Green SBA Mock Paper 4

Question 1

Which patients need peri-operative steroids and which do not?

Answer 1

Patients do not need peri-op steroids if they are taking less than 10mg Prednisolone, or have stopped regular steroids > 3 months ago.

If otherwise they will need.

Question 2

What is the steroid replacement for minor surgery?

Answer 2

Take pre-operative routine steroid

OR

25-50mg hydrocortisone at induction.

Question 3

Intermediate surgery steroid replacement regimen?

Answer 3

1. Take routine pre-op steroid,
2. 25-50mg Hydrocortisone at induction
3. and 100mg Hydrocortisone daily in divided doses for 24 hours.

Question 4

Steroid replacement regimen for major surgery?

Answer 4

1. Take routine steriod pre-op
2. 25-50mg Hydrocortisone at induction
3. 100mg Hydrocortisone daily in divided doses for 48-72 hours.

Question 5

What are the guidelines on patient temperature at which patient should be induced for anaesthesia?

Answer 5

Induction should only be performed when patients core temperature is >36 degrees

Question 6

Which other opiate is remifentanil equipotent to?

Answer 6

Fentanyl

Question 7

What are the boundaries of the epidural space?

Superior, Inferior, Anterior, Posterior, Lateral

Answer 7

SUPERIOR: fusion of three spinal and periosteal layers of dura at foramen magnum.

INFERIOR: saccrococygeal membrane

ANTERIOR: posterior longitudinal ligament

POSTERIOR: Ligamentum flavum

LATERAL: pedicles and intervertebral foraminae.

Question 8

What is the cerebral effect of nitrous oxide?

Answer 8

Raise ICP
Increase CBF
Increase cerebral metabolic rate for oxygen consumption
Impairs brains ability to auto-regulate.

Question 9

What enzyme is responsible for the metabolism of most volatile agents?

Answer 9

CYP2E1

Question 10

What enzymes are responsible for the metabolism of warfarin and theophylline?

Answer 10

CYP 1A2

Question 11

What enzyme is responsible for codeine to morphine/ accounts for the interindividual variation in metabolism?

Answer 11

CYP2D6

Question 12

What drug metabolism is CYP3A4 responsible for?

Answer 12

Paracetamol
Codeine
some Benzodiazepines
Sex steroid metabolism

Question 13

What is the purpose of use of sodium bicarbonate in salicylate poisoning/ overdose?

Answer 13

Increases the tubular secretion of salicylates

Bicarbonate alkalinises urine, thus unionised salicylate crosses into tubules and becomes ionised and trapped.

Question 14

What is the mode of action of sugammadex?

Answer 14

modified y-cyclodextrin.

Acts by forming a 1:1 complex with rocuronium, and prevents binding to acetylcholine receptors.

Water-soluble and produces a concentration gradient for rocuronium to diffuse away from the NMJ.

Excreted in urine without metabolism.

Question 15

What the EEG rhythm for:
1. 8 - 10 Hz
When does it occur

Answer 15

alpha waves,

occurs with closed eyes; coma

Question 16

What the EEG rhythm for:
1. 13 - 30 Hz
When does it occur?

Answer 16

beta waves

alert or active

Question 17

What the EEG rhythm for:
1. 4 Hz
When does it occur

Answer 17

upsilon

during sleep/ in children

Question 18

What the EEG rhythm for:
1. 4 - 8 Hz
When does it occur

Answer 18

theta

drowsiness/ in children

Question 19

Which nerve best reflects extent of neuromuscular blockade?

Answer 19

Facial nerve