Finals MCQs-Mar 2013

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I am trying to organize allocating MCQs pre-exam for people to remember. There are more than 50 of us so if everyone could participate I would appreciate it greatly as it means less questions per person.

I have got everyone from the Melbourne course on board and am trying to contact everyone in Australia/New Zealand/Singapore/Hong Kong.

I am also trying to study for this exam so if you could just email me with interest I will allocate you a number. Better yet if you could organize your local group that would be great. I will then try to email everyone before the exam to remind them of which questions they are responsible for.

Please email [email protected] (The sooner the better please so I can sort this and then get on with studying.)

Thanks, Kirstie

"Thanks everyone. This contribution to black bank made possible by the 50 volunteers
of the 2013 exam and a centralized process. There were still a number of questions
missing and the numbering is not quite correct but in the end it has been pulled
together by all their hard work. If you have found this beneficial, it would be nice
to pay it forward to your colleagues. It was only achievable thanks to the number of
people involved and would have been more accurate if more had contributed, so get
involved. Thanks again to everyone for their efforts." -Anonymous.

1. 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
D. The Line Isolation Monitor will alarm and disconnect power to the device
E. The RCD will rapidly disconnect the device from the power supply

2. EZ99 According to the current ANZCA approved standards for labeling, the appropriate colour label for an intraosseous infusion is (some remember it saying INTERosseous, not intraosseous... possibly typo, possibly trick question)

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

3. PP102 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

4. A 30 year-old pregnant patient develops contractions at 30/40 weeks gestation which of the following cannot be used for tocolysis

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

5. 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 seizure and losing consciousness. Which drug should NOT be given?

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

6. A patient with HOCM presents with dyspnoea and angina on exertion. Which of the following is the best agent to treat these symptoms

A. Glycerol trinitrate
B. Metoprolol
C. Morphine
D. Hydrochlorthiazide
E. Salbutamol

7. 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 mycocardial 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 a weeks 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

8. A 40 year-old lady with a history of a bleeding diathesis presents for a tonsillectomy. What is the most likely cause?

A. Factor V Leiden
B. Protein S deficiency
C. Haemophilia B
D. Antithrombin III deficiency
E. Protein C deficiency

9. What is the most cephalad intervertebral space at which a spinal can be sited in a neonate where the risk of damage to the spinal cord is minimal

A. L1/2
B. L2/3
C. L3/4
D. L4/5
E. L5/S1

10. St John's Wort (Hypericum perforatum) potentiates the effects of

A. Dabigatran
B. Heparin
C. Warfarin
D. Aspirin
E. Clopidogrel

11. 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

12. A patient is having an electrophysiological study and ablation for atrial fibrillation. Suddenly the blood pressure drops to 76/38 mmHg, with the heart rate at 110 in sinus rhythm. What is the best investigation to confirm the cause of hypotension?

A. Troponin
B. ST-segment elevation
C. Transoesophageal echocardiography
D. Coronary Angiogram
E. Electrocardiogram

13. Which is the most powerful predictor of atrial fibrillation post cardiac surgery.

A. Age
B. History of hypertension
C. History of CVA
D. History of diabetes
E. Time on Bypass

14. A man with a history of Parkinsons disease has undergone uncomplicated general anaesthetic for a knee replacement but develops post-operative nausea and vomiting (PONV). He received 4mg dexamethsone intraoperatively as prophylaxis. What would you use to treat his PONV in recovery?

A. Dexamethasone
B. Prochloperazine
C. Metoclopramide
D. Droperidol
E. Ondansetron

15. Which of the following is of the least benefit in the treatment of severe anaphylaxis?

A. Cardiopulmonary bypass
B. Nebulised salbutamol
C. IV crystalloid
D. IV vasopressin
E. Subcutaneous adrenaline

16. A 70 year old patient is being 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

17. The percentage of post dural puncture headaches that would resolve spontaneously by 1 week is closest to

A. 90%
B. 70%
C. 50%
D. 30%
E. 10%

18. Which piece of airway equipment is designed for use with a fibreoptic bronchoscope

A. Aintree
B. Cook’s airway exchange catheter
C. Frova introducer
D. ?
E. ?

19. A 50 year old lady is seen at the pre-operative assessment clinic, she is on 150mg/day methadone, what is the most likely ECG change to be found in her pre-op ECG?

