July-2006 Finals MCQs

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In th collection that I've got for 2006, there is one stem question that I could not find a reference for it , advise please:

What is the most common reason for malpractice claims against Canadian anesthesiologists

Anaesthesia

AA: Allergy & Anaphylaxis

AA01 [2001-Apr] Q84, [2003-Aug] Q74, [Jul06]q85

When investigating a patient following anaphylaxis during anaesthesia, the test most widely applicable and least likely to produce false positive results, in identifying the responsible drug or drugs is

A. skin prick testing
B. I125 radiommunoassay (RIA) to specific circulating IgE
C. RIA inhibition
D. intradermal skin testing
E. assessment of basophil degranulation and histamine release from leukocytes


AA15 [2001-Apr] Q27, [2002-Aug] Q17, [2003-Apr] Q19, [2004-Apr] Q13, [2004-Aug] Q22, [Mar06], [Jul06]q7

With respect to latex allergy

A. immediate IgE mediated hypersensitivity is thought to be due to polysaccharides retained within finished latex products

B. it is possible to distinguish between contact dermatitis and IgE mediated hypersensitivity on the basis of history

C. no further testing is required if a latex RAST or EAST (enzyme linked) test is positive

D. intradermal tests are used to make a diagnosis, because anaphylaxis has been reported with skin prick testing

E. less than 5% of atopic health workers are likely to skin test positive to latex


AA16 ANZCA version [2001-Aug] Q65, [2002-Mar] Q59, [Jul06] Q91, [Apr07] Q63

FALSE statements regarding natural latex rubber allergy include

A. sensitivity of skin prick testing is greater than that of specific IgE antibody detection (RAST)

B. signs of Type I hypersensitivity are usually immediate

C. latex antibodies fall in time in a latex free environment

D. the risk factors of frequent exposure and atopy are additive

E. theatre latex aerogens are lowest in the morning

AB: Blood & Blood products

AB11b ANZCA Version [Jul06]] Q137, [Apr07]

Cryoprecipitate contains each of the following clotting factors EXCEPT

A. factor VIII
B. factor IX
C. factor XIII
D. fibrinogen
E. von Willebrand factor


AB35c ANZCA Version [Jul06] Q118

When providing anaesthesia for a patient who is a Jehovah's Witness, it is NOT acceptable to use

A. erythropoietin
B. albumin and clotting factors
C. cardio-pulmonary bypass
D. isovolaemic haemodilution
E. blood products for children, if parents insist that they be witheld


AB45 ANZCA version [2004-Aug] Q120, [Jul06] Q86

The most common coagulopathy in trauma patients is

A. clotting factor inhibition and depletion

B. disseminated intravascular coagulation

C. citrate toxicity

D. hypofibrinogenaemia

E. thrombocytopenia


AB51 ANZCA Version [Jul06] Q103, [Apr07]

A fifty-five-year-old man on antihypertensive medication, including an ACE inhibitor, has a total knee replacement. Red cell transfusion is begun in recovery through a leukocyte reduction filter after brisk bleeding into his drains. A recognised complication of the use of this filter in this situation is

A. air embolism

B. clotting factor depletion

C. haemolysis

D. increased risk of postoperative infection

E. severe hypotension


AB52 ANZCA Version [Jul06] Q121

Blood donors most commonly implicated in TRALI (Transfusion Related Acute Lung Injury) are

A. diabetics

B. donors previously resident in the United Kingdom

C. indigenous Australians

D. men under 50 years of age

E. multiparous females


AB53 ANZCA Version [Jul06] Q106, [Apr07]

The administration of blood contaminated with Yersinia enterocolitica will typically produce symptoms of infection

A. during the transfusion

B. within 6 hours

C. within 12 hours

D. within 24 hours

E. within a week

AC: Complications

AC01a [2004-Aug] Q138, [2005-Apr] Q81, [Mar06], [Jul06] Q72

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


AC18b [Jul98] [Apr99] [2002-Aug] Q68, [2004-Apr] Q85 [2004-Aug] Q98, [Jul06]q92

When providing general anaesthesia to a patient with a history of asthma

A. thiopentone should not be used as it may cause bronchospasm

B. intravenous and topical tracheal lignocaine are equally effective in preventing bronchial hyperreactivity

C. ketamine provides little benefit in a patient with active wheezing

D. induction with propofol is effective in reducing the incidence of wheezing following intubation

E. isoflurane is as effective a bronchodilator as halothane when given in MAC equivalent doses


AC22e ANZCA July 2006 version [Jul06] Q114, [Apr07]:

Detrimental post-operative effects of hypothermia following general anaesthesia in the elderly include each of the following EXCEPT

A. delayed emergence

B. hypercoagulability

C. increased body metabolism

D. reduced elimination of anaesthetic agents

E. shivering


AC62b [2003-Apr] Q144, [2004-Apr] Q98, [2004-Aug] Q44, [Jul06] Q23

The most commonly reported cause of awareness during general anaesthesia for a non-obstetric procedure is

A. equipment failure

B. human error

C. lack of premedication

D. recreational drug use

E. the use of total intravenous anaesthesia


AC68a ANZCA version [2002-Aug] Q13, [Jul06] Q21 (Similar question reported in [Apr96] [Aug96] [Apr97] [Jul97] [Apr98])

The risk of seroconversion after a needlestick injury, with a hollow needle from a HIV positive patient, is:

A. 30%

B. 15%

C. 3%

D. 0.3%

E. 0.03%


AC132 [2004-Aug] Q136, [Jul06] Q76

During surgery for tracheostomy insertion surgical diathermy is being used at the tracheal incision. You are ventilating with 100% oxygen. As the trachea is opened you notice a blue flame shooting up from the incision. Your first action should be to

A. disconnect the breathing circuit from the endotracheal tube

B. douse the wound with saline

C. insert a tracheostomy tube

D. remove the endotracheal tube

E. turn off oxygen and ventilate with air


AC143 [Jul05] [Jul06]

Regarding postoperative nausea and vomiting (PONV):

A. Prophylactic droperidol is as good as prophylactic ondansetron

B. Metoclopramide provides good prophylaxis

C. Use of rescue ondansetron recommended if prophylactic (first) dose failed.

D. Dexamethasone should be given at the end of the operation

E. Prophylactic ondansetron should be given after induction


AC150 ANZCA Version [Mar06] Q142, [Jul 06] Q19

A female patient with a history of severe postoperative nause and vomiting presents for abdominal surgery. If a volatile agent is used for maintenance of anaesthesia the most effective treatment to reduce her risk of postoperative nausea and vomiting would be

A. avoidance of nitrous oxide

B. prophylactic dexamethasone (4 mg)

C. prophylactic droperidol (1.25 mg)

D. propylactic ondansetron (4 mg)

E. a combination of prophylactic dexamethasone and droperidol


AC151 ANZCA Version [Jul06] Q112, [Apr07]

Which of the following contributes the LEAST to motor neuropathy following the lithotomy position?

