24.2 Flashcards
During paediatric gas induction, the gas flow recommended by SPANZA for least environmental impact is:
a) 1L/min
b) 2L/min
c) 3L/min
d) 4L/min
e) 5L/min
Ans: 3L/min (0.15L/kg/min)
The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:
a) Mapleson A
b) Mapleson B
c) Mapleson C
d) Mapleson D
e) Mapleson E
Ans: Mapleson D
A - best for spontaneous ventilation
B, C - both crap
D, E, F - best for mechanical ventilation
SQUIRE guidelines
a) Provide a framework for reporting new knowledge about healthcare improvement
b) How to conduct a systematic review
Ans: Quality improvement
What is the five number summary on a box and whisker plot?
Ans:
- Minimum
- First quartile
- Median
- Third quartile
- Maximum
Axis of ECG- left axis deviation (aVR was isoelectric, AVF negative, I positive)
a) -45 degrees
b) -75 degrees
c) +15 degrees
Ans: -45?
AVF negative - must be between 0 and -180
I positive - must be between 0 and -90
AVR isoelectric - must be 90 degrees to -150 therefore answer is -60
(if the remembered leads are correct)
What does a green colour on the laryngoscope blade mean
a) Reusable
b) Recyclable
c) Single use
d) Disposable
e) Fibreoptic light source
Ans: fibreoptic light source (in handle), lamp in the blade, electrical connection
versus black (?) handle which has light source in the blade not the handle.
Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in the exam)
Vivasight components (arrow to the red bit in the exam)
a) Flush port
b) Light source
c) Aspiration port
Flush port
Semaglutide half life
a) 3 days
b) 7 days
c)14 days
6-7 days
From ANZCA clinical practice recommendation on periprocedural use of GLP-1/GIP receptor agonists
Exenatide 3.3-4 hours
Liraglutide 12.6-14.3 hours
Dulaglutide 4.7-5.5 days
Semaglutide 5.7-6.7 days
Tirzapatide 4.2-6.1 days
Gastric USS image
a) Empty stomach
Preoperative intravenous iron to treat anaemic before major abdominal surgery (PREVENTT) trial showed:
a) Reduced allogenic red cell transfusion
b) Reduced mortality
c) Reduced readmission rates within 30 days
d) Reduced infection rates
Ans: reduced readmission rates in 30 days
Published in the Lancet October 2020
Found that preoperative intravenous iron was not superior to placebo to reduce need for blood transfusion when administered to patients within anaemia 10-42 days before elective major abdominal surgery.
Readmissions to the hospital following surgery were significantly lower in the intravenous iron group in the first 8 weeks after the index operation.
Compared to UFH, enoxaparin preferences:
a) Thrombin
b) Xa
Xa
Child on 15mcg/kg steroids, when to give hydrocortisone (stress dosing)
a) > 2 weeks
b) > 1 month
c) > 2 months
Stress dose if >15mg/m^2 daily for > 1 month
Stress dose is 2mg/kg hydrocortisone.
DCD - last acceptable organ
a) Lungs
b) Kidney
c) Liver
d) Pancreas
e) Heart
Ans: lungs (90 minutes)
Liver and pancreas - 30 minutes from withdrawal of support
Heart - 30 minutes from systolic <90
Kidneys - 60 minutes from systolic <50
Liver - 90 minutes from systolic <50
DCD criteria, what doesn’t include
a) Immobility
b) Apnoea
c) Absent skin perfusion
d) Absence of circulation (no arterial pulsatility for 2 min)
Cannot recall other option, which was the answer (maybe absence of sedation?)
Ans: d
Should be absence of pulsatility for 5 minutes not 2 minutes.
Donatelife best practice guideline:
- Arterial blood pressure monitoring is recommended
- Absence of arterial pulsatility for 5 minutes is observed prior to confirmation of death
- Electrical asystole is not required, noting that electrical (ECG) activity may persist beyond circulatory arrest
- Death is confirmed by clinical examination (e.g. absence of spontaneous movement, breathing, heart sounds and central pulse)
- Post-mortem interventions that may restart the circulation should not be undertaken e.g. mechanical ventilation, chest compression
Post herpetic neuralgia, feels like insects crawling across head, what is it?
a) Allodynia
b) Dysaesthesia
c) Formication
d) Pruritis
e) Hyperpathia
Ans: Formication
Dysaesthesia “spontaneous or evoked unpleasant abnormal sensations”
Hyperalgesia “increased response to a normally painful stimulus”
Allodynia “pain due to a stimulus that does not normally evoke pain such as light touch”
What drug to avoid in congenital long QT
a) Propofol
b) Thiopentone
c) Ketamine
Uptodate:
= Droperidol, haloperidol, volatile, ondansetron, amiodarone. methadone
Propofol has least effect. Prop/remi TIVA is safe
“ketamine should be avoided because of its sympathomimetic effects”
Glyco and atropine can prolong QTc and precipitate torsades.
