Anzca Final Mcq 2010.1

B. Expiratory time

CEACCP 2008
Low respiratory rates, short inspiratory times, low PEEP, and tidal volumes of 5–6 ml kg-1 usually allow adequate pulmonary blood flow, normocarbia, and a low PVR.

C. Phenylephrine 35 mcg

Increase systematic resistance to reverse right to left shunt.

D. pheochromocytomas

"Management of anesthesia in patients with von Hippel-Lindau disease must consider the possible presence of pheochromocytomas" (Stoelting)

von Hippel-Lindau disease (VHL) is a rare, genetic multi-system disorder characterised by the abnormal growth of tumours in certain parts of the body (angiomatosis).
The tumors of the central nervous system (CNS) are benign and are comprised of a nest of blood vessels and are called hemangioblastomas (or angiomas in the eye). Hemangioblastomas may develop in the brain, the retina of the eyes, and other areas of the nervous system.
Other types of tumours develop in the adrenal glands, the kidneys, or the pancreas.

Symptoms of VHL vary among patients and depend on the size and location of the tumours.
Symptoms may include headaches, problems with balance and walking, dizziness, weakness of the limbs, vision problems, and high blood pressure. Cysts (fluid-filled sacs) and/or tumours (benign or cancerous) may develop around the hemangioblastomas and cause the symptoms listed above. Individuals with VHL are also at a higher risk than normal for certain types of cancer, especially kidney cancer.
Inheritance = Familial Autosomal dominant
Features= Retinal angiomas, Haemangioblastomas, Cerebellar and visceral tumours (usually benign but can cause pressure effects)
Associations = An increased incidence of Phaeochromocytoma - apparently 20%, Renal cysts, Renal cell carcinoma

Anaesthesia= Treat hypertension occurring with phaeochromocytoma, Haemangioblastoma of spinal cord may limit use of spinal although epidural has been used for LSCS, exaggerated hypertension with surgical stimulation or laryngoscopy = Treat with β blockers and/or SNP

From recollection, phaeos are associated with the Diseases of Von- Ie. Von Recklinghausen and Von Hippel Lindau.

D. Lepirudin

(use a direct thrombin inhibitor)

E. Short QT

Effects of hypercalcaemia: "Stones, Bones, Groans, Thrones and Psychiatric Overtones"
Stones (renal or biliary)
Bones (bone pain)
Groans (abdominal pain, nausea and vomiting)
Thrones (sit on throne - polyuria)
Psychiatric overtones (Depression 30-40%, anxiety, cognitive dysfunction, insomnia, coma)

Abnormal heart rhythms can result, and ECG findings of a short QT interval and a widened T wave suggest hypercalcaemia. Significant hypercalcaemia can cause ECG changes mimicking an acute myocardial infarction. Hypercalcaemia has also been known to cause an ECG finding mimicking hypothermia, known as an Osborn wave.

E. Postpone for 6 months

ACC/AHA Pre-op:
Thrombosis of DES may occur late and has been reported up to 1.5 years after implantation, particularly in the context of discontinuation of antiplatelet agents before noncardiac surgery.

Discontinuation of antiplatelet therapy in the early-surgery group resulted in a 30.7% incidence of MACE (all fatal) versus a 0% incidence in early-surgery patients who continued dual antiplatelet therapy perioperatively. Overall, there was no difference in MACE between patients with bare-metal stents and those with DES. The study reported that all patients with MACE had discontinued antiplatelet therapy before surgery, whereas only 46% without MACE had done so. The study also stated there was no difference in surgical risk between patients in whom antiplatelet agents were discontinued and those in whom they were not. Excessive blood loss occurred in 2 patients, 1 of whom was receiving antiplatelet agents and 1 of whom was not.

** The panel concurred with the AHA/ACC guideline recommendation for 12 months of dual-antiplatelet therapy after DES implantation in patients who are not at high risk for bleeding.
**1. Before implantation of a stent, the physician should discuss the need for dual-antiplatelet therapy. In patients not expected to comply with 12 months of thienopyridine therapy, whether for economic or other reasons, strong consideration should be given to avoiding a DES.

