2022.1 Flashcards
1
Q
A 45-year-old man presents with a history of shortness of breath and the following flow-volume loop is obtained. This is most consistent with
A
?
2
Q
A 72-year-old female smoker with hypertension presents to the emergency department with a wrist fracture after a fall. She has been increasingly tired and confused over the previous week. Her serum and urine electrolytes are (supplied). The most likely diagnosis is
A) SIADH
B) CSW
C) Hypothyroidism
D) Addison’s
Diuretics
A
?
3
Q
A 74-year old man complains of chest pain. An electrocardiograph is performed and displayed here. The occluded coronary artery could be the
a) LAD
b) LCx
c) RCA
d) Left main
A
Left main
4
Q
The recommended filter grade of a needle to be effective in excluding microorganisms is
a) 0.1 micron
b) 0.2 micron
c) 0.3 micron
d) 0.4 micron
A
b) 0.2 micron
5
Q
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
a) 5 mmol, slow push
b) 5 mmol, bolus
c) 10 mmol, slow push
d) 10 mmol, bolus
e) 30mmol KCl in 1L Nsaline, bolus
A
b) 5 mmol, bolus
6
Q
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
A) 16 mmHg
B) 26 mmHg
C) 36 mmHg
D) 46 mmHg
A
36 mmHg
7
Q
The current ANZCA guidelines for preoperative fasting of adult patients state that studies have shown that it is safe to administer
a) Unlimited clear fluids 2 hours prior to OT
b) 800mL clear fluids 2 hours prior to OT
c) 600mL clear fluids 2 hours prior to OT
d) 400mL clear fluids 2 hours prior to OT
e) 200mL clear fluids 1 hour prior to OT
A
d) 400mL clear fluids 2 hours prior to OT
8
Q
A two-year-old boy with a history of respiratory tract infection one week previously has just undergone squint surgery. His airway was managed with a size 4.5 mm cuffed endotracheal tube. The surgery was unremarkable. Twenty minutes after extubation he is awake and appears anxious, with stridor and a visible tracheal tug. His oxygen saturation is 96% on room air. The best initial management of this child is to administer
A) PEEP
B) Propofol
C) Fentanyl
D) Suxamethonium
E) Dexamethasone
A
Dexamethasone
9
Q
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
A) Anaphylaxis
b) Intravascular injection
c) Intrathecal injection
d) Epidural injection
e) LA mediated hypotension
A
C) intrathecal injection
10
Q
A patient is anaesthetised from the awake state to a state of surgical anaesthesia with propofol or a volatile anaesthetic. As the depth of anaesthesia increases, the patient’s electroencephalogram (EEG) will show oscillations that are of
a) Increased amplitude, increase d frequency
b) Increased amplitude, decreased frequency
c) Decreased amplitude, increased frequency
d) decreased amplitude, decreased frequency
A
b) Increased amplitude, decreased frequency
11
Q
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
a) Recurrent laryngeal nerve
b) Superior laryngeal nerve
c) Glossopharyngeal nerve
d) Facial nerve
e) Trigeminal nerve
A
Glossopharyngeal nerve
12
Q
The washing process of modern cell savers for intraoperative blood salvage removes all the following EXCEPT
a) vernix
b) foetal squamous cells
c) foetal red cells
d) amniotic fluid
A
c) foetal red cells
13
Q
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
a) mediastinal shift
b) massive tissue damge
c) suction to fail
d) suction to work as expected
A
d) suction to work as expected
14
Q
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
a) Remove it and apply pressure
b) Cancel surgery
c) Refer to vascular surgery
d) Use it for fluids only – no medications
A
Refer to vascular surgery
15
Q
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
A) Cancel surgery
B) Give Vit K
C) Give FFP
D) Repeat INR
A
Give Vit K
16
Q
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
a). Individually disconnect each piece of non-essential equipment until problem found
b). Disconnect CVC until problem found
c) ignore alarm
d) resite CVC
A
Individually disconnect each piece of non-essential equipment until problem found
