2022.2 Flashcards
The knee is not innervated by
Knee innvervation
Anterior
* Nerve to vastus medialis, intermedius, lateralis
* Superior and inferior medial genicular nerve
* Superior and inferior lateral genicular nerve
* Recurrent fibular nerve
* Saphenous nerve
Posterior
* Sciatic nerve –> tibial and common peroneal nerve
* Obturator nerve
A 47-year-old man is anaesthetised for an elective laparoscopic cholecystectomy. Three minutes after induction, he is noted to have a heart rate of 130 bpm and systolic blood pressure of 60 mmHg. The most appropriate initial dose of adrenaline is
If life threatening (severe hypotension and/or severe bronchospasm): IV 50-100mcg, then 200mcg if no response
If moderate (mucocutaneous signs with hypotension and/or bronchospasm): IV 10-20mcg, then 50mcg if no response
The influence of end-stage renal disease on the plasma clearance and dose of sugammadex is that the
Total plasma clearance of sugammadex in patients with ESRD was significantly lower than that in healthy controls
Can give 2mg/kg to reverse moderate block (TOFC at least 2), 4mg/kg for deep block (TOFC 0, PTC 1-2)
Not recommended for use in patients with severe renal impairment (CrCl <30ml/min), including those requiring dialysis
A patient under general anaesthesia monitored with transcranial cerebral oximetry has a decrease in their cerebral oxygen saturation. This is likely to be improved by an increase in all of the following EXCEPT
Factors that will INCREASE cerebral oxygen saturation
* Adequate CO (optimise HR and SV)
* Optimising MAP
* Increasing O2 sats (FiO2)
* Optimise ventilation (PaCO2)
* Correct anaemia
* Deepen anaesthesia
* Stop seizure
* Avoid hyperthermia
Aim is to increase O2 delivery and to decrease O2 consumption
A 54-year-old woman has a laryngeal mask airway (LMA) inserted for a surgical procedure. The following day she complains of tongue numbness and abnormal taste over the anterior two-thirds of the tongue. The most likely site of the nerve injury is the
Lingual branch of mandibular nerve (V3)
A 30-year-old previously healthy woman is four days post-caesarean section. You are asked to see her to manage her abdominal pain. Over the last two days she has had increasing abdominal pain, increasing abdominal distension, tachycardia and nausea. An abdominal x-ray shows a caecal diameter of 9 cm. After excluding mechanical obstruction, an appropriate management option is
Conservative management
Ogilvie’s syndrome (acute colonic pseudo-obstruction)
* Cecal diameter <12cm, mild-mod abdominal pain: conservative mx, supportive care (NBM, IVF and correct electrolytes, NGT decompression)
* Cecal diameter >12cm, severe abdominal pain, failure of conservative management (72hrs): IV neostigmine 2-5mg, colonic decompression
* Refractory symptoms, ischaemic, perforation or peritonitis: surgical management
Large doses of sugammadex can potentially lead to
Bradycardia, coagulopathy
The initial management for a seizure during an awake craniotomy is
Intraoperative seizures mainly occur due to electrical cortical stimulation during brain mapping, and the seizures can be easily controlled by cortical surface irrigation with cold saline by the surgeon
If this is ineffective, low doses of IV propofol or midazolam can be administered
A patient requiring an elective major joint replacement has had a recent stroke. The minimum recommended duration between the stroke and surgery is
Previously, recommended minimum period of 3 months. Recent BJA review suggests delaying non-urgent surgery for at least 9 months after an ischaemic stroke unless the benefits of earlier surgery outweigh the increased risks of perioperative stroke during this time
A 6-year-old patient (140 cm, 24 kg, BSA 0.97m2) is on hydrocortisone 15 mg/day. Perioperative glucocorticoid supplementation is
