Perioperative care of the surgical patient Flashcards
If we find a mass on a patient which of the following is NOT something we need to include when describing it?
1 - site
2 - size
3 - surface
4 - striation
5 - shape
4 - striation
When we generally look at a patient, there are 5 things we should always include based on what Mr Basu said. Which of the following is NOT one of these 5 things that we initially look at?
1 - anaemia
2 - masses
3 - jaundice
4 - cyanosis
5 - clubbing
6 - koilonychia
2 - masses
- this is Mr Basus 1st rule of 5s
What is koilonychia?
1 - nails that scoop upwards and appear depressed
2 - blood spots appear on nails
3 - nails that turn white
4 - nails appear fungal
1 - nails that scoop upwards
Koilonychia is when the nails scoop upwards and appear depressed. The following are commonly associated with Koilonychia, Which is the most common?
1 - iron deficiency anaemia
2 - liver disease (hemochromatosis)
3 - caeliac disease
4 - cancer
1 - iron deficiency anemia
- cant absorb enough or dont eat enough
When assessing a patients airway we use the mnemonic LEMON. What does the L stand for?
1 - Look
2 - Listen
3 - Ligate
4 - Leave
1 - Look
When assessing a patients airway we use the mnemonic LEMON. What does the E stand for?
1 - Eat
2 - Examination
3 - Elevate
4 - End tube
2 - Examination
When assessing a patients airway we use the mnemonic LEMON. What does the M stand for?
1 - Massage
2 - Masticate
3 - Mallampati (visualise the oropharynx)
4 - Modify
3 - Mallampati (visualise the oropharynx)
- Mallampati classification is a simple scoring system that relates the amount of mouth opening to the size of the tongue and provides an estimate of space available for oral intubation by direct laryngoscopy.
When assessing a patients airway we use the mnemonic LEMON. What does the O stand for?
1 - Open
2 - Obtuse
3 - Obstruction
3 - Obstruction
When assessing a patients airway we use the mnemonic LEMON. What does the N stand for?
1 - Neck movements
2 - Nill by mouth
3 - Nasal sounds
1 - Neck movements
When investigating a patient, which of the following would NOT routinely require a blood clotting screen?
1 - hypertensive patient
2 - bleeding disorder history/family history
3 - history of liver disease
4 - eclampsia(severe and dangerous rise in BP)
5 - taking antithrombotic or anticoagulant medication
1 - hypertensive patient
In a woman of child bearing age, what must we always test for in our investigations?
1 - CT scan
2 - pregnancy test
3 - blood clotting screen
4 - BMI
2 - pregnancy test
If a patient presents and has known valvular heart disease and/or left ventricle dysfunction, what imaging must they have?
1 - ultrasound
2 -ultrasound with doppler
3 - chest X-ray
4 - echocardiogram
4 - echocardiogram
If a patient is to have surgery, what must the blood pressure on the day of surgery be below?
1 - 120/80
2 - 150/100
3 - 180/110
4 - 100/70
3 - 180/110
- new hypertensive regimes must be stable for at least 2 weeks
Which of the following medications should be stopped 2-3 days prior to surgery?
1 - Direct oral anticoagulants
2 - Warfarin
3 - B blockers
4 - ACE and ACE receptor inhibitors
1 - Direct oral anticoagulants
Which of the following medications are safe to continue to take throughout the perioperative period?
1 - Direct oral anticoagulants
2 - Warfarin
3 - B blockers
4 - ACE and ACE receptor inhibitors
3 - B blockers
Which of the following medications must be stopped 24 hours prior to surgery?
1 - Direct oral anticoagulants
2 - Warfarin
3 - B blockers
4 - ACE and ACE receptor inhibitors
4 - ACE and ACE receptor inhibitors
- anaesthetic drug interactions causing hypotension
Which of the following medications must be stopped 5 days prior to surgery?
1 - Direct oral anticoagulants
2 - Warfarin
3 - B blockers
4 - ACE and ACE receptor inhibitors
2 - Warfarin
- risk of bleeding
- patient needs an INR <1.5 (normal is 1.1)
CHA2DS2-VASc stands for congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female). The CHA2DS2-VASc score can be used to asses a patients need for anti-coagulation medication. What cut off score indicates a patient needs anti-coagulation medication?
1 - >0
2 - >1
3 - >2
3 - >5
3 - >2
Which of the following scoring tools is used to assess a patients risk of sleep apnoea, which is linked with poor outcomes in surgery?
