1
Q
During paediatric gas induction, the gas flow recommended by SPANZA for least environmental impact is:
a) 1L/min
b) 2L/min
c) 3L/min
d) 4L/min
e) 5L/min
A
Ans: 3L/min (0.15L/kg/min)
2
Q
The Mapleson circuit to best achieve normocarbia with mechanical ventilation is:
a) Mapleson A
b) Mapleson B
c) Mapleson C
d) Mapleson D
e) Mapleson E
A
D is best for Mechanical ventilation
A - best for spontaneous ventilation
B, C - both crap
D, E, F - best for mechanical ventilation
3
Q
SQUIRE guidelines
a) Provide a framework for reporting new knowledge about healthcare improvement
b) How to conduct a systematic review
A
SQUIRE - framework for reporting and planning QI work
Standards for Quality Improvement Reporting Excellence (SQuIRE)
Four Main Sections:
(1) Why start?
(2) What did you do?
(3) What did you find?
(4) What does it mean?
4
Q
What is the five number summary on a box and whisker plot?
A
- Minimum
- First quartile
- Median
- Third quartile
- Maximum
5
Q
ECG axis (lead I positive, aVF negative, aVR isoelectric)
a) -15
b) -75
c) +45
d) -45
A
-75 degrees
Could be anywhere from 0 to -90 degrees
If II is +ve -> answer is -15
If II is -ve -> answer is -75
If II is isoelectric -> answer is -45
6
Q
What does a green colour on the laryngoscope blade mean
a) Reusable
b) Recyclable
c) Single use
d) Disposable
e) Fibreoptic light source
A
Ans: fibreoptic light source (in handle)
Black: handle which has light source in the blade not the handle.
7
Q
Arndt blocker attachment point for the breathing circuit (just a schematic drawing provided in the exam)
A
8
Q
Vivasight components (arrow to the red bit in the exam)
a) Flush port
b) Light source
c) Aspiration port
A
Red - Flush port
Blue cuff - Bronchial cuff
Clear cuff - Tracheal cuff
9
Q
Half life for SC semaglutide
- 1 day
- 3 days
- 7 days
A
6-7 days
From ANZCA clinical practice recommendation on periprocedural use of GLP-1/GIP receptor agonists
Exenatide 3.3-4 hours
Liraglutide 12.6-14.3 hours
Dulaglutide 4.7-5.5 days
Semaglutide 5.7-6.7 days
Tirzapatide 4.2-6.1 days
10
Q
Gastric USS image (identify each image)
A
(a) Empty antrum with bullseye or target appearance;
(b) Empty antrum with flattened ovoid appearance;
(c) Antrum with hypoechoic clear fluid;
(d) Manual tracing of antral cross-sectional area to determine fluid volume;
(e) Antrum with early-stage solid content showing ‘frosted glass’ pattern with obscuring of deeper structures;
(f) Hyperechoic late- stage solid content. Arrows = antrum; L = liver, Ao = Aorta, RA = rectus abdominis muscle
11
Q
What was a finding of the PREVENTT 2020 Lancet trial regarding the use of preoperative iron infusion in patients undergoing major surgery?
A. Iron infusion significantly reduced postoperative complications
B. Iron infusion led to a reduction in mortality rates
C. Iron infusion reduced the need for blood transfusions
D. Iron infusion had no effect on the need for blood transfusions
E. Iron infusion did not reduce readmission rates at 8 weeks
A
E. Iron infusion did not reduce readmission rates at 8 weeks
PREVENTT = IV iron with anaemia before elective open abdo surg:
- increases Hb preop
- no reduction in blood transfusion or mortality
- no reduction in postop in hospital complications or length of stay
- no benefits to quality of life
- reduced risk of readmission at 8 weeks to hospital for complications
12
Q
Compared to UFH, enoxaparin preferentially interacts with:
a) Thrombin
b) Xa
A
Xa
13
Q
6-year-old patient (140 cm, 24 kg, BSA 0.97m2) is on hydrocortisone 15 mg/day. Perioperative glucocorticoid supplementation is:
a) > 2 weeks
b) > 1 month
c) > 2 months
d) doesn’t need it
A
Stress dose if >15mg/m^2 daily for > 1 month
Stress dose is 2mg/kg hydrocortisone.
https://anaesthetists.org/Guidelines-and-publications/Guidelines/Management-of-glucocorticoids-during-the-peri-operative-period-for-patients-with-adrenal-insufficiency
14
Q
DCD - last acceptable organ
a) Lungs
b) Kidney
c) Liver
d) Pancreas
e) Heart
A
Ans: lungs (90 minutes)
Last Penis Hard Knows Love
Liver and pancreas - 30 minutes from withdrawal of support
Heart - 30 minutes from systolic <90
Kidneys - 60 minutes from systolic <50
Lungs - 90 minutes from systolic <50
15
Q
DCD criteria, what doesn’t include
a) Immobility
b) Apnoea
c) Absent skin perfusion
d) Absence of circulation (no arterial pulsatility for 2 min)
e) Absence of sedative drugs that may cause coma
Cannot recall other option, which was the answer (maybe absence of sedation?)
A
Absence of skin perfusion not a criteria
- note no output for 5 mins is the actual criteria, not 2 mins
Donate life requirements
* Apnoea
* Immobility
* No pulse/perfusion for 5 minutes
* Unresponsive
* Clinical exam occurs AFTER 5 minutes ( to prevent the potential resurg response)
16
Q
Post herpetic neuralgia, feels like insects crawling across head, what is it?
a) Allodynia
b) Dysaesthesia
c) Formication
d) Pruritis
e) Hyperpathia
A
**c) Formication: **
Formication is the sensation of insects crawling under or on the skin, even though no actual insects are present. It’s a type of tactile hallucination, also known as a paresthesia,
Dysaesthesia “spontaneous or evoked unpleasant abnormal sensations”
Hyperalgesia “increased response to a normally painful stimulus”
Allodynia “pain due to a stimulus that does not normally evoke pain such as light touch”
17
Q
What drug to avoid in congenital long QT
a) Propofol
b) Thiopentone
c) Ketamine
A
Uptodate:
= Droperidol, haloperidol, volatile, ondansetron, amiodarone. methadone
Propofol has least effect. Prop/remi TIVA is safe
“ketamine should be avoided because of its sympathomimetic effects”
Glyco and atropine can prolong QTc and precipitate torsades.
