Equipment Flashcards
22.2 Which is least likely to cause inaccuracies in pulse oximetry
a) Anaemia
b) Vasoconstriction
c) AF
d) Methaemoglobin
e) Carboxyhaemoglobin
a) Anaemia
No effect
- Fetal haemoglobin (HbF)
- SulphHb
- Bilirubin (absorption peaks are 460, 560 and 600 nm)
- dark skin
Falsely low reading
1. Methaemoglobin (MetHb). The presence of MetHb will prevent the oximeter from working accurately and the readings will tend towards 85%, regardless of the true saturation.
2. Methylene blue. When methylene blue is used in surgery (e.g. parathyroidectomy or to treat methaemoglobinaemia), a short-lived reduction in saturation estimations is seen. Readings may fall by 65% at a concentration of 2-5 mg/kg for between 10 and 60 minutes.
3. Indocyanine green. Use of this dye (e.g. in cardiac output studies) may cause a transient reduction in recorded saturations.
4. A reduction in peripheral pulsatile blood flow produced by peripheral vasoconstriction results in an inadequate signal for analysis.
5. Venous congestion, which may be caused by tricuspid regurgitation, high airway pressures and the Valsalva manoeuvre, may produce venous pulsations which can produce low readings.
6. Venous congestion of the limb may affect readings, as can a badly positioned probe.
7. External fluorescent light in the operating theatre may cause the oximeter to be inaccurate, and the signal may be interrupted by surgical diathermy. Shivering may cause difficulties in picking up an adequate signal.
8. Nail varnish may cause falsely low readings.
Falsely high reading
1. Carboxyhaemoglobin (CoHb). CoHb (haemoglobin combined with carbon monoxide) is registered as 90% oxygenated haemoglobin and 10% desaturated haemoglobin - therefore the oximeter will overestimate the saturation.
Calibration
- Oximeters are calibrated during manufacture and automatically check their internal circuits when they are turned on.
- They are accurate in the range of oxygen saturations of 70% to 100% (+/-2%), but are less accurate under 70%. Below the saturation of 70%, readings are extrapolated.
- The data for calibration came from human volunteer studies, hence it was unethical to allow the saturations to fall below 70%. Due to the shape of the oxyhaemoglobin curve, the saturation starts to fall rapidly at 90%.
Limitations
- The oximeter averages its readings every 10-20 seconds. Hence, they cannot detect acute desaturation. The finger probe has a response time of approximately 60 seconds, whereas the ear probe has a response time of 10-15 seconds.
- The site of application should be checked at regular intervals, as pressure sores and burns have been reported.
- The pulse oximeter only provides information about oxygenation. It does not give any indication of the patient’s carbon dioxide elimination.
N22.2 The piece of airway equipment shown is a
a. bullard laryngoscope
b. CMAC video stylet
c. lightwand
d. flexible bougie
CMAC video stylet
see image for alternative equipment images
21.1 The equipment shown in the picture is a (airway device shown)
a) Arndt bronchial blocker
b) Cohen bronchial
blocker
c) Microlaryngoscopy tube
d) Hunsaker tube
e) Parker flex ETT
Hunsaker Mon-jet ventilation tube for microlarnygeal surgery
Description:
-Laser-safe
-fluoroplastic
-self-centring catheter
Uses:
-subglottic ventilation during microlaryngeal surgery
Components:
- proximal end for attaching to jet insufflation system
-proximal end allows passage of stylet to aid insertion
-Side port at proximal end for monitopring airway pressure and ETCO2
-Outer diameter 4.3mm for maintaining good surgical access
-Green basket to keep the centre port at its tip away from tracheal mucosa and avoiding potential damage from jet ventilation
21.1 A respiratory effect of high flow nasal oxygen therapy is
A. Reduced RR
B. Reduced MV
C. Increased work of breathing
A. Reduced RR
BJA HFNOT
It has been demonstrated that patients with acute hypoxaemic respiratory failure experience improved comfort and tolerance with HFNOT compared with humidified oxygen via a facemask, and traditional non-invasive ventilation masks. Subjective feelings of dyspnoea AND RESPRIATORY RATES are REDUCED as is airway dryness.
