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138 Cards in this Set
- Front
- Back
EZ93 What is the chemical used in sodalime to indicate exhaustion? |
ANSWER A
Components of Sodalime NaOH 5% Ca(OH)2 94% Water Ethyl violet as indicator Binders |
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2. Repeat- Main heat loss in anaesthetic for neonate
A. vasodilatation B. radiation C. convection D. conduction E. evaporative |
ANSWER B
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AT08c [Apr97] [Jul98] [2001-Apr] Q50, [2001-Aug] Q31, [2003-Apr] Q3, [2003-Aug] Q54, [2005-Apr] Q38, [Jul05] [Mar06]
The most appropriate method for improving oxygenation during one lung anaesthesia, after institution of an FiO2 of 1.0, is application of A. 5cm H2O CPAP to the non-dependent lung B. 10cm H2O CPAP to the non-dependent lung C. 5cm H2O PEEP to the dependent lung D. 5cm H2O CPAP to the non-dependent and 5cm H2O PEEP to the dependent lung E. intermittent re-inflation to the non-dependent lung |
ANSWER D |
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4. Child with murmur- what would make it more likely for you to investigate if you heard the murmur
A. persist in supine position B. louder or softer with various manouveres |
EXCLUDE ON HISTORY |
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5. Repeat- Single lumen intubation after multiple attempts of difficult intubation, you put in a bronchoscope after and the tip is in the trachea. The structure B you seen corresponding to?
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Trachealis is posterior, use this to orientate
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7. Repeat- Neonate to drug addicts found by grandmother in the house, brought into ed, mildly jaundice, slight tachycapnic. ABG PH 7.54, PaCO2 46, pO2 74, HCO 13
A. Septicaemic B. Pyloric stenosis C. Opiod overdose D. Meningitis E. Hepatitis |
ANSWER B
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ET03 [Repeat] Jehovah's witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle:
A. Paternalism B. Maleficience C. Autonomy D. Beneficience |
ANSWER B?
Paternalism would be to proceed and give him blood regardless of his autonomy because we know best Non maleficence would be first to do no harm. In this case not proceeding with surgery. Autonomy would be to proceed and not give him blood even if he exsanguinates. Beneficience ?? action that is done for the benefit of others. Examples of beneficent actions: Resuscitating a drowning victim, providing vaccinations for the general population, encouraging a patient to quit smoking and start an exercise program, talking to the community about STD prevention. |
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9. Patient with aortic stenosis, the signs indicate poor prognosis
A. Palpitation B. Radiation to carotid arteries C. Something about characteristic of murmur |
??
Signs of severity 1. Weak plateau pulse 2. Small pulse pressure 3. Late peak systolic murmur 4. Reverse splitting S2 5. S4 6. Signs of LVH |
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Which is the best predictor of poor prognosis with aortic stenosis?
A. chest pain B. paroxysmal nocturnal dyspnoea C. syncope D. E. |
ANSWER B
Mean survival Onset of angina 2-4.7 yrs Onset of syncope 0.8-3.7 yrs Onset of heart failure 0.5-2.8 yrs (uptodate) |
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10. New- Patient indicated for prophylaxis of infective endocardititis
A. amoxicillin orally 2 hours prior B. amoxicillin IV 1 hour prior C. amoxicillin IV just before incision D. cefazolin IV 1 hour prior |
ANSWER D
ORAL Amoxillin 2g orally or 50mg/kg Allergic to penicillin: Clindamycin 600mg orally or 20mg/kg OR Cephazolin 2g orally or 50mg/kg OR Azithromycin or Clarithromycin 500mg orally or 15mg/kg INTRAVENOUS Ampicillin 2g IV or 50mg/kg Allergic to penicillin: Clindamycin 600mg IV or 20mg/kg IV OR Cefazolin or Ceftriaxone 1g IV/IM or 50mg/kg IV/IM (Lois) - B? - Amoxycillin PO 2g 1 hour pre-op If can't PO: - Amoxy/ampicillin 2g IV within 1hr pre-op (ideally 15-30min) OR - Amoxy/ampicillin 2g IM 30min pre-op If penicillin hypersensitivity: - Cephalexin 2g PO 1hr pre-op OR - Cephazolin 2g IV within 1 hr (ideally 15-30min) pre-op OR - Cephazolin 2g IM 30min pre-op If penicillin anaphylaxis: - Clindamycin 600mg PO 1hr preop or 600mg IV (over at least 20min) within 1hr (ideally 15-30min) pre-op |
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11. Circuit disconnection during spontaneous breathing anaesthesia
A. will be reliably detected by a fall in end-tidal carbon dioxide concentration B. will be detected early by the low inspired oxygen alarm C. will be most reliably detected by spirometry with minute volume alarms D. may be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration E. can be prevented by using new, single-use tubing |
ANSWER D
A. FALSE: Gas analyzer is still connected to patient despite disconnection of circuit, therefore ETCO2 will be normal B. FALSE: Disconnection allows entrainment of room air which will not be detected by low inspired O2 alarm C. FALSE : Depends where the spirometry is taken from, but some spirometry taken near the filter and so a disconnect at the machine will not be detected D. TRUE : Any disconnect will allow entrainment of room air into the circuit and allow escape of the volatiles, thus a drop in the ET-agent. E. FALSE: Single use tubing will not prevent a disconnection. Apnea/disconnect alarms may be based on 1. Chemical monitoring (lack of end tidal carbon dioxide) 2. Mechanical monitoring * Failure to reach normal inspiratory peak pressure, or * Failure to sense return of tidal volume on a spirometer 3. Visual monitoring * Failure of standing bellows to fill during mechanical ventilator exhalation * Failure of manual breathing bag to fill during mechanical ventilation (machines with fresh gas decoupling- the Apollo, Fabius GS, Narkomed 6000) 4. Auditory monitoring - lack of breath sounds in precordial, lack of sound from ventilator cycling, etc. 5. Optic monitoring - Failure of the hanging bellows to fill completely (the "garage door" electronic eye sensor on the Julian) |
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12. TMP-Jul10-036
Which is NOT a disadvantage of drawover vaporiser versus plenum vaporiser? A. Temperature compensation B. Cannot use sevoflurane C. Small volume reservoir D. Flow compensation E. |
Diadvantages
1. Poor temperature compensation (OMV suffer from a reduction in vapour ouput at lower temperatures) 2. Difficult to use sevoflurane (sevo requires high concentrations, therefore require extra wicks to maximise output, however loss of latent heat of vaporisation rapidly lowers its performance. Two OMVs are required to provide adequate sevo conc for induction) 3. Small volume reservior (OMV contains 50ml, which empties rapidly) 4. Basic temperature compensation 5. Less easy to observe spont vent with self inflating bag 6. cumbersome in paedatric use Advantages of draw over 1. easy to set up 2. in circuit 3. low resistance 4. mobile 5. non agent specific 6. no need for pressurized gas supply 7. robust, reliable 8. easily serviced |
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PZ130 Which drugs below does not need dose adjustment in renal failure patient
A. Buprenorphine B. Morphine C. Tramadol D. ? E. ? |
ANSWER A
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14. Repeat- Child after gas induction, LMA insertion without IV cannula- desaturate to 90%. Next step of action?
