Finals MCQs-Aug 2014

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Finals Black Bank

Contents

Past Papers

Mar15 | Mar14 | Aug13 | Mar13 | Aug12 | Mar12 | Sep11 | Mar11 | Aug10 | Mar10 | Aug09 | Apr09 Aug08 | Apr08 | Jul07 | Mar07


To candidates sitting in August 2015: Look for the draft email in the [email protected] account for question allocation to collate the August 2015 MCQs.
Please follow the process outlined below to keep the dream alive. 

Update: The email with allocations has been lost. Please go here http://www.kerrybrandis.com/wiki/mcqwiki/index.php?title=Finals_MCQs-Aug_2015 and edit the page to list your ID beside some MCQs

UPDATE (Aug2015): I have received an email informing me of log-in problems with the email address.
Google has detected "suspicious activity" which seems to be that people are logging in 
from many very geographically-distant places within a short time. The password was changed to 
thecollege999 (to get past the new-password-required screen) but the multiple distant log-in issue
remains and Gmail security will keep alerting about this.
If you are asked where you usually log-in from then enter Brisbane - that worked for my informant. 

A BETTER solution is to add all MCQs on this site.

TO ALL CANDIDATES SITTING IN MARCH 2015 Mar15

The process for selecting which questions to recall for March 2015 is as follows:

  1. Go to gmail and login to [email protected] password is: thecollege999 Do NOT follow the prompt to setup account restoration/security, just skip it.
  2. There is a draft email, containing the numbers 1 - 150. Put your name next to the ones you want (say 3 questions).
  3. Save the draft, don't send it. Write down the numbers you're going to remember somewhere so you don't forget them.
  4. After the exam you can log into the account and write your questions into the draft (again, don't send it) OR email the account with your remembered questions (remember to include the question numbers) OR enter the questions directly into the Black Bank. I'll periodically update the Black Bank as the questions trickle in.

Remember we only need 50 people to do this to recall an entire paper. Totally do-able.


Please enter your recollection of questions for August 2014 below

August 2014 - Numbered Questions

Q1. A transdermal fentanyl patch is often used for management of cancer pain. After application, the time to reach peak plasma levels is:

A. 1hr
B. 2hrs
C. 4hrs
D. 12hrs
E: 24hrs


Q2 : Pharmacological studies are undertaken in several phases. A phase 3 study involves:

A Animal studies
B Testing of drug on healthy volunteers
C Observational studies on patients with disease
D Post marketing surveillance
E Randomised controlled trials on target population


Q3 : A pregnant patient 28/40 gestation is involved in a high-speed MVA. On admission to the DEM she complains of sudden onset severe chest pain. Her vital signs show HR 120, BP 160/100, SpO2 95% RA and her ECG shows ST depression. Most likely diagnosis is:

A. Cardiac contusion
B. Tension pneumothorax
C. Aortic dissection
D. Sternal fracture
E. Myocardial infarction


Q4 : 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 MH
B ARF
C Cardiomyopathy
D Rhabdomyolysis
E Crush injury


Q5 to Q51 : See unnumbered question section


Q52 : A 30yr old pregnant patient develops contractions at 30/40 gestation. Which of the following can not be used for tocolysis? (Question does NOT ask about 34/40)

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


Q53 : In a patient with intraorbital haemorrhage, following local anaesthetic injection, the adequacy of occular perfusion is best assessed by:

A. Angiography
B. Indirect opthalmoscopy
C. Direct opthalmoscopy
D. Intra-occular pressure tonometry
E. Palpation of the globe by an experienced physician


Q54 :What is the appropriate post-operative ibuprofen dosage for a one year old child tds?

A. 5mg/kg
B. 7.5mg/kg
C. 10mg/kg
D. 15mg/kg
E. 20mg/kg


Q55 :You are inducing a 4yr old child with Arthrogrophysis multiplex congenita. After you administer the induction agents, you find it difficult to place the laryngoscope. What is the likely complication?

A. Malignant hyperthermia
B. Neuroleptic malignant syndrome
C. TMJ rigidity
D. Opioid-induced rigidity
E. Inadequate depth of anaesthesia


Q56 : What is the best measure of the anticoagulant effect of Dabigatran?

