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Part 2 MCQ > 2023.1 > Flashcards

2023.1 Flashcards

1
Q

A level two check of the inhalational anaesthesia delivery device does NOT include checking the
a. Check accuracy of delivered vapour concentration with regard to manufacturer?s specifications
b. Ensure electricity is connected to vaporisers that require it
c. Ensure all filling ports are sealed
d. Check correct seating, locking and interlocking of detachable vaporisers
e. Anaesthetic liquid level within marked limits

A

a. Check accuracy of delivered vapour concentration with regard to manufacturer?s specifications

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2
Q

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 greater than 1mm thick, and no intracerebral or intraventricular blood. Her World Federation of Neurosurgical Societies (WFNS) grade of subarachnoid haemorrhage is
a. I
b. II
c. III
d. IV
e. V

A

d. IV

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3
Q

A patient will open her eyes in response to voice, speak with inappropriate words and withdraw to a painful stimulus. Her Glasgow Coma Scale score is
a. 7
b. 8
c. 9
d. 10
e. 11

A

d. 10

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4
Q

A newborn baby is pale, limp, grimacing with stimulation, gasping weakly, and has a pulse rate of 90 beats per minute. This corresponds to an Apgar score of
a. 1
b. 2
c. 3
d. 4
e. 5

A

c. 3

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5
Q

A diagnosis of metabolic syndrome is NOT supported by
a. Abdominal obesity
b. High triglycerides
c. Impaired glucose tolerance
d. High HDL cholesterol
e. High blood pressure

A

d. High HDL cholesterol

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6
Q

A patient with long-term severe anorexia nervosa is commenced on a normal diet. Three days later she develops cardiac failure and exhibits a decreased level of consciousness. The most important parameter to assay and normalise is the plasma
a. Phosphate
b. Potassium
c. Sodium
d. Glucose
e. Chloride

A

a. Phosphate

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7
Q

A Laser-Flex tube has a double cuff with two separate pilot balloons. The correct colours of the pilot balloons are that
a. Proximal balloon is white, distal balloon is blue
b. Proximal balloon is blue, distal balloon is white
c. Both balloons are white
d. Both balloons are blue

A

a. Proximal balloon is white, distal balloon is blue

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8
Q

The difference between a size 5.0 microlaryngeal tube (MLT) and a standard size 5.0 endotracheal tube is that the size 5 MLT
a. Longer length
b. Outer diameter different
c. Inner diameter different
d. Smaller cuff size

A

a. Longer length

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9
Q

You have diagnosed malignant hyperthermia in a person weighing 80 kg. Australian and New Zealand guidelines recommend an initial dose of dantrolene (Dantrium) of
a. 8
b. 10
c. 12
d. 20
e. 32

A

b. 10

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10
Q

According to Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) anaphylaxis guidelines for adults, cardiopulmonary resuscitation should commence at a systolic blood pressure of less than
a. 30
b. 40
c. 50
d. 60
e. 70

A

c. 50

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11
Q

According to the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) guidelines for the investigation of a suspected anaphylactic reaction, serum tryptase should be measured at
a. 0, 1, 4, >24 hours
b. 0, 6, >24 hours
c. 1, 4, >24 hours
d. 1, 6, >24 hours

A

a. 0, 1, 4, >24 hours

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12
Q

One metabolic equivalent (1 MET) is defined as the
a. Oxygen consumed walking at 4km/hr
b. Oxygen consumed at rest
c. Energy expended walking at 4km/hr
d. Energy expended at rest

A

b. Oxygen consumed at rest

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13
Q

ANZCA recommends that after confirmed COVID-19 infection, non-urgent elective major surgery should be delayed for a minimum of
a. 2 weeks
b. 4 weeks
c. 6 weeks
d. 7 weeks
e. 8 weeks

A

a. 2 weeks

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14
Q

In patients without other comorbidities, bariatric weight loss surgery is indicated when the body mass index (kg/m2) is greater than
a. 25
b. 30
c. 35
d. 40
e. 45

A

d. 40

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15
Q

Reviewing the below image (ultrasound image shown), in order to safely perform an erector spinae block the probe needs to be moved

Intercostal view (ribs) instead of TP
a. Laterally
b. Medially
c. Caudal
d. Cephalad

A

b. Medially

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16
Q

An absolute contraindication to skin prick testing for the diagnosis of allergies is
a. Recent antihistamine use
b. Patient on beta-blockers
c. Pregnancy
d. Severe dermatographia
e. Severe asthma

A

d. Severe dermatographia

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17
Q

Findings associated with massive pericardial tamponade include
a. Electrical alternans
b. Pulsus alternans
c. Kussmaul?s sign
d. Exaggerated fall in JVP on respiration?

A

a. Electrical alternans
c. Kussmaul?s sign

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18
Q

Suxamethonium may be safely given to patients with
a. Duchenne’s muscular dystrophy
b. Cerebral palsy
c. Friedreich’s ataxia
d. Guillain-Barre syndrome
e. Becker?s muscular dystrophy

A

b. Cerebral palsy

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19
Q

A patient is undergoing a posterior spinal fusion with somatosensory evoked potential (SSEP) monitoring. Ischaemia is suggested by
a. Decreased amplitude, decreased latency
b. Decreased amplitude, increased latency
c. Increased amplitude, increased latency
d. Increased amplitude, decreased latency

A

b. Decreased amplitude, increased latency

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20
Q

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 ?g/mL propofol. Compared to the Marsh model, the propofol dose given by the Schnider model will be a
a. Smaller bolus and smaller overall amount
b. Smaller bolus and larger overall amount
c. Larger bolus and smaller overall amount
d. Larger bolus and larger overall amount
e. Larger bolus, while total amount will depend on length of the infusion

A

a. Smaller bolus and smaller overall amount

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21
Q

The neurosurgical registrar has telephoned about a patient with a spinal cord tumour who is on the list for tomorrow. The registrar tells you the patient has Brown-S quard syndrome (hemisection of the spinal cord). On clinical examination, below the level of the lesion, you would expect to find all EXCEPT

The initial recall and options said
?Brown sequard syndrome (hemisection of the spinal cord) results in everything ipsilateral
EXCEPT:?