A. age

B. BMI (body mass index) >25

C. diabetes

D. peripheral vascular disease

E. smoking

AM: Muscle disorders

AM04 ANZCA Version [Jul06] Q45

A 7 year old 30 kg. boy was booked for repair of an inguinal hernia. He was noted to have muscular looking arms and legs. Following midazolam premedication anaesthesia was induced with thiopentone intravenously and N2O/O2 by mask. Airway difficulties led to his being given 30 mg. of suxamethonium. He showed vigorous fasiculation followed by generalised muscular rigidity. The rigidity persisted despite another 30 mg. of suxamethonium intravenously. The probable cause of this response to suxamethonium is

A. atypical pseudocholinesterase

B. Duchenne's muscular dystrophy

C. familial periodic paralysis

D. hyperkalaemia

E. myotonia congenita


AM09c [2004-Aug] Q94, [Jul06] Q93

In the Neuroleptic malignant syndrome

A. there is a familial incidence

B. non depolarizing muscle relaxants decrease the muscle rigidity

C. creatinine kinase levels are elevated following an episode

D. there is an association with malignant hyperpyrexia

E. hyperthermia does not always occur


AM28c ANZCA version [Mar06] Q137, [Jul06] Q29, [Apr07] Q136

In patients with myasthenia gravis, features which increase the risk of requiring prolonged post-operative ventilation, include each of the following EXCEPT

A. a high dose of pyridostigmine preoperatively

B. a long history of the disease

C. high sensitiviey to neuromuscular blocking agents

D. history of a previous respiratory crisis

E. presence of a bulbar palsy


AM46 ANZCA Version [Jul06] Q150

Duchenne muscular dystrophy is a contra-indication to the use of

A. corticosteroids

B. non-depolarising neuromuscular blockers

C. suxamethonium

D. tramadol

E. volatile anaesthetic agents

AP: Pain medicine

AP36 ANZCA Version [Jul06] Q99, [Apr07]

In the treatment of phantom limb pain

A. calcitonin infusion is NOT effective

B. gabapentin reduces the pain

C. intravenous lignocaine reduces the pain

D. ketamine provides long-term pain relief

E. opiates are NOT effective

AT: Cardiothoracic anaesthesia

AT15 [Apr97] [Apr98] [Jul98] [Apr99] [Aug99] [2003-Apr] Q66, [2003-Aug] Q30, [Mar06] [Jul06]q8

The patient most likely to desaturate significantly during one lung anaesthesia is one who is having

A. a left sided thoracotomy, has reasonable PaO2 values during two-lung ventilation, but poor pre-operative spirometry

B. a right-sided thoracotomy, has relatively poor PaO2 values during two-lung ventilation but good pre-operative spirometry

C. a left-sided thoracotomy and has diminished perfusion but not ventilation to the operative lung on a V/Q scan

D. a right-sided thoracotomy, has relatively poor PaO2 values during two-lung ventilation and poor pre-operative spirometry


AT20b ANZCA Version Jul06] Q77, [Apr07] Q73

Major complications of mediastinoscopy include all of the following EXCEPT

A. compression of the great vessels

B. air embolism

C. pneumothorax

D. major haemorrhage

E. phrenic nerve damage


AT26 ANZCA Version [Jul06] Q101, [Apr07]

Following one-lung ventilation there is an increased risk of lung injury if plateau airway pressure (during one-lung ventilation) exceeds

A. 20 cm water

B. 30 cm water

C. 40 cm water

D. 50 cm water

E. lung injury is not related to ventilation pressure

AZ: Miscellaneous anaesthesia

AZ67 [2003-Apr] Q90, [Jul06] Q47, [Apr07]

The primary duty of an expert witness called by the defence is to the

A. Court

B. Defence Counsel

C. defendent doctor

D. medical profession

E. patient taking legal action


AZ76 ANZCA Version [2006-Mar] Q123, [Jul06] Q50

A 70-yr-old man is to undergo removal of cataract and intraocular lens implantation. He has long-standing atrial fibrillation and is on warfarin. He has no other health problems. He has never had a stroke. A sub-tenon’s block is planned for the procedure. His INR is 2.5. What should be the perioperative management of his warfarin therapy and anticoagulant status?

A. Interrupting warfarin therapy is optional for this procedure. If warfarin is interrupted for 5 days to allow normalisation of INR (< 1.5) no other perioperative anticoagulant prophylaxis is necessary

B. Warfarin therapy should be ceased 5 days preoperatively and no other perioperative anticoagulant prophylaxis is necessary. Surgery should proceed if INR is < 1.5

C. Warfarin therapy should be ceased 5 days preoperatively. He should commence daily low molecular weight heparin, omitting the dose on the day of surgery. Surgery should proceed if INR is < 1.5

D. Warfarin therapy should be ceased 5 days preoperatively. He should take daily clopidogrel till surgery. Surgery should proceed if INR is < 1.5

E. Warfarin therapy should be ceased 5 days preoperatively. He should take daily low dose aspirin till surgery. Surgery should proceed if INR is < 1.5


AZ77 ANZCA Version [Jul06] Q149

With regard to peri-operative cardiac risk reduction there is evidence that all of the following reduce perioperative cardiac morbidity EXCEPT

A. intra-operative use of nitrous oxide

B. peri-operative use of alpha-two agonists

C. perioperative use of diltiazem

D. peri-operative use of statins

E. tight peri-operative glycaemic control (blood sugar between 3.5 and 6mmol.l-1)

Equipment

EM: Monitoring

EM35c [Jul06]q66

TOE (trans-oesophageal echo): Picture of transgastric midpapillary short axis view arrow pointing to lump at the back. Is this the

A. posterolateral papillary muscle

B. posteromedial papillary muscle

C. anterolaterlal papillary muscle

D. mitral valve outflow

[note there was a handy key to the left of the image to show anterior vs inferior, left vs right]


EM37 ANZCA version [2001-Aug] Q57, [2002-Mar] Q52, [Jul06] Q81, [Apr07] (Similar reported question in [Apr96] [Aug96] [Apr97])

Systemic vascular resistance index (SVRI) is calculated from

A. systemic vascular resistance multiplied by body surface area

B. systemic vascular resistance divided by body surface area

C. mean aortic and central venous pressure difference divided by cardiac output

D. cardiac index divided by the mean aortic and central venous pressure difference

E. none of the above


EM40 [Aug96] [Apr97] [Jul97] [2001-Sep] Q35, [2002-Mar] Q15, [2004-Aug] Q31, [Jul05] [Mar06] [Jul06]q27

A Swan-Ganz catheter can be unreliable for measuring pulmonary artery systolic and diastolic pressures because the length and compliance of the tubing affects the measuring system by

A. reducing its resonant frequency

B. reducing its frequency response

C. reducing its damping coefficient

D. inducing a zero error

E. inducing baseline drift


EM52 [2003-Apr] Q67, [2003-Aug] Q69, [Jul06] Q61

The following capnograph tracing is most likely to represent

A. partial obstruction of sampling tube

B. sticking ventilator bellows

C. incomplete neuromuscular blockade

D. air entrainment into sampling tube

E. partial obstruction of endotracheal tube


EM58 ANZCA version [2003-Aug] Q120, [Jul06] Q62

During a transoesophageal echocardiography (TOE) examination the end-diastolic area is found to be 15 cm2 and the end-systolic area 10 cm2. Based on these measurements one could calculate this patient's

A. area ejection fraction to be 33%

B. area ejection fraction to be 67%

C. ejection fraction to be 50%

D. ejection fraction to be 67%

E. fractional area change to be 50%


EM60 [Mar06], [Jul06] Q84

PiCCO monitor (Pulsion Medical Systems) combines pulse contour analysis and transpulmonary thermodilution to provide a continuous measurement of:

A. cardiac output

B. cardiac output and intermittent assessment of intrathoracic blood volume

C. cardiac output and intermittent assessment of extravascular lung water

D. cardiac output and intermittent assessment of intrathoracic blood volume and extravascular lung water.


EM61 [Jul06]q100

Which statement about the use of Entropy depth of anaesthetic monitoring is true?

