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Yr4 Anaesthetics > passmed all > Flashcards

passmed all Flashcards

1
Q

New onset AF with feculent material in the wound drain

A

anastomotic leak

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2
Q

carotid endarterectomy surgery could injure what nerve

A

hypoglossal nerve

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3
Q

upper limb fracture repairs could injure what nerves

A

ulnar and median nerves

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4
Q

legs in lloyd davies position - legs out injures what nerve

A

common peroneal

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5
Q

why does an ileus occur post GI surgery

A

due to fluid sequestration and loss of electrolytes

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6
Q

what is malignant hyperthermia

A

occurs post suxamethonium injection as well as some antipsychotics

hyperpyrexia
muscle ridigity
excessive release of calcium from sarcoplasmic reticulum
auto dom

ck raised and contracture tests with caffeine and halothane

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7
Q

how do we manage malignant hyperthermia

A

dantrolene - prevents calcium release from the sarcoplasmic reticulum

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8
Q

one day insulin regime should be reduced by how much before surgery

A

Surgery / diabetes: once-daily insulin dose should generally be reduced by 20% on the day before and the day of surgery

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9
Q

is blood loss is unlikely in surgery what shuld you do

A

group and save eg lower segement c section or lap chol

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10
Q

if chance of transfusion is liekly what shoudl do

A

vcross match 2 units eg salpinectomy for ruptured ectopic or total hip replacement

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11
Q

if chance of transfusion is definite what should you do

A

cross match 4-6 units eg total gastrectomy oophorecgomy, elective AAA repair, cystectomy, hepatectomy

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12
Q

anyone in pred in moderate surgery and above need to be given what drug

A

hydrocortisone

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13
Q

how would you get access for chemo

A

Hickman line50%

A Hickman line is the most reliable long term option. Most Hickman lines are inserted under local anaesthesia with image guidance. They have a cuff that usually becomes integrated with the surrounding tissues. This requires a brief dissection during line removal.

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14
Q

peripherally stbael what access

A

20G peripheral cannula

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15
Q

Excessive infusions of any intravenous fluid carry the risk of development of tissue oedema and potentially cardiac failure. Excessive administration of sodium chloride is a recognised cause of

A

hyperchloraemic acidosis and therefore Hartmans solution may be preferred where large volumes of fluid are to be administered.

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16
Q

what drug not in penumonothax

A

NO

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17
Q

how can you assess oesophageal intubation

A

capnogrpahy - monitor end-tidal CO2

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18
Q

anastomic leak defintive mx

A

straight back to surgery

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19
Q

common presnetation post surgery of drowsy, with low ish blood pressure and high hr

A

hypovolaemia due to blood loss or dehydration
need to provide fluid challnege with NAcl

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20
Q

post op ileus what shoudl you check daily

A

electroyltes

Monitoring of electrolytes daily is important because abnormal fluid shifts can occur in the immobile bowel, causing derangement of multiple electrolytes. Potassium in particular can be lost in these fluid shifts, and also hypomagnesaemia can cause hypokalaemia so daily monitoring of electrolytes (including calcium and magnesium) until bowel function returns is the most important of these investigations

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21
Q

which commonly used anaethetic which potentiates GABAa preferred in pt with cardiac apthology as causes less hypotension but can cuase adrneal suppresion

A

etomidate

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22
Q

ketamine can be used in anastehtics when is it good

A

Acts as a dissociative anaesthetic.
* Doesn’t cause a drop in blood pressure so useful in trauma

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23
Q

side effects of ketamine

A

hallucinations and disorientation

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24
Q

ketamine moa

A

blocks NMDA receptors

25
Q

benefits of propofol

A

Has some anti-emetic effects - useful for patients with a high risk of post-operative vomiting
ventilated pt and intensive care

potentiates gabaa
can cause hypotension

26
Q

wound infections present how

A

Abdominal wound infections can cause post-op fevers after a few days and can be associated with systemic signs of infection

An anastomotic leak is possible in this time period but would not present with a soft abdomen and no pain. People are generally very sick with sepsis when they have an anastomotic leak.

27
Q

Please select the most appropriate method of delivering nutrition in each of the following scenarios.

A 28-year-old man is comatose, from head injuries, on the neurosurgical intensive care unit. There is no evidence of a basal skull fracture. He is recovering well and should be extubated soon.
A

NG tube

28
Q

Please select the most appropriate method of delivering nutrition in each of the following scenarios.

A 56-year-old man has undergone a potentially curative oesophagectomy for carcinoma.
A

feeding jejunostomy

29
Q

Please select the most appropriate method of delivering nutrition in each of the following scenarios.

A 43-year-old man is recovering from a laparoscopic low anterior resection with loop ileostomy.