Have added ipsilateral to all options
a. Ipsilateral Paralysis
b. Ipsilateral Loss of pain and temperature
c. Ipsilateral Loss of proprioception
d. Ipsilateral Hyperreflexia

A

b. Ipsilateral Loss of pain and temperature

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22
Q

A patient requiring an elective major joint replacement has had a recent stroke. The minimum recommended duration between the stroke and surgery is
a. 6 weeks
b. 3 months
c. 6 months
d. 9 months
e. 12 months

A

Depending on guideline
c. 6 months
d. 9 months

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23
Q

The antiemetic action of aprepitant is via receptors for
a. Substance P
b. Neurokinin A
c. Serotonin
d. Dopamine
e. NMDA

A

a. Substance P

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24
Q

Of the following, the drug which is most effective in the management of severe hyperthermia in serotonergic syndrome is
a. Dantrolene
b. Diazepam
c. Paracetamol
d. Rocuronium

A

d. Rocuronium

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25
Q

The nerve labelled with the arrow in the diagram is the (diagram of the brachial plexus shown)

This picture, no labels, pointing at this nerve
a. Musculocutaenous nerve
b. Median nerve
c. Axillary nerve
d. Ulnar nerve
e. Radial nerve

A

a. Musculocutaenous nerve

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26
Q

According to National Audit Project (NAP) 5, the incidence of awareness during general anaesthesia for lower segment caesarean section should be quoted as
a. 1:700
b. 1:8000
c. 1:20000
d. 1:36000
e. 1:140000

A

a. 1:700

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27
Q

The glucagon-like peptide-1 receptor (GLP-1) agonist semaglutide is associated with
a. Decreased gastric emptying
b. Hypoglycemia
c. Euglycaemic ketoacidosis
d. Weight gain
e. Lactic acidosis

A

a. Decreased gastric emptying

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28
Q

In cardiac surgery a low-normal central venous pressure and a low blood pressure with a hyperdynamic heart is suggestive of
a. LV failure
b. Hypovolaemia
c. Vasoplegia
d. Tamponade
e. Coronary occlusion/spasm

A

c. Vasoplegia

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29
Q

The odds ratio is the measure of choice for a
a. Case control
b. Cohort
c. Randomised control trial
d. Observational studies

A

a. Case control

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30
Q

In a patient with glucose-6-phosphate dehydrogenase deficiency (G6PD), the intravenous agent that should be avoided is
a. Methylene blue
b. Iodised contrast
c. Gadolinium contrast
d. Indocyanine green

A

a. Methylene blue

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31
Q

A drug that is NOT useful for the treatment of vasoplegic shock is
a. Dobutamine
b. Dopamine
c. Hydroxocobalamin
d. Vasopressin
e. Methylene blue

A

a. Dobutamine

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32
Q

You are called to assist in the resuscitation of a 75-year-old patient in the emergency department who is in extremis with severe hypotension and hypoxaemia. The image shown is of a focused transthoracic echocardiogram, parasternal short axis view. The most likely diagnosis is

Tiny LV. RV was blown out.
a. Cardiac tamponade
b. Anterior STEMI
c. Pulmonary embolism
d. Massive pleural effusion

A

c. Pulmonary embolism

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33
Q

In Australia and New Zealand, the proportion of blood donors who are cytomegalovirus (CMV) seropositive is
a. 6 - 8.5 per 100
b. 60-85 per 100
c. 60-85 per 1000
d. 60-85 per 10,000
e. 6 - 8.5 per million

A

b. 60-85 per 100

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34
Q

In preschool-aged children having tonsillectomy under general anaesthesia, delirium is more likely with the use of
a. Dexamethasone
b. Intranasal ketamine
c. Volatile anaesthetic use
d. Remifentanil at the end of the case

A

c. Volatile anaesthetic use

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35
Q

According to the Fourth Consensus Guidelines for the Management of Post-operative Nausea and Vomiting (PONV) published in 2020, multimodal PONV prophylaxis should be implemented in adult patients
a. Regardless of no. of risk factors
b. 1 or more
c. 2 or more
d. 3 or more

A

b. 1 or more

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36
Q

An otherwise healthy child with a history of leukaemia four years ago, now in remission, has an American Society of Anesthesiologists (ASA) classification of at least
a. I
b. II
c. III
d. IV
e. V

A

b. II

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37
Q

A patient presents for a transurethral resection of the prostate (TURP). He had a single drug-eluting coronary stent for angina pectoris inserted six months ago and is taking clopidogrel and aspirin. The most appropriate preoperative management of his medications is to
a. Cease both clopidogrel and aspirin
b. Cease clopidogrel for 5 days
c. Cease clopidogrel for 10 days
d. Ceased clopidogrel for 5 days and aspirin for 10 days
e. Continue both DAPT

A

b. Cease clopidogrel for 5 days

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38
Q

You are called to an airway emergency in the intensive care unit. A 40-year-old woman with morbid obesity and pneumonia had an elective percutaneous tracheostomy inserted eight hours previously. She is sedated, paralysed and ventilated. After being turned for pressure care, she desaturates and there is no clear CO2 trace on capnography. The tracheostomy tube is still in the neck but you are concerned it has been displaced. Your immediate management should be to
a. Reintubate from above
b. Use a fibreoptic scope to assess the position of the tracheostomy
c. Place an airway exchange catheter down the stoma
d. Pass a gum elastic bougie through tracheostomy
e. Needle cricothyroidotomy

