2022.1

Question 1

The recommended filter grade of a needle to be effective in excluding microorganisms is

Answer 1

0.2 micron filter grade

Question 2

A patient has severe hypokalaemia and is in cardiac arrest. The Australian Resuscitation Council and the New Zealand Resuscitation Council recommend intravenous potassium should be given as

Answer 2

IV bolus of 5mmol potassium chloride

Question 3

A 75-year-old man has a loud ejection systolic murmur detected on clinical examination before a joint replacement. A focused transthoracic echocardiogram (TTE) detects a calcified aortic valve with a peak aortic jet velocity of 3 m/s. The peak gradient across the aortic valve is

Answer 3

4 x 3^2 = 36mmHg

Bernoulli equation: P=4(V^2) where P = peak pressure gradient, V = peak velocity through the valve

Question 4

The current ANZCA guidelines for preoperative fasting of adult patients state that studies have shown that it is safe to administer

Answer 4

Up to 400ml of clear fluids 2hrs prior to surgery

Prescribed medications may be taken with a sip of water less than 2hrs prior to anaesthesia

Question 5

You place a paravertebral catheter for postoperative analgesia at the level of T5 in an adult patient prior to a thoracotomy. Two minutes following the injection of 0.75% ropivacaine 10 mL, the patient becomes bradycardic, hypotensive and apnoeic. The most likely cause of the complication is

Answer 5

Intrathecal spread

Question 6

A 54-year-old woman has a laryngeal mask airway inserted for a surgical procedure. The following day she complains of tongue numbness and abnormal taste over the posterior third of the tongue. The most likely site of the nerve injury is the

Answer 6

Glossopharyngeal nerve

Question 7

The washing process of modern cell savers for intraoperative blood salvage removes all the following EXCEPT

Answer 7

Red cells, fetal RBCs

Plasma, platelets, clotting factors, heparin, free Hb, inflammatory mediators are discarded with wash solution

Question 8

A patient with a haemopneumothorax has a chest drain in situ, which is attached to a three-bottle underwater seal drain apparatus. The system is attached to wall suction at -80 cmH20. This will cause

Answer 8

Pressure on the wall suction is irrelevant - safety feature of manometer bottle is that the distance below water = negative pressure geneated when suction is applied

Question 9

You inadvertently place a 7.5Fr central venous catheter into the carotid artery of a patient undergoing an emergency laparotomy for peritonitis. The best course of management is to

Answer 9

Consult vascular surgeon at completion of case

Question 10

A patient in atrial fibrillation with a CHA2DS2-VASc score of 2 has presented for elective hip surgery. Warfarin had been ceased for four days preoperatively and on the day before surgery the international normalized ratio (INR) was 2.1. The best course of action at this point is to

Answer 10

Delay elective surgery - low risk of thrombosis vs. high risk of bleeding

Question 11

An anaesthetised patient is ventilated and has standard monitoring plus a central venous line. As surgery commences, the line isolation monitor alarms, indicating a potential leakage current of greater than 5 mA from one of the power circuits in use. The most appropriate action is to

Answer 11

Disconnect non-essential equipment 1 by 1 to identify fault

Question 12

The dose of hydrocortisone that has equivalent glucocorticoid effect to 8 mg dexamethasone is

Answer 12

200mg

4mg dex = 25mg pred = 100mg hydrocortisone

Question 13

In the World Maternal Antifibrinolytic (WOMAN) trial, tranexamic acid administration within three hours of birth reduced the

Answer 13

Incidence of death due to bleeding

But no statistical difference in incidence of death from all causes or hysterectomy within 42 days of randomisation

Question 14

Preperitoneal pelvic packing is a surgical treatment of haemorrhage from a/an

Answer 14

Unstable pelvic fracture - both venous and arterial bleeding, prior to angiographic embolisation

Question 15

The gauge pressure on a gas cylinder does NOT necessarily represent the contents remaining if the cylinder is filled with

Answer 15

NItrous oxide (if there is liquid portion in cylinder)

Question 16

Maintaining a CO2 pneumoperitoneum at a pressure of 15mmHg is most likely to lead to

Answer 16

Increased SVR

<5mmHg: increased VR
5-15mmHg: compensation with increased SVR and maintained MAP
>15mmHg: decreased VR and MAP

Question 17

Of the following, the drug most likely to cause pulmonary arterial vasodilation with systemic arterial vasoconstriction when used in low doses is

Answer 17

Vasopressin

Question 18

You review a patient before major bowel surgery. Using the American Heart Association/American College of Cardiology consensus guidelines, you assess him as being at intermediate risk of a perioperative adverse cardiac event. When explaining this to the patient, this best translates to a numerical risk in the range of

Question 19

Postdural puncture headache in obstetric anaesthesia is associated with a greater likelihood of all of the following EXCEPT

Question 20

A woman with atrial fibrillation has no valvular heart disease. According to AHA guidelines, oral anticoagulants are definitely recommended if her CHA2DS2-VASc score is greater than or equal to

Answer 20

3 for females
2 for males

Question 21

A 30-year-old parturient presents in labour. She has a history of Addison’s disease from autoimmune adrenalitis and has been taking prednisolone 6 mg daily for ten years. On presentation the patient is given hydrocortisone 100 mg intravenously. The most appropriate steroid replacement regimen the patient should receive during labour is

Answer 21

Either continuous IV infusion of hydrocortisone 200mg/24hr or IM hydrocortisone 50mg q6hrly with rapid tapering (over 1-3 days) to the regular replacement dose after an uncomplicated delivery

IV 100mg hydrocortisone should be injected at the onset of active labour (already given in the stem)

Question 22

The fourth position of the international pacemaker (NBG) code represents the

Answer 22

Rate modulation and programmability

Position I - chamber(s) paced
Position II - chamber(s) sensed
Position III - response to sensing
Position IV - rate modulation
Position V - multisite pacing/antitachycardia features

Question 23

Abnormal Q waves are NOT a feature of the electrocardiogram in