1
Q
When can prophylactic clexane be given post epidural catheter removal
a) 2 hrs
b) 4 hrs
c) 6hrs
d) 12hrs
e) 24hrs
A
4 hours as per ASRA
2
Q
Temperature measurement during cardiopulmonary bypass - ?most accurate
A) Nasopharynx
B) Oxygenator arterial outlet
C) Oxygenator venous inflow
D) Bladder temp
E) PA Cath
A
B
The oxygenator arterial outlet blood temperature is recommended to be used as a surrogate for cerebral temperature measurement during cardiopulmonary bypass (CPB). (Class I, Level C)
https://pmc.ncbi.nlm.nih.gov/articles/PMC4631211/
3
Q
Giving DDAVP to VWD type 3
a) No effect
b) If they’ve had a positive challenge test
A
No effect
4
Q
Transition from acute to chronic postsurgical pain
A
Risk factors:
Female
High BMI
Poor education
Preoperative pain and opioid use
Psychological vulnerability
Workers compensation
Nerve damage
Acute postoperative pain especially day 5
Radiotherapy and chemotherapy
Postoperative complications
5
Q
Parkinson’s patient on apomorphine infusion what is the most appropriate antiemetic?
a) Ondansetron
b) Droperidol
c) Metoclopramide
d) Cyclizine
e) Another dopaminergic drug
A
D - cyclizine
Apomorphine is a dopamine agonist
Avoid anti-dopamine drugs (droperidol, metoclopramide)
Concomitant use of ondansetron and apomorphine can result in profound hypotension
6
Q
What has the most favourable number needed to treat (?for post op pain)
a) Paracetamol
b) Paracetamol + codeine
c) Paracetamol + ibuprofen
d) codeine
e) ibuprofen
A
7
Q
Role of ECG in timing of intra-aortic balloon counterpulsation
A
Inflate T wave
Deflate R wave
8
Q
Best NNT for prevention of post amputation pain
a) neuraxial
b) peripheral catheter
c) ketamine
d) gabapentinoid
A
Acute Pain Evidence
Epidural NNT 5.8
Gabapentin ineffective
9
Q
Child in ED needs procedural sedation. Unable to get IV access - What is the IM dose of ketamine?
1
2
3
4
5mg/kg
A
5mg/kg ketamine dart RCH premedication guidelines
RCH IV sedation guidelines state initial dose 4mg/kg, maximum 6mg/kg
https://www.rch.org.au/clinicalguide/guideline_index/Ketamine_use_for_procedural_sedation/
10
Q
Suxamethonium peak IM onset time?
30sec
1min
2min
4min
5min
A
2 minutes
2-3 mins stated by data sheet
https://www.medsafe.govt.nz/profs/datasheet/s/suxamethoniumchlorideinjmax.pdf
11
Q
Nerve topicalised between epiglottis and VC
A
a) Internal branch of superior laryngeal nerve
12
Q
Analgesia for sternal fracture
A
PECS II
13
Q
Fibrinogen replacement during postpartum haemorrhage, what level to aim? vs below what level do you replace fibrinogen?
A
2g/L
14
Q
Max safe ropivacaine dose in adults
450mg
650mg
770mg
1080mg
A
15
Q
ANZCA endorsed guideline of GLP-1 perioperative management
a) Do not cease periop and treat as unfasted
b) Cease 4 week
c) Cease 1 week
d) Various other options
A
Do not cease
24 hour clear fluid diet
16
Q
How to prevent microschock
a) Equipotential earthing
b) LIM
c) RCD
d) Fuse
A
Equipotential earthing
17
Q
Intralipid dose/max dose?
A
12mL/kg
18
Q
Fluid status in children
A
19
Q
Minimum current for VF macroshock
A
a) 100 mA
20
Q
Image of an abnormal capnogram trace
a) ETT cuff leak
b) Gas analyser partial disconnection
c) Unilateral lung transplant
d) Spont breathing during PPV
A
21
Q
Management of a can’t intubate, can’t oxygenate (CICO) scenario: when you inflate for 2sec breath, how frequently do you cycle breaths?