A

a. Reintubate from above

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39
Q

The initial treatment of a trigeminocardiac reflex during skull base surgery should be
a. Cease surgical stimulation
b. IV atropine
c. Local anaesthetic infiltration
d. Change to TIVA
e. Increase neuromuscular blockade

A

a. Cease surgical stimulation

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40
Q

Application of a pacemaker magnet to a dual-chamber implanted pacemaker would be expected to convert the operating mode to
a. VOO
b. DDD
c. DOO
d. AOO
e. VVI

A

c. DOO

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41
Q

Of the following drugs, the LEAST suitable for managing atrial arrhythmias in a patient with a left ventricular assist device is
a. Amiodarone
b. Digoxin
c. Metoprolol
d. Diltiazem
e. Bisoprolol

A

d. Diltiazem

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42
Q

A 72-year-old woman on aspirin therapy 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 also had a peribulbar block three weeks ago for surgery on the other eye. The most likely diagnosis is
a. Hyalase allergy
b. Conjunctivitis
c. Retrobulbar haemorrhage
d. Post operative oedema

A

d. Post operative oedema

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43
Q

A technique which is NOT effective in providing analgesia for a sternal fracture is a
a. PEC 1 block
b. PEC 2 block
c. Sub pectoral block
d. Transverse thoracic block
e. Parasternal block

A

a. PEC 1 block

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44
Q

The medication most strongly associated with an acute primary hypotensive reaction following transfusion of blood products is
a. Aspirin
b. Ibuprofen
c. Hydralazine
d. Metoprolol
e. Perindopril

A

e. Perindopril

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45
Q

The dose of hydrocortisone that has equivalent glucocorticoid effect to dexamethasone 8 mg is
a. 50mg
b. 100mg
c. 200mg

A

c. 200mg

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46
Q

For a woman who has a history of preeclampsia in a previous pregnancy, the intervention with the best evidence for prevention of preeclampsia during future pregnancies is
a. Magnesium 1g PO daily
b. Aspirin 150mg PO daily
c. Calcium was an option

A

b. Aspirin 150mg PO daily

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47
Q

A man has symptomatic carbon monoxide poisoning. His pulse oximetry (SpO2) and arterial blood gas (PaO2) would be expected to show
a. Normal SpO2, decreased PaO2
b. Normal SpO2, normal PaO2
c. Decreased SpO2, decreased PaO2
d. Decreased SpO2, normal PaO2

A

b. Normal SpO2, normal PaO2

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48
Q

According to the Revised Cardiac Risk Index, a 72-year-old male scheduled for a laparoscopic cholecystectomy with a history of hypertension, 20 pack-year history of smoking, type 2 diabetes requiring insulin and a previous stroke has a score of
a. 1
b. 2
c. 3
d. 4
e. 5

A

c. 3

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49
Q

A patient has an acute attack of shingles (herpes zoster). The development of post-herpetic neuralgia can best be reduced by the administration of
a. Aciclovir
b. Amitriptyline
c. Pregabalin
d. Gabapentin

A

b. Amitriptyline

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50
Q

Lowest risk cardiac condition in paediatrics for surgery?

APPEARS TO HAVE BEEN REMOVED
a. Fontan or Glenn shunt procedure
b. Severe LV failure
c. Pulmonary hypertension with pulmonary pressures equal to systemic pressures
d. Systemic pulmonary shunt
e. Complex unrepaired congenital heart disease

APPEARS TO HAVE BEEN REMOVED

A

a. Fontan or Glenn shunt procedure

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51
Q

In a 21-year-old man with an isolated acute severe traumatic brain injury, systolic blood pressure should be maintained at a level equal to or greater than
a. >90mmHg
b. >100 mmhg
c. >110mmHg
d. >120mmHg

A

c. >110mmHg

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52
Q

The technique of airway pressure release ventilation
a. Prolonged expiration to reduce CO2
b. Augment cardiac output in hypovolaemia
c. High pressure ventilation to improve recruitment
d. Spontaneous ventilation
e. Used for hypoxaemia in restrictive lung disease

A

c. High pressure ventilation to improve recruitment

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53
Q

Pulse pressure variation is defined as:
a. PP max - PP min / PP min
b. PP max - PP min / PP mean
c. SBP max - SBP min / SBP min
d. SBP max - SBP min / SBP mean

A

b. PP max - PP min / PP mean

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54
Q

Cerebral salt wasting and syndrome of inappropriate antidiuretic hormone secretion (SIADH) have the following common features EXCEPT for
a. Extracellular volume depletion
b. Low serum sodium
c. High urine sodium
d. High urine osmolality
e. Low uric acid concentration

A

a. Extracellular volume depletion

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55
Q

The glossopharyngeal nerve does NOT supply sensory innervation to the
a. Anterior portion of the epiglottis
b. Tonsils
c. Oropharynx
d. Anterior ? of the tongue

A

d. Anterior ? of the tongue

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56
Q

You are using intraoperative cell salvage during a high-risk caesarean section. The salvaged blood has been washed and reinfused through a leukodepletion filter. This process should remove all of the following EXCEPT
a. Fetal red cells
b. Vernix
c. Fetal squamous cells
d. Amniotic fluid

A

a. Fetal red cells

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57
Q

A central venous catheter is recognised as being inadvertently placed in the common carotid artery five hours after insertion. The most appropriate management is
a. Remove and apply pressure
b. Open repair
c. Balloon tamponade
d. Perctuanous closure device

