2011.2 Flashcards
EZ93 What is the chemical used in sodalime to indicate exhaustion?
A. ethyl violet
B. potassium permanganate
C. ?
A. Ethyl violet
Chemical reaction is;
H20 + CO2 → H2CO3
H2CO3 + 2NaOH → Na2CO3 + 2H2O
Na2CO3 + Ca(OH)2 → CaCO3 + 2NaOH
Indicators for SodasorbTM (such as ethyl violet) are colorless when fresh, and purple when exhausted, because of pH changes in the granules.
- Repeat- Main heat loss in anaesthetic for neonate
A. vasodilatation B. radiation C. convection D. conduction E. evaporative
B. Radiation
Radiation if > 28/40 PCA
Evaporation if
- Repeat- One lung ventilation- FIO2 1.0, desaturate
Management of hypoxaemia during OLV:
o Increased FiO2 to 1.0
o Confirm adequate lung isolation by talking to surgeon and checking positioning of DLT with bronchoscope
o Manually ventilate to assess compliance (?upper airway obstruction ?PTX, ?APO) - if poor compliance, suction down tube (down ventilated side) to exclude partial tube obstruction
o Ensure adequate muscle relation
o Optimise cardiac output (may need inotropes)
o Interventions to ventilated lung:
- Alveolar recruitment manoeuvre + increase PEEP (up to 10 cmH2O)
o Interventions to nonventilated lung (bearing in mind that these will interfere with surgery to varying extents)
- Alveolar recruitment manoeuvre followed by CPAP (e.g. 5-10 cmH2O) via an auxillary circuit
- Intermittent two lung ventilation
- Surgical clamping of the pulmonary artery on the operative side to decrease shunt (depending on surgery)
- Child with murmur- what would make it more likely for you to investigate if you heard the murmur
A. persist in supine position
B. louder or softer with various manouveres
??
Likely to be innocent:
- Asymptomatic
- Soft, no associated thrill
- Ejection systolic
- Lower sternal edge, does not radiate
Likely to be pathological:
- Child has chromosomal abnormality or syndrome
- Cardiac symptoms, frequent respiratory symptoms, e.g. cough, wheeze, recurrent respiratory infections
- Failure to thrive
- Family history of congenital heart diseaseInfant
- Repeat- Single lumen intubation after multiple attempts of difficult intubation, you put in a bronchoscope after and the tip is in the trachea. The structure B you see corresponds to?
??
- Repeat- CXR correspond to-
A. right side hydropneumothorax
??
- Repeat- Neonate to drug addicts found by grandmother in the house, brought into ed, mildly jaundice, slight tachycapnic. ABG PH 7.54, PaCO2 46, pO2 74, HCO 13
A. Septicaemic B. Pyloric stenosis C. Opiod overdose D. Meningitis E. Hepatitis
?? This ABG is impossible - ?incorrectly remembered
ET03 [Repeat] Jehovah’s witness refused blood- you have told him you refuse to do the surgery/anaesthesia for his own good. Ethical principle:
A. Paternalism
B. Maleficience
C. Autonomy
D. Beneficience
A. Paternalism
- Patient with aortic stenosis, the signs indicate poor prognosis
A. Palpitation
B. Radiation to carotid arteries
C. Something about characteristic of murmur
Poor prognosis:
- Angina: 5 year 50% survival
- Syncope: 3 year 50% survival
- Heart failure: 2 year 50% survival
Which is the best predictor of poor prognosis with aortic stenosis?
A. chest pain B. paroxysmal nocturnal dyspnoea C. syncope D. E.
B. Paroxysmal nocturnal dyspnoea
Poor prognosis:
- Angina: 5 year 50% survival
- Syncope: 3 year 50% survival
- Heart failure: 2 year 50% survival
- New- Patient indicated for prophylaxis of infective endocardititis
A. amoxicillin orally 2 hours prior
B. amoxicillin IV 1 hour prior
C. amoxicillin IV just before incision
D. cefazolin IV 1 hour prior
B. Amoxycillin IV 1 hour prior (best answer of the ones given)
TGA 2014
For standard prophylaxis, use:
amoxycillin 2 g (child: 50 mg/kg up to 2 g) orally, 1 hour before the procedure
OR
amoxy/ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, within the 60 minutes (ideally 15 to 30 minutes) before the procedure
OR
amoxy/ampicillin 2 g (child: 50 mg/kg up to 2 g) IM, 30 minutes before the procedure.
- Repeat- Spontaneously breathing patient under GA, what would detect the breathing tube disconnection
Loss of anaesthetic agent waveform/decrease in end-tidal agent
(may still have capnography trace if disconnection is proximal to the sampling line)
- Repeat- Plenum and flow over vaporiser- what is not the disadvantage of flow over vaporiser
Wiki:
- Not temperature compensated (drawback)
- Not flow compensated - output concentration depends on flow
The drawover vaporizer is driven by negative pressure developed by the patient, and must therefore have a low resistance to gas flow. Its performance depends on the minute volume of the patient: its output drops with increasing minute ventilation.
The design of the drawover vaporizer is much simpler: in general it is a simple glass reservoir mounted in the breathing attachment. Drawover vaporizers may be used with any liquid volatile agent (including older agents such as diethyl ether or chloroform, although it would be dangerous to use desflurane). Because the performance of the vaporizer is so variable, accurate calibration is impossible. However, many designs have a lever which adjusts the amount of fresh gas which enters the vaporising chamber.
