Finals MCQ-Aug 2013

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Finals Black Bank | Finals MCQs-Mar 2014 | Mar13 | Aug12 | Mar12 | Sep11 | Mar11 | Aug10 | Mar10 | Aug09 | Apr09 | Aug08 | Apr08 | Jul07 | Mar07

Please post MCQs below.


I am trying to organize people to remember 2 questions each of the coming exam to repeat what was achieved last time. There is an email website: [email protected] with the password Mcqpaper2014. If you want to put your name down for 2 questions go into that email account, open the last received email then resend the spreadsheet with your updated details. Each subsequent person should use the latest spreadsheet sent. This system should allow people to check themselves before the exam which questions they have been allocated and reduce the organizational workload. After the exam please send your questions to the same email address IMMEDIATELY to reduce the lost recall rate. I will then collate for the wiki site.

1. You are called to see a 30 year old man with rapidly deteriorating asthma. Following appropriate medical management an endotracheal tube is inserted and he is ventilated with a mechanical ventilator with a tidal volume of 600ml and a rate of 12 breaths per minute. Five minutes later the blood pressure is unrecordable and external cardiac massage is commenced. Arterial blood is taked and shows ph 7.08, pCO2 96 mmHg, pO2 36 mmHg, SpO2 46% and bicarbonate 27 mmol/L. He is administered adrenaline, salbutamol, pancuronium, bicarbonate and calcium gluconate. The ECG shows sinus rhythm at a rate of 60 beats per minute. The patient remains pulseless and cyanosed with fixed dilated pupils and distended neck veins. The most appropriate management is to

A. cease resuscitation
B. administer further adrenaline
C. insert bilateral intercostal drains
D. cease ventilation for 30 seconds and resume at a slower rate
E. increase peak inspiratory pressure

2. A patient known to have porphyria is inadvertently administered thiopentone on induction of anaesthesia. In recovery the patient complains of abdominal pain prior to having a seizur and losing consciousness. Which drug should NOT be given

A. Pethidine
B. Diazepam
C. Haematin
D. Suxamethonium
E. Pregabalin

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?

A. 24cm
B. 26cm
C. 28cm
D. 30cm
E. 32cm

4. What is the most effective method of minimizing acute kidney injury following an elective open abdominal aortic aneurysm repair?

A. give IV crystalloid as a ‘preload’ before cross-clamp
B. give IV mannitol before cross-clamp
C. give IV frusemide before cross-clamp
D. give preoperative N-acetylcysteine
E. minimize aortic cross-clamp time

5. [New] Features of severe pre-eclampsia include:

A. Foetal growth retardation
B. Peripheral oedema
C. Systolic BP more than 160
D. Thrombocytopenia
E. Severe proteinuria

6. [Repeat] Earliest sign of a high block in a neonate post awake caudal:

A. Increased HR
B. Increased BP
C. Reduced HR
D. Desaturation
E. Loss of consciousness

7. TMP-Jul10-044 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?

A. Awake Fibreoptic Intubation
B. CT scan for laryngeal fractures
C. Direct laryngoscopy after topicalising with local anaesthetic
D. Nasopharyngoscopy by an ENT surgeon
E. Soft tissue xray of the neck

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:

A. Early mitral inflow > inflow during atrial systole
B. Inferior wall hypokinesis
C. Severe MR
D. TR and RV dilatation
E. LV cavity obliteration at the end of systole

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

12. What is the test is decreased in Iron deficiency anaemia?

A. microcytosis
B. serum feritin
C. serum iron
D. transferin
E. total iron binding capacity

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

14. MRI Telsa 3, least likely to cause harm

A. Cochlear implant
B. mechanical heart valve
C. Implanted intrathecal pump
D. Recently placed aortic stent
E. shrapnel fragment

15-What happens when you place a magnet over a biventricular internal cardiac defibrillator

A. Switch to asynchronous pacing
B. Damage the internal programming
C. Nothing
D. Switch off antitachycardia function
E. Switch of rate responsiveness

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

A. facial, trigeminal, glossopharyngeal
B. facial, trigeminal, vagus
C. glossopharyngeal, trigeminal, vagus
D. trigeminal, glossopharyngeal, vagus
E. trigeminal, vagus, glossopharyngeal

19 Electrocardiogram in the Cs5 configuration. What are you looking at when monitoring lead I.

A. anterior ischaemia
B. atrial
C. inferior
D. lateral
E. septal

20 Lowest extension of thoracic paravertebral space

A. t10
B. t12
C. l2
D. l4
E. s1

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?