A. Prolonged PR interval
B. Prolonged QTc
C. ST depression
D. U wave
E. Tented T-waves

20. Current guidelines regarding cardiopulmonary resuscitation include all of the following EXCEPT

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

21. When a 3 lead ECG is applied correctly in the CS5 position, you will monitor lead II when you suspect which of the following conditions

A. Anterior ischemia
B. Inferior ischemia
C. Lateral ischemia
D. Atrial ischemia
E. Posterior ischemia

22. You are anaesthetizing a 50 year old man who is undergoing liver resection for removal of metastatic carcinoid tumour. He has persistent intraoperative hypotension despite fluid resuscitation and intravenous octreotide 50 ug. The treatment most likely to be effective in correcting the hypotension is:

A. Adrenaline
B. [[Dobutamine]
C. Levosimenden
D. Milrinone
E. Vasopressin

23. Using the American Heart Association specification, the colours of the electrodes in a 3-lead electrocardiographic (yes the typo is what they used) is

A. Right arm = Black; Left arm = White; Left leg = Red
B. Right arm = White; Left arm = Black; Left leg = Green
C. Right arm = Black; Left arm = Green; Left leg = Red
D. Right arm = White; Left arm = Black; Left leg = Red
E. Right arm = Red; Left arm = White; Left leg = Green

24.->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

25. You are doing a supraclavicular brachial plexus block on an awake 35 year-old lady who is healthy with no significant past medical hsitory. Soon after injecting 20mLs of 0.375% ropivicaine she becomes agitated, has a seizure and loses consciousness. Your 1st step in management is

A. Intralipid 20% 1.5ml/kg bolus
B. Midazolam
C. Propofol
D. Establish airway and give 100% O2 via a facemask
E. Feel for radial pulse and give 100mcg adrenaline

26. A G1P0 patient with a dilated cardiomyopathy and an ejection fraction (EF) of 35% presents for a caesarean section. The benefits of regional vs general anaesthesia are

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

27. ET05 A patient has a terminal malignancy. His family doesn’t want you to tell the patient about his diagnosis and prognosis. Your decision to inform him is an example of:

A. Autonomy
B. Beneficence
C. Confidentiality
D. Non-maleficence
E. Utilitarianism

28. A septic patient has a CVP of 12mmHg, a blood pressure of 80/40mmHg and a pulse rate of 90/minut:E. Which is the best agent to treat their hypotension

A. Dopamine
B. Dobutamine
C. Noradrenaline
D. Adrenaline
E. Levosimenden

29. Which organ is least tolerant of ischaemia following removal for transplantation

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

30. You are performing a TAP block. If the needle is correctly positioned where will you deposit the local anaesthetic

A. Beneath the peritoneum
B. Into the transverse abdominus muscle
C. Between the transverse adominus muscle and the internal oblique muscle
D. Between the transverse abdominus muscle and the external oblique muscle
E. Between the internal oblique and the external oblique muscle

31. You are inserting a left sided double lumen tube into a 140kg 160cm woman. At what depth measured at the incisors is it most likely to be in the correct position

A. 25cm
B. 26cm
C. 27cm
D. 28cm
E. 29cm

32. A patient is cooled to 33 degrees Celcius in an attempt to improve neurological outcome after out-of-hospital ventricular fibrillation cardiac arrest. The evidence for this treatment comes from

A. Case Reports
B. Case Control Studies
C. Systematic Review
D. Randomized Control Trial
E. Pseudo-randomized Trial

33. Which of the following decrease during pregnancy

A. Functional Residual Capacity
B. Forced Expiratory Volume in one second
C. Tidal Volume
D. Respiratory Rate
E. Vital Capacity

34. You are anaesthetizing a patient with chronic renal failure for removal of a Tenkoff catheter and have intubated using rocuronium at a dose of 1.2mg/kg. You are immediately unable to intubate or ventilate and you decide to reverse the patient with sugammadex. What dosage would you use

A. 2mg/kg
B. 4mg/kg
C. 8mg/kg
D. 12mg/kg
E. 16mg/kg

35. 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

36. A young female patient with anorexia nervosa, had just started eating again. After three days she develops dyspnea and is found to have cardiac failure. Which of the following is the most important to correct

A. Potassium
B. Chloride
C. Phosphate
D. Glucose
E. Sodium

37. A pregnant lady is undergoing neuroradiological coiling of a cerebral aneurysm. At what gestational age should you monitor foetal heart rate to ensure adequate uteroplacental blood flow

A. 20 weeks
B. 24 weeks
C. 28 weeks
D. 30 weeks
E. 32 weeks

38. 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

39. Which of the following is the best predictor of a difficult intubation in a morbidly obese patient

A. Pretracheal tissue volume (old question – neck circumference)
B. Mallampati score
C. Thyromental distance
E. Severity of OSA

40. A female patient with a history of COPD presents for lung volume reduction surgery, which of the following is a contraindication for surgery (? indicates a poor prognosis)

A. Age > 60 years
B. Chronic asthma
C. Evidence of bullous disease on CT scan
D. FEV < 25%
E. Long-term prednisolone 10mg/day

41. A patient with known metastatic lung cancer is found to have hypercalcaemia, all of the following would help excretion of calcium except

