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136 Cards in this Set
- Front
- Back
Pre-eclamptic woman, BP 170/110, headache, proteinuria 1.2g. Which of the following NOT to use for control of her hypertension: |
A. Magnesium - not for control of HTN |
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Male with a Haemoglobin of 8G% and reticulocyte count 10%. Possible diagnosis: |
E. Spherocytosis |
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Commonest organism causing meningitis post spinal: |
B. Staph salivarius |
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Exponential decline / definition of time constant (with various options) |
C. Time to decrease by 67%, or to 1/e |
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(This is a very old repeat) Relative humidity – air fully saturated at 20 %. What is the relative humidity at 37 degrees ? |
C. 40% |
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A 50 year old man with multiple fractures. The BEST parameter to monitor volume resuscitation is: |
NFI - Source says Changes in RAP with inspiration. |
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Anaphylaxis to rocuronium. Which is most likely to cause coss-reactivity ? |
E. Variable cross reactivity |
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Hypotension post propofol induction in elderly patient. More pronounced / profound than in younger patient. Reason ? |
A. Concentric LVH so preload dependent - we also overdose often due to slow circulation time and lower Vd but the agents are vasodilatory and hence the hypotension |
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Predictive factors for mortality in elderly patient (except): |
D. Cognitive dysfunction |
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The best clinical indicator of SEVERE AS |
A. Thrill |
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Elderly patient. Indications for pre Femoro-Popliteal Bypass angiogram include all EXCEPT: |
E. AICM "Preoperative evaluation of Vascular patients" includes arrhythmia as reason for angiography (& the others). |
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How do you minimise risk of intravenous cannulation with epidural insertion ? |
A. Inject saline through needle before catheter |
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Timing of peak respiratory depression post intrathecal 300 mcg morphine: |
B. 3.5-7.5 hr |
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Patient with aortic dissection. Blood pressure 150/90. Best drug to control BP: |
B. Esmolol - Beta blockers |
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Type of dissection – which is classically for NON-operative management: |
D. Stanford B - A is for surgical management, B for medical |
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TURP – patient under spinal. Confused. ABG: Na+ 117 / normal gas exchange. Treatment ? |
B. Since it says gas exchange ok (i.e. no pulmonary odema) and has severe hyponatraemia, for 3%NS |
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Male undergoing trans-sphenoidal surgery. Now Na+ 155mmol/l and thirsty with polydypsia. Treatment: |
A. DDAVP for diabetes insipidus |
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The STRONGEST stimulus for ADH secretion: |
C. Volume wins - sensitive to 1-2% change in osmolarity or 10% change in volume, but volume response is STRONGER |
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Stellate ganglion block. Needle entry next to SCM muscle at C6. Which direction to advance needle ? |
D. C6 |
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Thermoneutral zone in 1 month old infant ? |
D. 32-24 deg's (34-36 for younger neonate) |
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A 60 year old man describes orthopnoea. On examination: pansystolic murmur (at LSE)/ displaced apex beat. Likely diagnosis ? |
Um...MR? |
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A 4 year old child with VSD (repaired when 2 years old) for dental surgery. What antibiotic prophylaxis do the guidelines recommend? |
E. AHA guidelines say after 6 months nil required if no leak |
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A 4 year old child with Arthrogrophysis multiplex congenita for dental surgery. Jaw rigidity post induction. Likely cause ? |
A. Hrm. Not learning that one too much. No increased risk MH. |
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A 78 year old man with past difficult intubation for arm surgery. Supraclavicular block with 25 mls 0.5% bupivacaine. Shortly after begins convulsing. INITIAL management? |
A. Midaz. or thio but Midaz usually there and less paperwork now! Intralipid is for cardiac symptoms. |
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Advantages of bronchial blockers over double lumen tubes: |
A. Lobar isolation *by default. |
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Patient for pneumonectomy. Pre op FEV1 2.4. (Predicted 4.5L) FVC given as well. For R lower lobectomy. Postoperative predicted FEV1 ? |
C. Because of how many segments there are...to follow. |
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Post accidental dural puncture with epidural needle. Headache. Which does NOT fit ? |
I think B now |
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Cell saver. Which does NOT get filtered ? |
A. Fetal cells. But they've shown it's no worse than labour/delivery and the UK College recommends for LSCS now. |
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You are on a humanitarian aid mission in the developing world. Drawover vaporiser apparatus described being used. Given 400 mm tubing, OMV or diamedica vaporiser, 200mm tubing attached to self-inflating bag. Which other ONE piece of equipment is ESSENTIAL to make this system functional? |
C. Can use air instead of O2 |
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Regarding post craniotomy pain: |
A. LA good. Clonidine useless. |
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A 60 year old female is undergoing hysterectomy. Gabapentin reduces postoperative: |
A. Nausea. Going to have to try this! |
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Burns dressings. The following is proven to be of analgesic benefit: |
B. biosynthetic dressings then...If the pain book says, then it must be! |
