MCQ 24.2 Flashcards
Which of the following is the primary mechanism by which IV magnesium sulfate reduces the risk of eclampsia in pre-eclampsia?
a. Blocking calcium influx at the neuromuscular junction
b. Increasing renal perfusion
c. Inhibiting NMDA receptor activity in the CNS
d. Enhancing nitric oxide release from the endothelium
e. Reducing systemic vascular resistance
Correct Answer:
c. Inhibiting NMDA receptor activity in the CNS
Innervation of the Breast
Which of the following statements about breast innervation is correct?
a. The long thoracic nerve provides motor innervation to the pectoralis major muscle, which underlies the breast.
b. The lateral cutaneous branches of intercostal nerves provide the majority of sensory innervation to the breast.
c. The thoracodorsal nerve provides sensory innervation to the upper outer quadrant of the breast.
d. The supraclavicular nerve supplies the entire breast, including the nipple.
e. The medial cutaneous nerve of the arm contributes to sensory innervation of the nipple.
Correct Answer:
b. The lateral cutaneous branches of T4-T6 intercostal nerves provide the majority of sensory innervation to the breast.
Physiological Changes of Pregnancy
Which of the following best explains the increased susceptibility to hypoxemia in pregnant patients during apnea?
a. Increased tidal volume and respiratory rate
b. Decreased functional residual capacity and increased oxygen consumption
c. Decreased plasma oncotic pressure and increased airway edema
d. Increased cardiac output and decreased hemoglobin concentration
e. Decreased alveolar ventilation and increased dead space
Correct Answer:
b. Decreased functional residual capacity and increased oxygen consumption
Physiology of Hyperthyroidism
Which of the following hemodynamic findings is most characteristic of hyperthyroidism?
a. Increased systemic vascular resistance with normal cardiac output
b. Decreased systemic vascular resistance with increased cardiac output
c. Increased pulmonary artery pressure with decreased stroke volume
d. Increased preload with decreased ejection fraction
e. Decreased preload with normal ejection fraction
Correct Answer:
b. Decreased systemic vascular resistance with increased cardiac output
Mechanism of Action of Low Molecular Weight Heparin
What is the primary mechanism of action of low molecular weight heparin (LMWH)?
a. Inhibition of thrombin (Factor IIa) via direct binding
b. Activation of antithrombin to inhibit Factor Xa
c. Direct inhibition of Factor Xa
d. Inhibition of platelet aggregation via glycoprotein IIb/IIIa receptor blockade
e. Direct activation of the fibrinolytic pathway
Correct Answer:
b. Activation of antithrombin to inhibit Factor Xa
Actions of Hyaluronidase
Which of the following best describes the action of hyaluronidase in regional anesthesia?
a. Increases the lipid solubility of local anesthetics
b. Facilitates the spread of local anesthetics by breaking down interstitial hyaluronic acid
c. Enhances nerve blockade by inhibiting voltage-gated sodium channels
d. Prolongs the duration of nerve blockade by reducing local blood flow
e. Acts as a vasoconstrictor to decrease systemic absorption of local anesthetics
Correct Answer:
b. Facilitates the spread of local anesthetics by breaking down interstitial hyaluronic acid
Pacemaker Code
In a pacemaker with the code VVI, what does the second “V” represent?
a. The mode of pacing
b. The mode of sensing
c. The response to sensing
d. The location of the lead placement
e. The type of rhythm detected
Correct Answer:
b. The mode of sensing
Which of the following is most likely to cause interference with pulse oximetry readings?
a. Hypothermia
b. Carbon monoxide poisoning
c. Anemia with hemoglobin <7 g/dL
d. Hypoxemia with SpO2 <80%
e. Peripheral vasodilation
Correct Answer:
b. Carbon monoxide poisoning
Mechanism of Action of Low Molecular Weight Heparin
Which of the following is a characteristic of low molecular weight heparin (LMWH) compared to unfractionated heparin (UFH)?
a. Greater inhibition of thrombin (Factor IIa) than Factor Xa
b. Shorter half-life than unfractionated heparin
c. Does not require antithrombin for its action
d. Preferential inhibition of Factor Xa over thrombin
e. Reversible by protamine in a 1:1 ratio
Correct Answer:
d. Preferential inhibition of Factor Xa over thrombin
Actions of Hyaluronidase
Which of the following is a contraindication to the use of hyaluronidase in regional anesthesia?
a. Allergy to local anesthetics
b. Infection at the injection site
c. Concurrent use of vasopressors
d. History of hypertension
e. Use in pediatric patients
Correct Answer:
b. Infection at the injection site
Prognosis After Cardiac Arrest
Which of the following is most strongly associated with survival to hospital discharge after out-of-hospital cardiac arrest?
a. Administration of epinephrine within 5 minutes
b. Initial rhythm of ventricular fibrillation (VF)
c. Use of therapeutic hypothermia post-resuscitation
d. Age under 50 years
e. Normal serum lactate at admission
Correct Answer:
b. Initial rhythm of ventricular fibrillation (VF)
Pacemaker Code
In the pacemaker code DDD, what does the third “D” represent?
a. Dual sensing and pacing in the atrium and ventricle
b. The response to sensing is dual (inhibitory and triggered)
c. Dual lead placement in both atrium and ventricle
d. Default pacing mode in the absence of sensed activity
e. The type of rhythm detected
Correct Answer:
b. The response to sensing is dual (inhibitory and triggered)
Pulse Oximetry Interference
Which of the following conditions is least likely to interfere with pulse oximetry readings?
a. Methylene blue administration
b. Severe peripheral vasoconstriction
c. Elevated carboxyhemoglobin levels
d. Hyperbilirubinemia
e. Severe hypothermia
Correct Answer:
d. Hyperbilirubinemia
Trigeminal Neuralgia Effects
Which of the following is a typical feature of trigeminal neuralgia?
a. Constant dull pain
b. Pain triggered by light touch or chewing
c. Bilateral pain distribution
d. Pain primarily affecting the ophthalmic division
e. Onset after a viral infection
Correct Answer:
b. Pain triggered by light touch or chewing
What is the primary mechanism of heparin-induced thrombocytopenia (HIT)?
a. Direct platelet destruction by heparin
b. Activation of platelets by heparin-antibody complexes
c. Increased platelet clearance by the spleen
d. Inhibition of thrombin by heparin
e. Autoimmune destruction of megakaryocytes
Correct Answer:
b. Activation of platelets by heparin-antibody complexes
Which test is most commonly used to confirm a diagnosis of HIT?
a. Prothrombin time (PT)
b. Platelet function assay
c. Heparin-induced platelet aggregation assay
d. D-dimer levels
e. Anti-factor Xa activity
Correct Answer:
c. Heparin-induced platelet aggregation assay
Which echocardiographic view is most commonly used to assess myocardial ischaemia during surgery?
a. Apical four-chamber view
b. Mid-esophageal long-axis view
c. Transgastric short-axis view
d. Subcostal view
e. Suprasternal view
Correct Answer:
c. Transgastric short-axis view
What is the earliest echocardiographic sign of myocardial ischaemia?
a. Decreased ejection fraction
b. Hypokinesia of the affected wall
c. Appearance of new mitral regurgitation
d. Increased left atrial size
e. Global hypokinesia
Correct Answer:
b. Hypokinesia of the affected wall
What is the primary reason for using high fresh gas flows in paediatric anaesthesia with a Mapleson circuit?
a. To prevent rebreathing
b. To conserve heat and moisture
c. To reduce airway resistance
d. To avoid circuit disconnection
e. To ensure rapid emergence
Correct Answer:
a. To prevent rebreathing
Which Mapleson circuit is considered the most efficient for spontaneous ventilation in children?
a. Mapleson A
b. Mapleson B
c. Mapleson C
d. Mapleson D
e. Mapleson F
Correct Answer:
e. Mapleson A
Which Mapleson circuit is most efficient for controlled ventilation?
a. Mapleson A
b. Mapleson B
c. Mapleson C
d. Mapleson D
e. Mapleson F
Correct Answer:
d. Mapleson D
The most efficient circuit for controlled ventilation because the FGF forces alveolar air away from the patient and towards the APL valve. It’s often used for manual ventilation while transporting patients
The sciatic nerve provides motor innervation to which of the following muscles?
a. Quadriceps femoris
b. Gluteus maximus
c. Biceps femoris
d. Tensor fasciae latae
e. Sartorius
Correct Answer:
c. Biceps femoris
Which of the following is a sensory function of the sciatic nerve?
