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MCQs > 2018.1 > Flashcards

2018.1 Flashcards

1
Q 
Asystolic arrest, adrenaline 1mg given, when to give next dose?
A. When to give Adrenaline
B. 2 mins
C. 5 mins
D. Every loop of ALS cycle
E. Every second loop of ALS cycle
A

Every second loop. Ie every 4 mins

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2
Q

Ventilator loops shown (pressure time, volume time, flow time).
A. Obstructive disease
B. Pressure support ventilation
C. Gas trapping

A

?

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3
Q 
What is not a border of the adductor canal?
A. Adductor magnus
B. Adductor longus
C. Gracilis
D. Sartorius
E. Vastus medialis
A

Gracilis

Adductor canal
Post : AM and AL
Ant and lateral: VM
Roof and medially: sartorius

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4
Q 
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
A

BP change its passive leg raise

Passive Leg raise transiently increases venous return in patients who are fluid responsive (as such it is a diagnostic test not a treatment.)

It is a predictor of fluid responsiveness i.e. helps identify patients who are on the ascending portion of this starling curve and will have an increase in stroke volume in response to fluid administration.

Sit at 45 deg, raise legs to 45 degrees, wait 30-90 seconds. Assess for increase of 10% in SV or pulse pressure.

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5
Q 
Most pro-convulsant opioid: (pethidine definitely not an option)
A. Fentanyl
B. Alfentanil
C. Methadone
D. Morphine
E. Remifentanil
A

Alfentanil

All opioids are proconvulsant to some degree however most have history of being safe.
Except alfentanil which is a potent enhancer of EEG activity.
Melreidine metabolite normeperidine is also a potent proconvulsant.
Tramadol decreases seizure threshold ( probably because of its inhibition of monoamine reuptake)

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6
Q 
1.5% Glycine irrigation fluid has osmolarity:
A. 150 mOsmol/L
B. 200
C. 250
D. 300
E. 350
A

200mosm/L

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7
Q 
HbS threshold for transfusion to avoid sickle cell crisis:
A. 5%
B. 10
C. 20
D. 30
E. 50
A

30

Up to date

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8
Q 
Causes least hypotension in infant:
A. GA desflurane
B. GA sevoflurane
C. GA propofol TIVA
D. Spinal with sedation
E. Spinal with no sedation
A

Spinal no sedation

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9
Q 
Sore throat with video laryngoscopy compared to direct laryngoscopy:
A. One third as frequent
B. Half as frequent
C. The same - Cochrane review
D. Twice as frequent
E. Three times as frequent
A

The same - Cochrane review

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10
Q 
Image of spinal needle, long sharp bevel
A. Pitkin
B. Quincke
C. Sprotte
D. Whitacre
E. Tuohy
A

Quince

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11
Q

What does this ECG represent
A. Pacemaker failed to capture
B. Bigeminy
C. Cardiac Tamponade

A

Pulses paradoxus

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12
Q 
Hr 60, qrs 420. What is corrected qrs
A. 380ms
B. 400ms
C. 420ms - QT / square root of RR (which is 1 if 60bpm)
D. 440ms
E. 460ms
A

Bazetts formula

Qtc = QT / square root of RR interval

RR interval = 60/hr

In this case 420/ 1

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13
Q

For perioperative haemodynamic stability, patient with carcinoid should be treated with?

A

Octreotide 20-50mcg titrated to haemodynamic response

Vasopressin second line after octreotide

Other things to note
- avoid all histamine releasing drugs

Carcinoid

  • release of seretonin, histamine and other vasoactive substances
  • carcinoid Syndrome: flushing, diarrhea, hypotension, right sided heart valvular Disease
  • if heart disease present, statistically significant increase in periop complications
  • left sided heart disease uncommon
  • carcinoid crisis: exaggerated form with flushing, bronchospasm, tachycardia, widely fluctuation blood pressure including hypo and hypertension.
  • anaesthesia, surgical and radiological interventions can all cause crisis
  • NA and Ad may release bradykinin and worsen crises.
  • other thing to note is surgery will be hepatic resection. Mai rain low cvp
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14
Q 
CXR person with NGT in right lung, blood coming up NG post-op, removed. Now in recovery. What to do next?
A. Bronch
B. Review 4 hours
C. Chest drain
D. Gastroscopy
A

Bronch ?

