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2024.1 MCQ Flashcards

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

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”

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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

A

Platelets (ie reduced max amp, thin sausage)

LITFL DP CSL

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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

A

b) Reduced Lung compliance

UTD

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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

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

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5
Q

2024.1

5) 5. Duchenne muscular dystrophy is NOT associated with

A

No sux or VA

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

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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”

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

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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”

A

a) inhib GNP

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

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8
Q

2024.1

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

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”

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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

A

1

Kids should not have apnoeas

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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)

A

hFPP and MC both contraindicated??

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11
Q

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

Hepatorenal syndrome
Refractory ascites
Severe TR
Variceal bleeding
Budd chiari

A
  1. Severe TR
  2. Severe PHTN (MPAP > 45)
  3. HF
  4. 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)

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12
Q

12

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

4 criteria

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

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13
Q
  1. **The dataset that was used to create the Eleveld TCI model did NOT include patients who are / have

“Neonate
Elderly
Liver
Renal
Obese”

A

Liver?

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14
Q
  1. 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”

A

Plasma

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15
Q
  1. 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
“

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

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16
Q
  1. The anaesthetic technique associated with the highest rate of postprocedure patency of a newly-created arteriovenous fistula is

BP block
LA by surgeons

A

BP block

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16
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

A

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

ABC anaes

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17
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

A

COHb
(CarboxyHb)
(Miller)

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

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17
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 “

A

90 mins

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17
Q

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

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

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18
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

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)

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19
Q

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

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

Lead = view b/w + and - pole
Plane = cross sectional view

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

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20
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

A

Bupiv

357
BRL

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21
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”

A

UTD: Anticoagulant effect completely reversed within 15min

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22
Q

25. The intrinsic muscles of the larynx do NOT include

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

A

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

NO hyoid

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23
Q

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

A

HAGMA LTKR
lactate
toxin - salicylate
ketone
renal failure

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24
Q

27. The Glasgow Blatchford score is used to risk stratify

Pulmonary haemorrhage
Traumatic intraperitoneal haemorrhage
PPH
UGI bleed

A

UGIB

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

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25
Q

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

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

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26
Q

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

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

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27
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 “

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)

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28
Q

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

“AS
MS
MR
VSD
Mitral prolapse “

A

MVP

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

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29
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

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

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30
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

A

Mapleson circuits

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31
Q

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

A

sBP < 50 mmHg

ANZAAG

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32
Q

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

AP
OO
HL
Supracilli

A

Adductor pollicis

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

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33
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

A

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

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34
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 (This)
Iliacus
Sartorius
“

A

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

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35
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

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

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36
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

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

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37
Q

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

A

Body - white

Shoulder - blue and white

BOC medical cylinder chart

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38
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

A

0.1-0.3ml/kg 1:10,000

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

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39
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”

A

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

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40
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
“

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

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41
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

A

840mL

840mL/70kg =

12ml/kg

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

AAGBI

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42
Q

MH

4, 6, 8, 10, 12years

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/

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43
Q

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

“Aspirin
PTU
K iodine
B blocker
Steroid
“

A

Aspirin
NSAIDs - displaces thyroxine from TBP

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44
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

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

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

Fourth Universal Definition of Myocardial Infarction (2018) ESC

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45
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

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.

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46
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
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/

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47
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

A

12mo

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

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48
Q

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

A

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

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49
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”

A

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/

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50
Q

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

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

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

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51
Q

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

A

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

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52
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

A

Atrac
Miv

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

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53
Q

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

A

2

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

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54
Q

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

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.

