MCQ Flashcards by Jen Gaffney

Minimum fatigue achieved by;
Avoid sleep
Avoid sunlight
Napping before shift
Using benzodiazepines
Use caffeine

Nap before shift

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Safe antiemetic in porphyria;
Metoclopramide
Prochlorpromazine
Tropisetron
Ondansetron
Droperidol

Metoclopride

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What agent safe for BP with moclobemide;
Adrenaline
Dobutamine
Ephedrine
Meteraminol
Phenylephrine

Phenylephrine

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When topping up a labour epidural optimum level for light touch;

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15yo new mediastinal mass for supraclavicilar lymph node biopsy. Most important investigation;
CXR
CT chest
MRI
PET
TOE

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CTG with late decelerations cause;
GA
Head compression
Uteroplacental insufficiency
Acute asphyxia
Umbilical cord compression

Uteroplacental insufficiency

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New antiemetic decreases PONC by 33%. 8% who receive new treatment still get PONV. The # of patients who must get new Rx instead of old before one patient will benefit is;

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Previous anaphylaxis to ? Roc, no testing, what is appropriate drug to use;
Vec
Cis
Panc
Atracurium
Sux

Cis

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Increase bleeding except;
Garlic
Ginger
Ginkgo
Fish oil
Echinacea

Echinacea

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Commonest complication after hip ORIF;

Delirium

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Carcinoid tumour, persistent intraop HTN non responsive to fluid and octreotide 50mcg. Treatment likely to be effective is;
Adrenaline
Dobutamine
Levosimenden
Milrinone
Vasopressin

Vasopressin

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CS5 configuration. Lead I monitors;

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Pringles procedure involves clamping of;

Portal pedicle

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Before starting gabapentin it's important to;
Cease PPI
Check hepatic transaminases
Check renal function
Check QT interval
Decrease oxycodone

Renal

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39yo with # arm. Confused and agitated with temp tachy HTN - likely cause;
Heat stress
Encephalopathy
NMS
serotonin
Pain

NMS

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CO2 penetrates tissue with little underlying tissue damage because;
Well absorbed Hb
Poorly absorbed h2o
Disseminated in tissue
Long wavelength
Short wavelength

Long wavelength

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80yo TURP, diathermy lateral bladder wall, thigh adduction. Nerve involved;

Obturator

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ASA scores are what type of data;
Categorical
Nominal
Non parametric
Numerical
Ordinal

Ordinal

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Healthy man with anaemia - a test that most reliably indicates iron deficiency is;
MCV
Serum ferritin
Serum iron
Serum transferrin
Total iron binding capacity

Ferritin

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Max allowable atmospheric pressure from nitrous in OT in ppm is;

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What is associated with down regulation of nicotinic acetylcholine receptors;
GBS
Organophosphate od
Spinal cord injury
Stroke
Prolonged neuromuscular blockade

Organophosphate poisoning

And MG and anticholinesterase poisoning

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RA most common c spine abnormality is anterior subluxation. What is next most common;

Vertical (10-20%)

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MS pt needs GA. Most likely precipitant;
Hyperthermia
Hypocarbia
Muscle relaxant
TIvA
Volatile

Volatile

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Reduction in DLCO can be caused by;
Asthma
Emphysema
Left to right shunt
Pulm haemorrhage
Bronchitis

Emphysema

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Size (in French) if largest suction catheter that can be passed through size 8 tube they will not take up more than half internal diameter;

Pneumoperituneum causes a decrease in cardiac output at what pressure;

10mmHg

Patient with HITS (dvt on LMwH - plat from 300 -> 150). What is not acceptable;

Warfarin

Maximum dose of lignocaine with adrenaline for liposuction with tumescence technique;

35mg/kg

6yo, 20kg, unable to place 5.5 or 4.5 tube. What next;

LMA

What drug to avoid in women breast feeding 6/52 old baby;

codeine

3yo for elective hernia repair had 200mls apple juice 2 hours ago. What to do;

Continue

Aortic valve velocity 4m/s. What is peak pressure using Bernoulli principle;

64mmHg

New cardiac output monitor called WaCCO. Want to compare readings with gold standard. Best statistical method;

Bland-Altman plot

``` 40yo pulm HTN 80/60 preop. Lap chole. Suddenly sats 87% sbp 80/40 etCo2 ? Cause; Gas emboli Left heart failure MI PTx Righ heart failure ```

Right heart failure

60yo ihd for CABG post CPB hypotensive ST elevation II avF cvp 15, pcwp 25, normal pulm and svr. tOe will show;

Left inferior hypokinesis

Max amplitude teg or totem decreased give;

Platelets

IVDu on 100mg methadone for em laparotomy with effective epidural. Amount IV morphine needed per hour;

16mg 100mg methadone = 400mg morphine

10l /min via facemask size c cylinder 15,000kp lasts;

45mins

Ibuprofen dose 1yo

10mg/kg

To prevent transmission CJD airway contaminated equipment;

134 degrees C for 3min

Brugada syndrome;

Mutation in cardiac Na channel gene. | ST elevation >2mm in V1-3 followed by inverted T wave

``` Management to reduce intraop haemorrhage in liver surgery: High CVP Decreased MaP Deceased CVP Normal MAP Normal CVP ```

Low CVP

Max rise in Na over 24 hours from 105mmol/hr;

10mmol

``` Retro bulbar block - sign of brainstem spread- Atonic pupil Blind ipsilateral Blind contra lateral Diplopia Nystagmus ```

Contra lateral blindness

Distance from lips to carina in 70kg man;

27cm

Which muscle opens the cords;

Posterior cricoarytenoid

Arthrogrophylis multiplex congenita may make it difficult to place a larygoscope due to;

TMJ rigidity

MELd score is calculated using;

Bilirubin, creatinine and INR

Child Pugh is calculated using;

``` INR Albumin Bilirubin Ascites Encephalopathy ```

After resus of a newborn at what time do you like arterial sats to be 85-90;

10 mins ``` 60-70 1mim 65-85 2min 70-90 3 min 75-90 4 min 80-90 5min 85-90 10 min ```

Dibucaine number of 30-80;

What manoeuvre causes mac distension if IJV;

Valsalva

Best way to reduce VAP

Oral hygiene

Chronic AF with Hx HTN, DM, CVA has annual stoke risk of;

8.5% Chads score 4 (risk approx double score)

Airway equipment sterilisation with CJD;

Sterilise with heat at 134 degrees for 3 mins

What is neuropathic pain;

Pain initiated or caused by a primary lesion or dysfunction in the nervous system - causes may be iatrogenic, traumatic, inflammatory or infective Is a risk factor for developing chronic pain

Causes of blindness after surgery;

``` Direct trauma Acute glaucoma CVA Ischaemic optic neuropathy - low flow Central retinal artery occlusion - pressure ```

AHA guidelines for 4 Mets

Light housework (dish washing) Climbing flight of stairs (5mets) Walking on ground level at 4mph (6mets)

7yo with closed head injury, I&V in ICU, serum sodium 142. Most appropriate fluid is;

0.9% saline

``` Pneumoperituneum for laparoscopy is commonly associated with each of the following except; Arterial pressure Vasopressin secretion Inotropic action SVR Venous resistance ```

Inotropic action

Marfans syndrome, thoracoabdominal aortic aneurysm repair. 24 hours later blood noted in CSF drain and patient obtained. Most appropriate urgent management;

CT head

Most likely resp pattern seen in acute c5 spinal cord injury is;0

Increased resp rate

After load reduction is most useful in which of the following; TOF Mitral incompetence Aortic valve incompetence

Aortic valve incompetence

Anaphylaxis, when to check tryptase;

Between one and 3 hours Anzca; 1,4 >24 hours

Management of DBS in middle aged patient with Parkinson's disease;

Turn off DBS for duration of surgery but reactivate prior to emergence

Method for treating raised INR

Prothrombinex and vit k

Patient with metastatic cancer. What's not a useful way to increase ca excretion;

Bispihophonates

108 2014a Postpartum. Numbness over posterior thigh, lateral leg and foot. Weakness on flexion of knee. Had an epidural and instrumental delivery. Likely site of injury; Lunbosacral plexus Sciatic nerve

Sciatic nerve

``` Management of patient on 2l O2, on pca, mildly febrile, rr14, sats 88%, mildly sedated. Incentive spirometry Diuresis Abx Naloxone ```

Spirometry

0.75% ropivocaine placed around structure shown. Triangle structure.... Likely radial;

Unable to extend wrist Misculocutaneous - lateral Median next to it Ulnar superficial Radial under

Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vaporiser at a constant fresh gas flow and vapour dial setting the vapour produced will be;

The same partial pressure as is obtained at 1 atmosphere

Most likely to occur if the earth/grounding plate that is attached to the patient for use with diathermy malfunctions;

Electrical burns

25/40 BP 150/90 on 4 occasions, no signs PET. Which anti HTN not appropriate;

Enalapril

Why do infants desaturated faster than adults;

More difficult to preoxygenate

``` Patient with class 4 shock after gunshot. Clinically coagulopathic 30mins later, has been given 1l hartmanns. Coagulopathy likely related to; Acidosis Dilution of clotting factors Hypothermia Release of tissue factor Tissue hypoperfusion ```

Hypoperfusion

20kg child suffered 15% full thickness burns 6 hours ago. Optimum fluid resus for first hour is;

360mls

Normal response after ECT is;

Transient Brady followed by tachy and hypertension

50yo on bypass for AS. mAP 25 after cardioplegia- what to do?