Thiopental can be used in patients with prolonged QT (prolongs the QTc but reduces TDP - transmural dispersion of depolarization)
Long QT syndrome | BJA Education | Oxford Academic (oup.com)
18
Q
Recurrent torsades treatment, acceptable
a) Flecainide
b) Lignocaine
c) Procainamide
d) Amiodarone
e) Sotalol
A
Ans: Lignocaine (dose is 1mg/kg bolus - ANZCOR)
- Overdrive pacing - Lignocaine decreases the QTc - Beta blockers - Isoprenaline **
Uptodate:
- If baseline QTc is normal then less likely to respond to Mg and IV amiodarone may prevent recurrence.
“polymorphic VT” = without QT prolongation
“torsades” = a form of polymorphic VT with QT prolongation
If torsades storm (3+ in 24hrs). Additional mx:
1) isoprenaline: target HR 90-110bpm (suppresses TdP)
2) Electrical overdrive pacing: to 90-110bpm
3) Lignocaine 1-1.5mg/kg bolus +/- 1mg bolus
4) Phenytoin
19
Q
- Acceptable tryptase to diagnose anaphylaxis
a) (1.2 times normal) + 2
b) (1.8 times normal) + 2
c) Normal + 2
d) 10/mL
e) 15/mL
A
Ans: 2+ (1.2 x baseline)
Uptodate
20
Q
ANZAAG refractory anaphylaxis in someone on a Beta-blocker. GLucagon 1-2 mg IV given:
a) Once
b) Every 5 minutes until response
c) Every 10 minutes until response
d) Every 60 minutes until response
A
b) Glucagon 1-2mg every 5 minutes
https://www.anzca.edu.au/getContentAsset/5c38a92c-aa4a-4b2f-a9c4-ce5c02f1f87b/80feb437-d24d-46b8-a858-4a2a28b9b970/Anaphylaxis-Card-3-Adult-Refractory-Management-2022.pdf?language=en&view=1
21
Q
Fem-fem VA ECMO, where is best representative of coronary PaO2?
a) Right radial
b) Either radial
c) Left radial
d) Pre-oxygenator
e) Post-oxygenator
A
Right radial
22
Q
Post op cognitive decline has an onset within:
- Immediate post op
- With one day, lasting one week
- From 3 weeks to 10 days post op for a year
- From 1 month to 1 year
A
“POCD can be detectable FROM 7 days after surgery”
“Postop neurocognitive disorder” within 1 year of surgery
“Delayed neurocognitive recovery” if present within 30 days of surgery
Delirium = 24-72 hours post op
“Changes in cognition earlier than 7 days after surgery cannot be accurately tested and attributed to POCD”
23
Q
Pre-eclampsia at 30 weeks with IUGR:
a) Low CO, Low SVR
b) Low CO, High SVR
c) High CO, Low SVR
d) High CO, High SVR
A
c) Low CO, high SVR
24
Q
Burns - expected physiological changes within the first 24 hours
- High cardiac index
- Increased PVR
- Decreased SVR
- High stroke volume
A
Ans: increased PVR
First 48 hours (ebb phase) depressed myocardium, hypovolaemia (hypovolaemic shock)
- Increased Hct
- Increased PVR and SVR
- Decreased stroke volume
- Decreased cardiac index
- Decrease venous saturation
- Tachycardia
After 48 hours hypermetabolic state
- Decreased SVR, subclinical myocardial dysfunction
25
Which increases the risk of blood product related graft vs. host disease
* Genetic variability between donor and recipient
* Irradiated
* Leukodepleted
* Immunodeficiency
* Transfusion of non-cellular product
**Immunodeficiency of recipient** (genetic variability would be protective)
[Lifeblood ](http://www.lifeblood.com.au/health-professionals/clinical-practice/adverse-events/TA-GVHD)
The three primary risk factors for developing TA-GVHD are:
* degree of immunodeficiency of the recipient.
* number of viable T lymphocytes transfused (affected by the age of the blood transfused, degree of leucodepletion and irradiation status),
* genetic diversity between donor and recipient. Greatest risks are donations from blood relatives and with HLA-matched blood products.
26
When reconstituted, fibrinogen concentrate should be transfused within:
* 30 min
* 2h
* 1h
* 6h
* 8h
Stable for 6 hours after reconstitution if kept between 20-25 degrees
[CSL PI](http://www.cslbehring.com.au/-/media/cslb-australia/documents/aus-pis-and-cmis/riastap-au-pi-v1000.pdf?la=en-us&hash=BD9FB317DB4AD0C363AA451E9FA311484ECBB029)
27
A man has this device put in because he isn't suitable for anticoagulation with AF. What is a WATCHMAN device / where is it?
* Left atrial appendage
* SVC
* IVC
* Right atrium
* Ascending aorta
Left atrial appendage
Most likely site for clot formation in AF
Blocks off the LAA so no clot can form there
28
Aortic mechanical On-X valve has an inguinal hernia repair in 48 hours and INR is 1.5, what should you do?
* Bridge with enoxaparin
* Bridge with heparin
* Cease warfarin
* Cease aspirin
Okay to cease warfarin -> likely doesn't require bridging as no additional risk factors (AF, stroke). X-valve INR recommended is 1.5-2
On-X valve is mechanical bileaflet valve with approval for low INR target 1.5-2.0
29
The transthoracic echo demonstrates:
Tricuspid regurgitation
30
TTE echo parasternal long axis which chamber?