A

b. Open repair
d. Perctuanous closure device

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58
Q

The function of the (electrical) earth conductor in operating theatre patient monitoring equipment is to
a. Prevent electrocution
b. Prevent circuit overload
c. Prevent microshock

A

a. Prevent electrocution

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59
Q

Tranexamic acid is NOT useful for managing
a. GI bleeding
b. Post cardiac surgery
c. Obstetric surgery
d. Trauma
e. Intracranial injury

A

a. GI bleeding

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60
Q

A multitrauma patient is being managed with a resuscitative endovascular balloon occlusion device of the aorta (REBOA) as part of damage control resuscitation. The balloon has been inserted for intractable pelvic bleeding. The most appropriate location for the device placement is between the
a. Descending aorta and above coeliac plexus
b. Below coeliac plexus and above aortic bifurcation
c. Below coeliac plexus and above renal artery
d. Below renal artery and above aortic bifurcation

A

d. Below renal artery and above aortic bifurcation

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61
Q

You are performing a regional block for analgesia following knee surgery. You have an ultrasound probe scanning the anterior mid-thigh. The muscle indicated by the arrow in the ultrasound image below is the

No labels, just pointing at the muscle above the artery
a. Sartorius
b. Gracilis
c. Adductor magnus
d. Adductor longus
e. Vastus medialis

A

a. Sartorius

62
Q

The tip of an ideally-placed intra-aortic balloon catheter should lie in the
a. Ascending aorta distal to AV
b. Ascending aorta and right brachiocephalic artery
c. Descending aorta and distal to left common carotid artery
d. Descending aorta and distal to the left subclavian artery

A

d. Descending aorta and distal to the left subclavian artery

63
Q

During neonatal resuscitation, the pulse oximeter should be placed on the
a. Right hand
b. Left hand
c. Right leg
d. Left leg

A

a. Right hand

64
Q

Carbon monoxide poisoning, half life when given 15L by non-rebreather mask

APPEARS TO BE REMOVED
a. 30 minutes
b. 60 minutes
c. 90 minutes
d. 120 minutes
e. 240 minutes

APPEARS TO BE REMOVED

A

c. 90 minutes

65
Q

Cryoprecipitate contains coagulation factors
a. I, VIII, XIII, Vwf
b. II, VIII, XIII, Vwf
c. II, VII, VWF
d. I, VII, vWF

A

a. I, VIII, XIII, Vwf

66
Q

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
a. Lupus anticoagulant
b. Laboratory error
c. Haemophilia A
d. Cryoglobulinaemia
e. Cold agglutinins

A

a. Lupus anticoagulant

67
Q

A feature of citrate toxicity following massive blood transfusion is
a. Metabolic acidosis
b. Hyperkalaemia
c. Narrow pulse pressure
d. Hypothermia

A

c. Narrow pulse pressure

68
Q

Three-factor prothrombin complex concentrate reverses warfarin therapy within
a. Within 5 minutes
b. Within 15 minutes
c. Within an hour
d. 2 hours
e. 4 hours

A

b. Within 15 minutes

69
Q

Double sequential external defibrillation is performed by applying two shocks from
a. Single set of pads, something something
b. Single set of pads, something something
c. Two sets of pads, at the same time
d. Two sets of pads, <1 second apart
e. Two sets of pads, <5 seconds apart

A

d. Two sets of pads, <1 second apart

70
Q

The nerve most likely to be inadequately anaesthetised with an incomplete interscalene brachial plexus block is the
a. Posterior interosseous nerve
b. Subscapular
c. Median cutaneous nerve
d. ?

A

c. Median cutaneous nerve

71
Q

The next patient on your endoscopy list is a 50-year-old woman who has been scheduled for gastroscopy and colonoscopy under sedation, after unsatisfactory proceduralist-supervised midazolam and fentanyl sedation in the past. She states that she has egg anaphylaxis and carries an adrenaline (epinephrine) auto-injector. The most appropriate agent to use for her sedation is
a. Propofol
b. Ketamine
c. Sevoflurane
d. Remifentanil

A

a. Propofol

72
Q

The following is a chest X-ray from a patient complaining of dyspnoea after thoracic surgery. The diagnosis is

Looked like a sail sign
a. Left lobe collapse
b. Left pneumothorax
c. Pleural effusion
d. Ectatic aorta
e. Cardiac herniation

A

a. Left lobe collapse

73
Q

The bioavailability of an oral dose of ketamine is approximately
a. 20%
b. 30%
c. 50%
d. 60%
e. 80%

A

a. 20%

74
Q

A 30-year-old woman has her bipolar disorder well controlled with lithium therapy. The analgesic agent LEAST suitable for her is
a. Ibuprofen
b. Paracetamol
c. Gabapentin
d. Oxycodone

A

a. Ibuprofen

75
Q

A 58-year-old man with alcohol-related cirrhosis is booked to undergo a transjugular intrahepatic portosystemic shunt (TIPS) procedure. The calculation of his MELD-Na score to estimate his mortality risk requires all of the following EXCEPT
a. Albumin
b. Creatinine
c. Sodium
d. INR
e. Bilirubin

A

a. Albumin

76
Q

A woman who is to undergo a caesarean section reports that she is allergic to amoxicillin. The reaction is limited to a rash. For surgical antimicrobial prophylaxis, you should administer
a. Cefazolin
b. Vancomycin
c. Gentamicin
d. Clindamycin

A

a. Cefazolin

77
Q

A third heart sound at the apex may be heard in
a. Hypertension
b. Aortic stenosis
c. Mitral valve prolapse
d. Atrial fibrillation
e. Normal in under 45 year olds

A

c. Mitral valve prolapse

78
Q

HOCM murmur is

APPEARS TO HAVE BEEN REMOVED
a. Louder with squatting
b. Quieter with valsalva
c. Radiates to the carotids
d. Radiates to suprasternal notch
e. Loudest at apex

