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Yr 4 - ACC > Corrections 2 - Anaesthetics & ICU > Flashcards

Corrections 2 - Anaesthetics & ICU Flashcards

1
Q

Which are the main spinal tracts that carry pain signals through the spinal cord? (2)

A

1) Spinothalamic

2) Spinoreticular

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2
Q

What genetic condition involves the heart muscle being progressively replaced with fibrofatty tissue and becoming prone to ventricular arrhythmias? (1)

A

Arrhythmogenic cardiomyopathy

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3
Q

What is the name for treatment with a triple chamber pacemaker in severe heart failure with an ejection fraction of less than 35%? (1)

A

Cardiac resynchronisation therapy (CRT)

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4
Q

Which ECG leads are affected when acute coronary syndrome affects the left coronary artery? (1)

The left anterior descending? (1)

The circumflex artery? (1)

The right coronary artery? (1)

A

a) I, aVL, V3-V6

b) V1-V4

c) I, avL, V5-V6

d) II, III, aVF

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5
Q

Which class of drug, used as premedication, can help reduce the hypertensive response to the laryngoscope during intubation? (1)

A

Opiates

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6
Q

Which common condition can lead to gastrointestinal bleeding in critically unwell patients in ICU? (1)

A

Stress related mucosal disease

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7
Q

What is the name for the stiff metal wire (with a plastic coating) that is inserted into the endotracheal tube before intubation is attempted to help hold the endotracheal tube in a specific shape? (1)

A

Stylet

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8
Q

What is the first-line medication for managing trigeminal neuralgia? (1)

A

Carbamazepine

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9
Q

What are the features of the murmur caused by mitral regurgitation? (2)

Where does it radiate? (1)

A

Pansystolic
High pitched ‘whistling’

Radiates to L axilla

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10
Q

Give two examples of antimuscarinic medications used to treat bradycardia? (2)

A

1) Atropine

2) Glycopyronium

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11
Q

What are the most common causes of atrial fibrillation? (5)

A

1) IHD
2) Sepsis
3) Mitral valve pathology (stenosis or regurgitation)
4) Thyrotoxicosis
5) HTN

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12
Q

What are the features of the murmur caused by aortic regurgitation? (2)

A

1) Early diastolic
2) Soft murmur

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13
Q

What is the first step in maintaining cardiac function and cardiac output in an unwell patient? (1)

A

Optimise the fluid status

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14
Q

What is the atrial rate in atrial flutter? (1)

A

Around 300 bpm

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15
Q

Which term refers to the volume of air pushed in per breath during mechanical ventilation? (1)

A

Tidal volume

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16
Q

What is the mechanism of action of ondansetron? (1)

When would you avoid using it? (1)

A

5HT3 receptor antagonist

In patients at risk of prolonged QT interval

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17
Q

What is the most common use of a Vas Cath? (1)

A

Short term haemodialysis

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18
Q

What abdominal findings may be seen in tricuspid regurgitation? (2)

A

1) Pulsatile liver
2) Ascites

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19
Q

What are the levels of escalation for patients admitted to hospital? Where are they generally managed? (3)

A

Level 1 - general acute ward

Level 2 - HDU

Level 3 - ICU

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20
Q

What are the two groups of nerve fibres that transmit pain? (2)

Which of these is myelinated? (1)

Which has a larger diameter? (1)

A

C fibres & A delta fibres

A delta fibres are myelinated

A delta fibres have a larger diameter

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21
Q

Give an example of an alpha-2-adrenergic agonist that may be used as premedication before a general anaesthetic. (1)

A

Clonidine

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22
Q

What clinical sign is part of the diagnostic criteria for familial hypercholesterolaemia? (1)

A

Tendon xanthomata

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23
Q

What type of catheter involves a small chamber under the skin at the top of the chest? (1)

Where does this type of catheter enter the venous system? (1)

Where is the tip located? (1)

A

Portacath

Subclavian vein

Superior vena cava

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24
Q

What are the 3 sites for central line insertion?