Thiopental can be used in patients with prolonged QT (prolongs the QTc but reduces TDP - transmural dispersion of depolarization)
Long QT syndrome | BJA Education | Oxford Academic (oup.com)
Recurrent torsades treatment, acceptable
a) Flecainide
b) Lignocaine
c) Procainamide
d) Amiodarone
e) Sotalol
Ans: Lignocaine (dose is 1mg/kg bolus - ANZCOR)
- Overdrive pacing - Lignocaine decreases the QTc - Beta blockers - Isoprenaline
Uptodate:
- If baseline QTc is normal then less likely to respond to Mg and IV amiodarone may prevent recurrence.
“polymorphic VT” = without QT prolongation
“torsades” = a form of polymorphic VT with QT prolongation
- Acceptable tryptase to diagnose anaphylaxis
a) (1.2 times normal) + 2
b) (1.8 times normal) + 2
c) Normal + 2
d) 10/mL
e) 15/mL
Ans: 2+ (1.2 x baseline)
Uptodate
ANZAAG refractory anaphylaxis
a) Glucagon IV 10min
b) Glucagon IV 5 min
c) Glucagon IM 5 min
d) Glucagon IM 10 min
Other remembered “refractory anaphylaxis in someone on beta blocker”
a) Glucagon 1-2mg every 5 minutes until response
b) Once
c) Every 10 minutes
Ans: Glucagon 1-2mg every 5 minutes
- Fem-fem VA ECMO, where is best representative of coronary PaO2?
- Right radial
- Either radial
- Left radial
- Pre-oxygenator
- Post oxygenator
Right radial
- Post op cognitive decline has an onset within:
- Immediate post
- Within one day, lasting one week
- From ?3 weeks ?10 days post op for a year
From 1 month to 1 year
“Postop neurocognitive disorder” within 1 year of surgery
“Delayed neurocognitive recovery” if present within 30 days of surgery
Delirium = 24-72 hours post op
” changes in cognition earlier than 7 days after surgery cannot be accurately tested and attributed to POCD”
“POCD can be detectable FROM 7 days after surgery”
- Pre-eclampsia at 30 weeks with IUGR
- Low CO, low SVR
- Low CO, high SVR
- High CO, low SVR
High CO, high SVR
Low CO, high SVR
- Burns - expected physiological changes within the first 24 hours
- High cardiac index
- Increased PVR
- Decreased SVR
- High stroke volume
First 48 hours depressed myocardium, hypovolaemia (hypovolaemic shock)
- Increased Hct
- Increased PVR and SVR
- Decreased stroke volume
- Decreased cardiac index
- Decrease venous saturation
- Tachycardia
After 48 hours hypermetabolic state
- Decreased SVR, subclinical myocardial dysfunction
Ans: increased PVR
- 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
Immunodeficiency
- When reconstituted, fibrinogen concentrate should be transfused within:
- 30 min
- 4h
?
Stable for 6 hours after reconstitution if kept between 20-25 degrees
^^ Australian PI is different to American PI. Australian PI states 6 hours.
- 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
LAA
Left atrial appendage
- Most likely site for clot formation in AF Blocks off the LAA so no clot can form there
- Aortic mechanical On-X valve has an inguinal hernia repair in 48 hours and INR is 1.5, what should you do?
- Bridge with enoxaparin
- Bridge with heparin
- Cease warfarin
Cease aspirin
On-X valve is mechanical bileaflet valve with approval for low INR target 1.5-2.0/
The transthoracic echo demonstrates:
Tricuspid regurgitation
- TTE echo parasternal long axis which chamber?