A. APTT
B. Dilute thrombin time
C. Prothrombin time
D. Bleeding time
E. TEG


Q57 : What is the ratio of compression to breaths for neonatal resuscitation?

A. 3:1
B. 15:1
C. 30:1
D. 15:2
E. 30:2
Q58
Q59

Q60 : In patients with refractory elevated ICP, bilateral decompressive craniectomy is associated with reduction in ICP and also results in:

A. Reduced duration of ventilation
B. Reduced duration of hospitalisation
C. Improved overall mortality
D. Worse long-term neurological outcome
E. Unchanged long-term neurological outcome


Q61 :Tumour lysis syndrome causes all of the following biochemical abnormalities EXCEPT:

A. Hyperkalaemia
B. Hypernatraemia
C. Hyperphosphataemia
D. Hyperuricaemia
E. Hypocalcaemia


Q62 Q63 Q64 Q65

Q66 You are performing an interscalene nerve block using a nerve stimulator when your patient begins to hiccough. You should aim to position the tip of your needle more

A) Anterior
B) Posterior
C) Cephalad
D) Caudal
E) Superficial

Q67 The characteristic respiratory pattern in a patient with an acute C5 spinal cord injury is

A. Rapid respiratory rate
B. Arterial hypoxaemia
C. Chest wall immobility
D. Preserved cough
E. Preserved inspiratory force

Q68 Tavi vs Max medical therapy nonoperable aortic stenosis reduction in risk at 30 days of

A. AMI
B. AKI
C. Death
D. Atrial fibrillation
E. Stroke


Q69 Medial peribulbar block tip max distance past equator for minimal vein injury

A. 5
B. 10
C. 15
D. 20
E. 25
  • Q70
  • Q71
  • Q72
  • Q73
  • Q74
  • Q75

Q76 : A patient has suffered flash burns to half of the left upper limb, all of the left lower limb and the anterior surface of the abdomen. The approximate percentage of the body surface which has been burnt is:

A. 18%
B. 23%
C. 32%
D. 41%
E. 48%


Q77 : You are anaesthetising an ASA 1 woman for a laparoscopic gynaecological procedure. How long does it take for the PaCO2 to peak?

A. <15min
B. 15-30min
C. 30-60min
D. 60-90min
E. >90min
  • Q78-81 missing

Q82 : Anaemia post partial gastrectomy is most likely due to:

A folate deficiency secondary to steatorrhea
B ongoing haemorrhage from stomal ulcer '(yes Stomal not stomach)'
C malabsorption of iron
D Vit B12 deficiency due to loss of intrinsic factor
E folate deficiency due to lack of appetite


Q83 : 65year old for video assisted thoracoscopic lower lobe wedge resection. Surgeon requests lung isolation and one lung ventilation.

Predictors of intraoperative hypoxia are:

A central rather than peripheral lesion
B left sided lesion
C low Aa Oxygen gradient when ventilating both lungs
D right sided lesion
E supine rather than lateral position


  • Q84-93 not recalled by number; see unnumbered section


Q94 : Small air bubbles in the arterial line system will reduce
A. Dampening coefficient
B. ?Extrinsic Coefficient
C. Measured systolic pressure
D. Measured MAP
E. Resonant frequency


Q95 : RPT. Capnograph trace form a patient that is intubated and ventilated. What does it indicate

See previous paper for a picture, it was the same

A. Endotracheal intubation
B. Gas sample line leak
C. ETT cuff leak
D. Obstructive disease
E. Spontaneous breaths


  • Q96-109 : See un-numbered question section

Q98 You extubate a young woman after a dental procedure under GA. She has a history of hereditary angioedema and in recovery she develops airway oedema. Best treatment

A. FFP
B. IV Adrenaline
C. IV corticosteroids
D. IV promethazine
E. Nebulized adrenaline

Q99 A previously well 65 year old female develops acute shortness of breath 3 days post hip replacement. The most appropriate investigations to confirm PE is

A. CTPA
B. D-dimer
C. Echo
D. Ecg
E. V/Q scan

Q100 20 year old female with 25% burns to her body. She weighs 80 kg. How much replacement fluid should she be given over the next 8 hours?

