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  • Question 1 - Many of the processes we deal with in anaesthesia are exponential. What is...

    Correct

    • Many of the processes we deal with in anaesthesia are exponential. What is the underlying mathematical principle of an exponential process?

      Your Answer: The rate of change of x is dependent on the magnitude of x

      Explanation:

      The magnitude of x determines the rate of change of x. First-order drug kinetics is a good example. Most drugs’ plasma levels are controlled by an exponential process. The rate of change in drug metabolism is proportional to the current plasma concentration (so-called non-linear kinetics).

      A tear-away function is just one type of exponential relationship (y = ex), in which e is Euler’s number, x is the power, and e is the base. Natural logarithms rely on Euler’s number.

      Euler’s number is a mathematical constant, not a mathematical principle. It’s referred to as an irrational number. This is a number that cannot be expressed as a simple fraction or a ratio.

      A line or curve that acts as the limit of another line or curve is known as an asymptote. A washout exponential curve, for example, where the value y represents the plasma concentration of a drug in a single compartment model against time on the x axis. This descending curve approaches but never touches the x axis. This curve is asymptotic to the x axis, which is the curve’s asymptote. An asymptote isn’t just a characteristic of exponential curves.

    • This question is part of the following fields:

      • Basic Physics
      11.1
      Seconds
  • Question 2 - Prophylactic antibiotics are required for which of the following procedures? ...

    Correct

    • Prophylactic antibiotics are required for which of the following procedures?

      Your Answer: Caesarean section

      Explanation:

      Staphylococcus aureus infection is the most likely cause.

      Surgical site infections (SSI) occur when there is a breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection. They are a major cause of morbidity and mortality.

      SSI comprise up to 20% of healthcare associated infections and approximately 5% of patients undergoing surgery will develop an SSI as a result.
      The organisms are usually derived from the patient’s own body.

      Measures that may increase the risk of SSI include:
      -Shaving the wound using a single use electrical razor with a disposable head
      -Using a non iodine impregnated surgical drape if one is needed
      -Tissue hypoxia
      -Delayed prophylactic antibiotics administration in tourniquet surgery, patients with a prosthesis or valve, in clean-contaminated surgery of in contaminated surgery.

      Measures that may decrease the risk of SSI include:
      1. Intraoperatively
      – Prepare the skin with alcoholic chlorhexidine (Lowest incidence of SSI)
      -Cover surgical site with dressing

      In contrast to previous individual RCT’s, a recent meta analysis has confirmed that administration of supplementary oxygen does not reduce the risk of wound infection and wound edge protectors do not appear to confer benefit.

      2. Post operatively
      Tissue viability advice for management of surgical wounds healing by secondary intention

      Use of diathermy for skin incisions
      In the NICE guidelines the use of diathermy for skin incisions is not advocated. Several randomised controlled trials have been undertaken and demonstrated no increase in risk of SSI when diathermy is used.

    • This question is part of the following fields:

      • Physiology And Biochemistry
      4.8
      Seconds
  • Question 3 - A healthy 27-year old male who weighs 70kg has appendicitis. He is currently...

    Correct

    • A healthy 27-year old male who weighs 70kg has appendicitis. He is currently in the operating room and is being positioned to have a rapid sequence induction. Prior to preoxygenation, the compartment likely to have the best oxygen reserve is:

      Your Answer: Red blood cells

      Explanation:

      The following table shows the compartments and their relative oxygen reserve:
      Compartment Factors Room air (mL) 100% O2 (mL)
      Lung FAO2, FRC 630 2850
      Plasma PaO2, DF, PV 7 45
      Red blood cells Hb, TGV, SaO2 788 805
      Myoglobin 200 200
      Interstitial space 25 160

      Oxygen reserves in the body, with room air and after oxygenation.

      FAO2-alveolar fraction of oxygen rises to 95% after administration of 100% oxygen (CO2 = 5%)
      FRC- Functional residual capacity – (the most important store of oxygen in the body) – 2,500-3,000 mL in medium sized adults
      PaO2-partial pressure of oxygen dissolved in arterial blood (80 mmHg breathing room air and 500 mmHg breathing 100% oxygen)
      DF -dissolved form (0.3%)
      PV-plasma volume (3L)
      TG-total globular volume (5L)
      Hb-haemoglobin concentration
      SaO2-arterial oxygen concentration (98% breathing air and 100% when preoxygenated)

    • This question is part of the following fields:

      • Physiology
      21.3
      Seconds
  • Question 4 - Which of the following is true about the bispectral index (BIS)? ...

    Incorrect

    • Which of the following is true about the bispectral index (BIS)?