- RV
RA
- RV
Non-inferiority trial (repeat, line crossed 0 and non-inferior line)
- APRV ventilation
- Spont breathing
- Restrictive lung disease
- Short bursts of high pressure to aid recruitment
Long expiratory for clearance of CO2
- Best TOE view for detecting myocardial ischaemia
- Mid-oesophageal 4-chamber
- Long axis
- 2 chamber
Transgastric 2 chamber
transgastric mid-papillary short-axis view
- CXR with 3 lead pacemaker arrow pointing to:
- LV
- RV
Coronary sinus
- Avulsed tooth, what fluid to place it in
- Chlorhexidine
- Saline
- Balanced salt solution
- Fresh bovine milk
Water
Milk
- Pregnant MS lady, cat 1 CS within 30 minutes, what method
- Spinal
- CSE
- Epidural
- GA
Methylpred then GA
GA
^top end article (if this means mitral stenosis)
- Cat 2 CSE intrathecal morphine in spinal and slowly titrated epidural
- Cat 1 then GA
If this means multiple sclerosis then just do a spinal if there is time
Avoid hyperthermia
- Classic LMA cuff recommended maximum pressure
- 30
- 40
- 50
60
60 cmH2O for both classic LMA as well as a Supreme
- Narrow complex tachycardia ECG in young person post op PACU SBP 90 what treatment
- Modified valsalva
- Adenosine
Modified Valsalva
- Prilocaine Bier’s block, which condition it shouldn’t be used in
- G6PD
Porphyria
- G6PD
G6PD deficiency - risk of methaemoglobinemia
- Anaphylactic to MMR vaccine. What is contraindicated?
- Gelofusine
Sulphonamides
- Gelofusine
Gelofusine and gelatin is associated with anaphylaxis to MMR
65yo M presented with confusion and hypoxia. CXR left chest whiteout and tracheal deviation
- Left pleural effusion
- Left pneumonia
- Unilateral pulmonary oedema
Pneumonectomy
Left pleural effusion
- Post heart transplant recipient, expected sensitivity to:
- Adenosine
- Ephedrine - less effect
- Atropine
Glycopyrrolate
Adenosine - use 1.5 mg or 3 mg
- What nerve does not innervate the breast/for breast surgery?
- Long thoracic
- Anterior intercostal
- Posterior intercostal
Supraclavicular
Long thoracic
- Post prem baby, having surgery. The minimum time before considered for day surgery is.
- Postmenstrual age 54 weeks
- 60 weeks
54 weeks postmenstrual
- Fontan woman, pregnant, what drug to avoid in labour?
- Ergometrine
N2O
- Ergometrine
Ergometrine or carboprost - both increase PVRs
If giving oxytocin - give it slowly
- Dental surgery to bottom molar (38) with weird chin sensation post op. Which nerve damaged?
- Lingual
- Mental
- Inferior alveolar
Infratrochlear
Inferior alveolar nerve
- Child with status epilepticus, weight 20kg which is NOT a recommended treatment?
- Midaz IM 3mg
- Intranasal 6mg
- Intraosseous 3mg
- Buccal 6mg
IV 1.5mg
Nasal is 0.3mg/kg
Buccal 0.3mg/kg
IV 0.15mg/kg
IO 0.15mg/kg
- Highest rate of mortality is BMI in category of:
- <18.5
- 18.5-24.9
- 25-29.9
- 30-34.9
35-39.9
Mortality higher in <18.5
Above BMI 40 is almost the same as <18.5, then BMI 50-60 is higher than in 18.5 group.
- Major burns patient, pharmacologic effects in relation to non-depolarising NMBDs
Dose expected higher because of up-regulation of acetylcholine receptors
- Class 2 obesity has an ASA score of:
- 1
- 2
- 3
4
Class 1 30-35
Class 2 35-40
Class 3 40+
ASA II for class II (and class I)
ASA III for class III
- Obese patient, giving a dose of propofol for INDUCTION, what weight do you use?
- LBW
- IBW
- ABW
TBW
LBW
- NMBD - lean (non-depol) - Sux - total body weight - Prop induction - lean - Prop infusion - adjusted body weight - Reversal - adjusted body weight - Local anaesthetic - lean body weight - All Abx TBW except gentamicin which is LBW
(SOBA)
- Myasthenia gravis patients and NMBD:
- Sensitive to non-depolarizing, resistant to depolarising…
Variants of above
- Sensitive to non-depolarizing, resistant to depolarising…
Sensitive to non-depol (use a 1/10 - 1/5 dose)
Resistant to suxamethonium (2.5 times dose)
- Magnesium 20mmol given intraop is NOT associated with
- Reduced pain scores in PACU
- Reduced PONV
- Reduced MAC requirements
- Prolonged neuromuscular blockade
Respiratory depression postop
Statistically significant but small reduction in postop opioid requirements, no reduction in post op pain scores or PONV. (PS41)
APMSE 2020
- Severe hypokalaemia and cardiac arrest, ANZCOR recommends:
- 5mmol bolus IV
- 5mmol bolus IV over 5 mins
- 5mmol bolus IV over 10 mins
- 10mmol bolus IV over 5 mins
10mmol bolus IV over 10 mins
5mmol bolus IV
- Child and laparotomy, 23kg, what fluid will you give for maintenance?