BJA : most cx of endobronchial NG is ptx

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15
Q

Ultrasound of infraclavicular block name structure

A

Lateral @9pm
Posterior @ 7pm
Medial @ 3pm

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16
Q 
Pecs block, what is the muscle circled (serratus anterior)
A. Pec major
B. Pec minor
C. Serratus anterior
D. Lat Dorsi
A 
Pec major and minor to the left of screen (sup ant)
Serratus anterior (Inferior lateral)
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17
Q 
Structure located between ijv and Carotid artery on ultrasound
A. Vagus nerve
B. Ansa cervicalis
C. Phrenic nerve
D. Recurrent laryngeal nerve
A

Vagus

The four major structures contained in the carotid sheath are:

the common carotid artery as well as the internal carotid artery (medial)
internal jugular vein (lateral)
the vagus nerve (CN X) (posterior)
the deep cervical lymph nodes
The carotid artery lies medial to the internal jugular vein, and the vagus nerve is situated posteriorly between the two vessels.

In the upper part, the carotid sheath also contains the glossopharyngeal nerve (IX), the accessory nerve (XI), and the hypoglossal nerve (XII), which pierce the fascia of the carotid sheath.

The ansa cervicalis is embedded in the anterior wall of sheath. It is formed by “descendens hypoglossi” (C1) and “descendens cervicalis” (C2-C3).

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18
Q 
Ultrasound image of patient booked for urgent thoracic surgery Liver and lung shown
A. Empyema
B. Pleural effusion
C. Pneumonia
D. Pneumothorax
A

Pneumonia

Hepatisation of the lung seen in pneumonia

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19
Q

Classification of schedule D drug in pregnancy

A. Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed.

B. Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human fetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects.

C. Drugs which, owing to their pharmacological effects, have caused or may be suspected of causing, harmful effects on the human fetus or neonate without causing malformations. These effects may be reversible.

D. Drugs which have such a high risk of causing permanent damage to the fetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

E. Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed.

A

B

CAT A- Taken by large number of women with no negative effects
CAT B1- taken by limited number of women, no negative effects in animal studies
CAT B2- Taken by limited number of women, limited animal studies
CAT B3- taken by limited number of women, foetal damage in animals of unknown significance to humans
CAT C- drugs known to or suspected to causing harmful effects to foetus without malformations
CAT D- drugs known to or suspected to cause increased incidence of foetal abnormalities or irreversible damage

cAT X - high risk of permanent damage to foetus, don’t use.

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20
Q

Randomised controlled trial - REPEAT
A. Random allocation to intervention or placebo
B. Random allocation to treatment groups

A

A) treatment and placebo

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21
Q 
Scavenging outlet connector size
A. 12mm
B. 15mm
C. 22mm
D. 30mm
A

30mm

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22
Q

Radial nerve ultrasound
A. Most of the dorsum of the hand
B. Palmar aspect of the 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

A

Most of the Dorsum of the hand

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23
Q

What would be more definitive for ruling out a peripheral nerve lesion over neuraxial problem. Post delivery. Had an epidural in labour. Decreased sensation over lateral thigh.
Various Sensory/weakness combinations given. (I thought this said peripheral nerve versus nerve root lesion - not neuraxial)
A. Urinary incontinence
B. Weakness of hip flexion and adduction
C. Foot drop

A

? Urinary incontinence or foot drop

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24
Q

Man with great toe (?L5) motor issue. What treatment to offer?
A. Facet joint injection
B. Epidural Steroid

A

? Epidural steroid

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25
Q

Pregnant lady, Htn, tachy, mva with seat belt, hit stationary car. St depression inferior lateral associated with sudden onset chest pain
A. Cardiac injury
B. Aortic dissection

A

Maybe dissection

Aortic dissection can cause inferior STEMI if right cormorant involved. In general 0.1
% of STEMI are dissections.

Myocardial infarction second to blunt cardiac injury is a rare complication. LAD appears to be affected the most.

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26
Q 
Risk factor for pre-eclampsia that in isolation that would warrant prophylactic aspirin therapy
A. Family hx of pre-eclampsia
B. Autoimmune disease
C. Age >40
D. Not had a baby for >10yrs
A

autoimmune disease

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27
Q 
Highest risk of vte in pregnancy
A. Protein C deficiency
B. Protein S deficiency
C. Prothrombin mutation 320210A
D. Factors V Leiden heterozygote
E. Antithrombin III deficiency
A

Anti thrombin III Deficiency

Risk - up to date

  1. AT III
  2. Protein C
  3. Protein s
  4. FVL homozygous
  5. FVL heterozygous
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28
Q 
What is the Territory of the infarct
 A. RCA
B. PDA
C. LAD
D. LCX
E. Marginal branch
A