      Your Answer: Is reduced by intraoperative opioids

      Correct Answer: Sevoflurane lowers BIS more than ketamine

      Explanation:

      The bispectral index (BIS) monitors works to determine the level of consciousness of a patient by processing electroencephalographic (EEG) signals to obtain a value between 0 and 100, where 0 reflects no brain activity, and 100 reflects a patient is completely awake.

      The general meaning of BIS values are:

      >95: Patient is in an awake state.
      65-85: Patient is in a sedated state.
      40-65: Patient is in a state that is optimal for general surgery.
      <40: Patient is in a deep hypnotic state

      It is important in measuring the depths of anaesthesia to prevent haemodynamic changes or patient awareness during surgery.

      The nature of anaesthetic agent used is a determinant factor in resultant BIS values. Intravenous agents, such as propofol, thiopental and midazolam, result in a deeper hypnotic state, whilst inhalation agents have a lesser hypnotic effect at the same BIS values. Certain agents result in inaccurate BIS values such as ketamine and nitrous oxide (NO). These two agents appear to increase the BIS value, whilst putting the patient in a deeper hypnotic state, and should therefore not be used with BIS monitoring.

      Hypothermia also affects the BIS value as it causes a 1.12 per °C decrease in body temperature.

    • This question is part of the following fields:

      • Clinical Measurement
      13.8
      Seconds
  • Question 5 - A 55-year-old man with a ventricular rate of 210 beats per minute is...

    Correct

    • A 55-year-old man with a ventricular rate of 210 beats per minute is admitted to the emergency department with atrial fibrillation. The patient develops ventricular fibrillation shortly after receiving pharmacotherapy to treat his arrhythmia, from which he is successfully resuscitated. He has a PR interval of 40 Ms, a prominent delta wave in lead I, and a QRS duration of 120 Ms, according to an ECG from a previous admission. Which of the following drugs is most likely to be involved in this patient's development of ventricular fibrillation?

      Your Answer: Digoxin

      Explanation:

      The Wolff-Parkinson-White syndrome (WPWS) is linked to an additional electrical conduction pathway between the atria and ventricles. This accessory pathway (bundle of Kent), unlike the atrioventricular (AV) node, is incapable of slowing down a rapid rate of atrial depolarization. In other words, a short circuit bypasses the AV node. Patients with a rapid ventricular response or narrow complex AV re-entry tachycardia are more likely to develop atrial fibrillation or flutter.

      Digoxin can promote impulse transmission through this accessory pathway if a patient with WPWS develops atrial fibrillation because it works by blocking the AV node. This can cause ventricular fibrillation and an extremely rapid ventricular rate. As a result, it’s not advised.

      Adenosine, beta-blockers, and calcium channel blockers, among other drugs that interfere with AV nodal conduction, are also generally contraindicated.

      The class III antiarrhythmic drugs amiodarone and ibutilide (K+ channel block) and procainamide (Na+ channel block) are the drugs of choice.

    • This question is part of the following fields:

      • Pharmacology
      35.4
      Seconds
  • Question 6 - The resistance to flow in a blood vessel is affected by the following...

    Correct

    • The resistance to flow in a blood vessel is affected by the following except?

      Your Answer: Thickness of the vessel wall

      Explanation:

      The Poiseuille’s formula states that Q = ΔPÏ€r4/8Lη

      where
      ΔP = the pressure gradient along the vessel
      Q = flow rate
      r = radius of the vessel
      η = coefficient of viscosity (haematocrit) of the blood
      L = length of the blood vessel.

      Resistance is pressure difference/flow (ΔP/Q) (analogous to Ohm’s law)

      Rearranging Poiseuille’s equation ΔP/Q =8Lη/Ï€r4

      Although the stiffness of the vessel wall affects blood flow, the thickness of the vessel wall does not.

    • This question is part of the following fields:

      • Physiology
      20.6
      Seconds
  • Question 7 - In medical testing, there are true negative, true positive, false positive and false...

    Incorrect

    • In medical testing, there are true negative, true positive, false positive and false negative results for some test. How are the sensitivity of these predictive tests calculated?

      Your Answer: True positives / (true positives + false positives)

      Correct Answer: True positives / (true positives + false negatives)

      Explanation:

      The following terms are used in medical testing:

      True negative – The test is negative and the patient does not have the disease.
      True positive – The test is positive and the patient has the disease.
      False positive – The test is positive but the patient does not have the disease.
      False negative – The test is negative but the patient has the disease.

      The sensitivity of a predictive test = true positives / (true positives + false negatives).

      The specificity of a test = true negatives / (false positives + true negatives).

      The negative predictive value of a test = true negatives / (false negatives + true negatives).

    • This question is part of the following fields:

      • Statistical Methods
      24.4
      Seconds
  • Question 8 - General anaesthesia is administered to a patient in a hospital in Lhasa which...

