2024.1 MCQ Flashcards

Question 1

Q

2024.1

1) A medication that would be acceptable to a patient who refuses all products derived from human plasma is

a) albumin
b) F7
c) Fib conc
d) PT complex

Answer

A

recombinant F7

a) albumin (from plasma)
b) F7 (recombinant lab made)
c) Fib conc(from freeze dried plasma) d) PT complex (from plasma)

“https://www.bjanaesthesia.org.uk/action/showFullTableHTML?isHtml=true&tableId=AEV161TB1&pii=S0007-0912%2817%2931069-3

BJA artice of table of whats not ok and whats ok”

Question 2

Q

2024.1

2) An adult patient undergoing cardiac surgery exhibits excessive bleeding following cardiopulmonary bypass. A thromboelastogram performed on their blood is shown below. The most likely cause of the bleeding is

a) Platelets
b) Fibrinogen
c) Cryo
d) FFP

Answer

A

Platelets (ie reduced max amp, thin sausage)

LITFL DP CSL

Question 3

Q

2024.1

3) A term neonate is undergoing closure of gastroschisis under general anaesthesia with pressure control ventilation via an endotracheal tube. The estimated blood loss is 10 mL. Fluid therapy has been 4% albumin 40 mL/kg in addition to maintenance 10% dextrose 4 mL/kg/h. During closure of the defect, the oxygen saturation falls to 80%. The most likely cause of the desaturation is

a)Pulmonary oedema/excessive fluids
b) Reduced Lung compliance
c) Shunt
d) FiO2 too low

Answer

A

b) Reduced Lung compliance

UTD

Question 4

Q

2024.1

4) Phaeochromocytoma commonly presents with all of the following EXCEPT

a) RVH/ failure
b) stress induced cardiomyopathy
c)Pulmonary HTN
d) long QT (and VTs)
e) ST changes
f) Cardiomyopathy

Answer

A

c) Pulmonary HTN

a) RVH/ failure yes,
b)stress induced cardiomyopathy
c)Pulmonary HTN
d) long QT (and VTs)
e) ST changes. yes 2o ischaemia from HTN/ supply demand mismatch
f) Cardiomyopathy. yes 2o HTN

Unclear recalled options, list of sx

UTD

Question 5

Q

2024.1

5) 5. Duchenne muscular dystrophy is NOT associated with

Answer

A

No sux or VA

** Resistant to NDMR (can give, generally delayed onset, prolonged duration)
** Female carriers dont usually have CM”

Question 6

Q

2024.1

6) 6. When administered in combination with tramadol, the agent considered highest risk for the development of serotonin syndrome is

a) moclobemide
b) escitalopram
c) desvenlafaxine
d) tapentadol
e) TCAs”

Answer

A

a) moclobemide

Tramadol + MAOIs = CI because high risk serotonin syndrome!

“NPS Org - https://www.nps.org.au/assets/AP/pdf/p41-Perananthan-Buckley.pdf

Question 7

Q

2024.1

7) 7. The action of methylene blue in treating vasoplegia is mediated by

“a) inhib GNP
b) inhib indicible nitric oxidase
c) inhib constitutive nictric oxidase
d) binds to vasopressin recep
e) binds to angiotensin 2”

Answer

A

a) inhib GNP

https://academic.oup.com/ejcts/article/28/5/705/502264

Question 8

Q

2024.1

8) 8. A stellate ganglion block is NOT indicated in the management of

Answer

A

“sympathetically mediated pain from the head, neck and upper extremities
- reflex sympathetic dystrophy
- herpes zoster
vasospasm
- Raynaud disease
- temporal arteritis
- Buerger disease
hyperhidrosis
electrical storm 7
- three or more ventricular arrhythmias within 24 hours requiring defibrillation or overdrive pacing –> a left-sided (or bilateral) stellate ganglion block is preferred in this context 8

Contraindications are current coagulopathy, recent myocardial infarction, pathologic bradycardia, and glaucoma, contralateral phrenic nerve palsy”

Question 9

Q

2024.9. Obstructive sleep apnoea in children is diagnosed with an apnoea-hypopnoea index (AHI) of at least

a) 1
b) 5
c) 10

Answer

A

1

Kids should not have apnoeas

Question 10

Q

10

Neostigmine should be avoided in patients with

A Fredricks ataxia (frataxin)
B hypokalaemia FPP
C Becker MD/ Duschenes MD (dystrophin)
D Myotonia congenita (Cl channel)

Answer

A

hFPP and MC both contraindicated??

Myotonia congenita:
•	Myotonic Dystrophy Foundation: Neostigmine is contraindicated due to its ability to induce myotonic rigidity.
•	OpenAnesthesia: Avoid neostigmine as it exacerbates myotonia.
•	Anesthesia Considerations: Cholinesterase inhibitors (e.g., neostigmine) trigger myotonic contractures.

##

Neostigmine should be avoided in patients with D. Myotonia congenita (Cl channel).

The strongest evidence from multiple authoritative sources highlights:
- Neostigmine triggers myotonic crises (prolonged muscle rigidity) in chloride channel myotonia due to its acetylcholinesterase inhibition, which exacerbates abnormal muscle membrane excitability.
- Guidelines explicitly contraindicate neostigmine reversal in myotonic disorders, including myotonia congenita, due to this risk[2][4][7][10].

C. Becker/Duchenne MD (dystrophin):
- While some sources note neostigmine may worsen rhabdomyolysis risk in dystrophinopathies[4][9], others state antagonism with neostigmine is feasible[3]. This creates ambiguity, making it less definitive than D.
- Current recommendations prefer sugammadex for reversal but do not universally prohibit neostigmine in dystrophinopathies[3][12].
B. Hypokalaemic Familial Periodic Paralysis:
- No direct contraindication to neostigmine exists in the provided sources.
A. Friedreich Ataxia (frataxin):
- No evidence of neostigmine contraindication.

Myotonia congenita:
- Myotonic Dystrophy Foundation: Neostigmine is contraindicated due to its ability to induce myotonic rigidity[2][5].
- OpenAnesthesia: Avoid neostigmine as it exacerbates myotonia[10].
- Anesthesia Considerations: Cholinesterase inhibitors (e.g., neostigmine) trigger myotonic contractures[7].

Conclusion: The single correct answer is D, supported by unequivocal guidelines against neostigmine use in chloride channel myotonia.

Sources
[1] [PDF] Anaesthesia and the paediatric muscle disorders https://sajaa.co.za/index.php/sajaa/article/download/1090/1216
[2] [PDF] PRACTICAL SUGGESTIONS FOR THE ANESTHETIC … https://www.myotonic.org/sites/default/files/Anesthesia%20Guidelines.pdf
[3] [PDF] Anaesthesia recommendations for Duchenne muscular dystrophy https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/duchenne-muscular-dystrophy/809-duchenne-muscular-dystrophy-2/file.html
[4] European Neuromuscular Centre consensus statement on … https://pmc.ncbi.nlm.nih.gov/articles/PMC9826444/
[5] [PDF] PRACTICAL SUGGESTIONS FOR THE ANESTHETIC … https://www.myotonic.org/sites/default/files/MDF_LongForm_AnesGuidelines_01C.pdf
[6] [PDF] Beckers disease - OrphanAnesthesia https://www.orphananesthesia.eu/de/erkrankungen/handlungsempfehlungen/beckers-erkrankung/407-becker%E2%80%99s-disease-1/file.html
[7] Myotonic Dystrophy - Anesthesia Considerations https://www.anesthesiaconsiderations.com/myotonic-dystrophy-
[8] Medical Management - Duchenne Muscular Dystrophy (DMD) https://www.mda.org/disease/duchenne-muscular-dystrophy/medical-management
[9] A Review on the Anesthetic Management of Patients with … https://pmc.ncbi.nlm.nih.gov/articles/PMC10319043/
[10] Myotonic Dystrophy - OpenAnesthesia https://www.openanesthesia.org/keywords/myotonic-dystrophy/
[11] [PDF] Guideline on the clinical investigation of medicinal products for the … https://www.tga.gov.au/sites/default/files/2024-05/EMACHMP2369812011corr1%20GL%20on%20Duchenne%20Becker%20muscular%20dystCurrent%20CURRENT.PDF
[12] Anesthetic implications of muscular dystrophies - SciELO Colombia http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472018000300228
[13] [PDF] Anesthetic management of a patient with myotonia congenita https://www.apicareonline.com/index.php/APIC/article/download/1712/2616/
[14] S8251 - Sigma-Aldrich https://www.sigmaaldrich.com/US/en/search/s8251?focus=papers&page=1&perpage=30&sort=relevance&term=s8251&type=citation_search
[15] PROBLEMS OF ANESTHESIA IN PATIENTS WITH … https://www.sciencedirect.com/science/article/pii/S0889853705703576
[16] Neostigmine - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK470596/
[17] Muscular Dystrophy Guidelines - Medscape Reference https://emedicine.medscape.com/article/1259041-guidelines
[18] [PDF] Anaesthetic Management in Duchenne Muscular Dystrophy https://aacc.tums.ac.ir/index.php/aacc/article/download/411/597/
[19] [PDF] Anaesthetic guidance for patients with Myotonic Dystrophy https://www.nn.nhs.scot/smn/wp-content/uploads/sites/25/2023/07/NSD610-018.14-SMN-Anaesthetic-guidance-for-patients-with-Myotonic-Dystrophy.pdf
[20] New Becker muscular dystrophy drug on the horizon https://innovationdistrict.childrensnational.org/new-becker-muscular-dystrophy-drug-on-the-horizon/

Question 11

Q

11. A transjugular intrahepatic portosystemic shunt procedure is contraindicated in patients with

Hepatorenal syndrome
Refractory ascites
Severe TR
Variceal bleeding
Budd chiari

Answer

A

Severe TR
Severe PHTN (MPAP > 45)
HF
Multiple hep cysts

Contraindications: Absolute (heart failure, severe TR, severe pulm HTN (mean pulm pressures >45mmHg, multiple hepatic cysts, sepsis, biliary obstruction) Relative (HCC, obstruction of all hepatic veins, PV thrombosis, severe coagulopathy, thrombocytopenia < 20x10^9, prior encephalopathy, moderate pulmonary HTN)

BJA Ed 2016 - Anaesthesia for TIPS (https://academic.oup.com/bjaed/article/16/12/405/2632741)

Question 12

Q

12

When confirming correct placement of an endotracheal tube, verifying the presence of sustained exhaled carbon dioxide requires all the

4 criteria

Answer

A

4 criteria

“following criteria to be met (Fig. 2; [93]):
1. Amplitude rises during exhalation and falls during inspiration.
2. Consistent or increasing amplitude over at least seven breaths [74, 91]
3. Peak amplitude more than 1 kPa (7.5 mmHg) above baseline [74, 94].
4. Reading is clinically appropriate.”

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15817

Question 13

Q

**The dataset that was used to create the Eleveld TCI model did NOT include patients who are / have

“Neonate
Elderly
Liver
Renal
Obese”

Question 14

Q

The blood product that contains the highest concentration of citrate is

a) whole blood
b) platelet
c) plasmapheresis
d) platelet additive

Answer

A

Plasma

CITRATE:
Whole blood: 26g/l
Platelet(phoresis): 22g/l
Plasma (apheresis): 40g/l
Platelet additive: 0.3g/l

Red cells and albumin: NONE! SAGM”

https://www.lifeblood.com.au/sites/default/files/resource-library/2024-08/Blood_Component_Information_2.0_0.pdf

Question 15

Q

During a new pandemic, an anaesthetist refuses to provide sedation for an elective operation due to concern that the procedure may hasten community spread of the disease. This is the ethical principle of

“Beneficence
Non-maleficence
Justice
Conscientious objection
Professional autonomy
“

Answer

A

Non Malef

Patients brought to the hospital are at risk of spreading and contracting disease. The principle of non-maleficence, often referred to as the “do no harm” principle, strives to minimize the risk of harm to a patient, and argues that any procedure whose anticipated harms outweigh the expected benefits should not be performed [20]. During the current pandemic, the decision to suspend non-urgent elective procedures was made in part to protect surgical patients from disease transmission (i.e., harm). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082741

Question 16

Q

The anaesthetic technique associated with the highest rate of postprocedure patency of a newly-created arteriovenous fistula is

BP block
LA by surgeons

Answer

A

BP block

Long-Term Functional Patency and Cost-Effectiveness of Arteriovenous Fistula Creation under Regional Anesthesia: a Randomized Controlled Trial

https://pubmed.ncbi.nlm.nih.gov/32709710/?utm_source=perplexity

Compared with local anesthesia, regional anesthesia significantly improved both primary and functional AVF patency at 1 year and is cost-effective.