II, III, AVF st elevation

Therefore inferior infarct and RCA
10-20% of people will have L dominant and it will be LCx infarct

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29
Q

What is the best view on toe to diagnose ischemia
A. Transgastric short axis midpapillary view
B. Transgastric long axis
C. Midoesophageal long axis
D. Midoesophageal 4 chamber

A

Trans gastric short axis mid papillary

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30
Q 
Superficial Cervical plexus block
A. C1 spinal nerve
B. C5 dermatome
C. Greater occipital nerve
D. Ansa cervicalis
E. Transverse cervical nerve
A

Transverse cervical nerve

Superficial cervical plexus block

  • superficial branches are sensory and supply skin, deep branches are motor.
  • SCM forms roof
  • superficial plexus from C2-C4
  • roots combine to form, lesser occipital, grater auricular, transverse cervical and supraclavicular
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31
Q 
Nerve to ear with image most anterior part
A. Auricular branch of Vagus
B. Auriculotemporal
C. Greater auricular
D. Lesser occipital
A

?

Auriculotemporal: most superior part and preauricular skin (scalp block)
Great auricular= tragus
Auricular branch of vagus = inner cartilage
Lesser occipital: small medial part of cartilage

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32
Q

Intralipid max dose

A. 6mL/kg
B. 8mL/kg
C. 10mL/kg
D. 12ml/kg
E. 14mL/kg
A

12ml/kg (AAGBI guideline)

Bolus 1.5ml/kg up to 3 boluses for ongoing instability every 5 mins
Infusion= 15 ml/kg/hr and can increase to 30mls/kg/hr after 5 mins

Max dose should be reached in 20 mins if above is followed

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33
Q 
Dose for orchidopexy using ropivicaine 0.2% in a 12kg child - REPEAT
A. 8mL
B. 12ml
C. 18mL
D. 24mL
A

12mls

1ml/kg

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34
Q

CHADS2 calculation. Was an alcoholic with liver disease and other comorbidities but no score on the parameters given.
A. 0
B. 1
C. 2 D. 3 E. 4

A

CHA2DS2 VASc

  • CHF
  • HTN
  • Age >75 2 points
  • diabetes
  • stroke 2 points
  • vascular disease
  • age 65-74
  • sex = FEmale
1=1(0.6)
2=2.2
3=3.2
4=4 .8
5=7.2
6=9.7
7= 11.2
8= 10.8
9=12

CHADS2

  • CHF
  • HTN
  • age > 75
  • diabetes
  • stroke or previous TIA
0=1.9
1= 2.8
2=4
3=6
4= 8.5
5= 12.5
6=18
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35
Q

Next agent in sepsis after Norad A. Vasopressin

A

Vasopressin

Surviving sepsis 2016
- we suggest adding either vasopressin or ephedrine. Better evidence for vasopressin

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36
Q 
GCS calculation after coming off bike and hitting head. Opens eyes to voice, answers questions but sometimes confused, localises pain
A. 11
B. 12
C. 13
D. 14
E. 15
A

E3V4M5

= 12

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37
Q

SAH WFNS calculate score. Confused with unilateral hemiparesis A. 1
B. 2
C. 3
D. 4 E. 5

A

World federation of Neurosurgical societies (WFNS) grading system
- uses GCS And deficits to grade severity of SAH

Grade 1= GCS 15, no motor deficit
Grade 2= GCS 13-14, NO motor deficit
Grade 3= GCS 13-14, HAS motor deficit 
Grade 4= GCS 7-12 +/- motor deficit 
Grade 4= GCS 3-6 +/- motor deficit

GcS is greatest predictor of mortality and motor deficit of morbidity

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38
Q 
Epidural filter - particle size stops
A. 0.2um
B. 2um
C. 5um
D. 200um
A

0.2um according to Smith and Braun

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39
Q 
Repeat ruptured aneurysm during coiling- what not to do initially
A. Raise BP
B. Reverse anticoagulation
C. Mannitol
D. Hyperventilation
E. Thiopentone
A

Don’t raise BP

40
Q 
Recommended MAP for a child with TBI 
A. 30mmHg
B. 40mmHg
C. 50mmHg
D. 60mmHg
E. 70mmHg
A

Think 70?

Maintain MAP at >100mmhg for 50-70 yrs
And >110 mmh if above or below that range.

