2015.1

Question 1

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

Answer 1

D. 30 hours

Question 2

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.

Answer 2

C. Decreased CVP to reduce venous bleeding

Question 3

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

Answer 3

B. Obturator

Question 4

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

Answer 4

C. Normoglycaemia, hypokalaemia and hypernatraemia

Question 5

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

Answer 5

C. Prevent delayed cerebral ischaemia

Question 6

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

Answer 6

A. 0.21

Question 7

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

Answer 7

E. Observation

Question 8

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

Answer 8

A. For monopolar diathermy

Question 9

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

Answer 9

C. Neuroleptic malignant syndrome

Question 10

With surgical bleeding, the first clotting factor to reach a critical level is

A. I

B. II

C. VII

D. X

E. XIII

Answer 10

A. I (fibrinogen)

Question 11

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

Answer 11

B. 400 kPa

Question 12

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

Answer 12

C. Metabolic acidosis

Question 13

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

Answer 13

A. 2 mg

Question 14

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)

Answer 14

A. Radial and median

Question 15

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

Answer 15

C. 30 mL (1.5 mL/kg)

Question 16

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

Answer 16

C. Presents immediately postpartum

Question 17

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

Answer 17

C. Hypotension

Question 18

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

Answer 18

A. Absence of breathing

Question 19

What is the maintenance fluid rate for a 15kg child?

a) 50ml/hr

Answer 19

A. 50 mL/h ( [4 x 10] + [2 x 5])

Question 20

Patient’s K+ is 7.0 what is the best initial management?

a) give Ca
b) give insulin/ dextrose

Answer 20

A. Give calcium to stabilise the myocardium

Question 21

Which patients require antibiotic prophylaxis?

a) Previous Mitral valve ring annuloplasty
b) Previous patch repair of vsd

Answer 21

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)

Question 22

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

Answer 22

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

Question 23

A 23 yo has a traumatic brain injury. Which fluid isrelatively contraindicated?

a) Albumin
b) Normal saline
c) CSL
d) Colloid
e) Something else

Answer 23

A. Albumin (SAFE study)

CSL also relatively contraindicated due to low sodium content.

Question 24

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

Answer 24

D. Pulmonary fibrosis

Question 25

Traumatic brain injury patient. Cerebral angiogram shows Cerebral perfusion = 15mL/100g/min, cerebral oxygen consumption 3.5mL/100g/min. This is consistent with:

(a) Cerebral hyperperfusion
(b) Reperfusion injury
(c) Cerebral ischaemia
(d) Appropriate autoregulation
(e) Cereberal vasoconstriction

Answer 25

E. Cerebral vasoconstriction (Ganong: normal CBF 54 mL/100 g/min, normal CMRO2 3.3 mL/100g/min).

There is not enough information in the stem to infer ischaemia (need to know DO2, not just CBF), although this situation probably represents brain ischaemia (assuming Hb concentration of 15 g/dL and PaO2 100 –> O2 content = 20.4 mL/100 mL = 3.06 mL/15 mL)

Question 26

Absolute contraindication to ECT:

A. Cochlear implants

B. Epilepsy

C. Pregnancy

D. Raised intracranial pressure

E. Recent myocardial infarction

Answer 26

E. Recent myocardial infarction (and phaechromocytoma - only absolute, raised ICP - relative)

Question 27

FFP is given to a patient to treathypofibrinogenaemia. The volume required to raise the fibrinogen by 1g/L is

A 1mL/kg

B 5mL/kg

C 10mL/kg

D 20mL/kg

E 30mL/kg

Answer 27

E. 30 mL/kg

Question 28

The diluted thrombin time measures the anticoagulant activity of

A apixaban

B rivaroxaban

C dabigatran

D warfarin

E heparin

Answer 28

C. Dabigatran

Question 29

In a trauma patient the main mechanism by which hypothermia exacerbates bleeding is by

A altered blood viscosity

B causing DIC

C inhibition of clotting factors

D potentiation of anticoagulant effect of drugs used to treat DVT

E decreases platelet number and function

Answer 29

C. Inhibition of clotting factors

Question 30

A patient having a liver resection suffers a haemodynamically significant venous air embolism. During resuscitation how do you best position the patient?

A head up, right side down

B head up, left side down

C head up, no lateral tilt

D head down, right side down

E head down, left side down

Answer 30

E. Head down, left side down

to relieve RVOT obstruction

Question 31

In a normal adult what amount of IV potassium chlorideis needed to raise the serum potassium from 2.8 to 3.8mmol/L?

A 10mmol/L

B 20mmol/L

C 50mmol/L

D 100mmol/L

E 200mmol/L

Answer 31

??? these answers are concentrations, not amounts

Question 32

In a haemodynamically stable 20 year old man with blunt chest trauma, the best screening test to diagnose cardiac injury requiring treatment is:

A CXR

B serum CK-MB

C serum troponin

D 12 lead ECG

E Transthoracic Echocardiogram

Answer 32

D. 12-lead ECG

Question 33

With regards to medical ethics, the concept of fidelity involves:

A equitable distribution of resources

B following a professional code of conduct

C promoting well being

D wise use of resources

E witholding of futile treatments

Answer 33

B. Following a professional code of conduct

Question 34

What is the correct position for the tip of a PICC in a child

a) Carina
b) Below right tracheobronchial angle
c) Above right heart border
d) Sternoclavicular junction

Answer 34

B. Below right tracheobronchial angle

RCH website:

The most reliable anatomical landmark for the lower SVC in children is one vertebral body below the carina (consensus from RCH Interventional Radiology Department and available paediatric literature)

Less reliable landmarks of lower SVC include where the right superior cardiac shadow meets the mediastinal edge (the drawback is that this is obscured by the thymus in young children) and the T6 thoracic vertebrae (count down from the T1 Vertebrae which is joined by first rib)

Question 35

Image of a lateral C-spine Xray. Asked what the diagnosis was.