A. 4L
B. 4.8L
C. 5L
D. 6L
E. 8L

Q101 50 y.o female with a history of mennohhragia is having a hysterectomy. Her pre-operative Hb is 95. What serum ferritin would confirm iron deficiency anaemia?

A. 30 mcg/L
B. 3 mg/L
C. 3 mcg/L
D. 0.3 mg/L
E. 3000 mcg/L

Q102 An Adult Jehovah's Witness requires a redo hip replacement for a peritrochanteric fracture. They request that no blood products are given. The anaesthetists decision to PROCEED is best given by:

A. Autonomy
B. Beneficence
C. Justice
D. Nonmaleficence
E. Paternalism

Q103 100% Saturated air @ 20 degrees is what relative humidity @ 37 degrees

A. 20%
B. 30%
C. 40%
D. 50%
E. 60%

Q104 Maximum cumulative dose of intralipid (ml/kg)

A. 10
B. 12
C. 15
D. 20

Q105 60yo alcoholic with HTN, has abdominal pain. No findings at laparotomy. 12 hrs later: Na140 k5 cl115 HCO3 18. What is the most likely diagnosis?

A. ARF
B. Diabetic ketosis
C. Lactic acidosis
D. Methanol
E. NaCl infusion

Q106 Diagram of a CTG (showing late decelerations). Causes:

A. Uteroplacental insufficiency
B. Foetal head compression
C. Foetal asphyxia
D. Umbilical cord compression
E. General anaesthesia

Q107 In a clinical trial, researchers looked at 2 groups - smokers vs. non-smokers and followed then up for a period of time. This type of study is a

A. Cohort
B. Case study
C. Observational
D. RCT
E. ?


Q110 Prothrombinex VF is useful in the perioperative period to correct the coagulopathic defect of all of the following except

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


Q111 A 65 year old man otherwise fit and healthy is having a TKR under GA (O2, N2O, sevoflurane and fentanyl). His blood pressure has been stable through-out the case at 130/80. Before the orthopaedic surgeons start reaming and bone cemetation you should

A. Give heparin 5000 iu
B. Give a corticosteroid
C. Cease N2O
D. Induce hypotension
E. Give a vasopressor to increase blood pressure


  • Q112-150 : Not remembered by number so see unnumbered question section

Un-numbered Questions

(Photograph and Ultrasound picture of regional block. probe held transverse against posterolateral aspect of distal humerus over triceps. shows triangular nerve in close proximity to humerus) after infitraion of 5mls of 0.75% ropivacine Numbess in:

A. lateral aspect of forearm
B. ring dorsum??
C. medial??
D. palmar aspect and distal dorsal aspect of little finger and medial half of ring finger
E. palmar aspect and distal dorsal aspect of thumb, index and medial fingers and lateral half od ring finger


Lateral CXR given. Can see lower half of thorax and vertebrae but upper half is all black with clear demarcation

A. Loculated effusion
B. Artifact caused by patient's arm
C. Left lower lobe consolidation
D. Right middle lobe consolidation
E. Right lower lobe consolidation


12 year-old with idiopathic scoliosis, most likely have associated

A. Phaemochromocytoma
B. Renal artery stenosis
C. Mitral valve prolapse
D. Diabetes insipidus
E. ? abnormality with the larynx


Term neonate, noted to have intermittent stridor a few days after birth, then parents also notice stridor during feeding and sleep. Otherwise normal and healthy. Most likely condition is:

A Cri-du-chat syndrome
B Laryngomalacia
C Tracheomalacia
D Laryngocoele
E ? something to do with cord paralysis


A picture of an echo 4 chambers view

A Anterior mitral valve leaflet
B Posterior mitral valve leaflet
C ? Aortic non-coronary
D ? Tricuspid
E


Cryoprecipate, once thawed must use within

A 30 minutes
B 2 hours
C 4 hours
D 6 hours
E 12 hours


Glycine 1.5% used for TURP, osmolality is

A 200
B
C
D 300
E 320


Sick ICU patients seem to have moderate - severe ARDS PaO2/FIO2 ratio of 200, C.I. 1.7 (cardiac function seems okay). Decided to have ECMO, best mode is

A AV
B VA
C VV
D ? arterior-arterial
E ? atrio-aortic (yes that's how they spelt it)


Middle age women c/o pain in hands when hanging out washing. Also found to have muscle wasting on one of the hand associated with weaker radial pulse.

