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Phase 2 > Peri-Op > Flashcards

Peri-Op Flashcards

1
Q

List the cardinal features of bowel obstruction

A 
Vomiting
Colicky pain
Distension
Constipation 
\+ anorexia, faeculent vomit, tinkling bowel sounds
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2
Q

List causes of small bowel obstruction

A

Adhesions
Herniae
Malignancy

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3
Q

List causes of large bowel obstruction

A

Malignancy
Diverticular disease
Volvulus

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4
Q

Describe X-ray changes that would be seen with small bowel obstruction

A

Central gas shadow
Valvulae conniventes
No gas in large bowel
Dilated small bowel >3cm

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5
Q

Describe X-ray changes that would be seen with large bowel obstruction

A

Peripheral gas shadow proximal to blockage
Haustra
Dilated bowel >6cm or >9cm at caecum

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6
Q

List investigations relevant in suspected bowel obstruction

A

Bloods (FBC, U&E, CRP)
G&S
AXR, erect CXR
CT

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7
Q

List the management of bowel obstruction

A

Surgery (if LBO/strangulated)
Drip and suck (IV fluids, NGT)
Catheter (fluid balance)
Analgesia

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8
Q

List complications of bowel obstruction

A

Ischaemia
Perforation –> faecal peritonitis
Renal impairment

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9
Q

Describe the conditions (paralytic) ileus, pseudo obstruction

A

Paralytic ileus - adynamic bowel, absence of peristalsis and bowel sounds due to abdominal surgery/pancreatitis/spinal injury/low K+ or Na+, drugs (TCA)
Pseudo obstruction/Ogilvie’s syndrome - signs and symptoms of bowel obstruction without any lesion in the intestinal lumens, myopathic/neuropathic cause

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10
Q

Describe presentation, appearance on X-ray and management of sigmoid volvulus

A

Bowel twists on its mesentery leading to strangulation
Elderly, constipated
AXR = coffee bean
–> sigmoidoscopy, flatus tube/colectomy

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11
Q

List some causes of abdominal perforation

A 
Peptic ulcer disease
Foreign body
Infection
Ischaemia
Colitis (fistula/toxic megacolon)
Trauma
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12
Q

List signs and symptoms of perforation

A

Peritonism (rigid abdomen, guarding)
Fever, pallor, tachycardia, hypotension
Acute onset, crescendo severity, constant, radiates to back/shoulders, worse on movement

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13
Q

List investigations required in a suspected perforation

A 
Bloods
Amylase
G&S
Urinalysis
eCXR, AXR (Rigler's sign, psoas sign)
CT +/- contrast swallow
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14
Q

Describe management of perforation

A

Medical - IV fluids, analgesia, broad spectrum ABx, NBM, NGT, catheter
Surgical - thorough washout, perforation repair, resection +/- stoma formation

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15
Q

What is a Graham patch?

A

Patch of omentum used to cover stomach in peptic ulcer perforation

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16
Q

Describe Hartmann’s procedure

A

Surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy

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17
Q

List red flag symptoms for oesophageal problems

A 
Dysphagia
Weight loss
Abdo pain
Dyspepsia
>55 years 
\+ early satiety, malaise, decreased appetite, reflux 
--> refer to endoscopy
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18
Q

List causes of peptic ulcer disease

A 
NSAIDs
H. pylori infection
Excessive alchohol intake
Steroids
Zollinger-Ellison syndrome
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19
Q

Differentiate between symptoms of gastric and duodenal ulcers

A

Gastric - worse on eating, nausea, anorexia, weight loss, epigastric pain
Duodenal - worse after eating (2-5hrs) OR worse when fasting and alleviated by eating, central back pain

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20
Q

List treatment options and complications of peptic ulcer disease

A

Lifestyle advice
PPI 8 weeks OR triple therapy 7 days (PPI + amoxicillin + metronidazole/clarithromycin)
Partial gastrectomy/selective vagotomy
Complications - acute upper GI bleed, iron deficiency anaemia, perforation, gastric outlet obstruction, pyloric stenosis