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Subtenon’s block. What is the worst position to insert block? |
Any spot really okay but apparently more muscle insertion points medially so E? |
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Liposuction. Infiltration of lignocaine with 1:200,000 adrenaline. Peak plasma concentration of lignocaine occurs at: |
C. As per Novel uses of LA CEACCP. Up to 35mg/kg lignocaine used! |
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Child-Pugh score. Components ? |
A. Child-Pugh: |
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Which is NOT a disadvantage of drawover vaporiser versus plenum vaporiser: |
B. Modifications mean yes you can |
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Acute renal failure. Which is not an indication for dialysis ? |
C. Hypernatraemia? Usually metabolic acidosis is the issue but some references say "severe acid-base disturbances" |
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Chronic alcohol use. Which is not an associated complication ? |
D. As it causes cardiomyopathy, fat/fatty liver, delayed RBC maturation and pancreatic Ca. |
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Chest xray shown of patient post Left pneumonectomy with heart swung to left side. Management: |
B. Gravity is your friend :) |
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Salicylate poisoning: |
B. Get resp alkalosis and metabolic acidosis (non-anion gap) |
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New onset atrial fibrillation in a 10 week pregnant lady. BP 150/90, HR 160, SaO2 92%. Moderate mitral stenosis on TTE, no thrombus seen. Emergency doctor gave her anticoagulant (not specified what). Most appropriate management: |
Depends what sats of 92% mean. Probably a shock therefore D. Otherwise digoxin is recommended. |
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Patient post anterior cervical fusion. Patient in recovery. Confused and combative. Nurse concerned about haematoma Taken to theatre: Most appropriate way of securing airway: |
A. As per CEACCP article on C spine surgery. Try heliox, Dex and neb adrenaline; reintubation may be difficult, in a semi-sitting posture. Options are AFOI, or direct laryngoscopy after sevo and oxygen may be easier. If that 'combative' not sure. |
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Young asthmatic male in emergency department. RR 26, pCO2 27, SAO2 92%, struggling talking in sentences. Given nebulised salbutamol, and ipratropium, 200mg IV hydrocortisone. After 30 minutes - no improvement. Further management: |
C. Ahh the wonder drug. If he is okay with nebs then stick to them before IV salbutamol, aminophylline not indicated anymore and he's not quite at I&V state. |
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Called to emergency department to review a 20 y/o male punched in throat at a party. Some haemoptysis / hoarse / soft voice. Next step in management: |
E. See what you're dealing with. |
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How quickly does the CO2 rise in the apnoeic patient ? |
C. 3mmHg/min |
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Long-standing T6 paraplegia. All present EXCEPT ? |
A. Flaccid paralysis - after 8 weeks or so you have increased muscle tone and contractures. |
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Young female patient for tonsillectomy with history of bleeding tendency. Which is the most likely cause? |
C. Rest are pro-coagulant and she would clot clot clot. |
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Amniotic fluid embolism. Cause of death in first half hour ? |
A. Like a big PE as per OHA - "within the first 30 minutes, intense pulmonary vasoconstriction occurs and is associated with right heart failure, hypoxia, hypercarbia and acidosis" |
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Hypocalcaemia – earliest sign: |
A. Tingling |
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Elderly COAD patient. On home oxygen. 24 hours of worsening condition. Various blood gases given: |
Likely to see hypoxia / raised CO2 (normal for them probably 50-60, hence greater), high bicarb to indicate chronicity of CO2 retention... |
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Visual loss with pupillary reflexes retained. Likely cause ? |
B |
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Nerve block for anaesthesia over anterior 2/3 of ear? |
B. |
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Complex regional pain syndrome. What proportion of patients have motor involvement ? |
D. |
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Malignant hyperthermia. The number of people in the community at any given time with a predisposition is called the: |
Prevalence = measures how much of some disease or condition there is in a population at a particular point in time. |
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Patient with Hx COAD and suspected pneumonia – clinical findings supporting R pneumonia on examination: |
A |
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Thallium scan: |
A. |
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A 50 y/o male diabetic admitted to intensive care with pneumonia. Intubated and ventilated. Extensive results given. BP 80/-, HR 120, CVP 4, PCWP 6, SvO2 69% PaO2 80, BE -4 pH 7.2. Management: |
C. Fluids. Low CVP, hypotensive, tachycardic, low PCWP. |
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Young female having cholecystectomy. Venous air embolus: |
B. Classically due to insufflation of CO2 via a hasson cannula, but cut surfaces e.g. of liver may permit entry of gas. "This complication develops principally during the induction of pneumoperitoneum, particularly in patients with previous abdominal surgery." Miller 7th ed. p. 2188. |
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LUSCS for failure to progress. Spinal is inserted uneventfully. Next day the patient has foot drop. The most likely cause is? |
B. It's never us ;) CEACCP 2003: |
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Severe pre-eclampsia. WORST treatment option: |
D? C. ?? |
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In pregnancy the dural sac ends at: |
D. No different to normal. |
