Mixed/MCQ Questions Flashcards
T/F. Regional anaesthesia is associated with less blood loss?
True - due to reduced arterial and venous pressures
T/F. Epidural anaesthesia is associated with increased risk of DVT/ VTE?
False because:
1. Blood flow thru legs is improved due to sympathectomy-induced vasodilation.
2. Reduced perioperative hypercoagulopathy due to the surgical stress response.
Benefits of epidural analgesia?
- Better pain control
—can reduce pain from several hours to several days, depending on the technique used. - Earlier mobilization and discharge
—- due to improved pain management - Decreased blood loss
-Allows patient involvement in childbirth - Reduced rates of VTE
—- due to improved circulation in the legs & decreased perioperative hypercoagulopathy due to surgical stress response
T/F. Rate of csection is higher after epidural vs systemic analgesics (IM pethidine)
False. No difference between the two.
T/F. Epidural/intrathecal analgesia is associated with a shorter first and second stage of labour compared to systemic analgesia?
True
T/F. Incidence of agpars <7 are higher with epidural vs systemic analgesics.
False. Epidural is assoc with less aggars <7.
What are the contraindications to epidural analgesics?
- Patient refusal
- Anticoagulation/maternal coagulopathy
- Severe Thrombocytopenia <50
- Active maternal haemorrhage
- Maternal septicaemia
- Untreated febrile illness
- Infection at or near needle insertion site
- Allergy to local anaesthetic or opiates
Can an epidural be started in the second stage of labour?
Yes
What is a common delayed complication of epidural analgesia?
Postural puncture headache
— from leakage of CSF
—–Leads to decreased intracranial pressure and compensatory cerebral vasodilation.
—–‐— Causes traction on pain sensitive intracranial structures
T/F. Immune thrombocytopenia is often assoc with APH?
False. Spontaneous APH in these women is uncommon.
For a pt with immune thrombocytopenia, what platelet count is required for epidural?
> 80 x 10^9/L
For a pt with immune thrombocytopenia, what platelet count is required for csection?
At LEAST 50 x 10^9/L
What platelet count requires treatment, in pts with immune thrombocytopenia?
<20 x10^9/L
What are the treatment options for immune thrombocytopenia?
- Corticosteroids - first line
- IV gamma globulin for refractory disease
- Splenectomy - AVOID in pregnancy
Which drugs carry very high risk of harming the breastfed baby?
Antithyroid agents
- PTU may be at a higher conc in breastmilk than maternal plasma
What are the complications of massive blood transfusion?
- Hyperkalcaemia (lysis of rbcs)
- Hypocalcaemia (anticoagulants in blood products chelate calcium)
- thrombocytopenia
- coagulopathy [due to depleted clotting factors. Also anticoagulants in blood products accumulate to cause coagulopathy in MASSIVE transfusions].
Bowel adhesions to the anterior abdominal wall are seen in what percentage of patients without prior surgery?
0.5%
What is the advantage of open laparotomy?
Reduced vascular injury
Risks associated with urinary bladder catheterization?
- UTI
- uretral pain
- difficulty voiding post removal
- delayed ambulatory
- increased hospital stay
What is the numerical ratio for:
1. Very common
2. Common
3. Uncommon
4. Rare
5. Very rare
- 1/1 to 1/10
- 1/10 to 1/100
- 1/100 to 1/1,000
- 1/1,000 to 1/10,000
- Less than 1/10,00
What are the components of the Centor criteri foe pharyngitis
1.No cough
2.Tender anterior cervical lymphadenopathy
3. Fever
4. Tonsillar exudate