A. 2.4L N/S
B. 3.6L N/S
C. 3.6L Hartmann's
D. 4.8L N/S
E. 4.8L CSL

22 In regards to systemic sclerosis, what is the least likely cardiac manifestation?

A. accelerated coronary artery disease
B. atrioventricular conduction block
C. myocarditis
D. pericardial effusion
E. valvular regurgitation

23 (repeat) The reason that desflurane requires a heated vapour chamber can be best explained by its:

A. Low saturated vapour pressureb) High saturated vapour pressurec) High boiling point
B. ?
C. ?
D. Low molecular weight
E. Very low solubility

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:

A. Lumbosacral trunk
B. Lateral cutaneous nerve of the thigh
C. Pudendal nerve
D. L2/3 Nerve root
E. Sciatic nerve

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

A. 1
B. 2
C. 3a
D. 3b
E. 4

26. [AC108] 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

A. administer glyceryl trinitrate
B. administer esmolol
C. administer labetalol
D. administer sodium nitroprusside
E. deepen anaesthesia with isoflurane

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

A. 400mL
B. 500mL
C. 600mL
D. 700mL
E. 800mL

28. An adult male preoperatively complains of pain similar to his angina. Initial treatment is all below except:

A. Aspirin
B. heparin
C. morphine
D. nitrates
E. oxygen

29. What cannot be used for tocolysis in a 34/40 pregnant woman:

A. Clonidine
B. Indomethacin
C. Magnesium
D. Salbutamol
E. Nifedipine

30. Pringles procedure for life threatening liver haemorrhage includes clamping of:

A. Hepatic artery
B. Hepatic vein
C. Portal pedicle
D. Aorta
E. Splenic Artery

31. Your patient has smoked cannabis prior to arrival in the OT. Pt taking cannabis might lead to:

A. Intraoperative Bradycardia
B. Decreased anaesthetic requirement
C. Increased nausea and vomiting
D. Increased risk of awareness
E. Decreased BIS reliability

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:

A. Aortography
B. CT Chest

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

A. Cease warfarin and commence dabigatran
B. Cease warfarin and commence Enoxaparin
C. Cease warfarin and recommence post procedure
D. cease warfarin and commence heparin
E. Continue warfarin

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:

A. Coagulation studies
B. CSF microscopy and culture
C. CT Head
D. MRI Head
E. MRI Spine

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?

A. adenosine
B. amiodarone
C. DC cardioversion
E. metaraminol

37. The electrical requirement that distinguishes a "cardiac protected area" from a "body protected area" is the

A. isolation transformer
B. line isolation monitor
C. equipment has a maximum leakage current of 500 microamperes
D. residual current device
E. equipotentiality

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

37. The features that distinguish a “cardiac protected” from a “body protected” area is:

A. Equipotential earth
B. Isolating transformer
C. Line isolation monitor
D. Maximum patient leakage of <500microamperes
E. Residual current device

38. A 30 year old woman is admitted to ICU after a 500mg/kg aspirin overdose. What is the most effective therapy to enhance her elimination of the aspirin?

A. Frusemide
B. Haemodialysis
C. Mannitol
D. 0.9% sodium chloride
E. Sodium bicarbonate

39. Most cephalic interspace in neonate to perform spinal while minimising the possibility of spinal cord puncture

A. L1-L2
B. L2-L3
C. L3-L4
D. L4-L5
E. L5-S1

39. Most cephalad interspace to safely perform spinal anaesthesia in a neonate without damaging the spinal cord

A. L1-L2
B. L2-L3
C. L3-L4
D. L4-L5
E. L5-S1

40. 6 week old baby is booked for elective right inguinal hernia repair. An appropriate fasting time is

A. 2 hours for breast milk
B. 4 hours for formula
C. 5 hours for breast milk or formula
D. 6 hours for solids
E. 8 hours for solids, 4 hours for all fluids.

