ANZCA FINALS PAST MCQ EXAM WITH COMPLETE QUESTIONS AND 100%
CORRECT ANSWERS
1803 QUESTIONS AND ANSWERS
Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?
A: Distorted facial anatomy
B: Macroglossia
C: Glottic stenosis
D: Prognathe mandible
E: Arthritis of the neck - ANSWER ANSWER B
Ehlers-Danlos syndrome. Most important to specifically do all EXCEPT:
A: Avoid hyperextension of the neck
B: Damage to the teeth
C: Avoid joint hypermobility
D: Gastro oesophageal reflex
E: Strict temperature regulation - ANSWER ANSWER E
ISSUES
1. GORD and gastritis
2. Early satiety and delayed gastric emptying
3. High, narrow palate and dental crowding
4. Peridontal disease (friability, gingivitis, gum recession)
5. Joint laxity. Subluxations and dislocations are common and represent the major manifestation of the
condition. All sites can be involved, including the extremities, vertebral column, costo-vertebral and costo-
sternal joints, clavicular articulations, and temporomandibular joints.
An 85y.o for open AAA repair. Refuses blood because of risk of vCJD. You tell him you won't anaesthetise him
as the risk is too high. This is an example of:
A: Autonomy
B: Beneficence
C: Malevolence
D: Coercion
E: Paternalism - ANSWER ANSWER C
A 35yr old African-American with sickle cell and fractured ankle for ORIF. Hb 90, Haematocrit 0.3.
A: Transfuse 2 units packed cells (?pre-op)
B: Let him cool passively to low/normal temperature
C: Spinal is safe
D: Avoid thiopentone
E: Tourniquet is absolutely contra-indicated - ANSWER ANSWER C
A - WRONG: "Although widely practiced, prophylactic erythrocyte transfusion remains a treatment with
appreciable complications whose potential benefits have not been clearly demonstrated by a prospective,
,randomized clinical trial". Also a study in orthopaedic patients "did not detect a prophylactic effect from
preoperative transfusion" (Sickle Cell Disease and Anesthesia. Anesthesiology 2004; 101:766-85)
B - WRONG: "Although hypothermia would tend to retard sickling because of a left shift of the oxygen
dissociation curve, hypothermia is often identified as a precipitant of perioperative SCD complications".
"avoidance of patient hypothermia is a basic objective for most anesthetics" (Same reference)
C - CORRECT: "The use of regional anesthesia therefore does not appear to be contraindicated in SCD" (Same
reference) and OHA p202 agrees
D - ??? but seems unlikely
E - WRONG according to OHA p202 -JC
Absolute contraindication to sitting position for posterior fossa craniotomy for meningioma
A: Prescence of patent ventriculo-atrial drain/shunt
B: 0.5mm PFO
C: Oesophageal stricture so transoesophageal echo placement is out
D: History of TIA
E: Aortic stenosis - ANSWER ANSWER A
ABSOLUTE CONTRAINDICATIONS
* Patent ventriculo-atrial shunt
* Severe cardiovascular disease
* Large patent foramen ovale or other pulmonary-systemic shunt
* Cerebral ischaemia when upright and awake
* Anaesthesia or surgical team not familiar with the position
ECG- which does NOT have abnormal Q waves:
A: Digoxin toxicity
B: Anterior myocardial infartion
C: Previous AMI
D: LBBB
E: Wolff-Parkinson-White syndrome - ANSWER ANSWER A
Long stem about an old #NOF patient with aortic stenosis. What is a sign/ investigation/ symptom that shows
the most severity? (ie Which one of these would indicate that the lesion was severe?)
A: Thrill in Aortic area
B: Murmur in lower left sternal edge
C: Murmur radiating to carotids
D: History of ischaemic heart disease or coronary artery disease
E: history of angina/ syncope - ANSWER ANSWER A
A - True - "A precordial thrill may be felt, especially on leaning forward in expiration. Its presence is reasonably
specific for severe aortic stenosis"
Petit mal epilepsy - Which is true? (or words to that effect)
A: Most common in child <2 years old
,B: Can precipitate seizures by hyperventilating
C: Often seizures last for more than 30 seconds
D: Rarely familial
E: Isoelectric EEG during seizure (burst suppression) - ANSWER ANSWER B
Absence seizures
-abrupt and sudden onset of impairment of consciousness (blank stare, possible upward rotation of eyes)
-usually brief <20sec
-EEG generalised spike and slow wave discharges
-hyperventilation triggers in 90%
-treatment mainly valproate (second line lamotrigine)
-should not use carbamazepine, vigabatrin, tiagabine, phenytoin, gabapentin and pregabalin --> not effective in
treatment
Hypertension- severe- in pregnancy (or was it PET?) What NOT to use?
A: Hydrallazine
B: Nifedipine
C: Labetalol
D: Metoprolol
E: SNP - ANSWER ANSWER E
Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive
B: Start antiplatelet drugs
C: Start anticonvulsants
D: Do angio and stent
E: Nimodipine - ANSWER ANSWER A
Post operative left pneumonectomy. What to do with underwater seal drain?
