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Periop > Generic Periop > Flashcards

Generic Periop Flashcards

1
Q

why is a preop assessment carried out

A

to assess patient’s medical and physical state before surgery, determining possible complications and seeing what can be done to optimise a patient’s health preop

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2
Q

list the medications specifically asked about in the preop assessment

A
  • heparin
  • warfarin
    clopidogrel
  • steroids
  • contraceptive pill
  • HRT
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3
Q

why can steroids be a problem in surgery

A

steorids can cause adrenal suppression - as cortisol is usually increased during surgery; suppression may result in decreased BP or circulatory collapse during surgery

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4
Q

list the risk factors for PONV

A
  • female
  • motion sickness
  • duration of surgery
  • diabetes
  • laparoscopic surgery
  • previous PONV
    (each score one point)
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5
Q

list the preop bloods

A

FBC, INR/clotting, electrophoresis, u + e, LFT, lipids, glucose, HbA1C, TFT, G+S

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6
Q

list some of the preop investigations done in the preop assessment

A 
ecg
cxr
msu
pregnancy
mrsa
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7
Q

how is a patient who tests positively for mrsa in preop assessment be treated

A

the planned op may need to be delayed. treatment includes antibacterial wash, nose cream, side room admittance if urgent surgery

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8
Q

what is APACHE scoring

A

classification system rating severity of patien’s risk of dying in hospital; takes into account factors such as core temp, HR, BP, creat, age, chronic illness

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9
Q

what are high risk respiratory patients going for operations

A

asthma, COPD +/- steroid therapy. need to get this optimal

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10
Q

why should diabetes patients be put first on the list for operations

A

prevent hypo

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11
Q

which cardiac conditions increase operative risk

A

cvd/hf.arrhythmia/ihd

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12
Q

how may alcoholism affect a patient going for an operation

A

may be tolerant to BZDs, anaesthetic agents e.g. propofol requiring higher doses

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13
Q

how may obesity affect patients going for operations

A

may require higher O2 concs, make BP measurement less reliable, iv access more difficult

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14
Q

list some neurological/neuromuscular conditions significant in patients having surgery

A

malignant hyperthermia, myasthenia gravis, MS, stroke, Parkinson’s, muscular dystrophy, MND, myasthenic syndromes, epilepsy, dementia, Guillain Barre

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15
Q

what should a preop referral letter for a diabetic patient ideally contain

A

HbA1C, BP, wieght, details of complications, written information if drug regimen changes need to be made

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16
Q

how should insulin therapy during surgery be administeres

A

in 0.45% NaCl and glucose, with KCl to maintain electrolyte balance,

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17
Q

how are diabetic patients managed perioperatively in terms of drug regimen alterations

A
  • put first on list
  • stop long acting insulin night before
  • SC insulin omitted in morning if morning surgery; if op in afternoon then give morning insulin with breakfast
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18
Q

how often should you check blood glucose in a patient with diabetes, having surgery

A

hourly intraop then two hourly post op

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19
Q

how do you manage diabetic patients intraoperatively

A

set up infusion pump with sliding scale insulin

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20
Q

how do you manage diabetic patients post op

A

continue IV insulin + dextrose post op until patient can manage to feed
finger prick blood glucose every 2 hours

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21
Q

how do you manage a non insulin-dependent diabetic who is undergoing surgery

A
  • if poorly-controlled treat as per DM1
  • do NOT igve long acting sulfonylureas on morning of surgery
  • start SC/IV insulin if having major op
  • take oral hypoglycamics as normal on preceding day and stop on morning of surgery
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22
Q

what is a PICC line

A

peripherally-inserted central catheter, which is a form of iv access for a prolonged period of time

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23
Q

what may PICC lines be used for

A

chemo, extended abx, tpn

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24
Q

list some of the veins that a central line (or central venous catheter) may be inserted into

