Anaesthetics Formative Flashcards
Which of the following statements concerning crystalloids is most correct?
= D: The distribution of water in a balanced salt solution such as CSL used intravenously roughly matches that of Normal Saline
What is least likely to be of significant use in the treatment of post-operative nausea and vomiting?
= E: Substituting ondansetron 4mg IV for ondansetron 4mg oral wafer
- There is no evidence that ondansetron is more efficacious intravenously than as an oral wafer.
Preoxygenation must always precede the hypnotic agent to prevent desaturation, and the hypnotic agent must be given before the paralysing agent to prevent awareness.
= B: Ketamine
A diabetic hypertensive patient is scheduled for elective surgery in the morning. What option represents the best pre-operative management?
= B: No food from midnight: clear fluids until 06:00; take antihypertensive medications but omit diabetic medications on the morning; schedule patient first on the list
Which intervention is least likely to prevent the progression of acute postsurgical pain to chronic pain?
= E: Treatment of neurotocism with anxiolytic medication
You hear a systolic murmur in a middle-aged patient who is scheduled for elective surgery and general anaesthetic in 3 weeks. The cause of the murmur is not documented. Which statement is correct?
= A: Even if the patient is asymptomatic, an echocardiogram is indicated to determine the cause of the murmur
In determining the risk of serious morbidity and mortality from a proposed operation and associated anaesthetic, all other things being equal, what is the single most important consideration?
= D: The surgical factors
= B: If the decision is made to cease clopidogrel pre-operatively, it should be ceased at least 7 days before surgery.
= C. Hypoglycaemic agents and anticoagulants
- A: Arterial blood gas analysis (ABG)
- B: Bleeding time
- C: Coagulation profile
- D: CT scan of the chest
- E: CT scan of the head
- F: Dobutamine stress echocardiography
- G: Electroencephalogram
- H: Exercise stress testing
- I: Extended focused abdominal sonogram in trauma
- J: Full blood picture
- K: MRI brain
- L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- M: Transthoracic echocardiogram
- N: X-ray of skull
= F. Dobutamine stress echocardiogram
- A: Arterial blood gas analysis (ABG)
- B: Bleeding time
- C: Coagulation profile
- D: CT scan of the chest
- E: CT scan of the head
- F: Dobutamine stress echocardiography
- G: Electroencephalogram
- H: Exercise stress testing
- I: Extended focused abdominal sonogram in trauma
- J: Full blood picture
- K: MRI brain
- L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- M: Transthoracic echocardiogram
- N: X-ray of skull
= E: CT scan of the head
- A: Arterial blood gas analysis (ABG)
- B: Bleeding time
- C: Coagulation profile
- D: CT scan of the chest
- E: CT scan of the head
- F: Dobutamine stress echocardiography
- G: Electroencephalogram
- H: Exercise stress testing
- I: Extended focused abdominal sonogram in trauma
- J: Full blood picture
- K: MRI brain
- L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- M: Transthoracic echocardiogram
- N: X-ray of skull
= C: Coagulation profile
- A: Arterial blood gas analysis (ABG)
- B: Bleeding time
- C: Coagulation profile
- D: CT scan of the chest
- E: CT scan of the head
- F: Dobutamine stress echocardiography
- G: Electroencephalogram
- H: Exercise stress testing
- I: Extended focused abdominal sonogram in trauma
- J: Full blood picture
- K: MRI brain
- L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- M: Transthoracic echocardiogram
- N: X-ray of skull
= L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- A: Arterial blood gas analysis (ABG)
- B: Bleeding time
- C: Coagulation profile
- D: CT scan of the chest
- E: CT scan of the head
- F: Dobutamine stress echocardiography
- G: Electroencephalogram
- H: Exercise stress testing
- I: Extended focused abdominal sonogram in trauma
- J: Full blood picture
- K: MRI brain
- L: Spirometry (forced vital capacity FVC and forced expiratory volume in 1 second FEV1)
- M: Transthoracic echocardiogram
- N: X-ray of skull
- I: Extended focused abdominal sonogram in trauma
- When are the orthopaedic surgeons likely to want to operate? (1 mark)
- The open fracture of the ankle has a significant risk of infection and loss of limb. The orthopaedic risk is reduced by early surgery, ideally no more than about 6 hours after the injury, but the sooner the better. Does the likely time scale for going to theatre pose any particular anaesthetic risks? (3 marks)
= 6 hours for food, two hours for clear fluids - factual knowledge (Total 1 mark)
Orthopaedic surgeons are likely to want to operate as soon as reasonably practical - patient has an open fracture. (Total 1 mark)
- A general anaesthetic is required. What specific anaesthetic techniques will be needed to reduce the risks in this patient? (3 marks)
- What other major considerations related to the accident should be considered in this patient’s pre-operative workup? (2 marks)
Workup - High speed accident - any other injuries? It was a high speed accident so other injuries are quite possible. (2 marks)
