2018.1 Flashcards
1. Asystolic arrest. 1 mg of adrenaline given. when to give the next dose? A. Two minutes B.Five minutes C. Every loop of ALS D. Every 2nd loop of ALS
Every 2nd loop of ALS
Every 4 min
Ventilator loops
A. Obstructive
B. Pressure support
C. Gas trapping
…
What is not a border of adductor canal?
A. Adductor Magnus B. Adductor Longus C. Gracilis D. Sartorious E. Vastus medialis
Adductors- posterior
Sartorius- anterior
Vastus medialis - lateral
Adductor canal takes structures from femoral triangle to popliteal fossa
No gracilis in adductor canal
What is the best bedside test for fluid responsiveness?
A. JVP B. CVP C. HR and BP during passive leg raise D. HR E. BP
HR and BP in passive leg raise
Most pro convulsant opioid A. Fentanyl B. Alfentanil C. Methadone D. Morphine E. Remifentanil
Alfentanil
All opioids possess some degree of proconvulsive activity
Most have been used safely
Exception is alfentanil which is a potent enhancer of EEG activity
Avoid tramadol and pethidine
1.5% glycine irrigation fluid has osmolarity A. 150mosm/L B. 200mosm/L C. 250 D. 300 E. 350
220 😡
HbS threshold for transfusion to avoid sickle cell crisis A. 5 B. 10 C. 20 D. 30 E. 50
The ideal haematocrit is contentious…
Traditionally, aggressive treatment to HbS concentration <30%
Now some Clinicians will be happy with normal Hb of 10g/dl
In high risk procedures you might be need to be more aggressive
What causes the least hypotension in an infant?
A. GA desflurane B. GA sevoflurane C. GA propofol TIVA D. Spinal with sedation E. Spinal with no sedation
GAS study:
Hypotension in 87% of infants undergoing GA
Hypotension in 41% of infants with regional
? Assume Sedation would have more hypotension than no sedation
Sore throat with video laryngoscopes compared to direct laryngoscopy A. One third as frequent B. Half as frequent C. The same D. Twice as frequent E. Three times as frequent
Cochrane review video vs direct
No difference
- First attempts
- sore throat
What needle... long sharp bevel A. Pitkin B. Quincke C. Sprotte D. Whitacre E. Tuohey
Sounds like a quincke!
What does this ECG represent ?
A. Pacemaker not capturing
B. bigeminy
C. Cardiac tamponade
Tamponade-
Alternating amplitude of QRS
Short, tall, short, tall
HR 60, QRS 420ms
What is the corrected QRS?
A. 380 msec B. 400 msec C. 420 msec D. 440 msec E. 460 msec
Bazett formula
QRS / square root of R-R
QT corrected is the corrected QT interval if the rate was 60bpm
Normal QT for man- 460ms (men), 440ms (woman)
For perioperative haemodynamic stability, patient with carcinoid should be treated with?
Octreotide
Will control the hormonal effects of carcinoid
Give even if patient says they have good symptom control
Works in a similar way to somatostatin
CXR person with NGT and right lung, blood coming NGT post - op removed. Now in recovery- what to do next?
A. Bronch
B. Review 4/24
C. Chest drain
D. Gastroscopy
? Bronch seems to make sense
Can’t find an answer
Ultrasound image of lung and liver for a patient having urgent thoracic surgery A. Empyema B. Pleural effusion C. Pneumonia D. Pneumothorax
A lines
B lines
Lung sliding
Interstitial syndrome, Alveolar syndrome
Structure located between IJV and carotid artery on ultrasound A. Vague nerve B. Ansa cervicalis C. Phrenic nerve D. Recurrent laryngeal nerve
Vagus
Randomised control trial
A. Random allocation to intervention or placebo
B. Random allocation to treatment groups
Random- allocated at random 🤪 to an intervention, and a current treatment or placebo
Scavenging outlet A. 12mm B. 15mm C. 22mm D. 30mm
30mm
Radical nerve ultrasound
A. Most of Dorsum of the hand
B. Palmar aspect of first three fingers and dorsal aspect of the tips
C. Palmar aspect of the lateral two fingers and dorsal aspect of the tips
D. Lateral forearm
E. Medial forearm
Most of dorsum of the hand
What would be more definitive for ruling out a perioheral nerve lesion over neuraxial problem. Post delivery. Had an epidural in labour. Decreased sensation over lateral thigh. Various sensory/weakness combinations given.
A. Urinary incontinence
B. Weakness of hip flexion and adduction
C. Foot drop
? Urinary incontinence
Man with great toe motor issue
What treatment?
A. Epidural steroid
B. Facet joint injection
? Steroid
Pregnant lady, HTN, Tachy, MVA with sweat belt, hit stationary car. ST depression inferior lateral associated with sudden onset chest pain
A. Cardiac injury
B. Aortic dissection
Cardiac tamponade- suspect if there is a seat belt mark or fractured sternum
Presents with ECG changes, CK, Trop, chest pain
Conservative management
Risk factor for pre eclampsia that in isolation that would warrant prophylactic aspirin therapy A. Family Hx pre eclampsia B. Autoimmune disease C. Age > 40 D. Not had a baby for >10yrs
Incidence of PReeclampsia is 8% for high risk conditions- give aspirin to those patients from 12 weeks- previous pre eclampsia esp early Multiple pregnancy Chronic HTN Diabetes 1 or 2 CKD Autoimmune disease
Highest risk of VTE in pregnancy A. Protein c deficiency B. Protein s deficiency C. Prothrombin mutation 320210a D. Factor V Leiden heterozygote E. Antithrombin III deficiency
Risk in decreasing order
- antithrombin III
- factor V Leiden
- protein c
- protein s
Territory of the infarct (ECG changes in inferior leads) A. RCA B. PDA C. LAD D. LCX E. Marginal branch
RCA for inferior infarct
What is the best view on TOE to diagnose ischaemia
A. Transgastric short axis midpapillary view
B. Transgastric long axis
C. Midoesophageal long axis
D. Midoesophageal 4 chamber
Transgastric mid papillary short axis view is the best view for diagnosing ischaemia
Superficial cervical plexus block A. C1 spinal nerve B. C5 dermatome C. Greater occipital nerve D. Ansa cervacalis E. Tranverse cervical nerve
C?