A. Bisphosphates
B. Calcitonin
C. Frusemide
D. Sodium Chloride
E. IV crystalloids

42.What potentiates/interacts with adenosine

A. Aspirin
B. Warfarin
C. Clopidogrel
D. Dabigatran
E. Dipyrimadole

43. A 2 year-old child has just undergone strabismus surgery. They had an URTI 1/52 prior to surgery. They had an uneventful general anaesthetic with a 4.5mm cuffed ETT, was extubated and sent to recovery. 20 minutes later they develop respiratory distress. Their saturations are 96% on room air, and there is noticeable tracheal tug. What is the most appropriate initial management that will help with their respiratory distress

A. Apply CPAP via a facemask
B. Propofol 1mg/kg
C. Dexamethasone 0.4mg/kg
D. Gas induction and reintubate
E. Nebulized adrenaline (1:1000) 0.5mL/kg

44. Which antihypertensive is not safe to use in pregnancy

A. Aspirin
B. Enalapril
C. Metoprolol
D. Hydralazine
E. Nifedipine

45. Which has the weakest evidence for prevention of postoperative infection

A. Intraoperative low inspired O2
B. Intraoperative blood transfusion
C. Intraoperative hypothermia
D. Intraoperative hyperglycaemia
E. Cigarette smoking

46. During a cerebral aneurysm clipping, the anaesthetist can assist with the placement of the clip by giving the patient which drug immediately prior to clipping

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

47. The POISE trial showed that the perioperative administration of metoprolol XR resulted in decreased

A. Perioperative mortality
B. Hypotension
C. Congestive Cardiac Failure
D. Myocardial Infarction
E. Stroke

48. In paediatric trauma, the Broselow tape is used to estimate

A. Blood loss
B. Weight and drug dosages
C. Urine output
D. Abdominal girth
E. Head circumference

49. Which of the following should be used by a lay person to indicate that they should commence CPR

A. Absence of central pulse
B. Absence of peripheral pulse
C. Loss of consciousness
D. Absence of breathing
E. Obvious airway obstruction

50. A patient presents for dilation of a pharyngeal stenosis post laryngopharyngectomy 12 months earlier. After inducing anaesthesia you site a size 7 reinforced ETT in the stoma. Over the next 30 minutes the patient gradually desaturations. Despite hand bag ventilation and an increased FiO2 of 1 the saturations remain at 88%. This is due to

A. Endobronchial intubation
B. Aspiration
C. Tension Pneumothorax
D. Circuit leak
E. Blockage of ETT with secretions

51. PiCCO determines cardiac output utilizing

A. Thermodilution
B. Pulse contour analysis
C. Thermodilution and pulse contour analysis
D. ? Doppler
E. ?

52. During scoliosis surgery with monitoring of somatosensory evoked potentials, which tract are they mainly monitoring

A. Anterior horn
B. Anterior corticospinal tract
C. Dorsal column
D. Spinothalamic tract
E. Lateral corticospinal tract

53. A patient has suffered flash burns of the upper 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 burned is

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

54. Complications of mediastinoscopy include all of the following except

A. Air embolism
B. Cardiac laceration
C. Pneumothorax
D. Recurrent laryngeal nerve palsy
E. Tracheal compression

55. A 70 year old man with severe mitral stenosis and normally in sinus rhythm, is going for an ORIF of fractured radius and uln:::A. Soon after induction of GA, he develops a tachyarrhythmia with BP 70/40mmHg and HR 130bpm. The most appropriate immediate action is

A. Amiodarone
B. Adenosine
C. IV fluid bolus
D. Adrenaline
E. Direct cardioversion

56. The time constant of the alveoli is

A. Resistance multiplied by compliance
B. Resistance divided by compliance
C. Resistance plus compliance
D. Resistance minus compliance

57. The MAC awake:MAC ratio of sevoflurane is closest to

A. 0.22
B. 0.34
C. 0.45
D. 0.76
E. 1.00

58.Abnormal Q waves occur in all the following EXCEPT

A. Digitalis toxicity
C. Recent transmural MI
D. Wolff-Parkinson-White
E. Previous MI

59. Patient complains of numbness in the anterior 2/3 of tongue after GA with LM:::A. Most likely nerve injured is

A. Glossopharyngeal
B. Facial nerve
C. Mandibular
D. Superior vagus
E. Maxillary nerve

60. A 70 year old man with non-valvular atrial fibrillation is taken off his warfarin for 7 days prior to surgery and has no bridging therapy. His daily risk of stroke is

A. 0.001%
B. 0.01%
C. 0.1%
D. 4%
E. 10%

61. In patient with ankylosing spondylitis which of the following is INCORRECT

A. Amyloid renal infiltration is rarely seen
B. Cardiac complications occur in < 10%
C. Normocyctic anaemia occurs in 85% of cases
D. Uveitis is the most common extra-articular presentation
E. Sacroilitis is an early sign of presentation

