ANKI Decks Part 1 Flashcards
A 54-year-old woman had a laryngeal mask airway inserted during anesthesia. The next day she reports hoarseness. On indirect laryngoscopy the right vocal cord is in a paramedian position and is lower than the left vocal cord. The most likely site of the nerve injury is the right:
a) lingual
b) hypoglossal
c) glossopharyngeal
d) recurrent laryngeal
e) superior laryngeal
d) recurrent laryngeal
Vocal cord innervation:
- RLX innervates most muscles of the larynx
- Posterior cricoaretynoid is the abductor
— When paralysed, doesn’t abduct = ‘palsy’ - Lateral cricoaretynoid and interaretynoid muscles are adductors
- Thyroaretynoid and cricothyroid are tensors
A patient on an IV heparin infusion develops platelet antibodies and a decreasing platelet count which agent should you use for bypass:
A. Bivalirudin
B. Heparin
C. Fondaparinux
D. Danaparoid
E. Clexane
A. Bivalirudin
Bivalirudin
Heparin/protamine contraindication for CPB!
- Bivalirudin is first choice
- Comes in 250 mg powder vials; dilute 1 vial in 50 mg saline.
- Bolus dose is 1-1.5 mg/kg (0.3 mL/kg) plus 50 mg into the pump prime then an infusion at 2.5 mg/kg/hr (0.5 mL/kg/hr).
- Doses should be reduced in renal failure.
- Check response with kaolin ACT >2.5 x baseline
- No antidote/reversal except dialysis
- Argatroban another option but you can’t monitor
Created by the Global Initiative for Chronic Obstructive Lung Disease, the alphabetical GOLD groups A to D are tools for the assessment of chronic obstructive pulmonary disease. These classes are based on:
A. Exertional dyspnoea
B. Exertional dyspnoea and FEV1
C. Exertional dyspnoea and number of exacerbations per year
D. Spirometry FEV1 only
E. Number of exacerbations per year only
C. Exertional dyspnoea and number of exacerbations per year
COPD diagnosis is a post-bronchodilator FEV1/FVC value of
<0.7
COPD severity
* GOLD classes 1-4 based on FEV1
GOLD 1 - mild: FEV1 ≥80% predicted
GOLD 2 - moderate: 50% ≤ FEV1 <80% predicted
GOLD 3 - severe: 30% ≤ FEV1 <50% predicted
GOLD 4 - very severe: FEV1 <30% predicted.
In long-term use of nonsteroidal anti-inflammatory drugs, the risk of thromboembolic complications is lowest with
a. Naproxen
b. Diclofenac
c. Aspirin
d. Ibuprofen
e. Celecoxib
a. Naproxen
Most common side effect after an iron transfusion?
A. Hypophosphataemia
B. Anaphylaxis
C. Skin discolouration
D. Iron overload
E. Renal impairment
A. Hypophosphataemia
Iron adverse reactions:
IV
Hypophosphataemia occurs from increased FGF23 levels
90% ferric carboxymaltose (Ferinject) infusions, severely reduced phosphate (<0.3 mmol/L) rare but accounts for almost all
TGA reported hypophosphataemia
40% iron sucrose infusions
0% for ferumoxytol or LMW iron dextran infusions Skin discolouration if cannula tissues in up to 1.7%
Oral GI upset common
Consequences of hypophosphataemia
- Acute = associated with significant fatigue, pain, nausea and aesthenia
- Chronic = associated with osteomalacia and fractures
Tumour lysis syndrome causes all of the following biochemical abnormalities EXCEPT:
a) Hyperkalaemia
b) Hypernatraemia
c) Hyperphosphataemia
d) Hyperuricaemia
e) Hypocalcaemia
b) Hypernatraemia
You are anaesthetising a 6-month old infant for repair of a VSD. You perform an inhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant’s oxygen saturations fall to 85%. The most appropriate next step in management.
