2024.2 MCQ Flashcards

Question 1

Q

“1. During paediatric gas induction, the gas flow recommended by SPANZA for least
environmental impact is”

“● 1L/min
● 2L/min
● 3L/min
● 4L/min
● 5L/min”

Answer

A

3L/min

“https://journalwatch.org.au/reviews/reducing-the-environmental-impact-of-mask

0.15L/min/kg”

Question 2

Q

2.

The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:

“● Mapleson A
● Mapleson B
● Mapleson C
● Mapleson D
● Mapleson E”

Answer

A

Mapleson D

Journal article entitled Mapleson’s Breathing Systems 2013:

“For adults,

Mapleson A is the circuit of choice for spontaneous respiration where as

Mapleson D and its Bains modifications are best available circuits for controlled ventilation.

For neonates and paediatric patients Mapleson E and F (Jackson Rees modification) are the best circuits.”

Question 3

Q

3. SQUIRE guidelines

”- Provide a framework for reporting new knowledge about healthcare improvement
- How to conduct a systematic review”

Answer

A

Provide a framework for reporting new knowledge about healthcare improvement

“From the SQUIRE website: SQUIRE stands for Standards for QUality Improvement Reporting Excellence. The SQUIRE guidelines provide a framework for reporting new knowledge about how to improve healthcare. They are intended for reports that describe system level work to improve the quality, safety, and value of healthcare.

PRISMA: Systematic review”

Question 4

Q

4. Box and whisker plot - What does the box mean

”
Interquartile rage
2 std deviations”

Answer

A

“Interquartile range

“The five number summary is the:
minimum,
first quartile,
median,
third quartile and
maximum”

Question 5

Q

5. Axis of ECG - left axis deviation (aVR was isoelectric, AVF negative, I positive)

“(a) -45
(b) -75

(c) +15”

Question 6

Q

6. What does a green line on the rigid laryngoscope blade mean

“(a) Reusable
(b) Recyclable
(c) Single use - disposable
(d) Immersible”

Answer

A

?reusable

Question 7

Q

“7. Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in
the exam)”
“Points A
B
C
D”

Answer

A

“C
- Bit with the pop off top is for fibreoptic
- Bit without pop off top is for bronchial blocker
- Perpendicular bit is for breathing circuit”

https://www.researchgate.net/figure/Arndt-endobronchial-blockerR-by-Cook-Multiport-airway-adapter-A-Blocker-port-B-FOB_fig3_258103877

Question 8

Q

8. Vivasight components (arrow to the red bit in the exam)

“Flush port
Light source
Aspiration port

Answer

A

Flush port

https://www.ambuaustralia.com.au/airway-management/double-lumen-tubes/product/vivasight-2-dlt

Question 9

Q

9. Semaglutide half life

“3 days
7 days
14 days”

Answer

A

7 days

https://pubmed.ncbi.nlm.nih.gov/29915923/

Question 10

Q

10. Gastric USS image given - Exact image to R

Answer

A

Empty stomach

“https://www.bjaed.org/article/S2058-5349(19)30047-2/fulltext

ID landmarks: L liver border, antrum, pancreas, aorta, vertebrae
Empty - small antrum, target sign
CF - starry night
solid - enlarged antrum and can visualise solids”

Question 11

Q

11. PREVENTT trial- for major abdo surgery iron infusion:

”- Reduced allogenic red cell transfusion
- Reduced mortality
- Reduced readmission rates within 30 days
- Reduced infection rates”

Answer

A

REduced readmission rates within 30days

PREVENTT: surgery / Fe infusion

1’ outcome : No difference in transfusion/death between Fe vs no-Fe pre op

2’ outcome : Fewer unplanned readmissions BUT no difference in ave number of transfusions/LOS/self-reported QOL

Question 12

Q

12. Compared to UFH, Enoxaparin preference

Thrombin
Xa

Answer

A

Xa

“Enoxaparin works by binding to AT III to inactivate clotting factors, preferentially factor Xa, thereby blocking the conversion of prothrombin to thrombin, which is the coagulation cascade’s final common pathway.”

https://www.sciencedirect.com/science/article/pii/S2772993124000913#:~:text=Enoxaparin%20works%20by%20binding%20to,coagulation%20cascade’s%20final%20common%20pathway.

Question 13

Q

13. Child on 15mcg/kg steroids, when to give hydrocort

> 2 weeks
1 month
2 months

Answer

A

> 1month

“https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14963

"”Daily doses of prednisolone of 5 mg or greater in adults and 10–15 mg.m−2 hydrocortisone equivalent or greater in children may result in hypothalamo–pituitary–adrenal axis suppression if administered for 1 month or more by oral, inhaled, intranasal, intra-articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency.””
2mg/kg hydrocortisone stress dose
“

Question 14

Q

14. DCD - last acceptable organ

Lungs
Kidney
Liver
Pancreas
Heart

Answer

A

EKLung

“https://www.donatelife.gov.au/sites/default/files/2022-01/ota_bestpracticeguidelinedcdd_02.pdf

Liver/ pancreas/heart –> Kidneys –> Lungs”

Question 15

Q

15. DCD criteria, what doesn’t include

“● Immobility
● apnoea
● absent skin perfusion
● absence of circulation (no arterial pulsatility for 2 min)
● Cannot recall other option, which was the answer (maybe absense”

Answer

A

Absent skin perfusion

“This is just the standard criteria for certifying death:
Absence of breathing for 2 min
Absence of heart sounds 2 min
Pupils

Donate life: The determination of death using circulatory criteria
is a common event in medicine and the features are
well known. They include absence of movement and
unresponsiveness, absence of pulse and breathing, and
pupils that are dilated and unresponsive to light. “

Question 16

Q

16. Post herpetic neuralgia, feels insects crawling across head, what is it?

”- Allodynia
- Dysaesthesia
- Formication
- Pruritis”

Answer

A

“Formication

But does technically fall under dysaesthesia because it’s an abnormal sensation”

Question 17

Q

17. Congenital long QT, drug should avoid

“Prop
Thio
Ketamine”

Answer

A

Ketamine

“https://www.bjaed.org/article/S1743-1816(17)30428-6/pdf

Prop = no effect on QT
Vecuronium and atracurium do not prolong QTC in healthy individuals, and are probably safe to use in LQTS patients.
Thiopental is known to prolong the QTc, but reduces TDP, and can be used in patients with LQTS.
Midazolam has no effect on QTc in healthy adults.
Ketamine should be avoided because of its sympthomimetic effects.”