a. Sensation over the medial thigh
b. Sensation over the lateral thigh
c. Sensation over the sole of the foot
d. Sensation over the posterior thigh
e. Sensation over the medial malleolus
c. Sensation over the sole of the foot
What is the primary mechanism of action of methylene blue in vasoplegia?
a. Inhibition of guanylate cyclase
b. Activation of nitric oxide synthase
c. Inhibition of angiotensin-converting enzyme
d. Direct vasoconstriction of arterioles
e. Enhancement of cyclic AMP
Correct Answer:
a. Inhibition of guanylate cyclase
Which of the following is a contraindication to methylene blue administration?
a. Hypertension
b. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
c. Renal failure
d. Pregnancy
e. Heart failure
Correct Answer:
b. Glucose-6-phosphate dehydrogenase (G6PD) deficiency
What is the immediate management for a child suspected of swallowing a lithium coin battery?
a. Wait for spontaneous passage
b. Administer activated charcoal
c. Obtain a chest X-ray to localize the battery
d. Induce vomiting
e. Perform an upper endoscopy immediately
Correct Answer:
c. Obtain a chest X-ray to localize the battery
Transfusion-Associated Graft-Versus-Host Disease
What is the most effective strategy to prevent TA-GVHD?
a. Leukocyte filtration of blood products
b. Use of fresh frozen plasma
c. Irradiation of blood products
d. Administration of prophylactic steroids
e. Plasma exchange
Correct Answer:
c. Irradiation of blood products
A 25-year-old patient presents with a regular narrow-complex tachycardia at 180 bpm. Vagal manoeuvres are attempted but fail to terminate the rhythm. The next step in management is:
a. Intravenous metoprolol 5 mg
b. Intravenous verapamil 5 mg over 2 minutes
c. Intravenous adenosine 6 mg rapid bolus
d. Immediate synchronized cardioversion
e. Intravenous amiodarone 150 mg over 10 minutes
Correct Answer: c. Intravenous adenosine 6 mg rapid bolus
A monitored patient states he has chest pain. The 3 lead ECG shows ventricular tachycardia (VT) and a blood pressure of 75/40 mmHg. The most appropriate immediate management is:
a. Intravenous lidocaine 1 mg/kg bolus
b. Intravenous amiodarone 300 mg over 1 hour
c. Synchronized cardioversion at 100 J
d. Unsynchronized defibrillation at 200 J
e. Magnesium sulfate 2 g IV over 10 minutes
Correct Answer: c. Synchronized cardioversion at 100 J
Explanation: The patient is hemodynamically unstable due to VT, and the immediate treatment of choice is synchronized cardioversion. Unsynchronized defibrillation is reserved for pulseless VT or ventricular fibrillation.
A patient undergoing surgery develops sudden hypotension, bronchospasm, and urticaria after antibiotic administration. Despite 3 doses of 50 mcg intravenous adrenaline and 1L Crystalloid, the blood pressure remains 70/40 mmHg. The next step in management is:
a. Administer intravenous hydrocortisone 200 mg
b. Start an adrenaline infusion
c. Administer intravenous glucagon 1 mg
d. Administer intravenous vasopressin 2 units
e. Administer intravenous noradrenaline 10 mcg bolus
Correct Answer: b. Start an adrenaline infusion
Explanation: Refractory hypotension in anaphylaxis requires continuous adrenaline infusion to maintain blood pressure and counteract vasodilation and capillary leakage.
Which of the following is a potential adjunctive treatment for refractory hypotension in anaphylaxis in a beta-blocked patient?
a. Noradrenaline
b. Methylene blue
c. Glucagon
d. Phenylephrine
e. Atropine
Correct Answer: c. Glucagon
Explanation: Glucagon can bypass beta-receptor blockade by directly increasing intracellular cyclic AMP, improving cardiac output in refractory hypotension.
Intra-Aortic Balloon Pump Pressure Trace
Question 1:
In an intra-aortic balloon pump (IABP) pressure waveform, which of the following is the expected effect of correct timing of balloon inflation?
a. Increased end diastolic pressure
b. Increased systolic blood pressure
c. Increased diastolic pressure after the dicrotic notch
d. Increased cardiac workload
e. Increased afterload
Correct Answer: c. Increased diastolic pressure after the dicrotic notch
Explanation: Correct inflation of the IABP balloon during diastole increases diastolic pressure, improving coronary perfusion.
What is the primary hemodynamic goal of an intra-aortic balloon pump?
a. Increase systemic vascular resistance
b. Decrease preload
c. Increase coronary blood flow and decrease afterload
d. Maintain mean arterial pressure
e. Prevent arrhythmias
Correct Answer: c. Increase coronary blood flow and decrease afterload
Explanation: IABP improves myocardial oxygen supply by increasing diastolic pressure and reduces oxygen demand by decreasing afterload.
What does the yellow colour coding on a laryngoscope handle indicate?
a. Standard battery-powered handle
b. Rechargeable battery handle
c. Pediatric handle
d. Disposable handle
e. Low-light intensity handle
Correct Answer: b. Rechargeable battery handle
Explanation: Yellow indicates a rechargeable handle according to standard colour coding.
What does the blue colour coding on a laryngoscope blade or handle signify?
a. Pediatric size blade
b. Disposable blade
c. Fiber-optic compatible blade
d. Standard non-rechargeable handle
e. LED illumination
Correct Answer: b. Disposable blade
Explanation: Blue colour coding is often used to indicate disposable blades or handles to prevent cross-contamination.
What is the primary purpose of the green-coded laryngoscope system?
a. Compatibility with pediatric blades
b. Identification of disposable handles
c. Light source in the handle
d. Light source in the blade
e. Identification of disposable blades
c. Light source in the handle
https://www.youtube.com/watch?v=isxV4pphogE&ab_channel=PROACTMedical
What is the primary purpose of the black-coded laryngoscope system?
a. Compatibility with pediatric blades
b. Identification of disposable handles
c. Light source in the handle
d. Light source in the blade
e. Identification of disposable blades
d. Light source in the blade
https://www.youtube.com/watch?v=isxV4pphogE&ab_channel=PROACTMedical
In a patient with restrictive lung disease, which of the following is typically reduced?
a. FEV1/FVC ratio
b. Total lung capacity
c. Residual volume
d. Diffusing capacity of the lungs for carbon monoxide (DLCO)
e. Airway resistance
Correct Answer: b. Total lung capacity
Explanation: Restrictive lung disease is characterized by a reduction in total lung capacity.
Question 1:
What is the approximate half-life of unfractionated heparin at therapeutic doses of 100 IU/kg?
a. 30 minutes
b. 60 minutes
c. 90 minutes
d. 120 minutes
e. 180 minutes
Correct Answer: b. 60 minutes
Explanation: The half-life of unfractionated heparin at therapeutic doses is approximately 60 minutes.
Withheld for 4-6 hours before surgery = 4-6 half lives
Blue Book 2023
Which factor most significantly prolongs the half-life of unfractionated heparin?
a. Renal dysfunction
b. Hepatic dysfunction
c. Hypothermia
d. Thrombocytopenia
e. Acidosis
Correct Answer: c. Hypothermia
Explanation: Hypothermia reduces metabolism and clearance of heparin, prolonging its half-life.
Which of the following pulmonary function test findings is most suggestive of restrictive lung disease?
a. Decreased forced expiratory volume in 1 second (FEV1) with normal FEV1/FVC ratio
b. Decreased forced vital capacity (FVC) with normal FEV1/FVC ratio
c. Increased FEV1 with a decreased FEV1/FVC ratio
d. Increased total lung capacity (TLC) with decreased FEV1/FVC ratio
e. Decreased TLC with increased FEV1/FVC ratio
Correct Answer: b. Decreased forced vital capacity (FVC) with normal FEV1/FVC ratio
Explanation: Restrictive lung diseases typically show a reduction in FVC with a preserved or increased FEV1/FVC ratio.
What is the primary reason for increased resistance to non-depolarising muscle relaxants in patients with extensive burns?
a. Decreased plasma protein binding
b. Increased plasma cholinesterase activity
c. Upregulation of acetylcholine receptors
d. Increased clearance due to renal dysfunction
e. Decreased hepatic metabolism
Correct Answer: c. Upregulation of acetylcholine receptors
Explanation: Burn injury leads to an upregulation of acetylcholine receptors, which increases the resistance to non-depolarising muscle relaxants, requiring higher doses.
