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118 Cards in this Set
- Front
- Back
1. Given the following diagram, what does X represent? |
(Question 1 had the picture of the three container chest drain, with the suction limiting outlet the answer to the question) |
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2. RH28 Retrobulbar block. Sign of brainstem spread
A. Atonic pupil B. Unilateral blindness in blocked eye C. Contralateral blindness D. Diplopia- past papers remembered this as dysphagia E. Nystagmus |
E. Nystagmus
Contralateral blindness might just be spread to chiasm but not necessarily to brainstem. Atonic pupil, diplopia, blindness might just be unilateral block. |
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3. Something like: Otherwise healthy 20 yo male undergoes surgery for an ORIF tibia for open tib fracture. The limb is exanguinated and the tourniquet correctly applied at 250mmHg. His SBP is 120. When the surgeons go to start there is a small amount of bleeding. Do you.. |
A
Tourniquet inflation pressures, the lesser of: Upper limb - 200-250mmHg or 100>SBP Lower limb - 300-350 or 2xSBP
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4. What's this?
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Aortic dissection |
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5. Fatigue during night shifts can be minimized by: |
C |
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6. [New] Patient with Acute Intermittent Porphyria presents to hospital with abdominal pain and requires a general anaesthetic. Which drug for PONV would you avoid? |
A |
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7. A 65 year old man having a total hip placement under general anaesthetic has continued to take his moclobemide. He becomes hypotensive shortly after induction. The best treatment would be judicious use of |
E
Need to use Direct acting agent Norad effect might be prolonged if MAO inhibited Also, need CVL for inotropes
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8. The following capnography trace was observed in an intubated and ventilated patient. The most likely explanation for this respiratory pattern is |
C |
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9. When topping up a labour ward epidural to an epidural for lower segment caesarean section, the optimum level of block when assessed for light touch is to: |
C - most likely.
No dispute that T4 to ICE is the right level.
Light touch level varies depending on quoted source: OHA says T4 Int J of Obs Anaes says T6 |
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10. You are in the pre-admission clinic assessing a 60 year old male who is due to undergo total knee replacement in 10 days time. He is taking Dabigatran 150mg BD for chronic atrial fibrillation. He has no other past medical history and normal renal function. He is planned for a spinal anaesthetic. The most appropriate management for his anticoagulation is: |
A. Stop Dabigatran for 7 days.
http://bja.oxfordjournals.org/content/107/suppl_1/i96 This article specifically refers to neuraxial anaesthesia.
Previously, it was thought the answer to this question is B, due to the following reference, but this reference refers to surgery not neuraxial anaesthesia: "The Central European Journal of Medicine - Dabigatran in patients with atrial fibrillation: perioperative and peri-interventional management. For Major procedures ie TKR |
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11. A 15 yo girl with newly diagnosed mediastinal mass presents for supra-clavicular lymph node biopsy under GA. The most important investigation to perform pre-operativel |
B |
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12. A CTG recording with late prolonged decelerations. Cause: |
C
GA: sustained decreased variability |
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13. 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 |
D |
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14. 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:
A. vecuronium B. cisatracurium C. pancuronium D. atracurium E. suxamethonium |
B |
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15. Increase in period bleeding EXCEPT
A. Gingko B. Garlic C. Ginger D. Fish Oil E. Echinacea |
Answer: E |
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16. Post op hip ORIF, commonest periop complication
A. UTI B. PE C. Delirium D. AMI E. Pneumonia |
C or E
No agreed answer amongst study group |
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17. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is: |
E |
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18. 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: |
D |
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19 (Repeat) Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I. |
A |
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20. (Repeat) Pringles procedure for life threatening liver haemorrhage includes clamping of:
A. Aorta B. Hepatic artery C. Hepatic vein D. Portal pedicle E. Splenic Artery |
D |
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21. A 60 y.o. diabetic man has below knee amputation for ischaemic leg. His neuropathic pain is treated with oxycodone 40mg BD and paracetamol 1g QID. He is also on omeprazole 20mg BD for reflux. You decide to start him on gabapentin. Before choosing a dosing regime and starting treatment it is most important that you:
A. cease his omeprazole B. check his hepatic transaminase level C. check his renal function D. CHeck his QT interval on a resting ECG E. Decrease his oxycodone |
C |
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22. The anterior and posterior borders of the 'triangle of safety', the preferred insertion site for an intercostal catheter, are pec major and: |
C |
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23. A 39 yo male brought into ED with a compound fracture of his forearm. Has a history of schizophrenia and depression with nucertain medication compliance. He is confused and agitated wuth generalised rigidity but no hyperreflexia. Obs - HR 120, BP 160/90, RR 18, Sats 98 Temp 38.8 Likely Dx? |
C
"CART" - Confusion Autonomic instability Rigidity Temperature
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24. CO2 (laser??) penetrates surface tissue so well with little damage to underlying tissue because: |
D |
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25. (NEW) An 80yo man is having a transuretheral bladder resection, the surgeon is using diathermy close to the lateral bladder wall which results in patient thigh adduction. The nerve involved is:
A. Inferior gluteal B. Obturator C. Pudendal D. Scaitic E. Superior gluteal |
B |
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26. (New) You are involved in research and as part of data collection you collect ASA scores. This type of data is:
A. Categorical B. Nominal C. Non-parametric D. Numerical E. Ordinal |
E |
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27. An otherwise healthy man presents with anaemia. The test that most reliably indicates iron deficiency is decreased
A. MCV B. serum ferritin C. serum iron D. serum transferrin E. total iron binding capacity |
B
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28. Radical prostatectomy. Long operation and constant ooze. Surgeon asks if patient on 'aspirin'. You do a TEG. Shown TEG- fibrinolysis but also long r time. What treatment? A. FFP B. Cryoprecipitate C. Desmopressin D. Tranexamic acid TEG, think it was picture of low fibrinogen |
Answer depends on what the correct wording of the question is.
- r time means low in factors - k time is cryo - max amplitude indicates adequacy of platelets - the tail indicates fibrinolysis |
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30. The maximal allowable atmospheric concentration of nitrous oxide in Australian and New Zealand operating theatres (in parts per million) is
A. 5 B. 25 C. 50 D. 100 E. 200 |
B |
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31. What is associated with down regulation of nicotinic acetylcholine receptors: |
B |
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35. A reduction in DLCO can be caused by: |
B
Due to large volume of air trapped in lungs and decreased surface area by destroyed alveolar walls.
Left-Right shunt and Pulmonary haemorrhage Increase DLCO |
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36. 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 |
D |
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37. (New) The size (in French gauge) of the largest suction catheter which can be passed through a size 8 endotracheal tube which will take up not greater than half the internal diameter is size:
A. 6 B. 8 C. 10 D. 12 E. 14 |
Answer: D |
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38. (Repeat) Pneumoperitoneum cases a decrease in cardiac output at what pressure (or possibly ABOVE what pressure)
A. 10mmHg B. 20mmHg C. 30mmHg D. 40mmHg E. 50mmHg |
A |
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39. 60yo male had total knee replacement. 7 days post-operatively diagnosed with deep venous thrombosis on ultrasound. Was on LMWH. PLT dropped from 300 immediately post-op and now 150x10^9/L. All the following are acceptable treatments EXCEPT- |
Answer: E
Warfarin inhibits Vit K dependent factors II,VII,IX,X but also Protein C&S. It inhibits Protein C&S faster than the factors, so initially patient is PROthrombotic when starting warfarin. |
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40. [Repeat] Maximum dose (with low risk of toxicity) of lignocaine (with adrenaline 1:100000) for liposuction with tumescence technique:
A. 3 mg/kg B. 7 mg/kg C. 15 mg/kg D. 25 mg/kg E. 35 mg/kg |
E |
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43. Drug to facilitate clip placement during cerebral aneurysm surgery; |
C