    Correct

    • General anaesthesia is administered to a patient in a hospital in Lhasa which is one of the highest cities in the world (at 11,975 feet). An Anaesthetic rotameter is normally calibrated at 20 C and 1 bar pressure and is known to be underread at altitude. The temperature of the theatre was 10 C. Which one of the following physical properties is responsible for the rotameter inaccuracy in these conditions?

      Your Answer: Density of the gas

      Explanation:

      Since the gas is less dense at higher altitudes, the density of a gas influences flows when passing through the orifice. Due to this reason, for a given flow rate, the bobbin will not be forced as far up the rotameter tube.

      At higher altitudes, the volume of a fixed mass of gas increases, and therefore the molecules of gas are widely spaced resulting in a decrease in density with an increase in altitude.

      Viscosity is simply termed as friction of gas. The viscosity of a gas is important only at low flow rates when the flow characteristic of the gas is laminar.

      Charle’s law stated that the volume occupied by a fixed amount of gas is directly proportional to its absolute temperature (T) provided the pressure remains constant.

      Boyle’s law for a fixed amount of gas at constant temperature, the pressure (P) and volume (V) are inversely proportional.

    • This question is part of the following fields:

      • Basic Physics
      94.8
      Seconds
  • Question 9 - Regarding laminar gas flow, which of the following options has the most influence...

    Correct

    • Regarding laminar gas flow, which of the following options has the most influence on laminar flow?

      Your Answer: Diameter of tube

      Explanation:

      Laminar flow can be defined as the motion of a fluid where every particle in the fluid follows the same path of its previous particles. The following are properties of laminar flow of gas or fluids:

      1. Smooth unobstructed flow of gas through a tube of relatively uniform diameter
      2. Few directional changes
      3. Slow, steady flow through straight smooth, rigid, large calibre, cylindrical tube
      4. Outer layer flow slower than the centre due to friction, results in discrete cylindrical layers, or streamlines
      5. Double flow by doubling pressure as long as the flow pattern remains laminar

      Poiseuille’s Law relates the factors that determine laminar flow. It indicates the degree of resistance to fluid flow through a tube. The resistance to fluid flow through a tube is directly related to the length, flow and viscosity; and inversely related to the radius of the tube to the fourth power. This means that, when the radius is doubled, there is increase in flow by a factor of 16.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      16.6
      Seconds
  • Question 10 - Which of the following options are correct regarding epidemiology in public health? ...

    Correct

    • Which of the following options are correct regarding epidemiology in public health?

      Your Answer: Cross-sectional surveys can be used to estimate the prevalence of a condition in the population

      Explanation:

      The incidence is the number of new cases per population in a given time period whereas prevalence is the total number of cases per population at a particular point in time.

      For chronic diseases, prevalence is used rather than incidence. Prevalence differs from incidence proportion as prevalence includes all cases (new and pre-existing cases) in the population at the specified time whereas incidence is limited to new cases only. In acute diseases the prevalence and incidence are similar. For conditions such as the common cold the incidence may be greater than the prevalence

      Prevalence is usually greater than the incidence rate for a chronic disease as prevalence includes all cases (new and pre-existing cases) in the population at a specified time whereas incidence is only limited to new cases.

      Prevalence = incidence * duration of condition

    • This question is part of the following fields:

      • Statistical Methods
      27
      Seconds
  • Question 11 - A 25-year old man needs an emergency appendicectomy and has gone to the...

    Correct

    • A 25-year old man needs an emergency appendicectomy and has gone to the operating room. During general anaesthesia, ventilation is achieved using a circle system with a fresh gas flow (FGF) of 1L/min, with and air/oxygen and sevoflurane combination. The capnograph trace is normal. Changes to the end tidal and baseline CO2 measurements at 10 and 20 mins respectively are seen on the capnograph below: (10 minutes and 20 minutes). End-tidal CO2 4.9 kPa, 8.4 kPa. Baseline end-tidal CO2 0.2 kPa, 2.4 kPa. The other vitals were as follows: Pulse 100-105 beats per minute, Systolic blood pressure 120-133 mmHg, O2 saturation 99%. The next most important immediate step is which of the following?

      Your Answer: Increase the FGF

      Explanation:

      This scenario describes rebreathing management.

      Changes is exhaustion of the soda lime and a progressive rise in circuit deadspace is the most likely explanation for the capnograph.

      It is important that the soda lime canister is inspected for a change in colour of the granules. Initially fresh gas flow should be increased and then if necessary, replace the soda lime granules. Other strategies include changing to another circuit or bypassing the soda lime canister after the fresh gas flow is increased.

      Any other causes of increased equipment deadspace should be excluded.