Seemed to have anterior atlantodental interval >9mm.

a) Atlantoaxial instability
b) Retropharyngeal haematoma (?or abscess)
c) Tear drop fracture
d) Epiglottitis
e) unilateral facet joint dislocation

Answer 35

A. Atlantoaxial instability

Question 36

According to the ANZCA endorsed guidelines, what is the correct colour for the label for a subcutaneous ketamine infusion

a) Pink
b) Red
c) Beige
d) Blue
e) Yellow

Answer 36

C. Beige

Question 37

Prior to nasal intubation you spray Lignocaine/Phenylephrine preparation (CoPhenylcaine) into the nose. Some lands in the eye. What happens?

a) Ecchymosis
b) Myosis
c) Midriasis
d) Proptosis
e) Nystagmus

Answer 37

C. Midriasis

Question 38

You trial a new drug to prevent PONV. It is 50% more effective than the current drug. Four percent of people still experience PONV with the new drug. How many people need to receive the new drug in place of the current drug to have one person less suffering from PONV?

a) 2
b) 8
c) 15
d) 25
e) 33

Answer 38

D. 25 (NNT = 1/ARR)

Question 39

What does a white cylinder with a Grey coloured shoulders/neck contain?

a) Medical air
b) Carbon Dioxide
c) Helium
d) Oxygen
e) Argon

Answer 39

B. CO2

Question 40

The best solution to ensure asepsis prior to neuraxial anaesthesia is

A. 0.5% Chlorhexidine

B. 0.5% Chlorhexidine with 70% alcohol

C. 5% Povidine Iodine

D. 5% Povidine Iodine with 70% alcohol

E. 10% Povidine Iodine

Answer 40

B. 0.5% chlorhexidine with 70% alcohol

Question 41

You are anaesthetising a 25 year male for an open appendicectomy. He has a Fontans circulation on a background of tricuspid atresia. The best strategy to manage his ventilation intraoperatively would be:

A. Ensure adequate PEEP

B. Decrease Inspiratory time

C. Shorten I:E Ratio from 1:3 to 1:1.2

D. Increase Inspiratory time but with reduced inspiratory pressures

E. Ensure adequate spontaneous ventilation

Answer 41

B. Decrease inspiratory time (to minimise RV afterload)

CEACCP 2008:

• For relatively short procedures, Fontan patients are probably better off breathing spontaneously, as long as severe hypercarbia is avoided.
• For major surgery, or when prolonged anaesthesia is required, control of ventilation and active prevention of atelectasis is usually advisable.
• Potential disadvantages of mechanical ventilation in Fontan patients relate to the inevitable increase in mean intrathoracic pressure. This causes decreased venous return, decreased pulmonary blood flow, and hence, decreased cardiac output.
• Low respiratory rates, short inspiratory times, low PEEP, and tidal volumes of 5-6 mL/kg usually allow adequate pulmonary blood flow, normocarbia, and a low PVR.
• Hyperventilation tends to impair pulmonary blood flow, despite the induced respiratory alkalosis, because of the increased mean intrathoracic pressure.

Question 42

You are anaesthetising a 70 year old woman for CABG with a pulmonary artery catheter in situ. After separation from bypass you notice frank, copious blood rising in the endotracheal tube. Your immediate action should be to:

A. Check ACT

B. Insert a double lumen tube

C. Reinstate bypass

D. Administer protamine

E. Pull back the pulmonary arterycatheter several centimetres

Answer 42

B. Insert a DLT

Miller:

• Position pt with bleeding lung dependent
• Perform endotracheal intubation, oxygenation, airway toilet
• Isolate lung by endobronchial DLT or SLT or bronchial blocker
• Withdraw PAC several centimetres, leaving it in the main PA. Do not inflate the balloon (except with fluoroscopic guidance)
• Position pt with isolated bleeding lung nondependent. Administer PEEP to the bleeding lung if possible
• Transport the patient to medical imaging for diagnosis and embolisation if feasible

Question 43

Penetrating injury to chest. What part of the heart most likely injured?

A. RV

B. LV

C. RCA

D. LA

E. RA

Answer 43

A. RV

Question 44

General anaesthesia is preferred for endoluminal AAA stenting because:

A. Ischaemic renal pain

B. Prolonged periods of apnoea required

C. Painful aorta

D. Major risk of haemorrhage

E. Trash foot pain

Answer 44

D. Major risk of haemorrhage

Question 45

Which volatile agent has got minimum effect on ICP at 1 MAC

a) isoflurane
b) sevoflurane
c) desflurane
d) enflurane
e) halothane

Answer 45

Iso, sevo and des have minimal effect

Question 46

You are inserting a right internal jugular vein CVC. Why is it important to avoid turning the patient’s head extremely to the left?

a) Uncomfortable for the patient
b) Increases risk of internal carotid artery puncture
c) Compresses internal jugular vein and makes it more difficult to puncture
d) Distorts the anatomy, making the vein more difficult to correctly identify
e) Increases risk of external jugular vein puncture

Answer 46

D. Distorts anatomy, making vein more difficult to correctly identify.

Anaesthesia UK - TOTW: Central venous cannulation (2009)

The patient is supine, arms by their sides with a head down tilt to distend the veins and reduce the risk of air embolism. The head should be slightly turned away from the side of cannulation for better access (excessive turning should be avoided as it changes the relationship of the vein and artery and can collapse the vein). The patients neck can be extended by removing the pillow and putting a small towel under the shoulders.

