25.2 Flashcards by Rebecca L

Which view is not part of extended eFAST scan?

pericardial
thoracic
perisplenic
perinephric
perihepatic

Perinephric

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Performing block of median nerve in cubital fossa. Which US probe to use?

a) Curvilinear
b) Linear probe 8-12 Hz
c) Linear probe 5-10 Hz
d) Thinner probe

linear probe 8-12Hz

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Phaeochromocytoma - which drug to avoid

metoclopramide
phentolamine
prazosin
propofol
rocuronium

metoclopramide

Metoclopramide is a D2 receptor blocker and is known to precipitate pheochromocytoma crisis

https://doi.org/10.1210/jendso/bvac150.208

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Intubate with 1mg/kg rocuronium. Surgery ceases. TOF count 0. PTC 2. What dose sugammadex to give?

a) 1mg/kg
b) 2mg/kg
c) 4mg/kg
d) 8mg/kg
e) 16mg/kg

4mg/kg

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Where is the indicated pacemaker lead likely placed?

a) RV
b) LV
c) RA
d) Coronary sinus

Answer: Coronary Sinus

https://www.bjaed.org/article/S2058-5349%2817%2930025-2/fulltext similar to fig 1 -

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Opioid induced ventilatory impairment. Which is NOT a RF?

a) female
b) sleep disordered breathing
c) congestive cardiac failure
d) opioid naiive
e) long acting opioids

a) Female

Risk factors for postoperative opioid-induced respiratory depression include:

older age
male sex
opioid naivety
sleep-disordered breathing
heart failure.

https://doi.org/10.1016/j.bjae.2023.12.007

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AFE (amniotic fluid embolism) diagnosis is made via:

a) clinical diagnosis
b) cardiac monitoring of some sort
c) inflammatory complement system markers
d) decreased LV function on echo (?RV)

a) clinical diagnosis

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Quiescent inflammatory bowel disease in a patient Which analgesic will prompt a flare?

paracetamol
ibuprofen
tramadol
celecoxib

“It is estimated that NSAIDs may cause clinical relapse in ∼20% of patients with quiescent inflammatory bowel disease (IBD). Coxibs do not appear to be associated with relapse of IBD, but caution should still be exercised.”
2023 BJA NSAIDs

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Bronchopleural fistula pt in ICU. Which is the recommended ventilation strategy?

5 Options were 2 of 3 of TV/RR/PEEP (combos of high/low)
Low TV and low RR
Low TV and high RR
High PEEP and high RR

strategy: controlled, assist control, intermittent mandatory
lowest possible TV
lowest possible PEEP
short inspiratory time
encourage spontaneous breathing

https://litfl.com/bronchopleural-fistula/

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Re: site of CVL, subclavian lines have lowest complication rate of:

infection
pneumothorax
thrombosis
arterial puncture
infection and thrombosis

Infection and Thrombosis.

https://www.ncbi.nlm.nih.gov/books/NBK557798/

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What is the ASA status of a pt with a TIA from 2 years ago who has otherwise been well?

ASA 3

https://www.asahq.org/standards-and-practice-parameters/statement-on-asa-physical-status-classification-system

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In OT, what does the blue electric socket denote?

connected to backup power supply
cardiac protected
equipotential earthed
connected to uninterrupted power supply
connected to standard power point/RCD

Electrical circuits connected to the UPS are denoted by a dark blue power socket, and are reserved for essential equipment without adequate battery backup.

2015 BJA environmental emergencies
https://www.bjaed.org/article/S1743-1816(17)30006-9/fulltext

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A 64 year old man presenting for elective surgery is on thyroxine 100 mcg daily. His thyroid function tests are:
- TSH <0.05
- Both T4 and T3 within normal limits

These results are most consistent with:

a) Overtreatment
b) Subclinical hyperthyroidism
c) ?Sick euthyroid
d) Multinodular goitre
e) Previous hypophyseal resection

Subclinical Hyperthyroidism

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What is the concern with EMLA use in preterm babies?

methaemoglobinaemia
increased sensitivity due to liver insufficiency
increased absorption
decreased neurotoxicity threshold
decreased cardiotoxicity threshold

Methaemoglobinaemia

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In the event a pressure manometer is not available, what is the maximum volume of air that should be injected into the cuff of a classic LMA size 4?

a) 15mL
b) 20mL
c) 25mL
d) 30mL
e) 40mL

30mL

The manufacturers recommend inflating the laryngeal mask cuff until the intracuff pressure reaches 60 cmH2O or to inflate with the volume of air not exceeding the maximum recommended volume (size 3, 20 ml; size 4, 30 ml) if a manometer is not available

https://pmc.ncbi.nlm.nih.gov/articles/PMC7206679/#:~:text=The%20manufacturers%20recommend%20inflating%20the,available%20%5B7%E2%80%9311%5D.

