2023.2 Flashcards
A patient who underwent a thoractomy 6 months ago reports ongoing pain caused by light brushing of clothes against the skin on the chest wall. This is known as
a. Allodynia
b. Hyperalgesia
c. Dysasthesia
d. Paresthesia
a. Allodynia
According to Australian and New Zealand Committee on Resuscitation (ANZCOR) guidelines, during advanced life support for ventricular fibrillation, adrenaline 1mg should be administered
Adrenaline (1 mg), when indicated, should be administered after rhythm analysis (ñ shock), at the time of recommencement of CPR
The Sequential Organ Failure Assessment (SOFA) score is used in intensive care for the assesment 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
d. Serum lactate
In an adult patient with reduced mouth opening, insertion of a classic design LMA may be easier than with other supraglottic airways because of its
?deflatable cuff
?ability to contour the primary curve
You are asked to assess a patient in the intensive care unit who has a tracheostomy that may have become dislodged. To assess if the tracheostomy is patent you should NOT
Should NOT trial ventilation through potentially displaced tube to assess patency
SHOULD pass suction catheter
SOULD remove inner cannula, speaking valve and cap
Albumin is contraindicated in
TBI
A bleeding patient has ROTEM results including (ROTEM results shown). The most appropriate treatment is
(normal FIBTEM, EXTEM A5 low)
a. Give platelets
b. Cryo
c. Blood
d. FFP
e. TXA
a. Give platelets
A 56-year-old patient presents with exertional syncope. The most likely diagnosis is
a. HOCM
b. AS
c. Long QT
d. Cardiac failure
e. Postural hypotension syndrome
a. HOCM
The shoulder joint receives sensory innervation from all of the following nerves EXCEPT the
a. Lateral pectoral nerve
b. Supraclavicular
c. Axillary
d. Suprascapular
e. Subscapular
b. Supraclavicular
The most likely diagnosis for the following electrocardiograph is
a. Was -45 deg
a. Was -45 deg
The nerve labelled with an arrow in the diagram below (diagram of lumbar plexus shown) is
a. Genitofemoral
b. Iliohypogastric
c. Ilioinguinal
d. Lateral femoral cutaneous
e. Obturator
Obturator
A pregnant woman requires a caesarean section delivery within 30 minutes for fetal distress. Her body mass index (BMI) is 26 kg/m2. She has multiple sclerosis with lesions in her brain and spinal cord and receives monthly injections of the disease-modifying drug ofatumumab. The most appropriate plan for her delivery is
a. GA
b. CSE
c. Spinal
d. Epidural
Spinal
The needle whose tip is pictured is a
a. Tuohy
b. Sprotte
c. Whittacre
d. Quincke
a. Tuohy
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. Posterior aspect of the anterior arch of C1 to the anterior aspect of the dens
Abdominal compartment syndrome is defined by the presence of end-organ dysfunction with a lower limit of abdominal pressure measured at
a. 10mmHg
b. 20mmHg
c. 30mmHg
d. 40mmHg
e. 50mmHG
20mmHg
Pulmonary hypertension is defined as a mean pulmonary arterial pressure greater than
a. 15mmHg
b. 20mmHg
c. 25mmHg
d. 30mmHg
20mmHg
Of the following, the patient characteristic associated with an increased risk of developing severe bone cement implantation syndrome is
a. Male
b. Diuretics
c. Previous cement implantation syndrome
a. Male
b. Diuretics
An inappropriate irrigation solution when using monopolar diathermy during transurethral resection of prostate would be
a. 0.9% NaCl
b. Glycine
c. Others that were non conductive
a. 0.9% NaCl
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
c. High pressure ventilation to improve recruitment
The modified Aldrete scoring system uses all of the following EXCEPT the
paeds ? DC from PACU: Activity, respiration, circulation, consciousness & O2 sats
The ventilator waveforms shown represent
(This image was included in the recall document but not entirely sure what it represents)
a) ARDS
b) Gas trapping
c) Circuit leak
d) Obstructive disease
e) Patient triggered breathing
?