Question 47

Patient two hours after bilateral crush injuries to lower limbs. What would you expect to see?

a) Hypocalcaemia
b) Hypokalaemia
c) Hypophosphataemia
d) Hypouricaemia
e) Metabolic alkalosis

Answer 47

A. Hypocalcaemia

Wiki - crush syndrome:

‘…These systemic effects are caused by a traumatic rhabdomyolysis. As muscle cells die, they absorb sodium, water and calcium; the rhabdomyolysis releases potassium, myoglobin, phosphate, thromboplastin, creatine and creatine kinase…
…The clinician must protect the patient against hypotension, renal failure, acidosis, hyperkalemia and hypocalcemia.’j

ACEP - crush injury and crush syndrome:

‘Crush syndrome can cause local tissue injury, organ dysfunction, and metabolic abnormalities, including acidosis, hyperkalemia, and hypocalcemia.’

Question 48

Delivery of neonate. Meconium liqour. Baby floppy, blue, apnoeic, pulse rate 90bpm. What is the next step in managment?

a) Commence PPV
b) Suction the trachea
c) Commence CPR
d) Dry and stimulate

Answer 48

B. Suction trachea (intubate trachea immediately and suction down ETT, then remove ETT; only do this once and only if neonate is apnoeic - if it’s making spontaneous respiratory efforts, better to assist ventilation with PPV).

Question 49

You inject 10ml ropivicaine into a T5 paravertebral block. Patient becomes bradycardic, hypotensive and apnoeic. What is the cause.

A. Contralateral spread

B. Intrathecal spread

C. Inadvertent intravascular injection

D. Local anaesthetic toxicity

Answer 49

B. Intrathecal spread

Question 50

Medical therapy vs TAVI in inoperable patients. At 30 days, decreased risk of:

A

B Myocardial infact

C Death

D Stroke

E Atrial fibrillation

Answer 50

D. Decreased risk of stroke with medical therapy

TAVI (vs medical therapy):

Death – reduced but not statistically significant (not at 30 days)

Stroke – TAVI increased risk, also increased risk vascular complications

Atrial fibrillation – reduced but not statistically significant

Question 51

Glycine used during urology case. Osm is:

A.

B. 200

C. 250

D. 300

Answer 51

B. 200 (220 mosmol/kg: CEACCP Anaesthesia for TURP)

Question 52

Volatile analysis in most anaesthetic machines is done via which method?

A Gas chromatography

B Infrared analyser

C Raman spectometry

Answer 52

B. Infrared analyser

Question 53

What is not a constituent of Prothrombinex VF?

A. Antithrombin III

B. Factor II

C. Factor X

D. Protein C

E. Heparin

Answer 53

D. Protein C

Question 54

50yo lady for elective laparoscopic cholecystectomy seen in preadmission clinic. No symptoms of heart disease, walks her dog for 30 minutes each day. ECG [no image — described in words] shows LAD, RSR in V1, wide slurred S in V6 and QRS duration 0.13 msec. Your options:

A. Give atropine premedication

B. She needs a permanent pacemaker

C. She needs temporary pacing wires

D. Continue with the case

E. Refer to cardiology OP prior todoing the case

Answer 54

D. Crack on

Question 55

You are performing epidural anaesthesia on an adult patient. To minimize the chance of inserting the epidural catheter into a blood vessel you would:

A. Inject saline through the epidural needle prior to threading the catheter

B. Perform the proceedure with the patient lateral rather than sitting

C. Use a loss of resistance to air technique instead of loss of resistance to saline.

Answer 55

A. (injecting 5 mL saline) and B. (performing the procedure lateral) both reduce the risk of intravascular catheter placement.

? B. better answer - venous pressure would be significantly reduced in the lateral position and so veins less dilated.

Question 56

Failed intubation. Difficult ventilation. Rescued with a Classic LMA. Decide to use a bronchoscope to intubate down the LMA. Which device will allow you to intubate the patient safety?

A. Aintree catheter

B. Airway exchange catheter

C. Gumelastic bougie

D. Some angiogram wire I’ve neverheard of!

E. Two paediatric endotracheal tubes side-by-side

Answer 56

A. Aintree catheter

Question 57

Blalock-Taussig shunt inserts into the right pulmonary artery, originating from the:

a) Right subclavian artery
b) IVC
c) SVC
d) Aorta
e) Axillary artery

Answer 57

A. Right subclavian artery

Wiki:

The Blalock–Thomas–Taussig shunt (commonly called the Blalock–Taussig shunt) is a surgical procedure used to increase pulmonary blood flow for palliation in duct dependent cyanotic heart defects like pulmonary atresia, which are common causes of blue baby syndrome. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or palliative surgery.

One branch of the subclavian artery or carotid artery is separated and connected with the pulmonary artery. The lung receives more blood with low oxygenation from the body. The first area of application was tetralogy of Fallot.

The Blalock–Taussig shunt may be used as the first step in the Fontan procedure.