A

internal jugular or other veins including subclavian, axillary, femoral

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25
Q

what do central lines give an indication of

A

right atrial pressure therefore RV preload

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26
Q

what is the dose of cyclizine

A

50mg

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27
Q

what is the mech of action of cyclizine

A

anticholinergic/antihistaminic

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28
Q

what is the mech of action of ondansetron

A

5ht3 receptor antag

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29
Q

what is the mech of action of metoclopramide

A

D2 anatgonist

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30
Q

what is the dose of metoclopramide

A

10mg tds

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31
Q

what is the mech of action of prochlorperazine

A

D2 antagonist

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32
Q

what is the mech of action of hyoscine bromide

A

anticholinergic

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33
Q

what are the side effects of anticholinergics

A

drowsiness and xerostomia

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34
Q

what are the side effects of 5ht3 antagonists

A

confusion, dizziness, tachy

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35
Q

what are the side effects of dopamine atagonists

A

EPSE, resp depression, dystonia, restlessness, drowsiness

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36
Q

what is delirium (post op s/e)

A

organically-caused decline from previous cognitive function. has a fluctutating course, clouding of consciousness, behavioural changes, arousal changes, perceptional changes, sleep-wake cycle disturbance

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37
Q

what is dementia

A

long term gradual decline in cognitive function, with memory disorders, personality change, problems with language/emotional motivation/ (different types and underlying causes)

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38
Q

what does POCD stand for

A

post operative cognitive dysfunction

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39
Q

what is Post-op cognitive dysfunction

A

short-term decline in cognitive function (compared to before surgery) lasting a few days-weeks post op. distinct from delirium (does not share all the features).

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40
Q

which post op complications are expected to occur within the first 4 days post op

A

acute mi, pyrexia due to atelectasis, cva

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41
Q

which post op complications are expected within the first 7 days after surgery

A

renal impairment/failure

post op urinary retention

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42
Q

which post op complication is expected within days 5-10 post op

A

delerium tremens

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43
Q

which post op complications are expected within days 7-10 post op

A

chest infeciton, wound infection, uti, secondary haemorrhage

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44
Q

which post op complicatoins are expected from days 10 onwards from operation

A

dvt, pe, wound dehisence

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45
Q

how should significant post op blood loss +/- shock be managed, or even a late secondary haemorrhage

A

surgical exploration to find cause

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46
Q

list some of the resp complications that may occur post op

A

pulmonary collapse, infection, resp failure, plueral effusion, pneumothorax, ARDS

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47
Q

what is the reason that heart problems may occur post op

A

diseased heart may find it difficult to respond to increased demand in the post op period, e.g. acute hf, mi, arrhythmias etc may occur

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48
Q

list some of the complications associated with IV administration in an operative setting

A

bruising, haematoma, phlebitis, venous thrombosis, air embolus, site infection,
(if arterial cannula - rarely artery occlusion)

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49
Q

which arrhythmia is the commonest to occur post op, and may be due to haemodynamic disturbance

A

af

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50
Q

what are the most common types of shock seen as complications post op

A

hypovolaemic, cardiogenic, septic

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51
Q

what are the common features of cardiogenic and hypovolaemic shock

A

decreased bp, increased hr, sweating, vasoconstriction

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52
Q

what are the initial features of septic shock

A

hyperdynamic circultion, fever, rigors, warm vasodilated periphery, bounding pulse

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53
Q

what are the later features of septic shock

A

hypotension, peripheral vasoconstriction, oliguria, multisystem failure

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54
Q

list some of the renal post op complications

A

urnairy retention - overflow incontinence
renal failure
uti

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55
Q

what factors can increase chance of urinary retention occuring as a post op complication

A

pelvic/groin/perineal op
spinal/epidural anaesthesia
post op pain, anaesthetic drugs

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56
Q

list the three steps of virchows triad

A

increased coagulability, endothelial damage, stasis

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57
Q

list the risk factors for dvt

A
  • obesity
  • age
  • prolonged op
  • hip/pelvic surgery
  • varicose veins
  • pregnancy
  • malignancy
  • previous dvt
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58
Q

what adjustments are made for patients on the cocp having surgery

A

stop cocp 4 weeks before surgery, with alternative contraceptive cover

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59
Q

which two types of compression are used on the leg for patients undergoing surgery

A

TED graduated compression stockings, and mechanical calf compression (Intermittent Pneumatic Compression)

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60
Q

how is a dvt treated

A

SC LMWH and Warfarin. LMWH is stopped once fully anticoagulated, and warfarin is continued for 3-6months. inr maintained at 2-3

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61
Q

is pe’s continue to occur depsite anticoagulation post op etc, what measure can be taken

A

ivc filters

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62
Q

describe epidural anaesthesia

A

continuous infusion of anaesthetic + opioid into the epidural space, set to a certain rate.

