MCQ 25.1 Flashcards by Jason Ngai

. “E” in GOLD ABE for COPD means at least how many exacerbations/hospitalisations per year?
a. Options - 1, 2, 3, 4

. “E” in GOLD ABE
1 hospitalisation
2 exacerbations

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What percentage of Takotsubo cardiomyopathy patients fully recover to normal LVEF?

10%
25%
50%
75%
90%

90%

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Which risk factor is the LEAST associated with extravasation of vasopressors?

Elderly
Neonate
Low infusion rate
Drugs below pH 5.5
Diabetes

Low infusion rate

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Which one is mitral stenosis?

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What nerve is blocked by injection between thyrohyoid membrane that targets above cords and epiglottis?

Superior laryngeal nerve (internal branch)

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What is not a part of ANcA PG58A guidelines for QA & QI?

Planning
Acting
Doing
Benchmarking
Checking

Benchmarking

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Child in ED needs procedural sedation. Unable to gain IV access what is the ketamine IM dose?
1
2
3
4
5mg/kg

4mg/kg

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Best NNT for prevention of post amputation pain
a. Neuraxial
b. Peripheral catheter
c. Ketamine
d. Gabapentinoid

?ketamine

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Best NNT for post operative pain
a. Ibuprofen
b. Codeine
c. Paracetamol
d. Paracetamol/ibuprofen combo
E. Paracetamol/codeine combo

D. Paracetamol/ibuprofen

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Painless POVL with intact pupillary reflex, is due to

Vertebrobasilar ischemia, posterior ION
retinal detachment
corneal abrasion

Vertebrobasilar ischemia

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Potential effects of GLP1RA include all EXCEPT
reduced HR,
weight loss,
pancreatitis,
reduced myocardial adverse events

Reduced HR

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Paediatric maximum safe dose for lignocaine topicalisation of airway?
3mg/kg
4mg/kg
5mg/kg
7mg/kg
9mg/kg

4mg/kg

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For Hyperkalaemia treatment - what is the duration of action for nebulised salbutamol?
15 min,
30min
1 hour
1.5 hours
2 hours

2-3hrs (RCH website)

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Paediatric potential C-spine trauma in 3 year old, what’s the best management
a. Sedate the child until C-spine is adequately aligned
b. Use Hard collar
c. Use thoracic elevation device
d. Restrain child to hard board
e. CT as first line imaging

Use thoracic elevation device

SCH website https://www.rch.org.au/clinicalguide/guideline_index/cervical_spine_assessment/

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Dose of synchronised cardioversion for SVT in paediatrics
a. 1J/kg
b. 2J/kg
c. 3J/kg
d. 4J/kg

1J/kg first

Then 2 and 4.

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Max safe dose for ropivacaine per 24h period
450mg
650mg
770mg
1080mg

770mg

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Dyspnoea happens due to which position change in hepatopulmonary syndrome?
a. Left lateral to right lateral
b. Right lateral to left lateral
c. Supine to sitting
d. Sitting to supine
e. Supine to prone

c. supine to sitting (platypnea)

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RANZCOG guidelines for prophylactic antibiotics after instrumental vaginal delivery

a. IV Augmentin
b. IV cephazolin + metronidazole
c. IV cephazolin
d. IV metronidazole
e. Nothing

a. IV Augmentin

https://ranzcog.edu.au/wp-content/uploads/Prophylactic-Antibiotics-Obstetrics-Gynaecology.pdf

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Indocyanine green is contraindicated in
a. Iodide allergy
b. G6PD
c. Porphyria
d. Methylene blue allergy

a. Iodide allergy

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Which one is not high risk for cardiac adverse events?
Uncontrolled HTN
Previous history of cardiac failure
Ischemic heart disease
Diabetes
CKD

Uncontrolled HTN - not in RCRI

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Mild cystic fibrosis causes what kind of PFT?
Mixed obstructive/restrictive
Obstructive only
Restrictive only with normal DLCO
Restrictive only with low DLCO

Obstructive only

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Leukodepletion reduces the risk of
a. CMV transmission
b. HIV transmission
c. ABO incompatibility

a. CMV transmission

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Bivalirudin mechanism of action
a. Thrombin inhibitor
b. Factor Xa inhibitor
c. Antifibrinolytic
d. Factor V inhibitor
e. Factor I inhibitor

a. Thrombin inhibitor

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What is the likelihood of a p value equal to or greater than 0.05 for a study repeated with exactly the same conditions and same sample size for a study that produced a p value of 0.05?
5%
20%
50%
80%
95%