A decreased DLCO with normal lung volumes and normal spirometry is most likely to indicate which of the following?
a. Pulmonary hypertension
b. Asthma
c. Chronic obstructive pulmonary disease (COPD)
d. Restrictive lung disease
e. Bronchiectasis
a. Pulmonary hypertension
Explanation: A decreased DLCO with normal lung volumes and spirometry is characteristic of pulmonary vascular diseases, such as pulmonary hypertension, where gas exchange is impaired despite normal lung mechanics.
Which of the following is the primary mechanism by which clonidine enhances the effects of local anaesthetics when used as an adjuvant?
a. Inhibition of nociceptive transmission in the spinal cord
b. Potentiation of the effect of local anaesthetics on sodium channels
c. Inhibition of the reuptake of serotonin in the dorsal horn
d. Decreased systemic absorption of local anaesthetics
e. Inhibition of the sympathetic nervous system at the site of injection
Correct Answer: a. Inhibition of nociceptive transmission in the spinal cord
Explanation: Clonidine, an alpha-2 adrenergic agonist, enhances local anaesthetic effects primarily by inhibiting nociceptive transmission in the spinal cord.
Which of the following is the most reliable parameter to assess the adequacy of oxygenation in a patient receiving extracorporeal membrane oxygenation (ECMO)?
a. Arterial oxygen saturation (SpO2)
b. Oxygen content (CaO2)
c. Mixed venous oxygen saturation (SvO2)
d. End-tidal CO2 (EtCO2)
e. Arterial pH
Correct Answer: c. Mixed venous oxygen saturation (SvO2)
Explanation: SvO2 reflects the balance between oxygen delivery and consumption, making it the most reliable parameter for assessing the adequacy of oxygenation during ECMO.
What did the METS study show regarding pre-operative assessment of function capacity?
a. Subjective assessment has poor specificity
b. Subjective assessment has poor sensitivity
c. DASI has poor specificity
d. DASI has poor sensitivity
e. Subjective assessment has both poor specificity and poor sensitivity
b. Subjective assessment has poor sensitivity
Subjective assessment had 19·2% sensitivity (95% CI 14·2–25) and 94·7% specificity (93·2–95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83–0·99; p=0·03).
DASI <34 increases risk of myocardial infarction and death within 30 days
Subjective assessment of Exercise capacity had poor sensitivity 19.2% (just cause patient says they can go up a flight of stairs does not mean they actually can)
94.7% specificity (if patient says they can’t it’s pretty reliable)
Patient subjective assessment of METS based on stair climbing does not reflect actual CPET numbers
Which of the following adjuvants is contraindicated in patients with a history of porphyria?
a. Sodium bicarbonate
b. Clonidine
c. Dexmedetomidine
d. Dexamethasone
e. Magnesium sulfate
Correct Answer: d. Dexamethasone
Explanation: Dexamethasone is avoided in porphyria as it can exacerbate the condition by inducing enzymes involved in heme synthesis.
In the perioperative setting, which of the following timing of serum tryptase measurement is most critical for diagnosing anaphylaxis?
a. Baseline level before surgery
b. As soon as possible after symptom onset
c. 30 minutes after symptom onset
d. 1–2 hours after symptom onset
e. 24 hours after symptom onset
b. As soon as possible after symptom onset
Which of the following is the most likely initial sign of anaphylaxis during general anaesthesia?
a. Cutaneous flushing
b. Bronchospasm
c. Hypotension
d. Tachycardia
e. Reduced end-tidal CO2
Correct Answer: e. Reduced end-tidal CO2
Explanation: Reduced end-tidal CO2 is often the first detectable sign due to decreased cardiac output secondary to hypotension and vasodilation, which may precede other symptoms in anaesthetized patients.
During veno-venous ECMO, persistent hypercapnia despite high sweep gas flow rates is most likely due to:
a. Inadequate venous drainage
b. Oxygenator failure
c. Hemolysis
d. Recirculation of blood within the circuit
e. Pump malfunction
Correct Answer: d. Recirculation of blood within the circuit
Explanation: Recirculation reduces the efficiency of gas exchange, leading to persistent hypercapnia.
In patients with obesity, which of the following is the strongest predictor of long-term mortality?
a. BMI >40
b. Obstructive sleep apnoea
c. Presence of metabolic syndrome
d. Elevated intra-abdominal pressure
e. Reduced physical activity
Correct Answer: c. Presence of metabolic syndrome
Explanation: Metabolic syndrome, a combination of hypertension, hyperglycemia, and dyslipidemia, is a stronger predictor of long-term mortality than BMI alone.
Which of the following mechanisms is primarily responsible for increased perioperative mortality in patients with a BMI >40?
a. Decreased functional residual capacity
b. Increased risk of thromboembolism
c. Reduced cardiac output
d. Altered pharmacokinetics of anaesthetic drugs
e. Impaired immune response
Correct Answer: b. Increased risk of thromboembolism
Explanation: Obesity is associated with a hypercoagulable state, leading to an increased risk of thromboembolism, a major contributor to perioperative mortality.
Which of the following is a key feature of airway pressure release ventilation (APRV)?
a. Mandatory tidal volume is pre-set
b. The patient must be deeply sedated for optimal function
c. Allows for spontaneous breathing during high-pressure phases
d. Requires inverse inspiratory-to-expiratory (I:E) ratios
e. Does not permit adjustment of pressure-release duration
Correct Answer: c. Allows for spontaneous breathing during high-pressure phases
In APRV, the primary advantage over conventional ventilation in acute respiratory distress syndrome (ARDS) is:
a. Reduced risk of barotrauma due to lower peak pressures
b. Enhanced carbon dioxide elimination through fixed tidal volumes
c. Improved oxygenation by recruiting collapsed alveoli
d. Avoidance of the need for neuromuscular blockade
e. Decreased need for high oxygen fraction (FiO₂)
Correct Answer: c. Improved oxygenation by recruiting collapsed alveoli
In patients with multiple sclerosis, perioperative temperature control is critical because:
a. Hyperthermia can exacerbate neurological symptoms
b. Hypothermia increases the risk of relapse
c. Temperature fluctuations impair spinal cord perfusion
d. Elevated temperature accelerates local anaesthetic metabolism
e. Hypothermia increases the risk of autonomic dysreflexia
Correct Answer: a. Hyperthermia can exacerbate neurological symptoms
During neonatal resuscitation, HR is <60bpm, how do you provide positive pressure ventilation?
a. 15 breaths per minute
b. 20 breaths per minute
c. 30 breaths per minute
d. 40 breaths per minute
e. 60 breaths per minute
c. 90 chest compressions to 30 breaths per minute
During neonatal resuscitation, HR is 60-100 which of the following is the correct initial positive pressure ventilation (PPV) rate?
a. 20-30 breaths per minute
b. 30-40 breaths per minute
c. 40-60 breaths per minute
d. 60-80 breaths per minute
e. 80-100 breaths per minute
Correct Answer: c. 40-60 breaths per minute
The most reliable indicator of effective neonatal resuscitation is:
a. Visible chest rise with ventilation
b. A heart rate above 100 bpm
c. Improved oxygen saturation within 30 seconds
d. Audible breath sounds bilaterally
e. A decrease in cyanosis
Correct Answer: b. A heart rate above 100 bpm
The most common complication associated with an interscalene brachial plexus block is:
a. Pneumothorax
b. Horner’s syndrome
c. Phrenic nerve palsy
d. Vascular injury
e. Neuropraxia of the ulnar nerve
Correct Answer: c. Phrenic nerve palsy
Which nerve is most likely to be spared during an interscalene block?
a. Axillary nerve
b. Median nerve
c. Ulnar nerve
d. Musculocutaneous nerve
e. Radial nerve
Correct Answer: c. Ulnar nerve
Which of the following is not a category in the FLACC score?
a. Facial expression
b. Leg movement
c. Crying
d. Heart rate
e. Consolability
Correct Answer: d. Heart rate
In a patient with a mechanical aortic valve undergoing non-emergency surgery, bridging anticoagulation with low molecular weight heparin is recommended when:
a. The INR is below 2.5 for more than 48 hours
b. The patient has a history of thromboembolism
c. The surgery carries a high bleeding risk
d. As soon as INR is below 2.5
e. As soon as INR is below 2.0
Correct Answer: b. The patient has a history of thromboembolism
https://www.jtcvs.org/article/S0022-5223(18)31859-2/fulltext
A gastric antral cross-sectional area greater than which value in the right lateral decubitus position indicates a high risk of aspiration?