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44. Which drug should be avoided both intra- and post operatively in a woman having surgery who is breast feeding a 6 week old baby? |
A
Pregnancy drug classes: Paracetamol A Codeine A Morphine C Parecoxib C Tramadol C
E. Tramadol is concentrated in breast milk, but appears to be safe
Paech M, et al. Anesth Analg. 2012 Apr;114(4):837-44 states Parecoxib safe. |
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45. A three year old girl for an elective hernia repair is seen immediately prior to surgery. It is revealed she had 100mL of apple juice 2 hours ago. The best course of action is to: |
E |
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46. In accordance with their belief that blood transfusion is wrong, a Jehovah's Witness may consent to all of the following except: |
C Blue Book 2011: Acceptable: cryo, Hb, Ig, Albumin, clotting factors, EPO, interferon. |
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47. 80 year old lady with fractured NOF needing ORIF. On examination had a systolic murmur. Arranged TTE which showed a calcific aortic valve with peak velocity of 4 m/s. Using the simplified Bernoulli equation, what is the peak pressure gradient across the valve:
A. 16 mmHg B. 32 mmHg C. 48 mmHg D. 64 mmHg E. 80 mmHg |
D |
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48. You have developed a new cardiac output monitor called WaCCO. You want to compare the readings with the gold standard, a pulmonary artery catheter. What is the best statistical method to present the data/results:
A. Funnel plot B. Bland-Altman plot C. Forest plot D. Galbraith plot E. Partial regression plot |
B |
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50. A 60 year old, triple vessel disease normal LV Post CABG hypotensivem ST elevation II, avF, CVP 15 PCWP 25. Normal SVR. Echo shows:
A. A early diastolic mitral inflow dynamic with atrial systole B. Left inferior hypokinesis C. Left ventricle collapse in systole D. Right ventricle dilation and TR E. Severe Mitral Regurg |
B |
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51. Maximum amplitude from TEG or ROTEM decreased give
A. Cryoprecipitate B. FFP C. Platelets D. Prothrombinex E. Tranexamimic acid |
C |
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52. Young male, previous IVDU, now on 100mg Methadone per day has a laparotomy with an effective epidural. Amount of IV Morphine needed per HOUR:
A. 1mg B. 2mg C. 4mg D. 8mg E. 16mg |
NOT SURE Probably B
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53. A healthy 25 year old woman is 18 weeks pregnant. Her paternal uncle has had a confirmed episode of malignant hyperthermi:A. 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 |
D
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54. 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 |
Most likely E
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55.
10L/min via facemask. Cylinder C 15 000kPa lasts A. 10min B. 15min C. 30min D. 45min E. 60 min |
D
Size C is 490L if pressurised to full 16400kPa So 15000kPa is roughly 450L. So should last 45 minutes.
Size B 170L Size C 490L Size D 630L |
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57. Ibuprofen dose for one year old child tds regular post-op dose |
B |
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58. AICD, what does a magnet do |
None of the above.
I think they actually turn off the defibrillator, but maintain the usual pacing mode. |
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59. To prevent transmission of CJD? Airway-contaminated equipment should be: A. autoclaved B. protected plastic covers C. sterilise in ethylene oxide D. 134degreesC for 3 min E. thrown away |
E |
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60. A 35yo man collapses in shopping mall and is resuscitated by bystanders using an AED. On admission to hospital his ECG was as below;
ECG - sinus, rate ~60, normal axis, borderline PR interval, RSR' in V1 and V2 with ST elevation and inverted T waves (Brugada sign) A. Acute pericarditis B. Brugada C. Cocaine intoxication D. Coronary artery spasm E. Long QT syndrome |
B |
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61. A 58yo with solitary hepatic metastasis from colon cancer scheduled for resection of R lobe of liver. Inorder to manage the risk of intra-operative haemorrhage, it is most important to maintain: |
C |
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63. A man is admitted to ICU with a Sodium of 105 mmol/L. What is the maximum his sodium should be raised in the next 24 hours |
Answer: B New European guidelines say correct by 5mmol/L acutely if symptomatic by giving hypertonic saline, then correct by 10mmol/day for first day and 8mmol/day thereafter until 130. |
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64. What is the distance from lips to carina in a 70 Kg man?
A. 21 cm B. 23 cm C. 25 cm D. 27 cm E. 29cm |
D |
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65. The action of which laryngeal laryngeal muscle opens the cords?
