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  • Question 1 - A 7-year-old girl is scheduled for an elective tonsillectomy. Your consultant has requested...

    Incorrect

    • A 7-year-old girl is scheduled for an elective tonsillectomy. Your consultant has requested that you prepare all the airway equipment. What size of endotracheal tube (ETT) do you anticipate she will require?

      Your Answer: 4.5 cuffed ETT

      Correct Answer: 5.5 cuffed ETT

      Explanation:

      Choosing the Correct Endotracheal Tube Size for an 8-Year-Old Child

      When it comes to intubating an 8-year-old child, choosing the correct endotracheal tube (ETT) size is crucial. Cuffed ETTs are now considered safe for use in children, but not in neonates. To calculate the appropriate size of a cuffed ETT, use the formula (Child’s age/4) + 3.5. For an 8-year-old child, the correct size of a cuffed ETT would be 5.5 mm. If an uncuffed tube is preferred, use the formula (Child’s age/4) + 4 to calculate the tube size, which would be 6.0 mm for an 8-year-old child. It is important to note that using a cuffed tube offers more protection from aspiration. Avoid using a 4.5 mm cuffed ETT, as it is too small for an 8-year-old child.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      37.8
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  • Question 2 - What is the preferred intravenous induction agent for anesthesia in day case procedures?...

    Correct

    • What is the preferred intravenous induction agent for anesthesia in day case procedures?

      Your Answer: Propofol

      Explanation:

      Comparison of Different Anesthetic Agents

      Propofol is a short-acting anesthetic agent with an elimination half-life of four hours. It is commonly used for day case procedures and sedation in intensive care units. On the other hand, etomidate is no longer preferred due to its side effects such as postoperative nausea and vomiting, venous thrombosis, and interference with glucocorticoid production. Ketamine, a phencyclidine derivative, can cause hallucinations and nightmares. Methohexitone may lead to involuntary muscular movement and epileptiform activity on an EEG. Lastly, thiopentone has the longest elimination half-life of 12 hours, which can cause a prolonged hangover effect.

      In summary, different anesthetic agents have their own advantages and disadvantages. It is important to choose the appropriate agent based on the patient’s condition and the type of procedure being performed.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      30
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  • Question 3 - You are asked to see a patient on the high dependency unit following...

    Correct

    • You are asked to see a patient on the high dependency unit following an elective repair of her abdominal aortic aneurysm. Her last haemoglobin was 75 g/L (130-180) and your consultant has told you to give her four units of blood urgently.

      The nurse informs you that the patient's date of birth is incorrect on the blood she is about to give, although all other details are correct. The patient mentions that this has happened before. She has previously received six units of blood in theatre without any issues.

      What course of action should you take?

      Your Answer: Stop the blood transfusion

      Explanation:

      Importance of Correct Patient Identification in Transfusions

      Transfusions are a crucial aspect of medical treatment, but incorrect patient identification of samples and blood products can lead to fatal consequences. In fact, it is the most common cause of death following transfusion. Therefore, it is essential to ensure that patient identification is accurate and consistent throughout the process.

      If there are any inconsistencies or doubts about the patient’s identity, it is crucial to stop the transfusion immediately and inform the laboratory. This step can prevent serious harm or even death. It is better to err on the side of caution and take the necessary steps to ensure that the patient receives the correct blood product.

      In emergency situations where blood is needed immediately, and there is uncertainty about the patient’s identity, group O negative blood may be used. However, this should only be a temporary solution until the patient’s identity is confirmed, and the appropriate blood product can be administered.

      In conclusion, patient identification is a critical aspect of transfusions, and any errors or inconsistencies should be addressed immediately to prevent harm to the patient. It is better to take the necessary precautions and ensure that the patient receives the correct blood product, even if it means delaying the transfusion.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      63
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  • Question 4 - The following blood gas values were obtained on a different ventilated patient.
    pH 7.4...

    Incorrect

    • The following blood gas values were obtained on a different ventilated patient.
      pH 7.4 (7.35-7.45)
      pO2 95 mmHg (90-120)
      Bicarbonate 22 mmol/L (23-26)
      pCO2 30 mmHg (35-45)
      What is the most appropriate explanation for these results?

      Your Answer: Metabolic acidosis

      Correct Answer: Respiratory alkalosis

      Explanation:

      Respiratory Alkalosis: Causes and Effects

      Respiratory alkalosis is a condition that occurs when a person hyperventilates, leading to a decrease in the partial pressure of carbon dioxide (PaCO2) in the alveoli. This decrease in PaCO2 causes an increase in the ratio of bicarbonate concentration (HCO3) to PaCO2, which in turn increases the pH of the blood. As a result, the patient may appear to have an alkalosis with a high pH of 7.5, low pCO2, and normal PO2. However, the body tries to compensate for this by lowering the bicarbonate concentration. This condition can be caused by a variety of factors, including anxiety, fever, hypoxia, and pulmonary disease. It can also be a side effect of certain medications or a result of high altitude. Treatment for respiratory alkalosis depends on the underlying cause and may include addressing the underlying condition, breathing techniques, or medication.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      104
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  • Question 5 - You have watched the anaesthetist anaesthetise a 70-year-old patient for a laparoscopic appendicectomy...

