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297 Cards in this Set
- Front
- Back
Investigation of a suspected anaphylactic reaction requires measurement of tryptase |
A - 99% of body tryptase is in mast cells - true |
|
Which of the following statements regarding anaphylactic |
A. cross sensitivity between latex and bananas, chestnuts and avacado have been reported - true: "There is a recognized cross-reactivity between latex sensitivity and certain foods, especially bananas, chestnuts and avocado." (Anaphylaxis, in Continuing Education in Anaesthesia, Critical Care & Pain 2004 4(4):111-113) |
|
Post-transfusion hepatitis in Australia is associated with |
C |
|
Which of the following statements is INCORRECT? Recombinant Factor VIIa |
A. directly activates Factors IX and X on the surface of activated platelets, leading to thrombin formation |
|
The most frequently reported cause of mortality associated with transfusion of blood and blood products is |
TRALI |
|
In a patient requiring FFP where the patient’s blood group is unknown, it is ideal to give FFP of group |
A. A |
|
A young woman with type 1 von Willebrand disease presents for a dilatation and curettage. She is a |
A - Clearly true, acceptable to JWs |
|
During transfusion of platelets a patient develops fever, rigors and vomiting |
C (too systemically unwell for D) |
|
Features of the transurethral resection of the prostate (TURP) syndrome include a11 of the |
E |
|
The estimated risk of infection following percutaneous exposure (needlestick injury) to HIV is |
B |
|
The most important factor in reducing peri-operative morbidity in diabetic patients |
D |
|
The observed fall in cardiac output induced by carbon dioxide pneumoperitoneum (with intra- |
The observed fall in cardiac output induced by carbon dioxide pneumoperitoneum (with intra-abdominal pressures below 12 mmHg), during laparoscopic cholecystectomy is primarily a result of |
|
Post-operative delirium in the elderly is associated with all of the following factors EXCEPT |
E |
|
Regarding Epidural Abcess - which is WRONG |
A. Diagnosis is DEPENDENT on triad of back pain, fever, and paralysis - false and the ANSWER to CHOOSE: "The early signs and symptoms may be vague, the 'classic' triad of back pain, fever and variable neurological deficit occurred in only 13% of patients by the time of diagnosis, and contributed to diagnostic delay in 75%." (Grewal et al, Epidural Abscesses in BJA 2006 96(3):292-302) |
|
Possible mechanisms of postoperative visual loss include each of the following EXCEPT |
C |
|
The most frequently reported clinical sign in malignant hyperpyrexia is |
D |
|
A l3-year-old boy with Duchenne's muscular dystrophy |
B |
|
A 4y.o. boy presents for insertion of grommets. His |
C (only test that can rule out MH) |
|
Each of the following is effective in the treatment of pain from acute herpes zoster EXCEPT |
A. acyclovir - true: "Antiviral agents started within 72 hours of onset of the herpes zoster rash accelerate the resolution of acute pain (U) (Level I), but do not reduce the incidence of postherpetic neuralgia" |
|
A strategy shown to reduce the incidence of severe phantom limb pain |
A. continuous regional blockade using nerve sheath catheters - false: "Infusions of local anaesthetics via peripheral nerve sheath catheters, usually inserted by the surgeon at the time of amputation, are a safe method of providing excellent analgesia in the immediate postoperative period (Pinzur et al, 1996 Level II; Lambert et al, 2001 Level II). However, they are of no proven benefit in preventing phantom pain or stump pain (Halbert et al, 2002 Level I)." |
|
When compared with intra-muscular or subcutaneous opioid regimens, patient controlled analgesia (PCA} with opioids |
B |
|
Which of the following statements regarding the use of epidurally administered adjuvant drugs with epidural analgesia for acute postoperative pain is FALSE? |
B or C |
|
Complications of mediastinoscopy include all of the following EXCEPT |
A. air embolism - TRUE listed in both Miller and CEACCP article |
|
A healthy female patient is undergoing a laparoscopic sterilisation under a relaxant based general anaesthetic. |
ECG: correct "must be available for every anaesthetised patient" |
|
The single best predictor of difficult intubation in a morbidly obese patient is |
D |
|
Which of the following statements regarding infection control is FALSE ? |
A |
|
During elective major vascular surgery the best way to reduce the risk of acute renal failure is |
B or C |
|
Intubation of patients with acute C5 spinal cord injury |
E |
|
A 25-year-old 80 kg male with no other health problems is undergoing ECT |
A |
|
Which of the following is NOT an absolute contraindication to magnetic resonance imaging? |
E |
|
You have anaesthetised a patient with a partially obstructing right main bronchus tumour. |
B correct |
|
Isoflurane is administered in a hyperbaric chamber at 3 atmospheres absolute pressure using a |
The key point is that vaporisers use saturated vapour pressure, which is a function of temperature and not ambient pressure. The concentration delivered is inversely proportional to the ambient pressure (hence one third the indicated vapour concentration - A and B are wrong). "However, the partial pressure pressure of the agent, which determines the clinical effect, remains constant" (Ward's anaesthetic equipment, 5th edition, p491). Hence the answer must be D |
|
In a rotameter the: |
A. Bobbin spins inside a tube that has parallel sides - false - tube is tapered |
|
An anaesthetised patient is ventilated and has standard monitoring plus a central venous line. As the surgeon is commencing the case, the line isolation |
D |
|
The treatment LEAST likely to be useful for torsades de pointes is |
A. defibrillation - true: "Direct current cardioversion usually will transiently terminate the arrhythmia." (Complications during vascular surgery: basic principles and management of arrhythmias, in: Bailliere's Clinical Anaesthesiology Vol. 14, No. 1, pp. 87-96, 2000) |
|
In the management of torsades de pointes (polymorphic ventricular tachycardia), all the |
A. amiodarone - false and answer to choose: Amiodarone prolongs the QT interval and is widely reported as a precipitant of torsades de points. "We present two patients who had life-threatening arrhythmias, which are highly likely to be secondary to amiodarone. This class III anti-arrhythmic is commonly prescribed for the acute presentation of supra-ventricular and ventricular arrhythmias. However, occasionally its use can transform arrhythmias from benign to dangerous. These cases highlight the need for careful attention to the indications, cautions and contra-indications of amiodarone as well as the need for vigilance following initiation of anti-arrhythmic therapy." (Resuscitation, Volume 76, Issue 1, Pages 137-141 (January 2008)) |
|
Characteristic cardio-pulmonary effects of pulmonary thrombo-embolism include |
A |
|
A 24 year old female with mitral valve prolapse develops atrial flutter during a |
B |
|
Reverse splitting of the 2nd heart sound is caused by |
A. acute pulmonary embolism |
|
60 y.o with acute aortic regurgitation. In pulmonary oedema. BP 160/90. |
C |
|
When viewing the central venous pressure trace: |
A - False |
|
Clinical features supporting the diagnosis of cardiac tamponade include all of the following EXCEPT |