a. 2.0 cm²
b. 4.0 cm²
c. 6.0 cm²
d. 8.0 cm²
e. 10.0 cm²
c. 6.0 cm²
Figure 4. Gastric volume (ml) as a function of the antral cross-sectional area (cm²) measured in the right lateral decubitus position and patient age
ASRA
A gastric ultrasound with clear fluid is considered to be a “full stomach” when volume exceeds which amount?
a. 1.0 ml/kg
b. 1.5 ml/kg
c. 2.0 ml/kg
d. 2.5ml/kg
c. 3.0ml/kg
b. 1.5 ml/kg
A 3-year-old with tetralogy of Fallot develops a “Tet” spell during induction of anaesthesia. Which of the following is the most appropriate initial management?
a. Administer intravenous furosemide
b. Squatting or knee-to-chest position
c. Administer intravenous propranolol
d. Perform rapid-sequence intubation
e. Start high-dose intravenous milrinone
Squatting or knee-to-chest position increases afterload and reduces right to left shunt
A 5-year-old in status epilepticus does not respond to two doses of midazolam. According to current guidelines, the next recommended medication is:
a. Intravenous sodium valproate
b. Intravenous phenobarbital
c. Intravenous phenytoin
d. Intravenous levetiracetam
e. Intravenous propofol
Answer: d. Intravenous levetiracetam
In a non-inferiority trial, the primary endpoint is defined as:
a. Proving the new treatment is superior to the standard treatment
b. Showing the new treatment is equivalent to the standard treatment
c. Demonstrating the new treatment is not unacceptably worse than the standard treatment
d. Establishing the safety of the new treatment
e. Comparing the cost-effectiveness of two treatments
Answer: c. Demonstrating the new treatment is not unacceptably worse than the standard treatment
Which of the following is critical in designing a non-inferiority trial?
a. Blinding of participants
b. Selection of an appropriate non-inferiority margin
c. Randomisation of participants
d. Use of an intention-to-treat analysis exclusively
e. Minimisation of type II error
Answer: b. Selection of an appropriate non-inferiority margin
The toxic dose of paracetamol in adults is generally considered to be:
a. 100 mg/kg
b. 150 mg/kg
c. 200 mg/kg
d. 250 mg/kg
e. 300 mg/kg
Answer: c.200mg/kg
Which of the following is the bolus dose for intravenous potassium in an arrested patient with severe hypokalaemia?
a. 5 mmol
b. 10 mmol
c. 20 mmol
d. 30 mmol
e. 40 mmol
A bolus of 5 mmol of potassium chloride is given intravenously.
ANZOCR
Compared to plain bupivacaine, hyperbaric bupivacaine in spinal anaesthesia for LSCS:
a. Provides a faster onset of sensory blockade
b. Less conversion to GA
c. Less nausea and vomiting
d. Is less likely to cause hypotension
e. Is associated with a shorter duration of action
a. Provides a faster onset of sensory blockade
Cochrane review 2016
Hyperbaric versus isobaric bupivacaine for spinal anaesthesia for caesarean section
In the management of paracetamol overdose, N-acetylcysteine is most effective when administered within:
a. 2 hours of ingestion
b. 4 hours of ingestion
c. 8 hours of ingestion
d. 12 hours of ingestion
e. 24 hours of ingestion
Answer: c. 8 hours of ingestion
During thyroid surgery, unilateral injury to the recurrent laryngeal nerve results in:
a. Aphonia
b. Stridor and airway obstruction
c. Hoarseness due to a paralyzed vocal cord in a paramedian position
d. Complete loss of sensation in the larynx above the vocal cords
e. Hyperadduction of the vocal cords
Answer: c. Hoarseness due to a paralyzed vocal cord in a paramedian position
The primary mechanism of analgesia in the erector spinae plane (ESP) block is:
a. Direct blockade of the dorsal rami of spinal nerves
b. Spread of local anaesthetic to the paravertebral space
c. Blockade of the sympathetic chain
d. Inhibition of the intercostal nerves at their origins
e. Direct infiltration of the spinal cord
Answer: b. Spread of local anaesthetic to the paravertebral space
Which of the following is a major limitation of the erector spinae plane block?
a. High risk of vascular puncture
b. Limited evidence for visceral analgesia
c. Difficulty in identifying the correct anatomical plane
d. Increased risk of pneumothorax
e. High failure rate due to inadequate drug spread
Answer: b. Limited evidence for visceral analgesia
In a case-control study, the odds ratio is best interpreted as:
a. The relative risk of an outcome in the exposed group compared to the unexposed group
b. The probability of an event occurring in the exposed group
c. The odds of exposure among cases compared to controls
d. The absolute difference in risk between two groups
e. The likelihood of a type I error in the study
Answer: c. The odds of exposure among cases compared to controls
An odds ratio greater than 1 in a study indicates:
a. A protective effect of the exposure
b. A higher likelihood of the outcome in the exposed group
c. No association between exposure and outcome
d. A statistically significant relationship between exposure and outcome
e. The outcome is equally likely in exposed and unexposed groups
Answer: b. A higher likelihood of the outcome in the exposed group
What is the odds ratio?
3
What is the risk ratio?
2
Which of the following is the most critical physiological change during pregnancy that poses a risk to a patient with Fontan circulation?
A. Increased systemic vascular resistance
B. Decreased pulmonary vascular resistance
C. Increased cardiac output
D. Decreased venous return
E. Hypercoagulable state
Correct Answer: C. Increased cardiac output
Which of the following is the most appropriate anesthetic management consideration for a pregnant patient with Fontan circulation undergoing cesarean delivery?
A. Use of high-dose volatile anesthetics to reduce preload
B. Epidural anesthesia with careful fluid management
C. General anesthesia with high positive end-expiratory pressure (PEEP)
D. Administration of large fluid boluses to improve venous return
E. Avoidance of anticoagulation to minimize bleeding risk
Correct Answer: B. Epidural anesthesia with careful fluid management
Which of the following drugs should be avoided in pregnancy with Fontan circulation?
a. Flecainide
b. Oxytocin
c. Carboprost
d. Misoprostol
e. Metoprolol
c. Carboprost (and Ergometrine)
Metoprolol and Flecainide for SVT or ventricular arrhythmias - check maternal QT and fetal HR
https://academic.oup.com/eurjpc/article/31/11/1336/7658842#478917153
Which of the following is the primary reason heart transplant recipients are unresponsive to atropine?
A. Chronic use of immunosuppressants
B. Absence of vagal innervation
C. Altered β-adrenergic receptor sensitivity
D. Increased parasympathetic tone
E. Presence of denervated sinoatrial node
Correct Answer: B. Absence of vagal innervation
In heart transplant recipients, which of the following drugs is most likely to produce a significant increase in heart rate?
A. Atropine
B. Glycopyrrolate
C. Isoprenaline
D. Adenosine
E. Digoxin
C. Isoprenaline
Which of the following is the primary indication for the use of a vagal nerve stimulator?
A. Chronic pain
B. Refractory epilepsy
C. Parkinson’s disease
D. Essential tremor
E. Obstructive sleep apnea
B. Refractory epilepsy
During surgery on a patient with a vagal nerve stimulator, which of the following complications is most likely if the stimulator is activated?
A. Severe bradycardia
B. Hypertension
C. Tachycardia
D. Pulmonary edema
E. Hyperkalemia
Correct Answer: A. Severe bradycardia
Which of the following is the most common clinical indication for a VQ scan?
A. Diagnosis of pulmonary embolism
B. Assessment of pulmonary hypertension
C. Evaluation of lung cancer
D. Detection of interstitial lung disease
E. Assessment of diaphragmatic paralysis
Correct Answer: A. Diagnosis of pulmonary embolism
Which of the following findings on a VQ scan is most consistent with a high probability of pulmonary embolism?
A. Uniform ventilation and perfusion defects
B. Multiple matched ventilation-perfusion defects
C. Single large mismatched perfusion defect
D. Bilateral ventilation defects without perfusion defects
E. Diffuse perfusion defects
Correct Answer: C. Single large mismatched perfusion defect
Which of the following is the most sensitive transoesophageal echocardiographic finding for diagnosing aortic dissection?
A. Pericardial effusion
B. Aortic root dilation
C. Intimal flap in the aorta
D. Thrombus in the false lumen
E. Widened mediastinum
Correct Answer: C. Intimal flap in the aorta
In transoesophageal echocardiography, which of the following structures is most clearly identified in the transgastric short-axis view?