IV hydrocortisone 2mg/kg at induction followed by infusion 100mg/24hr (if major surgery). Once enteral feeding established post-operatively, double normal hydrocortisone doses for 24-48hrs then reduce to noraml doses over up to a week, add in fludrocortisone if appropriate when enteral feeding established
For a 70-year-old patient on rivaroxaban with normal renal function a major guideline recommends proceeding with hip fracture surgery after two half-lives of the drug. This equates to
24hrs
(T1/2 rivaroxaban = 5-9hrs if CrCl >50ml/min, 9-13hrs if CrCl 30-49ml/min)
Pulse pressure variation is defined as
PPV (%) = (PPmax - PPmin) / PPmean
Change in pulse pressure which occurs over time
In Australia and New Zealand, the proportion of blood donors who are cytomegalovirus (CMV) seropositive is
~60%
In critically ill patients undergoing mechanical ventilation, energy dense enteral nutrition (1.5 kcal/mL/kg) compared to routine (1 kcal/mL/kg) enteral feeding provides
No difference in survial time, receipt of organ support, number of days alive and out of ICU and hospital or free of organ support, or the incidence of infective complications or adverse events
A patient presents with sepsis-induced hypoperfusion or septic shock. The minimum suggested volume of intravenous crystalloid to be administered over the first three hours as outlined in the Surviving Sepsis Guideline is
At least 30 mL/kg of IV crystalloid fluid should be given within the first 3 hr of resuscitation (weak recommendation, low quality evidence)
The modified Aldrete scoring system is used for determining the
Appropriateness for discharge from PACU in paediatric population
Modified Aldrete Score
* Patient activity (0-2)
* Respiration (0-2)
* Circulation (BP) (0-2)
* Consciousness (0-2)
* Oxygen saturation (0-2)
Score >9 is required for discharge from PACU
When using the ECG to time intra-aortic balloon counterpulsation, balloon inflation should occur at the
End of T wave to R (during diastole to increase coronary perfusion)
Deflation at R to end of T wave (during systole to decrease afterload)
A 45-year-old male received a heart transplant one month ago. He develops a new supraventricular tachyarrhythmia without hypotension during a gastroscopy. The most appropriate therapy is
Adenosine
A 60-year-old man remains unconscious after an isolated head injury. The systolic blood pressure (in mmHg) should be kept above
100mmHg
- SBP ≥100 mmHg for age 50-69
- SBP ≥110 mmHg for age 15-49 or ≥70
A 34-year-old for a diagnostic laparoscopy has a height of 158 cm and a weight of 120 kg (BMI 48 kg/m2). For induction of anaesthesia, appropriate drug dosing includes
Propofol, thiopentone, nNMBDs, fentanyl - LBW (~70kg in females, ~100kg in males)
Suxamethonium - TBW
Suxamethonium may be safely given to patients with (list of neuromuscular diseases given)
Myasthenia gravis
Required dose may need to be increased by up to 2-fold (relative resistance to drug)
Non-anaesthetist practitioners wishing to provide procedural sedation should have training in sedation and/or anaesthesia for a minimum of
Minimum of 3 months FTE
In a burns patient, the blood concentration of propofol is
Decreased due to increased Vd and enhanced clearance
A patient with an acute subarachnoid haemorrhage arrives in the emergency department. Her Glasgow Coma Scale score is 10 and she has no motor deficit. A CT brain shows diffuse subarachnoid haemorrhage with no localised areas of blood > 1 mm thick, and no intracerebral nor intraventricular blood. Her World Federation of Neurosurgical Societies (WFNS) grade of subarachnoid haemorrhage is
WFNS IV (GCS 7-12)
Fisher 2
Which of the following risk factors for preeclampsia in isolation would be sufficient to recommend commencing low-dose aspirin?
