Q1-50 Flashcards by Vibhushan Manchanda

Which is the strongest indication for VV ECMO?
A. Pulmonary contusion
B. Sepsis
C. RV dysfunction
D. Pulmonary hypertension
E. Asthma

A. Pulmonary contusion
Explanation: VV ECMO is indicated for reversible hypoxaemic respiratory failure. Pulmonary contusion can cause severe ARDS-like pathology.

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What is the optimal site to deposit local anaesthetic for an ESP block?
A. Deep to erector spinae muscle and adjacent to transverse process
B. Anterior to erector spinae and posterior to transverse process
C. Deep to both erector spinae and transverse process
D. Superficial to erector spinae
E. Into the paravertebral space

A. Deep to erector spinae muscle and adjacent to transverse process. B is probably also correct. Depends on wording (remembered answers)
Explanation: The target plane for ESP block is deep to the erector spinae muscle but superficial to the transverse process.

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When performing a sphenopalatine ganglion block via transnasal approach, which structure must LA reach?
A. Greater palatine foramen
B. Lesser palatine foramen
C. Sphenopalatine foramen
D. Cribriform plate
E. Infraorbital foramen

C. Sphenopalatine foramen
Explanation: The sphenopalatine ganglion is accessed via the sphenopalatine foramen through the nasal cavity.

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What causes a 4th heart sound at the apex?
A. Hypertension
B. Aortic regurgitation
C. Atrial fibrillation
D. Trained athlete
E. Atrial septal defect

A. Hypertension
Explanation: An S4 sound is caused by atrial contraction against a stiff ventricle, common in LVH from chronic hypertension.

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In which condition would you have a lower arterial oxygen saturation target?
A. Sickle cell disease
B. Pneumothorax
C. Stroke
D. Pulmonary embolism
E. Cyanotic heart disease

remembered answers were A, B and C and then AI added D and E as options. So not sure what the real answer was. Could be C cos target is 92% (SNACC guidelines) hyperoxia can cause vasoconstriction.
E) cyanotic heart disease
goal in CHD is to maintain baseline O2 (usually 75-85%). O2 doesn’t fix R to L shunt. O2 can decrease PVR so more blood is directed to lungs and less to body (decreased R to L shunt in duct dependent physiology or in single ventricle). High FiO2 can close PDA in duct dependent lesions.

I guess other potential options could be COPD, bleomycin, maybe ARDS, MI (90% RA or 96% on O2)

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In what condition would you avoid giving Indocyanine green?
A. Methaemoglobinaemia
B. G6PD deficiency
C. Porphyria
D. Iodine allergy
E. Sulfa allergy

D. Iodine allergy
Explanation: Indocyanine green contains iodine and is contraindicated in patients with iodine allergy due to hypersensitivity risk.

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What causes the greatest reduction in efficacy of methadone?
A. Codeine
B. Escitalopram
C. Warfarin
D. Phenytoin
E. Grapefruit juice

D. Phenytoin
Explanation: Phenytoin induces hepatic enzymes, increasing methadone metabolism and reducing its clinical effect.

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According to NAP6, which medication has the highest anaphylaxis rate (per use)?
A. Suxamethonium
B. Rocuronium
C. Tobramycin
D. Teicoplanin
E. Cephazolin

D. Teicoplanin
Explanation: NAP6 data show teicoplanin as a leading cause of perioperative anaphylaxis, especially in patients labelled penicillin allergic.

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What is the mechanism of bivalirudin?
A. Direct thrombin inhibitor
B. Factor Xa inhibition
C. Factor XIIa inhibition
D. Platelet inhibition
E. tPA activation

A. Direct thrombin inhibitor
Explanation: Bivalirudin directly inhibits thrombin, preventing conversion of fibrinogen to fibrin in coagulation.

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After an eclamptic seizure, magnesium has been loaded and infusion started. How long should it continue?
A. 4 hours
B. 6 hours
C. 12 hours
D. 24 hours
E. Until delivery

D. 24 hours
Explanation: Magnesium sulphate infusion is continued for 24 hours post-seizure or delivery to prevent recurrence.

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Fontan patient undergoing open appendicectomy. Best ventilation strategy?
A. Long inspiratory time with PEEP
B. Long inspiratory time at low pressure
C. Short inspiratory time
D. Reduce respiratory rate
E. Maintain spontaneous ventilation

E. Maintain spontaneous ventilation
Explanation: Fontan circulation relies on passive pulmonary blood flow, best preserved with spontaneous breathing.

