ANZCA FINALS PAST MCQ Exam Questions And
Answers Verified 100% Correct
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
Answers Verified 100% Correct
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