A. artefacts caused by cardiac pacemaker produce a high RE (Response Entropy) value

B. RE only assesses the EEG (electroencephalogram) range from 32-47Hz (high frequency)

C. SE (State Entropy) values range from 0 – 100

D. SE is a stable indicator of the effects of hypnotics on the cortex

E. the RE algorithm filters the EMG (electromyogram) component

Alt remembered versions of options

F. Response Entropy (RE) only analyses the high end (ie ?32-47Hz) of the EEG spectrum

G. Sustained Entropy (SE) gives a reliable measure of ?cortical depression

H. SE has a range of 0-100

I. interference with cardiac pacemaker


EM65 ANZCA Version [Jul06] Q125

Insertion of a pulmonary artery catheter is relatively contraindicated if the patient has an ECG (electrocardiogram) showing

A. anterior fascicular block

B. atrial fibrillation

C. left bundle branch block

D. posterior fascicular block

E. right bundle branch block

EZ: Miscellaneous equipment

EZ68 ANZCA version [2002-Mar] Q96, [2002-Aug] Q31, [Jul06] Q33

Carbon monoxide production by soda lime degradation of volatile anaesthetic agents, is LEAST likely to occur with

A. the first case of the day and the use of isoflurane

B. the first case of the day and the use of sevoflurane

C. the first case of the day and the use of desflurane

D. fresh soda lime and the use of desflurane

E. fresh soda lime and the use of sevoflurane


EZ72 [2004-Apr] Q147, [Jul06] Q78, [Apr07]

The output of a diathermy machine does NOT cause patient electrocution because the

A. current is too low

B. current travels on the surface of the body

C. frequency is too high

D. return electrode is never placed between the heart and the operation site

E. voltage is too low


EZ78 ANZCA Version [Mar06] Q116, [Jul06] Q90

Regarding ball flowmeters the

A. flow control knob cannot stop gas leakage if the glass chamber is broken

B. flowmeter maintains accuracy when tilted

C. flowmeter will over estimate gas flow if connected to a high resistance device such as a nebuliser

D. gas flow rate is read at the centre of the ball

E. gas flow lifts the ball up in a parallel sided tube in the glass chamber


EZ79 ANZCA Version [2006-Mar] Q115, [Jul06] Q59

An infant is anaesthetised and ventilated using an endotracheal tube and circle breathing system with CO2 absorber. The item which causes the most resistance to breathing is the

A. airway pressure limiting (APL) valve

B. circuit hosing

C. endotracheal tube

D. heat and moisture exchange filter

E. inspiratory and expiratory valves


EZ80 [Mar06] Q150, [Jul06] Q56

Line isolation monitoring protects against microshock

A. In no circumstances

B. Only when all equipment in the region is monitored

C. As long as the hazard current is set to 30 milliamps

D. As long as the hazard current is set to 10 milliamps

E. Only if grounded equipment is used.


EZ81 ANZCA Version [Jul06] Q116

The Classic laryngeal mask airway (LMA - Classic™)

A. contain plasticisers (phthalates), which may be carcinogenic

B. involves a significant risk of prion transfer

C. is cheaper to use than disposable LMAs

D. is less permeable to N2O than disposable LMAs

E. may be reused 40 times


EZ82 ANZCA Version [Jul06] Q108, [Apr07]

A 60-year-old man with BMI (body mass index) of 30 is having an inguinal hernia repair. He has a LMA-Proseal® in place and you plan positive pressure ventilation. If the device is properly seated the maximum pressure in cm of water before leaking during positive pressure ventilation should be

A. 15

B. 20

C. 30

D. 40

E. 50

Medicine

MC: Cardiology

MC19b ANZCA Version [Jul06] Q17, [Apr07] A 50 year old patient is admitted with acute chest pain. An ECG shows tall R waves in lead V1. The most likely diagnosis is

A. occlusion of the anterior descending coronary artery

B. a lateral myocardial infarction

C. pulmonary infarction

D. posterior myocardial infarction

E. occlusion of the circumflex artery


MC55 ANZCA version [2001-Apr] Q45, [2001-Aug] Q34, [2004-Apr] Q34, [2004-Aug] Q7, [Jul06] Q14, [Apr07] Q9 (Similar reported question in [Aug93] [Mar94] [Aug94] [Jul97] [Jul98] [Aug99])

The J-point of the ECG waveform is altered by all of the following EXCEPT

A. hypothermia

B. tachycardia

C. myocardial ischaemia

D. calcium channel blockers

E. digoxin


MC81 [Jul97] [Apr98] [Jul98] [2001-Aug] Q45, [2002-Mar] Q43, [2004-Apr] Q47, [2004-Aug] Q23, [Mar06], [Jul06] Q1

A low ejection fraction is most likely to be seen in a patient with

A. poor left ventricular (LV) systolic function

B. poor LV systolic function and severe mitral regurgitation

C. poor LV diastolic function

D. septic shock

E. a post myocardial infarct ventricular septal defect


MC114 ANZCA version [2002-Aug] Q133, [2003-Apr] Q37, [2006-Mar] Q50, [Jul06] Q4

In Wolff-Parkinson-White (WPW) syndrome,

A. the delta wave is caused by a delay in conduction in the accessory pathway

B. the PR interval is of normal duration but the QRS complex is widened

C. a narrow complex supraventricular tachycardia (SVT) is the most common form of arrhythmia

D. central venous cannulation is unlikely to trigger SVT

E. cardioversion of arrhythmias is seldom effective


MC128 ANZCA version [2005-Apr] Q145, [Jul06] Q25

The normal range of the QRS axis in the ECG is

A. 0 to +180 degrees

B. 0 to +90 degrees

C. -30 to +90 degrees

D. -90 to +90 degrees

E. -90 to +30 degrees


MC135 ANZCA Version [Jul06] Q122

You are called to the cardiac catheter lab to assist when a 55-year-old man with unstable angina becomes restless during difficult placement of a right coronary artery stent. When you arrive he is conscious and responding to voice. He is sweating with a pulse of 60 beats per minute in sinus rhythm, blood pressure measured from arterial catheter of 80/50 mmHg and Sp02 of 97%. The arterial pressure wave has an exaggerated fall with inspiration. The most appropriate next clinical intervention would be to

A. administer atropine

B. commence an adrenalin infusion

C. perform a quick transthoracic echocardiograph

D. sedate and intubate

E. transfer to operating theatre immediately


MC137 [Jul06] Q104

A common finding in hereditary prolonged QT syndrome is

A. bifid T waves

B. inverted P waves

C. prolonged QRS complex

D. R axis deviation

E. short PR interval


MC138 ANZCA Version [Jul06] Q144

Ebstein's abnormality describes a congenital defect of the

A. aortic valve

B. mitral valve

C. pulmonary valve

D. pulmonary veins

E. tricuspid valve


MC139 ANZCA Version [Jul06] Q119

A diagnosis of pulmonary embolism is most strongly suggested by

A. intraluminal filling defects or vascular cutoffs on angiography

B. PaO2 less than 85 mmHg and an abnormal lung perfusion scan

C. PaO2 less than 85 mmHg and an elevated PaCOz

D. right ventricular hypertrophy with right ventricular strain and right axis deviation on electrocardiography

E. "unmatched" ventilation-perfusion defects


MC140 ANZCA Version [Mar06], [Jul06] Q42

Regarding a 75-year-old female patient with moderate aortic stenosis presenting for an elective hip replacement,

A. atrial systole has an increased contribution to stroke volume (compared to a patient with no aortic stenosis)

B. beta-blockers are poorly tolerated in this degree of aortic stenosis

C. hypotension is better tolerated than hypertension

D. rheumatic heart disease is the commonest aetiology in this age group in Western Society

E. single shot spinal anaesthesia is the preferred method of anaesthesia


MC151 ANZCA Version [Jul06] Q132, [Apr07]

The QT interval may be prolonged by each of the following EXCEPT

A. high intra-thoracic pressure

B. hypothermia

C. magnesium sulphate

D. suxamethonium

E. volatile anaesthetic agents

ME: Endocrinology

ME35 [Mar93] [Jul06] Q82, [Apr07]