17
Q
The dose of hydrocortisone that has equivalent glucocorticoid effect to 8 mg dexamethasone is
a) 24mg
b) 100mg
c) 200 mg
d) 240mg
A
200 mg
18
Q
In the World Maternal Antifibrinolytic (WOMAN) trial, tranexamic acid administration within three hours of birth reduced the
a) incidence of bleeding
b) risk of death overall
c) risk of death due to bleeding
d) risk of death due to MI
A
risk of death due to bleeding
19
Q
Preperitoneal pelvic packing is a surgical treatment of haemorrhage from a/an
a) surgical misadventure
b) pelvic fracture
c) abdominal stab wound
d) ruptured AAA
A
b) pelvic fracture
20
Q
The gauge pressure on a gas cylinder does NOT necessarily represent the contents remaining if the cylinder is filled with
a) O2
b) Air
c) Helium
d) N2O
A
d) N2O
21
Q
Maintaining a CO2 pneumoperitoneum at a pressure of 15 mmHg is most likely to lead to
A. Decreased arterial Blood pressure
B. Decreased Heart rate
C. Increased central venous pressure
D. Increased renal blood flow
E. Increased systemic vascular resistance
A
E. Increased systemic vascular resistance
22
Q
Of the following, the drug most likely to cause pulmonary arterial vasodilation with systemic arterial vasoconstriction when used in low doses is
Vasopressin
A
Vasopressin
23
Q
The amount of fresh frozen plasma that needs to be administered (in mL/kg) to increase plasma fibrinogen levels by 1 g/L is
a. 5 mls/kg
b. 10 mls/kg
c. 15mL/kg
d. 30 mls/kg
A
c. 15mL/kg from journal of transfusion
30ml/kg as per blue book
24
Q
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
A
?
25
Postdural puncture headache in obstetric anaesthesia is associated with a greater likelihood of all of the following EXCEPT
Depression
Bacterial meningitis
Chronic back pain
Cerebra venous thrombosis
?Other
A) Cortical vein thrombosis
B) Seizure
C) Subdural haematoma
D) Encephalitis
E) Stroke
D) Encephalitis
26
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
a)1
b) 2
c) 3
d) 4
e) 5
c) 3
27
When using cardioversion to revert a patient in atrial fibrillation to sinus rhythm, the direct current shock is synchronised with the ECG to coincide with the
a) P wave
b) Q wave
c) R wave
d) S wave
a) T wave
R wave
28
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
50mg QID or equivalent in infusion = 200/24 = 8mg/hr
50mg QID or equivalent in infusion = 200/24 = 8mg/hr
29
The fourth position of the international pacemaker (NBG) code represents the
Rate Modulation
Rate Modulation
30
In a 5-year-old child with severe life-threatening anaphylaxis and no intravenous access, the recommended initial dose of intramuscular adrenaline is
a) 1mg
b) 0.2mg
c) 0.1 mg
a) 0.5mg
0.2mg
31
A four-year-old boy is in refractory ventricular fibrillation. The recommended dose of amiodarone is
100mg
80mg
40mg
20mg
80mg
32
In comparison with fresh frozen plasma, cryoprecipitate contains an increased concentration of factor
Compared with the plasma from which it is prepared, cryoprecipitate contains a high concentration of coagulation factor VIII, coagulation factor XIII, and fibrinogen
33
Jet ventilation for shared airway surgery is traditionally delivered at pressures in atmospheres (atm) of
1 - 4 bar
34
Following the initial subarachnoid haemorrhage from a ruptured aneurysm, the patient is at greatest risk of rebleeding during the following
?
35
The sensory innervation to the larynx above the vocal cords is provided by the
a) Recurrent laryngeal nerve
b) Superior laryngeal nerve
c) Glossopharyngeal nerve
d) Facial nerve
a) Trigeminal nerve
Superior laryngeal nerve
36
The oral morphine equivalent of tapentadol 50 mg (immediate release) is
a) 5
b) 10
c) 15
d) 20
e) 25
15
37
The EXTEM plot from a ROTEM sample is shown. The most appropriate treatment for this bleeding patient is
?
38
A risk factor for the development of torsade de pointes is
?
39
In adults the spinal cord usually extends from the brainstem to the level of the inferior margin of the
?
