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Year 4 Overview/Random tests > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Why is rheumatoid arthritis relevant info for anaesthetistS?

A

Risk of atlantoaxial joint dislocation on intubation (over-extension)

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2
Q

What is the Mal-Pate score?

A

Grades of intubation

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3
Q

Why might TMJ dysfunction not be as bad as thought?

A

More pain than mechanical - so when sedated easier to manipulate

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4
Q

Why/when is aspirin and clopidogrel stopped for surgery?

A 
Only for 'microcirculation' procedures/high-risk bleeding eg some neurosurgeons
7 days (platelet production) - all irreversible inhibition
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5
Q

What bridging therapy used for patients on warfarin?

A

Stop warfarin 5 days prior.
3 days prior started on dalteparin (LMWH) injections.
Omitted morning of surgery.

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6
Q

What kind of pain is cancer pain?

A

Mixed (nociceptive/neuropathic)

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7
Q

Causes of neuropathies?

A

Diabetic
Peripheral
Chemotherapy/azathioprine

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8
Q

New name for gate control theory re: pain?

A

Modulation

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9
Q

Mechanism of action of clonidine?

A

alpha2 receptor agonist -> decreases systemic peripheral resistance -> lowers BP
Also used in ADHD, withdrawl, personality disorders, pain, etc etc.

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10
Q

Most likely MoA of acupuncture?

A

Endogenous opioid production stimulation

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11
Q

Emergency reversal of rivaroxaban?

A

andexanet alfa

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12
Q

Mechanism of action prochlorperazine?

A

D2 receptors in CTZ

Anticholinergic action too - M3 receptors

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13
Q

Mechanism of action haloperidol?

A

Central D2 antagonism

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14
Q

Mechanism of action metoclopramide?

A

Dopamine2, H1 and 5-HT3 antagonism

Increases gastric emptying

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15
Q

Mechanism of action cyclizine?

A

Antagonism of H1 central receptor
Anticholinergic
Cause tachycardia if IV

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16
Q

Mechanism of action ondansetron?

A

5-HT3 anatagonists

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17
Q

Mechanism of action lorazepam?

A

Gaba agonist

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18
Q

Mechanism of action cannabinoids?

A

CB1 receptors in CNS, lung, liver and kidney

Naturally occuring delta-9-tetrahydrocannibol

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19
Q

Mechanism of action of atropine/hyoscine?

A 
Cross BBB (non-polar)
Act on muscarinic receptors in vomiting centre and GI tract, reducing GI tract and salivary secretions and intestinal tone. 
Good for motion sickness and opiate-induced nausea
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20
Q

4 areas for risk factors for PONV?

A

Patient,
Anaesthetic,
Surgery,
Medical

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21
Q

Patient risk factors for PONV?

A 
Female > Male (2.5:1)
Anxiety
Personal hx of PONV
Motion sickness
Non-smoker
Pain
Gastric contents (unfasted)
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22
Q

Anaesthetic risk factors for PONV?

A 
Volatile agents
Nos
Opioids
Neostigimine
IV anaesthetics - ketamine and etomidate
Stomach insufflation
Spinal anaesthetic (w/ hypotentsion)
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23
Q

Surgical risk factors for PONV?

A 
ENT - esp middle ear, adenoids and tonsilectomy
Squint surgery
Gynaecological surgery
GI surgery
Laprascopic procedures
Intestinal obstruction
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24
Q

Medical risk factors for PONV?

A

Hypoxia
Uraemia
Metabolic disorders eg hypoglycaemia, hypercalcaemia

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25
Q

Nonpharmacological treatment?

A

Peri-op fluids
Acupuncture
Ginger
Hypnosis

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26
Q

What precedes vomiting?

A

Increased sympathetic activity

Increase in intra-abdo pressure

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27
Q

4 stages of poisoning and when we can intervene?

A

Contact -> ingestion -> metabolism -> elimination

Decontamination, antidotes, aid excretion

28
Q

Antidote for benzos?

A

Flumazenil

29
Q

Antidote for paracetamol?

A

N-acetyl Cysteine or Methionine

30
Q

Antidote for local anaesthetic toxicity?

