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MRCS A(My Own) > Post Operative > Flashcards

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

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2
Q

Which type of fluid can cause acute renal injury

A

Dextran 70

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3
Q

Cryo precipitate is trans fused how

A

As 6 unit pool

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4
Q

Constituents of cryoprecipetate

A

Factor VIII
Fibrinogen
von Willebrand factor
Factor XIII

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5
Q

Suxamethonium may cause

A

Malignant hyperthermia
Hyperkalemia
Muscular pain
Prolonged apnea

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6
Q

Names of depolarizing and nondpolarizing muscular relaxence

A

D: Suxamethonium
Non D: Atracurium,Vecuronium, Pancuronium and Rocurunium

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7
Q

Quickest onset muscular relaxant

A

Suxamethonium

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8
Q

Suxamethonium can be used in

A

Rapidl intubation
Short procedures

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9
Q

Atracurium vs Vecuronium

A

A is not cleared by liver or kidney
V does

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10
Q

Atracurium Side effects

A

Histamine release and allergic reactions

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11
Q

Which non depolarising drug used for rapid intubation

A

Rocurunium as it’s reversedby suggamedex which is widely available

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12
Q

Which drug reverses effect of nondepolarusing drug effects

A

Neostgmine

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13
Q

ward based analgesianot working then whatto do for metastatic disease of spine

A

Radiotherapy for lumbar spine

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14
Q

Side effects of spinal anaesthesia include:

A

hypotension, sensory and motor block, nausea and urinary retention.

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15
Q

preferred option analgesic post op major surgeries

A

Epidural

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16
Q

preferred technique analgesia when extensive laparoscopic abdominal procedures are performed

A

Transversus Abdominal Plane block (TAP)

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17
Q

Clearance of morphin versusPethidine

A

M bby liver
P by kidney

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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)

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19
Q

Clopidogrel should be stopped before surgery around

A

stopped around 5-7 days prior to surgery

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20
Q

Dose of Clopidogrel

A

75mg

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21
Q

Clopidogrel MOA

A

decreases ADP induced platelet aggregation persisting for 120 hours after the final dose

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22
Q

Which anaesthetic has strongest antiemetic properties

A

Propofol

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23
Q

muscle relaxants is an agent that is degraded by hydrolysis and may produce histamine release?

A

Atracurium

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24
Q

Which muscle relaxants is least likely to result in histamine release?

A

Vecuronium and suxamethonium

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25
Q

Which inotrope can be guven via the peripheral intra venous route in the non cardiac arrest setting?

A

Metaraminol is an alpha receptor agonist

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26
Q

A patient with locally advanced pancreatic cancer has persistent back pain
Rx

A

Pancreatic cancer can cause severe pain as a result of retroperitoneal nerve infiltration. It can be managed with chemical neurectomy/ nerve blocks.

Improve

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27
Q

Wh8ch anaesthetic agents has the strongest analgesic effect?

A

Ketamine

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28
Q

agent of choice for rapid sequence of induction

A

Sodium thiopentone

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29
Q

Side effects of neostigmine

A

Bradycardia thus atropine is given simultaneously

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30
Q

First line management of neuropathic pain in patients with orthostatic hypotension

A

pregabalin not amitriptylline as ami has a side effect of Ietho hypo

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31
Q

If diabetic neuropathic pain

A

Duloxetine

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32
Q

Orchidopexy
Pain relief through

A

Caudal block

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33
Q

Immediate pain reliefost hemmoidectomy

A

Caudal block

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34
Q

Which anesthetic is hepatotoxic

A

Halothane

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35
Q

adrenocortical depression by which anesthetic agent

A

Etomidate

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36
Q

Which anesthetic is used in neurosurgical procedures

A

Sodium thiopentone

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37
Q

agent of choice for rapid sequence of induction

A

Sodium thiopentone

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38
Q

Marked myocardial depression may occur by which anesthetic agent

A

Sodium thiopentone

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39
Q

dissociative anaesthesia resulting in nightmares caused by

A

Ketamine

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40
Q

Why we should avoid excessive IV fluid during surgery

A

Can cause ileus

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41
Q

carbohydrate loading drink in enhanced recovery program should be given

A

carbohydrate loading drink is given 2 hours pre procedure.