B |
|
The LEAST desirable position for the tip of a central venous catheter which has been |
B |
|
Regarding patients aged 65 years or older with recurrent atrial fibrillation (AF) |
B |
|
Addison's disease lab features: Which is NOT correct |
A. Ca 2.50 mmol/L - true: "Serum sodium may be low; potassium, calcium, and urea nitrogen may be elevated" (Quick answers) |
|
All of the following may be associated with ulcerative colitis EXCEPT |
A or C? |
|
Anaemia in chronic renal failure is characteristically |
E |
|
In HIV infected patients |
C |
|
The thromboelastogram pattern typical of that seen in haemophilia is labelled |
B |
|
Heparin induced thrombocytopenia (HITS) |
B |
|
Respiratory function in quadriplegics is improved by |
B |
|
An INCORRECT statement regarding the autonomic nervous system is that |
B |
|
A 33-year-old chronically spinally injured patient becomes hypertensive and sweaty |
A |
|
In chronic obstructive pulmonary disease (COPD), the variable most closely associated with prognosis is |
C |
|
Patho-physiological features of patients with morbid obesity include |
A. a blood volume:body weight ratio which is similar to that of patients with normal body weight - false: "Total blood volume is increased in the obese but on a volume/weight basis is less than that in non-obese individuals" (Adams and Murphy, Obesity in anaesthesia and intensive care, BJA 2000; 85:91-108) |
|
An INCORRECT statement regarding the management of hypocalcaemia is that |
A. Correcting a respiratory or metabolic alkalosis increases the level of ionised calcium - true: "Initial therapy (of hypocalcaemia in adults consists of correction of any coexisting respiratory or metabolic alkalosis" (Aguilera and Vaughan, "Calcium and the anaesthetist", Anaesthesia 2000, 55:779-790) |
|
In patients with chronic renal failure there is |
A. increased Ca absorption - false: "Renal osteodystrophy is a complication of chronic renal failure, reflecting the complex interaction of secondary hyperparathyroidism and decreased vitamin D production by the kidneys. As the GFR decreases, there is a parallel decrease in phosphate clearance and an increase in the serum phosphate concentrations that result in reciprocal decreases in serum calcium concentrations. Hypocalcaemia stimulates PTH secretion, which leads to bone resorption and calcium release. As a result of decreased renal production of Vitamin D by the kidneys, intestinal absorption of calcium is impaired, which also leads to hypocalcaemia, stimulation of PTH release, and bone resorption." (Stoelting's Anesthesia and Coexisting Disease, 5th ed, p.332) |
|
Which of the following statements regarding patients with ankylosing spondylitis is FALSE? |
C - only in about 15% |
|
In Marfan’s Syndrome which is NOT related: |
A: (get AR not AS) |
|
With respect to intra-arterial cannulation and monitoring |
A. following cardiopulmonary bypass, a cannula in the brachial artery will tend to give a more accurate blood pressure reading than in the radial artery - true |
|
Femoral artery cannulation for arterial pressure monitoring |
A. is associated with more major complications than radial artery cannulation - false: |
|
A 40y.o. man with Marfan's syndrome is to undergo thoraco-abdominal aortic |
A |
|
For a patient positioned for left lateral for posterolateral incision for thoracotomy |
Answer: A? "Compression also plays a predominant role in injury with the patient in the lateral decubitus position when the plexus is compressed against the thorax by the humeral head" From R. J. Sawyer, M. N. Richmond, J. D. Hickey, J. A. Jarrratt (2000)Peripheral nerve injuries associated with anaesthesia, Anaesthesia 55 (10), 980–991. |
|
Carbon dioxide is the most common gas used for insufflation |
C |
|
In relation to obstetric haemorrhage |
D |
|
Amniotic fluid embolism |
A |
|
Best evidence in obstetric anaesthesia supports each of the following |
B |
|
Regarding non-obstetric abdominal laparoscopic surgery during the second trimester of pregnancy |
A |
|
A 46 year old brewery worker has cirrhosis of the liver with oesophageal varices and |
?E |
|
The LEAST effective means of preventing post-operative deep venous thrombosis |
?? |
|
The most effective method of deep venous thrombosis (DVT) prophylaxis for a fifty-year-old |
E |
|
In regards to laparotomy and hemicolectomy, the least effective way to minimize post op surgical infection is: |
A |
|
Pneumoperitoneum for laparoscopy is commonly associated with an INCREASE in each of the following EXCEPT |
A. arterial pressure - does increase commonly |
|
45 y.o for elective laproscoptic choecystectomy. No recent hx cholelithiasis. |
B: True |
|
Patient presents with carcinoid syndrome and developes hypotension intraoperatively. Best drug to treat it is: |
D |
|
Each of the following statements regarding vasospasm occurring after SAH is true EXCEPT: |
A |
|
Post grade II SAH in 50 year old woman who has just returned from successful endoluminal |
??? |
|
Each of the following statements concerning surgery for correction of scoliosis is true EXCEPT |
D |
|
The absorption of fluid into the circulation during transurethral prostatectomy (TURP) |
E |
|
The absorption of fluid into the circulation during transurethral prostatectomy (TURP) |
A. prostate size - true: "Large prostatic glands have rich venous networks that promote intravascular absorption of irrigation solution" (Yao and Artusio's Anesthesiology, 6ED, p.808) |
|
Lowering intra-ocular pressure by applying pressure to the globe (e.g. Honan balloon) |
B |
|
In the recovery room, following general anaesthesia for renal transplant surgery, your patient is |
A. beta-blockers which he received peri-operatively - false |
|
Following a cadaveric renal transplant under general anaesthesia, your patient's plasma K+ increases |
B |
|
In congenital diaphragmatic hernia |
A. there is hyperplasia of pulmonary arterioles in the hypoplastic lung - true: "Intrapulmonary arteries become excessively muscularized during gestation with thickened adventitia and media; moreover, muscularization extends more peripherally" (King and Booker, Congenital diaphragmatic hernia in the neonate, Continuing Education in Anaesthesia, Critical Care & Pain, Volume 5 Number 5 2005) |
|
A 4-year-old child with obstructive sleep disorder presenting for tonsillectomy |
D - too low (up to 70%) |
|
Spinal anesthesia in infants |
C |
|
The peak effect of oral midazolam as a premedication in children occurs after |
20 - 30 minutes - true: "The dose of oral midazolam... usually results in a satisfactorily sedated child in approximately 10-15 min with a peak effect occurring at approximately 20-30 min, with minimal to no delay in recovery, even for brief procedures." (Cote, Preoperative preparation and premedication, BJA 1999, 83:16-28) |
|
Which of the following statements regarding pre-operative oral midazolam in children (in |
?D |
|
A 20 kilogram child has a haemoglobin of 60 g.l-1. The child is normovolaemic and there is no |
A simple solution is to use Frank Shann's equation: |
|
Pneumonia in children |
A |
|
Regarding endotracheal tubes for paediatric patients |
A. False - term neonate would be 3.0-3.5 - preterms would be 2.5 tubes |
|
The glomerular filtration rate of a paediatric patient (in ml.min-1.m-2) is |
C |
|
A one year old child arrests with VT. Has had 2x DC shocks, and 100 mcg adrenaline. |
C |
|