BARE METAL:
A thienopyridine (ticlopidine or clopidogrel) is generally administered with aspirin for 4 weeks after bare-metal stent placement. The thienopyridines and aspirin inhibit platelet aggregation and reduce stent thrombosis but increase the risk of bleeding. Rapid endothelialization of bare-metal stents makes late thrombosis rare, and thienopyridines are rarely needed for more than 4 weeks after implantation of baremetal stents. For this reason, delaying surgery 4 to 6 weeks after bare-metal stent placement allows proper thienopyridine use to reduce the risk of coronary stent thrombosis; then, after the thienopyridine has been discontinued, the noncardiac surgery can be performed. However, once the thienopyridine is stopped, its effects do not diminish immediately. It is for this reason that some surgical teams request a 1-week delay after thienopyridines are discontinued before the patient proceeds to surgery. In patients with bare-metal stents, daily aspirin antiplatelet therapy should be continued perioperatively. The risk of stopping the aspirin should be weighed against the benefit of reduction in bleeding complications from the planned surgery. In the setting of noncardiac surgery in patients who have recently received a bare-metal stent, the risk of stopping dual-antiplatelet agents prematurely (within 4 weeks of implantation) is significant compared with the risk of major bleeding from most commonly performed surgeries.

B. Can have had an uneventful 'triggering' anaesthetic

CAECCP Malignant Hyperthermia
On average, patients found to be susceptible to MH have had three previous uneventful general anaesthetics.

B. Malignant hyperthermia

Metabolic acidosis and respiratory acidosis

E. Miosis

A. true

E. Cocaine is a stimulant causing mydriasis (dilatation)

E. 35 mg/kg

Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction.
J Dermatol Surg Oncol 1990

C. Four times as potent

http://www.icuadelaide.com.au/files/primary/pharmacology/local_anaesthetics.pdf

C. Check TOF

SE is depth of anaesthesia
RE measures the temporalis muscle activity. This suggest paralysis is wearing off

?B. 10 min

Mivacurium 0.15 mg/kg

Clinical duration is ~15 min Miller 7th ed p 877
Thus 0.1 mg/kg will be less than that.

B. Posterior

Too anterior = phrenic nerve

E. 1520 dynes.sec/cm-5

SVR = 80(MAP-CVP)/CO
SVR = 80 x (100-5)/5
SVR = 1520

(80 to convert units)

A. Get vascular surgeon to repair it and continue with surgery and heparin

or B??

Need to continue with urgent CABG. Need heparin. Compression unlikely to stop bleeding once fully heparinised.

Guilbert M-C, Elkouri S, Bracco D et al. Arterial trauma during central venous catheter insertion Case series, review and proposed algorithm. J Vasc Surg 48:918-985, 2008

Postponing elective surgery will ensure that the anesthetized patient is not having an unrecognized stroke. Kron and colleagues recommend postponing elective open-heart surgery after two patients suffered serious complications when surgery was performed immediately after removal of the misplaced large sheath.

Complications with catheter removal and compression
1. Massive stroke and death
2. AV fistula require surgical repair
3. Pleural effusion, lung collapse requiring thoracic surgery to repair arterial hole and lung decortications
4. Hematoma and uncontrolled bleeding requiring open surgery to repair jugular vein and carotid artery

A. Anterior to scalenus anterior

A. can be blocked at the elbow immediately medial to the brachial artery

B. No, between PL and FC radialis

C. No, this is ulnar

D. Only lateral and medial cords

E. Radial half

A. Compression neuropraxia

Knee flexion is sciatic. This problem seems to have clinical onset at about 24 hours.
A: True. It is possible to be due to compression neurapraxia by tourniquet.
B: False. DVT does not cause neurological symptoms
C. Muscle ischaemia is unlikely to happen post 24 hours for knee replacement.
D. False. The symptom is more sciatic
E. False. Would expect bilateral distribution

?C. Get myocardial perfusion scan

NYHA class II.