A CRPS
B Lateral medullary syndrome
C Thoracic outlet syndrome
D Paraneoplastic syndrome
E


Same radial nerve question with photos of a probe over postero-lateral upper arm and ultrasound image that show a triangular shape nerve, most likely the radial nerve. Injecting 5 ml of 0.75% [[ropivacaine] will produce sensory block over

A Medial forearm
B Lateral forearm
C Dorsum part of hand
D Plantar surface of ring and little finger
E Plantar surface of middle and ring finger


Blue urticaria is a complication of

A. ?
B Methylene blue
C Patent blue something
D
E


Intraosseous sampling - least accurate on

A Albumin
B Urea
C ? Na or K
D Chloride
E


Subtenon's block - muscle most likely to have inadequate block

A Medial rectus
B Lateral
C Superior
D Superior oblique
E Inferior


For EVAR, the best method to reduce risk of renal impairment?

A Sodium bicarbonate
B N-acetylcysteine
C Normal saline
D
E


EVAR is preferred over open AAA repair because

A Lower cost
B Lower mortality
C Less follow up
D Less re-intervention
E Less need for critical care


Laser flex tube with double cuffs - how to inflate cuff(s)?

A Inflate proximal then distal
B Inflate distal then proximal
C
D Inflate distal only
E Inflate proximal only


Forceps delivery. Loss of sensation medial thigh with loss of adduction at hip joint - resulted from injury to

A Sciatic nerve
B lumbosacral plexus
C Lateral cutaneous nerve of thigh
D Obturator nerve
E


Called to cath lab because patient became agitated. Unstable angina having PCI,difficult right coronary stenting. Patient was hypotensive 80/40, HR 80/min in SR. What is the next best management step?

A Transfer to operating theater immediately
B Sedate and intubate
C ?crack on
D Transthoracic echocardiography


A printout of 12-lead ECG

A Atrial fibrillation with BBB
B Sinus tachycardia with BBB
C Torsades de pointes
D VT
E VF


(Repeat:) Diagram about 3-bottle underwater seal drain, with the height of the fluid level in the suction bottle indicates

A. Maximal suction applied to the system
B.
C.
D.
E.


Photo of a patient with tongue deviation post cervical spinal fusion. Which nerve is damaged?

A Glossopharyngeal nerve
B Vagus nerve
C Hypoglossal nerve
D Accessory nerve
E


Post cardiac surgery. Rhythm strip to assess pacing on AOO. What is the diagnosis?

A Pacing spikes with loss of capture
B
C
D
E


Young male with MVA + femur # on traction. Initial CXR normal. More than 24 hours. Became confused and drowsy, BP normal, crackles both lung fields with worsening O2 saturation to 85% on ward 12 hours later despite increasing oxygen flow. He has had 40mg morphine and a femoral nerve block. Diagnosis?

A Fat embolism
B Compartment syndrome
C Pulmonary embolism
D ? Pneumothorax
E ? Lung contusion

(other remembered options: LA toxicity, aspiration)


G5P5 in third stage labour. Found to be unresponsive, cyanosed, faint pulse. On oxytocin induction and epidural infusion 10ml/hour. Also oozing from previous IV or blood sampling sites. Diagnosis?

A High spinal
B AFE
C PE
D
E Massive haemorrhage


In iron deficiency anaemia, one will expect a serum ferritin level to be less than

A 300mg/L
B 30mg/L
C 30mcg/L
D 300mcg/L
E


Treatment for patients with congenital long QT syndrome

A Pacemaker/defibrillator
B Accessory pathway abalation
C Beta blocker
D Calcium channel blocker
E


An 18 month old child with VF arrest, shock with

A 10J
B 30J
C 50J
D 100J
E


Endovascular coiling of cerebral aneurysm under GA, patient suddenly develop hypertension. What is the most likely cause?