A
20sec
22
Q
Diabetes ANZCA document - which DOES NOT require a higher control of BGL 10 +- 2.5
a) Autonomic dysreflexia
b) Older than 75 years
c) Pregnancy
d) Hypo unawareness
A
C
BSL control in pregnancy should be tighter - 4-6mmol/L
23
Q
Drugs affecting defibrillation threshold
A
Amiodarone, lignocaine, verapamil, venlafaxine, anaesthetics
https://pubmed.ncbi.nlm.nih.gov/18370441/
24
Q
Young male burns first 24hrs (similar to previous year different options). Which of the following expected
a) Increased cardiac index
b) Inc stroke volume
c) Reduced PVR
d) Increased hepatic blood flow
e) Reduced SVR
A
?none
25
Drug dosing in a morbidly obese patient
LBW - propofol induction, thiopentone, fentanyl, alfentanil, morphine, NDMRs, paracetamol, LA
ABW - propofol infusion, neostigmine, sugammadex, antibiotics
TBW - suxamethonium, LMWH
LBW plateaus at 100kg for men, 70kg for women
IBW = height - 100cm in men, -105 in women
ABW = IBW + 40% of excess weight
SOBA UK
26
ECG with complete heart block
27
Clinical features in carcinoid heart disease
MR
AR
TR
MS
AS
TR
Vasoactive substances cause deposition of fibrous tissue around endothelial surfaces, especially of the right heart
thickened triscuspid and pulmonary valves
enlarged right atrium and ventricle
left sided lesions in 15%
https://www.ahajournals.org/doi/10.1161/circulationaha.107.701367
28
Postoperative visual loss painless with intact pupillary reflex is due to
a) vertebrobasilar ischaemia
b) posterior ION
c) retinal detatchment
d) corneal abrasion
Answer is A
Pupil reflex is intact in cortical blindness
ION is painless
Anterior ION has optic disc oedema and flame shaped haemorrhage
Posterior ION often has no abnormal opthalmoscopic findings
Retinal artery thrombosis shows "cherry red spot" and retinal pallor on fundoscopy
PION, AION, CRAO have absent or abnormal pupil reflexes
Retinal detachment has abnormal RAPD
Corneal abrasion does not cause vision loss
https://www.bjanaesthesia.org.uk/article/S0007-0912(17)34945-0/fulltext
https://www.openanesthesia.org/keywords/postoperative-visual-loss/
https://www.ncbi.nlm.nih.gov/books/NBK580561/
https://www.ncbi.nlm.nih.gov/books/NBK560626/
29
qSOFA score
Lactate
GCS
PF ratio
Bili
Plt
GCS < 15, SBP < 100, RR > 22
30
Hyperbaric o2 therapy
31
In brain death testing, which is NOT a method of imaging?
a) Intracerebral arterial catheter
b) Radionucleotide scan
c) CT angio
d) MRI
D) MRI
The three acceptable imaging techniques for demonstrating absent brain perfusion are intra-arterial catheter
angiography, radionuclide imaging and computed tomography angiography (CTA).
https://www.anzics.org/wp-content/uploads/2022/04/ANZICS-Statement-on-Death-and-Organ-Donation.pdf
32
Conns syndrome what happens to glucose, Na and K
Conn's syndrome is primary hyperaldosteronism.
Hence retain sodium, excrete potassium.
There is impaired glucose tolerance due to impairment of insulin secretion by hypokalemia, so glucose rises .
33
Management of an inadvertently placed central line in the carotid artery
Leave it in and call vascular surgery
34
Arndt blocker- which port does the bronch go down? Diagram provided
diagonal one
35
Medical air - what colour is the cylinder?
a) White body with black and white shoulder
36
Which one is NOT a risk factor for cardiac adverse events?
Uncontrolled HTN
Prev Hx cardiac failure
IHD
DM
CKD
Probably uncontrolled hypertension?
RCRI includes cardiac failure, ischemic heart disease, diabetes and renal failure
37
Methylprednisolone dose in TBI
0mg/kg
5mg/kg
10mg/kg
15
20
0mg/kg
The use of steroids is not recommended for improving outcome or reducing ICP. In patients with severe TBI, high-dose methylprednisolone was associated with increased mortality and is contraindicated.
https://braintrauma.org/coma/guidelines/severe-tbi
38
Takotsubo cardiomyopathy: What % of Takostubo CM patients fully recover to normal LVEF?
a) 10%
b) 20%
c) 50%
d) 75%
e) 90%
Probably high - 90%
This article states 96%
https://pmc.ncbi.nlm.nih.gov/articles/PMC7175432/#:~:text=Conclusion,recuperates%20in%203%2D4%20weeks.
39
Internal defibrillation
Maximum joules?
50J
https://www.mindray.com/content/dam/xpace/en_gb/resources/downloads/education/education-d3/Internal-Defibrillation-Paddles-Instructions-for-Use.pdf#:~:text=When%20internal%20paddles%20are%20used%20for%20defibrillation%2C,of%20possible%20cardiac%20damage%20from%20higher%20energies.
