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Medicine and Surgery Mushkies > Passmed Anaesthetics Mushkies > Flashcards

Passmed Anaesthetics Mushkies Flashcards

1
Q

4 IV induction agents?

A
  1. Propofol
  2. Sodium thiopentone
  3. Ketamine
  4. Etomidate
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2
Q

Food and water before general anaesthetics?

A

No food for 6 hours and no fluids for 2 hours before

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3
Q

3 s/e of halothane?

A
  1. Hepatotoxicity
  2. Myocardial depression
  3. Malignant hyperthermia
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4
Q

S/e of thiopental?

A

Laryngospasm

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5
Q

Favoured post-op fluid management?

A

Ringers lactate/Hartmanns

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6
Q

MOA of malignant hyperthermia?

A

Excessive release of Ca2+ from the sarcoplasmic reticulum of skeletal muscle

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7
Q

Mx of malignant hyperthermia?

A

Dantrolene (prevents Ca2+ release from the sarcoplasmic reticulum)

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8
Q

What anaesthetic agent has proven anti-emetic properties?

A

Propofol

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9
Q

Pre thyroid surgery prep?

A

Vocal cord checl

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10
Q

Pre parathyroid surgery prep?

A

Methylene blue to identify gland

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11
Q

Pre sentinel node biopsy prep?

A

Radioactive marker/patent blue dye

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12
Q

Pre colorectal surgery prep?

A

Bowel prep, esp. if left sided surgery

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13
Q

Types of VTE prophylaxis?

A
  1. Mechanical = stockings, intermittent compression boots

2. Pharm = Fondaparinux, LMWH, UFH

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14
Q

When to stop COCP before surgery?

A

4 weeks

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15
Q

Pseudocholinesterase deficiency aka?

A

Suxamethonium apnoea

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16
Q

Pseudocholinesterase deficiency defn?

A
  1. A rare abnormality in the production of plasma cholinesterases, leading to increased duration of action of muscle relaxants e.g. suxamethonium
  2. Respiratory arrest is inevitable unless the patient can be mechanically ventilated safely while waiting for the circulating muscle relaxants to degrade
  3. FHx
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17
Q

Some causes of paralytic ileus?

A
  1. Bowel surgery
  2. Pneumonia
  3. MI
  4. Stroke
  5. AKI
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18
Q

Dx of anastomotic leak?

A

Abdo CT

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19
Q

`Laporoscopic port insertion artery risk?

A

Inferior epigastric artery

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20
Q

Nerve injury following posterior triangle lymph node biopsy?

A

Accessory nerve

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21
Q

Nerve injury following posterior approach to hip?

A

Sciatic nerve

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22
Q

Nerve injury following axillary node clearance?

A

Long thoracic nerve

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23
Q

Nerve injury following pelvic cancer surgery?

A

Pelvic autonomic nerves

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24
Q

Nerve injury following thyroid surgery?

A

Recurrent laryngeal nerves

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25
Q

Nerve injury following carotid endarterectomy?

A

Hypoglossal nerve

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26
Q

Nerve injury following upper limb fracture repairs?

A

Ulnar and median nerves

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27
Q

IO access most commonly obtained where?

A

Anteromedial aspect of proximal tibia

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28
Q

3 sites of IO access/

A
  1. Proximal tibia
  2. Distal femur
  3. Humeral head
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29
Q

Maximal flow rates of cannulas?

A
  1. 14G = 270ml/min
  2. 16G = 180ml/min
  3. 18G = 80ml/min
  4. 20G = 54ml/min
  5. 22G = 33ml/min
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30
Q

Smoker ASA grade?

A

Grade 2

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31
Q

ASA 1?

A

Health, non-smoking, no or minimal alcohol use

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32
Q

Lidocaine toxicity mx?

A

IV 20% lipid emulsion

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33
Q

Suxamethonium e- s/e?

A

Hyperkalaemia

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34
Q

Classification of neuromuscular blocking drugs?

A
  1. Depolarising

2. Non-depolarising

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35
Q

Depolarising neuromuscular blocker MOA?

A

Binds to nACHR resulting in persistent depolarisation of motor end plate?

36
Q

Non-depolarising neuromuscular blocker MOA?

A

Competitive antagonist of nACHR

37
Q

Depolarising neuromuscular blocker example?

A

Suxamethonium (a.k.a succinylcholine)

38
Q

Non-depolarising neuromuscular blocker example?

A
  1. Atracurium

2. Vecuronium

39
Q

S/e of depolarising neuromuscular blocker?

A
  1. Malignant hyperthermia

2. Hyperkalaemia

40
Q

S/e of non-depolarising neuromuscular blocker?

A

Hypotension

41
Q

Reversal of non-depolarising neuromuscular blocker?

A

Acetylcholineterase inhibitors e.g. neostigmine

42
Q

Muscle relaxant of choice for rapid sequence induction and intubation?

A

Suxamethonium

43
Q

Neuromuscular blocker that causes fasciculations?