- 45ml/hr of 0.45% N/S and dextrose
- 65ml/hr of 0.9% saline and dextrose
65ml/hr other solutions
45ml/hr 0.9% N/S + dextrose
(2/3 maintenance for any patient that is sick)
- Child with uncorrected TOF, having a tet spell, what will not work?
- Prostaglandin
- Sedation
- Fluid bolus
Vasopressor
TOF:
- VSD
- Overriding aorta
- Pulmonary artery stenosis/atresia
- RV hypertrophy
Hypercyanotic spells (health.wa.gov.au)
Ans: prostaglandin
- Someone is on moclobemide, what drug is most likely to cause serotonin syndrome?
- Pethidine
- Tapentadol
- Methadone
Fentanyl
Pethidine –> precipitates serotonergic crisis.
Tramadol also bad news
- Young man collapsed, ECG depicting brugada, what is the recommendation:
- ICD
Flecainide
- ICD
ICD only therapy
- Parkinsons patient on apomorphine infusion, what drug to given for nausea?
- Cyclizine
- Ondansetron
- Droperidol
- Metoclopramide
Prochlorperazine
Cyclizine
Metoclopramide, droperidol are contraindicated in PD due to dopaminergic effects, also prochlorperazine.
- Refractory epilepsy and vagal stimulator, what is most likely to cause it to inadvertently fire?
- Hypertension
- Tachycardia
- Bradycardia
- Hypotension
- Hypothermia
Hyperthermia
For patients who have seizures and experience ‘ictal tachycardia’
It follows then that it might inadvertently fire when the patient is tachycardic for another reason?
Difficult to find a resource…
Uptodate “responsive” devices provide stimulation to increases in heart rate.
- What is the most consistent factor for increased PONV rate in children?
- Female sex
- Age 3 or older
- Use of short acting opioids
Nitrous oxide
Age >3
Uptodate:
- Preop:
○ Age >/= 3
○ History of PONV/POV
○ Hx motion sickness
○ FHx PONV/POV
○ Post puberty females
- Intraop:
○ Surgery:
§ Strabismus, adenotonsillectomy, otoplasty, surgery >30 min
○ Volatile anaesthetics
- Postop:
Long acting opioids
- Which muscle does not elevate the larynx?
- Sternohyoid
- Thyrohyoid
- Myelohyoid
Geniohyoid
Sternothyroid –> depresses the larynx
Sternohyoid, omohyoid –> indirect depressor
Thyrohyoid –> elevates the larynx
Myelohyoid, stylehyoid, geniohyoid –> indirect elevators of the larynx
- What is not a good indicator for neonate being ready for extubation?
- Grimace
- RR>16
Conjugate gaze
RR>16
Criteria for awake extubation:
- Conjugate gaze
- Facial grimace
- Eye opening
- Purposeful movement
- TV>5ml/kg
Deep extubation:
- No cough /confirm deep anaesthesia (cuff deflation)
- Adequate TV
Normal ventilatory pattern
- What nerve is not related to the trigeminal?
- Auriculotemporal
- Supratrochlear
- Infratrochlear
- Greater auricular
- Lingual
Infraorbital
Greater auricular
- Right homonomous hemianopia and right hemisensory loss - affected region
- Left posterior cerebral
- Left anterior cerebral
- Superior cerebellar
Left anterior inferior cerebellar
Symptoms of posterior cerebral artery stroke include contralateral homonymous hemianopia (due to occipital infarction), hemisensory loss (due to thalamic infarction) and hemi-body pain (usually burning in nature and due to thalamic infarction) 3. If bilateral, often there is reduced visual-motor coordination 3. It is generally considered that sensory loss and hemianopia unilaterally without paralysis, is diagnostic of PCA territory stroke 4.
- What is not a features of TURP syndrome?
