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Learning Outcomes Flashcards

1
Q

define frailty

A

“susceptibility state that leads to a person being more likely to lose function in the face of a given environmental challenge”

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2
Q

the triad of anaesthesia

A

the triad: analgesia, opiates and general anaesthetic agents feeding into “analgesia(removal of unpleasant stimulus), hypnosis, relaxation(muscle relaxation).”

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3
Q

biochemistry of general anaesthetic agents

A

interfere with neuronal ion channels by hyperpolarising them to reduce action potentials. Either inhalation to dissolve via membranes or I.V and bind to GABA receptors to open chloride channels.

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4
Q

physiology of general anaesthetic

A

Cerebral function lost from top down starting with complex processes, with reflexes relatively spared. IV rapid unconsciousness but rapid recovery. Blood level is very high but falls, muscle picks up the drug slowly but the effect is large because of the relative mass of skeletal muscle, fatty tissue picks up drug even more slowly but stores it due to solubility.

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5
Q

depolarising physiology of muscle relaxants

A

Depolarising (NMBS) depolarise motor end plate, render post-junctional membrane refractory to further stimulus.

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6
Q

physiology of non-depolarising muscle relaxants

A

Neuromuscular block non depolarising physiology competitive block of nicotinic acetylcholine which prevents the opening of sodium channels

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7
Q

central effects of general anaesthesia

A

depresses CV centre by reducing sympathetic outflow, ionotropic effect on the heart particularly on the cardiac output, reduced vasoconstrictor tone leading to vasodilation.

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8
Q

direct effects of general anaesthesia

A

: negative inotropic, vasodilation and venodilation decreased venous return and cardiac output.

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9
Q

respiratory effects of general anaesthesia

A

depressant reduces hypoxic and hyperbaric drive, decreased tidal volume, paralyse cilia and decrease Function respiratory capacity.

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10
Q

local anaesthetics physiology

A

sodium channel blockers, prevent propagation of action potential. LA molecules must pass into axon to block sodium channel from within, must be un-ionised to cross membranes

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11
Q

limiting factor of local anaesthetic

A

toxicity, absorption > rate of metabolism = high plasma levels

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12
Q

effects of local anaesthetic

A

Retain awareness, lack of global effects and proportional to anaesthetised area. All effects of RA are due to sympathectomy due to LA blockage of mixed spinal nerves.

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13
Q

spinal injection of local anaesthetic is in

A

the subarachnoid

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14
Q

epidural injections of local anaesthetic is in

A

extradural

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15
Q

how does one monitor consciousness during anaesthesia

A

loss of verbal contact, visually with movement, respiratory pattern and processed EEG.
monitoring
respiratory parameters, ECG, NIBP, FiO2, ETCO2, Agent monitoring, temperature, urine output, NMJ, arterial monitoring,

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16
Q

triple airway manoeuvre

A

Head tilt/chin lift/ jaw thrust.

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17
Q

potential of airway maintenances during anaesthesia

A 
face mask
triple airway manoeuvre
oropharyngeal airway
laryngeal mask airway
endotracheal intubation
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18
Q

oropharyngeal airway guidance

A

only tolerated in unconscious patient, may cause vomiting or laryngospasm

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19
Q

laryngeal mask airway guidance

A

cuffed tube mask, maintain airway but doesn’t protect. I-gel, easy insertion.

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20
Q

endotracheal intubation guidance

A

placement of cuffed tube in trachea: - protects from aspiration, artificial ventilation, prevents risk of blood contamination, strict control of blood gas

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21
Q

how to counteract the toxicity of anaesthesia

A

used alongside vasoconstrictors to reduce blood flow to reduce absorption

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22
Q

toxicity risk factors for anaesthesia

A

Toxicity depends on dose used, rate of absorption, patient weight and drug.

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23
Q

signs of anaesthetic toxicity

A

twitching, tinnitus, drowsiness, convulsion, coma and CV arrest

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24
Q

laryngospasm is

A

forced reflex adduction of vocal cords, may result in complete obstruction. Maye be caused by excitation phase on anaesthesia.

