ANZCA FINALS PAST MCQ UPDATED
ACTUAL Exam Questions and CORRECT
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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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) - CORRECT 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
ACTUAL Exam Questions and CORRECT
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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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) - CORRECT 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
