Finals MCQ-Aug 2012

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Finals Black Bank

Hey Guys,

Question for those sitting the March 2013 exam. In chatting with some of the physicians they manage to get a complete multi-choice paper for their colleagues coming through by instead of everyone randomly sending in the answers they are assigned 1 or 2 questions which they remember word perfect, jot down immediately and then send to someone to collaborate. Even if only 75 people are interested, we would only have to remember 2 questions each and we could post a complete exam for once. Yes I know I don't plan on sitting the exam again either but I certainly have a number of friends who would be most appreciative. I have created an e-mail page and am happy to collate if there is enough interest. Just send me your name and an e-mail to the following address and if we get enough people I will send you your questions the week or so before the exam.

finalexammarch2013@hotmail.com

Contents

Anaesthesia

AA23 0r AA13 Half-life of mast cell tryptase?

A. 1 hour
B. 2 hours

Ans:2 hrs

  • Tryptase peak at 1hr, in vivo half life of 2.5hrs, return to normal levels 12-24hrs.

pt: Best single predictor of difficult intubation in obese patient?

A. Mallampati score
B. Interincisor distance
C. Severe OSA

Rpt: Endocarditis prophylaxis is appropriate in?

A. Unrepaired CHD

Indications are:

  • dental procedures involving breaching integrity of mucosa
  • procedures on respiratory tract involving incision eg adenotonsillectomy
  • diagnostic procedures on GI or GU tract in presence of infection
  • abscesses: brrain, boils and carbuncles, perirectal, epidural, dacrocystitis, pyogenic liver, tooth

Rpt: Best aspiration prophylaxis for urgent surgery?

A. Na Citrate
B. Ranitidine
C. Omeprazole
D. Metoclopramide
E. Cisapride


Rpt: Most common cause of mortality post transfusion?

A. TRALI
B. Contamination/infection
C. Mismatched blood
D. GvHD
E. Anaphylaxis

Ans:TRALI

Rpt: Most common cause of awareness?

A. Failure to check apparatus

Rpt: Apnoeic oxygenation in obese patients is best aided by?

A. Sniffing position
B. Head up tilt
C. Prone
D. Supine
E. Lateral

Ans:B

  • Apnoeic oxygenation requires a patent airway to allow diffusion of oxygen down a concentration gradient to the alveoli.
  • Head up – reduces the decrease in FRC


Rpt: Best renal protection for endoluminal AAA repair?

A. NaCl
B. NAC
  • Answer A. The benefit of isotonic i.v. fluid expansion for the prevention of radiocontrast-induced nephropathy has been clearly demonstrated.
  • Substantial evidence supports the prophylactic use of the antioxidant N-acetylcysteine (NAC), along with intravascular volume expansion, for the prevention of radio-contrast nephropathy. Disappointingly, recent trials in the perioperative and ICU settings have shown a LACK of renal protective benefit of NAC. These trials have been performed in high-risk patients undergoing cardiac surgery, open abdominal aortic aneurysm repair,and abdominal aortic EVAR. CEACCP


Equipment

New: White cylinder with grey shoulder?

A. CO2
B. Air
C. O2
D. N2O
E. N2

New: Photograph of an Arndt endobronchial blocker. Orifice labelled 'X'. What goes in 'X'?

A. Bronchoscope

EZ93 Indicator in sodalime?

A. Ethyl violet
B. Potassium permangenate
C. Blue ?
D. ?
E. ?


Rpt: Desflurane vaporiser heated because:

A. High SVP
B. High boiling point
C. Low SVP
D. High MAC
E. Low MAC
  • Answer A
  • High SVP 
672 mmHg at 20C
Heated to 39C, SVP of 1550 mmHg. This means that desflurane is nearly boiling at room temperature. If administered in a conventional plenum-vaporiser could produce disastrous changes in output with small increases in temperature. If the vaporiser temperature rose above the boiling point a continuous flow of gaseous agent would be produced until all the liquid evaporated, or until the latent heat of vaporisation resulted in the temperature being lowered below the boiling point. The Tec6 overcomes this using a vaporiser with a sump heater so that vapour pressure is raised to around two atmospheres absolute pressure (37C) internally and then dispensed using a system of differential pressure transducers and variable resistance. The vapour can be mixed with fresh gas using a metering valve. The entire vapour pathway is heated to prevent the high partial pressure of the agent (potentially above the saturated vapour pressure at room temperature) from "raining out".
  • Properties: BP 23.5C; Blood:gas coefficient 0.42; Oil gas coefficient 19; MAC 6%;
  • SVP = pressure exerted by the molecules in a vapour at the point of equilibrium with its liquid phase. Dependent on agent and temperature. (mmHg)

• Other agents SVP at 20C: Sevo 157mmHg; isoflurane 238mmHg; enflurane 172mmHg; nitrous oxide 39,000mmHg


Rpt: What is NOT a disadvantage of drawover vaporizer?

A. Basic temperature compensation
B. Basic flow compensation


Rpt: FOB - can see a trifurcation. Where are you?

A. RUL
B. ?


Rpt: A Full Size C oxygen cylinder has pressure downregulated from?

A. 16,000 kPa to 400 kPa
B. 16,000 kPa to 240 kPa
C. 11,000 kPa to 400 kPa
D. 11,000 kPa to 240 kPa


Rpt: Intubating over a bougie. Rotate ETT?

A. 90 degrees anticlockwise


Rpt: Air bubble leads to decreased:

A. Damping coefficient
B. Resonant frequency

Answer B

  • Overdamping (increased D) with air bubble in tubing.
  • Bubble in catheter-transducer system also cause decreased resonant frequency

Medicine

New: At what valve area do you begin to get symptoms, at rest, with mitral stenosis?

