Finals MCQs-March 2010

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Finals Black Bank | Apr09 | Aug09 | Aug10

MCQs from the FINALS Exam 26th March 2010 

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MC157 [Mar10] New Q
An 18 yo with Fontan Circulation undergoing exploratory laparotomy. On ICU vent, sats 70%. Which ventilator parameter would you INCREASE to improve his sats?
A. Bilevel pressure
B. Expiratory time
C. Inspiratory time
D. Peak inspiratory pressure
E. PEEP


SC33 A 7 kg Infant with tetralogy of Fallot, post BT-shunt. Definitive repair at later date. Paralysed and vetilated. sats 85% baseline, now 70%, best treatment:
A. Increase FiO2 from 50 - 100%
B. Esmolol 70 mcg
C. Phenylephrine 35 mcg
D. Morphine 1 mg
E. 1/2 NS with 2.5% dex 70 mls


MN41 Von Hippel-Lindau disease is associated with:
A. increased risk of malignant hyperthermia
B. meningiomas
C. peripheral neuropathy
D. pheochromocytomas
E. poor dentition


MH59 70 year old post TKJR. On sub-cut heparin. Develops clinical DVT and platelets 40 (sounds like HITS type-II). Management
A. Enoxaparin
B. Fondoparinux
C. Heparin by infusion
D. Lepirudin
E. Warfarin


ME45 Hypercalcaemia
A. Chovostek's sign
B.
C.
D.
E. Short QT


MC161 Drug eluting stent 6 months old. On aspirin and prasugrel 10mg. Elective lap cholecystectomy for biliary colic.
A. Do case while taking both.
B. Do case while stopping both.
C. Stop Prasugrel for 7 days, keep taking aspirin.
D. Stop Prasugrel for some other different time
E. Post-pone for 6 months


AM50 For a person newly diagnosed as MH susceptible, which is true?
A. ?
B. Can have had an uneventful 'triggering' anaesthetic
C. Recommended to use an anaesthetic machine which has not had volatiles through it
D. ?
E. There have been case reports of MH occurring up to 48 h post op


MZ80 ABG pH 7.12, PO2 100, PCO2 65, HCO3 20.3, BE -10. Consistent with?
A. Chronic renal failure
B. Malignant hyperthermia
C. Diabetic ketoacidosis
D. End-stage respiratory failure
E. Ethylene glycol toxicity


Cocaine overdose. What is false? (rpt Q)
A. Euphoria
B. ?
C. ?
D. ?
E. Miosis

  • Cocaine DOES cause euphoria - therefore A is true. Cocaine causes pupillary dilatation (mydriasis), not miosis. Therefore ANSWER is E.


PL30 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


TMP-100 Compared to lignocaine, bupivacaine is
A. Twice as potent
B. Three times as potent
C. Four times as potent
D. Five times as potent
E. Same potency

TMP-101 Aneurysm sugery. Propofol / remifentanil / NMDR. DOA monitoring (Entropy). MAP 70 , HR 70/min, State entropy 50, Response entropy 70. What do you do?
A.
B. Metaraminol
C. Check TOF
D. Nothing
E. Increase TCI


TMP-114 Paralysed with atracurium. TOF is 1(25%). You give a dose of 0.1 mg/kg mivacurium to close the abdomen. When will you be back to TOF 1(25%)?
A. 5 min
B. 10 min
C. 30 min
D. 60 min
E. 90 min

EV19 Plenum Vaporiser
A.? something with fresh gas flows
B. Relies on a constant flow of pressurised gas
C. Out of circle
D. Not temperature compensated
E. volatile injected into fresh gas flow?

  • A - ?
  • B - TRUE. Upstream gas source required to push fresh gas through the vaporizer (opposite to Draw-over vaporizer)
  • C - ? FALSE. Don't exactly understand the question/stem. You can use a plenum vaporizer with OR without a circle (e.g. T-piece in paeds)
  • D - FALSE. Most ARE temperature compensated
  • E - FALSE. Not in a plenum vaporizer (Some vaporisers do inject volatile (eg Des Tec 6) but this is NOT a plenum vaporiser.

TMP-102 Interscalene block, patient hiccups...where do you redirect your needle?
A. Anterior
B. Posterior
C. Caudal
D. Cranial
E. Superficial


TMP-103 What is the SVR in a patient with MAP 100mmHg, CVP 5, PCWP 15, CO 5L/min?
A. ?0.8
B. ?3
C. 520
D. 1280
E. 1520 dynes.sec/cm-5


TMP-111 Accidentally cannulate carotid artery with 5 lumen 7 Fr CVC preop for a semi urgent CABG. Most appropriate next response is to
A. Get vascular surgeon to repair it and continue with surgery and heparin
B. Leave it in. Do CABG. Pull it out post op.
C. Pull it out, compress. Delay surgery for 24hrs
D. Pull it out compress. Continue with surgery + heparin.
E. Pull it out. Compress. Continue with surgery no heparin.


