25.1 Flashcards

Question

Bidirectional Glenn shunt what does it connect - SVC and right pulmonary artery - IVC and right pulmonary artery - SVC and pulmonary trunk - SVS and IVC and right pulmonary artery

Answer 1

The bidirectional Glenn shunt connects the superior vena cava (SVC) to the right pulmonary artery. This allows venous blood from the upper body to flow directly into the pulmonary circulation, bypassing the right atrium and ventricle. It is typically the second stage in the surgical management of single ventricle defects, performed after an initial neonatal shunt (such as the Norwood procedure) and before the final Fontan procedure

Answer 2

NORMOGlycaemia HYPOKalemia NORMO/HYPERNatremia + Hypertension (often resistant to treatment)

Answer 3

Hyponatremia Hyperkalemia Low Bicarbonate (HCO₃⁻) Hypoglycemia

Answer 4

Cholestasis in Pregnancy Gestational diabetes Hypertension/pre-eclampsia Miscarriage/stillbirth Thromboembolism Caesarean section Macrosomia Congenital anomalies Antenatal Depression

Answer 5

4mg/kg (https://pmc.ncbi.nlm.nih.gov/articles/PMC11782391/) (increased susceptibility to toxity, reduced protein binding, immature liver metabolism, smaller Vd) Adults topicalisation is 8-9mg/kg LBW w adrenaline

Answer 6

RR RTS = GCS score + SBP score + RR score Lower scores indicate more severe trauma and higher risk of mortality. Maximum score: 12 (best) Minimum score: 0 (worst)

Answer 7

HYPOPHOSPHATAEMIA Potassium and magnesium should also be monitored closely, as hypokalemia and hypomagnesemia can cause arrhythmias and neuromuscular symptoms, but phosphate is most directly linked to the classic features of weakness and heart failure in refeeding syndrome

Answer 8

LACTATE six organ systems, each scored from 0 (normal) to 4 (severe dysfunction), to assess the extent of organ failure: Respiratory: based on the PaO2/FiO2 ratio (partial pressure of oxygen in arterial blood to fraction of inspired oxygen). Coagulation: platelet count. Liver: bilirubin levels. Cardiovascular: mean arterial pressure and use/dose of vasopressors. Central Nervous System: Glasgow Coma Scale (GCS). Renal: creatinine levels or urine output. Each system's dysfunction adds to the total SOFA score, which predicts mortality risk in ICU patients, particularly those with sepsis. Additionally, a simplified quick SOFA (qSOFA) uses just three criteria—respiratory rate, altered mental status, and systolic blood pressure

Answer 9

Cardiac Arrest (Shockable Rhythm, e.g., VF/pulseless VT) IV/IO bolus: 5 mg/kg (may be repeated up to a total of 15 mg/kg in 24 hours if needed). Tachyarrhythmia (Perfusing Rhythm) IV infusion: 5 mg/kg over 20–60 minutes (consultation with a paediatric cardiologist recommended)

Answer 10

The maximum dose for internal cardiac defibrillation is 20J (Hol) Max 50j? Usual starting 20J.

Answer 11

Sotalol has been shown to either reduce or have no significant effect on defibrillator threshold (DFT). - Verapamil (CCB), diltiazem (CCB), and flecainide (Class I antiarrhythmic), Amiodarone (Class III antiarrhythmic) can increase the DFT. - Acidosis, Hypoxia, Severe electrolyte (K+) - AMI, myocardial fibrosis/scarring Atropine is not typically associated with an increased DFT, but among the options, sotalol is specifically noted in the literature as not increasing—and potentially lowering—the DFTn

Answer 12

60g When dantrolene is administered for malignant hyperthermia, each 20 mg vial (reconstituted w 60 mL sterile water) contains 3 grams of mannitol as an excipient to aid solubility. If a patient has received 400 mg of dantrolene, the total amount of mannitol administered is: 400 mg/ 20mg/vial = 20 vials 20x3g mannitol/vial =60g mannitol

Answer 13

Collection Chamber: Measures and collects fluid drained from the pleural space. Water Seal Chamber: Acts as a one-way valve to prevent backflow; bubbling here indicates an air leak (severity can be judged by the amount and persistence of bubbling). Suction Control Chamber: Regulates the amount of negative pressure applied if suction is used.