A. 1.5 cm2

The challenge of valvular heart disease. Cleveland Clinic Journal Of Medicine, Volume 71, Number 6, June 2004 
When is it time to operate? Mitral stenosis is most commonly caused by damage to the mitral valve from rheumatic fever, after which there typically is a long period of asymptomatic progressive valve narrowing. Symptoms at rest are rare until the mitral valve area is less than 1.5 cm2.


New: With regard to Digoxin toxicity which of the following is NOT a feature?

A. Atrial flutter

Rpt: What is not associated with ulcerative colitis?

A. Psoriasis

Rpt: 75 yo non-valvular AF. Off warfarin. What is his daily risk of stroke?

A. 0.01%

Rpt: ECG - Which does NOT have abnormal Q waves?

A. Digoxin toxicity
B. WPW
C. Anterior MI
D. Previous MI

Rpt: cTnI remains elevated for up to?

A. 5-14 days
  • Answer A

"Temporal profile of protein release in myocardial infarction": generally, in AMI the plasma concentration of troponin begins to increase above the cutoff value by 2–4 h after the onset of symptoms, reaching a peak after 24–48 h; concentrations may remain increased for up to 5–10 days (cTnI) or 5–14 days (cTnT)

Rpt: Inverted P waves in lead II may be caused by?

A. Junctional rhythm

Rpt: Hb 80 g/L with reticulocyte 10%:

A. Hereditary spherocytosis

Rpt: Pulsus paradoxus in constrictive pericarditis:

A. Decreased BP with inspiration
B. Decreased BP with inspiration greater than normal


Surgery

Q106: (New) Cause of visual loss in spinal surgery?

A. Optic ischaemia
B. Compression of eye

Visual disturbances have been quoted to occur in approximately 1 in 2,000 spinal procedures

Ischaemic optic neuropathy (ION) has been reported after a wide variety of surgical procedures, mostly in adults, less often in children, with most cases after cardiothoracic surgery, instrumented spinal fusion operations, head and neck surgery, and nose or sinus surgery. ION is the most frequently cited cause of postoperative visual loss following general anaesthesia.

Anaesthetic risk management with respect to PVL in prone spinal surgery should consider:

  • Positioning of the head in the neutral position.
  • The use of a soft head rest with cut-outs for eyes, nose and the tracheal tube.
  • Avoidance of direct pressure on the eyes.
  • Correction of anaemia (Hb < 80g/L).
  • Avoidance of prolonged arterial hypotension (SAP <90mmHg).
  • Balanced fluid replacement with crystalloids and colloids.
  • Where possible, ensure the patient’s head is level with or slightly higher than the torso.


TMP-Jul10-015 Which type of aortic dissection is typically managed non-operatively?

A. Debakey Type I
B. Debakey Type II
C. Stanford A
D. Stanford B
E. Stanford C

Rpt: SN18 Absolute CI to the sitting position in neurosurgical patient?

A. Patent VA shunt
B. Small PFO

Rpt: When do most patients with SAH rebleed?

A. 0-24 hours

Rpt: Unstable patient. Suspect aortic dissection. Most appropriate investigation?

A. TOE
B. MRI

Rpt: Contraindication to IABP?

A. AR
  • It is contraindicated in patients with aortic regurgitation because it worsens the amount of regurgitation.


Rpt: SG65 Prolonged trendelenberg position results in?

A. Increased myocardial work

Rpt: Scoliosis surgery. Which tract is being monitored with SSEPs?

A. Dorsal column

Rpt: Estimate GCS post head-trauma. E - Response to pain V - Mumbling incoherently M - Withdraws to pain (attempted IV cannulation)

A. 8
B. 9


Unclassified

New: Incidence of headache in first week post-partum?

A. 3-5%
B. 5-15%
C. 15-40%
D. 40-65%
E. 65-85%
  • CEACCP - Postpartum headache: Postpartum headache is described as a complaint of headache and neck or shoulder pain in the first 6 weeks after delivery. It is one of the most common symptoms with up to 39% of parturients experiencing headache in the first postpartum week


New: Oxycodone 20mg SR / Naloxone 20 mcg:

A. Decreased constipation
B. Reduced risk of drug misuse/abuse
  • decreased constipation
  • Reduces but doesn’t eleiminate opioid induced constipation.
  • Can initially provoke withdrawal symptoms or diarrhea in people who are opioid tolerant


New: Bowel surgery patient. Best method for intraoperative optimization of fluid therapy?

A. Arterial pulse pressure contour analysis
B. CVP
C. PAOP
D. UO

arterial pulse pressure contour analysis.

New: In what proportion of people is the AV node supplied by the Right coronary artery?

  • Various sources 85-90%.
  • R main coronary artery & branches supply – RV & RA & part of IV septum, SAN (65%), Bundle of HIS, AVN (80%), conducting system (80%)


New: Less blood wastage if:

A. Lower transfusion threshold

New: How long prior to a spinal anaesthetic should dabigatran be ceased?

A. 7 days
B. 2 days
C. ?

Dabigatran is renally excreted.

  • if Cr clearance > 80, t1/2 is 13 hrs discontinue 24 hrs.
  • if CrCl 50-80, t1/2 is 15 hrs discontinue 24 hrs
  • if CrCl <30 t1/2 27 hrs discontinue for 48hrs
  • if less discontinue for 2-5 days.

Tests after dabigatran are Thrombin time with linear dose response and ECT.


New: Day 4 epidural. On 40 mg SC enoxeparin daily postoperatively (8 pm). When is the most appropriate time to remove the epidural?

A. Day 5 at 12 midday
B. Day 5 at 6 am
C. Day 5 at 6 pm
D. Day 6 at ?
  • DAY 5 midday
  • does anyone have any suggestions
  • ASRA-remove after 12 hrs and delay next dose for 2 hrs.