      Intraoperative hypercarbia can be caused by:

      1. Hypoventilation – Breathing spontaneously; drugs which include anaesthetic agents, opioids, residual neuromuscular blockade, pre-existing respiratory or neuromuscular disease and cerebrovascular accident.
      2. Controlled ventilation- circuit leaks, disconnection, miscalculation of patient’s minute volume.
      3. Rebreathing – Soda lime exhaustion with circle, inadequate fresh gas flow into Mapleson circuits, increased breathing system deadspace.
      4. Endogenous source – Tourniquet release, hypermetabolic states (MH or thyroid storm) and release of vascular clamps.
      5. Exogenous source – Absorption of CO2 absorption from the pneumoperitoneum.

    • This question is part of the following fields:

      • Physiology
      50.4
      Seconds
  • Question 12 - The Kappa statistic (aka Cohen's kappa coefficient) can be used to measure which...

    Incorrect

    • The Kappa statistic (aka Cohen's kappa coefficient) can be used to measure which of the following?

      Your Answer: Internal consistency reliability

      Correct Answer: Inter-rater reliability

      Explanation:

      The Kappa Statistic or Cohen’s Kappa is a statistical measure of inter-rater reliability for categorical variables. It is used when two raters both apply a criterion based on a tool to assess whether or not some condition occur. A good example can be two doctors rating individuals for diabetes occurrence on the basis of symptoms.

      It gives a quantitative measure of the magnitude of agreement between observers.

      Kappa can take any value between 0 and 1. 0 implies the observers are in complete disagreement and a value of 1 implies complete agreement.

    • This question is part of the following fields:

      • Statistical Methods
      51.7
      Seconds
  • Question 13 - When compared to unipolar diathermy, which of the following is more specific to...

    Incorrect

    • When compared to unipolar diathermy, which of the following is more specific to bipolar diathermy?

      Your Answer: May interfere with pacemaker function

      Correct Answer: Has a power output of up to 140 joules per second

      Explanation:

      Electrocautery, also known as diathermy, is a technique for coagulation, tissue cutting, and fulguration that uses a high-frequency current to generate heat (cell destruction from dehydration).

      The two electrodes in bipolar diathermy are the tips of forceps, and current passes between the tips rather than through the patient. Bipolar diathermy’s power output (40-140 W) is lower than unipolar diathermy’s typical output (400 W). There is no earthing in the bipolar circuit.

      A cutting electrode and a indifferent electrode in the form of a metal plate are used in unipolar diathermy. The high-frequency current completes a circuit by passing through the patient from the active electrode to the metal plate. When used correctly, the current density at the indifferent electrode is low, and the patient is unlikely to be burned. Between the patient plate and the earth is placed an isolating capacitor. This has a low impedance to a high frequency current, such as diathermy current, and is used in modern diathermy machines. The capacitor has a high impedance to current at 50 Hz, which protects the patient from electrical shock.

      High frequency currents (500 KHz – 1 MHz) are used in both unipolar and bipolar diathermy, which can cause tissue damage and interfere with pacemaker function (less so with bipolar diathermy).

      The effect of diathermy is determined by the current density and waveform employed. The current is a pulsed square wave pattern in coagulation mode and a continuous square wave pattern in cutting mode.

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      39.4
      Seconds
  • Question 14 - Following a traumatic head injury, you are summoned to the emergency department to...

    Correct

    • Following a traumatic head injury, you are summoned to the emergency department to transfer a patient to the CT scanner. With a Glasgow coma score of 3, he has already been intubated and ventilated. It is important to ensure that cerebral protection strategies are implemented during the transfer. Which of the following methods is the most effective for reducing venous obstruction?

      Your Answer: Position with a head-up tilt of 30°

      Explanation:

      ICP is significant because it influences cerebral perfusion pressure and cerebral blood flow. The normal ICP ranges from 5 to 13 mmHg.

      The components within the skull include the brain (80%/1400 ml), blood (10%/150 ml), and cerebrospinal fluid (CSF) (10%/150 ml).

      Because the skull is a rigid box, if one of the three components increases in volume, one or more of the remaining components must decrease in volume to compensate, or the ICP will rise (Monroe-Kellie hypothesis).

      Primary brain injury occurs as a result of a head injury and is unavoidable unless precautions are taken to reduce the risk of head injury. A reduction in oxygen delivery due to hypoxemia (low arterial PaO2) or anaemia, a reduction in cerebral blood flow due to hypotension or reduced cardiac output, and factors that cause a raised ICP and reduced CPP are all causes of secondary brain injury. Secondary brain injury can be avoided with proper management.

      The most important initial management task is to make certain that:

      There is protection of the airway and the cervical spine
      There is proper ventilation and oxygenation
      Blood pressure and cerebral perfusion pressure are both adequate (CPP).