TMP-104 Stellate ganglion (Repeat Question)
A. Anterior to scalenius anterior
B. ?
C. ?
D. ?
E. ?


TMP-105 The median nerve (REPEAT)
A. can be blocked at the elbow immediately medial to the brachial artery
B. can be blocked at the wrist between palmaris longus and flexor carpi ulnaris
C. can be blocked at the wrist medial to flexor carpi ulnaris
D. is formed from the lateral, medial, and posterior cords of the brachial plexus
E. provides sensation to the ulna half of the palm


TMP-115 Patient for total knee replacement under spinal anaesthetic. Continous femoral nerve catheter put in for post op pain relief. Good analgesia and range of motion 18hrs post op. 24hrs post op, patchy decreased sensation in leg and unable flex knee. What is the cause?
A. Compression neurapraxia (i think it said due to torniquet)
B. DVT
C. Muscle ischaemia
D. Damage to femoral nerve
E. Spinal cord damage


TMP-106 A 75yo male with moderate aortic stenosis (valve area 1.1cm2).. Gets mild dyspnoea on exertion but otherwise asymptomatic. needs hip replacement.
A. Continue with surgery
B. Beta block then continue
C. Get myocardial perfusion scan
D. Postpone surgery awaiting AVR
E. Postpone surgery awaiting balloon valvotomy


TMP-112 (similar to above) Patient for fempop bypass (i believe it said "angioplasty"), history of CCF. Also has diabetes on oral hypoglycaemics, controlled hypertension and atrial fibrillation at rate of 80bpm .
A. Medium risk surgery, medium risk patient
B. Medium risk surgery, high risk patient
C. High risk surgery low risk patient
D. High risk surgery, medium risk patient
E. High risk surgery, high risk patient.


RH35 (NEW)
23.Best Approach for a Sub-Tenon's block?
A. inferonasal
b. inferotemporal
c. medial canthus
d. superior nasal
e. superior temporal


TMP-107 Baby with TracheoOesophageal Fistula found by bubbling saliva and nasogastric tube coiling on xray. Best immediate management?
A. Bag and mask ventilate
B. Intubate and ventilate
C. position head up, insert suction catheter in oesophagus (or to stomach?)
D. Place prone, head down to allow contents to drain
E. Insert gastrostomy


TMP-108 A 60yo Man with anterior mediastinal mass, during induction for mediastinoscopy....lose cardiac output, decreased saturations, drop in ETCO2. Management
A. Adrenaline
B. CPR
C. CPB
D. Place prone


TMP-116 Post thyroidectomy patient, patient in PACU for 30 minutes. Develops respiratory distress. Most likely cause?
A. Hypercalcemia from taking parathyroids
B. Bilateral laryngeal nerve palsies
C. bleeding and haematoma
D. Tracheomalacia
E.


27. Best way to prevent hypothermia in patient undergoing a general anaesthetic (Repeat question)
A. Prewarming of patient
B.
C.
D. Warm IV fluids

  • Answer=A


TMP-109 MAIN indication for biventricular pacing is
A. complete heart block
B. congestive cardiac failure
c. VF
D.


EV18 Desflurane TEC6 vaporiser, unable to turn dial on. This is NOT because
A. vapouriser is tilted
B. Hotter than 39C
C. On battery power
D. Interlock not engaged, or not seated properly (or something like that)
E. other vapouriser is already on

  • The TEC 6 desflurane vaporizer needs to warm up and the "operational" LED light needs to be illuminated before you can turn the dial to the ON position. If you try to turn it on before the "operational" light is on it will not work. I assume that any of the alarms which cause the "operational" light to go off (and subsequently halt delivery of desflurane) mean that if you turn the dial to 0% (i.e. OFF) then you will not be able to turn it back on, but I have not read that anywhere. According to Graham (BJA 1994; 72:470-73), causes of vaporizer shutdown include:
  • a tilt of about 10 degrees or more - although extremely unlikely given the design (A WILL cause you to be unable to turn the dial, so A is not the answer)
  • power failure. It will not work on battery power (C is not the answer)
  • the vaporizer will not work unless locked into the selectatec mount, and the selectatec mount wil not allow the use of multiple vaporizers simultaneously (therefore D and E are true, and neither is the answer)
  • Answer is therefore B.