Clinical trial registry name and registration number: Local Anaesthesia versus Regional Block for Arteriovenous Fistulae, NCT01706354.

Question 17

Q

17. The image below shows the arterial pressure (red, upper line) and balloon pressure (blue, lower line) from an intra-aortic balloon pump set at 1:2 augmentation. The point of the waveform indicated by the large green arrow is called

Answer

A

https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%20634/normal-iabp-waveform

ABC anaes

Question 18

Q

18. A patient’s true arterial oxygen saturation will be lower than a pulse oximeter reading in the presence of

COHB
Methylene blue
Sickle cell

SaO2 < SpO2

Answer

A

COHb
(CarboxyHb)
(Miller)

Also:
Skin pigmentation if saO2 < 80% (Miller)
IABP (UTD)
Inc HbA1c (UTD)

Question 19

Q

19. Organ procurement after circulatory death is generally stood down if the time from cessation of cardiorespiratory support to circulatory death extends beyond

“30
60
90
180mins “

Answer

A

90 mins

Organ procurement after circulatory death in Australia is generally stood down if circulatory death does not occur within 90 minutes after withdrawal of cardiorespiratory support. This timeframe is based on nationally accepted guidelines and clinical protocols to ensure organ viability[3][6][10][13].

90-minute threshold: The Australian Donation after Circulatory Determination of Death (DCDD) guidelines specify that organs are typically only procured if circulatory death occurs within 90 minutes of withdrawing life-sustaining treatment[10][13].
Organ-specific viability: While the stand-down period is 90 minutes, individual organs have shorter maximum warm ischemic tolerances (e.g., 30 minutes for liver/pancreas, 60 minutes for kidneys, and 90 minutes for lungs)[3][20].
Abandonment criteria: If death does not occur within this window, organ procurement is halted, though tissue donation may still proceed after death[3][6].

This approach balances ethical standards, organ viability, and clinical feasibility in alignment with Australian guidelines[10][13].

Sources
[1] [PDF] Organ Donation After Circulatory Death - NSW Health https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2024_010.pdf
[2] Donation after circulatory death (DCD)—lung procurement - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC8012413/
[3] PROTOCOL Organ and Tissue Donation and Procurement after … https://www.rch.org.au/picu/Donation_after_cardiac_death_protocol/
[4] [PDF] Untapped potential in Australian hospitals for organ donation after … https://www.mja.com.au/system/files/issues/207_07/10.5694mja16.01405.pdf
[5] Death and Organ Donation Statement - ANZICS https://www.anzics.org/death-and-organ-donation-app-content/
[6] Untapped potential in Australian hospitals for organ donation after … https://www.mja.com.au/journal/2017/207/7/untapped-potential-australian-hospitals-organ-donation-after-circulatory-death
[7] Best Practice Guideline for Donation after Circulatory Determination … https://www.donatelife.gov.au/for-healthcare-workers/clinical-guidelines-and-protocols/national-guideline-donation-after-circulatory-death
[8] [PDF] Clinical Guidelines for Organ Transplantation from Deceased Donors https://tsanz.com.au/storage/documents/TSANZ_Clinical_Guidelines_Version-111_13062023Final-Version.pdf
[9] Clinical guidelines and protocols - DonateLife https://www.donatelife.gov.au/for-healthcare-workers/clinical-guidelines-and-protocols
[10] [PDF] Donation after Circulatory Determination of Death (DCDD) in Australia https://www.donatelife.gov.au/media/best-practice-guideline-donation-after-circulatory-determination-death-australia-634-kb-pdf
[11] 2 Organ donor suitability - TSANZ https://tsanz.com.au/preview-page?p=6
[12] [PDF] The Statement on Death and Organ Donation | DonateLife https://www.donatelife.gov.au/media/anzics-statement-death-and-organ-donation-edition-41
[13] Organ donation after circulatory death (DCD) - NSW Health https://www.health.nsw.gov.au/organdonation/Pages/donation-following-circulatory-death.aspx
[14] Donation after Circulatory Death (DCD) - LITFL https://litfl.com/donation-after-circulatory-death-dcd/
[15] [PDF] Section 3 - Deceased Organ Donor Pathway - ANZDATA https://www.anzdata.org.au/wp-content/uploads/2022/05/s03_pathway_2021_ar_2022_v2.0_section_20220521_final.pdf
[16] “The Cadaveric Organ Shortage: a result of Australia’s … - AustLII http://www8.austlii.edu.au/cgi-bin/viewdoc/au/journals/CanLawRw/2022/7.html
[17] [PDF] Understanding death and donation | DonateLife https://www.donatelife.gov.au/media/otandfssunderstanding-death-donation-july-2021pdf
[18] [PDF] Deceased Organ Donation Pathway - ANZDATA https://www.anzdata.org.au/wp-content/uploads/2017/10/c03_pathway_v1.0_20171027.pdf
[19] [PDF] Ethical guidelines for organ transplantation from deceased donors https://www.nhmrc.gov.au/sites/default/files/documents/attachments/NHMRC-ethical-guidelines-organ-transplant.pdf
[20] Donation after circulatory determination of death https://derangedphysiology.com/main/required-reading/organ-and-tissue-donation/Chapter-616/donation-after-circulatory-determination-death

Question 20

Q

20. The rank of volatile anaesthetic agents from highest to lowest derived global warming potential over 100 years (GWP100) is

Answer

A

GWP 100 kills DINS (dinos)

The Global Warming Potential (GWP) 100 of inhaled anesthetics is a measure of how much each gas contributes to global warming over a 100-year period

D 2500 (20x sevo) (5x iso)
I 500 (2x n2o)
N 250 (2x sevo)
S 125

https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room/inhaled-anesthetics

Question 21

Q

21. A characteristic feature of postoperative visual loss due to posterior ischaemic optic neuropathy is

a) Resolves w/in 24h
b) Normal fundo
c) Painful
d) Visual inattention
e) No loss papillary reflex

Answer

A

a) Resolves w/in 24h (no)
b) Normal fundo
c) Painful (no)
d) Visual inattention (no, just normally bilat absent vision)
e) No loss papillary reflex (incorrect, papillary reflex is gone)

AION = painless, progressive VL, oedematous optic disc (PV+OF)

PION = painless, acute, unilateral or bilateral VL, normal optic disc (least blood flow = vulnerable)

Question 22

Q

22. The bipolar leads of a 12-lead electrocardiogram are

ALSO
what are the unipolar leads?
whare are the augmented leads?

Answer

A

Bipolar = 2 leads (+ and - electrode)

I, II, III

Limb leads = RA LA LL RL
6 limb lead = I/II/III + aVR/L/F

Chest/Praecordial leads = V1-V6
(6 unipolar praecordial lead)

“A”ugmented Lead = aVL, aVR, aVF
measure electrical activity between one limb and a single electrode
One lead = unipolar

R/L/F = POSITIVE electrode position

5 lead ECG = 5 electrodes
smoke over fire
white is right, snow over tree (Green/ground)
chocolate to the heart (chest)
I II III aVR/L/F and V
–> improve STE reading

12 lead ECG = 10 electrodes
- 4 on limbs; 6 praecordium

Plane = cross sectional view

Lead = view b/w + and - pole

https://www.ausmed.com.au/learn/articles/5-lead-ecg

Question 23

Q

23. The local anaesthetic with the lowest CC/CNS ratio (ratio of the drug dose required to cause cardiac collapse to the drug dose required to cause seizure) is

Answer

A

Bupiv

357
BRL

Question 24

Q

24. The time for reversal of therapeutic dabigatran after administration of idarucizumab 5 g is

“a) 5min
b) 15min
c) 30min
d) 60min
e) 120min”

Answer

A

UTD: Anticoagulant effect completely reversed within 15min

a) 5 min

Rationale:
Idarucizumab, a monoclonal antibody fragment, rapidly and completely reverses the anticoagulant effects of dabigatran by binding to it with high affinity. Clinical studies, including the pivotal RE-VERSE AD trial, demonstrate that coagulation parameters (e.g., dilute thrombin time, ecarin clotting time) normalize within minutes of administering the 5 g dose[1][2][8]. For example:

RE-VERSE AD Interim Analysis: In patients requiring urgent procedures, complete reversal occurred within minutes in 98.7% of cases based on dTT and 82.2% based on ECT, with median time to surgery initiation <2 hours in most cases[1][8].
Pharmacodynamic Studies: Idarucizumab normalizes clotting times (dTT, ECT, aPTT) within 5 minutes of administration, as shown in controlled volunteer trials and animal models[4][10][11].
Mechanism of Action: The rapid on-rate of idarucizumab binding to dabigatran ensures immediate neutralization of its anticoagulant activity, with unbound dabigatran concentrations dropping below therapeutic thresholds within 5 minutes[10][11].

While bleeding cessation or procedural hemostasis may take longer (e.g., median 2.5–11.4 hours for bleeding cessation), the reversal of anticoagulation itself is nearly instantaneous[2][8]. Thus, the correct answer is 5 minutes.

Answer: a) 5 min
Sources:[1][2][4][8][10][11]

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/31599808/
[2] https://pubmed.ncbi.nlm.nih.gov/26095746/
[3] https://pubmed.ncbi.nlm.nih.gov/30586692/
[4] https://www.medsafe.govt.nz/profs/datasheet/p/praxbindinj.pdf
[5] https://australianprescriber.tg.org.au/articles/idarucizumab.html
[6] https://www.nps.org.au/news/idarucizumab-praxbind-for-dabigatran-pradaxa-reversal-what-you-should-know
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC7237558/
[8] https://pubmed.ncbi.nlm.nih.gov/28693366/
[9] https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/SESLHDMG%20110%20-%20Idarucizumab%20in%20Urgent%20Dabigatran%20Reversal%20-%20Medicine%20Guideline.pdf
[10] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.115.019628
[11] https://www.tga.gov.au/sites/default/files/auspar-idarucizumab-161025-pi.pdf
[12] https://www.nice.org.uk/advice/esnm73/resources/reversal-of-the-anticoagulant-effect-of-dabigatran-idarucizumab-pdf-1502681164008901
[13] https://www.tga.gov.au/sites/default/files/auspar-idarucizumab-161025.docx
[14] https://www.thebottomline.org.uk/summaries/icm/idarucizumab-for-dabigatran-reversal/
[15] https://www.thewaltoncentre.nhs.uk/Downloads/disclosure-log/2022/January-2022/FOI5020_Dabigatran%20Reversal%20with%20Idarucizumab%20Guideline_Information%20Governance.pdf
[16] https://pubmed.ncbi.nlm.nih.gov/25789661/
[17] https://www.health.wa.gov.au/~/media/Files/Corporate/general%20documents/WATAG/Idarucizumab-for-reversal.pdf

Question 25

Q

25. The intrinsic muscles of the larynx do NOT include

a) cricothyroid
b) suprahyoid
c) thyroaretenoid
d) transverse arytenoid

Answer

A

Intrinsic muscles of the larynx:
cricothyroid
thyroaretenoid
posterior cricoarytenoid
lateral cricoarytenoid
transverse arytenoid

NO hyoid

Use “PLAT VCO” to recall all intrinsic muscles:
• Posterior cricoarytenoid
• Lateral cricoarytenoid
• Aryepiglotticus
• Transverse arytenoid
• Vocalis
• Cricothyroid
• Oblique arytenoid

Question 26

Q

26. When interpreting an arterial blood gas, a high serum anion gap is consistent with

Answer

A

HAGMA LTKR
lactate
toxin - salicylate
ketone
renal failure

Question 27

Q

27. The Glasgow Blatchford score is used to risk stratify

Pulmonary haemorrhage
Traumatic intraperitoneal haemorrhage
PPH
UGI bleed

Answer

A

UGIB

SAH (WFNS GCS and motor- survival and Fisher rad- vasospasm)

Question 28

Q

28. In a male patient with quadriplegia undergoing a rigid cystoscopy, the optimal choice of anaesthesia to prevent autonomic dysreflexia is

Answer

A

Neuraxial- spinal abolishes ADR and spasms,

epidural reduces ADR,

spinal blunts SNS when inflating bladder

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2044.1998.00337.x

Question 29

Q

29. Interference with pacemaker function can result from all of the following EXCEPT

Answer

A

Things that affect it:
MRI
Diathermy
?Maybe ECT
TENS Machine
Gamma radiation
Defibrillation/external shocks Peripheral nerve stimulator lithotripsy

https://academic.oup.com/europace/article/24/9/1512/6562768?login=false

Question 30

Q

30. A neonate with a postmenstrual age of 34 weeks (born at 26 weeks) and weighing 2 kg is undergoing retinal laser therapy under general anaesthesia. The oxygen saturation is 92% on the following ventilator settings: FiO2 0.4; inspiratory pressure 15 cmH2O; PEEP 5 cmH2O; rate 24 breaths per minute. The most appropriate course of action is to

“FiO2 to 100%
Peep to 7
Recruit
Do nothing “

Answer

A

do nothing: goal sats in prematurity 91%

https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/oxygen_delivery/#:~:text=91%20%2D%2095%25%20for%20premature%20and,bronchiolitis%20(link%20to%20Bronchiolitis%20CPG)

The neonate’s current oxygen saturation of 92% falls within the recommended target range (90–95% for preterm infants) during laser therapy and mechanical ventilation. Maintaining the current ventilator settings is appropriate, as adjusting parameters risks destabilizing oxygenation or increasing hyperoxia-related complications.