* LV
* LA
* RV
* RA
The standardised parasternal long axis view is characterised by the following cardiac structures:
* the free right ventricular wall near to the transducer in front of the right ventricular cavity (RV)
* the basal and mid anteroseptal region of the left ventricle (LV),
* the left ventricular cavity in the long axis,
* the basal and mid posterior region of the left ventricle
https://icuecho.com/windows/plax.php
31
Which of these trials demonstrates non-inferiority
Both C and D demonstrate non-inferiority
32
In a non-inferiority trial, the primary endpoint is defined as:
a. Proving the new treatment is superior to the standard treatment
b. Showing the new treatment is equivalent to the standard treatment
c. Demonstrating the new treatment is not unacceptably worse than the standard treatment
d. Establishing the safety of the new treatment
e. Comparing the cost-effectiveness of two treatments
c. Demonstrating the new treatment is not unacceptably worse than the standard treatment
33
APRV is:
- spont breathing
- Restrictive lung disease
- Short bursts of high pressure to aid recruitment
- Long expiratory for clearance of CO2
**Spont breathing**
Airway pressure release ventilation is inverse ratio (I:E ratio is inverted), pressure controlled, intermittent mandatory ventilation with unrestricted spontaneous breathing
Use: rescue therapy for severe ARDS
34
Best TOE view for detecting myocardial ischaemia
* Mid-oesophageal 4-chamber
* Long axis
* 2 chamber
* Transgastric 2 chamber (Mid pap)
* Mid oesophageal 4 chamber
**Transgastric short axis (mid-papillary) **
mid view of the left ventricle demonstrates areas of myocardium subtended by each of the three coronary arteries. It is therefore the most frequently used view for intraoperative monitoring of left ventricular ischaemia"transgastric mid-papillary short-axis view
35
Xray of 3 leads (CRT), where is the lead denoted C located:
- Coronary sinus
- RV
- RA
- LA
Coronary sinus lead
36
Avulsed tooth, what fluid to place it in:
* Chlorhexidine
* Saline
* Balanced salt solution
* Fresh bovine milk
* Water
Milk
37
Pregnant lady with multiple sclerosis, cat 1 CS within 30 minutes, what method:
* Spinal
* CSE
* Epidural
* GA
* Methylpred then GA
Spinal anaesthetic
Pregnancy in Multiple Sclerosis study (PRIMS) found no correlation between the use of neuraxial techniques and relapses of MS in the postpartum period. Numerous subsequent reports support these findings.
38
Pregnant lady with mitral stenosis, Cat 1 CS within 30 minutes, what method:
* Spinal
* CSE
* Epidural
* GA
* Methylpred then GA
**Anesthetic plan: carefully titrated neuraxial anesthesiaHemodynamic medication plan: vasopressor medications**
Hemodynamic goals: maintain aortic diastolic bloodpressure at baseline, normal sinus rhythm
Access: usual large-bore peripheral intravenous line
Monitoring: consider arterial line for severe stenotic le-sions; consider transthoracic echocardiography or point-of-care cardiac ultrasound
Postpartum hemorrhage prevention and management:usual care
Normovolaemia: pre-emptive diuresis if evidence of pulmonary oedema or right
ventricular failure before induction of labour. Preferential use of vasopressors over volume
for hypotension management. Percutaneous balloon valvuloplasty (see surgical management below).
[AHA guidelines](https://www.ahajournals.org/doi/epdf/10.1161/CIR.0000000000001121)
39
Classic LMA cuff recommended maximum pressure:
* 30 cm H20
* 40 cm H20
* 50 cm H20
* 60 cm H20
60 cmH2O
https://academic.oup.com/bja/article/doi/10.1093/bja/el_3580/2502957
Maximum for an ETT is 30cmH20
40
Narrow complex tachycardia ECG in young person post op PACU SBP 90 what treatment
* Modified valsalva
* Adenosine
Modified Valsalva
See algorithm from ANZCOR
41
Prilocaine bier’s block is contraindicated in:
* G6PD
* Porphyria
* Multiple Sclerosis
* Pseudocholinesterase deficiency
* Chronic Kidney Disease
G6PD contraindicated
"Prilocaine solutions are contraindicated in patients with congenital or idiopathic methaemoglobinaemia." [MedSafe NZ Gov](https://www.medsafe.govt.nz/profs/datasheet/c/Citanestplaininj.pdf) Only other contraindication is allergy.
42
MMR vaccine allergy, which of the follow can demonstrate cross-reactivity:
* Albumin
* Gelofusin
* Normal saline
* Hartmanns
* FFP
* Fibrinogen concentrate
* Prothrombinex
Gelofusin contains gelatin, MMR vaccine also has gelatin component as a stabilzer
43
CXR Left hemithorax whiteout (see images). 65 with hypoxia and confusion. Tracheal deviation away from whiteout:
* Pleural effusion
* Pneumonia
* Unilateral pulmonary oedema
* Haemothorax
* Pneumonectomy
Left pleural effusion
* Pleural effusion – meniscus sign, whiteout, trachea pushed away (mass effect)
* Pneumonia; consolidation, doesn’t usually push/pull trachea
* Pulmonary edema; ABCDE (alveolar opacification, bat wing, cardiomegaly, diffuse alveolar septae, may have small pleural effusion)
* Haemothorax= Push
* Pneumonectomy – pulls trachea toward
44
Which of the following statements about breast innervation is correct?
a. The long thoracic nerve provides motor innervation to the pectoralis major muscle, which underlies the breast.
b. The lateral cutaneous branches of intercostal nerves provide the majority of sensory innervation to the breast.
c. The thoracodorsal nerve provides sensory innervation to the upper outer quadrant of the breast.
d. The supraclavicular nerve supplies the entire breast, including the nipple.
e. The medial cutaneous nerve of the arm contributes to sensory innervation of the nipple.