62. Which of the following are NOT useful in the management of Torsades de Pointes

A. Isoprenaline
B. Procainamide
D. Electrical pacing
E. Magnesium

63. Compared with a plenium vaporizer what is NOT a disadvantage of draw-over vaporizer (repeat but still not quite remembered correctly)

A. Basic temperature compensation
B. Basic flow compensation
C. Cannot use sevoflurane
D. Small volume reservoir
E. ?

64. The desflurane vaporizer is heated because of its

A. High SVP
B. High boiling point
C. Low SVP
D. High MAC
E. Low MAC

65. The thermoneutral zone in a neonate in degrees celcius is

A. 26-28
B. 28-30
C. 30-32
D. 32-34
E. 34-36

66. Which of the following is most effective way to reduce renal failure in AAA surgery

A. Fluid bolus prior to aortic clamping
B. Fluid bolus after aortic clamp release
C. Frusemide
D. Minimize cross-clamp time
E. Mannitol

67. Which type of aortic dissection can be managed conservatively/non-operatively

A. Debakey 1
B. Debakey 2
C. Stanford A
D. Stanford B
E. Stanford C

68. The most likely cause of death after pharyngeal, esophageal or tracheal perforation is

A. Air embolus
B. Hemorrhage
C. Failure to intubate
D. Failure to ventilate
E. Sepsis

69. An essential criteria for diagnosis of left bundle branch block (LBBB) on ECG is

A. RSR in V1
B. Minimum duration QRS of 0.2 secs
C. Deep slurred S wave in V6
D. Loss of septal Q waves in V5 and V6
E. T waves opposite direction to main direction of QRS

70. If a patient experiences parasthesia in the little finger during supraclavicular brachial plexus block, the needle is in proximity to the

A. Posterior cord
B. Middle trunk
C. Ulnar nerve
D. Lower trunk
E. Medial cord

71. Which of the following are feature of Conn's syndrome?

A. Hypoglycaemia, hyponatremia, hyperkalemia
B. Hypoglycaemia, hypernatremia, hypokalemia
C. Normoglycaemia, hypernatremia , hypokalemia
D. Normoglycaemia, hyponatremia, hyperkalemia
E. Hyperglycaemia, hyponatremia, hyperkalemia

72 Commonest valvular heart disease seen in pregnancy is

A. Aortic stenosis
B. Aortic regurgitation
C. Mitral Stenosis
D. Mitral regurgitation
E. Tricuspid reguritation

73. Incidence and severity of vasospasm following sub-arachnoid haemorrhage is seen maximally at

A. 0-24 hrs
B. 2-4 days
C. 6-8 days (note 5-7 days in the old question)
D. 7-10 days
E. 2 weeks

74. The predominant pathology seen in restrictive heart disease is

A. Diastolic dysfunction
B. Systolic dysfunction
C. Valvular dysfunction
D. ?
E. ?

75. What is the first sign/symptom seen with an inadvertent total spinal whilst performing caudal anaesthesia in a neonate

A. Hypotension
B. Bradycardia
C. Desaturation
D. Tachycardia
E. Loss of consciousness

76. Which of the following is an absolute contraindication to electroconvulsive therapy

A. Cochlear implant
B. Epilepsy
C. Pregnancy
D. Raised Intracranial Pressure
E. Recent myocardial infarct

77. SG65 Prolonged Trendelenburg (head-down) positioning causes which of the following

A. No change in intracranial pressure
B. No change in intraocular presssre
C. No change in pulmonary venous pressure
D. Increased myocardial work
E. Increased pulmonary compliance

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

79. A 29 year old female undergoes craniotomy for posterior fossa tumour. Which of the following is an absolute contraindication to the sitting position

A. Patent ventriculo-atrial shunt
B. Previous back surgery
C. Pacemaker
D. Small patent foramen ovale
E. Oesophageal stricture contraindicated for transoesophageal echocardiogram

80. A 4 year old child booked for minor surgery is seen in pre-admission clinic where a murmur is detecte:D. Which feature will warrant further investigation

A. Loudness 4/6
B. Decreases on inspiration
C. Vibratory quality
D. Ejection systolic murmur
E. Louder on supine

81. The autonomic supply of the ciliary ganglion is such that it

A. Receives its sympathetic nerve supply from the cervical ganglion
B. Receives its parasympathetic nerve supply from the trochlear nerve
C. Is located inferiorly in the orbit
D. Is at risk from injury during peribulbar nerve block
E. Receives parasympathetic nerve supply from the Edinger Westphal Nucleus

82. Regarding Thallium Stress Testing in predicting perioperative cardiac events

A. A positive result requires further investigation with a pulmonary artery catheter
B. It has a high negative predictive value
C. It has a low negative predictive value
D. It has a high positive predictive value
E. Thallium Stress testing is considered inferior to Dobutamine Stress Echo

