MCQ 2025.1

Question 1

Sphenopalantine ganglion block which foramen is traversed?
Sphenopalatine foramen
Lesser palatine
Greater palatine

Answer 1

Sphenopalatine foramen

The sphenopalatine ganglion block is performed by targeting the sphenopalatine foramen.

The sphenopalatine ganglion (also called the pterygopalatine ganglion) is located in the pterygopalatine fossa, and access for the block is via the sphenopalatine foramen.

The sphenopalatine foramen is a natural opening between the nasal cavity and the pterygopalatine fossa, allowing access to the ganglion for local anaesthetic delivery

Question 2

Which local anaesthetic is safe in G6PD?
Prilocaine
Bupivacaine
Lignocaine
Articaine

Answer 2

Correct answer:
Bupivacaine

Prilocaine, lignocaine (lidocaine), and articaine are all associated with a risk of methemoglobinemia in G6PD deficiency and are best avoided.
Bupivacaine is considered safe.

Prilocaine: Known to cause methemoglobinemia and should be avoided in G6PD deficiency.

Lignocaine (lidocaine): Rarely, but has been reported to cause hemolysis and methemoglobinemia in G6PD deficiency, so caution is advised and alternatives are preferred.

Articaine: Also associated with methemoglobinemia risk and is best avoided in G6PD deficiency.

Bupivacaine: Not associated with increased oxidative stress or methemoglobinemia in G6PD deficiency and is generally considered safe.

Question 3

Young male patient with collapse has this ECG what is the diagnosis?
Had short PR and possibly a delta wave.

Answer 3

WPW

Question 4

RANZCOG guidelines for prophylactic antibiotics after instrumental vaginal delivery?

Ampicillin 1g plus 200 clavulanic acid
Cephazolin 2g
IV Metronidazole
Cephazolin 2g plus metronidazole 500mg
Nothing

Answer 4

The recommended prophylactic antibiotic for instrumental (operative vaginal) delivery is a single intravenous dose of amoxicillin-clavulanic acid (1 g amoxicillin + 200 mg clavulanic acid) within 6 hours of birth, according to major guidelines and large randomized controlled trials.

This regimen is supported by the Queensland Health, NICE, WHO, and landmark studies (e.g., The Lancet 2019), which showed significant reduction in maternal infection after instrumental vaginal birth with this prophylaxis.

Cephazolin (with or without metronidazole) and ampicillin alone are not recommended first-line for this indication.

Question 5

Contraindications or precautions for ICG

G6PD
Methaemoglobinaemia
Porphyrea
Iodine/iodide allergy

Answer 5

Iodine allergy is the relevant contraindication/precaution for ICG.
G6PD deficiency, methaemoglobinaemia, and porphyria are not.

Indocyanine Green for Injection USP contains sodium iodide and should be used with caution in patients who have a history of allergy to iodides because of the risk of anaphylaxis.

Question 6

COHb - what happens to spo2 and PaO2
Normal / normal
Normal / reduced
Reduced / reduced
Reduced / normal

Answer 6

Correct answer:
Normal / normal

SpO₂: Normal (falsely reassuring)
PaO₂: Normal

Standard pulse oximeters cannot distinguish between oxyhemoglobin and carboxyhemoglobin, so they “see” both as oxygenated hemoglobin, leading to an overestimation of true oxygen saturation.

> SpO₂ is normal, PaO₂ is reduced
- Left shift of the oxygen-hemoglobin dissociation curve (e.g., alkalosis, hypothermia, low 2,3-DPG)
- Technical errors: e.g., venous sampling labeled as arterial.
- Dyshemoglobinemias or hemoglobinopathies: Some rare variants may cause this dissociation

> Reduced / reduced
- Hypoxemic respiratory failure (e.g., pneumonia, ARDS, COPD exacerbation, pulmonary edema, PE, shunt, V/Q mismatch).
- High altitude (low inspired oxygen).

> Reduced / normal
- Dyshemoglobinemias (e.g., methemoglobinemia, sulfhemoglobinemia): Pulse oximeter reads low (SpO₂ ~85%), but PaO₂ (dissolved oxygen) is normal because oxygen is present in plasma but not available to tissues.
- Severe anemia: SpO₂ may be normal, but if a dyshemoglobinemia is present, SpO₂ may be low while PaO₂ is normal.
- Technical artifact: Nail polish, poor perfusion, motion artifact.

Question 7

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 for a study that produced a p value of 0.05?

5%
50%
95%
99%

Answer 7

50%

If you get a p-value of 0.05 and repeat the study, there’s a 50% chance you’ll get a p-value greater than 0.05 in the next test, as the p-value is a probability of observing the data or more extreme results if the null hypothesis is true.