50%

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Anatomical structure (arrow pointing to part labelled "posterior arch" in image below) atlas, axis, occipital protuberance

Atlas

What is not a risk factor for emergence delirium? Ent surgery Young age Parental anxiety Volatile anaesthetic Negative interaction with health professionals

Parental anxiety https://pubmed.ncbi.nlm.nih.gov/38676358/

What does ANZCA recommend about GLP1 agonists for non-endoscopy surgeries a. Stop for 2 weeks and treat as fasted b. Stop for 2 weeks and treat as unfasted c. Stop for 4 weeks, extended fasting time, treat as fasted d. Stop for 4 weeks and treat as unfasted e. Continue, normal fasting time, treat as unfasted

e. Continue, normal fasting time, treat as unfasted

What is the recommendation for DDP-4 (options) preoperatively? Withhold due to risk of -hypoglycemia -lactic acidosis -delayed gastric emptying -euglycemic ketoacidosis -don’t withhold

Don’t withhold

If a statistical test was required to look at the similarity between two outcomes below (in a similar graph), which analysis is required T-test P-test Logistic regression, Pearson coefficient, Spearman coefficient

Pearson coefficient

What does ANZCA say is NOT the purpose of open disclosure after something goes wrong a. To allow doctors to fulfil medicolegal obligations b. To allow patients to tell their experience from their POV c. To allow doctors to tell their experience from their POV d. To apologise and express regret e. To disclose what harm has happened or potential harm that could happen

a. To allow doctors to fulfil medicolegal obligations

Dose of amiodarone for ventricular arrhythmia in paediatrics 3mg/kg, 4mg/kg, 5mg/kg, 6mg/kg

5mg/kg

Mammalian meat allergy (Alpha-Gal syndrome) has lowest risk with which drug a. Heparin b. LMWH c. Recombinant 7 d. Human albumin e. Protamine

e. Protamine (salmon)

Conn syndrome a. Normoglycaemia, hypokalaemia, hypernatraemia b. Hyperglycaemia, hypokalaemia, hypernatraemia c. Hypoglycemia, hyponatremia Hyperkalemia d. Hypoglycemia, Hypernatremia, hypokalemia

a. Normoglycaemia, hypokalaemia, hypernatraemia

5% albumin should be avoided in a. Hypernatraemia b. Hyperkalemia c. Hypercalemia d. Hyperphosphetemia

Hypernatremia

Which hyponatraemic state has euvolaemia a. CCF b. Hypothyroidism c. Cerebral salt wasting d. Cirrhosis

Hypothyroidism

To do a sphenopalatine ganglion block, the LA needs to pass through a. Greater palatine foramen b. Lesser palatine foramen c. Sphenopalatine foramen d. Foramen rotundum

c. Sphenopalatine foramen https://www.bjanaesthesia.org/article/S0007-0912(20)30164-1/fulltext

2 year old child spontaneously breathing on Mapleson F running at 3L/min. High CO2. You want to transfer patient. What's the best management for CO2? a. Increase FGF b. Paralyse patient c. Assist ventilation d. Salbutamol

Assist ventilation 2yo is 12kg. Recommended FGF for spont breathing is 3x MV or 150ml/kg = 3L/min

Which of these is NOT a risk factor for Myaesthenia gravis for prolonged ventilation a. Pyridostigmine 500mg/day b. BMI 30 c. VC <1.8 d. Thoracic surgery e. Pre-existing COPD

Pyridostigmine Leventhal criteria is >750mg/day

Smallest weight for microcuff ETT a. 1kg b. 3kg c. 5kg d. 10kg e. 20kg

b. 3kg

Lambert-Eaton Syndrome is associated with increased or decreased sensitivity to depolarising/non depolarising paralytics

increased sensitivity to both

Upper BP threshold if CVA and not thrombolyzed or clot retrieved 160mmHg, 180mmHg, 200mmHg, 220mmHg

220mmHg

Gastric ultrasound, what is this image (similar to below) empty stomach with clear fluid, early emptying phase of solids, intermediate emptying phase of solids, late emptying phase of solids

Empty

Identify which line is mode/median/mean

If patient is taking fluoxetine, which drug has the lowest risk of serotonin syndrome tramadol, oxycodone, morphine, fentanyl pethidine

Morphine

What electrolyte is most inaccurate with VBG taken from IO?