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What is the nerve indicated in this picture?

a) Radial
b) Musculocutaneous
c) axillary
d) Ulnar
e) Median

Radial nerve was answer

Thie picture was similar to the standard ones in brain scape flash cards

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Anterior ischaemic optic neuropathy. What is characteristic?

a) visual inattention
b) resolves fully within 24-48hrs
c) papillary oedema
d) intact pupil reflex
e) painful

Papillary Oedema

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What is a risk factor for failed epidural blood patch for postdural puncture headache?

a) Using loss of resistance to air
b) Depth of space >5cm
c) Injection of epidural blood patch <48hrs after accidental dural puncture
d) Sitting up and performing
e) 20ml of blood injectate

Risk factors identified for failure include:

a history of migraine headache
accidental dural puncture at higher lumbar levels,
injection of epidural blood patch <48 h after accidental dural puncture.

BJA 2022 failed epidural

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Which nerve innervates lower third molar tooth?

a) Mental
b) Inferior alveolar
c) Lingual
d) Superior alveolar nerve

Inferior Alveolar

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According to Brain Trauma Foundation guidelines, what is the lower limit that adult GCS can be used?

a) 2 y/o
b) 4 y/o
c) 6 y/o
d) 8 y/o
e) 10 y/o

Couldn’t find BTF specifically
https://www.rch.org.au/trauma-service/manual/Head_injury/ says 4+

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A 3 year old child involved in an MVA presents to ED with a distended abdomen. An indication to go straight to theatre would be:

a) Pneumoperitoneum on CXR
b) Positive eFAST scan
c) Shocked at scene
d) Unresponsive to 20mL/kg blood during transfer to hospital
e) Grade V liver laceration

RCH trauma service recommends the following as indications for laparotomy:

Haemodynamic instability - despite resuscitation.
Transfusion requirements of more than 40 ml / kg during the period of acute resuscitation
free intra-peritoneal gas is an indication for urgent laparotomy

https://www.rch.org.au/trauma-service/manual/abdominal-injury/

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This type of tracheal tube is best described as a (picture of airway device shown)

a) Mini tracheostomy tube
b) South facing RAE
c) Laser tube
d) Laryngectomy tube

Rusch Larygoflex Reinforced Laryngectomy tube

https://www.teleflexarcatalog.com/anesthesia-respiratory/airway/product/121181080-rusch-laryngoflex-laryngectomy-tube

(repeat of 20.1)

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G6PD - what is the risk with giving methylene blue for shock?

a) Haemolytic anaemia
b) Serotonin syndrome
c) Methaemaglobinaemia

Haemolytic anaemia

https://journals.lww.com/md-journal/fulltext/2025/06130/co_occurrence_of_acute_hemolytic_anemia_and.87.aspx

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This Doppler trace obtained by transoesophageal echocardiography of the descending aorta (see far right) suggests:

a. Aortic dissection
b. Aortic stenosis
c. Aortic regurgitation
d. Normal flow
e. High flow state

AR - bidirectional

23.1 repeat

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In a patient undergoing surgery for epilepsy, which drug is expected to interfere with electroencephalography intraop the LEAST? - dexmedetomidine - ketamine - nitrous oxide - sevoflurane - midazolam

Perhaps dexmed? https://www.sciencedirect.com/science/article/pii/S1743919115003684

What is the lowest figure at which pulse pressure variation suggests fluid responsiveness? - 5% - 8% - 13% - 20%

13% Need reference??

Which heart murmur sound is HOCM?

Same as aortic stenosis: crescendo decrescendo - THANK GOD I CHOSE THIS

What is the mechanism of action of octreotide in Upper GI bleeding? - reduced splanchnic blood flow - vasoconstriction - increases platelet aggregation - increased portal venous pressure

MOA: splanchnic vasoconstriction

In neonatal resuscitation, what inspiratory pressure in H2O is INITIALLY recommended for positive pressure ventilation? a) 15 b) 20 c) 25 d) 30

Start at peak inspiratory pressure (PIP) of 30 cm H2O for a term neonate (20-25 cm H2O preterm neonate) and positive end expiratory pressure (PEEP) of 5 cm H2O at 40-60 breaths/minute https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/Neoresusdelivery20.pdf

A patient has numbness and weakness in her hand postoperatively. You are trying to distinguish between an ulnar nerve lesion and a C8-T1 radiculopathy. You can diagnose a C8-T1 radiculopathy if she has weakness a) Thumb adduction b) Thumb abduction c) Fingers adduction d) Fingers Abduction e) Little finger flexion

21.1 repeat - thumb ABduction

What is an absolute contraindication to cardiopulmonary exercise testing? - Unstable angina - Pulmonary hypertension - HOCM - Untreated left main disease - unable to get on the bike or something like that

Unstable angina

The Glasgow Blatchford score is used to risk stratify: a) Pulmonary haemorrhage b) Traumatic intraperitoneal haemorrhage c) PPH d) SAH e) UGI bleed