An absolute contraindication to transoesophageal echocardiography is
a. Oesophageal diverticulum
b. GORD
c. Oesophageal stricture
d. Varices
e. One other
Oesophageal stricture
According to the ATACAS trial, the continuation of low-dose aspirin prior to cardiac surgery is associated, in the postoperative period, with
a. Increased PRBC
b. Increase plt
c. Higher return to OT for bleeding
d. No difference in myocardial infarct
e. Decreased MI
No difference in myocardial infarct
A 43-year-old man is undergoing an elective endovascular coiling procedure for an 8 mm middle cerebral artery aneurysm. Midway through the procedure the interventionalist tells you they have ruptured the aneurysm. All of the following are appropriate initial interventions EXCEPT
A. Continue coiling
B. Protamine
C. Induce mild hypotension
D. Urgently to theatre
E. Mild hyperventilation
D. Urgently to theatre
A patient will open her eyes in response to voice, speak with inappropriate words andwithdraw to a painful stimulus. Her Glascow Coma Scale score is
a. 7
b. 8
c. 9
d. 10
e. 11
d. 10
Intravenous dexmedetomidine use does NOT result in
does result in
preservation of mm tone
preservation of ventilatory reflexes
spontaneous and evoked movements
awakening to external stimuli
once roused pts are cooperative and can typically obey simple instructions
?
The risk of developing postherpetic neuralgia may be reduced by treating acute herpes zoster (shingles) with
a. Aciclovir
b. Amitriptyline
c. Pregabalin
d. Gabapentin
b. Amitriptyline
Rapid reversal of the anticoagulant effect of dabigatran can be achieved with
a. Idarucizumab
b. Prothrombinex
c. Others that were wrong
a. Idarucizumab
The muscle or muscle group with the greatest sensitivity to the action of non-depolarising neuromuscular blocking agents is/are the
a. Pharyngeal muscles
b. Adductor pollicis
c. Diaphragm
d. Orbicularis occuli
e. Other that was wrong
a. Pharyngeal muscles
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
a. Increased minute ventilation
b. Deepen anaesthesia
c. Increase haematocrit
d. Increase MAP
a. Increased minute ventilation
Based on this tracing (single ECG lead shown), the mode in which this pacemaker is operating
a. VDD
b. VVI with intermittent loss of capture
c. VVI with intermittent loss of sensing
a. VVI with intermittent loss of capture
Elimination of remifentanil occurs following breakdown mainly by
Plasma esterases
RBC esterases
Hoffman degradation
Hepatic Metabolism
Plasma esterases
A patient who has had a previous axillary nodal dissection and who does not have lymphoedema of the affected arm presents for surgery. On the affected arm
Can do anything
Synchronised direct current cardioversion is NOT indicated when the arrhythmia is
Automatic rhythms (ectopic atrial tachycardia, MAT, sinus tachycardia), unlike reentry arrhythmias, are not responsive to electrical cardioversion
In a 20-year-old with cystic fibrosis, the most likely finding on pulmonary function tests is
a. Mixed obstructive and restrictive
b. Obstructive only
c. Restrictive only
d. Other wrong answers
a. Mixed obstructive and restrictive
Dulaglutide reduces blood glucose by
a. Delaying gastric emptying
b. Increasing incretin
a. Delaying gastric emptying
Ongoing cerebral seizure activity induced by electroconvulsive therapy should be medically terminated after
a. 30s
b. 60s
c. 90
d. 120 secs
e. 240s
120 secs
Characteristics of post-operative visual loss due to vertebrobasilar ischaemia include
Posterior cerebral artery infarcts result in contralateral homonymous hemianopia
The odds ratio is the measure of choice for a
retrospective (case-control) studies, where the total number of exposed people is not available,
The diagnostic criterion for severe obstructive sleep apnoea in adults is an apnoea/hypopnoea index of at least
a. AHI >5
b. >10
c. >20
d. >30
e. >35
> 30
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
a. 450mg
b. 600mg
c. 770mg
d. 1200mg
770mg
In a cardiac transplant recipient, hypotension due to general anaesthesia is least likely to respond to
indirect agents
anticholinergics
indirect agents
anticholinergics
When the infraclavicular approach is used, the brachial plexus is blocked at the level of the
cords
(roots, trunks, divisions, cords, branches)
cords
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
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