Potassium

SBP target if 55 year old male with TBI SBP 90, SBP 100, SBP 110

SBP 100

What is the dose (mg/kg) of methyl-prednisone in patient with TBI? None 5 10 15 20

None

Duration of action of IV Carbetocin a. 30 mins b. 1 hour c. 2 hour d. 4 hour

1 hour

Location of PENG block

a. Between psoas tendon and pubic ramus

50. Addition of IV vancomycin to routine IV cephazolin for surgical site infection a. Reduces SSI by 20% b. Reduces SSI by 40% c. No change

No Change https://www.nejm.org/doi/full/10.1056/NEJMoa2301401

How do SGLT2i work?

Causing glycosuria

52. Drug that reduces the efficacy of methadone

a. Phenytoin

53. Which group of patients is there a lower BSL target, that's not BSL 8-12? pregnant patients, poorly controlled DM recent hypoglycemia, emegency surgery

pregnant patients (4-6) ADS ANZCA Perioperative Diabetes Guidelines (2022)

54. Peak onset IM suxamethonium (repeat)

a. 4 min

55. What is the difference between AIR compared to MH (repeat)

a. No increased muscle rigidity

56. What does an inverted U wave signify (repeat)

a. Myocardial ischemia

57. ESPB location (repeat)

a. Anterior to erector spinae and posterior to TP

Mild Cystic fibrosis shows what PFT?

Obstructive FEV1 with normal FVC

59. NSAID with the worst profile for GI ulceration

a. Naproxen (https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)60900-9.pdf)

60. Which one is a risk factor for bone cement implantation syndrome

a. Diuretics

61. Oxygen pin index

a. 2,5

62. Manujet maximum pressure

a. 3.5 bar

63. Intralipid 20% maximum dose

a. 12mL/kg

64. Cause of 4th heart sound (repeat)

a. HTN

65. Delay brain death testing after cardiac arrest for (repeat)

a. 24hrs

66. Medical air gas cylinder colour

a. Black and white

67. Carcinoid syndrome has highest risk of which cardiac murmur? MR AR TR MS AS

a. Tricuspid regurg

68. Dose for macroshock for VF

a. 100mA

69. Risk of microshock is eliminated by

a. Equipotent earthing potential

70. ECG in young person with collapse

- likely WPW

71. ECG in middle age person with dizziness on exercise + anteroseptal TWI and large QRS complexes

- likely HCM

72. ECG with 3rd degree HB

73. How long before starting clexane after removal of epidural catheter

4 hours

74. Brain death testing, which is NOT a method of imaging a. Intracerebral arterial catheter b. Radionucleotide scan c. CT angiogram d. MRI

MRI

75. During CICO when you inflate for 2s breaths via Rapifit inhaler, how frequently do you cycle breaths

a. 30 seconds

76. Which drug crosses the BBB a. Pyridostigmine b. Edrophonium c. Neostigmine d. Physostigmine

d. Physostigmine

77. Addison's syndrome electrolytes and BSL

a. Hypoglycaemia, Hyperkalaemia, hyponatraemia

78. Purpose of this part of the chest drain

Records air leak

79. Stimulation of the posterior cord in infraclavicular block causes

a. Wrist extension - answer

80. Amount of FFP to increase fibrinogen by 1g/L

a. 30mL/kg

81. Capnograph waveform indicates what a. ETT cuff leak b. Gas analyser partial disconnection c. Unilateral Lung transplant d. Spontaneous breathing during PPV

b. Gas analyser partial disconnection

82. Antiemetic choice in parkinsons patient taking apomorphine

a. Cyclizine

83. Pressure in oxygen piping tube if oxygen tube kinked

a. 400kPa

84. Musculocutaneous nerve innervates

a. Elbow flexion

85. Which surgery has highest risk of awareness as per NAP

a. Cardiac surgery

86. Which block does NOT cover sternal fractures a. PECS 1 b. PECS 2 c. Parasternal block d. Transversus thoracic muscle plane block e. Pectointercostal fascial plane block

a. PECS 1

87. Classic LMA cuff pressure max

a. 60cmH2O

88. Which valve is labelled (arrow pointing to aortic valve) - a picture of both mitral and aortic valve replacements in CXR

89. Brachial plexus photos arrow pointing towards ulnar nerve

90. The correct blood collection tube for a mast cell tryptase test is a

a. Serum tube

91. The rank of volatile anaesthetic agents from highest to lowest derived global warming potential over 100 years (GWP100) is

a. Desflurane > isoflurane > nitrous > sevoflurane