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ANZCA Finals Custom > 24.2 > Flashcards

24.2 Flashcards

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”
A

3L/min

The Society of Paediatric Anesthesia recommends 0.15/min/kg as the minimum safe and effective FGF during induction i.e . 3L/min for a 20kg child. Many anaesthetists routinely run 6-10L/min regardless of the child’s weight.
https://journalwatch.org.au/reviews/reducing-the-environmental-impact-of-mask

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2
Q
  1. The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:
    “● Mapleson A
    ● Mapleson B
    ● Mapleson C
    ● Mapleson D
    ● Mapleson E”
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.”

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3
Q
  1. SQUIRE guidelines
A

“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”

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

Box = interquartile range

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

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5
Q
  1. What does a green line on the rigid laryngoscope blade mean
    (a) Reusable
    (b) Recyclable
    (c) Single use - disposable
    (d) Immersible
A

? - single use?

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6
Q

Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in
the exam)

A

C
perpendicular port for ventilation, pop top for bronch, oblique port for suction

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7
Q

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

A

Red port - flush port for the lens

Airway ports - blue = bronchial lumen, white = tracheal lumen
Monitor connector
Red port - flush for lens
Cuffs - tracheal clear, bronchial blue

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8
Q

What is the half life of semaglutide
3 days
7 days
14 days

A

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

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9
Q

PREVENTT trial showed that in major abdominal surgery, iron infusions:

A Reduced allogenic red cell transfusion
B Reduced mortality
C Reduced readmission rates within 30 days
D Reduced infection rates

A

C - Reduced readmission rates within 30 days

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10
Q

Compared to UFH, enoxaparin

A

More selective for factor Xa compared to UFH which binds both Xa and thrombin via ATIII

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11
Q
  1. Child on 15mcg/kg steroids, duration of treatment to give hydrocortisone peri-operatively

A > 2 weeks
B 1 month
C 2 months

A

B - 1 month

AOA guidelines

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12
Q

DCD which is the organ which can have the longest ischaemic time

A Lungs
B Kidneys
C Liver
D Pancreas
E Heart

A

A - Lungs (90mins)

Warm ischaemia time:
Liver and pancreas 30mins
Heart 30mins (from sBP <90mmHg to cold perfusion)
Kidneys 60mins (from sBP <50mmHg)
Lungs 90mins (from sBP <50mmHg)

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13
Q

DCD criteria does not include:
A Immobility
B apnoea
C absent skin perfusion
D absence of circulation (no arterial pulsatility for 2 min)

A

C - absent skin perfusion

DCD. -absence of circulation 5 mins for withdrawal of cardio resp support
- if ECG present need to observe asystole for 5mins
Unresponsive, apnoea, no pulse/heart sounds

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14
Q

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

  • Allodynia
  • Dysaesthesia
  • Formication
  • Pruritis
A

Formication
- although technically dysaesthesia

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15
Q

Congenital long QT, drug should avoid:

A propofol
B thiopentone
C ketamine

A

Ketamine

Triggers:
- beta-agonists, ketamine
- SNS stimulation
- Other QT prolonging medications: antiemetics, antipsychotics, amiodarone, methadone
- bradycardia, tachycardia, hypertension, hypoxaemia, hypercapnia
- electrolyte disturbance. - low K, Mg, Ca

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16
Q

Treatment for recurrent torsades de pointes?

A - Flecainide
B- Lignocaine
C -Procainamide
D - Amiodarone
E - Sotalol

A

Lignocaine

TdP is polymorphic VT with long QT
First line treatment is Magnesium then treat the long QT
Amiodarone and procainamide will lengthen QT

https://www.emdocs.net/ecg-pointers-recurrent-and-refractory-torsades-de-pointes/

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17
Q

What level tryptase acceptable to diagnose anaphylaxis?
A- (1.2 of normal) + 2 /ml
B- (1.8 of normal) + 2
C- Normal + 2
D- 10/ml
E- 15/ml

