Finals MCQs-March 2011

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Finals Black Bank | Apr09 | Aug09 | Mar10 | Aug10 | Sep11 | Mar12

MCQs from the Final Exam March 2011
Each paper has 50 new MCQs, 50 repeats from the previous MCQ paper, and 50 old repeat MCQs. 
If you can, please indicate whether you think each MCQ is a new one or a repeat one.


ME46 Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?

A: Distorted facial anatomy
B: Macroglossia
C: Glottic stenosis
D: Prognathe mandible
E: Arthritis of the neck


MZ82 Ehlers-Danlos syndrome. Most important to specifically do all EXCEPT:

A: Avoid hyperextension of the neck
B: Damage to the teeth
C: Avoid joint hypermobility
D: Gastro oesophageal reflex
E: Strict temperature regulation


ET02 An 85y.o for open AAA repair. Refuses blood because of risk of vCJD. You tell him you won't anaesthetise him as the risk is too high. This is an example of:

A: Autonomy
B: Beneficence
C: Malevolence
D: Coercion
E: Paternalism


MH61 A 35yr old African-American with sickle cell and fractured ankle for ORIF. Hb 90, Haematocrit 0.3.

A: Transfuse 2 units packed cells (?pre-op)
B: Let him cool passively to low/normal temperature
C: Spinal is safe
D: Avoid thiopentone
E: Tourniquet is absolutely contra-indicated


SN18 Absolute contraindication to sitting position for posterior fossa craniotomy for meningioma

A: Prescence of patent ventriculo-atrial drain/shunt
B: PFO
C: Oesophageal stricture so transoesophageal echo placement is out
D: ?
E: ?


MC42 ECG- which does NOT have abnormal Q waves:

A: Digoxin toxicity
B: Anterior myocardial infartion
C: Previous AMI
D: LBBB
E: Wolff-Parkinson-White syndrome


RB65 Coeliac plexus block. What is the complication?

A: Erectile dysfunction
B: Constipation
C: Hypertension which resolves spontaneously
D: Paralysis
E:


8. NEW. TMP-Jul10-010?? Long stem about an old #NOF patient with aortic stenosis. What is a sign/ investigation/ symptom that shows the most severity? (ie Which one of these would indicate that the lesion was severe?)

A: Thrill in Aortic area
B: Murmur in lower left sternal edge
C: Murmur radiating to carotids
D: History of ischaemic heart disease or coronary artery disease
E: history of angina/ syncope

Alternate:

D: valve area = 1.2cm2
E: gradient = 30mmHg


9. NEW. You get a TOE on a patient with aortic stenosis. What is the finding most likely to indicate that the valve needs replacement? possibly same as TMP-Jul10-010

A: Average pressure gradient 30mmHg
B: Valve area 1.2cm(squared)
C: dyspnoea


MN46 Petit mal epilepsy - Which is true? (or words to that effect)

A: Most common in child <2 years old
B: Can precipitate seizures by hyperventilating (+/- deliberately???)
C: Often seizures last for more than 30 seconds
D: Rarely familial
E: Isoelectric EEG during seizure (burst suppression)


11. NEW. (I know previous variants exist) Hypertension- severe- in pregnancy (or was it PET?) What NOT to use?

A: Hydrallazine
B: Nifedipine
C: Labetalol
D: Metoprolol
E: SNP

NB Magnesium was NOT an option


AC159 Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?

A: Add another antihypertensive
B: Start antiplatelet drugs
C: Start anticonvulsants
D: Do angio and stent
E: Nimodipine


13. NEW. Which have been shown to decrease vasospasm post aneurysm? All EXCEPT:

A: Antiplatelet drugs
B: Nimodipine
C: HHH therapy
D:
E:


14. NEW. Post operative left pneumonectomy. What to do with underwater seal drain?

A: Nurse patient in R lateral decubitus position
B: Expect to see bubbles
C: Suction every hour for 5 minutes
D: Unclamp drain once an hour for 5 minutes, leave clamp on for the rest of the time
E: Leave on free drainage

NOTE: this question looks similar to AT27


15. New? What is NOT true for PDPH following puncture

A: Prophylactic bed rest
B: Catheter in intrathecally
C:
D:
E:

I'm guessing the answer will be straight out of APMSE


16. Magnesium for treatment of pre-eclampsia. What is the therapeutic level? (I think this may be a repeat of an old question, but i remember two of the options were-

A:
B: 3 - 5
C: 5 - 7
D:
E:

Clearly remember these being options as I thought the answer was "5" so which to choose?