Multifetal gestation
Previous pre-eclampsia or HELLP
DM - type 1/2
Chronic HTN
CKD
Autoimmune diseases
Asssisted conception with oocyte donation
A 15-year-old patient with a known prolonged QT interval has a ventricular tachyarrhythmia while being monitored postoperatively in the postanaesthesia care unit. The patient is alert, orientated and without chest pain but feels unwell. The best initial management is
Magnesium
Synchronised shock if unstable
An eight-year-old child with sickle cell disease is scheduled for emergency fixation of a fractured radius. Her haemoglobin is 80 g/L. The most appropriate management is
- Child should be scheduled first on the list to minimise fasting time, need to ensure hydration
- Transfusion (TAPS study found patients had higher complications if not transfused in elective surgery)
- Maintain oxygenation and hydration, avoid acidosis, hypoxia, hypothermia, hypovolemia/hypotension, maintain normocarbia, normotension and normothermia
- Use of tourniquet based on risk vs benefit analysis
- Regional techniques are safe
During spinal surgery, the anaesthetic agent that is least likely to decrease motor evoked potentials is
Opioids
A four-year-old boy is in refractory ventricular fibrillation. The recommended dose of amiodarone is
5mg/kg
Weight = 2 x (age + 4)
The correct blood collection tube for a mast cell tryptase test is a
Plain (red)
Serum SST (gold)
Lithium heparin (green)
All patients over 70 years of age having received either spinal or general anaesthesia at Hospital X are reviewed 3 years later to assess cognitive function. The aim of the study is to determine whether exposure to general anaesthesia or spinal anaesthesia impacts cognitive function. This trial design is best described as a
Cohort study
All of the following conditions are associated with acromegaly EXCEPT
Conditions associated with acromegaly
* OSA
* Heart block
* Cardiomyopathy
* Biventricular dysfunction
* Arrhythmias
* Nerve entrapment (due to excess peripheral tissue)
* T2DM
A patient in the intensive care unit has ventricular fibrillation two hours after her coronary artery bypass graft procedure. Recommended immediate management does NOT include
External chest compressions (ECC) and full dose adrenaline
ECC can be delayed for up to 1min following identification of either VF or pVT to allow for expeditious defibrillation and to allow for institution of pacing in asystole or severe bradycardia. After this time, conventional ECC should be commenced. PEA arrest should receive immediate ECC.
Management of VF or pVT post CABG
1. 3 sequential 150J shocks
2. Amiodarone 300mg (alternatively, lignocaine 1mg/kg)
3. Prepare for emergency resternotomy within 5min
The sensor on a NIM (Nerve Integrity Monitor) endotracheal tube used for thyroid surgery directly records
Electromyograph of internal laryngeal muscles (stimulate LN and activity of vocal cord recorded displayed as sound)
A drug that is contraindicated for a patient with a history of heparin-induced thrombocytopaenia is
Prothrombinex
Heparins (due to risk of seroconversion)
The estimated proportion of human induced climate change attributable to nitrous oxide is
7%
Waste anaesthetic contribution to whole global warming = 0.1% but contribution to human induced climate change = 7%
Global warming potential of N2O is 250-300x CO2
Regarding cardiopulmonary exercise testing before major surgery, oxygen pulse is the
Oxygen consumption (VO2) divided by HR
Represents the product of stroke volume and the arterial-venous oxygen difference, can be viewed as surrogate for stroke volume, therefore should increase at start of exercise before slowly reaching a plateau at its highest predicted value
You are involved in the care of a two-year-old child who has ingested a button battery in the last four hours. You would consider giving
Honey
National Capital Poison Centre recommend Honey if child >12months old and within 12 hrs of ingestion. Risk of ingestion biggest in kids <6years old with button battery >20mm. Mucosal erosion can occur within <2hrs
The antiemetic that interferes with the effectiveness of oral hormonal contraception is
Aprepitant (NK-1 antagonist) - for up to 28 days
Despite an interscalene block being performed preoperatively for arthroscopic rotator cuff repair, a patient wakes up with posterior shoulder pain. The most appropriate procedure to consider would be a nerve block of the
Suprascapular and axillary nerve
Intraoperative lung protective ventilation strategies include all of the following EXCEPT
Lung protective ventilation strategies
* TV 6-8ml/kg (predicted body weight)
* Pplat <30cmH20
* Individualised PEEP ~5cmH2O - zero PEEP is not recommended
* I:E ratio 1:1 is not recommended
* Lowest possible FiO2 to achieve SpO2 ≥94%
An absolute contraindication to transoesophageal echocardiography is
Oesophageal stricture
Tracheoesophageal fistula
Post-oesophageal surgery
Oesophageal trauma
A 25-year-old ASA (American Society of Anesthesiologists) physical status classification I patient develops seizures five minutes after receiving a brachial plexus block with ropivacaine. Of the following, the most suitable initial intravenous treatment is
IV midazolam
IV propofol if only drug available
Regarding healthcare research, the SQUIRE guidelines describe
- SQUIRE stands for Standards for QUality Improvement Reporting Excellence
- The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare
- They are intended for reports that describe system level work to improve the quality, safety, and value of healthcare and used methods to establish that observed outcomes were due to the intervention(s).
