these symptoms is often associated with magnesium administration?
(a) Bradyarrhythmia
(b) Cardiac arrest
(c) Hypotension
(d) Depressed respiratory effort
C. Hypotension
The clinical sign that a lay person should use to decide whether to start CPR is:
(a) absence of breathing
(b) loss of central pulse
(c) loss of peripheral pulse
(d) loss of consciousness
(e) obvious airway obstruction
A. Absence of breathing
What is the maintenance fluid rate for a 15kg child?
a) 50ml/hr
A. 50 mL/h ( [4 x 10] + [2 x 5])
Patient’s K+ is 7.0 what is the best initial management?
a) give Ca
b) give insulin/ dextrose
A. Give calcium to stabilise the myocardium
Which patients require antibiotic prophylaxis?
a) Previous Mitral valve ring annuloplasty
b) Previous patch repair of vsd
Probably A best answer.
Antibiotic prophylaxis is still recommended (in certain situations) in high-risk patients, such as:
- Prosthetic cardiac valve (or valve repaired with prosthetic material)
- Previous IE
- Congenital heart defect, but only if it involves:
o Unrepaired cyanotic defects (including palliative shunts and conduits)
o Completely repaired defects with prosthetic material or devices during the first 6/12 after the procedure (after which the prosthetic material is likely to have been endothelialised)
o Repaired defects w/ residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation)
- RHD in high risk groups (Aboriginal, or non-Indigenous from low socioeconomic background)
- (Consider for post-cardiac transplant pts)
A 63 yo lady has a difficult thyroidectomy for cancer. Immediately post extubation she develops stridor and respiratory distress. The most likely cause is
A) Hypocalcaemia
B) recurrent laryngeal nerve palsies
c) tracheomalacia
d) Neck oedema and haematoma
e) Vocal cord oedema
Tracheomalacia best answer? (given the stridor occurs immediately after extubation)
Tracheomalacia is rare but is more common with malignant processes
Most common cause of delayed stridor would be neck oedema/haematoma
A 23 yo has a traumatic brain injury. Which fluid isrelatively contraindicated?
a) Albumin
b) Normal saline
c) CSL
d) Colloid
e) Something else
A. Albumin (SAFE study)
CSL also relatively contraindicated due to low sodium content.
50 something yr old smoker presents for laparotomy. RFTs given, what is the cause? FEV1, FVC both reduced, FEV1/FVC 98%. TLC, RV, DLCO 8 (pred = 30)
(a) PE
(b) Obesity
(c) Bilateral phrenic nerve palsies
(d) Pulmonary fibrosis
(e) COPD
D. Pulmonary fibrosis