Meteraminol

80yo ruptured AAA. GCS 12 HR 104, BP 80/50, temp 35, sats 92%. next step is;

Obtain IV access and crossmatch

PICCo works via;

Pulse contour analysis and thermodilution

Targin offers benefit of;

Less constipation

Immunity to hep B demonstrated by;

Hep B surface antibodies

Adult with advances cirrhosis. Best predictor of bleeding is;

Dysfibrinogenaemia

Hypercalcaemia. Initial treatment is with;

IV fluids

OD with 500mg/kg aspirin. Efficient therapy for elimination is;

Haemodialysis

To visualise a superficial peripheral nerve you should use a;

High frequency probe at 90 degrees to skin

80kg pt 30% burns how much fluid in 8 hours

4.8l csl

Regional for em LSCS. C/I chest pain, dyspnoea then loses consciousness. Most likely cause;

AFE

Faster desaturation in fatties due to;

Decreased FRC

Patient with tracheostomy. How to allow to talk;

Deflate cuff, one way valve, fenestrated

Triangle looking nerve = radial

Reduced wrist extension

Earliest sign of high block in neonate post caudal;

Desaturation

Effective method to reduce risk AKI post AAA;

Minimise clamp time

Porphyria patient given thiopentone. Then has a seizure. Which drug should not be given;

Pethidine

What test is decreased in iron deficiency anaemia;

Serum ferritin

Full size c cylinder has pressure regulated from;

1600kpa to 400kpa

MRI tesla 3 least likely to cause harm;

Mechanical heart valve

What happens with magnet over no ventricular ICD;

Switch of antitachycardia function

AFOI via nose. What nerves innervate;

(Olfactory) trigeminal glossopharyngeal vagus p

Cs5 configuration, lead 1;

Anterior Lead 2; inferior

Lowest extension thoracic paravertebral space;

T12

Systemic sclerosis. Which is least likely cardiac manifestation.

Valvular regurgitation

Reason desflurane needs heated vaporising chamber;

High saturated vapour pressure

Delivery with forceps. Loss of sensation over anterior arterial aspect of her left thigh. No motor symptoms. Best explanation is;

Lateral cutaneous nerve of the thigh

ANZCA approved labelling;

``` Yellow - regional/epidural Beige - subcutaneous Pink - other Blue - venous Red - arterial ```

8yo 30kg for OT, starting hct is 35% and transfusion trigger is 25%. Amount of blood to lose before transfusion;

Blood volume x (starting hct- target hct)/starting hct 600ml

Porphyria pt given this. C/o ANSI pain and has a seizure then LOC. What drug not to give;

Pethidine Diaz,sux, pregabalin ok Haematin given for an attack

``` HOCM presents with SOB and angina. What is the best agent to give; GTN Metoprolol Morphine Salbutamol ```

Metoprolol Murmur in HOCM will increase in intensity with Valsalva

Pt has a fempop bypass and has a mildly elevated troponin day 1 post op. No other signs or symptoms, what do you do?

Arrange for a cardiology follow up and outpatient angiogram because he is at increased risk for future MI

``` 40 yo lady with a history of bleeding diathesis presents for tonsillectomy. What is the most likely cause?; Factor V Leiden Protein S deficiency Haemophilia B Anti thrombin III deficiency Protein C deficiency ```

Haemophilia B Rest are pro coagulant

Most cephalad space for a spinal in a neonate where risk to cord minimal;

L3/4

``` St Johns wart potentiates effects of; Dabigatran Heparin Warfarin Aspirin Clopodogrel ```

Clopidogrel Reduced effect on warfarin, heparin, Dabigatran No effect on aspirin

AFOI through nose. Nerves encountered;

Trigeminal, glossopharyngeal, vagus

``` Most powerful predictor of AF post cardiac surgery; Age HTN CVA Diabetes Time on bypass ```

Age ``` Other; Male Hx AF Valvular OT COPD Renal failure Rheumatic heart disease ```

Parkinson's PONV. | What can you give;

Ondansetron

Pt who can shower self and manages other ADLs but get dyspnoea on mowing the lawn. NYHA class;

% PDPH that resolve spontaneously by one week is;

70% 70% 1 week and 95% by 6 weeks

Which piece of equipment is designed for use with a fibre optic bronchoscope; Aintree Cook exchange catheter Frova introducer

Aintree

Possible change on ECG on methadone;

Long QTc

``` Current guidelines regarding CPR include all of the following EXCePT; Allow equal time compress and relax 2 rescue breaths before CPR Compressions 100/min Compression at least 5cm Ratio 30:2 ```

2 rescue breaths before CPR

CS5 lead II

Inferior

Carcinoid tumour persistent hypotension despite fluids and octreotide 50mcg. Should use;

Vasopressin

``` Supraclavicular block, inject 20mls 0.375% ropivacaine, agitated seizure loc. 1st step is; Intralipid Midas Prop Airway and 100% Feel radial and give 100mcg adrenaline ```

Airway

Which organ is least tolerant of ischaemia following removal for transplantation.

Heart

Performing a TAP block. If needle correctly positioned where will you deposit LA;

Between internal oblique and transversus abdominus

DLT in 140kg 160cm. Which depth at incisors would be most likely;

28cm

``` Which of the following decrease during pregnancy; FRC FEV1 Vt RR Bc ```

FRC

``` What is not appropriate for treatment if thyroid storm; Carbimoazole Beta blocker Propythiouracil Plasmapheresis Hydrocortisone ```

Plasmaphoresis

Young pt with anorexia. After three days of eating found to have cardiac failure. Which is important to correct;

Phosphate

What is the mechanism of central sensitisation; Increased intracellular Mg Antagonism if NMDA receptor Glycerine is main neurotransmitter recurrent a delta fibre activation Alteration of gene expression

Alteration of gene expression Glutamine is main neurotransmitter C fibres are activated NMDA activated Mg is decreased

Lung reduction surgery main contraindication/? Poor prognosis;

Chronic asthma ``` Contraindications; Previous major thoracic surgery Prior pleurodesis Bronchitis;asthma;bronchospasm Rehab resistant Pulm HTN FEV1 20mg/day DLCO ```

``` Metastatic lung cancer hypercalcaemia, all would help except; Bisphosphonates Calcitonin Furosemide Na chloride IV crystalloids ```

Bisphosphonates

What potentiates/interacts with adenosine;

Dipyridamole

``` What has weakest evidence for prevention of postop infection; Low inspired 02 Intraop transfusion Hypothermia Hyperglycaemia Smoking ```

Blood transfusion Good evidence; Abx Hand hygiene Thermoreg Mid evidence; Sats Sugar

Paediatric trauma. Breslow tape used to estimate;

Weight and drug dosages

PICCO determines CO using;

Thermodilution and pulse contour analysis

During scoliosis surgery with monitoring if SSEP which tract is being monitored;

Dorsal columns

Complications of mediastinoscopy include all except;

Cardiac laceration ``` Complications; Haemorrhage Stroke Air embolism PTx Arrhythmias Phrenic nerve injury RLN injury Oesophageal tear Thoracic duct injury ```

The MAC awake:MaC ratio of sevo is closest to;

0.34

Numbness in anterior tongue following LMA due to injury of;

Mandibular ("lingular)

70yo non valvular AF off warfarin for 7 days. Daily stroke rate

0.01%

ank spond incorrect;

Normocytic anaemia occurs in 85% cases

What is not useful in Mx of torsades de pointes;

Procainamide

Thermoneutral zone in neonate is;

32-34

Which aortic dissection is managed conservatively;

Stanford B Stanford A and B Debakey 1-3

Essential criteria for LBBB;

Loss of Q waves in V5/6

Parasthesia in little finger during supraclavicilar block, needle is close to;

Lower trunk

Which is seen in conns syndrome;

Hypernatraemia, hypokalamia and normoglucaemia (or hyperglycaemia if anything...)

Commonest valvular disease seen in pregnancy;0

Mitral stenosis

Vasospasm following SAH seen maximally at;

6-8days

Predominant pathology seen in restrictive heart disease;

Diastolic dysfunction

First symptom inadvertent total spinal following caudal

Desaturation