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42
Q

first line investigation vs gold standard for PE

A

CTPA 1st line
Gold standard is pulmonary angiography

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43
Q

Which artery can be missed by CTpa

A

peripheral emboli affecting subsegmental arteries may be missed

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44
Q

ARDS

A

bilateral pulmonary infiltrates
severe hypoxemia (PaO2/FiO2 ratio < 200) in the absence of evidence for cardiogenic pulmonary oedema
Capillary wedge pressure <18

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45
Q

Stages of ARDS

A

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

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46
Q

Causes of ARDS include

A

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)

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47
Q

only treatment found to improve survival rates in ARDS

A

Low tidal volume ventilation

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48
Q

Rx of ARDS

A

Treat cause Like give
Ab if sepsis
Diuretics to get rid of fluids
PEEP, prone ventilation
Low tidal volume ventilation

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49
Q

Pulmonary artery occlusion pressure in ARDS vs pulmonary edema 2° overload

A

ARDS: Low pressure <5 with edema
Overload: High pressure >18mmHg

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50
Q

Cutfed vs uncuffed ETT

A

Cuffed prevents air Leaks thus needs to be given where chances of regurg are high
Uncuffed in children to prevent tracheal injury

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51
Q

which airway device can and cannot be used for high pressure ventilation

A

ETT can
Laryngeal mask cannot

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52
Q

Rx of malignant hyperthermia

A

Dantrolene - prevents Ca2+release from the sarcoplasmic reticulum

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53
Q

malignant hyperthermia is caused by defect in

A

Chromosome 19. encoding ryanodine receptor

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54
Q

Acute dystonic reaction is causedby

A

antipsychotics (haloperidol) and metoclopramide.

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55
Q

marked extrapyramidal effects can be caused by

A

antipsychotics (haloperidol) and metoclopramide

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56
Q

Serotonin syndrome symptoms

A

syndrome of agitation, tachycardia, hallucinations and hyper-reflexia.

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57
Q

Benzodiazepines affect on Post operative cognitive impairment

A

Use of benzodiazepines preoperatively reduces long-term POCD (9.9% vs. 5%)

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58
Q

Drug for post opt cognitive dysfunction

A

Haloperidol

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59
Q

Complication of TPN

A

sepsis, re-feeding syndromes and hepatic dysfunction.

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60
Q

Till how much BP surgeries can be performed

A

There is no evidence to support cancellation when blood pressure is below 180/110 mmHg.

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61
Q

most frequent clinical indications for TPN

A

•Undergone massive resection of the small intestine
•Who have intestinal fistula
•Who have prolonged intestinal failure for other reasons.

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62
Q

If opioid analgesia is required in a patient with renal impairment

A

consider using oxycodone or fentanyl rather than morphine

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63
Q

Time taken by morphine to act

A

Remember, morphine takes approximately 2-3 minutes to work if given intravenously, 20 minutes if taken orally, and 15 minutes if given intramuscularly

64
Q

Yellow /sulfor granules

A

Actinomycosis

65
Q

Rx of acute dystonic reaction

A

benzhexol and procyclidine

66
Q

Myoglobinuria and haemolysis result in

A

Necrosis

67
Q

aminoglycosides and radiological contrast media induce

A

apoptosis

68
Q

Post operative renal failure occurs by which mechanism

A

tubular cell death

69
Q

RIFLE Criteria of Kidney injury

A

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
Q

Pro op bowel preparation can cause

A

post op dehydration

71
Q

AKI diagnosis

A

≥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
Q

proximal to renal artery aortic clamp applied for too long causes

A

Renal Artery Stenosis

73
Q

Nephrotoxic drugs

A

NSAIDs, ACEi (or ARBs), antibiotics (such as aminoglycosides), or chemotherapy (such as cisplatin

74
Q

Most imp Postrenal cause of AKI post op

A

Acute urinary retention
Blocked catheter

75
Q

pre-renal and intrinsic causes of AKI

A

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
Q

Drugs to be potentially stopped: if suspected AKI

A

ACEi and ARBs
NSAIDs
Aminoglycoside antibiotics
Potassium-sparing diuretics (due to increased risk of hyperkalaemia)

77
Q

How to check whether the ETT is not in esophagus

A

Check End tidal CO2

78
Q

highest incidence of PONV in children due to

A

squint surgery

79
Q

which surgeries have greater risk of post-op nausea

A

Intra-abdominal laparoscopic surgery
Intracranial or middle ear surgery
Gynaecological surgery, especially ovarian
Squint surgery

80
Q

Anesthetic causes of PONV

A

Opiate analgesia or spinal anaesthesia
Inhalational agents (e.g. Isoflurane, nitrous oxide

81
Q

Which Drug at anesthesia to prevent ‘PONV

A

Dexa 8mg

82
Q

Antiemetic drugs in different situations
1. Impaired gastric emptying
2. Bowel obstruction
5. Opiod induced

A
  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
Q

Brain death criteria

A

Deep coma of known aetiology.