New: What drug should NOT be used for tocolysis in 32/40 female?

A. Indomethacin
B. Magnesium
C. Nifedipine
D. Salbutamol
  • ?B. Magnesium - Cochrane review on magnesium in preterm labour found an association with increased mortality in the subgroup with high maintenance dose. And metanalysis shows it does NOT work. See: Nanda & Grimes (2006). "Magnesium sulfate tocolysis: Time to quit". Obstetrics and Gynecology 108 (4): 986–989.
  • Indomethacin ->risk of PDA closure.
  • Useful comparative table at [1]


New: Following an eclamptic seizure the dose of MgSO4 is?

A. 1 gram
B. 4 grams
  • The regimen recommended by the Collaborative Eclampsia Trial is 4 to 5g MgSO4 intravenously over 5 min, followed by infusion of 1 g/hr. 

For a second seizure, give a further 2g bolus, and increase infusion to 2g/hr.


New: At what gestation should intraoperative monitoring of the fetus occur?

A. 20/40 weeks.

Intraoperative electronic fetal monitoring may be appropriate when all of the following apply:


  • The fetus is viable.

  • It is physically possible to perform intraoperative electronic fetal monitoring.

  • A health care provider with obstetric surgery privileges is available and willing to intervene during the surgical procedure for fetal indications.

  • When possible, the woman has given informed consent to emergency cesarean delivery.

  • The nature of the planned surgery will allow the safe interruption or alteration of the procedure to provide access to perform emergency delivery.
  • If previable - doppler prior to and after procedure

  • If viable - intraoperative, or pre and post CTG

Australia age of viability -therefore indication for monitoring

  • No resus 23wks
  • Optional 24wks
  • Offered 25wks
  • Mandatory 26wks


New: Trauma patient. CXR (not given): air fluid levels adjacent to heart/diaphragm/ribs.

A. Ruptured diaphragm
B. Hiatus hernia

New: Endocarditis prophylaxis in patient with MVR appropriate for?

A. Dental procedure ?which
B. Rigid bronchoscopy
C. Upper endoscopy with biopsy
D. D&C
E. Lithotripsy.

2007 AHA Endocarditis Prophylaxis


  • All dental procedures that involve manipulation of gingival tissues or periapical region of teeth or perforation of oral mucosa 

  • Procedures on respiratory tract 

  • Procedures on infected skin, skin structures, or musculoskeletal tissue 

  • Antibiotic prophylaxis solely to prevent IE is not recommended for GU or GI tract procedures including vaginal delivery and hysterectomy

  • Note: AN prophylaxis is not recommended for bronchoscopy unless the procedure entails incision of the respiratory mucosa


New: Photograph of TOE transgastric SAX image of LV. Which artery supplies [anterior wall of LV arrowed] region?

A. LAD
B. RCA
C. PDA
D. LCx

SG47 ?15% full thickness burns 6 hrs ago in a child weighing 20kg. How much fluid to give in first hour?

A. ?600 mls

RCH burn fluid guide: 3ml per kg x burn surface area-A 15x20x3=900 ml in 24 hrs. 450 in first 8 hrs ,since 6 hrs are lapsed so 450 ml in 2hrs i.e. in st hr about 250 ml. B-Maintenance fluid-60ml/hr total in 1st hr A+B= 310ML anyone has other calculations? --Gigs 18:36, 14 December 2012 (CST) See SG47 -- is actually a repeat question from long ago. 360ml is answer. --Farnsworth 20:57, 12 September 2014 (CDT)

New: Incarcerated inguinal hernia in a child with a mild URTI. Most appropriate course of action?

A. Postpone for 2 weeks
B. Continue without ETT
C. Continue with careful monitoring
  • Cannot postpone emergency surgery.


New: Congenital prolonged QT syndrome treated with propranolol. How do you confirm an adequate response?HR

A. HR <60 /min
B. Decreased QT interval in response to a valsalva manoeuvre
C. Normal QT interval
  • The dose of beta‐blocker is determined by ensuring a reduction in maximal heart rate on treadmill exercise testing to 130 beats/min or less. Where exercise testing is impractical, there should ideally be no change in the QT interval in response to a Valsalva manoeuvre.


New: Meconium stained liquour but neonate delivered is vigorous. Rationale for NOT suctioning the neonate?

A. May aspirate meconium
B. May cause bradycardia
C. May cause hypertension
  • Bradycardia.
  • ARC guidelines – suctioning in this situation doesn’t improve outcome but my stimulate a vagal response.


New: Patient with subdural hematoma and PPM for ?AV ablation. PPM technician >1 hour away. Surgeon wishes to proceed immediately. Do you?

A. Postpone and await a cardiologist review
B. Postpone and await arrival of PPM technician
C. Postpone and insert a transvenous temporary PM
D. Proceed after institution of transcutaneous pacing=Ans
E. Proceed with a magnet handy.

New: Which of the following does NOT occur following bilateral lung transplant?

A. Impaired mucociliary clearance
B. Impaired lymphatic drainage
C. Impaired HPV

New: Thoracodorsal nerve arises from?post cord of brachial plexus

New: Perform a brachial plexus block however the medial forearm is NOT numb. Which nerve has been missed?

A. Medial brachial cutanous nerve

it shld be medial ante brachial cutaneous nerve

New: Buprenorphine patch taken off. Time taken for plasma concentration to halve?

  • Norspan Patch 'Product Information Sheet' in Australia says: After removal of a Norspan patch, buprenorphine concentrations decline, decreasing approximately 50% in 12 hours (range 10-24h)


New: Incidence of fat embolism following closed femoral fracture?