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55
Q

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

A

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

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56
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

A
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57
Q

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

A

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

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58
Q

61. The effects of empagliflozin include a decrease in

A

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

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

59
Q

62. Oral naltrexone should be ceased preoperatively for

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

60
Q

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

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

61
Q
  1. Borders of the anterior triangle of the neck DO NOT include the
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/

62
Q
  1. In a patient presenting with an Addisonian crisis, the electrolyte disturbances MOST LIKELY to be seen are

a) hypocalcaemia, hyperkalaemia, hypoNa
b) high BGL, hyperK, hypoNa
c) low BSL, hyperK, hypoNa
d) low BSL, hyperK, hypoNa
e) hyperCa, hyperK, hypoNa

A

Hyperkalemia,
hyponatremia
Occasionalhypoglycemia
Hypercalcemia

KaCa high

Salt and sugar low

Miller’s 10e P. 895
OHA P. 229

63
Q
  1. A local anaesthetic agent that is considered safe to use in a patient with glucose-6-phosphate dehydrogenase deficiency is

“a) articaine
b) bupivacaine
c) lig
d) prilocaine
e) benzocaine”

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/ “

64
Q
  1. 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”

A

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

Refrac BRONCHOSPASM
- salbutamol
- Mag
- Inh
- Ketamine

65
Q

68. The abnormalities seen in the electrocardiogram below are consistent with

U waves

a) HyperCa
b) HyperMg
c) HyperPhos
d) HypoK
e) HyperK”

A

HypoK
Long QT–> TdP (polymorphic VT)

Monomorphic VT

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

66
Q

69. The following supraglottic airway devices allow direct intubation EXCEPT for the

A

(probably classic, anything with aperture bars)

67
Q

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

A

Dialysis, Cr, Bili, INR, Na

68
Q
  1. Postdural puncture headache in obstetric anaesthesia is associated with a greater likelihood of all of the following EXCEPT

a) Sheehan’s
b) Cortical vein thrombosis
c) Bacterial meningitis
d) post partum dep

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

69
Q

72. A healthy woman is admitted to the obstetric unit with threatened preterm labour at 29 weeks gestation. Her blood pressure is 140/80 mmHg. A magnesium sulfate infusion is indicated for the purpose of

“a) maternal seizure prevention
b) foetal lung dev
c) foetal neuroprotection”

A

BP ok
< 34w

Fetal neuroprotection - red incidence of CP

OHA P 870

70
Q

73. Cyclooxygenase-2 (COX-2) inhibitors in pregnancy are considered

a) not safe
b) safe
c) safe only in 1st trimes
d) safe only in 1st and 3rd trimes
e) not safe for 3rd trimes and 48h post delivery

A

not safe

“NSAIDS cat c except celecoxib B3
APMSE 2020”

71
Q

74. The commonest symptom or sign of uterine rupture during attempted vaginal birth after caesarean is

a) pain between contractions
b) CTG persistent foetal brady
c) variable decels on CTG
d) PV bleed
shoulder tip pain
haematuria”

A

Foetal brady (in ~80% of cases)

UTD

71
Q

75. A 50-year-old has had a headache for the last month which is relieved by lying flat. They have had no medical procedure to their spine such as epidural, spinal or lumbar puncture. Their brain magnetic resonance (MR) imaging scan shows diffuse meningeal enhancement and brain sagging. The neurologist suspects spontaneous intracranial hypotension and asks you to do an epidural blood patch. No spinal imaging has been performed to confirm a cerebrospinal fluid (CSF) leak. You should

“a) do LP to measure pressure and if low, do lumbar patch
b) do blood patch at lumbar level with no further Ix
c) do spine Ix, if CSF leak present, do blood patch at level
d) do spine Ix, if CSF leak present, do lumbar blood patch
e) refuse to do blood patch”

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”

72
Q

76. Following scoliosis surgery, a patient exhibits neurological changes in both legs. There is loss of power and reduced pain and temperature sensation. Proprioception and vibration sense are intact. The most likely mechanism of injury is

“a) misplaced pedicle screw
b) ant spinal art syndrome
c) posterior spinal art syndrome
d) brown-sequard syndrome
e) epi haematoma”

A

Anterior spinal artery syndrome

Lateral spinothalamic tract

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

73
Q

77. A seven-year-old child is ventilated in the intensive care unit after an isolated closed head injury. Their serum sodium concentration is 142 mmol/L. The most appropriate intravenous maintenance fluid is

a) 0.45% saline + 5% dex
b) 0.9% NS
c) CSL + 5% dex
d) CSL
e) 0.3% saline + 3% dex