Oxygen Saturation Targets:
- Preterm infants require tight SpO₂ regulation to avoid retinopathy of prematurity (ROP) progression while preventing hypoxia.
- Current guidelines recommend SpO₂ 90–95% for preterm neonates receiving oxygen therapy[2][7][28][50].
Ventilator Settings:
- FiO₂ 0.4 with SpO₂ 92% indicates adequate oxygenation without excessive oxygen exposure.
- PEEP 5 cmH₂O and rate 24 breaths/min are within typical neonatal ventilation parameters[24][28].
Anesthesia Context:
- General anesthesia during ROP laser therapy carries risks of postoperative ventilatory dependence[1][15].
- Stability in oxygenation (avoiding fluctuations) is prioritized over aggressive weaning during the procedure.

No changes to ventilator settings are needed. The current configuration achieves optimal balance between oxygenation safety and ROP risk mitigation. Adjustments should only occur if SpO₂ trends outside the 90–95% range or clinical deterioration arises.

Sources
[1] Anaesthesia modalities during laser photocoagulation for … https://pmc.ncbi.nlm.nih.gov/articles/PMC5278276/
[2] Oxygen saturation SpO2 level targeting in neonates https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/oxygen_saturation_spo2_level_targeting_premature_neonates/
[3] High or Low Oxygen Saturation and Severe Retinopathy of Prematurity https://pmc.ncbi.nlm.nih.gov/articles/PMC4016714/
[4] Supplemental oxygen for the treatment of prethreshold retinopathy … https://pmc.ncbi.nlm.nih.gov/articles/PMC7017219/
[5] Anaesthesia for the laser treatment of neonates with retinopathy of … https://www.nature.com/articles/6702502
[6] Strategies to Prevent Severe Retinopathy of Prematurity: A 2020 … https://publications.aap.org/neoreviews/article-abstract/21/4/e249/88504/Strategies-to-Prevent-Severe-Retinopathy-of?redirectedFrom=fulltext%3Fautologincheck%3Dredirected
[7] Target Ranges of Oxygen Saturation in Extremely Preterm Infants https://pmc.ncbi.nlm.nih.gov/articles/PMC2891970/
[8] Graded oxygen saturation targets and retinopathy of prematurity in … https://www.nature.com/articles/pr201698
[9] Laser treatment in infants with retinopathy of prematurity using sub … https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2044.2006.04945_4.x
[10] [PDF] A uthor Manuscript - Minerva Access https://minerva-access.unimelb.edu.au/bitstreams/bbe392c3-2dc8-54c2-a583-ce71d87c1e5d/download
[11] Anesthesia in retinopathy of prematurity - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC9583347/
[12] Current update on retinopathy of prematurity: screening and treatment https://pmc.ncbi.nlm.nih.gov/articles/PMC3319383/
[13] Ophthalmology : Treatment of ROP - The Royal Children’s Hospital https://www.rch.org.au/ophthal/patient_information/Treatment_of_ROP/
[14] Technical aspects of laser treatment for acute retinopathy of … https://pmc.ncbi.nlm.nih.gov/articles/PMC2993981/
[15] Anaesthesia for the laser treatment of neonates with retinopathy of … https://www.nature.com/articles/6703083
[16] neonatal services division - Pulse Oximetry Screening of Newborns https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Neonatal/Medical/nccretinopathy2019.pdf
[17] The practice of general anesthesia for the retinopathy of prematurity … https://journals.lww.com/ejanaesthesiology/fulltext/2014/06001/the_practice_of_general_anesthesia_for_the.461.aspx
[18] Screening Examination of Premature Infants for Retinopathy of … https://publications.aap.org/pediatrics/article/142/6/e20183061/37478/Screening-Examination-of-Premature-Infants-for?autologincheck=redirected
[19] [PDF] Our General Anesthesia Experiences in Premature Patients … https://app.mevlanamedsci.org/uploads/makale-pdf/our-general-anesthesia-experiences-in-premature-patients-undergoing-laser-photocoagulation-DrnUn2.pdf
[20] Inadequate laser coagulation is an important cause of treatment … https://onlinelibrary.wiley.com/doi/10.1111/aos.14406
[21] Anaesthesia modalities during laser photocoagulation … - BMJ Open https://bmjopen.bmj.com/content/bmjopen/7/1/e013344.full.pdf
[22] Ventilator Management - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK448186/
[23] [PDF] DRAFT #1 AARC - Neonatal ALI Guideline Page 1 of 5 American … https://www.aarc.org/wp-content/uploads/2020/03/neonatal_ventilation_000.pdf
[24] Setting the Ventilator in the NICU - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC7122498/
[25] [PDF] Respiratory Support https://www.ucsfbenioffchildrens.org/-/media/project/ucsf/ucsf-bch/pdf/manuals/6_respsupport.pdf?rev=2bb223b4b25f4ef6a92abfd429c20c96
[26] Oxygen therapy in children - Starship Hospital https://starship.org.nz/guidelines/oxygen-therapy
[27] [PDF] Neonatal Clinical Practice Guidelines 2018-2021 https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-32-02-guideline-2018-eng-neonatal-clinical-guidelines-2018-2021.pdf
[28] Respiratory Support in Neonates and Infants - MSD Manuals https://www.msdmanuals.com/professional/pediatrics/respiratory-problems-in-neonates/respiratory-support-in-neonates-and-infants
[29] Accuracy of the spontaneous breathing trial using a combined CPAP … https://pmc.ncbi.nlm.nih.gov/articles/PMC9632075/
[30] Nursing guidelines : Oxygen delivery - The Royal Children’s Hospital https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/oxygen_delivery/
[31] [PDF] Newborn Critical Care Center (NCCC) Clinical Guidelines https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/2021/04/UNC-CDH-Pathway-NCCC-PICU.pdf
[32] Oxygen saturation targets for children with respiratory distress https://pmc.ncbi.nlm.nih.gov/articles/PMC10577592/
[33] Retinopathy of prematurity and oxygen therapy: A changing … https://www.analesdepediatria.org/en-retinopathy-prematurity-oxygen-therapy-a-articulo-13070181
[34] [PDF] Nasal High-Flow Therapy during Neonatal Endotracheal Intubation https://medicine.unimelb.edu.au/__data/assets/pdf_file/0009/4114854/Kate_SHINE_nejmoa2116735.pdf
[35] [DOC] Retinopathy of Prematurity (ROP) in Neonates, Screening and … https://www.canberrahealthservices.act.gov.au/__data/assets/word_doc/0006/1981644/Retinopathy-of-Prematurity-ROP-in-Neonates,-Screening-and-Treatment.docx
[36] Comparative cohorts of retinopathy of prematurity outcomes of … https://bmjophth.bmj.com/content/6/1/e000626
[37] Oxygen saturation screening for newborns - Safer Care Victoria https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/oxygen-saturation-screening-for-newborns
[38] Retinopathy of prematurity (ROP) - Safer Care Victoria https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/retinopathy-of-prematurity-rop
[39] [PDF] Retinopathy of prematurity and oxygen therapy - Anales de Pediatría https://analesdepediatria.org/index.php?p=revista&tipo=pdf-simple&pii=13070181
[40] Perioperative use of oxygen: variabilities across age | BJA https://academic.oup.com/bja/article/113/suppl_2/ii26/227567
[41] Oxygen care and treatment of retinopathy of prematurity in ocular … https://www.nature.com/articles/s41598-021-04221-8
[42] High rate and large intercentre variability in retreatment of … https://bmjophth.bmj.com/content/6/1/e000695
[43] Retinal vascular development in an immature retina at 33–34 weeks … https://www.nature.com/articles/s41598-020-75151-0
[44] Twelve-year outcomes of bedside laser photocoagulation for severe … https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2023.1189236/full
[45] [PDF] Royal Hospital for Women (RHW) NEONATAL BUSINESS RULE … https://www.seslhd.health.nsw.gov.au/sites/default/files/groups/Royal_Hospital_for_Women/Neonatal/Medical/RHW%20CLIN083%20Retinopathy%20of%20Prematutity%20(ROP).pdf
[46] [PDF] Airway Management and Mask Ventilation of the Newborn https://www.anzcor.org/assets/anzcor-guidelines/guideline-13-4-airway-management-and-mask-ventilation-of-the-newborn-288.pdf
[47] [PDF] Guideline: Neonatal resuscitation - Queensland Health https://www.health.qld.gov.au/__data/assets/pdf_file/0011/140600/g-resus.pdf
[48] [PDF] Respiratory Support in Neonates - GCNIC - CHW https://resources.schn.health.nsw.gov.au/policies/policies/pdf/2007-0005.pdf
[49] [PDF] National Guideline on Management of Oxygen Therapy in Neonates https://health.gov.mv/storage/uploads/5oBvMkoG/pzqwvjv2.pdf
[50] Safe oxygen saturation targeting and monitoring in preterm infants https://pmc.ncbi.nlm.nih.gov/articles/PMC4225465/
[51] Oxygen Saturation Monitoring for the Preterm Infant - Nature https://www.nature.com/articles/pr200973
[52] Oxygen Saturation guidelines Oxygen titration guidelines April 2020 … https://fn.bmj.com/content/fetalneonatal/early/2022/08/23/archdischild-2022-324160/DC1/embed/inline-supplementary-material-1.pdf?download=true

Question 31

Q

31. When auscultating the heart the Valsalva manoeuvre will increase the murmur intensity of

“AS
MS
MR
VSD
Mitral prolapse “

Answer

A

MVP

https://journals.physiology.org/doi/full/10.1152/advan.00128.2011

Question 32

Q

32. The most appropriate order of blood products transfused sequentially through the same blood administration set is

Red cells plasma platelets
Red cells platelets plasma
Plasma red cells platelets
Platelets red cells plasma

Answer

A

platelets prior to pRBCs
n the setting of massive/rapid transfusion when platelets and plasma are both required, they may be transfused sequentially through the same blood administration set.”

Platelets must be transfused through a new blood administration set. In the setting of massive/rapid transfusion when platelets and plasma are both required, they may be transfused sequentially through the same blood administration set.
Platelets must not be transfused through a blood administration set which has previously been used for red cells, as red cell debris in the in-line filter may trap infused platelets.
Red cells may follow platelets through the same blood administration set, but not precede platelets.

https://www.lifeblood.com.au/health-professionals/clinical-practice/transfusion-process/administration

The most appropriate order for sequential transfusion of blood products through the same administration set is platelets first, followed by red cells, then plasma. This sequence minimizes risks of platelet trapping and ensures safe product compatibility with the administration set.