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21
Q

List causes and pathophysiology of acute appendicitis

A

Obstruction - trauma, faecolith, tumour, lymphadenitis, worms
Inflammation –> raised intraluminal pressure –> lymphoid swelling, decreased venous drainage, thrombosis, bacterial invasion –> abscess –> gangrene –> perforation –> peritonitis

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22
Q

List clinical features, investigations and management of acute appendicitis

A

Pain, fever, anorexia, abdo pain when moving (central –> RIF), nausea, vomiting, diarrhoea/constipation, fever, tachypnoea, furred tongue, abdo tenderness (++ at McBurney’s point), guarding, Rosving’s sign, psoas sign
Investigations - pregnancy test, bloods, CT (>65 or unclear diagnosis), USS (eliminate gynaecological cause)
Management - appendicectomy, IV ABx, analgesia

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23
Q

Name a scoring system that can be used in appendicitis

A

Alvardo

Appendicitis Inflammatory Response (AIR)

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24
Q

What anatomical position is the appendix in in most people

A

RIF, end of caecum
Retrocaecal
(Can be pelvic, retroileal, retrocolic)

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25
Q

Define the terms diverticulum, diverticulosis, diverticulitis, diverticular disease

A

Diverticulum - out-pouching of bowel wall composed of mucosa
Diverticulosis - presence of diverticulum
Diverticulitis - inflammation of diverticula
Diverticular disease - symptomatic diverticulum

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26
Q

List risk factors of diverticular disease

A 
Low fibre diet
Obesity
Smoking
FH
NSAID use
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27
Q

List clinical features, investigations and management of diverticular disease

A

CF - colicky LIF pain, relieved by defecation, altered bowel habit, flatulence, (painless) PR bleeding, anorexia, nausea, vomiting
Ix - bloods, G&S, ABG (lactate), urine dipstick, flexi sig. (not itis), AXR, eCXR, CT PA, barium enema
Mx - broad spectrum IV ABx, fluids, bowel rest, stool softener, analgesia, surgery (if perforation, sepsis, failure to improve) –> Hartmann’s/laparascopic peritoneal lavage

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28
Q

List complications of diverticular disease

A

Pericolic/paracolic mass/abscess
Peritonitis
Fistula (colovesical/colovaginal)
Stricture formation

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29
Q

List risk factors for developing colorectal cancer

A 
Age >60
Family history (APC gene --> FAP)
IBD
Low fibre diet
Smoking
Increased alcohol intake
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30
Q

List clinical features of colorectal cancer

A

Rectal - PR bleeding (deep red on stool surface), tenesmus, altered bowel habit
Descending/sigmoid - PR bleeding (dark, mixed with stool, clotted), mucus on PR, bloating, flatulence
Right sided - iron deficiency anaemia, RIF mass

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31
Q

List red flag symptoms of colorectal cancer that would require urgent investigation

A

> 40 with weight loss and abdominal pain
50 with PR bleeding
60 with iron deficiency anaemia/altered bowel habit
+ve faecal occult blood test

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32
Q

List investigations and management of colorectal cancer

A

Ix - FBC (microcytic anaemia), tumour marker CEA (to monitor), colonoscopy with biopsy, CT CAP/MRI rectum/endoanal US (for staging)
Mx - regional colectomy (right/left/sigmoid/anterior resection/abdominoperineal resection), chemotherapy, radiotherapy, palliative

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33
Q

Explain Duke’s staging

A

A - invasion into but not through bowel wall (limited to mucosa)
B - invasion through bowel wall but no lymph involvement
C - lymph involvement
D - distant metastases

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34
Q

Describe different types of bowel resection

A

Right hemicolectomy - caecum, ileocaecal valve, hepatic flexure, splenic (extended)
Left - splenic flexure –> sigmoid
Hartmann’s - emergency, rectosigmoid removal, no anastamosis, rectal stump
Anterior resection - sigmoid –> rectum
Abdominoperitoneal - rectum and anus removed