A

0.9% NS

“Maintain serum Na >140mmol/L

Aim isotonic solution
Starship kids hospital guideline NZ”

74
Q

78. You are anaesthetising an 18-year-old who has a Fontan circulation for exploratory laparotomy. They are intubated and ventilated with a ventilator that has been brought from the Intensive Care Unit. Their current arterial oxygen saturation is 70%. To improve oxygenation, you should INCREASE the

possible from similar questions:

A. Increasing the inspiratory time.
B. Decreasing the ventilator tidal volumes.
C. Adding positive end-expiratory pressure (PEEP).
D. Positioning reverse trendelenberg.
increase AW pressure
increase PIP
increase expiratory time

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

75
Q

79. A 6-year-old child with a history of asthma is intubated and ventilated for tonsillectomy. During surgery, the SpO2 falls. You increase the FiO2 to 1.0 and hand-ventilate, and note that ventilation is difficult. The next step in the management is to

a) deepen anaes
b) give salbutamol
c) ask surgeon to release gag
d) suction ETT
e) increase relaxant

A

C

76
Q

80. You are called to assist with a patient in the intensive care unit who has had cardiac surgery three days ago and is now in cardiac arrest. External cardiac massage should aim for a systolic blood pressure of

A

> 60mmHg

Note
* 50 mmHg start compress in anaphylaxis

CALS
Bedside Notebook

77
Q

81. A 65-year-old man is undergoing coronary artery bypass grafting. Immediately upon commencing cardiopulmonary bypass and prior to administering cardioplegia, the aortic line blood appears the same colour as the blood in the venous cannulae, and the low venous saturation alarm is activated on the bypass machine. The most appropriate management at this point is to

a. Connect extra O2 line to membrane oxygenator directly
b. Clamp aorta and start cardioplegia and continue lung ventilation
c. Wean from bypass and ventilated. Continue bypass and ventilate lungs FiO2 100% (or reinflate lungs)

A

wean from bypass and ventilate

??Failure of oxygenation via oxygenator

78
Q
  1. During rewarming on cardiopulmonary bypass, the most reliable surrogate for cerebral temperature measurement is

a) Bladder temperature
b) Nasopharyngeal temperature
c) Oxygenator arterial outlet blood temperature
d) Oxygenator venous inflow temperature
e) Pulmonary artery temperature

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

79
Q

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

A

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

80
Q

84. A patient presents for a trans-urethral resection of the prostate (TURP). He had a single drug-eluting coronary stent for angina pectoris inserted six months ago and is taking clopidogrel and aspirin. The most appropriate preoperative management of his medications is to

“a) cease aspirin, cont clopid
b) cease aspirin for 10/7, cease clopid for 5/7
c) cease clopid for 5/7, cont aspirin
d) cease clopid 10/7, cont aspirin
e) cont both aspirin and clopid”

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

81
Q

85. A 45-year-old received a heart transplant one month ago. They develop a new supraventricular tachyarrhythmia without hypotension during gastroscopy. The most appropriate therapy is

“a) Adenosine
b) Amiodarone
c) Digoxin
d) Esmolol
e) Verapamil”

A

Adenosine
then
B blocker

ACLS/AL2 tachycardia algorithm
? blue book 2021

82
Q

86. According to the 5th National Audit Project (NAP5), the incidence of awareness during general anaesthesia using a non-relaxant technique with a volatile agent is approximately

“a) 1:700
b) 1:8000
c) 1:10,000
d) 1:19,000
e) 1:136,000”

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)

83
Q

87. An open Ivor-Lewis oesophagectomy is performed via a

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

84
Q

88. A 69-year-old patient is dyspnoeic and complains of right shoulder tip pain while in the post-anaesthesia care unit after a laparoscopic-assisted anterior resection. A focused thoracic ultrasound is performed and an image of the right lung is shown below. This represents

A
85
Q

89. According to the RELIEF study, in major abdominal surgery a liberal fluid strategy (10 mL/kg of crystalloid at induction followed by 8 mL/kg/hour during the case) compared to a restrictive fluid strategy, results in

a) increased bowel anastamosis breakdown
b) incr mortality
c) decreased mortality
d) no difference in wound infec
e) decreased AKI