Newborn with diaphragmatic hernia. Initially sats 95% on RA. Now beginning |
A |
|
You are commencing general anaesthesia for a 2-year-old child to allow biopsy of an anterior mediastinal mass, A pre-operative CT scan demonstrated |
E |
|
With respect to gastric volumes and fasting in children, |
B |
|
The nerve which supplies the lobule of the ear is the |
great auricular - true: "The great auricular nerve (C2,3) is the largest cutaneous branch of the cervical plexus. It hooks around the mid-point of the posterior border of sternocleidomastoid, then passes across it in the direction of the angle of the mandible. On this muscle it breaks up into three terminal branches. |
|
The innervation of the human larynx is such that |
E. cord paralysis can be produced by a distended endotracheal cuff in the larynx compressing a branch of the recurrent laryngeal nerve against the thyroid cartilage - true: "Compression of the anterior branch of the recurrent laryngeal nerve between the cuff of the endotracheal tube and the posterior part of the thyroid cartilage was the likely mechanism" (of paralysis) [Anaesth Intensive Care. 2004 Jun;32(3):417-8. Bilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia.] |
|
The muscles of the larynx which separate the vocal cords are the |
D. posterior cricoarytenoid - true: "The posterior cricoarytenoid muscle arises from the posterior surface of the lamina of the cricoid and is inserted into the posterior aspect of the muscular process of the arytenoid. It abducts the cord by external rotation of the arytenoid and thus opens the glottis; it is the only muscle to do so." (Ellis, Anatomy for Anaesthetists, 8ED, p34) |
|
Stellate ganglion is where: |
E. |
|
The following is a view obtained at direct laryngoscopy. |
Grade 2. p41 Ellis and Feldman. Have a small amount of cords showing. |
|
Regarding spinal cord blood supply, the |
A: False…anterior spinal artery arises from a branch from each vertebral artery |
|
The best predictor of poor outcome for a peri-operative ulnar nerve injury is |
E. presence of mixed sensory and motor deficit - true: "Patients with only sensory deficits 3 months after their procedures had a greater chance of complete recovery at 1 yr than did patients with mixed sensory and motor deficits." (Warner et al, "Ulnar Neuropathy" in Anesthesiology, 1994, 81:1332-1340) |
|
Recognised factors that predispose upper limb nerves to compression, under anaesthesia include |
B. extreme flexion of elbows across chest - correct: "Injuries may also occur when the nerve is stretched around the medial epicondyle during extreme flexion of the elbow across the chest" (Anaesthesia ume 55, Issue 10, 2000. Pages: 980–991) |
|
What do C6/7 motor function do |
A c7,8 |
|
You are asked to see a 60 y.o. male 2 days following a |
D. weakness of the abductor pollicis brevis m - true: T1 and ulnar nerve have very similar sensory and motor distribution. HOWEVER, the one difference is that the LOAF muscles are supplied via the median nerve and provide a point of differentiation. See below quotes from Anatomy for Anaesthetists |
|
The syndrome known as transient radicular irritation, or transient neurologic symptoms, |
D. who experience an initial full recovery from spinal blockade - true: "Transient neurologic symptoms (TNS) are symptoms of pain in the gluteal region that can radiate down both legs and appear within a few hours to 24 hours after an uneventful spinal anesthetic." (Miller Ch 70) |
|
An 85-year-old woman requires an emergency repair of an |
D |
|
Block Height required for orchidectomy: |
Need block to T9/10 (OHA pg 641) = umbilicus (C) |
|
To achieve maximum anaesthesia with minimal risk of trauma to veins, the tip of a needle used for a |
?B |
|
The LEAST likely complication of a peribulbar regional block for cataract surgery is |
B? |
|
Following a retrobulbar block of the eye which of the following features would suggest brainstem spread |
D? |
|
The signs of exposure to a nerve agent such as Sarin or VX include |
D |
|
A 32-year-old patient is admitted with early acute liver failure (unrelated to paracetamol |
E. prophylactic antibiotics - true: "Prophylactic antimicrobials with broad-spectrum coverage of gram-positive and gram-negative activity including an anti-fungal (e.g. piperacillin with tazobactam and fluconazole) should be administered on admission, as this halves the incidence of infective episodes when compared with commencement at the time of suspected infection. However, this benefit must be balanced against the risk of developing multi-resistant pathogens." (Continuing Education in Anaesthesia, Critical Care & Pain | Volume 4 Number 2 2004, p40f) |
|
A 25-year-old man, involved in a motor vehicle crash, presented with a GCS (Glasgow Coma Score) of 5. He was intubated and ventilated, and CT scan of his head |
?B |
|
A 30-year-old man presents to the emergency department following a high speed motor vehicle accident. His blood pressure is 70/50 mmHg with a strongly positive |
D |
|
A 50-year-old female patient presents with a 12 hour history of feeling unwell and is found to fulfill the criteria |
E |
|
Which one of the following is most likely to be associated with a high mixed venous oxygen saturation (SvO2)? |
D |
|
The best indicator of adequate fluid resuscitation in the trauma patient is: |
E |
|
When optimising patients for surgery using goal-directed therapy, which of the following parameters is LEAST useful? |
?A |
|
The perioperative use of beta adrenergic antagonists |
A. exerts a cardioprotective effect entirely by reduction of heart rates - probably false |
|
The correct ranking of fat/blood partition co-efficients, in order of increasing solubility |
A |
|
The MAC (Minimum Alveolar Concentration) of volatile anaesthetics is DECREASED by |
D |
|
Effects of volatile anaesthetic agents on the brain include |
Option A - Incorrect. Cerebral blood flow is increased |
|
Norpethidine toxicity |
E |
|
In patients with renal failure each of the following drugs has prolonged |
B. Buprenorphine - true: |
|
Naltrexone |
E |
|
Which one of the following statements concerning Tramadol is FALSE? |
A. It has an active metabolite TRUE, THEREFORE NOT THE ANSWER = O desmethyltramadol |
|
With regard to non-depolarising muscle relaxants: |
A - False. (Hypokalaemia prolongs action, not hyperkalaemia) |
|
A ‘sleep dose’ of thiopentone in a healthy adult is likely to result in: |
A. A fall in peripheral resistance followed by a rise in cardiac output - false: CO falls |
|
Expected adverse drug effects in a geriatric population receiving a high dose |
A. hyponatraemia caused by inappropriate secretion of ADH |
|
In patients with renal failure each of the following drugs has prolonged |
Buprenorphine |
|
Fondaparinux Sodium (Arixtra) |
C. has a mechanism of action that is antithrombin (ATIII) dependent - true: "Fondaparinux is a synthetic and specific inhibitor of activated factor X (Xa) with no animal sourced components. The antithrombotic activity of fondaparinux is the result of antithrombin III (ATIII) mediated selective inhibition of factor Xa. By binding selectively to ATIII, fondaparinux potentiates (about 300 times) the innate neutralisation of factor Xa by antithrombin. Neutralisation of factor Xa interrupts the blood coagulation cascade and inhibits both thrombin formation and thrombus development." (MIMs Online) |
|