Hip replacement is intermediate risk surgery.

He is symptomatic (mildly) so depends on other cardiac risk factors??

OHA:

- symptomatic patients for elective non-cardiac surgery should have AVR first

- asymptomatic for major elective surgery with major fluid shifts with gradients > 50mmHg should have AVR considered prior to surgery

- asymptomatic for int/minor surgery do well if managed carefully

D. High risk surgery, medium risk patient

AHA

A. inferonasal

C. position head up, insert suction catheter in oesophagus (or to stomach?)

D

Ans D
Management of the patient with a large anterior mediastinal mass: recurring myths
Curr Opin Anaesthesiol 20:1-3 2007

Should try wake up the patient.
D. Place prone

Intraoperative life-threatening airway compression has usually responded to one of two therapies:
1. Repositioning of the patient (it should be determined before induction if there is one side or position that causes less symptomatic compression)
2. Rigid bronchoscopy and ventilation distal to the obstruction (this means that an experienced bronchoscopist and rigid bronchoscopy equipment must always be immediately available in the operating room during these cases).

For patients with life-threatening cardiovascular compression after induction that does not respond to lightening the anesthetic the only therapy is immediate sternotomy and surgical elevation of the mass off the great vessels.

C. bleeding and haematoma

A. Prewarming of patient

B. Congestive cardiac failure

B. Hotter than 39C

TEC 6 will not work:

- on battery power

- if tilted >10 degrees

- if interlock not engaged

- if another vapouriser is on

 The TEC 6 desflurane vaporizer needs to warm up and the "operational" LED light needs to be illuminated before you can turn the dial to the ON position. If you try to turn it on before the "operational" light is on it will not work. I assume that any of the alarms which cause the "operational" light to go off (and subsequently halt delivery of desflurane) mean that if you turn the dial to 0% (i.e. OFF) then you will not be able to turn it back on, but I have not read that anywhere. According to Graham (BJA 1994; 72:470-73), causes of vaporizer shutdown include:
 a tilt of about 10 degrees or more - although extremely unlikely given the design
 excessive tilting of the vaporizer activates auditory and visual alarms and causes cessation of desflurane output...Pharmacology of Inhaled Anaesthetics, p212
 it will not work on battery power
 the 9-volt battery does not supply the heaters with power or maintain the vaporizer in an operational mode...Pharmacology of Inhaled Anaesthetics, p212
 the vaporizer will not work unless locked into the selectatec mount, and the selectatec mount will not allow the use of multiple vaporizers simultaneously
 nb. note the "Tec" refers to the use with the Select-a-Tec manifold

A. High SVP

A. Wrist flexion and extension

A. PE

A. Loss of beat to beat variability
Evidence based practice of anaesthesiology (Fleischer)under conditions of very light sedation most narcotics and general anaesthetics decrease or obliterate long and short term FHR variability , hence one is left monitoring changes in baseline FHR.

A. Cirrhosis

Harrison's: Psoriasis affects 5–10% of patients with IBD; may get PSC leading to biliary cirrhosis

Ulcerative colitis may cause long-term problems such as arthritis, inflammation of the eye, liver disease (fatty liver, hepatitis, cirrhosis, and primary sclerosing cholangitis), osteoporosis, skin rashes, anaemia and kidney stones.

