anaesthetics

Question 1

how often before surgery should the oral contraceptive be stopped?

Answer 1

4 weeks prior

Question 2

what is suxamethonium apnoea ? how is it managed

Answer 2

Autosomal dominant mutation, leading to a lack of specific acetylcholistenerase in the plasma which acts to break down suxamethonium which terminates its muscle relaxant effect.

managed with mechanical ventilation and observation in ITU until effects of suxamethonium wear off

Question 3

what are the two categories of muscle relaxants used in anaesthetics? give examples of each

Answer 3

Depolarising muscle relaxants - suxamethonium
Non depolarising muscle relaxants - atracurium, vecuronium, pancuronium

Question 4

which anaesthetic agent is best for haemodynamically unstable patients and why?

Answer 4

Ketamine as it preserves blood pressure and does not cause cardio suppression

Question 5

which anaesthetic is the choice for rapid sequence induction?

Answer 5

sodium thiopentone

Question 6

what is the complication of excess infusion of sodium chloride?

Answer 6

Hyper-chloraemic acidosis

Question 7

what is a common complication after surgery involving the bowel ? what are its features? what blood marker should be checked? How is it managed?

Answer 7

Post-operative ileus - reduced bowel peristaltis resulting in pseudo-obstruction.

features :

abdominal distension, pain , nausea and vomiting, inability to flatus

deranged electrolytes

management -

NBM
NG tube if vomiting
IV fluids
total parenteral nutrition

Question 8

what is the ASA classification?

Answer 8

I : normal healthy, non smoker + minimal alcohol
II : mild systemic : smoker, social alcohol, pregnancy, obesity ( BMI 30-40) , Well controlled DM/ HTN, mild lung disease
III : severe systemic illness : substantive functional limitations - poorly controlled DM, HTN, COPD , morbid obesity ( BMI > 40) , esrd W dialysis, history of > 3 months of MI, Cerebrovascular accidents
IV : constant threat to life - sepsis, ongoing ischaemia, MI <3 m
V : not expected to survive without operation
VI : declared brain dead patient who’s organs are being removed for donor purposes

Question 9

oral fluids / fasting rules re surgery

Answer 9

fluids 2h before ( clear fluids) , 6h for solids/ non-clear liquids

Question 10

mx of patients on insulin undergoing minor procedures

Answer 10

good glycaemic control - adjustment of usual insulin regime ( defined as HbA1C < 69)

Question 11

in what circumstances should a VRII be used

Answer 11

more than one meal is to be missed
patients with poor glycaemic control
risk of renal injury - low eGFR/ contrast

Question 12

metformin - day before surgery, day of surgery ( morning) and day of surgery ( afternoon)

Answer 12

before - normal
morning - od, bd : normal
afternoon - od bd normal

basically for metformin the only time u make any changes is when the medication is being taken TDS - in which case lunchtime dose is omitted

Question 13

sulfonylureas - day before surgery, day of surgery ( morning) and day of surgery ( afternoon)

Answer 13

day before - normal
morning surgery - omit morning dose , take evening dose if BD
afternoon surgery - omit everything regardless of od, bd

Question 14

sglt-2 surgery rules

Answer 14

omit on day only

Question 15

insulin surgery rules

Answer 15

once daily regimens - reduce dose by 20% ( before, day of)
twice daily regimens - half morning dose on day of surgery

Question 16

what are the three phases of an operation

Answer 16

before induction of an anaesthesia - sign in
before incision of the skin - time out
before patient leaves the operating room- sign out

Question 17

what is the checklist confirmed before proceeding with an operation

Answer 17

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

Question 18

Abdominal pain, bloating and vomiting following bowel surgery

Answer 18

postoperative ileus

Question 19

what is the bowel prep required before a colonoscopy

Answer 19

laxatives the day before the examination
patients required not to eat 24h before colonoscopy

Question 20

what medication should be prescribed prior to surgery for patients taking prednisolone

Answer 20

hydrocortisone supplementation

Question 21

how should total parenteral nutrition be administered

Answer 21

central vein like subclavian line

Question 22

which anaesthetic has inherent anti emetic properties

Answer 22

propofol

Question 23

how do you manage severe anaemia prior to surgery

Answer 23

pre-operative blood transfusion

Question 24

how is local anaesthetic toxicity managed

Answer 24

IV lipid emulsion

Question 25

how long post total hip replacement should low molecular weight heparin be commenced

Answer 25

6-12 hours after surgery

Question 26

what is the action of lidocaine

Answer 26

blocking of sodium channels

Question 27

what is a cause of AF following gi surgery

Answer 27

anastomotic leak - presenting about 5 days post op

Question 28

mx of anastomotic leak

Answer 28

back to theate

Question 29

when should the following feeding options be used ng feeding naso jejunal pec parenteral

Answer 29

ng feeding - impaired swallow, c/ i in head injury naso-jejunal feeding - avoids aspiration, safe post oesophagogastric surgery feeding jejunostomy - long term feeding, post upper GI surgery percutaneous endoscopic gastrotomy - in patients who cannot undergo endoscopy total parenteral nutritional - enteral feeding c/i

Question 30

what are the adverse effects of depolarising anaesthetics

Answer 30

malignant hyperthermia hyperkalaemia

Question 31

what is malignant hyperthermia , how is managed

Answer 31

serious recognised side effect of suxamethonium presenting with tachycardia, muscle rigidity , rhabdomyolysis, hyperthermia and arryhtmia - to be managed with IV dantrolene

Question 32

what is the contraindication to nasopharyngeal airway

Answer 32

base of skull fracture

Question 33

what are some consequences of impaired thermo-regulation during surgery

Answer 33

bleeding intra operative hypothermia

Question 34

how is an anastomotic leak diagnosed

Answer 34

abdominal ct

Question 35

when is suxamethonium c/i

Answer 35

in trauma / burns patients as they increase the risk of hyperkalaemia

Question 36

what is the action of non depolarising muscle relaxants ? how are they reversed

Answer 36

Competitive antagonist of nicotinic acetylcholine receptors reversed using acetylcholinesterase inhibitors

Question 37

what are the most common causes of post- operative fever?