Regarding chemotherapy agents, |
B |
|
Which of the following is NOT associated with serotonin syndrome |
D |
|
An adult male patient requires general anaesthesia. He admits to long-standing |
?B |
|
The plasma half-life of low molecular weight heparin is |
B - True |
|
Intra-ocular pressure is increased by |
?B |
|
A morbidly obese 140kg, 40-year-old male is scheduled for cholecystectomy. He has no history of |
E? |
|
In a clinical trial, 3 out of 10 patients develop a complication in the control group, |
D |
|
In a trial, 75 patients with an uncommon, newly described complication and 50 matched |
A. the relative risk of this complication with drug exposure CANNOT be determined - true: |
|
Forty patients are randomly dived into two groups - one to receive induction agent A and another |
B. Mann-Whitney test - true: The scale is ordinal. "If there is a natural order among categories, so that there is a relative value among them... then the data can be considered ordinal data... Ordinal data are... a type of categorical data." (Myles and Gin p 2-3). There are two independent groups and the equivalent of the unpaired t-test for non-parametric data is the Mann-Whitney U test. "Mann-Whitney U Test (identical to the Wilcoxon rank sum) is a non-parametric equivalent to the unpaired Student's t-test" (Myles and Gin p.63) "The Mann-Whitney U test is the recommended test to use when comparing two groups that have data measured on an ordinal scale. However, if the data represent a variable that is, in effect, a continuous quantity, then a t-test may be used if the data are normally distributed. This is more likely with large samples (say n>100)." (p. 64) |
|
Publication Bias is that |
"Publication bias arises from the tendency for researchers and editors to handle experimental results that are positive (they found something) differently from results that are negative (found that something did not happen) or inconclusive" |
|
FALSE statements regarding natural latex rubber allergy include |
B |
|
Cryoprecipitate contains each of the following clotting factors EXCEPT |
Cryoprecipitate contains each of the following clotting factors EXCEPT |
|
A fifty-five-year-old man on antihypertensive medication, including an ACE inhibitor, has a total |
A fifty-five-year-old man on antihypertensive medication, including an ACE inhibitor, has a total knee replacement. Red cell transfusion is begun in recovery through a leukocyte reduction filter after brisk bleeding into his drains. A recognised complication of the use of this filter in this situation is |
|
The administration of blood contaminated with Yersinia enterocolitica will typically |
A. during the transfusion - true: "The onset of clinical symptoms typically occurs acutely during transfusion, with a mortality rate of 60% and a median time to death of only 25 hrs (27)." (Goodnough, Risks of blood transfusion, in Crit Care Med 2003 Vol. 31, No. 12 (Suppl.)) |
|
TRALI after administration of blood products occurs |
...The TRALI consensus conference and the US National Heart, Lung and Blood Institute defined TRALI as a form of acute lung injury meeting the criteria proposed by the AECC that is temporally and mechanistically related to transfusion of blood or blood components [6, 7, 15]. For a diagnosis of TRALI to be made there must be no pre-existing ALI before transfusion, the onset of signs and symptoms must occur during or within 6 h of transfusion and there must be no temporal relationship to an alternative risk factor for ALI... |
|
The most frequently reported cause of mortality associated with transfusion of blood and blood products is |
E |
|
In a patient requiring FFP where the patient’s blood group is unknown, it is ideal to give FFP of group |
C. AB - CORRECT: "Group AB FFP can be used in an emergency if the patient’s ABO blood group is unknown, but is likely to be in short supply... With regard to ABO blood groups, the first choice of FFP is that of the same ABO group as the patient. If this is not available, FFP of a different ABO group is acceptable so long as it has been shown not to possess anti-A or anti-B activity above a limit designed to detect ‘high titres’. FFP of group O should only be given to O recipients" (British Committee for Standards in Haematology, Blood Transfusion Task Force, Guidelines for the use of fresh-frozen plasma, cryoprecipitate and cryosupernatant, in British Journal of Haematology 2004:126, 11–28) |
|
When providing general anaesthesia to a patient with a history of asthma |
When providing general anaesthesia to a patient with a history of asthma |
|
AC22e [Jul06] [Apr07] Detrimental post-operative effects of hypothermia following general |
Detrimental post-operative effects of hypothermia following general anaesthesia in the elderly include each of the following EXCEPT: |
|
Effects of hypothermia at 25C: |
Effects of hypothermia at 25C: |
|
The most commonly reported cause of awareness during general anaesthesia for a non-obstetric |
D |
|
The clinical sign which has the highest correlation with awareness in a spontaneously |
A |
|
The most important factor in reducing peri-operative morbidity in diabetic patients |
D |
|
A healthy 20 year old patient undergoing nasal surgery under general anaesthesia has the nose packed with gauze |
B (beta-blockers in general are bad here as negative inotropy in face of increased peripheral resistance leads to cardiac arrest) |
|
During surgery for tracheostomy insertion surgical diathermy is being used at the tracheal |
A |
|
Appropriate practice when performing central neuro-axial block should include all of the |
D |
|
Which of the following contributes the LEAST to motor neuropathy following the lithotomy |
D. BMI >25 - correct answer: "Of the patient-related characteristics, low BMI was a powerful univariate risk factor for motor neuropathy" (Warner, et al., Lower-extremity Motor Neuropathy Associated with Surgery Performed on Patients in a Lithotomy position in Anesthesiology 81:6-12, 1984) Perhaps this is due to less self-padding? |
|
Regarding Epidural Abcess - which is WRONG |
A. Diagnosis is DEPENDENT on triad of back pain, fever, and paralysis - false and the ANSWER to CHOOSE: "The early signs and symptoms may be vague, the 'classic' triad of back pain, fever and variable neurological deficit occurred in only 13% of patients by the time of diagnosis, and contributed to diagnostic delay in 75%." (Grewal et al, Epidural Abscesses in BJA 2006 96(3):292-302) |
|
AC154 [Apr07] Q128 |
C |
|
A patient with severe COPD on home oxygen is having an excision of a submandibular |
A patient with severe COPD on home oxygen is having an excision of a submandibular tumour under local anaesthesia. The best way to prevent fire in the operating room is: |
|
In the Neuroleptic malignant syndrome |
In the Neuroleptic malignant syndrome |
|
The diagnosis of neuroleptic malignant syndrome requires the presence of: |
A. Diaphoresis |
|
In a patient with myasthenia gravis undergoing a laparotomy for large bowel obstruction, the |
A. daily dose of pyridostigmine > 180mg - false: "Criteria that correlate with the need for mechanical ventilation during the postoperative period following transsternal thymectomy include disease duration longer than 6 years, the presence of COPD unrelated to MG, a daily dose of pyridostigmine higher than 750mg, and a VC less than 2.9L" (Stoelting's Anesthesia and Co-Existing Disease, 5E, p.452) |