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35
Q

Describe the pathogenesis of acute pancreatitis

A
  1. Premature and exaggerated activation of digestive enzymes –> inflammation
  2. Increased vascular permeability = ‘third spacing’
  3. Autodigestion of fats and vessels
  4. Necrosis
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36
Q

List causes of acute pancreatitis

A 
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps
Autoimmune (e.g. SLE)
Scorpion venom
Hypercalcaemia
ERCP
Drugs (azathioprine, NSAIDs, diuretics)
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37
Q

Describe clinical features, investigations and management of acute pancreatitis

A

CF - sudden onset, severe epigastric pain, radiates to back, nausea, vomiting, fever, hypotension, tachycardia, tender and rigid abdomen, tetany, jaundice
Ix - bloods (amylase 3x upper limit of normal), LFTs, USS, AXR, contrast CT
Mx - oxygen, fluids, NGT, catheter, opioid analgesia, imipenem, ERCP if necessary

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38
Q

What are Grey-Turner’s and Cullen’s signs?

A

Signs of intraabdominal bleeding
Grey-Turner - flank bruise
Cullen’s - umbilicus bruise

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39
Q

List causes of a high amylase

A 
Pancreatitis
DKA
Ectopic pregnancy
Cholecystitis
Perforated ulcer
Mesenteric ischaemia
40
Q

Name and describe a scoring tool used in acute pancreatitis

A 
Glasgow criteria = severity of acute pancreatitis
PaO2 <8kPa
Age >55
Neutrophils >15 x10^9/L
Calcium <2 mmol/L
Renal urea >16 mmol/L
Enzymes LDH >600 U/L or AST >200 U/L
Albumin <32 g/L
Sugar >10 mmol/L
\+ APACHE II, Ranzen criteria, Balthazar score
41
Q

List complications of acute pancreatitis

A 
DIC
ARDS
Hypocalcaemia
Shock
Multi organ failure
Pancreatic necrosis
Pseudocyst
42
Q

List causes of chronic pancreatitis

A 
Chronic alcohol abuse
Idiopathic
Metabolic (hyperlipidaemia, hypercalcaemia)
Infection (viral, bacterial)
Hereditary (CF)
Autoimmune 
Obstruction (stricture, neoplasm)
Congenital
43
Q

Describe clinical features, investigations and management of chronic pancreatitis

A

CF - chronic epigastric pain, radiates to back, eased by leaning forward, nausea, vomiting, exocrine dysfunction (DM), endocrine dysfunction (steatorrhoea, malabsorption)
Ix - bloods, BM, serum calcium, LFTs, faecal elastase (low), USS, CT PA, MRCP/ERCP
Mx - analgesia, pancreatic enzyme supplements (Creon), ERCP, EUS (pseudocyst drainage), pancreatic sphincterotomy, Whipple’s pancreatectomy

44
Q

List complications of chronic pancreatitis

A 
Pseudocyst
Malabsorption
Diabetes
Effusions (ascites, pleural)
Low vitamin A, D, E, K/clotting 
Malignancy
45
Q

List risk factors of pancreatic cancer

A

Smoking
Recent onset DM
Chronic pancreatitis
Alcoholism

46
Q

Describe clinical features, investigations and management of pancreatic cancer

A

CF head - obstructive jaundice, epigastric/LUQ abdominal pain, radiates to back, hepatomegaly (mets), anorexia, nausea, vomiting, fatigue, malaise, pruritus, acute pancreatitis, thrombophlebitis migrans
CF body/tail - asymptomatic, weight loss, back pain, epigastric mass, diabetes
Ix - bloods (anaemia/thrombocytopenia), LFTs, CA19-9 tumour marker, abdo USS/EUS, CT contrast, ERCP
Mx - radical resection (Whipple’s/panceatectomy) + adjuvant chemo, palliation

47
Q

Explain Courvoisier’s law

A

Jaundice + enlarged/palpable gallbladder = biliary tree or pancreas malignancy

48
Q

List risk factors for gallstone disease

A 
Fat
Female
>Forty
FH
Fertile/OCP
Pregnancy
Haemolytic anaemia
Malabsorption (ileal resection/Crohn's)
49
Q

