Post Operative Management

Question 1

Factors which are likely to lead to renal failure post op? (7)

Answer 1

Elderly, PVD, High BMI, COPD, Vasopressors, Nephrotoxics, Emergency operation

Question 2

Malnourishment is described as

Answer 2

BMI<18.5, unintentional loss>10% 3 months, BMI <20 and weight loss 5% over 3 months

Question 3

2 main sites bleeding post colorectal surgery

Answer 3

Spleen and pre sacral veins

Question 4

How are low anterior resections routinely defunctioned?

Answer 4

Loop ileostomy

Question 5

Which area has the lowest leak rate?

Answer 5

Ileocolic and small bowel anastomosis

Question 6

Name a depolarising neuromuscular blocker

Answer 6

Suxamethonium

Question 7

What electrolyte effect can suxamethonium have?

Answer 7

increase K

Question 8

Deficiency in which enzyme effects breakdown of suxomethonium?

Answer 8

pseudocholinesterase

Question 9

Which muscle relaxant releases histamine?

Answer 9

atracarium

Question 10

First line for neuropathic pain?

Answer 10

amitriptyline / pregabalin

Question 11

How do you treat acute dystonic reaction?

Answer 11

procyclidine

Question 12

Benefits of propofol?

Answer 12

antiemetic, rapid anaesthesia

Question 13

FEV1/FVC for obstructive

Answer 13

<70%

Question 14

FEV1/FVC for restrictive

Answer 14

> 70%

Question 15

What is the main factor in cryoprecipitate?

Answer 15

Factor 8

Question 16

Massive transfusion complications (6)

Answer 16

Hypothermia, Hypocalcaemia, Hyperkalaemia, Delayed transfusion reaction, Transfusion related lung injury, Coagulopathy

Question 17

How should t1dm and their insulin be managed perioperatively?

Answer 17

insulin in t1dm should not be stopped and omission of 1 meal is likely to require a variable rate insulin infusion

Question 18

Which drug is used in a HER2+ve breast cancer?

Answer 18

Tranlizumab - herceptin

Question 19

What amount of Na and K is require daily?

Answer 19

50-100mmol of Na and 40-80mmol K, 1.5-2.5L of fluid

Question 20

What is the tacklers triad for boerhaaves syndrome?

Answer 20

vomiting, thoracic pain, surgical emphysema

Question 21

What is used to reverse intravenous heparin?

Answer 21

protamine sulphate

Question 22

What is used to reverse warfarin?

Answer 22

octaplex/ prothrombin complex concentrate

Question 23

What local anaesthetic is used for a biers block?

Answer 23

prilocaine

Question 24

What does LMWH work on?

Answer 24

Factor 10a (Xa)

Question 25

What is the best technique to destroy TB spore?

Answer 25

autoclaving

Question 26

What material is used for a t-tube post CBD exploration?

Answer 26

latex on passive drainage

Question 27

What is the cause of peptic and duodenal ulcers in H-Pylori?

Answer 27

increased acid production - leads to peptic/ duo ulcers

Question 28

What is a litchenstein mesh repair?

Answer 28

Hernia open repair - mesh sutured to posterior wall of inguinal canal

Question 29

What is the best way to defunction following an emergency rectal cancer operation?

Answer 29

loop colostomy - so CT and staging can take place

Question 30

What features will show on endoscopy with h-pylori?

Answer 30

NONE

Question 31

What is the best way to defunction a low anterior resection?

Answer 31

Loop ileostomy

Question 32

What day post op is most likely to have a burst abdomen?

Answer 32

6

Question 33

What is the best closure for a diabetic ray amputation?

Answer 33

vacum assisted closure system

Question 34

What is a non suction surgical drain called?

Answer 34

Wallace Robson drain