Answer 14

12ml Armitage formula: For 0.2% ropivicaine: - 0.5 ml/kg = Sacral, Perineal, anal - 1.0 ml/kg = Lumbar, Inguinal, lower abdominal (orchidopexy) - 1.25 ml/kg = Low thoracic (T10), umbilical, suprainguinal

Answer 15

For an 80 kg patient with suspected TCA overdose or hyperkalemia, the recommended initial dose of sodium bicarbonate is 1–2 mmol/kg as an IV bolus. 1 mmol/kg for 80 kg = 80 mmol Each 8.4% sodium bicarbonate ampoule contains 1 mmol/mL. Therefore, 80 mmol = 80 mL of 8.4% sodium bicarbonate.

Answer 16

20mg PARENTERAL MORPHINE 12 mg oral hydromorphone ≈ 60 mg oral morphine (using the usual conversion factor of 1 mg hydromorphone = 5 mg morphine).

Answer 17

40mg The standard conversion ratio for oral tramadol to oral morphine is 5:1—that is, 100 mg oral tramadol ≈ 20 mg oral morphine. PO Tapentadol 50mg = 15/16mg PO morphine PO Tramadol 50mg = 10mg PO morphine

Answer 18

Contact surgeons (vascular or cardiothoracic surgery) immediately.

Answer 19

2, 5 Gas Pin Positions NACHONE - Nitrogen 1, 4 - Air 1, 5 - Carbon dioxide (CO₂) + O₂ (>7% CO₂) 1, 6 - Heliox (O₂ + He <80% He) 2, 4 - Oxygen (O₂) 2, 5 - Nitrous oxide (N₂O) 3, 5 - Entonox (50% O₂/N₂O) 7 (single center pin) - Carbon dioxide (CO₂) + O₂ (<7% CO₂) 2, 6 - Heliox (O₂ + He >80% He) 4, 6

Answer 20

BLACK AND WHITE Oxygen (O₂) = White Nitrous oxide (N₂O) = Blue Medical Air = Black and white Carbon dioxide (CO₂) = Grey Entonox (N₂O/O₂ mix) = Blue and white Helium = Brown Heliox (He/O₂ mix) = Brown and white

Answer 21

4 ATM or 1 ATM Hospital wall oxygen is supplied at a regulated pressure (usually 400kPa/4atm absolute/3atm gauge above). The flow meter regulates and reduces the high wall supply pressure to a low, safe pressure just above atmospheric for patient delivery. Once the tubing is disconnected from the flow meter, it is exposed to room air, so any residual pressure rapidly equalizes to atmospheric.

Answer 22

30 seconds Initial insufflation: 4 seconds This delivers a large initial volume of oxygen (often 1–2 liters) to rapidly oxygenate the patient. Subsequent insufflations: 2 seconds every 30 seconds This maintains oxygenation while limiting the risk of barotrauma and hyperinflation. Arkar edit: have added the protocol from EMAC. I'm not sure about what option to put in the exam unless there was a different protocol on this?

Answer 23

Loss of sensation anterolateral neck

Answer 24

Too high TV? Too high PEEP may cause overdistension if excessive, but not the classic beak shape. Too low PEEP Does not cause overdistension Too high tidal volume causes Classic overexpansion/beak at upper inflection point

Answer 25

Supraclavicular (This nerve provides cutaneous (skin) sensation over the clavicle and upper chest, but does not supply the shoulder (glenohumeral) joint itself) Suprascapular = Posterior and superior capsule Axillary = Anteroinferior capsule Lateral pectoral = Anterosuperior capsule Subscapular (less common) = anterior capsule

Answer 26

Severe TR Other absolute contraindications: - Severe right heart failure - Severe tricuspid regurgitation - Severe pulmonary hypertension - polycystic liver disease - active sepsis - Severe hepatic failure - unrelieved biliary obstruction