Upper GI bleed

The manufacturer’s instructions for use of the i-gel supraglottic airway device recommend a minimum patient weight in kg of a) 1 b) 2 c) 3 d) 5 e) 10

2Kgs

Pt with history of syncope. What is the device shown on the xray? a) Implantable loop recorder b) Leadless PPM c) DBS d) mitraclip e) subcutaneously implanted ICD

https://radiopaedia.org/cases/implantable-loop-recorder-device was photo

ANOVA is: A. Assessing the strength of association between two continuous variables (e.g., height vs weight) B. Comparing the means of more than two groups C. Measuring agreement between two observers beyond chance D. Testing the difference between two sample means E. Analysing the proportion of categorical outcomes between groups

B. Comparison between 2 or more means (has been asked before)

What are the components of the MIST handover in trauma represents: - minutes from injury, Injuries, Symptoms, Treatment - minutes from injury, Injuries, Symptoms, Treatment - mechanism, Injuries, Symptoms, Treatment - mechanism, Investigations, signs, Treatment - mechanism, investigation, signs, time since injury

Mechanism, Injury, Signs, Treatment - investigations/symptoms in there as decoys (for I & S)

Which is NOT a risk factor for emergence agitation in paeds? - Nitrous oxide - Male - Autism spectrum disorder - Volatile use - Ages 2-5

2018 BJA emergence delirium lists MALE as RF. I think N2O is answer for what is NOT a risk factor. Child "temperament" is risk factor so ASD likely contributes.

Post femoral block, how long should noninvasive monitoring occur for? a) 10 mins b) 15 mins c) 30 mins d) 60 mins

Luke - I think its based on ANzca PS 03 which says 30 minutes - see to the right -->

When vitamin C is used in the treatment of acute postsurgical pain, what of the following is true? - Ineffective when given intravenously - ineffective when given orally - Reduces acute pain in a dose dependent relationship - Postoperative morphine requirements are reduced

Reduced morphine requirements. https://josr-online.biomedcentral.com/articles/10.1186/s13018-024-05193-x

Lateral calf innervation (calf had nerve distributions). Had to identify which nerve - superficial peroneal - sural - lateral plantar - saphenous nerve - lateral cutaenous nerve

to the right was the EXACT picture except the colors were different. Picture only had the right (posterior) image and wanted the blue section (SPN)

25 male with tibial shaft fracture who has pain, weakness dorsiflexion of foot, some other symptoms. Which leg compartment affected by compartment syndrome? (my memory of it was pain on plantarflexion of foot, weakness with extension of the big toe and numbness of the first webspace) a) anterior b) medial c) lateral d) superifical posterior e) deep posterior

Anterior!

What type of variable influences dependent and independent variables? A. Mediator B. Confounder C. Moderator D. Instrumental variable E. Collider

Confounder

What is the minimum battery life of an anaesthetic machine? 5min 10 min 30 min 60min 4hrs

30 minutes Repeat question

What mapleson circuit is this? A B C D

C Repeat question

What is the pin index system of medical air? a) 1-5 b) 2-5 c) 3-5 d) 1-6

1,5

The medication most strongly associated with an acute primary hypotensive reaction following transfusion of blood products is: a. Aspirin b. Ibuprofen c. Hydralazine d. Metoprolol e. Perindopril

Perindopril Made up options, but perindopril definitely in there

When is the risk of delayed cerebral ischaemia post subarachnoid haemorrhage highest? a) <24hrs b) 1-3 days c) 4-10 days d) >14 days

4-10 days

A woman presents with an acute subarachnoid haemorrhage amenable to clipping and coiling. Which intervention has best mortality benefit? a) Clipping <24hrs b) Clipping >24hrs c) Coiling <24hrs d) Coiling >24hrs e) Vasopasm management

Coil within 24hrs https://www.ahajournals.org/doi/10.1161/strokeaha.110.602888

Of the following, the congenital condition LEAST commonly associated with obstructive sleep apnoea in children is: a) Prada Willi Syndrome b) Duchenne Muscular dystrophy c) Down Syndrome d) Spina bifida e) Tetralogy of Fallot

Need to figure out

The blood product that contains the highest concentration of citrate is: a) Plasma b) RBCs c) Platelets d) Cryoprecipitate e) Fibrinogen concentrate f) FFP

FFP

A charcoal filter on a ventilator circuit is shown to be able to reduce the concentration of volatile to below 5ppm (parts per million) in a minimum of what time frame? a) 90 seconds b) 3 mins c) 5 mins d) 10 mins e) 30 mins

A 90s https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.14091 https://www.dynasthetics.com/Vapor-Clean/ lists <2mins

Crush injury - expected abnormality early: a) hypokalaemia b) hypocalcaemia c) hypophosphataemia d) Metabolic alkalosis e) Hypouricemia

