Finals MCQs-Sep 2011

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Finals Black Bank | Apr09 | Aug09 | Mar10 | Aug10 | Mar11 | Mar12

MCQs from the Final Exam September 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.

EZ93 What is the chemical used in sodalime to indicate exhaustion?

A. ethyl violet
B. potassium permanganate
C. ?

2. Repeat- Main heat loss in anaesthetic for neonate

A. vasodilatation
B. radiation
C. convection
D. conduction
E. evaporative

3. Repeat- One lung ventilation- FIO2 1.0, desaturate

4. Child with murmur- what would make it more likely for you to investigate if you heard the murmur

A. persist in supine position
B. louder or softer with various manouveres

5. Repeat- Single lumen intubation after multiple attempts of difficult intubation, you put in a bronchoscope after and the tip is in the trachea. The structure B you seen corresponding to?

6. Repeat- CXR correspond to-

A. right side hydropneumothorax

7. Repeat- Neonate to drug addicts found by grandmother in the house, brought into ed, mildly jaundice, slight tachycapnic. ABG PH 7.54, PaCO2 46, pO2 74, HCO 13

A. Septicaemic
B. Pyloric stenosis
C. Opiod overdose
D. Meningitis
E. Hepatitis

According to the Henderson Hasselbalch equation these blood gas results cannot exist -JC

ET03 [Repeat] Jehovah's witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle:

A. Paternalism
B. Maleficience
C. Autonomy
D. Beneficience

9. Patient with aortic stenosis, the signs indicate poor prognosis

A. Palpitation
B. Radiation to carotid arteries
C. Something about characteristic of murmur

Which is the best predictor of poor prognosis with aortic stenosis?

A. chest pain
B. paroxysmal nocturnal dyspnoea
C. syncope

10. New- Patient indicated for prophylaxis of infective endocardititis

A. amoxicillin orally 2 hours prior
B. amoxicillin IV 1 hourly prior
C. amoxicillin IV just before incision
D. cefazolin IV 1 hour prior

11. Repeat- Spontaneously breathing patient under GA, what would detect the breathing tube disconnection

12. Repeat- Plenum and flow over vaporiser- what is not the disadvantage of flow over vaporiser

PZ130 Which drugs below does not need dose adjustment in renal failure patient

A. Buprenorphine
B. Morphine
C. Tramadol
D. ?
E. ?

14. Repeat- Child after gas induction, LMA insertion without IV cannula- desaturate to 90%. Next step of action?

A. Bag with LMA insitu
B. Bag without LMA insitu

PZ128 Patient on cisapride. What drug NOT to give in recovery?

A. Tramadol
B. ?
C. ?

16. Repeat- Which herbal supplement reacts with tramadol?

A. Ephedra
B. St John's wort

17. Repeat- Fat: blood coefficient- N2O, D, S, I

18. Repeat- Immunology mediated heparin induced thrombocytopenia- intravascular thrombosis

19. Repeat- Half life or tirofiban?

A. 2 hours

TMP-131 Repeat- Troponin can be detected for how long:

A. 5-14 days
B. ?

21. Repeat- Neonate intubation- at lips

22. New - 72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is

A. IVC filter
B. Refer him for a pulmonary embolectomy
C. Supportive (fluids and inotropes)
D. Thrombolysis
E. Warfarin

23. Repeat- The test to diagnose pulmonary embolism

A. CT pulmonary angiogram
B. Echocardiogram
C. Electrocardiogram
D. Ventilation-perfusion scan

24. Repeat- Finding on haemophilia A patient

A. Female haemarthrosis
B. Male haemarthrosis
C. Normal PT, abnormal APTT
D. Abnormal PT, normal APTT

25.tmp11b25 New- LSCS for foetal distress, meconium stained liquor. Management of baby

A. Intrapartum suctioning
B. Intrapartum suctioning and post partum tracheal suction
C. Post partum tracheal suctioning
D. Routine neonatal care
E. Intubate

26. Repeat- 36yo male with sickle cell anaemia Hct 0.3 with close foot fracture, what is true

A. Transfusion 2 pint packed cell preop
B. Spinal can be done

27. New- An elderly lady has a closed neck of femur fracture and presents to ED. She is in chronic AF and on warfarin. INR is 2.6 and she is not bleeding. It is 9am and she is scheduled for repair the following day. According to current guidelines, how should her warfarin be reversed?