Go with highest MAP up until 95 I would think

41
Q 
Maternal arrest – which supports the diagnosis of an amniotic fluid embolism (repeat)
a. b. c. d. e.
Decreased complement levels (C3/C4) 
Significantly increased tryptase 
Thrombocytosis
Hyperfibrinoginaemia
Raised CRP
A

Decreased C3/4 levels

42
Q

During a propofol infusion in intensive care – how often must the propofol line be changed? (I remember this as maximum duration before changing injection line for Propofol infusion. It didn’t specify ICU or theatre)
a. b. c. d. e.
12 hours 24 hours 48 hours 72 hours
6 hours

A

12 hours

43
Q 
Woman in her 30’s after an operation on her left foot, complains of ongoing intermittent pain in her left foot. On examination she experiences greater pain in her left foot than her right on pinprick testing. This is:
a. b. c. d. e.
Dysaesthesia 
Allodynia
Hyperalgesia 
Hyperaesthesia 
Paraesthesia
A 
Dysthaesia = unpleasant abnormal sensation
Hyperlagesia= increased pain from stimulus that causes pain
Allodynia= pain from stimulus that normally doesn’t cause pain
Hyperaesthesia= increased sensitivity to stimulation
44
Q

Massive blood loss in pregnant woman – what is the trigger for Fibrinogen administration? a. 2.0

b. 2.5
c. 1.5
d. 1.0
e. 0.5

A

2

1 for normal population
2 for obstetrics

45
Q 
Spirometry can measure:
a. b. c. d. e.
Vital capacity 
Total lung capacity
Functional residual capacity 
Total lung volume
Residual volume
A

Vital capacity

Spirometer can’t measure RV or any capacity that includes RV (RV, FRC, TLC)

46
Q 
Most reliable test to confirm iron deficiency anaemia?
a. b. c. d. e.
MCV
Mean corpuscle haemoglobin
Transferrin 40% 
Ferritin <30ng/ml Hb level
A

Ferritin <30ng/ml Hb level

Serum ferritin less than 30 Ng/ml is diagnostic in an adult (blood cross)

47
Q

Which NSAID associated with the lowest risk of developing VTE?
a. Naproxen
b. Diclofenac
C. Aspirin
d. Ibuprofen
e. Celecoxib
NOTE: I thought aspirin was not an option

A

Naproxen

48
Q

Calculate the qSOFA score: 70 female, RR 20, spO2 100%, SBP 90mmHg, GCS 14. (I don’t remember this being on this exam)

a. 0 b. 1 c. 2 d. 3
e. 4

A

2

QSOFA
SBP <100
RR > 22
GCS<14

Score >2 suggests poor outcome in patients with suspected infection

49
Q

What does the Pringle manoeuvre involve? (don’t remember this being on exam)
a. b. c. d. e.
Hepatic artery and hepatic vein
Hepatic artery and portal vein
Portal vein and IVC
Infra and suprahepatic components of the IVC
Portal vein and hepatic vein

A

Clamping of portal pedicle to control haemorrhage

  • manual clamping of HA, PV and bile duct.
  • if bleeding stops post clamping then bleeding source is from HA or PV. If it doesn’t then bleeding possibly from vena cava or hepatic veins
50
Q 
How much potassium is required to increase serum K from 2.8mmol/L to 3.8 mmol/L? (don't remember this one either)
a. b. c. d. e.
10mmol 
20mmol 
30mmol
100mmol 
200mmol
A

100mmol

51
Q

Severe TBI in 24year old male – what is the target cerebral perfusion pressure? (I remember this as systolic pressure not CPP)

Yep SBP and 100-110mmHg was the answer
50-60mmHg 
60-70mmHg 
70-80mmHg 
80-90mmHg
90-100mmHg
A

60-70 if looking at CPP

Systolic 100

52
Q 
Ulnar nerve palsy secondary to position –which would be expected? (don't remember this)
Arm held in supination 
Weakness of thumb abductors
Weakness of finger adductors 
Wrist flexion
Numbness of the posterior arm
A

Weakness of finger adductors

Arm held in supination - median nerve, pronator
Weakness of thumb abductors - median nerve
Weakness of finger adductors -ulnar
Wrist flexion - median

53
Q 
The volatile with the longest time to environmental degradation is ( don't remember this)
a. b. c. d. e.
Sevoflurane 
Desflurane
Isoflurane 
Halothane 
Methoxyflurane
A

Desflurane

DES: takes 9-21 years to degrade
Also has 26 times the global warming potential of sevo and 13 times that of iso
Using DES for one hour =driving 500 miles