40
Lady having a vag hysterectomy her Dpp4i should be
a) Stopped due to hypoglycaemia
b) Stopped due to impaired gastric emptying
c) Stopped due to eDKA
d) Continued
A?
ANZCA ADS guidelines state - no hypoglycemia. Impaired gastric emptying not mentioned.
All oral diabetic meds should be stopped day of surgery
41
CXR showing valve replacement , which one is it? (there were two valves, it was pointing to the AV)
a) Aortic valve
b) Mitral valve
c) Pulmonary valve
d) Tricuspid valve
https://radiopaedia.org/cases/cardiac-valve-positions-on-chest-radiography
42
STOP-Bang
1 for each of:
Male
BMI > 35
Neck circumference > 40
Excessive daytime sleepiness
Snoring at night
Stops breathing at night
Hypertension
Age > 50
Low risk 0-2
Intermediate risk 3-4
High risk 5-8
http://www.stopbang.ca/osa/screening.php
43
Lambert-Eaton myasthenia syndrome is associated with
a) Increased vs decreased sensitivity and iterations to non depolarising and depolarising NMB
LEMS - Antibodies attack presynpatic calcium channels -> reduced calcium influx -> reduced acetylcholine release
44
What is the duration of action of carbetocin?
a) 1 hrs
b) 2 hrs
c) 3hrs
d) 4hrs
e) 5hrs
1 hour
https://www.tga.gov.au/sites/default/files/auspar-carbetocin-180823-pi.pdf
45
A nerve that does not provide sensory innervation to the shoulder joint is the
Axillary
Lateral Pectoral
Subscapular
Supraclavicular
Suprascapular
The lateral pectoral is a motor nerve for the pec major?
Axillary -lateral shoulder cutanoeus
Supraclavicular - cutaneous superior cape of shoulder
Suprascapular - sensory innervation to the glenohumeral and acromioclavicular joints
Subscapular - shoulder joint
https://www.jshoulderelbow.org/article/S1058-2746(20)30610-8/abstract
46
What is the likelihood of a p value equal to or greater than 0.05 for a study repeated with exactly the same conditions and same sample size that produced a p value of 0.05?
5%
20%
50%
80%
95%
95% as per google AI and reddit thread
47
Which risk factor is the LEAST associated with extravasation of vasopressor?
a) elderly
b) neonate
c) low infusion rate
d) drugs below pH 5.5
e) diabetes
C Low infusion rate
Extremes of age, drugs outside pH of 5.5-8.5, diabetes (peripheral neuropathy) are risk factors
https://www.bjaed.org/article/S2058-5349(22)00143-3/fulltext
https://www.bjaed.org/article/S1743-1816(17)30212-3/fulltext
Other risk factors include skin and vein fragility, impaired venous return, communication impediment, cannula distal to previous puncture site, fook/ankle/ACF, previous radiation or surgery over site, after lymph node clearance, non-visible site, power injectors, high infusion rate
48
Diagram: Identify nerve
49
A level 2 check of the inhalational anaesthesia delivery device does NOT include checking the...
accurate delivery of volatile concentration from vaporiser
50
Obesity in pregnancy
51
Refeeding syndrome
52
Medical gas pipeline system
53
Nerve stimulator to posterior cord what would you expect
a) Weakness elbow flexion
b) Weakness elbow extension
c) Weakness wrist extension
d) Wrist flexion
e) Thenar eminence
The posterior cord gives rise to the radial nerve and axillary nerve.
The radial nerve innervates the triceps and extensor muscles of the forearm, which would cause extension at the elbow, wrist and fingers.
54
Patient on chronic daily oral hydromorphone 12mg, what is an appropriate daily parenteral morphine dose
a. 5
b. 10
c. 15
d. 20
e. 25mg
D 20mg
PO hydromorphone 12mg = 12*5mg PO morphine
60mg PO morphine = 60/3mg IV morphine
PO Hydromorphine to PO morphine - times 5
PO morphine to IV morphine - divide by 3
55
Carbon monoxide poisoning
56
Glenn shunt anatomy
Second stage of conversion to Fontan circulation
SVC is anastomosed to the right pulmonary artery
Fontan is completed when IVC is connected to right pulmonary artery
(First stage is a Blalock Taussig shunt, where the subclavian artery is connected to the right pulmonary artery)
57
Least likely to affect thrombin time
a) Bivalirudin
b) Dabigatran
c) Warfarin
d) Clexane
e) Heparin
E - heparin
Thrombin time is the extrinsic pathway - factors VII, II
Bivalirudin is a direct thrombin inhibitor
So is dabiagran
Warfarin affects factors 2, 7, 9 and 10
Heparin can inhibit thrombin with a longer chain
Clexane only mainly affects factor X
58
Addition of vancomycin to cephalozin effect on SSI?
a) Reduce by 20%
b) Reduce by 40%
c) No change
d) Increase by 20%
e) Increase by 40%
C- no change as per
https://www.nejm.org/doi/full/10.1056/NEJMoa2301401
https://pmc.ncbi.nlm.nih.gov/articles/PMC10924330/
The addition of vancomycin to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections in arthroplasty among patients without known MRSA colonization.
