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110 Cards in this Set
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AUG2013 |
Answer: D
From Oh's:
Circulatory arrest with apparent electromechanical dis- sociation is a recognised complication that may occur within 10 minutes of intubation and can lead to death or severe cerebral ischaemic injury if not managed cor- rectly.112–114 Standard mechanical ventilation recommen- dations (minute ventilation 115 ml/kg per min) have been estimated to be safe for 80% of patients requiring mechanical ventilation for acute severe asthma, with the remaining 20% requiring a small to moderate reduction in minute ventilation to return DHI to a safe level.97 A small percentage of patients with unusually severe asthma can rapidly develop excessive DHI during initial uncontrolled mechanical ventilation, leading to electro- mechanical dissociation, sometimes despite ‘safe’ levels of minute ventilation. If the cause of this is not immediately recognised, it can lead to prolonged and unnecessary cardiopulmonary resuscitation, unsafe procedures such as intercostal vascular access needles or pericardial taps and risk cerebral injury and death.112–114 When this occurs, immediate disconnection from the ventilator for 60–90 seconds (the ‘apnoea test’; see above) or profound hypoventilation (2–3 breaths/min)54 will diagnose and improve this situation. An even smaller percentage of patients may remain hypotensive despite profound hypo- ventilation with marked hypercapnia, fluid loading and inotropes. These patients may require Heliox delivered by the mechanical ventilator115 or extracorporeal mem- brane oxygenation. |
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AUG 2013 |
ANSWER: A
No clinical reason to give pethidine. Also could make seizures worse. |
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AUG 2013 3. A 42 year old lady presents for right pneumonectomy with a left sided double-lumen tube. She is 132kg and 160cm. What depth, measured at the incisors, is likely to give the ideal position? |
Answer: C
29cm depth for 170cm tall. +/- 1cm for every +/- 10cm of height.
Good correlation between height and depth of insertion. |
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AUG 2013 |
Answer: E
CEACCP
The main cause of renal complications after AAA repair is the decrease in renal blood flow, decreased renal perfusion pressure (outside autoregulation) augmented by the increasing renal vascular resistance (by 30%) associated with aortic clamping. Myoglobin release from ischaemic tissues may contribute to acute tubular necrosis by decreasing local nitric oxide release. Acute kidney injury (AKI) may also be linked to ischaemic – reperfusion injury, decreased renal cortical blood flow, prostaglandin imbal- ance, and increased activity of renin – angiotensin system.10 Postoperative dialysis rates are similar in patients who have under- gone either suprarenal or infra-renal aortic cross-clamping.10 Intraoperative urine output does not correlate with the degree of decrease in glomerular filtration rate (GFR) or the incidence of postoperative AKI. |
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5. [New] Features of severe pre-eclampsia include: |
Answer: C as written. |
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6. [Repeat] Earliest sign of a high block in a neonate post awake caudal: |
D
Haemodynamic changes are minimal in total spinals in neonates, mainly due to immature SNS. Case reports in literature often list apnoea as first sign of total spinal and the need for ventilation and occasional pharmacologic intervention for blockade of cardiac acceleratory fibres. |
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7.A 20 year old man was punched in the throat 3 hours ago at a party. He is now complaining of severe pain, difficulty swallowing, has a hoarse voice and had has some haemoptysis. What is your next step in his management? |
ANSWER: D |
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8.A 60 year old man with normal LV function is having coronary artery bypass grafting. After separation from the bypass machine he becomes hypotensive with ST elevation in leads II and aVF. The Swan Ganz Catheter showed a PCWP of 25 and CVP of 15 with normal PVR and SVR. The TOE is likely to show: |
ANSWER: B
Consistent with inferior MI and acute LVF |
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11.You are working in a theatre with a line isolation monitor, which is working. You touch a wire. What is going to happen?