A. Cricothyroid B. Posterior cricoarytenoid C. Lateral Cricoarytenoid D. Thyroarytenoid E. Vocalis |
B |
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66. Induction of a 4yr old child with Arthrogrophysis multiplex congenita, however you find it difficult to place the laryngoscope. What is the concern? (paraphrased question here, can’t remember all possible answers)
A. MH B. Neuroleptic malignant syndrome C. ? D. opioid induced rigidity E. TMJ rigidity |
E |
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70. A patient is suffering from aortic dissection with acute aortic regurgitation. BP 160/90, HR 100 & evidence of acute pulmonary oedema. What is your immediate management?
A. Beta-blockers B. Dopamine C. Dobutamine D. Sodium nitroprusside E. Intra-aortic Balloon Pump |
A
This is the case despite the AR.
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71. Presented are a femoral arterial line trace & a central venous line (JVP) trace - looked like it was demonstrating elevated right atrial pressures... What is demonstrated by these pressure waveforms?
A. Aortic Stenosis B. Aortic Regurgitation C. Pulmonary Regurgitation D. Tricuspid Regurgitation E. Mitral Regurgitation 71. Given the following femoral AL and CVP traces, what is the most likely cause? [diagram] A. Pulmonary stenosis B. Left Ventricular Failure C. Tricuspid Regurgitation D. Aortic Stenosis E. Mitral Stenosis 71. Trace of an Arterial line and RA venous pressure. The venous pressure started escalating prior to the onset of the arterial pressure rise (all 4 regurg options, one stenotic option) |
Who knows, but probably tricuscpid regurg? |
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72. The MELD score is calculated using INR, Bilirubin & what?
A. Creatinine B. Albumin C. Urea D. AST E. Ammonia |
A |
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73. In resuscitating a newborn infant after delivery, the time at which you would like to achieve arterial oxygen saturation of 85-90%: |
E 1min 60-65 2min 65-70 3min 70-75 4min 75-80 5min 80-85 10min 85-90
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74. (repeat): You inserted a central venous line and peripheral arterial line for a patient who is having a tumour removed via craniotomy. The transducers of both the lines were placed at the level of the right atrium 13cm below the level of the external auditory canal. MAP is 80mmHg, CVP 5mmHg. What is the CPP? |
C
MAP at heart = 80 MAP at head = 70 CVP at heart = 5 CVP at head = -5 but collapsed, so is actually zero
Therefore, CPP = 70-0 =70 |
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75. What proportion of the population are heterozygous for plasma cholinesterase deficiency?Having a Dibucaine number of 30-80. |
C
96% people normal 4% heterozygous (slightly prolonged block) <1% homozygous (very prolonged block)
Peck & Hill |
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76. You are putting in a internal jugular central venous line. Which maneuvre causes maximal distension of the internal jugular vein? |
E
Valsalva - probably gives maximal distention |
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82. A 40 yo woman for laparotomy to remove phaeochromocytoma under combined epidural and general anaesthesia. Pre-operatively treated with phenoxybenzamine and metoprolol. Intra-operatively, blood pressure is 250/130 despite high dose phentolamine and SNP. HR is 70/min and SaO2 are 98%. The next most appropriate treatment is: |
Answer: D
CEACCP: Adequate pre-operative care aims to limit the severity of these episodes but vasodilators must be prepared and close at hand. Such agents include boluses of phentolamine 1–5 mg and labetalol 5–10 mg or sodium nitroprus- side, GTN and nicardipine infusions. Sodium nitroprusside has a rapid onset and offset of action; it is not associated with toxicity when used in recommended doses. Nicardipine is a calcium chan- nel blocker which has been used as an infusion for fast titration of blood pressure. The use of isoflurane as an antihypertensive agent is a practical alternative. Magnesium sulphate infusions have recently been described (inhibits catecholamine release, exerts a direct vasodilator effect and reduces α-receptor sensitivity). |
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83. Best option to reduce risk of Ventilator induced pneumonia? |
C
A - 30 degrees head up B - Avoiding intubation, limiting time C - Yes D - Increasing pH increases bacteria in GIT theoretically: ?increases pneumonia E - Leave connected |
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85. 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 A. Central diabetes insipidus B. Nephrogenic diabetes insipidus C. Psychogenic polydipsia D. Cerebral salt wasting E. SIADH |
C
Hyponatraemic |
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91. The American Heart Association (AHA) guidelines for preoperative cardiac risk assessment define a poor functional capacity as only able to exercise at a level of less than 4 metabolic equivalents (METs). Exercise capacity of 4 METs corresponds to |
A |
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92. Pneumoperitoneum for laparoscopy is commonly associated with each of the following EXCEPT |
C
Miller table
A - Up B - Up C - Correct - decreases D - Up E - Up |
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93. 7 year old with closed head injury. Intubated and ventilated in ICU. Serum sodium 142. Most appropriate maintenance fluid is: |
C |
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94. Patient with Marfan's syndrome. Thoracoabdominal aortic aneurysm repair. 24 hours later in ICU noted to be blood in CSF drain and patient obtunded. Most appropriate urgent management: |
A |
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99. (new) The respiratory pattern most likely seen in an acute C5 spinal cord injury: |
???