If the true effect is zero (null hypothesis is true), the probability that the next experiment yields a p-value above 0.05 is 50%—because under the null, p-values are uniformly distributed between 0 and 1

Question 8

Bronchial blocker adaptor - where does the fiberoptic bronchoscope (FOB)go?
A
B
C
D

Answer 8

For example, in the commonly used multiport adaptor (such as with the Arndt or EZ Blocker), the ports are typically:

One port for the endotracheal tube connection.

One port for the bronchial blocker.

One port for the ventilation circuit.

One port with a self-sealing membrane for the fiberoptic bronchoscope

Question 9

Salbutamol 10mg neb - how long does the K reduction last for
- 5 minutes
- 15 minutes
- 30 minutes
- 60 minutes

Answer 9

60mins.

Salbutamol effect lasts at least 2–3 hours.

Maximum reduction is typically seen at 30–60 minutes, but the effect persists beyond this

Question 10

Global warming potential (GWP100) from highest to lowest ranking of inhalational volatile agents?

• Desflurane > isoflurane > nitrous oxide > sevoflurane
• Desflurane > nitrous oxide > isoflurane > sevoflurane

Answer 10

Desflurane > isoflurane > nitrous oxide > sevoflurane.

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

Question 10

SVT in child - unstable - how many joules per kilogram
- 1
- 2
- 3
- 4
- 5

Answer 10

For an unstable child with supraventricular tachycardia (SVT), the recommended initial energy dose for synchronized cardioversion is 1 joule per kilogram (1 J/kg). If this is ineffective, the dose can be increased to 2 J/kg, and in some guidelines, up to 4 J/kg if needed.

Correct answer:

1 J/kg (initial dose for synchronized cardioversion in unstable paediatric SVT)

Question 11

ECG interpretation - middle aged person with dizziness on exercise with anterolateral TWI with some ?STD or ?Large QTS complexes - subtle.

• ACS
• HOCM
• LVH with strain pattern

Answer 11

Anterolateral T-wave inversion (TWI) with subtle ST depression is most strongly associated with acute coronary syndrome (ACS) among the options provided.

ACS - less likely LVH criteria, Pathological Q waves in infarcted territory TWI in leads corresponding to ischaemic territory; less deep than HOCM, often asymmetric, ST elevation (STEMI) or depression (NSTEMI/reciprocal); concordant with area of injury

HOCM: LVH (High QRS), Deep, narrow “dagger-like” Q waves (esp. lateral/inferior leads), Deep, symmetric TWI, especially anterolateral leads; giant negative T waves in apical HCM, Nonspecific ST changes; may have mild ST depression or elevation, often discordant to QRS

LVH with strain: Can cause lateral TWI and ST depression, but typically the TWI is asymmetric and accompanied by voltage criteria for LVH

Question 12

Chest xray pointing to valves. What is the one is it pointing to?
- AVR
- MVR
- PVR
- TVR

Answer 12

If the arrow or pointer is near the left atrial bulge/posterior heart border, the valve is the mitral valve (MVR).

If near the aortic knob/upper left heart border, it is the aortic valve (AVR).

If anterior and near the pulmonary artery, it is the pulmonary valve (PVR).

If near the right heart border inferiorly, it is the tricuspid valve (TVR).

Question 13

Torsades HD unstable but pulse present - Mg or shock? Synchronised and energy level?
- Asynchronous 50 joules
- Asynchronous 200 joules
- Synchronous 50 joules
- Synchronous 200 joules
- Magnesium

Answer 13

Magnesium
(- Adult dose: 1–2 g IV over 5–60 min, then 0.5–1 g/hr IV if needed.
- Pediatric dose: 25–50 mg/kg IV (max 2 g) over 10–20 min)

After Magnesium, if remaining unstable w a pulse, recommendation is start at synchronised 50 joules and escalate if necessary.

If the patient loses their pulse (cardiac arrest), then asynchronous (defibrillation) at 200 joules is indicated.

Question 14

OIVI risk factors which one is NOT a RF?