A. 0-3%
B. 4-7%
C. 8-11%
D. 12-15%
E. 16-19%
  • 1-2% for 1 bone up to 33% for multiple fractures

Fat Embolism - CEACCP 2007


  • Any single long bone 1-3%
  • It has been reported in up to 33% of patients with bilateral femoral fractures



New: Appropriate postoperative maintenance fluid in a child [can't recall situation, but something to do with head injury]:

A. 3% and 1/3 NS
B. 1/2 NS
C. Normal Saline
D. Hartmanns
E. Hartmanns with glucose


New: Which is a specific PDE inhibitor?

A. Theophylline
B. Dipyridimole
C. Milrinone

New: Maximum dose of local infiltration of 0.5% bupivacaine in an x kg child?

A. [dose corresponding to 2.5 mg/kg; there was no option corresponding to 2 mg/kg]
  • In paed surg, we commonly use up to 2.5mg/kg of 0.25% bupivacaine this working out at a MAX dose of 1ml/kg so east to remember. But this is a MAX dose.


New: Loading dose of IV paracetamol in x kg child?

A. ?
B. ?
C. 15mg/kg
D. 20mg/kg
E. 30mg/kg
  • 15mg/kg IV, 20mg/kg PO, 30mg/kg PR.
  • Dose for Neonates <10 kg is 7.5mg/kg with max in a day is 30mg/kg; more than 10kg is 15mg/kg.
  • Cf oral doses: 15mg/kg in children, up to 60mg/kg/day (if outpatient) or up to 90mg/kg/day (if inpatient)


New: Performing a caudal block in a child. What is the first sign of a total spinal anaesthetic?

New: Performing a caudal block in a child and add clonidine to prolong duration of block. What significant complication is increased?

A. Sedation
B. Urinary retention

New: New onset AF. For what period of time is it safe to perform DCCV without prior TOE to exclude thrombus?

A. <24 hours
B. <48 hours
C. <36 hours
D. <48 hours
E. <72 hours
  • The current treatment guidelines suggest it is permissible to cardiovert patients without continued anticoagulation in those for whom it is known that the duration of AF is <48 hours


New: Regarding remifentanil. All of the following are true EXCEPT:

A. Metabolized by plasma cholinesterase
B. High potency
C. Muscle rigidity in high doses
D. Weakly active metabolite
E. Short context-sensitive half time
  • "Unlike other synthetic opioids which are hepatically metabolized, remifentanil has an ester linkage which undergoes rapid hydrolysis by non-specific tissue and plasma esterases. This means that accumulation does not occur with remifentanil and its context-sensitive half-life remains at 4 minutes after a 4-hour infusion."

Remifentanil is metabolized to a compound (remifentanil acid) which has 1/4600th the potency of the parent compound.[12]

New: Off-label use of a drug refers to all of the following EXCEPT:

A. Different age-group
B. Different indication
C. Different concentration
D. Different route of administration
            Answer C. "‘Off-label’ prescribing occurs when a drug is prescribed for an indication, a route of administration, or a patient group that is not included in the approved product information document for that drug.” Day 2013 "Off-label prescribing" Australian Prescriber.--Farnsworth 09:24, 8 June 2014 (CDT)


New: Regarding mixed venous oxygen saturations:

A. 60% is normal
B. Can be used to calculate the CO

New: Cerebral oximetry measures?

A. Arterial saturation
B. Mostly arterial saturation and some venous saturation
C. Capillary saturation
D. Mostly venous saturation and some arterial saturation
E. Venous saturation
  • Cerebral oximetry differs from pulse oximetry in that tissue sampling represents primarily (70-75%) venous, and less (20-25%) arterial blood


New: Normal systolic BP at birth?

A. Something less than 70 mmHg
B. 70 mmHg
C. 85 mmHg
D. Something more than 85 mmHg
E. 115 mmHg
  • 70-80mmhg :OHA
  • NETS Victoria Neonatal Handbook: 75mmHg

Rpt: Epidural block to T2 causes all of the following EXCEPT:

A. Bradycardia
B. Vasodilatation
C. Reduced circulating catecholamines
D. Dyspnoea
E. Elevated PaCO2

Rpt: Preoperative autologous blood donation results in less:

A. Cost
B. Incompatible transfusion
C. Less blood wastage
D. Less unnecessary transfusion

Rpt: Penetrating injury to chest. What part of the heart most likely injured?

A. RV
B. LV
C. RCA

RV from EMST

Rpt: TMP-Jul10-056 Regarding a Thallium scan:

A. High NPV
B. Less useful in comparison to a DSE

Rpt: What is NOT a contraindication to MRI?

A. Pulmonary artery catheter
B. Arterial line
C. Scissors
D. Coiled ECG cable
E. Laryngoscope

Rpt: Skin between iliac crest and greater trochanter supplied by?

A. Subcostal nerve

Rpt: Regarding pyloric stenosis:

A. More common in females
B. Occurs most commonly in [some incorrect age group]
C. Acidic urine
D. Cause of hypokalemia is vomiting

Rpt: In comparison to Mallampati test, the TMD is:

A. Less sensitive, more specific

Rpt: Systematic review. What is NOT a weakness?

A. Systematic review author bias
B. Publication bias
C. Duplicate publication
D. Heterogeneity
E. Inclusion of historic studies

Rpt: Traumatic liver laceration. Conservative management is indicated if?

A. Haemodynamically stable

Rpt: Initial dose of IV GTN to relax the uterus is?

A. 5 mcg
B. 50 mcg
C. 200 mcg

Rpt: Dilated CM (LVEF 30%). No dyspnoea with ADLs. Best management?

A. Start ACEI
B. Stop beta-blocker

Rpt: CTG [pictured] demonstrating late decelerations. Most likely cause?