The RBWH guidelines recommend 4mg so I'd go B--Drpeace 04:13, 11 July 2012 (CDT)
OHCS says 2-4 , again B  --Methoxyflurane 19:40, 20 August 2012 (CDT)


17. NEW. Autonomic dysreflexia. Which ONE is true?

A: 50% of patients with a level below T6
B: Unlikely if below T10
C: Can be prevented??
D: Can be precipitated by light touch
E. ?

See MN28


18. NEW. Ageing (adult) causes:

A: Decreased FRC
B: Decreased Cardiac output
C: Diastolic dysfunction
D: Increased creatinine


19. NEW. TEG tracing given, post cardiac surgery. Had quite slim tail (ie fibrinolysis) but broader 'shoulders'.

A: Fibrinolysis
B: Hypofibrinogenaemia
C: Platelet dysfunction
D: Heparin effect
E: Surgical bleeding


20. NEW. Really poor copy of a CXR. Looked to me like a haemopneumothorax (you could very faintly see a collapsed lung outline, there was no 'meniscus' to the fluid shadow) but other people thought it was an artefact. It did indeed look like a pneumothorax and then someone had put a piece of metal up to simulate a haemothorax, because on the lateral you couldn't see past the ribs (ie the film was cut off at the rib borders). It was terrible quality (too black, and hard to discern tissue from air), and an inadequate film (cut off apices, and poor lateral view as before)

A: Pneumothorax
B: Haemopneumothorax
C:
D:
E: Artefact.


21. NEW? Post scoliosis repair, decreased movement bilaterally in the legs with decreased pain and temperature sensation but spared joint position sense and vibration. What is at fault?

A: Posterior spinal arteries
B: Anterior spinal arteries
C: Epidural haematoma
D: Misplaced pedicle screw
E: Lateral cord syndrome


22. NEW. Anaesthetising an obese patient. Acelerometer on TOF 0.9. Could dose suxamethonium on ideal body weight or total body weight. With respect to 1mg/kg IBW vs. TBW you will see:

A: shorter onset and faster twitch recovery
B: shorter onset and similar twitch recovery
C: shorter onset and slower twitch recovery
D: similar speed of onset with similar speed of twitch recovery
E: similar onset and longer recovery

http://www.anesthesia-analgesia.org/content/102/2/438.short

23. NEW: The half life of the active metabolite of levosimendan (OR-1896) is:

A: 1hr
B: 8hr
C: 24hr
D: 3 days
E: 7 days

see http://www.ncbi.nlm.nih.gov/pubmed/17888637

24. NEW. When compared to a non-obese patient, in an obese patient (BMI >35) when fasted for an elective procedure the gastric secretion will have:

A: more volume, higher pH
B: more volume, lower pH
C: same volume, same pH
D: less volume, lower pH
E: less volume, higher pH

Answer is B according to Obesity in Anaesthesia and Intensive Care. BJA 85(1):91-108 (2000) page 101 -JC

25. NEW. The anterior branch of the femoral nerve supplies everything but:

A: pectinius
B: rectus femoris
C: Medial thigh
D: anterior thigh
E: sartorius

Answer is B (supplied by posterior branch) according to Anatomy for Anaesthetists page 189 8th Ed. -JC

26. NEW: During interscalene block placement get medial movement of the scapula. This is secondary to stimulation of:

A: long thoracic nerve
B: dorsal scapula nerve
C: suprascapular nerve
D: supraclavicular nerve
E: accessory nerve

Answer B. From Google: the dorsal scapula nerve arises from C5. It innervates the rhomboids which medialise the scapula and levator scapulae which elevates the scapula (Nathan)