A. Left atrium
B. Aortic root
C. Mitral valve leaflets
D. Left ventricle papillary muscles
E. Right atrium
Correct Answer: D. Left ventricle papillary muscles
Pre-eclampsia 30 weeks
a. increased SVR and increased CO
b. increased SVR and decreased CO
c. increased SVR and normal CO
d. decreased SVR and increased CO
e. normal SVR and increased CO
b. increased SVR and decreased CO
Valensise demonstrated that preeclampsia developing before 34 weeks gestation was associated with high peripheral resistance and low cardiac output, and later onset preeclampsia was associated with low peripheral resistance and high cardiac output
https://www.sciencedirect.com/science/article/pii/S0378378222001323#bb0035
What is the EpiPen dose of adrenaline vs anaphylaxis guidelines for adult?
a. Higher dose and higher concentration
b. Same dose and lower concentration
c. Same dose and same concentration
d. Same dose and higher concentration
e. Lower dose and same concentration
e. Lower dose and same concentration
Epipen 300mcg in 0.3ml (1: 1,000)
Adult recommended dose 500mcg in 0.5ml (1:1000)
Vagal nerve stimulator for refractory epilepsy, what can cause autostimulation?
a. Hypertension
b. Tachycardia
c. Hypotension
d. Hyperthermia
e. Bradycardia
b. Tachycardia
What is the pharmacological treatment for Brugada syndrome in those who refuse AICD?
a. Lignocaine
b. Quinidine
c. Flecainide
d. Amiodarone
e. Metoprolol
Correct Answer:
b. Quinidine
Explanation:
Quinidine is the pharmacological treatment of choice for Brugada syndrome. It works by blocking the Ito (transient outward potassium) current, which helps normalize the action potential and reduce arrhythmogenic potential.
Lignocaine: Contraindicated as it may exacerbate arrhythmias in Brugada syndrome. Flecainide: Can worsen the condition by accentuating sodium channel blockade. Amiodarone: Generally ineffective in preventing arrhythmias in Brugada syndrome. Metoprolol: Not effective as Brugada syndrome is not typically driven by adrenergic mechanisms.
What does green on rigid laryngoscope blade indicate?
- Single use
- Recyclable
- Reusable
- Immersible
- Fibre optic
Correct Answer:
e. Fibre optic
Explanation:
The green marking on a rigid laryngoscope blade indicates that it is a fibre optic blade. This marking is part of a standardized system to distinguish fibre optic blades, which transmit light via a fibre optic bundle, from conventional blades with a bulb at the tip.
What is 5kpa in mmHg?
- 30mmHg
- 37mmHg
- 44mmHg
- 49mmHg
- 54mmHg
Correct Answer:
b. 37 mmHg
To convert kilopascals (kPa) to millimeters of mercury (mmHg), use the conversion factor:
1 kPa = 7.5 mmHg
Thus:
5 kPa × 7.5 mmHg/kPa = 37.5 mmHg
A DASI of 48 indicates what VO2 max?
a. 10 ml/kg/min
b. 20 ml/kg/min
c. 30 ml/kg/min
d. 40 ml/kg/min
e. 50 ml/kg/min
c. 30 ml/kg/min
VO₂ max (ml/kg/min) = 0.43 × DASI + 9.6
Where does the ventilation circuit connect to?
Answer 4
- bronchoscope
- bronchial blocker
- Patient end
Thyroid storm can present with all except?
a. Jaundice
b. Pulmonary odema
c. Bronchospasm
d. Arrhythmias
e. Hypertension
c. Bronchospasm
Can cause high cardiac output pulmonary odema and jaundice
What is the red port on Vivasight2?
a. Pressure sensing
b. Pressure relief
c. Suction
d. Camera light source
e. Flush port
e. Flush Port (for camera)
https://www.youtube.com/watch?v=YR-VOPDdApA&ab_channel=Ambu
Which of the following is true when comparing methylene blue and patent blue?
A. Methylene blue has a lower risk of anaphylaxis than patent blue
B. Methylene blue has lower risk of fat necrosis
C. Methylene blue has better uptake into lymph nodes
D. Methylene blue causes more interference with SpO₂ readings
E. Methylene blue is structurally similar to patent blue and has cross reactivity for anaphylaxis
A. Methylene blue has a lower risk of anaphylaxis than patent
https://www.tandfonline.com/doi/full/10.3109/0284186X.2011.562918blue
Methylene blue dye has no
structural similarity, but cross-reactivity in those individuals allergic to
Patent Blue dye has been described (Keller 2007).
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
NAP 6
What is the treatment for recurrent Torsades despite high dose magnesium?
- Sotalol
- Amiodarone
- Lignocaine
- Flecainide
- Procainamide
- Lignocaine
only one that shortens QT
Which drug should be avoided in long QT?
a. Rocuronium
b. Remifentanil
c. Atracurium
d. Suxamethonium
e. Midazolam
d. Suxamethonium
It is advisable not to give succinylcholine if at all possible, as it
is known to prolong the QTc.
https://www.bjaed.org/article/S1743-1816(17)30428-6/pdf
The Watchman device is placed in which anatomical location?
A. Left atrial appendage
B. Right atrial appendage
C. Left ventricle apex
D. Pulmonary vein ostium
E. Right atrium
A. Left atrial appendage
You have a neonate at 1 minute with vitals showing SpO2 75%, RR 40, HR 120. What do you do?
- Observe
- Oxygen
- PPV
- Intubate
- Apply positive pressure
- Observe
Explanation:
At 1 minute of life, a SpO₂ of 75% is within the normal range for neonates transitioning from fetal to postnatal circulation. The target pre-ductal SpO₂ at 1 minute is 60–65%, increasing gradually to 85–95% by 10 minutes.
Respiratory rate (RR) of 40 and heart rate (HR) of 120 are normal for a neonate. There is no indication for oxygen, positive pressure ventilation (PPV), or intubation in this scenario. The appropriate action is to observe and monitor the neonate's clinical status.
Oxygen pulse is a reflection of
a. Ventilatory capacity
b. Stroke volume
c. Anaerobic threshold
d. Contractility
e. Cardiac ischaemia
Correct Answer:
b. Stroke volume
Oxygen pulse is defined as the amount of oxygen consumed per heartbeat, and it is primarily a reflection of stroke volume (the volume of blood pumped by the heart per beat). As stroke volume increases, oxygen pulse also increases because more oxygen is delivered to the tissues with each contraction of the heart.
In status epilepticus, what is an incorrect dose of midazolam for a 20kg child?
- Buccal 6mg
- Intranasal 6mg
- IM 6mg
- IV 3mg
- IO 3mg
- IM 6mg
should be 3mg as well (IV/IO/IM all the same)
TAVI approach compared to surgical causes lower
- Paravalvular leak
- Reintervention rates
- Vascular complications
- Heart block
- Valve Gradient
Valve gradient
Higher rates of AR/perivalvular leak, vascular complications (stroke, dissection), heart block, re-intervention
Lower rates of AKI, AF, major bleeding, mortality
As per society of Pediatric Anaesthesia - to minimise environmental impact, Fresh Gas Flow rates for a gas induction for child weighing 20kg should be
- 1L/min
- 2L/min
- 3L/min
- 4L/min
- 5L/min
3L/min
(150ml per kg) at induction
Despite an interscalene block being performed preoperatively for arthroscopic rotator cuff repair, a patient wakes up with posterior
shoulder pain. The most appropriate procedure to consider would be a nerve block of the-
- Subscapular
- Suprascapular
- Supraclavicular
- Lateral pectoral
- Suprascapular
Explanation:
The suprascapular nerve innervates the posterior shoulder, and pain in this region is often due to inadequate analgesia in this area, despite the interscalene block.
Subscapular nerve: Primarily innervates the subscapularis muscle, but it is less likely to be the source of posterior shoulder pain in this context.
Supraclavicular block: This is a brachial plexus block that would affect the upper extremity but not specifically target the posterior shoulder.
Lateral pectoral nerve: This nerve innervates the pectoralis major muscle and is not involved in posterior shoulder pain.
What was a finding of the PREVENTT 2020 Lancet trial regarding the use of preoperative iron infusion in patients undergoing major surgery?
A. Iron infusion significantly reduced postoperative complications
B. Iron infusion led to a reduction in mortality rates
C. Iron infusion reduced the need for blood transfusions
D. Iron infusion had no effect on the need for blood transfusions
E. Iron infusion did not reduce readmission rates at 8 weeks
D. Iron infusion had no effect on the need for blood transfusions
Explanation:
The PREVENTT 2020 Lancet trial found that preoperative iron infusion did not significantly affect the need for blood transfusions or improve mortality. It did show reduction in readmission rates for complications after major abdominal surgery at 8 weeks.
