19.2 the anti-emetic action of aprepitant is via receptors for
a) serotonin
b) dopamine
c) Nmda
d) Neurokin A
e) Substance P
E) substance P
19.2 In patients with cephalosporin cross reactivity to penicillin, what is the causative component?
a) Thiazolidine ring
b) Beta lactam ring
c) R1 chain on the beta lactam ring
d) R2 chain on the thiazelidine ring
e) Dihydrothiazine ring
C) R1 side chain
19.2 Commonest cause of peri-operative stroke
a) Hypotensive
b) Embolic
c) Thrombotic
d) Hypertensive
e) Haemorrhagic
Embolic
19.2 Which has the highest capacity to absorb infrared radiation in the atmosphere?
a) Nitrous oxide
b) Sevoflurane
c) Desflurane
d) Isoflurane
e) CO2
c) desflurane
19.2 When do spinal reflexes normally return after an acute spinal injury?
A. 1-3 days
B. 7 days
C. 28-40 days
D. 120 days
E. 365 days
A. 1–3 days
Explanation
After an acute spinal cord injury, patients develop spinal shock, characterised by:
Flaccid paralysis
Areflexia
Loss of autonomic function below the lesion
Timeline of Reflex Return
Spinal shock progresses through phases:
Phase 1 (0–24 hrs)
Complete areflexia
Phase 2 (1–3 days)
Initial return of spinal reflexes
Often first reflex to return = bulbocavernosus reflex
Phase 3 (days–weeks)
Hyperreflexia begins
Phase 4 (weeks–months)
Spasticity and exaggerated reflexes
19.2 What are the minimum PACU nurse to patient ratios?
a) 1 nurse of each patient that has not regained airway reflexes, 1 nurse for 2 awake patients who have regained airway reflexes
b) 1 nurse of each patient that has not regained airway reflexes, 1 nurse for 3 awake patients who have regained airway reflexes
c) 1 nurse of each patient that has not regained airway reflexes, 1 nurse for 4 awake patients who have regained airway reflexes
d) 1 nurse of 2 patients that has not regained airway reflexes, 1 nurse for 2 awake patients who have regained airway reflexes
e) 1 nurse of 2 patients that has not regained airway reflexes, 1 nurse for 3 awake patients who have regained airway reflexes
a) 1 nurse for each patient who has not regained airway reflexes, and 1 nurse for 2 awake patients who have regained airway reflexes
19.2 The backboard of the anaesthetic machine is on fire.
What is the best way to put it out?
a) CO2
b) Fire blanket
c) Wet chemical powder
d) Foam
e) Water
a) CO₂
Reasoning
A fire involving the anaesthetic machine backboard is:
An electrical fire (Class E in Australia)
Possibly involving wiring, circuitry, or electrical components
Appropriate extinguisher for electrical fires:
CO₂ extinguisher
Why?
Non-conductive
Leaves no residue
Safe for electrical equipment
Rapidly displaces oxygen at the fire source
Why not the others?
Fire blanket → appropriate for patient fires, not electrical equipment
Dry chemical powder → works, but damages equipment and contaminates airway equipment
Foam → not appropriate for electrical fires
Water → dangerous (conducts electricity)
19.2 20 year old man has suffered a TBI. What SBP (mmHg) would you aim for?
a) 90
b) 100
c) 110
d) 120
e) 140
c) 110
19.2 The substance that should be avoided in a patient with history of anaphylaxis to MMR vaccine is?
a) Penicillin
b) Gelofusin
c) Sulphonamides
d) Hydrolase
b) Gelofusin
19.2 Thirteen year old boy playing sport collapses. Sweaty, abdominal pain, headache, palpitations and hyperglycaemic.
What is the most likely cause?
a) Phaeochromocytoma
b) Insulinoma
c) Hyperthyroidism
d) Hypothyroidism
e) Carcinoid syndrome
a) Phaeochromocytoma
This is the classic catecholamine excess triad:
Headache + Sweating + Palpitations
Add:
Collapse during exertion (triggered catecholamine surge)
Hyperglycaemia (β₂ stimulation → ↑ glycogenolysis & gluconeogenesis)
Why Phaeochromocytoma?
Phaeochromocytoma causes:
Episodic catecholamine release
Severe hypertension
Tachyarrhythmias
Hyperglycaemia
Abdominal pain
Sweating
Exercise can precipitate a crisis.