Answer 37

day 1-2 : wind ( pneumonia, aspiration ,PE) day 3-5 : water UTI day 5-7 : wound surgical site infection day 5 walking : dvt/ pe anytime - drugs, transfusion reactions, sepsis, line contamination

Question 38

what reverses the action of benzos

Answer 38

flumazenil

Question 39

which anaesthetic is associated with hepatotoxicity

Answer 39

halothane

Question 40

what is the s/e of long term total parenteral use

Answer 40

fatty liver and deranged LFT's

Question 41

in which procedures would addition of adrenaline to local anaesthetic be c/i

Answer 41

procedures with risk of digital ischaemia

Question 42

in which procedures is group and save performed

Answer 42

Hysterectomy (simple), appendicectomy, thyroidectomy, elective lower segment caesarean section, laparoscopic cholecystectomy

Question 43

Cross-match 2 units - which procedures

Answer 43

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

Question 44

Cross-match 4-6 units

Answer 44

Salpingectomy for ruptured ectopic pregnancy, total hip replacement

Question 45

Cross-match 4-6 units

Answer 45

Total gastrectomy, oophorectomy, oesophagectomy Elective AAA repair, cystectomy, hepatectomy

Question 46

what are the symptoms of bile leak post cholecystectomy

Answer 46

RUQ tenderness bilious fluid

Question 47

what can cause hyponatraemic encephalopathy in paediatric patients

Answer 47

hypotonic agents (0.45%)

Question 48

what can be done to minimize complications of poor BM control in patients requiring surgery

Answer 48

patient should be first on list

Question 49

A 22-year-old fit and well male undergoes an emergency appendicectomy. He is given suxamethonium. An inflamed appendix is removed and the patient is returned to recovery. One hour post operatively the patient develops a tachycardia of 120 bpm and a temperature of 40 ºC. He has generalised muscular rigidity. What is the most likely diagnosis?

Answer 49

malignant hyperthermia

Question 50

what intervention can reduce the risk of intra-abdominal adhesions

Answer 50

laparoscopy over open surgery

Question 51

what are the causes of post-operative surgical site infections

Answer 51

enterobacter staph aureus

Question 52

which agent has moderate- strong analgesic properties

Answer 52

ketamine

Question 53

which agent is contraindicated in patients with penetrating eye injuries or acute narrow angle glaucoma

Answer 53

suxamethonium - increases intraocular pressure

Question 54

what are early causes of post-op pyrexia

Answer 54

blood transfusion cellulitis uti physiological systemic inflammatory reaction pulmonary etelectasis 0-5 days

Question 55

what are the late causes of post op pyrexia

Answer 55

Venous thromboembolism Pneumonia Wound infection Anastomotic leak

Question 56

when are the following recommended pre-op ecg fbc

Answer 56

>65 may need ECG before surgery renal disease - fbc and ecg before intermediate surgery diabetes- ecg before intermediate surgery

Question 57

which positional manouvres to open the airway are recommended if there is concern about cervical spine injury

Answer 57

jaw thrust

Question 58

which anaesthetic agent causes fasciculations

Answer 58

suxamethonium

Question 59

which airway provides the poorest control against reflux of gastric contents ?

Answer 59

laryngeal mask

Question 60

which airway is best to prevent high risk of reflux

Answer 60

endotracheal tube

Question 61

what is the management of pre operative anticoagulation

Answer 61

stop warfarin 5 days before, switch to low molecular weight heparin and stop that before surgery

Question 62

which medication can slow bone healing

Answer 62

Non steroidal anti inflammatory drugs Steroids Immunosupressive agents Anti neoplastic drugs

Question 63

what can be used to identify accidental oesophageal intubation

Answer 63

end tidal carbon dioxide monitoring

Question 64

what is a complication of long term mechanical ventilation

Answer 64

trans-oesophageal fistula formation

Question 65

Dropping sats following intubation → ?

Answer 65

oesophageal intubation

Question 66

what airway is recommended in slow weaning

Answer 66

tracheostomy

Question 67

which airway is used for day surgery procedures

Answer 67

laryngeal mask

Question 68

what should be used with caution in patients with pneumothoraz

Answer 68

nitrous oxide

Question 69

which anaesthetic can cause adrenal suppression

Answer 69

adomidate

Question 70

which anaesthetic can cause laryngospasm

Answer 70

Thiopental

Question 71

Volatile liquid anaesthetics (isoflurane, desflurane, sevoflurane) s/e

Answer 71

malignant hyperthermia

Question 72

what are hypertrophic scars caused by

Answer 72

excessive amounts of collagen

Question 73

what are the advice for post-operative wound

Answer 73

Use sterile saline for wound cleansing up to 48 hours after surgery. Advise patients that they may shower safely 48 hours after surgery. Use tap water for wound cleansing after 48 hours if the surgical wound has separated or has been surgically opened to drain pus.

Question 74

Intraosseous access is most commonly obtained at the

Answer 74

proximal tibia