Question 18

Q

18. Recurrent torsades treatment, acceptable:

“Flecainide
Lignocaine
Procainamide
Amiodarone
Sotalol”

Answer

A

Lignocaine

“LITFL: ILCOR suggest the use of amiodarone or lidocaine in adults with shock refractory ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) (weak recommendation, low quality evidence).

UTD: Class 1b antiarrhythmics can be used eg lignocaine”

Question 19

Q

19. Acceptable tryptase to diagnose anaphylaxis..

”- (1.2 of normal) + 2 /ml
- (1.8 of normal) + 2
- Normal + 2
- 10/ml
- 15/ml”

Answer

A

1.2 x normal + 2

“Not stated in ANZCA Anaphylaxis doc

UTD: The minimal elevation of the acute total tryptase level that is considered to be clinically significant was suggested to be ≥(2 + 1.2 x baseline tryptase levels) in units of ng/mL or mcg/liter”

Question 20

Q

20. ANSAAG refractory anaphylaxis:

”- Glucagon IV 10 min
- Glucagon IV 5
- Glucagon IM 5 min
- Glucagon IM 10 min”

Answer

A

Glucagon IV Q5min

“https://www.anzca.edu.au/resources/professional-documents/endorsed-guidelines/anaphylaxis-card-3-adult-refractory-management-202.pdf
Glucagon 1– 2 mg IV every 5 min until response
Draw up and administer IV (Counteract β blockers

Paeds: Glucagon 40 microg/kg IV to max 1mg”

Question 21

Q

21. Fem-fem VA ECMO, where is BG best representative of coronary PaO2?

Answer

A

”- right radial

R radial because closest to where coronary arteries would come off post AV?

Question 22

Q

22. Post op cog decline has an onset within:

”- immediate post
- With one day, lasting one week
- From ?3wk ?10 days post op for a year
- From 1 month to 1 year”

Answer

A

From 1week to 1 year post op

Blue Book article 2019 - From 7 days post op til 1 year post

Question 23

Q

23. Pre-eclamspia at 30 weeks with IUGR

”- low CO, low SVR
- Low CO, high svr
- High CO, low svr
- High CO, high svr”

Answer

A

Low CO, high SVR

https://www.ahajournals.org/doi/epub/10.1161/HYPERTENSIONAHA.118.11092

Women who subsequently developed preeclampsia/fetal growth restriction had lower preconception cardiac output (4.9 versus 5.8 L/min; P=0.002) and cardiac index (2.9 versus 3.3 L/min per meter2; P=0.031) while mean arterial pressure (87.1 versus 82.3 mm Hg; P=0.05) and total peripheral resistance (1396.4 versus 1156.1 dynes sec cm−5; P<0.001) were higher.

https://www.ajog.org/article/S0002-9378(20)31283-7/fulltext

Question 24

Q

24. Burns - expected physiological change in first 24 hours

”- High cardiac index
- Increased PVR
- Decreased SVR
- High stroke volume”

Answer

A

Increased PVR

** as per Syd course from this Stapleton Burns journal article

This is driven by intense catecholamine release with persistent beta-adrenergic receptor stimulation, also implicated in subsequent myocardial depression that is commonly seen.

Intense initial systemic and pulmonary vasoconstriction occurs in the face of
low cardiac output with
decreased oxygen delivery and consumption
which slowly recovers over 24–48 h.

https://journals.sagepub.com/doi/10.1177/0310057X20914908?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Question 25

Q

25. Which increases the risk of blood product related graft vs host disease

genetic variability between donor and recipient
irradiated
leukodepleted
Immunodeficiency
transfusion of non-cellular product

Answer

A

genetic variability between donor and recipient
irradiated
leukodepleted
Immunodeficiency
transfusion of non-cellular product

Immunideficiency?

“Lifeblood: https://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TA-GVHD#:~:text=The%20three%20primary%20risk%20factors,diversity%20between%20donor%20and%20recipient.

The three primary risk factors for developing TA-GVHD are:
1. degree of immunodeficiency of the recipient.
2. number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status), and
3. genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products.”

Question 26

Q

26. When reconstituted, fibrinogen concentrate should be transfused within:

30min
4h
6h
8h

Answer

A

8h

looks like 6 hours according to an australian resource
- LITFL says 8 hours, however they reference the American datasheet, whereas NZ and
Oz datasheets say 6 hours. Research also states 8 hours.”

“RIASTAP product info:
If it is not administered immediately, it must be stored below 25oC and used within 6 hours of
reconstitution. The reconstituted solution should not be stored in the refrigerator”

Question 27

Q

“27. A man has this device put in because he isn’t suitable for anticoagulation with AF. What is a
WATCHMAN device/ where is it?”

”- left atrial appendage
- SVC
- IVC
- Right atrium
- Ascending aorta”

Answer

A

LAA parachute

Question 28

Q

28. A aortic mechanical On-X valve - has an inguinal hernia repair in 48 hours and his INR is 1.5, what should you do?

”- bridge with enoxaparin
- bridge with heparin
- just withhold the warfarin”

Answer

A

”- bridge with enoxaparin
- bridge with heparin
- just withhold the warfarin”

Withhold warfarin?? Can’t actually find a guideline on this anywhere

Only heart valve marketed for low INR 1.5-2

Question 29

Q

”
29. The transthoracic echo demonstrates:”

”- TR
- MR”

Answer

A

”- TR
- MR”

Question 30

Q

Transthoracic echo parasternal long axis. Which chamber (pointing RV)

Answer

A

”- RV
- RA

.”