83. An elderly gentleman on warfarin has suffered a subdural haematom:::A. His INR on admission was 4.5. The resident in Ed has already given him 2.5mg of Vit K. To reverse his coagulopathy prior to urgent surgery you should give him

A. Factor VIIa
C. Cryoprecipitate
D. Prothrominex
E. Prothrombinex and FFP

84. During caesarean section a meconium stained floppy apnoeic baby is delivere:D. When the midwife gives you the baby, it is apnoeic, cyanotic with heart rate of 90 bpm. What do you do next

A. Give naloxone
B. Dry and stimulate
C. Start chest compressions
D. Give positive pressure ventilation
E. Suction the trachea

85. A 70 year old lady suffered a subdural haematoma. She is currently confused and the neurosurgeon wants to take her to theatre for urgent decompression. She is a vague historian, but from notes you find out she had ablation and pacemaker put in 7 months ago - DDD mode. Cardiac technician in 1 hour away and the surgeon wants to proceed. What do you do

A. Postpone until cardiology review
B. Postpone until pacemaker checked by technician
C. Postpone until temporary pacemaker inserted
D. Proceed after having implemented external pacing
E. Proceed with magnet available

86. New blood pressure measuring device is develope:D. Best was to compare it to the current gold standard

B. Bland Altman Plot
C. Kendall Coefficient of Concordance
D. Pearsons coefficient
E. Friedmans ??

87. 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

88. A 54 year-old patient is on warfarin for AF. They have a history of alcohol abuse and liver failure with a bilirubin of 28 and an albumin of 30. He also has a history of DVT following a flight. What is his CHADS2 score

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

89. 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. ?

90. What is approximately the systolic blood pressure in an awake neonate

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

91. A 25 year male with a history of asthma who is usually on fluticonasone and salbutamol nebs presents with an acute exacerbation. On examination you see he is distressed, RR 26 bpm. On auscultation: poor air entry and polyphonic wheeze bilaterally. ABG: pH 7.45, pCO2 27, pO2 75, HCO3 24. He has been treated with salbutamol and ipratropium nebules and intrasvenous hydrocortison:E. What is the next step in his treatment

A. Inhaled helium/oxygen
B. IV aminophylline
C. IV magnesium
D. IVsalbutamol
E. Intubation and ventilation

92. You are doing an awake fibreoptic intubation and having difficulty identifying the anatomy of where you ar:E. Then you observe a trifurcation. The lobe of the lung to which this airway is conected is

B. Lingula

93. A 35kg 5 year old girl is having elective surgery for suturing of a superficial leg laceration. After induction with N2O/Sevoflurane/O2 and in absence of any visible veins you have placed an appropriately sized LM:::A. Following this her SpO2 immediately drop to 90%. What is your initial management

A. Remove LMA and increase inspired Sevoflurane concentration
B. Increase inspired Sevoflurane concentration through the LMA
C. Give sublingual Suxamethonium
D. Give intramuscular Atropine
E. Give intramuscular Suxamethonium

94. Ulcerative colitis is associated with all of the following EXCEPT:

A. Cirrhosis
B. Iritis
C. Psoriasis
D. Arthritis
E. Sclerosing cholangitis

95. Regarding rotameters EZ85

A. The bobbin is contained in a tube with parallel sides
B. There is laminar flow at high flows
C. The height of the bobbin is directly proportionate to the pressure drop across the bobbin.
D. There is a constant pressure difference across the bobbin at all flows.
E. Resistance increases at high flows

96. You see a man in his 60s in clinic 1 week prior to laparoscopic cholecystectomy. He has dilated cardiomyopathy with an ejection fraction of 30%, but does not get dyspnoeic with normal activities of daily living. What is the most appropriate management of his heart failure?

A. Amiodarone 100mg bd
B. Digoxin 250mcg daily
C. Enalapril 2.5mg bd
D. Metoprolol 100mg bd
E. Diltiazem slow release 240mg daily

97. The best clinical indicator of severe aortic stenosis is

A. Presence of a thrill
B. Mean pressure gradient of 30mmHg
C. Area 1.2cm2
D. Slow rising pulse
E. ESM radiating to the carotids

98. Atrial Septal Defect murmur is heard due to blood flow through

A. Tricuspid valve
B. Pulmonary valve
C. Mitral valve
D. Aortic valve
E. Atrial Septal Defect

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

A. 4.5 cm2
B. 3.5 cm2
C. 2.5 cm2
D. 1.5 cm2
E. 1.0 cm2

100. Nitrous oxide anaesthesia may cause all of the following EXCEPT

A. An increased incidence of myocardial ischaemia
B. Decreased leukocyte chemotactic response
C. Elevation of plasma homocysteine levels
D. Megaloblastic anaemia
E. Reversible inhibition of methionine synthetase