1 - CHA2DS2-VASc score
2 - CURB score
3 - STOP BANG score
4 - VTE score
3 - STOP BANG score
Which scoring system is used to assess a patients frailty?
1 - CHA2DS2-VASc score
2 - CURB score
3 - STOP BANG score
4 - Rockwood score
4 - Rockwood score
What is the normal Na+ levels in blood?
1 - 0.135 - 0.145 mmol/L)
2 - 1.35 - 1.45 mmol/L)
3 - 13.5 - 14.5 mmol/L)
4 - 135 - 145 mmol/L)
4 - 135 - 145 mmol/L)
- need 1-2mmol/kg/day
What is the normal K+ levels in blood?
1 - 0.35 - 0.45 mmol/L)
2 - 3.5 - 5.5 mmol/L)
3 - 35 - 45 mmol/L)
4 - 135 - 145 mmol/L)
2 - 3.5 - 5.5 mmol/L)
- need 1mmol/kg/day
What is the normal Cl- levels in blood?
1 - 0.98 - 0.108 mmol/L)
2 - 9.8 - 10.8 mmol/L)
3 - 98 - 108 mmol/L)
4 - 135 - 145 mmol/L)
3 - 98 - 108 mmol/L)
What is the normal HCO3- levels in blood?
1 - 0.22 - 0.30 mmol/L)
2 - 2.2 - 3.0 mmol/L)
3 - 22 - 30 mmol/L)
4 - 135 - 145 mmol/L)
3 - 22 - 30 mmol/L)
What is the normal plasma osmolality of blood?
1 - 0.275 - 0.145
2 - 27.5 - 14.5
3 - 275 - 145
4 - 275 - 295
4 - 275 - 295
Formula:
= 2Na+ add 2K+ add glucose add urea
How much fluid to we need to take in per day?
1 - 0.4ml/kg/day
2 - 4ml/kg/day
3 - 40ml/kg/day
4 - 400ml/kg/day
3 - 40ml/kg/day
For me it would be 40x82 = 3360ml or 3.36L
- maintenance fluids are typically 23-30
When prescribing a patient fluids, which of the following has the highest Na+ and Cl- content and osmolality?
1 - water
2 - 0.9% saline
3 - Hartmanns solution
4 - 5% glucose
2 - 0.9% saline
When prescribing a patient fluids, which of the following has the highest lactate and Ca2+?
1 - water
2 - 0.9% saline
3 - Hartmanns solution
4 - 5% glucose
3 - Hartmanns solution
When prescribing a patient fluids, which of the following has the highest glucose?
1 - water
2 - 0.9% saline
3 - Hartmanns solution
4 - 5% glucose
4 - 5% glucose
It is important to be aware that a rise in creatinine can be due acute kidney injury (AKI) and a decline in kidney function. What cut offs are used for creatinine to determine if a patient is at risk of AKI?
1 - ≥2.5umol or 1 fold increase from baseline
2 - ≥25umol or 1 fold increase from baseline
3 - ≥25umol or 1.5 fold increase from baseline
4 - ≥250umol or 1.5 fold increase from baseline
3 - ≥25umol or 1.5 fold increase from baseline
What is the definition of oliguria (low urine output)?
1 - <0.5ml/kg/hr
2 - <5ml/kg/hr
3 - <50ml/kg/hr
4 - <500ml/kg/hr
1 - <0.5ml/kg/hr
- anuria is the absence of urine output, generally due to kidney failure
According to the WHO analgesic ladder, which of the following drugs would be used on the first step of the ladder?
1 - paracetamol, Naproxen, Ibuprofen, Diclofenac, Aspirin
2 - paracetamol only
3 - NSAIDs: Naproxen, Ibuprofen, Diclofenac* Aspirin
4 - Codeine
1 - paracetamol, Naproxen, Ibuprofen, Diclofenac, Aspirin
- NSAIDs = Naproxen, Ibuprofen, Diclofenac, Aspirin
According to the WHO analgesic ladder, which of the following drugs would be used on the second step of the ladder?
1 - paracetamol, Naproxen, Ibuprofen, Diclofenac, Aspirin
2 - codeine phosphate, Tramadol
3 - NSAIDs: Naproxen, Ibuprofen, Diclofenac. Aspirin
4 - Morphine sulphate, Oxycodone, Methadone
2 - codeine phosphate, Tramadol
- essentially mild opioids
According to the WHO analgesic ladder, which of the following drugs would be used on the third step of the ladder?