Answer 27

Opportunity to fulfill medicolegal obligations Open disclosure: - Acknowledgement of the event - An explanation of what happened - An apology or expression of regret - discussion of potential consequences and the next steps - Opportunity for the patient to ask questions"

Answer 28

Benchmarking QA Step: - Planning - Doing - Checking - Acting

Answer 29

Phenytoin. REDUCERS EFFECT/INDUCE HEPATIC ENZYMES - Anticonvulsants (phenytoin, carbamazepine, phenobarbitone) - Antibiotics (Rifampicin) INCREASES EFFECT - Azole antifungals: fluconazole, ketoconazole (inhibit methadone metabolism, increasing levels). - Certain SSRIs: fluoxetine, fluvoxamine (especially fluvoxamine, which strongly inhibits methadone metabolism). - Protease inhibitors: ritonavir, indinavir, atazanavir (can inhibit methadone metabolism). - CNS depressants - Grapefruit juice

Answer 30

Feotal Red Cell

Answer 31

CMV Leucodepletion filter is a device used to remove white blood cells (leucocytes) from blood products, including red cell and platelet concentrates, before transfusion. Prevents Tramission of CMV. Prevents febrile non-haemolytic transfusion reactions Reduces risk of HLA alloimmunisation, transfusion associated graft v host disease, postop infection, mortality

Answer 32

Low-pressure leak The 2-bag test is performed as part of the anaesthetic machine check to ensure: The patency of the breathing system (i.e., no obstruction in the inspiratory or expiratory limb) The function of the unidirectional valves (if present) The function of the adjustable pressure limiting (APL) valve by squeezing both bags

Answer 33

Sample Line Leak Hard to know without the actual trace but could be endobronchial:

Answer 34

Superior Laryngeal nerve = above Vallecula = Glossopharyngeal nerve (CN IX) - Anterior epiglottis (pharyngeal) = Glossopharyngeal nerve (CN IX) - Posterior epiglottis (laryngeal) = internal branch of superior laryngeal nerve (CN X) If transtracheal = inject recurrent laryngeal nerve

Answer 35

Psoas Tendon and Pubic Ramus

Answer 36

Anterior/deep to erector spinae, posterior/superficial to T5 transverse process.

Answer 37

PECS1 PECS 1 block targets the lateral and medial pectoral nerves, providing analgesia to the pectoral muscles and the lateral chest wall, but it does not cover the anterior chest wall or sternum. PECS 2 block extends coverage laterally but still does not provide reliable analgesia for the sternum. Parasternal intercostal plane block (also called transversus thoracic muscle plane block) specifically targets the anterior cutaneous branches of the intercostal nerves, providing effective analgesia for the sternum and is used for sternal fracture pain. Paravertebral block can provide segmental analgesia to the anterior chest wall, including the sternum, depending on the level and spread.

Answer 38

?Spont Vent in pt w Open Appendicectomy If controlled ventilation is required, strategies should include low tidal volumes, short inspiratory times, low PEEP, and avoidance of hypercarbia or hypoxia to minimize increases in PVR and mean airway pressure. Use low tidal volumes (5–6 mL/kg), low PEEP, short inspiratory times, and avoid hypercarbia or hypoxia to minimize increases in pulmonary vascular resistance and mean airway pressure

Answer 39

The mechanism of action of empagliflozin is decreased glucose reabsorption in the kidneys. It works by inhibiting the sodium-glucose co-transporter-2 (SGLT2) in the proximal renal tubules, leading to increased urinary glucose excretion and reduced blood glucose levels

Answer 40

Cardiac arrest: Multiple high-quality studies and guidelines support the use of targeted temperature management (TTM) at 32–34°C for comatose (unconscious) adults after return of spontaneous circulation following cardiac arrest, particularly for out-of-hospital ventricular fibrillation or pulseless ventricular tachycardia.