APPEARS TO HAVE BEEN REMOVED

A

d. Radiates to suprasternal notch

79
Q

A nerve that does NOT provide sensory innervation to the shoulder joint is the
a. Lateral pectoral nerve
b. Supraclavicular
c. Axillary
d. Suprascapular
e. Subscapular

A

b. Supraclavicular

80
Q

The use of erythropoietin before major surgery results in
a. Decreased transfusion, increased thrombosis risk
b. Decreased transfusion, decreased thrombosis
c. Same transfusion, decreased thrombosis
d. Decreased transfusion, similar thrombosis risk

A

d. Decreased transfusion, similar thrombosis risk

81
Q

The BALANCED Anaesthesia Study compared older patients having deep anaesthesia (bispectral index target of 35) to lighter anaesthesia (bispectral index target of 50). It assessed postoperative mortality, and a substudy assessed postoperative delirium. These showed that, compared to light anaesthesia, deep anaesthesia causes
a. Similar 1 year mortality, decreased POCD
b. Worse 1 year mortality, decreased POCD
c. Similar 1 year mortality, increased POCD
d. Similar 1 year mortality, similar POCD

A

c. Similar 1 year mortality, increased POCD

82
Q

Desufflation after surgical pneumoperitoneum is NOT associated with an increase in
a. Cardiac output
b. Cardiac work index
c. Heart rate
d. Systemic vascular resistance
e. Ejection fraction

A

d. Systemic vascular resistance

83
Q

OSA has increased risk perioperatively of:

APPEARS TO HAVE BEEN REMOVED
a. AMI
b. Unplanned admission after ambulatory surgery
c. Respiratory events
d. Mortality

APPEARS TO HAVE BEEN REMOVED

A

c. Respiratory events

84
Q

A patient you anaesthetised for a cervical fusion reports rapidly progressing unilateral visual loss commencing two days postoperatively. Fundoscopic examination reveals optic disc oedema. The most likely diagnosis is
a. Central retinal artery occlusion
b. Posterior ischaemic optic neuropathy
c. Anterior ischaemic optic neuropathy
d. Cortical blindness
e. Retinal detachment

A

c. Anterior ischaemic optic neuropathy

85
Q

A 35-year-old woman is brought to the emergency department following a suspected amitriptyline overdose. She has a Glasgow Coma Scale score of 6 and her blood pressure is 90/46 mmHg. Her electrocardiogram is most likely to show
a. Complete heart block
b. Sinus bradycardia with widened QRS
c. Sinus tachycardia with widened QRS

A

c. Sinus tachycardia with widened QRS

86
Q

A new antiemetic reduces the risk of postoperative vomiting by 20%. In a population with a baseline risk of postoperative vomiting of 10%, the number needed to treat is
a. 10
b. 20
c. 25
d. 50

A

d. 50

87
Q

Anaesthesia-induced rhabdomyolysis differs from malignant hyperthermia in that it is NOT
a. Muscle rigidity
b. Increase etCO2
c. Hyperkalaemia
d. Myoglobinuria
e. Triggered by volatiles

A

a. Muscle rigidity

88
Q

Expected features of Guillain-Barr syndrome include
a. Descending motor loss
b. Unilateral paralysis
c. Flaccid paralysis
d. Low protein in CSF
e. Altered conscious state

A

c. Flaccid paralysis

89
Q

A feature that is atypical of multiple sclerosis is
a. Optic neuritis
b. Motor weakness
c. Aphasia
d. Diplopia
e. Unilateral paraesthesia

A

c. Aphasia

90
Q

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

A

d. 3b

91
Q

A patient is suffering an acute myocardial infarction. Australian and New Zealand guidelines recommend the threshold for the use of supplemental oxygen is when the SpO2 falls below
a. 89%
b. 93%
c. 97%
d. 100%

A

b. 93%

92
Q

To provide anaesthesia to the medial malleolus, the key nerve to block is the
a. Saphenous nerve
b. Sural nerve
c. Tibial nerve
d. Superficial peroneal nerve
e. Deep peroneal nerve

A

a. Saphenous nerve

93
Q

Of the following, the drug that is LEAST likely to provide effective analgesia following paediatric tonsillectomy is
a. Ketamine
b. Paracetamol
c. Clonidine
d. Parecoxib
e. Dexamethasone

A

c. Clonidine

94
Q

Rotational thromboelastometry (ROTEM) is performed on a bleeding patient with the following series of graphs produced. The most appropriate therapy to be administered is

Recall details:
ROTEM. FIBTEM A10 7mm. INTEM and EXTEM ML 100%. APTEM normal.
a. Cryoprecipitate
b. TXA
c. FFP
d. Platelets

A

b. TXA

95
Q

A patient with idiopathic pulmonary hypertension has had a right heart catheter with the following results. The transpulmonary gradient is

Recall Details:
Patient has RHC. Calculate transpulmonary gradient. MPAP 40mmHg. PCWP 13mmHg.
a. 27mmHg
b. 50mmHg

A

a. 27mmHg

96
Q

In children, severe sleep apnoea is suggested by an apnoea-hypopnoea index greater than
a. 5
b. 10
c. 15
d. 20
e. 30

A

b. 10

97
Q

During standard diagnostic nocturnal polysomnography for investigation of obstructive sleep apnoea, apnoea is defined as cessation of airflow for
a. 10 seconds
b. 20 seconds
c. 30 seconds
d. 10 seconds OR desaturation of 3% or greater
e. 20 seconds OR desaturation of 3% or greater