A. Fetal asphyxia
B. Head compression
C. Cord compression
D. Uteroplacental insufficiency
  • Ans A.
  • Early decelerations appear to be caused by vagal discharge produced when the head is compressed by uterine contractions. The onset and depth of early decelerations mirror the shape of the contraction, and tend to be proportional to the strength of the contraction.
  • Late decelerations occur when a fall in the level of oxygen in the fetal blood triggers chemoreceptors in the fetus to cause reflex constriction of blood vessels in non-vital peripheral areas in order to divert more blood flow to vital organs such as the adrenal glands, heart, and brain. Constriction of peripheral blood vessels causes hypertension that stimulates a baroreceptor mediated vagal response which slows the heart rate. The time consumed in this two-step process accounts for the delay in the timing of the deceleration relative to the contraction


Rpt: C6/7 muscle movements:

A. Wrist flexion and extension

Rpt: Paraesthesia in little finger during supraclavicular block. Likely contacting?

A. Medial cord

? lower trunk in supraclavicular region. Rpt: Sensitivity 90% and Specificity 99%.

A. False positive rate 1%

Rpt: SVRI.

A. SVR x BSA
B. SVR / BSA

Rpt: PP22 Features of Pierre-Robin syndrome include cleft palate, micrognathia, and?

A. Glossoptosis
B. Microstomia

Rpt: (See PI56)Ratio of MAC incision to MAC awake for sevoflurane?

A. 0.34

Rpt: Essential feature of LBBB includes?

A. Loss of QW's in V5-6
B. RSR in V1
C. Deep SW in V6
D. QRS duration > 0.2 secs

A. Rpt: Best indicator of opioid induced respiratory depression?

A. Sedation score
B. RR
C. SpO2
D. HR

Rpt: Intraoperative pediatric arrest during scoliosis surgery most likely due to?

A. Underappreciated degree of blood loss

Rpt: RCD installed. Electricity mains remains on. Touch neutral and ground.

A. Nothing will happen

Rpt: TMP-Jul10-043 Severe asthma attack. Given continuous nebs & IV hydrocortisone but not responding. PaCO2 low. SpO2 low. Next appropriate treatment?

A. IV Magnesium
B. IV Aminophylline
C. Heliox
D. IV salbutamol infusion
E. Intubate/ventilate


Rpt: ASD murmur is due to flow through which valve?

A. Pulmonary valve

Rpt: Best position for IABP is 1-2 cm:

A. Distal to Left SCA
B. Proximal to Left SCA
C. Distal to artery of Adamkiewicz
D. Distal to renal artery
E. Proximal to renal artery
  • Answer A. The Carina as a Useful Radiographic Landmark for Positioning the Intraaortic Balloon Pump. Anaesthesia & Analgesia. 105(3) 2007: 
"Ideally, the tip of the balloon should be positioned 2-3 cm distal to the origin of the left subclavian artery (LSCA)"


Rpt: Blood flow across which valve is used to estimate PASP during echocardiography examination?

A. Tricuspid valve
B. Pulmonary valve
C. Mitral valve
  • Answer A. TV
  • Systolic PAP - Tricuspid valve
  • Mean / Diastolic PAP - Pulmonary valve
  • Some TR is required, the velocity of the jet gives a pressure differential across the TR via modified bernouilli equation.

  • The RV and PA pressures then are this pressure plus your estimate of RAP.


Rpt: Cephalothin spectrum of activity does NOT cover?

A.
B.
C.
D.
E. Pseudomonas

Answer E.

First generation cephalosporins cover:
  • G+ staph and strep but not Coag neg Staph, MRSA, Enterococci;
  • G- E.coli
  • Klebsiella
  • Proteus mirabilis
  • Most anaerobes except B. fragilis


Rpt: With regard to CHADS2 score. All EXCEPT?

A. Gender

Rpt: 60kg female given 50mg rocuronium. Dose of sugammadex to reverse?

A. 240 mg
B. 800 mg
C. 960 mg
D. ?
  • Reversal of shallow neuromuscular = 2 mg/kg 

  • Reversal of profound neuromuscular blockade = 4 mg/kg
  • Immediate reversal of neuromuscular blockade = 16 mg/kg ->960mg in 60kg person


Rpt: Serum c/Ca++ 2.05 mmol/L in CKD patient. Most likely cause?

A. Secondary hyperparathyroidism

Rpt: Post CEA seizure. In order to prevent further seizures?

A. Add/start antihypertensive
B. Start anticonvulsant

Rpt: According to ANZCA-endorsed labelling standards a brachial plexus catheter should be labelled?

A. Red
B. Blue
C. Beige
D. Yellow

E. Pink

  • National Recommendations for User-applied Labelling of Injectable Medicines,
Fluids and Lines
Intra-arterial = Red 

Intravenous = Blue 

Epidural/Intrathecal/Regional = Yellow

Subcutaneous = Beige 

Other routes = Pink

Rpt: ME47 Conn's syndrome?

A. Normoglycemia, hypernatraemia, hypokalaemia
B. Hypoglycaemia, hypernatraemia, hypokalaemia
C. Hyperglycaemia, hyponatraemia, hyperkalaemia
D. Normoglycaemia, hyponatraemia, hyperkalaemia
E. Hypoglycaemia, hyponatraemia, hyperkalaemia
  • Conn Syndrome is an aldosterone-producing adenoma (->primary hyperaldosteronism). Most commonly it causes hypokalaemia and metablic alkalosis. Hypernatraemia is less common. Most patients don't have much by way of symptoms, though they are commonly hypertensive. Aldosteronew acts on principal cells in the late DCT and medullary collecting duct to cause increased Na reabsorption and increased K+ loss. Glucose levels are not affected. Renin levels are suppressed. See [2] & [3]


Rpt: Area burnt? (1/2 upper limb + anterior abdomen + whole lower limb)

A. 32%

Rpt: Dural Sac ends at what level in a neonate?