Answer 41

Don’t withhold and treat as unfasted. Treat all patients who have taken a GLP-1 agonist in the last 4 weeks as unfasted (full stomach) for anaesthesia or sedation.

Answer 42

The smallest weight for which a Microcuff paediatric endotracheal tube is recommended is 3 kg. The manufacturer’s sizing chart and multiple studies indicate that the 3.0 mm Microcuff ETT is suitable for term infants weighing ≥3 kg.

Answer 43

INCREASED SVR Initial "ebb phase" (first 24 hours) marked by increased SVR and decreased cardiac output (due to loss of intravascular volume, direct myocardial depression, increased pulmonary and systemic vascular resistance) The subsequent "flow phase" (after 24–48 hours) marked by decreased SVR and increased cardiac output.

Answer 44

RIGIDITY Feature|MH v AIR - RIGIDITY: Prominent, generalised, masseter spasm in MH v absent/uncommon in AIR - Elevated CO2 is common MH>AIR - Myoglobinuria is present in both, later in MH - Onset | Rapid (min) v delayed (hr) - Hyperthermia | rapid and severe in MH v may be absent or less pronounced in AIR. - Hyperkalaemia | May occur, but less severe v Often severe and early, risk of cardiac arrest. - CK Elevation | Present in MH v Marked in AIR (often >20,000 IU/L) MH: Uncontrolled calcium release from the sarcoplasmic reticulum leads to sustained muscle contraction, hypermetabolism, heat production, and rhabdomyolysis. AIR: Direct muscle breakdown due to membrane instability in myopathic muscle, especially after succinylcholine, with less pronounced hypermetabolic response

Answer 45

Increased sensitivity to both. MG patients are resistant to sux and sensitive to NDMRs; LEMS patients are sensitive to both.

Answer 46

Pyridostigmine Levanthal critera: 4 preoperative risk factors to predict need for postop mechanical ventilation in pts w MG, particularly those undergoing thymectomy: - Duration of myasthenia gravis ≥ 6 years - Chronic respiratory disease (such as COPD or other chronic lung conditions) - Pyridostigmine dose ≥ 750 mg per day - Vital capacity ≤ 2.9 litres/<20ml/kg - High/low BMI

Answer 47

Cataracts Bradycardia: Yes Rate-dependent reduction in cardiac output Hypermetropia : Yes Less common than myopia Cataracts : Yes (rare) Possible with extended/repeated exposures Hypoglycaemia: Yes Especially in diabetics Seizures: Yes CNS oxygen toxicity; rare and reversible Heart failure: Yes (rare, mostly in predisposed patients) Caution in pre-existing cardiac disease common - ear pain, fatigue, hypoglycemia, barotrauma, ocular (myopia, hypermetropia and accelerated maturation of cataracts), O2 toxicity (seizures), cardiac (bradycardia from hyperoxia/vagal tone, exacerbate HF from existing cardiac dysfunction)

Answer 48

2 or more Group E (Exacerbator phenotype) includes patients with 2 or more moderate exacerbations per year, or at least 1 exacerbation leading to hospitalization in the previous year

Answer 49

The best management for a 3-year-old with potential cervical spine trauma is to use a thoracic elevation device (such as a towel roll under the shoulders) to maintain the head and neck in a neutral position, minimizing movement and preventing flexion caused by the child's proportionally larger head

Answer 50

Asthma Asthma Normal/Increased Intact alveolar surface area, increased capillary blood volume Obesity Normal/Increased Increased cardiac output/blood volume Polycythemia Vera Increased Increased red blood cell mass Alveolar Hemorrhage Increased Extra hemoglobin in alveoli binds CO Congestive Heart Failure (early/mild) Normal/Increased Increased capillary blood volume Pregnancy Normal/Increased Increased blood volume Chest Wall/NM Restriction Normal Lung parenchyma/vessels are normal

Answer 51

Obstructive pattern with reduced FEV1 Early - reduced FEV1 Late - reduced FVC = mixed

Answer 52

R wave Diastole is End of the T wave

Answer 53

The MRI angiogram is NOT appropriate as an ancillary test for brain death determination.