- Hyperglycinaemia
- Hyponatraemia
- Hypervolaemia
- Hypokalaemia
- Hypoglycaemia
Hypoosmolar?
Hypokalaemia
- Equation for pulse pressure variation
100 x (ppmax-Ppmin)/Ppmean
- Oxygen pulse in CPET is surrogate for
- Stroke volume
- Anaerobic threshold
SV
- What increases DLCO?
- Pulmonary haemorrhage
- Pulmonary hypertension
COPD
Pulmonary haemorrhage
- What is an acceptable reason to defer #NOF?
- K+ 2.7
- HR 110, atrial fibrillation
- Hb 86
Na 126
K 2.7
Reasons to defer
* Haemoglobin < 80 g.l−1
* Plasma sodium concentration < 120 or > 150 mmol.l−1 and potassium concentration < 2.8 or > 6.0 mmol−1
* Uncontrolled diabetes
* Uncontrolled or acute onset left ventricular failure.
* Correctable cardiac arrhythmia with a ventricular rate > 120.min−1
* Chest infection with sepsis
Reversible coagulopathy
- Image of ROTEM, EXTEM “in this bleeding patient” what to give (shows hyperfibrinolysis)
- Plt
- Fibrinogen
TXA
Wine glass shape –> hyperfibrinolysis, give TXA
- V5 lead position for an ECG?
- Mid clavicular line 5th IC space
- Mid clavicular line 4th IC space
- Anterior axillary line 5th IC space
Anterior axillary line 4th IC space
Anterior axillary line 5th IC space
- What is the most sensitive predictor of 30 day mortality and MACE?
- DASI score 55
- AT<11
- proBNP >300
6MWT<…
I suspect the answer is a ProBNP > 300. a DASI of 55 is a good thing. Anaerobic threshold < 11 mL/kg/min was not as predictive. Hard to know what the distance was given of the 6MWT, generally cutoff of 370 m or less is bad, however it was also not as sensitive
This question is referencing the METS trial
- VO2 max and DASI questionnaire relationship, score of 40 on DASI equals what?
- 20L/min or ml/kg/min
- 30
- 40
- 50
Other: DASI 48 = 48 VO2 max?
Assuming a score of 48 on DASI (if misremembered) = (0.43 * 48) + 9.6 = 30.24 Ml/kg/min
To simplify it you can make it 40/2 + 10 = 30
If divide that by 3.5 you get METS -> 8.5 METS
- Drug that will not raise pulmonary vascular resistance at low doses?
- Dopamine
- Vasopressin
- Noradrenaline
- Milrinone
- Dobutamine
OR Which is most likely to cause pulmonary hypertension?
- Dopamine
- Dobutamine
- Vasopressin
- Milrinone
Prostacycline
Bit unclear this one.
I reckon that milrinone is probably the answer
But dobutamine also decreases PVR as well
Agree we think milrinone probably correct??
- Vasopressin also attenuates pulmonary hypertension
Uptodate:
Pulmonary vasoconstriction –> phenylephrine, adrenaline,
Milrinone and dobutamine inodilators. Milrinone also reduces PVR.
- Sepsis guidelines, which measure is NOT recommended to assess fluid status?
- Urine output
- Passive leg raise response
- PPV
- Response to fluid bolus
Echocardiogram
- For adults with sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation, over physical examination or static parameters alone
Weak recommendation, very low-quality evidence
Remarks
Dynamic parameters include response to a passive leg raise or a fluid bolus, using stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), or echocardiography, where available.
- Newborn at 1 minute, sats 75%, grimacing, pulse 120, RR 40, what do you do?
- Observe
- CPAP
- Intubate
CPR
Observe
- Patient has arrested day 10 post cardiac surgery, what do you NOT do:
- Give adrenaline 1mg
- Give amiodarone
- 3 sequential shocks
- Atropine 3mg
1L fluid bolus
Give adrenaline
CALS protocol 10 days is the cutoff
Borderline question…
- Diagnosis for TRALI not based on:
- Hypoxaemia
- Onset within 6 hours of transfusion
- PCWP high (??or low based on which remembered answer)
- Bilateral infiltrates on CXR
Raised BNP
CLINICAL FEATURES
* dyspnoea
* hypoxia
* fever
* hypotension or hypertension
DIAGNOSIS
* acute onset ALI(within 6 hours of a transfusion)
* hypoxia (PaO2/FiO2 <= 300mmHg regardless of PEEP or SpO2)
* bilateral pulmonary infiltrates
not cardiogenic in origin (PAWP < 18mmHg)
Diagnosis of HITS based on 4Ts score, which are:
- Thrombocytopaenia
- Timing of plt drop
- History of thrombus
- Other cause thrombocytopaenia
Plt serotonin release assay
MDCalc: –> diagnostic probability score 4 Ts
- Thrombocytopaenia - Timing of platelet count fall - Thrombosis or other sequelae - Other causes for thrombocytopaenia
Plt serotonin release assay –> diagnostic of HIT
IABP trace, green arrow pointing to unassisted diastolic pressure
To confirm ETT, need ETCO2 more than how much from baseline?
