Post Operative Flashcards
1
Q
What kind of electrolyte disturbance occurs when accessive amount of sodium chloride is replaced
A
Hyperchloraemic acidosis that’s why R/L is preferred
2
Q
Which type of fluid can cause acute renal injury
A
Dextran 70
3
Q
Cryo precipitate is trans fused how
A
As 6 unit pool
4
Q
Constituents of cryoprecipetate
A
Factor VIII
Fibrinogen
von Willebrand factor
Factor XIII
5
Q
Suxamethonium may cause
A
Malignant hyperthermia
Hyperkalemia
Muscular pain
Prolonged apnea
6
Q
Names of depolarizing and nondpolarizing muscular relaxence
A
D: Suxamethonium
Non D: Atracurium,Vecuronium, Pancuronium and Rocurunium
7
Q
Quickest onset muscular relaxant
A
Suxamethonium
8
Q
Suxamethonium can be used in
A
Rapidl intubation
Short procedures
9
Q
Atracurium vs Vecuronium
A
A is not cleared by liver or kidney
V does
10
Q
Atracurium Side effects
A
Histamine release and allergic reactions
11
Q
Which non depolarising drug used for rapid intubation
A
Rocurunium as it’s reversedby suggamedex which is widely available
12
Q
Which drug reverses effect of nondepolarusing drug effects
A
Neostgmine
13
Q
ward based analgesianot working then whatto do for metastatic disease of spine
A
Radiotherapy for lumbar spine
14
Q
Side effects of spinal anaesthesia include:
A
hypotension, sensory and motor block, nausea and urinary retention.
15
Q
preferred option analgesic post op major surgeries
A
Epidural
16
Q
preferred technique analgesia when extensive laparoscopic abdominal procedures are performed
A
Transversus Abdominal Plane block (TAP)
17
Q
Clearance of morphin versusPethidine
A
M bby liver
P by kidney
18
Q
Rx of neuropathic pain
A
First line: Amitriptyline (Imipramine if cannot tolerate) or pregabalin
Second line: Amitriptyline AND pregabalin
Third line: refer to pain specialist. Give tramadol in the interim (avoid morphine)
19
Q
Clopidogrel should be stopped before surgery around
A
stopped around 5-7 days prior to surgery
20
Q
Dose of Clopidogrel
A
75mg
21
Q
Clopidogrel MOA
A
decreases ADP induced platelet aggregation persisting for 120 hours after the final dose
22
Q
Which anaesthetic has strongest antiemetic properties
A
Propofol
23
Q
muscle relaxants is an agent that is degraded by hydrolysis and may produce histamine release?
A
Atracurium
24
Q
Which muscle relaxants is least likely to result in histamine release?
A
Vecuronium and suxamethonium
25
Which inotrope can be guven via the peripheral intra venous route in the non cardiac arrest setting?
Metaraminol is an alpha receptor agonist
26
A patient with locally advanced pancreatic cancer has persistent back pain
Rx
Pancreatic cancer can cause severe pain as a result of retroperitoneal nerve infiltration. It can be managed with chemical neurectomy/ nerve blocks.
Improve
27
Wh8ch anaesthetic agents has the strongest analgesic effect?
Ketamine
28
agent of choice for rapid sequence of induction
Sodium thiopentone
29
Side effects of neostigmine
Bradycardia thus atropine is given simultaneously
30
First line management of neuropathic pain in patients with orthostatic hypotension
pregabalin not amitriptylline as ami has a side effect of Ietho hypo
31
If diabetic neuropathic pain
Duloxetine
32
Orchidopexy
Pain relief through
Caudal block
33
Immediate pain reliefost hemmoidectomy
Caudal block
34
Which anesthetic is hepatotoxic
Halothane
35
adrenocortical depression by which anesthetic agent
Etomidate
36
Which anesthetic is used in neurosurgical procedures
Sodium thiopentone
37
agent of choice for rapid sequence of induction
Sodium thiopentone
38
Marked myocardial depression may occur by which anesthetic agent
Sodium thiopentone
39
dissociative anaesthesia resulting in nightmares caused by
Ketamine
40
Why we should avoid excessive IV fluid during surgery
Can cause ileus
41
carbohydrate loading drink in enhanced recovery program should be given
carbohydrate loading drink is given 2 hours pre procedure.