C. Post tetanic count

A. 27%

Based on the 'rule of nines', the estimated burn surface area would be as follows:
- half of upper arm = 2.25
- all of left leg = 18%
- anterior abdomen = approx 9%
-> TOTAL = 29%

A. Amiodarone

A. Magnesium

A. defibrillate

A. adenosine 6mg

D. can be damaged by torniquet

"tickle nerve" supplies axilla and originates from 2nd intercostal nerve

A. Headache immediately after procedure

A=FALSE. Usually starts 24-48 hrs after dural puncture.
B=True. Typically fronto-occipital, but can be frontal, occipital or nuchal (Evidence-Based Obstetric Anaesthesia, Halpern & Douglas, BMJ Books; Blackwell, 2005; p.192)
C=True. Most commonly starts 24-48 hrs later.
D=True. Hearing loss and/or tinnitus are features.
E=True. Neck stiffness and photophobia are common.
(REFS - Oxford Handbook of Anaesthesia (2nd ed), p.707

B. Increased investigations for sepsis

Chestnut's Obstetric Anesthesia: Principles and Practice (4th Edn), Chestnut et al. 2009; p457
Labour epidural analgesia is associated with an increase in maternal core body temperature, but also with an increased neonatal temperature and fetal heart rate. Several studies have shown that labour epidural analgesia is associated with increased neonatal neonatal sepsis evaluations, but no increase in neonatal sepsis.

B. Supportive

A. Autonomy

C. Non-maleficience

(Futility is not an ethical principle?)

Bioethical principles: autonomy, beneficence, non-malificence, and justice

A. Trachealis

If down tracheal lumen, trachealis muscle is seen posterior so L and R are easy to identify.

If down bronchial lumen, can look for RUL trifurcation and know that in R main bronchus

A. Right upper lobe

A true trifurcation is where the RUL bronchus divides into segmental bronchi.

A. 2hrs

A. Increase CVA

POISE trial = perioperative use of beta blockers

B. High inter-individual pharmacokinetic variability

Variations in CYP2D6 function affect how much codeine is converted to morphine, and therefore how effective it is, but also how "sensitive" patients are to codeine.

B. IV Magnesium

Phenoxybenzamine is an irreversible, non-selective alpha blocker and can result in tachycardia due to a2 blockade. A beta-blocker is then used to prevent tachycardia.

Options for intraop HD control:

- phentolamine

- SNP

- GTN

- Mg sulphate

- increase volatile

- CCB

- beta-blocker (esmolol, labetalol)

- antiarrhythmics (lidocaine, amiodarone)

http://www.frca.co.uk/Documents/151%20Phaeochromocytoma,%20perioperative%20management.pdf

C. Platelet count

Thalassemia trait - incorrect synthesis of Hb causing anaemia - is a red herring. No effect on clotting/epidural placement.

Need to rule out thrombocytopaenia with pre-eclampsia.
- If plt>100, proceed.
- If plt<100, do coags.
- If plt 80-100, and coags normal - regional is OK.

B. IV hydralazine

Severe pre-eclampsia needs urgent BP lowering, some IV fluids (~200-250ml) need to be given, then clonus needs IV magnesium to prevent seizures.

IV fluids need to match output (with careful IV fluid challenge) to prevent pulmonary oedema. Epidural only once platelet count established.

Oliguria should be treated with careful IV fluid challenge. The BJA CEACCP article (see below) states that a bolus of 250ml crystalloid should be given, but if no improvement (in urine output) a CVC should be inserted before any further fluid given. Then be guided by CVP and urine output.
B - TRUE. Initial management should aim to reduce the BP. This is the best of the options, although the CEACCP article also states that careful volume expansion should precede the use of vasodilators, so as not to drop the BP too much. That is not one of the options though, and I think this is the best option.
C - False. Initial attempts to reduce BP and improve urine output should probably precede Mg administration. Anyway, giving someone with minimal urine output a large bolus of IV Mg increases the chances of Mg toxicity. Should give IV fluids before giving Mg.
D - False. Epidurals are desirable in pre-eclampsia but in severe pre-eclampsia you should try and reduce the BP first, and always check the platelet count +/- coags BEFORE placing epidural.
-REFS: The diagnosis and management of pre-eclampsia. BJA CEACCP 2003; 3(2):38-42. Also see ANZCA obstetric anaesthesia: scientific evidence 2008 pages 15 and 18

C. Ranitidine

A. VSD

ACYANOTIC defects:

VSD=35%

ASD=9%

PDA=8%

Pulm. stenosis=8%

Aortic stenosis=6%

Coarctation=6%

Atrioventricular septal defect=3%

CYANOTIC defects:

Tetralogy=5%

Transposition=4%

Ref: Stoelting's Anesthesia & Co-Existing Disease - 5th edn; p.44

A. Venous hum

B. Organophosphate poisoning

A - Effectively a denervation injury which causes UP-regulation.
B - Organophosphate poisoning causes increases in miniature-end-plate potential (MEPP), and thus can cause DOWN-regulation of ACh receptors. Apparently continuous exposure to organophosphates can cause degeneration of pre-junctional and post-junctional structures.
C - Denervation causes UP-regulation.
D - Denervation causes UP-regulation.
E - Prolonged NMBD use can cause UP-regulation of ACh receptors.
REFS: Miller (7th edn) - p.358

D. Increased sensitivity to NMBDs

CEPD risk factors for IPPV postop (thymectomy) are:

1/ FVC<2.9L

2/ Concommitant COAD

3/ Acute fulminant crisis or respiratory involvement (grade 3)

4/ Myaesthenic crisis (grade 4)

OHA adds:

5/ Duration of disease >6yrs

6/ Pyridostigmine dose >750mg/d

7/ Major body cavity surgery

8/ Bulbar palsy that is predictive of intra and postop airway protection.

All patients with myasthenia gravis will be sensitive to muscle relaxants so this in itself is not a useful indicator.

Reference: CEPD Reviews 2002 p88- and OHA 246-

?A. SOB post pneumonectomy

BNP used to distringuish between respiratory and cardiac causes of dyspnoea.

Distinguishing pulmonary oedema due to acute lung injury (ALI) or the acute respiratory distress syndrome (ARDS) from hydrostatic or cardiogenic edema is challenging in critically ill patients.

B-type natriuretic peptide (BNP) can effectively identify congestive heart failure in the emergency room setting but, despite increasing use, its diagnostic utility has not been validated in the intensive care unit (ICU).

E. Cuff compression of recurrent laryngeal nerve against thryoid can cause palsy

Internal branch SLN: sensory to glottis and above

External branch SLN: cricothyroid muscle (tenses vocal cords for phonation)

RLN: motor to all other muscles of larynx and sensory to below glottis

NB. Posterior cricoarytenoid muscles abduct vocal cords to allow respiration.

B. Great auricular

Branches of mandibular nerve:

a. from main trunk (before the division):

- efferent nerves for the medial pterygoid, tensor tympani, and tensor veli palatini muscles

- meningeal branch (a sensory nerve)

b. from the anterior division

- masseteric nerve(motor)

- deep temporal nerves, anterior and posterior (motor)

- buccal nerve (sensory)

- lateral pterygoid nerve (motor)

c. from the posterior division

- auriculotemporal nerve (sensory)

- lingual nerve (sensory)

- inferior alveolar nerve

Great auricular nerve is a branch of cervical plexus

Haemodynamically stable

C. epiglottis

A. Propofol/fentanyl

No correct answer.


(Morphine is safe but no use for a seizure)

Drugs considered safe to use in convulsing porphyriacs include: midazolam, diazepam, propofol, gabapentin and magnesium.

Treatment of seizures in porphyria is a difficult situation given that most anticonvulsants are contraindicated (such as phenytoin, carbamazepine, thiopentone) because they induce hepatic P450 enzymes. (This consumes heme and thus reduces the negative feedback on ALA synthesase which is then free to generate heme/porphyrins products.)

C. neostigmine cannot reverse centrally acting cholinergics

A. exacerbated with heat

A. mm fasciculation

Sarin organophosphate

A. lateral femoral cutaneous nerve

Meralgia paraesthetica: chronic neurological disorder involves a single nerve, namely the lateral cutaneous nerve of thigh.