A. Bag with LMA insitu B. Bag without LMA insitu |
Remove offending stimulus
100% O2 with CPAP, deep anaesthetic Optimize airway with gentle jaw thrust Morgani maneuver Drugs Propfol 0.5mg/kg Sux 0.5mg/kg atrop 0.2mic/kg IM sux if no IV Refractory latngospasm: SLN block, Transtracheal lig through cric mem |
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PZ128 Patient on cisapride. What drug NOT to give in recovery?
A. Tramadol B. ? C. ? |
ANSWER A
Cisapride is a prokinetic *agonist at muscarinic (M2) and some serotonergic (5HT4) receptors, and as an antagonist at other serotonergic (5HT3) receptors. *increases SM tone, strength and co-ordination Risk of Prolong QTc *inhibit K+ channels *higher doses * reduced metabolism via Cytochrome P450 (e.g. macrolides, azole antifungals, grapefruit juice) * other QTc drugs (e.g. quinidine, sotalol). |
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16. Repeat- Which herbal supplement reacts with tramadol?
A. Ephedra B. St John's wort |
ANSWER B
Ephedra: cardiovascular instability: hypertension, angina acutely and catechol depletion chronically. St J Wort: P450 induction. Interaction with tramadol. Increased sensitivity to anaesthesia. Very important is the induction of metabolism of immunosuppressants, antiretrovirals and anticonvulsants. |
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17. Repeat- Fat: blood coefficient- N2O, D, S, I
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N2O 2.3
D 27 S 47 I 45 |
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18. Repeat- Immunology mediated heparin induced thrombocytopenia- intravascular thrombosis
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HITTS
Type 1 and Type 2 |
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19. Repeat- Half life or tirofiban?
A. 2 hours |
A
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TMP-131 Repeat- Troponin can be detected for how long:
A. 5-14 days B. ? |
A
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21. Repeat- Neonate intubation- at lips
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DEPTH Mouth Nose
Term 9 11 6 mo 11 13 1yo 12 14 Age/2 +12 +15 |
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22. New - 72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is
A. IVC filter B. Refer him for a pulmonary embolectomy C. Supportive (fluids and inotropes) D. Thrombolysis E. Warfarin |
ANSWER B
Absolute Previous intracranial bleeding at any time, stroke in less than 3months,closed head or facial trauma within 3 months,suspected aortic dissection ,ischemic stroke within 3 months(except in ischemic stroke within 3hours time), active bleeding diathesis, uncontrolled high blood pressure (>180 systolic or >100 diastolic),known structural cerebral vascular lesion viz av malformations. [edit] Relative Current anticoagulant use, invasive or surgical procedure in the last 2 weeks, prolonged cardiopulmonary resuscitation (CPR) defined as more than 10 minutes, known bleeding diathesis, pregnancy, hemorrhagic or diabetic retinopathies, active peptic ulcer, controlled severe hypertension. |
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23. Repeat- The test to diagnose pulmonary embolism
A. CT pulmonary angiogram B. Echocardiogram C. Electrocardiogram D. Ventilation-perfusion scan |
ANSWER A
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24. Repeat- Finding on haemophilia A patient
A. Female haemarthrosis B. Male haemarthrosis C. Normal PT, abnormal APTT D. Abnormal PT, normal APTT |
ANSWER C
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25.tmp11b25 New- LSCS for foetal distress, meconium stained liquor. Management of baby
A. Intrapartum suctioning B. Intrapartum suctioning and post partum tracheal suction C. Post partum tracheal suctioning D. Routine neonatal care E. Intubate |
ANSWER ?C
Rapid assessment: -pink and breathing-> routine care -apnoea/flat -> tracheal suction then CPAP 5 PIP 30 with air with neopuff mask -continue neopuff is adequate ventilation, HR>100, pink,Preductle Sat>90% -HR<60: commence CPR, atropine -Consider intubation if prem, difficulty with neopuff mask, expected prolonged respiratory support, HR<60 |
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26. Repeat- 36yo male with sickle cell anaemia Hct 0.3 with close foot fracture, what is true
A. Transfusion 2 pint packed cell preop B. Spinal can be done |
ANSWER B
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27. New- An elderly lady has a closed neck of femur fracture and presents to ED. She is in chronic AF and on warfarin. INR is 2.6 and she is not bleeding. It is 9am and she is scheduled for repair the following day. According to current guidelines, how should her warfarin be reversed?
A. Prothrombinex 25IU/kg immediately and then 2 units FFP immediately prior to surgery B. No immediate treatment then 2 units FFP immediately prior to surgery C. Vitamin K 1mg IV immediately D. Vitamin K 10mg IV immediately E. Withhold warfarin |
ANSWER C
INR <1.5 = proceed with surgery URGENT SURGERY INR <1.9 FFP INR <5.0 FFP + Vit K 1-3mg slow IV INR < 9 FFP Vit K 2-5mg slow IV SEMI URGENT INR <1.9 Vikt K 1mg oral INR< 5.0 Vit K 1.25mg oral, repeat INR INR <9.0, Vit K 2.5-5.0mg, repeat INR ELECTIVE SURGERY Bridging therapy if high risk of VTE Risk factors 1. Acute thrombosis, on treatment > 1month 2. Mechanical heart valve 3. Severe myocardial dysfunction 4. Atrial fibrillation Acute thrombosis <1month IVC filter |
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28. Repeat- Marfan syndrome. All EXCEPT-
A. Aortic stenosis |
Cardiac Manifestations
MVP AR Aortic dissection Conduction abnormalities |
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29. New- Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours
A. <5% B. 5-10% C. 10-15% D. 15-20% E. >20% |
ANSWER A
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30.TMP11B30 New- Post delivery neonate did not breath post stimulation by midwife, not vigorous, heart rate drop from 140 to 90bpm. Next step of action
A. 100% oxygen B. Positive pressure ventilation C. Intubation D. CPR E. Adrenaline |
ANSWER B
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31. New- The safe maximal pressure for endotracheal cuff at the lateral side of the trachea
A. 0-10 cm water B. 10-20 cm water C. 20-30 cm water D. 30-40 cm water E. 40-50 cm water |
ANSWER B
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32. Repeat- Allergy to penicillin- cross reaction to neuromuscular blocker
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?