23.1 In order to minimise the risk of cardiac arrhythmia, surgical diathermy has been designed to operate with
A. High frequency
B. High amplitude
C. Low frequency
D. Low amplitude
E. Using EES
A. High frequency
22.2 Based on this ECG tracing, the mode in which this pacemaker is operating is
a) VAI with intermittent failure to capture
b) AAI with intermittent failure to sense
c) DDD
d) VVI with intermittent failure to capture
e) VVI with intermittent failure to sense
e) VVI with intermittent failure to sense
21.1 You are performing a regional block for analgesia following knee surgery. You have an ultrasound probe scanning the anterior mid-thigh. The muscle indicated by the arrow in the ultrasound image below is the
A: Sartorius
B: Vastus Medialis
C: Adductor Longus
D: Gracilis
E: Rectus femoris
A: Sartorius
20.2 You are performing a regional block for analgesia following knee surgery. You have an ultrasound probe scanning the anterior mid-thigh. The muscle indicated by the arrow in the ultrasound image below is the
A. biceps femoris
B. Sartorius
C. Gracillis
D. Adductor longus
E. Adductor magnus
Sartorius
repeat
22.2 The Pin Index System positions on a C size cylinder of medical oxygen are
a) 1,5
b) 2,5
c) 3,5
d) 1,6
e) these options are made up
b) 2,5
Air: 1, 5
Oxygen: 2, 5
N2O: 3,5
CO2: 2, 6
He: 2, 4
Cyclopropane 3, 6
Entonox 7
21.1 The advantage of the Mapleson E circuit in paediatric anaesthesia is due to its
A. Can use low gas flows
B. Feel compliance
C. Assess tidal volume
D. Can rapidly change levels of CPAP
E. Low resistance
low resistance
MAPLESON E
- Derived from the Ayre T-piece used in Mapleson D circuit and functions on the same principle as Mapleson D
- The primary difference is in the length of the tubing that is increased to be greater than the patient’s tidal volume
- For spontaneous ventilation, the expiratory limb is open to the atmosphere
- It has no valves so there is no resistance to airflow nor points for possible mechanical failure
- Rebreathing is dependent on the fresh gas flow, patients minute volume and capacity of the expiratory limb
- Its main use is in paediatric patients
20.1 This type of tracheal tube is best described as a (picture of airway device shown)
a) Mini tracheostomy tube
b) South facing RAE
c) Laser tube
d) Laryngectomy tube
e) Fenestrated tracheostomy tube
laryngectomy tube
Rusch Larygoflex Reinforced Laryngectomy tube -
22.2 A patient is anaesthetised from the awake state to a state of surgical anaesthesia with propofol or a volatile anaesthetic. As the depth of anaesthesia increases, the patient’s electroencephalogram (EEG) will show oscillations that are of
a. low frequency low amplitude
b. low frequency high amplitude
c. high frequency low amplitude
d. high frequency high amplitude
b. low frequency high amplitude
Changes in the electroencephalogram during anaesthesia and their physiological basis
https://academic.oup.com/bja/article/115/suppl_1/i27/234261
Figure 1 shows raw EEG waveforms during isoflurane anaesthesia.
During light anaesthesia:
-amplitude is shallow and frequency is high.
When a higher concentration is administered:
-amplitude deepens and EEG frequency slows.
During deep anaesthesia:
- a ‘burst and suppression’ pattern becomes apparent, characterized by extreme activity, represented by high-frequency, large-amplitude waves (bursts), alternating with flat traces (suppression).
- This pattern, excluding brain ischaemia or other factors, indicates that anaesthesia is too deep. Beyond this, flat traces become dominant and, eventually waveforms are no longer apparent.
During isoflurane, sevoflurane or propofol anaesthesia, this sequence of changes in pattern is almost identical.
The major difference in EEG between the volatile agents (isoflurane or sevoflurane) and propofol is apparent in power in the theta range.