A Acute hydrocephalus
B Rupture of aneurysm
C Contrast reaction
D Cerebral embolism
E


A patient on citalopram. Post-op in PACU given tramadol. Developed fever, tremor, restlessness, confusion, hyperreflexia. Diagnosis is

A Neuroleptic malignant syndrome
B MH
C Serotonin syndrome
D
E


Best drug to reduce both gastric acidity and volume

A Ranitidine
B PPI
C Sodium citrate
D
E


Patient on moclobemide came in for surgery. In view of the use of vasopressor to treat hypotension one will give judicious amount of

A. ?
B. Metaraminol
C. Adrenaline
D. Noradrenaline
E. Phenylephrine


Patient with hyperthyroidism - proceed with elective surgery only if normal level of these hormones is seen

A TSH
B T4
C T3
D T3 & T4
E


In pregnant women the durac sac ends at

A
B L3
C L5
D S1
E S3


Full size oxygen cylinder providing 10L/min of oxygen flow to a patient during transport. How long will this cylinder last?

A
B
C 45 minutes
D
E


Something to do with Echinacea and renal transplant:

A. ?regarding immune system
B. bleeding risk
C. nephrotoxicity


Jehovah's witness patient is having a TKR. You agree to proceed with surgery. Which ethical principle are you honouring?

A Autonomy
B Non-maleficence
C Beneficence
D Justice
E Fidelity


Red-man syndrome secondary to vancomycin is due to

A Type II hypersensitivity reaction
B Vasodilation
C Mast cell degranulation
D IgE immediated response
E Serotonin release


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


Absolute contraindication to ECT

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

Additional unnumbered MCQs

Below are some questions I randomly (and incompletely) remembered. Please DO approach them
with a grain of caution as that's just how I remembered them. Please feel free to edit/correct
for those who remember them better than me.
Good luck to all, and remember to pay it forward!  - Anonimo egiziano.


Repeat: Stellate ganglion block. Needle entry next to SCM muscle at C6. Which direction to advance needle ?

A. C3
B. C4
C. C5
D. C6
E. C7

Repeat: CTG with early decelerations

A. GA
B. Fetal head compression
C. Uteroplacental insufficiency
D. Acute asphyxia
E. Umbilical cord compression.

Repeat: Endocarditis prophylaxis

A Bicuspid valve
B Congenital repair > 12 months ago
C Rheumatic heart valve
D Uncorrected cyanotic heart disease
E MVP

Repeat: CVL relatively contraindicated in:

A. LBBB

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

Repeat: You are 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

Repeat: What proportion of the population are heterozygous for pseudocholinesterase deficiency, i.e. have a dibucaine number 30-70?

A. 0.04%
B. 0.4%
C. 4%
D. 14%
E. 40%

Repeat: CO2 penetrates surface tissue so well with little damage to underlying tissue because:

A. Well absorbed by Hb
B. Poorly absorbed by H20
C. Widely disseminated in tissue
D. Long infrared wavelength
E. Short infrared wavelength

Repeat: With regards to ROTEM: maximal clot firmness (Increased MA: maximal amplitude on TEG) correlates best with needing to give:

A. FFP
B. Cryoprecipitate
C. Platelets
D. Prothrombinex
E. Tranexamimic acid

Repeat: The MELD score is calculated using INR, Bilirubin & what?

A. Creatinine
B. Albumin
C. Urea
D. AST
E. Ammonia


  • Repeat: Reduction of fraud in research - what's the MOST LIKELY to help? Backup of a well-known research institute, sole author (HOD), similar to published data...etc.


Repeat: 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

Repeat: 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


To exclude RICP in an awake patient the most reliable finding is what ?

