Perioperative Care

Question 1

Indication to Delay Surgery

MI

Answer 1

3-6 months

Question 2

1) pre OP stop aspirin
2) warfarin last dose pre op

abdominal hysterectomy name 2 drugs

HRT surgery delay time

Answer 2

!) Aspirin stopped 5 days before surgery

2) Warfarin stopped 5 days before surgery
3) Blood thinners stopped Warfarin, Enalapril
4) 4 weeks

Question 3

Parkland Formula

Answer 3

4 × 100 × percentage burn

Question 4

Disease highest pre OP risk

Answer 4

Type 1 diabetes

Question 5

Regular oral medication pre op

2. Timing for the last dose of a PPI/H2 antagonists / prokinetics before anaesthesia for patients at risk of regurgitation?

Answer 5

30 min

2. last PPI dose before surgery = 1hr 30min

Question 6

SUBJECT: Preparation for Surgery

Mr Firenzi is 55 year old man about to go in for surgery. His PMH includes porphyria and GORD. You are the 4th year medical student with the anaesthetist. During the surgery he is given suxamethonium.

1) Can Mr Firenzi have a snack 10 min before the operation?
2) Minimum starvation time before surgery?
2) What is the best way of putting a patient with GORD to sleep?
3) Name a post op complication of using suxamethonium

Answer 6

1. NO
2. starvation time before surgery= 6 hrs
3. GORD to sleep = Rapid Sequence Induction
4. Suxamethonium apnoea

Question 7

SUBJECT: Immediate post surgery complication

Mr Firenzi is 55 year old man has just finished surgery. You are the 4th year medical student with the anaesthetist. After the surgery the aneasthetist notices that Mr Firenzi’s temperature is 40, his muscles are rigid and he is tachycardic.

1) What could be causing these immediate post op symptoms of high temp, muscle rigidity and tachycardia?

Answer 7

1) immediate post op symptoms of high temp, muscle rigidity and tachycardia (malignant hyperthermia = reaction to anaesthetic agents

Question 8

SUBJECT: Preparation for Surgery
Title: ASA

What ASA grade am I?

1. Normal healthy patient
2. A patient with mild systemic disease
3. A patient with severe systemic disease
4. A declared brain-dead patient

Answer 8

ASA grade 1 = Normal healthy patient
ASA grade 2 = Mild systemic disease
ASA grade 3 = Severe systemic disease
ASA grade 6 = declared brain-dead patient

Question 9

Blank - Rest

Answer 9

Blank - Rest

Question 10

Blank - Rest

Answer 10

Blank - Rest

Question 11

Blank - Rest

Answer 11

Blank - Rest

Question 12

Preparation for Surgery

Answer 12

30 min

Question 13

Preparation for Surgery

Answer 13

90 min

Question 14

Preparation for Surgery VTE Risk

Virchow (1856) identified three factors as contributing to the formation of venous thrombi

Answer 14

Venous stasis
Hypercoagulability
Vessel wall injury

Question 15

The thrombus is composed of red cells, fibrin and platelets and is liable to embolize and cause pulmonary embolism (PE).

Which of the following are possible consequences of PE?

Right Ventricular Failure
Left Ventricular Failure

Answer 15

Right Ventricular Failure

Question 16

Post Surgery

All surgical inpatients should be offered ________ unless contraindicated, e.g. peripheral arterial disease

Answer 16

graduated compression anti-embolism stockings (thigh length or knee length)

Question 17

Preparation for Surgery

patients at increased risk of VTE and those having orthopaedic surgery should be offered

Answer 17

LMWH - enoxaparin

Question 18

Preparation for Surgery

Risk factors for venous thromboembolism include:

Select one or more options from the list below.

Possible answers:
A.	BMI of >25 kg/m2	
B.	Cancer	
C.	Age <40 years 	 
D.	Nephrotic syndrome 	
E.	Crohn’s disease

Answer 18

Cancer
Nephrotic Syndrome
Crohns

Question 19

Needlestick Injury

Which types of Hepatitis can be transmitted through blood

Answer 19

Hepatitis B

Hepatitis C

Question 20

SURGERY
Many patients undergoing major surgery have post-operative analgesia provided by a continued use of a regional technique. For abdominal, thoracic or lower limb surgery what type of pain management de

Answer 20

epidural catheter

Question 21

SURGERY
If adequate analgesia is not achieved within ___ minutes the epidural has failed
Complete the sentence

Answer 21

30 min

Question 22

DURING SURGERY
It is essential to monitor the patient’s blood pressure every ___ min for at least 20 min, treating hypotension with vasopressors.

Answer 22

5

Question 23

PONV

1st line anti-emetic post op to treat PONV

Answer 23

Ondansetron 4mg IV

Question 24

TITLE

A 78-year-old man is due to have an anterior resection for colorectal carcinoma. He is currently on clopidogrel. He has been on clopidogrel for the past 6 months due to the insertion of a drug eluting stent during primary percutaneous coronary intervention for a STEMI.

When should you advise him to stop taking his clopidogrel?

Answer 24

1 week before

Question 25

Perioperative History

1) Name of score to assess airway

Answer 25

1) Airway score - Mallampati
Peri Op Modifications

Igx Findings
Risk Assessment

Theatre Prep
Periop Patient Safety Features
ABCD Mgx
Physiological Monitoring and Intervention

Post Op Course
Pain Mgx
PACU
Future Mgx