**b. The lateral cutaneous branches of intercostal nerves provide the majority of sensory innervation to the breast.**
45
Post heart transplant recipient, expected sensitivity to:
* Adenosine
* Ephedrine
* Atropine
* Glycopyrrolate
Adenosine - use 1.5 mg or 3 mg
* indirect agents are ineffective (atropine, ephedrine, glycopyrrolate)
* direct acting agents are effective (adrenaline, isoprenaline, phenylephrine)
* adenosine will evoke a prolonged effect
* vasodilatory agents (hydralazine, GTN, propofol etc) will cause profound hypotension due to absence of reflex tachycardia
* digoxin won't rate control but will still have inotropic effect
46
What nerve does not innervate the breast/for breast surgery?
* Long thoracic
* Anterior intercostal
* Posterior intercostal
* Supraclavicular
Posterior intercostal
47
Post premature baby, having surgery. The minimum time before considered for day surgery is:
* Postmenstrual age 54 weeks
* Postmenstrual age 46 weeks
* 60 weeks
Postmenstrual age of 54 weeks
ANZCA PG 29A
Ex-preterm infants at risk of post-operative apnoea should not be considered for same day discharge unless they are medically fit and have reached a postmenstrual age of 54 weeks.
Day surgery at 46 weeks for term infants
48
Fontan pregnancy. Drug to avoid:
* Nitrous
* Ergometrine
#Alternate options
* Metoprolol
* Flecainide
* Oxytocin
* Carboprost
* Misoprostol
Ergometrine NOT safe pg 89 Blue Book 2021
Ergometrine or carboprost - both increase PVRs
If giving oxytocin - give it slowly
49
Chin numbness post 3rd molar (38) extraction is caused by neuropraxia of which nerve:
* Mental
* Inferior alveolar
* lingual
* infratrochlear
Inferior alveolar nerve
50
APLS 20kg child with status epilepticus. What is **NOT** correct mx?
* Midaz buccal 6mg
* Intranasal 6mg
* IM 3mg midaz
* IV 3mg midaz
* IV midazolam 1.5mg
**IV midazolam 1.5mg**
**Recommended Doses**
Nasal is 0.3mg/kg
Buccal 0.3mg/kg
IM/IV/IO 0.15 mg/kg
51
The highest mortality is within which BMI:
* <18.5
* 18.5-25
* 25-30
* 30-35
* 35-40
**Mortality higher in BMI < 18.5**
Above BMI 40 is almost the same as <18.5
BMI 50-60 is higher than in 18.5 group.
52
What is the primary reason for increased resistance to non-depolarising muscle relaxants in patients with extensive burns?
a. Decreased plasma protein binding
b. Increased plasma cholinesterase activity
c. Upregulation of acetylcholine receptors
d. Increased clearance due to renal dysfunction
e. Decreased hepatic metabolism
f. Down regulated acetyl choline receptors
g. Low alpha-1 acid glycoprotein
c. Upregulation of acetylcholine receptors
53
Class 2 obesity has an ASA score of:
* 1
* 2
* 3
* 4
**ASA II for class II (and class I)**
ASA III for class III
Obesity:
* Class 1 - BMI 30-35
* Class 2 - BMI 35-40
* Class 3 - BMI 40+
54
Obese patient, giving a dose of propofol for INDUCTION, what weight do you use?
* LBW
* IBW
* ABW
* TBW
**Answer: LBW**
* NMBD - lean (non-depol)
* Sux - total body weight
* Prop induction - lean
* Prop infusion - adjusted body weight
* Reversal - adjusted body weight
* Local anaesthetic - lean body weight
* All Abx TBW except gentamicin which is LBW
(SOBA)
55
Myasthenia gravis:
* sensitive to NDMB, sensitive to depol
* sensitive to NDMB resistant to depol
* resistant to NDMB, resistant to depol
* resistant to NDMB, sensitive to depol
Sensitive to non-depol (use a 1/10 - 1/5 dose)
Resistant to suxamethonium (2.5 times dose)
56
Magnesium 20mmol given intraop is NOT associated with:
* Reduce volatile requirements
* Less PONV
* Prolonged neuromuscular block
* Respiratory depression postop
* Reduced rescue analgesic requirements
**Resp depression most likely**
Statistically significant but small reduction in postop opioid requirements, no reduction in post op pain scores or PONV. (PS41)
APMSE 2020
57
Severe hypokalaemia and cardiac arrest, ANZCOR recommends:
- 5mmol bolus IV
- 5mmol bolus IV over 5 mins
- 5mmol bolus IV over 10 mins
- 10mmol bolus IV over 5 mins
10mmol bolus IV over 10 mins
5mmol bolus IV
58
A five-year-old child weighing 25 kg is to be strictly nil by mouth overnight following a laparotomy. The most appropriate fluid prescription is
A) 0.45% saline + 5% dextrose 45ml/hr
B) 0.45% saline + 5% dextrose 65ml/hr
C) 0.9% saline + 5% dextrose 65mlhr
D) 0.9% saline + 2.5% dextrose 45ml/hr
E) 0.9% saline + 5% dextrose 45ml/hr
E) 0.9% saline + 5% dextrose 45ml/hr
(2/3 maintenance for any patient that is sick)
59
Child with uncorrected TOF, having a tet spell, what will not work?
- Prostaglandin
- Sedation
- Fluid bolus
Vasopressor
TOF:
- VSD
- Overriding aorta
- Pulmonary artery stenosis/atresia
- RV hypertrophy
Hypercyanotic spells (health.wa.gov.au)
Ans: prostaglandin
60
59. Someone is on moclobemide, what drug is most likely to cause serotonin syndrome?
- Pethidine
- Tapentadol
- Methadone
Fentanyl
Pethidine --> precipitates serotonergic crisis.