59
Which causes the most gastric ulceration?
a) Naproxen
b) Ibuprofen
c) Diclofenac
d) Ketorolac
e) Indomethacin
Indomethacin has the greatest effect on COX-1 here
https://www.researchgate.net/figure/Relative-COX-1-COX-2-selectivity-of-various-nonselective-NSAIDs_fig2_259722202
60
Showing a modern chest drain, what do the numbers 1-5 represent
a) Severity of air leak
b) Suction
c) Intrapleural pressure
Severity of air leak
61
Physical characteristics of laryngeal mask airway
62
Supraventricular tachycardia in a child
RCH adenosine dosing
1st 100microg/kg max 6mg
2nd 200microg/kg max 12mg
3rd 300microg/kg max 12mg
Max cumulative dose 30mg
63
Intraosseous blood sample correlation
Good agreement for pH, glucose, lactate, Hb, Hct
Potassium, BE, bicarbonate higher in IO
Sodium and ionised calcium slightly lower in IO
64
Amiodarone dose 20kg child
a) 100 mg
65
Paediatric ?svt has a pulse but haemodynamically stable how many joules for synced shock
a) 1
b) 2
c) 4
d) Other options
RCH guideline
first dose 1J/kg
second dose 2J/kg
66
Anzca open disclosure framework purpose includes all except
a) Explain to patient
b) Patient gets to be heard
c) Opportunity to satisfy medic legal requirements
d) Other reasonable sounding options
C
67
What is not in beriplex?
a) Factor 7
b) Factor 10
c) Factor 2
d) Protein S
e) VWF
E - VWF
Beriplex contains:
2,7,9,10,C,S
https://www.cslbehring.com.au/-/media/cslb-australia/documents/aus-pis-and-cmis/beriplex-pn-cmi-600.pdf
68
Driving pressure guided ventilation
Driving pressure = P-plateau - PEEP = static compliance * tidal volume
Titrate PEEP for lowest driving pressure
69
You have been managing a case of malignant hyperthermia in an 80 kg man and have given a total of 400 mg of dantrolene (Dantrium). The amount of mannitol you have also administered is
a. None
b. 1.6g
c. 12g
d. 40g
e. 60g
60mg
There are 3g of mannitol in each 20mg ampoule of dantrolene (DANTRIUM)
https://www.mhaus.org/healthcare-professionals/be-prepared/what-should-be-on-an-mh-cart/
There is 0.125mg of mannitol in one ampoule of ryanodex (250mg)
70
A person with allergy to mammalian beef will most likely to be allergic to
a) Factor 7
b) Protamine
c) Heparin
d) Clexane
e) Bivalirudin
C Heparin
https://pmc.ncbi.nlm.nih.gov/articles/PMC8019687/
71
In hyperkaelamia, when does the maximum effect of 10mg nebulised salbutamol occur?
a) 5min
b) 15min
c) 30min
d) 4hrs
30min as per RCH guidelines
https://www.rch.org.au/clinicalguide/guideline_index/hyperkalaemia/
72
US picture superficial cervical plexus - what will result
a) Anterolateral neck numbness
b) Carotid sheath analgesia
c) Phrenic nerve palsy
A
73
Management of cardiac arrest secondary to tricyclic antidepressant overdose
Sodium Bicarbonate 1-2mmol/kg
Every 1-2min until max 6mmol/kg if VF
Hyperventilate
3% NS for Na of 155mol/L
Lignocaine 1mg/kg if above ineffective
Intralipid
VA ECMO
Defibrillation likely ineffective
https://litfl.com/tca-toxicity/
74
Image: Pressure-volume loop
75
Leucodepletion of blood products
Removes
granulocytes
lymphocytes
Advantages
Reduced TRALI, febrile non-haemolytic reactions, storage lesions, GVHD, CMV, CJD, alloimmunisation to class I HLA
https://derangedphysiology.com/main/required-reading/haematology-and-oncology/Chapter-306/leukodepleted-blood-products
76
Bone cement implantation syndrome
BCIS is characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery.