During propofol anaesthesia, theta power remains low regardless of concentration, but during isoflurane or sevoflurane anaesthesia, it increases at surgical concentrations of anaesthesia.
22.1 A drug which does NOT increase the defibrillation threshold in a patient with an implanted cardioverter defibrillator is
a. Amiodarone
b. Atropine
c. B-blocker
d. Flecainide
e. Sotalol
e. Sotalol
Drugs that INCREASE defibrillation threshold:
+ Amiodarone (Chronic)
+ Atropine
+ lignocaine
+ Diltiazem
+ Flecainide
+ Verapamil
+ Venlafaxine
+ Anaesthetic agents.
Drugs that DECREASE defibrillation threshold:
- Sotalol
- Amiodarone (acute)
- Nifekalant
Drugs with No Change in DFT
= B- blocker
= Disopyramide
= Procainamide
= Propafenone
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304797/
23.1 During standard diagnostic nocturnal polysomnography for investigation of obstructive sleep apnoea, apnoea is defined as cessation of airflow for
A. 10 sec
B. 20 sec
C. 30 sec
D. 10 sec with 3% desat
E. 20 sec with 3 % desat
A
Apnea is defined as the cessation of airflow for ten or more seconds.
Hypopnea is defined as a recognizable, transient reduction, but not a complete cessation of, breathing for ten or more seconds.
Hypopnea requires a 4% fall in SpO2
https://www.ncbi.nlm.nih.gov/books/NBK441909/#:~:text=Obstructive%20Sleep%20Apnea%20(OSA)%2C,for%20ten%20or%20more%20seconds.
22.1 When using an endotracheal tube in an adult, the highest recommended cuff pressure to avoid mucosal ischaemia is
a. 10cmH2O
b. 20
c. 30
d. 40
e. 50
c. 30cmH2O
22.2 According to ANZCA PS54(A), an anaesthetic machine requiring electrical power must, in the event of mains power failure, be able to operate under battery backup power for a minimum of
a) 30 min
b) 60 min
c) 120 min
d) 240 min
a) 30 min
If the anaesthesia machine requires electrical power for normal operation, a backup power supply must be a part of the machine and permit normal operation for at least 30 minutes after a mains power supply failure. An alarm must be activated at the time of the mains failure and the state of the reserve power supply must be indicated while it is in use.
https://www.anzca.edu.au/getattachment/f05e02ec-2023-4c50-b57f-9549ea0c4183/PS54(A)-Position-statement-on-the-minimum-safety-requirements-for-anaesthesia-machines-and-workstations-for-clinical-practice-2021#page=
23.1 A level two check of the inhalational anaesthesia delivery device does NOT include checking the
A. Accurate delivery of volatile concentration from vaporiser
B. Connection of vaporiser and seating
C. Secure vaporiser cap
D. Adequate filling of vaporizers
E. Power to vaporiser
a) Accurate delivery of volatile concentration from vaporiser
PS31
Level two check should be performed at the start of each anaesthetic list.
4.2.3.2 Inhalational anaesthesia delivery devices (vapouriser)
4.2.3.2.1 Ensure electricity is connected to vapourisers that require it.
4.2.3.2.2 Check the anaesthetic liquid level is within marked limits.
4.2.3.2.3 Ensure all filling ports are sealed.
4.2.3.2.4 Check correct seating, locking and interlocking of detachable vapourisers or casettes.
4.2.3.2.5 Test for circuit leaks with a cassette installed or for each vapouriser in the “on” and “off” state.
4.2.3.3 Check for machine leaks upstream from the common gas outlet or breathing system, using a protocol appropriate for the anaesthesia delivery system.
20.1 Best resolution US probe for median nerve visualisation:
d) 5-10mHz
e) 6-13mHz
High frequency probe at 90 degrees to the skin
- to best visualise superficial structures have the probe at 90 degrees to the skin with a high frequency transducer
it is best to use high-frequency transducers (up to 10–15 MHz range) to image superficial structures (such as for stellate ganglion blocks) and low-frequency transducers (typically 2–5 MHz) for imaging the lumbar neuraxial structures that are deep in most adults.
