Finals MCQs-Mar2017

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 PLEASE record questions you have remembered from the March 2017 Final ANZCA Exam. If you don't recall the exact Q number, then just mark as 17A- then a number (e.g. 17A-1, 17A-2, ... ). 


MCQs

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Questions dump with answers (unformatted):



1. What is the nominal maximum pressure that the Manujet can deliver? A) 1 ATM B) 2.5atm C) 2atm D) 3.5atm E) 5 atm Manujet: • The Manujet is connected to a high-pressure oxygen source such as wall or cylinder oxygen via a pin connection. • The pressure regulator on the ManujetTM device allows adjustment of pressure. • Pressure regulator guage set at 0 - 3.5bar (3.45ATM) • This feature is not available on the SandersTM Injector – which always delivers oxygen at 4 bar (or 4000 cm of water). • If the device allows pressure adjustment, the pressure should be set to 1BAR/ATM (or 1000 cm of water). This reduction in pressure reduces flows to more manageable levels. 1 Bar delivers 250 mls/sec.

2. A lady is having elective orthopedic procedure on a limb. She takes escitalopram for depression but is otherwise healthy. Which drug is not relatively contraindicated: A) clonidine B) omeprazole C) metoprolol D) pethidine E) tramadol

- Group decided on clonidine - escitalopram: SSRI o pethidine, tramadol  increased risk of serotonin syndrome o clonidine enhances sedative effects of escitalopram o omeprazole; possible enhanced effect of escitalopram – increase risk arrthymia  hepatic enzyme inducer - metoprolol effects is potentiated by escitalopram - Repeat 2012b


3. Intra-arterial propofol 10ml (100mg). Extreme pain. Most appropriate immediate management: a. 30ml normal saline intra-arterial b. heparin 500IU c. lignocaine 50mg d. papverine 50mg e. observe

- Group agrees with A - when injected intra-arterial: causes hypereamia and distal blanching - observe, heat pack, elevate limb




4. Best indicator of difficult intubation in obese patient A) interincisor gap B) mallampatti score C) pre-tracheal soft tissue thickness D) thyromental distance E) ROM cervical spine

- Euro Journal of ANaesthesia 2016 o BMI >50 and neck circumference independent risk factor for difficult intubation o Male sex, BMI>50 independent predictors for difficult BMV - Increased neck circumference to thyrimental distance >5 independent risk factor for difficult intubation


5.0 Where should V4 be positioned.



6.0 Ultrasound of lung. A lines and sliding lung are seen. This is consistent with A) pneumonia B) pleural effusion C) pulmonary oedema D) pneumothorax F) normal lung

- Normal lung o Lung sliding, A lines - pneumothorax: o loss of lung sliding o loss of short path reverbtion artifact: B lines, commet tail artifact, thin vertical bright artefacts o increased prominence of long path reverbation artefacts: A lines

- pneumonia o B lines and tiny areas of subpleural consolidation (parapneumonic effusion) o Hepatisation of lung o Irregular consolidation/air interface – shred sign o Aerated bronchi: air bronchograms and dynamic air bronchograms - pleural effusion - pleural oedema o B lines + pleural effusion

Q7. Aspriin efficacy is known to be reduced with the use of a) pareccoxib b) diclofenac c) ibuprofen d) naproxen e) calecoxib

Article 2013: Anteplatelet effects of aspirin: which anti-inflammatories interact Horn et al - ibuprofen, naproxen, indomethacin - one study found celecoxib to have an effect on anti-platelet function, whilst another study found the opposite - paracetamol, diclofenac, meloxicam, sulindoc does not effect the efficacy of aspirin

Q8. Risk of thromboembolic effect is LOWEST with a) parecoxib b) diclofenac c) ibuprofen d) naproxen e) celecoxib

reference https://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ArthritisAdvisoryCommittee/UCM386432.pdf

- lowest risk naproxen then ibuprofen - highest risk diclofenac


Q9 Known risk factor for propofol infusion syndrome a) hypotension b) hypoxeamia c) corticosteroids (if infusion) d) vasopressor requirement e) young age

CEACCP/LIFL risk factors for developing PRIS - severe head injuries/ acute neurological injury, sepsis, high exogenous or endogenous catecholamine and glucocorticoid levels, low CHO to high lipid intake, inborn errors of fatty acid oxidation - younger age - corticosteroid infusion PRIS - PRIS defined as acute refactory bradycardia  asystole in the presence of one of the following : metabolic acidosis, rhabdomyolysis or myoglobinuria, lipeamic plasma - Pathophysiology: impairment/uncoupling of mitochondrial oxidative phosphorylation and free fatty acid utilization  lactic acidosis and myuocyte necrosis - Prevention o Avoid in propofol sedation in patients for high risk of PRIS o Ensure adequatre CHO in diet o Don’t exceed doses >4mg/kg/hr - ABG: metabolic acidosis, increased lactate, ECG demonstrates Brugada morphology ECG (coved ST segment elevation V1-V3), RBBB, lipeamic plasma, increased K

Q10 Use of schnider rather Marsh model TCI Pharmacokinetics in a adult patient of normal weight for longer than 15minutes procedure will result in A) smaller loading dose and smaller overall dose B) smaller loading dose but larger overall dose C) a larger loading dose and larger overall dose D) a larger loading dose but smaller overall dose E) a larger/? Smaller loading dose and overall dose dependent