E. Increased systemic vascular resistance
The Myocardial Injury after Non Cardiac Surgery study showed elevated troponin in the first three post-operative days was strongly associated with
30 day mortality
The National Audit Project 6 found that the most common early clinical feature of perioperative anaphylaxis was
a. Hypotension
b. Anaphylaxis
c. Reduced ETCO2
d. Rash
e. Bronchospasm
a. Hypotension
You are inducing anaesthesia in a 20-year-old female through a cannula which was inserted in the right antecubital fossa while she was in the emergency department. After 10 ml of propofol has been injected, she complains of severe pain and it becomes clear that the cannula is intra- arterial. The most appropriate management is
-Elevate arm improves venous + lymphatic drainage
-Give analgesia and reassure patient
A patient with a history of restless leg syndrome is agitated in the post-anaesthesia care unit. After excluding other causes, the best treatment of the agitation in this patient is
a. Midazolam
b. Fentanyl
c. haloperidol
a. Midazolam
A man with a history of obesity and obstructive sleep apnoea has just had a transsphenoidal pituitary resection. Soon after extubation he is semi-conscious and is making a respiratory effort but has near complete upper airway obstruction with stridor. His arterial oxygen saturation is 93% and starting to fall. Your first actions should be to
Upper airway obstruction with stridor = laryngospasm
Probably in order:
PEEP
Propofol
If fails then paralysis
Measures to avoid venous air embolism when inserting an internal jugular central venous catheter in an awake patient include all of the following EXCEPT
- When placing catheters, the CVP should be raised (to decrease the pressure gradient) by placing the patient in the Trendelenburg position
- be ensured that patients are adequately hydrated to prevent hypovolemia and to increase CVP.
- Avoiding placement of venous catheters during inspiration when negative intra-thoracic pressure is at its maximum
- When there is no guide wire in place, the operator should occlude the needle hub with their thumb
- avoid a short subcutaneous path to the jugular vein, whenever possible
Diffusing capacity of the lungs for carbon monoxide (DLCO) is decreased in all of the following EXCEPT
Increased DLCO conditions:
Pulm Haemorrhage
Polycythaemia
Obesity
Asthma
A patient who is day 3 post laparotomy has used 30 mg oxycodone intravenously via patient controlled analgesia in the last 24 hours. The approximate oral morphine equivalent daily dose is
IV oxycodone = 3 x OMMED
3 x 30 = 90mg
The recommended dose of IV adrenaline in a 15 kg, 5 year old child with grade 2 (moderate) perioperative anaphylaxis is
a. 5mcg
b. 15mcg
c. 30mcg
d. 50mcg
e. 150mcg
30mcg
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 37.0øC. The most likely diagnosis is
Hyperreflexia = serotonin syndrome
Nausea and vomiting = serotonin syndrome
However nil tachycardia and normotensive
Normal temp
The success rate of stopping smoking before surgery is NOT improved by
a. Clonidine
b. Bupropion
c. Nicotine replacement
d. SSRI
e. Individual counselling
d. SSRI
The condition for which you would have a lower arterial oxygen saturation target is
COPD (Co2 retainers)
Stoke (hyperoxia is harmful)
In the thigh, the adductor canal is bordered by all of the following EXCEPT
a. Sartorius
b. Saphenous nerve
c. Adductor longus
d. Vastus medialis
e. Gracilis
e. Gracilis
When performing cannulation of the median cubital vein the structure that is LEAST likely to be inadvertently punctured or damaged is the
a) Ulnar artery
b) Brachial artery
c) Median nerve
d) MCN of forearm
e) Radial nerve
Radial nerve
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 K bolus
b. 10 mmol K bolus
c. 5mmol K infusion
d. 10mmol L infusion
e. Others
a. 5 mmol K bolus
You wish to place the tip of a central venous line at the cavo-atrial junction in an adult, which on a chest X-ray is at a level
2 vertebral levels above the carina
b. 1 vertebral level above the carina
c. At the carina
d. 1 vertebral level below the carina
e. 2 vertebral levels below the carina
e. 2 vertebral levels below the carina
In the POISE study the use of beta blockers on the day of surgery as a cardio protective strategy in high risk patients has been associated with
a. Increase mortality
b. Decrease hypotension
c. Increase heart rate?