40
A 60-year-old woman presents for thrombectomy with left lower leg ischaemia. She has not received any medications since presentation, and takes none at home. The sole abnormality on laboratory testing is an activated partial thromboplastin time (APTT) of 52 seconds. The most likely cause of the raised APTT is
antiphopholipid anticoagulant
41
The manufacturer’s instructions for use of the i-gel supraglottic airway device recommend a minimum patient weight of
2kg
https://www.intersurgical.com/info/igel#:~:text=Launched%20in%202007%20after%20years,between%202%2D90%2Bkg
42
A derived value from an arterial blood gas sample is
a) pH
b) PaCO2
c) PaO2
d) HCO3
HCO3
43
The most clinically useful indicator of effective ventilation during neonatal resuscitation is an improvement in
a) Sats
b) HR
c) CO2
d) BP
e) EtO2
HR
44
In the awake term neonate the systolic arterial blood pressure is normally approximately
a) 40
b) 50
c) 70
d) 100
e) 120
70
45
Predictors of successful awake extubation after volatile anaesthesia in infants do NOT include
a) Intact airway reflexes
b) Spontaneous ventilation
c) Adequate tidal volumes
d) Increased RR
Increased RR
46
A man underwent a heart transplant 12 months ago. A drug or therapy which is likely to result in an exaggerated effect in him is
a) Adrenaline
b) Digoxin
c) Adenosine
d) Noradrenaline
e) Epedrine
Adenosine
47
A 30-year-old woman has had a free flap operation of eight hours duration. She received an intraoperative remifentanil infusion and was given 10 mg morphine 30 minutes before the end of the operation. In recovery her pain score has increased from 6/10 on arrival in recovery to 9/10 in spite of a further 10 mg of intravenous morphine. The most likely diagnosis is
a) Inadequately controlled surgical pain
b) Post surgical chronic pain
c) Hyperalgesia
d) Allodynia
Hyperalgesia
48
Propofol infusion syndrome is characterised by all of the following EXCEPT
a) Bradycardia
b) Heart failure
c) Normal anion gap metabolic acidosis
d) Coagulopathy
e) Rhabdomyolysis
Normal anion gap metabolic acidosis
49
Of the following, the drug with the LEAST effect on serum potassium is
a) Insulin
b) Ventolin
c) Frusemide
d) Rocuronium
e) Suxamethonium
Rocuronium
50
The risk of a perioperative respiratory adverse event in a child is least likely to be increased by
a) URTI
b) Airway surgery
c) Hx of asthma
d) Non paediatric anaesthetist
e) Increasing age
Increasing age
51
The underlying trigger for the development of acute traumatic coagulopathy is
a) Increased fibrinogen
b) Catecholamine release
c) Hypovolaemia
d) Increased activated Protein C
e) MTP
Increased activated Protein C
52
Differential hypoxia is a syndrome characterised by lower arterial oxygen saturation in the upper body. It is a complication specific to the use of
a) IABP
b) ECMO
c) CPB
d) CRRT
ECMO
53
Under the NEXUS criteria, requirements to clear the cervical spine of trauma patients without radiographic imaging include all of the following EXCEPT
a) Neurological deficit
b) Spinal tenderness
c) Dangerous mechanism
d) Intoxication
e) Distracting injury
Dangerous mechanism
54
A 54-year-old woman had a laryngeal mask airway inserted during anaesthesia. The next day she reports hoarseness. On indirect laryngoscopy the right vocal cord is in a paramedian position and is lower than the left vocal cord. The most likely site of the nerve injury is the right
A) Recurrent laryngeal nerve
B) Superior laryngeal nerve
C) Glossopharyngeal nerve
D) Facial nerve
E) Trigeminal nerve
Recurrent laryngeal nerve
55
A patient undergoing robotic prostatectomy with volume-controlled ventilation has the following ventilatory measurements (supplied). The static compliance is
No recalled answers
Static compliance = TV / (plateau pressure- PEEP)
56
A patient presents for endoscopic retrograde cholangiopancreatography (ERCP) with a history of previous post-ERCP pancreatitis. The management most likely to reduce the likelihood of pancreatitis is
? Indomethacin rectally
? GTN
? Isosorbide dinitrate
? Allopurinol
? Octreotide
Indomethacin rectally
57
Idarucizumab is used to reverse life-threatening gastrointestinal bleeding associated with
a) Rivaroxaban
b) Apixaban
c) Warfarin
d) Dabigatran
e) Clopidogrel
Dabigatran
58
When compared to the interscalene block, the supraclavicular block has the advantage that
a) Less risk of phrenic nerve palsy
b) More superficial block
c) More dense analgesia
d) Less supplemental of other nerve blocks required
Less risk of phrenic nerve palsy
59
A ten-year-old child (weight 30 kg) presents to the emergency department in status epilepticus. He has received one dose of 15 mg midazolam buccally prior to his arrival. According to Advanced Paediatric Life Support Australia (APLS) guidelines the next drug treatment should be intravenous
a) Levetiracetam
b) phenytoin
c) Midazolam