42
first line investigation vs gold standard for PE
CTPA 1st line
Gold standard is pulmonary angiography
43
Which artery can be missed by CTpa
peripheral emboli affecting subsegmental arteries may be missed
44
ARDS
bilateral pulmonary infiltrates
severe hypoxemia (PaO2/FiO2 ratio < 200) in the absence of evidence for cardiogenic pulmonary oedema
Capillary wedge pressure <18
45
Stages of ARDS
Early stages consist of an exudative phase of injury with associated oedema.
Later stage is one of repair and consists of fibroproliferative changes. Subsequent scarring may result in poor lung function
46
Causes of ARDS include
Sepsis
Direct lung injury
Trauma
Acute pancreatitis
Long bone fracture or multiple fractures (through fat embolism)
Head injury (causes sympathetic nervous stimulation which leads to acute pulmonary hypertension)
47
only treatment found to improve survival rates in ARDS
Low tidal volume ventilation
48
Rx of ARDS
Treat cause Like give
Ab if sepsis
Diuretics to get rid of fluids
PEEP, prone ventilation
Low tidal volume ventilation
49
Pulmonary artery occlusion pressure in ARDS vs pulmonary edema 2° overload
ARDS: Low pressure <5 with edema
Overload: High pressure >18mmHg
50
Cutfed vs uncuffed ETT
Cuffed prevents air Leaks thus needs to be given where chances of regurg are high
Uncuffed in children to prevent tracheal injury
51
which airway device can and cannot be used for high pressure ventilation
ETT can
Laryngeal mask cannot
52
Rx of malignant hyperthermia
Dantrolene - prevents Ca2+ release from the sarcoplasmic reticulum
53
malignant hyperthermia is caused by defect in
Chromosome 19. encoding ryanodine receptor
54
Acute dystonic reaction is causedby
antipsychotics (haloperidol) and metoclopramide.
55
marked extrapyramidal effects can be caused by
antipsychotics (haloperidol) and metoclopramide
56
Serotonin syndrome symptoms
syndrome of agitation, tachycardia, hallucinations and hyper-reflexia.
57
Benzodiazepines affect on Post operative cognitive impairment
Use of benzodiazepines preoperatively reduces long-term POCD (9.9% vs. 5%)
58
Drug for post opt cognitive dysfunction
Haloperidol
59
Complication of TPN
sepsis, re-feeding syndromes and hepatic dysfunction.
60
Till how much BP surgeries can be performed
There is no evidence to support cancellation when blood pressure is below 180/110 mmHg.
61
most frequent clinical indications for TPN
•Undergone massive resection of the small intestine
•Who have intestinal fistula
•Who have prolonged intestinal failure for other reasons.
62
If opioid analgesia is required in a patient with renal impairment
consider using oxycodone or fentanyl rather than morphine
63
Time taken by morphine to act
Remember, morphine takes approximately 2-3 minutes to work if given intravenously, 20 minutes if taken orally, and 15 minutes if given intramuscularly
64
Yellow /sulfor granules
Actinomycosis
65
Rx of acute dystonic reaction
benzhexol and procyclidine
66
Myoglobinuria and haemolysis result in
Necrosis
67
aminoglycosides and radiological contrast media induce
apoptosis
68
Post operative renal failure occurs by which mechanism
tubular cell death
69
RIFLE Criteria of Kidney injury
Key points : Renal injury and acute renal failure: RIFLE Classification.
R=Risk (Serum Creatinine x1.5)
I=Injury (Serum Creatinine x 2)
F=Failure (Serum Creatinine x3)
L=Loss (Loss of renal function >4weeks)
E=End stage kidney disease
70
Pro op bowel preparation can cause
post op dehydration
71
AKI diagnosis
≥50% rise in serum creatinine from baseline within last 7 days
Increase in serum creatinine by ≥26.5mmol/l within 48 hours
Urine output <0.5mls/kg/hour (oliguria) for more than 6 hours
72
proximal to renal artery aortic clamp applied for too long causes
Renal Artery Stenosis
73
Nephrotoxic drugs
NSAIDs, ACEi (or ARBs), antibiotics (such as aminoglycosides), or chemotherapy (such as cisplatin
74
Most imp Postrenal cause of AKI post op
Acute urinary retention
Blocked catheter
75
pre-renal and intrinsic causes of AKI
Urine specific gravity and osmolality values will be higher in pre-renal causes, whilst urine Na excretion will be lower, due to the kidney actively conserving Na and water in pre-renal cases, compared to intrinsic causes.