Platelets first:
- Platelets must not be transfused through a blood administration set previously used for red cells, as residual red cell debris can trap platelets and reduce efficacy[10][16].
- Transfusing platelets first allows subsequent products (red cells or plasma) to safely use the same set[7][10].
Red cells second:
- Red cells can follow platelets through the same administration set without issues[10].
- Studies like the PROPPR trial prioritized platelet transfusion in massive hemorrhage protocols, followed by alternating red cells and plasma[1][5].
Plasma last:
- Plasma is compatible with the same administration set used for red cells or platelets[7].
- Plasma units often follow red cells in transfusion sequences to maintain ratio-based resuscitation strategies (e.g., 1:1:1)[1][5].

Red cells → platelets: Risks platelet entrapment in red cell debris[10][16].
Plasma → red cells → platelets: Exposes platelets to red cell debris if the same set is reused.
Red cells → plasma → platelets: Fails to prioritize platelets and risks contamination of the set for subsequent platelet transfusions.

This order aligns with clinical guidelines emphasizing platelet-first protocols in transfusion medicine[3][7][10].

Sources
[1] Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a … https://pmc.ncbi.nlm.nih.gov/articles/PMC4374744/
[2] Blood administration | Professional Education https://professionaleducation.blood.ca/en/transfusion/clinical-guide/blood-administration
[3] Transfusion Medicine - Pathology - University of Michigan https://www.pathology.med.umich.edu/blood-bank/faq
[4] [PDF] Safety Blood filters & giving sets Common blood products https://www.rch.org.au/uploadedFiles/Main/Content/bloodtrans/BLOOD_PRODUCT_ADMINISTRATION.pdf
[5] Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a … https://jamanetwork.com/journals/jama/fullarticle/2107789
[6] Single Unit Transfusion Guide | National Blood Authority https://www.blood.gov.au/blood-products/blood-product-management/single-unit-transfusion-guide
[7] [PDF] Blood Components and Blood Products Administration https://cahs.health.wa.gov.au/~/media/HSPs/CAHS/Documents/Health-Professionals/Neonatology-guidelines/Blood-Components-and-Blood-Products-Administration.pdf?thn=0
[8] [PDF] Ordering Fresh Blood and Albumin - Quick Reference Guide (QRG) https://emrmonashhealth.org/wp-content/uploads/2020/04/Ordering-a-Blood-Transfusion-QRG-v3.pdf
[9] ANZSBT Guidelines https://anzsbt.org.au/guidelines-standards/anzsbt-guidelines/
[10] Administration | Lifeblood https://www.lifeblood.com.au/health-professionals/clinical-practice/transfusion-process/administration
[11] Plasma, Platelets and Whole Blood | Red Cross Blood Services https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/blood-components.html
[12] Blood Management Standard https://www.safetyandquality.gov.au/standards/nsqhs-standards/blood-management-standard
[13] Blood administration - The Royal Children’s Hospital https://www.rch.org.au/bloodtrans/blood_administration/Blood_administration/
[14] Massive Transfusion - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK499929/
[15] Blood and blood products clinical tool | Emergency Care Institute https://aci.health.nsw.gov.au/networks/eci/clinical/tools/blood
[16] 3.15 Blood Administration Sets and Filters https://www.nzblood.co.nz/healthcare-professionals/transfusion-medicine/transfusion-medicine-handbook/3-guide-to-good-transfusion-practice/3-15-blood-administration-sets-and-filters/
[17] Types of transfusion - Lifeblood https://www.lifeblood.com.au/patients/types-of-transfusions
[18] Transfusion process | Lifeblood https://www.lifeblood.com.au/health-professionals/clinical-practice/transfusion-process
[19] Transfusion Guidelines https://www.vet.cornell.edu/animal-health-diagnostic-center/laboratories/comparative-coagulation/clinical-topics/transfusion-guidelines
[20] Clinical Practice Guidelines : Blood product prescription https://www.rch.org.au/clinicalguide/guideline_index/Blood_product_prescription/

Question 33

Q

33. The breathing system shown in the accompanying picture is an example of Mapleson

A
B
C (this), the one from recovery (the APL is proximal)
D
F

Answer

A

Mapleson circuits

Question 34

Q

34. In an anaesthetised patient with anaphylaxis, cardiac compression should be initiated at a systolic blood pressure of less than

Answer

A

sBP < 50 mmHg

ANZAAG

Question 35

Q

35. The muscle recommended for neuromuscular monitoring by the 2023 American Society of Anesthesiologists practice guidelines is the

AP
OO
HL
Supracilli

Answer

A

Adductor pollicis

https://pubs.asahq.org/anesthesiology/article/138/1/13/137379/2023-American-Society-of-Anesthesiologists

Question 36

Q

36. A single intraoperative dose of 8 mg dexamethasone compared to 4 mg results in

Potentially poorly remembered stems.

No difference in analgesia
No difference in PONV
No difference in BSL
Increased surgical site infection

Answer

A

No difference in PONV

Although both 4 mg and 8 mg have consistently been shown to provide effective prophylaxis (and treatment) for postoperative nausea and vomiting,

the higher dose (8 mg) almost certainly provides additional benefits for both analgesia and QoR, and perhaps earlier hospital discharge.

https://pubs.asahq.org/anesthesiology/article/135/5/895/116641/Benefits-and-Risks-of-Dexamethasone-in-Noncardiac

Question 37

Q

37. You are undertaking an ultrasound guided pericapsular nerve group (PENG) block for hip surgery. In the accompanying image, the structure labelled with the arrow is the

Psoas Tendon
Iliacus
Sartorius
“

Answer

A

“Psoas Tendon (This)
Iliacus
Sartorius
“

The anterior hip capsule is innervated by the articular branches from the
1. femoral, (AIIS IPE)
2. obturator, (pericap spread)
3. accessory obturator nerves (AIIS IPE)

while the posterior capsule is innervated by branches from the sacral plexus

https://www.asra.com/news-publications/asra-newsletter/newsletter-item/asra-news/2023/08/01/how-i-do-it-pericapsular-nerve-group-%28peng%29-block

Question 38

Q

39. In the event of an electrical fire in the operating room, the correct fire extinguisher type to use is

Foam
Power
Wet chemical
CO2

Answer

A

CO2 - covers both class A and E

Extra:
PASS
point, aim, squeeze, sweep

RACE
remove/rescue
alert
contain
evacuate

PS 55A - appendix 3 - minimum safe facility
FireExtinguishersInformationSheet

Question 39

Q

38. The tooth most commonly damaged during direct laryngoscopy is the

A. Right middle maxillary incisor
B. Left central maxillary incisor
C. Left middle mandibular incisor
D. Right middle mandibular incisor
E. Right 2nd mandibular molar

Answer

A

Maxillary incisors are the most commonly injured under GA.

Representing 50% of cases, theyare particularly prone to fracture, being small-rooted, of narrow cross-sectional area with a slight anterior axis.

The left central maxillary incisor is most vulnerable to damage from the flange of the laryngoscope blade if used as a fulcrum, usually when attempting to improve the view during a difficult intubation.”

BJA Education Dental Knowledge for Anaesthetists 2016

Question 40

Q

40. According to the ISO colour code for medical gas cylinders, Entonox is indicated by

Answer

A

Body - white

Shoulder - blue and white

BOC medical cylinder chart

Question 41

Q

41. During resuscitation of a newborn, the heart rate is noted to be 50 beats per minute despite optimal ventilation and chest compressions. The next step in management is to give intravenous adrenaline

0.1-0.3ml/kg 1:1000
0.5-1ml/kg 1:10,000
0.1-0.3ml/kg 1:10,000
0.1-0.3ml/kg 1:100, 000

Answer

A

0.1-0.3ml/kg 1:10,000

https://www.apls.org.au/algorithm-newborn-life-support

Question 42

Q

42. An adult weighing 80 kg has sustained full-thickness burns to 40% of their body. The recommended volume of fluid resuscitation in the first 24

“A 8000-9600
B 9600-12800
C 12800-14000”

Answer

A

mParkland
3mL/kg x TBW x %TBSA
3-4ml so B

Question 43

Q

43. In a can’t intubate, can’t oxygenate (CICO) scenario when using a 14G cannula and a Rapid-O2 oxygen delivery device, the initial rescue breath should be

“4 sec at 15L/m
4s at 10L/m
2s at 15L/m
2s at 10L/m
“

Answer

A

a 4 second/1000mL (250x60, /1000)= A 15L/m) initial rescue breath, followed by 2 second/500mL subsequent breaths guided by SpO2 measurement. These volumes are suggested for an “average adult”.

EMAC CICO

Question 44

Q

44. The maximum recommended cumulative dose of Intralipid 20% for the treatment of local anaesthesia systemic toxicity is

8ml/kg
9ml/kg
12ml/kg

Answer

A

840mL

840mL/70kg =

12ml/kg

1.5mL/kg bolus over 2-3 mins
15mL/kg/hr to 30mL/kg/h

AAGBI

Question 45

Q

MH

4, 6, 8, 10, 12years

Answer

A

10 years old (30kg) (need quadraceps bulk)

MH
AD
Early/developing/later signs

Most freq
CO2 high
tachy
masseter spasm
temp abn

MH

MH ANZ - https://malignanthyperthermia.org.au/mh-for-anaesthetists/

Question 46

Q

46. A medication that should be avoided in a patient with thyroid storm is

“Aspirin
PTU
K iodine
B blocker
Steroid
“

Answer

A

Aspirin
NSAIDs - displaces thyroxine from TBP

Question 47

Q

47. A patient with a perioperative troponin rise above normal, chest pain, left ventricular anterior regional wall motion abnormality, and atheroma without thrombus occluding 70% of the left anterior descending coronary artery has had a/an

A acute MI
B T1 infarct
C T2 infarct
D chronic myocardial unjury

Answer

A

Myo injury - cTn > 99th percentile URL
Acute if rise or fall

- Myo INFARCTION Myo Injury +clinical evidence of AMI + at least 1 of
1. MI sx
2. New ischaemia ECG changes
3. Path Q waves
4. Imaging - new loss myo or RWMA
5. ID cor thrombus by angio/autopsy

A rise and fall of cardiac troponin above the 99th percentile upper reference limit with clinical evidence of ischemia demonstrated by at least one of the following: symptoms of ischemia, new ECG changes, or imaging evidence of a new regional wall motion abnormality1. The absence of thrombus on angiography is a critical distinguishing feature that virtually eliminates Type 1 MI from the differential diagnosis1.

https://www.sciencedirect.com/science/article/pii/S0735109718369419?via%3Dihub#sec6

Fourth Universal Definition of Myocardial Infarction (2018) ESC

Question 48

Q

48. Regarding sex differences in the incidence of connected consciousness (ability to respond to command during general anaesthesia) in adults after tracheal intubation as measured by the isolated forearm technique,

Higher in females due to lower propofol ml/kg dose

Higher in females despite same dose propofol

Higher in males due to lower propofol ml/kg dose

Higher in males despite same propofol dose

No sex difference

Answer

A

Higher in females despite same dose propofol

Responses consistent with connected consciousness occurred in 37 of 338 subjects (11%), and were twice as likely to occur in female (13%) than in male (6%) subjects.

There were no differences in medical comorbidity, dosing of anaesthetic drugs, or performance of tracheal intubation to explain why some subjects experienced connected consciousness.

Lennertz
Connected consciousness after tracheal intubation in young adults: an international multicentre cohort study
Br J Anaesth. 2023 Feb; 130(2): e217–e224.

Question 49

Q

49. A patient who underwent a thoracotomy six months ago reports shooting pain on the chest wall occurring without any trigger. This is known as

Paraesthesia
abnormal sensation, un or provoked, not painful
Dysaesthesia spont or evoked, unpleasant abnormal sensation
Allodyina
Hyperalgesia

Answer

A

Chronic pain after thoracotomy afflicts up to 57% of patients at 3 months and 47% at 6 months.8

This incidence has not improved since the 1990s despite improvements in perioperative care.8

Patients present to the pain clinic describing a burning, numbness, or a cutting sensation along the thoracotomy scar, which may be constant or intermittent, and may be evoked by non-painful stimuli such as changes in temperature or donning clothing.

ALLODYNIA
Pain due to a stimulus that does not normally provoke pain.