d) phenobarbitone
e) Lorazepam
Midazolam
60
In long-term use of nonsteroidal anti-inflammatory drugs, the risk of thromboembolic complications is lowest with
a) Diclofenac
b) ibuprofen
c) meloxicam
d) naproxen
e) celecoxib
naproxen
61
A 74-year-old man presents for a femoral popliteal artery bypass procedure for peripheral limb ischaemia. Regarding its role in modifying his perioperative cardiovascular risk, clonidine
a) Decreases the risk of death or non-fatal MI
b) Decreases the risk of non-fatal cardiac arrest
c) Increases the risk of clinically important hypotension
D) Increases the risk of perioperative stroke
Increases the risk of clinically important hypotension
62
A 45-year-old man presents on the day of surgery for an elective inguinal hernia repair. He is well but is noted to be mildly jaundiced. He takes simvastatin for hyperlipidaemia and has no other medical history. He consumes about three standard drinks of alcohol per day and does not smoke. He briefly experimented with illicit drugs more than ten years ago. His laboratory results show: (supplied) The most likely diagnosis is
a) Gilbert’s syndrome
b) Alcoholic liver disease
c) Biliary obstruction
D) Haemolytic anaemia
Alcoholic liver disease
63
A 50-year-old man is admitted with a stroke and undergoes cerebral angiography. The artery marked by the arrow on the angiogram is the
a) Posterior cerebral artery
b) Posterior communicating artery
c) Middle cerebral artery
d) Anterior cerebral artery
E) Anterior communicating artery
Posterior communicating artery
64
The most common cause of maternal mortality in women with preeclampsia is
a) Stroke
b) APO
c) PPH
d) HELLP syndrome
E) Eclampsia
PPH
65
A patient with a body mass index 34 kg/m2 with no other disease has an ASA (American Society of Anesthesiologists) Physical Classification of at least
a) 1
b) 2
c) 3
d) 4
a) 5
1 or 2 depending on what resource you look at
66
Ehlers-Danlos Syndrome is associated with each of the following EXCEPT
a) Joint hypermobility
b) Increased risk of pneumothorax
c) Increased risk of arterial dissection
d) Decreased bleeding risk
Decreased bleeding risk
67
The effect of a drop in patient core temperature from 37 C to 34 C is to
a) Decrease serum glucose level
b) Increase risk of arrhythmia and VF
c) Cause loss of consciousness
d) Cause muscle weakness
Cause muscle weakness
68
According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as
a) Systemic inflammatory response syndrome with confirmed or presumed infection
b) Life-threatening organ dysfunction due to dysregulated host response to infection
c) Persistent hypotension due to infection despite adequate fluid resus
Infection with evidence of end-organ dysfunction
Life-threatening organ dysfunction due to dysregulated host response to infection
69
According to the 6th National Audit Project, the likelihood that a patient who reports an allergy to penicillin has a true allergy is approximately
a) 1%
b) 10%
c) 15%
d) 20%
10%
70
The calculation of the initial dose of suxamethonium for a morbidly obese patient should be based upon
a) Adjusted
b) Ideal
c) Actual
a) Lean
Actual
71
A 70-year-old man undergoes a stress echocardiogram as part of his preoperative preparation before a total hip replacement. If he has clinically significant coronary artery disease, the earliest indicator during his test is most likely to be
a) Attenuated HR response to exercise
b) Chest pain with stress
c) No RWMA at rest but RWMA with stress
d) ST depression on ECG
ST depression on ECG
72
Regarding the Australian and New Zealand categorisation system for prescribing medicines in pregnancy, Category C medicines are ones which
a) Are not expected to cause harm to the foetus
b) Are expected to cause harm to the foetus without causing malformation
c) Are expected to cause foetal malformation or irreversible harm
Should not be taken during pregnancy due to the risk of permanent harm to the foetus
Are expected to cause harm to the foetus without causing malformation
73
An adult male patient has a haemoglobin level of 80 g/L and his blood film shows a reticulocyte count of 10%. These findings are compatible with
a) Fe deficiency anaemia
b) Acute bleeding
c) Haemolytic anaemia
D) Aplastic anaemia
Haemolytic anaemia
74
Once a transfusion of a unit of packed red blood cells is commenced, the transfusion of that unit should be completed within
a) 1 hour
b) 2 hours
c) 4 hours
6 hours
4 hours
75
The most reliable clinical indicator of opioid-induced ventilatory impairment (OIVI) is decreased
a) Respiratory rate
b) SpO2
c) Pupil size
d) Alertness
PaCO2
Alertness
76
A straight laryngoscope blade is likely to be more useful than the Macintosh blade when performing direct laryngoscopy in patients with all of the following EXCEPT
a) Large floppy epiglottis
b) Anterior larynx
c) Limited neck extension
d) Large tongue?