A

Intra-lipid emulsion

31
Q

Antidote for atropine?

A

Beta-blockers or glucagon

32
Q

Antidote for TCAs?

A

Sodium bicarb

33
Q

Antidote for iron salts?

A

Desferrioximine

34
Q

Antidote for organophosphates?

A

atropine, pralidoxamine

35
Q

Antidote for Ethylene Glycol, Methanol?

A

ethanol

36
Q

Options for gut decontamination?

A

Rarely used
Activated charcoal/whole bowel irrigation
Boundary for activated charcoal: 1 hour after ingestion
Not suitable for alcohols or metal salts

37
Q

Three main options to aid elimination?

A

Urinary alkalinisation
Haemodialysis
Haemofiltration

38
Q

What is urinary alkalinisation used for?

A

Salicylates/volatile oils

39
Q

What is haemodialysis used for?

A

salicylates, alcohols, phenobarbitol, lithium and sodium valproate

40
Q

What is haemofiltration used for?

A

Theophylline, barbiturates, chloral hydrate

41
Q

If transient narrowing of QRS complexes when sodium bicarb given for suspected TCA overdose?
Dx?
Further tx?
Why?

A

Diagnoses most likely TCA culprit
Requires infusion after bolus
For sodium channel blockade not to narrow QRS

42
Q

What electrolyte abnormality are burns patients predisposed to?

A

Hyperkalaemia

43
Q

Head injury in kids - likely to vomit?

A

Yes very, allowed two before more concerned

44
Q

Important basic measure for head injury?

A

Sit them up

45
Q

Most important component of GCS?

A

M

46
Q

Fixed pupil - be aware of the…

A

False eye!

47
Q

Which antiemetics mostly avoided in concussion?

A

Metoclopramide/cyclizine

48
Q

What does pneumocephalus predispose to?

A

CNS infection

49
Q

Safe paracetamol dose/day?

What if a high risk group?

A

150mg/kg/day

75mg/kg/day

50
Q

Toxic metabolite of paracetamol?

A

N-acetyl-p-benzoquinone imine

NAPQI

51
Q

What can happen with first parvalex infusion?

A

Anaphylactoid reaction

52
Q

Cut-off for more vs less effective for starting parvalex?

A

Around 8 hours

53
Q

What is parvalex?

A

Glutathione

54
Q

When might toxicity risk be increased?

A

Any drugs acting on P450 system:
rifampicin, phenobarbital, phenytoin, carbamazepine and alcohol

Low glutathione levels (malnourished, HIV+ve, alcohol)

55
Q

Why is flumazenil often not used unless iatrogenic cause of benzo overdose?

A

Street valium
Even if reported/prescribed mixed in with other medication, can muddy water (irreversibly binds and has a long half life)

56
Q

When is a paracetamol level not reliable?

A

After 16 hours or if below 5 may read undetectable so err on side of caution

57
Q

If paracetamol overdose ingestion time is staggered - tx?

A

Start parvalex in case

58
Q

If paracetamol OD time is all within 1 hour?

A

Activated charcoal?

paracetamol levels at 1 hour

59
Q

Treatment of betablocker OD?

When given?

A

Glucagon - vomit often

In elderly mixed OD

60
Q

Ace inhibitor overdose?

A

Insulin (1mg/hour) and dextrose

61
Q

Anaphylaxis drug doses?

A

500mcg adrenaline (0.5ml of 1:10000)
10mg chlorphenamine
200mg Hydrocortisone

62
Q

How long should warfarin be stopped prior to elective surgery?

A

5 days

63
Q

Mechanism of action morphine?

A

Mu receptor agonist
NB also - causes histamine release
One of metabolites more potent than morphone

64
Q

Define base excess?

Normal values?

A

A measure of how much base must be removed or added to the system to correct the pH in standard conditions
-3-+3
or 2

65
Q

Naloxone given in practice?

A

40 mcg to ensure RR comes up but ? stay asleep

66
Q

Patients with diabetes - elective surgery?

A

1st on list
Fast for 6 hours
IV insulin with IV dextrose and potassium
Monitor glucose

Year 4 Overview/Random tests (11 decks)

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