41. For a nurse monitoring an opioid PCA, the earliest sign of respiratory depression is;

A. Number of boluses of PCA per hour
B. Respiratory rate
C. Oxygen saturation
D. Sedation score
E. Pupil size

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

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.

42. A reduction in DLCO can be caused by;

A. Asthma
C. Left to right shunt
D. Pulmonary haemorrhage
E. Bronchitis

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:

A. inject 5 mL of saline, and if you can no longer aspirate blood, leave in place and use
B. inject 5 mL lignocaine 2% with adrenaline. If there is no rise in HR be happy that it is not intravascular and secure in place and use
C. Remove and postpone surgery for 24 hours
D. Remove and place epidural 1 level higher
E. Remove and postpone surgery for 4 hours

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:

A. rocuronium
B. suxamethonium
C. pancuronium
D. atracurium
E. cisatracurium

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?

A. Factor VII
B. Cryoprecipitate
D. Prothrombinex
E. FFP + prothrombinex

46 Regarding endotracheal tubes used in laser surgery:

A. They are more resistant to combustion when the cuff is covered in blood
B. Resistant to ignition from electrocautery
C. The cuff is resistant to ignition if hit by the laser
D. Have an external diameter which is larger than a normal PVC endotracheal tube (compared to the internal diamater)
E. Have 2 cuffs which are resistant to combustion

49 Elderly lady post operatively with painful eye. Differential between narrow angle glaucoma and corneal abrasion

A.  ?
E. Relieved by topical local anaesthetic

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

A. Carbimazole
B. Beta-blocker
C. Propythiouracil
D. Plasmaphoresis
E. Hydrocortisone

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?

A. parasthesia in little finger
B. parasthesia in the distribution of the interscalene nerve
C. weakness in adductor digiti minimi
D. weakness in abductor pollicis brevis
E. weakness in lateral interosseus

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

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:

A. Cellular anaerobic metabolism
B: Capillary vasodilation
C: Increased cardiac output
D: Increased tissue oxygen extraction
E: Rightwards shift of the Oxygen – Haemoglobin dissociation curve

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

59. What is approximately the systolic blood pressure in an awake neonate (mmHg)

A. 55
B. 70
C. 85
D. 100
E. 115

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

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:

A: Increased LV wall thickness, abnormal septal wall motion, TR, RA dilation B: Increased RV:LV area, abnormal septal wall motion, increased LV wall thickness, RA dilation C: Increased RV:LV area, abnormal septal wall motion, TR, RA dilation D: Increased RV:LV area, abnormal septal wall motion, TR, PR E: Increased RV:LV area, TR, PR, RA dilation

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

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

A. 3
B. 4
C. 8
D. 25
E. 33

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

69. During apnoeic oxygenation under light anaesthesia, the expected rise in PaO2 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

70. In the Revised Trauma Score, the initial assessment parameters include Glascow Coma Scale, Blood Pressure, and :

A. Heart Rate
B. Saturation
C. Respiratory Rate
D. Urine Output
E. Temperature

72. Absolute Contraindication to ECT

A. Cochlear implants
B. Epilepsy
C. Pregnancy
D. Raised intracranial pressure
E. Myocardial infarction

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:

A. Instigate low dose beta blockade
B. Defer, and refer to a cardiologist
C. Perform a transoesophageal echo to get a better look at the valve
D. Proceed to surgery with no further investigation
E. Perform a dobutamine stress echo

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:

A. 4% albumin
B. Dextran 70 in 0.9%N/saline
C. 6% hydroxyethyl starch
D. Ringers lactate
E. 0.9% N/saline

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:

A. Administer Anti-D antibodies 6 hrs pre op
B. Admister desmopressin one hour pre op
C. Administer methylpred and IVIg 2 days pre op
D. Recheck platelet count morning of surgery and if not dropped continue
E. Platelet transfusion morning of surgery

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

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:

A. the indicated vapour concentration
B. three times the indicated vapour concentration
C. one third the partial pressure obtained at 1 atmosphere
D. the same partial pressure as is obtained at 1 atmosphere
E. three times the partial pressure obtained at 1 atmosphere

79. [AP CXR and lateral] – ‘’showed hydropneumothorax’’ This grossly abnormal CXR is