22.1 A patient is anaesthetised from the awake state to a state of surgical anaesthesia with propofol or a volatile anaesthetic. As the depth of anaesthesia increases, the patient’s electroencephalogram (EEG) will show oscillations that are of
Dominant EEG frequency decreases, and amplitude increases with increasing concentrations of anaesthetic. End result is burst suppression
https://academic.oup.com/bja/article/115/suppl_ 1/i27/234261
Figure 1 shows raw EEG waveforms during isoflurane anaesthesia.
During light anaesthesia:
-amplitude is shallow and frequency is high.
When a higher concentration is administered:
-amplitude deepens and EEG frequency slows.
During deep anaesthesia:
- a ‘burst and suppression’ pattern becomes apparent, characterized by extreme activity, represented by high-frequency, large-amplitude waves (bursts), alternating with flat traces (suppression).
- This pattern, excluding brain ischaemia or other factors, indicates that anaesthesia is too deep. Beyond this, flat traces become dominant and, eventually waveforms are no longer apparent.
During isoflurane, sevoflurane or propofol anaesthesia, this sequence of changes in pattern is almost identical.
The major difference in EEG between the volatile agents (isoflurane or sevoflurane) and propofol is apparent in power in the theta range.
During propofol anaesthesia, theta power remains low regardless of concentration, but during isoflurane or sevoflurane anaesthesia, it increases at surgical concentrations of anaesthesia.
20.1 The radial artery pressure trace shown below is from a patient who has an intra-aortic balloon pump in situ. The device has been switched to 1:2 augmentation to assess the timing. The trace shows an augmented beat followed by an un-augmented beat. With respect to the augmentation, the trace shows
a. Correct timing
b. Early inflation
c. Late inflation
d. Early deflation
e. Late deflation
Bonus question
b. Early inflation
Waveform features:
> Diastolic augmentation (peak B) encroaches on the peak corresponding to unassisted systole (peak A) – the two peaks have merged and are barely distinguishable.
> There is no ‘sharp V’ or dicrotic notch between peaks A and B.
Early IAB inflation may result in:
> Premature closure of the aortic valve and possible aortic regurgitation, thus impairing left ventricular emptying. There may be an increase in LVEDV, LVEDP and PCWP.
> Increased left ventricular wall stress (afterload) and increased myocardial oxygen consumption will occur.
how to correct:
Delay the onset of IAB inflation, so that it inflates at the dicrotic notch resulting in a ‘sharp V’ (see the normal pressure waveform).
22.2 A 45-year-old man is ventilated in the intensive care unit and is in a critical state. His pulmonary artery wedge pressure is 26 mmHg, cardiac index is 1.7 L/minute/m2 and his PaO2/FiO2 ratio is 200 mmHg. A decision is made to place him on extracorporeal membrane oxygenation. The most appropriate mode is
a) VV ECMO
b) VA ECMO
c) Atrio-aorto ECMO
d) Ventriculo-atrial ECMO
b) VA ECMO
PaO2/FiO2 ratio
Mild: 200-300 = mortality 27%
Moderate = 100-200 mortality 32%
Severe < 100 = Mortality 45%
Cardiac Index
Normal: 2.5-4.2l/min
PAWP:
Normal 4-12mmHg
CI is low, PaO2/FiO2 ratio is mild, PAWP is high
22.1 An anaesthetised patient is ventilated and has standard monitoring plus a central venous line. As surgery commences, the line isolation monitor alarms, indicating a potential leakage current of greater than 5 mA from one of the power circuits in use. The most appropriate action is to
a) Ignore it
b) Disconnect non-essential
equipment one by one to identify fault
Line isolation monitor alarms when single fault in system. If the alarm is going off, the last piece of equipment plugged in is usually suspect and should be unplugged.