*
Grade 1: moderate hypoxia (Spo2<94%) or hypotension [fall in systolic blood pressure (SBP) >20%].
*
Grade 2: severe hypoxia (Spo2<88%) or hypotension (fall in SBP >40%) or unexpected loss of consciousness.
*
Grade 3: cardiovascular collapse requiring CPR.
77
Graph of days in hospital vs frequency three lines needed to identify the mode mean and median
78
PONV is increased in paediatrics greater than or equal to
a) 1
b) 2
c) 3
d) 4
e) 5
3 years
79
Management of torsades with a pulse
a) Shock
b) Magnesium
2g Mg slow IV push
1-4g/hr infusion
Maintain Mg > 2mmol/L
Stop if Mg > 3mmol/L
https://www.ncbi.nlm.nih.gov/books/NBK459388/
80
Pharmacology of SGLT2 inhibitors
reduce glucose reabsorption by 30% to 60%, lower the renal threshold for glucose, and increase urinary glucose excretion, leading to an average hemoglobin A1c (HbA1c) reduction of 0.5% to 1.0% in patients with T2DM
81
Lung function test Low FEV1, normal FVC and normal DLCO
asthma
82
Minimum weight for a microcuff ETT
a) 1 kg
b) 3 kg
c) 5 kg
3kg for 3mm ID Microcuff ETT for term to <8months
https://www.anestesiar.org/wp-content/uploads/2012/04/Microcuff-Paed-Endo-Tube.pdf
83
Lateral neck XR
a) Axis
b) Atlas – posterior tubercle
84
Breast surgery: GA with volatile vs TIVA with regional
a) neuropathic pain reduced 6 mo / 12 mo
b) reduced scar pain 6 mo
c) no difference
d) reduced cancer recurrence
C No difference in cancer recurrence, frequency and severity of persistent breast pain
https://pubmed.ncbi.nlm.nih.gov/31645288/
Recurrence of breast cancer after regional or general anaesthesia: a randomised controlled trial
85
What is the youngest age for caffeine muscle biopsy testing for MH?
a) 2yo
b) 4yo
c) 8yo
d) 10yo
e) 12yo
10 years of age
https://malignanthyperthermia.org.au/information-for-patients
86
Management of severe traumatic brain injury
Steroids not recommended
SBP > 110mmHg ages 15-49 and > 70yo
SBP > 100mmHg ages 50-69
Secondary decompressive craniotomy recommended for late, but not early refractory ICP elevation
Hypothermia, prolonged hyperventilation not recommended
Feed by at least fifth day
Treat ICP above 22mmHg
Maintain CPP between 60-70mmHg
Jugular venous saturation > 50%
https://braintrauma.org/coma/guidelines/severe-tbi
87
Which condition can you not give indocyanine green?
a) porphyria
b) methhaemaglobin
c) G6PH
88
Which arterial line most likely to reflect coronary sinus in VA ECMO
a) Right radial artery
89
Characteristics of Manujet III jet ventilation system
Trigger
Gauge
Connecting tube 100cm long with luer lock
Adjustable pressure regular between 0 and 3.5 bar
Attachment for pressure hose
90
Core body temperature
91
How many hospitalizations to be classified GOLD E?
a) 1
b) 2
c) 3
d) 4
e) 5
A
Gold E requires 2 or more moderate exacerbations, or 1 or more exacerbations leading to hospitilisation per year
Gold A or B - 0 or 1 moderate exacerbations per year
Gold A - nMRC (dyspnoea scale) 0-1 or CAT < 10 (symptom severity scale)
Gold B nMRC 2 or more, CAT > 10
92
What is the systolic blood pressure for intervention for an ischaemic stroke which has not had lysis or clot retrieval (did not comment if intervention was for increased or decreased BP)
a) 140
b) 160
c) 180
d) 200
e) 220
Lower BP 185/110 before thrombolysis
https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.036143
If not treated with tPA, permissive hypertension unless blood pressure markedly elevated > 220/120
If haemorrhagic - lower SBP target to 140
During mechanical thrombectomy, target SBP > 140 and MAP > 70, SBP < 160
After mechanical thrombectomy, target SBP < 160 and MAP < 90
https://pmc.ncbi.nlm.nih.gov/articles/PMC10061853/
93
Pt is on fluoxetine, which drug has LOWEST risk of serotonin syndrome?
tramadol
oxycodone
morphine
fentanyl
pethidine
Probably oxycodone, though there are case reports of oxycodone interacting to cause serotonin syndrome
Morphine may stimulate the release of serotonin by a disinhibitory mechanism
https://www.bjanaesthesia.org.uk/article/S0007-0912(19)30632-4/fulltext
On the other hand, both fluoxetine and oxycodone are metabolised by CYP2D6, so they would compete there.