Hypocalcaemia. https://www.acep.org/imports/clinical-and-practice-management/resources/ems-and-disaster-preparedness/disaster-preparedness-grant-projects/cdc---blast-injury/cdc-blast-injury-fact-sheets/crush-injury-and-crush-syndrome

When will the SaO2 (of ABG) be higher than SpO2 (from pulse oximeter)? a) Sickle cell b) Methylene blue c) CO poisoning d) anaemia e) Polycythaemia

Carboxyhaemoglobin 24.1: A patient’s true arterial oxygen saturation will be lower than a pulse oximeter reading in the presence of (same options)

Which nerves does first stage of labour transmit through? a) S2-S4 b) T10-L1 c) L1-L2 d) T12-L3

T10-L1

Epidural placed for postop pain. According to ASRA guidelines, how soon after epidural removal can prophylactic clexane be given? a) 1hr b) 4hr c) 6hr d) 12hr e) 24hr

Think this was actually how long to withhold prophylactic clexane prior to epidural catheter removal - 12 hours as per ASRA (Abe)

Dialysis best at removing: a) warfarin b) rivaroxaban c) dabigatran d) apixaban e) clopidogrel

Dabigatran

Pt with known WPW. Develops rapid AF. Haemodynamically stable. What's the safest therapy? a) Digoxin b) Verapamil c) Cardioversion d) Metoprolol

Likely electricity https://litfl.com/wolff-parkinson-white-syndrome-ccc/

Benzatropine ameliorates the side effects of drugs that antagonise: a) Dopamine b) serotonin c) nicotine d) adrenaline e) Histamine

Dopamine

Pts on SSRI perioperatively may experience all of these except: - atrial fibrillation - excess bleeding and transfusion requirement - mental status changes - serotonin syndrome - ventricular arrhythmias

Need to figure out

When compared with nerve stimulator guided brachial plexus block, Ultrasound guided brachial plexus block results in: a) less neuropraxia b) less risk of systemic toxicity c) reduced time to motor/sensory onset d) Improved patient satisfaction e) reduced chance of intraneural injection

Need to sort out

Pulse pressure variation has reliable utility in which condition: a) thoracotomy b) spontaneously breathing c) pulmonary hypertension d) septic shock e) increased abdominal pressures

Need to sort out

A 35-year-old patient is undergoing a diagnostic laparoscopy. Three minutes after insufflation of CO2 her oxygen saturation falls to 85%. You note decreased air entry on the left side of her chest. Lung ultrasound on the left reveals lung pulse and no lung sliding. The best first action is to: a) Needle decomp mid clav 2nd intercostal b) Finger decomp c) Chest drain insertion d) Withdrraw ETT 1-2cm

Withdraw ETT 1-2cm

IO sample correlates well for: - Hb - Potassium - Platelets - Chloride? - WCC

Need to sort out

Trigeminal neuralgia - 1st line management: a) Tramadol b) Amitriptyline c) Carbamazepine d) NSAIDs e) opioids

Carbamazepine

What is the arrythmia in this ECG? a) 1st degree AV block b) Mobitz type 1 c) Mobitz type 2 d) Sinus bradycardia e) Complete heart block

Not exact ECG but i definitely remember it was mobitz 2, 2:1

Pacemaker code for V in NASPE/BPEG Generic (NBG) Pacemaker Code? a) Rate modulation b) Paced c) Sensed d) Response to sense e) Multi site pacing

Multisite pacing

NOF pt under GA. sBP drops to 75, you have given multiiple bouts of metaraminol with no improvement. ECG rhythm displayed. Next management: - amiodarone 300mg IV - cardioversion 200J - adrenaline - metoprolol

Shock

ALS in adult patient. VFib -> given 2 shocks, then IV adrenaline, then 1 shock. Next treatment: - DCCV 200J - amiodarone 300mg IV - adrenaline 1mg IV - lignocaine 100mg IV

Amiodarone

IV Dosing in anaphylaxis for paediatric patient in mg/kg for moderate (it specified grade 2) anaphylaxis: a) 1 b) 2 c) 4 d) 10

I distinctly remember that this question asked for IV adrenaline, even though this is not recommended in guidelines

1hr post open cardiac surgery. Pt arrests - they are ventilated. What's the next management? a) Immediate external cardiac massage b) Adrenaline 1mg c) Defibrillate as per ACLS guidelines d) Aim resternotomy within 30 minutes e) Switch from ventilator to BMV with 100%

defibrillate as per ACLS

For hyperkalaemic treatments, which has the most rapid onset of action? (or peak) a) IV insulin/dextrose b) IV sodium bicarbonate c) Nebulised salbutamol d) Oral Resonium e) PR resonium

Need to sort out

Pt has had a miscarriage for emergency suction curettage. INR (or PT) 1.2x normal, aPTT 65 seconds. What test to order next? a) Mixing tests b) Fibrinogen c) Factor 8 test d) Clotting time