22.2 1 MAC of sevoflurane affects the sensory evoked potential signal for spinal surgery by
a) increased latency, increased conduction speed, increased amplitude
b) increased latency, decreased conduction speed, decreased amplitude
c) decrease latency, increased conduction speed, decreased amplitude
d) increased latency, increased conduction speed, decreased aptitude
Increased latency, decreased conduction speed, decreased amplitude
21.1 Of the following, the device that delivers the greatest flow when using ‘Level 1® Fast Flow Fluid Warmer’ rapid fluid infuser system is a (list of intravascular catheters)
a. 6.5 Fr sheath
b. 8.5 Fr Multilumen line
c. 8.5 Fr Swan Ganz Sheath
d. Multilumen something 14G cannula (50mm?)
e. Peripheral RICC line, 8.5 Fr
e. Peripheral RICC line, 8.5 Fr
23.1 Rotational thromboelastometry (ROTEM) is performed on a bleeding patient with the
following series of graphs produced. The most appropriate therapy to be
administered is
a. TXA
b. Fibrinogen
c. Cryo
d. FFP
a) TXA
Hyperfibrinolysis
https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter%201.2.0.1/intepretation-abnormal-rotem-data
22.1 The train-of-four (TOF) ratio above which the majority of anaesthetists will NOT be able to visually detect fade on TOF stimulation is
a. 0.2
b. 0.4
c. 0.6
d. 0.7
e. 0.9
b. 0.4
BJA: Monitoring of neuromuscular block
https://academic.oup.com/bjaed/article/6/1/7/347026
When neuromuscular monitoring is used, visual or tactile evaluation of the degree of neuromuscular block is unreliable.
Even experienced anaesthetists are unable to detect fade when the TOF ratio is >0.4.
It is now thought that significant residual curarization is still present if the TOF ratio is <0.97 (not 0.7 as previously suggested8).
21.1, 20.1 The drug which has the LEAST impact on somatosensory evoked potentials (SSEPs) monitored in a 15-year-old patient undergoing scoliosis surgery is
A) propofol
B) fentanyl
C) desflurane
D) Midazolam
E) sevoflurane
B) fentanyl
Drugs which have the least impact on SSEPs
1. Ketamine
2. Opioids
3. Dexmedetomidine
Article in Anaesthesiology
https://pubs.asahq.org/anesthesiology/article/99/3/716/40407/Pharmacologic-and-Physiologic-Influences-Affecting
o SSEPs = small amplitude potentials measured over the sensory cortex or via epidural electrodes from stimuli applied to the posterior tibial nerves. SSEPs are transmitted via the posterior columns of the spinal cord in the territory of the posterior spinal arteries which supply the posterior 1/3 of the cord. As they are low amplitude they are affected by basal muscle tremor and the signal-to-noise ratio is improved by increasing the depth of muscle relaxation. Their use is not significantly affected by therapeutic concentrations of anaesthetic vapours
o MEPs = series of short-duration constant current stimuli of 300-700 V applied to the motor cortex and measured via needle electrodes inserted into tibialis anterior, abductor halluces and vastus medialis muscles along with selected small muscles of the hands for reference. MEPs rely on corticospinal tract integrity which lies in the territory of the anterior spinal artery. MEPs therefore complement SSEPs in their assessment of spinal cord function. MEPs are large amplitude potentials and are incompatible with profound muscle relaxation. Neuromuscular blocking agents are therefore best avoided or given by infusion and dose optomised with discussion with the technicians (or just give remi).
o All anaesthetic vapours reduce MEP amplitude in a dose-dependent manner, and more than 0.5 MAC are not compatible with reliable monitoring. Thus Propofol TIVA is preferred.
- Remifentanil is commonly used due to low context sensitive half life and negligible effect on intraop evoked responses
20.2 During the 21st century, the dominant ozone-depleting substance emitted as a result of medical usage to date has been
a) Desflurane
b) Nitrous oxide
c) CO2
d) Isoflurane
e) CFCs
Nitrous oxide
Halothane & isoflurane cause catalytic destruction of ozone, but halothane hardly used and isoflurane has short atmospheric lifetime.