Reversible causes excluded

No sedation

Normal electrolytes

84
Q

There are two criteria both required for a diagnosis of sepsis

A

Presence of a known or suspected infection
Clinical features of organ dysfunction

85
Q

SOFA score’

A

is a means by which clinicians can quantify the level of organ dysfunction

86
Q

What SOFA and qSOFAscore indicates sepsis

A

score greater than or equal to two indicates sepsis

87
Q

What is present in q SOFA score

A

Respiratory Rate ≥ 22/min (1 point)
Altered Mental State (1 point)
Systolic Blood Pressure ≤100mmHg (1 point)

88
Q

Septic shock

A

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
Q

Criteria of ICU shift in sepsis

A

Evidence of septic shock
Lactate > 4.0mmol
Failure to improve from initial management

90
Q

Resuscitation goals in sepsis

A

CVP 8-12mmHg
MAP >65mmHg
Urine output >0.5ml/kg per hour
Superior vena cava oxygen saturation >70%
Normal lactate

91
Q

Does TPN affects in 1 week

A

Yes

92
Q

On TPN
What to perform 6 mont9vs 1 year

A

Vit D in 6 months
Bone densitometry

93
Q

If on TPN.
what to check in 2-4 weeks after stable
and 3-6 months

A

2-4 weeks: Zn, Folate, B12 and Cu levels if stable
3-6months: iron and ferritin levels, manganese

94
Q

If on home TPN regime then what needs tobe checked apart from others

A

Magnese in 3-6 months

95
Q

What tests to perform in unstable TPN patients weekly

A

Weekly glucose, phosphate, magnesium, LFTs, Ca, albumin, FBC, MCV

96
Q

Benzodiazepines/ Midazolam reversal by

A

Flumanezil
antagonises the effects of benzodiazepines by competition at GABA binding sites.

97
Q

suitable agent for anaesthesia in those who are haemodynamically unstable

A

Ketamine

98
Q

Which anesthetic has antiemetic properties

A

Propofol

99
Q

Criteria of Malnourishment

A

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
Q

What line of administration for TPN in 14 days vs 30

A

In 14 give via IJV
In 30 give via subclavian tunnel line

101
Q

if feed needed > 2 weeks, which pattern of feeding

A

Cyclical instead of continuous

102
Q

How to prevent refeedimg syndrome,e

A

don’t give > 50% of daily regime to unwell patients in first 24-48 hours

103
Q

Complication of TPN

A

sepsis, re-feeding syndromes and hepatic dysfunction.

104
Q

Composition of TPN

A

glucose, lipids and essential electrolytes,
NO fibers

105
Q

Which fluid causes ana0hylaxis the most between dextran and gelatin

A

Dextran 70 the most

106
Q

outside hospital anesthetic for E R surgery

A

Ketamine

107
Q

How to check NG

A

Aspiration and pH

108
Q

post pyloric tubes are checked for their placement by

A

AXR

109
Q

Gastric feeding via NG vs gastrostomy

A

NG for < 4weeks
Gastrostomy for >4 weeks

110
Q

In an ICU patients
How to feed

A

Continuously for 16 to 24 hours

111
Q

PEG canbe used after how long post insertion

A

4 hours post insertion

112
Q

PEG shouldn’t be removed for how much post insertion

A

Atleeast 2 weeks

113
Q

Enteral vs parenteral

A

Both can be given for Malnourished, Unable to swallow people
Now look for intact GI for absorption
if yes then enteral otherwise parenteral

114
Q

If delayed gastric emptying post op then Rx is

A

1St antimotility agents
If this doesn’t work then try post pyloric feeding or parenteral feeding.