Reference VEZ pharmacology textbook, Goodman and gilllman - the Schneider moderl usually delivers a smaller loading dose and smaller total dose compared with the marsh model in the same patient - marsh model underdoses in children under age of 16 - marsh model does not account for age, schnider dose - one minute after bolus o marsh Cp = 4mcg/ml CE = 0.9mcg/ml o schnider CP = 8.2mcg/ml Ce = 3.6mcg/ml o differences less significant after 10minutes, after 30 minutes both estimate the same levels; net effect schnider administers less propofol - schnider has fixed V1 - marsh central compartment is a function of weight - schnider model has faster TTPE (1.6 vs 4.5min), less overshoot and undershoot w schnider effect site targeting than with Marsh - schnider probably more safe in elderly and compromised patients - side note: remifentinl minot model uses LBM, actual body weight can be entered


Q11. Patient for emergency laparotomy for peritonitis. You insert a 7.5F central line into the carotid artery. Most appropriate management a) immediately remove and apply pressure for 20minutes b) deliver 500IU heparin c) leave in situ for 24 hrs then remove and apply pressure for 20minutes d) leave in for 24hrs then remove and consult vascular surgery e) consult surgical vascular team at completion of case

https://emcrit.org/wp-content/uploads/2010/10/Vascular+Complications+of+Central+Venous+Catheter+Placement+Barash+and+Landoni+JCVA.pdf


Q12 Elderly patient from ICU with necrotic bowel for laparotomy. Borderline oxygenation and renal replacement therapy. Current INR 2.1, plt 105, fibrinogen 1 5g/L HB 90gm/L Appropriate management would be A 2 unit FPP and 1 platelets B 2 unit FFP, 1 unit PRBC to achieve correction of anaemia C cryoprecipitate to achieve fib >2g/L Fibrinogen concentrate to achieve fibrinogen <2g/L Proceed to surgery if no clinical signs of bleeding

Q 15. What is not indicated for refractory anaphylaxis management

E. Promethazine

P12 of “Perioperative Anaphylaxis Management Guidelines” reads: “oral antisitamines such as cetirizine have a better side effect profile compared with IV promethazine which can worse hypotension”.

Q 16 ISS score 34 what chance of coagulopathy? Trauma in young man, cerebral contusion, flail chest and broken femur.

Depends on options. Injury severity score (ISS) is an established score to assess trauma severity, ranging from 0 - 75 with ‘major trauma’ defined as an ISS > 15.

6 body regions (1. Head or neck; 2. Face; 3. Chest; 4. Abdo/pelvis; 5. Extremeities or pelvic girdle; 6. External) are scored out of six (1. Minor; 2. Moderate; 3. Serious; 4. Severe; 5. Critical; 6. Maximal / unsurvivable). The top 3 highest scoring regions scores are squared and added together to give final score (ISS = A2 + B2 + C2). If any region scores a 6 the overall ISS score is automatically 75.

Firth D, et al. Definition and drivers of acute traumatic coagulopathy. J Thomb Haemost. 2010;8(9):1919 – 1925. States an ISS > 15 (i.e. major trauma) is associated with a 67% incidence of traumatic coagulopathy.


Q17. RR 20 GCS 13-14, BP 90

qSOFA = quick sequential (sepsis related) organ failure assessment Score +2

Score out of 3:

1. Respiratory rate > 22 2. Altered Mentation 3. SBP <100mmHg

Ref: Singer M, et al. JAMA. 2016.

Q18. Repeat March 2014

ECG = brugada syndrome.

Q19. C.

Failure to oxygenate on CPB with opportunity to come off bypass as cardioplegia not yet delivered. Safest option is to return to lung ventilation and go off CPB until problem rectified.

Q20. In MS, greatest risk of deterioration Answer: Hyperthermia


Q21. D

Thrombin time is the most sensitive measure of dabigatran effect according to the Pradaxa drug info leaflet. In fact, TT is “too sensitive to give quantifiable results” so dilute TT is used for this purpose. Hemoclot is a thrombin inhibitor assay that is also of use.


Q23. Complications of SSRI include all EXCEPT A) bleeding requiring transfusion

Q25. Repeat 2014B

Distance below water in the 3rd bottle is equal to the negative pressure generated when suction is applied.

Q26. Non parametric data with 2 intervention and one placebo. Chi square test Fisher exact test ANOVA – for parametric data only

Chi-square and Fisher exact test both useful for non-parametric data comparing >2 groups. Fisher-exact test gives more accurate p-value (even with scant data) whereas Chi-square is an estimate.

Q27. 2 groups of patients one placebo one treatment. Compare each group at the start and 3months -

C. The groups being compared are unpaired. BP data is continuous  parametric.


Type of Data Goal Measurement (from Gaussian Population) Rank, Score, or Measurement (from Non- Gaussian Population) Binomial (Two Possible Outcomes) Survival Time Describe one group Mean, SD Median, interquartile range Proportion Kaplan Meier survival curve Compare one group to a hypothetical value One-sample ttest Wilcoxon test Chi-square or Binomial test ** Compare two unpaired groups Unpaired t test Mann-Whitney test Fisher's test (chi-square for large samples) Log-rank test or Mantel-Haenszel* Compare two paired groups Paired t test Wilcoxon test McNemar's test Conditional proportional hazards regression* Compare three or more unmatched groups One-way ANOVA Kruskal-Wallis test Chi-square test Cox proportional hazard regression** Compare three or more matched groups Repeated-measures ANOVA Friedman test Cochrane Q** Conditional proportional hazards regression** Quantify association between two variables Pearson correlation Spearman correlation Contingency coefficients** Predict value from another measured variable Simple linear regression or Nonlinear regression Nonparametric regression** Simple logistic regression* Cox proportional hazard regression* Predict value from several measured or binomial variables Multiple linear regression* or Multiple nonlinear regression** Multiple logistic regression* Cox proportional hazard regression*

Q28. D. Depends on interpretation of “0.05 or greater” and the exact wording in the exam.

p-value or probability value is the probability for a given statistical model that, when the null hypothesis is true, the statistical summary (such as the sample mean difference between two compared groups) would be the same as or more extreme than the actual observed results.