Desflurane + sevoflurane don’t cause ozone depletion.
20.2 This lung ultrasound shows
a) Normal lungs
b) Pulmonary odema
c) Pneumothorax
d) Pleural effusion
e) Pneumonia
b) Pulmonary oedema
B-lines
> Vertical echogenic short path reverberation artefacts originating at the pleural line and extending to the deepest part of the ultrasound image.
They interrupt any horizontal A-lines.
Occasional B-lines are considered normal.
More than 3 B-lines in any single view is considered pathological.
Where there are numerous B-lines in close proximity they become confluent.
B-lines move with lung movement.
They are caused by ultrasound energy reverberating in a fluid filled focus that is surrounded by air. These foci may be interstitial or alveolar.
Cardiogenic and noncardiogenic oedema may have very similar appearances.
Interstitial thickening due to fibrosis or lymphangitis can also create the sonographic appearance of diffuse B-lines.
21.2 The power board on the back of the anaesthesia machine has caught fire during an elective case. This should be extinguished with
a) CO2
b) Fire blanket
c) Wet chemical powder
d) Foam
e) Water
a) CO2
21.2 The equipment shown in the picture below is a
a) Parker flex tip
b) Hunsaker
c) Laryngectomy tube
d) NIM tube
e) Reinforced tube
NIM tube: Neural Integrity Monitor Electromyogram Tracheal Tube
22.1 A patient with a haemopneumothorax has a chest drain in situ, which is attached to a three-bottle underwater seal drain apparatus. The system is attached to wall suction at -80 cmH20. This will cause
a) Failure of underwater seal
b) Water in suction chamber will enter drainage chamber
c) Reexpansion of haemopneumothorax
d) Oscillation in tube will diminish
e) Inability for stuff to drain into first bottle
Oscillations in the tube will be diminished
23.1 This Doppler trace obtained by transoesophageal echocardiography of the descending aorta suggests
a. AS
b. AR
b. AR
https://litfl.com/oesophageal-doppler/
20.2 The equipment shown in the picture is a(n) (picture of an airway device shown)
Arndt bronchial blocker
- use with SLT
- 9fr, loop around scope for positioning
- suction to deflate lung
20.2 This lung ultrasound shows
a) Normal lungs
b) Pulmonary odema
c) Pneumothorax
d) Pleural effusion
e) Pneumonia
a) Normal lungs
M-mode image demonstrating seashore sign seen with normal lung sliding.
The manufacturer guidelines suggest the smallest sized endotracheal tube that should be safely passed over an Aintree Intubation Catheter is (internal diameter) size
A. 4.0
B. 5.0
C. 6.0
D. 7.0
E. 8.0
Size 7.0
The Tube
The endotracheal tube has a length and diameter. The endotracheal tubes size (“give me a 6.0 tube”) refers to its internal diameter in millimeters (mm). The ETT will typically list both the inner diameter and outer diameter on the tube (for example, a 6.0 endotracheal tube will list both the internal diameter, ID 6.0, and outer diameter, OD 8.8).
20.1 The catheter type most likely to be associated with bloodstream sepsis per days insertion is:
a) Peripheral venous catheter
b) PICC
c) non-tunneled CVL
d) tunneled CVL
e) Peripheral arterial catheter
c) non-tunneled CVL
UTD:
In a systematic review that included 200 studies, the risk of catheter-related blood stream infection per 1000 catheter-days and varied by types of intravascular catheter were as follows [38]:
●Peripherally inserted central catheters (PICCs) – 1.1 (95% CI 0.9-1.3)
●Cuffed and tunneled central venous catheters – 1.6 (95% CI 1.5-1.7)
●Noncuffed central venous catheters
*Nonmedicated and tunneled – 1.7 (95% CI 1.2-2.3)
*Nonmedicated and nontunneled – 2.7 (95% CI 2.6-2.9)
However, there was no adjustment for severity of illness. Therefore, a particular type of catheter could be associated with an increased risk of infection if it was preferentially used in more severely ill or vulnerable patients.