A: Nurse patient in R lateral decubitus position
B: Expect to see bubbles
C: Suction every hour for 5 minutes
D: Unclamp drain once an hour for 5 minutes, leave clamp on for the rest of the time
E: Leave on free drainage - ANSWER ANSWER D
What is NOT true for PDPH following puncture
A: Prophylactic bed rest
B: Decreased incidence when catheter is inserted intrathecally
C: Decreased incidence in elderly
D: Caffeine is not effective
E: Epidural blood patch is 80% effective - ANSWER ANSWER A
in Section 9.6.5 Acute Pain Management: Scientific Evidence (2005) and Update (2007)
Incidence of headache following dural puncture 0.4-24%
* postural in nature
* commoner in patients under 50 yrs
* commoner in parturients
, * significanntly less common in males than non-pregnant females (level 1 evidence - 2007 update)
* 90% resolve spontaneously within 10 days
Incidence may be reduced by using: (level I)
* 26 gauge or smaller needle (NNT=13)
* use of needle with a non-cutting bevel (NNT=27)
No evidence that bed rest is beneficial in preventing PDPH (Level I)
* PDPH may causes difficulty mobilising, and headache may then subside with bed rest
* Non-opioid and opioid analgesics may provide temoporary relief
* Preventive role of fluid therapy unclear (Level I)
NO evidence to support the use of:
* Sumatriptan (Level II)
* ACTH
* Epidurally administered saline, dextran, fibrin glue or neuraxial opioids
IV and oral caffeine (both level II) are:
* effective in treating PDPH
* do not reduce blood patch rate
Epidural blood patches:
* are common practice but further high quality trials are required to determine efficacy (level I)
* significant symptomatic relief obtained in 75-95% of patients given a 15 mL blood patch (level IV, three
studies)
* conflicting evidence regarding use of prophylactic blood patches - one trial showed decreased incidence of
PDPH (level III)
Autologous epidural blood patches may be contra-indicated in:
* leukaemia
* coagulopathy
* infection, including HIV
Autonomic dysreflexia. Which ONE is true?
A: 50% of patients with a level below T6
B: Unlikely if below T10
C: Can be prevented??
D: Can be precipitated by light touch
E. ? - ANSWER ANSWER B
Ageing (adult) causes:
A: Decreased FRC
B: Decreased Cardiac output
C: Diastolic dysfunction
D: Increased creatinine - ANSWER ANSWER C
CORRECT ANSWERS
1803 QUESTIONS AND ANSWERS
Acromegaly due to excess of growth hormone. Why is it difficult to do a direct laryngoscopy?
A: Distorted facial anatomy
B: Macroglossia
C: Glottic stenosis
D: Prognathe mandible
E: Arthritis of the neck - ANSWER ANSWER B
Ehlers-Danlos syndrome. Most important to specifically do all EXCEPT:
A: Avoid hyperextension of the neck
B: Damage to the teeth
C: Avoid joint hypermobility
D: Gastro oesophageal reflex
E: Strict temperature regulation - ANSWER ANSWER E
ISSUES
1. GORD and gastritis
2. Early satiety and delayed gastric emptying
3. High, narrow palate and dental crowding
4. Peridontal disease (friability, gingivitis, gum recession)
5. Joint laxity. Subluxations and dislocations are common and represent the major manifestation of the
condition. All sites can be involved, including the extremities, vertebral column, costo-vertebral and costo-
sternal joints, clavicular articulations, and temporomandibular joints.
An 85y.o for open AAA repair. Refuses blood because of risk of vCJD. You tell him you won't anaesthetise him
as the risk is too high. This is an example of:
A: Autonomy
B: Beneficence
C: Malevolence
D: Coercion
E: Paternalism - ANSWER ANSWER C
A 35yr old African-American with sickle cell and fractured ankle for ORIF. Hb 90, Haematocrit 0.3.
A: Transfuse 2 units packed cells (?pre-op)
B: Let him cool passively to low/normal temperature
C: Spinal is safe
D: Avoid thiopentone
E: Tourniquet is absolutely contra-indicated - ANSWER ANSWER C
A - WRONG: "Although widely practiced, prophylactic erythrocyte transfusion remains a treatment with
appreciable complications whose potential benefits have not been clearly demonstrated by a prospective,
,randomized clinical trial". Also a study in orthopaedic patients "did not detect a prophylactic effect from
preoperative transfusion" (Sickle Cell Disease and Anesthesia. Anesthesiology 2004; 101:766-85)
B - WRONG: "Although hypothermia would tend to retard sickling because of a left shift of the oxygen
dissociation curve, hypothermia is often identified as a precipitant of perioperative SCD complications".