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Inverted U waves on ECG are associated with:
A. Hypercalcaemia
B. Hypocalcaemia
C. Hypokalaemia
D. Hypomagnesaemia
E. Myocardial ischaemia

E. myocardial ishchaemia
https://litfl.com/u-wave-ecg-library/#:~:text=Common%20causes%20of%20inverted%20U,U%20waves%20in%20Prinzmetal%20angina

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Which of the following drugs crosses the blood-brain barrier?
A. Edrophonium
B. Neostigmine
C. Pyridostigmine
D. Physostigmine
E. Sugammadex

D. Physostigmine
Explanation: Physostigmine is a tertiary amine and crosses the BBB, unlike the quaternary compounds neostigmine and edrophonium.

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Most likely electrolyte abnormality following iron polymaltose infusion?
A. Hypocalcaemia
B. Hypokalaemia
C. Hypophosphataemia
D. Hyponatraemia
E. Hypomagnesaemia

C. Hypophosphataemia
Explanation: Iron polymaltose can increase FGF23, causing renal phosphate wasting and hypophosphataemia.

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In which condition is 5% albumin contraindicated?
A. Hyperkalaemia
B. Hypernatraemia
C. Hyperphosphataemia
D. Hypercalcaemia
E. Hyperchloraemia

B) hypernatraemia
5% is isotonic but oncotic pressure draws more water into vasculature, potentially worsening intracellular dehydration
Contains no K, PO4
Ca: binds ionised calcium, may alter measurements (lowering ionised Ca)
Cl: has less Cl than NaCl, safe

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In a patient with mammalian meat allergy, which is least likely to cause an allergic reaction?
A. Protamine
B. Heparin
C. Enoxaparin
D. Bivalirudin
E. Recombinant Factor VII

D. Bivalirudin
Explanation: Bivalirudin is a synthetic direct thrombin inhibitor and does not contain mammalian products.

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Best method to analyse non-parametric ordinal data?
A. Linear regression
B. Chi-squared test
C. Logistic regression
D. Spearman coefficient
E. Pearson coefficient

D. Spearman coefficient
Explanation: Spearman rank correlation is used for ordinal data and non-parametric variables.

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Capnograph shows gradually rising baseline. What is the most likely cause?
A. Endobronchial intubation
B. COPD
C. Cuff leak
D. Sampling line leak
E. Spontaneous ventilation

Of these options… only SV would really make any sense whereas the rest are incorrect

indicates rebreathing
exhausted/malfunctioning CO2 absorber
other causes: faulty unidirectional valve, insufficient FGF, large dead space, ventilator/circuit malfunction (not delivering clean gas)

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55-year-old with exertional dizziness. ECG shows LVH with strain. Likely diagnosis?
A. LVH
B. HOCM
C. Takotsubo’s
D. Myocardial infarction
E. Aortic stenosis

a classic stitch up of HOCM vs AS, I spoke to lots of people, who knows, 50/50, Vibhushan Manchanda’s plan is AS because HOCM typically presents age <40 (but then again I am also reading that AS manifests after age 60)

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In what percentage of Takotsubo cases does LV function fully recover?
A. 25%
B. 50%
C. 75%
D. 90%
E. 100%

D. 90%
Explanation: The majority of Takotsubo cardiomyopathy cases resolve with full recovery of LV function.

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A study finds p = 0.05. What does this mean?
A. 1% chance result is due to chance
B. 5% chance result is due to chance
C. 50% chance result is due to chance
D. 95% confidence in result
E. 99% confidence in result

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B. 5% chance result is due to chance
Explanation: A p-value of 0.05 means a 5% probability the result occurred due to chance under the null hypothesis.

Hydromorphone 12 mg PO is equivalent to how much parenteral morphine?
A. 10 mg
B. 20 mg
C. 30 mg
D. 60 mg
E. 90 mg

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C. 20 mg
Explanation: Oral hydromorphone 12 mg = 60mg PO = 20mg parenteral morphine equivalent.

Tramadol 100 mg PO BD is equivalent to how much PO morphine daily?
A. 10 mg
B. 20 mg
C. 40 mg
D. 60 mg
E. 80 mg

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C. 40 mg
Conversion factor 0.2 (i.e. divide by 5)

5-year-old (20 kg) requires procedural sedation. Appropriate ketamine dose?
A. 20 mg
B. 40 mg
C. 60 mg
D. 80 mg
E. 120 mg

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A. 20mg
PCH guideline 1-1.5mg/kg followed by 0.5mg/kg 10 minutely https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Ketamine-sedation
Apparently real question was asking for IM dose - 4mg/kg

25. 3-year-old with high-velocity trauma. Best initial cervical spine management? A. Diagnose with CT B. Strap down C. Hard collar D. Sedate as appropriate E. Thoracic elevation device

E. Thoracic elevation device Explanation: Children <8yo use thoracic elevation device. Teenager use head elevation device (RCH guideline https://www.rch.org.au/clinicalguide/guideline_index/cervical_spine_assessment/)