Question 31

Q

31. Non-inferiority trial:

Inconclusive

Answer

A

“🌮
Inconclusive”

“https://youtu.be/bv9GXUbqyfs

https://www.nature.com/articles/s41416-022-01937-w
For interpretation of results as this Q was likely showing a diagram that you had to interpret”

Question 32

Q

32. APRV ventilation

Spontaneously breathing patient
Longer inspiratory times (prolonged high pressure maximises recruitment) = better oxygenation
brief releases at lower pressure - facilitate CO2 clearance
Similar to constant recruitment method

Answer

A

Spont breathing patient

“https://litfl.com/airway-pressure-release-ventilation/#:~:text=PROS%20AND%20CONS,requirements%20to%20allow%20spontaneous%20breathing

pressure-controlled mode of ventilation that delivers an almost continuous positive pressure with intermittent, time-cycled, short releases at a lower pressure - aim high mean airway pressures for thoeretic alveolar recruitment, FRC preservation, lung homogeneity

https://www.bjaed.org/article/S2058-5349(19)30178-7/fulltext”

Question 33

Q

33. Best TOE view for detecting myocardial ischaemia..

”- Mid-Oesophageal 4 chamber
- Long axis
- 2 chamber
- Transgastric 2 chamber papillary”

Answer

A

Transgastric mid papillary

“TOE was found to be good at detecting new left ventricular RWMAs, associated with ischaemia. In particular the transgastric short axis mid view of the left ventricle demonstrates areas of myocardium subtended by each of the three coronary arteries. It is therefore the most frequently used view for intraoperative monitoring of left ventricular ischaemia.” https://www.sciencedirect.com/science/article/pii/S0007091217351863#:~:text=In%20particular%20the%20transgastric%20short,monitoring%20of%20left%20ventricular%20ischaemia.

Question 34

Q

”
#34. CXR with a 3 lead pacemaker. Arrow pointing to”

”- LV
- RV (around the back of the heart)
- Coronary sinus

Question 35

Q

35. Avulsed tooth, what fluid to place it in

chlorhexidine
Saline
Balanced salt solution
Fresh bovine milk
Water

Answer

A

RCH guideline says milk is “first choice”,

the dental article says 1. HBSS 2. milk 3. sterile saline.

UTD also milk

“https://www.aapd.org/globalassets/media/publications/archives/ram-26-03.pdf, https://www.rch.org.au/clinicalguide/guideline_index/Dental_trauma/

UTD: Place the tooth in a storage solution – As soon as possible, place the tooth in a storage solution to maintain the viability of the periodontal ligament on the tooth’s surface [42-44]. We suggest cold milk, oral rehydration solution (eg, Ricelyte or Pedialyte), or a cell culture medium (Hank’s balanced salt solution or Viaspan) used in avulsed tooth preservation kits. Cold milk is usually most readily available [44]. If milk or specialized mediums are not available, have the child spit into a container or place the tooth in saline instead. “

Question 36

Q

36. The pregnant MS lady, cat 1 section within 30min, what method

”- spinal
- CSE
- Epidural
- GA
- Methylpred then GA”

Answer

A

Neuraxial ok - no correlation between relapses of MS.

NMBD caution - ND may have prolonged effects, hyperK from denervation/misuse myopathy, resis to NMBA ?due to extrajunctional receps

“BJA Ed 2021 Anaesthesia and neurological disorders in pregnancy

PRIMS study”

Question 37

Q

37. Classic LMA cuff recommended pressure max”

“30
40
50
60 “

Answer

A

60mmHg (product guide)

https://www.lmaco.com/sites/default/files/31817-LMA-Classic-A4Data-0214-LORES-fnl.pdf

Question 38

Q

38. Narrow complex tachycardia ECG in young person post op in PACU with SBP 90. What treatment

“A. Modified valsalva
B. Adenosine
C. DCCV”

Answer

A

I’m guessing because not unstable, go with modified valsalva first?

Question 39

Q

39. Prilocaine Bier’s block, which condition it shouldn’t be used in

”- G6PD
- Porphyria”

Answer

A

“G6PD
“

https://www.orphananesthesia.eu/en/rare-diseases/published-guidelines/glucose-6-phosphate-dehydrogenase-deficiency/193-glucose-6-phosphate-dehydrogenase-deficiency/file.html

Question 40

Q

40. Anaphylactic to MMR vaccine. What is contraindicated?”

”- Gelofusine
- Sulphonamides”

Answer

A

Gelofusine (due to the gelatin!)

Journal of Clinical Immunology 1993, Journal of Military medicine 2020

Question 41

Q

41. 65yM, presented with confusion and hypoxia. CXR of L chest whiteout and tracheal deviation

Left pleural effusion
Left pneumonia
Unilateral pulmonary oedema
Pneumonectomy

Answer

A

Pleural effusion

Question 42

Q

42. Post heart transplant recipient, expected sensitivity to:

”- adenosine
- Ephedrine - less effect
- Atropine
- Glyco”

Answer

A

Adenosne

4x increase in SA & AV nodal blocking effect “denervation supersensitivity”

BJA https://watermark.silverchair.com/020074.pdf

Question 43

Q

43. What nerve does not innervate the breast/ for breast surgery?

Long thoracic
Anterior intercostal
Posterior intercostal
Supraclavicular

Answer

A

Long thoracic - does motor to serratus anterior

“The innervation of the breast is supplied mainly by the anterior branches of the 4th, 5th and 6th intercostal nerves which arise from the thoracic spinal nerves (T4-6). the apex of the axilla is supplied by the intercostobrachialis nerve; this is a cutaneous branch of the second intercostal nerve (T2). the pectoral major and minor muscles are innervated by the lateral pectoral nerve (C5-7) and medial pectoral nerve (C8-T1).