DYSESTHESIA
An unpleasant abnormal sensation, whether spontaneous or evoked.

Paraesethsia
An abnormal sensation, whether spontaneous or evoked (not unpleasant)

HYPERALGESIA
Increased pain from a stimulus that normally provokes pain.

https://www.iasp-pain.org/resources/terminology/

Question 50

Q

50. In Australia and New Zealand, a return to practice program is recommended after an absence from consultant anaesthetic practice for more than

1, 2, 4, 6 12 months

Answer

A

12mo

PS50
https://www.anzca.edu.au/fellowship/fellows-toolkit/taking-a-career-break-and-returning-to-anaesthesia

Question 51

Q

51. In this ultrasound image, the cricothyroid membrane is at the position marked

Answer

A

Advanced airway assessment techniques https://www.bjaed.org/article/S2058-5349(21)00056-1/pdf

Question 52

Q

52. A superficial cervical plexus block will block all of the following nerves EXCEPT the

“a) Greater occipital
b) greater auricular
c) lesser occipital
d) supraclav
e) transverse cervical”

Answer

A

GOn
LOGAn
SCTC

Cervical roots C2-4

Plexus branches =
great auricular n,
lesser occipital, supraclavicular, transverse cervical.

https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/head-and-neck/ultrasound-guided-cervical-plexus-block/

Question 53

Q

53. A drug which is unlikely to interfere with skin testing is oral

“a) diphenhydramine
b) amitriptyline
c) prednisolone
d) risperidone
e) ranitidine”

Answer

A

Oral corticosteroids probably do not significantly diminish the skin test reaction even after prolonged use

https://www.allergy.org.au/images/stories/pospapers/ASCIA_SPT_Manual_March_2016.pdf

Question 54

Q

54. According to the ANZCA guideline on fatigue risk management in anaesthesia practice the duration of an ideal nap is

a) 20 mins
b) 30 mins
c) 60 mins
d) 90 mins

Answer

A

10-20 mins nap (ideal) appendix 7

Minimisation

Effects may be minimised by:

Naps
2 hour nap prior to night duty
** 30 minute nap during night duty**

Naps are followed by a period of “sleep inertia”
15-30 minute period of impaired performance after waking.

PG43A 2020 Fatigue
Minimising the effects of night-time shift work may be achieved by taking a 60- 90 minute afternoon sleep prior to the night duty, taking a 20-30 minute nap during the shift, eating proper meals, and sleeping as soon as possible after completing their shift.9,10

Question 55

Q

55. A 39-year-old requires anaesthesia for a laparoscopic cholecystectomy. They have a history of mastocytosis and have never had an anaesthetic in the past. The non-depolarising muscle relaxant to avoid using is

Answer

A

Atrac
Miv

https://pubs.asahq.org/anesthesiology/article/120/3/753/13713/Perioperative-Management-of-Patients-with

For a 39-year-old patient with mastocytosis undergoing laparoscopic cholecystectomy, atracurium and mivacurium are the non-depolarizing muscle relaxants to avoid due to their high potential to trigger mast cell degranulation and hypersensitivity reactions[1][4][5][6]. These benzylisoquinolinium compounds directly activate mast cells, increasing the risk of severe perioperative complications like anaphylaxis[1][4].

Safer alternatives include rocuronium, vecuronium, and cisatracurium, which have minimal mast cell activation effects[1][5][6]. For laparoscopic procedures, cisatracurium combined with rocuronium has demonstrated stable muscle relaxation with reduced dosing requirements[3]. Prophylactic H1/H2 antihistamines and corticosteroids are recommended preoperatively to mitigate mast cell mediator release[1][5].

Sources
[1] [PDF] Mastocytosis and Anaesthesia Advice for patients https://www.rcoa.ac.uk/sites/default/files/documents/2020-09/Mastocytosis2014.pdf
[2] Mast cell activation syndrome—anesthetic challenges in two … https://pmc.ncbi.nlm.nih.gov/articles/PMC9724157/
[3] Effects of Combined Rocuronium and Cisatracurium in … https://pmc.ncbi.nlm.nih.gov/articles/PMC5332119/
[4] [PDF] NAP6 Chapter 6 - Summary of main findings.pdf https://www.nationalauditprojects.org.uk/downloads/NAP6%20Chapter%206%20-%20Summary%20of%20main%20findings.pdf
[5] [PDF] Anaesthesia recommendations for Systemic mastocytosis https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/systemic-mastocytosis/1710-systemic-mastocytosis-2/file.html
[6] Surgery and Anesthesia - Mastocytosis.ca https://www.mastocytosis.ca/en/treatment/surgery-and-anesthesia
[7] Succinylcholine Chloride - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK499984/
[8] Neuromuscular physiology and pharmacology: an update https://academic.oup.com/bjaed/article/12/5/237/289170
[9] Anaesthesia in a patient with mastocytosis - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC9511845/
[10] [PDF] Neuromuscular blocking agents and reversal agents - ? Heading 16 https://www.nationalauditprojects.org.uk/downloads/NAP6%20Chapter%2016%20-%20Neuromuscular%20blocking%20agents%20and%20reversal%20agents.pdf
[11] Perioperative Management - TMS - The Mast Cell Disease Society, Inc https://tmsforacure.org/perioperative-management/
[12] Neuromuscular Blocking Agents - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK537168/
[13] Muscle Relaxants Allergy - Sage Journals https://journals.sagepub.com/doi/pdf/10.1177/03946320110240S306
[14] Mastocytosis: anaphylaxis following emergency anaesthesia https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/pdf/10.21466/ac.MAFEA2.2015
[15] atracurium journal articles from PubMed - Unbound Medicine https://www.unboundmedicine.com/medline/research/atracurium
[16] Challenges in Drug and Hymenoptera Venom Hypersensitivity … https://www.mdpi.com/2075-4418/14/2/123
[17] Is Muscle Relaxant Necessary for Cardiac Surgery? - ResearchGate https://www.researchgate.net/publication/8215133_Is_Muscle_Relaxant_Necessary_for_Cardiac_Surgery
[18] Successful Management of Hypothermic Cardiopulmonary Bypass https://journals.lww.com/aoca/fulltext/2020/23030/successful_management_of_hypothermic.28.aspx
[19] Selecting Neuromuscular-Blocking Drugs for Elderly Patients https://www.researchgate.net/publication/10945622_Selecting_Neuromuscular-Blocking_Drugs_for_Elderly_Patients
[20] [PDF] A Practical Guide for Treatment of Pain in Patients with Systemic … https://www.painphysicianjournal.com/current/pdf?article=NDYxNQ%3D%3D&journal=107

Question 56

Q

56. A healthy woman with an uncomplicated pregnancy has an American Society of Anesthesiologists (ASA) Physical Status classification of

Answer

A

2

https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system

Question 57

Q

57. The antibiotic considered safest to be administered to a patient with myasthenia gravis in the perioperative period is

Answer

A

? Cephlosporins? not specifically told not to use them?

aminoglycosides: pre and post NMJ blockade.

Fluroquinolones: umnask and worsen MOA ?.

Fluroquinolones: avoid.

macrolides and telithromycin: avoid.

Based on the available information, the antibiotic considered safest to be administered to a patient with myasthenia gravis in the perioperative period is:

Amoxicillin

Rationale:

While no antibiotic is completely without risk in myasthenia gravis (MG) patients, amoxicillin appears to have the lowest risk profile among the options discussed in the search results:

Penicillins, including amoxicillin, are generally considered low-risk antibiotics for MG patients[2][4].
Amoxicillin is used as a reference antibiotic “not associated with MG risk” in comparative studies[6].
Other antibiotic classes have higher reported risks of exacerbating MG:
- Aminoglycosides have a high risk and should be used cautiously, if at all[1][2][5].
- Fluoroquinolones have a high risk and carry a black box warning against use in MG patients[2][5].
- Macrolides have a moderate risk and should be used cautiously, if at all[2][5].
While there are rare case reports of MG exacerbations with amoxicillin, the overall risk appears lower compared to other antibiotic classes[4].

It’s important to note that any antibiotic can potentially cause issues in MG patients, so close monitoring is always recommended regardless of the antibiotic chosen[4][5].

Citations:
[1] https://periop-handbook.ukclinicalpharmacy.org/drug/pyridostigmine/
[2] https://www.aliem.com/antibiotics-and-myasthenia-gravis/
[3] https://www.neurologyadvisor.com/features/guidance-for-antibiotic-use-in-myasthenia-gravis/
[4] https://pubmed.ncbi.nlm.nih.gov/32296986/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC8520038/
[6] https://consultqd.clevelandclinic.org/myasthenia-gravis-exacerbation-with-quinolone-and-macrolide-antibiotics-what-is-the-risk
[7] https://www.myaware.org/abn-guidelines
[8] https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/myasthenia-gravis/730-myasthenia-gravis-2/file.html
[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC8038781/
[10] https://www.neurology.org/doi/10.1212/WNL.0000000000011124
[11] https://myasthenia.org/wp-content/uploads/Portals/0/Cautionary%20Drugs.pdf
[12] https://www.ncbi.nlm.nih.gov/books/NBK572091/
[13] https://academic.oup.com/ofid/article/4/suppl_1/S342/4294794
[14] https://www.ccjm.org/content/90/2/81
[15] https://rightdecisions.scot.nhs.uk/nhs-dumfries-galloway-antimicrobial-handbook/additional-resources-incl-dosing-generaldrug-specific-advice-pils-sapg-guidance/general-antimicrobial-prescribing/myasthenia-gravis-and-antibiotics/
[16] http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S2524-177X2019000200098
[17] https://www.safetyandquality.gov.au/sites/default/files/migrated/3.8-Surgical-Antibiotic-Prophylaxis.pdf
[18] https://ccmsfiles.tg.org.au/s5/PDFs/ABG16-Surgical-antibiotic-prophylaxis-Collated-table-v4.pdf?type=Surgical+prophylaxis+-+summary+tables

Question 58

Q

58. The clinical laser type with the greatest tissue penetration is

Answer

A

“a) argon weakest, used in retinal surgery
b) Nd:YAG strongest laser
c) Er:YAG
d) CO2
e) holmium *lithotrypsy**”

Laser danger is proportional to penetration.
Penetration inversely prop

Based on comprehensive analysis of the available evidence, the ranking of these lasers from least to greatest tissue penetration is:

Er:YAG laser (least penetration)

CO₂ laser

Holmium lithotripsy laser

Argon laser

Nd:YAG laser (greatest penetration)

Question 59

Q

59. The accompanying image is obtained while doing an ultrasound guided erector spinae plane block at the level of the transverse process of the fourth thoracic vertebra. The muscle marked by the arrow is the

Question 60

Q

60. Risk factors for delirium after hip fracture surgery include all EXCEPT

a) Frailtyee
b) Age
c) GA vs neuraxial
d) male”

Answer

A

“a) Frailtyee
b) Age
** c) GA vs neuraxial**
d) male”

Question 61

Q

61. The effects of empagliflozin include a decrease in

“a) ketone production
b) intravasc volume
c) serum Cr
d)

Answer

A

“a) ketone production
b) intravasc volume **
c) serum Cr
d) “

https://www.tga.gov.au/sites/default/files/auspar-empagliflozin-171026-pi.pdf

Question 62

Q

62. Oral naltrexone should be ceased preoperatively for

Answer

A

Patients may need to be transitioned to oral naltrexone for this period, which can then be stopped 72 hours prior to surgery

Blue book 2023 P.106 107

Question 63

Q

63. A medication that has NOT been associated with arrhythmogenic potential in patients with Brugada syndrome is

Answer

A

Volatile appears safe

Avoid propofol infusion. Can give propofol bolus for induction if thio and etomidate not available

Beta agonism reduce STE
Isoprenaline (b1 and b1 AGONIST)

Note:
Medications that worsen STE in the precordial leads (V1–V3) consistent with Brugada pattern indicate a pro-arrhythmogenic state.

https://www.brugadadrugs.org/
Miller’s 10e P.879

Question 64

Q

Borders of the anterior triangle of the neck DO NOT include the

Answer

A

Anterior triangle borders
1. midline of neck
2. anterior border of SCM,
3. inferior border of mandible