A. right basal pneumothorax
B. right hydropneumothorax
C. artifact
D. right pleural effusion
E. right R lower lobe atelectases

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

A. Central diabetes insipidus
B. Nephrogenic diabetes insipidus
C. Psychogenic polydipsia
D. Cerebral salt wasting

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

A. Cushings
B. Diabetes
C. Primary hyperaldosteronism
D. Hypothyroidism
E. Phaeochromocytoma

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
E. Severity of OSA

85. You wish to compare a new method of BP measurement with the gold standard. The best way to do this is:

A. CUSUM analysis
B. Friedman's test
C. ?
D. Pearson’s correlation
E. Bland-Altman plot

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:

A. Auscultate the lungs
B. Release the APL valve
C. Remove the endotracheal tube and bag mask ventilate
D. Turn on the ventilator
E. Low positive end expiratory pressure

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:

A. C5
B. C6
C. C7
D. C8
E. T1

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

89 During the neurosurgical management of a cerebral aneurysm. The drug to administer to facilitate permanent clip placement is?

A. Nimodipine
B. Adenosine
C. Mannitol
D. Hypertonic Saline
E. Thiopentone

90. Prior to seeking consent from family/relatives for DCD, it is important to confirm which of the following?

A. Not a coroners case
B. Pt will have a cardiac death within 90 minutes in the absence of life-support
C. Potential organ recipient's identified and are available
D. Patient's wishes have been considered
E. Decision confirmed by an external committee

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:

A. C1-esterase deficiency
B. Factor V deficiency
C. Low bradykinin levels
D. Mast cell degranulation
E. Tryptase release

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:

A. Acute renal failure
B. Cardiomyopathy
C. Crush injury
D. Malignant hyperthermia
E. Rhabdomyolisis

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:

A. give a fluid bolus
B. change from sevoflurane to isoflurane
C. apply CPAP
D. reduce the FiO2
E. reduce sevoflurane

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:

A. amitriptyline
B. dextromethorphan
C. gabapentin
D. tramadol
E. pethidine

97. A 3 year old child has suffered a fractured arm. What is the most appropriate way to assess her pain?

A. the reported severity from the child
B. the reported severity from the parent
C. the reported severity from the nursing staff
D. using the FLACC scale
E. the Wong-Baker Faces scale

97. Child aged 3 with fractured femur ...

A. severity of pain best assessed from child
B. severity of pain best assessed from mother
C. severity of pain best assessed from nurse
E. Wong and Baker Faces

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

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

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

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.

B. CT chest
C. MRI chest
D. PET scan
E. Transthoracic echocardiogram

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?

A. <1%
B. 1.9%
C. 2.8%
D. 4%
E. 8.5%

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:

A. increase PEEP to 20cmH20
B. increase tidal volume to 10mls/kg
C. initiate nitrous oxide therapy
D. commence high flow oscillatory ventilation
E. ventilate in the prone position

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

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

A. The double insulation of the device will prevent macroshock when the outer casing is touched
B. The electrical fuse will immediately break and disconnect the device from the power supply
C. Equipotential earthing will prevent microshock from anyone who touches it.
D. The Line Isolation Monitor will alarm and disconnect power to the device
E. The RCD will immediately disconnect the device from the power supply

108. [Repeat 2013A] In adult cardiopulmonary resuscitation in the community include all of the following EXCEPT:

A. Allow equal time for chest compression and relaxation
B. Chest compression at 100bpm
C. C. Chest compression should be at least 5cm depth
D. D. Give 2 rescue breath before commencement of CPR
E. Chest compression to breaths ratio at 30:2

109. [New] Regarding intra-osseous cannulation in paediatric during resus for shock/cardio arrest, a correct statement is:

A. distal tibial above medial malleolus is preferred due to easy access
B. drug reaction time is the same as central venous route
C. 12G used to ensure adequate flow
D. bicarbonate cannot be infused due to bone damage
E. fat embolism is common complication

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

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:

A. decreased heart rate
B. decreased systolic blood pressure
C. increased ejection fraction
D. decreased preload
E. increased myocardial contractility

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:

A. decreased urinary calcium
B. extraosseous calcifications
C. increased plasma calcium
D. increased urinary phosphate
E. renal calculi

115. Patient is intubated and ventilated, the ETCO2 trace below is caused by

A. Endobronchial intubation
B. ETT cuff leak
C. Gas sample line leak
D. Spontaneous ventilation
E. obstructive airway disease

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)

A. Desflurane
B. Isoflurane
C. Sevoflurane
D. Propfol
E. N2O

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. ??