A patient has a history of polyuria and has an elevated serum calcium, normal parathyroid hormone level and an elevated angiotensin converting enzyme level. The most likely diagnosis is:

A. Milk-alkali syndrome

B. Primary hyperparathyroidism

C. Malignancy

D. Multiple myeloma

E. Sarcoidosis

MG: Gastroenterology

MG05 [1986] [Aug94] [Mar95] [Aug95] [Apr96] [Aug96] [Jul97] [Apr99] [2003-Aug] Q4, [2004-Aug] Q79, [2005-Apr] Q47, [Mar06] [Jul06] Q31

All of the following may be associated with ulcerative colitis EXCEPT

A. cirrhosis

B. iritis

C. psoriasis

D. arthritis

E. sclerosing cholangitis


MG12 ANZCA Version [Jul06] Q141, [Apr07]

The most important aspect of the peri-operative management of a patient with Gilbert's syndrome is

A. avoidance of fasting

B. avoidance of stress

C. pre-operative transfusion of fresh frozen plasma (FFP)

D. prophylaxis against hepato-renal syndrome

E. recognition of aetiology of the laboratory abnormality

MH: Haematology

MH10b ANZCA version [2005-Apr] Q108, [2005-Sep] Q60, [Jul06] Q18

Sickle cell disease (homozygous haemoglobin SS) is frequently associated with

A. cardiomyopathy

B. chronic respiratory dysfunction

C. nephropathy

D. peripheral neuropathy

E. all of the above


MH41 ANZCA version [Jul00] [2001-Aug] Q127, [2002-Mar] Q117, [Jul06] Q46 (now converted to type A version)

Anti-retroviral agents for HIV infection include

A. nucleoside r-transcriptase inhibitors (NRTIs) which are associated with diarrhoea and intravascular volume depletion

B. protease inhibitors which have important effects on the cytochrome P450 system

C. non-nucleoside r-transcriptase inhibitors (N-NRTIs) which may cause elevations in liver function tests

D. protease inhibitors which can lead to problematic hypoglycaemia

MM: Metabolic

MM18 ANZCA Version [Jul06] Q130, [Apr07]

Findings in a patient with serotonin syndrome include each of the following EXCEPT

A. clonus

B. diaphoresis

C. hyperreflexia

D. miosis

E. tachycardia


MM20 ANZCA Version [Jul06] Q129

Presenting features of carcinoid syndrome include:

A. hypoglycaemia

B. mitral regurgitation

C. renal failure

D. splenomegaly

E. supraventricular tachycardia

MR: Respiratory medicine

MR44 [2003-Aug] Q148, [2004-Aug] Q89, [2005-Apr] Q85, [Mar06], [Jul06] Q70

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


MR46 [2004-Aug] Q93, [Jul06] Q64

Physiological consequences of obstructive sleep apnoea usually include each of the following EXCEPT

A. stimulation of erythropoiesis

B. pulmonary vasoconstriction

C. tachycardia followed by bradycardia

D. systemic vasoconstriction

E. loss of deep sleep

MZ: Miscellaneous medicine

MZ72 ANZCA Version [Jul06] Q98

Correct statements regarding chronic fatigue syndrome are that

A. cognitive behavioural therapy is a primary treatment of the condition

B. it is associated with alcohol abuse (>40g/day)

C. it is associated with morbid obesity (BMI>30)

D. it is a major depressive disorder

E. SSRIs (selective serotonin reuptake inhibitors) are the mainstay of treatment

Surgery

SC: Cardiacthoracic surgery

SC26 [Mar06], [Jul06] Q89

Patient is scheduled for CABGs 2 hours after receiving tirofiban during coronary angiography and an unsuccessful stenting procedure. The most useful strategy to treat or prevent excessive peri-operative bleeding is:

A. concentrated factor VIII

B. cryoprecipitate

C. delaying surgery another 2 hours

D. haemofiltration during bypass

E. platelet transfusion


SC28 ANZCA Version [Jul06] Q143

A 25-year-old man with Marfan's syndrome is scheduled for aortic arch reconstruction under circulatory arrest. Cooling to 18 degrees is planned. The maximum time for circulatory arrest at this temperature after which the risk of long term neurological injury increases markedly is

A. 15 minutes

B. 25 minutes

C. 35 minutes

D. 45 minutes

E. 55 minutes


SC29 ANZCA Version [Jul06] Q120

A 40-year-old man with Marfan's syndrome has undergone successful thoracoabdominal aortic reconstruction for aortic dissection. He has a CSF (cerebrospinal fluid) drain in situ. 48 hours post-operatively the CSF is noted to be bloodstained and he becomes obtunded. The most appropriate urgent investigation is

A. CSF microscopy and culture

B. MRI (magnetic resonance imaging) brain

C. MRI spine

D. non-contrast head CAT scan

E. serum electrolytes


SC32 ANZCA Version [Jul06] Q143

A 25-year-old man with Marfan's syndrome is scheduled for aortic arch reconstruction under circulatory arrest. Cooling to 18 degrees is planned. The maximum time for circulatory arrest at this temperature after which the risk of long term neurological injury increases markedly is

A. 15 minutes

B. 25 minutes

C. 35 minutes

D. 45 minutes

E. 55 minutes

SF: Obstetrics & Gyanecology

SF38 ANZCA Version [Aug93], [Jul06] Q95

In pregnant patients with kyphoscoliosis:

A. Harrington rods (or equivalent) are an absolute contraindication to administration of epidural analgesia or anaesthesia

B. thoracic cage deformity severe enough to reduce vital capacity below one litre is not usually compatible with a successful fetal outcome

C. the severity of the extra-pulmonary restrictive pattern of pulmonary function is inversely proportional to the scoliosis angle

D. of the idiopathic type, there is an association with symptomatic mitral valve prolapse

E. there is a risk of progression of the scoliosis with consequent reduction in lung volumes


SF59 [2004-Apr] Q142, [2004-Aug] Q75, [Mar06], [Jul06] Q51

Multiple sclerosis in pregnancy is

A. a contraindication for epidural anaesthesia in labour

B. a contraindication for the use of suxamethonium

C. associated with an increased caesarean section rate

D. associated with an increase in relapse rate postpartum

E. associated with a worse fetal outcome


SF72 ANZCA Version [Jul06] Q148, [Apr07]

A 38-year-old primigravida presents with progressive dyspnoea in late pregnancy. The strongest indicator for further investigation would be

A. a 2/6 systolic ejection murmur

B. a raised JVP (jugular venous pressure)

C. a third heart sound

D. orthopnea

E. peripheral oedema


SF73 ANZCA Version [Jul06] Q146, [Apr07] Q145

Drugs that may be used for the management of heart failure, secondary to dilated cardiomyopathy in pregnancy, include each of the following EXCEPT

A. ACE (angiotensin-converting enzyme) inhibitor

B. beta-blockers

C. digoxin

D. loop diuretics

E. nitrates


SF74 ANZCA Version [Jul06] Q140

Immediately following delivery by caesarean section under regional anaesthesia a previously healthy primigradiva complains of chest pain and breathlessness, and then becomes unconscious. The most likely diagnosis is

A. accidental administration of suxamethonium

B. air embolism

C. amniotic fluid embolism

D. anaphylaxis to syntocinon

E. pulmonary thromboembolism

SG: General surgery

SG50 [2003-Apr] Q103, [Jul06] Q40

The most important effect of Lugol's iodine administration prior to thyroid surgery is

A. a reduced incidence of thyroid storm

B. a reduced incidence of vocal cord palsy

C. an increased chance of preservation of the parathyroid glands

D. increased pigmentation to assist in gland identification

E. reduced vascularity of the gland


SG53 ANZCA Version [2006-Mar] Q141, [Jul06] Q97

During laparoscopic surgery, pneumoperitoneum usually results in a fall in cardiac output when intra-abdominal pressure exceeds