• Male
• Pre-operative opioid use
• Diabetic

Answer 14

MALE

Female sex is more often associated with increased risk in the literature and guidelines

APSME 5th:
Risk factors for opioid-induced ventilatory impairment (OIVI):
- Pre-existing respiratory disease (COPD)
- Cardiac disease
- Diabetes
- Hypertension
- Neurological disease
- Two or more comorbidities
- Genetic variations in opioid metabolism
- Opioid tolerance (patients on chronic opioid therapy)
- Obesity
- Obstructive sleep apnoea
- Renal impairment
- Concomitant use of other central nervous system depressants (e.g., benzodiazepines, sedating antihistamines, alcohol)
- Advanced age

Question 15

A. Aim for higher BSL EXCEPT for patients with:

• Autonomic neuropathy
• Pregnancy
• Hypoglycaemia unawareness
• Emergency surgery with poor glycaemic control

B. OR Which group of patients is there a lower BSL target thats not BSL 8-12?
- Pregnant Patients
- Poorly Controlled DM
- Recent Hypoglycemia
- Emergency Surgery

Answer 15

A. Emergency surgery with poor glycaemic control

Why tighter control:
- Pregnancy -> Reduces risk of adverse fetal/maternal outcomes.
- Autonomic neuropathy -> Slows progression of nerve dysfunction, prevents complications/
- Hypoglycaemia unawareness -> Prevents severe hypoglycaemia, restores awareness through stable glycaemia

B. Pregnant Patients

Question 16

AHA which is NOT intermediate risk factors
- Uncontrolled HTN
- Diabetes
- Renal impairment
- History of congestive cardiac failure
- History of myocardial ischaemia

Answer 16

MI /CHF are both major risk factors.

Diabetes, renal impairment, and uncontrolled hypertension remain intermediate risk factors.

Question 17

Which is NOT a GLP1 agonists effect?
- Pancreatitis
- Weight loss
- Bradycardia
- Reduced cardiac events

Answer 17

Bradycardia

Question 18

DPP4 inhibitors - on day of surgery mgmt?

• Continue day of surgery
• Withhold because lactatemia
• Withhold because ketosis
• Withhold because of hypoglycaemia

Answer 18

Withold because of hypoglycemia.
OR DON’T WITHHOLD?

Sulfonylureas - hypoglycemia
Meglitinides - hypoglycemia (Inhibition of Hepatic Gluconeogenesis = pyruvate buildup + inhibits mitochondrial ETC = anaerobic metabolism)
Metformin - lactic acidosis
SGLT2 Inhibitors - euglycemic ketoacidosis
GLP1 agonists - aspiration, N/V.

Question 19

AV block ECG
- Mobitz type 1
- Mobitz type 2
- Third degree heart block

Answer 19

3rd degree

Mobitz type 1 - prolong PR then dropped QRS/beat (block at AV).
Mobitz type 2 - intermittent, sudden non-conducted P waves/dropped QRS waves, constant PR waves before+after (block at His-Purkinje)

Question 20

Salbutamol how many puffs for anaphylaxis - 8 yr old
- 6
- 8
- 12

Answer 20

12.

• 1–5 years: 6 puffs (100 mcg/puff) per dose
• 6 years and over (including adults): 12 puffs (100 mcg/puff) per dose
• Repeat every 20 minutes for up to three doses as needed

Nebulised dose equivalents:
- Children 4–12 years: 2.5 mg/dose
- Adults: 5 mg/dose

Question 21

Sensory innervation to medial aspect of the knee, leg, and foot, specifically the anteromedial and medial surfaces

• Superficial peroneal
• Saphenous
• Sural
• Deep peroneal

Answer 21

Saphenous - Medial knee, leg, and foot .
Nil motor.

• Tibial N:
  SENSORY: Sole of foot, posterolateral leg, lateral foot
  MOTOR: Posterior leg, most intrinsic foot
• Deep Peroneal -
  SENSORY: First web space (between 1st and 2nd toes)
  MOTOR: Anterior leg, some dorsal foot
• Superficial peroneal:
  SENSORY: dorsum of the foot and MOTOR: lower lateral leg
• Sural:
  SENSORY: lateral and lower posterolateral foot
  MOTOR: NIL

Question 22

What happens if you stimulate the posterior cord with nerve stimulator during infraclavicular block:

• Wrist flexion
• Wrist extension
• Supination
• Pronation

Answer 22

WRIST EXTENSION

• Posterior cord = Axillary, radial nerve = Wrist/finger extension, thumb abduction, or elbow extension (triceps).
• Lateral cord = Musculocutaneous, part of median = Elbow flexion (biceps contraction)
• Medial cord = Ulnar, part of median = Wrist flexion, finger flexion, or finger abduction (ulnar side)
  Musculocutaneous: Elbow flexion

MOTOR
Median: Wrist/finger flexion, thumb opposition

Ulnar: Medial finger flexion, finger ab/adduction

Radial: Wrist/finger extension, thumb abduction, supination

Axillary (for reference): Shoulder abduction (deltoid), external rotation (teres minor)

Question 23

Carbetocin 100 microg intravenously lasts for
- 1 hour
- 2 hours
- 4 hours
- 5 hours