A. equipotent earth B. the theatre floor won't conduct C. ? D. ? E. the RCD will protect you from shock |
ANSWER: B |
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12.What is the test is decreased in Iron deficiency anaemia? |
ANSWER B |
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13. A full size C oxygen cyclinder (size A in New Zealand) has pressure regulated from
A. 16000kpa to 400kpa B. 16000kpa to 240kpa C. 11000kpa to 400kpa D. 11000kpa to 240kpa E. 7600kpa to 240kpa |
Answer: A |
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14.MRI Telsa 3, least likely to cause harm |
Answer: B |
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15-What happens when you place a magnet over a biventricular internal cardiac defibrillator |
Answer: D |
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16-You are performing an awake fibreoptic intubation, through the nose, on an adult patient. In order, the fibrescope will encounter structures with sensory innervation from the following nerves |
Answer: D |
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19Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.
A. anterior ischaemia B. atrial C. inferior D. lateral E. septal |
ANSWER: A Lead II: Inferior ischaemia and arrhythmias
"The central subclavicular (CS5) lead is particularly well suited for the detection of anterior myocardial wall ischemia. The right arm (RA) electrode is placed under the right clavicle, the left arm (LA) electrode is placed in the V5position, and the left leg electrode is in its usual position to serve as a ground. Lead I is selected for detection of anterior wall ischemia, and lead II can be selected for monitoring inferior wall ischemia or for the detection of arrhythmias. If a unipolar precordial electrode is unavailable, this CS5 bipolar lead is the best and easiest alternative to a true V5 lead for monitoring myocardial ischemia." |
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20 Lowest extension of thoracic paravertebral space |
ANSWER: B |
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21.20 yr old male presents to ED with 30% burns from a fire. His approx weight is 80kg. Based on the Parkland formula, how much fluid is required in the first 8hrs from time of injury? |
Answer: E CEACCP:
I.V. fluid resuscitation is required in adults if the burn involves more than 15% BSA or 10% with smoke inhalation. The Parkland formula is the most widely used resuscitation guideline and is 4 ml kg21 (%burn)21 which predicts the fluid requirement for the first 24 h after the burn injury. Starting from the time of burn injury (not time of presentation), half of the fluid is given in the first 8 h and the remaining half is given over the next 16 h. The fluid of choice is Hartmann’s solution. Any fluid already given should be deducted from the calculated requirement. A urinary catheter A urinary catheter should be inserted and the hourly urine output should be used as a guide to resuscitation. In adults, at least 0.5mg/kg/h should be passed. |
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22 In regards to systemic sclerosis, what is the least likely cardiac manifestation? |
Answer: E Potentially difficult - small mouth / stiff tissues B - Fibrosing alveolitis & restrictive lung disease Pulmonary hypertension (2e pulmonary vascular disease) Lung cancer Pulmonary thrombosis (late) C - (Most common is 2e to pulmonary disease, but primary cardiac disease does occur) Right sided heart failure (2e pulmonary vascular disease) MI Raynauds Pericarditis Myocardial fibrosis and diastolic dysfunction Myocarditis Conduction disturbances (includes fatal ventricular dysrhythmias) Arrhythmias D - Fatigue Nerve entrapment Headaches Seizures Stroke E - Lower esophageal sphincter Dilated hypomotile stomach GORD High aspiration risk F - Chronic kidney disease - may abruptly go into ARF HT 2e kidney disease |
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23 (repeat) The reason that desflurane requires a heated vapour chamber can be best explained by its:
A. Low saturated vapour pressure B. High saturated vapour pressure C. High boiling point D. Low molecular weight E. Very low solubility |
Answer: B
The main problem with desflurane is that it has a high saturated vapor pressure at room temperature (700mmHg at 20°C). It boils at just 22.8°C (if you’ve ever spilled any you’ll know how quickly it disappears as it evaporates) compare with sevoflurane at 58.5°C or isoflurane at 48.5°C. What this means is that small changes in ambient temperature will cause marked changes in the performance of a vaporizer and great difficulty in controlling the delivered concentration of desflurane. |
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24 (New but on a repeated theme)A 30 year old lady has a vaginal forceps delivery without neuroaxial blockade. The next day she is noted to have loss of sensation over the anteriolateral aspect of her left thigh. There are NO motor symptoms. The is best explained by damage to the left sided: |
ANSWER: B.