A

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/

86
Q

90. Soon after a peribulbar block, the patient’s eye rapidly becomes proptosed and tense, and the visual acuity is markedly decreased. A lateral canthotomy is indicated to

a) allow globe to continue to swell
b) drain blood from behind eyeball
c) allow eye to proptose
d) reduce pressure on optic nerve

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

87
Q

91. An 85-year-old is scheduled for open reduction and internal fixation of a fractured neck of femur today. They have no significant past medical history. Preoperative review including physical examination, full blood count, electrolyte profile and electrocardiogram performed yesterday were normal. In the anaesthetic bay, the monitor shows the patient to be in atrial fibrillation with a ventricular rate of 110 to 145 beats per minute. The blood pressure is 130/80 mmHg. The best initial treatment for the atrial fibrillation is

A. Amiodarone
B. DC cardioversion post induction GA
C. Digoxin
D. Metoprolol
E. Anticoagulate

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

88
Q

92. A ten-year-old boy (weight 30 kg) has a displaced distal forearm fracture that requires manipulation and application of plaster. The volume of 0.5% lidocaine that should be used for intravenous regional anaesthesia (Bier block) is

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/

89
Q

93. A patient for elective general anaesthesia has been noted to be chewing gum in the pre-operative area. The most appropriate course of action is to

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

90
Q

94. An eight-year-old child with sickle cell disease is scheduled for emergency fixation of a fractured radius. Their preoperative haemoglobin (Hb) is 80 g/L. The most appropriate management is

a) Blood type and screen
b) exchange transfusion for HbSS < 30%
c) transfuse for Hb >100
d) careful haemostasis

A

C?

91
Q

95. In neonates, an imaginary line joining the most superior points of the iliac crests will cross the spinal interspace of

A

Intercristal line in NEONATES = L5/S1

92
Q

96. A normal systolic arterial blood pressure in the awake term neonate is approximately

“a) 55mmHg
b) 70
c) 80
d) 90”

A

70mmHg

Oxford Handbook

93
Q

97. A 10-year-old child (weight 30 kg) presents to the emergency department in status epilepticus. They have received one dose of 15 mg midazolam buccally prior to arrival to hospital. According to Advanced Paediatric Life Support Australia guidelines the next drug treatment should be intravenous

“a) midaz
b) prop
c) levetiracetam
d) phenytoin”

A

Midaz 0.15mg/kg

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

94
Q

98. In a 5-year-old child with severe life-threatening anaphylaxis and no intravenous access, the recommended initial dose of intramuscular adrenaline is

A

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

95
Q

99. A four-year-old child weighing 15 kg develops severe laryngospasm during an inhalational induction. Intravenous access is unobtainable. The recommended dose of intramuscular suxamethonium is

a) 15mg
b) 30mg
c) 60mg

A

4mg/kg

60mg

96
Q

100. In a patient who sustained significant burn injury, the blood concentration of propofol is

a) increased due to reduced CO
b) increased due to dehydration and reduced circ volume
c) reduced due to increased VD and Cl
d) increased due to reduced renal Cl
e) reduced due to increased inflamm cytokines

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

97
Q

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

a) dextrocardia
b) cardiac herniation
c) LLL collapse
d) tension PTX

A

sail sign

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

98
Q

102. A patient has blunt chest trauma. A thoracotomy is indicated if the immediate blood drainage after closed thoracostomy is greater than

a) 500mL
b) 750mL
c) 1L
d) 1.2L
e) 1.5L

A

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”

99
Q

103. B lines (comet tails) in lung ultrasound are NOT observed in

ARDS
ILD
PTX
Normal lung

A

pneumothorax or lung apex

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

100
Q

104. You have been asked to provide general anaesthesia for a complex thoracic endovascular aortic aneurysm repair. After the placement of a lumbar drain the recommended safe time before the administration of intravenous heparin is

A

ASRA

1h

101
Q

105. A 74-year-old presents for a femoral popliteal artery bypass procedure for peripheral limb ischaemia. Regarding its role in modifying their perioperative cardiovascular risk, clonidine

a) increased stroke
b) no change in complications
c) increased death
d) increased non fatal MI
e) increased risk of non fatal cardiac arrest

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.