In reality, probably all of the above. Starts with chest wall immobility below C5, then arterial hypoxaemia, then tachypnoea. |
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100. (new) Afterload reduction is most useful in which of the following: A. aortic stenosis |
D or E.
AS - worse Tetralogy of fallot - worse AR + MR - benefit Tamponade - benefit |
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101. 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? |
D |
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102. Preferred method for treating raised INR |
Answer: E. But only if it's a situation of raised INR with no bleeding, INR>10, and high bleeding risk.
IF BLEEDING: - Life-threatening bleed, INR>1.5 --> give K/P/F - Significant bleed, INR>2 --> give K/P - Minor bleed, INR>4.5 --> give K - Other --> nothing. W/H warfarin
IF NOT BLEEDING: - INR <4.5 --> nothing. W/H warfarin - INR <10 & low bleeding risk --> nothing - INR <10 & high bleeding risk --> give K - INR >10 & low bleeding risk --> give K - INR >10 & high bleeding risk --> give K/P
Legend: K=VitK, P=Prothrombinex, F=FFP |
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103. Regarding PS31, Level II check includes: |
Service Label High pressure system - O2 cylinder, pipeline supply Low pressure system - rotatmeters, vaporizers Leak Test CO2 absorbtion Ventilator Scavenging Emergency ventilation
Level three: Changed circuit Changed vaporizer IV anaesthetic devices Intubation / LMA gear Suction Gas analysis Monitoring and alarms Humidifiers Filters
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107.(New) A 50 yo man with a Deep Brain Stimulator (DBS) secondary to Parkinson's disease is scheduled for elective surgery. What is the best management regarding this device? |
D
CEACCP |
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108. (New) Fit and well G1P0 post epidural complaining of loss of sensation over posterior leg, lateral thigh and foot with weak flexion of knee. Which best explains the findings? (Not remembered quite correctly.) |
D |
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109. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except |
Answer: A |
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110. (New, long stem taking up half the page) Male in 60's one day post laparotomy. Management includes: IVH @40ml/hr, 2L oxygen via nasal prongs, and a morphine PCA. Observations: t38.8C, RR14, Sats 88% Examination: mildly sedated, bibasal creps. In addition to increasing the FiO2 what would be your initial management? |
A. Atelectasis most likely.
Bibasal creps: unlikely to be bilateral pneumonia, besides, it's too early. RR14: unlikely to be opioid narcosis Febrile: unlikely to be simple APO |
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111. A patient is coming for an operation on his upper limb. 5mls of 0.75% ropivacaine is placed around the structure seen below. What is the most likely consequence of this?
Picture was of probe on posterior upper arm |
B.
Probably radial nerve because it supplies EXTENSOR compartment of the arm |
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112. A 40 year old man suffered a traumatic brain injury 2 days ago. He does not meet the criteria to be certified brain dead. What investigation will be most useful to assess cerbral function prior to organ donation. F. Intra-arterial angiography |
F.
Angiography - demonstrating no intracranial blood flow.