A

oral intake

30
Q

NG feedings is usually via fine bore naso gastric feeding tube. safe in impaired swallow when can we not use it

A

following head injury due to risk of tube insertion

31
Q

naso jejunal feeding usually doen intra operatively - risk of aspiration and food pooling safe after what surgery

A

oesophagogastric surgery

32
Q

feeding jejunostomy is a surgically sited feeding tube which may be used for long term feeding – low risk of aspiration adn thus safe follwoing upper GI surgery
main risks are

A

tube displacement and peritubal leakage risk of peritonitis

33
Q

percutaneous endoscopic gastrostomy - combined endoscopic and percutaneous tube inserion - may not be possible if cannot undergo endoscopy what is the risk

A

risks include aspiration and leakage at the insertion site

34
Q

TPN used when

A

definitive option in those pt in whom enteral feeding is contra indicated.

central vein as strongly phelbitic

35
Q

long term use of TPN assoiciated with what

A

fatty liver
derranged LFTs

36
Q

elctrolyte side effcet of suxamethonium( neuromusculr blocker used alongside anaesthetic agent)

A

hyperkalemia

37
Q

eye side effect of suxamethonium

A

raised intraocular pressure

38
Q

√Which of the following local anaesthetic preparations would be most suitable for an 18-year-old male undergoing a unilateral Zadek’s procedure (ingrown toenail ablation)?

A

Ring block with 1% lignocaine alone

This is excision of the toenail and a fast-acting local anaesthetic is indicated. Adrenaline should be avoided in this setting as it can cause digital ischaemia.

39
Q

features of lidocaine toxiciity

A

Features of toxicity: Initial CNS over activity then depression as lidocaine initially blocks inhibitory pathways then blocks both inhibitory and activating pathways. Cardiac arrhythmias.

40
Q

Local anesthetic toxicity can be treated with

A

IV 20% lipid emulsion

41
Q

An agent which reverses the action of midazolam

A

Flumazenil66%

Flumazenil antagonises the effects of benzodiazepines by competition at GABA binding sites. Since may benzodiazepines have longer half lives than flumazenil patients still require close monitoring after receiving the drug.

42
Q

Intraosseous access is most commonly obtained at the

A

poximal tibia

43
Q

what airway adjunct is ideal for very short procedures

A

Ideal for very short procedures

44
Q

when should you not use a laryngeal mask

A

when pt has not fasted as poor control aginst reflux of gastric contents, not suitable fo rhigth pressure ventilation

45
Q

tracheostomy reduce work of breathing adn dead spae side effects

A

dries secretiosn, humidified air is usually required

46
Q

problems with endotracheal tube

A

oesophageal intubation - need to monitro en tidal co2

47
Q

maligant hypertherma tx

A

Dantrolene is the only available specific and effective treatment for MH and should be administered intravenously.

48
Q

do you need laxatives before colonoscopy

A

yes day before

49
Q

ecg pre

A

Patients over the age of 65 may need an ECG before major surgery.
Patients with renal disease may need a full blood count and an ECG depending on their ASA grade even before intermediate surgery.
Patients with hypertension do not need any specific investigations pre-operation.
Patients with diabetes may need an ECG before intermediate surgery.

50
Q

what drugs slow bone healing

A

NSAID
Steroids
Immunosupressive agents
Anti neoplastic drugs

51
Q

Isolated fever in well patient in first 24 hours following surgery? Think physiological reaction to operation

A

Early causes of post-op pyrexia (0-5 days) include:
Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction (usually within a day following the operation)
Pulmonary atelectasis - this if often listed but the evidence base to support this link is limited

Late causes (>5 days) include:
Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak

52
Q

clean wound post up what

A

sterile saline

53
Q

Long term mechanical ventilation in trauma patients can result

A

tracheo-oesophageal fistula formation

54
Q

Patients with myasthenia gravis are very sensitive to non-depolarising agents

A

Non-depolarising agents, such as rocuronium, work by antagonism of nicotinic acetylcholine receptors in the motor end plate, producing paralysis by their blockade. This is in contrast with suxamethonium, which produces paralysis by acting on these receptors. The myasthenic patient has fewer available nicotinic receptors due to autoimmune-mediated destruction, meaning that they are more sensitive to non-depolarising blockade.

55
Q

what diabetic drugs can be continued day of sruery

A

Surgery / diabetes: DPP IV inhibitors (-gliptins) and GLP-1 analogues (-tides) can be continued on the day of surgery

56
Q

when should people with diaebtes be on list for srugeyr

A

Patients with diabetes should ideally be put first on the operating list to prevent complications of poor BM control.

57
Q

early feature of parkinsons

A

anosmia

58
Q

Superior rectus: primary action is elevation, secondary actions include adduction and medial rotation of the eyeball.
Inferior rectus: primary action is depression, secondary actions include adduction and lateral rotation of the eyeball.
Medial rectus: adduction of the eyeball.
Lateral rectus: abduction of the eyeball.
Superior oblique: depresses, abducts and medially rotates the eyeball.
Inferior oblique: elevates, abducts and laterally rotates the eyeball.

A

Yr4 Anaesthetics (3 decks)

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