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63
Q

how long can an epidural catheter remain in place for

A

up to 5 days

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64
Q

list some of the causes of epidural anaesthesia failure

A

misplacement, displacement, inadequate analgesia, intolerable side effects

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65
Q

what are some complications of epidural anaesthesia

A

cephalad spread causing resp distress

permanent neurological damage

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66
Q

describe PCA

A

programmed pump delivers small predetermined doses of a drug (usually opiate) with a minimum period between doses (lock out)

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67
Q

what is a common setting for pca morphine

A

1mg, minimum 5 min intervals

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68
Q

what are some of the downsides to pca

A

patient must understand how it works, and have the required manual dexterity to operate it

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69
Q

what layers are gone through in order to insert an epidural

A

skin, subcut tissues, supraspinous ligament, interspinous ligament, ligamentum flavum, then enter the epidural space (dura mater on innermost)

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70
Q

why may patients who have had operation be more likely to get renal failure

A

recued perfusion to kidneys due to hypovolaemia, water depletion etc., s well as exacerbation by nephrotoxic agents, sepsis and hypoxia

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71
Q

list some of the things that can cause airway obstruction periop

A

obstruction by tongue, foreign bodies, layngeal spasm, laryngeal oedema, bronchospasm/bronchial obstruction

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72
Q

how is airway obstruction managed

A

recovery position

chin lift jaw thrust, guedel airway, o2, may need to reintubate

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73
Q

what should pao2 be

A

> 13kpa

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74
Q

what is defined as too low an oxygen kpa

A

less than 6.7kpa

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75
Q

what are the clinical and xray features of ards

A

impaired oxygenation, diffuse lung opacification on CXR and reduced lung compliance,

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76
Q

list some of the causes of post op ards

A

TRALI, pulmonary or systemic sepsis, aspiration of gastric contents

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77
Q

what are some of the clinical features of ards

A

tachypnoea, increased ventilatory effort, restlessness, confusion,

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78
Q

describe the pathophysiology of ards

A

thought to be due to inflammatory reaction abd release of cytokines, damaged vasculr endothelium, capillary leakage -> cause interstitial and alveolar oedema

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79
Q

what is the management of ards

A

a-e, ventilatory support, peep (positive end expiratory pressure), treat underlying cause

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80
Q

what are light’s crteria indicating that an effusion is an exudate

A
  • pleural;serum protein >/ 0.5
  • pleural:serum lactate >/ 0.6
  • pleural fluid lavtate dehydrogenase >/ 2/3 upper limit for serum LD
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81
Q

what periop factors increase the risk of pulmonary collapse for surgical patients

A
  • inability to breathe deeply (e.g. pain) and cough up secretions
  • anaesthetics and surgery
  • impaired diaphragmatic movement
  • oversedation
  • cilia paralysis due to inhaled anaesthetics
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82
Q

how may post op pulmonary collapse be prevented

A

encourage patient to breathe deeply, cough and mobilise
may need chest physio
o2 by mask for hypoxia
(assisted ventilation + endotracheal intubation may be reuired in some cases)

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83
Q

what may cause pulmonary infection in surgical patients

A

collapse or aspiration

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84
Q

what is step 1 on the WHO analgesic ladder

A

non opioids and adjuvants e.g. aspirin, nsaids, paracetamol, selective COX-2 inhibitors

85
Q

what is step 2 on the WHO analgesic ladder

A

mild opioids e.g. tramadol, cocodamol, codeine phsophate

86
Q

what is step 3 on the WHO analgesic ladder

A

opioid ananlgesics - moprhine, fentanyl, (diamorphine, buprenorphine)