SEVO 1.2 years
ISO 3.6 years

54
Q 
a. b. c. d. e.
Youden index 
Propensity score
Fragility index 
Bonferroni scale 
Jaccard index
A

Look up all of these

55
Q 
What test should be applied to non-parametric, continuous data from 2 groups? (don't remember this)
a. b. c. d. e.
Fischers Student T test
Mann Whitney U 
Bland Altman 
Analysis of variance
A

.? Mann Whitney

56
Q 
Patient post op THR, heparinsed for treatment of a PE. Develops hypotension, SBP < 80mmHg and tachycardia. What is the next step in management? (don't remember this)
a. b. c. d. e.
Fluids and inotropes 
Refer for embolectomy
IVC filter 
Thrombolysis
 Warfarin
A

Recent OT so not thrombolysis

Up to date
- embolectomy is indicated in patients with haemodynamically unstable PEin whom thrombolysis is contraindicated . Also a therapeutic option for those who fail thrombolysis

May consider thrombolysis 1-2 weeks out from surgery

Fluids should be used carefully if right heart dysfunction secondary to PE

57
Q 
CS5 ECG configuration. Lead I is best for detecting ischaemia in which territory? (don't remember this)
a. b. c. d. e.
Lateral wall
 Inferior wall
Posterior wall 
Septal wall 
Anterior wall
A

Inferior ischaemia

Cs5 commonly used in theatre
It is the best 3 lead alternative to 5 lead for monitoring for ischaemia 
- RA in right clavicle
- LA on V5
- LL usual position (ground)

Lead 1 = anterior ischaemia
Lead 2 = inferior ischamia

58
Q

What are the fasting requirements for an 8 month old child undergoing an elective procedure on the morning list?
a. b. c. d. e.
Fast from midnight
6 hours solids, breast milk, formula and 2 hours clear fluids
6 hours solid, 4 hours formula and breast milk, 2 hours clear fluids
6 hours solid, 3 hours formula and breast milk, 2 hours clear fluids
6 hours solid, 4 hours formula, 3 hours breast milk, 2 hours clear fluids

A

6 hours solids, breast milk, formula and

2 hours clear fluids

59
Q

1 year old child weighing 10 kg in VF arrest – how many joules required for shock delivery?

a. 20
b. 30
c. 40
d. 50
e. 100

A

4j/kg

40

To work out weight if not given
Weight = (age+ 4) x2

Eg 2 year old= (6) x 2= 12

60
Q 
Peribulbar block contraindicated in the following scenarios
a. b. c. d. e.
INR 2.5 with mechanical valve 
Presence of scleral buckle
Inferior nasal pterygium 
Glaucoma surgery 
Presence of a staphyloma
A

Staphyloma

61
Q

Talking to a patient with a tracheostomy in-situ in the Pre-admission clinic. In order for the patient to talk to you, you must: (don’t remember this)
a. b. c. d. e.
Inflate the tracheostomy cuff, insert fenestrated piece, insert one-way valve

Inflate tracheostomy cuff, insert un-fenestrated piece, insert one-way valve

Deflate tracheostomy cuff, insert fenestrated piece, insert one-way valve

Deflate tracheostomy cuff, insert fenestrated piece, remove one-way valve

Deflate tracheostomy cuff, insert un-fenestrated piece, insert one-way valve

A

Deflate tracheostomy cuff, insert fenestrated piece, insert one-way valve

62
Q

Your registrar calls you to assist with the insertion of a difficult labour epidural. You attend and only put on a pair of sterile gloves before taking over and successfully siting the epidural. This is known as a: (don’t remember this)

a. Slip
b. Lapse
c. Violation
d. Mistake
e. Deviation

A

Violation

63
Q 
A 15 year old male with known prolonged QT. You are called to PACU where he is noted to be in VT. GCS 15, Nil chest pain, states he is feeling dizzy. 
What is your management?
a. b. c. d. e.
Magnesium 
Synchronised shock
Amiodarone 
Adenosine 
Metoprolol
A 
Unstable pt: cardiovert
Unconscious : shockable pathway 
Stable: give magnesium. Do. OT give amiodarone or procainamide 
- mag loading dose 2g IV, 
- repeat once if no clinical effect
- start infusion at 1-4g/hr
64
Q 
EVAR compared to open AAA repair results in
a. b. c. d. e.
Decreased re-intervention rate 
Less use of critical care resources
Increased mortality
Increased perioperative morbidity 
Poorer short term outcomes
A

Less use of critical care resources

EVAR has higher mortality in the long run apparently according to up to date

65
Q 
Which muscle is most likely to be missed following a Sub-Tenons block?
a. b. c. d. e.
Inferior oblique 
Superior rectus
Lateral rectus 
Superior oblique 
Medial rectus
A

Lateral rectus or superior oblique

Superior oblique
- situated outside the fibrotendinous ring and is most difficult to anesthetize completely
(Same answer for subtenon and retrobulbar block)
bJA says lateralrectus for subtenon ??