d. Increased rate of myocardial infarction?
a. Increase mortality
Following denervation injury to muscles, critical hyperkalaemia associated with suxamethonium administration can occur as early as
?72 hours
A 25-year-old man suffers a burn involving 30% of his total body surface area. A cardiovascular physiological change expected within the first twenty-four hours is
Increased CI
Decreased SVR
Increased PVR
Increased hepatic flow
Increased stroke volume
Increased PVR
For an adult patient with septic shock, the 2021 Surviving Sepsis Guidelines suggest using procalcitonin to guide
a. Start antibiotics
b. Stop antibiotics
c. Start steroids
d. Stop steroids
Stop antibiotics
ANZCA guidelines recommend that under general anaesthesia, blood pressure should be measured no less frequently than every
5 minutes
10 minutes
15 minutes
10 minutes
Suxamethonium is safe to use for muscle relaxation in a patient with
a. Duchenne’s muscular dystrophy
b. Cerebral palsy
c. Friedreich’s ataxia
d. Guillain-Barre syndrome
e. Becker?s muscular dystrophy
b. Cerebral palsy
The changes in oximetry seen after intravenous injection of indocyanine green are
Increases NIRS, decreases peripheral
Decreases NIRS, decreases peripheral
No change NIRS, decreases peripheral
Increases NIRS and peripheral
Decreases NIRS, increases peripheral
Increases NIRS, decreases peripheral
Regarding cardiopulmonary exercise testing before major surgery, oxygen pulse is the
VO2/HR - surrogate of Stroke volume
Appropriate surgical anaesthesia with sevoflurane is characterized by a frontal EEG showing
increased a (8-12 Hz), and slow delta
The medical laser LEAST likely to cause eye injury is
a. CO2
b. Green
c. Others that aren?t safe
d. Holminium:YAG
Green
The smallest endotracheal tube that can be railroaded over an Aintree Intubation Catheter has an internal diameter of
6
6.5
7
7.5
8
7 or larger (LITFL)
When performing an erector spinae block in the lumbar region local anaesthetic should be placed
A. Superficial to erector spinae
B. Tip of transverse process?
C. Midpoint of transverse process
B. Tip of transverse process?
The drug that is LEAST likely to decrease blood flow to the splanchnic circulation is
a. Vasopressin
b. Adrenaline
c. Dopamine
d. Noradrenaline
Dopamine - vasodilate
A randomised control trial is performed on a new antiemetic medication. The rate of nausea in the placebo group is 20% and in the treatment group the rate is 5%. The number needed to treat to prevent nausea with this new drug is
?6
?6
The cardiac arrhythmia most commonly associated with the chronic use of methadone is
QT prolongation
A patient is dyspnoeic in the post anaesthesia care unit with oxygen saturations of 94% on 10 litres/min oxygen via face mask. A focused lung ultrasound is performed. The structures labelled with the white arrows represent
a. A lines
b. Reverberations from ribs
c. B lines
d. Comet tails
a. ?