A. 10 mmHg

B. 20 mmHg

C. 30 mmHg

D. 40 mmHg

E. 50 mmHg


SG54 ANZCA version [2005-Sep] Q133, [Jul06] Q49

Pneumoperitoneum to a pressure greater than 10 mmHg for laparoscopic surgery usually results in

A. a decreased arterial to end-tidal CO2 difference

B. a decrease in airway resistance

C. an increase in pulmonary compliance

D. an increase in physiological dead space

E. an increase in functional residual capacity (FRC)


SG55 [Jul05] [Jul06]q38

High phosphate bowel preparation is contraindicated in frail elderly patient because:

A. increased abdo pain, nausea, bloating

B. hypokalaemia

C. hypernatraemia

D. hypomagnesaemia

E. increased risk of large fluid shifts


SG58 ANZCA Version [Jul06] Q133

The Pringle manoeuvre (a surgical intervention when faced with exanguinating haemorrhage from the liver) involves clamping the

A. aorta above the coeliac axis

B. hepatic artery only

C. hepatic vein only

D. portal pedicle

E. splenic artery only

SN: Neurosurgery

SN13 ANZCA Version [Jul06] Q135, [Apr07]

The intraoperative hypothermia for aneurysm surgery trial (IHAST) showed that cooling to a target temperature of 33°C

A. did NOT improve neurological outcome in WFNS (World Federation of Neurosurgical Surgeons) grade I-III patients

B. did NOT improve neurological outcome in WFNS grade IV-V patients

C. improved neurological outcome in WFNS grade I-III

D. improved neurological outcome in WFNS grade III

E. improved neurological outcome in WFNS grade IV-V

SO: Orthopaedic surgery

SO18 ANZCA Version [Jul06] Q110

A previously healthy 20-year-old male is undergoing open reduction and internal fixation of a fractured tibia. The limb was exsanguinated and the tourniquet appropriately applied and inflated to 250 mmHg prior to surgery. A small amount of continued bleeding is noted after surgical exposure. The tourniquet still seems appropriately inflated. The patient's blood pressure is 110/70 mmHg. You should

A. accept that a tourniquets does not stop all bleeding

B. check the patient's coagulation profile

C. inflate the tourniquet to a higher pressure

D. reduce the patient's blood pressure

E. re-exsanguinate the limb and re-apply the tourniquet


SO20 ANZCA Version [Jul06] Q53

In anaesthetised patients undergoing controlled ventilation, release of a lower-limb arterial tourniquet after sixty minutes will

A. cause no change in end-tidal CO2 tension

B. decrease central venous pressure for more than 30 minutes before returning to baseline

C. decrease oxygen consumption

D. increase cerebral blood flow

E. increase core body temperature transiently

SZ: Miscellaenous surgery

SZ11 [2003-Aug] Q111, [Mar06], [Jul06] Q57

Lowering intra-ocular pressure by applying pressure to the globe (e.g. Honan balloon) is typically contraindicated in a patient having

A. a revision corneal graft

B. a revision trabeculectomy

C. an extra-capsular lens extraction

D. a redo vitrectomy

E. repeat retinal cryotherapy


SZ14a ANZCA version [2004-Apr] Q103, [2004-Aug] Q81, [Jul06] Q75, [Apr07]

In the recovery room, following general anaesthesia for renal transplant surgery, your patient is found to have a serum potassium concentration of 6 mmol.l-1, despite having a normal potassium concentration pre-operatively. His oxygen saturation is 96% on approximately 40% oxygen via a Hudson mask. He is still unconscious, but breathing spontaneously at 8 breaths per minute. The most likely cause of his hyperkalaemia is

A. beta-blockers which he received peri-operatively

B. catabolic stress of surgery

C. opioid induced narcosis causing carbon dioxide retention

D. renal graft failure

E. washed red blood cell transfusion, which he received intraoperatively


SZ18b ANZCA version [2006-Mar] Q148, [Jul06] Q35

Infra-renal aortic cross-clamping usually results in

A. decreased cardiac contractility

B. decreased coronary blood flow

C. decreased renal blood flow

D. minimal change in cardiac output

E. increased heart rate


SZ19 [2004-Aug] Q122, [2005-Apr] Q68, [Mar06] [Jul06]q3

The most correct statement regarding the Child-Pugh score for liver disease is that

A. a high-risk score is not possible with normal aminotransferase levels

B. a high-risk score is possible without encephalopathy

C. a prothrombin time greater than 10 seconds above normal confers extra points to the raw score

D. it has not been validated for non-shunt and non-transplant laparotomies

E. it was originally developed for patients undergoing hepatic transplantation


SZ22 [2005-Apr] Q129, [Mar06], [Jul06] Q88

Regarding a patient presenting for renal transplantation due to diabetic nephropathy, which of the following statements is LEAST correct?

A. angiotensin-converting enzyme (ACE) inhibitors are probably best discontinued preoperatively

B. dialysis is indicated if serum potassium concentration exceeds 6 mmol.1-l

C. intravenous access should preferably be obtained in a forearm vein of the non-fistulous arm

D. suxamethonium causes a rise in serum potassium concentration of up to 0.6 mmol.1-l

E. temporomandibular joint rigidity may be present


SZ27 ANZCA Version [2006-Mar] Q100, [Jul06] Q22

The following measures have been shown to reduce intraoperative blood loss in some surgical situations, EXCEPT

A. arterial hypotension (MAP = 50 mmHg)

B. controlled ventilation

C. hypothermia (less than 34°C)

D. maintenance of a low central venous pressure

E. regional anaesthesia

Paediatrics

PP54 ANZCA version [2001-Aug] Q69 [2006-Mar] Q90, [Jul06] Q87

Obstructive sleep disorder in children

A. is associated with pulmonary hypertension and dysfunction of left and right ventricles

B. has obesity as a major risk factor

C. is rarely seen in children less than 8 years old

D. is four times more prevalent in boys than girls

E. does NOT usually require tonsillectomy for its management


PP66 [2003-Apr] Q108, [2003-Aug] Q56, [Mar06], [Jul06] Q43

In infants with congenital pyloric stenosis

A. dehydration is associated with early hyponatremia

B. plasma chloride levels seldom fall below 85 mmol.1-I

C. renal conservation of hydrogen and potassium ions occurs

D. the urine is initially alkaline, then may become acidic

E. vomiting causes a loss of potassium ions


PP72 [2004-Apr] Q97, [2004-Aug] Q92, [Mar06], [Jul06] Q63

Ventricular fibrillation in children

A. if resistant to defibrillation, should be treated with amiodarone 5 mg.kg-1

B. is not associated with tricyclic antidepressant overdose

C. is often associated with respiratory arrest

D. is the commonest arrhythmia associated with cardiac arrest

E. should be immediately defibrillated with a 5 J.kg-1 shock


PP73 [2004-Apr] Q133, [Mar06], [Jul06] Q39

Conditions which are more commonly associated with exomphalos, compared to gastroschisis include

A. amniotic fluid peritonitis

B. cardiac abnormalities

C. fluid and electrolyte disturbances

D. hypothermia

E. prematurity


PP74 [2004-Apr] Q148, [2004-Aug] Q62, [Mar06], [Jul06] Q36

A 20 kilogram child has a haemoglobin of 60 g.l-1. The child is normovolaemic and there is no on-going blood loss. The volume of packed cells required to increase the haemoglobin level to 100 g.l-1 is