"avoidance of patient hypothermia is a basic objective for most anesthetics" (Same reference)
C - CORRECT: "The use of regional anesthesia therefore does not appear to be contraindicated in SCD" (Same
reference) and OHA p202 agrees
D - ??? but seems unlikely
E - WRONG according to OHA p202 -JC
Absolute contraindication to sitting position for posterior fossa craniotomy for meningioma
A: Prescence of patent ventriculo-atrial drain/shunt
B: 0.5mm PFO
C: Oesophageal stricture so transoesophageal echo placement is out
D: History of TIA
E: Aortic stenosis - ANSWER ANSWER A
ABSOLUTE CONTRAINDICATIONS
* Patent ventriculo-atrial shunt
* Severe cardiovascular disease
* Large patent foramen ovale or other pulmonary-systemic shunt
* Cerebral ischaemia when upright and awake
* Anaesthesia or surgical team not familiar with the position
ECG- which does NOT have abnormal Q waves:
A: Digoxin toxicity
B: Anterior myocardial infartion
C: Previous AMI
D: LBBB
E: Wolff-Parkinson-White syndrome - ANSWER ANSWER A
Long stem about an old #NOF patient with aortic stenosis. What is a sign/ investigation/ symptom that shows
the most severity? (ie Which one of these would indicate that the lesion was severe?)
A: Thrill in Aortic area
B: Murmur in lower left sternal edge
C: Murmur radiating to carotids
D: History of ischaemic heart disease or coronary artery disease
E: history of angina/ syncope - ANSWER ANSWER A
A - True - "A precordial thrill may be felt, especially on leaning forward in expiration. Its presence is reasonably
specific for severe aortic stenosis"
Petit mal epilepsy - Which is true? (or words to that effect)
A: Most common in child <2 years old
,B: Can precipitate seizures by hyperventilating
C: Often seizures last for more than 30 seconds
D: Rarely familial
E: Isoelectric EEG during seizure (burst suppression) - ANSWER ANSWER B
Absence seizures
-abrupt and sudden onset of impairment of consciousness (blank stare, possible upward rotation of eyes)
-usually brief <20sec
-EEG generalised spike and slow wave discharges
-hyperventilation triggers in 90%
-treatment mainly valproate (second line lamotrigine)
-should not use carbamazepine, vigabatrin, tiagabine, phenytoin, gabapentin and pregabalin --> not effective in
treatment
Hypertension- severe- in pregnancy (or was it PET?) What NOT to use?
A: Hydrallazine
B: Nifedipine
C: Labetalol
D: Metoprolol
E: SNP - ANSWER ANSWER E
Post CEA on ward, patient seizes. BP has been hard to control. What to do to prevent further seizures?
A: Add another antihypertensive
B: Start antiplatelet drugs
C: Start anticonvulsants
D: Do angio and stent
E: Nimodipine - ANSWER ANSWER A
Post operative left pneumonectomy. What to do with underwater seal drain?
A: Nurse patient in R lateral decubitus position
B: Expect to see bubbles
C: Suction every hour for 5 minutes
D: Unclamp drain once an hour for 5 minutes, leave clamp on for the rest of the time
E: Leave on free drainage - ANSWER ANSWER D
What is NOT true for PDPH following puncture
A: Prophylactic bed rest
B: Decreased incidence when catheter is inserted intrathecally
C: Decreased incidence in elderly
D: Caffeine is not effective
E: Epidural blood patch is 80% effective - ANSWER ANSWER A
in Section 9.6.5 Acute Pain Management: Scientific Evidence (2005) and Update (2007)
Incidence of headache following dural puncture 0.4-24%
* postural in nature
* commoner in patients under 50 yrs
* commoner in parturients
, * significanntly less common in males than non-pregnant females (level 1 evidence - 2007 update)
* 90% resolve spontaneously within 10 days
Incidence may be reduced by using: (level I)
* 26 gauge or smaller needle (NNT=13)
* use of needle with a non-cutting bevel (NNT=27)
No evidence that bed rest is beneficial in preventing PDPH (Level I)
* PDPH may causes difficulty mobilising, and headache may then subside with bed rest
* Non-opioid and opioid analgesics may provide temoporary relief
* Preventive role of fluid therapy unclear (Level I)
NO evidence to support the use of:
* Sumatriptan (Level II)
* ACTH
* Epidurally administered saline, dextran, fibrin glue or neuraxial opioids
IV and oral caffeine (both level II) are:
* effective in treating PDPH
* do not reduce blood patch rate
Epidural blood patches:
* are common practice but further high quality trials are required to determine efficacy (level I)
* significant symptomatic relief obtained in 75-95% of patients given a 15 mL blood patch (level IV, three
studies)
* conflicting evidence regarding use of prophylactic blood patches - one trial showed decreased incidence of
PDPH (level III)
Autologous epidural blood patches may be contra-indicated in:
* leukaemia
* coagulopathy
* infection, including HIV
Autonomic dysreflexia. Which ONE is true?
A: 50% of patients with a level below T6
B: Unlikely if below T10
C: Can be prevented??
D: Can be precipitated by light touch
E. ? - ANSWER ANSWER B
Ageing (adult) causes:
A: Decreased FRC
B: Decreased Cardiac output
C: Diastolic dysfunction
D: Increased creatinine - ANSWER ANSWER C