PI83 Desflurane vaporiser, heated because of
A. High SVP
B. High boiling poing
C. Low SVP
D. High MAC
E. Low MAC


31.Myotome of C6-7 (Repeat Question)
A. Wrist flexion and extension


SF86 Most common cause of maternal cardiac arrest
A. PE
B. AFE
C. Haemorrhage
D. Preeclampsia
E. cardiomyopathy


SF89 Most likely change on CTG with anaesthesia for non-obstetric surgery at 32 wks
A. Loss of beat to beat variability
B. No change
C. Late decels
D. Variable Deccels
E. uterine contractions


MG05 What is NOT associated with ulcerative colitis? (Repeat question)
A. Cirrhosis
B. Psoriasis
C. Arthritis
D.
E.


EM66 What's the most appropriate mode for neuromuscular monitoring during aneurysm clipping? (repeat question)
A. TOFC
B. TOFratio
C. Post tetanic count

  • Answer=C


TMP-118 What's the area burnt in man? Half of left upper arm, all of left leg and anterior abdomen (repeat qu).
A. 27%
B. 32%
C. 42%
D.
E.


MC59b Torsades, what's not useful? (Repeat question)
A. Amiodarone
B. Isoprenaline
C. ?
D. ?
E. ?


38.Treatment for long QTc (OR what does NOT increase the QT interval)
A. Magnesium
B. ?
C. ?
D. ?


39.HOCM, VF arrest on induction, what's the first priority in management?
A. defibrillate
B. amiodarone
C. Intubate and ventilate
D. Pre-cordial thump
E. adrenaline

  • According to the latest ARC Adult Advanced Life Support algorithm (2006), the precordial thump is the first priority for a monitored arrest, so the Answer=D.
  • However, one of the consultants I work with is on the ARC, and think I recall him saying the precordial thump may be removed at some point. But as the current ARC algorithm still contains the precordial thump I guess that is the answer. Realistically it would be swiftly followed by CPR and defibrillation.


40.Pregnant woman presents with narrow complex tachycardia HR 190, stable BP 100/60. No response to vagal manoevures. Management?
A. adenosine 6mg
B. DCR
C. amiodarone
D. Atenolol
E. ?

  • ARC Guideline 11.11 - Managing Acute Dysrhythmias says that in a patient with no "adverse features" start with vagal manoeuvres. If that does not work next step is adenosine 6mg, then 12mg if required. Next step is Ca2+-channel blocker (verapamil or diltiazem). The fact that she is pregnant is not irrelevant from the treatment point of view, but main priority is the life of the mother. Consideration of effects of drugs on fetus is important, but there is no point witholding the correct treatment because of potential effects on fetus if the mother dies as a result of witholding the drug anyway.
  • Answer=A.


RU19 [Mar10] [Aug10] The intercostobrachial nerve:
A. Arises from T2 trunk
B. Is usually blocked in brachial plexus block
C. Supplies antecubital fossa
D. can be damaged by torniquet
E. Arises from inferior trunk


42. Post dural puincture headache (PDPH) -(thoracic epidural) of "low pressure type". Features NOT consistent
A. headache Immediately after procedure
B. Frontal headache only
C. Starts 24hrs post
D. Auditory symptoms
E. Neck stiffness

  • A=FALSE. Usually starts 24-48 hrs after dural puncture.
  • B=True. Typically fronto-occipital, but can be frontal, occipital or nuchal (Evidence-Based Obstetric Anaesthesia, Halpern & Douglas, BMJ Books; Blackwell, 2005; p.192)
  • C=True. Most commonly starts 24-48 hrs later.
  • D=True. Hearing loss and/or tinnitus are features.
  • E=True. Neck stiffness and photophobia are common.
  • ANSWER=A. (REFS - Oxford Handbook of Anaesthesia (2nd ed), p.707


SF87 [Mar10] [Aug10] Labour epidurals increase maternal and foetal temperature. This results in neonatal
A. Increased sepsis
B. Increased investigations for sepsis
C. increased non shivering thermogenesis
D. Increased need for resuscitation
E. Cerebral palsy


SF88 [Mar10] [Aug10] Maternal cardiac arrest. In making the diagnosis of amniotic fluid embolism, large amount of PMNs surrounding foetal squamous cells are
A. Pathonomonic
B. Supportive
C. Only found at postmortem
D. Irrelevant
E. Incidental


ET03 Jehovah's witness patient refusing blood products. The ethical principle you are honouring if you continue with elective hip operation
A. Autonomy
B. Nonmaleficience
C. Justice
D. Paternalism


ET01 An 86yo with severe dementia and multiple medical problems.. Surgeons want to operate for faecal peritonitis/bowel perforation, and believe he will die without the surgery. Your decision NOT proceed with surgery is supported by which ethical principle?
A. Dignity B. Competence C. Non-maleficience D. Paternalism E. Futility