    Incorrect

    • You have watched the anaesthetist anaesthetise a 70-year-old patient for a laparoscopic appendicectomy using thiopentone and suxamethonium. She has never had an anaesthetic before. The patient is transferred from the anaesthetic room into theatre and you notice that she becomes difficult to ventilate with high airway pressures. She has an endotracheal tube (ETT) in situ, with equal chest rise and sats of 95% on 15 l of oxygen. On examining her cardiovascular system, she has a heart rate of 110 bpm with a blood pressure of 68/45 mmHg. She has an erythematosus rash across her chest and face.
      What is your first line of action?

      Your Answer: 0.5 ml of 1 : 1000 adrenaline intravenously (iv)

      Correct Answer: 0.5 ml of 1 : 1000 adrenaline intramuscularly (im)

      Explanation:

      Management of Anaphylaxis: Medications and Dosages

      Anaphylaxis is a severe and potentially life-threatening allergic reaction that requires immediate treatment. The first-line management for anaphylaxis is the administration of adrenaline, also known as epinephrine. The dosage of adrenaline varies depending on the age of the patient. For adults, 0.5 ml of 1 : 1000 adrenaline should be given intramuscularly (im), and the dose can be repeated after 5 minutes if there is no response. In children, the dosage ranges from 150 to 500 micrograms depending on age.

      Intravenous (iv) administration of adrenaline is not recommended at a concentration of 1 : 1000. However, iv adrenaline can be administered at a concentration of 1 : 10 000 by an anaesthetist, titrated according to effect. An adrenaline infusion may be necessary for cardiovascular support of the patient.

      Chlorpheniramine and hydrocortisone are also part of the treatment for anaphylaxis, but adrenaline takes priority. The dosages of these drugs vary depending on the age of the patient and can be given either im or through a slow iv injection.

      It is important to note that anaphylaxis is a medical emergency, and prompt treatment with the appropriate medications is crucial for a positive outcome.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      316.7
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  • Question 6 - A 42-year-old man was undergoing a routine appendectomy and was given general anaesthesia...

    Correct

    • A 42-year-old man was undergoing a routine appendectomy and was given general anaesthesia with succinylcholine and halothane. The patient was sedated and intubated during the procedure. After one hour, the anaesthetist observed that the patient had a temperature of 41 °C, blood pressure of 160/90 mmHg, and a pulse rate of 110 bpm. An arterial blood gas (ABG) test revealed a pH of 7.2 (normal value 7.35–7.45) and a PaCO2 of 6.6 kPa (normal value <4.5 kPa). What is the most likely diagnosis?

      Your Answer: Malignant hyperthermia

      Explanation:

      Common Adverse Reactions to Medications: Symptoms and Treatments

      Malignant Hyperthermia, Neuroleptic Malignant Syndrome, Serotonin Syndrome, Acute Dystonia, and Meningitis are all potential adverse reactions to medications.

      Malignant Hyperthermia is a rare condition that can occur after exposure to general anaesthetics or muscle relaxants. Symptoms include a sudden increase in temperature, acidosis, hypercapnia, and widespread skeletal muscle rigidity. Treatment involves dantrolene and supportive care such as cooling and correction of acidosis.

      Neuroleptic Malignant Syndrome is a rare idiosyncratic reaction that can occur as a response to taking high-potency anti-psychotic medication. Symptoms include hyperthermia, fluctuating consciousness, rigidity, tachycardia, labile blood pressure, and autonomic dysfunction. Treatment involves discontinuing the medication and supportive management such as fluids and cooling. Dantrolene or bromocriptine may also be used.

      Serotonin Syndrome occurs when a patient takes multiple doses, an overdose, or a combination of certain medications. Symptoms include confusion, agitation, hyperreflexia, shivering, sweating, tremor, fever, and ataxia. Treatment involves stopping the drugs and providing supportive care.

      Acute Dystonia presents with spasm of various muscle groups and is a side-effect of anti-psychotic medication. It can occur in the first few hours of administration of anti-psychotic medication. It is also seen with the antiemetic metoclopramide where it can cause an oculogyric crisis. It is not usually associated with anaesthesia.

      Meningitis is not a complication of anaesthesia or muscle relaxants.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      121.6
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  • Question 7 - You are conducting a pre-assessment for a 28-year-old man who is scheduled to...

    Correct

    • You are conducting a pre-assessment for a 28-year-old man who is scheduled to undergo a colectomy for treatment resistant ulcerative colitis. This will be his first surgery. Your intended anaesthetic plan involves using propofol and sevoflurane as induction agents and suxamethonium as a muscle relaxant. What aspects of the patient's medical history and condition would cause you to modify your anaesthetic plan?