Q29. A 99.8% (crossmatch) – March 2011

Kerry Brandis (not sure on page numbers as don’t have the book).

Q30. C.

Jacob et al. Anesthesiology. 2011;114(2):311-7.


MCQ

Qu 30) The peripheral nerve most commonly injured in surgical procedures is: a) Common peroneal b) Sciatic c) Ulnar d) Radial e) Lateral femoral cutaneous

ATOTW: ulnar nerve 28%, brachial plexus 20%, lumbosacral root 16%, spinal cord 13%. Injury is less common for the sciatic, median, radial and femoral nerves.

Reference: http://www.frca.co.uk/Documents/258%20Peripheral%20Nerve%20Injuries%20and%20Positioning%20for%20Anaesthesia.pdf

31) The peripheral nerve most commonly injured in total knee arthroplasty is: a) Lateral femoral cutaneous b) Infrapatellar branch of saphenous c) Sciatic

No recalled option here for peroneal nerve, but this is the answer. Peroneal nerve is the most commonly injured after knee arthroplasty. MOA is stretch or traction of nerve.

Reference: https://www.researchgate.net/publication/11615453_Nerve_injury_after_primary_total_knee_arthroplasty

32) For emergency surgery, the minimum effective prothrombinex dose to reduce an INR from 2.0 to 1.5 is: a) 5 b) 15 c) 25 d) 35 e) 50

PROTHROMBINEX DOSING • Recommended dose or prothrombinex in 2005 was 25- 50 IU/kg • This has been replaced in 2013 by doses according to inital INR and the target INR (i.e. 15-50 IU/kg Initial INR


Target INR 1.5–2.5 2.6–3.5 3.6–10.0 > 10.0 0.9–1.3 30 IU/kg 35 IU/kg 50 IU/kg 50 IU/kg 1.4–2.0 15 IU/kg 25 IU/kg 30 IU/kg 40 IU/kg

Reference: LITFL https://lifeinthefastlane.com/ccc/warfarin-reversal/

33) Patient for breast surgery. You undertake a thoracic wall block. The nerve which is unlikely to be blocked is: a) medial pectoral b) dorsal thoracic c) supraclavicular d) lateral pectoral e) thoracodorsal

PECS II is a thoracic wall fascial plane block using a relatively large volume of a local anesthetic to immerse the LPN, MPN, LTN, and lateral cutaneous branches of the T2–T4 intercostal nerves. The anterior cutaneous branches of the T2–T6 nerves, which supply the medial third of the breast, are spared. A Supplemental parasternal intercostal nerve block may be required for surgery involving this area. The upper part of the breast was not anesthetized by PECS II either. PECS II was previously demonstrated to have more favorable postoperative analgesia than did a single-level PVB for MRM [25]. Neither a single-level PVB nor PECS II alone provided complete anesthesia in radical breast surgery.

NYSORIA: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166227

34) The best evidence for medical treatment of trigeminal neuralgia supports use of: a) Amitryptyline b) Gabapentin c) Venlafaxine d) Carbamazepine e) Sodium valproate

Reference: Nurmikko, T.J. & Eldridge P.R. Trigeminal neuralgia – pathophysiology, diagnosis and current treatment. Br J Anaesth 2001; 87:117-32

35) Microvascular decompression for trigeminal neuralgia results in a mean ? resolution of symptoms for: a) 1 year b) 3 years c) 5 years d) 7 years e) 10 years

At 1-2 years the incidence of complete pain relief is 75-80%, at 8-10 years, this proportion has been reduced to 58-64%, with a further 4-12 % suffering from minor recurrence only.

Reference: Nurmikko, T.J. & Eldridge P.R. Trigeminal neuralgia – pathophysiology, diagnosis and current treatment. Br J Anaesth 2001; 87:117-32


36) Young man for thoracic surgery requiring OLV. You decide to use a Robert shaw left 39F DLT. You insert and inflate both cuffs and ventilate the bronchial lumen. Asucultation sounds like isolation of left lung. You then attempt to ventilate the tracheal lumen and get high pressures and no breath sounds but on deflating the bronchial cuff are able to ventilate both lungs. Appropriate management is to: a) change to 41 F b) insert further 1 cm c) change to 37F d) withdraw further 1 cm e) Remove DLT and start again

37) Kessel blade angulation is a) 90 degrees b) 100 degrees c) 110 degrees d) 120 degrees e) 130 degrees

https://lifeinthefastlane.com/ccc/laryngoscope-and-blades/

40) Hepatic resection and you suspect large venous air embolus with associated haemodynamic instability. Appropriate management includes positioning patient a) Head down, left tilt b) Head down, right tilt c) Head up, no tilt d) Head up left tilt e) Head up right tilt

Oxford handbook page 433

41) Long labour with motor and sensory defect suggesting obturator injury

?? really

CEACCP suggest that in prolonged second stage labour, the fetal head compressing the lumbosacral trunk causes foot drop. Also 25% of lesions occur with femoral or obturator. In stirrups, the peroneal nerve is affected the most.