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25
Q

anaesthesia induction

A

induction Iv with propofol, thiopentone + others.

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26
Q

anaesthesia induction in children

A

gas induction sevoflurane

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27
Q

what are the planes of anaesthesia?

A

analgesia
excitation (hyperreflexia)
anaesthesia
overdose

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28
Q

type 1 respiratory failure

A

oxygenation failure

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29
Q

type 2 respiratory failure

A

oxygenation and ventilation failure

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30
Q

types of shock

A

distributive, hypovolaemic, anaphylactic, neurogenic, cardiogenic

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31
Q

stroke volume consists of

A

preload/contractility/afterload

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32
Q

fluid challenge recommendation

A

30ml/Kg

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33
Q

comprehensive geriatric assessment refers to

A

assess and manage illness in older people. Determine the problems, what domains and what can be reversed. Leads to a management plan tailored for the individual. It is a MDT exercise.

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34
Q

statistical outcomes of performing CGA

A

more likely to be alive and living at home 6 months or 1.25, p<0.001, NNT17
less likely to be living in a residential care 0.78, p<0.001.

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35
Q

extrinsic causes of incontinence

A

physical state, mobility, confusion, drinking too much, medication, constipation, social

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36
Q

intrinsic causes of incontinences

A

bladder too weak or too strong, outlet too weak or too strong

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37
Q

risk factors for incontinences

A

menopause, weak pelvic floor muscles, older man with BPH, blocked urethra, bladder stones, stroke, MS, prolonged catheterisation.

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38
Q

stress incontinence symptoms

A

: urine leak on movement, coughing, laughing, squatting

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39
Q

urinary retention with overflow incontinence symptoms

A

poor urine flow, double voiding, hesitancy, post micturition dribbling

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40
Q

urge incontinence symptoms

A

sudden urge to pass urine immediately, very disabling.

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41
Q

neuropathic bladder symptoms

A

secondary to neurological disease, no awareness of bladder filing resulting in overflow incontinence.

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42
Q

stress incontinence Tx

A

PT, oestrogen cream and duloxetine. Surgical TVT/colposuspension
kegel exercises, biofeedback, vaginal cones, pelvic floor stimulators

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43
Q

urinary retention with overflow incontinence Tx

A

treat with alpha blockers, or anti-androgens or surgery (TURP). May need catheters.

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44
Q

urge incontinence Tx

A

anti-muscarinic, bladder retraining. May also use beta 3 adrenoceptor agonists to relax detrusor.

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45
Q

Neuropathic bladder Tx

A

; parasympathomimetics (toxic, only for the young and fit) catheter usually only effective treatment

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46
Q

alternative Tx from incontinence

A 
incontinence pads
urosheaths 
intermittent catheters 
long term urinary catheter
suprapubic catheter
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47
Q

what percentages of all in-patients will suffer cognitive impairment

A

20-30% of all in-patients

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48
Q

what percentages of people post surgery suffer from cognitive impairment

A

50%

49
Q

what percentages of people at end of life suffer cognitive impairment

A

85%

50
Q

signs and symptoms of delirium

A

Disturbed consciousness, change In cognition, acute onset and fluctuation. May also present with disturbance of sleep cycle, disturbed psychomotor behaviour and emotional disturbance.

51
Q

assessments for delirium

A

Typically recognised through the 4AT. DO NOT USE DIPSTICK TESTS FOR THE DIAGNOSIS OF UTI IN THE ELDERLY.

52
Q

non-pharmacological Tx for delirium

A 
re-orientate
early mobility
correction of sensory impairment
normalise sleep cycle
avoid catheter
discharge early
53
Q

pharmacological Tx for delirium

A

stop drugs

sedate early but only as last resort. Consultant or registrar decision.

54
Q

delirium is a risk factor for

A

future development of dementia, delirium or frailty syndromes.