A. Prothrombinex 25IU/kg immediately and then 2 units FFP immediately prior to surgery
B. No immediate treatment then 2 units FFP immediately prior to surgery
C. Vitamin K 1mg IV immediately
D. Vitamin K 10mg IV immediately
E. Withhold warfarin

28. Repeat- Marfan syndrome. All EXCEPT-

A. Aortic stenosis

29. New- Subarachnoid haemorrhage patient. What percentage rebleed in the first 24hours

A. <5%
B. 5-10%
C. 10-15%
D. 15-20%
E. >20%

A is correct according to OHA 2nd Ed p408 - 4% risk of rebleed in 1st 24 hours -JC

Anaswer is 5-10% from ceaccp on SAH 23/11/2012 - but that's quoted as 'within first 72 hours' c.f. in the first 24 hours as in this question - SYL

30.TMP11B30 New- Post delivery neonate did not breath post stimulation by midwife, not vigorous, heart rate drop from 140 to 90bpm. Next step of action

A. 100% oxygen
B. Positive pressure ventilation
C. Intubation
E. Adrenaline

31. New- The safe maximal pressure for endotracheal cuff at the lateral side of the trachea

A. 0-10 cm water
B. 10-20 cm water
C. 20-30 cm water
D. 30-40 cm water
E. 40-50 cm water

32. Repeat- Allergy to penicillin- cross reaction to neuromuscular blocker

33. New- Patient with mastocytosis. Intraop would probably be:

A. Severe hypotension

34. Repeat- Complication of celiac plexus block

A. Hypertension
B. Failure of erection
C. Constipation
D. Paraplegia
E. L3,4 lumbar pain

35. New- Post epidural and LSCS, the next day patient have persistent paraesthesia anterior thigh. What other injuries would indicate more of nerve roots instead of peripheral nerve injuries

A. Weakness on hip flexion and thigh adduction
B. Weakness on knee flexion and plantar flexion
C. Urinary incontinence
D. Foot drop

36. Repeat- Nerve supply to the upper eyelid-

A. ophthalmic branch of trigeminal and sympathetic from superior collicus ganglion

37. Repeat- Post LSCS foot drop-

A. Common peroneal nerve

38. Repeat- Post op cervical- patient complaint arm weakness. Differentiate C8, T1 versus ulnar nerve injuries- Abduction pollicis brevis

39. Repeat-Absent of Q waves-

A. Digitalis toxicity

40. Repeat- What can prolong QT interval except-

A. Magnesium

41. Repeat- Post carotidenderactomy in the ward, patient seizur:E. Noted patient operation side is more severe stenosis and post op difficult to control blood pressure. What would prevent seizure most

A. Add on antihypertensive
B. Start anti convulsant

42. Repeat- Post local anaesthetic block in difficult intubate patient- patient seizure. What would you give?

A. Midazolam 5mg
B. thiopentone
C. propofol
D. Suxamethonium

43. Repeat- Carcinoid patient intraop hypotension-

A. ocreotide

44. Repeat- Allergic question, which is true

A. Collect tryptase 8hours
B. RAST test most sensitive/ specific
C. Absent of trytase exclude anaphylactic
D. Skin and intradermal test- sensitivity, specificity

45. Repeat- What more likely to cause TRALI?


46. New- After transfusion of 5 unit of FFP what is least likely to occur

A. Haemolytic reaction
B. Hypocalcaemia
C. Infection
D. Hyperkalaemia

47. Severe asthmatic- tachycapnia, HR120, speaking in words, pH 7.45, pCO2 46, pO2 96, HCO3 24. Then given nebulised salbutamol continuously, nebulised ipratropium bromide, and hydrocortisone- The next step:

A. ?
B. ?

48. Repeat- Most common cause of awareness-

A. human error

49. New- There is evidence to avoid BIS <40 for more than 5minutes because

A. Safe cost
B. Increase incident of hypotension
C. Increase post op mortality
D. Decrease volatile (?) for poor cardiac output patient
E. Decrease the incidence of awareness