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Septic elderly man. Given lots of obs but essentially mixed venous oxygen sat 65%, lactate 4, MAP low. Mx. |
B. Points to inadequate perfusion --> needs resuscitation, especially if septic. Then maybe to squeezers (which can worsen lactate). |
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Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management? |
A. Adenosine or shock if unstable |
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Which gives the BEST seal? |
B. If it is referring to airway seal = Proseal. CEACCP 1:2, 2011 |
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Lady on citalopram. Which drug is relatively contraindicated? |
Serotonin syndrome - review... |
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A 30yo Male. 5 hour operation. Arms abducted to 60 degrees. Head turned slightly to left side. Post op numb palm/thumb/index finger/middle finger and lateral half of ring finger. Numb ventral forearm. Weak finger grip. Weak elbow flexion. Most likely nerve injured? |
?C. |
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Diastolic dysfunction is NOT caused by: |
A. Adrenaline |
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An 18 yo with Fontan circulation undergoing exploratory laparotomy. On ICU vent, sats 70%. Which ventilator parameter would you INCREASE to improve his sats? |
B. Expiratory time |
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A 7 kg Infant with tetralogy of fallot, post BT-shunt. Definitive repair at later date. Paralysed and ventilated. Sats 85% baseline, now 70%, best treatment: |
C. Phenylephrine - will increase SVR and L pressures, reducing R-L shunt. |
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Von Hippel-Lindau disease is associated with: |
D. Pheo |
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70 year old post TKJR. On sub-cut heparin. Develops clinical DVT and platelets 40 (sounds like HITS type-II). Management |
D - no other direct thrombin inhibitors on list. |
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Drug eluting stent 6 months old. On aspirin and prasugrel 10mg. Elective lap cholecystectomy for biliary colic. |
E |
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Arterial blood gases (ABGs): pH 7.12, PO2 100, PCO2 65, HCO3 20.3, BE -10. Consistent with? |
Combined metabolic and respiratory acidosis = MH! |
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Compared to lignocaine, bupivacaine is |
c. Just is |
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Aneurysm sugery. Propofol/remifentanil/NMDR. DOA monitoring (Entropy). MAP 70 , HR 70/min, State entropy 50, Response entropy 70. What do you do? |
Not sure what they're asking. |
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Interscalene block, patient hiccups...where do you redirect your needle? |
You are hitting the phrenic nerve which is ANTERIOR to the interscalene plexus therefore B |
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What is the SVR in a patient with MAP 100mmHg, CVP 5, PCWP 15, CO 5L/min? |
E. 1520 dynes.sec/cm3 |
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Stellate ganglion |
Yup, it is |
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The median nerve |
See my beautiful-about to be constructed anatomy pictures in full pen colour ;) |
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A 75yo male with moderate aortic stenosis (valve area 1.1cm2).. Gets mild dyspnoea on exertion but otherwise asymptomatic. Needs hip replacement. |
Is the dyspnoea from the AS? B/E wrong - maybe C as this would see if any LVF from the AS... |
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Baby with Tracheo-oesophageal fistula found by bubbling saliva and nasogastric tube coiling on Xray. Best immediate management? |
C |
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A 60yo man with anterior mediastinal mass, during induction for mediastinoscopy....lose cardiac output, decreased saturations, drop in ETCO2. Management: |
D |
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The MAIN indication for biventricular pacing is |
B |
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What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping? |
PTC = C |
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What's the area burnt in the following man? Half of left upper arm, all of left leg and anterior abdomen. |
Rule of 9's = 2-3% + 18% + 9% = 29% (A) |
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Torsades, what's not useful? |
A. Amiodarone - can cause it |
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The intercostobrachial nerve: |
D. |
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Labour epidurals increase maternal and foetal temperature. This results in neonatal |
B. Increased Ix for sepsis but NOT increased sepsis |
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Maternal cardiac arrest. In making the diagnosis of amniotic fluid embolism, large amount of PMNs surrounding foetal squamous cells are |
B. Supportive |
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Half life of tirofiban: |
A. 2 hours |
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Why is codeine not used in paediatrics? |
It is, but for argument's sake = B, high interindividual PK variability |
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Best agent to decrease gastric volume AND increase gastric pH before semi-urgent procedure |
Hrmm - either A or C |
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Myaesthenia gravis - features predicting need for post op ventilation EXCEPT |
D. Be careful instead |
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Innervation of larynx |
E. The larynx is innervated by branches of the vagus nerve on each side. Sensory innervation to the glottis and laryngeal vestibule is by the internal branch of the superior laryngeal nerve. The external branch of the superior laryngeal nerve innervates the cricothyroid muscle. Motor innervation to all other muscles of the larynx and sensory innervation to the subglottis is by the recurrent laryngeal nerve. While the sensory input described above is (general) visceral sensation (diffuse, poorly localized), the vocal fold also receives general somatic sensory innervation (proprioceptive and touch) by the superior laryngeal nerve. |