Small mouth opening
Limited neck extension
77
Prolonged paralysis associated with mivacurium is most appropriately managed with
a) Neostigmine
b) Sugammadex
c) Ongoing intubation, sedation and ventilation
FFP
Ongoing intubation, sedation and ventilation
78
The mechanism of action of tranexamic acid is to inhibit the formation of
a) Plasmin
b) Plasminogen
c) Protein C
a) Protein S
Plasmin
79
Local anaesthetics may exacerbate symptoms in patients with
a) Guillain-Barre syndrome
b) Motor neurone disease
c) Multiple sclerosis
a) Myasthenia gravis
Multiple sclerosis
80
According to the international consensus statement on uterotonic agents during caesarean section published in 2019, the suggested initial bolus dose of oxytocin to be administered after delivery of the fetus during an elective caesarean section is
a) 1 unit
b) 3 units
c) 5 units
10 units
1 unit
81
A patient with bipolar disorder is on long-term lithium therapy. The medication that should be avoided is
a. Ibuprofen
b. Paracetamol
c. Gabapentin
d. Oxycodone
Ibuprofen
82
A 45-year-old woman is being assessed for liver transplantation. In order to determine the severity of her liver disease the Model for End-stage Liver Disease score is derived using the international normalised ratio, serum bilirubin and
a) Creatinine
b) Albumin
c) APTT
d) Encephalopathy
Creatinine
83
The most common type of perioperative stroke is
a) Embolic
b) Thrombotic
c) Haemorrhagic
d) Hypoperfusion
e) Ischaemic
Embolic
84
A risk factor for postoperative nausea and vomiting in adults is age less than
a) 70
b) 60
c) 50
d) 40
50
85
A patient has a known IgE-mediated allergy to penicillin. The cephalosporin with the lowest risk of allergic cross-reactivity is
A) Cefalexin
b) Cefazolin
c) Cefuroxime
d) Ceftriaxone
d) Ceftriaxone
86
A 68-year-old woman presents with a loud systolic murmur in the anaesthesia room before total hip joint arthroplasty. A transthoracic echocardiogram is performed (image provided) and shows
?
87
A 78-year-old man is undergoing left heart catheter angiography. A graph displaying pressures in the aorta (Ao) and left ventricle (LV) as well as electrocardiography trace over time is demonstrated below. These pressure recordings are characteristic of
?
88
The abnormality shown in this image (image of shoulder shown) is LEAST likely to be caused by an injury to the
?