As per ANZICS document. |
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113. Isoflurane is administered in a hyperbaric chamber at 3 atmospheres using a variable bypass vapouriser, at a constant fresh gas flow and vapour dial setting, the vapour produced will be: |
D |
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114. What is most likely to occur if the earth/grounding plate that is attached to a patient for use with monopolar diathermy malfunctions? |
C
e.g. if plate only partially in contact with patient |
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115. A 24yo primigravida, 25/40 gestation, BP 150/90 on 4 occasions. No signs of pre-eclampsia. Which antihypertensive is inappropriate? |
C
ACEI bad for foetus! |
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116. Post-spinal surgery, patient notices paraesthesia of R arm, surgeon thinks this is an ulnar nerve palsy due to poor positioning. What sign will distinguish a C8-T1 nerve root lesion from ulnar nerve neuropathy? |
D.
Median nerve supplies LOAF Lumbricals x2 Opponens pollicis Abductor pollicis brevis Flexor pollicis brevis
Hint: "brevis" sounds like "bread" hence "LOAF". |
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119. According to PS09, the minimum requirement for administering propofol for conscious sedation is |
A |
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122. Reasons infants desaturate faster than adults on induction (?did it say rapid sequence?) |
A |
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125. Adenosine can be used to treat |
C |
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126. Induction with thio 5mg/kg, scoline 2mg/kg, Difficult to open mouth, Finally intubated. Next step |
Answer: A
OHA:
Switch to MH safe anaesthetic Wait 15 mins and monitor for increasing heart rate / CO2 |
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127. In a patient with an intra-orbital haemorrhage, following local anaesthetic injection, the adequacy of ocular perfusion is best assessed by: A. angiography B. direct ophthalmoscopy C. indirect ophthalmoscopy D. intra-ocular pressure tonometry E. palpation of the globe by an experienced clinician |
B.
Ref: ANZCA Podcast on eye surgery - to assess central retinal artery pulsations |
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128. A patient is in Class IV Haemorrhagic Shock, secondary to a gunshot wound to the abdomen. He is clinically coagulopathic 30 minutes later. He has received intravenous Hartmann's 1L. The coagulopathy is likely related to: A. acidosis B. dilution of clotting factors C. hypothermia D. systemic release of tissue factor E. tissue hypoperfusion |
E
Protein C inhibits Fx V and VIII V+VIII="intrinsic tenase" TF+VII="extrinsic tenase" These convert X to Xa
It's too early for dilution of clotting factors. |
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129. (Repeat) A 20 kilogram child suffered 15% full thickness burns 6 hours ago. Optimum crystalloid resuscitation for the first hour is: A. 160ml B. 260ml C. 360ml D. 460ml E. 660ml |
C. Parkland Formula 20kg x 15%TBSA x 4mL = 1200mL in the first 24 hours (1/2 in first 8 hours, 1/2 in next 16 hours)
So, 600mL in the first 8 hours SINCE TIME OF BURN. i.e. over the next 2 hours. =300mL/hr
Plus maintenance (4/2/1 rule) =60mL/hr
TOTAL = 360mL/hr in the first hour. |
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130. You’re anaesthetizing an otherwise well 40 yo male for a craniotomy. Propofol and remifentanil TIVA. Using entropy. The MAP is 70 mmHg, heart rate is 70 bpm, Sats are 98%, state entropy is 50 and the response entropy 70. Most appropriate next step is A. give 0.5 mg metaraminol iv B. use NMT to assess train of four ratio C. change to volatile anaesthetic D. do nothing E. increase propofol TCI concentration by 0.5 |
E
Probably some muscle activity but may be early sign of light anaesthesia
Can also increase Remi if possible |
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131. The normal physiological response following ECT is A. transient tachycardia followed by bradycardia and hypotension B. transient bradycardia followed by tachycardia and hypertension C. unpredictable D. transient tachycardia followed by bradycardia and hypertension E. tachycardia and hypotension |
B |