Tramadol also bad news
61
52. Young man collapsed, ECG depicting brugada, what is the recommendation:
- ICD
Flecainide
ICD only therapy
62
60. Parkinsons patient on apomorphine infusion, what drug to given for nausea?
- Cyclizine
- Ondansetron
- Droperidol
- Metoclopramide
Prochlorperazine
Cyclizine
Metoclopramide, droperidol are contraindicated in PD due to dopaminergic effects, also prochlorperazine.
63
61. Refractory epilepsy and vagal stimulator, what is most likely to cause it to inadvertently fire?
- Hypertension
- Tachycardia
- Bradycardia
- Hypotension
- Hypothermia
Hyperthermia
For patients who have seizures and experience 'ictal tachycardia'
It follows then that it might inadvertently fire when the patient is tachycardic for another reason?
Difficult to find a resource…
Uptodate "responsive" devices provide stimulation to increases in heart rate.
64
62. What is the most consistent factor for increased PONV rate in children?
- Female sex
- Age 3 or older
- Use of short acting opioids
Nitrous oxide
Age >3
Uptodate:
- Preop:
○ Age >/= 3
○ History of PONV/POV
○ Hx motion sickness
○ FHx PONV/POV
○ Post puberty females
- Intraop:
○ Surgery:
§ Strabismus, adenotonsillectomy, otoplasty, surgery >30 min
○ Volatile anaesthetics
- Postop:
Long acting opioids
65
63. Which muscle does not elevate the larynx?
- Sternohyoid
- Thyrohyoid
- Myelohyoid
Geniohyoid
Sternothyroid --> depresses the larynx
Sternohyoid, omohyoid --> indirect depressor
Thyrohyoid --> elevates the larynx
Myelohyoid, stylehyoid, geniohyoid --> indirect elevators of the larynx
66
64. What is not a good indicator for neonate being ready for extubation?
- Grimace
- RR>16
Conjugate gaze
RR>16
Criteria for awake extubation:
- Conjugate gaze
- Facial grimace
- Eye opening
- Purposeful movement
- TV>5ml/kg
Deep extubation:
- No cough /confirm deep anaesthesia (cuff deflation)
- Adequate TV
Normal ventilatory pattern
67
65. What nerve is not related to the trigeminal?
- Auriculotemporal
- Supratrochlear
- Infratrochlear
- Greater auricular
- Lingual
Infraorbital
Greater auricular
68
66. Right homonomous hemianopia and right hemisensory loss - affected region
- Left posterior cerebral
- Left anterior cerebral
- Superior cerebellar
Left anterior inferior cerebellar
Symptoms of posterior cerebral artery stroke include contralateral homonymous hemianopia (due to occipital infarction), hemisensory loss (due to thalamic infarction) and hemi-body pain (usually burning in nature and due to thalamic infarction) 3. If bilateral, often there is reduced visual-motor coordination 3. It is generally considered that sensory loss and hemianopia unilaterally without paralysis, is diagnostic of PCA territory stroke 4.
69
67. What is not a features of TURP syndrome?
- Hyperglycinaemia
- Hyponatraemia
- Hypervolaemia
- Hypokalaemia
- Hypoglycaemia
Hypoosmolar?
Hypokalaemia & hypoglycaemia
70
68. Equation for pulse pressure variation
- (pp max-pp min)/pp min
- (Ppmax-ppmin/((ppmax+ppmin)/2)
100 x (ppmax-Ppmin)/Ppmean
Ppmean = (Ppmax + Ppmin) / 2
71
69. Oxygen pulse in CPET is surrogate for
- Stroke volume
- Anaerobic threshold
SV - surrogate marker
Oxygen pulse defined by dividing oxygen uptake (VO2) by heart rate
Oxygen pulse is a measure of oxygen consumed per heart beat and may provide adjunctive information about the prognostic importance of exercise capacity with respect to CVD and all cause death. It is a measure for stroke volume and peripheral oxygen extraction during exercise.
72
70. What increases DLCO?
- Pulmonary haemorrhage
- Pulmonary hypertension
COPD
Pulmonary haemorrhage
73
71. What is an acceptable reason to defer #NOF?
- K+ 2.7
- HR 110, atrial fibrillation
- Hb 86
Na 126
K 2.7
Reasons to defer
* Haemoglobin < 80 g.l−1
* Plasma sodium concentration < 120 or > 150 mmol.l−1 and potassium concentration < 2.8 or > 6.0 mmol−1
* Uncontrolled diabetes
* Uncontrolled or acute onset left ventricular failure.
* Correctable cardiac arrhythmia with a ventricular rate > 120.min−1
* Chest infection with sepsis
Reversible coagulopathy
74
72. Image of ROTEM, EXTEM "in this bleeding patient" what to give (shows hyperfibrinolysis)
- Plt
- Fibrinogen
TXA
Wine glass shape --> hyperfibrinolysis, give TXA
75
73. V5 lead position for an ECG?
- Mid clavicular line 5th IC space
- Mid clavicular line 4th IC space
- Anterior axillary line 5th IC space
Anterior axillary line 4th IC space
Anterior axillary line 5th IC space
V4/5/6 lie in 5th ICS, along mid-clavicular, anterior axillary and mid-axillary line
V2 at 4th ICS along LEFT sternum
V1 at 4th ICS along RIGHT sternum
V3 midway between V2 and V4
76
74. What is the most sensitive predictor of 30 day mortality and MACE?
- DASI score 55
- AT<11
- proBNP >300
6MWT<…
I suspect the answer is a ProBNP > 300. a DASI of 55 is a good thing. Anaerobic threshold < 11 mL/kg/min was not as predictive. Hard to know what the distance was given of the 6MWT, generally cutoff of 370 m or less is bad, however it was also not as sensitive
This question is referencing the METS trial
77
75. VO2 max and DASI questionnaire relationship, score of 48 on DASI equals VO2 max?
- 10 ml/kg/min
- 20
- 30
- 40
- 50
Assuming a score of 48 on DASI (if misremembered) = (0.43 * 48) + 9.6 = 30.24 Ml/kg/min
If divide that by 3.5 you get METS -> 8.5 METS
78
76. Drug that will not raise pulmonary vascular resistance at low doses?
- Dopamine
- Vasopressin
- Noradrenaline
- Milrinone
- Dobutamine
OR Which is most likely to cause pulmonary hypertension?