87
Q

list some inhalational anaesthetics

A

halothane, nitrous oxide, enflurane, isoflurane, desflurane, sevoflurane

88
Q

do you need a low or high blood:gas coefficient for rapid induction

A

low (more stays in blood rather than going back into lungs and being breathed out)

89
Q

what are the two classes of muscle relaxants

A

depolarising and non-depolarising

90
Q

list the main depolarising muscle relaxant used in anaesthesia

A

suxamethonium/succinylcholine

91
Q

how does suxamtheonium/succinylcholine work

A

acts like acetylcholine by binding to AchRs, and causes AP’s. However, it is broken down much more slowly and the following depolarisation lasts for an extended period. there is flaccid paralysis.

92
Q

why is there initial muscle twitching with suxamethonium administration

A

when the sux binds to AchR’s it causes initial depol and AP’s, causing some initial twitching until paralysis ensues

93
Q

list four drugs that are non-depolarising muscle relaxants

A

atracurium, mivacurium

vecocuronium, pancuronium

94
Q

how do non-depolarising muscle relaxants work

A

compete with ACh at the NMJ, preventing depolaritisation

95
Q

how are muscle relaxants reversed

A

acetylcholinesterase inhibitors e.g. neostigmine to increase synaptic cleft ACh levels, hence compete with muscle relaxants bound to the receptors

96
Q

what are some of the adverse effects of IV anaesthetics

A

irritant to veins/painful, respiratory/cardiovascular depression

97
Q

which act more rapidly inhalational or iv anaesthetics, and why

A

iv - as they bypass the paradoxical excitement phase

98
Q

list some iv anaesthetics

A

propofol, thiopental, etomidate
others: BZDs e.g. midazolam, diazepam
ketamine for short operations

99
Q

what is the mechanism of action of propofol

A

potentiates GABA(A), but also Na channel blocker

100
Q

list some of the analgesics used in anaesthesia

A

morphine, pethidine, diamorphine, codeine, tramadol, fentanyl/alfentanyl/remifentanyl, co-codamol

101
Q

what is the mech of action of pethidine

A

like morphine - mu opioid receptor agonist

102
Q

list some local anesthetics

A

lidocaine, bupivicaine, levobupivicaine

103
Q

which has the shorter half life, lidocaine or bupivicaine

A

lidocaine

104
Q

which of the muscle relaxant classes are longer acting

A

non-depolarising relaxants - though they have a slower onset of action

105
Q

list the “premeds” used in anaesthesia

A

midaz, temaz, and ranitdine to reduce gastric acid secretion

106
Q

list the drugs used in induction of anaesthesia

A

propofol, thiopental, etmidate, or inhaled anesthetics

107
Q

what are the steps in rapid sequence induction of anaesthesia

A

1) preoxygenate
2) administer anaesthetic induction agent after some analgesia in vein
3) suxamethonium
4) wait for muscle fasciculations to cease
5) laryngoscopy + intubation with endotracheal tube
6) positioning of ET confirmed by presence of end-tidal CO2 trace, bilateral chest movements, auscultation

108
Q

what are the steps in emergence of anaesthesia

A

1) administer 100% O2
2) reverse neuromuscular blockade with neostigmine etc
3) extubate only when patient is fully awake and able to remove the ET tube themselves

109
Q

which agents may be used if bradycardia in emergence form anaesthesia

A

glycopyrolate or atropine

110
Q

which part of the brain is triggered to cause N+V

A

chemoreceptor trigger zone

111
Q

list the emergency drugs drawn up just in case for patients who go under anaesthesia, and what theyre for

A
  • atropine for bradycardia
  • ephedrine for hypotension
  • suxamethonium for emergency reintubation
112
Q

what are the symptoms of a massive pe

A

chest pain (pleuritic), SOB, pallor, shock

113
Q

which agents are used for fibrinolysis in patients with a pe

A

streptokinase or urokinase iv infusion

114
Q

in severe cases of pe, where fibrinolysis is not enough, what procudure can be carried out to remove the pe

A

embolectomy

115
Q

what signs may indicate a wound infection

A

local erythema, tenderness, cellulitis, swelling, frank abscess, wound discharge, pyrexia, pulse increased