According to National Audit Project (NAP)5, the incidence of awareness during general anaesthesia is
1/19000
- 1/8000 when NMB used
- Risk factors - female, age (younger adults but not children), obesity, anaesthetic seniority (junior trainees), previous awareness, out of hours operating, emergencies, type of surgery (obstetric, cardiac, thoracic) and use of NMB
- ASA physical status, race and use/omission of N2O were not risk factors
You are performing femoral venous cannulation in an obese man under ultrasound guidance. The image quality is suboptimal as the vein is deep. The best way to improve the image quality is to
Reduce frequency / Increase wavelength for deeper penetration
Use curvilinear probe
A patient is bleeding and her ROTEM displays a Fibtem A5 of 2 mm (normal > 4 mm). The most appropriate treatment is
Fib conc 4g
Approach to ROTEM
1. If FIBTEM a flat line, give TXA 1g and fibrinogen conc 4g
2. If FIBTEM A5 <10, give fibrinogen
- Fib conc 4g if time critical and FIBTEM A5 <8
- Otherwise give cryo 10-20U
3. If EXTEM A5 <35, give platelets
4. If EXTEM CT >90s, give FFP 2-4 units
5. If EXTEM ML >15%, give additional TXA 1g
After ceasing smoking, a patient’s immune function has effectively recovered to normal after
6 months
Smoking cessation timeline
* 12-24hrs - decrease nicotine and CO-Hb levels, improved tissue O2 delivery
* 3 weeks - improve wound healing
* 6-8 weeks - normalised sputum volumes, improved pulmonary function
* 6 months - improved immune function
The most consistent risk factor for postoperative vomiting in children is
?Hx of PONV
Risk scoring systems in children
* POVOC = strabismus surgery, age ≥3 yrs, duration of surgery >30 min and a history of PONV
* VPOP = above + multiple doses of opioids
Recirculation is a cannula position complication specific to the use of
Veno-venous ECMO
The composition of blood returned to the patient from intraoperative cell salvage shows
Clinically insignificant clotting factors and platelets
The diabetic medication that, as part of its therapeutic effect, significantly prolongs gastric emptying is
GLP-1 antagonist (exenatide)
The most likely side effect observed in the post anaesthetic care unit after the use of dexmedetomidine is
?Sedation, slow to wake
Bradycardia
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
Peak of QRS complex (R wave)
Adverse effects of the use of sodium-glucose co-transporter 2 inhibitors in the perioperative period do NOT include
Hypoglycaemia
Adverse effects of SGLT-2 inhibitors
* Euglycaemic ketoacidosis
* UTI
* AKI - polyuria, hypovolaemia, hypotension
* Increased risk of limb amputations (CANVAS trial)
The electrolyte abnormality most associated with an increased risk of laryngospasm is
Hypocalcaemia
A 21-year-old patient with a history of schizophrenia on quetiapine develops tremor, restlessness, hyperreflexia, nausea and vomiting in the post-anaesthesia care unit following an emergency laparoscopic cholecystectomy. Her heart rate is 80 / minute, blood pressure 130/90 mmHg, and her temperature is 37.0°C. The most likely diagnosis is
?Extra-pyramidal symptoms
The normal axial length of the globe of an adult eye is
22-25mm
Myopic eyes with an axial length of >26 mm are at increased risk of perforation during retrobulbar or peribulbar injection. This risk is increased by the associated likelihood of staphylomas (scleral outpouches), which typically lie posteriorly or inferiorly
A non-obese adult patient is administered a target-controlled propofol infusion for more than 15 minutes, with a constant target plasma concentration of 4 μg/ml propofol. Compared to the Marsh model, the propofol dose given by the Schnider model will be a
Smaller loading dose and smaller overall dose