Answer 54

No difference with cancer recurrence ??? Reduction 12mo neuropathic pain as per APMSE

Answer 55

Peripheral Nerve Block (this is for analgesia)

Answer 56

None. MRC CRASH trial (Corticosteroid Randomisation After Significant Head Injury), a large, randomized, placebo-controlled study. Overview of the MRC CRASH Trial Participants: 10,008 adults with head injury and a Glasgow Coma Scale (GCS) score of 14 or less, enrolled within 8 hours of injury. Intervention: Patients received a 48-hour infusion of high-dose methylprednisolone (loading dose 2 g over 1 hour, followed by 0.4 g per hour for 48 hours). Control: Placebo infusion. Primary Outcomes: Death at 14 days; death or disability at 6 months. Mortality at 14 days was significantly higher in the methylprednisolone group (21.1%) compared to placebo (17.9%). At 6 months, mortality was also higher in the methylprednisolone group (25.7% vs. 22.3%).

Answer 57

No difference. Australian Surgical Antibiotic Prophylaxis (ASAP) Trial (2023) Design: Multicenter, double-blind, placebo-controlled trial. Population: Adults undergoing joint arthroplasty without known MRSA colonization. Intervention: Vancomycin (1.5g) + cefazolin vs. cefazolin + placebo. Outcome: The addition of vancomycin to cefazolin did not significantly reduce surgical-site infection (SSI) rates compared to cefazolin alone (SSI rate 4.5% in the combination group vs. 3.5% with cefazolin alone; relative risk, 1.28; 95% CI, 0.94–1.73; p=0.11). The combination was linked to a higher risk of hypersensitivity reactions, but a lower rate of acute kidney injury. Conclusion: For patients without MRSA colonization, routine addition of IV vancomycin to cefazolin does not reduce SSIs compared to cefazolin alone. In some subgroups (such as knee replacements), the infection rate was actually higher in the vancomycin group

Answer 58

(SBP) greater than 100 mmHg. The Brain Trauma Foundation guidelines specifically recommend maintaining SBP >100 mmHg for patients aged 50–69 years to decrease mortality and improve outcomes. For patients younger than 50 or older than 70, the recommended target is >110 mmHg

Answer 59

Ketamine is probably not safe. Thiopentone appears to be safest Safe: Propofol (short-term), sevoflurane, thiopentone, lidocaine, benzodiazepines, fentanyl/remifentanil, sugammadex Not safe/avoid: Ketamine, bupivacaine (especially epidural), high-dose/prolonged propofol, neostigmine, alpha-agonists, beta-blockers, high-dose tramadol

Answer 60

Answer 61

HTN. S4 = atrial contraction forcing blood into a stiff or non-compliant ventricle. Causes of S4 - LVH - IHD AMI - Hypertrophic cardiomyopathy - AS - Ageing - PHTN right sided S4 - Fibrotic or infiltrative cardiomyopathies (e.g., amyloidosis)

Answer 62

2min IV onset 30–60 seconds.

Answer 63

Protamine/Prothrombinex

Answer 64

4mg/kg 20kg × 4mg/kg = 80mg

Answer 65

Negative Experience with Healthcare Workers is likely the answer PREOT Risk Factors - Young age (preschool children) - Preoperative anxiety (child and parental) - Pre-existing behavioural issues (e.g., night terrors, poor coping) - Developmental delay or neurological disease - High ASA physical status/severity of illness INTRAOT Risk Factors - Surgery (Type of surgery (ENT, EYE), long duration of surgery) - Anaesthetic (Volatile, rapid Emergence) - Medications (Anticholinergics, Corticosteroids) - Blood transfusion (perioperative) POSTOP Risk Factors - Severe postoperative pain - Inadequate pain control - Emergence in a noisy or unfamiliar environment

Answer 66

Direct Thrombin Inhibitor It binds specifically and reversibly to both the catalytic site and the anion-binding exosite of thrombin, inhibiting its activity on both circulating and clot-bound thrombin.