116
Q

what is wound dehiscence

A

partial or complete breakdown

117
Q

what is evisceration

A

extrusion of abdo viscera through complete abdo dehisence

118
Q

what is the total body water volume

A

42L

119
Q

what proportion of total body water in made up of ecf and icf

A

ecf - 1/3 (~14L)

icf = 2/3 (~28L)

120
Q

what proportion of ecf is made up of transcellular fluid, plasma, and interstitial fluid

A

interstitial + transcellular 4/5

intravasc 1/5 (~3L)

121
Q

what are the fluid requirements in adults

A

40ml/kg/24hr

122
Q

what are the fluid requirements in children

A

first 10kg = 4ml/kg/hour
next 10kg = 2ml/kg/hour
remainder above 20kg = 1ml/kg/hour

123
Q

what are the intracellular range for K+ and Na+

A 
K+ = 133
Na+ = 9
124
Q

what is the extracellular range for K+

A

3.5-5.5

125
Q

what is the extracellular range for Na+

A

143

126
Q

how is 5% dextrose distributed throughout the body fluid compartments, hence how much remains intravasc

A

it distributed throughout all body fluid compartments, hence 1/15 remains within the intravasc compartment (1/3 ecf x 1/5 intravasc). hence 1/15 of 1L bag

127
Q

how is 0.9% saline fluid distributed throughout body fluid compartments

A

restricted by Na-K-ATPase on cell membrane, hence remains in extracellular compartment thus distributed thoughout ecf only. of the ecf, 1/5 if intravasc, hence 1/5 of 1L (200ml) remains intravasc

128
Q

how are colloid fluids distributed throughout the body compartments

A

all remians intravasc (~100%) hence 1L of the 1L bag remains intravasc

129
Q

how are fluid requirements calculated

A

maintencnace requirements + preexisting defiict + replace ongoing losses

130
Q

list some sources of abnormal fluid loss

A

vomiting, diarrhoea, high output stoma, enterocutaneous fistula

131
Q

which electrolytes is diarrhoea rich in

A

K+ and HCO3-

132
Q

which electrolytes is vomitus rich in

A

H+, Cl-, K+

133
Q

which antibodies and which antigens are expressed in group A blood

A 
ag = A
ab = B
134
Q

which antigens and antibodies are expressed in group B blood

A 
ag = B
ab = A
135
Q

which antigens and which antibodies are epxressed in group AB blood

A 
ag = AB
ab = - (universal receiver)
136
Q

which antigens and which antibodies are expressed in group O blood

A 
ag = - (universal donor)
ab = AB
137
Q

how many pints is one unit of blood, hence how many L

A

1 unit = 1 pint

1 pint ~450mls

138
Q

how many pints/L of blood are there in the body

A 
pints = ~10
L = 4.7-5.5
139
Q

define a massive blood transfusion

A

transfer of 10 Units of blood (whole patient’s circulating volume) in 24hrs
OR >50% of patient’s blood volume (>5 Units) in 4 hours
in response to massive uncontrolled haemorrhage

140
Q

list the things that are tested for in a patient pre-tranfusion

A
  • blood group
  • antibody screen
  • x match (compatibility of patient’s blood with donor)
141
Q

what is the indication for blood transfusion

A

anaemia secondary to blood loss, Hb

142
Q

up to what proportion of their circulating blood can a healthy adult lose before feeling any effects

A

30-40%

143
Q

list some of the different components of blood that can be transfused into a patient

A
  • red cells
  • platelets
  • FFP
  • cryporeceiptate
  • human albumin
  • factor VIII/IX
  • prothrombin complex concentrate (e.g. Beriplex)
144
Q

what is FFP used for

A

multiple factor deficiency e.g severe bleeding or overcoagulation

145
Q

what does crypoprecipitate contain and what is it used for

A

fibrinogen, factor VIII, VWF, factor XIII, fibronectin

used when fibrinogen levels are low e.g. DIC

146
Q

when is human albumin transfusion used

A

if vascular permeability is increased e.g. burns, oedema, or ascites resistant to treatment with diuretics