|
In patients with myasthenia gravis, features which increase the risk of requiring prolonged |
C |
|
Each of the following is effective in the treatment of pain from acute herpes zoster EXCEPT |
A. acyclovir - true: "Antiviral agents started within 72 hours of onset of the herpes zoster rash accelerate the resolution of acute pain (U) (Level I), but do not reduce the incidence of postherpetic neuralgia" |
|
In the treatment of phantom limb pain |
B |
|
A strategy shown to reduce the incidence of severe phantom limb pain |
A. continuous regional blockade using nerve sheath catheters - false: "Infusions of local anaesthetics via peripheral nerve sheath catheters, usually inserted by the surgeon at the time of amputation, are a safe method of providing excellent analgesia in the immediate postoperative period (Pinzur et al, 1996 Level II; Lambert et al, 2001 Level II). However, they are of no proven benefit in preventing phantom pain or stump pain (Halbert et al, 2002 Level I)." |
|
When compared with intra-muscular or subcutaneous opioid regimens, patient controlled analgesia (PCA} with opioids |
B |
|
A 60-year-old diabetic has had a below knee amputation for an ischaemic leg. He has neuropathic pain being managed with oxycodoiie 40 mg bd and paracetamol 1 g |
C |
|
Major complications of mediastinoscopy include all of the following EXCEPT |
Major complications of mediastinoscopy include all of the following EXCEPT |
|
Following one-lung ventilation there is an increased risk of lung injury if plateau airway |
B |
|
Following a left sided pneumonectomy, a left intercostal drain is placed and |
E |
|
A patient with severe liver disease is scheduled to have a portacaval shunt for portal hypertension. |
A. use of vecuruonium as the relaxant of choice |
|
Regarding extracorporeal shockwave lithotripsy (ESWL) for renal calculi in patients with a |
A. ESWL is contraindicated |
|
The primary duty of an expert witness called by the defence is to the |
A is best answer |
|
During elective major vascular surgery the best way to reduce the risk of acute renal failure is |
C |
|
In the eldery patient |
C. True "elderly or debilitated patients shiver less effectively than younger patients" Perioperative hypothermia in the high-risk surgical patient. Best Practice & Research Clinical Anaesthesiology, Volume 17, Issue 4, Pages 485-498 K. Leslie, D. Sessler |
|
Patient having THR; BP normal; under GA with sevo/N2O/fentanyl, immediately before surgeon cementing, best thing to do: |
? |
|
You have anaesthetised a patient with a partially obstructing right main bronchus tumour. |
B correct |
|
The diagram below respresents a transgastric short axis view of the heart obtained using |
E |
|
Systemic vascular resistance index (SVRI) is calculated from |
A |
|
The risk of complications with insertion of a Swan-Ganz catheter is increased in all |
?B |
|
Which statement about the use of Entropy depth of anaesthetic monitoring is true? |
A. artefacts caused by cardiac pacemaker produce a high RE (Response Entropy) value - false |
|
Which capnograph suggests a tension capnothorax during laparoscopic fundoplication? |
?C |
|
Oxygen cannot be measured by: |
C |
|
The output of a diathermy machine does NOT cause patient electrocution because the |
C. frequency is too high - true: "As the frequency of the driving voltage increases, the heating effect increases and the stimulation decreases. Therefore, at frequencies above 100 kHz (i.e. radio frequencies) the effect is entirely heating." |
|
A 60-year-old man with BMI (body mass index) of 30 is having an inguinal hernia repair. He has a |
C |
|
You are performing a Level 2 check on the anaesthetic machine. The suction bulb at |
B |
|
In a rotameter the: |
D. Pressure drop across the bobbin is constant at varying flows - true: |
|
Adult male who is intubated and ventilated, with CVL in situ. Just before surgeon |
B? |
|
A 50 year old patient is admitted with acute chest pain. An ECG shows tall R waves in lead V1. |
D. posterior myocardial infarction - true: "Tall lead V1 (tall RV1), defined as an R/S ratio equal to or greater than 1, is not an infrequent occurrence in emergency department patients. This electrocardiographic finding exists as a normal variant in only 1% of patients. Physicians should therefore be familiar with the differential diagnosis for this important QRS configuration. The electrocardiographic entities which can present with this finding include right bundle branch block, left ventricular ectopy, right ventricular hypertrophy, acute right ventricular dilation (acute right heart strain), type a Wolff-Parkinson-White syndrome, posterior myocardial infarction, hypertrophic cardiomyopathy, progressive muscular dystrophy, dextrocardia, misplaced precordial leads, and normal variant." (Mattu et al, Prominent R wave in lead V1: electrocardiographic differential diagnosis. American Journal of Emergency Medicine - Volume 19, Issue 6 2001) |
|
The J-point of the ECG waveform is altered by all of the following EXCEPT |
D |
|
A diagnosis of pulmonary embolism is most strongly suggested by |
A |
|
Regarding atrial fibrillation |
D |
|
Reverse splitting of the 2nd heart sound is caused by |
C. complete LBBB - true: "The most common cause of reversed splitting is complete LBBB, which can be caused either by delayed activation of the LV, as seen in isolated proximal block, or to prolonged mechanical systole (primarily isovolumic contraction time), as seen in proximal or peripheral block invariably associated with significant LV dysfunction" |
|
In the diagnosis of postoperative myocardial infarction |
?C |
|
The QT interval may be prolonged by each of the following EXCEPT |
C (hypomagnesaemia can lead to prolonged QT) |
|
A patient has a history of polyuria and has an elevated serum calcium, normal |
D |
|
Features of anorexia nervosa include each of the following EXCEPT |
B - delayed not increased |
|
Addison's disease lab features: Which is NOT correct |
A. Ca 2.50 mmol/L - true: "Serum sodium may be low; potassium, calcium, and urea nitrogen may be elevated" (Quick answers) |
|
A 70kg male who has been taking prenisolone 10mg per |
D or A |
|
A known alcoholic with anorexia and nausea has become jaundiced. His urine is dark and his |
A (massively elevated AST consistent with viral hepatitis) |
|
The most important aspect of the peri-operative management of a patient with Gilbert's syndrome is |
E |
|
In HIV infected patients |
C. cardiomyopathy is a recognised complication - true: "Myocarditis, progressing to dilated cardiomyopathy, is common and may be caused by infection with Cryptococcus, coxsackie B, virus, CMV, Aspergillus species as well as lymphoma and HIV itself." (Anaesthesia and critical care for patients with HIV infection, Continuing Education in Anaesthesia, Critical Care & Pain | Volume 5 Number 5 2005) |
|
von Willebrands type 1: |
A |
|
Findings in a patient with serotonin syndrome include each of the following EXCEPT |
D |
|
Carcinoid syndrome may present as: |
supraventricular tachycardia - true: "5-HT has little, if any direct effect on the heart. With elevated levels, however, positive chronotropic and inotropic myocardial effects may occur, mediated by the release of noradrenaline" (Miller 6th ed p.1109) |
|
In chronic obstructive pulmonary disease (COPD), the variable most closely associated with prognosis is |