A

1) Internal jugular vein (most common)

2) Subclavian vein

3) Femoral vein

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25
Where does the central line tips terminate?
If inserted into IJV or SV --> SVC near the RA If inserted into FV --> IVC
26
What are the key indications for a central line?
1) Medications 2) Fluids (allows rapid flow) 3) Nutrition e.g. TPN 4) Haemodialysis 5) Patients have poor vascular access
27
Why are some medications given via central line?
1) Some medications are irritants e.g. potassium --> can cause issues if infused into small veins (i.e. in peripheral cannulas). 2) Some medications need central line e.g. vasoactive medications 3) Secured access
28
Which type of line is used if the patient is going to be going home with the line?
Tunnelled e.g. Hickmann
29
What are the indications for acute dialysis in patients with a severe acute kidney injury? (AEIOU mnemonic) (5)
Acidosis (severe and not responding to treatment) Electrolytes (particularly treatment resistant hyperkalaemia) Intoxicants e.g. overdose of certain medications Oedema (severe and unresponsive pulmonary oedema) Uraemia symptoms e.g. seizures, reduced consciousness
30
What is the mechanism of action of cyclizine? (1)
H1 receptor antagonist
31
Which two factors contribute to the mean arterial pressure? (2)
1) systemic vascular resistance 2) cardiac output
32
Which scoring system can be used for identifying delirium in acutely unwell patients? (1)
Confusion assessment method (CAM)
33
What are the three beneficial cardiovascular effects of using an intra-aortic balloon pump? (3)
Increased coronary blood flow Reduced afterload Increased cardiac output
34
What is the APACHE score used for? (1)
To predict mortality at the time of admission to ICU
35
What is the name of the extra hole on the side of the tip of an endotracheal tube that gas can flow through should the main opening become occluded? (1)
Murphy's eye
36
What are the four stages used when there is unanticipated difficulty intubating a patient? (4)
1) Laryngoscopy with tracheal intubation 2) SGA 3) Face mask ventilation and wake patient up 4) Cricothyroidectomy
37
What duration of symptoms is required to diagnose chronic pain versus acute pain? (1)
>3 months
38
What duration of symptoms is required to diagnose chronic pain versus acute pain? (1)
Allodynia
39
Which class of medication are most positive inotropes? (1)
Catecholamines
40
What is the treatment for malignant hyperthermia? (1)
Dantrolene
41
Which other term can be used to describe a spinal anaesthesia / spinal block? (1)
Central neuraxial anaesthesia
42
What type of catheter is a Swan-Ganz catheter? (1) Where is the tip of the catheter located? (1) What does measuring the pressure in this area indicate? (1)
Pulmonary artery catheter Pulnonary artery LA pressure
43
When is a variable rate intravenous insulin infusion (VRIII) required in surgery?
1) Patients on insulin who are either undergoing major procedures (surgery requiring a long fasting period of more than one missed meal) 2) Patients whose diabetes is poorly controlled
44
Should blood products be ordered prior to an elective LSCS?
No - just group & save
45
Management of antiplatelets prior to surgery in patients with drug eluding stents?
Normally aspirin and clopidogrel are stopped a week before surgery due to the increased bleeding risk. However, in patients with drug eluting stents, altering these medications may lead to stent stenosis. It is advisable to discuss such patients with cardiology
46
When should ACEi be stopped prior to surgery?
Day before
47
When should warfarin be stopped prior to surgery?
5 days before --> start patients on bridging LMWH until the night before
48
When should clopidogrel be stopped prior to surgery?
7 days before
49
When should sulfonylureas be stopped prior to surgery?
Withold on day of surgery (due to risk of hypoglycaemia)
50