``` 30yo, severe hypertension post topical anaesthesia placed for nasal ot. Least appropriate Mx; GTN Esmolol Labetolol Snp Deepen anaesthesia ```

Labetolol

8yo 30kg starting hct 35%, happy down to 25%. How much loss ok;

600mls

Smoked cannabis prior to OT. May lead to;

Decreased anaesthetic requirement

``` MVA BP 100/60 HR 100 with cxr widened mediastinum. Next appropriate investigation; Aorthography Ct chest MRI Toe Tte ```

CT chest

Slow AF on warfarin INR 2.2 for pacemaker. Prior to insertion;

Continue warfarin

Marfans post thoracoabdominal aneury. Blood in CSF drain. Next course of action;

CT head

Electrical requirement that distinguishes cardiac protected area from body protected area is the;

Equipotentiality

Ingestion 500mg/kg aspirin, most efficient to enhance elimination;

Haemodialysis

Most cephalon interspace in neonate while minimising the possibility of spinal cord puncture;

L3/4

For PCA earliest sign of resp depression is;

Sedation score

``` 6 week old for elective procedure. Appropriate fasting is; 2 breast 4 formula 5 both 6 solids 8 solid, 4 fluids ```

4 hours formula

Reduction DLCO caused by;

COPD

INR 4.5. Needs urgent OT. Vit K already given. What to give;

FFP and prothrombin x

How to differentiate between narrow angle glaucoma and corneal abrasion;

Relieved by topical anaesthesia

Post spinal OT. Parasthesia right arm. Surgeon thinks due to poor positioning. What distinguishes c8-T1 nerve root lesion from ulnar nerve neuropathy;

Weakness in abductor pollisis brevis (median)

Dilutional anaemia compensated by;

Increased cardiac output

Approx BP in awake neonate;

Volatile most likely associated with carbon monoxide poisoning with soda line scrubber;

Desflurane

Principle resistance to airflow in ETT is;

Diameter of tube

Primary pulmonary hypertension (80/60), during procedure desats to 87% BP 89/40, etco2 45mmHg. TOE findings;

Increased RV:LV area, abnormal septal wall motion, TR, RA dilation

Revised trauma score;

GCS BP Resp rate

Apnoeic oxygenation expected rise in CO2 is;

3mmHg

Decrease PONv 33% vs conventional treatment. 8% still get PONv with new treatment. NNT;

Absolute contraindication to ECT is;

Raised ICP

40yo ITP. Retinal detachment OT in 2 days. Platelets 40. Mx of ITP is;

Methylpred and iVIg 2 days preop

Obese man with headache, weakness and polyuria. BP 150/70, displaced apex. Na 145, K2.8, cl 101, most likely Dx;

Primary hyperaldosteronism

Compare new with gold standard using;

Bland-Altman

Thoracic epidural. On waking, pt is weak. Can breath, flex Biceps but can't extend triceps. Level of block will be;

You man describes throat swelling and difficulty breathing following minor dental procedures. Brother had similar episodes. Most likely mechanism;

C1 esterase deficiency Use c1 inhibitor concentrate or FFP to treat

5yo duchenne muscular dystrophy. Inhalation with sevo. 10 mins later arrest with K 8.5. Likely mechanism;

Rhabdomyolisis

6/12 old VSD. Inhalation 8% sevo and 50% nitrous. Trying to get Iv access, sats 85%. Next step;

Reduce sevoflurane

``` Drug to best reduce post op pain following amputation; Amitripyline GABA Tramadol Pethidine ```

Gabapentin

How to assess pain 3yo;

FLACC

Bupremorphine. When does plasma level reach half original;

24 hours

When to start CPR lay person;

Loss of consciousness

Central centizisation due to;

Increased intracellular gene expression

IO cannula correct statement is;

Drug reaction time same as central

Highest risk vasoapasm post SAH is at days;

6-8

Endovascular aneurysm repair GA preferred due to;

Long duration of Apnoeic time

35yo G1P0 dilated cardiomyopathy for LSCS. EF 35%, benefits of regional;

Increaed EF

``` All of the following are found in hyper parathyroid disease except; Decrease urinary calcium Expraossius calcifications Increased plasma calcium Increased urinary phosphate Renal calculi ```

Decreased urinary calcium

Which volatile is the worst for greenhouse gas;

Desflurane

St Johns wart will reduce the effect of;

Warfarin

Normal sensation medial forearm following brachial plexus block. Which part is missed;

Inferior trunk

Prothrombin x useful in period period correct all except;

Isolated factor 7 deficiency

CCf, dyspnoea with mowing lawn, but ok with shower and ADLs;

Class 2

RLL lobe tony. Preop spiro FEV1 2.4l FVC 2.4l. Predicted postop FEV1;

1.7

How does insulin work;

Increases glucose uptake into skeletal muscle

Features of severe AS

Peak velocity 4.2m2 | Area 40

Which regarding ank spond is false;

Normochromic anaemia in 85% cases

Pain from 1st stage labour is from;

T10-L1 2nd stage; S2-4

Sens and spec 90%, prevalence 10% | What is PPV;

50%

``` Type 1 vWillenbrand disease for d&c. Is a JW. In regards to desmopression, all are true except; Synthetic and acceptable to JW Likely to reduce haemorrhage Given as infusion 30mins prior to OT Effect will last 5 days Dose is 0.3mcg/kg ```

Effect will only last 6 hours

Ventilating neonates to target 85-89% desaturation, vs 91-95 associated with;

Increased mortality BOOST2 study

Post lumbar sympathetic block most likely side effect is;

Genitofemoral neuralgia

Regarding la forte fractures;

Le fort 3 associated with fracture cribiform plate

Transient neurological syndrome occurs only with;

Compete resolution of motor blcokadep

Prolonged trendelenberg causes;

Increased myocardial work

Brachial plexus block. Normal sensation medial forearm, which part likely missed;

Inferior trunk (medial cutaneous nerve)

Absolute contraindication to sitting position for posterior fossa surgery;

Patent ventriculo-atrial shunt And large PFO, cerebral ischaemia upright and team not familiar

``` 4yo with murmer. Which feature warrants investigation; Loudness 4/6 Decrease on inspiration Vibratory quality ESM Louder when supine ```

Loudness 4/6 ``` Other; Symptomatic Diastolic, pan systolic, late systolic Variable or harsh Percordial thrill No chance with posture ```

Autonomic supply of ciliary ganglion is such that;

Receives parasympathetic nerve supply from Edinger-Westphalia nucleus (via occulomotor) One of 4 parasympathetic ganglion in head. Located in apex of orbit (ie posterior) It constricts the pupil

Regarding thallium stress testing in predicting periop cardiac events;

High negative predictive value

Meconium delivery Apnoeic cyanotic HR 90. What to do first;

Suction trachea

What happens with magnet over ICD;

Turns off antitachycardia function

Full size c cylinder has pressure regulated from;