Lateral femoral cutaneous nerve arises from L2+L3 is a direct branch of the lumbar plexus. It supplies sensation to the lateral and anterior aspects of the thigh
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25.->AZ84 When performing laryngoscopy using a Macintosh blade, your best view is of the patient's epiglottis touching the posterior pharyngeal wall. Using the Cormack and Lehane scale this is grade |
ANSWER: D |
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26. A healthy 20 year old patient undergoing nasal surgery under general anaesthesia has the nose packed with gauze soaked in 0.5% phenylephrine and a submucosal injection of lignocaine with 1:100,000 adrenaline. Over the next 10 minutes the blood pressure rises from 130/80 to 220/120 mmHg and the heart rate from 60 to 100 beats per minute. The LEAST appropriate management of this situation would be to |
ANSWER:B esmolol -B blockade gives unoposed alpha stimulation |
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27.An 8 year old 30kg girl presents for resection of a Wilms tumour. Her starting haematocrit is 35% and you decide that your trigger for transfusion will be 25%. The amount of blood that she will need to lose prior to transfusion is |
Answer = C |
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28. An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except: |
Answer = B
ANGINA NOT NSTEMI, for NSTEMI need to stratify to high or intermediate risk to get clexane, STEMI are the ones who get heparin. |
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29. What cannot be used for tocolysis in a 34/40 pregnant woman:
A. Clonidine B. Indomethacin C. Magnesium D. Salbutamol E. Nifedipine |
ANSWER: A |
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30. Pringles procedure for life threatening liver haemorrhage includes clamping of: |
ANSWER: C
Note: "includes". Hepatic pedicle includes hepatic artery and portal vein.
Portal pedicle appears to be made up. |
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31. Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to: |
ANSWER: A |
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32. MVA trauma patient arrives in ED BP100/60 HR 100 with the following CXR (‘’I thought it looked like an aortic dissection/rupture with a widened mediastinum’’). The most appropriate next investigation would be: |
Answer: D
A CT scan is relatively rapid and non-invasive and with con- trast image enhancement the extent of the dissection along with the true and false lumens can be identified. This technique is not appropriate if the patient is haemodynamically unstable. Transthoracic echocardiography (TTE) is easily available and the ascending aorta and aortic arch can be visualized 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. |
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33. A 70 year old man with slow atrial fibrillation is reviewed for insertion of a permanent pacemaker. He is otherwise well. He is on warfarin with an INR of 2.2. Prior to PPM insertion do you |
Answer: C
Should give bridging anticoagulation for any patient with a CHADS2 score of 3 or more. |
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34. A 40 year old man with Marfan's has undergone a thoracoabdominal aneurysm repair. 48 hours post procedure there is blood noted in his CSF drain and he is obtunded. Your next course of action is: |
ANSWER: C
Drainage should stop when there is evidence ‘bloody’ or ‘blood-tinged’ CSF and coagulopathy should be corrected. Radiographic CT-testing should be done to exclude intracranial bleeding or a spinal haematoma. |
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36. You are anaesthetising a fit 50 year old woman for an elective laparoscopic cholecystectomy. In her pre operative assessment she has a normal cardiovascular exam and her BP is 115/75. You induce anaesthesia with 100mcg fentanyl, 100mg propofol and 50 mg rocuronium. Soon after induction her ECG looks like this (showed narrow complex tachycardia around 180-200/min – ie SVT). Her BP is now 95/50. What is the most appropriate management? |
ANSWER: A |
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37. The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the |
Answer: E |
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38. After ingestion of 500mg/kg aspirin, the most efficient therapy to enhance the elimination is
A. normal saline infusion B. bicarbonate infusion C. mannitol D. frusemide E. haemodialysis |
Answer: E
From Oh's: "Extracorporeal techniques are very effective in removing salicylates and correcting acid–base disturbance. "
From CEACCP |
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39. Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture |
Answer: C
Adults: L1-2 |
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40. A 6 week old is planned for an elective Right inguinal hernia repair. What is the most apprioate advice you give about fasting times.