115
Q

Marked Myocardial depression occurs by which anesthetic agent

A

Na Thiopentone

116
Q

Which anesthetic is known antiemetic vs emetic

A

Propofol is antiemetic
Etomidate is emetic

117
Q

Propofol usage

A

maintaining sedation on ITU,
total IV anaesthesia and
for daycase surgery

118
Q

first and most common finding in hyperkalaemia.

A

Peaked T waves

119
Q

ECG findings in Hyperkalemia

A

Peaking of T waves (occurs first)
Loss of P waves
Broad QRS complexes
Ventricullar fibrillation

120
Q

Pethidine points

A

is much more lipid soluble than morphine. It produces less biliary tract spasm than morphine.
Can be given IM
Metabolized by liver

121
Q

Weak opiod vs strong

A

Codeine and dextropropoxyphene are weak
Morphine is strong

122
Q

Pyrexia of Unknown Origin (PUO

A

recurrent fever (>38oc) persisting for >3wks without an obvious cause, despite >1wk of inpatient investigation.

123
Q

Post operative Pyrexia causes based on days

A

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
Q

Post op ileuw caused by

A

Opiates

125
Q

Reactive Bleeding

A

Within 24 hours of operation

126
Q

Absolute vs relative contraindication of Epidural

A

A: Coagulopathies
R: INFECTION

127
Q

Most popu drug in Patient Controlled Analgesia (PCA)

A

Morphine

128
Q

Which drugs are Class C controlled substances

A

Pregabalin and gapapentin
Thus chk for addiction hx before starting it

129
Q

Airway in long term weaning

A

Tracheostomy

130
Q

Which airway Reduces the work of breathing (and dead space)

A

Tracheostomy

131
Q

Which airway is used as bridge to more definitive airway

A

Oropharhngeal airway

132
Q

If a patientis biting down then which airway

A

Nasopharyngeal airway

133
Q

Most common type of hypovolemia

A

Covert compensated

134
Q

Covert compensated hypovolemia is which SHOCK

A

Type 1

135
Q

Diagnosis of Covert compensated hypovolemia

A

By urinalysis
Have high urine osmolality and Dec Na concentration

136
Q

If uncomplicated surgery of abdomen (even colectomy)
When to start oral diet

A

Within 24 hours if SAFE SWALLOW

137
Q

When to start oral feeding in uncomplicated abdominal, gynecological and c section

A

Within 24 hours of operation
Only after fulfilling the oral feeding criteria

138
Q

Effect on light diet and liquid on anastomosis

A

Administration of liquid and even light diet does not increase the risk of anastomotic leak.
Thus start feeding 24 hours post op

139
Q

Airway device used in day case procedure like inguinal repair

A

Laryngeal mask

140
Q

Laryngeal mask few points

A

•In day case surgeries
•Paralysis not required
•Chances of reflux
•Not suitab for high lress ventilation

141
Q

Which tests for PE are highly sensitive but bad specific
Means if negative then the disease is ruled out

A

D Dimer
V/Q mismatch

142
Q

CT for Pulmonary embolism

A

If negative for PE then no need for MRI

143
Q

Dosage of midazolam

A

2-5mg

144
Q

Midazolam 0elimination by

A

cytochrome P450 pathway in the liver. I

145
Q

Best advantage of midazolam

A

Amnesia

146
Q

muscle relaxants will tend to incite neuromuscular excitability following administration?

A

Suxamethonium

147
Q

Which one is Fastest onset and shortest duration of action of all muscle relaxants

A

Suxamethonium

148
Q

Kyphoscoliosis causes which pulmonary disease

A

Restrictive

149
Q

Restrictive causes of lung

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis
Neuromuscular disorders

150
Q

Worsening renal function plus muddy brown casts

A

ATN sec to myoglobinuria

151
Q

ATN with myoglobinuria

A
152
Q

If any injury which can raise potassium levels then what anesthetic agent not tongive

A

Suxamethonium as it can cause hyperkalemia

153
Q

Which drugs don’t release histamine at all

A

Suxa
Vecuronium

154
Q

If any surgical procedure in infants
What to give for pain

A

Paracetamol

155
Q

Codeine in neonates

A

Contraindicated

156
Q

phosphodiesterase inhibitor

A

Milirinone

157
Q

first-line for trigeminal neuralgia

A

carbamazepine

MRCS A(My Own) (28 decks)

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