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33. New- Patient with mastocytosis. Intraop would probably be:
A. Severe hypotension |
A
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34. Repeat- Complication of celiac plexus block
A. Hypertension B. Failure of erection C. Constipation D. Paraplegia E. L3,4 lumbar pain |
ANSWER D
Complications • Severe hypotension may result, even after unilateral block. • Local pain during procedure • Diarrhoea • Intramuscular injection into the psoas muscle. • Bleeding due to aorta or inferior vena cava injury by the needle. • Intravascular injection (should be prevented by checking the needle position with radio-opaque dye). • Upper abdominal organ puncture with abscess/cyst formation. • Paraplegia from injecting phenol into the arteries that supply the spinal cord (prevented by checking the needle position with radio-opaque dye). • Lumbar nerve root irritation (injected solution tracks backwards towards the lumbar plexus). • Sexual dysfunction (injected solution spreads to the sympathetic chain bilaterally) = inability to ejaculate • Pneumothorax • Shoulder/chest/pleuritic pain/hiccupping – diaphragmatic irritation • Haematuria from renal pouncture |
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35. New- Post epidural and LSCS, the next day patient have persistent paraesthesia anterior thigh. What other injuries would indicate more of nerve roots instead of peripheral nerve injuries
A. Weakness on hip flexion and thigh adduction B. Weakness on knee flexion and plantar flexion C. Urinary incontinence D. Foot drop |
ANSWER D
A - L1/femoral B - sciatic C - sacral nerve roots D - lumbosacral/common peroneal |
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36. Repeat- Nerve supply to the upper eyelid-
A. ophthalmic branch of trigeminal and sympathetic from superior collicus ganglion |
A
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37
TMP-Jul10-059 [Aug10] LUSCS for failure to progress. Spinal is inserted uneventfully. Next day the patient has foot drop. The most likely cause is? A. epidural haematoma B. lumbosacral palsy C. sciatic nerve palsy D. common peroneal palsy E. ? |
Lois - B as per below reference
lumbosacral plexus > comm. peroneal ANSWER D |
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38 ANZCA Version [Jul07]Q.150
You are asked to see a 60 y.o. male 2 days following a cervical laminectomy because he has new new neurological symptoms in his right arm. The surgical team think these may be due to poor patient positioning. The sign that would most help differentiate c C8-T1 nerve root injury from an ulnar nerve injury is A. loss of sensation in the index finger B. loss of sensation in the little finger C. weakness of the abductor digiti minimi muscle D. weakness of the abductor pollicis brevis m E. weakness of the first dorsal interosseous m. |
ANSWER D
A. FALSE: neither ulnar nerve or C8T1 supply, therefore non differentiating B. FALSE. both ulnar and C8T1 supply therefore non differentiating C. FALSE: both affected by C8T1 and ulnar therefore non differentiating D. TRUE: T1 and median nerve supply, but ulnar does not E. FALSE. both supplied by c8T1 and ulnar nerve therefore non differentiating |
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39
ECG- which does NOT have abnormal Q waves: A: Digoxin toxicity B: Anterior myocardial infartion C: Previous AMI D: LBBB E: Wolff-Parkinson-White syndrome |
ANSWER A
Digoxin does not cause Q waves |
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40 The QT interval may be prolonged by each of the following EXCEPT
A. high intra-thoracic pressure B. hypothermia C. magnesium sulphate D. suxamethonium E. volatile anaesthetic agents |
ANSWER C
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41. Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive B: Start antiplatelet drugs C: Start anticonvulsants D: Do angio and stent E: Nimodipine |
ANSWER A
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42. Repeat- Post local anaesthetic block in difficult intubate patient- patient seizure. What would you give?
A. Midazolam 5mg B. thiopentone C. propofol D. Suxamethonium |
ANSWER A
ABC/Benzos first then consider intralipid If cardiovascular collapse - intralipid |
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43
SG62 [Jul07] Patient presents with carcinoid syndrome and developes hypotension intraoperatively. Best drug to treat it is: A. Noradrenaline B. Adrenaline C. Metaraminol D. Octreotide E. Ephedrine |
ANSWER D
the occurrence of intraoperative carcinoid crisis manifesting as bronchospasm or hypotension is treated with IV octreotide 100-200 mcg...Stoelting...drstitch Vasopressin 2nd line |
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44. Repeat- Allergic question, which is true
A. Collect tryptase 8hours B. RAST test most sensitive/ specific C. Absent of trytase exclude anaphylactic D. Skin and intradermal test- sensitivity, specificity |
ANSWER ???
Skin prick is easy to perform, safe and provides the best sensitivity/specificy combo. However it requires a skilled proceduralist Interdermal has higher sensitivity but higher anaphylaxis rate. RAST is 100% specific but only 75% senstive. Used to determine if pt has IgE antibodies to particular agents. It does not diagnoses anaphylaxis (as this requires 2 IgE to crosslink) |
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45
AB50 ANZCA version [2005-Sep] Q120 Transfusion related acute lung injury (TRALI) A. can be caused by all homologous blood components, but particularly FFP (fresh frozen plasma) B. is associated with significantly elevated pulmonary artery pressure C. is the commonest cause of morbidity associated with blood transfusion D. should be treated with high dose steroids E. typically presents 24 hours following transfusion |
Lois - C?
Another answer said A not true since TRALI not caused after albumin ANSWER A |
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46. New- After transfusion of 5 unit of FFP what is least likely to occur
A. Haemolytic reaction B. Hypocalcaemia C. Infection D. Hyperkalaemia |
ANSWER D
A. FALSE: can occur if not matched B. FALSE: likely to occur if tranfused >1ml/kg/min C. FALSE: viral transmission possible D. TRUE: FFP does not contain potassium |
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47. Severe asthmatic- tachycapnia, HR120, speaking in words, pH 7.45, pCO2 46, pO2 96, HCO3 24. Then given nebulised salbutamol continuously, nebulised ipratropium bromide, and hydrocortisone- The next step:
A. IV salbutamol B. Mg |
ANSWER Magnesium
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48. AC62b ANZCA version [2003-Apr] Q144, [2004-Apr] Q98, [2004-Aug] Q44, [Jul06] Q23
The most commonly reported cause of awareness during general anaesthesia for a non-obstetric procedure is A. equipment failure B. human error C. lack of premedication D. recreational drug use E. the use of total intravenous anaesthesia |
ANSWER B
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49. New- There is evidence to avoid BIS <40 for more than 5minutes because
A. Safe cost B. Increase incident of hypotension C. Increase post op mortality D. Decrease volatile (?) for poor cardiac output patient E. Decrease the incidence of awareness |
ANSWER C