      Following the implementation of these management principles, additional strategies to reduce ICP and preserve cerebral perfusion are required. The volume of one or more of the contents of the skull can be reduced using techniques that can be used to reduce ICP.

      Reduce the volume of brain tissue
      Blood volume should be reduced.
      CSF volume should be reduced.

      The following are some methods for reducing the volume of brain tissue:
      Abscess removal or tumour resection
      Steroids (especially dexamethasone) are used to treat oedema in the brain.
      To reduce intracellular volume, use mannitol/furosemide or hypertonic saline.
      To increase intracranial volume, a decompressive craniectomy is performed.

      The following are some methods for reducing blood volume:

      Haematomas must be evacuated.
      Barbiturate coma reduces cerebral metabolic rate and oxygen consumption, lowering cerebral blood volume as a result.
      Hypoxemia, hypercarbia, hyperthermia, vasodilator drugs, and hypotension should all be avoided in the arterial system.
      PEEP/airway obstruction/CVP lines in neck: patient positioning with 30° head up, avoid neck compression with ties/excessive rotation, avoid PEEP/airway obstruction/CVP lines in neck

      The following are some methods for reducing CSF volume:

      To reduce CSF volume, an external ventricular drain or a ventriculoperitoneal shunt is inserted (although more a long term measure).

    • This question is part of the following fields:

      • Pathophysiology
      18.2
      Seconds
  • Question 15 - A 61-year-old woman, present to her general practitioner. She complains of a severe...

    Correct

    • A 61-year-old woman, present to her general practitioner. She complains of a severe lancinating pain in her forehead that only last a few seconds, possibly triggered by washing her face, occurring over the previous six weeks. On examination, she is normal with no other signs or symptoms. Which nerve is the most likely cause of her pain?

      Your Answer: Sensory branches of the ophthalmic division of the trigeminal nerve

      Explanation:

      Her symptoms are suggestive of trigeminal neuralgia which is a short, sudden, severe sharp unilateral pain in the facial region. The pain often follows the sensory distribution of the trigeminal nerve (CN V).

      The trigeminal nerve gives rise to 3 sensory and 1 motor nuclei. Neuralgia can arise from any of the 3 sensory divisions.

      The ophthalmic division gives rise to 3 further sensory branches, which are the frontal, lacrimal and nasociliary.

      The frontal branch of the ophthalmic division of the trigeminal nerve is responsible for the innervation of the area in question.

      The superior alveolar dental, zygomatic and sphenopalatine nerves are all branches arising from the maxillary division of the trigeminal nerve.

      The mandibular division of the trigeminal nerve provides sensory and motor innervation. The sensory innervation is carried out by the auriculotemporal nerve which supplies the lower third of the face, while the motor fibres are responsible for controlling the muscles of mastication.

      The somatic sensory branches of the vagus nerve are responsible for sensory innervation of the external acoustic meatus and tympanic membrane.

    • This question is part of the following fields:

      • Pathophysiology
      20.8
      Seconds
  • Question 16 - Which of the following statements is true regarding antibiotics? ...

    Correct

    • Which of the following statements is true regarding antibiotics?

      Your Answer: Staphylococcus aureus colonises the nasopharynx in >20% of the general population

      Explanation:

      Staphylococcus aureus colonizes the nasopharynx in >20% of the general population.

      Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to flucloxacillin.

      Trimethoprim binds to dihydrofolate reductase and inhibits the reduction of dihydrofolic acid (DHF) to tetrahydrofolic acid (THF). THF is an essential precursor in the thymidine synthesis pathway and interference with this pathway inhibits bacterial DNA synthesis.

      All β-lactam antibiotics like penicillin interfere with the synthesis of the bacterial cell walls. The β-lactam antibiotics inhibit the transpeptidases so that cross-linking (which maintains the close-knit structure of the cell wall) does not take place

    • This question is part of the following fields:

      • Pharmacology
      25.6
      Seconds
  • Question 17 - Following an acute appendicectomy, a 6-year-old child is admitted to the recovery unit....

    Correct

    • Following an acute appendicectomy, a 6-year-old child is admitted to the recovery unit. Your consultant has requested that you prescribe maintenance fluids for the next 12 hours. The child is 21 kg in weight. What is the most suitable fluid volume to be prescribed?

      Your Answer: 732 ml

      Explanation:

      After a paediatric case, you’ll frequently have to calculate and prescribe maintenance fluids. The ‘4-2-1 rule’ should be used as a guideline:

      1st 10 kg – 4 ml/kg/hr
      2nd 10 kg – 2 ml/kg/hr
      Subsequent kg – 1 ml/kg/hr

      Hence

      1st 10 kg = 4 × 10 = 40 ml
      2nd 10 kg = 2 × 10 = 20 ml
      Subsequent kg = 1 × 1 = 1 ml
      Total = 61 ml/hr

      61 × 12 = 732 ml over 12 hrs.

