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Coventry Anaesthetic Course - RCOA Mar 2015 Questions 1. You are called to see a patient with tracheostomy . His saturation dropped from 98% to 86% on 50% oxygen. What will be your next immediate step? a. Call for help b. Connect the tracheostomy tube to a circuit and do manual bagging c. Give 100% oxygen d. Pass suction catheter through tracheostomy tube e. Remove tracheostomy tube 2. 74yo man with 4month history of post herpetic neuralgia. What is the best initial treatment? a. Amitryptiline 150mg daily b. Gabapentin up to 900mg daily c. Oral morphine (slow release) 10mg d. Ibuprofen 400mg TDS e. Paracetamol 1g QDS 3. 2 year old child with meningococcal septicaemia. Sats 93% on high flow oxygen, BP 40/30 HR 220. What is your next course of action? a. 240ml fluid bolus, intubate using 3.5 cuffed ETT and cuff pressure <20 b. 240ml fluid bolus, intubate using 3.5 ETT inflate cuff until no leak c. 240ml fluid bolus, intubate with 4.5 uncuffed ETT d. 240ml fluid bolus, intubate with 4.5 uncuffed tube and use throat pack e. Fluid resuscitate and start CPAP 4. A 64 year old man has a complete T4 spinal cord injury from an RTA several years ago. He has suffered dusted lexis since. He also has COPD and has a scar from a tracheostomy. He is due to undergo cystoscopy and removal of bladder stones. What is the most appropriate anaesthetic plan? a. LMA and GA b. No anaesthetic is required c. Spinal anaesthetic d. Epidural anaesthetic e. Local anaesthetic and sedation 5. 70 year old male undergoes radical neck dissection for maligancy. Patient becomes unstable when tumour is being dissected from carotid sheath. SBP drops to 60, HR 110, SpO2 87% and ETco2 1.9kpa. Cause most likely is: a. Anaphylaxis b. Carotid sinus manipulation c. Myocardial ischaemia d. Tension pneomothorax e. Venous air embolism. 6. Haemodynamically stable patient on ICU, suspect PE, best way to diagnose: a. D-dimer b. TOE c. CTPA d. V/Q scan e. ECG Thanks to our to our candidates from Feb 2015 Coventry Anaesthetic Course - RCOA Mar 2015 Questions 7. An 18 year old female attends alone to the maternity unit for surgical termination of pregnancy at 10 weeks. She is otherwise fit & well. On questioning, she tells the nursing staff she will get a taxi home and a friend will "pop her head in" later this evening to check she's ok. She refuses to stay in hospital overnight. What is the best course of action? a. Cancel the procedure & rearrange b. Pre-operatively ensure appropriate transport is arranged & someone can stay with her overnight. c. Continue with the procedure as planned. d. Continue with the procedure as planned under local anaesthesia e. Convince the Obstetrician to administer a medical termination 8. You are anaesthetising a 2 year old for bilateral cochlear implants. The surgeon asked you how much local anaesthetic they can use for the first incision. What is most appropriate dose of LA: a. 3.5ml of 1% lidocaine with 1:80,000 adrenaline b. 3.5mls of 1% lidocaine with 1:200,000 adrenaline c. 3.5mls of 2% lidocaine with 1:200,00 adrenaline d. 2ml of 0.5% bupivicaine with 1:200,000 adrenaline e. 4mls of 0.25% bupivicaine with 1:200,000 adrenaline a. A 4 year old children, 10kg, is having bilateral tympanoplasty. The surgeon wants to know how much local anaesthetic he can inject before incision. What do you recommend per side? a. Lidocaine 7mls 1% + adrenaline 1:80,000 b. Lidocaine 3.5mls 2% + adrenaline 1:200,000 c. Bupivocaine 0.5% 2mls + adrenaline 1:200,000 d. Bupivocaine 0.25% 4 mls + adrenaline 1:200,000 e. Lidocaine 1% 3.5mls + adrenaline 1:200,000 9. You are anaesthetising a pt with significant peripheral vascular disease for small bowel obstruction. You decide to site an art line pre induction. After fluid resuscitation the blood pressure dropped a little on induction but responded to a bolus of metaraminol. On transferring to theatre you notice that the art line reads 60/40 and the NIBP reads 120/80. What is the most like cause? a. An over damped trace b. A faulty transducer c. The transducer is set too high above the patient d. Calcification of arteries e. ......... 10. A patient with the orthotopic bladder resection. He is confused and refusing oral intake on the ward. BP, HR, and urine output are all within normal limits. Bloods results: Na 147, K 3.1, Hco3 16, Ph 7.26, Cl 116, Glu 14. What is the most appropriate treatment? a. Potassium via central line b. Bicarbonate and iv potassium c. IV fluids with saline d. Breath into a paper bag e. Insulin sliding scale Thanks to our to our candidates from Feb 2015 Coventry Anaesthetic Course - RCOA Mar 2015 Questions 11. A lady with bony metastasis from primary breast ca. On oxycodone 60mg qds she is experiencing severe breakthrough pain twice a day lasting 20 minutes. When her oxycodone was increased to 80mg bd she became very drowsy. What is the most appropriate next step? a. Ibandruic acid 50mg b. Transmucosal fentanyl c. Increase Oxycodone to 120mg d. Paracetamol 1g qds e. Ibuprofen 400mg tds 12. A 78 year old male with continuing neuropathic pain