Question 58

Time taken for insulin to reduce K+ in hyperkalaemia

A. 2 mins

B. 4 mins

C. 10 mins

D. 20 mins

E. 30 mins

Answer 58

C. 10 mins

Question 59

Increased risk with eye block:

A: Peribulbar done medial canthus

B: Peribulbar done inferior-temporal

C: Sub-tenons

D:

Answer 59

A. Peribulbar done medial cants

Question 60

2/12 old baby. Initially on 30th centile and now on 5th. Murmur, systolic, loud at apex. Pulses are weak, “most easily felt atthe femoral”.

A: VSD

B: Co-arctation

C: Venous hum

D: PDA

Answer 60

A. VSD

Question 61

Some diathermy pads have two separate electrodes onthe patient pad, each with its own cable back to the machine. Why?

A: In case one fails the other can serve as a back-up

B: One for coag and one for cutting

C: For bipolar? - worded slightly differently

D: For capacitance measurement - again wording not right

E: For return electrode monitoring

Answer 61

E. For return electrode monitoring

Question 62

Cisatracurium left out of fridge for 4 days. Its efficacy is now:

A. 60%

B. 70%

C. 90%

D. 50%

E. 99%

Answer 62

E. 99%

Question 63

In which type of von willebrand’s disease is DDAVP contraindicated?

A. Type 1

B. Type 2a

C. Type 2b

D. Type 3

E. None of the above

Answer 63

D. Type 3

(From US National Heart, Lung and Blood Institute website)

Type 2B VWD previously was a contraindication to DDAVP therapy because platelet counts usually fell after DDAVP stimulation.257 However, thrombocytopenia after DDAVP in type 2B VWD is usually transient and often is not associated with bleeding or thrombosis.258 In patients who have type 2B VWD, decrease in platelet count after DDAVP administration has been considered “pseudothrombocytopenia” by some authors because it is related to platelet agglutination in vitro rather than in vivo agglutination and clearance.63,239 Therefore, DDAVP may be cautiously considered for patients who have type 2B VWD. Patients who have type 3 VWD almost never experience a clinically relevant rise in VWF:RCo or FVIII activities, and DDAVP is not considered clinically useful in these patients.224,230

Question 64

This ECG with AAI pacing shows:
(The 12-lead ECG showed pacing spikes followed by p-waves, with QRS’s following the p-waves with progressive prolongation of the PR until a QRS was dropped. In other word, second degree heart block (type 1, although the type was not required to answer the question). The ECG looked very much like “Example 8” from lifeinthefastlane. I think it was lifted from this website.

A. Failure to capture

B. CHB

C. 2nd degree

Answer 64

C. 2nd degree heart block

Question 65

The NAP4 audit showed that the most common cause of airway problems/complications/disasters in INTENSIVE CARE is:

A. Aspiration

B. Dislodged tracheostomy tube

Answer 65

B. Dislodged tracheostomy tube

Question 66

The target serum magnesium level in a patient with pre-eclampsia receiving a magnesium infusion is

A. 1-2 mmol/l

B. 2-3.5 mmol/l

C. 3-6 mmol/l

D. 4-6 mmol/l

E. 5-8 mmol/l

Answer 66

B. 2-3.5 mmol/L

Question 67

Timing of peak respiratory depression after intrathecal 300 mcg morphine:

A. 18 hours

Answer 67

B. 3.5-7.5 h

Peak at 6 hours - CEACCP: intrathecal opioids in the management of acute postoperative pain, 2008

Question 68

What part of a modern anaesthesia machine allows jet ventilation to be performed using the oxygen flush button?

A. Non-return valve downstream of the vaporisers

B. Pressure-limiting valve at the outlet

C. The presence of a common gas outlet

D. Presence of auxillary oxygen flowmeter

Answer 68

A. Non-return valve downstream of the vaporisers.

Barash - Clinical Anaesthesia:

The oxygen flush valve can provide a high-pressure oxygen source suitable for jet ventilation under the following circumstances:
(1) the anesthesia machine is equipped with a one-way check valve positioned between the vaporisers and the oxygen flush valve, and (2) when a positive pressure relief valve exists downstream of the vaporisers, this pressure relief valve must be upstream of the outlet check valve.

Question 69

Red-man syndrome secondary to vancomycin is due to

A Type II hypersensitivity reaction

B Vasodilation

C Mast cell degranulation

D IgE immediated response

E Serotonin release

Answer 69

C. Mast cell degranulation (causing histamine-mediated vasodilation)

Question 70

Patient with IgA deficiency. What is the main issue in anaesthesia?

A. Anaphylaxis to blood products

B. Renal impairment

C.

D. Sensitivity to opioids

E. Sensitivity to muscle relaxants

Answer 70

A. Anaphylaxis to blood products

(from transfusion.com.au)

Anaphylactic transfusion reactions can occur when IgE antibody in the patient interacts with an allergen, usually a plasma protein in the blood component.

The following mechanisms have been implicated in anaphylactic reactions:

• IgA-deficient patients who have anti-IgA antibodies
• Patient antibodies to plasma proteins (such as IgG, albumin, haptoglobin, transferrin, C3, C4 or cytokines)
• Transfusing an allergen to a sensitised patient (for example, penicillin or nuts consumed by a donor)
• Rarely the transfusion of IgE antibodies from a donor to an allergen present in the recipient.

Question 71

Cryo “should be used within” or “must be used within” or “is most effective if used within” (can’t recall exactly):

A 30 minutes

B 3 hours

C 6 hours

Answer 71

C. 6 hours

(from Australian Red Cross Blood Service fact sheet)

• From storage temperature of -25C or below, cryoprecipitate is thawed.
• It should be maintained at 20-24C until transfusion and should be used within 4-6 hours

Question 72

Designing a study on PONV. What is the advantage of incorporating multivariate analysis?