26. What is least effective in preventing transition from acute to chronic post-surgical pain? A. Gabapentinoids B. Regional block C. Ketamine D. Duloxetine E. Reduction in preoperative opioid use

D: My answer will be duloxetine (source APMSE but sketchy) Gabapentinoids: pregabalin reduces neuropathic chronic postsurgical pain but not non-neuropathic. gabapentin has no demonstrated effect. Regional, ketamine - level I evidence Duloxetine - not mentioned Reduced preop opioids - not mentioned but makes sense hyperalgesia etc

27. Compared to sevoflurane and opioids, using paravertebral block with propofol TIVA during breast cancer surgery results in: A. Less nociceptive pain at 6 months B. Less neuropathic pain at 6 months C. Less neuropathic pain at 12 months D. Lower cancer recurrence E. Faster recovery room discharge

C. Less neuropathic pain at 12 months Explanation: Paravertebral block with TIVA has been shown to reduce persistent neuropathic pain up to 12 months post-op.

28. What is the duration of action of 100 mg intravenous carbetocin? A. 1 hour B. 2 hours C. 3 hours D. 4 hours E. 5 hours

C. 1 Explanation: Carbetocin has a prolonged uterotonic effect with a duration of action of 1 hr for IV and 2 hrs for IM https://www.tga.gov.au/sites/default/files/auspar-carbetocin-180823-pi.pdf

29. When can prophylactic enoxaparin be started after removal of a neuraxial catheter? A. 1 hour B. 2 hours C. 4 hours D. 6 hours E. 12 hours

D. 4 hours Explanation: ASRA guidelines 12 hrs after insertion, 4 hrs after removal

30. Which is the safest drug to use in a patient with a history of serotonin syndrome? A. Methadone B. Fentanyl C. Morphine D. Codeine E. Tramadol

C. Morphine Explanation: Morphine has minimal serotonergic activity and is considered safer than other opioids in patients with serotonin syndrome history.

31. Injecting LA through the thyrohyoid membrane blocks which nerve? A. Glossopharyngeal nerve B. Hypoglossal nerve C. Lingual nerve D. Recurrent laryngeal nerve E. Superior laryngeal nerve

E. Superior laryngeal nerve Explanation: The superior laryngeal nerve is blocked by injecting local anaesthetic through the thyrohyoid membrane.

32. Which technique is not effective for analgesia for sternal fractures? A. Parasternal intercostal nerve block B. PECS I C. PECS II D. Transversus thoracic muscle plane block E. Subpectoral interfascial plane block

B. PECS I Explanation: PECS I targets the medial and lateral pectoral nerves and does not provide coverage for sternal fractures.

33. What is the maximum dose of ropivacaine for continuous infusion over 24 hours? A. 192 mg B. 300 mg C. 620 mg D. 770 mg E. 1200 mg

C. 770 mg Explanation: 11mg/kg for 70kg person.

34. ANZCA guidance for semaglutide in non-endoscopic surgery? A. Cease for 2 weeks. Extended fasting. Treat as unfasted. B. Cease for 2 weeks. Normal fasting. Treat as unfasted. C. Cease for 4 weeks. Extend fasting. Treat as fasted. D. Cease for 4 weeks. Extend fasting. Treat as unfasted. E. Continue usual dose. Normal fasting. Treat as unfasted.

ZINGER Explanation: none of the above. continue GLP1. 24 hrs clear fluid, 6 hr fast. If solids consumed in last 24 hrs or fasting <6 hrs, then consider gastric USS/IV erythromycin/local protocols for unfasted patients/defer procedures. https://www.anzca.edu.au/getContentAsset/0f35028e-e371-4220-a49a-ddee877051c8/80feb437-d24d-46b8-a858-4a2a28b9b970/Periprocedural-GLP-1-use-consensus-clinical-guide_P2.pdf

35. Microshock can be prevented by which of the following? A. Equipment isolation B. Equipotential earthing system C. Fused equipment D. Line isolation system with monitor E. Residual current device

D. Line isolation system with monitor Explanation: Line isolation systems with monitors are used in operating theatres to prevent microshock risk to patients.