The effect of bispectral index monitoring on long-term survival in the B-Aware Trial. Anesth Analg 2010 BACKGROUND: When anesthesia is titrated using bispectral index (BIS) monitoring, patients generally receive lower doses of hypnotic drugs. Intraoperative hypotension and organ toxicity might be avoided if lower doses of anesthetics are administered, but whether this translates into a reduction in serious morbidity or mortality remains controversial. The B-Aware Trial randomly allocated 2463 patients at high risk of awareness to BIS-guided anesthesia or routine care. We tested the hypothesis that the risks of death, myocardial infarction (MI), and stroke would be lower in patients allocated to BIS-guided management than in those allocated to routine care. METHODS: The medical records of all patients who had not died within 30 days of surgery were reviewed. The date and cause of death and occurrence of MI or stroke were recorded. A telephone interview was then conducted with all surviving patients. The primary end point of the study was survival. RESULTS: The median follow-up time was 4.1 (range: 0-6.5) years. Five hundred forty-eight patients (22.2%) had died since the index surgery, 220 patients (8.9%) had an MI, and 115 patients (4.7%) had a stroke. The risk of death in BIS patients was not significantly different than in routine care patients (hazard ratio = 0.86 [95% confidence interval {CI}: 0.72-1.01]; P = 0.07). However, propensity score analysis indicated that the hazard ratio for death in patients who recorded BIS values <40 for >5 min compared with other BIS-monitored patients was 1.41 (95% CI: 1.02-1.95; P = 0.039). In addition, the odds ratios for MI in patients who recorded BIS values <40 for >5 min compared with other BIS-monitored patients was 1.94 (95% CI: 1.12-3.35; P = 0.02) and the odds ratio for stroke was 3.23 (95% CI: 1.29-8.07; P = 0.01). CONCLUSIONS: Monitoring with BIS and absence of BIS values <40 for >5 min were associated with improved survival and reduced morbidity in patients enrolled in the B-Aware Trial. |
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50. New- Most common cause of paediatric post anaesthesia cardiac arrest
A. Drug error B. Respiratory cause C. Multifactorial D. Cardiac problem (?) |
ANSWER B
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51. New- Post cervical spine op, there is bulging noted under the incision site. Patient desaturated, combative, keep pulling off the oxygen facemask. Next course of action
A. Rapid sequence induction B. Gas induction C. Needle aspiration of the bulge at the neck |
ANSWER A
Lois - B? - bulging may mean haematoma, clinically severe enough to impede airway --> highly likely to be difficult, would aim to keep pt spont. vent |
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52. New- What drug known to cause prolong QT and risk of Torsades de Pointes
A. Metoclopramide B. Droperidol C. Tranexamic acid |
ANSWER B
Black label for droperidol |
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53. New- During cardiac catheterisation (?) patient become BP 80/60, HR 110, CVP 16. What is the next most important investigation
A. Echocardiogram B. CXR C. Electrocardiogram |
ANSWER A
?tamponade |
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54. Intraop hyperfibrinolysis- how to diagnose (euglobulin lysis time NOT an option in the answer)
A. TEG B. PT C. APTT |
ANSWER A
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55. New- 75yo patient seen for femoral bypass surgery, no significant cardiac risk factor. He will be admitted 3 days prior to operation. You decided NOT to start on beta blocker and you are justified because:
A. There is increase mortality and morbidity B. There is not enough time to safely start beta blocker C. The beta blocker may make the patient claudication worst D. ? |
ANSWER A
POISE TRIAL |
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56. New- You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?
A. amiodarone 100mg bd B. digoxin 250mcg daily C. enalapril 2.5mg bd D. metoprolol 100mg bd E. diltiazem slow release 240mg daily |
ANSWER C
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57.EZ80 Repeat- A line isolation monitor protects against microshock
A. only if the warning current is set at 10mA B. only if the warning current is set at 30mA C. under no circumstances D. only if the equipment used is grounded E. only if it monitors all the equipment in the region |
ANSWER C
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58. AT27 [Apr07] Q108
Following a left sided pneumonectomy, a left intercostal drain is placed and connected to an underwater drainage system. In the postoperative period A. A leakage of air is expected from the drain B. The patient should be nursed in the right lateral decubitus position C. The underwater seal drain should be left on continuous free drainage
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ANSWER E
Prevent cardiac herniation |
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59.RB53 Repeat- Post dural punture headache
A. 24hour bed rest B. Prone position worst C. Increase incidence with insertion of spinal catheter D. Hearing loss |
ANSWER D
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60. New- Patient ingested 500mg/kg aspirin. In ICU, the most effective method to remove aspirin
A. IV fluid B. Haemodialysis C. Sodium bicarbonate infusion D. Frusemide |
ANSWER B
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61. Repeat- The most effective method of decrease renal impairment in AAA surgery
AZ69a ANZCA version [2003-Apr] Q137 During elective major vascular surgery the best way to reduce the risk of acute renal failure is to maintain a normal A. cardiac output B. central venous pressure C. mean arterial blood pressure D. pulmonary capillary wedge pressure E. renal blood flow AZ69b ANZCA version [2003-Aug] Q129, [2004-Apr] Q77, [Mar06] Q71, [Apr07] Q129, [Jul07] During elective major vascular surgery the best way to reduce the risk of acute renal failure is to maintain a normal A. central venous pressure B. mean arterial blood pressure C. renal blood flow D. systemic vascular resistance E. urine output |
Maintain renal flow
Limit AoX time Avoid supra renal AoX |
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62.
SZ18b ANZCA version [2006-Mar] Q148, [Jul06] Q35 Infra-renal aortic cross-clamping usually results in A. decreased cardiac contractility B. decreased coronary blood flow C. decreased renal blood flow D. minimal change in cardiac output E. increased heart rate |
ANSWER C
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63. Repeat- The most effective method for cerebral protection in aortic arch aneurysm repair
A. Systemic hypothermia 20degrees B. Antegrade perfusion to carotid arteries C. Retrograde perfusion to jugular veins D. Thiopentone E. Steroid (?) |
ANSWER A
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SF53 ANZCA version [2001-Apr] Q6, [2001-Aug] Q4, [2003-Aug] Q66, [2004-Apr] Q55, [Mar 10],[Aug10]
Carbon dioxide is the most common gas used for insufflation for laparoscopy because it A. is cheap and readily available B. is slow to be absorbed from the peritoneum and thus safer C. is not as dangerous as some other gases if inadvertently given intravenously D. provides the best surgical conditions for vision and diathermy E. will not produce any problems with gas emboli as it dissolves rapidly in blood |
ANSWER C
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65. Repeat- Most common signs of malignant hyperthermia-
A. tachycardia |
ANSWER A
The signs and symptoms of the acute episode are: * Increased CO2 production (the most sensitive indicator) * Tachycardia * Muscular rigidity * Increased body temperature (relatively late) * Metabolic and respiratory acidosis * Masseter spasm * Tachypnoea (if spontaneous respiration) Late signs are: * Complex arrhythmias * Cyanosis * Hypotension * Electrolyte abnormalities * Rhabdomyolysis Differential diagnosis (Ali et al, 2003 (http://www.sciencedirect.com/science/article/B6WBC-49WH6NS-4/2/e600ed74c16e6edf8d10dd86be60e0fb)): * Thyroid storm * Neuroleptic malignant syndrome * Iatrogenic overheating * Heat illness * Pheochromocytoma * Sepsis * Cocaine, ecstasy overdose * Hypoxic encephalopathy * Faulty equipment for measuring temperature, carbon dioxide * Intrathecal injection of inappropriate radiological contrast agent * Sudden cardiac arrest in a patient with occult myopathy |
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66. New- The below would increase A-a oxygen gradient Except