Reference: https://academic.oup.com/bjaed/article/13/2/63/283709/Post-natal-neurological-problems


42) Neurosurgical case. Volatile which at 1 MAC has the least effect on ICP a) Desflurane b) Isoflurane c) Halothane d) Enflurane e) Sevoflurane

At 0.5 MAC, isoflurane, desflurane, and sevoflurane minimally delay, but preserve the cerebral autoregulation, whereas at 1.5 MAC autoregulation is considerably reduced by isoflurane and desflurane. Sevoflurane, in contrast, produces much lesser cerebral vasodilation and delays but preserves the autoregulatory response even at 1.5 MAC, making it the favoured volatile agent during neuroanaesthesia.

Reference: https://academic.oup.com/bjaed/article/13/4/113/345118/Cerebral-physiology

43) Anasthetic machine required for trigger free anaesthetic. Has been flushed but no carbon filters available. For entire case flows should run at a minimum of a) 2L/min b) 4 L/min c) 6 L/min d) 8 L/min e) 10 L/min

MHANZ Guidelines. http://www.anaesthesia.mh.org.au/mh-resource-kit/w1/i1002692/

See the MH introduction download tab.

44) JW for AAA repair refusing blood products despite long discussion. You refuse to do the case. This is an example of: a) Beneficence b) Autonomy c) Maleficence d) Justice e) Paternalism




45) Cardiac output achieved with effective CPR a) Less than 10% b) 10-20% c) 20-30% d) 30-40% e) 40-50%


45 - Effective CO in CPR - ANS C

-25-33% Emerg med website

46 - Newborn Resus SaO2 Target - ANS C

-at 5min the target is 80-90%
 -at 1min it is 60-70

-at 2min it is 65-85 -at 3min it is 70-90 -at 4min it is 75-90 -at 5min it is 80-90 -at 10min it is 85-90

47 - Stroke risk ANS ?9% if going off CHADS2 - D - 12% as CHADS 2 is 12.5% -CHADS2 Vs CHA2DS2VASc (CHadsvasc for this question) CHADS

-CCF, HTN, Age >75, DM, Stroke x2, 
  0 - 1.9
  1 - 2.8
  2 - 4
  3 - 5.9
  4 - 8.5
  5 - 12.5
  6 - 18.2

CHA2DS2VASc

-CCF, HTN, Age 65-74, DM, Stroke 2x, Vascular Dx, Age >75, Sex - female

0 – 0.6
1 - 1.3
2 - 2.2
3 - 3.2 
4 - 4.8
5 - 7.2
6 - 9.8
7 - 11.2
8 - 10.8 
9 - 12.2

Aspirin if 0-1, WRF if 2 or greater

48 - Contraindications to peribulbar block ANS Staphyloma C

Why? Relative contriaindications are axial length greater than 26mm in severe myopia which as a long AP diameter and my contain staphylomas (outpouching) Other include trauma, infection, inability to lie flat or still


49 - Sparing of lateral forearm ANS A - sparing of musculocutaneous

WHy? The lateral antebrachial cutaneous nerve is a terminal branch of the musculocutaneous

- the medial forearm is supplied by the medial antebrachial which is C8-T1 and often spared

50 - Maximum time for tourniquet? ANS D - 120min

Source - CEACCP article suggesting literature is 90-120min, question asks for maxiumum

51 - Length of cuff inflation with biers block when using prilocaine (methaem) ANS? remembered wrong?

Options given 15min 30min 45min 60min 75mins

Answer: B

Anaesthesia UK says 20min minimum UK ED college says 20min minimum

52 - ABS prior to torniquet ?ANS B - 30min prior??

NCBI article states literature says 5-10min before inflation AAGBI guidelines 2010 state at least 5min prior


53 - Molar 48 removal and left chin numbness ? ANS C?


Mental nerve - branch of Inferior alveolar nerve -

Out of interest teeth are labelled by the ISO system Right Upper is 1, Left upper is 2, Left Lower is 3 and R lower is 4 Teeth are then labelled from centre to lateral starting at 1

Inferior alveolar nerve supplies sensation to the teeth (branch of the mandibular (trigeminal) Mental nerve - sensation to chin and lower lip BUT is a branch of the inferior alveolar nerve

Neurpraxia of the alveolar nerve has been reported with wisdom tooth extraction


54 - Numbness on upper lip ANS - Infraorbital B

Lacrimal nerve - branch of opthalmic (trigeminal), supplys sensory to lacrimal gland, conjunctiva and upper eyelid Infraorbital - actually starts as the maxillary nerve (trigeminal), supplies lower eyelid, upper lip, nasal vestibule Infratrochlear Nerve (branch of nasocilliary), supplies upper eyelid, conjunctiva, bridge of the nose Supraorbital Nerve - supplies upper eyelid, conjunctiva. Branch of frontal nerve Occulomotor - 3rd cranial, most of the movements of the eye, also accomodation and pupils

55 - Abdominal contractions with brachial plexus block ANS B - repeat phrenic nerve Hiccups – phrenic nerve