A. L1
B. L3
C. L5
D. S1
E. S3

Rpt: SpO2 90%. No IV access. Place LMA and laryngospasm. Most appropriate course of action?

A. Increase inhaled sevoflurane concentration with LMA in situ
B. Increase inhaled sevoflurane concentration after removing LMA
C. Intra-lingual suxamethonium (no dose stated)
D. Intramuscular suxamethonium (no dose stated)
E. Intramuscular atropine (no dose stated)

Rpt: Clopidogrel half-life?

A. 6 hrs
B. 14hrs
C. 24 hrs
  • D. 7 days
  • Answer A. After a single, oral dose of 75 mg, clopidogrel has a half-life of approximately 6 hours. The half-life of the active metabolite is about 30 minutes.


Rpt: Which of the following is not a MAJOR complication following mediastinoscopy?

A. Air embolism
B. Cardiac laceration
C. PTX
D. Tracheal compression

Rpt: What sign most suggests a significant murmur in a child?

A. 4/6 loudness
B. ????vibratory/flutter sound

Rpt: Thermoneutral zone in 1 month old child?

A. 26-28 degr C
B. 29-31 degr C
C. 32-34 degr C

Rpt: Indicative of severe AS?

A. Palpitations
B. Fatigue
C. PND
D. Angina
E. Syncope

Rpt: Risk factor for PPH?

A. Prolonged labour
B. Age <20 yrs old
C. Primiparity
D. FV Leiden Deficiency (yes it said deficiency!)
E. Oligohydramnios

Rpt: Muscle observed when monitoring the NMJ and stimulating ulner nerve?

A. Adductor pollicis
B. Abductor pollicis brevis
C. Flexor pollicis brevis

Rpt: Fat:blood coefficients?

A. N2O~Des > Sevo > Iso
B. N2O > Des > Sevo~Iso

Rpt: Routine SV GA under LMA in an 18 month old child. Sudden onset of SVT with HR 220/min, BP 86/40; PETCO22 32 mmHg; SpO2 98%^. Most appropriate course of action is:

A. Adenosine 100 mcg/kg
B. DCR 2J/kg
C. DCR 4j/kg
D. Amiodarone 5mg/kg
E. CPR
  • Adenosine rapid with flush


Rpt: Clinically the most significant murmur in pregnancy is?

A. MS

Rpt: Required for diagnosis of NMS?

A. Muscle rigidity
B. Elevated CK

Rpt: Hyponatremic child intubated/ventilated in ICU following seizure. Treatment?

A. Hypertonic saline (no dose/infusion rate given)

Rpt: Weakness of proximal and distal muscles following an URTI 10/7 ago. No sensory involvement. T 37.8 degr C. Most likely diagnosis?

A. Guillain-Barre

Rpt: Post-operative develops severe CP and ST elevation in PACU. Most appropriate initial treatment?

A. ASA
B. beta-blocker
C. IV heparin infusion

ASA? Rpt: Circuit disconnect during spontaneous breathing may be detected by?

A. An unexpected drop in ETagent

Rpt: Time-constant?

A. RxC

Rpt: Neonate - main resistance in circle is due to?

A. ETT

Rpt: Iron deficiency anaemia:

A. Low ferritin, low serum iron
B. Low ferritin, low TIBC
C. Elevated ferritin, low marrow iron
D. Elevated ferritin, ?
E. Elevated ferritin, ?

Rpt: Long-standing T6 paraplegia. Which is INCORRECT?

A. Flaccid paralysis
B. Poikilothermia
C. Labile BP

Rpt: Lap chole on citalopram. What is NOT relatively contraindicated?

A. Omeprazole
B. Clonidine
C. Pethidine
D. Tramadol
E. ?Midazolam

Cldnt find any interaction with midazolam and clonidine

Rpt: Most effective treatment for post-sevoflurane agitation following grommets in a 4yo child?

A. 1 mg/kg propofol
B. 1 mcg/kg fentanyl
C. 1 mcg/kg clonidine
D. ?dose midazolam
E. Sucrose

Rpt: What is NOT useful in the treatment of Torsades?

A. Isoprenaline
B. Procainamide
C. DCCV
D. Electrical pacing

(Amiodarone was not an option)

Rpt: MS and tachyarrhythmia; hypotension?

A. DCCV

Rpt: Little space between epiglottis and posterior pharyngeal wall. Modified C&L classification?

A. IIIa

2 similar Rpts involving: Numb tongue and impaired taste sensation post LMA anaesthesia.

A. Facial Nerve
B. Mandibular division of CNV
C. Lingual Nerve

Rpt: Lateral approach to popliteal block.

A. Passes through semimembranosis
B. May be performed supine or prone
C. Adequate for ankle surgery
D. Less effective in comparison to posterior approach
E. Eversion is an endpoint for nerve stimulation

Rpt: Risk factors for postoperative ulnar nerve injury?

A. Contralateral arm

Rpt July 2007 Q35: In a rotameter the:

A. Bobbin ....

Rpt: SAH. Hyponatremia. Elevated urinary Na concentration. Most likely cause?

A. CSW
B. SIADH

(neither the FENa nor the patient's volume status were described in the question)

Rpt: Question about the ciliary ganglion.

Rpt: Urgent reversal of INR 4.5. Intern already gave vitamin K.

A. FFP
B. Prothrombinex
C. Prothrombinex AND FFP

Rpt: Major cause of death following difficult intubation with perforated oesophagus?

