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Phase 3B > Misc Teaching > Flashcards

Misc Teaching Flashcards

1
Q

What are potential complications of surgery?

A
  • Wrong patient
  • Wrong site
  • Wrong operation
  • Lack of notification of allergy status
  • Complications of anaesthetic
  • Lack of airway control and breathing
  • Circulatory complications
  • Poor skin quality
  • Infection
  • Fractures
  • Lesions of nerves and arteries
  • Perforation of organs
  • Abandoned swabs, instruments post surgery
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2
Q

What are the different types of anaesthetic?

A
  • Local
  • General
  • Spinal
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3
Q

How does local anaesthetic work?

A

-Prevents the uptake of sodium ions into the nerve so an action potential is not generated

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4
Q

What happens if local anaesthetic is injected into the blood stream?

A

-Muscle paralysis = heart becomes paralysed –> death

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5
Q

What are some complications of general anaesthetic?

A
  • Incorrect dose
  • Unknown allergy to anaesthetic
  • Ventialation problems
  • Co-morbidities
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6
Q

What are some intubation complications that can result from surgery?

A
  • Knock out the teeth
  • Soft palate lesion
  • Can intubate the stomach - stomach inflates with test breath, hypoxia
  • Intubate into the pharyngeal pouches
  • Lesion of vocal cords (affected by recurrent laryngeal nerve)
  • Intubation size (too narrow or too wide)
  • Intubate too far into one bronchus - (right as more lobes of the lung - more steep bronchus)
  • Inflation breaths: incorrect rate, depth
  • Pneumothorax
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7
Q

What are some complications of spinal anaesthetic?

A
  • Poor skin quality at site (ie infection)
  • Excess fat (high BMI)
  • Lesion of muscles
  • Wrong site of administration (should be L3/L4)
  • Lesion of blood vessels supplying spinal cord
  • Low pressure headaches (meningeal headache)
  • Administration of drug into wrong space ie sub dural, subarachnoid, epidural
  • Administration into intervertebral disc
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8
Q

What are the different types of shock?

A
  • Hypovolaemic
  • Cardiogenic
  • Septic
  • Anaphylatic
  • Neuralgic
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9
Q

What is hypovolaemic shock?

A

-Loss of fluid volume in the blood vessels due to a lesion

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10
Q

What are some causes of hypovolaemic shock?

A
  • Bleeding
  • Burns
  • Severe dehydration ie N+V, DKA, Diabetes insipidus
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11
Q

What is one of the first signs of hypovolaemic shock?

A
  • Increased resp rate

- Increased heart rate

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12
Q

What is cardiogenic shock?

A

-Dysfunctional heart. Stops pumping blood effectively around the body

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13
Q

What are some causes of cardiogenic shock?

A
  • Cardiac arrest
  • MI
  • Cardiomyopathy
  • Arrhythmia
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14
Q

What is shock?

A

-Inadequate perfusion of the tissues and organs

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15
Q

What is septic shock?

A

-An inflammatory response to bacteraemia

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16
Q

What are signs of septic shock?

A
  • Temperature
  • Tachycardia
  • Increased resp rate
17
Q

What is the management for septic shock?

A
  • Fluids
  • Antibiotics
  • Steroids
  • Adrenaline
  • Monitor urine output (fluid balance)
  • Analgesia
  • Find the source
18
Q

What is anaphylactic shock?

A

-An exaggerated inflammatory response to a foreign body

19
Q

What causes the inflammatory process?

A
  • interleukins
  • prostaglandins
  • histamine
20
Q

How do you manage anaphylactic shock?

A
  • Adrenaline
  • Noradrenaline
  • Steroids
  • removal of cause
  • Fluids
21
Q

What is neuralgic shock?

A
  • Dysregulation of nerves controlling the blood vessels = vasodilation
  • ->Hypovolaemia which doesn’t respond to fluids. Usually post surgery but returns to normal
22
Q

What are examples of drugs that are p450 inducers?

A
  • Antiepileptics: phenytoin, carbamazepine
  • Barbiturates: phenobarbitone
  • Rifampicin
  • St John’s Wort
  • Chronic alcohol intake
  • Griseofulvin
  • Smoking
23
Q

What are examples of drugs that are p450 inhibitors?

A
  • antibiotics: ciprofloxacin, erythromycin
  • isoniazid
  • cimetidine,omeprazole
  • amiodarone
  • allopurinol
  • imidazoles: ketoconazole, fluconazole
  • SSRIs: fluoxetine, sertraline
  • ritonavir
  • sodium valproate
  • acute alcohol intake
  • quinupristin
24
Q

What is Phaeochromocytoma?

A

Phaeochromocytoma is a rare catecholamine secreting tumour. About 10% are familial and may be associated with MEN type II, neurofibromatosis and von Hippel-Lindau syndrome

25
Q

What are the clinical features of phaeochromocytoma?

A

Features are typically episodic

  • hypertension (around 90% of cases, may be sustained)
  • headaches
  • palpitations
  • sweating
  • anxiety
26
Q

Investigations for phaeochromocytoma?

A
  • 24 hr urinary collection of metanephrines

- CT if metanephrines are positive

27
Q

What is the treatment for phaeochromocytoma?

A

-Surgery is the definitive management.
-The patient must first however be stabilized with medical management:
>alpha-blocker (e.g. phenoxybenzamine), given before a
>beta-blocker (e.g. propranolol)

28
Q

What are some endocrine side effects of glucocorticoids?

A
  • Impaired glucose secretion

- Increased appetite/weight gain, hirsutism, hyperlipidaemia

29
Q

What are some of the Cushing’s syndrome features?

A
  • Moon face
  • Buffalo hump
  • Striae
30
Q

What are some msk side effects of glucocorticoids?

A
  • Osteoporosis
  • Proxiaml myopathy
  • Avascular necrosis of the femoral head
31
Q

What are some of the immunosuppression side effects of glucocorticoids

A
  • increased susceptibility to severe infections

- reactivation of tb

32
Q

What are some psychiatric side effects of glucocorticoids?

A
  • Insomnia
  • Mania
  • Depression
  • Psychosis
33
Q

What are some GI side effects of glucocorticoids?

A

-Peptic ulcers adn acute pancreatitis

34
Q

What are some ophthalmic side effects of glucocorticoids?

A
  • glaucoma

- cataracts

35
Q

How might steroids affect children adversely?

A

-Growth suppression

36
Q

What are some mineralocorticoid side effects?

A
  • Fluid retention

- Hypertension

37
Q

Which drugs are known to cause impaired glucose intolerance?

A
  • Thiazides
  • Steroids
  • Tacrolimus
  • Ciclopsorins
  • Interferon-alpha
  • Nicotinic acid
  • Antipsychotics
38
Q

Which vaccines are live attenuated?

A
  • BCG
  • MMR
  • oral polio
  • yellow fever
  • oral typhoid
39
Q

What is Reynold’s pentad?

A

-Chacot’s triad plus hypotension and confusion

>ruq pain, fever/rigors, vomiting

Phase 3B (14 decks)

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