Which compartment of the leg is affected?
Pain, toe flexion weakness, plantar sensory loss
a. Deep posterior
b. Superficial posterior
c. Anterior
d. Lateral
e. Medial
Correct Answer:
a. Deep posterior
The deep posterior compartment contains the tibialis posterior, flexor hallucis longus, and flexor digitorum longus, which are responsible for toe flexion. Sensory loss in the plantar aspect of the foot (due to the involvement of the posterior tibial nerve).
Superficial posterior compartment: Primarily involves the gastrocnemius and soleus muscles, and sural nerve (posterior lateral calf and lateral foot) Anterior compartment: Involves muscles like the tibialis anterior, EHL ankle and toe dorsiflexion and deep peroneal nerve (1st web space) Lateral compartment: Contains the peroneal muscles, and is associated with foot eversion and plantar flexion and superficial peroneal nerve (dorsum of foot)
There is no medial compartment
Which one of these nerve does NOT innervate the knee joint?
- Common peroneal
- Tibial
- Saphenous
- Obturator
- Posterior cutaneous of the thigh
- Posterior cutaneous of the thigh
Medial knee: Saphenous nerve, Anterior branch of the obturator nerve, and a branch from the sciatic nerve
Supero-lateral knee: The sciatic nerve and the nerve to the vastus lateralis
Infero-lateral knee: The fibular nerve
Posterior knee: The tibial nerve and the posterior branch of the obturator nerve
Genicular nerves: Common peroneal nerve branches around the knee joint include the superolateral genicular nerve (SLGN) and the superomedial genicular nerve (SMGN)
Magnesium 20mmol intraoperative does not cause
- Reduced volatile requirements
- Less PONV
- Prolonged Neuromuscular block
- Respiratory depression postop
- Reduced rescue analgesic requirements
Respiratory depression postop
Lower MAC requirement lead to lower PONV
During anaesthesia for epilepsy surgery, which agent isleast likely to affect electrocorticography (ECOG)?
- Ketamine
- N2O
- Sevo
- Remifentanil
- Midazolam
Correct Answer:
- Remifentanil
Explanation:
In epilepsy surgery, the choice of anesthetic agents is critical as some drugs can affect electrocorticography (ECoG) readings, which are used to localize seizure foci. Here’s how the options affect ECoG:
Ketamine: Can increase cortical excitability and affect ECoG by enhancing epileptiform activity. Nitrous Oxide (N₂O): Can alter neuronal activity and affect ECoG. Sevoflurane: A volatile anesthetic that can suppress cortical activity and affect ECoG readings. Midazolam: A benzodiazepine that suppresses epileptiform activity and can interfere with ECoG. Remifentanil: Least likely to affect ECoG as it is an opioid with minimal effects on cortical electrical activity. It is often preferred in epilepsy surgeries for this reason.
A child is having a hypercyanotic episode “Tet spell”, management includes all except?
- Fluid bolus
- Vasopressor
- Beta blocker
- Sedation
- Prostaglandin
Correct Answer:
- Prostaglandin
Explanation:
A Tet spell (hypercyanotic spell) occurs in children with Tetralogy of Fallot and is characterized by severe cyanosis due to right-to-left shunting of blood across the ventricular septal defect. Management focuses on reducing right ventricular outflow tract obstruction, increasing systemic vascular resistance, and calming the child. Here’s how the options apply:
Fluid bolus: Helps increase preload, which can reduce the severity of the right-to-left shunt. Vasopressor: Agents like phenylephrine increase systemic vascular resistance, reducing the right-to-left shunting. Beta blocker: Propranolol or esmolol can relax the right ventricular outflow tract and reduce infundibular spasm. Sedation: Helps calm the child and reduce catecholamine-induced infundibular spasm.
Prostaglandin is not typically used in the acute management of a Tet spell. It is used in duct-dependent lesions to maintain ductal patency, which is not the primary issue in Tet spells.
Which of the following best describes the clinical significance of TAPSE (Tricuspid Annular Plane Systolic Excursion) in echocardiography?
A. Assesses left ventricular systolic function
B. Evaluates tricuspid regurgitation severity
C. Measures right ventricular systolic function
D. Quantifies pulmonary artery pressure
E. Detects pericardial effusion
C. Measures right ventricular systolic function
Explanation:
TAPSE is an echocardiographic measurement that evaluates right ventricular (RV) systolic function by assessing the longitudinal movement of the tricuspid annulus during systole.
A. Assesses left ventricular systolic function: This is incorrect as TAPSE specifically evaluates the right ventricle, not the left. B. Evaluates tricuspid regurgitation severity: TAPSE does not directly assess the severity of tricuspid regurgitation. C. Measures right ventricular systolic function: Correct, as TAPSE is a key parameter for RV function. D. Quantifies pulmonary artery pressure: While RV function and pulmonary pressure are related, TAPSE does not directly measure pulmonary artery pressure. E. Detects pericardial effusion: Pericardial effusion is identified through other echocardiographic methods, not TAPSE.
What is the cutoff value for TAPSE to indicate impaired right ventricular systolic function in echocardiography?
A. <10 mm
B. <12 mm
C. <16 mm
D. <20 mm
E. <24 mm
C. <16 mm or 17
Explanation:
TAPSE (Tricuspid Annular Plane Systolic Excursion) is graded to assess right ventricular (RV) systolic function. A TAPSE value <16 mm is considered indicative of impaired RV systolic function.
What does the Borg Scale primarily measure in clinical and exercise settings?
A. Oxygen saturation during exercise
B. Heart rate variability
C. Subjective dyspnoea
D. Blood pressure response
E. Respiratory rate during activity
C. Subjective dyspnoea/Perceived exertion
Where is the V5 ECG electrode placed during a standard 12-lead ECG?
A. Left midclavicular line, 4th intercostal space
B. Left anterior axillary line, 5th intercostal space
C. Left midaxillary line, 5th intercostal space
D. Left midclavicular line, 5th intercostal space
E. Left sternal border, 4th intercostal space
Correct Answer:
B. Left anterior axillary line, 5th intercostal space
V1 4th ICS, R sternal border
V2 4th ICS, L sternal border
V3 between V2 and V4
V4 5th ICS, mid clavicular
V5, 5th ICS, anterior axillary
V6, 5th ICS, mid axillary line
CXR showing Left hemithorax whiteout with Tracheal deviation away from whiteout. What is the cause?
- Pleural effusion
- Pneumonia
- Unilateral pulmonary oedema
- Mainstem bronchus obstruction
- Pneumonectomy
Correct Answer:
- Pleural effusion
Explanation:
Pleural effusion: AWAY from the affected side.
Pneumonia: NO tracheal deviation.
Unilateral pulmonary oedema: NO tracheal deviation.
Left mainstem bronchus obstruction: TOWARDS collapse
Pneumonectomy: TOWARDS the side of the pneumonectomy
AWAY = Pneumothorax, Pleural Effusion, Lung Cancer, Diaphragmatic hernia
TOWARDS = collapse, pneumonectomy
NONE = Pneumonia, Consolidation, Pleural Mass, Chest wall Mass, Pulmonary edema
Where is this lead placed?
- coronary sinus
- RV
- RA
- LA
- LV
- coronary sinus
Parkinson’s taking apomorphine which antiemetic should be used?
- Cyclizine
- Ondansetron
- Droperidol
- Prochlorpromazine
- Metoclopramide
- Cyclizine
Ondansetron contraindicated with apomorphine (non selective D2 agonist with 5HT2 antagonism) causes severe hypotension
Which of the following is the primary diagnostic criterion for POTS in adults?
A. A rise in heart rate of ≥20 beats per minute (bpm) within 3 minutes of standing
B. A drop in systolic blood pressure ≥20 mmHg within 3 minutes of standing
C. A rise in heart rate of ≥30 bpm within 10 minutes of standing without significant hypotension
D. Persistent tachycardia exceeding 120 bpm in the supine position
E. A drop in diastolic blood pressure ≥10 mmHg with associated symptoms upon standing
Answer: C. A rise in heart rate of ≥30 bpm within 10 minutes of standing without significant hypotension
Which of the following is a common non-pharmacological treatment for POTS?
