2024.1 MCQ Flashcards
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
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”
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
Platelets (ie reduced max amp, thin sausage)
LITFL DP CSL
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
b) Reduced Lung compliance
UTD
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
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
2024.1
5) 5. Duchenne muscular dystrophy is NOT associated with
No sux or VA
** Resistant to NDMR (can give, generally delayed onset, prolonged duration)
** Female carriers dont usually have CM”
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”
a) moclobemide
Tramadol + MAOIs = CI because high risk serotonin syndrome!
“NPS Org - https://www.nps.org.au/assets/AP/pdf/p41-Perananthan-Buckley.pdf
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”
“a) inhib GNP
https://academic.oup.com/ejcts/article/28/5/705/502264
2024.1
8) 8. A stellate ganglion block is NOT indicated in the management of
“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”
2024.9. Obstructive sleep apnoea in children is diagnosed with an apnoea-hypopnoea index (AHI) of at least
a) 1
b) 5
c) 10
1
Kids should not have apnoeas
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)
11. A transjugular intrahepatic portosystemic shunt procedure is contraindicated in patients with
Hepatorenal syndrome
Refractory ascites
Severe TR
Variceal bleeding
Budd chiari
- 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)
12
- When confirming correct placement of an endotracheal tube, verifying the presence of sustained exhaled carbon dioxide requires all the
4 criteria
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
- **The dataset that was used to create the Eleveld TCI model did NOT include patients who are / have
“Neonate
Elderly
Liver
Renal
Obese”
Liver?
- The blood product that contains the highest concentration of citrate is
”
CITRATE:
Whole blood: 26g/l
Platelet(phoresis): 22g/l
Plasmapheresis 40g/l
Platelet additive: 0.3g/l
Red cells and albumin: NONE! SAGM”
Plasma
- 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
“
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
- The anaesthetic technique associated with the highest rate of postprocedure patency of a newly-created arteriovenous fistula is
BP block
LA by surgeons
BP block
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
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
COHb
(CarboxyHb)
(Miller)
Also:
Skin pigmentation if saO2 < 80% (Miller)
IABP (UTD)
Inc HbA1c (UTD)
- 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 “
90 mins
20. The rank of volatile anaesthetic agents from highest to lowest derived global warming potential over 100 years (GWP100) is
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
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
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)
22. The bipolar leads of a 12-lead electrocardiogram are
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
Lead = view b/w + and - pole
Plane = cross sectional view
https://www.ausmed.com.au/learn/articles/5-lead-ecg
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
Bupiv
357
BRL
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”
UTD: Anticoagulant effect completely reversed within 15min
25. The intrinsic muscles of the larynx do NOT include
a) cricothyroid
b) suprahyoid
c) thyroaretenoid
d) transverse arytenoid
Intrinsic muscles of the larynx:
cricothyroid
thyroaretenoid
posterior cricoarytenoid
lateral cricoarytenoid
transverse arytenoid
NO hyoid
26. When interpreting an arterial blood gas, a high serum anion gap is consistent with
HAGMA LTKR
lactate
toxin - salicylate
ketone
renal failure
27. The Glasgow Blatchford score is used to risk stratify
Pulmonary haemorrhage
Traumatic intraperitoneal haemorrhage
PPH
UGI bleed
UGIB
SAH (WFNS GCS and motor- survival and Fisher rad- vasospasm)
28. In a male patient with quadriplegia undergoing a rigid cystoscopy, the optimal choice of anaesthesia to prevent autonomic dysreflexia is
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
29. Interference with pacemaker function can result from all of the following EXCEPT
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
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 “
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)
31. When auscultating the heart the Valsalva manoeuvre will increase the murmur intensity of
“AS
MS
MR
VSD
Mitral prolapse “
MVP
https://journals.physiology.org/doi/full/10.1152/advan.00128.2011
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
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
33. The breathing system shown in the accompanying picture is an example of Mapleson
Mapleson circuits
34. In an anaesthetised patient with anaphylaxis, cardiac compression should be initiated at a systolic blood pressure of less than
sBP < 50 mmHg
ANZAAG
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
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
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
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
40. According to the ISO colour code for medical gas cylinders, Entonox is indicated by
Body - white
Shoulder - blue and white
BOC medical cylinder chart
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
0.1-0.3ml/kg 1:10,000
https://www.apls.org.au/algorithm-newborn-life-support
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
“
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
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
12mo
PS50
https://www.anzca.edu.au/fellowship/fellows-toolkit/taking-a-career-break-and-returning-to-anaesthesia
51. In this ultrasound image, the cricothyroid membrane is at the position marked
Advanced airway assessment techniques https://www.bjaed.org/article/S2058-5349(21)00056-1/pdf
56. A healthy woman with an uncomplicated pregnancy has an American Society of Anesthesiologists (ASA) Physical Status classification of
2
https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system
58. The clinical laser type with the greatest tissue penetration is
“a) argon (weakest, used in retinal surgery)
b) Nd:YAG*
c) Er:YAG
d) CO2 strongest laser
e) holmium lithotrypsy”
60. Risk factors for delirium after hip fracture surgery include all EXCEPT
“a) Frailty
b) Age
** c) GA vs neuraxial**
d) male”
63. A medication that has NOT been associated with arrhythmogenic potential in patients with Brugada syndrome is
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
- The ANZAAG-ANZCA guideline for management of resistant hypotension during perioperative refractory anaphylaxis in an adult includes all of the following EXCEPT
”
a. Metaraminol
b. Glucagon
c. Promethazine
d. Vasopressin
other remembered answers
a) fluid bolus 20mL/kg
b) cont Ad
c) NAd inf
d) vaso bolus
e) glucagon”
IV fluid bolus (50mL/kg),
norad infusion +/-
vasopressin +/-
metaraminol/phenylephrine,
glucagon (1-2mg Q5m)
Refrac BRONCHOSPASM
- salbutamol
- Mag
- Inh
- Ketamine
68. The abnormalities seen in the electrocardiogram below are consistent with
U waves
a) HyperCa
b) HyperMg
c) HyperPhos
d) HypoK
e) HyperK”
HypoK
Long QT–> TdP (polymorphic VT)
Monomorphic VT
https://ecgwaves.com/topic/ecg-electrolyte-imbalance-electrolyte-disorder-calcium-potassium-magnesium/
70. The MELD-Na (Model for End-Stage Liver Disease-Sodium) score includes all of the following parameters EXCEPT
a) Bili
b) INR
c) Alb
d) Cr
Dialysis, Cr, Bili, INR, Na
83. The image below is from the transoesophageal echocardiogram of an adult patient who is about to undergo cardiac surgery. The structure labelled with the arrow is the
In TOE 4 chamber view, leaflet closest to septum is **anterior mitral leaflet **