      Your Answer: The patient’s mother was ‘unable to move’ for 5 h after having an abdominal hysterectomy

      Explanation:

      Considerations for Anesthesia in a Patient with Medical History

      When administering anesthesia to a patient, it is important to take into account their medical history and any potential risk factors. Here are some considerations for a patient with specific medical history:

      Anesthesia Considerations for a Patient with Medical History

      – Prolonged Paralysis: If a patient has a family or personal history of prolonged paralysis after receiving suxamethonium, it may be necessary to consider using a different muscle relaxant during surgery.
      – Asthma: Patients with asthma are at a higher risk of airway irritation during endotracheal intubation. However, in some surgeries, intubation is necessary and careful monitoring is required.
      – Blood Pressure: While a blood pressure of 110/75 may be normal for a 26-year-old male, it is important to review the patient’s past blood pressure measurements to ensure that this is the case. Induction agents with profound cardiovascular effects should be avoided if the patient is in shock.
      – Family History of Cardiac Arrest: If a patient has a family history of cardiac arrest, it is important to review the facts of the case and consider any independent risk factors that may have contributed to the event.
      – Penicillin Allergy: While anesthesia agents do not contain penicillin, it is important to document any allergies in case the patient requires antibiotics after surgery.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      128.4
      Seconds
  • Question 8 - A 57-year-old woman has undergone a mitral valve repair and is experiencing a...

    Incorrect

    • A 57-year-old woman has undergone a mitral valve repair and is experiencing a prolonged recovery in the cardiac intensive care unit. To aid in her management, a pulmonary artery catheter is inserted.
      What is one of the calculated measurements provided by the pulmonary artery catheter?

      Your Answer: Central venous saturations

      Correct Answer: Cardiac output

      Explanation:

      Measuring Cardiac Output and Pressures with a Pulmonary Artery Catheter

      A pulmonary artery catheter can provide direct and derived measurements for assessing cardiac function. Direct measurements include right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary artery wedge pressure, core temperature, and mixed venous saturation. The catheter can also be used to calculate cardiac output using the method of thermodilution. This involves a proximal port with a heater and a distal thermistor that senses changes in temperature.

      Pulmonary artery wedge pressure is a direct measurement that can be obtained with the catheter, reflecting left atrial filling. However, it may not always accurately reflect the pressure in the left atrium due to various factors. Right ventricular pressure is another direct measurement that can be obtained.

      Central venous saturation is a direct measure in some machines with a built-in saturation measurement probe, while in others, samples can be taken via the distal port and measured using a gas machine. Overall, a pulmonary artery catheter can provide valuable information for monitoring cardiac output and pressures in critically ill patients.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      73.1
      Seconds
  • Question 9 - To visualize the vocal cords, where should the tip of a Macintosh laryngoscope...

    Correct

    • To visualize the vocal cords, where should the tip of a Macintosh laryngoscope be inserted?

      Your Answer: Into the vallecula

      Explanation:

      Macintosh Laryngoscope: A Tool for Visualizing the Vocal Cords

      The Macintosh laryngoscope is a medical instrument designed to aid in the visualization of the vocal cords. Its curved blade is specifically shaped to fit into the oral and oropharyngeal cavity. To use it, the blade is inserted through the right side of the mouth and gradually advanced, pushing the tongue to the left and out of view. The blade has a small bulbous tip that is intended to sit in the vallecula, a small depression between the base of the tongue and the epiglottis.

      By lifting the laryngoscope up and forwards, the larynx is elevated, allowing for a clear view of the vocal cords. This tool is commonly used in medical settings, such as during intubation procedures or when examining the airway. Its design allows for a safe and effective way to visualize the vocal cords, aiding in the diagnosis and treatment of various medical conditions.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      11.4
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  • Question 10 - What is the combination of ingredients in Hartmann's solution? ...

    Correct

    • What is the combination of ingredients in Hartmann's solution?

      Your Answer: Sodium, chloride, potassium, calcium and lactate

      Explanation:

      Hartmann’s Solution Composition and Metabolism

      Hartmann’s solution, also known as lactated Ringer’s solution, is an intravenous fluid that is isotonic in nature. It contains various compounds, including sodium, chloride, potassium, calcium, and lactate. A litre of this solution contains 131 mmol of sodium, 111 mmol of chloride, 5 mmol of potassium, 2 mmol of calcium, and 29 mmol of lactate.

      One of the unique features of Hartmann’s solution is the presence of lactate, which is metabolized by the liver to release bicarbonate. This process is important because bicarbonate would otherwise combine with calcium to form calcium carbonate, which can cause complications. Therefore, the metabolism of lactate helps to maintain the stability of the solution and prevent any adverse effects.

    • This question is part of the following fields:

      • Anaesthetics & ITU
      8.3
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SESSION STATS - PERFORMANCE PER SPECIALTY

Anaesthetics & ITU (6/10) 60%
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