As per Chrimes paper
7.5mmHg
Third heart sound due to:
- health person less than 40y
- HTN
- Mitral prolapse
Talley and O’Connor:
- 3rd heart sound sounds like “Kentucky’
- Diastolic sound heard best with the bell
- Normal to hear in states of states of increased cardiac output
○ Pregnancy, thyrotoxicosis, some children
Otherwise from poorly compliant ventricle
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
- Cease clopidogrel for 5 days
- Cease clopidogrel for 10 days
- Continue both
Cease clopidogrel for 7 days and aspirin for 20 days
Flow chart from AHA 2024
Cease for 5-7 days
Painless visual loss, with preserved pupilliary reflex
- AION
- PION
- Vertebrobasilar (?stroke)
- Corneal abrasion
Cerebral infarct
Cerebral infarct
Won’t be preserved reflex in AION or PION
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
COPD
What is the half life of a 100u/kg heparin dose?
- 30mins
- 1 hour
- 2 hours
- 3 hours
- 4 hours
- 30 min after 25 IU/kg
- 60 min after 100 IU/kg
150 min after 400 IU/kg
- 60 min after 100 IU/kg
What does not innervate the knee?
- Posterior cutaneous
- Obturator nerve
- Peroneal nerve
- Tibial nerve
Other options from other remembered document: - Common peroneal - Tibial - Saphenous - Obturator Posterior cutaneous nerve of the thigh
Cutaneous:
- Saphenous = anteromedial (from femoral nerve)
- Common peroneal = lateral
- Posterior femoral cutaneous nerve = posterior
Osseous:
- Obturator - medial femoral condyle
- Sciatic - posterior and lateral side of femoral condyle
- Common peroneal - top of fibula + fibular side of tibia
- Femoral - patella, anterior knee, some of tibia
Muscular:
- Quads and sartorius = femoral
- Hamstrings = sciatic
- Dorsiflexors = common peroneal
- Plantarflexors = tibial
Answer is unclear.
What DOESN’T the sciatic nerve do?
- Foot plantar flexion
- Toe extension
- Knee flexion
- Knee extension
knee extension
What nerve is not potentially damaged by insertion of supraglottic airway?
- Facial
- Trigeminal
- Glossopharyngeal
- Vagus
- Lingual
Facial
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
Stage 2 – descent of baby through the birth canal
* Somatic pain starts – more well localised, carried by A delta fibres
* Vagina, rectum, perineum
* Pudendal nerve and perineal branches of posterior cutaneous nerve -> S2-S4
* Ilioinguinal and genitofemoral nerves -> L1-L2
Inferior gluteal
Dental extraction, now numbness over lower chin, which nerve has been damaged?
- Inferior alveolar
- Mental
- Infraorbital
Depends where the lesion is, if molar tooth then damage to inferior alveolar. If front tooth then possibly mental nerve.
Cryoprecipitate does NOT contain
- Factor IX
- Factor XIII
- Fibronectin
- Von Willebrand Factor
Factor IX
Tibial fracture, Posterior tibial nerve injury, which compartment
- Superficial posterior
- Deep posterior
- Anterior
Other remembered: what compartment? Pain, toe flexion, plantar sensory loss.
- Deep posterior
- Superficial posterior
- Anteral
- Lateral
Medial
Deep posterior
Hyalase increases the following:
- Speed of muscle akinesis
- Chemosis
- Rate of allergic reactions
Speed of muscle akinesis
Use of methylene blue rather than patent blue
- Reduced rate of anaphylaxis
- More expensive
- Easier to see sentinel nodes
- Reduced O2 saturations
Fourth most common cause of anaphylaxis in NAP6
The use of methylene blue in the UK has largely been superseded by Patent Blue because of concerns about the adequacy of lymphatic uptake and fat necrosis at the injection site.