50. New- Most common cause of paediatric post anaesthesia cardiac arrest

A. Drug error
B. Respiratory cause
C. Multifactorial
D. Cardiac problem (?)

51. New- Post cervical spine op, there is bulging noted under the incision sit:E. Patient desaturated, combative, keep pulling off the oxygen facemask. Next course of action

A. Rapid sequence induction
B. Gas induction
C. Needle aspiration of the bulge at the neck

52. New- What drug known to cause prolong QT and risk of Torsades de pointes

A. Metoclopramide
B. Droperidol
C. Tranexamic acid

53. New- During cardiac catheterisation (?) patient become BP 80/60, HR 110, CVP 16. What is the next most important investigation

A. Echocardiogram
C. Electrocardiogram

54. Intraop hyperfibrinolysis- how to diagnose (euglobulin lysis time NOT an option in the answer)


55. New- 75yo patient seen for femoral bypass surgery, no significant cardiac risk factor. He will be admitted 3 days prior to operation. You decided NOT to start on beta blocker and you are justified because:

A. There is increase mortality and morbidity
B. There is not enough time to safely start beta blocker
C. The beta blocker may make the patient claudication worst
D. ?

56. New- 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

57.EZ80 Repeat- A line isolation monitor protects against microshock

A. only if the warning current is set at 10mA
B. only if the warning current is set at 30mA
C. under no circumstances
D. only if the equipment used is grounded
E. only if it monitors all the equipment in the region

58. Repeat- Post pneumonectomy patient care- clamp chest tube with intermittent release

59.RB53 Repeat- Post dural punture headache

A. 24hour bed rest
B. Prone position worst
C. Increase incidence with insertion of spinal catheter
D. Hearing loss

60. New- Patient ingested 500mg/kg aspirin. In ICU, the most effective method to remove aspirin

A. IV fluid
B. Haemodialysis
C. Sodium bicarbonate infusion
D. Frusemide

Sodium Bicarbonate Infusion to alkalinate urine is "treatment of choice" according to Oh's Intensive Care Manual 6th Ed. p905 -JC

61. Repeat- The most effective method of decrease renal impairment in AAA surgery

62.SZ18 Repeat- What happen after infra-renal clamping in AAA- decrease renal blood flow

63. Repeat- The most effective method for cerebral protection in aortic arch aneurysm repair

A. Systemic hypothermia 20degrees
B. Antegrade perfusion to carotid arteries
C. Retrograde perfusion to jugular veins
D. Thiopentone
E. Steroid (?)

64. Repeat- CO2 used in pneumoperitoneum because-

A. less adverse effect in embolism

65. Repeat- Most common signs of malignant hyperthermia-

A. tachycardia

66. New- The below would increase A-a oxygen gradient Except

A. Increase FIO2
B. Decrease FIO2
C. Decrease cardiac output
D. Increase shunt

67. Repeat- Stellate ganglion-

A. anterior to scalenous anterior

68. Repeat- Patient cough during interscalene block- insertion needle should be directed- posteriorly

69. New- Interscalene block after injection of 2ml bupivacaine- patient seizure. Most likely injected to

A. Dural cuff
B. Vertebral arteries
C. Internal carotid arteries
D. Jugular veins
E. Subarachnoid (?)

70. New- Post intubation, you manual ventilate and noted patient high airway pressure. What would you do next

A. Open the APL valve
B. Auscultate the lung
C. Switch to ventilator

71. Repeat- Acromegaly- difficult intubation because-

A. Macroglossia

72.->AZ84 New- Modified Cormack and Lehane grade - You cannot see beyond the epiglottis and there is a little space between the epiglottis and the posterior pharyngeal wall (? remembered as epiglottis touching posterior pharyngeal wall)