147
Q

when is factor VIII/IX cocentrate used

A

Christmas disease/ haemophilia

148
Q

when is prothombin complex concentrate used, and what does it contain

A

factors II, IX, X, VII (vit K dependent). to reverse the nticoag effects of warfarin when there is major bleeding

149
Q

what checks are one when transfusing a patient with blood

A
  • correct patient
  • completed blood request form
    double check identitiy of atient, abo and rhd type compatibility
  • check donation number on pack, expiry, ensure no leaks/haemolysis
  • vital signs before transfusion, during and after
150
Q

list some acute reactions to blood transfusion

A
  • acute haemolytic transfusion reaction
  • TRALI
  • febrile non haemolytic transfusion reaction
  • allergic reaction
  • sepsis due to bacterial contamination
  • circulatory overload
151
Q

why would acute haemolytic transfusion reaction occur

A

abo incompatibility

152
Q

why would TRALI occur

A

Ab’s in donor plasma react with recipient’s leucocytes

153
Q

why would febrile non-haemolytic transfusion reaction occur

A

neutrophil Ab in recipient plasma reacts with donor leucocytes

154
Q

list some delayed transfusion reactions

A
  • delayed haemolytic reaction
  • allommunisation
  • post transfusion purpura
  • graft vs host disease
  • transfusion-transmittted infections e.g. bbv, cmv
  • iron overload (accumulation in tissues)
155
Q

what is alloimmunisation in tranfusion of blood

A

ab are formed in response to donor antigens

156
Q

why may post transfusion purpura occur

A

platelet specific antibodies attacking platelets

157
Q

list three methods of autologous transfusion

A
  • preop donation
  • isovolaemic haemodilution
  • cell salvage
158
Q

how does preop donation work as autologous transfusion

A

patient’s blood is collected prior to surgery and stored for up to 35days preop (usually only used for rare blood groups)

159
Q

how does isovolaemic haemodilution work

A

blood drawn preop and put in bag with anticoag + saline, and reinfused during surgery/post op (where significant blood loss is anticipated)

160
Q

what is cell salvage

A

blood collected form op site, processed by machine, anticoagulated, cells washed from clots and debris. returned to patient

161
Q

when is cell salvage contraindicated

A

malignancy, sepsis

162
Q

what are the good things and downsides to cell salvage

A 
good = reduced exposure to allogenic blood
bad = not haemodyanmically intact due to consumption of clotting factors
163
Q

list three reasons why direct arterial pressure monitoring may be carried out

A
  • failure of indirect monitoring
  • arterial blood sampling
  • continuous reactive monitoring
164
Q

what is a possible complication of direct arterial monitoring

A

distal ischaemia

165
Q

list some of the complications of arterial catheter placement

A

arterial puncture, haematoma, haemothorax, nerve injury, pneumothorax, air embolism, sepsis, endocarditis, venous thrombosis, pe, cardiac tampomade

166
Q

what is prothrombin time a measure of

A

for those on warfarin (like inr), extrinsic factors VII, V, X, prothrombin and fibrinogen

167
Q

what des prolonged prothrombin time indicate

A

deficiency in one or more of the factors tested for - can mean there is a vit k deficiency, or liver disease

168
Q

what does aptt measure

A

used for patients on heparin to measure intrinsic system factors e.g. XII, XI, VII, IX

169
Q

what does increased aptt mean

A

deficiency in clotting factors tested for, liver disease, bleeding disorder etc

170
Q

what is the mechanism of action of warfarin

A

inhibits vitamin K - dependent synthesis of biologically-active forms of clotting factors II, VII, IX and X, as well as protein C and S. inhibits reduction of vitamin k

171
Q

what is the mechanism of action of unfractionated heparin

A

works by binding to antithrombin III, thrombin and factor Xa

172
Q

what is the mechanism of action of lmwh

A

binds to ATIII and factor Xa (NOT thrombin)

173
Q

what is ASA I

A

normal healthy patient

174
Q

what is ASA II

A

patient with mild systemic disease, and no functional limitations

175
Q

what is ASA III

A

patient with moderate or severe systemic disease, that results in some functional limitation

