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ANAESTHETICS Flashcards

1
Q

does smoking make you hyper-coagulable or hypo-coagulable?

A

hyper

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2
Q

does alcohol make you hyper-coagulable or hypo-coagulable?

A

hypo

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3
Q

what are the components of an anaesthetic pre-assessment?

A 
social history
current health
physical examination
drug history
past medical/surgical hx
blood tests
hospital anxiety & depression scale
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4
Q

what are the 3 different types of anaesthetic?

A

general
regional
local

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5
Q

which of these is not a component of general anaesthesia?

a) amnesia
b) analgesia
c) apyrexia
d) akinesis

A

c) apyrexia

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6
Q

what is the CEPOD classification in surgery?

a) urgency
b) anaesthesia
c) open vs keyhole
d) morbidity

A

a) urgency

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7
Q

which of these is NOT a classification under the CEPOD urgency of surgery system?

a) immediate
b) urgent
c) expedited
d) elective
e) non-urgent

A

e) non-urgent

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8
Q

which of these is NOT a form of cardiovascular monitoring used whilst a patient is under general anaesthetic?

a) central venous catheter
b) ECG
c) NIBP

A

a) central venous catheter

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9
Q

which of these is NOT an air gas regularly monitored when a patient is under general anaesthetic?

a) O2
b) Nitrogen
c) CO2
d) vapour
e) pressure

A

b) Nitrogen

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10
Q

which of these is the largest IV venflon cannula?

a) 14G
b) 24G

A

a) 14G

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11
Q

how long do induction agents take to induce loss of consciousness?

a) 2-5secs
b) 10-20secs
c) 30-40secs
d) 1 min

A

b) 10-20secs

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12
Q

how long do induction agents’ effects last?

a) 1-2 mins
b) 4-10 mins
c) 15-30 mins
d) 30mins - 1 hour

A

b) 4-10 mins

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13
Q

what is the most common induction agent used?

A

propofol

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14
Q

what is an added bonus of propofol as an induction agent?

a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-secretions

A

a) suppresses airway reflexes

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15
Q 
fill in the gap:
propofol causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop
A

a) drop; drop

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16
Q

which is the fastest induction agent to use?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

b) thiopentone

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17
Q

which induction agent is used in rapid sequence induction?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

b) thiopentone

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18
Q

what is an added bonus of thiopentone as an induction agent?

a) suppresses airway reflexes
b) anti-pyretic properties
c) anti-bacterial properties
d) anti-epileptic properties

A

d) anti-epileptic properties

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19
Q 
fill in the gap:
thiopentone causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop
A

d) raise; drop

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20
Q

true or false:

propofol is painful on injection

A

true

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21
Q

why can thiopentone result in a rash and/or bronchospasm?

a) dopamine release
b) bradykinin release
c) histamine release
d) choline release

A

c) histamine release

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22
Q

which induction agent is contraindicated in porphyria?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

b) thiopentone

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23
Q

which induction agent has the slowest onset (around 90secs)

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

c) ketamine

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24
Q 
fill in the gap:
ketamine causes a \_\_\_\_\_ in heart rate and \_\_\_\_\_ is blood pressure when used
a) drop; drop
b) raise; raise
c) drop; raise
d) raise; drop
A

b) raise; raise

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25
Q

which induction agent is the most haemo-dynamically stable?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

d) etomidate

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26
Q

what is the benefit of etomidate being haemo-dynamically stable?

A

useful in patient’s with heart failure

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27
Q

which induction agent has the lowest incidence of hypersensitivity?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

d) etomidate

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28
Q

which induction agent has the lowest incidence of nausea & vomiting?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

a) propofol

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29
Q

which induction agent has the highest incidence of nausea & vomiting?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

d) etomidate

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30
Q

true or false:

thiopentone is painful on injection

A

false

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31
Q

true or false:

ketamine is painful on injection

A

false

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32
Q

true or false:

etomidate is painful on injection

A

true

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33
Q

which induction agent causes adreno-cortical suppression?

a) propofol
b) thiopentone
c) ketamine
d) etomidate

A

d) etomidate

the patient may need to be given supplementary cortisol following ‘stress’ periods e.g. bleeding

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34
Q

give an example of an amnesic vapour

A

isoflurane
sevoflurane
desflurane

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35
Q

which amnesic vapour affects organ blood flow THE LEAST?

a) isoflurane
b) sevoflurane
c) desflurane

A

a) isoflurane

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36
Q

which amnesic vapour has the lowest MAC?

a) isoflurane
b) sevoflurane
c) desflurane

A

a) isoflurane

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37
Q

what does MAC stand for (in terms of amnesic agents?)

a) maximum arterial concentration
b) my ass is candy
c) minimum alveolar concentration
d) maximum affected cells

A

c) minimum alveolar concentration

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38
Q

which amnesic vapour has a sweet smell?

a) isoflurane
b) sevoflurane
c) desflurane

A

b) sevoflurane

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39
Q

which amnesic vapour is most suitable for long operations?

a) isoflurane
b) sevoflurane
c) desflurane

A

c) desflurane

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40
Q

give an examples of a short acting analgesic used in patients under general anaesthetic

A

fentanyl
alfentanyl
(sometimes remifentanil)

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41
Q

give an example of a long-acting analgesic used intra and post-operatively for patients under general anaesthetic

A

morphine

oxycodone

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42
Q

diclofenac, parecoxib (IV) and ketorolac (IV) are examples of what type of analgesic?

