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MRCS Part A (KF edition) > Peri-Operative management > Flashcards

Peri-Operative management Flashcards

1
Q

What are the definitions of the ASA scoring system?

A

ASA 1: no organic, physiological, biochemical or psychiatric disturbance. Surgical pathology is localised

ASA 2: Mild/Mod systemic disruption caused by the surgical disease or pre-existing disease

ASA 3: Severe systemic disruption caused by surgical pathology or pre-existing disease

ASA 4: Severe systemic disease that is a constant threat to life

ASA 5: moribund and will not survive without surgery

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2
Q

What medication should be administered to a patient who is due to have surgery for a pheochromocytoma?

A

Alpha and beta blockers

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3
Q

What is the risk of over using normal saline as a resuscitation fluid?

A

Hypercholeraemic metabolic acidosis

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4
Q

What is a complication of central lines?

A

Pneumothorax

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5
Q

What is atropine?

A

Muscarinic antagonist

Inhibits parasympathetic activity

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6
Q

What are the effects of Lidocaine/Lignocaine?

A
  • Local anaesthetic
  • Less commonly used a anti arrhythmic drug

Affects Na channels in the axons of nerves

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7
Q

What are the features of toxicity of Lidocaine/Lignocaine?

A

CNS overactivity first
CNS depression later

Lidocaine initially blocks inhibitory pathways but then begins to also block activating pathways causing cardiac arrhythmias

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8
Q

How can higher doses of lidocaine/ligocaine be used?

A

Administer with adrenaline to limit systemic absorption

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9
Q

What is an alternative agent to lidocaine if a patient has an allergy to lidocaine?

A

Bupivacaine

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10
Q

What aesthetic agent is used in intravenous regional anaesthesia (e.g. Biers block)?

A

Prilocaine

It is a lot less cardiotoxic

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11
Q

What is the max dose of lidocaine with and without adrenaline?

A

Plain: 3mg/kg

With adrenaline: 7mg/kg

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12
Q

In which scenarios should you never use adrenaline with the LA?

A

Finger related surgeries
Circumcision

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13
Q

In which clinical situations is Bupivicaine used?

A
  • Allergy to lidocaine
  • Flail chest
  • Spinal access surgery
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14
Q

Which anaesthetic agent is normally used to rapidly sedate an UNSTABLE patient?

A

Ketamine

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15
Q

What is the most commonly used anaesthetic agent in everyday theatre, ITU and electives?

A

Propofol

  • has anti-emetic effedcts
  • Rapid onset
  • Pain on injection
  • causes myocardial depression
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16
Q

What is a side effect of using ketamine for sedation?

A

Dissociative anaesthesia (nightmares while under)

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17
Q

What is the most commonly used muscle relaxant used in theatre and how does it work?

A

Suxamethonium

  • Inhibits ACH and depolarises
  • Rapid onset leading to paralysis
  • SE of Hyperkalaemia and Malignant Hyperthermia
18
Q

What is malignant hyperthermia characterised by and how is it managed?

A
  • Hyperpyrexia
  • Muscle rigidity

Managed by Dantrolene (prevents Ca2+ release from the sarcoplasmic reticulum from skeletal muscle)

19
Q

When is the use of tourniquet in surgery contraindicated?

A
  • AV fistula
  • Severe PVD
  • Prev vascular surgery
20
Q

What tourniquet pressures are used on the upper and lower limbs?

A

Upper limb: SBP 250

Lower limb: SBP 350

21
Q

If a patient receives a blood transfusion, they can still be a blood donor?

A

No

22
Q

If young child who is fit and healthy is being prepared for an elective tonsillectomy, will they need any pre-operative tests and if so, which ones?

A

No tests required

The patient is ASA 1 and is being admitted for minor/moderate surgery as per NICE guidelines

23
Q

What is the criteria for brain death testing?

A
  • Deep coma of known aetiology
  • Reversible causes excluded
  • No sedation
  • Normal electrolytes
24
Q

What would be the recommended analgesia to use for a patient post thoracotomy/lobectomy?

A

Epidural analgesia

25
Q

What type of block is given for a episiotomy?

A

Pudendal block

26
Q

What type of block is done for a haemorhoidectomy?

A

Caudal block

27
Q

What is the first line analgesia used in advanced pancreatic cancer?

A

NSAIDs

28
Q

How is pain controlled in patients with flail chest?

A

Bupivicaine infiltration + O2

29
Q

What is the first line medication for neuropathic pain?

A
  • Amitriptylline (SE of hypotension)
  • Pregabalin if pt hypotensive/orthostatic hypotension
30
Q

What is the first line medication for diabetic neuropathy?

A

Duloxetine

31
Q

What is the definition of massive haemorrhage?

A
  • 50% blood loss in 3hrs
  • Blood loss of 150ml/min
32
Q

What are biochemical side effects of massive blood transfusions?

A
  • Hypocalcaemia
  • Hyperkalaemia
33
Q

What is the name of the screen tool for malnutrition?

A

MUST

34
Q

What are the criteria for diagnosis of malnutrition?

A
  • BMI <18.5
  • Unintentional wt loss >10% over 3-6 months
  • BMI <20 AND unintentional weight loss >5% over 3-6 months
35
Q

What are the metabolic consequences of referring syndrome?

A
  • Hypophosphataemia
  • Hypokalaemia
  • Hypomagnesaemia
  • Abnormal fluid balance
36
Q

What nerve is at risk of injury during an axillary node clearance?

A

Long thoracic nerve

37
Q

What nerve is at risk of injury during a carotid endarterectomy?

A

Hypoglossal nerve

38
Q

What structure can most commonly be damaged during colonic resections?

A

Ureter

39
Q

Why are beta blockers not stopped acutely prior to surgery?

A

May cause rebound effect causing more intra-operative complications

40
Q

What dye can be used to identify the parathyroid gland intra-operatively?

A

Methylene blue dye IV

Stains parathyroid glands

41
Q

When should clopidogrel be stopped pre-operatively?

A

5-7 days prior

MRCS Part A (KF edition) (18 decks)

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