A. Increase FIO2 B. Decrease FIO2 C. Decrease cardiac output D. Increase shunt |
ANSWER B
A-a gradient * increases 5-7mmHg for every 10% increase in FiO2 * increases with age * increases with increased shunt * V/Q mismatch * defect in diffusion |
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TMP-104 [Mar10] [Aug10]
Stellate ganglion A. Anterior to scalenius anterior B. ? C. ? D. ? E. ? |
ANSWER A
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68. Repeat- Patient cough during interscalene block- insertion needle should be directed-
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ANSWER posterior
Stimulation of diaphragm : phrenic nerve : needle tip is anterior to plexus Stimulation of trapezoid : needle tip is posterior to plexus |
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69. New- Interscalene block after injection of 2ml bupivacaine- patient seizure. Most likely injected to
A. Dural cuff B. Vertebral arteries C. Internal carotid arteries D. Jugular veins E. Subarachnoid (?) |
ANSWER B
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70. New- Post intubation, you manual ventilate and noted patient high airway pressure. What would you do next
A. Open the APL valve B. Auscultate the lung C. Switch to ventilator |
ANSWER B
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71
E46 Mar2011 Acromegaly due to excess of growth hormone. Why hard to do direct laryngoscopy? A. Distorted facial anatomy B. Macroglossia C. Glottic stenosis D. Prognathe mandible E. Arthritis of the neck |
ANSWER B
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72. New- Modified Cormack and Lehane grade - You cannot see beyond the epiglottis and there is a little space between the epiglottis and the posterior pharyngeal wall (? remembered as epiglottis touching posterior pharyngeal wall)
A. 2a B. 2b C. 3a D. 3b E. 4 |
C
Grade I: Complete glottis visible. |
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73
Stellate ganglion block associated with all except: A. Ptosis B. Miosis C. Sweating D. Facial flushing E. Nasal stuffiness |
ANSWER C
Stellate Ganglion produces Horners syndrome * Ptosis * Miosis * Anhidrosis In addition, several other eye signs are present: * Conjunctival injection * Lacrimation |
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74. Repeat- Most safe side to insert subtenon block
A. Inferonasal B. Inferotemporal C. Medial D. Superonasal E. Superotemporal |
ANSWER A
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75. Compared to retrobulbar block, peribulbar block is associated with
A. More bleeding B. More risk to optic nerve C. More akinetic eye D. Less block to orbicularis oculi |
ANSWER D
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76. Repeat- Diastolic dysfunction Not caused by
A. Adrenaline B. Myocardial fibrosis C. Aortic stenosis D. Hypertension |
ANSWER A
Adrenaline increases the efflux of Ca, therefore aiding relaxation (lusitropy) |
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ANZCA Version [Apr07]
Reverse splitting of the 2nd heart sound is caused by A. acute pulmonary embolism B. ASD C. complete LBBB D. severe MR E. pulmonary HT |
ANSWER C
Split during inspiration : Normal Split during expiration = Reverse splitting *Aortic stenosis *hypertrophic cardiomyopathy *left bundle branch block (LBBB) * ventricular pacemaker Split during both inspiration and expiration = fixed split S2 * atrial septal defect (ASD) * ventricular septal defect (VSD). |
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78. Lumbarsacral nerve does not supply:
A. Subcostal nerve B. Ilioinguinal n C. Iliohypogastric n D. Femoral n E. Genitofemoral n (?) |
ANSWER A
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79. Repeat- Relative humidity of fully saturated air at 20degree and 37 degrees-
A. 40% |
Absolute humidity
@20deg 17g @37deg 44g 17/44 = 40% |
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80.IC90 Repeat- Trauma patient best indicator of good resuscitation (?)-
A. Lactate level B. Heart rate C. Blood pressure D Acidosis (?) |
ANSWER A
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81. New- Pregnant patient seatbelt, driver- involved in car accident. Suddenly developed severe central chest pain, HR 110, BP 154/80, RR 26, Sat 100%. The most likely cause?
A. Sternal fracture B. Aortic dissection C. Pneumothorax D. Rib fracture E. Myocardial infarction |
ANSWER B
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82. New- ASD murmur heard at
A. ASD B. Tricuspid valve C. Pulmonary valve D. Mitral valve E. Aortic valve |
ANSWER C
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84
TMP-Jul10-038 Chronic alcohol use. Which is not an associated complication ? A. Pancreatitis B. Atrial fibrillation C. Macrocytosis D. Nephrotic syndrome E. Hypertriglyceridaemia |
ANSWER D
CNS Wernicke–Korsakoff syndrome Metabolic Hyperlipidaemia Peripheral neuropathy Obesity. Hypoglycaemia Autonomic dysfunction Hypokalaemia Hypomagnesaemia Hyperuricaemia CVS Cardiomyopathy Haematological Macrocytosis Heart failure Thrombocytopenia Hypertension Leucopoenia Arrhythmias (e.g. AF, SVT, VT) GI Alcoholic liver disease Musculoskeletal Myopathy Pancreatitis Osteoporosis Gastritis Osteomalacia Oesophageal and bowel carcinoma |
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83.
AB58 ANZCA version [Jul07] Q141 A young woman with type 1 von Willebrand disease presents for a dilatation and curettage. She is a Jehovah's Witness. You consider administering intravenous desmopressin in an attempt to reduce haemorrhage. Which of the following statements regarding desmopressin is FALSE? A. it is a synthetic substance and is acceptable to Jehovah's Witnesses
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ANSWER D
Elimination half life 2.4-4-4 hrs |
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85 TMP-Jul10-044
Called to emergency department to review a 20 year old male punched in throat at a party. Some haemoptysis / hoarse / soft voice. Next step in management: A. CT to rule out thyroid cartilage fracture B. XR to rule out fractured hyoid C. Rapid sequence induction / laryngoscopy / intubation D. Awake fibreoptic intubation E. Nasendoscopy by ENT in emergency department |
ANSWER E
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86
TMP-Jul10-045 How quickly does the CO2 rise in the apnoeic patient ? A. 1 mmHg per min B. 2 mmHg per min C. 3 mmHg per min D. 4 mmHg per min E. 5 or ?8 mmHg per min |
ANSWER C
From Miller, 1st minute Co2 increases by 6 mm Hg all subsequent minutes 3 -4 mm Hg |
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87. New- Apnoeic oxygenation in obese patient can be increased by
A. Sniffing position B. Prone C. Supine D. Lateral E. Head up |
Lois - E
ANSWER D? E? |
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88
MN21 [1985] [1986] [1987] [1988] [Mar93] [Apr98] (type A) Which of the following is NOT a feature of long-standing paraplegia above T6? A. Flaccidity of the leg muscles B. Poikilothermia C. Mass autonomic reflex D. Hyperkalaemia after Suxamethonium administration E. Labile blood pressure |
ANSWER A
flaccidity resolves after a while (?time) |
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89 TMP-Jul10-048
Amniotic fluid embolism. Cause of death in first half hour ? A. Pulmonary hypertension B. Malignant arrhythmia C. Pulmonary oedema D. E. |
ANSWER A
first severe pulmonary vasoconstriction ,Rt ventricular failure ,then Lt ventricular failure and pulmonary oedema ,embolism is probably a misleading name,its actual pathology is anaphylaxis to foetal tissues |
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90. New- Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is:
A. Low C3, C4 B. Increase complement C. Increase tryptase D. Increase histamine? E. petechial rash |
Lois - A
ANSWER E |
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91 TMP-Jul10-049
The EARLIEST sign of hypocalcaemia is: A. Tingling of face and hands B. Chvostek’s sign C. Carpopedal spasm D. ? E. ? |