94
ANZCA guidelines for intraoperative BP measurement
Blood pressure monitoring should be no less frequent than 10 minutely
95
Lung anatomy
96
Brugada syndrome - which drug is safe?
a) Propofol
b) Ketamine
c) Lignocaine
d) Amiodarone
e) Thiopentone
Propofol pro-arrythmogenic
Lignocaine is a sodium channel blocker whilst Brugada is a sodium channelopathy but seems to be safe
https://pmc.ncbi.nlm.nih.gov/articles/PMC10435784/\
Ketamine can cause brugada like ECG but at much higher levels
Thiopental - no problems reported
Amiodarone is contraindicated
97
Postoperative implications in myasthenia gravis
98
A new antiemetic drug ‘X’ is being evaluated. The percentage of patients who suffered postoperative nausea and vomiting (PONV) after administration of either the drug ‘X’ or placebo is as follows: percentage of patients with PONV after drug X = 20%; percentage of patients with PONV after placebo = 25%. The number needed to treat (NNT) is
a. 5
b. 20
c. 22.5
d. 25
e. 45
Absolute risk reduction = 0.25-0.2 = 0.05
NNT = 1 / ARR
= 20
Thus B
99
Topicalisation for paeds AFOI
a) Variety of doses based on provided weight, up to 9 mg/kg
100
Mast cell tryptase testing
Immediately, 1 hour, 4 hours, 24 hours
101
Oral bioavailability of ketamine
a) 10%
b) 20%
c) 40%
d) 80%
B 20%
102
Pin index system for oxygen
a) 1,5
b) 2,5
c) 3,5
d) 1,6
Oxygen 2,5
103
What nerve supplies this? Picture of back of calf with bit coloured in.
a) Sural
b) Deep peroneal
c) Superficial peroneal
d) Lateral cutaneous nerve of the calf
e) Saphenous
Saphenous medially
Lateral sural nerve
104
Emergence delirium is increased by all of the following except
a) younger age
b) parental anxiety
c) bad interaction with medical professionals
d) volatile anaesthetic
A
Emergence delirium affects children aged two to ten years old, babies and teenagers are generally not affected
https://www.rch.org.au/kidsinfo/fact_sheets/Emergence_delirium/
105
?benchmarking
a) Acting
b) Doing
c) Planning
d) Benchmarking
e) Checking
106
Revised Trauma Score (RTS)
The revised trauma score has three parameters - GCS, SBP and RR
Scores 0-4 for each; with worse parameters leading to a lower score
107
Global warming potential of inhalation anaesthetic agents
Lifetimes
N2O 120 years
Isoflurane 3.2 years
Desflurane 14 years
Sevoflurane 1.1 years
GWP100
Des 2540
Iso 539
N2O 273
Sevo 144
GWP100 = equivalent to 1kg of CO2 in the atmosphere for 100 years heating
Doesn't account for amount of agent used
108
Indication for VV ECMO
a) pulmonary contusion
b) pulmonary htn
c) right heart failure
pulmonary contusion
109
Location of erector spinae block / clinical anatomy related to uss guided ESPB
a) anterior erector spinae posterior to tp t5
110
What foramen does the LA go through for sphenopalatine block?
a) Greater palantine foramen
b) Lesser palantine foramen
Greater palatine foramen
https://www.ncbi.nlm.nih.gov/books/NBK557751/
111
prev remembered stems from other ECG qs:
a) Atrial fibrillation
b) Lown-Ganong-Levine (LGL) Syndrome
c) Previous Myocardial Infarction
d) Wolf-Parkinson White Type B
d) Left Ventricular Hypertrophy
112
Arterial oxygen saturation targets
113
Fourth heart sound
Low pitched sound coincident with late diastolic filling due to atrial contraction - shortly before first heart sound.
Indicates increased resistance to filling of ventricle due to reduced compliance and increased LVEDP
Can also be heard in anemia, thyrotoxicosis, acute MR, acute MI
Conditions that cause reduced compliance - AS, HOCM, HTN
https://www.ncbi.nlm.nih.gov/books/NBK344/
114
Bivalirudin mechanism of action
a) Direct thrombin inhibitor
b) Factor xa inhibitor
c) Factor 2a inhibitor
Direct thrombin inhibitor
A and C are the same? ?