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The nerve supplying area of skin between greater trochanter and iliac crest: |
A. Subcostal nerve |
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IV paracetamol: |
A |
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Patient with diastolic dysfunction. Is it caused by: |
A |
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Most likely to result in myocardial infarction: |
B |
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Indication for percutaneous closure of ASD |
C |
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Respiratory function in quadriplegics is improved by |
B. |
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Carbon dioxide is the most common gas used for insufflation for laparoscopy because it |
C |
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Histamine release in anaphylaxis does NOT cause: |
B |
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A device that detects a 10mA difference in active and neutral leads and causes turning off of the circuit within 40 ms. This is a: |
D |
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Which of the following is NOT an absolute contra-indication for MRI? |
B |
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One lung ventilation and hypoxaemia. After 100% O2 and FOB next step is: |
Controversial! |
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Long duration of surgery, arms stretched out, head turned 30 degrees to right. On waking patient has a neurological deficit. Sensory loss over ventral lateral palm and 3 fingers, some weakness of the hand, weakness of the wrist, some paraesthesia of the forearm and weak elbow flexions. Most likely injury is |
D. again |
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Plasma glucose level compared to blood glucose level |
B? 14% higher |
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With regards to obstructive sleep apnoea (OSA), which of the following statements is INCORRECT? |
E. Seriously?! |
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Management of rhabdomyolysis – best option? |
Fluids fluids and more fluids!! D |
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Residual current devices: |
A |
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Serotonin syndrome has been reported following SSRI coadministration with: |
D. St John's Wort --> Increases serotonin |
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Child with ?pyloric stenosis and 3 days of vomiting. Which bloods would you expect? [Not given pH] |
B. Hypochloraemic hypokalaemic metabolic alkalosis |
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Which LMA has highest seal pressure? |
Depends what we're referring to again - ILMA has highest oesophageal pressure seal / Proseal has highest laryngeal |
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Why is tachycardia bad in mitral stenosis? |
B |
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You intubate a young male patient for a left thoracotomy with a 39FG Robertshaw tube. When you inflate both cuffs and ventilate the bronchial lumen you get left sided ventilation. When you attempt to ventilate the tracheal lumen the pressures are very high and you get no air entry. Yet when you deflate BRONCHIAL cuff you can ventilate BOTH left and right lungs through the tracheal lumen. The most appropriate step to take next is: |
C. Cuff herniating into other bronchus? |
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The average expected depth of insertion of an oral endotracheal tube, from the lip, in a normal newborn infant is |
C. |
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What is NOT a feature of high spinal block? |
E. Bradycardia from blockage of sympathetic thoraco-lumbar fibres (PNS = cervical and sacral) |
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Positive predictive value is: |
C |
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Stellate ganglion block is associated with all EXCEPT: |
C. |
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Recognised clinical associations with dystrophia myotonica include |
E. |
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Left bundle branch block (LBBB) on the ECG is |
A. No - RBBB can be normal. LBBB is pathological from LVH or IHD (Stoelting) |
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When hearing loss occurs following spinal anaesthesia it is usually in which of the following frequency ranges: |
A. |
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Anaemia in chronic renal failure is characteristically |
E. |
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A 12 year old child with hip dislocation at 4pm. Ate something 1 hour after injury. Now 11 pm. Best anaesthetic: |
A or C |
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Central anticholinergic syndrome, which is NOT true: |
A. Physostigmine is the only treatment as cross BBB |
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Carcinoid syndrome - finding on examining heart: |
C |
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Lowering intra-ocular pressure by applying pressure to the globe (e.g. Honan balloon) is typically contraindicated in a patient having |
B. As per the consensus on wiki. |
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Troponin is elevated post-infarct |
C |
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Myotome of C6-7 |
D. Wrist flexion and extension |
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Head Trauma patient with unilateral dilated pupil, whats the diagnosis ? |
D. Concerning! |
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The PREDOMINANT pathophysiological effect of restrictive cardiomyopathy is: |
B |
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When does effect of diclofenac on platelets wear off? |
B |
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What does C6/7 do? |
E |
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Muscle NOT supplied by sciatic nerve: |
B |
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Negative predictive value is best described as |
B |
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Time to reach peak plasma concentration after injection of 2% lignocaine with adrenaline into epidural space |
B |