Masterclass Anaesthetic

1. Masterclass Anaesthetic Dr Rick Horton Senior Staff Specialist Western Health and Director of Anaesthetic training April 2010

2. Paper 1 8 The best indicator of cardiorespiratory capacity and reserve for surgery is:   A. Transthoracic Echocardiography   B. Arterial Blood Gas Analysis   C. Thallium Persantin Nuclear Imaging of the heart   D. Functional Exercise Capacity   E. Electrographic stress test

3. Paper 1 9 The commonest reason for poor outcome after Anaesthesia is:   A. Inadequate preoperative assessment and optimisation   B. Poor anaesthetic assistance   C. Blood product unavailability   D. Poor choice of Anaesthetic agents   E. Inadequate intravenous access        

4. Paper 1 10 Absolute contra-indications to performing neuraxial (epidural or spinal) local   anaesthetic blockade include all of the following except:   A. Coagulopathy   B. Patient Refusal   C. Systemic sepsis   D. Local Infection at insertion site   E. Pre-existing neurologic deficit

5. Paper 1 32 A 24 year old male was admitted 2 days ago with acute pancreatitis. His pain has been treated with a pethidine infusion.       Which one of the following is true regarding his pethidine infusion   a) Pethidine is metabolised to norpethidine which may cause seizures.   b) Pethidine has fewer side effects when compared to morphine   c) Pethidine has an oral bioavailability greater than 50%   d) Pethidine is a natural drug derived from the opium poppy   e) The dose of pethidine should be increased in the patient with renal failure

6. Paper1 33 6 weeks ago a 75 year old man has had an amputation of is left leg due to peripheral vascular disease. He is now complaining of burning pain at night in his stump.   Which of the following would NOT be useful in the treatment of his pain.   a) Tri-cyclic antidepressants   b) Anti-convulsants   c) Steroids   d) Opiates   e) Multi modal analgesia

7. Paper 2 1 As the covering night RMO you are asked to see Ms. Proster, an 86 year old lay who has been in hospital for 10 days with pneumonia. Four days ago she fell from bed and fractured her ankle which requires open reduction and internal fixation ( ORIF). She is now well enough to have the operation but because of her age and co-morbidities she will have the procedure under a spinal anaesthetic.   The nursing staff have called you to come and review her pre op blood tests that the day RMO didn’t get around to.   The results are:   APTT 42 seconds ( < 37 seconds)   INR – 1.1 ( n <1.3 seconds)   Fibrinogen – 2.4 ( n > 2.0)       Which of the following should you do?   a) Allow the operation to proceed as the clotting and haemostatic abnormality is mild.   b) Check to see if the patient is on prophylactic dose heparin and advise both the lab and the anaesthetist of this.   c) Check when her warfarin was ceased and request Fresh Frozen Plasma ( FFP) from the lab.   d) Check if the patient is on Aspirin and with-hold the dose prior to surgery.

8. Paper 2  25 The commonest reason for poor outcome after Anaesthesia is:   A. Inadequate preoperative assessment and optimisation   B. Poor anaesthetic assistance   C. Blood product unavailability   D. Poor choice of Anaesthetic agents   E. Inadequate intravenous access

9. Paper 2 34 Which of the following is true regarding neuropathic pain?   a) It is not responsive to anti-inflammatory drugs   b) It is usually described as a constant throbbing pain   c) Antidepressants can be used in treatment   d) It is often managed using a PCA (patient controlled analgesia)   e) Low dose oral opiates are often effective        

10. Paper 2 35 With regard to acute pain, which of the following is true?   a) Abnormal investigation results are a good predictor of pain   b) The transdermal route of drug administration is useful in acute pain because of its rapid onset.   c) Morphine requirements are related more to a patient’s age rather than weight   d) The patient’s vital signs are a good guide to the amount of pain they have   e) The use of morphine to treat acute pain can lead to addiction    

11. Paper 2  36 Side effects of morphine include which one of the following?   a) renal failure   b) myotonic jerks   c) constipation   d) aplastic anaemia   e) cardiac arrhythmia

12. Paper 4 40 You witness Mrs Apno collapse in the outpatients corridor. You note that she falls into the foetal position, right side. She weighs approximately 80 kg and is 170cm tall.       Your first response is to:   a) assess her airway and circulation.   b) assist her breathing.   c) check area and patient for danger.   d) remove the syringe and needle from her arm.

13. Paper 4 41 Mrs Apno is peripherally and centrally cyanosed. She makes no visible respiratory effort. The needle and syringe are safely removed and stored.       It is now appropriate to:   a) perform mouth to mouth resuscitation   b) clear her airway with your fingers   c) provide jaw thrust/chin lif   d) turn her onto her back

14. Paper 4 42 The emergency resuscitation equipment arrives quickly. Mrs Apno has very shallow breaths at approximately 1 breath every 15 seconds. She has a small amount of blood oozing from the needle insertion point in her arm.       The order of priority of treatment is to:   a) don protective gear, give IMI Narcan in 2 mg doses for effect   b) don protective gear, start bag/valve/mask assisted ventilation   c) don protective gear, start full cardiopulmonary resuscitation   d) don protective gear, bandage bleeding puncture wound.    

15. Paper 4 43 Assuming you obtain a good seal with the bag/valve/mask device, what tidal volume would you aim to administer?   a) 800mls   b) 500mls   c) 1500mls   d) 300mls    

16. Paper 4 52 Mrs White presents to the Emergency Department with headache, fever of 38.5 degrees Celsius and generalized aches and pains. She has a history of left mastectomy five years ago.       The initial most appropriate tests include:   a) Full ward urine test, U&E, FBE, ESR, Blood Cultures   b) Urine Microscopy & Culture, T cell lymphocyte count   c) Blood Cultures, haemoglobin, haematocrit, ACT   d) FBE, TFT, LFT    

17. Paper 4 53 Mrs White is slightly dehydrated and ordered a litre of normal saline over 4 hours. She is also ordered intravenous antibiotics, bolus dose 6 hourly.       What size IV cannula is appropriate to insert?   a) 14g   b) 25g   c) 18g   d) 16g

18. Paper 4 54 Choose the MOST appropriate IV cannula insertion site for Mrs White.   a) left forearm   b) right cubital fossae   c) left dorsum.   d) Right forearm    

19. Paper 4 55 The blood tests, including blood cultures, should be taken   a) separately to IV Cannulation   b) after the first antibiotic dose   c) at the removal of the IV cannula stillette   d) after the cannula is flushed.       56 Upon cannulating Mrs White, you note a regular pulsation in the hub of the cannula. This is most likely due to:   a) cannulation of an artery   b) high right ventricular pressures   c) high left ventricular pressures   d) cannulation of a vein.