The drawover vaporizer may be mounted either way round, and may be used in circuits where re-breathing takes place, or inside the circle breathing attachment.
Drawover vaporizers typically have no temperature compensating features. With prolonged use, the liquid agent may cool to the point where condensation and even frost may form on the outside of the reservoir. This cooling impairs the efficiency of the vaporizer. One way of minimising this effect is to place the vaporizer in a bowl of water.
The relative inefficiency of the drawover vaporizer contributes to its safety. A more efficient design would produce too much anaesthetic vapour. The output concentration from a drawover vaporizer may greatly exceed that produced by a plenum vaporizer, especially at low flows. For safest use, the concentration of anaesthetic vapour in the breathing attachment should be continuously monitored.
PZ130 Which drugs below does not need dose adjustment in renal failure patient
A. Buprenorphine B. Morphine C. Tramadol D. ? E. ?
A. Buprenorphine
- Repeat- Child after gas induction, LMA insertion without IV cannula- desaturate to 90%. Next step of action?
A. Bag with LMA insitu
B. Bag without LMA insitu
B. Remove LMA and provide CPAP via mask
PZ128 Patient on cisapride. What drug NOT to give in recovery?
A. Tramadol
B. ?
C. ?
?? - Avoid QT prolonging drugs, also avoid serotonergic drugs
As a prokinetic agent that increases gastrointestinal motility, cisapride acts as a selective serotonin agonist in the 5-HT 4 receptor subtype. Cisapride also relieves constipation-like symptoms by indirectly stimulating the release of acetylcholine in the muscarinic receptors
Most data on cisapride interactions are derived from case reports. However, current prescribing information warns against the coadministration of cisapride and any medications known to prolong the QT interval, such as class IA or III antiarrhythmic drugs, tricyclic antidepressants, erythromycin, clarithromycin and phenothiazines.
- Repeat- Which herbal supplement reacts with tramadol?
A. Ephedra
B. St John’s wort
B. St John’s wort
Similar to more conventional antidepressants, its effects are thought to be because of the inhibition of serotonin, norepinephrine, and dopamine re-uptake by neurones.
- Repeat- Fat: blood coefficient- N2O, D, S, I
Fat:blood coefficients:
- N2O: 2.3
- Des: 27
- Iso: 45
- Sevo: 48
- Repeat- Immunology mediated heparin induced thrombocytopenia
? Answer was intravascular thrombosis
- Repeat- Half life or tirofiban?
A. 2 hours
A. 2 hours
Time to normal platelet function = 4-8 hours (can perform neuraxial block at 8 hours)
TMP-131 Repeat- Troponin can be detected for how long:
A. 5-14 days
B. ?
A. 5-14 days
- Repeat- Neonate intubation- at lips
~ 9 cm
Distance at the lips:
- There are lots of formulas, but they don’t take into account natural variation, or head position (e.g. needs to go in further if head flexed).
- Look at the child: you want the tip of the tube to be half-way between the cords and the carina - this half-way point corresponds to the heads of the clavicles in most children –> so the distance between the heads of the clavicles and the cricoid cartilage is the length of tube you want past the cords.
- Phil Ragg reckons this ‘length of tube past the cords’ also corresponds to the internal diameter of the tube (but obviously in cm, not mm)
- Another useful formula is ‘distance at the lips = 3 x ETT size (ID)’
- New - 72 year old has had hip replacement surgery and 3 days postop has a pulmonary embolus. He is fully heparinised, but still dyspnoeic, clammy, BP 80/40, pulse 120 and CVP 18. The most appropriate next step is
A. IVC filter B. Refer him for a pulmonary embolectomy C. Supportive (fluids and inotropes) D. Thrombolysis E. Warfarin
C. Supportive (fluids and inotropes) - and if this fails, then consideration of pulmonary embolectomy.
Stoelting:
Treatment options for acute pulmonary embolism include anticoagulation, thrombolytic therapy, inferior vena caval filter placement, and surgical embolectomy.
Heparin remains the cornerstone of treatment for acute pulmonary embolism.
Patients who cannot undergo anticoagulation, experience significant bleeding while being treated with anticoagulants, or have recurrent pulmonary emboli despite receiving anticoagulant therapy may require insertion of a vena cava filter to prevent lower-extremity thrombi from becoming pulmonary emboli. The use of vena cava filters should be reserved for patients with contraindications to anticoagulant treatment.
Thrombolytic therapy may be considered to hasten dissolution of pulmonary emboli, especially if there is hemodynamic instability or severe hypoxemia. Hemorrhage is the principal adverse effect of thrombolytic therapy, and so this treatment is contraindicated in patients at high risk of bleeding.
The hypotension caused by a pulmonary embolism may require treatment with inotropes such as dopamine and dobutamine or a vasoconstrictor such as norepinephrine. A pulmonary vasodilator may be needed to help control pulmonary hypertension.
Pulmonary artery embolectomy is reserved for patients who have a massive pulmonary embolism that is unresponsive to medical therapy and who cannot receive thrombolytic therapy.
- Repeat- The test to diagnose pulmonary embolism
A. CT pulmonary angiogram
B. Echocardiogram
C. Electrocardiogram
D. Ventilation-perfusion scan
A. CTPA