16000kpa to 400kpa

Asthmatic give. Salbutamol and atrovent and steroid. Next treatment;

``` Ulcerative colitis is associated with all except; Cirrhosis Iritis Psoriasis Arthritis Sclerosing cholangitis ```

Psoriasis

Regarding rotameters;

Constant pressure difference across the bobbin at all flows

Dilated cardiomyopathy with EF 30%. Best treatment is;

Enalapril

Best clinical indicator of severe AS is;

Prescience of a thrill Mean gradient > 40 Areas

ASS murmur heard due to blood flow through;

Pulmonary valve

What area do you get symptoms at rest with Mitral stenosis;

Nitrous oxide anaesthesia may cause all of the following except;

Reversible inhibition of methionine synthestase | It is irreversible

Diagnosis of neuroleptic malignant requires the presence;

Muscle rigidity Criteria; Major - fevers, rigidity, increase CK Minor - tachy, hypotension, low GCs, increased lymphocytes

Regarding tryptase level testing for suspected anaphylaxis. All true except; Levels peak within one hour Increased anaphylactoid and anaphylaxis reactions 99% found in mast cells Levels >20ng/ml suggestive of anaphylaxis Test repeated 24-48 hours

Levels peak within an hour - it is 1-2 hours

Incidence of FES following unilateral closed femoral fracture;

0-3%

Thoracodorsal nerve arises from;

Posterior cord of brachial plexus

``` Which of the following is least likely to cause hypoxia in aRDS; NORAD Milrinone Isoprenaline Isoflurane SNP ```

NORAD

Best predictor of poor prognosis with AS;

PND (2 yr mortality 50%) Syncope 50% 3yr Chest pain 50% 5 yr

Pierre Robin sequence is cleft palate, miccrognathia and

Glossoptosis

2ml 0.75 ropiv injected for interscalene block. Then LOC. Most likely place for inadvertent injection is;

Subdural

18month old SVT 220, otherwise stable BP 84/60. Management;

Adenosine 100mcg/ml BP in children 80+ age(2) If hypotensive DCCV 2j/kg

When stimulating ulnar nerve which muscle twitches;

Adductor pollicus brevis

Circuit disconnection during spont breathing detected by;

Unexpected drop in end tidal volatile anaesthetic agent concentration

``` Patient undergone lung transplant. All impaired except; Mucociliary clearance Fought reflex distal to anastomosis HPV Response to CO2 Lymphatic drainage ```

HPV

Long QT. How to know if treatment effective;

No further prolongation of QT with Valsalva

Neonate born with Meconium. Otherwise ok: don't suction trachea due to;

Bradycardia

Organism most commonly causes meningitis post spinal;

Strep salivarius

Male patient Hb 8, reticulocyte count 10%. Most likely diagnosis is;

Hereditary spherocytosis

Advantage of supraclavicilar block over interscalene is;

Less phrenic nerve block

Head injury. Unilateral dilated pupil with no direct or consensual response to light. Most likely;

Transtentorial herniation

In an arterial line system;

Wide range of damping coefficient associated with good performance if system has high natural frequency

Commonest post op complication of NOf is;

Delirium Then UTi, LRTI, MI

What is advantage of BB over DLT;

Able to isolate separate lobes

Pulsus paradoxus is;

Larger drop in BP than usual with inspiration

``` Laparotomy for pt with Hx pulm HTN. Regarding Mx; Alpha agonist inotrope of choice Hypothermia protective ISO will decrease PAP Ketamine ok ```

Iaoflurane will decrease PAP

Severe RA. what radiological finding is most consistent with severe Atlantoaxial instability;

9mm gap between anterior arch c1 and odontoid peg

Dose of IV GtN for uterine relaxation;

50mcg

Accurate method of HR in neonate;

Auscultation with stethoscope

60yo having mediastinoscopy. Lose CO, desats and drop CO2. Best Mx,

Place prone

Definitive evaluation of MH does not include; Abnormalities on MRI spectroscopy Ca release from B lymphocytes to caffeine Certain mutations on ryanodine receptor Myofibrillar necrosis on muscle biopsy plasma CK levels above 800u/l

CK levels

What is true of eaton lambert syndrome that differentiates it from mg;

Repeated excercise -> improves

Presented to ED with heel ulcer, BP 100/60, hr 110, temp 35.8, Na 125, K 2.7, BSL 55, creat 180. Most urgent treatment;

Crystalloids

Cause of hypoxia during OLV;

Perfusion of unventilated lung

Child with intraop blood loss. Cardiac arrest most likely because of;

Underestimated blood loss

Lobar plexus supplies all of following except;

Sub costal nerve ``` Contains; Femoral Obtrurator Ilioinguinal Iliohypogratric Genitofemoral Lateral cutaneous Long saphenous ```

To determine specificity of a new test it should be administered to;

A series of people know to not suffer from disease

Pt after anterior cervical fusion. Resp distress and bulge under incision. Combative and removing oxygen. Appropriate management is;

? Gas? Iv

Hypercalcaemia due to hyperparathyroidism associated with;

Polyuria and polydipsia Story QT Muscle weakness

Cause of early mortality in AFE;

Pulmonary hypertension

Best predictor of DI in overweight;

Pretracheal fat

Endocarditis prophylaxis given to;

In repaired CHD Previous IE Mechanical valve Repaired CHD

Best aspiration prophylaxis for urgent OT;

Ranitidine

Most common cause of mortality post transfusion;

TRALI

Most common cause of awareness,

Human error

Apnoeic oxygenation in obese aided by;

Head up tilt

Best renal protection for endoluminal AAA;

NaCl

White cylinder grey shoulder;

CO2

Indicator in soda lime;

Ethyl violet

Intubation over a boogie. Rotate ETT

90 anticlockwise

What is not advantage of drawover vaporiser;

Basic flow compensation

Which does not have abnormal q waves;

Digoxin toxicity

Troponin remains elevated for how long;

5-14 days

Inverted p waves in II can be caused by;

Junctional rhythm

When do most SAh bleed;

First 24 hours

Contraindications IA BP;

AR Irreversible aortic stent Aortic dissection Relative; sepsis

Which tract monitored with SSEP

Dorsal column

Incidence of headache postpartum;

38%

What proportion people AV node supplied by RCA;

80%

Less blood wastage if;

Low transfusion threshold

How long prior to spinal should Dabigatran be ceased,

7 days

When can you remove epidural after prophylactic LMWH dose give;

10-12 hours

Eclampsia dose Mg is;

4-5g over 5 mins

Endocarditis in pt with MVR approapite;

Lithotripsy Some dental providers; extraction, root, replanting teeth D&c if infected Long labour

What is a specific PDE inhibitor;

Milrinone (3) Aminophylline non selective Dipyridamole 1&5

Loading dose for Iv paracetamol;

15mg/kg ie no load Iv | If

Caudal block with clonidine what is increased;

Hypotension and Brady

New onset AF. When can you shock without tOe;

48 hours

Cerebral oximetry measures;

Mostly venous, some arterial saturation

Off label use of drug include;

Different age, indication, route NOT concentration

Not true re remifentail

Metabolised by plasma cholinesterase (it's red cell cholinesterase)

Regarding mixed venous sats;

Can be used to calculate CO

``` Epidural block to T2 causes all of the following except; Bradycardia Vasodilator ion Reduced catecholamines Dyspnoea Elevated co2 ```

Elevated co2

Preop autologous blood transfusion results in less;

Incompatable transfusion

Penetrating chest injury. Most likely to be injured;

Skin between iliac crest and greater trochanter supplied by;

Sub costal nerve

Regarding pyloric stenosis;

Acidic urine

In comparison to MP score, TMD is;

Less sensitive, more specific

Traumatic liver lac. Treat conservatively if;

Haemodynamically stable

C6/7 muscle movement;

Wrist flexion and extension

Paraesthesia in little finger during supraclavicilar block due to contact with;

Lower trunk

SVRI

SVR x BSA

Ratio MaC incision to MAc awake for sevo;

0.34

ASD murmur due to flow through which valve;

Pulmonary

Essential feature of LBBB

Loss of Q waves v5-6 QRS > 0.12s No secondary r wave in V1

RCD installed. Electricity mains | On. Touch neutral and ground. What will happen;

Nothing

Best position IAbP;

1-2cm distal to left subclavian

Blood flow through which valve used to estimate PASP

Tricuspid

Cephalothin doesn't cover

Pseudomonas

Low ca in CkD patient. Cause

Secondary gyperparathyroidism

Conns syndrome;

Hypermatraemia, hypokalamia, normoglucaemia

Dural sac ends where in neonate;

Clopidogrel t1/2

6 hours

What is not a major complication of mediastinoscopy;

Cardiac laceration

Fat: blood coefficient;

Nitrous

SVT in child. Management

Adenosine 100mcg:kg

Clinically most significant murmur in pregnancy;

``` Patient in citalopram. What is not contraindicated; Omen razor Clonidine Pethidine Tramadol Midazolam ```

Clonidine

Most effective treatment post sevo agitation in 4yo;

Fent 1mcg\kg

What is not useful treatment in torsades;

Procainamide

Numb tongue and impaired taste after LMA.