89
The biochemical diagnosis of a growth hormone (GH)-secreting tumour such as in acromegaly is based on oral glucose tolerance test demonstrating
a) Lower GH post glucose load
b) Persistently elevated GH post glucose load
c) Reduced then elevated GH levels
d) No change in GH levels
Persistently elevated GH post glucose load
90
Complex regional pain syndrome is NOT characterised by
a) Dermatomal distrubtion of pain
b) Odema
c) Temperature asymmetry
d) Motor dysfunction
Dermatomal distrubtion of pain
91
A 45-year-old woman is reviewed in the preadmission clinic. She is scheduled to undergo a microwave endometrial ablation for menorrhagia in one week’s time. Her preoperative laboratory investigations include the following blood results (full blood examination and iron studies shown). The most appropriate course of action would be to
a) Proceed without intervention
b) Start oral iron; proceed as planned
c) Dose of IV iron today; proceed as planned
d) Dose of EPO today; proceed as planned
e) 1x unit PRBC today; proceed as planned
Dose of IV iron today; proceed as planned
92
The outer diameter of an Aintree Intubation Catheter is
a) 6
b) 6.5
c) 7
d) 7.5
b) 6.5
93
Extended life plasma is thawed fresh frozen plasma which can be stored at 2 to 6 C for a maximum period of
a) 1 day
b) 2 days
c) 3 days
d) 4 days
e) 5 days
e) 5 days
94
Created by the Global Initiative for Chronic Obstructive Lung Disease, the alphabetical GOLD groups A to D are tools for the assessment of chronic obstructive pulmonary disease. These classes are based on
a) FEV 1
b) Exacerbation number
c) Symptoms
d) Exacerbation number AND symptoms
e) None
Exacerbation number AND symptoms
95
Red man syndrome as a consequence of vancomycin administration is caused by
A) IgE mediated mechanisms
b) Direct activation of mast cells and basophils
c) Direct activation of complement
d) Anaphylaxis
b) Direct activation of mast cells and basophils
96
A 35-year-old patient is undergoing a diagnostic laparoscopy. Three minutes after insufflation of CO2 her oxygen saturation falls to 85%. You note decreased air entry on the left side of her chest. Lung ultrasound on the left reveals lung pulse and no lung sliding. The best first action is to
A) Needle thoracocentesis
b) Release pneumoperitoneum
c) Ask surgeons to insert ICC
d) Insert DLT
b) Release pneumoperitoneum
97
A 26-year-old patient presents with exertional syncope. The most likely diagnosis is
a. HOCM
b. Long qt
c. Ccf
d. Myocardial ischemia
e. Aortic stenosis
HOCM
98
Bowel preparation prior to elective colorectal surgery is associated with
a) No benefit
b) Reduced SSI
c) Reduced anastamotic leaks
d) Reduced length of stay
No benefit
99
The part of the lung that is typically divided into apical, anterior and posterior segments is the
Right Superior lobe
100
The most common cause of bilateral blindness following spinal surgery and anaesthesia is
Ischaemic optic neuropathy
101
The 2012 Berlin definition of the Acute Respiratory Distress Syndrome (ARDS) defines moderate disease as one with a PaO2 / FiO2 ratio (in mmHg) of
a) <100
b) 100-200
c) 200 - 300
b) 100-200
102
This image is an apical four chamber view obtained by transthoracic echocardiography. The artery that supplies the area indicated by the arrow is the
?
103
A patient has undergone a multilevel cervical spine fusion and upon emergence from anaesthesia reports complete visual loss. Fundoscopic examination shows a pale optic disc with haemorrhages. This supports a diagnosis of
a) central retinal arterial occlusion
b) stroke
c) Anterior ischaemic optic neuropathy
d) Posterior ischaemic optic neuropathy
c) Anterior ischaemic optic neuropathy
104
An asymptomatic 65-year-old male with squamous cell carcinoma of the left lung has been referred for assessment of suitability for lung resection. There is no evidence of spread on computerised tomography scanning. PaCO2, electrocardiogram, full blood count and electrolytes are normal. His SpO2 on room air is 95%. His forced expiratory volume in one second is 2.3 litres (predicted 3.3 litres) and forced vital capacity is 3.4 litres (predicted 4.4 litres). The most appropriate course of action is to
?
105
Findings associated with massive pericardial tamponade include
a. Electrical alternans
b. Pulsus alternans
c. Kussmaul’s sign
d. Exaggerated fall in JVP on respiration?
Kussmaul’s sign
a)possibly but represents large effusion rather than tamponade
b) Due LV pathology
c) yes
d) this is the opposite to kussmaul's
106
The first-line drug recommended by both the Australian Resuscitation Council and the New Zealand Resuscitation Council to treat severe cyanide poisoning is
hydroxycobalamin (vitamin B 12 )
107
Complications of severe anorexia nervosa (body weight < 40% ideal) include all of the following EXCEPT
?
108
A patient requires a peripherally inserted central venous catheter. Electrocardiographic (ECG)- aided tip localisation is used to site the tip of the catheter. The initial ECG from the catheter is shown. The ECG when the catheter is placed appropriately will be
Maximum P wave
109
You are asked to review a patient two days after a surgically difficult total knee replacement that was undertaken under tourniquet. The anaesthesia and analgesia technique used was spinal anaesthesia in combination with an ultrasound-guided adductor canal block and high-volume local anaesthetic infiltration by the surgeon. The patient complains of a new onset of leg weakness on the operative side. The nerve LEAST likely to be involved in this weakness is the
?