A

a. 10 seconds

98
Q

Under the NEXUS criteria, requirements to clear the cervical spine of trauma patients without radiographic imaging include all of the following EXCEPT
a. Full range of motion (no pain on full neck movement)
b. No midline tenderness
c. Absence focal neurology
d. Normal alertness
e. No distracting injury

A

a. Full range of motion (no pain on full neck movement)

99
Q

A 40-year-old woman is administered a nerve block for extraction of her right lower wisdom tooth. The nerve that should be blocked is the
a. Inferior alveolar nerve
b. Mental nerve
c. Inferior trochlear nerve
d. Lingual nerve

A

a. Inferior alveolar nerve

100
Q

The sensory supply of the external nose is provided by all of the following nerves EXCEPT the
a. Supratrochlear
b. Anterior ethmoidal
c. Lacrimal nerve
d. Infratrocheal

A

c. Lacrimal nerve

101
Q

You are asked to review a 5-year-old child weighing 24 kg in the recovery room for acute pain management after a tonsillectomy performed for obstructive sleep apnoea. The most appropriate analgesic regimen would be

Recall Info
?Painstop contains 24mg of paracetamol and 1mg of codeine phosphate.?
Stupid Question
a. Regular paracetamol, regular ibuprofen, tramadol PRN
b. Some options with regular/PRN painstop, either paracetamol or ibuprofen (not
both) and either tramadol or oxycodone IR
c. Reg Parac, Reg Ibuprofen, Oxycodone PRN

A

c. Reg Parac, Reg Ibuprofen, Oxycodone PRN

102
Q

A 50-year-old man presents with a subarachnoid haemorrhage. He undergoes cerebral angiography and the frontal view is shown below. His cerebral aneurysm is in the
Sort of looked like this, aneurysm was midline
a. Anterior communication artery
b. Middle meningeal artery
c. Ophthalmic artery
d. Middle cerebral artery

A

a. Anterior communication artery

103
Q

The Sequential Organ Failure Assessment (SOFA) score is used in intensive care for the assessment of sepsis. This score does NOT include the
a. Glasgow coma score
b. Platelet count
c. PaO2/FiO2 ratio
d. Serum lactate
e. Serum bilirubin

A

d. Serum lactate

104
Q

To assist with guiding intravenous fluid resuscitation in adults with sepsis or septic shock, the 2021 Surviving Sepsis Guidelines suggest using any of the following EXCEPT
a. Echocardiography
b. Hourly urine output
c. Response to passive leg raise
d. Response to IV fluid bolus
e. Pulse pressure variation

A

b. Hourly urine output

105
Q

According to the categorisation system used in Australia and New Zealand for prescribing medicines safely in pregnancy, category X denotes drugs which are
a. Absolutely contraindicated
b. Safe throughout
c. Safe only in 1st trimester
d. Safe in 3rd trimester until 48 hours prior to birth
e. No permanent harm

A

a. Absolutely contraindicated

106
Q

Despite two separate 300 IU/kg doses of heparin, you have failed to attain your target activated clotting time prior to instituting cardiopulmonary bypass. An appropriate option now would be to give
a. FFP
b. More heparin
c. LMWH
d. Bivalirudin

A

a. FFP

107
Q

A 36-year-old woman sustains an injury to her left arm and presents with pain. She informs you that she experiences unpleasant intermittent and spontaneous shooting sensations in her arm. This sensation is
a. Dysasthesia
b. Allodynia
c. Paraesthesia
d. Hyperalgesia
e. Hyperaesthesia

A

a. Dysasthesia

108
Q

In order to provide anaesthesia of the scalp for awake craniotomy, it is necessary to block branches of the
a. Trigeminal, greater auricular, greater occipital
b. Trigeminal, greater auricular, lesser occipital
c. Greater auricular, lesser occipital, greater occipital
d. Trigeminal, Lesser occipital, greater occipital, greater auricular

A

d. Trigeminal, Lesser occipital, greater occipital, greater auricular

109
Q

Self-report of pain in children is usually possible by the age of
a. 4 years
b. 6 years
c. 8 years
d. 10 years
e. 12 years

A

a. 4 years

110
Q

Therapeutic privilege is defined as
a. Withholding information which is thought to be harmful to the patient.
b. Getting a coffee break during your morning list.
c. Giving a certain treatment to one population group only.
d. Only allowing certain clinicians to perform certain procedures.

A

a. Withholding information which is thought to be harmful to the patient.

111
Q

This 12 lead ECG shows

Something like this
a. LAF + RBBB
b. LPF + RBBB
c. Complete heart block
d. Mobitz 1
e. Mobitz 2

A

a. LAF + RBBB

112
Q

A woman is having a potentially curative primary breast cancer resection. Compared with a sevoflurane and opioid technique, using a regional anaesthesia-analgesia technique with paravertebral block and a propofol infusion will result in
a. Reduce incisional pain at 6 months
b. Reduce neuropathic pain at 6 months
c. Reduce neuropathic pain at 1 year
d. Reduce cancer recurrence
e. No impact on pain or cancer recurrence

A

c. Reduce neuropathic pain at 1 year
e. No impact on pain or cancer recurrence

113
Q

A healthy woman is admitted to the obstetric unit with threatened preterm labour at 29 weeks gestation. Her blood pressure is 140/80 mmHg. A magnesium sulfate infusion is indicated for the purpose of
a. Tocolysis
b. Seizure prevention
c. Fetal lung maturation
d. Fetal neuroprotection
e. Treat hypertension

A

d. Fetal neuroprotection

114
Q

A 65 year old women is having a knee arthroplasty. What is the most predictive for chronic post operative pain?
A. Anxiety
B. Catastrophising
C. Depression
D. Female
E. Pain at other sites