Answer 23

1HR IV
4-6HR IM

Question 24

Gastric ultrasound image interpretation - <100mL - >100mL - Middle stage Solids - Late stage solids

Question 25

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 25

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

Question 26

Conns Syndrome BSL K SODIUM

Answer 26

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

Question 27

Addisonian Crisis Electrolyte abnormalities SODIUM K BSL HCO3

Answer 27

Hyponatremia Hyperkalemia Low Bicarbonate (HCO₃⁻) Hypoglycemia

Question 28

Cervical spine x-ray identification

Question 29

Brachial Plexus Diagram

Question 30

Obesity in pregnancy - what is it NOT a risk factor: - Antenatal Depression - Pre-eclampsia - HTN in pregnancy - Cholestasis of pregnancy

Answer 30

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

Question 31

Topicalisation of infant airway weighing 5kg maximum dose - 5mg per kg - 7mg per kg - 9mg per kg

Answer 31

Most guidelines recommend no more than 3–5 mg/kg for topical use in infants and young children (increased susceptibility to toxity, reduced protein binding, immature liver metabolism, smaller Vd) Adults topicalisation is 8-9mg/kg LBW w adrenaline

Question 32

Albumin - which electrolyte derangement to have caution in: - Hypernatremia - Hyperphosphatemia - Hyperkalemia

Answer 32

Hypernatraemia 20% albumin is hypertonic

Question 32

Rapid trauma score involves GCS, BP and: - Respiratory rate - Saturations - Heart rate - Temperature

Answer 32

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)

Question 33

Anorexia nervosa with refeeding - what electrolyte do you monitor with weakness, heart failure - Hypophosphatemia - Hypomagnesemia

Answer 33

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

Question 34

SOFA score in sepsis doesn't include: - Lactate - Bilirubin - Platelets - Pa/FiO2 - GCS

Answer 34

LACTATE The SOFA score includes: - Bilirubin (liver function) - Platelets (coagulation) - PaO₂/FiO₂ ratio (respiratory function) - GCS (neurological function)

Question 35

Amiodarone dose for paeds patient

Answer 35

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)

Question 36

Internal cardiac defibrillation - max dose - 10 J - 20 J - 50 J - 100 J

Answer 36

The maximum dose for internal cardiac defibrillation is 50 Joules.

Question 37

Which drug does NOT increase the defib threshold in patient with ICD? - Verapamil - Atropine - Diltiazem - Flecainide - Sotalol

Answer 37

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 DFT

Question 38

Mannitol given in a patient who had received 400mg dantrolene - 12g - 60g

Answer 38

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

Question 39

What does this part of the chest drain show? - Severity of air leak on chest drain - Intrapleural pressure - Amount of suction

Answer 39

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.

Question 40

Caudal dose of 2 year old weighing 12kg with 0.2% ropivacaine for orchidopexy - 3ml - 5ml - 6ml - 12ml

Answer 40

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

Question 41

Sodium bicarbonate dose for 80kg patient with ?TCA overdose or kyperkalemia - 40mL - 60mL - 80mL

Answer 41

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.

Question 42

Oral hydromorphone 12mg to parenteral to morphine - 10mg - 20mg - 40mg - 60mg

Answer 42

20mg PARENTERAL MORPHINE Conversion factor: 1 mg oral hydromorphone = 5 mg oral morphine. 12 mg oral hydromorphone × 5 = 60 mg oral morphine. Oral morphine to parenteral morphine: Conversion factor: 3 mg oral morphine = 1 mg parenteral morphine. 60 mg oral morphine ÷ 3 = 20 mg parenteral morphine.

Question 43

Tramadol 100mg BD to daily oral morphine equivalent - 10mg - 20mg - 40mg

Answer 43

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

Question 44

7.5Fr CVC into carotid artery for elective TAVI - what do you do. - Contact surgeons - Pull out and put pressure - Heparinise - Leave in 24 hours or something

Answer 44

Contact surgeons (vascular or cardiothoracic surgery) immediately.

Question 45

PISS for oxygen - 1, 5 - 1, 6 - 2, 5 - 2, 6

Answer 45

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

Question 46

Colour on the shoulder for air cylinder: - Grey - Blue - Black - Black and white - White

Answer 46

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

Question 47

Max ropivacaine dose in 24hrs - 300mg - 770mg - 620mg - 1220mg

Answer 47

770mg

Question 48

Atmospheres of pressure if you kink oxygen tubing for hudson mask running at 6l/min connected to wall - 4 atm - 1 atm - 2 atm - 3 atm

Answer 48

1 atm This is because hospital wall oxygen is supplied at a regulated pressure (usually 400–500 kPa or about 4–5 atm absolute), but the flowmeter and downstream tubing deliver oxygen at or near atmospheric pressure, regardless of flow rate or downstream occlusion.

