2012.1 Flashcards
- A patient undergoing liver surgery has a venous air embolism, what is the most appropriate position to place them in:
a. Reverse trendelenburg, right side up
b. Reverse trendelenburg left side up
c. Reverse trendelenburg, neutral
d. Trendelenburg right side up
e. Trendeleburg left side up
A. Reverse Trendelenburg, right side up
CEACCP - Gas embolism in anaesthesia (2002)
Treatment goals:
- Resuscitation
- Prevent further air entry
- Reduce the size of the embolism
- Overcome any mechanical obstruction caused by the embolism
Preventing further air entry:
- Immediately eliminate high pressure gas source if in use (e.g. pneumoperitoneum)
- The surgeon should flood the operative site with saline
- Venous pressure at the procedural site should be elevated by: (i) positioning it below the level of the right atrium (if possible); (ii) IV volume loading; and (iii) increasing intrathoracic pressure with a Valsalva manoeuvre, thus reducing venous return.
Reducing the size of the embolus:
- Discontinue N2O if in use
- 100% O2 (+/- hyperbaric)
- Aspirate from RA lumen of CVC/PAC
Overcoming the mechanical obstruction
- The left lateral decubitus position described by Durant may help overcome the airlock within the RV by positioning it superior to the RVOT. The Trendelenburg position has a similar effect
- Which of the following is NOT a side effect of cyclosporine
a. Alopecia
b. Hypertension
c. Renal impairment
d. Gum hyperplasia
A. Alopecia
- What is the half life of clopidogrel?
a. 6 hours
b. 14 hours
c. 24 hours
d. 7 days
A. 6 hours
although not clinically relevant given irreversible effect on platelet function
- When administering adrenaline and atropine via ETT dose compared with IV should be
a. Same dose
b. Double
c. Quadruple
d. Six times
D. Six times
ARC 2010
endotracheal administration of some medications is possible, although the absorption is variable and plasma concentrations are substantially lower than those achieved when the same drug is given by the intravenous route (increase in dose 3-10 times may be required).
Neonatal formulary
Tracheal administration is of doubtful efficacy and should only be tried if IV access is unavailable - a higher dose (50 to 100 microgram/kg) is suggested.
EV14 What splitting ratio gives a 3% concentration of isoflurane?
a. 1/5
b. 1/9
c. 1/13
d. 1/20
e. 1/23
C. 1/13
- What transfusion related complication is the commonest cause of mortality
a. Bacterial infection
b. TRALI
c. ABO incompatibility
d. ?
e.
B. TRALI
Blood journal:
Today, the leading causes of allogeneic blood transfusion (ABT)–related mortality in the United States—in the order of reported number of deaths—are transfusion-related acute lung injury (TRALI), ABO and non-ABO hemolytic transfusion reactions (HTRs), and transfusion-associated sepsis (TAS).
- Which of the following is not included in the CHADS2 AF thromboembolic risk scoring system
a. Age
b. Gender
c. Diabetes
d. Heart failure
e. Previous TIA
B. Gender
- What is the ratio of breaths to compressions in neonatal resuscitation
a. 1:3
b. 1:5
c. 2:15
d. 2:30
A. 1:3
- What is the innervation of the hard palate
a. Greater palatine and nasopalatine nerves
A. Greater palatine and nasopalatine nerves
- Which of the following is suggesting of an inhaled foreign body in a child on chest x ray
a. Foreign body visible in front of airway
b. Hyper-expanded hemithorax
c. Collapse
B. Hyper-expanded hemithorax
Sims and Johnson:
Air trapping with hyperinflation might be seen on expiratory film due to a ‘ball valve effect’, but while this is classical, it is not common.
- What is the distance from the lips to the carina in an 70kg adult male in cm
a. 21
b. 23
c. 25
d. 27
e. 29
D. 27 cm
Tube tip should be 5 cm above carina. Average distance at the lips in an adult male is 22 cm.
