Anesthesia

Question 1

What happens in malignant hyperpyrexia?

Answer 1

Rapid rise in temp and masseter spams precipitated by anaesthetic drugs eg halothane and suxamethonium.

Rx: dantrolene and cooling

Question 2

How does atelectasis present?

Answer 2

Soon after surgery
Mild pyrexia
Dyspnoea
Dull bases with less air entry

Mx: analgesia to aid coughing
Chest physio

Question 3

What are the complications of aortic surgery,

Answer 3

Gut ischemia 
Renal failure (loss of blood supply)
Aotro-enteric fistula 
Anterior spinal syndrome (paraplegia)
Emboli - distal ischemia eg trash foot

Question 4

What are the complications of thyriodectomy?

Answer 4

Wound haemotoma (tracheal obstruction)
Recurrentn L nerve trauma (hoarse voice) 
Hypoparathyrid (low Ca)
Thyriod storm
Hypothyriodism

Question 5

How to assess DVT?

Answer 5

Wells score:

Low risk - d-dimer if positive do US
High risk - do US

Question 6

Treatment for DVT

Answer 6

Therapeutic: LMWH enoxiparin 1.5mg/kg/24hrs 
Start warfarin 
Stop LMWH when INR 2.5
Duration 
- below knee 6-12weeks
- above knee 3-6months 
- ongoing cause - indefinite

Question 7

When to stop OCP before surgery?

Answer 7

4 weeks

Question 8

Causes of post surgery hypotension?

Answer 8

CHOD

Cardiogenic - MI, fluid overload
Hypovolemia - inadequate fluid, haemorrhage
Obstructive - PE
Distributive - sepsis, neurogenic shock

Question 9

What are the contrindications for nasopharyngeal airway?

Answer 9

Base of skull fractures

Question 10

Which drugs are used for induction of anaesthesia?

Answer 10

Propofol- anti emetic properties good choice in day case operations
Sodium thiopentone - for rapid sequence induction
Ketamine - anaesthetic and analgesic effect, can be used in haemodynamic instability, can be used outside of hospital eg emergency amputation
Etomidate - favourable cardiac safety

Question 11

What’s the difference in VTE prophylactis in medical and surgerical patients?

Answer 11

Medical - pharmacology

Surgical - pharm plus mechanical

Fondaparinux, LMWH or unfractioned hep are used. Start about 6 hours after surgery.

Question 12

What is the underlying problem in suxamethonium apnoea during surgery?

Answer 12

Pseudocholinesterase deficiency- caused increased action of muscle relaxants and therefore respiratory arrest.

Question 13

Which agents can cause malignant hyperthermia?

Answer 13

Halothane
Suxamethonium
Antipsychotics (neuroleptic malignant syndrome)

Question 14

Investigations for malignant hyperthermia?

Answer 14

CK raised

Question 15

Management for malignant hyperthermia?

Answer 15

Dantrolene

Question 16

What are the drugs used as muscle relaxants in anaesthetics?

Answer 16

Suxamethonium - fast onset, short duration, Depolarising NM blocker
Atracurium - non depolarising NM blocker, histamine release, reverse with neostigmine
Vecuronium - similar to above
Pancuronium - quick onset, partial reversal by neostigmine

Question 17

What’s type is the universal PLAMSA donor?

Answer 17

Type AB plasma (due to no anti-A, on anti-B antibodies)

Question 18

What’s the max amount of lidocaine can you give to someone for local anaesthetic?

Answer 18

3mg per kg

52x3= 156
1% lidocaine = 15.6ml

Question 19

Which is the best vein to measure the central venous pressure?

Answer 19

Right internal jugular vein