The maintenance anaesthetic technique that has the lowest environmental impact from greenhouse gas is
?propofol TIVA
?propofol TIVA
Cryoprecipitate is a concentrated source of all the following EXCEPT
Contains fibrinogen, XIII, fibronectin, vWF, VIII
Doesn?t contain much II, VII or IX, X
With regard to Donation after Circulatory Determination of Death (DCDD), the maximum acceptable time from withdrawal of cardio-respiratory support to cold perfusion for liver donation is
Liver, Pancreas: <30 minutes from withdrawal of cardiopulmonary support to cold perfusion
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
If the anaesthesia machine requires electrical power for normal operation, a backup power supply must be a part of the machine and permit normal operation for at least 30 minutes after a mains power supply failure
When commencing treatment of proximal deep vein thrombosis or pulmonary embolus, factor Xa inhibitors (apixaban, rivaroxaban) are preferred to dabigatran or warfarin because they do not require
Answer - Rivaroxaban or apixaban are generally favoured over dabigatran or warfarin as they do not require a period of parenteral anticoagulation or routine laboratory monitoring
A patient with a history of hereditary angioedema presents to the emergency department with difficulty with breathing, abdominal pain and swelling of the face, hands and feet. The most effective therapy for managing this is
a. C1 esterase inhibitor
b. Danazol
c. Steroids
d. Adrenaline
e. Steroids
a. C1 esterase inhibitor
A thoracic regional technique that will NOT provide analgesia for sternal fractures is a
a. Pecs 1
b. Pecs 2
c. Parasternal intercostal block
d. Transfasical plane block (deep to TA around L1, lateral)
e. Pecto-intercostal plane block
a. Pecs 1
Drug classes demonstrated to reduce mortality in chronic heart failure with reduced ejection fraction include all of the following EXCEPT
ACEI
ARBs
Beta blockers
Spirinolactone and eplerenone
Diuretics
ACEI - do
ARBs - do
Beta blockers - do
Spirinolactone and eplerenone - do
Diuretics- don’t
In the three-bottle chest drainage system set up shown, the maximum suction pressure (cm H2O) generated inside the underwater seal bottle would be minus
The picture was; UWSD 2cm under liquid, tube in the suction control bottle 20cm deep under the liquid
-20 cm H20
Somatic pain in the second stage of labour is NOT transmitted via the
?c fibres
?T10-L1 dorsal horn
?c fibres
?T10-L1 dorsal horn
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. FFP
During a thyroidectomy, the surgeon is concerned the parathyroid glands have been devascularised. From the time of potential damage, a serum calcium level should be checked in
a. 1 hr
b. 6hrs
c. 12 hrs
d. 24 hrs
6 hours
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. Wide QRS tachycardia
b. Narrow QRS tachycardia
c. Complete heart block
d. Sinus tachycardia
Sinus tachycardia
A patient with a perioperative troponin rise above the upper limit of normal, chest pain, left ventricular anterior regional wall motion abnormality, and atheroma with a partially occluding thrombus of the left anterior descending coronary artery has had a/an
a. Type 1 MI
b. Type 2 MI
c. Perioperative MI
a. Type 1 MI
A patient requires elective surgery under general anaesthesia with neuromuscular relaxation. The recommended preoperative management of donepezil is to
a. Don?t stop
b. 6hrs
c. 12hrs
d. 24hrs
e. 48hrs
a. Don?t stop
Cyclooxygenase type 2 inhibitors (COX-2) in pregnancy are considered
a. Not safe
b. Safe
c. Safe 1st trimester
d. Safe 1st and 3rd trimester
E) not safe up to 48 hours prior to delivery
E) not safe up to 48 hours prior to delivery
A 75 year-old patient is given a Fleet© sodium phosphate enema prior to a colonoscopy. The hyperphosphataemia from the laxative can directly cause
a. Hypocalcaemia
b. Hyperkalaemia
C. Hyponatraemia
a. Hypocalcaemia
The electrolyte abnormality most associated with an increased risk of laryngospasm is
a. Hypocalcaemia
b. Hypercalcaemia
c. Hyperkalaemia
d. Hyperphosphatemia
e. hypercalcaemia
a. Hypocalcaemia
The QRS axis of the attached electrocardiograph is closest to
