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Internship - Anaesthetics > Midblock Assessment 3 > Flashcards

Midblock Assessment 3 Flashcards

1
Q

Regarding oxygen cylinders:

  1. What is the Colour (1)
  2. Pressure in a full cylinder (2). [value&unit]
  3. Minimum acceptable pressure (2) [value&unit]
A
  1. Black with white shoulder
  2. Full = 137 x 100 kPa (137 bar)
  3. > 5000 kPa (50x100kPa)
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2
Q

What are the standard pipeline colour codings for the following? (4)

  1. Oxygen
  2. Air
  3. Nitrous oxide
  4. Vacuum
A
  1. Oxygen - White
  2. Air - Black & white
  3. Nitrous oxide - Blue
  4. Vacuum - Yellow
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3
Q

What device should be available in each OT to ventilate a patient in case of anaesthetic machine failure? (1)

A

Ambubag

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4
Q

List 3 devices available to assist with a difficult intubation. State for each when it would be appropriate to use them. (6)

A
  1. Video laryngoscopy – difficulty visualising cords
  2. Bougie – difficulty passing ETT through cords
  3. LMA – failure of intubation x3
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5
Q

Name 2 commonly used breathing systems and the main characteristic of each. (4)

A
  1. Circle:
  2. 1 Contained system
  3. 2 CO2 removed with soda lime
  4. 3 Efficient flow of gasses
  5. 4 Can use low flow
  6. Jackson Rees:
  7. 1 Decreased resistance due to not having valves
  8. 2 Useful in paeds cases
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6
Q

When doing a pre-operative airway assessment, which 3 aspects regarding airway management have to be assessed? (3)

A
  1. Assessing difficulty with mask ventilation
  2. Assessing difficulty with laryngoscopy
  3. Assessing difficulty with rescue airway
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7
Q

Describe the optimal positioning of a patient for direct laryngoscopy. (2)

A
  1. Neck flexed
  2. Head extended
  3. In “sniffing position”
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8
Q

Which size laryngoscope blades should be available for an adult? (2)

A
  1. Size 3

2. Size 4

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9
Q

What is the formula to calculate the size of uncuffed ETT + length to use in paediatrics? (1)

A
  1. Size: (Age/4) + 4

2. Length: ETT size x 3

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10
Q

Which size ETT would you use for:

  1. An adult male (1)
  2. An adult female (1)
A
  1. Male: 7.5 - 8.0

2. Female: 7.0 - 7.5

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11
Q

List 3 bloodresults you should review before anaesthetising a patient with pre-eclampsia for CS? Give a reason for each. (6)

A
  1. Hb – haemolysis – possible HELLP syndrome
  2. Platelets - thrombocytopenia – bleeding risk - possible HELLP syndrome
  3. U&E – proteinuria and renal disfunction
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12
Q

Name 3 investigations that should be done for a 60yr old diabetic and hypertensive patient prior to a BKA? (3)

A
  1. CXR
  2. ECG
  3. U&E
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13
Q

What investigation would you request for an 18yr old well patient coming for a minor orthopaedic procedure? (1)

A
  1. Ward Hb
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14
Q

What are the standard fasting guidelines for:

  1. Clear fluids
  2. Breastmilk
  3. Formula milk
  4. Solids
A
  1. Clear fluids - 2 hours
  2. Breastmilk - 4 hours
  3. Formula milk - 6 hours
  4. Solids - 6 hours
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15
Q

Regarding a rapid sequence induction:

  1. What is the aim of a RSI? (1)
  2. List the sequence of actions during a RSI. (5)
A
    1. Secure the airway quickly and safely
  2. 2 Reducing the risk of aspiration.
  3. RSI:
  4. Assessment
  5. Preparation: Pre-calculate doses of induction agent + MR
  6. Position head/neck
  7. Pre-O2 w/ 100% O2
  8. Cricoid pressure
  9. Give induction agent + MR
  10. Timer
  11. Intubate
  12. Confirm placement
  13. Change to vent
  14. Secure tube
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16
Q