A

NSAIDS

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43
Q

true or false

tramadol can be used with morphine

A

true

44
Q

fill in the gaps:
muscle contraction occurs when ______ enters the ___-_______ junction. ___ is released at the _________ junction leading to depolarisation of _________ receptors

potassium, calcium, sodium, ACh, ACh-esterase
pre-synaptic, post-synaptic, inter-synaptic, neuromuscular, nicotinic

A 
calcium
pre-synaptic 
ACh
neuromuscular
nicotinic
45
Q

how do depolarising muscle relaxants work?

A

act like ACh but are broken down more slowly by ACh-esterase

this leads to extended muscle contraction and fatigue (as calcium needed for contraction is used up). the muscle relaxes

46
Q

is suxamethonium an example of a depolarising or non-depolarising muscle relaxant?

A

depolarising

47
Q

true or false:

suxamethonium is used in rapid sequence induction

A

true (rapid onset of 30-60secs)

48
Q

how long does suxamethonium last?

a) 1-2 mins
b) 6-10 mins
c) 20-30 mins
c) 60 mins

A

b) 6-10 mins

49
Q

which of these is NOT a side effect of suxamethonium?

a) fasciculations
b) hyperkalaemia
c) rise in OCP/IOP/gastric pressure
d) hearing loss

A

d) hearing loss - that’s gentamicin bro

50
Q

how can use of suxamethonium lead to hyperkalaemia?

A

potassium released if muscle fibres break

51
Q

how do non-depolarising muscle relaxants work?

A

block nicotinic receptors leading to muscle relaxation

52
Q

is atracurium an example of a depolarising or non-depolarising muscle relaxant?

A

non-depolarising

53
Q

true or false:

atracurium is used in rapid sequence induction

A

false - all non-depolarising muscle relaxants have a slow onset

54
Q

which group of muscle relaxants have LESS side effects?

a) depolarising
b) non-depolarising

A

b) non-depolarising

55
Q

give an example of a short acting muscle relaxant (30 mins)

A

atracurium

mivacurium

56
Q

give an example of an intermediate acting muscle relaxant (60 mins)

A

vecuronium

rocuronium

57
Q

give an example of an long acting muscle relaxant (90 mins)

A

pancuronium

58
Q

name a drug used to reverse non-depolarising muscle relaxants and it’s mechanism

A

neostigmine - ACh inhibitor

glycopyrrolate - muscarinic antagonist (protects against bradycardia)

59
Q 
put the following drugs in order of administration in the general anaesthetic process:
muscle relaxant
short-acting analgesic
amnesic vapour
induction agent
long-acting analgesic
A 
short-acting analgesic
induction agent
muscle relaxant
amnesic vapour
long-acting analgesic
60
Q

what percentage of patients experience PONV?

a) 5-10%
b) 20-30%
c) 50-60%
d) 80-90%

A

b) 20-30%

61
Q

name the most commonly used anti-emetic for PONV

A

ondansetron

then dexamethasone, then cyclizine

62
Q

name a type of surgery which pre-disposes to PONV

A

ENT
eye
laparotomy
gynae

63
Q

name a demographic factor which can predispose to PONV

A 
female
previous PONV
motion sickness
non-smoker
obese
64
Q

give an indication for rapid sequence induction

A

emergency situation when there is a full stomach

65
Q

how long should you pre-oxygenate the patient before rapid sequence induction

a) you don’t need to
b) 1 min
c) 3 mins
d) 7 mins

A

c) 3 mins

66
Q

what 3 drugs are used in rapid sequence induction?

A

thiopentone
propofol
suxamethonium

67
Q

fill in the blanks:

cardiac output = ____ ____ x ____ ____

A

stroke volume

heart rate

68
Q

fill in the blanks:

mean arterial pressure = ____ ____ x ____ ____ _____

A

cardiac output

systemic vascular resistance

69
Q

which 2 of these spinal regions does the sympathetic nervous system NOT originate from?

a) cranial
b) cervical
c) thoracic
d) lumbar

A

a) cranial

d) lumbar

70
Q

which of these is NOT a receptor used by the sympathetic nervous system?

a) ACh
b) nicotinic
c) dopaminergic

A

c) dopaminergic

71
Q

true or false:

the sympathetic nervous system is associated with ‘fight or flight’

A

true

72
Q

do alpha 1 receptors act pre- or post- synaptically?