Need to sort out

A 45yo man presents with a hx of SOB and the following flow-volume loop is obtained. This is most consistent with: a) fixed b) variable intrathoracic c) variable extrathoracic d) early airflow obstruction

Variable intrathoracic - same as 22.1 I thought it showed decreased inspiration so would be extrathoracic variable? agree with this - extrathoracic variable

What is not in beriplex? a) Factor 7 b) Factor 10 c) Factor 8 d) Protein C e) Factor 9

Factor 8

Differential hypoxia is a syndrome characterised by lower arterial oxygen saturation in the upper body. It is a complication specific to the use of a) VA ECMO b) VV ECMO c) ECCO2 device d) Haemodialysis e) Peritoneal dialysis

VA ECMO

Which von Willebrand Disease type is desmopressin ineffective?

Type 3 always ineffective https://www.rch.org.au/clinicalguide/guideline_index/Von_Willebrand_Disease_vWD/

Arndt bronchial blocker- which port does the bronchoscope go down? A B C D

Port C

An electrocardiogram (ECG) abnormality which is NOT usually associated with severe anorexia nervosa is: a. Resting tachycardia b. Wandering pacemaker c. ST depression d. TWI e. Prolonged QT

21B repeat - resting tachycardia

What does the bit indicated in the picture do? a) Suction indicator b) Drainage chamber c) Air leak detector d) Water seal chamber e) Sampling port

Was poitning to air leak. Exam used this exact image.

Pt with lean body mass 50kg. Given 100mg lignocaine. If assuming max dose lignocaine 4mg/kg and bupivacaine 2mg/kg, how much bupivacaine can safely be given concurrently to this pt? a) 20mg b) 50mg c) 100mg d) 200mg e) 250mg

50mg

A patient who is day 3 post laparotomy has used 30 mg oxycodone intravenously via patient controlled analgesia in the last 24 hours. The approximate oral morphine equivalent daily dose is: a) 20 mg b) 30 mg c) 60 mg d) 90 mg e) 120 mg

90mg

Which antidiabetic med reduces renal glucose absorption? a) GLP1 agonists b) SGLT2 inhibitors c) sulfonylureas d) biguanides e) insulin

SGLT2 inhibitor

The part of the lung that is typically divided into apical, anterior and posterior segments is the a) RUL b) RML c) RLL d) LUL e) LLL

RUL

The shoulder joint receives sensory innervation from all of the following nerves EXCEPT the: Axillary Long thoracic Lateral pectoral Suprascapular Subscapular

23.2 - long thoracic

SBP target if 80 year old male with TBI: * SBP 65 mmHg * SBP 80 mmHg * SBP 90 mmHg * SBP 100 mmHg * SBP 110 mmHg

110 mmHg Per BTF guidelines: * 15–49 years old: ≥ 110 mmHg * 50–69 years old: ≥ 100 mmHg * > 70 years old: ≥ 110 mmHg

Obesity in pregnancy does not increase risk of: a. antenatal depression, b. cholestasis of pregnancy c. pre eclampsia d. gestational HTN e. DVT

Cholestasis

A thoracic regional technique that will NOT provide analgesia for sternal fractures is a: a. Transversus throacic plane block b. PECS I c. Parasternal intercostal nerve block d. Thoracic epidural

PECS 1

The MELD (Model for End-Stage Liver Disease) score includes all of the following parameters EXCEPT: a) Bilirubin b) INR c) Albumin d) Creatinine e) Sodium

24.1 - Albumin.. interestingly they didn't call it MELD-Na this time around but i still think the answer most correct is albumin

A 10-year-old child (weight 30 kg) presents to the emergency department in status epilepticus. They have received one dose of 10 mg midazolam buccally prior to arrival to hospital. According to Advanced Paediatric Life Support Australia guidelines the next drug treatment should be intravenous: a) Phenytoin b) Midazolam c) Propofol d) Levetiracetam

Midazolam

For a skewed distribution of data the best measure of dispersion of data is the: a) range b) mode c) standard deviation d) variance e) interquartile Range

Interquartile Range

According to the surviving sepsis guidelines 2021, for adults with septic shock and an ongoing requirement for vasopressor therapy we suggest using IV corticosteroids if: a) MAP remains <65 despite IV noradrenaline b) The dose of noradrenaline required is >0.1mcg/kg/min no matter the duration c) The dose of noradrenaline required is ≥ 0.25 mcg/kg/min at least 4 hours after initiation d) The dose of noradrenaline required is ≥ 0.5 mcg/kg/min at least 2 hours after initiation

It is suggested that this is commenced at a dose of norepinephrine or epinephrine ≥ 0.25 mcg/kg/min at least 4 hours after initiation. https://journals.lww.com/ccmjournal/fulltext/2021/11000/surviving_sepsis_campaign__international.21.aspx