You have been managing a case of malignant hyperthermia in an 80 kg man and have given a total of 400 mg of dantrolene (Dantrium). The amount of mannitol you have also administered is
3g mannitol in 1 vial of dantrolene (20mg)
400mg dantrolene = 3g mannitol x 20 vials = 60g mannitol
The smallest recommended endotracheal tube that should be railroaded over an Aintree catheter has an internal diameter of
7mm
External diameter of Aintree catheter = 6.5mm
According to ANZCA PS54(A), an anaesthetic machine requiring electrical power must, in the event of mains power failure, be able to operate under battery backup power for a minimum of
30 minutes
You are inserting a pulmonary artery catheter in an intubated patient prior to cardiac surgery and a significant amount of blood appears in the endotracheal tube. The most appropriate specific initial management is to
WIthdraw PAC 2cm and insert DLT
An analgesic which is a category A drug using the Australian and New Zealand categories for prescribing medicines in pregnancy is
Paracetamol
A thoracic regional technique that will NOT provide analgesia for sternal fractures is a
Erector spinae plane block
A 72-year-old man with peripheral vascular disease presents for a femoral angioplasty and is currently taking aspirin. Regarding the perioperative management of his aspirin
Continue
In preschool-aged children having tonsillectomy under general anaesthesia, delirium is more likely with the use of
Volatile
72-year-old woman on aspirin presents to her ophthalmologist for follow-up three days after you performed a transconjunctival peribulbar block for cataract surgery on her left eye. She complains of painless periorbital swelling, erythema, and mild chemosis which started the day after surgery but is improving. She had a peribulbar block three weeks ago for surgery on the other eye. The most likely diagnosis is
Subconjunctival haemorrhage
You have diagnosed anaphylaxis in an eight-year-old girl having an appendicectomy. She weighs 20 kg and has refractory bronchospasm despite an adrenaline (epinephrine) infusion running at 15 mcg/min. The recommended initial dose of salbutamol (100 mcg/puff) via metered dose inhaler is
12 puffs
> 6 years old: 12 puffs
<6 years old: 6 puffs
For a skewed distribution of data the best measure of dispersion of data is the
Interquartile range
The analgesic drug with the most favourable Number Needed to Treat (NNT) for neuropathic pain is
Amitriptyline (NNT 3.6)
The most common complication of extracorporeal membrane oxygenation (ECMO) in adults is
Bleeding
A 25-year-old male has continued postoperative bleeding after an extraction of an impacted third molar tooth under a general anaesthetic. The patient mentions that his father bruises quite easily. His coagulation screen reveals: (provided). The most likely diagnosis is
If prolonged APTT with normal PT, BT and platelet count, likely Haemophilia A (more common than Haemophilia B) - and being X linked, more likely in this case being male
Blockade of the superficial cervical plexus includes the
Greater auricular nerve
Lesser occipital nerve
Transverse cervical nerve
Supraclavicular nerve
You will anaesthetise a 39-year-old woman for a laparoscopic cholecystectomy. She has a history of mastocytosis and has never had an anaesthetic in the past. A drug which you should avoid is
Anything that increases histamine release
Can premed with midaz, use antihistamine (evidence for this lacking), fentanyl and prop safe, paracetamol safe, NSAIDS is controversial, can use roc, no contraindication to have muscle relaxant reversal, try and use regional where possible
A test for a condition which has a prevalence of 1 in 1,000 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
1%