Induction agents:

  1. What is the induction dose of propofol? (1)
  2. What is the induction dose of etomidate?(1)
  3. What would be your induction agent of choice for an unstable trauma patient. Motivate. (1)
A
  1. 1 - 2 mg/kg
  2. 0.2 - 0.3 mg/kg
  3. Etomidate:
  4. 1 Minimal CVS depression
  5. 2 Good for use in CVS compromise
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17
Q

For adrenalin. What is the:

  1. Dose in cardiac arrest (1)
  2. Ampoule size (1)
  3. Concentration in ampoule (1)
A
  1. 1 mg IVI repeated every 4 min
  2. 1 ml amp
  3. 1 mg/ml
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18
Q

Isoflurane:

  1. Colour coding
  2. MAC
A
  1. Purple

2. 1.15%

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19
Q

Sevoflurane:

  1. Colour coding
  2. MAC
A
  1. Yellow

2. 2%

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20
Q

In addition to blood, name 3 blood products that may be required in a patient with massive blood loss. (3)

A
  1. Freeze dried plasma (FPD)
  2. Platelets 1 pooled megaunit
  3. Cryoprecipitate
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21
Q

Which ABO blood group is regarded as the universal donor? (1)

A

Type O negative blood.

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22
Q

In addition to the ABO blood group, which other blood group has to be checked before administering blood to a female? 


Why and how would you check this? (3)

A
  1. Rh
  2. How to check:
  3. 1 Rhesus card:
  4. 2 Drip blood
  5. 3 Then add reagents
  6. 4 If clumps +:
  7. Why to check:
  8. 1 Need to check as can sensitise an Rh- mother should she fall pregnant and her child be Rh+
  9. 2 Causes intrapartum complications - eg hydrops fetalis
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23
Q

List 3 of the details you would check before administering a unit of packed cells to a patient.(3)

A
  1. Correct patient name & IP number
  2. Correct pack number
  3. Correct expiry date

(Correct blood group of patient + blood)

24
Q

A 23 yr old well patient is booked for emergency CS.

Which local anaesthetic and adjunct (name&dose) would you use for the spinal? (2)

A

1.8 mls of 0.5% Heavy macaine + 0.2 mls of fentanyl (50 ug/ml)

25
Q

A 23 yr old well patient is booked for emergency CS.

The patient’s BP 5min after the spinal is 80/48 with a pulse rate of 70, what must you do? (5)

A
  1. ABC
  2. Ensure wedge is in place
  3. Fluid bolus
  4. Vasopressor – preferably phenylephrine
  5. Speak to the patient and make sure they are responsive:
  6. 1 Check the level of your spinal
  7. 2 Check for sudden haemorrhage, difficulty breathing or signs of tamponade/tension pneumothorax
  8. 3 Check BP cuff position & function
26
Q

A 23 yr old well patient is booked for emergency CS.

  1. What would you administer immediately after delivery of the baby?
  2. How would you give this drug?
  3. Name 1 major side effect of this drug. (3)
A
  1. Give oxytocin immediately after delivery of the baby
  2. 1 Give 2.5 IU oxytocin IVI over 1 min
  3. 2 Give 7.5 IU as slow infusion
  4. 3 After completion of the C/S 20 IU in one litre to run at 125ml/hr
  5. 1 Vasodilator
  6. 2 Myometrial contraction
  7. 3 Arrhythmias
27
Q

Paracetamol:

  1. Adult dose
  2. Paediatric dose
  3. Dosing interval
A
  1. PO: 20 mg/kg 6hrly - rounded to 1 g 6 hourly
    IV: 15 mg/kg 6hrly - rounded to 1 g 6 hourly
  2. IV + PO: 15 mg/kg 6hrly
  3. Dose 6hrly
28
Q

Diclofenac:

  1. Adult dose
  2. Paediatric dose
  3. Dosing interval
  4. Main side effect
A
  1. 1 mg/kg IVI in 200 mls N/S over 20 mins 8hrly x 3 doses
    Then 12hrly
  2. 1 mg/kg PO/IVI 8hrly
  3. Dose 8hrly
  4. GIT ulcer/bleed; platelet dysfunction
29
Q

Fentanyl:

  1. Adult dose
  2. Paediatric dose
  3. Onset of action
  4. Duration of action
  5. Main side effect
A
  1. 1 ug/kg
  2. 1 ug/kg
  3. 5 min
  4. 20 - 30 min
  5. Respiratory depression
30
Q

Morphine:

  1. Adult dose
  2. Paediatric dose
  3. Onset of action
  4. Duration of action
  5. Dosing interval
  6. Main side effect
A
  1. 0.1 mg/kg
  2. 0.1 mg/kg
  3. 20-30 min
  4. 3-4 hours
  5. 6hrly
  6. Respiratory depression
31
Q

Name 5 devices used to monitor a patientintra-op? [5]

A
  1. Pulse oximetry
  2. 3 lead ECG
  3. NIBP
  4. Capnography
  5. Temperature

(PAW/spirometry)

32
Q

Name any 5 things you would assess when youcarry out a machine check? [5]

A
  1. Power supply & battery
  2. Wall connections & pipeline pressures
  3. Emergency oxygen cylinder
  4. O2 hypoxic device & O2 failure alarm
  5. Vaporisers
  6. Soda lime
  7. Circuit leaks
  8. Ventilator
33
Q

Name 5 emergency drugs you would prepare before starting a case? [5]

A
  1. Suxamethonium - 100 mg in 2ml (50 mg/ml)
  2. Atropine – 1 mg in 10 ml (0.1 mg/ml)
  3. Ephedrine – 50 mg in 10 ml (5 mg/ml)
  4. Phenylephrine – 10 mg in 200 ml NaCl (50 ug/ml)
  5. Adrenaline – 1 mg to 200 ml NaCl (5 ug/ml)
34
Q

Name 6 items that should be found on the standard airway trolley? [6]

A
  1. Introducer/ stylet/ bougie
  2. Magill’s forceps, face masks
  3. OPA, LMA
  4. Laryngoscopes + blades
  5. ETT of various sizes
  6. Syringe,strapping,available suction
35
Q

Name 4 items that you may find on a difficult airway trolley? [4]

A
  1. Different blades
  2. Short handle laryngoscope
  3. Video laryngoscope
  4. Fastrac intubating LMA
  5. Light wands
  6. Cricothyroidotomy set
36
Q

Name 4 drugs you could use for induction of a GA with their doses? [8]

A
  1. Propofol – 1 - 2 mg/kg
  2. Etomidate – 0.2 - 0.3 mg/kg
  3. Thiopentone - 3 - 5 mg/kg
  4. Ketamine – 2 mg/kg
  5. Midazolam - 0.2 mg/kg
37
Q

Name 2 drugs (and their doses) you would used to treat spinal hypotension in an obstetric case? [4]

A
  1. Phenylephrine – 100 ug boluses 2-3min

2. Ephedrine – 5 mg boluses 2-3min

38
Q

List 4 concerns when anaesthetising children? [4]

A
  1. Large head
  2. Short neck
  3. Prominent occiput
  4. Large tongue
  5. Long epiglottis
  6. Larynx cephalad and anteriorly
  7. Narrowest at cricoid – high risk of trauma
  8. Short trachea – easily intubate bronchi
39
Q

List 4 factors that increase risk of post op nausea and vomiting? [4]

A
  1. Female
  2. Non-smoker
  3. Hx of PONV or motion sickness
  4. Post-op opioids
40
Q

List 3 drugs (and their doses) that are used to treat PONV? [6]

A
  1. Dexamethasone 4-8 mg
  2. Ondansetron 4-8 mg
  3. Droperidole 0.625 mg
41
Q

What are the 3 H’s used when approaching an unconscious pt?