Question 49

Manujet max pressure you can set - 0.5 bar - 2 bar - 3.5 bar - 5 bar

Answer 49

3.5 Bar

Question 50

Rapid O2 via needle cricothyroid - how often to do the 2s insufflation - 10 seconds - 20 seconds - 30 seconds - 60 seconds

Answer 50

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.

Question 51

Ultrasound image of supraclavicular or superficial cervical plexus saying 5 mL in this area likely to get - Shoulder anaesthesia - Diaphragm paralysis - Loss of sensation anterolateral neck

Answer 51

Loss of sensation anterolateral neck

Question 52

Graph of values / data points falling on exponential decay looking curve. What test would you use to determine relationship? - Logistic regression - Pearson - linear regression - Chi Square test

Answer 52

Linear regression (after log-transforming the y-values) or Kolmogorov-Smirnov test If your data points fall on an exponential decay curve, the most appropriate test to determine the relationship is not linear regression or Pearson correlation, since those assume a linear relationship.

Question 53

Overexpansion volume pressure curve - Too high PEEP - Too low PEEP - Too high tidal volume

Answer 53

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

Question 54

Which nerve doesn't innervate the shoulder joint - Axillary - Supraclavicular - Lateral pectoral - Suprascapular

Answer 54

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

Question 55

Absolute contraindication for TIPS - Severe TR - Hepatocellular carcinoma - Portal Vein thrombosis

Answer 55

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

Question 56

Open disclosure - according to ANZCA document which is not a component - Opportunity to fulfill medicolegal obligations - Apologise or display regret

Answer 56

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"

Question 57

What is not QA step according to ANZCA document - Planning - Doing - Acting - Benchmarking - Checking

Answer 57

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

Question 58

Patient is on an SSRI ( maybe fluoxetine?) Serotonin syndrome which is lowest risk with: - Oxycodone - Morphine - Fentanyl - Tramadol - Methadone

Answer 58

Morphine

Question 59

What reduces the methadone effect - Grapefruit - Phenytoin

Answer 59

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

Question 60

Cell salvage what doesn't it guarantee removal of: - foetal red cells - Free haemoglobin

Answer 60

Feotal Red Cell

Question 61

Leucodepletion filter - what does it help prevent? - CMV - Allergy - HCV - Acute haemolytic reaction - ABO incompatibility

Answer 61

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

Question 62

Level 2 check, 2-bag test what does it NOT check for - Low-pressure leak - Expiratory limb obstruction - Inspiratory limb obstruction - Proper functioning of valves and APL valve

Answer 62

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

Question 63

Capnograph what is the problem (normal ETCO2 followed by steep upsloping ETCO2 towards end of expiration/delta wave up) - Sample line leak - Endobronchial - COPD - Patient triggering the ventilator

Answer 63

Sample Line Leak

Question 64

Block via thyrohyoid membrane - blocking between VC and epiglottis. What nerve? - Glossopharyngeal - Hypoglossal - Superior laryngeal - Recurrent laryngeal

Answer 64

Vallecula = Glossopharyngeal nerve (CN IX) - Anterior epiglottis (pharyngeal) = Glossopharyngeal nerve (CN IX) - Posterior epiglottis (laryngeal) = internal branch of superior laryngeal nerve (CN X)

Question 65

PENG - where does local go - Between iliacus and femoral neck - Psoas tendon something - Between psoas tendon and pubic ramus

Answer 65

Psoas Tendon and Pubic Ramus

Question 66

68. ESPB block where does catheter go - Deep to erector spinae and deep to T5 transverse process - Lateral to erector spinae and posterior to 6th rib - Between erector spinae and rhomboid - Anterior to erector spinae superficial to T5 transverse process

Answer 66

Anterior to erector spinae, superficial to T5 transverse process.

Question 67

Sternal fracture - what block does not cover - PECS 1 - PECS 2 - Parasternal intercostal plane - Paravertebral block

Answer 67

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.

Question 68

Fontan intraop ventilation best management for open appendectomy - Try to maintain spontaneous ventilation - Short inspiratory time - Longer inspiratory time with lower pressures - Increase inspiratory pressures - Add PEEP

Answer 68

?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

Question 69

What is the mechanism of action of empagliflozin - Decreased glucose reabsorption - Sensitisation to insulin

Answer 69

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

Question 70

Clexane - when can you restart Clexane after removal of the epidural catheter? - 1 hour - 2 hours - 6 hours - 24 hours - 48 hours

Answer 70

4 hours

Question 71

Hypothermia specifically 32-34 degrees who will benefit if unconscious? - Stroke - cardiac arrest - isolated TBI - Subarachnoid haemorrhage

Answer 71

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.

