Patient evaluation, informed consent, preoperative assessment and care

Question 1

Lignocaine and prilocaine are the preferred anaesthetics for pregnancy.

Answer 1

T

Question 2

There are no adverse effects associated with bupivacaine and mepivacaine use in pregnancy. .

Answer 2

F

Associated with increased risk of foetal bradycardia

Question 3

Erythromycin estolate is safe to use during pregnancy.

Answer 3

F

Assoc with hepatotoxicity during pregnancy.

Question 4

Intrapartum use of tetracycline may result in staining of foetal dental enamel.

Answer 4

T

Question 5

Small volumes of adrenaline-containing anaesthetics cannot be given safely in patients with advanced heart disease.

Answer 5

F
can be
must be max conc 1:200,000

Question 6

The risk of cardiac conditions has been stratified into high, moderate, low or negligible risks by the American Heart Association

Answer 6

T

Question 7

Patients with surgically repaired atrial or ventral septal defects are high-risk for developing bacterial endocarditis following a surgical procedure.

Answer 7

F
Low-risk
High-risk are pts with prosthetic valves, previous endocarditis, complex congenital heart disease, surgically constructed systemic-pulmonary shunts.

Question 8

Patients with hypertrophic cardiomyopathy and mitral valve prolapse with regurgitation are medium-risk for developing bacterial endocarditis following a surgical procedure.

Answer 8

T
High-risk categories include patients with prosthetic valves, a previous history of endocarditis, complex congenital cyanotic heart disease, and surgically constructed systemic–pulmonary shunts

Question 9

Patients with implanted pacemakers and defibrillators and patients with physiologic heart murmurs are low-risk for development of bacterial endocarditis following surgery.

Answer 9

T

Question 10

Appropriate antibiotics to prevent bacterial endocarditis in at risk patients are amoxicillin or if allergic, cefalexin, axithro or clindamicin

Answer 10

T
60min pre op
Amox 2g
Ceflex 2g
Azithro 500mg
Clinda 600mg
- same for immmunosuppressed pts who have been advised they need prophylaxis

Question 11

Procedures involving infected or eroded skin are associated with significantly higher infection risk and warrant the use of prophylactic antibiotics.

Answer 11

T

Question 12

Heat electrocautery or bipolar coagulation should not be used in patients with implanted cardiac pacemakers.

Answer 12

F

These are advocated.

Question 13

Antiviral prophylaxis for laser resurfacing should begin within 48hrs preoperatively and continue until re-epithelialisation is complete, generally within 7-10 days.

Answer 13

T

Question 14

Electrocautery is the preferred method of haemostasis in patients with implanted deep-brain stimulators.

Answer 14

T

Question 15

Inactivation of the deep-brain stimulator has never been necessary as effective hemostasis can be achieved with electrocautery in dermatologic surgery

Answer 15

T

Question 16

Vitamin E (alpha-tocopherol) is a potential anticoagulant.

Answer 16

T

Question 17

Garlic, ginseng, ginger, ginkgo, St John’s wort and feverfew are all potential anticoagulants.

Answer 17

T

Question 18

Alcohol may result in an increased bleeding potential.

Answer 18

T

advise pts to avoid for 2 days prior to surgery and at least until day afterwards

Question 19

Patients who have had organ transplants should have Abx prophylaxis with cefalexin 1g, dicloxacillin 1g or azithromycin 500mg orally just before the procedure

Answer 19

F
1 hour before
if their physician has advised it

Question 20

The combination of non selective beta blockers (such as propranolol) and adrenaline may result in malignant hypertension, reflex bradycardia and even death

Answer 20

T

Selective beta blockers are ok

Question 21

Cephalospirin Abx can usually be given safely to penicillin allergic patients who do not have anyphylactic response to penicillin

Answer 21

T

Question 22

Alternatives to penicillins include macrolides

Answer 22

T

Question 23

Lidocaine and prilocaine are the preferred anesthetics for use during pregnancy

Answer 23

T
cat A in Aus
(B in USA but stil preferred)

Question 24

Consider delaying surgery in hypertensive patients with a systolic pressure of >170 mmHg and/or a diastolic pressure >100 mmHg

Answer 24

T
bleeding risk and stroke risk
send to GP for BP lowering

Question 25

In pts with Hx of HSV undergoing facial resurfacing procedures antivral prophylaxis options include acyclovir 400 mg three times daily, valacyclovir 500 mg twice daily, and famciclovir 250 mg twice daily.

Answer 25

T

start 48 hrs before and continue until re-epithelialization 7-10 days after

Question 26

Use of the hyfrecator is acceptable in pts with deep brain stimulators

Answer 26

F
Use Electrocautery (hot wire)

Question 27

Fondaparinux and Rivaroxiban are factor 9 (IX) inhibitors

Answer 27

F
factor 10a (Xa) inhibitors

Question 28

Dabigaptran (Pradaxa) is a factor Xa inhibitor

Answer 28

F

direct thrombin inhibitor