115
In NAP which drug most likely to cause anaphylaxis
a) Teicoplanin
116
cryoprecipitate
Contains
Fibrinogen
Factor 8
vWF
Factor 13
Fibronectin
117
Effect of drugs on methadone efficacy
Methadone is metabolised by CYP3A4
Carbamazepine, phenytoin, rifampicin and SJ Wort are inducers
Fluoxetine, antifungals, HIV1 protease are inhibitors
https://www.bjaed.org/article/S2058-5349(17)30087-2/fulltext
118
How to avoid gas-trapping with COPD during PPV
a) Decreased RR
b) Reduce TV
c) Increase inspiratory time
Decrease RR
119
(Gastric ultrasound image) shows:
a) Fluid less than 100
b) Fluid over 100ml
c) Late stage solid
d) Early stage solid
https://www.gastricultrasound.org/en/extra-material/image-gallery/
120
Opioid-induced ventilatory impairment
Modifiable, avoidable risk factors for sedation and respiratory depression (OIVI) include:
* Use of more than one opioid analgesic at a time
* Use of modified release oral and transdermal opioid analgesics
* Use of continuous opioid analgesic infusions
* Continued administration of opioid analgesics to treat pain that is not responding to opioid analgesics
* Co-administration of central nervous system (CNS) depressants such as benzodiazepines and other sedative hypnotics, barbiturates, gabapentinoids, alcohol and recreational drugs
Obesity, sleep disordered breathing, COPD, renal disease, cardiac disease, neurological disorders, ASA 3-4, age > 65 years
https://www.nps.org.au/assets/NPS/pdf/NPSMW2447_Safe_Use_Opioids_Surgery.pdf
121
Addisonian crisis what happens to glucose, Na and K
Hyponatremia, hyperkalemia, hypoglycemia
122
Shortness of breath in hepatopulmonary syndrome
Worse when erect due to increased shunt due to redistribtion of blood flow to dependent regions where shunt occurs due to vasodilating effects of liver vasoactives
123
Corticosteroid administration in anticipated preterm birth
When gestational age is 34 weeks and 6 days, or less.
When preterm birth is planned or expected within the next seven days, even if birth is likely within 24 hours
Regardless of the reason the woman is considered at risk of preterm birth.
Optimal timing is when birth is planned within the next 48 hours
Betamethasone 24mg in divided doses, completed between 12 and 36 hours
Dexamethasone 24mg in divided doses, completed between 24 and 40 hours
6mg, 12 hours apart
Repeat dose not less than 7 days following single course
when gestational age is 32 weeks and 6 days or less
124
Data set (something like the picture, not exact). What is the most appropriate method for analysis
a) Logistic regression
b) Pearson correlation
c) Spearmans rho
Some other options....
Logistic regression - creates a model for a discrete outcome against an indepedent, continuous variable
eg. pass/fail exam against hours studied
pearson correlation - between two continuous variables, must be linear relationship. parametric.
spearmans rho - strength and direction of association between two ranked variables, used when linear assumptions don't hold
assumes monotonic - consistently increasing or decreasing
non-parametric
125
Which leads to something DLCO
a) Sarcoidosis
b) Asthma
c) Obesity
d) Anemia
asthma, obesity, polycythemia and left to right shunts cause higher DLCO
Sarcoid and anemia cause lower DLCO
126
Intraoperative cell salvage
127
Dose of FFP to raise the fibrinogen by 1.0
a) 30 mL/kg
128
Hyponatremia
129
Diagram: Auscultation of heart sounds
130
C spine injury in a child
History of conditions known to predispose to CSI
Previous cervical spinal surgery
Trisomy 21
Osteogenesis imperfecta, Achondroplasia
Other rheumatological, genetic or metabolic conditions
131
What is an appropriate dose/volume for a caudal for an orchidopexy for a 2yr old
a) Options were in mL/kg based on weight
Bupivacaine 0.25%
0.5mL/kg for sacrolumbar block
1.0mL/kg for abdominal block
132
Testing for brain death after return of spontaneous circulation
Should be delayed at least 24 hours after acute hypoxic-ischemic encephalopathy or post cardiac arrest
133
Anaphylaxis management in a child
Paediatric anaphylaxis doses
IM adrenaline 10microg/kg or 0.01mL/kg of 1:1000 (RCH)
(ANZCA)
<6 years = 150microg (0.15mL of 1:1000)
6-12 years = 300 microg (0.3mL of 1:1000)
Q5min
IV
1mg in 50mL
0.1mL/kg (2microg/kg) q1-2min for moderate anaphylaxis
0.2-0.5mL/kg (4-10microg/kg) for life threatening anaphylaxis
Infusion 0.3mL/kg/hr, titrate to max 6mL/kg/hr of 20microg/mL solution
134
ECG
a) Acute coronary syndrome
b) LVH
c) HOCM
135
Patient on 100mg tramadol BD what is the oral morphine equivalent
a) 10mg
b) 20mg
c) 30mg
d) 40mg
e) 50mg
Tramadol * 0.2 = PO morphine
Thus 20mg.