- Methylene blue is less expensive - Methylene blue has a lower rate of anaphylaxis Easier to see sentinel nodes with patent blue
Best method to reduce post ERCP pancreatitis?
- Rectal indomethacin
Uptodate:
Rectal diclofenac or indomethacin
Epipen dose compared to normal 1:1000 IM adrenaline dose in adult anaphylaxis?
- Same
- Reduced
- Increased
Anapen 500mcg in 0.3mL
Epipen 300mcg in 0.3mL
How to clean laryngoscope handle?
PG28 Infection control
- Handle clean with soap and water (non-critical)
Critical - penetrates mucosa (blade)
Semi-critical - contact with intact mucous membranes
What additive prolongs block best?
- Clonidine
- Dexamethasone
- Bicarbonate
- Adrenaline
Dexamethasone
What is not acceptable for ARDS?
- Recruitment manoeuvres
- Proning
- High PEEP
- Neuromuscular blockade
- Keep dry
We think recruitment manoeuvres is the answer
- Improve PaO2 transiently but in long term found to be harmful
The recommended skin preparation for a neuraxial:
- 0.5% chlorhex/ 70% alcohol.
Expected blood volume in preggers lady
- 60 ml/kg
- 70 ml/kg
- 80 ml/kg
- 90 ml/kg
- 100 ml/kg
100ml/kg
What is the 4th pacemaker letter meaning
- chamber sensed
- Chamber paced
- Rate modulation
- Multi chamber pacing
Rate modulation
Time for reversal of therapeutic dabigatran after administration of Idarucizumab 5 g is
- 5mins
- 15mins
30mins
5 mins (maximum)
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
- Trapezius - Rhomboid - Deltoid Erector spinae
Rhomboid
“TRE”- trap, rhomboid, erector spinae
Max dose topicalisation airway in mg/kg
- 7
- 9
- 11
9mg/kg
BD morphine, bowel obstruction, showing signs of withdrawal. What is this?
- opioid dependence
- Physical dependence
- Tolerance
- Opioid use disorder
Physical dependence
NAP 5 - cardiac anaesthesia awareness
- 1/8000
- 1/700
1/8000 (answer)
GA LSCS = 1/670
Overall GA = 1/19,000
GA no muscle relaxant = 1/130,000
NAP7 - most common cause perioperative arrest
- Major haemorrhage
- Anaphylaxis
- Airway issues
major haemorrhage (17%)
bradyarrhythmia 9%
cardiac ischaemia 7%
DDAVP not used for:
- nocturnal enuresis
- Haemophillia B
- Von Wil disease 2A
- Uraemic bleeding
- Central diabetes insipidus
Haemophilia B
Noradrenaline has tissued into skin from peripheral cannula, most appropriate first step is:
- remove cannula
- Flush with saline
- Heparin?
- Hyalase?
- Cold compress
- Subcut phentolamine
- Stop infusion
- Do not remove IV line
- Elevate limb if possible, do not apply pressure
- Do not flush the line
- Attempt aspiration of remaining drug from IV line with small syringe
- Do not use ice/cold compress (causes further vasoconstriction)
See below reference, phentolamine and hyaluronidase mentioned.
We are going with phentolamine as answer.
What is not associated with POTS?
- COVID-19
- Hypermobility disorder
- Normal resting LV function
- ECG changes
ECG changes
Pregnancy highest risk
- bicuspid valve with dilated aortic root
WHO Class IV
Aortic dissection, which is NOT a bad sign
- RWMA
- Right dilated ventricle
- Dilated aortic root
AR
Right dilated ventricle
PFT in dude, detect nitric oxide >70ppm number ppm. Meaning
- Smoker
- COPD
Exacerbation of asthma
Fractional exhaled nitric oxide - helps to diagnose asthma
Measures amount of nitric oxide exhaled from a breath
Produced by cells involved in inflammatory process
Cutoff point for test is approximately 40
Answer: Exacerbation of asthma
- Compared to a continuous infusion, PCEA does NOT reduce
- Incidence instrumental delivery
- Incidence of C-section rates
- Clinical workload
Motor weakness
- Incidence of C-section rates
Blue book article Harriet Wood
- 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
- ECG changes
- RWMA/diastolic dysfunction
- Angina
Hypotension
- RWMA/diastolic dysfunction
Diastolic dysfunction comes first, then RWMA
Return to practice
4 weeks for every year
“the total duration of a formal return to practice program will be determined by the learning needs analysis. The starting point for calculating the total duration is one month per year of absence from anaesthesia practice.”