ANSWER A
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92
RH12b [Mar92] To operate on the anterior 2/3rds of the ear you would need to block: A. Mandibular n B. Maxillary n C. Vagus n D. Greater auricular n |
ANSWER A
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93
TMP-Jul10-054 Malignant hyperthermia. The number of people in the community at any given time with a predisposition is called the: A. Prevalence B. Incidence C. ? D. E. |
ANSWER A
Incidence measures the rate of occurrence of new cases of a disease or condition. Prevalence measures how much of some disease or condition there is in a population at a particular point in time. |
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ST19 ANZCA version [2002-Mar] Q62, [2002-Aug] Q59, [2005-Apr] Q58, [2005-Sep] Q50
A diagnostic test has a sensitivity of 90% and a specificity of 99% in detecting a certain disease. From this we can conclude that A. the false positive rate of this test is 1% B. the false negative rate of this test is 1% C. the positive predictive value of this test is 90% D. the negative predictive value of this test is 90% E. this test would be a useful screening test for this disease |
ANSWER A
For PPV/NPV you need prevalence so can't work out just by using sens/spec Sensitivity = TP / (TP + FN) Specificity = TN / (TN + FP)
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95 TMP-121 [Apr08] [Aug08]
Levosimendan: A. Increases contractility and myocardial oxygen consumption B. Increases SVR C. Binds to troponin C and induces a conformational change D. Increases contractility by increasing calcium influx E. Causes coronary vasodilation but NOT peripheral vasodilation |
ANSWER C
Levosimendan causes conformational changes in cardiac troponin C during systole, leading to sensitisation of the contractile apparatus to calcium ions It increases contractility without increasing oxygen requirements Causes coronary and systemic vasodilation |
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96 TMP-Jul10-062 [Aug10]
In pregnancy the dural sac ends at: A. T12 B. L2 C. L4 D. S2 E. S4 |
ANSWER D
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97
TMP-Jul10-064 [Aug10] Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management? A. Adenosine 6mg B. DCR C. Amiodarone D. Atenolol E. ? |
ANSWER A
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98
Which patients do not get pulmonary hypertension a. ASD b. Chronic thromboembolism c. Tetralogy d. MR e. MS |
ANSWER C
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99 MC157 [Mar10] [Aug10]
An 18 yo with Fontan circulation undergoing exploratory laparotomy. On ICU ventilation, saturation is 70%. Which ventilator parameter would you INCREASE to improve his saturation? A. Bilevel pressure B. Expiratory time C. Inspiratory time D. Peak inspiratory pressure E. PEEP |
ANSWER B
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100
EM37 ANZCA version [2001-Aug] Q57, [2002-Mar] Q52, [Jul06] Q81, [Apr07] (Similar reported question in [Apr96] [Aug96] [Apr97]) Systemic vascular resistance index (SVRI) is calculated from A. systemic vascular resistance multiplied by body surface area B. systemic vascular resistance divided by body surface area C. mean aortic and central venous pressure difference divided by cardiac output D. cardiac index divided by the mean aortic and central venous pressure difference E. none of the above |
ANSWER A
SVR = 80 x (MAP - CVP)/CO SVRI = 80 x (MAP - CVP)/CI CI = CO/BSA SVRI = SVR x BSA |
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101. New- Young pregnant patient with moderate mitral stenosis, normal LV function. The best delivery method
A. Epidural anaesthesia LSCS B. Spinal with LSCS C. Epidural analgesia and normal vaginal delivery D. GA LSCS E. Normal vaginal delivery with remifentanil PCA |
ANSWER C
MS is a fixed output valvular disease -transmitral gradient is proportional to CO squared, therefore increasing CO by 50%, will increase the gradient 2.3 fold -generally pregnancy will increase NYHA class by One Aims are to keep the patient at they are -maintain preload -normal HR -maintain afterload MS should be evaluated before pregnancy -prophylactic percutaneous mitral balloon valvotomy -NHYA 2-4 or high PTH high risk of complications and death Treat antenatal with diuretic and beta blockers -care should be taken to avoid hypovolaemia -ACEI are contraindicated in pregnancy Labour and post partum are the most dangerous times -Epidural to blunt sympathetic response (attenuate HR, CO, therefore minimised increasing transmitral gradient) -Most delivery, sudden increase in preload with autotransfusion can lead to APO -Cautious use of Syntocinon during 3rd stage. Vasodilation can cause hypotension with compensatory tachycardia leading to overdistention of LA (due to MS) and AF => APO -AF should be electrically cardioverted. |
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102
PP84b ANZCA version [2005-Sep] Q141 Tracheo-oesophageal Fistula (TOF)
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ANSWER E
A. Cardiac in 20% B. Atresia in 80-90% C. 1:1 D. right |
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103
MC30b ANZCA version [2004-Aug] Q128, [2005-Apr] Q55 A patient with pulmonary hypertension secondary to lung disease presents for a laparotomy. Regarding this patient's anaesthetic management A. an alpha-agonist is the inotrope of choice B. hypothermia is protective against rises in pulmonary artery pressure C. isoflurane will tend to decrease pulmonary artery pressure D. ketamine is an appropriate anaesthetic agent E. right heart failure is not a concern |
A patient with pulmonary hypertension secondary to lung disease presents for a laparotomy. Regarding this patient's anaesthetic management
* A. an alpha-agonist is the inotrope of choice - probably true and best answer: o there are No α-1 adrenergic receptors are present in the pulmonary circulation (Blaise, Anaesthesiology, 2003, 99(6):1421) so α-1 agonists are fine and may assist RV function by increasing coronary perfusion pressure (although some prefer dobutamine initially becuase it increases contractility and may pulmonary vasodilate) o the wording is confusing and might subequently change now. Both the Blaise article and Stoelting 5th ed. suggest that causes of hypotension are multifactorial and should be treated accordingly. Specifically pulm HTN crisis requiring inotropy, the 'inotrope' of choice might be milrione (or possibly dobutamine), however R heart ischaemia and low SVR (with fixed PVR) are important causes of hypotension specifically treated with noradrenaline * B. hypothermia is protective against rises in pulmonary artery pressure - false o Hypothermia increases PVR (A & A ,Volume 96(6), June 2003, pp 1603-1616) * C. isoflurane will tend to decrease pulmonary artery pressure - false o PVR does not change with volatiles except N2O which does increase PVR (Stoelting Pharmacology p47) o Isoflurane has no effect on baseline pulmonary vessel tone. (Blaise, Anaesthesiology, 2003, 99(6):1421) * D. ketamine is an appropriate anaesthetic agent - false o 'In patients who have pulmonary artery pressure, ketamine seems to cause a more pronounced increase in pulmonary than systemic vascular resistance' (Miller, p348) o 'The sympathomimetic properties of ketamine may preclude use in the setting of pulmonary hypertension (Yao, p96) o In-vitro ketamine increases PVR in rat lung...(and)...ketamine attenuates endothelium-dependent pulmonary vasorelaxation in response to acetylcholine and bradykinin ...(and)...sympathetic innervation of the pulmonary circulation does exist (Blaise, Anaesthesiology, 2003, 99(6):1421) * E. right heart failure is not a concern - false |
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104. New- Neonate desaturate faster than adult at induction because
A. FRC decrease more B. Faster onset of induction agents C. More difficult to pre-oxygenation |
???