27. NEW. Popliteal block placed from the lateral approach:

A: Passes through semimembranosus
B: Has eversion of the foot as the end point
C: Has increased failure rate compared to a posterior approach
D: ?
E: Can be performed supine or prone


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

A: Dorsal column
B: Spinothalamic tract
C: Lateral Corticospinal tract
D: Cerebrospinal tract
E: Anterior horn cells


29. NEW. During lumbar plexus block placement, which of the following indicates inappropriate needle placement?

A: hip flexion
B: hip adduction
C: knee extension
D: knee flexion
E: lumbar extension


30. NEW. Flow with the O2 flush button pressed and volatile agent turned on will give you:

A: 20-30l/min O2
B: 30-70l/min O2
C: volatile agent + 30l/m O2
D: volatile agent + 40l/m O2
E: volatile agent + 50l/min O2


31. NEW. Which of the following causes the most heat loss in a neonate?

A: conduction
B: convection
C: evaporation
D: radiation
E: vasodilation


32. NEW. 75 year old with non-valvular AF usually on warfarin has their warfarin stopped for one week. What is their daily risk of stroke?

A: 1%
B: 0.1%
C: 0.01%
D: 4%
E: 10%

Answer is C according to OHA 2nd ed, p 82 -JC


33. NEW. If type and Rh specific blood is given to a patient, how safe is the transfusion (Can't quite remember wording, but similar to what is in Dr Brandis' physiology viva book)?

A: ?
B: ?
C: 97%
D: 98.6%
E: 99.8%


34. NEW. Patient with Marfan's and 2 hours of severe chest pain, mild hypertension and ECG showing ischaemia. The next best step is urgent:

A: CT
B: TOE
C: ?
D: Angiography and PCI
E: Thrombolysis


35. New. What percentage of patients with SAH are troponin positive?

A: <5%
B: 15-30%
C: 40-60%
D: 70-90%
E: 100%

""Contin Educ Anaesth Crit Care Pain (2008) 8 (2): 62-66. states 20%""


36. NEW. What is the major cause of death in a patient with perforation of the pharynx, oesophagus or trachea?

A: failure to intubate
B: failure to ventilation
C: sepsis


37. New (?). Eisenmengers syndrome:

A: decrease Hb to <180 with venesection
B: Give high FiO2
C: Pulmonary vasodilators will treat the pulmonary hypertension
D: terminal RV failure usually occurs in the 3rd-4th decade

38. NEW. Your registrar gives a Duchenne patient 1mg/kg of suxamethonium. What are you most worried about?

A: hyperkalaemia
B: rhabomyolysis
C: MH


39. NEW. Fontan patient having an open appendicectomy. What do you want?

A: long I time and PEEP
B: long I time
C: short I time
D: raised ETCO2
E: spontaneous ventilation


40. NEW. What makes tramadol less effective?

A: ondansetron
B: prochlorperazine
C: metoclopramide


41. NEW. 75 year old male with normal renal function for an endoluminal aortic repair. What is the best protection to prevent the development of renal dysfunction?

A: NaCl
B: NAC
C: mannitol
D: dopamine
E: dialysis


42 NEW. Very sick patient on CVVHF. On norad, changed to adrenaline with no improvement in haemodynamic variables. What is your next step?

A: change to another inotrope
B: check their response to a synacthen test
C: give hydrocortisone


43. NEW. What is the most common way to measure end tidal gas concentrations on our anaesthetic machines?

A: mass spectometry
B: Raman scattering
C: ultrasonic
D: infrared
E: piezoelectric


44. NEW. Multiple attempts to place ETT during difficult intubation causing pharyngeal and oesophageal perforations. Most likely cause of death?

A: Failure to intubate
B: Failure to ventilate
C: Bleeding
D: Sepsis

45. NEW. How far to insert PICC line in a kid beyond the carina A: At the carina B: 1cm below C: 1cm above

http://www.anzca.edu.au/news/e-newsletter/e-news-articles/Coroners%20report%20PICC%20line%20AR%20summary%20Feb%2010.doc/view?searchterm=picc%20coroners ... speedy


OLD ONES: I am reliably informed by the smartest cookie in our study group there were 104 repeats.