Question 72

GLP1 for non-diabetics - what are the ANZCA guidelines? - Don’t withhold and treat as unfasted - Withhold 2 weeks and treat as unfasted - Withhold for 2 weeks and treat as fasted - Withhold 4 weeks and treat as unfasted - Withhold for 4 weeks and treat as fasted

Answer 72

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.

Question 73

Smallest weight for microcuff ETT (in kg) - 1 - 3 - 5

Answer 73

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.

Question 74

Burns 30% BSA what physiological change would you expect in first 24hrs - Increased SVR - Decreased PVR - Increased cardiac index - Increased stroke volume - Increased hepatic blood flow

Answer 74

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.

Question 75

Which physiological finding to differential between malignant hyperthermia and anaesthesia induced rhabdomyolysis - Elevated carbon dioxide - Myoglobinuria - Rigidity

Answer 75

RIGIDITY Feature|MH v AIR -Rigidity| Prominent (generalsied, masseter spasm) v Rare - Elevated CO2 | Common v Common - Myoglobinuria | Possible v Common - Onset | Rapid v often delayed - Muscle Rigidity | Prominent (generalized, masseter spasm) v Rare or absent - Hypercapnia | Marked and early (↑ETCO₂) v mayoccur, less prominent - Hyperthermia | rapid and severe v may be absent or less pronounced. - Myoglobinuria | Common, but later v Common and often early. - Hyperkalaemia | May occur, but less severe v Often severe and early, risk of cardiac arrest. - CK Elevation | Present, but not as high as AIR v Marked, 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

Question 76

Which is not a risk factor for OSA identified in STOPBANG: - Alcohol - Daytime tiredness - Gender - Hypertension

Answer 76

Alcohol

Question 77

Lambert Eaton Myasthenic syndrome - sensitivty to sux and NMBD - Increased sensitivity to depolarising, decreased sensitivity to nondepolarizing - Decreased sensitivity to depolarising, increased sensitivity to nondepolarising - No change in sensitive to depolarising or non-depolarising muscle relaxants - Increased sensitivity to both

Answer 77

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

Question 78

Which one is a predictor of postoperative respiratory impairment in patients with myasthenia gravis: - Pyridostigmine 500mg - BMI 30 - COPD related lung disease

Answer 78

COPD 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

Question 79

What is NOT an adverse effect for HBOT - Bradycardia - Reversible hypermetropia - Cataracts - Hypoglycaemia - Seizures

Answer 79

Cataracts Bradycardia: Has been reported as a cardiovascular effect during HBOT, especially in patients with underlying heart disease. Reversible hypermetropia: HBOT can cause changes in vision, most commonly transient myopia (nearsightedness), but reversible hypermetropia (farsightedness) is also reported as a temporary effect. Cataracts: While HBOT can accelerate the progression of existing cataracts, it does not cause new cataract formation as a direct adverse effect. Cataract formation is not generally listed as a primary adverse effect of HBOT in major reviews. Hypoglycaemia: HBOT can lower blood sugar, especially in diabetic patients. Seizures: Oxygen toxicity during HBOT can cause seizures

Question 80

How many exacerbations in the GOLD E classification for COPD - 1 or more - 2 or more - 3 or more

Answer 80

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

Question 81

Potential C Spine trauma in 3 y.o. What is the best management? - Sedate child until C Spine is adequately aligned - Hard Collar - Use Thoracic Elevation Device - Restrain child to hard board - CT as first line imaging

Answer 81

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

Question 82

Spirometry interpretation - Slightly low FEV1, FVC 96% predicted, DLCO normal. - Obesity - Sarcoid - Asthma - Emphysema

Answer 82

Obesity

Question 83

Which does not reduce DLCO? - Anaemia - Asthma - Emphysema

Answer 83

Asthma

Question 84

What is the usual spirometry finding in cystic fibrosis - mixed obstructive + restrictive - Obstructive pattern with reduced FEV1 - Obstructive pattern with reduced FVC - Restrictive pattern

Answer 84

Obstructive pattern with reduced FEV1

Question 85

ECG triggered timing for deflation of balloon pump - Beginning of t wave - Middle of t wave - End of t wave - R wave - S wave

Answer 85

The correct answer is: End of the T wave

Question 86

Brain death testing - which one is NOT appropriate? - Radionuclide testing - Intra-arterial vessel angiogram - MRI angiogram - CT angiogram