Was -45 deg:
A) LAD
B) normal
C) RAD
D) extreme
a. LAD (-30 to -90)
An anaesthetic drug that is safe to use for a patient with porphyria is
? Antacids ? Na+ citrate
? Induction ? propofol
? Inhalational agents ? N2O, halothane, isoflurane (use with caution)
? NMBD ? sux, pancuronium and vecuronium
? Reversal ? atropine, glycopyrulate, neostigmine
? Analgesia ? opioids
? LA ? bupivacaine
? Sedatives ? midazolam, temazepam, lorazepam
? Antiemetics ? droperidol
? Cardiovascular drugs ? adrenaline, phenylephrine, salbutamol, Mg2+, beta-blockers, phentolamine
A patient has received high dose hydroxocobalamin for refractory vasoplegia post cardiac surgery. Observed effects include all of the following EXCEPT
Mechanism: binds NO and inhibits NOS and cGMP ? inhibits vascular smooth muscle relaxation
Dose: 5-10g IV over 10 minutes
Effects:
- CVS: increased BP
- Renal: renal impairment, calcium oxalate nephrolithiasis, urine discolouration
Skin: skin discolouration, rash, photosensitivity
The bioavailability of an oral dose of ketamine is approximately
10%
20%
30%
40%
50%
20%
A venturi mask delivers a fraction of inspired oxygen of 0.28 at the recommended fresh gas flow rate of 6 litres per minute. Increasing the flow rate to 12 litres per minute will deliver a fraction of inspired oxygen of
0.28
0.35
0.5
0.8
0.28
An inverted u wave is an electrocardiographic sign of
A negative U wave is highly specific for the presence of heart disease
Common causes of inverted U waves
? Coronary artery disease
? Valvular disease
? Cardiomyopathy
The use of direct oral anticoagulants [DOAC] in atrial fibrillation is contraindicated in the presence of
?mechanical heart valve
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 regime the patient should receive during labour is
a. 8mg per hr IV infusion hydrocortisone
b. 6mg PO pred
c. 25mg IV hydrocort qid
d. 50mg TDS hydrocortisone
a. 8mg per hr IV infusion hydrocortisone
One metabolic equivalent (MET) is equal to
a. 3.5ml O2/kg/min
b. Other wrong options
a. 3.5ml O2/kg/min
A 64 year old man presenting for elective surgery is on thyroxine 100 mcg daily. His thyroid function tests are: (test results shown) These results are most consistent with
a. Subclinical hyperthyroidism
b. Pituitary hypophysectomy
c. Goitre
d. Too much thyroxine
a. ?
A 42-year-old female is admitted with subarachnoid haemorrhage. She has a severe headache, has eyes open spontaneously, and is confused but is obeying commands. She is unable to move her left side. The World Federation of Neurological Surgeons grade is
a. 1
b. 2
c. 3
d. 4
e. 5
2
Hepatopulmonary syndrome can be treated with
- Embolisation of intra-pulmonary vasodilation
- TIPS procedure
- Liver transplantation
Octreotide
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
Ogilvie syndrome
- If caecal diameter < 12 cm and mild-moderate abdominal pain:
Supportive care for 72 hours
- If caecal diameter > 12 cm or severe abdo pain:
1st line: neostigmine 2-5 mg IV over 5 minutes with cardiac monitoring (can be repeated after 24 hours if no response)
2nd line: colonoscopic decompression
The most effective treatment for pain following wisdom teeth extraction as a single oral dose
Paracetamol + ibuprofen
Paracetamol
Endone
Tramadol
Paracetamol + ibuprofen
The maximum recommended cuff inflation pressure for the classic LMA is
30cmH20
40cmH20
50cmH20
60 cmH2O
60 cmH2O
You have induced a 20-year-old male for appendicectomy with propofol, fentanyl and suxamethonium. You are maintaining anaesthesia with oxygen, air and sevoflurane. His heart rate has climbed to 150 /minute, the ETCO2 is 50 mmHg and his temperature is 40øC. After turning off the sevoflurane, you should
Hyperventilate with 100% FiO2 at 15 L/min
Hyperventilate with 100% FiO2 at 15 L/min
When using the ECG to time intra-aortic balloon counterpulsation, balloon deflation should occur at the
peak r wave
Peak q wave
Peak t wave
Peak of p wave
peak r wave
Individuals with Prader-Willi syndrome having an anaesthetic are at most risk of
a. Hypothermia
b. hypoglycaemia
hypoglycaemia
Cross clamping of the descending aorta is NOT expected to cause
?