The study marked with the star in a noninferiority study shows: a) Inferiority b) Non-inferiority c) Superiority d) Harm e) Inconclusive

Non-inferiority

First line treatment of extravasated norad is: - Remove cannula - Flush cannula - Cold compress - SC phentolamine - heparin

S/C phentolamine

NAP 7 most common cause of arrest intraop: - Anaphylaxis - Cardiac Ischaemia - Major haemorrhage - Pulmonary embolism - Local anaesthetic toxicity

Major haemorrhage

Predictors of successful awake extubation after volatile anaesthesia in infants include: a. 2mL/kg tidal volume b. grimacing c. coughing d. RR > 20 e. CO2 > 60

Grimacing

Which drug to avoid in cocaine toxicity? A) Adenosine B) Diazepam C) Metoprolol D) Glyceryl trinitrate E) Verapamil

Metoprolol

You are performing femoral venous cannulation in an obese man under ultrasound guidance. The image quality is suboptimal as the vein is deep. The best way to improve the image quality is to: a. Increase the frequency of the wavelength b. Use a probe with a lower frequency c. increase the contrast d. Increase the wavelength e. Increase the speed of the ultrasound waves

Need to sort out 22B

The concept of equity and fair access for all patients describes which ethical principle? a) autonomy b) beneficence c) justice d) non-malifencence e) fidelity

Need to sort out

When interpreting an arterial blood gas, a high serum anion gap is consistent with: a) Lithium toxicity b) Salicylate toxiticy c) Hypercholeraemia d) Hypoalbuminaemia e) Hypercalcaemia

Need to sort out 24.1

A medication that should be avoided in a patient with thyroid storm is: a) Ibuprofen b) Propranolol c) Potassium Iodide d) PTU: Propylthiouracil

24.1

The clinical laser type with the greatest tissue penetration is: a) Argon b) Nd:yag c) Er:yag d) Co2 e) Holmium

Need to sort out 24.1

Oral naltrexone should be ceased preoperatively for: a) 24 hours b) 48 hours c) 72 hours d) 96 hours

Need to sort out. Blue book article. 24.1

Which is not lost in anterior spinal artery syndrome? a) Pain b) Temperature c) Motor d) Proprioception e) Bladder function

Proprioception, fine touch, and vibratory sense are typically not lost because they are carried by the dorsal columns Anterior spinal artery syndrome usually includes tracts in the anterior two-thirds of the spinal cord, which include the CSTs, the spinothalamic tracts, and descending autonomic tracts to the sacral centers for bladder control. CST involvements produce weakness and reflex changes. A spinothalamic tract deficit produces the bilateral loss of pain and temperature sensation. Tactile, position, and vibratory sensation are normal. Urinary incontinence is usually present.

According to the 5th National Audit Project (NAP5), the incidence of awareness during general anaesthesia using a non-relaxant technique is approximately: a. 1:1360 b. 1:13,600 c. 1:136,000 d. 1:1,136,000

Need to sort out

A patient for elective general anaesthesia has been noted to be chewing gum in the pre-operative area. The most appropriate course of action is to: a) Postpone the surgery b) Give IV metoclopramide and delay 2 hours c) Give IV metoclopramide and delay 4 hours d) Delay for 6 hours e) Discard gum then proceed without delay

Need to sort out

Preoperative predictors of chronic postsurgical pain do NOT include: a) Anxiety b) Depression c) Elderly d) Preop opioid use e) Preexisting chronic pain

Need to sort out

Which intervention for acute pain does not reduce the risk of persistent postoperative opioid use? a) Opioid wean preop b) Education/expectation setting preop c) Titrating opioids to pain scores alone d) Avoiding long-acting opioids

Titrate to pain scores alone https://www.anzca.edu.au/getContentAsset/136f5a83-d1d0-4f34-be72-87b62b721d14/80feb437-d24d-46b8-a858-4a2a28b9b970/PS41(G)-Acute-pain-2023.pdf

The analgesic drug with the most favourable Number Needed to Treat (NNT) for neuropathic pain is: a) Amitriptyline b) Gabapentin c) Tramadol d) Pregabalin e) Carbamazepine

Need to sort out 24.1

A 36-year-old woman sustains an injury to her left arm and presents with pain. She informs you that she experiences unpleasant intermittent and spontaneous shooting sensations in her arm. This sensation is: a. Dysaesthesia b. Allodynia c. Hyperalgesia d. Hyperaesthesia e. Paraesthesia

Need to sort out 23.1

The nerve labelled with an arrow in the diagram below (diagram of lumbar plexus shown) is the: a) Femoral b) Iliohypogastric c) Lateral femoral cutaneous d) Obdurator e) Genitofemoral