47.Inserted DLT. FOB down tracheal lumen. What feature is most helpful in identifying Left vs Right main bronchus
A. Trachealis muscle
B. "there are 3 lobes in right lung"
C. LMB longer than right
D. Angle of RMB vs left
E. Three segments of RUL

  • A simple look down the scope will tell you which side is left or right - seems like a silly question to me. However....
  • A - False. Trachealis muscle divides at carina and continues in each main bronchus, so not particularly helpful. BUT ..I thought trachealis was only located posteriorly connecting the ends of the C-shaped cartilage. If you know whats the front and whats the back wouldnt this make it easy to figure out L from R ? - Isoma
  • B - False. While there are indeed 3 lobes in the right lung, that fact is not helpful to determine which is right or left main bronchus.
  • C - True. The LMB is about 5cm long before it gives off any subsequent lobar bronchi, whereas the RMB gives off a lobar bronchus (the RUL bronchus) about 2.5cm from the carina. This can help to determine between RMB and LMB.
  • D - ? False. While there is a difference in the angle (from the vertical) of the LMB and RMB, I don't know if this would be significantly appreciable bronchoscopically. Anyone?
  • E - True. The RUL bronchus has a trifurcation for each of the RUL segments, and this may also be useful in determining which side you are on.


48.You are performing a bronchoscopy, but are unsure of your location. Then you see trifurcation of bronchi. Most likely location is:
A. Right upper lobe
B. RML
C. RLL
D. LUL
E. Lingula <br

  • Only place I am aware of that there is a true trifurcation is when the RUL bronchus divides into segmental bronchi - therefore answer is A.


PC50 Elimination Half life of Tirofiban (woohoo... closed my eyes and pointed!)
A. 2hrs
B. 8hrs
C. 12hrs
D. 24hrs
E. 15 minutes


50.POISE trial showed
A. Increase CVA
B. Anaphylaxis
C. renal failure
D. Increased AMI

  • Answer is A.


51.Why is codeine not used in paeds
A. Poor taste
B. High inter-individual pharmacokinetic variability
C. Not licensed for <10yo
D. not as effective as adult when given in ?weight adjusted dose?

  • A - as far as I am aware it doesn't have a particularly nasty taste, and is used in cough suppressants, so FALSE.
  • B - TRUE. Variations in CYP2D6 function affect how much codeine is converted to morphine, and therefore how effective it is, but also how "sensitive" patients are to codeine.
  • C - Painstop was used in children when I was an RMO a few years ago and contains codeine, and as far as I know it is still used, but I don't know the specific licensing info for codeine in paeds. It is not used in our hospital, but mostly because we use oxycodone instead.
  • D - ? False. It's crap in children just like it's crap in adults isn't it!


52.Patient on table for phaeochromocytoma with GA and epidural insitu. Pt on phenoxybenzamine and metoprolol preop, high dose nitroprusside and phentolamine. BP still high ?250/-. Next step
A. IV hydralazine
B. IV Magnesium
C. Propofol
D. Epidural lignocaine bolus
E. Esmolol

  • A - ?FALSE. Duration of action may be a problem, as once tumour is out you may need a vasopressor and won't want the hydralazine hanging around. Plasma half-life is 2-3 hours (significantly more in renal impairment, but may be less in "rapid acetylators"). Anyway, 4 half-lives is 8-12 hours (less if you're a fast acetylator), and that's not ideal.
  • B - TRUE. Oxford Handbook says this is a good option.
  • C - False. Not the best option.
  • D - False. Epidural bolus will not negate the effects of circulating vasoactive catecholamines.
  • E - False. Esmolol for tachycardia, but not for BP control.


53.25 yo primip ?38/40 gestation with beta thalassemia trait for epidural. BP 140/95, mild proteinuria ...something else... Best test before you will put in epidural
A. Coagulation screen
B. Hb
C. Platelet count
D. skin bleeding time
E.

  • Thalassemia trait is a red-herring. No effect on clotting/epidural placement. Money is on pre-eclampsia Main thing to look at is the platelet count. Answer is C.
  • See Oxford Handbook 2nd edn - p.744.
- If plt>100, proceed.
- If plt<100, do coags.
- If plt 80-100, and coags normal - regional is OK.