When should COCP be stopped before surgery and restarted?
Stopped: 4-6 weeks before Restarted: 2 weeks after (when patient is mobile)
51
What BMI is ASA II?
30-40
52
How does an anastomotic leak typically present?
- raised WCC - localised pain - fever
53
What is a flail chest?
A serious complication of multiple rib fractures that can occur following trauma. The flail segment moves paradoxically during respiration and impairs ventilation of the lung on the side of injury.
54
Management of flail cehst?
Often requires treatment with invasive ventilation and surgical fixation to prevent complications
55
What is the best diagnostic investigation for a flail chest?
CT scan of the chest
56
Next step in analgesia for rib fracture that is not responding to opiate treatment?
Regional anaesthesia with a thoracic epidural
57
What pH is sufficient to confirm the placement of an NG tube?
<5
58
What is involved in the pre-operative management of anaemia if <6 weeks until planned surgery?
IV iron
59
What is involved in the pre-operative management of anaemia if >6 weeks until planned surgery?
IV iron
60
What medication may be beneficial in the prophylactic treatment of cluster headaches?
Verapamil (& steroids)
61
What is the recommended volume of maintenance fluids?
Total volume of 25-30ml/kg/day.
62
A 67 year old gentleman has just undergone an emergency Hartmann's procedure for a perforated rectal cancer. He is now waiting in recovery. He has had a 1 litre bag of 0.9% saline IV over the last 24 hours with no oral intake. His catheter has drained 1500mL over the last 24 hours. His weight is 70kg. What would be the most appropriate fluid volume to prescribe him over the next 24 hours?
30ml x 70kg = 2100ml 1500-1000 = 500ml fluid deficit (as given 1000ml of saline but catheter drained 1500ml). 2100+500=2600ml Total volume in range of 2250-2600ml is appropriate.
63
An epidural haematoma is a rare but serious complication of epidural anaesthesia. How does it classically present?
Similar to cord compression --> due to compression of UMNs of both motor and sensory tracts: - back pain - shooting sensations down both legs - bladder incontinence - loss of sensation at lower limb dermatomes - hyperreflexia - increased tone bilaterally in both legs
64
What is a useful stategy for lowering ICP in cases of conservative management?
Short-term hyperventilation
65
How can short-term hyperventilation lower ICP?
Hyperventilation reduces pCO2 --> causes vasoconstriction of the cerberal arteries, --> results in a rapid reduction in ICP.
65
What is the specific antidote for TCA overdose?
Sodium bicarbonate
66
What antiemetic needs to be avoided post-GI surgery?
Metoclopramide
67
How does diarrhoea affect the anion gap?
Causes a normal anion gap metabolic acidosis
68
Why does diarrhoea cause a normal anion gap?
As the GI loss of bicarb causes a reciprocal increase in serum chloride.
69
How does DKA affect the anoin gap?
Causes a metabolic acidosis with a raised anion gap.
70
Why does DKA cause a raised anion gap?
As leads to the generation of an anion that is not included in the calculation of anion gap (i.e. ketones).
71
How does septic shock affect the anoin gap?
Causes a raised anion gap metabolic acidosis (due to rise in lactic acid).
72
1st line management of TIA?
Clopidogrel lifelong
73
1st line management of ischaemic stroke?
300mg aspirin daily for 2 weeks Then 75mg clopidogrel daily lifelong
74
2nd line management of ischaemic stroke lifelong (if clopidogrel contraindicated)?
Aspirin + dipyridamole lifelong
75
What is the classic presentation of a haemolytic transfusion reaction?
Fever + abdo/flank pain + hypotension
76
What is a key side effect of bupivacaine (LA)?
Cardiotoxicity --> contraindicated in regional blockage in case tourniquet fails.
77
Which general anaesthetic can result in adrenal suppression?
Etomidate
78
VTE prophylaxis in patients undergoing elective hip replacement?
