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
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
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)
Absolute contraindication to ECT:
A. Cochlear implants
B. Epilepsy
C. Pregnancy
D. Raised intracranial pressure
E. Recent myocardial infarction
E. Recent myocardial infarction (and phaechromocytoma - only absolute, raised ICP - relative)
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
E. 30 mL/kg
The diluted thrombin time measures the anticoagulant activity of
A apixaban
B rivaroxaban
C dabigatran
D warfarin
E heparin
C. Dabigatran
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
C. Inhibition of clotting factors
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
E. Head down, left side down
to relieve RVOT obstruction
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
??? these answers are concentrations, not amounts
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
D. 12-lead ECG
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
B. Following a professional code of conduct
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
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)
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
A. Atlantoaxial instability
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
C. Beige
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
C. Midriasis
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
D. 25 (NNT = 1/ARR)
What does a white cylinder with a Grey coloured shoulders/neck contain?
a) Medical air
b) Carbon Dioxide
c) Helium
d) Oxygen
e) Argon
B. CO2
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
B. 0.5% chlorhexidine with 70% alcohol
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
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.
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
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
Penetrating injury to chest. What part of the heart most likely injured?
A. RV
B. LV
C. RCA
D. LA
E. RA
A. RV
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
D. Major risk of haemorrhage
Which volatile agent has got minimum effect on ICP at 1 MAC
a) isoflurane
b) sevoflurane
c) desflurane
d) enflurane
e) halothane
Iso, sevo and des have minimal effect
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
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.
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
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.’
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
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).
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
B. Intrathecal spread
Medical therapy vs TAVI in inoperable patients. At 30 days, decreased risk of:
A
B Myocardial infact
C Death
D Stroke
E Atrial fibrillation
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
Glycine used during urology case. Osm is:
A.
B. 200
C. 250
D. 300
B. 200 (220 mosmol/kg: CEACCP Anaesthesia for TURP)
Volatile analysis in most anaesthetic machines is done via which method?
A Gas chromatography
B Infrared analyser
C Raman spectometry
B. Infrared analyser
What is not a constituent of Prothrombinex VF?
A. Antithrombin III
B. Factor II
C. Factor X
D. Protein C
E. Heparin
D. Protein C
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
D. Crack on
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.
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.
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
A. Aintree catheter
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
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.
Time taken for insulin to reduce K+ in hyperkalaemia
A. 2 mins
B. 4 mins
C. 10 mins
D. 20 mins
E. 30 mins
C. 10 mins
Increased risk with eye block:
A: Peribulbar done medial canthus
B: Peribulbar done inferior-temporal
C: Sub-tenons
D:
A. Peribulbar done medial cants
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
A. VSD
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
E. For return electrode monitoring
Cisatracurium left out of fridge for 4 days. Its efficacy is now:
A. 60%
B. 70%
C. 90%
D. 50%
E. 99%
E. 99%
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
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
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
C. 2nd degree heart block
The NAP4 audit showed that the most common cause of airway problems/complications/disasters in INTENSIVE CARE is:
A. Aspiration
B. Dislodged tracheostomy tube
B. Dislodged tracheostomy tube
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
B. 2-3.5 mmol/L
Timing of peak respiratory depression after intrathecal 300 mcg morphine:
A. 18 hours
B. 3.5-7.5 h
Peak at 6 hours - CEACCP: intrathecal opioids in the management of acute postoperative pain, 2008
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
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.
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
C. Mast cell degranulation (causing histamine-mediated vasodilation)
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
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.
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
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
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
D. Less confounding
Bleeding intraopratively. TEG shows hyperfibrinolysis. What should be used to treat?
A TXA
B Platelets
C Cryo
D FFP
A. TXA
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
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.
4-chamber TTE view. What lesion is present? Image showed mitral regurg.
A. mitral regurgitation
A. mitral regurgitation
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
A. thrown away
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
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.
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
C. 3A
(3B - epiglottis adherent to posterior pharyngeal wall - ‘unbougiable’
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
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.
Line isolation monitor alarming at 5ma – what do to?
A. Disconnect non essential equipment 1 by 1 to identify fault
B. Ignore it
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.
Maintenance fluid rate in 15kg child – mls/hr
A. 40mls/hr
B. 50mls/hr
C. 90mls/hr
D. 300mls/hr
B. 50 mL/h
“Hypothermia makes bleeding in trauma worse because…”
A. Reduced platelet function AND number
B. Reduced activity of clotting factors
B. Reduced activity of clotting factors
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
D. 15 units Actrapid and 50 mL 50% dextrose
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
E. VVI with failure to sense
Relative contraindications to mediastinoscopy include
A. Cervical spondylosis
B. Emphysema
C. Mediastinal lymphadenopathy
D. Poor left ventricular function
E. Superior vena cava syndrome
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.