136
Pulmonary function test in cystic fibrosis
Generally obstructive
https://www.bjaed.org/article/S1743-1816(17)30191-9/fulltext
137
How to quickly reduce CO2 in a mapleson F with a FGf of 3L/min
a) Increase ventilation
b) Remove filter
c) Increased FGF
C
High fresh gas flows 2.5-3x minute volume required to prevent rebreathing
After expiration fresh gas flow pushes expired gases back into the bag and out the end
138
Anatomy of the brachial plexus
ulnar nerve
139
Transjugular intrahepatic portosystemic shunt (TIPS)
Useful for refractory ascites and variceal bleeding
Contraindicated in heart failure, severe TR, severe pulmonary hypertension, sepsis, biliary obstruction, hepatic cysts
Encephalopathy occurs in 20% of patients after TIPS
140
Human albumin 5%
Osmolality 258mOsm/kg - mildly hypo-oncotic
Na 140mmol/L - isotonic
pH 6.7-7.3
4mmol sodium acetyltryptophanate and 4mmol of sodium octonoate
Chloride
https://www.tga.gov.au/sites/default/files/auspar-albumin-human-170502-pi-01.pdf
141
Ventilation strategy in an adult with Fontan circulation
Spontaneous if possible
Low respiratory rate, short inspiratory time, low PEEP, tidal volume 5-6mL/kg
But need to maintain normocarbia.
142
Correct prophylaxis for instrumental delivery to protect against maternal sepsis
ANODE trial - prophylaxis with single dose of IV amoxicillin/clavulanic acid 1.2g resulted in significantly fewer confirmed or suspected infections after instrumental delivery compared to placebo.
143
An inverted u wave is an electrocardiographic sign of
a) Hypocalcaemia
b) Ischaemia
c) Hypomagnesaemia
d) Hypothermia
B Ischemia
https://litfl.com/u-wave-ecg-library/
144
Awareness in NAP – which one most likely
a) Cardiac surgery (there was no option for LSCS in this set)
b) ENT surgery
c) Neurosurgery
A
145
Magnesium sulphate in obstetrics
Neuroprotection:
24 - 30 weeks
Commence MgSO4 as close to 4 hours prior to delivery as possible
4g over 20 minutes then 1g/hr
Pre-eclampsia
Similar dosing
146
Anaesthesia-induced rhabdomyolysis
147
Iron therapy is given. Expected abnormality?
a) Hypophosphatemia
148
Which drug crosses the blood brain barrier?
a) Edeophonium
b) Neostigmine
c) Pyridostigmine
d) Physiostigmine
Physostigmine
149
Dose of salbutamol in 8yo
a) 6 puffs
B) 12 puffs
RCH guidelines
Severe asthma
Age 1-5 years 6 puff salbutamol + 4 puff ipratropium
Every 20 min for 3 doses
Age > 6 years
12 puffs salbutamol + 8 puffs ipratropium
Every 20min for 3 doses
Dexamethasone 0.6mg/kg max 16mg or hydrocortisone 4mg/kg max 100mg
150
Dose of bicarbonate in 80kg patient
a. 60 mL
b. 100 mL
c. 80 mL
d. 10 ml
Sodibic 8.4% is 1mmol/L
dose is 1mmol/kg
Hence 1mL/kg = 80mL
151
Flow volume loop (report states pressure vol loop?)
a) overinflation
152
Anorexia nervosa has cardiac arrest what electrolyte abnormality
a) Hypophosphatemia... again? really?
153
Duration of action for nebulised salbutamol
a) 1 hour
b) 2 hour
c) 30 min
2-3 hours for hyperkalemia RCH guidelines
https://www.rch.org.au/clinicalguide/guideline_index/hyperkalaemia/
154
Which diagram corresponds to the murmur for mitral stenosis? (this exact picture)
A)
B)
C)
D)
E)
155
Which of the following have least effect on chronic pain following surgery
a) Ketamine
b) Duloxetine
c) Regional blocks
d) Gabapentinoids
Duloxetine
156
a) Elderly
b) Paeds
c) Diabetics
d) Fast rate of vasopressor
e) Slow rate of vasopressor
ANZCA Final Exam
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