Answer 67

Plateau pressure - PEEP Delta P = Pplat - PEEP

Answer 68

24 hours after restoration of spontaneous circulation in cases of acute hypoxic-ischaemic brain injury

Answer 69

Mode = tallest peak Median = b/w tallest peak and mean. Mean = furthest away from peak

Answer 70

Timing: Mid-diastolic Character: Low-pitched, rumbling Location: Loudest at the apex, best heard with the bell of the stethoscope Associated sounds: Loud S1, opening snap after S2, pre-systolic accentuation (if no atrial fibrillation) No radiation Duration increases with severity.

Answer 71

Lower oxygen saturation targets (88–92%) are specifically recommended for patients at risk of hypercapnic respiratory failure (such as those with COPD, obesity hypoventilation, bronchiectasis, neuromuscular disease, or chest wall deformity. For other acute medical conditions (including pneumothorax, carbon monoxide poisoning, asthma, stroke, and sickle cell disease), the recommended target is higher—usually 92–96% or 94–98%. Carbon monoxide poisoning can be an exception where the guideline is to give high-flow oxygen regardless of SpO₂, as pulse oximetry is unreliable in this context

Answer 72

Physostigmine is a tertiary amine, making it lipid-soluble and able to penetrate the BBB, which is why it is used to treat central anticholinergic toxicity. Edrophonium, neostigmine, and pyridostigmine are quaternary ammonium compounds; they are more polar, less lipid-soluble, and do not cross the BBB in significant amounts

Answer 73

100mA The minimum current (macroshock) required to elicit ventricular fibrillation is 100 mA (milliamperes). Microshock (direct to myocardium): as low as 0.05–0.1 mA (50–100 microamps). Macroshock (across the body): ~100 mA (much higher due to skin resistance and current path)

Answer 74

Equipotential earthing. Equipotential earthing ensures that all devices and conductive surfaces in the patient environment are at the SAME electrical potential, preventing small voltage differences that could drive dangerous microcurrents through intracardiac or intravascular lines. This is specifically recommended for cardiac (microshock) protection in areas where patients have direct conductive connections to the heart (e.g., central lines, pacing wires). - RCDs (Residual Current Devices) and Fuses primarily protect against MACROshock. - LIMS (Line Isolation Monitoring System) is designed to monitor and protect isolated power supplies, mainly for macroshock prevention.

Answer 75

Elbow flexion is most affected by musculocutaneous nerve block. - Shoulder abduction by deltoid, supraspinatus = Axillary nerve + suprascapular nerve. - Wrist extension by Extensor carpi radialis longus/brevis, extensor digitorum = Radial nerve. - Wrist flexion by Flexor carpi radialis, flexor carpi ulnaris = Median nerve (flexor carpi radialis) + ulnar nerve (flexor carpi ulnaris). - Forearm supination by Supinator, biceps brachii = Radial nerve (supinator) + musculocutaneous nerve (biceps brachii). Weakened

Answer 76

Hypothyroidism. Also SIADH can.

Answer 77

Diuretics Old question: independent risk factors for BCIS include all EXCEPT - diuretics - increasing age - male gender - severe cardiopulmonary disease - GA <- answer

Answer 78

Slow Infusion Rate. Risk Factor for extravasation injury: - Patient factors: Elderly, neonates/infants, reduced sensation, thrombosed veins, obesity. - Administration factors: High pressure infusion, bolus injection, central line misplacement. - Drug/Formulation factors: Vesicants, hyperosmolar / acidic / alkaline solutions, large volume / concentration/ - Other factors: Inexperienced staff, poor site selection, impaired local circulation

Answer 79

CTSx RF for Awareness: - Patient: Female sex, younger adults, obesity, previous awareness, difficult airway. - Anaesthetic/Provider: Junior anaesthetist, out-of-hours, emergency, NMB, thiopental, rapid sequence, interruptions. - Surgery: Obstetric (Caesarean), cardiac, thoracic surgery. - Timing/Phase: Induction and emergence phases (esp. with NMB or difficult airway) Caesarean section (obstetric surgery), with an incidence of accidental awareness around 1 in 670 cases. Cardiac surgery (cardiothoracic anaesthesia), with incidences similar to procedures involving neuromuscular blockade at about 1 in 8,600. Surgeries involving neuromuscular blockade, which significantly increase the risk of awareness, with an incidence of about 1 in 8,200.

