MCQ Recalls Flashcards
Immediate treatment for avulsed tooth that can’t be replantation?
Placed in refrigerated cow milk
Pre-eclampsia woman at 30 weeks - what are the cardiovascular changes?
High BP due to increased SVR.
Reduced cardiac output due to combination of diastolic dysfunction and increased after load
Dose of adenosine for SVT?
incremental dose of 6mg, 12 mg, then further 12 mg if needed.
Usually attempt vagal manoeuvres prior to adenosine
ECG findings of Brugada?
What’s the management?
Coved ST segment elevation ≥2mm in one or more right precordial leads V1-V3.
- The elevation is followed by a negative T wave
ICD implantation is recommended.
5 kpa = ?mmHg?
5x7.5 = 37.5mmHg
What is the use of a Arndt connector?
For bronchial blocker - used to establish OLV.
side port for circuit.
Straight port for bronchoscope
Side, diagonal port fro bronchial blocker
ANZCA return to practice guideline - how long in terms of supervision is required for every year missing?
4 weeks
When does thyroid storm present in the periop period?
Usually in early post-op period, but also on induction, intra-op, and in the first 4 days after surgery
Symptoms of thyroid storm?
High fever, tachycardia, hypertension, agitation/confusion, jaundice, abdominal pain.
Treatment of thyroid storm perioperatively
Beta-blockers in the acute phase (propranolol, labetalol)
Corticosteroids
TTE findings of pulmonary HTN ?
Elevated tricuspid regurgitation velocity of > 3.4m/s
Estimated RVSP of >35-40mmHg
RV/RA dilation, RV hypertrophy, reduced RV systolic function
Methylene blue vs. patent blue?
Methylene blue
- lower anaphylaxis
- higher fat necrosis at injection site
- similar sentinel node identification
- does not cause drop in pulse ox
What can cause auto stimulation for a deep brain stimulator/vagal nerve stimulator used for refractory epilepsy
Tachycardia
Treatment for recurrent Torsade?
Lignocaine or mexiletine
What is a Watchman device?
Small, implantable medical device designed to reduce the risk of stroke in patients with non-valvular AF.
Designed to close off the LA appendage
Which anti-emetics should patients with Parkinson’s disease avoid?
Metoclopramide
Prochloreperazine
Chlorpromazine
Droperidol
Promethazine
Safer options are domperidone, ondansetron, cyclizine
Major findings of the METS study in terms of
- NT Pro BNP
- Subjective assessment
- 6MWT
- DASI
Elevated BNP >300 = increased risks of post-op 30 day myocardial injury/death
Subjective assessment = poor agreement with validated questionnaires
DASI, combined with Revised Cardiac Risk Index, associated with 30d mortality or MI, but not as strong as pro BNP
6MWT below 350m =poorer outcome
What does pulse pressure variation indicate?
a PPV of >15% in a mechanically ventilated patient indicates fluid responsiveness
Dose of midazolam in children for status epilepticus?
For 20kg child
Buccal 0.3mg/kg -> 6mg
IN 0.3mg/kg -> 6mg
IV 0.15mg/kg -> 3mg
IM 0.2mg/kg -> 4mg
TAVI vs. SAVR disadvantages
Higher risk of paravalvular leak
Increased need of PPM
Higher is of vascular Cx
Potential for valve pop-outs
Higher risk of coronary occlusion
Higher reintervention rate
Posterior shoulder pain post interscalene nerve block - which nerve should be targeted?
Suprascapular nerve
What did the PREVENTT trial show?
Pre-op IV iron for major abdominal surgery.
- Increased pre-op Hb level by 8g/L
- No significant difference in need for blood transfusion or death at 30 days.
- No diff in safety and secondary outcomes
Chin numbness post 3rd molar extraction cause by neuropraxia of which nerve
Inferior alveolar nerve
Main sensory innervation to the breast comes from?
Anterior and lateral cutaneous branches of the thoracic intercostal nerves T3-T5
Supraclavicular nerve from C3-C4 innervating the upper and lateral portions of the breast
Benefits of Intraop 20mmol/L magnesium
Reduce anaesthetic requirement
Analgesia
Potentiates NDMR
Lower PONV and shivering
Haemodynamic stability
Treatments of a Tet spell?
(cyanosis when SNS activated)
Fluid bolus
Vasopressor
Beta-blocker
Sedation
What is a tet spell?
Reduced pulmonary blood flow -> increased right to left shunt in TOF -> cyanosis
What does TAPSE indicate?
RV systolic function / contractility
<17 = RV dysfunction
Key differences of CALS vs. conventional ALS?
Avoidance of external chest compressions and full dose adrenaline
Three-stacked shocks + resterntomy within 5 mins of arrest
What is the Borg scale during stress test
Rating of perceived exertion
Rumack-Matthew nomogram is validated for use in paracetamol overdose with
Single ingestion of immediate release only
Prilocaine bier’s block who not to give it to patients with?
G6PD deficiency
Heart transplant patient has increased sensitivity to
Adenosine
NNT of ibuprofen?
2.4, very good
1.6 for ketorelac
DDAVP indications include EXCEPT
- Haemophilia B
- Uraemic bleeding
- vWD type 2a
- Diabetes inspidius
- Noctural polyuria
Haem B
V5 ECG dot location?
Anterior axillary line, 5th intercostal space
Tracheal deviation away from lung white out.
Ddx?
Mass effect
- Pleural effusion
- Intra-pulmonary mass
- Diaphragmatic hernia
Tracheal deviation toward lung white out.
Ddx?
Mainstem obstruction
Pneumonectomy
Pulmonary hypoplasia
Due to volume loss
When to prognosticate after cardiac arrest?
72 hours
What is formication?
Sensation of ants or insects crawling on or under the skin.
A specific type of paraesthesia
What is warm ischaemia time?
Time an organ remains at body temperature after blood flow is stopped, or before it is cooled for preservation
Cut off of EtCO2 to rule out oesophageal intubation?
> 10mmHg
Treatment of extravasated Norad?
SC phentolamine
What does cryoprecipitate contain?
Fibrinogen
Factor 13, factor VIII
vWF
Fibronectin
Most common cause of cardiac arrest intra-op?
major haemorrhage
What does addition of heavy formulation to 0.5% bupivocaine do cf. standard 0.5% plain
higher block
shorter duration
Typical diagnostic criteria for serum tryptase for anaphylaxis?
1.2x baseline level, and the increase is greater than 2ng/ml