110
When using an endotracheal tube in an adult, the highest recommended cuff pressure to avoid mucosal ischaemia is
30cmH20
111
A drug which does NOT increase the defibrillation threshold in a patient with an implanted cardioverter defibrillator is
Does increase:
- IB (lidocaine, phenytoin)
- Amiodaraone
Sotalol an b blockers decreases
Does increase:
IB (lidocaine, phenytoin)
Amiodaraone
Sotalol an b blockers decreases
112
The nerve labelled by the arrow in the diagram (image of brachial plexus given) is the
?
113
A test for a condition which has a prevalence of 1 in 1000 has a sensitivity of 100% and a specificity of 90%. The probability of a patient who receives a positive result actually having the condition is
a. 90%
b. 99%
c. 1%
d. 100%
1%
114
This posteroanterior chest X-ray shows enlargement of the
?
115
Your patient has been administered 50 mL of oral 5-aminolevulinic acid hydrochloride (Gliolan) three hours prior to her scheduled craniotomy for resection of a glioblastoma. Care should be taken perioperatively to avoid the adverse effect of
?
116
Anaesthesia-induced rhabdomyolysis differs from malignant hyperthermia in that it is NOT
Muscle rigidity
117
You are planning to perform a peribulbar block and wish to check the axial length of the eye prior to proceeding. The average axial length of the globe in adults as measured by ultrasound is
b. 23mm
118
A 25-year-old man suffers a 30% total body surface area burn. A physiological change expected within the first 24 hours is
Increased PVR
119
Of the following clinical conditions, difficult intubation is LEAST likely to be associated with
?
120
Somatosensory evoked potentials (SSEPs) are used to monitor spinal cord function during scoliosis surgery. They are LEAST affected by
Opioids
121
Suxamethonium may be safely given to patients with
Duchenne's muscular dystrophy
Cerebral palsy
Friedreich's ataxia
Guillain-Barre syndrome
Becker’s muscular dystrophy
Cerebral palsy
122
A 65-year-old man presents to the preadmission clinic two weeks prior to his total knee replacement. His blood results include haemoglobin 100 g/L, ferritin 20 µg/L and normal C-reactive protein. The best course of action is to
?
123
A patient’s glomerular filtration rate is estimated at 35 mL/min/1.73m2. The patient’s chronic kidney disease can be classified as Stage
3b
124
To allow cardiopulmonary bypass in a patient with heparin resistance, fresh frozen plasma may be administered in order to increase the level of
AT 3
125
The image shows results from noninferiority trials. The trial labelled N is best described a
?
126
The radial artery pressure trace shown below is from a patient who has an intra-aortic balloon pump in situ. The device has been switched to 1:2 augmentation to assess the timing. The trace shows an augmented beat followed by a nonaugmented beat. With respect to the augmentation, the trace shows
?
127
A patient is undergoing treatment for a malignant hyperthermia crisis. Active cooling should be ceased when the patient’s core temperature has dropped to
38
128
A 63-year-old woman is to undergo an elective total hip replacement. Her past medical history includes hypertension, stroke, type 2 diabetes mellitus, chronic atrial fibrillation and chronic renal impairment with an estimated creatinine clearance of 46 mL/min. Her medications include dabigatran 150 mg bd for stroke prevention. Perioperatively, her dabigatran therapy should
4 days
129
A 50-year-old man with carcinoid syndrome having a resection of a peripheral hepatic metastasis develops a sudden fall in BP from 110/70 mmHg to 85/50 mmHg without significant bleeding. The most appropriate management is
Octreotide
130
The nerve(s) that need to be blocked with local anaesthetic to achieve complete anaesthesia for amputation of the fifth toe is/are
Sureal, superficial peroneal and posterior tibial
131
A man has symptomatic carbon monoxide poisoning. His pulse oximetry (SpO2) and arterial blood gas (PaO2) would be expected to show
Normal, Normal
132
Venous air embolism during frontal craniotomy is most likely to arise from the
VAE is a complication seen in craniosynostosis repair and is most likely to occur when the head is positioned above the heart and the bony venous sinusoids or dural sinuses are exposed?