    • This question is part of the following fields:

      • Physiology
      10.3
      Seconds
  • Question 18 - The clavipectoral fascia is penetrated by the cephalic vein to terminate in which...

    Correct

    • The clavipectoral fascia is penetrated by the cephalic vein to terminate in which of the listed veins?

      Your Answer: Axillary

      Explanation:

      The cephalic vein is a superficial vein that runs through the forearm and the arm, before draining into the axillary vein where it terminates.

    • This question is part of the following fields:

      • Anatomy
      14
      Seconds
  • Question 19 - A caudal anaesthetic block is planned for a 3-year-old girl presenting for inguinal...

    Incorrect

    • A caudal anaesthetic block is planned for a 3-year-old girl presenting for inguinal hernia repair. Choose the best answer that explains why the caudal epidural space is accessed via the sacral hiatus.

      Your Answer: The dural sac ends at the level of the sacral hiatus

      Correct Answer: The failure of fusion of the laminae of S4 and S5 provides a suitable point of entry

      Explanation:

      The sacral hiatus is shaped by incomplete midline fusion of the posterior elements of the distal portion of S4 and S5. This inverted U shaped space is covered by the posterior aspect of the sacrococcygeal membrane and is an important landmark in caudal anaesthetic block. Distal most portion of the dural sac and the sacral hiatus usually terminate between levels S1 and S3. The dural sac ends at the level of S2 in adults and S3 in children.

      An equilateral triangle is formed between the apex of the sacral hiatus and the posterior superior iliac spines. This triangle is used to determine the location of the sacral hiatus during caudal anaesthetic block.

    • This question is part of the following fields:

      • Anatomy
      32.6
      Seconds
  • Question 20 - A 55-year-old man has complaints of severe tearing chest pain. A preliminary diagnosis...

    Correct

    • A 55-year-old man has complaints of severe tearing chest pain. A preliminary diagnosis of aortic dissection is made in the emergency department. In aortic dissection, which layers have blood flowing in between them?

      Your Answer: Tunica intima and tunica media

      Explanation:

      The wall of an artery has three layers: (innermost to outermost)
      1. Tunica intima – in direct contact with the blood inside the vessel and contains endothelial cells separated by gap junctions.
      2. Tunica media – contains smooth muscle cells and is separated from the intima by the internal elastic lamina and the adventitia by the external elastic lamina.
      3. Tunica adventitia – contains the vasa vasorum, fibroblast, and collagen.

      Aortic dissection is when a tear arises in the innermost layer of the aorta and penetrates through the tear, entering the media layer. The inner and middle layers of the aorta split (dissect).

    • This question is part of the following fields:

      • Anatomy
      29.7
      Seconds
  • Question 21 - A 58-year-old man, visits his general practitioner complaining of a lump in his...

    Incorrect

    • A 58-year-old man, visits his general practitioner complaining of a lump in his groin. He explains he is otherwise well and reports no other symptoms. The lump is examined and is found to be soft, and can be reduced without causing the patient pain. The GP diagnoses an inguinal hernia. To determine the nature of the hernia, the GP reduced the lump and applies pressure on the deep inguinal ring. The deep inguinal ring has what anatomical landmark?

      Your Answer: Superior and medial to the pubic tubercle

      Correct Answer: Superior to the midpoint of the inguinal ligament

      Explanation:

      The deep inguinal ring lies approximately 1.5-2cm above the midpoint of the inguinal ligament, the halfway point between the anterior superior iliac spine and the pubic tubercle, next to the epigastric vessels.

      It is an important point in determining the nature of an inguinal hernia (direct or indirect). The patient is asked to cough after the hernia is reduced, with pressure applied to the deep inguinal ring. The hernia reappearing indicates it is direct, moving through the posterior wall of the inguinal canal.

      Inferior and lateral to the pubic tubercle is the normal anatomical position of the neck of a femoral hernia.

      Superior and medial to the pubic tubercle is the site of the superficial inguinal ring, and the normal anatomical position of the neck of an inguinal hernia.

      The mid-inguinal point is located halways between the pubic symphysis and the anterior superior iliac spine. It is the surface marking for taking the femoral pulse.

    • This question is part of the following fields:

      • Anatomy
      49.3
      Seconds
  • Question 22 - An aged patient that has been suffering from diabetes criticised the health minister...

    Correct

    • An aged patient that has been suffering from diabetes criticised the health minister for his comments on incidence and prevalence. The minister had said that they both are two separate entities. It can be therefore inferred that the patient thinks that prevalence and incidence are the same thing. Is he right?