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133. A 50 year old male is having an aortic valve replacement for aortic stenosis. He is stable on bypass initially but after the first dose of cardioplegia his MAP falls to 25mmHg, CVP 1 and his mixed venous oxygen saturation is 80%. What is the best management in this situation. A. Metaraminol bolus B. Commence an adrenaline infusion C. Increase oxygen flow rate D. Increase pump flow rate E. IV crystalloid bolus |
A
He was stable on bypass so the hypotension and low CVP unlikely due to cardiac output or volume issue. |
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134. An eighty year old man presents to the emergency department with two hours of severe abdominal pain. On examination he has a tender pulsatile 8cm mass. His GCS is 12, heart rate 104, blood pressure 80/49, Temp 35 degrees, SpO2 92%, respiratory rate is 30/min. What is the next appropriate step. A. Commence a vassopressor to support the circulation and improve end organ perfusion. B. Obtain IV access and crossmatch C. Intubate to secure the airway and prevent aspiration D. Perform an abdominal ultrasound to confirm diagnosis E. Ventilate with a bag valve mask to improve saturations |
B
Can't commence vasopressor without IV! Don't need to intubate because GCS>8 |
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A. Lithium Dilution Cardiac Output (LiDCO) B. Pulse contour analysis C. Pulse contour analysis and thermodilution D. Thermodilution E. Thermodilution and aortic flow doppler |
C |
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138. A tablet containing OxyContin 40mg and naloxone 20mg offers the following advantage over OxyContin alone. A. Less potential for abuse B. Less constipation C. Less sedation D. Less respiratory depression E. Less pruritus |
B. Primary effect
Also less potential for abuse. |
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141. Immunity to Hepatitis B is demonstrated by the presence of A. Hepatits B core antibodies B. Hepatits B core antigens C. Hepatits B surface antibodies D. Hepatits B surface antigens E. Any of the above |
C |
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142. In an adult with advanced liver cirrhosis, the best predictor of bleeding is A. Dysfibrinogenaemia B. Hypoalbuminaemia C. Prolonged Prothrombin time D. Portal Hypertension E. Thrombocytopaenia |
E. Thrombocytopenia is best PREDICTOR of bleeding (Oxford Handbook). Whereas, INR is a good sign of hepatic function. |
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143. 65 year old lady with acute cholecystitis presenting for cholecystectomy. Has known hyperparathyroidism. Calcium 2.2mmol/L (normal values given). Initial treatment with: A. calcitonin B. frusemide C. intravenous fluids D. magnesium E. mythramycin |
C.
Strategies include: 1. Increase excretion: fluids, frusemide 2. Reduce resorption/absorption: bisphosphonate, calcitonin |
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144. SG67 20 year old male 80kg presents post house fire with 30% burns. Using the Parkland formula how much fluid should he have replaced in the first 8 hours. A. 2.6L N/saline B. 3.6L N/saline C. 3.6L CSL D. 4.8L N/saline E. 4.8L CSL |
E.
But what about maintenance?!?! |
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145 The thoracic paravertebral space is continuous down to A. T10 B. T12 C. L2 D. L4 E. S1 |
B. Thoracic paravertebral space is contiguous with adjacent levels.
Paravertebral space also exists in C and L spine but are not contiguous with adjacent levels. |
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146. To best visualise a superficial peripheral nerve you should use a A. low frequency probe at 90 degrees to the skin B. high frequency probe at 90 degrees to the skin C. low frequency probe at 45 degrees to the skin D. high frequency probe at 45 degrees to the skin E. low frequency probe at 75 degrees to the skin |
B |
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148: (Repeat). 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 |
B - since the question asks about "enhancing" elimination.
Haemodialysis is the most effect to ELIMINATE aspirin but doesn't "enhance" the body's elimination. |
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149. After an uneventful Caesarean section under regional anaesthesia a healthy primigravida complains of chest pain and shortness of breath before rapidly losing consciousness. What is the most likely cause? A. Inadvertent administration of suxamethonium B. Pulmonary embolism C. Amniotic fluid embolism D. Anaphylaxis to oxytocin E. Venous air embolism |
B
PE risk is higher than AFE risk. Plus PE risk is even higher in LSCS. Plus AFE chest pain rare.