54.Another pregnant lady ?39/40 with BP185/115 , 4+proteinuria, clonus. IDC placed, 10mLs of dark coloured urine only for the last few hours. Initial management
A. 500mL Crystalloid bolus
B. IV hydralazine
C. IV Magnesium
D. insert epidural

  • By definition she has SEVERE pre-eclampsia.
  • A - False. Although they are usually intravascularly deplete, IV fluids should be given cautiously as these women are prone to develop pulmonary oedema. Volume expansion alone can reduce SVR and systolic BP. Oliguria should be treated with careful IV fluid challenge. The BJA CEACCP article (see below) states that a bolus of 250ml crystalloid should be given, but if no improvement (in urine output) a CVC should be inserted before any further fluid given. Then be guided by CVP and urine output. Crystalloid decreases plasma oncotic pressure, while colloids increase it and have a greater tendency to cause pulmonary oedema. However, if CVP low, can use colloid. I say false because 500ml is probably a bit too large as a bolus initially.
  • B - TRUE. Initial management should aim to reduce the BP. This is the best of the options, although the CEACCP article also states that careful volume expansion should precede the use of vasodilators, so as not to drop the BP too much. That is not one of the options though, and I think this is the best option.
  • C - False. Initial attempts to reduce BP and improve urine output should probably precede Mg administration. Anyway, giving someone with minimal urine output a large bolus of IV Mg increases the chances of Mg toxicity. Should give IV fluids before giving Mg.
  • D - False. Epidurals are desirable in pre-eclampsia but in severe pre-eclampsia you should try and reduce the BP first, and always check the platelet count +/- coags BEFORE placing epidural.
- REFS: The diagnosis and management of pre-eclampsia. BJA CEACCP 2003; 3(2):38-42. Also see ANZCA obstetric anaesthesia: scientific evidence 2008 pages 15 and 18


TMP-113 The BEST agent to decrease gastric volume AND increase gastric pH before semi-urgent procedure
A. Omeprazole
B. Cimetidine
C. Ranitidine
D. Sodium citrate
E. ?


56.Most common congenital heart disease (repeat)
A. VSD
B. PDA
C. ?
D. ?

  • Answer is A. (Ref: Stoelting's Anesthesia & Co-Existing Disease - 5th edn; p.44)
  • ACYANOTIC defects: VSD=35%, ASD=9%, PDA=8%, Pulm. stenosis=8%, Aortic stenosis=6%, Coarctation=6%, Atrioventricular septal defect=3%
  • CYANOTIC defects: Tetralogy=5%, Transposition=4%


57.Active 4 year old. Ts & As. Continuous murmur, disappears on lying down (repeat)
A. Venous hum


Acetylcholine receptors are down regulated in
A. Guillain-Barre syndrome
B. Organophosphate poisoning
C. Spinal cord injury
D. Stroke
E. Prolonged NMBD use

  • A - False. Effectively a denervation injury which causes UP-regulation.
  • B - TRUE. Organophosphate poisoning causes increases in miniature-end-plate potential (MEPP), and thus can cause DOWN-regulation of ACh receptors. Apparently continuous exposure to organophosphates can cause degeneration of pre-junctional and post-junctional structures.
  • C - False. Denervation causes UP-regulation.
  • D - False. As for spinal cord injury.
  • E - Prolonged NMBD use can cause UP-regulation of ACh receptors.
REFS: Miller (7th edn) - p.358


58.Myaesthenia gravis - features predicting need for post op ventilation EXCEPT
A. Prolonged disease
B. High dose Rx
C. Previous respiratory crisis
D. Increased sensitivity to NMB's
E. bulbar dysfunction
(repeat question, definitely an except question with same options as past one)


Reference: CEPD Reviews 2002 p88- and OHA 246-

Consider D-Increased sensitivity to NMB's

The CEPD risk factors for IPPV postop (thymectomy) are: 1/ FVC<2.9L; 2/ Concommitant COAD; 3/ Acute fulminant crisis or respiratory involvement (grade 3); 4/ Myasthenic crisis (grade 4); OHA adds: 5/ Duration of disease >6yrs 6/ Pyridostigmine dose >750mg/d 7/ Major body cavity surgery 8/ Bulbar palsy that is predictive of intra and postop airway protection.

All patients with myasthenia gravis should be sensitive to muscle relaxants so this in itself is not a useful indicator.


59.Diagnositic Utility of BNP best in (repeat)
A. SOB post pneumonectomy dyspnoea
B. Confusion post CABG


60.Innervation of Larynx (repeat)
A. the ineternal branch of the superior branch of the...
B.
C.
D.
E. Cuff compression of recurrent laryngeal nerve against thryoid can cause palsy


61.Which is not a branch of the mandibular nerve (repeat)
A. Auricultemporal
B. Great Auricular
C. ?


62.Reason not to operate liver injury(repeat)
A. Haemodynamically stable
B. Low grade injury on CT
C. ?