A

A - 1.2 x normal + 2

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

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18
Q

Treatment for refractory anaphylaxis?
A Glucagon IV 10 min
B Glucagon IV 5
C Glucagon IM 5 min
D Glucagon IM 10 min

A

Glucagon IV q 5mins (1-2mg)

other refractory treatment:
Norad infusion 3-40mcg/min
vasopressin bolus 1-2 units then 2U/hr
+/- metaraminol or phenylephrine

bronchospasm
salbutamol MDI 12 puffs (1200mcg) - IV bolus 100-200mcg +/- infusion 5-25mcg/min
Mg 2g over 20mins
+/ volatiles or ketamine

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19
Q
  1. Fem-fem VA ECMO, where is BG best representative of coronary PaO2?
  • right radial
  • Either radial
  • Left radial
  • Pre oxygenator
  • Post oxygenator
A

Right radial

https://pmc.ncbi.nlm.nih.gov/articles/PMC8292640/

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20
Q
  1. Post op cognitive decline has an onset within:
  • immediate post
  • Within one day, lasting one week
  • From ?3wk
  • ?10 days post op for a year
  • From 1 month to 1 year
A

From 7 days post op til 1 year post

Blue Book article 2019

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21
Q

Pre-eclamspia at 30 weeks with IUGR

A- low CO, low SVR
B- Low CO, high svr
C- High CO, low svr
D- High CO, high svr

A

B - 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

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22
Q

Burns - expected physiological change in first 24 hours

A- High cardiac index
B- Increased PVR
C- Decreased SVR
D- High stroke volume

A

Increased PVR
- initially loss of intravascular volume + low CO and catecholamine surge -> vasoconstriction

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

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23
Q

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
A

Immunodeficiency

The three primary risk factors for developing TA-GVHD are:

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

Factors increasing risk:
- degree of immunodeficiency of the recipient.
- number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status), and
- genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products (because in GVHD, the body cannot recognise the foreign T cells and allows them to engraft)

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24
Q

When reconstituted, fibrinogen concentrate should be transfused within:
- 30min
- 4h
- 6h
- 8h

A

6 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”

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25
Q
  1. 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
A

LA appendage

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26
Q

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
A

Withhold warfarin

On-X is approved for use with INR use 1.5-2.0

https://academic.oup.com/ejcts/article/65/5/ezae117/7646070

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27
Q

APRV ventilation

A

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

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28
Q

Best TOE view for detecting myocardial ischaemia

  • Mid-Oesophageal 4 chamber
  • Long axis
  • 2 chamber
  • Transgastric 2 chamber papillary
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.

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29
Q

The pregnant MS lady, cat 1 section within 30min, what method
- spinal
- CSE
- Epidural
- GA
- Methylpred then GA

A

Spinal

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30
Q

Classic LMA cuff recommended pressure max (CmH2O)
30
40
50
60

A

60cmH2O intracuff pressure

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31
Q

Narrow complex tachycardia ECG in young person post op in PACU with SBP 90. What treatment
A. Modified valsalva
B. Adenosine
C. DCCV

A

valsalva

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32
Q

Child with status epilepticus, weight 20kg, which is NOT a recommended treatment with midazolam:

  • IM 3mg
  • intranasal 6mg
  • intraosseous 3mg
  • buccal 6mg
  • IV 1.5mg
A

IV and IM doses too low

Buccal/ intranasal 0.3mg/kg x20 = 6mg
IV/ IO 0.15mg/kg x20= 3mg
IM 0.2mg/kg x20= 4mg

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

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33
Q

Highest rate of mortality is in BMI category of
- <18.5
- 18.5-24.9 - 25-29.9
- 30-34.9
- 35-39.9

A

BMI <18.5

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34
Q

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

A
  • Dose expected higher because of up-regulation of acetylcholine receptors
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35
Q
  1. Class 2 obesity has an ASA score of:
    1
    2
    3
    4
A

2

36
Q

What are the features of Brugada syndrome on ECG?