Lingual nerve (from Mandibular cn5)

Lateral approach to popliteal block;

Can be performed supine or prone. Inversion is endpoint

Iron deficiency anaemia;

Low ferritin, tibc high Tibc is low in anaemia of chronic disease

Which is not a Side effect of cyclosporine;

Alopecia ``` Common se's; HTN Renal impairment Gum hyperplasia Dizziness Flu like Headache Increased hair ```

What plotting ratio gives 3% isoflurane

1/13

Ratio breaths compressions neonatal resus;

1:3

What innervate a hard palate;

Maxillary nerve branches | - greater palatine and nasopalatine

Distance from lips to carina in 70kg adult;

27cm

How much air in a 5 LMA;

49mld

Max dose of Intralipid;

12mls/kg

Contraindication IABP

What volumes of FFP required to increase fibrinogen level by 1g/L;

30ml/kg

Bleeding in trauma is reduced by(

Tranexamic acid

In an infant the intercristine line at the level of;

L5-S1

Contraindication to left DLT;

``` Tumour left main Left broncial stent Left lung transplant Left tracheobronchial disruption Left pneumonectomy ```

Pain for the uterus during labour is transmitted via;

The inferior hypo gastric plexus | And Anterior roots of T10-L1

Size c cylinder reads 5000kpa contains how many litres of oxygen;

150 Full size - 13700kpa = 420l

What statistical test will evaluate effects of ?2 drugs in patients at ?3 different points;

ANOVA - test differences in >2 groups

Man working with electrical appliances at home with RCD. If he touched the active and the neutral wire he will suffer;

RCD will protect him from macro shock

Stellate ganglion block causes;

Conjunctival injection

Features of VT do not include;

Absent p waves

Child with 10% dehydration is likely to have;

Rapid deep breathing

Acromegaly due to excessive GH. Why Is laryngoscopy difficult;

Macroglossia

Main loss of heat for neonate is;

Radiation

What drug does not need dose adjustment in renal failure;

Bupremorphine

Average depth of tube in newborn infant;

9cm sims and Johnson Wt in kg +6; qld health

What is mechanism of central sensitisation;

Alteration in gene expression

What is oxygen concentration in standard bottle of heliox

30%

Patient undergoing partial hepatic resection develops venous air embolism. Best position;

Head down, right side up

Time constant calculated by;

Resistance x compliance

Finding of haemophilia A patient;

Normal PT, abnormal APTT

Motor innervation of upper eyelid;

Occulomotor

What proportion heterozygous for pseudo cholinesterase deficiency, ie have dibucaine number 30-70

4% | 0.04

Complication of coeliac plexus block;

Paraplegia

All can prolong QTc interval except;

Magnesium

Patient with mastic typists intraoptively would most likely have;

Hypotension

Carcinoid patient develops hypotension intraop;

Octreotide 100-200mcg

Sensitivity 90%, specificity 99%

False positive 1%

Features if longstanding paraplegia includes all except;

Flaccid paralysis

Commonest feature of anaphylaxis

Hypotension

Safest site for subtenon block;

Inferonasal Worse - medial canthus

Levosomendin;

Conformational change on trop c, t1/2 of metabolite 72 hours

Increased Aa gradient caused by all except;

Decrease Fi02

Stellate ganglion is located;

Anterior to scalenous anterior

Reversed splitting in;

LBBB

Congenital diaphragmatic hernia;

Hyperplasia of pulmonary arteries

Time to reach peak plasma levels for fentanyl patch is;

24hourd

Pharmacological studies phase 3 is;

Randomised trials in target populations

Chemical in soda lime to indicate exhaustion;

Ethyl violet

Main heat loss for neonate;

Radiation Then; Convection Evaporation Conduction

What herbal supplement reacts with tramadol;

St Johns Wart

Retro bulbar block, sign of brainstem spread.

Contra lateral blindness

Marian syndrome. What is not a common association;

AS ``` They get; MR Dissection Conduction abnormalities Mitral valve prolapse ```

Infant with failure to thrive, apical systolic murmur, weak pulses, femoral felt easily. Likely have;

VSD

SAH rebleed in first 24 hours;

Max safe pressure of ETT cuff on lateral tracheal wall

20-30cmH20

Complication of celiac plexus block

Paraplegia Failure to ejaculate

Nerve supply to upper eyelid;

Ophthalmic branch CNV and sympathetic from superior collicus ganglion

Post epidural and LSCS. Next day has Paraesthesia anterior thigh. What additional injury indicates nerve roots instead of peripheral injuries.

Weakness on hip flexion and thigh adduction

All can prolong QTc except for;

Magnesium

Post local block in DI patient, seizure. What to give;

Midazolam

Carcinoid with intraop hypotension. Manage with;

Octreotide

``` Allergic reaction, what is true; Tryptase 8 hours RAST best sens and spec Absent tryptase excludes anaphylaxis Skin and intradermal test sens and specificity ```

Skin test

What most likely to cause TRALI

FFP

``` After 5 units FFP what is least likely to occur; Haemolytic reaction Hypocalcaemia Infection Hyperkalemia ```

Hyperkalemia

Evidence to avoid BIS 5 mins because

Increase post op mortality - b aware trial

What drug causes prolonged QT and risk of torsades

Droperidol

During cardiac cath becomes unstable. What investigation;

Echo

A line isolation monitor protects against micro shock

Under no circumstances

Intraop hyper fibrinolysis. How to diagnose;

TEG

``` What happens after infra renal clamping in AAA; Decreased cardiac contractility Decreased coronary blood flow Deceased renal blood flow Minim hangs co Increased hr ```

Decrease renal flow

Most effective method for cerebral protection in aortic arch aneurysm repair;

Systemic hypothermia to 20

Most common sign if MH;

Tachycardia

Stellate ganglion is located;

Anterior to scalenous anterior

Patient coughs during interscalene block; should direct needle;

Posteriorly

Interscalene block, patient seizure. Most likely injected into;

Vertebral artery

Acromegaly. DI due to;

Macroglossia

Stellate ganglion block associated with all except;

Sweating of face Produces horners; Ptosis Miosis Anhydrosis

Most safe site for subtenon;

Inferonasal

Compared to retrobulbar block, peri bulbar block associated with;

? Less block to orbicularis oculi (cn7)

Diastolic dysfunction not caused by;

Adrenaline

Reversed splitting Hs2 associated with;

LBBB

Lumbarsacral nerve does not supply;

Sub costal nerve

Trauma patient best indicator of good resuscitation;

Lactate

Pregnant patient, involved in car accident, sudden onset central chest pain hr 110, BP 154/80, rr 26, sats 100. Most likely cause;

Aortic dissection

ASD murmur heard at;

Pulmonary valve

Chronic alcohol is not associated with

Nephritic syndrome

Apnoeic oxygenation increased by,

Head up

AFE cause of death;

Pulmonary hypertension

Post partum sudden collapse, suspected AFE, consistent finding is;

Low c3 and c4 | - not diagnostic but is consistent

Nerve block anterior 2/3 ear;

Mandibular

Earliest sign of hypocalcaemia;

Tingling - symptom

Which CHD does not have pulmonary hypertension;

Tetralogy of fallot

Pregnant moderate MS, normal LV, best delivery method;

Epidural analgesia and normal vaginal delivery

TOF correct statement; Mainly left side Cardiac lesions in 60% Usually does not need contrast

Usually doesn't need contrast M=f 20% cardiac lesions

Pulmonary hypertension secondary to lung disease;

Alpha agonist can be used

Sux dose higher in neonates vs adults due to;

Faster diffusion awake from neuromuscular junction

Baby with TOF mx;

Head up, drainage tube in oesophagus

CTG pregnant women non obs OT;

Loss of beat to beat variability

Autonomic neuropathy get all except;

Sinus arrhythmias ``` Symptoms; Fatigue, thirst, dizziness Fluctuating BP Sob Altered HR Gastropesesis Mudras is Urinary incontinence Constipation Heat intolerance Erectile dysfunction ```

Best indicator of return of laryngeal function;

TOF 0.9

Not useful in torsades

Procainamide

Febrile after 8 hours in labour with epidural analgesia;

Inflammatory response

Supply of sensation above vocal | Cords;

Internal branch of superior laryngeal nerve

Supply of carotid sinus;