A. 80 ml

B. 160 ml

C. 320 ml

D. 500 ml

E. 750 ml


PP83 ANZCA Version [2006-Mar] Q117, [Jul06] Q80

Regarding endotracheal tubes for paediatric patients

A. a 2.5 mm endotracheal tube is the appropriate size for a term neonate

B. armoured (wire spiral) endotracheal tubes have the same outside diameter as non-armoured endotracheal tubes (of the same internal diameter)

C. the outside diameter (in mm) of an appropriately sized tube is given by the formula (Age/4) +4

D. the same diameter tube is used for nasal and oral intubation in a child

E. uncuffed, paediatric endotracheal tubes do NOT have a Murphy’s eye


PP87 ANZCA Version [Jul06] Q107

The weight of a child can be estimated using the formula

A. (age + 2) x 3

B. (age + 4) x 2

C. (age x 2) + 4

D. (age x 3) + 2

E. age x 4


PP88 ANZCA Version [Jul06] Q131, [Jul07]

The glomerular filtration rate of a paediatric patient (in ml.min-1.m-2) is similar to that of an adult by the age of approximately

A. 1 month

B. 6 months

C. 2 years

D. 4 years

E. 6 years


PP89 ANZCA Version [Jul06] Q115

An 8-year-old boy who is wheelchair bound with cerebral palsy and spastic quadriplegia is booked for an MRI (magnetic resonance imaging), under general anaesthesia for a rapid deterioration in his epilepsy control. On arrival to the MRI suite (with no premedication) he is distressed and inconsolable. Immediate management of this situation should include

A. an inhalation induction with parental/carer presence

B. cancellation and rescheduling with sedative premedication

C. cancellation of procedure until epilepsy is better controlled

D. detailed discussion with parents/carer regarding anaesthetic options

E. intramuscular or oral ketamine induction


PP90 ANZCA Version [Jul06] Q142, [Apr07]

A 12-year-old boy with spasstic cerebral palsy and painful muscle spasms presents for multilevel osteotomies of his legs. The most effective option for post-operative analgesia would be

A. a combination of NSAIDs (non-steroidal anti-inflammatory drugs) and regular tramadol

B. continuous lumbar epidural analgesia with a mixture of local anaesthetic and clonidine

C. regular paracetamol and oxycodone

D. patient controlled morphine

E. spinal morphine


PP91 ANZCA Version [Jul06] Q124

An otherwise healthy 4-year-old presenting for adenotonsillectomy develops a cough and laryngospasm during gaseous induction. At intubation clear secretions are visible at the glottis and after intubation transient wheezing is noticed. Clear fluid is aspirated from the endotracheal tube. At the end of the case, the child has a SpO2 of 96% with an FiO2 of 0.3. Airway pressures are normal. The most appropriate further management of this suspected aspiration is to

A. administer broad spectrum antibiotics and otherwise manage routinely

B. administer steroids and extubate after 1 hour if chest is clear on auscultation

C. extubate and observe in recovery for 4-6 hours

D. measure pH of tracheal aspirate and base further management on findings

E. perform on-table chest X-ray and base further management on findings

Anatomy

NA11 [1987] [1988] [2004-Apr] Q41, [Mar06], [Jul06] Q60

The segmental nerve supply to the renal pelvis and the ureter gives an anatomical basis for the surface representation of the pain of renal colic. The segments concerned are

A. T11 and T12

B. L1

C. L1 and L2

D. T11, T12, L1 and L2

E. T12 and L1


NH14 [1985] [Mar93] [Mar94] [Aug96] [Apr99] [2004-Aug] Q24, [2005-Apr] Q48, [Jul06]

Sensation from the lobule of the external ear is mediated mostly by

A. the auriculo-temporal nerve

B. the great auricular nerve

C. the lesser occipital nerve

D. the greater occipital nerve

E. none of the above


NH20c ANZCA Version [Jul06] Q16

The largest and most direct branch of the internal carotid artery is the

A. ophthalmic

B. anterior cerebral

C. middle cerebral

D. posterior cerebral

E. choroidal


NL04 [1986] [Mar94] [2004-Aug] Q41, [2005-Apr] Q62, [Mar06], [Jul06] Q24

The sciatic nerve supplies the following muscles EXCEPT

A. biceps femoris

B. semitendinosus

C. semimembranosus

D. gluteus maximus

E. adductor magnus


NN31 [Jul06]q11

What fibres does the recurrent laryngeal nerve carry?

A. motor to cricothyroid

B. motor to crico-arytenoids

C. sensory to (?above/?below) cords

D. sensory to cricothyroid joint??

E. motor to all intrinsic muscles of the larynx EXCEPT cricothyroid


NT34 [Jul98] [Apr99] [2002-Aug] Q75, [2004-Apr] Q89, [Mar06] [Jul06]q94

The intercostal nerves

A. arise as the sensory fibres of the anterior primary rami from their spinal segments

B. give off a lateral cutaneous branch at the angle of the rib

C. lie in the subcostal groove in only 50% of people

D. lie between the intercostalis intimi and the pleura

E. are enclosed in a dural sheath from their origin to the angle of the rib


NT35 ANZCA Version [Jul06]q127

Regarding thoracic anatomy, the

A. aorta passes through the diaphragm posteriorly at T10

B. carina most commonly lies at T4 in the adult

C. lungs compromise 16 bronchopulmonary segments in total

D. oblique fissures runs along the 6th rib on both sides

E. right main bronchus runs 45° to the vertical


NV36f [2005-Apr] Q42, [2006-March] Q139, [Jul06] Q13

Perioperative ulnar neuropathy

A. is more common in diabetics

B. is more common in women

C. is often associated with contralateral clinical neuropathy

D. is usually found to be the result of excess external pressure

E. usually presents within 24 hours


NV38b [2005-Apr] Q65 [Mar06] [Jul06]

The median nerve

A. can be blocked at the elbow immediately lateral 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 radial half of the palm


NV45 [July06] Q15 ANZCA Version

At the wrist joint

A. The median nerve lies between the tendons of palmaris longus and flexor carpi radialis

B. The median nerve lies medial to the tendon of flexor carpi ulnaris

C. The radial artery is usually palpable just medial to the tendon of flexor carpi radialis

D. The ulnar artery and nerve enter the hand by passing deep to the flexor retinaculum


NZ03 ANZCA Version [2003-Aug] Q123, [2004-Apr] Q79, [Jul06] Q79, [Apr07] Q123

Pre-ganglionic sympathetic fibres pass to the

A. otic ganglion

B. carotid body

C. ciliary ganglion

D. coeliac ganglion

E. all of the above

Regional anaesthesia

RB58 ANZCA Version [Jul06] Q126

The characteristics of a high spinal block do NOT include

A. dyspnoea

B. hypotension

C. inability to make a fist

D. loss of phonation

E. tachycardia


RB59 ANZCA Version [Jul06] Q34

During an epidural block, an indication that all sympathetic cardio-accelerator fibres have been blocked would be an upper sensory level at the

A. tip of the xiphoid

B. nipple line

C. apex of the axilla

D. inner aspect of the upper arm

E. little finger


RB62 ANZCA Version [Jul06] Q128

Recommendations for the inital management of post dural puncture headache include

A. ensuring adequate analgesia

B. intravenous caffeine infusion

C. oral sumatriptan

D. prolonged bed rest

E. prophylactic blood patching


RH22b ANZCA Version [2006-Mar] Q107, [Jul06] Q73

Complications of an intra-orbital local anaesthetic block are minimised if

A. the eye is oriented in a supero-medial direction for an infero-lateral injection

B. the anaesthetic solution is placed posteriorly where the nerves are close together

C. a shallow bevel (Atkinson-type) rather than a sharp intravenous-type needle is used

D. the injection site is medial rather than supero-medial

E. retro-bulbar needle placement is used for all myopic patients


RH25 [2002-Aug] Q82, [Jul05], [Jul06] Q74

Of the following situations, the strongest contraindication to retrobulbar anaesthesia is

A. an operative eye axial length of 24 mm

B. a staphyloma of the operative eye

C. warfarin for embolism prophylaxis in a patient in atrial fibrillation

D. treated glaucoma

E. a vitreous humour biopsy for diagnosis and treatment of enophthalmitis


RU18 [Jul06]q55

Which of the following manoeuvres/strategies reduce the incidence of pneumothorax in when performing a subclavian axillary block?