102
Q

106. A 65-year-old presents with an acute dissection of their thoracic aorta. Their blood pressure is 150/90 mmHg. The best medication to reduce the blood pressure is

a) esmolol
b) SNP
c) HTN
d) hydralazine

A

esmolol

“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”

103
Q
  1. The strongest independent preoperative predictor of chronic postsurgical pain after knee arthroplasty is

A. Anxiety
B. Catastrophising
C. Depression
D. Female
E. Pain at other sites

A

Catastrophising

APMSE p24

104
Q
  1. The analgesic drug with the most favourable Number Needed to Treat (NNT) for neuropathic pain is

A. Gabapentin 6.3
B. Venlafaxine 6.4
C. Pregabalin 7.7
D. Tramadol
E. Methadone
F. Duloxetine
G. Amitriptyline

A

Amitriptyline 3.6

Tramadol (NNT 4.4)

APMSE p 137

105
Q

109. Self-report of pain in children is usually possible by the age of

A. 2
B. 4
C. 6
D. 8

A

RCH guidelines

Wong-baker by age 4

Visual analogue scale by age 8

106
Q

110. A 30-year-old has had a free-flap operation of eight hours duration. They received an intraoperative remifentanil infusion and 10 mg morphine 30 minutes before the end of the operation. During recovery their pain score increased from 6/10 on arrival to 9/10 despite a further 10 mg of intravenous morphine. The most likely diagnosis is

A. Acute behav change
B. OIH
C. Inadequate analgesia
D. Physical dependence

A

OIH

107
Q

111. Tranexamic acid is NOT useful in the management of

a) post cardiac bypass
b) neurotrauma
c) PPH
d) trauma
e) UGI bleed

A

“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”

108
Q

112. A drug that is contraindicated for a patient with a history of heparin induced thrombocytopaenia is

a) bivalirudin
b) danaparoid
c) prothrombinex
d) fib conc
e) argatroban

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”

109
Q

113. The use of intraoperative dexamethasone for tonsillectomy

a) Increased oedema
b) Increased post tonsillectomy bleed
c) Increased Analgesic requirement
d) Reduced time to resumption of oral intake

A

Reduced time to resumption of oral intake

110
Q

114. A patient experiences a postpartum haemorrhage associated with uterine atony that is unresponsive to oxytocin and ergometrine. The recommended intramuscular dose of carboprost (15-methyl prostaglandin F2 alpha) to be administered is

“a) 250mcg IM once
b) 250mcg IM Q15min, up to 2mg
c) 500mcg IM
d) 250mcg IV
e) 500mcg IV”

A

“250mcg IM Q15min, up to 2mg
“

111
Q
  1. The oral morphine equivalent of tapentadol 50 mg (immediate release) is

“a) 5mg
b) 10mg
c) 15mg
d) 20mg
e) 25mg”

A

15mg

112
Q

116. A patient with known suxamethonium allergy is most likely to demonstrate cross reactivity with

“a) pancuronium 11
b) vecuronium 22
c) atracurium
d) rocuronium 33
e) cisatracurium”

A

rocuronium (24% - fig 4)

NAP6

113
Q

117. The correct blood collection tube for a mast cell tryptase test is a

“a. Potassium EDTA
b. serum separating tube
c. sodium citrate
d. sodium oxalate something
heparin
lithium”

A

SST/serum tube (Gold top)

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

114
Q

118. Once a unit of fresh packed red blood cells has been removed from controlled refrigeration the transfusion should be completed within

“a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours
e. 10 hours”

A

4 hrs

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

115
Q

119. A previously healthy 22-year-old man is involved in an altercation and sustains a ruptured spleen. During splenectomy he is transfused with packed red blood cells. One hour into the transfusion his SpO2 rapidly decreases, his ventilator pressures increase, frothy sputum appears in the endotracheal tube and he is febrile. The likely cause is