Glossopharyngeal nerve

Post of pneumonectomy SOB, Ix

BNP

On Mg infusion, respiratory depression. Management;

Calcium gluconate

ESRF with low calcium. Likely due to;

Secondary hyperparathyroidism

How to estimate weight in child;

(Age+4)x2

Commonest presenting feature anaphylaxis:

Hypotension

Advantage off pump CABG;

Decreased transfusion rate

After CABG FRC is;

Decreased 20%

Iron deficiency;

Low serum ferritin, normal serum iron

Why should NSAIDs avoided in >30/40;

Cause closure PDA

Dilated cardiomyopathy EF 30% for LSCS. Benefit of regional vs epidural;

Incensed ejection fraction

Class 1 equipment faulty such that active wire in contact with casing. What will happen when plugged in and turned on;

Electrical fuse immediately break and disconnect from power supply

What is if least benefit it anaphylaxis

Subcutaneous adrenaline

In arterial line system;

Wide range of damping coefficient associated with good performance if system has high natural frequency

Buprenorphine patch on/off | Fentanyl patch on/off

Bup on 12-24, off 12 | Fent on 24-72, off 18

Increased bleeding with all except;

Echinacea ``` Bleeding increases with Ginger Garlic Ginkgo Fish oil ```

Liver surgery. VAE position;

Trendelenberg, right side up

Distance from lips to carina in 70kg male;

27cm

In acute liver injury, highest risk of bleeding;

Coagulopathy

Home handyman, RCD, touches ground and neutral;

Prevented from macro shock by RCD

OLV desaturate; what to do;

Inflation breath upper Peep dependent lung Cpap upper

Most common cause paediatric post anaesthesia cardiac arrest;

Cardiac problem

High airway pressure after tube placed. Next;

Auscultation lung

Relative humidity of fully saturated air at 20degrees and 37 degrees

40%

Best indicator of resuscitation;

Lactate

ASD murmur heard at;

Pulmonary valve

Apnoeic oxygenation in obese increased by;

Head up

Sensitivity 90% and specificity 99% | False positive is;

what is supportive of AFE;

Low c3 and c4 levels

In pregnancy Dural sac ends at;

What CHD does not have pulm | HTN;

Tetralogy of fallot

Indicates autonomic neuropathy except; Reflux Postural hypotension Sinus arrhythmia

Sinus arrhythmia ``` Presenting symptoms; Fatigue Thirst Dizziness Fluctuating BP Sob Gastroporesis Heat intolerance Erectile dysfunction Urinary incontinence Constipation ```

Sensory supply above vocal cords:

Internal branch of superior laryngeal nerve

Post pneumonectomy SOB. Investigation;

BNP

On Mg infusion. Found in respiratory distress. Management;

Calcium

Estimation of weight in child;

Age+4 x2

Compared to mallampati, thyromental distance is;

Less sensitive, more specific

Most commonly reported sign in MH;

Tachycardia

Advantage off pump CABG over on pump;

Decreased transfusion rate

After CABG the FRC is;

Decreased by 20%

Iron deficiency;

Decreased serum ferritin; normal serum iron (1st stage) 3rd stage; low ferritin, absence bone marrow iron

62yo has CRF, total serum ca 2.05. This is due to;

Secondary hyperparathyroidism

When a reaction to an anaesthetic drug is suspected;

The morphine IgE radioimmunoassay is a sensitive and efficient test for detection of IgE antibodies to neuromuscular blocking drugs

Acromegaly due to excess of growth hormone. What is direct laryngoscopy difficult;

Macroglossia

``` Ehlos- danlos most important to specifically do except; Avoid hyper extension Damage to teeth Avoid joint hyper mobility gORD Strict temp control ```

Strict temp control

``` Pt with sickle cell. Hb 90, hct 0.3; Tranfuse Cool him Spinal is safe Avoid thio Tourniquet is absolutely contraindicated ```

Spinal is safe

ECG ; which does not have abnormal q waves;

Digoxin toxicity

Coeliac plexus block. What is a complication;

Paralysis

``` Petit mal seizure. Which is true; Can precipitate seizures by hyperventilating Most common In child 30seconds Rarely familial Isoelectric EEG during seizure ```

Can precipitate seizures by hyperventilating

Post op pneumonectomy. What to do with underwater seal;

Unclamp drain once an hour for 5 mins, leave clamp on rest of time

Therapeutic level of Mg in pre-eclampsia;

3-5 (2 - 3.5

``` Ageing causes; Decreased FRC Decreased CO Diastolic dysfunction Increased creatinine ```

Diastolic dysfunction

Post scoliosis. Decreased movement bilaterally in legs with decreased pain and temperature but spared joint position sense and vibration. What is a fault?

Anterior spinal artery

Obese patient. | Sux - 1mg/kg IBW vs TBW ->

Similar onset similar recovery Should use total body weight - better conditions

T1/2 of active metabolite of levosimendan;

3 days

Anterior branch of femoral | Nerve supplies everything but;

Rectus femoris

Interscalene block placement get medial movement of the scapula. This is secondary to stimulation;

Dorsal scapula nerve

Popliteal block placed from lateral approach;

Can be performed supine or lateral

Scoliosis surgery. Monitor somatosensory evoked potentials. Which tract monitored;

Dorsal column

Flow with O2 flush will give you(

30-70l/min

Heat loss in neonate;

Radiation

If type and Rh specific blood given how safe is it;

99.8%

% SAH troponin positive;

15-30%

Duchenne muscular patient give sux. What are you most worried about;

Hyperkalemia

Fontan patient having an appendicectomy. What do you want;

Spont ventilation

What makes tramadol less effective;

Ondansetron

Most common way to measure end tidal gas concentrations on anaesthetic machines;

Infrared

How far to inset PICC in child in relation to carina;

1cm above

Reverse splitting of heart sounds due to;

LBBB

TRALI most likely after

FFP

What is not a disadvantage to drawover vaporiser vs plenum ;

Can not use sevoflurane

Number of people in community with predisposition at any given time is;

Prevalence

OLV and hypoxia. After 100% oxygen and FOB next step is;

PEEP bottom lung

``` Exponential decline (time Constant definition) ```

Time to reach 37% of initial value

TURP. Patient under spinal, Na 117. Treatment;

3% n saline 100ml/hr

How fast does co2 rise in apnoea;

3mmHg

``` Visual loss with pupillary reflexes intact; Retinal detachment Occipital mass Frontal mass Chiasmal mass Optic neuritis ```

Occipital Mass

4yo for tonsillectomy; | PONV risk;

40% if no antiemetic given

Recommended FiO2 for neonatal resuscitation

0.21

First clotting favour to reach critical level with surgical bleeding

Level 1 - fibrinogen

``` Most useful sign to distinguish between severe serotonin syndrome syndrome and malignant hyperthermia are; Clonus Hyperthermia Met acidosis Muscle rigidity Wheeze ```

Clonus

Pred 10mg/day. | What is equivalent dose of dexamethasone;

2mg

20kg child with LA toxicity. What dose Intralipid;

30mg

PDPH which is inconsistent

Presents immediately post | Partum

``` Eclamptic. On Mg infusion. Common symptom; Brady Arrest Hypotension Depressed resp effort ```

Hypotension - bolts Low resp effort infusion

Difficult thyroidectomy. Immediately post extubation develops stridor and resp distress. Likely cause;

Recurrent laryngeal nerve palsy

RFTS show fev1 and FVC reduced. Ratio 98%, DLCO 8 ( predicted 30). cause?