a) give fluid bolus
b) change from sevoflurane to isoflurane
c) apply CPAP
d) reduce the FiO2
e) reduce sevoflurane
e) reduce sevoflurane
reduce sevoflurane thereby Improving the SVR –> reverses shunt
100kg patient paralysed with rocuronium. What is the dose of sugammadex to reverse paralysis with PTC of 2 and TOFC 0:
A. 150 mg
B. 200 mg
C. 400 mg
D. 800mg
E. 1600 mg
C. 400 mg
2yo child, 12kg for orchidopexy. You perform a caudal and use 0.2% ropivocaine. How much do you give to provide post-op analgesia?
a) 3ml
b) 6ml
c) 12ml
d) 18ml
e) 24ml
c) 12ml
12 mL
Typical dose is 1 mL/kg 0.2% ropivacaine with 1 mcg/kg clonidine
This leaves 0.5 mL/kg 0.2% ropivacaine for infiltration
3 yr old child with fractured forearm, best way to valid pain assessment
a) the reported severity from the child
b) the reported severity from the parent
c) the reported severity from the nursing staff
d) using the FLACC scale
e) the Wong-Baker Faces scale
d) using the FLACC scale
4 year old having a GA for bone marrow biopsy in a suspected case of ALL which antiemetic to avoid
A. Droperiodol
B. Ondansetron
C. Dexamethasone
D. Metaclopramide
E. Cyclazine
C. Dexamethasone
Contraindicated due to possibility of tumor lysis syndrome
A 15 year old male with known prolonged QT. You are called to PACU where he is noted to be in VT. GCS 15 and chest pain is noted. What is your management?
A. Magnesium
B. Synchronized shock
C. Amiodarone
D. Adenosine
E. Metoprolol
A. Magnesium
A 30-year-old woman has had a free flap operation of eight hours duration. She received an intraoperative remifentanil infusion and was given 10 mg morphine 30 minutes before the end of the operation. In recovery her pain score has increased from 6/10 on arrival in recovery to 9/10 in spite of a further 10 mg of intravenous morphine. The most likely diagnosis is
A. Tolerance
B. Apparent tolerance
C. Opioid induced hyperalgesia
D. Dependence
E. Flap congestion or ischaemia
C. Opioid induced hyperalgesia
A 24 year old G1P0 had a maternal arrest. Which of the following supports the diagnosis of an amniotic fluid embolism?
a) Decreased complement levels
b) Significantly increased tryptase
c) Thrombocytosis
d) Hyperfibrinogenaemia
e) Raised CRP
a) Decreased complement levels
A 34 year old primigravida collapses soon after delivery of her baby, how would you support a diagnosis of AFE?
A markedly raised serum tryptase
B decreased C3-C4 levels
C clinical diagnosis of exclusion
D raised CRP
E hyperfibrinogenemia
C clinical diagnosis of exclusion
A 36-year-old man complains of left calf pain for two weeks. His pain is worse on walking but not completely relieved by sitting or lying down. On examination, he has mild weakness of left big toe extension. The most likely finding on MRI would be
A. Cauda equina syndrome
B. L4/L5 disc herniation
C. L5/S1 disc herniation
D. Peroneal nerve injury
C. L5/S1 disc herniation
- This is a very common presentation of acute L5 radiculopathy
A 45-year-old woman is being assessed for liver transplantation. In order to determine the severity of her liver disease the Model for End-stage Liver Disease score is derived using the international normalised ratio, serum bilirubin and
A. Albumin
B. Potassium
C. ALT
D. AST
E. Creatinine
E. Creatinine
MELD (Model for End-stage Liver Disease)
Creatinine
Dialysis (Y/N)
Bilirubin
INR
Sodium
- Used to predict 3-month mortality and refer for liver transplant
- Maximum score = 40 (71% mortality at 3 months)
- Hepatology review and/or transplant referral indicated if MELD = 10 (6% mortality at 3 months)
A 54-year-old woman has a laryngeal mask airway inserted for a surgical procedure. The following day she complains of tongue numbness and abnormal taste over the posterior third of the tongue. The most likely site of the nerve injury is the:
A. Glossopharyngeal nerve
B. Vagus nerve
C. Mandibular nerve
D. Lingual nerve
E. Facial nerve
Glossopharyngeal nerve
A 60-year-old woman presents for thrombectomy with left lower leg ischaemia. She has not received any medications since presentation, and takes none at home. The sole abnormality on laboratory testing is an activated partial thromboplastin time (APTT) of 52 seconds. The most likely cause of the raised APTT is
A. Anti-Phospholipid Syndrome
B. Factor 8 deficiency
C. Factor 9 deficiency
D. Factor 13 deficiency
E. vWF disease
A. Anti-Phospholipid Syndrome
- The patient is clotting
APTT is raised in all of the above but they cause bleeding
A 66 year old male patient has undergone a VAT-assisted upper lobectomy. He becomes dyspneic at PACU. You perform a lung ultrasound and obtain “B-lines”. What is the most likely cause of his dyspnea?