Terminal branches of the supraclavicular nerves (C3-4) innervate the upper part of the breast and this should be taken into account when the surgical procedure involves this area, because Pecs blocks will not block the supraclavicular nerve. Breast surgery however, is rarely performed at this level.
BMJ”

Question 44

Q

44. Post prem baby, having surgery. The minimum time before considered for day surgery is

”- Postmenstrual age 54 weeks
- 60 weeks”

Answer

A

“Ex-preterm infants at risk of postoperative apnoea should not be considered for same
day discharge unless they are medically fit and have reached a postmenstrual age of
54 weeks.”

https://www.anzca.edu.au/getattachment/568bad2d-7517-4eea-9c5d-cb7aa1c60c01/PG29(A)-Guideline-for-the-provision-of-anaesthesia-care-to-children-(PS29)

Question 45

Q

45. Fontan woman, pregnant, what drug to avoid in labour

”- Ergometrine
- N2O”

Answer

A

ergometrine

https://www.bjaed.org/action/showPdf?pii=S1743-1816%2817%2930438-9

Question 46

Q

46. Dental surgery to bottom molar (38) with weird chin sensation post op. Which nerve damaged”

lingual
Mental
Inferior alveolar
Infratrochlear”

Answer

A

inferior alveolar nerve

https://radiopaedia.org/articles/mental-nerve

Question 47

Q

47. Child with status epilepticus, weight 20kg, which is NOT a recommended treatment”

Midaz IM 3mg
intranasal 6mg
intraosseous 3mg
buccal 6mg
IV 1.5mg

Answer

A

Buccal/ intranasal 0.3x20 = 6mg

IV/ IO 0.15x20= 3mg
IM 0.2x20= 4mg

https://www.childrens.health.qld.gov.au/__data/assets/pdf_file/0021/174180/status-epilepticus-flowchart-and-medications.pdf

Question 48

Q

48. Highest rate of mortality is in BMI category of:

< 18.5
18.5-24.9 - 25-29.9
30-34.9
35-39.9

Answer

A

underweight < 18.5

BJA anaesthesia for the obese patient 2020

Question 49

Q

49. Major burns patient, pharmacologic effects in relation to non-depolarising neuromuscular blockers

-Dose expected higher/low and reason?

Answer

A

-Dose expected higher because of up-regulation of acetylcholine receptors

Question 50

Q

50. Class 2 obesity has an ASA score of:

“1
2
3
4”

Answer

A

2

“https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system. Mild diseases only without substantive functional limitations. Current smoker, social alcohol drinker, pregnancy, obesity (30<BMI<40), well-controlled DM/HTN, mild lung disease

Class 2 obesity (BMI 35-39.9) = ASA 2
Class 3 obesity (BMI >40) = ASA 3”

Question 51

Q

52. Young man collapsed. Fuzzy and terrible ECG depicting brugada, what is the recommendation:”

Answer

A

the only proven therapy is an

** implantable cardioverter – defibrillator (ICD) **

LITFL Brugada syndrome

Question 52

Q

53. Obese patient, giving a dose of propofol for induction, what weight do you use?”

lean body weight
IBW
ABW
TBW

Answer

A

LBW is a more appropriate dosing scalar

Mnemonic:
TBW = Xa (TXa)
ABW = PINSA (A PINS)
prop inf/neo/suga/anti

SOBA

https://www.sobauk.co.uk/_files/ugd/373d41_eebe369c3c6b4021bff6f3da059aa796.pdf

Question 53

Q

54. Myasthenia gravis patients and NMB:

sensitive to ND, resistant to depolarising
Variants of this combo

Answer

A

Sensitive to ND, resistant to depol

“BJA Myaesthenia gravis and periop rx
1/10 normal Roc/ (NDNMBD)”

Question 54

Q

55. Magnesium 20mmol given intra-op is NOT associated with

reduced pain scores in PACU
reduced PONV
Reduced MAC requirements
Prolonged NMB
Resp depression post op

Answer

A

Resp dep postop - mcq group

Wrong!
Reduced MAC requirements

“https://pmc.ncbi.nlm.nih.gov/articles/PMC6319973/#:~:text=Albrecht%20et%20al%20reviewed%2025,any%20reported%20serious%20adverse%20effects.
Albrecht et al reviewed 25 RCTs including 1461 patients and concluded that perioperative intravenous magnesium can reduce opioid consumption and pain scores in the first 24 hours postoperatively without any reported serious adverse effects

https://www.mdpi.com/2072-6643/16/14/2375
administration of magnesium sulfate
**1. reduces the intraoperative opioid use,
2. decreases the pain severity within the first 24 h postoperatively, and
3. reduces the incidence of PONV while exerting a minimal effect on the length of stay in the PACU. **

Mg in toxic doses can cause respiratory depression”

Question 55

Q

56. Severe hypokalaemia and cardiac arrest, ANZCOR recommends

5 mmol bolus of K+
Vs over 5 min
Vs over 10min
10mmol 5 min
Vs 10min

Answer

A

5 mmol bolus of K+

ALS 2 Handbook P. 134

Question 56

Q

57. Child and laparotomy, 23 kg, what fluid will you give for maintenance

45ml/hr of 0.45% saline and dextrose
45ml/hr of 0.9% saline and dextrose
65 ml /hr of solutions
something else never to give

Answer

A

63mL/h of 0.9% saline with 5% dex

–> Give 2/3 maintenance once resus’d because prone to secreting ADH+++, and never give hypotonic solution to children!!