      Your Answer: No. In chronic disease prevalence is greater than incidence.

      Explanation:

      Only on rare occasions has it been found that the prevalence and incidence were same. Incidence can be greater than prevalence in acute cases only. In case of chronic diseases prevalence is far greater than incidence. One needs to have a deeper understanding of both the concepts to understand the health literature.

    • This question is part of the following fields:

      • Statistical Methods
      16.7
      Seconds
  • Question 23 - Which of the following is true regarding Noradrenaline (Norepinephrine)? ...

    Correct

    • Which of the following is true regarding Noradrenaline (Norepinephrine)?

      Your Answer: Sympathomimetic effects work mainly through α1 but also β receptors

      Explanation:

      Noradrenaline acts as a sympathomimetic effect via alpha as well as a beta receptor. However, they have weak β2 action.

      Natural catecholamines are Adrenaline, Noradrenaline, and Dopamine

    • This question is part of the following fields:

      • Pharmacology
      22.6
      Seconds
  • Question 24 - The principal root innervation for the small muscles of the hand is? ...

    Correct

    • The principal root innervation for the small muscles of the hand is?

      Your Answer: T1

      Explanation:

      The principal innervation of the small muscles of the hand is T1.

    • This question is part of the following fields:

      • Anatomy
      4.5
      Seconds
  • Question 25 - A 40 year old female is planned for an critical appendicectomy. A fast...

    Incorrect

    • A 40 year old female is planned for an critical appendicectomy. A fast arrangements inductance is organized. The patient has had a preoperative respiratory tract evaluation and there are no adverse features. The patient is ideally positioned and preoxygenated. The anaesthetic applied cricoid pressure of 10 N. Acceptance of anaesthesia is at that point carried out with 250 mg thiopentone and 100 mg suxamethonium with 30 N of cricoid pressure. Initial laryngoscopy shows a review of grade 4. Three endeavours are made at putting a estimate 7 mm ID tracheal tube; two with a standard laryngoscope and one with a McCoy edge and bougie. Then one advance attempt is made employing a video laryngoscope. At this point the suxamethonium is starts to wear off. Oxygen immersion is 95%. Which one of the following treatment option is the another most suitable arrange of action?

      Your Answer: Insert a 2 generation supraglottic airway

      Correct Answer: Maintain oxygenation and anaesthesia and declare a failed intubation

      Explanation:

      Firstly, always call for an early help. This understanding is at hazard of gastro-oesophageal reflux, the reason a fast arrangement acceptance has been picked for within the first place. The patient isn’t pregnant and the critical surgery isn’t immediate.

      The scheme A is to perform a fast arrangement acceptance under ideal conditions and effectively secure the respiratory tract with a tracheal tube.

      Whilst no more than three attempts with coordinate laryngoscope (+ 1 endeavour with video laryngoscope) ought to be made to intubate the trachea, the reality is that the suxamethonium is wearing off ought to be borne in mind. One step is to make certain satisfactory neuromuscular blockade at this level, if oxygenation can be kept up by bag-mask ventilation, this might involve the administration of a non-depolarising relaxant. As the surgery isn’t prompt there should be a baseline to stop scheme A at intubation and resort to scheme B.

      An elective procedure can be planned at that time.

      The first most vital step is to report a failed intubation as this will halt you from continuing to intubate and notify your collaborator that scheme A has failed. Keeping up oxygenation and anaesthesia is additionally critical earlier to the initiation of scheme B.

      Do not administer another dose of suxamethonium. If there’s collapse of oxygenation and failure to preserve satisfactory ventilation, then insert a supraglottic airway. Plan D takes after the affirmation of a CICO.

    • This question is part of the following fields:

      • Pharmacology
      54.3
      Seconds
  • Question 26 - A 63-year old man has palpitations and goes to the emergency room. An...

    Correct

    • A 63-year old man has palpitations and goes to the emergency room. An ECG shows tall tented T waves, which corresponds to phase 3 of the cardiac action potential. The shape of the T wave is as a result of which of the following?

      Your Answer: Repolarisation due to efflux of potassium

      Explanation:

      Cardiac conduction

      Phase 0 – Rapid depolarization. Opening of fast sodium channels with large influx of sodium

      Phase 1 – Rapid partial depolarization. Opening of potassium channels and efflux of potassium ions. Sodium channels close and influx of sodium ions stop

      Phase 2 – Plateau phase with large influx of calcium ions. Offsets action of potassium channels. The absolute refractory period

      Phase 3 – Repolarization due to potassium efflux after calcium channels close. Relative refractory period

      Phase 4 – Repolarization continues as sodium/potassium pump restores the ionic gradient by pumping out 3 sodium ions in exchange for 2 potassium ions coming into the cell. Relative refractory period

    • This question is part of the following fields:

      • Physiology And Biochemistry
      53.1
      Seconds
  • Question 27 - Which of the following statements is TRUE regarding an epidural set? ...