A. 2 hours breast milk B. 4 hours formula C. 5 hours for formula and breast milk D. Solids for 6 hours E. 8 hours for solids and 4 hours for fluids |
Answer: B
From ANZCA PS15 |
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41. What is the best method of detecting early respiratory depression when a person is using a PCA
A. Something about looking at PCA settings B. Pupil size C. Sedation D. Respiratory Rate E. Number of Bolus doses used. |
ANSWER: C |
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42. A reduction in DLCO can be caused by;
A. Asthma B. COPD C. Left to right shunt D. Pulmonary haemorrhage E. Bronchitis |
Answer: B
A. Asthma - normal or high DLCO
Older textbooks suggest that thickening of the alveolar-capillary membrane (in interstitial lung disease) and loss of alveolar membrane surface area (in emphysema) are the primary causes of a low DLCO. However, subsequent experimental data suggest these and most other diseases that influence the DLCO do so by reducing the volume of red blood cells in the pulmonary capillaries. The total volume of blood in the lungs in healthy adults at rest is less than 150 mL; the volume of blood in the pulmonary capillaries and the DLCO are increased in the following circumstances: |
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43. You place a thoracic epidural for a patient having an elective open AAA repair. There are 4cm in the epidural space and you aspirate blood. What is the most appropriate management plan: |
ANSWER: C |
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44. You are anaethetising a lady for elective laparoscopic cholecystectomy, who apparently had an anaphylactic reaction to rocuronium in her last anaesthetic. There has not been sufficient time for her to undergo cross-reactivity testing. What would be the most appropriate drug to use: |
ANSWER: E
A. No |
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45 Patient with subdural haematoma, on warfarin. INR 4.5. Needs urgent craniotomy. Vit K given already by ED resident. What further do you give for urgent reversal of this patient's INR? |
Answer: E
MJA: |
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46 Regarding endotracheal tubes used in laser surgery: |
Answer: D
Endotracheal tubes for laser surgery |
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50 During an elective thyroidectomy a patient develops symptoms consistent with the diagnosis of “thyroid storm” which of the following treatment options in NOT appropriate |
Answer: D
ANSWER: D (has been used in some cases, but not first line, not practical in OT) |
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53 Two days post upper spinal surgery, patient notices parathesia of the right arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from an ulnar nerve neuropathy? |
ANSWER: D
The ulnar nerve (C7, 8, T1), shown in Figs 117 and 121, is the continuation of the medial cord after this has given off the medial head of the median nerve. The ulnar nerve is usually composed of fibres from C7, 8 and T1, but in some 15% of cases there is no C7 contribution.
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54 A 54 year old man, is on warfarin for atrial fibrillation, has a history of alcohol abuse and liver failure with an albumin of 30 and a bilirubin of 28. What is his CHADS 2 score?
A. 0 B. 1 C. 2 D. 3 E. 4 |
ANSWER: A |
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57 You are 2 hours into an operation. 3L of IV Crystalloid has been given. There has been minimal blood loss. The dilutional anaemia is compensated by: |
Answer: C
"From Miller, Ch 57. The hypervolumetric haemodilution will lower PaO2 but compensatory mechanisms occur to ensure surplus Oxygen delivery to the tissues continues. A sudden reduction of [RBC] – reduction in viscosity – reduced peripheral resistance- and so increased VR with increased CO results." |
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58 You are putting in an Internal Jugular CVC. Which manoeuvre will cause maximum venous distension of the jugular vein?