1 - paracetamol, Naproxen, Ibuprofen, Diclofenac, Aspirin
2 - codeine phosphate, Tramadol
3 - NSAIDs: Naproxen, Ibuprofen, Diclofenac. Aspirin
4 - Morphine sulphate, Oxycodone, Methadone
4 - Morphine sulphate, Oxycodone, Methadone
- essentially strong opioids
Lidocaine is a local anaesthetic (means only a small part of the body is treated and patient is generally awake) medication that is used to block pain sensations in a wide variety of superficial and invasive procedures. Lidocaine is able to inhibit action potentials, therefore reducing the sensation of pain in the CNS. What is the mechanism of action of Lidocaine?
1 - enters cell, ionised, binds with K+ channels and keeps them closed
2 - enters cell, ionised, binds with Ca2+ channels and keeps them closed
3 - enters cell, ionised, binds with Na+ channels and keeps them closed
4 - enters cell, ionised, binds with Po+4 channels and keeps them closed
3 - enters cell, ionised, binds with Na+ channels and keeps them closed
- passes into cells
- low pH in cell ionises lidocaine so it cannot leave the cell
- ionised lidocaine binds and closed Na+ channels
- no action potential are possible
Propofol is a general anaesthetic (means the whole body is treated and patient is generally unconscious) medication that is used to block pain sensations in a wide variety of procedures. What is the mechanism of action of propofol?
1 - binds NMDA receptors acting as glutamate agonist
2 - binds GABA receptors and inhibits GABA action
3 - binds GABA receptors acting as GABA agonist
4 - binds NMDA receptors acting as glutamate antagonist
3 - binds GABA receptors acting as GABA agonist
- bind with GABA-A receptors and acting as agonist
- essentially allows lots of Cl- into cells and stops depolarisation
Halogenated ethers is an inhaled aesthetic used clinically. What is the mechanism of action of this anapaestic drug?
1 - binds NMDA receptors acting as glutamate agonist
2 - binds GABA receptors and inhibits GABA action
3 - binds GABA receptors acting as GABA agonist and binds NMDA receptors acting as glutamate antagonist
4 - binds NMDA receptors acting as glutamate antagonist
3 - binds GABA receptors acting as GABA agonist and binds NMDA receptors acting as glutamate antagonist
What is patient controlled analgesics?
1 - drugs prescribed to a patient including recreational
2 - drugs prescribed to a patient
3 - drugs administered on the patients behalf
4 - drug controlled by patient when needed, delivered as a bolus
4 - drug controlled by patient when needed, delivered as a bolus
- essentially tells the patient when the next bolus can be taken
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. When does the Ebb phase begin?
1 - 12-48 hours
2 - 3-7 days
3 - weeks
4 - months
1 - 12-48 hours
- important phase for body to maintain and conserve fluid and energy stores for recovery and repair
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. The Ebb phase, generally occurring in the first 12-48 hours. Which of the following generally does NOT cause this?
1 - Hypovolemia
2 - Decreased basal metabolic rate
3 - Reduced cardiac output
4 - Hypothermia
5 - Hypertension
6 - Lactic acidosis
5 - Hypertension
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. Typically when does flow phase begin?
1 - 12-48 hours
2 - 3-7 days
3 - weeks
4 - months
2 - 3-7 days
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. Is the Ebb or Flow phase more catabolic?
- flow phase
- catabolic is the breakdown of tissue for energy, like in starvation
- important for body to mobilise energy from stores
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. Is the Ebb or Flow phase more catabolic?
- flow phase
- catabolic is the breakdown of tissue for energy, like in starvation
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. In the Ebb and Flow phase there are a number of hormones and cytokines involved. Which of the following hormones is NOT generally involved in the Ebb phase?
1 - catecholamines
2 - glucagon
3 - cortisol
4 - aldosterone
2 - glucagon
The body has a myriad of responses to stress. One of these is the bodies metabolic response to injury, which has been described as the Ebb and Flow model. In the Ebb and Flow phase there are a number of hormones and cytokines involved. Which of the following hormones is NOT generally involved in the Flow phase?
1 - catecholamines
2 - glucagon
3 - cortisol
4 - insulin
5 - aldosterone
5 - aldosterone