A woman experiences a postpartum haemorrhage associated with uterine atony that is unresponsive to oxytocin and ergometrine. The recommended intramuscular dose of carboprost (15-methyl prostaglandin F2 alpha) to be administered is
IM 250mcg q15min up to 2mg
Intramyometrial 500mcg
A patient has blunt chest trauma. A thoracotomy is indicated if the immediate blood drainage after closed thoracostomy is greater than
Initial drainage of >1500 ml blood or ongoing output >200 ml/hr for 2–4 h should prompt surgical exploration to be considered
Anterior spinal artery syndrome would NOT result in
Loss of proprioception, vibration or fine touch
It would result in loss of pain and temperature however
The amount of intravenous potassium chloride required to raise the plasma potassium level from 2.8 mmol/L to 3.8 mmol/L in a normal adult is approximately
100mmol
A five-month-old child is to undergo routine elective morning surgery. Current ANZCA guidelines advise minimum fasting intervals prior to anaesthesia of
4 hours formula
3 hours breast milk
1 hour clear fluids (3ml/kg)
In >6 months: 6 hours formula, 4 hours breast milk, 1 hour clear fluids
Of the following, the condition that is an absolute contraindication to administration of electroconvulsive therapy is
Recent MI or cerebrovascular accident
Raised ICP
But none is absolute ??
Your patient underwent a stellate ganglion block two hours ago. Prior to discharge you are asked to review the patient in recovery because of a droopy upper eyelid. The patient would also be expected to have ipsilateral
Miosis, anhidrosis
Horner’s syndrome - ipsilateral ptosis, miosis, anhidrosis
A raised (> 140% predicted) single-breath diffusing capacity of the lung for carbon monoxide (DLCO) can be caused by
Obesity, asthma, polycythaemia
You are performing a focused cardiac ultrasound in the postanaesthesia care unit on a patient who is hypotensive for unclear reasons. His heart rate is 100 beats/min. The left ventricular velocity time integral is 10 cm. The left ventricular outflow area is 3 cm2. The left ventricular ejection fraction is 25%. The right ventricular systolic pressure is 40 mmHg. The inferior vena cava diameter is 20 mm. The estimated cardiac output is
3L/min
CO = SV x HR
SV = LVOT area x LVOT VTI = 3 x 10 = 30cm^3 = 30ml
CO = 30ml x 100 beats/min = 3000ml/min = 3L/min
Of the following, the congenital condition LEAST commonly associated with obstructive sleep apnoea in children is
Conditions associated with paediatric OSA
* Down
* Crouzon
* Apert
* Treacher-Collins
* Pierre-Robin
* Pfeiffer syndromes
* Cerebral palsy
An open Ivor-Lewis oesophagectomy is performed via a
Upper midline laparotomy + Right thoracotomy
Of the following, the procedure that is most commonly associated with chronic pain after surgery is
Amputation
Followed by thoracotomy
Of the following, all are useful for the treatment of status epilepticus EXCEPT
Drugs used for management of status epilepticus in adults
* BZDs - clonazepam, diazepam, lorazepam, midazolam
* Phenobarbitone, thiopentone
* Phenytoin
* Propofol
When used for prolonged analgesia in a healthy adult, the recommended maximum dose of ropivacaine via continuous infusion or bolus dosing in a 24-hour period is
770mg
According to the RELIEF study, in major abdominal surgery a liberal fluid strategy (10 mL/kg of crystalloid at induction followed by 8 mL/kg/hour during the case) compared to a restrictive fluid strategy, results in
No difference in disability-free survival up to 1 year after surgery
No difference in composite of 30 day mortality or major septic complications (sepsis, surgical-site infection, anastomotic leak or pneumonia)
The prevention of microbial contamination of living tissues or sterile materials is known as
Asepsis