176
Q

what is ASA IV

A

patient with severe systemic disease that is a constant threat to life and functionally incapacitating

177
Q

what is ASA V

A

moribund patient, who is not expected to survive 24 hours without surgery

178
Q

how many days before surgery must clopidogrel be stopped

A

7

179
Q

where does haemopoeisis occur in the first few weeks

A

yolk sac

180
Q

where does haemopoeisis occur in the next few months of life

A

liver and spleen

181
Q

where does haemopoeisis occur after 6-7months after conception

A

bone marrow

182
Q

what are the two main cell lines from whcih blood components arise

A

common myeloid and common lymphoid

183
Q

why may extramedullary haemopoeisis occur

A

failure of bone marrow to produce blood cells

184
Q

which factor is important in B12 absorption

A

intrinsic factor

185
Q

why do red blood cells require folate and vit B12

A

to progress through mitosis

186
Q

except for rbc changes, what other blood cellsdoes vit b12 and folate deficiency cause

A

giant hypersegmented neutrophils

187
Q

which drug s given to chelate iron in those with sickle cell disease

A

hydroxycarbamide

188
Q

what is the difference between alpha and beta thalassaemia

A

alpha thalassameia is caused by alpha genes missing/inactive wherease beta is caused by beta genes missing/inactive

189
Q

what do rbc’s look like in vit b12 deficiency

A

large, oval shaped

190
Q

which bbvs can cause immune destruction of platelets

A

hiv, hep

191
Q

give some common causes of microcytic anaemia

A

thalassaemia, anaemia of chronic disease, iron deficiency

192
Q

Which INR level is acceptable for surgery

A

Less than 2.5

193
Q

What is sick sinus syndorme

A

Sinus node dysfunction which causes one of two things

  • tachy Brady syndrome
  • Brady +/- arrest
194
Q

How you manage a patient with sick sinus syndrome

A

Pacing

195
Q

How may you be able to control ventricular rate in atrial fibrillation/flutter

A

Digoxin loading dose followed by maintenance

196
Q

What is an avnrt (AVN ree try tachy)

A

Ree try circuit within or just next to the AVN

197
Q

Which arrhythmia is avrt commonly associated with

A

Wpw syndrome

198
Q

What is avrt (av reentry tachy)

A

Accessory pathways occurs between the atria and ventricles allowing electrical signal to pass from ventricles back to atria and cause premature contraction. This occurs alongside the normal AVN pathway, where depolarisation goes down heart normally and back up into atria through accessory pathway - loop. Creates a complete re entrant tachy

199
Q

What is wpw syndrome

A

Individuals have an accessory pathway that doesn’t share the rate slowing properties of the AVN (bypasses this) - hence electrical activity is conducted at a higher rate
Retrograde or anterograde
Type of preexcitation syndrome

200
Q

List the differentials for narrow complex tachycardia

A 
Sinus tachy
SVT
AF
Atrial flutter
Junctional tachy
201
Q

List the differentials for broad complex tachy

A

Vt, incliding torsades de pointes

SVT with aberrant conduction

202
Q

What is a capture beat

A

Normal qrs between abnormal beats

203
Q

What is a fusion beat

A

Normal beat fuses with vt complex

204
Q

List the different types of junctional tachy

A
  • avrt
  • avnrt
  • his bundle tachy
205
Q

What drug do you initially give to someone with a junctional tachy

A

Adenosine

206
Q

What is carcinoid syndrome

A

Array of symptoms that occur secondary to carcinoid tumours. Includes flushing, diarrhoea, and less frequently heart failure and bronchoconstriction
Caused by endogenous secretion of serotonin and kallikrein

207
Q

What is a rock all score used to calculate

A

Risk of death in a patient with an acute upper gi bleed

208
Q

List the parameters involved in calculating a rockall score

A
  • age
  • shock/haemodynamic instability
  • comorbidities e.g. Ihd, liver/kidney disease
  • diagnosis, Malory Weiss, upper gi ca, any other
  • avoidance of belled ding on ogd
209
Q

What is the blatchford score

A

In gi bleeds, used to assess if patients can be managed out of hospital or need to be in a hospital setting

Periop (3 decks)

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