Emergency Medicine and Intensive Care/Perioperative and Anaesthesia

Question 1

ASA classification

Answer 1

1 - health non drinker
2 - smoker, social drinker, pregnant, BMI >30, well controlled disease
3 - Poorly controlled disease, BMI >40, end stage renal, stroke or MI >3m
4 - stroke or MI < 3m, sepsis, DIC
5 - expected to die without operation eg rupture aneurysm, massive trauma
6 - braindead

Question 2

Mechanism propofol and properties

Answer 2

GABA agonist

Rapid onset, antiemnetic

Question 3

Choice for rapid onset induction

Answer 3

Sodium thiopentane

Question 4

Mechanism ketamine and properties

Answer 4

NMDA receptor antagonist

Strong analgesia

Question 5

Choice for induction in trauma

Answer 5

Ketamine

Question 6

Choice for induction in haemodynamic instability

Answer 6

Etomidate

Question 7

Blood matching units

Answer 7

Unlikely - group and save
Likely - 2 units
Definite - 4 to 6 units

Question 8

Inhaled general anesthetics

Answer 8

Volatile liquids (ends in -flurone) - induction and maintanence
Nitrous oxide - induction and maintanence

Question 9

Avoid in pneumothorax

Answer 9

Nitrous oxide

Question 10

IV general anaesthetics

Answer 10

Propofol
Thiopentane
Etomidate
Ketamine

Question 11

Mechanism thiopentane

Answer 11

GABA agonist

Question 12

Mechanism etomidate

Answer 12

GABA agonist

Question 13

Lidocaine mechanism

Answer 13

Na channel antagnoist

Question 14

Lidocaine toxicity treatment

Answer 14

IV 20% lipid emulsion

Question 15

Recognise malignant hyperthermia

Answer 15

Inherited dominant fashion, related halothene and suxamethasone
Raised CK, temp, muscle rigidity

Question 16

Treatment malignant hyperthermia

Answer 16

Dentrolene

Question 17

Choice muscle relaxants

Answer 17

Suxamethasone
Atracurium
Vecuronium
Pancuronium

Question 18

Only depolarising muscle relaxant

Answer 18

Suxamethasone

Question 19

Fastest onset muscle relaxant

Answer 19

Suxamethasone

Question 20

Reverse non depolarising muscle relaxants

Answer 20

Neostigmine, polarising cannot be reversed

Question 21

Nasopharngeal airway contraindicated

Answer 21

Base skull fractures

Question 22

Mechanism suxamethonium

Answer 22

Blocks acetylcholine receptors

Question 23

Causes post op pyrexia

Answer 23

0-5d after - cellulitis, UTI, physiological, atelectasis

>5d - VTE, pneumonia, wound leak, anastomotic leak

Question 24

Fasting before surgery

Answer 24

Clear 2h before

Food 6h before

Question 25

Metformin for surgery

Answer 25

Day before normal

On day omit lunch dose if take 3x

Question 26

Sulphonylureas for surgery

Answer 26

Day before normal

On day omit if 1x, omit morning dose if 2x

Question 27

DPP inhibitors (-gliptins) for surgery

Answer 27

Take as normal

Question 28

GLP1 analogues (-tides) for surgery

Answer 28

Take as normal

Question 29

SGLT2 inhibitors before surgery

Answer 29

Day before normal

Omit on day

Question 30

VTE prophylaxis for surgery

Answer 30

1) Stockings if low risk

2) LMWH if higher risk, unfractionate heparin in CKD

Question 31

Diagnose anastomotic leak

Answer 31

CT scan

Question 32

Prep for colonscopy

Answer 32

Laxatives day before

Question 33

Poor post op pain management leads to

Answer 33

Pneumonia

Question 34

Lots of saline can cause

Answer 34

Hypercholoraemic acidosis

Question 35

Common cause confusion after op

Answer 35

Hyponatraemia