Why the others are incorrect
b) Insulinoma
Causes hypoglycaemia (not hyperglycaemia)
c) Hyperthyroidism
Palpitations and sweating possible
But not typically episodic collapse with abdominal pain
Hyperglycaemia less marked
d) Hypothyroidism
Opposite picture
e) Carcinoid syndrome
Flushing, diarrhoea, bronchospasm
Not hyperglycaemia or collapse during exertion
19.2 What is the corrected QTc for someone with QT interval of 420ms at a rate of 60bpm?
a) 360 ms
b) 380 ms
c) 420 ms
d) 460 ms
e) 480 ms
c) 420 ms
19.2 What is the cause?
a) Hypothermia
b) Hypocalcaemia
c) Hypomagnesaemia
d) Hyponatraemia
e) Hypothyroid
Hypothermia J wave
19.2 An 80-year-old woman is admitted to hospital with respiratory failure. Her arterial blood gas on oxygen 4 litres per minute via a Hudson mask is as follows: Ph 7.2
P02 91
Pc02 84
BE 16
HCO3 43
NA 145
Which of the following most accurately describes this blood gas result?
a) Metabolic alkalosis, acute resp acidosis + normal AG
b) Metabolic alkalosis resp acidaemia + abnormal AG
c) Mixed acidaemia
d) Respiratory Acidosis with incomplete compensation
e) Compensated Respiratory acidosis
d) Respiratory acidosis with incomplete compensation
19.2 A 65 year old female is having a knee arthroplasty. What is the most predictive factor for chronic post operative pain?
a) Anxiety
b) Catastrophising
c) Depression
d) Female
e) Pain at other sites
b) catastrophising
High levels of pain catastrophizing prior to surgery had the largest effect on the level of postoperative pain.
https://www.bjaed.org/article/S2058-5349(24)00048-9/fulltext
19.2 A size 9 SLT is closest in external diameter to what size DLT?
a) 27Fr
b) 35Fr
c) 37Fr
d) 39Fr
e) 41Fr
c) 37F
Size 9 SLT OD = 12.2mm
french gauge OD is gauge/3
12.2x3 = 36.6
19.2 Soon after a peribulbar block, the patient’s eye rapidly becomes proptosed and tense, and the visual acuity is markedly decreased. A lateral canthotomy is indicated to:
a) Allow globe to continue to swell
b) Drain blood from behind eyeball
c) Allow the eye to proptose
d) Reduce pressure on the optic nerve
Could be C or D
I’d go with D
19.2 Patient had a hysteroscopy and is now woken up in PACU. ABG done with Na 118, K 3.1. Patient is orientated to person but not to time and place. What is the best management?
A. Frusemide 40mg IV stat
B. Potassium 40mmol over 4 hours
C. 500ml normal saline
D. 100ml 3% saline
E. Fluid restrict
D. 100ml 3% saline
19.2 A stroke patient presenting for clot retrieval with a right hemisensory loss and right homonymous hemianopia most likely has occlusion of the left .
Most likely lesion is in right:
a.anterior cerebral artery
b.anterior inferior cerebellar artery
c.posterior cerebral artery
d.posterior inferior cerebellar artery
e.superior cerebral artery
c.posterior cerebral artery
19.2 If a women being treated for neuropathic pain becomes pregnant, what is the safest neuropathic analgesic to use in pregnancy?
A. Carbamazepine
B. Lamotrigine
C. Gabapentin
D. Sodium valproate
E. Phenytoin
C. Gabapentin
Category B1
All others are Cat D
APMSE https://www.anzca.edu.au/getContentAsset/d94f994b-0e35-40c8-a3e1-93d8caed0cc4/80feb437-d24d-46b8-a858-4a2a28b9b970/Acute-Pain-Management_-Scientific-Evidence-5th-edition-(2020)-(1).PDF?language=en
pages 718 and 719
19.2 When to medically intervene in seizure post ECT?
A. 30 seconds
B. 60 seconds
C. 90 seconds
D. 120 seconds
E. 150 seconds
D. 120s
19.2 WHO essential services criteria (i.e. procedure that is indication of provision…) Bellwether Procedure
A. Manual removal of placenta
B. Laparotomy
C. Cleft palate
D. Skin grafts
E. Cataracts
B. Laparotomy
What is a Bellwether procedure?
Definition: A procedure that indicates a hospital can deliver a broad range of essential surgical services.
The three original Bellwether procedures (WHO / Lancet Commission):
Cesarean section
Laparotomy (for emergencies like bowel obstruction, trauma, perforation)
Open fracture management / treatment of a fracture
If a hospital can perform these three safely and reliably, it is considered capable of providing essential surgical care.
19.2 When using ROTEM, the APTEM relates to:
A. Clotting factors
B. Hypofibrinoginaemia
C. Direct thrombin inhibition
D. Decreased platelets
E. Fibrinolysis
E. Fibrinolysis
aprotinin added (antifibrinolytic) -> if correction of Ly30/Ly60 cf EXTEM -> fibrinolysis present
19.2 Where is the tip of this PICC line?
A. Azygous vein
B. Coronary sinus
C. RA
D. LA
E. SVC
19.2 Which brachial plexus block has the highest chance of a paralysed hemidiaphgram?
A. Interscalene
B. Supraclavicular
C. Infraclavicular
D. Axillary
E. Cervical
A. Interscalene