A Less type 1 error

B Less complex

C Less difficult to interpret

D Less confounding

E Fewer patients required

Answer 72

D. Less confounding

Question 73

Bleeding intraopratively. TEG shows hyperfibrinolysis. What should be used to treat?

A TXA

B Platelets

C Cryo

D FFP

Answer 73

A. TXA

Question 74

A size C oxygen cylinder (in New Zealand, “A”) that reads 5000kpa contains approximately how many litres of oxygen

a. 100
b. 150
c. 200
d. 350
e. 600

Answer 74

C. 200 (best answer)

Size C cylinders when full contain 490 L O2 at a pressure of 13,700 kPa.

If the pressure is 5000 kPa, the volume of O2 is 490 x (5000/13700) = 179 L.

Question 75

4-chamber TTE view. What lesion is present? Image showed mitral regurg.

A. mitral regurgitation

Answer 75

A. mitral regurgitation

Question 76

Appropriate infection control measures when anaesthetising a patient with iatrogenic variant-CJD, the airway equipment should be: 


a. thrown away
b. plastic sheath, reuse
c. sterilization with ethylene oxide

d. sterilization with heat at 134 degrees for 3 minutes.
e. autoclave

Answer 76

A. thrown away

Question 77

A variant on the theme of the previous question referring to PS9. Minimum requirements to provide sedation. This time asked what staffing is required when providing conscious sedation, using propofol.

A. medical practitioner trained in use of propofol

B. medical practitioner trained in use of propofol + their assistant

Answer 77

Need a medical practitioner or dentist trained in the use of Propofol and a proceduralist and assistant shared between the two.

N.B. dentists are only allowed to perform conscious sedation, not deeper sedation. Conscious sedation can be achieved with propofol, although there is an obvious risk that it may progress to deeper sedation.

Conscious sedation is defined as a drug-induced depression of consciousness during which patients are able to respond purposefully to verbal commands or light tactile stimulation. Interventions to maintain a patent airway, spontaneous ventilation or cardiovascular function may, in exceptional situations, be required. Conscious sedation may be achieved by a wide variety of drugs including propofol, and may accompany local anaesthesia. All conscious sedation techniques should provide a margin of safety that is wide enough to render loss of consciousness unlikely.

Deeper sedation is characterised by depression of consciousness that can readily progress to the point where consciousness is lost and patients respond only to painful stimulation. It is associated with loss of the ability to maintain a patent airway, inadequate spontaneous ventilation and/or impaired cardiovascular function, and has similar risks to general anaesthesia, requiring an equivalent level of care.

A medical or dental practitioner who is skilled in airway management and cardiopulmonary resuscitation, relevant to the patient’s age and condition, must be present whenever procedural sedation and/or analgesia are administered.

Techniques intended to produce deeper sedation or general anaesthesia must not be used unless an anaesthetist, or other trained and credentialed medical practitioner within his/her scope of practice, is present.

Question 78

Intubation view: Little space between epiglottis and posterior pharyngeal wall. What is the modified C&L classification?

A 2A

B 2B

C 3A

D 3B

E 4

Answer 78

C. 3A

(3B - epiglottis adherent to posterior pharyngeal wall - ‘unbougiable’

Question 79

What feature most increases vasospasm in setting of SAH?

A. Size of aneurysm

B. Age of patient

C. Position of Aneurysm

D. large amount of blood on CT

E. GCS on arrival to ED

Answer 79

D. large amount of blood on CT

CEACCP - acute management of aneurysmal SAH (2012):

Patients with poor grade SAH, large subarachnoid blood load, intraventricular haemorrhage, and smokers are particularly at risk for the development of vasospasm.

Question 80

Line isolation monitor alarming at 5ma – what do to?

A. Disconnect non essential equipment 1 by 1 to identify fault

B. Ignore it

Answer 80

A. Disconnect non-essential equipment 1 by 1 to identify fault.

(Sydney Uni website):

Isolating Transformers and Line Isolation Monitors.

These are the more expensive alternative to RCD’s and are widely used in operating theatres because they do not disconnect the power when a fault is detected, yet provide safety should such a fault exist.

The first component is a large transformer (the Isolating Transformer) mounted in the wall cavity which converts the earth-referenced mains supply to a “floating” supply. The floating supply provides 240V between two active wires, but because the supply is not earth-referenced, the presence of an earth circuit through the patient or anyone else is perfectly safe and no current will flow. All the circuit to earth does is to reference the floating supply to earth; no current actually flows through the earth connection.

The Line Isolation Monitor continually checks that the floating supply is not earth-referenced, and indicates on a dial how much current could flow to earth if there was an earth connection. If the potential earth current would be more than 5mA an alarm will sound, alerting the anaesthetist to the presence of a loss of the “floating” nature of the supply. It does this by intermittently connecting one of the two active wires to ground through a very large resistance. If the other wire is connected to ground a circuit will be formed and current will flow, and this indicates how much current would flow through the circuit if either of the two active wires are connected to ground.

As with an RCD the device will not alarm under 5mA, so microshock may still occur unnoticed, however macroshock is very unlikely; only current flowing through the patient from between the active wires will no be detected.

(RCH - electrical safety):

Line Isolation overload Monitors (LIMs)
In critical life support applications where loss of power supply cannot be tolerated, special power outlets powered by isolation transformers are installed.

Line Isolation Monitors are installed to continually monitor electrical leakage in the power supply system. If an electrical fault develops in a medical device connected to an isolated power outlet, the LIM will detect the leakage current. The LIM will alarm and indicate the level of leakage current, but will not shut off the electric supply.