A. Continuous Positive Airway Pressure (No value given) B: Breath hold at end-expiration C: Manual compression at the base of the neck D: Trendelenburg position E: Patient performs a valsalva |
ANSWER: D |
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59. What is approximately the systolic blood pressure in an awake neonate (mmHg) |
Answer: B
From http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-0-7020-3479-4..00053-2--bib1&isbn=978-0-7020-3479-4 |
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60. The volatile agent most likely to be associated with carbon monoxide production when used with a soda lime scrubber is:
A. Desflurane B. Isoflurane C. Sevoflurane D. Halothane E. Enflurane |
ANWER: A |
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61. A 40yo female with primary pulmonary hypertension is to have a laparoscopic cholecystectomy. Her preoperative pulmonary artery pressure is 80/60mmHg. During the procedure she suddenly desaturates to 87%, BP 80/40mmHg, and ETCO2 45mmHg. Likely findings on TOE will include: |
Answer: C
From UTD: |
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62 The principal resistance to airflow in an ETT is:
A: density of the gas B: diameter of the tube C: length of the tube D: temperature of the gas E: viscosity of the gas |
Answer: B |
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65. A new antiemetic decreases the incidence of PONV by 33% compared with conventional treatment. 8% who receive the new treatment still experience PONV. The no of patients who must receive the new treatment instead of the conventional before 1 extra patient will benefit is |
Answer: D |
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66. According to guidelines endorsed by ANZCA, the label of an intra-osseous infusion should be
A. beige B. blue C. Pink D. Red E. yellow |
Answer: C
From http://www.safetyandquality.gov.au/wp-content/uploads/2012/03/Labelling-Recommendations-2nd-edition-February-2012.pdf |
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69. During apnoeic oxygenation under light anaesthesia, the expected rise in PaCO2 would be:
A. 0.5 mmHg per min B. 1 mmHg per min C. 2 mmHg per min D. 3 mmHg per min E. 5 mmHg per min |
Question as remembered makes no sense. |
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70. In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and : |
Answer: C
http://www.trauma.org/archive/scores/rts.html |
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72. Absolute Contraindication to ECT |
ANSWER: D |
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73. 80 year old female for open reduction and internal fixation of a fractured neck of femur. Fit and well. You notice a systolic murmur on examination. Blood pressure normal. On transthoracic echo, she has a calcified aortic valve, with aortic stenosis with a mean gradient of 40mmHg. How do you manage her: |
ANSWER: D
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75 A 25 y.o. male has a traumatic brain injury on a construction site. GCS 7. Intubated on site and transported 1 hour to hospital. Haemodynamically stable and no other injuries. Most appropriate pre hospital fluid: |
ANSWER: E |
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76 A 40 y.o. female newly diagnosed ITP. Retinal detachment for surgery in 2 days. Platelets 40 and blood group A+. Management of her ITP: |
Up To Date: Answer: C |
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77. (Rpt) A neonate will desaturate faster than an adult at induction because
A. FRC decreased more B. Faster onset of induction agents C. More difficult to pre-oxygenate D. E. |
ANSWER: A |
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78. (Rpt Jul 07) Isoflurane is administered in a hyperbaric chamber at 3 atmospheres absolute pressure using a variable bypass vaporizer. At a given dial setting and constant fresh gas flow, vapour will be produced at: |
Answer D |
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80. 37 female presents to ED with headache and confusion. She is otherwise neurological normal and haemodynamically stable. Urine catheter and bloods takes. UO > 400ml/hr for 2 consecutive hours, Serum Na 123 mmol/l, Serum Osmolality 268, Urine Osmolality 85 The most likely diagnosis is |
ANSWER: C |
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83 A 45 year old obese man complains of headache, lower limb weakness and polyuria. On examination, his blood pressure is 150/70mmHg. He has a displaced apex beat. Bloods revealed Na145, K2.8, Cl101, HCO3 27. What is the most likely diagnosis |
Answer: c |
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84 Which of the following is the best predictor of a difficult intubation in a morbidly obese patient
A. Pretracheal tissue volume B. Mallampati score C. Thyromental distance D. BMI E. Severity of OSA |
Answer: A
In 50 morbidly obese patients, we quantified the soft tissue of the neck from the skin to the anterior |
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85. You wish to compare a new method of BP measurement with the gold standard. The best way to do this is: |
Answer: E |
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86. After intubating for an elective case you connect up the circuit and notice that you are unable to ventilate and observe high airway pressures. The next most appropriate step is to: |
Answer: A
Clinically seems like the best first step. ?wheeze from reactive airways disease / allergy. |
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87. You insert a thoracic epidural in a patient for a liver resection with an upper abdominal incision. You have recently topped it up. On waking the patient appears weak, despite adequate reversal. He can breathe spontaneously and can flex his biceps but is not able to extend triceps. The level of the block is most likely to be: |
Answer: C |
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88. (repeat) You are anaesthetizing a pregnant woman for neuro-radiological coiling. At what gestation is it important to monitor uteroplacental sufficiency?