- Dopamine
- Dobutamine
- Vasopressin
- Milrinone
Prostacycline
Bit unclear this one.
I reckon that milrinone is probably the answer
But dobutamine also decreases PVR as well
Agree we think milrinone probably correct??
- Vasopressin also attenuates pulmonary hypertension
Uptodate:
Pulmonary vasoconstriction --> phenylephrine, adrenaline,
Milrinone and dobutamine inodilators. Milrinone also reduces PVR.
79
77. Sepsis guidelines, which measure is NOT recommended to assess fluid status?
- Urine output
- Passive leg raise response
- PPV
- Response to fluid bolus
Echocardiogram
Urine output!
6. For adults with sepsis or septic shock, we suggest using dynamic measures to guide fluid resuscitation, over physical examination or static parameters alone
Weak recommendation, very low-quality evidence
Remarks
Dynamic parameters include response to a passive leg raise or a fluid bolus, using stroke volume (SV), stroke volume variation (SVV), pulse pressure variation (PPV), or echocardiography, where available.
80
78. Newborn at 1 minute, sats 75%, grimacing, pulse 120, RR 40, what do you do?
- Observe
- CPAP
- Intubate
CPR
Observe
81
79. Patient has arrested day 10 post cardiac surgery, what do you NOT do:
- Give adrenaline 1mg
- Give amiodarone
- 3 sequential shocks
- Atropine 3mg
1L fluid bolus
Do NOT give adrenaline 1mg (50-100mcg ok). Atropine is also not recommended
CALS protocol 10 days is the cutoff
Borderline question…
82
80. Diagnosis for TRALI not based on:
- Hypoxaemia
- Onset within 6 hours of transfusion
- PCWP low
- Bilateral infiltrates on CXR
Raised BNP
Raised BNP
CLINICAL FEATURES
* dyspnoea
* hypoxia
* fever
* hypotension or hypertension
DIAGNOSIS
* acute onset ALI(within 6 hours of a transfusion)
* hypoxia (PaO2/FiO2 <= 300mmHg regardless of PEEP or SpO2)
* bilateral pulmonary infiltrates
not cardiogenic in origin (PAWP < 18mmHg)
83
Diagnosis of HITS based on 4Ts score, which are:
- Thrombocytopaenia
- Timing of plt drop
- History of thrombus
- Other cause thrombocytopaenia
Plt serotonin release assay
MDCalc: --> diagnostic probability score 4 Ts
- Thrombocytopaenia
- Timing of platelet count fall
- Thrombosis or other sequelae
- Other causes for thrombocytopaenia
Plt serotonin release assay --> diagnostic of HIT
84
IABP trace, green arrow pointing to unassisted diastolic pressure
85
To confirm ETT, need ETCO2 more than how much from baseline?
As per Chrimes paper
7.5mmHg
86
Third heart sound due to:
- health person less than 40y
- HTN
- Mitral prolapse
Talley and O'Connor:
- 3rd heart sound sounds like "Kentucky'
- Diastolic sound heard best with the bell
- Normal to hear in states of states of increased cardiac output
○ Pregnancy, thyrotoxicosis, some children
Otherwise from poorly compliant ventricle
87
Patient presents for a trans-urethral resection of the prostate (TURP). He had a single drug-eluting coronary stent for angina pectoris inserted six months ago and is taking clopidogrel and aspirin. The most appropriate preoperative management of his medications is to
- Cease clopidogrel for 5 days
- Cease clopidogrel for 10 days
- Continue both
Cease clopidogrel for 7 days and aspirin for 20 days
Flow chart from AHA 2024
Cease for 5-7 days
88
Painless visual loss, with preserved pupilliary reflex
- AION
- PION
- Vertebrobasilar (?stroke)
- Corneal abrasion
Cerebral infarct
Cerebral infarct
Won't be preserved reflex in AION or PION
89
Woman complaining of persistent shortness of breath 3 days post prolonged knee operation. v/q scan showing patchy, non segmental areas of equal non ventilation and perfusion. Cause
- PE
- Pulm infarct
- COPD
- Atelectasis
COPD
90
What is the half life of a 100u/kg heparin dose?
- 30mins
- 1 hour
- 2 hours
- 3 hours
- 4 hours
- 30 min after 25 IU/kg
- 60 min after 100 IU/kg
150 min after 400 IU/kg
91
What does not innervate the knee?
- Posterior cutaneous
- Obturator nerve
- Peroneal nerve
- Tibial nerve
Other options from other remembered document:
- Common peroneal
- Tibial
- Saphenous
- Obturator
Posterior cutaneous nerve of the thigh
Luke: posterior cutaneous nerve of thigh
Cutaneous:
- Saphenous = anteromedial (from femoral nerve)
- Common peroneal = lateral
- Posterior femoral cutaneous nerve = posterior
Osseous:
- Obturator - medial femoral condyle
- Sciatic - posterior and lateral side of femoral condyle
- Common peroneal - top of fibula + fibular side of tibia
- Femoral - patella, anterior knee, some of tibia
Muscular:
- Quads and sartorius = femoral
- Hamstrings = sciatic
- Dorsiflexors = common peroneal
- Plantarflexors = tibial
Answer is unclear.
92
What DOESN’T the sciatic nerve do?
- Foot plantar flexion
- Toe extension
- Knee flexion
- Knee extension
knee extension
93
What nerve is not potentially damaged by insertion of supraglottic airway?