Of the following, the LEAST likely to occur during one-lung ventilation in the lateral decubitus position is
?
Refeeding syndrome following the commencement of total parenteral nutrition is associated with the development of
Hypophosphataemia
The peak effect of intravenous insulin on serum potassium when treating hyperkalaemia occurs at approximately
5 min
10 min
15 min
30 min
15 min
A relative contraindication to a peribulbar needle technique for cataract surgery is
- Inability to comply (e.g. movement disorders, confusion, communication issues)
- Coagulopathy
Globe perforation
This arterial blood gas is consistent with a diagnosis of
?
Assuming a blood volume of 70 ml/kg, a massive transfusion in a 20 kg, 5-year-old child is defined as a three-hour packed red blood cell (PRBC) transfusion volume of
500 ml
700ml
1000 ml
1500 ml
700mL
> 10%, per minute
50%TBV, 3 hours
100% TBV, 24h
Therefore 70 x 20 = 1400ml TBV, 700ml in 3 horus
According to the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines, an acceptable reason to delay surgery in a patient with a fractured neck of femur is
- Hb <80
- Na <120 or >150, K <2.8 or >6
- Uncontrolled diabetes
- Uncontrolled or acute onset LV failure
- Correctable cardiac arrythmia with ventricular rate >120
- Chest infection with sepsis
- Reversible coagulopathy
Local anaesthetic blockade of the musculocutaneous nerve in the upper limb will result in weakness of
Weakness of
- shoulder flexion (pectoralis major can still perform)
- elbow flexion (brachioradialis can still perform)
- forearm supination
In patients with symptomatic carotid stenosis, endarterectomy can be performed within two weeks of each initial symptoms if there is/are
50-99% stenosis
NASCET/ECST trails for secondary prevention
- Symptomatic + >70% stenosis NNT = 6
- Symptomatic + >50% stenosis NNT = 22
Of the following, the drug most likely to cause pulmonary arterial vasodilation with systemic arterial vasoconstriction when used in low doses is
Vasopressin
Complications of hyperbaric oxygen therapy do NOT include
Complications include pressure barotrauma, oxygen toxicity and claustrophobia
Central retinal artery occlusion
The option below which ranks these pressures from highest to lowest is (atm = atmosphere, cmH2O = centimetres of water, kPa = kilopascals, mmHg = millimetres of mercury, psi = pounds per square inch)
a. 10 atm > 10 psi > 10 kPa > 10mmHg > 10 cmH2O
b. Other wrong answers
a. 10 atm > 10 psi > 10 kPa > 10mmHg > 10 cmH2O
A patient taking tranylcypromine, a monoamine oxidase inhibitor, requires elective surgery. The best management is to
Traditionally ceased by tricky to stop so can continue avoiding serotinergics
A 25-year-old woman is administered two doses of aprepitant for postoperative nausea and vomiting after a sleeve gastrectomy. She normally takes the oral contraceptive pill. You should advise her to use alternative contraception for the next
a. should advise her to use alternative contraception for the next Barrier for 28 days
b. Keep taking pill
c. Barrier for 7 days
d. Just keep on keeping on
a. should advise her to use alternative contraception for the next Barrier for 28 days
A four-year-old boy with a history of waddling gait, larger than normal calves and frequent falls receives a spontaneously breathing volatile-based anaesthetic with sevoflurane. One hour into the case he develops peaked T waves and then the end-tidal CO2 begins to rise. The most appropriate immediate treatment is to
a. stop volatile, give calcium
b. other wrong answers
a. stop volatile, give calcium
Jet ventilation for shared airway surgery is traditionally delivered at pressures in atmospheres (atm) of