A. 2a
B. 2b
C. 3a
D. 3b
E. 4

73. Repeat- Stellate ganglion block associated with all except- sweating of face

74. Repeat- Most safe side to insert subtenon block

A. Inferonasal
B. Inferotemporal
C. Medial
D. Superonasal
E. Superotemporal

75. Compared to retrobulbar block, peribulbar block is associated with

A. More bleeding
B. More risk to optic nerve
C. More akinetic eye
D. Less block to orbicularis oculi

76. Repeat- Diastolic dysfunction Not caused by

A. Adrenaline
B. Myocardial fibrosis
C. Aortic stenosis
D. Hypertension

77. Repeat- Reversed splitting of second heart sound associated with-


78. Lumbarsacral nerve does not supply:

A. Subcostal nerve
B. Ilioinguinal n
C. Iliohypogastric n
D. Femoral n
E. Genitofemoral n (?)

79. Repeat- Relative humidity of fully saturated air at 20degree and 37 degrees-

A. 40%

80.IC90 Repeat- Trauma patient best indicator of good resuscitation (?)-

A. Lactate level
B. Heart rate
C. Blood pressure
D Acidosis (?)

81. New- Pregnant patient seatbelt, driver- involved in car accident. Suddenly developed severe central chest pain, HR 110, BP 154/80, RR 26, Sat 100%. The most likely cause?

A. Sternal fracture
B. Aortic dissection
C. Pneumothorax
D. Rib fracture
E. Myocardial infarction

82. New- ASD murmur heard at

B. Tricuspid valve
C. Pulmonary valve
D. Mitral valve
E. Aortic valve

83. Repeat- something answer with DDAVP

84. Repeat- Chronic alcohol is not associated with- nephritic syndrome

85. Repeat- Blunt throat trauma- next step- nasoendoscopy

86. Repeat- Rate of CO2 rise in apnea oxygenation

87. New- Apnoeic oxygenation in obese patient can be increased by

A. Sniffing position
B. Prone
C. Supine
D. Lateral
E. Head up

88. Repeat- Long standing T6 paraplegia, except- flaccid paralysis

89. Repeat- Amniotic fluid embolism- cause of early death- Pulmonary hypertension

90. New- Post partum sudden collapse, suspected amniotic fluid embolism. The consistent finding is:

A. Low C3, C4
B. Increase complement
C. Increase tryptase
D. Increase histamine?
E. petechial rash

Which is supportive of a diagnosis of amniotic fluid embolism?

A. decreased C3 & C4 levels
B. hyperfibrinogenaemia
C. thrombocytosis
D. markedly elevated tryptase
E. ?

91. Repeat- Earliest sign of hypocalcaemia- tingling

92. Repeat- Nerve block anterior 2/3 of ear- mandibular

93. Repeat- the no of people in the population with a predisposition of a disease- prevalence

94. Repeat- sensitivity 90%, specificity 99%- False positive 1%

95. Repeat- Levosimendin-

A. alteration of calcium binding

96. Repeat- In pregnancy dural sac end at – S2

97. Repeat- ? Stable narrow complex tachycardia not responding to vagal maneuvres- adenosine

98. Repeat- Which does not have pulmonary hypertension- Tetralogy of Fallot

99. Repeat- Fontan circulation-

A. short inspiratory time
B. prolong inspiratory time with positive pressure ventilation

100. Repeat- SVRI = SVR x BSA

101. New- Young pregnant patient with moderate mitral stenosis, normal LV function. The best delivery method

A. Epidural anaesthesia LSCS
B. Spinal with LSCS
C. Epidural analgesia and normal vaginal delivery
E. Normal vaginal delivery with remifentanil PCA

102. Repeat- Tracheo-oesophageal fistula, correct statement

A. Usually does not need contrast for diagnosis
B. Mainly left side
C. Associated with cardiac lesion 60%
D. ..?.. 20%

103. Repeat- Pulmonary hypertension secondary of lung disease- true

A. Alpha agonist can be used
B. Isoflurane will decrease the pulmonary pressure significantly
C. N2O
D. Ketamine
E. Spontaneous breathing

104. New- Neonate desaturate faster than adult at induction because

A. FRC decrease more
B. Faster onset of induction agents
C. More difficult to pre-oxygenation

105. New- The cause of hypoxia in one lung ventilation

A. Blood flow through non ventilated lung
B. Impairment of hypoxic pulmonary vasoconstriction
C. Ventilation perfusion mismatched (?)