101. The diagnosis of neuroleptic malignant syndrome requires the presence of

A. Diaphoresis
B. Elevated plasma creatine kinase
C. Hypertension
D. Muscle rigidity
E. Tachycardia

102. Regarding tryptase level testing for suspected anaphylaxis, all are true EXCEPT:

A. Levels peak within 1 hour
B. Increased with anaphylactoid and anaphylactic reactions
C. 99% of the body’s stores are found in mast cells
D. Levels of > 20ng/mL are suggestive of anaphylaxis
E. Test should be repeated at 24-48 hours

103. An 18 month old boy presents for surgery for an incarcerated inguinal hernia. On examination you note that he has had an URTI for approximately one week. Your advice regarding surgery should be

A. Postpone the surgery for two weeks
B. Proceed with surgery under spinal anaesthetic
C. Proceed with surgery with a full course of antibiotics to treat the URTI
D. Undertake surgery, but avoid the use of an ETT
E. Proceed with surgery with careful monitoring

104. The incidence of fat embolism syndrome following a unilateral closed femoral fracture is

A. 0 -3%
B. 4 – 7%
C. 8 -11%
D. 12 – 15%
E. 16 - 19%

105. The thoracodorsal nerve arises from

A. A Medial cord of brachial plexus
B. Lateral cord of brachial plexus
C. Posterior cord of brachial plexus
D. Dorsal scapular nerve
E. Long thoracic nerve

106. SN19 Neurosurgery operation in the sitting position. MAP 80mmHg, CVP 5mmHg, the transducers are located 13cm below the external auditory meatus. What is the CPP? *Note - I specifically remember that 70mmHg was an option*

A. 62 mmHg
B. 65 mmHg
C. 67 mmHg
D. 72 mmHg
E. 75 mmHg

107. A man attending his daughter's wedding is involved in fight with his son-in-law. He does not know where he is, opens eyes to voice, but removes tie when instructed. What is his GCS?

A. 10
B. 11
C. 12
D. 13
E. 14

108. Which of the following drugs is least likely to cause hypoxia in ARDS

A. Noradrenaline
B. Milrinone
C. Isoprenaline
D. Isoflurane
E. Sodium nitroprusside

109. What is the best predictor of poor prognosis with aortic stenosis?

A. Chest pain
B. Paroxysmal nocturnal dyspnoea
C. Syncope
D. Palpitations
E. Fatigue

110. Pierre-Robin sequence is characterized by cleft palate, micrognathia and

A. Craniosynostosis
B. Macroglossia
C. Glossoptosis
D. Microstomia
E. ?

111. After 3 litres of normal saline, the dilutional anaemia is initially offset by

A. Increased cardiac output
B. Increased oxygen extraction
C. Capillary vasodilation
D. ?
E. ?

112. Anaesthetic Machine is left on all weekend with flow rate of oxygen at 6 litres/min. A Desflurane vaporiser is placed on it on Monday morning without changing the CO2 absorber. What is the most likely toxic product produced?

A. Ca(OH)2
B. Carbon dioxide
C. Carbon monoxide
D. Compound A
E. Compound B

113. 2ml of 0.75% ropivacaine is injected for an interscalene block. Soon after the patient loses consciousness. The most likely place of inadvertent injection is

A. Subdural
B. Internal jugular vein
C. Common carotid artery
D. External jugular vein
E. Vertebral artery

114. An 18 month old infant is undergoing a routine spontaneously breathing GA with an LMA. They have a sudden onset of SVT with a heart rate of 220 and a BP of 84/60 with an ETCO2 of 32 and SpO2 of 98. The best management strategy is

A. Adenosine 100mcg/kg
B. DCR 2J/kg
C. DCR 4J/kg
D. Amiodarone 5mg/kg

115. When stimulating the ulnar nerve with a nerve stimulator, which muscle do you see twitch

A. Opponens abducens
B. Abductor pollicis brevis
C. Adductor pollicis brevis
D. Extensor pollicis
E. Flexor pollicis brevis

116. A middle-aged male with severe mitral stenosis having general anaesthesia for repair of fractured ulna/radius. Ten minutes into the case you notice a tachyarrythmia with his HR 130 and BP 70/-. He is normally in sinus rhythm. What do you do

A. Adenosine
B. Amiodarone
C. Shock
D. Volume
E. Metaraminol

117. Circuit disconnection during spontaneous breathing anaesthesia

A. Will be reliably detected by a fall in end-tidal carbon dioxide concentration
B. Will be detected early by the low inspired oxygen alarm
C. Will be most reliably detected by spirometry with minute volume alarms
D. May be detected by an unexpected drop in end-tidal volatile anaesthetic agent concentration
E. Can be prevented by using new, single-use tubing