Of the following, the agent that has the greatest capacity to absorb infrared radiation in the atmosphere is
a) CO2
b) desflurane
c) sevoflurane
d) nitrous
e) isoflurane
b) Desflurane
Atmospheric heat absorbed by a substance compared with CO2 is its GWP
GWP CO2 = 1
GWP N20 = 265 (atmospheric lifetime of 114yrs)
GWP sevo = 130 (atmospheric lifetime of 1.1yrs)
GWP desflurane = 2540 (atmospheric lifetime of 14yrs)
20.1 The maximum fraction of inspired oxygen that can be prescribed with a Venturi mask is
a) 30%
b) 40%
c) 50%
d) 60%
e) 70%
c) 60%
22.1 The fourth position of the international pacemaker (NBG) code represents the
A. Pacing
B. Programability
C. Sensing
D. Anti-dyrhythmic functions
E: Inhibition
B. Programability ? Multi-site pacing?
21.1 The function of the bottle labelled ‘D’ in the diagram below is to protect against the consequences of
(diagram of chest drain bottles)
a. Suction failure
b. Excess positive pressure
c. Drain kinking
d. Excess negative pressure
bottle A = fluid trap or collection bottle, can be independently emptied and allows accurate record of drainage amount
- first tube connecting drain to drainage bottles must be wide to decreased resistance
- volume capacity of this tube should exceed ½ of patient’s maximum inspiratory volume (otherwise H2O may enter chest)
bottle B = underwater seal drain, maintained at a predetermined level whilst still allowing for drainage of pleural fluid (if bubbling continuously -> bronchopleural fistula)
- volume of H2O in bottle B should exceed ½ patient’s maximum inspiratory volume to prevent indrawing of air during inspiration
bottle C = manometer or pressure-regulating bottle allows suction to be attached and should bubble continuously
- The maximum negative pressure (in cm H2O) generated by suction equals to the distance (in cm) the vent tube is below the water line (this can be adjusted)
-The negative pressure generated by the vent tube is independent of the amount of pleural drainage that is collected in the trap bottle
- If suction is turned off then tubing must be unplugged -> so air can escape into atmosphere
20.1 You are using ultrasound with colour flow Doppler to scan a patient’s neck prior to placing an internal jugular line. In the short axis view of the carotid artery, the colour Doppler image will be
A. Red because blood is going away from the probe
B. Blue because blood is going away from the probe
C. Blue when the blood is coming to the probe, red when the blood is going away from the probe
D. Red when the blood is coming toward the probe, blue when the blood is going away from the probe
E. The colour depends on the angle you hold the probe at
E. The colour depends on the angle you hold the probe at
Radiopaedia article: change of wording may change the answer to the question
22.2 A patient under general anaesthesia monitored with transcranial cerebral oximetry has a decrease in their cerebral oxygen saturation. This is likely to be improved by an increase in all of the following EXCEPT
A. Increasing blood pressure
B. Deepening anaesthesia
C. Increased minute ventilation
D. Transfusion
C. Increased minute ventilation
Cerebral blood flow
Cardiac output
Acid–base status
Major haemorrhage
Arterial inflow/venous outflow obstruction
Oxygen content
Haemoglobin concentration
Haemoglobin saturation
Pulmonary function
Inspired oxygen concentration
Inspired oxygen concentration
20.2, 23.2 Complications of hyperbaric oxygen therapy do NOT include
a) Myopia
b) Central retinal occlusion
c) Seizures
d) Hypoglycaemia
e) Bradycardia
b) Central retinal occlusion
SE’s from HBOT:
- progressive myopia (reversible)
- seizures
- hypoglycaemia
- sinus bradycardia from stimulation of vagal activity bassociated with hyperbaric pressures
The needle tip pictured is called a
a Sprotte
b Whittacre
c Quincke
d Trocar
e Tuohy
c Quincke
Needles for spinal anesthesia or lumbar puncture can be classified according to the needle tip.