A

Suxamethonium

44
Q

Suxamethonium C/I?

A
  1. Penetrating eye injuries
  2. Acute narrow angle glaucoma
    As suxamethonium increases intra-ocular pressure
45
Q

Maximum 1% lignocaine dose?

A

3mg/kg - 200ml (20ml)

46
Q

Maximum 1% lignocaine with 1 in 200,000 adrenaline dose?

A

7mg/kg - 500mg (50ml)

47
Q

Long-term mechanical ventilation in trauma pts s/e?

A

Tracheo-oesophageal fistula formation

48
Q

4 airway managements?

A
  1. Oropharyngeal airway
  2. Laryngeal mask
  3. Tracheostomy
  4. ET tube
49
Q

Oculogyric crises and diffuse muscle spasm after thyroidectomy?

A

Hypocalcaemic tetany –> IV calcium

50
Q

Bowel prep for colonoscopy?

A

Bowel prep the day before the colonoscopy

51
Q

Hypovolaemia and e- disturbance in the few days following surgery?

52
Q

What blood product doesnt have to be cross matched?

53
Q

WHO checklist 3 phases?

A
  1. Before the induction of anaesthesia (sign in)
  2. Before incision of the skin (time out)
  3. Before the pt leaves the operating room (time out)
54
Q

When does VTE usually present post-op?

A

Within 5-10 days

55
Q

4 stages of wound healing?

A
  1. Haemostasis = mins-hrs
  2. Inflammation = 1-5 days
  3. Regeneration = d7-56
  4. Remodelling = 6w-1yr
56
Q

4 drugs which impair wound healing?

A
  1. NSAIDs
  2. Steroids
  3. Immunosuppressives
  4. Anti-neoplsatic
57
Q

Complication of poor post-operative pain management?

A

Pneumonia (abdo pain –> shallow breathing –> RF for atelectasis and respiratory tract infections)

58
Q

Potential cause of new-onset AF following GI surgery?

A

Anastomotic leak

59
Q

Ischaemic colitis Hx?

A

Severe abdominal pain and passing of bloody stools

60
Q

Nasopharygneal airway C/I?

A

Base of skull fractures

61
Q

Nasopharyngeal airway is ideal for what pt?

62
Q

Mx of post-op ileus?

A

NBM and NGT

63
Q

When can pt shower post-op w/ surgical wound?

64
Q

Mycosis fungoides aka?

A

Cutaneous T cell lymphoma

65
Q

Keloid scar description?

A

A shiny dark protuberant scar tissue that projects beyond the limits of the skin incision

66
Q

Benzo OD mx?

A

Flumazenil

67
Q

Isolated fever in well pt in first 24 hours following surgery?

A

Physiological reaction to operation

68
Q

Lidocaine MOA?

A

Blockage of sodium channels, disrupting the AP

69
Q

2 causative agents of malignant hyperthermia?

A
  1. Halothane

2. Suxamethonium

70
Q

How should TPN be administered?

A

Central vein

71
Q

6 feeding options in surgical pts?

A
  1. Oral
  2. NG
  3. NJ
  4. Feeding jejunostomy
  5. PEG
  6. TPN
72
Q

Hyperchloraemic acidosis post op cause?

A

Excessive infusion of IV fluid

73
Q

Anastomotic leak mx?

A

Surgical emergency and pts must be taken back to theatre ASAP

74
Q

Why does hypothermia cause increased bleeding intra-operatively?

A

Coagulation factors are less effective

75
Q

Ways thermoregulation is affected during surgery?

A
  1. Administration of unwarmed IV fluids, inhalation gases, or or irrigation of body cavities
  2. Cold theatre environment
  3. Muscle relaxants prevent shivering
  4. Spinal/epidural anaesthesia prevents peipheral vasoconstriction via reduced sympathetic tone
76
Q

What neuromuscular blocking drug cannot be reversed?

A

Suxamethonium

77
Q

Elective hip replacement VTE prophylaxis duration?

78
Q

Elective knee replacement VTE prophylaxis duration?

79
Q

Hip fracture VTE prophylaxis duration?

A

Until the pt no longer has significantly reduced mobility

80
Q

Morbidly obese (BMI>40) ASA grade?

81
Q

Local anaesthetic toxicity IV 20% lipid emulsion MOA?

A

It is proposed that lipid infusion creates a lipid phase that extracts the hydrophobic molecules of LA from the aqueous plasma phase and hence reduces serum LA concentration.

82
Q

Muscle relaxant of choice for rapid sequence induction for intubation?

A

Suxamethonium

83
Q

What is required prior to surgery for pts taking prednisolone?

A

Hydrocortisone supplementation

84
Q

Flumazenil MOA?

A

Competes with BZDs for GABA binding sites

85
Q

What anaesthetic agent is hepatotoxic?

86
Q

Post-oesophagectomy feeding?

A

Feeding jejunostomy

87
Q

When should LMWH be started post surgery?

Medicine and Surgery Mushkies (52 decks)

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