? Superior saggital sinus
133
St. John’s wort (herbal medicine Hypericum perforatum) will reduce the effects of
It may induce some cytochrome p450 enzymes, resulting in increased metabolism of many drugs including warfarin, digoxin, theophylline and oral contraceptive drugs.
134
The QRS axis for the electrocardiogram shown is
?
135
You are about to anaesthetise a 25-year-old man for an open appendicectomy. He has a history of tricuspid atresia for which he has had a Fontan procedure. An important goal in managing his ventilation under anaesthesia is to ensure
a) Hyperventilation to achieve low PaCO2
b) Minimal PEEP and inspiratory pressures
c) Tidal volumes 4-6 mL/kg
Low-normal SpO2
Minimal PEEP and inspiratory pressures
136
According to the ‘Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting (PONV)’ published in 2020, multimodal PONV prophylaxis should be implemented in adult patients
a) With 0 risk factors for PONV
b) 1 or more
c) 2 or more
3 or more
1 or more
137
When using ROTEM thromboelastometry, the APTEM test is used to assess
a) Intrinsic pathway
b) Extrinsic pathway
c) Fibrinogen function
d) Presence of hyperfibrinolysis
Presence of hyperfibrinolysis
138
Of the following, the drug that is LEAST likely to provide effective analgesia following paediatric tonsillectomy is
a) Paracetamol
b) Parecoxib
c) Dexamethasone
d) Ketamine
Clonidine
Clonidine
139
You are anaesthetising a patient for implantation of an automated implantable cardioverter defibrillator. The patient is a 48-year-old with dilated cardiomyopathy and pulmonary hypertension. The preoperative echocardiogram report states that the estimated pulmonary artery systolic pressure is 55 mmHg, and that there is mild right ventricular systolic dysfunction. To avoid worsening right ventricular function during induction, it would be best to consider using
a) Noradrenaline
b) Dobutamine
c) Adrenaline
Ketamine
Noradrenaline
140
Regarding healthcare research, the PICO framework describes
a) The study design of an RCT
b) A research question
How a study is conducted from enrolment to analysis
A research question
141
A 36-year-old man complains of left calf pain for two weeks. His pain is worse on walking but not completely relieved by sitting or lying down. On examination, he has mild weakness of left big toe extension. The most likely finding on MRI would be
a) L4 nerve root compression
b) L5 nerve root compression
c) S1 nerve root compression
S2 nerve root compression
L5 nerve root compression
142
A normal sized six-year-old girl has a haemoglobin of 70 g/L following surgery. The volume of packed red blood cells that you would plan to infuse to raise her haemoglobin to 80 g/L is
a) 250 mL
b) 100 mL
c) 70 mL
d) 60 mL
100 mL
weight x 0.5 x Hb change
= 20 (age+4x2) x 0.5 x 10
= 100mls
143
A 57-year-old female smoker presents for a laparotomy with the following pulmonary function tests (supplied) They are consistent with a diagnosis of
a) Asthma
b) COPD
c) ILD
Pulmonary HTN
?
144
A 24-year-old man with Wolff-Parkinson-White syndrome is having anaesthesia for a knee arthroscopy. During the procedure he develops the following rhythm. His blood pressure is 100/65 mmHg. The most appropriate treatment is
a) DCR
b) Digoxin 500 mcg IV
c) Amiodarone 5 mg/kg IV over 1 hour
d) Metoprolol 5 mg IV
E) Procainamide 15 mg/kg
E) Procainamide 15 mg/kg
145
The train-of-four (TOF) ratio above which the majority of anaesthetists will NOT be able to visually detect fade on TOF stimulation is
a) 0.8
b) 0.6
c) 0.4
0.2
0.4
146
A high mixed venous oxygen saturation (SvO2) is most likely to be associated with
a) Hypothermia
b) Anaemia
c) Infection
Cardiogenic shock
Hypothermia
147
You have anaesthetised a 25-year-old woman for a sleeve gastrectomy. She normally takes the oral contraceptive pill. You used rocuronium and at the end of the case reversed it with 4 mg/kg of sugammadex. Prior to discharge you should advise her to use non-hormonal contraception for the next
A) Day
B) Week
C) Month
A) 3 months
Week
148
Moderate obstructive sleep apnoea in children is diagnosed by an apnoea-hypopnoea index of
a) 1
b) 2
c) 5
d) 6
a) 10
5- 10 (unsure if recalls are correct