Obturator

Patients with rheumatoid arthritis and the most common form of atlantoaxial instability have a widened atlantodental interval. This is measured between the: a) distance from posterior margin of dens to anterior surface of posterior arch of atlas b) distance from anterior margin of dens to anterior surface of posterior arch of atlas c) distance from posterior margin of dens to anterior surface of anterior arch of atlas d) distance from posterior margin of dens to posterior surface of posterior arch of atlas e) distance from anterior margin of dense to posterior surface of anterior arch of atlas

Need to sort out

Intravenous dexmedetomidine use does NOT result in: Hypertension Bradycardia Decreased urine output Decreased opioid consumption Increased regional nerve block duration

Need to sort out

A patient under general anaesthesia monitored with transcranial cerebral oximetry has a decrease in their cerebral oxygen saturation. This is likely to be improved by an increase in all of the following EXCEPT: A) Increased MAP B) Increased MV C) Increased anaesthetic depth D) Increased Hb E) Increased FiO2

23.2

ECT does NOT result in: a) initial sympathetic stimulation b) increased ICP c) decrease LV function for 4-6 hrs d) Increased SBP 30-40%

Presumably early sympathetic stimulation https://www.ranzcp.org/getmedia/ba0a9810-06bd-4ef4-8df9-a8f3abe3f77e/anaesthesia-for-ect.pdf has other options as effects

The Myocardial Injury after Non Cardiac Surgery study showed elevated troponin in the first three post-operative days was strongly associated with: A. 30-day mortality B. 30-day myocardial infarction C. Stroke within 30 days D. Surgical site infection E. 30-day hospital readmission

A man with a history of obesity and obstructive sleep apnoea has just had a transsphenoidal pituitary resection. Soon after extubation he is semi-conscious and is making a respiratory effort but has near complete upper airway obstruction with stridor. His arterial oxygen saturation is 93% and starting to fall. Your first actions should be to: a) Propofol to deepen anaesthesia, insert LMA and provide positive pressure ventilation b) Propofol to deepen anaesthesia, insert oropharyngeal device and provide positive pressure ventilation c) Insert a nasopharyngeal airway, assist ventilation and allow to wake d) Insert an LMA, assist ventilation and allow to wake e) Insert an oropharnygeal, provide CPAP and allow to wake

In the thigh, the adductor canal is bordered by all of the following EXCEPT: Vastus medialis Adductor magnus Adductor longus Adductor brevis Sartorius

Safest approach for peribulbar if short eye length? - Inferotemporal - superior temporal - medial canthal - lateral canthal - Other approaches

Need to sort out

Assuming a blood volume of 80 ml/kg, a massive transfusion child is defined as a three-hour packed red blood cell (PRBC) transfusion volume of: a) 20mk/kg b) 40ml/kg c) 60ml/kg d) 80ml/kg

40mL/kg

The antiemetic that interferes with the effectiveness of oral hormonal contraception is: a) Aprepitant b) Ondansetron c) Metoclopramide d) Prochlorperazine e) Midazolam

Aprepitant

Extra-adrenal tumour with raised metanephrines. What medication is likely instituted preoperatively? a) Phentolamine b) Metoprolol c) Phenoxybenzamine d) Prazosin

Need to sort out

On a ROTEM, lysis is defined as decrease in clot strength <15% at how many minutes? a) 10 min b) 15 min c) 20min d) 30min e) 60min

I think it's 60. i remember this one because I have it on my shower door, and I couldnt' remember, and picked 30. -L

What artery are the arrows in this image pointing to? a) Anterior communicating b) Posterior communicating c) Middle cerebral d) basilar e) Vertebral

Desufflation after surgical pneumoperitoneum is NOT associated with an increase in: - Stroke work index - Cardiac output - Systemic vascular resistance - Venous return - LV stroke work

Need to sort out

In a venous blood gas sample, the pH is expected to differ from arterial pH by: a) +0.03 b) +0.3 c) -0.03 d) -0.3

Need to sort out

With a WELL FUNCTIONING intra-aortic balloon pump, what would you not expect to see? a) Decreased renal blood flow b) Decreased Hb c) Decreased cardiac work d) Increased cardiac perfusion e) Increased aortic root diastolic pressure

Need to sort out

Of the following, the drug which is most effective in the management of severe hyperthermia in serotonergic syndrome is: a. Dantrolene b. Diazepam c. Paracetamol d. Rocuronium

Need to sort out

In order to minimise the risk of cardiac arrhythmia surgical diathermy has been designed to operate with: a. High frequency b. High voltage c. Low frequency d. Low voltage e. Equipotential earthing

Need to sort out

All patients over 70 years of age having received either spinal or general anaesthesia at Hospital X are reviewed 3 years later to assess cognitive function. The aim of the study is to determine whether exposure to general anaesthesia or spinal anaesthesia impacts cognitive function. This trial design is best described as a: a) RCT b) cohort study c) case-control study d) case series e) cross-sectional study

Need to sort out 22.2

Intraoperative lung protective ventilation strategies include all of the following EXCEPT: a. Alveolar recruitment manouevres b. Individualised PEEP c. I:E ratio 1:3 d. TV 6-8ml/kg e. Minimising ventilatory driving pressure