A. not having air in the needle/syringe?

B. putting the patient head down

C. asking the patient to take a deep breath as you advance the needle

D. using a short fine gauge needle

E. CXR after procedure

Intensive care & resuscitation

IC80 ANZCA Version [Jul06] Q105, [Apr07] Q3

A 30-year-old man presents to the Emergency Department following a high speed motor vehicle accident. He has marked abdominal distenson, a pulse rate of 130 and a blood pressure of 80/50 mmHg. The most appropriate initial investigation would be

A. abdominal angiogram

B. abdominal paracentesis

C. CAT scan of the abdomen

D. plain X-ray of the abdomen

E. FAST (focussed abdominal sonography for trauma) scan


IC81 ANZCA Version [Jul06] Q123

A 16-year-old arrives in your Emergency Department having fallen from, and been trampled by, a horse. The ambulance officers report that this initial GCS (Glasgow Coma Scale) was 15 and is now 11. His pulse is 120 and blood pressure 80/60 mmHg. SpO2 is 97% when breathing on a Hudson mask. On auscultation his chest is clear. He has facial bruising and a tender abdomen. Your first priority now is to

A. administer an IV (intravenous) fluid bolus

B. arrange an urgent CT scan of the head

C. administer mannitol

D. perform a FAST (focussed assessment with sonography for trauma) examination

E. secure the airway by intubation


IC82 ANZCA Version [Jul06] Q102

A 30-year-old man presents to the Emergency Department following a high speed motor vehicle accident. He has a Glasgow Coma Score of 7 and arrives with a cervical collar in situ and an 18 gauge intravenous cannula in his right hand. You first priority in managing this patient would be to

A. insert a large bore intravenous cannula

B. perform a CAT scan of the brain

C. perform a cervical spine X-ray

D. perform a plain chest and pelvic X-ray

E. secure the airway with an endotracheal tube


IC83 [Jul06]q65

Sudden cardiovascular collapse 48 hours post gastrectomy, Temp 39C, HR 130/min, BP 80 systolic, CVP 2cm above sternal angle. Cause?

A. Anastomotic breakdown

B. Acute gastric dilatation

C. septicaemia

D. haemorrhage

E. PE


IC84 ANZCA Version [Jul06] Q145, [Jul07]

A 32-year-old patient is admitted with early acute liver failure (unrelated to paracetamol ingestion). Management should include:

A. avoidance of intubation to monitor encephalopathic progress

B. consideration for liver transplant if the INR (international normalised ratio) is over 3

C. limited use of sodium containing fluids during acute resuscitation

D. N-acetyl-cysteine as a generall hepatoprotective agent

E. prophylactic antibiotics

Pharmacology

PC35 ANZCA version [Apr99] [2002-Aug] Q56, [2003-Apr] Q11, [2006-March] Q45, [Jul06] Q30

Side effects of digoxin are increased by

A. hyperthyroidism

B. hypocalcaemia

C. hyperkalaemia

D. hypermagnesaemia

E. hypothyroidism


PI77 [Mar06], [Jul06] Q67

Each of the following have been associated with Nitrous Oxide EXCEPT

A. Myocardial Ischaemia

B. reversible inhibition of methionine synthase

C. Megaloblastic Bone Marrow

D. Peripheral Neuropathy.

E. increase homocysteine levels


PL11 ANZCA Version [Jul06] Q109, [Apr07]

The local anaesthetic LEAST likely to cause cardiac toxicity after inadvertent intravenous injection is

A. bupivacaine

B. etidocaine

C. levobupivacaine

D. lignocaine

E. ropivacaine


PL26 ANZCA Version [Jul06] Q111

In severe bupivacaine toxicity, drugs likely to improve the cardiac conduction abnormalities include

A. clonidine

B. lignocaine

C. ketamine

D. metoprolol

E. propofol


PL28 [2004-Apr] Q137, [2004-Aug] Q59, [Jul06] Q41

Intra-nasal topical cocaine used in nasal surgery

A. has a duration of action of the order of 6 hours

B. is metabolised more quickly by the liver if the patient is using ecothiopate eye drops

C. is typically used in a dose of approximately 5 ml of 5% solution in an adult

D. may be metabolised more slowly in patients with liver disease

E. reaches a peak plasma concentration in 3 hours


PN42 ANZCA Version [2006-Mar] Q125, [Jul06] Q69

When instructing ward staff on monitoring for respiratory depression in a patient using PCA (patient controlled analgesia) you would advise that early respiratory depression is best detected by monitoring

A. frequency of boluses on PCA machine

B. pulse oximetry

C. pupil size

D. respiratory rate

E. sedation scores


PN43b ANZCA Version [March-2006] Q128, [Jul06] Q83

Concerning opioids,

A. fentanyl is the agent of choice for patient controlled analgesia (PCA) in the opioid addicted patient presenting for surgery

B. morphine in therapeutic dosage is a common cause of postoperative confusion

C. pethidine is suitable for subcutaneous injection

D. sufentanil has a higher affinity for the mu receptor than morphine

E. the patient's age is the best clinical indicator of opioid requirement in the perioperative period.


PN43a ANZCA Version [Jul06] Q147, [Apr07]

Which statement regarding the use of opiates for the management of acute pain is true?

A. in adults weight is the best predictor of opioid requirements

B. metabolism to codeine-6-glucuronide produces the analgesic effect of codeine

C. morphine produces more nausea and vomiting than pethidine

D. pethidine is superior to morphine in the management of renal colic pain

E. tramadol has a lower risk of respiratory depression than other opioids at equianalgesic doses


PN47 ANZCA version [2006-Mar] Q129, [Jul06] Q48

Correct statements concerning naloxone include each of the following EXCEPT

A. appropriate titration of naloxone will allow reversal of opioid induced respiratory depression

B. naloxone is a partial agonist

C. naloxone is most effective at blocking mu receptors

D. serious side effects such as arrhythmias and pulmonary oedema are rare

E. the elimination half-life of naloxone is approximately 60 minutes


PZ26 ANZCA version [1988] [Mar91] [2002-Aug] Q43, [2003-Aug] Q76, [2004-Apr] Q46, [Mar06], [Jul06] Q9

The antibiotic LEAST likely to be effective for the management of anaerobic peritonitis is

A. carbenicillin

B. cefoxitin

C. cephalothin

D. chloramphenicol

E. clindamycin


PZ65b ANZCA version [2003-Apr] Q113, [Jul06] Q52, [Apr07] Q113

To normalise platelet function prior to surgery, chronic diclofenac therapy should be ceased for at least

A. 12 hours

B. 1-2 days

C. 4 days

D. 7 days

E. 10 days


PZ68b [2002-Aug] Q93, [2003-Apr] Q58, [2004-Apr] Q49, [2004-Aug] Q80, [Jul05], [Mar06], [Jul06] Q12

Immunologically mediated heparin-induced thrombocytopaenia is characterised by

A. onset within a few days of first starting heparin therapy

B. intravascular thromboses

C. platelet count rarely reduced below 100 x 109.1-I

D. continuation of thrombocytopaenia after cessation of heparin

E. presence of non-specific (heparin-independent) platelet antibodies


PZ79b [2003-Aug] Q105, [2004-Apr] Q69, [Jul06] Q54, [Apr07] Q105

Features of paracetamol administration in children include

A. limitation of the daily dose to a maximum of 150 mg.kg-1 because of the risk of hepatotoxicity

B. reliable absorption when administered rectally with most patients achieving a therapeutic concentration with a loading dose of 20 mg.kg-1