Answer 80

Vertebrobasilar ischemia Retinal artery occlusion typically presents as sudden, painless, monocular vision loss. The pupillary reflex may remain intact if the lesion is distal enough not to affect the afferent limb of the reflex, or there may be a relative afferent pupillary defect if the entire retina is affected. Corneal abrasion usually causes painful vision loss and does not typically affect the pupillary reflex. Vertebrobasilar ischaemia can cause bilateral vision loss (cortical blindness), but this is often associated with other neurological signs and the pupillary reflex remains intact because the lesion is cortical, not ocular. ischemic optic neuropathy (ION), the pupillary reflex is typically abnormal in the affected eye. Specifically, a relative afferent pupillary defect (RAPD, also known as a Marcus Gunn pupil) is often present as long as the contralateral eye is normal. This finding reflects impaired conduction of the light reflex through the damaged optic nerve.

Answer 81

VWF 4-factor prothrombin complex concentrate (PCC), such as Beriplex, contains: - Factor II - Factor VII - Factor IX - Factor X - Protein C - Protein S

Answer 82

Factor 2. Cryo contains: fibrinogen, Factor VIII, Factor XIII, von Willebrand factor (vWF), and fibronectin

Answer 83

TR Carcinoid causes right-sided heart valve problems because the vasoactive substances (Serotonin, Histamine, Bradykinin, Prostaglandins) are inactivated in the lungs, protecting the left heart, while the right heart is exposed directly to these substances The predominant lesion is tricuspid regurgitation, followed by pulmonary stenosis and pulmonary regurgitation. - Classic Features of Carcinoid: crisis (Flushing, Bronchospasm, Hypotension/Hypertension, arrhythmia), RHF (TR/PS), diarrhea. - Triggers: induction, surgical manipulation of carcinoid tumour, stress, pain, hypercapnia, hypotension, catecholamine sux, morphine, ephedrine - Rx: Somatosatin analogue, fluid, EUC, ECHO, avoid histamine release, minimise triggers, monitor for delay crisis.

Answer 84

NOT EFFECTIVE Complete deficiency of VWF in Type 3.

Answer 85

Increase FGF Raising the fresh gas flow is the most effective and immediate intervention to reduce CO₂ rebreathing in a spontaneously breathing child on a Mapleson F circuit. If hypercarbia persists despite adequate FGF, then consider assisting ventilation, but the first step is always to optimize circuit flow. The Mapleson F system requires a fresh gas flow of 2.5–3 times the patient's minute volume during spontaneous ventilation to prevent rebreathing of carbon dioxide and thus avoid hypercarbia Weight=12 kg TV = 7 mL/kg × 12 kg = ~80 mL Respiratory Rate (RR) 25 breaths/min Minute Ventilation = 2L/min. Therefore requires 5–6 L/min or more for a 2-year-old. a. Increase FGF — Correct and first-line (per ANZCA, RCH, and standard texts). b. Paralyse patient — Not appropriate unless intubation/controlled ventilation is required. c. Assist ventilation — Correct only if there’s no spontaneous ventilation or it remains inadequate after increasing FGF, but increasing FGF always comes first. d. Salbutamol — Not relevant for CO2 retention due to rebreathing.

Answer 86

Reducing preoperative opioid use. Preoperative opioid use a risk factor for developing chronic post-surgical pain. Reducing opioids preoperatively can decrease this risk. Interventions such as regional anaesthesia, ketamine, and duloxetine are supported by evidence in APMSE 5th edition as strategies that can reduce the transition from acute to chronic post-surgical pain.