55
Q

WHO definition of alt. medicine

A

“broad set of health care practices that are not part of that country’s own tradition and are not integrated into the dominant health care system”

56
Q

what percentage of the population use alt. medicine

A

80%

57
Q

what percentage of Scottish GP practices recommend CAMS

A

60%

58
Q

what percentage of maternity staff recommend CAMS

A

30%

59
Q

why do patients use CAMS

A

health control, dissatisfaction with conventional medicine, lack of modern medicine holistic approach, concerns over prescriptions, aligns with their values. Thinks its safe, natural and harmless.

60
Q

preoperative investigations

A 
CV
ECG
Exercise tolerance test
ECHO
myocardial perfusion scan
cardiac catheter 
CT coronary angiogram
Resp. 
saturations
ABG
CXR
Peak flow
FVC/FEV
gas transfer
CT chest
61
Q

what to do with concurrent medications before undergoing anaesthesia

A

continue as normal usually especially inhalers, anti-anginal and ant-epileptics. Exception is to maintain anti-diabetic medication and anti-coagulants.

62
Q

per increase in metabolic equivalents leads to what percentage reduction in mortality?

A

15%

63
Q

categories of pain

A

duration; acute, chronic, acute on chronic
cause; cancer, non-cancer
mechanism; nociceptive(inflammatory, well localised, sharp or dull) , neuropathic (burning, shooting, numbness, not well localised).

64
Q

peripheral pain Tx

A

RICE, NSAIDS, local anaesthetics

65
Q

spinal cord Tx for pain

A

acupuncture, massage, TENS, local anaesthetics, opioids, ketamine.

66
Q

brain Tx for pain

A

psychological, paracetamol, opioids, amitriptyline, clonidine.

67
Q

nociceptive pain Tx

A

NSAIDS, codeine, morphine

68
Q

is codeine good for chronic pain?

A

no

69
Q

chronic cancer pain Tx

A

morphine

70
Q

neuropathic Tx

A

amitriptyline, anticonvulsants

71
Q

RICE stands for

A

rest
ice
compression
elevation

72
Q

RAT

A

recognise
assess
treat

73
Q

mild pain on the ladder Tx

A

paracetamol (+/- NSAIDS)

74
Q

moderate pain on the ladder Tx

A

paracetamol (NSAIDS + codeine/alt)

75
Q

severe pain on the ladder Tx

A

paracetamol (NSAIDS + morphine)

76
Q

hospital inpatient prevention for falls

A

ensure vision and mobility aids and call bell in reach, consider bed rails, regular obs, tell people.

77
Q

hospital inpatient has fallen what signs/symptoms and condition would they be in

A

Drugs (decrease BP/HR/awareness)( increase urine output, sedation, hallucinations, dizzy).
very likely to be acutely unwell, significant injury possible

78
Q

MDT tests for patient falls in-patient

A

MDT (eye test, ECG, BP, incontinence questionnaire, MMSE, gait and balance, osteoporosis screen)

79
Q

the patient presenting to the hospital after a fall causing injury

A

likely to be well patient, difficult and multifactorial falls

80
Q

if in A+E for a fall what do you consider?

A

ABCDE, check CK for rhabdomyolysis, skin injury etc

81
Q

MDT assessments for an A+E fall

A

(eye test, ECG, BP, incontinence questionnaire, 4AT, MMSE, gait and balance, osteoporosis screen) CT if head injury, glucose. If pain on moving a joint then x-ray. .

82
Q

history of a fall in A+E

A

history (memory of fall, palpitations, on turning, near misses, exertion, sensory) also urinary, gait, drugs.

83
Q

examination points for a fall in A+E

A

Examination for CN, neglect, cerebellar signs, Parkisons, BP, HF, respiratory disease, abdominal, prostate, kyphosis etc). also neuro and coordination of feet, Rombergs and gait.

84
Q

G.P. practice cost of drugs

A

974 million

85
Q

five R’s of good prescribing

A 
Right patient 
right dose
Right route
right drug
right time
86
Q

the role of MHRA

A

Medicine and healthcare products regulatory agency:
post marketing surveillance, assessment and authorisation, devices, quality control, clinical trials regulation.

ensures that human medicines meet acceptable standards on safety, quality and efficacy. Ensures that the sometimes-difficult balance between safety and effectiveness is achieved.