The faulty equipment can be identified by un plugging one item of equipment at a time from the supply until the alarm stops sounding. Equipment that is not faulty may be reconnected. Faulty equipment should be appropriately labelled and sent to Biomedical Engineering for repair.

The LIM also monitors how much power is being used by the equpiment connected to it. If too much power is being used, the LIM will alarm and indicate that there is an overload. The power used must be reduced immediately by moving some equipment to another circuit as soon as possible until the alarm stops sounding. Failure to reduce the load on the LIM will result in the circuit breaker tripping and loss of power to the circuit.

Question 81

Maintenance fluid rate in 15kg child – mls/hr

A. 40mls/hr

B. 50mls/hr

C. 90mls/hr

D. 300mls/hr

Answer 81

B. 50 mL/h

Question 82

“Hypothermia makes bleeding in trauma worse because…”

A. Reduced platelet function AND number

B. Reduced activity of clotting factors

Answer 82

B. Reduced activity of clotting factors

Question 83

Most effective (?quickest) way to reduce serum K+ level in hyperkalaemia 8.0 meq/L?

A. Calcium gluconate

B. Resonium

C. Salbutamol NEB

D. 15 units actrapid and 50 mls of 50% Dextrose

E. Sodium bicarbonate ?50mmol

Answer 83

D. 15 units Actrapid and 50 mL 50% dextrose

Question 84

ECG rhythm strip. Showed regular pacing spike followed by wide QRS complexes. But once there is a narrow QRS occurring without apacing spike, followed shortly-after by a pacing spike but no capture. Can’t find anything matching it on Google. What does ECG show?

A. AAI with failure to capture

B. AAI with failure to sense

C

D. VVI with failure to capture

E. VVI with failure to sense

Answer 84

E. VVI with failure to sense

Question 85

Relative contraindications to mediastinoscopy include

A. Cervical spondylosis

B. Emphysema

C. Mediastinal lymphadenopathy

D. Poor left ventricular function

E. Superior vena cava syndrome

Answer 85

E. SVC syndrome (or A. cervical spondylosis)

CEACCP - Anaesthesia for mediastinoscopy (2007)

Previous mediastinoscopy is a relatively strong contraindication to a repeat procedure because scar tissue eliminates the plane of dissection. Superior vena cava (SVC) syndrome increases the risk of bleeding from distended veins and is a relative contraindication. Other relative contraindications include severe tracheal deviation, cerebrovascular disease, severe cervical spine disease with limited neck extension, previous chest radiotherapy, and thoracic aortic aneurysm.

Question 86

How should you dose suxamethonium for intubation in an obese patient?

a) Lean body weight
b) Ideal body weight
c) Ideal body weight + 25%
d) Actual body weight
e) Actual body weight + 25%

Answer 86

D. Actual body weight

Question 87

Time to onset of TRALI with transfusion?

a) 2 hours
b) 4 hours
c) 12 hours
d) 24 hours
e) 48 hours

Answer 87

B. 4 hours

(transfusion.com.au)

This is an acute (

Question 88

When performing regional anaesthesia for eye surgery, needle damage to the globe of the eye is more common with:

A. a globe axial length of less than 25 mm

B. patients aged less than 45 years

C. peribulbar block using the inferotemporal approach

D. peribulbar block using the medial canthus approach

E. sub-Tenon block

Answer 88

D. Peribulbar block using the medial cants approach

Question 89

Best method to assess reversal of neuromuscular blockade?

A. Sustained head lift 5 sec

B. Sustained leg lift 5 sec

C. TOF 0.9 with accelerometer

D. DBS no fade

E. Tetanus 50Hz

F. Tidal volumes…

Answer 89

C. TOF 0.9 with accelerometer

Question 90

The Neonatal Facial Coding Scale (NFCS), used to assess pain in neonates, includes all of the following EXCEPT

A. brow bulge

B. chin quiver

C. closed mouth

D. deep nasolabial fold

E. eyes squeezed shut

Answer 90

C. closed mouth

Question 91

What is the best measure of the anticoagulant effect of Dabigatran?

A. APTT

B. Dilute thrombin time

C. Prothrombin time

D. Bleeding time

E. TEG

Answer 91

B. Dilute thrombin time

Question 92

Small air bubbles in the arterial line system will ALWAYS REDUCE the

A. Dampening coefficient

B. Extrinsic Coefficient

C. Measured systolic pressure

D. Measured MAP

E. Resonant frequency

Answer 92

E. Resonant frequency

also reduces measured systolic pressure, due to damping

Question 93

A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in:

a. Reverse trendelenburg, right side up
b. Reverse trendelenburg left side up
c. Reverse trendelenburg, neutral
d. Trendelenburg right side up
e. Trendeleburg left side up

Answer 93

D. Trendelenburg, right side up

Question 94

During interscalene block placement get medial movement of the scapula. This is secondary to stimulation of:

A: long thoracic nerve

B: dorsal scapular nerve

C: suprascapular nerve

D: supraclavicular nerve

E: accessory nerve

Answer 94

B. Dorsal scapular nerve

Question 95

Blue urticaria is a complication of

A

B Methylene blue

C Patent blue V

D Anaphylaxis

Answer 95

C. Patent blue V

Question 96

Subtenon’s block. What is the BEST position to insert block?