A
  1. Hazards
  2. Help
  3. Hello
42
Q

What is the ratio of chest compressions to rescue breathes in adult resus? [2]

A

30:2

43
Q

What rate should you aim for when doing adult chest compressions? [1]

A

100 - 120 bpm

44
Q

Name 2 shockable and 2 non-shockable cardiac rhythms? [4]

A
  1. Shockable - Vfib, Vtach

2. Non-shockable - pulseless electrical activity (PEA) and asystole

45
Q

Name classes off local anaesthetics and give an example of each?

A
  1. Esters - cocaine

2. Amides - lignocaine

46
Q

Toxic doses of lignocaine & bupivacaine:

A
  1. Lignocaine:
    3 mg/kg without adrenaline
    7 mg/kg with adrenaline
  2. Bupivacaine:
    2 mg/kg with or without adrenaline
47
Q

4 S/E of local anaesthetics:

A
  1. Local:
  2. 1 Cardiotoxicity
  3. 2 Neurotoxicity
  4. 3 Transient neurological Sx
  5. Systemic:
    2.1 CNS toxicity - Perioral paresthesia (initial), Dizziness
    Slurred speech, Seizures
    2.2 CVS toxicity - Decreased CO, Sinus bradycardia/arrhythmias, Asystole
48
Q

List 10 reversible causes to be excluded in event of a cardiac arrest.

A
  1. Hypoxia
  2. Hypovolaemia
  3. Hypothermia
  4. Hypo/hyperK
  5. H+ ion (acidosis)
  6. Tension pneumothorax
  7. Thrombosis - coronary (AMI)
  8. Thrombosis - PE
  9. Tamponade - cardiac
  10. Toxins/trauma
49
Q

Useful dermatomes for spinal anaesthesia

A
  1. T10 dermatome - umbilicus
  2. T6 dermatome - xiphoid.
  3. T4 dermatome - nipples.
50
Q

When performing a spinal anaesthetic using the midline approach, the layers of anatomy that are traversed (from posterior to anterior) are:

A
  1. Skin
  2. Subcutaneous fat
  3. Supraspinous ligament
  4. Interspinous ligament
  5. Ligamentum flavum
  6. Dura mater
  7. Subdural space
  8. Arachnoid mater
  9. Subarachnoid space
51
Q

Absolute CIs to spinal:

A
  1. Pt. refusal
  2. Raised ICP/ active neurological disease
  3. Haemodynamically unstable pt.
  4. Fixed CO states - severe AS/MS
  5. Coagulopathies: Plt < 80; INR > 1.5; PTT > 1.5
  6. Septic pt.
  7. Infection over site of injection
  8. Allergy to LA
  9. Dr unable to provide GA
52
Q

What is a high spinal?

A
  1. The spread of intrathecal local anaesthetic

2. Above T4

53
Q

What is total spinal?

A
  1. Intrathecal local anaesthetic-induced depression

2. Of the cervical spinal cord and/or brainstem

54
Q

What factors determine the intrathecal spread of local anaesthetic?

A
  1. Local anaesthetic: dosage, volume and baricity
  2. Patient position
  3. Patient characteristics - height
  4. Injection technique - speed of injection, barbotage
55
Q

What are the clinical features of high spinal blockade?

A
  1. Cardiovascular:
  2. 1 Hypotension (vasodilation)
  3. 2 Bradycardia (inhibition of cardio-accelerator fibres T1-T4)
  4. Resp:
  5. 1 IC mm paralysis
  6. 2 Resp arrest (C3 blocked)
  7. 3 Apnoea (total spinal involving brainstem)
  8. Neuro:
  9. 1 LOC (total spinal)
  10. Sensory:
  11. 1 Paraesthesia in upper limbs
  12. Motor:
  13. 1 Motor loss in upper limbs

Internship - Anaesthetics (17 decks)

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