2.5?3.5 bar for adults
A 46-year-old woman with menorrhagia is booked for abdominal hysterectomy. Her preoperative bloods show (electrolyte results shown) The most likely reason for these findings is
a. low phosphate
b. other incorrect answers
a. low phosphate
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. No change at 12 months
b. Other wrong answers
a. No change at 12 months
A 58-year-old man with ischaemic cardiomyopathy is undergoing a ventricular tachycardia ablation procedure in the catheter laboratory. Partway through the procedure his systolic blood pressure abruptly falls from 110 mmHg to 50 mmHg. The most likely cause for his hypotension is
- Rhythm: purposely induce arrhythmia to find arrythmogenic focus
- Bleeding: aortic rupture, tran-septal puncture
- Thrombo-emolic: massive PE
A 25-year-old male has continued post operative 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 (test results shown). The most likely diagnosis is
a. vWD
b. Haemophilia A
c. Haemophilia B
d. Haemolytic uremic syndrome
a. vWD
The coronary artery most likely occluded in this ECG of an acute ST-elevation myocardial infarction is the
?
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. 0 RFs
b. > or equal to 1 RF
c. >/= 2 risk factors
d. >/= 3 risk factors
> or equal to 1 RF
The most appropriate initial diagnostic test for a suspected phaeochromocytoma is a/an
Plasma free metanephrines
An adult patient is administered a target controlled propofol infusion for more than 30 minutes with a constant effect-site target of 4 mcg/
ml propofol plasma concentration. Compared to the Schnider model, the propofol dose given by the Eleveld model will be a
a. Bigger bolus, bigger overall volume
b. Smaller bolus, smaller over all
c. Other combos of above
a. Bigger bolus, bigger overall volume
??
A 4 week old full term neonate with an inguinal hernia, who is otherwise healthy, has an ASA(American Society of Anesthesiologists) classification of at least
ASA 3 (full term <6 weeks)
ASA 3 (full term <6 weeks)
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
a. Deflate, withdraw 2cm then insert DLT
b. Wedge the PAC
c. Remove PAC completely
d. Other options were wrong
a. Deflate, withdraw 2cm then insert DLT
This patient has been requested to look straight ahead. He is suffering from a right (photo of eyes with divergent gaze shown)
a. CN 3
b. CN 4
c. CN 5
d. CN 6
e. CN 7
a. CN 3
A baby is brought to the emergency department three days after a term home birth. It has not been feeding well and has had few wet nappies. The child is grey in appearance and femoral pulses are difficult to palpate. You note an enlarged liver and marked tachycardia. Pulse oximetry reveals saturations of 75% despite oxygen being administered. You suspect a duct- dependent circulation. The best initial management is
a. Prostaglandin E1
b. Others
a. Prostaglandin E1
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
> /= 2 in men
/= 3 in women
The antiemetic least likely to precipitate an arrhythmia in a patient with this ECG is (pretty sure ECG showed prolonged QT)
- dexamethasone
- benzodiazepines
- NK1RA (aprepitant)
- cannabinoids
The CRASH-2 trial showed tranexamic acid administration to trauma victims results in a reduction in
a. Reduced death from bleeding and over all death, but no change in blood products
b. Other options that were wrong
a. Reduced death from bleeding and over all death, but no change in blood products
Of the following, the lowest level at which neurogenic shock is likely if an acute spinal cord injury were to occur at that level is
a. C7
b. T1
c. T5
d. Other options
T5