A

Brugada sign - Coved ST segment elevation >2mm in one of V1-V3 followed by negative T wave

37
Q
  1. Magnesium 20mmol given intra-op is NOT associated with
    A - reduced pain scores in PACU
    B - reduced PONV
    C - Reduced MAC requirements
    D - Prolonged NMB
    E - Resp depression post op
A

Reduced MAC requirements

Does result in post-op resp depression
and decreased opioid consumption

38
Q

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

A

Prostaglandin

39
Q
  1. Someone is on long acting MAOi, what drug is most likely to cause serotonin syndrome?
  • pethidine
  • tapentadol
  • Methadone
  • sux
  • fent
A

pethidine

40
Q
  1. Parkinson patient on an apomorphine infusion, what drug to give for nausea
    - cyclizine
    - ondansetron
    - droperidol
    - metoclopramide
A

Cyclizine

ondansetron interacts with apomorphine

41
Q

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

  • hypertension
  • tachycardia
  • bradycardia
  • Hypotension - Hyperthermia
A

Tachycardia

42
Q

What is the most consistent factor to increase PONV rate in children?
- female sex
- age 3 years or older
- Use of short acting opioids

A

> 3 years old

Pre-op risk factors:
>= 3yo, Hx of POV/PONV/motion sickness
Fhx of POV/PONV
Post-pubertal female

43
Q

What is not a good indicator of a neonate being ready for extubation?
- Grimace
- RR>16
- conjugate gaze

A

RR >16

Eight features have been found to be associated with successful awake extubation in children: eye opening, facial grimace, movement of the patient other than coughing, conjugate gaze, purposeful movement, low end-tidal anaesthetic concentration (<0.2% for sevoflurane, <0.15% for isoflurane and <1% for desflurane), Spo2 > 97%, tidal volume 5 ml kg−1 and a positive laryngeal stimulation test.

44
Q

What nerve is not related to the trigeminal?

  • auriculotemporal
  • supratrochlear
  • infratrochloear
  • great auricular
A

Great auricular nerve - branch of C2/3

45
Q

Right homonomous hemianopia and right hemisensory loss - affected region
- left posterior cerebral
- Left anterior cerebral
- Superior cerebellar
- Left anterior inferior cerebellar

A

left posterior cerebral a.

46
Q

What is NOT a feature of TURP?
- hyperglycinaemia
- hyponatraemia
- hypervolaemia
- hypokalaemia

A

hypokalemia

47
Q

Oxygen pulse in CPET is surrogate for:
- stroke volume
- anaerobic threshold

A

Stroke volume
(&peripheral 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.”

48
Q

What increases DLCO?

A

Pulmonary haemorrhage

“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”

49
Q

What acceptable reason to defer NOF?
- K+2.7
- HR 110, AF
- Hb86
- Na126

A

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

50
Q
  1. What is the most sensitive predictor of 30 day mortality and MACE? .
    - DASI score 55
    - AT<11
    - proBNP >300
    - 6MWT<…
    - VO2 <11
A

High proBNP

DASI score improved RCRI prediction of 30d mortality/MI and 1yr mortality
METS study

51
Q

VO2 max and DASI questionnaire relationship - score of 48 on DASI something equals
VO2 peak of?

A - 20ml/kg/min
B - 30
C - 40
D - 50

A

30ml/kg/min

DASI conversion formula - 𝑉o2 peak (ml kg−1 min−1) = (0.43×DASI)+9.6.

52
Q

Sepsis guidelines, what measure is NOT recommended to assess fluid status/ dynamic?

  • urine output
  • passive leg raise
  • PPV”
A

urine output

surviving sepsis - “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”

53
Q

Newborn at 1min, sats 75%, grimacing, pulse 120, RR 40. What do you do?
a Observe
b CPAP
c Intubate
d CPR

A

Observe

ANZCOR guidelines - at 1min, sats expected 60-70%. HR >100

54
Q

Diagnosis for TRALI NOT based on

A- hypoxaemia
B- Onset within 6 hours of transfusion
C- PCWP high
D- Bilateral infiltrate on CXR

A

C - High PCWP

“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”

55
Q

Diagnosis HITS based on 4Ts Score, which are:

A

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

56
Q

To confirm ETT, need ETCO2 more than how much from baseline?