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%
D. Actual body weight
Time to onset of TRALI with transfusion?
a) 2 hours
b) 4 hours
c) 12 hours
d) 24 hours
e) 48 hours
B. 4 hours
(transfusion.com.au)
This is an acute (
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
D. Peribulbar block using the medial cants approach
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…
C. TOF 0.9 with accelerometer
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
C. closed mouth
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
B. Dilute thrombin time
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
E. Resonant frequency
also reduces measured systolic pressure, due to damping
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
D. Trendelenburg, right side up
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
B. Dorsal scapular nerve
Blue urticaria is a complication of
A
B Methylene blue
C Patent blue V
D Anaphylaxis
C. Patent blue V
Subtenon’s block. What is the BEST position to insert block?
A. Inferonasal
B. Inferotemporal
C. Superonasal
D. Superotemporal
E. Medial / canthal
A. Inferonasal
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
(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
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
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.
Adenosine can be used to terminate an arrhythmia dueto:
A. Atrial fibrillation
B. Atrial flutter
C. WPW
D. ??VT
E. ??Torsades
C. WPW
Mast cell tryptase half life:
A. 1 hours
B. 3 hours
C. 6 hours
D. 12 hours
?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.
Best indicator of Severe pulm HT:
A. mean PA pressure 45mmHg
B. orthopnoea
C. PND
D. ex tol less than 4 mets
E. fev1, …
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.
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
C. Epidural analgesia and normal vaginal delivery.
St John’s Wort (Hypericum perforatum) potentiates the effects of
A. Dabigatran
B. Heparin
C. Warfarin
D. Aspirin
E. Clopidogrel
E. Clopidogrel
Clopidogrel is metabolically activated by cytochrome P450 (CYP) isoenzymes, which St John’s Wort induces
St John’s wort will reduce the effect of
A. aspirin
B. clopidogrel
C. dabigatran
D. heparin
E. warfarin
E. warfarin (St John’s Wort is an enzyme inducer)
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
B. Lepirudin
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
A. Skeletal uptake
Liver and brain don’t require insulin for glucose uptake
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
E. Continue with surgery
Acute intermittent porphyria, signs except:
A. abdominal pain
B. hypotension
C. confusion
D. tachycardia
E. peripheral neuropathy
B. Hypotension
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
E. Numerical
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
A. GA and LA have similar risk of stroke
Threshold for micro shock:
A. 1uA
B. 10uA
C. 1mA
D. 5mA
E. 10mA
B. 10 uA
CEACCP article on electrical safety says 50 uA, but 10 uA quoted on howequipmentworks.com
Asystolic arrest adrenaline just given, how often do you give adrenaline?
Every 4 minutes (every second cycle)
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
A. Inflate proximal then distal
inflate both with saline
Patient with HOCM has HR 60, SBP 70 post induction, what to do:
A. give volume
B. adrenaline
C. metaraminol
D. ?beta-blocker
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.
The following changes occur in aging except:
increased CSF volume
?? CSF volume does increase with ageing (think of old people’s CTBs - large ventricles)
Paediatric paracetamol loading dose PR mg/kg:
A. 7.5
B. 10
C. 15
D. 20…
30-40 mg/kg
Postpartumpost epidural with peripheral neurology.
lumbosacral plexus palsy
? (maybe, if more information given!)
Posterior cord of brachial plexus
weakness of wrist extension
(Posterior cord gives off axillary and radial nerves)
Endocarditis prophylaxis
A Bicuspid valve
B Congenital repair > 12 months ago
C Rheumatic heart valve
D Uncorrected cyanotic heart disease
E MVP + ?MR
D. Uncorrected cyanotic heart disease
+ RHD in Aboriginal patients
1mg/kg rocuronium given in 70kg patient. Now CICO. What is the total dose of sugammadex that you will give?
16 mg/kg = 1120 mg (6 vials)
Why don’t you turn head too much in awake pt for CVC insertion?
Excessive turning should be avoided as it changes the relationship of the vein and artery and can collapse the vein.
Max size vessel for CVC insertion
?
How do you prevent breath staking in COPD?
Low resp rate or low I:E ratio.
CVC just inserted into patient. LIM then goes off. What do you do?
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.
Pneumoperitoneum created, sinus brady down to 20BPM. What to do?
Release pneumoperitoneum.
Cell salvage results in less what?
Less allogenic blood transfusion.
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
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
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
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
What gestation to monitor uteroplacental flow inlady having coiling?
A 20 weeks
B 24 weeks
C 28 weeks
D 32 weeks
E 36 weeks
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.)
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
D. inflammatory response
What is not an element of Child Pugh score?
a. GGT
b. Albumin
c. Bilirubin
d. INR
e. Encephalopathy
A. GGT