A. 22 weeks B. 24 weeks C. 26 weeks D. 28 weeks E. 32 weeks |
Answer: B |
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89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is? |
Answer: B
Produces transient asystole. |
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90. Prior to seeking consent from family/relatives for DCD, it is important to confirm which of the following? |
Answer: B 1.need medical suitability -includes fulfilling criteria 2. consider wishes of pt 3. formal consent
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91. You see a young man prior to surgery. He describes a history of throat swelling and difficulty breathing both spontaneously and in association with minor dental procedures. His brother has had similar episodes. The most likely mechanism is: |
Answer: A |
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92. A 5 year-old child with recently diagnosed Duchenne muscular dystrophy has an inhalation induction with sevoflurane for closed reduction of a distal forearm fracture. No other drugs have been given. 10 minutes later the child suffers a cardiac arrest. After a further 5 minutes a venous blood sample shows a potassium level of 8.5mmol/L. The most likely mechanism for the hyperkalaemia is: |
Answer: E |
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95. You are anaesthetising a 6 month-old infant for repair of a VSD. You perform an inhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant’s oxygen saturations fall to 85%. The most appropriate next step in management: |
Answer: E |
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96. A 30-year old patient, who takes paroxetine, has suffered a traumatic amputation. The most appropriate medication to reduce her developing chronic post-operative pain is: |
Answer: C |
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97. A 3 year old child has suffered a fractured arm. What is the most appropriate way to assess her pain? |
Answer: ?E |
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98 buprenorphine patch removed morning of surgery. What time till PLASMA reaches half original level
A. 12 hours B. 18 hours C. 24 hours D. 30 hours E. 36 hours |
Answer: A |
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101. [Repeat - 2013A Q48] The clinical sign that a lay person should use to decide whether to start CPR is:
A. Absent central pulse B. Absent peripheral pulse C. Loss of consciousness D. Obvious airway obstruction E. Absence of breathing |
Answer: E
Danger? Response? -> Open airway. Breathing? -> CPR. -> Attach AED |
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102. [Similar to 2013A Q38] Central sensitization, resulting in prolongation of post-operative pain, is caused by:
A. Increased intra-cellular gene expression B. Increased intra-cellular magnesium C. Low frequency activation of A-delta fibres D. Primary activation of N-methyl-D-aspartate receptor E. Increased glycine as a major neurotransmitter |
Answer: A
See: When does acute pain become chronic? |
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103. [New] A 15yo girl with a newly diagnosed mediastinal mass presents for lymph node biopsy under general anaesthesia. The most important investigation to perform preoperatively is. |
Answer: B
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104. [New] A 63yo woman with chronic AF has a history of hypertension, Type 2 Diabetes Mellitus and has previously had a CVA. What is her annual risk of stroke without anticoagulation? |
Answer: E
C - 0 H - 1 A - 0 D - 1 S - 2
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105. [New] A 30 year old multi trauma patient one week post injury has severe ARDS. He is currently ventilated at 6ml/kg tidal volume, PEEP of 15cm H20 and pa02/Fi02 is less than 150. The next step to improve oxygenation is: |
Answer: E
(i) plateau inspiratory pressure between 25 and 30 cm H2O,
See ARDSnet |
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106. [Repeat 2013A] The incidence and severity of vasospasm post sub arachnoid haemorrhage is greatest at:
A. 0 -24 hours B. 2 - 4 days C. 6 - 8 days D. 10 - 12 days E. greater than 2 weeks |
Answer: C
CEACCP says greatest days 4-10 |
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107. [Repeat 2013A] The insulation on the power cord of a piece of class 1 equipment is faulty such that the active wire is in contact with the equipment casing. What will happen when the power cord is plugged in and the piece of equipment is turned on |
Answer: B |
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108. [Repeat 2013A] In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT: |
Answer: D
CPR first |
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109. [New] Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is: |
