4th Year Pain and Operative Care

Question 1

why does post-op pain need managed?

Answer 1

can lead to hypertension and tachycardia leading to increased myocardial demand
risks progressive to chronic pain

Question 2

four point score for pain

Answer 2

0= none
3= continuous pain at rest and severe on movement

Question 3

why is sedation charted?

Answer 3

watch for respiratory depression

Question 4

cautions in NSAIDs

Answer 4

asthma
renal failure (especially in elderly + hepatic function impaired)
bleeding (platelets + GI)
GI bleeding

Question 5

what are SE of opioids

Answer 5

constipation
N&V
respiratory depression
pruritis

Question 6

management of opioid SE

Answer 6

naloxone (maintains RR)

chlorpheniramine

Question 7

what is used in catheters for pain control?

Answer 7

peripheral nerve blockade

Question 8

what to always co-prescribe with opioids?

Answer 8

laxatives

Question 9

management of burning/tingling pain?

Answer 9

tricyclics e.g. amitriptyline

Question 10

management of shooting pain?

Answer 10

anti-convulsants e.g. gabapentin, sodium valproate and carbamazepine

Question 11

chronic pain methods

Answer 11

drugs
stimulation analgesia (TENS and acupuncture)
nerve blocks
neuro-surgical techniques

Question 12

what to check before anaesthetic can be given?

Answer 12

cardiac and respiratory function

check patient stairs/ exercise tolerance

Question 13

drugs that can be given prior to anaesthetic/ surgery

Answer 13

• relive anxiety and pain
• intercurrent diseases (some must be stopped)
• infection and VTE prophylaxis

Question 14

complications of anaesthetic

Answer 14

bradycardia (vagal overactivity)
aspiration pneumonia (Mendelson's syndrome)

Question 15

drugs that should be stopped prior to surgery?

Answer 15

warfarin
MAOI
OCP

Question 16

what drugs need manipulation prior to surgery?

Answer 16

hypoglycaemics

steroids

Question 17

what is the role of anaesthetic?

Answer 17

depress consciousness
block pain
relax skeletal muscle

Question 18

what is the triad of analgesia (balanced)?

Answer 18

sleep
analgesia
relaxation

Question 19

delivery of anaesthetic

Answer 19

IV

inhalation

Question 20

what is the most immediate effect of anaesthetic?

Answer 20

loss of the airway

Question 21

what should post-op assessment involve?

Answer 21

cardiovascular (hypotension, haemorrhage)
respiratory (anaesthetic, cough)
GI (PONV, ileus)
CNS
urinary (oligouria)

Question 22

classification of post-op bleeding

Answer 22

primary

secondary (2nd day post-op

Question 23

cause of primary post-op bleeding

Answer 23

bleeding diathesis

drugs

Question 24

what is secondary post-op bleeding usually caused by?

Answer 24

infection