A

post-synamptically

73
Q

which intracellular messanger do alpha 1 receptors increase when activated?

a) sodium
b) calcium
c) potassium
d) noradrenaline

A

b) calcium

74
Q

which of these actions is NOT increased by alpha-1 receptors?

a) heart rate
b) vasoconstriction
c) peripheral resistance
d) systemic arterial pressure

A

a) heart rate

75
Q

do alpha 2 receptors act pre- or post- synaptically?

A

pre-synaptically

76
Q

which intracellular messenger do alpha 2 receptors inhibit when activated?

a) sodium
b) calcium
c) potassium
d) noradrenaline

A

d) noradrenaline (inhibition results in inhibition of caMP)

77
Q

what is the result of beta 1 receptor activation?

a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)

A

a) increased contractility and heart rate

also increase cAMP formation

78
Q

what is the result of beta 2 receptor activation?

a) increased contractility and heart rate
b) smooth muscle relaxation (vascular & non-vascular)

A

b) smooth muscle relaxation (vascular & non-vascular)

also increase cAMP formation

79
Q

what type of receptor does the parasympathetic nervous system act on?

A

muscarinic

80
Q

ephedrine, phenyephrine, metaraminol, methoxamine, xylometazoline, oxymetalozine, adrenaline and noradrenaline are examples of drugs which act on which receptors?

A

alpha 1
VASOCONSTRICTION
phenyephrine can cause reflex bradycardia

81
Q

clonidine is an example of a drug which works on which receptors?

A

alpha 2 - sedative

82
Q

isoprenaline, salbutamol and adrenaline are examples of drugs which act on which receptors?

A

beta
adrenaline = beta 1
isoprenaline = beta 1 & 2
salbutamol = beta 2

83
Q

give an example of an alpha blocker and a beta blocker

A

doxazocin

labetalol

84
Q

give an example of an ACh inhibitor

A

neostigmine

85
Q

give some examples of muscarinic receptor antagonists

A

atropine
glycopyrrolate
ipatropium

86
Q

what is the name of this law?
as a myocyte stretches, its contractility increases, therefore the greater the volume of blood in the heart during diastole, the more forceful the cardiac contraction (up to a point e.g. HF)

A

starling’s law

87
Q

what do you give in the occurence of local anaesthetic toxicity?

A

intralipid IV

88
Q

what is the difference in location between the epidural and spinal anaesthetics?

A

epidural is in epidural space LOL

spinal is in subarachnoid

89
Q

why is the epidural needle curved?

A

to allow fitting of catheter

makes a ‘pop’ sound after it pierces ligamentum flavum so you know you’re in the right place

90
Q

what is recommended treatment for post epidural/spinal/LP headache?

A

lie on back, drink caffeine - conservative

if still not working can do spinal tap - blood clot to block hole

91
Q

are amide or ester LAs used most commonly nowadays?

A

amides

92
Q

give an example of a short, medium and long acting LA

A

short - prilocaine (ester)

med - lignocaine (amide) long - bupivicaine (amide)

93
Q

what is the dose of lignocaine, prilocaine & bupivicane with and withut adrenaline

A 
lignocaine = 3ml/kg or 7 w adrenaline
prilocaine = 6ml/kg or 9 w adrenaline
bupivicaine = 2ml/kg or 2 w adrenaline
94
Q

why would you give adrenaline with LAs?

A

causes vasoconstriction
reduces systemic absorption
increases conc in area injected

95
Q

which ASA grade is this?

healthy patient, no co-morbidities or significant PMHx

A

ASA 1

96
Q

which ASA grade is this?

mild systemic disease

A

ASA 2

97
Q

which ASA grade is this?

severe systemic disease

A

ASA 3

98
Q

which ASA grade is this?

severe systemic disease that is a constant threat to life

A

ASA 4

99
Q

which ASA grade is this?

moribund, won’t survive without this operation

A

ASA 5

100
Q

which ASA grade is this?

brain dead, organs being removed (cheerful thought)

A

ASA 6

101
Q

what is the most common patient position

A

supine

102
Q

when would yu tilt a supine patient to the left?

A

risk of SVC compression e.g. pregnancy, obese

103
Q

what is the trendelenburg position?

A

45’ head down

reverse trendelenburg equals opposite duh (e.g. for raised ICP or GORD)

104
Q

what is the lloyd davis/lithotomy position?

A

legs in stirrups

105
Q

what is a major complication of the lloyd davis/lithotomy position?

A

calf compression - DVT and compartment syndrome

106
Q

what is the lateral position

A

patient laid on side

one lung is underventilated compared to the other

ACC (1 decks)

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