76
Drugs to be potentially stopped: if suspected AKI
ACEi and ARBs
NSAIDs
Aminoglycoside antibiotics
Potassium-sparing diuretics (due to increased risk of hyperkalaemia)
77
How to check whether the ETT is not in esophagus
Check End tidal CO2
78
highest incidence of PONV in children due to
squint surgery
79
which surgeries have greater risk of post-op nausea
Intra-abdominal laparoscopic surgery
Intracranial or middle ear surgery
Gynaecological surgery, especially ovarian
Squint surgery
80
Anesthetic causes of PONV
Opiate analgesia or spinal anaesthesia
Inhalational agents (e.g. Isoflurane, nitrous oxide
81
Which Drug at anesthesia to prevent 'PONV
Dexa 8mg
82
Antiemetic drugs in different situations
1. Impaired gastric emptying
2. Bowel obstruction
5. Opiod induced
1. prokinetic agent, such as metoclopramide (dopamine antagonist) or domperidone (dopamine antagonist)
2. Hyoscine (anti-muscarinic) can help to reduce secretions
3. ondansetron (5-HT3 receptor antagonist) or cyclizine (H1 Histamine receptor antagonist)
83
Brain death criteria
Deep coma of known aetiology.
Reversible causes excluded
No sedation
Normal electrolytes
84
There are two criteria both required for a diagnosis of sepsis
Presence of a known or suspected infection
Clinical features of organ dysfunction
85
SOFA score’
is a means by which clinicians can quantify the level of organ dysfunction
86
What SOFA and qSOFAscore indicates sepsis
score greater than or equal to two indicates sepsis
87
What is present in q SOFA score
Respiratory Rate ≥ 22/min (1 point)
Altered Mental State (1 point)
Systolic Blood Pressure ≤100mmHg (1 point)
88
Septic shock
Septic shock is defined as sepsis with hypotension, despite adequate fluid resuscitation or requiring the use of inotropic agents to maintain a normal systolic blood pressure.
Lactate >2
89
Criteria of ICU shift in sepsis
Evidence of septic shock
Lactate > 4.0mmol
Failure to improve from initial management
90
Resuscitation goals in sepsis
CVP 8-12mmHg
MAP >65mmHg
Urine output >0.5ml/kg per hour
Superior vena cava oxygen saturation >70%
Normal lactate
91
Does TPN affects in 1 week
Yes
92
On TPN
What to perform 6 mont9vs 1 year
Vit D in 6 months
Bone densitometry
93
If on TPN.
what to check in 2-4 weeks after stable
and 3-6 months
2-4 weeks: Zn, Folate, B12 and Cu levels if stable
3-6months: iron and ferritin levels, manganese
94
If on home TPN regime then what needs tobe checked apart from others
Magnese in 3-6 months
95
What tests to perform in unstable TPN patients weekly
Weekly glucose, phosphate, magnesium, LFTs, Ca, albumin, FBC, MCV
96
Benzodiazepines/ Midazolam reversal by
Flumanezil
antagonises the effects of benzodiazepines by competition at GABA binding sites.
97
suitable agent for anaesthesia in those who are haemodynamically unstable
Ketamine
98
Which anesthetic has antiemetic properties
Propofol
99
Criteria of Malnourishment
BMI < 18.5 kg/m2
unintentional weight loss of > 10% over 3-6/12
BMI < 20 kg/m2 and unintentional weight loss of > 5% over 3-6/12
100
What line of administration for TPN in 14 days vs 30
In 14 give via IJV
In 30 give via subclavian tunnel line
101
if feed needed > 2 weeks, which pattern of feeding
Cyclical instead of continuous
102
How to prevent refeedimg syndrome,e
don't give > 50% of daily regime to unwell patients in first 24-48 hours
103
Complication of TPN
sepsis, re-feeding syndromes and hepatic dysfunction.
104
Composition of TPN
glucose, lipids and essential electrolytes,
NO fibers
105
Which fluid causes ana0hylaxis the most between dextran and gelatin
Dextran 70 the most
106
outside hospital anesthetic for E R surgery
Ketamine
107
How to check NG
Aspiration and pH
108
post pyloric tubes are checked for their placement by
AXR
109
Gastric feeding via NG vs gastrostomy
NG for < 4weeks
Gastrostomy for >4 weeks
110
In an ICU patients
How to feed
Continuously for 16 to 24 hours
111
PEG canbe used after how long post insertion
4 hours post insertion
112
PEG shouldn't be removed for how much post insertion
Atleeast 2 weeks
113
Enteral vs parenteral
Both can be given for Malnourished, Unable to swallow people
Now look for intact GI for absorption
if yes then enteral otherwise parenteral
114
If delayed gastric emptying post op then Rx is
1St antimotility agents
If this doesn't work then try post pyloric feeding or parenteral feeding.