CPET Borg’s scale, what is it for?
Subjective effort
Rating of perceived exertion
12 on Borg scale corresponds to 60%
‘Very hard’ = 16 = 80% VO2 max
Scale is from 6-20
ANZCOR recommendations on minimum time from cardiac arrest to post arrest prognostication?
- 24 hours
- 48 hours
72 hours
72 hours
CT within 48 hours also mentioned by anzcor
Spinal, 3ml, patient supine and horizontal, hyperbaric qualities vs normal bupivacaine
- Lesser block height, shorted duration of action
- Lesser block height, longer DOA
- Greater block height, shorter DOA
- Greater block height, longer DOA
No difference in block height, longer DOA
Greater block height, shorter duration
Epilepsy surgery, some sort brain monitoring and which drugs affect it the least
- Remifentanil
- Ketamine
Sevoflurane
Remifentanil
Giving indocyanine green
- Increased O2 cerebral, decreased peripheral
Variations on above
- Increases NIRS but decreased peripheral sats
Accuracy of pulse ox, which does NOT affect
- Anaemia
- AF
- Carboxyhaemoglobin
Poor peripheral perfusion
- Anaemia
MetHb - brings sats towards 85%
CarboxyHb - falsely high reading
Best post-op analgesia after wisdom tooth removal
- Ibuprofen
- Celexocib
- Tramadol
Paracetamol
- Ibuprofen
However APMSE scientific evidence says similar efficacy between non-selective NSAIDs and celexocib
What is NOT a feature of thyroid storm?
- Jaundice
- Bronchospasm
Seizures
Bronchospasm
Expected physiological change in hyperthyroidism
Reduced SVR
Hyperdynamic circulation
Somatic pain in the second stage of labour is NOT transmitted via the
- Pudendal
- Ilioinguinal
- Genitofemoral
- Inferior gluteal
Posterior cutaneous nerve of the thigh
Inferior gluteal
Which drug NOT to give with cocaine toxicity?
- Phentolamine
- Metoprolol
- GTN
Propofol bolus
- Metoprolol
Giving B blockade may lead to reduced myocardial contractility and HR in the setting of unopposed alpha effects (peripheral vasoconstriction etc.) –> failure
SGLT-2i use for diabetes, what do they NOT cause?
- Glycosuria
- Reduced eGFR
- Euglycaemic ketosis
Hypoglycaemia
- Hypoglycaemia?
- Can cause hypoglycaemia if used in combination with insulin or sulfonylurea
- As monotherapy do not cause hypoglycaemia
However they definitely DON’T reduce eGFR as they are used to prevent progression of chronic kidney disease? RACGP - Sodium glucose cotransporter 2 inhibitors for chronic kidney disease
Buprenorphine patch stopped, when will plasma levels drop by 50%
- 12 hours
- 24 hours
- 48 hours
72 hours
24 hours
Autonomic dysreflexia is more likely seen in spinal lesions at the level of:
- T5 incomplete injury
- T5 complete injury
- T10 incomplete injury
T10 complete injury
T5 complete injury
5 kPa is approximately equivalent to
- 37 mmHg
45 mmHg
37 mmHg
Baby swallows battery, what to give
Sucralfate (or honey)
Risk of AFE is highest in:
- Caesarean
- Induction of labour
Labour augmented by oxytocin infusion
Age>35, multiple pregnancy, induction of labour all associated
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 CXR
Left needle decompression 2nd IC space
Compared with open mechanical aortic valve repair, TAVI has:
- Reduced mean gradient
- Reduced vascular injury
- Reduced arrhythmia
Reduced paravalvular leaks
Reduced arrhythmia
The number of segments in the left lower lobe of the lung is:
3, 4, 2
4
Current ANZCA recommendations for a child 7 months old fasting prior to surgery are:
- Clear fluids one hour, breast milk 3 hours
Clear fluids two hours, breast milk 3 hours
Clear fluids 1 hour, breast milk 3 hours
In relation to ECHO, TAPSE refers to:
- Right ventricular contraction
Tricuspid valve something
- Tricuspid annular plane systolic excursion
Used to estimate RV ejection fraction
- EPO given perioperatively
No increase in risk of thrombosis
- No increased thrombosis risk
- Reduces perioperative blood transfusion
No change in AKI, mortality, reoperation