“a) TRALI
b) TACO
c) Resus incompatibility
d) Anaphylaxis
e) infection”

A

TRALI

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

116
Q
  1. The main difference between a size 5 microlaryngeal tube (MLT) and a standard size 5 endotracheal tube is that the size 5 MLT

“A. Smaller cuff
B. Longer length
C. Larger external diameter”

A

longer length

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

117
Q

121. When using an endotracheal tube in an adult, the highest recommended cuff pressure to avoid mucosal ischaemia is

“a. 10cmH2O
b. 20
c. 30
d. 40
e. 50”

A

30cmH20

30cmh20 - thats the top of the green zone

118
Q

122. The sensor on a NIM (Nerve Integrity Monitor) endotracheal tube used for thyroid surgery directly records

“a. Electromyography of internal laryngeal muscles
b. Recurrent laryngeal nerve action potential
c. Movement of the vocal cords on the endotracheal tube
d. Pressure of the vocal cords on the endotracheal tube
“

A

EMG

119
Q

123. Double sequential external defibrillation is performed by applying two shocks from

”
a. Single set of pads, < 1 second apart
b. Single set of pads, < 5 seconds apart
c. Two sets of pads, < 1 second apart
d. Two sets of pads, < 5 seconds apart
e. Two sets of pads, simultaneously”

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”””

120
Q

124. The initial management for a seizure during an awake craniotomy is

“a) cold saline irrigation
b) midaz
c) prop
d) keppra”

A

Cold saline irrigation

SMACC quick reference guidelines #9

121
Q
  1. A new antiemetic reduces the risk of post-operative vomiting by 20%. In a population with a baseline risk of post-operative vomiting of 10%, the number needed to treat is

“a) 2
b) 5
c) 10
d) 20
3) 50”

A

50

122
Q

126. A risk factor which increases the likelihood of developing local anaesthetic systemic toxicity is

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”

123
Q

127. The image below shows results from non-inferiority trials. The trial labelled ‘M’ is best described as

“a) Non-inferiority is not demonstrated
b) Non-inferiority is demonstrated
c) Superiority is demonstrated
d) Inferiority is demonstrated”Non-inferiority is not demonstrated

A

Non-inferiority is not demonstrated

124
Q

128. A 30-year-old athlete undergoing a knee arthroscopy under general anaesthesia develops intraoperative tachycardia. A 12-lead electrocardiogram is obtained and shown below. The most likely diagnosis is

“a) Atrial fibrillation
b) Atrial flutter
c) Sinus tachycardia
d) WPW”

A
125
Q

129. Analysis of variance (ANOVA) is a statistical test to determine

“a) comparisons of means between two groups in normally distributed data
b) comparisons of means between two groups in non-normally distributed data
c) comparisons of means between three groups (unpaired) in normally distr data
d) comparisons of means between three groups (unpaired) in non-normally dist data”

A

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

BJA

126
Q

130. When performing a brachial plexus block at the level of the axilla, the structure indicated by the arrow is the

A
127
Q

131. A third heart sound at the apex may be heard in

a) pulm stenosis
b) pulm HTN
c) pericarditis
d) preg
Mitral regurg
Normal in ages up to 40yrs

A

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

128
Q

132. In pulmonary function testing the presence of airflow limitation is defined by a post-bronchodilator FEV1/FVC ratio less than

a) 0.5
b) 0.6
c) 0.7
d) 0.8

A

0.7

129
Q

133. Local anaesthetic-induced myotoxicity is most likely to be associated with

A. Biers
B. Interscalene
C. Sciatic
D. Adductor Canal
E. femoral block

A

Adductor Canal

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

130
Q

134. Regarding healthcare research, the PICO framework describes

“a) critical appraisal
b) meta-analysis
c) observational study
d) systematic review”

A

Critical appraisal

131
Q

135. The 12-lead electrocardiogram shown is most consistent with acute total occlusion of the

a) Post desc
b) RCA
c) LAD
d) OM

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)