115
Marked Myocardial depression occurs by which anesthetic agent
Na Thiopentone
116
Which anesthetic is known antiemetic vs emetic
Propofol is antiemetic
Etomidate is emetic
117
Propofol usage
maintaining sedation on ITU,
total IV anaesthesia and
for daycase surgery
118
first and most common finding in hyperkalaemia.
Peaked T waves
119
ECG findings in Hyperkalemia
Peaking of T waves (occurs first)
Loss of P waves
Broad QRS complexes
Ventricullar fibrillation
120
Pethidine points
is much more lipid soluble than morphine. It produces less biliary tract spasm than morphine.
Can be given IM
Metabolized by liver
121
Weak opiod vs strong
Codeine and dextropropoxyphene are weak
Morphine is strong
122
Pyrexia of Unknown Origin (PUO
recurrent fever (>38oc) persisting for >3wks without an obvious cause, despite >1wk of inpatient investigation.
123
Post operative Pyrexia causes based on days
Day 1-2 – respiratory source (or body’s routine response to surgery)
Day 3-5 – respiratory or urinary tract source
Day 5-7 – surgical site infection or abscess/collection formation
Any day post-operatively – consider infected IV lines or central lines as a source
124
Post op ileuw caused by
Opiates
125
Reactive Bleeding
Within 24 hours of operation
126
Absolute vs relative contraindication of Epidural
A: Coagulopathies
R: INFECTION
127
Most popu drug in Patient Controlled Analgesia (PCA)
Morphine
128
Which drugs are Class C controlled substances
Pregabalin and gapapentin
Thus chk for addiction hx before starting it
129
Airway in long term weaning
Tracheostomy
130
Which airway Reduces the work of breathing (and dead space)
Tracheostomy
131
Which airway is used as bridge to more definitive airway
Oropharhngeal airway
132
If a patientis biting down then which airway
Nasopharyngeal airway
133
Most common type of hypovolemia
Covert compensated
134
Covert compensated hypovolemia is which SHOCK
Type 1
135
Diagnosis of Covert compensated hypovolemia
By urinalysis
Have high urine osmolality and Dec Na concentration
136
If uncomplicated surgery of abdomen (even colectomy)
When to start oral diet
Within 24 hours if SAFE SWALLOW
137
When to start oral feeding in uncomplicated abdominal, gynecological and c section
Within 24 hours of operation
Only after fulfilling the oral feeding criteria
138
Effect on light diet and liquid on anastomosis
Administration of liquid and even light diet does not increase the risk of anastomotic leak.
Thus start feeding 24 hours post op
139
Airway device used in day case procedure like inguinal repair
Laryngeal mask
140
Laryngeal mask few points
•In day case surgeries
•Paralysis not required
•Chances of reflux
•Not suitab for high lress ventilation
141
Which tests for PE are highly sensitive but bad specific
Means if negative then the disease is ruled out
D Dimer
V/Q mismatch
142
CT for Pulmonary embolism
If negative for PE then no need for MRI
143
Dosage of midazolam
2-5mg
144
Midazolam 0elimination by
cytochrome P450 pathway in the liver. I
145
Best advantage of midazolam
Amnesia
146
muscle relaxants will tend to incite neuromuscular excitability following administration?
Suxamethonium
147
Which one is Fastest onset and shortest duration of action of all muscle relaxants
Suxamethonium
148
Kyphoscoliosis causes which pulmonary disease
Restrictive
149
Restrictive causes of lung
Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis
Neuromuscular disorders
150
Worsening renal function plus muddy brown casts
ATN sec to myoglobinuria
151
ATN with myoglobinuria
152
If any injury which can raise potassium levels then what anesthetic agent not tongive
Suxamethonium as it can cause hyperkalemia
153
Which drugs don't release histamine at all
Suxa
Vecuronium
154
If any surgical procedure in infants
What to give for pain
Paracetamol
155
Codeine in neonates
Contraindicated
156
phosphodiesterase inhibitor
Milirinone
157
first-line for trigeminal neuralgia
carbamazepine