- What colour is the label for subcutaneously administered drugs
a. Pink
b. Yellow
c. Brown
d. Red
e. Blue
C. Brown
- What is the maximum volume of air (in mL) that should be used to inflate a 5 LMA classic cuff
a. 15
b. 20
c. 25
d. 40
e. 45
D. 40 mL
Size 3 - 20 mL
Size 4 - 30 mL
Size 5 - 40 mL
- Where should the tip of an IABP lie
a. 2cm distal to the left subclavian
b. 2 cm proximal to the left subclavian
c. 2cm proximal to the renal artery
d. 2 cm distal to the renal artery
A. 2 cm distal to the left subclavian artery
- A 60kg female is given 50 mg of rocuronium, she is unable to be intubated or ventilated, what dose of sugamadex is required to reverse the rocuronium
a. 240
b. 800
c. 960
C. 960 mg (16 mg/kg)
IC67 In a penetrating chest injury what part of the heart is most likely to be injured
a. Left ventricle
b. Right ventricle
c. Right coronary artery
d. Right atrium
e. Sinus node
B. Right ventricle
- What is the maximum recommended dose of Intralipid in local anesthetic toxicity (ml/kg)
a. 6
b. 8
c. 10
d. 12
e. 14
D. 12 mL/kg
- What is a contraindication to an IABP?
A. Aortic regurgitation
B. Aortic stenosis
A. Aortic regurgitation
- An infant is born with meconium stained liquor and is apnoeic and floppy… your first step should be
a. Stimulate and dry
b. Positive pressure ventilation
c. Suction the trachea
C. Suction the trachea
suction from mouth and pharynx then CPAP, or intubate then suction from trachea
- Central sensitization occurs due to
a. Primary events mediated by the NMDA receptor
b. Alterations in gene expression
c. Increased magnesium
B. Alterations in gene expression
Central sensitization represents an enhancement in the function of neurons and circuits in nociceptive pathways caused by increases in membrane excitability and synaptic efficacy as well as to reduced inhibition and is a manifestation of the remarkable plasticity of the somatosensory nervous system in response to activity, inflammation, and neural injury. The net effect of central sensitization is to recruit previously subthreshold synaptic inputs to nociceptive neurons, generating an increased or augmented action potential output: a state of facilitation, potentiation, augmentation, or amplification. Central sensitization is responsible for many of the temporal, spatial, and threshold changes in pain sensibility in acute and chronic clinical pain settings and exemplifies the fundamental contribution of the central nervous system to the generation of pain hypersensitivity. Because central sensitization results from changes in the properties of neurons in the central nervous system, the pain is no longer coupled, as acute nociceptive pain is, to the presence, intensity, or duration of noxious peripheral stimuli. Instead, central sensitization produces pain hypersensitivity by changing the sensory response elicited by normal inputs, including those that usually evoke innocuous sensations.
- What volume of FFP is required to increase fibrinogen level by 1g/L (I think it was FFP or did it say cryoprecipitate?)
a. 10-15ml/kg
b. 30ml/kg
B. 30 mL/kg (for FFP)
- An epidural in a healthy individual causes all EXCEPT
a. Raised Co2
b. Bradycardia
c. Vasodilation
d. Dyspnea
A. Raised CO2
- The Revised Trauma Score includes GCS, Blood pressure and what other parameter?
a. HR
b. Saturation
c. Respiratory rate
d. Urine output
C. Respiratory rate
The Revised Trauma Score is made up of a three categories: Glasgow Coma Scale, Systolic blood pressure, and respiratory rate. The score range is 0-12. In START triage, a patient with an RTS score of 12 is labeled delayed, 11 is urgent, and 10-3 is immediate. Those who have an RTS below 3 are declared dead and should not receive certain care because they are highly unlikely to survive without a significant amount of resources.[citation needed]
- Autologous transfusion results in less
a. Cost
b. Blood waste
c. Incompatible transfusion
d. Unrequired transfusion
C. Incompatible transfusion
CEACCP - Autologous blood transfusion (2006)
Controversies:
The evidence-base proving that cell salvage saves allogenic blood transfusion and is cost-effective is limited. A recent Cochrane review of 49 randomized controlled trials over a 24-yr period showed that the use of cell salvage reduced the rate of exposure to allogenic blood transfusion by 40%. It did not adversely affect mortality or complications such as bleeding, infection, myocardial infarction, thrombosis and stroke. The review concluded that better quality research specifically designed to assess the cost-effectiveness of cell salvage across a range of surgical procedures is required.
In surgery for malignancy there is concern because of potential systemic dissemination of tumour cells from salvaged blood. Malignant cells may be removed by filtration and further reductions achieved by irradiation. This remains an area of much research. The use of cell salvage during caesarean section remains controversial because of concerns regarding amniotic fluid embolism and rhesus sensitisation resulting from reinfusion of foetal cells in salvaged blood. There are a small number of studies indicating that it can be used without these complications, but larger safety studies are required.