63.World Federation Neurosurgeons (repeat)
A. No improvement cooling Grade I to III
B. ?
C. ?


64.Most distant anatomy seen on grade III laryngoscopy
A. soft palate B. hard palate C. Epiglottis
D. arytenoid cartillage E. opening to ?


65.Text Re: Trauma pt, Head Injury GCS 5, high ICPs, best management for ortho procedure(repeat)
A. Propofol/fentanyl
B. Propofol / nitrous
C. Other options with volatiles


66.Drug NOT used to treat acute intermittent porphyria - question was: person with AIP given ?something and triggered a seizure, what not to use (repeat)
A. Morphine
B. Phenytoin


Reference: [1] and Harper's Illustrated Biochemistry

Suggest B-Phenytoin but morphine while safe to use but will not be used to treat a convulsion so make sure you read the question...

Treatment of seizures in porphyriacs is a difficult situation given that most anticonvulsants are contraindicated (such as phenytoin, carbamazepine, thiopentone) because they induce hepatic P450 enzymes. (This consumes heme and thus reduces the negative feedback on ALA synthesase which is then free to generate heme/porphyrins products.) Drugs considered safe to use in convulsing porphyriacs include: midazolam, propofol, gabapentin and magnesium.


67.Regarding anticholinesterases:
A. pyridostigmine has slow onset of effect
B. physostigmine does not rely on renal metabolism/excretion
C. neostigmine cannot reverse centrally acting cholinergics
D. edrophonium is less reliable in reversal?


68.rpt question about multiple sclerosis (rpt):
A. exacerbated with heat


69.rpt question about signs seen in sarin poisoning (rpt):
A. mm fasciculation
B. dry skin


70.nerve to block for painful meralgia parasthetica
A. lateral femoral cutaneous nerve
B. femoral nerve


71.paternal uncle has MH, pregnant lady, how best to test for MH (rpt q)
A. muscle biopsy on pregnant lady
B. negative muscle biopsy of her father
C. genetic testing of pregnant lady

Note: they now specified that she was 14 weeks pregnant, so muscle biopsy under FNB now a more realistic option


72.The nerve supplying area of skin between greater trochanter and iliac crest:
A. subcostal nerve
B. ilioinguinal nerve
C. genitofemoral nerve
D. femoral nerve
E. lat cutaneous femoral nerve

The lateral cutaneous branch of the last thoracic nerve is large, and does not divide into an anterior and a posterior branch. It perforates the Obliqui internus and externus, descends over the iliac crest in front of the lateral cutaneous branch of the iliohypogastric (Fig. 819), and is distributed to the skin of the front part of the gluteal region, some of its filaments extending as low as the greater trochanter. http://education.yahoo.com/reference/gray/illustrations/figure?id=820 When you look at the assoc. picture, it looks like this nerve will supply this bit skin (Lat cut br of the 12th Thoracic nerve). Difficult to say for sure. 30/6/12 Disco


73.Hydroxyethylstarch with intermediate volume replacement/ duration(rpt):
A. 6% HES 130/0.4


74.Pyloric stenosis (rpt Q)
A. alkaline then acid urine
B. ?
C. ?


75.Which can deliver minute ventilation of greater than 5L/min using a 14 G cannula used for needle cricothyroidotomy
A. jet ventilation using pressure 400KPA
B. oxygen flush button on anaesthetic machine
C. oxygen tubing on oxygen port on anaesthetic machine at 12L/min
D.
E. none of the above


76.congenital diaphragmatic hernia (rpt)
A. "there is hyperplasia of pulmonary arterioles"
B.


77.young man in trauma, hypotensive ?BP70/40. CXR widened mediastinum. Fast STRONGLY POSITIVE. "best way to assess the widened mediastinum is" (rpt)
A. intraop TOE
B. TTE


78.IV paracetamol
A. late plasma levels around the same as oral
B. highly protein bound
C. ?30%? renally excreted
D. VD 10L/kg


79.Head Trauma patient with unilateral dialated pupil, wahts the diagnosis ?
A.Global injury
B.Optic nerve injury
C.Horners syndrome
D.Tenstentorial herniation
E.....


80. Question about CO2 Laser. Does not cause deep tissue damage because
a. High Frequency
b. Penumbra effect
c. ? Dissipation of energy
d
e.


81. Patient with diastolic dysfunction. Is it caused by:
a. Restrictive cardiomyopathy
b. Dilated cardiomyopathy
c.
d.
e.


82. supine hypotension syndrome (rpt)
a. high SVR
b. tachycardia


83.Non-normally distributed pain scores. What is the best way to describe spread of data?
A. Inter-quartile range
B. Standard deviation
C. Standard error of the mean
D. ?
E. ?