A. Sepsis
B. Failure to intubate
C. Failure to ventilate

The following Questions I can't remember for certain were on the exam

Rpt: Labour epidurals may cause maternal fever. This leads to:

A. Increased investigations for neonatal sepsis

Rpt: ASA grading was introduced in order to:

A. Predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardize description of physical status
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk
  • Answer C. The ASA physical status classification system is a system for assessing the fitness of patients before surgery. Neither the type of anesthesia nor the location of the procedure/operation is considered. See also [4]

Rpt: I can't recollect the Question, but the options included, increased:

A. Glucagon
B. ACTH/cortisol
C. GH

Rpt: Lignocaine vs bupivacaine potency:

A. Four times

Rpt: Best agent to decrease both gastric volume and gastric acidity?

A. Omeprazole
B. Ranitidine
C. Metoclopramide
D. Cisapride
E. Sodium citrate

PPI (such as omeprazole) increase gastric pH and reduce gastric volume but required to be given 12hrs in advance. Sodium citrate increase pH & increases gastric volume. H2 receptor antagonists reduce gastric volume and increase pH if given 1-2hrs in advance. (Remember "acidity" decreases as pH increases).


Rpt: Cholecystectomy.

A. Most likely to get gas embolism at initial CO2 insufflation

Rpt: Diastolic dysfunction is NOT caused by?

A. Adrenaline
B. Constrictive pericarditis
  • Answer A.
Any condition or process that leads to stiffening of the left ventricle can lead to diastolic dysfunction. Causes of left ventricular stiffening include:
-A long standing hypertension, where - as a result of left ventricular muscle hypertrophy to deal with the high pressure - the left ventricle has become, stiff)
-Aortic stenosis of any cause: the ventricular muscle becomes hypertrophied and thence stiff as a result of the increased pressure load placed on it by the stenosis)
-Diabetes
-Age - elderly patients mainly if they have hypertension.
  • Causes of isolated right ventricular diastolic failure are uncommon. These causes include:
- Constrictive pericarditis
- Restrictive cardiomyopathy, which includes Amyloidosis (most common restrictive), Sarcoidosis and fibrosis.
- Adrenaline increases systolic blood pressure (beta-1 action) with slight decrease in diastolic blood pressure (beta2 -> vasodilation).


Rpt: Amniotic fluid embolism. Early cause of death?

A. Pulmonary HTN
B. Malignant arrhythmia
C. Pulmonary oedema
D. Hypovolaemic shock
  • Answer A
  • Phase 1: Amniotic fluid and fetal cells enter the maternal circulation resulting in the release of biochemical mediators which cause pulmonary artery vasospasm followed by pulmonary hypertension. This results in elevated right ventricular pressures and right ventricular dysfunction, which will lead to hypoxaemia and hypotension with associated myocardial and capillary damage. Phase 1 may last up to 30 min.
  • Phase 2: This occurs in patients who survive the initial insult. Left ventricular failure and pulmonary oedema occur. Biochemical mediators trigger DIC leading to massive haemorrhage and uterine atony.

Rpt: Nerve block anterior 2/3rds of ear?

A. Auriculotemporal nerve.

Rpt: Fixed, dilated pupil in trauma patient?

A. Transtentorial herniation


Rpt: Central anticholinergic syndrome, INCORRECT statement?

A. Will improve with neostigmine
B. Peripheral anti-cholinergic symptoms
C. Caused by anti-Parkinson drugs
D. CNS depression
E. Associated with agitation, delirium & ..?..


Rpt: MH diagnosis?

A. Muscle rigidity


Another collection of stems emailed to me

ANZCA MCQ 2012 August

1) Indication for IE prophylaxis in pt with CHD:

a) Gastroscopy with biopsy
b) Dental with RCT
C) D&C

2) Repeat: Indication for IE pro - Uncorrected CHD

3) Half life of Clopidogrel - 6 hrs

4) TRALI

5) CHADS2

6) Nerve block cathetre colour code

7) Penetrating injury of chest - RV

8) Meconium stain liquor - Suction Trachea

9) Time constant - RXC

10) Dura in child ends at -S3

11) GCS calculation

12) Pirrer robins syndrome

13) Adductor pollisic

14) Post endaretrectomy with seziure -Add antiHT

15) Severity of AS - pnd

16) Neonate Loss of heat - Radiation

17) Circuit disconnection -End tidal agent

18) FAT: BLOOD

19) Mallampatti vs Thyromental

20)Thallium role in prediction of perioerative MI

21) PPH - Prolonged labour

22) ( ME 47)Features of Conn synd

23) ( ez 94)Handyman with neutral and ground - Nothing will happen

24)( ru12) Paraesthesia in little finger - Lower trunk

IC97 Bleeding in trauma - Tranexamic acid

26) Optimal dose of GTN - 50 MCG

27) Sever MS with tachy and hypo - DC shock

28) MAC Awake : MAC Sevo - 0.34

29) PCA monitoring - Secation score

30) 50 mg Rocuronium - Reversal with 960 mg Suggamadex

31) Post hyponatremia sezuire in child - Hypertonic Saline

32) ( EZ79) Circuit resistance in neonate -ETT

33) PA pressure across which valve in ECHO - Tricuspid

34) Monitoring in Preg beat to beat variablit - 24 wks

35) SE of cyclosporin - Alopecia

36) ( q 122) Diagnosis of NMS - Diaphorosis

37) Cepahlothin not efffective against - Pseudomonas

38) Dialated cardiomyopathy with no symp -ACE inhibitors

39) Child with WPW syndrome with intraop tachy , drug of choice - Amiodarone

40) Haemophilia A patient will have - Nml PT and Abnml aPTT

41) Cause of hypoxia in OLV - Blood flow to upper lung

41) Compairing New instrument of BP measurement with gold std - choice of test

42) Air bubble in IA line - decreased RF

43) LBBB in ECG features

44) Tip of IABP - 2 CM distal to lt subclavian

45) 70 yrs post hip with crusing chest pain - aspirin

46) Feature of long standing cord paralysis all except - paraplegia

47) SVRI - SVR X BSA

48) ( AT 27) Left sided pneumonectomy , for chest drain -

49) ETT over bougie - rotate anticlockwise

50) SSEP monitors - Dorsal column

51) Death in esophageal perforation - Sepsis

52) Role of C6-7 - Wrist flexion and extension

53) Modified CM score for laryngoscopy - 3a

54) Iron deficinecy - Low ferretin , Increased TIBC

55) Popliteal by lateral approach - Foot eversion

56) ( EZ93) Chemical for sodalime change - Ethyl Voilet

57) Pathological Murmur in child - 4/6

58) FOB see trifurcation - RT UL

59) Consent/ Ethics question

60) Not a disadv of flow over vaporiser -

61) All need reduced dose in renal failure except -Bupernorphine

62) Post induction larungospasm in child - Increase sevo and remove LMA

63) Investigation of choice in dissection of aorta in hemodynamic unstable adult - Aortogram

64) Peak incidence of vasospam post SAH -

65) Risk of stroke in pt with AF per day - 0.01 %

66) Absent q wave feature of all except - Digitalis toxicity

67) Sever asthma with all treatment given - Magnesium

68) Most cause of awareness -

69) Post cervical spine op distress in recovery - inhalation innduction

70) Most effective way to reduce renal failure in AAA surgery - Minimize cross clamp time

71) CO2 is used in pneumoperitoneum - less effect if venous air emboism

72) Malignant hyperthermia most common sign - Tacy

73) Best indicator for trauma resus - Lactate

74) ASD murmur across - Pulmonary valve

75) Method to improve aponic oxygenation - Head up

76) Finding against AFE -

77) Nerve injury following LMA with loss of sensation in ant 2/3rd - Branch of Mandibular nerve

78) Loss of taste and sensation in ant 2/3 - Lingual / Corda tympani

79) Mode of monitoring in neuro surgery - PTC

80) Termoneutral zone in 1 mth old neonate -

81) Supply of carotid sinus - Glossopharyngeal nerve

82) Weakness of systemic reivew all except -

83) All used to prolong preg except - Indomethacin

84) Absolute C/I for sitting position surgery - Small PFO vs/ Shunt

85) Drug must be given based on IBW -

86) Supply of skin between greater trochanter and _ : subcostal

87) Thraco dorsal is branch of posterior cord

88) Pt on diabigatram for AF coming surgery after 10 day , most appropriate thing to do -

89) Conservative mgtm in aortic dissection - Stanford B

90) Low serum sodium with high urinnary sodium -


91) Plasma glu vs Blood glu

92) First sign of total spinal in neonate

93) Arndt blocker ( Pic)

94) RCA supply AV node in how many persantage of population

94) Artery suppling anterion papillary muscle ( Pic)

95) CTG corresponds to - ( pic)

96) Best agent to decrease the gastric volume - H2 blocker

97) Exact loading dose of iv paracetamol -

98) Percentage of women get post partal headche -

99) Histamine causes all except - Myocardial depression

100) All can cause injury during MRI except - IA line

101) SE 99, SP 90 - FP 1

102) Effect of trendelenburg - increased myocardial work

103) Pyloric stenosis kid can present with - Acidification of urine

104) 12 yrs old had eaten and trauma - RSI with ETTT

105) Maintenance Fluid of choice for child on ventilator in ICU with closed head injury

106) Most common cause of post op visual loss - ION

107) ( MZ Q96 AUG 08) Feauture of AS all except - Anemia > 85%

108) ( NH Q 139 AUG 08) Ciliary ganglion - parasympathetic fibre from EW nucleus

109) Thoracic epidural helps with all except - circulating catecholamine levels

110) Witnessed VF - Defib

111) Motor cyclist RTA with chest Xray suggestive of gas with fluid level in Left thorax - Rupture diaphragm

112) Best inndicator for difficult intubation in obesity - increased soft tissue in suprathyroid region

113) Low venous oxygen does not affect?

114) 40 mg Oxycodone + 20 mg Naloxone combined tabalet, useful for-

115) ?? about what would exclude a child from MH

116) Larger area of back to be resected in 25 kg child surgeon wants to use 0.5% bupivacaine - volume allowed?

117) COX inhibitor ?

118) Absolute CI for ECT - Increased ICP VS Resent MI

119) Complication of Mediastinoscopy all except - Cardiac laceration

120) Entropy with difference in SE and RE -

121) Rotameter with circular bobbin - pressure drop across in constant

122) Lung transplant preserved function - HPV

123) Percentage area of Burns in Half of upper arm, full lower leg and ant abdominal wall - 32

124) PONV??

125) Pressure range allowed for type c cylinder - Different range

126) Cylinder with grey shoulder and white body - Air/ Co2/ N2o/Nitrous

127) True about remifenatly all except -

128) ? GABA

129) ( Aug 2005)Caused of inverted P wave in lead 2 includes all except -

130) All associated with Ulcerative colitis except - Psoriasis

131) Muscles which separate vocal cords - Post cycricaretyenoids ???

132) Constant sparing of medial aspect of fore arm sensation following brachial plexus block is indicative of sparing of -

133) 20 kg child suffered 15% burns 6 hrs after amt of fluid to be given?

134) When will palsma bupernorphine level ll fall to half after discontinuation of cutaneous patch?

135) Time till cardiovesion can be comfortably done after new onset AF without ECHO- 24, 48, 72 hrs

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