A

B. Catastrophising

115
Q

Following the insertion of a peripherally inserted central catheter (PICC) into the cephalic vein in the upper arm, the patient complains of numbness in their forearm. It is likely that during insertion the operator has injured the
a. Medial brachial cutaneous nerve?
b. Medial antebrachial nerve?
c. lateral antebrachial cutaneous nerve

A

c. lateral antebrachial cutaneous nerve

116
Q

A 69-year-old man is dyspnoeic and complains of right shoulder tip pain whilst in the postanaesthesia care unit after a laparoscopic-assisted anterior resection. A focused thoracic ultrasound is performed and an image of the right lung is shown below. This represents
a. Normal lung
b. Subcut emphysema
c. Pneumothorax
d. Collapse/consolidation

A

a. Normal lung

117
Q

An adult patient undergoing surgical aortic valve replacement is in ventricular fibrillation after the removal of the aortic cross clamp and requires internal defibrillation. It has been shown it is safe to deliver a charge of up to
a. 10J
b. 20J
c. 50J
d. 100J
e. 200J

A

c. 50J

118
Q

Of the following drugs, the LEAST likely to cause pulmonary vasodilation when used at low doses in patients with chronic pulmonary hypertension is
a. Dopamine
b. Vasopressin
c. Prostacyclin
d. Milrinone
e. Dobutamine

A

a. Dopamine

119
Q

Compared to a continuous epidural infusion, patient controlled epidural analgesia does NOT reduce

Updated answer
a. Clinical workload
b. Motor block
c. Dose of local anaesthesia
d. Instrumental delivery rate
e. Caesarean section rate

A

e. Caesarean section rate

120
Q

The causes of macrocytic anaemia include
a. Liver disease
b. Thalassaemia
c. Renal failure
d. Vitamin E deficiency

A

a. Liver disease

121
Q

Patients with rheumatoid arthritis and the most common form of atlantoaxial instability have a widened atlantodental interval. This is measured between the
a. Posterior aspect of the anterior arch of C1 to the anterior aspect of the dens
b. Anterior aspect of the posterior arch of C1 to the posterior aspect of the dens
c. Anterior aspect of the anterior arch of C1 to the posterior aspect of the dens
d. Posterior aspect of the posterior arch of C1 to the anterior aspect of the dens

A

a. Posterior aspect of the anterior arch of C1 to the anterior aspect of the dens

122
Q

Patient with hereditary angioedema having emergency surgery. What medication should be administered as prophylaxis?

APPEARS TO HAVE BEEN REMOVED
a. Icatibant 30mg subcut 2 hour prior to surgery
b. FFP
c. Danazole 600mg orally 2 hours prior to sugery
d. Steroids
e. Definitely no berinert as an option

APPEARS TO HAVE BEEN REMOVED

A

Management of patients who present for emergency surgery will
require preoperative infusion of C1-INH concentrate (Berinert)

123
Q

Burns sustained from electrocardiography equipment during magnetic resonance imaging (MRI) scanning are minimised by
a. Shaved skin
b. Looped leads
c. Leads close to skin
d. Low impedance leads
e. Wet skin

A

a. Shaved skin

124
Q

A 25-year-old woman has critical bleeding following major trauma. Her blood group is unknown. Fresh frozen plasma that she receives should ideally be from
a. Group AB
b. Group A
c. Group B
d. Group O

A

a. Group AB

125
Q

Sacubitril use reduces the plasma levels of
a. Neprilysin
b. Angiotensin converting enzyme
c. BNP
d. Angiotensin II
e. NT-pro-BNP

A

e. NT-pro-BNP

126
Q

Features of hypocalcaemia include all of the following EXCEPT
a. Hallucinations
b. Laryngospasm
c. Polydipsia
d. Circumoral tingling
e. Prolonged QTc

A

c. Polydipsia

127
Q

Type 3 vWD has epistaxis. First line management?

APPEARS TO HAVE BEEN REMOVED
a. TXA
b. DDAVP
c. Factor VIII
d. Factor VIIa

APPEARS TO HAVE BEEN REMOVED

A

a. TXA

128
Q

A 65-year-old man with hypertension, type 2 diabetes and significant obstructive sleep apnoea on CPAP is scheduled for an abdominoperineal resection, with a high dependency unit admission planned postoperatively. He currently takes a calcium channel blocker, a sodium-glucose cotransporter 2 (SGLT2) inhibitor and metformin. ANZCA guidelines recommend withholding SGLT2 inhibitors
a. Withhold 1 day prior to surgery and day of surgery
b. WIthhold 2 days prior to surgery and day of surgery
c. Withhold 3 days prior to surgery and day of surgery
d. Do not withhold, perform ketones and base excess on day of surgery

A

b. WIthhold 2 days prior to surgery and day of surgery

129
Q

A 24-year-old man has been brought into the emergency department with a traumatic fracture of the femur. His observations are: heart rate 90 beats per minute; blood pressure 120/80 mmHg; respiratory rate 25 breaths per minute. A peripheral VENOUS blood gas sample shows a pH of 7.29. The arterial blood pH can be estimated to be
a. 7.29
b. 7.32
c. 7.35
d. 7.38
e. 7.41

A

b. 7.32

130
Q

The success rate of stopping smoking before surgery is NOT improved by
a. Clonidine
b. Bupropion
c. Nicotine replacement
d. SSRI
e. Individual counselling

A

d. SSRI

131
Q

A 63-year-old man has undergone a right pneumonectomy for malignancy. Twelve hours postoperatively he suddenly develops profound hypotension and shock. Clinical examination reveals a raised central venous pressure. The most useful IMMEDIATE action would be to
a. Position left lateral
b. Clamp open chest tube
c. Insert new chest tube
d. Prepare for rethoracotomy
e. Periocardiocentesis

A

a. Position left lateral

132
Q

Causes of exhaled carbon dioxide detection following oesophageal intubation include all of the following EXCEPT
a. CO2 insufflation on gastroscopy
b. Lots of gas while you were face mask ventilating
c. Recent carbonated drink intake
d. Tip of tube at tracheooesophageal fistula
e. Large bronchopleural fistula

A

e. Large bronchopleural fistula

133
Q

According to the ANZICS Statement on Death and Organ Donation (2021), for the diagnosis of brain death after resuscitation and return of circulation following cardiorespiratory arrest, clinical testing should be delayed for at least
a. 12 hours
b. 24 hours
c. 48 hours
d. 72 hours
e. 96 hours

A

b. 24 hours

134
Q

The following pressure-volume loop is displayed on your ventilator screen. The shape of this loop indicates
a. Too much PEEP
b. Overdistension
c. Underinflation
d. Optimal?