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?

A. Arrange for a cardiology follow-up and outpatient angiogram because he is at increased risk of future myocardial infarction
B. Arrange coronary angiogram as an inpatient prior to discharge
C. Inform the patient that while the result is real the significance is questionable
D. Repeat in one week’s time as a second troponin is a better indicator of long-term myocardial infarction risk
E. Ignore the result as it is likely a laboratory error

121. St John's wort will reduce the effect of

A. aspirin
B. clopidogrel
C. dabigatran
D. heparin
E. warfarin

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.

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

A. Inferior trunk
B. Ulnar nerve
C. Median brachial cutaneous nerve
D. Anterior division
E. Posterior cord

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

A. Class 1
B. Class 2
C. Class 3a
D. Class 3b
E. Class 4

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

127 Prothrombin VX useful in perioperative period to correct the coagulopathic defect of all except

A. Isolated factor II deficiency
B. Isolated factor VII deficiency
C. Isolated factor IX deficiency
D. Isolated factor X deficiency
E. Warfarin

129. (Repeat Q) A 70 year old male presents for right lower lobectomy. Preoperative spirometry shows an FEV1 of 2.4L and an FVC of 4.2L. The predicted post-operative FEV1 is: A. 1.0 B. 1.3 C. 1.5 D. 1.7 E. 1.9

130. (Repeat Q) You see a Type 1 diabetic woman preoperatively at 0700hrs who has been starved since 2200hrs for surgery today. You decide to start her on a Glucose-Insulin-Potassium infusion. Insulin decreases glucose levels by: A. Increasing glucose uptake into hepatocytes B. Increasing glucose uptake into skeletal muscle C. Increasing gluconeogenesis D. Decreasing proteolysis E. Inhibiting glucagon release

133. The organ that is least tolerant of ischaemia, after removal for transplant, is:

A. Cornea
B. Heart
C. Kidney
D. Liver
E. Pancreas

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:

A. Mean gradient across aortic valve of 30mmHg
B. Peak gradient across aortic valve of 40mmHg
C. Peak velocity across aortic valve of 4.2m/s
D. Aortic valve area of 1.2cm2
E. Calcification and restriction of the aortic valve

135. Which of the following statements regarding patients with ankylosing spondylitis is FALSE?

A. amyloid renal infiltration is rarely seen
B. cardiac complications occur in less than 10% of cases
C. normochromic anaemia occurs in over 85% of cases
D. sacroileitis is an early sign of presentation
E. uveitis is the most common extra-articular manifestation

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

A. Genetic test father
B. Genetic test woman
C. Muscle biopsy sibling
D. Muscle biopsy father
E. Muscle biopsy woman

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)

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%

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:

A. It is a synthetic substance and therefore acceptable to Jehovah's Witnesses
B. It is likely to reduce haemorrhage in this patient
C. It should be given as an infusion 30 minutes prior to surgery
D. The effect will last 5 days
E. The dose is 0.3μg/kg

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

(This is about the BOOST 2 trial which was published in May 2013 in NEJM. Answer is increased mortality -obviously this trial was done in aus and nz and also in the UK).

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

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

?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

146. A 2yr child post op following stabismus surgery. ETT 4.5 used. Awake, stridor and tracheal tug. Immediate action?

A. inhalational induction
B. CPAP with facemask
C. propofol 1mg/kg
D. dexamethasone 0.4mg/kg
E. adrenaline nebuliser 1:1000 05ml/kg

149. Transient neurological (radicular) syndrome ONLY occurs with

A. Hyperbaric local anaesthetics
B. Intrathecal lignocaine
C. Lithotomy positioning
D. Following complete resolution of motor blockade
E. When there has been a dense motor block with spinal anaesthetic

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?

A. 2
B. 3
C. 5
D. 8
E. 12
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