87
Q

the role of the SMC

A

Scottish medicines consortium
make decisions on the cost effectiveness of new/existing pharmaceutical products in respect of their use in NHS Scotland. Use of 3 month assessment process.

88
Q

medication marketing authorisation refers too

A

ensures meets the standards of safety, quality and efficacy. Granted for periods up to 5 years.

89
Q

medication off label refers too

A

prescribed out with the terms of marketing authorisation

90
Q

unlicensed medication use refers to

A

no marketing authorisation

91
Q

POM refers too

A

prescription only medicines. Usually new medicines are given out this way.

92
Q

osmolarity refers too

A

measure of solute concentration per unit volume of solvent.

93
Q

osmolality refers too

A

: measure of solute concentration per unit mass of solvent.

94
Q

tonicity refers too

A

measure of osmotic pressure gradient between two solutions.

95
Q

fluid distribution is

A

2/3rd’s fluid intracellular

1/3rd fluid extracellular (20% of this is intravascular).

96
Q

sodium recommendation daily

A

1mmol/kg/day

97
Q

potassium daily recommendation

A

– 1mmol/Kg/day

98
Q

glucose daily recommendation

A

(50-100g/day)

99
Q

hypovolaemia symptoms

A

nauseous, thirsty, flat veins, cool peripheries, no sweat, low or postural BP and high HR, concentrate oliguria

100
Q

hypervolemia symptoms

A

feels breathless, not thirsty, veins distended, warm and oedematous extremities, sweaty, high BP, high HR, dilute urine

101
Q

hypovolaemia treatment

A

needs resuscitation fluids if low B.P. or rehydration fluids -> plug the leak.

102
Q

hypervolemia treatment

A

no more fluids, possibly diuretics if respiratory compromised.

103
Q

Dextrose properties

A

Total body water, moves through all compartments, isotonic.

104
Q

Dextrose use

A

Useful in chronic dehydration, hypernatremia, not used in resus or low albumin.

105
Q

crystalloids properties

A

utilitarian, remain in ECF, high sodium load

106
Q

crystalloids use

A

Useful in acute dehydration, AKI, resus not in long term maintenance, hypernatremia.

107
Q

plasma expanders use

A

colloid stays in IVS (blood, TPN) useful in liver patients select intra-operative and not much else.

108
Q

four step approach for fluids admin

A

patient’s volume status?: ABDDE
patient need IV fluids?
how much fluid do they need?: work out deficits (insensible loss is 400-800mls)
what types of fluid do they need?: (5 R’s)

109
Q

five R;s of fluid resus

A 
Resus
routine maintenance
replacement
redistribution 
re-assessment
110
Q

routine maintenance fluid refers too

A

IV fluids if not orally or enterally possible

111
Q

replacement fluid refers too

A

IV additional to maintenance to correct deficit but only some

112
Q

A pharmacokinetics for the elderly

A

altered rate but not extent of absorption (delayed response) such as reduced saliva production.

113
Q

D pharmacokinetics for the elderly

A

reduced body mass, increased fat, reduced body water. Protein binding reduced and increase blood brain barrier permeability.

114
Q

M pharmacokinetics for the elderly

A

hepatic affected by decreased liver mass, decreased liver blood flow. Toxicity risk increased and reduced first pass metabolism.

115
Q

E pharmacokinetics for the elderly

A

renal function decreases with age, reduced clearance and increased half-life.

116
Q

pharmacodynamics in elderly

A

receptor binding
decreased receptor numbers
altered translation of a receptor initiated cellular response.

117
Q

what help is available in altering drug dosages for geriatric care

A

BNF, Beers criteria, STOPP-START, NHS polypharmacy guidance.

118
Q

what drugs most commonly cause ADRS In the elderly

A

NSAIDS
diuretics
warfarin.

119
Q

what drugs cause the most adverse effects in the elderly

A

anticholinergics and sedatives though.

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