A. No headache
B. No diplopia
C. No vomiting
D. Pulsatile retinal vein
E. No papilloedema


  • Repeat: % of those with raised troponin post SAH: 15-30%
  • Repeat: Best determinant of a neonate's heart rate: Auscultate the chest.
  • Repeat: Optimal fluid management during laparotomy: Pulse pressure variation, EF on a TOE, CVP, BP and HR
  • Repeat: Just gone onto CPB, MAP 25, CVP 1, sVO2 80% - Give metaraminol.
  • Repeat: Maximum recommended time for an adult tourniquet: 90 min? 120 min?
  • Repeat: Best way to achieve cerebral perfusion during aortic arch repair: Anterograde via carotids
  • Given an ECG with wide complex tachycardia - Sinus tachy with BBB, VT, VF. Sorry, can't remember what I chose in the end. Anyone remembers better?
  • Repeat: Awaits renal transplant. Why would you ask them to stop Echinacia? Immune suppression, hepatotoxic, coagulopathy, nephrotoxic. Something else?
  • Hypotensive in cath-lab for a difficult PCI to RCA. Sweaty, increased hypotension with inspiration, raised CVP. What do you do? Take to OR immediately? Perform an ECHO? Some other options.
  • Repeat: Post (R) pneumonectomy on the ward becomes acutely unwell, hypotensive, raised CVP. What do you do? Turn left lateral.
  • Repeat: Venous air embolism. How to position the patient? Head up + R) up, Head up + L) up, Head down + R) up or Head down + L) up. [Head down and (R) side up]
  • Repeat: Diagram with 3-chamber chest drain system - X marks what? Maximum suction that can be achieved. Sorry, can't remember the other options.
  • Repeat: Hours for trypatse to peak?
Blue urticaria - caused by what? [Cyanotic patient]
  • Repeat: TBI - What fluid NOT to give? Synthetic colloids, saline, albumin etc


Which population is more liable to CNS damage from Hyponatraemia?

A. Children
B. Young males
C. Young females
D. Old males
E. Old females


You are anaesthetising an ASA 1 woman for a laparoscopic gynaecological procedure. How long does it take for the PaCO2 to peak?

A. <15min
B. 15-30min
C. 30-60min
D. 60-90min
E. >90min


  • Lateral CXR of consolidation at the base. Which lobe and which side? [Can still see diaphragm and can still see spines. Ends abruptly obliquely.]
  • Hb 86 post TKJR in an asymptomatic patient with stable angina. Transfuse to 120, transfuse to 100, observe overnight and Repeat: mane.
  • USS over the radial nerve. Previously the question was asked as what muscle action will be lost (wrist flexion/extension). This time the question was the pattern of sensory loss.


Health care worker. HBV exposure. Known to have immunisation titres. What do you do?

A. Booster dose of his immunisation
B. HBV immunoglobulins
C. Pegylated Interferon
D. Aciclovir


  • HIV seroconversion post needlestick injury: 0.3%, 3%, 30%...etc
  • Repeat: Craniotomy, MAP 80, transducer 13cm below, CVP given, what's the CPP
  • Repeat: Unremakable finding on a laparotomy. Has been given 3L cystalloid and minimal EBL. Physiological response to such haemodilution includes ALL EXCEPT: Increased myocardial O2 extraction. Increased tissue O2 extraction. Increased tissue flow due to decrease viscosity. Increased tissue flow due to vasodilatation.
  • Idiopathic scoliosis in a young female. Likely associated pathology: MV prolapse, renal artery stenosis, abnormality with the larynx...etc
  • Repeat: ABG as you diagnose intraoperative MH: Acidosis/alkalosis, high pCO2, Zero BE vs. -9 BE.


Repeat: A 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

Repeat: A 50 year old male in recovery after an anterior cervical spinal fusion, developing increasing respiratory distress, bulge under original incision, combative, repeatedly removing oxygen mask, SpO2 96%. What is the most appropriate management ?

A. Direct laryngoscopy and intubation after inhalational induction with sevoflurane
B. Awake tracheostomy by surgeons
C. Awake fibreoptic intubation using minimal sedation
D. Direct laryngoscopy and intubation with propofol and sux
E. Retrograde intubation


Asthmatic paediatric patient, tonsillectomy. Desaturates and stiff to bag. First thing to do?