Answer 86

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

Question 87

PVB + propofol VERSUS sevoflurane for mastectomy - No difference with cancer recurrence - No difference in chronic pain - Reduction in incisional pain at 6 months - Reduction in neuropathic pain at 6 months - Reduction in neuropathic pain at 12 months

Answer 87

No difference with cancer recurrence

Question 88

Best for post amputation pain - Peripheral nerve block - Neuraxial - Gabapentin - NMDA receptor antagonists

Answer 88

Peripheral Nerve Block

Question 89

Methylpred dose in Traumatic Brain Injury - None - 1g - 1.5g - 2g

Answer 89

None. Systemic corticosteroids should not be used to treat TBI due to evidence of increased mortality and lack of benefit. CRASH trial demonstrated increased mortality with high-dose methylprednisolone in TBI patients.

Question 90

What are the benefits of intravenous vancomycin in conjunction with cefazolin compared to cefazolin only for joint arthroplasty? - 20% decrease in surgical site infection - 50% decrease surgical site infection - 20% increase in surgical site infection - 50% increase in surgical site infection - No difference

Answer 90

No difference. The ASAP trial (Australian Surgical Antibiotic Prophylaxis trial, 2023), a large, multicenter, randomized controlled trial, found that adding intravenous vancomycin to cefazolin for joint arthroplasty did not reduce surgical site infection rates compared to cefazolin alone. In some subgroups (such as knee replacements), the infection rate was actually higher in the vancomycin group

Question 91

55 year old patient with TBI. What SBP would you aim for? - >90 - >100 - >110 - >120

Answer 91

(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

Question 92

Brugada - what drug is NOT safe? - Thiopentone - Propofol - Ketamine

Answer 92

Ketamine 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

Question 93

Smallest number needed to treat for analgesia - Paracetamol - Codeine - Ibuprofen - Paracetamol plus codeine - Paracetamol plus ibuprofen

Answer 93

Paracetamol plus ibuprofen has the smallest NNT for analgesia as per APSME 5th edition. DRUG|NNT Paracetamol + ibuprofen|1.5–1.6 Paracetamol + codeine (1000/60 mg) | 2.2–2.7 Ibuprofen (400 mg) 2.5 Paracetamol (1000 mg) | 3.6–3.8 Codeine (60 mg) | 12

Question 94

4th heart sound at the apex - Normal < 40 - Athlete - HTN - ?Pregnancy

Answer 94

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

Question 95

Time to onset IM suxamethonium - 30 seconds - 1 minute - 2 minutes - 4 minutes

Answer 95

2min IV = 30–60 seconds.

Question 96

Mammalian meat allergy NOT likely to react to: - Recombinant factor 7a (eptacog alpha) - Prothrombinex - Protamine - Some other recombinant factor - Heparin

Answer 96

HEPARIN - Recombinant factor VIIa (eptacog alpha) and other recombinant factors are produced using recombinant DNA technology in non-mammalian cell lines - Prothrombinex is a plasma-derived product from human blood, - Protamine is derived from fish sperm

Question 97

Dose of IM ketamine you would use initially in ED for procedural sedation 20kg child - 20mg - 40mg - 60mg - 100mg - 120mg

Answer 97

100mg For a 20 kg child requiring IM ketamine for procedural sedation in the Emergency Department, the recommended initial dose is 4–5 mg/kg IM

Question 98

Ketamine oral bioavailability - 10% - 20% - 30% - 50%

Answer 98

20%

Question 99

Intralipid total maximum cumulative dose - 10 ml/kg - 12 ml/kg - 15 ml/kg - 20 ml/kg - 25 ml/kg

Answer 99

12ml/kg

Question 100

Which is not a risk factor for postoperative delirium in paediatrics? - ENT surgery - Parental anxiety - Sevoflurane anaesthetic - Negative experience with healthcare workers

Answer 100

Negative Experience with Healthcare Workers. 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

Question 101

Which is least likely to affect thrombin time - Bivalirudin - Warfarin - LMWH - Dabigatran

Answer 101

Warfarin (Prothrombin time, not thrombin time)

Question 101

What is the mechanism of action of bivalirudin - Direct thrombin inhibitor - Factor Xa inhibitor - Platelet inhibition

Answer 101

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.