66
Q

What is the first line treatment for a young man in ED recently diagnosed with
phaechromocytoma who has presented with severe hypertension and tachycardia? He is not on any current treatment.
a. Esmolol
b. Phentolamine
c. Phenoxybenzamine
d. GTN

A

Phentolamine

67
Q

The Nerve Integrity Monitor (NIM) endotracheal tube works by monitoring

a. Electromyography of internal laryngeal muscles
b. Recurrent laryngeal nerve action potential
c. Movement of the vocal cords on the endotracheal tube
d. Pressure of the vocal cords on the endotracheal tube

A

Electromyography of internal laryngeal muscles

68
Q

Which electrical safety feature of operating theatres is impaired by extension cord and power boards

a. RCD
b. LIOM
c. Equipotential earthing d. Floating circuit

A

Equipotential earthing

Extension cords increase the resistance to earth

69
Q

For a lower limb orthopaedic procedure when a tourniquet will be used, when should antimicrobial prophylaxis be given pre-operatively?

a. Infusion during the case
b. 30 minutes prior to skin incision
c. 60 minutes prior to skin incision d. After release of the tourniquet

A

30 mins prior to skin incision and tourniquet being inflated

70
Q

Unilateral lumbar sympathetic block. Most likely side effect?

a. Genitofemoral neuralgia
b. Haematuria
c. Postural hypotension
d. Lumbar radiculopathy e. Psoas haematoma

A

Genitofemoral neuralgia

71
Q

The afferent limb of the occulocardiac reflex is mediated by: (don’t remember this)

a. Long and short ciliary nerves b. Facial nerve
c. Vagus nerve
d. Optic nerve
e. Ophthalmic nerve

A

Long and short ciliary nerves (CN5)

72
Q

SAH, delayed ischaemia most common

a. 24-28 hours
b. 4-10 days
c. 10-14 days
d. 14-21 days

A

4-10 days

Delated cerebral ischemia is a clinical syndrome of focal neurological, cognitive deficits, or both that occurs unpredictably in 30% of patients 3 to 14 days after the initial hemorrhage

73
Q

87yo has had selective neck dissection for laryngeal cancer with musculocutaneous flap repair. He is in PACU, awake and sitting up. BP 120/70. Flap is purple, with capillary refill time <1 sec. What is best management?

a. IV fluid bolus
b. intra-arterial streptokinase c. IV dextran 40
d. IV heparin
e. Re-explore flap surgically

A

? Re explore

74
Q

Dental extraction of right lower 3rd molar (48). Patient complains of paraesthesia to the chin. This is most likely neuropraxia to

a. glossopharyngeal n
b. inferior alveolar n
c. lingual n
d. long bucchal nerve e. mental nerve

A

Inferior alveolar nerve

75
Q

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

Right subclavian to right pulmonary artery

76
Q

Healthy mother undergoing surgery 4 weeks post-partum. What are current recommendations regarding when to resume breast-feeding post-surgery? a. 12 hours after procedure

b. 24 hours after procedure
c. Discard first feed post procedure
d. Discard first two feeds post procedure e. No need to discard

A

No need to discard acc to ANZCA

77
Q

Patient for elective CABG surgery. You insert a 7.5Fr central line into the carotid artery. Most appropriate management.

a. Immediately remove and apply pressure for 20 minutes
b. Deliver 500IU heparin
c. Leave in situ for 24 hours then remove and apply pressure for 20 minutes d. Leave in situ for 24 hours then remove and consult vascular surgical team
e. Consult vascular surgical team to consider interventional radiological or open repair. (I remember this as immediate repair)

A

Consult vascular surgical team to consider interventional radiological or open repair. (I remember this as immediate repair)

78
Q

Elderly patient from ICU with necrotic bowel for laparotomy. Borderline oxygenation and ongoing renal replacement therapy. Current INR 2.1, platelets 105, fibrinogen 1.5g/L, and Hb 80 g/L. Appropriate management would be+
a. 2 units FFP and 1 platelet
b. 2 units FFP and 1 PRBC to correct anaemia
c. Cryoprecipitate to achieve fibrinogen >2g/L
d. Fibrinogen concentrate to achieve fibrinogen >2g/L e. Proceed to surgery if no clinical signs of bleeding
F. Prothrombinex 50IU/kg to reverse INR