RCH Guidelines:
The preferred fluid type for IV maintenance is sodium chloride 0.9% with glucose 5%

Alternative maintenance fluid options include:
Plasma-Lyte 148 with glucose 5% (contains 5 mmol/L of potassium) - generally stocked in tertiary paediatric centres and intensive care
Hartmann’s with glucose 5%

4-2-1 rule = 4mL/h x 10kg + 2mL/h x 10kg + 1mL/h x 3 kg = 40+20+3 =63mL/h

Question 57

Q

58. Child 4mo with uncorrected TOF, having a tet spell, what will not work? or maybe “what would you avoid giving”?

”- prostaglandin
- sedation
- fluid bolus
- vasopressor
- beta blocker”

Answer

A

Prostaglandin

Try sedation, beta blockers, IVF bolus, phenylephrine/metaraminol

Craig Sims P. 386

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

Try sedation, beta blockers, IVF bolus, phenylephrine/metaraminol”

Question 58

Q

59. Someone is on long acting MAOi, what drug is most likely to cause serotonin syndrome?

”- pethidine
- tapentadol
- Methadone
- sux
- fent”

Answer

A

Pethidine

“NPS
Tramadol + MAOIs = highest risk SS

Some opioids such as tramadol, pethidine, dextromethorphan and tapentadol increase
serotonergic activity. Fentanyl and methadone also do this but to a lesser extent.

Pethidine: The highest risk opioid drugs are tramadol, pethidine and dextromethorphan.
Tapentadol: Currently, it is unclear if tapentadol has a greater risk of serotonin toxicity than other opioids.
Methadone: Methadone has been associated with serotonin toxicity when given with other serotonergic medicines but the risk appears low
Sux:
Fent: Co-administration with an SSRI has been reported to cause an agitated delirium consistent with serotonin toxicity.2”

Question 59

Q

60. Parkinson patient on an apomorphine infusion, what drug to give for nausea

”- cyclizine
- ondansetron
- droperidol
- metoclopramide”

Answer

A

Cyclizine

“https://www.drugs.com/drug-interactions/apomorphine-with-ondansetron-224-0-1752-0.html

States not for apomorphine + ondans

PD pt not for antiD2 drugs therefore no droperidol or metoclopramide”

Question 60

Q

61. Refractory epilepsy and vagal stimulator, what is most likely to cause it to inadvertently fire?

”- hypertension
- tachycardia
- bradycardia
- Hypotension - Hyperthermia
(Looks like maybe tachycardia)
“

Answer

A

??tachycardia

Vague mention of tachycardia in UTD but I haven’t foudn anything definitive

Question 61

Q

”
#62. Some question worded like - what is the most consistent factor to increase PONV rate in children?”

”- female sex
- age 3 years or older
- Use of short acting opioids”

Answer

A

Age >3 then? Given that the alternative is post pubertal girls

“RCH website: Risk Factors
Age > 3, Past history of PONV, History of motion sickness, Post-pubertal girls, Preoperative anxiety

Surgery type
Strabismus, Otoplasty, Adenotonsillectomy, Surgery requiring postoperative inpatient (vs day stay),Volatile anaesthesia”

Question 62

Q

63. Which muscle does not elevate the larynx?”

”- Sterno-hyoid or something sterno
- Glenohyoid
- Thyrohyoid
- Myelohyoid”

Answer

A

The sterno-hyoid option

–> Depresses hyoid bone after swallowing

Various anatomy websites

Question 63

Q

64. What is not a good indicator of a neonate being ready for extubation?”

”
- Grimace
- RR>16
- conjugate gaze
“

Answer

A

RR >16 not mentioned in that list so I guess I’ll go with that despite the articel being about children, not neonates

“https://www.bjaed.org/article/S2058-5349(21)00133-5/fulltext
Eight features have been found to be associated with successful awake extubation in children:
1. eye opening,
2. facial grimace,
3. movement of the patient other than coughing,
4. conjugate gaze,
5. purposeful movement,
6. low end-tidal anaesthetic concentration (< 0.2% for sevoflurane, < 0.15% for isoflurane and < 1% for desflurane),
7. Spo2 > 97%,
8. tidal volume 5 ml kg−1 and a
positive laryngeal stimulation test.”

Question 64

Q

65. What nerve is not related to the trigeminal?

auriculotemporal
supratrochlear
infratrochloear
greater auricular”

Answer

A

Greater auricular - comes off C2-C3 of cervical plexus

Answer 63

A

L posterior cerebral artery?

Answer 64

A

Hypokalaemia

“LITFL:
Laboratory

hyponatraemia (dilutional effect of a large volume of absorbed irrigation fluid, but later due to natriuresis)

iso-osmolar (or mildly hypo-osmolar)

increased osmolar gap from absorbed glycine
hyperglycinaemia (up to 20 mM; normal is 0.15-0.3mmol/L)

hyperserinaemia (major metabolite of glycine)
hyperammonaemia (due to deamination of glycine and serine)

hyperoxaluria and hypocalcaemia (glycine is metabolised to glycoxylic acid and oxalic acid, the latter forms calclium oxalate crystals in the urinary tracts and may contribute to renal failure)

metabolic acidosis

haemodilution and haemolysis

?more likely to get hyPERkalaemia from cell lysis”

Answer 65

A

100 x PPmax-PPmin/ PPmean

Answer 66

A

SV and periph O2 extraction

Novel techniques for quantifying oxygen pulse curve characteristics during cardiopulmonary exercise testing in tetralogy of fallot 2024 - “Oxygen pulse (O2P) is the CPET surrogate for stroke volume and peripheral oxygen extraction.”