Posterior
1. A: posterior SCM
2. P: anterior traps
3. Inferior: mid 1/3 clavicle

EJV, SCV, SCA

https://teachmeanatomy.info/neck/areas/anterior-triangle/

Answer 63

A

Hyperkalemia,
hyponatremia
Occasionalhypoglycemia
Hypercalcemia

KaCa high

Salt and sugar low

Miller’s 10e P. 895
OHA P. 229

Answer 64

A

Bup

“Avoid due to methaemaglobinaemia: benzocaine, lidocaine, articaine, prilocaine; https://accessanesthesiology.mhmedical.com/content.aspx?bookid=572&sectionid=42543607
Bupivacaine - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9658825/ “

Answer 65

A

IV fluid bolus (50mL/kg),
norad infusion +/-
vasopressin +/-
metaraminol/phenylephrine,
glucagon (1-2mg Q5m)

Refrac BRONCHOSPASM
- salbutamol
- Mag
- Inh
- Ketamine

Answer 66

A

HypoK
Long QT–> TdP (polymorphic VT)

Monomorphic VT

https://ecgwaves.com/topic/ecg-electrolyte-imbalance-electrolyte-disorder-calcium-potassium-magnesium/

Answer 67

A

(probably classic, anything with aperture bars)

Answer 68

A

Dialysis, Cr, Bili, INR, Na

Answer 69

A

Sheehan

Post–dural puncture headache is associated with a substan- tially increased risk of
cerebral venous thrombosis and sub- dural hematoma (composite adjusted odds ratio [aOR] 19.0 [95% confidence interval (CI) 11.2–32.1]) and bacterial meningitis

(aOR 39.7 (95% CI 13.6–115.1)]. Therefore rec- ognizing, treating and monitoring patients who suffer PDPH is vitally important.384

In addition to the acute, severe symptoms associated with a PDPH, new studies have shown an increased risk of long-term adverse effects such as
**
- chronic back pain,
- chronic headache,
- decreased breast- feeding, postpartum depression, and posttraumatic stress disorder.218–220**

Miller’s

Answer 70

A

BP ok
< 34w

Fetal neuroprotection - red incidence of CP

OHA P 870

Answer 71

A

not safe

“NSAIDS cat c except celecoxib B3
APMSE 2020”

Answer 72

A

b) CTG persistent foetal brady

The most common sign of uterine rupture during attempted vaginal birth after cesarean (VBAC) is abnormal fetal heart rate tracing, particularly prolonged deceleration or fetal bradycardia. This is consistently reported across multiple clinical guidelines and studies as the most reliable and frequently observed indicator[1][2][4][6][7][11][12].

Abnormal fetal heart rate (FHR) patterns
- Present in 55–87% of uterine rupture cases[2][6].
- Prolonged fetal bradycardia (sudden drop in heart rate) is the most consistent finding[7][11].
- Occurs due to placental separation or compromised uteroplacental circulation during uterine tearing[4][14].
Other supporting signs
- Severe abdominal pain persisting between contractions, though this may be masked by epidural analgesia[2][3][6][12].
- Loss of fetal station (recession of the baby’s head into the birth canal)[1][4][6].
- Maternal tachycardia, hypotension, or signs of shock[1][3][6].

While uterine rupture is rare (<1% in VBAC attempts)[1][5], prompt recognition is critical. Abnormal FHR often precedes maternal symptoms[4][11].
Continuous electronic fetal monitoring is mandatory during VBAC due to this risk[4][12].

For example, a study cited by BJA Education notes that FHR abnormalities were the first sign in 66–76% of uterine rupture cases[4][12]. UpToDate similarly highlights FHR changes as the most common initial indicator[11].

In summary, vigilance for fetal bradycardia or prolonged deceleration on cardiotocography is paramount, as delayed intervention beyond 10–40 minutes significantly increases neonatal mortality[5][7].

Sources
[1] Uterine Rupture: Causes, Symptoms, and Treatment https://www.healthline.com/health/pregnancy/complications-uterine-rupture
[2] Anaesthetic Considerations for Vaginal Birth After Caesarean Delivery https://resources.wfsahq.org/atotw/anaesthetic-considerations-for-vaginal-birth-after-caesarean-delivery/
[3] Uterine rupture https://patient.info/doctor/uterine-rupture
[4] [PDF] Birth After Previous Caesarean Section - WA Health https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Birth-After-Previous-Caesarean-Section.pdf?thn=0
[5] Uterine Rupture | Childbirth complications | Treatment https://www.drshivahk.com/uterine-rupture/
[6] [PDF] Guideline for the Management of Uterine Rupture - WISDOM https://wisdom.nhs.wales/health-board-guidelines/cwm-taf-maternity-file/uterine-rupture-management-guideline/
[7] Ruptured Uterus https://www.birthinjuryhelpcenter.org/birth-injuries/delivery-complications/uterine-rupture/
[8] Uterine Rupture - Risk Factors - Management - Surgery - TeachMeObGyn https://teachmeobgyn.com/labour/emergencies/uterine-rupture/
[9] Uterine Rupture - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK559209/
[10] What Is Uterine Rupture? https://www.webmd.com/baby/what-is-uterine-rupture
[11] Vaginal Birth After Cesarean Delivery - StatPearls - NCBI Bookshelf https://www.ncbi.nlm.nih.gov/books/NBK507844/
[12] 1 https://www.barnsleyhospital.nhs.uk/sites/default/files/2023-07/uterine-rupture.pdf
[13] [PDF] Anaesthetic Considerations for Vaginal Birth After Caesarean Delivery https://resources.wfsahq.org/wp-content/uploads/atow-450-00-1-6.pdf
[14] Uterine Rupture: Signs, Symptoms, Risks & Treatment https://my.clevelandclinic.org/health/diseases/24480-uterine-rupture
[15] [PDF] Supporting Women in their Next Birth After Caesarean Section (NBAC) https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2014_004.pdf
[16] Uterine Rupture: What Family Physicians Need to Know https://www.aafp.org/pubs/afp/issues/2002/0901/p823.html
[17] [PDF] Birth after Caesarean Section - SA Health https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/resources/policies/birth+after+caesarean+section+-+sa+perinatal+practice+guidelines
[18] [PDF] Guideline for the Management of Uterine Rupture - WISDOM https://wisdom.nhs.wales/health-board-guidelines/cwm-taf-maternity-file/guideline-for-the-management-of-uterine-rupture/

Answer 73

A

crack on and do blood patch at lumbar level!!

“UTD ““Dx and Tx of spontaneous intracranial hypotension””
- Want brain MRI AND spine MRI but spine MRI is not to visualise CSF –> Seems to be to image spinal in case there’s a tumor etc or something else prohibiting you from doing an epidural blood patch”

Answer 74

A

Anterior spinal artery syndrome

Lateral spinothalamic tract

“Deranged phys
Power, pain, temp = anterior tracts
priop + vibration = posterior “

Answer 75

A

0.9% NS

“Maintain serum Na >140mmol/L

Aim isotonic solution
Starship kids hospital guideline NZ”

Answer 76

A

Dec/short Insp time
Inc Exp time

Blue book - 2021

Maintian pulm bf:
Lim peak insp pressure to < 20cmH2o,
short insp time,
avoid excesive PEEP,
reduce RR to < 20

Answer 77

A

C

In this scenario of sudden hypoxemia and difficult ventilation during tonsillectomy in an intubated asthmatic child, option C (ask surgeon to release gag) is the correct next step. Here’s why:

Mechanical obstruction from gag placement is the most likely immediate cause of difficult ventilation during tonsillectomy surgery. The mouth gag used for surgical exposure can compress the endotracheal tube (ETT) against the hard palate or teeth, particularly in pediatric patients with smaller airways.
First-line intervention should focus on relieving reversible iatrogenic causes before addressing bronchospasm (option B) or tube obstruction (option D). Releasing the gag often immediately improves ventilation by relieving ETT compression.
Sequence of action:
- Release gag → reassess ventilation
- If persists → suction ETT (option D)
- If still problematic → consider bronchospasm treatment (option B)

This approach follows the ASA difficult airway algorithm’s emphasis on addressing positional/mechanical causes first in OR emergencies. While bronchospasm (option B) is important in asthmatics, it wouldn’t typically cause sudden onset of difficult ventilation during gag manipulation.

Sources

Answer 78

A

> 60mmHg

Note
* 50 mmHg start compress in anaphylaxis

CALS
Bedside Notebook

Answer 79

A

wean from bypass and ventilate

??Failure of oxygenation via oxygenator

Answer 80

A

Temperatures measured at the nasopharyngeal,
esophageal,
bladder,
rectal, or
skin surface sites underestimate jugular bulb temperature during rewarming.314,315

Because monitoring jugular bulb temperature is not usually feasible, monitoring the temperature of the blood in the arterial line of the CPB circuit is considered the closest surrogate for brain temperature.315,317

Temperature measured in the PA or the nasopharynx (class IIa, Level C) are also reasonable sites to monitor during weaning from CPB.

Miller 10e P. 1620

Answer 81

A

In TOE 4 chamber view, leaflet closest to septum is **anterior mitral leaflet **

Answer 82

A

BMS 6/12 DAPT
DES 6-12/12 DAPT

If surg mandatory, cease clopid 5/7, cont aspirin

Cease P2Y12 inhibitor
- In high or intermediate risk surgery
- Restart and reload after 24-72 hours

Bedside Notebook

Answer 83

A

Adenosine
then
B blocker

ACLS/AL2 tachycardia algorithm
? blue book 2021

Answer 84

A

1:8000 with muscle relaxant b)

1:670 GA LSCS a)
1:8600 CTS c)
1:8200 volatile + NMBD b)

Overall 1:19,000 d)

e)

Answer 85

A

Laparotomy and R thoracotomy

Ivor Lewis Esophagectomy

In the Ivor Lewis esphagectomy, the esophageal tumor is removed through an abdominal incision and a right thoracotomy (a surgical incision of the chest wall). The esophagogastric anastomosis (reconnection between the stomach and remaining esophagus) is located in the upper chest.

The first stage consisted of a laparotomy and mobilization of the stomach, and the second stage performed 10 to 15 days later was a right thoracotomy, resection of the esophagus, and esophagastric anastomosis.

https://stanfordhealthcare.org/medical-treatments/e/esophagectomy/types/ivor-lewis-esophagectomy.html

https://www.optechtcs.com/article/S1522-2942(09)00058-0/fulltext

Answer 86

A

e) decreased AKI

RELIEF Trial: Key Findings Summary

Study Design: Large international RCT with 3,000 patients across 47 hospitals in 7 countries undergoing major abdominal surgery.
Fluid Protocols: Liberal strategy (10 mL/kg bolus at induction + 8 mL/kg/hr intraoperatively) vs. Restrictive strategy (5 mL/kg bolus + 5 mL/kg/hr intraoperatively).
Total Fluid Volumes: Liberal group received median 6.1L vs. restrictive group 3.7L (p<0.001).
Acute Kidney Injury: Liberal strategy resulted in significantly lower AKI rates (5.0%) compared to restrictive strategy (8.6%), p<0.001.
Renal Replacement Therapy: Trend toward lower requirement in liberal group (0.3% vs 0.9%, p=0.048), not significant after adjustment.
Disability-free Survival: No significant difference at 1 year (82.3% liberal vs 81.9% restrictive).
Surgical Site Infections: Lower in liberal group (13.6% vs 16.5%, p=0.02), not significant after adjustment.
Anastomotic Leak: No statistically significant difference (2.4% liberal vs 3.3% restrictive).
Conclusion: Liberal fluid strategy in major abdominal surgery decreased AKI compared to restrictive strategy.

Answer from Perplexity: pplx.ai/share

ANZCA study! The bottom line:

Primary outcome: No difference in disability-free survival up to 1 year after surgery

–> Acute kidney injury at 30 days occurred more commonly in the restrictive fluid group

Liberal group - decreased AKI

No difference in mortality or major septic complications

https://www.thebottomline.org.uk/summaries/relief/

Answer 87

A

Allow eye to proptose

Retrobulbar haemorrhage
reduces orbital compartment pressure

Vision treatment requires prompt intervention with immediate decompression of the expanding hematoma by dissection of the lateral canthus (lateral canthotomy) and disinsertion of at least the inferior crus of the lateral canthal tendon (inferior cantholysis).