A

Prothrombinex

Or 2FFP 1 unit blood

79
Q

Kessel blade angulation is

a. 90
b. 100
c. 110
d. 120
e. 130

A

110

80
Q

Hepatic resection and you suspect large VAE with associated haemodynamic instability. Appropriate management includes positioning patient

a. Head down left tilt
b. Head down right tilt
c. Head up no tilt
d. Head up left tilt
e. Head up right tilt

A

Head down and left tilt to move the entrained air towards the right atrium and away from the coronary
Same position if you were to aspirate the air via central line

81
Q

Upper limb surgery with tourniquet. Maximum recommended time for inflation prior to deflation is

a. 30 min
b. 60 min
c. 90 min
d. 120 min
e. 150 min

A

120mins

75 mins for a child

82
Q

Scalp blocks for awake craniotomy requires blockade of the following nerves:

a. Greater and lesser occipital and greater auricular nerves
b. Trigeminal, greater and lesser occipital nerves
c. Trigeminal, greater occipital and greater auricular nerves
d. Facial, trigeminal and greater occipital nerves
e. Facial, greater and lesser occipital nerves

A

Trigeminal, greater and lesser occipital nerves

83
Q 
25 year old MBA. Femur fracture. Femoral nerve block and 25 mg morphine. In ED for 12/24. Normal CXR on admission. Now with RR 25, BP 120/80, HR 90, crackles on chest, sats 90%.
What is the cause?
a. Lung contusion
b. Aspiration
c. Fat embolism
d. Opioid overdose
A

Fat embolism

84
Q

What product is not in Cryoprecipitate? (don’t remember this)

a. Fibrinogen
b. Factor 8
c. Factor 13
d. Factor 9
e. Von willebrand factor

A

This component, either derived from whole blood or collected via apheresis, is prepared by thawing fresh frozen plasma between
1–6 ˚C and recovering the precipitate. The cold-insoluble precipitate is refrozen.

One unit of cryoprecipitate apheresis is approximately equivalent to 2 units of cryoprecipitate derived from whole blood.

It contains most of the Factor VIII, fibrinogen, Factor XIII, von Willebrand Factor and fibronectin from fresh frozen plasma.

Cryoprecipitate can be stored for 12 months at –25º C or below.

85
Q

What is your aim for systolic blood pressure in a closed head injury with severe TBI?

a. 90 mmHg
b. 100 mmHg
c. 110 mmHg
d. 120 mmHg
e. 130mmHg

A

Sbp 100 if 50-70 years old

Sbp 110 if 15-49 yo, or >70 yo

86
Q

Patient having resection of a lesion from the lateral border of their lower right lip. The surgeon does not want to perform local infiltration and the patient refuses a GA. Which nerve will you block?

a) facial n
b) hypoglossal n
c) infraorbital n d) lingual n
e) mental n

A

Mental will block lower lip

87
Q

How much FFP will it take to increase fibrinogen by 1g/L?

a) 1ml/kg
b) 5ml/kg
c) 10ml/kg
d) 20ml/kg
e) 30ml/kg

A

FFP 30mls/kg

CRYO 5 mls/kg
Fribrinogen concentrate 4g of powder increases fibrinogen levels by 1g/L

88
Q

Horner’s syndrome results from blockade of which structure?

a) Ciliary ganglion
b) Stellate ganglion
c) Pterygopalatine ganglion
d) Otic ganglion
e) Submadibular ganglion

A

Stellar ganglion

Horners: ptosis, miosis, anhydrosis

89
Q

You are asked by your hospital to advise on staffing requirements for setting up a new endoscopy suite, where it is envisaged that propofol sedation will be given. According to PS09, the minimum requirement is: (these options look different -the all started with minimum of __ people, then had options like specialist anaesthetist or medical practitioner or dentist)

a) Medical practitioner with a skilled assistant that is separate from the assistant to the proceduralist
b) Medical practitioner or dentist with a skilled assistant assisting them and the proceduralist
c) Nurse supervised by proceduralist with recent ALS training
d) Specialist anaesthetist with a skilled assistant assisting them and the proceduralist
e) Specialist anaesthetist with a skilled assistant that is separate from the assistant to the proceduralist

A

Medical practitioner or dentist with a skilled assistant assisting them and the proceduralist