Mar2010 Q66. Drug used to treat aip- what not to use after a seizure

Mar2010 Q85. If a test is negative...

Mar2010 Q109. Reverse splitting of the second heart sound occurs with... (options were in a different order than the ones on the bb here)

AB50: TRALI most likely after transfusion of...

TMP-Jul10-024 A 78 year old man with past difficult intubation for arm surgery. Supraclavicular block with 25 mls 0.5% bupivacaine. Shortly after begins convulsing. INITIAL management?

A. Midazolam 5mg
B. Intralipid 20% 1.5 ml/kg
C. Thiopentone 150mg
D. Suxamethonium 50mg
E. Propofol 50mg

TMP-Jul10-033 Subtenon’s block. What is the worst position to insert block?

A. Inferonasal
B. Inferotemporal
C. Superonasal
D. Supertemporal
E. Medial / canthal


TMP-Jul10-036 Which is NOT a disadvantage of drawover vaporiser versus plenum vaporiser:

A. Temperature compensation
B. Cannot use sevoflurane
C. Small volume reservoir
D. Flow compensation
E. ?

TMP-Jul10-048 Amniotic fluid embolism. Cause of death in first half hour ?

A. Pulmonary hypertension
B. Malignant arrhythmia
C. Pulmonary oedema
D. Hypovolaemic shock
E.

TMP-Jul10-054 Malignant hyperthermia. The number of people in the community at any given time with a predisposition is called the:

A. Prevalence
B. Incidence
C.
D.
E.

TMP-Jul10-056 Thallium scan:

AT08c [Aug10] One lung ventilation and hypoxaemia. After 100% 02 and FOB next step is:

PZ115(?)... about fondaparinux

Apr2008 Q125 : RH Globe perforation of eye blocks is most likely with:

TMP-Jul10-004 Exponential decline / definition of time constant (with various options)

A. time for exponential process to reach log(e) of its initial value
B. Time until exponential process reaches zero
C. Time to reach 37% of initial value
D. Time to reach half if its initial value
E. 69% of half life

TMP-Jul10-010 The best clinical indicator of SEVERE Aortic stenosis

A. Presence of thrill
B. Mean Gradient 30mmHg
C. Area 1.2 cm2
D. Slow rising pulse and ESM radiating to carotids
E. Shortness of breath

TMP-Jul10-016 TURP – patient under spinal. Confused. ABG: Na+ 117 / normal gas exchange. Treatment ?

A. 10 ml 20% Saline as fast push IV
B. 3% NS 100 ml/h
C. Normal saline 200 ml/h
D. Frusemide 40 mg IV
E. Fluid restrict 500 ml/day

TMP-Jul10-042 Patient post anterior cervical fusion. Patient in recovery. Confused and combative. Nurse concerned about haematoma. Taken to theatre: Most appropriate way of securing airway:

A. Gas induction / laryngoscopy / intubate
B. Awake tracheostomy
C. Awake fibreoptic intubation using minimal sedation
D. Thiopentone, suxamethonium, direct laryngoscopy and intubation
E. Retrograde intubation

TMP-Jul10-043 Young asthmatic male in emergency department. RR 26, pCO2 27, SAO2 92%, struggling talking in sentences. Given nebulised salbutamol, and ipratropium, 200mg IV hydrocortisone. After 30 minutes - no improvement. Further management:

A. IV salbutamol
B. IV aminophylline
C. IV magnesium
D. Intubate and ventilate
E. ???IV adrenaline?

(I remember seeing the options and thinking the answer was more obvious than what is on the BB)

TMP-Jul10-045 How quickly does the CO2 rise in the apnoeic patient ?

A. 1 mmHg per min
B. 2 mmHg per min
C. 3 mmHg per min
D. 4 mmHg per min
E. 5 or ?8 mmHg per min

TMP-Jul10-051 Visual loss with pupillary reflexes retained. Likely cause ?

A. Retinal detachment
B. Occipital mass (! I don't think this option was on the 2011 paper??)
C. Frontal mass
D. Chiasmal mass
E. Optic neuritis

TMP-Jul10-062 In pregnancy the dural sac ends at:

A. T12
B. L2
C. L4
D. S2
E. S4
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