132
Q

136. A 70-year-old patient booked for a revision total hip replacement is reviewed in preadmission clinic ten days before surgery. The following blood test results are noted: haemoglobin 110 g/L; ferritin 51 mcg/L; CRP (c-reactive protein) 10 mg/L. The most appropriate management for this patient should be to

a) tf 2u PRBC
b) give oral Fe therapy and cont surgery
c) give ora Fe therapy and defer surgery
d) give IV Fe
e) do nothing

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

133
Q

137. A 55-year-old with no past history of ischaemic heart disease is three days post-total hip replacement surgery. They have an episode of chest pain at rest with features typical of angina that lasts 30 minutes before fully resolving. There are no electrocardiogram changes and no troponin rise. The diagnosis is

a) no Dx made
b) unstable angina
c) STEMI
d) NSTEMI
e) MINS

A

Unstable angina (no trop rise)

(NSTEMI and MINS will both have trop rise)

134
Q

138. The QRS axis of the attached electrocardiograph is closest to

a) -90
b) -45
c) +45
d) +90

A

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

135
Q

139. In septic shock, the recommended target mean arterial pressure in an adult is

“50mmHg
55
60
65
70
75”

A

65

Norad first line

Surviving sepsis guidelines 2021

136
Q

140. A 50-year-old patient with carcinoid syndrome undergoing resection of a peripheral hepatic metastasis develops a sudden fall in blood pressure from 110/70 mmHg to 85/50 mmHg without significant bleeding. The most appropriate management is

“a. Normal saline bolus
b. Octreotide 50mcg bolus
c. Metaraminol 0.5mg
d. Noradrenaline 5mcg bolus
e. Calcium 6.8mmol”

A

octreotide bolus

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

137
Q

141. In cardiac surgery a low-normal central venous pressure and a low blood pressure with a hyperdynamic heart is suggestive of

“a) hypovol
b) vasopleg
c) LV dysFx
cardiomyopathy”

A

Vasopleg

138
Q
  1. One metabolic equivalent (1MET) is defined as the

“a) O2 consump during walking 4km/h (METS 2-3)
b) O2 consump at rest
c) Energy consump while walking at 4km/h
d) Energy consump during rest”

A

O2 consumption at rest

139
Q
  1. According to the Australian and New Zealand Committee on Resuscitation guidelines, the minimum distance a defibrillation pad should be placed away from a pacemaker or implantable cardiac defibrillator generator is

“a. 4 cm
b. 8 cm
c. 12 cm
d. 16 cm
e. 20 cm”

A

8cm

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

140
Q
  1. A 25-year-old sustains a burn to 30% of their total body surface area. A physiological change expected within the first 24 hours is

“a) incr Cl
b) decr SVR
c) incr PVR
d) incr hepatic bf”

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”

141
Q

145. When inadvertent total spinal anaesthesia occurs in an awake neonate, the first sign is most likely to be

“a) decre HR
b) decr BP
c) desat
d) LOC”

A

Desat

Cote’s Practice of Anaes for Infants

142
Q

146. A bleeding patient has ROTEM results including: [table attached]. The most appropriate treatment is

A
143
Q

147. A 54-year-old has a laryngeal mask airway inserted for a surgical procedure. The following day it is noted that the tongue is deviated to the right. The most likely site of nerve injury is the right

“a) Glossopharyngeal nerve - posterior 1/3 tongue sensation and taste
b) Lingual nerve - anterior 2/3 tongue sensation
c) Facial nerve
d) Vagus nerve
e) Hypoglossal nerve - tongue motor function”

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)

144
Q

148. The nerve marked by the arrow is the

A
145
Q

149. In an adult weighing 70 kg, a bedside assessment of haemodynamic status shows a left ventricular end-diastolic diameter of 2.4 cm. This finding suggests

“a) hypovol
b) normal
c) hypervol”

A

hypovolaemia

Normal ED cm = 3.5-5.6cm

146
Q

150. For driving pressure guided ventilation, driving pressure is the

”

a) Pplat - PEEP
b) Peak pressure-peep
c) plateau pressure”

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/”

Final Exam (39 decks)

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