This will allow for the globe to prolapse anteriorly relieving the pressure within the orbit.

https://surgeryreference.aofoundation.org/cmf/trauma/midface/further-reading/retrobulbar-hemmorage

Answer 88

A

Irregular narrow-complex tachycardia

In the acute care setting the simplest approach to managing this condition is to control the rate of ventricular response. This can be achieved with agents such as oral or intravenous beta blockers (metoprolol 5mg IV) (contraindications would include a history of bronchospasm or evidence of decompensated heart failure) or digoxin (250 mcg to 500mcg IV or PO). In cases of paroxysmal (intermittent) atrial fibrillation many patients revert to a normal heart rhythm spontaneously.

The common symptoms of tachycardia include syncope (fainting), shortness of breath, dizziness, chest pain or palpitations. The following adverse features suggest a need for immediate treatment (see tachycardia algorithm):

sBP < 90 mmHg;
HR > 150/min;
chest pain;
heart failure; or
drowsiness or confusion

Add:

Regular broad complex tachy = amiodarone 300mg then 900

Irregular broad complex tachy =
AF = BBB = avoid adeno/dig/verap/diltiazem

TdP VT = mag 5mmol over 10min; repeated x1; infusion 20mmmol over 4 hrs

TdP from HB and brady = pacing, sync DC
Avoid amiodarone

https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-9-managing-acute-dysrhythmias/

+ AHA guideline

Answer 89

A

18mL

Local anaesthetic for the block:

Dilute lidocaine (lignocaine) 1% with an equal quantity of normal saline to make a 0.5% solution
- Lidocaine (lignocaine) dose: 3 mg/kg **(0.6 mL/kg of 0.5%; max 200 mg or 40 mL) **

RCH guidelines - Rec dilute lig to 0.5%

https://www.rch.org.au/clinicalguide/guideline_index/Bier_block/

Answer 90

A

“Chewing gum and boiled sweets should be discarded prior to inducing anaesthesia to avoid them being
inhaled as a foreign body but do not constitute an indication for delaying any procedure unless they have been ingested.”

PG07

Answer 91

A

Intercristal line in NEONATES = L5/S1

Answer 92

A

70mmHg

Oxford Handbook

Answer 93

A

Midaz 0.15mg/kg

https://www.apls.org.au/algorithm-status-epilepticus

Answer 94

A

IM Ad (paeds)
0-6yo = 150mcg
6-12yrs = 300mcg
q5m in lateral thigh

Answer 95

A

4mg/kg

60mg

Answer 96

A

Reduced due to incr VD and Cl

The pharmacokinetic characteristics of a propofol bolus administered in patients with major burns were enhanced clearance and expanded volume of distribution. BURN and WT were the important covariates.
Population pharmacokinetics of a propofol bolus administered in patients with major burns - 2010

Answer 97

A

sail sign

Probably LLL collapse? Look for sail sign or double R heart border

Answer 98

A

ANZCOR - 1L

2.1.5L

“LITFL:
Massive hemothorax is defined by the need for thoracotomy — the indications are:

Blood loss > 1,500 mL or 1/3rd of blood volume
Blood loss >200 mL/h (3 mL/kg/h) for 2-4 hours”

Answer 99

A

pneumothorax or lung apex

https://academic.oup.com/bjaed/article/16/2/39/2897763

Answer 100

A

incr risk non fatal cardiac arrest

POISE2 trial: Conclusions: Administration of low-dose clonidine in patients undergoing noncardiac surgery did not reduce the rate of the composite outcome of death or nonfatal myocardial infarction; it did, however, increase the risk of clinically important hypotension and nonfatal cardiac arrest.

Answer 101

A

esmolol

Answer:
a) esmolol

Rationale:
In acute aortic dissection, the primary therapeutic goals are to reduce systolic blood pressure (target <120 mmHg) and lower the rate of pressure rise (dP/dt) to minimize aortic wall stress. Beta-blockers like esmolol are first-line agents because they achieve both objectives by reducing heart rate and myocardial contractility[1][2][5][7]. Esmolol’s ultra-short half-life (9 minutes) allows precise titration, making it ideal for unstable patients[1][2].

Vasodilators like sodium nitroprusside (SNP) or hydralazine are contraindicated as monotherapy due to reflex tachycardia, which increases dP/dt and propagation risk[2][8]. Guidelines explicitly state hydralazine should not be used in aortic dissection[3][6][8]. SNP may be added after beta-blockade for additional blood pressure control[2][7]. HTN (hypertension) is not a medication. Thus, esmolol is the optimal initial choice[1][5][7][10].

Citations:
[1] https://pubmed.ncbi.nlm.nih.gov/32354528/
[2] https://emedicine.medscape.com/article/2062452-medication
[3] https://www.bhs.org.au/bhsapps/govdoc/gdhtml/GDDRG0034-25949-63479.pdf
[4] https://nyulangone.org/conditions/aortic-dissection/treatments/medication-for-aortic-dissection
[5] https://institutionalrepository.aah.org/cgi/viewcontent.cgi?article=1077&context=sciday
[6] https://www.ahajournals.org/doi/10.1161/ATVBAHA.118.310956
[7] https://journals.sagepub.com/doi/10.1177/17511437231162219
[8] https://www.uhbw.nhs.uk/assets/1/22-201_aortic_dissection_redacted.pdf
[9] https://aci.health.nsw.gov.au/networks/eci/clinical/tools/cardiology/aortic-dissection
[10] https://litfl.com/acute-aortic-dissection/
[11] https://www.annalscts.com/article/view/4188/pdf
[12] https://pmc.ncbi.nlm.nih.gov/articles/PMC10726980/
[13] https://www.emra.org/emresident/article/thoracic-aortic-dissection
[14] https://www.ncbi.nlm.nih.gov/books/NBK518965/
[15] https://coreem.net/core/aortic-dissection/
[16] https://academic.oup.com/bjaed/article/9/1/14/465697
[17] https://www.ahajournals.org/doi/10.1161/CIR.0000000000001106
[18] https://www.ncbi.nlm.nih.gov/books/NBK470296/
[19] https://www.bloodpressureclinic.ed.ac.uk/sites/default/files/atoms/files/type_b_aortic_dissection.pdf
[20] https://emcrit.org/ibcc/htn/
[21] https://www.ncbi.nlm.nih.gov/books/NBK441963/
[22] https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.118.312436

“Up TO Date
Initial treatment consists typically of an intravenous beta blocker to reduce the heart rate to 60 to 80 beats/minute [75]. Esmolol is useful in the acute setting due to its short half-life and ability to titrate to effect –> Then SNP”

Answer 102

A

Catastrophising

APMSE p24

Answer 103

A

Amitriptyline 3.6

Tramadol (NNT 4.4)

APMSE p 137

Answer 104

A

RCH guidelines

Wong-baker by age 4

Visual analogue scale by age 8

Answer 105

A

Tranexamic Acid Efficacy in Different Clinical Scenarios

Tranexamic acid (TXA) is an antifibrinolytic agent that inhibits the enzymatic breakdown of fibrinogen and fibrin by plasmin. While it has proven beneficial in several clinical scenarios involving hemorrhage, its efficacy is not universal across all bleeding conditions.

Evaluation of Tranexamic Acid Across Clinical Settings

Cardiac Surgery Applications

TXA demonstrates significant benefit in cardiac surgery settings. The ATACAS trial, which examined tranexamic acid use in patients undergoing coronary artery surgery, found that TXA was “associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery”[3]. While TXA did increase the risk of postoperative seizures, its hemostatic benefits were clear, with significantly reduced blood product transfusion requirements and fewer reoperations for bleeding[3][8].

Neurotrauma Management

In traumatic brain injury (TBI), the CRASH-3 trial demonstrated that timely TXA administration reduces mortality in specific patient groups. Particularly beneficial effects were observed “in patients with reactive pupils and those with a mild to moderate GCS at baseline”[4]. The trial emphasized that treatment delay reduces benefit, highlighting the importance of early administration[4][9].

Postpartum Hemorrhage

The WOMAN trial provided compelling evidence for TXA in postpartum hemorrhage (PPH). Results showed that when administered within 3 hours of birth, TXA “can reduce the risk of death due to bleeding by one-third and the need for surgery to stop bleeding by over one-third”[5][10]. With PPH being a leading cause of maternal mortality worldwide, this represents a significant clinical advance in obstetric care.

Trauma-Related Hemorrhage

The landmark CRASH-2 trial established TXA’s role in trauma management. This international study demonstrated mortality benefits when TXA was administered to bleeding trauma patients, particularly when given early after injury[6][11]. The evidence has been robust enough to influence trauma protocols globally.

Gastrointestinal Bleeding

In stark contrast to the aforementioned scenarios, the HALT-IT trial found that TXA provides no mortality benefit in gastrointestinal bleeding. This international, randomized, double-blind, placebo-controlled trial involving 12,009 patients conclusively demonstrated that “tranexamic acid did not reduce death from gastrointestinal bleeding”[16]. The trial reported “death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82-1·18)”[16].

More concerning, the study found that TXA was “associated with an increased risk of venous thromboembolic events (deep vein thrombosis or pulmonary embolism)”[16]. The trial investigators explicitly concluded that “tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial”[16].

Conclusion

Based on the comprehensive evidence from major clinical trials, tranexamic acid has proven beneficial in cardiac surgery, traumatic brain injury, postpartum hemorrhage, and general trauma management. However, the HALT-IT trial clearly establishes that TXA is not useful in the management of upper gastrointestinal bleeding, where it shows no benefit and potential harm.

Therefore, the correct answer is e) UGI bleed.

Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC6668177/
[2] https://txacentral.lshtm.ac.uk/gi-bleeding/
[3] https://pubmed.ncbi.nlm.nih.gov/27774838/
[4] https://pubmed.ncbi.nlm.nih.gov/32076783/
[5] https://www.thebottomline.org.uk/summaries/icm/woman-trial/
[6] https://pubmed.ncbi.nlm.nih.gov/23477634/
[7] https://bmjopen.bmj.com/content/bmjopen/13/2/e059982.full.pdf
[8] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069606
[9] https://pmc.ncbi.nlm.nih.gov/articles/PMC3481366/
[10] https://txacentral.lshtm.ac.uk/post-partum-haemorrhage/
[11] https://onlinelibrary.wiley.com/doi/10.1155/2015/874920
[12] https://www.thebottomline.org.uk/summaries/halt-it/
[13] https://bmjopen.bmj.com/content/13/2/e059982
[14] https://www.theresusroom.co.uk/courses/txa-in-gi-bleeds/
[15] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)308485/fulltext
[16] https://pubmed.ncbi.nlm.nih.gov/32563378/
[17] https://ashpublications.org/ashclinicalnews/news/5319/Tranexamic-Acid-for-Gastrointestinal-Bleeding-Time
[18] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30975-2/fulltext
[19] https://pubmed.ncbi.nlm.nih.gov/7793735/
[20] https://txacentral.lshtm.ac.uk/wp-content/uploads/2021/03/CRASH-3_neuroprotective-effect-of-tranexamic-acid.pdf
[21] https://pmc.ncbi.nlm.nih.gov/articles/PMC2864262/
[22] https://www.journalslibrary.nihr.ac.uk/hta/HTA17100
[23] https://jamanetwork.com/journals/jama/fullarticle/2794565
[24] https://www.thebottomline.org.uk/summaries/crash-3/
[25] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30638-4/fulltext
[26] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60835-5/fulltext
[27] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32233-0/fulltext
[28] https://pubmed.ncbi.nlm.nih.gov/28456509/
[29] https://www.ncbi.nlm.nih.gov/books/NBK260390/
[30] https://www.thelancet.com/article/S0140-6736(19)32312-8/fulltext

Answer from Perplexity: pplx.ai/share

“Multiple trials with TXA
- CRASH-2 showed reduction in 28-day mortality in patients who received TXA within 3 hours of injury
- CRASH-3 was a trial of TXA in head injured patients. The group with mild-moderate head injury benefited from TXA, but overall there was no significant effect
- TRAAP2 showed the use of prophylactic TXA for caesarean delivery reduces the rates of PPH as defined by an estimated blood loss of > 1000ml or red cell transfusion by day 2
- HALT-IT showed TXA does not reduce death from GI bleeding and should not be used as part of a uniform approach to treat GI bleeding + harm shown
- ATACAS 2017 showed the use of TXA was associated with a lower risk of bleeding post-operatively and was not associated with increased risk of death or thrombotic effects when compared to the administration of a placebo”