A

7.5mmHg

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

57
Q

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 clopidogrel for 5 days
B - Cease clopidogrel for 10 days
C - Continue both
D - Cease clopidogrel for 7 days and aspirin for 20 days

A

A - cease clopidogrel 5 days

58
Q

Woman complaining of persistent shortness of breath 3 days post prolonged knee operation. v/q scan showing patchy, non segmental areas of equal non ventilation and perfusion. Cause
- PE
- Pulm infarct
- COPD
- Atelectasis

A

COPD

Airway abnormality eg mucous 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

59
Q

What is the half life of a 100u/kg heparin dose?

  • 30mins
  • 1hour
  • 2 hours
  • 3 hours
  • 4 hours”
A

60 mins

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

60
Q

What nerve is not potentially damaged by insertion of supraglottic airway?
- Facial
- Trigeminal
- Glossopharyngeal - Vagus
- Lingual

A

Facial nerve

61
Q
  1. Somatic innervation in the second stage of labour includes the following nerves EXCEPT
  • Genitofemoral nerve
  • Posterior cutaneous nerve of the thigh
  • Inferior gluteal nerve
  • Pudendal nerve
A

Inferior gluteal nerve - motor to thigh

62
Q

Cryoprecipitate does NOT contain
- Factor IX
- Factor XIII
- Fibronectin
- Von Willebrand Factor

A

Factor IX

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

63
Q

Use of methylene blue rather than patent blue
- Reduced rate of anaphylaxis
- More expensive
- Easier to see sentinel nodes
- Reduced O2 saturations

A

Reduced rate of anaphylaxis

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

64
Q

Which additive prolongs block longest?
A - Clonidine
B - Dexamethasone
C - Bicarbonate
D- Adrenaline

A

Dexamethasone

Clonidine +2hrs
Bicarbonate - increased speed of onset
Adrenaline +1hr

65
Q

The recommended skin preparation for a neuraxial?

A

0.5% chlorhex/ 70% alcohol.

66
Q

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
(what is the sequence of muscles?)

A

Trapezius
Rhomboids
Erector Spinae

67
Q

NAP7 - most common cause perioperative arrest?
- Major haemorrhage
- Anaphylaxis
- Airway issues

A

Major Haemorrhage

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

68
Q

DDAVP NOT used for:
- nocturnal enuresis
- Haemophillia B
- Von Willebrand disease 2A
- Uraemic bleeding
- Central diabetes insipidus

A

Haemophilia B

69
Q

Noradrenaline has tissued into skin from peripheral cannula, most appropriate first step is:
- remove cannula
- Flush with saline
- Hyalase
- Cold compress
- phentolamine

A

Phentolamine

Avoid cold compress, don’t flush
Hyalase can be used for large volume extravasation
Keep cannula in situ

70
Q

What is not associated with POTS?
- COVID-19
- Hypermobility disorder
- Normal resting LV function
- ECG changes

A

ECG changes

  • 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.”
71
Q

PFT in patient, detect nitric oxide >70ppm number ppb. SIgnificance?
- Smoker
- COPD
- Exacerbation of asthma

A

Exacerbation of asthma

72
Q

Compared to a continuous infusion, PCEA does NOT reduce
- Incidence of instrumental delivery
- Incidence of C-section rates
- Clinical workload
- Motor weakness

A

Incidence of CS

* PIB superior analgesia to Infusion 
	○ Better spread (bolus under pressure)
	○ Less breakthrough pain (better analgesia)
	○ Longer time to PCEA use
	○ Less overall LA required
	○ No difference in instrumental delivery and CS rate Less motor block (2.7 vs 37% and 1% vs 21.8%)
73
Q

A 70-year-old man undergoes a stress echocardiogram as part of his preoperative preparation before a total hip replacement. If he has clinically significant coronary artery disease, the earliest indicator during his test is most likely to be:

A - ECG changes
B - RWMA
C - diastolic dysfunction
D - Angina
E - Hypotension

A

?Diastolic dysfunction

74
Q

What is the purpose of the Modified Borg scale for CPET?