Im assuming they mean phrenic nerve contractions, which can occur with interscalene mainly but also supraclavicular blocks -the phrenic nerve roots (C3,4,5) are more anterior and thus move the needle more posterior ALSO NEVER aim the needle cephalad as increases the chances of cervical cord injury


56 - ANS b (L3/4) – 2015 A

L2/3 is the level that the cord ends (conus medullaris) in neonates, (L1 in adults) NYSORA recommends lower than L2/3 for safety Interestingly truffiers line is L3/4 in adults, in kids this is also more caudad and is at the level of L4/5 or even S1 so is a safe level



57 Scalp Block ANS A

Another shit question, largely a relic and not used that much anymore Nerves blocked -Supratrochlear (trigeminal) V1 -Zygomaticotemporal (trigeminal) V2 -Auriculotemporal (trigeminal) V3 -Lesser Occipital (branch of second or third cervical spinal) -Greater Occipital (branch of third cervical spinal) -Greater Auricular (branch of 3rd cervical spinal)


58 Difficult OBS airway - ANS B - insert supraglottic

source is the 2015 DAS obstetric guidelines, clearly state to insert LMA or mask post 2x attempts at intubation, then consider waking


59 AICD - ANS E

Ceases defib and doesnt effect pacing usually

60 March 2015

A Albumin in Head injury - contraindicated SAFE Study, higher mortality when compared to NS


61 TURP Sx, March 2012

A:20% saline bolus B 3% saline at 100mls/Hr C Normal saline maintanence D Frusemide 40 mg IV

Mx of Symptomatic hypoNa is B

62

Emergence Delerium, ANS ?B

May have been misremembered, propofol as a single agent is associated with lower rates, transition does help but not as much as dexmetatomidine, clonidine, fentanyl Review article 2016

63 Procedure contraindicated patients with DBS A) Cardioversion for ECT B) Emergent cardioversion C) MRI D) ECT

Answer: C


DBS and procedures

ECT is ok with DBS, not contraindicated, does require review and planning tho Cardioversion doesnt seem to be contraindicated MRI is in some settings so probably best answer



64 A 5 month old child is for surgery in the morning. What is the fasting time advice:

a) 6 hours for breast milk and 2 hours for clear fluids b) Fast from midnight c) 3 hours for breast milk and 2 hours for clear fluids d) 4 hours for breast milk and 2 hours for clear fluids e) 3 hours for breast milk and clear fluids up to time of surgery


For children over six months of age having an elective procedure, breast milk or formula and limited solid food may be given up to six hours and clear fluids up to two hours prior to anaesthesia.

iii. For infants under six months of age having an elective procedure, formula may be given up to four hours, breast milk up to three hours and clear fluids up to two hours prior to anaesthesia.


65 You perform a lung ultrasound in a patient. You see A lines and sliding lung. What is the diagnosis? a) Normal b) Pneumonia c) Pneumothorax d) Pulmonary oedema

Answer: A


66 NIM tube question (REPEAT)(REPEAT)

18) The nerve integrity monitor (NIM) endotracheal tube works by monitoring: a) Electromyography of internal laryngeal muscles b) Recurrent laryngeal nerve action potential c) Movement of the vocal cords on the endotracheal tube d) Pressure of the vocal cords on the endotracheal tube F) Recurrent laryngeal nerve action potential

Answer: A


67 TEG hyperfibrinolysis (REPEAT) (REPEAT)

2016 Aug Q143

68 Obturator nerve Question (REPEAT) (REPEAT)

69 Inferior alveolar nerve question -lower lip question 2016b – inferior alveolar nerve via the mental nerve

(REPEAT) (REPEAT)


70 A patient has ceased his dabigatran. He is bleeding intra-op in the morning suspect dabigatran causing the bleeding. What is the most effective treatment?

a) Some monoclonal antibody b) Idarucixumab c) Prothrombinex d) Novo 7 e) TXA

Answer: B

71) Dabigatran. What will give the most accurate estimate of effect? a) b) INR c) dilute thrombin time d) APTT

Answer: C

72) Patient with weak toe dorsiflexion. Pain in the lateral calf. What is the most effective treatment? (seemed like L5 root compression) a) Epidural steroid b) Facet joint injection

Kerry says need to be fully reviewed, neurosurgeons involved, if nothing to be done then a medial branch block

73) Patient on SSRI. What is the LEAST likely post-op effect? a) AF b) Post op bleeding requiring transfusion c) VT Answer: B

74) What is the 1st line agent for trigeminal neuralgia?

a) Carbamazepine b) Pregabalin c) NSAID d) Amitriptyline

Answer: A

75) What is the expected time to return of pain after trigeminal nerve decompression? a) 2 years b) 3 years c) 5 years d) 10 years e) 15 years

Answer: D


76) From NAP5 what is the incidence of awareness when NMB used? a) 1:500 b) 1:1000 c) 1:2000 d) 1:8000 e) 1:11000

D

NAP5 The incidence of certain/probable and possible accidental awareness cases was ~1:19,600 anaesthetics

The incidence with neuromuscular block (NMB) was ~1:8200 (1:7030-9700), and without, it was ~1:135,900 (1:78,600-299,000)

The incidence of accidental awareness during Caesarean section was ~1:670 (1:380-1300)

Two-thirds (82, 66%) of cases of accidental awareness experiences arose in the dynamic phases of anaesthesia, namely induction of and emergence from anaesthesia