A

?

135
Q

In patients with primary adrenal insufficiency, a markedly elevated renin is most likely due to
a. Underdosed fludrocortisone
b. Underdose cortisol
c. Overdose fludrocortisone
d. Overdose cortisol

A

a. Underdosed fludrocortisone

136
Q

You are planning to extubate a patient following airway surgery. The patient has FAILED the cuff-leak test when
a. <110ml cuff leak
b. >110ml cuff leak
c. Audible leak with cuff inflated
d. Audible lead with cuff deflated

A

a. <110ml cuff leak

137
Q

A patient with severe abdominal trauma develops acute respiratory distress syndrome. A diagnosis of abdominal compartment syndrome is confirmed if the patient also has a sustained intraabdominal pressure greater than
a. >8
b. >12
c. >20mmHg
d. >24

A

c. >20mmHg

138
Q

Ongoing cerebral seizure activity induced by electroconvulsive therapy should be medically terminated after
a. 30 seconds
b. 60 seconds
c. 90 seconds
d. 120 seconds
e. 240 seconds

A

d. 120 seconds

139
Q

The initial management for a seizure during an awake craniotomy is
a. Cold water
b. Propofol
c. Keppra
d. Midazolam

A

a. Cold water

140
Q

Consideration for same-day discharge in an ex-premature infant after orchidopexy for undescended testis would be suitable at a minimum postmenstrual age of
a. 46 weeks PMA
b. 54 weeks PMA
c. 58 weeks PMA

A

b. 54 weeks PMA

141
Q

You are called to recovery to review an 80-year-old woman after neck of femur fracture fixation performed under general anaesthesia with a fascia iliaca block. She has a history of mild dementia. She has become confused and agitated after initially being cooperative and is pain-free. The most appropriate drug therapy to manage her is intravenous
a. IV fentanyl
b. IV haloperidol
c. IV midazolam
d. IV dexmedetomidine

A

b. IV haloperidol

142
Q

In a 20-year-old with cystic fibrosis, the most likely finding on pulmonary function tests is
A. Mixed pattern
B. Obstructive pattern with reduced FEV1
C. Restrictive pattern with normal DLCO
D. Obstructive pattern with normal DLCO
E. Obstructive pattern with reduced DLCO

A

It would largely depend on the stage of disease.

Obstructive alone would be the classic picture.
Restrictive and abnormal DLCO will come late in disease progression.

Out of the given options I would choose D

143
Q

A 75-year-old man has this right heart catheter trace as part of his investigation of dyspnoea. His pulmonary capillary wedge pressure is 24 mmHg. The most likely diagnosis is
a. Left heart failure
b. Portopulmonary syndrome
c. Pulmonary arterial hypertension
d. Pulmonary embolism
e. Pulmonary fibrosis

A

a. Left heart failure

144
Q

The parameter that changes most with increasing age in the otherwise normal lung is the
a. Closing capacity
b. Functional residual capacity
c. FEV1
d. RV
e. TLV

A

a. Closing capacity

145
Q

A five-year-old child weighing 25 kg is to be strictly nil by mouth overnight following a laparotomy. The most appropriate fluid prescription is
a. 0.45% saline and 5% glucose 45ml/hr
b. 0.45% saline and 5% glucose 65ml/hr
c. 0.9% saline and 5% glucose at 45ml/hr
d. 0.9% saline and 5% glucose at 65ml/hr

A

d. 0.9% saline and 5% glucose at 65ml/hr

unwell so 2/3 maintenance

146
Q

Diagnostic criteria for adult systemic inflammatory response syndrome include all of the following EXCEPT
a. Hypotension
b. Tachypnoea
c. Hyperthermia
d. Leukopenia
e. Tachycardia

A

a. Hypotension

147
Q

The main advantage of using noradrenaline (norepinephrine) over phenylephrine for the prevention of hypotension as a result of spinal anaesthesia for elective caesarean section is
a. Less maternal bradycardia
b. Less maternal hypotension
c. Better foetal APGARs
d. Better foetal cord gas
e. Less foetal bradycardia

A

a. Less maternal bradycardia

148
Q

In subarachnoid block for caesarean section, hyperbaric local anaesthetic compared to regular local anaesthetic has been shown to reduce the
a. Faster onset of anaesthesia
b. More adequate anaesthesia
c. Higher block
d. More hypotesnion

A

a. Faster onset of anaesthesia

149
Q

In order to minimise the risk of cardiac arrhythmia, surgical diathermy has been designed to operate with
a. High frequency
b. High voltage
c. Low frequency

A

a. High frequency

150
Q

This Doppler trace obtained by transoesophageal echocardiography of the descending aorta suggests

Some picture like this with flow reversal
a. Aortic dissection
b. Aortic stenosis
c. Aortic regurgitation
d. Normal flow
e. High flow state

A

c. Aortic regurgitation

Part 2 MCQ (7 decks)

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