Differentiate clinical features of biliary colic and acute cholecystitis

A

Biliary colic - acute, dull, colicky RUQ pain, radiates to back/epigastrium, nausea, vomiting, precipitated by fatty foods
Acute cholecystitis - constant, persistent (despite pain relief) pain, raised WCC, fever, tachycardia, tender RUQ, deranged LFTs, +ve Murphy’s sign

50
Q

List investigations and management for gallstone disease

A

Ix - urinalysis, pregnancy test, bloods, LFTs, amylase, USS, MRCP
Mx BC - analgesia, antiemetic, lifestyle advice, elective cholecystectomy
Mx AC - IV ABx (co-amoxiclav + metronidazole), fluid, NGT, NBM, analgesia, antiemetic, laparoscopic cholecystectomy (72h-1 week)

51
Q

List complications of gallstone disease

A

Gallbladder empyema
Chronic cholecystitis
Fistula –> obstruction (Bouveret’s syndrome/Gallstone ileus)
Acute pancreatitis

52
Q

Describe the clinical features, investigations and management of cholangitis

A

CF - Charcot’s triad (RUQ pain, fever, jaundice), itching, pyrexia, RUQ tenderness, rigors, Reynold’s pentad (Charcot’s triad + hypotension + confusion)
Ix - bloods, blood culture, USS, ERCP
Mx - sepsis six if septic, endoscopic biliary decompression, ERCP +/- sphincterotomy, stunting, percutaneous transhepatic cholangiography (PTC), cholecystectomy

53
Q

Describe the pathophysiology, risk factors, clinical features, investigations and management of cholangiocarcinoma

A

Cancer of the biliary system, most common site is bifurcation of R/L hepatic duct (Klatskin tumour), higher incidence in south-east asia
RF - PSC, excessive alcohol intake, UC, diabetes, infective (liver flukes, HIV), toxins (rubber, aircraft), congenital
CF - asymptomatic until late, post hepatic jaundice - pruritus, pale stools, dark urine, cachexia, Courvoisier’s law
Ix - LFTs, tumour markers CEA, CA19-9, USS, MRCP, CT (staging)
Mx - complete surgical resection (Whipple’s/partial hepatectomy), radiotherapy, chemotherapy, ERCP stenting

54
Q

What is a hernia?

A

Protrusion of a whole or part of an organ through the wall of the cavity that contains it into an abnormal position

55
Q

Differentiate between different types of hiatus hernia

A

Sliding - gastrooesophageal junction above diaphragm

Rolling - gastric funds lies alongside normal gastrooesophageal junction

56
Q

List risk factors, clinical features, investigations and management of hiatus hernias

A

RF - age, pregnancy, obesity, ascites
CF - (severe and treatment resistant) GORD, vomiting, weight loss, bleeding +/- anaemia, hiccups/palpitations, swallowing difficulties
Ix - OGD, CT/MRI, contrast swallow
Mx - conservative = PPIs, lifestyle advice, surgical = curoplasty, fundoplication

57
Q

What is Bouchardt’s triad

A

Signs of gastric volvulus:
Severe epigastric pain
Retching with no vomiting
Inability to pass NGT

58
Q

Differentiate between direct and indirect hernias

A

Direct - through weakness of Hesselbach’s triangle, medial to inferior epigastric vessels
Indirect - via deep inguinal ring, incomplete closure of processes vaginalis, lateral to inferior epigastric vessels

59
Q

List risk factors, clinical features and management of inguinal hernias

A

RF - male, age, obesity, increased intraabdominal pressure (chronic cough, heavy lifting, constipation)
CF - groin lump, pain, tender, erythematous
Mx - conservative (if asymptomatic), Lichtenstein mesh open/laparoscopic surgery