Answer 106

A

Prothrombinex - contains heparin

“Bivalirudin is the non-heparin agent of choice for anticoag in HIT - UTD
Danaparoid is a non-heparin anticoagulant used to treat HIT - NSW Guideline”

Answer 107

A

Reduced time to resumption of oral intake

Answer 108

A

“250mcg IM Q15min, up to 2mg
“

Answer 109

A

rocuronium (24% - fig 4)

NAP6

Answer 110

A

SST/serum tube (Gold top)

https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/T/Tryptase

Answer 111

A

4 hrs

https://www.lifeblood.com.au/health-professionals/clinical-practice/transfusion-process/administration

Answer 112

A

TRALI

https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TRALI

Answer 113

A

longer length

https://aam.ucsf.edu/microlaryngoscopy-tube-mlt%C2%AE

Answer 114

A

30cmH20

30cmh20 - thats the top of the green zone

Answer 115

A

“Two defibrillators with pads in 2 different planes (AL, AP)
note - DSED better neurologic outcomes and survival to d/c vs standard defib in refractory VF
< 1 sec”

“https://www.nejm.org/doi/full/10.1056/NEJMoa2207304

"”two near-simultaneous defibrillation shocks provided by two defibrillators”””

Answer 116

A

Cold saline irrigation

SMACC quick reference guidelines #9

Answer 117

A

“a) Hypoxia
b) Alkalaemia
c) High alpha1-acid glycoprotein
d) Hypocarbia
e) Increased carnitine levels”

hypoxia (decreases protein binding as per BJA)

“https://litfl.com/local-anaesthetic-toxicity-ccc/
risk factors: type of LA and dose, site of injection, the patient’s comorbidities, extremes of age, and small size or limited muscle mass, organ dysfunction (cardiac, hepatic, renal), the serum level of the binding proteins, and age. Worse with hypoxia, hypercarbia, acidosis. Carnitine deficiency may predispose to toxicity - https://pubmed.ncbi.nlm.nih.gov/21537157/
alpha 1 GP binds amide LA. Lower levels -> increased toxicity risk”

Answer 118

A

Non-inferiority is not demonstrated

Answer 119

A

comparisons of means between three groups (unpaired) in normally distr data

BJA

Answer 120

A

Pregnancy - 3rd heart sound reflects rapid LV distension along with increased AV flow

Answer 121

A

Adductor Canal

adductor canal block - https://www.bjanaesthesia.org/article/S0007-0912(18)30572-5/pdf

Answer 122

A

Critical appraisal

Answer 123

A

RCA - inferior - II III aVF
LAD - anterior - V3 V4
OM - LCx - lateral - I aVL V5 V6
Post - RCA/RCx - V7 V8 V9 (reciprocal STD V1-V3)

Answer 124

A

Give IV iron **

Serum ferritin level < 30 μg.l−1 is the most sensitive and specific test used for the identification of absolute iron deficiency. However, in the presence of inflammation (C-reactive protein > 5 mg.l−1) and/or transferrin saturation < 20%, a serum ferritin level < 100 μg.l−1 is indicative of iron deficiency.

Hb 110 (< 130) = anaemia
CRP 10mg/L = inflammation
Ferritin < 100 = iron deficiency
10 days pre op ( < 6 weeks dx)

= IV iron

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.13773

International consensus statement on the peri-operative management of anaemia and iron deficiency

Sufficient data exist to support intravenous iron as efficacious and safe. Intravenous iron should be used as front-line therapy in patients who do not respond to oral iron or are not able to tolerate it, or if surgery is planned for < 6 weeks after the diagnosis of iron deficiency.

Ferritin < 30 = PO iron
Ferritin 30-100 = IV iron

Answer 125

A

Unstable angina (no trop rise)

(NSTEMI and MINS will both have trop rise)

Answer 126

A

Normal 0 to 90 deg
LAD 0 to - 90
extreme axis -90 to 180

Answer 127

A

65

Norad first line

Surviving sepsis guidelines 2021

Answer 128

A

octreotide bolus

https://academic.oup.com/bjaed/article/11/1/9/285683

Answer 129

A

Vasoplegia

Hemodynamic Profile in Cardiac Surgery: Low-Normal CVP, Hypotension, and Hyperdynamic Heart

Hemodynamic monitoring during cardiac surgery provides critical information about a patient’s cardiovascular status. When confronted with a pattern of low-normal central venous pressure (CVP), low blood pressure, and a hyperdynamic heart, clinicians must correctly identify the underlying pathophysiology to implement appropriate treatment strategies. This specific hemodynamic profile strongly suggests vasoplegia, but it’s important to understand why this is the case and rule out other potential conditions.

Vasoplegia as the Correct Answer

Vasoplegia is defined as hypotension and low systemic vascular resistance (SVR) despite normal or elevated cardiac index, a complication frequently following cardiac surgery[1]. This hemodynamic profile perfectly matches the scenario described: low blood pressure (hypotension) with a hyperdynamic heart (indicating normal or elevated cardiac output) and a low-normal CVP.

The pathophysiology of vasoplegia involves profound vasodilation leading to increased vascular capacitance. This excessive vasodilation results in relative hypovolemia despite potentially normal total blood volume, explaining the low-normal CVP[8]. The heart attempts to compensate for this decreased vascular resistance by increasing cardiac output, resulting in the hyperdynamic state described in the question.

Vasoplegia is a common complication following cardiovascular surgery with cardiopulmonary bypass (CPB), with an incidence varying from 5% to 44%[4]. It represents a distributive form of shock characterized by a significant drop in vascular resistance. The pathophysiology involves multiple mechanisms, including activation of inflammatory pathways, excessive nitric oxide production, and vascular smooth muscle cell hyperpolarization through potassium channel activation[6][8].

Why Hypovolemia is Incorrect

Hypovolemia refers to a decreased intravascular volume state. While hypovolemia can certainly cause low blood pressure and low CVP, it doesn’t typically maintain a hyperdynamic cardiac state when severe enough to cause hypotension[5]. In significant hypovolemia, the heart initially becomes hyperdynamic as a compensatory mechanism, but as volume depletion continues, cardiac output eventually decreases due to inadequate preload.

The extreme hyperdynamic state (EHS) described in one study is characterized by SVR below 450 dynes × s/cm^5 and a cardiac output above 7 L/min/m^2, but this was observed in conditions like cirrhosis and sepsis rather than pure hypovolemia[5]. In cardiac surgery, persistent hyperdynamic circulation with hypotension despite adequate volume replacement strongly points toward vasoplegia rather than simple hypovolemia.

Why LV Dysfunction is Incorrect

Left ventricular dysfunction presents with a fundamentally different hemodynamic profile than the one described. LV dysfunction typically causes:

Elevated CVP (not low-normal) due to backward failure and congestion in the venous system
Low blood pressure due to reduced forward flow
Reduced cardiac output (not hyperdynamic)[2]

Heart failure with reduced ejection fraction is actually a risk factor for developing vasoplegia, with studies showing increased incidence of vasoplegia up to 74% in patients with poor LV function (EF < 37%) exposed to prolonged CPB duration[4]. This suggests that the hyperdynamic state described in the question cannot be attributed to LV dysfunction.

Why Cardiomyopathy is Incorrect

Cardiomyopathy, particularly dilated cardiomyopathy, presents with hemodynamics similar to LV dysfunction:

Elevated filling pressures, including increased CVP
Low blood pressure from decreased forward flow
Reduced cardiac output

The hemodynamic profile would show a failing heart unable to generate adequate cardiac output, not the hyperdynamic state described in the question[7]. Like LV dysfunction, cardiomyopathy is characterized by impaired contractility, which is inconsistent with the hyperdynamic heart mentioned in the scenario.

Conclusion

The combination of low-normal CVP, low blood pressure, and a hyperdynamic heart in cardiac surgery most strongly suggests vasoplegia. This distributive shock state commonly occurs after cardiopulmonary bypass due to systemic inflammatory response, nitric oxide overproduction, and vasopressin deficiency, leading to pathologic vasodilation[1][4]. The other options—hypovolemia, LV dysfunction, and cardiomyopathy—each have hemodynamic profiles that differ significantly from the pattern described in the question, making vasoplegia the correct diagnosis.

Citations:
[1] https://www.eajm.org/Content/files/sayilar/221/92-100.pdf
[2] https://litfl.com/cvp-measurement/
[3] https://www.ahajournals.org/doi/10.1161/JAHA.117.008377
[4] https://pmc.ncbi.nlm.nih.gov/articles/PMC9658078/
[5] https://pmc.ncbi.nlm.nih.gov/articles/PMC29017/
[6] https://www.mdpi.com/2077-0383/11/21/6407
[7] https://onlinelibrary.wiley.com/doi/10.1111/jocs.15805
[8] https://pmc.ncbi.nlm.nih.gov/articles/PMC6035427/
[9] https://www.ncbi.nlm.nih.gov/books/NBK519493/
[10] https://pmc.ncbi.nlm.nih.gov/articles/PMC10402787/
[11] https://www.racgp.org.au/afp/2014/may/dizziness
[12] https://www.medintensiva.org/en-how-use-echocardiography-manage-patients-articulo-S217357272300200X
[13] https://www.mdpi.com/1648-9144/60/12/2064
[14] https://onlinelibrary.wiley.com/doi/10.1111/liv.13589
[15] https://criticalcarenow.com/vasoplegia/
[16] https://academic.oup.com/ejcts/article/25/3/327/379777
[17] https://emcrit.org/pulmcrit/mythbusting-empty-ivc-hyperkinetic-heart-%E2%89%A0-volume-depletion/
[18] https://jeccm.amegroups.org/article/view/5248/html
[19] https://www.medintensiva.org/en-factors-associated-with-vasoplegic-shock-articulo-S217357272400081X
[20] https://www.ahajournals.org/doi/10.1161/circulationaha.108.803965

Answer from Perplexity: pplx.ai/share

Answer 130

A

O2 consumption at rest

Answer 131

A

8cm

https://www.resus.org.nz/assets/Uploads/ANZCOR-Guideline-11.4-Elect-Jan16.pdf

Answer 132

A

Incr pulmonary vascular resistance

-

“UTD
- decrease in cardiac output up to 60% therefore decrease in cardiac index
- Increased SVR due to vasopressin
- increased hep bf only after 48h”

Answer 133

A

Desat

In an awake neonate experiencing inadvertent total spinal anaesthesia, desaturation due to respiratory compromise is most likely to be the first observable clinical sign, followed by cardiovascular changes and eventually loss of consciousness if the condition progresses without intervention. (Perplexity)

Cote’s Practice of Anaes for Infants

Answer 134

A

More serious injury results from neuropraxia associated with pressure on cranial nerves from the tube (lingual nerve), or cuff (hypoglossal and recurrent laryngeal nerves) of the SAD have been reported in small case series. Injury to the lingual nerve usually presents as loss of taste and sensation to the tip of the tongue,hypoglossal nerve as dysphagia, and recurrent laryngeal nerve as altered voice and rarely, stridor.

Iatrogenic airway injury BJA Education, 18(10): 310e316 (2018)

Answer 135

A

hypovolaemia

Normal ED cm = 3.5-5.6cm

Answer 136

A

ΔP = Pplat – PEEP

Clinical need

Protective lung ventilation strategies and ‘open lung’ approaches are associated with less ventilator-induced lung injury (VILI), improved oxygenation and improved outcomes
Important components of these strategies all decrease stress on the lung:
    lower tidal volumes
    lower plateau pressure
    higher PEEP

Conclusion:
1. Titrating VT to prevent ΔP >13 cmH2O, if has minimal costs in terms of CO2 clearance, appears to be a reasonable adjunct to a protective lung ventilation approach
2. However, the use of driving pressure is yet to be subjected to a high quality randomised controlled trial confirming its clinical utility and safety
3. Optimal threshold for ΔP, if any, is unknown (various studies suggests targets in the range of 10-15 cmH2O).

“https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280884/

https://litfl.com/driving-pressure/”