    Incorrect

    • Which of the following statements is TRUE regarding an epidural set?

      Your Answer: An 18G Tuohy needle is 8 cm in length

      Correct Answer: 19G Tuohy needles have 0.5 cm markings

      Explanation:

      A paediatric 19G Tuohy catheter is available that is 5cm in length and has 0.5cm markings

      18G Tuohy catheters are generally 9 to 10cm to hub

      Distal end of catheter is angled (15 to 30 degrees) and closed to avoid puncturing the dura

      Epidural mesh are usually 0.2 microns and are used to filter bacteria and viruses to ensure sterility of procedure

      Transparent catheters are 90cm long with diameters depending on gauge size. It has 1cm graduations from 5 to 20cm to ensure they have been inserted amply and removed completely. Distal end is smooth which can be open or closed (with lateral openings).

    • This question is part of the following fields:

      • Anaesthesia Related Apparatus
      29.5
      Seconds
  • Question 28 - Which of the following antihypertensive drug is alpha-blocker? ...

    Correct

    • Which of the following antihypertensive drug is alpha-blocker?

      Your Answer: Doxazosin

      Explanation:

      Doxazosin is selective alpha 1 blocker (so causes less tachycardia than a nonselective alpha-blocker) and is the drug of choice for a patient with hypertension and benign hyperplasia of the prostate (BHP).

      The major adverse effect of alpha-blocker is first-dose hypotension.

    • This question is part of the following fields:

      • Pharmacology
      19.6
      Seconds
  • Question 29 - A patient is evaluated for persistent dysphonia six months after undergoing a subtotal...

    Correct

    • A patient is evaluated for persistent dysphonia six months after undergoing a subtotal thyroidectomy. Which of the following is the most likely reason for the change in this patient's voice?

      Your Answer: Damage to recurrent laryngeal nerve

      Explanation:

      After thyroid surgery, about 10-15% of patients experience a temporary subjective voice change of varying degrees. A frog in the throat or cracking of the voice, or a weak voice, are common descriptions. These modifications are only temporary, lasting a few days to a few weeks.

      Swelling of the muscles in the area of the dissection, as well as inflammation and oedema of the larynx due to the dissection, or minor trauma from the tracheal tube, are all suspected causes.

      On both sides of the thyroid gland, the superior laryngeal nerve (EBSLN) runs along the upper part. The muscles that fine-tune the vocal cords are innervated by these nerves. The quality of their voice is usually normal if they are injured, but making high-pitched sounds may be difficult. Injury to the EBSLN occurs in about 2% of the population.

      Injuries to the recurrent laryngeal nerve (RLN) have been reported to occur in 1 percent to 14 percent of people. Except for the cricothyroid muscle, the RLN supplies all of the laryngeal intrinsic muscles.

      This complication is usually unilateral and temporary, but it can also be bilateral and permanent, and it can be intentional or unintentional. The most common complication following thyroid surgery is a permanent lesion of damaged RLN, which manifests as an irreversible phonation dysfunction.

      The crico-arytenoid joint dislocation is a relatively uncommon complication of tracheal intubation and blunt neck trauma. The probability is less than one in a thousand.

      Vocal cord polyps affect 0.8 percent of people.

    • This question is part of the following fields:

      • Pathophysiology
      8.9
      Seconds
  • Question 30 - The following is true about the extracellular fluid (ECF) in a normal adult...

    Correct

    • The following is true about the extracellular fluid (ECF) in a normal adult woman weighing 60 kg.

      Your Answer: Has a total volume of about 12 litres

      Explanation:

      Total body water (TBW) is about 50% to 70% in adults depending on how much fat is present. ECF is relatively contracted in an obese person.

      The simple rule is 60-40-20. (60% of weight = total body water, 40% of body weight is ICF and 20% is ECF)

      For this woman, the total body water is 36 litres (0.6 × 60). ECF is 12 litres (1/3 of TBW) and 24 litres (2/3 of TBW) is intracellular fluid .

      Sodium concentration is approximately 135-145 mmol/L in the ECF.

      The ECF is made up of both intravascular and extravascular fluid and plasma proteins is found in both.

    • This question is part of the following fields:

      • Physiology
      9
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Basic Physics (2/2) 100%
Physiology And Biochemistry (2/2) 100%
Physiology (5/5) 100%
Clinical Measurement (0/1) 0%
Pharmacology (4/5) 80%
Statistical Methods (2/4) 50%
Anaesthesia Related Apparatus (1/3) 33%
Pathophysiology (3/3) 100%
Anatomy (3/5) 60%
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