Assessment of surgical patient

Question 1

Malignant hyperthermia

Answer 1

Reaction to volatile anaesthetic agents and neuromuscular blocking drugs
High temperature and muscle contractions

Question 2

Suxamethonium apnoea

Answer 2

Deficiency in enzymes to break down suxamethonium

Prolonged paralysis of skeletal muscle

Question 3

Wilson’s score <5

Answer 3

Easy laryngoscopy

Question 4

Wilson’s 8-10

Answer 4

Severe difficulty in laryngoscopy

Question 5

Factors in Wilson score

Answer 5

Weight
Head and neck movement
Jaw movement
Receding mandible
Buck teeth

Question 6

Mallampati score

Answer 6

Ease of endotracheal intubation

Question 7

What does irregular pulse indicate

Answer 7

AF

Question 8

Slow rising pulse

Answer 8

Aortic stenosis

Question 9

Pounding pulse

Answer 9

Aortic regurgitation and CO2 retention

Question 10

Thready pulse

Answer 10

Intravascular hypovolaemia

In sepsis

Question 11

Causes of raised JVP

Answer 11

RSHF

Question 12

Causes of tricuspid regurgitation

Answer 12

Infective endocarditis

Rheumatic heart disease

Question 13

Murmur in aortic stenosis

Answer 13

Ejection systolic murmur

Question 14

Murmur in aortic regurgitation

Answer 14

Early diastolic murmur

Question 15

Mitral stenosis murmur

Answer 15

Mid-diastolic murmur

Question 16

Mitral regurgitation murmur

Answer 16

Pan-systolic murmur

Question 17

Third heart sound indicates

Answer 17

CHF

Question 18

Pericardial rub or muffled heart sounds indicate

Answer 18

Pericarditis

Question 19

What are the side effects of NSAIDs

Answer 19

Interactions with other medication (warfarin)
Gastric ulceration (PPI cover)
Renal impairment
Asthma sensitivity
Bleeding risk 
I-GRAB

Question 20

What does NSQIP
NCEPOD
Duke activity status
Assess

Answer 20

NSQIP: post-op complications (ACS)
NCEPOD: risk of death within 30days (SORT)
Duke activity status: function post surgery, <30 is bad

Question 21

What drugs need to be stopped pre-operatively?

Answer 21

Clopidogrel- 7 days before
Hypoglycaemic
OCP/HRT stopped 4 weeks before due to DVT risk
Warfarin: stopped 5 days prior, INR needs to be <1.5
ACE/ARB omitted 24hours before to reduce risk of hypotension
DOAC stopped 24-48hours before
Stop aspirin 7-10days prior, unless it’s for secondary prevention
Stop ticagrelor 5 days pre-op

Question 22

What are the principles of anaesthesia

Answer 22

Induction
Maintenance
Analgesia
Neuromuscular blockage
Emergence

Question 23

Seldinger technique

Answer 23

Medical procedure used to get safe access to blood vessels and other hollow organs

Question 24

What happens in sign out

Answer 24

Increase flow of oxygen in circulation to get rid of anaesthetic agent
Neostigmine to reverse effects of NMB, plus glycopyrrolate (anticholinergic) to block unwanted muscarinic effects of neostigmine

Question 25

How is a spinal anaesthetic administered

Answer 25

``` T10 and below paralysis Decreased risk of complications L4/5 Vasodilatation, reduced risk of DVT or ischaemic complications Don’t need ventilation ```

Question 26

General anaesthetic

Answer 26

Drug-induced coma Decreases brainstems response to an increase in C02 Need ventilation

Question 27

Post op assessment

Answer 27

History Allergies Medications PMH Last meal/drink Events leading up to admission/ current situation/ current positive examination findings Ask about operation, complications, post-op instructions, drug use,d recover

Question 28

BOXED in post-op assessment

Answer 28

``` Bedside tests (basic obs, ECG), bloods Orifices (sputum, swab results, urine culture/output, drain output, stool output X-RAY (imaging and special tests) Escalation plan Do not attempt CPR ```

Question 29

What two systems are affected by lidocaine overdose?

Answer 29

CNS and CVS

Question 30

How does lidocaine affect the CNS?

Answer 30

Light headedness Dizziness Drowsiness

Question 31

How does lidocaine overdose affect CVS

Answer 31

Hypotension Bradycardia Myocardial depression

Question 32

How long do the effects of lidocaine usually last?

Answer 32

2 hours

Question 33

How long does lidocaine take to work, and how long is it’s duration of action?

Answer 33

4 minutes | 1-2 hours