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Year 6 > Palliative Extras > Flashcards

Palliative Extras Flashcards

1
Q

Patient is breathless + pain eg due to end stage COPD. What do you give

A

Morphine PO - reduces resp rate + helps with pain
start small dose then titrate up

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2
Q

how does ASA rankings work for surgery

A

ASA score of 1 would be awarded to a healthy patient who does not smoke and has no or low alcohol intake
2 –with mild systemic disease
score of 3 is for patients with severe systemic disease and functional limitations
score of 4 is for patients with systemic disease severe enough to constantly threaten life
score of 5 are unlikely to survive if surgery does not go ahead

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3
Q

if using more than 2 doses of breakthrough pain medication eg if He takes modified-release morphine sulphate tablets (MST) 20 mg twice daily. He also takes 4–6 doses daily of oramorph 10 mg/5 ml for breakthrough pain, what should you do

A

increase dose of longer acting analgesia

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4
Q

what must be given the day before colonoscopy

A

laxatives

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5
Q

diabetes control in major surgery/poorly controlled diabetes into surgery

A

variable rate insulin

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6
Q

what is used for the neuromuscular relaxation part of rapid sequence induction

A

suxamethonium

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7
Q

how do you calculate breakthrough dose of morphine

A

1/6th of daily morphine dose

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8
Q

what type of airway intervention can you not use in basal skull fractures

A

nasopharyngeal airways

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9
Q

what are the opioid of choice for pain management in severe renal impairment

A

buprenorphine or fentanyl

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10
Q

what are features of malignant hyperthermia

A

happens after anaesthetics
hyperpyrexia and muscle rigidity
susceptibility is inherited in autosomal dominant fashion

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11
Q

what drugs cause malignant hyperthermia

A

halothane
suxamethonium

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12
Q

what investigations do you do in malignant hyperthermia

A

CK raised

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13
Q

what is the management of malignant hyperthermia

A

dantrolene

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14
Q

what are indications and contraindications for cyclizine use

A

indication -
movement related nausea/vomiting
bowel obstruction

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15
Q

what are indications and contraindications for dexamethasone use

A

indications -
intracranial disease eg metastases
bowel obstruction

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16
Q

what are indications and contraindications for domperidone use

A

useful in gastric stasis
can be used in parkinsons/not cross BBB
Contraindication - bowel obstruction

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17
Q

what are indications and contraindications for metaclopramide use

A

useful in gastric stasis
contraindication - not in parkinsons
not in bowel obstruction

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18
Q

treatment for anxiety related nausea/vomiting

A

lorazepam

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19
Q

treatment for chemotherapy related nausea/vomiting

A

ondansetron

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20
Q

when should you start LMWH after surgery

A

6-12 hours after

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21
Q

when can you have clear fluids until before surgery

A

until 2 hours before

22
Q

when can you have non clear liquids/food until before surgery

A

6 hours before

23
Q

decreased oxygen saturation 10 minutes after intubation

A

intubation was done in oesophagus

24
Q

what are the things that are checked before induction of anaesthesia

A

Patient has confirmed: Site, identity, procedure, consent
Site is marked
Anaesthesia safety check completed
Pulse oximeter is on patient and functioning
Does the patient have a known allergy?
Is there a difficult airway/aspiration risk?
Is there a risk of > 500ml blood loss (7ml/kg in children)?

25
Q

what analgesia is given in mild-moderate renal impairment

A

oxycodone

26
Q

how should wounds be cleaned post surgery up to 48 hours

A

sterile saline

27
Q

when can a patient shower after surgery

A

after 48 hours

28
Q

what BMI is ASA 2 and 3

A

BMI 30-40 = 2
BMI 40+ = 3

29
Q

how do you manage secretions at end of life
eg patient makes gargling noises, dullness to percussion

A

Hyoscine hydrobromide or hyoscine butylbromide
subcut

30
Q

what treatment is given for reducing discomfort in a painful mouth eg due to ulcers

A

Benzydamine hydrochloride mouthwash or spray

31
Q

how can multiple intubations lead to increased infections

A

formation of a Tracheo-oesophageal fistula

32
Q

how do you convert morphine to diamorphine

A

/3

33
Q

what would you give for bowel colic eg abdominal pain in bowel cancer

A

hyoscine hydrobromide, hyoscine butylbromide, or glycopyrronium bromide

34
Q

how would you treat local anaesthetic toxicity eg due to lidocaine

A

IV 20% lipid emulsion

35
Q

what changes to prednisolone are made prior to surgery

A

supplement with hydrocortisone

36
Q

isolated fever in a patient 24 hours after surgery

A

physiological reaction to operation

37
Q

What is given for the actual induction agent in rapid sequence induction

A

sodium thiopentone

38
Q

What drugs slow down wound healing

A

Non steroidal anti inflammatory drugs
Steroids
Immunosupressive agents
Anti neoplastic drugs

39
Q

if patients temp is <36 degrees before operation, can you do operation

A

No unless urgent -> must warm up

40
Q

Causes of post operative fever pneumonic

A

Day 1-2: ‘Wind’ - Pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - Urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - Infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - Deep vein thrombosis or pulmonary embolism
Any time: Drugs, transfusion reactions, sepsis, line contamination.

41
Q

for hip replacement, what VTE prophylaxis is used and when

A

TED stockings once admitted and LMWH 6 hours after surgery

42
Q

treatment for hiccups in palliative care

A

chlorpromazine or haloperidol

43
Q

When would you use total parenteral nutrition

A

when the intestines dont work

44
Q

what vessel is TPN given through

A

subclavian line

45
Q

codeine to morphine conversion

A

/10

46
Q

what anaesthetic agent would you use if the patient is haemodynamically unstable

A

ketamine

47
Q

What drug can be given to reverse neuromuscular blockade

A

neostigmine

48
Q

oral morphine to subcut morphine conversion

A

/2

49
Q

what is the risk of giving hypotonic (0.45%) fluid in paediatric patients

A

risk of hyponatraemic encephalopathy

50
Q

what is central pontine myelinolysis

A

rapid correction of hyponatraemia

51
Q

what is a contraindication for suxamethonium

A

penetrating eye injuries or acute narrow angle glaucoma, as suxamethonium increases intra-ocular pressure

52
Q
A

Year 6 (24 decks)

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