Answer: B
A. Proximal tibia or proximal humerus are preferred B. More equivalent to IV route.
E. Fat embolism can occur: From UTD Microscopic fat and bone marrow emboli were found in the pulmonary autopsy specimens of two children who received intraosseous infusion during resuscitation attempts and in 100 percent of study subjects in several animal studies of intraosseous infusion [44,45]. However, the clinical relevance of these emboli is not clear. No significant alterations in arterial oxygenation or intrapulmonary shunting occurred during a four-hour study period, despite the universal finding of fat and bone marrow emboli. |
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110. [New] During endovascular aneurysm repair, GA is preferred due to:
A. risk of uncontrolled haemorrhage B. renal ischaemia is painful C. aorta traction is painful D. long duration of apnoea is needed E. contrast used can cause CVS instability |
Answer: probably A |
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111. [Repeat 2013A Q26] A 35yo G1P0 with a dilated cardiomyopathy presents for a Caesarean section. She has an ejection fraction of 35%. The benefits of a regional anaesthetic over a general anesthetic in this patient may include: |
Answer: C |
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112. [New] In attempting to make a precise diagnosis of parathyroid adenoma, you would expect all of the following are found in hyperparathyroid disease EXCEPT: |
Answer: A |
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116. Which general anaesthetic agent contributes the most to green house gas? (Now I'm not 100% sure on the stem recall, but I got the impression it was asking for the agent that is the absolute worse for green house gases (desflurane), not so much which one do we use the most and thus ends up contributing the most to the total green house gas volume (iso or sevo) |
Answer: A |
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119. [New] A patient's competence to give informed consent is determined by all the following EXCEPT:
A. Ability to communicate a choice B. Ability to apply reasoning C. Ability to understand consequences D. The provision of significant information E. ?? |
Answer: ?D |
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120. [Repeat] A patient undergoes a femoral-popliteal bypass and has a mildly elevated troponin on day 1 post-operatively. They are otherwise asymptomatic with no other signs/symptoms of myocardial infarction and have an uneventful recovery. What do you do? |
Answer: A |
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121. St John's wort will reduce the effect of |
Answer: E
It is also a potent inducer of hepatic cytochrome P450 CYP3A4 isoform. Hence, it may significantly increase the metabolism of many concomitantly administered drugs such as alfentanil, mida- zolam, and lidocaine. It also induces the P450 2C9 isoform that results in the reduction in effect of warfarin and NSAIDs. Pharmacokinetic data suggest that St John’s Wort should be stopped for at least 5 days before surgery. This discontinuation is especially important for patients awaiting organ transplant and hence requires immunosuppressants and patients who may require oral anticoagulation. Potentiates clopidogrel. (clopidogrel is a prodrug, and St John's Wort induces the enzyme that activates it) |
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122. The most important effect of Lugol's iodine administration before thyroid surgery is
A. reduce incidence of thyroid storm B. reduce incidence of vocal cord palsy C. increase likelihood to identify and preserve parathyroid glands D. pigmentation of thyroid gland to help identify thyroid gland E. reduce vascularity of thyroid gland. |
Answer: E
Antithyroid drugs make the thyroid more vascular. Giving iodine for 10 days pre-op reduces the vascularity of the thyroid and reduces bleeding. Not commonly done any more, as the thyroid is now usually resected whole - ie: without being transected.