60
Q

Describe how you would undertake a hernia examination

A

Offer chaperone
Examine standing, front, side
Look - size, shape, scrotal extension, cough impulse
Feel - scrotal lump (can get above it?), site, size, shape, consistency, contours, colour, tenderness, temperature, transillumination, cough impulse, reducibility
Percuss, auscultate for bowel within lump

61
Q

List risk factors, clinical features and management of femoral hernias

A

RF - female, age, pregnancy, increased intraabdominal pressure
CF - groin lump (inferolateral to PT, medial to femoral pulse), unlikely to be reducible
Mx - surgical (risk of strangulation) reduction and narrowing of femoral ring

62
Q

Define different hernias including epigastric, paraumbilical, spigelian, obturator, littre’s, richter’s incisional

A

Epigastric - midline through fibres of linea alba
Paraumbilical - through linea alba around umbilicus
Spigelian - at semilunar line around level of arcuate line
Obturator - of the pelvic floor at obturator foramen into obturator canal, mass in upper medial thigh
Littre’s - herniation of Meckel’s diverticulum (inguinal canal)
Richter’s - only anti mesenteric border becomes strangulated –> tender, irreducible mass
Incisional - after operation through previously made incision

63
Q

What size is an abdominal aorta aneurysm?

A

Dilation >3cm

64
Q

List risk factors, clinical features and management of an AAA

A

RF - smoking, hyperlipidaemia, male, hypertension, age
CF - abdo/back/loin pain, distal embolisation, pulsatile abdominal mass
Mx <5.5cm - monitor via duplex USS yearly (3.0-4.4cm) or 3 monthly (5.0-5.4cm)
Mx >5.5cm/>1cm per year expansion/symptomatic - open repair/EVAR
*>6 cm - DVLA notification, smoking cessation, anti hypertensive therapy, statin, aspirin, lose weight

65
Q

List clinical features and management of an AAA rupture

A

CF - sudden flank/back pain, hypotension, pulsatile abdominal mass
Mx - high flow O2, IV access, urgent bloods and X-match, vascular unit transfer (open/CT angiogram)

66
Q

Explain the condition aortic dissection and the different types

A

Tear in intimal layer –> blood splits layers apart
Stanford classification A - Debakey types I + II
Stanford classification B - Debakey type III
Debakey type I - ascending aorta –> arch
Debakey type II - ascending aorta
Debakey type III - subclavian artery –> descending aorta –> diaphragm/AA

67
Q

Describe clinical features, investigations, management and complications of aortic dissection

A

CF - tearing/stabbing chest pain, radiates to back, tachycardia, hypotension, murmur (AR), end organ hypo perfusion, paraplegia
Ix - bloods, troponin, coagulation, X-match, ECG, CT angiogram, TOE
Mx Type A = surgical (removal of ascending aorta, graft replacement)
Mx Type B = medical (B-blockers, CCBs) or surgical (EVAR)
*lifelong antihypertensives, surveillance imaging
Complications - aortic rupture, AR, MI (SCAD), cardiac tamponade, stroke/paraplegia

68
Q

What is acute limb ischaemia?

A

Sudden decrease in limb perfusion, threatens limb viability <6 hrs

69
Q

List the clinical features of acute limb ischaemia

A 
Pain
Pallor
Pulselessness
Paraesthesia
Perishingly cold
Paralysis
70
Q

Describe investigations, management and complications of acute limb ischaemia

A

Ix - bloods (serum lactate), thrombophilia screen, G&S, ECG, doppler USS +/- CT angiogram
Mx - high flow O2, IV access, heparin (infusion), surgical (thrombolysis/angioplasty/bypass surgery, embolectomy via Fogarty catheter, fasciotomy, amputation), OT/PT, rehab plan, decrease CVD mortality risk
Complications - death, repurfusion injury (compartment syndrome, hyperkalaemia, rhabdomyolysis/AKI, acidosis

71
Q

Describe different categories of acute limb ischaemia

A

I - viable, no immediate threat, no sensory/motor loss, artery and vein on doppler
IIA - marginally threatened, salvageable if treated promptly, sensory loss in toes, no motor loss, no artery on doppler
IIB - immediately threatened, salvageable if revascularised promptly, sensory loss of more than toes, rest pain, mild/moderate motor loss, no artery on doppler
III - irreversible, permanent damage, profound sensory loss, paralysis, no artery or vein on doppler

72
Q

What is chronic limb ischaemia

A

Peripheral vascular disease, decreased blood flow to limbs

73
Q

Describe the Fontaine classification of chronic limb ischaemia

A

I - asymptomatic
II - intermittent claudication
III - ischaemic rest pain
IV - ulceration +/- gangrene

74
Q

What is critical limb ischaemia?