A. High-salt diet and increased fluid intake
B. Beta-blocker therapy
C. Intravenous corticosteroids
D. Calcium channel blockers
E. Anticoagulation therapy
Answer: A. High-salt diet and increased fluid intake
POTS (Postural Orthostatic Tachycardia Syndrome) is NOT associated with:
A. Reduced left ventricular resting ejection fractions
B. ECG changes
C. COVID
D. Hypermobility disorders
E. Female gender
Answer: A. Reduced left ventricular resting ejection fractions
Left Ventricular Resting Ejection Fractions:
POTS is not typically associated with reduced left ventricular resting ejection fractions. While some studies have noted smaller left ventricular mass and volume in POTS patients, resting ejection fraction generally remains within normal limits. ESC 365 - the cardiology knowledge hub
ECG Changes:
Can cause flattened T wave associated with SNS activation https://www.sciencedirect.com/science/article/abs/pii/S1566070202002138#:~:text=Ventricular%20repolarization%20was%20assessed%20by,outflow%20to%20the%20ventricular%20myocardium.
COVID-19:
There is evidence linking POTS with COVID-19. Individuals recovering from COVID-19 have reported experiencing POTS within 6 to 8 months post-infection. PMC
Hypermobility Disorders:
POTS has been associated with hypermobility disorders, such as Ehlers-Danlos syndrome. Patients with hypermobility may have connective tissue abnormalities affecting blood vessel elasticity, contributing to POTS symptoms. Wikipedia
Female Gender:
POTS predominantly affects females, with a higher prevalence observed in women of childbearing age. Wikipedia
What is the ASA Physical Status Classification for a patient with a BMI of 35–39 and no other significant systemic disease?
A. ASA 1
B. ASA 2
C. ASA 3
D. ASA 4
E. ASA 5
Answer: B. ASA 2
Highest mortality BMI
- <18.5
- 18.5-25
- 25-30
- 30-35
- 35-40
- <18.5
Obesity paradox
Worse thing for ARDS
- Recruitment
- High PEEP
- Relaxant
- Prone
- Negative fluid balance
- Recruitment
Dabigatran reversal: how long does it take?
● 5m
● 15m
● 30m
● 60m
● 90m
● 5m
Compared to a continuous epidural infusion, patient controlled epidural analgesia does NOT reduce
a. C-section rates
b. Instrumental deliveries
c. Total dose of LA
d. High blocks and motor blocks
e. Clinician workload
a. C-section rates
Which statement is true regarding Dabigatran and clotting tests?
A) Dabigatran has no effect on PT/INR.
B) Dabigatran primarily affects PT/INR, causing prolonged results.
C) aPTT is the best test to monitor Dabigatran.
D) Dabigatran prolongs aPTT and is best monitored with dilute thrombin time (dTT).
E) Dabigatran does not require laboratory monitoring.
D) Dabigatran prolongs aPTT and is best monitored with dilute thrombin time (dTT).
Contraindications for IABP include all EXCEPT?
- Aortic dissection
- Aortic regurgitation
- Severe coagulopathy
- Mitral regurgitation
- Mitral regurgitation (this is an indication)
TURP (Transurethral Resection of the Prostate) can cause all of the following EXCEPT:
A) Hyperglycerinaemia
B) Hyponatraemia
C) Hypervolaemia
D) Hypoglycaemia
E) Hypoosmolarity
D) Hypoglycaemia
Hyponatraemia: This is a well-known complication of TURP due to the absorption of hypotonic irrigation fluids, such as glycine or saline, causing dilutional hyponatraemia. (Source: “Hyponatraemia following TURP: Pathophysiology and management” - Journal of Urology, 2004)
Hypervolaemia: The absorption of large volumes of irrigation fluids can also lead to fluid overload, which results in hypervolaemia. (Source: “TURP syndrome: A clinical update” - British Journal of Urology International, 2007)
Hyperglycerinaemia: When glycine is used as an irrigation fluid during TURP, it can be absorbed and metabolized, leading to elevated glycerin levels in the bloodstream. (Source: “TURP syndrome: The effects of glycine on the central nervous system and metabolism” - European Urology, 2002)
Hypoosmolarity: Due to the dilutional effect of absorbed irrigation fluids, osmolarity in the bloodstream may decrease, leading to hypoosmolarity. (Source: “Water intoxication during TURP” - American Journal of Kidney Diseases, 2001)
However, hypoglycaemia is not a typical complication of TURP. Although TURP can lead to fluid and electrolyte imbalances, it does not generally cause a significant drop in blood glucose levels. (Source: “Metabolic and electrolyte disturbances in TURP” - Urology Journal, 2005)
What are high risk TOE findings with dissection?
- pericardial effusion
- RV dilatation
- Aortic root dilation
- Aortic regurgitation
- Regional wall abnormalities
- Aortic regurgitation
6-year-old patient (140 cm, 24 kg, BSA 0.97m2) is on hydrocortisone 15 mg/day. Perioperative glucocorticoid supplementation is
A. Doesn’t need it
B. Needs it if on steroids > 2 weeks
C. Needs it if on steroids > 1 month
D. Needs it if on steroids > 3 months
C. Needs it if on steroids > 1 month
What is the maximum safe cocaine dose?
A) 1 mg/kg
B) 2 mg/kg
C) 3 mg/kg
D) 4 mg/kg
E) 5 mg/kg
C) 3 mg/kg
Which drug to avoid in cocaine toxicity?
A) Adenosine
B) Diazepam
C) Metoprolol
D) Glyceryl trinitrate
E) Verapamil
C) Metoprolol (must avoid unopposed alpha)
Branches of which cranial nerves not injured with LMA
- Glossopharyngeal
- Trigeminal
- Facial
- Vagus
- Hypoglossal
- Facial
Cranial nerve injury after the use of a supraglottic airway device is an unusual but more serious complication. So far, injuries of lingual, inferior alveolar, infra-orbital (CNV), glossopharyngeal, recurrent laryngeal and hypoglossal nerves have been reported.
Which is not branch of trigeminal nerve?
- Auriculotemporal
- Greater auricular
- Lingual
- Infraorbital
- Greater auricular (is part of cervical plexus)
Mot effective single analgesia post dental extraction
- 400mg ibuprofen
- 200mg celecoxib
- 1g paracetamol
- 100mg Tramadol
- 60mg Codeine
- 400mg ibuprofen
NNT
- 400mg ibuprofen 2.5
- 200mg celecoxib 4.2
- 1g paracetamol 3.6
- 100mg Tramadol 4.6
- 60mg Codeine 12
4Ts score for HITS does NOT include?
- Thrombocytopaenia
- Timing
- Thrombosis
- Other causes of Thrombocytopaenia are not evident.
- Platelet-serotonin complex
- Platelet-serotonin complex
What does not elevate the larynx
- Stylohyoid
- Myohyoid
- Sternohyoid
- Geniohyoid
- Sternohyoid
Serotonin syndrome risk when given with moclobemide. Greatest with:
- Pethidine
- Tramadol
- Methadone
- Fentanyl
Pethidine
or tramadol
A serum tryptase level is positive for a diagnosis of anaphylaxis if?
- Acute elevation 1.2x baseline plus 2
- Acute elevation 1.4x baseline plus 2
- Acute elevation 1.6x baseline plus 2
- Acute elevation 1.8x baseline plus 2
- Acute elevation 2.0x baseline plus 2
- Acute elevation 1.2x baseline plus 2
or Acute elvetaion abvoe normal levels >11 or 13 mcg/L)
MMR vaccine allergy, which of the follow can demonstrate cross-reactivity
- Gelofusin
- Albumin
- FFP
- Fibrinogen concentrate
- Prothrombinex
Gelofusin
The measles, mumps, and rubella (MMR) vaccine contains gelatin as a stabilizer
Predictors of successful awake extubation after volatile anaesthesia in infants do NOT include
a. Grimace
b. RR >16
c. TV >5ml/kg
d. Conjugate gaze
e. Eye opening
RR >16
DDAVP indications include EXCEPT
- Haemophilia B
- Uraemic bleeding
- vWD type 2a
- Diabetes inspidius
- Noctural polyuria
Haemophilia B.
Haemophilia B - NOT an indication. Factor IX deficiency is not influenced by DDAVP. Uraemic bleeding - DDAVP can improve platelet function in uremic patients. vWD type 2a - DDAVP is effective in some forms of von Willebrand disease (vWD), including type 2A, by releasing stored von Willebrand factor. Diabetes insipidus - DDAVP is used to treat central diabetes insipidus. Nocturnal polyuria - DDAVP can reduce urine production in conditions like nocturnal enuresis or nocturia.