A 45-year-old man is ventilated in the intensive care unit and is in a critical state. His pulmonary artery wedge pressure is 26 mmHg, cardiac index is 1.7 L/minute/m2 and his PaO2/FiO2 ratio is 200 mmHg. A decision is made to place him on extracorporeal membrane oxygenation. The most appropriate mode is
Veno-arterial (VA-ECMO)
* Provides both gas exchange and haemodynamic support
* Used in cardiac conditions with low CO (CI <2L/min/m2) and hypotension (SBP <90mmHg) despite inotropic and intra-aortic balloon pump support
VV-ECMO is used for respiratory support only and provides no haemodynamic support - indications typically ARDS, status asthmatimus, massive haemoptysis or pulmonary haemorrhage, bridge to lung transplant, support for lung resections in unstable patients
AV-ECMO facilitates gas exchange by using the patient’s own arterial pressure to pump the blood from arterial to venous side. Used if cardiac index >2.5L/min/m2 (normal 2.5-4.2L/min/m2)
A 48-year-old man is day two post-laparoscopic high anterior resection. He has used 42 mg of intravenous morphine in the past 24 hours. You wish to start him on oral tapentadol immediate release. The most appropriate equianalgesic dosage would be
IV 40mg morphine = PO 120mg morphine = PO 400mg tapentadol
During an infraclavicular approach to the brachial plexus, the tip of the needle is positioned closest to the
Lateral cord
The Pin Index System positions on a C size cylinder of medical oxygen are
2 and 5
Air is 1 and 5
O2 is 2 and 5
N2O is 3 and 5
CO2 is 1 and 6
In a previously normal patient with cardiac failure secondary to acute pulmonary embolism, the best choice of vasoactive agent for initial treatment is
Dobutamine
Dopamine
Noradrenaline
You are reviewing a primigravida at 32 weeks gestation with a Fontan circulation in the anaesthetic preassessment clinic. Peripartum care should avoid the use of
Drugs that increase PVR - alpha agonists
Drugs that have negative inotropic effects - beta blockers
Cyclooxygenase type 2 inhibitors (COX-2) in pregnancy are considered
Celecoxib category B3
Parecoxib category C
NSAIDS in general
Category D in 3rd trimester
Category B in 1st and 2nd trimesters
Compared to a normothermic patient, a patient with mild intraoperative hypothermia (35.0C) will have
Impaired platelet function, coagulation cascade
Increased relative risk of transfusion
Increased incidence of surgical site infection
Delayed recovery - prolonged action of volatile, propofol, opiates, neuromuscular block
Increased rate of cardiac events
The 2012 Berlin definition of the acute respiratory distress syndrome (ARDS) defines moderate disease as one with a PaO2 / FiO2 ratio (in mmHg) of
100-200mmHg with PEEP 5cmH2O
Mild 200-300mmHg
Moderate 100-200mmHg
Severe <100mmHg
Normal (0.9%) saline has the physical properties of
Isotonic
Iso-osmotic
pH 4.5-8.0
Osmolality 296mOsm/L
The medication most strongly associated with an acute primary hypotensive reaction following transfusion of blood products is
ACE inhibitors
Due to excess of bradykinin -> vasodilation -> hypotension
A patient has return of spontaneous circulation (ROSC) but remains unresponsive after cardiac arrest. ANZCOR Guidelines recommend all the following measures EXCEPT
Post-resuscitation care
* Re-evaluate ABCDE
* 12 lead ECG
* Treat precipitating causes
* Aim for SpO2 94-98%, normocapnia and normoglycaemia
* Avoid hypoxia and hyperoxia
* Targeted temperature management
* AGAINST routine seizure prophylaxis, but recommends treatment of seizures
1 MAC of sevoflurane affects the sensory evoked potential signal for spinal surgery by
Dose-related increase in latency and decrease in amplitudes - adequate SSEPs can usually be recorded at <1 MAC
But lesser in degree compared to desflurane (i.e. at the same MAC, desflurane has a stronger inhibitory effect than sevoflurane)