118. ET04 An 85 year old patient with a bleeding disorder (? haemophilia) suffers a fractured neck of femur (#NOF). You discuss the possibility of a needing a blood transfusion but despite your explanation they refuse because they are scared of CJD infection post transfusion. Subsequently you decide not to proceed with the case because of the high risk of bleeding. The ethical principle that this is an example of is

A. Paternalism
B. Coercion
C. Justice
D. Beneficience
E. Autonomy

119. A type I diabetic is fasting pre-operatively and you decide to place them on an IV insulin infusion to optimize their perioperative glycaemic control. Their BSL is 7 mmol/L. By what mechanism does the insulin infusion decrease their BSL

A. Stimulates glucose uptake into the liver
B. Stimulates glucose uptake into skeletal muscle
C. Inhibits glucose production in the liver
D. Decreases glucose absorption from the gastrointestinal tract
E. Inhibit glucagon release

120. Patient has undergone a bilateral lung transplant. All of following are impaired EXCEPT

A. Mucociliary clearance
B. Cough reflex distal to anastomosis
C. Hypoxic pulmonary vasoconstriction
D. Response to CO2
E. Lymphatic drainage

121. Patient with history of long QT syndrome treated with long term propranolol. How do you know the treatment is effective

A. Normal QTc
B. No further prolongation of QT in response to valsalva manoeuvre
C. ?
D. ?
E. ?

122. A neonate is born with meconium stained liquor but is vigorous and crying. The reason for not suctioning the pharynx is

A. Hypertension
B. Hypotension
C. Bradycardia
D. Tachycardia
E. ?

123. What organism most commonly causes meningitis post spinal anaesthesia

A. Staphylococcus epidermidis
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Streptococcus salivarius
E. Escherichia coli

124. A male patient has a haemoglobin of 8g/dL and reticulocyte count 10%. The most likely diagnosis is

A. Untreated pernicious anaemia
B. Aplastic anaemia
C. Acute leukaemia
D. Anaemia of chronic disease
E. Hereditary spherocytosis

125. An advantage of supraclavicular block over an interscalene nerve block for shoulder surgery

A. Less phrenic nerve block
B. Easier landmarks in obese patient
C. Arm can be in any position for block
D. Less risk pneumothorax
E. Better cover for shoulder surgery

126. A patient with a head injury is found to have a unilateral dilated pupil with no direct or consensual response to light. What is the most likely diagnosis

A. Global injury
B. Optic nerve injury
C. Horners syndrome
D. Transtentorial herniation
E. Injury to the pons

127. EM68 In an arterial line system

A. Overdamping exaggerates mean pressure
B. Underdamping increases mean pressure
C. Underdamping underestimates systolic pressure
D. Wide range of damping coefficient associated with good performance if system has high natural frequency
E. Compliant tubing is good

128. The commonest postoperative complication in a patient with a neck of femur fracture (#NOF) is

B. Pneumonia
C. Myocardial Infarction
D. Delirium
E. ?

129. Which of the following is an advantage of a bronchial blocker of a double lumen tube

A. Able to isolate separate lobes
B. Significantly easier to deflate non-ventilated lung
C. Better suited to pneumonectomy
D. Less pressure on bronchial tissue
E. Lower incidence of tube malpositioning

130. Laser endotracheal tubes

A. More resistant to ignition when covered in blood
B. Resistant to electrosurgical cautery
C. Wont ignite when touched by laser
D. Have larger external diameter for same internal diameter relative to standard PVC tubes
E. Have double cuffs which are resistant to puncture by laser

131. Pulsus paradoxus in cardiac tamponade, the blood pressure decreases

A. Every second beat
B. In expiration when increase is normal
C. In expiration more than normal subjects
D. In inspiration when increase is normal
E. In inspiration more than normal subjects

132. You are anesthetizing a patient for a laparotomy who has a history of pulmonary hypertension. Regarding the patients anaesthetic management

A. An alpha-agonist is the inotrope of choice
B. Hypothermia is protective against a rise in pulmonary artery pressure
C. Isoflurane will tend to decrease pulmonary artery pressure
D. Ketamine is an appropriate anaesthetic agent
E. ? RHF

133. In a patient with severe rheumatoid arthritis, which radiological finding is most consistent with severe atlantoaxial instability (? C1/C2 instability)

A. A 9mm gap between the anterior arch of C1 and the odontoid peg
B. Increased saggital diameter
C. Posterior atlantodental interval of > 14mm
D. Midpart of C1 over C2
E. Tear drop sign of C2

134. You are called to the labour ward to assist in the manual removal of a retained placenta in a healthy woman. The obstetrician asks you to administer intravenous glycerol trinitrate. An initial safe dose, that you would expect to be effective, would be

A. 5mcg
B. 50mcg
C. 250mcg
D. 500mcg
E. 1000mcg

135. What is the most accurate method of determining foetal heart rate in a neonate

A. Palpation of an umbilical vein pulse
B. Auscultation with a stethoscope
C. Palpation of the femoral artery
D. Pulse oximetry
E. ?