B. negative muscle biopsy of her father

A. Not advised to test in pregnancy

B. 1st order relative of proband, should test

C. No use if father is negative

A. subcostal nerve

Fundamentals of Regional Anaesthesia
A. Subcostal: sends fibre to the first lumbar nerve and its lateral cutaneous branch runs over the iliac crest to innervate the skin of the lateral aspect of the buttock as far as the greater trochanter
B. Ilioinguinal: enters the inguinal canal accompanies the spermatic cord and supplies the skin of the root of the penis and anterior part of the scrotum, mons pubis and labium majorum.
C. Genitofemoral: two branches.
a. Genital branch enters the inguinal canal and supply the spermatic cord and innervate the same cutaneous area as the ilioinguinal nerve.
b. Femoral branch: skin over the femoral triangle.
D. Femoral: supplies the muscles and the skin of the anterior compartment of the thigh
E. Lateral cutaneous nerve:
a. Anterior branch: supplies the skin over the antero-lateral aspect of the thigh down to the knee
b. Posterior branch: the skin of the lateral aspect of the leg from the greater trochanter to the mid-thigh

Ans A

A. alkaline then acidic urine

Initially aim to correct alkalosis. Then switches to preserving volume (activation of RAAS) and retention of Na in exchange for H+.

A. jet ventilation using pressure 400kPa

A. "there is hyperplasia of pulmonary arterioles"

A. intraop TOE

Transthoracic echocardiography (TTE) is easily available and the ascending aorta and aortic arch can be visualised well. In obese or chest trauma patients, image quality may be inadequate due to poor echo windows. Transoesophageal echocardiography (TOE) has become more popular as experience and availability increase. It is useful perioperatively in the haemodynamically unstable patient. TOE images the entire thoracic aorta except for the most distal ascending aorta and a part of the arch obscured by the trachea or right main bronchus. Echocardiography can be used with high accuracy for decision-making in acute dissection.

A. late plasma levels around the same as oral

D.Transtentorial herniation

c. ? Dissipation of energy

Characteristics of the CO2 laser and its uses:
The radiant energy produced by the CO2 laser is strongly absorbed by pure, homogeneous water and by all biologic tissues high in water content. The extinction length of this wavelength is about 0.03mm in water and in soft tissue.

a. Restrictive cardiomyopathy

A and B

Sharma S. Shock and Pregnancy. eMedicine.com. URL: http://www.emedicine.com/med/topic3285.htm
Aortocaval compression is thought to be the cause of supine hypotensive syndrome. Supine hypotensive syndrome is characterised by pallor, bradycardia, sweating, nausea, hypotension and dizziness and occurs when a pregnant woman lies on her back and resolves when she is turned on her side.

A. Inter-quartile range

B. Specificity

D. Negative Predictive Value

A. F9
Cryoprecipitate is prepared from plasma and contains fibrinogen, von Willebrand factor, factor VIII, factor XIII and fibronectin. Cryoprecipitate is the only adequate fibrinogen concentrate available for intravenous use.

B. post op myocardial ischaemia

Peri-op myocardial ischaemia peaks in the early post-op period and is significantly associated with MI and cardiac complications. Intraop ischaemia is less common and infrequently associated with post-op MI. Peri-op MI is almost exclusively preceded by ST depression type ischaemia. (STEMI is uncommon)
Peri-op MI is mostly silent (only 50% have any sx) and occur in first 24-48 hours post-op pick with cont. ECG monitoring and ST trend analysis and troponin.
http://bja.oxfordjournals.org/cgi/content/full/95/1/3

From Landesberg G: The Pathophysiology of peri-op MI: the facts and perspectives. J Cardiothoracic and Vac Anaes 2003: 17(1): 90-100

A. Euvolaemic

DI caused by insufficient vasopressin.

c. Secundum < 3 cm

CEACCP Anaesthesia for percutaneous closure of atrial septal defects 2008
Only an ostium secundum ASD is suitable for percutaneous closure.
If the defect is very large (>3 cm) or complicated (associated with other abnormalities), or an incomplete rim is detected, referral for surgical closure is indicated.

a. 1-2 days ??