A. Inferonasal

B. Inferotemporal

C. Superonasal

D. Superotemporal

E. Medial / canthal

Answer 96

A. Inferonasal

Question 97

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

Answer 97

C. L3-4

(nysora.com)

The spinal cord terminates at a much more caudad level in neonates and in infants compared to adults. The conus medullaris ends at approximately L1 in adults and at the L2 or L3 level in neonates and infants. In order to avoid potential injury to the spinal cord, dural puncture should be performed below the level of the spinal cord, i.e. below L2-L3 in neonates and infants

Question 98

With respect to a patient with Multiple sclerosis, which of the following alters the risk of a flair post partum

a) An Epidural
b) A spinal
c) A flair in the year pre-partum
d) A general anaesthetic
e) Breast feeding

Answer 98

B. A spinal (not definitively proven)

CEACCP: anaesthetic implications of neurological disease in pregnancy (2011)

MS is a chronic disease characterized by relapsing and remitting exacerbations. The condition is common among women of child-bearing age with 70% of presentations occurring between the ages of 20 and 40 yr and nearly 10% of cases presenting initially in pregnancy.8 There has previously been a reluctance to provide regional anaesthesia to these women because of a concern regarding neurotoxicity of local anaesthetics. Spinal anaesthesia may expose demyelinated areas of the spinal cord to the potential neurotoxic effects of local anaesthetics, but there is no evidence that this is a real risk. The concentration of local anaesthetic in the subarachnoid space is lower with epidural anaesthesia and therefore theoretically poses less of a risk unless multiple doses are administered. Intraoperative hypotension may be resistant to vasopressors but must be aggressively managed to prevent further spinal cord injury secondary to ischaemia. The current UK practice suggests that many anaesthetists are willing to proceed with regional anaesthesia, providing that the patient understands the potential for relapse and is carefully followed up.8 A combined spinal–epidural technique allows for the minimal use of local anaesthetic in the subarachnoid space and augmentation of anaesthesia if necessary. Obtaining well-documented informed consent is essential even in the emergency setting where there may be less time to thoroughly discuss the risks and benefits with the patient.

The MS sufferer must be carefully assessed in the postpartum period as they may interpret symptoms such as paraesthesia or bladder dysfunction as a relapse. The Pregnancy In Multiple Sclerosis (PRIMS) study reported a slight reduction in relapse rates during pregnancy but a significant increase in relapse in the first 3 month postpartum, regardless of anaesthetic technique or mode of delivery.9 Importantly though, there was no difference in relapse rates between MS patients who received epidural analgesia and those who had not.

Question 99

Adenosine can be used to terminate an arrhythmia dueto:

A. Atrial fibrillation

B. Atrial flutter

C. WPW

D. ??VT

E. ??Torsades

Answer 99

C. WPW

Question 100

Mast cell tryptase half life:

A. 1 hours

B. 3 hours

C. 6 hours

D. 12 hours

Answer 100

?A. or B.

CEACCP: anaesthesia-related anaphylaxis: investigation and follow-up (2013)

MCT has a half-life of 2 h, peaking at 1 h after anaphylaxis onset.

Question 101

Best indicator of Severe pulm HT:

A. mean PA pressure 45mmHg

B. orthopnoea

C. PND

D. ex tol less than 4 mets

E. fev1, …

Answer 101

D. Exercise tolerance less than 4 METs.

CEACCP: pulmonary hypertension (2006)

The cardinal symptom of pulmonary hypertension is breathlessness. This may be mild initially but progresses and can later be accompanied by chest pains (frequently similar to angina) and syncope, often on exercise. Syncope usually reflects a low cardiac output and indicates severe disease. This may be compounded by impaired filling of the LV due to its compression by enlarged right-sided chambers. Syncope at rest should raise the suspicion of arrhythmias but can simply reflect severe disease. The presence of symptoms such as unexplained dyspnoea, unexplained or exertional syncope, a family history of similar symptoms, or sudden death, should all alert to the possibility of pulmonary hypertension.

…orthopnoea and paroxysmal nocturnal dyspnoea are not features of pulmonary arterial hypertension.

Question 102

Young pregnant patient with mild mitral regurgitation and moderate mitral stenosis, normal LV function. The best delivery method:

A. Epidural anaesthesia LSCS

B. Spinal with LSCS

C. Epidural analgesia and normal vaginal delivery

D. GA LSCS

E. Normal vaginal delivery with remifentanil PCA

Answer 102

C. Epidural analgesia and normal vaginal delivery.

Question 103

St John’s Wort (Hypericum perforatum) potentiates the effects of

A. Dabigatran

B. Heparin

C. Warfarin

D. Aspirin

E. Clopidogrel

Answer 103

E. Clopidogrel

Clopidogrel is metabolically activated by cytochrome P450 (CYP) isoenzymes, which St John’s Wort induces

Question 104

St John’s wort will reduce the effect of

A. aspirin

B. clopidogrel

C. dabigatran

D. heparin

E. warfarin

Answer 104

E. warfarin (St John’s Wort is an enzyme inducer)

Question 105

7/7 post laparotomy platelet down to 40, no bleeding or bruising, but has painful swollen lower leg, most appropriate tx?

A. Fondaparinux

B. lepirudin

C. IV heparin

D. clexane

E. warfarin

Answer 105

B. Lepirudin

Question 106

Type 1 diabetes fasting since 2200, insulin infusion commenced 0700, BSL 7, what is MOA of insulin?