C |
|
Unequal consolidation on a CXR can be caused by all except |
Unequal consolidation on a CXR can be caused by all except |
|
An INCORRECT statement regarding the management of hypocalcaemia is that |
A. Correcting a respiratory or metabolic alkalosis increases the level of ionised calcium - true: "Initial therapy (of hypocalcaemia in adults consists of correction of any coexisting respiratory or metabolic alkalosis" (Aguilera and Vaughan, "Calcium and the anaesthetist", Anaesthesia 2000, 55:779-790) |
|
Patho-physiological features of patients with morbid obesity include |
A. a blood volume:body weight ratio which is similar to that of patients with normal body weight - false: "Total blood volume is increased in the obese but on a volume/weight basis is less than that in non-obese individuals" (Adams and Murphy, Obesity in anaesthesia and intensive care, BJA 2000; 85:91-108) |
|
In patients with chronic renal failure there is |
A. increased Ca absorption - false: "Renal osteodystrophy is a complication of chronic renal failure, reflecting the complex interaction of secondary hyperparathyroidism and decreased vitamin D production by the kidneys. As the GFR decreases, there is a parallel decrease in phosphate clearance and an increase in the serum phosphate concentrations that result in reciprocal decreases in serum calcium concentrations. Hypocalcaemia stimulates PTH secretion, which leads to bone resorption and calcium release. As a result of decreased renal production of Vitamin D by the kidneys, intestinal absorption of calcium is impaired, which also leads to hypocalcaemia, stimulation of PTH release, and bone resorption." (Stoelting's Anesthesia and Coexisting Disease, 5th ed, p.332) |
|
Consider the following blood gases. Normal ranges are in brackets. |
D |
|
A 40y.o. man with Marfan's syndrome is to undergo thoraco-abdominal aortic |
A. allow drainage of CSF - true |
|
For a patient positioned for left lateral for posterolateral incision for thoracotomy |
Answer: A? "Compression also plays a predominant role in injury with the patient in the lateral decubitus position when the plexus is compressed against the thorax by the humeral head" From R. J. Sawyer, M. N. Richmond, J. D. Hickey, J. A. Jarrratt (2000)Peripheral nerve injuries associated with anaesthesia, Anaesthesia 55 (10), 980–991. |
|
Relative contraindications to mediastinoscopy include |
?E |
|
In relation to obstetric haemorrhage |
A. amniotic fluid embolism is unlikely to present as unexplained haemorrhage |
|
Supine hypotension during late pregnancy is associated with |
C or A |
|
Drugs that may be used for the management of heart failure, secondary to dilated cardiomyopathy |
A class D - ACE inhibitors have also been associated with fetal death in utero. |
|
A pregnant woman is 36 weeks gestation and complains of progressive dyspnoea. |
?B |
|
Best evidence in obstetric anaesthesia supports each of the following |
?B |
|
Analgesic requirements during labour are reduced by each of the following except |
A. Acupressure - false: "Published in the Cochrane Library collection of evidence-based literature was a systematic review of complementary and alternative therapies for pain management in labor. This meta-analysis of 14 studies evaluated the efficacy of acupuncture, acupressure, audioanalgesia, aromatherapy, hypnosis, massage, and relaxation for labor analgesia. Only two therapies were found to be beneficial, acupuncture and hypnosis." (Macarthur, Gerard W. Ostheimer “What’s New in Obstetric Anesthesia” Lecture, in Anesthesiology 2008; 108:777–85) |
|
The most effective method of deep venous thrombosis (DVT) prophylaxis for a fifty-year-old |
A. electrical calf stimulation - false: Mechanical forms of VTE prevention are "considered generally less efficient than pharmacologic intervention." (Nielsen and Asmis, Hypercoagulability in the perioperative period, in Best Practice & Research Clinical Anaesthesiology Volume 24, Issue 1, March 2010, Pages 133-144) |
|
In regards to laparotomy and hemicolectomy, the least effective way to minimize post op surgical infection is: |
A. Aggressive peri-operative fluid management - false and answer to choose: "At this time, it seems that aggressive fluid resuscitation does not decrease the incidence of SSI, and maintenance of euvolemia is recommended based on clinical parameters." (The Anesthesiologist's Role in the Prevention of Surgical Site Infections in Anesthesiology Issue: Volume 105(2), August 2006, pp 413-421) |
|
Post liver resection, the time when prothrombin time derangement is maximal is: |
A |
|
Phosphate-containing bowel preparations for colonoscopy are contra-indicated in frail, elderly |
E (large fluid shifts) is the primary reason. "Phosphate preparations have the potential to cause electrolyte disturbances including serious hyperphosphataemia and hypocalcaemia; deaths have been reported. Sodium phosphate must therefore be avoided in patients with impaired renal function and used with great care in the presence of congestive cardiac failure because of the potential large fluid shifts. The frail, elderly and the very young are particularly at risk of fluid and electrolyte complications and alternative preparations should be used." Australian Prescriber |
|
Blunt liver trauma can be treated non surgically if |
D |
|
The intraoperative hypothermia for aneurysm surgery trial (IHAST) showed that cooling to a target |
A |
|
Each of the following statements regarding vasospasm occurring after SAH is true EXCEPT: |
?A |
|
Post grade II SAH in 50 year old woman who has just returned from successful endoluminal |
?A ?C |
|
A patient is having posterior fossa surgery in the sitting position. |
C. ↑PAP, ↓ETCO2, ↑PaCO2, ↑CVP - true "End tidal carbon dioxide falls... In 25% of patients the CVP is elevated and the pulmonary artery pressure rises in 50%. Arterial blood gases may reveal hypoxaemia and, less commonly hypercarbia." (S Webber , J Andrzejowski , and G Francis Gas embolism in anaesthesia BJA CEPD Reviews 2: 53-57.) |
|
A previously healthy 20-year-old male is undergoing open reduction and internal fixation of a |
E. re-exsanguinate the limb and re-apply the tourniquet - probably the best answer: "Common causes of intraoperative bleeding include incomplete exsanguination of the limb and a poorly fitting or under-pressurized cuff. Intraoperative bleeding may also be caused by blood entering through the intramedullary vessels of long bones." (Arterial Tourniquets, Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(2):56-60) |
|
A well 65 year old is having a total hip replacement under general anaesthesia with sevo/N2O/fentanyl. BP is 130/70. |
C. Turn off nitrous - maybe and potentially the best answer: "Whether early administration of oxygen actually prevents the onset of the syndrome by preventing hypoxaemia, further catecholamine response and fat mobilisation remains unclear." (Mellor and Soni, Fat Embolism Review Article, Anaesthesia, 2001, 56, pages 145-154) Assuming that turning off the nitrous means increasing the FiO2, this is a relatively simple procedure to do with very little downside. |
|
The absorption of fluid into the circulation during transurethral prostatectomy (TURP) |