Answer 67

A

Pulm hemorrhage

“UTD:
The diffusing capacity of the lungs for carbon monoxide (DLCO) is designed to reflect properties of the alveolar-capillary membrane, specifically the ease with which oxygen moves from inhaled air to the red blood cells in the pulmonary capillaries.
Increased DLCO — Disorders to consider when the DLCO is near or above the upper limit of the normal range include the following [17,72,73]:

●Obesity
●Asthma
●High altitude
●Polycythemia
●Pulmonary hemorrhage
●Left-to-right intracardiac shunting
●Mild left heart failure (due to increased pulmonary capillary blood volume)
●Exercise just prior to the test session (due to increased cardiac output)
●Supine position; Mueller maneuver”

Answer 68

A

K 2.7

“AAGBI 7 acceptable reasons for delaying NOF
1. Hb <80
2. Acute CCF
3. Uncontrolled DM
4. Correctable cardiac arrhythmia with vent rate >120bpm
5. Na <120 or >150, K <2.8 or >6
6. Reversible coagulopathy
7. Chest infection with sepsis”

Answer 69

A

Ant axillary line 5th intercostal space

“12-lead Precordial lead placement

V1: 4th intercostal space (ICS), RIGHT margin of the sternum
V2: 4th ICS along the LEFT margin of the sternum
V4: 5th ICS, mid-clavicular line
V3: midway between V2 and V4
V5: 5th ICS, anterior axillary line (same level as V4)
V6: 5th ICS, mid-axillary line (same level as V4)”

Answer 70

A

High proBNP

“https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31131-0/abstract

UTD re: METS trial
*Subjective assessment did not predict postoperative myocardial infarction (MI), myocardial injury, or myocardial complications.
*Lower DASI scores predicted 30-day death or MI and 30-day death or myocardial injury.
*Reduced peak oxygen consumption and anaerobic threshold measured by CPET were not associated with postoperative MI or myocardial injury.
*Higher NT-proBNP levels predicted 30-day death or MI and one-year death.”

Answer 71

A

VO2 max ~32

“V˙o2 peak (ml kg−1 min−1) = (0.43 × DASI) + 9.6

[VO2max = half DASI + 10]”

Answer 72

A

Milrinone as an inodilator

Dopamine low dose = no effect PVR
Dopamine high dose = incr PVR
Vaso low dose = no effect PVR
NAd = incr PVR and SVR
Dobutamine low dose = reduces PVR as per (Hemmings and Egan)

Answer 73

A

UO

“For adults iwth sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation over physical examination or static parameters alone. Weak recommendation, v low quality evidence.

Dynamic parameters = passive leg raise, fluid bolus, SV, SVV, PPV, echo”

Answer 74

A

Probs observe as per algorithm. “Consider CPAP”

“https://www.anzcor.org/assets/Uploads/Newborn-Life-Support-August-2023-1-v4.pdf

The determining factor after 1min is whether HR <100. This neonate’s parameters all seem very normal!”

Answer 75

A

Give adrenaline

BJA
During early resternotomy for VF/VT,

a bolus of 300 mg of amiodarone should be administered with a further dose of
150 mg in refractory cases.
Lidocaine at a dose of 1 mg kg 1 is a
suitable alternative.

Answer 76

A

“PCWP high
Because TRALI is clinical Dx with the criteria to the L”

“UTD:
TRALI is a clinical diagnosis made using the criteria outlined by the NHLBI’s working group on TRALI or the Canadian Consensus Conference (CCC) on TRALI
The diagnostic criteria for TRALI and possible TRALI share the following features: acute onset of hypoxemia, bilateral infiltrates on frontal chest radiograph, and absence of circulatory overload as the primary etiology of respiratory insufficiency. For a diagnosis of TRALI to be made, all of these features must be present. In addition, there should be no pre-existing ALI/ARDS risk factors at the time of transfusion”

Answer 77

A

“Platelet serotonin release assay - this is the gold standard test but not part of the 4Ts
score.”

“UTD:
Thrombocytopenia
*Platelet count fall >50 percent and nadir ≥20,000/microL – 2 points
*Platelet count fall 30 to 50 percent or nadir 10 to 19,000/microL – 1 point
*Platelet count fall < 30 percent or nadir < 10,000/microL – 0 points
●Timing of platelet count fall
*Clear onset between days 5 and 10 or platelet count fall at ≤1 day if prior heparin exposure within the last 30 days – 2 points
*Consistent with fall at 5 to 10 days but unclear (eg, missing platelet counts), onset after day 10, or fall ≤1 day with prior heparin exposure within 30 to 100 days – 1 point
*Platelet count fall at < 4 days without recent exposure – 0 points
●Thrombosis or other sequelae
*Confirmed new thrombosis, skin necrosis, or acute systemic reaction after intravenous unfractionated heparin bolus – 2 points
*Progressive or recurrent thrombosis, non-necrotizing (erythematous) skin lesions, or suspected thrombosis that has not been proven – 1 point
*None – 0 points
●Other causes for thrombocytopenia
*None apparent – 2 points
*Possible – 1 point
*Definite – 0 points”

Answer 78

A

Unassisted diastole

Answer 79

A

7.5mmHg

“Association of Anaes doc
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15817
Amplitude rises during exhalation and falls during inspiration.
Consistent or increasing amplitude over at least seven breaths [74, 91].
Peak amplitude more than 1 kPa (7.5 mmHg) above baseline [74, 94].
Reading is clinically appropriate.”

Answer 80

A

Healthy person less than 40yo

Answer 81

A

5. In patients with DES-PCI who require time-sensitive NCS with interruption of ≥1 antiplatelet agents, NCS may be considered ≥3 months after PCI if

the risk of delaying surgery outweighs the risk of MACE.5,23,24

2024 AHA/ACC 7.5

Answer 82

A

AION

“UTD: Both PION and AION have painless visual loss and both have afferent defect

Although anterior ischemic optic neuropathy (AION) appears to be more common than PION after cardiac surgery, PION is relatively more common in cases of spine surgery and radical neck dissection

”

Answer 83

A

COPD

“Airway abnormality eg muscous plugging causes matched defect secondary to HPV
vs
Flow abnormality eg PE/infarct causes a mismitch V/Q because you can stop blood flow but lung will remain ventilated”

Answer 84

A

60min

“Blue Book 2023
Heparin
25iU/kg –> t1/2 30min
100IU/kg –> 60min
400IU/kg –> 150min”

Answer 85

A

/?Peroneal

NYSORA - unclear

Answer 86

A

Facial nerve

Answer 87

A

Inf gluteal

inf gluteal = motor to glute

Answer 88

A

Inferior alveolar …or is this one mental n. because it hasn’t specified a tooth they’re taking out?