A. Skeletal uptake

B. liver uptake

C. inhib glucagon (release)

D. inhib glycogenolysis

Answer 106

A. Skeletal uptake

Liver and brain don’t require insulin for glucose uptake

Question 107

A three year old girl for an elective hernia repair isseen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to:

A. Postpone surgery for 2 hours

B. Postpone surgery for 4 hours

C. Postpone surgery for 6 hours

D. Cancel surgery

E. Continue with surgery

Answer 107

E. Continue with surgery

Question 108

Acute intermittent porphyria, signs except:

A. abdominal pain

B. hypotension

C. confusion

D. tachycardia

E. peripheral neuropathy

Answer 108

B. Hypotension

Question 109

Audit in department of prevalence of acute myocardial ischaemia in vascular surgery. What type of data is this?

A. Nominal

B. ordinal

C. categorical

D. non-parametric

E. numerical

Answer 109

E. Numerical

Question 110

Preop clinic carotid endarterectomy asks about GA vs LA, you tell her:

A. GA and LA have similar risk of stroke

B. GA has slightly increased risk of stroke compared to LA

C. LA has slightly increased risk of stroke compared to GA

D. GA has significantly increased risk of stroke compared to LA

E. LA has significantly increased stroke compared to GA

Answer 110

A. GA and LA have similar risk of stroke

Question 111

Threshold for micro shock:

A. 1uA

B. 10uA

C. 1mA

D. 5mA

E. 10mA

Answer 111

B. 10 uA

CEACCP article on electrical safety says 50 uA, but 10 uA quoted on howequipmentworks.com

Question 112

Asystolic arrest adrenaline just given, how often do you give adrenaline?

Answer 112

Every 4 minutes (every second cycle)

Question 113

Laser flex tube with double cuffs - how to inflate cuff(s)?

A Inflate proximal then distal

B Inflate distal then proximal

C ?Inflate both with saline?

D Inflate distal only

E Inflate proximal only

Answer 113

A. Inflate proximal then distal

inflate both with saline

Question 114

Patient with HOCM has HR 60, SBP 70 post induction, what to do:

A. give volume

B. adrenaline

C. metaraminol

D. ?beta-blocker

Answer 114

C. metaraminol

(maintain high/normal afterload, high/normal preload, low heart rate and normal contractility - not high contractility as it worsens dynamic LVOT obstruction)

You would probably give both metaraminol and volume, but metaraminol will work quicker.

Question 115

The following changes occur in aging except:

increased CSF volume

Answer 115

?? CSF volume does increase with ageing (think of old people’s CTBs - large ventricles)

Question 116

Paediatric paracetamol loading dose PR mg/kg:

A. 7.5

B. 10

C. 15

D. 20…

Answer 116

30-40 mg/kg

Question 117

Postpartumpost epidural with peripheral neurology.

lumbosacral plexus palsy

Answer 117

? (maybe, if more information given!)

Question 118

Posterior cord of brachial plexus

weakness of wrist extension

Answer 118

(Posterior cord gives off axillary and radial nerves)

Question 119

Endocarditis prophylaxis

A Bicuspid valve

B Congenital repair > 12 months ago

C Rheumatic heart valve

D Uncorrected cyanotic heart disease

E MVP + ?MR

Answer 119

D. Uncorrected cyanotic heart disease

+ RHD in Aboriginal patients

Question 120

1mg/kg rocuronium given in 70kg patient. Now CICO. What is the total dose of sugammadex that you will give?

Answer 120

16 mg/kg = 1120 mg (6 vials)

Question 121

Why don’t you turn head too much in awake pt for CVC insertion?

Answer 121

Excessive turning should be avoided as it changes the relationship of the vein and artery and can collapse the vein.

Question 122

Max size vessel for CVC insertion

Answer 122

?

Question 123

How do you prevent breath staking in COPD?

Answer 123

Low resp rate or low I:E ratio.

Question 124

CVC just inserted into patient. LIM then goes off. What do you do?

Answer 124

Do not transduce the CVP, and do not connect any of the lumens up to any electrically powered infusions. If the alarm is going off, the last piece of equipment plugged in is usually suspect and should be unplugged.

Question 125

Pneumoperitoneum created, sinus brady down to 20BPM. What to do?

Answer 125

Release pneumoperitoneum.

Question 126

Cell salvage results in less what?

Answer 126

Less allogenic blood transfusion.

Question 127

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.

Answer 127

B. 4 hours for formula

Question 128

The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size:

A. 6

B. 8

C. 10

D. 12

E. 14

Answer 128

D. 12

French size is the circumference in mm

Diameter of suction catheter must be = 4

Circ = 2 x pi x r, = pi x diam, = 3.14 x 4, = 12

Question 129

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

Answer 129

D. Nasopharyngoscopy by an ENT surgeon

Question 130

What gestation to monitor uteroplacental flow inlady having coiling?

A 20 weeks

B 24 weeks

C 28 weeks

D 32 weeks

E 36 weeks

Answer 130

B. 24 weeks

BJA 2011 - Anaesthetic consideration for non-obstetric surgery.

From 18 to 22 weeks, fetal heart rate monitoring is practical, and from 25 weeks, heart rate variability can be readily observed…

…When induced hypotension is deemed necessary, fetal heart rate monitoring should be used and the period of hypotension.

(Doesn’t mention uteroplacental flow.)

Question 131

A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is

A. altered thermoregulation

B. chorioamnionitis

C. urinary tract infection

D. inflammatory response

E. neuraxial infection

Answer 131

D. inflammatory response

Question 132

What is not an element of Child Pugh score?

a. GGT
b. Albumin
c. Bilirubin
d. INR
e. Encephalopathy

Answer 132

A. GGT