84.What term means the number of people who are correctly identified as not having a disease:
A. Sensitivity
B. Specificity
C. Positive predictive value
D. Negative predictive value


85.If a test is negative, what proportion will not have the disease:
A. Sensitivity
B. Specificity
C. Positive Predictive Value
D. Negative Predisctive Value


86. Cryoppt: insufficient (rpt)
A. F9
B. F13


AC90 Most likely to result in myocardial infarction (rpt):
A. intraop myocardial ischaemia
B. post op myocardial ischaemia


88.Awake patient with diabetes insipidus
A. Euvolaemic
B.
C.
D.
E. urinary Na <20


TMP-128 Indication for percutaneous closure of ASD

a. Primun < 3cm
b. Primun > 3cm
c. Secundum < 3 cm
d. Secundum > 3cm
e. sinus venosus ASD

90.Timing of worst coagulopathy after liver transplant
a. 1-2 days
b. 3-4 days
c. 5-6 days
etc


91.ASA grading was introduced to
A. predict intraop anaesthetic risk
B. Predict intraop surgical and anaesthetic risk
C. Standardise the physical status classification of patients
D. Predict periop anaesthetic risk
E. Predict periop anaesthetic and surgical risk


92.Pulsus paradoxus is: (the Q was something like - severe asthmatic - when take BP you would find)
A. Reduced BP on inspiration unlike normal (ie normally increased on insp)
B. Reduced BP on inspiration exaggerated from normal
C. Reduced BP on expiration unlike normal
D. Reduced BP on expiration exaggerated from normal
E. ?


92.Respiratory function in quadriplegics is improved by
A. abdominal distension
B. an increase in chest wall spasticity
C. interscalene nerve block
D. the upright position
E. unilateral compliance reduction


93.An INCORRECT statement regarding the autonomic nervous system is that
A. autonomic dysfunction is a predictor for worse long term survival after myocardial infarction
B. heart rate responses are primarily mediated through the sympathetic nervous system
C. inhalation anaesthetics all impair autonomic reflex responses
D. autonomic dysfunction is a predictor for haemodynamic instability following anaesthetic induction
E. low heart rate variability is associated with worse cardiac outcomes following non-cardiac surgery


94.Correct statements regarding expiratory-inspiratory flow-volume loops include all of the following EXCEPT
A. in obstructive disease the expiratory curve has a scooped out or concave appearance
B. in restrictive disease expiratory flows are usually decreased in relation to lung volume
C. in restrictive disease the expiratory curve has a convex appearance
D. the expiratory curve is largely effort independent
E. the inspiratory curve is effort dependent


95.Carbon dioxide is the most common gas used for insufflation for laparoscopy because it
A. is cheap and readily available
B. is slow to be absorbed from the peritoneum and thus safer
C. is not as dangerous as some other gases if inadvertently given intravenously
D. provides the best surgical conditions for vision and diathermy
E. will not produce any problems with gas emboli as it dissolves rapidly in blood


SZ14b Following a cadaveric renal transplant under general anaesthesia, your patient's plasma K+ increases to 6.0 mmol.l-1 in recovery after being 5.0 mmol.l-1 pre and intra-operatively. This patient requires (this is where i'm talking about figments of imagination - i'm pretty sure this paper had the version where RR 8/min, what is the most likely cause etc etc)
A. an intravenous infusion of CaCl2 (10 mls over 20 minutes)
B. arterial blood gases to ascertain the acid/base status
C. potassium exchange resins rectally
D. sodium bicarbonate infusion (50- 100 mEq over 5- 10 minutes)
E. urgent haemodialysis


97. Carcinoid syndrome - finding on examining heart:
A. Fine inspiratory crepitations
B. Systolic murmur at apex
C. Systolic murmur at left sternal edge
D. Murmur at apex with opening snap
E. Pericardial rub


98.Histamine release in anaphylaxis does NOT cause:
A. Tachycardia
B. Myocardial depression
C. Coronary artery vasodilatation
D. Prolonged PR interval
E. Decreased impulse conduction]


99.Pre-ganglionic sympathetic fibres pass to the
A. otic ganglion
B. carotid body
C. ciliary ganglion
D. coeliac ganglion
E. all of the above


100.Branches of the mandibular nerve do NOT include the
A. auriculotemporal nerve
B. long buccal nerve
C. lingual nerve
D. great auricular nerve
E. chorda tympani nerve

The chorda tympani is a nerve that branches from the facial nerve (cranial nerve VII) inside the facial canal, just before the facial nerve exits the skull via the stylomastoid foramen.