Mechanical (TED stockings) + pharmalogical (LMWH e.g. dalteparin sodium)
79
When should LMWH be started following a hip replacement?
At least 6 hours after the operation
80
When should nitrous oxide be used with caution?
In cases of pneumothorax --> risk of developing a tension pneumothorax.
81
What is the risk of using nitrous oxide in a pneumothorax?
Risk of developing tension pneumothorax
82
What is a serious cause of new onset AF following GI surgery?
Anastomotic leak (typically occurs 5 days after surgery)
83
How is susceptibility to malignant hyperthermia inherited?
Autosomal dominant
84
Key contraindications for suxamethonium?
1) Penetrating eye injuries 2) Acute narrow angle glaucoma As suxamethonium increases IOP.
85
What is the muscule relaxant of choice in RSI?
Suxamethonium
86
Which type of anaesthetic drug can cause fasciculations?
Depolarising muscle relaxants e.g. suxamethonium
87
Why should you avoid using hypotonic (0.45%) saline in paed patients?
Risk of hyponatraemic encephalopathy
88
Mx of patients taking the equivalent to 10mg or more of prednisolone daily undergoing surgery?
Will require hydrocortisone supplementation to prevent an Addisonian crisis.
89
Mx of sulfonylureas (e.g. gliclazide) on day prior & day of surgery?
Take medication day PRIOR to surgery. Omit on day of surgery (exception is morning surgery in patients who take BD - can have the afternoon dose).
90
Where is IO access most commonly obtained?
Proximal tibia
91
Diagnostic investigation of anastomatic leak?
Abdo CT
92
What enzyme is deficient in suxamethonium apnoea?
Acetylcholinesterase (this acts to break down suxamethonium)
93
Mx of post-op ileus?
NG tube insertion & NBM
94
What 2 scores are used to conduct an airway assessment as part of a pre-op assessment?
1) Wilson's score 2) Mallampati score
95
Purpose of Wilson's score?
Used to predict difficult layngoscopy.
96
What is the Wilson's score out of?
10
97
What Wilson's score indicates: a) easy laryngoscopy b) potentially difficult laryngoscopy c) risk of severe difficulty in laryngoscopy
a) <5 b) 5-8 c) 8-10
98
What 5 factors make up Wilson's score?
1) Weight 2) Head and neck movement 3) Jaw movement 4) Receding mandible 5) Buck teeth
99
Describe 'weight' section for Wilson's score
0 = <90kg 1 = >90kg 2 = >110kg
100
Describe 'head and neck' section for Wilson's score
0 = neck extension >90 degrees 1 = neck extension = 90 degrees 2 = neck extension <90 degrees
101
Describe 'jaw movement' section for Wilson's score
0 = ICG >5cm or JP >0 1 = ICG <5cm and JP = 0 2 = ICG <5cm and JP <0 ICG = interincisor gap when mouth fully open JP = forward protrusion of lower incisors beyond upper incisors
102
Describe 'receding mandible' section for Wilson's score
0 = normal 1 = moderate 2 = severe
103
Describe 'buck teeth' section for Wilson's score
0 = normal 1 = moderate 2 = severe
104
What is the purpose of the Mallampati score?
Used to predict the ease of endotracheal intubation. It is a visual assessment of the distance from the tongue base to the roof of the mouth and is graded 1-4.
105
When should ramipril be stopped before surgery?
usually 24h before
106
Patients with which condition are particularly sensitive to non-depolarising agents (e.g. rocuronium)?
Myasthenia gravis
107
Why are patients with myasthenia gravis particularly sensitive to non-depolarising agents (e.g. rocuronium) and not depolarising agents (e.g. suxamethonium)?
Non-depolarising agents work by antagonism of nicotinic ACh receptors in the motor end plate, producing paralysis by their blockade. This is in contrast with suxamethonium, which produces paralysis by acting on these receptors. The myasthenic patient has FEWER available nicotinic receptors due to autoimmune-mediated destruction, meaning that they are more sensitive to non-depolarising blockade.
108

Yr 4 - ACC (73 decks)

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