E. type of irrigation fluid - false and the answer to choose: As described below, fluid is absorbed through the venous networks rather than across a semi-permeable membrane. The makeup of the fluid DOES affect the likelihood of TURP syndrome as it may alter electrolyte homeostasis, BUT it will not affect the volume of fluid absorbed. |
|
In the recovery room, following general anaesthesia for renal transplant surgery, your patient is |
A. beta-blockers which he received peri-operatively - false |
|
The physiological change most likely to be associated with infrarenal cross-clamping of the aorta is |
B. decreased renal blood flow - true: "Although it is clear that a suprarenal cross-clamp will decrease renal blood flow up to 80% an infrarenal cross-clamp also causes a decrease in renal cortical blood flow with an associated decrease in GFR." (Yao and Artusio, 6E Ch 11 p 291) |
|
In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy |
???B |
|
A six year old boy requires return to theatre for arrest of post-tonsillectomy haemorrhage. |
From the recent CEACP review, regarding the bleeding tonsil: "Before induction, in addition to the standard equipment, a selection of laryngoscope blades, smaller than expected tracheal tubes, and two suction catheters should be immediately available". Looks like C |
|
A 60y.o. man with a 45 pack year history of smoking and heavy drinking |
D |
|
Block of the maxillary nerve in the pterygopalatine fossa causes ipsilateral |
A. Hard palate - true: "The hard and soft palate is innervated by the palatine branches; the greater (anterior) and lesser (middle and posterior) palatine nerves. After descending through the pterygopalatine canal, the greater palatine nerve exits the greater palatine foramen onto the hard palate. The nerve provides sensory innervation to the palatal mucosa and bone of the hard and soft palate. The lesser palatine nerves emerge from the lesser palatine foramen to innervate the soft palate and tonsillar region." (Nysora.com[1]) |
|
Advantages of local anaesthesia for middle ear surgery compared with general anaesthesia |
C. ability to monitor facial nerve integrity - false and answer to choose: CN VII can be monitored under GA or LA, but LA frequently tracks around to block the facial nerve rendering monitoring impossible |
|
In performing a retrobulbar block, the complication of brainstem anaesthesia: |
C |
|
A patient requires forefoot amputation. You wish to block the most peripheral nerves |
From NYSORA website "An ankle block is essentially a block of four branches of the sciatic nerve (deep and superficial peroneal, tibial and sural nerves) and one cutaneous branch of the femoral nerve (saphe-nous nerve). An ankle block is a basic, peripheral nerve block technique. It is simple to perform, essentially devoid of systemic complications, and highly effective for a wide variety of proce-dures on the foot and toes. As such, this technique should be in the armamentarium of every anesthesiologist. In our institution, an ankle block is most commonly used in podiatry surgery and foot and toes debridement or amputation." |
|
The nerve which supplies the lobule of the ear is the |
A. great auricular - true: "The great auricular nerve (C2,3) is the largest cutaneous branch of the cervical plexus. It hooks around the mid-point of the posterior border of sternocleidomastoid, then passes across it in the direction of the angle of the mandible. On this muscle it breaks up into three terminal branches. |
|
The largest and most direct branch of the internal carotid artery is the |
C |
|
The carotid sinus derives its nerve supply from the |
B. glossopharyngeal nerve - true: "The glossopharyngeal nerve contains sensory fibres for the pharynx, the tonsillar region and the posterior one-third of the tongue (including the taste buds), motor fibres for the stylopharyngeus muscle and secretomotor fibres for the parotid gland. It also innervates the carotid sinus and body... The carotid sinus is a bulge at the start of the internal carotid artery. Here the arterial wall is thin and has a particularly rich nerve supply from the glossopharyngeal nerve." |
|
The innervation of the human larynx is such that |
E. cord paralysis can be produced by a distended endotracheal cuff in the larynx compressing a branch of the recurrent laryngeal nerve against the thyroid cartilage - true: "Compression of the anterior branch of the recurrent laryngeal nerve between the cuff of the endotracheal tube and the posterior part of the thyroid cartilage was the likely mechanism" (of paralysis) [Anaesth Intensive Care. 2004 Jun;32(3):417-8. Bilateral adductor vocal cord paresis following endotracheal intubation for general anaesthesia.] |
|
Stellate ganglion is where: |
?E |
|
The best predictor of poor outcome for a peri-operative ulnar nerve injury is |
E. presence of mixed sensory and motor deficit - true: "Patients with only sensory deficits 3 months after their procedures had a greater chance of complete recovery at 1 yr than did patients with mixed sensory and motor deficits." (Warner et al, "Ulnar Neuropathy" in Anesthesiology, 1994, 81:1332-1340) |
|
The median nerve |
A. can be blocked at the elbow immediately lateral to the brachial artery - false: lies medial |
|
What do C6/7 motor function do |
A c7,8 |
|
At the wrist joint |
A. the median nerve lies between the tendons of palmaris longus and flexor carpi radialis - true: The median nerve lies superficially "with the tendon of FCR lying laterally and those of FDS and palmaris longus medially" (Anatomy for Anaesthetists 7ED p. 180) |
|
Pre-ganglionic sympathetic fibres pass to the |
D |
|
The peak effect of oral midazolam as a premedication in children occurs after |
B. 20 - 30 minutes - true: "The dose of oral midazolam... usually results in a satisfactorily sedated child in approximately 10-15 min with a peak effect occurring at approximately 20-30 min, with minimal to no delay in recovery, even for brief procedures." (Cote, Preoperative preparation and premedication, BJA 1999, 83:16-28) |
|
A six-week-old baby is booked for elective right inguinal hernia repair. |
B. 4 hours for formula - true: "For healthy infants under 6 weeks of age having an elective procedure, formula or breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia." ANZCA PS 15 4.5.2.3 |
|
A 12-year-old boy with spastic cerebral palsy and painful muscle spasms presents for multilevel |
B |
|
An otherwise healthy 4-year-old presenting for adenotonsillectomy develops a cough |
E. perform on-table chest X-ray and base further management on findings - the exam answer: "A chest radiograph should always be obtained if aspiration is suspected." (Kluger et al, Crisis management during anaesthesia: regurgitation, vomiting, and aspiration, in Qual Saf Health Care 2005;14:e4 |
|
Stellate ganglion is where: |
?E |
|
The best predictor of poor outcome for a peri-operative ulnar nerve injury is |
E. presence of mixed sensory and motor deficit - true: "Patients with only sensory deficits 3 months after their procedures had a greater chance of complete recovery at 1 yr than did patients with mixed sensory and motor deficits." (Warner et al, "Ulnar Neuropathy" in Anesthesiology, 1994, 81:1332-1340) |
|
The median nerve |
A. can be blocked at the elbow immediately lateral to the brachial artery - false: lies medial |
|
What do C6/7 motor function do |
A c7,8 |
|
At the wrist joint |