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
Lower frequency
Higher amplitude
At surgical levels of GA - Slow delta 1-4Hz and alpha oscillations 8-12Hz
Analysis of variance (ANOVA) is a statistical test to determine
If there is a statistically significant difference between two or more categorical groups by testing for differences of means using a variance
Created by the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2017), the numerical GOLD classes 1 to 4 are classes of severity for chronic obstructive pulmonary disease (COPD). These classes are
based on an assessment of the
Post-bronchodilator FEV1 (compared to predicted)
In patients with FEV1/FVC <0.7:
GOLD 1 (mild) - FEV1 ≥80% predicted
GOLD 2 (moderate) - 50% ≤ FEV1 <80% predicted
GOLD 3 (severe) - 30% ≤ FEV1 <50% predicted
GOLD 4 (very severe) - FEV1 <30% predicted
The drug of choice for the treatment of duct-dependent congenital heart disease is
PGE1 alprostadil
Predictors of difficult sedation (agitation or inability to complete the procedure) of patients undergoing gastroscopy do NOT include
Factors in SCOPE score for gastroscopy
* Young adults
* Reflux, oesophagitis, Barrett’s
* Male gender
* Psychiatric history
* BZD or opioid use
* Presence of GI trainee
Factors in SCOPE score for colonoscopy
* Young adults
* Diagnostic colonoscopy
* Female gender
* BMI <25
* Tobacco use
* BZD or opioid use
* Other psychoactive medication use
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
Routine rectal administration of 100mg diclofenac or indomethacin immediately before ERCP
A 72-year-old patient is undergoing resection of an anterior skull based tumour using a combined endoscopic and frontal craniotomy approach. Seven hours into the procedure she has a large diuresis of pale urine and
you suspect she may have developed diabetes insipidus. The most
Serum sodium, paired serum and urine osmolality
The amount of fresh frozen plasma that needs to be administered (in mL/kg) to increase plasma fibrinogen levels by 1 g/L is
30ml/kg of FFP
100mls of cryoprecipitate
Unsupported ventilation in a non-anaesthetised patient with long-standing tetraplegia is improved when
Patient is positioned supine or in Trendelenburg position
Drug classes demonstrated to reduce mortality in chronic heart failure with reduced ejection fraction include all of the following EXCEPT
Digoxin - reduces HF hospitalisation but not all cause mortality
Drugs used in HFrEF - ACE inhibitors, ARBs, beta blockers, spironolactone
The use of intraoperative dexamethasone for tonsillectomy
Reduces the risk of PONV
Overall risk of post-tonsillectomy haemorrhage in children is not significantly increased by the perioperative use of dexamethasone
When using an endotracheal tube in an adult, the highest recommended cuff pressure to avoid mucosal ischaemia is
30cmH2O
Accepted norm 20-30cmH2O
According to the ANZICS Statement on Death and Organ Donation 2021, circulatory determination of death in the context of organ donation requires the absence of evidence of circulation for at least
5 minutes
A six-year-old child weighing 20 kg presents to hospital two hours after sustaining a burn to 25% of her body. Appropriate fluid management should include 1000 mL Hartmann’s solution in the next
6 hours
4 x 25 x 20 = 2L
1L in first 8 hours, and 2 hours already past therefore 6 hours
Dabigatran differs from rivaroxaban and apixaban because it inhibits
Thrombin (factor IIa)
Rivaroxaban and apixaban inhibits factor Xa
The recommended antibiotic prophylaxis for surgical termination of pregnancy is
Possible regimens:
1. PO doxycycline 100mg pre-op and 200mg post-op
2. PO doxycycline 400mg 10-12hr pre-op
3. PO metronidazole 2g + 1g azithromycin pre-op in those at high risk of infection