Answer 89

A

FIX

Mnemonic:
III F

VIII
XIII
Fibro x2
vwF

Cryo contains: vwF, fibronectin, fibrinogen (I), VIII, XIII

Answer 90

A

Deep posterior

The PTN is one of the two terminal divisions of the sciatic nerve and consists of muscular, cutaneous, and articular branches. It extends from the arch of the soleus muscle to the tibiotalocalcaneal canal. In the upper two-thirds of the leg the nerve is located deep in the posterior compartment.

Answer 91

A

Speed of muscle akinesis

HYALASE is used as an aid in different medical conditions to allow injected substances to be rapidly dispersed and absorbed.

https://www.nps.org.au/medicine-finder/hyalase-injection

Answer 92

A

Reduced rate of anaphylaxis

“https://www.nationalauditprojects.org.uk/downloads/NAP6%20Chapter%2018%20-%20Patent%20Blue%20dye.pdf

https://pubmed.ncbi.nlm.nih.gov/28355372/
Methylene blue is more widely available and less expensive than patent blue, with an apparently lower risk of anaphylaxis.
Patent blue = easier to see the nodes”

Answer 93

A

Rectal indomethacin

“NEJM
APMSE - Rectal diclofenac and indomethacin”

Answer 94

A

Lower dose, same conc

“Epipen = 300microg
1:1000 = 1mg
1000microg/mL

ANAPEN 500mcg adrenaline (epinephrine) 500 micrograms/0.3 mL solution for injection pre-filled syringe (auto-injector)

Epipen 300mcg Ad in 0.3mL “

A device containing either 300 micrograms ( EpiPen®) OR
a device containing 500 micrograms (Anapen®) should be used.

EpiPen® = one dose of 0.3 mg epinephrine, USP 0.3 mg/0.3 mL
EpiPen Jr® = one dose of 0.15 mg epinephrine, USP 0.15 mg/0.3 mL

Anapen
150/300/500 microg / 0.3mL
All 0.3mL

Answer 95

A

Soap and water

“Laryngoscope handles, being non-critical devices, should be cleaned with
detergent and water between each patient use. If contaminated with blood,
they should be washed and disinfected”

PG 28 2015 P.4

Answer 96

A

dexamethasone

“https://www.bjaed.org/action/showPdf?pii=S2058-5349%2819%2930079-4

Dexamethasone –> Dexmed –> Clonidine “

Answer 97

A

High PEEP

“Blue Book 2017
PEEP prevents de-recruitment of alveoli at the end of each expiration thus maintaining functional residual
capacity (FRC). Patients with ARDS often receive PEEP of 5 to 20 cm of water. Higher PEEP levels may improve
oxygenation but may also cause circulatory depression and lung injury from over distention. Thus, optimal
PEEP is that which prevents atelectrauma and at the same time prevents over distension of normal alveoli – it
needs to be individualised to the patient’s respiratory mechanics. How to set “optimal PEEP” remains controversial.”

Answer 98

A

For skin preparation, 0.5 per cent chlorhexidine in alcohol, where available, is recommended for neuraxial techniques

PG 28 Infection control https://www.anzca.edu.au/getattachment/e4e601e6-d344-42ce-9849-7ae9bfa19f15/PG28(A)-Guideline-on-infection-control-in-anaesthesia

Answer 99

A

100ml/kg

Parameters for pregnant lady

https://www.ahajournals.org/doi/10.1161/circulationaha.114.009029

Answer 100

A

PSA RM
rate modulation
multichamber pacing

https://litfl.com/pacemaker-rhythms-normal-patterns/

Answer 101

A

5 mins

”"”neutralizing their anticoagulant effect immediately after administration”” Praxbind website https://pro.boehringer-ingelheim.com/us/products/praxbind/idarucizumab/reversing-pradaxa#

2021 Blue book - Almost immediate”

Answer 102

A

TRE: traps –> rhomboids –> erector spinae in that order

Answer 103

A

maximum of 8-9mg/kg lignocaine can be used for topicalisation

https://www.anzca.edu.au/resources/sig-resources/2019-airway-management-sig-afoi-topicalisation-sed

Answer 104

A

Physical dependence

Answer 105

A

cardiothoracic anaesthesia (~1:8,600)

“NAP 5 2014
GA CS 1:670
Paralysed pt 1:8000
In general for GA with paralysis 1: 20,000
GA without paralysis 1:136,000”

Answer 106

A

major haemorrhage

NAP 7

NAP 7 2023: The most common causes of perioperative cardiac arrest were major haemorrhage (17%), bradyarrhythmia (9.4%) and cardiac ischaemia (7.3%) but varied by surgical specialty

Answer 107

A

Haemophilia B

“BJA + UTD
DDAVP stim factor VIII”

Answer 108

A

Phentolamine if “ischaemia…’”

https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Medicine%20Guideline%20-%20Phentolamine%20in%20the%20treatment%20of%20dermal%20necrosis%20or%20sloughing%20following%20extravasation%20of%20peripherally%20administered%20noradrenaline%20%28norepinephrine%29.pdf

Answer 109

A

ECG changes

PoTS

”- Need a normal ECG for PoTS
- IS assoc w/ long covid, EDS, and need normal LV function
- https://www.acc.org/Latest-in-Cardiology/Articles/2016/01/25/14/01/Postural-Tachycardia-Syndrome-POTS-Diagnosis-and-Treatment-Basics-and-New-Developments#:~:text=Left%20ventricular%20function%20must%20be,could%20mimic%20a%20POTS%20presentation.”