One-third (43, 33%) of accidental awareness events arose during the maintenance phase of anaesthesia, mostly due to problems at induction or towards the end of anaesthesia


77) Patient with AF, 73 year old, HTN, diet controlled DM, recent slurred speech, female and weak arm (yes that what it says). What is the risk of stroke?

a) 4% b) 6% c) 9% d) 12% e) 18%

Answer: B Score of 5



78) 25 year old MBA. Femur fracture.. Femoral nerve block and 25 mg morphine. In ED for 12/24. Normal CXR on admission. Now with RR 25, BP 120/80, HR 90, Crackles on chest, Sats 90%

What is the cause?

a) Lung contusion b) Aspiration c) Fat embolism d) Opioid overdose

Answer: A Normal BP but crackles – and a bit early for both fat embolism and pulmonary contusions. BP normal and HR normal

2014b Q57 (repeat)

79 Child brought in, Purpuric rash, lethargy and reduced respiratory rate. What would be the ABG?


Answer: ?A Likely metabolic acidosis secondary to sepsis and tiring out hence increase PCO2

80 Nasal Prongs at 3L/min. What is max FiO2?

a) 0.24 b) 0.28 c) 0.32 d) 0.36 e) 0.4

Answer: C


81 6 year old child with Hb 70. How much blood (mls) to give to achieve an Hb of 80? a) 80 b) 120 c) 160 d) 200 e) 240

Answer: A

Frank Shann's equation: 4ml/kg of packed cells will increase Hb by 10g/L. Thus 4x20x4 = 320 mls

Alternatively, National Blood Transfusion equation: (basically the same equation) volume of packed cells (ml) = 0.4 x pt weight (kg) x desired increase in Hb (g/L)


82 what is the dose of IM adrenaline for 14 year old with Grade 3 anaphylaxis?

a) 100 mcgs b) 200 c) 300 d) 400 e) 500

Answer: E AAGBI Adrenaline Intramuscular > 12 years: 500 lg IM (0.5 ml of a 1 : 1000 solution) 300 lg IM (0.3 ml of a 1 : 1000 solution) if the child is small 6-12 years: 300 lg IM (0.3 ml of a 1 : 1000 solution) Up to 6 years: 150 lg IM (0.15 ml of a 1 : 1000 solution)


83) You place a 39 Fr DLT in a man. Inflate bronchial cuff up and ventilate left lung. Then inflate tracheal cuff with high inspiratory pressures and can’t ventilate. Deflate bronchial cuff and can ventilate both lungs. What to do?

a) Exchange for 37 Fr b) Exchange for 41 Fr c) Deflate both cuffs and advance DLT d) Remove DLT and start again e) Deflate cuffs and pull out DLT a bit

Answer: C (repeat 2009Mar 2010 Aug)

84 Just commenced cardiopulmonary bypass. No cardioplegia yet. Blood in arterial line is same colour as venous line. Sats 90%. What is the next step?

a) Connect extra O2 line to membrane oxygenator directly b) Clamp aorta and start cardioplegia and continue lung ventilation c) Wean from bypass and ventilate d) Continue bypass and ventilate lungs Fi02 100% ( or reinflate lungs)

Answer: C


85 Just weaned from cardiac pulmonary bypass and blood coming up from the mouth. Pulmonary artery catheter in situ. What is the management? a) Pull back on PAC b) Restart CPB and heparinize c) Start vasopressor

Answer: ?B Pulmonary artery rupture.


86) Patient for AAA. Patient refuses blood transfusion due to risk of CJD. Despite knowing risks of not having blood, patient still refuses. In considering the high risk of not allowing a transfusion with this procedure, the anaesthetist refuses to anaesthetize. The principle that best describes this:

a) Maleficience b) Beneficience c) Paternalism d) Autonomy e) Justice

Answer: C


87 FiO2 for flat neonate

88 Sats for neonate at 5 mins

89 (repeat) What product is not in Cryoprecipitate? a) Fibrinogen b) Factor 8 c) Factor 13 d) Factor 9 e) Von willebrand factor

Answer: D

90 (repeat) Patient with signs of DVT. Was on heparin infusion last week. Platelets now 40. What is the most appropriate treatment?

a) Clexane b) Fondaparineux c) Therapeutic heparin d) Lepirudin e) Warfarin

Answer: D

?Is lepirudin available in Australia – so is

91 Patient for AV fistula. Had interscalene

block. Incision in lateral forearm and immediate pain. Which nerve not blocked?

a) Musculocutaneous nerve b) Axillary c) Ulnar d) Median e) Radial Answer: A

Lateral antebrachial cutaneous nerve is a terminal branch of the musculocutaneous

- the medial forearm is supplied by the medial antebrachial which is C8-T1 and often spared

92 What is this device? (PICTURE of bivent PPM with AICD) a) Dual chamber bivent PPM with AICD (answer) b) Single chamber PPM c) Dual chamber PPM d) AICD e) Loop Device

https://radiopaedia.org/articles/cardiac-conduction-devices





93 25 year old brought in for syncope. Brugada ECG RBBB, ST elevation in V1-V2, HR 100. What is the management?

a) AICD b) Metoprolol c) Amiodarone d) Ramipril e) Aspirin

Answer: A Life in the fast lane

94 (repeat) Which drug will reduce the analgesic effect of tramadol?

b)Ondansetron


95 Tramadol Question and AF? a) Clonidine b) Metoprolol



96 Perform GA for emergency LUSCS for foetal bradycardia. 2 failed attempts at intubation. What to do?

a) Reattempt at intubation b) LMA insertion c) Get consultant to intubate d) Perform needle cricothyroidotomy e) Wake patient up

Answer: B source is the 2015 DAS obstetric guidelines, clearly state to insert LMA or mask post 2x attempts at intubation, then consider waking





97) Patient post TKR with tourniquet with spinal. 12/24 post op good knee flex and extension. 18/24 post op weak flexion, paraesthesia in calf and pain. Cause?

a) spinal trauma b) cuff neurapraxia c) muscle necrosis

Femoral nerve block the cause?