Answer 87

220mmHg The BJA and SNACC reference the 2013 AHA/ASA Guidelines, which recommend permissive hypertension up to 220/120 mmHg in acute ischaemic stroke patients who are not candidates for reperfusion therapy (thrombolysis or ECR). Stroke without thrombolysis/ECR: permissive hypertension allowed up to ~220/120 mmHg. In contrast, patients who have received thrombolysis or ECR have stricter targets, generally aiming for an upper SBP limit of 180–185 mmHg before treatment, and often less than 140–160 mmHg after reperfusion to reduce hemorrhagic risk

Answer 88

Serum separating tube (SST) [or gel tube (gold top)] EDTA, sodium citrate, and sodium heparin tubes are not recommended for tryptase collection. Note at MMH a green top (sodium heparin) tube is accepted and I believe is in the anaphylaxis kit.

Answer 89

Teicoplanin

Answer 90

Decrease RR Decreasing the respiratory rate increases expiratory time, helping to prevent air trapping and intrinsic PEEP (auto-PEEP), which are the hallmarks of breath stacking in COPD/emphysema

Answer 91

Pulmonary contusion. VV ECMO is indicated for severe respiratory failure that is refractory to optimal mechanical ventilation and medical therapy, including conditions such as ARDS, pneumonia, aspiration, and pulmonary contusion. Pulmonary hypertension is a contraindication for VV ECMO, and septic shock (especially with cardiac dysfunction) would require VA ECMO, not VV ECMO

Answer 92

Maternal Mortality Robust evidence shows that antenatal corticosteroids reduce neonatal mortality, perinatal mortality, and the risk of premature respiratory disease (such as respiratory distress syndrome) in preterm infants

Answer 93

“Children are considered to be at risk for PONV from 3 years of age.”

Answer 94

Cyclizine may be used with caution if necessary, but is not first-line. Domperidone is the preferred antiemetic where available. Apomorphine - dopamine agonist - Ondansetron: risk of profound hypotension and LOC - Metoclopramide: worsens motor parkinsonism due to dopamine antagonism. - Cyclizine: note may increase CNS depression; limited data. - Droperidol - dopamine antagonist; may antagonize apomorphine and worsen parkinsonism. If asked about Levodopa - Domperidone and Ondansetron safe - Metoclopramide, Prochlorperazine, Promethazine, Chlorpromazine, Droperidol are not safe

Answer 95

30 seconds

Answer 96

a. Naproxen Piroxicam > Ketorolac > Indomethacin > Naproxen > Diclofenac > Meloxicam > Ibuprofen > Celecoxib GI Toxicity: As noted earlier, naproxen has the highest risk of GI ulceration, followed by diclofenac and meloxicam with intermediate risk, while ibuprofen has the lowest GI risk profile. This aligns with their COX selectivity and systemic effects. Cardiovascular Risk: Some NSAIDs, notably diclofenac and higher-dose naproxen, carry a higher risk of cardiovascular events compared with ibuprofen, which generally has a more favorable cardiovascular profile. Meloxicam, as a preferential COX-2 inhibitor, also has an intermediate cardiovascular risk.

Answer 97

Myocardial Ischemia Also, CAD - LAD, HTN, Aortic/Mitral valvular disease, hypertrophy cardiomyopathy, and hyperthyroidism. Hypokalemia: Characteristically causes large, upright U waves, not inverted ones.

Answer 98

Uncontrolled HTN - not in RCRI

Answer 99

c. Supine to sitting Platypnea and Orthodeoxia (hypoxemia in upright) Related to intrapulmonary shunts (vasodilated pulmonary vessels)

Answer 100

Warfarin (Prothrombin time, not thrombin time)

Answer 101

Hypernatraemia 20% albumin is hypertonic

Answer 102

Desflurane > isoflurane > nitrous oxide > sevoflurane. Desflurane has the highest GWP (2540), followed by isoflurane (539), nitrous oxide (273), and sevoflurane (144

Answer 103

Answer 10 years Probably. Age of 4 years is discussed but felt to be inappropriate due to the large amount of muscle needed. Most guidelines say to wait until 10 years

25.1 Flashcards

(146 cards)