19.2 the anti-emetic action of aprepitant is via receptors for
a) serotonin
b) dopamine
c) Nmda
d) Neurokin A
e) Substance P
Subs 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
19.2 Commonest cause of peri-operative stroke
a) Hypotensive
b) Embolic
c) Thrombotic
d) Hypertensive
e) Haemorrhagic
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
- Desflurane
DINS
CO2 = reference gas (1)
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
1-3 d
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
M1:1 for any patient who has not regained protective airway reflexes
(i.e., still sedated, obstructing risk, opioid-loaded, residual NMB etc.)
• 1:2 for awake, stable 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
CO2
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
110 outside this
100 for 50-70 y
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
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
Not
Insulinoma
→ Causes hypoglycaemia, not hyperglycaemia.
Hyperthyroidism
Can cause palpitations + sweating but not sudden collapse with severe hyperglycaemia.
Hypothyroidism
Bradycardic, cold, lethargic — nothing like this.
Carcinoid syndrome
Typically flushing + diarrhoea, not hyperglycaemia, palpitations, or exercise-triggered collapse.
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
QTc = QT/✔️RR
At 60 bpm, RR = 1.0 sec
QTc = 420/✔️1 = 420ms
19.2 What is the cause?
a) Hypothermia
b) Hypocalcaemia
c) Hypomagnesaemia
d) Hyponatraemia
e) Hypothyroid
Hypothermia J wave
Also occur with hypERcalcaemia
• Normal variants (young, athletic patients) • Early repolarisation pattern • Brugada syndrome • Hypercalcaemia • Ischaemia • Hypothermia (→ Osborn wave subtype)
👉 J-wave = umbrella term
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
e) Compensated respiratory acidosis
Quick breakdown:
pH 7.20 → acidaemia
PaCO₂ 84 mmHg → very high → primary respiratory acidosis
HCO₃⁻ 43 mmol/L, BE +16 → markedly elevated → metabolic compensation, not acidosis
No chloride given → you can’t comment on anion gap, so (a) and (b) are out.
Mixed acidaemia (c) would require low HCO₃⁻, not 43.
Check expected compensation:
ΔCO₂ = 84 − 40 = 44 mmHg
For chronic resp acidosis, HCO₃⁻ ↑ ≈ 3.5–4 mmol/L per 10 mmHg →
Expected HCO₃⁻ ≈ 24 + (4 × 4.4) ≈ 24 + 17.6 ≈ 41–42
Actual HCO₃⁻ 43 → fits chronic (compensated) respiratory acidosis, not acute/incomplete.
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
Catastrophising is the strongest psychological predictor of developing chronic postoperative pain.
It outperforms:
Anxiety
Depression
Female sex
Pre-operative pain at other sites
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
37Fr / 3 = 12.3mm ED
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
c) Allow the eye to proptose
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
Symptomatic hyponatraemia
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 .
a.anterior cerebral artery
b.anterior inferior cerebellar artery
c.posterior cerebral artery
d.posterior inferior cerebellar artery
e.superior cerebral artery
left posterior cerebral artery (PCA)
left occipital lobe (visual cortex)
* Nasal retinal fibres cross in the optic chiasm
* Temporal fibres stay ipsilateral
* Both sets project to the contralateral lateral geniculate nucleus (LGN)
* Then to the contralateral occipital lobe
left thalamus (VPL nucleus)
* Spinothalamic + dorsal column pathways
* Ascend to the contralateral thalamus (VPL nucleus)
* Then to the contralateral sensory cortex
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
Lamotrigine
Lowest teratogenic risk among antiepileptics
Major congenital malformation (MCM) rate ≈ 2–3%, similar to background
No increased risk of neural tube defects
Widely considered the drug of choice for women of child-bearing age when an anticonvulsant is required
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
120s
19.2 WHO essential services criteria (i.e. procedures that are an indication of provision of services include…
A. Manual removal of placenta
B. Laparotomy
C. Cleft palate
D. Skin grafts
E. Cataracts
Lancet Commission (Lancet 2015;386:569–624):
The Commission identifies three operations that act as indicators of a health system’s surgical capability:
Laparotomy
Caesarean delivery
Management of open fractures
19.2 When using ROTEM, the APTEM relates to:
A. Clotting factors
B. Hypofibrinoginaemia
C. Direct thrombin inhibition
D. Decreased platelets
E. Fibrinolysis
Fibrinolysis
Aprotinin or TXA added
- plasmin inhibitor
TXA attaches to lysine-binding sites on plasminogen preventing binding og tissue plasminogen activator
^MCQ asking where TXA binds
19.2 Where is the tip of this PICC line?
A. Azygous vein
B. Coronary sinus
C. RA
D. LA
E. SVC
Azygous vein
Radiographics review – Central Venous Catheter Malposition
(Radiographics 2014;34:1528–1545)
A catheter entering the azygos vein typically turns medially then ascends, creating a curved or upward-directed tip at the right mediastinal border.
19.2 Which brachial plexus block has the highest chance of a paralysed hemidiaphgram?
A. Interscalene
B. Supraclavicular
C. Infraclavicular
D. Axillary
E. Cervical
Interscalene