Reasons for neonatal desat 1. High metabolic rate 2-3 x adult (required mainly for temperature control, high BSA to mass) 2. Small absolute FRC (same as adult 30ml/kg) therefore less oxygen 3. CC >FRC, neonate generates autoPEEP by partial closure of glottis, this is lost at induction, causing airway closure and V/Q mismatch |
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105. New- The cause of hypoxia in one lung ventilation
A. Blood flow through non ventilated lung B. Impairment of hypoxic pulmonary vasoconstriction C. Ventilation perfusion mismatched (?) |
A
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106. New- Suxamethonium dosage higher in neonates compare to adult because
A. Increased volume of distribution B. Increased pseudocholinesterase activity C. More receptors D. Higher cardiac output (?) E. Decreased sensitivity of nicotinic ACH receptors to suxamethonium F. Faster diffusion away from neuromuscular junction |
ANSWER A
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107 TMP-107 [Mar10] [Aug10]
Baby with Tracheo-oesophageal fistula found by bubbling saliva and nasogastric tube coiling on Xray. BEST immediate management? A. Bag and mask ventilate B. Intubate and ventilate C. position head up, insert suction catheter in oesophagus (or to stomach?) D. Place prone, head down to allow contents to drain E. Insert gastrostomy |
ANSWER C
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108 NV42 [Apr07] [Jul07]
What do C6/7 motor function do A. flex/extension of fingers B. flex /extend wrist C. shoulder ext rotation / abduction D. elbow pronation/supination E. flexion at elbow |
ANSWER B
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109
SF89 [Mar10] Most likely change on CTG with anaesthesia for non-obstetric surgery at 32 wks: A. Loss of beat to beat variability B. No change C. Late decelerations D. Variable decelerationss E. Uterine contractions |
ANSWER A
# Normal CTG under GA = Loss of beat to beat variability, no decelerations. # Normal CTG under neuraxial block without sedation = No change |
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110. New- Indicates autonomic neuropathy except
A. Sinus arrthymias B. Gastric reflux C. Postural hypotension |
ANSWER A
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111. Repeat- Best indicator of return function of laryngeal muscle
A. Sustained head lift 5 sec B. Sustained leg lift 5 sec C. TOF accelerometer 0.9 D. DBS no fade E. Tetanus 50Hz |
ANSWER C
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112 MC59b ANZCA version [2003-Apr] Q125, [2003-Aug] Q85, [2005-Sep] Q69, [Mar06] Q48 [Mar10] [Aug10]
In the management of torsades de pointes (polymorphic ventricular tachycardia), all the following drugs may be useful EXCEPT A. amiodarone B. isoprenaline C. [[lignocaine] D. magnesium E. phenytoin |
ANSWER A
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113. New- A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is
A. altered thermoregulation B. chorioamnionitis C. urinary tract infection D. inflammatory response E. neuraxial infection |
ANSWER D
Epidural associated fever is common, ranging from mild hyperthermia to overt fever. Risk Factors 1. Nullparious 2. Prolonged labor 3. PROM Mechanisms postulated 1. Inflammation: most accepted explanation, unknown if it is infectious or non infectious (women with fever and epidural do not have evidence of chorioamonitis on histology) 2. Altered thermoregulation: hyperventilation during labor is diminished, resulting in reduced heat loss. 3. Effect of opioids: opioids suppress IL-2 formation www.anesthesia-analgesia.org/content/111/6/1467.full.pdf |
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114 Can01-113 What nerve supplies sensation to the larynx above the vocal cords:
A. internal branch of superior laryngeal nerve B. external branch of superior laryngeal nerve C. recurrent laryngeal nerve D. glossopharyngeal nerve E. palatotonsillar nerve |
ANSWER A
Glossopharyngeal nerve - supplies tongue and lingular surface of epiglottis Internal branch of SLN - supplies glottic surface of epiglottis and mucosa of larynx up to the cords RLN - Cord + subglottic sensation Motor - intrinsic muscles of larynx except cricothyroid (external branch of SLN) |
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115
NN05 ANZCA version [2004-Aug] Q17, [2005-Apr] Q63, [Apr07] (Similar question reported in [1985] [Aug96] [Jul97] [Jul98]) The carotid sinus derives its nerve supply from the A. vagus nerve B. glossopharyngeal nerve C. ansa cervicalis (hypoglossi) D. middle cervical ganglion E. stellate ganglion |
ANSWER B
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116. ? Post op pneumonectomy short of breath- investigation
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BNP
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AC155 [Apr07]
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:
C. decr FIO2 to maintain sats 97% |
ANSWER B
* A. seal the surgical site from the patients airway with adhesive drapes - potentially correct: "Oxygen is heavier than air, and can therefore accumulate under surgical drapes. This accumulation may be reduced by the use of ‘incise drapes’ that protect the wound from high oxygen concentrations and by tenting surgical drapes to dilute oxygen with room air." (Muchatuta and Sale, Fires and explosions, Anaesth&IC, 2007, 8:11) The answer will depend on what the examiners mean by adhesive drapes
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118 MN38 ANZCA version [2004-Apr] Q124, [2005-Apr] Q100, [2005-Sep] Q94, [Jul07] [Apr08] [Aug08] [Aug09][Mar10] [Aug10]
Respiratory function in quadriplegics is improved by A. abdominal distension B. an increase in chest wall spasticity C. interscalene nerve block D. the upright position E. unilateral compliance reduction |
ANSWER B
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119.92.Pulsus paradoxus is: (the Q was something like - severe asthmatic - when take BP you would find)
A. Reduced BP on inspiration unlike normal (ie normally increased on insp) B. Reduced BP on inspiration exaggerated from normal C. Reduced BP on expiration unlike normal D. Reduced BP on expiration exaggerated from normal E. ? |
ANSWER B
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120. New- Pre eclamptic patient post LSCS continue on Mg infusion in ICU. Found to be in respiratory depressed. Next management
A. Calcium gluconate B. IV fluid C. Frusemide |
ANSWER A
From RWH Request magnesium level and review management if: * respiratory rate < 12 breaths/minute * urine output < 100mLs in 4 hours * loss of patellar reflexes * further seizures occur. Response to magnesium toxicity The following clinical signs of magnesium toxicity must be reviewed by a consultant obstetrician/anaesthetist: * urine output <100mL in 4 hours * absent patellar reflexes * respiratory depression. The antidote for magnesium toxicity is: calcium gluconate (10mL of 10% solution over 10 minutes) by slow intravenous injection. The patient requires ECG monitoring during and after administration because of the potential for cardiac arrhythmias. Resuscitation and ventilator support should be available during and after dose administration of both magnesium sulphate and calcium gluconate. |
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121. New- Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have
A. Primary hyperparathyroidism B. Secondary hyperparathyroidism C. Tertiary hyperparathyroidism |
ANSWER B
Primary hyperparathyroidism causes hypercalcemia (elevated blood calcium levels) through the excessive secretion of parathyroid hormone (PTH), usually by an adenoma (benign tumors) of the parathyroid glands. Secondary hyperparathyroidism refers to the excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia (low blood calcium levels) and associated hypertrophy of the glands. Tertiary hyperparathyroidism is a state of excessive secretion of parathyroid hormone (PTH) after a long period of secondary hyperparathyroidism and resulting hypercalcemia. It reflects development of autonomous (unregulated) parathyroid function following a period of persistent parathyroid stimulation. |
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122. Repeat- How to estimate weight in child-
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(Age+4) x2
Age |
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123 SG59 [Apr07]
Blunt liver trauma can be treated non surgically if A. No peritoneal signs B. Low Grade injury on CT scan C. Severe COPD D. Haemodynamically stable E. US confirms <500mls peritoneal fluid collection (i thought this was a paracentesis result) |
ANSWER D
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124 AZ (Q120 Aug 2008) Preoperative assessment shows a malampati (ML) score of III and thyromental distance (TMD) of < 6cm. A grade 3 to 4 on Cormark and Lehanes is predicted. Compared to the ML score, the TMD is:
A less sensitive, less specific B less sensitive, more specific C more sensitive, less specific D more sensitive, more specific E equal sensitivity an specificity |
ANSWER B
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125. New- Compare to Myasthenia gravis, which symptoms is more likely to be Eaton Lambert syndrome?