- Facial
- Trigeminal
- Glossopharyngeal
- Vagus
- Lingual
Facial
94
Somatic innervation in the second stage of labour includes the following nerves EXCEPT
- Genitofemoral nerve
- Posterior cutaneous nerve of the thigh
- Inferior gluteal nerve
- Pudendal nerve
Stage 2 – descent of baby through the birth canal
* Somatic pain starts – more well localised, carried by A delta fibres
* Vagina, rectum, perineum
* Pudendal nerve and perineal branches of posterior cutaneous nerve -> S2-S4
* Ilioinguinal and genitofemoral nerves -> L1-L2
Inferior gluteal
95
Dental extraction, now numbness over lower chin, which nerve has been damaged?
- Inferior alveolar
- Mental
- Infraorbital
Depends where the lesion is, if molar tooth then damage to inferior alveolar. If front tooth then possibly mental nerve.
96
Cryoprecipitate does NOT contain
- Factor IX
- Factor XIII
- Fibronectin
- Von Willebrand Factor
Factor IX
97
Tibial fracture, Posterior tibial nerve injury, which compartment
- Superficial posterior
- Deep posterior
- Anterior
Other remembered: what compartment? Pain, toe flexion, plantar sensory loss.
- Deep posterior
- Superficial posterior
- Anteral
- Lateral
Medial
Deep posterior
98
Hyalase increases the following:
- Speed of muscle akinesis
- Chemosis
- Rate of allergic reactions
Speed of muscle akinesis
99
Use of methylene blue rather than patent blue
- Reduced rate of anaphylaxis
- More expensive
- Easier to see sentinel nodes
- Reduced O2 saturations
Fourth most common cause of anaphylaxis in NAP6
Methylene blue has less uptake and more fat/skin necrosis.
The use of methylene blue in the UK has largely been superseded by Patent Blue because of concerns about the adequacy of lymphatic uptake and fat necrosis at the injection site.
- Methylene blue is less expensive
- Methylene blue has a lower rate of anaphylaxis
- Easier to see sentinel nodes with patent blue
100
Best method to reduce post ERCP pancreatitis?
- IV clonidine
- PR indomethacin
- paracetamol
- creon postop
- NAC infusion
Uptodate:
Rectal diclofenac or indomethacin
101
Epipen dose compared to normal 1:1000 IM adrenaline dose in adult anaphylaxis?
- Same
- Reduced
- Increased
Anapen 500mcg in 0.3mL
Epipen 300mcg in 0.3mL
Lower dose same concentration
Tim:
Anaphylaxis ANZAAG adults: 500mcg (0.5mL) of 1:1,000
- paeds: <6 y/o = 0.15mL (150mcg) of 1:1,000
- paeds: >6 y/o = 0.3mL (300mcg) of 1:1,000
anaphylaxis guidelines always use 1:1,000 concentration
Same question but for Paeds: epipen give same dose, but lower concentration
102
How to clean laryngoscope handle?
PG28 Infection control
- Handle clean with soap and water (non-critical)
Critical - penetrates mucosa (blade)
Semi-critical - contact with intact mucous membranes
103
What additive prolongs block best?
- Clonidine
- Dexamethasone
- Bicarbonate
- Adrenaline
Dexamethasone
104
What is not acceptable for ARDS?
- Recruitment manoeuvres
- Proning
- High PEEP
- Neuromuscular blockade
- Keep dry
We think recruitment manoeuvres is the answer
- Improve PaO2 transiently but in long term found to be harmful
105
The recommended skin preparation for a neuraxial:
- 0.5% chlorhex/ 70% alcohol.
106
Expected blood volume in preggers lady
- 60 ml/kg
- 70 ml/kg
- 80 ml/kg
- 90 ml/kg
- 100 ml/kg
100ml/kg
107
What is the 4th pacemaker letter meaning
- chamber sensed
- Chamber paced
- Rate modulation
- Multi chamber pacing
Rate modulation
108
Time for reversal of therapeutic dabigatran after administration of Idarucizumab 5 g is
- 5mins
- 15mins
30mins
5 mins (maximum)
109
The accompanying image is obtained while doing an ultrasound guided erector spinae plane block at the level of the transverse process of the fourth thoracic vertebra. The muscle marked by the arrow is the
- Trapezius
- Rhomboid
- Deltoid
Erector spinae
Rhomboid
"TRE"- trap, rhomboid, erector spinae
110
Max dose topicalisation airway in mg/kg
- 7
- 9
- 11
9mg/kg
111
BD morphine, bowel obstruction, showing signs of withdrawal. What is this?
- opioid dependence
- Physical dependence
- Tolerance
- Opioid use disorder
Physical dependence
112
NAP 5 - cardiac anaesthesia awareness
- 1/8000
- 1/700
1/8000 (answer)
GA LSCS = 1/670
Overall GA = 1/19,000
GA no muscle relaxant = 1/130,000
113
NAP7 - most common cause perioperative arrest
- Major haemorrhage
- Anaphylaxis
- Airway issues
major haemorrhage (17%)
bradyarrhythmia 9%
cardiac ischaemia 7%
114
DDAVP not used for:
- nocturnal enuresis
- Haemophillia B
- Von Wil disease 2A
- Uraemic bleeding
- Central diabetes insipidus
Haemophilia B
115
Noradrenaline has tissued into skin from peripheral cannula, most appropriate first step is:
- remove cannula
- Flush with saline
- Heparin?
- Hyalase?
- Cold compress
- Subcut phentolamine
- Stop infusion
- Do not remove IV line
- Elevate limb if possible, do not apply pressure
- Do not flush the line
- Attempt aspiration of remaining drug from IV line with small syringe
- Do not use ice/cold compress (causes further vasoconstriction)
See below reference, phentolamine and hyaluronidase mentioned.
We are going with phentolamine as answer.
116
What is not associated with POTS?