A test for a condition which has a prevalence of 1 in 1,000 has a sensitivity of 100% and a specificity of 90%. The probability of a patient who receives a positive result actually having the condition is: a. 1% b. 10% c. 90% d. 99% e. 100%

22B

Your patient underwent a stellate ganglion block two hours ago. Prior to discharge you are asked to review the patient in recovery because of a droopy upper eyelid. The patient would also be expected to have ipsilateral: a) Pupillary constriction and reaction to light b) Pupillary constriction and no response to light c) Pupillary dilation and response to light d) Pupillary dilation and no response to light

22.2

Compared to a normothermic patient, a patient with mild intraoperative hypothermia (35.0 oC) will have: a. More bleeding, normal INR and APTT b. More bleeding, normal INR and raised APTT c. More bleeding, raised INR and normal APTT d. Unchanged bleeding, normal INR and APTT e. Unchanged bleeding, elevated INR and APTT

Not sure if this is dead on, but similar to 22.2

The first-line drug recommended by both the Australian Resuscitation Council and the New Zealand Resuscitation Council to treat severe cyanide poisoning is: a) methylene blue b) hydroxycobalamin c) sodium thiosulphate d) Amyl nitrite e) Dicobalt edetate

Hydroxycobalamin

A respiratory effect of high flow nasal oxygen therapy is: a. Reduced RR b. Reduced MV c. Increased work of breathing d. Increased deadspace

Need to sort out

When performing a gastric ultrasound on a supine patient, the probe should be positioned: Saggital midclavicular Saggital midaxillary Transverse subxiphoid Transverse subxiphoid Saggital subxiphoid

Sagittal, subxiphoid

If group A RhD negative cryo is not available for use in an A RhD positive patient, of the following your next best choice should be: a) Group AB Rh+ rhesus b) Group B Rh+ c) Group B Rh d)Group O Rh+ e) Group O Rh-

https://www.lifeblood.com.au/health-professionals/products/component-compatibility

Button battery >20mm - how long until erosion can occur? a) within 1hr b) within 2hrs c) within 4hrs d) within 24hrs

FB BJA 2hrs if in oesophagus, or symptomatic in stomatch

Organ procurement after circulatory death is generally stood down if the time from cessation of cardiorespiratory support to circulatory death extends beyond: a) 60min b) 90min c) 120min d) 5min

Need to sort out

A patient requires a general anaesthetic and is breastfeeding. Current advice regarding breastmilk following anaesthetic includes: a) Express milk, discard that feed, and then safe to continue to feed as normal b) Delay breastfeeding 6h postop c) No requirement to express and discard, feed as usual d) Delay breastfeeding 24hrs

Feed straight away

Brain death testing - what is NOT in the criterion? - Lack of corneal reflex - Lack of oculocephalic reflex - Pt must be >35 degrees - Apnoeic and no sign of triggering ventilator for 2 hours - GCS3

https://anzics.org/wp-content/uploads/2022/04/Table-1.2.pdf: seems like oculocephalic less recommended as well There is a minimum 4-hour observation period prior to neurological determination of death using clinical examination alone. Throughout this observation period, all preconditions are met, the patient has a Glasgow Coma Scale of 3, with pupils nonreactive to light, absent cough/tracheal reflex and apparent apnoea on a ventilator. Following an acute hypoxic-ischaemic encephalopathy or hypothermia (<35°C) of duration greater than 6 hours, there should be a waiting period of 24 hours before determination of death using clinical examination alone.

What is the atrial rate in this ECG? - 60bpm - 80bpm - 100bpm - 120bpm

Following an operation, a patient with type 2 diabetes remains in PACU. According to (some guideline) how often should BGLs be measured? a) 30 mins b) 1 hourly c) 2 hourly d 4 hourly

b) 1 hourly

A patient has a lung ultraosund which shows A lines and lung sliding. Which of the following is most likely: a) PTX b) Pleural effusion c) Normal lung d) Pneumonia

What is the observed common associated metabolic abnormality with hypercholermia? a) High-anion gap metabolic acidosis b) Normal-anion gap metabolic alkalosis c) High-anion gap metabolic acidosis d) Normal anion gap metabolic acidosis

d) NAGMA

Which of the following is an independent risk factor for increased PPH? a) Platelets 70 b) PT > 1.2 c) Fibrinogen <2.0

During a thyroidectomy, the surgeon is concerned the parathyroid glands have been devascularised. From the time of potenial damage, a serum calcium level should be checked in: a) 1 hour b) 6 hours c) 12 hours d) 24 hours e) 36 hours

Ongoing cerebral seizure activity induced by electroconvulsive therapy should be medically terminated after a. 60 sec b. 90 sec c. 120 sec d. 150 sec

25.2 Flashcards

(148 cards)