A. Hemothorax
B. Pulmonary edema
C. Pneumonia
D. Pneumothorax
B. Pulmonary edema
Absence of B lines and absence lung sliding on a “POCUS” assessment would most typically pertains to:
A. Normal elderly lung
B. Pulmonary edema
C. Pneumonia
D. Pneumothorax
D. Pneumothorax
Which of the following represents the MOST important hemodynamic goal in a patient with a severe valvular aortic stenosis?
(A) Heart rate over 100 beats/min
(B) Decreased preload
(C) Decreased contractility
(D) Maintenance of afterload
(D) Maintenance of afterload
Category 1 <15 min LSCS in a primip with multiple sclerosis. How do you provide anaesthesia?
A. Remove epidural and give spinal anaesthesia with heavy bupivacaine and fentanyl
B. Top up epidural with 20 mL ligocaine 1% and adrenaline
C. Top up epidural
D. RSI and GA
E. Continuous Spinal Epidural
C. Top up epidural
Elimination of remifentanil occurs following breakdown mainly by
A. Plama esterases
B. RBC esterases
C. Hoffman degradation
D. Hepatic metabolism
RBC esterases
Findings associated with a massive pericardial tamponade include all of the following EXCEPT
A. Hypotension
B. Jugular venous distension
C. Muffled heart sounds
D. Electrical alternans
E. Bradycardia
E. Bradycardia
Idarucizumab reverses the anticoagulant effect of:
A. Dabigatran
B. Clopidogrel
C. Apixaban
D. Warfarin
A. Dabigatran
- Idarucizumab reverses dabigatran
- Andexanet alfa reverses rivaroxaban and apixaban
In a pre-eclamptic patient, which of the following does not result from magnesium?
A. Decreased risk of seizures
B. Decreased hyperreflexia
C. Decreased risk of cardiac failure
D. Decreased blood pressure
C. Decreased risk of cardiac failure
In an infant, the intercristal line corresponds to:
a. L1-2
b. L2-3
c. L3-4
d. L4-5
e. L5-S1
e. L5-S1
Which of the following branches of the lumbar plexus does not belong to the posterior group of division?
A. Ilioinguinal N.
B. Obturator N.
C. Genitofemoral N.
D. Lateral Femoral Cutaneous N.
D. Lateral Femoral Cutaneous N.
In planning the induction of anesthesia in a morbidly obese patient, the total body weight should be used to calculate the dose of:
A. Suxamethonium
B. Rocuronium
C. Propofol
D. Fentanyl
E. Alfentanil
A. Suxamethonium
In shock the lactate is elevated due to which mechanism?
a. Cori cycle
b. Gluconeogenesis
c. Glycolysis
d. Krebs cycle
e. Oxidative phosphorylation
c. Glycolysis
A 22 year old male sustained a complete spinal cord injury at T1 four weeks ago. Which of the following is least consistent with acute hyperreflexia?
A. Profound hypotension
B. AF
C. Lightheadedness
D. Piloerection below T1
A. Profound hypotension
Typically, Acute Autonomic Dysreflexia presents with hypertension.
