Passmed

Question 1

What are the pros and cons of nasojejunal feeding vs nasogastric feeding?

Answer 1

The nasojejunal tube prevents pooling of food in stomach and hence risk of aspiration
It can be used for oesophageal-gastric surgery
Insertion of feeding tube more complicated than nasogastric

Question 2

What are the pros and cons of a feeding jejunostony?

Answer 2

Pros
Prevents risk of aspiration
Can be used long term
Can be used after upper gi surgery
Cons
Risk of peritonitis if leaks postoperatively

Question 3

What are the pros and cons of percutaneous endoscopic gastrostomy?

Answer 3

This is insertion of a feeding tube using a combined endoscopic and percutaneous approach
Cons
Difficult procedure
Aspiration and leakage at insertion site

Question 4

What is total parenteral nutrition?

Answer 4

This is nutrition purely IV

Causes phlebitis so a central vein should be used

Question 5

What is a typical cause of postoperative low catheter output? How should this be treated?

Answer 5

Hypovolemia

Treat with a 500mle saline fluid bolus challenge

Question 6

What are the stages of the asa scoring system?

Answer 6

1 - Normally Healthy
2 - mild systemic disease with no limitation of activity
3 - severe systemic disease that limits activity
4 - Incapacitating systemic disease which poses a threat to life
5 - moribund, not expected to live without surgery
6 - braindead for organ harvesting

Question 7

What drug type slows fracture healing?

Answer 7

Nsaids

Question 8

What asa grade are morbidly obese patients (>40)?

Answer 8

3

Question 9

What does excessive administration of sodium chloride infusion cause?

Answer 9

Hyperchloraemic acidosis

Question 10

What is the first blood product that should be used for disseminated intravascular coagulation as a result of haemorrhage?

Answer 10

Fresh frozen plasma

This is to replace the clotting factors that are being lost

Question 11

When should the combined oral contraceptive pill be stopped prior to surgery?

Answer 11

It should be stopped 4 weeks prior due to increased risk of dvt

Question 12

What is a possible complication that would result in abdominal bloating from long term mechanical ventilation?

Answer 12

A trachyeosophageal fistula formation

Question 13

When is low weight molecular heparin usually given for surgery?

Answer 13

6-12 hours after surgery

Question 14

Why does pain increase the risk of pneumonia?

Answer 14

Shallow breathing results in patients not properly ventilating

Question 15

What length of time should patients not eat food or drink before an operation

Answer 15

Food should not be eaten 6 hours before surgery

No water for 2 hours before surgery

Question 16

What kind of liquid should be used for wound cleaning up to 48 hours after surgery?

Answer 16

Sterile saline

Question 17

What does use of hypotonic (0.45%) sodium chloride solution sometimes cause in children that means it should be avoided?

Answer 17

Hyponatraic encephalopathy

Question 18

What does rapid correction of hyponatremia cause?

Answer 18

Central pontine demyelination

Question 19

How long is vte prophylaxis through use of heparin required for patients having a hip replacement and a knee replacement?

Answer 19

Hip replacement is 28 days and a knee replacement is 14 days

This is if they can’t take aspirin

Question 20

Which muscle relaxant is chosen for rapid sequence induction?

Answer 20

Suxamethonium

Question 21

What anesthetic agent typically causes malignant hyperthermia?

Answer 21

Suxemethomium

Question 22

What are some of the early causes of post operative pyrexia? (in the first 5 days)

Answer 22

Cellulitis
Blood transfusion
UTI
pulmonary atelectasis

Question 23

What are some of the late causes of post operative pyrexia? (after 5 days)

Answer 23

Wound infection
pneumonia
Venous thromboembolism
anastomotic leak

Question 24

Which imaging modality should be used to diagnose anastomtotic leak?

Answer 24

CT abdo

Question 25

How long before surgery should the combined oral contraceptive pill be stopped?

Answer 25

4 weeks

Question 26

Which anaesthetic agent produces the best analgesia?

Answer 26

Ketamine has moderate to strong analgesic effects

Question 27

What are the 4 commonly used IV anaesthetic agents?

Answer 27

Propofol
Ketamine
Sodium thiopentone
Etomidate

Question 28

How is total parenteral nutrition given to the patient?

Answer 28

It is parenteral so not through the gut

Given through a central line as it is strongly phelbitic to peripheral veins