Cutting-tip, or Quincke, needles have sharp, cutting tips, with the hole at the end of the needle.
Whitacre and Sprotte needles are two types of pencil point, or noncutting tip needles. They have a closed tip shaped like a pencil, with the hole on the side of the needle near the tip.
Pencil point needles are designed to minimize leak of cerebrospinal fluid after puncture and reduce the chance of postdural puncture headache.
20.1 The function of the bottle labelled D in the diagram is to protect against the consequences of
a. Loss of vacuum
b. Kinking ICC
c. Overflow of first bottle
d. High negative pressure
A
21.2 Complications of hyperbaric oxygen therapy include all of the following EXCEPT
a) Hypoglycaemia
b) Cataract
c) Worsening CCF
d) Seizures
e) Reversible hypermetropia
e) Reversible hypermetropia
20.1 Epidural filters are designed to retain particles down to a diameter of
A. 20 nanometers
B. 200 nanometers
C. 2 micrometers
D. 20 micrometers
E. 200micrometers
B. 200 nanometers (0.2 micrometres)
22.1 Maintaining a CO2 pneumoperitoneum at a pressure of 15 mmHg is most likely to lead to
a) Lactic acidosis
b) Decreased arterial blood pressure
c) Decreased heart rate
d) Increased CVP
e) Increased renal blood flow
f) Increased SVR
f) Increased SVR
20.1
a) Gas trapping
b) Patient triggering
c) COPD
d) Circuit leak
c) gas trapping
Specific features of increased airway resistance seen here are:
High peak airway pressure, but a normal plateau pressure
Slow return of the flow-time curve to baseline
The flow-time curve does not reach baseline (indicating that emptying is incomplete)
21.2 The advantage of the Mapleson E circuit in paediatric anaesthesia is due to its
a) Use with low FGF
b) Ability to assess compliance
c) Ability to assess tidal volume
d) Ability to rapidly change levels of CPAP
e) Low resistance
e) Low resistance
A bleeding patient has ROTEM results including (ROTEM results shown). The most
appropriate treatment is
a) Plts
b) FFP
c) Cryo
d) TXA
c) Cryo
Cryo or TXA,
TXA first line treatment however patient has low fibrinogen and requires fibrinogen replacement.
The needle whose tip is pictured is a
a) Sprotte
b) Quinke
c) Touhy
d) Whitacre
c) Touhy
The ventilator waveforms shown represent (actual image from exam)
a) Triggered breaths
b) Bronchospasm
c) Obstructive pattern
d) Gas trapping
C) Obstructive Pattern
https://thoracickey.com/ventilator-graphics/
Image 9.6
A patient under general anaesthesia monitored with transcranial cerebral oximetry has a decrease in their cerebral oxygen saturation. This is likely to be improved by an increase in all of the following EXCEPT
A. Increasing blood pressure
B. Deepening anaesthesia
C. Increased minute ventilation
D. Transfusion
C. Increased minute ventilation
Cerebral blood flow
Cardiac output
Acid–base status
Major haemorrhage
Arterial inflow/venous outflow obstruction
Oxygen content
Haemoglobin concentration
Haemoglobin saturation
Pulmonary function
Inspired oxygen concentration
Inspired oxygen concentration
In the three-bottle chest drainage system set up shown, the maximum suction pressure (cmH2O) generated inside the underwater seal bottle would be minus
Depth of tube in water in bottle 3
An adult patient is administered a target controlled propofol infusion for more than 30
minutes with a constant effect-site target of 4 mcg/ml propofol plasma concentration.
Compared to the Schnider model, the propofol dose given by the Eleveld model will be a
a) Smaller bolus lower infusion rate
b) Smaller bolus hihger infusion rate
c) Larger bolus lower infusion rate
d) Larger bolus highier infusion rate
e) Smaller bolus same infusion rate
c) Larger bolus lower infusion rate
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.13345
https://journals.lww.com/anesthesia-analgesia/fulltext/2014/06000/a_general_purpose_pharmacokinetic_model_for.12.aspx