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EATON LAMBERT SYNDROME
Myasthenic syndrome Definition: autoimmune NM disorder characterized by IgG Ab to pre-synaptic Ca channels and decreased ACh release • Associated with malignancy 50-60% • Small cell lung Ca CLINICAL • Proximal muscles weakness, esp lower limbs • Strength improves with activity • Although 30% demonstrate fatigability • Myalgia • Tendon reflex is absent • Ocular/bulbar dysfunction • Autonomic dysfunction ANAESTHETIC IMPLICATIONS • Sensitive to both sux and NDMR TREATMENT • Not reverse by anticholinestases • Immunosuppression with steroid • Plasma exchange |
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126 AM41 ANZCA version [2004-Aug] Q15, [Mar06] Q11, [Jul07]
The most frequently reported clinical sign in malignant hyperpyrexia is A. arrhythmia B. cyanosis C. sweating D. tachycardia E. rigidity |
ANSWER D
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127 RH26b ANZCA version [2004-Apr] Q126, [Jul07]
To achieve maximum anaesthesia with minimal risk of trauma to veins, the tip of a needle used for a medial peribulbar injection should be advanced no further past the equator of the globe than:
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ANSWER B
10mm past equator as CEACCP says should not go past posterior border of globe. |
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128 PR04 ANZCA version [1985] [Mar95] [Apr97] [Jul97] [Apr98] [Jul98] [2002-Aug] Q11, [2003-Apr] Q39, [2005-Sep] Q46, [Mar06] Q25
The percentage of the population which is heterozygous as regards pseudocholinesterase, thus having a dibucaine number between 30 and 80, is A. 0.04% B. 0.4% C. 4.0% D. 14.0% E. 40.0% |
ANSWER C
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129 ST22 ANZCA version [2002-Aug] Q81, [2004-Apr] Q88, [2004-Aug] Q78
Recognised weaknesses of systematic reviews include all of the following EXCEPT A. publication bias B. duplicate publication C. study heterogeneity D. inclusion of outdated studies E. systematic review author bias |
ANSWER E
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130 AA22 ANZCA version [2005-Apr] Q106
The commonest initial presenting feature in anaphylaxis is A. coughing B. desaturation C. hypotension D. rash E. wheeze |
ANSER C
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131. New - When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch?
A. opponens abducens B. abductor pollicis brevis C. adductor pollicis brevis D. extensor pollicis E. flexor pollicis brevis |
ANSWER C
Ulnar nerve supplies the intrinsic muscles of the hand, except LOAF |
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132. New - When intubating over a bougie / awake fibreoptic, which direction do you rotate the tube to stop it catching on structures in the glottis
A. no change from normal B. 90 degrees clockwise C. 90 degrees counterclockwise D. 180 degrees E. try either direction |
ANSWER C
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133. New - Advantages of off-pump CABG over on-pump CABG
A. decreased transfusion rate B. decreased mortality C. decreased cost D. increased graft patency E. less cognitive impairment F. less stroke |
ANSWER A
CEACCP Hett 2006 Benefits of OPCABG -mortality reduced from 2.9% -> 2.3% and complication rate 12% -> 8% (conflicting results from other studies) -Most studies have shown a reduction in the need for transfusion and other blood products (effect of extracorporeal circulation and hypothermia) -Incidence of stroke is less (no manipulation of aorta resulting in macro and micro embolii) -reduced rise in inflammatory markers No difference -mortality and morbidity is unchanged -incidence of AF is similar -short term patency rate are comparable. There is no info on long term patency -no difference in neurological dysfunction |
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134. New - After coronary artery bypass graft surgery, the FRC is
A. increased 40% B. increased 20% C. unchanged D. decreased 20% E. decreased 40% |
ANSWER D
Compared to preop -open sternotomy 55% increase -closure decrease 10% -day 1 decrease 20% |
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135. New - A 60 year old man 24 hours post CABG is confused, oliguric, with BP 80/40, pulse 120. The most appropriate and useful investigation is
A. electrocardiogram B. echocardiogram C. chest x-ray D. arterial blood gas E. coronary angiogram |
ANSWER B
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136. Iron deficiency
A. decreased serum ferritin, increased serum iron B. decreased serum ferritin, absence of bone marrow iron C. decreased serum ferritin, normal serum iron D. increased serum ferritin, decreased serum iron E. increased serum ferritin, decreased total iron binding capacity |
ANSWER B
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137. New - Why should NSAIDs be avoided in pregnant women >30 weeks gestation?
A. cause neonatal acute renal failure B. increased antepartum haemorrhage C. increased rate of pre-eclampsia D. cause closure of the fetal ductus arteriosus E. increase preterm labour |
ANSWER D
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138. A 62 year old man has chronic renal failure. You notice his total serum calcium is 2.05 mmol/L. This is because he has
A. high serum vitamin D B. hypoparathyroidism C. primary hyperparathyroidism D. secondary hyperparathyroidism E. tertiary hyperparathyroidism |
Total or ionised!? ANSWER D if total (low Ca) Normal Total: 2.12 - 2.65 mmol/l Ionised: 1.0 - 1.25 mmol/l |