Criteria to rule out Oesophageal intubation is CO2 above baseline
- 5mmHg
- 7.5mmHg
- 10mmHg
- 15mmHg
- 20mmHg
7.5mmHg
PUMA
Which drug most likely to cause pulmonary hypertension?
- Dopamine
- Dobutamine
- Vasopressin
- Milronone
- Prostacylcin
Vasopressin
Prilocaine is unsafe in patients with?
- G6PD- deficiency
- Porphoria
- Multiple Sclerosis
- Pseudocholinesterase deficiency
- Chronic Kidney Disease
- G6PD- deficiency
Prilocaine is metabolized to o-toluidine, which can cause methemoglobinemia. Patients with G6PD deficiency are at higher risk of oxidative stress, which can exacerbate methemoglobinemia
In refractory anaphylaxis in patient on beta blocker, glucagon 1-2mg is given every
- Once
- Every 5 minutes until response
- Every 10 mins until response
- Every 60 mins
- Every 5 minutes until response
Which adjunct is most effective at prolonging peripheral nerve block?
- Dexamethasone
- Clonidine
- Hyalase
- Fentanyl
- Adrenaline
-Dexamethasone (3.0 hours)
Clonidine (1.1 hours)
Both (6.2 hours)
Adrenaline = none
Autonomic dysflexia is most likely with spinal cord injury above
- Complete and above T6
- Incomplete and above T6
- Above T9
- Above T12
- Complete and above T6
NAP 7 risk of cardiac arrest in anaesthesia for all patients is?
A) 1 in 2,000
B) 1 in 3,000
C) 1 in 4,000
D) 1 in 5,000
B) 1 in 3,000
NAP 7 risk of cardiac arrest in ASA 1-3 patients during anaesthesia is?
A) 1 in 5,000
B) 1 in 8,000
C) 1 in 10,000
D) 1 in 15,000
B) 1 in 8,000
Which rhythm is associated with the best survival to discharge in NAP 7 cardiac arrest during anaesthesia?
A) VT
B) VF
C) PEA
D) Bradyarrhythmia
D) Bradyarrhythmia
What is the effect of indocyanine green on SPO2 and NIRS?
A) Decreases SPO2, Decreases NIRS
B) Increases SPO2, Decreases NIRS
C) Decreases SPO2, Increases NIRS
D) Increases SPO2, Increases NIRS
C) Decreases SPO2, Increases NIRS
TRALI does not include
- CXR pulmonary oedema/bilateral infiltrates
- Raised BNP
- Low wedge pressure
- Hypoxia
- Raised BNP (this is TACO)
Half life for SC semaglutide
- 1 day
- 3 days
- 5 days
- 7 days
- 7 days
Heart transplant patient has increased sensitivity to
- Ephedrine
- Metaraminol
- Phenylephrine
- Adenosine
- Adenosine
First line treatment of extravasated norad is
- Remove cannula
- Flush cannula
- Cold compress
- SC phentolamine
- Heparin
-Remove cannula
(Warm compress, SC phentolamine later)
Cryoprecipitate is a concentrated source of all the following EXCEPT
- Fibronectin
- Factor 13
- VwF
- Fibrinogen
- Factor 9
- Factor 9
NAP 7 most common cause of arrest intraop
- Anaphylaxis
- Cardiac Ischaemia
- Major haemorrhage
- Bradyarrhythmia
- Hypoxia
- Major haemorrhage
Right homonymous hemiapnopia caused by left
- Anterior Inferior Cerebellar Artery (AICA)
- Posterior Inferior Cerebellar Artery (PICA)
- Anterior Cerebral Artery (ACA)
- Posterior Cerebral Artery (PCA)
- Posterior Cerebral Artery (PCA)
VA femoral femoral ECMO best sample for coronary artery oxygenation
- Right radial
- Left radial
- Pre-oxygenator
- Post oxygenator
- Right radial
https://onlinelibrary.wiley.com/doi/10.1155/2014/393258
Obese patient for cochlear surgery, base propofol induction dose on BMI 55
- Lean body weight
- Total body weight
- Ideal body weight
- Lean body weight
A five-month-old child is to undergo routine elective morning surgery. Current ANZCA guidelines advise minimum fasting intervals
prior to anaesthesia of
- 3 hr breast milk, 1 hr clear fluids
- 3 hr breast milk, 2 hr clear fluids
- 4 hr breast milk, 2 hr clear fluids
- 6 hr breast milk, 1 hr clear fluids
- 3 hr breast milk, 1 hr clear fluids (3ml/kg/hr)
Segments in left lower lobe
- 3
- 4
- 5
- 6
- 4
SPAL (superior, posterior, anterior, lateral)
Buprenorphine patch once removed, drop of plasma levels to half occurs at
- 3 days
- 7 days
- 12 hours
- 24 hours
- 12 hours
Somatic pain in the second stage of labour is NOT transmitted via the
a. Genitofemoral
b. Pudendal
c. Posterior cutaneous nerve of thigh
d. Ilioinguinal
e. Inferior gluteal
e. Inferior gluteal (this is a purely motor nerve)
Pudendal nerve: Major contributor to somatic pain. Genitofemoral nerve: Innervates parts of the perineum. Posterior cutaneous nerve of the thigh: Contributes to sensation in the perineal region. Ilioinguinal nerve: Provides sensory innervation to the inguinal and upper perineal areas.
The inferior gluteal nerve, however, is a motor nerve that supplies the gluteus maximus
The National Audit Project 6 found that the most common early clinical feature of
perioperative anaphylaxis was
a. Hypotension
b. Urticaria rash
c. Bronchospasm
d. Loss of ETCO2 trace
a. Hypotension
Hypotension>high airway pressures> tachycardia> flushing/non uritcaria rash
The odds ratio is the measure of choice for a
a. Case control
b. Cohort study
c. Epidemiologic study
d. RC
Case control uses OR
If outcome is rare OR and RR are similar
If common RR is better measure
Cohort studies: Relative risk (RR) is typically used because incidence can be directly measured.
Epidemiologic studies: The choice of measure depends on the specific design (e.g., OR for case-control, RR for cohort).
Randomized controlled trials (RCTs): Relative risk or risk difference is more commonly used.
According to the Association of Anaesthetists of Great Britain and Ireland (AAGBI)
guidelines, an acceptable reason to delay surgery in a patient with a fractured neck of femur
is
a. AF 110bpm
b. K 2.7
c. Na 125
d. Clopidogrel taken within 3 days
b. K 2.7
Seven ‘acceptable’ reasons for delaying surgery:
1 Hb < 80 g.l−1
2 Na < 120 or > 150 mmol.l−1 or K< 2.8 or > 6.0 mmol−1
3 Uncontrolled diabetes
4 Uncontrolled or acute onset left ventricular failure.
5 Correctable cardiac arrhythmia with a ventricular rate > 120.min−1
6 Chest infection with sepsis
7 Reversible coagulopathy
To assist with guiding intravenous fluid resuscitation in adults with sepsis or septic shock, the 2021 Surviving Sepsis Guidelines suggest
using any of the following EXCEPT
a. Urine output
b. PPV
c. Response to passive leg raise
d. Response to fluid bolus
e. Echo
b. PPV (requires intubation and mechanical ventilation)
A five-year-old child weighing 25 kg is to be strictly nil by mouth overnight following a laparotomy. The most appropriate fluid prescription
is
A) 0.45% saline + 5% dextrose 45ml/hr
B) 0.45% saline + 5% dextrose 65ml/hr
C) 0.9% saline + 5% dextrose 65mlhr
D) 0.9% saline + 2.5% dextrose 45ml/hr
E) 0.9% saline + 5% dextrose 45ml/hr
E) 0.9% saline + 5% dextrose 45ml/hr
After major surgery, given rates should be reduced by 30–50% to account for increased antidiuretic hormone (ADH) secretion and to mitigate the risk of hyponatraemia.
The use of erythropoietin (EPO) before major surgery results in
a. Decreased transfusion requirement and decreased thrombosis
b. Increased transfusion and increased thrombosis
c. No change in transfusion and increased thrombosis
d. Decreased transfusion and increased thrombosis
e. Decreased transfusion requirement and no change thrombosis
e. Decreased transfusion requirement and no change thrombosis
The most consistent risk factor for PONV in children is
- age over 2
- Pre-pubertal Female
- Intraop opioids
- Nitrous oxide
- Strabismus surgery
- Strabismus surgery