90
Q

The characteristic respiratory pattern in a patient with an acute C5 spinal cord injury is

a) Rapid respiratory rate
b) Arterial hypoxaemia
c) Chest wall immobility
d) Preserved cough
e) Preserved inspiratory force

A

As per ceaccp, a C5 injury will lead to rapid shallow breathing

  • ultimately hypo ventilation and respiratory failure is common if allowed to deteriorate.
  • also see paradoxical chest movement
  • also impaired cough, impaired inspirations
91
Q

What is the mechanism of central sensitisation? (don’t remember this)

a) Increased intracellular magnesium
b) Antagonism of the NMDA receptor
c) Glycine is the major neurotransmitter involved
d) Recurrent a-delta fibre activation e) Alteration in gene expression

A

Increased gene expression, specifically COX-2 and IL.

False answers:
A. Decreased intracellular magnesium
B. Activation (not antagonism) of the NMDA receptor
C. Glutamate is the major neurotransmitter involved
D. c fibre activation
F. NMDA is sensitised, but may not be the correct answer depending on what is meant by “primary activation”:

“These changes begin in the periphery with upregulation of [COX-2] and interleukin-1β-sensitizing first-order neurones, which eventually sensitize second-order spinal neurones by activating [NMDA] acid channels and signalling microglia to alter neuronal cytoarchitecture.”

BJA recent article “When does acute pain become chronic?”

92
Q

You suspect your patient just had anaphylactic reaction. The optimal times to take blood for serum tryptase measurement: (don’t think they said “within” just listed the times)

a) within 15min of onset of event, 3 hours, 24 hours
b) within 15min of onset of event, 4 hours, 24 hours
c) within 1 hour of onset of event, 4 hours, 24 hours
d) within 1 hour of onset of event, 3 hours, 24 hours
e) within 1 hour of onset of event, 6 hours, 24 hours

A

1,4,24 as per ANZAAG

93
Q

You see your trainee self-injecting propofol while at work. What is the best immediate action?

a) notify trainee’s next of kin
b) notify medical board
c) notify trainee’s supervisor of training
d) relieve trainee of clinical duties e) terminate trainee’s employment

A

The doctor must be relieved of any clinical duties

94
Q

Man undergoing transcatheter aortic valve replacement, the below rhythm appears on the monitor (complete heart block) after wire crosses the valve and is then pulled back. What is the best way of managing this. (looked like a couple of ventricular ectopic then complete heart block to me)

a) atropine
b) external pacing
c) adrenaline
d) isoprenaline
e) transvenous pacing

A

Ceaccp 2012
The transvenous pacing wires can be used in case of complete heart block

B. external pacing - much quicker than transvenous, given urgency of situation, this is more appropriate than E
vs
e.. transvenous pacing

BUT TRANSVENOUS PACING ALWAYS PLACED DURING TAVR?

As per Rabb’s notes 2015B
Happens as they get damage to the AV node and budle of HIS

Intraoperative Complete HB
The management of intraoperative heart block starts with ECG & rhythm strip assessment to diagnose the type of block. If the patient is haemodynamically unstable, give 100% oxygen and trial atropine, up to 20ug/kg. However, this is rarely effective. Other management options are:
• Start an isoprenaline infusion 1-10ug/min, to buy time if hypotension is severe.

  • Transcutaneous pacing if electrodes can be placed. Otherwise, oesophageal pacing is also effective. Pass the electrode into the oesophagus via the nasopharynx (similar to inserting a naso-gastric tube) and connect to the pulse generator. Reposition the electrode until ventricular capture.
  • Transvenous pacing is more effective and reliable than the above. Senior help must be gained.
95
Q

Risk of anaphylaxis recurring post-suxamethonium anaphylaxis is greatest with:

a) atracurium
b) mivacurium
c) pancuronium
d) vecuronium
e) rocuronium

A

Allergy to
ROCURONIUM: xreactivity to: S>V>A>P>c
RSV, APC

SUX: xreactivity to: R>V>C> P=A
SRV, CPA

VEC: xreactivity to: S=R=P> A
VSRP, A

96
Q

Open AAA repair, best method to reduce risk of renal impairment?

a) Sodium bicarbonate
b) N-acetylcysteine
c) Maintaining intravascular volume
d) Maintaining urine output
e) Mannito

A

I think maintaining intravascular volume

Miller:
Optimal systemic haemodynamics, including maintenance of intravascular volume, is general,y considered most effective means of renal protection during and after cross clamping.

MCQs (18 decks)

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