A. the median nerve lies between the tendons of palmaris longus and flexor carpi radialis - true: The median nerve lies superficially "with the tendon of FCR lying laterally and those of FDS and palmaris longus medially" (Anatomy for Anaesthetists 7ED p. 180) |
|
Pre-ganglionic sympathetic fibres pass to the |
D |
|
The peak effect of oral midazolam as a premedication in children occurs after |
B. 20 - 30 minutes - true: "The dose of oral midazolam... usually results in a satisfactorily sedated child in approximately 10-15 min with a peak effect occurring at approximately 20-30 min, with minimal to no delay in recovery, even for brief procedures." (Cote, Preoperative preparation and premedication, BJA 1999, 83:16-28) |
|
A six-week-old baby is booked for elective right inguinal hernia repair. |
B. 4 hours for formula - true: "For healthy infants under 6 weeks of age having an elective procedure, formula or breast milk may be given up to four hours and clear fluids up to two hours prior to anaesthesia." ANZCA PS 15 4.5.2.3 |
|
A 12-year-old boy with spastic cerebral palsy and painful muscle spasms presents for multilevel |
B |
|
An otherwise healthy 4-year-old presenting for adenotonsillectomy develops a cough |
E. perform on-table chest X-ray and base further management on findings - the exam answer: "A chest radiograph should always be obtained if aspiration is suspected." (Kluger et al, Crisis management during anaesthesia: regurgitation, vomiting, and aspiration, in Qual Saf Health Care 2005;14:e4 |
|
A 25kg child is having liver resection and is rapidly given 1 unit of blood. |
D |
|
5yo 35kg child having repair of leg laceration. gas induction with sevo N2O |
A |
|
The Neonatal Facial Coding Scale (NFCS) used to assess pain in neonates includes all of the following except |
C |
|
A young woman has an MVA when driving home from a nightclub. She was known to have |
B |
|
The signs of exposure to a nerve agent such as Sarin or VX include |
C |
|
A 30-year-old man presents to the Emergency Department following a high speed motor vehicle |
E |
|
A young boy sustains a head injury and CT scan shows diffuse axonal injury. He is intubated |
E |
|
A 30-year-old man presents to the emergency department following a high speed motor vehicle accident. His blood pressure is 70/50 mmHg with a strongly positive |
D. Intraop TOE - probably the answer after much pondering: this guy needs to go theatre pronto. An on table TOE will not delay this. |
|
The action of which drug is unchanged in a recipient following cardiac transplantation |
E |
|
The correct ranking of fat/blood partition co-efficients, in order of increasing solubility |
A. N2O < D < S approximately = I - true: see below |
|
The local anaesthetic LEAST likely to cause cardiac toxicity after inadvertent |
D |
|
Norpethidine toxicity |
E |
|
In patients with renal failure each of the following drugs has prolonged |
B. Buprenorphine - true: |
|
Which statement regarding the use of opiates for the management of acute pain is true? |
E. tramadol has a lower risk of respiratory depression than other opioids at equianalgesic doses - true: "Tramadol has a lower risk of respiratory depression and impairs gastrointestinal motor function less than other opioids at equianalgesic doses (U) (Level II)." ANZCA pai |
|
Plasma clearance of non-depolarising muscle relaxants in pregnant patients |
D. Accelerated because the elimination half-life is shortened due to increased hepatic and renal clearance due to hormonal changes in pregnancy - true: "The clearance of vecuronium may be accelerated during late pregnancy, possibly relecting stimulation of hepatic microsomal enzymes by progesterone as well as by cardiovascular changes and fluid shifts that occur during pregnancy" (Stoelting Pharm and phys p.238 4th ed) |
|
A ‘sleep dose’ of thiopentone in a healthy adult is likely to result in: |
C |
|
To normalise platelet function prior to surgery, chronic diclofenac therapy |
A. would seem appropriate for rapidly absorbed formulations |
|
Features of paracetamol administration in children include |
D. a one hour delay between peak plasma concentration and maximum analgesia - true: "paracetamol should be administered 1–2 h before the desired peak effect because of a delay of 1 h between peak plasma concentrations and maximum analgesia obtained." (Howell, What we should know about paracetamol, Pediatric Anesthesia, 1999, Volume 9 Issue 4, Pages 367 - 370) |
|
When using NSAIDs and COX-2 inhibitors for postop analgesia |
A. COX-2 inhibitors are more effective analgesics than NSAIDs - false: "Non-selective NSAIDs and coxibs are effective analgesics of similar efficacy for acute pain" |
|
A 25-year-old male presents for ECT (electroconvulsive shock therapy) at a free-standing facility. |
?D |
|
Fondaparinux Sodium (Arixtra) |
C. has a mechanism of action that is antithrombin (ATIII) dependent - true: "Fondaparinux is a synthetic and specific inhibitor of activated factor X (Xa) with no animal sourced components. The antithrombotic activity of fondaparinux is the result of antithrombin III (ATIII) mediated selective inhibition of factor Xa. By binding selectively to ATIII, fondaparinux potentiates (about 300 times) the innate neutralisation of factor Xa by antithrombin. Neutralisation of factor Xa interrupts the blood coagulation cascade and inhibits both thrombin formation and thrombus development." |
|
Intra-ocular pressure is increased by |
E |
|
In a trial, 75 patients with an uncommon, newly described complication and 50 matched |
A. the relative risk of this complication with drug exposure CANNOT be determined - true: |
|
Forty patients are randomly dived into two groups - one to receive induction agent A and another |
B. Mann-Whitney test - true: The scale is ordinal. "If there is a natural order among categories, so that there is a relative value among them... then the data can be considered ordinal data... Ordinal data are... a type of categorical data." (Myles and Gin p 2-3). There are two independent groups and the equivalent of the unpaired t-test for non-parametric data is the Mann-Whitney U test. "Mann-Whitney U Test (identical to the Wilcoxon rank sum) is a non-parametric equivalent to the unpaired Student's t-test" (Myles and Gin p.63) "The Mann-Whitney U test is the recommended test to use when comparing two groups that have data measured on an ordinal scale. However, if the data represent a variable that is, in effect, a continuous quantity, then a t-test may be used if the data are normally distributed. This is more likely with large samples (say n>100)." (p. 64) |
|
A new test has been developed to diagnose a disease. To determine the SPECIFICITY of this new |
Specificity = True Negative / True negative + False Positive Answer B sounds pretty good because if you know all the sample are negative and the test picks up that say 5% are positive, the specificity would be 95% |
|
Correct statements regarding confidence intervals (CI) include all the following EXCEPT |
E. The width of the CI depends on the mean value of the sample - false and answer to choose |
|
When a new diagnostic test is evaluated in a population of subjects in whom the diagnosis |
E, 90%. ie TN/(TN+FN) = 180/(180+20) =180/200 = 18/20 = 9/10 = 90% NPV is the proportion of true negs out of all those testing negative, and means that the risk of someone who tests neg truly doesn't have disease is 90% in this case. Affected by prevalence, ie if disease is rare, NPV increases. |