136. Definitive evaluation of malignant hyperthermia (MH) susceptibility does NOT include observing

A. Abnormalities on magnetic resonance imaging (MRI) spectroscopy
B. Calcium release from B lymphocytes in response to caffeine stimulation
C. Certain mutations in the ryanodine receptor gene
D. Myofibrillar necrosis on muscle biopsy plasma
E. Creatine kinase (CK) levels above 800 units/L

137. A 60 year-old man with anterior mediastinal mass, is having a mediaastinoscopy. During induction they lose cardiac output, desaturate and drop their ETCO2. What is the best management strategy

A. Adrenaline
D. Place prone
E. ?

138. Which is true of Eaton-Lambert syndrome that differentiates it from myasthenia gravis?

A. Immune antibodies against post-synaptic ion channels
B. Associated with thymoma
C. Repeated exercise causes weakness to initially improve
D. Good response to edrophonium
E. Resistant to non-depolarizing muscle relaxants

139. A 55 year-old man presents to the emergency department with an obviously infected heel ulcer - BP 100/60, PR 110/minute, temperature 35.8, Na 125, K 2.7, BSL 55, Creatinine 180. Which do you give first/most urgently?

A. Antibioitcs
B. Crystalloid
C. Insulin
D. Potassium
E. Adrenaline

140. A new test has been developed to diagnose a diseas:E. To determine the SPECIFICITY of this new test it should be administered to

A. A mixed series of patients i.:E. some known to be suffering from the disease and some known to NOT be suffering from it
B. A series of patients known to NOT be suffering from the disease
C. A series of patients known to NOT be suffering form the disease and an estimate of the prevalence of the disease in the population obtained
D. A series of patients known to be suffering from the disease
E. A series of patients known to be suffering from the disease and an estimate of the prevalence of the disease in the population obtained

141. During one lung ventilation, hypoxaemia can occur. The cause for this is:

A. Loss of hypoxic pulmonary vasoconstriction
B. Perfusion of the unventilated lung
C. Ventilation perfusion mismatch of the ventilated lung
D. Atelectasis of the ventilated lung
E. Upper lobe collapse of the ventilated lung

142. A child with intra-operative blood loss. A cardiac arrest is most likely because of

A. A delay in delivery of blood from the blood bank
B. Inadequate intravenous access
C. Underestimated intra-operative blood loss
D. Underestimated pre-operative hypovolaemia
E. Complication of transfusion

143. The lumbar plexus supplies all of the following EXCEPT:

A. Subcostal nerve
B. Obturator nerve
C. Lateral cutaneous femoral nerve
D. Long saphenous nerve
E. Iliohypogastric nerve

144. The symptom indicating poorest prognosis in an adult patient with aortic stenosis

A. Chest pain
B. Malaise
C. Palpitations
D. Paroxysmal nocturnal dyspnoea
E. Syncope

(NB: This is the SAME question as the one numbered 109.)

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

A. Aspirate the collection with a 19G needle and syringe
B. Awake fibreoptic intubation with minimal sedation
C. Direct laryngoscopy and intubation after sevoflurane/O2 gaseous induction
D. Direct laryngoscopy and intubation after propofol/suxamethonium induction
E. Intubation via intubating LMA

146. RB67 Regarding post dural puncture headache, all of the following are true, EXCEPT:

A. If puncture with the tuohy needle during epidural insertion, subsequent blood patch is 30-50% effective
B. Caffeine is often used to treat mild headache
C. Subdural haemorrhage can occur rarely
D. ?
E. Unlikely to be post dural puncture headache if the headache is only in the occipital area

147. A 70 year-old male presents for right lower lobectomy. Preoperative spirometry shows FEV1 2.4L (4.2L predicted), FVC 4L (5L predicted). The predicted post-operative FEV1 is:

A. 1.0L
B. 1.3L
C. 1.7L
D. 1.9L
E. 2.2L

148. What is the most important immediate treatment for a cardiac arrest due to ventricular fibrillation in a patient with hypertrophic obstructive cardiomyopathy?

A. Adrenaline
B. Amiodarone
C. Defibrillation
D. Intubation, ventilation and oxygenation
E. Precordial thump

149. Hypercalcaemia due to hyperparathyroidism is associated with

A. A shortened PR interval
B. A prolonged QTc interval
C. Muscle rigidity
D. Polyuria and polydipsia
E. Increased glomerular filtration rate

150. The cause of early mortality (early - within 30 minutes) in a pregnant women with amniotic fluid embolism is

A. Bronchospasm
B. Hypovolaemia
C. Malignant arrhythmia
D. Pulmonary hypertension
E. Pulmonary oedema
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