Oh manual: would do coag tds for first day
I guess many of the clotting factors plasma half life are <24 hours and many patients for liver transplant has poor liver function to start with. For the new liver to start making new factors take >1day.

C. Standardise the physical status classification of patients

B. Reduced BP on inspiration exaggerated from normal

B. an increase in chest wall spasticity

B. heart rate responses are primarily mediated through the sympathetic nervous system

Heart rate is intrinsically 100bpm. This is then modified by the parasympathetic system

C. in restrictive disease the expiratory curve has a convex appearance

C. is not as dangerous as some other gases if inadvertently given intravenously

B. arterial blood gases to ascertain the acid/base status

C. Systolic murmur at left sternal edge

RHF associated with liver mets releasing factors (which are inactivated by the lungs so they don't affect left heart). They cause fibrosis of valves and can cause stenosis or regurgitation.

B. Myocardial depression

H1 via PLC
Coronary constriction
Bronchoconstriction
Slow AV node
Release of prostacyclin

H2 via cAMP
Inotropy
Coronary dilation
Bronchodilation
Tachyarrhythmia
Increase PR
Ventricular irritability
Decrease VF threshold
Shift in pacemaker rate
CNS stimulation
Increase H+ secretion by parietal cells
Both H1&2 increase capillary leakage

D. coeliac ganglion

Ciliary ganglion: PSNS ganglion in posterior orbit papillary constriction and ciliary accommodation
Otic ganglion: small PSNS in infratemporal fossa (one of four PSNS ganglion of head and nexk- also ciliary, submandibular, pterygopalatine)
Carotid chemoreceptor CNIX, aortic body is via CNX

D. great auricular nerve, AND

E. chorda tympani nerve

The chorda tympani is a nerve that branches from the facial nerve (cranial nerve VII) inside the facial canal, just before the facial nerve exits the skull via the stylomastoid foramen.
Chorda tympani is a branch of the facial nerve (the seventh cranial nerve) that serves the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain.

D. atherosclerosis

D. Residual Current Device

CEACCP electrical safety in the operating theatre

A. Class 1 Device: Any conducting part of Class I equipment accessible to the user, such as the metal casing, is connected to earth by an earth wire. If a fault occurs, this allows the live supply to come into contact with an accessible part, current flows down the earth wire. This new circuit has a lower resistance, resulting in an increased current which melts the protective fuses and breaks the circuit, removing the source of potential electrocution.
B. Equipotential earthing: the terminals of each piece of equipment in a stack can be connected to each other bringing them all to the same potential.
C. Line isolation monitor: measures the potential for current flow from the isolated power supply to the ground. i.e. active and neutral should have the same current. If there is a fault, a device is grounded then the current through to neutral would decrease. There is then a current able to flow through the line isolation monitor and sounds an alarm.
D. Residual current device: If the current in the live and neutral conductors is the same, the magnetic fluxes cancel themselves out. However, if they are different (due to excessive current leakage) there is a resultant magnetic field. This induces a current in the third winding causing the relay to break the circuit.
E. Fuse: a material that melts with increased current and breaks the circuit.

C. hepatitis B in the majority of patients

Hep B 1 in 764,000
Hep C 1 in 1,935,000
Miller transfusion Therapy chap 55
A: Less than 1/3 in with hep C develop jaundice.
B: 23% development chronic hepatitis with hep C. Hep C accounts for >90% of post transfusion hepatitis
C: Hep B is the majority of patients
D: Traditionally associated with hep C but now less with nucleic acid testing

C. AB

AB should not have antibodies against ABO antigens

E. tinnitus

D. tachycardia

B. heart valve prosthesis

A. LBBB

Reverse splitting of S2 with delayed LV outflow LBBB or severe AS
Normally the A2 precedes P2 because LV empties first