Pulmonary fibrosis

TBI. Cerebral perfusion 15ml/100g/min. Consistent with;

Cerebral ischaemia

Dilated thrombin time measures anticoagulant activity of;

Dabigatran

In trauma hypothermia exacerbates bleeding by;

Inhibition of clotting factors

How much K needed to raise from 2.8 to 3.8

100mmol 1mmol increase needs 10mmol kcl

Haemodynamically stable. Blunt chest trauma. Best screening test;

12lead ECG

Fidelity;

Following professional code of conduct

Correct position of PICC in child;;

1-2cm above carina

Cophenylcaine in eyes. Results in;

Midriasis

New drug 50% more effective. 4% still get PONV. NNT is;

White cylinder with grey shoulders contains;

CO2

Inserting IJ line, why not turn head to far lateral;

Compresses vein

``` 2hrs post crush injury. What would you see; Low ca Low k Low phos Low irate Alkalosis ```

Low ca

Floppy Apnoeic blue hr 90 neonate. What to do

Suction trachea

Medical therapy vs TAVI at 30 days decreased risk of;

Stroke

Volatile agent analysed via;

Infrared

What is not constituent of prothrombinex VF

Protein c

Asymptomatic lady. ECG LAD RSR V1 wide slurred s in V6 and QRS 0.13. Options for OT;

Continue - Bifasicular block with anterior fascicle gone (ok)

Blalock taussig shunt into right PA from;

Right subclavian

Half life of mast cell tryptase

2 hours

Most common cause of mortality post transfusion;

TRALI

Air bubble leads to decreased;

Resonant frequency

What valve area get symptoms at rest MS

1cm2

Inverted p waves caused by;

Junctional rhythm

Hb 80, reticulocyte 10%

Hereditary spherocytosis

Prolonged trendelenberg results in;

Increased myocardial work

Contraindication to IABP

Scoliosis OT. Which tract monitored with SSEP

Dorsal column

How long prior to spinal anaesthetic should Dabigatran be ceased

5 days

Following eclampsic seizure dose of Mg is;

4 grams

Mec stained liquor with vigorous neonate. Rationale to not suction;

Bradycardia

What does NOT occur following bilateral lung transplant

Impaired HPV

Caudal block in child, add clonidine to prolong. What significant complication is increased;

Sedation

``` Systematic review. What is not a weakness; Author bias Publication bias Duplicate publication Heterogeneity Inclusion if historic studies ```

Inclusion of historic studies

Sats 90%. No IV. LMA and spasm. What to do;

IM sux

Required for diagnosis of NMS

Muscle rigidity

``` Lap chole on citalopram. What is NOT relatively contraindicated; Omeprazole Clonidine Pethidine Tramadol Midaz ```

Clonidine

Question about ciliary ganglion

Preganglionic parasympathetic originates from Edinger Westphal nucleus

All need reduced dose in renal failure;

Buprenorphine

Most common sign in malignant hyperthermia

Tachycardia

Plasma glucose vs blood | Glucose

14% higher

Most common cause if post op visual loss

Ischaemic optic neuropathy

Dura in child ends at

Handy man, touches neutral and ground. What will happen

Nothing will happen

What splitting ratio gives 3% concentration ISO;

1:13

Half life of clopidogrel

6 hours

What is NOT A SIDE EFFECT OF cyclosporine

Alopecia ``` Common SE; HTN Renal impairment Gum hyperplasia Dizziness Flu like Headache Increased hair ```

Innervation of hard palate;

Maxillary nerve; | Greater palatine and nasopalatine

Distance from lips to carina in 70kg male

27cm

Air in size 5 LMA

40ml

Intercristine line in infant

L5-S1 Cord ends L3 Dura ends S3/4

MAC awake: MAC of sevo;

0.34

Pain from uterus is from;

Inferior hypo gastric plexus | Dorsal roots T10-L1

Size c cylinder reads 5000kpa contains approximately how many litres if oxygen;

150L

Loss of sensation to anterior part of tongue;

Lingual Branch of trigeminal nerve V3

Failure to thrive. Apical systolic murmur, weak pulses, femoral felt most easily. Likely have;

VSD

Acute liver injury, highest risk of bleeding due to;

Coagulopathy

Stellate ganglion block causes;

Conjunctival injection

Features if VT does not include;

Absence of p waves

When studying control and two test grips, best statistical method is;

Analysis of variance

Child with 10% dehydration likely to have;

Rapid deep breathing

Why is direct laryngoscopy difficult in acromegaly;

Macroglossia

Circuit disconnect during spont breathing;

May be detected by an unexpected drop omens tidal volatile anaesthetic agent concentration

Paraesthesia in little finger during supraclavicilar block. Needle is in proximity to;

Lower trunk

Best predictor of severe bleeding in cirrhosis;

Hypofibrinogeneamia

Oxygen concentration in Heliox

30%

Fontan. Best way to maintain cardiac output

Short inspiratory time

Clinically significant cardiac lesion in pregnancy;

Blood flow across which valve measures PAP during echo

Tricuspid

Machine left on over weekend. Des put in. What toxic substance will be produced;

Carbon monoxide

What two nerves most reliably blocked in fascia iliaca block

Femoral and lateral cutaneous

What is true of MG and ELS. What happens with exercise

EL better, MG worse

WPW, develops tachy. Best drug to cardiovert;

Amioderone

What gestation to monitor uteroplacental flow;

24weeks

Pulmonary hypertension in all except;

Tetralogy of fallot

Movement supplied by c6:7

Wrist flexion and extension

Mastocytosis. Intraop would expect;

Hypotension

A line isolation monitor protects against micro shock,

Under no circumstances

Air fully saturated at 20%. What is relative humidity at 37 degrees

40%

50yo with multiple fractures. Best parameter to monitor volume resuscitation is;

Changes in right atrial pressure during inspiration

Anaphylaxis to rocuronium. What is most likely to cause cross reactivity;

Pancuronium

Hypotension post propofol in elderly. More profound than in younger patients. Reason?

Concentric LVH associated with ageing and therefore preload dependent

``` Predictive factors for mortality in elderly patient all except; AS DM Elevated creat Cognitive dysfunction Type of surgery ```

Cognitive dysfunction

``` Elderly patient. Indications for pre fem-pop bypass angiogram include all except; Severe HF Suspicion left main disease Symptomatic tachyarrhythmia Unstable angina Stable angina with positive thallium ```

Symptomatic tachyarrhythmia

How to minimise risk of iv cannulation with epidural insertion is;

Injection of saline through epidural needle before catheter insertion

Timing of peak respiratory depression post intrathecal 300mcg morphine;

Peak 6 hours... Between 3.5-12

What is the strongest stimulus for ADH secretion

Hypocalcaemia High serum oscillatory is most sensitive

Stellate ganglion block. Needle entry next to C6. What direction to advance needle.

Thermoneutral zone in 1 month old;

32-34 degrees

4yo with arthrgrophysis multiplex congenita for dental surgery. Jaw rigidity post induction. Likely cause.

TMJ rigidity

Cell saver. What doesn't get filtered;

Foetal cells

Humanitarian mission. What one element needed;

Non rebreathing valve

Gabapentin reduces postop;

Nausea

Burns dressings. What has proven analgesic benefit;

Biosynthetic

Subtenon. Worst position;

Superonasal

Liposuction. Infiltration with 1:200,000 adrenaline. Peak plasma concentration occurs at;

18hours

Salycilate poisoning.

Metabolic acidosis Also causes hyperthermia

Combative patient post ACDF. In recovery. Confused and combative. Most appropriate way to secure airway;

Gas induction, laryngoscopy and intubate

Hypocalcaemia. Earliest sign

Tingling of face and hands

Young patient for tonsillectomy with history of bleeding. What is most likely cause;

Haemophilia B (Christmas disease)

Visual loss with pupillary reflexes retained. Likely cause

Occipital mass

Nerve block for anaesthesia anterior 2/3 of ear

Mandibular nerves

CRPS. What proportion have motor involvement;

75%

Patient with Hx COAD and suspected pneumonia. Clinical finding supporting right pneumonia:

Dull percussion note and increased vocal resonance

Young woman having cholecystectomy. Venous air embolism;

Most lovely to occur at initial gas insufflation, but can occur and any time.

LSCS for failure to progress. Spinal inserted uneventfully. Next day patient has foot drop. Most likely cause is;

Lunbosacral palsy

What LMA gives best seal;

Intubating - oesophagus | Proseal at trachea

Peak plasma level of lignocaine after epidural;

30mins

On citalopram. What drug is relatively contraindicated.

Tramadol

30yo. Long operation. Arms abducted to 60 degree. Head turned slightly to left. Post op numb palm, thumb, index finger, middle finger and lateral half ring finger. Numb ventral forearm. Weak finger grip. Weak elbow flexion. Most likely injured;

Upper trunk brachial plexus

Fontan. What ventilator setting to increase to improve sats

Exploratory time

Von hippel lindau disease associated with;

Phaeochromocytoma

7kg infant with TOF post BT shunt. Paralysed and ventilated. Sats 85% usually. Now 70%. Best treatment;

Phenylelhrine 35mcg -> increase LV afterload

Sub cut heparin, develops DVT and platelets 40. Management;

Lepirudin

Compared to lignocaine, bupivicaine is ;

Four times as potent

Interscalene block. Patient hiccups. Where do you redirect needle.

Posterior

Stellate ganglion;

Anterior to scalenous anterior

The median nerve;

Can be blocked at the elbow immediately medial to the brachial artery

Baby with TOF found by bubbling salvia and NgT coiling on CXR. Best Mx

Position head up and insert suction catheter in oesophagus

Main indication biventricular pacing;

CCF

The intercostal brachial nerve

Can be damaged by tourniquet

Post carsiac arrest. Making Dx of AFE large amount of PMNs surrounding foetal squamous cells are;

Supportive

Half life tirofiban

2 hours

Why is codeine not using in paediatrics

High inter individual pharmacokinetic variability

MG. Features predicting need for post op ventilation except;

Increased sensitivity to NMBs

Innervation of larynx

Cuff compression recurrent laryngeal nerve against thyroid can cause palsy

IV paracetamol;

Late plasma levels around the same as oral

Most likely to result in myocardial infarction

Post op myocardial ischaemia

Indication for percutaneous closure if ASD

Secundum

Respiratory function in quadriplegics is improved by

Increase in chest wall spasticity

Histamine release in anaphylaxis does not cause;

Myocardial depression

A device that detects a 10mV difference in active and neutral leads and causes turning off of the curciut within 40ms. This is a

Residual current device

OLV and hypoxia. After 100% O2 and FOB next step is;

PEEP 5cm bottom lung

Plasma glucose compared to blood glucose level;

14% higher

With regards to OSA which statement is incorrect;

Rarely has an obstructive component

Management of rhabdo. Best management

IV fluids

RCD

Compare current between active and neutral lines

Serotonin syndrome reported following SSRI with

St Johns wort

Why is tachycardia bad in MS

Increases transvalvilar pressure gradient

What is not a feature of high spinal block

Tachycardia

Stellate ganglion block associated with all except;

Sweating