A

Subjective grade of dyspnoea as rating of percieved exertion

75
Q
  1. ANZCOR recommendations on minimum time from cardiac arrest to post arrest prognostication?
    A - 24hrs
    B - 48hrs
    C - 72hrs
A

72hrs - testing done at this time

brain death certification with ANZICs - >24hrs post arrest

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

76
Q

Spinal, 3ml, patient supine and horizontal, hyperbaric qualities vs normal bupivacaine

A Lesser block height, shorter DoA
B Lesser block height, Longer DoA
C Greater block height + shorter DoA
D Greater block height+ Longer DoA
E No difference in block height, longer DoA

A

Greater block height, shorter DOA

77
Q

Which anaesthetic has least effect on ECOG - electrocorticography for epilepsy surgery?
A ketamine
B propofol
C remifentanil

A

Remifentanil
Dexmed also good

conflicting - sevo/propofol
avoid - ketamine, midaz
https://pubmed.ncbi.nlm.nih.gov/33819715/

78
Q

Best post-op analgesia after wisdom tooth removal
A Ibuprofen
B Celecoxib
C Tramadol
D paracetamol

A

Celecoxib

https://www.thejcdp.com/doi/pdf/10.5005/jp-journals-10024-2428

79
Q

Which drug NOT to give with cocaine toxicity?
A - phentolamine
B - Metoprolol
C - GTN
D - Propofol bolus

A

B- metoprolol ->unopposed alpha stimulation

80
Q

SGLT-2i use for diabetes, what do they NOT cause?
A Glycosuria
B Reduced eGFR
C Euglycaemic ketosis
D Hypoglycaemia

A

Hypoglycaemia.- low risk

reduced GFR - GFR dip on initiation of SGLT2i

81
Q

Buprenorphine patch stopped, when will plasma levels drop by 50%
A - 12hrs
B - 24hrs
C - 48hrs
D - 72hrs

A

A - 12 hrs

82
Q

5 kPa is approximately equivalent to:
A - 37 mmHg
B - 45 mmHg

A

37mmHg

1kPA = 7.5mmHg

83
Q

Risk of AFE is highest in:
A - Caesarean Section
B - induction of labour
C - Labour augmented by oxytocin

A

Induction of labour
- increased again if oxytocin used

84
Q

You have induced a patient (I forget this part) and ten minutes later - reduced air entry left side, sats 85%, hypotensive. Lung USS on the left side shows no sliding and a lung point sign.

  • Left needle decompression 2nd IC space
  • Left chest drain insertion
  • Left finger thoracostomy
  • Pull the ETT back 2cm
  • Get a chest XR
A

Needle decompression, 2nd IC space

85
Q

Compared with open mechanical aortic valve repair, TAVI has:
- Reduced mean gradient
- Reduced vascular injury
- Reduced arrhythmia
- Reduced paravalvular leaks

A

Reduced arrhythmia - less likely to need a pacemaker

TAVR has -> only significant results
RR all cause death 0.67
RR disabling stroke 0.35
RR AKI 0.21
RR rehospitalisation 0.63
RR AF 0.25
RR risk of bleeding 0.37

RR vascular complications 1.92
RR pacemaker 2.9
RR mild paravalvular leak 6.6, moderate 4.67
RR reintervention 3.7 in high risk cases
similar valve gradients

86
Q

The number of segments in the left lower lobe of the lung is:
A 2
B 3
C 4

A

Four - Superior, Anteromedial, Lateral, Posterior

87
Q
A

ANZCA Finals Custom (18 decks)

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