C. peak blood levels being reached approximately 1 hour following rectal administration

D. a one hour delay between peak plasma concentration and maximum analgesia

E. a faster absorption of high dose rectal paracetamol compared to oral administration


PZ80d ANZCA version [2002-Aug] Q44, [2003-Apr] Q27, [Jul06] Q32

The plasma half-life of low molecular weight heparin is

A. increased in conditions with raised plasma proteins

B. 2 to 4 times that of unfractionated heparin

C. much less predictable than unfractionated heparin

D. dependent upon a saturatable mechanism for clearance

E. longer than unfractionated heparin because of a higher affinity for plasma protein


PZ86d ANZCA Version [Mar06] Q96, [Jul06] Q20

Each of the following herbal treatments is associated with an increased risk of perioperative bleeding EXCEPT

A. garlic

B. ginger

C. ginko

D. ginseng

E. St. John’s Wort


PZ104 [Jul06] q37

Established Legionnaires disease is treated with

A. Aminoglycosides

B. Cephalosporins

C. Chloramphenicol

D. Crystalline penicillin

E. Erythromycin


PZ105 ANZCA Version [Jul06] Q117

In morbidly obese patients drugs can be administered on a per kilogram of total body weight (TBW) or a per kilogram of ideal body weight (IBW) basis. It is correct to say,

A. atracurium should be administered on an IBW basis

B. induction dose of propofol should be administered on an IBW basis

C. induction dose of thiopentone should be administered on a TBW basis

D. suxamethonium should be administered on a TBW basis

E. vecuronium should be administered on a TBW basis


PZ106 ANZCA Version [Jul06] Q136, [Apr07]

A 25-year-old male presents for ECT (electroconvulsive shock therapy) at a free-standing facility. He has a life-threatening depressive illness that has not responded adequately to medication, however he is still taking tranylcypramine (Parnate). You should

A. cancel the procedure, cease tranylcypramine and perform the ECT in 2 weeks

B. proceed with the ECT, but induce with midazolam and remifentanil

C. proceed with the ECT, but pre-treat with esmolol

D. proceed with the ECT with caution, but with your usual drugs

E. transfer the patient to a tertiary centre for their ECT


PZ107 [Mar06] [Jul06] q96

In patients with renal impairment, doses of all of the following may require adjustment EXCEPT

A. Carbamazepine

B. Gabapentin

C. Hydromorphone

D. Morphine

E. Oxycodone


PZ108 ANZCA Version [Jul06] Q138

A patient with bipolar disorder presents for elective laparoscopic cholecystectomy. She takes lithium and has therapeutic blood levels. The lithium

A. may increase her requirement for volatile anaesthetic agents

B. may prolong the duration off depolarising muscle relaxants

C. may prolong the duration of non-depolarising muscle relaxants

D. may prolong the duration of both depolarising and non-depolarising muscle relaxants

E. should be ceased 2 weeks pre-operatively


PZ109 ANZCA Version [Jul06] Q134

When using NSAIDs (non-steroidal anti-inflammatory drugs) and COX-2 (cyclo-oxygenase 2) inhibitors for postoperative analgesia,

A. COX-2 inhibitors are more effective analgesics than NSAIDs

B. COX-2 inhibitors have less effect on renal function than NSAIDs

C. COX-2 inhibitors impair platelet function

D. COX-2 inhibitors trigger aspirin induced respiratory disease with a similar likelihood to NSAIDs

E. NSAIDS increase the risk of peri-operative bleeding after some types of surgery


PZ110 Moved - same as MC151


PZ112 ANZCA version [2004-Apr] Q105, [Mar06], [Jul06] Q2

Hepatotoxicity from paracetamol overdose is enhanced in

A. chronic renal failure

B. concomitant ingestion of benzopdiazepines

C. conditions associated with glutathione deficiency

D. obese patients

E. patients with hepatitis C antibody


PZ121 ANZCA Version [2006-Mar] Q114, [Jul06] Q68

In elderly patients each of the following statements is true EXCEPT

A. antagonism of neuromuscular blockade with aniticholinesterases is less likely to be effective than in the younger patient

B. atropine produces a lesser heart rate response than in younger patients

C. ephedrine is less likely to be effective (at raising blood pressure) than in the younger patient

D. MAC of all inhalational agents is reduced by 20 to 40%

E. time of onset of neuromuscular blockade is prolonged due to a reduction in cardiac output


PZ126 ANZCA Version [2006-Mar] Q133 [2006-Jul] Q6

Transient Neurological Syndrome

A. comprises pain localised to the back

B. diagnosis is confirmed by typical findings on neurological examination

C. is associated with consistent abnormalities on magnetic resonance imaging and electrophysiological studies (EPS)

D. is associated with long term deficits in 5% of cases

E. may occur with lignocaine, bupivacaine, prilocaine and procaine

Physiology

PH58 [2003-Aug] Q112, [Mar06] [Jul06] q26

When intravenous magnesium sulphate is administered in the management of severe pre-eclampsia, deep tendon reflexes are lost at a serum Mg2+ level of

A. 2 mmol/l

B. 3.5 mmol/l

C. 5 mmol/l

D. 8 mmol/l

E. 12 mmol/l


PH59 [Jul06] Q58

Normal values for pregnant woman:

A. Base excess +5mmol/L

B. pH = 7.4

C. Increased FRC

D. pCO2 = 45mmHg

E.

Statistics

ST04b [Mar93] [Aug93] [Mar94] [Mar95] [Aug95] [Aug96] [Jul97] [Apr98] [Apr99] [Jul00] [2001-Apr] Q38, [2002-Aug] Q26, [2003-Apr] Q38, [Mar06], [Jul06]

The power of a statistical test can be expected to decrease, if there is an increase in

A. the sample size

B. the size of the treatment effect

C. the chance of making a Type 1 error

D. the variability of the population

E. none of the above


ST26 [2004-Apr] Q91, [2004-Aug] Q74, [Jul06] Q71, [Apr07]

Correct statements regarding confidence intervals (CI) include all the following EXCEPT

A. CI are derived from the standard error (of the mean).

B. CI can be used to assess the precision of population parameter estimates.

C. The width of the CI depends on the degree of confidence required.

D. The width of the CI depends on the sample size.

E. The width of the CI depends on the mean value of the sample


ST28 [2004-Apr] Q115, [2004-Aug] Q50, [Jul06]Q44

One hundred vomiting patients receive ondansetron. If 25 patients, who would not have stopped vomiting had they received a placebo, stop vomiting, then the number needed to treat (NNT) for ondansetron to stop vomiting is

A. 1.3

B. 4

C. 25

D. 100

E. can't be calculated without information on placebo success rate


ST32 ANZCA Version [Jul06] Q113, [Apr07]

A new test has been developed to diagnose a disease. 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 suffereing from the disease

C. a series of patients known to NOT be suffereing from the disease and an estimate of the prevalence of the disease in the population obtained

D. a series of patients known to be suffereing from the disease

E. a series of patients known to be suffereing from the disease and an estimate of the prevalence of the disease in the population obtained


ST35 ANZCA Version [Jul06] Q139, [Apr07]

When a new diagnosstic test is evaluated in a population of subjects in whom the diagnosis
is known, the following results are obtained

                            Disease known      Disease known
                            to be present      to be absent
New test result positive          80                40
New test result negative          20                180

In this population the NEGATIVE predictive value of this test is closest to

A. 10% 
B. 33%
C. 67%
D. 80%
E. 90%
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