PE risk 1:1000 to 1:3000 PE risk increases 2-8 fold for LSCS AFE risk 1:8000 to 1:80000 |
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150. The faster rate to desaturation observed in morbidly obese patients is due to: A. Decreased residual volume B. Decreased functional residual capacity C. Decreased diffusion capacity D. Increased closing capacity E. Increased pulmonary blood volume |
B |
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[Nonum 1] In preadmission clinic with patient with a tracheostomy. To enable patient to talk you would- A. Deflate tracheostomy cuff, insert one-way valve, insert fenestrated piece B. Deflate tracheostomy cuff, remove one-way valve, insert fenestrated piece C. Inflate tracheostomy cuff, remove one-way valve, insert fenestrated piece D. Inflate tracheostomy cuff, insert one-way valve, insert fenestrated piece E. ? |
A |
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[Nonum 2] Rheumatoid arthritis. Most common C-spine abnormality is anterior subluxation. What is next most common? A. Posterior B. Vertical C. Lateral D. Subaxial E. ? |
B
Anterior subluxation 80% Vertical / Lateral 10-20%, with the majority being Vertical. Posterior 5% Subaxial <2% |
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[Nonum 3] A 13kg child booked for elective procedure. Has had 100mL of clear fluid 2 hours ago. Management? A. Delay surgery for 2hours B. Delay surgery for 4hours C. Delay surgery for 6hours D. Proceed with surgery E. Cancel surgery |
D |
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[Nonum 5] Which is least likely to fraudulent research reduction strategy? A. Published in a peer review journal B. Multiple authors C. Departmental director sole author D. Research findings similar to other published studies E. Backing of a major research institute |
A is good but may not reduce fraud B is good C is high risk for fraud D is neither good or bad E is bad |
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[Nonum 6] With respect to the triangle of safety and intercostal chest drain (ICC) insertion, if pectoralis major and the 4th - 5th intercostal space form two borders what forms the other? A. Latissimus dorsi B. Serratus anterior C. Midaxillary Line (maybe wasn't an option) D. Posterior Axillary Line (maybe wasn't an option) E. Trapezius Anatomy for insertion of intercostal chest drain - triangle bordered by axilla, pectoralis major and ...? A: Latissimus dorsi E. Trapezius |
A |
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[Nonum 7] Small picture trying to show USS probe on inferio-posterior R arm of a teenager's arm with an associated USS image of a very triangular looking peripheral nerve between two muscle fascia (radial N). Blockade of this nerve would result in? A. Reduced pronation B. Reduced hand grip. C. Reduced elbow flexion D. Reduced wrist extension E. ? Alt: US picture of radial nerve at upper arm, which motion blocked (wrist extension, pronation) Alt: Picture showing USS probe in the lower lateral arm near elbow (ie radial nerve) - nerve block confirmed by? A. Thumb adduction B. Pronation |
D |
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[Nonum 8] USS picture of an axillary brachial plexus nerve block with all four nerve unlabelled, the humerus, brachioradialis and biceps brachii marked. (Good quality image provided) What is the structure labelled 1.? A. Musculocutaneous nerve B. was Radial N C. was Ulnar N D. was Median N |
A was the answer |
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[Nonum 9] Patient with known PAH with pulmonary pressures of 80/60 undergoing a lap cholecystectomy. About 20mins into case there is a sudden acute drop in SpO2 88%, hypotension. This is most likely to be? A. Pulmonary embolism B. Venous air embolism C. Acute right heart failure D. ? E. ? |
B?
Any of the above really. |
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[Nonum 10] Paediatric intubation of 20kg, 5.5 doesnt fit, 4.5 doesn't fit, what next? A. 4.0 tube B. LMA C. flex bronch D. ? E. ? |
A? |
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Trauma patient undergoes delayed ORIF FEMUR. Induction consists of suxamethonium, propofol and an ETT. Cephalozin is given and rocuronium Femoral Nerve Block, turned lateral. Suddenly BRADYCARDIC, ETCO2 45, MAP 50mmHg. This is most likely to be ..? A. PE B. Fat embolism C. Anaphylaxis D. LA Toxicity E. ? |
D. LA Toxicity
PE and Fat Embolism should cause decreased ETCO2 Anaphylaxis causes tachycardia |