Question 102

Propofol induction dose in obese patients - Lean body weight - Ideal body weight - Actual body weight - Adjusted body weight

Answer 102

LBW

Question 103

Maximum recommended inflation pressure for classic LMA - 30 - 40 - 50 - 60

Answer 103

60cm H2O

Question 104

Driving pressure in pressure control ventilation is - Peak pressure - PEEP - Plateau pressure - PEEP - Peak pressure - Plateau pressure

Answer 104

Plateau pressure - PEEP Delta P = Pplat - PEEP

Question 105

When can you do brain testing after cardiac arrest according to ANZICS? - 72hrs - 24hrs - 36hrs - 96hrs

Answer 105

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

Question 106

Percentage of people that have full recovery after Takotsubo Cardiomyopathy? - 90% - 70% - 50% - 10%

Answer 106

90%

Question 107

Mean mode median bell curve diagram. Where does the mean/median and mode sit on the graph (diagram can be negatively or positively skewed)

Answer 107

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

Question 108

What murmur is mitral stenosis

Answer 108

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.

Question 109

Who to adjust a lower saturation targets to - Pneumothorax - Carbon monoxide - Asthma - Stroke - Sickle cell - COPD

Answer 109

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

Question 110

What crosses the brain barrier - Edrophonium - Neostigmine - Pyridostigmine - Physostigmine

Answer 110

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

Question 111

Minimum current macroshock to elicit ventricular fibrillation - 10 micro Amps - 100 micro Amps - 100 mA

Answer 111

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)

Question 112

How to prevent microshock - RCD - Fuse - LIMS - Equipotential earthing

Answer 112

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.

Question 113

If musculocutaneous nerve blocked which muscle affected - Shoulder abduction - Wrist extension - Wrist flexion - Forearm supination - Elbow flexion

Answer 113

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

Question 114

What causes euvolaemic hyponatremia - Hypothyroidism - Liver failure - Pregnancy

Answer 114

Hypothyroidism. Also SIADH can.

Question 115

Risk factor for increased severity of bone cement implantation syndrome? - Young - Male - Diuretics - Beta blockers

Answer 115

Diuretics

Question 116

What is NOT a risk factor for extravasation injury - Elderly - Young <28days - Slow infusion rate

Answer 116

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

Question 117

Surgery with highest risk of awareness according to NAP 5 - CTSx - ENT - Plastics - Neurosurg

Answer 117

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)

Question 118

Painless vision loss with intact pupillary reflexes. What is the most likely cause? - Corneal abrasion - Vertebrobasilar ischaemia - Retinal artery occlusion

Answer 118

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.

Question 119

What does 4 factor prothrombinex complex concentrate NOT contain - Factor 2 - Factor 7 - Factor 9 - Protein S - VWF

Answer 119

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

Question 120

What does cryoprecipitate not contain? - Factor 2 - Factor 8 - Fibronectin - Factor 13

Answer 120

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

Question 121

Carcinoid Syndrome which valves condition is most likely - Aortic regurg - Aortic stenosis - Mitral regurg - Mitral stenosis - Tricuspid regurgitation

Answer 121

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.

Question 122

DDAVP in type 3 VWD - Effective - Not effective - Effective with some combo involving factor 8

Answer 122

NOT EFFECTIVE Complete deficiency of VWF in Type 3.

Question 123

Mapleson F circuit: how do you prevent hypercarbia en route to recovery with paeds case who is spontaneously breathing. - Turn up the flow - Start assisting ventilation

Answer 123

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

Question 124

What does not reduce transition from acute to chronic post surgical pain - Duloxetine - Regional - Ketamine - Reduction pre op opioid use

Answer 124

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.

Question 125

SBP threshold in stroke patient who hasn't received ECR or thrombolysis - 140 - 180 - 200 - 220

Answer 125

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). Lower thresholds (such as 180 or 140 mmHg) apply to patients who have received thrombolysis or ECR, not those managed conservatively.

Question 126

Tryptase collection tube - EDTA - serum separating - Sodium citrate - Sodium heparin

Answer 126

Serum separating tube (SST) [or gel tube (gold top)] EDTA, sodium citrate, and sodium heparin tubes are not recommended for tryptase collection.

Question 127

NAP6 anaphylaxis most common drug - Teicoplanin - Cefazolin - Rocuronium - Suxamethonium - Chlorhexidine

Answer 127

Teicoplanin

Question 128

What to do to avoid breath stacking with COPD/emphysema: - Avoid PEEP - Change I:E ratio to 1:1.5 from 1:2 - Decrease respiratory rate

Answer 128

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

Question 129

Which is an indication for VV ECMO - Pulmonary hypertension - Septic shock - Pulmonary contusion

Answer 129

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

Question 130

Steroids in pregnancy does NOT reduce: - Maternal mortality - Neonatal mortality - Perinatal mortality - Premature respiratory disease

Answer 130

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

Question 131

Above what age is there an increased risk of PONV in children? - 1 - 2 - 3 - 5

Answer 131

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