36. In LAST with cardiac arrest, what is the max dose of 20% Intralipid? A. 6 mL/kg B. 12 mL/kg C. 15 mL/kg D. 20 mL/kg E. 25 mL/kg

B. 12ml/kg AAGBI https://anaesthetists.org/Portals/0/PDFs/Guidelines%20PDFs/New%20archived/Guideline_management_severe_local_anaesthetic_toxicity_v2_2010_archived.pdf?ver=2023-06-23-134115-697

37. Most accurate way to assess fluid status in a child? A. Urine output B. Blood pressure C. Capillary refill D. Change in weight E. Change in HR

D. Change in weight Explanation: Daily weight is the most accurate indicator of fluid status in paediatric patients. https://www.rch.org.au/clinicalguide/guideline_index/dehydration/

38. Minimum current for macroshock to induce VF? A. 10 microamps B. 100 microamps C. 100 mA D. 1 A E. 100 A

C. 100 mA Explanation: Macroshock of 100 mA across the heart can induce ventricular fibrillation.

39. Carcinoid syndrome with new murmur. Most likely valvular lesion? A. Tricuspid regurgitation B. Aortic stenosis C. Aortic regurgitation D. Mitral stenosis E. Mitral regurgitation

A. Tricuspid regurgitation Explanation: Serotonin from carcinoid syndrome causes fibrosis, especially of right-sided valves, leading to tricuspid regurgitation.

40. Inadvertent intra-arterial CVC placement during elective surgery. Best initial management? A. Leave in situ and consult vascular surgeon B. Remove and compress site C. Start heparin infusion D. Ultrasound to check patency E. Call interventional radiology

B. Remove and compress site Explanation: If detected early during elective surgery, the safest option is to remove the catheter and apply pressure immediately.

41. During shoulder surgery, interscalene block is performed. Which nerve is least likely to be blocked? A. Axillary nerve B. Suprascapular nerve C. Long thoracic nerve D. Musculocutaneous nerve E. Median nerve

E. Median nerve Explanation: The median nerve originates from the medial and lateral cords, and is often not reliably blocked by interscalene approach. Not sure about this. I know it misses C8/T1 and ulnar nerve. ABCD all seem pretty correct for ISB. So I guess median nerve is what's left?

42. What is the recommended strategy to reduce awareness during general anaesthesia? A. Use of N2O B. BIS monitoring C. Neuromuscular monitoring D. End-tidal CO2 monitoring E. TIVA with high-dose opioids

B. BIS monitoring Explanation: BIS-guided anaesthesia can reduce the risk of awareness, especially in high-risk patients or during TIVA.

43. Which of the following statements regarding sugammadex is true? A. Effective for benzylisoquinolinium NMBAs B. Contraindicated in renal failure C. Causes bradycardia via muscarinic agonism D. Cross-reacts with neostigmine E. Acts by acetylcholinesterase inhibition

B. Contraindicated in renal failure Explanation: Sugammadex is primarily renally excreted and should be avoided in patients with severe renal impairment.

44. Which property of nitrous oxide contributes to risk of bowel expansion? A. High MAC B. Low solubility C. High blood-gas coefficient D. High lipid solubility E. Low molecular weight

B. Low solubility Explanation: N₂O diffuses rapidly into closed air spaces due to its low blood solubility, increasing volume and pressure.

45. Best predictor of difficult bag-mask ventilation? A. Beard B. BMI >30 C. Edentulous D. Neck circumference E. Mallampati score

A. Beard Explanation: Beards worst OR in ANZCA airway assessment doc

46. Most appropriate management of intraoperative bronchospasm? A. Salbutamol B. Propofol bolus C. IV magnesium D. Increase volatile agent E. Deepen anaesthesia with ketamine

these are hard options

47. Which local anaesthetic has the lowest risk of systemic toxicity? A. Bupivacaine B. Lignocaine C. Prilocaine D. Ropivacaine E. Tetracaine

C. Prilocaine Lower cardiac and CNS toxicity than lignocaine and bupivacaine Metabolised quickly, low plasma concentrations But does have risk of methaemoglobinaeima

48. High spinal block with bradycardia and hypotension. What is the cause of bradycardia? A. Sympathetic blockade below T10 B. Reduced preload activating baroreflex C. Carotid sinus reflex D. Unopposed parasympathetic tone E. Hypoxia

D - unopposed parasympathetic tone Due to blockade of cardiac fibres T1-T4

49. What is the main mechanism of renal impairment in sepsis? A. Vasoconstriction B. Tubular obstruction C. Apoptosis D. Ischaemia-reperfusion injury E. Endothelial dysfunction

D: ischaemia-reperfusion Combination of hypoperfusion (ischaemia) followed by reperfusion leading to oxidative stress, inflammation, endothelial dysfunction, and mitochondrial damage

50. Which medication is most effective for reducing emergence delirium in children? A. Midazolam B. Fentanyl C. Clonidine D. Ketamine E. Dexmedetomidine

E. Dexmedetomidine Explanation: Dexmedetomidine has strong evidence for reducing emergence delirium due to its sedative and anxiolytic properties. Midaz - less effective Fentanyl - reduced pain related agitation but do not prevent true emergence delirium Clonidine - moderate, less than dexmed Ketamine - may worsen ED with hallucinations

Q1-50 Flashcards

(50 cards)