following an episode of shingles four months ago presents to pain clinic. Which is the most reasonable initial approach from the following: a. Amitryptilline 150mg/day b. Carbamazepine 100mg TDS c. Gabapentin 900mg/day d. Ibuprofen 400mg TDS e. Morphine SR 10mg BD 13. An ICU patient with tracheostomy suddenly desaturates to 80% on 60% oxygen. What is the next immediate appropriate action? a. Call for help b. 100% o2 c. Pass a suction catheter down d. Take the tracheostomy out e. Ventilate with a mapleson's c circuit 14. Post-op patient in recovery, complaining of nausea, fast AF 140 bpm, BP 92/40. Management: a. IV digoxin 0.5mg b. Antiemetics c. DC cardioversion d. Amiodarone 300mg e. Magnesium 2g IV over 20 mins 15. You need to anaesthetise a woman who doesn't speak English for a Cat 3 section. What is the best way of taking a history and providing info? A. Language line b. O+g registrar who has some understanding of the patients language c. Husband d. Patients 11 year old daughter who is bi-lingual e. Written translated materials 16. 70 yr old with depression on phenelzine, bendroflumethiazide and enalapril undergoes laparotomy for severe peritonitis. Intra-op, BP drops to 65/30, HR 100, no response to fluid. Most appropriate: a. Ephedrine b. Metaraminol c. Norad d. Phenylephrine e. Vasopressin Thanks to our to our candidates from Feb 2015 Coventry Anaesthetic Course - RCOA Mar 2015 Questions 17. Patient with history of asthma, RSI for appendicectomy, develops severe bronchospasm and ETCO2 trace is low. Best treatment: a. IV aminophylline 250mg b. IV adrenaline 50-100mcg c. IV adrenaline 500mcg d. Adrenaline 500 mcg IM e. IV salbutamol 250 mcg 18. Patient admitted to ICU with severe pancreatitis, best way of assessing severity? a. Abdominal USS b. CT abdo c. Serial amylase d. Serial Ca e. Exploratory laparotomy 19. 34/40 induction of labour, previous C section, previous IUFD. Becomes hypotensive, pale and collapses. Most likely cause? a. Ruptured uterus b. AFE c. Aortocaval compression d. Analphylaxis e. Septic shock 20. 66 yr old patient pre-op for CABG, wants to know re risk factors for stroke. Which of these is the biggest risk factor for stroke? a. Hypertension b. Previous stroke c. Asymptomatic carotid bruit d. Proximal atheroma aorta e. IDDM 21. 60 yr old with OSA, AF, INR 1.9 for elective hernia repair. Best management: a. Controlled ventilation with des + remi + inguinal field block b. Controlled vent with sevo + remi + inguinal field block c. Spontaneous vent with prop + remi _ inguinal field block d. SV with sevo plus inguinal field blcok e. SV + prop plus PCA 22. Best way of effectively pre-O2 a patient with BMI 35 for RSI a. O2 6l/min circle, supine, 3 min b. O2 6l/min mapleson A, 30 degrees head up 4 vital capacity breaths c. O2 6l/min mapleson A supine 3 mins d. O2 6l/min mapleson A 30 degrees up 3 mins e. O2 6l/min Bain circuit, supine, 3 min Thanks to our to our candidates from Feb 2015 Coventry Anaesthetic Course - RCOA Mar 2015 Questions 23. 60 year old male, vomiting, severe headache, photophobia in ED. Best next step? a. Intubate and ventilate b. Transfer to ICU c. CT head d. Refer neurosurgeons e..... 24. You have anaesthetised a 45 year old lady for abdominal hysterectomy. You are asked to see her two hours later because she has passed no urine. Her blood pressure has been 85/45 and 105/60. The cause of her lack of urine is most likely due to: a. Hypotension b. Blocked catheter c. Nsaid nephropathy d. Poor preoperative fluid status e. Bilateral ureteric damage intraoperatively 25. Adult with history of burns around face, mouth and suspected of inhalational burns. Patient is agitated and confused. Regional burns unit is 35 miles away. Best way of transferring patient is: a. On High flow oxygen, with IV fluids b. Intubate and ventilate, with IV fluids c. Anaesthetic trainee escort in case of airway emergencies d. .... e. .... Thanks to our to our candidates from Feb 2015 Coventry Anaesthetic Course - RCOA Mar 2015 Questions MTF MCQ 1. A pregnant lady has multiple sclerosis. The following are true or false: a. Her symptoms are more likely to relapse during pregnancy. b. Any neurological deficit is a contraindication to spinal anaesthesia. c. She is more likely to have a c section d. ... e. ... 2. Syncope a. is more often due to heart disease b. associated with Bradycardia c. May be precipitated by failure of vision d. can be indirectly due to retention of urine e. due to decrease in urine output. 3. To calculate P(A-a)O2 the following are required: a. CvO2- CaO2 b. resp quotient c. FIO2 d. QT e. Haematocrit 4. Parkinsons disease is associated with the following: a. increased pigmentation substantia nigra b. resting tremor c. increased dopamine levels d. .... e. .... 5. Electroconvulsive therapy is a. indicated in endogenous severe depression b. contraindicated in well controlled grand mal epilepsy c. contraindicated in the presence of a pacemaker d. contraindicated in a patient with a brain tumour e. contraindicated in patients above the age of 60 years Thanks to our to our candidates from Feb 2015