``` Recognised clinical associations with dystrophia myotonia include; DM Abnormal intestinal motility Cardiomyopathy Ovarian dysfunction All of above ```

All of above

When hearing loss occurs following spinal anaesthesia it is usually in which range;

125-1000Hz

Anaemia in chronic renal failure is characteristically

Associated with increased 2,3DPG levers in blood cells

Central anticholinergic syndrome which is NOT true;

Will improve with neostigmine

Carcinoid syndrome. Finding on examining heart

Systolic murmur left eternal edge

Lowering intra ocular pressure by applying pressure in the globe is typically contraindicated in a patient having

A revision traveculectomy

Muscle not supplied by sciatic nerve

Gluteus maximums

Hypercalcaemia

Short QT

Cocaine overdose. What is false

Miosis

Plenum vaporiser

Realies on constant flow of pressurised gas

Paralysed with area curium. TOF is 1. You give dose 0.1mg/kg mivacurium to close abdomen. When will you be back to TOF 1

10 mins

SVR in patient with MAP 100, CO 5, PCWP 15, CO 5

1520 dynes/sec/cm

Accidentally cannulate carotid artery with 5 lumen CVC before semi urgent CABG. Appropriate next step

Vascular surgeon to repair it

Post TKR. Femoral nerve catheter | In place. Good analgesia and ROM 18 hrs later, 24hours post op unable to flex knee. What is cause

Compression neuropraxia

75yo moderate AS (area 1.1). Asymptomatic. Needs hip replacement;

Continue with surgery

JW having THR. Most effective technique to minimise post op anaemia

Cell salvage

``` Recognised associations with dystrophia myotonia include; DM abnormal intestinal motility Cardiomyopathy Ovarian dysfunction All of the above ```

All the above

Elderly patients and opioids;

There is impairment if pain inhibitory systems

Anticoagulant Mx when performing sub tenon block.

Continue if target

``` Sympathetic block could be effective in treating all of the following conditions except; Chronic tinnitus Quinine poisoning Post cardiac surgery pain Phantom limb pain Compartment syndrome ```

Compartment syndrome

``` Earliest sign in MH Acidosis Hyperthermia Increase ETCO2 Muscle rigidity Myoglobinuria ```

ETCO2

Chronic post op pain;

After thoracotomy has an incidence of 50%

Correct statement regarding medical laser hazards include all except; Co2 cause corneal opacification Co2 readily absorbed by most tissues In general shorter wavelengths are most strongly absorbed Nd:YAG laser can injury the retina Effect of laser depends in wavelength and power density

Incorrect; short wavelength more strongly absorbed

Post partum foot drop most frequently caused by

Compression of Lunbosacral trunk by foetal head or forceps

When iv Mg is used loss if deep tendon reflexes seen at

3.5 - 5 mmol

Transient neurological syndrome. Clinical features include;

Increased risk with early ambulation

Regarding codeine

When given orally it has approximately 5% of the analgesic potency of morphine

What statement about fondaparinux is not true

It has a structure unrelated to heparin

When is it necessary to use glycine as irrigation fluid for TURP;

Monopolar diathermy

The most useful sign to distinguish between severe serotonin syndrome and malignant hyperthermia is

Clonus

With surgical bleeding the first clotting factor to reach critical level is

1 - fibrinogen

PPV

Proportion who have a positive test result who do have disease

Post thyroidectomy. 30mins post op. Develop resp distress. Likey cause;

Bleeding and haematoma

Best way to prevent hypothermia

Prewarming

Desflurane vaporiser can't turn on. NOT because;

Hotter than 39 degree

Most common cause maternal cardiac arrest

Most likely change CTG with anaesthesia for non obs surgery at 32 weeks.

Loss of beat to beat variability

HOCM. VF on induction. First priority;

Defibrillate

PDPH. What not consistent

Headache immediately after procedure

Phaeochromocytoma GA and epidural. On phenonoxybenzamine and metoprolol. On SNP and phentolamine. BP still high. Next step

IV Mg

Pt with thallesemia trait for epidural. BP up, mild proteinuria, before placing epidural check;

Platelets

Most common CHD

VSD

Ach receptor down regulated in;

Organophosphate poisoning (and MG)

MG. Need for post op VF ventilation except for;

sensitivity NMBD

What is not a branch of Mandibular

Great auricular

What not to use for seizure management in porphyria

Phenytoin

Multiple sclerosis is exacerbate by

Heat

``` With MS best to avoid; Regional Neostigmine Panc Sux ```

Six

Question about sarin

Fasiculation

Nerve to block for painful neuralgia parathetica

Lateral femoral cutaneous nerve ( Bernard and Roth syndrome)

Pyloric stenosis

Alkaline then acidic urine

Which can deliver minute ventilation of greater than 5l/min using a 14G cannula used for needle cric

Jet ventilation using pressue 400 kpa

Congenital diphragmatic hernia

There is hyperplasia of pulmonary arteries

CO2 laser Does Not cause deep tissue damage because

Dissipation of energy

Supine hypotension in late pregnancy associated with

High SVR

Non normal distributed pain scores. What is best way to describe the spread of data

Inter quartile range

Number of people correctly identified as not having disease

Specificity

If a test is negative what proportion of people will not have disease

NPV

Cryo insufficient in

Factor 9

Most likely to result in MI

Post op myocardial ischaemia

Awake patient with DI

Urine Na

Worst coahulopthy after liver transplant

1-2 days

ASA was first introduced to

Standardise physical status class of patients

An incorrect statement about autonomic nervous system is;

Heart rate response is primarily | Mediated through sympathetic nervous system

What is not true about flow volume loops

Restrictive loops have convex appearance expiraotry

Cadaveric renal Tx. k has increased. Patient required

ABG to asses acid base status

Pre ganglionic fibres pass to the

Coeliac ganglion

BP measurement overestimates with

Atherosclerosis

Post transfusion hepatitis in Australia is associated with

Hep b in majority

In a trial 75 Patients have uncommon complication and 50 matched patients without complication are selected for comparison. From this data

The relative risk of this complication with the drug can not be determined

Features of TURP all except

Tinnitus

Scoliosis surgery. What is incorrect

Major neurological deficits that occur are due to posterior column

Which hormone not released during surgery

TSH

Paeds VF arrest. | Which is true

If resident to defin give amioderone 5mg/kg

Smoked cannabis prior to OT. Taking it might lead to;

Decreased anaesthetic requirement

Sens and spec 90% for disease with prevalence for 10%. What is ppv

50%