A

Ischaemic rest pain >2 weeks requiring opiate analgesia
Prescence of ischaemic lesions or gangrene
ABPI <0.5

75
Q

Describe investigations and management of chronic limb ischaemia

A

Ix - Buerger’s test, ABPI, CT angiography, CV risk assessment (BP, glucose, lipids, ECG)
Mx - CV risk modification (lifestyle, statin, anti platelet), supervised exercise, angioplasty +/- stenting, bypass surgery

76
Q

Define ABPI

A 
Ankle brachial pressure index - ratio of blood pressure at the ankle to blood pressure in the upper arm (systolic ankle/systolic arm):
Normal - >0.9
Mild - 0.8-0.9
Moderate - 0.5-0.8
Severe <0.5
*>1.2 = calcification
77
Q

What are varicose veins?

A

Tortuous, dilated segments of vein with incompetent valves –> venous hypertension, dilatation

78
Q

List risk factors, clinical features, management and complications of varicose veins

A

RF - prolonged standing, obesity, FH, pregnancy
CF - cosmetic issues (visible veins, skin discolouration), pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, bleeding, venous insufficiency (haemosiderin deposits, lipdermatosclerosis, atrophie blanche, saphena varix)
Mx - patient education/lifestyle advice, compression sticking, four layer banding, vein ligation, stripping, avulsion, foam sclerotherapy, thermal ablation
Complications - haemorrhage, thrombophlebitis, recurrence, DVT, nerve damage

79
Q

Describe the CEAP classification for venous insufficiency

A 
C0 - no signs
C1 - telangiectasia/reticular veins
C2 - varicose veins
C3 - oedema
C4a - pigmentation/eczema
C4b - lipodermatosclerosis/atrophie blanche
C5 - healed venous ulcer
C6 - active venous ulver
80
Q

Describe how you would undertake a varicose veins examination

A

Look (front/back) - colour changes, ankle swelling, venous insufficiency (haemosiderin deposits, eczema, lipodermatosclerois, venous ulcers, atrophie blanche, varicose vein distribution, colour, prominence
Feel - tenderness, hardness (phlebitis), saphenofemoral junction, cough impulse, rate of venous emptying, tourniquet test, calf tenderness (DVT)
Percuss (for incompetency) and auscultate (for turbulent flow)
Pitting oedema, JVP, arterial pulses

81
Q

What is the purpose of a pre-operative assessment?

A

Identify comorbidities (2-4 weeks before surgery) that may lead to anaesthetic/surgical/post-op complications

82
Q

List questions to ask in a pre-operative assessment

A

History - HPC, confirm procedure, R/L side, PMH (CVS, resp, renal, endocrine), pregnancy, sickle cell anaemia, PSH, PAH (PONV), DH (allergies), FH (malignant hyperthermia), SH (smoking, alcohol, exercise tolerance)

83
Q

List some airway observations

A

Mouth opening - inter incisor distance >3cm
Teeth/dentures
Oropharynx (Mallampati classification I-IV)
Neck - thyromental distance >6.5cm

84
Q

Describe the different ASA Grades

A

ASA I - normal, healthy
ASA II - mild systemic disease, smoker, pregnant, obese
ASA III - severe systemic disease, functional limitation e.g. COPD, pacemaker, ESRD with dialysis
ASA IV - severe systemic disease, constant threat to life, recent (<3 months) MI/CVA, sepsis, ESRD without dialysis
ASA V - moribund, not expected to survive without surgery, ruptured AAA, massive trauma, ischaemic bowel
ASA VI - declared brain dead, organs being removed for donor purposes
*E = emergency operation