Answer 110

A

RV dilated/dysFx

LITFL Echo: AR, RWMA heralding cor art occlusion, acute dilation aortic root, pericardial eff

Answer 111

A

exacerbation of asthma

”- Normal is < 25ppb
https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/exhaled-nitric-oxide-test”

Answer 112

A

incidence of CS

Blue book article

Blue book 2021.

Answer 113

A

Diastolic dys

“https://www.ahajournals.org/doi/10.1161/01.cir.83.5.1605?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Cascade of events: Diastolic dys, sys dysFx, ECG changes, Sx angina - from some rando paper Bonny found”

Answer 114

A

4 weeks for every year of absence

PS

PS 50 Return to Practice 2017

Answer 115

A

Subjective effort

“rating of pecieved exertion” test

Answer 116

A

72 hours

ALS ANZCOR - detailed

ANZCOR
48h: CTB
72 hours: pupillary light reflex, pupillometry, corneal reflex, eeg, NSE, MRI 72h-7d
4 days GCS >3
7 days (status) myoclonus

https://www.anzcor.org/home/adult-advanced-life-support/guideline-11-7-post-resuscitation-therapy-in-adult-advanced-life-support/
2.3-3.5

Answer 117

A

Greater height, shorter DOA

Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery; BJA intrathecal drug spread 2004

Answer 118

A

?

I havent found a reference for this, the lecture from Syndey said ketamine does inrease MPSS, surely sevo is worse than remi??

Answer 119

A

“increased cerebral O2 (SctO2) and decreased peripheral SpO2

ie. Increases NIRS, decreases periph (falsely)”

https://pmc.ncbi.nlm.nih.gov/articles/PMC4384398/#:~:text=Intravenously%20administered%20indocyanine%20green%20(ICG,carotid%20endarterectomy%20under%20general%20anesthesia.

Answer 120

A

Celecoxib

Cobbled together from a few different papers, brufen superior to panadol, but celecoxib (and diclofenac) superior to panadol, meloxicam superior to tramadol

Answer 121

A

No bronchospasm

“https://www.bjanaesthesia.org/action/showPdf?pii=S0007-0912%2821%2900437-2 table of Burch and Wartofski score for thyrotoxicosis dx

UTD:
Temp, neuro signs (agitation –> seizure/coma), UG (diarrhoea –> jaundice), tachy, AF, HF, precipitant criteria”

Answer 122

A

reduced SVR

reduced SVR (hence flushing!)

“UTD thyroid CVS table https://www.uptodate.com/contents/cardiovascular-effects-of-hyperthyroidism

+ diastolic down –> widened pulse pressure”

Answer 123

A

inferior gluteal, its a motor nerve to glute, for stair climbing type movement

primary/ KN/ radiopedia

Answer 124

A

metoprolol (unopposed alpha)

This was on an episode of ER. But also; https://www.bjaed.org/action/showPdf?pii=S1743-1816%2817%2930053-7. LITFL. primary viva, open anaesthesia

Answer 125

A

least likely hypoglycaemia?? , they can cause all of these things..

“2019 blue book article

Initial increase in Cr which normalises over time”

“2019 blue book article Initial increase in Cr which normalises over time

https://www.tga.gov.au/sites/default/files/auspar-empagliflozin-171026-pi.pdf SGLT2-i monotherapy does not cause hypoglycaemia”

Answer 126

A

12h

APMSE
Steady state reached after 3d
Terminal t1/2 12h
vs
Fent patch onset 12-24h
t1/2 17h”

Answer 127

A

50-70% above T6, and more likely if complete

https://www.bjaed.org/article/S2058-5349(17)30152-X/pdf

Answer 128

A

5 x 7.5= 37.5mmHg

its in the blue book article about hyperbaric medicine: 1kpa = 7.5mmHg

Answer 129

A

Honey

“50-150ml 0.25% sterile acetic acid to neutralise residual alkali (LITFL), sulcrafate recommended by USA Poisons centre.

RCH: Honey at home, suculfate in ED”

Answer 130

A

Induction

https://www.bjaed.org/article/S2058-5349(18)30060-X/fulltext. “strong evidence that induction of labour by any method increases the risk of AFE”

Answer 131

A

BMJ says needle decompression first, then definitive rx with ICC to follow

“https://qualitysafety.bmj.com/content/qhc/14/3/e18.full.pdf. Crisis management during anaesthesia: pneumothorax
“

Answer 132

A

TAVI: reduced all cause mortality, stroke, AKI, new onset AF, major bleed. TAVI higher major vascular complication, PPM

2019 European heart journal https://www.escardio.org/Sub-specialty-communities/European-Association-of-Percutaneous-Cardiovascular-Interventions-(EAPCI)/Research-and-Publications/Commented-articles/transcatheter-aortic-valve-implantation-vs-surgical-aortic-valve-replacement-fo

Answer 133

A

“four bronchopulmonary segments:

superior segment
anteromedial segment
lateral segment
posterior segment”

radiopedia

Answer 134

A

CF 1h, Br milk 3 hours

< 12 mo: 1:3:4
> 12 mo: 1:3:6
CF:BF:Formula
CF 3mL/kg/hr

PG07 https://www.anzca.edu.au/resources/professional-documents/guidelines/ps07-guidelines-on-pre-anaesthesia-consultation-an

Answer 135

A

RV contraction from these options

“LITFL https://litfl.com/right-ventricular-function-and-haemodynamic-assessment-echocardiography/. measure of RV Systolic function:
TAPSE (Tricuspid Annular Plane Systolic Excursion) normal is >1.7cm (less useful post some cardiac surgery) [measured in AP4C w/ M Mode]”

Answer 136

A

I think this was remembered incorrectly, BJA says decreased transfusion in cardac and ortho patients, and INCREASED mortality and thrombotic complications therefore dont give to surgical patients , as per NICE guidelines

https://watermark.silverchair.com/mkw061.pdf

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