Chorda tympani is a branch of the facial nerve (the seventh cranial nerve) that serves the taste buds in the front of the tongue, runs through the middle ear, and carries taste messages to the brain. (Wikipedia) Disco 30/6/10


101. In a trial, 75 patients with an uncommon, newly described complication and 50 matched patients without this complication are selected for comparison of their exposure to a new drug. The results show

Complication present Complication absent
Exposed to new drug 50 25
NOT exposed 25 25

From this data
A. the relative risk of this complication with drug exposure CANNOT be determined
B. the odds ratio of this complication with drug exposure CANNOT be determined
C. the relative risk of this complication with drug exposure is 2
D. the odds ratio of this complication with drug exposure is 1.33
E. none of the above


102.BP measurement - overestimates with:
A. big (wide) cuff
B. skinny arm
C. severely peripherally vasoconstricted
D. atherosclerosis (it was arteriosclerosis - yes indeed)
E. slow cuff deflation


103. A device that detects a 10mA difference in active and neutral leads and causes turning off of the circuit within 40 ms. this is a :
A. Class 1 device
B. Equipotential earthing
C. LIM
D. Residual Current Device
E. Fuse


104.Post-transfusion hepatitis in Australia is associated with
A. jaundice in over 50% of patients
B. development of chronic disease in less than 10% of patients
C. hepatitis B in the majority of patients
D. the presence of antigen or antibody to hepatitis C
E. elevation of serum alkaline phosphatase


105.In a patient requiring FFP where the patient’s blood group is unknown, it is ideal to give FFP of group
A. A
B. B
C. AB
D. O
E. Blood group of FFP in this situation does not matter


106.Features of the transurethral resection of the prostate (TURP) syndrome include all of the following EXCEPT
A. agitation
B. angina
C. bradycardia
D. nausea
E. tinnitus


107.The most frequently reported clinical sign in malignant hyperpyrexia is
A. arrhythmia
B. cyanosis
C. sweating
D. tachycardia
E. rigidity


SZ80 Which of the following is not an absolute contra-indication for MRI?

A. cochlear implant
B. heart valve prosthesis
C. ICD
D. pacemaker
E. intracranial clips


109.Reverse splitting of the second heart sound occurs with:
A. LBBB
B. Pulmonary hypertension
C. Acute pulmonary embolus
D. ASD
E. Severe MR


110. Atrial fibrillation:
A. Cardioversion results in longer life expectency than rate control
B. Need to stay on warfarin following cardioversion
C. Pt with HR <80 generally do not require anticoagulation
D.


111.Scoliosis surgery. what is incorrect
A. one third of the blood loss occurs postoperatively
B. major blood loss is frequently accompanied by a consumptive coagulopathy
C. surgery will halt progression of the restrictive lung deficit
D. the major neurological deficits that occur are usually due to damage to the posterior columns of the spinal cord
E. the use of aprotinin reduces blood loss


112.About transient neurological syndrome..


113. Epidural infection...


114. Difference between cardiac protected and body protected area
A. Equipotential earthing


115. Which hormone is not released during surgery?
A. cortisol
B.
C. TSH
D. growth hormone


116. Asystolic aortic arch repair. The best method for cerebral protection is:
A. anterograde perfusion via coronary vessel
B. retrograde perfusion via jugular vein
C. thiopentone IV
D. hypothermia to 20 degrees celcius


117. Specificity most closely means
A. chance of a positive test in people with the disease
B. chance of a negative test in people without disease
C. chance of...


118. Negative predictive value most closely means
A. chance of a positive test in people with the disease
B. chance of a negative test in people without disease
C. chance of...

(NB there were definitely two questions with identical options a. through e. (and each option was wordy and a bit confusing). The stems were definitely specificity and NPV)


119. Performing a bronchoscopy. The best way to orient the scope is: (see Q48)
A. angle of the bronchus
B. length of the bronchus
c. RUL

(NB there were definitely two new questions on bronchoscopy)

120. Symptoms of hypercalcaemia include: (see Q5)
A.
B.
C. seizures
D. short ST segment


121. Paediatric VF arrest. Which is true?
A. if resistant to defibrillation should give amiodarone 5mg/kg
B.
C. commonly associated with respiratory arrest
D. is the most common form of arrest in this patient group
E. should defibrillate with 5J/kg


RU19 Intercostobrachial nerve
A. Is often damaged by torniquet
B. supplies sensation to cubital fossa
C. is blocked by interscalene brachial plexus block
D. ?
E. ?

123. OLV hypoxaemia. After 100% O2 and FOB next step is: (rpt)
A. CPAP 5cm top lung
B. CPAP 10cm top lung
C. PEEP 5cm bottom lung
D. CPAP 5cm top + PEEP 5cm bottom
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