B. Need to stay on warfarin following cardioversion

Warfarin 3 weeks prior and one month post
Rate control has equal morbidity to cardioversion in those >65 years
Anticoagulation is required regardless of rate

usually due to damage to the posterior columns of the spinal cord

A True: About a third of the blood loss occurs in the postoperative period.
B True: The coagulopathy is both dilutional and consumptive
C True: Surgical correction does not reverse the restrictive lung deficit but will halt its progression
D False: most vulnerable to ischaemic injury are the motor pathways supplied by the anterior spinal artery
E True: The serine protease inhibitor aprotinin is the most studied and the most effective, halving blood loss in high-risk patients

(Anaesthesia for correction of scoliosis in children)

E. May occur with lignocaine, bupivacaine, prilocaine and procaine.

This phenomenon is associated with pain or sensory abnormalities in the lower back, buttock, or lower extremities. The symptoms of burning pain and dysaesthesthia in the L5 and S1 dermatomes usually start after the effects of spinal anesthesia have concluded and may last up to hours to four days.

C. Occurs with an incidence in the range of 1-2 per 10,000

A. The commonest microorganisms found in spinal infection are bacteria (90% cases), particularly Staphylococcus aureus.

B. ??

C. OHA p1103 states risk of abscess 0.01-0.05% ie 1-5 in 10,000

D. Much lower rate in obstetric patients

BJA Review article Epidural abscess 2006

E. CEACCP "Although there may be a place for conservative management with antibiotics alone in carefully selected patients without neurological signs, this would be unusual and require careful monitoring. "

CEACCP Epidural drug delivery 2007

OHA p1103

http://bja.oxfordjournals.org/content/96/3/292.full.pdf

A. diagnosis is dependent on triad of back pain, fever and paralysis

B. Rate is 1-5:10,000 OHA p 1103

C. Probably correct as epidurals generally used for you,fit parturients, or older patients with comorbidities undergoing major surgery.

A. False. Only 13% of patients with epidural abscess present with the classical triad of fever, back pain, and neurological change. Back pain is the initial symptom in 75% cases; therefore, one in four patients has no back pain. Fever occurs in only 66% of cases.

C. BJA Review article on Epidural abscess 2006: "doubling of likelihood of poor outcome for each decade of age"

http://bja.oxfordjournals.org/content/96/3/292.full.pdf

D. Usually staph, then strep

E. CEACCP "Although there may be a place for conservative management with antibiotics alone in carefully selected patients without neurological signs, this would be unusual and require careful monitoring. "

http://bja.oxfordjournals.org/content/96/3/292.full.pdf

CEACCP Epidural drug delivery 2007

A. Equipotential earthing

Equipotential earth required for cardiac protected area to protect against microshock (1mA)

C. TSH

Catecholamine, corticosteroids, GH, glucagon all increased. GH only anabolic hormone. TSH unchanged. Thyroxine may be increased by sympathetic stimulation, but catabolic effect.

D. hypothermia to 20 degrees celcius

though new treatment is combination of deep/intermediate hypothermic arrest plus ?anterograde perfusion

B. chance of a negative test in people without disease

C. chance of a person who tested negative truly not having the disease

NPV = TN / (TN+TP)

c. RUL trifurcation

A. if resistant to defibrillation should give amiodarone 5mg/kg

ARC
Persistent or refractory VF or VT may be treated with antiarrhythmics such as amiodarone 5 mg/kg iv

DC shock is 2J/kg then 4 J/kg thereafter

The most common arrest scenario in children is bradycardia proceeding to asystole (a response to severe hypoxia and acidosis.)
VF is relatively uncommon, but may complicated hypothermia, TCA poisoning and those children with pre-existing cardiac disease.

A. Is often damaged by torniquet

The intercostobrachial and the medial brachial nerves originate in the lower neck and upper thorax and become cutaneous on medial upper arm. Both must be blocked proximal to the axilla for shoulder surgery or for any upper extremity procedure that involves use of a pneumatic tourniquet. The Intercostobrachial nerve derives from T2 posteromedial aspect of the arm
Medial brachial cutaneous nerve derives from C8 and T1 shoulder

C then A

C. Miller

A. CEACCP