106. New- Suxamethonium dosage is higher in neonates compared to adults because:

A. Increased volume of distribution
B. Increased pseudocholinesterase activity
C. More receptors
D. Higher cardiac output (?)
E. Decreased sensitivity of nicotinic ACH receptors to suxamethonium
F. Faster diffusion away from neuromuscular junction

107. Repeat- Baby with trache-oesophageal fistula management- head up, drainage tube in oesophagus

108. Repeat- C6/7- wrist flexion and extension

109. Repeat- CTG for pregnant patient underanaesthesia for noNew-obstetric surgery- loss of beat to beat variability

110. New- Indicates autonomic neuropathy EXCEPT:

A. Sinus arrthymias
B. Gastric reflux
C. Postural hypotension

111. Repeat- Best indicator of return of function of laryngeal muscles is:

A. Sustained head lift 5 sec
B. Sustained leg lift 5 sec
C. TOF 0.9
D. DBS no fade
E. Tetanus 50Hz

112. Repeat- Torsades not useful-

A. Amiodarone
B. ?

113. New- A nulliparous woman in labour for 8 hours with epidural analgesia has a fever 37.6 degrees. The most likely reason for this is

A. altered thermoregulation
B. chorioamnionitis
C. urinary tract infection
D. inflammatory response
E. neuraxial infection

114. Repeat- Supply of sensation above the vocal cord- external branch of superior laryngeal nerve

115. Repeat- Supply of carotid sinus- Glossopharyngeal nerve

116. ? Post op pneumonectomy short of breath- investigation

117. Repeat- COAD on home oxygen, submandibular lymph nodes biopsy under LA. How to prevent airway fires- Bipolar instead of unipolar diathermy

118. Repeat- ? Respiratory function in quadriplegic- A. improve with chest wall spasticity

119. Repeat- Pulsus paraxodus-

A. exaggeration of normal systolic pressure on inspiration

120. New- Pre eclamptic patient post LSCS continue on Mg infusion in ICU. Found to be in respiratory depressed. Next management

A. Calcium gluconate
B. IV fluid
C. Frusemide

121. New- Periop clinic reviewing a patient with chronic/ end stage renal failure. Her calcium found to be low. He most certainly have

A. Primary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Tertiary hyperparathyroidism

122. Repeat- How to estimate weight in child-

A. (age+4) x2

123. Repeat- Post trauma with liver laceratioNew- would not be operated

A. Haemodynamically stable

124. Repeat- Compare to Mallampati Score, thyromental distance is- less sensitive more specific

125. New- Compare to Myasthenia gravis, which symptoms is more likely to be Eaton Lambert syndrome?

126. Repeat- Acute malignant hyperthermia- muscle rigidity 75% in cases

127. Repeat- Medial peribulbar block advance no further pass the equator than-

A. 10mm

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

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

129. Repeat- Systemic review weakness is

130. Repeat- Commonest presenting features of anaphylaxis- hypotension

131. New - 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

132. New - When intubating over a bougie / awake fibreoptic, which direction do you rotate the tube to stop it catching on structures in the glottis

A. no change from normal
B. 90 degrees clockwise
C. 90 degrees counterclockwise
D. 180 degrees
E. try either direction

133. New - Advantages of off-pump CABG over on-pump CABG

A. decreased transfusion rate
B. decreased mortality
C. decreased cost
D. increased graft patency
E. less cognitive impairment
F. less stroke

134. New - After coronary artery bypass graft surgery, the FRC is

A. increased 40%
B. increased 20%
C. unchanged
D. decreased 20%
E. decreased 40%

135. New - A 60 year old man 24 hours post CABG is confused, oliguric, with BP 80/40, pulse 120. The most appropriate and useful investigation is

A. electrocardiogram
B. echocardiogram
C. chest x-ray
D. arterial blood gas
E. coronary angiogram

136. Iron deficiency

A. decreased serum ferritin, increased serum iron
B. decreased serum ferritin, absence of bone marrow iron
C. decreased serum ferritin, normal serum iron
D. increased serum ferritin, decreased serum iron
E. increased serum ferritin, decreased total iron binding capacity

137. New - Why should NSAIDs be avoided in pregnant women >30 weeks gestation?

A. cause neonatal acute renal failure
B. increased antepartum haemorrhage
C. increased rate of pre-eclampsia
D. cause closure of the fetal ductus arteriosus
E. increase preterm labour

138. A 62 year old man has chronic renal failure. You notice his total serum calcium is 2.05 mmol/L. This is because he has

A. high serum vitamin D
B. hypoparathyroidism
C. primary hyperparathyroidism
D. secondary hyperparathyroidism
E. tertiary hyperparathyroidism
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