85
Q

List investigations necessary pre-operatively

A

Bloods - FBC, U&E, LFT, clotting screen, G&S, X-match
Imaging - ECG, CXR
Others - pregnancy test, sickle cell test, MRSA swabs, urinalysis
Routine HbA1c if diabetic

86
Q

What advice should a patient be given pre-operatively about food and drink

A

No food - 6h

No clear fluids - 2h

87
Q

What drugs should a patient be told to stop/alter/start

A

Stop - clopidogrel (7 days), hypoglycaemics, OCP/HRT (4 weeks), warfarin (5 days)
Alter - insulin, steroids
Start - LMWH, AES, ABx prophylaxis

88
Q

What are the indications for fluid?

A

Resuscitation
Replacement
Maintenance

89
Q

What are the daily requirements for water, sodium, potassium and glucose?

A

Water - 25-35ml/kg/day
Na/K+ - 1 mmol/kg/day
Glucose - 50g/day

90
Q

Describe the WHO analgesia ladder

A

Strong opioid e.g. morphine
Weak opioid e.g. codeine
Non-opioid e.g. paracetamol, NSAIDs

91
Q

List side effects of NSAIDs

A 
IGRAB:
Interactions (e.g. warfarin)
Gastric ulceration
Renal impairment
Asthma sensitivity
Bleeding risk
92
Q

List side effects of opiates

A 
Constipation
Nausea
Sedation/confusion
Respiratory depression
Tolerance/dependence
93
Q

List risk factors for PONV

A

Patient - female, previous PONV/motion sickness, non smoker
Surgical - laparascopic, intracranial/middle ear, squint, gynaecological (ovarian), long duration
Anaesthetic - opiate analgesia, inhalationen agent, long duration, spinal, dehydration/bleeding, bag-mask overuse

94
Q

Name different antiemetics and their method of action

A

5HT3 antagonist - ondansetron, metoclopramide
Dopamine antagonist - domperidone, prochlorperazine, metoclopramide
Histamine antagonist - cyclizine
Anticholinergic - hyoscine

95
Q

Describe likely causes for post operative pyrexia and how you would investigate

A 
Day 1-2 - respiratory (wind)
Day 3-5 - urinary (water)
Day 4-6 - VTE (walk)
Day 5-7 - surgical site/abscess (wound) 
Iatrogenic - drug induced 
Unknown - vasculitis, lymphoma

Investigations - septic screen, bloods, urine dip, culture, CXR, sputum

96
Q

Describe management of different infections

A

LRTI - co-amox 625mg PO TDS 5/7
L urinary - trimethoprim 200mg PO BD 3/7 OR nitrofurantoin 100mg PO BD 3/7
U urinary - co-amox 625mg PO TDS 14/7
Surgical site - flucloxacilin 500 mg QDS 5/7
IV/central line - flucloxacillin 500mg QDS 5/7
Intraabdominal - cefuroxime 1.5g TDS + metronidazole 500 mg IV TDS
Septic arthritis - flucloxacillin 2gIV QDS
Unknown source - cefuroxime 1.5g IV TDS + metronidazole 500mg IV TDS + gentamicin 5mg/kg STAT

97
Q

Describe classification and management of haemorrhage

A

I - <15% loss, <750mls, <100 HR, normal BP, 14-20 RR, UO >30 ml/hr, normal mental state
II - 15-30% blood loss, 750-1500mls, 100-120 HR, normal BP, 20-30 RR, UO 20-30 ml/hr, mild anxiety
III - 30-40% loss, 1500-2000mls, 120-140 HR, low BP, 30-40 RR, UO 5-15ml/hr, anxious and confused
IV - >40% blood loss, >2000mls, >140 HR, very low BP, >35 RR, UO negligible, lethargic or unconscious
Mamangement - A-E, >18G cannula, direct pressure, senior review, urgent blood transfusion

Phase 2 (11 decks)

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