98 Post TKR patient has absent plantar flexion, calf muscle weakness and decreased sensation on top of the foot. Injury to which nerve? a) Common peroneal b) Deep peroneal c) Femoral nerve D) Tibial nerve E) Sciatic

Answer: E


99 which drug inhibits the antiplatelet effect of aspriin?

a) Celecoxib b) Ibuprofen c) Diclofenac d) Ketorolac e) Parecoxib

Answer: B (see above)

100 A patient is allergic to Sulphur drugs. Reaction after taking co-trimoxazole (generic name). Which of these can she not take?

a) Frusemide b) Metoprolol c) Morphine sulphate d) Celecoxib e) Trimethoprim

Answer: E


101) Which volatile increases the ICP the least at 1 MAC?

a) Desflurane b) Enflurance c) Isoflurance d) Sevoflurane

D (repeat)

102) How long does it take for buprenorphine patch to reach full effect?

a) 1 day b) 2 days c) 3 d) 4 e) 5

Answer: C

Fentanyl patch:

  Peak:  24 - 72 hours.
  Half-life:  22-25 hours.

Buprenorphine patch:

  Peak:  by 72 hours
  Half-life:  12 hours.


103) Need to remove upper lip lesion. Which nerve to block?

a) Infraorbital b) Infratrochlear c) Supraorbital d) Mental

Answer: A


104 what is the most sensitive (or accurate) predictor of difficult intubation in obesity?

a) MP score b) Pretracheal soft tissue c) Mouth opening

Answer: B (repeat)




105 Where on the chest is lead v4 placed?


106 Patient is flushed diaphoretic with diarrhea. Scheduled for hemicolectomy for tumour excision. What is the best first treatment?

a) Octreotide b) Phenoxybenxamine c) Prazosin

Answer: A

Carcinoid tumour causing syndrome

Symptoms: Intermittent flushing - head neck torso (90%) Diarrhoea (78%) Bronchospasm (20%) Cardiovascular instability - hypo/hypertension, tachy hyperglycaemia right heart failure - endocardial fibrosis - pulmonary & tricuspid valves (mediators metabolised in lung before reaching L heart)



107 Which is not relatively contraindicated with escitalopram?

a) Clonidine b) Omeprazole c) Metoprolol d) And e) sympathomimetics or vagolytics Answer: A

108) what is the cause of lactic acidosis with metformin use?

a) Reduced Gluconeogenesis b) Reduced glycolysis c) Reduced lactate clearance d) Reduced renal function e) Liver failure?


Answer: A

California poison control system The exact mechanism and role of metformin in the setting of MALA is a controversial subject. The mechanism for the reduction of hepatic gluconeogenesis is due to inhibition of mitochondrial respiratory chain complex I causing a decline in cellular ATP production. Gluconeogenesis, an energetically costly process, is reduced as the result of an impaired energy state. It is this mitochondrial impairment that leads to a buildup of lactic acid, a substrate of stalled gluconeogenesis.


109) There is a new drug for hypertension management. It will be compared to another drug and BP measures at 3 separate time intervals. To determine if there is a significant difference this requires what statistical test?

 (normal distribution with 3 different measurements)

a) Students t –test with Bonferroni correction b) Mann- Whitney U test c) Chi squared test

Answer: ?A

Type of Data Goal Measurement (from Gaussian Population) Rank, Score, or Measurement (from Non- Gaussian Population) Binomial (Two Possible Outcomes) Survival Time Describe one group Mean, SD Median, interquartile range Proportion Kaplan Meier survival curve Compare one group to a hypothetical value One-sample ttest Wilcoxon test Chi-square or Binomial test ** Compare two unpaired groups Unpaired t test Mann-Whitney test Fisher's test (chi-square for large samples) Log-rank test or Mantel-Haenszel* Compare two paired groups Paired t test Wilcoxon test McNemar's test Conditional proportional hazards regression* Compare three or more unmatched groups One-way ANOVA Kruskal-Wallis test Chi-square test Cox proportional hazard regression** Compare three or more matched groups Repeated-measures ANOVA Friedman test Cochrane Q** Conditional proportional hazards regression** Quantify association between two variables Pearson correlation Spearman correlation Contingency coefficients** Predict value from another measured variable Simple linear regression or Nonlinear regression Nonparametric regression** Simple logistic regression* Cox proportional hazard regression* Predict value from several measured or binomial variables Multiple linear regression* or Multiple nonlinear regression** Multiple logistic regression* Cox proportional hazard regression*


110) What is an absolute contraindication to sitting craniotomy?

a) Small PFO b) Ventricular atrial shunt

Answer: A and B Absolute CI – cerebral ischaemia when upright and awake – patent VA shunt – PFO

Relative CI - uncontrolled HTN - age extremes (?Cutoff) - COPD


111) A patient with sepsis has RR25 HR 110 Temp 38.9C. What is qSOFA score

a) 1 b) 2 c) 4 d) 5 e) 6

Answer: A


112) Which nerve distributions need to be covered for awake craniotomy?

a) trigeminal, greater auricular, greater occipital b) trigeminal, greater occipital, lesser occipital c) ophthalmic, maxillary, greater auricular d) greater occipital, lesser occipital, auriculotemporal e) Trigeminal, greater occipital, posterior auricular

Answer: A or B?