A. Salbutamol
B. Suction
C. Ask surgeon to release gag
D. Paralysis
E. ? reintubate


Balloon pump trace 2:1

A. Early inflation
B. Late inflation
C. Early deflation
D. Late deflation
E. ? No problem


Repeat: 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:

A. Epidural Lignocaine
B. IV Esmolol
C. IV Hydralazine
D. IV Magnesium
E. IV Propofol


  • Fasting times for a 6week old (Repeat:)
  • Unremarkable/negative laparotomy. 3L saline given. ABG results (Hyperchloraemic acidosis - Repeat:)
  • How many hours/ minutes will the O2 cylinder last for (150 L at 10L/min => 15min is the answer to choose. Re-worded from a similar prev question)
AAI paced ECG: 1) Failure to capture 2) CHB, 3) 2nd degree HB, 4) AF [I think it looked like progressive prolongation of PR interval after the spikes, hence 2nd degree HB]
  • Hyperkalaemia of 7 or 8. Most appropriate immediate (or was it most "effective") therapy: Insulin + Glucose vs Bicarb vs Salbutamol vs resin vs something else.


Comments regarding recollection as above

Correct INR range for a patient with a mechanical valve

A
B
C
D
E


Flow volume loop diagram

A. Variable intra-thoracic obstruction
B. Variable extra-thoracic obstruction
C. Restrictive pattern
D. Obstructive pattern
E. Fixed obstruction


Four (4) METS is how many ml O2 / min?

A. ?
B. ?
C. ?


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


Repeat: 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:

A. T2
B. T4
C. T6
D. T8
E. T11


Repeat: 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


Repeat: During a pneumoperitoneum, at what level of intra-abdominal does cardiac output fall?

A. 10 mmHg
B. 20 mmHg
C. 30 mmHg
D. 40 mmHg
E. 50 mmHg


Repeat: Best option to reduce risk of ventilator induced pneumonia?

A. Nurse in supine position
B. Early spontaneous ventilation through ETT
C. Oral hygiene
D. Use antacids
E. Regularly change breathing circle


Repeat: 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. codeine
B. morphine
C. paracetamol
D. parecoxib
E. tramadol


Repeat: A patient is in Class 4 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


Repeat: 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


Repeat: 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. ?

Repeat: What is NOT a contraindication to MRI?

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


Repeat: What is the mechanism of central sensitisation?

A. Increased intracellular magnesium
B. Antagonism of the NMDA receptor
C. Glycine is the major neurotransmitter involved
D. Recurrent a-delta fibre activation
E. Alteration in gene expression


Repeat: Which volatile contributes most to greenhouse gases / environmental pollutant ?

A Desflurane
B N2O
C Sevoflurane
D Isoflurane
E Halothane


Repeat: 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


Repeat: 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. ?


?? First line treatment for acute attack of hereditary angioedema?

A FFP
B Adrenaline
C Steroids
D C1 inhibitor concentrate
E anti-histamine


Repeat: Adult male who is intubated and ventilated, with CVL in situ. Just before surgeon starts the Line Isolation Monitor alarms about a leak at 5mA. What do you do?

A. stop procedure and move to a safe location
B. sequentially remove non essential monitors from the circuit until fault is identified
C. unplug the CVL to electrically isolate it until fault is identified
D. ensure the patient is earthed
E. Check the diathermy pad


Repeat: Patient with Haemophilia A with known high titres of inhibitors to factor 8. What would you give to prevent bleeding in the patient for OT

A. Factor VIIa
B. High dose Factor VIII concentrate
C. FFP
D. Cryoprecipitate
E. Platelets


Mec stained liquor post LSCS Did not state if infant flat or vigorous

A. Suction
B. Routine care


SN20 A 55 year old subarachnoid haemorrhage secondary to aneurysm. Patient is confused with a oculomotor (3rd cranial nerve) palsy, complains of a severe headache. This patient is in Hunt and Hess class:

A. 0
B. 1
C. 2
D. 3
E. 4


Repeat: In a 140kg obese patient, compared to a 70 kg person:

A. cardiac output >20% lower
B. cardiac output 10% lower
C. cardiac output no different
D. cardiac output 10% higher
E. cardiac output >20% higher
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