- COVID-19
- Hypermobility disorder
- Normal resting LV function
- ECG changes
ECG changes
117
Pregnancy highest risk
- bicuspid valve with dilated aortic root
WHO Class IV
118
Aortic dissection, which is NOT a bad sign
- RWMA
- Right dilated ventricle
- Dilated aortic root
AR
Right dilated ventricle
119
PFT in dude, detect nitric oxide >70ppm number ppm. Meaning
- Smoker
- COPD
Exacerbation of asthma
Fractional exhaled nitric oxide - helps to diagnose asthma
Measures amount of nitric oxide exhaled from a breath
Produced by cells involved in inflammatory process
Cutoff point for test is approximately 40
Answer: Exacerbation of asthma
120
118. Compared to a continuous infusion, PCEA does NOT reduce
- Incidence instrumental delivery
- Incidence of C-section rates
- Clinical workload
Motor weakness
- Incidence of C-section rates
Blue book article Harriet Wood
121
119. A 70-year-old man undergoes a stress echocardiogram as part of his preoperative preparation before a total hip replacement. If he has clinically significant coronary artery disease, the earliest indicator during his test is most likely to be
- ECG changes
- RWMA/diastolic dysfunction
- Angina
Hypotension
- RWMA/diastolic dysfunction
Diastolic dysfunction comes first, then RWMA
122
Return to practice
4 weeks for every year
"the total duration of a formal return to practice program will be determined by the learning needs analysis. The starting point for calculating the total duration is one month per year of absence from anaesthesia practice."
123
CPET Borg’s scale, what is it for?
Subjective effort
Rating of perceived exertion
12 on Borg scale corresponds to 60%
'Very hard' = 16 = 80% VO2 max
Scale is from 6-20
124
ANZCOR recommendations on minimum time from cardiac arrest to post arrest prognostication?
- 24 hours
- 48 hours
72 hours
72 hours
CT within 48 hours also mentioned by anzcor
125
Spinal, 3ml, patient supine and horizontal, hyperbaric qualities vs normal bupivacaine
- Lesser block height, shorted duration of action
- Lesser block height, longer DOA
- Greater block height, shorter DOA
- Greater block height, longer DOA
No difference in block height, longer DOA
Greater block height, shorter duration
126
Epilepsy surgery, some sort brain monitoring and which drugs affect it the least
- Remifentanil
- Ketamine
Sevoflurane
Remifentanil
127
Giving indocyanine green
- Increased O2 cerebral, decreased peripheral
Variations on above
- Increases NIRS but decreased peripheral sats
128
Accuracy of pulse ox, which does NOT affect
- Anaemia
- AF
- Carboxyhaemoglobin
Poor peripheral perfusion
- Anaemia
MetHb - brings sats towards 85%
CarboxyHb - falsely high reading
129
Best post-op analgesia after wisdom tooth removal
- Ibuprofen
- Celexocib
- Tramadol
Paracetamol
- Ibuprofen
However APMSE scientific evidence says similar efficacy between non-selective NSAIDs and celexocib
130
What is NOT a feature of thyroid storm?
- Jaundice
- Bronchospasm
Seizures
Bronchospasm
131
Expected physiological change in hyperthyroidism
Reduced SVR
Hyperdynamic circulation
132
Somatic pain in the second stage of labour is NOT transmitted via the
- Pudendal
- Ilioinguinal
- Genitofemoral
- Inferior gluteal
Posterior cutaneous nerve of the thigh
Inferior gluteal
133
Which drug NOT to give with cocaine toxicity?
- Phentolamine
- Metoprolol
- GTN
Propofol bolus
- Metoprolol
Giving B blockade may lead to reduced myocardial contractility and HR in the setting of unopposed alpha effects (peripheral vasoconstriction etc.) --> failure
134
SGLT-2i use for diabetes, what do they NOT cause?
- Glycosuria
- Reduced eGFR
- Euglycaemic ketosis
Hypoglycaemia
- Hypoglycaemia?
* Can cause hypoglycaemia if used in combination with insulin or sulfonylurea
* As monotherapy do not cause hypoglycaemia
However they definitely DON'T reduce eGFR as they are used to prevent progression of chronic kidney disease? RACGP - Sodium glucose cotransporter 2 inhibitors for chronic kidney disease
135
Buprenorphine patch stopped, when will plasma levels drop by 50%
- 12 hours
- 24 hours
- 48 hours
72 hours
24 hours
136
Autonomic dysreflexia is more likely seen in spinal lesions at the level of:
- T5 incomplete injury
- T5 complete injury
- T10 incomplete injury
T10 complete injury
T5 complete injury
137
5 kPa is approximately equivalent to
- 37 mmHg
45 mmHg
37 mmHg
138
Baby swallows battery, what to give
Sucralfate (or honey)
139
Risk of AFE is highest in:
- Caesarean
- Induction of labour
Labour augmented by oxytocin infusion
Age>35, multiple pregnancy, induction of labour all associated
140
You have induced a patient (I forget this part) and ten minutes later- reduced air entry left side, sats 85%, hypotensive. Lung USS on the left side shows no sliding and a lung point sign.
- Left needle decompression 2nd IC space
- Left chest drain insertion
- Left finger thoracostomy
- Pull the ETT back 2cm
Get a CXR
Left needle decompression 2nd IC space
141
Compared with open mechanical aortic valve repair, TAVI has:
- Reduced mean gradient
- Reduced vascular injury
- Reduced arrhythmia
Reduced paravalvular leaks
Reduced arrhythmia
142
The number of segments in the left lower lobe of the lung is:
3, 4, 2
4
143
Current ANZCA recommendations for a child 7 months old fasting prior to surgery are:
- Clear fluids one hour, breast milk 3 hours
Clear fluids two hours, breast milk 3 hours
Clear fluids 1 hour, breast milk 3 hours
144
In relation to ECHO, TAPSE refers to:
- Right ventricular contraction
Tricuspid valve something
- Tricuspid annular plane systolic excursion
Used to estimate RV ejection fraction
145
143. EPO given perioperatively
No increase in risk of thrombosis
- No increased thrombosis risk
- Reduces perioperative blood transfusion
No change in AKI, mortality, reoperation