1. 3rd molar removal with LA block . Tingling of the chin noticed. What nerve is responsible? Mental nerve Other options cant remember

2. Post peri bulbar block tingling and ipsilateral upper lip. What is the nerve involved? Infra-orbital

3. Contra indications for peri bulbar block. INR 2.2 Staphyloma Pterygeum Scleral buckle Axial length 24


4. Left temporal and R nasal visual field loss

     R/optic tract (repeat) mar 2016

5. According to NAP 5, awareness under GA 1:8000

6. In 12 lead ECG, Where is V4 position 5th intercostal space Mid clavicular line

7. In thoracic wall block, what nerve is unlikely to not be blocked? Supraclavicular nerve Thoracodorsal nerve Long thoracic nerve Lateral pectoral nerve Medial pectoral nerve

Answer: A Justin says supraclavicular is part of brachial block


8.Scalp block include below nerves Trigeminal, Greater occipital, Lesser occipital Trigeminal, greater auricular, lesser occipital

9.Rpt DLT bronchial cuff herniation Q Deflate cuff push in

10. Least risk of DVT what NSAID

Increasing incidence: Naproxen< Diclofenac< Ibuprofen< Celecoxib< Rofecoxib


Schmidt et al - NSAIDs use and DVT 2011


11.Bi directional Glen shunt SVC- R/ pulmonary artery SVC- main pulmonary artery

12.What can decrease the effect of Aspirin Ibuprofen

13. What factor is deficient in Cryo

 Factor IX
VWB

14. Prothrombinex dose to decrease INR from2 to 1.5 25 mg/kg 50mg/kg

15What is the blood test of choice to test Dabigatran activity ACT APTT ROTEM PT


16. what is the Dabigatran reversal agent Idarucizumab

17. Not safe for MRI , Post MVR day 2 Epicardial wires Sternal wires

18.Regarding Deep Brain Stimulator true EXCEPT Not safe for MRI Cannot use monopolar


19.Pulmonary haemorrhage immediate post bypass ?

recommence  CPB

20. On CPB arterial line blood as same colours as venous line. What to do?

Increased ventilation Increased oxygen concentration of pump Addition of oxygen to tubing Wean by pass


21Increased rate of mask acceptance in paediatric population least likely clown doctors midazolam parental presence


22.Emergence delirium decreased by

Sevo induction/ maintenance transition to propofol


23. Mast cells

24. Tryptase checked in post anaphylaxis (RPT) 1,4, 24 hours


25. For resistance anaphylaxis as per ANZCA guidelines EXCEPT Metaraminol Glucagon Promethazine Vasopressin

26. 14 yr old boy anaphylaxis , what is the dose of IM adrenaline 400mcg 500mcg 200mcg

27. Fibrooptic bronchoscope sterilization according to ANZCA

B

Critical: the device will penetrate skin or mucous membranes, enter the vascular system or a sterile space – these devices require sterilisation.

Semi-critical: the device will be in contact with intact mucous membranes or may become contaminated with readily transmissible organisms – these devices require high level disinfection or sterilisation. (bronchoscope)

Non-critical: the device contacts intact skin or does not contact patient directly – these devices require low level disinfection or cleaning.


28. ECG 1 large square ( 5 small squares equivalent to 200msec- 0.5 mv 100msec- 0.5 mv 200msec 0.1mv 200msec 1mV


29. ECG ? Brugada/ ? WPW v1, v2 ST elevation and TWI

30. Ketamine oral bio availability 10% 20% 60%

31. p value <0.05 in one study, if you were to repeat the same study maintaining same conditions chances of getting the same results

0.05% 50% 99% 0.95% 0.01%

32. Chlorhexidine used for skin prep for neuraxial block 4% 2% 0.5% 0.1%


33 Betadine Vs Chlorhexidine for skin prep for CNB EXCEPT less neurotoxicity

povidone Bacteriostatic

Chlorhexidine Bacteriocidal Faster onset, Longer duration of action Efficacy in presence of blood Lower incidence of skin reaction Less colonisation of epidural catheter

http://www.aagbi.org/sites/default/files/skin_antisepsis_v3_for_members%2011APRIL14.pdf


34. magnet on PPM + Defibrillator Deactivate defibrillation function+ not activate asynchronous mode

35. Lung function FVC 4.3, FEV1 3.4 Can proceed for pneumonectomy or lobectomy

36. CPR chest compression effective <20% 20-30%

37. Gabapentin steady state 1 day 2 days 3 days


38. resuscitation goals in a child with pyloric stenosis Wet nappies 2 per 12 hours and dry Mucous membranes pH 7.4 Na 140 Cl 80 Uop 2 ml/kg


39 old man with anaemia , most likely blood picture

microcytic hypochromic



40. strong ion difference with normal abumin

+40 +20 0 -20 -40


41.


Tracheal stenosis Lung transplant COPD Asthma Vocal cord tumor

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