From BJA thyroid disease |
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123. Performed a brachial plexus block. Normal sensation still remains in medial forearm. Which part of brachial plexus is most likely to have been missed |
Answer: C |
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124. You are pre assessing A 70 year old patient treated for congestive cardiac failure. They are able to shower themselves and complete other ADLs but get dyspneoa on mowing the lawn. They are New York Heart Association classification |
Answer: B
I : no symptoms and no limitations in ordinary physical activiy |
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126 Fluoroscopy in the operating theatre increases the exposure of theatre personnel to ionising radiation. Best method to minimise one's exposure to such radiation is to
A. have dosimeter checked at least 6-monthly B. limit exposure time to radiation C. maximal distance from radiation source D. stand behind transmitter of C arm E. wear protective garments |
Answer: C
From Miller:Because the intensity of scattered radiation is inversely proportional to the square of the distance from the source, the best protection is physical separation. A distance of at least 3 feet from the patient is recommended. Six feet of air provides protection the equivalent of 9 inches of concrete or 2.5 mm of lead. |
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127 Prothrombinex VF useful in perioperative period to correct the coagulopathic defect of all except |
Answer: B |
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133. The organ that is least tolerant of ischaemia, after removal for transplant, is:
A. Cornea B. Heart C. Kidney D. Liver E. Pancreas |
Answer: B |
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134. 75yo woman with an ejection systolic murmur presents for elective total knee joint replacement. Focussed transthoracic echocardiogram is performed. The feature most consistent with severe aortic stenosis is: |
Answer: C |
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135. Which of the following statements regarding patients with ankylosing spondylitis is FALSE? |
Answer C
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136. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermia. She has never had susceptibility testing. Her father and siblings have not been tested either. The best test to exclude malignant hyperthermia susceptibility before she delivers is |
Answer: D |
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139. During the first stage of labour, pain from uterine contractions + cervical dilatation is from nerve roots: A.-E. ( multiple options of thoracic - lumbar roots (sorry can't remember the exact ones, thought it was a repeat question so didn't write it all down) |
Uterus: T10-L2 |
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140. A test has a sensitivity + specificity of 90% for a disease with a prevalence of 10%. What is the positive predictive value?
A. 10% B. 50% C. 82% D. 90% E. 99% |
Answer: B |
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141. A female with type 1 von Willebrand disease presents for a dilation and curettage. She is a Jehovah’s Witness. In regards to desmopression to prevent haemorrhage in this patient all of the following are true EXCEPT: |
Answer: D (8-20 hours) |
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142. A 25 week post conceptual age infant is being ventilated in the Neonatal Intensive Care Unit. To reduce the risk of retinopathy of prematurity, they are being ventilated to a target oxygen saturation of 85-89% instead of 91-95%. This is associated with:
A. Increased acute lung injury B. Increased mortality C. Increased sepsis D. Reduced intracerebral haemorrhage E. Reduced necrotizing enterocolitis |
Answer: B
BOOST 2 |
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144. An 80 year old man undergoes a unilateral lumbar sympathectic blockade. THe most likely side effect that he experiences is:
A. Genitofemoral neuralgia B. Haematuria C. Postural hypotension D. Lumbar radiculopathy E. Psoas haematoma |
Answer: A
ANZCA Book ‘Pain Management, 2ed (ClinicalKey) Waldman’ |
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145. Regarding Le Fort fractures:
A. External signs correlate with internal skeletal damage B. Le Fort fractures don't usually occur in combination (for example I and II) C. Patients with a Le Fort I fracture should NOT undergo nasal intubation D. Patients with a Le Fort II fracture should have evaluation of the base of skull prior to nasal intubation E. Le Fort III fracture is associated with fracture of the cribiform plate |
Answer: E |
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?145. Greatest predictor of AF post CPB
A. advanced age B. history of hypertension C. history of CVA D. history of CCF E. prolonged CPB |
Answer: A |
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146. 2yr child post op following stabismus surgery. ETT 4.5 used. Awake, stridor and tracheal tug. Immediate action? |
Answer: B
Laryngospasm: CPAP, jaw thrust, stop painful stimulus Consider sux 0.5mg/kg IV or 2-4mg/kg IM. Low dose propofol. |
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149. Transient neurological (radicular) syndrome ONLY occurs with |
Answer: D |
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150. 50yo lady, attempted suicide attempt, jumped from 5th floor building. She does not open her eyes or vocalise and there is no response to pressure on her nail-bed. What is her GCS? |
Answer: B |